Thoughts on global public health and consequences after corona

Mina Bulbul Hossain and Mohammad Nazmul Hada

The whole world seems to have been brought to a standstill. The coronavirus has brought everyone together. Basically we need the same standard of global health and education structure. Now the question that comes into our minds is that do the lower-class people today not understand the meaning of quarantine, or did scientists and researchers never want to understand the human language?

We are stunned that neither artificial intellect nor the arrogance of nuclear weapons can help us. Instead, we have been humbled by the need to wash our hands with soap. One percent of the population owns trillions of dollars while millions of people are malnourished and don’t have access to water or toilets. 

How will they wash their hands? This inequality in the construction of civilization did not happen overnight, it has a long history hidden behind it.

In today's neo-colonial world, dealing with coronavirus can be more complex deal than at any time in the past. So it is important to talk about how the relationship between colonialism and power has affected the spread of these pandemic diseases and the history of the post-disease world.

While alaria, black plague and smallpox, among other pandemics gave birth to the world's deepest and longest-running illnesses, cholera is the most infamous amongst them. Cholera alone led to seven pandemics, the first of which is ‘The Great Bengal Cholera’.

Cholera has been rampant south of the Ganges Basin for a long time. Almost everyone defecates in the open. The more water pollution flows from the top to the bottom, the more the number of patients increases. This was referenced in our villages for thousands of years in stories and novels.

Objections started when the disease spread beyond the subcontinent. The pandemic, which began with the Bengal cholera, continued to hit Europe throughout the nineteenth century. 

The aristocracy of Europe was then crushed by the ‘barbaric’ disease. Cholera is easily contracted by factory workers who live in unhealthy environments and extremely low living standards. Like any other part of the world, rich people then start blaming them and deprivation, oppression and prohibition begin.

Cholera in Bengal brought prosperity to Europe after its death and destruction. Gradually a new branch of knowledge was created there - modern public health, sanitary engineering was developed alongside it. New policies were made, laws were formulated. Not all of this is due to the spread of cholera. But there is no doubt about its influence.

Although those countries are successful, the "backward" subcontinent is still battling cholera and other waterborne diseases. Almost two hundred years later, when Bangladesh became open defecation free in 2015, nearly 40 per cent of people in India were still using open defecation. 

So the question arises, though the coronavirus might be removed from the western countries in a while but will it be removed from the whole world? Or will the poor countries have to carry the mark for a long time?

The strange thing is that today the message of washing hands is urgently needed to save mankind. This simple but very effective life-saving technique had to go through many trials to get recognition as a 'scientific fact'. The easiest way to fight germs was discovered by Ignaz Semmelweis.

The Hungarian scientist had a degree in medicine from the University of Vienna and later became an obstetrician. Physicians at that time were anxious to reduce infant and maternal mortality rates across Europe. In 1847, the scientist concluded that healthy mothers had died of postpartum fever after being infected by doctors who had touched other corpses.

At the same time, he told the clinic that doctors should clean their hands with chlorinated lime (calcium hypochlorite) between two consecutive visits. This bleach he used was based on a lot of speculation. 

It was through this that he was able to get rid of the dead-organic stench completely. The practice of hand washing by doctors brought a wonderful result to the Vienna Clinic. Very quickly the death rate in the clinic came down to almost zero.

The then medical community strongly opposed Semmelweis ‘proposal. Not only did they dismiss the fact that mothers died in childbirth due to lack of care, but they also started mocking Semmelweis. In contrast, Semmelweis continued to attack the medical establishment in Europe. Critics also compared the only book written by Semmelweis to Theology, which failed to become science.

At one time he became tired of waging a war in science. As his behavior became increasingly incoherent, he ended up in Vienna insane asylum. Semmelweis wanted to teach people how to wash their hands, but in the end, in a state of utter despair, he was beaten by the guards in a dark room and died tragically.

The story of Semmelweis greatly affected all of us including Khairul Alam, a journalist from Pachuria, and pushes Abdul Gaffar Chowdhury (living legend and country’s eminent columnist) in different ways about this global pandemic. It has contributed to the creation of values of empirical knowledge throughout history. This story also questions the conventional statement of knowledge construction and recognition. It indicates elitism hidden in the world of epistemology.

After a long time, however, the issue of hand washing is now officially recognized as an important hygiene component of public health. Hygiene, combined with water and sanitation, has been read and practiced as a 'wash' intervention. Just as there is now talk of repeated hand washing to prevent the coronavirus, it should be seen as a great opportunity to make it a habit all the time, especially in underdeveloped and developing countries where poor people are at high risk of contracting the disease.

Research says that only proper hand washing can halve the death rate from diarrhea. We also understand how difficult it is for scientists in countries with weak power structures to innovate. But the truth is that low cost and easy life saving food saline was made from our country.

There has already been a lot of talk about how effective the West's 'social distancing' or 'stay at home' process is in poor countries like ours. People have left their homes for various reasons besides economic reasons. Even garment workers are protesting. Evidence of human irrationality is found everywhere from Brahmanbaria, Bangladesh to Michigan in the United States.

So the failure of the various methods of dealing with corona is not only due to the illiteracy and superstition of the people of South Asia. On the contrary, modern economics rarely sees people as rational beings, and there has been a lot of research on the irrational workings of people around the world.

Nobel laureate Daniel Kahneman is famous for his many works related to Psychology of Judgment and Decision Making. One of his various empirical findings is the loss aversion theory - in simple terms, it is to avoid loss rather than profit. For example, people think it is more convenient not to lose 500 taka than to get 500 taka.

Instead of saying “if you use the toilet, your health will be better” it’s more effective to say “if you do not defecate in the open, you will have more diarrhea, you will have to go to the doctor, it will cost more money”. 

The result of saying this has been proved in Bangladesh. These led to the success of a movement called Community Led Total Sanitation (CLTS). In the same way, instead of saying “stay at home to prevent the transmission of coronavirus, you will avoid the disease” it’s better to say “if you go out, your risk of dying will increase”.

Millions of people gathered at the funeral of a religious leader in the lockdown. We need to analyze and explain the irrational behavior of the gathered crowd. Because of the optimism bias in thinking, people think that negative events are less likely to happen in their life. The people in the gathering may also think that they will not be affected by corona.

Maybe they were wrong in risk measurement. Since people do not understand the actual probability of being infected, they are doing comparative measurements. One might think they are less likely to be infected than others because he is a good or pious person.

Such bias can also come from self-imposed stereotyped thinking. Many people think that the people from different faiths are more likely to get infected coronavirus - here people are comparing themselves to imaginary 'bad' people. Needless to say, this thinking is unreasonable.

Having enough information about yourself makes it easier to think of yourself as a person. Another reason may be to magnify ourselves. Corona will not come to Bangladesh, because there is a lot of religious discussion here. Here Bangladeshis are imposing desire and result on themselves. People think they can control events. Thus optimism bias can be created due to various factors.

We need to think about people's irrational behaviors as well as rewarding lockdowns by rationally helping poor people with food or money. For this, people need to be given the right information and a kind of optimism bias can be created with the importance of staying at home. This is a scientific step which has no alternative.

Mina Bulbul Hossain is a Public Health Specialist, Chemist and Environmental Analyst

Mohammad Nazmul Hada is Manager (Administration), West Zone Power Distribution Company Ltd