Читать книгу The Social Causes of Health and Disease - William C. Cockerham - Страница 8

Coronavirus (COVID-19) unleashed itself on the world in the fall of 2019 in Wuhan, China, a city of 11 million. It subsequently spread across the globe as the most widely contagious pandemic yet to come since the Spanish flu of 1918. By the summer of 2020, over 10 million people were confirmed to have been infected, more than 500,000 were thought to have died, and trade and travel were severely disrupted on a global basis. Final tallies on the disease’s deadly and varied effects are not available as the pandemic is ongoing as this book goes to press. However, it was nevertheless clear at the time that COVID-19 ranks as an event of historic proportions. Nearly every country in the world was affected, air travel and cruise ships were shut down, public gatherings cancelled, businesses and schools closed, stay-at-home orders issued, unemployment soared, and the 2020 Olympics postponed for a year.

Does the “social” have a causation role with respect to COVID-19? The answer is clearly “yes,” as seen in the stringent requirement for “social distancing” (keeping away from other people) and the likely causal trail. Early information indicated that the coronavirus originated in bats in China that likely infected an anteater-like creature known as a pangolin. The evidence comes from testing the genome sequence of the coronavirus in bats and pangolins, which was found to be almost identical with the virus’s genome in infected humans (Andersen et al. 2020; Zhou et al. 2020). If the coronavirus had stayed isolated among bats and pangolins in the wild, it would have remained a biological anomaly. But it didn’t. As a result of urbanization, globalization, and climate change in recent decades, wildlife habitats have been affected and exposed various species to greater contact with humans (Armelagos and Harper 2016; Cockerham and Cockerham 2010).

At the point pangolins became infected, the “social” began to take over as a cause of the pandemic. Pangolins are a desired food delicacy in China and sold in Wuhan’s Huanan Seafood Wholesale Market where live wild animals can be purchased for human consumption. Just as the SARS (severe acute respiratory syndrome) pandemic of 2002–3 began in China’s live wild animal “wet” markets, coronavirus apparently took a similar transmission path from bats through animals (pangolins instead of civets and raccoon dogs) to reach humans in a crowded marketplace. Lax health and safety regulations, combined with ineffective local government inspections in such markets, likely made transmission easier. Regardless of where it originated, a human became sick. The first case (the so-called patient “zero”?) was allegedly a 55-year-old Chinese man in Hubei Province where Wuhan is located. He was hospitalized in mid-November 2019 with a previously unknown pneumonia. By December 8, there were more patients.

No public alarm was sounded until December 30, 2019, when Dr. Li Wenliang, a 34-year-old ophthalmologist at Wuhan Central Hospital, began noticing some of his patients had a viral infection. He thought it was a reoccurrence of SARS and began alerting his colleagues through social media. The Wuhan police took Dr. Li into custody the first week of January 2020 for spreading a false rumor. They required him to sign a confession admitting his alleged deception before releasing him. A month later (February 7), he died from the coronavirus after catching it from a patient he was treating for glaucoma, becoming one of the real heroes of the pandemic.

A travel ban to and from Wuhan was issued on January 23, 2020, but by that time, infected Chinese had traveled to cities throughout the country and abroad. The Wuhan Municipal Health Commission informed the World Health Organization on January 31 of an epidemic caused by a new virus that was initially named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). WHO changed the name to COVID-19 on February 12. By mid-February, the coronavirus had erupted into a full-scale epidemic, centered in Wuhan, infecting some 90,000 people and killing at least 4,600 in China while dispersing worldwide through tourism, business travel, and community spread. The Chinese government took Draconian measures to restrict people inside their homes, close whole regions of the country to travel, and mobilize medical resources to test for the virus and treat it as best they could since no cure was available. By mid-March, the situation in China improved.

Yet other countries began having severe problems, especially Iran in the Middle East and Spain and Italy in Europe. The problem in Italy, as it was in China, was a late start in isolating affected areas and restricting movement. The first known patient, a 38-year-old man in the Lombardy region in northern Italy, had not been to China and was thought to have contracted the virus from another European. He refused hospitalization and went home before returning a second time, infecting several people at the hospital and others he visited, conducting an active social life and playing on a soccer team while contagious. The spread of the disease was so quick that in the next 24 hours some 36 additional patients were admitted to the hospital, none of whom had any direct contact with the first patient. Out of some 234,000 confirmed cases in Italy in late spring 2020, more than 34,000 died. Spain had even more cases, nearly 287,000, with fewer than 30,000 deaths. Britain later moved to the top in deaths in Europe and then Russia.

The United States, with its large number of international visitors and travelers, was impacted the most. Nearly 2.5 million people were confirmed as infected by late June with over 126,000 deaths. However, the number of cases changes daily as the pandemic is ongoing and are likely to be even higher by the time this book is published. The coronavirus first appeared on the West coast in the state of Washington, and soon after that, California. The hardest-hit state was New York, with more than 30 percent of all cases nationwide. COVID-19 apparently arrived there by way of a traveler from Europe. By late June, New York’s more than 395,000 confirmed cases were greater than those of most countries except the US as a whole, Brazil, Russia, and India. Males were more likely to be infected than females and older people age 65 and above with pre-existing health problems such as obesity, hypertension, heart disease, diabetes, dementia, atrial fibrillation, and chronic obstructive pulmonary disease (COPD) were especially subject to infection and death. Nursing homes were major sites for infection, with about 20 percent of all deaths nationwide. Fortunately, children were the least affected. One reason Italy had such a high mortality rate was because of its large, disproportionately elderly population. The final story on the 2019–20 coronavirus pandemic has yet to be written at this time, but it serves as an example of the social causation of disease as “social distancing” and “stay at home” measures become the primary means of preventing infection, or conversely, acquiring it through close social proximity.