Covid-19 Watch: Great Progress in Vaccines?

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

England is halfway through four weeks of renewed lockdown. There are some differences from the first round, the main one being educational establishments, particularly schools, remain open. This week we learnt Prime Minister Boris Johnson is self-isolating again. He was in contact with an MP who subsequently tested positive for Covid-19. I note that he does not look particularly well. In the past week he has faced political turmoil, with key advisers being forced out of Downing Street. They were not particularly impressive individuals, one, Dominic Cummings is best known for his driving ‘to test my eyes’ during the last lockdown. It is a sign of turmoil and continued lack of leadership.

In the United States Donald Trump is refusing to concede the election and allow the new administration, under Joe Biden, to begin the transition. This extends to the Coronavirus response. It is effectively dead in the water at the federal level, although states can respond independently. The number of new cases reached a record high on 13 November. In South Africa most of the restrictions on daily life have been lifted although travel to and from the country remains difficult. This is not necessarily because of South Africa’s rules but those of destination and originating countries.

When I began this blog in March the first posting asked what the virus meant for us individually. I am going to return to this theme. The constant bombardment of data, opinions, contradictory information, and rumour means that there is confusion and weariness. This week’s guest column is by Graham Hayes, a South African academic and psychologist with years of experience in clinical practice. I asked him to reflect on the mental health implications of Covid-19. It is no surprise this epidemic is detrimental to our individual and collective states of mind. The Lancet of 14th November 2020 reviews the book ‘How to stay sane in an age of division’ by Elif Shafak.1 I have it on order! From a scientific point of view there has been more good news with at least two and possibly more vaccines waiting for testing and approval.

Last week I promised to talk about the pros and cons of lockdowns. On Monday 23rd I am taking part in a debate with Nick Hudson of Pandemic Data and Analytics (PANDA), the head of a South African group of actuaries who question the lockdown policy. This is being organised by BizNews2 as a special episode of their noontime webinar. It will be interesting; I suspect we agree on more than we disagree on. You can register to view the webinar here.

Numbers

As of 18th November, there have been 55,627,041 cases globally.3 The United States leads with 11.3 million and is extending the gap with the next highest country, India (9 million). The ‘millionaire club’ now includes, in order of cases Brazil, France (which just tipped into having over two million infections), Russia, Spain, the United Kingdom, Argentina, Italy, Colombia, and Mexico. South Africa has dropped to 15th place with just over three quarters of a million cases. In most countries, the exceptions being India and Brazil, the new cases are rising as we enter the northern winter. As with previous blogs I urge readers to go to other websites to look at the data that interests them. In many countries data is broken down to localised administrative levels. It is quite remarkable how this is done, although I remain unconvinced as to how helpful it is for ‘normal people ‘in planning their lives. Please look at the Economist’s excellent data tracker, especially the excess death graphs.4


Guest Column: The Coronavirus & Mental Health by Grahame Hayes5

Much has been made of the mental health implications of the pandemic. The first mental health alert was the highlighting of the stresses and strains health workers were dealing with in their care of infected people, and especially those requiring ICU treatment. The problems experienced by health workers included working exceptionally long hours, the fear of becoming infected themselves, and watching as more and more people sadly died. More or less immediately calls from mental health professional bodies went out to members asking for assistance in supporting these frontline health workers. The services were offered free and mostly through teletherapy. The Covid-19 health workers were being treated for emotional exhaustion, persistent anxiety, and depression.

The second alert came soon after lockdown when stories emerged of people, mostly those living alone, struggling to cope with their isolation, and being overwhelmed by feelings of loneliness and desperation. As reported by mental health bodies the rates of anxiety and depression have significantly increased during lockdown. One of the main drivers of anxiety and despondency has been the financial insecurity people have had to deal with, as their livelihoods have either collapsed or been seriously affected through the pandemic. Added to this is the uncertainty of when it all might end, exacerbating people’s psychological distress.6

It is difficult to talk about the effects of the pandemic in general terms as there are different consequences depending on which groups of people are implicated. For instance, the elderly; people living with co-morbidities; people living alone; the poor; those who have lost their jobs; teenagers; and so on. As variable as the responses may be to the pandemic it is worthwhile addressing some common features that we might all experience. It does not appear to be an exaggeration to suggest there is a general malaise regarding the pandemic that is unsettling people’s ability to cope.

