Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com
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.
As of 3rd November, there have been 46,909,107 cases globally.6 The cumulative case data from the Johns Hopkins website show that in the ‘millionaires’ category the USA is highest, with 9.29 million cases. The highest daily total ever was on 30 October at 570,759. India follows with 8.2 million; Brazil at 5.5; Russia at 1.6; France at 1.4 million, Spain at 1.2 million; Argentina at 1.83 million and the UK, now in 8th place, has joined the category of over a million cases at 1.05 million. South Africa has dropped two places to 14th. I advise readers of this blog to look at the Economist’s excellent data tracker, especially the graphs showing excess death.
So, what can we learn from the data? The rate of increase in most countries is slowing. This indicates either prevention measures are working or there is a point of saturation of susceptible people. We are going to have to stop looking at cumulative cases, it is simply a tally and does not have enough information to understand the dynamics of the disease. We need to start looking at the economic effects and ‘collateral’ damage and how to address it.
Guest: Scientific Polarisation on Covid responses by Kristof Decoster7
Last week, at the (virtual) ITM colloquium, a debate took place on whether the Covid-19 response had been balanced enough. In the slipstream of the discussion, before and after the debate a poll was conducted with as main choices, ‘a top-down blueprint’ versus ‘a more flexible’ approach. It was an animated debate, similar to the fierce discussions we witness on the Covid-19 Sub-Saharan Africa Google group (where discussions don’t seem confined to SSA, as it’s hard to just refrain from commenting on one’s own setting or country, especially when there’s a new “wave”).
Even if the virus and Covid-19 still present many mysteries, it’s fair to say we know a lot more now than at the start of the pandemic. As scientists got to know the virus one would expect polarization, at least amongst experts, would have decreased, especially eight months into the pandemic. But the opposite seems true. What are some of the reasons for this (continuing) scientific disagreement? Let me give it a try. Below are tentative reasons, but I’m sure there’s a lot more to it.
Unlike polarization in public opinion, we can’t really blame the “Infodemic”, let alone wacko conspiracy theories for this disagreement. No scientist thinks that 6G will bring the ultimate solution, or Bill Gates (many of us agree he’s way too powerful in the Covid-19 ecosystem, and global health in general) will include a chip in vaccines to make people more docile, etc. (there are other reasons why public opinion is polarized, including the impact of public health measures on their lives).
Scientists, however, mostly know “the facts”, though some understand the intricacies of the virus or, say, modelling, better than others. Put simply, by and large, they tend to have all the ‘health literacy’ needed on Covid-19, unlike most ordinary citizens. Yet, we seem to interpret these facts in quite different ways at this stage in the pandemic. It appears many scientists currently want to occupy some pristine territory between the Great Barrington Declaration and the John Snow memorandum.8 The poll pointed in that direction. More people favoured the ‘flexible’ over the ‘blueprint’ approach’ (problematic wording, if you ask me, as most scientists, who like to think of themselves as being “smartasses”, want to be ‘flexible’ rather than seen as ‘rigid’). Eight months into the pandemic, most scientists try to live in the mythical land of “systemic Pasteurists”. While I subscribe to that, unfortunately it’s not entirely clear what it involves, so we differ hugely in our opinion on this “middle ground”, even among people using more or less similar ideological lenses.
And that’s part of the reason, I guess, why at the end of the day you might get some “strange bedfellows” (as was noticed this summer on the streets of Berlin, where at some point ‘dreamy left’ and ‘extreme right’ were demonstrating happily together against the measures). From my vantage point, some of the more maverick scientists even get rather close to Trumpean statements, even if they embrace a radically different paradigm and structural measures.
I don’t think ‘scientific discipline’ is the main explanatory factor. Some MDs are very much into Foucault, I notice, while others rigorously subscribe to the John Snow Memorandum (disclaimer: I signed the memorandum. Editor’s note: so did I), and virologists’ views. Conversely, some social scientists are currently accused of suffering from a “medical gaze” 😊.
So what is it then?
- A mix of personality (scientists with a libertarian streak, with, for some, a touch of machismo vs more cautious ones);
- the “path dependency” of scientists (professional and personal, some, for example, having worked in dire humanitarian emergencies);
- their ideology (how they perceive/frame: ‘Sweden’ & ‘South Korea’ is a good indicator), although even scientists with relatively similar ideology sometimes seem to end up very far from each other on the response approach they favour, including with their views on neoliberal austerity damage done in recent decades in health systems and society in general;
- the fact that first order (health) and second order impact (socio economic, mental health) are, to a large extent, occurring at the same time;
- a tendency to [over]generalize lessons from one’s own country or countries one knows very well, having lived there for years; and
- scientists’ philosophy of life and even faiths
It is probably a mix of all of these, and then some more, like their comparative attention for civil rights and rule of law, and respective worry about “surveillance states”.
Long-term strategy no doubt also has to do with it: how to capitalize on this Covid pandemic moment to get to a fairer and more sustainable world, and not squander a great opportunity for real structural change? As the saying goes, “If not now, then when?” (as compared to what is seen by some as ‘propping up the status quo’, in the mainstream ‘pandemic mitigation’ discourse). Others think, first things first, let us first deal with the health care emergency, while trying to mitigate consequences for the vulnerable, and in a few months, pick up the all-important structural agenda. This parallels the Allies preparing for the world after WWII, while still focusing on beating Hitler.
One’s focus of empathy (except family, of course) also plays a role. It is different depending on family members, education, upbringing, professional environment, and history. Some focus more on (health) care staff under enormous pressure; others who know single mothers with children may be more afraid of lockdowns; many think of the enormous tragedies happening in many LMICs or humanitarian settings, far from Western media coverage.
