Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1
Over the past week I have watched increasing infighting and politicisation both over the Covid-19 pandemic and the response. In the UK Dominic Cummings, a senior advisor to Boris Johnson, became the story when he flagrantly disobeyed lockdown orders, though he, and the government, claim he did not. The Tanzanian president denies the epidemic, the South African emergence from lockdown is fraught, and there was a political attack on Professor Glenda Gray, President of the South African Medical Research Council (SAMRC) and a member of the Ministerial Advisory Council (MAC).
I write these communiques from a well-appointed shed in the garden of my home in Norwich, UK. My sanity is helped as spring is well advanced and I can leave the door open and revel in bird song. The robin sits just outside on the hawthorn bush and looks at me quizzically. My youth spent in church brings to mind:
“Behold the fowls of the air: for they sow not, neither do they reap, nor gather into barns; yet your heavenly Father feedeth them.” Matthew 6:25-34, King James Version.
The suburban wildlife does not care about the pandemic. In fact, the hedgehog said, “Pandemic, what pandemic”.2 This week has seen the changes in the countries with the worst entrenched epidemics (Table 1). The US leads the field followed by Brazil, Russia and the UK. Spain and Italy are relegated to fifth and sixth.
At 8 am on 27th May 2020 the JHU Coronavirus Resource Centre recorded 5,594,175 global infections.3 Absolute numbers are in Table 1. Russia and Brazil were added last week, this week I am simplifying the table by changing the dates to report cases every two weeks.
|Date||Global cases||China||France||Italy||Russia||Brazil||South Africa||Spain||UK||USA|
At the beginning of an epidemic actual cases provide the best, and often, the only data. As it evolves, other information becomes important and valuable. It is hard to compare absolute numbers in China with its population of 1.439 billion, with the United States’ 331 million people, or South Africa’s 59 million people. To make useful comparisons we need to look at rates.
|China||France||Italy||Russia||South Korea||South Africa||Spain||UK||USA|
|Deaths per million (19 May)||3.33||421.07||529.64||18.84||Error*||Error*||593.04*||523.33||275.8|
|Total cases per million (20 May)||58.4||2,189||3,736||1,991||25||277||4,953||3,629||4,557|
|Deaths per million (26 May)||3.33||424.27||544.04||25.15||5.21||8.32||574.31||555.19||299.79|
|Total cases per million (25 or 26 May)||58.4||2,225||3,806||2,421||216||398||5,034||3,847||4,964|
*misread these data last week
There is not much to report on the numbers this week. A fear is they (and the increases) have become normalised. We watch the mounting toll with a sense of helplessness, and even a growing indifference, unless of course Covid-19 touches people we know.
The antibody test will tell who has been infected and recovered. This is increasingly important for knowing where we are in the pandemic and allowing individuals to adapt behaviour. However, the development, certification and marketing of these tests is complex. They will be a gold mine for the developers, especially if they are bought by governments. The Telegraph, a British paper reported:
“the Department of Health is in negotiations with the Swiss healthcare company Roche to buy millions of the company’s kits.
Mologic, a Bedfordshire company that produces pregnancy tests, was granted £1 million by the Government to develop the coronavirus test.
SureScreen, a Derby firm, has created a finger-prick test which they say takes 10 minutes to return a result and is 98 per cent accurate. The tests are reportedly being used by private companies in a number of European countries”.6
We have to hope that the FDA in the USA, NICE in the UK, or the Medicines Control Council in South Africa will ensure we get accurate and affordable tests. They need to be available globally.
Scientific freedom and academic integrity came under attack over the past week. The president of the Medical Research Council (MRC) Glenda Gray commented that she and fellow clinicians were seeing children with malnutrition at Chris Hani Baragwanath academic Hospital. “We have not seen malnutrition for decades so we are seeing it for the first time in the hospital”.7 This resulted in a reprimand from Zweli Mkize the South African Minister of Health who said: “The statement made by Prof Gray is at the least devoid of the truth. Having read the article, I have been taken aback by the obvious inaccuracies it contains which have, in my view, caused unnecessary sensationalism and doubt on the work and effort of government in dealing with Covid-19.”8 His top civil servant, the Acting Director General, called the chair of the MRC to complain about Gray’s allegations and request her conduct be investigated.9
Academics and many others rallied behind Prof Gray. On 26 May the MRC announced they would not investigate Gray as she had not breached any policies. This is symptomatic of the inability of politicians to accept any criticism. It is reminiscent of the Mbeki response to the AIDS epidemic in 2000. Surely if ever there were a time to stand together it is now.
