|Year : 2020 | Volume
| Issue : 1 | Page : 1-8
Cerebral musings on environmental humanities, human transgression, and healthcare preparedness: Looking beyond the “streetlight effect” of the COVID-19 pandemic
Bhaskara P Shelley
Department of Neurology, Yenepoya Medical College, Yenepoya (Deemed to be) University, Mangalore, Karnataka, India
|Date of Submission||15-May-2020|
|Date of Decision||06-Jun-2020|
|Date of Acceptance||06-Jun-2020|
|Date of Web Publication||20-Jun-2020|
Dr. Bhaskara P Shelley
MBBS, MD, DM, FRCP Edin, Department of Neurology, Yenepoya Medical College, Yenepoya (Deemed to be) University, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shelley BP. Cerebral musings on environmental humanities, human transgression, and healthcare preparedness: Looking beyond the “streetlight effect” of the COVID-19 pandemic. Arch Med Health Sci 2020;8:1-8
|How to cite this URL:|
Shelley BP. Cerebral musings on environmental humanities, human transgression, and healthcare preparedness: Looking beyond the “streetlight effect” of the COVID-19 pandemic. Arch Med Health Sci [serial online] 2020 [cited 2020 Sep 29];8:1-8. Available from: http://www.amhsjournal.org/text.asp?2020/8/1/1/287375
”Man is a part of nature, and his war against nature is inevitably a war against himself.”
– Rachel Carson
”A policeman sees a drunken man searching for something under a streetlight and asks what the drunk has lost. He says he lost his keys and they both look under the streetlight together. After a few minutes, the policeman asks if he is sure he lost them here, and the drunker replies, no, and that he lost them in the park. The policeman asks why he is searching here, and the drunker replies, “This is where the light is.”
– The Streetlight Effect
| COVID-19 Pandemic: the Impact of Emerging Infectious Diseases and Their Power over Humanity|| |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an 50-250 nm diameter tiny virus, has unbelievably “locked-down” the world, and undoubtedly inflicted a humanitarian crisis of epic proportions. Indeed a public health crisis of global proportions, a crisis of health inequity, and global health systems pandemic unpreparedness. The cataclysmic effect of the COVID-19 pandemic has left indelible imprints on the psyche of the humankind despite the widespread acts of human solidarity to mitigate the viral pandemic. It has not only jeopardized the global economy, enforced more than half of humanity in lockdown, but also has tragically caused an insurmountable catastrophic loss of human lives and the livelihoods of millions. COVID-19 pandemic now poses a monumental challenge to humanity in the 21st century. The pandemic has exposed many unprecedented challenges for all of humanity such as the viral pandemic per se, an economic pandemic (economic meltdown), a psychological pandemic (psychiatric, neuropsychiatric and mental healthcare, psychological effects of a COVID-19 'Cabin fever'), and a human behavioural pandemic (going through the phases of the Kupler Rose Model, the social and behavioural change to the pandemic, and acceptance of the 'new normal'). COVID-19 is certainly the most devastating, apocalyptic humanitarian catastrophe, and global healthcare (systems) preparedness crisis of this century. Have we the humankind learned valuable lessons from the history of pandemics? What can we learn from human responses to epidemics and pandemics in history? What insights can ecological and environmental humanities' perspectives provide? Does the human civilization not seem to have a “déjà vu” from the pandemics that have afflicted humans in recent times, such as SARS and MERS? Will COVID-19 generate sustained and intensified global health preparedness for emerging infectious diseases, resulting from dysfunctional interconnectedness of humans, animals, and ecosystems? Perhaps, from civilizational epidemiology of the human race, it is very apt to reflect on the quote “We learn from history that we learn nothing from history” as echoed by Georg Wilhelm Friedrich Hegel and later George Bernard Shaw. Therefore, the critical inner voice that haunts my mind, out of fear, curiosity, and inquiry is “Will humanity's inability to learn its lessons from a history of pushing the boundaries of our 'finite' ecosystems to yet another apocalyptic pandemic triggering 'human annihilation' from the Mother Nature?” Is it going to require a new wave of collective consciousness, or will it need a new world to adopt a different way of thinking beyond the human? In this context, I foresee the future of “Anthropocene–The Human Epoch” by the quote, “You are either part of the solution or part of the problem.”
Human pandemic history is indeed in a crisis. Pandemics has impacted and reshaped the human history; however, despite “writings on the wall,” and the 'technicolour' human experience gained from the “retrospectoscope” of pandemics history, we have have ignored lessons from the past with plague of Justinian (541–740 AD), The Black Death (1347–1353), Smallpox (15th–17th century), Cholera (Peak 1817–1823), Influenza Spanish Flu H1N1 (1918–1919), Hong Kong Flu H3N2 (1968–1970), HIV/AIDS (1981), Severe Acute Respiratory Syndrome (SARS: 2002–2003), Swine Flu (2009–2010), Ebola (Peak 2014–2016), Polio, Measles, Malaria, and Typhus. Despite the tremendous advances in molecular biology, emerging infectious diseases, and epidemiology, I would say that several lessons were not learned, the main reason being the inertia and failure of effective global public health systems, disaster and outbreak medicine, pandemic/disaster preparedness, disaster management systems, and the sheer lack of global healthcare systems preparedness. By visualizing the history of pandemics, coupled with our societal philosophy of capitalism and neoliberalism, the follies of humankind centered on the “unpreparedness” in these crucial areas are so evident even in the times of an absence of a crisis. This, to me, has resulted in a failure of a “shared responsibility” in the “global health solidarity” and “security in global health.” I would reiterate that there is no stability without solidarity and no solidarity without stability.
