Covid-19 Watch: Setbacks

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 try to exercise every day. I have come to enjoy cycling and have a circuit of between 20 and 26 kilometres, which takes me just under two hours. I cycle around the end of Norwich International Airport, through the villages of Horsham St Faith and Drayton. There I join a cycle track, the Marriot Way, (another old railway line) that runs along the Wensum river valley. The last five kilometres home are through a recreation ground and end with a meander through our suburbs.

It has been pleasant and interesting to see the seasons change. A few days ago, there was quite a stiff easterly breeze. This is a pain; it blows in my face for the most difficult part of the ride. On this occasion though, I saw a kestrel, one of the resident birds of prey in Norfolk. It was riding the wind on the edge of a field, hovering, almost motionless, scanning the ground looking for mice or voles. Perhaps I should encourage it to meet my squirrels, although it is too small to take an adult squirrel.

On the squirrel issue, the battle continues. The walnuts are ripening and now there are two squirrels raiding the tree. My squirt gun is not powerful enough to reach the top branches, and anyway they have worked out that the denser foliage on the adjacent tree means I can’t see them. My message is now, “OK squirrels you win, but please only take the nuts I won’t be able to reach”. Alternatively, does anyone have a recipe for walnut and squirrel stew?

There is a new set of Coronavirus regulations in the UK. There is some variation in these, depending on which of the devolved regions citizens live in. I cover this in more detail below. The big picture globally is that we may be reaching a plateau, but there is variation across the world, within countries, and by population groups. The bad news is that the numbers of new cases seems to be rising, again, across many European countries. The good news is that they have fallen in South Africa, the country able to collect and provide the best data on the African continent. It also seems that the infection fatality rate (number of deaths) is falling everywhere.

The Numbers

There have been 29,571,333 cumulative Covid-19 cases globally. The peak of new cases was on 11th September with 319,888 cases, the previous highest number was on 14th August with 304,449 cases, however, the next three days saw remarkable falls. It may be too early to read too much into this.

The USA accounts for 6.6 million cases. Next are India, Brazil, Russia, Peru, Columbia, Mexico, South Africa, Spain, Argentina, Chile, France, Iran, and the UK. Table 1 shows selected countries by cases. It is worth looking at the table as the rate of increase in most of these countries is slowing.

There is a very worrying increase in cases in some European countries. In the UK the peak was 5,486 new daily cases on 7th April. The daily total fell from May and was down to between 500 and 1,000 up to August. It began to rise on the 6th and 7th of September and has continued to do so, reaching 3,545 cases on 9th September. This is a sharp increase but is important to remember this is the rate of positive tests. As Donald Trump pointed out, no tests no increase! The group experiencing the rise are mainly aged 17-21, but there is also an increase in 40-year olds. The increase is relatively consistent across the UK. Boris and his cabinet are increasingly concerned about a generalised second wave. Critically the rates of hospitalisation and death remain low. The response is discussed in a special below.

Table 1: Global and National Cumulative Numbers of Confirmed Covid-19 Cases (alphabetical order every 2 weeks)1, 2, 3
Date Global cases Brazil Chile∞ India∞ Mexico∞ Peru∞ Russia South Africa UK USA
15 Feb 69,000 0 2 0 9 43
4 Mar 93,000 4 3 0 86 149
18 Mar 201,500 372 147 116 2,600 7,800
1 Apr 861,000 6,836 2,777 1,400 29,900 213,400
15 Apr 1,982,552 28,280 24,490 2,415 94,845 609,422
29 Apr 3,117,756 79,685 93,399 4,996 162,350 1,012,583
13 May 4,262,799 180,000* 232,243 11,350 227,741 1,369,964
27 May 5,594,175 291,222 362,342 24,264 241,408β 1,681,418
10 Jun 7,250,909 739,503 493,023 52,991 262,098 1,979,893
24 Jun 9,264,569 1,145,906 264,689 456,183 196,847 264,689 598,878 106,108 277,200 2,347,022
8 Jul 11,830,885 1,668,539 312,911 742,417 261,750 312,911 693,215 215,885 286,979 2,996,098
29 Jul 16,741,049 2,483,191 349,800 1,531,669 402,697 395,005 827,509 459,761 302,295 4,352,083
17 Aug 22,145,643 3,407,354 388,855 2,767,253 531,239 549,321 930,276 592,144 322,177 5,482,602
3 Sep 25,761,430 3,950,931 413,145 3,769,523 606,036 657,129 997,972 628,259 339,415 6,075,652
16 Sep 29,576,191 4,382,263 437,983 5,020,359 676,487 738,020 1,069,873 651,521 376,670 6,606,293

