Inside poverty: How we gave a voice to Asia’s poor during Covid-19

‘When COVID-19 struck in 2020, sending many Asian countries into lockdown, CNA’s Insight series zoomed in on its impact on the poor - with teams on the ground in Indonesia, Malaysia, the Philippines, Bangladesh, India and Hong Kong. Poverty rates soared for the first time in almost two decades, dealing a blow to decades worth of poverty alleviation efforts.

‘With well over 100,000 views per episode, Poverty in Asia drew thousands of comments, ranging from words of encouragement for our profiles, to asking questions such as “is this poverty porn?” and “Why do the poor have so many children?”.

‘The producers behind the episodes, Aji Yahurti from Indonesia, Chen Yih Wen from Malaysia, Lolita Lachia from Philippines and Insight’s Ikhwan Adrian Rivai answer viewers’ questions and talk the about the challenges faced in recording the stories of the poor, amid a pandemic.

‘They also share about unexpected kindnesses and life lessons they learnt from those living in scarcity. One profile from the Philippines, Tricia Borromeo, had received $2,000 in donations to resume her university education, after the episode was released.’

View here (Channel News Asia video, Feb 18, 2021)

No jab, no job? Ethical issues in mandatory Covid-19 vaccination of healthcare personnel

‘Mandating COVID-19 vaccination of healthcare personnel (HCP) could maximise vaccine uptake, but risks exacerbating breakdowns in trust between HCP and their institutions.

‘Ethical arguments for mandating COVID-19 vaccination of HCP appeal to their duties to ‘do no harm’ and to care for patients, but the fulfilment of these duties requires a safe working environment.

‘We argue for policies aimed at strengthening HCP’s trust in healthcare systems by addressing HCP concerns, including the institutional factors that have put them at risk of infection throughout the COVID-19 pandemic, before considering a COVID-19 vaccine mandate.’

Read here (BJM, February 17, 2021)

‘Wildly unfair’: UN boss says 10 nations used 75% of all vaccines

‘The United Nations chief has sharply criticised the “wildly uneven and unfair” distribution of COVID-19 vaccines, pointing out that just 10 countries have administered 75 percent of all vaccinations. Addressing a high-level meeting of the UN Security Council on Wednesday, Antonio Guterres said 130 countries have not received a single dose of vaccine.’

Read here (Aljazeera, Feb 17, 2021)

Malaysia’s National Covid-19 Immunisation Plan: The missing details — Ezzaty Hasbullah

‘The Malaysian Government has recently published its National Covid-19 Immunisation Programme (NIP) outlining its strategy to achieve coverage by February of 2022. Though the document gives a good overview of the country’s vaccination plan from procurement to vaccination, it omits the minute execution details on several aspects along this value chain. The missing details:

• Trust building and outreach
• Ensuring equity in access
• Task-shifting and training
• Strengthening digital infrastructure

‘What the NIP gives is a general overview of the immunisation efforts in the months to come. What it does not give are the particulars in each step towards achieving this goal. More information on the actual particulars in realising this strategy has to be made available for public scrutiny — if such particulars are even available. These details could be the differentiating factors in determining Malaysia’s success or failure to achieve its 2022 immunisation targets because, as always, the devil is in the details.’

Read here (Malay Mail, Feb 17, 2021)

How much testing is enough? It’s complicated

‘One of the key measures of a country’s Covid-19 response is how much testing is done. The more cases in the community, the greater the need to expand testing to keep pace with the outbreak. But just how much testing is enough?

‘At a press conference on Tuesday, Health Ministry director-general Dr Noor Hisham Abdullah said the benchmark set by the World Health Organisation (WHO) is to have at least ten negative tests for every person found to be positive. In other words, the test positivity rate should be no higher than about 10 percent. Any higher, it suggests many cases are being missed.

‘However, several sources including health experts quoted in previous Malaysiakini reports had instead cited a five percent figure as the benchmark to meet. One source, the website "Our World in Data", even cited WHO for setting it as the benchmark. So, who is right? And how did different sources attribute different numbers to WHO?’

Read here (Malaysiakini, Feb 17, 2021)

Vaccine hesitancy: Israel's much-publicised vaccination drive hits stumbling blocks

‘Prime Minister Benjamin Nethanyahu, who's made the vaccination campaign a major election issue, warned that more than half a million Israelis over the age of 50 have still not gone to get their jab. "I remind you of the most dramatic piece of data," he said this week. "97% of deaths and 93% of severe cases are in this group." Since the start of the pandemic over 5,400 people have died of COVID-19.

‘Overall, four million Israelis have been vaccinated so far, and about 2,6 million of them have received both shots. Since February, everybody aged over 16 has been called upon to get their shot. "We are trying to see what are the attitudes of people towards the vaccine. There is a tremendous amount of fake news in the public," says Dr. Boaz Lev, head of the vaccine task force at the Ministry of Health in Jerusalem. "This is worrisome, but it will take a while to know what the compliance is."

Read here (DW, Feb 17, 2020)

Covid-19 cases are dropping fast. Why?

‘One month ago, the CDC published the results of more than 20 pandemic forecasting models. Most projected that COVID-19 cases would continue to grow through February, or at least plateau. Instead, COVID-19 is in retreat in America. New daily cases have plunged, and hospitalizations are down almost 50 percent in the past month. This is not an artifact of infrequent testing, since the share of regional daily tests that are coming back positive has declined even more than the number of cases. Some pandemic statistics are foggy, but the current decline of COVID-19 is crystal clear.

**Four reasons: social distancing, seasonality, seroprevalence, and shots.’

Read here (The Atlantic, Feb 17, 2021) 

‘India’s Covid-19 infections grossly underestimated’

‘India’s southern state of Karnataka alone may have had 31.5 million cases of COVID-19 or nearly 95 times greater than have been reported, says a new study that puts a question mark on the 10 million plus cases reported for the whole country so far.

‘Published this month in the Journal of the American Medical Association, the study is based on data collected from a representative sample of households in 20 districts of Karnataka, home to 70 million of India’s 1.3 billion people.’

Read here (SciDev, Feb 17, 2021)

The coronavirus is here to stay — here’s what that means

‘In January, Nature asked more than 100 immunologists, infectious-disease researchers and virologists working on the coronavirus whether it could be eradicated. Almost 90% of respondents think that the coronavirus will become endemic — meaning that it will continue to circulate in pockets of the global population for years to come (see 'Endemic future')...

‘More than one-third of the respondents to Nature’s survey thought that it would be possible to eliminate SARS-CoV-2 from some regions while it continued to circulate in others. In zero-COVID regions there would be a continual risk of disease outbreaks, but they could be quenched quickly by herd immunity if most people had been vaccinated.’ 

Read here (Nature, Feb 16, 2021)

FLCCC to Merck: The data shows ivermectin's strong efficacy against Covid-19

‘The Front Line COVID-19 Critical Care Alliance (FLCCC) has issued a public statement in response to a press release recently issued by Merck.

‘The FLCCC Alliance reports that the Merck release of February 4, 2021— which concluded that there was no meaningful evidence for the clinical efficacy of ivermectin in patients with COVID-19 disease — did not provide any scientific data or analyses by Merck to support their conclusion.

‘Dr. Pierre Kory, President and Chief Medical Officer of the FLCCC said that, "The company's disregard for the most current medical evidence is an evidentiary indictment of their uncorroborated position. Merck's press release will cause governments, health authorities, medical providers, business leaders, and citizens to retreat from pursuing a medical agent that, according to our recent peer-reviewed and accepted publication to the highly regarded Frontiers in Pharmacology, has been proven to be an effective and globally available agent to prevent and treat every phase of COVID-19 disease."

Read here (PRWeb, Feb 16, 2021)

Private hospitals to work with govt in vaccine rollout

‘Private hospitals across the country say they are ready to work with the government in vaccinating the public to speed up the National Covid-19 Immunisation Programme.

‘Association of Private Hospitals of Malaysia (APHM) president Dr Kuljit Singh said the group was waiting to discuss the mechanism of the programme as “many would be happy to be vaccinated in private hospitals”. “It is a service we can provide for the public. However, we are waiting for further instructions,” he said in a statement.’

Read here (Free Malaysia Today, Feb 16, 2021)

IP, vaccine imperialism cause death and suffering, delay recovery

‘Vaccine developers’ refusal to share publicly funded vaccine research findings is stalling broader, affordable vaccinations which would more rapidly contain COVID-19 contagion. The pandemic had infected at least 109 million people worldwide, causing over 2.4 million deaths as of mid-February.

‘Avoidable delays in preventive vaccination are imposing terrible burdens on the world economy and human welfare, with economic disruption demanding more relief and recovery measures. They have cost US$28 trillion in lost output globally, with developed countries contracting by 7% in 2020.’

Read here (IPS News, Feb 16, 2021)

Trump’s false posts were treated with kid gloves by Facebook

‘In August, as the election approached and misinformation about COVID-19 spread, Facebook announced it would give new fact-checking labels to posts, including more nuanced options than simply “false.” But data from The Markup’s Citizen Browser project, which tracks a nationwide panel of Facebook users’ feeds, shows how unevenly those labels were applied: Posts were rarely called “false,” even when they contained debunked conspiracy theories. And posts by Donald Trump were treated with the less direct flags, even when they contained lies. The Markup shared the underlying data for this story with Facebook.’

