Cerebral musings on environmental humanities, human transgression, and healthcare preparedness: Looking beyond the “streetlight effect” of the COVID-19 pandemic
2020; Medknow; Volume: 8; Issue: 1 Linguagem: Inglês
10.4103/amhs.amhs_99_20
ISSN2321-6085
Autores Tópico(s)Geographies of human-animal interactions
Resumo"Man is a part of nature, and his war against nature is inevitably a war against himself." – Rachel Carson "A policeman sees a drunken man searching for something under a streetlight and asks what the drunk has lost. He says he lost his keys and they both look under the streetlight together. After a few minutes, the policeman asks if he is sure he lost them here, and the drunker replies, no, and that he lost them in the park. The policeman asks why he is searching here, and the drunker replies, "This is where the light is." – The Streetlight Effect COVID-19 PANDEMIC: THE IMPACT OF EMERGING INFECTIOUS DISEASES AND THEIR POWER OVER HUMANITY Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an 50-250 nm diameter tiny virus, has unbelievably "locked-down" the world, and undoubtedly inflicted a humanitarian crisis of epic proportions. Indeed a public health crisis of global proportions, a crisis of health inequity, and global health systems pandemic unpreparedness. The cataclysmic effect of the COVID-19 pandemic has left indelible imprints on the psyche of the humankind despite the widespread acts of human solidarity to mitigate the viral pandemic. It has not only jeopardized the global economy, enforced more than half of humanity in lockdown, but also has tragically caused an insurmountable catastrophic loss of human lives and the livelihoods of millions. COVID-19 pandemic now poses a monumental challenge to humanity in the 21st century. The pandemic has exposed many unprecedented challenges for all of humanity such as the viral pandemic per se, an economic pandemic (economic meltdown), a psychological pandemic (psychiatric, neuropsychiatric and mental healthcare, psychological effects of a COVID-19 'Cabin fever'), and a human behavioural pandemic (going through the phases of the Kupler Rose Model, the social and behavioural change to the pandemic, and acceptance of the 'new normal'). COVID-19 is certainly the most devastating, apocalyptic humanitarian catastrophe, and global healthcare (systems) preparedness crisis of this century. Have we the humankind learned valuable lessons from the history of pandemics? What can we learn from human responses to epidemics and pandemics in history? What insights can ecological and environmental humanities' perspectives provide? Does the human civilization not seem to have a "déjà vu" from the pandemics that have afflicted humans in recent times, such as SARS and MERS? Will COVID-19 generate sustained and intensified global health preparedness for emerging infectious diseases, resulting from dysfunctional interconnectedness of humans, animals, and ecosystems? Perhaps, from civilizational epidemiology of the human race, it is very apt to reflect on the quote "We learn from history that we learn nothing from history" as echoed by Georg Wilhelm Friedrich Hegel and later George Bernard Shaw. Therefore, the critical inner voice that haunts my mind, out of fear, curiosity, and inquiry is "Will humanity's inability to learn its lessons from a history of pushing the boundaries of our 'finite' ecosystems to yet another apocalyptic pandemic triggering 'human annihilation' from the Mother Nature?" Is it going to require a new wave of collective consciousness, or will it need a new world to adopt a different way of thinking beyond the human? In this context, I foresee the future of "Anthropocene–The Human Epoch" by the quote, "You are either part of the solution or part of the problem." Human pandemic history is indeed in a crisis. Pandemics has impacted and reshaped the human history; however, despite "writings on the wall," and the 'technicolour' human experience gained from the "retrospectoscope" of pandemics history, we have have ignored lessons from the past with plague of Justinian (541–740 AD), The Black Death (1347–1353), Smallpox (15th–17th century), Cholera (Peak 1817–1823), Influenza Spanish Flu H1N1 (1918–1919), Hong Kong Flu H3N2 (1968–1970), HIV/AIDS (1981), Severe Acute Respiratory Syndrome (SARS: 2002–2003), Swine Flu (2009–2010), Ebola (Peak 2014–2016), Polio, Measles, Malaria, and Typhus.