Cancer, Like COVID: A Public Health Failure

Ed Yong’s recent sobering piece in The Atlantic on the U.S.’s lack of preparedness for the next pandemic that’s inevitably “barreling toward us”  hit my inbox with a ‘must read’ thud.

The Atlantic’s first Pulitzer Prize winner in the publication’s 150+ year history, Yong is the 2021 recipient for Explanatory Reporting on the coronavirus pandemic.

Cogently written, it provides historical context for the myriad errors committed—and how the many lessons learned early on with COVID were somehow not actionable for the next episode of death: the Delta variant.

Immediately, the piece laid bare some deep and disturbing similarities between the U.S.’s approach to COVID and how it considers another public scourge… cancer.

Not lost on those living with cancer should be how these acute waves of coronavirus infections have cast light on an ever-crumbling public health situation.

During the pandemic, ‘traditional’ cancer prevention measures have been harder to access, and often delayed, resulting in more cancer diagnoses at advanced stages and, ultimately, more unnecessary death.

Screenings for breast, colorectal, cervical, and lung cancers decreased dramatically as hospitals focused on acute COVID patients. Dynamics around the pandemic—and how it was ‘managed’—led many patients to put off screenings so as not to be at increased risk to contract COVID; others purposely delayed active treatment.

Put simply, and depressingly: the spikes with COVID outbreaks have increased the number of cancers diagnosed at a later stage, and resulted in more death.  We just haven’t quantified what the total impact is… yet.

To be fair, cancer prevention and its early diagnosis is not the only area negatively affected by the attention given to COVID. Mental health and substance abuse has been profoundly impacted. Even preventable amputations have been on the rise because of COVID.


Below, I’ve paraphrased passages from Yong’s insightful piece, then followed with my commentary specific to our largely non-communicable, but nonetheless seemingly intractable, cancer epidemic.

Yong writes about how, despite a century of medical advances, the new coronavirus has claimed more American lives than the 1918 pandemic (in the U.S.). Further, he gives commentary on vulnerability to new diseases—and the inevitability of their arrival: it may appear U.S. approaches are strong, but below the surface there are huge problems.  

It makes sense that there have been more COVID deaths in the U.S. than last century’s Spanish Flu. The general population is larger and more concentrated. No longer predominantly rural dwellers, we live closer to each other and interact with more people than previous populations due to public transportation, social activities, and workplaces in which ‘teams’ are interconnected.

Early on, with COVID, it was a lack of widely and consistently followed low-tech, low-cost prevention and tracking methods, co-opted by the pull of politics, which greatly contributed to the alarming number of deaths.

The ongoing political haymaking, seeding of conspiracy theories, and conflation of personal liberties pitted against public health policy, allowed further death to flow unabated.

Specific to cancer, the ‘cursory or superficial’ strengths are our profound over-reliance on (albeit, ever-improving but rarely a panacea) anticancer drug therapies—including immunotherapies and targeted agents—more precise delivery of radiation beams, and groundbreaking surgical approaches.

Yes, deaths attributed to malignancy have also exploded in the last 100 years, in no small part—specific to several types of chronic malignancies—due to the lack of low-tech prevention approaches such as breathing fresh air, moving our bodies, eating clean and nutritious food, managing stress, and the teachings of resiliency.

In summary, whether its cancer, COVID, or any other disease, injury, or illness—we are not focusing on prevention through the creation of wellness. We certainly aren’t moving as much or eating the same amount of fresh, unadulterated food as our ancestors.

The 5,000 word missive noted that the U.S. needs to face its profound social failings. There exists a health-care system inaccessible by millions of U.S. citizens. Until an overhaul takes place, to put folks on equal footing, huge sections of society will remain extremely vulnerable to new viruses.

By and large, these are the same confounders and inequities too many Americans face when accessing, government-supported and largely free, cancer prevention health checkups.

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Yong examples population vulnerability through the dynamics of inequity by expressing how the U.S. psyche is committed to advances in medicine, but fails to analyze how those advances can benefit all. Additionally, he points out that such “medical magic bullets” are powerless when they are released in an unequal society; he explains COVID should have demonstrated that flaw.

Similarly, biomedical ‘magic bullets’’ against cancer have not fully materialized.  Sure, we are likely to continue to make remarkable progress in high-tech from a drug and commercialization standpoint but, as Yong has pointed out, if that magic is not unleashed in a way that serves all, grave issues in public health will continue.

The piece continues on the topic of ‘germ theory’ and social concerns—race, education, culture, housing… even psychology and politics—to make a point that when the sought after solutions relating to disease were only focused on pathogens, then all those social issues were discounted. In Yong’s words, “…instead of staring into the abyss of society’s ills, physicians could simply stare at a bug under a microscope and devise ways of killing it.” Yong pointed out that complete solutions require a concentrated study from a sociological point of view as much as studying germs through the lens of a microscope.

