COVID-19

The warning signs in Hong Kong

In 2017 I traveled to Hong Kong to do research for a paper about the pandemic risks posed by wet markets (marketplaces which sold and slaughtered live animals). I traveled to wet markets large and small, and took notes on their practices and clientele. I also interviewed public health experts and doctors about the territories system to control avian influenza in poultry.

Card in a Shenzhen hotel, which explains China’s internet restrictions to guests. Sorry for the bad lighting. Photo by Shawn Smallman

While in Hong Kong, I also traveled to Macau and Shenzhen. When I crossed into mainland China, I was struck by the extent to which information was restricted. It’s one thing to know that China has a separate digital ecosystem. It’s another to no longer be able to use Google Maps, and to know that there’s no point in even trying to use a VPN to connect with websites at home. When I arrived in Shenzhen, I found this card in my hotel. You couldn’t access your files in Google Drive, check Twitter, watch a YouTube video, or see your kids’ posts on Instagram. The Great Firewall of China is  both pervasive and efficient.

While I was in Hong Kong, I also had an opportunity to talk to someone whom I greatly respected. At one point in our discussion they asked me “Do people see what is happening here in Hong Kong? Are they following what is happening here?” I said that no, in my opinion most Americans did not. In the United States people were focused on the new presidency of Donald Trump. She/he seemed very disappointed by my answer, and asked the same question again with slightly different wording. I gave the same answer. In 2017, I don’t think most Americans -and perhaps most Europeans- were carefully following what was happening in Hong Kong. That would change over the next year and a half. …

Taiwan, Australia, and COVID-19

 

Photo by Tommy on Unsplash

This year I am honored to be a Taiwan Fellow, and am planning to travel to National Taiwan University in Taipei, to work on a research project about how Taiwan used digital tools to control COVID-19. I say “planning” because Taiwan recently closed its borders. For over a year Taiwan had controlled the virus, which was ravaging the United States, Europe and South America. How did Taiwan do so well for so long, only for its public health efforts to unravel in the end?

Taiwan’s intelligence services notified the country’s leadership of an unusual outbreak in China relatively early in the COVID-19 outbreak. Taiwan quickly controlled its borders and notified other countries of the danger. It adopted digital tools to enforce quarantines and permit contact tracing. All travelers entered into quarantine hotels. This response worked, and Taiwan was free of sustained community transition for over a year.

Then -as in Australia- the system around quarantine hotels broke down. A local hotel by the airport wanted to find more customers. So they advertised that people could come to stay at their airport hotel, where people could watch the planes take off and land. They even advertised with financial support from local government. The people came and stayed. And then they left and went to museums, tea houses (brothels for an older clientele) and a masonic lodge meeting. Only later watching the local news did they find out that they had paid to stay at a quarantine hotel. While the people had not been hosted on the same floors as the air crews, they were in the same building. …

COVID-19, the Delta variant and “fleeting contact” in Australia

Few countries have done such a good job controlling COVID-19 as Australia, but now the nation is facing a significant test in Bondi. A driver (sometimes described as a bus driver, and sometimes as a “car-for-hire driver) worked shuttling air crews to quarantine hotels, as well as driving the general public. Even though he was a front-line worker, he was not vaccinated. He also seems to have had poor personal protective equipment (PPE). Unfortunately he was infected with COVID-19. While in the contagious phase he went to see a movie, visited a cafe twice, had lunch at a Japanese restaurant, and drove a large number of passengers.

What was most remarkable, however, was his visit to a mall in Bondi (Westfield Bondi Junction). In that mall, he appears to have infected people despite “fleeting contact” which was recorded on store cameras. There were a number of such cases. One woman was sitting outside at a cafe, where he was sitting indoors. Normally the risk of outdoor transmission is believed to be low. But she was infected. In another case he appears to have passed a shopper, in the briefest of interactions, which was captured on CCT cameras. But that person was infected. The old rules -fifteen minutes of contact is required for transmission; outdoor transmission is rare- don’t seem to apply in this case, which is causing some justified worry in Australia. People are lining up in their cars for testing.

