Posts Tagged ‘coronavirus’

Whether for Haiti cholera, Ebola or the coronavirus, the WHO leadership failed

April 9, 2020

The WHO has many skilled, dedicated and hard working staff.

But the WHO leadership and the organisation are not fit for purpose.

After the Haiti earthquake it was poorly screened UN troops who took cholera into Haiti in 2010. But the UN and the WHO leadership were more concerned with appearing politically correct and with CYA than anything else.

NY Times (Dec 2016):

After six years and 10,000 deaths, the United Nations issued a carefully worded public apology on Thursday for its role in the 2010 cholera outbreak in Haiti and the widespread suffering it has caused since then.

The mea culpa, which Secretary General Ban Ki-moon delivered before the General Assembly, avoided any mention of who brought cholera to Haiti, even though the disease was not present in the country until United Nations peacekeepers arrived from Nepal, where an outbreak was underway. ……

One of the reasons the disease spread so widely, public health experts have said, is because it was allowed to; had there been a vigorous response in the first couple of years, it would have been far easier to contain, and fewer people would have died. The death toll stands at an estimated 10,000; some say it could be higher. ………

The WHO knew about the outbreak and the causes but was incapable of taking any actions which might have political implications.

The WHO was even worse with their “egregious failure” after the Ebola outbreak of 2013.

Reuters (Nov 2015):

The World Health Organization’s failure to sound the alarm until months into West Africa’s Ebola outbreak was an “egregious failure” which added to the enormous suffering and death toll, ……

The Ebola epidemic has killed at least 11,300 people in Guinea, Sierra Leone and Liberia since it began in December 2013. The crisis brought already weak health services to their knees and caused social and economic havoc.

“The most egregious failure was by WHO in the delay in sounding the alarm,” said Ashish K. Jha, HGHI’s director and a leading member of the panel. “People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring, and yet it took until August to declare a public health emergency.” …..

And now with the coronavirus outbreak, the WHO leadership has failed again. Instead of preparing for a pandemic it has wasted time on the imaginary threats of climate change, on placating China and playing nice with celebrities.

There are three charges against WHO. First, it failed to prepare the world for a pandemic, spending the years since the Sars and ebola alarms talking more about climate change, obesity and tobacco, while others, including the Wellcome Trust and the Gates foundation, actually set up a coalition for epidemic preparedness innovation, and countries like Singapore and South Korea put in place measures to cope with an outbreak like SARS in the future.

Second, once the epidemic began in China, WHO downplayed its significance, tweeting as late as January 14 that “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus”, when it had already been warned by the Taiwanese health authorities among others of strong evidence for medical staff in Wuhan becoming ill.

The Chinese government at this stage had known for weeks that the virus was spreading, probably person to person, yet WHO then sycophantically praised the Chinese government. “China is actually setting a new standard for outbreak response,” said WHO’s director-general, Tedros Adhanom Ghebreyesus, a former foreign minister of Ethiopia, a country run by a repressive regime heavily dependent on China. “China is really good at keeping people alive,” echoed the assistant director-general, Bruce Aylward, on 3 March.

On 29 March, a Hong Kong-based journalist asked Aylward to comment on Taiwan’s highly-successful efforts to defeat the virus. At first Aylward ignored the question, claiming not to have heard it. When the journalist offered to repeat it, strangely he said no, he would rather move on to another question. When she pressed, the call was mysteriously cut off. When the journalist called back and asked the question again, he answered a different question, talking about China, rather than Taiwan. The background here is that China is a big funder of WHO and insists that Taiwan be excluded from the organisation since it does not recognise Taiwan’s existence as a separate country. Taiwan banned travel from China very early in the pandemic.

The third charge against WHO is that it has failed before. When the ebola outbreak in West Africa that was to kill 11,000 people began in late 2013, on its own admission WHO hindered the fight against the virus, obsessed with not letting others find out what was happening. In April 2014, the charity Medecins Sans Frontieres announced that the outbreak was out of control. They were promptly slapped down by a WHO spokesman. Others tried again in June to alert WHO. It was not until August that WHO admitted the gravity of the situation.

