Curfew

[Kalk, Andreas GIZ CD]

Dear colleagues,

I am still persuaded that it would make sense to define an overarching goal before discussing specific Corona control measures. Please allow me to evoke some possible goals:

 

• If you want to prevent all potentially lethal airborne diseases from circulating (the more airborne diseases being transmissible before the onset of symptoms), you might have to establish social distancing measures forever. In my eyes, this would require some kind of new social contract and can not be decided top-down by politicians with some virologists and epidemiologists on their side.
• Even to eliminate Corona virus from human-to-human transmission (if possible at all) might require a very long time span – the longer, the more drastic the control measures. This is exactly what Europe is experiencing right now.
• The ‘herd immunity approach’ might be seriously jeopardized by the seemingly low infectiousness of the virus. Some data suggest that the epidemic will – like influenza – cease to spread once a minority of the population (10 %?) is infected. I am not sure, but this impression makes me believe that herd immunity will be never achieved.
• One objective I could very well subscribe to is the idea to protect health services from being overwhelmed. This objective would, indeed, require well-tailored measures both related to high risk groups as to the health services. Some examples are given by Guido, but others – and quite acceptable ones – could be imagined easily, I think.

 

Please allow me some more comments: I do feel that this whole discussion has a lot to do with the increasing risk aversion in modern society and the increasing neglect of the fact that the endpoint of all life is death, anyhow. Sorry to be that brutal, but hugging your grandchildren (as a grandparent) or dancing through the night (probably more interesting for the younger generation) are part of the quality of life, and all these control measures sacrifice this quality for the sake of quantity. Even this way of thinking requires in my opinion some kind of general social approval.

 

Some of you shared personal experiences with the participants of this web room. I found them very interesting to read, so allow me to do so myself:

My father proposed me to be sent to a so-called ‘humanistic’ high school where Latin and even ancient Greek (though I learnt French instead) were standard topics taught. I accepted, and I enjoyed it very much! The very first day (in 1968, by the way) I went to this school joint by my parents, a group of older students were sitting on the lawn in front of the building. They were actually in hunger strike against a Latin teacher they accused of introducing Nazi ideology into the classroom. One slogan they promoted was: ‘The one who gives up his personal freedom for his safety, deserves neither freedom nor safety.’

I am aware of the fact that this slogan is ambiguous, but it guided me in quite some funny situations throughout my life, and I do not want to miss any of the experiences I made in this context…

 

Having said that I wish all of you a nice weekend,

 

Dr Andreas Kalk MS (Gen Surg) MCommH

Directeur Résident

Bureau GIZ à Kinshasa

(Rep. Dém. du Congo, Rép. du Congo)

7, av. Comité Urbain

B. P. 7555, Gombe, Kinshasa

République Démocratique du Congo

 

Tel. : +243-810 844 577

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GSM Allemagne/Germany : +49-151-7189 0706

Skype : andreas-kalk

 

E-Mail : andrea...@giz.de

Internet : www.giz.de

 

De : covid...@googlegroups.com <covid...@googlegroups.com> De la part de Guido Vanham
Envoyé : jeudi 15 octobre 2020 17:06
À : Kristof Decoster <kdec...@itg.be>
Cc : Covid-19 in SSA <covid...@googlegroups.com>
Objet : RE: fyi - John Snow Memorandum

 

Done!  

 

Important to see the reality: each time that the epidemic curves come down a little bit in Europe, lay people and some colleagues are pleading for a more “relaxed” attitude or more “surgical” interventions (e.g. only focus on the elderly and let the youngsters free). 

 

But then the virus strikes back and causes first the exponential growth of infections, followed by hospitalizations and by mortality. (Geert Molenberghs uses the metaphor of “three giants that wake up each other”).   Result: HCW are overwhelmed, the whole care system gets exhausted and society suffers…..

 

Clearly, in Europe with the “baby boomers” growing old, we have to choose between two options:   

• Take serious measures to limit close contacts in the entire society (including within families and amongst friends), without closing schools, workplaces, theaters etc. Stop quarreling about face masks: just use good quality, well fitted masks consistently; ventilate rooms well with fresh air; keep your distance wherever possible and apply the basic hygienic rules.  The whole of East-Asia practices these principles since February, with thriving societies as a result.  WHY ARE WE HESITATING TO FOLLOW THEIIR GOOD EXAMPLE?  Bring the curves down effectively and KEEP THEM THERE.  Still, some people will get infected, some will be hospitalized and die, just like happens all the time with flu, pneumococci….. But the rest of medical care will not suffer and economy, social life etc will continue in an “COVID-adapted fashion”.  
• The alternative is to lock up everybody above 65 in hermetically closed reservations.  Then you can let the rest of society function freely, as if COVID was not really there and let young people infect each other with few ending up in intensive care, an acceptable burden on the health system.

 

During the March-April lockdown, my neighbor (who is 85, has a heart condition and survived prostate cancer) said: This complete lockdown situation is worse than the second world war.  

