Fatigue

Posted on by

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

Regular readers will have noticed that it is three weeks since I last posted a blog. I am planning to write one more piece after this and will then end regular posts on Covid-19. I will still blog once a month but it will be a more general article. There are several reasons for this: preparing and writing is time consuming; the situation with regard to the numbers and response is increasingly complex, it might be possible to focus on one continent, but globally the situation is ever more diverse; it has dawned on me how incredibly disruptive and damaging the pandemic is, frankly it is too depressing to keep going; and finally there are many other resources available. Among them is pandem-ic.com:

‘This personal site provides data analytics on the COVID-19 pandemic through the lens of the World Bank country income classification – hence “pandem-ic”.’

It is produced by Philip Schellekens, a Senior Economic Advisor at the World Bank Group, but is a personal blog.1

The numbers

My preferred source for numbers remains the Johns Hopkins data.2 Globally, as of 23rd June, there had been nearly 180 million cases and close to four million deaths. The graphs show the number of new cases has fallen over the past few months while the number of deaths has been constant. The positive news is the number of vaccine doses administered has reached 2,718,142,248, a remarkable achievement that means one in three have received a dose (the global population is nearly 8 billion).

The largest number of cumulative cases continues to be reported by the USA, at 33,566,075, with 602,465 deaths. India has the second highest case load and may overtake the US. It has just over 30 million cases and has recorded 390,660 deaths. Brazil is third with about 18 million cases and half a million deaths, and continued increases. France is fourth, and has the most cases in Europe, 5,821,797 with 110,991 deaths, but the UK with 4,668,043 cases has the largest number of deaths in Europe: 128,272, slightly more than Italy. In Europe the number of cases and deaths continues to fall. South Africa has the highest case load in Africa with 1,843,572, and 59,092 deaths.3 A very useful chart can be found on pandem-ic.com.

The British Daily Telegraph reported gleefully on 22nd June:

“The graph has flipped. The number of people dying with flu and pneumonia on their death certificate in England and Wales is now 10 times higher than those with Covid, figures show. The latest weekly data on deaths from the Office for National Statistics reveal there were 84 fatalities mentioning Covid in the week ending June 11. There were 1,163 involving flu and pneumonia. Registered Covid deaths now make up just 0.8 per cent of all deaths – down from 1.3 per cent in the previous week. Crunching the numbers, Science Editor Sarah Knapton reports that the latest Covid deaths tally is one of the lowest since the pandemic began. It comes as separate figures show antibody rates are more than 50 per cent higher than epidemiologists predicted they would be by now…”

The paper argues for a faster easing of restrictions.4

Around the world there are significant flare ups. Case numbers are rising rapidly in some African countries. An article in the South African Daily Maverick warned ‘African governments must act quickly to curb a third wave of coronavirus infections that is sweeping across the continent’5

“Cases rose by more than a fifth week-on-week, pushing cases to more than 5 million, WHO Regional Director for Africa Matshidiso Moeti6 said … The spike in infections should push countries and governments into “urgent action” to expand vaccinations and inoculate priority groups, she said. As she pointed out cases of Covid-19 can quickly rebound and overwhelm the health system. “The number of new cases reported in the week has now exceeded half the second-wave peak of 224,000 in January, with the Democratic Republic of Congo, Uganda and Namibia reporting the highest number of weekly cases … Seven African nations have used all the vaccine doses they received from Covax, the vaccine sharing facility. Seven more have used over 80% of their doses. “If we are to curb the third wave Africa needs doses here and now.”

In my last post I said

“A key question is what will happen to Covid in Africa, will the Indian situation be replicated? It seems unlikely this will happen across the continent, but it might be the case in some crowded poor urban settings.”

I fear I may have been wrong.

Inequality and Social and Economic Consequences7

The pandemic highlights inequality. This is not just in who is infected, falls ill and dies in a society and between countries, but also in the consequences and the long-term implications. The theme of inequality in health has been explored by numerous thinkers and establishments. The pioneering and most accessible work is by Richard Wilkinson.8 It is depressing that we do not seem to have learnt from it, the reality is inequality causes poor health and poor health causes inequality.

How are we going to pay for the response? What are the long-term prospects? Tanzania last week asked the International Monetary Fund for a $571 million loan to help it tackle the challenges caused by the Covid-19 pandemic. This loan would come with conditions, such as sharing data on coronavirus infections, something Tanzania hasn’t done for over a year.

Emerging Challenges

The most important current issues relate to variants.

“Since December 2020, SARS-CoV-2 variants with multiple substitutions in the spike protein that confer enhanced transmissibility have emerged in the United Kingdom (B.1.1.7, also called Alpha), South Africa (B.1.351, also called Beta), Brazil (B.1.1.28, also called P1 or Gamma), United States (B.1.427/B.1.429, also called Epsilon) and India (B.1.617, also called Delta). All but B.1.1.28 have been reported in Africa.”9

The Delta variant in the UK seems to be placing the comprehensive unlocking under peril. It has led to Angela Merkel of Germany suggesting people from the UK should not be welcomed in Europe.

The economic, social and psychological consequences have still not been properly assessed. These must be addressed soon as so many people are being seriously adversely affected. I have decided that some reading on the flu pandemic of 1918 might provide pointers to both consequences and ways forward.

Thank you for reading, reposting and providing comments. What I write is public domain. Please share, forward and disseminate. My contact is: awhiteside@balsillieschool.ca

  1. https://pandem-ic.com/
  2. https://coronavirus.jhu.edu/map.html accessed 23rd June 2021
  3. https://pandem-ic.com/daily-cases-by-region-top-50
  4. The Telegraph, “Flu and pneumonia deaths 10 times higher than Covid”, June 22nd 2021
  5. https://www.dailymaverick.co.za/article/2021-06-21-urgent-action-needed-as-third-virus-wave-sweeps-africa-who-says
  6. Moeti, a citizen of Botswana was at the same school as me in Swaziland (Waterford) and it is interesting that I am far more prepared to accept her comments as true. Bias?
  7. This is the one area where urgent research is still needed.
  8. Richard Wilkinson. Darwinism Today: Mind the Gap. London: Weidenfeld and Nicolson, 2000
  9. https://www.nature.com/articles/s41577-021-00579-y