The Gap Widens

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

On 2nd May I had my second Covid-19 vaccination. It was my decision to have it earlier than the prescribed 12 weeks to acquire when I travel later in the month. The programme is so efficient, as before. The vaccination centre is in the food court of a major shopping mall in the city. At 4 pm on Sunday I walked in, and 5 minutes later, walked out newly vaccinated. I had the Oxford/AstraZeneca vaccine. It is incredible how rapidly the programme has been scaled up. This probably cannot be maintained so a question is: how often booster shots will be needed? We simply do not know; my guess is it will be annual.

Although I and many readers live in countries where immunisation programmes are moving rapidly, we need to remind ourselves that the Covid-19 pandemic is not over. At the moment there are parts of the world where it seems to be under control: notably the UK and USA. There are places where progress has been and continues to be made: most of Europe falls into this category. Parts of Asia (China and South Korea) and New Zealand and Australia have managed to keep the incidence of Covid-19 cases to exceptionally low levels. Much of South America is in the grip of an expanding pandemic. In Africa, except for South Africa, numbers seem low. The news, though, is dominated by events in India.1

On Saturday, April 17, the world passed three million reported deaths due to Covid-19. The true total of cases and deaths may never be known: cases because many people have no or slight symptoms, and deaths because of under reporting in many countries. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) warns the world is

“approaching the highest rate of infection”

so far in the pandemic, and several countries are facing

“a severe crisis, with high transmission and intensive care units overflowing with patients and running short on essential supplies, like oxygen.”2

In addition, there is the question of Covid variants, where are they emerging, how fast, and how should the global community respond?3

The health, social, and economic impact of the pandemic is still to be felt in its true magnitude. The only good news is the speed with which vaccinations are being delivered, although there is unevenness in the pace with which populations are reached, both between and within countries. This is the Matthew effect from the verse in Matthew Chapter 25,

“For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.”4

The numbers

The largest number of cumulative cases continues to be reported from the USA, at over 32 million, but the number of new infections peaked in January and has since fallen. The second highest is India, where the epidemic is out of control with a total of over 22 million recorded up to 4th May and over 350,000 per day for the last week. Third is Brazil with 14 million cases and a high, but stable, number of new cases. There is a big gap to the next cohort of countries. Those with fewer than six million infections: France has under six million, Turkey, Russia, the UK and Italy have between four and five million. Spain has just over 3.5 million and Germany nearly 3.5 million. The first African country to enter the table for absolute number of infections is South Africa with nearly 1.6 million. Of course, it must be remembered that these are total recorded cases since the beginning of the epidemic. The data should be assessed through two other dimensions, how many cases and deaths as a rate (usually per million), and what the trends are. Globally there were 105 new cases per million on 1st May 2021.5 The Seychelles currently has the highest daily cases per million at 968.94, but the total population is just under 100,000.6 Figure 1, accessed 2nd May 2021, shows daily cases per million for selected countries. Figure 2 shows the case fatality rate (CFR) for the same countries.

Daily new confirmed COVID-19 cases per million people.

Figure 1: Daily new confirmed COVID-19 cases per million people, from Our World in Data

Case fatality rate (CFR) of the ongoing COVID-19 pandemic

Figure 2: Case fatality rate (CFR) of the ongoing COVID-19 pandemic, from Our World in Data

The highest CFR in the world is in Vanuatu at 25% followed by Yemen at just under 20%. The highest in Africa is Tanzania with a 4.13 CFR, an indictment of the late president and his attitude to Covid-19. Most countries fall well below 5%, the second chart shows this for selected countries.

India

Everyone is appalled by the epidemic in India. When covering this story, reporters in the UK warn ‘some viewers may find these images distressing’. The story is predictable: desperate families trying to get loved ones into hospitals that are already packed; the search for oxygen (and the black market for it); medical staff describing the strain they are under; and film of the crematoria with flickering pyres and staff saying they are overwhelmed. All this is filmed against a backdrop of busy streets and crowds of people.

