Covid-19: Looking for glimmers of hope in second wave – SA health policy expert Prof Whiteside

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South Africa is in the vice grip of a second wave of the Covid-19 virus. After a year of social isolation, financial pressure, emotional turmoil and fear Covid-19 is delivering an even more devastating blow. A new strain of Sars CoV-2 has been identified. It spreads more easily and younger, healthy people are succumbing to the disease in hospitals, Discovery Health’s Covid-19 expert Dr Ronald Whelan recently told BizNews.com. This second wave is being driven by the new variant and healthcare experts are expressing concern that the latest wave has a much steeper curve with more deaths and intensive care unit admissions. The Western Cape‘s healthcare system is buckling under the wave and private facilities are sending patients into the public sector. Healthcare workers in the province are falling ill and a third of 7,000 workers have taken Covid-19 related leave this year. The province says it needs to hire more than 1,300 additional nurses. Meanwhile pandemic fatigue has set in as South Africans let down their guard and travel to popular holiday destinations on the coast. Vaccines are rolling out around the world but government has only announced vague details of plans to vaccinate just 10% of the population near the middle of next year, well into flu season. It’s no wonder Alan Whiteside – an international health policy expert of global standing – feels burnt out. – Melani Nathan

Covid-19 watch: Christmas is cancelled

By Prof Alan Whiteside*

Introduction

I took a break last week and this blog is posted on Monday, 21 December. The next will be on 11 January in 2021. I was beginning to feel rather burnt out. Although the posts are quite short, they take time to craft, proof, and check. Today there have been about 77,000,000 cases of Covid-19 globally and nearly 2,000,000 deaths. In the UK a new more transmissible variant is spreading rapidly. Johnson warned “it may be “up to 70 per cent” more transmissible than earlier strains.”1 There is no evidence yet to suggest it causes more severe or less severe disease. It has, however, led to bans on travel from the UK and a number of other countries.

Alan Whiteside

Whilst the inexorable progress of the epidemic remains a great source of concern, the year ends with some good news. Treatments continue to evolve and improve. More importantly there has been rapid progress in understanding the virus and developing vaccines. Vaccines have been rolled out in a number of countries, and many more are various stages of development.

The consequences of the pandemic, and our response to it, have been life changing. In the next year lockdowns will be lifted and government support packages, where they exist, will come to an end. The current response cannot be sustained. Initially people suggested the effect of the epidemic might be V-shaped. A rapid decline in whatever indicator one looked at, followed by an equally rapid recovery, until we were back at status quo. As time went on the talk became of a U-shaped effect. The decline is followed by a period of constraint before the recovery. A more sophisticated and accurate picture of the epidemic is of a K. The decline is followed by a divergence as some people recover, and indeed grow ever richer, whilst others, the majority, see a continued decline.

My prediction is a year from now the pandemic will be medically under control. The social, economic, political, educational, and psychological effects will still be evolving. For example, we have no idea what effect this period of lock down, and suspension of education will have on many millions of children who have spent months out of school. They have, at best, been inadequately educated by stressed parents or through unstable internet connections (for those lucky enough to have computers and access to the internet).

I hope we take the opportunity to reflect on how we live and interact with each other, and the natural environment. If we do, we may be prepared for the next big challenge, probably, but not necessarily, environmental collapse. This week I will identify some of the websites that are exceptionally useful in helping understand the epidemic, the science, and some of the ramifications.

The first virus tracker I discovered was produced by Johns Hopkins.2 Their Coronavirus Resource Centre has a useful dashboard. There is a table of infections by country and information on daily cases, daily deaths, cumulative cases, cumulative deaths and a log representation of cases are shown on graphs. There are other pages for additional information. I still visit it, although it seems a little tired in comparison to some of the other sources.

The numbers

The USA continues to lead the global league table with about 18 million confirmed cases and the gap is widening with India, the next country reporting over 10 million cases. The leader board has not changed much. Brazil, Russia, France, and the United Kingdom take the next four places. South Africa has fallen to 18th place with just under 1 million confirmed cases. The US epidemic is quite unbelievable. 16th December saw the highest number of deaths on one day since the epidemic began, with 3,668 people losing their lives according to the John Hopkins website. With the political upheavals in the USA the focus has been on Donald Trump and his behaviour during and after the election.