As well as absolute numbers we need to look at rates. Belgium has the highest rate at 865 deaths per million. The UK is second. The US leads the number of cases per million. The daily death toll has fallen significantly. South Africa is down from fifth to eighth place in cumulative cases.4

Table 2: Covid-19 Deaths and Cases per million (alphabetical order)5
Belgium France Italy Russia South Korea South Africa Spain UK USA
Deaths (19 May) 421.07 529.64 18.84 5.13 5.26 593.04* 523.33 275.8
Total cases (20 May) 2,189 3,736 1,991 216 277 4,953 3,629 4,557
Deaths (3 June) 429.83 533.93 33.56 5.27 13.35 580.58 587.24 320.93
Total cases (2 or 3 June) 2,320 3,856 2,905 225 579 5,125 4,070 5,472
Deaths (17 June) 438.73 568.76 49.01 5.38 27.14 580.78 627.71 354.46
Total cases (16 or 17 June) 2,410 3,924 3,681 237 1,239 5,221 4,372 6,386
Deaths (1 July) 444 574 63 5 43 606 655 385
Total cases (30 June or 1 July) 2,516 3,976 4,393 249 2,432 5,140 4,595 7,826
Deaths (8 July) 444 575 64 5 46 606 657 388
Total cases (7 or 8 July) 2,759* 3,999 4,713 257 3,317 5,400 4,209 8,877
Deaths (22 July) 449 581 93 5.7 122 608 688 451
Total cases (21 July) 2,804 4,073 5,606 277 7,630 5,693 4,420 12,961
Deaths (12 August) 451 582 104 5.9 186 611 699 501
Total cases (13 August) 3,127 4,155 6,150 287 9,545 7,214 4,607 15,532
Deaths (26 August) 865 453 586 113 6 227 617 623 540
Total cases (25 August) 7,075 3,751 4,305 6,588 350 10,309 8,257 4,811 17,344
Deaths (8 September) 867 456 588 123 6 259 631 624 576
Total cases (8 September) 7,651 5,040 4,610 7,062 418 10,780 11,240° 5,157 19,035
Deaths (15 September) 869 460 589 128 7 268 638 626 592
Total cases (15 September) 8,129 5,932 4,775 7,320 436 10,972 12,112° 5,466 19,808

*misread these data °data from the previous one or two days

Responding

Growing numbers, growing control — the UK case

There has been a sense of panic in the English government over the past week. Daily press briefings have been reinstated. This is when two scientists flank a senior politician and try to hold a common line! The reason for this is that the number of new infections is rising. On the 11th September there were 3,544 cases, just 2,000 shy of the worst day of 22nd April which saw 5,505 cases. The government points out a different cohort of people being infected, the majority are young adults rather than the vulnerable elderly. These individuals are less likely to become symptomatic and require treatment. This is reflected in the mortality data, where the daily death toll is still frequently in single figures.

With Covid-19 cases and the R number rising above 1 for the first time in 6 months, governments have redoubled efforts to flatten the curve. New rules came into effect in the United Kingdom from Monday 14th of September.6 There is variation between England, Scotland, Wales and Northern Ireland. It bears repeating that the epidemic is a devolved responsibility. It may l, in my view, hasten the breakup of the Union. The SNP and Scottish nationalists are pushing for another referendum.

The new ‘rule of six’7 is in place for all adults meeting inside private homes. Children under 12 and under 11 are excluded from the six in Scotland and Wales respectively. In England the six can be from multiple households, in Wales they can be from an “extended household” and in Scotland and Northern Ireland they can be from two households. The rule of six, with the caveats, applies to outdoor meetings in England and Wales. Up to 30 people can meet in Wales, in Northern Ireland the magic number is 15. The police have the power to issue fines – but they keep stressing that this type of policing has to be by consent.