Another factor: although all scientists agree that a vaccine will not be a ‘silver bullet’, they often differ in their assessment of the likelihood that a vaccine or some other medical treatment/invention will drastically change the picture in the months to come.
Finally, with Covid-19 implying a major paradigm shift at least as big as HIV (and probably bigger), scientists differ on how to interpret this paradigm shift. For some, the pandemic, as a syndemic, allows finally for more attention for social and political determinants and NCDs allowing us to look with new eyes at these long-overlooked key issues. For others, Covid feels like a “black hole” that sucks up all attention from these many other worthy causes, often (certainly in some settings) resulting in many more casualties.
As for my preference, having signed the JS memorandum, as you can imagine I’m in favour of strict public health measures being put in place rapidly if the trend is going in the wrong direction. I would personally look to the “winners” of this Covid pandemic, (billionaires, the financial sector, GAFA, and some other MNCs who are raking in billions while people suffer) to mitigate the socio-economic havoc wreaked on precarious people through lockdowns or other strict public health measures.
So even if one agrees on the framing of Covid-19 as a ‘syndemic pandemic’, preferred responses by scientists can still be very different, as the pandemic hits those who are most vulnerable, but so does the ‘collateral damage’. That leads to vastly different assessments on what response is needed. These are some of the reasons I see for the, sometimes, ferocious disagreement between scientists on Covid-19 responses. I’m sure there are many more. And of course, feel free to disagree.
Still, in a democracy, it’s good to disagree and make your reasons why explicit. Hopefully, we’ll all get wiser as a result!
Other ‘collateral’ damage
Many of us have forgotten what it is like to go to a concert, live show, or the cinema. The English government’s ‘Eat Out to Help Out’ scheme meant that people visited restaurants, to the point where it was blamed as a significant contributor to the second wave. I increasingly appreciate the importance of the arts to civilisation. If you want to see a play you probably want to see a live performance. The cinema is a shared experience. And what about festivals?
The Economist covered the impact of the pandemic on the arts in the piece ‘Busking for bail-outs’.9 They note the importance of government at all levels for support to all types of cultural activities, from ballet to film festivals.
“Spending on cultural services runs to about 1% of the total government budget in the average EU country. An exact comparison is hard to find, but in America 0.7% of government spending goes to cultural services, recreation and religion; in France and Germany that figure is 2.3%. … Covid-19 hit this cheerful scene like the last act of Götterdämmerung.”10
The government support to the sector is welcome but spare a thought for the performers and talent. In Norwich ‘The Playhouse’, a smaller venue in the city, gave space to a range of acts. The theatre’s stage, until recently, was repurposed as seating for its bar and the people who would have performed there are having to make a living generally in areas that do not use their skills. It is not just the ‘talent’, everyone from the ticket sellers to the ‘roadies’ are suffering. I remain uncertain as to how to make my small contribution, or even if it is a priority over food banks. We are going to have to decide what we value and then put a value on it. This may be, as the Economist notes, the opportunity for some ‘avant-garde theatres with lower overheads that are happy to perform to an audience of 30’.11
On the 2nd November Geneva announced it would go beyond Swiss national measures and close all bars, restaurants and non-essential shops to curb rising infection rates. The implication of this is that there is a tension between local and national responses.
In the course of writing this weekly communique I have been struck how most of Africa has been spared the rapid rise in cases; how most East Asian countries seem to have controlled their epidemics, albeit at the price of constant vigilance. I have not attempted to explain the, mostly serious, Latin American epidemics since this is beyond my expertise. I will end this blog by pointing to an excellent long read from the Financial Times, ‘How Africa fought the pandemic — and what coronavirus has taught the world. Can similar future outbreaks be prevented? The vital lessons of Covid-19 can be learned from African countries’ powerful response’. It is in the reference list as a must read. Also referenced is the brave, but puissant article on Coronoaphobia.
References (readings worth looking at)
Andreas Kalk and Wim Van Damme, ‘Coronaphobia – An Emerging Mental Disorder Super-Spreading Globally by Communication’, Institute of Tropical Medicine 28 Oct 2020 on https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3716921
David Pilling, ‘How Africa fought the pandemic — and what coronavirus has taught the world Can similar future outbreaks be prevented? The vital lessons of Covid-19 can be learned from African countries’ powerful response’ The Financial Times 23rd October 2020 https://www.ft.com/content/c0badd91-a395-4644-a734-316e71d60bf7
I brought the production of the communique forward to Tuesday. The events in the USA will dominate much of the world for the next few days.
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- New month-long lockdown. Overrunning of the NHS a “medical and moral disaster” http://www.telegraph.co.uk/news/2020/10/31/prime-minister-orders-fresh-month-long-national-lockdown-told
- A well-known and tenacious British Journalist https://en.wikipedia.org/wiki/Andrew_Neil
- Randy Shilts, ‘And the Band Played on’, Viking, 1987
- Johns Hopkins University https://coronavirus.jhu.edu/map.html
- Kristof Decoster works at the Institute for Tropical Medicine (ITM) in Antwerp. He produces a weekly roundup of health news. His blog is at https://kdecoster.blogspot.com/2020/11/polarisation-among-scientists-on-covid.html
- Great Barrington Declaration https://gbdeclaration.org John Snow memorandum http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32153-X/fulltext
- Busking for bail-outs’ Covid-19 is forcing the arts in Europe back into the arms of government. As punters stay away, museums and theatres lobby for state aid https://www.economist.com/europe/2020/10/29/covid-19-is-forcing-the-arts-in-europe-back-into-the-arms-of-government
- In German Mythology. the destruction of the gods and of all things in a final battle with evil