Showing posts from category: Public health,
Behind the Coronavirus Counts, How well do the Numbers Stack up?
Every day we are reminded of the global reach of the novel coronavirus crisis. We know it’s a pandemic because WHO and other health agencies publish data showing that 211 countries and territories have been affected by the disease. The international media coverage tends to focus largely on the unenviable “big five” chart-toppers who have been most affected – the US, Italy, Spain, France and the UK. A number of sites publish constantly updated lists of the growing toll of Covid-19 casualties, a sort of sombre “score card” listing all the countries who have recorded instances of the disease.
Confirmed Coronavirus Cases: Globally tracked, country-by-country – as @ 23-Apr-2020
Sources: WHO http://covid19.who.int/;
Country Total cases Total deaths Region
USA 850,000 47,700 Americas
Italy 188,000 25,500 Western Europe
Spain 208,500 21,750 Western Europe
France 160,000 21,500 Western Europe
UK 134,000 18,300 Western Europe
http://worldometers.info/
When we scroll through the world tables of where the pandemic has landed, it’s instructive to look at the comparative totals by continent – Europe has a bit over 1.28 million confirmed cases recorded, and the Americas, 995,510 (predominantly from the US), compare these to South-East Asia, a bit more than 38,572 and Africa, a mere 18,234 cases✺✺.
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From a statistical standpoint we might wonder if the published data gives a true impression of the extent of of the pandemic? It needs to be kept in mind that the numbers we have are those that have been reported to the World Health Organisation. Population differences aside, it is clear that the low numbers in South-East Asia and Africa (examples: Cambodia 122 cases, zero fatalities✺✺, Myanmar 139 cases, five fatalities✺✺, Ghana 1,279 cases, 10 fatalities✺✺, Ethiopia 117 cases, three fatalities✺✺) mask the full impact of the catastrophe. They are a product of limited testing by countries in these regions … widespread poverty, surplus populations, lack of resources and infrastructure mitigate against the capacity to take corrective, safety monitoring measures.
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Limited testing capacity and weak surveillance The small numbers of recorded cases and handful of reported deaths in Africa and S.E. Asia (the Caribbean is another such case in point) can engender a false security and justify a lack of action by such already economically and health-challenged countries, thus the risk of infections spreading is magnified. In the early phases of the outbreak some S.E. Asian states were slow to acknowledge the risks…even as late as mid-March, Myanmar’s government was still attributing it’s low number of cases to the superior “lifestyle and diet” of the locals. The fight against Covid-19 by Third World countries is further retarded by a failure to test widely and in the numbers necessitated by the crisis. It shouldn’t be overlooked that some of these countries have quite repressive regimes that don’t rank the goal of a universal healthcare system as their highest priority [‘Experts Doubt Low Coronavirus Counts of Some Southeast Asian Countries’, (Zsombor Peter), VOA, 29-Mar-2020, www.voanews.com].
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For the bulk of African countries the story is similar. A by-product of their lack of development is that their health systems are fragile before the onset of coronavirus hits them. Awareness of the inability to cope with a full-blown health crisis, had led some leaders to advocate so-called “miracle cures” for the virus (eg, Madagascar’s president’s championing of untested traditional plant remedies). Nigeria (Africa’s largest nation by population) shows only 981 confirmed cases and 31 deaths✺✺ to date but is looking as vulnerable as anyone in Africa. Oil exports are the hub of Nigeria’s economy and the fall of the world’s crude oil price to a record low will hamstrung the country’s efforts to contain any future eruptions of the disease [‘Coronavirus: How drop in oil price affects Nigeria’s economy’, (Michael Eboh), Vanguard, 17-Mar-2020, www.vanguardngr.com]. The outbreak of pandemic hotspots in Nigeria could be devastating, especially in the north, given the country’s population of nearly 200 million people and it’s inadequate healthcare capacity⋉.
