Pandemic: Providing Context for COVID-19
By Samantha Kirby
On May 22, Garrett Seal, a worship arts major at John Brown University, asked Arkansas Gov. Asa Hutchinson a pointed question: “If we do see a resurgence [of coronavirus cases] in the fall, as some scholars are saying that we will, what direction are you planning on leading Arkansas?”
“We’ve got to plow through it,” Gov. Hutchinson said. “You have to help control the virus in a way that you can also live, educate and have some sort of normalcy in day-to-day activities. And the key to all of that is social distancing, protecting yourself and others, as well as the infrastructure of testing and contact tracing.”
Hutchinson was interacting with students such as Seal in the final session of the Honors College intersession forum Pandemic, an interdisciplinary, inter-institutional “pop-up course” with a wide audience. Nineteen students were admitted to the course for credit, but 173 students and community members from as far away as Florida tuned in to audit the course. Honors students from institutions across the state were able to enroll thanks to Honors Arkansas, a consortium of university-level honors colleges and programs in the state founded by the Honors College. During the course, professors, doctors and administrators from the University of Arkansas, Washington Regional Medical Center, the London School of Hygiene and Tropical Medicine, and the Arkansas state government met virtually with students and auditors every morning for two weeks. Lectures spanned a wide variety of fields; here are some highlights.
You have to help control the virus in a way that you can also live, educate and have some sort of normalcy in day-to-day activities.
Editor’s Note: This discussion was informed by statistics at the time it took place, in early May. As we go to print in early October, the COVID-19 outbreak in Arkansas has surged to more than 88,000 cases and 1,469 deaths.
Hunkering Down at Home
The course, one of the first in the nation to focus exclusively on the COVID-19 pandemic, was expansive in scope, but it began locally, with a discussion of the ways Northwest Arkansas’ own Washington Regional Medical Center has modified its operations in response to the looming threat of COVID-19.
Dr. James Newton, an infectious diseases physician who is director of antimicrobial stewardship and chairman of infection prevention and control committee, and Dr. Mark Thomas, vice president and medical director of population health, provided students with an introduction to epidemiology, discussing the infection rate of SARS-CoV-2, the virus that causes COVID-19; symptoms of the virus; possible treatments; revised hospital protocols; and why Arkansas had, at that time in May, been spared the worst of it.
“The real benefit was time,” explained Dr. Thomas, when discussing Arkansas’ low number of infections and hospitalizations. The virus first arrived in Arkansas relatively late in its initial tour of the U.S. and spread much more slowly due to the state’s low population density and few travelers and tourists. In contrast, he said, “New York didn’t have the time to take the necessary actions.”
The real benefit was time.
“Typhoid Mary”
Alamy.com
“At the Gates,” Harpers Weekly, 5 Sept. 1885.
Courtesy of the National Library of Medicine.
Liberty Loan Parade, 1918
The Library Company of Philadelphia.
Looking to the past is an instinct that we have when we encounter something new … but the past is a mixed bag.
Ghosts of Pandemics Past
“Looking to the past is an instinct that we have when we encounter something new … but the past is a mixed bag,” said Tricia Starks, a historian of medicine and public health in Fulbright College. “There are many good things, but there are many cautionary things.”
The concept of quarantining against disease, for example, is not new: 14th-century cities across Europe ordered 40-day quarantines to stop the spread of the Black Death. Starks emphasized that quarantine has often been a bitter pill to swallow. Take, for example, the depressing contrast between Philadelphia and St. Louis’ response to the 1918 influenza pandemic: Philadelphia’s leadership downplayed the threat of the disease, allowing a 200,000-person parade for war bonds to go on. “Within 72 hours every hospital bed in the city was filled,” said Starks; the city’s healthcare system was completely overwhelmed. St. Louis, on the other hand, went into lockdown two days after their first case was confirmed, resulting in a flu epidemic that was easier to control and easier to treat.
With or without government intervention, our ability to protect ourselves often depends largely on socioeconomic status. “Health events hit the most vulnerable in the hardest ways,” said Starks. “Looking at past failures, we see social consequences for families and communities; economic consequences in the way the disadvantaged are hit. Dangers to minority populations, demonization,” and a desire to pin the blame on any group that was “other.”
Just look at the discrimination faced by Mary Mallon, known to history as Typhoid Mary, an Irish-American cook who was forced into isolation on North Brother Island in the East River of New York City for decades, despite other such suspected “super spreaders” being identified and allowed to go free. Or the blame that European Christians were quick to place on Jewish people for the Black Death. Or literally any cholera outbreak, which highlighted rampant discrimination against and fear of impoverished populations.
