Showing posts tagged as: WHO
Coronavirus Responses and Patterns in Africa: Southern and West Africa
Three months ago when the COVID-19 outbreak started to move around the globe, the World Health Organisation issued a warning to the continent of Africa whose nations were just starting to feel its impact [‘Coronavirus: WHO tells African countries to ‘prepare for the worst’, Eye on Africa, 18-Mar-2020, www.france24.com]. The pandemic was late in reaching Africa and initially slow to make inroads, taking 98 days to register its first 100,000 confirmed cases but is now accelerating – only taking 18 more days to hit the 200,000 mark of cases [‘COVID-19: WHO warns of virus acceleration in Africa’, Vanguard, 14-Jun-2020, www.vanguardngr.com]. Overall African fatalities sit at 6,793 (16-Jun-2020) with just five countries (Algeria, Egypt, Nigeria, South Africa and Nigeria) accounting for 70% of the deaths✹.
Southern Africa: To date South Africa has been the nation most heavily affected by the public health emergency – over 73,000 confirmed cases and 1,568 deaths (16-Apr-2020). The Western Cape province has become the epicentre of the RSA pandemic, recording so far around 75% of the country’s fatalities. The province’s high incidence of cases has been attributed to the presence of poor, densely populated townships like Khayelitsha, a shantytown of 500,000 people. Cape Town’s thriving tourism (before the closedown) has also been advanced as contributing to the outbreak’s toll. South Africa, with a more developed economy and better health care system, has conducted more a million virus tests, while many other African countries have racked up only a few thousands. The clear implication of this is that ”the disease is spreading undetected elsewhere on the continent” [‘Cape Town becomes South Africa’s coronavirus hotspot’, (Jevans Nyabiage), South China Morning Post, 12-Jun-2020, www.amp.scmp.com].
⍐ Bulawayo, Zim. (Photo: Philimon Bulawayo/Reuters)
South Africa’s smaller, northern neighbour Zimbabwe has done surprisingly well on paper in the crisis (four deaths recorded only), but with the rider that testing for the disease—hampered by a critical shortage of health equipment and infrastructure—has been very limited…by 10th April it had tested a mere 392 people [‘In Zimbabwe, lack of tests sparks fear COVID-19 goes undetected’, (Chris Muronzi), Aljazeera, 10-Apr-2020, www.aljazeera.com].
(Image: SABC News)
West Africa: Results of the fight against the pandemic in West Africa have been mixed. Senegal began its counter-measures early in January, closing the borders, implementing contact-tracing, etc. The country was able to produce a test kit for COVID-19 costing only $1 per patient and has managed to accommodate every coronavirus patient either in hospital or in a community health facility. African countries who experienced the 2013/14 Ebola virus outbreak like Senegal put that experience to good use, prohibiting large gatherings, strict night-time curfews, banning intercity travel, etc. Côte d’Ivoire (the Ivory Coast) followed Senegal’s approach, declaring a state of emergency and trying to impose curfews in it’s main city Abidjan, but the country’s buoyant economy has taken quite a hit from the coronavirus crisis. Ghana has utilised an extensive system of contact-tracing and a “pool-testing” mechanism which follows up only on positive results [‘Why are Africa’s coronavirus successes being overlooked?’, (Afua Hirsch), The Guardian, 21-May-2020, www.theguardian.com; ‘Women unite against COVID-19 in Senegal’, Relief web, 10-Jun-2020, www.reliefweb.int].
The speeding up of coronavirus cases in a small African country like Guinea-Bissau has occurred notwithstanding it’s small population and limited testing, reflecting a reality stretching across the whole continent, the sheer incapacity of weak and under-resourced national health infrastructures to cope with the pandemic [‘West Africa facing food crisis as coronavirus spreads’, (Emmanuel Akinwotu), The Guardian, 16-May-2020, www.theguardian.com].
⍐ Kano (Photo: Reuters/Luc Gnago)
In Nigeria, Africa’s most populous country, the most worrying hotspot has been the north in Kano state and metropolis. The pandemic has gotten out of hand here because of a confluence of factors, including the state government’s early failure to admit the presence of coronavirus (which it initially tried to pass off as an upsurge in other illnesses), costing it vital lost time in the fight against the disease; the closure of Kano’s only testing centre for a week in April; acute shortages of PPE; and the pre-existing displacement of 1.8m people in the region [‘Covid-19 Outbreak in Nigeria Is Just One of Africa’s Alarming Hot Spots’, (Ruth Maclean), New York Times, 17-May-2020, www.nytimes.com].
Dakar, Senegal (Photo: John Wessels/AFP via Getty Images)
PostScript: A young and rural population Africa’s avoidance of the worse excesses of COVID-19 thus far has prompted the theory that the continent’s demographics is working in it’s favour. A study in the journal BMJ Global Health attributes this to Africa’s young, rural-based population▣ …60% of the population is under 25, cf. Europe (95% of its deaths from the virus have been people over 60). BMJ hypothesises that Africa will likely suffer “more infections but most will be asymptomatic or mild, and probably (go) undetected” [‘Africa’s young and rural population may limit spread and severity of coronavirus, study says’, (Jevans Nyabiage), South China Morning Post, 28-May-2020, www.amp.scmp.com].
