Covid-19 Watch: A Rocky Start to the Year

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

The most depressing day of the northern hemisphere year is reputed to be the third Monday of January. The Independent reports, ‘the formula is essentially pseudoscience and has urged Brits to “refute the whole notion” of Blue Monday’.1 However, as I sit in my shed, faced with grey skies and temperatures just above freezing, and Covid-19 numbers rising I wonder. We are breaking records for the number of cases and deaths. On the other hand, when I step outside into the garden there are signs of life and renewal. The green shoots of the snowdrops are pushing through the earth, the birdfeeder is visited by wrens, blue and great tits. The blackbirds eat the seed off of the ground. When there is sunshine, it looks full of promise.

The situation regarding the coronavirus pandemic is bleak. A new lockdown has been introduced in the UK, and there is talk of tightening the regulations further. We are being warned to stay at home; that the situation is at its worst for hospitalisations and deaths; and the future is said by the politicians ‘to be baked in.’ The legislation that gave the English government power to introduce new rules specifies these do not have to be reviewed before 31st March 2021.

I don’t want to be too much of a Cassandra.2 There has been rapid progress in understanding the virus and developing vaccines. Treatments are evolving and improving. Vaccines are being rolled out in an ever-increasing number globally. Many more are in development. My prediction is a year from now the pandemic may be medically under control. The social, economic, political, educational, and psychological effects will still be evolving. This Covid-19 communique, the first of 2021, focuses on vaccines, and has a guest article from friend and colleague Simon Dalby, ‘Seeing 2020: COVID, Climate and the Failure to Anticipate’.

The numbers

On 12th January 91,027,775 Covid-19 cases and 1,948,236 deaths had been recorded globally. There seems, from the data, to be a clear pattern of new cases continuing to rise steadily. The graph shows an interesting pattern of reported cases being highest in the middle of the week and falling at the weekend. The USA continues to lead the global league table with 22,619,030 cases and 376,283 deaths. To date the US record for daily cases was on the 21st December 2020 with 302,506 cases reported, the highest daily death toll was 4,194 deaths on the 7th January.3

It should be noted there are countries where the data shows the epidemic seems under control: China reports 96,941 cases; South Korea has fewer than 70,000. The leader board has barely changed in the past month: the USA, India, Brazil, Russia, and the UK have more than three million cases. Countries with between two and three million cases include France, Turkey, Italy, and Spain. Germany, Colombia, Argentina, Mexico, Poland, Iran, and South Africa have between one and two million. Most other countries are seeing increases, as is shown on various websites.

The US epidemic is quite unbelievable. The 16th of December saw the highest number of deaths on a single day since the epidemic began, with 3,668 people losing their lives according to the John Hopkins website. With the political upheavals in the USA, the focus has been on Donald Trump and his behaviour during and after the election. He has allowed the virus to spread with great speed. The events in Washington may have given it an additional spurt. It is the biggest challenge Biden faces.

Vaccines

Vaccination is not simple. First there must be approved vaccines. They must then reach people and be accepted. There should be a prioritisation of who gets vaccinated first. Shabir Madhi, professor of vaccinology at the University of the Witwatersrand and the director of the South African Medical Research Council: Vaccine and Infectious Diseases Analytics Research Unit notes

‘the search for Covid-19 vaccines has been “phenomenally successful”. … However, each vaccine faces four “valleys of death”, … The first is getting licensed. The second is scaling up manufacturing to meet global demand – this is where it is at, right now. The third is affordability and access. The fourth is the implementation of an immunisation programme. … he explains. “You can have the greatest vaccine but if you can’t eventually get people immunised then those vaccines count for very little.”’4

In the west the first to be approved and administered was the Pfizer/BioNTech vaccine. It has been endorsed in the US, UK, European Union (EU) and Canada. The drawback of this vaccine is that it requires very cold storage. The cost is €12 per dose. The UK was the first country to inject patients. As an aside, I was surprised to see my colleague, Martin Kenyon (91), interviewed on CNN. He is a remarkable man, who played an important role in the fight against apartheid and getting Waterford School established in Swaziland. It was a delightful surprise.