Later WHO admitted its “initial response was slow and insufficient, we were not aggressive in alerting the world, our surge capacity was limited, we did not work effectively in coordination with other partners, there were shortcomings in risk communication.”

All of which is true again today.

The first case was in November 2019. By December the Chinese authorities knew but were suppressing the news. By end December Taiwan and others had warned the WHO about the outbreak. The pandemic was declared on 12th March 2020. The WHO will not live down this now infamous tweet on January 14th.

The Japanese Deputy Prime Minister recently suggested that the WHO change its name to the China Health Organisation.

The WHO suppresses information, and releases cherry-picked information, to suit what its leadership considers politically correct. Multilateral organisations such as the WHO (and even those of the UN and the EU) do not necessarily level up. They all too often sink to the lowest common level set by what is often compounded among the  worst members.

What is striking is that the global problem of the coronovirus has to find national – not globalised – solutions.


 

Swedish coronavirus policy least successful of the Nordic countries

April 8, 2020

Much as I admire Anders Tegnell (Sweden’s Chief epidemiologist) he appeared, at today’s press conference, to be brushing aside the differences between the Nordic countries a little too lightly. I am sure the health services have done a fantastic job. But, for whatever the reason, Sweden’s policy has so far resulted in many more fatalities (actual and per capita) than in the surrounding Nordic countries. The fatality rate is almost twice that of the next nearest Nordic country (Denmark). There is most likely a lapse of policy, rather than lack of equipment or failure of care, which lies behind this reality.

The reason is probably not unconnected with the overwhelming representation of the over-70’s (88% of all deaths in Sweden) among the fatalities.  (They are not particularly over-represented in the number of cases registered). It seems as if many of these older people were a “captive and doomed” population, stuck helplessly within their care homes – not protected in time from infection by the developing policy.

 


Note for reference:

In the Nordic countries the crude mortality rate (all causes) is between 7,000  and 8,000 per million of population every year. Sweden would normally see about 70,000 -80,000 deaths every year (all causes) compared to the 687 attributed so far to covid-19.

In Italy with a population of 60 million, there would be about 450,000 deaths due to all causes every year. The deaths attributed to covid-19 are currently about 17,500.


 

Have the old been sacrificed in Sweden?

April 8, 2020

We can never know what might have been.

But the aged in their care-homes did not go out and bring in the virus. They were infected by others. As of 7th April, 7,693 cases have been registered in Sweden and 591 deaths have been attributed to the coronavirus. Of these 2,807 cases (36% of total cases) and 519  deaths (88% of all deaths) were of people over 70 years old. Just in Stockholm’s care homes, 159 deaths have been registered. The major difference in deaths per capita between Sweden and the other Nordic countries is the much higher number of deaths among the old in Sweden.

It may well be that those infected mildly and showing no symptoms have been the main carriers of the virus. In one department at a major hospital more than half of all the employees were without symptoms but were infected with Covid-19.

Of course, there is a youth obsession in Sweden. Of course, those who are labeled “retired” have a lower value. Of course, the care-homes are a place for the old to be tucked away out of sight. Of course, there is a formal perception that with a lower “expected remaining life”, the old have a lower value to society and get a lower priority for care. It could have been worse, of course.

It may not have been intentional but the numbers say that in the fight against the coronavirus, the old have been sacrificed in Sweden.

As of 7th April 2020


Related:

When healthy and young has priority over sick and old


 

Coronavirus deaths per capita paint a different picture

April 7, 2020

UPDATE!

The figures below are as of March 30th. There have been more deaths in the eight days since and the per capita fatality rates keep increasing. For example the rate in Sweden after the latest figures announced today, is almost 59 deaths per million of population compared to the 10.8 it was a week ago. Many of the deaths reported today are from earlier days which had gone previously unrecorded. So the numbers have changed though the shape of the curves has not. It would seem that many European countries are at, close to, or have just passed, a peak (hopefully the only peak).


