Science by Press Release

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

In my last communique I reported I had received my first AstraZeneca inoculation. I have, psychologically, felt as though my immunity has been building day by day. I also noted I had not, up to then, seen reports of adverse events. Since then, things have changed specifically regarding AstraZeneca. We watched as, because of fears of side effects and reports of deaths, European and other governments banned then unbanned the vaccination, said it should be restricted to over 65s, and then changed to under 60-year-olds. At one extreme South Africa is reported to have sold all the doses they had obtained to other African countries. This morning, Wednesday 7th April the report in the Guardian notes:

‘Some UK drug safety experts believe there could be a causal link between the AstraZeneca jab and rare blood clotting events including cerebral venous sinus thrombosis (CVST). But they said vaccination programmes must continue, with risk mitigation for women under 55.’1

It is also difficult to make sense of the epidemic numbers. In the UK, the prime minister, flanked by Chris Whitty, the Chief Medical Officer, and Patrick Vallance, the Chief Government Scientist, use press conferences to inform the nation on what is going on with numbers and changes in the regulations. The official team is usually male, and when it is, it comprises two wise men and Boris! The data follows the same pattern: the number of Covid infections in the last 24 hours: 3,423 on 3rd April down from the peak of 68,053 on 8th January, the number of hospitalisations down by about 75 percent, the number of deaths (always prefaced by ‘sadly’), down from 1,348 deaths on 23rd January to just 26 on the 5th April. Finally they tell us the number of cumulative vaccinations, the good news, rose from 86,465 on 13th December 2020 and 31,523,010 on 3rd April.

As the months pass there is a growing sense of frustration and desire to open up societies and economies. The British Government has set out a road map to unlock the country. It was made clear that it was to be driven by ‘data not dates’. The schools went back at the beginning of March. At the end of the month people were allowed to meet outside in groups of not more than six. On the 12th April non-essential retail and restaurants and pubs will be allowed to reopen – but patrons will only be allowed to be seated outside! The one point we need to remember is that the return to pre-pandemic freedoms is still a long way off. Even if entertainment is allowed inside, then there will still be restrictions on the numbers, the idea of normal is not appropriate, we need to think of a ‘new normal’. The question on everyone’s minds was ‘can we go on holiday during the summer holidays, in Spain and Portugal for example’. The government remains extremely cautious on this.2

The numbers

So where are we regarding Covid-19? The vaccination campaign has been extremely successful in the UK, thanks to the NHS. The number of cases globally continues to rise steadily and there have been over 132 million cases since the epidemic began. In this communique I am including two graphs from Our World in Data.3 The website I was most familiar and comfortable with is the Johns Hopkins Coronavirus Resource Center, for some reason it has been offline for some days now. The Our World in Data site uses the JHU data. I don’t understand why JHU is offline, and can’t find any reason on the website to indicate why this is.

The first diagram shows the daily new confirmed cases per million, a seven-day rolling average. The worst affected country over the course of the pandemic was Belgium. The second-worst was the United Kingdom, early in 2021. As already noted, the turnaround in the UK has been remarkable. Many people would ascribe this to the extraordinarily successful vaccination campaigns.

But the chart does not show unalloyed success. The data for Hungary show it had close to 1,000 cases per day in the past few weeks. The numbers have risen significantly in France, a cause of concern in the United Kingdom. The US, UK and South Africa saw their epidemics peak at roughly the same time, towards the end of 2020 and the beginning of 2021. In the case of the UK the turnaround has been remarkable. Why is there the increase in Hungary, France and Belgium? There are, in my view, no simple explanations. The vaccination programmes have made a difference, it has yet to be rolled out in France and South Africa.