Moderna was the second approved vaccine. Currently it is cleared in the US, UK, the EU and Canada, this costs €14.68 per dose. Moderna and Pfizer use a new approach involving messenger RNA and are believed to be 95% effective. The most recently approved vaccine is from AstraZeneca/Oxford. It is available in India and the UK, is estimated to be 70% effective, and costs €1.78 per dose. This is the vaccine pushed by Boris Johnson, the links to Oxford lead to a burst of patriotism from him. All these vaccines require two inoculations to give the maximum protection. There is one Russian vaccine being distributed, the Gamaleya known as Sputnik V. It is said to be 91% effective. The only other vaccine to have approval, to date, is the Chinese Sinopharm which was said to be 79% effective. The price for the Russian and Chinese vaccines is not known.

There has been a suggestion in the UK to increase the gap between the two doses, thereby increasing coverage. This has no basis in the science, nor has it been approved by the manufacturers. The government logic is:

“Given the high level of protection afforded by the first dose, models suggest that initially vaccinating a greater number of people with a single dose will prevent more deaths and hospitalisations than vaccinating a smaller number of people with 2 doses. The second dose is still important to provide longer lasting protection and is expected to be as or more effective when delivered at an interval of 12 weeks from the first dose”.5

The website goes on to say the Joint Committee on Vaccination and Immunisation (JCVI) advises prioritising delivery of the first dose, as this will have a greater short term public health impact and reduce preventable deaths from Covid-19. I hope a change in dosing does not happen.

There are numerous other vaccines in various stages of development mainly in Europe, the USA, and China. The best vaccine tracker I have come across is produced by Bloomberg, a financial information, software and media firm.6 This tracks the biggest vaccination campaign in history which is now underway. On the 12th January more than 29 million doses in 43 countries had been administered, and as of 11th January there had been 9.27 million doses given in the US, with health-care workers prioritised. My Covid communique that covered this in depth was at the end of November.7 Also of interest is a January article in the New York Times.8

Demand and Supply

We are pinning our hopes on vaccines for a return to a more normal life. The critical questions are:

  1. Can enough vaccine doses be manufactured?
  2. Can the vaccines be distributed from manufacturers to the recipients?
  3. Will these doses be fairly distributed?
  4. Will the vaccines be affordable to governments and individuals?

There are also questions around the efficacy of the vaccines. We may know what level of protection the vaccines offer, but we do not yet know how long this will last. Will there need to be a new vaccine every year, as with the current influenza shots, or could it last for years as with the yellow fever vaccines? There are questions about whether the vaccine will provide protection as the virus mutates. These are distractions, the key is to get as many people as possible immunised.

The anti-vax movement is an issue. There are people who don’t want to be vaccinated for a range of reasons, from not trusting the government to not believing it will work. The issue of vaccine scepticism in South Africa was well covered in the Daily Maverick, where

“there are high levels of anti-vaxxing sentiment. It’s not just Chief Justice Mogoeng Mogoeng, who last year voiced his concern that a Covid-19 vaccine might demonically scramble DNA. This week, Cosatu president Zingiswa Losi said while chairing an event that South Africans didn’t want “non-organic” vaccines. And former ANC MP Tony Yengeni posted on Twitter that he would never accept the “stupid vaccine” for his family.”9

The Ministerial Advisory Committee (MAC) on vaccines wrote in December 2020:

“The issues around science denialism, anti-vax sentiments and vaccine hesitancy in South Africa should be addressed through an understanding of the main drivers of the hesitancy and the development of effective local responses.”10

In my view this is a distraction, vaccination programmes should be rolled out as rapidly as possible, following a priority list. People who refuse the vaccination can be passively sanctioned. If you are not immunised you could be denied access to public transport, refused admission to public facilities including education, or not allowed to cross borders.

