Making the invisible visible: Faces of poverty in Malaysia revealed under the MCO

This article, by Bridget Welsh and Calvin Cheng, is written in the context of the current movement control order (MCO) as a result of the Covid-19 outbreak. It concludes:

‘Moving ahead, a serious rethink of how to address vulnerabilities and the poor is needed, beyond cash transfers of assistance and other immediate relief measures. The poor as a whole need to be recognised and disaggregated, with more attention to how to treat those facing the most serious hardships. A key step is to start getting the numbers right and to stop leaving out the many different groups being affected.

‘Practically, a task force can be set up to look at different sets of policies that are more holistic in addressing needs and causes along the various dimensions, with greater collaboration with NGOs, academics and international organisations, notably United Nations High Commissioner for Refugees (UNHCR). This will allow for better targeting of available limited resources, offer opportunities to find new resources and importantly, allow for the framing of sound policies that will not just ameliorate problems caused by Covid-19, but also work to address the underlying social conditions that will inevitably worsen as the economy contracts.

‘A crucial part of the way forward is to make the reality of poverty more visible.’

Read here (Malaysiakini, April 4, 2020)

Arundhati Roy: ‘The pandemic is a portal’

The novelist starts by telling how the coronavirus has changed our lives and how it has overwhelmed us so suddenly. However, she says: ‘The tragedy is the wreckage of a train that has been careening down the track for years.’ She goes on to examine how leadership has failed and how the disease threatens India, especially the disadvantaged. She also talks about what the country, and the world, should do next.

‘Whatever it is, coronavirus has made the mighty kneel and brought the world to a halt like nothing else could. Our minds are still racing back and forth, longing for a return to “normality”, trying to stitch our future to our past and refusing to acknowledge the rupture. But the rupture exists. And in the midst of this terrible despair, it offers us a chance to rethink the doomsday machine we have built for ourselves. Nothing could be worse than a return to normality.

‘Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next.

‘We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.’

Read here (Financial Times, April 4, 2020)

Covid-19: To mask or not to mask? — Amar Singh

‘The wearing of mask is an issue that is currently being hotly debated in many parts of the world. Some are calling it the “great mask debate”. I had planned earlier this week to write a full article on this but I think it would serve us better to read some of the very valuable commentaries that have already been done. What I hope to do is to summarise the key points to help us come to a better understanding on whether the general public should wear masks.’

Read here (The Malay Mail, April 3, 2020)

Shockwave: Adam Tooze on the pandemic’s consequences for the world economy

This lengthy essay begins by painting the economic background of this crisis, covering the weaknesses of the globalised system and its over-dependence on government stimulus post-2008. There were detractors though. ‘True conservatives, as distinct from those merely wedded to the religion of the stock market, welcomed the prospect of a shakeout. It was time for a purge, time to slim down the businesses that had gorged on too much cheap funding, time for a return to discipline." However, as we know, it was not to be.

When Covid-19 hit, the three main economic blocs responded, strapped to the underpinnings of their own socio-economic systems. Many East Asian countries, notably China, South Korea, Hong Kong, Taiwan and Singapore, employed ‘the hammer and the dance’ by hitting the virus hard and fast. Europe ended up in an uncoordinated and dispiriting stalemate. ‘From the point of view of the wider world, what matters is that Europe does not unleash a sovereign debt crisis.’ In the US, ‘more than the flame-out of Trump, is the gulf between the competence of the American government machine in managing global finance and the Punch and Judy show of its politics. That tension has been more and more glaring since at least the 1990s, but the virus has exposed it as never before.’

‘If you swiftly declare an emergency and are prepared to interrupt business as usual, both the medical and economic costs of confronting the virus appear more reasonable, and the conventional priorities of modern politics remain basically in place... As the Europeans and Americans have discovered, once you lose control all the options are bad: shut down the economy for an unforeseeable duration, or hundreds of thousands die.’

Tooze concludes that ‘for those of us in Europe and America these questions [about opening up] are premature. The worst is just beginning.’

Read here (London Review of Books, April 3, 2020)

Beijing approves TCM drugs for Covid-19

‘China has added three patented items of traditional Chinese medicines (TCM) to the treatments for COVID-19. The drugs, specifically Jinhua Qinggan granules, Lianhua Qingwen capsules, and Xuebijing injections have undergone clinical trials with the National Medical Products Administration and now list treating COVID-19 as one of their uses. 

"That means these three drugs have passed strict reviews by the administration, and can be commonly and widely used in China. Their effects are exact and backed with ample evidence. So people may have a new choice if there's a similar epidemic in the future," said Zhang Boli, president of Tianjin Hospital of TCM.’

Read here (CGTN, April 4, 2020)

Bringing in the experts: Blame deflection and the COVID-19 crisis

“The contemporary visibility and political emphasis on ‘the experts’ is therefore a double-edged sword. On the one hand, it is completely rational to heed the advice of those who have dedicated their professional lives to understanding and protecting public health; on the other hand, it is also a depoliticisation strategy in the sense that politicians who have dedicated their professional lives to not going MAD (i.e. falling foul of ‘multiple accountabilities disorder’) will understand the benefit of allowing ‘the experts’ to become the public face of the crisis.”

Read here (LSE, April 3, 2020)

Coronavirus: Out of many, one -- What the US federal government and the states should do to fight the coronavirus

‘It makes political and economic sense for the US to suppress the coronavirus. For that, states and the federal government each have their own roles that they need to adjust.

‘The US is now the country with most coronavirus cases in the world. It is likely to keep that title in the history books. Two key reasons are government decentralisation and concerns about the economic impact of aggressive social distancing measures. Here’s what we’re going to cover today, with a lot of data, charts and sources: (a) What’s the situation in the US and its states (b) Why the coronavirus should be a bipartisan issue (c) The economics of controlling the virus (d) Which decisions should be left to the federal government or to states

Read here (Medium, April 2, 2020)

Read here for a list of people who have endorsed or shared his article

Nations with mandatory TB vaccines show fewer coronavirus deaths

‘The preliminary study posted on medRxiv, a site for unpublished medical research, finds a correlation between countries that require citizens to get the bacillus Calmette-Guerin (BCG) vaccine and those showing fewer number of confirmed cases and deaths from Covid-19. Though only a correlation, clinicians in at least six countries are running trials that involve giving frontline health workers and elderly people the BCG vaccine to see whether it can indeed provide some level of protection against the new coronavirus.’

Read here (Bloomberg, April 2, 2020)

Privacy: Thrown to the wind in the pandemic?

‘These are strange times. Germany, perhaps the most privacy conscious nation on earth, is considering a mobile phone app that would trace the contacts of anyone infected with Covid-19.

‘So are we becoming more relaxed about privacy because of the pandemic, or are we in danger of allowing governments and corporations to trample over our rights using the excuse of the emergency?...

‘Earlier this week the British Prime Minister shared a picture of an online Cabinet meeting, complete with the Zoom meeting ID and the usernames of ministers. And millions of us are sharing views of our kitchens over this and other video-conferencing apps, without apparently being too concerned about poor privacy controls.

‘Meanwhile, the National Health Service in England has sent out a document that appears to mark a shift in its policy on patient data, giving staff more latitude to share information relating to the coronavirus. In particular, it mentions the use of data to understand trends in the spread and impact of the virus and “the management of patients with or at risk of Covid-19 including: locating, contacting, screening, flagging and monitoring such patients”.’

Read here (BBC, April 2, 2020)

China rolls out the Health Silk Road

 ‘In a graphic demonstration of soft power, so far China has offered Covid-19-related equipment and medical help to no fewer than 89 nations – and counting...

‘That covers Africa (especially South Africa, Namibia and Kenya, with Alibaba in fact announcing it will send help to all African nations); Latin America (Brazil, Argentina, Venezuela, Peru); the arc from East Asia to Southwest Asia; and Europe...