Chart depicting daily new confirmed COVID-19 cases per million people, from Our World in Data

Daily new confirmed COVID-19 cases per million people, from Our World in Data

Looking at the data for the continent of Africa, it has about 1.65% of daily confirmed cases, South America 15.73%, North America 13.8%, Europe 20.7%, Asia 40%. It should be noted that China has virtually no cases at all.4 There is a sense among some that there is a cover-up in several countries and that China might be one of these. I might be proven to be wrong, but I think, remarkably, Covid-19 is under control in China. It should be remembered the public health restrictions can all to easily reinforce political ones. The pro-democracy demonstrations in Hong Kong now seem like a distant memory.

It is quite hard to make sense of the data on cases, deaths and case rates on anything other than an individual country basis. Over the past few months, I have seen the epidemic getting out of control in the UK and then have a very rapid fall. The second graph, see below, showing vaccinations is an illustration of possible causality. The more a country reaches its population with immunisation the fewer cases there may be, although this is not proven. What is known is that illness and death is lower among those vaccinated. This blog began with me writing what I thought friends and relatives needed to know. It has somewhat morphed with the ever-increasing amount of easily accessible information. I would advise friends to follow some of the links to the various websites.

Vaccinations

I find it difficult to make sense of exactly what is going on with the apparent politicisation of vaccines, but there is one key message: the risk of death from Covid-19 is greater in people who are unvaccinated than those who are vaccinated. While this is true, I can see how the issue of whether to vaccinate or not might be a concern to some cohorts, for example, women below the age of 60 who seem to be at some risk of adverse events.

According to the 3rd April’s Guardian the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) had received 22 reports of a blood clot in the brain — cerebral venous sinus thrombosis (CVST) accompanied by a low platelet count — as well as eight reports of other blood clotting problems up to 24th March.5 Germany had reported 31 cases of CVST after giving 2.7 million AstraZeneca doses, and nine people died. The response has been to suspend the vaccine for people under the age of 60, and in Canada under the age of 55.

Chart depicting share of people who received at least one dose of COVID-19 vaccine, from Our World in Data

Share of people who received at least one dose of COVID-19 vaccine, from Our World in Data

The Observer, a British Sunday newspaper, had a useful article in their Comment and Analysis section ‘Undermining the AstraZeneca jab is a dangerous act of political folly’ by Robin McKie.6 This suggests that the vaccine is ‘under hostile scrutiny’ and ‘Not for the first time this vaccine has become enmeshed in geopolitics and its usefulness questioned’. The vaccine was approved by the European Medicines Agency (EMA).7 The website notes ‘Vaxzevria (previously COVID-19 Vaccine AstraZeneca)’ is authorised for use in the EU’. I would note that a name change, if that is what it is, will need to be carefully managed!

The issue of safety was well covered by The Atlantic on 30th March under the heading ‘We Need to Talk About the AstraZeneca Vaccine: For the moment, reports of a very rare, dangerous blood disorder among recipients cannot be ignored’ by Hilda Bastian. As Bastian writes,

“None of these critics said that potential risks should be ignored. They argued instead that, given the available data, the known harms from COVID-19 were clearly many orders of magnitude more significant. The cost of losing time from a temporary pause in vaccination was therefore disproportionate and unbearable; worse, it was likely to exacerbate concerns among vaccine-wary Europeans. Indeed, close to 60 percent of French adults now say they have little or no confidence in the AstraZeneca vaccine; similar poll numbers are turning up in Germany, Italy, and Spain”.

There is a very real danger of fuelling anti-vaxxer causes and vaccine hesitancy.

While confusion reigns in Europe, as can be seen on the chart the UK and USA continue to roll out their vaccination programmes (Israel, the top nation, is only now starting to provide this for Palestinians). In the US President Biden has named Gayle Smith, a former U.S. Agency for International Development (USAID) coordinator under the Obama administration, as the coordinator for the Global Covid Response & Health Security at the State Department. The message is that the US is looking at how to share vaccines around the world.

“U.S. effort to boost its vaccine supplies to the rest of the world comes as Washington works to push back against China’s widening vaccine diplomacy. Russia has also offered several million doses with financing to an African Union (AU) purchasing scheme”.

