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

On 4th March in 2020 I started posting a ‘Covid-19’ blog to replace my normal monthly meanderings. It began:

“I am expected to know something about epidemics and pandemics, their causes and consequences. Many friends and colleagues have been asking me about Covid-19.

Here is a quick ‘fact sheet’ as of 4 March – what we know, what we don’t know, and what we need to know. I include hot links. Please feel free to send it on.”

Initially I used red text to indicate where figures or information would change, and bold text to show key points. I managed to keep up a weekly report for over a year. I then reduced it to every two weeks, but gaps increased and I am afraid I lost steam.

More than a month after I previously posted my Covid blog, this is the last. If you are getting it as someone who signed up for the Covid update you might want to ‘unsign’. If you do not, you will continue to receive my monthly personal blog. This is about what I am doing, books I am reading, ideas, and the minutiae of daily life – there is a lot about flights, airports and aircraft. The first of this new series will be posted in a couple of weeks.

As to the reasons for me ending this blog, the main ones are: it was surprisingly time consuming; the situation with regard to the science, numbers and response is increasingly complex; and it was getting too depressing to keep going. There are plenty of other people doing what I was trying to do. Nonetheless there are still areas that are ripe for research and writing. In particular the consequences of the pandemic, its economic, social, psychological and political effects. They are, of course, still unfolding.

The numbers

My preferred source for numbers remains the Johns Hopkins data.¹ Globally, as of 8th August, there had been over 200 million cases and nearly 4.3 million deaths. The graphs show that the global number of new cases fell from May to the end of July, but have begun to rise again. The number of deaths remains constant. The number of vaccine doses administered has reached over 4 billion, a remarkable achievement that means about one in three people have received at least one dose. The global population is nearly 8 billion, and immunisation requires two doses of most vaccines and so it is not clear what percentage of the world’s population is partially vaccinated and what is fully protected.

The largest number of cumulative cases continues to be reported by the USA. On 8th August there had been 35,744,920 cases and 616,742 deaths. Nationally the number of new cases began to rise again at the end of July. This increase is, however, being driven by a small number of mainly southern states, in particular Arizona, Alabama, Texas, and Florida. The epidemic in Florida is seeing the most rapid rise. There are more new cases being reported than at any point previously, and, alarmingly, the rise is exponential. It is important to remember all national data are made up of reports from many local epidemics, and that this is not just the case in the USA. Where data quality is good, local outbreaks can be tracked, but in most of the poorer world the information may not be readily available.

India has the second highest case load, with nearly 32 million cases and has recorded 427,862 deaths. Brazil is third with about 20 million cases and over half a million deaths, although the numbers are now falling. Russia is in fourth place. France is fifth and has the most cases in Europe, 6,350,899 and 112,379 deaths. The UK with 6,070,884 cases has the greatest number of deaths in Europe, at 130,585. European case numbers and deaths continue to fall. South Africa has the highest case load in Africa with 2,523,488 and 74,623 deaths.² It has been noted in these blogs that getting consistent and reliable data is problematic. Table 1 is taken from the Economist.³ This shows the countries with the highest (Peru) and lowest (South Korea) rates of excess deaths in the world, plus countries of interest.

Table 1: Covid Deaths, Excess Deaths (all cause), and excess deaths per 100,000 people

Country	Time period	Covid-19 Deaths	Excess Deaths	Excess Deaths per 100,000 people
Peru	Mar 23 – Jul 18, 2021	195,010	191,490	583
South Africa	Apr 12 – Jul 17, 2021	66,650	183,290	307
Brazil	Mar 1 – Jun 30, 2021	518,070	548,150	261
Italy	Mar 2 – May 2, 2021	121,140	143,820	238
USA	Mar 8 – Jul 10, 2021	597,000	721,790	221
UK	Mar 14 – Jul 2, 2021	128,440	115,290	170
Canada	Mar 22 – Mar 27, 2021	22,810	15,470	41
New Zealand	Feb 3 – Jun 27, 2021	30	-2,200	43
South Korea	Mar 2 – May 2, 2021	1,820	-5,530	-11

The data that is most reliable is generally deaths since most countries have a system for collecting vital statistics: the number of births and deaths, the gender of people and location of the events. Thus, the number of excess deaths – those that exceed the expected death rate – provides a measure of the severity of the epidemic in a country.

