Prompt 12: Institutionalist versus anti-institutionalist views

     The CDC and WHO have largely impacted my COVID experience. These are major institutions that have affected the travel of individuals. We could not leave the country to visit family members in my family due to travel restrictions. Suppose individuals are vaccinated and agree to quarantine/practice safe COVID practices (like handwashing and mask-wearing). In that case, they should be able to travel. Placing strict travel bans has separated families from each other, international students from their institutions, and have majoring disrupted any other necessary travel. The CDC has also affected my college experience with social distancing and mask policies. To make these institutions more equitable for all communities, I would have them make individual recommendations for regions and not the whole world. For example, Mumbai should have different regulations than a town in Iowa. There should be better monitoring systems that can accurately update the regulations needed to keep people safe. 

 

    Lexington Public Health Department has also affected my COVID experience on a more local scale. This organization has affected how local businesses and organizations operate during COVID. For example, the men's shelter was shut down due to the number rising, but that left the people in need with a deficiency in resources. The public health department should expand resources given to groups affected by their actions (or at least some support).  

Prompt 11: Evolutionary and recent time scales

 Diseases can change and mutate through the years.  With COVID-19, the way we interact with the virus may change dramatically over decades.  We have already seen mutations of the SARS virus with the Delta and Omnicom variants. There may be more variants in the future. People must get vaccinated so that we can be better prepared to fight off future variants.

On the other hand, as time goes on, we also understand the virus. For example, the CDC thought COVID-19 may be contracted by a fomite transmission, but we now know that this is untrue. In the Middle Ages, the bubonic plague wiped out almost 1/3 of the world's population. Still, as time has progressed, the bubonic plague no longer haunts us. I think that COVID can follow this trend as technology and knowledge advance. We also will be able to study the disease and create new and better treatments as time goes on. 

Three factors that change SARS-Cov-2 are mask-wearing, vaccination rates, and government policies. When people wear masks and are vaccinated, they change the trajectory of the rates of COVID dramatically. When governments do not or cannot implement good practices to stop covid, it can dramatically increase the transmission rates of COVID. 

Prompt 10: Top-down and bottom up innovations

     COVAX is a joint effort by many groups (UNICEF, WHO, GAVI, CEPI, National Children's Fund, and a few more) that hope to evenly distribute the vaccines by population size to countries worldwide. The idea is that money is invested early on in the vaccine production and then distributed later. The bill and Melinda gates foundation, alongside the World Bank, have donated money to the cause. COVAX is struggling to provide the promised vaccines due to a shortage of supplies. India, a large producer of pharmaceuticals and vaccines, has turned inward to deal with its own COVID outbreaks and has not exported vaccines since March. Other countries have begun to seek different ways to get vaccines. Still, the trend is those larger countries that can afford to get vaccines are getting them while smaller countries suffer. Cuba and Tanzania opted out of the program. 

    A bottom-up approach specializes in health treatment to individual communities to better target disease. In the reading, bottom-up approaches helped identify channels of influence like friends and peers that made people more likely to receive a vaccine. Also, working closely with a community established trust among marginalized people groups. Open communication is also fostered when working from the bottom up, allowing for accurate patient and health provider information. Overall livelihoods of communities are also preserved or restored. Lastly, comprehensive health care initiatives are more impactful when working with a small community. 

Prompt 9: Eradication versus control

 Eradication should be the goal when it is financially and biologically feasible.  For example, smallpox could be eradicated because there was no other reservoir for the disease to live. If a virus had another reservoir, like commonly lived in bats, eradication would be impossible.  Humans would have to eliminate the bat population and not transmit the virus among themselves to eradicate the virus. In the case of smallpox, there was no other reservoir other than humans, so the main obstacle was ending human-to-human transmission. A vaccine was available, and the national community decided to dedicate its resources.  The smallpox vaccine initiative was also financially feasible.  