The South African priority list is:

  • Phase 1 Healthcare workers;
  • Phase 2 Essential workers (including teachers, police, miners, retail workers), People in prisons, shelters and care homes, People in the hospitality and tourism industry. People 60 years and older, People older than 18 with comorbidities; and
  • Phase 3 Other people above 18 years.

The UK’s order of priority is:

  1. Residents in care homes for older adults and their carers;
  2. 80-year-olds and over and frontline health and social care workers;
  3. 75-year-olds and over;
  4. 70-year-olds and over and clinically extremely vulnerable individuals;
  5. 65-year-olds and over;
  6. 16- to 64-year-olds with serious underlying health conditions;
  7. 60-year-olds and over;
  8. 55-year-olds and over; and
  9. 50-year-olds and over.

Once these groups are done the vaccine will be rolled out across the rest of the population.

There are a number of helpful websites for looking at vaccines.11 The latest Economist has considerable coverage on the virus, it’s epidemic and the vaccines. They said that their coverage of coronavirus (which is excellent) is free. I have yet to work out how to access it, which means that all I can do is point you to the magazine. The key message on vaccines is they are the good news of the crisis. The rollout gives us a way back to a semblance of normality, although nothing is ever totally simple.


Guest Article: Seeing 2020: COVID, Climate and the Failure to Anticipate. By Simon Dalby, Balsillie School of International Affairs.

Hindsight maybe, as the old but rather inaccurate saying has it, 2020. Looking back over 2020, and the course of the COVID-19 pandemic, much was known about pandemics and the likely consequences of failing to prepare for them. But the clear warnings by health professionals and security planners were ignored until matters were out of hand. In part this has been a failure on the part of politicians and decision makers to clearly understand the context of the new world of the twenty-first century. We live in a globally interconnected economy operating in a rapidly changing ecological context, an increasingly artificial world, the implications of which are not widely understood.

In key places in the United States and elsewhere, including Canada, key agencies and warning systems had been eliminated in recent years. They were judged as surplus to requirements; global matters were of less importance apparently than attending to national priorities. In the United States and the United Kingdom, supposedly among the countries best prepared to deal with pandemics, the death toll rose alarmingly through the latter part of 2020. Partial lockdowns, the policy decisions frequently influenced by business interests, rather than epidemiological knowledge, failed to stifle the spread of a nastily infectious virus in many societies.

As 2020 ended the rapid production of vaccines offered the promise of a technical fix and did so with commendable international cooperation in the scientific community. While this technical fix to the pandemic is clearly to be welcomed, the rapid roll out may yet obscure the more important lessons about the failure to prepare. The rush to “get back to normal” suggests that an opportunity to use government largesse for intelligent planning to deal with climate change impacts and other future threats to human wellbeing will be missed in many places.

Part of this problem of failing to think through future dangers is clearly political; urgent matters repeatedly dis-place attention from important matters. Politicians operate with a focus on short-term issues and crisis management; a week is a long time in politics. But in addition, many politicians and policy makers also operate on outdated geographical premises that assume that we live in a world of relatively discrete spaces, and ones that function in a world where the environment is relatively stable, and where “nature” is mostly separate from important human matters.

The rapid spread of the COVID-19 virus, that jumped species and spread rapidly around the world, belies the first and third of these assumptions. The looming crisis of accelerating climate change gives the lie to the second. We are, as the earth system scientists say these days, living in new circumstances. Humanity is now changing environments, and the climate on such a scale that they suggest we are living in a new geological period, commonly called the Anthropocene. The implications of this new recognition, one that is now beginning to find its way into policy making circles, is that the old assumptions that discrete spaces, those administrative conveniences we call states, are no longer the appropriate mode of governance for these new times. Policies of national security premised on “keeping the bad guys out” don’t work in a globally connected economy where careful coordination of standards, financial arrangements and much else are needed to keep everything moving, and people safe.