The current raging “Black Swan” of the SARS-CoV-2 (COVID-19), “a once-in-a-century-pandemic,” has now posed to be a global biosecurity emergency and a humanitarian crisis the planet has witnessed after the World War II. I see humanity on the brink. In the medical warzone of COVID-19 with society immobilized and overwhelmed hospitals, the stark reality of pandemic death is a painful tragedy of being alone, in isolation, and unable to reach out and comfort those who mourn, those who are facing imminent death, no goodbyes, no human touch, and to gather and honor their deaths by being able to be with their loved one's bodies as a connection for a healing grief and bereavement. The flip side of this tragic milestone is the dying in complete solitude, the deaths in isolation, deaths without goodbyes, burial without rituals, and mass burials. There are innumerable emotional and harrowing stories of pain, solitude, fear of “death prowls,” dying alone, and sufferings “at the gates of hell” in COVID-19 intensive care units. Another emotional catastrophe and a tsunami of human grief is to see the obituary sections in the local Italian newspapers stretching to over 10 pages; coffins overflowing; waiting list for funeral services, virtual funerals emanating from laptops or smartphones, expressing sorrow through digital space without a hug or a human touch, all of which are emblematic of the most basic human empathy at times of this catastrophic bereavement. We have witnessed the harnessing of humanity to battle and navigate the uncharted COVID-19 pandemic. This solidarity is certainly in resonance with “A Song in Storm” poem written by Ruyard Kipling that I dedicate as a tribute to the COVID warriors, to the fallen global medical heroes, and COVID-19 victims.
”No matter though our decks be swept
And mast and timber crack
We can make good all loss except
The loss of turning back.”
In fact, after the various pandemics, the world has witnessed in the past, and from the pandemic-centered movies such as “Contagion” with striking semblance to the COVID-19 pandemic, I would rephrase that the SARS-CoV-2 pandemic is in fact not a “Black Swan,” not an unforeseen catastrophe, instead a “Grey Swan” being a known unknown. Heeding Mother Nature's warning from the previous global pandemics and disease outbreaks was virtually abysmal on the part of humanity. In the future of human civilization, these emerging infectious diseases and disease outbreaks, which we are certain to witness, will only become a “White Swan” event. I vividly recollect the how the world rejected Peter May's manuscript of his novel 'Lockdown' in 2005 as the thriller concept of H5N1 (bird flu) affecting London with a lockdown being imposed was just out of the world idea then. To my surprise, this novel is now published (April 2020) since the storyline parallels the current COVID-19 Lockdown 2020. Indeed this novel is now the top 10 bestseller.
The human race should not suffer from “global amnesia,” not learning from the lessons of the past pandemics, and become the advocates of the “Cassandra dilemma.” This editorial is a “firework of ideas” based on the Pollyanna principle to see beyond the “streetlight effect” by “thinking through environmentalism,” “the human–nature systems,” and the “environmental humanities”. I believe that humanity and nature are inseparable and that our personal health does unequivocally involve planetary health and ecohealth. To my introspective mind, this chapter of COVID-19 pandemic is not just a global pandemic, instead represents a critical point, a reflective and contemplative moment of our collective consciousness to ponder on the symbiotic interconnectedness of human environment-animal (wildlife) interface and in a broader perspective 'The Earth-Human System' interactions. We need to question the “human hubris of anthropocentrism,” the very purpose of human existence, in relation to ecosystems health, and realize how we are on a collision course between the human species and environmental and nature's ecosystems.
My musings in this editorial does indeed represent my 'Sehnsucht' to endorse biospheric egalitarianism for 'planetary health' concept of 'Healthy people, healthy planet'. It is essential that we teach environmental humanities from schools to medical universities as a core curriculum to increase awareness of the real danger ahead in our Earth-Human systems. Only then can steps be taken to turn us away from the abyss.
| Nature's ” Writings on the Wall” and Human Transgression:a Wake-Up Call|| |
”We can no longer exploit the resources of this earth—the trees, the water, and other natural resources—without any care for coming generations. Common sense tells us that unless we change, we won't survive. This Earth Day let's resolve to live in harmony with nature.”
