Covid-19 Watch: Reflection and consolidation

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 has been five months since the first blog was posted in early March, ‘Covid 19 (the SARS-C0V-2) and you’. Since then it has become a weekly event, often bolstered, and supported with the help of friends writing guest columns. The pandemic has exceeded my worst fears; numbers are increasing almost exponentially. On 4th March there were a mere 93,000 cases, mostly in China. Today there are close to 19,000,000 and the largest number is in the US. I watched the pandemic and the responses particularly closely in the UK and South Africa. In one, the reaction has been confused and inconsistent, and in the other ineffectual. See below!

The first post was meant to be a quick ‘fact sheet’: what we know, what we don’t know, and what we need to know. How did we get to this parlous situation five months later? This is my blog, so I will touch on what Covid-19 has meant for me. As I am on sabbatical this year, I am not in Waterloo Ontario, but in Norwich with my family. We have a pleasant garden and so I have not felt confined, however, this would not have been the case in Waterloo.

Our lockdown in the UK began on 19th March. We were told to stay at home, except for essential trips, and for one hour of exercise per day. We took the exercise instruction seriously, but being rebellious, I spent between up to two hours walking or cycling. The pandemic means I am considerably fitter! Unfortunately, increased alcohol consumption means I am not any thinner!

Cycling is something I have not done for decades. Once I had the bikes unearthed and serviced, I re-discovered how much fun it is. The ride to Norwich market, at a sedate pace, takes 40 minutes. On Monday I cycled to The Eagle, a ‘gastropub’, which means a good menu and excellent food for lunch with a friend from University (45 years ago).

The Eagle was named originally for Michael “Eddie the Eagle” Edwards, who represented Great Britain in the 1988 Olympic ski jumping, the first Briton since 1928. He got into the team through amazing persistence and finished last in both events he entered. There is a 2016 film called, unsurprisingly, Eddie the Eagle. He ranks alongside Eric Moussambani Malonga, (Eric the Eel) the 2000 Olympics Equatorial Guinean ‘swimmer’, who won his heat as other competitors were disqualified and holds the record for the slowest ever Olympic 100 metres freestyle.1

Norwich is well known for pubs and churches. It used to be said that there was a pub for every day of the year and a church for every Sunday. Cycling home, I passed one church that never ceases to amuse me. The Zoar Baptist Chapel, built in 1886, advertises itself as “Zoar Strict and Particular Baptist Chapel St Mary’s Place”. It would be worth going to a service just to experience it.

Part of the reason for going out for my lunch was because it was the first day of the ‘meal deals’ announced by the British Chancellor. In August, from Mondays to Wednesdays, half the cost of a meal, up to the value of £10 per customer, will be paid by the government. Sensibly alcohol is excluded from the offer. This is one of the ways Chancellor Sunak hopes to get the economy moving. It begins as the generous furlough scheme ends. There are still furlough options, but employers have to contribute to the costs now. The next few months and years will be exceedingly difficult for many.

The Numbers

There are 18,541,862 Covid-19 cases globally. The USA accounts for the most, at around 4.7 million cases. Brazil is second, India third, Russia fourth and South Africa fifth. Mexico, Peru, Chile, Columbia and Iran make up the next five pushing the United Kingdom into 11th place. The number of new daily cases seems to be plateauing. 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)2, 3
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
5 Aug 18,541,862 2,801,921 362,962 88,206 1,908,254 449,961 439,890 859,762 521,318 307,356 4,771,087

* 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 was flat. 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)4
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 (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 (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 (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 (3 August) 3 450 581 98 5.8 147 619 695 474
Total cases (3 August) 60 2,748 4,057 5,447 272 6,880 5,826 4,496 12,187

*misread these data °data missing

The European Epidemic

The Data

The British public get regular briefings from a variety of politicians and public officials. They use this to try to shape the reaction to the pandemic and frankly it is primarily a political event. The Observer of the 2nd August ran a comparison of views between Boris Johnson and Chris Whitty the Chief Medical Officer under the headline ‘Policy v science: an upbeat PM and a gloomy chief medical officer’.5 On 19th March Johnson said

‘I think, looking at it all, that we can turn the tide within the next 12 weeks, and I am absolutely confident that we can send the virus packing in this country.’

