Arquivo da tag: Distanciamento social

Coronavírus: Médicos defendem ‘abordagem cirúrgica’ em vez de lockdown indefinido (Brazil Journal)

Geraldo Samor e Pedro Arbex – 22.03.2020


Thomas Friedman, um dos colunistas mais influentes do mundo, ouviu três médicos e escreveu o artigo mais contundente até agora sobre o risco do lockdown global se estender por muito tempo.

No texto, publicado hoje à tarde no The New York Times, Friedman nota que os políticos estão tendo que tomar “decisões enormes de vida ou morte, enquanto atravessam uma neblina com informação imperfeita e todo mundo no banco de trás gritando com eles. Eles estão fazendo o melhor que podem.”

Mas com o desemprego se alastrando pelo mundo tão rápido quanto o vírus, “alguns especialistas estão começando a questionar: ‘Espera um minuto! O que estamos fazendo com nós mesmos? Com nossa economia? Com a próxima geração? Será que essa cura — mesmo que por um período curto — será pior que a doença?’”

Friedman diz que as lideranças políticas estão ouvindo o conselho de epidemiologistas sérios e especialistas em saúde pública. Ainda assim, ele diz que o mundo tem que ter cuidado com o “pensamento de grupo” e que até “pequenas escolhas erradas podem ter grandes consequências.”

Para ele, a questão é como podemos ser mais cirúrgicos na resposta ao vírus de forma a manter a letalidade baixa e ao mesmo tempo permitir que as pessoas voltem ao trabalho o mais cedo possível e com segurança.

Friedman diz que “se a minha caixa de email for alguma indicação, uma reação mais inteligente está começando a brotar.”

Ele cita um artigo publicado semana passada pelo Dr. John P. A. Ioannidis, um epidemiologista e co-diretor do Centro de Inovação em Meta-Pesquisa de Stanford. No artigo, Ioannidis diz que a comunidade científica ainda não sabe exatamente qual é a taxa de mortalidade do coronavírus. Segundo ele, “as evidências disponíveis hoje indicam que a letalidade pode ser de 1% ou ainda menor.”

“Se essa for a taxa verdadeira, paralisar o mundo todo com implicações financeiras e sociais potencialmente tremendas pode ser totalmente irracional. É como um elefante sendo atacado por um gato doméstico. Frustrado e tentando fugir do gato, o elefante acidentalmente pula do penhasco e morre.”

Friedman também cita o Dr. Steven Woolf, diretor emérito do Centro Sobre a Sociedade e Saúde da Universidade da Virgínia, para quem o lockdown “pode ser necessário para conter a transmissão comunitária, mas pode prejudicar a saúde de outras formas, custando vidas.”

“Imagine um paciente com dor no peito ou sofrendo um derrame — casos em que a rapidez de resposta é essencial para salvar vidas — hesitando em chamar o serviço de emergência por medo de pegar coronavírus. Ou um paciente de câncer tendo que adiar sua quimioterapia porque a clínica está fechada.”

Friedman complementa: “Imagine o estresse e a doença mental que virá — já está vindo — de termos fechado a economia, gerando desemprego em massa.”

Woolf, o médico da Virgínia, afirma no artigo que a renda é uma das variáveis mais fortes a afetar a saúde e a longevidade. “Os pobres, que já sofrem há gerações com taxas de mortalidade mais altas, serão os mais prejudicados e provavelmente os que receberão menos ajuda. São as camareiras dos hotéis fechados e as famílias sem opções quando o transporte público fecha.”

Há outro caminho?, pergunta Friedman.

Para ele, a melhor ideia até agora veio do Dr. David Katz, diretor do Centro de Prevenção e Pesquisa da Universidade de Yale e um especialista em saúde pública e medicina preventiva.

Num artigo publicado sexta-feira no The New York Times, o Dr. Katz diz que há três objetivos neste momento: salvar tantas vidas quanto possível, garantindo que o sistema de saúde não entre em colapso, “mas também garantir que no processo de atingir os dois primeiros objetivos não destruamos nossa economia e, como resultado disso, ainda mais vidas.”

Como fazer isso?

Katz diz que o mundo tem que pivotar da estratégia de “interdição horizontal” que estamos empregando agora — restringindo o movimento e o comércio de toda a população, sem considerar a variância no risco de infecção severa — para uma estratégia mais “cirúrgica”, ou de “interdição vertical”.

“A abordagem cirúrgica e vertical focaria em proteger e isolar os que correm maior risco de morrer ou sofrer danos de longo prazo — isto é, os idosos, pessoas com doenças crônicas e com baixa imunidade — e tratar o resto da sociedade basicamente da mesma forma que sempre lidamos com ameaças mais familiares como a gripe.”

