As I write this, there are more than 2 million COVID-19 cases worldwide, and over 139,000 deaths according to the World Health Organization. In the U.S., there are about 633,000 cases, and over 28,000 deaths since March.
Yes, there are other diseases that cause greater total morbidity and mortality. But not so quickly, not all at once, and not triggered simply by the ordinary activities of life.
The SARS-CoV-2 virus is impersonal and impartial. Given certain conditions, it proliferates. In other conditions it wanes. It cannot be reasoned with, petitioned, mandated, bought off, or bullied. It has no conscience and no fear; its essence is self-replication and self-replication only. It respects no borders, recognizes no ethnic, racial, religious, cultural, or class distinctions. It has sickened and killed people of all ages, races, and social standings.
That said, its impact is not uniform. It has taken its greatest toll on populations already vulnerable: the elderly, the poor, those with longstanding chronic conditions.
In many ways, COVID-19 is a mirror, showing us—as individuals, as communities, and as nations—what we value, what we trust, what we are willing and unwilling to do, and for whom.
It is precisely because the virus is impartial that it provides such a clear, unbiased reflection of our social and economic realities.
The difference between containment and catastrophe is largely dependent on us, not on the virus.
Like all calamities, the pandemic is bringing out the best and the worst of us. It is showing us the effects we have on ourselves, our neighbors, and our environs. It is showing us who and what we are.
Here’s what I’m seeing in the COVID-19 mirror. Some of it is heartening, some of it is sickening.
In the main, people are willing to do what’s right for public health, once given clear information about realities and risks. The shuttering or suspension of businesses, bans on large gatherings, closure of schools, the prolonged social distancing, the extra precautions—none of this is easy. Interruption of work and income has pushed many families to the brink of poverty. For others, new pressures of working from home while schooling anxious kids are testing psychological limits. For others, the loneliness can be crushing. Yet we make the best of it, with good humor and shared concern for communities.
Here in NYC—the epicenter of the U.S. caseload—people are taking social distancing seriously. On nice days, we are out and about, but having conversations from six-feet away. At night, the normally crowded streets are like a Twilight Zone episode. The traffic lights change for cars that are not there. Sure, there are some who dismiss the risk. Others have no homes to shelter in, no money for protective gear. But most ordinary New Yorkers, like Americans everywhere, do their best to be sensible and sensitive.
Some have no choice but to continue going to work. From frontline medical professionals to farmers and field laborers, from sanitation workers to those who drive trucks or maintain electronic infrastructures—millions are still at their jobs, making sure essential services remain available and supply chains are intact.
Everywhere, people are stepping up to help as they can: sewing masks for friends, neighbors, and medical personnel; feeding frontline hospital staff; volunteering at food banks and soup kitchens; donating to major charities and crowd-funding campaigns to offset medical costs and burials; offering free online classes, concerts, and virtual gatherings. All of this reflects the best of humanity.
The term “COVID-19” is so ubiquitous now, it is easy to forget that in January, it had not even been named. In a 4-month period, the international research community figured out that this was a transmissible virus. They characterized it and decoded its genome; discovered how it enters human alveolar cells and what it does when it gets in. They developed diagnostic tests—imperfect yes, but somewhat predictive. They identified viral vulnerabilities and potential therapeutic targets.
Those are astonishing achievements, and they happened very fast thanks to the Internet, the dedication of the researchers, and a culture of free exchange that still exists despite considerable political and commercial pressures.
I started my medical journalism career during the early phase of the HIV/AIDS epidemic. It took researchers a decade to understand about HIV what scientists have learned about SARS-CoV-2 in a mere 4 months.
Interest in Health & Self-Care
COVID-19 has sparked a surge of public interest in health—especially immune health and resilience. Mainstream medicine has no drug, no vaccine, and no procedure to treat COVID-19 beyond the inpatient ICU support that gets some, but not all, patients through the life-threatening phases.
Consequently, many more people now recognize that self-care is no longer a luxury; it is a necessity. This is amplified by the fact that chronic conditions like diabetes, heart disease, and obesity raise the risk for COVID-19. Overall, this been good for our industry, so far.
Industry leaders are reporting explosive sales growth, especially for products containing vitamins C and D, zinc, elderberry, medicinal mushrooms, and other “immune” ingredients. Some practitioner channel executives said they are challenged to keep up with demand, even despite massive drops in clinic visits.