Over the past few weeks, India has experienced a devastating surge of Covid-19 cases. The country accounted for 38 percent of global cases reported for the week of April 18-25. The rapid escalation of cases has left the health system struggling. There is a critical oxygen shortage. In the capital, Delhi, where test positivity rates remain dangerously high (over 30 percent over the past week), the city extended its lockdown initially to 3rd May7 then to 10th May.8 So far, the UK has sent 200 ventilators, 495 oxygen concentrators and 3 oxygen generation units to Indian hospitals, and on the 2nd May announced it would send a further 1,000 ventilators. It is possible that prime minister of India Narendra Modi’s ineptitude in addressing the epidemic resulted in his party losing a key regional election.9, 10

The epidemic will peak soon, and while the relative rates are not record breaking in global terms, the size of the population makes it seem overwhelming. An article in the Times of India on April 11, 2021 by Sanjeev Sabhlok of the Swarna Bharat Party was entitled ‘Yes, 850 died of covid recently in a day, but 27,000 die every day in India.’11 It began

‘Governments, international organisations and mainstream media continue to drum up fear and panic in India, even as the facts entirely contradict their claims’,

argues against lockdowns and states,

‘We can say without the slightest hesitation that covid is not a major pandemic by any stretch of imagination’.

The argument is around proportionality: 27,000 people die daily from all causes. When the article was written about 850 people died of Covid-19 daily, around 3 percent of the deaths.

“But if that is the worst that covid can do, it is definitely not a severe pandemic”.12

Since then the prediction has been for over 2,300 deaths per day by the first week of June. Is that a severe pandemic? The numbers seeking care are overwhelming and not, as Sabhlok, irresponsibly suggests, random noise. This is the curve other countries sought to flatten. More on this in two weeks.

Easing the Rules

In some areas there is a deliberate move to relaxing lockdowns and easing the rules. There is clear evidence that people in much of Europe are taking matters into their own hands. This was brought home to me last Saturday watching a news report. I have always taken a mild interest in the performance of Norwich City Football Club. The team oscillates between the Premier League and the Championship, a year ago they were demoted from the Premier League. On the 1st May they clinched the Championship title and were duly promoted for next season. The local paper had a photograph of the presentation of the Player of the Season award. The two owners of the club were pictured handing it over with great glee. But virtually no one was wearing a mask!13

Meanwhile across the Atlantic, with 43 percent of the U.S. adult population having received at least one dose of a Covid-19 vaccine, the U.S. Centers for Disease Control and Prevention (CDC) announced new recommendations for mask wearing on Tuesday, April 27. The guidance states that fully vaccinated people no longer need to wear a mask outdoors, except in crowded settings.14

In South Africa

‘Covid-19 fatigue, causing people not to wear their masks, wash their hands and maintain physical distancing, has been identified as a major possible driver of a potential third wave of Covid-19 infections in South Africa, the director-general of the National Department of Health said this week’.15

Nationally the number of cases fell by 16.9% week-on-week, but the testing rate has fallen. There are places where numbers seem to be rising. The Northern Cape has the highest incidence rate of positive Covid-19 cases at 256.3/100,000 and the Free State has the highest hospitalisation rate at 12.9/100,000. The country has a case fatality rate of 3.4%. Health workers are being vaccinated and vaccine trials are ongoing.

‘Buthelezi pointed out that work being done by the South African Covid-19 Modelling Consortium in formulating a forecast for the third wave had identified behaviour change, a reduced adherence to non-pharmaceutical interventions, the easing of restrictions, holiday travel and super-spreader events as possible drivers of the third wave. Viral mutations and waning immunity from previous infections were also identified as possible factors that could trigger a third wave.’16

In the UK, the Telegraph reported that new modelling shows the risk of a third wave has fallen dramatically. The third step of easing restrictions: indoor household mixing and hospitality’s intended reintroduction from 17th May is likely to go ahead. This is based on new projections and modelling.