I think the control approach should be the first response for global health. Suppose health officials can support communities to alleviate most of the adverse side effects of the disease. In that case, I do not think eradication is needed. Take cancer as an example: cancer will most likely not be eradicated soon, but significant strides have been made in treating this disease. My younger brother was diagnosed with a stage two Wilm's tumor at 8 months old. He had a tumor the size of a cantaloupe surrounding his kidney, and if he had been born before the 1990s, his diagnosis would have been a death sentence. Instead, he went into surgery to remove the tumor and underwent 9 months of chemotherapy. The chemo made him sick, but chemo can have few side effects since then.  Suppose chemotherapy can continue to advance, possibly small pills with little to no major effects. In that case, a cancer diagnosis could be like strep throat. 

In COVID, I think a control approach to the pandemic is more realistic. We have already seen the SARs virus mutate into different variants. We are unsure how many reservoirs the virus would live in.  For now, masks should be worn in highly populated areas, and individuals should be vaccinated when they can be.  These approaches may seem like they are attempting eradication, but both methods are not 100% capable of stopping viral transmission. Eventually, eradication may be possible if a more effective vaccine is available and more individuals receive it. Still, for now, the control approach is most appropriate. 

Prompt 8: Wealth, class, and lifespan

    I think people have a longer life with a college degree due more to the opportunities they have versus the actual knowledge they gained while at university. For example, suppose a student is studying engineering. In that case, I doubt their thermodynamics class will provide much vital information that directly impacts their health. But on the flip side, they now have to knowledge to be an engineer, work at a high-paying job, afford insurance and health care, eat a well-balanced/nutritional diet, save for retirement, and have a less stressful life compared to people with financial instability. I believe that a student's financial income before college increases the likelihood of completing a four-year education, but it does not inherently mean that they will or will not succeed in school. Plenty of students from high-income families fail out, and some first-generation students succeed while at school.

  There may be class differences that persist in our cohorts after higher education.  For example, the first-generation students may not experience the exponential wealth increase through generations as students who had parents with a college degree. Students who were the first to complete higher education may be expected to support their parents, siblings, and other family members after college since they are making the most money in the family. Compared to a student who does not have to support their family because of financials, this would be very draining for the first-gen student. There are also other socio-economic influences of a society that are not erased due to completing a degree. Institutionalized racism in health care systems still disproportionately affects people of color, especially black women. For example, black women are not appropriately screened for heart attacks as their symptoms present differently from white populations. 

Prompt 7: Political instability and COVID-19

 At the start of the COVID-19 pandemic, India proactively protected their 1.3 billion citizens through lockdowns and other programs.   While this was widely successful, the second wave of COVID-19 is beginning to take a toll in India, and politicians are doing little to combat the issue.  According to the New York Times, India reported 145,384 new infections a day (Mashal & Kumar).  While this is still relatively low for a large country, these numbers can quickly spiral out of control.  Indian politicians have also started to hold political rallies to gain support for future elections. Still, these events do not correspond with the public health efforts to lower the rates of transmissions.  Public health officials have urged the government to deploy vaccines to its own population (India is one of the largest producers of pharmaceutical products in the world). Still, the prime minister has downplayed the pandemic.  India only has administered  340 million vaccine doses, which is less than 5% of the population (Kumar).  There was also reporting of 14 people selling "covid vaccines" that were really just salt water; the police are currently investigating (Kumar). Public health officials also claim that Priminsiter Modi and the Indian government are vastly underestimating the pandemic's real toll.  Without a realistic and non-hypocritical response to this disease, the political nature of the Indian government will not be working for the people.  Politicians are overly worried about how the COVID-19 pandemic is affecting their political campaigns. Still, they forget that their actions in the present are actively changing the future.  In Delhi, a passed law stated that if a taxi driver was not wearing a mask, they would be punished, but on the same day, politicians held large gatherings and drove around the city unmasked (Kumar). The actions of local and national politicians should not be rooted in their security of a political future. Instead, they should start to make improvements to stop the disease like mandating lockdowns, distributing vaccines, reporting an accurate number of cases and deaths, and eliminating hypocritical actions to protect the citizens politicians represent. 

Kumar, Hari. “Indian Police Investigate Whether Scammers Gave Thousands of Shots of Salt Water Instead of Vaccine.” The New York Times, The New York Times, 4 July 2021, https://www.nytimes.com/2021/07/04/world/asia/india-covid-vaccine-scam.html. 

