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.
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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!
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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.
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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.
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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.

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Covid-19 Watch: Taking Stock

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 rules in the UK were confused. Then on Monday Prime Minister Boris Johnson took the opportunity to clarify and strengthen them. I am still, and now even more, confused. I feared the situation regarding restaurants might change, so we went for dinner on Saturday at Stower Grange. If you are in, or need to be in, Norwich check it out. In fact the situation is that we can still go out for dinner. This may change with the introduction of a ‘circuit breaker’.

On Monday the South African newspaper Maverick Citizen carried an opinion-editorial piece by Nina Overton-de Klerk and Caroline Azionya: “The world is drowning in Covid-19 communication but isn’t much smarter for it”.1 The authors point out in 1968 a pandemic

“caused by an influenza A (H3N2) virus … (was) first noted in the United States … The estimated number of deaths was 1 million worldwide and about 100,000 in the United States. Most excess deaths were in people 65 years and older”.2

They report a (recent)

“WhatsApp message did the rounds with a picture of a rock guitarist playing to thousands of waving people. It read: “In 1969 the Hong Kong virus (H3N2) killed over one million people worldwide and over 100,000 Americans. Instead of shutting everything down and ruining people’s lives, they held Woodstock.””3

This deserves thinking about.

Vaccines probably offer us the only way out of this crisis. This week’s guest section is by Mitchell Warren, the Executive Director of AVAC. This is a non-profit organization that seeks to accelerate ethical development and global delivery of HIV prevention options. He became a friend, and a fellow traveller in search of global development and truth, more years ago than I care to recall in Durban. Mitchell tackles vaccines and his measured informative input is well worth reading.
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Covid-19 Watch: Gloom

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 few days in the run up to the publication of this blog have been glorious. The days have been warm and sunny while the nights are starting to turn chilly. On Sunday we took advantage of the weather to visit the beach and have a long walk. The national restrictions meant that we had to eat lunch outside of the little café, but that was fine. Driving through the beautiful Norfolk countryside, it would have been hard to know that the UK is wracked by the Covid-19 pandemic.

The news is generally not good, although, as you read this week’s blog, remember that there are countries where the epidemic is under control or has not rebounded. The situation in China and other Asian countries seems under control. Australia saw two spikes, but the number of Covid cases have since fallen dramatically. In most African countries (apart from South Africa) the numbers remain low, while there is under reporting, the epidemic is not as serious as was initially feared.

This week I focus on the situation in the UK as the situation is rapidly evolving here. The bulk of the blog was written in the early part of the week, but I finalised it on Wednesday. The number of cases has been climbing rapidly and the leadership is beginning to panic. On Monday there was a special broadcast by Sir Patrick Vallance, the Government Chief Scientific Adviser, and Professor Chris Whitty, the Chief Medical Officer for England and the UK government’s Chief Medical Adviser. The presentation was given without any politicians present. It was a simple statement of current position and where the country could be without effective intervention.

Vallance and Whitty are responsible for providing scientific advice to the Prime Minister and members of cabinet; advising the government on policy on science and technology; ensuring and improving the quality and use of scientific evidence and advice; and supporting analysis and evidenced-based decision-making. The ultimate responsibility for decisions rests with the politicians.

On Tuesday Boris Johnson addressed Parliament, and in the evening spoke to the nation. The upshot of this is new restrictions that are pretty uniform across the UK. The nation was warned of a tough winter ahead and the possibility of a second national lockdown. The restrictions include a 10pm closing time for pubs and restaurants, bans on indoor team sports, and stricter rules on mask-wearing. There are even stricter local lockdowns. An indication of the government’s flailing response was the suggestion “freedom-loving” Britons will be blamed for more draconian restrictions.1
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Covid-19 Watch: More Signs of Hope

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

Many people in the UK increased the amount of exercise they did during lockdown. I had our family bicycles repaired, sadly before the government introduced the bike repair subsidy, and began going for relatively long rides in the countryside. One circuit goes past the end of our local airport. The runways were laid down during the second world war and they, as well as the taxiways, are extensive. As a result, there are a large number of aircraft parked here. I was finally able to identify the livery on seven or eight of the planes as belonging to Fly Bra, a Norwegian airline operating mainly in Sweden. The second largest group are British Airways aircraft. I wonder what will happen to them in the longer term.

