Co-Written by Kesavan Rajasekharan Nayar, Shabanaroze Chowdhury and Arathi P Rao

The body fluids and transmission of infections have been now well-known. The role of intimate contacts between males and females during sexual intercourse have been held responsible for transmitting HIV/AIDS. History reveals many diseases which have been acquired through genital contact. Syphilis, a bacterial disease, for instance, is transmitted through sexual contact (Sexually Transmitted Diseases) which stigmatized the afflicted people for centuries. Like the Spanish flu, it also carried an identifier prefix as various enemy countries blamed each other and even religious groups attributed its origin to the other religion1. It is also believed that the great expeditions of the Europeans, or even Columbus, played a significant role in its spread to other continents. It is assumed that Treponema Pallidum evolved through various mutations over centuries from even BC era and achieved the virulence. Many other diseases like Tuberculosis, has affected  artists and poets, sometimes attributed to their bohemian life. Some of the well-known personalities who got afflicted are, Alphonse Daudet, Thomas Chatterton, Keats, James Boswell, Dostoievski and Oscar Wild.

Like syphilis, which achieved near epidemic status centuries back, the one disease due to exchange of body fluids and which became an epidemic in the near history is HIV/AIDS. It resulted in stigmatizing African Americans who were most affected when the epidemic started and even  today. In 2018, African Americans accounted for 13% of the US population,  however, contributed   42% of the 37,832 new HIV cases in the United States and elsewhere. Other racial minorities also were affected. It was largely due to homosexual contacst among both African Americans and Hispanics. Heterosexual sexual contact was only secondary. The whites were less affected leading to stigmatization and even discrimination. These negative trends and further progress of the disease were somehow contained due to a well-organized campaign which included the use of condoms during sex. The importance of using condoms during sex was highlighted in order to prevent direct contacts and exchange of body fluids. Proper education of commercial sex workers also helped in the process.

There are many other diseases which are spread through exchange of body fluids or contacts with body fluids like hepatitis A and B.  There also some diseases such as conjunctivitis, chicken pox, scabies and a number of skin infections spread through contacts between humans.  These are apart from those diseases spread through faecal contamination  such as cholera, gastroenteritis etc. It is a complex but role of human contacts, exchange of fluids and infections through excretions did play an important role in disease transmission. Fortunately, timely medical research and epidemiological research helped in understanding many processes associated with disease transmission which helped in evolving suitable strategies including drugs to control many diseases. Human helplessness also was revealed in many cases especially HIV/AIDS when suitable cure was not found even with extensive research in various countries. In any case, access and assessment of data by scientists and public health scholars certainly play an important role in understanding and containing diseases.

Direct exchange of body fluids is not important in some other diseases. For instance, there are a few diseases which are linked to droplets when the infected person coughs or sneezes and therefore the transmission is fundamentally through a medium, air, surface or a fomite. The common cold is now a harmless viral infection spread through airborne droplets carrying the virus. And in this case, there may be number of viruses which can cause a cold and infection of upper respiratory tract. The body fluids, infected secretions or particles emitted by the infected person indeed are responsible for the infection. But these are often forgotten when someone catches cold. They are treated normally and people do not even consider them infectious largely because of lack of  its threat perception. This becomes part of daily routine for the people affected by common cold as they sneeze or cough in public places and public transports. The behaviour patterns of the affected is important because they cough openly into other people’s faces.. This behaviour pattern also includes indiscriminate spitting even from moving vehicles and openly in walkways. The persistence of phlegm production lead them to regularly engage in such actions. Apart from this, open spitting is also a regular feature largely among males. One can only observe from such routine behaviour that common cold has become a naturalised expression of human behaviour although fundamentally it is an infection due to a virus.

The previous experiences with epidemics or massive outbreaks of diseases were important to understand the behaviour of human beings when diseases strike them. Most of our current behavioural and communicable strategies are based on these experiences with suitable contextual modifications and particular features of diseases. Such behavioural approaches are important in the case of COVID-19 pandemic as well.

Perception of threat, in the form of severity or fear of death, is indeed an important and a well-established  dimension of human mind for taking appropriate action to ameliorate the problem. This applies to both communicable and non-communicable diseases but in case of communicable, as the severity increases, other factors set in. These are stigmatization and fear of not only self but the other as well. The death perception in the case of COVID-19 could have played a major role in adherence to the age-old preventive strategies. The notion of ‘distance’ will be taken as a novel psychologically internalised phenomenon to not just prevent infection but to prevent death and all the factors associated with the disease. Distance was a known factor regarding transmission of especially viral infections but this was forgotten in recent years due to the so-called false sense of ‘security’  and invisibility among people.

In the case of COVID-19, which is a droplet infection,  this has become extremely important The pandemic has given rise to new forms of responses to diseases, a form of human behaviour which the present generation has not witnessed in recent times. Evidently, it is certain that stigmatization of those who cough and sneeze will now emerge as a new response by people. At least, it is possible that they will be snared upon. But one interesting fact is that the world has not grown beyond masks, isolation, distancing, enforcement and lockdowns. Post-COVID, some of these will continue to be practiced or they will remain within the psyche.

Given the possibilities of evolving a sustainable package for positive health behaviour post-COVID are immense. This package should include a mobile application with general information on communicable and non-communicable diseases and the causative factors. The positive and negative behavioural factors which lead to diseases and which transmit diseases could also be enlisted. This would prevent circulation of all the negative and fake posts through social media3 . Such campaigns played an extremely negative role in developing responses of the people especially panic and fear.  It is important that our primary health care workers including ASHA workers should be technically empowered to handle such crises by which they can provide valuable inputs to individual and community level behavioural orientations even in non-affected villages and during post-COVID situations. Such actions will help to minimise post-COVID shocks.

Certainly, the world has moved ahead surviving many such pandemics. It will continue to do so!

 

[1] Tampa M, Sarbu I, Matei C, Benea V, Georgescu SR. Brief history of syphilis. J Med Life. 2014;7(1):4–10.

[2] https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.htm accessed on 20.04.2020

[3] Nayar K Rajasekharan, Sadasivan Lal, Shaff, Muhammed, Vijayan Bindhya and P Rao Arathi, Social Media Messages Related to COVID-19: A Content Analysis (March 25, 2020). Available at SSRN: https://ssrn.com/abstract=3560666 or http://dx.doi.org/10.2139/ssrn.3560666

Professor Kesavan Rajasekharan Nayar PhD  is affiliated to Global Institute of Public Health and Santhigiri Research Foundation, Trivandrum, Kerala; Dr.Shabanaroze Chowdhury, a medical doctor is an independent public health scholar based in Kolkota; Dr. Arathi P Rao, a medical doctor is a faculty in Prasanna School of Public Health, Manipal


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