|Ahead of print publication
Pandemic, panic, policies, and the paradox of control
Department of Community Medicine, Dr .DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||04-Sep-2020|
|Date of Decision||06-Sep-2020|
|Date of Acceptance||10-Sep-2020|
Department of Community Medicine, Dr .DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
The ongoing pandemic of COVID-19 is causing unprecedented panic, leading to hasty policies and the paradox of control. These have been precipitated by a number of misleading cues resulting in unprecedented drastic and draconian measures with devastating impact on economy and society.
To begin with, the outbreak first originated in Wuhan, China, in December 2019. Being the bête-noire of most nations, social media in many countries was flooded with gory images and videos, showing people collapsing on the streets of Wuhan. The seeds of global panic were sown by such information spiced with subtle doses of misinformation and China's reputation for opacity. All provided a heady combination for public imagination to run wild.
Meanwhile, China put Wuhan and other cities in Hubei district under lockdown in January 2020. This added to the Schadenfreude as illustrated by reservation and criticism of this harsh measure by the West including the World Health Organization (WHO). The WHO representative in Beijing stated that a lockdown of 56 million people is “unprecedented in public health history, so it is certainly not a recommendation the WHO has made.”, The Western media dubbed China's lockdown “harsh,” “extreme,” “severe,” and controversial, offering no guarantee of controlling the virus. Legal experts in the West were firm that such measures would be unconstitutional in a democracy and stressed on the darker sides of lockdown and quarantine, degenerating into a social tool of authoritarianism rather than a scientific strategy. Who could have imagined that within months almost all governments around the globe including democracies would outdo China in such blunt and coercive measures!
The virus spread to other countries in subsequent months and in March, the WHO declared COVID-19 a pandemic. The very countries which criticized China on its harsh measures surpassed it in implementing more crude and extreme forms of lockdowns. Concerns about authoritarianism and the dark side of quarantine vanished overnight. The experts advocated this as the norm to “flatten the curve.”
The lethality of the virus was grossly overestimated in the early stages of the pandemic, contributing to panic and knee-jerk reactions. The Lancet, in the early March, suggested that the case fatality rate can be as high as 20%. Subsequent studies including serological surveys refined the infection fatality rate to as low as 0.06%. However, before the results of such study became widespread, the damage in the form of panic due to perceived high lethality of the virus had already been done.
While Thailand, the first country outside China where the virus spread, did not catch fire, Italy was a totally different picture. Because of its aged population mostly in nursing homes, the COVID-19 hit the ground running and took a heavy toll in Italy, soon overwhelming the coping capacity of its hospitals. In the ensuing panic and chaos, Italy was the first country in the world to implement a country-wide lockdown.
The media went into overdrive. It focused on absolute numbers and medical emergency rooms, dramatizing the situation out of context. The informal social media amplified the panic. People locked down for prolonged periods absorbed these messages, some factual, most fake, illustrating that how these unverified sources of information can be a double-edged sword. The pandemic of panic and hysteria fanned public opinion toward demanding more stringent measures.
Regrettably, scientific institutions of repute too erred miserably. Predictions based on mathematical models instead of proper epidemiological surveillance and scientific papers published online without proper peer reviews projected doomsday. Popular simulation models created shock and awe. Amidst this academic and scientific anarchy, government policies took shape.
Government policies and recommendations from organizations such as the WHO and CDC continue to flip-flop, reflecting the uncertainties and lack of an evidence-based approach. First, there were conflicting messages regarding the efficacy of face masks in preventing transmission. Then came the WHO U-turn after it stated that COVID-19 transmission is rare in asymptomatic cases. More recently, the director of CDC backtracked on a statement posted on their website suggesting that asymptomatic people exposed to coronavirus do not need to be tested.
Such mixed messages undermine the public trust, if not adding to the panic and chaos. Such ambiguous statements suggest that even experts lack the courage of conviction. When courage is lacking, healthy debate is discouraged, giving way to authoritarian ways. While according to the precautionary principle it is perfectly justified to err on the side of safety and advocate mask wearing, testing, tracing, isolation, and other nonpharmacological interventions including the most extreme, that is, lockdowns, such “illusions of control” do not ensure the desired outcomes if these are not reviewed periodically in light of the emerging evidence. Such “illusions of control,” which arise due to intolerance of uncertainty or alternative views, can be counterproductive. Sometimes letting go of this urge to control can be beneficial. This “paradox of control” has been discussed in detail by a team comprising a statistician, a cognitive psychologist, and a decision scientist.
Most world governments succumbed mindlessly to this illusion of control. Measures enforced to control the pandemic, based mostly on computer simulations and models, were medieval, causing much misery and collateral damage. Millions of people around the world lost their livelihoods. People with other diseases could not get timely treatment as all resources were diverted to COVID-19. The poor and marginalized bore the brunt of these draconian measures, increasing the existing inequities. No deliberations seem to have been entertained on the social and economic consequences of these measures.
Few countries, a miniscule minority, did not go with the trend, some by commission and some by omission. They deliberately refrained from lockdown, or could not enforce it properly. Sweden and Japan did not decree strict lockdowns like the rest of the world, whereas Pakistan flip-flopped and never had any clear anti-COVID strategy.
The media predicted, rather prematurely, that Pakistan is heading for a major disaster and Sweden's strategy has failed miserably. At the time of writing, both Sweden and Pakistan are none the worse compared to other countries in their respective regions, whereas Japan has one of the lowest fatality rates from coronavirus in the world in spite of having one of the lowest testing rates [Table 1]. This puts under question one of the other “illusions of control,” that is, test, trace, and isolate. Recently, a joint statement by the Indian Association of Public Health, the Indian Association of Preventive and Social Medicine, and the Indian Association of Epidemiologists, questioned the rationale of testing, given the large proportion of subclinical cases as evidenced by serosurveys in various parts of the country. The results of these surveys indicate that <5% of the estimated infections are identified by the test-and-track policy, which hardly has any impact on transmission. The statement instead recommended “targeted testing” of symptomatic people, elderly, and those with comorbidities to save scarce resources.
The available data also do not support the case for extensive testing and contact tracing as evident from testing rates and fatalities from COVID-19 in some selected countries [Table 1]. The countries with some of the lowest fatalities such as Sri Lanka and Japan have also conducted the lowest tests per million.
It will remain a mystery for decades to come, why such extreme measures were taken and continue to be taken by world governments without weighing the tradeoffs in terms of other competing public health problems (particularly in Asian countries), loss of livelihoods, fractured society, and immense harm to the economy, which will take many more lives compared to lives saved from COVID-19. Besides, people all over the world have been psyched into a state of neuroses and many may go into posttraumatic stress disorders haunting them for a lifetime.
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