Covid-19 Watch: Unexpected Surges: Local Responses?

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

There are 16,741,049 million Covid-19 cases globally. The USA accounts for the most, at around 4.3 million cases. Brazil is second, India third, Russia fourth, and South Africa fifth. Peru, Mexico, Chile, the United Kingdom, and Iran make up the rest of the top ten. The global new case curve is steepening.

The guest column this week is by my colleague; Ronald Quejas-Risdon, who worked for many years as a United Nations Peacekeeper. He ended up in Norwich where I met him at United Nations Association meetings. He recently moved back to the USA, so who better to write a comparative ‘view from the street’.

The big news in the UK is the decision to impose a 14-day quarantine on anyone travelling from Spain. This was done at short notice and is causing disquiet among travellers and tourist operators. It depends on the returning individuals to do this voluntarily. There is neither the capacity nor the appetite to police it. Indeed, I wonder how many people will say, as one person interviewed on the media did, ‘the hell with this’. At the same time, albeit with more notice, compulsory wearing of face masks in shops was introduced from the 24th July in England.

Two personal observations. One of my younger and fitter colleagues spent eight days on oxygen in a hospital in Durban, we are all relieved that he has been discharged. Second is that in Norwich nearly everyone is wearing face masks. Despite, or perhaps because of this, the shopping areas and town centre seem very empty. I am not sure that is what economic recovery looks like!

The Numbers

Table 1 shows the top nine countries (and China) by total number of cases. There has been little movement in ranking, but the numbers climb across the world.

Table 1: Global and National Cumulative Numbers of Confirmed Covid-19 Cases (alphabetical order every 2 weeks)1, 2
Date Global cases Brazil Chile∞ China India∞ Mexico∞ Peru∞ Russia South Africa UK USA
15 Feb 69,000 0 68,400 2 0 9 43
4 Mar 93,000 4 80,480 3 0 86 149
18 Mar 201,500 372 81,100 147 116 2,600 7,800
1 Apr 861,000 6,836 82,400 2,777 1,400 29,900 213,400
15 Apr 1,982,552 28,280 83,351 24,490 2,415 94,845 609,422
29 Apr 3,117,756 79,685 83,940 93,399 4,996 162,350 1,012,583
13 May 4,262,799 180,000* 84,018 232,243 11,350 227,741 1,369,964
27 May 5,594,175 291,222 84,103 362,342 24,264 241,408β 1,681,418
10 Jun 7,250,909 739,503 84,198 493,023 52,991 262,098 1,979,893
24 Jun 9,264,569 1,145,906 264,689 84,653 456,183 196,847 264,689 598,878 106,108 277,200 2,347,022
8 Jul 11,830,885 1,668,539 312,911 84,917 742,417 261,750 312,911 693,215 215,885 286,979 2,996,098
15 Jul 13,323,530 1,926,824 319,493 85,226 936,181 311,486 333,867 738,787 298,292 292,931 3,431,754
29 Jul 16,741,049 2,483,191 349,800 86,990 1,531,669 402,697 395,005 1,531,669 459,761 302,295 4,352,083

* estimate ∞ these countries were added and so the early data has not been extracted. β Data for the UK from Worldometer

When I first produced a table, on 8th April, it was to try to make sense of the data. China had 80,000 cases on 4th March, on 29th July there were just 86,990 cases and the curve is flat. This column may go. It is hard to compare absolute numbers when populations are so different. To make useful assessments we need to look at rates as is done in Table 2.