‘Key recipients in Europe include Italy, France, Spain, Belgium, the Netherlands, Serbia and Poland. But Italy, most of all, is a very special case. Most are donations. Some are trade – like millions of masks sold to France (and the US)...

‘This Chinese soft power offensive is carefully calibrated to offset the current paralysis of global supply chains. China is now working overtime to supply many parts of the world with medicine and related healthcare items – always with the Belt and Road framework in mind, as if doubling down on Globalization 2.0.’

Read here (Asia Times, April 2, 2020)

The four rules of pandemic economics: A playbook that should govern America’s short-term reaction to the health crisis.

Rule 1: “Save the economy or save lives” is a false choice. ‘The infamous trade-off between people and GDP? It doesn’t exist—or, at least, it didn’t in 1918. The reason, Verner told me, is that pandemics are “so, so disruptive that anything that you can do to mitigate that destructive impact of the pandemic itself is going to be useful.” Without a healthy population, there can be no healthy economy.’

Rule 2: Pay people a living wage to stop working. ‘Once the government has put the economy into an artificial coma, it must keep the patient alive. The US economic-relief package does so in a few ways. Washington will send to most households one-time payments of $1,200 per adult—plus $500 per child—and expand unemployment benefits, bumping up weekly payments for eligible workers, including independent contractors and the self-employed, by $600 for the next few months. The new law also delays tax filing, suspends wage garnishing among those who have defaulted on their student loans, and establishes a four-month eviction moratorium among landlords with mortgages from federal entities, such as Fannie Mae and Freddie Mac. This is a huge and kaleidoscopic response. But it still might not be enough.’

Rule 3: Build companies a time machine. ‘“We have to build companies a time machine,” Justin Wolfers, an economist at the University of Michigan, told me. He isn’t talking about the H G Wells contraption. He’s referring to anything—including grants, cheap loans, and debt relief—that would allow companies to shift their expenses to the future.’

Rule 4: The business of America is now science. ‘Our lack of knowledge about the virus is our greatest weakness in combatting it. Not knowing who has the virus, or who is most susceptible, contributes to higher infection rates. Not knowing who has recovered from, and built immunity to, the virus delays our ability to treat individuals, or release select individuals from isolation. The possibility that the virus is anywhere means that we have to shut down economic activity everywhere. The road back to normalcy is through more clear and public information.’

Read here (The Atlantic, April 2, 2020)

The impact of the coronavirus on global higher education: Exclusive QS survey data

‘When asked for their thoughts on the higher education sector’s approach to crisis management and the coronavirus, many respondents emphasised the importance of: (1) Online learning (2) International coordination and collaboration (3) Proactive, preventative measures (4) Strong university leadership (5) Flexibility for assessment deadlines and exams (6) Stricter sanitation initiatives (7) Clear communication from university leadership and administrators.’

Download here (QS, April 2, 2020)

Corona, East and West: Has Western-centrism mitigated against our well-being in the UK?

“That there is something special and distinct about Europe/the West, the ‘miracle’ view of Europe/West (Bhambra 2007; Sayyid 1997) are inextricably intertwined with othering views of the non-West. Such perceptions and views have contributed to narrow understanding of not just the West, but also the West’s understanding of ‘the Rest’. We need an examination of the extent to which such views and assumptions about the ‘West’ and ‘the Rest’ have come to shape the UK government’s reactions to the risks posed by the coronavirus.”

Read here (Discover Society, April 2, 2020)

Three lessons from this pandemic by Dr Lim Mah Hui & Dr Michael Heng

‘There are three lessons to draw from this crisis.

‘First, the pandemic exposes the flaws of neoliberalism which deifies the free market and vilifies the state... Under this scenario, risks are socialised while profits are privatised. It weakens the capacity and readiness of society to respond to unanticipated nation-wide crisis.

‘Second, had the rich western countries cast off their ideological blinkers and used the opportunities after the GFC to invest in infrastructure, research and development, public goods, reduction of huge inequalities and other form of capital development, the whole world would have been in better conditions to deal with the unfolding situation.

‘Third, the crisis underscores the interdependence resulting from systematic integration over the past several decades. It is a cliché now to say that pathogen respects no border. It took only a few weeks for the virus to travel worldwide. A global solidarity is needed to tackle problem of this nature which unfortunately is not being displayed...

‘The world has to act in a concerted action. We are all in the same boat; a leak in one part will sink the boat no matter where the source.’

Read here (IPS News, April 1, 2020)

Timeless lessons from Albert Camus’ “The Plague” (published 1947)

‘There is no more important book to understand our times than Albert Camus's The Plague, a novel about a virus that spreads uncontrollably from animals to humans and ends up destroying half the population of a representative modern town. Camus speaks to us now not because he was a magical seer, but because he correctly sized up human nature. As he wrote: “Everyone has inside it himself this plague, because no one in the world, no one, can ever be immune”.’

View here (The School of Life, YouTube, April 1, 2020)

Covid-19 in Malaysia: Fours ways to address the problem of transmission

We have reached a plateau, but we must do more to reduce the transmission rate, says Jeyakumar Devaraj:

1. Masks for all those venturing out of their homes
2. More effective quarantining of contacts
3. Earlier testing of symptomatic cases
4. Winning the trust of the migrant worker population

Read here (Aliran, April 1, 2020)

Questions on the government stimulus package

‘The way the government has crafted the package raises a host of questions. Does it help those in greatest need? Is it the most effective way to help the needy and keep the economy intact? Is the principle of sharing pain, i.e. the well to do should do their part to sacrifice a bit of their income for the needy, adhered to? Are some groups getting more at the expense of others?’

Read here (FreeMalaysiaToday, April 1, 2020)

MIT revives project to build makeshift ventilators at US$400-500 using existing hospital supplies: An idea developing countries can consider too

‘Researchers at the Massachusetts Institute of Technology have revived a project from several years ago to develop a makeshift ventilator using “ambu” resuscitation bags, widely available at hospitals around the world. The team intends to share its design instructions free of charge, which will allow others to construct their own unit, using US$400-500 in supplies. The units are not currently FDA-approved, but the team hopes to obtain approval in the future."

This is the reasoning behind the project:

‘We are one of several teams who recognised the challenges faced by Italian physicians, and are working to find a solution to the anticipated global lack of ventilators. In the US alone, the COVID-19 pandemic may cause ventilator shortages on the order of 300,000-700,000 units (CDC Pandemic Response Plans). These could present on a national scale within weeks, and are already being felt in certain areas. An increase in conventional ventilator production is very likely to fall short and with significant associated cost (paywall warning).

‘Almost every bed in a hospital has a manual resuscitator (Ambu-Bag) nearby, available in the event of a rapid response or code where healthcare workers maintain oxygenation by squeezing the bag. Automating this appears to be the simplest strategy that satisfies the need for low-cost mechanical ventilation, with the ability to be rapidly manufactured in large quantities. However, doing this safely is not trivial.

‘Use of a bag-valve mask (BVM) in emergency situations is not a new concept. A portable ventilator utilizing an ambu-bag was introduced in 2010 by a student team in the MIT class 2.75 Medical Device Design (original paper here and news story here), but did not move past the prototype stage. Around the same time, a team from Stanford developed a lower-cost ventilator for emergency stockpiles and the developing world. It looks similar to a modern ICU ventilator (Onebreath), but “production for US hospitals would start [in] about 11 months”, making it “a second wave solution” (MIT Tech Review Article).

‘Last year, the AMBU®️ Bag concept was re-visited by two student teams, one from Rice university (here & here), and another Boston-based team who won MIT Sloan’s Healthcare prize (MIT News: Umbilizer).’

Read here (MIT, April 1, 2020)

Mathematical modelling, "herd immunity" and the resultant failure of "test, test, test" in Britain

‘According to Richard Horton, editor-in-chief of the Lancet medical journal, the dominant voices in the Scientific Advisory Group for Emergencies (Sage), the scientific expert group advising the government, were mathematical modellers and behavioural scientists, including [David] Halpern...