[1] Despite the tremendous advances in molecular biology, emerging infectious diseases, and epidemiology, I would say that several lessons were not learned, the main reason being the inertia and failure of effective global public health systems, disaster and outbreak medicine, pandemic/disaster preparedness, disaster management systems, and the sheer lack of global healthcare systems preparedness. By visualizing the history of pandemics, coupled with our societal philosophy of capitalism and neoliberalism, the follies of humankind centered on the "unpreparedness" in these crucial areas are so evident even in the times of an absence of a crisis. This, to me, has resulted in a failure of a "shared responsibility" in the "global health solidarity" and "security in global health." I would reiterate that there is no stability without solidarity and no solidarity without stability. The current raging "Black Swan" of the SARS-CoV-2 (COVID-19), "a once-in-a-century-pandemic," has now posed to be a global biosecurity emergency and a humanitarian crisis the planet has witnessed after the World War II. I see humanity on the brink. In the medical warzone of COVID-19 with society immobilized and overwhelmed hospitals, the stark reality of pandemic death is a painful tragedy of being alone, in isolation, and unable to reach out and comfort those who mourn, those who are facing imminent death, no goodbyes, no human touch, and to gather and honor their deaths by being able to be with their loved one's bodies as a connection for a healing grief and bereavement. The flip side of this tragic milestone is the dying in complete solitude, the deaths in isolation, deaths without goodbyes, burial without rituals, and mass burials. There are innumerable emotional and harrowing stories of pain, solitude, fear of "death prowls," dying alone, and sufferings "at the gates of hell" in COVID-19 intensive care units. Another emotional catastrophe and a tsunami of human grief is to see the obituary sections in the local Italian newspapers stretching to over 10 pages; coffins overflowing; waiting list for funeral services, virtual funerals emanating from laptops or smartphones, expressing sorrow through digital space without a hug or a human touch, all of which are emblematic of the most basic human empathy at times of this catastrophic bereavement. We have witnessed the harnessing of humanity to battle and navigate the uncharted COVID-19 pandemic. This solidarity is certainly in resonance with "A Song in Storm" poem written by Ruyard Kipling that I dedicate as a tribute to the COVID warriors, to the fallen global medical heroes, and COVID-19 victims. "No matter though our decks be swept And mast and timber crack We can make good all loss except The loss of turning back." In fact, after the various pandemics, the world has witnessed in the past, and from the pandemic-centered movies such as "Contagion" with striking semblance to the COVID-19 pandemic, I would rephrase that the SARS-CoV-2 pandemic is in fact not a "Black Swan," not an unforeseen catastrophe, instead a "Grey Swan" being a known unknown. Heeding Mother Nature's warning from the previous global pandemics and disease outbreaks was virtually abysmal on the part of humanity. In the future of human civilization, these emerging infectious diseases and disease outbreaks, which we are certain to witness, will only become a "White Swan" event. I vividly recollect the how the world rejected Peter May's manuscript of his novel 'Lockdown' in 2005 as the thriller concept of H5N1 (bird flu) affecting London with a lockdown being imposed was just out of the world idea then. To my surprise, this novel is now published (April 2020) since the storyline parallels the current COVID-19 Lockdown 2020. Indeed this novel is now the top 10 bestseller. The human race should not suffer from "global amnesia," not learning from the lessons of the past pandemics, and become the advocates of the "Cassandra dilemma." This editorial is a "firework of ideas" based on the Pollyanna principle to see beyond the "streetlight effect" by "thinking through environmentalism," "the human–nature systems," and the "environmental humanities". I believe that humanity and nature are inseparable and that our personal health does unequivocally involve planetary health and ecohealth. To my introspective mind, this chapter of COVID-19 pandemic is not just a global pandemic, instead represents a critical point, a reflective and contemplative moment of our collective consciousness to ponder on the symbiotic interconnectedness of human environment-animal (wildlife) interface and in a broader perspective 'The Earth-Human System' interactions. We need to question the "human hubris of anthropocentrism," the very purpose of human existence, in relation to ecosystems health, and realize how we are on a collision course between the human species and environmental and nature's ecosystems. My musings in this editorial does indeed represent my 'Sehnsucht' to endorse biospheric egalitarianism for 'planetary health' concept of 'Healthy people, healthy planet'. It is essential that we teach environmental humanities from schools to medical universities as a core curriculum to increase awareness of the real danger ahead in our Earth-Human systems. Only then can steps be taken to turn us away from the abyss. NATURE'S "WRITINGS ON THE WALL" AND HUMAN TRANSGRESSION: A WAKE-UP CALL "We can no longer exploit the resources of this earth—the trees, the water, and other natural resources—without any care for coming generations. Common sense tells us that unless we change, we won't survive. This Earth Day let's resolve to live in harmony