Read here (The Markup,  Feb 16, 2021)

More people died of drug overdoses last year than ever before in US

‘The data for the 12-month period ending last June showed 81,003 deaths, a 20% increase over the previous year. Separate research found that weekly counts of all drug overdoses were up to 45% higher in 2020 than in 2019.

• Stat: During Covid-19 pandemic, overdose deaths reached new heights 
• USA Today: Covid pandemic sends more people to ER for drug overdoses’

Read here (Kaiser Health News, Feb 16, 2021)

NY Times lies to say WHO investigators dissatisfied with Chinese cooperation

This story carries the rebuttals on Twitter by two WHO expert-team members, Peter Daszak, British zoologist, and Thea Kølsen Fischer, a Danish epidemiologist. It also provides a background to the story, quoting various findings elsewhere in the world. The earlier studies suggest that the Covid-19 virus could have circulated in Europe before it surfaced in Wuhan. 

Read here (Scoop NZ, Feb 15, 2021)

The next pandemic? It may already be upon us

‘Antimicrobial resistance (AMR) won’t race across the world like Covid-19, but its effects will be devastating. Thankfully, we already know what we need to do to defeat it...

‘Reining in the inappropriate use of antibiotics, in humans and in farmed animals, is key to staying ahead of AMR, but we also need novel anti-infectives coming down the pipeline – new last resorts. The thing holding up that pipeline to date has been the same thing that meant we had no coronavirus vaccines at the start of this pandemic: the economic incentives are few. Because antibiotics tend to be needed in relatively small quantities at a time, there are no economies of scale to be had either.

‘That’s the bad news; now for the good. Efforts are afoot to stimulate the development of novel anti-infectives. Outterson is the founder and executive director of CARB-X, which is funded by the British and German governments, the Wellcome Trust, the Bill & Melinda Gates Foundation and several arms of the US government, and which promotes the early stages of R&D – technically, the preclinical and phase 1 clinical phases. Meanwhile, last July the International Federation of Pharmaceutical Manufacturers and Associations launched a $1bn initiative, the AMR Action Fund, to finance the much more expensive phase 2 and 3 clinical trials that bring a drug – the few that get that far – to the threshold of regulatory approval. And the UK is experimenting with a new subscription-style payment model that pays drug companies upfront for access to novel antibiotics, so decoupling profit from volume sold.’

Read here (The Guardian, Feb 15, 2021)

Sensationalising, misrepresenting facts does disservice to people: Jeyakumar Devaraj

‘Yesterday morning, I came across an article titled “UK Government releases shocking report on Covid vaccine side effects” in one of the WhatsApp chat groups I am in. This article by dailyexpose.co.uk, dated 9 February 2021, states that 70,500 adverse reactions were reported in the 6.9 million people vaccinated in the UK between 8 December 2020 and 24 January 2021.

‘The article says five people went blind, 21 suffered strokes, 69 developed facial nerve weakness (Bell’s Palsy) and 107 died because of the Covid vaccine they received.

‘This is a terribly unscientific way of looking at the data. People get sick, suffer various maladies and die even when not vaccinated. So, we need to check whether the incidence of each of these adverse events is actually higher in the vaccinated cohort when compared to the baseline figures for that population. If it is, then it could be possible that the vaccine predisposes to these conditions, and we would have to look more closely.

‘Let’s take the deaths first. According to the UK Office for National Registration, in 2019 there were 1,079.4 deaths per 100,000 males and 798.9 deaths per 100,000 females – over the whole year.

‘The 107 deaths observed in the 6.9 million vaccinated individuals gives a mortality rate of 1.6 per 100,000 – over seven weeks. If we annualise it by multiplying 1.6 by 52 and dividing it by 7, we arrive at a figure of 11.5 per 100,000 – much lower than the UK Crude Death Rate (CDR) for 2019 (CDR = overall death rate without breaking it down into death rates for each age group). These figures indicate that it would be difficult to sustain an argument that the Covid vaccine increases the risk of dying in the UK population.’

Read here (Aliran, Feb 15, 2021)

Israeli study finds 94% drop in symptomatic Covid-19 cases with Pfizer vaccine

‘Israel's largest healthcare provider on Sunday (Oct 14) reported a 94 per cent drop in symptomatic COVID-19 infections among 600,000 people who received two doses of the Pfizer's vaccine in the country's biggest study to date.

‘Health maintenance organization (HMO) Clalit, which covers more than half of all Israelis, said the same group was also 92 per cent less likely to develop severe illness from the virus.’

Read here (Channel News Asia, Feb 15, 2021)

Bill Gates: Solving Covid easy compared with climate

‘Fifty-one billion and zero - the two numbers Bill Gates says you need to know about climate. Solving climate change would be "the most amazing thing humanity has ever done", says the billionaire founder of Microsoft. By comparison, ending the pandemic is "very, very easy", he claims.

‘Mr Gates's new book, How to Avoid a Climate Disaster, is a guide to tackling global warming. Don't underestimate the scale of the challenge, he told me when we spoke last week. "We've never made a transition like we're talking about doing in the next 30 years. There is no precedent for this."

‘Fifty-one billion is how many tonnes of greenhouse gases the world typically adds to the atmosphere each year. Zero is where we need to get to.’

Read here (BBC, Feb 15, 2021)

Coronavirus: Is the pandemic finally coming to an end in India?

‘By the middle of last week, India was barely counting an average of 10,000 Covid cases every day. The seven-day rolling average of daily deaths from the disease slid to below 100. More than half of India's states were not reporting any Covid deaths. On Tuesday, Delhi, once an infection hotspot, did not record a single Covid death, for the first time in 10 months.

‘So far, India has recorded more than 10 million infections - the second-highest in the world after the US. There have been over 150,000 reported deaths from the disease. The number of deaths per million people stands at 112, much lower than what has been reported in Europe or North America. It is also clear that the decline in cases is not because of lower testing.

‘Most pandemics typically rise and fall in a bell-shaped curve. India has been no exception. Also, it has seen a high proportion of cases and deaths of people above the age of 65 living in densely packed cities, hewing to infection trends around the world. "There's nothing unusual about infections dropping in India. There's no miracle here," says Dr Shahid Jameel, a leading virologist. Experts say there's no dearth of possible causes - explained below - for the relatively low severity of the disease and its toll.’

Read here (BBC, Feb 15, 2021)

Anatomy of a conspiracy: With Covid, China took leading role

‘From Beijing and Washington to Moscow and Tehran, political leaders and allied media effectively functioned as superspreaders, using their stature to amplify politically expedient conspiracies already in circulation. But it was China -- not Russia – that took the lead in spreading foreign disinformation about COVID-19’s origins, as it came under attack for its early handling of the outbreak.

‘A nine-month Associated Press investigation of state-sponsored disinformation conducted in collaboration with the Atlantic Council’s Digital Forensic Research Lab, shows how a rumor that the U.S. created the virus that causes COVID-19 was weaponized by the Chinese government, spreading from the dark corners of the Internet to millions across the globe. The analysis was based on a review of millions of social media postings and articles on Twitter, Facebook, VK, Weibo, WeChat, YouTube, Telegram and other platforms.’

Read here (Associated Press, Feb 15, 2021)

As vaccinations lag, Israel combats online misinformation

‘After surging ahead in the race to vaccinate its population against the coronavirus, Israel is blaming online misinformation for a sudden slowdown in the campaign. Now, officials are fighting back.

‘Israel’s Health Ministry, which is spearheading the vaccination efforts, is employing both warnings and incentives as it tries to persuade reluctant holdouts to get immunized. It has beefed up a digital task force to counter spurious claims about the vaccines, while local governments are turning to DJs and free food to lure people to vaccination centers. Concerts and museums could soon be off limits to the unvaccinated.’

Read here (AP, Feb 15, 2021)

WHO experts slam NYT for twisting, misquoting their words on virus origins probe

‘WHO experts who recently visited Wuhan slammed the New York Times for twisting their words and casting shadows over the efforts to uncover the origins of the virus, after the newspaper accused China of refusing to hand over sensitive data to WHO experts.

‘The report by New York Times titled “On WHO Trip, China Refused to Hand Over Important Data” accuses China of failing to share important data that may help in identifying the origins of the virus and prevent future outbreaks.

 ‘After the report was published, two WHO experts [Peter Daszak, British zoologist and Thea Kølsen Fischer, a Danish epidemiologist] slammed New York Times for misquoting them in the report to fit its own narrative, with the report casting a shadow over the scientific work of seeking for virus origin.’

Read here (Global Times, Feb 14, 2021)

US and UK in a spat with China over WHO probe on Covid-19

• White House cites 'deep concerns' about WHO Covid-19 report, demands early data from China (read here)
• UK says it shares US concerns over WHO COVID-19 mission to China (read here)
• China fires back at US allegations of lack of transparency over Covid-19 probe (read here)

All reports on Channel News Asia, Feb 14, 2021

On WHO trip, China refused to hand over important data

‘Chinese scientists refused to share raw data that might bring the world closer to understanding the origins of the coronavirus pandemic, independent investigators for the World Health Organization said Friday.

‘The investigators, who recently returned from a fact-finding trip to the Chinese city of Wuhan, said disagreements over patient records and other issues were so tense that they sometimes erupted into shouts among the typically mild-mannered scientists on both sides.

‘China’s continued resistance to revealing information about the early days of the coronavirus outbreak, the scientists say, makes it difficult for them to uncover important clues that could help stop future outbreaks of such dangerous diseases.