‘Testing, isolation and quarantine – basic public health interventions – were barely on the agenda. Warnings from Chinese scientists of the severity of Covid-19 had not been understood.

‘“We thought we could have a controlled epidemic. We thought we could manage that epidemic over the course of March and April, push the curve to the right, build up herd immunity and that way we could protect people,” said Horton. “The reason why that strategy was wrong is it didn’t recognise that 20% of people infected would end up with severe critical illness. The evidence was there at the end of January.”

‘Anthony Costello, a UK paediatrician and former director of the WHO, also fiercely criticised the decision to stop tests. “For me and the WHO people I have spoken to, this is absolutely the wrong policy,” he said. “The basic public health approach is playing second fiddle to mathematical modelling.”

Read here (The Guardian, April 1, 2020)

Case for wearing face masks (3): WHO considering changing guidelines

‘Speaking at a Chatham House briefing on Wednesday, Prof David Heymann, an infectious disease expert who led the global response to the SARS outbreak, said that new evidence from Hong Kong had prompted a reconsideration of the role of face masks. “The WHO is debating that tomorrow to understand if there is evidence that would call for a change in what WHO is recommending,” he said.

‘The data from Hong Kong was shared confidentially with the WHO, but is likely to be published soon, Heymann said. He added that, in reassessing its policy, the WHO would take into account health workers’ need for masks in all countries.’

Read here (The Guardian, April 1, 2020)

Face masks: Asia may have been right about coronavirus and face masks, and the rest of the world is coming around

‘Writing last month, Adrien Burch, an expert in microbiology at the University of California, Berkeley, noted that “despite hearing that face masks ‘don't work,’ you probably haven't seen any strong evidence to support that claim. That's because it doesn't exist…

‘In fact, there is evidence of the exact opposite: that masks help prevent viral infections like the current pandemic.

‘Burch pointed to a Cochrane Review -- a systemic analysis of published studies on a given topic -- which found strong evidence during the 2003 SARS epidemic in support of wearing masks. One study of community transmission in Beijing found that "consistently wearing a mask in public was associated with a 70% reduction in the risk of catching SARS.”’

Read here (CNN, April 1, 2020)

Case for wearing face masks (2): Microdroplets pose coronavirus risk

‘An NHK experiment found that microdroplets emitted while sneezing and coughing and during conversations stay in the air for longer than normal droplets, potentially posing a uniquely dangerous risk for coronavirus infection.’

View here (NHK, March 31, 2020)

Exit strategies for Covid-19 a.k.a can life return to normal? — Dr Amar-Singh HSS and Dr Lim Swee Im

‘We are living in a new reality, what I call the “post-coronavirus reality” and we have to learn how we need to change, how we can adapt and survive this reality. We would like to share with you some preliminary ideas and thoughts on exit strategies from a “lockdown”.

They discuss three exit strategies (1) Give up and give in (2) Segregate old people and children/adults with chronic conditions and (3) A more realistic exit strategy which ‘will require us to cooperate and to work together in a way like we have never done so before. Not as individuals but as a responsible family, a nation of sisters and brothers.’

It will require the following: (1) Continue to maintain strict physical (social) distancing as a long term lifestyle (2) Cleaning hands and surfaces must be normative (3) Using masks must become common place (4) Develop rapid response coronavirus teams ('precision quarantine') (5) Availability of mass testing capability (6) Using technology wisely to track contacts (7) All travellers into the country should be screened (8) Waiting for vaccines to arrive and provide immunity to the population

Read here (The Malay Mail, March 30, 2020)

New research suggests industrial livestock, not wet markets, might be origin of Covid-19

‘There is a growing body of evidence that points to a different origin story for Covid-19. We now know that none of the animals tested at the Wuhan seafood market tested positive and about a third of the initial set of reported cases in people in Wuhan from early December 2019 had no connection to the seafood market, including the first reported case. And we also now know, thanks to the leak of an official Chinese report to the South China Morning Post that the actual first known case of Covid-19 in Hubei was detected in mid-November, weeks before the cluster of cases connected to the Wuhan seafood market were reported.’

Two studies quoted in this article point to industrial farming of animals as the more probable cause, in particular that of pigs.

Read here (Grain, March 30, 2020)

Related article: Viral times - The politics of emerging global animal diseases (Grain, Jan 20, 2020). Read here

For the record: Two game-changing studies from Imperial College that affected Europe-wide policies

The Imperial College COVID-19 Response Team in London produced two studies that influenced policy in Europe in a big way. In particular, it helped push Britain to switch its strategy from one based on ‘herd immunity’ to that of "suppression".

(1) March 16: ‘Suppression the only viable strategy’

The first study, published March 16, 2020, concluded that ‘epidemic suppression is the only viable strategy at the current time. The social and economic effects of the measures which are needed to achieve this policy goal will be profound. Many countries have adopted such measures already, but even those countries at an earlier stage of their epidemic (such as the UK) will need to do so imminently.’

Read here (Imperial College, March 16, 2020)

(2) March 30: ‘59,000 lives saved in 11 European countries via non-pharmacologial interventions, between 7 to 43 million individuals infected -- as of March 31’

The second study, published March 30, 2020, said that ‘with current interventions remaining in place to at least the end of March, we estimate that interventions across all 11 countries will have averted 59,000 deaths up to 31 March [95% credible interval 21,000-120,000]. Many more deaths will be averted through ensuring that interventions remain in place until transmission drops to low levels.

‘We estimate that, across all 11 countries between 7 and 43 million individuals have been infected with SARS-CoV-2 up to 28th March, representing between 1.88% and 11.43% of the population. The proportion of the population infected to date – the attack rate - is estimated to be highest in Spain followed by Italy and lowest in Germany and Norway, reflecting the relative stages of the epidemics.’

Read here (Imperial College, March 30, 2020)

Work from home tips for staying sane and productive during stressful times of Covid-19 lockdowns

‘Whether you’re new to working from home or you’ve worked remotely for years, COVID-19 is presenting challenges for all workers right now. It’s stressful enough to process the big changes happening to our economy and society, but there’s probably a lot happening within your own home too.

‘While all these changes add stress to your day, it can be tough to concentrate. Here are a few tips we’ve learned over the years to stay productive and focused during difficult times.’

Read here (Upwork, March 20, 2020)

White House airlifts medical supplies from China amid Covid-19 crisis: 22 planeloads scheduled

‘A commercial aircraft carrying 80 tons of gloves, masks, gowns and other medical supplies from Shanghai touched down in New York on Sunday, the first of 22 scheduled flights that White House officials say will funnel much-needed goods to the United States by early April as it battles the world’s largest coronavirus outbreak.

‘The plane delivered 130,000 N95 masks, 1.8 million face masks and gowns, 10 million gloves and thousands of thermometers for distribution to New York, New Jersey and Connecticut, said Lizzie Litzow, a spokeswoman for the Federal Emergency Management Agency. Ms. Litzow said that flights would be arriving in Chicago on Monday and in Ohio on Tuesday, and that supplies would be sent from there to other states using private-sector distribution networks.

‘While the goods that arrived in New York on Sunday will be welcomed by hospitals and health care workers — some of whom have resorted to rationing protective gear or using homemade supplies — they represent just a tiny portion of what American hospitals need. The Department of Health and Human Services has estimated that the United States will require 3.5 billion masks if the pandemic lasts a year.’

Read here (New York Times, March 30, 2020)

Coronavirus lockdown measures may have saved 59,000 lives in Europe already, says new study by Imperial College

 ‘At least 59,000 lives have already been saved in 11 European countries due to the social distancing measures introduced to stem the spread of Covid-19, new modelling suggests.

‘According to the analysis, 370 deaths have already been averted in the UK - where a nationwide lockdown came into effect just one week ago - while Italian interventions have saved 38,000 lives to date.

‘But the study also shows that the continent remains a long way from developing “herd immunity”, whereby the vast majority of people have caught, recovered and become immune to the coronavirus.

