Pandemics and travels

It has been an inordinately long time since I last posted to my website. A lot has happened. In early July I travelled from Durban to Cape Town for a few days, seeing friends and staying with Derek and Lynn (my brother and wife). On Sunday 10th July I flew from Cape Town back to Norwich via Amsterdam. By Thursday I had a scratchy throat, headache, cough, and a metallic taste in my mouth. A day later I tested positive for Covid-19. The virus I had written so much about got me! I was not seriously ill, but it was not pleasant. I am convinced I was infected in an airport or on a plane.

I was due to travel to Montreal for the International AIDS Economics Network (IAEN) meeting ahead of the International AIDS Conference on Monday 25th July. Although I do not believe I was infectious, travelling seemed unwise. I was very relieved to consistently test negative in the days before I flew. At one point I thought my attendance was in doubt which would have been difficult for my colleagues as we were co-organising a meeting.

Covid-19 is a horrible disease. I had two vaccinations and a booster, but it did not stop me getting the virus. At no point did I feel my life was threatened, and indeed the new, essential, bit of medical kit, a pulse oximeter, indicated that my blood oxygen levels remained high. I was lucky I think, but the cough is taking ages to disappear. It is still annoying, especially at night. Thank heavens for the vaccinations. Interestingly, at the conference, when I revealed I had just had Covid, more than half the people I was speaking to said, “oh so have I”. It seems there has been a pandemic wave which, because it did not kill or hospitalise most people, has not been recorded or noted. Interestingly the other members of the household in the UK remained well! The conference may well have been a super-spreader event.

My reflection, having had the disease, is that it is probably impossible to avoid infection. Certainly, international travel, airplanes and airports mean one is very likely to be exposed, despite wearing masks (which was not mandatory for passengers on the flight to Europe). However, if people have been vaccinated, they should not get seriously ill. It can be treated with a range of drugs. A friend I saw at the conference, who took the medicine, warned that this seems to lead to a rebound positive test a few days later. I really hope vaccinations plus infection will ensure a degree of immunity for a decent time, but I don’t know if this will be the case.

It is over two decades since the first meeting of the IAEN was convened in Durban and I was involved from the very beginning. The Network generally held two-day meetings ahead of the International AIDS Society’s biannual AIDS Conference. In 2020 a virtual meeting was held in conjunction with the San Francisco conference. In Montreal we had a ‘hybrid’ meeting, as they are now called, with a mix of in person and virtual presentations.

Our meeting faced a number of challenges. In the past we raised sponsorship for scholarships and partnered with local academic establishments to save money on room hire. We were not able to do either this year. In addition, many potential participants from the developing world were unable to obtain visas in time for the meeting, indeed the senior Canadian government minister who was expected to attend did not. We suspect he knew he would be heckled and did not want the confrontation or the bad press that would follow. This lack of support was covered in the Canadian press, not that it will make any difference. Despite all this we were delighted to have 60 people in the room and present a full programme of research.

Montreal is a delightful city and I enjoy it, although we did not have very much time for sightseeing. Initially I stayed in the hotel my colleague booked us into. I won’t name it here though. It is a family hotel, run by Taiwanese immigrants, right on the edge of the red-light area. There is a hard to find door on the street that leads up to the reception area and then there were two floors of rooms. These were adequate but in need of renovation and redecoration. The reception was not staffed all the time, not that it made much difference since most people who appeared behind the desk did not speak very much English. I had to resort to the standard English practice when faced with this: speaking loudly, slowly and clearly and using mime. As I left one midday there was a couple checking in, without luggage. This led me to speculate that the rooms may be let for periods of less than a night. I found an unopened package of condoms on the floor next to my bed which tended to confirm this supposition.

I had been unable to get accommodation in this cheap hotel for the entire period, so ended up moving to an anonymous, but very standard, Travel lodge style hotel. This was nearer the conference centre, so it suited me. This hotel even had a gym, an amenity I would have used religiously until quite recently, indeed I found it marginally worrying that I did not feel guilty about it. Mind you the ‘Palais de Congress’ is a vast building, as a result I had no difficulty in managing my 10,000 steps per day. Unfortunately, I also kept up my wine intake.

