Tag Archives: Covid-19

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Fantasy and Denial: Our Public Health Challenges

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Routine protocols for dealing with fast-spreading viral diseases have been reimagined as partisan ploys designed to destroy personal freedom.

In the last year my colleagues who specialize in health communication have had to face a landscape of public opinion fissures beyond what most could have imagined. Health communication explores how we can acquire information that will allow us to make better personal choices. One of the triggers for this area of study was the realization decades ago that it was costing much more to treat seriously ill smokers than to educate them about the risks. Public health practitioners realized that they needed the help of people trained in the arts of shaping public opinion.

Many who do this kind of research could be forgiven for thinking that the route to control of a treatable malady is a straight path involving the conversion of the best expert advice into coherent messages, producing high levels of compliance. But no. By nature, humans are fantasists more than critical thinkers. If vaccine resistance has taken many of us by surprise, it is perhaps because we thought we understood the power of credible medical advice. But ask members of our species about material causes for a particular result, and some will manage to weave together alternate narratives that have no bases in fact.

There is irony in living in an information-rich age that also supports bubbles of completely looney “truths.” We never need to look far. Many of us have seen folks look a reporter in the eye an assert that the seditious acts of January 6 against certifying a new Democratic president were the work of the Democratic Party. Where do you start with these people?

The eradication of polio is a representative case. In the mid-1950s, Americans anxiously lined up their children for the first vaccine against the highly infectious disease that left thousands of children paralyzed. As medical historian David Oshinsky has noted,

“If you had to pick a moment as the high point of respect for scientific discovery, it would have been then, After World War II, you had antibiotics rolling off the production line for the first time. People believed infectious disease was [being] conquered. And then this amazing vaccine is announced. People couldn’t get it fast enough.”

By early 1960, polio in the U.S. had been all but eliminated.

But this is not 1954. The pandemic has turned into an unforeseen world-wide experiment in how to manage the rapid transmission of a deadly virus while fighting off the dross of misleading messages. As it has turned out, and in spite of advances in immunology, helpful advice would have to outpace the lightning dissemination of misinformation, frequently with fantasies that a Hollywood screenwriter would have thought too outrageous. Perhaps eight to ten percent of the population is untethered to the ground, expressing phantom fears and wanting unobtainable guarantees of perfect safety.

Although many of us may owe our lives to the COVID vaccines that became available last March, widely expressed doubts about the helpfulness of masks, social distancing, and vaccines were triggered by this countermovement. It has expanded beyond the small core of anti-vaxxers and conspiracy-paranoids that have always been around. If we want to know how misguided public attitudes can be, we need look no further than many narratives that have turned treatment into a government plot. Routine protocols for dealing with fast-spreading viral diseases have been reimagined as partisan ploys designed to destroy freedom of action.

Thousands are going from hospital ICUs to their graves with the belief that COVID was a governmental plot

As this is written, only 48 percent of the residents of Alabama have gotten two doses of a COVID vaccine, with the predictable result of abnormally high per-capita death rates. Indeed, using the New York Times’ database derived from the CDC and other sources, some states like Idaho may not even know how many citizens have received vaccines. And the inequities of care within a single state can be vast. In Texas, 82 percent of the residents of Webb County are vaccinated, but only 21 percent in Gaines County.

Core public health best practices for the control of the spread of disease have been known for decades, granting some variations for local factors like weather, the mobility of the population, and the variability of medical care. Even so, it is settled science that immunization and wearing facemasks can reduce the spread of infectious disease in Burlington Vermont as well as Miami. But against the uniformity of guidelines lies the darker immutability of human conduct. Again, our dilemma is that prior beliefs and fantasies are difficult to dislodge even with sound evidence. Overlay this resistance to new fantasies that political treatments are surreptitious tools of thought control, and suddenly medical staffs have been forced to deal with wild speculation as well as disease. Indeed, a small percentage—but maybe thousands–are going from hospital ICUs to their graves with the belief that COVID was a governmental plot.

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Another Vaccine Story

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The sense that help is on the way also spread through American households in the mid-1950s.

The current effort to vaccinate citizens against the COVID-19 virus rings bells for people my age, some of whom became the first to receive the Salk polio vaccine in 1954. Recent stories celebrating the apparent success of the new drugs are a reminder of the maelstrom of parental dread about polio that few children probably understood. To be sure, my eight-year-old self was particularly clueless to the risks of being around other kids, or going to parties or swimming pools where the paralyzing disease could attack. Back then, the habit of many parents was to worry alone about the risk of a paralysis that could immobilize their children. Those conversations were mostly saved for other parents. Anyway, kids have a natural habit of living in their own world. Then it was music, radio and bicycles. If we were skating on thin ice as potential victims of a disease, we were only dimly aware of it.

What a contrast with the current pendemic. Our more invasive media mean that there is no such shielding of children from the worries and disruptions of the virus.  COVID-19 is their crisis as well.  As is often true with kids, many are handling it better than the rest of us.

The current sense that help is on the way similarly spread through American households in the 1950s. Jonas Salk at the University of Pittsburgh in the Oakland section of the city led a team that found a workable vaccine. All that was left was to manufacture and distribute it, but in reverse order of today’s vaccine roll out. Kids went first because they were most at risk.

Like many others, my third-grade class at Ashley Elementary School would be among the first “polio pioneers,” having volunteered in true Ashley fashion by doing what we were told. It was not that big a deal to get the shot. And there is no doubt the Salk and later Sabin vaccines saved millions from paralysis, withered limbs and leg braces.

The subject didn’t surface in my still unfocused brain until junior high, when I could no long make my legs flexible enough to run. I was stiff most of the time, choosing activities that did not require speed or agility. I warmed the bench in little league, put on weight from too many visits to the Dairy Queen, and preferred to roam surrounding neighborhoods on my bicycle. Only after a checkup, did our family doctor begin to wonder about my stiffness. The most probable cause: the dose of vaccine given to me may have contained some of the virus that had not been fully neutralized. Some minimal physical therapy took place in Denver’s children’s hospital. But the best recommendation was to have me join the track team at my tiny high school when my family moved to the nearby mountains. I was on the team not to compete, but to get back to level of mobility comparable to my peers. It was a chore, since my speed was only slightly better than an enormous shot putter who joined the group for fun. The two of us inadvertently reenacted “The Little Engine that Could” on every slope.

I would not say I had polio. Even while it may have been the cause of my symptoms, the vaccine surely spared me the full effects of the disease. If anything, over the years the Salk Vaccine made me a stronger believer in the power of childhood vaccination. Watching a recreation of F.D.R.’s struggle with polio was the tipping point for a degree of self-awareness. His legs were so sapped of energy that he was carried like a child when he had to be moved to places that were beyond the reach of his wheelchair. Viewing the film as a high school senior, I began to realize that I had perhaps skated closer to the edge than I knew.

                                           UPMC Oakland

Sixteen years later I began a graduate program at the University of Pittsburgh, trekking daily from my apartment on Craft Avenue up to the University about five blocks north. In my daily walks to the center of campus, I never failed to be in awe of the sprawling medical and public health campuses of the University of Pittsburgh Medical Center, their massive structures made even taller as they marched up the steep hillside above Fifth Avenue. UMPC is how God would want a vast medical complex to look like. It was enough to always remember that this is the spot where my childhood was given both a medical challenge and reprieve. To this day the geography of Pittsburgh is still my reference point for thinking about how dedicated researchers can suddenly tame a terrible disease.