“If you are data focused, and if you are a professional,” said Thea Kølsen Fischer, a Danish epidemiologist on the team, then obtaining data is “like for a clinical doctor looking at the patient and seeing them by your own eyes.”

‘For 27 days in January and February, the team of 14 experts for the WHO led the mission to trace the origins of the pandemic. Several say their Chinese counterparts were frustrated by the team’s persistent questioning and demands for data.’

Read here (New York Times via Economic Times, India, Feb 13, 2021)

Oxford University to test Covid-19 vaccine response among children for first time

‘The University of Oxford has launched a study to assess the safety and immune response of the Covid-19 vaccine it has developed with AstraZeneca in children for the first time, it said on Saturday (Feb 13).

‘The new mid-stage trial will determine whether the vaccine is effective on people between the ages of 6 and 17, according to an emailed statement from the university. Around 300 volunteers will be enrolled and first inoculations are expected this month, Oxford said.’

Read here (Straits Times, Feb 13, 2021)

Germany: Ways out of the coronavirus crisis

‘Northeastern Germany has managed the crisis better than the rest of the country. As Rostock eases restrictions, it aims to be a model for other cities.’

View video here (DW, Feb 13, 2021) 

Medical services restored to pre-Covid-19 level in Uttar Pradesh

‘Following the continuous decline in the number of Covid-19 cases and active infections, the Uttar Pradesh government has directed state medical colleges and institutions to fully restore all outpatient and in patient services.

‘The order issued by the chief minister’s office on Friday has to be implemented with immediate effect. “Following the decline in the prevalence of coronavirus pandemic, all outdoor and inpatient services must be restored at the earliest so that people in need can have access to the required help.” 

Read here (Times of India, Feb 13, 2021)

WHO says all hypotheses still open in probe into COVID-19 origins

‘All hypotheses are still open in the World Health Organization's search for the origins of COVID-19, WHO Director-General Tedros Adhanom Ghebreyesus told a briefing on Friday (Feb 12), after Washington said it wants to review data from a WHO-led mission to China.

‘The mission, which spent four weeks in China looking into the origins of the COVID-19 outbreak, said this week that it was not looking further into the question of whether the virus escaped from a lab, which it considered highly unlikely.

‘The previous US administration of President Donald Trump, which left office last month, had said it suspected the virus may have escaped from a Chinese lab, which Beijing strongly denies.’

Read here (Channel News Asia, Feb 13, 2021)

The ‘saviour’ loan apps that trapped pandemic-struck Indians

‘The apps proliferated as the pandemic and the lockdown left millions in India jobless. While many working class jobs have returned, salaried professionals - from engineers and software developers to salesmen - and small businesses have struggled to survive. So the apps helped them out when they needed money quickly.

‘For loans as small as $150 and for periods as short as 15 days, these apps charge a one-time processing fee, a convenience fee and steep interest rates - some as high as 30%. Compare this to to Indian banks, which lend at 10-20% with a tenure of at least 12 months.

‘Like many other apps, at the time of download, these apps too ask for permission to access contacts and photo galleries. When an unsuspecting borrower agrees to this, they become more vulnerable.

"When I investigated one such case, I found that these apps are actually not only able to read and access your contact list, they're also capturing your images, videos and location. They also know many things about you - like, where you have actually used this money, to whom you have transferred this money," says cyber security expert Amit Dubey.’

Read here (BBC, Feb 13, 2021)

The pandemic has unmasked America’s deepest inequities: Covid’s disparate racial impacts, by the numbers

‘Covid-19 doesn’t discriminate, but the havoc wrought by the virus—the deaths, economic devastation, and intergenerational trauma—has disproportionately affected Black, Latino, and Native American communities. The Trump administration’s feckless response didn’t help, yet even proactive steps have reinforced preexisting inequities: Stay-at-home orders protected people with the privilege to work remotely while frontline workers, disproportionately Black and Latino, took on greater risk of exposure. People of color have also experienced more unemployment and financial insecurity. As Mary Bassett, director of Harvard’s François-Xavier Bagnoud Center for Health and Human Rights, explains, none of this is caused by the virus itself: “It’s because of the social consequences of race in our society, which has been reinforced by decades, centuries of bad practices and policies.”

Read here (Mother Jones, Feb 12, 2021) 

Khairy: Non-citizens to receive free Covid-19 vaccines to ensure everyone is safe

‘Malaysia will only be safe from the Covid-19 pandemic if the people, including foreign citizens living here, receive the vaccines, said Science, Technology and Innovation Minister Khairy Jamaluddin. He said that even if Malaysians were to receive the vaccines, it would not mean they are safe because Malaysia has about three million foreigners who are likely to cause the virus to spread and infect Malaysians.

“That is why this (giving free vaccines to non-citizens) needs to be done because we are not safe until everyone is safe. In vaccine science, if there are more vaccine recipients, then we are safe and the virus cannot infect others. As such, we are targeting 80 per cent of the population to create group immunity and form enough antibodies so that the virus does not infect people in the country. If we (locals) are the only recipients, we will not be safe because they (foreigners) may still infect us, or the virus could spread among the foreigners. That is why it is important that we protect everyone. This is the right decision for the sake of humanity,” he said.’

Read here (Malay Mail, Feb 12, 2021)

Khairy: Registration for Covid-19 vaccination to start in March

‘Registration for Covid-19 vaccination to members of the public is expected to kick off in March and this will be on a volunteer basis, said Science, Technology and Innovation Minister Khairy Jamaluddin. 

He said there are five ways for the public to sign up for the vaccine, including via the MySejahtera application. “If they have no access to MySejahtera, they may go to the JKJAV (Covid-19 Vaccine Supply Access Guarantee Special Committee) website, which will be launched by the prime minister next week.

“In addition there is the hotline (number to be fixed later), manual registration at public and private clinics and hospitals, and lastly, for people living in the rural areas, we will be working with the state government to get them to register the recipients including senior citizens,” he said during the Ruang Bicara programme aired on Bernama TV, yesterday...

‘The first phase, from February to April, is for the 500,000 frontliners who are directly involved in the fight against Covid-19, while the second phase, from April to August, for the high-risk group, comprising senior citizens aged 60 and above and the vulnerable group with morbidity problems, such as heart disease, obesity, diabetes and high blood pressure, as well as persons with disabilities (PwD).

‘The third phase is from May to February next year and it is for those aged 18 and above.’

Read here (Malay Mail, Feb 12, 2021)

Covid-19 pandemic has shown humanity at its best – & at its worst: WHO DG before the UNICEF Executive Board

‘Ultimately, our fight is not against a single virus. Our fight is against the inequalities that leave children in some countries exposed to deadly diseases that are easily prevented in others; Our fight is against the inequalities that mean women and their babies die during childbirth in some countries because of complications that are easily prevented in others;

‘And our fight is to ensure that health is no longer a commodity or a luxury item, but a fundamental human right, and the foundation of the safer, fairer and more sustainable world we all want.

‘History will not judge us solely by how we ended the COVID-19 pandemic, but what we learned, what we changed, and the future we left our children.’

Read here (IPS News, Feb 11, 2021)

How to manage vaccine liability in Malaysia

‘While different systems vary in terms of elements of compensation and funding mechanisms, we can adapt the policies related to funding, proving injury and distributing compensation involving multiple parties. For example, we can set up a bespoke Covid-19 vaccine compensation programme. The programme could be co-financed by a mixture of public and private funds (eg. led by insurers), to achieve effective immunisation roll-out while providing a fair and equitable remedy and reduce overall costs to society.  

‘Two, Malaysia’s government can adapt the Singapore model and completely assume the financial costs of any serious adverse events from the vaccine. The list of serious adverse events that are covered, the mechanism of approval and the ministry which will pay are details that can be decided by a relevant committee. Given serious adverse events are rare, the overall cost should be manageable and represents a good investment for public confidence.

‘A third option is the Covax Facility’s no-fault-compensation scheme for indemnification and liability. The scheme proposed by Covax aims to set up a compensation fund for vaccine recipients in participating countries who might suffer any side-effects from COVID-19 vaccines. The scheme proposes a new mechanism to pay a lump-sum based on severity of harm to victims from Covid-19 vaccines associated side effects. The proposed mechanism would be funded by earmarking funds from high income countries or by charging taxes on pharmaceutical companies.  

‘There are reasonable solutions to the problem, and Malaysia must have a full-frontal and honest conversation about how to manage adverse events, no matter how unlikely they might be. All the solutions described above are not mutually exclusive. However, implementing them requires political will and courage. Covid-19 vaccination is a collective national effort, and we must do all we can to increase public confidence in the vaccine by providing appropriate liability protections.’

Read here (Malay Mail, Feb 11, 2021) 

Why it’s so hard to make antiviral drugs for Covid and other diseases

‘Antibiotics abound, but virus-fighting drugs are harder to come by. Fortunately, scientists are getting better at making and finding them...

‘The pandemic has sent scientists scrambling to find treatments. Heise [virologist Mark Heise of the University of North Carolina at Chapel Hill], for one, is testing a wide range of drugs—not just standard antivirals—against SARS-CoV-2 in lab dishes, as part of the Rapidly Emerging Antiviral Drug Discovery Initiative (READDI). The idea is that, because the virus depends on many processes in human cells, a variety of medications that act on human proteins might give doctors an edge by hurting the virus more than the patient. That throws the doors open to considering medications that were originally designed for cancer, psychosis, inflammatory conditions and autoimmune disease, to see if they might have a shot against Covid-19.