This blog was partly written on the train from Montreal to Toronto, a journey of just under six hours. The train was late! I ended up in a carriage with two Chinese families in the seats in front of me. One mother was travelling with two children, about five and two. She brought their own food, and it was interesting watching the littlest one using chopsticks, she had about as much skill as I do. Obviously, this is a skill which has to be learnt rapidly. She spent a happy half an hour playing with her facemask and then moved on to sticky sweets! The journey is not particularly interesting, scenic, or fast! But trains are comfortable and environmentally friendly and the connection to Kitchener is good.

It was fantastic to connect with so many old friends and colleagues. One I only bumped into on the last day. Mitchell Warren heads up AVAC. I first met him when he was starting his career in Durban. I was able to tell him that I thought of him and his family frequently in Durban, my walk to the Glenwood Bakery takes me past the house they lived in. He was amused and pleased to learn this. The South African contingent was sizable and very present. I was told there were over 30 Swazis there, but I only met one. In the past we would have organised a meeting of Swazi researchers, but I failed to do this, largely I think because of travel and not being very well.

We did however manage to publish a special issue of the African Journal of AIDS Research on ‘AIDS in the Time of COVID’. This was thanks to superhuman efforts by the editorial team in Grahamstown, and the fact that authors and reviewers were responsive to the deadlines. Inevitably a few articles simply did not make it, so we will mop them up with a special section in the next issue, assuming, of course, that they get through the peer review process. I was delighted that we were able to produce such a timely issue with the support of UNAIDS. Even more pleasing is the fact that it is open access, anyone can look at it and download the articles, including anyone who reads this blog!

‘Love Light’ and ‘Love Life’. Reflections on Retirement

The heading for this posting is taken from a festival held in Norwich in mid-February and my own admonition to myself. It has been a while since I last posted anything on my website, it was at the beginning of January I see. Confusingly quite a lot has happened, but at the same time it seems as though not very much has. Perhaps a sign of the times.

I am coming to the end of my second month of retirement. It is challenging. One of my wise friends wrote to me saying there were three things to be aware of with this changing status. The first is a dramatic decline in income. This is certainly true. That is not to say that I don’t have enough, I do, but instead of, in economic terms, drawing from the flow I may need to dip into the stock. Some argue good planning means the cheque for one’s funeral should bounce because there are insufficient funds. Sadly, I think this is not a feasible option. Gene Perret, a Hollywood screenwriter, said:

“Retirement: it is nice to be out of the rat race, but you have to learn to get along with less cheese.”

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Of Birds and Viruses

I have officially been retired since Saturday 1st January, or perhaps, to be pedantic, since midnight on 31st December 2021. I must confess to feeling a little uncertain as to what the future holds. There needs to be a plan, budget, and cash flow projection, all but the first can be done quickly. The Covid crisis has made planning difficult. I really want to do some travelling, but it is hard to book tickets with any confidence. This is changing slowly though. It is hard to believe that the world began this seismic shift just two years ago. I became aware of this new disease in January 2020. I had no idea how rapidly and far it would spread, or the incredible disruption it would cause. More on this later.

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Lovely Lisbon and Demonstrating in Norwich

I went to my first conference in nearly two years last month. It was fantastic for many reasons: a chance to get out of the UK; visit a new country and city; meet with colleagues; catch up with developments in the field; and above all be reminded of what we had lost. My word I enjoyed myself. The primary purpose of the trip was to attend the International Association of Providers in AIDS Care’s (IAPAC) Fast-Track Cities 2021 Conference.

To their credit the conference organizers included Covid-19 in the programme. My presentation, which I shared with Corey Prachniak-Rincon, an IAPAC staffer, was on ‘Exploring Legal, Public Policy, and Finance Dimensions of Health Responses.’ The take-home messages were not encouraging, until Covid is on the decline, HIV will not be a priority, even though it (HIV) is not going away. The number of HIV infections continues to rise.

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The clock ticks

I was shocked to see it has been over a month since I last posted. I have two countdowns going on in my life. The first, at the end of 2021 I will get my last salary cheque. Apart from a few short ‘student type’ jobs, since 1980 I have always had someone paying me a regular income. The short jobs in Swaziland included working for a school book supplier one holiday, and a week as a ‘hanger round’ at the Central News Agency in Mbabane. In the UK I spent a week packing bulbs (tulips and daffodils) etc. in a warehouse, ironically in the industrial site near where we live. I was fired for being too bolshy. I also spent three summer months as a warehouseman in Her Majesty’s Stationery Office. The second milestone is, in March 2022, on my 66th birthday, I become eligible for a British State pension.

