当前位置: X-MOL 学术Sociology of Health & Illness › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Comparing West Nile Virus and COVID‐19
Sociology of Health & Illness ( IF 2.957 ) Pub Date : 2020-11-06 , DOI: 10.1111/1467-9566.13193
Kristoffer Whitney 1 , Sabrina McCormick 2
Affiliation  

In 2013, we wrote a Sociology of Health & Illness article as part of a special issue on ‘Pandemics and Emerging Infectious Diseases.’ We focused on the first U.S. occurrence of West Nile Virus (WNV) – the 1999 outbreak in New York City – and used the disease as a case study in the creation of Public Health Emergencies by governments, to understand both their immediate effects and long‐term consequences.

At the time, West Nile Virus was the first infectious disease to be formally declared an emergency by the U.S. Federal government. This declaration had long‐term consequences for State‐level action on WNV and public health infrastructure in the long‐term. On March 13th of this year, the President of the U.S. declared COVID‐19 a nationwide emergency. Given the similarities – and differences – between these diseases and the U.S. government’s response, this seems an important time to compare the two and reflect on what the novel coronavirus may mean for American citizens and populations worldwide now and in the future.

First, an important caveat: West Nile Virus and the novel coronavirus currently wreaking havoc across the globe are very different. The former is vector‐borne (spread by mosquitoes), the latter is infectious. We’ve had much more time to understand the transmission, symptoms and treatments for West Nile, whereas understanding and treating COVID‐19 remains a steep, and deadly, learning curve. And though the statistical understanding of the novel coronavirus remains in flux, the cases and fatality numbers for the two diseases just in the U.S. make the differing scale of the problem very clear: since the 1999 outbreak through 2018, there were 50,830 total reported cases of West Nile Virus, and 2330 deaths. As of this writing (on the 10 of August, 2020), the Johns Hopkins Coronavirus Resource Center puts the number of confirmed COVID cases at 5,044,864, with 162,938 deaths and a case‐fatality rate of 3.2%.

That said, what we found with West Nile Virus may have important applications for COVID‐19. In our original article, we argued that…‘the construction of crisis as a state of emergency…allows those in power to assert social and technological control over populations by implementing practices that would, under normal circumstances, require public deliberation…[enabling] potentially marginalising crisis interventions. These interventions…outlast the initial moment of crisis to become the structurally favoured solution thereafter’. This argument is related to a number of similarities and differences between WNV and the coronavirus.

First is the initial confusion at the outset of these epidemics. In the case of WNV, the virus in question was initially misidentified by the U.S. Center for Disease Control (CDC) as most likely St. Louis Encephalitis, only to be correctly identified by the U.S. Army’s Armed Forces Institute of Pathology after the peak in human cases. Analysts after the fact described this confusion as a result of the lack of communication between different public health agencies and, in this instance of a zoonotic disease, ineffectual communication between human and animal health agencies. And today, analysts like Princeton political scientist Tali Mendelberg describe the relatively slow and patchwork response to COVID‐19 in the U.S. as a result of America’s multiplicity of agencies related to health and disease, with no clear chain of command (exacerbated by a relatively weak response by the current Federal administration).

Also similar is the lack of preparedness for these two illnesses – indicating a public health infrastructure that is ill‐suited to the nature of the disease or simply ineffectual. In the case of WNV, mosquito management was the structurally favoured solution, which resulted in pesticide spraying that may have created additional long‐term health effects. And the many ways in which health systems in U.S. States and the Federal government were underfunded and not prepared for COVID has resulted in higher death rates in the short term, at least.