Given there is much we do not understand about the virus, it is not surprising many people are experiencing high levels of vulnerability, accompanied with the fear of becoming infected. This can manifest itself in various ways; being overly self-conscious about our health and the potential threats to it, and thus in some cases over-interpreting “symptoms” as evidence we are infected or have Covid-19. The sense of vulnerability has resulted in many people engaging in extreme forms of self-isolation and not venturing out of their homes for weeks and months on end. This avoidance of social spaces can result in mild degrees of paranoia, as people project their fears onto certain physical objects, social spaces, and unfortunately onto people they see as unfamiliar or other.7

Besides the fear of infection, and possible death, there is the unpredictability of the future. How long is the pandemic going to last; will a vaccine protect us and for how long; and will there be a post-pandemic time? While the future is not predictable at the best of times, the pandemic has put on hold plans people might have had for the future. This abeyance of our lives adds to the frustration and general uneasiness with not being able to give meaning to our future. Questions like, where will I be in two years’ time?, and will the economy have settled enough for me to feel secure about making a living?, are ones we can’t easily answer during this time of the pandemic.

The pandemic has wreaked havoc with our inherent sociality as human beings. Social distancing and covering our faces with masks are profoundly anti-social practices, yet we need to do these things to keep ourselves and others safe and healthy. Susie Orbach noted in a lecture in May, our bodies have been seriously transformed, both in relation to ourselves, and of other people:

“I, like all of us, am accommodating to multiple corporeal realities: bodies alone, bodies distant, bodies in the park to be avoided, bodies of disobedient youths hanging out in groups, bodies in lines outside shops, bodies and voices flattened on screens and above all, bodies of dead health workers and carers. Black bodies, brown bodies. Working-class bodies. Bodies not normally praised, now being celebrated.”8

Accommodating these multiple corporeal realities means not recognizing the people we know behind the masks, not being sure if we should shake some one’s hand or hug people we usually did hug, or how close we should stand when in conversation. These disruptions to our previously taken-for-granted modes of social intercourse are not without consequences for our general sense of wellbeing. Some are dealing with these restrictions on our bodily movements with defiance and a brazen machismo that denies the real dangers we still face and will face for a long time to come. Two examples of this reckless behaviour come to mind. The first is the way Trump dealt with his own Covid-19 experience by making light of being infected and suggesting that it is easy to recover from Covid-19 – a version of the strong man syndrome.9 And the second is the delinquent socialising of groups of people in South Africa’s Eastern Cape Province that is now witnessing a significant surge in infections. Our invincibility against the virus is not a helpful message to be promoting as it encourages people to take unnecessary risks, thus endangering themselves and others.

The presence of the pandemic is a continual unwelcome reminder of our mortality. It is psychologically daunting to realise that our sociality could kill us, and it is not just that we can die from this virus, but how we, and those close to us, will die. Rodrigo Garcia notes,

“It’s not just death that frightens us, but the circumstances. A final exit without goodbyes, attended by strangers dressed as extra-terrestrials, machines beeping heartlessly, surrounded by others in similar situations, but far from our people. Your very own worst fear, loneliness.”10

The pandemic is taking a toll on people who were already struggling with mental health issues, and also on all of us who have to find “new ways of being social” (to quote Dr Anthony Fauci). We are able to be social in new ways and are already doing so. We can be caring and supportive to each other, and to those in need in our communities. Through our compassion for each other we can (re-) build psychological reliance, and at the same time make sure we remain safe from infection.


Travel

Our worlds have shrunk. The number of airline flights and passengers has plummeted. Business trips have been replaced by conference calls, using technological platforms from Facetime to Meetup to Zoom. In England people in care homes and their loved ones have been unable to visit. The lockdown regulations mean people are to remain at home, unless they have very good reason for travel. The regulation states

‘if you live in England, you must stay at home and avoid travel in the UK or overseas, unless for work education or other legally permitted reasons. … If you need to travel, we encourage you to walk or cycle where possible, and to plan ahead and avoid busy times and routes on public transport. This will allow you to practice social distancing while you travel.’11

Even when these restrictions are lifted many people will be nervous about journeys on public transport. Given my ‘split personality’ with links to Canada and South Africa air travel has been a prominent feature of my life. How safe is flying? This is a question many readers would like answered. There is an excellent article in Vox, ‘How risky is air travel in the pandemic? Here’s what the science says’.12 I strongly recommend reading it. In brief, the answer is no it is not entirely safe, and the article gives the reasons and cites the studies done to date. The point is made that, with precautions, flying can be made safer but not 100%.

