Using Research to Save Lives
Every Thursday at 5:30 a.m., I leave my house in a residential section of São Paulo to shop for fruits and vegetables at a nearby outdoor organic farmer’s market. Since the second week in March, it is the only time I venture forth from my home. Since early March, I have been using a mask, wiping my hands with sanitizer and trying to keep social distance of six feet. It has not been easy.
On most days, I am the first person at the street market, although senior citizen shoppers usually show up shortly thereafter. Even now in early June, when masks have been obligatory in our city for several weeks, several shoppers do not wear masks. And these are consumers who are going out of their way to buy healthier food from local farmers!
Back in mid-April, I finally decided to supplement my farmers market purchases with groceries from a nearby supermarket. When I arrived at 6:45 a.m., the store was not open, but loud gospel music was playing on the radio as the staff got ready for opening. The manager supervised his staff who all lined up at the market entrance as if it were the end of a wedding ceremony. The employees held hands and prayed at close distance and without masks. Then they began to sing a song to welcome me and the two other customers waiting to enter the market. I can not forget the shock I felt at watching them, and I can not forget trying to scream through my mask that they were putting all of us at risk. Since I refused to enter the market and waited, they kept singing welcoming me to enter the market. I realized that the employees could not risk losing their job by not singing and praying, and perhaps did not realize how serious of a risk this posed to them and their families. I never returned to that grocery store.
As a political scientist, I can’t help but wonder why people act that way. I am intensely interested in politics, and in evaluating the effect of public policies in Latin America, and I try to connect my personal experience with flagrant violations of state-mandated norms with academic understanding. As a faculty member at the Department of Political Science at the University of Sao Paulo, COVID-19 has provided me with intense lessons of the immense challenges facing the developing world and its ability to confront the pandemic. Individuals, households, communities and businesses are struggling with whether to adhere to social distancing measures and debating how long they should persist in these practices. In highly unequal societies in the developing world, there are additional pressures as resource-poor small municipalities and cash-strapped metropolis cities struggle to design policies that address the distinct challenges specific to their localities in communities already burdened by high levels of poverty and unmet basic needs.
Yet, my research and training constantly remind me that the responses to the pandemic are driven by politics. This is not to say that science does not face severe challenges, but it is to underscore that in any country, the managing of the epidemic requires tackling the health consequences of the outbreak, as well as its social, political, security and economic context. This implies setting priorities and reconciling various interests and goals. I am all too keenly aware that the policies that will be prioritized will be largely determined by politics.
Politics and political beliefs are one of the underlying and most important factors influencing the effectiveness of adherence to social distancing during the pandemic is driven by. At the individual level, social scientists have produced findings suggesting that the willingness of individuals to embrace practices, such as wearing a mask, is strongly correlated with ideology. As the case of Brazil clearly underscores, federal, state, and local governments have introduced, and continue to modify social distancing policies in a contrarian and adverse manner.
Indeed, in Brazil, the level of political conflict is so high in some settings that municipal governments are suing state governments in federal courts so they can adhere to the policies prescribed by the president; the same policies which are recognized to be contrary to those advised by the World Health Organization.
When I realized a pandemic hit our world, I realized I might not be able to see my parents in Argentina again. I live in São Paulo with my husband and three kids. My parents, both retired Argentine physicians who dedicated their lives to working with the Latino community in California, now live in Buenos Aires. With our borders closed, and both considered part of the “at-risk” population, I realized quickly that I would not be able to see them in an emergency. Even if I were able to enter Argentina for a visit, I would have to wait more than 14 days to see them. The situation felt heart-breaking.
I then thought of my younger sister. She lives in London and suffers from asthma. At the time, Britain was not advocating more rigid social distancing to slow the spread of the virus, and these policies made it all the more clear to me that the likelihood that my sister and her family could contract Covid-19 was increasing. I thought again of my parents. No mother or father wants to see their children suffer alone even if the costs of being with your children is exposing yourself to a disease that can kill you. Politics are intensely personal, and have individual impacts on all of us.
