1- Editorial: COVID-19

Editorial: COVID-19

Said Shahtahmasebi, PhD

radisolevoo@gmail.com

[citation: Shahtahmasebi, S. (2020). Editorial: COVID-19. DHH, 7(2): https://journalofhealth.co.nz/?page_id=2147].

New Zealand has just been declared to be free of COVID-19 and the government has lifted the lockdown (https://www.bbc.com/news/world-asia-52961539). However, if the government’s priority changed from protecting the economy to also protect the public against the virus then it failed on both count. The question is whether New Zealand could have managed the virus without damaging the economy sooner? I believe so.

The economy has been one of the key factors in winning a general election. The sole emphasis to protect the economy and the fear of damaging the economy often attenuates plans to address social and/or health issues in an election year. In particular, the government’s early attempts to stop the spread of COVID-19 were significantly slow to the point that it seemed a lockdown was inevitable. As late as mid-March 2020, there were travellers from known COVID-19 epicentres (USA and Italy) freely touring New Zealand without having to quarantine and without face masks. However, a lockdown could have been avoided and the economy might have been protected with a more stringent control of the borders, together with other behavioural changes such as mandatory face masks, and more testing for COVID-19, over and above testing of those who presented with symptoms, based on statistical sampling over time, e.g. random samples selected by age and gender and post-code.

In an editorial (Shahtahmasebi, 2017) the issue that we are not prepared for the impending changing world was raised. It was argued that change cannot be avoided because of the evolutionary nature of our world. However, we can accept “change” as the key factor in our planning – and accept that processes such as social, economic, health, and the environment etc. are dynamic. Furthermore, how one process behaves and changes affects other processes both directly and indirectly and over time (Shahtahmasebi, 2006). In other words, developing, for example, social policies – must be directly in conjunction with policies for the economy, environment, health, transport, education and political processes. Otherwise, policies will have a short shelf life only affecting a proportion of the population, and will be prone to crises and failure, e.g. see (Shahtahmasebi, 2019a, 2019b).

In New Zealand, and presumably the rest of the world, COVID-19 has dominated life over the past several months and continues to do so. All forms of media is still concentrating on COVID-19 with particular reference to national and global economies. There has been no mention of other news items which had dominated the media before the lockdown such as conflicts, war and destruction, plight of refugees, and current affairs.

In the context of policy development, it appears that the economy and the environment are a contradiction in terms. The current political belief equates improvements in our environment to economic sacrifices that may lead economic crisis. The common global concern is that in order to improve the environment; local and world economies have to be sacrificed. There are no models to predict patterns of economy if social, health, economic and environmental policies change in favour of the environment. Yet the assumption is that social, health, and environmental friendly policies will impose greater financial impact on the economy. The reason for this is a lack of data and the unwillingness of governments to experiment with the economy because of the fear of damaging the economy in the process. To truly understand the relationship between the economy and the environment we need longitudinal data not only on economic outcome measures but also public health, education, environment, and so on. Such an experiment has been deemed socially and financially prohibitive. So the world has been slow to react to environmental changes.

But it is possible to collect such data and develop environmental-economic appropriate and relevant policies if economic or environmental policy development is viewed and processed as part of a holistic approach to decision making (Said Shahtahmasebi, 2006).

Understandably, the usual approach to such phenomena is to intervene. During the pandemic and the global defence of lockdown against COVID-19 we observed experts making recommendations, microbiologists explaining the virus and pandemics, and epidemiological models being developed to predict the virus’s pattern. Most of the efforts have been directed on understanding how the virus may behave. But, to understand the virus we need more data than just the number of cases and number of deaths. These models do not tell us anything about patterns of economic behaviour. To understand the effect of the pandemic we need to understand ourselves. In other words we need more information over and above epidemiological data.

Globally, count data show the rapid progression of COVID-19 followed by an exponential death rate. But, there are wide variations between and within countries. For example, the lag-time in infection rates in some countries, such as USA, UK, Italy, Spain and Brazil, has turned lead-time, where infection and death rates these countries due to COVID-19 are now the highest in the world. This lag-lead-time effect is, at least in part, due to the lack of preparedness for change, and therefore, differences in the timing and nature of interventional policies adopted by each country. On the other hand we do not know how COVID-19 mutates, and whether as a result it becomes stronger or weaker. Furthermore, we don’t really know who is affected and how badly – all we know is that the virus affects older people more aggressively.