with nature." – Dalai Lama (50th World Earth Day Tweet; April 22, 2020) It is indeed, to my cerebral musings, that we heed to nature's 'writings on the wall' and it is hightime to galvalnise a health research coalition to address the Human environment-Wildlife ecosystems not only from the global governmental and inter-governmental organizations, but I underscore the need for a curriculum change from the medical educational perspective. This connectome of concerted efforts will be the key to ensure a both biodiversity conservation and safeguard sustainable future of planetary health. During these unprecedented and apocalyptic times of COVID-19, the humankind is indeed navigating the uncharted unknowns. Humanity is on the brink as COVID-19 pandemic has assumed proportions akin to a medical warzone. In this context, I do not wish to look for the "keys under the lamp post," instead look beyond the "streetlight effect" of this pandemic. First, during these eerie times of the COVID-19 pandemic, my mind stands testimony to the COVID-19 infodemics, Pandora's Box of COVIDdences (the knowledge gaps, both the known unknowns and unknown unknowns, including the ethical misconducts and lack of scientific rigour leading to the retraction of scientific papers from the prestigious Lancet and NEJM journals), and the COVID-19 elephanomics not only justifying to me the limitations of our scientism but also painfully unraveling "the science of uncertainties." It is poignant for me to realize that Modern medicine certainly has progressed so much, yet so little to offer in the COVID-19 pandemic. Second, as an awakening of anthropocentric spirituality, I am reminded of the English poet John Donne's 400-year-old poem titled, "No Man is an Island" "No man is an island entire of itself; every man is a piece of the continent, a part of the main;…" Should not humanity need to institute a new policy of "peaceful coexistence" with Mother Nature through Environmental Medicine and Humanities? Thus, my perspective unravels the "Forgotten Truths" on the triple frontier of human transgression (anthropocentrism), biodiversity loss, and pandemics. Emerging infectious diseases and pandemics is a wakeup call for a paradigm shift from a human-centric anthropocentrism (human centeredness) philosophy to embrace "eco-biocentrism" (nature-centered living). This will undoubtedly restore the delicate balance of "The Earth–Human System." Finally, I wish to see a new "post-COVID 19" reality, a renaissance in global healthcare systems and medical education that incorporates "holistic, inter- and trans-disciplinary connectedness" of environmental humanities, environmental (climate) medicine, disaster medicine, and earth ecosystems health that fosters in connecting the dots to link global ecosystem health as the basis for safeguarding human health, healthy living, and planetary health.[2] I reiterate our "shared humanity" to learn, unlearn, and relearn the concept of "human–nature connectedness" that is quintessential in sustainability science, conservation biology, environmental humanities, environmental (climate) medicine, and medical education. RESPECT FOR NATURE'S LAWS "Nature no longer runs the Earth. We do. It is our choice what happens from here." – Lynas, 2011 I pose a reflective question on the philosophy of environmentalism – "Is the COVID-19 pandemic Mother Nature's response to human transgression?" I would state that anthropocentrism, the lack of understanding of the "human–nature connectedness," and environmentally responsible behavior for biodiversity conservation, the "human–wildlife conflict" are fundamentally the pristine factors for the various emerging infectious disorders and disease outbreaks, ultimately making us vulnerable to pandemics. While pondering on the age of human environmentalism and the loss of respect for an independent nature, human–animal relationship, and the Earth ecosystems, I am distressed by the degradation of Earth's ecosystems and its consequences to global human health security and global public health security. The worldwide lockdown has given evidence to underscore how the magnitude of human activity takes a toll on the delicate earth's climate systems. Lockdown has decreased air pollution and greenhouse gas emissions because of reduced transportation, electricity generation, and industrial production. An unbelievable environmental change in air quality index has been recorded over the UK, Italy, and China with even record dip in air pollution indices across various Indian cities. The coronavirus lockdowns has shown that the Earth is healing as evidenced by the Ganges water being sparkling clean, the snowcapped Himalayan range being visible from towns in Punjab and from the Singhwahini village in Bihar, and has indeed also cut global carbon emissions by more than 8% so far. Climate-related infectious disease outbreaks, vector-borne illnesses, respiratory diseases, cardiovascular diseases, and cerebrovascular disorders such as stroke, dementia, and mental health are just