A tale of two pandemics: the true cost of Covid in the global south

‘As the climate crisis was telling us long before Covid blared the message, what happens in one place can have repercussions in many places. That’s why the pandemic must be understood not as an anvil-from-the-sky medical crisis, but as something far more encompassing. “Science is the exit strategy,” the head of the Wellcome Trust famously said, early in the pandemic. But, though science is necessary, it’s hardly sufficient, particularly when we’re interested not simply in exit but in re-entry. As raucous, inward-turned nationalisms continue to claim followers, we’ll need to resist the go-it-alone fantasies of autarky. Rather, a post-pandemic era calls for a richer sense of our mutual obligations.’

Read here (The Guardian, Nov 23, 2021)

‘Maybe the coronavirus was lower-hanging fruit’

‘Emerging mRNA technology proved excellent for COVID vaccines. BioNTech’s founders preview what that could mean for cancer and other mysteries...

‘The fact that mRNA technology had never delivered an authorized therapy before the coronavirus pandemic could tell us one of two things. Perhaps synthetic mRNA is like a miraculous key that humankind pulled out of our pockets in this pandemic, but it was so perfectly shaped for the coronavirus that we shouldn’t expect it to unlock other scientific mysteries any time soon.

‘Or perhaps mRNA is merely in the first chapter of a more extraordinary story. This month, BioNTech announced that it had initiated Phase 2 trials of personalized cancer vaccines for patients with colorectal cancer. It is working on other personalized cancer vaccines and exploring possible therapies for malaria using a version of the mRNA technology that had its breakout moment in 2020.’

Read here (The Atlantic, Oct 18, 2021)

How Covid can change your personality

‘I’m trying to describe a year in which we’ve all been physically hunkered down but socially and morally less connected. This has induced, at least in me, a greater fragility but also a great sense of flexibility, and a greater potential for change.

‘I’ve found I’ve burned out on my screens, burned out about the politicization of everything, and have rediscovered my love for the New York Mets. People who have endured an era of vulnerability emerge with great strength. I’m also convinced that the second half of this year is going to be more fantastic than we can imagine right now. We are going to become hyper-appreciators, savoring every small pleasure, living in a thousand delicious moments, getting together with friends and strangers and seeing them with the joy of new and grateful eyes.’

Read here (New York Times, Apr 1, 2021)

Opioid deaths in America reached new highs in the pandemic

‘Last year (2020) was a woeful time for people suffering from a drug addiction. Government shutdowns brought job losses and social isolation—conditions that make a transportive high all the more enticing. Those who had previously used drugs with others did so alone; if they overdosed, no one was around to call for help or administer naloxone, a medication that reverses opioid overdoses.

‘Fatal overdoses were marching upwards before the pandemic. But they leapt in the first part of last year as states locked down, according to provisional data from the Centres for Disease Control and Prevention. Deaths from synthetic opioids—the biggest killer—were up by 52% year-on-year in the 12 months to August, the last month for which data are available. Those drugs killed nearly 52,000 Americans during the period; cocaine and heroin killed about 16,000 and 14,000, respectively (see chart). Once fatalities are fully tallied for 2020, in a few months’ time, it is likely to be the deadliest year yet in America’s opioid epidemic.’

Read here (The Economist, Mar 30, 2021)

How mRNA technology could change the world

‘mRNA’s story likely will not end with COVID-19: Its potential stretches far beyond this pandemic...

‘But mRNA’s story likely will not end with COVID-19: Its potential stretches far beyond this pandemic. This year, a team at Yale patented a similar RNA-based technology to vaccinate against malaria, perhaps the world’s most devastating disease. Because mRNA is so easy to edit, Pfizer says that it is planning to use it against seasonal flu, which mutates constantly and kills hundreds of thousands of people around the world every year. The company that partnered with Pfizer last year, BioNTech, is developing individualized therapies that would create on-demand proteins associated with specific tumors to teach the body to fight off advanced cancer. In mouse trials, synthetic-mRNA therapies have been shown to slow and reverse the effects of multiple sclerosis. “I’m fully convinced now even more than before that mRNA can be broadly transformational,” Özlem Türeci, BioNTech’s chief medical officer, told me. “In principle, everything you can do with protein can be substituted by mRNA”.’

