Health DG responds to open letter to PM from ‘MOH specialist’

Dr Noor Hisham Abdullah responds to the open letter of Dr Tachdjian to the prime minister "Covid-19: Wake up, enough talk, take action". ‘Even though it is not directed to me, but as the director-general of Health, I have to understand what this "Health Ministry (MOH) staffer" is trying to relay, regardless of the person's rank, grade, or profession. It occurred to me when it was said that the doctor was an "MOH specialist" it would surely attract everyone's attention to read it...’

Read here (Malaysiakini, Oct 12, 2020)

Wake up, enough talk, take action: An open letter to the PM from ‘MOH specialist’

‘Wake up dear Prime Minister Muhyiddin Yassin – you are a self-proclaimed “abah” (father) that wishes to “rotan” (cane) his rakyat for misbehaving and not following standard operating procedure (SOP). You fail to realise that the saddening facts of this Covid-19 wave listed down above are not due to Covid-19, but rather the failure of your administration to prioritise the health of the rakyat above all else...’

Read here (Malaysiakini, Oct 11, 2020) 

Dying in a leadership vacuum: NEJM editorial

‘Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.

‘The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.’

Read here (New England Journal of Medicine, Oct 8, 2020)

Germans embrace fresh air to ward off coronavirus

‘Ventilating rooms has been added to the German government’s formula for tackling coronavirus, in refreshing news for the country’s air hygiene experts who have been calling for it to become official for months. The custom is something of a national obsession, with many Germans habitually opening windows twice a day, even in winter. Often the requirement is included as a legally binding clause in rental agreements, mainly to protect against mould and bad smells. But while some people may dismiss the method as primitive, “it may be one of the cheapest and most effective ways” of containing the spread of the virus, Angela Merkel insisted on Tuesday.’

Read here (The Guardian, Sept 30, 2020) 

On the futility of contact tracing (in badly-affected countries like the US)

‘Is contact tracing now futile for the COVID-19 epidemic in most of the world? Probably yes. The infection is already too widespread for disease eradication to be feasible in most places. It might be useful in slowing the spread of the epidemic in areas where hospital resources are at risk of congestion. This benefit will come, however, at considerable costs to the privacy rights and civil liberties of traced individuals, often with no public health benefit because of testing errors. Some may argue that these costs are worth paying temporarily if contact tracing really can help slow the spread of the epidemic. But contact tracing creates incentives to avoid testing and may make the epidemic worse. Studies involving contact tracing can provide useful information to help us better understand transmission dynamics—one fascinating study involving contact tracing has clarified the very limited role that children play in disease spread. Apart from this ancillary benefit, contact tracing does not deserve the central place it has received in the tool kit public health authorities use to control COVID-19.’

Read here (Inference, Sept 28, 2020)

Countries should meet these five criteria before easing lockdowns, study says. Many aren't even close

‘Countries should not ease coronavirus lockdown restrictions until they meet five criteria -- and many nations are not even close, according to a new analysis published in The Lancet medical journal. The research, published Thursday, said that the prerequisites for easing Covid-19 measures are: knowledge of infection status, community engagement, adequate public health capacity, adequate health system capacity and border controls.

‘The authors looked at nine high-income countries and territories that have started to relax restrictions -- Hong Kong, Japan, New Zealand, Singapore, South Korea, Germany, Norway, Spain and the UK. They found that many governments had failed to meet the criteria necessary to avoid new waves of infection, as seen in Spain, Germany and the UK.’

Read here (CNN, Sept 25, 2020)

Bill Gates: The pandemic has erased years of progress

‘The US had a lot of assets going into this. We weren’t ground zero, so the US had more time to get ready. The US has more PCR [polymerase chain reaction] machines than all other countries per capita. We are very blessed with an expensive medical infrastructure. And we have groups like the CDC [Centers for Disease Control and Prevention] and BARDA [the Biomedical Advanced Research and Development Authority]. So the US had done more to get ready than other countries had in advance...

‘Certainly humility is called for because the damage—whether it’s economic, educational, mental health—is so large. Other than a world war, this is the worst thing that’s happened in over a century. And so we should all say, “Wow, we didn’t understand about masks; we didn’t understand about asymptomatics.” Even the medical profession. We haven’t taken understanding these different respiratory diseases quite as seriously as we should. So everyone has lessons here.’

Read here (The Atlantic, Sept 21, 2020)

Covid-19 and health equity — Time to think big

To achieve health equity, we need to reach beyond the health care system — and think big. New social policies on a few key fronts could advance both health equity and the Covid-19 response.

• First, we propose establishing a universal food income.
• Second, we recommend reforming unemployment insurance.
• Finally, we need policies supporting investment in community development.

