Infectious diseases affect communities even when they’re not present. Anticipation of disease and its aftermath can have real consequences for people’s relationships, mental health, productivity and more, writes Courtney Addison
Since public reports of Covid-19 first emerged in January, this new virus has spread to over 100 countries and claimed over 6000 lives. The World Health Organisation has declared the outbreak a pandemic. Researchers around the world are working on vaccines against the virus and medical treatments for the respiratory symptoms it causes. However, clinical research takes time, even when the need is urgent.
In countries like New Zealand, we are used to having scientific solutions when medical issues arise. But there is no immediate scientific ‘fix’ for Covid-19. To date, the most effective way of containing the virus’ spread has been through ‘social distancing’ – lockdowns on human activity combined with close monitoring, and tracing the contacts of those affected.
What this highlights is that, like all infectious diseases, coronavirus is a social issue as well as a medical one. The death toll of Covid-19 will come down to social action; the psychological toll will come down to social action; the economic cost of the outbreak will (you guessed it) come down to social action.
This is true for New Zealand right now. We know from previous research that infectious diseases affect communities even when they are not present: the anticipation of disease and its aftermath can both have very real consequences for people’s relationships, mental health, productivity and more.
For the vast majority of us, the major impacts will be to our working lives, social lives and day-to-day experience. How we organise these aspects of our lives will determine how well New Zealand fares over the coming months and years. Fortunately, we have some precedents for how Covid-19 might impact us, thanks to research into other infectious diseases, including SARS, Ebola and here in New Zealand with measles.
- Infectious diseases are fundamentally social
Infectious diseases like Covid-19 rely on interaction. If an infectious disease takes hold in a population, every interaction people have creates a potential bridge for the virus to cross. This means controlling the spread of disease requires changing how we interact. Think about every human interaction you’ve had today. What would the consequences have been if you were carrying Covid-19?
When Ebola hit West Africa, one of the biggest challenges to stopping its spread was changing social practices. Health authorities tried to stop people washing the bodies of their dead – but caring for your dead is a deeply important way of demonstrating love and of coping with loss. Anthropologists were able to suggest safer burial practices, reaching a compromise between completely eliminating important social customs and keeping healthy people safe from this highly infectious disease.
Now, New Zealand is not West Africa and Covid-19 is not Ebola. But we all do things that feel important and unchangeable or so mundane they mustn’t be worth changing. For infectious diseases, though, this is precisely where we have the best opportunity to protect each other. Adapting our social lives is key – and by social I mean all aspects of your life that involve interacting with other people. This is why some large businesses are testing out work-from-home systems and why people are being advised to have two weeks of food in their house at all times. Think about how you would get on if you had to cut off all contact with other people tomorrow: do you have the supplies you need on hand? Do you have ways of communicating with people you love who you can’t see in person?
- If you’re resilient to coronavirus, you have a responsibility for those who aren’t
But many of us feel confident Covid-19 won’t seriously affect us individually – we have strong immune systems and are fit and healthy. If you are a healthy person, it is up to you to make your society as safe as possible for the people who aren’t as well or resilient as you. We don’t know conclusively what makes someone ‘vulnerable’ to this particular virus, but there are signs that blood pressure, age and pre-existing respiratory difficulties increase the likelihood of complications or death. These people are often already living cautiously. Their health is in the hands of every other person they interact with and everyone that person has interacted with too.
- Small changes can have a big impact
Current advice from our health officials is to wash hands well and often, to practise good ‘cough hygiene’ by coughing and sneezing into arms and elbows rather than hands, and to stay home if sick. The thing about a pandemic is it feels big, and these actions feel small. However, small actions done by a lot of people can add up to a big barrier to viral spread.
The most obvious example of this is vaccination. When a certain proportion of the population vaccinates against a disease, the population gets what’s called ‘herd immunity’ – so many people are protected that the disease can’t get a foothold in the population at all. Four million individual decisions to get an injection add up to national protection against a disease. Now, in New Zealand not everyone follows this logic, and the consequences can be tragic. We saw this when measles killed 83 Samoan babies and children last year, after an unvaccinated person flew there from New Zealand. We have an opportunity to do better with Covid-19. But it requires everyone doing their bit and chipping in for the greater good. It’s worth noting that ‘chipping in’ will quite likely mean doing less, rather than more – less activity, less work, less socialising. This will probably feel wrong, even though it’s actually right.
Another way you can contribute to preparedness is by refusing to spread misinformation. Because there is a lot of uncertainty about Covid-19, inaccurate information circulates easily. Theories and hypotheses can be confused for facts and ineffective ‘solutions’ can be passed off as remedies. Before sharing information, check it comes from an authoritative source such as a government ministry, international health organisation or academic journal. Remember that even reliable scientific knowledge is built incrementally, so a single article doesn’t necessarily provide reliable enough information to act on. The reason our government agencies and international organisations like the World Health Organisation are good sources of information is they collect, assess and interpret this information en masse before communicating it. The same goes for our public science communicators like Siouxsie Wiles. Similarly, if you see dodgy ideas being shared by people you know, point out their limitations using neutral language and, if you can, suggest alternative, reputable data.
- But bigger changes are needed too
In addition to these individual and family-scale precautions, there are also larger-scale social challenges specific to New Zealand that need to be addressed to give us the best chance of combating coronavirus. Two major examples are our employment laws and socio-economic inequality.
Our national sick leave entitlement is five days, which is not enough to self-isolate, let alone to actually cope with having coronavirus. Keeping the population healthy means keeping sick people out of public space. If the only way people can pay their rent or buy their groceries is to show up at work after their five days of paid sick leave runs out, that’s what they will do. If you are an employer, you have a duty of care to your employees and to society more widely. Not taking this disease seriously when you have decision-making power over where employees spend their time puts them, their families and much wider social fields at risk.
Socio-economic inequality will also profoundly shape who this impacts and how. Not every family in this country can afford to buy two weeks of food, household supplies and medicine in one go. Not every family in this country has a warm, dry house to keep their lungs and airways healthy. If previously the majority of the population has been able to see this as other people’s problems, it should now be very clear this is a problem for all of us. In the long run, there need to be serious changes to our housing regulations and more support for people experiencing socio-economic hardship.
- So… what now?
To date, there have been eight cases of Covid-19 in New Zealand. Our government and scientific experts are providing excellent leadership, maintaining open levels of communication and on Tuesday demonstrating their readiness to commit substantial resources to people’s wellbeing. Our doctors, nurses and healthcare professionals are preparing to mobilise when needed and now have the funding to scale these preparations up significantly. Globally, things are changing quickly.
New Zealand, we have an opportunity to keep the dangers of Covid-19 to a minimum and we’re fortunate to be in a strong position at a time when other places haven’t been so lucky. Importantly, we have been able to see and learn from other countries’ experiences and we know what to do to slow the spread of Covid-19 if more cases arise here. Reader, it’s up to you and yours.