‘But the READDI collaborators—including academic centers, pharmaceutical companies and nongovernmental organizations—are aiming for more than a Covid-19 treatment. READDI hopes to identify and test potential medications for as-yet-unknown infections that may crop up in the future.

‘By getting early human safety testing done ahead of time, they’ll be ready to spring into action when those future outbreaks happen. As Heise says, “We don’t want to repeat what we’ve just been through.”

Read here (Scientific American, Feb 11, 2021)

Online scammers are rushing to exploit people desperate to get the Covid-19 vaccine

‘Many Americans are eager to get the Covid-19 vaccine as quickly as possible. But that inevitably means there are scammers ready to use the internet to take advantage of these vaccine seekers to steal their money and personal information.

‘Similar to earlier in the pandemic, when fraudsters flooded the internet with ads for sketchy “cures,” bogus Covid-19 tests, and scarce personal protective equipment, online schemers are now selling fake vaccine appointments and knockoff vaccine cards. (These cards document the date that vaccinated people received their doses, the manufacturer of their vaccine, and its batch number; they’re seen as a record of vaccination.)

‘Vaccine schemes are alarming. In late January, one man in Washington state was arrested after advertising fake Covid-19 vaccines online for as much as $1,000, and even injected people with an unknown substance, according to the Department of Justice, which is investigating these types of fraud cases.’

Read here (Vox, Feb 11, 2021)

‘Pure, liquid hope’: What the vaccine means to me as a GP

‘Clinicians everywhere are all nervous about what will happen if that loosening of restrictions occurs too quickly. Though death from Covid among the under-50s is relatively rare, it can still be a terrible, terrifying disease, capable of rendering its victims breathless and exhausted for weeks (and in some cases, months) after its fevers have run their course. One of my own patients, a nurse in his 20s, used to run 10km three or four times a week. The staff vaccination programme was too late for him: he caught Covid on the wards just before Christmas. Though he’s now back at work, he still hasn’t recovered sufficiently to be able to get back to running.

‘For the next six months, all my colleagues and I will be vaccinating as needed, as many hours as we’re able to. This week I’ve been gladly trudging the streets in the snow, vaccinating our housebound patients, and there aren’t too many still to go. In Scotland, the programme is anticipated to go on at least until 31 July, and the hope is that everyone over 50 will have had a first dose by May.

‘The numbers are daunting, but there’s a spirit of anticipation and celebration in the air. Many are starting to dare to plan for a world post-Covid, and I’m tempted to share that optimism. Opening my first box of vials, I thought of a friend in Orkney, a GP who’d already vaccinated all the over-80s of his practice, and who’d begun to call in the over-70s. We met briefly in Kirkwall, outdoors, on my journey from Orkney back to Edinburgh. “How did it feel to get started?” I asked him.

“I almost wept as I opened that box of vials,” he said, smiling at the memory. “Each one was hope – pure, liquid hope.”

Read here (The Guardian, Feb 11, 2021)

Immunitee Malaysia's first health passport accepted in Singapore

‘Malaysia’s Immunitee Health Passport has partnered with Temasek-founded Affinidi to become the country’s first health passport to be accepted in Singapore, via Affinidi’s Unifier digital credential platform.

‘The Immunitee Health Passport is a system designed to store personal immunisation records and vaccine data, which helps to facilitate users’ clearance at border health checkpoints, ensure data protection and security through blockchain, and verify the authenticity of Covid-19 tests and vaccines.

‘In a statement today, Immunitee said the Unifier platform provided interoperability, enabling the secure sharing of necessary data with the various national health check systems being put in place globally.’

Read here (The Edge, Feb 10, 2021)

Ground SOPs in science: The Academy of Medicine of Malaysia

‘The Academy of Medicine of Malaysia is troubled by the introduction of the Prevention and Control of Infectious Diseases (Exemption) Order 2021, which states that Cabinet ministers returning from official overseas visits must only quarantine for 3 days instead of the mandatory 10 days for inbound travellers. The Health Minister clarified that only Cabinet ministers who travel in a ‘bubble itinerary’ will undergo 3-day quarantine. Moreover, this move is intended to open up the economy as the policy will eventually be applicable to foreign dignitaries and business travellers.

‘We, the Academy of Medicine of Malaysia, wholeheartedly oppose the Exemption Order as well as any plans to extend the 3-day quarantine rule to other travellers.

‘We wish to remind the government that all standard operating procedures (SOP) must be grounded in science. The quarantine period for inbound travellers is set at 10 days based on research which shows that the risk of transmission is extremely low (~1%) after 10 days with monitoring and testing in place. The incubation period for Covid-19 is on average 5 to 6 days but can be as long as 14 days. Therefore, three days is insufficient to detect symptoms. There must be an evidence-based, public health explanation for the government’s decision to reduce quarantine days.

‘The effectiveness of so-called ‘travel bubbles’ are also still in question as new variants of Covid-19 with increased transmission capability spread rapidly around the world. There is insufficient data on the mutations to develop robust protocols for safe travel. We understand there is urgency to restart the economy for the benefit of Malaysians and businesses that are struggling, but this can only be done by bringing the pandemic under control first. The government must not open up our borders to ‘bubble’ delegations and risk bringing in new variants that could overwhelm our health system.

‘We call on the government to revoke the Exemption Order and—until there is scientific evidence that suggests differently—enforce a 10-day quarantine for all.’

Read here (AMM press release, Feb 10, 2021)

Common asthma drug cuts Covid-19 hospitalisation risk, recovery time: Oxford study

‘A commonly used asthma treatment appears to reduce the need for hospitalisations as well as recovery time for COVID-19 patients if given within seven days of symptoms appearing, researchers at the University of Oxford said on Tuesday (Feb 9).

‘The findings were made following a mid-stage study of the steroid budesonide, sold as Pulmicort by AstraZeneca and also used for treating smoker's lung.

‘The 28-day study of 146 patients suggested that inhaled budesonide reduced the risk of urgent care or hospitalisation by 90 per cent when compared with usual care, Oxford University said.’

Read here (Channel News Asia, Feb 10, 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)

Trust in Covid vaccines is growing

‘Attitudes towards COVID-19 vaccines seem to be improving in some parts of the world, a survey of thousands of people in 15 countries has found. Researchers have welcomed the results, which suggest that an increasing proportion of people are willing to be immunized. But they caution that some problems persist, such as concerns about vaccine safety. “For the first time since the pandemic began, I can sense that optimism is spreading faster than the virus,” says behavioural scientist Sarah Jones at Imperial College London, who co-led the global attitudes towards a COVID-19 vaccine survey.

‘The survey is part of the COVID-19 behaviour tracker, run by Imperial together with the UK market-research company YouGov.’

Read here (Nature, Feb 10, 2021)

Rebuilding a better, post-Covid-19 world with a new mindset of stakeholders: WEF founder Klaus Schwab

‘World War II was a time of great crisis and hardship, which forged a sense of solidarity that helped pull ravaged communities together. "To a certain extent, we are in a similar situation today...we went through a major crisis, which affected everybody in the world," says the founder and executive chairman of the World Economic Forum (WEF).

‘He is also here for the launch of his new book, Stakeholder Capitalism: A Global Economy That Works For Progress, People And Planet, which he has written with a WEF colleague, Mr Peter Vanham...

‘Indeed the stakeholder concept has featured prominently in his work since the 1973 Davos Manifesto, which set out the role of business managements to "serve clients, shareholders, workers and employees, as well as societies, and to harmonise the different interests of the stakeholders".

‘It is a theme he delves into deeper in his new book. "The idea that we need to rebuild differently post-Covid is widely shared. The sudden and all-encompassing impact of Covid-19 made us understand, much more than the gradual effects of climate change or increasing inequality, that an economic system driven by selfish and short-term interests is not sustainable...’

Read here (Straits Times, Feb 10, 2021)

Nonstimulus arithmetic: Why the American Rescue Plan has to be big -- Krugman

‘We are not in a conventional recession — a decline in output due to insufficient aggregate demand. What we’re suffering from, instead, is a partial lockdown, the result of both public policy and private choices, that has sharply curtailed high-infection-risk activities, like indoor dining.

‘Pumping up overall spending with fiscal and monetary policy wouldn’t send diners back into restaurants, nor should it. So we aren’t experiencing a normal output gap, something that should be closed by stimulus. It’s actually not clear whether we even want employment and GDP to be higher before vaccination gives us herd immunity.

‘What, then, is the role of policy? As some of us have been arguing all along, it’s not stimulus, it’s disaster relief: an attempt to shore up the living standards of those hurt by the temporary lockdown, as well as providing resources to deal with the pandemic itself. Or as I recently argued, you can think of what we’re doing as being something like fighting a war — special expenditure in the face of an emergency.’

Read here (paulkrugman.substack, Feb 10, 2021)

Bhutan: The unlikeliest pandemic success story

‘On January 7, a 34-year-old man who had been admitted to a hospital in Bhutan’s capital, Thimphu, with preexisting liver and kidney problems died of COVID-19. His was the country’s first death from the coronavirus. Not the first death that day, that week, or that month: the very first coronavirus death since the pandemic began.