Air travel was one of the main reasons the pandemic spread so rapidly and widely in the early part of the year. It took a matter of days, if not hours, for this highly infectious virus travel across the world. It is probable this was inevitable, and the suspension of most routes indicated a recognition of the problem. Being on an aircraft can be made safer with the standard precautions we all know. The longer the flight the greater the risk. Of course, it is worth noting the process of departing and arriving at the destination still carries risk. In addition, risk particularly to cabin crew is ever present.

One response, and this is being done at a number of airports, is to offer testing to passengers before departure and/or on arrival. This is still in development but is, I suspect, a way in which the beleaguered industry will try to recover. The Independent of 17th November reported

“A transatlantic flight on which all on board have tested negative for coronavirus has touched down in London. United Airlines flight 14 from Newark airport in New York to Heathrow landed at 6.41am. It is the first in a series of a dozen transatlantic flights in November and December for which the crew and all passengers aged two and above are obliged to take a free Covid test before boarding the plane. Each passenger takes a nucleic acid amplification test, known as NAAT, at Newark airport.”13

The pre-departure testing could eliminate the need for quarantine of arriving passengers.

The cruise industry has had a dose of bad news. CNN reported on the 17th November,

“SeaDream Yacht Club is cancelling the rest of its 2020 cruises in the wake of a Covid-19 outbreak on board one of its ships last week. Multiple negative PCR tests were required before the guests boarded, but this was not sufficient to prevent Covid-19 onboard,” the company said in a statement released Tuesday”.14

Seven passengers and two crew members on SeaDream 1 tested positive for Covid-19. The cruise was ‘to show that regular testing aboard the ship and other safety protocols could allow cruise voyages to take place safely during the pandemic’. It is, sadly clear, that this did not work, and the sector remains crippled.

Vaccines15

Last week came the news of the first promising vaccine developed by US-based pharmaceutical company Pfizer Inc. and BioNTech SE, a German biotechnology company. According to the Wall Street Journal it was more than 90% effective in the first 94 subjects infected by the coronavirus.16 Within the last few days Moderna,17 a drug company based in Cambridge, Massachusetts said it has developed a vaccine that is 94.5% effective in a preliminary analysis. The vaccine does not need deep cold storage needed by Pfizer’s.18

It is probable that other companies will report soon and there may well be other successful candidates. There are further steps before these become widely available. Pfizer is scheduled to apply for emergency use authorisation as this blog goes to press. Some reports have suggested immunisations before the new year, more likely is the first quarter of 2021. There will be a triage of who will get immunised first. Ideally it should be health care workers followed by the most vulnerable members of society.

Conclusion

Last week we thought we were welcoming the US back to the rational world. It seems this might have been optimistic, with Trump bunkered down in the White House, and the Republicans unwilling to beard him in the lair. There will be vaccines available sooner than we dreamed possible. This is most encouraging. But we are not out of the woods, and we need to look at the consequences of the epidemic and the global response: unemployment, poverty, hunger and despair.

And finally from today’s Guardian:

“The Treasury is planning to slash billions from the overseas aid budget despite the foreign secretary, Dominic Raab, praising the government’s 0.7% aid target on Monday as representing UK values in front of aides to Joe Biden. The Treasury wants to cut the aid budget from 0.7% of gross national income to 0.5% next year and plans to make the announcement as part of next Monday’s one-year spending review”.19

I had always been proud of the fact that the UK stuck to the 0.7% target. We realised the absolute amount of money was going to decline with the shrinking economy, but this is a disgrace.