“Professor Adam Kucharski of the London School of Hygiene and Tropical Medicine, who works on modelling provided to Sage, pointed to the new real-world data on vaccine effectiveness. “There was considerable uncertainty about the impact of vaccines on infection and transmission earlier this year, but recent studies are landing at the more optimistic end of the scale – at least for the dominant B.1.1.7 variant,” he told the Telegraph. “We could still see some increase in transmission as things reopen, but the resulting impact could be relatively low if the vaccine programme stays on track and we don’t end up with variants that can partially evade immunity.”17

Conclusion

I left Swaziland in 1975 to go to university in the UK. My father said, “Do you want to go to university in South Africa or England”. (I fully acknowledge how privileged this makes me). It was not a difficult choice, the apartheid government in South Africa was becoming ever more repressive. There was a war going on in Northern Namibia and pressure was building in the townships in South Africa. All young white males were conscripted into the national defence force, the alternative was imprisonment for years. A number of friends ended up defending the indefensible and living with trauma for decades. The fact that I held a British passport, and had never lived in the country, did not provide protection against the call-up.

We used to listen to South African radio. Over the weekends there were request programmes where people wrote in asking for songs for family and friends. This was a means of communicating with the troops, especially the younger conscripts. A typical request might have been “I want to send all my love to Boetie from Brakpan, we all miss you, stay safe” and so on. Frequently the message would end with the phrase: “Vas byt, min daar”. This meant, literally, “bite fast, almost there” or hang in because ‘this too shall end. This is where we are with the Covid pandemic in many parts of the world. We are getting there but not at the same rate across the world.

There is an excellent article in The Times, “Three things you need to make sense in a Changing World” by Tim Harford.18 He says, with regard to statistics,

“For a proud geek like me, it was refreshing that statistics were no longer being used as a weapon but as a tool. Like radar, ultrasound, or the humble telescope, data show us things that are otherwise invisible. But they can only help us if we use them wisely; indeed, they can only help us if we are willing to use them at all”.

Harford has three simple steps for looking at data on Covid-19:

Step 1, keep calm.

“At the risk of sounding like a mindfulness guru with a calculator, I believe we should all notice our emotional reactions to the statistical claims that swirl around us. The media and social media thrive on fear, joy, anger and smug vindication”.

Step 2, get context.

“Statistics can seem bewildering, but you can get a long way with simple questions about context. What is being measured here? Is it going up or going down? Is it big or small?”

Step 3, be curious.

“Vaccines can be political. The data already suggest a gap emerging in the US, where Democrats are getting vaccinated, while Republicans are more likely to hesitate or refuse. … an unexpected cure (is): curiosity. Curiosity means being open to surprises and willing to admit to gaps in your knowledge … Most of us tend to be dismissive of new information that challenges our preconceptions but curious people tend to be more open-minded, finding the new facts intriguing rather than threatening”.

I strongly urge you to get the full article, it is the best thing I have read all week. And that is it for the first week of May.

Publications: Here is a really interesting website from the World Bank do take a look at it. https://datanalytics.worldbank.org/covid-dashboard/#section-covid-19-case-data

Thank you for reading, reposting and providing comments. What I write is public domain. Please share, forward and disseminate. My contact is: awhiteside@balsillieschool.ca – In the next installment I hope to cover vaccine passports and economics.