‘How is this possible? Since the novel coronavirus was first identified more than a year ago, health systems in rich and poor countries have approached collapse, economies worldwide have been devastated, millions of lives have been lost. How has Bhutan—a tiny, poor nation best known for its guiding policy of Gross National Happiness, which balances economic development with environmental conservation and cultural values—managed such a feat? And what can we in the United States, which has so tragically mismanaged the crisis, learn from its success?’

Read here (The Atlantic, Feb 10, 2021)

WHO team says theory Covid began in Wuhan lab ‘extremely unlikely’

‘The World Health Organization team that visited Wuhan to investigate the origins of the coronavirus pandemic has all but dismissed a theory that the virus leaked from a laboratory, while giving some credence to China’s focus on the possibility of transmission via frozen food.

‘They said the team’s work did not dramatically change the picture they had before they began, but had added important details to the story. The team found no evidence of widespread circulation of the virus in Wuhan prior to December 2019, and said it was still unclear how it got into the Huanan seafood market, where the virus was initially detected. But, they added, “all the work that has been done on the virus and trying to identify its origin continue to point toward a natural reservoir”.’

Read here (The Guardian, Feb 9, 2021)

Prevalence and outcomes of SARS-CoV-2 infection among migrant workers in Singapore

‘There were 43 dormitories housing 198 320 migrant workers with a median occupancy of 3578 (interquartile range, 1458-6120); 99.8% of residents were male, with a median age of 33 years (interquartile range, 28-39 years). As of July 25, 95.1% of all residents had at least 1 SARS-CoV-2 test, including 63.6% with PCR and 68.4% with serology. There were 111 280 residents with a positive PCR or serology result, for an overall infection prevalence of 56.1% (95% CI, 55.9%-56.3%) (range per dormitory, 0%-74.7%; median, 52.9%). 

‘There were 24 197 clinical cases (12.2% of all residents; 21.7% of infected) from 42 dormitories and 87 083 subclinical cases (43.9% of all residents; 78.3% of all infected) (Table). Of all clinical cases, 20 cases required ICU admission (0.08% [95% CI, 0.05%-0.13%]), with 1 COVID-19 attributable death (case-fatality rate, 0.004% [95% CI, 0.0002%-0.027%]).’

Read here (JamaNetwork, Feb 9, 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)

Protein behind corona’s slow Asia spread: Study

‘Deficiency in a particular human protein, which is more common in Europe and the United States than in Asia, could explain why coronavirus is not spreading as fast in Asian countries. A team of scientists from the National Institute of Biomedical Genomics in Kalyani, West Bengal, have found a biological reason for the slower spread of a mutant of coronavirus in Asia compared to the West. The team has explained how higher levels of a human protein — neutrophil elastase — helps the virus to enter the human cell, multiply and also spread faster from infected individuals... 

“However, some naturally-occurring mutations in the AAT-producing gene results in deficiency of the AAT protein. This deficiency is known to be much higher in the Caucasians of Europe and America than among Asians,” said Majumder. “While we used AAT deficiency data from East Asia, along with North America and Europe, for the study, considering the pace at which the coronavirus is spreading, the numbers are representative of other Asian regions too, including India.”... 

‘As per their data, AAT deficiency is the least in East Asian countries — 8 per 1,000 individuals in Malaysia, 5.4 per 1,000 in South Korea, 2.5 in Singapore. On the other hand, 67.3 in per 1,000 individuals in Spain are AAT deficient, 34.6 in the UK and 51.9 in France and in the US it is prevalent in 29 individuals among 1,000.’

Read here (Times of India, Feb 9, 2021)

Tribal health providers have figured out the key to Covid-19 vaccine success. Here's their secret

‘It's important to note that there are 574 federally recognized tribes, making it difficult to broadly characterize how the vaccine rollout is going across Indian Country. Native people get their health care from a patchwork system of Indian Health Service facilities, tribally-operated clinics and urban Indian health centers, and vaccination efforts have varied from tribe to tribe and state to state.

Still, the successes of some tribal health providers offer lessons for communities struggling to vaccinate their populations efficiently. Here are some of them.

• They tailored their messaging to build trust
• They have the autonomy to decide who gets priority
• This health system is owned by its people
• They made big investments in health care
• Ultimately, success depends on the nation's vaccine supply

Read here (CNN, Feb 9, 2021)

Covid lockdowns in Hong Kong: Ambush-style action clearly works

‘The ambush-style lockdowns in Hong Kong are being criticised as a violation of human rights. However, such sudden lockdowns may remain the most efficient way for the city to control the spread of Covid-19 (“Hong Kong’s latest lockdowns uncover four Covid-19 cases in three buildings”, February 8).

‘To know the reason for this, we must know the answer to two questions: why a lockdown, and why ambush-style... (1) Lockdowns are the most effective way known for tracing or eliminating the virus infection chain... (2) As for the ambush style adopted, the lack of notice is the only way to ensure that no one can escape the lockdown...’

Read here (South China Morning Post, Feb 9, 2021)

Travelling during Covid: ‘I was nervous using a fake Covid-19 test certificate’

‘Coronavirus has changed the way we travel and many countries now demand proof of a negative Covid test before letting you in - with tests often costing hundreds of pounds. BBC reporter Joice Etutu has been speaking to two women who admit using and selling fake certificates...

‘Jessica* is also 24. She admits to selling fake Covid-19 certificates to people who wanted to travel abroad by advertising her services on social media. She says it was "easy money". "They just didn't want to pay £150 for a private test," she says. "We charged them £50. "Because it was so cheap people were asking so many questions, like 'how does it work?', 'when I get to the place are they gonna double check?', 'how did you do it?', 'am I gonna get in trouble?'"

‘Buying or even attempting to buy a forged certificate is a crime in the UK and using a forged certificate to travel is fraud by false representation. If you're caught selling fake certificates in the UK, you might face a prison sentence. Currently, it's the responsibility of airlines to check that passengers have a negative test result.’

Read here (BBC, Feb 9, 2021)

Four principles for urgent pharma action to combat Covid-19

‘Collaboration is needed between pharmaceutical companies and governments to combat the spread of COVID-19 and accelerate access to tests, treatments and vaccines. Norway, which co-chairs the Facilitation Council of the ACT-Accelerator, is committed to ensuring the global vaccination effort is managed effectively. Here are four principles which could ensure equitable access to COVID-19 tools and health products, particularly for low and middle-income countries:

• Principle 1: File for registration rapidly, widely and on the basis of the most rigorous standards
• Principle 2: Price health technologies fairly
• Principle 3: Expand production and supply capacity
• Principle 4: Transparency

Read here (World Economic Forum, Feb 9, 2021)

Is China to blame for Covid-19: Interview with The Lancet's editor Richard Horton

‘Whether it's Donald Trump, Tom Tugendhat or Paul Joseph Watson, various voices during this pandemic have blamed China for the mess we're in. How true is this? Editor-in-chief of the Lancet medical Journal, Richard Horton, argues that much of this stems from anti-Chinese racism and that we owe a debt of gratitude to the doctors, nurses and scientists of China.’

View here (Youtube, Novara Media, Feb 8, 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)

Intellectual property cause of death, genocide

‘Refusal to temporarily suspend several World Trade Organization (WTO) intellectual property (IP) provisions to enable much faster and broader progress in addressing the COVID-19 pandemic should be grounds for International Criminal Court prosecution for genocide. 

‘Making life-saving vaccines, medicines and equipment available, freely or affordably, has been crucial for containing the spread of many infectious diseases such as tuberculosis, HIV-AIDS, polio and smallpox. 

‘Jonas Salk, who developed the polio vaccine, insisted that it remain patent free. Asked who owned the patent 65 years ago, he replied, “The people I would say. There is no patent. You might as well ask, could you patent the sun?”

Read here (ksjomo.org, Feb 8, 2020)

China, Russia steal a vaccine diplomacy march

‘Russia and China are rising to the rich versus poor challenge by supplying much-needed vaccines to nations that would otherwise be far down on the global list. While the US and EU remain preoccupied with their own Covid-19 problems, Russian and Chinese companies are forming partnerships with each other and countries around the world.

‘That “vaccine diplomacy” success, however, is already starting to raise concerns in the West. Russia’s Sputnik V vaccine, originally poo-pooed in the West as a mere publicity stunt by President Vladimir Putin, has not only proved to be one of the most effective vaccines – providing over 90% protection – but also is inexpensive and easy to use...

‘Until recently, China’s vaccine industry was considered a relatively minor player on the international scene. But the race to develop and deploy Covid-19 vaccines has provided China the impetus to massively upgrade its capacities while establishing itself as a major global supplier. 

‘Covid-19 vaccines by at least four Chinese producers are in final, Phase III trials in a dozen countries, with more in the pipeline. More importantly, the two presently leading Chinese vaccines, produced by the Sinovac and Sinopharm companies, have already been administered to many millions of people in emergency vaccination campaigns in the developing world.’ 

Read here (Asia Times, Feb 8, 2021)

Inhaled budesonide in the treatment of early Covid-19 illness: A randomised controlled trial

Background Multiple early hospital cohorts of coronavirus disease 2019 (COVID-19) showed that patients with chronic respiratory disease were significantly under-represented. We hypothesised that the widespread use of inhaled glucocorticoids was responsible for this finding and tested if inhaled glucorticoids would be an effective treatment for early COVID-19 illness.