 

Together with my neighbor, I choose for the first option, because it is reasonable and right and therefore I signed the petition.  

 

Guido   

 

 

 

From: covid...@googlegroups.com <covid...@googlegroups.com> On Behalf Of Kristof Decoster
Sent: donderdag 15 oktober 2020 12:22
To: EV...@googlegroups.com; Covid-19 in SSA <covid...@googlegroups.com>
Subject: fyi - John Snow Memorandum

 

https://www.johnsnowmemo.com/

 

In case you want to sign as well, see below.

 

Regards,

 

Kristof

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[Elisabeth Paul]

Thanks Andreas, I can't agree more on the need to make the goal(s) clear. Three thoughts about it:

1) Instead of narrow-minded and probably elusive objectives such as "reduce virus X transmission", why not go back to basics and aim at the highest level of health? As a reminder, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." ... Doing so would definitely change the focus, as the recent GBD illustrates. Youngsters are accused of threatening a generation that even didn't leave them fresh air to breathe and of overwhelming health services. Why does this suddenly happen, while there has never been such shame put on smokers (who actually overwhelm health services far more) and why is it socially acceptable to continue poisoning ourselves with pesticides, junk food and sugary drinks?

2) The objective of "flattening the curve" makes sense and gets adherence of population. But why not raise the line (system capacities) too? Why is the population accused of being all of the problem, while policymakers didn't do anything to strengthen the system, and continue spending hundreds of millions in using inappropriate tests on non-at-risk population? Who is responsible of the problem?

3) The elephant in the room: what is the cost-benefit of measures taken, from a society perspective, in terms of DALY/QALY?

Finally, I didn't sign the John Snow call for the following reasons. First, they are wrong when they say there is "scientific consensus" on Covid-19. Scientific consensus takes years to be reached - and cannot be reached in such an instable situation, with such a rapid evolution. Second, a scientific consensus is always dependent on the paradigm in which it is formed. We are clearly confronting a paradigm "war", currently dominated by the Pasteurians but where the tenants of a holistic view of health would have so much to say (cf. the syndemic piece). Third, policymaking is NEVER a purely "scientific"/technical matter. It is all about making trade-offs based on values and criteria, so it is before all political. Fourth, I actually don't understand what they recommend, concretely! ;-)

Enjoy your week-end,

Elisabeth

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[Dr.Bergis Schmidt-Ehry]

Dear Elisabeth

Thank you for your pertinent comment. Could I add an aspect which has a lot to do with our (inappropriate) health systems:

most debate is about the virus, but very little about the disease (diseases?)

You said in August rightly: "it would be worth communicating better - to the public and policymakers - on the difference between COVID-19 and "the" coronavirus that causes it“

But it’s not only communicating, it’s as well about research and how to deal with. What makes out of the infection the severe disease? And this is not only a question of at risk groups. We need to know more bout the mechanisms. 

Then we might be in a much better position to take appropriate measures of primary and secondary prevention!

Thanks and have a nice weekend!

Bergis

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[Elisabeth Paul]

Dear Bergis,

Totally agree, I hope to be able to share a paper (currently under review) on this subject!

Best regards and long live the GTZ diaspora :D

Elisabeth

[Alan Whiteside]

thank you very much for this really interesting discussion. I am going to try to summarise it in my blog this week (unless someone else would like to send me a 1000 word contribution, the blog appears on Wednesday on my website. Notifications go to 350 followers it gets mailed out to 60 individuals and I flag it on Facebook and LinkedIn). I am reluctant to push it in this world where we are overwhelmed with information. I rarely add to these crucial conversations, although I (like many I think), read with great interest.   

Thamnk you and keep up the converation   
 

Alan Whiteside OBE D.Econ

Chair in Global Health Policy, School of International Policy and Governance

Wilfrid Laurier University and Balsillie School of International Affairs, Waterloo 

and Professor Emeritus University of KwaZulu-Natal
alternative email awhites...@gmail.com

Skype profalanwhiteside1 

Personal Website www.alan-whiteside.com

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From: covid...@googlegroups.com <covid...@googlegroups.com> on behalf of Elisabeth Paul <elisabeth....@gmail.com>
Sent: October 17, 2020 2:55 PM
To: Dr.Bergis Schmidt-Ehry <ber...@schmidt-ehry.de>
Cc: Dr Kalk Andreas <andrea...@giz.de>; Guido Vanham <GVa...@ext.itg.be>; Kristof Decoster <kdec...@itg.be>; Covid-19 in SSA <covid...@googlegroups.com>
Subject: Re: Curfew

 

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/CAHP9VQFF3LsyZZFPh78gde3nkb31CHJNT%2BRKv5cSwx67upK_%3Dw%40mail.gmail.com.

[Kristof Decoster]

Dear all,

 

Thanks all for this interesting discussion.

