Evan Lee and Jon Bastow*
‘Hyperdarwinism’ is the word that’s come into use to describe the moments in evolution where we adapt or evolve in a quantum shift to a changing environment. The extinction of dinosaurs, humans’ development of tools, the industrial revolution etc are moments of dramatic evolution that interspersed times of more gentle or progressive evolution.
COVID-19 looks like one of those moments of hyperdarwinism in the making and we explore below how different cultures are adapting as many countries around the world start ‘Edging from Lockdown to post-lockdown’ .
We get an initial clue from the term used: “Lockdown” has been used in the US – a harsh sounding term that is usually associated with violent settings such as prisons and shooting drills, while France and Spain have used the term: “confinement” and “confinamiento” – connoting containment, which is defined as :”keeping something harmful under control”[1]. Perhaps this may give us some understanding as to how different countries and cultures experience the transition to the next phase of living with and managing the pandemic?
First - on the science, which is still very much evolving. There have been studies that indicate that there is a significant portion of individuals who are asymptomatic, which has a number of implications: first - that there could be more ongoing transmission within the community than at first may appear just by looking at the number of ill individuals who are diagnosed, and second - that the actual risk of falling severely ill or dying may be less than we originally thought. Furthermore, there is evidence that the risk of transmission to others may diminish fairly quickly - as soon as 5-8 days after initial infection even for people who fall ill.
And yes, there are high hopes that a vaccine could be the golden bullet we need. Some of the biggest bets ever made on health technology are being made in the vaccine area where more than 110 potential vaccines are being developed. There are also close to 200 treatments being considered, and numerous new diagnostics on the market - with more on the way.
Although WHO are understandably reluctant to make any policy statements based on this science or on the state of the vaccine pipeline for fear of encouraging reckless behaviour, there are some reassuring aspects that will help in the short-term as restrictions are progressively lifted: This Economist piece draws from experience from other coronaviruses - including those that cause the common cold, and summarises some ‘basic science’ principles about immunity - pointing out that on the one hand, although there may be more widespread immunity within communities (as measured by the presence of antibodies), that there are unknowns as to the degree and duration of protection that this means in practical terms, but concludes that the state of science currently has: “no lead to offer” for government leaders.
Countries are therefore compelled to balance evolving health policy advice with economic considerations as they make big decisions involving trade-offs between their economies and the well-being of their populations.
Furthermore, these decisions are being made at a time when the level of global debt has hit a new high. Doubtless these debts will be restructured and in some cases written off and overall this major fiscal ‘correction’ may change the relative economic strength of countries going forward. How will natural and human assets be valued and how will environmental considerations be incorporated? Is it possible that COVID is the wake up call that finally causes a change from consumerism to a more sustainable way?
As two expatriates, living in the Geneva area who have worked on global health issues across the NGO, UN, and private healthcare sectors, we thought it would be useful to comment on the outlines of the guiding frameworks that the US, France, and Switzerland have put forward as they attempt to gradually re-open their countries.
From this sample, we see how these reflect the known character traits of the different countries. The US guidelines are quite top line with lots of imperatives, but one wonders on how these will be implemented and complied with in a culture which is highly individualistic! The French guidelines are prescriptive but conditional, with plenty of caveats and exemptions which are simultaneously thoughtful… but convoluted. And the Swiss guidelines are a bit of both, describing the principles yet wonderfully pragmatic, stating what you can do vs. what you CAN’T do.
As French residents who spend time in Switzerland and abroad, we’re seeing that the days of a tactile culture will be over for now as France encourages the widespread use of masks alongside hand sanitisers.
Elderly and at risk populations (with comorbidities such as cardiovascular disease) will face more restrictions going forward, such as restrictions on them returning to work or undertaking higher risk activities such as shopping and accessing medical care. Yet they are also the group that need more access to medical care and retail products. Perhaps France could look to Canada who have done particularly well at developing plans for children, elderly and adults, recognising their different needs.
Beyond that it is also paramount to consider everyone's mental health as highly sociable beings who have to live with less physical contact. Looking to our children, we see platforms such as Houseparty, and Discord, being used to connect in yet new ways alongside Facebook, Skype, and Zoom. How will we use these alongside more traditional tools such as phones to connect and communicate as we find our “new normal”? And how will they fit in our lives alongside having to re-connect physically in adapted ways? How will things like international travel, communal gatherings such as sport and music, working remotely look in this new normal?
As Sovereign authorities aim to address the pandemic and motivate their citizens to adopt behaviours that move us beyond ‘lockdown’ to functional economies, we will all as individuals have to adapt to this evolving world order - while still looking for ways to find solidarity while making significant lifestyle changes.
Good luck and may we all thrive and survive!
* Authors
Evan Lee is a Geneva-based consultant and an expert in global health policy. He has previously worked for pharmaceutical company Eli Lilly, the Foundation for Innovative New Diagnostics (FIND), Management Sciences for Health and Medicines Sans Frontieres. A medically qualified doctor by training, he has a BA in chemistry and physics from Harvard University, a medical degree from New York University School of Medicine and an MBA from Massachusetts Institute of Technology.
Jon Bastow brings over 30 years of experience in healthcare, having led R&D projects in diseases such as Alzheimers, psoriasis and cancer and led access initiatives for infectious diseases such as malaria, multiple sclerosis and diabetes. He has held senior roles in pharmaceutical companies and international organisations such as FIND and the Global Fund, building partnerships between private sector healthcare and tech companies, NGO’s and governments addressing major problems of poverty. Jon is a member of the Chartered Institute of Marketing, holds degrees in Biochemistry and Philosophy and has given lectures at IMD, London Business School, INSEAD and the Graduate Institute in Geneva.