How Countries’ COVID Measures Stack Up

Whether out of fear of repeating the past, the virus, economic trouble, or public criticism, nations have responded differently to the pandemic. Although it’s not over, and it’s still too early to determine the long-term effects of each strategy, the data thus far does suggest which measures have worked best and why. 

Two methods for containing the spread of coronavirus are herd immunity and lockdowns. The Mayo Clinic states that herd immunity occurs when a large portion of the community becomes immune to a disease making the spread of it unlikely. Ideally, herd immunity is achieved through vaccinations. Vaccines have a low risk of complications and illness, they protect vulnerable populations that cannot receive vaccinations, and they have a strong history of controlling the spread of highly infectious diseases.  

At the beginning of the pandemic, vaccines were a hopeful but distant solution. Now, the first shipment of Pfizer’s vaccine will arrive in the U.S. on December 15. The U.K. became the first to approve it for use with their announcement on December 2. The shortened approval process, 10 months as compared to 10 years, as well as the U.K.’s reliance on Pfizer’s data instead of independent analysis, has made some hesitant to follow Britain’s lead. Dr. Anthony Fauci, the U.S.’s top infectious disease expert, took the opportunity to praise the Food and Drug Administration’s slower regulation process and offer support for the agency which has been under pressure by the White House to approve the vaccine. 

Achieving herd immunity can be difficult when people refuse to take the vaccine. Additionally, the effectiveness of vaccines can wane over time. If multiple vaccines are necessary to inoculate against a certain disease, it’s not guaranteed people will complete the series lessening the effectiveness. 

The World Health Organization (WHO) has criticized the other, widely used approach, lockdowns. Lockdowns, or large scale physical distancing measures, slow the spread by limiting contact. They harm social and economic life and disproportionately affect people living in poverty, internally displaced people, and refugees. 

In Europe, both Italy and Greece have utilized lockdowns with different results. Originally, Italy was the hotspot of Europe, while Greece initially had a low number of cases. Italy declared a state of emergency and placed a strict lockdown. Greece acted similarly but did not declare a state of emergency. With such similar methods, the two nations should have yielded similar results. However, one key factor that separates them is timing. Italy began suspending events and closing schools nine days after the third confirmed death from coronavirus. It closed non-essential shops and banned non-essential movement after two weeks. In comparison, Greece suspended events and closed schools before the third confirmed death, closed non-essential shops one day after, and banned all non-essential movement only eight days after the third death. 

Timing also played a key role as to why Taiwan and South Korea have both had continued success with their efforts. Taiwan went into a strict lockdown very early, like Greece. However, it did not last long. Instead, they moved to closing borders, banning the export of surgical masks, contact tracing, and mobile SIM tracking. They kept businesses open by requiring temperature checks and offering sanitizer before each person entered. These efforts have resulted in just seven deaths. South Korea responded similarly and has not only low death rates but also a low case count. Their early and aggressive response included and still includes extensive testing, isolation, contact tracing, and tracking COVID patients in real-time. They have also managed to keep businesses open, and a sizable government stimulus helped citizens financially.       

Both nations had experience with epidemics in recent history, Taiwan with SARS 20 years ago and South Korea with MERS in 2015. This may have made them better prepared and primed citizens to comply with strict and invasive measures early on. While some question the privacy violations associated with SIM contact tracing and patient tracking, the low case and death count, as well as the public’s willingness to follow such measures, highlight that people are willing to make the tradeoff between personal freedoms and restrictions to avoid disastrous outcomes.       

Rather than focusing on limiting the spread of COVID and protecting citizens, Turkey has focused on restricting the spread of information. Starting in March, officials have investigated doctors and healthcare workers commenting on the government’s actions and coronavirus in the media. In one instance, after a health expert talked about underreporting of cases with local media, a governor claimed they were “misinforming the public” and “causing panic.” The investigation brought against them was dropped only after multiple rights groups condemned it. 