Katz sugere que o isolamento atual dure duas semanas, em vez de um período indefinido. Para os infectados, os sintomas aparecerão nesse período. “Aqueles que tiverem uma infecção sintomática devem se auto-isolar em seguida, com ou sem testes, que é exatamente o que fazemos com a gripe. Quem não estiver sintomático e fizer parte da população de baixo risco deveria voltar ao trabalho ou a escola depois daquelas duas semanas.”

“O efeito rejuvenescedor na alma humana e na economia — de saber que existe luz no fim do túnel — é difícil de superestimar. O risco não será zero, mas o risco de acontecer algo ruim com qualquer um de nós em qualquer dia da nossa vida nunca é zero.”

SAIBA MAIS

O custo econômico do shutdown global (e a busca por alternativas)

Texto original

‘It’s OK to feel anxious.’ How a professor in China faced coronavirus disruptions and fears (Science)

Robert Neubecker

By Kai Liu – Mar. 17, 2020 , 9:00 AM

In early February, I was working from home when I received a message informing me—and all the other professors at my university in China—that courses would be taught online because of the novel coronavirus. I was already feeling anxious about the mounting epidemic, and my university had locked its doors a few days earlier. Then, when I realized I’d have to teach students online, my anxiety level grew. I didn’t have any experience with online teaching platforms. I was also skeptical about how effective they’d be. “How will I gauge the students’ reactions to my lectures through a computer screen?” I wondered. “Will they learn anything?”

people sitting at a dinner table

I live in Xuzhou, China—roughly 500 kilometers from Wuhan, the epicenter of the COVID-19 pandemic. Unlike Wuhan, my city isn’t on lockdown, but residents have been discouraged from going outside and many businesses and institutions are closed. I’ve spent most of the past 2 months at home, along with my wife and daughter, fearful of the future and wondering when life will get back to normal.  

Thankfully, none of my family members, friends, or colleagues have tested positive for the novel coronavirus. Working from home is also possible for me because my research doesn’t involve lab work. But the spread of the virus and the rapidly rising death toll have weighed heavily on my mind. I’ve found it difficult to sleep. I’ve also had trouble focusing on work. One day early in the outbreak, I sat down at my computer intending to write a grant proposal. But all I could do was stare at the screen.

Years ago, I’d heard that Taoism philosophies were helpful for finding internal peace. So, I decided to listen to a few recordings. One instructed listeners to “govern [yourself] by doing nothing that goes against nature.” That resonated with me because I realized that I’d been trying to push my anxieties aside and force myself to concentrate on work—an approach that wasn’t working because it didn’t feel natural. From then on, I told myself that it was OK to feel anxious, even if it impeded my work. That helped to lessen my internal struggles.

Over the past 2 months, I’ve also learned how to teach courses online, and I have found unexpected joy in that process—even though I struggled at first. There were multiple online teaching platforms to choose from, and I didn’t know which one was best or how to use it. I opted for a platform that had a large server, thinking that it would cope better with heavy usage. My university provided some helpful guidance, and I also learned through trial and error.

I’ve spent most of the past 2 months at home … wondering when life will get back to normal.

My first lecture was especially difficult because I couldn’t see the students’ faces. I was accustomed to lecturing in front of an audience. Online, I felt like I was speaking at my students but not getting anything in return. I communicated with a few of them afterward to get their feedback and they agreed with me, saying that I needed to find a way to make my lectures more interactive. So, I started to encourage my students to leave questions for me in the platform’s comment section during my lectures.

Almost immediately, my students started peppering me with questions. I was surprised by the level of engagement. In a normal classroom setting, they are afraid to raise their hands; most wait until after the lecture is over to approach me and ask a question. But online, students were more comfortable sharing their questions in front of the entire class. That was a great outcome because if one student has a question, it’s likely that another student has the same question and would benefit from hearing the answer. I’ve also been pleased to see from the homework assignments that they are following my teaching well.

China was the first country to close its universities, but over the past month, universities in Italy, the United States, and elsewhere have made similar moves. I hope that my story can provide inspiration for academics who are fearful of what’s to come. It’s OK to feel anxious. But I’d also recommend staying open to change. You never know what you’ll learn.

Original publication

Pandemic Hardship/Pandemic Change (Psychology Today)

How the COVID-19 coronavirus pandemic can change how we live

Paul Stoller

Posted Mar 16, 2020

Most of us face multiple hardships in life—financial stress, job loss, divorce, the premature death of a spouse or parent.  Painful and unsettling life events divert our lives into unimaginable paths filled with stress and pain. Like most people, I have experienced a number of painful events: religious discrimination, the suicide of a loved one, divorce, and the death of parents.  I have also been diagnosed with and treated for Non-Hodgkin Lymphoma (NHL), a series of blood cancers most of which are classified as incurable. These life-altering experiences have shaped the course of my personal and professional life—in unexpected ways. 