The numbers being reported by countries as “infected” is a function of the testing strategy being followed and is not really a sound measure of the spread of the coronavirus. The number of deaths being reported as due to the coronavirus are probably a better measure though even this number is distorted by

  • political considereations (for example N Korea denies any deaths and West Bengal in India reports them as deaths by other causes),
  • overestimates due to deaths by other causes being attributed to the coronavirus, and
  • underestimates in countries where coronavirus testing is lacking or haphazard,
  • variations in quality of care in different countries.

Nevertheless, the number of deaths per million of population paints a somewhat different picture than that based on number infected.

deaths per million of population

The highest fatality rates in Europe are in Italy (178), Spain, Netherlands, France Belgium and Switzerland (35). Sweden comes in at 10.8 while Germany is an outlier in Europe with a fatality rate of only 6.5 per million. By this measure, China comes in at a very low 2.38. However there is a suggestion that China has under-reported deaths by a factor of 10 (with, in some reports from the crematoriums, just Wuhan suffering some 40,000 fatalities). If true it would take China up to a death rate in the twenties per million of population.

Japan and Indonesia have fatality rates of 0.43 per million while India currently is showing a fatality rate of 0.02 per million.

The variation across the EU countries and how they correlate with different lock-down policies will be something to study when the infection wave is over. The geographical spread, or lack of spread, will also be of great interest. I would not be surprised, at first glance, if latitude and prevailing weather has had some effect. I note also that in India, anecdotal evidence is that chloroquine has been widely used as a prophylactic.


 

Cured and discharged – a 100 day epidemic in each country

April 6, 2020

The number of those infected, hospitalised, and now cured and discharged is just beginning its steep rise.

Global data including China (Worldometers)

It seems as if Italy and Spain, after China, are showing a downturn in the number infected. Other countries, including the US, should reach their peaks in the next two or three weeks. India and Africa are more uncertain.

It does look like the global pandemic may take another 6 – 8 weeks to be on the downturn everywhere. However the epidemic in each country seems to be taking about 100 days to reach its peak.


 

Knowing what you don’t know: Ambushed by the coronavirus

April 2, 2020

Ambushed by the coronavirus, 15.5 billion km ago.

10 year old: So the earth moves around the sun and we move with it?

Dad: Yes.

10 year old: And in one hour we have moved 107,000 km along with the earth?

Dad: Yes.

10 year old: And the sun moves around the centre of the galaxy?

Dad: Yes, the sun and the entire solar system orbit the centre of the Milky Way Galaxy.

10 year old: And in one hour the sun has moved 828,000 km?

Dad: Yes.

10 year old: So in one hour I have travelled 935,000 km around the galaxy?

Dad: Yes.

10 year old: And does the galaxy move?

Dad: Yes, It is thought that the galaxy moves 2,160,000 km relative to other galaxies in an hour.

10 year old: So where did the coronavirus come from?

Dad: We don’t know.

10 year old: And it came in November last year?

Dad: Yes.

10 year old: And we have travelled 15.5 billion km since last November?

Dad: Aaaah, Yes. About that.

10 year old: So we could have been ambushed by coronaviruses lying in wait for us there?

Dad: No.

10 year old: But you don’t know where it comes from.

Dad: We don’t know where it came from, but we know it didn’t come from space.

10 year old: So you do know what you don’t know.



									

Sweden: Flattening the curve (update 1)

March 31, 2020

The time-series of new Covid-19 cases detected every day might suggest that a peak has been passed.

However, it is very difficult on the exponential growth section to be able to tell when the curve begins to flatten off. The growth of Covid-19 cases is better looked at, I think, in terms of new cases against the cumulative number of cases rather than just the traditional time-series. A caveat is that the number of positive cases depends upon the testing strategy. Nevertheless plotting the daily new cases against the cumulative cases on logarithmic scales is a better guide as to whether exponential growth is still occurring.

There are indications that the growth may just be getting off the exponential growth rate but it is not clear yet.

In any event I prefer this plot to the simple time-series.


Sweden’s voluntary lock-down may be able to flatten the curve


 

Strange: In the EU, Covid-19 deaths have not yet changed the all-causes mortality

March 29, 2020

The “European monitoring of excess mortality for public health action” (Euromomo) publishes weekly mortality statistics across 24 countries of the EU.

