Here We Go Again-CORVID-19

Here we go again…Each decade brings its own international health crisis. During the last one it was Ebola and MERS, and in the one before that, SARS. These emergencies terrify and, as humans, we are usually not able to process the threat without making up stories and spreading foolish ideas all over the place. And in today’s internet age, destructive memes take on lives of their own. We dig ourselves into a wormhole in which more and more bizarre ideas propagate themselves and breed new ones. How do we climb out of the hole, is the question.

It is not as if we are still in the dark ages. We know a lot more about how things work than we did in the days when people believed that epidemics, such as these, were a pestilence inflicted by an angry or vengeful god. Interestingly, there is, by the way, another type of “plague”, locusts, the likes of which was also thought in ancient days to be inflicted by a god fed up with human misbehaviour, currently playing itself out in Eastern Africa. As in the case of a virus outbreak, there is absolutely no need to invoke angry passions to explain how this other ecological threat arose.

Back to the current virus outbreak. There has been speculation that the virus, now named officially COVID-19, made a species jump from exotic creatures like bats or even reptile – snake, no less (horror of horrors!) to us humans, biologically unready to handle the challenge. Protection against such challenges requires some level of naturally-occurring immunity and/or immunity induced through preventive immunization which, incidentally, reminds us of the need for public health vaccination, wherever available. But that is another story, previously commented on in this forum. In the current situation, at-risk humanity (the majority of us) are an easy target for this novel virus, resulting in the epidemic that is now running uncontrolled in China and threatening to go global too. The public health authorities in China are doing their best to promote practices designed to limit the incidence of exposure in the community until the herd immunity we mentioned earlier develops, and/or, until an effective vaccine is designed, tested, manufactured and distributed in what is, predictably, a long series of steps.

What do we do while we wait? And how do we manage reasonable fears without being part of the problem? Scientists are doing their bit, proceeding in an orderly manner, trying to understand the behaviour of the virus. And with the WHO taking charge of managing the public relations aspects, latter-day soothsayers and snake oil merchants are, hopefully, made irrelevant.  It is still necessary, though, to clarify how you separate apparently infected individuals from the non-infected. Do you mask and glove your entire population, sick or apparently well? Or, do evacuate your citizens from China, thereby risking turning a local epidemic into a worldwide pandemic? Is it right to lockdown Wuhan city or Hubei Province? Do you impose total exclusion from individuals travelling from China? It is one thing to quarantine one or two luxury cruise ships, but it is quite another to seal off an entire country with the third largest landmass from the rest of the world.

China itself has compounded the difficulties by initially not allowing the truth of the potential epidemic to get out as soon as it should have. But that is predictable: Like authoritarian governments everywhere, shooting the messenger and suppressing information is the first order of business whenever an uncomfortable truth is delivered. Thus was the unfortunate Dr Li Wenliang, who was the first to alert the Wuhan authorities about the emerging crisis, and who has since died, was put through the Chinese disinformation mangle. It is little comfort that he has received validation, post mortem, albeit.

Knowing what to call the new virus is a good first step. CoViD-19, has the ring of authority in it, commanding us to Keep Calm and Carry On.

Tell Fren Tru

Kill Fest

 It is an epidemic...

I mean, mass shooting in America.
Can anyone say they understand it?

I can’t. Neither, evidently, can the world at large outside America. And within that country itself, there seems to be a paralysis of spirit around the subject. What you hear, even from top politicians (especially, perhaps), is an unimpeded flow of nonsense. Meanwhile, the rest of the world stands aghast as, time after time, a presumably “ordinary” citizen picks up a gun- usually an automatic or semiautomatic, crams it full with ammunition, packs up an extra supply to make sure he does not run out before his awful purpose is fully realised. Thus equipped, he - it is always a he - packs the arsenal into his vehicle and sets off on a murder spree, targeting his fellow citizens in what has become almost a ritual: One of mass slaying at a location where hundreds, or even more, are gathered for work or play, education or worship, celebration, or any of the other ordinary things that people do when they try to live their daily lives.

The script, from Act I Scene l, to the Finale is now fairly predictable and, has even become almost pedestrian, except that the denouement is always so horrible: The perpetrator murders his fellow-citizens in industrial quantities and, sometimes, kills himself or is killed by law-enforcement or, in some cases, captured alive. But all in all, an appalling scene.  