Read here (The Atlantic, Mar 29, 2021)

Covid-19's impact could mean millions more child marriages: UNICEF

‘The outsized impact COVID-19 has had on women in some countries could result in an additional 10 million child marriages in this decade, according to a new analysis released on Monday (Mar 8) by UNICEF. "School closures, economic stress, service disruptions, pregnancy and parental deaths due to the pandemic are putting the most vulnerable girls at increased risk of child marriage," said a study titled COVID-19: A Threat to Progress Against Child Marriage.’

Read here (Straits Times, Mar 7, 2021)

How Covid-19 vaccine efforts could help defeat other diseases

• A proposed way of immunizing against malaria uses an RNA-based approach similar to COVID-19 vaccines.
• ‘Viral vector’ methods used to stem the pandemic could also yield vaccines for other purposes.
• COVID-19 vaccination achievements could be applied to diseases that kill millions of people annually.

Read here (World Economic Forum, Mar 4, 2021)

What Covid-19 has done to our well-being, in 12 charts

‘How has Covid-19 and the related shift to WFH affected workers? A group of researchers surveyed HBR readers and others in the fall of 2020 and found that the vast majority reported declines in both general and workplace well-being. The biggest culprits? Mental health struggles, increased job demands, and home-life challenges. A much smaller percentage reported an increase in well-being, attributing it to reduced commutes and business travel and having more time to focus on health.’

Read here (Harvard Business Review, Feb 10, 2021)

Safely reopening requires testing, tracing and isolation, not just vaccines

‘The Moderna and Pfizer vaccines were developed in record time. However, these announcements highlight significant challenges: delivering two-dose vaccines with stringent cold-chain requirements to almost eight billion people, many of whom reside in communities with underfunded and strained health systems, is no small feat. Even if we address the logistical challenges, the reality is that it takes time and funding to deliver vaccines, treatments and tests that reach everyone in need. It is a sobering reminder that when lifesaving antiretrovirals were introduced for HIV-positive people, it took seven years before the medicine reached the poorest communities. And during that time, millions of people died, and millions more were infected, and the HIV pandemic continued to grow.

‘Until we can overcome these obstacles and ensure equitable delivery of vaccines and treatments once available across the globe, the fundamentals of controlling this virus remain as important as ever.

‘For a long time, many countries will continue to rely on already proven tools to control the pandemic. The formula is simple: test, trace and isolate. This straightforward but effective process is key to safely reopening economies and societies. It is made possible through the rapid and equitable scale-up of diagnostics, which have proven to be the most important tool for limiting the spread of COVID-19. Test, trace and isolate—and ultimately test, trace and treat once more treatments become available—is an efficient, sustainable way to control the virus, especially in contrast to last-resort emergency lockdown measures, which can erode the public support and trust necessary for the success of many other helpful public health measures, including vaccination and mask-wearing.

‘We have seen this strategy implemented successfully around the world for decades with age-old diseases like tuberculosis. This strategy is also making a difference in the fight against COVID-19.’

Read here (Scientific American, Feb 9, 2021)

Dawn beckons as Covid vaccines roll out, but the next few months promise to be the darkest yet, and echoes of the AIDS era

‘One strange aspect of plagues is that they often finish strong. I learned this the hard way last time around. Many people have a general sense of AIDS being terrible in the 1980s and then slowly petering out in the 1990s, as treatments improved. It’s intuitive to think this way, and even to remember things this way. But, in reality, the worst ever year for deaths from AIDS in the US was 1995 — over a decade after the first deaths in America — and just before the arrival of the cocktail therapy that turned everything around. The virus killed more people in America in the year right before the medical breakthrough than in any other previous year.

‘...this [Covid] plague, like many others, could become worse yet before it suddenly turns the corner. The next couple of months may be the most fatal of the entire pandemic — even as freedom from this virus is within sight. There’s a special agony to those deaths, as there will be for all those human beings who will die of a virus for which a vaccine already exists.’