Table 2: Covid-19 Deaths and Cases per million (alphabetical order)3
China France Italy Russia South Korea South Africa Spain UK USA
Deaths (19 May) 3.33 421.07 529.64 18.84 Error* Error* 593.04* 523.33 275.8
Total cases (20 May) 58.4 2,189 3,736 1,991 216 277 4,953 3,629 4,557
Deaths (26 May) 3.33 424.27 544.04 25.15 5.21 8.32 574.31 555.19 299.79
Total cases (25 or 26 May) 58.4 2,225 3,806 2,421 216 398 5,034 3,847 4,964
Deaths (3 June) 3.33 429.83 533.93 33.56 5.27 Error* 580.58 587.24 320.93
Total cases (2 or 3 June) 58.4 2,320 3,856 2,905 225 579 5,125 4,070 5,472
Deaths (17 June) 3.33 438.73 568.76 49.01 5.38 27.14 580.78 627.71 354.46
Total cases (16 or 17 June) 58 2,410 3,924 3,681 237 1,239 5,221 4,372 6,386
Deaths (23 June) 3.33 442 573 59 5 38 606 865 370
Total cases (22 or 23 June) 58 2,462 3,942 4,058 243 1,712 ° 4,497 6,985
Deaths (1 July) 3.33 444 574 63 5 43 606 655 385
Total cases (30 June or 1 July) 58 2,516 3,976 4,393 249 2,432 ° 4,595 7,826
Deaths (8 July) 3 444 575 64 5 46 606 657 388
Total cases (7 or 8 July) 59 2,759 3,999 4,713 257 3,317 ° 4,209 8,877
Deaths (15 July) 3 447 578 80 5.6 75 608 676 416
Total cases (14 or 15 July) 59 2,640 4,024 5,070 264 5,029 5,488 4,292 10,367
Deaths (22 July) 3 450 580 85 5.7 89 608 681 430
Total cases (21 July) 59 2,707 4,045 5,327 269 6,299 ° 4,351 2,949
Deaths (29 July) 3 449 581 93 5.7 122 608 688 451
Total cases (28 July) 60 2,804 4,073 5,606 277 7,630 ° 4,420 12,961

*misread these data °data missing

What should we do and who should we trust?

The epidemic is evolving. The consequences for our lives are not yet clear, but they will be dramatic and, for most people, adverse. Covid-19 has shaken our beings to the core, and made us deeply uneasy about the present and the future. I have dear friends who have seen their income streams dry up, life plans thrown into disarray, and futures become increasingly uncertain. As someone who has a cushion, not least because of age, I recognise my privilege.

One of the first things we should do is recognise the way we try to make sense of the pandemic. Here we immediately face the problem of cognitive dissonance: people’s inability to admit mistakes or accept scientific findings. It is well described in an excellent article in The Atlantic.4 This dynamic is playing out during the pandemic among the people who refuse to wear masks, practice social distancing and change behaviour. As the authors say:

‘The minute we make any decision—I think Covid-19 is serious; no, I’m sure it is a hoax—we begin to justify the wisdom of our choice and find reasons to dismiss the alternative’.

We need to recognise this in others as well as in ourselves. It helps explain some of the bizarre decisions taken by leadership at the highest levels, including Donald Trump. I will never forget many years ago being told by a friend that the price of gold would go up. I pushed for reasons and in the end, it came down to the fact that he was holding gold shares. A more realistic view came from a friend, the strategist Clem Sunter who said: “The price of gold could go up, or it could go down, but not necessarily in that order”.

Travel

The skies are still relatively empty. The travel industry from airlines to agents is facing a difficult time. An example is the British tourists in Spain. They were the major source markets for Spanish beach tourism, making up 24% of arrivals, followed by Germany and France, at around 15-16% each, then Scandinavia and Italy with around 7% each. In terms of expenditure Spain receives the largest proportion of UK outbound tourism, spending £7.9 billion in 2016, equivalent to 18% of the world total and 31% of UK tourists’ entire spend in Europe. Provincial governments in parts of Spain are calling for regional exemptions arguing their infection rates are low. It is clear why Spain has reacted so badly to the British announcement on Saturday 25th July that all returning travellers should quarantine themselves for 14 days. Tourists were told if they returned to the UK by 11pm on Saturday they could avoid the 14-day social isolation. There is some schadenfreude in knowing that Grant Shapps, the transport secretary was caught up in this.