Read here (New England Journal of Medicine,  Sept 17, 2020)

With effective prevention of outbreaks, nations do not need to choose between public health and economy: WHO chief

‘The head of the World Health Organisation (WHO) has debunked arguments that countries have to choose between public health and the economy when they look at whether to ease restrictions following a lockdown. "That is a false choice," said WHO director-general Tedros Adhanom Ghebreyesus. Instead, the WHO urges countries to focus on four essential priorities:

• Prevent Covid-19 amplifying events. All around the world, explosive outbreaks have been linked to gatherings, in places like stadiums, nightclubs and places of worship.
• Protect the vulnerable to save lives and reduce the burden on the health systems in terms of severely and critically ill patients.
• Educate and empower communities to protect themselves and others. Physical distancing, hand hygiene, respiratory etiquette and masks can help to curb transmission and save lives, not when done in isolation, but by practising all the measures together.
• Persist with the public health basics. Find, isolate, test and care for people who have been infected, and trace and quarantine their contacts.

Read here (Straits Times, Sept 17, 2020)

Only 15 per cent in 13 advanced economies in Europe, North America and Asia approve of US handling of the coronavirus: Pew Research Centre survey

‘The median percentage of people polled in 13 countries who said the US has done a good job dealing with the coronavirus was only 15 per cent, the study says... China received a median approval rating of 37 per cent, while nearly two out of three people believed the WHO, from which the US withdrew this year over allegations of a bias toward China, had done a good job. The study “clearly indicates that around the globe no one is buying the Trump administration’s ardent efforts to pin blame on the pandemic upon China and the WHO,” said Allen Carlson, an associate professor in Cornell University’s government department.’

Read here (South China Morning Post, Sept 15, 2020)

Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly

Executive summary: ‘The Lancet COVID-19 Commission was launched on July 9, 2020, to assist governments, civil society, and UN institutions in responding effectively to the COVID-19 pandemic. The Commission aims to offer practical solutions to the four main global challenges posed by the pandemic: suppressing the pandemic by means of pharmaceutical and non-pharmaceutical interventions; overcoming humanitarian emergencies, including poverty, hunger, and mental distress, caused by the pandemic; restructuring public and private finances in the wake of the pandemic; and rebuilding the world economy in an inclusive, resilient, and sustainable way that is aligned with the Sustainable Development Goals (SDGs) and the Paris Climate Agreement. Many creative solutions are already being implemented, and a key aim of the Commission is to accelerate their adoption worldwide.’

Download full statement here (Sept 14, 2020)

A world in disorder

On September 14th 2020, the GPMB released its second report titled, A World in Disorder. In this report, the GPMB provides a harsh assessment of the global COVID-19 response, warning that the world cannot afford to be unprepared again when the next pandemic hits. The Board called for five urgent actions to be taken to bring order out of the catastrophe and chaos currently facing the world: responsible leadership; engaged citizenship; strong and agile systems for health security; sustained investment; and robust global governance of preparedness.

The Global Preparedness Monitoring Board (GPMB) is an independent monitoring and accountability body to ensure preparedness for global health crises. Comprised of political leaders, agency principals and world-class experts, the Board provides an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences. In short, the work of the GPMB will be to chart a roadmap for a safer world.

Download here (Global Preparedness Monitoring Board, Sept 14, 2020)

How to decide who should get a Covid-19 vaccine first

‘If and when a safe and effective COVID-19 vaccine is available, what is the fairest way to distribute it? In a policy report published on Thursday in Science, 19 public health experts laid out an ethical framework called the Fair Priority Model. It is geared toward three principles: benefiting people and limiting harm, prioritizing countries already disadvantaged by poverty or low life expectancy, and avoiding discrimination.

‘The report is critical of previously suggested vaccine allocation plans, including two proposed by the World Health Organization: one of them would distribute vaccines to each country according to its population size, and the other would prioritize health care workers and adults who are above age 65 or have underlying health conditions.’

Read here (Scientific American, Sept 3, 2020)

Why the United States is having a coronavirus data crisis

 ‘Political meddling, disorganization and years of neglect of public-health data management mean the country is flying blind...

‘Almost every day for the past seven months, the Korea Centers for Disease Control and Prevention has updated its website with near-real-time information on local outbreaks. The site also reports several COVID-19 statistics for every region of the country. Data dashboards in Singapore and New Zealand offer similar windows into how the coronavirus is spreading within their borders. This helps policymakers and citizens determine how to go about daily life, while reducing risks—and provides researchers with a wealth of data. 

‘By contrast, the United States offers vanishingly few details on how the disease is spreading, even as people increasingly socialize and travel, and authorities reopen schools and businesses. This state of affairs is frustrating data researchers, who want to help authorities make decisions that can save lives...

‘Although information isn’t the only tool that can be used against a pandemic, South Korea’s attention to data correlates with its overall success at controlling the outbreak: the country has had about 3.5 cases per 10,000 people overall, and there have been around 2 COVID-19 deaths per week over the past month. By contrast, the United States has had 175 cases per 10,000 people overall, and about 7,000 people have died of the disease every week for the past month.’

Read here (Scientific American, August 26, 2020)

Is Sweden's coronavirus strategy a cautionary tale or a success story?