Fortunately, people seem to have been isolating as asked, and wearing masks. As of today, there are still only eleven cases. Hopefully, this outbreak will be controlled. Health authorities are currently dealing with over a hundred exposure sites. One of the places people were exposed was on a bus. This incident raises this question: is the unusual pattern of spread the result of the new, more transmissible Delta variant, or was this something particular to this individual patient. Epidemiologists are discussing this question is multiple venues. Currently 3.2% of Australians are fully vaccinated.

Whatever the answer in this case, we may see more examples. As was the case with Taiwan, the critical failing was around quarantine hotels and air crews. All people who work in any respect with air crews (in nations without community transmission) need to be fully vaccinated. And the system for hotel quarantine needs to be improved. And more broadly, here in the US we are still far off our record for one day COVID-19 vaccinations, despite a slight uptick recently. People need to be vaccinated now, as the Delta variant is growing rapidly. Although it was originally thought that it would be the dominant strain of COVID-19 in the US as early as this August, it’s now looking as though that might happen as early this July. If you’re fully vaccinated, you have a good level of protection and don’t need to worry. If you’re not fully vaccinated, now is the time to do so.

Shawn Smallman, 2021

Where things went right: Bhutan and COVID-19

Photo by Kinshuk Bose on Unsplash

After so much bad news about COVID-19 globally, it helps to hear about a place that managed to vaccinate its entire population. Bhutan not only did so, but this remarkable job was done in weeks. Fortunately, this task was completed before the Delta variant of COVID-19 washed over both India and Nepal. But the story of this vaccination campaign -which was timed based on the advice of astrologers and guidance from monks- is a remarkable one, as is Bhutan’s health care system. I want to thank Paula Heimberg, a doctor who volunteered in Bhutan, for this interview in my podcast, Dispatch 7.

Shawn Smallman

Britain’s vaccine success in the midst of a pandemic

The early story of Britain’s reaction to COVID-19 was an unmitigated disaster, driven in part by uniformed cabinet discussions of herd immunity. Even Prime Minister Boris Johnston himself was infected with COVID-19. As if this story was not difficult enough, a new variant of COVID-19 appeared in Essex towards the end of 2020. We now know that not only is this variant more communicable, but also may be more deadly. In late December this virus came to dominate all the COVID-19 clades in Britain, and caused a remarkable surge in infections.

In spite of this difficult history, Britain has pulled of two remarkable achievements. First, it has conducted outstanding genomic surveillance. While Denmark was also doing so, it was the British tracking which revealed the extent of the threat these new variants posed. Now other nations, such as the United States, are playing catch-up, as they try to create an effective system for genomic surveillance. Even more remarkable, Britain has joined a short list of nations (along with Israel and the United Arab Emirates) leading the global race to vaccinate their populations. How was this success achieved?

Paul Waldie has a remarkable article in Canada’s Globe and Mail, titled “How Britain became a world leader in COVID-19 vaccine distribution – despite other pandemic problems.” In Waldie’s narrative one remarkable woman, Kate Bingham, and the task force that she led, managed to identify the likely winners in the vaccine race, negotiate contracts, and bring vaccine production home to Britain. What is most impressive is how proactive the task force was. Britain has had many missteps and still faces many challenges. Yet when the history of this pandemic is written, I think that -based on Waldie’s description- this task forces’ actions will be held up as a case-study of effective leadership during a crisis.

Shawn Smallman

Cyber, Cities and COVID-19- why urban leaders need a digital strategy

Photo by Isabella Mori, who provides this context: In traditional Taiwanese night markets, since people and sellers are in close contact, most people / vendors wear masks now, in order to protect themselves and others.

The 1918 Influenza pandemic likely killed between fifty and one hundred million people globally. While the case fatality rate varies with circumstances, the current outbreak of COVID-19 may be as deadly unless vaccines are developed in time. Since the start of this year global cities like New York have faced immense strains. As always during a pandemic, one of the concerns that leaders face is how to prevent panic and discrimination, which can be spread by social media and other digital platforms. At the same time, the internet provides a host of tools that can help during a pandemic, with everything from telemedicine to mass collaboration. While cyber tools -such as digital tracking apps for individuals under quarantine- are powerful, they also come with human rights questions. In adapting these cyber tools for telemedicine, digital health communication, outbreak modeling and other uses (Liu and the HIMSS Greater China Health Team, 2020), city leaders and health authorities must address issues of transparency, privacy and public trust, which will require them to have a strategy for digital issues.