The British Foreign & Commonwealth Office

‘currently advises British nationals against all but essential international travel. Travel to some countries and territories is currently exempted. This advice is being kept under constant review. Travel disruption is still possible and national control measures may be brought in with little notice, so check our travel guidance.’5

This decision is further bruising for the holiday industry and airlines.

I can’t give the references but, on the 29th July as I listened to BBC Radio 4’s ‘PM’ programme Boris Johnson refused to make recommendations about travel, while Nicola Sturgeon, the First Minister of Scotland, was clear and warned against taking holidays abroad. Mexico tops the list of countries vulnerable to falling tourism, where 15.5% of GDP came from travel and tourism, in second place is Spain, 14.3%; third is Italy 13% followed by China at 11.3%. Many countries are vulnerable to the fall in travel. Even in the US although the total contribution of travel and tourism is lower (8.6% of GDP), it directly supports more than 6 million people, and indirectly 16.8 million jobs.6

Isolate or quarantine7

The South African newspaper The Daily Maverick is publishing articles co-written by leading medical scientists and academics to ‘provide practical life-saving advice based on the best emerging knowledge and evidence of Covid-19’. They say

‘We are learning all the time, so it is highly likely that advice will change … the basic principles … will stand and help inform your decisions. … It sometimes appears that the public is being given conflicting advice in media interviews, slide sets from the Department of Health that circulate over social media, and differences with guidelines from WHO and other countries.’

I am happy to note that they provide references.

The definitions are:

“Isolation means that after you develop symptoms of Covid-19 and/or test positive for the SARS-CoV-2 virus, you need to stay apart from others so as to not spread the virus to them. This includes asymptomatic people who have a positive test.

Quarantine means that after you have had a high-risk exposure to Covid-19 (ie, close and prolonged (more than 15 minutes) contact without prevention strategies (eg, wearing of face masks or good ventilation), you need to stop being in contact with people and stay apart. This is in case you have contracted Covid-19 from your initial exposure. … To summarise the recommendations: You should isolate for 10 days after the start of suggestive symptoms (unless hospitalised, see below) or testing positive, and quarantine for 14 days if you are exposed to a high-risk situation.”

Five (unhelpful) prinicples

The Udugu Institute, based in Harare, issued a document: ‘Five Principles to underpin COVID-19 response in Sub-Saharan Africa’. Their principles are to:

  1. Make the most of available resources
  2. Pay attention to organisation
  3. Build popular understanding and support
  4. Learn and adapt as the situation changes
  5. History matters as a teacher

The problem is that these are not easily applicable in the resource poor world, especially where leadership is corrupt and self-serving. The paper does stress these are principles ‘to inform dialogue’. They could work in this regard, but one hopes for better discourse.

Other news

In the world of HIV, work goes on. Covid-19 is not instead of HIV and AIDS, it is in addition to it. For decades there has been work on providing women with prevention technology that they can control. As an aside for readers without the history of working in this field, there are female controlled contraceptives that women can, theoretically, use without needing permission of male partners – the pill and injectables. One of the key proven methods of preventing HIV transmission was use of condoms.

There has been ongoing research into microbicides that would be female controlled. There was good news this week that the European Medicines Agency (EMA) gave ‘a positive opinion’ on the dapivirine vaginal ring. There is still much to do and approvals to be obtained. This is a huge and overdue step in the direction of providing a long-acting HIV prevention product designed to help address women’s unmet needs. Well done to the International Partnership for Microbicides (IPM).8


Guest Spot: How To Deal With COVID-19: The UK and the US by Ronald Quejas-Risdon9

I divide my time between the UK and America, living in Norwich in winter and early spring months and spending summer and autumn in Michigan. This year has been different from any other. It has given me the opportunity to see how differently the two nations handled the COVID-19 crisis.

I returned to the UK on 17 March from a visit to Kenya, just as we were going into mask wearing and social distancing, or lockdown mode. There were, of course, those who thought this was a ridiculous over reaction of the ‘BBC liberal’ crowd. Being good citizens, when the government implemented these measures the vast majority of people wore masks, only went out for short walks and to corner shops. Schools and businesses were closed. There was an initial run on toilet paper, hand sanitizer and a few other items, but really nothing serious. The thing I missed most was good coffee since coffee shops were closed and my kitchen access was limited. I was reduced to drinking instant.

