Covid-19 Watch: Steady Growth

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

As we prepared to host the International AIDS Conference in Durban in July 2000, the South African leadership, President Mbeki and Health Minister Manto Tshabalala-Msimang, were in the throes of denying the existence of the disease. It was a bleak time. There are parallels with the situation in the United States of America today.

In January of that year I was planning my activities, thinking about the situation and seriousness of the epidemic we faced. I had empty weeks in my diary. ‘What about writing a book on AIDS in South Africa in time for the conference’ I thought. I contacted Captain of Industry and leading thinker Clem Sunter,1 well known for his ‘high road, low road’ scenario planning, and suggested we work together. He responded immediately and enthusiastically. The result was AIDS The Challenge for South Africa2 written, edited and published in five months. The publishers, when asked when they needed the manuscript to get it on the bookshelves in time for the conference, replied ‘October last year’. I was reminded of this reading Horton’s The COVID-19 Catastrophe (the book review this week).

There have been some significant steps taken in England this week. Public houses, bars and restaurants were able to open on 4th July provided they obeyed social distancing rules. In the USA the President continues to deny the severity of the crises he faces. The paradox of increasingly long lines for food relief and the seemingly buoyant economy is perplexing. This week’s guest ‘insert’ focuses on South Africa, where the epidemic seems to have spun out of control.

The Numbers

On Wednesday there were nearly 11 million cases globally. The US leads the table with nearly three million, second was Brazil, India has moved into third place, with Russia in fourth. New entrants to the table are Peru and Chile moving the UK into seventh place. The table will be altered next week.

Table 1: Global and National Cumulative Numbers of Confirmed Covid-19 Cases (alphabetical order)3
Date Global cases China India ∞ Italy Russia Brazil South Africa Spain UK USA
15 Feb 69,000 68,400 3 2 0 0 2 9 43
4 Mar 93,000 80,480 3,100 3 4 0 222 86 149
18 Mar 201,500 81,100 35,700 147 372 116 13,900 2,600 7,800
1 Apr 861,000 82,400 110,600 2,777 6,836 1,400 104,100 29,900 213,400
15 Apr 1,982,552 83,351 162,488 24,490 28,280 2,415 174,060 94,845 609,422
29 Apr 3,117,756 83,940 201,505 99,399 79,685 4,996 232,128 162,350 1,012,583
13 May 4,262,799 84,018 221,216 232,243 180,000* 11,350 228,030 227,741 1,369,964
27 May 5,594,175 84,103 230,555 362,342 291,222 24,264 236,259 266,599 1,681,418
10 June 7,250,909 84,198 235,561 493,023 739,503 52,991 241,966 290,581 1,979,893
24 June 9,264,569 84,653° 456,183 238,833 598,878 1,145,906 106,108 245,752 307,682 2,347,022
1 July 10,477,554 84,785 585,481 240,578 646,929 1,402,041 151,209 249,271 314,160 2,636,538
8 July 11,830,885 84,917 742,417 241,956 693,215 1,668,539 215,885 252,130 287,880 2,996,098

*estimate °this does not make sense ∞will add greater detail next week

It is hard to compare absolute numbers then populations are so different. In order to make useful assessments we need to look at rates as is done in Table 2.

Table 2: Covid-19 Deaths and Cases per million (alphabetical order)4
China France Italy Russia South Korea South Africa Spain UK USA
Deaths per million (19 May) 3.33 421.07 529.64 18.84 Error* Error* 593.04* 523.33 275.8
Total cases per million (20 May) 58.4 2,189 3,736 1,991 216 277 4,953 3,629 4,557
Deaths per million (26 May) 3.33 424.27 544.04 25.15 5.21 8.32 574.31 555.19 299.79
Total cases per million (25 or 26 May) 58.4 2,225 3,806 2,421 216 398 5,034 3,847 4,964
Deaths per million (3 June) 3.33 429.83 533.93 33.56 5.27 Error* 580.58 587.24 320.93
Total cases per million (2 or 3 June) 58.4 2,320 3,856 2,905 225 579 5,125 4,070 5,472
Deaths per million (17 June) 3.33 438.73 568.76 49.01 5.38 27.14 580.78 627.71 354.46
Total cases per million (16 or 17 June) 58 2,410 3,924 3,681 237 1,239 5,221 4,372 6,386
Deaths per million (23 June) 3.33 442 573 59 5 38 606 865 370
Total cases per million (22 or 23 June) 58 2,462 3,942 4,058 243 1,712 ° 4,497 6,985
Deaths per million (1 July) 3.33 444 574 63 5 43 606 655 385
Total cases per million (30 June or 1 July) 58 2,516 3,976 4,393 249 2,432 ° 4,595 7,826
Deaths per million (8 July) 3 444 575 64 5 46 606 657 388
Total cases per million (7 or 8 July) 59 2,759 3,999 4,713 257 3,317 ° 4,209 8,877

