Global Health Blogs with Professor Swahn

In December 2019 I turned in a short essay for my Environmental Health class. The prompt was “what do you think is the biggest threat to your health from the environment?” Now I knew everyone was going to write about air pollution, climate change (in general), the food crisis, or WASH because those had been the main topics of the course, but I wanted to choose something less talked about. I had recently watched a short video about the melting ice caps and the ancient microbes that could emerge, uh scary! This led me into an internet rabbit hole of research on emerging infectious diseases, resulting in my choice of pandemics as the biggest threat to our health from the environment.

I turned that essay in on December 16th, 2019, and by January we were hearing about a novel coronavirus and by March the World Health Organization officially declared COVID-19 a pandemic. Now how did I predict this just a month prior? Well, because the scientific community had already done so. There was ample information out there on the risk of pandemics in our current world, but it was not a subject commonly talked about to the general public. Here I will highlight a few reasons why the scientific community already knew the risk and inevitability of a global pandemic in the near future, using research that was already available years before now.

Factors that Contribute to Today’s Risk of Pandemics:

Emerging and reemerging infectious diseases: 

Emerging and reemerging infectious diseases have been increasing at a rate never seen before since the 1970s. One reason that emerging infectious diseases are on the rise is due to global urbanization.

The rapid urbanization around the world poses many challenges within cities, more so for underdeveloped countries. The increase in urban populations leads to overcrowding and inability to provide safe housing, drinking water, and sanitation facilities, ideal conditions for amplification and transmission of a pathogen. Dense urban populations living in small areas tend to live in close proximity with domestic animals and rodents such as rats, who are known to carry many diseases. Constant interaction with such animals, as well as, urban development’s encroachment on wildlife, increases the probability of zoonotic emerging infectious pathogens, jumping from their normal animal host to humans.

Another factor contributing to the risk of emerging infectious diseases is climate change. Though ancient microbes living in melting glaciers first spiked my interest, after further research this isn’t much a concern due to the low probability such microbes would be able to infect warm blooded humans. But it is not impossible! It’s estimated that the number of microbes trapped beneath the ice sheet may be more than 1000 times that of all humans living. Ice allows these microbes to preserve their genetic material until they’re released in the future; and there is the possibility that ancient pathogens which early humans had gained immunity to, could survive in the ice, waiting until enough time as passed and thus our immunity also. But more so, the risk from climate change is due to the fact that with warming climates, there will be a change in pathogen habitats, spreading to new geographic areas. Changes in distribution could result in global outbreaks in previously non- endemic areas, infecting populations who do not have the experience, adequate medications, or any sort of immunity to deal with the outbreaks. Climate and geographical changes can also cause mutations in the microbes, possibility becoming more (or less) infective.

The risk of reemerging infectious diseases is increasing because of rapid evolution of known pathogens, antibiotic resistance, and decreased vaccine usage. As we should all know by now Influenza has caused pandemics in the past and still poses a significant risk due to its high mutation rates and ability to jump from animals to humans. Also, the continuing increase in antibiotic resistance is a threat. Every year 2.6 million people are infected with antibiotic resistant microbes, with many currently defined as urgent threats to public health. Without antibiotics to stop and prevent infections, an outbreak of such resistant pathogens would be devastating: possibly leading to a pandemic which none of our available medicines would help.

Now this wouldn’t be an issue if we were actively researching new antibiotics and ones specifically for antibiotic resistant bacteria, but we aren’t…Due to a lack of return on investment because of the long shelf life and short-term usage of antibiotics, companies have dropped out of antibiotic field. The cost of development is high, but the price of antibiotics needs to be cheap. Thankfully in recent years public health organizations have created incentives to increase such research, but who knows how long results will take!

Don’t even get me started on anti-vaxxers… A decrease in vaccine use, specifically in developed countries, has increased the risk of previously controlled or eradicated diseases of the past reemerging, one example being measles. You can read more about this here.

Why such infectious pathogens could cause a pandemic, rather than just isolated outbreaks:

Well the extensive network of global travel and trade in todays world means that a pathogen could be carried across the world within days. From 1950 to 2013 international tourist arrivals increased from 25 million to 1087 million and by 2030 its expected to reach 1.8 billion. People could carry the pathogen around the world before they even knew they were sick.