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


  1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32345-X/fulltext#%20 staying sane
  2. https://www.biznews.com/
  3. Johns Hopkins University – https://coronavirus.jhu.edu/map.html
  4. https://www.economist.com/graphic-detail/2020/07/15/tracking-covid-19-excess-deaths-across-countries
  5. Grahame Hayes is practicing psychologist based north of Durban in South Africa
  6. A short article on the COVID stress syndrome. https://theconversation.com/covid-stress-syndrome-5-ways-the-pandemic-is-affecting-mental-health-147413?
  7. https://www.versobooks.com/blogs/4597-paranoia-and-the-coronavirus-how-eve-sedgwick-s-affect-theory-persists-through-quarantine-and-self-isolation
  8. https://www.theguardian.com/lifeandstyle/2020/may/07/patterns-of-pain-covid-19-psychotherapy-susie-orbach-bodies
  9. https://www.versobooks.com/blogs/4902-strongman-vs-miss-rona
  10. Garcia, R (2020) A letter to my father, Gabriel Garcia Marquez. New York Times, 6 May 2020. https://www.nytimes.com/2020/05/06/opinion/coronavirus-garcia-marquez.html
  11. https://www.gov.uk/guidance/new-national-restrictions-from-5-november#travel
  12. https://www.vox.com/platform/amp/21525068/covid-19-airplane-risk-coronavirus-pandemic-airports
  13. http://www.independent.co.uk/travel/news-and-advice/flight-new-york-london-heathrow-united-airlines-covid-test-b1723907.html
  14. https://edition.cnn.com/travel/article/caribbean-cruises-canceled-seadream-covid/index.html
  15. https://coronavirus.jhu.edu/vaccines
  16. Jared S Hopkins. ‘Pfizer’s Covid-19 Vaccine Proves 90% Effective in Latest Trials: Drugmaker and partner BioNTech could seek FDA authorisation by end of November. Wall Street Journal 9th November 2020
  17. https://www.modernatx.com/about-us/moderna-facts
  18. https://www.biznews.com/global-investing/2020/11/16/first-covid-19-vaccines
  19. https://www.theguardian.com/global-development/2020/nov/17/uk-aid-budget-facing-billions-in-cuts

Covid-19 Watch: Great Progress in Vaccines?

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

Last week I promised to talk about the pros and cons of lockdowns. That is not going to happen as there is too much else to report. The presidential election in the United States was last Tuesday. We had to wait until Saturday for the result to be definitively called. Democrat Joe Biden was clearly the winner. It remains to be seen what additional damage Trump and his Republican confederacy will do over the next few weeks. The Andrew Marr Show on the BBC on Sunday mornings does a review of the British papers. This brought to our attention the headline in the Ayrshire Daily News, a small regional Scottish paper. It was: “South Ayrshire golf club owner loses 2020 presidential election”.1

The blog is published on 11 November, Armistice Day. It is the day we remember those killed in armed conflicts around the world. This year it is particularly poignant, as the Second World War ended 75 years ago. There are still veterans who, in the absence Covid-19, would have joined a shrinking band of fellow servicemen to mark the event. Next year there will be fewer. Two years ago, I trudged through snow to the service at the cenotaph in Waterloo. It was the Centenary of the end of the First World War. It was particularly moving for me; my father ran away from school aged 15 and joined up. He survived the trenches with minor wounds and lived to 90.

Today humankind is engaged in numerous battles for survival. Covid-19 is the immediate one, with the vaccine news and ‘The Biden-Harris plan to beat COVID-19’.2 At the same time, the urgent challenges of climate change and environmental degradation remain. Covid-19 is a zoonotic disease, spread from animals to humans. The news of an outbreak of a mutated Covid-19 transmitted on mink farms in Denmark is extremely concerning. According to the World Health Organisation “Since June 2020 214 human cases have been identified in Denmark with SARS-CoV-2 variants associated with farmed mink.”3 The WHO suggests the mink were infected by humans, and acted as a reservoir before re-infecting humans with a mutated version. The Danish response is to cull. Seventeen million animals will be slaughtered. The only reason these animals are farmed is for their fur. Unbelievable!
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Covid-19 Watch: Bleak and Bleaker

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 blog is posted on Tuesday 3 November, the day US citizens go to the polls, as people will be focussed elsewhere on Wednesday. The election’s outcome is crucially important globally. I am desperately hoping for a change in the presidency. This would result in, hopefully, a sea change in the Covid response, reducing the shocking mortality, and give rationality and science a chance.

There are few silver linings on the dark clouds. Boris Johnson announced his new restrictions in a press conference on Saturday 31st October.1 The nation was told his address would be at 5 pm. This timeslot came and went. Eventually he appeared at the podium just before 7 pm. The journalists, especially on the 24-hour news channels, were desperately filling time, turning to the various ‘experts’ who were lined up, and filibustering. Remember, Boris speaks only for England. Wales, Scotland, and Northern Ireland can make, and enforce, their own regulations.

