“How COVID-19 Sparked a Wake-Up Call for Public Health: Lessons Learned Too Late” – The Boston Globe

In 2020, I contracted tuberculosis (TB), an ancient and deadly disease. It was a shock. I was experiencing symptoms like a persistent cough, fevers, and fatigue that didn’t seem to go away. Initially, my nurse thought it might be asthma or pneumonia. After a week of antibiotics, my fever dropped, but the cough lingered. It wasn’t until the pandemic hit and my husband expressed concern that I decided to get an X-ray.

That X-ray revealed granulomas—indicators of TB—in my lungs. Suddenly, my life changed. The local health department took over my case, which meant monitoring my every step as I began treatment. One of the first calls I received was from Joan, a nurse who would oversee my medication.

In New York, laws mandate that patients with TB adhere to a strict regimen of treatment. I had to take eight pills daily for two months, followed by three daily for four more months. Joan had to watch me take my medication daily, part of a strategy to prevent drug-resistant TB, which can arise from skipping doses.

Initially, I appreciated the support. The state provided all my medical needs, from prescriptions to follow-up checks, making everything free of charge. This felt almost like a model healthcare system.

Yet, as I got better and the lockdown stretched on, the daily video calls with Joan became increasingly frustrating. I knew I was committed to my treatment; I didn’t want to skip doses like those who refused help. While I understood Joan’s vigilance, the constant monitoring felt condescending. I began to question the necessity of this structure.

Public health and individual rights have always been at odds, and the pandemic heightened these tensions. The current model assumes that if you’re sick, you can’t be trusted to take care of yourself. This philosophy can lead to coercive practices. A 2015 review indicated that daily observed therapy for TB doesn’t necessarily lead to better health outcomes. So why was I being treated like a child?

Historically, public health has often marginalized those it seeks to protect. During the AIDS epidemic, for instance, marginalized communities faced blame and stigmatization. Public health strategies need to evolve from viewing patients as potential threats to partners in healing.

Many health experts believe there needs to be a balance between public safety and personal agency. Dr. Francis Collins, former director of the National Institutes of Health, stated that public health decisions often lacked a broader view of community impact. The approach must not only save lives but also respect the dignity of individuals living those lives.

The pandemic offered a lens through which to examine the flaws in our public health system. While many officials acted in good faith, the implementation often came across as too heavy-handed. As a society, we must advocate for a more respectful and trusting public health approach, one that empowers rather than mandates compliance.

In the future, we can expect outbreaks similar to COVID-19, and it’s crucial to learn from the past. Rebuilding trust between public health authorities and the public is essential. The goal should be a public health system that values lives and respects the complexities of those lives.

The lessons from my TB experience and the pandemic urge a conversation: how can public health be both protective and respectful? It’s a dialogue worth having for the health of everyone.



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