Epidemics as three-act social dramas. COVID-19 coronavirus (2)

Dr. Anton Titov, MD. You are a professor of a culture of medicine at Harvard, a trained pediatrician and a psychiatrist. You just published the New England Journal of Medicine, a fascinating article, “History in the crisis: lessons for COVID-19”. Medical second opinion is important. Let’s talk about those lessons. Perhaps we can start by discussing an epidemic as a three-act social drama. You are right that this holds remarkably true throughout the history of infectious disease spread in human society. One of the things that historians always struggle with is the desire to focus on the specific contexts in. This events take place. Then the desire to draw universal lessons from that history. It is clear from the study of the history of epidemics. Dr. David S. Jones, MD. That context does matter. Epidemics have a different course, depending on where they strike when they strike. Even basic questions know that the mode of transmission of any pathogen has a huge impact on how society responds. Dr. David S. Jones, MD. We react differently to respiratory pathogens versus gastrointestinal pathogens or sexual pathogens. Dr. David S. Jones, MD. That said, there do seem to be certain universal patterns and how we respond to epidemics. There is something about the crisis that epidemics pose that trigger a series of very characteristic reactions from the societies that they strike. Historians looking at epidemics have observed that they often go through three characteristic phases. When an epidemic enters a community, there are often early warning signs that aren’t noticed right away; the significance of the events might not capture anyone’s attention. Classic accounts of a disease like the bubonic plague. Dr. Anton Titov, MD. You’ll often hear stories of the first victims of the plague being the rats that live in the city. Patients will be walking through the streets of a city. They’ll see a few dead rats and not think twice about that. It is only once there have been many, many, many patients noticing lots of rats. On the street. Dr. David S. Jones, MD. That they start to suspect that maybe something is going on here. For diseases like COVID, you can see that as well,. The symptoms. The kinds of deaths patients have been experiencing, aren’t particularly unique. Sometimes there were a single case of smallpox in the world, patients would immediately realize what’s happening. But for COVID presents, like any of the million other respiratory viruses that are out there. Medical second opinion is important. It is possible for these patients to start getting sick and start dying from this new disease without anyone realizing what was happening. Medical second opinion is important. There is almost always this period of delayed recognition. What happens next is that eventually the number of patients who are sick or the number of patients of dying starts to increase and become significant enough that patients have a harder time, averting their gaze and pretending that nothing unusual is happening, even when the signal starts to become more dramatic. Dr. Anton Titov, MD. You will still find patients trying to reassure themselves that nothing unusual is going on here. You can certainly see that and the response of the government in the United States through February, saying yes, this has happened in China. But it is going to end soon. They are not that many deaths. There is nothing for us to be worried about here. Sometimes that is just simple psychological reassurance. Sometimes there are financial or economic conflicts of interest that are underneath that minimization. Everyone has known it has been very clear from history that when an epidemic strikes, it has terrible effects, on trade, on the industry, on Commerce, on the economy of a society. Medical second opinion is important. Many patients will want to deny that something has happened as an effort to preserve normal, healthy economic relationships. But denial can only go so far if the epidemic is accelerating. So what happened this winter first in China. Now throughout the world, patients have been forced To realize that we are grappling with something new and very serious. Once you get to that stage of delayed recognition, then you’ll start to see how societies struggle to respond to the epidemic. These responses take many forms. One of the first things that have to happen is that society has to explain what is going on. Dr. David S. Jones, MD. That often plays out in parallel on many different levels. Societies often look for the medical explanation, what is the cause of this epidemic? Dr. Anton Titov, MD. Sometimes that can be quite difficult when flu struck in 1918. The science of virology was not very advanced. Everyone assumed that they were dealing with a bacterial illness. They searched for years for the bacterial cause of Spanish influenza. Of course, they never found one because the cause was a virus that was only recognized after the fact. It took many years. After aids had first appeared before the virus was eventually characterized. What’s unusual about this epidemic is that the Chinese scientists did amazing work. Within a couple of weeks of the first cases being reported, not only had they identified the virus. But they had fully sequenced it and made that RNA sequence available online for other researchers. But it is not simply a question of medical explanation. People often want moral or social or economic explanations. Why has this happened to us now? Dr. Anton Titov, MD. Why is it that this virus has struck us at this time? Dr. Anton Titov, MD. Why did it first happened in Wuhan? Dr. Anton Titov, MD. These kinds of social explanations often go in the direction of blame and responsibility? Dr. Anton Titov, MD. Dr. David S. Jones, MD. That is the second act of social drama. Yeah, so the second act of this social drama is this desire to explain often to blame. Then to respond that is based on this so again, you can see a plane out. In January, in February, there was much early interest in these meat markets in the city of Wuhan food practices that seemed quite different in China than they are in the United States or elsewhere. Medical second opinion is important. There is a lot of attention on these live meat markets. Blaming them for what’s going on. Even though many patients had initially been impressed with how the Chinese had responded, now. The Trump administration is full of blame, saying that they failed to control this. They let this spread throughout the world. It is their fault. Dr. David S. Jones, MD. I was talking to some Chinese officials the other day. They will certainly agree that Wu Han was the first place where this was diagnosed. But they will say it is an open question where this virus first came from, how did it get Taiwan? Dr. Anton Titov, MD. It came from somewhere. Now there is a world of conspiracy theories about where this virus originated. One of the things that frustrate me is that none of this effort to point fingers into blame is going to help us out of the current crisis. The virus has gone global; we can’t turn the clock on that. To contain the virus, what we need to do is to organize concerted public reactions, not just at the level of a city or a state or a country. But global responses. All of the finger-pointing in this discourse of blame is going to undermine that effort at concerted global action. So to the extent that blame is inevitable, it often inevitably compromises our efforts to respond to the epidemic that we are trying to contain.