Lessons from the Covid-19 pandemic

One year after the first case of Covid-19 was reported in China, what have we learned from the pandemic?

Trying to answer that question in 600 words would be like drawing an apeirogon made of an infinite and ever-expanding number of images. I shall therefore leave the recounting of stories of sacrifice, resilience, and complex human emotions to writers, poets and artists. The lessons I am sharing here are rather dry and non-sentimental – focusing on the role of public health in our lives.

To begin, let’s examine why some countries – like S Korea, Japan, Taiwan, Viet Nam and New Zealand, are coping much better than most industrialized countries of the Western hemisphere, thus cutting a path to fewer humanitarian challenges and economic problems. These countries all have universal healthcare coverage, and primed by experience with SARS1 virus two decades ago, have maintained a vigorous public health system. They readily contained isolated cases and small outbreaks before they got out of hand, using the classic combination of testing, contact tracing and quarantine, social distancing and temporary lockdowns when feasible, pairing temporary laws with social awareness and health education (handwashing and face masks) to maintain public trust. Second wave outbreaks are also quickly dealt with the same rigor.

Here, more than just exposing the inequalities and dysfunction of our healthcare system, the pandemic has shed light on non-medical determinants of health: outcomes are strongly correlated with differences in social class and wealth, living environment, education and work conditions, and access to healthcare. It also exposed the fragility of employer-based insurance and many issues in our workforce.  These topics, albeit important, are beyond the scope of this essay.

What started as localized, uncontained outbreaks are now a devastating tragedy, leaving an uneven toll of economic, medical and psychological scarring across our land. We have world class scientists and epidemiologists, the best medical technology, yet so far have failed miserably. So, what went wrong? Instead of being proactive in implementing early comprehensive and preventive measures, our mitigating actions continue to be reactive, too little, too late, and too often fractured by political chauvinism contradicting scientific recommendations, generating confusion and loss of public trust.

This loss of confidence in public institutions has deeper roots – a general suspicion against official authorities in general and against academic and scientific figures in particular, seen as elitists. Conspiracy theories, riding on the fears and prejudices that living with uncertainty and anger brings, only magnify the problem. 

But lessons from this pandemic don’t need to be just gloom and doom. Out of challenges and necessities, new ways of thinking and problem-solving will emerge. Pandemics come and go, and I am confident that science and technology can control the Covid virus. But we should remember that infectious agents thrive by exploiting our human vulnerabilities. For some, it may be the weakness in our immune system caused by age or underlying medical conditions. But as a nation, our vulnerability comes from self-inflicted wounds – the social rifts and fractures that are more difficult to bridge and heal. 

Too often laws are crafted to favor special interests, but public health laws are created to make all of us safe by improving human behavior, asking of us self-discipline and social responsibility. They are the most equitable, the easiest to comply with, and the most cost-effective laws – just think how many lives and societal costs are saved by laws requiring car-seat belts, bike helmets, and immunizations. But laws and institutions only work if the public is engaged and committed. All of us should give public health, and ourselves, another chance to succeed in stopping the pandemic.

(Submitted to the Gazette-Times of Corvallis, OR, on Dec 10; published on Dec 18, 2020)

Confessions of an atheist

It seems awkward for an atheist to join in the Interfaith voices, but may I share with you my thoughts about God and religion. They have evolved during various stages of my life.

Children have an innate gift for detecting hypocrisy, apparent when the whole story is not told.  School books seldom mention the fact that gunboats and slave ships followed missionaries, that cathedrals and temples, just like royal palaces and empires, were built with huge taxes on peasants and the blood and bones of artisans and serfs. In my rebellious youth, I readily embraced Karl Marx’s proposition that “religion is the opium of the people”, promoted by kings, politicians and priests who use God to shield their abuse of power.

As an adult equipped with abstract thinking but starting to feel that my feet are made of clay, I pondered, like others, about the existence of a Creator. How else can we explain the wonders and mysteries of life, and who do we pray to when other humans have failed us? Voltaire quipped: “If God did not exist, it would be necessary to invent him.” Pascal proposed that believing in God is one’s best bet: If I believe in God, but God does not exist, I have lost nothing; if God exists and I don’t believe in him, I would be damned! So why take the risk of not believing in God? Ben Franklin simply stated: "Religion is useful". All very true, maybe, but hardly a spiritual journey, if God exists only to satisfy our human caprices or relieve our insecurity.

Now, I am an old man no longer asking questions for which answers can only be imagined or fabricated. On the death of a young child or the loss of thousands of lives from a natural disaster, please don't tell me "God works in mysterious ways". Even if there actually were a God, his/her words would likely come to us filtered through the minds and lips of fallible humans. Still, I respect individual choice of religious beliefs and practices, so I don’t question the faith of folks who claim to have been blessed by a divine life-changing experience, especially if it moves them to do good things. Myself, I have rediscovered the hero of my youth, Albert Camus, and his existentialist-humanist “faith” – if you can call it a faith. In his plague-stricken city, when asked whether he believes in God, Dr Rieux answered: “No – but what does that mean? I’m fumbling in the dark…under the vast indifference of the sky”. To attain peace, he put his compassion (from the Latin, to "suffer with") to work, find meaning in life by bringing relief to others. Not for heroism, but out of empathy. Driven by social decency, not charity. 