↜↝↜↝↜↝↜↝↜↝↜↝↜↝↜↝ ↜↝↜↝↜↝↜↝↜↝↜↝↜↝↜↝ ✹ Egypt and South Africa alone account for nearly 48% of the entire continent’s corona-related deaths ▣ the study focused on Kenya, Senegal and Ghana
Russia’s Coronavirus Anomaly, a Question of What You Count
From the start of this month Russia began a gradual re-opening of services after a ten-week pandemic lockdown. This is happening despite new cases of COVID-19 continuing to materialise – the tally of confirmed case of the virus has now ticked over the 500,000 mark (as at 12-Jun-2020). There are several reasons contributing to the decision to re-open, some political and some economic.
Concern for the damage sustained by the Russian economy by the pandemic was foremost to the Kremlin but President Putin also wanted things functioning as close to normal in time for two upcoming events important to him. The 75th end of WWII anniversary military parade in Red Square—a PR showcase of Russian power—postponed from May is rescheduled for 24th of June. Even more personally important for the Russian leader is the July 1 vote✱, Putin has put up far-reaching constitutional amendments for approval, the main outcome of which could see Putin’s iron-grip on the federation extend till 2036.
(Photo: Reuthers / SPUTNIK)
Discontent with Russia’s approach to the crisis
An underlying reason for the hasty end to the national lockdown might be that it hasn’t been as successful as hoped. The tracing app utilised in Moscow (the epicentre of the country’s COVID-19 outbreak) has had issues with its effectiveness. Putin’s personal popularity was at risk with public resentment voiced at the prolonged restrictions (murmurings of Orwellian and Soviet-like echoes). The medical response by the Kremlin has been called out by many front-line responders for its shortcomings⊘. One doctor, Anastasia Vasilyeva (leader of a Russian doctors’ union), frustrated at the president’s insistence that the public health crisis was under control, has been at great risk to herself distributing PPE to medical workers on the front-line, provoking retribution from the Kremlin [‘The doctor who defied a President’, ABC News, (Foreign Correspondent, Eric Campbell), 06-Jun-2020, www.abcnews.com.au]. This is symptomatic of Moscow’s neglect of the regions who are expected to handle both the outbreaks without the medical infrastructure to deal with a large volume of cases✩ and the economic fallout from the crisis without adequate financial assistance [‘Russia’s coronavirus cases top 300,000 but deaths suspiciously low: ‘We conceal nothing’ Kremlin says’, (Holly Ellyatt), CNBC, Upd 21-May-2020, www.cnbc.com].
Counting the virus’ toll: a small exercise in data massaging? Some Russia watchers have cast doubts about the reported COVID-19 figures released by Moscow. This includes WHO has questioned Russia’s low death toll, describing it as ‘unusual’ [‘WHO asks Russia to review its Covid-19 death toll in rare rebuke’, (Natalia Vasilyeva), The Telegraph, 11-Jun-2020, www.telegraph.co.uk]. While the number of Russian virus cases is comparatively high, the official record of fatalities is disproportionately low compared to the rest of Europe…Russia’s fatality rate is 0.9% cf. UK’s, 14.4% (roughly 10% of the mean figure for Western Europe) [‘How Russia’s Coronavirus Outbreak Became One of the World’s Worst’, (Madeline Roache), Time, 15-May-2020, www.time.com]. The Kremlin has rejected the criticism that it is withholding the full impact of the pandemic, but outside observers pinpoint an anomaly in the methodology it uses to count cases. Unlike say Belgium (which is strictly inclusive), Russia has not counted deaths as caused by the coronavirus where other co-morbidities are present, ie, if a patient tested positive for the virus and then had a subsequent critical episode, the cause of death is not recorded as COVID-19 [‘Russia Is Boasting About Low Coronavirus Deaths. The Numbers Are Deceiving’, (Piotr Sauer & Evan Gershkovich), The Moscow Times, 14-May-2020, www.themoscowtimes.com].
A deserted, locked-down Red Square (Source: www.citizen.co.za)
Compartmentalising the fatalities This persuasively accounts for the recent discordant mortality statistics reported by Russian sources, eg, if you separate fatalities directly attributable to coronavirus from other fatalities for May, the unexplained “excess deaths” recorded for Moscow is up about 5,800 on that occurring during the previous three Mays [‘New data suggests Russia may have a lot more COVID-19 deaths than it says it has’, (Alexandra Odynova), CBS News, 11-Jun-2020, www.cbsnews.com]. A look at Dagestan, a region with one of the largest clusters outside of the capital, is also instructive. As of mid-May it had experienced 35 deaths listed as caused by coronavirus, but in the same timeframe it recorded 650 deaths attributed to “community-acquired pneumonia”. One explanation from Russia watchers is that “local officials want to present Moscow with ‘good’ figures” (Ellyatt). If the Kremlin were to publish both sets of figures in its official data, such transparency would deflect much of the doubt and questioning by outsiders (Sauer & Gershkovich).
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✱ that Putin is prepared to push through the referendum at this time and risk aggregating the public health and safety of Russians, confirms for many the president’s prioritising of his own political motives [‘Russian officials, citing COVID-19, balk at working July 1 constitutional referendum’, CBC News, 11–Jun-2020, www.cbc.ca]
⊘ many medical practitioners in Russia have been disaffected by both a critical shortage of equipment to fight the virus and by unpaid wages [‘Exclusive: Did Russia pass the coronavirus test? Kremlin spokesman Dimitry Peskov Responds’, (M Chance, Z Ullah & N Hodge), CNN, 09-Jun-2020, www.amp.cnn.com]
✩ the COVID-19 emergency has exposed the deteriorating state of the Russian health service in the Putin era – the Semashko system infrastructure allowed to run down while the private medical sector has flourished [‘Can the Russian Health Care System Cope with the Coronavirus?’, (Estelle Levresse), The Nation, 09-Jun-2020, www.thenation.com]
The Choral Powder Keg: A Health Hazard Tailor-made for the COVID-19 Crisis
When a pandemic or some similar “Black Swan” event sweeps the world, hitting many countries with great intensity, particularly in Western societies with a high degree of religiosity, comfort and solace is often sought within the spiritual “safe house” of the church. As soon as the novel coronavirus landed and spread, it was apparent the church services especially where high rates of attendance was commonplace, would pose a public health risk.
