global health

Laura Spinney’s Pale Rider: A book review

Historical photo of the 1918 Spanish influenza ward at Camp Funston, Kansas, showing the many patients ill with the flu- U.S. Army photographer

After the wonderful histories of Alfred Crosby and John Barry, readers might wonder if there is truly anything new left to write about the 1918 influenza pandemic, which killed between 50 and 100 million people world-wide, at a time when the world’s population was much smaller. Laura Spinney’s detailed, beautifully written and insightful work shows how much study can yet be done on this topic.

As Spinney describes in the opening to her book, in the 1990s much of the writing on this pandemic had been done on Europe and the United States. Of course there were exceptions. In Canada Eileen Pettigrew created a rich narrative of people’s experiences from survivors accounts, while Betty O’Keefe and Ian MacDonald told the story of how medical officer Fred Underhill fought the disease in Vancouver, Canada. There were similar accounts of popular experiences with the pandemic in other countries, such as Australia and New Zealand. But voices in Asia, Latin America and Africa were often not included. Since the 1990s there has been a plethora of work in many different nations, at the same that scientific advances have made it possible to have a much better understanding of the pandemic.

HIV/AIDS, an “Introduction to International Studies” class lecture

Mercator Map of the Congo, 1595, from the Northwestern University Library Maps of Africa collection, accessed through Wikipedia.

I wrote a book, the AIDS Pandemic in Latin America, and have studied public policy and infectious disease for nearly twenty years. Here is a lecture that I wrote (around 2010?) for an “Introduction to International Studies” class. It would need to be updated now; it may also some references to my own experiences, which would need to be removed. But my hope is that it might prove a useful starting place for someone who wants to do a lecture on this topic in a similar class.

Shawn Smallman

HIV/AIDS

Terms:

clades

HIV 1-B

HIV 2

Retrovirus

Cameroon

 

Character of the Virus:

  • HIV is not one virus but many
  • The result of more than one introduction into humanity
  • Two main forms: HIV-1; HIV-2
  • Great diversity
  • Difficult to create vaccine
  • 10 year latency
  • initial infection- blood/sex/mother daughter
  • flu-like symptoms
  • body holds the virus in check
  • over time, the virus gradually erodes the immune system’s ability to defend the body
  • the person dies of opportunistic infections
  • there are different latency periods for different people: my Cuban experience
  • medicines don’t work with everyone: my experience in the support group in Sao Paulo
  • most people, the medications are effective
  • recently realized: in a discordant couple medications prevent transmission in 98% of cases
  • means that treatment is prevention
  • heart-breaking: long argued that treatment was too expensive
  • the only economical way to treat the virus was prevention
  • proves to have been a flawed paradigm

Ethiopia, Innovation and COVID-19

In Taiwan, before entering museums (and many other public institutions, offices, etc.), one needs to enter the Real-Name System (with one’s cellphone, by scanning the QR Code), on top of getting one’s temperature taken / sanitize hands with alcohol. By leaving one’s name and contact information, if a person got infected by COVID-19 and have been to the museum, the government will know who he / she have been in contact with. Photo by Isabella Mori.

One of the realizations that has come with COVID-19 is that the old binary between developed and developing countries is deeply flawed. Some nations that are less wealthy (Vietnam, Thailand) have succeeded very well in limiting the virus’s spread (at least in June 2020), while some wealthier countries (the United States and Great Britain saw their governments fail to control the outbreak, despite not only their relative wealth, but also sophisticated health care systems.

In the United States the CDC and FDA decided not to adopt a test for COVID-19 that was recommended by the World Health Organization (WHO). But their effort to create their own test was badly flawed. When that test proved not to work, it set the US testing back perhaps a month or more behind other nations at the most critical moment in the virus’s spread within the United States. In contrast, countries that adopted the WHO’s recommended test were able to test their populations at scale.

In Boston, there was a testing debacle after a number of people were infected at a Biogen conference. Even after people reported symptoms and repeatedly sought testing they were unable to be tested, because they did not meet the overly strict criteria that included travel to China, or contact with someone from China. The result was a disaster, which saw the outbreak flare so that Boston had one of the worst outbreaks in the world. Meanwhile, Vietnam carried out a very thorough testing program that has allowed to control the outbreak to this date.

