Why this Harvard doctor is optimistic about US overcoming COVID-19 despite ‘epidemic of mistrust’ – USA TODAY

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Dr. Paul Farmers friends accuse him of being pathologically optimistic. That may explain how hes managed to spend his life helping people in some of the most traumatized parts of the world: Haiti before and after the 2010 earthquake; Rwanda after the genocide there; West Africa during the Ebola outbreak of 2014-2015; and now the United States during COVID-19.

He'ssorely disappointed inhow his home country has handled the pandemic. "There's a lot to be done," he said. Buthe remains confident that the pandemic can "be brought to heel."

Farmer chairs the Department of Global Health and Social Medicine at Harvard Medical School and co-founded Partners In Health, a Bostonnonprofit that provides medical care in developing countries andthe U.S. His work is the subject of a recent Netflix documentary, "Bending the Arc."

Dr. Paul Farmer, chair of the Department of Global Health and Social Medicine at Harvard Medical School and co-founder of Partners In Health, has treated patients in Haiti, Rwanda and West Africa, and is now helping to tackle COVID-19 in the U.S. and elsewhere. He recently published a new book, "Fevers, Feuds, and Diamonds," about the Ebola epidemic of 2014-2015.(Photo: Partners In Health)

Farmers latest book, Fever, Feuds and Diamonds, published this month, focuses on the Ebola outbreak and the public health mistakes that made it worse.

He tells harrowing stories about people in Sierra Leone, Liberia and Guineawho lost parents, childrenor spousessometimes all three. He argues the outbreak could have been less lethal if the French, British and American colonial powers had left the regionwith a medical infrastructure, and if international efforts had focused onhelping Ebola patients get better, rather than containing the diseases spread.

With COVID-19 raging across the country and the world, Farmer talked with USA TODAY about what the lessons of West Africa, Haiti and Rwanda can teach us about our own struggle.

Dr. Paul Farmer treats a boy in Haiti in 2019.(Photo: Partners in Health)

In the U.S., we tend to think of disease outbreaks as something of the past the plague of the 15th century or the 1918 flu epidemic not something that happens to us.

Farmer: Theres a long history of declaring plagues over. Not just individual plagues but all plagues. With the advent of effective and non-toxic antibiotics, there were declarations of the end of the infectious pathogen from the American Surgeon General on down.

Of course, thats never going to happen. We live in uneasy symbiosis with viruses theyre the worst, usually bacteria, parasites. Thats the way its going to be.

Thats another reason for us to think really hard about our investment in public health and safety nets in the United States.

In many countries, medical scourges are still common. What can we learn from them about how to deal with COVID?

Farmer: Some of the places that Ive worked in over the last 35 years, people are living in so much proximity to that kind of danger, that they know more about the lessons.

(Photo: The Associated Press)

Thats one of the reasons Rwanda has done a great job of responding to COVID: They had just been trying to protect their western flank from Ebola when COVID hit.

They knew what contact tracing was (the process of identifying people who may have come into contact with an infected person). They had hired and trained, not just a few thousand community health workers to do contact tracing, but probably 60,000 in a very poor country of 11 million people.

Weve had to struggle in every state in the union to get contact tracing elevated and supported fully,so when you call someone on the phone and say, "You need to isolate, you have a close contact (who has COVID),"that youre able to provide the necessary support for those people (whichPartners in Health does).

Some of these lessons are just closer to home in places that have not been spared the kind of risks we usually are spared here.

What concerns you most about Americas fight against COVID?

Farmer: We have clear evidence of "clinical nihilism"in a lot of places Ive worked the claim that theres nothing we can do for this patient, theyre beyond recall, this disease is too deadly. All the things that were said again and again and mindlessly about Ebola.

In the United States, what Im seeing now is a "containment nihilism,"where people are saying, "Its too much for us to hope to contain this."

Travelers wearing protective face masks walk through Concourse D at the Miami International Airport on Nov. 22, 2020. With the coronavirus surging out of control, the nation's top public health agency pleaded with Americans not to travel for Thanksgiving and not to spend the holiday with people from outside their household.(Photo: David Santiago, AP)

What do you think is behind that sense of hopelessness?

Farmer: Theres been a real toll of under-investment andlack of clear federal guidelines.

Do you think that will change when Joe Biden takes officein January?

Farmer: I think itll help. Leadership matters, tone matters, how our leaders conduct themselves matters. But tone is not enough. We need to invest much more heavily in public health.

Ive lost friends and family to COVID. I have friends and family whove lost their jobs or are furloughed. Im waiting to see more relief and support for those people as well. I think there are innumerable things we can do.

I never shame people for not wearing masks. ... COVID-shaming strikes me as no more appealing than shaming people around AIDS. Im disappointed, but thats not the way to move forward.

What about masks? Are you upset more people arent wearing them?

Farmer: I never shame people for not wearing masks. Its not the way I roll. COVID-shaming strikes me as no more appealing than shaming people around AIDS. Im disappointed, but thats not the way to move forward.

