How ready are you to confront your limits and the current limits of established institutions?

‘We are all living on borrowed time’ is an old proverb that reminds us of our mortality. Before you quit this page searching for writing that reminds you of a more cheerful tone, let me preface this by saying that acknowledging our mortality can be a liberating experience. Because we are mortal and finite, our choices matter.

If you thought life would never end, philosopher Martin Haglund argues in his book This life, then nothing could ever genuinely matter because you’d never be faced with having to decide whether or not to use a portion of your precious life on something.

But the tug you felt to quit reading this essay is not something to run away from. As philosopher Martin Heidegger argues, the central challenge of human existence is whether you are willing to confront your finitude. We must live out our lives, to whatever extent we can, in clear-eyed acknowledgment of our limitations, in the undeluded mode of existence that Heidegger calls ‘Being-towards-death.’ Aware that this is it. Life is not a dress rehearsal in that every choice requires numerous sacrifices, and time is always already running out. It may run out today, tomorrow, or next month.

Now, as limited as our time(4000 weeks on average) might be, what about other new limitations that you might have to contend with and could make our quality of life worse? What if you don’t die but your quality of life goes down the drain? What then? If you’ve had a family member go through Cancer, you can probably relate. For those who haven’t gone through that and want to know what that feels like, I’d recommend you read Crying in H Mart or The Fault in our stars.

Mortality gets all the attention of philosophers, for it is a central challenge of the human condition. But what about its neglected cousin, Morbidity? The World Health Organization (WHO) defines health as not merely the absence of disease or infirmity, but a state of complete psychical, mental and social well-being. My question is, how well is the medical establishment following this definition of health today? Just because racism is no longer legal in the letter of the law, we still see gross injustices propagated.

My experience, along with countless others with Long Covid, says that looking at health with this broader definition is the exception rather than the norm. The assumption with Covid is that if you don’t make it to the hospital, you don’t have a severe illness. Also, when patients are discharged, they are assumed to be “recovered.” To this day, countless doctors are unaware of the chronic effects of COVID despite it being acknowledged by WHO and Antony Fauci.

Dr. Fauci recently said that “10 to up to 30 plus percent of people will go on to have persistence of symptoms [and] even mild cases are included in that possibility... Long-term symptoms usually include shortness of breath, fatigue, difficulty concentrating, insomnia and brain fog”

This can significantly affect your quality of life negatively, with the acknowledgment by Joe Biden(President of the USA) that Long covid can cause disability. Just like racism runs rampant, so does ableism in medical circles despite institutional acknowledgment.

Even Doctors acknowledge this ableism. Dr. David Putrino, Director of Rehabilitation Innovation for the Mount Sinai Health System in New York, US, grimly described his interactions with physicians for whom anxiety is still a default explanation of long haulers’ symptoms.

“Everyone should know that long COVID is real, but a lot of people are not there yet. I am having many conversations with [doctors] from states that are now where New York was in March/April in terms of COVID numbers. They’re coming to me completely fresh, completely naïve, saying symptoms of COVID aren’t supposed to last this long.” Dr. David Putrino

These kinds of symptoms not only persist after coronaviruses- We knew about the post-Ebola syndrome, Post-West Nile virus, and Post-Epstein Barr (mononucleosis). Heck, 96% of Polio cases were mild. Our leaders were responsible for preparing people for the truth that you can have a severe illness even if you don’t need hospitalization. And with the Coronavirus, all levels of severity can lead to chronic illness(even asymptomatic). They made a choice not to do that. Countries like Sweden chose to let the virus go rampant without restrictions of masks. Sweden had deaths to the tune of 158 people per 100,000(whereas its neighbor Norway had 24 deaths per 100K people) and unacknowledged long covid patients. With its limited physical infrastructure, countries like India had 38 deaths per 100,000 population. Even if you assume the numbers in India were off by a factor of 2X, it would still be far lower than Sweden. I have to add the disclaimer that I lived in Sweden when the covid pandemic started, and I have moved back to India after two years of the pandemic, so my views are far from objective on this topic.

“Every virus has a post-viral syndrome,” said Putrino. “In a global pandemic, we’re going to have a certain number of patients present with a post-viral syndrome, and shame on us for not being ready.”

In this article from Vice, a question is posed- How could top scientists and medical professionals suffer collective amnesia about this crucial piece of information? Why weren’t we warned about two types of potential COVID complications, acute and chronic? The answer is simple: Our medical system is radically unequipped, practically and conceptually, to serve patients whose tests come back normal and whose chronic symptoms cannot be explained with a biological diagnosis or outsourced to a specialist. If not for support groups like Body Politic, which have provided excellent support to patients and caregivers, people with Long Covid would have been lost.

