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docmary · 3 years

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The politics of a pandemic, how not to manage coronavirus

No man is an island, Entire of itself, Every man is a piece of the continent, A part of the main. If a clod be washed away by the sea, Europe is the less. As well as if a promontory were. As well as if a manor of thy friend's Or of thine own were: Any man's death diminishes me,

Because I am involved in mankind, And therefore never send to know for whom the bell tolls.

It tolls for thee.

John Donne

1624

The poet John Donne warned of the dangers of isolation and imagining oneself as self-sufficient, without need of community. It was true 500 years ago; it still holds true today. No man is an island…every man is a part of the main. As wave upon wave of SARS-CoV-2 reached every continent, even Antarctica, most of us have tried to isolate ourselves on this crowded planet - with mixed results.

As of May 30, 2021, by every metric, the United States was leading the world in the number of cases and deaths from COVD-19. Brazil and India are catching up quickly. In the US, the underlying tension between public health and personal liberty has had disastrous consequences. As successful as the vaccine roll-out has been, and even with the numbers of new cases, hospitalizations, and deaths dropping, this is no time to be complacent.

India, with a population of over 1 billion, and Brazil, a pariah among countries in Latin America for its poor response to the pandemic, cause or should cause great concern to everyone everywhere. Not having the resources of rich countries, they will require help to manage the tragic situation their leaders have put their populations in and it is in our interest to do so because...the bell tolls for thee.

India

When the World Health Organization (WHO) declared COVID-19 a global pandemic in March 2020, there had been 330,000 cases and 30,000 deaths from SARS-CoV-2 reported worldwide. In the early days of the pandemic, India was considered a model of how to manage the worst public health crisis in recent memory. India responded with a strict lockdown. International flights and exports of masks, ventilators, and certain medicines were banned. As a result, India did not see the same initial explosion in new cases and deaths compared to other countries.

Three months later, India’s Prime Minister Narendra Modi began easing lockdown restrictions - like the American football player who does the end-zone dance on the two-yard line—not a good idea. When the lockdown lifted, many Indians stopped taking precautions. Mr. Modi allowed large gatherings, including campaigns in state elections that he attended, without wearing a mask, at rallies of thousands of mask-less supporters, to help his governing Bharatiya Janata party. Large religious festivals resumed drawing millions of people as well. By July 2020, India had seen 600,000 cases and 17,834 deaths due to COVID. An editorial from The Lancet, said that Mr. Modi “seemed more intent on removing criticism” on social media than “trying to control the pandemic.” Sound familiar?

As recently as March 2021, India’s health minister assured the public that they had reached the pandemic’s “endgame”.

The New York Times reported in May 2021 that India was responsible for more than half of the world’s daily COVID cases, setting a record-breaking pace of 400,000 new cases in one day. Researchers believe the B.1.1.7 variant and the delta variant, which are also major variants in Britain and the US, are to blame for the surge. Clinics across India report desperate shortages of hospital beds, protective equipment, and oxygen.[1]

Just to add to the global disaster, India is one of the world’s leading vaccine manufacturers. It is struggling to inoculate its own citizens; less than 10% of Indians have gotten even one dose.[2] In September 2020, Serum Institute of India (SII) received $150 million from the Bill and Melinda Gates foundation to accelerate production of Oxford University’s AstraZenica (AZ) vaccine and the American vaccine Novavax as soon as the WHO granted regulatory approval. Under the original terms of the agreement, 50% of vaccines would be earmarked for India and the remainder would go to other low- and middle-income countries.[3]Currently, exports of vaccines from India have been shut down.

Brazil

In an editorial from The Lancet, dated May 9, 2020, the president of Brazil, Jair Bolsanoro, was criticized for allowing the SARS-CoV-2 virus to spread widely while presenting himself as a “messiah” touting unproven medicines like hydroxychloroquine, with support from his rightwing allies.

At the time, Brazil had the most cases (105,000) and deaths (72,88) in Latin America. Estimates suggest the death rate was doubling every five days. When asked by a reporter about the rapidly increasing numbers of COVID-19 cases, Mr. Bolsanaro responded: “So what? What do you want me to do?”[4]

In March 2021, Brazil’s pandemic spiraled out of control. Its Latin American neighbors grounded flights, closed land borders, and regional sports events were canceled in attempts to stop the P.1 variant (and approximately 90 other variants) from spreading to their populations.

The British Medical Journal reported that 400,000 Brazilians have died from COVID-19—13% of deaths worldwide.[5] Some models predict the death toll in Brazil will reach half a million this month. That trajectory could be an indicator for what is to come for its neighbors. As Paraguay’s director of health surveillance, Guillermo Sequera, has said: “When Brazil sneezes, Paraguay gets a cold.”[6]

COVAX

With a fast-moving pandemic, no one is safe, unless everyone is safe.

author unknown. Retrieved from: https://www.who.int/initiatives/act-accelerator/covax

COVAX is an initiative dedicated to equitable access to a vaccine, particularly to healthcare workers and those most at risk. To date (5/31/2021), COVAX has shipped more than 77 million COVID-19 vaccines to 127 participants. It is co-led by[7]:

CEPI-Coalition for Epidemic Preparedness Innovations. The governing board has 12 voting members; four investors and eight independent members with competencies in industry, global health, science, resource mobilization, and finance—and five observers (17 total). Financial support comes from public sources including US Agency for International Development (USAID).