We know that has been an increase in malnutrition among children. This will continue, and get very much worse, as the economic turmoil, massive increases in unemployment, and general uncertainty regarding the pandemic persists.
The UK is a divided nation, it seems there are also deep divisions in England alone. The uproar over the movements of Dominic Cummings, the Prime Minister’s adviser, during the lockdown resulted in his extensive press conference on 25 May.
Cummings drove his ill wife and child from London to Durham and back during the height of the lockdown. This is where his parents and extended family live, and he argued it was the only way he and his wife could obtain childcare. He compounded this offence by being seen visiting a local beauty spot before returning to London. The press was persistent, but Johnson has indicated, thus far, he intends to take no further action. The already somewhat strained willingness of the public to trust the government and continue to follow distancing regulations is threatened. Various police forces have confirmed this attitude.10
Thai Medical News reports that some leaders have been downplaying the seriousness of the coronavirus epidemic.11 According to an article ‘certain high levels authorities requested that any mention of the airborne nature of the virus and all footage of the event be deleted’. Global News in Canada retained footage. It is posted on YouTube. The important segment is from minute 38 to minute 40. I cannot comment on the Thai website’s reliability, but I do believe the Global News so here are the words of the WHO director general. ‘Corona is airborne. It is more contagious… it has more potency, virulence’.
In Brazil President Bolsonaro continues to flout the Health Ministry’s physical distancing guidelines and is unwilling to take Covid-19 seriously. On the other side of the world the Tanzanian President’s denial of the coronavirus is a cause of great concern. Perhaps we should take comfort from the fact he called for three days of national prayers and has said they were answered.12
Guest Contribution: Complexity by Simon Dalby13
As the COVID-19 pandemic spreads around the world so too do attempts to respond. The policy discussions about how to deal with the disease, and the economic shocks that such attempts have set in motion, are proliferating even faster than the virus itself in many places.
Two things are especially noteworthy in all this.
First, what is being emphasized in most of this discussion is the interconnectedness of humans, nature and our social and economic arrangements. The speed of the spread of the virus, and the complicated routes it has taken, revealed by attempts at contact tracing those who get sick, make clear just how complicated links are between people and their surroundings. The disease has also revealed numerous weaknesses in contemporary economic arrangements; the dependence of urban dwellers on long supply chains is now very clear. And now as the Northern Hemisphere starts hurricane, typhoon and cyclone season, the disruptions from more severe weather events add to the difficulties. Storms have already hammered the Philippines, India and Bangladesh, while tornadoes and floods add to pandemic woes in the US.
Ironically some scientists have suggested that cyclone Amphan, which recently hit Kolkata, might have been made worse by the economic shut down in India. Clear skies, due to the absence of pollution over the Bay of Bengal, may have allowed more sunshine than usual to heat the already warm waters there, making the storm more severe. The clear implication is that we can no longer assume an external environment separate to humanity; the rich and powerful parts of humanity are remaking the planetary system quite dramatically by the sheer scale of industrial and economic actions.
This goes too for the origins of zoonotic diseases like the corona viruses. While ever further penetrations of human activity into forests and wildernesses offer opportunities for viruses to jump from animals to humans, so too do industrial farming arrangements where massive numbers of food animals are concentrated. Understanding the increasingly artificial nature of this situation, of the earth being remade by the rich and powerful among us humans, both in terms of the destruction of remaining relatively “natural” spaces, and the construction of huge industrial systems, is key to careful thinking about the context within which policy responses to both COVID-19, and the economic disruptions of the present, have to be undertaken.
Second is that the pandemic is loosening the policy consensus on the appropriate roles for government in economic and social life in many places. Conventional assumptions about who needs to do what where are being challenged. The pandemic response has emphasized the role for governments in shaping economic activities; in many places the priority given to “the market” has been shoved aside as disease control became the priority. But clumsily shutting down key parts of the retail and consumer part of the economy, has highlighted the vulnerability of poorly paid workers to economic disruptions, as well as the plight of small businesses dependent on continuous consumption of their products. Some larger corporations, and airlines and hotels at the heart of the tourism industry in particular, are in financial trouble too. This is a very brittle system leaving huge numbers of people vulnerable.