The tables I included for some months when I first began posting are reproduced and updated. Initially the largest number of cases were in China, France, Italy, South Korea, Spain, the United Kingdom (UK), and the United States. I included South Africa since it is home. South Korea and China rapidly brought their epidemics under control. They currently have 49,665 cases and 95,027 cases respectively. Italy and Spain still face serious epidemics.

The top five countries are the USA, India, Brazil, Russia, France, and the UK. South Africa is in 18th place. The table gives the cumulative number of cases since the pandemic began. These are not only active cases, but also those who died or recovered. The data is from Johns Hopkins.3 The advice to readers is if you want to know what is going on in your country or region then go to the appropriate website. Most wealthier nations have their own public health departments and are producing data for their citizens. It is also relevant to remember the websites presenting global data have to get it from somewhere. This is usually obtained, however inadequate, from local disease control and public health departments.

Table 1: Selected numbers confirmed Covid-19 cases (alphabetical order)4, 5
Date Global cases Brazil India ∞ Mexico ∞ Russia S. Africa UK USA
15 Feb 69,000 0 2 0 9 43
1 Apr 861,000 6,836 2,777 1,400 29,900 213,400
13 May 4,262,799 180,000* 232,243 11,350 227,741 1,369,964
10 Jun 7,250,909 739,503 493,023 52,991 262,098 1,979,893
8 Jul 11,830,885 1,668,539 742,417 261,750 693,215 215,885 286,979 2,996,098
17 Aug 22,145,643 3,407,354 2,767,253 531,239 930,276 592,144 322,177 5,482,602
16 Sep 29,576,191 4,382,263 5,020,359 676,487 1,069,873 651,521 376,670 6,606,293
7 Oct 35,813,384 4,969,141 6,757,131 794,608 1,231,277 683,242 532,799 7,501,769
18 Nov 56,355,000 5,946,000 8,958,000 1,015,000 1,976,000 757,144 1,434,000 11,592,000
20 Dec 76,437,510 7,213,755 10,031,223 1,313,675 2,821,815 912,477 2,010,121 17,667,545
Table 2: Covid-19 deaths and cases per million, selected dates (alphabetical order)6
Belgium France Italy Russia S. Korea S. Africa UK USA
Deaths (19 May) 421.07 529.64 18.84 5.13 5.26 523.33 275.8
Tot. Cases (20 May) 2,189 3,736 1,991 216 277 3,629 4,557
Deaths (3 Jun) 429.83 533.93 33.56 5.27 13.35 587.24 320.93
Tot. Cases (2/3 Jun) 2,320 3,856 2,905 225 579 4,070 5,472
Deaths (17 Jun) 438.73 568.76 49.01 5.38 27.14 627.71 354.46
Tot. Cases (16/17 Jun) 2,410 3,924 3,681 237 1,239 4,372 6,386
Deaths (1 Jul) 444 574 63 5 43 655 385
Tot. Cases (30/1 Jun/Jul) 2,516 3,976 4,393 249 2,432 4,595 7,826
Deaths (8 Jul) 444 575 64 5 46 657 388
Tot. Cases (7/8 Jul) 2,759* 3,999 4,713 257 3,317 4,209 8,877
Deaths (22 Jul) 449 581 93 5.7 122 688 451
Tot. Cases (21 Jul) 2,804 4,073 5,606 277 7,630 4,420 12,961
Deaths (12 Aug) 451 582 104 5.9 186 699 501
Tot. Cases (13 Aug) 3,127 4,155 6,150 287 9,545 4,607 15,532
Deaths (26 Aug) 865 453 586 113 6 227 623 540
Tot. Cases (25 Aug) 7,075 3,751 4,305 6,588 350 10,309 4,811 17,344
Deaths (8 Sep) 867 456 588 123 6 259 624 576
Tot. Cases (8 Sep) 7,651 5,040 4,610 7,062 418 10,780 5,157 19,035
Deaths (23 Sep) 966 460 589 129 7 270 626 597
Tot. Cases (23 Sep) 9,071 7,170 4,976 7,645 452 11,183 5,944 20,834
Deaths (30 Sep) 874 471 593 140 8 287 631 624
Tot. Cases (30 Sep) 9,945 8,313 5,149 7,945 462 11,324 6,466 21,595
Deaths (16 Dec) 1,582 870 1,092 328 12 404 969 921
Tot. Cases (19 Dec) 53,820 38,560 32,054 19,136 968 15,385 29,609 53,339

