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

Introduction

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

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

Introduction

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

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

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