COVID-19

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

The strange trip from Chronic Fatigue to long COVID

Every pandemic leaves in its wake people who survived, but were changed by their infection. The most famous example of this is likely encephalitis lethargica, which famously reduced some people to living in a near coma after they survived the 1918 influenza pandemic. For decades some people have been arguing that Chronic Fatigue Syndrome (and perhaps chronic Lyme disease) are also caused by viruses and bacteria, which cause immense but hidden damage in the body. These sequelae endure after the initial infection subsides. Over the last several months many people who were infected by COVID-19 have developed long COVID, a syndrome that remains a medical mystery. One of my favorite new podcasts is Unexplainable, which looks at scientific mysteries. Their recent episode, “The Viral Ghosts of Long COVID” paints an unsettling picture of this disorder. The podcast begins with someone describing the long term effects of their Ebola infection, which closely resemble the symptoms reported by COVID survivors. Many people now wonder whether more research on Chronic Fatigue Syndrome earlier might not have made us better prepared to face this new challenge now.

Shawn Smallman

The odd reasons for Taiwan’s COVID-19 outbreak

I am fortunate to be a Taiwan Fellow this fall. I plan to study Taiwan’s response to the COVID-19 outbreak at National Taiwan University starting this September, where I am being hosted by the global health program. I just received my visa to travel to Taiwan last week. Unfortunately, there is currently a growing outbreak in Taipei. I first heard of it last week, when I was talking with my conversational partner in Taiwan. At that time, she said that the outbreak was still relatively small, as it involved perhaps thirty individuals. But this morning I had an email and a text -the latter of which was sent to everyone who recently received a visa- to say that Taiwan is halting all travel to the island, except for residents. I am hopeful that Taiwan will soon have the situation back under control. But what happened?

Taiwan received human intelligence about the outbreak in China in December 2019. Taiwan acted quickly, in part because it’s political leaders remembered the SARS outbreak in 2003. Since that time, it has used digital apps for contact tracing, mandatory quarantine hotels for travelers, and an effective public health system to contain COVID. Then some odd things happened. Angelica Oung has written a fascinating story (How Taiwan Finally Fell) recounting how a Taiwanese hotel decided to offer a tourism package so that Taiwanese could stay in a hotel near the airport and watch the flights land and depart from their rooms. The local tourism board even advertised this. Although the people were housed on different floors from airplane crews, somehow infected pilots and crews spread the virus to the domestic tourists. After nine pilots tested positive the domestic tourists apparently found out that they had been staying at a quarantine hotel by watching the TV news. But by this point some infected people attended a Lion’s Club meeting, went to karaoke, and then attended “Grandpa shops/tea parlors” in which older women sexually catered to a senior clientele. Genomic testing revealed that everyone with COVID-19 had been infected by the same English variant. …

Singapore’s strange ad to vaccinate

Photo by Pang Yuhao on Unsplash

All around the developed world nations and local governments are trying to persuade people to go have a COVID-19 vaccination. Where I live, I am flooded with ads, which are mostly politicians and public health authorities. These ads mostly have a talking head format, so they don’t have a lot of visual interest. And no catchy songs. Then there is Singapore’s approach.

Singapore’s most recent ad highlights a comic duo, a musical number, uni-color background shots, Singlish and dance. I’m not sure where I first read about this two minute ad, but it shows another approach to public health communication. Here in the United States, I hope that we’ll see ads with football quarterbacks, basketball players, religious leaders, movie stars, musicians and others. People need to see spokespeople supporting the vaccine who aren’t epidemiologists. And maybe somebody else could do a musical about vaccinating. “Steady pom pi pi” everyone.

Shawn Smallman, 2021

Photo by Pang Yuhao on Unsplash

The best source for COVID-19 information?

Photo by Martin Sanchez on Unsplash

Who would have guessed that one of the best sources for regular and reliable COVID-19 information would be a retired nurse teacher in northern England? By this point in the pandemic, one would expect that the last thing that anyone would want to hear would be more news about COVID-19. Yet people turn in daily for Dr. John Campbell’s YouTube update, which usually feature Winston -a stuffed dog- wearing a mask in the background. One of the reasons that the show is so popular is Campbell’s English humor, his guests from different parts of the world, and his concise description of major trends in the pandemic. I don’t know that I always agree with all that Dr. Campbell suggests, such as the strength of the evidence for vitamin D being advantageous. But I enjoyed watching him debate the issue with a vitamin D skeptic, who was also a leading researcher in this field. Such reasoned and respectful academic debate is too rare now.

As I write these words, the situation in India is truly dire. I’ve just been texting with a friend in the country, who said that so many bodies are being burned that their city is covered in smog. The Daily, a news podcast of the Times, has a remarkable episode about what is happening in India now. As an article in Canada’s National Post suggests, India’s experience is a warning to the rest of the world about what can happen if a nation becomes overconfident that they have managed the pandemic. But India is not alone, as COVID-19 cases are also surging in Chile, despite a high level of vaccination with a Chinese vaccine. In the United States numbers are in a steady decline, despite an uptick in both Colorado and Oregon. But we still have a long way to go in this pandemic. In many parts of the world, such as Thailand and Cambodia, the situation is worsening. And Japan is still holding the Olympics, even though most of the country’s citizens do not want to host it. I recommend John Campbell’s YouTube channel for anyone who wants to stay current with COVID-19 news.