A recent Nutrition Business Journal survey indicated that 36% of 1,000 representative U.S. consumers use more supplements now than prior to the pandemic. And 20% of previous “never users” are now buying supplements.
We’ll see how long that lasts. Prolonged unemployment or under-employment, and depletions of savings could blunt the boom—so might supply chain issues.
Most of the world’s vitamin C, and roughly 70% of all other supplement ingredients come from China, which is still scrambling to return to pre-COVID-19 production levels. Though the country has regained much of its pre-coronavirus output, shipping is a massive challenge. U.S. executives say they’re seeing three- to five-fold increases in freight costs, which they’re reluctant to pass on to customers. But at some point, they may have to.
There’s also the issue of unscrupulous and unfounded COVID-19 claims. The FDA has made clear that it will not tolerate this, and all the major industry trade groups echo that condemnation. Yet the claims abound. A big class-action lawsuit or two could tarnish the public’s trust. Let’s hope that does not happen.
But the shift toward self-care and personal health responsibility will outlast both COVID-19 and the oscillations in quarter-to-quarter sales. It is a positive, and much needed trend.
Our Environmental Impact
It is astonishing what happens when we humans turn off our engines for a little while. We’ve all seen the videos and photos: clear skies over formerly smoggy cities like Beijing and Los Angeles. The normally polluted Ganges river running clean for the first time in decades. Quiet nights in New York City. Coyotes howling in downtown San Francisco; wild boars walking the empty streets of Barcelona.
Three weeks into the COVID-19 epidemic, total CO2 emissions over China—which accounts for 27% of all global emissions—dropped by a staggering 25%. Vehicular exhaust was down by 35%. By mid-March, aggregate motor traffic in NYC had dropped by 35% compared to March 2019, and emissions were down by 50%.
Of course, the pandemic brings its own ecological challenges. What happens to the billions of gloves, masks, bottles of sanitizer, and other protective items? And all the additional medical waste? Most of it is single-use, contaminated, and must be incinerated.
Nothing in our long, strange history on this planet has shown us so clearly our environmental impact as has this pandemic. The question now is what do we do with this knowledge?
The Recognition of Interdependence
Close the schools, and we find out that teachers fulfill many vital community roles. Threaten food shortages, we learn just how dependent we are on farm labor, truckers, and grocery store workers. Close down retail and restaurants, and suddenly those harried delivery guys are our new best friends. Oblige us to stay at home for weeks on end, and art, music, literature, and other humanities become really important.
Should you need medical care, you’ll quickly discover the value of science, and the character of those special people who chose to become doctors and nurses. Behind them are the assistants, technicians, and cleaning crews, some of whom work very risky jobs for very low pay.
If this pandemic teaches us anything, it is that we are interconnected and interdependent. Federal, state, and local governments have the bitter task of determining which businesses are “essential” and which must close. But every business is “essential” to the people that founded it, run it, are employed by it.
A crisis like COVID-19 puts us face to face with the fact that we need each other, we depend on each other, we are connected to each other—even if those connections are usually invisible.
The Gaping Holes in Our Healthcare Systems
Did you feel sick at the sight of nurses wearing trash bags as protective gear? Disgusted by the political wrangling over distribution of ventilators and other life-saving medical supplies? Blown away by the numbers of medical personnel sickened and dying from COVID-19? Creeped out by the hospital hallways lined with desperate patients? Heartbroken by Facebook posts from young doctors writing their wills?
More than anything, this epidemic is showing us that our hospitals and public health systems are woefully unprepared for major crises. Like much of the nation’s infrastructure, many medical centers have been in bad shape for years—overburdened, understaffed, mismanaged. The sudden pressure caused by COVID-19 exposed all the cracks.
Like many other facets of the social safety net, healthcare—especially public healthcare—is torn and frayed. In times of great need, many of our major centers have been unable to pivot. They’re ill-equipped to respond quickly, to ensure the safety of their workers, or the optimal outcomes for their patients.
This is true in other countries as well. And it is interesting to note that having a national healthcare system has not been the decisive factor in COVID-19 containment. Italy and Spain both have national healthcare systems; both were ruinously overwhelmed. Germany, South Korea, and other “top-performing” countries also have national healthcare, and fared much better. But it is equally clear that our “market-based” healthcare system does not work well under stress.
