April 17, 2020
By: Nago Humbert (Translation from the French by: Elysée Nouvet)
In the midst of this pandemic, as is the norm in humanitarian catastrophes, those suffering from chronic illnesses (diabetes, pulmonary disease, hypertension, kidney failure, mental health, kidney) or cancer often pay the heaviest price. Those responsible at political or public health levels constantly refocus our attention on the immediate and newest catastrophe, and in the process so many other and previously at-risk populations become “the forgotten”.
It is crucial to remember that despite the public health emergency provoked by Covid-19, and the considerable financial and social means activated (with reason) to combat its impact on global health, many have entered this emergency already managing complex health issues. Their precarious health status, their risk of death, their suffering in some cases, predates Covid-19. We have not heard from this population enough in the media. We have not, arguably, been thinking globally even in the midst of a global health emergency.
What is the impact of quasi-confinement, if not imposed isolation and quarantine, on those already seriously ill, frail, or medically vulnerable, before this emergency? What is the impact on this population, of messages from the authorities and experts related to the responsibility to stay home, the possibility or reality of triaging who will get access to hospitals? What is happening to ensure ongoing supply of life-saving medications, such as insulin, or supplies to those who are dependent on these in their homes, especially in low- and middle-income countries where patients and families may have relied on public transit or income from now interrupted wages, to secure these? What support is being provided to families and communities in the midst of lock-downs or risks of links in chains (neighbors, family) of support being unable all of sudden to provide the day to day or weekly care they have?
Medically, we can expect pandemic limits on healthcare services to reverberate in the short and long term. Such impacts were well documented during the Ebola outbreak in West Africa, and this time it is health jurisdictions everywhere that will feel those reverberations. The impact of interrupting standard but efficient diagnostic, preventative, or therapeutic procedures such as mammograms and colonoscopies, may reverberate for years to come at a yet to be measured cost, such as reduced early detection and treatment of common cancers. For some, there are more immediate impacts and risks of increased pain, as sometimes life-transforming surgical procedures, such as hip and knee replacements, are on hold. For those already at risk of dying from chronic disease before the pandemic, added may be the anxiety of dying alone, since families are not allowed to visit their loved ones at their home, in nursing homes, or in intensive care units.
How information is presented and disseminated during this major public health and social crisis is also troubling to me. Media is focused almost entirely on the pandemic. Radio and television, in Switzerland as in France, seems to have only one story. What, other than provoking and maintaining a generalized anxiety, is being accomplished by running images such as those coming out of Bergamo at the end of March, or ICUs in Swiss hospitals non-stop? I pose the question without having the answer. I wonder: “Should we not limit images and reports from hospitals to that which is strictly necessary to public health purposes? For example, key information about how to prevent further spread of Covid-19, and thus limit further cases? While internationally, where Covid-19 remains to hit as hard as here in Switzerland, mass depiction of healthcare provider distress and overwhelmed hospitals may serve as an important warning, what do these stories and images accomplish, at the local level, during the pandemic? I am not one for censorship, and yet I do wonder what exactly such stories of raw grief, of body bags, and abandoned patients produce? There is one thing these images from pandemic epicentres produce. With the hypervisibility of pandemic horrors, what we have seen is the eclipsing of medical conditions and biomedically dependent lives. These were rarely if ever media-worthy, but this cannot justify their total erasure.
I cannot finish these few reflections on the collateral effects of this pandemic, without thinking of the vulnerable populations, particularly those in Africa, who will pay a double price in this disaster. This is, on the one hand, because of the lack of health structures, means, and health personnel. It is also, however, due to so many comorbidities including poverty (even if poverty is not in itself a disease) endemic to so many on the African continent. The risk of social abandonment of those most vulnerable is both global and local.
Prof Nago Humbert is Adjunct Professor in the Department of Pediatrics of the Faculty of Medicine of the University of Montreal, and Founding President of Médecins du Monde Switzerland. He is a consultant in pediatric palliative care and he is also President of the French-speaking Network in pediatric palliative care.
Humanitarian Health Ethics 