With global travel only projected to increase, this leads me into the other major factor that increases the risk of  a pandemic: the lack of resources and an adequate global plan. After the SARS pandemic of 2003, The World Health Assembly updated the International Health Regulations (IHR) to push for all members of WHO to adhere to specific standards for detecting, reporting, and responding to outbreaks. Though these regulations were put in place, many countries are not able to meet the requirements of the IHR, specifically in under-developed regions where infectious diseases and epidemic are still prevalent. Outbreaks in Africa over the past decade have shown gaps in timely detection, tracing contacts, quarantine procedures, and lack of global coordination and response. Also, no matter the development level of a country, during outbreaks facilities have a large influx of patients, leading to an inadequate amount of resources to care for them all, decreasing the integrity of control mechanisms. 

Before the next pandemic we need to:

1. Implement measures to improve living conditions and sanitation in urban communities, while reducing the interaction with animals and wildlife, as to reduce the possibility of emerging zoonic infectious diseases.
2. Fast and efficient global surveillance and alert systems. This global collaboration is necessary to react to a threat in a timely manner with modern global travel.
3. “Scaling up” local surge capacity of health systems, including building a stockpile of medicines and equipment, as well as appropriate health financing and access to necessary medical technologies.
4. More health care workforce training and simulation exercises, as well as strengthening relationships between different stakeholders in the community. 
5. Research! More public health research is needed in the areas of, antibiotic resistance, medications for emerging and reemerging infectious diseases, true risk of climate change on pandemics, and how underdeveloped countries can more efficiently catch outbreaks and communicate with other countries.

Now I sit here, amidst a pandemic which has lasted almost the whole year, and ponder the irony of my December assignment… the irony of how much info was available to take preventive measures. Now I know these measures are easier said than done, costing a significant amount of money and effort, but I hope that with the current pandemic highlighting the failures of global preparedness, (I could write a whole blog about how all these factors have been proven by COVID-19 , but I’ll leave that for you to examine) countries, including our own, will take more action to better prepare for the inevitable next pandemic.

The coronavirus pandemic has enormously changed the world. From social distancing norms, mandated mask norms, decreased in-person socializing, and increasing use of technology to stay in touch to the adoption of remote work, decline for small newly established businesses, and change in urbanization trends, Covid-19 has brought a vast change in our day to day life and this change is here to stay.

A recent article in The New York Times “It’s 2022. What Does Life Look Like?” has described how the Covid-19 has affected businesses, schools, shopping experiences, economy, and employment and will continue to do so through 2022. Its been a difficult year for businesses, especially those which rely on in-person experiences. For instance, due to the entire world shifting online, small business owners at malls or grocery store owners are doing poorly. Owing to the poor returns in online shopping or no income at all, several business owners have reopened in-person businesses, resulting in mixed reactions from the general population, politicians, and other business owners as well. While Covid-19 still continues to be a known risk to the population, such business owners are also facing the wrath of rent deposits, mortgages, loan installments, and having to provide for their families as well.

Another important sector affected due to Covid-19 is higher education. Revenue for schools and universities has dropped due to online learning, which unfortunately has not been the best of experience for a large part of the population. Online learning has been a boon, for sure, in such unprecedented times. However, the pre-requisites to a flawless online learning experience are not feasible to everyone, especially, the low socio-economic stratum in low and middle-income countries. An article in DownToEarth “COVID-19: How viable is online education?” clearly explains the possible drawbacks of online learning. Furthermore, online learning without skills development is not beneficial and will further exacerbate the growing unemployment.

This has also created problems for teachers. In India, a lot of states have decided to cut down teacher salaries to less than half due to the ongoing pandemic and the absence of revenue in online learning. However, teachers have been facing the same technological barriers and feasibility problems that the students and parents are facing. Having to invest in resources, and teach several classes from home, while managing their own children, and receiving absolutely nothing in return is not fair either. NewAge Bangladesh in their article “Teachers’ woes continue as they face job loss, salary cut” has recounted the experiences of teachers who have faced job loss and salary cuts and the government that has failed to provide adequate compensation to teachers.

