Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com
It is hard to believe the first in-depth coverage, in the western media, of SARS-CoV-19 (more commonly known as Covid-19 or just Covid), appeared just over a year ago. The first reports came from Wuhan in China. The global reaction of scientists and health professionals was one of great concern over this new disease. For weeks, while they were hampered by a lack of reliable information, the disease spread exponentially.1 By the end of March there were nearly 200,000 cases reported around the world; the one million mark was reached on 27th April; 10 million by 8th November 2020. The year ended with a global cumulative total of just over 83,519,000 cases and 1,818,000 deaths.2
I remain in the United Kingdom. While in theory it is possible to travel, it is not recommended and, logistically, is complex. There used to be four flights a day from our little airport to Amsterdam, from where people (and viruses) could disperse to the four corners of the world with great ease. This was reduced to just one a day. On 23rd January 2021, The Government of the Netherlands issued a ban on passenger flights from the UK, Cabo Verde, South Africa, the Dominican Republic and countries in South America.
“The purpose of the flight ban is to prevent the further spread of new variants of coronavirus in the Netherlands and Bonaire, St Eustatius and Saba. A docking ban is in force for ferries carrying passengers from the United Kingdom … The flight ban is due to remain in place until 22 February but may be ended sooner if there are grounds for doing so.”3
There are faint glimmers of good news and hope. The UK is rapidly rolling out its vaccination programme. This is the one success of the otherwise, mostly incompetent, national government. Within a few days the number of people I knew who had been vaccinated, mostly elderly neighbours and relatives, exceeded the number I knew who had died from Covid. A minor, personal, milestone. Happily, this gap will grow. The inauguration of President Joe Biden was cause for great celebration. He will have a huge impact in the United States and help change the course of the global pandemic. The US has already re-joined the World Health Organisation, providing people and money. Their anti-science and uncompassionate government is gone.
In Norwich we have experienced a cold snap. Over the weekend we woke to a light dusting of snow. It was beautiful but did not last for more than a few hours. Walking around the neighbourhood, my main form of exercise along with cycling, it is encouraging to see how many people have bird feeders in their gardens. The number of birds has increased. This may be helped by an apparent, but noticeable, decline in the number of cats. Twenty years ago, many households had a cat, today I see very few. The increase in bird life is observed, the decline in felines is a guess.
On Wednesday, 27th January, a year after the world began taking notice of the virus, there are over 100 million confirmed cases globally. The numbers of new daily cases do appear to be decreasing overall. The peak was in early January 2021, with about 850,000 cases, which fell to 550,400 on 24th January. The daily case reports reflect very clearly the drop over the weekends and then a rise during the week. The number of daily deaths appears to still be rising globally.
The Johns Hopkins Coronavirus Resource Centre continues to provide excellent data that is easy to access and interpret. The United States leads the world in case numbers with over 25 million, and, to date, over 430,000 deaths. The next nearest country is India with nearly 11,000,000 cases followed by Brazil with about 9 million cases. Russia and the United Kingdom have over 3.5 million cases each. France has over 3 million, countries with more than 2 million include Spain, Italy, Turkey, Germany, and Colombia. South Africa remains at the same place in the table, 15th, with close to 1,500,000 cases. Canada currently has about three quarters of a million cases.4
My intention is to spend more time on the data in the next bulletin. We should remember there are countries where the data shows that the epidemic seems under control: China, Korea, Australia and New Zealand are doing well. There are other nations where the situation is bleak. I will focus on the USA and UK.
The number of daily deaths in the UK was the highest ever at 1,826 on 20th January 2021 and the cumulative total of deaths broke through the 100,000 ceiling on the same day. The government’s daily briefing shows the number of daily cases fell from the peak of 68,192 on 8th January to 20,167 on 26th January; the number of hospital admissions continues to rise, and the death toll remains high. Given the progress of the disease, with the time between infection and death being weeks rather than days, this trend will continue.
