Covid-19 Watch: Hope by Christmas?

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

Yesterday, 1st December, was a significant day in the annual global health calendar: World AIDS Day. Until this year, AIDS was the pandemic dominating global thinking, activism, and response. It is the disease I began working on in 1987. I looked at migrant workers travelling to South Africa to work in mines, on farms and in industry. The majority were men. They travelled on annual contracts and mainly lived in single sex hostels away from wives and families. The ideal environment for a sexually transmitted infection to spread.

HIV, the virus that caused AIDS, was first noted in New York and San Francisco in 1981. A classic book tracking the emergence of HIV is ‘And the band played on’ by Randy Shilts.1 As the numbers of infected people rose dramatically globally it became clear, in most of the world, specific groups were bearing the burden of the disease: men who had sex with men; people who used drugs intravenously; recipients of untested blood and blood products; and female sex workers. There are areas with generalised epidemics, in particular Africa, where the Southern cone is the epicentre.

In the 1980s our source of data was surveys of pregnant women. We watched in horror as infection rates rose dramatically, up to 40%. Initially there was no treatment. Hundreds and thousands of people fell ill and died as their immune systems were overwhelmed. The arrival of treatment, antiretroviral drugs, in 1996 was game changing. The HIV and AIDS world faces two challenges: reducing the number of new infections and ensuring people access and stick to treatment.

In 2018 there were 37.9 million people living with HIV, including 1.7 million children. This gives a global prevalence of 0.8% among adults and 21% do not know that they are infected. It is estimated that an additional 32 million people have died of aids related illnesses. To date there have been just over 63 million cases and just under 1.5 million deaths of Covid-19. The number of cases will greatly exceed those of AIDS, the number of deaths should, fortunately, remain lower. Whilst both diseases are zoonotic retroviruses, there are differences, the main one being most recover from Covid-19.

AIDS played an important role in our response to Covid-19. The scientific advances in immunology, virology, vaccine development and a host of other disciplines meant that a great deal of basic knowledge was there already. Public health institutions and health workers were able to pivot. The effect of Covid-19 on AIDS is less beneficial. It has drawn attention and resources away from a deadly disease. As you read this week’s blog be aware of the many other health issues faced by people, especially those in the developing world. I know most about AIDS hence this introduction. There are many other needs: malaria, tuberculosis, hepatitis and numerous childhood diseases.

Numbers

As of 2nd December there are 63,930,654 cases globally. The United States leads with 13,725,916 cases, the most recent peak was on 27th November at 205,557 cases. India is still second at just under 1.5 million cases, followed by Brazil, Russia, France, Spain, and the United Kingdom. South Africa has fallen to 16th place in the league, although there was a slight increase in the numbers at the end of November.

Today the UK emerged from its second period of lockdown, although a new tier system has been put in place. Once again there are differences between the four nations. The UK government’s website sets out the restrictions in England and gives links to Scotland, Wales, and Northern Ireland.2 There has been a 30% reduction in new cases over the past four weeks, the period of the lockdown, and the government has promised further easing for five days over Christmas. It is possible numbers will start to rise as we reach this easing. That will give a further boost to the pandemic and then in the second half of January we will again enter a lockdown. This will hopefully be when vaccines start becoming more widely available. In my view commerce, a desire for popularity and sheer ineptitude are driving the English response, science and epidemiology are not!

Planning

This blog seems to be mostly personal historical references, but I assure you they are relevant. In the 1980s life in South Africa was bleak. It seemed Apartheid would never end. There were initiatives to bring about change: global disapprobation and the use of sanctions. Within the country Anglo America had a project where they looked at scenarios for the country. This initiative was led by a remarkable man, Clem Sunter.3 The output, a book and presentation, set out possible scenarios: the high road – negotiated change and an optimistic future; or the low road – continued conflict, impoverishment, and deaths. It was presented to everyone who would listen, from church groups to the African National Congress and National Party. Clem has recently turned his mind to Covid-19. In April 2020 he described four possible scenarios for how the coronavirus pandemic could play out: “Much Ado About Nothing”, “The Camel’s Straw”, “Spain Again” and “Walking the Tightrope”. He has revisited this, and his scenarios are summarised below.