Secularism means to separate human values from religious considerations, while atheism implies a denial of God's existence. But labels don't say much to me anymore. What matters is putting to work our innate human empathy, our duty to others, and our common resilience in times of adversity, whether God exists or not. Still pained by all the injustice and violence unabated by prayers, I long for a humanity not divided between the saved and the damned, the sinners and the pious, the faithful and the infidels. I can’t say much about Heaven or Hell, but here on earth, where I live, I want to reach out to others, and work together for a better Karma for our common humanity and other living things.  With only my social human conscience to guide me, unchained by religious dogmas. God's mercy not needed.

Published in the Gazette Times, Corvallis, November 14, 2020

(Chinh Le was raised in Viet Nam in the Confucian-Buddhist tradition. He is currently a member of the Unitarian Universalist Fellowship of Corvallis. The views expressed here are strictly his own.)

More on Statin drug recommendations

The headline of the Aug 25 "To Your Good Health" column reads: "Over 70? It might be time for a statin!". The case in point: a healthy 71 year-old man with no pre-existing cardiovascular condition was given an estimated 19% risk of having a heart attack or stroke in the next 10 years. The risk would be reduced to 15% if he takes a statin drug, a "reasonable plan" if the patient does not mind taking the medication.  

Because of a paucity of data, previous guidelines had been controversial for the role of statins for the primary prevention of cardiovascular diseases for healthy elderly persons. Confirming Dr Roach's advice, a new observational, retrospective study of VA patients published in the J Amer Med Assoc, July 7, 2020, reported a 20-25% decrease in death rate and a 10% reduction in cardiovascular disease when comparing statin users with nonusers. Limitations noted: it may make 2-5 years for benefits to appear, and the incidence of stroke was unaffected.

Impressive as the statistical results may appear, let's look at the other side of the coin: If one were to extrapolate the case cited by Dr Roach in a population-based analysis, the cost-effectiveness to the individual and to society would be as follows: for 100 healthy elderly individuals prescribed a statin for 10 years, 4 would benefit, while for the other 96, the medication would do nothing. 

Medical statistics are important in making health decisions. But it depends on how you frame your observations.

(Submitted Aug 27, published Sept 4, 2020 in the Gazette Times, Corvallis)

On Dr Anthony Fauci

After years of reading individual opinions in this newspaper column, I have learned not to get myself upset by reacting to those whose sources of information are so contradictory to my own take of life realities. I have also restrained myself from offering a different viewpoint to the authors of those opinions, since they have already made up their minds. As humans, our brain processes only what our heart have already chosen to believe, and so there is no point in engaging myself in a civil discussion with people who are not ready to open their hearts.

But I will have to pick up my pen here to stand up for Dr Anthony Fauci, who has been viciously attacked ( Gazette Times mailbag June 21). I have known Dr Fauci for years, his scientific intellect and personal integrity is stellar and exemplary among those who have worked with him in medicine and public health. He is staying on in his official position only because of his deep sense of social responsibility and civic duty in this nation currently so battered by an irresponsible and misleading administration. To accuse him of financial conflict of interest in this pandemic is simply outrageous.

At the end of the day, people will believe and can say what they want, but when we choose to speak ill of others, we only end up disclosing what kind of person we ourselves really are.

(Submitted June 21, published in the Gazette Times, July 2, 2020)

Re-directing our resources in health and criminal justice

For decades, healthcare professionals and advocates have recognized the importance of "social determinants of health" that are beyond the scope of clinical practice and hospital care. Starting with fetal and childhood adverse conditions, and throughout one's life time, diseases and stress-related illnesses are more associated with unsafe environment and poor housing, limited access to good nutrition, education, recreation, jobs, and healthcare services than with genetic factors. Having good hospitals is important, but they often function as fancy and expensive "repair shops" owned by for-profit corporations and are now the greatest cost figures in our health expenditures. 

We are now having a similar re-examination of the role of police and our entire criminal justice system. They have never been effective as deterrent to bad behavior, nor accountable for their social class bias and abuse of force, whether the systemic violence is a knee over someone's neck or a harsher sentencing of marginalized individuals. In practice they ignore the "social determinants of criminality" while deepening injustice and increasing human and societal costs.

I see a historical parallel between the failure of previous half-hearted police and healthcare "reform" measures. There is now a unique opportunity to address in tandem the above social determinants of ill health and crime, their solutions coming down to similar moral and practical interventions. We can, and must shift the huge expenditures we are now spending on our police "forces" and hospital excesses toward investment in our community social services and our preventive public health outreach.

(Submitted to the Gazette Times, Corvallis, June 13, and published on June 25, 2020)