Parallels between pandemics and the bystander effect

Cristina Roure
 

I remember how, just a few weeks before the declaration of the state of alarm, we looked first at China and later at Italy with astonishment and disbelief, as if what was happening there was not with us, as mere spectators. Perhaps we thought that borders could protect us, or at least give us time to anticipate and do better than the Chinese or the Italians. When we took action, our still fresh health contingency plans were pulverized in less than 48 hours by a tsunami that drove us straight to the ground of improvisation.

Not all pandemics are that fast. In fact, since the 1980s we have been contemplating another global health threat that will have a much greater impact than COVID-19: the climate emergency. We cannot say that we have not had time to anticipate, but the climate emergency "does not sell, it does not go with us." this entry may break the record of being one of the least read of this successful blog. Don't get me wrong, as citizens we try to contribute to the fight against the environmental crisis on an individual basis. However, collectively, as members of the health sector, despite being directly involved in addressing its health consequences, which are not few, and being responsible for the emission of 5% of greenhouse gases, in general, we have adopted a role more of mere spectators than of leading actors.

There is a phenomenon described in psychology known as the "bystander effect", according to which someone is less likely to intervene in an emergency when there are more people around. I wonder if this is not the cause of our lack of leadership in the fight against climate emergency. If you have 9 minutes, listen to Emergency Medicine Specialist Dr Hanna Linstadt explain why climate change is a health emergency that requires urgent action and leadership from healthcare professionals or take a quick look at the graphic below:

Font: Climate effects on health. CDC Centers for Disease Control and Prevention.

But let's focus on opportunities and not dwell on negativity. Learning from the COVID-19 crisis could help prepare us to face the climate emergency and future pandemics. A recent article points out some parallels between the two. Apart from having an obvious global character and typical of any pandemic: (1)

• Both show in a delayed way their true destructive power in health and the economy. Any delay in containment and alleviation strategies can have irreversible consequences. We cannot wait for the consequences to manifest themselves locally in our countries to make drastic decisions.
• They need scientific leadership and health professionals to deal with them. Their evidence is constantly questioned by deniers and both generate heated debates about whether to prioritize health or the economy as if it were possible to separate the two objectives. Political actions against the pandemic must be based on scientific arguments and need the involvement of professionals.
• They require global political leadership and international cooperation that are difficult to achieve. Substantive solutions are highly unpopular and pose great challenges to governments that often abandon the commitments made by previous governments as has happened with the Paris agreement. Nor is international cooperation currently being observed to face the COVID-19 pandemic and we have even seen different countries compete for the purchase of protective equipment and medicines.
• They require the involvement of citizens in solutions that involve significant sacrifices on their part. To achieve this implication, there must be a perception of a real threat, much more difficult in the climate crisis than in COVID because the times are longer and the effects are more delayed. Health professionals can contribute to this perception of threat.
• They exacerbate social inequalities. As in the case of COVID, in the climate crisis, the poor will also suffer the consequences more and have fewer resources to prevent it and to adapt to the crisis itself and mitigation strategies. Therefore, it’s important to compensate for the social inequalities that are synonymous with disease.

Some of the great challenges posed by both pandemics are indeed far beyond our reach as health professionals. But some "green shoots" and possibilities can help us react and move from spectators to actors, even if it’s a supporting role.

The concept of net-zero or zero-emissions balance in healthcare means reaching a balance for greenhouse gas emissions that are generated directly or indirectly in a building or a given activity. The aim is to cover all energy needs with renewable energies, or to compensate them by other means, to achieve "climate neutrality" annually for all of its operations.

The health sector consumes much more energy than most other commercial and service activities. The British National Health Service has been the first health system to announce its commitment to reach the net-zero targets by 2040 and has designed a plan to achieve it.(2) For the 80% of emissions it directly controls, the target is it will reach as early as 2030, but it will take more time to reach those that are not under its direct control (supplies or mobility of patients and professionals). On January 21, the Council of Ministers declared a climate emergency in Spain and promised to develop 30 lines of action to face the crisis. A few days before, in Catalonia, the Public Health Agency presented the Response Program against the climatic emergency and announced the creation of a specific website to provide citizens and health professionals with access to information and health indicators with relation to the effects of the climate emergency in Catalonia.

We might think that it’s only a matter of energy efficiency and that engineers are already in charge of that, but it’s not like that. Health professionals can do a lot, I assure you that there is a lot of room for improvement. Telemedicine is an obvious example of how our processes can not only be more efficient, but also more respectful of the environment and how, if we perceive them as an emergency, we can transform them quickly. Health prevention and promotion and the right care movement also contribute to this by reducing the demand for preventable health care, as I mentioned in a previous blog post. The carbon footprint generated will also have to be incorporated into our evaluation of health technologies. I recommend an interesting article that includes studies on the carbon footprint generated by different health sectors (pharmaceutical industry), medical specialities (emergencies, surgery, and intensive medicine), procedures or treatments (kidney dialysis, cataract surgery, inhalers for asthma).(3) The article explains how to move towards the “zero emissions” goal in healthcare, describes some initiatives and strategies, and appeals to the medical community to lead this change and take advantage of the opportunities that adaptations have revealed system emergencies during the COVID-19 pandemic.

Connecting clinical practice and health management with the climate crisis offers us other opportunities. It should not be forgotten that the funds for economic recovery after COVID-19 are intended to transform the system. Innovative care models that use the lessons learned during the pandemic will possibly have more opportunities to receive funding, especially if they fit with the European Commission's post-COVID recovery and resilience strategy based on the so-called Green Deal or European Green Pact of sustainable growth towards climate neutrality by 2050.

On the other hand, a strategy of commitment and leadership in the face of the climate crisis in our organizations would also help us to create an inclusive culture to which we add not only health professionals, but also the rest of the professionals who work in the organization (physical resources, cleaning, logistics, etc.).

The COVID19 crisis and the climate emergency have obvious parallels. As professionals engaged in health we should learn from the current COVID pandemic and take advantage of the multiple opportunities it offers us to go from being spectators to actors in the containment and mitigation of the true great pandemic of our century that is already here and does not allow delay.

Bibliography

1. Klenert D, Funke F, Mattauch L, and O'Callaghan B. Five Lessons from COVID-19 for Advancing Climate Change Mitigation (June 2, 2020).

2. SSRN: https://ssrn.com/abstract=3622201 or http://dx.doi.org/10.2139/ssrn.3622201.

3. Torjesen I. NHS aims to become world’s first “net zero” health service by 2040. BMJ 2020;371:m3856. doi: 10.1136/bmj.m3856 pmid: 33008827.

4. Salas N R, Maibach E, Pencheon D, Frumik H. A pathway to net zero emissions for healthcare BMJ 2020;371:m3785. http://dx.doi.org/10.1136/bmj.m3785.