According to Starks, humanity the world over has a legacy of equating health with beauty, goodness and cleanliness, and sickness with ugliness, dirtiness and sin. Within this rhetoric lies a tendency to treat those who fall ill as though they are at fault for contracting a disease. During 19th-century cholera outbreaks, for example, the poor, who are often forced into overcrowded, unsanitary living conditions, were frequently vilified and cast as the source of the problem, rather than victims of poor social infrastructure or discriminatory healthcare systems.
In the present day, this sort of discrimination is still embedded in our own infrastructure and healthcare systems, and as a result, the coronavirus is disproportionately impacting the poor and people of color (as measured by instances per 10,000 people in that population): by early October, for instance, Arkansas Department of Health data showed that Blacks and Latinos are hospitalized at twice the rate of whites. Compared to whites, Pacific Islanders suffered more than nine times the amount of deaths based on population size. In addition, quarantine becomes difficult when someone lives in an overcrowded home or has no housing at all. “How do you quarantine somebody if they are a line worker in a protein production plant and they live in a two-bedroom apartment with eight other people?” Dr. Thomas asked.
History shows that international commerce and warfare have long been a Petri dish for contagion. New evidence from DNA in the dental pulp of fossilized teeth suggests that the Black Death originated in Tibet or eastern China and spread into Europe in the 14th century. The flu pandemic of 1918, which likely originated in Haskell County, Kansas, was facilitated by the global transport of military personnel, medical teams and supplies during World War I.
Looking at today’s globalized world of international trade and adventurous travelers, it’s unsurprising that the coronavirus pandemic would follow the same pattern as these earlier diseases. And just like the flu and the plague, we have our close interaction with animals to thank for COVID-19.
Animal Origins
COVID-19 and other recent epidemics such as AIDS, swine flu, SARS, MERS and Ebola are what biologists call “emerging infectious diseases,” about 70% of which are zoonotic in origin — that is, they “spill over” into humans from animals such as bats and rodents. As agricultural practices around the world change, enterprising humans are clearing out more and more wilderness areas for development. The more humans encroach on wilderness habitats, the more likely we and our domesticated animals are to interact with wildlife, as well as with their leavings, such as droppings and saliva.
“If we have more opportunities to be exposed to animals and their pathogens, it’s very natural that they’re going to spill over more often from animals to people,” said Fulbright College biologist Kristian Forbes, who has spent years conducting groundbreaking field work in East Africa, identifying different strains of Ebola virus endemic in bats.
It might be tempting to demonize the nocturnal flyers, but in fact, bats perform important ecosystem services, such as pollination, seed distribution and controlling insect populations. “I don’t want to see bats exterminated,” Forbes said, “… that’s not a realistic solution.” Instead, he said, to protect ourselves, “We’ve got to protect the environment. Human health is dependent on animal health and environmental health.”
Forbes’ lecture got the students thinking about what we can and can’t know with certainty, when it comes to virus spillover and spread. U of A honors information systems major Sophia Gesualdi, for example, wondered about the zoonotic source of SARS-CoV-2: “I just kind of want to know … is there a possible way to get to one solid conclusion about [the origins of the coronavirus]?” she asked.
“It’s really hard to get definitive answers here,” Forbes replied. Currently, the novel coronavirus is hypothesized to have been transferred from bats to an intermediate host. By comparing the genetic sequences of SARS-CoV-2 in humans to that of the same virus in different animals we find very similar sequences in pangolins, which are sold in wet markets for use in traditional medicinal practices. “But that’s not to say that some other animal we haven’t thought of might get screened, and we might find an even more similar virus to ours in that animal. Really, it’s very difficult to say with certainty,” Forbes cautioned.
Playing the Blame Game
Unfortunately, the geographical origins of the virus have contributed to a baseless backlash against people of Asian descent. Such profiling is fueled in part by the fact that the virus was first discovered in China, and by conspiracy theories and misinformation. Politicians and other high-profile individuals referring to COVID-19 as “the Asian virus” or “the Chinese virus” on social media also contribute to rising prejudices against Asian populations. This sort of labeling in the U.S. “presents Chinese people as an essentialized ethnic group that caused the virus. It’s scapegoating for political reasons,” said history professor Kelly Hammond. Hammond noted that a similar sort of discrimination had been prevalent against African merchants in southern China when the country was being hard hit by the virus.
