Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com¹

Introduction

‘The times they are a-changin’’ as Bob Dylan sang in 1964.² Much is happening and some of it is good. The numbers in Europe’s worst affected countries are stable or declining. Some countries are tentatively starting the process of emerging from lockdown. The feared increases in Africa are still to materialise, the USA with the world’s worst epidemic is experiencing waves with a slight downward trend. That is the good news. On the debit side some leaderships have lost it and economic and social impacts are emerging. They are worse than we dreamed. I have key, usually short, readings at the end.

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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com¹

Introduction

On 22nd April, the day this commentary is released, I was supposed to be at the Heidelberg Institute for Global Health (IGH).² On the 4th March I published the first Covid-19 commentary, and I went to see the nurse at my health service. Because the IGH is attached to a hospital, longer term guests must be immunised against everything! To my relief instead of giving me shots, the nurse took an armful of blood for antibody tests. We will see what I actually need. Also on that day the Johns Hopkins University (JHU) website reported 95,100 Covid-19 cases globally; 262 in Germany; and 86 in the United Kingdom. Today the figures are global cases 2,565,258, Germany 148,453 and the UK 130,184.

I should reiterate the limitations of these posts. Most examples are drawn from countries and health systems I know best. These are the UK, South Africa, Canada, and Eswatini. This epidemic is, without doubt, the greatest challenge to humankind I have seen. The mantra is: ‘we will get through it’. But society is changing and will be fundamentally different. It could be better! I have 30 years’ experience, much working on the social, political, economic, and psychological causes and consequences of HIV and AIDS. Covid-19 is new. There is a lot we don’t know, and we are developing responses as the epidemic spreads. I read widely and listen to key lectures and webinars. Despite that it is easy to feel overwhelmed by the amount being written and published. There is also a problem of ‘fake’ news and unreviewed papers.

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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com¹ – note: this blog includes an Appendix written for parents “Supporting Children During Lockdown”.

Introduction

On the weekend of 11th April Boris Johnson, the British Prime Minister, was released from St Thomas’ Hospital in London recovering from Covid-19. He was hospitalised for a week, including three days in intensive care. To his credit he has not returned to work but will spend time recuperating. In a brief video message, he recognised that the National Health Service (NHS) saved his life and took the opportunity to name some of the carers. He specifically ‘called out’ nurses from New Zealand and Portugal. Hopefully this will give rise to renewed respect and additional funding for the NHS, and a realisation as to how dependent the nation is on migrant health workers.

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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com¹

Introduction

Many of us have time on our hands at the moment. This is illustrated in unexpected ways: a clear-out resulting in a table of toys at the front of a house with a notice ‘FREE’; the distance we have walked on Sunday, an unbelievable – for me – 11 kilometres; and the recipe books being dusted off. I read a great deal normally and have just finished Erik Larson’s ‘The Splendid and the Vile: A Saga of Churchill, Family and Defiance During the Blitz’. It covers the period from Churchill’s appointment as Prime Minister on 10th May 1940, when Nazi forces over-ran Europe, to the end of 1941.² There are similarities between that period and where we are now: a sense of dread, a formidable and heartless enemy, and the need for good science and unity. This is not, as many journalists have implied: ‘the blitz spirit’, which has been parodied, most notably in Private Eye.³ It is rather a sense of helplessness.
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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Red text indicates figures or information will change. Bold text indicates a key point.

Introduction

I believe there are, at last, signs of hope in some of the data. My sense of optimism is, of course, helped by the weather and the advancing spring in Norwich. Mornings begin with a wonderful dawn chorus, quite unlike South Africa’s raucous hadedas. In the UK the chorus is begun by a robin, joined by blackbirds and many other species. In addition, the garden is full of daffodils, sadly just past their peak.