As we waited impatiently, I suggested we phone Boris and ask about the delay. My sister called up an old BBC report of Radio 5 Live presenter Chris Warburton interviewing Michael Gove, Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office. Warburton asked what the chance was of Boris Johnson agreeing to an interview by Andrew Neil.2 He pressed Gove to give odds: something between one and ten. Gove responded,

“I think the number would be 020 7930 4433, that is the Downing Street number and if you ring the Prime Minister’s diary secretary he or she will know what the Prime Minister is going to do, I’m not the Prime Minister’s diary secretary.”3

This is the Downing Street number. We called, and to our amazement got through to the switchboard. If you phone from outside the UK the country code is +44. Dial +44 2079304433. Good luck. But remember you will get through to a person with no control over government’s decisions.

What do we know? A great deal about the science and epidemiology, but much less about the politics, economics, and psychology. On Sunday 1st November the BBC showed a two-hour, recently-released documentary Totally Under Control.4 This is the story of the outbreak and the administration’s response to it, from the first cases to the point when Trump announced he had Covid-19. It is in the style of the classic book ‘And the band played on’ that chronicled the early years of AIDS.5 The documentary interviewed experts actively engaged with the American epidemic. Tellingly some public health doctors, whose mandate is just that – protect the health of the public – teared up. They watched the epidemic unfold, had a plan, and were ignored.

I include a guest column by Kristof Decoster, a colleague from Antwerp. He tries to make sense of the mass of information we receive daily. This blog will not have much analysis. The crucial question of lockdowns is touched on, but will be discussed next week. The references are worth a look.
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Covid-19 Watch: Ups and Downs (Mostly 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

For people who rely only on the media as their source of information the situation looks very bleak. It is worth remembering it’s bad news and names that sell papers. It is hard to be optimistic: confusion reigns in the UK; the USA has a nightmare conjunction of an ill-tempered election and Covid-19; in many European countries the numbers are rising and lockdowns are being reimposed. But there are still glimmers of good news.

In the Australian province of Victoria, the premier announced that Melbourne’s months-long lockdown would end:

“From midnight on Tuesday cafes, restaurants, bars and beauty services will reopen, subject to patron limits, and people will be able to leave their home for any reason”.

There were cheers and tears.1 Jacinda Ardern, recently re-elected Prime Minister of New Zealand, and her government have managed to control, but not entirely prevent, epidemic spread. The collection and presentation of data in New Zealand is exceptional.2 China is managing to go for periods with virtually no new cases, although this week they reported 137 asymptomatic cases in the north-western region of Xinjiang, the first new local cases for 10 days. These cases were linked to a garment factory.3 It is encouraging how quickly they are dealt with.

The impact of the virus and our response is dramatic, and indeed much of what I write about reflects this. We know there are massive impacts on peoples’ lives and plans. The episode of the British investigative programme Panorama on the 26th October was entitled ‘Has Covid Stolen My Future?’. The interviews with a series of young people were heartbreaking. Globally people are mobile, moving to work, learn, join family members, and seek new lives. Young people are generally flexible. Canada is a migrant accepting country and the economy and society need the skills and ideas of the migrants. This movement has almost ground to a halt, as this week’s guest writer, Canadian immigration expert Chris Daw, reflects.
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Covid-19 Watch: Shocks

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 has been another bad week for high income countries, some Gulf States, a number of Latin American countries, South Africa and India. The number of new Covid-19 cases is rising rapidly and there is a sense, in some jurisdictions, that the epidemic is out of control again. My caveat, that needs repeating, is that I focus on Europe, North America and South Africa. Readers who want other data can find it on websites: The Johns Hopkins website and Our World in Data to name but two.1

We also need to remember how the data are gathered and presented. To be counted as a confirmed case a person has to test positive for Covid-19. As the numbers of tests have increased rapidly so the number of recorded cases has risen. Most infected people will have no or only mild symptoms, and indeed the only way to know they have been infected is through a test. An antigen test will show those currently infected, and antibody tests will show who has been infected. Rising numbers of cases alone do not indicate a crisis. What we need to know is what percentage of those being tested are infected: the incidence of new cases. If that is rising, we have cause for concern.