So why do you think people arent doing things like mask-wearing that clearly benefit both themselves and others?

Farmer: Were dealing with an epidemic of mistrust.

Angry residents react when the Utah County Commission meeting was adjourned before it even started, Wednesday, July 15, 2020, in Provo, Utah. The group protesting against face masks being required in schools removed the social distancing tape on the chairs and filled the Utah County Commission room to over flowing, prompting Commissioner Tanner Ainge to call for a vote to adjourn the meeting.(Photo: Rick Egan)

You describe a similar epidemic of mistrust in West Africa during the Ebola outbreak. How did they counter that?

Farmer: Changes in policy and laws that were, by the way, very unwelcome, often. I saw families who bitterly resisted a lot of these laws and rules, and were also deeply relieved by them, because they allowed people to say,"Im sorry I cant help bury our uncle,"or "Im sorry I cant clean up the mess of our niece or my sister in another house, but its the law."

That was something that changed me: seeing the ambivalence, the doubt and the relief all in the same household.

How do you explain the fact that Black Americans and other people of color are falling sick and dying at much higher rates than whites?

Farmer: Theres nothing genetic or essential about this. This is social. And thats good, because if its social, that means its in humans hands, not Gods hands. I think that lends (itself) to a kind of optimism.

I understand if African Americans, Latinos, the Navajo, I understand if theyre not optimistic about this. Why should they be?They have ample historical reason not to be optimistic. But it does mean its not carved in stone. I am convinced that we can bring this to heel. We will bring it to heel.

Deadly discrimination: America's history of racism was a preexisting condition for COVID-19

Maria Guadalupe Ortega Valladarez worked in the fields of Imperial County for 40 years. She was infected with COVID-19 and was hospitalized due to medical complications. She has partially lost her sight due to diabetes that she didn't attend for years. (Photo: Omar Ornelas, USA TODAY Network)

How would you compare the COVID-19 experience in the U.S. with that of other countries?

Farmer: Weve clearly done very poorly compared to peer nations meaning, other rich, industrialized nations. But weve done very poorly compared to Rwanda. We can draw on those lessons. Why shouldnt we?

Do you think Americans can overcome the lack of trust and nihilism you describe?

Farmer: We have no choice but to try. Were not going to succeed by demonizing huge segments of the population. That too was the case in Rwanda. By some estimates, up to 15% of men who were called Hutu were involved in direct execution of orders to kill.

Thats worse than what were facing.It was a decades-long buildup and explosion and much shorter rapid dismantling of structural violence. It was a deeply moving thing to see.

Partners in Health provides contact tracing services, identifying people who may have been exposed, encouraging them to stay home so they don't get others sick, and connecting them to resources to get food and pay rent. But so far, contact tracing hasnt worked well in the United States. Why?

Farmer: Contact tracing (has to be) linked to a real commitment to social support. If we cant think about the needs of those who are being called to isolate themselves, if we dont tend to their everyday needs for food, shelter (and) pay their rent and cell phone bills, were not going to have good contact tracing.

Public health nurse Jennifer Morgan, right, checks-in via phone with a patient self-quarantined at home who had some risk of exposure to the coronavirus as University of Washington epidemiology student Erika Feutz observes at the public health agency for Seattle and King County on Feb. 13. Washington state now has about 700 people focused on tracing contacts, with plans to expand the workforce to 1,500 by the second week of May.(Photo: ELAINE THOMPSON / ASSOCIATED PRESS)

That sounds pretty idealistic: that were going to provide enough support for vast numbers of people to stay home, away from work and families long enough to bring the epidemic under control.

Farmer: The thing about idealism, is if you can always link it to pragmatism, youre going to be OK.

I think theres nothing more pragmatic than trying to stand up a 1,200-person team to do contact tracing in eastern Massachusetts (as Partners in Health has done). Infusing that pragmatism with idealism is probably whats going to turn the epidemic around in the United States.

It seems like you were very personally affected by the Ebola survivors you met and the stories they told.

Farmer: It was very hard. Its always hard to see young people wither away like that or hear about people like some of these folks who lost their parents, children and spouses. It was just very hard.

Do you keep in touch with many of them?

Farmer: Thats one of the reasons (Im)optimistic. Weve seen these devastated families and devastated individuals weve seen them get better. That squares with my experience everywhere in the world. Usually our patients get better.

This interview has been edited for length and clarity.

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input

Benhur Lee, Professor of Microbiology at the Icahn School of Medicine at Mount Sinai in New York City, handles a coronavirus sample in his lab on Sept. 29, 2020. Lee has been researching the COVID-19 virus since January. Through August, his lab worked round the clock on nothing but COVID-19. They are now doing research on COVID-19 as well as other forms of the coronavirus. (Via OlyDrop)(Photo: Seth Harrison, USA TODAY Network)

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Why this Harvard doctor is optimistic about US overcoming COVID-19 despite 'epidemic of mistrust' - USA TODAY