The Fight against the Coronavirus Pandemic: Reflecting on the Numbers

Posted on by funambulator@live.com
Geography, Media & Communications, Medical history, Natural Environment, Political geography, Public health,

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 Government’s War on Coronavirus: The Great COVID-19 War from Ground Level

Posted on by Bonza Rottwheeler
Economics and society,, Environmental, Futurism, Media & Communications, Medical history, Science and society

(Source: www.thesummitexpress.com)

A few years ago one of the incumbents of the revolving door that is the Australian prime ministership intoned: “these are the most exciting times to be alive”… well, for “exciting” substitute “worrying and challenging” and you have the status quo, 2020. We are getting bombarded daily, even hourly it seems, with mixed messages from news sources – it was okay to go to the football last Sunday and mingle with crowds of much more than the 500 limit but somehow it’s not okay to do this on Monday, the day after (what changed?!?); the medical experts warn us to keep a distance of one-and-a-half metres from anyone else, yet it’s fully expected that people will still travel on trains and buses which will generally make that an impossibility; the government tells us not to fly overseas but it’s still okay to fly within Australia (a lifeline to the national carrier?). 

(Image: www.nature.com)

Every day media outlets offer up a doomsday book of horror stories…”London faces stricter lockdown after coronavirus advice ‘ignored’” |”Italy coronavirus deaths rise by record 475 in a day” |”All of us have to assume we have the virus’: COVID-19 infections rise past 300 in NSW” |”Yes, young people are falling seriously ill from Covid-19” |”Trump spent weeks downplaying the coronavirus. He’s now pretending that never happened” | “Stay home’. Grey nomads unwelcome as Top End coronavirus tensions grows’ | “Coronavirus UK: Boris to impose FOUR-MONTH quarantine for elderly under ‘wartime’ measures” | “China blaming US for coronavirus? It refuses to come clean about origin” | “Privacy fears as India hand stamps suspected coronavirus cases” | “Coronavirus: One dead every 10 minutes in Iran as government faces backlash over late response” | “Spring Breakers Pack Some Florida Beaches, Ignoring Social Distancing Warning Amid Coronavirus“ | “Italy overtakes China in coronavirus toll”. Panicked consumerism born of exaggerated fears of limited resources➀, foolhardy apathy as the young party on regardless in fatalistic Titanic style (‘Millennialmania’), doom and gloom, finger-pointing recriminations, the media has been full of it for two months…sorry, we don’t do calm, rational, measured responses here. 

A corona red world, March 2020 (Credit: www.abcnews.go.com)

It’s a climate ready-made for rumour-mongering and this is not confined to the West…China is rife with rumours ‘explaining’ the epidemic’s origin starting with the fiction of it’s supposed transmission from bats in January. The rumours soon became more fanciful and more conspiratorial, ranging from coronavirus being deliberately released to cull excess numbers of pensioners in society to it being a bio-weapon brought to Wuhan by the US Army to it being the consequence of the zodiac signs being out of harmony in the Year of the Rat!

The pandemic has caused divisiveness. Not just between rival countries trying to shift the blame and score political points, but at a grass roots level. We’ve seen the spectacle of shoppers in supermarkets fighting over the providence of a single pack of toilet roll➁.We’ve got incorrigible prepper-minded hoarders boasting online of their Fort Knox-sized storage bunkers of stockpiled household essentials, counter-balanced by the shopper-shaming of overzealous buyers queueing up with 150 rolls of toilet paper in their trolly (human behaviouralists tell us that buying ridiculous quantities of toilet rolls gives us reassurance, a warm and fuzzy feeling in a time of fear). The supermarkets, one of the very few sectors doing spectacularly well out of the crisis, have responded (too late) with partial war rationing to head off the panic buyers. War rationing seems apt as democratic governments across the world channel their inner Churchill and rush to set up “war cabinets” to deal with the extraordinary and unprecedented situation.

