As the world becomes more familiar with the concept of “social distancing”, COVID19 reveals the consequences of the pre-existing social distancing that we have already allowed to occur within and across national borders, a distancing that COVID19 reminds us is perceived, artificial, and at odds with our very real interconnectedness.
We seemed unwilling to accept that what happened in another country will happen here. Or that what happened to an older person, could happen to us, or our parents. Or that what happened to our patients could happen to fellow health professionals. Yet these are the realities that were facing citizens and physicians in China, are very much ongoing in Italy, and increasingly in the US.
This disease highlights our interconnectedness because, like many challenges we face, it ignores our perceived barriers, our borders, our customs and our languages. It doesn’t care about postcodes. It ignores race, religious beliefs and political leanings. It ignores “optics”. It cares not if we are on holiday because we choose to be despite government advice, if we are in work because we must be, or because we are in a crowded cell awaiting deportation because there were no good choices to begin with.
The most vulnerable face the greatest risk, as other commentators have stated. However, perhaps the most important lesson of COVID should not be that the vulnerable always suffer most, though this is unquestionably the case, but rather, that we are all reliant on and influenced by each other, and that the “vulnerable” is a much bigger and more encompassing group than many of us choose to accept. Consider senators and representatives and civic leaders at all levels, not least those present at presidential briefings or candidates currently running for president. Many of those at the podium informing us of the latest recommendations themselves fall within the groups at higher risk of serious illness. As the effects of both COVID and social distancing start to affect the economy and in particular employment, more and more of us will find ourselves vulnerable to change and isolated from support.
If we are more connected, and more vulnerable, than we first thought, there are some lessons from this outbreak that should outlast this critical challenge.
First, the longer we allow our perceived isolation from each other to persist, the harsher the consequences for everyone, not just the most vulnerable. In this way, it is no different to many other critical health problems, from climate change to AIDs, from opioids to firearms. It is merely revealing our perceived barriers to be illusory, blinkered, and harmful. If we lack compassion for the suffering of others at this time, including those in other countries, we not only fail to reduce their suffering, but ultimately, increase the likelihood that we too will suffer. We fail to see the harm that is coming our way, because harm to others doesn’t affect us as it perhaps should.
Second, that COVID is only the latest and most obvious consequence of our history of perceived social distance. As I write this article, next door, emergency triage tents are being erected outside the Boston Medical Centre on Albany Street, a rare sight for an American city. However, it is worth noting that emergency triage tents have been the last refuge for humans in many parts of the world. This is a norm for many millions. This was somehow less concerning when it was a “them” problem, not an “us” problem. It is also worth noting that for many on Albany Street, day to day life was already one characterized by homelessness, substance abuse disorders, mental illness and associated stigma. Another “them”, not “us” problem. If we acknowledge that the notion of “us” and them” is a perceived one, that should inform not just our individual acts of compassion now, as important as they are, but how we choose to shape our societies, and how we perceive ourselves as part of a global community. As we learn the value of compassion through our battle to halt COVID19, perhaps we could apply it in reducing deaths from alcohol, opioids and suicide, so-called deaths of despair, that claim approximately 150,000 lives per year in the US, or to helping the 1 in 9 people worldwide who do not have access to sufficient nutrition.
Third, that there can be no national solutions to truly global problems because such problems ignore our borders. In the case of COVID19 or climate change, the world is a single country. In realizing the limitations of national ownership over these issues, we must act to reverse a recent trend in decreasing support for global institutions.
In a recent article, Sandro Galea, Dean of Boston University School of Public Health, called for love, “not just to address the threat of COVID19, but to lay the foundation for a world where a disease like this cannot find its footing.”
COVID-19 is the public health challenge of our time, and we have failed to learn from the hard-won progress in other countries, or be warned by their suffering, in part because of a lack of a world-embracing vision grounded in compassion. Love and compassion are at times perceived as blinkering, but in reality, it is a lack of them that has blinkered us as individuals and societies, to the real suffering we allow to occur around us, and to the global nature of the problems we face. Restructuring our societies in ways that give collective expression to compassion would not only be more just, but would do much to improve disease surveillance and prevention, by acknowledging the reality of our interconnectedness, rather than the illusion of our distance.