Conclusion

I believe the vaccine situation will be clearer by the time I write my next communique. One question that has not been answered is should children get vaccinated? It is being hotly debated.

We also need to discuss and communicate as to what level of risk we are prepared to accept in any society. How do we discuss this in a realistic manner? I also want to start focusing on what happens after the lockdowns are lifted. The 12th April is the big day in England, so more then.

Thank you for reading, reposting and providing comments. What I write is public domain so please share, forward and disseminate. My contact is: awhiteside@balsillieschool.ca


  1. https://www.theguardian.com/world/2021/apr/06/oxfordastrazeneca-jab-could-have-causal-link-to-rare-blood-clots-say-uk-experts
  2. https://www.theguardian.com/world/2021/apr/05/boris-johnson-confirms-easing-of-england-lockdown-next-week
  3. https://ourworldindata.org/covid-cases
  4. ourworldindata.org
  5. The Guardian 3rd April ‘Seven UK Deaths linked to blood clots after AstraZeneca jab, says regulator’, Page 6
  6. Robin McKie, ‘Undermining the AstraZeneca jab is a dangerous act of political folly’ Comment and Analysis, The Observer, 4th April 2021
  7. https://www.ema.europa.eu/en/news/astrazeneca-covid-19-vaccine-review-very-rare-cases-unusual-blood-clots-continues

Update on Vaccinations

I received my first Covid-19 vaccination on 12th March. The NHS team have taken over the food court in one of the malls in Norwich. They are operating with military precision, with appointments every five minutes. I entered the mostly deserted mall for my appointment at 18h05. Numerous people were on hand to guide the patients up to the area where the shots are being administered. It was extremely efficient. My name was checked off the list, I waited in socially-distanced seating, and was taken forward for questions to establish I was healthy and did not have any critical allergies. I then went to a nurse, bared my upper arm, was given the immunisation, and sent on my way.

The vaccination programme has been an astonishing success in the United Kingdom. By Tuesday there had been 27,997,976 people given their first dose and 2,281,384 had received both.1 It gives us hope that the planned relaxation in the lockdown can begin. However, supply issues may delay this.2

The hernia repair I described in my last letter is healing slowly. Having to self-inject the blood thinner was horrible, but that is now over. This experience, combined with the vaccination roll out, confirms the UKs health service is amazing. But it is increasingly clear one of the results of the pandemic is people will be expected to take more responsibility for their health. The self-administration of the post-operative blood thinner is one example. Self-testing for Covid-19 is another. Education staff, teachers and ancillary workers are expected to test themselves three times a week. Self-isolation is, as the name suggests, something one must take one’s own responsibly for.

Access to the health system is constrained and responsibility for gatekeeping is being devolved. I am not sure what the role of the General Practitioner will be post-Covid-19. An additional problem is that this transformation is taking place in the UK under a conservative government, and they are not a compassionate people’s government. There are calls for an inquiry into the pandemic’s handling. So, let us begin by looking at what is going on around the world. First there is an anniversary, yesterday it was a year since the UK went into lockdown. There is a growing restlessness and civil disobedience. Second, I have been writing communiques for over a year.3
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Warning: mostly not about Covid-19, but On Operations and Lockdowns

This is not a Covid-19 communique but rather a standard blog post. Don’t feel you have to read on. The reason for the change in emphasis this week is that Covid-19 events simply passed me by. The explanation is that I was engaged with the National Health Service (NHS), finally having elective surgery for an umbilical hernia. It has been a long road to get here, I am relieved to have it sorted.