(Source: www.newslocker.com)
Yet in the US eleven state governors chose to maintain freedom of worship over community safety by exempting religious institutions from the general prohibition on public gatherings, notwithstanding that some of the states registered the biggest clusters of COVID-19. Even in other states there was a pushback by church men and women against government bans on assembly in places of worship. As a consequent 71 members of a single church in Sacramento were infected by the virus [‘Pastor who refused to close church due to coronavirus killed by outbreak’, (Rebecca Nicholson), Express, 15-Apr-2020, www.express.co.uk].
This was mirrored in overseas scenarios, in South Korea in February, one infected churchgoer infected at least 37 other members of her church on a single contact [“‘Superspreader’ in South Korea infects nearly 40 people with coronavirus’, (Nicolette Lanese), Live Science, 23-Feb-2020, www.livescience.com].
South Korean choir with face masks (Source: AP)
The choral petri-dish The holding of packed sermons in churches and other places of worship, like any close contact between confined, concentrations of people, breaches the prescribed social distancing guidelines and exacerbates the incidence of coronavirus infection. But just as dangerous and with even more potential to transmit the viral disease through communities is the choral activities of churches. The activities of choirs initially continued unabated in the early stages of the pandemic but an incident in Washington state in early March brought home how risky choir practice is. 61 people attended a choir practice at a Presbyterian church in Skagit County, within a short time 45 of the group had been infected by COVID-19 and two had died. Other choir outbreaks, some fatal, have occurred In Calgary (Canada), Amsterdam (Netherlands) and in South Korea [‘Scientists to choirs: Group singing can spread the coronavirus, despite what CDC may say’, Richard Read), Los Angeles Times, 01-Jun-2020, www.latimes.com].
Infectious diseases experts have pinpointed the obvious dangers of contagion associated with choir singing…unrestrained vocal activity at close quarters in often poorly-ventilated, confined space. The vocalists exhale and inhale deeply to sing which makes them highly susceptible to the passage of airborne particles. Through the process of aerosolisation, the virus floats freely in the air (and has been observed to survive for up to three hours) [‘Churches can be the Deadliest Places in the COVID-19 Pandemic’, (Kevin Kavanagh), Infection Control Today, 03-Apr-2020, www.infectioncontroltoday.com; Read].
Inexplicable change of stance by CDC With eyes fixed on the November elections and the need to shore up vital support from the Evangelical Christian Right, President Trump from his White House ‘pulpit’ intensified his call in May for governors to reopen religious institutions as an essential service, eliciting pushback from some governors. At the same time, surprisingly the Centers for Disease Control and Prevention (CDC) decided to drop their warnings against choral singing despite the inherent danger it poses. CDC justifies this change of position by downplaying the likelihood of airborne transmission beyond six feet⊞ [‘Behind Trump’s demands to reopen churches: Slipping poll numbers and alarm inside his campaign’, (Gabby Orr), Politico, 22-May-2020, www.politico.com; Read).
Heightening the risk of unleashing ‘super-spreaders’ CDC’s controversial move has drawn broad criticism from medical experts including specialists in bio-aerosol research who have refuted CDC’s claim, calling it “hazardous, very dangerous and irresponsible”, and that it exposes America to new waves of super-spreading from the activity of choir members (Read).
⇑ With religious singing relegated to the home, some American churches have tried to get round the prohibition on in-house congregational services by organising drive-in sermons
Fallout from the churches Although many parishes and parishioners in the US have adjusted well to the new world of online sermons, some traditional congregationalists worry that the new ‘norm’ will spell the disappearance of the in-person church experience altogether [‘How the Pandemic Will Change Us’, (Rod Dreher), The American Conservative, 13-Mar-2020, www.theamericanconservative.com].
(Photo: www.stjohnswhitchurch.org.uk)
Endnote: The economics of the choral closedown The halt to choral activities due to COVID-19 has led to a whole bunch of “knock-on” problems worldwide. Like anybody else with their income source impacted adversely by the crisis, choristers, classical musicians and organists attached to the churches affected have been deprived of livelihood. But it goes even beyond that. As the Royal School of Church Music in the UK indicated, the pandemic ”has literally ripped apart the many close-knit groups of singers and instrumentalists who (need to) spend significant amounts of time together”. Church musicians who rely on the service are especially hard hit. It is doubly hard for self-employed church organists who have lost their access to practice – unlike other musicians who keep their instruments at home, they rely on “using instruments in public buildings for the vital practice which enables them to maintain their hard-earned skill” (Royal College of Organists). [‘Pandemic has ‘ripped apart’ church choirs’, (Hattie Williams), Church Times, 01-Apr-2020, www.churchtimes.co.uk].
(Source: eBay)
PostScript: There is another side problem resulting from the non-use of organs in churches. Like the raft of airplanes grounded due to the coronavirus, complex and expensive organs require continual attention. They need “regular playing to ensure that the fragile technical components are kept in good working order“ and free from damage (Williams).
