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].
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✹ 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].
──── ୨୧ ────
✱ 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.
Sardine distancing (Source: www.quora.com)
Japan, unpropitious conditions for avoiding a 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].
₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪
✺ 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)
International Conference on the Great Manchurian Plague: A Pioneering Blueprint for Public Health Advances and Safeguards
Once the authorities in Manchuria had secured a firm handle on the plague outbreak in Heilongjiang, Kirin and Fengtian provinces by February 1911, little time was wasted calling for a conference of international medical specialists to enquire into all aspects of the epidemic and promote the advancement of future disease control. Scientists including disease specialists from many countries were invited to attend the location chosen for the conference, Mukden (Shenyang), which was one of the cities in North-East China hardest hit by the pneumonic epidemic.
Despite the pressingly urgent need to canvas expert international input into the dire health catastrophe, China must have had some reservations about what it was doing. Both Russia and Japan with undisguised Manchurian ambitions already held firm footholds in N.E. China (control over railway lines, ports, territorial concessions, etc), plus other Western powers controlled Chinese treaty ports further south. But with no politicians taking part in the conference and all attendees pledging that it’s focus was to be on scientific investigation and not about imposing any further external controls on China, the central government pushed on with it [‘In 1911, another epidemic swept through China. That time, the world came together’, (Paul French), CNN, 19-Apr-2020, www.cnn.com]. Dr Wu Lien-teh, the “plague fighter-general” of Harbin, was appointed conference chairperson. There were a few “nationalistic frictions” with the Japanese mainly resulting from some anti-Chinese remarks injudiciously made by the Japanese delegate, Professor Kitasato, before leaving Tokyo for the conference, but this did not impede the cohesion of the conference [Eli Chernin (1989). “Richard Pearson Strong and the Manchurian Epidemic of Pneumonic Plague, 1910—1911” (PDF). Journal of the History of Medicine and Allied Sciences. 44(3): 296–319. doi:101093/jhmas/44.3.296. PMID 2671146].
🔻 Safety precautions at Harbin plague site
A congress of international disease experts The International Plague Conference (IPC) was a ground-breaking series of ‘firsts’, the first international scientific symposium held in China, the first time in modern history of a multi-nation approach focusing on disease control. The conference also anticipated the purpose of later world bodies dedicated to international health maintenance, the League of Nations’ Health Organisation (LNHO), established in 1923, and it’s successor, the UN’s World Health Organisation (WHO), created after the Second World War.
Scientists from ten countries joined host China at the Plague Conference in the repurposed Shao Ho Yien palace – the US, UK, France, Russia, Japan, Italy, Germany, Austro-Hungary, Netherlands and Mexico, an indication of how seriously the international medical community took the Manchurian outbreak and its implications. The delegates were drawn from several relevant and related fields including epidemiologists, virologists, bacteriologists, tropical medicine specialists and illness consultants.
🔻 Contemporary coverage of the conference in ‘The Lancet’
The conference, getting into the “nitty-gritty’ High on the conference’s agenda was the question of aetiology, what were the Great Manchurian Plague’s causal factors? American delegate Richard P Strong, who arrived prior to the conference, undertook pathological experimentation which verified the infectious role played by tarbagan marmots in the plague (which he published in the Philippine Journal of Science, 1912). The experts had to sift through a raft of unhelpful faux-scientific beliefs and assumptions to get to “the scientific root of the bacteria”, again underlining the IPC’s emphasis on science and medicine. Containment was another key issue at the conference. The discussion was around what worked best in the plague? Measures like ‘blanket’ quarantines, travel bans, face masks and ad hoc plague hospitals (swiftly assembled to isolate the infected from the healthy), all got a big tick…an endorsement of Dr Wu Lien-teh’s positive measures in the war against the pneumonic epidemic, deemed by the conference delegates as essential tools in the fight against future outbreaks and waves of plague (French).
🔺 The admirable Dr Wu
Seeds of a nationwide public health service One of the conference’s finest and far-reaching achievements was to establish the Manchurian Plague Prevention Service (under the helm of Dr Wu). The MPPS and Wu identified medical education as the “holy grail”, the service’s role was to disseminate materials to the public, promote the efficacy of sanitary conditions and health in the community, and overall playing a leading role in adopting Western medicine (Xīyào) and methods of disease control in China. MPPS provided the model for a future Chinese national health service (French).
The follow-up to the three-and-a-half week International Plague Conference put Chinese medicine on the path to modernisation. Many of the country’s medical advances began here …. the IPC laid down a blueprint for handling future plagues which included the use of autopsies, instructional dissection and cremation, all of which became institutionalised practice afterwards (Chernin).
Medicine and health before politics
The Mukden IPC in April 1911, conducted in an atmosphere free of politicising, demonstrated the cooperative humanitarian efforts of a group of medical professionals…when left to it by the politicians, they showed single-minded unity of purpose, what could be achieved, collectively and internationally, to counter the danger of a disease with immediate and future global ramifications for public health. I need not emphasise the stark contrast with the management of the world’s current pandemic in which some of the major powers, distracted from the only really important priority, are happy to engage in a ”political blame game” over the coronavirus‘ origins, instead of co-operating with each other to meet a pernicious and deadly health risk to the planet head-on and in unison.
Endnote: Lessening future shock The gains in medicine and public health protection coming out of the conference were soon put to use in China. Disease re-emerged in the 1919 malaria epidemic and the 1921 plague (again in Harbin) which was to test China’s embryonic national quarantine system. Dr Wu again took charge to guide China through these medical crises. The improvements in public health since 1911, it is estimated, reduced casualties in the second outbreak of pneumatic plague by four-fifths [‘Portraits of a plague: the 19th-century pandemic that killed 12 million people’, History Extra, 21-Jul-2015, www.historyextra.com].
Behind the 24–Hour Cycle 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✺✺.
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.
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].
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⋉.
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].
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 @ 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
໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱໒꒱
✺✺ figures as @ 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 Government’s War on Coronavirus: The Great COVID-19 War from Ground Level
(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 airport 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.
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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
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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.