– Dalai Lama (50th World Earth Day Tweet; April 22, 2020)
It is indeed, to my cerebral musings, that we heed to nature's 'writings on the wall' and it is hightime to galvalnise a health research coalition to address the Human environment-Wildlife ecosystems not only from the global governmental and inter-governmental organizations, but I underscore the need for a curriculum change from the medical educational perspective. This connectome of concerted efforts will be the key to ensure a both biodiversity conservation and safeguard sustainable future of planetary health. During these unprecedented and apocalyptic times of COVID-19, the humankind is indeed navigating the uncharted unknowns. Humanity is on the brink as COVID-19 pandemic has assumed proportions akin to a medical warzone. In this context, I do not wish to look for the “keys under the lamp post,” instead look beyond the “streetlight effect” of this pandemic. First, during these eerie times of the COVID-19 pandemic, my mind stands testimony to the COVID-19 infodemics, Pandora's Box of COVIDdences (the knowledge gaps, both the known unknowns and unknown unknowns, including the ethical misconducts and lack of scientific rigour leading to the retraction of scientific papers from the prestigious Lancet and NEJM journals), and the COVID-19 elephanomics not only justifying to me the limitations of our scientism but also painfully unraveling “the science of uncertainties.” It is poignant for me to realize that Modern medicine certainly has progressed so much, yet so little to offer in the COVID-19 pandemic.
Second, as an awakening of anthropocentric spirituality, I am reminded of the English poet John Donne's 400-year-old poem titled, “No Man is an Island” “No man is an island entire of itself; every man is a piece of the continent, a part of the main;…” Should not humanity need to institute a new policy of “peaceful coexistence” with Mother Nature through Environmental Medicine and Humanities? Thus, my perspective unravels the “Forgotten Truths” on the triple frontier of human transgression (anthropocentrism), biodiversity loss, and pandemics. Emerging infectious diseases and pandemics is a wakeup call for a paradigm shift from a human-centric anthropocentrism (human centeredness) philosophy to embrace “eco-biocentrism” (nature-centered living). This will undoubtedly restore the delicate balance of “The Earth–Human System.”
Finally, I wish to see a new “post-COVID 19” reality, a renaissance in global healthcare systems and medical education that incorporates “holistic, inter- and trans-disciplinary connectedness” of environmental humanities, environmental (climate) medicine, disaster medicine, and earth ecosystems health that fosters in connecting the dots to link global ecosystem health as the basis for safeguarding human health, healthy living, and planetary health. I reiterate our “shared humanity” to learn, unlearn, and relearn the concept of “human–nature connectedness” that is quintessential in sustainability science, conservation biology, environmental humanities, environmental (climate) medicine, and medical education.
| Respect for Nature's Laws|| |
”Nature no longer runs the Earth. We do. It is our choice what happens from here.”
– Lynas, 2011
I pose a reflective question on the philosophy of environmentalism – “Is the COVID-19 pandemic Mother Nature's response to human transgression?” I would state that anthropocentrism, the lack of understanding of the “human–nature connectedness,” and environmentally responsible behavior for biodiversity conservation, the “human–wildlife conflict” are fundamentally the pristine factors for the various emerging infectious disorders and disease outbreaks, ultimately making us vulnerable to pandemics. While pondering on the age of human environmentalism and the loss of respect for an independent nature, human–animal relationship, and the Earth ecosystems, I am distressed by the degradation of Earth's ecosystems and its consequences to global human health security and global public health security. The worldwide lockdown has given evidence to underscore how the magnitude of human activity takes a toll on the delicate earth's climate systems. Lockdown has decreased air pollution and greenhouse gas emissions because of reduced transportation, electricity generation, and industrial production. An unbelievable environmental change in air quality index has been recorded over the UK, Italy, and China with even record dip in air pollution indices across various Indian cities. The coronavirus lockdowns has shown that the Earth is healing as evidenced by the Ganges water being sparkling clean, the snowcapped Himalayan range being visible from towns in Punjab and from the Singhwahini village in Bihar, and has indeed also cut global carbon emissions by more than 8% so far. Climate-related infectious disease outbreaks, vector-borne illnesses, respiratory diseases, cardiovascular diseases, and cerebrovascular disorders such as stroke, dementia, and mental health are just the tip of the iceberg afflictions linking climate adversity and human health. I underscore the need to dwell on the future trajectory of humankind by engaging in sciences, humanities, and philosophies that will galvanize the interconnectedness between human health and planetary health, which I would state are nothing but the offshoots from the wellsprings of holistic medicine to a personal and public health perspective. We need to build bridges between health care, public health, and medicine that will embrace a much broader ecologically-informed perspective on human health, that the health of each of us is connected to the health of our planet, and the need to harmoniously reintegrate of our human relationships with nature. To put it simply and effectively, I would reiterate the undeniable fact that human health is intricately and inextricably connected to our planet's ecosystem health.
| The Hubris of Anthropocentrism to Ecocentrism: Unsettling the Humanities|| |
Humans have the belief that they are the dominant species on the Earth coupled with their scientific materialism. Humans believe that Nature is nothing but physical matter rationally organized according to physical law but devoid of any “laws of Nature” and that the human enterprise are the only masters of Nature. I pose this question, “Is Nature to be considered as only a warehouse of resources to serve human needs?” The philosophy of environmental ethics would be able to give a transcendental inquiry to this question. Another intriguing question would be, “Is our destruction of nature responsible for COVID-19 pandemic?”
