The traps of calling the public health response to COVID-19 “an unexpected war against an invisible enemy”

The theory of miasmas popular in the 1800s accepted the notion that a poisonous vapor or mist made up of particles from decomposing material could cause disease. In the early twentieth century the miasma theory was replaced by the germ theory, further verifying the cause of infection—not particles, but germs. In the last two hundred years, scientists provided ample evidence for real disease-causing agents—bacteria, protozoa, viruses—and the role of humans in unleashing multiple routes of transmission.

Scientists and public health workers made tremendous strides to produce vaccines, treatments, and preventive measures to create the barriers against spreading infections. Yet, the progress depends on continuous targeted efforts in reducing factors that lead to the wide spread of infections. Notably, the most devastating infectious outbreaks are typically amplified by the man-made conditions, like poor hygiene and sanitation, crowding, malnutrition, civic unrest, and income inequality.

From the start of the COVID-19 pandemic, news, media, and specialized literature circulated images of a coronavirus—an agent causing corona virus infectious disease (COVID-19). Reputable sources, such as the US Centers for Disease Control and Prevention (CDC), had posted highly magnified, digitally colored transmission electron microscopic images that revealed ultrastructural details exhibited by a single, spherical shaped, Middle East respiratory syndrome coronavirus (MERS-CoV) virion [1]. No mysteries, no invisible, just need of a powerful microscope and experts able to create an illustrated visualization aiming to inform and educate the public about the disease. Why then the insistence on the ‘invisible’ even figuratively? And why especially when these images are produced by a reputable organization, such as the United States National Institute of Allergy and Infectious Diseases (NIAID)?

This colorful 3D rendering of a spiky fuzzball has spread around the world as fast as the infection. The ‘mug’ shots isolated a culprit, one that has been targeting human health, and demanding global response. The virus became an enemy and joins the list of ongoing wars on obesity, guns, cancers. I wonder if along with calling for attention to important public health matters we are also shifting the focus to demonizing pathogens, narrowing of our understanding of disease transmission, and diluting human responsibility for acquiring, carrying, and distributing disease among ourselves. By blaming the virus, humans appear to be less culpable for failures in early warning, detection, planning, programming, interventions, and for creating conditions for a virus to thrive. In the twenty-first century, even a metaphoric use of an invisible enemy, recklessly amplified by those with the access to large audiences, denies the knowledge and progress achieved over 200 years of science.

Many common infections, such as influenza (flu), salmonellosis, and rotaviral infections, manifest themselves by seasonal outbreaks. Flu is notorious for reminding us with remarkable consistency that humans are part of a complex evolutionary process. In this process, resilient species are not those better at fighting against others but rather those who are better at living with others. The concept of tolerating an infection, an evolutionary-ingrained strategy, is not new. Steady worldwide growth in life expectancy and quality of life has been achieved by reducing exposure to pathogens, improving nutrition, and implementing vaccination programs. Seasonal infections are the consistent reminders of ongoing evolution. The human genetic makeup reflects a process in which selection of specific Human Leukocyte Antigen (HLA) types amounts to a footprint of thousands of years of building evolutionary-based tolerance—that protects humans. We are who we are because of the centuries of evolution and several decades of active boosting of immune responses with vaccines. Well-designed vaccination strategies offer well-controlled boosts for humans’ immune systems-and these drive future health responses to seasonal outbreaks. By understanding the seasonal disease patterns, we learn how to make vaccination strategies efficient: when and whom to vaccinate and how to measure the success and failures. By anticipating seasonal reoccurrence of COVID, we should find ways to protect the public and provide services our communities deserve.

Communities and their governing systems, which we, humans, have built, can amplify and dampen the outbursts of infection. We, humans, are creating conditions in which the distribution of risks among those exposed is unequal. We, humans, are making the decisions about how to distribute protective gear, mobilize fiscal resources, or train medical personnel [2]. When the decision chain works correctly, we all receive the right protection according to the dose, intensity, and duration of potential exposure. Yet, when the decision chain is broken or not even established, a sudden search for an invisible enemy starts, and war rhetoric easily pushes forward an invisible culprit. The slogan of ‘war on a virus,’ is easy to turn into a war on scientists, reporters, whistleblowers [3]. The rhetoric of war is divisive and distracts from challenges of finding solutions and building consensus.

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