During this time, in early April, something happened that was key. Boris Johnson was rushed to the ICU with COVID. With daily news bulletins and pictures showing vacant lackluster eyes and his hair looking even wilder than usual, the national government could not deny COVID existed and it was more serious then run-of-the-mill flu. Would it have made a difference in the US if Donald Trump had been struck early and hard? Somehow, I doubt it. He would have just denied he ever had it.

Perhaps the thing that was most striking was how, each Thursday evening at eight o’clock, Britons came out of their houses, or stood at an open window, and applauded members of the NHS, hospital staff, first responders and essential workers. Those who served as the first line of defence for the rest of us. What impressed me was how this simple action seemed to tie an otherwise diverse population together, reinforcing and encouraging the behaviour that would eventually lead to the suppression of this horrible outbreak. I could imagine a direct line to that same spirit that bound this nation so tightly together when they faced the very real threat of World War II. Even a friend who thought wearing masks and social distancing was an unnecessary intrusion in our lives wore his mask, kept his distance and applauded the troops on Thursday evenings.

The scourge of Corona is still with us, but in the UK the numbers are low and curves are all going in the right direction. I think this is almost entirely due to taking relatively early action and having some commonly accepted plan in place (yes, it could have been better, but we had one). Perhaps most importantly, people followed the plan and displayed good sense.

Arrival to the US

After rescheduling my return flight several times, I departed the UK on 3rd June. Not being sure what to expect on arrival to Detroit I was pleasantly surprised. Everyone was on good behavior and used masks. Other than a cursory check of my temperature on getting off the plane, I was through arrival procedures and had my luggage in absolute record time. I got my rental car and drove the three hours to my Michigan home. Two days later I got a call from a friendly nurse at the county health department, who followed up with daily calls over the next 14 days to check up on any symptoms I might be showing.

Life in Trump Country

To be honest, choosing where to live in America is important to one’s well being and my house was located in an area quite similar to Indiana. The unchecked virus has gotten worse in Indiana, prompting their Republican governor, a big fan of Trump to finally and very belatedly implement a mandate to wear face masks in stores and public places. Like in Michigan, this brought out the quasi-military camo clad, automatic rifle toting crowd in massive Hummers and pickup trucks. It was quite depressing to see one carrying a sign which stated “No Mandated Masks or Shutdown. Freedom First”. I guess she meant her freedom to spread COVID while playing at being a patriot. As the situation has grown more divided and extreme in the nation as a whole, it has become a burden to continue living in the Midwest. So I decided to move and wanted to get the house on the market.

Still, I was encouraged to find at least half of the general public actually using face masks and practicing adequate social distancing. Which means half either didn’t care or saw it as a political issue, an infringement on their God given rights. In talking to some of the neighbors I got statements such as: that bitch governor (our female Democratic governor) isn’t going to tell me what to do, it’s all a hoax and fake news anyway, the economy is more important than a few people getting the flu. All things they hear every day from the current administration and on any right wing news media of their choice.

Despite everything, when I arrived the spread of COVID was slowing and even beginning to decrease. But without strong, or even moderately weak but consistent leadership at the national level the idea that all this mask stuff was an attempt to emasculate the grand American spirit was too strong. Without having suppressed it, America has for the most part opened up and Corona virus has roared back. If Florida, Texas, or southern California were separate countries they would each be in the top five nations in the world in both rates of infection and virus related deaths. I think the only way the US will ever get control of this is if and when an effective vaccine is found.

Even with a vaccine, we know that the best way to control this virus is through the use of some simple personal measures, along with adequate testing and tracking. This requires leadership and coordination, especially at the national level. It pains me to say they also seem to lack the self discipline or mature insight necessary to demand that appropriate actions be taken, and to implement these simple proven methods.