Anthropocentrism (humanocentrism; human centeredness) refers to a philosophical world view where human beings are seen as superior to other living and nonliving things. It justifies the exploitation of nature for the sake of human welfare. On the other hand, enlightened (humanistic) anthropocentrism is a world view that says humans have ethical obligations toward the environment but those can be justified in terms of obligations toward other humans. On the contrary, ecocentrism rejects the notion of human superiority, shifts to a biocentric outlook on life, and is more inclined to advocate the “doctrine of species impartiality.” Therefore, ecocentrism emphasizes a nature centered, as opposed to human centered (i.e., anthropocentric), which fundamentally revolves around a system of values that follow the doctrine of “biospherical egalitarianism” and “species egalitarianism.” These concepts of environmental ethics only go to strengthen the environmental philosophy that humanity and nature are not separate (human–nature harmony), and life as an entanglement unified in a biocentric world concept of human–earth system's integration.
Human-induced environmental issues and expansion of human activities into the natural landscapes have now intruded into every aspect of the environment on a global scale, extending through the whole planet putting biodiversity conservation into jeopardy. Such anthropogenic factors, especially human transgression and fragmentation of wildlife habitats, have undoubtedly caused environmental degradation, habitat fragmentation, and biodiversity loss, resulting in “human–wildlife conflict” as well as an earth systems crisis. The global habitat fragmentation, degraded landscapes, and habitat loss with the disrupted ecosytem inevitably drive the wild animals out of their natural habitats and bring people into closer contact with animal species they never may have been near before. The human transgression (deforestation, logging, mining, road building, wildlife hunting, wild animal trade, and bush meat trade) reduces the natural barriers between virus host animals and humans, encouraging the transmission of pathogens from animals to humans. The bush meat, including bat bush meat and game meat, and wild animal trade certainly have created increased opportunities for the transmission of several zoonotic viruses from animal hosts to humans, such as Ebola virus, and various species of coronavirus, including SARS-CoV-2. These species of animals may be natural reservoirs of many unknown viruses. The resultant disruption of the human–animal interface becomes the “time bomb” for potential zoonotic “spill-over” emerging infectious diseases' outbreaks that could scale up to an epidemic or pandemic proportions. Human history has revealed this enormous “spill-over” contagious crisis though the unforgettable lessons of Ebola, malaria, dengue, yellow fever, and sleeping sickness (in North Gabon); Lassa fever in Nigeria; rabies, plague, and Nipah Virus from Malaysia; SARS from China; MERS in the Middle East; Zika and West Nile virus from Africa. The Wet Market animal trade makes a perfect storm for cross-species transmission of pathogens and the risk of diseases spilling over from animals to humans. It may not be wrong of me to state that COVID-19 may be just the end of only the beginning of many more pandemics to unleash on humanity unless we mitigate human transgression and prevent the “Human–Wildlife Conflict.”
At this juncture, I pose another question. Are bats the enemy in the fight against COVID-19 and other infectious diseases such as Ebola and Nipah virus outbreaks? The answer to this question underscores the delicate boundaries of bat ecology research, bat conservation, and bat-borne virus surveillance and yet put in place the highest research safety standards (BSL-4 Laboratory Facility) to safeguard human health to prevent virus spill-over to incidental hosts. Although bats provide a reservoir of zoonotic viruses (including coronaviruses), it is the loss of bat habitat, bat conservation threat, and other anthropogenic drivers that promote the human–wildlife conflict and altered host–virus dynamics to be the major risk factor for zoonotic disease emergence by increasing the risk of viral spillover from bats. Human behaviour and activities that increase exposure to bats will likely increase the opportunity for infections. Understandably, bats are not to blamed. Therefore, I would reiterate the implementation of a research culture of meaningful transboundary bat research networks (bat ecologists, conservationists, virologists, and public health), while maintaining an advocacy of “bats for peace” philosophy, promote bat conservation, and mitigate bat–human interactions. It will be wrong of me if I omit the ecological importance of bats and why their conservation is mandatory. They play an important ecological role in prey and predator (biological pest control), arthropod suppression, seed dispersal, plant pollination, soil fertility, and nutrient distribution. Bats are among the most overlooked species in spite of their economic and ecological importance, and hence, their conservation is mandatory. Human transgression of the natural bat habitats will play a crucial role in mitigating bat–animal and bat–human interactions and interspecies jumping of bat zoonotic viruses, including bat coronaviruses.