Methods We conducted a randomised, open label trial of inhaled budesonide, compared to usual care, in adults within 7 days of the onset of mild Covid-19 symptoms. The primary end point was COVID-19-related urgent care visit, emergency department assessment or hospitalisation. The trial was stopped early after independent statistical review concluded that study outcome would not change with further participant enrolment.

Results 146 patients underwent randomisation. For the per protocol population (n=139), the primary outcome occurred in 10 participants and 1 participant in the usual care and budesonide arms respectively (difference in proportion 0.131, p=0.004). The number needed to treat with inhaled budesonide to reduce COVID-19 deterioration was 8. Clinical recovery was 1 day shorter in the budesonide arm compared to the usual care arm (median of 7 days versus 8 days respectively, logrank test p=0.007). Proportion of days with a fever and proportion of participants with at least 1 day of fever was lower in the budesonide arm. Fewer participants randomised to budesonide had persistent symptoms at day 14 and day 28 compared to participants receiving usual care.

Conclusion Early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery following early COVID-19 infection.

Evidence before this study The majority of interventions studied for the COVID-19 pandemic are focused on hospitalised patients. Widely available and broadly relevant interventions for mild COVID-19 are urgently needed.

Added value of this study In this open label randomised controlled trial, inhaled budesonide, when given to adults with early COVID-19 illness, reduces the likelihood of requiring urgent care, emergency department consultation or hospitalisation. There was also a quicker resolution of fever, a known poor prognostic marker in COVID-19 and a faster self-reported and questionnaire reported symptom resolution. There were fewer participants with persistent COVID-19 symptoms at 14 and 28 days after budesonide therapy compared to usual care.

Implications of all the available evidence The STOIC trial potentially provides the first easily accessible effective intervention in early COVID-19. By assessing health care resource utilisation, the study provides an exciting option to help with the worldwide pressure on health care systems due to the COVID-19 pandemic. Data from this study also suggests a potentially effective treatment to prevent the long term morbidity from persistent COVID-19 symptoms.

Read here (Medrxiv, Feb 8, 2021)

Variants v Vaccines: The race between the tortoise and the hare -- Tomas Pueyo

‘The B117 variant will probably take over between February and March in most developed countries. That’s without taking into account the Brazilian and South African variants. Emerging countries are in an even worse position: Not only will they have the 3 variants. They will also receive vaccines much later. And in the Southern hemisphere, they’re now enjoying summer. Winter, with more variants and not enough vaccines, might be less forgiving.

‘So keep tight for a few more months. Don’t let your guard down. The end of the tunnel is near. Get a vaccine if you can. If not, wait till the summer. By September, we’ll likely be back to the new normal in developed countries. And in emerging ones, let’s hope more vaccines and a fast rollout avoids a repeat of 2020.’ 

Read here (substack.com, Feb 8, 2021)

Growing number of Covid-19 patients dying at home [in Malaysia]

‘In the first week of this month, 10 Covid-19 patients have died before they could receive treatment at a hospital. The youngest to suffer such a fate this month is an 18-year-old girl who was brought in dead at the Selayang Hospital, Selangor. Her infection was compounded by asthma. Her death was reported by the Health Ministry in its daily statistics yesterday.

‘According to Malaysiakini’s tracking, 22 people infected with Covid-19 were brought in dead in December last year. Another 41 people were brought in dead in January this year. That means since December last year, 73 out of the 512 recorded fatalities were brought in dead, slightly above 14 percent.’

Read here (Malaysiakini, Feb 8, 2021) 

Equity in vaccination: A plan to work with communities of colour toward Covid-19 recovery and beyond -- Introduction

‘The coronavirus disease 2019 (COVID-19) pandemic has had tragic and disproportionate adverse effects on Black, Indigenous, and People of Color (BIPOC) communities across the United States. The number of cases, hospitalizations, and deaths related to this disease is significantly higher in these groups. Additionally, members of BIPOC communities are among those hit the hardest by the economic and social upheavals caused by the pandemic.

‘As the COVID-19 vaccination campaign begins, it is critical that vaccines be delivered fairly and equitably—so that everyone has the same level of access to this lifesaving technology. Just as pressing is the need to address longstanding disparities that have created the unequal situation that BIPOC communities are now in.

‘This plan provides elected and appointed officials with the tools to create, implement, and support a vaccination campaign that works with BIPOC communities to remedy COVID-19 impacts, prevent even more health burdens, lay the foundation for unbiased healthcare delivery, and enable broader social change and durable community-level opportunities.

‘The 5 key principles and their associated action items in the plan are:

‘Iteration: Repeated engagement with BIPOC communities is necessary. There is a race to get as many people vaccinated as soon as possible, and this urgency must be balanced with the need to build real trust in BIPOC communities. In many areas, this trust is low or nonexistent, which means that building trust will take time. It will require committing to engaging with BIPOC communities, including organizing productive “listen-and-plan” sessions in which community members have the opportunity to explain their thoughts on COVID-19 vaccination and where officials have the opportunity to listen and hear what is being said, and in partnership, put these ideas into action.

 ‘Involvement: Moving forward, BIPOC community representatives and advocates must become active collaborators in the public health process. This will involve implementing mechanisms for 2-way communication (particularly with trusted leaders, influencers, and pillar institutions in local BIPOC communities) and engaging with these key representatives as partners, not as audiences to persuade or subordinates to command. One way this can be done is by encouraging BIPOC individuals and community organizers to actively participate in the COVID-19 vaccination campaign in ways that respect their self-determination and strengthen their self-reliance. A longer-term approach is to ensure BIPOC individuals are in positions of power in government and public health.

 ‘Information: Effective communication with BIPOC community members is essential in the ongoing COVID-19 vaccination effort. Applying best practices for communication during this time will be useful for moving forward. As a starting point, it is important to recognize that vaccination messages must be tailored to address the specific concerns of local BIPOC communities. This can be done in one of the following ways (or through a combination of these approaches): identify and support trusted BIPOC individuals and organizations who can relay information and help set community norms related to COVID-19 vaccination, apply learning from “listen-and-plan” sessions to frame COVID-19 vaccination in the communities’ own terms, and enlist allies to blanket BIPOC communities with accurate information that can drown out misinformation.

 ‘Investment: All of the efforts described above will require investments of time, attention, and funding. At the same time, the vaccination process itself can be viewed as an opportunity for economic revitalization, with the potential to lead communities out of the pandemic and its economic hardships. This type of revitalization is particularly important to BIPOC communities that historically, and presently, are often economically challenged. Practical suggestions for investment include: pull together the necessary resources to ensure COVID-19 vaccination is equitable (meaning, easily available to the most marginalized individuals in the community) and then fight to keep these resources in place moving forward; creatively finance nonprofit and for-profit entities with BIPOC community roots to strengthen the vaccination enterprise; and enlist the help of private capital to support vaccination, for example, by getting transportation companies to commit to providing free rides to and from vaccination sites or by having a local grocery store sponsor a “get vaccinated” poster contest for schoolchildren.

 ‘Integration: Looking forward to the end of the pandemic, it is important to recognize that recovery will take time. COVID-19 will have long-lasting physical, psychological, and financial effects, especially in BIPOC communities. Because of this, the COVID-19 vaccination campaign cannot be viewed as a final step in returning to “normalcy.” Instead, it needs to be seen as a step toward a more complete recovery that can, and should, include meaningful social change. This can take place as the recommendations outlined above—including “listen-and-plan” sessions, empowering BIPOC individuals and communities, and investing in equitable public health—are integrated into ongoing community initiatives and as government and public health officials commit to ensuring durable social change and community benefits that include adequate housing, food security, living wages, and leadership opportunities.

‘This approach will be challenging. Some may argue that a lack of time or funding or interest are barriers that make such an approach unrealistic, especially in the middle of a pandemic that is challenging on every front. However, it is important to keep in mind that challenges like the one we are currently facing often stem from social inequity and provide opportunities to change and improve. Some actions may be more appropriate to prioritize in the near term, but many actions that are crucial for the long term will have more of an overall impact if those efforts are initiated now.

‘COVID-19 vaccination is the most likely way out of the current pandemic. It is also an opening to create equity and durable benefits for BIPOC communities, who have been devalued and too often cut out of opportunities in the United States. We hope that you consider this and the specific recommendations made in this report as you begin to implement COVID-19 vaccination campaigns in your own towns, cities, and states.’

Download PDF here (John Hopkins Center for Health Security, Feb 09, 2021) 

Israel is the world’s most vaccinated country. Why are cases rising?

‘Rahav [Galia Rahav, the head of the infectious-disease unit at Tel Aviv’s Sheba Medical Center] attributes the soaring rate of infection in the general population to the weariness of Israelis — on their third or fourth lockdown, depending on how you count — with having their children at home, restrictions limiting them to 1,000 yards from their homes, and of the “politicization” of the ever-shifting rules of confinement.

‘Like many other countries, Israel launched its vaccination campaign with the two most vulnerable sectors: frontline medical workers and citizens over the age of 65. In January, as jubilant grandparents and ambulance drivers got vaccinated, and slowly stopped falling ill, younger and less cautious Israelis flouted caution — turning themselves into spreaders just as the highly infectious British mutation of the virus wafted into the country.’

Read here (New York magazine, Feb 7, 2021)

MCO 2.0 should have been tool of last resort, says ex-deputy defence minister Liew Chin Tong

‘The current movement control order (MCO) would not have to be implemented if the Health Ministry (MOH) had properly conducted Covid-19 tracing and screening as far back as April last year, according to deputy defence minister Liew Chin Tong. The DAP senator said a whole-of-government approach from the start, rather than one that placed the burden solely on the MOH, would have prevented the current high number of infections in the country.

