The COVID-19 Infodemic: Some May Overlook Evidence, but We Cannot Ignore History
By Carlos Santos-Burgoa and Elizabeth Andrade
“The Plague” (yersinia pestis) pandemic decreased the world population by one-third in the 14th century, killing about 100 million people. It took the world between 75 to 150 years to recover. During the conquest of the Americas, exposure to a new virus destroyed the Inca and Aztec civilizations; it has been estimated that the population was subsequently reduced by 8 million.
There is widespread discussion on SARS-CoV-2 naturally acquired herd immunity by spontaneous contagion. In natural herd immunity, it keeps the strongest of the population alive (normal curve), and discards the nutritionally, genetically or immunologically weakest, often the poorest or those considered “disposable” in society. This is consistent with the “overman” concept. We do not support this concept or how it would play out in real life, but some political groups and country policies favor it.
It was not until practices aimed at eliminating germs came into the delivery room that healthy women, who would have otherwise developed post-delivery infections, stopped dying. In the most significant military encounters, “influenza and pneumonia killed more American soldiers and sailors during the war than did enemy weapons.” Still, while asepsis was vehemently endorsed by Robert Koch, it was resisted by traditional surgeons.
It was not until hygiene and sanitation improved that the modern society expanded and advanced. This was even more so the case with the introduction of vaccines and pharmaceutical treatment with antibiotics.
While its neighboring country, Mexico, closed schools and stopped the economy to slow the spread of Influenza A(H1N1) in 2009, and the culture of handwashing with soap, use of alcohol-based hand sanitizer, and covering coughs spread, similar shifts in normative behaviors did not take hold in the U.S. Furthermore, the crowding of bars, restaurants, stores and marketplaces, airplanes, transportation, sporting events, and music concerts have become a social imprint, further facilitating the propagation of infectious diseases. There were an estimated 12,469 deaths that occurred in the U.S. in 2009 for a crude mortality rate of 4.03/100,000, while in Mexico, there were 1,969 deaths, with a crude mortality rate of 1.79 /100,000. This situation created a compelling natural experiment.
Contrary to the 2009 H1N1 pandemic, the emerging resistance to preventive measures for COVID-19 is more visible, purposeful, and potentially more devastating. We are facing an “infodemic,” whereby rumors and misinformation spread rapidly through social media, prompting the abandonment of recommended preventive practices being implemented to different degrees throughout the world. Many of these efforts to derail prevention efforts have become quite sophisticated, and often lack identifiable, credible institutional support. This phenomenon demonstrates a willingness to diminish the validity of scientific or public health concerns and prioritize the interests of capital gains over human lives. Since the very beginning of the pandemic, the World Health Organization has been asking health professionals to battle this infodemic on all fronts.
Marginalized populations, whether in less developed countries or among the poorest in the U.S., find themselves on the pandemic’s front lines — out of a need to work and also due to the increased likelihood of working in essential services or the informal economy. Many of them do not have the choice to discuss the option of herd immunity: they are already victims of it, as statistics currently show in the differential mortality data from COVID-19.
Improved hygiene and sanitation are historically proven public health interventions. Combined with improvements in infrastructure, they greatly benefit the economy, intellectual and social advancement, and overall population wellbeing. Handwashing and covering coughs and sneezes are basic hygiene interventions. Cleaning high-touch surfaces and reducing crowding in housing, events, and places where people gather are basic sanitation interventions. This is well-known, and based in evidence and in experience. The power to thrive as a society is in our hands — we do not need to wait for the development of medical treatments or vaccines. As institutions and as citizens, we must all do our part — to show leadership, create policies, and make decisions that support recommended hygiene and sanitation to deter the COVID-19 pandemic.
Carlos Santos-Burgoa, MD, MPH, PhD is a Professor of Global Health and Environmental and Occupational Health, and Director of the Global Health Policy Program at the George Washington University Milken Institute School of Public Health.
Elizabeth Andrade, DrPH, MPH is an Assistant Professor of Prevention and Community Health at the George Washington University Milken Institute School of Public Health.