Thus, it is extremely clear that the destruction of biodiversity and habitat fragmentation is unequivocally opening a Pandora's Box for new disease outbreak to emerge. Don't we need a new discipline of planetary health, environmental humanities, and ecocentrism as opposed to anthropocentrism to secure ecobiodiversity and nature's law to foster a harmony, the well-being of humans, other living things, and entire ecosystems? Where is our collective consciousness in this regard? Our war and the lack of cohabitation with nature are the root causes to the emergence of pandemics. I would state that the “Grey Swan” of disease outbreaks and pandemics is an unprecedented wake-up call for cooperation for human health and biodiversity conservation as a part of environmental humanities. We need an activism to respect nature and earth systems and recognize its limits and curb human-induced environmental issues to mitigate the earth from plunging into a danger zone. Perhaps, this may have to start from the cradle as a prescription for cultivating environmental awareness ranging from preschool children, schools and colleges, the public community, governments, and policymakers.
| Biospheric Egalitarianism and Co-Existentialism: Human– Earth Systems|| |
”Humans neither can nor ought to denature their planet… On larger planetary scales it is better to build our cultures in intelligent harmony with the way the world is already built, rather than take control and rebuild this promising planet by ourselves… We do not want a de-natured life on a denatured planet.”
– (Rolston 2012)
To my mind, biodiversity and human health are intricately intertwined to each other. Human interference and transgression with “Human–Wildlife (Animal) Conflict” affect, both structurally and functionally, the ecosystem health with habitat fragmentation and loss of biodiversity. My musings center on this interdependence of human health and healthy ecosystems, as well as the ecosystem regulation of infectious disorders. It is only too clear that human transgression has resulted in our collision with Nature's Laws' habitat fragmentation, loss of biodiversity, and environmental degradation. It is an absolute reality to be fully aware that a war on the nature is ultimately a war against ourselves, as echoed by the pioneering 20th century conservationist Rachel Carson. “The reality is that we, human beings, have globalized the planet…we have stressed the environment, we have invaded the animal-human interface, we have allowed diseases to cross into humans and when those diseases do cross from animals to humans those diseases can amplify.” This has been so vividly portrayed in movies with the Nostradamus revelation of the invasion ecologies and kinetics of a pandemic disaster such as Outbreak (1995), Pandemic (2009), Carriers (2009), Contagion (2011), and the Indian-Malayalam Virus (2019), including the novel The Eyes of Darkness by Dean Koontz. This novel depicted the strange semblance to an artificial fictional bioweapon designated “Gorki-400,” (1981) and later called “Wuhan-400” in the 1989 edition. The human disruption of the global environment, “human–animal (wildlife) conflicts” are indeed behaviors that could readily spread microbes between people and from animals to humans, creating an imbalance that would guarantee a global surge in epidemics, perhaps even a pandemic. This narrative has been elegantly described in a 1994 book titled, “The Coming Plague: Newly Emerging Diseases in a World Out of Balance.”
Not succumbing to the prevalent ideologies of anthropocentrism, capitalistic society, neoliberalism, and geopolitical hegemony in the global community we live in, I am dwelling on the concepts of a postapocalyptic, postanthropocentrism ideology, which will embrace a paradigm shift of the human ethos to eco-biocentrism, environmental humanities, and environmental medicine. Should not humanity need to institute a new policy of “peaceful coexistence” with Mother Nature through Environmental Medicine and Humanities? I reiterate that through environmental humanities, we must pledge toward ecocentrism, environmental justice, and biospheric egalitarianism, perhaps I can refer this “Human–Nature Symbioses” or “Co-Existentialism” in Sanskrit as “Vasudhaiva Kutumbakam.” COVID-19 pandemic is the time to pause, reflect with collective consciousness, and call for the advocacy of the interdependence of human health and healthy ecosystems.
| Teaching Environmental Humanities in Medical School Curriculum: Preparing Physicians for the Future|| |
Being in the medical profession, I would reiterate that the COVID-19 pandemic should call for a renewed era for a “climate–environmental medicine” core curriculum in medical schools and public health curriculum, a rather neglected area in the traditional medical school training. I would vehemently state that it is time to advocate environmental humanities as a core curriculum in medical schools that underscores the concept of “planetary health education” and fosters ecohealth literacy. Such integrated health curriculum interventions right from the undergraduate medical education would foster necessary critical-thinking, participation in global health, and public health literacy, which I would reiterate are the necessary and essential physician skills in a rapidly changing Human–Earth System.