If in fact it turns out that the COVID-19 virus did initially spread to humans in the wet markets of Wuhan, then, once again humanity has been plagued by a zoonotic disease, where some entity jumped from one species to another. There is an interesting twist in the human-animal transmission story this time round. In Denmark the COVID-19 virus jumped from humans to mink in the industrial farms there. The resultant extermination of many million animals to try to prevent reinfection in humans drew attention to the links between the artificial environments of factory farming and human populations, emphasizing the point that we all live in increasingly artificial circumstances where assumptions of nature separate from humanity make no sense.

Climate change is an entirely predictable threat, and one caused by industrial activity and the widespread burning of fossil fuels. We know it is accelerating, but we are just not sure which of its symptoms will appear precisely when and where. As the pandemic should have taught us, preparation is better than frantic scrambling to try to regain control once disaster strikes. There is no vaccine for climate disruptions; only prevention will work. We also know from the pandemic that we may suffer nasty consequences of policies trying to deal with disasters if they aren’t thought through properly, or implemented effectively and in time.

The novel threats that the artificial environments of the Anthropocene present to their human inhabitants is now the appropriate contextualization for security policies, health and otherwise. Setting up institutions designed to survive short-term political attention and budget fluctuations, with a focus on the long term to prevent future global disasters, simply must be a policy priority for governments. Educating politicians to understand the complexity of global interconnections may be rather more difficult, but it too is a necessary task in our new circumstances.


Conclusion

A conclusion is hard to write. It is as though we are in limbo between an out-of-control epidemic and the hope of a vaccine. I am going to not even try to write more this week. The thing I take comfort in is knowing people who have received two doses of vaccine and who are now protected. As this rolls out, we must start thinking about the ghastly consequences. My next blog will be on 27th January. I am giving updates on key developments in the epidemiology and science, and will have more analysis.

Useful resources

Transformation, Vol 104, 2020, Special issue Covid-19. https://muse.jhu.edu/journal/198

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


  1. https://www.independent.co.uk/life-style/blue-monday-real-truth-depressing-day-21-january-truth-facts-bills-work-christmas-a8736531.html
  2. https://en.wikipedia.org/wiki/Cassandra
  3. All data from https://coronavirus.jhu.edu/
  4. https://www.dailymaverick.co.za/article/2021-01-09-a-snapshot-of-global-covid-19-vaccines
  5. https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-30-december-2020
  6. https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/
  7. https://alan-whiteside.com/2020/11/25/vaccines-vaccines-vaccines/
  8. https://www.nytimes.com/2021/01/07/opinion/coronavirus-vaccine-distribution
  9. https://www.dailymaverick.co.za/article/2021-01-09-the-horror-the-horror-inside-south-africas-battle-against-covid-19/
  10. https://www.medicalbrief.co.za/archives/tag/ministerial-advisory-committee-mac/
  11. https://developmentreimagined.com/2021/01/08/covid19vaccinesin2021

Covid-19 Watch: Christmas is Cancelled

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

I took a break last week and this blog is posted on Monday, 21 December. The next will be on 11 January in 2021. I was beginning to feel rather burnt out. Although the posts are quite short, they take time to craft, proof, and check. Today there have been about 77,000,000 cases of Covid-19 globally and nearly 2,000,000 deaths. In the UK a new more transmissible variant is spreading rapidly. Johnson warned “it may be “up to 70 per cent” more transmissible than earlier strains.”1 There is no evidence yet to suggest it causes more severe or less severe disease. It has, however, led to bans on travel from the UK and a number of other countries.

Whilst the inexorable progress of the epidemic remains a great source of concern, the year ends with some good news. Treatments continue to evolve and improve. More importantly there has been rapid progress in understanding the virus and developing vaccines. Vaccines have been rolled out in a number of countries, and many more are various stages of development.