*misread these data °data missing

The ‘Big Movers’

The JHU website is worth spending time on. The situation in the Americas tops the charts and the UK has been pushed down the table. On the site, clicking on the country name and looking at the bottom left panel give data on cumulative confirmed cases (absolute and logarithmic), and the daily new cases. The UK’s daily total has fallen considerably, a cause for hope. The ineptitude of the authorities is described in the book review below. South Africa is probably in deepest trouble in Africa as this week’s guest writer notes. However, across Africa, numbers are rising rapidly in many countries, albeit from low bases. I fear cases numbers in Africa will rise rapidly.

Science Snippets

Reading for the blog I come across much that is interesting from the scientific and medical world. Sometimes it seems contradictory and I cannot claim to understand it all. Here are a few items that have engaged my attention over the past week. Please note two have not been peer reviewed yet.

‘New research from Karolinska Institutet and Karolinska University Hospital shows that many people with mild or asymptomatic COVID-19 demonstrate so-called T-cell-mediated immunity to the new coronavirus, even if they have not tested positively for antibodies. According to the researchers, this means that public immunity is probably higher than antibody tests suggest. The article is freely available on the bioRxiv server and has been submitted for publication in a scientific journal.’5

The Telegraph reports

“Exposure to the common cold could provide some measure of immunity to Covid-19, a new study suggests. The key to this immunity lies in T-cells, a type of white blood cell that helps the immune system fight off viruses, which experts believe may have just as important a role to play as antibodies in fighting off the virus. Researchers at Tubingen University in Germany compared blood cells from patients who had recovered from Covid-19 with those that had not had the disease. Their research, published on the pre-print server Research Square and not peer reviewed, showed that 81 per cent of the 185 people they tested who had not had the disease had a T-cell response to Sars-Cov-2, the virus that causes Covid-19. And this immune response was linked to previous exposure to common cold coronaviruses…”6

The importance of testing is a drum beaten long and loud in this blog. This crossed my screen last week:

“As cases of COVID-19 continue to climb to record numbers, it might seem impossible that something is already out there that could dramatically reduce new infections — and even bring us back to some semblance of normal life.

I’m not referring to a vaccine. It’s a rapid, inexpensive home test. … You’re forgiven for being incredulous. Indeed, you might be discouraged by a depressing sense of deja vu as you hear that hard-hit communities again must suffer delays on both obtaining tests and getting results.

And it’s not just Arizona, Texas, and Florida. Testing volume for COVID-19 has so overwhelmed commercial and national reference labs that turnaround times to get results are at the very least several days, and can be a week or longer — tests ordered from anywhere in the country. … The problem is that we’re doing it all wrong. Again.

We need to test more broadly, even in people without symptoms. The critical window period for transmitting the virus starts a day before symptom onset.”7

The danger is more testing may give Trump additional ammunition.

Are African data accurate?

‘The World Health Organization has said it does not believe African countries are harbouring a significant number of unrecorded coronavirus infections, though there may be underestimates in some places. … “We think that there is a certain underestimation of cases,” said Matshidiso Moeti, the health body’s regional director, adding that the WHO was working with countries to improve their surveillance.’8


A Question of leadership – A Passive Revolt9
Guest Contribution by Tim Hosking, Building Economist

The Covid-19 crisis has upturned many areas of South Africa’s society. The economy and the government’s ability to look after the people has been seriously compromised. The government needs to align its management to handle the emotional reactions and behavioural responses of citizens. The situation demands a change in the way leaders manage the psychological requirements of a highly emotional and increasingly irrational population before they disconnect from authorities.

