Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com
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.
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.
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.
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.
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.
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- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32345-X/fulltext#%20 staying sane
- Johns Hopkins University – https://coronavirus.jhu.edu/map.html
- Grahame Hayes is practicing psychologist based north of Durban in South Africa
- A short article on the COVID stress syndrome. https://theconversation.com/covid-stress-syndrome-5-ways-the-pandemic-is-affecting-mental-health-147413?
- 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
- 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