As discussed in “Higher Education Responses to Coronavirus (COVID-19)” even though, universities have shifted to online learning or hybrid learning and face shortages of revenue owing to refunds, fewer admissions, and dorm cleaning process, several schools have offered resources to students such as opening university libraries, provide mobile hotspots, and refunds to on-campus students. With the closure of university campuses across the country, several colleges have created emergency relief funds to help students with their expenses. Additionally, a lot of students held on-campus employments which have been affected due to Covid-19. The department of Education has thus allowed institutions to continue paying wages to such students. Also, the Coronavirus Aid, Relief, and Economic Security Act (CARES) stimulus package have relaxed student loan payments by deferring payments and interest on federal loans, suspending penalties for borrowers, and waiving the requirement of the entire loan amount paid in the event that the student withdraws from the course through September 30, 2020.

The impact of Covid-19 in the health sector has been profound. But an equally profound surge in the number of domestic violence cases, suicides, and sexual and physical harassment cases across the globe has been noted. 1 out of every 3 women will experience some form of abuse in their lifetime. In such unfortunate times, when the victim is locked with the abuser, the cases have increased drastically. At the same time, suicide cases have also increased. Stress due to the financial burden, lockdown, and existing physical conditions have exacerbated mental health issues. Mental health is a highly ignored issue and cases of poor mental health are extremely unnoticed. “Impact of COVID-19 on domestic violence in Bangladesh” provides some of the alarming domestic violence statistics since the beginning of the pandemic.

Another lingering question is the vaccine we have all been waiting for. How will life continue until vaccines are available? Will life return to normal? I believe life will never be the same. Mask selfies, remote work, increased online meetings over in-person meetings, and socializing over the phone have become the new normal. Countries across the globe are racing to provide the world with the much-anticipated vaccine however, the big question is accessibility and affordability. The price of the vaccine should be such that is equally affordable to the high-income countries as well as to the middle and low-income countries, and to the rich and the poor alike. The vulnerable populations are highly susceptible to the virus, given their living conditions, and the lack of health care. Without proper price controls, such populations would be hit the hardest. However, price control introduces a new problem. Price control on vaccines will discourage providers from an equal distribution of the vaccine. STAT news “A coronavirus vaccine should be for everyone, not just those who can afford it” very aptly describes problems of affordability.

Despite all the health hazards that COVID-19 has surrounded the world with, it has done a good job of improving the environment with a decrease in carbon emissions, clean air, and clean water. Additionally, with most work now online, people have more time to spend with their families. People are spending more time with friends and family and have been able to restructure their lives in a positive way.

The Covid-19 pandemic has helped us relearn our basic health and hygiene measures. People are more consciously and regularly washing their hands and maintaining better personal hygiene. It has also reminded us of the risks associated with non-communicable diseases, and the need to eat right.

We have all spent more than half of the year locked away in our homes with little or no physical interaction with others. We can all hope that the coming year would bring positive news!

At this time in the world, I think it is appropriate to assume that the majority of the population has heard something about the ongoing pandemic. COVID-19, coronavirus, SARS-CoV-2 . The names all sound different, but they mean the same thing….but what exactly does it mean? COVID-19 is a severe acute respiratory disease that is highly transmissible. What began as a “mysterious coronavirus-related pneumonia” in China reported on January 9th by the World Health Organization, is now responsible for 7,436,278 illnesses and 209,560 deaths in the United States alone, with plenty more reported cases in different countries around the world. Symptoms involving difficulty breathing, muscle and body aches, headaches, losses of taste and smell, and fatigue are just a few signs that you have likely been infected with this lethal virus. We have been told to stay at home, to quarantine with loved ones, to wear a mask in public, and to wash our hands thoroughly as safety measures in order to combat the growing number of cases every day. Public health officials, medical professionals, and essential workers alike have all banded together to stop the spread, but how are people coping with all of these vast changes? What can be said about the state of our “new normal?” Although the physical effects of COVID-19 are extremely evident in the world right now, we often overlook symptoms that are not visible. When asked the question, “How are you doing?” it is so easy to plaster on a smile and respond with a simple “fine,” but when taking a closer look, things may not really be just “fine.” How is the mental state of the population living through this unimaginable time, and how can we help those who are mentally suffering in silence?