Our personal health does unequivocally involve planetary health, and therefore, I ruminate on the transdisciplinary areas of environmental humanities, ecosocialism, anthropocentrism and human transgression, ecocentrism, human–earth systems, climate and environmental medicine, outbreak and disaster medicine, disaster mental health, disaster and pandemic preparedness, and ultimately the global healthcare systems' preparedness. From the experiences of the past pandemics, the current COVID-19, and despite climate change health threats, these transdisciplinary disciplines are still a sorely neglected topic in the medical education and training systems and in public health. I stress the need for an integrated medical school core curriculum connecting the human health, the natural ecosystems, and the environmental humanities, all of which converge to the concept of planetary health which in turn will determine the sustainability and ecological civilization of the Anthropocene epoch. To my mind, the medical community must have the resilience and ingenuity to develop curricular shifts in medical schools enabling world communities to protect health, which will enable the next generation of effective physicians to mitigate climate crisis and environment-related health issues and the emerging infectious diseases as a broader exploration of this major public health emergency. Such curricular reforms involving the teaching of environmental humanities, pandemic (emerging infectious disorders stemming from human–wildlife contact/conflict) syllabus, and other integrated disciplines in medical schools are also a Healthcare story. Such reforms in medical school curriculum, competency skills training, continuing medical education along with faculty development, coupled with global policymakers and intergovernmental organizations to invest in the environment sciences and humanities, would fundamentally change the trajectory of human economic and social development, which will be a new reality for tomorrow as far as planetary and human health is concerned.
The COVID-19 pandemic has also changed the landscape of the traditional patient–physician encounter since physicians have now shifted from the “bedside to the webside” using the virtual platform of telemedicine. Therefore, I would also stress on preparing competent clinicians trained in telehealth education, informatics modules, virtual healthcare, and telemedicine, which would be ideal for the technoholic millennial generation, i.e., Generation Y and the postmillennial Generation Z.
| Bridging the Healthcare Preparedness Gap|| |
It will not be wrong for me to state that the current epidemic has exposed how global healthcare systems preparedness failed. This may be evident from the Global Health Security (GHS) index score among 195 countries. The warning lessons come from the data that the average overall GHS index score is 40.2 out of a possible 100, while high-income countries report an average score of 51.9. This strengthens the critical fact that the international healthcare systems/disaster medicine preparedness collectively remains very weak. Preparedness is one of the four phases of the disaster medicine cycle. The other phases include planning and mitigation, response, and recovery. From the COVID-19 overwhelming global healthcare systems unpreparedness, I pose certain questions. Should a disaster medicine preparedness, pandemic curriculum, and pandemic education be taught as a part of curriculum in the medical schools and right from undergraduate medical education? When I speak of healthcare (systems) preparedness, it should include disaster medicine preparedness, infectious disease and pandemic preparedness, as well as biological warfare and bioterrorism preparedness. In my view, the traditional clinical-oriented medical education has led to a huge gap between the knowledge level on disaster medicine and the current needs of disaster preparedness. Looking through the lens of a conspiracy theory or conspiracy reality as far as tracking down the origins of SARS-CoV-2 virus and patient zero (P0), these are now unprecedented times of global domination and unconventional warfare. I am forced to ask another vexing question – “How prepared are we for possible Bioterrorist attacks as far as our health systems and medical workforce are concerned?” This stark reality is due to the existing turbulence in global political economy, a trade war, and the world systems' ideological struggle for geopolitical hegemony. Having read books by political and military strategists such as “Unrestricted Warfare” and “Transfinite Warfare,” it is only quintessential to have core curriculums in medical schools that engagee training in bioterrorism and disaster medicine as an emergency critical preparedness in our future world.
Medical educators must engage in developing an innovative curriculum and pedagogical strategies in teaching disaster medicine preparedness as a comprehensive interdisciplinary curriculum for medical student education. The current knowledge gaps need to be researched and an innovative curriculum be proposed adopting critical areas for the course content, competency-based learning and implementation, and evaluation of disaster medicine preparedness among healthcare profession and medical students., Critical knowledge gaps in the knowledge (K), attitude (A), and readiness to practice (rP) of healthcare professionals, physicians, and medical students in disaster medicine are fertile area for research and should be a top priority area for disaster medicine education in the post-COVID medical in medical schools and medical educators.
Future education research should focus on developing interdisciplinary education to help disseminate disaster medicine topics across all 4 years of undergraduate medical schools. I would indeed reiterate that teaching disaster medicine preparedness, pandemic, bioterrorism, and disaster medicine as a critical emergency preparedness among medical specialties indeed need to be relooked as a priority discipline after this catastrophic global pandemic for the next generation of physicians. This will undoubtedly be the building blocks in disaster medicine management and close the gaps in emergency healthcare preparedness. Such reforms to identify critical educational gaps in disaster medicine preparedness will be instrumental to prepare and strengthen a cohesive, competent coalition of health workforce across nations throughout the globe. As medical educators, we have to realize the case for effective ethical education of our medical students with such core competencies as medical students are our future, our tomorrow's doctors. They will be the next generation who will have to deal with future pandemics, with much greater global healthcare preparedness.
| Thinking Beyond the Human|| |
”I believe that truth has only one face: That of a violent contradiction.”