the tip of the iceberg afflictions linking climate adversity and human health. I underscore the need to dwell on the future trajectory of humankind by engaging in sciences, humanities, and philosophies that will galvanize the interconnectedness between human health and planetary health, which I would state are nothing but the offshoots from the wellsprings of holistic medicine to a personal and public health perspective. We need to build bridges between health care, public health, and medicine that will embrace a much broader ecologically-informed perspective on human health, that the health of each of us is connected to the health of our planet, and the need to harmoniously reintegrate of our human relationships with nature. To put it simply and effectively, I would reiterate the undeniable fact that human health is intricately and inextricably connected to our planet's ecosystem health. THE HUBRIS OF ANTHROPOCENTRISM TO ECOCENTRISM: UNSETTLING THE HUMANITIES Humans have the belief that they are the dominant species on the Earth coupled with their scientific materialism. Humans believe that Nature is nothing but physical matter rationally organized according to physical law but devoid of any "laws of Nature" and that the human enterprise are the only masters of Nature. I pose this question, "Is Nature to be considered as only a warehouse of resources to serve human needs?" The philosophy of environmental ethics would be able to give a transcendental inquiry to this question. Another intriguing question would be, "Is our destruction of nature responsible for COVID-19 pandemic?" Anthropocentrism (humanocentrism; human centeredness) refers to a philosophical world view where human beings are seen as superior to other living and nonliving things.[3] It justifies the exploitation of nature for the sake of human welfare. On the other hand, enlightened (humanistic) anthropocentrism is a world view that says humans have ethical obligations toward the environment but those can be justified in terms of obligations toward other humans. On the contrary, ecocentrism rejects the notion of human superiority, shifts to a biocentric outlook on life, and is more inclined to advocate the "doctrine of species impartiality." Therefore, ecocentrism emphasizes a nature centered, as opposed to human centered (i.e., anthropocentric), which fundamentally revolves around a system of values that follow the doctrine of "biospherical egalitarianism" and "species egalitarianism." These concepts of environmental ethics only go to strengthen the environmental philosophy that humanity and nature are not separate (human–nature harmony), and life as an entanglement unified in a biocentric world concept of human–earth system's integration. Human-induced environmental issues and expansion of human activities into the natural landscapes have now intruded into every aspect of the environment on a global scale, extending through the whole planet putting biodiversity conservation into jeopardy. Such anthropogenic factors, especially human transgression and fragmentation of wildlife habitats, have undoubtedly caused environmental degradation, habitat fragmentation, and biodiversity loss, resulting in "human–wildlife conflict" as well as an earth systems crisis. The global habitat fragmentation, degraded landscapes, and habitat loss with the disrupted ecosytem inevitably drive the wild animals out of their natural habitats and bring people into closer contact with animal species they never may have been near before.[4] The human transgression (deforestation, logging, mining, road building, wildlife hunting, wild animal trade, and bush meat trade) reduces the natural barriers between virus host animals and humans, encouraging the transmission of pathogens from animals to humans. The bush meat, including bat bush meat and game meat, and wild animal trade certainly have created increased opportunities for the transmission of several zoonotic viruses from animal hosts to humans, such as Ebola virus, and various species of coronavirus, including SARS-CoV-2. These species of animals may be natural reservoirs of many unknown viruses. The resultant disruption of the human–animal interface becomes the "time bomb" for potential zoonotic "spill-over" emerging infectious diseases' outbreaks that could scale up to an epidemic or pandemic proportions.