A Passive Revolt

A passive revolt has been growing into an open rejection of the handling of the lockdown and the economy. South Africans have been increasingly disobeying lockdown rules, particularly where they won’t get caught and where neighbours won’t report them. Many minor incidences of a breach are mistakes of omission as people’s concern and diligence wane to wariness. Desperate to put food on their table, keep a roof over their heads, and increasingly suffering from psychological and physiological fatigue, people take increasingly higher risks to feed their families. This is not deliberate defiance, but rather a passive revolt. As many families struggle with little to no income and inadequate supplies they are facing hunger and evictions.

Desperation

Desperation has a chaotic and destructive effect on leadership. People and businesses will turn inward towards immediate and short term survival actions at the expense of long term plans and long term relationships. South Africa started the lockdown on the back foot as it was already in a recession, with high unemployment and high national debt. The day the lockdown started South Africa was downgraded by Moody’s to ‘Junk-bond’ status.10

The lockdown was extended from 3 weeks and continues beyond 3 months (at different levels). At the start of the 3-week lockdown, most owners of nonessential businesses put them on pause. When it was extended many businesses closed and the jobs they offered disappeared. Without the government having a clear exit plan it is extremely difficult for companies to plan.

The South African government was proactive and provided a large emergency fund11 for replacing lost income through the UIF (Unemployment Insurance Fund) and some additional social pay-outs. This has however been a difficult exercise for an overburdened UIF. Many informal workers were left out of the UIF and had to turn to social grants. The extension of the lockdown means the emergency funding is expected to last more months than intended, and there is a fear it will run out.

This emergency fund added to an already overstressed national budget. Major government enterprises, South African Airlines (S.A.A) and Eskom (the main electricity providers) were asking for bailouts. Banks who initially offered a loan repayment holiday of three months for many of their clients, are now facing a serious credit blowback as many of these extended loans are going to default. Existing suppliers and clients of the government were already suffering from outstanding payments and with the crisis don’t have the cash flow to support their overheads.

People hope that the government is going to save them, their businesses, and their homes. This is very unlikely given a shortage of resources. It will take a combination of effort and innovation to put the economy back on a growth path under Covid-19.

Frustration

The imposed isolation and complex bureaucratic impositions have frustrated people and businesses. Information has been readily available, but the rules are complex. Numbers are quoted while people respond better to ratios. There is significant information fatigue where numbers don’t matter anymore as what they represent is too abstract to comprehend. False information has boosted information avoidance. Where the facts are uncomfortable, and people turn to false statistics to discount the value of what they don’t want to hear, and consequently make faulty statements and decisions.

The greatest frustration comes from not knowing where we are going. The undefined final lifting of the lockdown has put private plans on hold, where they will remain, until the government releases the exit plan with timing. False media has done considerable damage to the ongoing release of information and new findings. There is a penalty for sending misleading information, but it has not been used to actively or adequately refute and suppress this behaviour.

Trust

An essential element of leading, is trust. Trust in the leadership’s competency, transparency, fairness resources, and direction. Pre-Covid-19 South Africa was battling with very public, endemic corruption. The swift and strong lockdown with immediate plans regained the faith of many. The Confirmation Bias meant that South Africans had been expecting people to try and defraud the emergency fund, but people’s new faith bought hope. The eThekwini blanket scandal,12 where the Social Development Department purchased R22m of blankets at an inflated price through middlemen, and Covid-19 procurement investigations meant people began to lose this new faith. Additionally, a minister was caught breaching lockdown rules and put on special leave. This was seen as unfair due to 230,000 citizens being prosecuted for lockdown violations.13

People and businesses were providing food parcels to the needy when the government intervened because they didn’t meet South African Social Security Agency (SASSA) requirements. This has had a disproportionately negative reaction and withdrawal of private support. Much of the bureaucratic reasoning was reasonable. However, the overreach was disparaging for donors.14

Risk / Opportunity to Passively Revolt

The High Court has deemed many of the restrictions invalid. This is being challenged but is creating dissension and giving an excuse for people to discount the lockdown rules. False information has been a powerful problem providing excuses for people to discount information they don’t like. The weight of getting results is measured against the risk of penalties and getting seriously ill. An affluent person would only breach lockdown if there was little risk of getting caught or getting ill. Healthy young people have a low risk of serious illness from Covid-19 and many are now discounting that risk entirely. A poor person seeking to put food on the family table is willing to face greater risk of Covid-19 and legal consequences to feed his family. Penalties are heavily time discounted.

