What’s next, I ask?

Welcome to the first of my monthly, meandering blogs, put on my website, and emailed to everyone who signed up to receive my news. Let me begin with a warning, this is not primarily about Covid, so you may wish to take yourself off the list. Obviously, I am still following Covid, but no longer closely, and certainly not enough to write regular posts. Having said that here is something everyone should read – “How the risk of side effects could change with Covid-19 vaccine boosters” – we are all, probably going to offered these soon.

At the end of this year, I will end my ‘formal’ working life. No longer will I have someone paying me a salary! It is going to be a milestone and feels rather strange. The question is what next – beyond death and decay, that is. I am strangely unwilling to make any commitments now. There is so much I could do, and I really do need to start making plans. Getting back to Canada and to South Africa are high on the agenda. Anyone coming from South Africa must be quarantined in a hotel near the airport for 11 days, so that is not going to happen soon. Canada is a bit easier.

I have been dabbling in writing a memoir, so doing a course on memoir writing might be a good idea. These are available in Norwich through the Writer’s Centre. This writing is slow going, but I have learnt some very interesting things about my family. For example my father, having served through the second world war with the Indian Army as an engineer, returned in 1945 for a further period of service. During this he was on the Northwest Frontier in Karadinand and then Razmak. He described skirmishes with the forces of the Faquir of Ipi whose troops would lob shells into their cantonment. What a wonderful title for a tribal leader! This is also very relevant today; as we are seeing Afghanistan is not a country for foreigners!

The result of the Covid pandemic, as far as I am concerned, is that so little happened, and it was over such a long time. As I have said before, I think the greatest real victims are the very young, for whom this has taken an inordinate amount of their lives, and the very old who effectively lost time to be with loved ones. However I don’t think I made the best possible use of the time and that annoys me.

I started a weekly blog to keep friends posted on what I thought was important. This replaced my monthly meandering, which I have kept up for many years. After about a year I realised that I could not manage to write something new and interesting every week, so cut the frequency. Finally, about a month ago I stopped. There were several reasons: firstly I felt the pandemic and its response were getting too complex for me to understand; secondly it was a huge commitment of time, even though writing can be quite rapid, the research and thinking took a while; and thirdly I was beginning to find it all quite depressing.

There have been unprecedented and huge strides in the science and that is very welcome. The vaccine development has been exceptional. Therapeutics do not appear to have kept pace, unless there are things I don’t know. The real effect of the pandemic is on economic, social, cultural and political life and frankly we don’t know what this will be. It will emerge over the next few years. There is a chance to influence this of course. I hope but am not convinced this will happen, and that the world will be a better, fairer place, with an appreciation of what really matters.

August 2021 mirrored my mood, it seemed as though the whole month was grey, damp, and oppressive. In addition, the garden, while full of plants and insects, seemed to be a bird-free zone (apart from pigeons, and I don’t count them)! I hoped it was because many of our birds go to the nearby fields at the height of summer. I am very pleased to say that, as I write this in the first week of September, the garden seems to be once again alive with birds. The weather has also changed, and we are forecast to have a spell of warm sunny days. Of course, it won’t be too long before we are scanning the sky hoping for rain!

My reading (both fiction and non-fiction) is generally advised by recommendations from friends and reviews in the newspapers. Pat Barker is a well-known British author who wrote the brilliant Regeneration Trilogy about the first world wars. One of the papers mentioned a recent book, The Silence of the Girls, published in 2018. It is the story of Queen Briseis, the queen of Lyrnessus, a city sacked by Achilles as he besieged Troy. The tale is told by Briseis as she is enslaved and awarded to Achilles, as the ‘prize of honour’. As the ‘blub’ says, this war, and the siege of Troy, was ostensibly a fight over a woman – Helen of Troy – but the book gives the other women a voice. It is a brutal book. In her despair Briseis thinks that this all for naught, but then reflects that the stories will live on, and of course they have. I can strongly recommend it. I am still thinking about it and what it means.

Over the past six weeks Norwich has been hosting the ‘Head out not Home’ initiative. That meant that there were musicians and other entertainers in five of the public spaces around the city each Sunday. They all played five short gigs and, of course, it was all free. The level of organisation that went into it was extraordinary. These types of events are one of the things that made me proud to be a resident of Norwich. We can all play a part in making the city vibrant, even if it is just turning up! I only went to one music event: Tom Moore and Archie Moss. They were great and it made me realise that I had missed out. It is, of course, possible to enter the artists’ names into Spotify or other streaming services and hear the music, but it is not the same.

