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

The Numbers

The cumulative global number of Covid-19 cases has now exceeded 30 million. There was a new peak of 324,221 cases on 18th September. This slightly exceeded the previous peak on 11th September of 319,888 cases. The data shows that the rate of increase is flattening. The highest reported number of cases is on a Friday with sharp falls. It would be really interesting to see an analysis of the patterns of reporting and the reasons for spikes. An alternative would be to use three- or seven-day rolling average, as is used when official data are presented in the UK. The largest number of cases are in the USA, currently over 7 million. Next are India where numbers are rising rapidly, Brazil, Russia, Peru, Columbia, Mexico, South Africa, Spain, Argentina, Chile, France, Iran, and the UK. Table 1 shows selected countries by cases. The rate of increase in most countries is slowing. There is, however, a very worrying increase in cases in some European countries. When UK government officials and scientists presented slides the comparators are France and Spain. Their data make the UK look good. Critically rates of hospitalisation and death are low.

Table 1: Global and National Cumulative Numbers of Confirmed Covid-19 Cases (alphabetical order every 2 weeks)^{2, 3, 4}

Date	Global cases	Brazil	Chile∞	India∞	Mexico∞	Peru∞	Russia	South Africa	UK	USA
15 Feb	69,000	0					2	0	9	43
4 Mar	93,000	4					3	0	86	149
18 Mar	201,500	372					147	116	2,600	7,800
1 Apr	861,000	6,836					2,777	1,400	29,900	213,400
15 Apr	1,982,552	28,280					24,490	2,415	94,845	609,422
29 Apr	3,117,756	79,685					93,399	4,996	162,350	1,012,583
13 May	4,262,799	180,000*					232,243	11,350	227,741	1,369,964
27 May	5,594,175	291,222					362,342	24,264	241,408β	1,681,418
10 Jun	7,250,909	739,503					493,023	52,991	262,098	1,979,893
24 Jun	9,264,569	1,145,906	264,689	456,183	196,847	264,689	598,878	106,108	277,200	2,347,022
8 Jul	11,830,885	1,668,539	312,911	742,417	261,750	312,911	693,215	215,885	286,979	2,996,098
29 Jul	16,741,049	2,483,191	349,800	1,531,669	402,697	395,005	827,509	459,761	302,295	4,352,083
17 Aug	22,145,643	3,407,354	388,855	2,767,253	531,239	549,321	930,276	592,144	322,177	5,482,602
3 Sep	25,761,430	3,950,931	413,145	3,769,523	606,036	657,129	997,972	628,259	339,415	6,075,652
16 Sep	29,576,191	4,382,263	437,983	5,020,359	676,487	738,020	1,069,873	651,521	376,670	6,606,293
23 Sep	31,600,754	4,591,364	448,523	5,646,010	705,263	768,895	1,111,157	663,282	406,058	6,896,274

Table 2: Covid-19 Deaths and Cases per million (alphabetical order)⁵

	Belgium	France	Italy	Russia	South Korea	South Africa	Spain	UK	USA
Deaths (19 May)		421.07	529.64	18.84	5.13	5.26	593.04*	523.33	275.8
Total cases (20 May)		2,189	3,736	1,991	216	277	4,953	3,629	4,557
Deaths (3 June)		429.83	533.93	33.56	5.27	13.35	580.58	587.24	320.93
Total cases (2 or 3 June)		2,320	3,856	2,905	225	579	5,125	4,070	5,472
Deaths (17 June)		438.73	568.76	49.01	5.38	27.14	580.78	627.71	354.46
Total cases (16 or 17 June)		2,410	3,924	3,681	237	1,239	5,221	4,372	6,386
Deaths (1 July)		444	574	63	5	43	606	655	385
Total cases (30 June or 1 July)		2,516	3,976	4,393	249	2,432	5,140	4,595	7,826
Deaths (8 July)		444	575	64	5	46	606	657	388
Total cases (7 or 8 July)		2,759*	3,999	4,713	257	3,317	5,400	4,209	8,877
Deaths (22 July)		449	581	93	5.7	122	608	688	451
Total cases (21 July)		2,804	4,073	5,606	277	7,630	5,693	4,420	12,961
Deaths (12 August)		451	582	104	5.9	186	611	699	501
Total cases (13 August)		3,127	4,155	6,150	287	9,545	7,214	4,607	15,532
Deaths (26 August)	865	453	586	113	6	227	617	623	540
Total cases (25 August)	7,075	3,751	4,305	6,588	350	10,309	8,257	4,811	17,344
Deaths (8 September)	867	456	588	123	6	259	631	624	576
Total cases (8 September)	7,651	5,040	4,610	7,062	418	10,780	11,240°	5,157	19,035
Deaths (23 September)	966	460	589	129	7	270	642	626	597
Total cases (23 September)	9,071	7,170	4,976	7,645	452	11,183	14,592	5,944	20,834