However, circumstances beyond our control have forced a major economic crisis upon governments around the world. Social lockdown was inevitable, even in those countries who did not take such a decision, because major economic powers such as China had no choice but to close off their borders to slow down the pandemic. It seems that the world was caught off guard by the virus and reacted as circumstances dictated.

The world economy has taken a major hit and is in crisis, and, it seems all efforts have been concentrated on getting the economy to pre COVID-19 levels, including ending or breaking the social lockdown rules prematurely.

Certainly, having protection against COVID-19 will increase the chances of returning to “normal” economic activities sooner. So another global reaction has been to concentrate international attention onto developing a vaccine for the virus. The question arises how often will we have to intervene and spend time and resources in search of a vaccine given the ever changing world? Can the New Zealand economy, or the world economies, sustain another lockdown?

The world has been, and still is reacting to a phenomenon but not as part of wider decision making plans. A policy development process need not be a reactive intervention. The good life holistic approach (Shahtahmasebi, 2006) while placing an emphasis on the economy also allows the contribution and influence from other processes such as health, social, and the environment. Thus, resulting policies will meet short-term needs as well as being flexible to be responsive to the medium- and long-term requirements of the population. Of course, high quality and relevant data is essential in order to follow the good life holistic approach.

For example, Figure 1 shows an example of processes that have over time influenced decision outcomes. Clearly, we have very little knowledge as to how these processes operate and may be related to each other. Furthermore, there may be other processes (greyed out symbols in Fig. 1) acting either as a filter between the main processes, and/or are the result of the interactions between them.

However, the silver lining to the COVID-19 pandemic is the provision of information on the socio-economic, economic, environmental and political processes and how these processes may interact. These data assist with quantification of models arising from the good life approach and also support the conceptualisation of the holistic approach (Said Shahtahmasebi, 2006). So modelling can begin by using the new information to theorise and quantify the conceptualisation of an unified database and support holistic policy development (Shahtahmasebi, 2016; Shahtahmasebi & Liddell, 2011; Shahtahmasebi & Millar, 2013).

In this issue of DHH two articles will present and discuss some of the issues related to the social and behavioural aspects of COVID-19 – see (Allabadi et al. 2020, Shahtahmasebi 2020).

Figure 1.

Brief explanation of Fig.1: the Good Life approach assumes that each process is only bounded by its relationship with other processes; some relationships are known and some are not (greyed out areas). The point being that food, health, environment, or economy cannot be the focus of attention without the other processes (for full details see Shahtahmasebi, 2006).

References

Shahtahmasebi, S. (2006). The Good life: A holistic approach to the health of the population. ScientificWorldJournal, 6, 2117-2132. doi: 10.1100/tsw.2006.341

Shahtahmasebi, S. (2016). The information paradox: researching health service information systems development. International Journal of Computers in Clinical Practice (IJCCP), 1(1), 28-41.

Shahtahmasebi, S. (2017). Editorial: are we ever ready for change? Dynamics of Human Behaviour, 4(4), https://journalofhealth.co.nz/wp-content/uploads/2017/2011/DHH_Editorial-Dec-2017_Said_BC.pdf.

Shahtahmasebi, S. (2019a). Suicide prevention strategy: buzzwords and personal opinions. Dynamics of Human Health (DHH), 6(2), https://journalofhealth.co.nz/?page_id=1838.

Shahtahmasebi, S. (2019b). “Wellbeing” approach: flawed politics or a gimmick? Dynamics of Human Health (DHH), 6(2), https://journalofhealth.co.nz/?page_id=1830.

Shahtahmasebi, S. & Liddell, J. (2011). Learning through the life span: a conceptual virtual simulation model. Health Care and Informatics Review Online, 15(2), http://www.hinz.org.nz/journal.

Shahtahmasebi, S. & Millar, R. (2013). Conceptualising the Future of Health Informatics: A Discussion. International Journal of Informaiton Science (IJIS), 3(3), <http://article.sapub.org/10.5923.j.ijis.20130303.20130304.html>.

Shahtahmasebi, S. (2020). COVID-19 in a social context. DHH, 7(2):

Allabadi, Hala.; Dabis, Jennifer.; Aghabekian, Varsen.; Khader, Amer.; Khammash, Umaiyah. (202). Impact of COVID-19 lockdown on dietary and lifestyle behaviours among adolescents in Palestine. DHH, 7(2):