Much Ado About Nothing

This scenario suggested the pandemic is little more than an annual bout of common flu and will disappear of its own accord. It is much ado about nothing created by the media. Clem does not believe in the validity of this scenario, but there are plenty of people who do. This is particularly seen in the USA but the UK has also seen demonstrations against restrictions. The evidence is clear, there is a virus, it is causing people to fall ill and die, and it is not a flu.

The Camel’s Straw

This scenario is because the global economy was already fragile, the pandemic could be the straw that breaks the camel’s back. The lockdowns and the collapse of many businesses could stretch out the economic recovery process for a long time. The recovery will be ‘U’ rather than a ‘V’ shape. It will take several years to get back to ‘normal’, with big changes in the way people live and work.

As Sunter notes:

“The burden of additional debt creation by governments to finance relief packages will have to be taken into account as well. That debt has to be repaid over time; and government tax and expenditure policies will need to reflect this. It probably means that interest rates will remain spectacularly low for the foreseeable future. The world’s stock markets, buoyed by the news (of) effective vaccines … believe that it will be back to business as usual by the middle of next year …. They may be right; but the flags to watch from now on are those attached to the real economy of Main Street rather than the investment world of Wall Street. … It all might take longer than people think …the monthly statistics around a country’s GDP, unemployment, consumer expenditure, the creation of new businesses to replace those lost in the pandemic, and its performance in international trade must be watched like a hawk.”

Spain Again

This scenario presumes a repeat of the 1918 Spanish Flu, which killed 3 to 5% of the world’s population. “With the announcements on the various vaccines being rolled out soon, the chances of this scenario materializing have fallen to a level which puts it into the ’highly unlikely’ category.” It must be remembered that the science and effectiveness of the vaccines is still being studied. There is the possibility of virus mutations and vigilance is required.

Walking the Tightrope

The final scenario is about the balancing act between preserving lives and livelihoods. In April Sunter noted the importance of governments making decisions on lifting restrictions. He said:

“there is reason to hope that the end of the tightrope is in sight. Vaccines should be distributed soon which may restore a level of normality to life next year, depending on how effective they are”.

I would add to this we need to be aware that distribution is going to be critical, who gets these and when.

In my view, with the development of vaccines, we need to develop a new set of scenarios. It is time to start looking at the political, social, psychological, and economic consequences of the pandemic. As government furlough and other support schemes end what are the consequences going to be. There will be a generation growing up in material poverty, will it also be a time in which the populace feels undervalued and have a growing sense of anomie. The markets are out of step with people’s lived experience, and inequality is growing.

Vaccines

Last week I wrote about vaccine development and set out the three western front runners. Today, the UK approved the Pfizer/BioNTech coronavirus vaccine for widespread use. It is the first country in the world to approve a western developed vaccine. The regulator says the vaccine, which offers up to 95% protection, is safe. “It will be rolled out from next week, beginning with people who need it most. … Health Secretary Matt Hancock tweeted “Help is on its way”.4 The order in which people will receive the vaccine has been suggested by the Joint Committee on Vaccine and Immunisation. Care home residents and workers should receive the first doses, then healthcare staff, people aged 80 and over and social care workers.5

This is good news, however there are reasons for caution. The Pfizer/BioNTech vaccine must be stored at -70°. We have been assured of the safety, but there may be unexpected events. There is resistance to vaccines from the public: 30% of Britons and 50% of Americans expressed reservation in one report. And of course, we have not really addressed how it will be distributed in the developing world. Let us hope Moderna’s and AstraZeneca/Oxford University’s vaccines are soon available.

I did not cover the Russian and Chinese vaccines as they have not been submitted to the same regulatory agencies. There is however news that China has been successful in their efforts which began almost as the genetic code was sequenced. This is not something generally covered by mainstream western media. An excellent article in Science sets out how this has developed and notes the vaccine will be a part of Chinese diplomacy.6

The reality is there is still too much ‘information by press release’ for me to say more about vaccines this week. I set out key questions to be answered last week. They have not been answered yet and are worth repeating:

  • How much is being spent on and by whom (government, private sector, foundations, charities). Is anyone doing economic analysis?
  • How many doses are being promised by the manufacturers?
  • Governments are seeking to pre-purchase. Will they pay if the vaccine does not work?
  • What happens to the many unsuccessful companies?
  • How much will the vaccine cost?
  • How will it reach developing countries? WHO Director-General Tedros argues the goal should be to ‘vaccinate some people in all countries, not all people in some countries’.

