The 'New Normal' of the Corona pandemic

Thingnam Rajshree / Rajendra Kshetri *

Recalling the story of the 'The Last Leaf' by celebrated American writer O Henry, which many of us are acquainted with, one can recall that in the story, Johnsy's recovery was not just the social, emotional and medical support of Sue, Behrman and the doctor but also her own will and determination to live. Placebo effect, in fact, has a huge role in one's life.

The greater the positivity in one's mind set, the greater its efficacy. Nevertheless, it alone cannot be a cure for any form of human ailment. Rather, it can be a catalyst for us to formulate a right trajectory towards a healthy life. It is ever more necessary at the current times with the Covid pandemic engulfing our lives in a muddle.

Ever since its arrival in the late part of 2019, life has never been the same but thanks to technology and years of medical and scientific repertoire the pandemic is not going to be the end of the world.

According to Geoffrey Rose, 'The scale and pattern of disease reflect the way that people live and their social, economic, and environmental circumstances, and all of these can change quickly. This implies that most diseases are, in theory, preventable.' (Outwater, Leshabari, Nolte, 2017)

The Covid-19 pandemic if analyzed through this theoretical lens is not something that cannot be stopped. Any infection caused by a virus has no cure but with the help of vaccines it can be eradicated and hence the emphasis given currently on vaccination worldwide. However, the magnitude of the infection is such that neglecting other ways to prevent the disease would prove more and more challenging if the public do not come into terms with it.

Herd immunity in terms of the concerned infection can be more efficiently achieved by a transition into a new lifestyle along with vaccination. That the infection is spreading like wildfire points to the fact that the conditions of the virus to spread are conducive and thus, the requirement to change it.

These changes cannot be achieved overnight but collective efforts and a determined sense of personal as well as social responsibility can make it a lot easier. It also does not come without challenges as well.

These changes or the new normal we often talk about or hear doesn't require a radical uprooting of our existing lifestyles but rather an assimilation of certain aspects about the infection, its epidemiology and preventive interventions which also includes the SOPs or Standard Operating Principles or such as the usage of face mask, social distancing, and so on.

These changes were introduced to us at the very beginning of the pandemic and yet it has not produced its intended results due to the lag between material and non-material culture. Yes, we have masks, sanitizers, soap, hand wash and many more items to keep the virus away in every household but without assimilating the what, why and how of these materials in our mental space we often see people neglecting it or using it in an inaccurate manner.

We first ought to change our perspective on the whole pandemic itself first. We need to realize that we have substantial amount of control over it first because for one to contract the infection is primarily dependent upon being subjected to circumstances, places and things which enables its transmission from one infected person to another.

And thus, it becomes imperative to spread detailed awareness of the epidemiological underpinnings of the Coronavirus pandemic first. Only after the public in general become rightly aware of it can they understand the requirement of the preventive interventions and practice it efficiently.

No it is not an understatement to say that the present scenario calls for a paradigm shift in lifestyle. In fact, it had already become indispensable from the moment the Coronavirus outbreak that came in 2019 had taken a toll on the entire human race.

By lifestyle, we generally comprehend a style or way of living but we often forget that lifestyle is not just a subjective aspect but also social. In this context, dealing with this pandemic is not just about dealing with a 'disease' but also with dealing with 'illness' and 'sickness'.

This triad distinction of disease, illness and sickness was first made by Andrew Twaddle in 1967 and thrives in the domains of medical sociology, medical anthropology and philosophy of medicine. It has since, been subjected to further elaboration and conceptualization but the understanding and implementation of this distinction is of utmost importance this day. The triad basically designates disease, illness and sickness as medical, personal and social aspects of human ailment.

The triad connotes to basic phenomenon associated with each which distinguishes one from the other. Disease is the medical perspective of human ailment and entails the 'physiological, biochemical, genetic and mental entities and events'.

Illness, on the other hand, includes 'emotions and experience, such as anxiety, fear, pain and suffering' and is a personal and subjective experience but it can also be medically studied through verbal reports. Sickness is social in the sense that it includes 'expectations, conventions, policies, and social norms and roles'. (Hofmann, 2002)

Understanding the Covid-19 pandemic and dealing with it can be much simpler once we comprehend the dynamics of this triad distinction. Implementation of lockdown and curfew alone cannot fight the virus but a nexus practice of medical, personal and social responsibilities along with lockdown.

