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by Jonathan J. Halperin   |   August 14, 2020

CANCER AND COVID-19 – The High Cost of Waiting 

I had surgery as hospitals began setting up triage tents and reporting shortages of essential protective gear. I needed to recover from it before I could undergo additional treatment for prostate cancer. Because the window for that treatment was closing, waiting until after COVID-19 was not an option.

Laying in pre-op looking up at a painting of sky and clouds on the ceiling I had time to think about my own cancer in the context of the global pandemic. And they actually have a lot in common. Many of the questions, as well as the answers, have an eerie similarity: Why now? Why me? What next?

People with cancer have a special perspective on uncertainty. The fears of cells – my cells, in my body – growing out of control is unlike other unknowns. We ask, half wanting and half not wanting to know: has it spread? Now everyone has a personal sense of what metastasis means on a global scale: “the spread of a disease-producing agency from the initial or primary site of disease to another part of the body.” (Merriam-Webster)  Patient zero is the planetary cousin of the body part where cancer is first found.

Some cancers spread rapidly and are very hard to treat; others travel away from their initial site more slowly and can be harder or impossible to treat. Sound familiar now? Just like with our pandemic, the urgent questions focus on preventing, testing, stopping the rogue cells. And when all those efforts fail, even partially, we are left only with the option to contain the disease, the virus, until we know how to kill it.

Obviously, cancer is not contagious, but in both a pandemic and cancer, identification and early detection (or testing) are critical. Avoidance and denial don’t work; you cannot run away from either.  There is no escape.  

Invading viruses or rogue cells often move faster, or adapt more readily, than do the defenses a society or a person can muster. The ‘viral load’ of either can overwhelm a body part or — a cruise ship, an individual or a city. One starts small with an individual, a test result, that call from the doctor, when he pauses. In the case of the virus, we’ve all seen the graphs of exponential growth, spreading like wildfire.

Whether through lymph nodes or on doorknobs, Covid-19 and cancer both need transport to do maximum damage. But there is also a profound difference. With cancer, there is no direct connection between my choice to have surgery last week and your life this week. With Covid-19, however, there is with absolute certainty a connection between my choices and your life. The choices I make or don’t make – to stay home, to shop, to practice social distancing – can literally kill you or save your life.  Individual choices have massive public consequences.

Responsibility and empathy are thus at the root of whether we either stop or keep spreading COVID-19.  If I can truly put myself in your shoes, empathy, then I can take some responsibility for you when I make my choice whether to wear or not wear a mask.  

And when we act responsibly, as individuals or organizations, we stand against what economists call ‘externalities.’ There are two types. When a company up-river pollutes the water so badly that the farmer down-river cannot use it to water crops, it places an unreasonable burden on the farmer.  The other kind of externality uses time rather than place (up- or down-river) to shift the burden. I bury my hazardous waste, knowing that at some time in the future someone else will have to deal with it. 

Someone, somewhere, some time, always pays the bill. And the cost of waiting can be very high. We each thus have a choice to make; either we take responsibility now or we ‘pass it on.’  Literally. 

Taking even a smidgeon of responsibility for others is the essence of the social contract. Now that means washing hands and staying home. If we don’t take responsibility for one another, then only the fittest survive. And what is that if not triage? None of us want to live under the terms of that social contract.