global health

COVID-19 and denial

Fighting SARS Memorial, Hong Kong

Today seems to be the day in which the words and numbers that international organizations and national governments used to describe the COVID-19 pandemic increasingly diverged from facts. To begin there was an overall context in which the virus rapidly spread in the Middle East, while cases dramatically climbed in Korea (833). In the Middle East, there were new cases in Afghanistan, Bahrain, Egypt, Iraq, Israel, Lebanon, and the United Arab Emirates. Most of these cases were tied to Iranian travelers.  In Italy the number of cases rose sharply. Venice ended the remaining days of Carnival. Italians in northern Italy rushed to stores, some of which were cleaned out and left with empty shelves. In the United States, ongoing problems with testing for SARs-CoV-2 has meant that health authorities have been unable to test at scale, as in Korea, Singapore and Canada. Finally, in China the rate of increase has slowed, but the nation still has over 77,000 cases. But neither the rising number of cases nor other problems caused corresponding expressions of concern by WHO or the Iranian government.

First, Dr. Tedros at the World Health Organization (WHO) said at a press conference that the WHO would not call COVID-19 a pandemic. Indeed, the WHO has stated that it no longer uses “pandemic” as a category. At the current time, there is ongoing transmission of a novel virus in multiple world regions, with a case fatality rate of perhaps two percent. If this is not a pandemic, what would be? The goal of deleting the term pandemic seemed to be more to avoid causing fear than to accurately describe reality. If the WHO does not play the role of declaring a pandemic, then who does? The risk of this is that the public in different nations may begin to lose confidence in the WHO. The pandemic exists even if the category does not.  …

COVID19 and teaching in China

This letter written by Mi Fei. By 米芾(べい ふつ、1051年 – 1107年、中国の北宋末の文学者・書家・画家) [Public domain], via Wikimedia Commons
I am very grateful to our guest blogger, who teaches at a university in China, for this powerful guest blog post:

January 24th is the biggest holiday of the year in China: the lunar Chinese New Year. As usual, most Chinese prepared for it several weeks before the occasion: food, candies, tickets back home…Nobody expected this New Year would become a most unforgettable one even in his/her whole life. The coronavirus became a household word almost overnight and quarantine also came suddenly before people realized. Over the past almost a month, people, especially those in epidemic areas, went through hard times. On the other hand, we are moved by one story after another about the devoted doctors, nurses, volunteers and all those in the whole world that extended their hands to help.

The spring term in our university originally planned to start on February 17. At the end of January, it was clear that the starting date had to be postponed. The school administration sent some documents early in February notifying all the staff and faculty to make a plan for the month. We were asked to make better use of the online platforms and resources. As a result of the encouragement from the Ministry of Education and development of online courses, there have been thousands of moocs available on the Internet for free, which in my opinion cover nearly all disciplines. As for my course (college English), we have been utilizing the online platforms for the textbook developed by the publishing press over the past five years. Therefore, what we need is to transfer the platforms from kind of self-learning to more guided learning. At the same time, we selected some relevant moocs either as a required component of the course or as recommended resources.

Novel Coronavirus- a study abroad story

Empty Chinese street

I am grateful to Celine Kuang for the following guest post:

Studied at Shanghai University, August – December 2019

Studied at Southwest Minzu University, January 2020

I’m a double major student in international studies and Mandarin Chinese. I mainly went to China to study the Chinese language and gain a broader cultural experience. I studied at Shanghai University for five months before going to Southwest Minzu University in Chengdu, China. During school breaks, I traveled around China to explore its cities, including Beijing, Nanjing, Hangzhou, Xi’an, Guangzhou, Shenzhen, Zhuhai, Shaoxing, Suzhou, and more. Everywhere I went China emphasized its status of being the most populated country in the world. The virus changed all of China’s populous and vibrant cities to ghost towns within a week’s time. In December is when the virus first started to appear. The Chinese government thought the news would create fear amongst its citizens, so they restricted news of the outbreak. The government was right about fear and as a result, many rumors started going around on social media. One Chinese friend even asked me if the U.S. planted the novel coronavirus outbreak. I was shocked that someone would ask me that, but I answered that it’s not possible. That was only the beginning of a whirlwind of issues.

