'Sick Societies Have Sick Institutions' - From Typhus Epidemic Of 1800s To Current Pandemic, What Has Remained Unchanged?
That, and some absurdities, a bit of Little Prince, Hearse by Mustafa, Timothée Chalamet's Met Gala beats and two planes colliding in mid-air.
“One only understands the things that one tames,” said the fox. “Men have
no more time to understand anything. They buy things all ready made at the
shops. But there is no shop anywhere where one can buy friendship, and so
men have no friends any more. If you want a friend, tame me. . .
To me, you are still nothing more than a little boy who is just like a hundred thousand other little boys. And I have no need of you. And you, on your part, have no need of me. To you, I am nothing more than a fox like a hundred thousand other foxes. But if you tame me, then we shall need each other. To me, you will be unique in all the world. To you, I shall be unique in all the world...”
That’s from The Little Prince, a book of tiny length and very few pages but so much love, laugh and aha moments. Highly recommend you get a copy, it’s so collection worthy and repeat reading.
Epidemic and Epidemiology
Epidemiology and Epidemiologists were lurking in the shadows until Jan last year. Not anymore. Epidemiology is part of our conversation now. Anthony Fauci, an epidemiologist has acquired a celestial halo by now. Their tribe largely deals with numbers i.e., most of their job involves counting. And by some sort of cosmic design, our brains dislike numbers, it sort of shuts down when it sees numbers. We sometimes read a line with a number by subconsciously skipping that number. But their job is very important and crucial for public health. Their "counting starts with descriptive statistics on the daily state of the pandemic — who’s infected, who’s sick, how many have died. And then those numbers are used to forecast the pandemic’s future, which lets officials plan and mobilize resources."
Covid-19 is caused by the SARS-CoV-2 virus is a simple and well-known fact. But why do only a few of us who get exposed get infected and others don't, why do few require hospitalization and few get well without any care still remain a mystery. This is where epidemiology steps in. It is they who use all those counting to “discern patterns over time and among different groups of people and to determine reasons some get sick and others don’t. That’s the hard part of epidemiology.” By now so many scientific papers on Covid-19 have been written and they have used raw data to derive many hypotheses. For instance, in the early months when the US and parts of the world were getting ravaged by the coronavirus while South Asia and Africa remained relatively unharmed, many attributed it to hot weather and well-ventilated houses here. But then the second wave came across and infections in India piled up, graveyards and cemeteries ran full, bodies started getting burnt on pavements in absence of space and those hypotheses quickly fizzled out. That is not to say Science got it wrong and scientific methods are flawed. There are no certainties or universal truths in Science. Anyone can disprove any held truths provided they have proofs and answers to all sorts of questions asked of their theories. Science corrects itself on the way forward. Bad postulates get replaced by better ones all the time. It gets better. And in the course of this journey, some theories stand the test of time and are proved right decade after decade, epidemic after epidemic. One such is from the mid-1800s by Dr Rudolf Virchow, known as "the father of modern pathology", the founder of social medicine, and to his colleagues, the "Pope of medicine".
In the winter of 1847/1848, a typhus epidemic erupted in Upper Silesia, an economically depressed and impoverished Eastern province of the Kingdom of Prussia inhabited by a significant Polish minority. The epidemic coincided with a famine, which had resulted from crop failures in previous years. The conditions in this region deteriorated rapidly and to such an extent that, with the local authorities unable to control the situation, the central government in Berlin, fearing a public scandal, appointed a commission, including the 26-year old Virchow, to obtain detailed information regarding the relapsing fever ("famine fever") epidemic and submit recommendations for its alleviation.
Like with coronavirus, the expectation was to know what was causing this fever and how to treat and prevent its further spread - medically - like how we are looking at vaccines as magic cures for walking out of the current pandemic. But instead, the report submitted by Dr Virchow went far beyond the medical technicalities and ventured into societal aspects of epidemics which eventually gave rise to a new field of study in medicine. The report was "uncompromising and scathing in its description of the abject poverty and abysmal living conditions of the Silesian peasants. The effects of the epidemic were concentrated amongst the poor, with malnutrition and bad housing rendering them vulnerable to disease. The report concluded that the typhus epidemic was more a social than a medical problem and that the improvement of such conditions and prevention of similar crises in the future could be achieved only through prosperity, education, culture and the elimination of social inequality."
