EDITORIAL

Bull Assoc Med Int Lourdes, Winter 2020; 93 (350): 90-94

Alfredo Guarino

Professore ordinario di Pediatria, Università Federico II di Napoli
Responsabile Centro Hub regionale per l’infezione da Covid-19 in Pediatria
Membro del CMIL

The new pandemic and the new words ... while waiting to return to Lourdes.

For almost a year, we have been receiving daily updates on the pandemic caused by Covid. This information concerns new cases, hospitalisations, deaths and threatening predictions for the future. There is no shortage of headlines in the media and they often turn out to be either overly optimistic or pessimistic.

We are, without a doubt, facing the most devastating epidemic of the past 100 years. Although to this day, AIDS remains the leading cause of death “similar” to Sars-2CoV-19, caused as it was by a new virus (new in the 1980s), it is clear that we are currently experiencing a profound and rapid change in our lives and in society, the like of which has never been seen before on a global level.

Unlike AIDS, the infection caused by Covid takes dysregulated pathways, and unlike AIDS, it may be possible to produce an effective vaccine quickly. However, to date, the vaccine represents a realistic hope rather than a guarantee. Without a vaccine, the pandemic is doomed to continue with more or less intense phases, also subject to local laws and measures. And, even with the vaccine, it may not provide a definitive solution, as the duration of immunity against Covid-19 is unclear.

Measures limiting contact between people and prohibiting travel now seem to be the only measures capable of mitigating the contagion. Mitigate means mitigate, not resolve. This mitigation prolongs the period of spread of the contagion, thus allowing health services to meet the needs for beds, in particular in intensive care. The technical term “mitigate” therefore has a clearly pessimistic connotation, as  it refers to making a frightening event easier (more manageable), such as the need for resuscitation and its possible unavailability.

The pandemic is relatively unpredictable because it is a new disease, caused by a new virus. Today, however, it has already transformed our lives and some changes are likely to continue for many years to come. The two most obvious consequences are fear and social distancing. This last term has also taken on a different meaning from the one it usually has. Social distancing is NOT desirable under ordinary conditions, but it is becoming so today because it is necessary to protect us from existing contacts during the pandemic. Social distancing results in loneliness for all of us. It affects some people more seriously than others, and the particularly negative consequences are for the health of chronically ill people, whose medical checks-ups have been disrupted by the pandemic, and are still evident today. In fact, it seems that certain chronic diseases are associated with an increased susceptibility to infection caused by Covid-19. Here too, susceptibility is an unusual term because it defines an increased risk of catching an infection or suffering more serious consequences, while its common meaning often refers to a person’s “responsiveness” to criticism, even if friendly.

In this phase of the pandemic, measures adopted by most European countries are aimed to limit the contact between people, travel and many other activities – going so far as to prohibit them. These measures often appear illogical, even grotesque. However, we need to recognise that social contact has proved to be the main cause of the contagion spreading. The virus arrived in Europe via travelers from China. It then spread to hospitals, then, over the summer, to places of entertainment (nightclubs) and in the autumn, to schools.

The other characteristic of the epidemic caused by Covid-19 is its very “political” as opposed to “medical” management, accompanied by very significant media coverage of the news. Decisions made are the result of compromises that accept “reasonable” risk. It goes without saying that here the term “reasonable” is a long way from being defined, and leaves a great margin of freedom as to its interpretation. Political management is, in part, due to the need to preserve social and industrial infrastructures, as well as the economic aspects of our society, but it shows worrisome, sometimes illogical, even unacceptable elements, which can only be explained by the seriousness of the situation. Figures are treated with reckless enthusiasm or with unwarranted nihilism, i.e. it is not uncommon for economics to appear more important than health and for entire categories or areas of activity to disappear, while others prosper. 

This scenario is likely to continue for several months, but it is reasonable to hope that, with the onset of good weather, the contagion will abate and freedom will gradually return. This forecast is an estimate that coincides with an (optimistic) view of vaccine availability and efficacy.

What will happen to Lourdes?

Lourdes plays a strong and important role in the lives of all of us and we will come back to that. Lourdes does not change and is the most important place of pilgrimage in the world for people with chronic diseases. For them, it is the genuine place of personal as well as spiritual contact. Lourdes is the representation of a way of caring that involves contact, an intense and deep personal contact between the sick and their carers on the front line, the nurses, the brancardiers, the doctors and the extraordinary volunteers of Lourdes.