But public support for Turkish doctors and nurses is waning. Increases in resignations led some to liken them to soldiers fleeing a battlefield. However, many that left public hospitals did not leave medicine altogether but moved to private care facilities that have better working conditions. Doctors were even prohibited from retiring between March 28 and June 8 and starting again on October 27. 

Turkey has continued to declare the situation is under control and lift partial lockdowns even when independent doctors and medical associations warn against it. In addition to keeping information from its people, Turkey has also not followed WHO’s recommendation of regularly releasing case and death numbers by city or include probable causes in their counts. 

While many countries took action at the beginning of outbreaks, the strength and continued enforcement of their policies have differentiated the success of their efforts. Time will tell if Italy and Greece’s regional measures and extended lockdowns save them from further spikes. Countries like Taiwan and South Korea have managed to not only protect most of their people but also protect their economies. This has improved their governments’ images both among their people and around the world. Turkey inverted its approach, starting with appearances and putting science second, leading to discontent among its people and healthcare force, arguably making their efforts a failure.

How the Pandemic Has Redesigned the Food Pyramid

At the beginning of 2020, food analysts and registered dietitians predicted innovations in food and people’s increasing concern about the practices that go into making what’s on their plate would lead to improvements both for individuals and the planet. The Kerry Health and Nutrition Institute predicted sustainability would be a megatrend. One big way to work towards a greener food industry was by eating greens. 2020 would see aisles filled with plant-based ice creams, vegetable pastas, and, of course, plenty of chik’n tenders and meatless burgers. Not only would this help the planet by reducing the carbon footprint of heavy emitters like beef and cheese, but it would also improve individuals’ health. Getting sufficient servings of vegetables and fruits has long been one of the biggest challenges to a balanced diet. Incorporating a wider variety in convenient and novel ways was going to help.

Going from the global scale to the individual, the next trend focused on tailoring diets to meet individuals’ needs. As certain intolerances and allergies became more widespread, new diets also sprung up. The keto, paleo, and low FODMAP diets are various approaches to help people lose weight or ease digestive issues by eliminating certain food groups. One of the big draws to the paleo diet is that it helps those with Celiac or gluten intolerances. But there are also some benefits to choosing gluten-free options for those that don’t need to. For example, swapping chickpea or lentil pasta for traditional wheat pasta adds bonus protein and vegetables to lunch or dinner. 

Similarly, the low FODMAP diet aids those with digestive conditions like Crohn’s disease or IBS. The diet eliminates many fruits, sources of fat like nuts, grains, and dairy products. Diets like this have contributed to the growing demand for dairy alternatives. Milk alternatives now include banana, hemp, and oat. While the FDA is currently trying to ban the label “milk” used with these products, the popularity of these diets and the growing number of allergies means these mylks are here to stay.             

Functional nutrition shares much of its philosophy with alternative medicine. Like some practices in alternative medicine, functional nutrition seeks to support and heal the body through natural remedies such as eating more whole foods and adding supplements. Probiotics and prebiotics found in foods like kombucha, kimchi, and sauerkraut promote the good bacteria necessary for a healthy gut microbiome. The microbiome is thought to play a role in the development of conditions like eczema, cancer, and depression. 

In addition to helping the body, functional nutrition can also help the mind. Some mood-boosting foods fall under the category of botanicals, specifically nootropics and adaptogens. Examples include turmeric, ginseng, B vitamins, and ginkgo. CBD is another additive that was expected to grow in popularity. It is the non-psychoactive component of marijuana and hemp. While hemp products like protein and oil are legal, CBD products are not. However, it made its way into ginger beers, ciders, and water despite lack of approval from the FDA by complying with all other FDA standards like labeling and avoiding unsubstantiated claims. Additionally, while the FDA has currently outlawed it, some states have legalized CBD and regulate it as a food ingredient.                                  

Now more than ever, people are looking for ways to take their health into their own hands. Dietitians and food experts predict functional nutrition for immunity support and mood-boosting will continue through 2021. More people will look to prevent illness by taking supplements like zinc, selenium, vitamin D, and vitamin C. There will also be increased use in alternative medicines like echinacea, elderberry, turmeric, and ginger, as well as antioxidant-rich whole foods. 