This has given rise to furious debate. What risk can and do people accept and who has the right to decide this? Will people ‘snitch’ on their neighbours if they break the rules? Writing in the Sunday Telegraph8 Salley Vickers’ states:

I don’t want the lives of our young to be mortgaged in order to spare me a few more years of mine: I would rather risk dying and have the joy of their company than lose that vital contribution to my own happiness’. … Don’t get me wrong. I am not a Covid denier. Covid is a menace and a real one. But to my mind, the downside of the means taken to tackle this challenge now far outweigh the gains. … hear this, Mr Hancock: I emphatically do not want my grandchildren growing up in fear for their lives, or, worse, fearful that they might unwittingly be the cause of my untimely death.

I would rather risk dying and have the certain joy of their company than lose that vital contribution to my own happiness, growth and emotional survival. Nor do I want the lives of our 17 to 25 year olds mortgaged in order to spare me a few more years of mine. Let us not allow this virus fracture our natural ties or lose sight of perspective, or worse still, hope.9

Vickers puts her fingers on the big issue. What level of disruption and lack of choice are we prepared to accept? At the macro-level economic and social shutdowns were initially accepted as necessary to prevent the spread of the virus and in particular to protect the elderly. The costs, economic, social, mental, and cultural have been huge. This year has been a year of deaths, not just the estimated (but probably undercounted one million deaths of Covid), but the death of normal life, the death of ambitions and plans, and the death of many forms of social interaction to name but a few. It is hardly surprising that we are collectively in mourning. In the UK:

‘The Government’s new strategy is no longer to minimise excess deaths, regardless of economic and social cost: it is to minimise excess deaths subject to keeping schools open and not crashing the economy. This is a less ridiculous optimisation problem. … predicated on a “budget” for total tolerable social interactions: any additional freedom in one area (such as schools) must be compensated by a reduction in another (family meetings).

This shift in the mathematics has mixed implications for the economy. The return to offices, in as much as it was ever going to happen, may even go into reverse. Strict restrictions will remain on public transport. … .unknown is the … flu season: it could trigger an explosion in self-isolation and Covid false alarms. The impact on the economy will be profound.’10

It is not just in the UK the numbers are rising, this is happening in Spain, France and Greece.

Falling numbers, falling restrictions — the South African scenario

When I started writing this blog I indicated the main countries I would cover were the UK and South Africa. The situation in South Africa is fascinating. The number of cases rose dramatically at the end of the lockdown from the middle of June, stood at high levels through July and fell equally rapidly from the beginning of August. On 15th September, according to the JHU data South Africa had a cumulative 650,749 cases and 15,499 deaths. The daily death toll is now fewer than 100.

Of greater interest is the number of people believed to have been infected. On the 4th September the Daily Maverick reported a survey of 2,700 pregnant women and people living with HIV using the public health system. It found 37% of pregnant women and 42% percent of people living with HIV tested positive for Covid-19. If anything, reported the researcher, “the low sensitivity of the test may mean we are slightly under-detecting the proportion of people who have been infected.”11 The data appears to be confirmed in an article in the same paper a few days later.

‘Between 35% and 40% of people living in densely populated areas … had probably been infected with the coronavirus, the latest figures available for the Western Cape and Gauteng show. …. (this) was way above the confirmed figure of 650,000; “it is more in the region of 15 million to 20 million”, Madhi12 said. “Nobody could have predicted what would happen in South Africa.” … initial infection models estimated that about 25% of the population would be infected. … the high prevalence of infections did not, however, translate into high rates of hospitalisations and deaths. … the theory he favours is South Africans had an “underpinning immunity, probably because of exposure to common cold coronaviruses” … offering cross-protective immunity against the Covid-19 virus.’13

Although the focus is on South Africa there is a similar question in Kenya. A report from Moi County Referral Hospital in Voi, Southern Kenya, found despite doctors preparing for the worst: stockpiling protective equipment and cutting routine services, the epidemic has not hit. The hospital’s 16-bed quarantine centre is almost empty.

‘We have only had about five positive cases out of about 1,000 tests we’ve done,” says one hospital worker. “Almost all the cases seem to be asymptomatic. We assume that there are some people dying in rural areas, but we have had no deaths here,” they added.