‘The modelling, published yesterday by Imperial College, London, analyses the impact of lockdown in 11 European countries, including the UK.’

Read here (Telegraph, March 30, 2020)

The mechanics of mobile contact tracing: Information collected can be quite extensive

‘A mobile phone App can make contact tracing and notification instantaneous upon case confirmation. By keeping a temporary record of proximity events between individuals, it can immediately alert recent close contacts of diagnosed cases and prompt them to self-isolate.

‘Apps with similar aims have been deployed in China. Public health policy was implemented using an App which was not compulsory but was required to move between quarters and into public spaces and public transport. The App allows a central database to collect data on user movement and coronavirus diagnosis and displays a green, amber or red code to relax or enforce restrictions on movement. The database is reported to be analysed by an artificial intelligence algorithm that issues the colour codes. The App is a plug-in for the WeChat and Alipay Apps and has been generally adopted...’

Read here (Science, March 30, 2020)

‘Consider this: COVID-19’ with Jomo Kwame Sundaram

On March 30, 2020, Sharaad Kuttan and Melisa Idris interviewed Dr Jomo Kwame Sundaram on Covid-19 and its fallout. In their Astro Awani show, ‘Consider this’, they covered the three topics:

1. ‘Not a normal crisis’. View here
2. Is government looking over its shoulder? View here
3. A war time approach? View here

China to reveal a key virus data point: People with no symptoms

‘China’s government indicated it will start releasing data on how many people are infected with coronavirus but don’t have symptoms, seemingly responding to a growing chorus of domestic and international criticism of China’s data on the outbreak.’

Read here (Bloomberg, March 30, 2020)

Coronavirus: Don’t politicise medical supply problems, China says

‘China has urged countries not to “politicise” concerns about the quality of medical supplies after some countries in Europe reported defective products sourced from China. Chinese foreign ministry spokeswoman Hua Chunying said on Monday, March 30, that an objective approach was needed to solve the problems.’

Countries affected include Slovakia, the Netherlands, Spain and the Philippines.

Read here (South China Morning Post, March 30, 2020)

RM250bil stimulus: Priorities in response to a three-faceted crisis

Commentary by Jeyakumar Devaraj

“The first aspect and the precipitating cause of this crisis is the Covid-19 pandemic that is sweeping the world. The pandemic is causing a massive overload on the medical services even in the richest countries in the world...

“The second aspect of the crisis is that many Malaysians in the B40 and M40 groups, especially daily rated workers and small business people have already run out of their meagre savings after 10 days of the Movement Control Order (MCO) and are already having difficulty in providing food for their families...

“The third aspect of the problem is that our small and medium-sized enterprises (SMEs) which employ about 65percent of our workforce are seriously under threat. The lockdown means that the vast majority of these SMEs have had no income since March 18.

“Given this bleak scenario, several measures have to be implemented quickly to address each aspect of the crisis. The capacity of our health care system to respond to the Covid 19 epidemic has to be bolstered, measures to ensure that the poorer 50% of our population have access to food and other basic necessities have to be rolled out and another set of measures to ensure that as many as possible of our SMEs are kept viable so that they can provide employment to the rakyat when we are able to restart the economy.”

Read here (Malaysiakini, March 29, 2020)

Locked down and locked up: Domestic violence during the pandemic

As the implementation of movement restriction measures disrupts our daily lives, governments are compelled to respond to the high demand for support as domestic violence cases soar in a short period of time. With such measures predicted to last for weeks and even months to come, the urgency to address this issue is unprecedented.

Read here (ISIS Malaysia, March 29, 2020)

Preparing for a new normal

Governments around the world have had to scramble to find ways to manage an unprecedented crisis with varying levels of success. While Malaysia has done well compared to its peers, do we have the institutional capacity to manage present and future crises to come?

Read here (ISIS Malaysia, March 29, 2020)

Approved: System to decontaminate N95 masks and allow reuse -- as many as 20 times

‘A system to decontaminate N95 masks to allow healthcare workers to safely reuse them -- as many as 20 times -- has been approved by the US FDA. It uses hydrogen peroxide vapour to “destroy bacteria, viruses and other contaminants, including... SARS-CoV-2,” and it can process up to 80,000 masks per day.’

Note: This is interesting. If the principle of decontamination and re-use is acceptable, what other ways can we use to recycle personal protection equipment (PPEs) especially in poor countries?

Read here (Politico, March 29, 2020)

A road map to reopening: US-focused but we can learn a thing or two

‘This report provides a road map for navigating through the current COVID-19 pandemic in the United States. It outlines specific directions for adapting our public-health approach away from sweeping mitigation strategies as we limit the epidemic spread of COVID-19, such that we can transition to new tools and approaches to prevent further spread of the disease.

‘The authors outline the steps that can be taken as epidemic transmission is brought under control in different regions. They also suggest measurable milestones for identifying when we can make these transitions and start reopening America for businesses and families.

‘In each phase, the authors outline the steps that the federal government, working with the states and public-health and health care partners, should take to inform the response. This will take time, but planning for each phase should begin now so the infrastructure is in place when it is time to transition.’

Read here (AEI, March 29, 2020)

Covid-19 package: The woes of a small business owner

‘There is a saying, “Give a man a fish and you can feed him for a day. Teach a man to fish and you feed him for a lifetime”. So help small businesses stay afloat.

‘Revenues are down. Margins, if any are non existent. Wages, rentals and raw material are the three main costs of business. Government assistance is needed to subsidise one part of the expense to keep Malaysians employed.

‘We have been told that we are fighting a war with an invisible enemy. We issue a one-off  “Coronavirus War Bond” to fund this fight to keep jobs. It will break the budget deficit ceilings. What alternative do we have?’

Read here (FocusMalaysia, March 29, 2020)

In Singapore, quarantine comes with sea view, room service

“The government said last week it’s placing residents returning from the US and the UK in hotels to prevent them from potentially spreading the virus to their families, a measure that’s tighter than one that earlier allowed them to serve the period at home.”

Read here (Bloomberg, March 28, 2020)

Offline: COVID-19 and the NHS—“a national scandal” - Commentary in The Lancet

“When this is all over, the NHS England board should resign in their entirety.” So wrote one National Health Service (NHS) health worker last weekend. The scale of anger and frustration is unprecedented, and coronavirus disease 2019 (COVID-19) is the cause. The UK Government's Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn't follow WHO’s advice to “test, test, test” every suspected case. They didn't isolate and quarantine. They didn't contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The UK now has a new plan—Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come...

Read here (The Lancet, March 28, 2020)

Checking the pandemic of Covid-19 misinformation and disinformation

“Advice on how to prevent, treat and cure COVID-19 has been shared in every corner of the globe. It often comes from  ‘doctors’ or ‘health experts’ and sometimes includes reasonable suggestions alongside nonsensical and harmful claims. It has fooled many smart, well-meaning people who have shared it with the best of intentions. There is currently no ‘cure’ for COVID-19.”

This AFP site allows us to check the misinformation that has spread regarding Covid-19.

Read here (AFP, continually updated, started March 28, 2020)

Not all or nothing: Anti-virus lockdowns could lift slowly

“While we may yearn for a clear timeline for when life will return to normal, scientists say that isn’t exactly the right question. Routines won’t resume exactly as they were for several months, or longer – but that doesn’t mean we’ll all be stuck in total lockdowns until then.”

Read here (Associated Press, March 27, 2020)

'It’s a razor’s edge we’re walking': Inside the race to develop a coronavirus vaccine...

'Like every other scientist, Heeney spends part of his days worrying about funding. All these vaccine projects hurtling towards trials may yet be drawn to a screeching halt by a lack of money. Trials are expensive; so is the outlay on manufacturing and marketing vaccines. “If you’re going to make enough doses for the whole world, you’re going to need billions and billions of dollars,” Heeney said. Earlier this week, the Wellcome Trust put an exact number on it: a further $3bn, across the industry, to fund and produce enough vaccines to beat the pandemic.