Vaccines

Since I last wrote the Pfizer and BioNTech vaccine is being rolled out across the UK. There had been 1.8 million vaccinations given by 20th December. The Bloomberg website shows vaccinations being given in Canada, China, Russia and the USA.7 It should be noted that there are reports of Chinese vaccines being administered in a number of countries in Africa, the Middle East and South America. Solid data are hard to find. The Guardian published the prices the EU had agreed to pay for vaccines, they reported these were inadvertently posted on Twitter by the budget state secretary.8 These are:

  • Oxford/AstraZeneca €1.78
  • Johnson & Johnson $8.50 (note: dollar price, but this needs only one dose. In €6.93)
  • Sanofi/GSK €7.56
  • Pfizer/BioNTech €12
  • CureVac €10
  • Moderna $18 (note: dollar price. In €14.68)

This list is interesting not just for the prices, but because it indicates which vaccines the EU thinks will work and be approved. There are no prices for the three Chinese vaccines. The questions, as vaccines are rolled out, are not just price but also availability. There will also have to be constant monitoring for adverse events.

Consequences

The number of new cases in the UK has risen rapidly. On Saturday, 19th December Prime Minister Johnson went on national television. Flanked by the Chief Medical Officer and the Chief Scientific Officer he announced Christmas was cancelled. Prior to this, the plan was that restrictions were to be eased for five days over the holiday period to allow families to gather. To quote Johnson: “we cannot continue Christmas as planned”. Increased restriction on London and parts of its hinterland have been imposed, a new Tier Four has been imposed. Because health is a devolved responsibility, Scotland, Wales and Northern Ireland can make their own decisions.

The process through which the decision as to which tiers should be imposed is based on: “the total number of Covid cases in an area; the number of cases in the over-60s; the rate at which cases are rising or falling; the proportion of test results coming back positive; and pressure on the NHS.”9 The first Minister of Scotland Nicola Sturgeon has adopted the same level of restrictions. They are almost the same in Wales and Northern Ireland. It is hard to find a simple straight forward official guide to the Tiers, why are we not surprised? The website in this reference asks for your postcode.10

The emergence of the more infectious variant has led to travel restrictions on movement from the UK. First was the Netherlands, banning all passenger flights until 1 January. France suspended all travel, including freight lorries, with the UK for 48 hours from midnight on Sunday. The Eurotunnel suspended access to its Folkestone terminal from 22:00 GMT. Ireland banned flights from England, Wales and Scotland for 48 hours. Germany banned planes from the UK from midnight on Sunday. Belgium suspended flights and train arrivals from the UK from midnight on Sunday for at least 24 hours. Italy is blocking all flights from the UK until 6 January. Austria, Turkey and Switzerland have banned flights for an unspecified period. Bulgaria’s banned flights until 31 January.11 Other countries imposing flight bans are Argentina, Chile, Colombia and Canada.12

This is the last communiqué of the year. In 2021 the first communiqué will be on 11th January. I intend to develop a survey and work out how to proceed (if at all) beyond that, weekly is too frequent for me alone. I may revert to monthly posts. Please, in due course, take 10 minutes to complete another survey or drop me a line. I won’t be offended by honesty and would love ideas.

Conclusion

When I began writing in early March, I aimed to provide updates on where we were and where we were going. There are a few things one can still ‘bring to the table’. I can provide an overview of some of the science: developments and discoveries, what is important as I see it. At the end of 2020 it is the report on the development and distribution of vaccines, and to document the consequences of the pandemic, that is crucial. It is the reaction to the virus that is causing the global calamity.

So, what next, the Telegraph has an article on ‘economic long Covid ‘today (Monday 21st). Roger Bootle writes: “This danger is particularly great now for, much more so than in a normal recession, the coronavirus catastrophe is surely going to radically reshape the economy. We can speculate as to what the new shape will be, but no one can be remotely sure about it.” This where I suspect we may disagree; it is a chance for a fairer more caring society to develop. We need to make sure this happens, and I am really not sure how to go about it.

Useful resources

These are useful websites

Thank you for reading, reposting and providing comments. What I write is public domain so please share, forward and disseminate. My contact is: [email protected]

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