COVID-19
By Dr David Nabarro, Strategic Director of 4SD, Special Envoy to the World Health Organization Director-General on COVID-19 and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London
As countries all around the world enter the most restrictive peacetime measures they may have experienced, people everywhere will experience a range of moods and emotions that will impact on their lives. Such emotional swings and changes are not to be discounted lightly; they will shape how countries, communities and citizens respond to the requirements of the situation we collectively face. It is important that we understand them, see the collective pattern and ascertain where we are individually and collectively in order to determine appropriate responses.
We foresee that after the initial burst of energy associated with the introduction of tough new measures, we may enter a period of despondency and disillusionment as the reality of the situation takes hold before we begin to emerge into a new world. We need to be conscious of how our moods change: this will help us as we navigate through uncharted territory together in an epic struggle that has profound implications for us all. We’ve characterised three changes of mood through song titles that can help us to appreciate what is happening to us and millions of others at this time: No regrets, Stuck in the Middle and I can see clearly now.
NO REGRETS
As each country announces measures unprecedented outside of war zones, the first thing we see is a surge in energy. This is exhibited in numerous places. Journalists trying to get the story, make sense of it for their audiences. Businesses trying to put in place the activities that will ensure their continuity. Families working out how they will now manage things, less income, children home from school, keeping in touch with elderly relatives. Healthcare teams, already overstretched, rapidly trying to figure out how to cope with exponentially increasing demand.
People will be running on adrenaline, trying to figure out multiple complex things. There may also be some anger arising from our frustration at what might have been and what we feel we are losing. It is worth reminding ourselves that this virus, COVID-19, is new, we’ve never dealt with it before. The people who have been trying to shape our responses have been working phenomenally hard on our behalf. They’ve had little or incomplete data. The environment is genuinely complex. There are multiple competing pressures and demands, all true, all justifiable. Satisfying one raises problems for another. There is no single correct answer to this complexity. We are all finding our way through it all together.
All our thoughts are evolving as the disease progresses. Points of view we held weeks or even days ago can now look silly as things rapidly change. We mustn’t be tough on ourselves for this, we’re still the same people, making our judgements as best we can. We read the stories from people in countries further along the progression. We reflect on them and hear how others have had to adapt their understanding like we are. We Learn from them.
This is why our message for now is ‘Be Fast, No Blame, No Regrets’.
Speed trumps perfection. In an exponential growth, and COVID-19 infection cases double in under five days, even a few days delay might dramatically increase suffering. We cannot know the implications of all our actions and plan properly for every eventually. We need to act, now, and mean it.
Anybody can be infected. We can each of us be carrying the disease for days before we know it. During that time, we might ourselves infect several people. The people guiding us are genuinely brilliant. But they can’t know everything because there is much that is just not known. Social media combined with enforced downtime can create an army of armchair experts. As we interpret what we read, we had best be generous, not harsh. We hear the experts as they try to do what is for the best, based on years of experience with handling outbreaks. They will be the first to tell us that they are still learning about the virus and how it behaves, sifting through rapidly unfolding fields of information.
If speed is critical then we mustn’t be shy of looking foolish. Would we rather feel silly because we over-reacted or would we prefer to live with eternal guilt because we didn’t act when doing so might have reduced much suffering? In truth, if we all react rapidly and robustly, being rigorous about suppressing outbreaks before they take hold, the advance of this pandemic will be slowed and dramatic lock-downs will not be necessary. A stitch in time saves many more than nine. We should reason with the tough guys who deny the threat and continue down the road to regret. If they are infected, even with only mild symptoms, they might end up sparking new chains of transmission with massive consequences.
STUCK IN THE MIDDLE
After a while we will settle into the pattern of living within a confined life. As one French meme puts it, ‘our grandparents were called to fight, we are called to the sofa, we can do this’. Yet as days turn to weeks and the enforced isolation, inactivity and intrusion continue, the positive energy of the initial phase will start to disappear. We will come to terms with the reality of an exponentially growing threat as we see health systems creaking under the strain and hear of people, maybe friends or relatives, who have died. Sooner or later we will all be troubled because we cannot see how it might end. We wonder where it is all going and whether life will ever return to normal.