'Most of this money will go towards trials and production, the costs of which are now frequently borne by drug companies. After the 80s, when a series of mergers left the pharma industry in the hands of a few behemoth companies, vaccines fell thoroughly under the sway of market forces, subject to the kind of logic that prompted Goldman Sachs, in a 2018 report, to wonder: “Is curing patients a sustainable business model?” (It isn’t, the analysts concluded.)

'Diseases that are borne out of poverty, and that require cheap vaccines, such as cholera, are largely ignored, says Peter Jay Hotez, the dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston. So are diseases that are uncommon, or diseases that have come and gone. Taxpayers fund most vaccine research, but the pharma titans that can make them at scale are reluctant to commit to a vaccine if the likelihood of profit is meagre. “We have a broken ecosystem for making vaccines,” Hotez told me.'

Read here (The Guardian, March 27, 2020)

Coronavirus has not suspended politics – it has revealed the nature of power

‘In recent years, it has sometimes appeared that global politics is simply a choice between rival forms of technocracy. In China, it is a government of engineers backed up by a one-party state. In the west, it is the rule of economists and central bankers, operating within the constraints of a democratic system. This creates the impression that the real choices are technical judgments about how to run vast, complex economic and social systems.

‘But in the last few weeks another reality has pushed through. The ultimate judgments are about how to use coercive power. These aren’t simply technical questions. Some arbitrariness is unavoidable. And the contest in the exercise of that power between democratic adaptability and autocratic ruthlessness will shape all of our futures. We are a long way from the frightening and violent world that Hobbes sought to escape nearly 400 years ago. But our political world is still one Hobbes would recognise.’

Read here (The Guardian, March 27, 2020)

Covid-19 exposes the fragility of our belief-systems

‘You could say COVID-19 has exposed the extent to which we are in a ‘meaning crisis’ (to use John Vervaeke’s phrase). But I’m a little wary of this term as a historical concept. When did this ‘meaning crisis’ begin? For who? Maybe young Americans are in something of a meaning crisis now, as they turn away from Christianity, but British people went through that loss of faith in the late 19th century, and I’m sure it’s different for every culture around the world.

‘I’d suggest humans are always in a meaning crisis, we always have been. We have a tiny mind-map, equivalent to a photo of a street, and we’re out there in a great megapolis trying to use this photo as if it was Google Maps. We look around bewildered, look at our photo, and think ‘this looks a bit familiar’.

‘There is so much we don’t know, and we can learn to be OK with that. As a rule of thumb, we can be suspicious of any expert who seems over-certain, who rarely pauses for breath or questions their assumptions. When was the last time they admitted they were wrong? When was the last time they said ‘I’m not very sure about this, this isn’t my field of expertise’?’

Read here (Medium, Jules Evans, Mar 27, 2020)

Questions about leadership and open-mindedness: A response to why Covid-19 deniers stick to their beliefs

‘Q: What kind of leadership is needed right now, given our belief systems and what is at stake?

‘A: We all need to be more intellectually humble. We all need to recognise that how certain we feel is irrelevant to how certain we should be. We need to recognise that there are scientists and medical experts out there who have the knowledge and expertise we need to make smart decisions, and they are willing and able to share that information with us.

‘We need our leaders especially right now to understand the role they have in all of this. Words aren’t just words. Words are the basis of beliefs, and beliefs drive our behaviour. People who don’t believe the pandemic is real or that it will spread put themselves and everyone else at risk by not doing what needs to be done to stop it…

‘Q: Can people be taught to be more open-minded?

‘A: It’s possible. Beliefs are not stable, finished things because we are constantly taking in new data and updating. It may seem disheartening that people shut down once they become certain. But I see hope in the fact that people are fundamentally social and that they seek to engage with one another.

‘People are sensitive to the beliefs of those around them. When those beliefs change, people may reconsider their positions. That’s why talking about what is happening is important, and informed people who know the most should be talking the loudest.’

Read here (Futurity, March 27, 2020)

Trump’s response to the pandemic has been haunted by the science denialism of his ultraconservative religious allies

‘Donald Trump rose to power with the determined assistance of a movement that denies science, bashes government and prioritised loyalty over professional expertise. In the current crisis, we are all reaping what that movement has sown...

‘It is fair to point out that the failings of the Trump administration in the current pandemic are at least as attributable to its economic ideology as they are to its religious inclinations. When the so-called private sector is supposed to have the answer to every problem, it’s hard to deal effectively with the very public problem of a pandemic and its economic consequences. But if you examine the political roots of the life-threatening belief in the privatisation of everything, you’ll see that Christian nationalism played a major role in creating and promoting the economic foundations of America’s incompetent response to the pandemic.’

Read here (New York Times, March 27, 2020)

Mild cases as infectious as severe ones? There are strong correlations in Lombardy and Guangzhou. If proven true, this would underscore the need for tweaking social-distancing policies for the longer term...

 ‘If you have a high viral load, you are more likely to infect other people, because you may be shedding more virus particles. However, in the case of covid-19, it doesn’t necessarily follow that a higher viral load will lead to more severe symptoms.

‘For instance, health workers investigating the covid-19 outbreak in the Lombardy region of Italy looked at more than 5,000 infected people and found no difference in viral load between those with symptoms and those without. They reached this conclusion after tracing people who had been in contact with someone known to be infected with the coronavirus and testing them to see if they were also infected.

‘Similarly, when doctors at the Guangzhou Eighth People’s Hospital in China took repeated throat swabs from 94 covid-19 patients, starting on the day they became ill and finishing when they cleared the virus, they found no obvious difference in viral load between milder cases and those who developed more severe symptoms...

‘It is early days, but if the infectious dose doesn’t correlate with the severity of disease symptoms, this would mark covid-19 out as different from influenza, MERS and SARS...’

Read here (New Scientist, March 27, 2020)

Genomic study points to natural origin of COVID-19, says NIH Director’s blog. Two scenarios suggested

‘In the first scenario, as the new coronavirus evolved in its natural hosts, possibly bats or pangolins, its spike proteins mutated to bind to molecules similar in structure to the human ACE2 protein, thereby enabling it to infect human cells. This scenario seems to fit other recent outbreaks of coronavirus-caused disease in humans, such as SARS, which arose from cat-like civets; and Middle East respiratory syndrome (MERS), which arose from camels.

‘The second scenario is that the new coronavirus crossed from animals into humans before it became capable of causing human disease. Then, as a result of gradual evolutionary changes over years or perhaps decades, the virus eventually gained the ability to spread from human-to-human and cause serious, often life-threatening disease.

‘Either way, this study leaves little room to refute a natural origin for COVID-19. And that’s a good thing because it helps us keep focused on what really matters: observing good hygiene, practicing social distancing, and supporting the efforts of all the dedicated health-care professionals and researchers who are working so hard to address this major public health challenge.’

Read here (NIH Director’s Blog, March 26, 2020)

Read here too on ‘The proximal origin of SARS-CoV-2’ (Nature Medicine, March 17, 2020)

Modes of contact and risk of transmission in COVID-19 among close contacts

A new preprint on medRxiv examines the modes of contact and the level of transmission among close contacts of persons infected with COVID-19. The study follows just under 5,000 close contacts in Guangzhou, China. Of the close contacts identified, 2.6% of cases developed symptoms during their quarantine, the majority of which were mild or moderate cases (89.9%) and a small portion of which were asymptomatic (6.2%). They authors found that contacts within the same household were at the highest risk of contracting COVID-19.

Read here (Medrxiv, March 26, 2020)

Note: As the Covid-19 situation worsens in the US, Europe and other countries, our students and other citizens are coming home in large numbers. They are being told to self-quarantine. Many are doing it at home, in which case they may infect others if they are carrying the virus. Some are sending their folks to AirBNBs.