Most young people, certainly those under 40, see people aged 50 to 80 here as an exceptionally fortunate generation. This is true for a high proportion of us. We had access to free university education, jobs, and many will get a state pension that, while not hugely generous, is significant. We were able to travel widely. We only became aware of the appalling damage we have wrought on the world, in terms of over exploitation and environmental damage, as we were doing it.

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What’s next, I ask?

Welcome to the first of my monthly, meandering blogs, put on my website, and emailed to everyone who signed up to receive my news. Let me begin with a warning, this is not primarily about Covid, so you may wish to take yourself off the list. Obviously, I am still following Covid, but no longer closely, and certainly not enough to write regular posts. Having said that here is something everyone should read – “How the risk of side effects could change with Covid-19 vaccine boosters” – we are all, probably going to offered these soon.

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And, finally, for now

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 4th March in 2020 I started posting a ‘Covid-19’ blog to replace my normal monthly meanderings. It began:

“I am expected to know something about epidemics and pandemics, their causes and consequences. Many friends and colleagues have been asking me about Covid-19.

Here is a quick ‘fact sheet’ as of 4 March – what we know, what we don’t know, and what we need to know. I include hot links. Please feel free to send it on.”

Initially I used red text to indicate where figures or information would change, and bold text to show key points. I managed to keep up a weekly report for over a year. I then reduced it to every two weeks, but gaps increased and I am afraid I lost steam.

More than a month after I previously posted my Covid blog, this is the last. If you are getting it as someone who signed up for the Covid update you might want to ‘unsign’. If you do not, you will continue to receive my monthly personal blog. This is about what I am doing, books I am reading, ideas, and the minutiae of daily life – there is a lot about flights, airports and aircraft. The first of this new series will be posted in a couple of weeks.

As to the reasons for me ending this blog, the main ones are: it was surprisingly time consuming; the situation with regard to the science, numbers and response is increasingly complex; and it was getting too depressing to keep going. There are plenty of other people doing what I was trying to do. Nonetheless there are still areas that are ripe for research and writing. In particular the consequences of the pandemic, its economic, social, psychological and political effects. They are, of course, still unfolding.
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Fatigue

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

Regular readers will have noticed that it is three weeks since I last posted a blog. I am planning to write one more piece after this and will then end regular posts on Covid-19. I will still blog once a month but it will be a more general article. There are several reasons for this: preparing and writing is time consuming; the situation with regard to the numbers and response is increasingly complex, it might be possible to focus on one continent, but globally the situation is ever more diverse; it has dawned on me how incredibly disruptive and damaging the pandemic is, frankly it is too depressing to keep going; and finally there are many other resources available. Among them is pandem-ic.com:

‘This personal site provides data analytics on the COVID-19 pandemic through the lens of the World Bank country income classification – hence “pandem-ic”.’

It is produced by Philip Schellekens, a Senior Economic Advisor at the World Bank Group, but is a personal blog.1
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Are we winning? Yes and no!

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

I finished my quarantine in my Waterloo apartment a week ago. I had three days confined in an airport hotel and then 11 more in Waterloo. The government was efficient at checking up on me. Every day I got an automated email with a weblink, and had to complete a form online. There were at least two phone calls and one visit from a private investigator, who had been repurposed as a quarantine inspector, complete with stab proof vest. He came to the door of the apartment, but said he was not allowed to enter it – which somewhat defeats the objective of checking.

The whole of the post-hotel quarantine depends on the honesty of individuals entering Canada. The press has reported, with outrage, of people flying to American airports and crossing the border by road, thus avoiding some of the more intrusive processes. I must be honest and say it was not too bad, though the current lockdown is wearing. Friends made sure I was well supplied with the essentials (food and wine), and so my incarceration went by reasonably quickly. But then I have a large apartment with a great view. I am privileged and I recognise it.

