Showing posts tagged as: WHO
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 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 at 0130 hrs EAT time, 25-April-2020) USA 890,200 cases | 50,403 deaths Italy 189,973 cases | 25,549 deaths Spain 219,764 cases | 22,524 deaths France 158,183 cases | 21,856 deaths UK 143,464 cases | 19,506 deaths
——————————————————————————————————————————————————————————————————
✺✺ figures as at 0130 hrs EAT time, 25-Apr-2020
⋉ just over the last week the African continent experienced a sudden surge in infections, ‘Africa’s 43% jump in virus cases in 1 week worries experts’, (Gerard Zim Rae), ABC News, 23-Apr-2020, www.abcnews.go.com
⤱ although Russia did close its eastern border with China after the virus breakout
Revisiting the Coronavirus Origin Theories
(Image: KPBS)
China notified the World Health Organisation on 31 December 2019 of a series of “pneumonia-like” cases popping up in Wuhan, however it took some time for peripheral parts of the country to get wind of the burgeoning health crisis. Information from the government, when it did come, was pretty sketchy in the early stages of the outbreak. Soon after Chinese migrant workers began returning home from Wuhan, rumours of what might have caused the virus started to circulate in the regions.
Zoonotic source As the infection rates in Wuhan and Hubei province started to steeple in early February, there was lots of speculations about animal transmission to coronavirus’ “Patient Zero”. Civets, snakes, seafood, wolf cubs, rats—all live wildlife sold at the Wuhan ‘wet’ markets—got mentions as possible candidates for transmission. The story most heard and retold at the time was that it was bats that had transmitted the pathogen to humans at the Hua’nan markets⌧ (‘How It All Started: China’s Early Coronavirus Missteps’, (J Page, WX Fan & N Khan), WSJ, 06-Mar-2020), www.wsj.com). The Rhinolophus bat (Horseshoe bat) has been identified as the specific type of bat likely to have carried the infection (‘Coronavirus animal origin’, Crikey, 16-Apr-2020, www.crickey.com.au). A few weeks later there was a new prime suspect – the pangolin, the world’s most trafficked mammal. Chinese virologists⚘ had traced the virus to pangolins being sold at those same seafood markets in Wuhan (‘Mystery deepens over animal source of coronavirus’, (David Cyrenoski), Nature, 26-Feb-2020, www.nature.com).
(Image: Frans Lanting / National Geographic)
The inevitable conspiracy theories: Genetically-engineered virus Since February China and the US have exchanged accusations that Covid-19 was deliberately created as a biological weapon—all without foundation (‘No, COVID-19 Coronavirus Was Not Bioengineered. Here’s The Research That Debunks That Idea’, (Bruce Y Lee), Forbes, 17-Mar-2020, www.forbes.com). Chinese officials have also made the wild claim that the US Army brought the virus to Wuhan when it participated in the Military Games in the city in October last year.
🔺 Wuhan markets (Photo: NOEL CELIS /AFP via Getty Images)
Over the last couple of months, another story disseminated by southern Republicans has been doing the rounds of the conservative media in America. It espouses the view that coronavirus originated not from a wet market but from a biosafety lab in Wuhan (Wuhan Institute of Virology), from an accidental leakage. Again this view is bereft of any hard evidence to support it but this hasn’t stopped President Trump and his allies at Fox from seizing on it!✱ (“’Biological Chernobyl’: How China’s secrecy fueled coronavirus suspicions”, (Q Forgey, D Lippmann, N Bertrand & L Morello), Politico, 17-Apr-2020, www.politico.com).
While Covid-19 continues to wreak its trail of carnage worldwide, media and social media platforms will no doubt continue to throw up theories about the causes but until China releases the clinical and epidemiological data on the Wuhan outbreak, the pandemic’s precise origin cannot be scientifically determined (Politico).
🔺 Exporting America’s homegrown “Gates-gate”conspiracy – ‘Covidiocy‘ to Melbourne (Photo: AAP/Ricky Barbour)
______________________________________________ ⌧ bats are major reservoirs of many viruses, and prevalent in both the SARS and MERS outbreaks ⚘ scientific evidence for the pangolin as the culprit is based on a high match of its genome sequencing with that of SARS-CoV-2, however the research remains unpublished and therefore unreviewed; it is thought that pangolins may have been intermediate hosts for the disease … bat ⇝ pangolin ⇝ human ✱ these are only the less implausible theories, a raft of other ludicrous and wacky conspiratorial notions have been floated purporting to explain the epidemic’s genesis – ranging from Bill Gates having manufactured the virus to establish himself as the ‘Czar’ of US health care, to Covid-19 being caused by the installation of the 5G cellphone network (‘Coronavirus spawns conspiracy theories’, (David Knowles), Yahoo!news, 18-Apr-2020, www.yahoonews.com)
The 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 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.