Governments are losing credibility in the fight against Covid-19

Over the past weekend, parks, beaches and woodlands in the United Kingdom were teaming with people taking advantage of the balmy weather that the country is currently experiencing. This was the weekend when the country's Covid-19 death rate reached 50,000. Clapham Common, an area where you could see four or five people wandering around the deserted streets in the early days of the lockdown, was packed with the younger upwardly mobile that tend to live in the area. There was no sign of the social distancing that Britons carefully adhered to since their lockdown began on the 23^rd of  March.  It is a reflection of the credibility that the government in the UK has lost and as Professor Alan Whiteside writes in his weekly insight into Covid-19; it is happening in countries all around the world. Like many other governments, President Cyril Ramaphosa enjoyed many pats on the back for his initial response but it has descended into widespread concern about the loss of political rights and the initial ban on alcohol and continuing one on cigarettes, turned many South Africans into contraband specialists. Prof Whiteside also looks at the data which reflects how well countries have been dealing with the pandemic and includes a section written by a Russian writer on how the country initially reported low numbers but have since adjusted the data. This reliance on "national reporting with regards to confirmed Covid-19 cases and deaths", Prof Whiteside said… "could pose serious problems once countries begin to open their borders."  – Linda van Tilburg

By Alan Whiteside*

Introduction

Cities in the USA have erupted in flames as civil unrest and protest spread. In the UK the government's credibility is in shreds. The World Health Organisation's leadership is lacking. In many poorer nations the leadership and populations watch horrified as their economies contract, and, in time, may collapse. This is a global crisis; no country is untouched.

Perhaps the most obvious hit, other than deserted streets and empty city centres, has been in decreased mobility of populations, both business and leisure travellers. There are few aircraft flying and hotels and resorts are empty. Tourism and travel have, over the past few decades, become major contributors to Gross Domestic Product (GDP) and employment. Macau leads the table with 72.2% of GDP from travel and tourism. In Thailand it contributes 21.6%, in Greece 20.6%, in the UK 11%, and in South Africa 8.6%.^[1] Tourism employs 11.6% of those working in the UK, in Greece it is 23.9%.^[2]

There is not much reason for optimism in the short term. While the spread of Covid-19 is under control in some areas, in others the numbers continue to rise. However, this crisis is an opportunity to reset the global discourse, establish what is important to us individually, as nations and as humans.

We need to understand that this is a worldwide crisis and I am happy to include a special section by guest writer Alison Reiszadeh on the epidemic in Russia. In addition my colleague Warren Parker and I worked with BSIA students Jill Barclay and Felicia Clement to produce two papers for the Balsillie Papers series: see https://www.balsillieschool.ca/papers.

The numbers

At 8 am on 3^rd June 2020 the JHU Coronavirus Resource Centre recorded 6,328,951 global infections^[1]. Absolute numbers are in Table 1, I am simplifying this by reporting cases every two weeks.

Table 1: Global & National Cumulative Numbers of Confirmed Covid-19 Cases (Alphabetical order)^[2]

^*estimate

At the beginning of an epidemic actual cases provide the best data. As it evolves, other information becomes available. It is hard to compare absolute numbers for China with a population of 1.439 billion, with the United States' 331 million people, or South Africa's 59 million people. To make useful comparisons we need to look at rates.

Table 2: Covid-19 Deaths and Cases per million (alphabetical order) ^[3]

*misread these data

^[1] https://coronavirus.jhu.edu/map.html

^[2] These data are from the JHUM website. The countries are chosen because of their epidemics.

^[3] Sources: Deaths www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/  Case per million ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people

There is not much to report on the numbers this week. A fear is they, and their increases, have become normalised. It is hard to know how to make them interesting in the media but I watch the mounting toll with a sense of helplessness. The economic and social impacts are bleak.

An antibody test will tell who has been infected and recovered, let us know where we are in the pandemic, and allow targeted behaviour adaption. In the UK the National Health Service website said:

"Ask for a test to check if you have coronavirus

If you have symptoms of coronavirus (Covid-19), you can ask for a test to check if you have the virus. This is called an antigen test.

There is another type of test (antibody test) that checks if you've already had the virus. This test is not widely available yet. You can find out about antibody testing on GOV.UK". ^[6]

Actually, there is nothing worthwhile on antibody tests there. Yet again government is disassembling. There do not seem to be government-approved antibody tests available. The political response to the failure to deliver is to go silent. Government scientists at the briefings simply look very embarrassed.

The Lockdowns

Across the world the first round of lockdown releases is underway, haltingly and uncertainly. Are we doing the right thing? That is difficult to answer. The end result seems to be confusion amongst the citizenry. People reading this blog will have a sense of what is going on in their countries, I will touch on the situation in South Africa, England (Northern Ireland, Wales and Scotland are going their own way, as they are entitled to under devolved government) and the Scandinavian nations of Sweden and Norway.