During Chinese New Year many Chinese migrate back to their parent’s home to celebrate which helped to spread the virus even faster than anticipated. Less than a week into the family gathering, the Chinese government started locking down cities, increasing health checks in neighborhoods, and restricting all forms of travel between cities everywhere. This caused serious traffic congestions and delayed resources from efficiently reaching consumers. I’m not suggesting that China shouldn’t take such drastic measures, but these measures do have economic consequences as many scholars and researchers have already explained. Yet, even more concerning may be the how the necessary resources such as medical face masks (to prevent the virus from spreading) are becoming extraordinarily rare in this short time period. Many people are unable to buy new masks. Some pharmacies even started selling face masks at ten times the original price to seek profit at another’s expense. Some people started to create and sell their own brands of face masks but the quality of the masks is so poor that it can be considered a scam for the less educated populations. My mom informed me of her friend asking if she would buy face masks from the U.S. and send the masks internationally to them. Soon after, the friend told my mom not to bother sending the masks because no packages right now can be received anyway due to travel restrictions all over China. The friend is hoping that steaming and boiling them under hot water would help disinfect the used the masks so the family may continue using them.

I, myself, barely made it out of China during this hectic time. Three days into the Chinese New Year break, the Chengdu program I was in said they’ll continue classes and we’ll all wear masks during lectures. The following day they said they will consider holding lectures through webinars. That next morning I woke up to a classmate knocking on my bedroom door asking for my Chinese visa extension receipt. She told me the assistant resident director will be going to the consulate to get the passports of several others and mine back from the Chinese Consulate. She said I should check the conversation going on in the group chats and that the program is now cancelled. I was dumbfounded that in such a short period of time every changed for the worse. I emailed my scholarship and said I need to return to the U.S. as my program is being cancelled and the heightened travel advisory went from level one to level four in a week’s time. That night I bought plane tickets to leave Chengdu. Besides me there are hundreds of other students on the same scholarship as I am. Two days after receiving numerous emails(including mine), the scholarship sent a mass email out telling us to leave ASAP. We must all leave within eight days they told us.

Every time I read the news it says how many flights are being cancelled between China and the rest of the world. I finally packed everything I needed to leave but one days before my flight it got cancelled. I became worried. I called my airline through an international call for forty minutes to change my tickets. Plane tickets went from around 400 USD to 1000 USD in two days. That’s when I realized the vulnerable situation I was in. I was lucky enough to make it out of China before being infected. To be certain I still went through the fourteen day self-quarantine after I returned to the U.S.

Many Chinese friends have posted on the popular messaging app of China, WeChat, that they hope school would start soon or they can’t stay indoors any longer. Some of them went out for the first time after weeks of quarantine at home with their family. They posted photos of deserted parks, streets, and metro stations. Some posted food they ordered from the few restaurants that are still open during this novel coronavirus outbreak. It is understandable why China is trying to protect the non-exposed population by restricting travel between cities. However, the problem of being able to provide the necessary resources, such as face masks, to citizens throughout China can really hinder the control of the virus. This is only one of numerous issues following that China and the rest of the world has to worry about. In three months’ time the death rate is over 2,100 (this does not include those who died at home without going to the hospital) which is nearly three times the death rate of SARS. Of course, there is the hope that the virus will be controlled sooner rather than later. Currently, over 16,000 have recovered from the virus but how many more will die before the situation is under control?  I hope the worse will pass by soon for everyone in China and a cure will emerge for the infected.