*misread these data °data from the previous one or two days

We have all been deeply and adversely affected by the pandemic and the restrictions placed on daily life. Millions have lost their livelihoods. Travel virtually ceased and social activities have been severely restricted. The two groups who have borne the brunt of the pandemic are the young and the old. This week I want to focus on the young. This links to a World Bank report on human capital and guest blog by a friend and colleague who is the Head of a College in Germany.

The Young and The World Bank Human Capital Index⁶

The Bank produces a country-by-country ranking of human capital. The 2020 version was published in March, describing the world’s human capital before Covid-19. The average human capital index score was 0.56 on a scale of 0 to 1.

“That means that on average, a child in the world can expect to achieve 56% of her potential future productivity, as a result of the health and educational support structures in place. … children born in low-income countries (were) projected to attain 37% of their productivity potential, children … in high-income countries … 70%.”⁷

What are the pandemic’s implications for health and social services and human capital, especially in low- and middle-income countries? According to the Bank the pandemic has already resulted in a 12% drop in global employment. The curtailing of labour migration means global remittances have fallen steeply in many countries and that in turn has pushed down income levels. The Bank

“expects the pandemic to push more than 100 million people into extreme poverty and plans to update that figure again in early October, according to (World Bank President) David Malpass. He added that 80 million children are missing out on essential vaccinations. … ‘We think more than a billion children have been out of school due to COVID, and that could lose as much as $10 trillion in lifetime earnings because of … reduced learning, the school closings, and … potential for dropping out.’”⁸

This area is where I began my career, as an Overseas Development Institute Fellow, employed as the Planning Officer for Education in the Ministry of Finance and Development Planning in Botswana in the early 1980s. We understood building human capital was essential to the financial and economic future of the nation and the advancement of the citizens. It is the reason why I believe in education, and served on the Waterford Governing Council, and why one of my good causes is Tujatane, the Tongabezi Trust School in Zambia. Please, readers, understand the next generations are the real victims of this pandemic, they are losing their futures. Look into how you can help. Not just for the children but for humanity.

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Guest Column: Laurence Nodder⁹

Alan asked I write about my Covid-19 experience running an international boarding school. I am Rektor of the United World College (UWC) in Germany, UWC Robert Bosch College (RBC). Prior to this I was Principal of Waterford Kamhlaba UWC in the Kingdom of Eswatini, Alan’s alma mater, and on whose Governing Council he served for two decades. I am in close contact with colleague Heads at 16 UWCs in different parts of the world.

Covid-19 presents an interesting, some might say terrifying, array of dilemmas for all schools and school leaders. Perhaps the greatest dilemma for an international boarding school, especially one where the majority of students come from afar (as is the case with UWCs), is what to do when it looks likely that the relevant Authorities will close schools. This happened in different parts of the world starting late January. Send students home ‘early’ and they and their parents might lose confidence in the school as a reliable provider of education. Wait until borders start closing and flights start being cancelled, and students might well become stranded, some distressingly in transit airports / countries. Evacuate students to local / regional families, themselves potentially in stress because of lockdown constraints, and it might appear like an exercise in abdicating responsibility. Who will intervene if the host adults fall ill and cannot provide daily resources and care?

Alone of the UWCs, RBC obtained permission to stay open as a boarding establishment – and so could offer parents and students the choice of whether to return home (which a few chose) or to stay, at their own risk, but with institutional support and the continued, reassuring presence of adults. This also allowed the college to recommence in-person classes as soon as these were permitted and without quarantining all the students who had stayed.

