Nothing is Simple

Mark Wesson, MPH, FACHE,  Prinipal, Healthcare Development Consultancy, 110 37th Avenue, San Mateo, CA 94403, USA; E-mail: wesma31@gmail.com

The emergence of the coronavirus disease-2019 (COVID-19) pandemic has given an unrequested, rare, and prominent moment to the discipline of Epidemiology. The rigors and tools of epidemiology are critical in such situations, as public health threats progress from misunderstood or poorly understood to managed to possible eradication. Those trained well can hold the dual levers of scientific knowledge and public office at the same moment and steer societies from fear and suspicion when outbreaks occur to a sense of calm accomplishment and resumption of “life as normal.” In these moments epidemiology’s true influence over the last 200 years is evident. However, no force can act alone.

It is often said in business that “culture beats strategy”. The most beautifully crafted management plans can be derailed by attitudes, beliefs, and behaviors of groups. While epidemiology offers powerful tools for understanding the origin(s), population spread patterns and prediction by nature its focus is the population. And it depends upon the population’s adherence to timetested infectious disease precautions. Perhaps the modern-era and regretfully still challenging experience with the correct and consistent use of condoms in reducing Human Immunodeficiency Virus transmission provides a parallel example.

At this moment, the United States is experiencing a third “wave” of infections, if the first is counted. Hospitalizations and patient mortality rates are up and yet 50 million Americans and 90% of last year’s Thanksgiving airline travelers planned travel. What is often apparent to epidemiologists or other scientists or clinicians is not always clear to the public. The nature and magnitude of risk posed by airline travel to family gatherings where multiple groups travel to be together is hard to know for sure but likely approaches levels unquantifiable by modern science. While policymakers and scientists pleaded with the public not to travel, many did so and a predictable increase in infections has followed. The Christmas holiday is approaching. Will we decide to do the same again?

Vaccines have arrived and optimism abounds in the United States and in other countries. Perhaps the beginning of the end is here. Until it is, individual responsibility to the group to remain well and prevent infections will continue to be critical. And the rationality and clarity of Epidemiology will compete with the subjective, shifting winds of culture.