On 17th July he said

‘It is my strong and sincere hope that we will be able to review the outstanding restrictions and allow a more normal return to normality from November at the earliest, possibly in time for Christmas.’

By contrast Chris Whitty said on 10th June

‘Be very clear, we are not at the end of this epidemic, not by a long way. We are in the middle of it’.

On 23rd June he warned

‘If people hear a distorted view of what is being said that says ‘this is all fine now, its gone away, and start behaving in ways they normally would have before the virus happened, yes we will get an uptick for sure’.

So where are we in the UK?6 On 1st August, the seven-day rolling average for new cases was 771. This is an increase from early July when it was about 560, but well below the peak on 2nd May of 5,125. There were 670 new confirmed cases, this is an increase of about 120 cases per day. These are cases identified through testing, the government acknowledges many cases go undetected. These are people who, whilst asymptomatic, are infectious. The numbers are increasing.

The number of patients admitted to hospital peaked in England on 1st April at 3,099. The trend since has been downwards and on 1st August it was just 59.7 A similar pattern has been seen in deaths, on the 21st April these peaked in England at 1,123. The numbers have fallen dramatically and in early August there were two days when there were fewer than 10. The total cumulative number of deaths attributed to Covid-19 in the UK on 4th August was 46,299. The limitations of this figure had been discussed previously.

There is an excellent public information fact checker in the UK called Full Fact, self-described as the UK’s independent fact checking charity (I occasionally make donations as I think they are an excellent resource). They have covered Covid-19 recently and note

“though we could not answer every question directly, we did take the time to read them carefully, group them into themes, and make sense of what matters to our audience”.

“The topic we received most questions (37%) was about behaviour rules during the lockdown. Many members of the public asked us when, how, and for how long someone should self-isolate; or similarly, what exactly they were allowed, and not allowed to do, in line with social distancing recommendations. … The second … was of a medical nature (16%). … the interpretation of symptoms, but many of them also wanted to know how pre-existing health conditions shaped their risk of contracting or developing a severe form of Covid-19. …The final …. was transmission (12%) … “can I catch coronavirus from”. The most frequent variation … was around catching the virus from other people. … whether the virus travels in smoke from vaping, or from joggers running past”.8

The Trends

One of the more interesting ways to track the progress of the virus in a ‘medical sense’ is to look at excess deaths. As the Economist of 15 July notes:

“people have become grimly familiar with the death tolls that their governments publish each day. Unfortunately, the total number of fatalities caused by the pandemic may be even higher, for several reasons. First, the official statistics in many countries exclude victims who did not test positive for coronavirus before dying … a substantial majority in places with little capacity for testing. Second, hospitals and civil registries may not process death certificates for several days, or even weeks, which creates lags in the data. And third, the pandemic has made it harder for doctors to treat other conditions and discouraged people from going to hospital, which may have indirectly caused an increase in fatalities from diseases other than covid-19. One way to account for these methodological problems is to use a simpler measure, known as “excess deaths”: take the number of people who die from any cause in a given region and period, and then compare it with the recent historical average. Many Western countries, and a handful of nations and regions elsewhere, publish such data regularly.”9

There are many fascinating graphs in this article. It shows the highest number of excess deaths in Europe per 100,000 people were in Spain (24.6 on 31 March, of which 15.5 were attributed to Covid, second came the UK, where the peak was on 17 April, with 19.2 excess deaths of which 14.3 were Covid attributed). The graphs then fall steeply in every other European country. It should be noted, in some settings the number of excess deaths then falls below the average, meaning fewer people are dying than would be expected. The implication is that the Covid-19 crisis brought some inevitable and imminent deaths forward, and not just from the disease, but because people were too scared to access the health care system, elective procedures were postponed and, despite their best efforts, the health care systems faltered.