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⊞ the Washington Post states that CDC acted on a White House directive to omit the choir warning from it’s website guidance information. CDC may have also relied on earlier statements from WHO contending that “there is no evidence of transmission of the virus as an airborne pathogen”. WHO’s conclusions have themselves been debunked as “decades-old dogma that held that droplets only travel an arm’s length in the air” (Read)
The Pandemic’s “Holy Grail”, the Elusive Vaccine: For the “Global Public Good” or an Inward-looking Assertion of Vaccine Nationalism?
At this point in the war on COVID-19 there are over 120 separate vaccination projects—involving Big Pharma, the public sector, academe, smaller biotech firms and NGOs—all working flat out worldwide trying to invent the ‘magical’ vaccine that many people believe will be necessary to bring the current pandemic to an end. While nothing is guaranteed (there’s still no cure for the HIV/AIDS virus around since the Eighties), the sheer weight of numbers dedicated to the single task, even if say 94% of the efforts fail, there’s still a reasonable chance of success for achieving a vaccine for coronavirus✱ [“Former WHO board member warns world against coronavirus ‘vaccine nationalism’”, (Paul Karp), The Guardian, 18-May-2020, www.theguardian.com].
(Source: CEPI)
If and when the vaccine arrives, will it get to those in greatest need? The way the coronavirus crisis has been handled between nations so far doesn’t exactly give grounds for optimism. Collective cooperation on fighting the pandemic has been sadly absent from the dialogue. We’ve seen the US attack China over coronavirus’ origins with President Trump labelling it the “China virus” and the “Wuhan virus”, and China retaliating with far-fetched accusations of America importing the virus to Wuhan via a visiting military sporting team, and the whole thing becoming entwined in a looming trade war between the two economic powers❂.
(source: www.socioecomonics.net)
The advent of COVID-19 has introduced us to terms such as “contact tracing”, “social distancing”, “covidiot” and the like, but recently we‘ve been hearing a new term thrown about, one with more ominous implications – “vaccine nationalism”. As the scattered islands of scientific teams continue the hunt for the “silver bullet” that presumably will fix the disease, there is a growing sense that the country or countries who first achieve the breakthrough will adopt a “my nation first” approach to the distribution of the vaccine. There are multiple signs that this may be the reality…the US government has launched the curiously named “Operation Warp Speed”, aimed at securing the first 300 million doses of the vaccine available by January 2021 for Americans [‘Trump’s ‘Operation Warp Speed’ Aims to Rush Coronavirus Vaccine’, (Jennifer Jacobs & Drew Armstrong), Bloomberg, 30-Apr-2020, www.bloomberg.com]. In the UK Oxford University is working with biopharma company AstraZeneca to invent a vaccine that will be prioritised towards British needs.
(Source: IndiaMart)
A “vac race” Not to be outdone, China, operating through Sinovac Biotech, is at the forefront of testing potential cures for COVID-19. The pressing need for a vaccine to safeguard its own population aside, Beijing’s rationale includes a heavy investment in national pride and the demonstration of Chinese scientific superiority (cf. Trump’s motivation). The Sino-US rivalry over finding a cure for the pandemic has been compared to the Cold War era ”Space Race” between the US and the USSR (Milne & Crow). A political war of superpower v superpower on a new battlefield…noted as bring part of a longer trend of the “securitisation of global health “ where the health objective increasingly has to share the stage with issues of national security and international diplomacy (E/Prof Stuart Blume, quoted in ibid.).
An environment of competition in lieu of collaboration Even prior to the start of serious talk about the vaccine, the coronavirus crisis was provoking an “everyone for themselves”, non-cooperative approach. With the onset of equipment shortages needed to combat the virus outbreak, an international bunfight developed over access to PPE (personal protection equipment). 3M masks destined for Germany were intercepted by the White House and re-routed to US recipients; French president, Emmanuel Macron, seized millions of masks that were on route to Sweden; Trump purportedly tried to buy CureVac, a German biopharma company working on the vaccine [‘Why vaccine ‘nationalism’ could slow the coronavirus fight’, (Richard Milne & David Crow), Financial Times, 14-May-20320, www.ft.com/]. India (under Hindu nationalist Modi), the world’s largest supplier of hydroxychloroquine (touted as a cure for the virus), withheld it from being exported. As part of this neo-protectionism of the corona medical trove, more than 69 countries banned the export of PPE, medical devices and medicines [‘A New Front for Nationalism: The Global Battle Against a Virus’, (Peter S Goodman, Katie Thomas, Sui-Lee Wee & Jeffrey Gettleman), New York Times, 10-Apr-2020, www.nytimes.com].
Politics and economics over science and global health? Will narrow self-interest and economic advantage prevail? Will Big Pharma sell the virus panacea to the highest bidders? A zero-sum game in which those who can’t afford the cost fall by the wayside? There are precedents…the distribution of the H1N1 vaccine for the 2009 Swine Flu was predicated on the purchasing power of the higher-income countries, not on the risk of international transmission [‘The Danger of Vaccine Nationalism’, (Rebecca Weintraub, Asaf Britton & Mark L Rosenberg), Harvard Business Review, 22-May-2020, www.hbr.org/]. The availability of the vaccine is seen as integral to restarting the global economy (Milne & Crow).