At this point it is easy to feel disillusioned and despondent. Will we find that life has been permanently altered as we stay ready for repeated waves of infection? Or will we adapt, learning how to pick up the early signs and respond before outbreaks take hold and grow explosively? Now is the time to learn from experience, to cherish hope and discover meaning.
The people and authorities in China, South Korea and Singapore learnt a lot during the 2002 outbreak of SARS (also caused by a Coronavirus): they demonstrated the importance of rapid and rigorous action that is implemented robustly. They have shown that COVID-19 outbreaks can be suppressed through the engagement of people backed up by highly organized public health services, good quality patient care and full support from all sectors of government. These countries have been able to ‘bend the curve’ – their experience is the basis for our being stubbornly hopeful. Speed trumps perfection. In an exponential growth, and COVID-19 infection cases double in under five days, even a few days delay might dramatically increase suffering. We cannot know the implications of all our actions and plan properly for every eventually. We need to act, now, and mean it.
The experience of ‘curve-bending’ countries demonstrates the benefit of people taking responsibility for the public good and sticking together, aligning in solidarity. People are prepared to relinquish freedoms and adapt behaviours, if the outcome is something of value for the future of society. This has real meaning and is well worth the sacrifice!
As the great Irish writer, Seamus Heaney once said, ‘if we can winter this one out, we can summer anywhere’.
I CAN SEE CLEARLY NOW
And it will come to an end. How and in what way is difficult to predict with certainty. Experiences with the West Africa Ebola outbreak suggest that there might be a bumpy landing. The timeframe may be uncertain with many ups and downs, but we will get there. As that happens, we will see our society in new light. Just as wars had such impact on the future generations of Europeans, COVID-19 will change how we all will see the future world and determine what matters.
As we reach the end of the pandemic we will be more conscious of the realities in our complex world
This consciousness will lead to dramatic enhancement of adaptive capacity in our world: this is absolutely vital as we seek ways to work together in our globally inter-connected society. This applies to the many other inter-linked challenges that are faced by our world such as climate change, sustainable food systems, and migration. What matters most in framing our responses is what connects us and not what marks us apart or separates us. COVID-19 is a brutal shock. Containing the pandemic is an epic struggle.
If we are wise, we can come out of it better equipped for the bigger challenges that will lie ahead.
Songs for our times, credit:
Emotional Rescue (The Rolling Stones)
No regrets (Edith Piaf) (Robbie Williams)
Stuck in the middle (Stealers wheel)
I can see clearly now (Johnny Nash)
On 21 February 2020, Dr David Nabarro, Strategic Director of 4SD and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London, was appointed as a World Health Organization (WHO) Director-General Special Envoy on COVID-19. In this role, David and five other special envoys are providing strategic advice and high-level political advocacy and engagement in different parts of the world to help WHO coordinate the global response to the epidemic. David joins special envoys Professor Dr Maha El Rabbat, former Minister of Health of Egypt; Dr John Nkengasong, Director of the African Centres for Disease Control and Prevention; Dr Mirta Roses, former Director of the WHO Region of the Americas; Dr Shin Young-soo, former Regional Director of the WHO Region of the Western Pacific and Professor Samba Sow, Director-General of the Center for Vaccine Development in Mali in this collective effort.
Please visit: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 for official guidance from the World Health Organisation on the virus. These Narratives are being written and shared by David for those who want more information and to help raise awareness and readiness of all actors.
Copyright © 2023 4SD Foundation. All Rights Reserved.
4SD Foundation, Maison Internationale de l’Environnement II, Chemin de Balexert 7-9
1219 Geneva, Switzerland.
With generous support from:
Copyright © 2023 4SD Foundation. All Rights Reserved.
4SD Foundation, Maison Internationale de l’Environnement II, Chemin de Balexert 7-9
1219 Geneva, Switzerland.
With generous support from:
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