– Georges Bataille
As I survive each day during this unprecedented and eerie times of Lockdown 4.0 in India with 'work from home' (WFH) and webside of Teleneurology/WhatsApp Neurology consultations (not the human touch of the 'bedside'), witnessing the human behaviour world across, I reflect on the human predicament. As humans going through this harrowing times of the viral pandemic tragedy, from a psychological view point of 'Kupler Rose Model', I wonder if the collective human sociological behaviour during this pandemic has become 'deeply irrational' and deeply illogical as we move through the pandemic. Is dealing with a 'new normal', a changing reality? Will this tragic era of human history create a 'lockdown generation'or a 'COVID generation' shaped by the sweeping behavioural changes in our personal and professional lives in 2020 (and beyond) be brought about by the coronavirus pandemic? Having read the book 'Man's Search For meaning' by Dr. Viktor E. Frankl, a Professor of Neurology and Psychiatry at the University of Vienna Medical School, the founder of the doctrine of 'Logotherapy' (1930), I draw some truths from Frankl's insights on Existential anthropology. Many ascribe the COVID 19 pandemic in parallel to the Pearl Harbour incident, World War II, and the Nazi Auschwitz Camp. The evil that Frankl suffered at the Auschwitz Camp was beyond his control, but his reactions to it were within his control. This concept gave birth to logotherapy, a system of healing through the search for meaning. I would certainly subscribe to Frankl's statement that “life is never made unbearable by situations, but only by a scarcity of meaning and purpose” even today during the COVID 19 pandemic. I believe we need to adopt a 'shared responsibility', “a collective human consciousness”, and “finding purpose” for our common humanity, a hope to live for harnessing humanity's best through learned optimism.
Looking beyond the “streetlight effect” to address the political landscape and ramifications of the COVID-19 pandemic is certainly intriguing. COVID-19 era will be a turning point in terms of capitalism, global governance and geopolitical hegemony. We still do not know who “patient zero” is. Perhaps 'truth begins in lies' and there is a war of information and disinformation on the origins of the SARS-CoV-2 virus. Is the Wuhan virology institute the origin of the SARS-CoV-2 virus? Is it a conspiracy theory or conspiracy reality regarding the origins of SARS-CoV-2 – a “zoonotic spillover hypothesis” from the Wuhan wet market or a BSL-4 “laboratory leak hypothesis?” Is it a genetically bioengineered virus? In the research arena of virology, I would raise my eyebrows for the ethical and philosophical consideration of 'Gain-of-Function' (GOF virology research) especially its risks and benefits of GOF research, and the need for to search for alternative research methodologies. The molecular technologies, such as reverse genetics, viral genome modification using the bacterial CRISPR-associated protein-9 nuclease as an editing tool are the basic premise of GOF experiments. GOF experiments would therefore be capable of generating viruses with increased virulence, transmissibility, and pathogenicity. This is a matter of debate and is arguably a high-risk, unjustified form of GOF- Proposed Research Involving Enhanced Potential Pandemic Pathogens (GOF/PPP) research. It is presumed that such experiments would help to develop new antiviral drugs, immunotherapy, and ultimately promote vaccine development. GOF/PPP experiments require BSL3/BSL4 (Biosafety Level) facilities. The Coronavirus 2019-nCoV is reported to contain a furin-like cleavage site that is absent in CoV of the same clade, and this important feature has not observed in other coronaviruses. It is quintessential to take cognizance of the increasing number of global high-containment biological laboratories (HCBLs) that work with biosafety level (BSL) 3 and 4 pathogens. This mandates that the highest level and most stringent of biosecurity measures to be implemented. Hence, to my mind, accidents due to human error in high-biocontainment labs does certainly seem likely for a pandemic threat, even among reputable scientists working in state-of-the-art laboratories. A question I would pose is “how likely is the research to result in benefits and how great would these benefits be, and how likely is the research to result in harm, and how great would these harms be?” Would enhancing potential pandemic pathogens in this manner is simply not worth the risk? I wonder if there are unequivocal compelling arguments that has been made for why these GOF/PPP studies are indeed necessary. In this context, I reiterate the importance of bioterrorism and disaster medicine. There is an absolute need to have a heightened awareness and to evolve effective training in order to achieve the preparedness for natural, intentional, or accidental disease outbreaks. This will undoubtedly improve the global nations' resiliency to infectious disease emergencies and disasters.
COVID-19 has underscored the fragility of human existence. My musings center on a philosophy of collective consciousness and Jungian collective unconsciousness on the human health–ecosystem health perspective. I reiterate, as a collective responsibility embracing our shared humanity, and collective awareness, that we inevitably need transdisciplinary medical education interventions to reconnect and revitalize the human–nature relationship toward the universal concept of planetary health. The earth does not belong to human beings, instead human beings belong to the earth, and ecocentrism and environmental humanities will be the way forward for a peaceful coexistence with nature, which will undoubtedly preserve the environmental biosecurity of nature, and the health of humankind.
In conclusion, I poignantly visualize the COVID-19 pandemic era as “living through an unprecedented biopsychosocial crisis,” and as a global citizen, as a medical academician, and as a physician, I must engage with a critical voice of reason, for the dire need for reshaping medical education. The pandemic has clearly shown many weaknesses in our healthcare system. To my mind, this must involve the teaching of environmental humanities, climate–environmental medicine, outbreak and disaster medicine; disaster medicine preparedness, public health preparedness, and telemedicine (telehealth) in medical school's curriculum as well as a national and global coalition for healthcare systems' preparedness and epidemic preparedness.