It doesn’t help that this entire matter has become so political that we cannot have intelligent enlightened discussion of something as fundamental as opening public schools. I overheard a conversation recently in my doctor’s office in which an older man was telling friends that we need to open all the schools. He assured them it is safe to open schools because kids cannot get the virus and therefore cannot spread it. All patently untrue, things he has picked up from such authorities as the Secretary of Education Betsy DeVos and her boss, the President. Following Trump’s lead, DeVos is making the rounds of news shows flatly stating that children do not get Coronavirus, do not spread it (she calls them “stoppers”). So, they must return to school to help get the economy back up to speed. Apparently we are willing to sacrifice our children for his political agenda?

I’m not sure but I don’t think that a majority of Americans actually believe such fake facts. I do however believe they are stunned and tired, and without honest intelligent leadership they may not get out of the death spiral in which they find themselves.

Stunned America

Recently, I spoke with a small gathering on a friend’s deck. Wearing face masks and maintaining at least six feet distance, we did not share food or drinks. They were small business owners, attorneys, administrators and a human resource officer for a bank. All of them educated, responsible and reasonable. When I asked who would win the upcoming presidential elections, to a person they said Trump. The reasons they gave were that the election will be rigged or is already, people still buy into his false reality (shiny objects do distract the gullible electorate), a few of his multi-billionaires buds will just buy the election.

Why do so many hold that pessimistic view while all current polls in the US show support and approval of Trump is plunging? Unfortunately, I agree Trump likely will win reelection but for the following reasons. The polls were wrong last time and the current polling is not reaching Trump supporters, in short, polls are biased and don’t really reflect the true situation.

None of the friends at this gathering supported Trump, yet their answers point out a huge problem. Americans lack confidence. After the disastrous failure of polling coupled with our blind acceptance of popular opinion last time, Americans are scared. They no longer feel that voters are competent and fear that the system does not work. And that makes me very afraid. Afraid that like last time we will begin to believe our own hype, believe that Trump cannot possibly get reelected and we will take our eye off the prize. Trump supporters are laying low, waiting for the election.

Another major issue is that there is still plenty of time for Trump to bring his numbers back up. Biden’s run is too early and I cringe every time I see a poll showing Biden pulling ahead. A significant portion of the voting public is fickle and in the end will forgive the Republicans. It would take only a few percent to swing it to Trump. Democrats, if they take a win for granted like they did in 2016, will defeat themselves. They must realize that just winning the popular vote in America is not enough. “One man, one vote”, besides being misogynistic, has never really been true.

In my more optimistic days I feel the US may still survive this if (and that is a big if) it can get back on track. Not just change administrations but also get the radical extremism under control. America does not have much longer to do this. If reelected, another term of destroying and weakening American institutions, withdrawing from the world and stacking the courts with extremist judges will surely spell the death of the American experiment. Too far gone to make a comeback, it will become just another Russian style, middle level, strongman dominated country and of necessity the world will look elsewhere for Leadership.


Conclusion

This epidemic is not homogenous, it is complicated. Global news remains dominated by the virus. I will try to start with some conclusions next week. I am afraid that this week the well is absolutely dry.

References

Stephen Hodgins, Abdulmumin Saad, Will the Higher-Income Country Blueprint for COVID-19 Work in Low- and Lower Middle-Income Countries?, Global Health Science and Practice https://www.ghspjournal.org/content/early/2020/06/13/GHSP-D-20-00217