Well, the brief answer to that question is that a lot of the population is “not fine” and there is A LOT we can do for those suffering in silence. However, this issue requires a lot more than a brief answer, so let’s talk about the effects COVID-19 is having on our mental health. Amidst this pandemic, we have witnessed large amounts of loss whether that be in regards to human lives, employment opportunities, or normalcy and as a result, our population has become susceptible to large amounts of stress. According to a tracking poll conducted in July by the Kaiser Family Foundation, it was found that 53% of adults in the United States reported an decrease in their mental health while dealing with large amounts of worry and stress from the ongoing pandemic (Panchal et al., 2020). Stress  causes a myriad of negative symptoms on the body including the development of depression and anxiety, prolonged activation of the immune system, heart illnesses, difficulty sleeping, and changes in behavior. As the COVID-19 pandemic persists, studies have found an increase in depression and anxiety rates throughout the country. While large populations, such as Public Health workers, have suffered from the stress of dealing with inadequate testing measures, limited treatment options, insufficient personal protective equipment and other important medical supplies such as ventilators, extended workloads, and a general overwhelm of the system in such a short period of time, many smaller populations have contributed to the increased reporting of stress (Pfefferbaum, 2020). Some smaller population studies explore the correlation between job losses due to the pandemic and increased depression, anxiety, distress and low self-esteem rates, while other studies focus on the impact of isolation in adults or adolescents on their mental health statuses (Panchal et al., 2020). Regardless of what the focus of the study may be, the inference that the COVID-19 pandemic has caused a large increase in the presence of mental health illnesses cannot be avoided.

So, what can we do about this? There are a lot of ways in which we can provide assistance for those struggling, beginning with the recognition of symptoms. If you or someone you love are struggling with falling asleep, concentrating, using or abusing alcohol or other substances, or are deteriorating in health, it is important to speak to someone whether that be a friend or a medical professional. The COVID-19 pandemic is stressful! Worrying about loved ones who may be essential workers or may have fallen ill to the disease is a lot to cope with on your own, therefore it is important to reach out to the resources at hand. It is crucial to know that you are absolutely NOT alone in this! Furthermore, it is always important to check in with those you believe may be struggling. You can do so by giving them a call, reminding them to take a break from any responsibilities they may have, ensuring they are getting proper exercise and sleep, and by asking them if they need anything, within reason, that you may be able to provide. In addition to checking in on your loved ones, it is important to check in with yourself as well. Not everything lands on your shoulders and there is no reason to believe that you are responsible for other people’s actions, so make sure to take some time to free yourself from your responsibilities as well. In addition to checking in on our loved ones, important policies and programs need to be created for communities in order to combat mental health illnesses. Education and training programs need to be provided to health system leaders, first responders, and health care professionals on psychosocial issues (Pfefferbaum, 2020). Furthermore, emergency response communities need to work together to identify and develop resources that can be related to mental health triage and referrals (Pfefferbaum, 2020). Lastly, it is important to integrate mental health practices as health care workers are already overworked in their efforts to combat the disease medically  (Pfefferbaum, 2020).

The COVID-19 pandemic has impacted so many people worldwide. This disease is ruthless and persistent and it is important now more than ever to band together in order to fight it. In order to decrease stress levels and the increasing rate of mental health illnesses, we need to listen to public health officials and follow the instructions laid out for our safety from organizations such as the Center for Disease Control and Prevention. It is important to practice safety methods such as wearing a mask while in public places, thoroughly washing your hands, social distancing, and leaving your home for essential things such as food and work to keep yourself and others healthy. No one person can combat this disease on their own, but a joint effort can create the ripple effect we need to end the spread and get back to some sense of normalcy again. Not everything will be the same, but so long as we emerge united, we can fight to take our lives back, together.

By now, most every person around the world has heard the name coronavirus or COVID-19 or (one of my favorites) “the rona”. If someone has not heard of it, here is some decent information on the virus with some useful videos on what it is and how to stay safe. 

The coronavirus has changed the lives of people in areas such as school, work, and even the normal recreation activities that everyone are used to. And because of the social media/internet world we live in, information on the coronavirus is everywhere. From real information such as information from NIH and the CDC, questionable information from your family and friends on Facebook and Twitter (that they probably heard from your cousin’s half-brother’s friend’s grandma), to the ever present conspiracy theories going around. Whether or not people want to believe in the existence of the coronavirus, it is REAL. And the coronavirus is not just in the developed/high-income countries, it has spread to all over the world.