Deserted departure lounges 🔺

Whole industries grind to a halt, workers laid off with mortgages and bills that won’t disappear, while those of us investing in the stock market have taken an instant massive hit and the Aussie dollar plunges ever lower. Border closures, tourism industry bottoming out, small businesses going to the wall, nightlife, restaurants, bars, cafes, shows, movies, public events, etc…all nix! The hackneyed T-shirt slogan “Keep calm and carry on” is now “Keep calm, stay home and don’t go anywhere”. Lockdowns, compulsory home quarantine for targetted groups of the population, Pacific cruising virus-traps, a safe and effective vaccine for the virus still up to 18 months away. Talk in the UK of prioritising “herd immunity” uncomfortably evokes the spectre of eugenics. Some have called for the euthanasia of family pets, which is drawing a long bow even if you accept the possibility (far from definitively proven at this stage) that the virus was transmitted to humans by pangolins (scaly ant-eaters) in a Wuhan wet market. What next, euthanasia vans going round the suburbs to collect the weak and elderly? Reality at the moment looks increasingly like an unbelievable dystopian novel or movie! Welcome to the scary new world of indefinite uncertainty. 

Thanks to COVID-19 we’re learning a slew of new buzzwords, for a start social distancing and elbow bump (sounds and looks dorky but it’ll catch on, trust me), and us non-statisticians in the community are already tired of hearing TV expert commentators rabbiting on about the merits of “flattening the curve”. I am waiting to hear (and am surprised not to have heard it yet) the adjective “Orwellian” uttered in the current crisis. 

Bay County beach, Fla. (Ya Photo: WJHG/WECP)

I don’t know anyone who envies the governments or the frontline health care sector at the moment, but the government responses do have their critics? To take the scenario I am most familiar with, Australia…on the credit side the mortality rate is low (so far) though the morbidity rate is climbing fast and winter and the flu season are on the near horizon. However, under the government’s partisan “war cabinet” a coordinated approach to the crisis seems to be missing. We are looking for more systematic and less chaotic here! One example, the distribution of scarce essential goods depleted by panic buying is held up by a failure to get councils involved so they can free up the delivery schedule. Some medical and communications experts have asked where the government’s public awareness campaign is? Unlike some other countries, we are bereft of the myriad of community billboards and the television and social media advertisements which can raise awareness in the public of the disease. Overcoming ignorance is a first step to diminishing fear and apathy.

As with something this truly extraordinary, of such novel complexity and uncertainty, despite (or perhaps because of) the deluge of information, more questions than answers remain…should we lockdown cities or not? What are we not doing here to stem the crisis that appears to be working overseas? Face masks, yes/no?➂ Test for virus or not test? Can I be infected, recover and be infected a second time? What’s the shelf life of an infected surface? What do I do if I’m at high-risk and social distancing is not a viable option? Should we let the grandparents babysit our pre-schoolers any more? And then of course there’s the greatest imponderable of all, when is this whole nightmarish scenario going to end?

No issues with social distancing here (Photo: AP)

All the punter at ground zero can do is listen to the official medical advice➃, make sure we inform ourselves about Coronavirus 101 and get the basics down pat. This means identifying the likely symptoms—persistent cough, sore throat, runny nose, headache, (and more seriously) fever, shortness of breath, difficulty in breathing—all the usual suspects. Understand that coronavirus can be either symptomatic or asymptomatic, that it can be mild as well as severe, and that lethality generally (but not universally) hinges on considerations of age and serious pre-existing health conditions. Learn how to avoid contagion, what to do with the lethal weapons which are our hands – washing and drying them the correct way, eschewing the convention of shaking hands with people and start guesstimating our own personal space in public➄, sneezing into your elbow, not your hands, cleaning and disinfecting surfaces and door handles, using hand sanitisers, etc. Thus armed against ignorance, and hopefully the pandemic too, we will bunker down for the long haul, tough it out and try (very hard) not to add to the growing count of national virus statistics.

⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕ ⍕

➀ and thus creating a self-fulfilling prophecy
➁ almost as unedifying was the sight of Aldi staff hurling blocks of toilet paper into the air so that demonic shoppers could jostle and wrestle each other for the prized commodity (classy look!)
➂ surgical masks have become a bit of an “us and them” issue, adding to the emerging divisive atmosphere…the war cabinet’s medical experts (in line with WHO’s recommendations) have pooh-poohed the wearing of masks for the general populace as not beneficial and unnecessary, saying they only need to be worn by people diagnosed with the disease. Given that the Chinese community in Australia tend to wear the masks sometimes for cultural reasons as much as protection, this leaves them open to wild and inaccurate assumptions about their health status as a group
➃ this will probably require a judgement call as some of the medical advice has been contradictory
➄ the latest edict in the social distancing caper from the war cabinet limits indoor gatherings of 25 in a space of 100sq m (one person to every 4sq m). I can’t wait to see police officers turning up in clubs and pubs armed with measuring tapes

⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎ ⍎ ⍎ ⍎ ⍎⍎⍎

PS. All the big business houses and major financial institutions have started sending out “touchy-feely, look we really are human” messages, along the lines of we’re here to help “our people” get through COVID-19 … excuse me while I go and bolt down my raging cynicism to the floor.

The 1918 Spanish Flu: History’s Most Deadly Pandemic

Posted on by funambulator@live.com
Environmental, International Relations, Medical history, Military history, Public health,, Regional History, Science and society

The ongoing fight to contain the outbreak of COVID-19, the Coranavirus—now entering a new stage of transforming itself into a global epidemic—gives rise to recollection of another virus that swept the world just over one hundred years ago, the so-called Spanish Flu✺. For most of the rest of the 20th century, the Spanish Flu (sometimes known as La Grippe) was largely neglected by researchers and mainstream historians, and study confined to actuaries, specialist epidemiologists and virologists and medical historians [Laura Spinney, Pale Rider: The Spanish Flu of 1918 and How it Changed the World, (2017)].

(Credit: CNN International)

Why did such a devastating pandemic fly under the radar for so long? The timing of the outbreak goes a good way to explain this. After having suffered four long years of a unique world war, people tended to treat the Spanish Flu as a footnote to the Great War conflagration. Moreover, the war, concentrated in Europe and the Middle East, had a limited geographical focus for people, contrasting with the pneumonic influenza outbreak which was truly global [The Spanish Flu Pandemic’, (L Spinney), History Today, 67(4), April 2017]. As catastrophic events go, the two stand in stark contrast. With today’s scientific and medical advances experts estimate that the Spanish Flu killed at least 50 million people worldwide, some estimates put it as high as 100 million [NP Johnson & J Mueller 2002;76: 105-115 (‘Updating the accounts: Global mortality of the 1918-1920 “Spanish” Flu pandemic’, Bull Hist Med)]. Estimates of World War I casualties—military and civilian–—sit somewhere in the range of 20 to 22 million deaths [‘WW1 Casualties’, (WW1 Facts), http://ww1facts.net]⌖. By the late 20th century and early 2000s outbreaks of new viruses like SARS, Asian Bird Flu, Swine Flu, etc, spurred mainstream historians◙ to look afresh at the great global influenza of 1918-20.

An abnormal spike in morbidity and mortality
The Spanish Flu was truly global, like the Coronavirus its lethal reach touched every continent except Antartica, both are novel (new) respiratory illnesses. Similarities have been noted between the responses to the two outbreaks, eg, the issuing of instructions or recommendations by the authorities for the public to wear masks, avoid shaking hands (part of social distancing), good hygiene, quarantine, an alarmist overreaction by the media [‘Coronavirus response may draw from Spanish flu pandemic of 100 years ago’, ABC News, (Matt Bamford), 05-Mar-2020, www.amp.abc.net.au]. The great flu of 1918’s morbidity and mortality rates were frighteningly high and far-reaching…one in three people on earth were affected by it✪. Between 2.5 and 5% of the world’s population perished, including India a mind-boggling 17M-plus, Dutch East Indies 1.5M, US (up to) 675,000◍, Britain 250,000, France 400,000, Persia (Iran) (up to) 2.4M, Japan 390,000-plus, Ghana (at least) 100,000, Brazil 300,000, USSR (unknown, but conservatively, greater than 500,000)⊞.