At the time the decision to remain open as a boarding establishment was taken, no-one could be sure that health systems in this part of Germany would not be overwhelmed (placing at higher risk also those whose illnesses or traumas were unrelated to Covid-19), that food supplies and other basic services would hold out, or that a sufficient number of on-campus members of staff would remain healthy, resilient, and available for ongoing care of students. The view was taken that students would not be placed at a significantly higher risk by staying than by being sent home or to host families.

RBC realized that travel and other restrictions were unlikely to fall away miraculously in June, at the start of the summer break. Student accommodation and support was made available throughout the European summer (and beyond for RBC, May 2020 graduates are still unable to go home).

The next set of ‘special’ international boarding school challenges arise in the context of bringing students back for the new academic year. Most UWCs have faced visa or other restrictions. Some have had to re-open online, still with uncertainty as to if or when international students may (re)enter the host country. Other host countries have allowed returning students to re-enter but have remained closed to new students from a range of national backgrounds. (The German Authorities created an exemption to allow international high school boarding students to enter Germany two days before the start of the Semester, with several students’ visa application processes previously having been on hold.) A pure online offering of indefinite duration might be sustainable for an international school. At least teachers have a clear task within the realm of possibility, even if it might not be attractive in the medium to long-term for students and their parents. It is far harder to expect teachers to deliver in-class lessons to many of their students, and to provide online support for those who cannot (yet) travel.

Visa and travel arrangements are “challenges”; it remains a dilemma how to bring young people traveling from around the world onto campus in a way that is Covid-19 safe, meets local quarantine requirements and provides a level of confidence to a wide range of interested parties: parents, teachers, the neighbouring community, politicians. Those UWCs that have been allowed to bring students onto campus have all required in-country testing for Covid-19 infection. Some kept students in individual quarantine (generally in government facilities or hotels) for 14 days and required a negative Covid-19 test before they were allowed onto campus, some involved a mandatory second test. At RBC the Authorities permitted a less onerous quarantine: students to remain on campus for 14 days but not in strict isolation within it after a negative Covid-19 test, masked engagement and social distancing for the 14 days.

There is little research on transmission of the coronavirus in secondary schools: student to student, student to staff and staff to student. Classroom lessons are relatively easy to manage in terms of Covid-19 precautions. It is what happens around student interaction beyond these set pieces that present the challenge. A boarding school has some advantages over a day school, off-campus interactions of students (and staff) are more easily limited. In all schools, my observation based on 38 years’ experience is most teenagers are not ‘designed’ for social (physical) distancing.

A study in some small residential US colleges provides some statistical insights.¹⁰ The factors that limited transmission in those contexts were: a significant reduction in the number of students for the given facilities, students wearing masks including in social engagements and limiting these engagements, and testing of (25%) of the community every week.

The students and staff at RBC are attempting a different approach. This is premised on limiting the places students can visit when off-campus – essentially to open-air venues, and a limited range of indoor contexts where strong infection-protection measures are enforced. There is agreement that students always remain physically distanced from non-college people. These measures are supported by strict masking when indoors and in interactions with staff and off-campus people. Soon we will test the saying ‘there is no such thing as bad weather, only inappropriate clothing’.

In terms of preventing the spread of Covid-19 infection in and from an international boarding school it would seem to me that there a sequencing of these priorities: for political reasons and because we can’t know any underlying health conditions in members of the public, the first priority has to be to keep the public safe from students (and staff). Because members of staff are older and some carry additional risk factors, the 2nd priority is to keep the staff safe from infection from students and fellow members of staff. The third priority is to keep Covid-19 infection out of the student body.

At RBC we work on the assumption our students would be interacting with families and friends if they had not come to RBC. We presume they would be living carefully, but not lives of ‘zero Covid-19 risk’. It would be a lost educational opportunity and counter-productive if we attempted to enforce a zero-risk lifestyle. Rather we want to engage students in mutual responsibility. The means of transmission and prevention are understood by 16-year-olds. UWC Founder Kurt Hahn commented:

“There are three ways of trying to win the young. There is persuasion, there is compulsion, and there is attraction. You can preach at them: that is a hook without a worm. You can say, You must volunteer, and that is of the Devil. You can tell them, You are needed. That appeal hardly ever fails.”

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Conclusion

Covid-19 has transformed the way we live. Were and are the right decisions being made, is the trade-off between mortality and prosperity correct? This issue is covered in The Guardian which writes

“Rival groups of scientists are at loggerheads over how government should handle the Covid pandemic, with one advising that only over-65s and the vulnerable should be shielded, while the other backs nationwide measures. The conflicting advice to the UK government and chief medical officers (CMOs) came in two open letters issued on Monday by the rival camps.”