One area that experts were expecting to have high numbers is Africa. However, when the rest of the world was seeing high case numbers of coronavirus, Africa only had about 6,000 cases as of April 1st, 2020 with most of the countries having less than 100 cases (PreventEpidemics, 2020). These numbers are drastically different than the data from other countries and continents. To help put this into perspective, here are some other continents and their coronavirus case numbers for April 1st, 2020: in Europe there were 464,212 confirmed cases, in the Eastern Mediterranean region there were 54,281 confirmed cases, and in the Americas region there were 188,751 confirmed cases (WHO, 2020).

Shown above is the map from the WHO containing the coronavirus case numbers that were reported between March 26th ,2020 to April 1st, 2020. In contrast to other countries, Africa as a whole was more strict on their policies regarding social distancing, closing schools and workplaces, limiting travel, etc. In addition to the strict rules, differences in the populations in the individual countries play a role in the transmission of the coronavirus. Some examples of differences in the populations that would affect transmission levels are socioeconomic status, nutritional status, population density, and household size. Another potential reason that Africa has had much lower numbers than expected is the level of contact tracing. Many of the countries in Africa have already had some experience with contract tracing through other epidemics such as ebola and other infectious diseases. But there is always a potential for these reported numbers to not be accurate, not only in Africa but in any country. According to PreventEpidemics in 2020 “Among countries that do report testing data, there are generally lower rates of testing for countries in Africa compared to other countries”. Therefore, if there are not as many tests being conducted throughout countries in Africa as compared to those in other countries, there is a potential for the case numbers to be skewed. The number of cases in Africa could be underestimated. For more information on the coronavirus response and data on the coronavirus cases in Africa, please check out this awesome website here.

Overall, the pandemic has changed health and healthcare drastically across the world. Especially in the United States, healthcare has changed from in-person visits with a healthcare practitioner to a telehealth visit. There have been many positive and negative effects that vary greatly from person to person concerning this switch. For example, many of the large health insurance companies have begun to cover telehealth visits at 100% to their subscribers with no copay, therefore benefiting the patients to use this service. A potential major obstacle to telehealth visits for some people could be internet access or computer and internet access. In contrast though, most Americans have access to a computer/mobile phone with internet capabilities. For those healthcare practitioners/offices that cannot participate in telehealth visits such as chiropractors, oncology, allergist, etc. patient care has still continued on, just with a very different look than patients are used to. The chairs in the waiting room (if the waiting room is even open) are 6 feet apart, everyone is required to wear masks, cleaning of rooms and surfaces has increased drastically, and charting has been moved to 100% digital. Some of these changes are for the better and I hope will stay implemented even after the pandemic has “ended”. The current coronavirus pandemic has made everyone aware that the United States and arguably most countries across the world, were not and are not prepared for a pandemic and the associated burdens that it places on the healthcare world and the economic world. Here is to hoping that people learn something from this pandemic and we as a whole world are better prepared for the next one when it comes around. 

References:

• InTouch Technologies. (2020). 5 Things You Never Knew About Telehealth. Retrieved 2020, from https://intouchhealth.com/5-things-you-never-knew-about-telehealth/
• PreventEpidemics. Update on COVID-19 in Africa. (2020, September 02). Retrieved October 07, 2020, from        https://preventepidemics.org/covid19/science/insights/update-on-covid-19-in-africa/
• World Health Organization. (2020, April 1). Coronavirus disease 2019 (COVID-19) Situation Report – 72. Retrieved 2020, from https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200401-sitrep-72-covid-19.pdf?sfvrsn=3dd8971b_2

     A number of countries had the COVID-19 outbreak before the United States giving us fair warning and plenty of time to prepare. Why have we failed so miserably? This is a conversation that’s been had several times at this point but it’s important in deciding how we move on at the occurrences of second waves of COVID-19. If we continue on like we are the deaths will continue to rise. COVID-19 is the pressing issue at hand but is really just exposing the faults that were already in the system like the disconnect between and public health and healthcare practices, poor decision making by political leader’s lack of compliance among the US and ideas like American exceptionalism.

It is no secret that the United States healthcare system is inefficient and full of inequities. Of the developed world we have the highest spending rates with equal or worst overall healthcare outcomes. The united states healthcare system charges more money for similar services and medications than other countries. We also generally recommend more services than needed to patients. Instead of making patients priority and acting from a patient centered view, money and politics are involved in the decisions made. The combination of many hospitals has reduced competition allowing prices to be raised. There are also a disproportionate amount of administrative cost of four times more than the average developed nation (excluding the US).