 

A few additional things, perhaps:

 

• The John Snow memorandum was clearly drafted to counter the Great Barrington Declaration. Would be good to hear you opinion on the latter also.  (Yes, Willem and Werner, I’m looking in your direction 😊.)  
• I do think there’s an issue of timing here. When there’s a second wave on the horizon (or rather all over us now), I think there’s not much else one can do besides trying to mitigate pressure on the health system (and also trying to avoid the worst of havoc in the rest of society, socio-economic, loneliness, …). At least in Belgium, I think decision makers are now aiming for this very difficult trade-off exercise. The broader agenda, well described by Elisabeth for example (and with which I agree, clearly), then just has to wait a bit, I’m afraid – although you always have to keep it in mind (when implementing socio-economic constraints), to the extent possible.
• What I don’t agree with, though, is this ‘generational argument’. My mother (now 77) is allergic to it, and rightly so. You can’t just blame a whole generation for the neoliberal/ecological legacy left behind.  By the way, last time I checked, pre-Corona, many youngsters were (also) happily flying with Ryanair and Easyjet. They aren’t all Greta Thunbergs or Anuna De Wevers. PS: it’s a legacy that indeed also has heavily constrained our medium/long term ‘freedom’ now, as well as ‘safety’ in the year 2020 and far beyond.   

 

 

So I find it debatable that the Covid situation is about an increasing ‘risk aversion’ society. We’re in a mess, as a species. Covid makes us realize this, at a planetary level, perhaps for the first time.  Yes, we all have to die, but at the same time, there’s nothing wrong with trying to avoid it, as long as we can 😊. It’s not as if it’s so cosy under the ground.

 

Best,

 

Kristof

[Willem van de put]

Dear all,

 

Yes, Kristof, I think the “Great Barrington Declaration” is OK, although not really 'great', in the sense that I do not believe we should take reaching either herd immunity or a vaccine as leading in our thoughts, and more importantly because its aim is rather small - not so great. I will try to explain. Why not be more realistic and start thinking from a worst case scenario, where neither of these things are achieved in the coming years? Why not? For the same reason we should have done the things to bring down climate change much earlier: even if the sceptics can prove decades later that it was not necessary, bringing down emissions, shifting to more sustainable food production, cleaning the environment etc) still helps to achieve many good things even the sceptics appreciate.

So even without early solutions in sight, Focused Protection is a good idea: “allow those who are at minimal risk of death to live their lives normally, while better protecting those who are at highest risk.” Come to think of it Focused Protection is an even better way to react if there will be no vaccine of herd immunity!

So how to do it? Apart from what is proposed in the Barrington Declaration[1], I have a few suggestions:

1.      Let’s realize that it is not too late to correct the mistake made at the very beginning, and stop talking about ‘social distancing’. Especially now we know how hard people find it to stick to physical distancing and how easy we all accept the fast-growing social distance between the haves and have-not’s, within and between societies as a result of the measures taken. So change that it in the campaigns and communications: keep physical distance and strengthen social bonding.

2.      Let’s indeed, as Elisabeth proposes, not be shy and aim at the highest level of health. The importance of a focus on well-being rather than on ‘health’ has been shown over and over again and again, once more at and after the 40 years Alma Ata celebrations. This helps to uncover a small herd of elephants in the room.

a)     The first one is the matter of, in this case literally, the ‘political economy’ of the pandemic. Even the health sector cannot escape from the gap between limited resources in practice and theoretically limitless wants - the very basic economic problem. These kind of problems are political in nature and can indeed not be solved by any kind of ‘scientific consensus’ – in whatever field. That is why the recent release of the ‘return of the virologists’ at our television screens is such an eerie sight, and makes one think of how every sequel is of lower quality that the original version.

b)     Another elephant is the ambiguity in how the existential ‘Angst’ that goes around is expressed. It is cried out loud in endless newspaper articles and popular talk shows, it pops up in more serious media and platforms as a poorly defined but widely agreed ‘need for mental health’. But when we look at measures taken by governments, it is  a cry that goes completely unanswered in terms of funds or even good ideas. It is perhaps best understood as a well know reaction to fear, like the silent tears of someone in freeze, not knowing anymore whether to fight or flee from the clear and present danger.

c)      These two elephants seem to have produced an extra one, a baby elephant joining the herd. This has to do with protecting health services from being overwhelmed.

d)     At the top level of costs and attention are the intensive care units in the rich countries. Here, the aversion to even think about how to address scarcity in resources when it comes to an equal distribution of means is frightening and disheartening. Frightening because the longer we avoid talking about entry criteria in relation to IC-occupation, the sooner we put health professionals in terrible positions, as they have to make those decisions themselves without any support. Time for my own personal note: I have found myself several times in this position, in conflict situations and emergencies where I was the only person representing a medical organisation. And as much as I had wanted to, I could not always avoid getting there,  and once there, I simply could not avoid taking decisions, way beyond any capacity . Because not taking a decision is in its  effects one of the worst decisions you can take. Now we are getting close on a much larger scale, we can think about it in all the luxury and comfort we have, and we shy away from it. That is the disheartening part of it.

