Special about COVID-19

Coronavirus Alert

The Butterfly Defect

Disease and disconnection

Looking at the world today, however, it seems that we have collectively failed at coming to a deeper understanding of this intimate relationship. Instead of seeing ourselves as part of an interdependent whole, we’ve disconnected so far from it and restructured the system into an anthropocentric model, believing us to be superior to all other species.

Despite the planet having enough resources to sustain us, we’ve severely depleted it to keep up with the ceaseless demand of a growing world population. We’ve encroached on nature and cut down acres upon acres of life-giving forests in the name of mass production without thinking of the massive consequences on other living beings — and ourselves. We’ve overfished our seas and choked our oceans with plastic. We’ve eroded our lands from agricultural use and stripped our freshwater tables that we’re so dangerously close to zero. We’re poisoning nature needlessly with harmful chemical pesticides. Something as seemingly “small” and inconsequential to us as killing off scores of native milkweed plants with pesticides means cutting off the food supply of monarch butterflies.

To believe that we are invincible from the consequences of our actions is supreme arrogance. And so it is with supreme irony that we, the self-appointed sovereign of the food chain, are reminded of our sheer vulnerability when faced with a tiny, invisible co-inhabitant of the natural world.

Spillover to humans

Long before the Covid-19 pandemic and ensuing global economic paralysis, we already had numerous, glaring clues of what was to come from the hundreds of diseases that have

emerged over the last several decades. Deadly diseases such as Ebola, SARS (Severe Acute Respiratory Syndrome, H1N1 (swine flu) and coronavirus are the effect of what we have done and continue to do to nature as we usurp and destroy natural habitats.

About 60% of infectious diseases that affect humans are zoonotic; they come from animals. Influenza originated from birds and pigs, HIV came from chimpanzees, the Ebola virus, which was transferred to humans through the handling of bushmeat (wild animals hunted for food), infected villagers in rural Gabon who had captured and eaten a chimpanzee from a nearby forest in 1996.

A New York Times article in 2015 reported on a study by the International Livestock Research Institute that had found that more than two million people a year are killed by diseases that spread to humans from wild and domestic animals. The report highlighted the Nipah virus in South Asia and the Hendra virus in Australia as examples of how disrupting an ecosystem leads to disease. These viruses find an ideal host in fruit bats, which are immune to the virus because of millions of years of evolution. It was very likely that a fruit bat had infected a piggery in a forest, causing a deadly outbreak in rural Malaysia in 1999, where people suffered and died from permanent neurological disorders.

Fast forward to the era of Covid-19 — scientists have offered the possibility that the SARS-CoV-2 virus was transmitted to humans by an intermediate animal host infected by a bat. It is a theory echoed by a top infectious diseases expert, Professor Kim Woo-Ju of the University Guro Hospital in Seoul, who is responsible for providing public information on the most up-to-date, accurate information about Covid-19. In an interview with Asian Boss, the professor stated, “It was in a wholesale seafood market in Wuhan where [the virus] is believed to have been transmitted to a human...there had to be intermediate hosts, whether a pangolin or snake, we are not entirely sure yet. The virus known as SARS-CoV-2 that caused Covid-19 jumped from a bat to an intermediate host, a pangolin or a snake, and then to a human, resulting in severe pneumonia”.

A recent CNN report stated, “When a bat is stressed - by being hunted, or having its

habitat damaged by deforestation - its immune system is challenged and finds it harder to cope with pathogens it otherwise took in its stride”...thus allowing infections to increase and be excreted.

The spillover to humans has been traced back by researchers to the Huanan Market in Wuhan, China, a likely ground zero because 21 out of the first 41 patients of COVID-19 had been to this wet market notorious for selling wild animals for consumption. This was not the first time a similar incident had occurred — in 2002, SARS was also traced to a wet market in Guangzhou, southern China. It was very possible that the virus survived in the animal hosts being kept in captivity in these markets.

Climate change and disease

There have been numerous scientific studies linking the rise of new infectious diseases to the changing climate. We can look as far back as the Medieval Warm Period (AD 950-1300), which “may have helped rats and fleas to thrive in Europe, paving the way for the Black Death that killed a third of Europeans between 1347 and 1352”, according to The Thinking Person’s Guide to Climate Change (2019) by Robert Henson.