Oxford university create a scale to measure the response of different governments to the COVID 19 pandemic. This scale looks at how strict protocols were and what measures were taken. This includes quarantines, mask enforcement, contact tracing as well as things like stimulus checks to relieve financial pressures. The united states had a score 5.7 two weeks after their first confirmed case while South Korea had a score of 38. When comparing their deaths taking into account the population differences South Korea would have almost 2K deaths when the United States has 118K deaths. There was also a wide inconsistency in public policies. Different states issued stay at home mandates at various times and often didn’t implement them fir very long. Low testing rates led to a more rapid spread in the virus as unknown carriers continued to go out and live life to the fullest.

There is a loop of behavior happening. We underestimated it and spread the virus then got serious and hunkered down for quarantine then decided it wasn’t that bad again and spread it more. People are continuing to travel during the pandemic. I personally know plenty of people still taking trips. Looking at the bureau of transportation statistics travel dropped down 100 million people quick and sudden in from March to April but rose just as much by May. Travel has still decreased significantly from before the pandemic but looking at different times there is a pattern of panic and relief. When relief comes a heightened comfort level comes as well and travel begins again. Currently it looks like we might be on the rise.

There is a concept of American exceptionalism that is a cultural idea that the united states is better than everyone else in virtues like justice and freedom even among our constant failures and frankly embarrassing results across many domains. We are winning in mass incarceration, school shootings, most money spent on healthcare (With poor results) police brutality, debt and now COVID-19 cases. It’s really a perplexing argument to make with all this evidence against us. The dangers of this thinking blinds people to the idea that the United States can do wrong and deters them from being critical of policies and laws being implemented in our system. It’s a sort of blind trust that keeps those in office from taking responsibility for unjust decision making. Since the decision being made effect the lives of millions of Americans this is a dangerous concept to have. This hubris has allowed COVID-19 to run rampant in this country.

Another issue not spoken about enough is the debilitation and long-term effects of COVID-19. The focus has been on the worst-case scenario which can arguably be death. But there are worst results from contracting COVID-19. There have been many reports of lingering symptoms after contraction and recovery from COVID-19. The virus effects not only the lungs but the heart and brain as well. This sends patients home with many medications to treat these symptoms. Patients then have to take medical leave to continue recovery with thousands of dollars’ worth of medical bills. They then risk losing their job due to inability to work. Most Americans are provided insurance through their employers so this would be a tremendous blow on someone’s life especially if this insurance includes their children. Loss of employment can also lead to loss of housing. Our focus on death has shifted our perspective leaving those still alive to suffer dire consequences. That is why financial assistance is so important. Americans received one stimulus check since the pandemic started and our current president is threatening to withhold anymore unless he is reelected. Other than the fact that this is outrageous it is also very little compared to other countries. Canada for example gave 1400 for four consecutive months. In the Netherlands 90% of salaries were still paid out. The support given to the most vulnerable populations in America is beyond poor and must be addressed.

It is too late to reverse these deaths and those that have already contracted the virus. But, it is not too late for us as a community to comply with public health recommendations and come together to make the needed changes for a better and healthier future.

COVID19 has effected every age group in our nation, throughout the different races, cultures, and populations of the United States. Sadly, one of COVID’s most impacted population groups have been children (UNICEF Data hub, 2020), but maybe not in the way that you think. Yes- children have gotten sick with, and have even died, from COVID19 since it started spreading, but they’ve also been affected in many other indirect ways as well. The financial stress the pandemic has put on families has affected the mental and physical wellbeing of the children involved. Imagine the daily stress of not only not knowing if you are going to be evicted from your home every day due to nonpayment, or the stress of not being able to enjoy breakfast, because Mom isn’t eating so that you and your siblings can. Or similarly, you can’t enjoy breakfast because you don’t know if there is going to be a lunch or dinner that day. Children are at risk of toxic stress and many other ACEs (adverse childhood experiences), which can cause many dangerous implications for them and their mental health down the line (https://www.allhealthpolicy.org/the-immediate-and-lasting-impacts-of-covid-19-on-children/). Let’s think about this for a second: this pandemic from a child’s perspective. Kids living through COVID have experienced a loss of learning(temporarily, in the least), a likely increase in child or domestic abuse in the home (stemming from everyone simply being home more and stressed from the strain of the pandemic, grief, and a lack of predictability of the future (which is likely stressing adults out too). These kids are feeling isolated, irritated, and confused. And these are just the short term effects. Long term, these children will likely experience a widened education gap and an increase in child poverty even long after the crises is over (https://youtu.be/q2ZPrQ8a4n0).