I have always considered myself fit (but overweight), playing squash, touch rugby and running. A few years ago, I noticed I was developing bulge in my belly button. It was confirmed as an umbilical hernia. All the sources of advice: doctors and the internet recommend these occurrences need to be dealt with, and that means surgery. Two years ago, I arranged to have the hernia operation in Durban. It could have been a day surgery but, stupidly, I decided to spend the night after the operation in the hospital. It was that or go back to the flat. The surgery was straightforward, the hospital experience was not great. Unbelievably the morning began, at 05h30 am, with inappropriately cheerful nurses. I was on a men’s ward where all had more serious conditions and concerns, and felt somewhat fraudulent.

The original surgeon gave me options for the repair. I selected stitching rather than putting in a mesh. This was a mistake, as I realised, when the bulge reappeared some months later. This time I did more homework and consulted with medical professionals in Waterloo, Norwich, and Durban (as well as qualified friends). The consensus was it had to be redone, but with a mesh. In addition, I learnt I would have to wait at least a year before a surgeon would even consider reopening the wound.

Covid-19 meant that, after arriving in Norwich in December 2019, I have not travelled outside the UK or even on a plane for 14 months. (I am seriously tempted to go for a flying lesson as soon as it is permitted just to get in the air!) This in turn necessitated arranging to have the surgery in Norfolk. I began the process and expected to have to wait for at least a year. As it happens it was quicker than that, but my word it became a complicated process, and it has been an insight into the amazing NHS and how they function in time of crisis.

The centre for these surgeries in Norfolk is the James Paget Hospital. This is in Gorleston on the Norfolk coast, about 50 minutes (or 30 miles) away. The process involved visits for assessments, an MRI scan, a Covid test and other ancillary events. The surgery was originally scheduled for January 2021. However, the government unwisely relaxed restrictions in England at Christmas, and the number of cases soared. On 8th January 2021, they peaked at 68,192 up from just 12,386 on 12th December 2020. The hospital called me to say, regrettably, the surgery would be postponed. I expected this!

I was quite happy to wait, after all it was elective, and not urgent. The next, and unexpected development was the hospital called and offered me a date, at a private hospital in Colchester, some 60 miles away. One of the ways the NHS is trying to manage their waiting list is to outsource some procedures to the private sector. I declined the option and eventually heard from the local surgeon who said that the surgery could be scheduled for 2nd March. As an aside the number of new Covid-19 cases across the UK on that day was 6,411.

On the day, I had to get to the hospital by 7 am. Ailsa drove me down and dropped me off. I checked in to the day procedure ward and was wheeled into the theatre at 11 am. I had hoped it would be earlier. This delay was entirely my fault. When we got up, just before 5 am, I had a cup of tea with milk in it. Note to self: read the instructions carefully and follow them! I could have had water or black tea; it was the milk that was the issue!

Apart from extra hygiene precautions and wearing masks, the part of the hospital I was in appeared to be functioning normally. There is a separate terribly busy Covid section. The biggest obvious difference is visitors are not allowed at all. This makes for a very much quieter environment. The day procedure centre was active, but not manic and the nursing staff were caring, professional and calm. Everything went smoothly and, after passing urine, (a non-negotiable apparently) I was discharged in the evening. I left with a ‘goody bag’ of everything I needed for post-operative self-care.

My ‘N’ for hernia operations is now 2. The first was an incision while this second was done laparoscopically, through five places on my stomach. I had to take a few painkillers, far fewer than prescribed. Generally, I have been fine although getting up and lying down have been challenging. In addition, I was given about 10 preloaded syringes with blood thinning medication, to inject into my stomach. Not a pleasant process. I have been really impressed by the standard of service in the NHS despite the Covid-19 crisis. This also needs to be seen against the backdrop of a public sector pay freeze except for nurses, who have been offered a derisory 1%. They are furious, feeling it as a slap in the face, and I quite understand. I recognize the need for fiscal conservatism to pay for the Covid-19 response. It has cost billions, not just care costs, but also keeping families and supporting the furlough programme so people have jobs to return to. This stingy pay offer to core staff stinks.