All that is fine but is that relevant to us now? Does Virchow's theory still hold with respect to the coronavirus? I would say yes. For instance, think of the number of “excess (or preventable) deaths across countries during the pandemic. Looking at those countries most severely affected, such as Peru, Bolivia, South Africa and Brazil, one sees mostly middle-income countries in political turmoil and with weak social institutions. Countries that had fewer deaths than would be expected based on pre-pandemic trends, on the other hand, are often richer, but also distinguished by high levels of political cohesiveness, social trust, income equality and collectivism, like New Zealand, Taiwan, Norway, Iceland, Japan, Singapore and Denmark." Remember when the first Covid cluster emerged in India what we did? Tablighi Jamaat, a congregation of Muslim religious groups just a stone’s throw away from a police station in India's capital was tom-tomed by ruling party politicians, their friendly media houses and social media filled with their supporters as a conspiracy against India, an anti-India force congregating at a place to spread the disease to each other and then travelling far and wide of India so as to spread the virus. It’s wrong of the media how it portrayed this gathering which took place long before India declared lockdown and during when the government’s own MPs were refusing to acknowledge Covid-19 as a concern. But it was criminal how a central government body defied its own guideline and read out Covid numbers separately tracing infections to Tablighi Jamaat. According to the joint secretary of the Ministry of Health and Family Welfare (MoHFW), there were two kinds of Covid-19 positives in India then - Tablighi Jamaat positive and rest. This distinction served no medical purpose. Both were infected by the same strain of the virus. Both needed the same treatment. This was political dog-whistling. This led to attacks on Muslims - as if that needed any more reasons in post-2014 India. Old videos would be circulated on WhatsApp with all sorts of nonsense. Next, Kanika Kapoor, a singer tested positive after attending a party that was attended by many VIPs including politicians. She was hounded and called names as if she was intentionally spreading the disease. And so a pattern emerged and a social norm was set. Those infected with the virus were now looked at as if they had committed a horrific crime. And so many started to hide their symptoms out of fear of social ostracization which was even reported by sections of media. And so many feared the Covid tests more than the actual infection and refused to get themselves tested. We even got comfortable with fudged tests. All this had huge medical and economic costs. A disease was stigmatized and a large population was trained to fear a medical test that could identify a possible infection and treat it before it could spread and cause a catastrophe. And it did cause a catastrophe. If we could - test, trace and treat - early on then we could have had less load on hospitals resulting in fewer deaths of doctors and the general public who had to die because of the lack of medical attention than the disease itself. Many who died of Covid-19 especially in the second wave were avoidable deaths. Our level of apathy, absence of planning and preparedness, mammoth negligence (think of political rallies and religious congregations) culminated in crematoriums running full of burning pyres and holy Ganges river swelling from dead corpses. It was political will (or absence of it) that caused this catastrophe more than the virus.
Right now, at least in India, there is no data store to dip and see which social group is worst affected and which has relatively stayed safe. We will only know of the real damage some years later. But I'm certain Virchow's theory will hold even then that "our current pandemic is socially patterned." Thus it "comes as no surprise to even the casual observer that the pandemic struck most ferociously in countries ridden with political division and social conflict."
766 doctors lost their lives in the second wave alone. So it was not just the general population that bore brunt of political and social negligence but also the doctors. We target doctors and scientists who hold and express political opinions with contempt and derision as if they come from a different planet. Pandemic at least has proved how their profession and even their life is intertwined to politics of the day and region. There is a high chance a doctor will stay alive and stress-free in a stable and peaceful Nordic country than they will be in an unstable and socially divided country like India. Many doctors and hospital staff lost their lives and many are under stress today owing to the unparalleled and impossible weight of patients they had to attend to within a short span of time. And that load of patients were created disproportionately in countries with divisive and unstable political and social relations. The decisions or absence of decisions from political leaders affected (and affect) doctors and scientists, as much as others. Dr Virchow understood this rather too well. So Virchow, who has in his name some 2000 publications including his famous book, “Cellular Pathology", not merely "excelled in the medical field but also in the political arena. As an elected member of the German Reichstag, he promoted the public health movement, and his political activities were followed by Friedrich Engels and Karl Marx, amongst others."
Science is a social process, and we all live amid the social soup of personalities, parties and power. The political dysfunction that holds America hostage also holds science hostage. The real problem is simply that sick societies have sick institutions. Science is not some cloistered preserve in the clouds, but is buried in the muck with everything else. This is why, just eight days after his investigation in Upper Silesia, Dr. Virchow went to the barricades in Berlin to fight for the revolution.