This lack of robust and appropriate public health infrastructure has had disproportionate effects on people of colour and marginalised communities. The City of New York used its emergency powers to enact a rapid regimen of possibly unnecessary and toxic pesticide applications, involving the ground and aerial spraying of malathion over the entire city multiple times. Marginalised communities spoke out against this action, feeling the City’s response was too rapid – enforcing a dramatic control measure with little notification and no deliberation, possibly just trading one risk (infection) for another (malathion exposure). Although the communities involved are different, and the frequent critique of the U.S. government now is that it has been too slow to react, we again see marginalised communities bearing the brunt of the emergency and of the structurally favoured response (or lack thereof) – in the case of the coronavirus, vulnerable populations, communities of colour and those in institutions like prisons and nursing homes have been disproportionately affected by COVID‐19.

Given the differences in scale, it is difficult to tease out the implications of these similarities and differences. But one paradoxical suggestion of the responses to disease outbreaks like WNV and COVID in the U.S. is that the decentralised nature of the public health system can be both a liability and an opportunity. As we pointed out in our 2013 article, there were other options for WNV response other than the blanket spraying of pesticides that New York City chose. In the state of Connecticut, adjacent to New York, a much more limited spraying regime was able to maintain a very low rate of human infection, and as WNV spread across the country, different states and regions were able to adopt and adapt different strategies for containment. Similarly, while the lack of a centralised, coordinated response to the coronavirus has been problematic in the U.S., it also provides the opportunity to learn from cities and regions that have done a better job of containing COVID‐19 over the past months. New York, once the epicentre of the epidemic in America, can now serve as both a cautionary tale and a model for states like Texas and Florida seeing massive spikes of infections in the wake of ‘reopening’.

Finally, the selective attention paid to experts and public health expertise (even including military science) plays a role in the response measures (again, or lack thereof) in both cases. If we had anticipated these emergent vector‐borne diseases – as climate scientists had been projecting prior to WNV – or listened to the military scientists who, for example, warned of our unpreparedness for a coronavirus outbreak years ago, we may have saved many lives.

As we argued with regard to WNV, understanding public health emergencies in the past is an important part of learning and planning for emergent diseases in the future. And given the longevity of public health infrastructure, investing in expertise and protecting the marginalised now will help structurally favour the voices and lives of our most vulnerable citizens during this and future pandemics.



中文翻译:

比较西尼罗河病毒和COVID‐19

2013年,我们撰写了《健康与疾病社会学》文章,作为“流行病与新兴传染病”专刊的一部分。我们集中研究了美国首例西尼罗河病毒(WNV)-1999年在纽约市的爆发-并以该病为例研究了政府在创建突发公共卫生事件中的作用,以了解其即时影响和长期任期后果。

当时,西尼罗河病毒是美国联邦政府正式宣布为紧急情况的第一种传染病。长期而言,该声明对国家一级对非传染性病毒和公共卫生基础设施的行动产生了长期影响。今年3月13,美国总统宣布COVID-19为全国性紧急情况。考虑到这些疾病与美国政府的应对措施之间的相似性和差异性,现在似乎是比较两者并反思新型冠状病毒对现在和将来全球美国公民和人口可能意味着什么的重要时刻。

首先,一个重要的警告:西尼罗河病毒和目前在全球范围内造成严重破坏的新型冠状病毒截然不同。前者是媒介传播的(通过蚊子传播),后者是传染性的。我们有更多的时间来了解西尼罗河的传播,症状和治疗方法,而了解和治疗COVID-19仍然是一条陡峭而致命的学习曲线。尽管对新型冠状病毒的统计理解仍在不断变化,但是仅在美国,这两种疾病的病例和死亡人数就清楚地说明了问题的不同程度:自1999年爆发至2018年,报告的病例总数为50,830西尼罗河病毒死亡2330人。撰写本文时(2020年8月10日),约翰霍普金斯州冠状病毒资源中心将确认的COVID病例数定为5,044,864,

就是说,我们发现的西尼罗河病毒可能对COVID-19具有重要的应用。在我们的原始文章中,我们认为……“将危机构建为紧急状态……使当权者可以通过实施通常情况下需要公众审议的做法来主张对人口进行社会和技术控制……[有可能]边缘化危机干预措施。这些干预措施……在危机的最初时刻延续到后来成为结构上受青睐的解决方案”。该论点与WNV和冠状病毒之间的许多相似之处和不同之处有关。