Although people have established new normals, it is still a stressful time. Companies will seek to support people with products aimed at reducing anxiety and improving sleep. With CBD still a gray area, Copaiba may be the next big thing. The completely legal essential oil made from tree resin supposedly has similar effects as CBD. Established brands are also joining the “food as medicine” trend. Pepsi created Driftwell, a drink that contains magnesium and L-theanine and is supposed to help consumers relax before bed. 

A more balanced approach to eating will also provide some emotional support. While still good options for those that need to avoid certain foods due to intolerances or allergies, the restrictive diets of 2020 will fall out of favor as people continue to use food for comfort. However, people will still want to lower the number on the scale. One survey found over 3 in 4 Americans say they’ve gained up to 16 pounds in isolation. This may be due to lower activity levels, returning to comfort foods, and an increase in snacking. 

The emphasis on sustainability and plant-based eating will also stick around. These “climitarians” may become “flexitarians,” meaning there is more variation in their diet as opposed to strict veganism or vegetarianism. These flexitarians will still take action to limit the environmental impact their food has but do so in more moderate ways. This may include swapping beef for chicken, having meat fewer times per week, or opting for blended options like mushroom and beef burgers. Plant-based options will still be key for this trend, but all veggies or all meat will no longer be the only choices. Consumers will also look for ways to reduce their carbon footprint by continuing to pay attention to the manufacturing practices and packaging of their food. While this trend is still predicted for 2021, the pandemic has forced companies to put some climate-friendly initiatives on hold. They are choosing to delay or cancel new product launches.    A final trend for 2021 borne out of the pandemic is ghost restaurants and kitchens. These are defined as “a professional food preparation and cooking facility set up for the preparation of delivery-only meals.” Restaurants now double as grocery stores and turn fan favorites into meal kits for people to assemble at home. These alternatives are useful as lockdown policies continue to change when outdoor dining is and is not allowed.  Finding new ways to keep restaurants alive and bring them into people’s homes will continue in 2021. 

Is Diversity a Disqualification to Practicing Medicine?

A breakdown of the first twenty-one Google image search results for “doctor” yields roughly equal images of men and women, nine pictures with people of color, and three show an animated or ambiguous partial image. Looking further, both pediatricians are female, the only surgeon is a white male, and all appear not to have a disability. While difficult and even impossible to gauge identifiers like race and ethnicity, disability, and sexuality from images, this rudimentary analysis reveals some key truths about these categories of diversity in medicine while also misrepresenting others. 

Starting with what Google got wrong, women do not make up half the physician population. They’re actually closer to 36%. Additionally, about 2% of physicians identify as having a disability. While not a large portion, it is completely excluded from the results even when scrolling far past the sample. Google did get some things right, although that is not entirely positive. The racial breakdown is surprisingly accurate. 43.8% of physicians identify as a racial or ethnic minority. The majority are Asian, while Hispanic, Black or African American, and Native Americans make up a combined 11%. Almost three-quarters of surgeons are white, and two-thirds are male. And the proportion of women in family medicine, as opposed to general surgery, is higher than males. 

The percentages of acceptees to and graduates from medical school for men and women are almost equal. But research shows almost 40% of women physicians go part-time or leave medicine completely within six years of completing their residencies. The majority of women reduce hours or leave to achieve a better work-family balance. Women in medicine “take on an average of 8.5 hours more work at home each week than men. Married men with children worked 7 hours longer and spent 12 hours less per week on parenting or domestic tasks than women.” Women lessen their hours at significantly higher rates than men, pointing to larger issues in gender dynamics. 

Another factor, lack of support for women with families that stay. Women have an average of 8.6 weeks paid family leave as opposed to the recommended 12. Having to decide between family and career is one of the main reasons why women are steered away from surgical specialties and encouraged to choose disciplines with less demanding residencies and professional schedules like family medicine. This also plays on the stereotype that women are more nurturing and emotional, thus more suited to working with children. 