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. These data are from Johns Hopkins University https://coronavirus.jhu.edu/map.html
  2. The UK data from 27th May is taken from Worldometers.info.coronavirus/country/uk
  3. Deaths http://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/
    Case per million ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people
  4. Elliot Aronson and Carol Tavris, The Role of Cognitive Dissonance in the Pandemic’, The Atlantic, 12th July 2020 http://www.theatlantic.com/ideas/archive/2020/07/role-cognitive-dissonance-pandemic/614074
  5. https://www.gov.uk/foreign-travel-advice accessed 28th July 2020
  6. https://www.statista.com/chart/21391/total-contribution-of-travel-and-tourism-to-gdp-of-selected-countries/
  7. The Scientists Collective, How long should I isolate or quarantine for?, The Daily Maverick, 28th July
    https://www.dailymaverick.co.za/article/2020-07-28-how-long-should-i-isolate-or-quarantine-for
  8. https://www.ipmglobal.org/content/milestone-women%E2%80%99s-hiv-prevention-european-medicines-agency-adopts-positive-opinion-monthly
  9. Ronald Quejas-Risdon retired from United Nations Peacekeeping. He is on the Board of Directors and is a Director for East Africa, The Unforgotten Fund and is active in United Nations Association in the US and UK. He can be reached at https://quejas-risdon.com/

Covid-19 Watch: Considering Curves

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 week there were just under 15 million Covid-19 cases globally. The USA accounts for the most, at around 3.9 million cases. South Africa is in fifth place, with Brazil second, India third, and Russia fourth. Peru, Mexico, Chile, the United Kingdom, and Iran make up the balance of the top ten. The global curve of new cases appears to be steepening.

In this week’s communique I am delighted to include a guest column by Katherine Marshall and Olivia Wilkinson, What’s faith got to do with COVID-19? Apart from being well qualified to contribute, they cover an important topic. The role of faith is central, in terms of response and providing people succour and meaning.

By now we know that almost all recover from this virus, some are not even aware they are infected. Those who do end up in hospital, on oxygen or ventilators, are seriously ill and may suffer long term ill health. A small number die. Mortality from Covid-19 is higher than seasonal flu, although much below SARS, MERS and the bird flus of the last two decades. The distinguishing features are the period of asymptomatic infectiousness; the highly contagious nature of the virus; lack of treatment; the astronomical numbers we are seeing; the incredible disruption to lives, including the economic catastrophe we are facing; and the sense we do not yet have answers – either vaccines or treatment.
Continue reading

Covid-19 Watch: Back and Forth, Up and Down: A Deadly Dance

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 year marked the first time since 1992 that I was not involved in the International AIDS Conference, organised by the Geneva-based International AIDS Society (IAS). It was scheduled to be held in Oakland, San Francisco, and would have attracted up to 25,000 delegates. I would have been amongst them. I was on the IAS Governing Council for 12 years, the last four as Treasurer, so my heart went out to the staff, executive and Governing Council. This will have been a blow. However, there was a swift pivot and the virtual meeting included a great deal of material on Covid. I watched online presentations and will refer to some. It is clunky, but will improve. One panel, highlighted below: “COVID beyond the health”.

This week it is time to reflect on the Covid-19 numbers and how they have changed over the past few months. There have been significant changes in the ‘hotspots’, however the global trend is, tragically, upwards. The two clear messages are: there needs to be constant vigilance against the introduction of new cases, which has been seen in New Zealand and Australia, as well as outbreaks in some European countries; the second is the rate of spread can be exceptionally rapid.
Continue reading

Covid-19 Watch: Steady Growth

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

As we prepared to host the International AIDS Conference in Durban in July 2000, the South African leadership, President Mbeki and Health Minister Manto Tshabalala-Msimang, were in the throes of denying the existence of the disease. It was a bleak time. There are parallels with the situation in the United States of America today.

In January of that year I was planning my activities, thinking about the situation and seriousness of the epidemic we faced. I had empty weeks in my diary. ‘What about writing a book on AIDS in South Africa in time for the conference’ I thought. I contacted Captain of Industry and leading thinker Clem Sunter,1 well known for his ‘high road, low road’ scenario planning, and suggested we work together. He responded immediately and enthusiastically. The result was AIDS The Challenge for South Africa2 written, edited and published in five months. The publishers, when asked when they needed the manuscript to get it on the bookshelves in time for the conference, replied ‘October last year’. I was reminded of this reading Horton’s The COVID-19 Catastrophe (the book review this week).