My thoughts then shifted to politics, and about my understanding of the multifaceted challenges facing Latin America. Together with a multidisciplinary team of scholars, we created the Rede Solidária de Pesquisa em Políticas Públicas & Sociedade. Our network has sought to bring together researchers and organizations interested in assessing the repercussions of the spread of the new coronavirus Covid-19 (SARS-CoV-2). We wanted to help provide evidence-based research to aid in evaluating the effects of public policies and to improve the effectiveness of measures under implementation.
In the last eight weeks, we have made important progress. We are a team of more than 50 researchers ranging from university professors to undergraduate students, all driven by scientific rigor and the aim of producing reproducible research. In my specific research group, my team of students and I have worked to map government policies at the federal, state and local level. Our indicators have helped to underscore the fragmented, disjointed and oftentimes contradictory response that is being taken across Brazil.
We have also produced research to show why it is hard to design social distancing with the mathematical and statistical models that have been developed to mimic the spread of the disease and how transmission rates are affected by containment policies. These models have long been used to study epidemics and have been instrumental in helping governments to understand which types of settings are most likely to increase transmission. Nevertheless, the predicted effects of social distancing policies on disease transmission in mathematical models cannot be easily translated into similar outcomes in society.
Among the reasons why theoretical models do not easily translate into applied outcomes is that individual, community, private and public sector behaviors can vary widely in response to the same set of social distancing policies, as we saw with my personal market experiences. Practices used to limit the spread of the virus include many voluntary actions that are dependent on mutual trust and respect. This reality has been underscored in the case of São Paulo as researchers have sought to study a sample of individuals to detect the prevalence of IgG and IgM antibodies to SARS-CoV-2 in different neighborhoods, and in a similar study on prevalence rates in 90 sampled cities in Brazil. Survey teams were questioned by local authorities, and individuals declined to participate. Survey evidence reported by these same researchers also indicate that the level of adherence to social distancing by families, communities or businesses does not necessarily align with the level of risk of infection of their members. Subjective and collective beliefs and perceptions influence individual behavior.
However, it’s not all a matter of belief and perceptions. People experience social and economic conditions that are quite real and objective and may influence whether they can practice social distancing or not. In communities lacking sanitation and water supply, for example, it is difficult for people to carry out fundamental practices such as frequent handwashing. There are also reasons to suspect that social distancing practices have distinct effects depending on the availability of public health interventions. In regions where public health clinics and health workers are actively engaged in working with communities to advance early detection and treatment of those who are affected such as the elderly and other at-risk people, and where there are more significant efforts to undertaking testing for the presence of the virus in large segments of the population, the likelihood of containing the spread of the disease is higher. These interventions begin with prevention-oriented health policies and include services related to the management of resources that are most precious and scarce at this moment— the availability of sufficient intensive care hospital beds and respirators in hospitals nearest to those who most need these facilities.
Moreover, school and work closures have distinct impacts in more dense urban and impoverished environments. In the developed world, governments have also been using their capacity to borrow to implement massive relief packages intended to support companies and households. Given their limited borrowing capacities and resource-constrained realities, governments in developing countries have enacted more limited economic policies. In the case of Brazil, governments—local and federal—have adopted social protection programs to provide cash and food that are instrumental to sheltering the country’s poorest citizens from the risk of hunger and destitution while adhering to social distancing. To date, however, creative work and economic programs, such as the furlough programs in Europe, have yet to be fully developed, let alone enacted in the Western Hemisphere’s second largest democracy. As a result, large segments of the workforce remain vulnerable and lack sufficient incentives or capabilities to abide by stay-at-home recommendations. In a similar fashion, children who belong to the significantly large share of households who lack access to internet, mobile phones, and computers have had more limited opportunities to engage in distance learning during the pandemic.
We plan to continue to monitor and track public policies to determine how they are affecting the death and infection tolls in our region. My hope through this work is to also use my training producing higher quality research so desperately needed right now to help save lives. Every day, I see that my work helps me to connect me to my family. It is the best way I can think of saying thank you to the physicians who raised me, and to affirm our resilience as a family and as a society.
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