I have taken several lessons from this experience. The first is to read and follow instructions carefully. Second is that the health service is amazing. Even when it is under immense pressure, people are seen and treated. At the same time as this was going on, the government is rolling out a vaccination campaign. I was able to go online and book both the appointments I need, the first on 12th March and the second three months later. My hub is the Food Court, in the currently shuttered, Castle Mall Shopping Centre in Norwich.

I do have a few quibbles though. The main one is about ‘joined-up’ thinking. The provision of a decent health system is part of the social contract, but the major challenge faced by humankind is climate change. I have been taken aback by the use of resources in the health service, much of which probably can’t be recycled. I was given 14 disposable syringes, each in separate plastic wrapping. It may be that there are no options! However the instructions and pamphlets were on recycled paper.

I have talked before about how fortunate I feel we are. We have a home, an income, and a family close at hand. The children are coping with this as well as anyone. My extended family are all OK, although no one is very happy. In addition to that, our environment is changing in two significant ways. First with regard to Covid-19, the numbers are falling, and the vaccination programme is working very well. Second, there are signs of spring. I can see the first leaves beginning to bud on the rose bushes and today we spotted blossom on the trees in the neighbour’s garden. It is still chilly but there are signs of spring.

This good fortune was brought home to me when we walked to a local shop to get some essentials and the Observer newspaper. The rule is only one person from a household should go in and so I waited outside. There is a ‘security guard’ at the entrance to make sure people wear masks and sanitise their hands. I think he is from Norwich. I started chatting with him and this is his story: he worked on cruise ships out of Fort Lauderdale in Florida and was also paid as an American Football Player. I know this may come as a shock to readers of this blog, but there is a league in the UK and Norwich has a team which he was part of before going off adventuring. He said he played in Australia, before going on to join a team in Vladivostok in Eastern Russia. Covid put an end to this, and I think he was lucky to get back to Norwich. I would never have known any of this. What a story. The next instalment will be interesting, and I am looking forward to it. End of personal stuff, some COVID-19 coverage next.

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Covid-19: Roadmaps and Vaccines

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – http://www.alan-whiteside.com

Introduction

The consequences of Covid-19 stretch far beyond illness and death. In this blog I will look at some of these, but I begin with a personal note. On Monday we went to the James Paget Hospital,1 which is about 45 km away from our home. I require minor, elective surgery to deal with an umbilical hernia. The National Health Service (NHS) assessed my situation and put me on the list. This trip was a ‘pre-operative assessment’ which involved being assessed by two sets of nurses, all very straight forward. At least it is now. The surgery was scheduled for the end of January but had to be delayed because of a surge in Covid-19 cases and admissions.

The hospital corridors were quiet, a notice on the front door says: ‘No visitors allowed’! All patients and staff must wear surgical masks. I had to visit two offices, but it took next to no time. The nurses say they have a sense they are over the worst of this surge. Make no mistake there are still people being admitted. On 22nd February, the local news reported four deaths at the hospital the previous day. The reality is many patients have put off attending hospital because ‘they do not want to be a bother to the NHS’ or they fear entering health facilities. There will be a huge backlog of people needing attention, and data suggests the excess mortality of the past year is due not only to Covid-19. In January 2021, Covid-19 was the main cause of death in the USA, with an average of more than 3,000 deaths per day. Heart disease is typically the number one cause of death, followed by cancer.

Back at the James Paget, a Covid-19 testing tent is set up outside the hospital. On this coming Saturday I have to be tested there, then isolate completely for three days. This means not seeing anyone other than the household, and not leaving the house or garden. I am also checking the availability of vaccines. Although the NHS is following a procedure, with nine priority groups (my cohort have not been called yet), people can check availability online and book if there are spaces. My half-sister and brother-in-law (in their nineties) and their daughter (about my age) have received their first doses. My sister, a head teacher at a primary school, has just received her first vaccination in London, and was offered a choice between Pfizer and AstraZeneca. Using the government website, I can find spots, but they are miles away.
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Covid-19 Vaccine Progress

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

We have been experiencing a winter storm in Norwich. It began on Sunday, as I started planning and writing the blog and continued up to the time it was posted. There have been Amber weather warnings for much of the south and east of the United Kingdom, with forecasts of snow and strong winds. It was not pleasant to be outside and I found myself wondering and worrying how the garden birds are faring. Hopefully, this will be the last bad winter weather for this season. It made the Covid-19 pandemic seem even bleaker.