There have been some significant steps taken in England this week. Public houses, bars and restaurants were able to open on 4th July provided they obeyed social distancing rules. In the USA the President continues to deny the severity of the crises he faces. The paradox of increasingly long lines for food relief and the seemingly buoyant economy is perplexing. This week’s guest ‘insert’ focuses on South Africa, where the epidemic seems to have spun out of control.
Continue reading

Covid-19 Watch: Global Divergence

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 have just finished reading Hilary Mantel’s latest (nearly 900 page) book, The Mirror and the Light, the last in her Thomas Cromwell trilogy. It is set during the reign of Henry VIII; it opens with the execution of Anne Boleyn and ends with Cromwell’s own beheading in 1540. I am halfway through George Alagiah’s book, The Burning Land, ‘a gripping, pacey thriller about corruption and homicide in South Africa’. Both are worth reading.

But what does this have to do with Covid-19? One of the problems with being immersed in a world-changing event like this pandemic is having a sense of proportion. Mantel’s work provides this. It is a window into the lives, hopes and fears of people 500 years ago. It is a realisation of the futility of much of what went on among fallible people. Alagiah interviewed me about HIV, more than 30 years ago, when he was a BBC correspondent based in Zimbabwe. His book is a realistic window into the struggles in South Africa of a few years ago. This is the pre-Covid-19 world. I wondered how it would change if it were written today. Will it date? Unfortunately, I don’t have Richard Horton’s book, The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again, so that review will have to wait.

There is no startling new information this week. The numbers continue to rise at a truly alarming rate. The Americas are worst affected. In England pubs and other social centres are set to open on 4th July. The efforts to find treatments and develop vaccines continue, but global political and epidemiologic leadership remain lacking.

I am delighted to include a piece written by Jonathan Crush and Zhenzhong Si on ‘COVID-19 and Food Security in the Global South’. Under ‘Responses’ I have used the Association of Science of South Africa statement, lots of common sense there.

There are three items listed in the reference section. All three help to understand risks and should be of interest. We are getting a clearer sense of the disease.
Continue reading

Covid-19 Watch: Missing voices

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

There was hopeful news from the University of Oxford last week of a treatment breakthrough: low doses of the steroid dexamethasone can cut mortality. This has not been contradicted or undermined – yet! This is encouraging. Elsewhere the number of new infections continues to climb, South America being seen as the current hotspot. I find South Africa particularly worrying, due to my close connections with that nation.

Summer has arrived in England, although one can never entirely count on it. On Sunday, Father’s Day, my family and I went up to the north Norfolk coast for takeaway chips and a walk on the beach. The little town of Sheringham is normally teeming with tourists at this time of year. There were a fair number of people about, but most shops were closed, and there was a slight tension in the air as families tried to make their way along narrow pavements.

Driving along the coast past the huge, empty holiday parks of serried mobile homes, and shuttered country pubs, brought home what an economic disaster this pandemic is. North Norfolk’s economy is dependent on tourism, and there was no one about. Mind you the message from the area, which has one of the oldest populations in the UK, was ‘please stay away and protect our residents’. We don’t know how badly the economy has been damaged and when we will see recovery. We have no idea how many people on furlough will be re-employed. We don’t know which establishments will be able to reopen. Most of the resource rich world has mechanisms in place to reduce suffering. The major impact will be psychological and everyone is affected. In the resource poor world who knows!

Continue reading

Covid-19 Watch: A different background

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

Over the weeks following the murder of George Floyd in Minneapolis there have been global protests. The Black Lives Matter campaign gained momentum and there have been demonstrations around the world. These gatherings have often been ‘illegal’ in terms of the Covid-19 regulations, but they have been allowed to proceed. Encouragingly most demonstrators are visibly wearing masks or face coverings. Is demonstrating worth it when the Covid-19 risk undoubtedly increases? Clearly the demonstrators, and I, think so and authorities do not want confrontations.