When we look at the medical handling of the situation it can be universal in the sense that the same kind of treatment and drugs are being implemented to treat the infection in a larger sense. Treatment itself does not begin or end here, but as the old and inescapable saying goes 'Prevention is better than cure', it begins from doing one's best to not get infected to trying to not spread it to others.

However, when it comes to personal and social aspects we need to take into account that the contextual situations and circumstances have a huge impact on fighting against the disease. It can be as subjective to the sense that it has to do with an individual entity alone. Personal health, living situations and such come into play here.

For instance, co-morbidity factors and/or placebo effect alone can pause greater threat to the individual entity but not the social group or community entirely. But again, considering economic situation, living conditions, and such can be both personal as well as social.

Looking at the social aspect of the ailment, it is quintessential to take into account the social determinants of health which plays a major role in defining who or how it is more susceptible to get infected with the virus. It will also further help the concerned Government organizations or civil bodies to make practical and efficacious policies.

It is in this context that community health becomes extremely important. Achieving a well maintained community health marker is not a difficult or an impossible task once we come into consensus with its importance and start doing the rightful starting from oneself.

The cultural and contextual differences also need to be taken into account in order to formulate and manifest rational practices which shall help to fight against the virus. It is then, that the practicality of the triad distinction can be applied in the best possible manner in the current scenario.

The pandemic is something we need to battle at all three levels. It is not the responsibility of the health workers alone or the Government but we as individuals and as members of a community at large need to do our part as well. No matter how big or small every little action we take can have a butterfly effect over the existing condition.

This is true for all kinds of human ailment but it needs to be emphasized greatly as it is the need of the hour. Understanding this shall also help in maintaining healthy relations with health workers, other communities and even within our own social groups and help in the overall welfare of the society.

Many incidents of violence against health workers have been observed at such times of crisis and this is due to the fact that in many cases, we often forget that they are there to help us with treatment and recovery but unless we play our part even that shall not effective. Health workers may help us with dealing with the disease but illness and sickness associated with it needs to be handled from our side as well and not just professionals.

Illness, as it is subjective, needs be dealt with personally and/or with the help of mental health professionals. Treatment is not just taking pills, getting operated on or other medical procedures but it entails a huge arena of interventions at individual as well as social levels, strategically implemented in various steps and phases of prevention of the occurrence or spread of the ailment itself.

One may better comprehend the meaning of what prevention actually is by looking into the various interventions involved in various stages of the same. According to the (UK) Committee of Inquiry into the Future Development of the Public Health, 1988 prevention has been defined as "the science and art of preventing disease promoting health and prolonging life through organized efforts of the society."

Even in Greek mythology there has been clear distinction between 'treatment' and prevention with Panacea representing treatment and Hygeia representing 'embodied living wisely and preserving health'. "Disease prevention can be attained by modifying our interactions with the broader environment." (Outwater, Leshabari, Nolte, 2017).

Preventive medicine categorizes four levels prevention each categorizing certain aspects of a disease's development with the needful interventions to deal with each category respectively.

The first level is the primordial prevention indicated before the onset of the disease itself and aims to 'inhibit the emergence of environmental, economic, social and cultural determinants of lifestyles that are known to increase the risk of the disease.' It is basically about making healthy choices which would lead to less occurrence of the disease. It talks about the epidemiological insights of diseases relating it with social and cultural factors.

The second level deals more pronouncedly with infectious diseases and delegates the necessity of public health. It 'seeks to lower the incidence of disease and other departures from good health by controlling causes and risk factors. It comprises of measures that prevent the occurrence of a disease by individual and collective efforts such as improved nutrition, immunization, and eliminating environmental risks.' (ibid)

Again, it needs to be emphasized that the coronavirus cannot be eliminated but getting infected with it and the risks of getting the infection can be reduced. With it being a highly infectious disease if we were to eliminate the risks of getting it would enable us to control the pandemic and it is as basic as that. But without understanding this we cannot just wait for our turn to get the infection and then get the necessary treatment.

Thus, the importance of vaccination and reducing our risks of getting the infection is of utmost necessity. Boosting our immune through a good diet, maintaining physical and social distancing, using face masks in the correct manner, washing our hands regularly, using sanitizer, etc., are all priority responsibilities we all need to follow and advocate right now.