WeChat message

 

 

Cruise ships, travel restrictions and fear

Bust and Plaque at the Fighting SARS memorial, Hong Kong

It is time for a hard discussion in the field of global health. In an earlier blog post I talked about how quarantine saved American Samoa during the 1918 influenza pandemic, whereas Western Samoa (now Samoa) lost nearly a quarter of its population. In the latter case, a single ship from New Zealand named the Tahune brought the virus. This video, “1918 Samoa & The Talune – Ship of Death” on YouTube shows the impact that this single ship had on the island’s history. At that time decisions about quarantine and trade were not made by the island’s inhabitants themselves, but rather by colonial administrators. Similarly, in Labrador the Moravian supply ship Harmony brought the 1918 influenza to Indigenous communities, which destroyed some entire population centers. You can see the human cost of this experience in the video, “The Last Days of Okak,” which Newfoundland archives has placed on YouTube.

The point with these two examples is that neither of communities that were affected had any say in the travel restrictions that could have protected them. Those decisions were made elsewhere. In American Samoa a harsh quarantine saved people. Of course there were economic costs to the quarantine, but those were ephemeral, whereas the lost lives in Western Samoa were permanent. But there is another lesson to the experience of these islands. The case fatality rate for the 1918 influenza was perhaps two percent globally. But there were communities (such as in Alaska) where the fatality rate was drastically higher. Some populations are more vulnerable than others, based on isolation, poor health care facilities, economic deprivation, lack of sufficient living space, and other factors. As in 1918, we may see drastic differences in fatality rates with COVID-19. …

Guest blog: Chinese student questions about nCoV

I want to say my deep thanks for today’s guest blogger, who looks at the questions that Chinese middle school students have about nCoV in China:

Rachael G.

Middle School Teacher

Hangzhou, China

Resident in China since 2017

My CoN experience started prior to leaving Hangzhou in January. Reports were filtering out over WeChat concerning a virus in Wuhan similar to SARS. While I wasn’t overly concerned, I did pay attention to the news as I had been planning to travel to China prior to the SARS epidemic and had also been in the Middle East a year or so after the MERS outbreak. Suffice to say, these diseases were on my radar.

While visiting Portland during Chinese New Year, I was kept abreast of the situation by my school, the US Consulate in Shanghai, and news coming out of China and the Western news media. As the days progressed, my concerns grew and led to questions as to whether I would be able to return let alone whether I should return. After assessing the Chinese response to the outbreak, I made the decision to return based on many factors, including the seriousness with which the Chinese government was working to mitigate the spread and help Wuhan.

I am neither naïve nor uneducated. I know that my access to the internet and information is more limited in China due to a variety of factors I will not be addressing here. What I’d like to focus on at present is my students’ questions in response to the CoN. I teach grades 7 through 9 at a private school here in Hangzhou, Zhejiang Province, China. Our students come from a variety of socioeconomic backgrounds as entrance to the school is based on entrance exams and not the ability to afford tuition.

Prior to my return, my middle school head of department sent out these questions that the students were asking in regards to the Con outbreak.

Student Questions:

  1. Why can’t the medical supplies get to the hospital?
  2. Where does my money go?
  3. Why can’t we go out for walks or to appreciate nature in unoccupied areas?
  4. Did the closure of Wuhan really isolate the disease? Is closure good or bad?
  5. How can Chinese people help during this time?
  6. What will be the impact on those who left the city hours before or after the closure?
  7. Should the city have been closed or not?
  8. Should foreign countries open their doors to China during this time?
  9. How can we continue eat wild animals without getting sick?
  10. Why did it spread quicker than SARS?
  11. Why are there so many false statements being circulated?
  12. How will this affect our country’s economy and international status after it is fully resolved?
  13. How many people are likely to lose their jobs after this?

These questions led me to think about what is being said on the media the students have access to, what their parents might be sharing, the freedom they felt in inquiring, and their understanding of how the CoN affects not only themselves but their country as a whole and its place in the global community. These questions posed by 12-14 year old students range from concrete to abstract thinking.