The consequences of the pandemic, and our response to it, have been life changing. In the next year lockdowns will be lifted and government support packages, where they exist, will come to an end. The current response cannot be sustained. Initially people suggested the effect of the epidemic might be V-shaped. A rapid decline in whatever indicator one looked at, followed by an equally rapid recovery, until we were back at status quo. As time went on the talk became of a U-shaped effect. The decline is followed by a period of constraint before the recovery. A more sophisticated and accurate picture of the epidemic is of a K. The decline is followed by a divergence as some people recover, and indeed grow ever richer, whilst others, the majority, see a continued decline.

My prediction is a year from now the pandemic will be medically under control. The social, economic, political, educational, and psychological effects will still be evolving. For example, we have no idea what effect this period of lock down, and suspension of education will have on many millions of children who have spent months out of school. They have, at best, been inadequately educated by stressed parents or through unstable internet connections (for those lucky enough to have computers and access to the internet).

I hope we take the opportunity to reflect on how we live and interact with each other, and the natural environment. If we do, we may be prepared for the next big challenge, probably, but not necessarily, environmental collapse. This week I will identify some of the websites that are exceptionally useful in helping understand the epidemic, the science, and some of the ramifications.

The first virus tracker I discovered was produced by Johns Hopkins.2 Their Coronavirus Resource Centre has a useful dashboard. There is a table of infections by country and information on daily cases, daily deaths, cumulative cases, cumulative deaths and a log representation of cases are shown on graphs. There are other pages for additional information. I still visit it, although it seems a little tired in comparison to some of the other sources.
Continue reading

Covid-19 Watch: Mood Music Changes

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

This is the second last communiqué of the year. I will post the final, more reflective piece on Monday, 21st December. In 2021 the first communique will be on 11th January. I will survey readers and work out how to proceed beyond that (if at all), weekly is too frequent for me alone. I may revert to monthly posts. Please take 10 minutes to complete another survey. I won’t be offended by honesty and would love ideas. This personal rethink is appropriate, we know so much more about the pandemic and its consequences. With the vaccines becoming available the end is in sight.

When I began writing in early March, I aimed to provide updates on where we were and where we were going. The goal was to draw on my knowledge and experience to make sense of the situation. It was initially desperately worrying, then grindingly depressing, now there is cause for cautious optimism. The worry and depression were not just because of the virus, but also the appalling lack of leadership in many settings. Who believed that a virus could bring normal human interactions to a grinding halt globally, and so quickly? Who would have predicted some countries would see run away epidemics, while others brought it under control? Who expected the huge strides from science, medicine, and epidemiology?

My working life was driven by the HIV/AIDS epidemics, first seen in 1981 when I was in Botswana. By the time I had been in South Africa for seven years, 1983 to 1990, it was clear AIDS was going to be catastrophic, but, unlike Covid-19, not everywhere. By 2000 it was apparent Southern Africa was going to be the world’s worst affected region. HIV infection is for life. Infected people will, in the absence of treatment, experience periods of illness that increase in frequency, severity and duration and usually end in death. Fortunately, most people will recover from Covid-19.

From this knowledge base, I tracked the Covid-19 pandemic and tried to follow the science. The rollout of vaccines, which began in the UK on 8th December, marks a step change in the way we view and respond to the disease. It is a remarkable achievement that we should have one vaccine being rolled out, others approaching approval and many more in the development.
Continue reading

Covid-19 Watch: Hope by Christmas?

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

Yesterday, 1st December, was a significant day in the annual global health calendar: World AIDS Day. Until this year, AIDS was the pandemic dominating global thinking, activism, and response. It is the disease I began working on in 1987. I looked at migrant workers travelling to South Africa to work in mines, on farms and in industry. The majority were men. They travelled on annual contracts and mainly lived in single sex hostels away from wives and families. The ideal environment for a sexually transmitted infection to spread.