Ways Forward for Government

  • Simplify information and rules so everyone can understand. Enforce them equally and fairly.
  • Have short bulletins each evening held by the President or a relevant Minister. This additionally provides psychological support.
  • Be a reliable and accurate presence on social media, active in quashing false information, and clearing rumours and misunderstandings as they come.
  • Use the Nudge Theory recommendations to ascertain what is needed most to gauge the best route to lead people and the country where they need to go.
  • Form a rough plan to exit, showing a way out of the crisis. Businesses will follow with plans of their own or close their operations early. It is a major psychological support tool.
  • Where businesses are already evolving to suit the new conditions use them as a foundation for exit plans.

Conclusion

There is a lot to think about. Writing to a colleague who has nothing to do with Covid or health I suggest there are three key areas to watch:

  • The epidemiology and numbers. Effectively there are three broad groups of countries. Those where there was an increase in the number of cases in March and April. Subsequently, the number of new cases has fallen and the disease appears to be under control. Examples include China, South Korea, Spain, France, Germany and the UK. There are significant differences in how serious the epidemic and the case fatality rate (the number infected who died – high in the UK and low in Germany). Second are countries where the epidemic is still increasing rapidly, for example the USA, which has the worst epidemic in the world, South Africa and India. Third there are those where the pattern is still developing.
  • The science and medicine is evolving rapidly and will bring relief but don’t expect anything soon!
  • Economic, psychological and social consequences will be immense. We have not yet gotten to grips with this.

Review

Richard Horton, The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop it Happening Again, Polity Press, Cambridge, 2020, 133 pages

Richard Horton is the Editor of the Lancet and is well placed to bring scientific rigour and journalistic readability to the Covid-19 pandemic. This little book is extremely welcome as it is authoritative and, in part, hopeful. The book was written because Horton

“was struck by the gap between the accumulating evidence of scientists and the practice of governments. As this space grew larger, I became angry. Missed opportunities and appalling misjudgements were leading to the avoidable deaths of tens of thousands of citizens. There had to be a reckoning. This book is their story”. Page ix

Forged in the white heat of outrage against the injustices of Covid-19, this is a stiletto of information and should be used as such. It is short and mostly to the point. Horton traces the emergence of SARS-CoV-2 from the markets of Wuhan up to the point when there were more than a million cases in the USA and over 3.5 million cases worldwide. His description of the Chinese response to the epidemic explains why cases in China leapt to about 80,000 at the beginning of March and why, since then, there have been fewer than 5,000 additional cases. Horton pours scorn on Donald Trump and his response. He notes ‘the verdict on the virtues of China’s response remains to be written. There are legitimate questions the Chinese government must answer’. He makes the point that the people of China are suffering, if not from the disease then from its consequences, as much as any nation. In my view of the numerous Chinese sins the most egregious were of omission, they had a brief opportunity to become leaders in global health and failed miserably.

Much of Horton’s excoriating commentary is reserved for the incompetence of the British, primarily English, government. If I were Scottish, Northern Irish or Welsh, this episode would be grounds for divorce, with substantial damages to be awarded. I suspect it, in addition to the Brexit fiasco, will lead to the dissolution of the Union in my lifetime.

“At every press conference, the government spokesperson always includes the same line – ‘We have been following the medical and scientific advice’. It is a good line. And it’s partly true. But government knew … that the NHS was unprepared”. p. 55.

A government statement was ‘keeping deaths from COVID-19 to below 20,000 would be a ‘good outcome’. Horton notes that line was breached on 25 April, ‘a very sad day for the nation’” p. 55. On the 6th July the official death toll stood at 44,321!