“Some wonder why no increased mortality is observed in the reported mortality figures for the COVID-19 affected countries”.

European mortality bulletin week 12, 2020

Pooled estimates of all-cause mortality show, overall, normal expected levels in the participating countries; however, increased excess mortality is notable in Italy.

Data from 24 participating countries or regions were included in this week’s pooled analysis of all-cause mortality in Europe.

The number of deaths in the recent weeks should be interpreted with caution as adjustments for delayed registrations may be imprecise. Furthermore, results of pooled analyses may vary depending on countries included in the weekly analyses. Pooled analyses are adjusted for variation between the included countries and for differences in the local delay in reporting.

Note concerning COVID-19 related mortality as part of the all-cause mortality figures reported by EuroMOMO

Over the past few days, the EuroMOMO hub has received many questions about the weekly all-cause mortality data and the possible contribution of any COVID-19 related mortality. Some wonder why no increased mortality is observed in the reported mortality figures for the COVID-19 affected countries.

The answer is that increased mortality that may occur primarily at subnational level or within smaller focal areas, and/or concentrated within smaller age groups, may not be detectable at the national level, even more so not in the pooled analysis at European level, given the large total population denominator. Furthermore, there is always a few weeks of delay in death registration and reporting. Hence, the EuroMOMO mortality figures for the most recent weeks must be interpreted with some caution.

Therefore, although increased mortality may not be immediately observable in the EuroMOMO figures, this does not mean that increased mortality does not occur in some areas or in some age groups, including mortality related to COVID-19.

source: Euromomo Bulletin week 12

As of now Euromomo does not have any explanation. The data does not yet show that Covid-19 has contributed any significant increase to the total, all-causes deaths which may even be showing a small decrease.

It could be that the lockdowns are preventing other more usual viral infections and other deaths from occurring.


First seen at Roy Spencer’s blog.


 

Coronavirus ethics: When healthy and young has priority over sick and old

March 29, 2020

In the last few days, the prospect of limited intensive care places and too many patients has become more real. Professors of philosophy have been sought after for their views. In Sweden, the National Board of Health and Welfare (Socialstyrelsen) has produced new guidelines so that doctors and nurses forced to make life and death choices have support for their decisions. The guiding principle is stated to be the “expected remaining lifetime” without consideration of “social standing, disabilities or actual age”. Of course this is inherently contradictory since expected remaining lifetime and actual age cannot be divorced. In their new guidelines the Board skates over this contradiction by claiming that it is “biological age” that is being considered and not “actual age”.

The guidelines define priorities for intensive care (my translation):

Priority 1: Patients who have a serious illness but are expected to survive longer than 12 months. If it becomes necessary to prioritize within this group, it must not be done based on the patient’s social situation / position,  any disabilities or the person’s actual age. It may, however, be based on what is called biological age. The latter means that the expected life expectancy is calculated using a number of factors. Those who are younger are then given priority over the older if the health status of both is otherwise equal. But conversely, a patient who is older but otherwise in good health should be given priority over a younger person who, due to illness or otherwise, is expected to live shorter.

Priority 2: Patients with one or more severe systemic disorders with significant functional limitation. These include, for example, insufficiently controlled diabetes, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol abuse, pacemaker addiction and a heart attack or stroke older than three months. This group also includes those who have an expected survival of 6-12 months.

Priority 3: Patients with an expected low probability of survival. These may be cases where the intensive care unit is normally only used to enable a renewed assessment and consultation with related persons.

Swedish television reports:

SvT:

If the corona crisis worsens, healthcare will be forced to prioritize – and patients who have had good prospects of coping may be rejected. “It can be so in an extreme situation”, says Lars Sandman, Professor of health ethics.

Health care always needs to be prioritized. But in a situation where the number of corona-infected who need intensive care is increasing dramatically, this can result in many difficult decisions. Therefore, new guidelines for priorities in health care have been developed on behalf of the National Board of Health and Welfare. “Suppose we get completely full departments with many very seriously ill people who have marginal conditions to come back to life after intensive care and then other more basically healthy people knock at the door. Then it can be a very difficult decision”, says Andreas Hvarfner, chief physician in anesthesia and intensive care at Karolinska University Hospital in Solna.