Conclusion

It is time to start thinking about and planning for a post Covid-19 world. There is finally an end in sight. There will also have to be reviews (commissions) on how we responded to the pandemic. Were the lockdowns necessary? Did the damage they caused outweigh the benefits?

A good place to start is a recently published and thoughtful Devex article by Kent Buse and Wafa Aftab.7 They point out the dominant response to the pandemic was bio-medical, top-down, command-and-control oriented.

“Society was told it was “at war.” To defeat the virus, a range of bio-security measures were imposed to protect citizens against harmful pathogens. Key workers were sent to the front lines as warriors and — rightly — valorized; borders were closed to protect against attacks from invisible enemies; wider society was put under lockdown. … citizens and civil society were largely locked-out of meaningful decision-making, as in many cases were local leaders. … new laws and rules increasingly enforced behavior change. Around the world, as people and communities were disempowered, alienated, and criminalized, trust between leaders and those at the sharp end of restrictions dissipated. … Emergency powers often removed checks and balances on leaders (and) … overcentralized responses that excluded the public, paradoxically undermining confidence, and voluntary compliance with necessary public health measures a science-based public health movement.”

The easy part of the pandemic is nearly over. We now have to count the cost, see what worked and why and start planning the society we want to live in. Above all we have to understand the trauma of Covid-19 which is something we have all felt.

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. Randy Shilts, ‘And the band played on’, Viking, London 1987
  2. https://www.gov.uk/guidance/local-restriction-tiers-what-you-need-to-know
    Wales https://gov.wales/coronavirus-regulations-guidance
    Scotland https://www.gov.scot/coronavirus-covid-19/ and Northern Ireland https://www.nidirect.gov.uk/articles/coronavirus-covid-19-regulations-guidance-what-restrictions-mean-you
  3. http://www.clemsunter.co.za/ and https://www.biznews.com/thought-leaders/2020/11/24/clem-sunter-updates-scenarios
  4. Michelle Roberts, Covid-19: Pfizer/BioNTech vaccine approved for use next week in UK, BBC News online https://www.bbc.co.uk/news/health-55145696
  5. Henry Bodkin, NHS hospitals told to be ready for vaccine from this week The Telegraph, 30 November 2020 https://uk.news.yahoo.com/nhs-hospitals-told-ready-vaccine-020930904.html?guccounter=1
  6. https://www.sciencemag.org/news/2020/11/global-push-covid-19-vaccines-china-aims-win-friends-and-cut-deals
  7. By Kent Buse and Wafa Aftab, Opinion: COVID-19 and the neo-public health movement — bringing back the public, https://www.devex.com/news/opinion-covid-19-and-the-neo-public-health-movement-bringing-back-the-public-98659

Vaccines, vaccines, 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

On Wednesday 25th November there were just under 60 million confirmed Covid-19 cases globally. There have been 1.4 million deaths. This pandemic is not under control. Despite the numbers, the last week has brought encouraging news both on medical and political fronts.

In the USA, the process of transition from the Trump presidency to Joe Biden’s has finally begun. The General Services Administrator Emily Murphy felt able to send the letter to Biden on Monday 23rd November saying he could begin the transition and giving him the requisite resources.1 This came as it was clear Trump’s lawsuits challenging the election result were going to fail. What this delay will mean for national security and the Covid-19 morbidity and mortality remains to be seen. The US will sign up to the Paris agreement (again) to address global climate change. They will rejoin the World Health Organisation (WHO), especially welcome as they are the largest bilateral funder.

There are now promising vaccines in Phase Three trials and that is the focus of this communique. I will try to make sense of this and produce a summary table of what is available. The science has leapt forward, and this includes advances in treatments not covered here. As mentioned before, the lens through which I report is most influenced by western news sources and, even narrower, I am most aware of what is going on in the UK and the USA.

I participated in a one-hour debate on BizNews radio2 with South African actuary Nick Hudson. He was one of the movers behind the Great Barrington Declaration (GBD). The moderator suggested that there might be fireworks because, as the publicity noted, I had been uncomplimentary about the GBD. It is a great pity when positions become polarised and I made a mental note to not ‘shoot from the hip’. Nick is a member of Pandemics ~ Data & Analytics (PANDA).3 Disagreement can be healthy, especially in the case of a new disease when there is much to learn. We concurred Covid-19 is a serious new illness, where we part is on how to respond, in particular the value of lockdowns.