Horton documents the malfunctions of the WHO, the decision of Trump to withdraw the US’ support, and the failure of other nations to defend the organisation. On the WHO his conclusion is, to paraphrase Voltaire, “if there was not a WHO it would be necessary to invent one”. On the other hand, the lies that he documents of the political leadership in Whitehall are inexcusable. He says the government selectively quoted his tweets. “There was international scientific consensus. The government had simply chosen to ignore it.” p.95. Perhaps though Horton is ignoring a key lesson here, don’t tweet.

This epidemic is, he notes, not a crisis about health, but is more and worse. The final chapter is both a call to arms and a manifesto. He concludes Covid-19 will change societies; government; publics; medicine and science. In the end he comes back to a South African concept encompassed in the word Ubuntu, “I am, because you are”. The word ubuntu is part of the Zulu phrase “Ubuntu ngumuntu ngabantu”, which means that a person is a person through other people.

Horton does not engage adequately with the concepts of risk, not surprising given his background. The question that no one has answered and few have even had the courage to ask is how much risk are we prepared to accept? There are huge economic, social and psychological consequences from the lockdown, and it is not clear how important they were as the guest insert in this blog suggests. Despite the flaws, this is a book anyone engaged in Covid-19 issues, health governance and infectious diseases must have. Equally it is worth reading by anyone with an interest in the area. Well done Richard Horton!

References (risks)

Richard Horton, The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop it Happening Again, Polity Press, Cambridge, 2020, 133 pages

The Telegraph, Was lockdown really worth it? Telegraph writers and experts give their verdict. http://www.telegraph.co.uk/news/2020/07/05/lockdown-really-worth-telegraph-writers-experts-give-verdict

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. http://www.clemsunter.co.za/index.html
  2. Alan Whiteside and Clem Sunter, AIDS The Challenge for South Africa, Human & Rousseau. Cape Town 2000
  3. These data are from Johns Hopkins University https://coronavirus.jhu.edu/map.html
  4. Deaths http://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/
    Case per million ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people
  5. Immunity to COVID-19 is probably higher than tests have shown https://news.ki.se/immunity-to-covid-19-is-probably-higher-than-tests-have-shown
  6. https://www.telegraph.co.uk/global-health/science-and-disease/exposure-common-cold-couldprovide-immunity-covid-19/
  7. Rapid, Inexpensive Home Testing for COVID-19 May Get Us Out of This Mess Before a Vaccine, 91-divoc.com/pages/covid-visualization/
  8. https://www.theguardian.com/world/2020/jul/02/global-report-who-official-says-no-large-hidden-toll-in-africa
  9. https://www.iol.co.za/news/politics/coronavirus-restrictions-call-for-apartheid-style-worker-revolt-warns-cosatu-45188797
  10. https://www.cnbcafrica.com/news/2020/03/27/moodys-to-cut-south-africas-sovereign-credit-rating-to-junk-economists/
  11. https://www.dailymaverick.co.za/article/2020-06-22-unprecedented-covid-19-emergency-budget-to-avoid-debt-crisis-amid-sharp-economic-downturn/
  12. https://mg.co.za/article/2020-04-16-blanket-scandal-exposes-potential-for-covid-19-corruption/
  13. https://businesstech.co.za/news/lifestyle/400831/230000-cases-opened-against-people-for-breaking-south-africas-lockdown-rules/
  14. https://www.dailymaverick.co.za/article/2020-05-05-how-red-tape-is-hampering-the-hungry-from-receiving-food-in-south-africa/
  15. Horton hears the WHO, but does the WHO hear Horton

Covid-19 Watch: Global Divergence

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 have just finished reading Hilary Mantel’s latest (nearly 900 page) book, The Mirror and the Light, the last in her Thomas Cromwell trilogy. It is set during the reign of Henry VIII; it opens with the execution of Anne Boleyn and ends with Cromwell’s own beheading in 1540. I am halfway through George Alagiah’s book, The Burning Land, ‘a gripping, pacey thriller about corruption and homicide in South Africa’. Both are worth reading.

But what does this have to do with Covid-19? One of the problems with being immersed in a world-changing event like this pandemic is having a sense of proportion. Mantel’s work provides this. It is a window into the lives, hopes and fears of people 500 years ago. It is a realisation of the futility of much of what went on among fallible people. Alagiah interviewed me about HIV, more than 30 years ago, when he was a BBC correspondent based in Zimbabwe. His book is a realistic window into the struggles in South Africa of a few years ago. This is the pre-Covid-19 world. I wondered how it would change if it were written today. Will it date? Unfortunately, I don’t have Richard Horton’s book, The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again, so that review will have to wait.