Shawn Smallman, 2021

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

Two pandemics: Ghosts of the 1918 outbreak

Recently I’ve been reading a book (published in 2004) by Betty O’Keefe and Ian McDonald titled, Dr Fred and the Spanish Lady. The work examines the experience of Dr. Fred Underhill, who was the senior public health officer in Vancouver during the 1918 pandemic. While there had been a host of influenza pandemics through history, the 1918 pandemic killed perhaps 100 million people globally.

What struck me while reading the work was the manifold similarities between our experience of COVID-19 and that of almost exactly a century before. During our current pandemic some countries, such as Australia, New Zealand and Taiwan, acted quickly to enact travel restrictions. But that was the exception rather than the norm. Similarly, in 1918 troop ships brought influenza to Canada, even though during the crossings the ships would have to repeatedly stop for the burial of sea for returning soldiers (O-Keefe and MacDonald, 30-31). In 1918, travel restrictions were not implemented because everyone in Canada wanted to bring the troops home. While understandable, this was also tragic. During COVID-19 there were no effective limits on returning citizens in the United States, likely because there just was not enough public support for this measure. Of course, there were limits on non-citizens’ travel. But since the SARS-Cov2 virus does not discriminate based on citizenship, those countries that did not limit their citizen’s movement, and quarantine them on arrival, have paid a heavy price. …

How quickly can you catch COVID-19?

Throughout the last several months, the US Center for Disease Control has messaged that in order to catch COVID-19 you had to be within six feet of an infected person for fifteen minutes. This was reassuring information. But sadly the US was also perhaps in a difficult place to answer detailed questions about COVID cases, because the contact tracing system has been overwhelmed. The US has also lacked a national COVID tracking app, as many other nations (Australia) have had. Realistically, this would have been a political impossibility to implement in the US, given that even masks have been highly politicized here. So, how realistic was the CDC’s guidance?

The CDC itself pointed to a case in Vermont in which a masked corrections officer was infected with COVID even though he never spent more than a single minute with infected prisoners. Instead, he spent perhaps a total of 17 minutes in a day with them over the course of multiple brief visits, all of which were captured on video. He also wore a mask, gown, and goggles. The prisoners sometimes wore their masks, and sometimes not. After this case, the CDC changed its rules to reflect cumulative exposure. Still, the fifteen minute rule still held. But would new information change these guidelines?

In Korea, contact tracing has been highly effective. It turns out that the combination of a digital tracking app with highly skilled contact tracers has been more successful than either purely digital or human tracing would be. And what Korea has learned -in a remarkable piece of scientific work- is that in one case a high school senior was infected after five minutes of exposure and from twenty feet away. The infection took place in a restaurant (which had video recording) and it turns out that an air conditioning unit was wafting air from an infected person towards the student. The quality of the data that the contact tracers obtained -and the history of how they learned it- is remarkable, and well worth reading.

There is nothing magic that happens at the six feet mark from another person. And being exposed to an infected person indoors can be risky even when the CDC’s old guidelines might make us feel safe. In this case, Korea has given us not only important information, but also let us see the quality of information contact tracing can provide. The key message is that neither six feet of distance, or avoiding more than fifteen minutes of exposure to another person, may be enough to keep you safe from infection, particularly indoors. So indoor dining is probably always unsafe.

Shawn Smallman

Do we already have a vaccine to prevent COVID-19?

Bust and Plaque at the Fighting SARS memorial, Hong Kong

A recent study published in the American Journal of Microbiology journal, MBIO, suggests that MMR 2 vaccine helps to prevent COVID-19 symptoms. It’s a study based on a small population (80), but the MMR blood titers show a very strong association with the severity of COVID-19 illness. People with high titers were all asymptomatic. Everyone who became severely ill had titers under 32. This wasn’t the first article exploring this idea of an association between MMR vaccination and COVID-19 resistance. But it’s an intriguing one that deserves more attention and research.

As a press release from the American Journal of Microbiology states, this could also explain why children don’t seem to get seriously ill. The MMR blood titers fall as you age. And the elderly may never have had this vaccine, in part because they’ve had measles or mumps. One significant point to the study was that having had the mumps doesn’t protect you. People need to have the vaccine itself. This contradicts the argument of vaccine critics who say that it’s better to have natural immunity. But in this case, the vaccine seems to give better immunity. As someone who had mumps as a child (and then gave it to my sister) I’m in favor of a vaccine-based approach to public health, rather than natural or herd-immunity.

I want to emphasize again that this study was based on the MMR blood titer results of only eighty people who had COVID-19. So this is a preliminary study. But the risks of the MMR are very low; at least hundreds of millions of people have had it since it was first introduced in 1971. Please note that this study only examined the MMR 2, not the quad vax, which also includes varicella.

Even though new COVID vaccines are coming soon, it will take months to roll the out at scale. It would be wonderful if we could use an existing vaccine with a long track record for safety to help us to buy time.

Shawn Smallman

COVID-19 in Latin America

Years ago I wrote a book on the HIV pandemic in Latin America, which focused on the diversity of epidemics within the region. How could one virus cause such a diversity of outbreaks? Of course it’s impossible to discuss an epidemic without considering human behavior, which we certainly see now with COVID-19. What’s interesting to me is the contrast between Africa, where the death rate has been relatively low, and the severe outbreaks in some Latin American states. Two of my colleagues and I discussed Latin America’s experience with the outbreak in late May, on a panel that focused on Argentina, Brazil and Mexico. Of course, much has happened since then, from the terrible outbreak in Peru, to the mounting challenges faced by Argentina. Still, the broad strokes about how these nations responded to the pandemic has remained similar, such as the populism and denial of Brazil’s President Bolsonaro. You can view our panel here on YouTube.

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