In general, in much of the world the pandemic may have passed its peak. There have been suggestions that this is the case in South Africa, which we will address next week. It seems that many outbreaks can be tracked to specific geographic locations and events: a nightclub in Korea, a meatpacking plant in Germany and textile factories in Leicester. The reaction is to impose local lockdowns and use track and test. It is worth noting the promise to get this up and running in the UK by the end of June was not kept. It still is not working as needed.

Conclusion

This week’s output will be a little shorter than usual. I want to remark on some big picture issues.

  • This pandemic has shown the feet of clay and lack of subtlety many political leaders have. On the evening of Thursday 30 July, the eve of the Muslim festival of Eid, the English government banned gatherings in parts of the North West. There are areas with concentrations of Muslim populations who were immediately and adversely affected. Why was there no structured thinking? No communication?
  • The Dominic Cummings affair continues to resonate, Boris Johnson and his coterie are simply not trusted.
  • I really do not want to touch on the disaster that is the US. Here we are seeing the ghastly response of shooting the messengers who bring the bad news. More next week.

I am part of a closed discussion group. Some of the (unattributed) comments have been:

  1. “Sorry to be back and to be reiterative, but I continue to be flabbergasted by the idea to eliminate an airborne disease with patients being infectious before or even whilst presenting any symptom.”
  2. “Please allow me to repeat … my hypothesis that the Corona virus is not infectious enough (like the flu virus) to create ‘herd immunity’. … most interesting news on BBC: A sero-prevalence study in Mumbai’s slums concludes (1) that 57% of slum dwellers has been exposed (meaning probably, “have covid-19 antibodies”?); and raises the question (2) is the city approaching herd immunity. … a large section of people had been infected and survived with no or little symptoms, leading to a low fatality rate in these areas – one in one thousand to one in two thousand. If my understanding is right, the densely populated slums of Mumbai have relatively low incidence of clinical covid-19 and presumably a low CFR, but a high sero-prevalence. If this would be confirmed, and similar in e.g. Kinshasa or Lagos, that would be good news!
  3. “the Scottish strategy is unsustainable, … wanting to reach 0 infection and maintain 0 new infection?”

As we enter the second set of six months of the pandemic we are still not clear on how serious this disease is medically for most people: the evidence seems to suggest ‘not very’. We can see the economic devastation the lockdowns have brought and do not know if this was the appropriate response for every country.

An excellent long read in the Economist notes:

“The exponential growth predicted by Rik Thomas and his spreadsheet at the beginning of March suddenly stopped. The debate about why this happened will rumble on – but it seems likely that locking down the country successfully suppressed contagion. The precise lethality of the disease remains uncertain. Four months on, it is still difficult to calculate the hospitalisation and death rates … Covid-19 seems unlikely to disappear. The best that can be hoped for is that the disease becomes manageable, like flu, so doctors can treat it in an orderly fashion.”10

The world has changed. We are not yet able to think about what it means and how we want the new world order to look. Who better than to pose some of these questions than the ‘Dean of Thoughtful Commentary’, friend and colleague Stephen Lewis. In his 3rd August commentary he asks: ‘What kind of world will we inherit after COVID-19 if we lose all the urgent priorities, from infectious disease to human rights?’11 I urge you to look at it.

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. All this can be found on Wikipedia
  2. These data are from Johns Hopkins University https://coronavirus.jhu.edu/map.html
  3. The UK data from 27th May is taken from Worldometers.info.coronavirus/country/uk
  4. 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
  5. The Observer, 2nd August 2020, page 4
  6. A useful website https://coronavirus.data.gov.uk/
  7. This graphic does not give a total for the UK and the numbers have to be read off the graph.
  8. https://fullfact.org/blog/2020/apr/public-concerns-coronavirus/
  9. https://www.economist.com/graphic-detail/2020/07/15/tracking-covid-19-excess-deaths-across-countries
  10. https://www.economist.com/1843/2020/07/26/the-inside-story-of-britains-fight-against-covid-19
  11. https://aidsfreeworld.org/commentary/2020/8/3/week-in-review-268-covid-19-puts-civil-society-on-the-ropes

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!
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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.
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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.
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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.
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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.
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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!

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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.
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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.

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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.

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