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Too good to be …
Some countries have reported being lightly or relatively lightly touched by the onslaught of the coronavirus, these results have surprised outside observers. One such country that raises eyebrows in this respect is Russia. The republic has 146 million people and shares long borders with China⤱, yet it fesses up to having had only 68,622 cases✺✺ (well under half of that of the UK) and suffered only a comparatively low 615 deaths✺✺ from the epidemic (most of those since the start of April). If you cast aside the anomalies, on paper it’s an excellent result! But whether Soviet or post-Soviet, there’s always an air of suspicious doubt about Russian information. The Russian Bear has had form in the past with cover-ups…a prime example—the Soviet Union throwing a tarpaulin over the Chernobyl nuclear disaster in the 1980s —indicative of a less than honest response to major disasters [‘The Very Low Number of Russia’s Reported COVID-19 Cases Raises Questions of a Cover-Up’, (Rick Moran), PJ Media, 22-Mar-2020, www.pjmedia.com].
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Russia, if it so erred, is not “Robinson Crusoe” in deliberately underreporting the pandemic’s effect. China for nearly three months from the initial outbreak didn’t include asymptomatic patients in the official stats, and only rectified this oversight on April Fools Day [‘China acknowledges underreporting coronavirus cases in official count’, (Mark Moore), New York Post, 01-Apr-2001, www.nypost.com]. For six weeks after WHO declared a global health emergency Indonesia did not report a single Covid-19 case (unlike most of it’s S.E. Asian neighbours). Considering the republic’s population size (more than 270 million) and it’s close links with China, this aroused widespread suspicion of underreporting and criticism in a Harvard University study which seemed to belatedly jolt Indonesia into disclosure. The first notification by Djakarta of coronavirus cases occurred on 2nd March, and from then on Indonesia’s curve has been on an upward trajectory – currently 8,211 cases, 689 deaths✺✺ [‘Why are there no reported cases of coronavirus in Indonesia?’, (Randy Mulyanto & Febriana Firdaus), Aljazeera, 18-Feb-2020, www.aljazeera.com].
Doubting a hermetically-sealed “Hermit Kingdom” North-East Asia’s renegade, secretive state, North Korea, can be added to the list of countries purporting to be Covid-19–free. Pyongyang‘s official line has been met with disbelief from several external sources such as South Korea and Radio Free Europe which asserts that disclosures from within North Korean military circles confirm the occurrence of coronavirus cases in the border areas [‘What Is the Coronavirus Doing to North Korea’, (Nicholas Eberstadt), New York Times, 22-Apr-2020, www.nytimes.com]
Addendum: (Coronavirus as at 0130 hrs EAT time, 25-April-2020) USA 890,200 cases | 50,403 deaths Italy 189,973 cases | 25,549 deaths Spain 219,764 cases | 22,524 deaths France 158,183 cases | 21,856 deaths UK 143,464 cases | 19,506 deaths
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✺✺ figures as at 0130 hrs EAT time, 25-Apr-2020
⋉ just over the last week the African continent experienced a sudden surge in infections, ‘Africa’s 43% jump in virus cases in 1 week worries experts’, (Gerard Zim Rae), ABC News, 23-Apr-2020, www.abcnews.go.com
⤱ although Russia did close its eastern border with China after the virus breakout
Revisiting the Coronavirus Origin Theories
(Image: KPBS)
China notified the World Health Organisation on 31 December 2019 of a series of “pneumonia-like” cases popping up in Wuhan, however it took some time for peripheral parts of the country to get wind of the burgeoning health crisis. Information from the government, when it did come, was pretty sketchy in the early stages of the outbreak. Soon after Chinese migrant workers began returning home from Wuhan, rumours of what might have caused the virus started to circulate in the regions.
Zoonotic source As the infection rates in Wuhan and Hubei province started to steeple in early February, there was lots of speculations about animal transmission to coronavirus’ “Patient Zero”. Civets, snakes, seafood, wolf cubs, rats—all live wildlife sold at the Wuhan ‘wet’ markets—got mentions as possible candidates for transmission. The story most heard and retold at the time was that it was bats that had transmitted the pathogen to humans at the Hua’nan markets⌧ (‘How It All Started: China’s Early Coronavirus Missteps’, (J Page, WX Fan & N Khan), WSJ, 06-Mar-2020), www.wsj.com). The Rhinolophus bat (Horseshoe bat) has been identified as the specific type of bat likely to have carried the infection (‘Coronavirus animal origin’, Crikey, 16-Apr-2020, www.crickey.com.au). A few weeks later there was a new prime suspect – the pangolin, the world’s most trafficked mammal. Chinese virologists⚘ had traced the virus to pangolins being sold at those same seafood markets in Wuhan (‘Mystery deepens over animal source of coronavirus’, (David Cyrenoski), Nature, 26-Feb-2020, www.nature.com).
