The short game and the long game of COVID-19

By Simon Sutcliffe

The COVID-19 pandemic has captured the attention of Canadians with an urgency and a level of grudging acceptance unlike any other medical or natural disaster in our lifetime. We have complied with imposed restrictions and privations that would have been thought impossible and unacceptable under normal circumstances mere days before they were imposed.

Containment of this first episode of disease is emerging, and while containment is not cure, it buys time until herd immunity or an effective vaccine confers disease control, as in the past with smallpox, polio and measles. The promise of containment presages “a return to normal.”

But resuming “normal life” will be simply a prelude to ongoing COVID-19 outbreaks (until a vaccine) or to the next pathogen that emerges. After all, SARS-CoV-2 is but one of many coronaviruses and other animal viruses that could give rise to the next pandemic.

The repeated emergence of pandemics presents the greater and on-going threat to present and future society.

We have demonstrated we can change behaviours, lifestyles and social and business practices for short, sustained periods to overcome an acute challenge to our well-being. But do we have the collective courage, resolve and wisdom to confront the global circumstances that generate the conditions in which pandemics arise?  

It’s not good enough to contain this pandemic. We need to reduce the risk of future and recurring pandemics.

Control of pandemics requires more from us societally and politically than containment of the infection. COVID-19 and major pandemics of past eras have not been caused by a new pathogen, but a pathogen new to us. They result from transfer of an animal pathogen into a human, either directly, or through a secondary animal host.

Pandemics are a mirror of our choices and actions that create the conditions that favour novel virus transmission between animals, commonly wild, and humans. How does this happen?

It can happen through deforestation with the consequent reduction of biodiversity, the destruction of habitats due to human encroachment for agriculture and trade, juxtaposing agriculture and urbanization without consideration of public health infrastructure, climate change causing habitat change, altering wet lands, river flows and flood plains with consequent human and animal migration and change in insect vector distribution, for example. 

There are also wild animal markets bringing live wild and domesticated food sources into human contact, the hunting and sale of wild animals as “bush-meat,” the ownership of exotic wild species as pets and air travel transferring infections anywhere in 24 hours without the possibility of quarantine.

Such factors are exacerbated by social circumstances, including poverty, hunger, overcrowding, limited education, poor hygiene and the social distress of disparities, insecurity and uncertainty.

This constellation of circumstances creates the conditions in which human and animal interaction share viral transfers that become global pandemics.

A return to pre-COVID-19 “normal” would be a complacent acceptance of the status quo – a short-term, high cost fix – the cost of containment. But if the control of pandemics is the goal, then the means are neither easy, nor short-term.

Controlling future pandemics requires us to take a clear position on issues relating to our global future – leadership to champion the social, environmental and economic conditions underlying the emergence of pandemics, and solidarity to stand squarely with those who have made the choices necessary to achieve pandemic control.

Canadians have done quite well with containment of COVID-19 – at least so far. Can we take that same energy, leadership and momentum and put it towards the ultimate goal of controlling pandemics? That is a bigger consideration than “returning to normal.”

Simon Sutcliffe is a clinical oncologist and former CEO of the BC Cancer Agency and Princess Margaret Hospital. His current activities address population-based aspects of cancer control, palliative care and global health, particularly in lesser-resourced countries.

Photo: Julian Wan, Unsplash