But in order to make these practices assimilate into our lifestyles more effectively certain steps need to be taken up in order to make the general public thoroughly aware of what all these are, why it is necessary and how it can be effectively implemented. With the technological developments almost everyone has access to smartphones and the internet. But with these tools being flooded with information the general public often has a sense of confusion with regards to the pandemic and many in fact fall victims to hoax thereby preventing them to take up essential and necessary actions.

One possibility would be the utilization of popular culture mediums to the maximum possible to make informed and most urgent information reach the public with precision. Only when this awareness is achieved fully will the public understand the value and the urgency of the situation thereby facilitating the accustomization to the interventions in a more efficacious manner filling that cultural lag.

If we had not known how to cook we shall be eating raw and if we had not known how to cook properly we shall still be eating raw. Therefore, the 'what', 'why' and 'how' of these interventions need to be thoroughly understood by all.

But all these interventions also need to be understood critically with relation to cultural, economic and social contexts. The nutritional chart implemented for other parts of the world will be difficult to adapt in Manipur because of the difference in the eating pattern of our society with that or northern India for instance, or the limited availability or access to certain food products. This may be due to seasonal, economic, productivity factors and many more.

So finding an alternative nutritional chart for boosting our immunity by nutritional experts which caters to our cultural or economic conditions would be necessary. Or the generous use of sanitizers or masks would be a costly affair for many economically weak households in our state.

Likewise, various other interventions taken up need to be assessed contextually by experts and concerned authorities to make it adaptable and accessible to everyone and anyone equally. The social determinants of health (SDH) which the World Health Organization defines as the "non-medical factors which influence health outcomes" needs to be thoroughly understood and taken into account to make all these possible.

The third level is the secondary prevention which aims to 'intervene before the disease arises either by reducing the risk factors or by treating the underlying abnormality'. It is directed towards diseases with 'measurable risk factors or an abnormal condition that predates the emergence of disease.' The interventions involved include early detection, screening, tracing contacts in case of infectious disease, interrupting the progression of the disease to a more serious stage, etc.

While the fourth level also known as the tertiary prevention aims at reducing the impact of the established disease by 'eliminating and reducing disability; minimizing suffering and maximizing potential years of quality life' and is generally considered as the task of therapy and rehabilitation. (ibid)

Both these steps are also very important while dealing with coronavirus as risk factors play a crucial role as causal factors of infection, transmission and complications.

For instance, a person coming from an economically unstable situation with poor working and living conditions are more prone to getting infected than people who can work online from homes with proper access to good nutrition and health facilities. For a poor person, one day with no work and income can have a huge impact. Many women in Manipur thrive through handloom industries or many other households through agriculture and farming.

With the closing of Ima market, they have suffered hugely. Some of them are able to sell their products online but the whole online marketing system also has a brokerage structure behind it which keeps the producers as the poorest of the poor with little to no profit at all and for others, suffering heavy losses. These people are the ones with the greatest risk factors because even maintaining a balanced diet would be close to impossible for them.

For middle class families and elites who have the luxury of home isolation the situation is better off as both the patient and the families can deal with the situation relatively more comfortably. But for those who have to send their beloved ones to quarantine centres it's a different scenario altogether and is tantamount to the fear of the dark.

For them and also for people who have lost their dear and near ones therapy and counselling are a must so that they have assurity but also the awareness to the uncertainty of the situation and also so that their grief and misery can be lessened.

Proper and accurate awareness about the infection, its complications, risk factors and others which affect the outcome of the situation ought to reach every section of the society. This will help in the timely detection of the disease and to curb it effectively.

Understanding the dynamics of the triad distinction and the levels of preventions will be of benefit for the whole society as the current pandemic is something we ought to fight mentally together first so that we can physically do away with it sooner. And with it comes the importance of strategic implementation of interventions, policies and its effective execution by understanding the pandemic from a holistic viewpoint.

But more importantly we need to address the cultural and contextual circumstances and situations that come into play so as to make these changes in our lifestyles more accommodable in an equitable way. Each individual along with the society as a whole has to play their roles in whatever way possible; keeping in mind that by doing so we are not saving our own lives but also the lives of others as well.

References:

Outwater, A.H., Leshabari, S.C., Nolte, E., 2017. Disease Prevention: An Overview. The International Encyclopedia of Public Health, 2nd edition. vol. 2, pp. 338–349. Oxford: Academic Press.
Bjørn Hofmann. 25 Oct 2016, Disease, Illness, and Sickness from: The Routledge Companion to Philosophy of Medicine Routledge.