The cause of a death may be more difficult to determine. There is a consensus that the number of Covid deaths is under-reported. In the UK the definition of a Covid death is one that occurs within 28 days of a Covid positive test. The World Health Organisation states:

“A death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death. A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of pre-existing conditions that are suspected of triggering a severe course of COVID-19.”⁴

The most important data for health services are the number of cases they can expect to admit to health facilities, and, related to this, how many patients require intensive care and/or ventilation. Since the beginning of the pandemic, although the number of cases has fluctuated, the case fatality rate (CFR), the ratio between confirmed cases and confirmed fatalities, has fallen significantly. Globally it is 2.12%.⁵

The data by income classification is interesting. The CFR is 2.77% in upper middle-income; 2.66% in low income; 1.86% in high income; and 1.72% in lower middle-income countries. This difference may be a function of the reporting of deaths, but it can also be impacted by where a country is in their epidemic and vaccination programme. In the USA the CFR is 1.73%, Canada 1.84%, the UK 2.14% and in South Africa 2.95%. In the early stages of the pandemic the vast majority of those who were admitted to hospital and/or died were elderly and most had comorbidities. That pattern has changed in countries that have been successful at rolling out immunisations, since in most the first target for vaccination were people at highest risk of illness and death. The highest and lowest CFR’s in the world are Yemen at 19.34% and Singapore at 0.06%.

Economic and Social Consequences⁶

The economic effects of the pandemic are significant.

“In January 2020, economists polled by The Financial Times predicted that the UK economy would grow by approximately 1.4% in 2020. This prediction could hardly have been further off the mark (the economy contracted by 9.8% in 2020) due to the adverse effects of the COVID-19 pandemic.”⁷

There is an interesting graph on Statistica which shows the change in value of selected stock market indices worldwide from January 1 to March 18, 2020. The worst affected was Greece where between 6th and 18th March the market lost 28.8% of its value, this was followed by Italy 27.3%, France 26.7% and Germany 26.4%.⁸ The UK economy has been particularly badly hit by the combined effects of Brexit and Covid. I believe there are some slow signs of recovery in the UK. My own observation is there are more people on the streets and in the shops. However, there is a great deal of caution, despite being told that masks are not necessary, in most settings people continue to wear them. The furlough scheme, which started to taper off from July 2021, when employers were required to make greater contributions, is projected to be entirely phased out by September 2021.

“While there is no way to tell exactly what the economic damage from the global COVID-19 coronavirus pandemic will be, there is widespread agreement among economists that it will have severe negative impacts on the global economy. Early estimates predicted that, should the virus become a global pandemic, most major economies will lose at least 2.9 percent of their gross domestic product (GDP) over 2020. This forecast was already restated to a GDP loss of 4.5 percent.”⁹

My bellwether¹⁰ is air travel. I mentioned in an earlier blog that Norwich International Airport was one of the locations where many aircraft have been mothballed. At the peak there were about 25 planes parked on the runway. There are still over 20! And a source of immediate concern to me is that the Norwich to Amsterdam route, which used to have four flights a day, now has only one, and it does not connect with the flight to Toronto.

Two excellent books have just been published. The head of the Wellcome Trust, Jeremy Farrar’s ‘Spike The Virus vs the People The Inside Story’ appeared in July 2021. Sarah Gilbert and Catherine Green’s ‘Vaxxers The Inside Story of the Oxford AstraZeneca Vaccine and the Race Against the Virus’ was about the same time. Not much has been written about the economic, social, psychological and cultural consequences, in no small part because it is still unfolding. This is where the impact will be most markedly felt. The move to nationalism is already clear and is epitomised in the over-purchase of vaccines by governments. Farrar argues for a ‘muscular, independent World Health Organisation to set public health standards, convene nations and act immediately on the information that emerges’.¹¹ Neither book gets to grips with the politics of pandemics in particular, and health in general. There is a greater awareness in Farrar’s writing of the politicisation of the situation in the UK, he makes frequent mention of Dominic Cummings. He is appalled by Boris Johnson’s behaviour and unwillingness to face the pandemic and what needed to be done to protect the UK.