(Image: Frans Lanting / National Geographic)
The inevitable conspiracy theories: Genetically-engineered virus Since February China and the US have exchanged accusations that Covid-19 was deliberately created as a biological weapon—all without foundation (‘No, COVID-19 Coronavirus Was Not Bioengineered. Here’s The Research That Debunks That Idea’, (Bruce Y Lee), Forbes, 17-Mar-2020, www.forbes.com). Chinese officials have also made the wild claim that the US Army brought the virus to Wuhan when it participated in the Military Games in the city in October last year.
🔺 Wuhan markets (Photo: NOEL CELIS /AFP via Getty Images)
Over the last couple of months, another story disseminated by southern Republicans has been doing the rounds of the conservative media in America. It espouses the view that coronavirus originated not from a wet market but from a biosafety lab in Wuhan (Wuhan Institute of Virology), from an accidental leakage. Again this view is bereft of any hard evidence to support it but this hasn’t stopped President Trump and his allies at Fox from seizing on it!✱ (“’Biological Chernobyl’: How China’s secrecy fueled coronavirus suspicions”, (Q Forgey, D Lippmann, N Bertrand & L Morello), Politico, 17-Apr-2020, www.politico.com).
While Covid-19 continues to wreak its trail of carnage worldwide, media and social media platforms will no doubt continue to throw up theories about the causes but until China releases the clinical and epidemiological data on the Wuhan outbreak, the pandemic’s precise origin cannot be scientifically determined (Politico).
🔺 Exporting America’s homegrown “Gates-gate”conspiracy – ‘Covidiocy‘ to Melbourne (Photo: AAP/Ricky Barbour)
______________________________________________ ⌧ bats are major reservoirs of many viruses, and prevalent in both the SARS and MERS outbreaks ⚘ scientific evidence for the pangolin as the culprit is based on a high match of its genome sequencing with that of SARS-CoV-2, however the research remains unpublished and therefore unreviewed; it is thought that pangolins may have been intermediate hosts for the disease … bat ⇝ pangolin ⇝ human ✱ these are only the less implausible theories, a raft of other ludicrous and wacky conspiratorial notions have been floated purporting to explain the epidemic’s genesis – ranging from Bill Gates having manufactured the virus to establish himself as the ‘Czar’ of US health care, to Covid-19 being caused by the installation of the 5G cellphone network (‘Coronavirus spawns conspiracy theories’, (David Knowles), Yahoo!news, 18-Apr-2020, www.yahoonews.com)
The Fight against the Coronavirus Pandemic: Reflecting on the Numbers
The war against the coronavirus outbreak is indeed global, infecting to date 199 countries and territories and every continent with the possible exception of (largely and seasonally unpopulated) Antartica. Every day the apps on social media and the news broadcasts inform us of the rising tally of coronavirus cases and of the fatalities, but what we do know is that these totals do not convey a true picture of the populations affected by the virus. They are often an indicator only, a way of charting the trajectory of the elusive curve that every health service and provincial and national government strives to flatten.
Distribution of Covid-19 cases worldwide, 31-Mar-2020 (www.ecdc.europa.eu)
The complexity of the disease partly explains the inexactness. That being infected with coronavirus can be asymptomatic and remains recordable for those never tested, highlights this problem. On a country by country basis the uncertainty over numbers magnifies. Some countries (a lot in Africa for instance) have no or minimal records of testing, which is not the same as saying they have no coronavirus cases! The reason for this might lie in the fact these predominantly impoverished countries have not the wherewithal nor the infrastructure to test even significant numbers of the population, they simply can’t cope. Thus their true numbers are never ascertained. There are other countries in the world who are motivated by reasons other than capacity to report the incidence of infection and mortality, eg, a desire to mask the extent of the calamity for domestic or external purposes.