Some of the elements in this tableau are pretty obvious: It can be argued, fairly, that such murderers are not “normal”. The “shooter”, as they are now called, almost certainly has some mental disorder that renders him unable to resolve internal conflicts in a normal way. I am just supposing here, because I do not have the credentials that would qualify me to make such an assessment. But, what is also obvious is that all of us are beset to a similar, if not the same extent, by the propaganda and misinformation that emanates from the various sources, ranging from tweets to campaign stops, to blogs, to TV and talk radio, and in the open web or in its darker regions; a poisonous brew poured out by top politicians and other opinion-makers, some by innuendo, others full-frontal.

Most of us, however, manage to sift out the dross and concentrate on what is real and logical, and true. But even among people who cannot separate the nonsensical from the sensible, most remain harmless, although they may fume and rage privately or among friends but go to their bed at night without harming anyone. The problem with America lies in its guns. But, for some reason, Americans seem unable to understand the link between the wide availability of firearms of all kinds in the population and the impulse to use them. Americans (some, at any rate) peddle nonsense about a Second Amendment to the constitution that allows citizens to “bear” arms. As follows: ‘A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed’. One supposes that it is all in the meaning of what a ‘free state’ is and what role the armed citizen, whether as an individual or in a collective or militia can do to maintain the state as a free entity. And while we are appalled by the power of the weapons held in private hands, there can be no contest between official government military on the one hand and a militia on the other, however well-regulated the latter might be. But in any case, that militia, whether regulated or not, is definitely not intended for unleashing its firepower against unarmed fellow-citizens going about their normal business. Restricting the type of weapons an ordinary citizen might wish to possess to just single-shot rifles or shotguns for use in killing animals for sport is bad enough. but that is something one can live with, knowing that the destructive power of such instruments would be limited when deployed in an urban setting. Otherwise, it is ludicrous to claim that repeater rifles have a place in downtown Dayton or suburban Denver or most recently Odessa, Tx, for example.

The country has to get real and understand that a deliberate misunderstanding of Second Amendment provisions is a sure track to ruin even for those who manufacture and sell firearms.

Tell Fren Tru

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Cleaning up our Act

I just came back from holiday to find Sierra Leone grip(p)ed by a cholera epidemic.

Why I am not surprised? Cholera has had a lurking presence in the country for as long as I can remember and, from time to time, depending on the intensity of the rainy season, emerges and runs through the population like a dose of salts. I can recall, as a freshly-minted doctor, my first epidemic there. Bursting with knowledge about the way cholera and other waterborne diseases spread, I readily remembered lessons taught in med school, about how an astute physician, John Snow, had sussed out cholera by merely observing how the infection clustered around a street pump in the Soho district of Victorian London.

I recall also how I was immediately conscripted into teams managing cases desiccated almost to extinction by the diarrhoea and vomiting that are typical of the infection. We fought valiantly then, but the epidemic took its course, regardless, and faded away only at the end of the rainy season.

Yes, we have come a long way since Victorian days. Most of us no longer invoke mysterious forces when an epidemic rages. We know that a physical element is involved, and that in this case, if we keep feces separate from the food we eat and the water we drink, we will not catch diseases that have a fecal origin and die from them.

            And yes, we also know that the more crowded the environment, the more likely it is, when the barrier between excrement and clean food and drink is breached, that epidemics will occur. And yes, even in towns and villages that are not so crowded, run-off from heavy and persistent rain will enter pit latrines, cause them to overflow and discharge their contents into the environment, contaminating everything. This is what happened forty years ago and this is what is happening today and what has always happened.

Yes, hand-washing is crucial in breaking the cycle during epidemics and even in more settled times. But where do you get the clean water to wash your hands with when everywhere is contaminated?

The answer to this simple problem is beyond politics or ideology. Neither political posturing nor the dialectics of ideology can stem the tide. Germs will do what germs do. We know how the disease is caused, how it is transmitted. So all we need is a plan. I mean an actual blueprint of the future sewage systems in our main cities and towns.

Did I say beyond politics? I was wrong, of course.

I just read that the President of Sierra Leone recently signed a massive memorandum of understanding (MOU) with the government of China, in which they agreed to cooperate in a whole raft of activities including huge engineering projects. But, significantly, there was no mention of how to deal with sewage in the country’s towns and cities.

I know, I know. Such documents are drawn up months in advance of their signing, and yes, yes, the epidemic burst upon us in the last six weeks (surprise, surprise, it only rains torrentially every year from May to November). But here, we have an urgent, urgent public health priority that must be handled as urgently, even if it means adding a paragraph or two to that MOU. It would give us the chance to revisit the plan that imperial Britain proposed for Freetown more than a century ago, a vantage from which we can begin to talk meaningfully about how we can get this doo-doo out of our face.

Tell Fren Tru