My scars are from the Thabo Mbeki years, with the denial of the AIDS epidemic, and unwillingness to roll out treatment. This resulted in hundreds of thousands of premature deaths. With fellow scientists in South Africa, we faced a phalanx of denialists of various categories. Some argued that there was absolutely no such thing as HIV; others, that HIV was a harmless ‘passenger virus’; a third group suggested that whilst HIV existed, the drugs were the real cause of morbidity and mortality, (there was a subtext here of HIV being exploited by the global pharmaceutical industry); finally, in their ranks, were several who were so incoherent we never knew exactly what they stood for.

I write from the UK. We are approaching the end of our third week of our second lockdown, it is supposed to end on 2nd December, in time for Christmas shopping. I am extremely concerned about the impact this will have as millions flock to the streets to buy presents for friends and family. The tier system will be reintroduced and continue to be opaque.
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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

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: Schadenfreude

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 past two weekends have seen heavy rain and strong wind in the UK. This meant every last walnut on the tree was gone in 24 hours. I blame the squirrels as I simply could not find any windfall nuts. I think they watched the forecast and then had a very busy few hours. Hopefully, most of the nuts are safe and dry in the drey, and not buried around the garden. In addition, because of the gales, a roof tile had come loose. It was within an ace of falling through the conservatory roof. That was dealt with by an amazing roofer in about 20 minutes, who responded in record time. Thank you, Richard Bartram of Hellesdon Roofing who simply climbed onto the roof, replaced the tile and dealt with a second that we had not seen, not to mention fixing a leak in the fibreglass!

The Covid-19 epidemic continues to pass milestones: there have been over 35 million cases globally and over a million people have died. While the cumulative number of cases continues to rise, the number of active cases is falling as people recover, and the daily increase seems to be stabilising. The situation in the UK is bleak with unclear messaging and many issues. Large parts of the country are under lockdown, but many are up in arms about the totalitarian way it is being done. There is more on this in the section on the UK. Last Wednesday I downloaded the Trump/Biden debate and listened to it over a few walks and cycle rides. Trump was beyond ghastly, but Biden was not inspiring. Oh dear, this left me with a sense of foreboding for global politics. Then, on Friday, Trump was taken to hospital with Covid-19. This is covered in the section on the USA.

The looming issue is how we are going to deal with the economic, social and psychological effect of the pandemic. How do we deal with the terrible sense felt by so many young people that their futures have been stolen? What happens to imprisoned, isolated and lonely elderly people.
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Covid-19 Watch: Confusion

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

On Tuesday, the global death toll attributed to the coronavirus topped one million people. The largest share, by an order of magnitude, was reported from the USA. This bleak milestone has been extensively covered by the worlds’ media. However, in terms of the daily number of confirmed cases there seems to be a plateau, or at the very least, the numbers are not rising as rapidly. To put Covid-19 into perspective, in 2017 there were 620,000 deaths from malaria, 794,000 from suicide and 954,000 from HIV and AIDS.1 This is the greatest death toll from a pandemic for centuries.

In this blog I want to turn to, and revisit, some fundamental issues:

  • How many coronavirus cases have there been?
  • How many of the cases matter and how much?
  • What does excess mortality look like?
  • One major concern has been the link between HIV and Covid-19. It seems there is some clarity on this – and good news, as discussed in a special section.
  • Finally, in the conclusion, I ask what is the impact of the virus?

The reason for this revisit is because of the way data are portrayed. Each evening in the UK we are informed by newsreaders of the number of new cases and the number of deaths. One graph shows the new cases recorded since the epidemic began. At first sight is deeply concerning, there are far more new cases reported at present than there were in April at the height of the pandemic. On the 25th September there were 6,878 new cases, well above the previous peak of 5,505 on the 22nd April. It should be noted this is data for the United Kingdom, it can be disaggregated for the four nations: England, Scotland, Wales and Northern Ireland.

This pattern is seen in several other European countries. How concerned should we be? There is a sense of real worry because the northern hemisphere is entering the winter, and no one is quite sure what this means. Normally there will be many respiratory illnesses and indeed with schools having reopened and students returned to university, (where many students are now, unbelievably, locked in)2 there is a sense that there will be an inevitable increase in cases. At the same time, the number of deaths and hospitalisations has fallen dramatically and may well remain low.

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