The eclipse of multinationalism? With WHO in the eyes of some international players seemingly tarnished by its relationship with China, and by Trump’s undermining of its effectiveness by threatening to withdraw American support, multilateralism is on the back foot. There have been some attempts to stem the tide, CEPI (Coalition for Epidemic Preparedness Innovations’)▣, with a mission of promoting a collective response to emerging infectious diseases, is trying to advance both the development of coronavirus vaccines and equitable access to them (http://cepi.net/).
Getting to an “equitable distribution” of the vaccine As CEPI recognises, and is committed to redressing, there is no formal mechanism in existence for fairly distributing vaccines for epidemics…one step being taken is to try to get an equitable distribution strategy accepted by the G20 nations. The only way forward to ensure that allocation is fair and prioritised according to needs is through a coordinated global effort (Milne & Crow; Weintraub eg al).
The fear is thus well founded that if and when a vaccine is discovered and developed, the richer nations will secure a monopoly over it and prevent it getting to poorer nations where it would be urgently needed by the elderly, the immunocompromised and the “first responder” health workers. There are many who hope fervently that a different scenario will be played out, that a more enlightened type of self-interest will prevail. This would require the wealthier countries seeing the bigger picture – the danger that if they don’t redistribute the cures, the outcome will be an adverse effect on the global supply chain and on the world‘s economies. As Gayle Smith (CEO of “One Campaign“, a Washington-based NGO fighting extreme poverty) put it: it is in the richer countries‘ own interests ”to ensure that the virus isn’t running rampant in other countries” (Milne and Crow). “If an international deal can be reached“, CEPI CEO Dr Richard Hatchett said, ”Everyone will win, if not, the race may turn into a free-for-all” with the losers in plain sight [‘Why the race for a Covid-19 vaccine is as much about politics as it is about science’, (Paul Nuki), The Telegraph (UK), 10-Apr-2020, www.telegraph.co.uk].
(Source: www.euroweeklynews.com)
PostScript: Its no done deal! – reining in the wave of vaccine optimism Even some of the scientists working on developing a vaccine are less than sanguine about the prospects. As immunologist Professor Ian Frazer (UQld) explains: there is no model of how to attack the virus. Trying to come up with a vaccine for upper respiratory tract diseases is complicated due to “the virus landing on the outside of you”, as we have seen with the common cold. What’s needed is “an immunise response which migrates out to where (the coronavirus) lands” [‘No vaccine for coronavirus a possibility’, (Candace Sutton), News, 19-Apr-2020, www.news.com.au].
_______________________________________________________________________________ ✱ a matter of getting “the maximum shots on goal” as Jane Halton, a former member of the WHO board, put it ❂ with Trump aided and abetted in this mission by Peter Navarro (who Bloomberg calls “Trump’s Trade Warrior”) enthusiastically leading the charge in the undeclared trade war with China ▣ with funding from the Bill and Melinda Gates Foundation
Coronavirus and Age Vulnerability: The Riddle of Japan
Both the medical experts and the empirical evidence on the ground tell us that the elderly are the cohort in the community most susceptible to COVID-19. The Office of National Statistics (UK) calculates that people aged 80 and over have >59% risk of dying from coronavirus (www.ons.gov.uk/). The pandemic’ age bias skewed against older populations is one explanation, in the absence of much hard data, put forward to explain the African continent’s current low rate of mortality due to the virus – overall 111,812 confirmed cases and only 3,354 deaths (as at 25-May-2020) [‘Coronavirus in Africa tracker’, BBC News, www.bbc.co.uk/]. The percentage of the African population aged under 25 is 60% (in sub-Saharan Africa the number over 65 is only 3%)[‘Coronavirus in Africa reaches new milestone as cases exceed 100,000’, (Orion Rummler), Axion, 22-May-2020, www.axios.com].
And if we needed any more empirical proof of the salience of the age factor, there is the tragic example of Italy’s corona-toll. 32,785 dead✤ from COVID-19 in a country with the oldest population in Europe. Nearly 58% of the country’s deaths in the pandemic have been Italians aged 80 and over [Statistica Research Department, (22-May-2020), www.statista.com/].
With Italy’s grim corona-death tally falling disproportionately heavily on the country’s senectitude, you would think that it would not bode well for Japan which has the world’s highest percentage of older people (28.2% aged 65 and more) [Population Reference Bureau, www.pbr.org/]. When you add in other demographic factors relevant to Japan, this would seem doubly ominous for the “land of the rising sun” – a population of >126 millions on a land area of 377,944 sq km, including the mega-city of Tokyo✪ with its notoriously packed commuter trains. On top of all these is Japan’s proximity to China, the virus’ original causal point.
(Source: www.quora.com)
Japan, unpropitious conditions for avoiding an global epidemic? With such cards stacked against it, worried Japanese health officials might have feared a catastrophe eventuating on the scale of that befalling the US, Italy and UK. And Japan has not come out of the pandemic unscathed but the result-to-date (25-May-2020)—16,550 confirmed cases and 820 deaths—is much better than many comparably sized and larger countries. Of course, Japan’s public health authorities are very mindful, as is every country, of being swamped by a second wave of the coronavirus.
(Photo: www.english.kyodonews.net)
How has Japan done as well as it has?