For physicians with disabilities, stereotypes also affect perceptions of them and their abilities. One doctor that uses a wheelchair recalled how a fellow physician mistook her for a patient in the cafeteria even though she was wearing her uniform and had “doctor” written on her badge. She described how this moment underscored that she, and others with disabilities, are often seen as a person with a disability before anything else. While disability is often underreported, those that do identify themselves only make up 2.7% of physicians when including learning or psychological disabilities. Those that don’t report may fear they will be perceived as weak or not capable of fulfilling their duties.    

A lack of self-identifying, rather than actual absence from medical professions, also accounts for the underrepresentation of LGBTQ+ doctors. While not much research has been conducted on sexual minorities in medicine, one study from Stanford University found “about one-third…chose not to disclose that information while in medical school, with 40 percent admitting they feared discrimination.” However, one poll conducted from 2017 to 2019 found the rates of students identifying as bisexual, gay, lesbian, and transgender had increased. While not huge numbers, as more research is done and more workers feel comfortable identifying themselves, perhaps these numbers will improve even more.       

Diversity, or lack thereof, in healthcare professions also has roots in education, particularly for racial and ethnic minority groups and those with disabilities. Black men cited a lack of educational opportunities and economic barriers as key reasons for not pursuing medicine. Black women gave similar reasons adding that 40% recalled a “high school or college counselor trying to dissuade them” from a career in medicine. 

Barriers persist throughout education. The economic hurdles that hold some Black men from applying also contribute to why they and other minorities do not stay in medical school. The majority of medical students come from affluent backgrounds. Students coming from “low socioeconomic status families are underrepresented” and “more likely to leave medical school within the first two years.” Researchers theorize racial stereotypes leading to feelings of exclusion also explain why “Black and Latinx students in STEM programs are more likely to drop out or switch majors than their White peers.” Finding community significantly contributes to why these students stay or leave. Minority-serving institutions like Howard University and The University of Puerto Rico graduate the largest amount of Black and Latinx physicians. A study showed that while students at historically Black colleges saw their STEM programs as diverse and felt supported, students at predominantly white institutions felt excluded. 

Application barriers may also discourage students with disabilities. Schools’ websites vary in advertising their accommodation policies. Researchers found only a third clearly stated they would accommodate students with disabilities that are otherwise qualified, while “another half had vague information about who they would accept.” Even when the researchers posed as students and inquired, multiple schools did not respond. In many cases, the technical standards (TSs), what a school will or will not accommodate, are not clear or readily available. Each school determines its TSs. Rather than helping students receive necessary accommodations, they may help institutions unwilling to make them disqualify students with disabilities.              

From Google images to prestigious universities and world-class hospitals, the need for greater diversity exists at all levels. But diversity isn’t necessary just for diversity’s sake. Those that identify as members of underserved or underrepresented groups are not only more likely to serve those communities, understand their specific needs, and teach other students and physicians how to address them, making for better health care.    

Benefits of Alternative Medicine Overshadowed by Wellness Culture Greed

Yoga, meditation, green tea- to some this may sound like the perfect morning routine; to others, it is a list of different types of Complementary Alternative Medicine (CAM). CAM includes a diverse range of therapies, practices, and products, like acupuncture, chiropractic medicine, and herbal medicine. What unites them and what defines CAM is simply that they are not currently considered conventional medicine. Because of this, the list changes as the therapies and products are proven safe and effective becoming mainstream. 

CAM use is growing, especially among women and those with chronic or recurring conditions who have not found relief with traditional treatments. About half the general population in developed countries uses it, and the majority use it along with conventional medicine. But with more popularity comes more criticism. Skeptics of CAM point to the lack of research and proven efficacy of treatments in clinical trial settings as key problems. They also argue that placebo effects and people’s ability to self-administer some of these treatments may lead people away from scientifically-proven solutions doing more harm than good. For example, relying on garlic supplements rather than prescribed blood pressure drugs. Additionally, because there is little research on the benefits, the risks of treatments of certain treatments are also unknown. 