I have already given an example of rules to decide who will be admitted (and therefore who will be not) from the Dutch draft elsewhere (for those that have not seen it: a triage system could control the patient flow by step-by-step considerations of priority, in this order: patients who are expected to require a relatively short ICU admission; patients who are active in care and have had risky contact with patients; patients from a younger generation (0-20 years, 20-40 years, 40-60 years, 60-80 years and 80+ years); and if all these conditions are inconclusive, a draw will decide.)

3.      If we want to take the syndemic aspects seriously, and if we believe action is needed from the health sector to underline the importance of wellbeing, we need to go far beyond the “Great Barrington Declaration” and realize that we are also part of a globalized world. IN this world, inequity, ecological disasters, ongoing conflicts in African, Middle-East, Latin American, Asian settings continue. They also continue close to our homes, around our corners in parts of the city where we do not dare to go to have discussions on moral philosophy.  All these things that are continuing while we focus on our mouth masks need attention, urgently, because they are the root cause of the problem, including the pandemic itself. So no, Kristof, I am sorry to have to disagree: these things cannot wait – and they will certainly not ‘wait a bit’ by themselves.

e)     We may not all aspire to be Greta Thunbergs, and most of us can’t, given how she embodies the combination of youth and conviction. But I hope  we take inspiration from this example of speaking truth to power. There are measures that will help to address the pandemic as well as the underlying causes. These range from small, local actions with an inclusive nature to world-wide policy change, from taking local responses, such as reported here from East Africa, more serious as models for our own range of community response to a redistribution of wealth where super-tax is used to prevent further social distance between the rich and the poor. I think we have to speak these truths about how the most vulnerable across the globe suffer social, health and economic impacts of COVID-19 and the associated policy responses. I consider that a core task of public health professionals, but that is my own opinion.

 

If we do not aim for something higher than a declaration, in order to stand up for the values and lives of all people and not just to closest to our own home and families, I would almost start to believe that all these great concepts of international solidarity melt away as soon as a real crisis knocks on our own doors. Or, as Andreas Kark put it much better in his quoted slogan: “The one who gives up his personal freedom for his safety, deserves neither freedom nor safety.”

 

Have a good Sunday!

 

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[1] By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals. 

 

Willem van de Put

willemv...@gmail.com

+31622908419

 

Op zo 18 okt. 2020 om 07:53 schreef Kristof Decoster <kdec...@itg.be>:

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[Kristof Decoster]

Thanks, Willem, for this extensive reply. Will let others respond now. It’s great to agree about so many things and still disagree about so many others 😊.

 

A few clarifications, though:

 

• When I say, timing matters, I mean with respect to the key emergency, at that moment, in a particular setting. In Belgium, now, for example, that seems the risk of overwhelmed health systems (given the second wave) – with the rest having to wait a few months (it’s for a reason that health economists also seem to have shut up, temporarily : ) ) ; while for many LMICs in the South (many SSA countries notably), it’s the massive economic havoc.  Which is why I focus in my newsletter, for example, a lot on the importance of G20/WB/IMF… support/debt relief/… *now* . Not in six months or in a few years.  And of course, I’d like the more structural transformation (see UNCTAD proposals, …) even more.
• Timing (with outbreaks) also matters in terms of speed (of trying to prevent the worst).
• I’m a bit surprised that much of this debate seems to ignore the fact that a vaccine will, someday, be there. While I admit it probably won’t be perfect, it will be yet another tool in the toolbox to learn to live with Covid. And perhaps make the ‘Build back better’ agenda on some many fronts, more feasible. Including, very much so, the syndemic aspects of this pandemic. Anyway, the vaccine issue (and whether you have some faith in the global quest leading to something that works to some extent, within a year or so) matters for (suggested) timing of measures too.   

 

PS: I read in the newspaper today that a PVDA MD, Merckx, points out Covid hits her (often vulnerable) patients hard. And yes, she rightly translates that into political recommendations (and criticism) too, now.  But for the moment, she abstains from full ‘beyond capitalism’ transformation, in her recommendations. There’s a time for everything. But I certainly agree with you that we can start planting the seeds for this paradigm shift. In fact, it’s our duty to do so. But let’s also have a little bit of empathy with the care workers now (and I specifically want to mention the nurses and care workers in nursing homes).