Gavi, the Vaccine Alliance-a public/private partnership which has helped to vaccinate 760 million children in the world’s poorest countries.[8] It ensures that infrastructure is in place and technical support is available to make sure that COVID-19 vaccines can be safely delivered to support the participation of 92 lower-middle and lower-income economies. It is part of the health systems work of Access to COVID-19 Tools (ACT) Accelerator effort, focusing on areas where it has expertise and experience, such as keeping vaccines at the correct temperature.

World Health Organization (WHO)

United Nations International Children’s Emergency Fund (UNICEF)

COVAX hopes to get 280 million doses of vaccines to Latin America but has been hit with delays to eight manufacturers (including SII) it has deals with and does not expect to deliver them until the end of 2021.[8]This has led South American nations to look to China’s Coronavac and Russia’s Sputnik V vaccine supplies. One study found that Coronovac was only 50% effective after a single dose. The Biden administration has pledged to purchase 500 million doses of Pfizer BioNTech vaccine to give to COVAX; the first 200 million doses will be distributed this year, with the subsequent 300 million in the first half of next year.[10]

My Take

In what can only be called being one step ahead of the game, armed robbers in Hong Kong stole $16,000 worth of toilet paper as coronavirus sparked panic-buying of essential goods a month before WHO declared a global pandemic in March 2020.[11] (Good times)

In July 2020, President Trump formally notified Congress and the United Nations that the US was withdrawing from WHO because of course he did.

Several articles, including one from the Journal of the American Medical Association (JAMA)[12] have compared weekly deaths in the US that would be expected from historical trends with COVID and non-COVID deaths from March 2020 until January 2021. There was an increase of 22.9% of all-cause mortality. This far exceeds expectations. Excess deaths attributed to non-COVID causes could be the result of deaths that were, in fact, COVID but misclassified. They might also be due to delayed care, an overwhelmed healthcare system, or behavioral health crises. On the other side of the ledger, no doubt at least some of the deaths that would have been anticipated from non-COVID causes might have died from the coronavirus instead. Which is to say, these are at best estimates of the mortality rates. During surges in various parts of the US, deaths from several non-COVID diseases like heart disease and Alzheimer’s increased. Either way, the excess deaths could have been helped with a better response to the pandemic early on.[13]

For those “give me liberty, or give me death” fans, do I really need to point out that Patrick Henry was referring to his own death, not the deaths of millions all over the world? My parents’ generation made many sacrifices during WWII, including blood and treasure, and considered it worth the price to defeat Hitler. Wearing a mask to defeat a virus? Really? Who have we become?

It comes as a surprise to no one that the countries with the largest death tolls to date, the US, India, and Brazil, are also countries in which partisan politics was the priority over public health measures. It isn’t a good idea. Why don’t we just stop?

[1] What to know about India’s coronavirus crisis. What is behind the explosion of new coronavirus cases that is overwhelming the South Asian country? NY Times, May 25, 2021. Retrieved from: https://www.nytimes.com/article/india-coronavirus-cases-deaths.html

[2] ibid

[3]Raghavan, P. 2020. $150 million dollar shot for serum production of COVID vaccine, India Express.

[4]Lancet editorial. September 19, 2020. COVID-19 in Brazil: “So what?”, Lancet, 395: 1461. doi: 10.1016/s0140-6736(20)31095-3

[5]Taylor, L. 5/20/2021. COVID-19: How the Brazilian variant took hold of South America, BMJ 2021, 373: n1277. doi: 10.1136/bmj.n1277

[6]ibid

[7]World Health Organization: COVAX Working for global equitable access to COVID-19 vaccines. Retrieved from: https://www.who.int/initiatives/act-accelerator/covax

[8]Raghavan. Op cit.

[9]Taylor. Op cit.

[10] Page, T, Rauhala, E. Jun 9, 2021. Biden administration to buy 500 million Pfizer coronavirus vaccine doses to donate to the world, Washington Post, retrieved from: https://www.washingtonpost.com/politics/biden-vaccine-donate/2021/06/09/c2744674-c934-11eb-93fa-9053a95eb9f2_story.html

[11]www.thinkglobalhealth.org/article1

[12]Woolf, SH, Chapman, DH, Sabo, RT, Zimmerman, EB. May 4,2021.Excess deaths from COVID-19 and other causes in the US, March 1 2020, to January 2, 2021,JAMA, 325(17): 1786-1789. doi: 10.1001/jama.2021.5199

[13]ibid

#COVID-19 #Brazil #India #COVAX #vaccine #AstraZeneca #PfizerBioNTech

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