Read here (Genetic Literacy Project, Feb 8, 2021)

Covid has a dramatic impact on children

‘It was in December that Axel Gerschlauer noticed the crisis within the crisis. In the last three weeks before Christmas, the pediatrician found himself treating three minors who had slashed their lower arms. Three youths in three weeks — Gerschlauer says he usually sees this sort of thing about once every three to six months. "This kind of frequency,” he says, "brought the scale of the problem home to me."

‘And this at a time when Gerschlauer is not even getting to see all his regular patients. Some are avoiding his practice altogether for fear of infection. His phone, meanwhile, has hardly stopped ringing, as desperate parents seek his advice. "There has been a shift of emphasis towards psychological issues, ranging from anxieties to concentration disorders to sleep disorders. In recent months, mental health issues have increased massively."

Read here (DW, Feb 4, 2021)

Five things you need to know about living with a disability during Covid-19

1. Risk of contracting COVID-19 is higher for persons with disabilities
2. Risk of severe symptoms and death is higher
3. Living in institutions increases the risk of contracting and dying from COVID-19
4. Discrimination in accessibility of healthcare and life-saving procedures
5. The broader COVID-19 crisis affects persons with disabilities more

Read here (UN DESA Voice, December 2020)

A larger, more sinister pandemic lurks beneath Covid-19

‘More than one in five Americans hospitalised with COVID-19 also contracts a bacterial infection. Absent effective antibiotics, those lucky enough to beat the coronavirus might die at the hands of these not-so-novel pathogens. 

‘Unfortunately, the pipeline of new antibiotics is running dry. Less than 100 years after the development of penicillin, drug-resistant superbugs are threatening to gain the upper hand in our fight against bacterial infections.Superbugs already take an enormous toll on health-care systems around the world. About 700,000 people globally die each year due to antimicrobial resistance (AMR). Without new and better treatments, that figure could rise to ten million by 2050.’

Read here (Channel News Asia, Nov 23, 2020)

Addressing Malaysia’s nutrition crisis post Covid-19: Time for nutrition-focused social protection

• With stunting and wasting at 21.8 and 9.7% respectively in 2019, Malaysia was experiencing a malnutrition crisis even prior to COVID-19.
• The COVID-19 pandemic has directly resulted in a severe economic crisis that will exacerbate food and nutrition insecurity.
• People who are already exposed to critical food and dietary deprivations before COVID-19 are most vulnerable to food insecurity.
• Food and nutrition insecurity are linked to malnutrition, where children in households with food insecurity were more likely to be malnourished.
• Beyond the consequences for individuals and families, food and nutrition insecurity has been linked to long-term economic effects such as higher health care expenditures, lower educational achievement, lost productivity, lower earnings in adulthood and increased risk of poverty later in life.
• Strengthening child-sensitive and nutrition-focused social protection is essential to reducing vulnerability, building resilience, and mitigating the impacts of COVID-19 crisis and should be a top policy priority

Download PDF here (Unicef, Nov 2020)

How many people has the coronavirus killed?

‘In times of upheaval — wars, natural disasters, outbreaks of disease — researchers need to tally deaths rapidly, and usually turn to a blunt but reliable metric: excess mortality. It’s a comparison of expected deaths with ones that actually happened, and, to many scientists, it’s the most robust way to gauge the impact of the pandemic. It can help epidemiologists to draw comparisons between countries, and, because it can be calculated quickly, it can identify COVID-19 hotspots that would otherwise have gone undetected. 

‘According to data from more than 30 countries for which estimates of excess deaths are available (see ‘Terrible toll’), there were nearly 600,000 more deaths than would normally be predicted in these nations for the period between the onset of the pandemic and the end of July (413,041 of those were officially attributed to COVID-19).’

Read here (Nature, Sept 1, 2020)

The Covid-19 pandemic is fueling the opioid crisis

 This fact sheet provided by the US National Institute of Environmental Health Sciences:

• Identifies the link between the COVID-19 pandemic and an increased risk of opioid misuse.
• Provides tips to manage stressors caused by the pandemic.