Mashal, Mujib, and Hari Kumar. “Complacency and Missteps Deepen a Covid-19 Crisis in India.” The New York Times, The New York Times, 9 Apr. 2021, https://www.nytimes.com/2021/04/09/world/asia/india-covid-vaccine-variant.html. 

Prompt 6: The context of these approaches

    I believe that a country's cultures and history affect whether a top-down approach works versus a bottom-up approach. In the United States, the nation was founded on the idea that individual liberties are essential.  Frequently, people who are more right-leaning in politics believe that the government should not have the right to have a significant say in the individual's life.  This idea pertains to the economy, education, local and federal regulations, and even health.  Suppose people do not want the federal government to intervene in their life. In that case, they will not easily comply with a top-down approach. This can be seen today with the availability of the covid vaccine and unvaccinated populations. Areas that are typically more right-leaning have significantly lower vaccination rates than more liberal populations. 

    Personally, I am open to top-down approaches. When other people or organizations do the work (like creating a nationally available vaccine) and develop resources for the population to use.  I was very excited to get the vaccine when it first became available. I encouraged all my family members and friends to participate.  Many people in my family were not on the same page as I, and some are still unvaccinated.  Because of our different beliefs, I think that a top-down and bottom-up approach should be used simultaneously.  If a national campaign allowed all people to get a vaccine and local organizations and leaders encouraged their communities to participate in these programs, health initiatives would be more effective. 

Fry, Erika, and Nicolas Rapp. “Covid Vaccination Rate by State. See If Your State Met Biden's Goal.” Fortune, Fortune, 2 July 2021, https://fortune.com/2021/07/02/america-wont-make-bidens-july-4-covid-vaccine-goal-see-which-states-will/. 

Prompt 5: Top-down or bottom-up approaches?

     An example of a top-down approach in response to the COVID-19 pandemic is nationwide lockdowns.  Most communities around the world experienced some form of a lockdown, but the strictness and length of lockdowns varied from country to country.  The United States had "stay at home" orders implemented at the state level but never experienced a national lockdown. The first lockdown was put in place on March 17, affecting cities in California.  These measures were effective only slightly. Many people had to continue to work to keep up with bills and other expenses. Lower-income communities were disproportionately affected by COVID-19 and lockdown policies as they could not stay home for extended periods.  In New Zealand, the country took a tough stance on COVID-19 lockdowns. The entire country was on lockdown, and it effectively limited the transmission of the disease. All luxury or nonessential activities are closed overnight (restaurants, sports, schools, pools, and playgrounds), leaving only the essentials open (gas stations, hospitals, and supermarkets). These measures were highly influential.  According to the New England Journal of Medicine, New Zealand had declared the pandemic to be over only 103 days from the first positive case.  Compared to other top-down approaches across the globe, this is a remarkable feat.  

In my personal opinion, bottom-up approaches work better for individual communities.  In a pandemic, this can look like public health operations looking at individual counties and making decisions for their community.  For example, suppose a county is struggling with an outbreak. In that case, officials can encourage individuals to participate in their health, making their decisions more impactful for their community.  In the United States, some pockets of people believe that their individual liberties come before protecting people, leaving vulnerable and immunocompromised people to suffer. Suppose we can provide local resources to these people and have their health be their decision. In that case, it could change the responses and behaviors of all communities. After all, top-down approaches cannot work if the individual doesn't respond to them. If the government gave all citizens a vaccine, but no one took it, the whole is still unvaccinated. 

Others, D. Mevorach and, et al. “Successful Elimination of Covid-19 Transmission in New Zealand: Nejm.” New England Journal of Medicine, 6 Oct. 2021, https://www.nejm.org/doi/full/10.1056/NEJMc2025203. 

Prompt 4: Pandemic risks for a globalized world

 Two effects of globalization seen in the COVID-19 pandemic is the overpopulation of cities and economic inequalities.  Major cities like New York were hit the hardest, experiencing large cases, hospitalizations, and deaths. Because we live in a global world, these large cities have millions of people interacting every day. Public transportation, restaurants, nightlife, daycares, and jobs are opportunities for a virus to spread among larger populations. For the first time in 100 years, the NYC subway system shut down for a deep clean.  In communities that are less globally-connected, covid-19 had less of a dramatic effect.  Economic inequalities are also larger; the rich are richer, and the poor are poorer. People who have money are less affected by COVID-19. The rich have the opportunity to leave large cities, have food delivered to them, have their children continue their education online, etc.  People who live in poverty cannot afford to not go to their job. Often, their children do not have the technology to stay connected to online school. Also, jobs that typically pay less, like waiters and waitresses, shut down during the pandemic, whereas salary jobs were moved online. Once again, affluent individuals were not drastically affected by COVID-19. 