Healthcare front liners demand action

“If this virus is not stringently contained now, the repercussions to the health of the American population, as well as the impact on the country’s economic, educational and welfare systems, will be incalculable,” notes Megan E. Brunson, RN, president of the American Association of Critical‐Care Nurses.

Critical care front liners in the US plead for (1) greater public cooperation (2) suspension of non-essential activities -- stop mass travel and close hotels and hospitality venues (3) suspension of non-essential health care (4) at least three weeks stay-in-place.

“Our guidance to the public, US Federal Government and state and local governments comes after substantial input from the U.S. Centers for Disease Control and Prevention (CDC) and careful examination of best practices from other health officials from around the world.”

Read here

Nurses. Nurses. Nurses

“Among the nine countries with the highest number of Covid-19 cases, the country that has the highest nurse rate also has the lowest death rate from the disease. Germany has 13.2 nurses per 1,000 (echoing a trend for high nurse numbers throughout Northern Europe) far above the other heavily Covid-19 affected countries.

“This may be just another armchair epidemiologist observation of course. But higher numbers of nurses may reflect one of two beneficial factors (or both): first, that nurses, the backbone of hospital (and especially ICU) care, are essential to patient management and, ultimately, survival.

“The second is that the sort of hospital or country that knows the value of nurses also is a hospital or country that understands how to deliver effective health care and has likely made countless other unmeasured adjustments to improve quality.”

Read here (CNN, March 25, 2020)

The analogy between Covid-19 and climate change is eerily precise

“We went through the stages of climate change denial in the matter of a week,” said Gordon Pennycook, a psychologist at the University of Regina in Saskatchewan, Canada, who studies how misinformation spreads. Naomi Oreskes, a historian of science who has studied the origins of climate disinformation, spelled out the pattern in an email: “First, one denies the problem, then one denies its severity, and then one says it is too difficult or expensive to fix, and/or that the proposed solution threatens our freedom.”

Read here (Wired, March 25, 2020)

How the pandemic will end

‘The US may end up with the worst COVID-19 outbreak in the industrialised world. This is how it’s going to play out...

‘Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation’s psyche.’

Read here (The Atlantic, March 25, 2020)

Social distancing in China now: A vlog by The China Traveller, a UK citizen who lived through the lockdown in Beijing

‘Life is very gradually returning to normal in China, but there are still loads of social distancing measures in place. Some measures are hi-tech whereas others are quite the opposite. I want to show everyone how social distancing works in the capital, Beijing, at a time when people are starting to return to their normal lives. If you're in another country and you're still unsure of what social distancing should entail, this video might help you understand how others around the world are doing it.’

View here (The China Traveller, Youtube, March 25, 2020)

How will the Covid-19 pandemic end?

This long article discusses the near-term effects, end-game and aftermath of the Covid-19 crisis in the US. It concludes that the lessons that America draws from this experience are hard to predict but there could be two extreme scenarios, with many variations in between. As the most powerful socio-economic and political entity in the world, whichever path it takes, it will affect the entire world. 

NEGATIVE ENGAGEMENT: ‘One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero. During the second term of his presidency, the U.S. turns further inward and pulls out of NATO and other international alliances, builds actual and figurative walls, and disinvests in other nations. As Gen C grows up, foreign plagues replace communists and terrorists as the new generational threat.’

POSITIVE ENGAGEMENT: ‘One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbours both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation. Buoyed by steady investments and an influx of the brightest minds, the health-care workforce surges. Gen C kids write school essays about growing up to be epidemiologists. Public health becomes the centerpiece of foreign policy. The US leads a new global partnership focused on solving challenges like pandemics and climate change.’

Read here (The Atlantic, March 25, 2020)

Potential Covid-19 game changer in the UK: Fingerprick tests

‘Widespread availability of a fingerprick test that produces results in 10 to 15 minutes would be a game-changer. NHS doctors and nurses with symptoms would know immediately whether they have had Covid-19, enabling them to get back to work sooner.

‘NHS workers or anyone else would be able to know if they have had the virus and are therefore immune, which means they could resume their normal lives, no longer having to work from home or keep their distance from other people. It is widely thought that having had Covid-19 makes people immune to the disease. There have been cases of apparent reinfection, though they are rare.

‘The test detects the presence of IGM, an antibody that arises very early on in the infection, and IGG, which is increased in the body’s response to the virus. The results of some of the tests on order can be read by anyone, but others would need to be interpreted by healthcare professionals.

‘The UK is not the only country ordering the antibody tests. “Tests are being ordered across Europe and elsewhere and purchased in south-east Asia. This is widespread practice. We are not alone in doing this,” said Peacock [Prof Sharon Peacock, the director of the national infection service at PHE].’

Read here (The Guardian, March 25, 2020)

Case for wearing face masks (4): History -- showing how Wu Lien-Teh from Penang, in the face of racism and widespread doubt, soldiered on to make the face mask an icon of modern healthcare

‘In the fall of 1910, a plague broke out across Manchuria—what we know now as Northern China—which was broken up in politically complex jurisdictions shared between China and Russia...

‘The Chinese Imperial Court brought in a doctor named Lien-teh Wu to head its efforts. He was born in Penang and studied medicine at Cambridge. Wu was young, and he spoke lousy Mandarin. In a plague that quickly attracted international attention and doctors from around the world, he was “completely unimportant,” according to Lynteris. But after conducting an autopsy on one of the victims, Wu determined that the plague was not spread by fleas, as many suspected, but through the air.

‘Expanding upon the surgery masks he’d seen in the West, Wu developed a hardier mask from gauze and cotton, which wrapped securely around one’s face and added several layers of cloth to filter inhalations. His invention was a breakthrough, but some doctors still doubted its efficacy.

‘“There’s a famous incident. He’s confronted by a famous old hand in the region, a French doctor [Gérald Mesny] . . . and Wu explains to the French doctor his theory that plague is pneumonic and airborne,” Lynteris says. “And the French guy humiliates him . . . and in very racist terms says, ‘What can we expect from a Chinaman?’ And to prove this point, [Mesny] goes and attends the sick in a plague hospital without wearing Wu’s mask, and he dies in two days with plague.”

‘Other doctors in the region quickly developed their own masks. “Some are . . . completely strange things,” Lynteris says. “Hoods with glasses, like diving masks.”

‘But Wu’s mask won out because in empirical testing, it protected users from bacteria. According to Lynteris, it was also a great design. It could be constructed by hand out of materials that were cheap and in ready supply. Between January and February of 1911, mask production ramped up to unknown numbers. Medical staff wore them, soldiers wore them, and some everyday people wore them, too. Not only did that help thwart the spread of the plague; the masks became a symbol of modern medical science looking an epidemic right in the eye.’

Read here (Fast Company, March 24, 2020)

Kerala: An often overlooked region of India is a beacon to the world for taking on the coronavirus

‘KK Shailaja is the health minister in the Left Democratic Front government in Kerala, the state in the southwest of India that has a population of 35 million people. On January 25, 2020, she convened a high-level meeting to discuss the outbreak of COVID-19 in Wuhan, China. What had particularly worried her is that there were many students from Kerala studying in that province of China.

‘Shailaja had won widespread praise for the swift and efficient way she had steered her department through the Nipah virus that hit Kerala in 2018. She recognised that there was no time to be lost if the virus spread from Wuhan; the government had to set up mechanisms for identifying possibly infected persons, and then for testing, mitigation, and treatment. On January 26, 2020, her department set up a control room to coordinate the work...’

Read here (Citizen Truth, March 24, 2020)

Yuval Noah Harari: The world after coronavirus

‘Humankind is now facing a global crisis. Perhaps the biggest crisis of our generation. The decisions people and governments take in the next few weeks will probably shape the world for years to come. They will shape not just our healthcare systems but also our economy, politics and culture. We must act quickly and decisively. We should also take into account the long-term consequences of our actions. When choosing between alternatives, we should ask ourselves not only how to overcome the immediate threat, but also what kind of world we will inhabit once the storm passes. Yes, the storm will pass, humankind will survive, most of us will still be alive — but we will inhabit a different world...