The key determinants for effective mitigation appear to be: A) political leaders that respect science and are willing to act quickly based on guidance from public health researchers; B) a general sense of public trust in leadership; C) a strong overall social safety net; and D) respect and fiscal support for medical personnel. All of these are lacking in the U.S.
Glaring Socioeconomic Disparities
Everyone knows someone who’s died from COVID-19, or who’s gotten very sick. Statistically, though, a disproportionate number of cases and deaths are in Black, Latin-American, and other minority communities. African-Americans represent roughly 13% of the total U.S. population, but 33% of all patients hospitalized for COVID-19, according to CDC data.
It is also a stark fact that morbidity and mortality also correlate inversely with socioeconomic status: the richer you are, the lower your mortality; the poorer you are, the higher your risk.
Many variables influence the prevalence and severity of an infection like COVID-19, but there’s no question a confluence of racial, social, and economic factors are playing out.
Black people are not genetically any more susceptible to coronavirus than Whites. But they are statistically more likely to be poor. Likewise, poor people are not inherently more susceptible, but they are more likely to have pre-existing chronic conditions, to work in high-risk jobs, to live in substandard housing conditions, and to lack access to consistent medical care.
The number of Americans pushed into poverty is rising rapidly. Roughly 22 million people filed for unemployment since the epidemic began. In the last week of March alone, there was a record surge of 3.28 million. If unemployment rises to 30%, which is possible, then the number of people deemed “poor” will increase by 50%. There are already more than 21 million Americans in poverty, the highest poverty rate since 1967. Food banks across the land can’t keep pace with demand. One food bank in San Antonio, TX, reported a back-up of 10,000 cars in a single day.
The safety net for Wall Street and big corporations—and those who run them—is vast and strong. For ordinary working people, small business owners, and those already marginalized, it is a very different situation.
The impulse to quickly “reopen the country” is reasonable: a prolonged shut-down will pauperize many people. And in regions where the prevalence is low, the restrictions seem preposterous. But uncontrolled infection and loss of life—a very real possibility if we re-start too soon—could be ruinous. Either way, the consequences will fall hardest on the poorest people.
Consolidation of Wealth & Control
This pandemic has decimated small businesses, especially in the retail, restaurant, and hospitality industries. No doubt it has taken a toll on large companies too. But big corporations have faster access to far more relief funding. They’ll bounce back. I’m far less confident about that clothing shop down the block, the falafel place around the corner, the young graphic design firm next door.
Beyond basics like groceries, most of us now do most of our shopping online, which means further concentration of commerce onto the already gargantuan online retail platforms, Amazon being the largest. When all of this is over, it’s a safe bet that online retail will hold an even larger portion of the total retail pie than it did pre-COVID-19.
We’re now doing more of everything online. This means our business meetings, the education of our children, our religious observances—even in some cases last words with loved ones—will be mediated and monitored by Internet service providers and their algorithms.
Consider that Google, Amazon, Microsoft, and other big tech players all have massive healthcare operations: pharmacy benefits management, EMR systems, disease management programs, self-tracking apps. Google and Apple are working on a smartphone-based COVID-19 contact tracing app. Amazon’s already got its own dedicated COVID-19 testing lab—initially for its own employees. Through its “Grand Challenge” unit, Amazon’s also working on a vaccine for the common cold.
Then there’s telemedicine. With many clinics partially or fully closed, online consults are soaring. The federal government “temporarily” lifted HIPAA regulations to enable previously non-HIPAA compliant telemed companies to enter the field. HIPAA was burdensome and imperfect. But it contained important privacy protections. We throw it away at our own risk.
The convergence of telecom, IT, and commerce was already in full swing in the BC-era. The pandemic turbocharged the process, concentrating evermore wealth and control into fewer hands.
Our Love of Heroes
America loves the drama of the selfless hero. The noble soul rising against long odds, dying a martyr’s death on behalf of the common good. Whether it’s military personnel, firefighters, police officers, or political leaders, nothing stirs our collective soul quite like someone dying in the line of duty. Today, we’re projecting that onto doctors and nurses.