The big news continues to be the vaccines. There are three vaccines in use in England and most of Europe. The UK’s evening ‘broadcast of doom’ used to only contain data on the number of new cases, the hospitalisations, and the deaths. It must be a relief for the news anchors to have something like ‘good’ news in the number of vaccinations that have been administered. I will talk about this in greater detail below.

It is pleasant to reflect on the fact that it is over a month since the failed insurrection and assault on the Capitol in Washington DC. That, to my mind, was the point at which Donald Trump let go of the last ounce of any real credibility he had. Joe Biden has barely had time to settle into the White House, but at least the country now has a President who listens to experts on the coronavirus, cares about the death toll of citizens, and is acting in response to the pandemic.
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Covid-19 Watch: Stops and Starts and Ups and Downs

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

It is hard to believe the first in-depth coverage, in the western media, of SARS-CoV-19 (more commonly known as Covid-19 or just Covid), appeared just over a year ago. The first reports came from Wuhan in China. The global reaction of scientists and health professionals was one of great concern over this new disease. For weeks, while they were hampered by a lack of reliable information, the disease spread exponentially.1 By the end of March there were nearly 200,000 cases reported around the world; the one million mark was reached on 27th April; 10 million by 8th November 2020. The year ended with a global cumulative total of just over 83,519,000 cases and 1,818,000 deaths.2

I remain in the United Kingdom. While in theory it is possible to travel, it is not recommended and, logistically, is complex. There used to be four flights a day from our little airport to Amsterdam, from where people (and viruses) could disperse to the four corners of the world with great ease. This was reduced to just one a day. On 23rd January 2021, The Government of the Netherlands issued a ban on passenger flights from the UK, Cabo Verde, South Africa, the Dominican Republic and countries in South America.

“The purpose of the flight ban is to prevent the further spread of new variants of coronavirus in the Netherlands and Bonaire, St Eustatius and Saba. A docking ban is in force for ferries carrying passengers from the United Kingdom … The flight ban is due to remain in place until 22 February but may be ended sooner if there are grounds for doing so.”3

There are faint glimmers of good news and hope. The UK is rapidly rolling out its vaccination programme. This is the one success of the otherwise, mostly incompetent, national government. Within a few days the number of people I knew who had been vaccinated, mostly elderly neighbours and relatives, exceeded the number I knew who had died from Covid. A minor, personal, milestone. Happily, this gap will grow. The inauguration of President Joe Biden was cause for great celebration. He will have a huge impact in the United States and help change the course of the global pandemic. The US has already re-joined the World Health Organisation, providing people and money. Their anti-science and uncompassionate government is gone.

In Norwich we have experienced a cold snap. Over the weekend we woke to a light dusting of snow. It was beautiful but did not last for more than a few hours. Walking around the neighbourhood, my main form of exercise along with cycling, it is encouraging to see how many people have bird feeders in their gardens. The number of birds has increased. This may be helped by an apparent, but noticeable, decline in the number of cats. Twenty years ago, many households had a cat, today I see very few. The increase in bird life is observed, the decline in felines is a guess.
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Covid-19 Watch: A Rocky Start to the Year

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

The most depressing day of the northern hemisphere year is reputed to be the third Monday of January. The Independent reports, ‘the formula is essentially pseudoscience and has urged Brits to “refute the whole notion” of Blue Monday’.1 However, as I sit in my shed, faced with grey skies and temperatures just above freezing, and Covid-19 numbers rising I wonder. We are breaking records for the number of cases and deaths. On the other hand, when I step outside into the garden there are signs of life and renewal. The green shoots of the snowdrops are pushing through the earth, the birdfeeder is visited by wrens, blue and great tits. The blackbirds eat the seed off of the ground. When there is sunshine, it looks full of promise.

