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. …

The possible coronavirus pandemic

Hong Kong. Photo by Shawn Smallman

Even though it’s only been a few days, my last blog post is becoming out of date with amazing speed. This article in Eurosurveillance describes much of what we know to date. In Wuhan, China there is evidence that the corona virus outbreak is beginning to overwhelm the health care system. The New York Times has had disturbing videos taken from inside the hospitals, where dead people lay in the halls, and a patient begs a doctor to save her. He turns and strides away without a word. The South China Morning Post has incredible coverage of the outbreak. In one article, Mimi Lau described how desperately ill people were turned away from treatment at one overwhelmed hospital after another. Of course, it’s also important to note than in these hospitals, where health care workers are short on equipment, gloves, masks and medicines, people are still working to care for patients at great personal risk.

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