PLANETARY HEALTH WEEKLY

by Dr. Jay Kravitz 

Blog #1 posted October 15, 2020

As a retired, public health professional and global health educator for >30 years, I am appalled by COVID-19 conspiracy theories with inexplicable agendas that do direct harm or are expounded by self-righteousness persons with a lack of understanding about scientific knowledge or evidence. These “theories” are based on misinformed, political motives that do not place the health and safety of people first, nor that of progress within societies. Yes, we have compelling, competing societal interests regarding political, psychological, ethical, economic and environmental issues with serious competition for government fiscal allocations.¹ However, if people die because of unwise public policy and economies are shattered because people choose not to heed protective advice, what have we gained?

Having worked abroad during international complex disasters, I view the defunding of the U.S. government’s pandemic preparedness office two years ago representative of a number of incomprehensible decisions…Why? 

1. U.S. Nationally: One might infer that current policy makers are rather clueless and vindictive. The Centers for Disease Control (CDC) has been relegated to an undefined, secondary role and subject to direct political manipulation. Its risk communication messages have been weakened and edited to suit a political agenda. Those messages, ignoring scientific evidence, have led to confusion and lack of consensus leading to inconsistent policies across the country. Unfortunately, its initial attempt to produce accurate, reliable test kits failed. Accurate, timely testing has been a widespread challenge. Regardless, CDC’s public health professionals should have guided critical COVID-19 policy discussions, rather than being sidelined by egocentric, misguided, tunnel-vision leadership. 
2. U.S. Locally: Provincial, national ill-advised policy is mirrored at my former university in Oregon, where I served on faculty for 21 years. The Preventive Medicine Residency, a training program for public health physicians with an historical legacy of >50 years, was defunded in 2019. Former trainees have served at CDC, nationally and internationally.
3. Globally: Distancing from the World Health Organization is tragically myopic. We must engage, not distance ourselves, from the other 7.2 billion people on our planet.

Evolving COVID-19 deliberations and judgements by public health officials is NORMAL. When I served as public health officer at a county Health Department we would begin investigations of reported infectious disease outbreaks with a question: “What is our case definition?” The case definition strategy was relied upon to establish whether an outbreak or epidemic was, in fact, unfolding. This detailed quest for data analyzed potential time, person and place contributing factors to guide our initial efforts. (People can have the same diagnosis and not have related sources of disease.) As more information was gained, we might adjust/alter our case definition to ensure a more appropriate, ongoing response…restaurant closures, school interventions, small scale quarantines if tuberculosis was discovered in a household, or when measles outbreak occurred in unvaccinated children, etc.

Certainly when new diseases are recognized, one can expect an initial steep learning curve. The COVID-19 pandemic provides an excellent case study that emphasizes the necessity of altering a case definition, as needed, when additional pertinent data are amassed. Multiple, complex factors must be addressed in this critical situation: available antibody testing to accurately guesstimate disease prevalence to guide policy; variable intervals of viral shedding, infectivity, clinical expression (symptoms suffered by patients), and host immunity or antibody response; multiple, still-to-be-discovered, potential treatment options; research trials leading to safe, effective and accepted vaccines; reports that 80% of patients may have sequelae (mental fog, loss of smell, hypertension, chronic cough or arrhythmia) during prolonged recovery; post-COVID recovery PTSD; and the imperative to develop a readily accessible point-of-care test.²

Those unschooled in public health do not realize the number of infectious diseases of animal origin (zoonoses) that have killed millions of people over the centuries. Bovine tuberculosis (pasteurization has saved many lives), smallpox, plague, Ebola, rabies, West Nile fever, HIV/AIDS, giardia, amoebiasis, influenza, Zika virus, and SARS driven to extinction by a combination of sophisticated contact-tracing and quirks of the virus itself3  ).

This list is long. In the future it WILL grow larger, as we continue to infringe on animal habitat to live or recreate, exploit natural resources, eat animals without proper preparation, or refuse safe and effective vaccines. Examples of vaccine-preventable diseases are many, including measles and polio. Vaccines have reduced widespread suffering and saved many lives. There is no longer any smallpox which killed hundreds of millions over centuries. 

We live in a complex global ecosystem! Climate change is a serious environmental threat. There is in fact climate crisis. It seems ludicrous to refute that excessive numbers of people are contributing to this current, major planetary peril. One can expect expanding arbovirus disease habitat. Arboviral diseases are caused by viruses transmitted by mosquitoes, ticks or other arthropods. Maladies include encephalitis, dengue, Lyme disease, Rocky Mountain spotted fever and yellow fever. Given multiple, potentially dangerous health concerns, government health agencies must be strengthened to surveil adverse health trends, protect food supplies, and monitor/further regulate the pharmaceutical industry to keep people safe.

Despite wide-ranging educational opportunities in the Western Hemisphere and internationally, we are being misinformed by those who, generally without any formal knowledge, training or preparation, disregard the primary importance of public health. They seek to diminish this prominent discipline and spread falsehoods. Are public health professionals correct 100% of the time? No. No one is. But, that’s why evolving case definitions are a valuable strategy seeking to help protect all of us. Yes, economics is obviously important, but if people fall sick or are dying because of ill-advised public policy and misinformation, what have we gained?

1. Ventres W, Kravitz J, Dharamsi S. PEARLS+: Connecting Societal Forces, Social Determinants, and Health Outcomes. Academic Medicine 2018;93:143.
2. Marsal S, Moreno R, Drummond W, Jin J, Hotchkin D. COVID-19: Local Updates. Providence Oregon Region; Medical Grand Rounds. September 15, 2020.
3. Gorvett Z. The deadly viruses that vanished without trace.  September 20, 2020. https://www.bbc.com/future/article/20200918-why-some-deadly-viruses-vanish-and-go-extinct/

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N.B. Spillover: Animal Infections and the Next Human Pandemic (2012), authored by David Quammen. (New York Times best-seller list) Quammen insightfully delves into historical zoonoses and describes many zoonotic disease hazards. It seems at times that he is actually commenting and speculating about current events.