Speaking with environmental law and climate change expert, Frank A. Fritz, Senior Fellow at the University of Nevada, Las Vegas (UNLV), who previously worked for several years at the US Environmental Protection

Agency (EPA) and is currently part of a UNLV think tank to advance environmental legislation in the United States, said “The American Public Health Association (AHPA) and the U.S. National Climate Assessment state that increased median temperatures, duration of warm seasons, changes in precipitation and increased flooding and storms, which are all associated with climate change, are increasing disease carried by insects in North America, such as Lyme disease, Zika, West Nile virus and dengue fever”.

With respect to food safety and nutrition, Fritz points to the latest US National Climate Assessment (2018), which states, “Climate change, including rising temperatures and changes in weather extremes, is projected to adversely affect food security by altering exposures to certain pathogens and toxins (for example, Salmonella, Campylobacter, Vibrio parahaemolyticus in raw oysters, and mycotoxigenic fungi).”

Rising global temperatures could make it more favorable for microorganisms to adapt much easier, and come in closer contact with humans. In January 2020, the Journal of Clinical Investigation published articles by Johns Hopkins University School of Medicine professors warning that global climate change is likely to “unlock dangerous new microbes, as well as threaten humans’ ability to regulate body temperature.” In the journal, Professor Arturo Casadevall, M.D., Ph.D writes, “Given that microbes can adapt to higher temperatures, there is concern that

Madrid’s Puerta del Sol remains empty following coronavirus lockdown | Photo by Enrique Campo Bello

tomorrow he begins working in the intensive care unit of his hospital which is set aside for Covid-19 affected patients and says he finds himself surprised by how relaxed he is. In his hospital and in the Basque Country, the state of mind of his colleagues is slightly different. At the time I speak to Miguel, his colleagues are not overloaded with patients, and therefore are not worried or exhausted because of the amount of work they have, but are concerned about the imminent future and that what they have seen in other parts of the country may repeat itself there.

What they fear in the Basque Country is a situation like that in Madrid, a situation which urologist Alejandro, currently finds himself in . “Everything has changed. Everything we did beforehand, we don’t do now…. we are worried and uncertain, you never know on a new day what they are going to ask you to do”. His speciality now takes a backseat, as all are called upon to take on multiple functions. He adds that the hospital “is full of coronavirus” and that “all of the hospitals in Madrid, 100% of them, are completely jammed up”. Radiography Therapist Vanesa, also based in Madrid, says “right now we live day by day”, despite the normally highly methodical

and programmed routine of her department. Palliative specialist Ana, who works in Navarra is experiencing similar incertitude and flux as those working in Madrid. “Right now, I can’t organise my work at all, because we never know what we are going to find each day when we arrive”.

Despite being stretched thin, and full of incertitude, at times fear, at times anger at the situation having reached this point, the general attitude of Spain’s medical staff seems to be best summarised by Fernando, a GP from Andalucía who says “People are very motivated. There are colleagues who are very afraid but in general the level of motivation is very high. Everyone is willing to do what needs to be done”.

The loss of human touch

Ana finds her work particularly heavily affected by the new regulations that enforce minimum contact with her patients. As a palliative specialist, having to face deaths amongst her patients is of course, part of the job, and therefore not necessarily the part which most affects her, as it may other

No traffic in the surroundings of Madrid’s | Photo by El País

workers who are currently having to work in extreme circumstances. The elimination of human touch is what she identifies as the most difficult challenge she has to overcome. She says “there are times when the patient is dying and you have to tell their family that they are dying, and you can’t even put a hand on their shoulder. We revert back a lot to I am so sorry I can’t hug you or give you a cuddle, but I am giving it to you with my heart, my soul, for me this is really hard.….This is the most difficult part because it dehumanises my work”.

Urologist Alejandro on the other hand, sees physical contact as something that is going to be affected in both society and medicine. “People are going to maintain their distance...the world is going to change after this coronavirus crisis, and it has to”. He adds “unnecessary physical contact has to be eliminated” even going as far as to say he “may never shake a patient’s hand ever again”.

This term “unnecessary physical contact” may prove to become highly controversial and subjective in the world of medicine after the crisis. Ana puts forward “I think that [humans] are social beings and physical contact for us is indispensable. The problem is we aren’t conscious of it”. Bringing this idea back to the current state of affairs she says “… there are people who break down and cry and you can’t console them with more than words, and words sometimes aren’t enough”.