[5] Human history has revealed this enormous "spill-over" contagious crisis though the unforgettable lessons of Ebola, malaria, dengue, yellow fever, and sleeping sickness (in North Gabon); Lassa fever in Nigeria; rabies, plague, and Nipah Virus from Malaysia; SARS from China; MERS in the Middle East; Zika and West Nile virus from Africa. The Wet Market animal trade makes a perfect storm for cross-species transmission of pathogens and the risk of diseases spilling over from animals to humans. It may not be wrong of me to state that COVID-19 may be just the end of only the beginning of many more pandemics to unleash on humanity unless we mitigate human transgression and prevent the "Human–Wildlife Conflict." At this juncture, I pose another question. Are bats the enemy in the fight against COVID-19 and other infectious diseases such as Ebola and Nipah virus outbreaks? The answer to this question underscores the delicate boundaries of bat ecology research, bat conservation, and bat-borne virus surveillance and yet put in place the highest research safety standards (BSL-4 Laboratory Facility) to safeguard human health to prevent virus spill-over to incidental hosts. Although bats provide a reservoir of zoonotic viruses (including coronaviruses), it is the loss of bat habitat, bat conservation threat, and other anthropogenic drivers that promote the human–wildlife conflict and altered host–virus dynamics to be the major risk factor for zoonotic disease emergence by increasing the risk of viral spillover from bats. Human behaviour and activities that increase exposure to bats will likely increase the opportunity for infections. Understandably, bats are not to blamed. Therefore, I would reiterate the implementation of a research culture of meaningful transboundary bat research networks (bat ecologists, conservationists, virologists, and public health), while maintaining an advocacy of "bats for peace" philosophy, promote bat conservation, and mitigate bat–human interactions. It will be wrong of me if I omit the ecological importance of bats and why their conservation is mandatory. They play an important ecological role in prey and predator (biological pest control), arthropod suppression, seed dispersal, plant pollination, soil fertility, and nutrient distribution. Bats are among the most overlooked species in spite of their economic and ecological importance, and hence, their conservation is mandatory. Human transgression of the natural bat habitats will play a crucial role in mitigating bat–animal and bat–human interactions and interspecies jumping of bat zoonotic viruses, including bat coronaviruses. Thus, it is extremely clear that the destruction of biodiversity and habitat fragmentation is unequivocally opening a Pandora's Box for new disease outbreak to emerge. Don't we need a new discipline of planetary health, environmental humanities, and ecocentrism as opposed to anthropocentrism to secure ecobiodiversity and nature's law to foster a harmony, the well-being of humans, other living things, and entire ecosystems? Where is our collective consciousness in this regard? Our war and the lack of cohabitation with nature are the root causes to the emergence of pandemics. I would state that the "Grey Swan" of disease outbreaks and pandemics is an unprecedented wake-up call for cooperation for human health and biodiversity conservation as a part of environmental humanities. We need an activism to respect nature and earth systems and recognize its limits and curb human-induced environmental issues to mitigate the earth from plunging into a danger zone. Perhaps, this may have to start from the cradle as a prescription for cultivating environmental awareness ranging from preschool children, schools and colleges, the public community, governments, and policymakers. BIOSPHERIC EGALITARIANISM AND CO-EXISTENTIALISM: HUMAN– EARTH SYSTEMS "Humans neither can nor ought to denature their planet… On larger planetary scales it is better to build our cultures in intelligent harmony with the way the world is already built, rather than take control and rebuild this promising planet by ourselves… We do not want a de-natured life on a denatured planet." – (Rolston 2012) To my mind, biodiversity and human health are intricately intertwined to each other. Human interference and transgression with "Human–Wildlife (Animal) Conflict" affect, both structurally and functionally, the ecosystem health with habitat fragmentation and loss of biodiversity. My musings center on this interdependence of human health and healthy ecosystems, as well as the ecosystem regulation of infectious disorders. It is only too clear that human transgression has resulted in our collision with Nature's Laws' habitat fragmentation, loss of biodiversity, and environmental degradation.[6] It is an absolute reality to be fully aware that a war on the nature is ultimately a war against ourselves, as echoed by the pioneering 20th century conservationist Rachel Carson. "The reality is that we, human beings, have globalized the planet…we have stressed the environment, we have invaded the animal-human interface, we have allowed diseases to cross into humans and when those diseases do cross from animals to humans those diseases can amplify." This has been so vividly portrayed in movies with the Nostradamus revelation of the invasion ecologies and kinetics of a pandemic disaster such as Outbreak (1995), Pandemic (2009), Carriers (2009), Contagion (2011), and the Indian-Malayalam Virus (2019), including the novel The Eyes of Darkness by Dean Koontz. This novel depicted the strange semblance to an artificial fictional bioweapon designated "Gorki-400," (1981) and later called "Wuhan-400" in the 1989 