‘In this time of crisis, we face two particularly important choices. The first is between totalitarian surveillance and citizen empowerment. The second is between nationalist isolation and global solidarity.’

Read here (Financial Times, Mar 20, 2020) 

South Korea amassed the world’s most comprehensive coronavirus data. What it’s taught us so far

“South Korea’s data is valuable, in part, because it provides a stark warning to the world that there are likely far more young and asymptomatic carriers of the coronavirus than are currently being tallied, especially in countries like the U.S. that are suffering from ongoing testing shortages.

“As of March 14, South Korea reported that nearly 30% of its confirmed coronavirus cases were in patients ages 20 to 29. In Italy, by comparison, 3.7% of coronavirus patients fell into that age range, according to a report from Andreas Backhaus, a research fellow at the Centre for European Policy Studies.”

Read here (Fortune, March 19, 2020)

Coronavirus: Why you must act now -- Politicians, community leaders and business leaders: What should you do and when?

This article by Tomas Pueyo, which has received over 40 million views, and translated into over 40 languages as at March 19, begins with the following:

‘With everything that’s happening about the Coronavirus, it might be very hard to make a decision of what to do today. Should you wait for more information? Do something today? What?... Here’s what I’m going to cover in this article, with lots of charts, data and models with plenty of sources: (1) How many cases of coronavirus will there be in your area? (2) What will happen when these cases materialise? (3) What should you do? (4) When?’

Read here (Medium, updated March 19, 2020)

List of prominent people who have endorsed or shared his article. Read here

Moving online now: How to keep teaching during coronavirus

‘As the coronavirus spreads, colleges are scrambling to respond to potential health-care crises, campus closings, and other issues that are arising and evolving on a daily basis. A major challenge: How can institutions continue to offer instruction if they decide to close or to cancel in-person classes? A growing number are moving classes online as a short-term solution. This special Chronicle collection includes our best advice guides and opinion pieces on online learning, to help faculty and staff members make the adjustment if that time comes.’

Download here (Ohio State University, March 19, 2020)

Coronavirus will change the world permanently. Here’s how

‘A global, novel virus that keeps us contained in our homes—maybe for months—is already reorienting our relationship to government, to the outside world, even to each other. Some changes these experts expect to see in the coming months or years might feel unfamiliar or unsettling: Will nations stay closed? Will touch become taboo? What will become of restaurants?

‘But crisis moments also present opportunity: more sophisticated and flexible use of technology, less polarization, a revived appreciation for the outdoors and life’s other simple pleasures. No one knows exactly what will come, but here is our best stab at a guide to the unknown ways that society—government, healthcare, the economy, our lifestyles and more—will change.’

Read here (Politico, March 19, 2020)

Video on dynamics of pandemics

“This 8 minute video is more informative than 2 weeks of cable news.” This is one of the comments on this video. It gives a great summary of how pandemics develop so that people can be better prepared for their consequences. It is a useful way to explain the epidemiology of pandemics to a mass audience.

View here

Six effective traditional Chinese medicines for Covid-19

‘Traditional Chinese medicine has been playing a critical role in the prevention, treatment and rehabilitation of the COVID-19. Official figures showed that, up to Sunday, 91.6 percent of the patients in Hubei province, the epicenter of the outbreak, and 92.4 percent of the patients nationwide have been treated with TCM. "Three formulas and three medicines" have been proven to be effective in curbing the virus, according to the State Administration of Traditional Chinese Medicine:

1. Jinhua Qinggan Granule (金花清感颗粒) 
2. Lianhua Qingwen Capsule/Granule (连花清瘟胶囊/颗粒)
3. Xuebijing Injection (血必净注射液)
4. Lung Cleansing and Detoxifying Decoction (清肺排毒汤)
5. HuaShiBaiDu Formula (化湿败毒方)
6. XuanFeiBaiDu Granule (宣肺败毒颗粒)

Read here (China Daily, Mar 17, 2020) 

Improving epidemic surveillance and response: Big data is dead, long live big data. The Lancet

Urgent investment in surveillance systems and global partnerships are needed to prepare for the pandemics that will continue to emerge in the coming decades. The following are three key challenges that pertain to creating useful epidemic forecasts during an outbreak.

The first challenge: Misaligned incentives. Academics are largely incentivised to write scientific articles and to fund their work through individually led grants... Companies are incentivised by profit, and are rightly beholden to national regulatory frameworks and the public with respect to the data they collect.

The second challenge: Gap between (1) technological or methodological innovation, which often occurs in academic settings in high-income countries, and (2) implementation in field settings, frequently done by NGOs or governments in low-income and middle-income countries.

The third challenge: Epidemic forecasting is inherently uncertain... [With] emerging outbreaks—with COVID-19 highlighting this point—we often lack accurate data about case counts and biological processes driving an epidemic, let alone the behavioural responses of people affected, making it challenging to swiftly adapt or interpret very complex models on the spatiotemporal scales relevant for decision making.

‘These innovations will remain dislocated and impractical until the challenges above are addressed. Encouragingly, all three issues could be improved by moving much of the focus of funding and expertise to the populations most vulnerable to epidemics.’

Read here (The Lancet, March 17, 2020)

Malaysian Health Coalition urges the government to act decisively, firmly

The MHC, who are Malaysia’s emergency physicians, critical care specialists, intensivists and public health physicians, have asked to to take three decisive and firm steps:

1. Act decisively in prohibiting mass gatherings. This should be uniformly applied across all government agencies, private businesses, civil societies, religious authorities and communities. This is not a lockdown, which is too extreme and unnecessary. Essential services should continue, and citizens should have basic freedom of movement.
2. Act firmly to educate the public about “social distancing”, which is the best intervention to reduce viral spread. We must provide adequate support for workers (who may lose income), employers (who may lose revenue) and citizens (who may lose services). We must protect the mental and physical health of older adults staying at home; civil society organizations can help fill this gap.
3. Deliver clear, coordinated and confident risk communications to Malaysians, to provide a reliable source of information, advice and recommendations.

Read here (Malaysian Health Coalition, March 16, 2020)

ISIS Focus: The race against a raging virus

The regular publication of ISIS Malaysia, ISIS Focus, has produced a special edition called “The race against a raging virus”, a compilation of articles (many in other publications) authored or co-authored by people associated with the institute.

Read here (ISIS Malaysia, March 2020)

Penang Monthly focuses on Covid-19

The March 2020 issue carries 14 features ranging from journalism at a time of crisis and effects on the art world, and from Malaysia’s response to the crisis to how it affects the poor...

Read here (Penang Monthly, March 2020)

Hard choices for the Covid-19 outbreak

Dr Amar Singh outlines three choices before us:

1. The first is to carry on as usual. Put minimum restriction on society. Allow free movement of individuals and allow travel and businesses to continue as usual. This will allow the virus to spread widely and over time we can develop community herd immunity.
2. The second option is to continue as we are doing now. Isolation of all infected individuals. Vigilant contact tracing of infected individuals. Limiting travel to and from countries that are of high risk. Screening at entry points to our country.
3. The third option is the one that I am advocating for. A pre-emptive strike. That is, we prepare as if an outbreak is imminent or already in place. This will be painful for all of us and it will have to be thought through and will require sustainability measures over time.

Read here (The Malay Mail, March 11, 2020)

Infectious Diseases Society of America (IDSA) issues guidelines on the treatment and management of patients with COVID-19

The IDSA have issued 7 recommendations on the treatment and management of COVID-19 patients. These are part of their aim to “develop evidence-based rapid guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of [these] patients.”

They recognise the limitations imposed by “the understandable urgency in producing, synthesising and disseminating data during the current pandemic”. In the rush to publish, there has been (1) circumvention of usual research steps (2) limited peer-review process and (3) increased potential for publication bias (in the interest of showing promising data and in the race to achieve recognition).

