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!

Reconnecting with the country

Earlier this month I did a six-day road trip from Cape Town to Durban. My travelling companion was an old friend: a gaunt, chain smoking (when he had the chance and not in the car, hotels or restaurants), grey haired academic, who shall be called Sancho, after Don Quixote’ Sancho Panza, he was going to remain nameless, but that did not work. We have been friends for over 35 years, having originally met on the touch rugby field in Durban in the 1980s. The game took place, once a week, for well over 20 years. It was ‘the left’ at play, and some deep long-term friendships developed.

I am not going to make this a ‘traditional’ travelogue, so let me quickly get the description of the trip out of the way. I will put in the links throughout.

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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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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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Heat and Humidity

The Canadian summer has been hot and humid. I have never enjoyed humidity and so wonder why I managed to do summers in South Africa and Canada. The UN held a Climate Summit in September and there is increasing recognition of the environmental crisis we are facing. Earlier, in mid-September, the running news bar on the BBC was that the bird population has fallen precipitously in North America. In Waterloo there was a climate strike day on the 27th and people marched from the Universities to the town square. There were thousands of participants and I was proud to be among them.

Another running news bar on the BBC has been that ‘flight shaming’ means the growth in airline travel is expected to fall. Looking back more than 40 years I was so excited to take my first flight. I got a ride from Mbabane to Johannesburg, and boarded a flight to Heathrow to go to University. At 19, this was the first time I had been on a plane. I have a record of all the flights I took on a computer file, it is a bit scary.

Today when I board a plane I feel somewhat guilty. It is my intention to drastically reduce the amount of air travel and increase the amount of train travel. From Norwich to London is two hours by rail, and from there it is easy to get to Brussels or Paris. Plans for 2020 including going to Ireland (Norwich, London, Fishguard and the ferry to Dublin), and, perhaps, Amsterdam (Norwich, Harwich and ferry to Rotterdam). The possibilities are numerous.

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Frying in Norfolk

Anyone who denies climate change, and more specifically, global warming, is seriously wrong. At the end of August we had record temperatures in Norwich. Fortunately it cooled down in the evenings so sleeping has not been too difficult. However, this summer the rowan tree in the front garden died from a mixture of disease and heat stress. Ailsa has been using the water from the rain butts to keep some of her favourite plants alive, but it is an uphill battle. It presents a dismal picture and I really wonder what the next 10 to 20 years will hold. I am increasingly aware of my contribution to this crisis, particularly through flying, but I do not consider myself to be a flamboyant consumer of other things.

Having said that, I have to begin this blog by reflecting on my travelling over the past month. My final class in Waterloo was on 30th July. I had to complete the marking and submit the marks by 8th August. I was able to do this, and almost all of the students should have been pleased with the outcome. The temperatures and humidity gradually rose in Waterloo, and I was glad to be heading for Norwich. I did not realise how hot Norwich was going to be.

I travelled over on Sunday 11th August, flying via Amsterdam. Toronto to Amsterdam is not all that long, just 7½ hours. This is not long enough to take a sleeping pill, so I sat and watched the film ‘Red Joan’. This was about a British woman who became a Soviet spy in the 1940s and 50s. Oddly I was reading a book called ‘And Is There Honey Still For Tea?’, by Peter Murphy, set in the same time period and covering the same topics. It is hard to believe how much skullduggery there was going on then. I guess it is still happening, with electronic surveillance playing an ever-increasing role.

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A Dry Spell

It seems that the weather dominates the opening paragraphs of my monthly posts. At the end of June there was a very warm spell in Norwich, and no rain for over two weeks. More worrying is there is no rain in the forecast for at least 10 days. A stubborn area of high pressure has located itself over us. Of course East Anglia is the driest part of the British Isles, not widely known, but this has been quite exceptional. Some of the plants in the garden are given favoured treatment. They get water from the butts that drain off the roof of shed. The lawn, however, does not, and it is beginning to look rather the worse for wear.

My sister came up from London to visit for a weekend. Ailsa was away visiting her mother so Douglas and I were in charge. I think we acquitted ourselves well. We had thought of going to see a film, the choices at the local cinema were the ‘Happy Prince’ or ‘Oceans Eight’. In the end we did not. The weather was so pleasant that sitting inside a cinema would have seemed like heresy. What we did do was to go eat in Waterloo Park.

I have mentioned before that Norwich has some amazing municipal parks. In 1919 Captain Sandys-Winsch was appointed as the City Parks and Gardens Superintendent, and he stayed in the post until 1953. He is largely responsible for the fine public parks. There was government funding after World War I as part of a building and planting programme to provide unemployment relief, aimed mainly at ex-service men. Waterloo Park actually predated this, it began in 1904 as Catton Recreation Ground. A new design was drawn up in 1929, and in 1933 it reopened as Waterloo Park. It is 18 acres with a mixture of play areas and gardens, with lots of magnificent trees. There is, as in most of the parks, a pavilion which has a café.

There are many reasons to visit the park, but at the weekend we went for brunch. The café is run by Britannia Enterprises and most of the staff at this, and the two other sites, are serving or ex-offenders from Her Majesty’s Prison in Norwich. The project aims to offer mentoring, training, employment and rehabilitation to prisoners. They claim that just five percent of participants in the programme re-offend, compared to the national average of 46 percent. It is an excellent example of a social enterprise, and the food is good and reasonably priced. As it was such a beautiful, warm and sunny day, we were able to sit outside, and that meant we could take the dog.

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Driving and relaxing

I finished teaching in Konstanz on Friday 3rd November. Rowan arrived on the Wednesday before this. The cancellation of a train from Zurich Airport meant she got in sometime later than we hoped. As predicted by the family, she got the bedroom and I took over the sofa bed in the apartment’s lounge. This made sense since I get up frequently during the night. She had only two full days in the town and we went to Friedrichshafen and the Spa, both second visits for me, but no less enjoyable. She came to class on the Friday, my last session. All students produced blog posts, those who wanted, have them posted with this blog.

On Saturday 4th November we flew from Zurich to Amsterdam and stayed in an Ibis Budget hotel not far from the airport. The actual hotel was very basic but entirely fine, the rooms sleep three people with a bunk bed arrangement over the double bed. There should, perhaps, be a warning “Beware of falling children”.

It seemed a very remote spot and I was not confident of our ability to get into the city. The receptionist said confidently that there was a bus stop across the road, and the bus, a number 193, went punctually every 15 minutes. I expected a lonely pole on the banks of a drainage ditch, but instead it was a busy barn sized structure with numerous buses. All we had to do was cross four lanes of traffic. We went to Leidseplein near the centre of Amsterdam, found a decent restaurant, enjoyed a good meal, and got the bus back with no difficulty at all.

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Halloween in Germany

I had the opportunity to spend two weeks teaching at the University of Konstanz in the state of Baden-Württemberg on the border with Switzerland. I decided to jump at the chance, so am, I think, the first academic to come over from the Balsillie School and do this stint. The idea was to spend a fortnight here in Germany, and teach 14 sessions on a Global Health and HIV and AIDS. The University covered my costs.

There was an additional reason though. Due to the tax rules in the UK I am severely penalized if I spend more than 90 days in Britain. This trip to Europe was therefore a really good opportunity to see a new University, teach different students, and have time with the family. They had to come to Germany for this to happen. Douglas and I travelled together on Saturday 21st October. He left on Wednesday. Ailsa came from Thursday to Sunday and the plan is that Rowan will join me on the last Wednesday. We will then leave together on Saturday and travel to Amsterdam for a night. From there she will fly to Norwich while I go to Cape Town.

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