South Africa

Last week the story was of scientific freedom and academic integrity coming under attack. This seems to have been resolved. This week the focus is on the impact. A thoughtful article in the Daily Maverick of the 3^rd of June makes many key points.^[7] The initial response was a partnership between policy makers and scientists, the fracas of a week ago was an unwelcome distraction. The core policy of lockdown and banning sales of alcohol and cigarettes worked initially, but there were gaps: between implementation and intention; rich and poor. This led to opportunities for criminals and heavy handed un-nuanced enforcement.

Currently the numbers are climbing. The intervention bought time, but at a cost. As Jonas writes: "Pain has been felt across the board but the lockdown fell hardest on the poorest – ordinary workers who lost their jobs and those who live and work in the informal sector, who have no savings, no property and whose only means of support, if they cannot work, are their families… The problem is an un-nuanced narrative that pits public health versus the economy as a zero-sum or binary choice. There are ways to open up that protect public health".^[8]

England

The UK is a divided nation, it seems there are also deep divisions in England alone. The uproar over the movements of Dominic Cummings, the Prime Minister's adviser, during the lockdown resulted in his extensive ill-advised press conference on 25 May. The result of that was a series of 'new' initiatives and 'success' stories from the government to try and turn attention away from the Cummings train crash. This has not worked. While Cummings may not have the same level of press coverage, the levels of confidence in the government and its advice have plummeted.

According to YouGov: "Britons themselves tend to agree – there is no European country that Britons believe has handled the outbreak less well than the UK. They are most evenly split on Italy, with 23% of Britons believing the UK has done worse compared to 22% better, and they do consider themselves to have handled the crisis better than China, at 35% to 30%."^[9] The polling organisation notes that Leave voters have a more positive view of the crisis management relative to other European countries than Remain voters, but they concede Britain's European neighbours have done better.

On 1^st June there were moves to ease the lockdown. Two year groups returned to primary school (on a voluntary basis), the number of people allowed to meet outside was increased, and private gardens were included in this. More high street shops are expected to open on 15^th June. Most other shops and personal service establishments such as hairdressers, nail bars and beauty salons, cafes, pubs will open on a phased basis.

Norway and Sweden

There is a great contrast in the way Norway and Sweden treated the crisis. As mentioned in previous communiques Sweden kept schools, bars, restaurants, and shops open and based their response on voluntary measures of social distancing and basic hygiene.^[10] The data shows that Sweden has the highest number of Covid-19 deaths globally, per capita. It recorded 5.7 deaths per million inhabitants per day in a rolling seven-day average on June 1^st. By contrast the rates in Norway was 0.03 and in Denmark 0.3. between 12 May and 19 May.^[11]

The Swedish action was not entirely economically driven. Epidemiologist, Anders Tegnell, "says his approach is more sustainable when tackling a virus that's likely to be here for the long term… Tegnell's theory is widely accepted by Swedes and has won some support from the World Health Organisation. Michael Ryan, who runs WHO's health emergencies program, recently said, 'If we are to reach a new normal, in many ways Sweden represents a future model.'"^[12]

Across the border a week ago (27^th May) "Norway's prime minister Erna Solberg went on Norwegian television to make a startling admission: she had panicked. Some, even most, of the tough measures imposed in Norway's lockdown now looked like steps too far. "Was it necessary to close schools?" she mused. "Perhaps not. … I probably took many of the decisions out of fear," she admitted, reminding viewers of the terrifying images then flooding their screens from Italy.

She is not the first to conclude  closing schools and kindergartens, making everyone work from home, or limiting gatherings to a maximum of five people might have been excessive. On May 5 The Norwegian Institute of Public Health (NIPH) reported when lockdown was imposed on March 12, the reproduction number had  fallen to 1.1, and went under 1 on March 19. "Our assessment now… is that we could possibly have achieved the same effects and avoided some of the unfortunate impacts by not locking down, but by instead keeping open but with infection control measures," Camilla Stoltenberg, the Director General… said in a TV interview earlier this month."^[13]

There will be a period of taking stock when this pandemic is over and the question of whether or not to lockdown, and how much to do so will need to be addressed. This will be addressed in the next communique. In Brazil President Bolsonaro flouts the Health Ministry's physical distancing guidelines and does not take Covid-19 seriously. This and South Africa can provide additional case studies.

Guest Contribution: Covid-19 in Russia by Alison Reiszadeh^[14]

Covid-19 has transformed the world. Over the course of a few weeks countries diligently began to close their borders, halt production, reallocate public expenditures, and enforce 'stay at home' orders; all in an attempt to "flatten the curve" of coronavirus cases within their borders. The United States, Brazil, and Russia have risen to the top of the charts of most confirmed Covid-19 cases. The speed with which they reached this status was remarkable.