 

Best,

 

Kristof

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[Elisabeth Paul]

Dear Kristof,

Thanks for this interesting discussion. But we (actually, they) have had 6 months to prepare for the very predictable Autumn/Winter crisis, and they didn't. In Belgium, they found 500 million Euros to support the cafés/restaurants sector following their obligation to shut down, but did not find a penny to hire more nurses (while they are needed every Autumn/Winter -- for instance, the CHU (teaching hospital) in Liege closes its emergency services every now and then, for lack of personnel; having been hospitalized twice there returning from Africa, I can confirm that there are not enough beds nor staff). They (and you as well, seemingly :-) ) bet everything on the vaccine, while it is still elusive. No vaccine against AIDS after 40 years of trial. No efficient vaccine against the flu -- with presumptive viral interference with coronaviruses (https://pubmed.ncbi.nlm.nih.gov/31607599/). Currently testing hazardous vaccines on healthy people who won't need it, with potential serious neurological damages, to potentially protect people whose immune system does not respond to vaccines (cf. the papers you sent in your letter - BTW I'm an unconditional fan, thanks!) and with no idea of long-term effects.

I don't adhere to the John Snow call who finds that still it is inequitable to put restrictions only to the vulnerable, we should push everybody (except the very rich) into poverty and insanity.

I'm close to ending up like the youngsters: despaired (never meant to say that all people above 60 were fools, nor that all people below 25 were angels; just observe that the young generation is despaired and cannot adhere to... what exactly? I can't understand what "the policy" is...).

That is why I believe we must operate the paradigm shift NOW. We don't have alternatives. TINA.

So concretely, in the very short term, what can be done? A few ideas: 

1) Leave bars and restaurants open, and invest the magical 500 millions Euros into nurses and care staff.

2) Stop wasting money in testing all those asymptomatic, non at-risk people; the virus has circulated too much to be able to control it by the "test, trace and isolate" policy, it's too late; save that money to invest in proactive campaigns to at-risk populations, giving them the tools to protect themselves and vulnerable ones.

3) We know that vitamin D deficiency doubles the risk of developing severe Covid; put all the Northern hemisphere under Vit. D supplementation during Autumn and Winter; this will not only decrease severe Covid cases, but also plenty of other diseases (https://www.bbc.com/news/health-54526652 ; https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30268-0/fulltext ; https://www.medscape.com/viewarticle/938303).

4) Let general practitioners do their job and take care of their patients. They know them better than any epidemiologist.

5) Come on, in March/April we didn't know how to treat Covid, but now we know (more or less), don't we? Non-invasive ventilation, dexamethasone, etc.

6) Now that the governments don't hesitate to act in the sake of populations' health, do it for true. Prohibit (or at least, tax heavily) all the currently legal poisons that harm us more than any virus (sugar, junk food, pesticides, tobacco), prevent drug abuse, help people heal their mental problems and explain them the risks linked to obesity, stress and sleep deprivation.

7) Change the way research is funded and invest in the research question: "what makes people healthy?" instead of dealing with every pathogen on earth.

Any follower on those proposals?

Best regards,

Elisabeth

[Kristof Decoster]

Thanks, Elizabeth. Always interesting to read your arguments.

 

I won’t reply – just noticing that while I agree with a lot, I also disagree with a lot.

 

The fact that this is the case (with people like you and me who follow Covid on a daily basis, although perhaps from different (professional) angles) makes me understand better why these must be very confusing times for ordinary citizens. 

 

Best,

 

Kristof

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[Claudia Hanson]

Dear all,

 

could you send me examples of ways to isolate the elderly and risk groups? Much appreciated if we can learn of what works, as we will need to prepare for the coming 10 years at least for the virus to circulate…

 

Best wishes

 

Claudia

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[pearl...@gmail.com]

Dear Kristof and all

Elisabeth makes a lot of sense for me. I have been observing with growing concern that investments in underlying health systems  problems in general seem to be minimal. We all know for instance that inadequate numbers of human resources for health have been one and remain of the health system problems. However, many governments (at least in the LMIC countries I've worked in) don't say much about increasing these numbers (e.g. training more, increasing numbers of public sector posts and subsequent health system capacity to reflect increased demands; putting up scholarships for basic skills training in health- such as bachelor degrees instead of only postgraduate scholarships, etc.).What are we doing to increase these as as part of the Covid-19 response everywhere?  We've also known for a while from health service delivery preparedness studies, that infrastructure (includes hospital building square footage, numbers of hospital beds, etc.) are not enough. Yet, I don't know many donors that are willing to fund health infrastructure development. Everyone is willing to go for 'low hanging fruit' kind of problems like in-service training to improve health staff skills for example. While this is needed, and useful, it is not enough to address the other health system issues that will inevitable affect the productivity of these skills sharpened health professionals after completion of the in-service course.

Unfortunately, we seem to be repeating these past mistakes in how we approach Covid-19 related interventions. I agree, vaccines alone are not the silver bullet on this one. We need to do much more on the overall health system as well. Just my reflection.....

Kind regards

Siphiwe

[Willem van de put]

Dear Elisabeth,

Yes, I would follow your proposals! And although we are not the ones that can take these policy decisions, it is part of our 'formal' task (as in our jobs) to keep searching for measures like this, keep promoting them on a sound basis, and keep trying to understand why they are not implemented. Part of our 'informal' tasks, as 'ordinary citizens', is to participate in the processes in a democracy to make these things happen. 