There is no startling new information this week. The numbers continue to rise at a truly alarming rate. The Americas are worst affected. In England pubs and other social centres are set to open on 4th July. The efforts to find treatments and develop vaccines continue, but global political and epidemiologic leadership remain lacking.

I am delighted to include a piece written by Jonathan Crush and Zhenzhong Si on ‘COVID-19 and Food Security in the Global South’. Under ‘Responses’ I have used the Association of Science of South Africa statement, lots of common sense there.

There are three items listed in the reference section. All three help to understand risks and should be of interest. We are getting a clearer sense of the disease.
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Covid-19 Watch: Missing voices

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

There was hopeful news from the University of Oxford last week of a treatment breakthrough: low doses of the steroid dexamethasone can cut mortality. This has not been contradicted or undermined – yet! This is encouraging. Elsewhere the number of new infections continues to climb, South America being seen as the current hotspot. I find South Africa particularly worrying, due to my close connections with that nation.

Summer has arrived in England, although one can never entirely count on it. On Sunday, Father’s Day, my family and I went up to the north Norfolk coast for takeaway chips and a walk on the beach. The little town of Sheringham is normally teeming with tourists at this time of year. There were a fair number of people about, but most shops were closed, and there was a slight tension in the air as families tried to make their way along narrow pavements.

Driving along the coast past the huge, empty holiday parks of serried mobile homes, and shuttered country pubs, brought home what an economic disaster this pandemic is. North Norfolk’s economy is dependent on tourism, and there was no one about. Mind you the message from the area, which has one of the oldest populations in the UK, was ‘please stay away and protect our residents’. We don’t know how badly the economy has been damaged and when we will see recovery. We have no idea how many people on furlough will be re-employed. We don’t know which establishments will be able to reopen. Most of the resource rich world has mechanisms in place to reduce suffering. The major impact will be psychological and everyone is affected. In the resource poor world who knows!

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Covid-19 Watch: A different background

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

Over the weeks following the murder of George Floyd in Minneapolis there have been global protests. The Black Lives Matter campaign gained momentum and there have been demonstrations around the world. These gatherings have often been ‘illegal’ in terms of the Covid-19 regulations, but they have been allowed to proceed. Encouragingly most demonstrators are visibly wearing masks or face coverings. Is demonstrating worth it when the Covid-19 risk undoubtedly increases? Clearly the demonstrators, and I, think so and authorities do not want confrontations.

As I finished writing this week, news came of a breakthrough in treatment. Scientists at the University of Oxford announced low doses of a readily available steroid, dexamethasone, cut mortality rates. The gains are not huge, one life saved for every eight patients on a ventilator and one for every 20-25 treated with oxygen. The treatment takes 10 days and costs about £5 per dose.1 Also in the news are encouraging results from other drugs. This points, in my view, as in AIDS treatment, to a combination therapy being the most effective response.

This week my guest columnist is Arnau van Wyngaard, an ordained minister of the Swaziland Reformed Church, with whom I have written over many years.
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Covid-19 Watch: Anger Grows

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 month of May was incredibly dry in the UK, I do not think there was a drop of rain in the east of England. Fortunately, on Friday 5th June it started to rain, and we had consistent showers over the weekend. It is amazing how quickly the green is returning to the dry, brown lawn. Would that we were able to recover as quickly from the Covid-19 crisis.

The sad reality is that it will take us years to get over the pandemic. We can, albeit imperfectly, count the number of people who have died. It is possible, in countries with developed functioning health systems, to get an idea of the number of cases. There is a degree of uncertainty as to the scale of the epidemic in countries with fewer resources. Once we have the antibody test, we will be able to establish how many people have been infected.

It is also a matter of record how countries reacted and what the lockdowns they imposed looked like. In many nations we have an idea of how much money governments have set aside for Covid-19. This is in terms of both direct support and income forgone, for example through tax holidays. Once it is over, we know the direct costs of providing treatment and all spent on prevention. There will be inquiries into how governments, international organisations and the global community responded to the pandemic. I do not think they will make comfortable reading.