Diane O’Leary argues that medical science had proceeded as a mechanical sort of endeavor for centuries. Doctors’ focal concern through this model had been the body and its diseases, with a sense that medicine can best remedy disease through a piecemeal approach to the body’s parts. Through this “biomedical model” (BMM), medicine aimed for the kind of objectivity that generally characterizes the sciences, but in the late twentieth century, that approach faced a reckoning. Medicine’s exclusive focus on the body had encouraged doctors to treat patients as things. The problem, it became clear, was that medicine should not be focused just on the body. It should be focused on the person.

I contend that all medicine is in crisis and, further, that medicine’s crisis derives from the same basic fault as psychiatry’s, namely, adherence to a model of disease no longer adequate for the scientific tasks and social responsibilities of either medicine or psychiatry…. The biomedical model not only requires that disease be dealt with as an entity independent of social behavior, it also demands that behavioral aberrations be explained on the basis of disordered somatic…processes. Thus the biomedical model embraces…reductionism, the philosophic view that complex phenomena are ultimately derived from a single primary principle… (Engel 1977, p. 129).

Complex systems are systems where the whole is greater than the sum of its parts. The human being is most certainly a complex system. So, you tell me, where is the logic in applying a reductionist approach towards a human being on disease diagnosis?

To this day, the medical establishment, to a large part, deals with patients using the BMM model. It’s like physicists trying to understand the behavior of subatomic particles using Newtonian mechanics. It’s like they never got the memo on Quantum mechanics. Newtonian mechanics works under certain conditions(describing macroscopic everyday objects), but it fails pretty miserably when representing microscopic entities like electrons. The BMM model works well when re-plumbing the body with surgeries but not so much for post-viral illnesses.

Nassim Nicholas Taleb mentions that medicine has been Iatrogenically negative for the largest portion of history. The name for such net loss, the (usually hidden or delayed) damage from treatment in excess of the benefits, is iatrogenics, literally “caused by the healer,” iatros being a healer in Greek. Some iatrogenic events, like amputation of the wrong limb, are apparent, whereas others, like drug interactions, can evade recognition. For a classic example of iatrogenics, consider the death of George Washington in December 1799: we have enough evidence that his doctors greatly helped, or at least hastened, his death, thanks to the then-standard treatment that included bloodletting (between five and nine pounds of blood). Now, these risks of harm by the healer can be so overlooked that, depending on how you account for it, until penicillin, medicine had a largely negative balance sheet — going to the doctor increased your chance of death. The famously mistreated Austro-Hungarian doctor Ignaz Semmelweis observed that more women died giving birth in hospitals than on the street.
These events are not a thing of the past-In a 2013 estimate, about 20 million adverse effects from treatment had occurred globally. In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990.

Medicine has known about iatrogenics since at least the fourth century before our era — primum non nocere (“first do no harm”) is a first principle attributed to Hippocrates and integrated into the so-called Hippocratic Oath taken by every medical doctor on his commencement day. It has been about twenty-four centuries since this idea has come to be, but how well are our doctors and the medical establishment following it? As of today, there are nearly 300 million covid cases and 5 million deaths. Assuming that we select 10% of people who get long covid(lower estimate in Dr. Fauci’s statement), that would mean potentially a minimum of 30 million people with disabling long covid. That is the entire population of Canada or Nepal. With Omicron surges your likelihood of catching Long covid is as much as any other variant. With the medical establishment still not clued in on long covid, it harms patients who barely have the energy to get out of bed, let alone go to a doctor who gaslights you and calls it anxiety. This reminds me of HIV/AIDS denialism, where large swathes of people refused to acknowledge that human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS), despite conclusive evidence. Some of its proponents reject the existence of HIV, while others accept that HIV exists but argue that it is a harmless passenger virus and not the cause of AIDS. In retrospect, that might sound trivial, but which side in history won out is clear. Now, everyone acknowledges the relationship between HIV and AIDS. It’s not a matter of debate anymore. When I watched the hilarious and gut-wrenching satirical black comedy, Don’t look up, I got reminded more of the looming Long covid crisis in our immediate future, which is largely unacknowledged. It’s like people don’t want to look up(and see the climate crisis or disabling long covid) because they prefer certainty even if they might be clinging onto a fantasy.

What kind of doctors and medical system do you want to look after you if you or someone you care about ever catch Long Covid or another post-viral illness? And which side of history will you be in when chronic post-viral diseases are better understood?