Why explaining away, the sheer shame of it—will not help?

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By Misaki Wayengera

Mr David Wallace-Well ‘ in his recent NY times opinion article titled: ‘Who ‘won’ COVID? It depends how you measure’, though seemingly acknowledging the time constant problem of the inability to make accurate measurements for any two ‘conjugate variables within the COVID realm as is for the quantum field’, embarks on disturbingly very unscientific methods of shifting the scales; to justify his hypothesis if not to perpetuate the long stayed yet contextually threatened notion that the Western health systems despite the many casualties accrued due to COVID19, are no doubt superior to those of their under-developed south.

The excess crude and age adjusted mortality experienced by the Western world (North America and Europe) during the COVID-19 pandemic represent never before seen statistics except during the plague or world wars (I and II). That this happened against the background of what are supposed to be the most advanced health systems in the world, alone begs for answers.

Unfortunately, some like Mr Wallace-Well have been caught up in the irrational, sometimes obsessive desire to show how—despite the reported low incidence of cases and fatalities seen on the African continent, possibly Europe did better. This is a neo-colonialistic stagnation on the popular superiority ideology that has been propagated and perpetuated for decades; without desiring to rationally answer the question of what happened or went wrong. We find that continuing to do so tantamount to nothing, but the behaviour of an ostrich that opts to bury its head in the sand when faced with evidence of clear on-coming danger, rather than confronting the realities thereof.

It may alternatively be equated to an obsession with neo-colonialistic delusions of grandeur, that some of our colleagues unfortunately continue to suffer from in the 21st century. Neither may be deemed progressive especially at the time when nations are negotiating a new pandemic treaty, with the notion of making the world a better place. This is because the factors that saved Africa had nothing to do with superior health systems; instead,

• a dominantly younger population with less comorbidities,
• under globalisation and urbanization, and
• possibly pre-existing, cross reactive and protective immunity; explain the differences observed. Not to mention, most African societies do not pile their elderly into congregate care facilities; but rather, let them retire to their rural homes where social support is provided to them, individually.

This alone removes the risk of widespread transmission and deaths in congregate homes of the elderly, seen in places like Italy, Spain, UK and though Well (by continuously peeling away on facts and re-inventing data via new analyses) denies this was the case, the surgeon general’s of many American states like NY, will not agree.

Specifically, I find that it is irrational, if not obsessive, to continue trying to justify lived experiences; rather than asking the important questions regarding ‘what went wrong and what should be planned better’. The real failure in the current efforts to compare outcomes stems from its disregard of what should be the role of advances in health care systems and technology in the developed West, towards saving the lives of the elderly there in face of infectious disease outbreaks, when compared to the ramshackle systems of the developing world? To compare a stone aged health system to a 21st century advanced care system is unfortunate if not unwise; stupid utmost, sorry to say.

Scientifically speaking, the West’s health systems were never built for epidemic response; and this has been reinforced by the ever-reducing incidence of outbreaks of infectious diseases of high consequence here.

Much as populations of pre-industrial revolution Europe suffered epidemics of plague and smallpox, and sanatoriums existed all over Europe to isolate and quarantine people diagnosed with TB, this has long been gone. Instead, because of better hygiene or sanitary environments and practices here; the majority of the health burden has been on emergencies related to either accidents or noncommunicable diseases (NCDs).

Therefore, the health systems in the West have been built to respond to these sorts of individualized, non-epidemic emergencies; which are more or less unscalable to the public health levels seen with infectious disease outbreaks. While the same emergency medical response and acute care systems should have been useful in the context of COVID19; therefore; the same could not withstand the sheer numbers that assailed the rapid transmission rates. Let’s not forget to say that the acute respiratory distress syndrome (ARDS) of COVID19; was not purely respiratory (perfusion) but possibly circulatory (blood clots) such that no amounts of ventilation could help.

We believe that, by facing the issue upfront rather than attempting to wish away the incidental facts; will help the modern western health systems better orientate and prepare for outbreaks of infectious disease emergencies; which for long had been designated, relegated and neglected as problems of the developing world. A joint external evaluation (JEE) of the capacities for epidemic response done right before COVID19; we argue, would have found many of the West’s advanced health systems ill prepared to respond to an outbreak of an infectious agent. This explains why, when worse doomsday predictions were made about the public health implications of say for Uganda’s outbreak of sudan ebolavirus, because of the in-built resilience of the health system here due to continued outbreaks of infectious agents, the outcome was totally different.

In conclusion, the Western scholars and experts should humble themselves to the unchanging facts around the ‘use and disuse’ theory advanced by the French zoologist Jean-Baptiste Lamarck; and challenge their advanced health care systems continuously; say through planned exercises or drills, to retain some muscle fibers for response to an infectious disease outbreak. This will make their future responses better.

The writers: Misaki Wayengera  is the Chair of the Uganda MoH Minsterial Scientific Advisory Committee on Epidemics & Dangerous Pathogens)

Henry K. BOSSA (Incident Commander—Uganda MoH Incident Management Team)