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Darrell Hudson: We must be aware of the 'prevention paradox' during the current pandemic

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The social distancing measures being implemented are inconvenient for most of us. For some of us, these measures threaten our very livelihood. People are anxious and frustrated.

A common question is — how bad can this possibly be? For people who are relatively young and healthy, the closed schools, bars and restaurants seem like overkill. Nonetheless, these evidence-based practices are necessary to prevent transmission, especially among those who are most vulnerable in our society. Of course, this includes health care workers, older adults and people with chronic health conditions.

However, people who work in hourly positions and cannot afford to take any time off work are also at great risk, especially those who do not have health insurance. What happens if they get sick but continue to work? Even during the time it takes to develop symptoms, they are contagious. The recovery time and the contagious period both are significantly longer than the flu. These people become walking vectors transmitting the novel coronavirus to other people within their vicinity.

In the field of public health, there is a concept called the “prevention paradox.” The prevention paradox occurs when society enacts a costly policy — cost includes time, effort, inconvenience, boredom and loneliness — and the potential benefit to individuals is relatively low. People will ask: Is this truly necessary? Is the juice worth the squeeze?

For example, most Americans have never met someone with polio, measles, mumps or rubella. This is because vaccination efforts have been so productive that there are not any new cases of these diseases. However, when there are no new cases, people start to ask: Why do we need vaccinations again? Therein lies the prevention paradox. The prevention strategy has worked so well, that there is no one around with polio to demonstrate an alternative display of how debilitating that condition is.

Therefore, we must be aware of the prevention paradox during the current pandemic. People are wondering aloud, especially on social media, whether this is all overblown, especially since most people will not contract the novel coronavirus disease. If we are effective in preventing the spread of the virus, people will say that we overreacted. Nevertheless, what if we do not act so aggressively to contain this condition? Do we really need to see someone with polio to understand the effectiveness of the vaccine?

There are personal-protection equipment and cleaning protocols that must be observed to keep health care workers safe and prevent further transmission. In other words, coronavirus reduces hospital efficiency. The last thing we need is a corps of health care workers, who are also struggling with their own childcare challenges, fatigue and uncertainty, to be forced to decide who warrants care and who does not as was the case for physicians in northern Italy. Furthermore, would you want to seek care from a health care facility that is absolutely overwhelmed?

This could threaten the health of people who would typically make a full recovery. By now, many people have heard about the slow roll out of testing and “flattening the curve.” The best approach now is to take steps to slow down the spread of the disease, so we do not overwhelm the health care system.

Prevention efforts invite many questions. What if we are overreacting? Is all this worth it? Are we just fueling paranoia?

This conundrum also highlights other challenging, expensive problems, such as the lack of universal health care in the United States (or Medicaid expansion in Missouri) and the fragility of our social service safety net. Simply put, containing a global pandemic is extremely difficult. The estimates of total cases and fatality rates are rapidly changing. There is no way to accurately account for how many people have the virus. Our best-case scenario during this pandemic is the prevention paradox.

Darrell Hudson, PhD., is an associate professor at the Institute for Public Health at Washington University’s Brown School.


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