One scenario presented by the United Nations in April forecast that with no intervention, some 3.3 million Africans could die from the virus. Other predictions said hundreds of thousands of people would die within months. … workers say these dire projections have fallen flat. Kenya has … recorded some 35,000 cases of coronavirus and just 600 deaths.’14

South Africa is moving out of lockdown, but it is still at Alert level 2 where physical distancing and restrictions on leisure and social activities to prevent a resurgence of the virus remain in force.15 The influential Business News estimates ‘from a medical perspective, that the early and hard lockdown saved 16,000 lives by delaying the spread of the virus. This gave SA’s healthcare system time to prepare for the expected wave of infections and also helped local doctors apply treatments that had worked elsewhere, thus improving survival rates.’ But ‘we … know from Stats SA that second quarter GDP fell 51%, which translates into a R750-billion wipeout. Divide that by those 16,000 lives, and simple arithmetic gives us a cost of R46-million for each grateful citizen saved.’16 While we can debate exact numbers. The cost of the lockdown has been huge everywhere.


Guest Column: Small town experience in South Africa: in limbo or two steps forward and, maybe, one step back? By Tim Quinlan17

South Africans, we are told, are now emerging out of the worst of the Covid-19 epidemic. The ‘curve is flattening’. Many ‘lock-down’ restrictions have been removed. There is talk of soon having to contend with ‘Level 1’ restrictions only. I am not so sure about the optimism. Hope mixes with scepticism in my mind. It depends on what cap I wear: resident of a small rural town, health researcher, parent, or man who is ‘high-risk’ (male, older, smoker).

And so, I dwelt on which metaphors to use to describe living through lockdown in a small South African town. Being in limbo seemed apt for its various connotations. But I wasn’t brought up a Roman Catholic and so don’t know how to make that metaphor work. Hence, it is a prosaic idiom, two steps forward/one back. The “maybe” part signals uncertainty about where we are going.

I live in a rural town in the Overberg, Western Cape, 140km east of Cape Town – where the national road has an L-bend. The population is just over 5,000. There are two petrol stations, one at each end of the town, and a church mid-way. The big businesses are two industrial workshops, which can pretty well make or repair whatever a farmer needs. Some roads are tarred. There are an adequate number of shops and other services. A critical feature of this urban ecology during lockdown was the ready availability of cigarettes.

Most importantly, the town survived the Covid-19 hit relatively unscathed. For a month or so, there were no cases. Then, in the space of 5-6 weeks, the cases multiplied rapidly: from 5 to 12 to 64. To date, there have been a total of 77 cases, there are no active cases now, and no deaths, even amidst the cases among residents in a care home.

As importantly, there was and still is humanitarian assistance, involving coordinated activities by various churches and farmers. It has been a cold, hard winter. This is South Africa. There is a poor part of town with shacks. There are homeless people. The town had relatively low unemployment rates before March 2020, but wages are low for the majority of employed people. Post-March, several businesses closed. Not all have reopened. That is devastating in such a small population. For example, the fast food outlet at one petrol station, which employed at least 10 individuals, closed. It has not re-opened. It will reopen when a new owner decides to invest in it. The one at the other petrol station has re-opened but, seemingly, with half the number of staff who used to work there.

What, I think, has helped is the long-standing expertise of the doctors and nurses at the public health clinic, built up over the years of dealing with the HIV epidemic in poor populations. They know how to do community outreach work. Likewise, there is established expertise for collecting and distributing food and other support for the indigent.

But there are caveats. Our local police are now struggling with a rising crime rate which must have its roots in the increasing poverty in and around the town. At root, the epidemic exacerbates the vast social and economic inequalities and inequities in this country.

I am sceptical of some current political and health narratives. There is a lot of noise. One of the many platitudes uttered regularly by President Ramaphosa is the plan to build a “new economy”. What ‘new’ means, and how this will be done in a country which had 29% unemployment before the Covid-19 epidemic, has not been spelt out. I have doubts about politicians’ and medical scientists’ advocacy for a physical return of children to schools. That advocacy is not convincing for being primarily the perspective of medical science and evidence in terms of ‘what we know so far about the virus’. I am sceptical of advocacy that does not consider context; in this case, lack of consideration of practitioners’ and other scientists’ knowledge of the state of most of the country’s schools, the capabilities of the Education and Social Development ministries, and size of the school-going population that lives in multi-generational homes.