My overarching impression in Ontario is of a province on its knees, and an overwhelming weariness with the whole process. The smiles are becoming fixed, that is when you can see them because people wear masks outside. The problem is the lack of clarity and consistency. As I understand the situation, rules are enforced at the local level. Where I am, it is enforced by Region of Waterloo Public Health. They work closely with Public Health Ontario, the relevant section of the provincial government, which sets policy, and at the national level, with the Federal Ministry of Health. The lockdown is tight; people should only leave their homes for essential reasons, socialising is not allowed, and currently schools are closed. This last regulation has, as in Europe, had an extremely detrimental effect on children and their parents.

A large part of the problem is the Provincial Government, run by the Progressive Conservative Party of Ontario under the leadership of Doug Ford. The world over, conservative governments have reduced public health expenditures and services, and Ontario is no exception. Indeed, Ford was forced into a humiliating climb down when he attempted to announce that the provincial police would enforce his regulations,1 only to have various forces announce the next day that they would not be doing this.2 The numbers in the province are coming down slowly. There is a decent website3 giving data for the province. The citizenry needs clear guidance and, above all, to know the nightmare will end soon, but this is lacking.

The little mall across the road has a security officer at a desk at each entrance. Their task: to ask each customer if they have any Covid symptoms as they enter. It would take a pretty stupid individual to admit to having signs of Covid. I suppose it is important to be seen to be doing something, and this has certainly created employment. Interestingly most of the security officers seem to be recent immigrants from Southeast Asian countries. That probably indicates that these are minimum wage jobs.
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Vaccination: the way ahead

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 is being written as I quarantine in my Waterloo apartment. Getting here was surprisingly easy, despite a great deal of bureaucracy. The story began in December 2019 when I travelled from Waterloo to the UK for a year’s sabbatical. I planned a busy year, with visiting fellowships at two German and a British University, and visiting status with two English Universities. It was set to be a full, productive, and fun year. And then Covid-19 arrived, and everything was put on hold. I did not leave Norwich for over a year but making a trip to Canada was increasingly urgent. Travel was not easy, cheap or pleasant.

The first step was getting permission to leave the UK. International travel was not allowed until 17th May, unless the traveller has good reason. There is, of course, a government website. The “Declaration for International Travel” has a drop-down menu of about 10 reasons, from ‘Work’ to ‘Other reasonable excuse – please specify’. I dutifully completed and printed it. No one asked to see it at any point. There were no flights for my preferred route (Norwich, Amsterdam, Toronto) so I booked from Heathrow. There is extensive guidance on travelling to Canada on the Canadian government website. Only four airports accept international flights: Calgary, Montreal, Toronto, and Vancouver. At the moment, there is no recognition in the terms of travel and restrictions of vaccine status. I am fully vaccinated and have a flimsy little record card to prove it. I made photocopies for officials. No one asked or showed an interest.

To enter Canada (and various other countries) a traveller has to have a negative Covid test within three days of boarding. In the UK, private laboratories produce a “Fit to Travel Certificate for SARS CoV-2/Covid-19 Testing”. At a price of course. Also required is an arrival form to allow border officials to track you.

“Speed up your arrival process in Canada and spend less time with border and public health officers. Use ArriveCAN1 to provide mandatory travel information… Help … keep Canadians safe and healthy.”

The aircraft, a Boeing 787 Dreamliner, seats about 250 people. I booked myself in the premium economy section for more room. What a waste of money, there were only 19 passengers! There was a full complement of very bored cabin crew and consequently we had excellent service and some interesting conversations. Clearly, they had time to check the passenger list, halfway through the journey they began addressing me as Professor!

On arrival getting through the Canadian formalities was straightforward. The test is a nasal swab. There was no interest in my vaccination status – but there were a few comments on Canada’s failure to roll out a vaccine. Mind you I was on an empty plane; the next scheduled flight from Manila had 350 passengers. The government requires you to pay for three days’ quarantine in a hotel. My choice was a bog-standard business hotel, where the confinement included three meals brought to the door in large brown paper packets. I understand Pavlov’s dogs better now. Within 24 hours I recognized the rustle from the moment the delivery person exited the lift. There was nothing to get excited about on the menu though.

At Heathrow I bought a couple of bottles of duty-free wine and when I checked into the hotel, I asked for a third. The clerk said that he was glad I asked before he checked me in. He is not allowed to send alcohol to the quarantine rooms! There was no corkscrew in the room and the desk said they had none so here are some tips.
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