Good question! The Japanese themselves can’t really explain how they’ve managed to escape a major outbreak of the virus⌧. WHO has called it a “success story”, but it’s one that continues to mystify. In so far as explanations were forthcoming from Japan’s health ministry, it was attributed at least in part to a raft of cultural factors. First, hygiene and cleanliness is something ingrained in the Japanese psyche, Japanese people tend not to shake hands and hugs others, preferring to bow as the form of greeting. Second, the practice of wearing face masks was already the norm in Japan ante-COVID-19 (the Japanese go through 5.5bn a year, averaging 43 per head of population) [‘Most coronavirus success stories can be explained. Japan’s remains a ‘mystery’’, (Jake Sturmer & Yumi Asada), ABC News, 23-May-2020, www.abc.com.au; ’How Japan keeps COVID-19 under control’, (Martin Fritz), DM, 25-Mar-2020, www.dm.com].
Other cultural factors Other suppositions put forward to explain the Japanese success include the practice of inoculating young children with BCG vaccinations, which according to its advocates give Japanese people a basic immunity which helps their defence against coronavirus. Physiology was also cited as a factor in guarding against the disease, the low obesity of Japanese is thought to help, as is the Japanese diet (eg, natto, a soybean yoghurt, is thought to boost the immune system) [‘’From near disaster to success story: how Japan has tackled coronavirus’, (Justin McCurry), The Guardian, 23-May-2020, www.msn.com/; ‘Has Japan dodged the coronavirus bullet?’, Richard Carter & Natsuko Fuhue, Yahoo News, 14-May-2020, www.au.news.yahoo.com; Sturmer & Asada].
(Photo: www..Forbes.com)
The “Diamond Princess” In addition to all of the domestic factors hindering Japan’s fight against COVID-19, an external element exacerbating the early outbreak in Japan was the debacle of the “Diamond Princess” cruise ship. When the international ship docked at Yokohama in February, the Japanese authorities injudiciously prevented healthy passengers and crew on-board from disembarking during the quarantine – with no separation made between well and contaminated passengers, and no self-isolation of the sick! This led to a blow-out of virus contamination which eventually infected 712 passengers, creating the first big cluster of coronavirus outside of Wuhan [‘How lax rules and missed warnings led to Japan’s second coronavirus-hit cruise ship’, (Ju-Min Park), The Japan Times, 07-May-2020, www.japantimes.co.jp].
A cautious reaction from politicians, one eye on the XXXII Olympiad? Let’s look in detail at what Japan did – or didn’t do! When the disease first arrived, the government took a cautious approach to tackling the virus. Borders initially remained open and Chinese visitors were still allowed into the country in huge numbers, 89,000 came in February (after the first outbreak), which was on top of the 925,000 who visited during January! Prime Minister Abe came in for a lot of flak, some including a former PM, Yukio Hatoyama, accused him of holding off from going full-tilt against the pandemic so as to preserve the Tokyo Olympics event (Fritz). Critics railed against a lack of leadership from the Abe government, criticising its failure to appoint anyone to take firm control of the crisis, and that those efforts to counter the virus were hamstrung by the multiplication of bureaucratic silos [‘A Japan divided over COVID-19 control’, (Hiromi Murakami), East Asia Forum, 08-Mar-2020, www.eastasiaforum.org].
Lockdown-lite, testing-lite The Abe government’s belated state of emergency saw sport suspended and schools closed, but overall only a partial lockdown was imposed✺, many businesses, restaurants were permitted to stay open, albeit with reduced hours. Citizens were asked to stay home but compliance was only on a voluntary basis, with no surveillance technology deployed and no punitive action taken against anyone failing to adhere to the government’s request.
(Image: www.japantimes.co.jp)
Targeted testing
It was in testing that Japan adopted a very different crisis approach to most of the leading western countries. Rather than going for high volume, it deliberately tested under capacity. By mid-May it had tested a mere 0.185% of the country’s population, averaging two tests per 1,000 people, cf. Australia, >40 per 1,000 (Sturmer & Asada). It was highly selective, only those with serious virus symptoms were tested. The rationale for such a low-testing regime was concern for the capacity of widespread testing infrastructure, by limiting testing this would lighten the load on testing centres. Rather than mine-sweep the country with testing, the Japanese pursued a strategy of targeting virus clusters as they were identified to pinpoint the sources of the infection [‘Has Japan found a viable long-term strategy for the pandemic’, (Kazuto Suzuki), The Diplomat, 24-Apr-2020, www.thediplomat.com; Gramenz].
Consequently, Japanese medical experts concede that the official counts may be well short of the reality, which puts a rider on the country’s achievement. Even with a smaller number of cases Japan found itself lacking in IPUs (only five per 100,000 people cf. 35 in the US) , there was also a shortage of PPE as well as face masks which were rationed out only two per household (and derided as “Abe-no masks”). This calls into question the faith that the Japanese placed in the robustness of the nation’s health system [‘Japan’s Halfhearted Coronavirus Measures Are Working Anyway’, (William Sposato), Foreign Policy Magazine, 14-May-2020, www.foreignpolicy.com]⊚.
Self-complying social distancing? Social distancing, a nightmare to try to enforce in people-dense Tokyo, was not a major focus for authorities. This was largely left to the goodwill of the individual, aided by some subtle social shaming – government workers walking through Tokyo nightlife areas with signs asking people to go home (Sposato). In any event the authorities’ measures were only partly effective – Japanese people continue to flock to the cherry blossom spring events in large numbers. Where social distancing was more manageable was in shutting off obvious potential hotspots, closed spaces with poor ventilation (karaoke clubs and pubs), crowded places with many people people in the immediate vicinity and other close, intimate contact settings (Suzuki).
