COVID-19 may have made science accessible to the public, perhaps, as never before. However, people may not have learned to interpret its logic and language or grasp the way it works.
By Pradeep Krishnatray
Despite the present twists and turns on COVID-19, the scientific community has well-established ways of classifying diseases. However, over the centuries, people and cultures have evolved their own unique systems of interpreting them. A simple heuristic they follow is whether the disease is curable or not (or whether a person afflicted with a disease can return to leading a normal life).
Following this mode of unexceptionable logic, one may classify diseases into four categories: The first category is those diseases that once ravaged populations, but have now disappeared. Smallpox is a good example of this. People are relieved that they do not suffer from it anymore.
The second category of diseases are those that are virulent enough to adversely affect much of the population but have vaccines or drugs to control them, such as measles or TB. People are reassured that they can lead a disability-free life after vaccination.
The third category are those diseases where cure is not available, but people are able to manage them and live a near-normal life. Diseases such as diabetes belong to this category. People do not show any visible or external sign of ailment and may not feel the need to admit that they suffer from it.
COVID-19 falls in the fourth category about which health experts or epidemiologists, at the present juncture, cannot say anything substantial about medication with certainty.
Uncertain by nature
By its very nature, a pandemic is a confusion wrapped in a conundrum. Experts have opinions and explanations, but no answers. Their predictions are often based on past knowledge or incomplete or doubtful assumptions, but no two pandemics are alike. That is why they are pandemic – a disease that has lost control of itself.
The first few months of COVID-19 have shown that an emerging infectious disease science follows a long and tortuous path. To begin with, we did not know what the virus was or to which family it belonged. However, we got over the ignorance with remarkable alacrity. The next phase, exploration, allowed us to understand its structure and etiology, and name it. It was during this phase that governments announced lockdowns and issued stay-at-home orders.
The confusion phase soon followed when various models predicted severe loss of life. The WHO continued to emphasise testing and contact tracing, but several countries were woefully short of infrastructure and resources. Some countries favoured the drug Hydroxychloroquine (HCQ). However, WHO soon instructed the investigators to interrupt the HCQ arm of the trial with ‘immediate effect’. HCQ was not found effective.
Some scientists believed that allowing the virus to run its course would help develop immunity in the population. Others did not agree. Lockdowns were no longer favoured, as a group of scientists and public health experts called for ‘focussed protection’; others did not agree. Almost overnight facemasks and coverings became important. Some said healthy people should not wear masks. Others said it was necessary. Then there were those who said not long ago that masks are not necessary but later said otherwise.
It would be safe to say that we have not fully understood how pandemics behave; or, for that matter, who would become infected and die, and who would be symptomatic or asymptomatic. With COVID-19, we may have scraped through the understanding phase to enter the resolution phase. For policymakers, politicians, and the people, resolution of pandemic occurs when a safe and effective vaccine is developed, when normalcy returns.
What next?
Several pandemics have traversed the same tortuous path. The last major one, in 1918-19, unfairly called the Spanish flu, cost us dearly. There were no antibiotics or diagnostic tests then to test for influenza infection. Even the doctors did not know that influenza viruses existed. In fact, many health experts believed that a bacterium had caused the pandemic. The virus was actually ‘reconstructed’ almost 80 years later – much after the pandemic had long gone!
As a rigorous science, drug or vaccine development relies on incontrovertible evidence. When evidence itself undergoes frequent and rapid change, it seeps and spreads into society not as theory or knowledge, but uncertainty. However, this is how evidence accumulates into a science – this is how science works. COVID-19 may have made science accessible to the public, perhaps, as never before. However, people may not have learned to interpret its logic and language or grasp the way it works.
Public health and infectious disease experts have recommended behaviours for individuals to follow: Washing hands with soap or using sanitiser, maintaining social distance, wearing a mask, staying indoors. Each of these recommended behaviours is simple to practice, but practicing them all at the same time is a challenge. Equally important but not so widely emphasised are behaviours that people should not perform (not go to the office or school, not visit restaurants, hotels, pubs, gyms, beach, etc.).
At one time, the recommended behaviours looked like temporary measures. Over time, however, they have acquired a permanence of their own. No one is quite sure how long these would last. There appears no closure in sight. Given this complexity, compliance has become a challenge. Harvard professor Dr. K. Viswanath got it right when he said, “Complexity is the enemy of compliance.”
(The author is former director, research and strategic planning, Johns Hopkins Center for Communication Programs, New Delhi.)
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