It should be remembered the death count is an underestimate.
“Dr David Spiegelhalter, chair of the Winton Centre at Cambridge University, said: “There will be a lot of attention given to deaths with Covid reaching 100,000, but this is based on the figures released each day, which only include people who had a positive test and then died within 28 days. The more accurate ONS data show that over 100,000 people in the UK had already died with Covid on their death certificate by 7 January, nearly three weeks ago. This rose to 108,000 by 15 January, and the total now will be nearly 120,000”.”5
In the USA the peak of daily cases was 300,372 on 2nd January. Yesterday it was 146,640, but the effects of the election insurrections (protestors were mostly mask-less and very vocal), have yet to work through the system. The daily death peak was 4,462 on 21st January and this remains high. The same caveat about events on 6th January remains. It is the biggest immediate challenge Biden faces.
The vaccination programme in the UK has been remarkably successful to date, close to 7 million immunisations have been given. It is the most successful programme in the OECD countries. Israel has delivered vaccinations to a greater proportion of their population (but not their Palestinian neighbours). Provided the second doses are delivered the most vulnerable should be protected and kept out of hospital. I will return to this as the following issues need to be discussed,7, 8
- We do not yet know if the vaccines curb transmission, though it is reasonable to hope they might. How do they fit into epidemic control? Vaccination might not induce sufficient herd immunity to stamp out the virus.
- The current vaccines work against most variants, but will this continue?
- The disease of “long Covid”, is characterised by fatigue and breathlessness that lasts months. How do we deal with this?
- What about the pandemic of trauma among survivors and carers?
- Can enough vaccine doses be manufactured?
- Will doses be fairly distributed, we are seeing the emergence of bad-tempered vaccine ‘wars’ and verbal conflicts.
- Will vaccines reach and be affordable to governments and individuals in the global south?
What we can do
I don’t know many people who were not glued to the television during the assault on the capitol on 6th January. It was a rapidly moving event, and the stakes were huge. Covid is not like that. There are few changes between one news bulletin and the next. So, we need to take care of our mental health and one way to do this is to not focus on the epidemic. I find that watching one bulletin of news a day is ample. The Johns Hopkins website remains my ‘go to’, but only three or four times a week.
The media is looking for the sensational stories. We read of miraculous new treatments; the danger of variants that will be resistant to vaccines; the virus developing to become more transmissible and dangerous and so on. The key is to not react immediately but wait and see how the story develops and, even then, go to fact checkers. For example:
“Former pathologist Dr John Lee claimed in an interview with talkRADIO last week that we are within the range of normal mortality—even below the long-term average”.
Fullfact9 then checked the statement and gave their verdict
“Incorrect. Over the final four weeks of 2020, the number of deaths was 16% above the 27-year average and 20% above the five-year average”.
There is ample data to back their statement.
Please do not buy into conspiracy theories, they are not helpful and cause unnecessary infections leading to illness and death. When faced by friends or relatives touting these, listen politely and master your facts to counter them, confrontation is not helpful. One key question to ask is who benefits from the conspiracy? And remember, in the long run you can choose your friends, but you can’t choose your family.
When your turn comes, get vaccinated. It is crucial for your health and the health of people around you. Without vaccination this nightmare will not end for a very long time. I am not sure it is worth entertaining conversations with anti-vaxxers.
Hold the leadership to account, but be generous. When someone says, ‘we do not know’, that is probably true. There is still much about this virus that is not known, but the science is moving at an amazing speed and more is known each day.
In my view the one ingredient lacking in political leadership is foresight people willing to make projections as to how long this will continue. Early in the epidemic we did not know enough. I think I know leaders are reluctant to be pinned down, but the populace is not stupid and can work things through for themselves. Keep pressuring the leaders at every level.
Working from home is one of the strategies to prevent the virus spread. It is well documented that this can cause isolation and depression. In addition, children have been, in some cases, cooped up with their parents for many months and subjected to home schooling.