It is interesting to understand why governments keep using the wartime metaphors, but stop short in acting upon them in a productive sense. We are told that we have to stand together to kill the virus, but I have not seen measures that governments take when there is an 'ordinary war' - about economics and national pride, for example, not about saving lives. Like 

- how "During the Second World War, the USA top individual tax rate rose to 94 percent and remained at 91 percent for nearly two decades—until 1964".* 

- or how, in fighting this 'war', we create an alternative to the draft for military service and think about a draft for social service for those people who can't go to school or can't find a job because of the crisis. A social 'army' could help in providing services for those people that need to be protected, including those that ask for isolation. 

- This army of semi-volunteers can help to lighten the burden of the health workers - we have quite some experience from low-income countries in task-shifting in the health sector when there is a lack of resources. Compulsory enlistment of people in a national service has also shown to add to social cohesion and shared social responsibility. 

And, however horrible it may sound, “there is a deep historical relationship between the terrible ordeal of war and some of the social innovation that occurred afterwards and created the open society vision. Wars also have had the effect of adding to social cohesion" as was recently shared by Michael Ignatieff and Margaret MacMillan (https://www.ceu.edu/article/2018-03-17/war-can-bring-social-progress-we-must-remember-costs-macmillan-says). 

 

So if we keep talking about war and a real, sincere effort to jointly beat the virus, let's do it smart, reform the health sector, reform the tax sector, build social cohesion and use all this to also tackle other challenges such as climate and inequity. Then we can manage this war to indeed be the 'Great Equalizer' - which might have more appeal than just to lock everything down and keep war-mongering in language but acting to save the status-quo.

Have a good week! 

Willem van de Put

willemv...@gmail.com

+31622908419

 

* https://www.taxpolicycenter.org/taxvox/what-tax-experts-can-contribute-lessons-world-war-ii

Op zo 18 okt. 2020 om 21:27 schreef Elisabeth Paul <elisabeth....@gmail.com>:

[Gerry Bloom]

I have found the discussions very useful. We are at a stage, when we need to begin to think beyond immediate emergency responses. It may be helpful to differentiate between short term adjustments for the next year or so and longer-term structural adaptations that could be put in place.

 

My age qualifies me as at risk. During the summer it has been easy to live a life divided between the safety of my flat and the outdoors. As winter approaches, the lack of safe public spaces is promising to be a major issue.

 

I suggest that we need to move beyond the emphasis on isolation of people at risk. In the UK, where I live, all discussions of measures to mitigate the economic and social impacts of the response to covid focus on some form of individual financial support. The government is covering some costs of bars, gyms, restaurants and so forth to protect them from bankruptcy, but there is no expectation that they could use some of their resources to meet the needs of people at risk. The underlying vision appears to be that at risk people should avoid all public spaces, except for care homes – or retirement communities for the affluent. And, they should find individual strategies for keeping themselves safe. There are public messages asking the general population to wear masks to improve the safety of public spaces.

 

Other that wearing masks – we may need to accept more age segregation in some public spaces and develop strategies for keeping them safer and enabling access by all social classes. The market is likely to lead to the creation of a variety of expensive public spaces for the affluent.

 

We could begin to think of safer public spaces for the people at risk who are relatively well. These spaces could be expected to undertake more rigorous cleaning, have very good ventilation and so forth. And, people entering them could be asked to complete a questionnaire about exposure and symptoms and be asked to act in a  more responsible manner than we expect of the general public. The kind of spaces I have in mind are: cafes, gyms, restaurants. In the short term the focus should be on spaces that are particularly important to enable people to exercise, keep healthy and meet socially. Without this kind of access, we can expect problems with physical and mental health and also growing political frustration.  If governments do not take action on this matter, the market is likely to lead to the creation of a variety of expensive public spaces for the affluent who are at risk.

 

Governments need to move from an almost total focus on individual behaviour and some aspects of financial protection to pro-active planning for a context that takes the risks of viral infections into account.

 

The covid pandemic may push us to give more emphasis to social medicine/public health and to look for social solutions as well as changes in behaviour and culture.

 

Gerry

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[Sara Van Belle]

Hello,

 

Just a small remark re discussion: With a small group and an MA anthropologist / social geographer  we are looking into COVID and use of public / green / blue space in Antwerp. She is currently doing ethnographic fieldwork in the one of Antwerp’s public parks, where people with a migrant background and children tend to come together. But it might also be interesting, in Belgium, to look at public libraries and the OCMW wijkcentra- restaurants. As for the public library, I know in Antwerp a lot of elderly men (with small pensions?) use this extensively to come read the newspapers each day and meet up with each other, talk a bit to each other…You could reserve the library each day a few hours especially for this group.

Not sure whether this is the same in the UK – what are the public spaces, or elsewhere, these approaches should be quite contextual. I do think we need to think more long term – how are people going to get through winter socially without more domestic violence / social isolation/substance abuse…some positive actions towards targeted groups next to better communication might help.

