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No epidemic has affected the rich more than the poor

2020-10-21T13:04:43.937Z


Diego Armus, doctor in History from the University of California, investigates covid-19 as a political and cultural phenomenon and recalls how other diseases such as tuberculosis were linked to a social class


Diego Armus, doctor in History from the University of California and professor of Latin American history at Swarthmore College (United States), investigates the disease as a political and cultural phenomenon.

Armus is Argentine and in a book he wrote about tuberculosis in Buenos Aires, he portrays how it was linked to a social class, a definition of woman and even a type of tango, “la milonguita”

(

La Ciudad Impura: Salud, Tuberculosis Y Culture In Buenos Aires, 1870-1950

, is the title of his research).

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Question.

One of their arguments is that diseases become a public concern when they affect those in power.

It exemplifies the Chagas disease that has sickened and killed for almost a century in Latin America.

Answer.

It is a communicable disease, distinctive of the rural and semi-rural poverty of many regions in South America.

A problem that the poor, the common people, accept as a fact of daily life.

But now it is reaching the northern hemisphere and there are voices that propose to speak of

the Chagas disease epidemic

.

Malaria is another example.

People lived with malaria and accepted it, "well it's like that", until the political power, for whatever reasons, began to take notice of "it."

Q.

What lessons can we draw from this to deal with covid-19?

R.

Little.

I am reluctant to seek teachings in history.

Perhaps the historian of public health can identify in the past instruments to develop better public policy, but the historian of the disease learns to beware of generalizations.

Each epidemic is unique, resulting from a microorganism and the way a society confronts, reacts and interprets it.

Also, the present is not a good student of the past.

History can point to a road map, but nothing more.

Q.

What history does teach is that epidemics are the kingdom of uncertainties.

R.

The first thing to do is recognize and learn to live with uncertainties: those things for which I have a question but cannot formulate an answer.

Articulating a political, public health response, amid the uncertainty brought by a new epidemic such as COVID-19, is a brutal challenge.

P.

In addition to uncertainty, another pattern that characterizes epidemics is that they do not affect everyone equally.

R.

Epidemics are not democratic.

They can affect everyone, but those who die the most are the poor, the most vulnerable.

There is no epidemic that has affected the rich more than the poor.

Q.

A characteristic case in Latin America is the cholera epidemic that occurred in Peru in the 1990s. Then, 2,909 people died and the worst hit populations were rural areas and the Amazon, due to their lack of access to drinking water and adequate sewer network.

A. This case shows how little some countries learn from their health crises.

If you follow the news about covid-19, it seems that nothing was understood about the cholera epidemic, because the drinking water infrastructure network is still as precarious as in the 90s in Peru.

Q.

What strategy should be followed to combat covid-19 in Latin America?

R. In many countries of the periphery what was tried to do, and Argentina is a case, was to use the same resources that Europeans are using.

As if Argentina were a middle class country.

That perspective can work - and only up to a point - in Buenos Aires.

In Greater Buenos Aires the situation is different and it is horrible, with almost 50% of the population below the poverty level.

So the anti-epidemic agenda to mitigate the contagion needs to be localized.

Sierra Leone's cities are not middle-class cities, Liberia's are not;

in Vietnam, in Ho Chi Min City, overcrowding is no exception.

But in those countries epidemiological surveillance, so far, has yielded good results.

It seems to me that there is something in Latin America that is not working well, and do not ask me for a very convincing explanation because I do not have one.

Q.

In mid-September, Martha Lincoln, a health anthropologist, wondered about the role of "arrogance" when it comes to combating covid-19.

R.

More than arrogance, what affected authorities and scientists in France, Italy, England, especially at the beginning of the pandemic, was the recognition of their own perplexity in the face of the tsunami, which is an epidemic.

The State that manages to develop an awareness of health civility in society has already won a first battle.

New Zealand is doing it in its own way.

And Vietnam, where according to the news the health civility is remarkable.

The reality is that at this juncture they are much better.

And it seems that these achievements have to do with another matter: an epidemic is a marathon, not a 100-meter race.

To run it you need a good dose of confidence to collectively navigate in the middle of a fog that affects everyone.

If uncertainty is assumed, if society and government understand that the page cannot be turned so quickly, then building confidence in what public health can do and science becomes a political priority.

Everything indicates that in the Far East they have partly succeeded.

Q.

The African case also stands out, where some countries learned about Ebola.

R. Do you think that in Sierra Leone and in Liberia there are many more doctors or ventilators?

No, but they have managed to consolidate, even in the tremendous scarcity of resources, instruments that allow nurturing and reproducing a health civility: epidemiological surveillance networks at the community level, based on health agents and not necessarily doctors, who are key figures in the effort. to mitigate the contagion.

Q.

You speak of the "dramaturgy of the disease."

What do you mean?

A. All epidemics share a kind of dramaturgy that begins naturally with the denial of what is happening.

Recall that the Covid-19 was also denied, even very progressive sanitarians said that it was a problem in the north, that the problems in the southern countries were others, such as measles and dengue.

Luckily, they soon understood that these two epidemics had to be added that of covid-19.

After that first act, that of denial, comes the second, where, for whatever reasons, contagion and the fear of contagion are so obvious that you have to take charge.

Then society and culture begin to interpret, in the midst of uncertainty, what is happening.

This largely discursive moment is very specific to each epidemic and disease.

In the Middle Ages, the heresies of some served to explain the epidemic scourge and also the concomitant punishments.

In Brazil, with AIDS, the first interpretation that emanates from power is that it is a punishment for the large presence of homosexuals in society.

Then we enter the third act of the dramaturgy: the interventions arrive, destined to try to control the contagion.

They are interventions that do not always produce results.

In fact, there are many cases of epidemics that, after wreaking havoc, fade in their lethality.

The last act is that of forgetting, as happened with the 1918 influenza pandemic, which killed between 50 and 100 million people, but no one spoke of it a couple of years after it was over.

With AIDS, in Brazil and the world, this last act has not arrived.

Q.

What happened?

A. AIDS has become a kind of chronic disease, for which there are treatments but no vaccines.

This must be borne in mind, because we want to think that we will soon come out of this pandemic with a vaccine.

And yes, vaccines may be on a not too distant horizon, but when they arrive they will present immense problems of logistics and accessibility, and with them inequities between rich and poor nations, and, within all nations, between rich and poor.

The

original version

of this interview was published by the Center for Journalistic Investigation (

CIPER

) of Chile, and in

The Conversation Spain.

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Source: elparis

All news articles on 2020-10-21

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