Our biggest issue at present aside from fighting the CoN is fighting erroneous information. My students are asking in-depth questions. The country is fighting rumors and inflammatory news reporting, none of which help people get the accurate information they need to avoid transmission or understand the situation. This is not unique to China, as we see it in the Western world as well. Our biggest obstacles are fear and greed.

Tips to avoid Coronavirus/避免冠状病毒的提示

Sign to SARS memorial in Hong Kong

This week my Mandarin homework was to write tips to avoid novel coronavirus. I cheated and used Google Translate at points, so don’t think that my Chinese is this good. Here is what I wrote (after editing from my teacher) in Chinese first and then English.  More importantly, please remember, I am not a doctor or scientist. I have written this assuming that the reader lives in a place with active coronavirus cases in their local area:

新型冠状病毒是一个严重的问题. 那些事情可能有助于保护您和您的家人. 

  1. 避免虚假新闻。会有很多谣言。听专家
  2. 如果附近有新的冠状病毒病例,请进行社交隔离。尽量在家工作吗?
  3. 经常洗手。避免触摸眼睛。
  4. 尽可能多的睡眠。照顾好自己的身体
  5. 注射流感疫苗。这将有助于您在流行病期间远离医生办公室。它还将帮助您避免同时感染新型冠状病毒和流感
  6. 如果您六十五多岁或患有哮喘,请与您的医生谈谈肺炎疫苗。

In order to keep you and your family safe from coronavirus, you should:

  1. Be careful to avoid Fake News, especially on social media. There are many rumors. It’s best to trust experts.
  2. Practice social isolation. Work from home if possible. If not, try to keep more distance from people at work.
  3. Wash your hands frequently.  Avoid touching your eyes.
  4. Get as much sleep as you can. Take good care of your overall health.
  5. Get a flu shot. This may keep you out of the doctor’s office where people are sick. It will also help to keep you from catching both the flu and the novel coronavirus at the same time.
  6. If you have asthma (or another respiratory disease) or are sixty-five or older, talk to your doctor about the pneumonia vaccine. This will help you to avoid pneumonia (and meningitis and other infections) even if you are never infected with the new coronavirus.

For the record, I have no tie to (or investments in) any company that makes vaccines for pneumococcal vaccines. You can also see the Center for Disease Control’s advice on this topic here. And you can see my blog post about nCoV and quarantine here. 

Shawn Smallman, 2020

 

Coronavirus data visualization

The South China Morning Post has an amazing data visualization related on the novel coronavirus outbreak and how it compares to the SARS epidemic. The data visualizations include a map of cases over time, graphs comparing the number of infections to SARS, point visualizations to illustrate the health status of coronavirus patients in China, maps to demonstrate the distribution and fatality rates of different infectious diseases compared to nCoV, an image of a person with a display of symptoms by body area, and a fascinating visual display showing where people from Wuhan traveled between the start of the lunar New Year and the imposition of quarantine, a map of the area around the seafood market where the outbreak began, a chart of the top ten international travel destinations from Wuhan, images of the kind of animals sold in the live market (who knew that it sold the Chinese giant salamander; and why are they selling the scolependra?), a labeled photograph of a live market vendor at work butchering a frog, a map of railway lines from Wuhan, a map of Chinese cities and lockdown and more. The page shows how data visualizations can be combined with art to convey information. Impressive work.

Caixin (this link is to global edition) and the South China Morning Post are doing outstanding work covering this epidemic. The New York Times has an excellent article talking about the Chinese media coverage of the epidemic in a broader context.

For anyone interested in more recent updates about this epidemic, you can also follow my Twitter feed. Lastly, I have a blog post about nCoV and quarantine here. 

