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: 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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