Did you have a stock of fitted, unexpired N95 masks in your closet and a six-month supply of non-perishable foods in the pantry? Pretty much nobody was fully prepared, including me. Were you relying on the healthcare system to keep supplies on hand? In this case, the healthcare system was itself rapidly overwhelmed and close to collapse. Should we expect better preparedness from ourselves and our society?
“Way back” in 2003/4, with the SARS outbreak in Toronto, we were also surprised. We were not at all fully prepared for an outbreak of these proportions. Justice Archie Campbell, in his investigation of this, pointed out deficiencies in the system. These were not recommendations for treatment of patients. He made specific recommendations regarding systemic improvement. These improvements were only partially implemented, and the COVID-19 pandemic was as much a surprise in Ontario as it was elsewhere. His most important recommendation/suggestion/warning was that the precautionary principle was needed in future, in that “reasonable efforts to reduce risk need not await scientific proof.”
It may be that an expectation of full coordination, cooperation, communication, and logistical nimbleness is too much to ask of healthcare, public health, and societal systems that are not as much of an organized “system” as is believed. So, let’s leave that out of the discussion for now, and focus on the precautionary principle as the most important element of preparedness, as Campbell suggested.
In 2003 in Toronto, we were initially advised to take full airborne precautions; we wore N95 masks, with gowns and gloves. Why? Because the organism and the disease were totally unknown, and public health was taking few chances. What of the precautionary principle 19 years later? An article in Nature in April 2022 by D. Lewis pointed out several reasons why it took the World Health Organization (WHO) two years to declare that COVID-19 is airborne. A number of these reasons invoked a failure to use the precautionary principle. This required significant disregard for the WHO’s own documents and recommendations from two decades earlier. Ministers of both Health and Environment, for the Member States in the WHO European Region “way back” in 2004 declared: “We reaffirm the importance of the precautionary principle as a risk management tool, and we therefore recommend that it should be applied”. As well, another WHO publication from 2004 dealing entirely with the precautionary principle stated that, “If used intelligently, imaginatively and daringly, the precautionary principle will support efforts to strive towards a healthier and safer world”.
“At its simplest, the precautionary principle means that when there is serious risk, one should not wait for scientific confirmation before taking action.”
The precautionary principle had its origins in environmental protections in the 1970s. Although there is no universal definition, at its simplest, the precautionary principle means that when there is serious risk, one should not wait for scientific confirmation before taking action. There is a mistaken impression that the precautionary principle calls for jumping from the frying pan without scientific evidence of the characteristics of the fire. One may take action without waiting for scientific confirmation of the size of the fire, the number of BTUs produced, and the radius of the fire ring, if the frying pan is getting hot. Without full knowledge, there is indeed a risk of landing in the fire. However, if there is an estimate of the fire, then jumping may be a much safer alternative than waiting in the frying pan. The truth is that the precautionary principle is a clarion call for scientific evidence, as noted by Dr Martuzzi: “Thus, precaution requires more and better science.”
It seems reasonable to make preparations for catastrophe, if there is some evidence of impending catastrophe, even if the precise nature and extent of the catastrophe is not yet fully delineated. Should it turn out that there was no catastrophe, or that the risk was not great, “minimizers” look brilliant, having predicted the outcome correctly. As bets go, that would be a good bet—catastrophes are rare. In the process, they manage to fully protect the comfort of many people by minimizing danger and worry. More importantly, they also fully protect their budgets. A Forbes article in 2020, called the precautionary principle “Anti-Science” on the basis that it held up developments of medical advances whose releases were postponed, awaiting more scientific proof. This article, or its ilk, are worth consideration, but I do not agree that it is cause to outright reject the precautionary principle.
Should, in the end, there be no catastrophe, those who issued warnings using the precautionary principle will be assailed on the basis of having disturbed both comfort and budgets. On the other hand, should it turn out that the catastrophe was inevitable, those who used the precautionary principle do look very good. Regarding COVID-19, in January 2020, I said to my hospital staff “here we go again—maybe—take care.” A year later, the nurses were asking, “how did you know?” I knew because of my experience in Toronto in 2003/4. The accurate prediction of the possibility brought me no joy. I didn’t know the precise risk, but I knew there was a risk, and I thought information using the precautionary principle was important to communicate.
Why does the precautionary principle apply to pandemics? Because the downside of refusing to apply the precautionary principle to pandemics is dire. We have not yet left the current COVID-19 pandemic behind us, but it is a certainty that the next pandemic is coming. We don’t know where or when, but it is coming. Are you prepared? Are we all prepared? Are we prepared to face the costs of being prepared?
“Why does the precautionary principle apply to pandemics? Because the downside of refusing to apply the precautionary principle to pandemics is dire. We have not yet left the current COVID-19 pandemic behind us, but it is a certainty that the next pandemic is coming. We don’t know where or when, but it is coming. Are you prepared? Are we all prepared? Are we prepared to face the costs of being prepared?” I agree. I enjoyed reading this blogpost, thank you, Dr John Patcai!
I live in Taipei, Taiwan. I think it is fair to say that Taiwan had a better experience of Covid-19 more than many countries around the world, thanks to the precautionary principle. It was largely developed the last time Taiwan experienced SARS. And as Dr Lai says, in his podcast interview with me a while ago, Taiwan developed robust protocols during the last SARS crisis and she was well set up to deal with Covid-19 when it broke out in 2020. See, https://thekamugasachallenge.com/community-doctor-in-taiwan/
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