Russia has shocked the world with their dramatic increase in cases. On April 1st, 2020 Russia had reported only 2,700 cases, this reached 106,400 by April 30^th. By the beginning of June there were over 415,000 cases. The epicenter of the national epidemic is Moscow, currently with about two-thirds of the cases. So what happened? How did this number grow so quickly? And what does this mean for citizens moving forward? Before diving into these questions, it is important to note, Russia's mortality rate is significantly lower than rates reported in other developed nations.

According to the JHU^[15] Russia reported a mortality rate of just 1%. In comparison, Canada and the United States report a rate of over 6%, while Western Europe including Italy, France, Spain, Belgium and the UK have experienced a mortality rate over 10%. The precise reason for this discrepancy remains unclear. (Editor's note – this may be a factor of where the country is on the epidemic curve, it takes about a month for a case to move from initial infection to resolution: death or recovery).

Dr. Elena Malinnikova, the Chief of Infectious Diseases in the Russian Ministry of Health explained the low death toll is due to the speed and efficiency of detection and treatment within the Russian healthcare system.^[16] However, we do not know how Russia attributes death to Covid-19. In fact, on May 29^th the government presented more detailed mortality figures for April that included more deaths linked with coronavirus. The toll under new criteria^[17] could be nearly 60% more than previously tallied.

With no mechanism to enforce a standardized method of data collection, the international community has to rely on the national reporting with regards to confirmed Covid-19 cases and deaths. This could pose serious problems once countries begin to open their borders.

Russia's response

Compared to elsewhere in Europe and Asia, the impact of Covid-19 in Russia was delayed. During February, dozens of cases were being reported in Europe. Apart from one Chinese national, treated in Siberia, no other cases were reported that month.

Illusions of Russia's invulnerability to the disease dissipated in March. On March 30^th President Vladimir Putin imposed a nationwide lockdown. On May 12^th during the peak of Covid-19 cases, he decided to ease lockdown measures. Over the past two decades Putin created the impression that he makes all the important decisions in Russia, yet he seemed strangely absent during the Covid-19 crisis. Over the past 5 months, the pandemic has highlighted what has always been Putin's biggest vulnerability: "a pronounced lack of interest or success in tackling intractable domestic problems like dilapidated hospitals, pockets of entrenched poverty and years of falling real incomes."^[18]

Covid-19 and Healthcare

Inadequate health care funding is a chronic issue in Russia.^[19] On paper, citizens are entitled to free universal healthcare. In practice, it is commonplace for patients at state hospitals to bribe doctors for adequate treatment. The grim reality of Russian provincial state healthcare often has more in common with low income countries than a supposed resurgent superpower: 17,500 towns and villages across Russia have no medical infrastructure at all.

Between the beginning of 2013 and the end of 2019, Russia's healthcare reform more than halved medical staff including junior nurses and orderlies, and cut fully fledged nursing staff by 9.3%.^[20] This prompted the deployment of medical students to hospitals strained by the pandemic. They are playing a key role in the battle against COVID.

When understaffed and underfunded hospitals are met with a new global disease, the current state of affairs in Russian hospitals, the consequences are not difficult to predict. Facing dire shortages of protective gear, 400 Russian hospitals suffered outbreaks of the coronavirus, and over 180 medical workers have lost their lives. Doctors at Moscow's top hospitals are reporting nearly overwhelming levels of infection among their colleagues.

Given the current states of affairs, what do Russia's leading healthcare officials have to say about it? On March 20^th 2020, Doctor and television presenter Alexander Myasnikov, predicted the Covid-19 epidemic should wane by mid-April, and called the coronavirus a "seasonal phenomenon."^[21] Myasnikov was appointed in April to the role of head of coronavirus information, tasked with informing Russians about coronavirus treatment and prevention methods and countering "fake news".  However, on May 26^th, Myasnikov dismissed panic over the novel coronavirus as "bulls—t" in an interview with Russian television personality Ksenia Sobchak for her YouTube Project.^[22] He continued, "It's all exaggerated. It's an acute respiratory disease with minimal mortality."

It is reasonable to assume that Russia's lack of preparedness and competing narratives has placed the wellbeing and lives of Russian citizens in jeopardy. Moving forward, the situation will challenge society and government while the ability of Russians' propensity to prosper will be on full display.

Conclusion

The sclerotic speed with which scientific advances are being announced is deeply concerning. In order to reset the world, economically and socially we need a vaccine or an effective, inexpensive and accessible treatment. Ideally, we need both. A week ago, European governments (these were France, Belgium, Italy and the UK) halted the use of hydroxychloroquine as a Covid-19 treatment. This is, of course, the drug Donald Trump said he was taking as a prevention. The ban was due to safety issues, people developed irregular heartbeats and were more likely to die.^[23] It will still be used in clinical trials.