Over the past few weeks, I went through the process of getting new glasses. It took longer than expected. The test was straightforward, although I have to say my local branch of ‘Specsavers’ really does not seem to care about the time their clients waste waiting. I suspect though it is a model of capitalist efficiency. Two things stood out: first the optician was Canadian, from Edmonton and one of his colleagues put her head round the door, a Canadian from Calgary – why; second the collection of the new glasses had to be postponed because they did not arrive as promised or expected.

The combination of Brexit and Covid is having a negative effect on economic activity in the UK. One of the major bottlenecks currently seems to be trained delivery drivers, there is even a shortage of cab drivers. I arranged to meet Rowan at a pub for dinner a week or so ago, ‘Take a cab’, she said, ‘That way you can have a drink without worrying’. Sensible advice, well I phoned every company in Norwich, but all warned of a wait of at least an hour. In the end I drove and did not drink.

Let me end off there and say thank you for reading this posting. I try to keep them below 1,300 words, and only post once a month, but again please feel free to unsubscribe (you can do so by clicking the ‘unsubscribe’ link at the bottom of the email).

Feedback is always welcome, either by leaving a comment here or by emailing me: awhiteside@balsillieschool.ca

And, finally, for now

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 4th March in 2020 I started posting a ‘Covid-19’ blog to replace my normal monthly meanderings. It began:

“I am expected to know something about epidemics and pandemics, their causes and consequences. Many friends and colleagues have been asking me about Covid-19.

Here is a quick ‘fact sheet’ as of 4 March – what we know, what we don’t know, and what we need to know. I include hot links. Please feel free to send it on.”

Initially I used red text to indicate where figures or information would change, and bold text to show key points. I managed to keep up a weekly report for over a year. I then reduced it to every two weeks, but gaps increased and I am afraid I lost steam.

More than a month after I previously posted my Covid blog, this is the last. If you are getting it as someone who signed up for the Covid update you might want to ‘unsign’. If you do not, you will continue to receive my monthly personal blog. This is about what I am doing, books I am reading, ideas, and the minutiae of daily life – there is a lot about flights, airports and aircraft. The first of this new series will be posted in a couple of weeks.

As to the reasons for me ending this blog, the main ones are: it was surprisingly time consuming; the situation with regard to the science, numbers and response is increasingly complex; and it was getting too depressing to keep going. There are plenty of other people doing what I was trying to do. Nonetheless there are still areas that are ripe for research and writing. In particular the consequences of the pandemic, its economic, social, psychological and political effects. They are, of course, still unfolding.
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Announcement: The Next and Last Pandemics – The Consequences of COVID-19 and its Impact on the HIV/AIDS Response

The University of the West Indies, HEU, Centre for Health Economics, International AIDS Economic Network (IAEN), and the Pan Caribbean Partnership against HIV and AIDS (PANCAP), invite you to participate in a virtual discussion on “The Next and Last Pandemics – The Consequences of COVID-19 and its Impact on the HIV/AIDS Response”, Wednesday, 21 July 2021 from 9:00 AM – 11:00 AM Eastern Time.

You can register for the virtual discussion by clicking here.

Poster for "The Next and Last Pandemics: The Consequences of COVID-19 and its Impact on the HIV/AIDS Response" virtual discussion

Fatigue

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

Regular readers will have noticed that it is three weeks since I last posted a blog. I am planning to write one more piece after this and will then end regular posts on Covid-19. I will still blog once a month but it will be a more general article. There are several reasons for this: preparing and writing is time consuming; the situation with regard to the numbers and response is increasingly complex, it might be possible to focus on one continent, but globally the situation is ever more diverse; it has dawned on me how incredibly disruptive and damaging the pandemic is, frankly it is too depressing to keep going; and finally there are many other resources available. Among them is pandem-ic.com:

‘This personal site provides data analytics on the COVID-19 pandemic through the lens of the World Bank country income classification – hence “pandem-ic”.’

It is produced by Philip Schellekens, a Senior Economic Advisor at the World Bank Group, but is a personal blog.1
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Are we winning? Yes and no!

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 finished my quarantine in my Waterloo apartment a week ago. I had three days confined in an airport hotel and then 11 more in Waterloo. The government was efficient at checking up on me. Every day I got an automated email with a weblink, and had to complete a form online. There were at least two phone calls and one visit from a private investigator, who had been repurposed as a quarantine inspector, complete with stab proof vest. He came to the door of the apartment, but said he was not allowed to enter it – which somewhat defeats the objective of checking.

The whole of the post-hotel quarantine depends on the honesty of individuals entering Canada. The press has reported, with outrage, of people flying to American airports and crossing the border by road, thus avoiding some of the more intrusive processes. I must be honest and say it was not too bad, though the current lockdown is wearing. Friends made sure I was well supplied with the essentials (food and wine), and so my incarceration went by reasonably quickly. But then I have a large apartment with a great view. I am privileged and I recognise it.