My life as an anthropologist has afforded me a particular perspective on existentially troubling life events.  During early fieldwork in the Republic of Niger, one of the poorest nations in the world, I had to confront the psychological and existential ramifications of yearly meningitis outbreaks.  These always occurred during the hot dry season—from March until the first rains of June.  In hot and dry conditions that were perfect for transmission, a few of my students, some of my friends and many children got sick. 

Many of the children died. 

One year during a particularly bad outbreak I witnessed daily processions of men and women carrying the newly dead to their final resting place. Men walked silently their gazes downcast.  Women wailed as they accompanied their loved ones to the cemetery.  During that outbreak, a pall settled over the rural village where I lived. Conversations lapsed into stressful silences.  We all wondered if we would be next.  Was the tightness in my neck muscular, or was it the onset of meningitis? Invisible and silent, the scourge of meningitis put my life at risk, a visceral threat that forced me to consider what was important in my life.

 Paul Stoller
In Niger, hot and dry conditions create a perfect storm for meningitis outbreaks. Source: Paul Stoller

During another year of fieldwork in Niger, I lived through a cholera epidemic. While the transmission of meningitis bacteria and/or virus comes from close contact with infected others—cholera makes its way to human beings through contaminated water or food. 

That year, many people in the region of Tillaberi became cholera victims.  In response to a flood of new cholera patients, the local government, which had no funds to meet the challenges of the outbreak, set up a makeshift lean-to village—a horrible place to put the sick and dying.  The lean-to village had been built close to the dunetop compound where I was living.  From our compound we observed the arrival of hundreds of emaciated victims, wrapped in soiled rags, being transported on donkey-pulled carts to the cholera village.  The stench of that lean-to village saturated my senses and haunts me to this day. During that time of contagion, conversations focused on the onset of cholera, treatment regimens, and death rates, which soared in an exceedingly poor region of rural Niger.  The long shadow of cholera cast its shade on us all. Despite my relative privilege among the poor and destitute, I nonetheless wondered about the safety of my water and food.  Would I succumb to cholera?  Again, the threat of an epidemic compelled me to think about what mattered in my life:  love, family and my contributions, however small they might be, to my community and my profession.

We are now living through the COVID-19 coronavirus pandemic.  The deadly virus is spreading exponentially, and there is no apparent end is in sight.  An unsettling eeriness extends itself over our lives and our communities.  Are we unwitting carriers of the virus who have exposed our loved ones and our friends to the COVID-19 coronavirus?  It is a hard reality to bear.  Even so, we don’t know if we’ll be infected or not.  And if we are infected, we don’t know if our illness will be serious—or even deadly. We are, in fact, living in a moment of a devastating uncertainty in which we have been told to practice social distancing—a good way to slow the rate of contagion. Concerts have been cancelled. Sporting events have been postponed. Theaters have gone dark. In grocery stores, it is difficult to find bread, water, eggs, milk and TP.

Paul Stoller
Coronavirus shopping on March 14, 2020 Source: Paul Stoller

Travel has been curtailed.  Gyms and restaurants are closed. Universities have emptied their dormitories and have transitioned to remote education. K-12 public and private schools have shut their doors. The entire populations of Italy, Spain, France have been placed on lockdown.  Where I live, people have been told to stay at home—all to contain the silent and invisible virus.  If this surreal scenario is not the end of the world, it may well be the end of social life as we have known it.

The great French surrealist thinker Antonin Artaud thought that most of us make our way through life in a half-conscious state.  “You look but you don’t see,” as a wise elder among the Songhay people of Niger and Mali once told me. “You listen but you don’t hear. You touch but you don’t feel.”  Indeed, the routine of everyday life can numb our sensibilities. Each day, most of us wake up, go to school, or to work. At midday we eat lunch. At day’s end we return home, enjoy some sort of dinner, enjoy a night watching television, or steaming a film.  Sometimes we break the routine.  We hang out with our friends. We go out for dinner, have a drink at our favorite bar, or attend a sporting event or a concert.

This routine is, for all intents and purposes, social life as we expect it to unfold.  When those expectations are subverted—by an outbreak of meningitis, a cholera epidemic or the COVID-19 coronavirus pandemic—we are forced to change our routines and reconfigure our personal and social expectations.  Facing potential illness or possible death, many of us are provoked to think about what is important, about what we might do for our family, our neighbors, our communities.

We are about to experience the full turbulence of a pandemic.  There will be isolation, confusion, pain, suffering and loss, but such a state can also provoke penetratingly honest self-reflection, deep listening, existential change, and social transformation. Pandemic hardship can bring on pandemic change.  Trapped in this unsettled moment between our past and future, perhaps we can take time to reconnect and, to paraphrase T.S. Elliot, know ourselves for the first time.  

Paul Stoller, Ph.D., is a professor at the Department of Anthropology-Sociology, West Chester University in Pennsylvania.