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

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

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

Read here (Citizen Truth, March 24, 2020)

Yuval Noah Harari: The world after coronavirus

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

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

Read here (Financial Times, Mar 20, 2020) 

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

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

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

Read here (Fortune, March 19, 2020)

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

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

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

Read here (Medium, updated March 19, 2020)

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

Moving online now: How to keep teaching during coronavirus

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

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

Coronavirus will change the world permanently. Here’s how

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

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

Read here (Politico, March 19, 2020)

Video on dynamics of pandemics

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

View here

Six effective traditional Chinese medicines for Covid-19

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

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

Read here (China Daily, Mar 17, 2020) 

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

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

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

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

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

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

Read here (The Lancet, March 17, 2020)

Malaysian Health Coalition urges the government to act decisively, firmly

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

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

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

ISIS Focus: The race against a raging virus

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

Read here (ISIS Malaysia, March 2020)

Penang Monthly focuses on Covid-19

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

Read here (Penang Monthly, March 2020)

Hard choices for the Covid-19 outbreak

Dr Amar Singh outlines three choices before us:

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

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

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

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

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

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

Read here (IDSA, March 11, 2020)

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

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

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

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

Read here (Foreign Affairs, March 7, 2020)

Covid-19: The gendered impacts of the outbreak

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

Read here (The Lancet, March 6, 2020)

‘Rethink healthcare for migrant workers’

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

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

Read here (The Star, Mar 3, 2020)

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

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

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

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

Read here (JamaNetwork, March 3, 2020)

Read related article in Stanford.edu here

Pandemic rules and the law: Shad Saleem Faruqi

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

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

Read here (The Star, March 26, 2020)

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

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

Read here (The Lancet, Feb 26, 2020)

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

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

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

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

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

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

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

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

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

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

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

Read here (Nature, November 19, 2019)

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

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

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

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

The new astrology: By fetishising mathematical models, economists turned economics into a highly paid pseudoscience

‘Nonetheless, surveys indicate that economists see their discipline as ‘the most scientific of the social sciences’. What is the basis of this collective faith, shared by universities, presidents and billionaires? Shouldn’t successful and powerful people be the first to spot the exaggerated worth of a discipline, and the least likely to pay for it?

‘In the hypothetical worlds of rational markets, where much of economic theory is set, perhaps. But real-world history tells a different story, of mathematical models masquerading as science and a public eager to buy them, mistaking elegant equations for empirical accuracy.’

[Note: This is an old article published April 4, 2016. We should read this in the context of the epidemiological modelling being used now to forecast Covid-19.]

Read here (Aeon, April 4, 2016)

The Thucydides Trap: Are the US and China headed for war? (written in 2015)

‘But if anyone’s forecasts are worth heeding, it’s those of Lee Kuan Yew, the world’s premier China watcher and a mentor to Chinese leaders since Deng Xiaoping. Before his death in March, the founder of Singapore put the odds of China continuing to grow at several times U.S. rates for the next decade and beyond as “four chances in five.” On whether China’s leaders are serious about displacing the United States as the top power in Asia in the foreseeable future, Lee answered directly: “Of course. Why not … how could they not aspire to be number one in Asia and in time the world?” And about accepting its place in an international order designed and led by America, he said absolutely not: “China wants to be China and accepted as such—not as an honorary member of the West.’

Read here (The Atlantic, Sept 24, 2015)

Case for wearing face masks (1): People who wore masks during the SARS outbreak had a 70% lower risk of being diagnosed compared with those who never wore masks

‘We also used this investigation to quantify the impact of behaviours (i.e. mask wearing, handwashing) that were promoted to reduce the risk for SARS. Wearing masks outside the home in a reference period corresponding to the 2 weeks before symptom onset for cases was significantly protective against clinical SARS.

‘Supporting the validity of this finding, there was a dose-response effect: by multivariable analysis, persons who always wore masks had a 70% lower risk of being diagnosed with clinical SARS compared with those who never wore masks, and persons with intermittent mask use had a 60% lower risk.’

Read here (NIH, 2004)