Crucially, in the last few months rising concerns about climate change have begun to penetrate into economic and financial circles. Larry Fink, the CEO of Blackwell, one of the key international investment management companies, has been arguing for some time now that sustainability has to be priority number one for corporations. McKinsey’s business management consultants seem to have come to the same conclusion recently. In late May an Economist magazine editorial used language reminiscent of that used by many climate change activists to insist that the response to the pandemic needed to be one that took the opportunity to reshape economies away from a reliance on fossil fuels. Carbon pricing, and building electric infrastructure are seen as crucial to flattening the climate curve. This new emphasis on thinking about humanity as part of a rapidly changing ecosphere just might be the silver lining in the dark clouds of pandemic chaos.
But there is nothing certain in these times. The attempts by fossil fuel corporations, hit hard by the price fluctuations in early 2020, to get bailouts, and in the case of the Trump administration a whole scale demolition of safety and emissions standards to facilitate further fracking and gas consumption, suggest a major political fight is in the offing. If attempts to rebuild cities and our economies on ecologically sensible lines are to be successful, then thinking through how ecology and economy can be made to operate together, without using massive amounts of fossil fuels, or making us all vulnerable to species jumping zoonotic diseases, has to be a key part of the policy deliberations, and all our political efforts in coming months.
There are few winners in the Covid-19 epidemic. Undoubtedly some medical companies and drug money manufacturers will do well. Perhaps in the long term we will see a change in how we treat our environment, in which case we will all be winners. Possibly the wealthy will realise that ‘enough’ is less than they have. The major losers are the poor and the weak. One group of people who need special consideration are those avoiding hospitals out of fear. This is not confined to the developing world, the numbers attending accident and emergency departments in the UK have decreased significantly since the epidemic began.
It is hard to arrive at conclusions in this week’s communiqué. Perhaps the most significant point is that patience is wearing thin and leadership is fraying. With lockdown being eased, it will be essential to scrutinise the number of cases and see, if in seriously affected countries like Spain, Italy and the United Kingdom, they remain low or rebound. If they rise again then the consequences will be bleak.
The next communiqué will have a guest writer covering Russia and Eastern Europe.
Mark Heywood, MAVERICK CITIZEN, Malnutrition, health services and democracy: The responsibility to speak out, 26 May 2020 https://www.dailymaverick.co.za/article/2020-05-26-malnutrition-health-services-and-democracy-the-responsibility-to-speak-out/
Atul Gawande, Amid the Coronavirus Crisis a Regimen for Re-entry, The New Yorker, 13th May 2020
The Independent SAGE Report, COVID-19: what are the options for the UK? Recommendations for government based on an open and transparent examination of the scientific evidence, Report
Submitted to The UK Government and the People of Great Britain & Northern Ireland by Sir David King, former Chief Scientific Adviser, UK Government, Chair of Independent SAGE. http://www.independentSAGE.org
Thank you to everyone reading, reposting and providing comments. For those who are interested in the economics of COVID-19, join the group “Economics of COVID-19” LinkedIn group. What I write is public domain, share, forward and disseminate. My contact: email@example.com
- Red text indicates figures or information will change. Bold text indicates a key point.
- I don’t believe the hedgehog is conversing with me, that would be silly – he does not understand epidemiology.
- These data are from the JHUM website. The countries are chosen because of their epidemics.
- Sources: Deaths http://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/
Case per million ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people
- Mark Heywood, MAVERICK CITIZEN, Malnutrition, health services and democracy: The responsibility to speak out, 26 May 2020 https://www.dailymaverick.co.za/article/2020-05-26-malnutrition-health-services-and-democracy-the-responsibility-to-speak-out/
- This raised so many questions – including why did his wife not drive?
- Simon Dalby is a Professor of Geography and Environmental Studies at Wilfrid Laurier University. His published research deals with climate change, environmental security and geopolitics. He was educated at Trinity College Dublin, the University of Victoria and holds a Ph.D. from Simon Fraser University.