The prerequisite for returning to Lourdes is the end (or mitigation) of the travel bans. Hopefully they will be relaxed and the reopening will be measured and gradual. It will therefore take some time before it is possible to return to Lourdes safely.

Many of the pilgrims who come to Lourdes are people in “fragile” states, another technical word that evokes characteristics other than those used in medicine, suggesting “materials that break easily” rather than vulnerable people who need to be protected with love and care.

In reality, the characteristic of the Lourdes pilgrim is very different from fragility and can be defined by another technical word very fashionable in medicine and which is the opposite of fragility. This term is “resilience”, a technical word derived from a characteristic of metals describing their resistance to break down under pressure. In times of a pandemic, resilience refers to the resistance and at the same time adaptability of a person with health problems and under stress. In other words, resilience is the ability of a person to transform a traumatic event, such as chronic illness or disability, or even the risk due to a pandemic, into a positive situation. Thus, the Lourdes pilgrim resists and adapts to difficult conditions, just like the people who assist and support them. At the same time, however, we are going to have to act responsibly on future pilgrimages and to follow the rules that will be in place to prevent further contagion.

The large numbers of people present in Lourdes makes gatherings inevitable – another word whose present negative connotation does not fit well with the joyful participation of the crowds of pilgrims in Lourdes.

The logical conditions are therefore in place to ensure that, thanks to the mitigation of the epidemic and the bans that stem from that, Lourdes, driven by its history and the pilgrims’ desire to return “home”, can start living again. The return to Lourdes will however require certain precautions and restrictions, especially in the initial phases, which we hope to see next spring / summer.

We have to explore communication strategies, to maintain contacts, to create ways of living, to share. It is about strengthening resilience, adapting to the hostile conditions of the pandemic. We have to overcome the temptation to wait passively for all of this to pass, so that we can return to “normality”.

 

As of today, however, two sensitive issues are already attracting our attention.

The first is the continuity of Lourdes at a time that demands distance. We are not sure when we will return to Lourdes, but we feel the need. We miss Lourdes and it is necessary for us to keep in touch with Lourdes. Television channels and social networks, telecommunications in general, must ensure the continuity of this contact. All over the world, we are redefining the diagnostic and therapeutic pathways of patients according to the pandemic. We are developing remote medicine (telemedicine), we are highlighting the importance of case histories (anamnesis), we are assessing symptoms in relation to signs that are difficult to detect without a face-to-face consultation, and we look for signs that are visible from a distance (respiratory rate or skin rashes, visible in photos or videos). In a difficult period, we are exploring new resources and new means; we are making use of what is available to us. We are discovering new resources and new paths that had been brushed aside.

The same goes for social contact. Modern technologies open up possibilities that were previously unthinkable. We do courses, medical examinations, interviews and organise groups remotely. The word “webinar” is a neologism amalgamating web (network, in reference to the Internet) and seminar. It ultimately identifies a communication, lecture or sermon that we watch and listen to from a distance. Although at a distance, these are direct contacts, which are the most common forms of learning today.

You have to be in Lourdes, but you have to, at the same time, stay at home. We have to do what we can for Lourdes, while waiting to be able to return there. Contact between pilgrims, workers, religious men and women and all the different stakeholders belonging to the “world of Lourdes” is important. We have to explore communication strategies, to maintain contacts, to create ways of living, to share. It is about strengthening resilience, adapting to the hostile conditions of the pandemic. We have to overcome the temptation to wait passively for all of this to pass, so that we can return to “normality”.

We will return to Lourdes but we do not know when, and we will have changed a bit because of this experience and because of what we have been able to do and be during this pandemic.

Annual CMIL meeting by internet , October 2020

We need your help

In this time of pandemic, very few of you have come to Lourdes this year.

If you wish, you can renew your annual subscription to the AMIL Bulletin but also make a donation to the Association in order to allow us to ensure the continuity of the services and actions of the association.

There are several ways of doing this; you can donate either online via our website, or by bank transfer to the AMIL account (IBAN FR 76 3000 3020 5100 0372 6327 004 BIC SOGEFRPP) (we are unable to accept cheques).

We trust that our request will be met with the customary generosity of spirit. On behalf of AMIL, thank you in advance.