Increased interest and use of CAM is a double-edged sword. As practices become more mainstream, prejudice against them may lessen. However, with influxes of users, practices can become diluted if the right teachers aren’t followed. Wellness culture, on the surface, promotes a balanced, holistic approach to health, incorporating mind, body, and spirit. This makes it the perfect proponent of CAM. But it is now associated with carefully curated, aesthetically pleasing brands, promising customers their products will help them live natural and holistic Instagram-worthy lives. 

The wellness market is flooded with these celebrity-backed brands. While some may have a vested interest in the practices, there’s no denying money is part of the appeal. The global wellness economy is valued at $4.5 trillion, and CAM accounts for $360 billion of that. Looking at how they become popular through social media and celebrity endorsements, it’s no surprise that the big brands and not local practitioners take the lion’s share of the profits. 

One company that’s earned a lot of attention is goop. Started in 2008 by actress Gwyneth Paltrow, the lifestyle and wellness brand is worth $250 million. It has articles on the benefits of herbal pairings, overcoming first-time acupuncture nerves, and a wellness gift guide complete with an $80 meditation pillow, a 30-day supply of goop brand immune-boosting elderberry extract chews for $55, and a $105 metal whistle that helps with breathing. While it may seem like the website endorses CAM practices, it actually promotes a specific, expensive version of wellness using CAM. When goop elderberry chews cost twice as much as other brands, CAM and wellness become associated with wealth. As an article on the darker side of wellness states, brands like goop are built around “commercialized gurus metamorphosing ancient medicines and practices into an aspirational and desirable lifestyle.” 

This criticism points to bigger trends in the wellness industry. Although the use of CAM has increased, there is an expanding gap “in the rate of CAM use between non-Hispanic whites and African American and Hispanic populations. Whites are more than twice as likely to see a CAM provider than African Americans and Hispanics.” Asians use CAM slightly less than whites. Much of wellness culture is problematic because of who it says wellness is for. When the face of the company is a wealthy, white, Hollywood-elite, only so many people can see themselves stepping into the life portrayed. By making wellness exclusive and exclusionary, these brands give CAM a bad reputation by association. The practices face scrutiny, not from a medical or scientific standpoint, but because they are seen as elitist.   

Another problem: “‘Sometimes Western people take what they think is something powerful used in the Indigenous world, say a plant, an herb, a tea,” says Margaret P. Moss Ph.D., R.N., director of First Nations House of Learning and an associate professor in the school of nursing at the University of British Columbia, ‘without taking the whole system that came with it, that made it work.’” In many cases, these celebrities and influencers simply appropriate practices. They do not take into account the full context and history of where they come from and potentially spread misinformation with little concern for how this could damage the reputation of such practices. The negative opinion people hold of these brands reflects badly on the practices they endorse. 

CAM has real potential to help people. Those that want more autonomy or those with chronic conditions can find real relief. There are a variety of options tailored to meet individuals’ needs. Those with chronic conditions may find CAM treatments beneficial when other, conventional approaches have been exhausted. Furthermore, “as long as alternative treatments are used alongside conventional treatments, the majority of medical doctors find most forms of complementary medicine acceptable.” An article in the National Center for Biotechnology Information argues against the distinction between conventional and alternative medicine. Instead, they propose, “there is only medicine that has been adequately tested and medicine that has not…Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.” While this is a nice idea when taken too far, arguments like this perpetuate the problems outlined above. It is important to remember where practices come from, their histories and contexts because they don’t just add trivia; they are part of the practices. 

Could Genetic Testing Be Part of Your Next Job Application?

As genetic testing advances, results may predict not just health but personality and intelligence, raising ethical questions about the applications of such information.  

From video calls with doctors to watches that sense irregular heart rhythms medical technology has become increasingly personal. And it doesn’t get any more personal than examining DNA- the essence of every person and what makes them unique. Genetic testing has come a long way since its initial use in the 1950s. It can provide a wide array of information about individuals’ health by looking for mutations in DNA. The results may empower people to seek treatment, adopt healthier habits, and better prepare them for the future. 