‘Sweden was one of the few European countries not to impose a compulsory lockdown. Its unusual strategy for tackling the coronavirus outbreak has been both hailed as a success and condemned as a failure. So which is it? Those who regard the strategy as a success claim it reduced the economic impact, but it isn’t clear that it did. What is clear is that so far Sweden has had a more protracted outbreak with far more deaths per capita than its neighbours.

‘While it is sometimes implied that Sweden didn’t have a lockdown, it did. It was just largely voluntary, with only a few legal measures such as a ban on gatherings of more than 50 people. “Voluntary restrictions work as well as legal ones,” says the architect of Sweden’s strategy, chief epidemiologist Anders Tegnell.

Read here (New Scientist, August 13, 2020) 

How the pandemic revealed Britain’s national illness

‘Much of the focus has been on Johnson: an apparent manifestation of all that has gone wrong in Britain, a caricature of imperial nostalgia, Trumpian populism, and a general lack of seriousness. Yet this was not simply an issue of inept political leadership, inept or otherwise: Johnson stuck closely to a strategy designed and endorsed by the government’s experts, leaders in their fields and respected internationally. Even if the prime minister did make serious mistakes, the country’s issues run far deeper. The British government as a whole made poorer decisions, based on poorer advice, founded on poorer evidence, supplied by poorer testing, with the inevitable consequence that it achieved poorer results than almost any of its peers. It failed in its preparation, its diagnosis, and its treatment...

‘As prime minister, Johnson must accept that Britain’s failures are his as well. Still, the difficult truth is that the country’s failures clearly go beyond Johnson. They were collective, multilayered, and deadly. The most difficult question about all this is also the simplest: Why?... What emerges is a picture of a country whose systemic weaknesses were exposed with appalling brutality, a country that believed it was stronger than it was, and that paid the price for failures that have built up for years.’

Read here (The Atlantic, August 12, 2020)

How the pandemic defeated America

‘It is hard to stare directly at the biggest problems of our age. Pandemics, climate change, the sixth extinction of wildlife, food and water shortages—their scope is planetary, and their stakes are overwhelming. We have no choice, though, but to grapple with them. It is now abundantly clear what happens when global disasters collide with historical negligence.

‘COVID‑19 is an assault on America’s body, and a referendum on the ideas that animate its culture. Recovery is possible, but it demands radical introspection. America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a health-care system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net, and its trust in empiricism. It should address the health inequities that flow from its history. Not least, it should elect leaders with sound judgment, high character, and respect for science, logic, and reason.

‘The pandemic has been both tragedy and teacher. Its very etymology offers a clue about what is at stake in the greatest challenges of the future, and what is needed to address them. Pandemic. Pan and demos. All people.’

Read here (The Atlantic, August 4, 2020)

Two decades of pandemic war games failed to account for Donald Trump

‘The scenarios foresaw leaky travel bans, a scramble for vaccines and disputes between state and federal leaders, but none could anticipate the current levels of dysfunction in the United States...

’Perhaps the biggest limitation of simulation exercises was that they didn’t actually drive policymakers to prioritize and fund improvements to the public-health system. Morrison [J. Stephen Morrison, director of global health policy at the Center for Strategic and International Studies in Washington DC] now questions whether it’s even possible to do that through simulations alone, or whether people must experience an epidemic at first hand. After more than 70 people in Taiwan died as a result of SARS in 2003, the government mapped out its emergency-response network. “Every year since then, for the past 17 years, they’ve held annual outbreak exercises and practised, practised, practised,” Morrison says...

’Now, the United States has experienced a tragedy, too. The daily number of new COVID-19 cases broke records throughout much of July, after many states attempted to reopen their economies. Frieden [Tom Frieden, a former director of the US Centers for Disease Control and Prevention (CDC)] says that one of the most crucial actions now is for health departments to strengthen their response systems by analysing data in real time, so that they can tailor interventions as needed. “The best public-health programme is a programme that uses real-time data to make real-time decisions,” he says. “Real life is our exercise.”

Read here (Science Magazine, August 4, 2020)

What we know – and what we don’t know – about stopping the spread of the coronavirus

What's successful: (1) Fast action (2) Well-timed lockdowns (3) Travel restrictions (4) Face masks and coverings. What we still don’t know about the virus’ spread: (1) Mass gatherings (2) Super-spreaders (3) Indoor locations (4) Schools 

Read here (South China Morning Post, July 25, 2020)

Finland’s cautious lockdown vs Sweden’s laidback approach

‘Despite being neighbours with some social similarities, Finland and Sweden adopted vastly different methods in confronting the coronavirus pandemic. Their differing ways of confronting this virulent disease resulted in a wide gap in the number of infections and deaths in both Scandinavian countries. Finland opted for a cautious lockdown; it has reported over 7,300 infections and more than 300 deaths. In contrast, Sweden embraced a laidback attitude; it has now over 78,500 confirmed infections and nearly 5,700 deaths.’

Read here (Aliran, July 24, 2020)