By RAFAEL FONSECA, MD
Reopening safely out of the current pandemic ought to be done via persuasion, not coercion.
It has been more than five months since the world first learned about COVID-19. Models predicted a sharp increase in the number of cases, and a seemingly high likelihood the pandemic would overwhelm our hospitals. These models were often inaccurate, and we have all come to learn about the imprecision of epidemiological prediction. Nevertheless, the infection is far worse than anyone initially accepted – becoming a staple of our generation. Fearing uncountable deaths and the possible need to prioritize resources for those affected, initial government measures were put in place to curtail the spread of the virus. Images of the Lombardic tragedy compelled all to stay in place and wait for the storm to pass, and with few exceptions most complied. Realizing the gravity of the situation, governments gradually implemented measures to prevent infections. With some vacillation, we evolved from travel restrictions, to social distancing, shelter in place and universal mask use.
As the pandemic ensued, we watched the horror stories taking place in New York City and Boston. Even while we are in the midst of the so-called first wave, with thousands of deaths per day, many have started to wonder how long society will remain isolated and locked. Politicians look to experts for recommendations regarding policies that might save lives, and for the most part they have complied. However, as the weeks ensue, we see growing jobless claims, lines for food banks, and impatience.
This brewing impatience is a response to an unknown future dictated by the vagaries of nature and the lack of a coherent strategy to resume a life with a resemblance to normal. The public searches for guidance from federal agencies, state governments, and health authorities. A lack of clear direction from these institutions has heightened this anxious impatience. Additionally, the conversation is now ideological, with an almost Manichaean division between those wanting to save lives more so than the economy, and vice versa, creating cartoons of opposing perspectives. Even for those recognized as accomplished, dissenting from orthodoxy is punished severely. In the background, the public’s patience is running thinner.
We observe nonsensical tactics that further erode public trust. Sand-filled skateboard parks are the epitome of this dystopian reality. Police officers chase socially distant individuals in the ocean and on the beach. There has been no room to consider how families with small children living in apartments in New York City should cope.
Now, protests have started. Occasionally armed groups with American flags present themselves at government buildings demanding back their freedoms (all demonstrations have been peaceful). This seems to be an emotional reaction to the tyrannical smell of the environment. Politicians clash with law enforcement as to whether violators should be identified, fined or jailed. Citizens have started to feel like pawns in a game being orchestrated by those who “knew better.” As C.S. Lewis wisely said, “there is no worse tyranny than that done for the good of the victim.” It turns out that those making decisions do not even know if this is “good,” no one knows for sure. But why not, lets maximize safety through coercion.
Only retrospectively will we know the cost and consequences of current policy decisions and their effect on the mortality of COVID-19. In time, we will know whether Sweden was the greatest mistake in public health history, or a visionary strategy. Only in time will we know if stay-at-home orders helped, and whether decisions were made in a timely fashion. We will regret the polarization of the pandemic, nationally and globally. We know that the virus can only propagate when carried by humans, but not much about the efficacy of social distancing, the net benefit of masks, the transmissibility via fomites, the durability of immunity and so many other things. Humanity has never seen such a rapid rise in medical knowledge as we now see for COVID-19, but we still remain quite ignorant.
Because of growing public mistrust, the opportunity to convince seems lost. Heeding advice would have been far more productive than coercing. Once you fill a park with sand, recommending universal use of masks becomes much more difficult. Regrettably, this mistrust has now fueled conspiracy theories about the origins of the pandemic, and some people have outright rejected the idea of getting vaccinated (should a vaccine become available). My optimism makes me hope that there is still a chance for persuasion, but it now seems the pandemic will follow a tortuous road with many more deaths to come and a yet to be understood effect on the well-being of current and future generations.
Society cannot remain indefinitely quarantined at the cost of jobs, poverty, and a receding economy. Those more economically capable to weather an economic downfall struggle to understand why hair salons dared open against local laws. Sadly, this sense of economic security is only possible for a small minority. People need their sustenance. The ideological polarization also grows because of the portrayal by some that only those in medicine and epidemiologist knew. We have learned through this pandemic that society is far more complex than we can comprehend. Unidimensional accusatory statements have eroded trust by those “not in the know.” It remains impossible for any individual to possess all the requisite skill sets and knowledge to reliably know what the best steps forward with regards to policy are.
A clear message that persuades citizens on a safe approach to reopening is missing. A message that outright acknowledges the unknowns about the virus while proposing a plan for most to return to work, albeit with revised behaviors and some acceptance of risk, is absent. A persuasive message regarding the potential benefits of universal mask meets defiance as a sign of mistrust and an affirmation of people’s yearning for liberty. Persuasion could enhance behaviors such as continued hand washing and social distancing. However, such persuasion seems less likely. It could have been different.
I hope the future shows persuasion cutting across ideology.
Rafael Fonseca, MD is the Interim Executive Director at Mayo Clinic Cancer Center. This post originally appeared on his blog here.