A large portion of testing determines individuals’ risk for having, developing, or being a carrier of a genetic disorder. Patients may require genetic testing if they have a family history, belong to an ethnic group at higher risk, or if they present symptoms and their physician wants to confirm a diagnosis. Depending on the reasons for the test, the results are used differently. A positive diagnostic test may mean starting a treatment plan. A carrier test may be useful before having children, especially for heterosexual couples that suspect both partners are carriers.  

Another type of testing used in family planning is preimplantation genetic diagnosis (PGD). This looks for markers of diseases and disorders in an embryo giving parents knowledge about their potential children. PGD has been at the center of much controversy especially for those that believe life begins at fertilization. They make points similar to those used in anti-abortion arguments, that not implanting an embryo disregards or devalues “the sanctity of life.” However, U.S. laws and health policy do not confirm this belief as they progressively place greater moral status on embryos, fetuses, and newborns as they develop. State laws vary in how late abortions may be performed, illustrating that earlier stages of development are viewed differently from later stages. 

Opponents also object to this type of genetic testing believing, over time, the selection of certain traits will lessen genetic diversity. Advocates for those with disabilities endorse this argument, adding that selection also discriminates against those with disabilities sending the message people with them are less valuable or less desirable. Parents may choose to fertilize one sex of embryos if they have a family history of a sex-linked disorder. Those against PGD argue parents will begin selecting based not just on “health” but preference for one sex over the other. They claim this will lead to selection based on other preferences such as appearance, “talent, personality…even though it is not technically possible at this time.”  

While not possible yet, advances in genetic testing have started conversations about what tests may look for in the future and the applications of such results. Discrimination based on genetic testing was a real concern before the passing of the Genetic Information Nondiscrimination Act (GINA) in 2008. The law focuses on protecting people in two key areas of life- employment and health insurance. But one article in the Oxford Academic Journal of Law and the Biosciences explores how more accurate and precise testing may lessen protections in both areas to the benefit of some and detriment of others. For example, “there is some evidence that certain genetic variants are correlated with world-class athletic performance.” Those wishing to become professional athletes may want to have genetic testing to see if they have a variance that would make them more appealing to teams. Similarly, professions that value intelligence and empathy may utilize genetic testing if it advances to predicting such traits. Empathy has proven to be an essential skill in healthcare professions. Medical schools and hospitals could look at results before admitting students and residents. 

Tests may also work against people predicting liabilities rather than assets. In high-risk situations such as driving a school bus or flying planes, employers “may have a legitimate interest in genetic factors that would, hypothetically, significantly increase the chance of suffering an epileptic attack.” However, if genetic information was more widely used and publicized a case could be made for accommodations and protections for those with “liabilities.” Similar to the Americans with Disabilities Act, employees may continue to work but with modifications made to their environments. 

Allowing the use of genetic information in one protected area could have devastating consequences in the other. Some may argue those who have a genetic condition use healthcare services more and therefore should contribute more to the cost of those services through higher premiums. This raises similar points about selecting job candidates. These practices would discriminate against those with perceived or possible disabilities. But unlike choosing job candidates, this concerns profits not safety. This system would punish people for something outside of their control based on possibly inaccurate results. Furthermore, despite certain, outdated arguments against, healthcare is a basic human right. As stated by the World Health Organization (WHO), “When people are marginalized or face stigma or discrimination, their physical and mental health suffers. Discrimination in health care is unacceptable and is a major barrier to development.” Putting barriers to care will not create a healthier society, it will only push those that cannot access care further from the help they need. 

Currently, genetic information is protected. Those wishing to be tested should not fear potential discrimination. While there is still room for error, testing provides useful information for patients and their doctors. A good way to gauge if testing is necessary is by talking with family members, writing down what conditions they have, when they were diagnosed, and what symptoms they experience. Health professionals can then use this information to determine the best course of action. It may include genetic testing or simply earlier and more frequent screenings. Additionally, knowing family history can encourage other preventative actions patients can do on their own, like exercising regularly and maintaining a healthy diet. Since some of these conditions are multifactorial, environmental improvements and lifestyle changes can have a positive effect.