Sustainability of reactions to Covid-19

It is a bit more than a year since Covid-19 pandemic has been declared by WHO, several million are dead or suffering from serious consequences, while numerous variants continue hitting different parts of the world. In the 21^st century this is the first global pandemic, and it is revealing the weaknesses of globalisation and lack of our ability to respond effectively. The test was hard and our performance generally was less than satisfactory. What were the main mistakes committed?

Firstly, many governments reacted in panic, no clear strategy has been developed as to what is to be done, and protective regimes have changed almost on weekly basis: between complete lockdowns, to liberal regimes allowing people to develop their own biological protection. Neither has proven fully satisfactory and - besides social distancing and waring the masks – the pharma industry has rushed to offer several vaccines, and millions are receiving them, while some experts claim they are actually still giny pigs (since none of the vaccines had the time to be properly tested and evaluated. Manifested side effects are pragmatically justified as being smaller risk than refusing to be vaccinated – which is mathematically correct.

The differences and quick changes in government policies demonstrate several things: politics acts primarily to receive public approval for addressing the problem, and follows the advice of medical science to the extent serving its primary interest. Part of the scientific community, on the other hand, is either not participating in the public debate, or refrains from insisting on scientifically proven positions. Sometimes this is simply to remain in advisory positions, which is humanly understandable, but harmful, since it gives politicians the needed cover of legitimacy.

And last but not least, a part of the public has unfortunately also reacted rather irresponsibly: protesting and demonstrating against legitimate government measures, like social distancing and even wearing masks (both indisputably effective). This is also demonstrating that sustainable democracy requires responsible and law-respecting citizens.

Covid-19 impact and reactions

In late 2019, after the new coronavirus disease (Covid-19) started quickly to spread around the world, the virus caused serious respiratory difficulties, posing major and immediate health threats and killing especially elders above 60 years of age. The transmission can be slowed by strict hygiene practices and limiting social contact and such mitigative actions require individual citizens to suddenly change their lifestyles in drastic ways. In many cases, public responses to Covid-19 have been remarkably well-coordinated, rapid and forceful, particularly at the early stages of the crises. For instance, during early Covid-19 outbreaks, some countries enforced strict lockdowns (for example, China, Italy, New Zealand, Philippines and South Africa). Many schools and businesses were shut, individuals engaged in strict hygiene practices, social distancing and self-quarantining, which all involved substantial personal and social costs. Millions of workers were forced to start working from home, and online learning has replaced the majority of classes, which hit very hard especially younger children. Let us point out that public responses to global environmental crises are typically less powerful¹.

Today, after more than one year, the coronavirus is suspending the economy and global politics, tearing at the social fabric, and also, by extension, brutalizing the arts — cancelled performances, delayed releases, gig economy workers left to fend for themselves. The sudden outbreak and global spread of Covid-19 represents one of the most profound societal and public health challenges in modern times. Governments have imposed pervasive societal interventions, such as lockdowns, in the public and private sectors. While the intended consequence was to isolate millions of individuals, thereby containing viral transmission, an unintended consequence has been an economic crisis as companies are pushed into bankruptcy and unemployment rates increase rapidly. Clemmensen et al. discuss the possibility that the combination of imposed isolation and subsequent socioeconomic hardship and deterioration of psychosocial health might result in long-lasting effects on metabolic health.

As responsible citizens, we have been told that our lives must change radically. To continue our old ways is to endanger ourselves and those who are vulnerable. Although commonly thought of in terms of public “awareness” and dissemination of expert knowledge, responsibilisation is as much a matter of emotion, as it is a matter of reason. Emotions such as hope, shame and pride play a decisive role. Do we feel responsible? Do we feel that our actions can make a real difference? Are we ashamed when we fail to act responsibly? It is one thing to be indifferent to statistics and expert warnings, and another to experience shaming for contributing to the suffering and death of others, as hospitals run out of beds and respirators? Personal responsibility is often based on the ability to relate emotionally to other human beings – their hopes and fears, their pain and suffering.

As New York Times commentator Charlie Warzel observed recently, one reason Covid-19 advice has been framed as a matter of personal choice and responsibility was to avoid the costs and duties of political and collective intervention. Political-economic research has taught us that responsibilisation entails a shifting of burden from the state and corporations to individual citizens and consumers – a shift that does not always serve the public interest. Governments, corporations and other institutions must accept their share of responsibility too, even when this requires taking unpopular and costly measures.