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Covid-19 Watch: Taking Stock

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 rules in the UK were confused. Then on Monday Prime Minister Boris Johnson took the opportunity to clarify and strengthen them. I am still, and now even more, confused. I feared the situation regarding restaurants might change, so we went for dinner on Saturday at Stower Grange. If you are in, or need to be in, Norwich check it out. In fact the situation is that we can still go out for dinner. This may change with the introduction of a ‘circuit breaker’.

On Monday the South African newspaper Maverick Citizen carried an opinion-editorial piece by Nina Overton-de Klerk and Caroline Azionya: “The world is drowning in Covid-19 communication but isn’t much smarter for it”.1 The authors point out in 1968 a pandemic

“caused by an influenza A (H3N2) virus … (was) first noted in the United States … The estimated number of deaths was 1 million worldwide and about 100,000 in the United States. Most excess deaths were in people 65 years and older”.2

They report a (recent)

“WhatsApp message did the rounds with a picture of a rock guitarist playing to thousands of waving people. It read: “In 1969 the Hong Kong virus (H3N2) killed over one million people worldwide and over 100,000 Americans. Instead of shutting everything down and ruining people’s lives, they held Woodstock.””3

This deserves thinking about.

Vaccines probably offer us the only way out of this crisis. This week’s guest section is by Mitchell Warren, the Executive Director of AVAC. This is a non-profit organization that seeks to accelerate ethical development and global delivery of HIV prevention options. He became a friend, and a fellow traveller in search of global development and truth, more years ago than I care to recall in Durban. Mitchell tackles vaccines and his measured informative input is well worth reading.
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Covid-19 Watch: Schadenfreude

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 past two weekends have seen heavy rain and strong wind in the UK. This meant every last walnut on the tree was gone in 24 hours. I blame the squirrels as I simply could not find any windfall nuts. I think they watched the forecast and then had a very busy few hours. Hopefully, most of the nuts are safe and dry in the drey, and not buried around the garden. In addition, because of the gales, a roof tile had come loose. It was within an ace of falling through the conservatory roof. That was dealt with by an amazing roofer in about 20 minutes, who responded in record time. Thank you, Richard Bartram of Hellesdon Roofing who simply climbed onto the roof, replaced the tile and dealt with a second that we had not seen, not to mention fixing a leak in the fibreglass!

The Covid-19 epidemic continues to pass milestones: there have been over 35 million cases globally and over a million people have died. While the cumulative number of cases continues to rise, the number of active cases is falling as people recover, and the daily increase seems to be stabilising. The situation in the UK is bleak with unclear messaging and many issues. Large parts of the country are under lockdown, but many are up in arms about the totalitarian way it is being done. There is more on this in the section on the UK. Last Wednesday I downloaded the Trump/Biden debate and listened to it over a few walks and cycle rides. Trump was beyond ghastly, but Biden was not inspiring. Oh dear, this left me with a sense of foreboding for global politics. Then, on Friday, Trump was taken to hospital with Covid-19. This is covered in the section on the USA.

The looming issue is how we are going to deal with the economic, social and psychological effect of the pandemic. How do we deal with the terrible sense felt by so many young people that their futures have been stolen? What happens to imprisoned, isolated and lonely elderly people.
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Covid-19 Watch: Confusion

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 Tuesday, the global death toll attributed to the coronavirus topped one million people. The largest share, by an order of magnitude, was reported from the USA. This bleak milestone has been extensively covered by the worlds’ media. However, in terms of the daily number of confirmed cases there seems to be a plateau, or at the very least, the numbers are not rising as rapidly. To put Covid-19 into perspective, in 2017 there were 620,000 deaths from malaria, 794,000 from suicide and 954,000 from HIV and AIDS.1 This is the greatest death toll from a pandemic for centuries.

In this blog I want to turn to, and revisit, some fundamental issues:

  • How many coronavirus cases have there been?
  • How many of the cases matter and how much?
  • What does excess mortality look like?
  • One major concern has been the link between HIV and Covid-19. It seems there is some clarity on this – and good news, as discussed in a special section.
  • Finally, in the conclusion, I ask what is the impact of the virus?

The reason for this revisit is because of the way data are portrayed. Each evening in the UK we are informed by newsreaders of the number of new cases and the number of deaths. One graph shows the new cases recorded since the epidemic began. At first sight is deeply concerning, there are far more new cases reported at present than there were in April at the height of the pandemic. On the 25th September there were 6,878 new cases, well above the previous peak of 5,505 on the 22nd April. It should be noted this is data for the United Kingdom, it can be disaggregated for the four nations: England, Scotland, Wales and Northern Ireland.