Quarantined across borders, a blog

Before entering restaurants in Taiwan people sanitize their hands and have their temperature taken. Image courtesy of Isabella Mori.

Recently my colleague, Dr. Priya Kapoor, shared a blog with me “Media Rise: Quarantined across borders.” Every day, two or three new blog posts are added. What I like about this site is that it focused on the personal experiences of people who have impacted by COVID-19, from a Pakistani study-abroad student in China, to an American facing anti-Asian discrimination. Each piece is quite brief, perhaps just a couple of pages, but they still provide an interesting point of view on our diverse experiences during the pandemic. I particularly recommend Dr. Kapoor’s piece, which speaks to how adults connect with distant parents during a pandemic, and the ties that bind a family.

Shawn Smallman

The power of smartphones in online teaching

Before entering restaurants in Taiwan people sanitize their hands and have their temperature taken. Image courtesy of Isabella Mori.

One of the great lessons in life is the power of radical simplification. Everyone who has traveled has had the experience of realizing that even the most basic statements and vocabulary can allow you to exchange key information. Right now, many people are radically simplifying their lives in self-quarantine, whether it be having a family member cut their hair, or using an old sewing machine to make face masks. The number of people rediscovering the value of even a small garden reminds me of England during World War Two. Our grandparents and great-grandparents already did this.

So it’s interesting to learn that the same trend is happening in online education, where people are interested in how to use phones as a learning tool. The idea alone might make some of my senior colleagues’ heads’ spin around much like Linda Blair’s in the 1973 American horror film “the Exorcist.” They believe that phones are responsible for the decline of civilization and culture, much as Plato and Socrates once argued that the invention of writing had destroyed memory skills and damaged learning. Nonetheless, in some developing nations smart phones are playing a key role in permitting online learning during the COVID-19. I recommend this article by Anya Kamenentz in NPR on “How Cellphones Can Keep People Learning Around The World.” It turns out that phones may also be an appropriate technology in many educational contexts. …

Health care and Cyber-attacks

An Opte Project visualization of routing paths through a portion of the Internet. (http://creativecommons.org/licenses/by/2.5) via Wikimedia Commons.

Sadly, one of the most common cyberattacks is upon health care centers, particularly ransom-ware attacks upon hospitals. While digital records and telemedicine are proving essential during the COVID-19 pandemic, hospitals’ reliance upon digital resources also make our health care systems vulnerable to attack. As this article by Jocelinn Kang and Tom Uren says, cyber-defense efforts now need to prioritize our health care systems.

If you are interested in hearing more about global topics, please listen to my podcast, Dispatch 7. You can find it on Spotify here, or by searching whichever podcast platform you prefer.

Shawn Smallman, 2020

Cyber tools for predicting COVID-19’s spread

 

The Spanish Influenza. Chart showing mortality from the 1918 influenza pandemic in the US and Europe. Wikipedia commons.

The New York Times had a remarkable story yesterday morning by Donald G. McNeil Jr. , which talked about a company (Kinsa) that markets smart thermometers. The company can use the data on fevers from these devices to foretell where the outbreak will grow, before that data shows up in other sources.  You can see the company’s map here. As the NYT article says, there is so much interesting data here.

As someone who has spent a lot of time in Florida (my mother was a mystery writer, who set her novels in the bars of West Florida) I am deeply worried by the data on southeast Florida, as well as around Tampa. And even some of northern Florida, such as Duval county, has high levels of atypical fevers. But what is happening in Michigan? The map around Detroit has not lit up as red as Miami, but there is a swath in the south of the state where the levels of atypical fevers have raised. The swatch stretches as far west in the state as Kent county. I wouldn’t have expected what appears to be happening in Utah county, and Salt Lake county, Utah. But these counties still do not light up as much as Broward, Palm Beach, and Miami-Dade do in Florida. …

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