HIV, the virus that caused AIDS, was first noted in New York and San Francisco in 1981. A classic book tracking the emergence of HIV is ‘And the band played on’ by Randy Shilts.1 As the numbers of infected people rose dramatically globally it became clear, in most of the world, specific groups were bearing the burden of the disease: men who had sex with men; people who used drugs intravenously; recipients of untested blood and blood products; and female sex workers. There are areas with generalised epidemics, in particular Africa, where the Southern cone is the epicentre.

In the 1980s our source of data was surveys of pregnant women. We watched in horror as infection rates rose dramatically, up to 40%. Initially there was no treatment. Hundreds and thousands of people fell ill and died as their immune systems were overwhelmed. The arrival of treatment, antiretroviral drugs, in 1996 was game changing. The HIV and AIDS world faces two challenges: reducing the number of new infections and ensuring people access and stick to treatment.

In 2018 there were 37.9 million people living with HIV, including 1.7 million children. This gives a global prevalence of 0.8% among adults and 21% do not know that they are infected. It is estimated that an additional 32 million people have died of aids related illnesses. To date there have been just over 63 million cases and just under 1.5 million deaths of Covid-19. The number of cases will greatly exceed those of AIDS, the number of deaths should, fortunately, remain lower. Whilst both diseases are zoonotic retroviruses, there are differences, the main one being most recover from Covid-19.

AIDS played an important role in our response to Covid-19. The scientific advances in immunology, virology, vaccine development and a host of other disciplines meant that a great deal of basic knowledge was there already. Public health institutions and health workers were able to pivot. The effect of Covid-19 on AIDS is less beneficial. It has drawn attention and resources away from a deadly disease. As you read this week’s blog be aware of the many other health issues faced by people, especially those in the developing world. I know most about AIDS hence this introduction. There are many other needs: malaria, tuberculosis, hepatitis and numerous childhood diseases.
Continue reading

Vaccines, vaccines, vaccines!

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 Wednesday 25th November there were just under 60 million confirmed Covid-19 cases globally. There have been 1.4 million deaths. This pandemic is not under control. Despite the numbers, the last week has brought encouraging news both on medical and political fronts.

In the USA, the process of transition from the Trump presidency to Joe Biden’s has finally begun. The General Services Administrator Emily Murphy felt able to send the letter to Biden on Monday 23rd November saying he could begin the transition and giving him the requisite resources.1 This came as it was clear Trump’s lawsuits challenging the election result were going to fail. What this delay will mean for national security and the Covid-19 morbidity and mortality remains to be seen. The US will sign up to the Paris agreement (again) to address global climate change. They will rejoin the World Health Organisation (WHO), especially welcome as they are the largest bilateral funder.

There are now promising vaccines in Phase Three trials and that is the focus of this communique. I will try to make sense of this and produce a summary table of what is available. The science has leapt forward, and this includes advances in treatments not covered here. As mentioned before, the lens through which I report is most influenced by western news sources and, even narrower, I am most aware of what is going on in the UK and the USA.

I participated in a one-hour debate on BizNews radio2 with South African actuary Nick Hudson. He was one of the movers behind the Great Barrington Declaration (GBD). The moderator suggested that there might be fireworks because, as the publicity noted, I had been uncomplimentary about the GBD. It is a great pity when positions become polarised and I made a mental note to not ‘shoot from the hip’. Nick is a member of Pandemics ~ Data & Analytics (PANDA).3 Disagreement can be healthy, especially in the case of a new disease when there is much to learn. We concurred Covid-19 is a serious new illness, where we part is on how to respond, in particular the value of lockdowns.

