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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Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com¹ – note: this blog includes an Appendix written for parents “Supporting Children During Lockdown”.

Introduction

On the weekend of 11th April Boris Johnson, the British Prime Minister, was released from St Thomas’ Hospital in London recovering from Covid-19. He was hospitalised for a week, including three days in intensive care. To his credit he has not returned to work but will spend time recuperating. In a brief video message, he recognised that the National Health Service (NHS) saved his life and took the opportunity to name some of the carers. He specifically ‘called out’ nurses from New Zealand and Portugal. Hopefully this will give rise to renewed respect and additional funding for the NHS, and a realisation as to how dependent the nation is on migrant health workers.

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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

Many of us have time on our hands at the moment. This is illustrated in unexpected ways: a clear-out resulting in a table of toys at the front of a house with a notice ‘FREE’; the distance we have walked on Sunday, an unbelievable – for me – 11 kilometres; and the recipe books being dusted off. I read a great deal normally and have just finished Erik Larson’s ‘The Splendid and the Vile: A Saga of Churchill, Family and Defiance During the Blitz’. It covers the period from Churchill’s appointment as Prime Minister on 10th May 1940, when Nazi forces over-ran Europe, to the end of 1941.² There are similarities between that period and where we are now: a sense of dread, a formidable and heartless enemy, and the need for good science and unity. This is not, as many journalists have implied: ‘the blitz spirit’, which has been parodied, most notably in Private Eye.³ It is rather a sense of helplessness.
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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

Red text indicates figures or information will change. Bold text indicates a key point.

Introduction

I believe there are, at last, signs of hope in some of the data. My sense of optimism is, of course, helped by the weather and the advancing spring in Norwich. Mornings begin with a wonderful dawn chorus, quite unlike South Africa’s raucous hadedas. In the UK the chorus is begun by a robin, joined by blackbirds and many other species. In addition, the garden is full of daffodils, sadly just past their peak.

“I wandered lonely as a Cloud
That floats on high o’er vales and Hills,
When all at once I saw a crowd,
A host, of golden Daffodils;
Beside the Lake, beneath the trees,
Fluttering and dancing in the breeze.” – William Wordsworth

On 4th March, the Johns Hopkins website reported 93,000 Covid cases, mostly in China. A week later, on 11th March, there were nearly 120,000 cases. China still had the largest number but only a slight increase. By Wednesday 18th March there were 201,530 cases. On 25th March there were 423,121. On the morning of 1st April there were 860,793 cases. The global doubling time is a little less than a week. There are excellent websites tracking the epidemic.¹

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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

Thank you everyone who is reading and reposting. Everything I write is public domain so please share. I am keeping this and future posts to about 4 pages of text. I provide sources as well as commentary. Red text indicates figures or information will change, probably rapidly. Bold text indicates a key point.

Introduction

The first blog was published on 4th March. I have issued one every Wednesday since. Last night, as I walked from my office to the back door of the house, I nearly kicked a hedgehog. I have not seen one in our garden for years. I wish I had its ability to curl into a ball and wait for troubles to pass. Unfortunately, we cannot, so read on.

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