That said, in the case of my family, I was persuaded by my daughter’s appeals, coupled with wearing my researcher cap, to let her return to her government school. There has been a dramatic decrease in the incidence of Covid-19 infections in the small town where her school is located. I am impressed with their protocols and practices for preventing infections and managing any incident cases. The principal and teachers, it seems, have gone beyond the guidelines and thought through ‘what works.’ I am also reminded my daughter is not a tear-away teenager, nor are her friends. Here, I have to admit that my reticence to date was based partly on a prejudicial model: my ignorant, rebel without a cause mentality when I was her age. I can live with her exasperation in the face (literally) of my caveat that returning to school now is no guarantee for the same in the new year.

As for being a high-risk statistic, I run with the sound advice for social interactions which, for the most part, South Africans seem to still adhere to. As my family moves out into the wider world, I do not think I am different from many other people in making informed, uninformed, and cautious judgements. There are places to avoid if possible: hospitals for obvious reasons; police stations (‘hotspots’ of infection amongst policemen and women, who also are often not acknowledged as being on the ‘Covid frontline’); traffic licensing offices (always busy places); and shopping malls (can I trust the property managers to have sorted out the ventilation systems?).

All of which is to say, the experience has been about making decisions on the basis of limited information to define ‘acceptable risk’. The lack of adequate data on the epidemic can drive me to distraction. I have cause for hope from the data which shows that the virus transmission rate is slowing down. However, we have yet to see data allowing better insight into the course of the epidemic. This means data to reveal the links with the social and economic circumstances of those infected and affected; where in the country the prognosis looks good and does not; whether Covid-19 is likely to be endemic for a long time and, if so, where and amongst which sub-populations.

For the here and now, I am exploring an idea with a local doctor and, in due course, others involved in local community work. The suggestion is whether there is merit in doing some research: assessing the resilience of what is being done in this town to deal with Covid-19; possible future spikes; and the social and economic consequences.


Conclusion

Covid-19 has transformed the way we live. Were the right decisions made, was the trade-off between mortality and prosperity correct? These are big questions and they need to be addressed. It is likely the next set of major decisions will centre around focusing on climate change, which needs urgent action now to prevent major catastrophe and loss of life in a few short decades.

What I have learnt from watching this epidemic is that we simply do not have well enough developed skills to think across national borders and across disciplines within countries. In England there is SAGE18 and Alternate SAGE19 both made up of expert scientists and social scientists, but with different perspectives. In South Africa there is the government’s Ministerial Advisory Committee20 and the alternative PANDA.21

The political leadership at every level from local to international has been a real disappointment. This has recently been epitomised in Canada.22 Politicians are risk averse and have a short-term perspective. This is a problem. It is said a politician is someone who looks to the next election, a statesman or woman looks to the next generation. We need more of the latter. We need to understand this epidemic, where it came from, how we responded and whether the response was appropriate (my view is that it was correct initially but was not in the medium and long term).