As I finished writing this week, news came of a breakthrough in treatment. Scientists at the University of Oxford announced low doses of a readily available steroid, dexamethasone, cut mortality rates. The gains are not huge, one life saved for every eight patients on a ventilator and one for every 20-25 treated with oxygen. The treatment takes 10 days and costs about £5 per dose.1 Also in the news are encouraging results from other drugs. This points, in my view, as in AIDS treatment, to a combination therapy being the most effective response.

This week my guest columnist is Arnau van Wyngaard, an ordained minister of the Swaziland Reformed Church, with whom I have written over many years.
Continue reading

Covid-19 Watch: Anger Grows

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 month of May was incredibly dry in the UK, I do not think there was a drop of rain in the east of England. Fortunately, on Friday 5th June it started to rain, and we had consistent showers over the weekend. It is amazing how quickly the green is returning to the dry, brown lawn. Would that we were able to recover as quickly from the Covid-19 crisis.

The sad reality is that it will take us years to get over the pandemic. We can, albeit imperfectly, count the number of people who have died. It is possible, in countries with developed functioning health systems, to get an idea of the number of cases. There is a degree of uncertainty as to the scale of the epidemic in countries with fewer resources. Once we have the antibody test, we will be able to establish how many people have been infected.

It is also a matter of record how countries reacted and what the lockdowns they imposed looked like. In many nations we have an idea of how much money governments have set aside for Covid-19. This is in terms of both direct support and income forgone, for example through tax holidays. Once it is over, we know the direct costs of providing treatment and all spent on prevention. There will be inquiries into how governments, international organisations and the global community responded to the pandemic. I do not think they will make comfortable reading.

Continue reading

Covid-19 Watch: Distractions

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

Cities in the USA have erupted in flames as civil unrest and protest spread. In the UK the government’s credibility is in shreds. The World Health Organisation’s leadership is lacking. In many poorer nations the leadership and populations watch horrified as their economies contract, and, in time, may collapse. This is a global crisis; no country is untouched.

Perhaps the most obvious hit, other than deserted streets and empty city centres, has been in decreased mobility of populations, both business and leisure travellers. There are few aircraft flying and hotels and resorts are empty. Tourism and travel have, over the past few decades, become major contributors to Gross Domestic Product (GDP) and employment. Macau leads the table with 72.2% of GDP from travel and tourism. In Thailand it contributes 21.6%, in Greece 20.6%, in the UK 11%, and in South Africa 8.6%.1 Tourism employs 11.6% of those working in the UK, in Greece it is 23.9%.2

There is not much reason for optimism in the short term. While the spread of Covid-19 is under control in some areas, in others the numbers continue to rise. However, this crisis is an opportunity to reset the global discourse, establish what is important to us individually, as nations and as humans.

Continue reading

Covid-19 Watch: Politics

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1

Introduction

Over the past week I have watched increasing infighting and politicisation both over the Covid-19 pandemic and the response. In the UK Dominic Cummings, a senior advisor to Boris Johnson, became the story when he flagrantly disobeyed lockdown orders, though he, and the government, claim he did not. The Tanzanian president denies the epidemic, the South African emergence from lockdown is fraught, and there was a political attack on Professor Glenda Gray, President of the South African Medical Research Council (SAMRC) and a member of the Ministerial Advisory Council (MAC).

I write these communiques from a well-appointed shed in the garden of my home in Norwich, UK. My sanity is helped as spring is well advanced and I can leave the door open and revel in bird song. The robin sits just outside on the hawthorn bush and looks at me quizzically. My youth spent in church brings to mind:

“Behold the fowls of the air: for they sow not, neither do they reap, nor gather into barns; yet your heavenly Father feedeth them.” Matthew 6:25-34, King James Version.

The suburban wildlife does not care about the pandemic. In fact, the hedgehog said, “Pandemic, what pandemic”.2 This week has seen the changes in the countries with the worst entrenched epidemics (Table 1). The US leads the field followed by Brazil, Russia and the UK. Spain and Italy are relegated to fifth and sixth.
Continue reading