global health

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. …

Strengthening the U.S. health care system

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

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:

  1. A health care system that invests heavily in technology, but less so in people, such as the public health professionals who do contact tracing.
  2. A lack of recent experience with pandemics, such as South Korea and Canada had with SARS and MERS.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Deep health inequalities, which mean that case fatality rates may vary widely depending upon class and geography.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. An over-reliance on overseas manufacturing for key health goods, for everything from masks to medications.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.

Maps, Charts and data for COVID-19

Local market sign in Cambridge, Massachusetts, March 17, 2020

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.

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