One of the most interesting points for me has been the relative difference in innovation between some developing countries and the United States, which is the home of Silicon Valley. In the U.S. there is still no national contact tracing app. Instead individual states (such as North and South Dakota) have had develop their own. But at a national level, the rate of innovation has been painfully slow. In contrast, some developing countries have moved with amazing speed. One of the success stories has been Ethiopia. As Simon Marks described in an article on the Voice of America website, Ethiopian developers quickly created seven different apps to help with everything from contact tracing to supporting health care workers. What is clear is that the size of nation’s economy does not necessarily correspond to its ability to innovate and adapt. American exceptionalism aside, wealthy nations must overcome the hubris and sense of exceptionalism, which have hampered their response to the pandemic. When developed nations take an interest in the the innovations in places from Ethiopia to Thailand, their own response will improve.

A few years ago, I was in Hong Kong, Macau and Shenzhen. When I asked at a coffee shop in Hong Kong if I could pay with a credit card, the clerk said that they could do that. Would I mind waiting while they took the machine out from the cupboard? It would take just a minute to find the keys to the cupboard. At this point, I was embarrassed and ask them not to. But they wanted to help me, and insisted on hooking up the credit card machine for the foreigner. But credit cards felt antiquated in a world in people used WeChat to pay for their subway cards, get their groceries, and order deliveries. People never had touch a device to put in a PIN. When I came back, I realized how antiquated our entire payment architecture is. I think about this during the pandemic every time I go to a gas station or department store and have to first swipe a card, and then put in my PIN on a grungy pad. Of course this is the tip of the iceberg. Why do I still need to pay bills with a check in an age of Venmo and Paypal? In Australia checks have nearly disappeared as a payment form, and it has been more than a decade since most people used one. Five years ago I was talking with an Australian. She said that she was stunned when she moved to the U.S. and people still wanted checks. And why do forms in the US still ask for my department’s fax number?

In Shenzhen I saw the sophisticated drones, electronic devices, and pristine infrastructure. Afterwards when I traveled to New York and saw the state of the airport, it felt like traveling twenty years back in time. In the United States, there is a sense of exceptionalism, which equates modernity and power with being American. But from Asia to Africa there are innovations, technologies and approaches that Western nations -particularly the United States and Britain- would benefit from adopting, particularly during this pandemic. It’s not that the developed/developing binary doesn’t isn’t useful in some circumstances. But in some respects it can conceal more than it reveals.

Shawn Smallman

Dispatch 7, Anemia in Peru

Image of globe on light, McGill University. Photo by Smallman

In episode three of my podcast, “Dispatch 7: Global Trends on all seven continents” I interviewed my honors thesis student Samantha G.  Alarcon Basurto about anemia in Peru. You can find the podcast on different platforms (including Apple podcasts), as well as on Anchor here:

Shawn Smallman

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 1918 pandemic and COVID-19

Food market in Taiwan. Note the plastic partitions separating customers. Photo taken by Isabella Mori in May 2020.

Like many people, I’ve been struck by the parallels between the current COVID-19 pandemic and the 1918 pandemic.  In 1918 many media outlets in Europe and the United States did not initially give the outbreak adequate coverage, because they were censored during the war, or did not want to reveal their nation’s weaknesses. In the United States and Brazil now, populist leaders are dismissive of the news and data on COVID-19, because it reveals their failures. For this reason, their followers tend to view all COVID-19 information through the lens of partisan politics. Indeed, President Bolsonaro of Brazil has called his followers to storm hospitals to take photos and videos to show whether COVID-19 patients are truly filling hospital beds, as the hospitals and state leaders claim. Such denial has caused painful climbs in COVID-19 deaths in both Brazil and the United States. …

COVID-19 in Latin America

Flyer for our upcoming presentation

Next Tuesday my department will be having a presentation on Zoom  about COVID-19  in Latin America. During this discussion I’ll be talking about Bolsonaro’s leadership in Brazil, and the current pandemic trends in that country. Dr. Rodriguez will be talking about Argentina’s response, while Dr. Young will be discussing the experience of both Cuba and Mexico. Since I know little about the COVID-19 situation outside of Brazil in Latin America, I am particularly interested to hear what my co-presenters will say. The talk will be 2pm West Coast (US) time. Please RSVP if you are interested in participating.

Shawn Smallman

Fear, Fact and Fiction: COVID-19’s Origins and Spread

 

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

I gave a talk yesterday for WorldOregon on COVID-19, and what we know about it’s origins and spread, as compared to conspiracy theories. What you might not know when you watch this is that I wrote a talk before asking how long it should be. So I wound up having a fifty minute talk for a twenty minute delivery. Throughout the whole talk I was trying to summarize. My bad. But I had a good time and enjoyed hearing the questions. Thanks WorldOregon! …

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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