Little girl looking longingly at an apple. (Photo obtained from nokidhungry.org)

America already had a high number of food-insecure individuals, which included over 11 million children in 2018, but with the strife of the pandemic already pushing everyone to their limits, this number likely climbed (https://www.feedingamerica.org/research/coronavirus-hunger-research). If you and your family already struggled to put food on the table, can you imagine the stress of trying to consider how to buy food in bulk for your family to self-quarantine? Especially now that the kids are no longer getting the 2 meals a day they were getting at school five days of the week. It has been found that as many as 370 million children may miss out on nutritious school meals (data.unicef.org).  Food security during the pandemic is such a popular issue, that Feeding America has even created an interactive map to show the expected impact on food insecurity in 2020.

                Although children are expected to be able to fight the virus a bit better than those in population who are elderly or immunosuppressed, those that are experiencing food insecurity are more likely to have poorer health, and more likely to have an underlying condition, such as diabetes (feedingamerica.org). These likely preexisting conditions make fighting this contagious virus even more difficult for children who already have it rough. The public’s efforts to reduce the transmission of COVID19, while having good intentions, have disrupted the food services that many families relied heavily on.

When considering the inequitable woes that these children are facing, we also have to consider their parents’ line of work. In the best case scenario, let us assume the child’s parent did not lose their job during the pandemic (unlike thousands of Americans). If their parent(s) work in “Financial Activities”, the expected Food Insecurity Rate in 10% less than a parents’ whose job was in the hospitality industry (feedingamerica.gov.). See the graph below for more surprising connections found between food insecurity and the workforce industry.

Another indirect, but still pivotal way COVID19 is affecting children is reducing their access to healthcare. Also to reduce transmission of the virus, many primary care doctor offices either closed temporarily, reduced their hours, or refused to take people with COVID like symptoms (suggesting they go to their nearest Emergency Room or Testing Center instead). But this about what else this means more children: no more regular doctor check-ups or healthcare maintenance. Already almost 14 million children did not get any vaccines in 2019 (data.nicef.org), and this number is expected to rise. About 80 million children under the age of one (in at least 68 different countries) may miss out on receiving a life-saving vaccine, thanks to COVID19 (data.unicef.org). One of the most concerning related health threats among children is the upturn of HIV cases. The amount of new HIV cases has been decreasing over the years, and has decreased by half in the past ten years. However, scientists are expecting COVID to reverse this gain in healthcare quickly. As many as an additional 124,000 kids could possibly be infected with HIV if preventative measures are disrupted for 6 months (data.unicef.org). Check out the graphs here for estimations on the effect of HIV disruption on novel infections among children ages 0-14.

All of this to say this pandemic has been hard on everyone, yes, but especially hard on our children. The trauma children are experiencing during this pandemic from being sick themselves, seeing friends or loved ones sick, food and shelter insecurity, dramatic changes in their routine, etc. could be having lasting adverse effects on their long term functions and all around wellbeing. If you have about an hour, watch this webinar put on by the Alliance for Health Policy on ‘The Immediate and Lasting Impacts of COVID-19 on Children’. So maybe the next time your kid is acting out or being moody, instead of responding with “Stop that!”, maybe think for a second. An appropriate response may be “What’s the matter?”.

Sources

COVID-19 and children. (2020, October 07). Retrieved October 08, 2020, from https://data.unicef.org/covid-19-and-children/

Data hub, U. (n.d.). COVID-19 and children. Retrieved October 08, 2020, from https://data.unicef.org/covid-19-and-children/

The Immediate and Lasting Impacts of COVID-19 on Children. (2020, August 04). Retrieved October 08, 2020, from https://www.allhealthpolicy.org/the-immediate-and-lasting-impacts-of-covid-19-on-children/

Now the Pandemic – Next What?