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. These data are from Johns Hopkins University https://coronavirus.jhu.edu/map.html
  2. The UK data from 27th May is taken from Worldometers.info.coronavirus/country/uk
  3. *estimate ∞ these countries were added, early data is not included. β Data for the UK from Worldometer
  4. https://www.groundup.org.za/article/how-well-has-south-africa-done-reducing-covid-deaths/
  5. Deaths http://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/
    Case per million ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people
  6. https://www.bbc.co.uk/news/uk-51506729
  7. I think we are straying into the world of authors Arthur Conan Doyle or John Buchan here.
  8. Not my first choice of newspaper
  9. Salley Vickers, ‘I don’t want the lives of our young to be mortgaged in order to spare me a few more years of mine’ Sunday Telegraph 13th September 2020 https://www.telegraph.co.uk/family/grandparents/dont-want-lives-young-mortgaged-order-spare-years-mine/
  10. Allistair Heath, Britain’s second lockdown will be even more terrible than the first, 9th September 2020 https://www.telegraph.co.uk/news/2020/09/09/britains-second-lockdown-will-even-terrible-first
  11. http://www.dailymaverick.co.za/aricle/2020-09-04-covid-high-preavelnce-found-in-cape-town-antibody-study
  12. Madhi is Professor of Vaccinology and Director of the MRC Respiratory and Meningeal Pathogens Research Unit at the University of the Witwatersrand and a member of the Ministerial Advisory Committee
  13. Estelle Ellis, ‘Covid-19 may have already infected 20 million in South Africa, says Prof Madhi’ DAILY MAVERICK 14 September 2020, https://www.dailymaverick.co.za/article/2020-09-14-covid-19-may-have-already-infected-20-million-in-south-africa-says-prof-madhi/
  14. Will Brown, ‘No one really knows’: On the front line of Kenya’s coronavirus mystery Across Africa the huge death toll predicted at the beginning of the pandemic has simply not happened – the reasons why are still a mystery, The Sunday Telegraph, 14th September 2020 https://www.telegraph.co.uk/global-health/science-and-disease/no-one-really-knows-front-line-kenyas-coronavirus-mystery
  15. https://www.gov.za/coronavirus/alert-level-2
  16. https://www.biznews.com/premium/2020/09/14/sa-lockdown
  17. Tim Quinlan is a research associate at HEARD, University of KwaZulu-Natal. Trained as an anthropologist, he worked in environmental sciences for 12 years before engaging, in 2002, with HIV/AIDS research.
  18. https://www.gov.uk/government/organisations/scientific-advisory-group-for-emergencies
  19. https://www.independentsage.org/
  20. https://bhekisisa.org/resources/general-resource/2020-05-22-what-south-africas-covid-19-ministerial-advisory-committee-did-and-didnt-advise-on/
  21. https://www.pandata.org.za/
  22. https://www.theglobeandmail.com/canada/article-ottawa-appoints-new-management-to-strengthen-pandemic-surveillance/

Covid-19 Watch: Rebounds cause concern

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

We are moving towards autumn here; the early mornings are cool and the nights are drawing in. There should be a last burst of summer though, a few days of decent temperatures. Saturday was a reasonably warm day and I went to ride in the countryside. The Bure Valley Railway is a 15 inch (381 mm) minimum gauge heritage railway. It runs north of Norwich from Wroxham to Aylsham (9 miles or 14.5 kilometres), and is a major tourist attraction in the area.

The track bed is on the former Great Eastern Railway, originally opened in 1880. I suspect my grandfather (a Norfolk railway man who lived in a railway crossing keeper’s cottage at Tungate just outside North Walsham) and father will have known it when it was in operation. Passenger traffic ended in 1952 and freight in 1982, the wide gauge track was lifted soon after. Fortunately, Norfolk County Council ‘safeguarded’ closed railway lines for use as public footpaths. The narrow-gauge line was built through a partnership between local government and the private sector. I cycled the entire length of the line (and back), taking a little over two hours to do so. I enjoyed the peace and quiet but also enjoyed seeing the five or six trains running on the line.

The squirrel wars continue, and I am losing. The creature shows little fear of me but has learnt the sound of my office door opening means it should decamp as rapidly as possible, scooting through the treetops to its lair at the back of the garden. There are plenty of nuts, so we can have peaceful coexistence.

One of the big questions we are all asking is what the future will look like. Yanis Varoufakis, the left leaning economist and Greek Minister of Finance in 2015, has just published a new book called Another Now which sets out ways we might seek to get ourselves out of this mess. The concept of a basic income grant features prominently. The book is reviewed in the Guardian‘s Review of 5th September. He has some ideas that do not fit with my agenda. Nonetheless I think he is probably one of the key thinkers in the world today.
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Covid-19 Watch: Identifying the Vulnerable

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 weekend involved a journey to visit family in East Yorkshire and, in particular, an elderly relative. This is one of the reasons why this blog is later and shorter than usual. We were able to do this as there is no longer a blanket ban on travelling and visiting people. It was a learning experience. It made me aware it was time to focus on some of the more vulnerable groups in our society.