Shawn Smallman, 2020

Coronavirus and Quarantine

Health education poster, Hong Kong. Photo by Shawn Smallman

As I write these words nurses in Hong Kong are on strike to protest the fact that the Chief Executive, Carrie Lam, will not close the border to China. To be clear, the executive has sharply restricted entry to Hong Kong, closed most crossings, and forbidden entry from the most affected Chinese state, Hubei.  But there are still strong calls for a complete border closure coming from within Hong Kong’s medical community.  Similarly, the United States has restricted flights from China to U.S. citizens only; some U.S. airlines had already canceled service to China. All such quarantine measures are controversial.

On social media, such as Twitter, and in the press, a number of experts have denounced all quarantines as being not only ineffective but also in violation of WHO guidelines. These authors worried about panic overcoming good judgement, the economic costs of restricting travel, the stigma imposed on those from affected areas (Chinese in particular, but also all Asia), and the importance of upholding International Health Regulations. These are valid and important points. Some authors have also pointed to studies based on computer models showing that quarantines are ineffective with highly contagious respiratory diseases.

Recently the tone has shifted in the discussion, as it has become clear that some cases of the virus are being spread asymptomatically. The number of cases has grown quickly. Some apparent facts (such as no human to human transmission) that seemed true in mid-January are no longer true. So the stridency of the debate about quarantine has declined, but the debate continues.

So is there any role for quarantines to manage such a pandemic? And is there some other way to make a judgement that relies less on computer models? I would suggest that looking at the past history of respiratory pandemics, such as the 1918 influenza pandemic, might be useful. Can history suggest particular circumstances in which quarantines may work? …

Maps and the coronavirus outbreak

Hong Kong Harbor. Photo by Shawn Smallman, 2017

As we track the spread of the coronavirus outbreak, it’s helpful to have maps and other data visualizations to understand the data.

One useful site is Ncov2019Tracking, which says that it: “taps into the Twitter Streaming API and monitors tweets mentioning keywords related to the Novel coronavirus (2019-nCov) outbreak. A machine learning system trained with the supervision of experts filters informative tweets. Geographical entities mentioned in tweets – such as country and city names – are identified using the GeoNames database and used to place tweets on a global map.” This tool provides a useful means to track where people are discussing the epidemic on Twitter. It’s very clear (based on the map on January 31, 2020) that there is a lot of discussion related to the coronavirus taking place that concerns Indonesia and the Philippines.

Researchers at Johns Hopkins Center for Systems Science and Engineering have also created an excellent map and dashboard which shows the geographical location of 2019-nCoV cases (we need a better name). A dashboard also shows total deaths (213 at today’s right), the total number of recovered (222 today) and the total number of confirmed cases (5,806). On the left hand side of the screen there is the total count of cases (9,925) and their geographical locations. At this time, there are 9,783 cases in mainland China, 19 in Thailand, 15 in Japan, and 13 in Singapore. There are also an eclectic group of countries that have a single case: Cambodia, Finland, India, Nepal, Philippines, Sri Lanka, and Sweden.

While technology has made it easier to track the outbreak, authorities in China are reportedly also using drones to chastise people who go out in public without masks, as this video purportedly shows. Lastly, you can read a blog post about quarantine and nCoV here, with some historical context on this question based on the 1918 influenza pandemic. 

Shawn Smallman, 2020

 

Coronavirus podcast

Window of Chinese medicine store in Hong Kong, China. Photo by Shawn Smallman

There is so much discussion of the coronavirus epidemic in the media that it can be hard to find reliable information. One good source of measured, thoughtful information is this podcast, “Coronavirus Infections—More Than Just the Common Cold,” which is an interview with Anthony, S Fauci, the director of the National Institute for Allergy and Infectious Disease. You can also find this podcast on Stitcher and other podcast platforms. To listen to it on Apple podcasts, please search for “JAMA Author interviews,” and go to January 27, 2020.

If you are interested in learning more about live markets, you can read my work here. And this blog posts discusses quarantine and nCoV based on some historical context from the 1918 influenza pandemic.

Shawn Smallman, 2020

Market Sign, Hong Kong. Photo by Shawn Smallman

 

 

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