Geographical distribution of Covid-19 cases worldwide, 31-Mar-2020 (www.ecdc.europa.eu)
The media’s daily servings, the table of virus mortality and morbidity gives us the bare bones of the depth of the human catastrophe — Italy a disaster, Spain a disaster, China a disaster but seemingly over the hump, Iran shockingly bad, France shockingly bad, USA very bad but likely to become even more catastrophic, UK and Netherlands, both worsening, etc. But of equal curiosity is those countries positioned much lower on the ladder of gloom that stand out as demographic anomalies, their numbers almost too good to believe…indeed! Two such are Russia and India. Russia, a vast country with around 145 million people has fessed up to just 17 deaths⋇. On face value a result that would hearten the most pessimistic, but you have to wonder about the level of reportage? India, with 1.3 billion-plus people has so far recorded a mere 32 deaths⋇ (compared to Italy with 60 million people which has lost just shy of 11,600 lives⋇). With India, the lowness of the figure is overshadowed by the inevitability of magnification…the sheer mass of humanity confined within such an acute density of space means that for the substrata of Indians, the poorest classes, no matter how earnestly their prime minister entreats them, they simply cannot physically isolate themselves. The directive from on high to keep a “social distance” from others to ward off the virulent effect of the epidemic remains for the vast masses a pipe dream. That many, many of these unfortunate souls will not escape infection and worse—either recorded or unrecorded—remains inevitable.
At 26-Mar-2020 (Source: Newsweek Statista)
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⋇ as at 1515 hrs, Greenwich Mean-time, 31st March 2020, ‘Confirmed Cases and Deaths by Country, Territory, or Conveyance’, www.worldometers.info/
The COVID-19 Crisis: Are We Creating a Whole Generation of New Scofflaws?
Scofflaw: (n) as neologisms go, the word scofflaw has an interesting back story. It is a portmanteau word, derived by combining scoff + law. Scofflaw’s origin came about in 1923 when Massachusetts banker Delcevare King offered up a prize of $200 in gold to the American public for the best word which described “the lawless drinker”.. America being knee-deep in the era of Prohibition at the time and King being one of Prohibition’s greatest zealots. The winning entry (in fact ‘entries’, as two separate entrants submitted the same word), came from Henry Irving Dale and Kate L Butler (who herself was a Anti-Saloon Leaguer) who shared the prize. ‘Scofflaw’ beat a field of over 25,000 entries which included ‘boozocrat’ and ‘boozshevik’ (“DELCEVARE KING, BANKER, 89 DEAD; Prohibitionist’s Contest Led to Coining of ‘Scofflaw’ “, New York Times, 22-Mar-1964; “Ken Burns & Lynn Novick: Prohibition”, PBS, broadcast 2011, www.pbs.org). So, it’s original meaning was someone who drinks illegally (earning the opprobrium of prohibitionists like Mr King) or someone who mocks (scoffs) or ridicules anti-drinking laws. Over time scofflaw was extended to mean “a person who flouts the law, especially by failing to comply with a law that is difficult to enforce effectively”…in the US since the 1950s the word has largely been applied to individuals who habitually violate laws of a less serious, non-criminal nature, especially traffic violations (‘Scofflaw’ Wikipedia, http://en.m.wikipedia.org/; www.thefreedictionary.com/).
Prohibition: confiscating barrels of illegal grog in America (Source: Pinterest)
As part of the government mantra directed towards us home-front civilians in the war on coronavirus, we are asked by our leaders, entreated even, to practice safe social distancing. In the early days of the war against the invisible biological enemy we were told to immediately implement social distancing from others at all times. Later this was quantified and codified – 1.5 metres distance outdoors from others, no congregations of people of more than 500, indoors a four to one ratio, no more than 25 people in a room 100 square metres. And yet at the same time—this is where the mixed messaging starts to gain traction—we were told we can keep using public transport to go to work or school or uni or TAFE. So we pile onto crowded buses, trains and LRVs like the George Street ‘Snail’, at peak time. We shop in scarcity-hit supermarkets teeming with increasingly chaotic shoppers, we sit in class rooms and cafés and pubs and restaurants, or line up in the ever-lengthening queues of the recently unemployed outside Centrelink offices – in all instances numerically and spatially infringing the prescribed limits✱. We should all, even the politicians, shout as one – “I’m a violator!” All of us at some point have been or will be violators – by design or default!