The various pandemics, and disease outbreaks, and the current raging storm of COVID-19 pandemic reflect humanity's dysfunctional relationship to the Earth's ecosystem, leading to collapse human–earth systems interactions. At death's doorstep, I would reiterate that we need to move away from the “hubristic ideologies of human powers” and the “hubris of anthropocentrism.” Instead we need to pave the way forward through the adoption of “humanities–social and natural sciences' disciplines.” Such insights from environmental humanities would go a long way to help us understand and engage with global ecological problems. It is only too evident that in the post-COVID 19 “new normal,” we need to “re-think beyond the human” on the future of humanism, models of transdisciplinary, human exceptionalism, and the philosophy of environmental humanities.
Similar to Viktor Frankl's logotherapy to rediscover the depth of humanizing effort to survive and resurrect from the Nazi concentration camps, we should galvanize and summon our irreducible gift of 'shared responsibility' through the transcedence mindset for human-nature-wildlife symbiosis and coexistentialism. I complete my editorial with an epilogue, where I wonder which of my philosophical musings are true (i) Those who do not learn history are doomed to repeat it or (ii) Is it just that human nature never changes or learns from unforgettable lesions? Will we learn? or, once past this crisis, will history repeat itself, simultaneously as a tragedy and a farce? Does human civilization suffer from an inability to conceptualise our future on this planet? The answers may emanate from evolutionary psychology. The evolution of our behavioral and moral tendencies posits that human nature is a chimera of “good” (sheer humanity, natural goodness, and determinism) and/or “evil” (human freewill) as propounded by Jean-Jacques Rousseau and Thomas Hobbes, respectively. Would there be an inherent quality in the human nature that has a propensity to extract all the good out of all the evil? Will this tiny SARS-CoV-2 virus empower Man's search for a renewed meaning of planetary health, and Human-Nature egalitarianism and co-existentialism? The answer to my intriguing question may lie in Viktor Frankl's quote “He who knows a 'why' for living, will surmount almost every 'how'.”
I am skeptical of the human nature, and hence, I end with another quote by Carl Gustav Jung which might either promise a better tomorrow or seal the fate of human civilization on planet earth. Nevertheless, a hope for a collective consciousness to harness humanity and shared responsibility is a worthwhile risk we must run and fight for. My pledge of sorrow and tribute to the known, unknown and unrecorded COVID-19 victims, as they are not just mortality figures, instead they were real people and real lives lost. Stay safe, Be resilient, Be healthy. Let us recognize the embodiment of a shared humanity. Being homo sapiens is evolutionary anthropology, but preserving the collective consciousness of humanity and 'being human' is our choice!
”The only danger that exists is man himself. He is the great danger. We are the origin of all coming evil. And we are pitifully unaware of it. We know nothing of man, too far little. His psyche should be studied. We need far more understanding of the human nature.”
– Carl Gustav Jung (1959)
| References|| |
Pike BL, Saylors KE, Fair JN, Lebreton M, Tamoufe U, Djoko CF, et al
. The origin and prevention of pandemics. Clin Infect Dis 2010;50:1636-40.
Barker T, Fisher J. Ecosystem health as the basis for human health. In
Water and Sanitation Related Diseases and the Changing Environment: Challenges, Interventions, and Preventive Measures, JMH Selendy, P
Farmer, and W Fawzi (eds), 2nd
ed, Ch.19. John Wiley & Sons, Inc. USA. 2019, p. 245-70.
Goralnik L, Nelson MP. Anthropocentrism. In: Chadwick R, editor. Encyclopedia of Applied Ethics. 2nd
ed., Vol. 1. San Diego: Academic Press; 2012. p. 145-55.
Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, Daszak P. Global Trends in emerging infectious disorders. Nature 2008;451:990-3.
Daszak P, Cunningham AA, Hyatt AD. Emerging infectious diseases of wildlife--threats to biodiversity and human health. Science 2000;287:443-9.
Pongsiri MJ, Roman J, Ezenwa VO, Goldberg TL, Koren HS, Newbold SC, et al
. Biodiversity loss affects global disease ecology. BioScience 2009;59:945-54.
O'Gorman E, Van Dooren T, Munster U, Adamson J, Mauch C, Sorlin S, et al
. Teaching the environmental humanities: International perspectives and practices. Environ Humanities 2019;11:427-60.
Finkel ML. A call for action: Integrating climate change into the medical school curriculum. Perspect Med Educ 2019;8:265-6.
Wellbery C, Sheffield P, Timmireddy K, Sarfaty M, Teherani A, Fallar R. It's time for medical schools to introduce climate change into their curricula. Acad Med 2018;93:1774-7.
Barrimah I, Adam I, Al-Mohaimeed A. Disaster medicine education for medical students: Is it a real need? Med Teach 2016;38 Suppl 1:S60-5.