As a public health physician, and as a family physician, I am ashamed. In response to COVID, my colleagues in public health officialdom are losing credibility as they search for politically driven quick fixes and remain silent when individual freedoms are restricted without clear evidence of an enduring relationship to positive outcomes.
For example, in many locations globally, the public health response to the highly contagious Delta variant of the COVID virus has been to advise governments to restrict movements of citizens outside their residences.
This is in reaction to the high degree of transmissibility of COVID-19 in general and the Delta variant in particular, notwithstanding that transmissibility in infections does not correlate well with disease control. Tuberculosis (TB) is a useful example. While newer, drug-resistant TB strains are rarely transmitted, the few that are transmitted cause large disease clusters. These strains seem to occur by chance and not as a result of any survival mechanism of the fittest TB bacterium.
Since we don’t know what causes these strains to evolve and TB is the largest cause of communicable disease deaths this century, more than 1.5 million per year, should we be quarantining cities with outbreaks of this deadly disease and prohibiting travel?
That strategy has not been the adopted for managing TB. Perhaps because TB is bacterial and largely responsive, in its most infectious forms, to combinations of antibiotics.
COVID is caused by the SARS virus, and the medical profession does not have as long a history in successfully treating viral infections. Take HIV, the leading cause of communicable deaths in the last half decade. More than 36 million people have died from HIV since 1988. Despite early homophobic calls for quarantining gay men, no legal nor government restrictions were placed on the movement nor sexual activity of HIV-positive individuals in the major Western nations. Rather, a strong campaign of social responsibility and destigmatisation has meant that deaths from HIV/AIDS have fallen by 51% during the last 20 years, moving from the world’s 8th leading cause of death in 2000 to the 19th in 2019 – and that’s without a vaccine.
So why do travel bans exist for HIV in 48 countries – many of which deny its existence and evidence of an increasing prevalence of HIV in their populations despite evidence to the contrary?
The pervasiveness and persistence of social control measures in these countries is a testament to the failure of government control and criminalization managing epidemics in the long term.
It took more than 20 years and adequate treatment and preventive strategies to gain some control over HIV mortality and morbidity.
Approaches to contain COVID should focus on similar strategies employed to contain HIV such as empowering individuals to support persons to protect their own and one another’s health. With technology already available, personalized recommendations can be developed to minimise the spread of infectious diseases rather than blanket coercion. A novel idea could be to tailor times for accessing certain activities such as shopping and travel routes of people who are less responsive to the immediacy of change required to comply with what they perceive to be unsubstantiated or contradictory messages (these kinds of messages are to be expected as the pandemic situation unfolds). For example, many shops already have special hours for the elderly. Why not special hours for those who eschew vaccines, or don’t want to wear masks? We need creative thinking, not one-size-fits-all shutdowns
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