Back in Norwich, the nuts are falling from the walnut tree in the garden. There will be an exceptional crop this year, enough so the squirrel has not been able to steal them all. They drive us wild by planting them around the garden, so we end up with walnut tree saplings. I don’t mind sharing, but I do object to being taken for granted so have invested in a powerful water gun!

I spent a happy hour or so shucking the green exterior off the nuts. The problem is that I was not wearing gloves, so my fingers are now stained a very dark brown. Google was not helpful. My first question: ‘how does one harvest walnuts?’, the answer ‘hit and shake the branches’. The second, ‘how to get walnut stains off your hands?’. The answer: ‘Wash your hands thoroughly, using a good quality soap and warm water. Apply lemon juice. Follow up with a round of cooking oil. Wash up.’ Well… not really! Gloves are going to be needed in the future!
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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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Covid-19 Watch: I don’t think I understand anything anymore!

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 year I turned 50, rather a long time ago, I decided I wanted to acquire three new skills. These were learning to fly a small plane; bodyboarding (I recognised ‘standing-up’ surfing was already beyond me); and ballroom dancing. I tried all and can do none. Flying was fantastic fun. I accumulated 24 hours, but the minimum to get a license is 44. Taking off was amazing: powering down the runway; pulling back the stick; lifting off; levelling out to pick up more speed; and then up and off. The problem was landing – the instructor said, “Alan I can teach you how to fly, but I can’t teach you how to land, you have to feel the moment when the wheels touch down and you take the power off”. Thinking, talking, and writing about Covid-19 feels a bit like this. We got up, and now do not know how to get down, making up the checklists as we go.1

This week I want to pose a conundrum and ask if anyone has any insights. The conundrum is: at the beginning of the epidemic it was suggested the virus would rampage through populations. So far it has not, or at least not to the levels predicted, and this is especially the case in Africa at the moment. It was discussed in the covid19ssa google group chat I am a part of. One contribution was headed ‘a tempest in a teapot?’.

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Covid-19 Watch: Reflection and consolidation

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

It has been five months since the first blog was posted in early March, ‘Covid 19 (the SARS-C0V-2) and you’. Since then it has become a weekly event, often bolstered, and supported with the help of friends writing guest columns. The pandemic has exceeded my worst fears; numbers are increasing almost exponentially. On 4th March there were a mere 93,000 cases, mostly in China. Today there are close to 19,000,000 and the largest number is in the US. I watched the pandemic and the responses particularly closely in the UK and South Africa. In one, the reaction has been confused and inconsistent, and in the other ineffectual. See below!

The first post was meant to be a quick ‘fact sheet’: what we know, what we don’t know, and what we need to know. How did we get to this parlous situation five months later? This is my blog, so I will touch on what Covid-19 has meant for me. As I am on sabbatical this year, I am not in Waterloo Ontario, but in Norwich with my family. We have a pleasant garden and so I have not felt confined, however, this would not have been the case in Waterloo.

Our lockdown in the UK began on 19th March. We were told to stay at home, except for essential trips, and for one hour of exercise per day. We took the exercise instruction seriously, but being rebellious, I spent between up to two hours walking or cycling. The pandemic means I am considerably fitter! Unfortunately, increased alcohol consumption means I am not any thinner!

Cycling is something I have not done for decades. Once I had the bikes unearthed and serviced, I re-discovered how much fun it is. The ride to Norwich market, at a sedate pace, takes 40 minutes. On Monday I cycled to The Eagle, a ‘gastropub’, which means a good menu and excellent food for lunch with a friend from University (45 years ago).

The Eagle was named originally for Michael “Eddie the Eagle” Edwards, who represented Great Britain in the 1988 Olympic ski jumping, the first Briton since 1928. He got into the team through amazing persistence and finished last in both events he entered. There is a 2016 film called, unsurprisingly, Eddie the Eagle. He ranks alongside Eric Moussambani Malonga, (Eric the Eel) the 2000 Olympics Equatorial Guinean ‘swimmer’, who won his heat as other competitors were disqualified and holds the record for the slowest ever Olympic 100 metres freestyle.1

Norwich is well known for pubs and churches. It used to be said that there was a pub for every day of the year and a church for every Sunday. Cycling home, I passed one church that never ceases to amuse me. The Zoar Baptist Chapel, built in 1886, advertises itself as “Zoar Strict and Particular Baptist Chapel St Mary’s Place”. It would be worth going to a service just to experience it.