首先是这些流行病开始时的最初混乱。就WNV而言,该病毒最初被美国疾病控制中心(CDC)误认为是最可能的圣路易斯脑炎,但此后仅由美国陆军武装部队病理研究所正确识别在人类案件中达到顶峰。事后的分析人士称,这种混乱是由于不同的公共卫生机构之间缺乏沟通,而在人畜共患疾病的情况下,人与动物卫生机构之间缺乏有效的沟通。如今,普林斯顿大学的政治学家塔利·门德尔伯格(Tali Mendelberg)等分析师表示,由于美国与卫生和疾病相关的机构众多,指挥链不清晰(相对较弱的情况加剧了),因此对美国对COVID-19的响应相对缓慢且错落有致当前联邦政府的回应)。

同样,缺乏对这两种疾病的防备措施-表示公共卫生基础设施不适合该疾病的性质或根本无效。就WNV而言,在结构上偏爱采用蚊子管理解决方案,这导致喷洒农药可能对健康产生进一步的长期影响。而且,至少在短期内,美国和联邦政府的卫生系统资金不足且没有为COVID做准备的许多方式导致了更高的死亡率。

缺乏健壮和适当的公共卫生基础设施对有色人种和边缘化社区造成了不成比例的影响。纽约市利用其紧急权力迅速制定了可能不必要和有毒农药应用的快速方案,包括在整个城市多次地面和空中喷洒马拉硫磷。边缘化社区表示反对该行动,感到纽约市的反应太快了–采取了戏剧性的控制措施,几乎没有通知,也没有进行商议,可能只是将一种风险(感染)换成另一种风险(感染了马拉硫磷)。尽管所涉及的社区有所不同,但美国政府现在经常批评它进展太慢为了做出反应,我们再次看到边缘化社区首当其冲,受到紧急情况和结构上有利的响应(或缺乏响应)的首当其冲–就冠状病毒而言,弱势群体,有色人种社区以及监狱和疗养院等机构中的人们受COVID-19的影响不成比例。

考虑到规模上的差异,很难弄清这些异同的含义。但是,对于美国应对WNV和COVID等疾病暴发的反应,一个反常的建议是,公共卫生系统的去中心化性质既可以是责任,也可以是机会。正如我们在2013年的文章中所指出的那样,除了纽约市选择的全面喷洒农药外,还有其他应对WNV的选择。在毗邻纽约州的康涅狄格州,更为有限的喷洒方式能够维持极低的人类感染率,并且随着WNV在全国的传播,不同的州和地区能够采用和适应不同的策略遏制。同样,尽管缺乏集中化 在美国,对冠状病毒的协调反应一直存在问题,它也提供了向过去几个月在遏制COVID-19方面做得更好的城市和地区学习的机会。纽约曾经是美国流行病的中心,现在可以作为一个警示故事,也可以作为德克萨斯州和佛罗里达州在“重新开放”之后看到大量感染激增的典范。

最后,在这两种情况下,对专家和公共卫生专业知识(甚至包括军事科学)的选择性关注在应对措施中(再次存在或缺乏)都发挥了作用。如果我们曾预料到这些新兴的媒介传播疾病(如气候科学家在WNV之前所做的预测),或听军方科学家的警告,例如,几年前我们对我们没有做好冠状病毒爆发的准备,我们可能挽救了许多生命。

正如我们在WNV方面所争论的那样,了解过去的公共卫生突发事件是将来学习和计划突发疾病的重要组成部分。鉴于公共卫生基础设施的使用寿命长,现在对专业知识进行投资并保护边缘化人群将在结构上有利于我们在此乃至未来的大流行中最脆弱的公民的声音和生活。

更新日期:2021-01-08
down
wechat
bug