There are some encouraging developments. Placing patients on their fronts makes breathing easier. Ibuprofen can reduce inflammation, and is cheap. The value of using face masks is beginning to be appreciated and may become mandatory in public spaces in more countries soon. And of course, there are some countries where they appear to have dodged the pandemic bullet, Namibia had had no deaths up to 28^th May and was preparing to ease their lockdown. The next communiqué will include a discussion on lockdowns and their consequences. Were they the right thing to do?

References:

Chan Yuk Wah and David Haines, Diseasescape: Coping with Coronavirus, Mobility, and Politics,

May 29, 2020, Volume13, Issue 33

www.21global.ucsb.edu/global-e/may-2020/diseasescape-coping-coronavirus-mobility-and-politics

Kimberly A. Prather, Chia C. Wang, Robert T. Schooley, Reducing transmission of SARS-CoV-2, Science,  27 May 2020: eabc6197 DOI: 10.1126/science.abc6197 a worthwhile technical paper https://science.sciencemag.org/content/early/2020/06/02/science.abc6197.full

Mcebisi Jonas, We need to rethink (just about) everything, OP-ED, Daily Maverick, 3^rd June 2020

www.dailymaverick.co.za/article/2020-06-03-we-need-to-rethink-just-about-everything/

Thank you to everyone reading, reposting and providing comments.  For those who are interested in the economics of COVID-19, join the group "Economics of COVID-19" LinkedIn group. What I write is public domain, share, forward and disseminate. My contact: awhiteside@balsillieschool.ca 

^[1] https://knoema.com/atlas/topics/Tourism/Travel-and-Tourism-Total-Contribution-to-GDP/Contribution-of-travel-and-tourism-to-GDP-percent-of-GDP

^[2] https://ec.europa.eu/eurostat/statistics-explained/index.php/Tourism_industries_-_employment#The_tourism_industries_employ_over_13_million_people_in_the_EU

^[3] https://coronavirus.jhu.edu/map.html

^[4] These data are from the JHUM website. The countries are chosen because of their epidemics.

^[5] Sources: Deaths www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/  Case per million ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people

^[6] https://www.gov.uk/government/publications/coronavirus-covid-19-antibody-tests/coronavirus-covid-19-antibody-tests#about-antibody-tests

^[7] Mcebisi Jonas, We need to rethink (just about) everything, OP-ED, Daily Maverick, 3rd June 2020

www.dailymaverick.co.za/article/2020-06-03-we-need-to-rethink-just-about-everything/

^[8] ibid.

^[9] https://yougov.co.uk/topics/international/articles-reports/2020/06/02/europeans-think-uk-has-managed-covid-19-poorly-and

^[10] https://www.independent.co.uk/news/world/europe/coronavirus-sweden-highest-deaths-per-capita-europe-bars-restaurants-a9526221.html

^[11] https://ourworldindata.org/coronavirus-data-explorer?yScale=log&zoomToSelection=true&deathsMetric=true&dailyFreq=true&aligned=true&perCapita=true&smoothing=7&country=USA~GBR~CAN~BRA~IND~DEU~FRA~MEX~CHL~ZAF~SWE~NOR~DNK

^[12] https://www.bloomberg.com/news/articles/2020-05-19/sweden-in-very-deep-economic-crisis-despite-soft-lockdown

^[13]   https://www.telegraph.co.uk/news/2020/05/30/coronavirus-norway-wonders-should-have-like-sweden

^[14] Alison Reiszadeh is a graduate of the BSIA and has just returned to Canada from a placement in Ukraine.

^[15] https://coronavirus.jhu.edu/data/mortality

^[16] https://iz.ru/1007510/2020-05-04/spetcialist-obiasnila-nizkuiu-smertnost-ot-koronavirusa-v-rossii

^[17] https://www.cbc.ca/news/world/russia-coronavirus-deaths-stats-covid-19-1.5591150

^[18] Andrew Higgins (April, 2020). "Putin, Russia's Man of Action, Is Passive, Even Bored, in the Coronavirus Era". The New York Times, https://www.nytimes.com/2020/04/30/world/europe/russia-putin-coronavirus.html

^[19] https://www.independent.co.uk/news/world/the-horror-of-russian-healthcare-a7443121.html

^[20] https://www.vedomosti.ru/society/articles/2020/04/09/827471-gotovo-rossiiskoe

^[21] https://www.gazeta.ru/social/2020/03/20/13013815.shtml

^[22] https://www.youtube.com/watch?v=6CpI22QJ07Q&feature=youtu.be&t=3360

^[23] www.dailymaverick.co.za/article/2020-05-29-eu-governments-ban-malaria-drug-for=covid-19-trial-paused-as-safety-fears-grow

• Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal www.alan-whiteside.com.