Read here (NIH, undated circa 2020)

When a substance abuse crisis and pandemic intersect

‘Even before coronavirus, U.S. drug overdose deaths reached a record high of 70,980 in 2019, an increase of 4.6% from 2018, according to Politico. Fentanyl and other synthetic opioids caused 36,500 of the overdose deaths. A more region-specific study underscores the depths of a national problem. Investigating 7 years of deaths in San Francisco, investigators found that more than 1 in 6 deaths attributed to out-of-hospital cardiac arrest were actually due to overdose. The findings are significant in that San Francisco’s age-adjusted overdose mortality rate nearly mirrors the national rate.

‘White House and health officials said they expected the COVID-19 pandemic to result in the overdose death rate climbing higher this year.

‘Major news organizations have since linked the events of COVID-19 to increased illicit drug use and mortality. Politico reported on a White House drug policy office analysis showing that drug overdose deaths had risen 11.4% in the first four months of this year compared to the same period last year. According to Politico, Kentucky saw a 25% increase in overdose deaths between January and March, while emergency medical system calls and emergency department visits related to overdoses also rose between March and June. West Virginia reported a 50% increase in emergency calls in May. The Washington Post similarly reported that suspected overdoses have steadily increased, from an 18% jump in March 2020 compared to March 2019 to a 42% increase in May 2020 compared to last May.’

Read here (AACC, Aug 20, 2020)

How to stop Covid-19 fuelling a resurgence of AIDS, malaria and tuberculosis

‘A focus on the coronavirus has disrupted detection and treatment of other infectious diseases. Governments and funders can do four things to avert a catastrophe.

‘First, hospitals and health authorities in affected cities and regions must recognize that AIDS, malaria and TB are surging again... Second, researchers must continue to refine their models using more real-world data... Third, there is a need for public-information campaigns... Fourth, these campaigns cannot on their own keep surgeries and wards open, or equipment functioning. The resurgence of infectious diseases has created a greater demand for tests, treatments and research. All of these need more funding.’

Read here (Nature, August 12, 2020)

Dengue fever, second wave: What are the hurdles Singapore faces in its coronavirus fight?

(1) Clearing the Covid-19 disease from worker dormitories remains the biggest challenge. ‘The testing in dorms is now in the “final stretch”, with 232,000 cases confirmed as recovered or virus-free as of July 16.’
(2) Singapore’s second challenge comes from imported cases, although the city state has limited this risk by shutting its borders.
(3) Singapore also faces the risk of a resurgence in infections triggered by a failure to comply with safe-distancing rules, which remain in place despite the lockdown being lifted.
(4) The fourth challenge is the simultaneous onset of dengue fever in Singapore, which has seen some 19,000 cases so far this year.

Read here (South China Morning Post, July 22, 2020)

This is not a normal mental-health disaster

‘The full extent of the fallout will not come into focus for some time. Psychological disorders can be slow to develop, and as a result, the Textbook of Disaster Psychiatry, which Morganstein helped write, warns that demand for mental-health care may spike even as a pandemic subsides. “If history is any indicator,” Morganstein says of COVID-19, “we should expect a significant tail of mental-health effects, and those could be extraordinary.” Taylor worries that the virus will cause significant upticks in obsessive-compulsive disorder, agoraphobia, and germaphobia, not to mention possible neuropsychiatric effects, such as chronic fatigue syndrome...

‘In 2013, reflecting on the tenth anniversary of the SARS pandemic, newspapers in Hong Kong described a city scarred by plague. When COVID-19 arrived there seven years later, they did so again. SARS had traumatized that city, but it had also prepared it. Face masks had become commonplace. People used tissues to press elevator buttons. Public spaces were sanitized and resanitized. In New York City, COVID-19 has killed more than 22,600 people; in Hong Kong, a metropolis of nearly the same size, it has killed seven. The city has learned from its scars.’

[Joshua Morganstein is the chair of the American Psychiatric Association’s Committee on the Psychiatric Dimensions of Disaster; Steven Taylor is a psychiatrist at the University of British Columbia and the author of The Psychology of Pandemics]

Read here (The Atlantic, July 7, 2020)