Conclusion

As this is my last blog for a while it is incumbent on me to try to draw some conclusions from the last 18 months. For me the early months January to July 2020 were spent watching numbers climb. We were unsure of so much. This included the origin of Covid-19; main forms of transmission; what, if any drugs, could be used against the virus; what the key public health messages should be, although we mostly got that right, with some small hiccups; and just how long this was going to go on for. A year on and we have vaccines available and most of the vulnerable populations of the OECD countries are protected. There is huge inequality in access and the international community is not addressing this properly.

The decision to name the variants Alpha, Beta, Gamma, Epsilon and Delta was long overdue, rather than identifying them with parts of the world. However, we can expect more, and increasingly virulent, variants. That is natural selection at work. However, science will hopefully keep pace and tweak existing vaccines or develop new ones. Some may require booster shots. The vaccine risk was set out by Dr Andreas Kalk reporting

“The German Paul Ehrlich Institute reports the following figures:
After Vaxzevria vaccination 0.04 % ‘serious’ side effects
After Comirnaty or Moderna vaccination 0.01 % ‘serious’ side effects
After Janssen vaccination 0.003 % such effects
Death rate after any vaccination 0.0024 %
No data on hospitalisation rate”¹²

It was amazing how willingly, and for the most part, unquestioningly, populations adapted to the public health messages that were put in place, a truly heart-warming sight as we put the needs of the collective above our individualities. The eerie sight of empty streets and skies took some getting used to. I don’t think governments were particularly good at communicating messages and they were undermined by senior staff and politicians acting as though the rules did not apply to them.

What, I asked, in March 2020 does Covid mean for us? It has been and continues to be mostly bad news. The fact that science has made such rapid progress gives us grounds for hope. The genuine sense of community has been astonishing. We have all suffered mentally from the pandemic. However, many people have done relatively well economically. Those who continued to be paid found that there was less to spend money on – entertainment, travelling and eating out were put on hold, though takeaway orders skyrocketed. It would be good to think that there will be a post pandemic redistribution of wealth. For some this will be done anyway, for others, governments will have to put it in place. After apartheid ended in South Africa the government introduced the reconstruction and development tax. I was one of the people who saw my tax bill increase, and because of the history and need to right wrongs accepted it. A lesson I learnt is that things have changed, and we need to be more aware of what we should do to make the world a fairer place. Covid is a curtain raiser for other, more severe, challenges humanity will face.

Books

Jeremy Farrar with Anjana Ahuja, ‘Spike The Virus vs the People The Inside Story’ Profile Books, London July 2021. This is deeply interesting, especially with regard to the appalling (and it continues) response of Boris Johnson’s government.

Sarah Gilbert and Catherine Green’s ‘Vaxxers The Inside Story of the Oxford AstraZeneca Vaccine and and the Race Against the Virus’, Hodder and Stoughton, London 2021. The opening is gripping, Green explaining to a member of the public she does know what’s in vaccines, she was one of the key scientists.

Thank you to everyone who has read, reposted and provided comments. Remember you need to unsubscribe from the blog as the Covid series is ending with this post. What I write is public domain. Please share, forward and disseminate. My contact is: awhiteside@balsillieschool.ca
Goodbye and good luck.

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1. https://coronavirus.jhu.edu/map.html accessed 23rd June 2021
2. Ibid.
3. https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker
4. https://www.who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-19.pdf
5. https://ourworldindata.org/grapher/deaths-covid-19-vs-case-fatality-rate
6. This is the one area where urgent research is still needed.
7. Costas Milas https://blogs.lse.ac.uk/businessreview/2021/07/05/the-impact-of-covid-19-restrictions-on-uk-growth-and-the-benefits-of-full-inoculation/ July 5th, 2021
8. https://www.statista.com/statistics/1105021/coronavirus-outbreak-stock-market-change/
9. https://www.statista.com/topics/6139/covid-19-impact-on-the-global-economy/
10. A bellwether is a leader or an indicator of trends. It derives from Middle English bellewether and originates from the practice of placing a bell around the neck of a castrated ram (a wether) leading a flock of sheep.
11. Farrar, ibid. page 213
12. Google Groups “Covid-19 in SSA” group.