“To put it into context, it doesn’t inspire confidence if halfway into a war, the army general (in this case, the Health DG) complained to the media that the air force (the other health institutions/labs) has forgotten to provide for air cover,” Liew said on his Facebook page today. He was referring to Health director-general Tan Sri Dr Noor Hisham Abdullah’s recent statement that MOH labs have nearly reached their maximum capacity of 76,000 Covid-19 tests daily, even as there is a need to increase screening to between 150,000 to 200,000 tests daily.

“Dr Noor Hisham lamented that so far the testing capacity at university hospitals was at 27 per cent, private laboratories (31 per cent) and laboratories in the Malaysian Armed Forces hospitals (24 per cent). These facilities are underutilised and could increase their capacity up to 100 per cent to achieve the daily test target.’

Read here (Malay Mail, Feb 7, 2021)

Vaccine strategy needs rethink after resistant variants emerge, say scientists

‘Leading vaccine scientists are calling for a rethink of the goals of vaccination programmes, saying that herd immunity through vaccination is unlikely to be possible because of the emergence of variants like that in South Africa. The comments came as the University of Oxford and AstraZeneca acknowledged that their vaccine will not protect people against mild to moderate Covid illness caused by the South African variant. The Oxford vaccine is the mainstay of the UK’s immunisation programme and vitally important around the world because of its low cost and ease of use.

‘The findings came from a study involving more than 2,000 people in South Africa. They followed results from two vaccines, from Novavax and Janssen, which were trialled there in recent months and were found to have much reduced protection against the variant – at about 60%. Pfizer/BioNTech and Moderna have also said the variant affects the efficacy of their vaccines, although on the basis of lab studies only.

‘All the vaccines, however, have been found to protect against the most severe disease, hospitalisation and death.’

Read here (The Guardian, Feb 7, 2021)

Fighting vaccine hesitancy with information, trust

‘It appears that vaccine hesitancy is due to lack of information and trust. Despite the government's assurances about Covid-19 vaccines, which include repeated television announcements by Special Adviser to the Prime Minister on Public Health Tan Sri Dr Jemilah Mahmood, many people are still hesitant to get inoculated, with some cynically telling their friends and relatives: "It's not that I don't trust the vaccines, but let's wait and see what happens to the people who will get their shots first."

‘Since efforts to build trust in public institutions, such as the Health Ministry, have been made, we need more sound bites, including building a more credible perception of the vaccines' safety and effectiveness. Hence it is good to ensure that politicians from both sides of the divide, officials and prominent figures, are among the first to be vaccinated. Leading by example, the prime minister would be among the first to be immunised when the National Immunisation Plan gets underway by the end of this month.

‘The authorities must boost public awareness of vaccine development and production, as well as their importance during a pandemic, and at the same, debunk myths. They must explain that the vaccines will not make the virus disappear since it is already too wide spread. They should also tell the public that the vaccines could prevent its spread and reduce its severity.’

Read here (New Straits Times, Feb 7, 2021) 

Approve Ivermectin as Plan B for vaccination

‘On Jan 22, it was announced that the Ministry of Health (MOH) would be conducting clinical trials for two medicines, Ivermectin and Favipiravi, to determine their efficacy in treating Covid-19. Health Director-General Tan Sri Dr Noor Hisham Abdullah has acknowledged that Ivermectin "is cheap, easily available and safe for use." But in Malaysia, it is only licensed for use in animals...

‘In view of the worsening case on Covid-19 infections in our country, many unanswered questions and lack of data on the long term safety aspects of the Pfizer experimental mRNA vaccine (which our country has already been ordered) and the current production problems faced by vaccine manufacturers overseas (with the possibility of delays), the government here should have a "PLAN B".

‘It should quickly approve Ivermectin to provide a safe, cheap and effective "weapon" against Covid-19. The clinical trials by MOH on the efficacy of Ivermectin can continue but we should not need to wait (and let many more people suffer and die from Covid-19 in the meantime) since Ivermectin has ALREADY been PROVEN to be VERY SAFE over the last 30 years or so.

‘What have we got to lose by approving Ivermectin today in Malaysia as an option for doctors to prescribe against Covid-19?’

Read here (New Straits Times, Feb 7, 2021)

Lancet editor says inequality and Covid-19 have converged to create a ‘syndemic’

‘In his new book "The COVID-19 Catastrophe: What's Gone Wrong and How to Stop It Happening Again," Dr. Richard Horton does more than trace the history of the COVID-19 pandemic and explain how we should listen to scientific experts in confronting this global scourge.

‘He does this, of course, but Horton is more ambitious than that. As editor-in-chief of "The Lancet" — one of the world's oldest, most famous and most prestigious medical journals — Horton has overseen the publication of countless articles on a variety of medical subjects. Hence, one can sense in his book a desire to apply the full breadth of his knowledge and experience to this problem. His conclusion is both fascinating and extremely relevant, even urgent.

‘As Horton explains, the COVID-19 pandemic was unnecessarily worsened by deeper social problems, from economic policies that left millions upon millions of people especially vulnerable to Western governments who made political assumptions about the virus that proved to be gravely mistaken. Speaking with Salon, Horton discussed everything from President Donald Trump's failure to address the pandemic (as well as President Joe Biden's early successes) to an intriguing thought experiment on what would have happened if the governments the world could have simply paid people to stay home.’

Read here (Salon, Feb 6, 2021)

Covid-19 - Improve management of mild cases, close contacts: MMA

‘Improvements are urgently needed in the Health Ministry's handling of mild cases of Covid-19 (category 1 and 2) and their close contacts to eliminate confusion and prevent possible flouting of the home quarantine SOPs which can lead to an increase in community transmissions. The Malaysian Medical Association (MMA) once again urges the Health Ministry to revert to its earlier policy of testing all close contacts. The Health Ministry's current policy is to only test symptomatic close contacts.

‘In its preventive measures, only isolating them will not be sufficient. The health status of all close contacts should be established early or there can be a risk of infections spreading among family members in the household and into the community if they breach the quarantine. Screening close contacts will also improve management of early symptoms of Covid-19.

‘MMA had earlier proposed that the government consider roping in the private sector doctors to test close contacts if it is faced with a shortage in manpower.’

Read here (Malaysiakini, Feb 6, 2021)

Pfizer withdraws vaccine application in India [after failing to present needed information to experts]

‘Pfizer Inc says it has withdrawn its application for emergency use of its COVID-19 vaccine in India. The company said Friday that it participated in a meeting of experts of the drug regulator on Feb. 3. Based on the deliberation of that meeting and “our understanding of additional information that the regulator may need, the company has decided to withdraw its application at this time,” it said in a statement.

‘The company was the first to approach the Indian regulator in December for its messenger RNA vaccine that it has developed with Germany’s BioNTech. They were closely followed by applications for two other vaccines --- a version of the AstraZeneca made by Serum Institute of India and another by Indian company Bharat Biotech -- which eventually got the nod for emergency use on Jan. 3. However, India’s Health Ministry has said that Pfizer hadn’t made its presentation to experts who needed to clear the vaccine, before the regulator could green-light its use in India.’

Read here (The Independent, Feb 6, 2021)

Explainer: How ministry decides between RT-PCR and RTK to test for Covid-19

‘Health Ministry experts have explained their rationale for choosing between RT-PCR tests and antigen-based rapid test kits (RTK-Ag) for detecting Covid-19 cases.

‘The RT-PCR is more accurate but takes longer to process, and is preferred for confirming Covid-19 infections. It can be used for mass testing using the “pool testing” method but only where virus prevalence was low.

‘The RTK-Ag is useful as a mass screening tool due to its far shorter turnaround time. Even with lower accuracy, it can be used as a confirmatory test if a patient has a high probability of being infected.’

Read here (Malaysiakini,  Feb 6, 2021)

Covid-19 and the convergence of nations

‘Few, if any [government], have set out recovery strategies that include the goal to reduce inequalities as part of future pandemic preparedness. Yet an essential truth of this emergency is that stronger security depends on fairer societies. But that is not the whole story...

‘In a working paper published last week by the US National Bureau of Economic Research, the Nobel economist Angus Deaton concludes that, at least in terms of global income, inequalities have decreased. He claims that the views of several respected authorities, ranging from fellow Nobel laureate Joseph Stiglitz to the UN Development Programme, are plain wrong. His argument is that high-income nations have suffered higher rates of mortality than low-income and middle-income countries. These higher mortality rates have translated into larger falls in wealth. This is an important observation...

‘The reality is that health and prosperity go hand-in-hand. During this pandemic, the smaller the number of deaths, the larger the income of a nation. The result has been that incomes per person in wealthier countries have fallen more than those in low-income countries. International income inequalities have therefore decreased. Nations have converged, not diverged. As Deaton notes, the pandemic “has brought countries closer together, not further apart”.

Read here (The Lancet, Feb 6, 2021)

Experimental cancer drug could help hospitalised coronavirus patients recover within five days, Israeli trial claims

‘An experimental cancer drug could help hospitalised coronavirus recover quicker, researchers believe. Israeli academics today claimed 29 of 30 patients with moderate to severe case of Covid treated with EXO-CD24 made a full recovery within five days. 

