COVID-19 — the numbers

It is December 16, 2020, approximately 1 year since the start of this global pandemic. The COVID-19 pandemic has run unchecked, wave after wave of death, suffering, and despair. Today, the “Numbers” are unfathomable: 74 million COVID-19 cases worldwide and 1.6 million deaths globally. In the United States alone, we have almost 17 million COVID-19 cases and more than 300,000 deaths. Brazil has 7 million COVID-19 cases and close to 200,000 deaths. 10 million cases in India with 150,000 deaths. Europe has over 20 million cases and 470,000 deaths. The “Numbers” alone cannot capture the scope and depth of the fear, pain, loss, grief, and trauma of this global human tragedy. The pandemic has exposed many flaws in our civilization's culture and civil societies: poverty, hunger, and inequity in access to and provision of adequate health care. It has also exposed, in my opinion, profound damage to the basic human moral virtue of “Trust.”

Shattered trust and the pandemic

“Trust” is the firm belief in the reliability, truth, ability, or strength of someone or something. During the COVID-19 pandemic, our “Trust” in government, public health policy, science, and each other has been profoundly tested. In many circumstances, “Trust” has been shattered. We all live in societies where we rely on our governments to, at the very least, keep us safe. Some of us live under autocratic leadership, with limited freedoms, while many of us live in civil societies with representative democracies, free elections, and a free press. We rely on our leaders, particularly freely elected leaders, to have our best interests at the forefront of their decision making. We certainly expect our freely and democratically elected leaders to enact public health policies, during a deadly global pandemic, that are guided by the best science and public health expertise. I believed, my entire life, that I lived in such a democracy. I was wrong. With only 4% of the globe's population, the United States has 20% of COVID-19-related deaths! How did that happen in the world's wealthiest economy and most advanced scientific and technologic infrastructure? The answers are shocking and sobering. As a medical human rights advocate, I have long been aware that the United States has always failed, and continues to fail, in fulfilling the United Nations Declaration and World Health Organization's Declaration of Human Rights calling for access and provision of medical care to its citizens as a basic human right. We have at least 30–50 million Americans who have no health insurance whatsoever, and tens of millions more who are under-insured or have limited access to health care. Given the fact that we are the world's richest country, we have staggering levels of poverty, food insecurity, and homelessness. Our economy has the largest degrees of wealth inequality of any developed country in the world. This has only worsened under the recent tenure of our current President and Republican-controlled government. The rich have become richer, and the poor have become poorer. The COVID-19 pandemic has horrifically uncovered the gaps in our health care system and the multiple systemic injustices in our country.

What we have now learned, after a year of suffering and death related to the COVID-19 pandemic, is that decisions, regarding public health policies to mitigate against the spread and lethality of the pandemic, have not been transparent and have not been solely driven by the best public health science available. Policies around mandates for wearing masks, social distancing, and other mitigation strategies were manipulated by our government, at federal and at many state levels, for political and economic objectives and goals. Decisions were made based on factors that would benefit leaders in power to stay in power and be reelected. Decisions were made to protect the economy, particularly the rich. Most shockingly, however, is the recent revelation that the United States was surreptitiously pursuing a strategy of promoting the spread of COVID-19 under the misguided and scientifically unsound goal of achieving “herd immunity.” This resulted in a massive death toll of genocidal proportions. We were lied to. We were lied to repeatedly and with no shame. Crimes against humanity have been committed here in the United States. And while this surreptitious policy of achieving herd immunity through promoting the spread of COVID-19 in the United States was taking place, we had a President who tweeted that “doctors and health care workers and hospitals are only trying to make money off of the pandemic!”

Trust and the COVID-19 vaccine

Now the vaccine! In an amazing scientific achievement, a highly effective and apparently safe set of COVID-19 vaccines have been developed in record time. As of mid- December, health care workers have been receiving vaccinations with the Pfizer-BioNTech COVID-19 vaccine. A similar messenger RNA vaccine developed by Moderna has just been FDA approved in the United States. More vaccines are coming. But now the world will face another crisis of trust. Can we trust “Science”? Did politics cause scientists and governmental agencies to cut corners and not thoroughly or adequately test the safety and efficacy of these vaccines? Will the vaccine be distributed in an equitable and scientifically/public health appropriately guided and sound process? Given the history of “broken trust” in medicine for so many people of color in the United States and the broken trust of how our governmental leaders have managed the COVID-19 pandemic to date, these questions are legitimate. They are also a profound obstacle to successfully vaccinating the necessary percentage of our population to finally put an end to this pandemic. From all the available scientific data, the Pfizer and Moderna vaccines appear to be highly effective and very safe. Ending the COVID-19 pandemic now seems to come down to “A Matter of Trust.” All of us in healthcare must recognize that trust needs to be restored.