I had just finished my certification exam to be able to work as a doctor in Albania, when I heard the news about a respiratory virus that was spreading across China. I remember most of the people back then did not seem to be worried about it, but I had a little bit of curiosity to know more on what was going on.

And everytime I have a curiosity to learn something I turn to the academia world on Twitter. 

Yes, exactly like that…you learn from the best and for free. I started following Marc Lipsitch (infectious disease epidemiologist and director at the Center for Communicable Disease Dynamics at Harvard Chan), Helen Branswell (Canadian infectious diseases and global health reporter at Stat News). Helen led coverage of many pandemics before like Ebola, Zika, and SARS.

 Jody Lanard, is a former WHO senior advisor on influenza pandemics and together with Peter Sandman (expert risk communication) shared their lessons learned from working on previous pandemics.

These people on Twitter were the first one to say that it was past time to tell the public “It Will Probably Go Pandemic”, and We Should All Prepare Now. 

The information that they were sharing was requiring immediate action to be taken, and they were all talking about a risk which I could not sense from other sources in the media. The virus looked far away in China, but looked really close home from Twitter. I remember one tweet which stayed for me during all this time. It was the end of February and it said

 “The world as we know it, is over.” 

I was shocked.  I did not want to believe it. I kept on telling myself that everything will turn to normal. We will overcome this, and we will go back to normality again, which I believe would happen by this summer.  And as we all know now, this is far from happening.

So what are some of the predictions for the future:

First of all, as a paper from Nature explains it, the future of the pandemic will depend on when a vaccine will become available or not and how long the immunity from the virus lasts.

A study from the Center for Infectious Disease Research and Policy explains three scenarios that might happen.

Scenario number 1: the current wave we had in spring will be followed by a consistently bumpy ride of “peaks and valleys” that will gradually diminish over a year or two.

Scenario number 2:  the current wave will be followed by a larger “fall peak,” or perhaps a winter peak, with subsequent smaller waves thereafter.

Scenario number 3: the current wave we had will be followed with “less pronounced” ups and downs.

So exactly how long the virus is going to say remains to be seen, – but one thing is clear, – even after the vaccine and better treatment will be developed, the world will be reshaped. 

1. All the inequalities and disparities regarding health and health care re-emerged.

They have always been there, but societies have tried to hide them. COVID-19 is disproportionately hitting Black and Latinx. They do not just have chronic conditions which are a risk factor for worsen outcomes from COVID-19, but they have also have other social determinants like: more likely to work in service industries where exposure is higher, more likely to live in the same household with multiple generations, less likely tp have access to health coverage and healthcare services.

As Dora Hughes M.D., M.P.H explains it in this interview the systems and structural drivers of inequities that are seen during this pandemic need to be addressed at a community level, at state level so we do not just go back to where we were, but we get to where we should be, we move forward.

So now that we are more aware of the shocking magnitude of health disparities, a lot more pressure will be put on policymakers to take future actions for the issue.

2. It is a Global Issue

As I have previously addressed it on my blog regarding the Sustainable Development Goals, COVID-19 has reversed the work done to achieve the goals. So the future will look with a lot more extreme poverty, hunger and food insecurity. The GDP is expected to decline by 4.2% only in 2020, and a lot of companies which have an impact on the economy, will not make it alive after the pandemic. Local newspapers, department stores not offering online shopping, and higher education are the three industries most likely to be affected, as explained by David Leonhardt in his New York Times Article. 

3. Who wants to work at the office anymore

Zoom in the beginning was boring, and energy consuming, but now everyone seems pretty happy with doing work from the comfortness of their own home. Working from home is efficient, it saves time and allows for more flexibility. A lot of companies don’t expect to use as much office space as they used before. So even after the pandemic is over, a lot of companies might give their employers the option to fully work from home. 

After all, does the future really look so dark? 

This is not the first pandemic ever. The Black Death, the Spanish Flu, the Great Depression. We have learned not just to survive, but to come out stronger. 

In only the first months of quarantine we shifted the way we work and the way we teach and learn, to working from home and studying online. We bought our food online, and held our doctor’s appointment through Zoom. 

We are built to respond to acute change and stressors, and to constantly make our lives better. And if it is one thing that history teaches is that “most of the things won’t change”.