edition. The human disruption of the global environment, "human–animal (wildlife) conflicts" are indeed behaviors that could readily spread microbes between people and from animals to humans, creating an imbalance that would guarantee a global surge in epidemics, perhaps even a pandemic. This narrative has been elegantly described in a 1994 book titled, "The Coming Plague: Newly Emerging Diseases in a World Out of Balance." Not succumbing to the prevalent ideologies of anthropocentrism, capitalistic society, neoliberalism, and geopolitical hegemony in the global community we live in, I am dwelling on the concepts of a postapocalyptic, postanthropocentrism ideology, which will embrace a paradigm shift of the human ethos to eco-biocentrism, environmental humanities, and environmental medicine. Should not humanity need to institute a new policy of "peaceful coexistence" with Mother Nature through Environmental Medicine and Humanities? I reiterate that through environmental humanities, we must pledge toward ecocentrism, environmental justice, and biospheric egalitarianism, perhaps I can refer this "Human–Nature Symbioses" or "Co-Existentialism" in Sanskrit as "Vasudhaiva Kutumbakam." COVID-19 pandemic is the time to pause, reflect with collective consciousness, and call for the advocacy of the interdependence of human health and healthy ecosystems. TEACHING ENVIRONMENTAL HUMANITIES IN MEDICAL SCHOOL CURRICULUM: PREPARING PHYSICIANS FOR THE FUTURE Being in the medical profession, I would reiterate that the COVID-19 pandemic should call for a renewed era for a "climate–environmental medicine" core curriculum in medical schools and public health curriculum, a rather neglected area in the traditional medical school training. I would vehemently state that it is time to advocate environmental humanities as a core curriculum in medical schools that underscores the concept of "planetary health education" and fosters ecohealth literacy.[7] Such integrated health curriculum interventions right from the undergraduate medical education would foster necessary critical-thinking, participation in global health, and public health literacy, which I would reiterate are the necessary and essential physician skills in a rapidly changing Human–Earth System. Our personal health does unequivocally involve planetary health, and therefore, I ruminate on the transdisciplinary areas of environmental humanities, ecosocialism, anthropocentrism and human transgression, ecocentrism, human–earth systems, climate and environmental medicine, outbreak and disaster medicine, disaster mental health, disaster and pandemic preparedness, and ultimately the global healthcare systems' preparedness. From the experiences of the past pandemics, the current COVID-19, and despite climate change health threats, these transdisciplinary disciplines are still a sorely neglected topic in the medical education and training systems and in public health. I stress the need for an integrated medical school core curriculum connecting the human health, the natural ecosystems, and the environmental humanities, all of which converge to the concept of planetary health which in turn will determine the sustainability and ecological civilization of the Anthropocene epoch. To my mind, the medical community must have the resilience and ingenuity to develop curricular shifts in medical schools enabling world communities to protect health, which will enable the next generation of effective physicians to mitigate climate crisis and environment-related health issues and the emerging infectious diseases as a broader exploration of this major public health emergency. Such curricular reforms involving the teaching of environmental humanities, pandemic (emerging infectious disorders stemming from human–wildlife contact/conflict) syllabus, and other integrated disciplines in medical schools are also a Healthcare story.[8] Such reforms in medical school curriculum, competency skills training, continuing medical education along with faculty development, coupled with global policymakers and intergovernmental organizations to invest in the environment sciences and humanities, would fundamentally change the trajectory of human economic and social development, which will be a new reality for tomorrow as far as planetary and human health is concerned. The COVID-19 pandemic has also changed the landscape of the traditional patient–physician encounter since physicians have now shifted from the "bedside to the webside" using the virtual platform of telemedicine. Therefore, I would also stress on preparing competent clinicians trained in telehealth education, informatics modules, virtual healthcare, and telemedicine, which would be ideal for the technoholic millennial generation, i.e., Generation Y and the postmillennial Generation Z. BRIDGING THE HEALTHCARE PREPAREDNESS GAP It will not be wrong for me to state that the current epidemic has exposed how global healthcare systems preparedness failed. This may
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