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Covid-19 Watch: Distractions

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

Cities in the USA have erupted in flames as civil unrest and protest spread. In the UK the government’s credibility is in shreds. The World Health Organisation’s leadership is lacking. In many poorer nations the leadership and populations watch horrified as their economies contract, and, in time, may collapse. This is a global crisis; no country is untouched.

Perhaps the most obvious hit, other than deserted streets and empty city centres, has been in decreased mobility of populations, both business and leisure travellers. There are few aircraft flying and hotels and resorts are empty. Tourism and travel have, over the past few decades, become major contributors to Gross Domestic Product (GDP) and employment. Macau leads the table with 72.2% of GDP from travel and tourism. In Thailand it contributes 21.6%, in Greece 20.6%, in the UK 11%, and in South Africa 8.6%.1 Tourism employs 11.6% of those working in the UK, in Greece it is 23.9%.2

There is not much reason for optimism in the short term. While the spread of Covid-19 is under control in some areas, in others the numbers continue to rise. However, this crisis is an opportunity to reset the global discourse, establish what is important to us individually, as nations and as humans.

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Covid-19 Watch: Politics

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

Over the past week I have watched increasing infighting and politicisation both over the Covid-19 pandemic and the response. In the UK Dominic Cummings, a senior advisor to Boris Johnson, became the story when he flagrantly disobeyed lockdown orders, though he, and the government, claim he did not. The Tanzanian president denies the epidemic, the South African emergence from lockdown is fraught, and there was a political attack on Professor Glenda Gray, President of the South African Medical Research Council (SAMRC) and a member of the Ministerial Advisory Council (MAC).

I write these communiques from a well-appointed shed in the garden of my home in Norwich, UK. My sanity is helped as spring is well advanced and I can leave the door open and revel in bird song. The robin sits just outside on the hawthorn bush and looks at me quizzically. My youth spent in church brings to mind:

“Behold the fowls of the air: for they sow not, neither do they reap, nor gather into barns; yet your heavenly Father feedeth them.” Matthew 6:25-34, King James Version.

The suburban wildlife does not care about the pandemic. In fact, the hedgehog said, “Pandemic, what pandemic”.2 This week has seen the changes in the countries with the worst entrenched epidemics (Table 1). The US leads the field followed by Brazil, Russia and the UK. Spain and Italy are relegated to fifth and sixth.
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Covid-19 Watch: The ‘Leader Board’ Changes

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 Covid-19-driven lockdowns have led to a range of reactions, from acceptance to seeing it as an assault on liberty. The responses depend on many things: national and regional politics; family situations; resources; resilience; and, of course, the severity of the regulations. The rules are being eased in most countries, but the manner and speed varies greatly. In this blog I will focus on lockdowns, the effect they have, are going to have, and how we might get out of them.

This week has seen significant changes in the countries with the worst epidemics (Table 1). South Korea is being dropped from my table, they had 10,000 confirmed cases in early April and took over a month to add a further 1,000. There are outbreaks but it no longer needs to be discussed, other than as a success. Brazil is the replacement country; it now ranks third in the world.
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Covid-19 Watch: Reproduction Rates, Graphs and Face Masks

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

When writing I use quotations, aphorisms, and occasionally lines of poetry. Leonard Courtney (1832 – 1918), a British politician and president of the Royal Statistical Society said, ‘the price of peace is eternal vigilance’. Our watchword must be ‘the price of epidemic control is eternal vigilance.’2 The Covid-19 pandemic is entering a new phase. That is not to suggest it is under control or that the battle is over. Far from it. In some countries cases and deaths continue to climb, in others the control is precarious. We need to monitor, and be ready to act.

This week has been especially fascinating with interesting new developments. There is more evidence the virus reached Europe before the end of 2019. In addition to the case in France, a choir in Bradford (UK) reported a cluster of illness in early January. It began with the partner of a man who returned from business in Wuhan on 17 or 18 December.3 Korea was a poster child for epidemic control but in the last week has seen a small number of new cases.

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Covid-19 Watch: Science and Social Impact

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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