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. …
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.
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. …
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
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. …
In our textbook, the health chapter begins by this comparison of nations: “Chile, Costa Rica, Cyprus, Guadalupe, Hong Kong, Israel, Macau, Malta, Martinique, Singapore, and the United Arab Emirates are a diverse set of nations and territories. Yet they all have one fact in common: their citizens live longer than those of the United States, as do the citizens of many developed countries (United Nations 2006). This truth is unexpected, given the wide gap between the wealth, power, and technology of these countries and that of the United States. But health inevitably becomes linked to broader issues of politics and policy.” This is certainly the case in the United States’ ability to respond to a pandemic.
What have some of the lessons of this pandemic been for the United States? Our health care system has a number of weaknesses during an epidemic:
- A health care system that invests heavily in technology, but less so in people, such as the public health professionals who do contact tracing.
- A lack of recent experience with pandemics, such as South Korea and Canada had with SARS and MERS.
- An inadequate stockpile of personal protective equipment. A failed effort to develop a stockpile of ventilators wasted over a decade, and left the United States undersupplied.
- A popular belief that epidemics are something that happens elsewhere, so that the first and best response is only to put in place border restrictions.
- A sense of hubris, so that outbreaks in China or South Korea are assumed to be something that could not happen here, because our hospitals -with their advanced technologies- would be able to manage the situation.
- A health care system in which peoples’ insurance is tied to their employment. This has meant that when people lose their employment during a pandemic, they also lose health care.
- Deep health inequalities, which mean that case fatality rates may vary widely depending upon class and geography.
- A lack of sick leave for U.S. workers, so that people feel compelled to come to work when they are sick, or to face an immediate financial crisis if they are forced to stay at home.
- A sense of hubris regarding the U.S. medical system, which led U.S. health authorities to reject a German developed test for COVID-19 that the World Health Organization (WHO) endorsed. Instead, the U.S. frittered away precious time developing its own test. When that did not work, the CDC and FDA wasted even more time resolving the situation.
- A CDC and FDA that had become too swamped by bureaucracy and hence struggled to adapt, despite having outstanding and dedicated people. The system’s senior leadership has ossified.
- A U.S. health care system that is too decentralized to respond to a national level emergency, although this decentralization also has some benefits when there are failures at the top.
- An over-reliance on overseas manufacturing for key health goods, for everything from masks to medications.
- A society that undervalues the very people who turn out to be particularly critical during a pandemic: janitors, grocery store clerks, truck drivers, nurses, farmers, and others. As many people have said, it is only during a pandemic you learn whose job really counts. And there is not a good correlation between peoples’ pay and how important their job truly is. The same holds true for respect.
- A high rate of chronic diseases that leave people vulnerable to a disease such as COVID-19. The “diseases of development” such as diabetes, sleep apnea, high blood pressure and morbid obesity have led to higher case fatality rates. Most of these issues connect to the Standard American Diet (SAD) and the U.S. food system. No technology can replace a good diet.
- A chronic underfunding of public health. A good public health system is like a seat belt. You forget that it should be there until you really need it. And it seems kind of basic, but when the moment comes, there is nothing else that can replace it.
- Basic public health relies on people, and salaries are expensive. But not having an adequately funded public health system is what is truly expensive. Contact tracing, outreach, education, follow-up, monitoring, epidemiology, and health communication take time and people. Perhaps because they do not rely as much on technology they are also undervalued in the United States, which always likes to use technology to solve all problems. But there is no substitute for public health professionals.
- The basic systems that are always there in public health -nurses in schools, communication campaigns, testing systems, contract tracing- are the same systems that are needed in a pandemic. So having good public health in ordinary times gives you the tools and the people that are needed during extraordinary times.
The COVID19 pandemic is now moving quickly. While northern Italy has been overwhelmed by infections, Spain and Iran are also now experiencing a disaster. Here in the United States, there are serious outbreaks in Seattle and New York. So what are the best maps and other data visualizations to keep track of what is happening? Here are my top recommendations:
Global Level Data- 冠状病毒数据
This John Hopkins map provides a global look at COVID19’s spread, combined with charts of country cases, as well as the number of dead and recovered. I would guess that this is one of the three most popular maps for tracking the pandemic.
Outbreakinfo is an outstanding dashboard, which provides a vast amount of information in a limited space. This is one of the top three sources for tracking the pandemic.
The Worldometer Coronavirus webpage has a plethora of charts with data on the outbreak, in particular country by country data on infections, new infections, deaths and recoveries.
Health map provides another global map of the outbreak, although it is not accompanied by the data in charts that accompanies the John Hopkins’ map above. It does have, however, an “animate spread” feature that shows a visual history of the virus’s spread, which is hypnotic.
The University of Washington novel Coronavirus map is similar to the John Hopkins map, but has a less cluttered (and less detailed) collection of data in charts.
A US high school student created this useful website with COVID19 data both globally and in the United States.