‘Further human trials are now needed to prove that the inhaled drug - designed as a medication to fight ovarian cancer - actually works. The study did not compare the drug to a placebo, meaning scientists cannot say for certain that the medicine was behind the patients' speedy recovery.’

Read here (The Mail Online, Feb 5, 2021)

More Covid vaccine choices mean new equity challenges

‘More questions about priority are likely as the distribution effort matures, says Julie Swann, a vaccine supply chain expert at North Carolina State University. Soon, there should be more than three vaccines—shots from AstraZeneca and Novavax are likely next—and each will come with pros and cons. Even if shots are eventually targeted for one group or another, transparency will be key, she notes. “You can tell people that one is less effective but you wouldn’t have to come back, and the other is more effective but you need a second dose,” she says. Some people may have preferences between one or the other. Maybe some will seek out a different shot elsewhere. Maybe some will wait. But most, she hopes, will see little choice in the range of good options. In the middle of a crisis, a shot is a shot.’

Read here (Wired, Feb 5, 2021)

Vaccines are curbing Covid: Data from Israel show drop in infections

‘Close to 90% of people aged 60 and older in the country have received their first dose of Pfizer’s 2-dose vaccine so far. Now, data collected by Israel’s Ministry of Health show that there was a 41% drop in confirmed COVID-19 infections in that age group, and a 31% drop in hospitalizations from mid-January to early February. In comparison, for people aged 59 and younger — of which just more than 30% have been vaccinated — cases dropped by only 12% and hospitalizations by 5% over the same time. The figures are based on analysis of roughly a quarter of a million COVID-19 infections.’

Read here (Nature, Feb 5, 2021)

Matt Hancock orders third review on link between vitamin D and Covid

‘A third review into the link between vitamin D and Covid has been ordered by the UK health secretary as more studies suggest that having low levels of the “sunshine hormone” raises the risk of death.

‘Matt Hancock has again asked the National Institute for Health and Care Excellence (Nice), which sets NHS England clinical guidelines, and Public Health England (PHE) to “re-review” their prior appraisals, after the authorities began “encouraging” people to take vitamin D supplements rather than merely “advising” it.

‘Nice has twice said there was not sufficient causal evidence to support the use of vitamin D in high doses in hospitals to treat or prevent the respiratory illness. However, recent pilot and observational studies have suggested positive effects. A Queen Mary University of London study recently found that high-dose vitamin D supplementation significantly protects against respiratory illness.’

Read here (The Guardian, Feb 5, 2021)

It’s time to trust China’s and Russia’s vaccines

‘The fact is that no Covid-19 vaccine has been developed or released as transparently as it should have been. And while China and Russia may have botched their rollouts more than some Western companies, that doesn’t necessarily mean their vaccines are shoddy. The mounting evidence showing that the Chinese and Russian vaccines are reliable should be taken seriously, and fast, especially considering supply issues throughout the world...

‘What’s more, most big pharmaceutical companies in the West have resisted licensing their vaccines to non-Western manufacturers, and several wealthy countries are blocking a proposal by India and South Africa that the World Trade Organization temporarily suspend some intellectual property protections for Covid-19-related vaccines and treatments.

‘On the other hand, according to our latest analysis of data provided by the analytics firm Airfinity, Sinovac has already signed deals to export this year more than 350 million doses of its vaccine to 12 countries; Sinopharm, around 194 million doses to 11 countries; Sputnik V, about 400 million doses to 17 countries. All three manufacturers have stated publicly that they will have the capacity to produce up to 1 billion doses each in 2021. And all three have licensed their vaccines to local manufacturers in several countries.’

Read here (New York Times, Feb 5, 2021)

The play cure: In a clinical setting, playful activities are not distractions; they take patients deep into trauma – and out the other side...

‘Take a pen. Place it on the paper. Draw wherever you want. However you want. You know, Paul Klee said: “Drawing is like taking a line for a walk.”’ In the hospital workshop, I turn towards a patient, smile and continue: ‘So, let’s draw together. We could draw houses, and draw a path between our homes. Let’s grab paints. Turn the paper around. Upside down. If you don’t mind, I can paint your sky and you can paint mine… We can play and make…’

‘For more than 20 years, I’ve been saying these sentences, playing and making, as a clinical arts therapist, specialising in mental health, and as a lecturer and consultant using creative techniques with doctors, hospital directors, nursing managers and entrepreneurs. Guided by artists such as Louise Bourgeois and Jackson Pollock, and by Plato, I spend my days tapping into what the phenomenologist and philosopher of play Eugen Fink calls the ‘peach skin of things’. It glows.’

Two paragraphs that may interest you to read the whole story

• ‘Play, as Fink writes, unites ‘the highest desire and the deepest suffering’. For years, I worked with teenagers diagnosed with psychosis. A highlight of our work was a short surrealist play, ‘The Lost Potato Masher’, which they devised based around kitchen objects. The main roles were taken by a fridge, a cupboard, a toaster, a cooker, a table and chairs, and the lost potato masher. The text dealt with parental abandonment, despair, solitude, violence, fate and hope. In a training context, a hospital manager, in an improvisation, once acted the role of the file of a dead patient that had been thrown into a bin. Both of these examples show the cathartic effect of play, allowing us to sit with our shadows...
• ‘A recent study by the psychologists Maja Stanko-Kaczmarek and Lukasz Kaczmarek at the Adam Mickiewicz University in Poland found that the tactile sensations of finger-painting provoked a state of mindfulness connected with wellbeing. As we paint, we’re present in the moment, and we have a broader attention. This can be contrasted with the ‘mindlessness’ state, often a symptom of mental illness, characterised by past or future ruminations. The physical nature of play and making locates us in the here and now: it centres us in ourselves, mobilising an embodied cognition that’s important in skill learning. At all stages of life, Lego-making, knitting, embroidery and painting can contribute to psychological wellbeing.’

Read here (Aeon, Feb 4, 2021)

How to heal the 'mass trauma' of Covid-19

‘When the pandemic is over, how should we process the memories of what happened? Ed Prideaux discovers counter-intuitive answers from the science of trauma... 

• What happens when trauma goes viral
• How trauma affects groups and individuals
• The problem of forgetting

‘Covid-19 is a mass trauma the likes of which we've never seen before. Our most complex social extensions, and the building-blocks of our personal realities, have been coloured indelibly. The ways we live and work together, and view each other as common citizens: everything means something different in the viral era, and with potentially traumatic effect. 

‘All pandemics end, however. And this one will. But to forget the trauma, move on, and pay it no mind, won't help. It'd be a disservice to history and our own minds. Maybe to the future, too. ’

Read here (BBC, Feb 4, 2021) 

Covid-19: Social murder, they wrote — elected, unaccountable, and unrepentant

‘After two million deaths, we must have redress for mishandling the pandemic... Murder is an emotive word. In law, it requires premeditation. Death must be deemed to be unlawful. How could “murder” apply to failures of a pandemic response? Perhaps it can’t, and never will, but it is worth considering. When politicians and experts say that they are willing to allow tens of thousands of premature deaths for the sake of population immunity or in the hope of propping up the economy, is that not premeditated and reckless indifference to human life? If policy failures lead to recurrent and mistimed lockdowns, who is responsible for the resulting non-covid excess deaths? When politicians wilfully neglect scientific advice, international and historical experience, and their own alarming statistics and modelling because to act goes against their political strategy or ideology, is that lawful? Is inaction, action?1 How big an omission is not acting immediately after the World Health Organization declared a public health emergency of international concern on 30 January 2020?

‘At the very least, covid-19 might be classified as “social murder,” as recently explained by two professors of criminology. The philosopher Friedrich Engels coined the phrase when describing the political and social power held by the ruling elite over the working classes in 19th century England. His argument was that the conditions created by privileged classes inevitably led to premature and “unnatural” death among the poorest classes. In The Road to Wigan Pier, George Orwell echoed these themes in describing the life and living conditions of working class people in England’s industrial north. Today, “social murder” may describe the lack of political attention to social determinants and inequities that exacerbate the pandemic. Michael Marmot argues that as we emerge from covid-19 we must build back fairer...

Getting redress

‘Where then should citizens turn for accountability, if they don’t find it in their leaders and feel unsupported by experts and the media? The law remains one form of redress, and indeed some legal avenues, including criminal negligence and misconduct in public office, are being explored, although proving any such claims will be difficult and drawn out. But the notion of murder, at least “social murder,” is hard to shake emotionally, and strengthens with every denial of responsibility and every refusal to be held accountable or to change course.

‘That leaves three options. The first is to push for a public inquiry, as The BMJ and others argued for in the summer of 2020—a rapid, forward looking review rather than an exercise in apportioning blame that will identify lessons and save lives. The second is to vote out elected leaders and governments that avoid accountability and remain unrepentant. The US showed that a political reckoning is possible, and perhaps a legal one can follow, although research suggests that mishandling a pandemic may not lose votes.21 The third is for mechanisms of global governance, such as the International Criminal Court, to be broadened to cover state failings in pandemics...

‘The “social murder” of populations is more than a relic of a bygone age. It is very real today, exposed and magnified by covid-19. It cannot be ignored or spun away. Politicians must be held to account by legal and electoral means, indeed by any national and international constitutional means necessary. State failures that led us to two million deaths are “actions” and “inactions” that should shame us all.’

Read here (British Medical Journal, Feb 4, 2021)