But while we love to glorify heroes, we generally do a lousy job of taking care of them. It’s easy to say “Support the Troops.” It’s another thing to increase funding for veterans’ services. It’s easy to clap and cheer for medical caregivers every evening at 7. It is another thing to ensure their safety, health, and financial security.
We are right to honor doctors, nurses, EMTs, and other medical personnel. They really are doing heroic work, saving thousands of lives every day, often in grueling conditions. But we will be even more right if we provide them with the equipment they need, the financial compensation they deserve, and working conditions in which they thrive rather than burn out.
I’ve seen a number of social media posts lately from nurses and doctors who resent the COVID-19 adulation. “I am no hero. I am not ready to die,” wrote one ICU nurse. “I studied to save lives. I signed up to care for the sick and dying, and yes, I acknowledge that this is all at the risk of my own health. But, do not misconstrue my choice of profession for a diminished sense of self-worth; I did not sign up to die. I want the country to know that if I end up on that ICU bed, it is because I was not given a hazmat suit or enough PPE to protect me. I want the country to know that America has failed its people, most especially those it deems ‘essential.’”
The reality is, medical people are always doing heroic work. But on the whole, their compensation has declined relative to the costs of living, the costs of education, and certainly relative to the earnings of the executives that run hospitals and insurance plans.
For years, physicians and nurses have warned us about the dire conditions of our hospitals—the chronic understaffing, frenzied pace, abusive working conditions, mismanagement and finance-driven oversight, rising risk of nosocomial infection, wage freezes. We have not listened. Even now, with this crisis upon us, medical personnel are being fired for speaking out about the holes in the system.
We as a society now ask our medical people to put their own lives—and those of their families—on the line. And they do so. Because those drawn to medical careers usually have a deep sense of altruism. But this noble virtue can easily morph into a martyrdom complex. And martyrs are very useful to exploitative business systems: they give much and demand little. Unfortunately, many of our country’s hospital systems have become just that: rapacious and exploitative.
Our Love of Scapegoats
Our love for heroes is well-matched by our love for scapegoats. It did not take too long, following the first U.S. COVID-19 cases, for the finger-pointing to begin. “It’s the Chinese!” “It’s the Orthodox Jews!” “It’s the Evangelicals!” “It’s those immigrants and foreigners!” “It’s those city folks with their liberal lifestyles!” “It’s those anti-science country people!” “It’s a Leftist plot to destroy the economy!” “It’s a Right-Wing power grab!” The list goes on.
Blame-casting and scapegoating is a deeply engrained human tendency. It was well-recognized in biblical days. And it strikes like a viper in times of crisis.
It is certainly not unique to the U.S. In the Chinese city of Guangzhou right now, landlords are evicting African immigrants—many of whom have paid rent 6 months in advance—simply because they are Africans. Once out on the street, some are beaten by mobs. This is because some Chinese believe that immigrants will trigger a COVID-19 resurgence, though very few new cases have been traced to Africans. This occurs as Chinese officials decry the racist, anti-Chinese tone in some American dialogue about COVID-19.
At its root, scapegoating is a natural survival reflex, an impulse to identify and eliminate the root of a problem. But history has shown time and again that blame-casting seldom leads to creative problem-solving, and often has disastrous consequences.
In her excellent book, The End of Days, author Erna Paris chronicles how medieval Spain—a multi-cultural civilization characterized by remarkable tolerance and stunning achievements in architecture, science, music, and literature—was quickly consumed in the fires of the Inquisition.
The catalyst? The Black Plague—a lethal disease with an invisible, unexplainable cause. Stoked by leaders with their own ambitions, Spain’s fearful and angry people defaulted to scapegoating and mythologizing: The disease is caused by “those” people. It is divine retribution for straying from the true course. It is a herald of Armageddon and the Messianic Age.
The net result? Mass murder, exile, and the rapid demise of a culture that took centuries to create. Paris’ book is a cautionary tale well worth heeding.
The Predominance of the Germ Theory
Since the earliest days of science, people have recognized that in any given epidemic many people are exposed to the disease but only some get sick. This simple truth led to a long-running intellectual battle between those who believe that the power to make someone sick lies primarily with the pathogens—bacteria, viruses, or fungi—and those who contend that individual susceptibility was the key determinant.
This dialectic is most famously capsulized in the rivalry between Louis Pasteur, who argued that germs were king, and Pierre Béchamp, who held that it was the “terrain”—the individual’s overall health status—that determined whether a germ had the power to make someone sick.