The recommendations are based on “evidence from the best available clinical studies with patient-important endpoints”. They also discuss trade-offs between “highly uncertain benefits” and “known putative harms”. They cover treatments involving drugs like azithromycin, hydroxychloroquine, lopinavir-ritonavir, corticosteroids and tocilizumab.

Read here (IDSA, March 11, 2020)

Past pandemics exposed China’s weaknesses: The current one highlights its strengths

‘...[The] audience for Xi’s performance is as much global as domestic. Just as in the past, whether in the time of SARS or of plague, outside observers are assessing China’s governance by its capacity to manage its health. COVID-19 has become an important test for the virtues of authoritarian governance versus those of citizen empowerment. Aware of this high-stakes diplomacy, China is reframing the narrative to emphasize the success of its mass-containment measures and downplay concerns about its initial failures. China has shared its expertise with the European Union, pledged $20 million to the WHO in its fight against the virus, dispatched medical teams and supplies to Iran, Iraq, Italy, and Serbia, and promised to help African countries meet the crisis. All at once, Xi has begun to look more like a global leader committed to health for all...

‘The new coronavirus has revealed a fractured geopolitical landscape and reactivated old arguments about openness and efficiency. The virus has laid bare China’s strongman leadership, but it has also highlighted incompetencies within Western democracies. As governments of democratic states impose sweeping quarantine measures, China is hoping that its draconian style of epidemic management will prevail as the new global norm.’

NOTE: There is a mention Wu Lien-Teh in this story. ‘In 1910, as Qing rule crumbled, the British-educated, Penang-born physician Wu Lien-teh was sent by the Chinese government to curtail the spread of pneumonic plague across Northeast China. He enacted stringent containment strategies based on modern scientific teachings: postmortems, bacteriological investigations, and mass cremations, to name a few. Wu’s program was markedly different from the response to the bubonic plague just two decades prior, when endeavors to halt the contagion were left to local charitable organizations or to the foreign officials who staffed the Imperial Maritime Customs Service with minimal oversight from the viceroy at Canton.’

Read here (Foreign Affairs, March 7, 2020)

Covid-19: The gendered impacts of the outbreak

‘Experience from past outbreaks shows the importance of incorporating a gender analysis into preparedness and response efforts to improve the effectiveness of health interventions and promote gender and health equity goals. During the 2014–16 west African outbreak of Ebola virus disease, gendered norms meant that women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as front-line health-care workers...’

Read here (The Lancet, March 6, 2020)

‘Rethink healthcare for migrant workers’

‘The government needs to rethink its healthcare policies towards undocumented migrant workers as the current policy drives them underground and made contact tracing and quarantine difficult for management of outbreaks, said epidemiologist Dr Chan Chee Khoon. He said Malaysia could not ignore its large pool of undocumented migrant workers as long as contact tracing (those who have come in close contact with those who have been tested positive with Covid-19) and quarantine remained as tools for managing the outbreak.

“The Health Ministry and Home Ministry need to rethink their policies towards undocumented migrant workers, which currently drive them underground rather than encourage them to come forth to seek treatment when afflicted with infectious and other ailments. It would be extremely difficult to carry out contact tracing when undocumented migrant workers have strong incentives to avoid contact with government agencies, ” he said.

Read here (The Star, Mar 3, 2020)

Response to COVID-19 in Taiwan: Big data analytics, new technology, and proactive testing

This paper published in the JAMA (Journal of the American Medical Association) network, covers how Taiwan (1) recognised the crisis (2) managed it (3) communicated to the public about it. It concludes:

‘Taiwan’s government learned from its 2003 SARS experience and established a public health response mechanism for enabling rapid actions for the next crisis. Well-trained and experienced teams of officials were quick to recognize the crisis and activated emergency management structures to address the emerging outbreak.

‘In a crisis, governments often make difficult decisions under uncertainty and time constraints. These decisions must be both culturally appropriate and sensitive to the population. Through early recognition of the crisis, daily briefings to the public, and simple health messaging, the government was able to reassure the public by delivering timely, accurate, and transparent information regarding the evolving epidemic. Taiwan is an example of how a society can respond quickly to a crisis and protect the interests of its citizens.’

Read here (JamaNetwork, March 3, 2020)

Read related article in Stanford.edu here

Pandemic rules and the law: Shad Saleem Faruqi

‘Those in positions of authority must also remain cognisant of the rule of law dimension. Power is not inherent. It must be derived from the law and its exercise must remain within the four corners of the enabling legislation.

‘From the rule-of-law point of view, an executive order, policy, directive, instruction or scheme does not amount to ‘law’ (and thereby require obedience) simply because of expediency, workability or reasonableness. It must be anchored in and derived from legislation or subsidiary legislation.‘

Read here (The Star, March 26, 2020)

The psychological impact of quarantine and how to reduce it: Rapid review of the evidence

‘The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.’

Read here (The Lancet, Feb 26, 2020)

Caregiving and the soul of medicine: Discussion among Eric J Topol, Abraham Verghese and Arthur M Kleinman

Kleinman: ‘It's surprising that I learned this from my personal experience; I should have known it from my professional experience—but care does not end with the death of the person you're caring for. You're caring for memories after that. A clinician also cares for memories, remembering how to think about the care and how to perhaps use a particular case to improve care in the future. The family member, of course, is rebuilding a story about one's life and one's family. Central to that is the memory of the care you gave and what you've gone through. The attention to those memories, their ordering, the time we spend developing them becomes a very important part of our lives after the practical acts of care no longer need be given because the person has passed. Those are the kinds of things I was concerned with.

‘I came to realize two things: First, that care was disappearing from clinical medicine, that clinicians have become so tied up with technologies, and so tied up with delivering the technologies effectively, that they are forgetting about the role that care plays. And second, there's some question as to whether in the future, even in families, we'll have care, given the limited time that family members have today, the fact that both husbands and wives work—this was women's work in the past—and men in our time, no matter how "woke" and liberated they claim to be, are not picking up the task of care.’

Eric J. Topol, MD, is one of the top 10 most cited researchers in medicine and frequently writes about technology in healthcare, including in his latest book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.

Abraham Verghese, MD, is a critically acclaimed best-selling author and a physician with an international reputation for his focus on healing in an era when technology often overwhelms the human side of medicine.

Arthur M. Kleinman, MD, MA, is a founder of the field of medical anthropology. He has written over 40 books, including The Illness Narratives: Suffering, Healing, and the Human Condition. His latest book is The Soul of Care: The Moral Education of a Husband and a Doctor.

https://www.medscape.com/viewarticle/920514#vp_3

View video and read transcript here (Medscape, Nov 19, 2019)

Google health-data scandal spooks researchers. Something to think about as we use big data to help in healthcare

Last year, before the Covid-19 outbreak, ‘Google and one of the largest health-care networks in the United States are embroiled in a data-privacy controversy that researchers fear could jeopardise public trust in data-sharing practices and, potentially, academic studies.

’At issue is a project dubbed Nightingale that gives Google access to the health-care information, including names and other identifiable data, of tens of millions of people without their knowledge. The people were treated at facilities run by the health network Ascension, which is based in St Louis, Missouri.’

Read here (Nature, November 19, 2019)

Economic growth is an unnecessary evil, Jacinda Ardern is right to deprioritise it

‘New guidance on policy suggests all new spending must advance one of five government priorities: improving mental health, reducing child poverty, addressing the inequalities faced by indigenous Maori and Pacific islands people, thriving in a digital age, and transitioning to a low-emission, sustainable economy.

‘Take a look at the biggest problems faced world-wide and you would be hard pushed to find examples that are more grave than the ones set out in Ardern’s provisional proposals. Rising inequality, a mental health crisis and climate change are all significant threats, but as long as other major economies prioritise economic growth over wellbeing New Zealand may become a lone wolf trapped in an increasingly hungry bear pit.’

Read here (The London Economic, May 31, 2019)