My overarching impression in Ontario is of a province on its knees, and an overwhelming weariness with the whole process. The smiles are becoming fixed, that is when you can see them because people wear masks outside. The problem is the lack of clarity and consistency. As I understand the situation, rules are enforced at the local level. Where I am, it is enforced by Region of Waterloo Public Health. They work closely with Public Health Ontario, the relevant section of the provincial government, which sets policy, and at the national level, with the Federal Ministry of Health. The lockdown is tight; people should only leave their homes for essential reasons, socialising is not allowed, and currently schools are closed. This last regulation has, as in Europe, had an extremely detrimental effect on children and their parents.

A large part of the problem is the Provincial Government, run by the Progressive Conservative Party of Ontario under the leadership of Doug Ford. The world over, conservative governments have reduced public health expenditures and services, and Ontario is no exception. Indeed, Ford was forced into a humiliating climb down when he attempted to announce that the provincial police would enforce his regulations,1 only to have various forces announce the next day that they would not be doing this.2 The numbers in the province are coming down slowly. There is a decent website3 giving data for the province. The citizenry needs clear guidance and, above all, to know the nightmare will end soon, but this is lacking.

The little mall across the road has a security officer at a desk at each entrance. Their task: to ask each customer if they have any Covid symptoms as they enter. It would take a pretty stupid individual to admit to having signs of Covid. I suppose it is important to be seen to be doing something, and this has certainly created employment. Interestingly most of the security officers seem to be recent immigrants from Southeast Asian countries. That probably indicates that these are minimum wage jobs.
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Vaccination: the way ahead

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

Introduction

This is being written as I quarantine in my Waterloo apartment. Getting here was surprisingly easy, despite a great deal of bureaucracy. The story began in December 2019 when I travelled from Waterloo to the UK for a year’s sabbatical. I planned a busy year, with visiting fellowships at two German and a British University, and visiting status with two English Universities. It was set to be a full, productive, and fun year. And then Covid-19 arrived, and everything was put on hold. I did not leave Norwich for over a year but making a trip to Canada was increasingly urgent. Travel was not easy, cheap or pleasant.

The first step was getting permission to leave the UK. International travel was not allowed until 17th May, unless the traveller has good reason. There is, of course, a government website. The “Declaration for International Travel” has a drop-down menu of about 10 reasons, from ‘Work’ to ‘Other reasonable excuse – please specify’. I dutifully completed and printed it. No one asked to see it at any point. There were no flights for my preferred route (Norwich, Amsterdam, Toronto) so I booked from Heathrow. There is extensive guidance on travelling to Canada on the Canadian government website. Only four airports accept international flights: Calgary, Montreal, Toronto, and Vancouver. At the moment, there is no recognition in the terms of travel and restrictions of vaccine status. I am fully vaccinated and have a flimsy little record card to prove it. I made photocopies for officials. No one asked or showed an interest.

To enter Canada (and various other countries) a traveller has to have a negative Covid test within three days of boarding. In the UK, private laboratories produce a “Fit to Travel Certificate for SARS CoV-2/Covid-19 Testing”. At a price of course. Also required is an arrival form to allow border officials to track you.

“Speed up your arrival process in Canada and spend less time with border and public health officers. Use ArriveCAN1 to provide mandatory travel information… Help … keep Canadians safe and healthy.”

The aircraft, a Boeing 787 Dreamliner, seats about 250 people. I booked myself in the premium economy section for more room. What a waste of money, there were only 19 passengers! There was a full complement of very bored cabin crew and consequently we had excellent service and some interesting conversations. Clearly, they had time to check the passenger list, halfway through the journey they began addressing me as Professor!

On arrival getting through the Canadian formalities was straightforward. The test is a nasal swab. There was no interest in my vaccination status – but there were a few comments on Canada’s failure to roll out a vaccine. Mind you I was on an empty plane; the next scheduled flight from Manila had 350 passengers. The government requires you to pay for three days’ quarantine in a hotel. My choice was a bog-standard business hotel, where the confinement included three meals brought to the door in large brown paper packets. I understand Pavlov’s dogs better now. Within 24 hours I recognized the rustle from the moment the delivery person exited the lift. There was nothing to get excited about on the menu though.

At Heathrow I bought a couple of bottles of duty-free wine and when I checked into the hotel, I asked for a third. The clerk said that he was glad I asked before he checked me in. He is not allowed to send alcohol to the quarantine rooms! There was no corkscrew in the room and the desk said they had none so here are some tips.
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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

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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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