Will this mean that infected elderly patients who have severe diabetes, lung disease, pacemakers and are overweight are at risk of not receiving intensive care? “Of course, that may eventually be so” says Andreas Hvarfner.

Lars Sandman, professor of health ethics at Linköping University, has been involved in developing the new guidelines. “When faced with these difficult decisions, it is important that there is clear support and that one can lean back on ethical principles that in this case are legal and instituted by Parliament in 1997. We have tried to clarify how they should be interpreted” , he said.

If there is now a storm that many believe, will people prioritize between people who may have roughly the same conditions? “It can be so in an extreme situation. Then we have stated in the guidelines that you can choose the one that has the longest remaining life expectancy . We want to avoid getting into that situation and therefore we are working hard to get more intensive care places”. This means that young people do come ahead of the elderly if they have similar conditions to survive. According to Lars Sandman, the problem is that there are no alternatives. “You can of course imagine a queuing situation, but then you run the risk that a patient who may have less chance of survival gets the place and that two patients instead of one die in the end”.

Consider the case of two sick patients and only one intensive care place. Younger and healthier will always have a higher expected remaining life and have a higher priority. If both have the same chance of survival, the younger will always get priority. For an older person to get priority by the remaining lifetime criterion, the chance of survival will have to be much higher than for the younger person. The stipulation that social standing have no impact means that a younger, healthier, anti-social, scrounger will get a higher priority than a worthy, productive, sicker, older person.

Of course, this is oversimplified. In reality the chances of survival with intensive care have to be first judged against chances of survival without. It is unlikely that chances of survival without intensive care could both be zero in two cases which had widely different chances with intensive care.

Take:  expected remaining life = (life expectancy – actual age) x chance of survival

Let us assume a life expectancy of 90 years and a base case of a very sick 20 year old with only a 10% chance of survival. Expected remaining life would then be 10% of life remaining giving 7 years. An older person would have priority if their chance of survival was sufficient to give an expected life remaining of greater than 7 years. To get priority a 50 year old would need a chance of survival of 17.5%, a 70 year old would need 35% and and an 80 year old would need a 70% chance of survival. Anybody over 83 would never get priority – even if they had a 99% chance of survival.

Of course, it is age discrimination disguised with words (biological age) to ostensibly comply with the laws on discrimination. But the Board really has no choice.

The issue I have is not really with the Board but with the delusion that the value of humans is not connected to their social behaviour and the myth that humans are equal.


 

In Sweden there is some encouraging data, but ……..

March 28, 2020

I would expect that the really heavy load on the Swedish health care system is dominated by the number of coronavirus patients needing intensive care places. Of course any patient who needs hospitalization and isolation also raises the load. The number of tests to be carried out places a load on the labs and the health care system in general but probably not specifically on hospitals.

Maybe I am just an optimist and it is probably too early to be sure, but the daily number of cases needing intensive care has dropped over the last few days. At the time of writing there are a total of 310 Covid-19 patients in intensive care. The daily new cases for intensive care reached 43 and 42 respectively on 23rd and 24th March. However, there has been a drop in new cases since then.

Source: Swedish Intensive Care Register

The age and gender distribution of the 310 intensive care cases (as of 28th March) show a predominance of men and over 50% between the ages of 50 and 70. Those over 70 account for 28% of intensive care cases. It seems a relative under-representation which, in turn, suggests some success with the voluntary social distancing.

78% of those in intensive care are people with some “risk” condition (chronic heart-lung conditions, chronic liver-kidney conditions, hypertension, diabetes, ……)

It is far too early to draw any clear conclusions but possibly Sweden has yet to see any wave of Phase 3 “community transmission” of the virus.

My guess is that after 3 weeks of a voluntary lock-down, it will be time to start allowing manufacturing to restart, but that service businesses with high levels of customer contact will need another 3 weeks after that. The risk groups will probably need to practice social distancing for 2 – 3 months.


 


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