Part of the reason for going out for my lunch was because it was the first day of the ‘meal deals’ announced by the British Chancellor. In August, from Mondays to Wednesdays, half the cost of a meal, up to the value of £10 per customer, will be paid by the government. Sensibly alcohol is excluded from the offer. This is one of the ways Chancellor Sunak hopes to get the economy moving. It begins as the generous furlough scheme ends. There are still furlough options, but employers have to contribute to the costs now. The next few months and years will be exceedingly difficult for many.
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Covid-19 Watch: Unexpected Surges: Local Responses?

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 are 16,741,049 million Covid-19 cases globally. The USA accounts for the most, at around 4.3 million cases. Brazil is second, India third, Russia fourth, and South Africa fifth. Peru, Mexico, Chile, the United Kingdom, and Iran make up the rest of the top ten. The global new case curve is steepening.

The guest column this week is by my colleague; Ronald Quejas-Risdon, who worked for many years as a United Nations Peacekeeper. He ended up in Norwich where I met him at United Nations Association meetings. He recently moved back to the USA, so who better to write a comparative ‘view from the street’.

The big news in the UK is the decision to impose a 14-day quarantine on anyone travelling from Spain. This was done at short notice and is causing disquiet among travellers and tourist operators. It depends on the returning individuals to do this voluntarily. There is neither the capacity nor the appetite to police it. Indeed, I wonder how many people will say, as one person interviewed on the media did, ‘the hell with this’. At the same time, albeit with more notice, compulsory wearing of face masks in shops was introduced from the 24th July in England.

Two personal observations. One of my younger and fitter colleagues spent eight days on oxygen in a hospital in Durban, we are all relieved that he has been discharged. Second is that in Norwich nearly everyone is wearing face masks. Despite, or perhaps because of this, the shopping areas and town centre seem very empty. I am not sure that is what economic recovery looks like!
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Covid-19 Watch: Considering Curves

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 week there were just under 15 million Covid-19 cases globally. The USA accounts for the most, at around 3.9 million cases. South Africa is in fifth place, with Brazil second, India third, and Russia fourth. Peru, Mexico, Chile, the United Kingdom, and Iran make up the balance of the top ten. The global curve of new cases appears to be steepening.

In this week’s communique I am delighted to include a guest column by Katherine Marshall and Olivia Wilkinson, What’s faith got to do with COVID-19? Apart from being well qualified to contribute, they cover an important topic. The role of faith is central, in terms of response and providing people succour and meaning.

By now we know that almost all recover from this virus, some are not even aware they are infected. Those who do end up in hospital, on oxygen or ventilators, are seriously ill and may suffer long term ill health. A small number die. Mortality from Covid-19 is higher than seasonal flu, although much below SARS, MERS and the bird flus of the last two decades. The distinguishing features are the period of asymptomatic infectiousness; the highly contagious nature of the virus; lack of treatment; the astronomical numbers we are seeing; the incredible disruption to lives, including the economic catastrophe we are facing; and the sense we do not yet have answers – either vaccines or treatment.
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Covid-19 Watch: Back and Forth, Up and Down: A Deadly Dance

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 year marked the first time since 1992 that I was not involved in the International AIDS Conference, organised by the Geneva-based International AIDS Society (IAS). It was scheduled to be held in Oakland, San Francisco, and would have attracted up to 25,000 delegates. I would have been amongst them. I was on the IAS Governing Council for 12 years, the last four as Treasurer, so my heart went out to the staff, executive and Governing Council. This will have been a blow. However, there was a swift pivot and the virtual meeting included a great deal of material on Covid. I watched online presentations and will refer to some. It is clunky, but will improve. One panel, highlighted below: “COVID beyond the health”.

This week it is time to reflect on the Covid-19 numbers and how they have changed over the past few months. There have been significant changes in the ‘hotspots’, however the global trend is, tragically, upwards. The two clear messages are: there needs to be constant vigilance against the introduction of new cases, which has been seen in New Zealand and Australia, as well as outbreaks in some European countries; the second is the rate of spread can be exceptionally rapid.
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