  1. https://coronavirus.jhu.edu/map.html
  2. https://www.independent.co.uk/news/health/covid-infection-highest-levels-who-b1832683.html
  3. COVID-19 News and Client Highlights from Rabin Martin https://rabinmartin.us6.list-manage.com/subscribe?u=2ec992c445622e8cffdf51007&id=3f1d97461d
  4. The Bible, Matthew 25:29, King James Version
  5. http://www.ourworldindata.org/covid-cases accessed 2nd May 2021
  6. An interesting question is what happens in small countries with high caseloads, cases studies would be useful. It is important to remember Leo Tolstoy’s Anna Karenina: “Happy families are all alike; every unhappy family is unhappy in its own way.”
  7. COVID-19 News and Client Highlights from Rabin Martin https://rabinmartin.us6.list-manage.com/subscribe?u=2ec992c445622e8cffdf51007&id=3f1d97461d
  8. https://www.financialexpress.com/lifestyle/health/covid-19-coronavirus-cases-may-4-live-updates-india-lockdown-latest-news-delhi-tamil-nadu-haryana-uttar-pradesh-maharashtra-cowin-corona-vaccine-mumbai-hyderabad-pune-bengaluru-lucknow-noida-punjab-ch/2245408/
  9. The Telegraph, ‘Narendra Modi pays price at the polls as India suffers another day of record deaths’. https://www.telegraph.co.uk/news/2021/05/02/modis-bjp-fails-win-west-bengal-election-india-hits-another
  10. https://www.economist.com/asia/2021/05/02/battered-by-covid-19-narendra-modi-is-humiliated-by-indian-voters
  11. https://timesofindia.indiatimes.com/blogs/seeing-the-invisible/yes-850-died-of-covid-recently-in-a-day-but-27000-die-every-day-in-india/
  12. ibid
  13. http://www.eveningnews24.co.uk/sport/norwich-city/norwich-city-reading-championship-match-report-7940272
  14. COVID-19 News and Client Highlights from Rabin Martin https://rabinmartin.us6.list-manage.com/subscribe?u=2ec992c445622e8cffdf51007&id=3f1d97461d
  15. https://www.dailymaverick.co.za/article/2021-05-01-fears-that-covid-19-fatigue-could-be-the-major-driver-of-a-third-wave
  16. ibid
  17. https://www.telegraph.co.uk/news/2021/05/01/covid-modellers-optimistic-third-wave-may-not-happen
  18. Tim Harford, “Three things you need to make sense in a Changing World”, 1st May 2021 http://www.thetimes.co.uk Harford presents BBC Radio 4’s More or Less which I consider and excellent short (nine minute) programme explaining data. His book How To Make The World Add Up is published in paperback on May 6

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

Spring is well entrenched in Norfolk. The leaves are appearing with great speed, the daffodils are past their best, and it is delightfully warm in the sunshine. Traditionally Spring is a time of regeneration and hopefulness. This is certainly the case in the United Kingdom where the Covid-19 pandemic seems to be under control. The number of new cases has fallen dramatically and has, in turn, been tracked by the decreases in hospitalisations and deaths. As readers of this blog know, although I try to track the global pandemic, I follow events in Canada – particularly Ontario, South Africa, and the UK especially closely.

In my last communique I reported receiving my first AstraZeneca inoculation. This week I am delighted to report that my partner received her second shot. Once again, the location was the food court at the Castle Mall Shopping Centre in the city. The procedure was a model of efficiency, although on a Sunday afternoon, it was quiet. We were in and out in 15 minutes. I asked if they would consider giving me a second dose. I want to be fully protected when I travel in a few weeks. We had an unhurried discussion, and the upshot was that, although they were willing to do the inoculation, we agreed I should wait a couple of weeks. The reason for waiting was that the immunity would be better if there were a longer gap, and, they thought, side effects should be less intense. I cannot praise the NHS and all the voluntary services that are making this happen enough.

The daily UK report on the virus has been of consistent good news. The reported number of new cases, hospitalisations and deaths continue to fall, while the number vaccinated is rising rapidly, including those who have received second doses. This is not the case around the world, the situation in Brazil and India is particularly bleak, not only are the rates going up, but the numbers are extremely high. A quick look at the excess death data gives a sense of bad the epidemic is by country. The New York Times does not seem to have kept their graphs up to date, the Economist has.1 Elsewhere there is cause for cautious optimism, but the price is constant vigilance. The economic, social, and psychological costs remain uncertain. In the UK this uncertainty will continue until the furlough scheme has ended. That will be when we understand how many people have lost their incomes. This will not just be those on furlough but so many small businesses who will either close or may fail.
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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
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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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