The situation regarding the coronavirus pandemic is bleak. A new lockdown has been introduced in the UK, and there is talk of tightening the regulations further. We are being warned to stay at home; that the situation is at its worst for hospitalisations and deaths; and the future is said by the politicians ‘to be baked in.’ The legislation that gave the English government power to introduce new rules specifies these do not have to be reviewed before 31st March 2021.

I don’t want to be too much of a Cassandra.2 There has been rapid progress in understanding the virus and developing vaccines. Treatments are evolving and improving. Vaccines are being rolled out in an ever-increasing number globally. Many more are in development. My prediction is a year from now the pandemic may be medically under control. The social, economic, political, educational, and psychological effects will still be evolving. This Covid-19 communique, the first of 2021, focuses on vaccines, and has a guest article from friend and colleague Simon Dalby, ‘Seeing 2020: COVID, Climate and the Failure to Anticipate’.
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Covid-19 Watch: Christmas is Cancelled

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

I took a break last week and this blog is posted on Monday, 21 December. The next will be on 11 January in 2021. I was beginning to feel rather burnt out. Although the posts are quite short, they take time to craft, proof, and check. Today there have been about 77,000,000 cases of Covid-19 globally and nearly 2,000,000 deaths. In the UK a new more transmissible variant is spreading rapidly. Johnson warned “it may be “up to 70 per cent” more transmissible than earlier strains.”1 There is no evidence yet to suggest it causes more severe or less severe disease. It has, however, led to bans on travel from the UK and a number of other countries.

Whilst the inexorable progress of the epidemic remains a great source of concern, the year ends with some good news. Treatments continue to evolve and improve. More importantly there has been rapid progress in understanding the virus and developing vaccines. Vaccines have been rolled out in a number of countries, and many more are various stages of development.

The consequences of the pandemic, and our response to it, have been life changing. In the next year lockdowns will be lifted and government support packages, where they exist, will come to an end. The current response cannot be sustained. Initially people suggested the effect of the epidemic might be V-shaped. A rapid decline in whatever indicator one looked at, followed by an equally rapid recovery, until we were back at status quo. As time went on the talk became of a U-shaped effect. The decline is followed by a period of constraint before the recovery. A more sophisticated and accurate picture of the epidemic is of a K. The decline is followed by a divergence as some people recover, and indeed grow ever richer, whilst others, the majority, see a continued decline.

My prediction is a year from now the pandemic will be medically under control. The social, economic, political, educational, and psychological effects will still be evolving. For example, we have no idea what effect this period of lock down, and suspension of education will have on many millions of children who have spent months out of school. They have, at best, been inadequately educated by stressed parents or through unstable internet connections (for those lucky enough to have computers and access to the internet).

I hope we take the opportunity to reflect on how we live and interact with each other, and the natural environment. If we do, we may be prepared for the next big challenge, probably, but not necessarily, environmental collapse. This week I will identify some of the websites that are exceptionally useful in helping understand the epidemic, the science, and some of the ramifications.

The first virus tracker I discovered was produced by Johns Hopkins.2 Their Coronavirus Resource Centre has a useful dashboard. There is a table of infections by country and information on daily cases, daily deaths, cumulative cases, cumulative deaths and a log representation of cases are shown on graphs. There are other pages for additional information. I still visit it, although it seems a little tired in comparison to some of the other sources.
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Covid-19 Watch: Mood Music Changes

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

This is the second last communiqué of the year. I will post the final, more reflective piece on Monday, 21st December. In 2021 the first communique will be on 11th January. I will survey readers and work out how to proceed beyond that (if at all), weekly is too frequent for me alone. I may revert to monthly posts. Please take 10 minutes to complete another survey. I won’t be offended by honesty and would love ideas. This personal rethink is appropriate, we know so much more about the pandemic and its consequences. With the vaccines becoming available the end is in sight.