 

Sara

 

From: <covid...@googlegroups.com> on behalf of Willem van de put <willemv...@gmail.com>

Date: Monday, 19 October 2020 at 09:06
To: Elisabeth Paul <elisabeth....@gmail.com>

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/CANKm708rkcEVnJWZ1NOwXcLCniOsgpd01hKmWmcDLLxvkXuu1Q%40mail.gmail.com.

[Kristof Decoster]

Obviously agree with that, Siphiwe.

 

But as I said before, I prefer to stick to my own setting in this discussion (Flanders, or Belgium, even if I largely follow the debate through Flemish media, so probably don’t know the way the debate goes in the other part of our country), the discussion on LMICs I clearly prefer to leave to you guys, who live there.

 

But on the issue on investing (a lot more on/in) health systems: well, I would have liked a particular health economist to make that case forcefully, in recent months, as also in Belgium we have under-resourced care homes etc. But no, he chose to attack virologists on their turf (or at least that’s what people will mostly remember from his intervention). A risky strategy, it turned out.

 

As for the vaccine: no, it won’t be a silver bullet. But yes, I think we’ll get something, by the end of next year, that is at least somewhat effective (though perhaps not for all), and it will be yet another tool in the medium-term toolbox.  Let’s hope we also get (and fund) global access, then.

 

Best,

 

Kristof

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[Guido Vanham]

I couldn’t agree more with Kristof, and, sorry, disagree with Elisabeth.  

 

It is not correct to state that there is “more or less” a treatment, while, in fact, there is no specific treatment yet for this virus.  Sorry, but with oxygen, dexamethasone and Vitamin D, you can try and support the patient’s vital functions and immune system to some extent only, not kill the virus.  Fortunately, quite a few people survive, thanks to a lot of effort by HCW, but many also die.  A real treatment for a virus in the 21^st century is with anti-virals and for this one, those drugs are to be developed yet.  I’m sure we will have some by next year, but, unfortunately not now.  

 

I’m disturbed by the suggestion that the virus should be left “free circulating’” (at least that’s what I understand), that we should turn “a blind eye” to its spread and then let the general practitioners “do their job”.  In the meantime our entire health system is really under threat with people who are ILL and HCW, who struggle to keep the patient flood under control, are desperate and exhausted.  Stating from the side-line that they should just “do their job” and NOT pleading for very strong prevention, I just cannot understand.    

 

I get so many questions from students, colleagues and all kind of people, but, indeed, if this type of very controversial messages continues to be spread by professionals, even at times of very urgent and obvious crisis, as if this virus is just a “hype” or a “hoax”,  it becomes very difficult for the medical world as a whole to be credible.   And if we lose credibility, regular people as well as policy makers will also get desperate.  

 

Please learn from East-Asia,  Denmark, Norway and Finland: they took the virus very seriously, took quick and clear measures and convinced their population to follow them.  Their populations are safe and thriving now, while we, in Belgium, NL, FR, Spain… are quarreling, hesitating, trying to make a compromise with the virus, since the beginning. We ended up in a terrible situation, because of our own mistakes, let’s face it and not try to rationalize it away.  Consistent communication and action is needed now, not more confusion.  

 

Best wishes,

 

Guido (a damned immune-virologist, with 30 years of experience in HIV research)

[Marleen Temmerman]

I fully agree Guido,

 

Also lessons to be learned from Kenya, where since the first covid-19 case on March 13^th, the government took though measures including lockdown, curfew, masks, physical distancing, clear communication and leadership…..not perfect of course, but currently 40,000 covid+, and 800 deaths /50 million population.

Of course, there are many factors that play a role, but adhering to public health measures is key,

 

Greetings from Nairobi,

 

Marleen

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[Elisabeth Paul]

Dear Guido,

Thanks a lot for sharing your opinion. This debate perfectly illustrates what Andreas and I put forth prima facie:

- We need to set an overarching goal: reaching the highest health status of populations, but also taking account of equity, responsiveness and efficiency - these objectives somewhat imply trade-offs and must be balanced according to society values -- thus need to be discussed in a transparent way;

- We are facing a paradigm struggle between Pasteurians and systemists. Only by recognizing it (which is always more difficult to do for the dominant one ;-) ), can we find the best of both to reach our common objectives. Instead of a struggle, we need to work together so as to find the right balance. We (systemists) need you to better understand what makes the viral infection turn into a catastrophe for some people - and how to prevent it. You (virologists) need us to see beyond the virus, find ways to strengthen the health system, to promote better health and also to take account of indirect effects of policies into the equation.

Together we stand, divided we fall...