In her lecture, Hammond humanized the virus for the students, speaking to the fact that individual Chinese citizens are dealing with the crisis in much the same ways we are: “They’re sewing, they’re making silly TikTok videos,” she said. Hammond emphasized that across the world, nations are encountering the same infrastructure problems caused by the virus, like, for example, “a lack of internet for rural students. We’re reacting to this crisis in national ways, but we need to cooperate with others to move forward.”
We’re reacting to this crisis in national ways, but we need to cooperate with others to move forward.
Illustration of the five stages through which pathogens of animals evolve to cause diseases confined to humans. The four agents depicted have reached different stages in the process, ranging from rabies (still acquired only from animals) to HIV-1 (now acquired only from humans).
Reprinted by permission from SpringerNature: Nature, Origins of major human infectious diseases, Nathan D. Wolfe et al., copyright 2007.
Information Overload
Isolation prompted many people to turn to social media for a sense of connection, only to encounter other, virtual pathogens: an excess of news, much of it unvetted. Brian Primack, dean of the College of Education and Health Professions and a licensed physician, reminded students that it’s important to limit your screen time and avoid overloading yourself with information.
“We need to realize that these days, what you see in the media can be as real as the real thing,” Primack concluded. Since the beginning of state lockdown measures, there has been a massive increase in reported feelings of social isolation and loneliness, which, according to a study cited by Primack, can increase your risk of death by as much as 29%. Excessive consumption of media of any kind can lead to PTSD, anxiety, chronic feelings of loneliness and other mental health issues. The ability to limit your time on media outlets, and to think critically about what you’re seeing on Twitter and other media feeds, is an essential skill in the 21st century, and one that Primack hoped to hone in the students. And the students were listening.
“I definitely think what we learned over the last two weeks have helped us weed out false information. It’s amazing how quickly fake news spreads,” said Niala Gotel, an honors English major from NorthWest Arkansas Community College.
Supply Chain Chokepoints
We all remember the signs limiting us to “two (2) per customer,” gracing empty grocery store shelves where the Charmin and Quilted Northern used to be. But while most of us were coping with minor inconveniences, there were far more serious shortages facing hospitals, doctors and other healthcare workers.
“COVID-19 has not spread uniformly across the country, but hospitals everywhere are being asked to prepare uniformly across the country” by ordering personal protective equipment (PPE) and preparing for the worst, said supply chain professor David Dobrzykowski. Supply chains are scrambling to accommodate this desperate need.
To respond, Dobrzykowski, along with Walton College colleague John Kent, spent Spring Break launching a temporary international supply chain for medical PPE equipment. Together with the Arkansas Asian Business Association, the George H. Bush Foundation for U.S.-China Relations, Lomason Consulting LLC and Guangxi Vista International Trade Co. Ltd., they bolstered depleted stocks in the United States.
By the time the Pandemic course was underway, the Coronavirus Action Network had grown from four people sharing ideas in a WeChat conversation to a global network of more than 100 partners, and had worked to secure the delivery of hundreds of thousands of N95 masks from China to Los Angeles: the first, they hope, of many.
Looking Forward
Kent is not alone in his uncertainty: At this point in time, no one can predict what the future holds. Gov. Hutchinson was blunt when contextualizing the state’s continued response to this ongoing emergency: “We’re right in the middle of a pandemic still — we’re making judgments every day.”
Now and throughout the course of COVID-19, we face difficult questions about what we value as a society, and what we are willing to trade for a return to normalcy.
John Cairns, a health economist at the London School of Hygiene and Tropical Medicine, asked the students to consider the question of tradeoffs, between saving lives in the short term and the long-term wellbeing of a nation’s citizens. “How many person-weeks of lockdown do we need to avoid one COVID-19 death? Is the degree of restriction on economic activity and the future problems it might generate — is that a price worth paying, a cost worth incurring?”
Whatever the cost we choose to incur, the fact remains that we are facing a global problem that is here to stay, at least for the foreseeable future. Washington Regional’s Dr. Thomas was realistic in his predictions for the future: “We’ll be dancing with this virus for many months to come,” he said.
Only time will tell if the response to the coronavirus pandemic will go down in history as a success or a failure, but the Pandemic course gave students and auditors the tools to place their current situation in context from a wide variety of perspectives. And for some students, the course’s impact could extend far beyond COVID-19. “This course kind of changed my perspective on what I want to do in the future,” said Mia Alshami, a U of A Sturgis Fellow majoring in biochemistry and psychology. “[Dr. Primack’s] lecture on public health opened my eyes to maybe getting a master’s in public health. I never realized how holistic the view of public health is.”
It’s amazing how quickly fake news spreads.
This course kind of changed my perspective on what I want to do in the future.