Germ theory is not unlike the theory of battling or killing cancer. Focus on the malignancy, the tumor burden—the cancer cells themselves—and just keep the host alive to get through the barrage. Fight, kill, destroy—all the useless metaphors we’re best to put in the rearview.  

Unfortunately the last two U.S. administrations double-downed on these counterproductive allegories with COVID-killing rhetoric. Comparatively, the attitude can be equated to not seeing—or, in fairness, not having the capacity to delineate—the forest for the trees. Quite tragically—harsh and accusatory as it may seem—it tends to focus on killing the ‘invading disease, germs, or illness’ while forgetting to look at all the people on the periphery who will—due to personal circumstance—fall regardless.

Continuing his outreach through journalism, Yong expresses that the worldview has increased, and has highlighted the differences between various professionals in branches of medicine. Those caring for the ‘already sick’, and those public health representatives tasked to prevent folks in their communities from becoming sick, seemed to turn away from each other and seemed to be, well, uncooperative and uncollaborative. As noted, in previous centuries, specifically the 19th, all those in the disciplines of caring for the infirm, and those in the field of preventing sickness, complemented each other. Their overlap served a single purpose—wellness. But by the 20th century, and currently, the professions have split into two camps.

We will never be able to invent biomedical solutions only to innovate our way to a healthier population, be that cancer, diabetes, or any other chronic disease. This is only possible with a sustainably funded public health strategy focused on true prevention, that is, beyond the government’s current definition of ‘prevention’.

A brief history of the ever-shrinking Prevention and Public Health Fund, as part of the ACA, can be accessed in this published paper in the American Journal for Public Health.

Weakened immune systems and comorbidities have been the perfect target for death by COVID. Cancer is the same opportunist. There is little difference. The focus must be on the host environment.

[Related content: Open Letter to Joe Biden: We Need a Cancer ‘Prevention’ Moonshot]

Yong’s essay tied the U.S.  to a profit-driven system that saw the preventive work of public health as a financial threat. Yong quotes Brandt and Gardner:  “Some suggested that if prevention could eliminate all disease, there would be no need for medicine in the future.”

It is incredibly tragic that prevention is seen by some as a threat. Even if it wasn’t, prevention alone cannot eliminate all disease—not by a long shot—but approached intelligently and comprehensively, and delivered effectively, could save a staggering amount of treasure, lives, and an incalculable amount of heartbreak.

I am pro-capitalism and believe medicine should be commercially viable, just like I advocate for wellness, prevention, and self-care to be equally commercially viable. This drives innovation and investment. But the incentive structure for U.S. medical care is broken, because it rarely rewards good outcomes. Sadly, providers must see more patients, spend less time listening to each patient, and provide more tests and procedures, in order to grow their income or that of their center, hospital or institution.

Yong writes about public-health workers and how they have to cope with infectious diseases ‘and’ air and water pollution, food safety, maternal and child health, the opioid crisis, and tobacco control. He shares figures of departments having lost 55,000 jobs since the 2008 recession, and reports many had to pause their usual duties to deal with COVID-19.

The direct impact to cancer here is undeniable. The fundamentals of public health activities will help ensure a sustainable human living condition. Without ‘building back smarter and better’, the disparities of those able to understand, access and achieve health creation—and true disease prevention—will only widen.

When a doctor saves a patient, that person is grateful. The disease or injury was visible, measured, tracked, and healed in some way. But, when an epidemiologist prevents someone from catching a virus, that person who did not catch a virus is usually oblivious to the efforts behind the scenes.

The tenets of prevention require investment before an illness is spotted. Sadly, we are a society that insists on seeing the flaw before we put the energy into  fixing it. Until something cracks or breaks we do not pay attention. Out of sight, out of mind, short-term vision, avoidance, or ambivalence blocks the path to true population health.

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It gets simpler. Doctors save lives—yes. So do gyms, tracks, trails, meditation sessions, uplifting events, and the produce aisle, but the latter group is not adequately promoted, or equally accessible.

More Challenges Ahead

The challenges continue to mount by the day. The unfolding climate calamity is the perfect breeding ground for public health disaster.

In this just-released paper from The Lancet, we are seeing how human-caused climate change is imperiling human health in myriad, measurable ways—and how our leaders are missing opportunities to mitigate the wrath ahead.

Meanwhile, Create Your Own Public Personal Health Plan

Our public health system has failed us. We will need to be incredibly proactive on our own. I remain hopeful that we will one day: move toward a more sensible paradigm that invests in true disease prevention; adopt a public health framework that is fully funded and protected; and become laser focused on population health through strengthening immunity and greatly eliminating preventable chronic disease.

Will the politics of health and disease ever make this possible?

Until then, those living with cancer, or trying to prevent it, must understand that acute and virulent communicable diseases will always take precedence to all else, even over the most vulnerable among us with compromised immunity and zero or otherwise inadequate antibody responses from various vaccines, including COVID.

Brace yourself because, as Yong reports the views of the insightful: more pandemics are on the way.

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