In this blog I will make some predictions about what is going to happen. It is time to think about where we are going and how long this may take. The guest spot is taken by Ian Ralph on the incredibly important topic of lockdown and mental health.

The Lancet published the first nationwide, population-based seroprevalence study of antibodies against SARS-CoV-2. This was in Spain, at national and regional levels, with more than 61,000 participants. It was to provide ‘accurate prevalence figures according to sex, age—from babies to nonagenarians— and selected risk factors.’1 The results are fascinating. The national antibody prevalence was about 5%, with regional differences. Madrid’s prevalence was five times that of low-risk regions. A third of positive results were asymptomatic. There was no difference between men and women, little variation by age, and not much variation by occupation. Their conclusion:

“Despite the high impact of COVID-19 in Spain, prevalence estimates remain low and are clearly insufficient to provide herd immunity. This cannot be achieved without accepting the collateral damage of many deaths in the susceptible population and overburdening of health systems. In this situation, social distancing measures and efforts to identify and isolate new cases and their contacts are imperative for future epidemic control.”2

New Zealand went for over 100 days without any community infections. The nation was congratulating itself on its success. Then, on Monday 17th August, the country reported 13 new cases. Donald Trump said “Even New Zealand, did you see what’s going on in New Zealand? ‘They beat it, they beat it.’ It was like front page, they beat it, because they wanted to show me something,” he added. “The problem is, big surge in New Zealand … it’s terrible.”3 On the same day, the United States reported its highest daily total of 64,294 new cases. This is cognitive dissonance.
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Covid-19 Watch: Green Shoots!

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 had been no rain in Norwich for six weeks and the garden was looking decidedly wilted. Finally, on Sunday night, the heavens opened, and to the accompaniment of thunder and lightning, sheets of rain fell. The lawn had been brown and within 24 hours was transformed into a green swath. The rain butts filled within a few days as showers continued to march across East Anglia. It was a reminder that nature is beyond our control, and Covid-19 is a reminder that it can turn on us. Zoonotic events like the one that gave us SARS-Cov-2 are becoming more frequent. We must both prevent them through better stewardship, and be prepared for them. The Wall Street Journal has an interesting analysis: ‘A deadly coronavirus was inevitable. Why was no one ready?’ the subheading: ‘Scientists warned of a pandemic for decades, yet when Covid-19 arrived, the world had few resources and little understanding’. The authors conclude withdrawal of support to the Atlanta based Centers for Disease Control meant early warnings mechanisms were lost.1

In general, the epidemic is beginning to become more predictable and there are a growing number of countries where daily cases have peaked and are now falling. This includes South Africa, the subject of this week’s guest contribution, where the number of new cases peaked towards the end of July. Across much of Europe the daily number of new cases was declining but some countries, notably Spain, France and the Netherlands have, over the past week, reported increases. Boris Johnson’s government has imposed quarantines on people arriving from certain countries, the footnote sets out the complex governance in the UK.2 Wales, Scotland and Northern Ireland have different rules and regulations regarding gathering and could, but don’t yet, have different quarantines.

In this blog I wanted to make some predictions about the future. It is time to think about where we are going and how long this may take. I am aware that this is inadvisable, after all Sir Arthur Conan Doyle’s Sherlock Holmes said: “It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts”.3 In addition, I am aware that this week’s offering is becoming too long, so I will hold that over for a week.
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Covid-19 Watch: Lockdowns and Economics

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1 and Dr Steven Forsythe, Deputy Director of Economics and Costing, Avenir Health

Introduction

After I began posting I promised to invite guest contributions. It is with great pleasure (and some relief) that this post focuses on the economics of Covid-19, written by friend and colleague Dr Steven Forsythe. Please, readers, feel free to suggest what you want covered in greater depth. The world is stirring as countries tentatively start the process of emerging from lockdown. This is a key topic for next week.2 I am adding three key, usually short, readings per week at the end of the blog.

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