My scars are from the Thabo Mbeki years, with the denial of the AIDS epidemic, and unwillingness to roll out treatment. This resulted in hundreds of thousands of premature deaths. With fellow scientists in South Africa, we faced a phalanx of denialists of various categories. Some argued that there was absolutely no such thing as HIV; others, that HIV was a harmless ‘passenger virus’; a third group suggested that whilst HIV existed, the drugs were the real cause of morbidity and mortality, (there was a subtext here of HIV being exploited by the global pharmaceutical industry); finally, in their ranks, were several who were so incoherent we never knew exactly what they stood for.

I write from the UK. We are approaching the end of our third week of our second lockdown, it is supposed to end on 2nd December, in time for Christmas shopping. I am extremely concerned about the impact this will have as millions flock to the streets to buy presents for friends and family. The tier system will be reintroduced and continue to be opaque.
Continue reading

Covid-19 Watch: Great Progress in Vaccines?

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

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.
Continue reading

Covid-19 Watch: Great Progress in Vaccines?

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

Last week I promised to talk about the pros and cons of lockdowns. That is not going to happen as there is too much else to report. The presidential election in the United States was last Tuesday. We had to wait until Saturday for the result to be definitively called. Democrat Joe Biden was clearly the winner. It remains to be seen what additional damage Trump and his Republican confederacy will do over the next few weeks. The Andrew Marr Show on the BBC on Sunday mornings does a review of the British papers. This brought to our attention the headline in the Ayrshire Daily News, a small regional Scottish paper. It was: “South Ayrshire golf club owner loses 2020 presidential election”.1

The blog is published on 11 November, Armistice Day. It is the day we remember those killed in armed conflicts around the world. This year it is particularly poignant, as the Second World War ended 75 years ago. There are still veterans who, in the absence Covid-19, would have joined a shrinking band of fellow servicemen to mark the event. Next year there will be fewer. Two years ago, I trudged through snow to the service at the cenotaph in Waterloo. It was the Centenary of the end of the First World War. It was particularly moving for me; my father ran away from school aged 15 and joined up. He survived the trenches with minor wounds and lived to 90.

Today humankind is engaged in numerous battles for survival. Covid-19 is the immediate one, with the vaccine news and ‘The Biden-Harris plan to beat COVID-19’.2 At the same time, the urgent challenges of climate change and environmental degradation remain. Covid-19 is a zoonotic disease, spread from animals to humans. The news of an outbreak of a mutated Covid-19 transmitted on mink farms in Denmark is extremely concerning. According to the World Health Organisation “Since June 2020 214 human cases have been identified in Denmark with SARS-CoV-2 variants associated with farmed mink.”3 The WHO suggests the mink were infected by humans, and acted as a reservoir before re-infecting humans with a mutated version. The Danish response is to cull. Seventeen million animals will be slaughtered. The only reason these animals are farmed is for their fur. Unbelievable!
Continue reading

Covid-19 Watch: Bleak and Bleaker

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

This blog is posted on Tuesday 3 November, the day US citizens go to the polls, as people will be focussed elsewhere on Wednesday. The election’s outcome is crucially important globally. I am desperately hoping for a change in the presidency. This would result in, hopefully, a sea change in the Covid response, reducing the shocking mortality, and give rationality and science a chance.

There are few silver linings on the dark clouds. Boris Johnson announced his new restrictions in a press conference on Saturday 31st October.1 The nation was told his address would be at 5 pm. This timeslot came and went. Eventually he appeared at the podium just before 7 pm. The journalists, especially on the 24-hour news channels, were desperately filling time, turning to the various ‘experts’ who were lined up, and filibustering. Remember, Boris speaks only for England. Wales, Scotland, and Northern Ireland can make, and enforce, their own regulations.