Cherry blossom time: no voluntary social distancing here (Photo: www.bloomberg.com)
Tokyo transport
Tokyo’s mass transit network is a petri dish in-waiting for coronavirus, but it appears that preventive measures (some pre-planned) have lessened the impact on public health. Tokyo business working hours have been staggered and large companies like NEC started to adopt telecommuting and teleworking, as well as a big increase of people riding bikes to work occurring. Consequently, transits at Tokyo’s central station on May 18th was down by 73% on the corresponding day in 2019 [‘Remote possibilities: Can every home in Japan become an office?’, (Alex Martin), The Japan Times, 23-May-2020, www.japantimes.co.jp].
(Image: Getty Images/AFP. P Fong)
Most pundits and observers conclude that Japan, with its ageing population and all its drawbacks and encumbrances, has (so far) warded off the worst of the pandemic. With no “silver bullet” in sight, we are left to speculate whether that they have achieved this outcome by sheer good luck, by good judgement, by the personal habits and cultural traits (especially hygiene) of its citizens, or by a combination of all of the above (McCurry).
Endnote: Low tester, early starter Another Asian country which has mirrored Japan’s pattern of choosing not to test in high volumes is Taiwan. The Taipei China republic, commencing measures to counter the virus as early as anyone did, had tested only 2,900 people per million of population (Worldometer, as at 20th May), but it’s mortality rate (deaths per million) was only 0.3 (total of seven deaths) compared to Japan which was 6.0 per million.
˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚˙˙˚
✤ as at 25-May-2020
✪ the largest metropolis prefecture in the world, around 14 million people
⌧ Japan’s health officials had themselves projected a worse-case scenario of up to 400,000 deaths (Gramenz)
✺ to be fair, there are constitutional impediments in Japan that prevent the declaration of a full, European-style lockdown (McCurry)
⊚ a Kyodo news poll indicated that 57.5% of people were unhappy with the government’s handling of the emergency. In so far as Japanese people have given credit to the success, it has gone to medical experts for efficiently managing Japan’s cluster tracing and containment efforts, rather than to Abe who many view with distrust based on its past track record [‘Time to Give Japan Credit for its COVID-19 Response’, (Rob Fahey & Paul Nadeau), Tokyo Review, 18-May-2020, www.tokyoreview.net]
The Kerala COVID-19 Template: How to Lead in the Fight against a Pandemic
When the coronavirus pandemic eventually reached India, it was always going to pose a challenge of epic proportions for a country of 1.3+ billion people, with such a dense population domiciled in such close quarters, and with a widespread underbelly of poverty. The Spanish flu of 1918 inflicted a death toll on India in the many millions, something no doubt in the back of the minds of public health officials. So, two or three months into the crisis, on paper, India’s COVID-19 record, on paper, doesn’t look as frightening as many other nations. As at 17-May-2020, so far it has had a shade under 91 thousand confirmed cases and a total of 2,872 deaths (www.worldometers.info).
(Photo: Indranil Mukherjee / Agence France-Presse – Getty Images)
There is a perception within medical circles however that these figures don’t portray the full extent of the outbreak. India’s urban areas are packed with masses of people living face to face, beset with poor sanitation conditions, up to 100 people sharing the same toilet in some cases, adding up to a recipe for catastrophe in plague time. Obtaining a test for coronavirus in India has tended to not be straightforward, thus the level of testing has lagged woefully behind what is desirable, eg, by well into March India was averaging only five tests per ten lakhs (= one million) people, compared with South Korea which had managed 4,800 per ten lakhs.
Too many migrant workers waiting for too few buses to take them home after the lockdown was announced (Photo: Yawar Nazir – Getty Images)
Containment measures have been far short of perfect, and with some glaring omissions…there has been passive resistance to the lockdowns from sceptical Indians, and the ban on public gatherings has from time to time been skirted round (some ‘scofflaw’ political parties continue to hold mass rallies). Although India’s borders were closed fairly promptly, some have been critical of the procrastination of Indian leaders’ during the crucial early days of the crisis, one Indian epidemiologist characterised it as a “let’s wait till tomorrow” attitude [‘India Scrambles to Escape a Coronavirus Crisis. So Far It’s Working’, (J Gettleman, S Raj, KD Singh & K Schultz), New York Times, 17-March-2020, www.nytimes.com]. This early reticence to act emanated from Delhi. The Modi BJP government, initially seemingly more concerned with the impact on India’s under-performing economy, issued no public health warnings or media briefings at the onset of the pandemic [‘What the world can learn from Kerala about how to fight covid-19’, (Sonia Faleiro), MIT Technology Review, 13-Apr-2020, www.technologyreview.com].
(www.anayahotels.com)
Kerala, leading from the periphery Kerala is one state that these general criticisms of Indian public health efforts against COVID-19 cannot be levelled. The small southwestern Indian state is one of the most picturesque parts of the land with its coconut trees and irenic and serene back-waterways. Known as a tourist mecca, Kerala, population 35 million, is more affluent than many parts of India (GDP per capital GB£2,200). 20% of India’s gold is consumed here, and it produces over 90% of the country’s rubber. Literacy is nearly 20% higher than the overall Indian average, and life expectancy too, is higher (www.holidify.com). All of these were contributing factors buttressing Kerala’s capacity to cope with the disease when it came.
Local vulnerabilities to the epidemic Kerala was coronavirus “ground zero” for India’s very first patients. Three students returning from Wuhan were tested positive and hospitalised (in all 70% of the state’s total virus patients have come from outside India). Certain preconditions pertaining to the state exacerbated the risk of disease outbreak, including a large number of Keralite migrant workers in the Gulf states, a huge expat population (working in Kerala from other Indian states), porous borders, and an early summer monsoon season (contributing to Kerala’s high rate of annual communicable diseases) [‘Coronavirus: How India’s Kerala state flattened the curve’, (Soutik Biswas), BBC News, 16-Apr-2020, www.bbcnews.com].