Bondi: defying the coronavirus warnings (Source: AAP)
Scofflaws and recusants of the world unite!And what of those other violators of social distancing in this time of pestilence, the beach-going masses whose capers—from Sydney all the way to Florida—the media have revelled in? The beach-goers at Bondi and other popular summer-time beaches who are either indifferent or wilfully tone-deaf to the authorities’ daily mantra of abstinence or are pleading ignorance of the messages on the grounds of being Generation X, Y, Z, Millennials, Xennials (or whatever term you prefer) and therefore invincible. We can add peripatetic domestic tourists currently roaming around the country to the list of sloth-minded transgressors. Whether the violators are blatantly snubbing their noses at society and authority or are forced by circumstance into breaking the government’s edicts, the trajectory of the crisis suggests that a new generation of scofflaws is in the making. These multitudes, theses new scofflaws or recusants, some with a very deliberate rationale of defiance, will undoubtably continue to breach government warnings and (now) rules on social distancing and contact as the crisis continues⊞, replacing the traditional notion we have of scofflaws – unrepentant recidivists who accumulate unpaid parking fines or debts, ignore summonses or graffiti public or private property.
Given the sheer impossibility of compelling all citizens to maintain social distances in public (considering the scale of the enterprise and the limitations of the enforcement agencies), it will probably come down to the will and commitment of governments and bureaucracies to enforce these rules. The stick is already out…the NSW police minister has announced that individuals breaching the social distancing guidelines will be instantly fined $1,000 or even jailed (this second option however is highly implausible in the present health climate which sees the country’s prisons under fire for crowding too many inmates in together!) (‘Breaking social distancing rules will lead to on-the-spot fines of $1,000’, ABC News, 25-Mar-2020, www.abcnews.com.au). Tough talk✬ but it remains to be seen how thoroughly this threat to act will be prosecuted or how practical it will be to implement. You can also expect the civil libertarians of the community to come out in earnest support of the Covid scofflaws, defending to the last adjective their right to freedom of movement. Watch this space.
Footnote: Of course the opposite could also happen – if recent reports of public reactions to self-isolation are an indication. We may witness a whole lot of people coming out of the woodwork, channeling their inner Oliver Cromwell and dobbing in their scofflaw neighbours to the local constabulary for breaching their two week home quarantine.
Postscript: Tips for occupying some of the 960 minutes a day of stay-at-home time you are awake
The more realistic and level-headed of us who are not still spending our days at the beach (yes there are scofflaws still trying to circumvent the barriers now in place at popular beaches) are hunkering down for the long haul during the pandemic. So if you are looking for some light reading material while in mandatory hibernation for the winter, there’s always that classic allegory of unrelentingly grim reality, Camus’ The Plague☌, or if you want something more apocalyptically contemporary, try The Road or Station Eleven.
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✱ even more unfathomably bizarre, after the latest round of war cabinet lockdowns, is the circumstance of hairdressers and barbers – they have been allowed to stay open and serve the public, whilst still observing the 1.5 m gap. How that will be expected happen remains a mystery to all except the inner workings of the war cabinet I surmise (robotic arms and 150cm-long scissors may be the answer!)
⊞ the best the government can hope for is to minimise the non-compliance of this cohort so that the numbers of them who are infected and the numbers that they infect are kept as low as possible
✬ certainly a considerably more substantial deterrent than the drop in the ocean £30 Boris has announced he’ll fine scofflaw Britons
☌ incidentally, sales of Camus’ book about a disease-infested 1940s Algerian town have soared during the pandemic (The Economist, April 2020)