“I wandered lonely as a Cloud
That floats on high o’er vales and Hills,
When all at once I saw a crowd,
A host, of golden Daffodils;
Beside the Lake, beneath the trees,
Fluttering and dancing in the breeze.” – William Wordsworth

On 4th March, the Johns Hopkins website reported 93,000 Covid cases, mostly in China. A week later, on 11th March, there were nearly 120,000 cases. China still had the largest number but only a slight increase. By Wednesday 18th March there were 201,530 cases. On 25th March there were 423,121. On the morning of 1st April there were 860,793 cases. The global doubling time is a little less than a week. There are excellent websites tracking the epidemic.¹

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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Thank you everyone who is reading and reposting. Everything I write is public domain so please share. I am keeping this and future posts to about 4 pages of text. I provide sources as well as commentary. Red text indicates figures or information will change, probably rapidly. Bold text indicates a key point.

Introduction

The first blog was published on 4th March. I have issued one every Wednesday since. Last night, as I walked from my office to the back door of the house, I nearly kicked a hedgehog. I have not seen one in our garden for years. I wish I had its ability to curl into a ball and wait for troubles to pass. Unfortunately, we cannot, so read on.

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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Thank you to everyone reading and reposting this. Everything I write is public domain so please share. I am keeping this, and future posts to about 4 pages of text. I provide sources as well as commentary. Red text indicates figures or information will change, probably rapidly. Bold text indicates a key point.

Introduction

Covid-19 was officially declared a pandemic by the Director General of the WHO on 11th March.¹ This is largely a formality and does not change the response. The need for clear information and guidance remains paramount. A week ago, the British Government appeared to be going its own way, essentially arguing for building up herd immunity. On 6th March Prime Minister Johnson held a lengthy press conference changing advice, based on newly released science.² This will be addressed below.

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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

A week ago, I posted my first blog (or communique) on Covid-19. I was taken aback to learn that, by Monday, there had been over 14,000 visits to the article. Thank you. I find it humbling and greatly appreciate your engagement. Everything I write is public domain so please feel free to share this blog.

Red text indicates figures or information will change, probably rapidly. Bold text indicates a key point.

So, a week on, what has changed, what do we need to know and what do we need to do? I am going to keep this, and future posts to 4 pages of text. I continue to provide sources as well as commentary.

The consensus is, there is a need for clear information and guidance, which will evolve with the epidemic. The recent article by Anderson et. al. gives an excellent summary of what is known about Covid-19. It is a must read.¹ We should adapt. For example, if the first presenting symptom is fever, people need to self-isolate immediately, not wait for a cough or shortness of breath. It may not be Covid-19, but this is the appropriate, effective early response, and will prevent onward transmission.

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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal http://www.alan-whiteside.com

4th March 2020

Introduction

I am expected to know something about epidemics and pandemics,¹ and 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.

Red text indicates the figures or information will change, and probably rapidly.

Bold text indicates a key point.

Obvious public sources of information are:

• the World Health Organisation (WHO);
• government websites, for example Public Health England, but be aware that government websites may have biases;
• academic institutions such as Johns Hopkins University;
• and NGOs and AID Agencies.

There is no shortage of information, but it needs sorting and sifting. There is a great deal of uncertainty about the trajectory of the epidemic, and how and when it will resolve.

Predicting the course and consequences of epidemic disease is not new. It has been addressed in the science and intelligence communities and in literature. The emergence of AIDS in the 1980s gave rise to a concern about the security implications of disease. One result was the US National Intelligence Council’s National Intelligence Estimate on the Global Infectious Disease Threat, January 2000. It noted the surge in HIV/AIDS, TB, malaria, hepatitis, with HIV/AIDS and TB expected to be the major cause of death in developing countries by 2020. It stated: “Acute lower respiratory infections—including pneumonia and influenza—as well as diarrheal diseases and measles, appear to have peaked at high incidence levels”². In the UK the Foresight project³ looked specifically at infectious disease and produced a multi-volume report in 2006⁴. These and subsequent government work are prescient. The works of fiction detailing such events range from Albert Camus’ 1947 book The Plague to South African thriller writer Deon Meyer’s 2016 Fever.

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