This pattern is seen in several other European countries. How concerned should we be? There is a sense of real worry because the northern hemisphere is entering the winter, and no one is quite sure what this means. Normally there will be many respiratory illnesses and indeed with schools having reopened and students returned to university, (where many students are now, unbelievably, locked in)2 there is a sense that there will be an inevitable increase in cases. At the same time, the number of deaths and hospitalisations has fallen dramatically and may well remain low.

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Covid-19 Watch: Gloom

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 few days in the run up to the publication of this blog have been glorious. The days have been warm and sunny while the nights are starting to turn chilly. On Sunday we took advantage of the weather to visit the beach and have a long walk. The national restrictions meant that we had to eat lunch outside of the little café, but that was fine. Driving through the beautiful Norfolk countryside, it would have been hard to know that the UK is wracked by the Covid-19 pandemic.

The news is generally not good, although, as you read this week’s blog, remember that there are countries where the epidemic is under control or has not rebounded. The situation in China and other Asian countries seems under control. Australia saw two spikes, but the number of Covid cases have since fallen dramatically. In most African countries (apart from South Africa) the numbers remain low, while there is under reporting, the epidemic is not as serious as was initially feared.

This week I focus on the situation in the UK as the situation is rapidly evolving here. The bulk of the blog was written in the early part of the week, but I finalised it on Wednesday. The number of cases has been climbing rapidly and the leadership is beginning to panic. On Monday there was a special broadcast by Sir Patrick Vallance, the Government Chief Scientific Adviser, and Professor Chris Whitty, the Chief Medical Officer for England and the UK government’s Chief Medical Adviser. The presentation was given without any politicians present. It was a simple statement of current position and where the country could be without effective intervention.

Vallance and Whitty are responsible for providing scientific advice to the Prime Minister and members of cabinet; advising the government on policy on science and technology; ensuring and improving the quality and use of scientific evidence and advice; and supporting analysis and evidenced-based decision-making. The ultimate responsibility for decisions rests with the politicians.

On Tuesday Boris Johnson addressed Parliament, and in the evening spoke to the nation. The upshot of this is new restrictions that are pretty uniform across the UK. The nation was warned of a tough winter ahead and the possibility of a second national lockdown. The restrictions include a 10pm closing time for pubs and restaurants, bans on indoor team sports, and stricter rules on mask-wearing. There are even stricter local lockdowns. An indication of the government’s flailing response was the suggestion “freedom-loving” Britons will be blamed for more draconian restrictions.1
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Covid-19 Watch: Setbacks

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 try to exercise every day. I have come to enjoy cycling and have a circuit of between 20 and 26 kilometres, which takes me just under two hours. I cycle around the end of Norwich International Airport, through the villages of Horsham St Faith and Drayton. There I join a cycle track, the Marriot Way, (another old railway line) that runs along the Wensum river valley. The last five kilometres home are through a recreation ground and end with a meander through our suburbs.

It has been pleasant and interesting to see the seasons change. A few days ago, there was quite a stiff easterly breeze. This is a pain; it blows in my face for the most difficult part of the ride. On this occasion though, I saw a kestrel, one of the resident birds of prey in Norfolk. It was riding the wind on the edge of a field, hovering, almost motionless, scanning the ground looking for mice or voles. Perhaps I should encourage it to meet my squirrels, although it is too small to take an adult squirrel.

On the squirrel issue, the battle continues. The walnuts are ripening and now there are two squirrels raiding the tree. My squirt gun is not powerful enough to reach the top branches, and anyway they have worked out that the denser foliage on the adjacent tree means I can’t see them. My message is now, “OK squirrels you win, but please only take the nuts I won’t be able to reach”. Alternatively, does anyone have a recipe for walnut and squirrel stew?

There is a new set of Coronavirus regulations in the UK. There is some variation in these, depending on which of the devolved regions citizens live in. I cover this in more detail below. The big picture globally is that we may be reaching a plateau, but there is variation across the world, within countries, and by population groups. The bad news is that the numbers of new cases seems to be rising, again, across many European countries. The good news is that they have fallen in South Africa, the country able to collect and provide the best data on the African continent. It also seems that the infection fatality rate (number of deaths) is falling everywhere.
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