When I began writing in early March, I aimed to provide updates on where we were and where we were going. The goal was to draw on my knowledge and experience to make sense of the situation. It was initially desperately worrying, then grindingly depressing, now there is cause for cautious optimism. The worry and depression were not just because of the virus, but also the appalling lack of leadership in many settings. Who believed that a virus could bring normal human interactions to a grinding halt globally, and so quickly? Who would have predicted some countries would see run away epidemics, while others brought it under control? Who expected the huge strides from science, medicine, and epidemiology?

My working life was driven by the HIV/AIDS epidemics, first seen in 1981 when I was in Botswana. By the time I had been in South Africa for seven years, 1983 to 1990, it was clear AIDS was going to be catastrophic, but, unlike Covid-19, not everywhere. By 2000 it was apparent Southern Africa was going to be the world’s worst affected region. HIV infection is for life. Infected people will, in the absence of treatment, experience periods of illness that increase in frequency, severity and duration and usually end in death. Fortunately, most people will recover from Covid-19.

From this knowledge base, I tracked the Covid-19 pandemic and tried to follow the science. The rollout of vaccines, which began in the UK on 8th December, marks a step change in the way we view and respond to the disease. It is a remarkable achievement that we should have one vaccine being rolled out, others approaching approval and many more in the development.
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Covid-19 Watch: Hope by Christmas?

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

Yesterday, 1st December, was a significant day in the annual global health calendar: World AIDS Day. Until this year, AIDS was the pandemic dominating global thinking, activism, and response. It is the disease I began working on in 1987. I looked at migrant workers travelling to South Africa to work in mines, on farms and in industry. The majority were men. They travelled on annual contracts and mainly lived in single sex hostels away from wives and families. The ideal environment for a sexually transmitted infection to spread.

HIV, the virus that caused AIDS, was first noted in New York and San Francisco in 1981. A classic book tracking the emergence of HIV is ‘And the band played on’ by Randy Shilts.1 As the numbers of infected people rose dramatically globally it became clear, in most of the world, specific groups were bearing the burden of the disease: men who had sex with men; people who used drugs intravenously; recipients of untested blood and blood products; and female sex workers. There are areas with generalised epidemics, in particular Africa, where the Southern cone is the epicentre.

In the 1980s our source of data was surveys of pregnant women. We watched in horror as infection rates rose dramatically, up to 40%. Initially there was no treatment. Hundreds and thousands of people fell ill and died as their immune systems were overwhelmed. The arrival of treatment, antiretroviral drugs, in 1996 was game changing. The HIV and AIDS world faces two challenges: reducing the number of new infections and ensuring people access and stick to treatment.

In 2018 there were 37.9 million people living with HIV, including 1.7 million children. This gives a global prevalence of 0.8% among adults and 21% do not know that they are infected. It is estimated that an additional 32 million people have died of aids related illnesses. To date there have been just over 63 million cases and just under 1.5 million deaths of Covid-19. The number of cases will greatly exceed those of AIDS, the number of deaths should, fortunately, remain lower. Whilst both diseases are zoonotic retroviruses, there are differences, the main one being most recover from Covid-19.

AIDS played an important role in our response to Covid-19. The scientific advances in immunology, virology, vaccine development and a host of other disciplines meant that a great deal of basic knowledge was there already. Public health institutions and health workers were able to pivot. The effect of Covid-19 on AIDS is less beneficial. It has drawn attention and resources away from a deadly disease. As you read this week’s blog be aware of the many other health issues faced by people, especially those in the developing world. I know most about AIDS hence this introduction. There are many other needs: malaria, tuberculosis, hepatitis and numerous childhood diseases.
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