There is increasing emphasis on getting ‘essential’ workers back into their workplaces. There is a reasonable consensus about who the essential workers are: people in the health service, supermarket staff, transport operatives (although the stay-at-home ruling means relatively few people are travelling), and some other categories. Obviously in parts of the world the state can afford to provide for those who have been furloughed, although for how much longer remains uncertain. The next step is to take the argument beyond essential workers to work is essential for many people. This may be to feed families but in many cases, it is critical for well-being. Societies must be opened up safely with recognition that, for example, for an estate agent or a mechanic their work may be ‘essential‘ to them and their families.
The lockdown will change the way our society works. At the worst it may lead to poverty, hunger, domestic violence and suicide and self-harm. The BBC Radio programme ‘More or Less: Behind the Stats’10 addresses some of these issues and is well worth listening to. They have been focusing on Covid in recent podcasts. Encouraging news is that there has not (yet) been a significant rise in suicide and self-harm in the United Kingdom.
COVID-19, Gender and the health workforce https://www.genderandcovid-19.org/webinar/gender-covid-19-health-workforce/
We are far enough into the pandemic for more full-length books to appear. The Guardian Review of 23 January covers two. Rachel Clarke, Breath-taking: Inside the NHS in a time of the pandemic, published by Little, Brown; Gavin Francis, Intensive Care: A GP, a Community & Covid 19, published by Profile. The reviewer, Madeleine Bunting, reminds readers of Susan Sontag’s book, Illness as a Metaphor, with the idea of dual citizenship, ‘in the kingdom of the well and in the kingdom of the sick”.
I worked out that I have written about 400,000 words on Covid so far. I am reading a great deal, and very widely. Elizabeth Gilbert is best known for her successful 2006 book, Eat, Pray, Love. This story, of her search for meaning in Italy, India and Indonesia, spoke to a generation. She has matured and her writing can be thought provoking. City of Girls published in 2019 by Bloomsbury was most enjoyable. The concluding paragraphs really made me think, especially in the context of the notice below. So, from page 490:
“This is what I have found out about life, as I’ve gotten older: you start to lose people, Angela. It’s not that there is ever a shortage of people – o heavens no. It is merely that – as the years pass – there comes to be a terrible shortage of your people. The ones you love. The ones who knew the people that you both loved. The ones who know your whole history.
Those people started to be plucked away by death, and they are awfully hard to replace after they go. After a certain age, it can become difficult to make new friends. The world can begin to feel lonely and sparse, teeming though it may be with freshly minted young souls.”
Dr Arthi Ramkissoon attended Waterford Kamhlaba in Swaziland in the 1970s. She studied medicine and lived in Durban. Our paths did not cross frequently but I knew of her leadership and compassion. She was the founder and executive director of Maternal, Adolescent & Child Health (MatCH), and the CEO of KZN Children’s Hospital Trust, a passion project. Arthi died of Covid-19. The world is a poorer place. Rest in peace, and condolences to her family, friends and colleagues.
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- 54 Day:s China and the Pandemic, a BBC series. An excellent two-part documentary. The first was on Tuesday 26th January. The ‘blurb’ says ‘A year ago, Beijing stunned the world when it locked down Wuhan, a city of 11 million people. For weeks, Chinese officials had maintained that the outbreak was under control – just a few dozen cases linked to a live animal market. 54 Days tells the story of the events that led to the lockdown and the gulf between what Chinese officials and scientists knew and what they told the world’. Worrying but riveting https://www.bbc.co.uk/iplayer/episode/m000rqy2/54-days-series-1-1-china-and-the-pandemic
- John Hopkins https://coronavirus.jhu.edu/ data read from graphs
- All data from https://coronavirus.jhu.edu/
- Google Groups “Covid-19 in SSA” group. To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/PAXPR05MB79365A0D09E9F29769E8370DDFBC0%40PAXPR05MB7936.eurprd05.prod.outlook.com