Covid19 disaster: View from Philadelphia, USA

authored by Prof. Arthur L. Frank, Philadelphia, USA

In the Philadelphia area of the USA we have one of the hot spots for the Covid-19 in our country. We see here too the unfairness of the response to the virus. 

Our minority populations get sick and die at a higher rate, given issues such as poverty, which means more underlying disease, and that poorer people have essential jobs ie transport, food stores etc, and must work. 

There is unfairness all over the world, but even so in our rich country, and we see how precarious life is here too with thousands lining up for food distribution. 

May all this pass quickly, but I fear a longer than shorter time will be involved. 

The current Covid-19 pandemic, as implied by the use of the word pandemic , has affected the whole world, Some countries have been more straightforward in recognizing the seriousness of this issue and more rather than less accurately reporting on the disease around the world.  

Some countries have done especially well in protecting their populations such as South Korea and Germany. Any country that has advocated for widespread shutdowns and quarantine has done well. Others have come to that realization later than others and have not fared as well. We hear nothing from North Korea, Russia covered up its crisis for a long time, and Brazil’s leadership asks nothing of its scared population.  When quarantines have been used before, going back to the Venetians keeping folks on ships for 40 days in the era of the plague, or those cities in the US in 1918 that did well we saw less disease. 

The city I work in, Philadelphia, in 1918 held, against advice, a great parade and immediately after many thousands died. We risk the same with this virus if folks are allowed out to circulate too soon. Those that have not recognized and ACTED on the obvious hazard, such as Brazil, the USA with its current bizarre leadership, and places like Ecuador, have seen far more death than needed. 

Ever since the work of Johann Peter Frank in the 1700s who advocated for the “police powers” of public health, regulating what happens in society during health crises has been shown to be useful. It is imperative that those with the training and experience to answer difficult scientific questions and give best available advice about how to proceed should be heeded. This would include epidemiologists, virologists, infectious disease experts, vaccine scientists and the like. 

The problem we have with is now is the newness of this virus and absolutely no experience as to how it might act over time. We have new tools that allow us to sequence the virus components, and many, maybe too many, tools to respond. With poor regulation and oversight too many useless and inappropriate test are coming on line without adequate evaluation and testing. We can make things far worse going forward if we rush a vaccine that at the end of the day was not properly vetted and ends up causing more disease that would have otherwise occurred.  Access to reliable information has been in short supply. It is a shame that it is not the Federal government through the CDC that is collecting data, that being left to the folks at Johns Hopkins University. Their data can be trusted, but is only as good as what comes in. 

In the US, there is no single definition among States of what is a Covid-19 death has been promulgated and there is a great likelihood of underreporting. It is also unfortunate that government experts must navigate political minefields when they speak or risk firing or demotion. The CDC and the Surgeon General have lost credibility in the US, and variably around the world various leaders can be, or should not be believed. 

Even the WHO has been called into question as to its behavior, although they do seem to be trying as well as they can. Many scientific organizations have been putting out information, and those trying to learn or report should turn to reading the literature coming from groups such as the American Thoracic Society and the New England Journal of Medicine, among others. 

Several university folks in the US who have for years been at the leading edge of pandemic work and infectious disease are also reliable sources. We still have much to learn about the behavior of this virus, and these folks will accurately say what is known, what is unknown, and what is being done to gain the needed knowledge. 

As complex as this situation is, the way forward is straightforward in some ways. There needs to be widespread testing with ACCURATE tests, contact tracing, and while this goes on and folks need to stay in quarantine, no matter the economic pressures, work on curative medicines and a TESTED and valid vaccine needs to move forward. Accurate measurements need to be made after infection as to immunity, and we need to understand if having the disease once is protective, and if so, for how long. 

Lastly, there needs to be coordination to provide all those that MUST work now, health care personnel, transport workers, first responders, food related workers and others, to have the necessary protective equipment to keep them and their families safe as they work to assist the rest of us. 

The model used in the US, a free-for-all, should not be how the world approaches the acquisition of such equipment. After the acuteness of the pandemic is all over then everywhere in the world should be trying to make the health care systems around the world more robust and more equitable. 

--
A.L. Frank MD, PhD, Professor of Public Health and Professor of Medicine

The author is at Drnsife School of Public Health, Philadelphia, USA. 

Frank's areas of research include agricultural safety and health, pneumoconiosis, occupational toxicology, occupational cancers, occupational lung disease and environmental pollution.

Frank received a medical degree from the Mount Sinai School of Medicine and a doctoral degree in biomedical sciences from the City University of New York. He was trained in both internal medicine and occupational medicine and holds board certification in both fields. As a commissioned officer in the Public Health Service, he conducted research at the National Cancer Institute.

  

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