While densely crowded communities were thought the biggest risk of mass infection, the Flu caused human devastation even in remote, isolated corners of the world, eg, in Oceania, Samoa bereft of immunity, lost 22% of its population in two months, the Fijian islands lost 14% in a 16-day period⌀. The kill rate was something around 2.5% cf. a ‘normal’ flu outbreak a rate of no more than 0.1% would be expected [‘The Spanish Flu Pandemic’, (Spinney, History Today ; ‘The Spanish Flu’, Wikipedia, http://en.m.wikipedia.org/].(Source: National Library of Australia)

If the Spanish Flu didn’t originate in Spain, where did it originate?
No one knows for sure is the short answer…but there has been much speculation on the topic. At the time of the epidemic a popular notion was that the Flu started in China, but China experienced low rates of infection compared to other regions of the world. The explanation for this perhaps lay in that China was subjected to an initial, mild flu season which gave its citizens an acquired immunity to the disease when the more severe strain of the virus hit them.

🔺 Red Cross volunteers: caring for the sick during the Spanish Flu fell overwhelmingly on women (volunteers and professional nurses) who bore the brunt of the work at quarantine stations and camps, as well as exposing themselves to great personal risk

Influenza-ravaged Ft Riley soldiers in hospital camp 🔻

The military, mobility and zoonosis
Another theory attributes the Spanish Flu’s beginnings to the movements of the combatants in WWI. Virologist John Oxford favours the village of Étaples in France as the centre of the 1918 influenza infection. From a hospital camp here, 10,000 troops passed through every day…with their immune systems weakened by malnourishment and the stresses of battle and chemical attacks they were susceptible to the disease which was probably transmitted via a piggery and poultry on the same site. Once contracted, it’s dissemination was likely facilitated by mass transportation of troops by train.

Another view that has gained wide currency locates the Flu’s genesis in America’s Midwest. In recent times, historians led by Alfred W Crosby have supported the view that the epidemic started not in Europe but in a US Army base in Kansas in 1917 (America’s Forgotten Pandemic). According to adherents of this theory soldiers training at Fort Riley for combat in Europe contracted the H1N1 influenza virus which had mutated from pigs. The infected troops, they contend, then spread the virus via the war on the Western Front. Whether or not the virus started with WWI fighting men in France or in the US, it is undeniable that the soldiers moving around in trains and sailors in ships were agents of the Flu’s rapid dissemination [‘Spanish Flu’, History Today, (Upd. 05-Feb-2020), www.historytoday.com]. A recent, alternative origin view by molecular pathologist Jeffrey Taubenberger rejects the porcine transference explanation. Based on tests he did on exhumed victim tissue, Taubenberger contends that the epidemic was the result of bird-to-human transmission [‘Spanish flu: the killer that still stalks us, 100 years on’, (Mark Honigsbaum), The Guardian, 09-Sep-2018, www.theguardian.com].

(Image credit: Guia turístico)

Demographics: differential age groups
The pattern of Coronavirus mortality points to the disease being most virulent and most fatal to elderly people (the seventies to the nineties age group). This accords with most flu season deaths, although unlike seasonal flu outbreaks Coronavirus contagion has (thus far) had minimal impact on children, in particular the under-fives (Honigsbaum). But the pattern of Spanish Flu was markedly different, the records show a targeting of young adults, eg, in the US 99% of fatalities in 1918-19 were people under 65, with nearly 50% in the 20 to 40 age bracket (‘Spanish Flu’, Wiki). Statistics from other countries on the 1918 outbreak conform to a similar trend.

🔺 Conveying the health message to the public (Source: www.shelflife.cooklib.org)

The Flu in a series of varyingly virulent waves
The first wave of the Flu in early 1918 was relatively mild. This was followed by a second, killer wave in August. This mutated strain was especially virulent in three disparate places on the globe, Brest in France, Freetown in Sierra Leone and Boston in the US. There were myriad victims, some died (quickly) because they had not been exposed to the first, milder wave which prevented them from building up immunity to this more powerful strain [‘Four lessons the Spanish flu can teach us about coronavirus’ (Hannah Devlin), The Guardian, 04-Mar-2020, www.msn.com]. The second wave was a global pathogen sui generis. The bulk of the deaths occurred in a 13-week period (September to December). The lethality of the disease, and especially the speed with which it progressed, was the scariest part✧.