To better understand the effects of science communications in the context of the pandemic, Kreps and Kriner developed five survey experiments and used them to assess shifting public attitudes toward references to Covid-19 models from prominent Democrats and Republicans in US. The surveys were designed to test responses to both the cue giver (the Democrat or Republican), and to whether his or her statement ignored, acknowledged, highlighted, or weaponized model uncertainty. Based on their findings, Kreps suggests scientists should avoid emphasizing dire implications associated with epidemiological models while sidestepping uncertainty altogether, since this approach could backfire if projections prove incorrect. "Instead, they should acknowledge that models are simplifications of reality and our best estimate based on a lot of moving parts," she says. "Politicians can help convey to the public what we know and what we still don't know about the virus, and stress the need to adapt policies in response to new information," Kriner adds.

The case of Sweden

Sweden’s approach to the coronavirus pandemic was different from the start. The government never ordered a “shutdown” and kept day-care centers and primary schools open. Of course, the country and its population did not ignore the serious threat. Although stores and restaurants remained open, many Swedes stayed at home, at rates similar to their European neighbours (who had no choice because the restaurants were closed). But Sweden adopted strikingly different policies from those of other European countries, trying to disrupt the daily life of citizens as little as possible. Swedish authorities also discouraged people from wearing face masks everywhere, which they said would spread panic, are often worn the wrong way, and can provide a false sense of safety.

Anders Tegnell, chief epidemiologist for the Swedish public health authority, said repeatedly that the Swedish strategy takes a holistic view of public health, aiming to balance the risk of the virus with the damage from counter-measures like closed schools. The goal was to protect the elderly and other high-risk groups while slowing viral spread enough to avoid hospitals being overwhelmed. Protecting the economy was not the aim, he says. Initial data suggest Sweden’s economy contracted about as much as its immediate neighbours’ as exports and consumer spending dropped.

Sweden’s light approach seems more sustainable than the harsher methods used in other countries, Tegnell also argues. He regrets the death toll in nursing homes and says Sweden should have made it easier financially for caregivers to stay home. “It was a very bad situation for a month,” he says, “but after that, it changed completely.” Once strong restrictions were in place, transmission in nursing homes “became lower than in the community.” Tegnell has also said he suspects the number of infections and deaths in other countries will eventually match Sweden’s.

Global Risk Management

With billions of workers and consumers on lock-down, Covid-19 is having an enormous impact on the global economy, disrupting production and trade worldwide. Companies face unprecedented levels of Pestle risk as a result of travel restrictions and serious resource and workforce shortages that are disrupting supply chains and business as usual. The Covid-19 risk tracker, powered by Nexis Newsdesk, features interactive charts that provide insights into how coronavirus pandemic coverage exposes political, economic, societal, technological, legal and environmental risks in near real time.

According to the graphs, wages and salaries are clearly a top-of-the-mind issue. On a related note, layoffs are a trending topic in terms of Covid-19 and economic risk, however the impact on manufacturing facilities is also dominating as reported in the media. When all of the Pestle factors are tracked in relation to companies, it’s easy to see that the impact of the coronavirus pandemic leaves no industry untouched—airlines and automakers, banking and finance, even the digital communication platforms that are enabling social interaction in times of physical distancing restrictions.

Closing thoughts

In the public debate, the whole picture has rarely been depicted properly. Namely, when the health systems are under such pressure, many patients from various age groups waiting for urgent interventions and operations, are pushed aside and forced to wait. Thousands in the meantime actually die – while the scheduled operation would have saved them. This is also part of the problem, but not receiving due attention.

In their drive to act and demonstrate their ability to address the problem of the pandemic, governments focus on vaccination, determining the priorities and organising massive vaccination, while neglecting the fact that none of the available vaccines have been dully tested. The pressure on drug approval authorities has been undoubtedly enormous, and under circumstances, it is not difficult to understand that it all went unusually quickly. In the US the vaccination has been even an electoral issue, and the newly elected president Biden was obliged to mobilize anyone available to speed up the process. At the same time, particularly in Florida people behave as if Covid-19 did not exist, and it is clear that a high price will be paid for this politically motivated, irresponsible attitude.

The only country having achieved the best possible results in combatting Corona is undoubtedly China. The obvious two reasons are: firstly, the central government acted strategically, swiftly and energetically, and secondly, people followed the measures understanding that they are introduced to protect them.

It is still early to draw relevant lessons from this dramatic experience, but several elements seem to be rather uncontroversial:

the more “politicized” gets the issue of government response, the more difficult it becomes to select a sustainable, balanced approach to address the pandemic;
medical science has to stand for its independence, particularly when providing advice to governments;
civil society, and specially relevant NGOs, should be a partner in the adoption of government measures, and should encourage responsible attitudes in society versus applied safety measures.

(Prepared by the KEN Secretariat: prof. dr. Ajda Fošner and prof. dr. Boris Cizelj).

¹ Bouman, T., Steg, L., Dietz, T. Insights from early COVID-19 responses about promoting sustainable action. Nat. Sustain 4, 194–200 (2021).