Virchow linked disease, disability and premature death to the material conditions of social class and in particular to the poor access amongst the working class to nutrition, housing and clothing. He substantiated this view by reference to the higher rates of morbidity and mortality, especially infant mortality, in working-class areas than in wealthier parts of the cities. This correlative relationship was based on statistics cited by Friedrich Engels in ‘The Condition of the Working Class in England’ and on Virchow's own data collected from German cities.
Virchow's studies on the social origins of illness and “social medicine” led him to demand social and political change as a solution to medical problems. Virchow's understanding of the social origins of illness called for a public health service with publicly owned and operated health care facilities and health workers employed by the state. In this system, the public health workers (“doctors of the poor”) would provide medical care and advocate for changes in poor people's material conditions (“natural attorneys of the poor”), which should assure material security and contribute to health rather than illness.
Virchow's statement, "if disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life”, still holds true today.
In the United States and the United Kingdom, the available findings have demonstrated the presence of socioeconomic inequalities in infection risks and severity of the course of COVID-19, with socioeconomically less privileged groups being affected more severely. Individuals with higher levels of education in Brazil were 44% less likely to die from COVID-19, and lower education levels were strongly associated with increased rates of both COVID-19 cases and fatalities in the United States. Furthermore, infection fatality rates in young people, which are usually very low, were found to be higher in low-income city municipalities.
As I write this, in Uttar Pradesh’s western districts of Firozabad, Mathura, Agra and Etah, a mystery fever has spread like wildfire and killed at least 64 people, mostly children, in the last two weeks of August. Mathura village residents are mortgaging property to save their children’s lives. Do you see Virchow’s theory at play here? Dengue and Typhus are not new diseases and its course of treatment and care are not unknown to today’s world and yet here we are with dead children.
Virchow identified poor diet, bad housing, lack of sanitation, hazardous working conditions and inferior education as social and political root causes of epidemics. While Virchow's call for governments to address health inequities determined by social conditions was revolutionary in his time, the view that medicine needs the support of government policies to improve population health has become commonplace in many modern textbooks of public health.
Most of that was from a recent peer-reviewed scientific paper. I have extensively quoted since original lines were perfect to be used as-is. One last thing. The paper ends with this note: The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Some moons ago Anthony Fauci’s assertion that the Indian made vaccine COVAXIN neutralizing many strains of SARS-Cov-2 including the feared B.1.617 was making waves in the Indian press. Fauci’s source was a scientific paper. But none cared to mention the conflict of interest. Covaxin is jointly developed by Bharat Biotech and ICMR which is a government body. One of the authors on this paper that says COVAXIN neutralizes B.1.617 is the son of the founder of Bharat Biotech, the vaccine manufacturer. There was no disclosure in the paper. Conflict of interest announcements are important everywhere and especially so in scientific claims. That is sadly the robustness and integrity of our press, institutions and political discourse.
That was long, was it?
Here, relax your senses with this 14-second clip of Timothée Chalamet Dancing with the Drumline at the Met Gala.
The Absurd
Adults have right to choose their matrimonial partner irrespective of religion: Allahabad High Court. And children have the right to pee when they want to pee.
A 19-year-old student, who turned up in shorts for an entrance test, was made to wrap a curtain around her legs in order to sit for the exam in Assam’s Tezpur town. “They did not check for Covid protocols, masks or even temperature…but they checked for shorts”, she said.
It is close to two years since the Modi govt passed the controversial Citizenship (Amendment) Act - CAA - through the parliament. Tamilnadu assembly recently passed a resolution against the act making it the eighth state to do so. Yeah, that’s how much the act is resisted by its citizens and federal units and yet the union government in Delhi continues to play its autocratic hand.
Have you heard of FiftyTwoDotIn? Well, if you are a fan of long-form journalism like me then you will love them. They publish excellent long-form pieces every week. So far they have written forty-eight such pieces. I especially like their one or at most two-word minimal headlines. If you haven’t known them then let me guide you to their first piece - collision - about two planes colliding with each other in mid-air and plunging into the mustard and cotton fields of a Haryana village, and how this compelled the aviation industry of the world to formulate basic rules of aviation including the communication and what language to communicate in.
Swear I wasn't lookin' for no beef, I got a family to feed
There's room for everyone to eat, I was all about thе peace
I didn't wanna risk it all, oh, I know what's at stake
But you madе yourself special, I wanna throw my life away for you
Those are lyrics from ‘Hearse’, a song from the debut album of a 24-year-old Canadian musician, Mustafa. He dwells on violence, folk, grief and loss, almost in a meditative tone.
That’s all for this one. We shall discuss more music, something closer to home and a lot more in the next one. Thanks for reading so far and staying by me on this one.
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