Prompt 3: My health and COVID-19

 In the first couple of months of the pandemic, I experienced depression. I had little to no desire to leave my house, exercise, or eat food. I averaged one meal a day and primarily was sedentary. At some point, I think my parents began to notice my mood and decided there was a need for change. They had me take the dogs for an hour-long walk every day, rain or shine. Walking every day was not something I had done consistently before covid as I did not have much free time in high school. I noticed my mood began to improve as the weather became warmer, and I continued to exercise. My appetite also started to come back.  In the first month of COVID, my family stockpiled can food and frozen meat to limit the number of times spent at the grocery store. This changed our diets slightly because the food was no longer as fresh as it used to be.

For example, instead of going to the market to get fresh bread, fruits, and vegetables, we ate processed bread that could be frozen and canned fruits and veggies.  Later, we had the financial means to try out meal delivery kits. This allowed us to get high-quality meals delivered to our house without the fear of getting COVID. COVID exposures were a bit of a worry at the beginning of the pandemic. My mom has Immune thrombocytopenia (ITP), an autoimmune disease that caused her to need her spleen removed. My little brother had cancer and is now missing a kidney, and both of us kids have struggled with asthma. If one of us had COVID, these non-communicable diseases might have made it more difficult for us to fight it off. 

Luckily, everyone in my family received their vaccine very quickly. By late April, my immediate family and extended family were all protected against COVID-19. 

Prompt 2: Pop culture and Covid

 This is an animated music video from Vietnam that was published February 28, 2020.  This video is for educational purposes. The video teaches the audience what corona is, where it is from, and how people should respond all through a catchy song. Music videos and bands (for example K-Pop) is very popular in Asian culture, and this video is an example of that. Introducing, Jealous Corona!

Prompt 1: No single pandemic

     On March 13, 2020, the start of the COVID-19 pandemic began to pick up in the United States. My grandmother (who typically lives in Houston) was staying with us kids in Minnesota. My parents were out of town, and possibly out of the country, when school was canceled for “two weeks.” My parents weren’t apprehensive and decided to stay there, leaving my siblings and me at home. It wasn’t until the NBA cancelled the season that my father became worried and decided to come home. 

See, the Persful family usually is always on the move. It was a common occurrence for me to call my dad to see what he wanted for dinner, and his response would be something like, “oh, I’m in Paris for a meeting.” Since we were little, my brother and I have been flying by ourselves, and I left the country 4 times unaccompanied while in high school; the Persful family was always on the move. 

Since the pandemic, 2020 has been the only time I can remember that we all were together for a long time. My father and I painted in our studio every day, I walked the dogs, we learned to cook, and we had way more intentionality in being with each other. My father was considered a front-line worker since he provided important manufacturing pieces for the COVID isolation sites and emergency camps.  His work typically happened on the computer instead of in-person meetings. My school was fortunate enough to already have the technological resources available to continue online instruction, so my day-to-day life only really changed in the social sense. This part of the pandemic was peaceful. 

On the other hand, the beginning of covid was one of the more stressful times in my life. My mother went to work every day at the hospital, caring for her cancer patients. She experienced severe anxiety early in the pandemic. I remember her crying in the supermarket vegetable aisle because she was worried about who had touched the food and if it could have been contaminated with COVID.  My mother would change her clothes in the garage every day and leave her shoes outside, run upstairs as fast as she could, and take a boiling hot shower. She was afraid of getting us sick, and the heaviness of her worry was sensed by our household. 

Reflecting, COVID was a complexity of blessing and curses. While I am grateful for the change in pace provided for my family, it was also a time of deep anxiety and isolation. As a child of two front-line workers, it was a thought in my head that my parents would be the first ones to get sick. With the uncertainty of the severity of COVID, this was a terrifying thought.