When a country comes together

While as Fernando says, in the hospitals everyone is willing to do what needs to be done, the same can be said of the majority of Spanish society who have followed Government protocols during the lockdown. Those who spoke to us were satisfied that Spanish society had reacted well both in terms of following instruction and in the solidarity they have shown with those still working.

Juan, a Military Police Officer from Andalucía tells me that tomorrow he is going to “collect a packet of masks from a sewing shop”. Several interviewees identified similar sewing projects and other initiatives, such as people with 3D printers who are making respirators, proving that the Spanish people are supporting each other at this time of crisis.

All those I spoke to were clear in mentioning that they are referring to a majority, unfortunately there are always some who do not take on board the gravity of the situation. Bearing in mind that some countries are only now entering their first week of lockdown, Ana has a few choice words for anyone who feels that they can still head over to their friend’s place to hang out for a while — “This is everyone’s problem, not just your problem. If the whole world makes an exception, this exception stops being an exception and becomes a norm”.

Initial panicked reactions which have seen unprecedented bulk buying of toilet paper and hand sanitiser are perhaps down to misinformation according to ICU nurse, Miguel. Dr Francesc Xavier, neuroscientist at the Center of Molecular Biology Severo Ochoa in Madrid expands on this point, commenting that “fake news is inevitable nowadays with social networks and the technology we have at our hands….it is important that people try to look for official channels, at a Governmental level or through channels of recognised science, pages of CSIC (Spanish National Research Council), official institutes…”. The problem of false information is also highlighted by paediatrician Guadalupe, who recommends people look at the simply expressed information compiled by the World Health Organization and the Ministry Of Health.

People in the balcony of his appartments during the lockdown ordered by the goverment in Spain | Photo by larioja.com

People in the balcony of his appartments during the lockdown ordered by the goverment in Spain | Photo by Axel Alvarez

From the outside looking in

As is the case with much of the western world especially, responses in Spain have come too late. Yu Ching is an entrepreneur and economics graduate currently living in Spain, but originally from Taiwan, one of the countries which has contained the virus most effectively. She says that the general reaction in Taiwan to the West’s failure to contain the virus has been one of surprise. Miguel comments that “we are in the hands of people like Trump, Bolsonaro, Boris Johnson, to manage this — it’s complicated”. Although poor handling of the situation has been more or less universal, as Miguel suggests, these three names stand out as the nominees for most reckless leadership. In late March, President Bolsonaro continued to dismiss the virus as both a “little flu” and a media campaign to force him out of power. The US President meanwhile, after ignoring advice for earlier lockdowns, and having seen the extremity of cases in Europe and rise in the States, is now saying 100,000-200,000 deaths in the USA would be a triumph. Attitude more than anything is what has been frustrating amongst these leaders — UK Prime Minister Boris Johnson, the epitome of irresponsibility, as a few weeks ago, despite the necessity for collective responsibility, boasted of still shaking hands with everyone. Somewhat inevitably, the PM has since tested positive for coronavirus.

A combination of poor coordination and in some cases frustratingly careless leadership have certainly been of no help to the cause. Yu Ching goes on to offer that “maybe [Taiwan handled it better] because we have more experience working with China”, and also points out that the country learned many lessons from the devastating effects of the SARS crisis 17 years ago. Nonetheless, she says the people in Taiwan are surprised by the inefficiency of both European countries and the United States.

The time to “give it your all”

Whilst the failure to prevent the spread has been a global failure, what is happening now in Spain is a matter of people making the best of what they can of the situation. GP Fernando comments “it is not so much the moment to criticise, as it is to give it your all”, which is agreed upon by Guadalupe, who says — “Of course there are things that can be improved, but this is the moment to roll up your sleeves and work and not criticise”.

Taking a hard look at our value-system

As the world’s eyes look not just to hospitals, but to laboratories in hope of a vaccine, how we value the world of research is in need of desperate attention. Dr Francesc Xavier is not particularly optimistic about a greater sense of value for scientists in the near future and attributes positive attention to human action in a moment of crisis, also pointing towards the problem of research taking time to produce results, and therefore not receiving the attention it needs.