Best,

Elisabeth

[Robert Colebunders]

I agree also with Guido for Europe

However I have the impression in SSA this epidemic is different, as in several countries where there has been no drastic measures there seem to have been a similar low mortality as in Kenia and may be with limited collateral damage

“need to know your epidemic” we always said for HIV.  This also seems to be important for COVID  

 

Robert (Bob) Colebunders

International citizen project COVID-19 (ICPCovid)

NSETHIO project

Campus drie Eiken

Gouverneur Kinsbergen Centrum

Doornstraat 331, 2610 Wilrijk

+3232651804

+32486920149

Skype name Robert colebunders

robert.co...@uantwerpen.be

 

 

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/b391cadde4a34138845bff2d8a118efd%40UGent.be.

[Willem van de put]

Hear hear!

Willem van de Put

willemv...@gmail.com

+31622908419

 

Op ma 19 okt. 2020 om 10:36 schreef Elisabeth Paul <elisabeth....@gmail.com>:

[Thetard, Rudi]

Hi all

One advantage in Africa (at least in some countries I know) is that the health system has a well-defined organisational structure. This allows at least a systematic roll out of interventions.

In Malawi we were able to systematically scale up rapid response teams in all districts and also systematically roll out risk communication messages deeply into communities.

Right now CHWs (health surveillance assistants) are being oriented on community-based surveillance - almost 10,000 of them - a long process but a feasible process. 

None of these actions are necessarily easy and requires much work and collaboration but it is possible. 

Of course there are probably many other factors involved but I think an organised system is an advantage, especially when the health system is subject to epidemics such as cholera which leaves an institutional memory.

 

Thanks

Rudi

Dr RCH Thetard

Chief of Party

USAID's ONSE Health Activity

Tel     +265991200025

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[Guido Vanham]

Dear Elisabeth and other “systemists”,

 

Please tell me what could have been wrong in studying how East Asia and the largest part of Scandinavia were able to avoid a lot of human suffering, with acceptable “fall out” on economy and society, and learn from them?

 

(Please don’t avoid the question by re-opening the exhausting discussion on the ”Swedish exception”)  

 

Guido

[Elisabeth Paul]

Dear Guido,

I'm sorry I don't quite understand your question. What measures do you mean exactly? Do you mean "Test, track and isolate"? It is of course very good when done wisely, and when the spread of virus is rather circumvented - like they did in Germany in March-April. But the way it is now done in Belgium?? Masks? We wear them now, no? And the virus circulates more than ever. Hygiene and physical distancing? We also do it too, no? So it seems that it is not so much what we do, than how we do it and in in which context that matters (Africa is even a better example at this respect). So of course it's important to understand '"what works, for whom, in which context". But let's also act to make the context better playing in our favour: we can't change the seasonal pattern but we can hire more nurses and carers; augment health literacy in general; strengthen people's health system; pay particular attention to social determinants and community sensitization. And try to get people's adherence, instead of mixing retaliation and guilt. I can't understand why you see these as in competition to your search for antivirals??

[Guido Vanham]

So, you choose to avoid the question…

[Alan Whiteside]

you are trying to have an argument that looks at economically rationality in a society that refuses to value life. I don't think you can even engage. Gorik Ooms where are you?

Alan Whiteside OBE D.Econ

Chair in Global Health Policy, School of International Policy and Governance

Wilfrid Laurier University and Balsillie School of International Affairs, Waterloo 

and Professor Emeritus University of KwaZulu-Natal
alternative email awhites...@gmail.com

Skype profalanwhiteside1 

Personal Website www.alan-whiteside.com

---

From: covid...@googlegroups.com <covid...@googlegroups.com> on behalf of Guido Vanham <GVa...@ext.itg.be>
Sent: October 19, 2020 11:01 AM
To: Elisabeth Paul <elisabeth....@gmail.com>

Cc: Kristof Decoster <kdec...@itg.be>; willemvandeput <willemv...@gmail.com>; Kalk, Andreas GIZ CD <andrea...@giz.de>; Covid-19 in SSA <covid...@googlegroups.com>

Subject: RE: Curfew

 

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/AM0PR05MB6724EA3599545644F6405580941E0%40AM0PR05MB6724.eurprd05.prod.outlook.com.

[Kristof Decoster]

A few reads in BMJ on this issue, from this morning:

 

https://www.bmj.com/content/371/bmj.m4024 

 

https://www.bmj.com/content/371/bmj.m3979

 

K

[Luc Bonneux]

This is not only funny, but also brilliant television over a very serious issue. For those not understanding Dutch: this part of a satyrical show demonstrates how social media push you in no time to the rabbithole of an extreme viewpoint.

youtu.be/FLoR2Spftwg 

It explains why so many good people end up in polarised debates, in covid-19 the apocalyptians (the end is near) versus negationists (it's a flu)

Luc B

Op ma 19 okt. 2020 om 12:18 schreef Kristof Decoster <kdec...@itg.be>:

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/AM0PR0502MB4052165EC1D9D479AF0759CFDF1E0%40AM0PR0502MB4052.eurprd05.prod.outlook.com.

--

Luc Bonneux

lucbonneux.blogspot.com