Most modern public health experts acknowledge that infectious diseases are the result of three factors: the nature and virulence of the pathogens, individual susceptibilities, and environmental conditions. But from a practical—and commercial—standpoint, Pasteur won.
The history of allopathic medicine is largely the history of Germ Theory, writ large. Conventional medicine is all about detecting pathogens and trying to destroy them. Even in conditions like heart disease, the focus is on biochemical “pathogens”—LDL cholesterol, for example—for which an “anti” drug can be discovered and marketed.
We expend extraordinary resources trying to destroy pathogens, and far less on understanding the “terrain” in which a pathogen does or does not cause disease.
This tendency is glaringly obvious in the COVID-19 situation. Yes, there really is a virus and it really does cause harm. It has sickened and killed young, apparently healthy people, but it is more likely to kill people with compromised immune systems or chronic metabolic disorders.
Yet the entire public health dialogue is about routing the virus; few leaders are talking about how to engender good health.
How many times have you heard a politician say, “Until there’s a vaccine …”? How many news blips did you see about chloroquine? Yet no major political player, left or right, has publicly advocated for routine high-dose vitamin C. I’ve not heard of any major funding streams to study oil of oregano, or medicinal mushrooms, or elderberry, or any number of other botanicals that might help people mitigate the risk of COVID-19.
We want fast, easy answers. Drugs and vaccines fit that bill. They can also be very lucrative. As a nation, we’re ever ready to spend public resources for prescriptions, and far less willing to invest in cultivating good health.
Yes, we need good antivirals, and an effective vaccine would mitigate the spread of COVID-19. But neither drugs nor vaccines are 100% efficacious. Strain matches for ordinary flu vaccines are consistently below 50% year to year. What makes us think that a 2020 coronavirus vaccine would be fail-safe against 2021’s virus? Then there’s the matter of convincing (or forcing) everyone to take the shot, an effort that would likely meet strong resistance.
A Predilection for False Dichotomies
A few weeks ago, the cover story of the The Economist featured the headline: “A Grim Calculus—The Stark Choices Between Life, Death, and the Economy.” Throughout the media and the political discourse on COVID-19 we are presented with seemingly intractable either/or propositions, and always cast in economic terms:
- We can have pollution-free skies and happy wildlife OR a thriving economy, but not both.
- We can protect the elderly, the ill, and the vulnerable OR we can have a thriving economy, but not both.
- We can have a well-run healthcare system accessible to all citizens, regardless of job status, financial status, or geographic location OR we can have economic growth, but not both.
- We can take collective community action for the common good OR we can respect individual rights, but not both.
All of these are false dichotomies based on narrow perspectives that limit the scope of inquiry and endeavor. They serve only the interests of those most heavily invested in the socioeconomic status quo. Worse still, they lack imagination.
I believe we can have a thriving economy that is also ecologically sound. We can have good social safety nets and strong healthcare and a thriving private sector. We can develop tools to fend off pathogens and also foster good health and minimize the socioeconomic impediments to it. We can develop public health measures that minimize risk for the maximum number without defaulting to vilification of the already vulnerable or collapsing the world economy.
We are the smart primates who figured out how to land things on other planets. We’ve invented and implemented a worldwide system that enables us to transmit messages anywhere in the world in milliseconds. We have the intelligence. We have the information. Do we have the will to solve the challenges we now face?
In 1963, Buckminster Fuller wrote: “We are blessed with technology that would be indescribable to our forefathers. We have the wherewithal, the know-it-all to feed everybody, clothe everybody, and give every human on Earth a chance. We know now what we could never have known before—that we now have the option for all humanity to make it successfully on this planet in this lifetime. Whether it is to be Utopia or Oblivion will be a touch-and-go relay race right up to the final moment.”
The reflections in the COVID-19 mirror will tell us much about which way we’re tending.
Holistic Primary Care
Erik Goldman is co-founder and editor of Holistic Primary Care: News for Health & Healing, a quarterly medical publication reaching about 60,000 physicians and other healthcare professionals nationwide. He is also co-producer of the Practitioner Channel Forum, the nation’s leading conference focused on opportunities and challenges in the practitioner segment of the dietary supplement industry.