Both Juan and Guadalupe put forward more optimistic perspectives in how the general public will appreciate people in their respective sectors on the other side of the crisis. What they are both more wary of is whether politicians’ memories will be as long as the public’s. Miguel is sceptical of both political and public revaluation in the long-term. Whilst he is thankful that in the Basque Country, their health system has been fairly well maintained over the last few years, he says “in Madrid, for example, they have had 20 years of cuts with the PP (Popular Party) government. In those twenty years, healthcare professionals have protested in the streets and really, people have not supported them as they should have”. Whilst politicisation of the crisis may be seen as untimely by some, neglect of public health cannot be overlooked if we are to all learn from the mistakes of the past, both in Spain and abroad. In Andalucía,

Guardia Civil officers applaud to show their support to medical staff fighting
coronavirus pandemic | Photo by Enrique Campo Bello

Fernando highlights similar problems to those being seen in Madrid— “The scarcity of the means that we have is fruit of a lack of investment over the last few years. This is a system that was working at the limit in normal conditions. When a crisis has arrived we have seen overflows because we were at the limit. Every year with the flu, we are on the edge of collapse”.

Fernando’s perspective is important in the current context, taking into account Alejandro’s assertion that the main fear amongst his colleagues in Madrid is lack of equipment and being infected with Covid-19, bearing the double impact of not being able to work and infecting patients. Radiography Therapist Vanesa is also critical of the lack of protection for medical workers, saying that she was saddened when she herself had to negotiate with the supplies department for masks, when it is normally a very simple item, which is ordered without thinking twice. She and her husband, who is also a Radiography Therapist, both tested positive for the virus in mid-March. Whilst suffering a rough opening three days with a thirty-eight degree fever and “not even being able to move”, after that she recovered. Her husband however, continued to suffer much more severe symptoms. “I saw my husband sunken, defeated, throwing in the towel… I had to take him to emergencies twice… My colleagues have told me that they have seen how radiographies of how [the virus] consumes a lung in three hours… this was my fear”. Thankfully Vanesa’s husband has recovered, though she explains “he is very weak, he has lost 7 kilos, I have lost four”.

Neither Vanesa or her husband are in a high risk demographic in terms of age, but of course, despite the protocols they enforced in their own houses, with the amount of infected patients they have had to see and limited protection — infection was hard to avoid.

Life on the other side of the tunnel

With regards to the idea of a new positivity and attention given to the health system, whilst Vanesa is “sure that we are going to suffer cuts again”, others are more optimistic. Paediatrician Guadalupe believes that the crisis is initially going to give public health a boost, though she is not so sure how long this new energy is going to last. Fernando agrees, and adds that the momentum that those who pushed for privatisation over the past few years, particularly in Madrid, will be significantly damaged as they will struggle to find support.

Around the idea of us being able to revalue our lives and society, there is wishfulness, optimism and pessimism amongst those who are confronting the coronavirus daily in Spain. Guadalupe points to the crisis of 2008 which also saw a greater sense of solidarity amongst the Spanish people. The difference this time, as she says, is that “this crisis affects us all. It doesn’t matter if you’re old, young, white, black, homosexual, rich, poor…”. Her hope is that society may reevaluate itself in the same way that an individual may find a new awareness after recovering from a serious illness.

Miguel hopes that this crisis will see us “give a little value to what truly has value rather than what we are made to think has value” and that rather than “Messi or Cristiano” it is “the medics, the nurses, the ambulance drivers, the greengrocers that we need”. Vanesa is also quick to point out the importance of collective value, and sings the praises not just of medical staff, but those staying in their houses and cashiers at supermarkets “who are risking their lives every day”.

In terms of changing attitudes, Fernando is less optimistic, concluding that “he fears that as ever after crises, there will be winners and losers. And capital will win again, and lower-level people will lose again, we will return to the old path, the triumph of capitalism, the rich will come out richer and the poor poorer”. If we look to Taiwan, as highlighted by Yu Ching, there are some lessons in attitude we can learn from. In a time of crisis, government regulation has proven to be key in the field of supplies when responding to the virus in Taiwan. Yu Ching explains that the government regulates both the amount of masks that a person can buy (one a day using a public health card), export of masks was not allowed, and that regulation also caused the prices to remain the same, whereas the prices for gloves and masks in Spain has rocketed.