Covid-19 Chronicles #9: Fighting to breathe

  • Science, She Wrote
  • Friday, 05 Jun 2020

My memories of studying medicine in Russia include heavy grey winter skies, warm pirozhki in the freezing cold, and the choking odour of formalin-bathed cadavers in anatomy practicals. I remember vividly one cadaver we studied belonged to a lady.

The calf of her leg was striking. Without the skin, the exposed fibers of her muscles were beautifully preserved. I imagined her dancing ballet, sitting cross-legged, and taking long walks. Without the skin, she could have been anyone, of any race. She was human.

Similarly, this is how germs view us. Although humans may have genetic variations that make them more inherently resistant or vulnerable to many infectious diseases, viruses like SARS-CoV-2, which jumped from animals to cause Covid-19 in humans, generally do not care about the shade of a person’s skin, their age, gender, religion, job title, citizenship, or legal status. SARS-CoV-2 indiscriminately targets the ACE2 receptors, coating the surface of most cells in our body—their gateway to invade and multiply, and consequently destroy.

But we also know the risk of getting infected and disease severity varies by socioeconomic factors. People in conditions that are crowded, without good ventilation or sunlight; battling malnutrition, chronic illnesses, other infections; with limited access to funds, and healthcare services, and limited empowerment to protect their health, tend to face higher risk of catching and dying from infectious diseases.

Upon autopsy, George Floyd was found to have harbored a Covid-19 infection. Indeed, studies show that African American and Hispanic communities across the US are being disproportionately affected by the pandemic. While testing increased across the country, they did not sufficiently reach areas with majority black populations—who are thrice more likely to die from this disease.

But it was not Covid-19 that killed George Floyd.

What killed him was decades of diminishing empathy and compassion, increasing systemic inequities, a gun-fueled culture of violence and fear, and rampant abuse in law enforcement, particularly towards blacks and minorities.

When the officers confronted George Floyd because he was allegedly paying for cigarettes using counterfeit bills, when one of them continued to knee Floyd’s neck against the street as he gasped for air and pleaded, "I can't breathe,” they likely only perceived the stereotypical black man, blinded by ideas of race, and statistics that associate blacks with poverty, lower education and crime.

They failed to see him as someone’s father, brother, child and friend. A human, with a life, loved ones and a story. They failed to see he needed to breathe. They killed him. Devastingly, he is but just one name in a sea of victims of similar crimes.

But it was his death last week that resparked the Black Lives Matter movement, consisting of largely peaceful protest and denouncements across the world. Facing threats to health and safety from Covid-19 and armed forces, protestors wearing masks lie on the street chanting, “I can’t breathe”. Amidst a backdrop of unprecedented crisis from a contagious respiratory disease, these protests scream that for far too long, blankets of suffocating inequities persist throughout human societies.

Chimamanda Adichie said the danger of stereotypes is not that they are untrue, but that they are incomplete.

And the stereotypes go both ways. Recently, top medical journal the Lancet retracted a study related to antimalarial drug hydroxychloroquinolone, repurposed to treat Covid-19. Because of its reputation, the study published only two weeks ago already spurred the WHO to halt their hydroxychloroquinolone trial. (Malaysia however continued, while monitoring potential adverse effects.)

On the surface, the now-retracted Lancet study seemed groundbreaking: data from 96,032 patients showing a controversial drug was potentially deadly. But it took rigorous scrutiny from hundreds of researchers to uncover the complete story: the observational data behind the study was severely flawed, procured through an unreputed data analytics company and could not be verified.

For now, we still don’t know if the drug is effective or safe against Covid-19. But this retraction precipitates deeper questions within science and research, such as the process of peer-review, data verification, and ethics, in the urgent race to find a cure for the pandemic.

This massive research controversy and civil movement against systemic injustices as the pandemic continues to unfold, highlights the danger of judging the superficial and neglecting to appreciate the whole being.

While Covid-19 is the battle the world fights together, it is also fought amidst the battle against other infectious and non-infectious threats to health; against inequities, discrimination and abuses; and against harmful stereotypes, unhealthy competition and perverse incentives that compromise ethics and quality in science and research.

For too long, we judge and act too often on the basis of skin, religion, reputation, language or documents, without viewing the whole human being, and the whole context—we continue to be guilty of it even here in Malaysia.

Martin Luther King Jr said in Selma, 55 years ago, “We must come to see that the end we seek is a society at peace with itself, a society that can live with its conscience. That will be a day not of the white man, not of the black man. That will be the day of man as man.”

Both MLK Jr and George Floyd’s time on Earth have ended. In their death they left loved ones to grapple with loss, and the world a chance to regain its conscience.

As a young woman, learning anatomy using another woman’s skinless body I remember thinking, will someone look at me this way someday? I could only imagine how she lived, but I experienced the woman’s contribution to medicine in her death.

As we all try to survive the end of this pandemic and beyond, now is a time to also ask how we can fight the inequities and injustices that choke us.

How can we change so we can continue to live with our conscience?

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Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah is senior lecturer in Medical Microbiology at Universiti Sains Malaysia, and an affiliate of Young Scientists Network-Academy of Sciences Malaysia. She is active in science communication and infectious disease biomedical research. She was the first female Asian champion of FameLab, the world’s longest running science communication competition, in 2018. The writer’s views are her own.


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