2nd wave curve in the US, 1918: note the different mortality peaks during Oct-Dec 1918 for St Louis (imposed a stringent lockdown) vs Philadelphia (much less restrictive approach)
(Source: Proceedings of the National Academy of Sciences, 2007)

The symptoms of this murderously effective strain were unusual and extreme, eg, haemorrhaging from mucous membranes, bleeding from the eyes, ears and orifices, etc. The extreme severity of the symptoms were thought to be caused by cytokine storms (overreaction of the body’s immune system) (‘Spanish Flu’, Wiki) [‘Spanish Flu’, History, 12-Oct-2010, www.history.com]. The third and last strain of the Flu, in 1919, was markedly milder by comparison to the second, but still more intense than the first.

Many parallels exist between the 1918 flu outbreak and the present pandemic – of a positive nature, the widespread advocacy of wearing masks to limit the spread of disease and mandatory lockdowns. Plenty of negative parallels too – the disregarding of science and medical expertise on how to tackle the outbreak; countries engaging in playing the “blame game” against each other rather then co-operating on a united approach to the pandemic. There was especially, but not only in the US, a repetition by some of the denial at the national leadership level to square up to the pandemic and give it the complete seriousness it demanded.

✥ ⌯ ✥ ⌯ ✥

In 1919 in the middle of the flu crisis, Irish poet WB Yeats wrote in a poem the line for which he is perhaps best remembered: “Things fall apart; the centre cannot hold; mere anarchy is loosed upon the world…”

✥ ⌯ ✥ ⌯ ✥

Footnote: The health authorities’ inability to check the juggernaut of the 1918 virus was exacerbated by misdiagnosis – at it’s onset the Spanish Flu was widely believed to be a bacterium like the Black Death, not a virus. Misreading the symptoms, the influenza outbreak was variously and erroneously diagnosed as dengue, cholera or typhoid (Spinney, ‘History Today’; ‘Spanish Flu’, History).

(Photo: State Archives & Records, NSW)

PostScript: The upside of a global catastrophe
The Spanish Flu in it’s vast human decimation rammed home lessons for post-WWI governments and health practitioners in its wake. Being helpless to prevent or halt the virus once in full swing, the vital need to develop vaccines to counter pandemics was subsequently understood. Advanced countries started to restructure their public health systems to try to cope (such as the United States’ NIH – National Institutes of Health, which emerged about 10 years after the Spanish Flu) [‘The great influenza The epic story of the deadliest plague in history‘ (JM Barry), Reviewed by Peter Palese, (JCI), www.ncbi.nim.nih.gov]. And of course the 1918 flu virus had other, indirect, outcomes…it led to universal healthcare, alternative medicine, intensive care facilities and a modern preoccupation with the benefits of healthy exercise under clean, clear skies (‘Pale Rider’).

⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴⌴

✺ the name is a misnomer. The Spanish association came about thus: with the Great War still raging other combatant European nations such as France and Germany had imposed censorship restrictions on the reportage of the flu outbreak, whereas Spain being neutral in the war did not. When the Spanish press freely reported a serious eruption of the Flu, people outside the country unquestioningly assumed that the influenza came from Spain
⌖ to further break that down, more American troops died from the Spanish Flu than in combat during WWI (‘Pale Rider‘)
⊞ the numbers cited tend to be approximations given the paucity of adequate record-keeping at the time
◙ part of a new multidisciplinary approach to the subject including economists, sociologists and psychologists
◍ consequently life expectancy for Americans dropped by 12 years in 1918, and for the first time since Britain commenced recording data, the death-rate in 1919 exceeded the birth-rate (Honigsbaum)
✪ Pandemic: pan ⤑ all ║ demos ⤑ the people (not literally but fairly close)
⌀ although isolation did prove beneficial in some instances, such as in Australia where the virus didn’t arrive until 1919 and entry was closely monitored with a maritime quarantine program. As a result Australia’s death-rate of 2.7 per 1000 of population was one of the lowest recorded [‘Influenza pandemic’, National Museum of Australia, www.nma.gov.au]
✧ Philadelphia alone experienced 4,597 influenza deaths in a single week