Please take a look at these views and let me know what you think.¹¹

References (only if you are interested)

The Annual Report on Global Preparedness for Health Emergencies

On September 14th 2020, the Global Preparedness Monitoring Board (GPMB) released its second report: ‘A World in Disorder’.

“The GPMB provides a harsh assessment of the global COVID-19 response, warning that the world cannot afford to be unprepared again when the next pandemic hits. The Board called for five urgent actions to be taken to bring order out of the catastrophe and chaos currently facing the world: responsible leadership; engaged citizenship; strong and agile systems for health security; sustained investment; and robust global governance of preparedness”.¹²

The co-chairs are Norway’s former Prime Minister Gro Harlem Brundtland and former Secretary General of the International Federation of Red Cross and Red Crescent Societies Elhadj As Sy.

The 2020 Global Action Plan for Healthy Lives and Well-being for All progress¹³

This is the first progress report of the Global Action Plan for Healthy Lives and Well-being for All initiative. It covers the first eight months of implementation since its launch at the UN General Assembly in September 2019.

“The signatory agencies have moved from the four key commitments made in the GAP – Engage, Accelerate, Align, Account – to action, and are beginning to lay the groundwork for sustainable impact and demonstrate progress. Building on existing collaborations, the agencies are also committed to leveraging the GAP to fill gaps in and add value to existing global, regional and national coordination mechanisms in the response to the COVID-19 pandemic.”

Bill & Melinda Gates Foundation, 2020 GOALKEEPERS REPORT COVID-19 A GLOBAL PERSPECTIVE¹⁴

“In past editions of the Goalkeepers Report—almost every time we have opened our mouths or put pen to paper, in fact—we have celebrated decades of historic progress in fighting poverty and disease. But we have to confront the current reality with candor: This progress has now stopped. In this report, we track 18 indicators included in the United Nations’ Sustainable Development Goals (SDGs). In recent years, the world has improved on every single one. This year, on the vast majority, we’ve regressed. And so this essay has two goals. First, we analyze the damage the pandemic has done and is still doing—to health, to economies, and to virtually everything else. Second, we argue for a collaborative response. There is no such thing as a national solution to a global crisis. All countries must work together to end the pandemic and begin rebuilding economies. The longer it takes us to realize that, the longer it will take (and the more it will cost) to get back on our feet…. The Telegraph commenting on the report notes that the pandemic has set global development back ’25 years in just 25 weeks’.

The conclusions from these publications are bleak, the world continues to be in trouble.

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

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1. https://www.theguardian.com/world/2020/sep/22/johnson-refuses-to-rule-out-second-covid-19-lockdown-amid-new-restrictions
2. These data are from Johns Hopkins University https://coronavirus.jhu.edu/map.html
3. The UK data from 27th May is taken from Worldometers.info.coronavirus/country/uk
4. *estimate ∞ these countries were added, early data is not included. β Data for the UK from Worldometer
5. 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
6. https://www.worldbank.org/en/publication/human-capital
7. Michael Igoe, World Bank warns of COVID-19 toll on human capital, 16 September 2020 https://www.devex.com/news/world-bank-warns-of-covid-19-toll-on-human-capital-98100
8. Ibid.
9. Laurence Nodder is Rektor of the UWC Robert Bosch College in Freiburg Germany http://www.uwcrobertboschcollege.de He was the principal at Waterford Kamhlaba from 1999 to 2012
10. https://arxiv.org/pdf/2008.09597.pdf
11. https://www.theguardian.com/science/2020/sep/22/scientists-disagree-over-targeted-versus-nationwide-measures-to-tackle-covid
12. Global Preparedness Monitoring Board. A world in disorder: annual report on global preparedness for health emergencies. Geneva: World Health Organization; 2019. https://apps.who.int/gpmb/assets/annual_report/GPMB_AWID_ES_2020_EN.pdf
13. https://www.who.int/publications/i/item/9789240010277
14. https://www.gatesfoundation.org/goalkeepers/report/2020-report/#GlobalPerspective or https://www.telegraph.co.uk/global-health/climate-and-people/pandemic-set-global-development-back-25-years-just-25-weeks/