As we waited impatiently, I suggested we phone Boris and ask about the delay. My sister called up an old BBC report of Radio 5 Live presenter Chris Warburton interviewing Michael Gove, Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office. Warburton asked what the chance was of Boris Johnson agreeing to an interview by Andrew Neil.2 He pressed Gove to give odds: something between one and ten. Gove responded,

“I think the number would be 020 7930 4433, that is the Downing Street number and if you ring the Prime Minister’s diary secretary he or she will know what the Prime Minister is going to do, I’m not the Prime Minister’s diary secretary.”3

This is the Downing Street number. We called, and to our amazement got through to the switchboard. If you phone from outside the UK the country code is +44. Dial +44 2079304433. Good luck. But remember you will get through to a person with no control over government’s decisions.

What do we know? A great deal about the science and epidemiology, but much less about the politics, economics, and psychology. On Sunday 1st November the BBC showed a two-hour, recently-released documentary Totally Under Control.4 This is the story of the outbreak and the administration’s response to it, from the first cases to the point when Trump announced he had Covid-19. It is in the style of the classic book ‘And the band played on’ that chronicled the early years of AIDS.5 The documentary interviewed experts actively engaged with the American epidemic. Tellingly some public health doctors, whose mandate is just that – protect the health of the public – teared up. They watched the epidemic unfold, had a plan, and were ignored.

I include a guest column by Kristof Decoster, a colleague from Antwerp. He tries to make sense of the mass of information we receive daily. This blog will not have much analysis. The crucial question of lockdowns is touched on, but will be discussed next week. The references are worth a look.
Continue reading

Covid-19 Watch: Ups and Downs (Mostly Downs)

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

For people who rely only on the media as their source of information the situation looks very bleak. It is worth remembering it’s bad news and names that sell papers. It is hard to be optimistic: confusion reigns in the UK; the USA has a nightmare conjunction of an ill-tempered election and Covid-19; in many European countries the numbers are rising and lockdowns are being reimposed. But there are still glimmers of good news.

In the Australian province of Victoria, the premier announced that Melbourne’s months-long lockdown would end:

“From midnight on Tuesday cafes, restaurants, bars and beauty services will reopen, subject to patron limits, and people will be able to leave their home for any reason”.

There were cheers and tears.1 Jacinda Ardern, recently re-elected Prime Minister of New Zealand, and her government have managed to control, but not entirely prevent, epidemic spread. The collection and presentation of data in New Zealand is exceptional.2 China is managing to go for periods with virtually no new cases, although this week they reported 137 asymptomatic cases in the north-western region of Xinjiang, the first new local cases for 10 days. These cases were linked to a garment factory.3 It is encouraging how quickly they are dealt with.

The impact of the virus and our response is dramatic, and indeed much of what I write about reflects this. We know there are massive impacts on peoples’ lives and plans. The episode of the British investigative programme Panorama on the 26th October was entitled ‘Has Covid Stolen My Future?’. The interviews with a series of young people were heartbreaking. Globally people are mobile, moving to work, learn, join family members, and seek new lives. Young people are generally flexible. Canada is a migrant accepting country and the economy and society need the skills and ideas of the migrants. This movement has almost ground to a halt, as this week’s guest writer, Canadian immigration expert Chris Daw, reflects.
Continue reading

Covid-19 Watch: Shocks

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

This has been another bad week for high income countries, some Gulf States, a number of Latin American countries, South Africa and India. The number of new Covid-19 cases is rising rapidly and there is a sense, in some jurisdictions, that the epidemic is out of control again. My caveat, that needs repeating, is that I focus on Europe, North America and South Africa. Readers who want other data can find it on websites: The Johns Hopkins website and Our World in Data to name but two.1

We also need to remember how the data are gathered and presented. To be counted as a confirmed case a person has to test positive for Covid-19. As the numbers of tests have increased rapidly so the number of recorded cases has risen. Most infected people will have no or only mild symptoms, and indeed the only way to know they have been infected is through a test. An antigen test will show those currently infected, and antibody tests will show who has been infected. Rising numbers of cases alone do not indicate a crisis. What we need to know is what percentage of those being tested are infected: the incidence of new cases. If that is rising, we have cause for concern.

Continue reading