Preparation and planning Kerala was prepared for COVID-19 before the onset of the disease. The earlier Nipah viral outbreak (NiV) In Kerala (2018) proved a good trial run for the health service, giving the local authorities an opportunity to iron out chinks in it. Kerala’s communist-left coalition government had established a strong social welfare foundation, investing in the state’s infrastructure with a focus on health and education, and on tackling the state’s poverty✺. [‘How the Indian State of Kerala flattened the coronavirus curve’, (Oommen C Kurian), Guardian, 21-Apr-2020, www.theguardian.com].
Minister Shailaja (Source: www.manoramonline.com)
Shailaja ‘Teacher’, a woman with a plan When the epidemic arrived in Kerala, the proactive state health minister KK Shailaja took charge. With the full backing of Kerala chief minister, Pinarayi Vijayan, she had already organised a rapid response team to focus on targeted clusters, and liaised with the provincial councils. Kerala adopted the WHO protocols of test, trace, isolate and support. Rigorous contact tracing was employed, utilising detailed “route maps”. Testing of suspected carriers was decisive, with a quick, 48-hour turnaround of the result [‘Kerala has best coronavirus test rate in the country, but is it enough?’, (Vishnu Varna), The Indian Express, 01-Apr-2020, www.indianexpress.com], allowing them to move quickly on to the quarantine phase. 17,000 people were quarantined under strict surveillance, the poor without quarantine facilities were placed in improvised isolation. Recovered patients were duly released back into the community. Quarantine compliance was achieved through an admixture of phone monitoring (>340,000 calls and a neighbourhood watch system [‘The coronavirus slayer! How Kerala’s rock star health minister helped save it from Covid-19’, (Laura Spinney), The Guardian, 14-May-2020, www.theguardian.com; Kurian]. One of the sternest challenges, very early on, came from the district of Pathanamthitta. A family returning from Italy tested positive, but refused to disclose their movements upon return to Kerala. The civil servant in charge of the district, PB Nooh, and his team, worked round this obstacle by accessing the family’s GPS phone data, allowing them to trace all of their contacts (almost 300 people!). Nooh’s staff then tested the contacts for infection, thus shutting down the risk of the virus being exponentially transmitted to others in the community, ie, “breaking the chain” (Faleiro).
The coronavirus certainly didn’t miss Kerala, one-fifth of all Indian cases of the disease have occurred in the state. Under Shailaja, Kerala hit the ground running, before the end of January, screenings of arrivals at all four of the state’s international airports was introduced. The government imposed a lockdown even before the national lockdown was called…schools, malls, cinemas, public gatherings, were closed down, and the lockdown was stricter and longer than the national one (Kurian). Face masks were distributed to slum dwellers. Planning was precise and focused, a state stimulus package of Rs20,000 crore was directed towards the economic and medical crises.The medical task force was mobilised (doctors on leave were recalled, others asked to delay their leave). Those suffering hardship included migrant workers from other states were provided with free lunches by the state.
Communication with citizens informing them about all aspects of the crisis was clear and consistent (“Break the Chain” campaign which emphasises public and personal hygiene). Accordingly, community participation, both voluntary and active, was forthcoming. Some Keralites made accommodation available (including vacant homes in some instances) to those in need when requested to by the government [‘The Kerala Way of Tackling a Pandemic’, Times of India, 20-Mar-2020, www.timesofindia.com].
The Kerala government’s campaign against the virus has been aided by the polity’s decentralised nature of it’s structures. The coordination achieved allows the local councils to follow through on a lot of the public health measures needed to be implemented in the crisis (Biswas). The result of all this detailed planning and effort by Kerala – 587 confirmed cases and only four deaths and apparently no significant community transmissions (17-Apr-2020).
The state of Kerala and Shailaja ‘Teacher’ (so known because her occupation before entering politics was that of science teacher) are not resting on their laurels, being very mindful of the chance of a second wave of COVID-19 due to impending factors—Prime Minister Modi’s anticipated ending of the national lockdown, which will trigger a mass return of Kerala’s migrant workers based in the Gulf, and the approach of the tropical wet season in Kerala (June) [‘Kerala Lays Down Specific Plans To Tackle Monsoon Amid COVID-19 Pandemic’, NDTV, 15-May-2020, www.ndtv.com]. Minister Shaijala has been making preparations for such an event, many of the state’s teachers have been retrained as nurses to cope with a new upsurge in virus hotspots (Spinney).
EndNote: No time for Kerala complacency but a most worthy blueprint on offer The threat of new clusters emerging in Kerala remains very real, especially coming from outside, with a spike as recent as this past Friday—imported from neighbouring Tamil Nadu and Maharashtra as well as from overseas—reminding Shailaja and Co that the battle’s still far from won. Nonetheless, for elsewhere in India and beyond, there are lessons from Kerala‘s formidable achievement to be had from the state’s “nimble-footed, community-oriented, cautiously-aggressive approach” to the outbreak [Kurian; ‘Kerala reports 11 new Covid-19 cases’, (Ramesh Babu), Hindustan Times,16-May-2020, www.hindustantimes.com].
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✺ the Kerala government is Marxist in ideology but pragmatic in practice, it’s policies are moderately social-democratic, with a highly-privatised public health system (Kurian)