Apr 25 , 2020
By Dawit Wondimagegn ( Dawit Wondimagegn (MD) (dawitwondimagegn@gmail.com), associate professor of psychiatry at Addis Abeba University’s School of Medicine and chief executive director of Tikur Anbessa Hospital. )

In the plagues of yesteryear, epidemics were equated and explained by social and spiritual phenomena. As the treatment for pandemics entered the "medical model," the persecution and elimination of the abstract culprits became a form of treatment. The Novel Coronavirus (COVID-19), though viral in origin, is a disease that reveals the same old social and spiritual ills in society.

Take the great pox, for example. It was called "the French disease" by the Italians, "the English disease" and "the Spanish disease" by the French, and the "Neopolitan disease" by the Spaniards. We now call it Syphilis, but it serves to show how civilizations blame socio-spiritual causes for pandemics.

It ravaged the French army and Spanish mercenaries during the siege of Naples in the mid-1490s. The discovery that it is transmitted through sexual contact led some authors of the time to advise people to refrain from “succumbing to the attraction of love.” The name for Syphilis comes from a poem in which a shepherd by that name is punished by a god for worshiping a king instead of the deity.

Over the years, advances in medicine helped to treat the illness. As the disease sometimes was self-limiting, any treatment might have helped some cases. However, the disease has neither been eradicated nor controlled. This is because treating disease medically is one thing, but eliminating it is part of the more difficult task of interfering with behaviour.

A number of people are suggesting that human evil is the cause of the COVID-19 pandemic. Some are going so far as to argue that this pandemic is punishment specifically for sins committed by health professionals in the course of their duties. They also say that this is especially the case here in Ethiopia.

What COVID-19 is revealing to us is what happens when a society with high levels of suggestibility encounters an abstract challenge like a virus. If the threat was an imminent war, then patriotism and aggression would have claimed centre stage.

It is not that spirituality has no place in the fight against COVID-19. It absolutely does in as far as it helps us find meaning, calm and purpose in what we do - some of the prayers from some denominations have been especially comforting. However, blaming sin for something we can deal with by the act of washing our hands is dangerous or, at best, absurd.

As we are forced to consider our mortality in the face of this pandemic, questions regarding the meaning of life come to the fore. In this circumstance, there is no place to hide but our spirituality as an end in and of itself.

This epidemic is also bringing our attention to love.

Do we love the people we love, humanity or ourselves?

With Syphilis, people were warned not to fall for the attractions of love. Now we are being asked to fall for love, specifically the platonic kind, at a distance of two metres. COVID-19 is revealing to us that sometimes we show how much we love others by staying away from them.

As an illness that is getting us to rethink our attitudes and spirituality, it should be stressed that it actually does not compare to others we have encountered before.

Throughout history, Leprosy has probably inflicted more discrimination and social prejudice than any other disease. As we now know, and the people who were victims of that epidemic probably realised as well, Leprosy is far less contagious than other diseases. But the public health and legislative measures taken were less to control it and more to do with saving the rich and the powerful from the sight of those disfigured by the illness.

Biblical and medieval Leprosy was probably a name for many types of diseases that may or may not have included the disease we now refer to with that name. However, in most places in the world, old control measures persist.

There is a lesson to be taken here: control measures we take have the habit of enduring for years. Some of the control measures we are employing now will have an impact on the trajectory of this current epidemic. Some will go on to have social, economic, political, cultural and spiritual implications that will last longer than the epidemic. It is for this reason that we need to be careful and calm when we legislate interventions.

Take, for example, the decree in some places that citizens have a responsibility to inform the authorities if they suspect their neighbor of having COVID-19 symptoms.

We must realise that this gives citizens the power to diagnose and intervene - the responsibilities of health professionals. We are also encouraging citizens to break an age-long social fabric of standing together, a trait we need to depend on at this time.

A measure that will serve the same purpose without the same damage is to say “anyone who observes that someone is displaying symptoms of COVID-19 should advise, educate or encourage them to seek help.”

What we are considering here is what our responsibility is to others. The pandemic is revealing both the good and bad in our society. At times we are seen taking our responsibility for others quite seriously and observing all the commands, while at other times we are seen coiling into a posture of selfishness. COVID-19 is revealing how human we all are, after all.

Cholera and Typhus are examples of diseases where ineffective and discriminatory intervention strategies led to more disease instead of less. The early 19th century was a period when the practice of medicine was very laissez-faire. This was mostly because health was assumed to be the affair of bureaucrats, whose only interest was balancing the budget, and physicians, who focused only on treating, not preventing, the diseases.

This was all done on the back of public health interests, which were predicated on impulses to protect the well and help the sick. This led to interventions where people with symptoms of Cholera were kept together, contaminating each other and dying for reasons other than the disease. This continued even after the connection between Cholera and water contamination was established, since many doctors remained convinced that the disease came from immigrants, the poor and the dirty. The same fate was to affect Typhus victims that were put in overcrowded rooms.

In modern history, the need for public health interventions has never been this dire. Over the years, there is no doubt that significant milestones have been reached in the control and prevention of disease and in promoting health. What makes the current pandemic unique is the urgency of the need for smart local interventions that are sensitive to the context.

What do we do when what we know does not seem to work?

We either give it up or start to think. COVID-19 is making it evident that we need more than what is written in books and articles. We must consider and face what people think and feel. If there is anything to be said about COVID-19, it is that it reveals much about who we are.

Dawit Wondimagegn (MD) is associate professor of psychiatry at Addis Abeba University’s School of Medicine and chief executive director of Tikur Anbessa Hospital. His views are personal and do not represent the opinion of any institution. He can be reached at dawitwondimagegn@gmail.com.


PUBLISHED ON Apr 25,2020 [ VOL 21 , NO 1043]

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