H5N1

Our long night of the virus

The Tyee has published my long review of four important new books about the pandemic: Our Long Night of the Virus. Excerpt:

The pandemic and climate change, combined, have triggered what [Adam] Tooze calls a “great acceleration,” when events outrun earlier predictions and solutions. We will therefore have to improvise new solutions — or, like the populists, stick to a very old non-solution of anti-science white supremacy in the hope of returning to the “before times.” 

The imperial infection  

Rupa Marya, an American physician of Indian descent, and Raj Patel, a British academic, journalist and author, offer a solution from the before times in their book Inflamed: Deep Medicine and the Anatomy of Injustice. They argue that this pandemic, like countless disease outbreaks before it, is a consequence not just of a virus but of an imperialist world order that triggered disease and then built a medical system to serve the rulers, not the victims.  

This is not some radical Marxist spin, but established medical history. In the early 19th century, British development turned wetlands into farmlands in what is now Bangladesh, and brought a marine bacterium called Vibrio cholera into human guts. Cholera rapidly migrated on trade routes to London and beyond.  

In London, Dr. John Snow founded modern epidemiology by spotting the precise well that was infecting the neighbourhood. His medical colleagues dismissed his idea, but eventually Britain rebuilt its water supply system and greatly improved its workers’ health. Travellers from India were screened at Suez to try to stop further outbreaks from reaching Europe. But like Omicron, cholera was all over the planet by the time it was recognized.  

Meanwhile, cholera was left to ravage India itself, and we are now in the seventh cholera pandemic, which began in Indonesia in 1961 and most recently exploded in Haiti in 2010.  

Marya and Patel are by far the most radical analysts of this pandemic. They have no interest in blaming Donald Trump or the CDC; they are just the agents of a system created to serve the interests of 19th century empires, and which now protects the white heirs of those empires while ignoring the “essential” workers who serve those heirs.  

The authors have strong confirmation from others like Alex de Waal, whose recent book shows how Louis Pasteur’s germ theory defeated the German scientist-politician Rudolf Virchow, who had long argued for social and economic inequality as the root of disease outbreaks. Pasteur had blamed individual microbes, which could be isolated, fought and defeated like rebellious tribesmen in some remote colony. We still fall back on war metaphors to describe our response to the pandemic.

Canada: National health expenditure trends

Via the Canadian Institute for Health Information: National Health Expenditure Trends. Excerpt

November 4, 2021 — National Health Expenditure Trends, 2021 — the 25th edition of the annual publication on health expenditure trends — provides detailed information on health spending in Canada using the National Health Expenditure Database (NHEX).  

This year’s release presents finalized 2019 actual health expenditures and preliminary estimates for 2020 and 2021. The 2020 and 2021 projections include government-budgeted funding for health-related activities as a time-limited emergency response to the COVID-19 pandemic. National Health Expenditure Trends forecasts are based on main estimates and budgets for the public sector.  

Note: Preliminary estimates are subject to revision when actual data becomes available in subsequent years. This year’s spending estimates may experience larger revisions than usual due to uncertainty around COVID-19 pandemic spending.

Key findings  

• Total health spending in Canada is expected to reach a new level in 2021, at more than $308 billion, or $8,019 per Canadian. It is anticipated that health expenditure will represent 12.7% of Canada’s gross domestic product (GDP) in 2021, following a high of 13.7% in 2020.  

• Total health expenditure in Canada rose by 12.8% in 2020 due to pandemic response funding. Prior to the pandemic, from 2015 to 2019, growth in health spending averaged 4% per year.  

• Hospitals (25%), Drugs (14%) and Physicians (13%) are expected to continue to account for the largest shares of health dollars (more than 50% of total health spending) in 2021. A new spending category — COVID-19 Response Funding — makes up 7% of total health spending, which includes federal direct and provincial/territorial government–sector spending.

Consumption in the G20 nations causes particulate air pollution resulting in two million premature deaths annually

Via Nature Communications: Consumption in the G20 nations causes particulate air pollution resulting in two million premature deaths annually. The abstract:

Worldwide exposure to ambient PM2.5 causes over 4 million premature deaths annually. As most of these deaths are in developing countries, without internationally coordinated efforts this polarized situation will continue. As yet, however, no studies have quantified nation-to-nation consumer responsibility for global mortality due to both primary and secondary PM2.5 particles. 

Here we quantify the global footprint of PM2.5-driven premature deaths for the 19 G20 nations in a position to lead such efforts. G20 consumption in 2010 was responsible for 1.983 [95% Confidence Interval: 1.685–2.285] million premature deaths, at an average age of 67, including 78.6 [71.5–84.8] thousand infant deaths, implying that the G20 lifetime consumption of about 28 [24–33] people claims one life. 

Our results indicate that G20 nations should take responsibility for their footprint rather than focusing solely on transboundary air pollution, as this would expand opportunities for reducing PM2.5-driven premature mortality. Given the infant mortality footprint identified, it would moreover contribute to ensuring infant lives are not unfairly left behind in countries like South Africa, which have a weak relationship with G20 nations.

Reading about COVID-19

Early next year, I'll be teaching "Perspectives on Pandemics," a course for Eldercollege here on the North Shore—going back to the Athenian and Justinianic plagues and the Black Death, but focusing on COVID-19. I'm pulling together a suggested reading list for my students, and it occurred to me that others might want to explore some of these titles as well. So here they are. Some include links to my Tyee reviews; others will be mentioned in a long article I'm working on. I'll update this list from time to time.

Peter Baldwin, Fighting the First Wave: Why the Coronavirus Was Tackled So Differently Across the Globe. Cambridge University Press, 2021. My review: https://thetyee.ca/Analysis/2021/03/30/Best-Book-Written-About-COVID-Pandemic/

Alex De Waal, New Pandemics, Old Politics: Two Hundred Years of War on Disease and Its Alternatives. Polity Press, 2021. My review: https://thetyee.ca/Culture/2021/07/09/All-Plagues-Are-Political/

Elaine Dewar, On the Origin of the Deadliest Pandemic in 100 Years: An Investigation. Biblioasis, 2021.

Fang Fang, Wuhan Diary: Dispatches from a Quarantined City, translated by Michael Berry. HarperCollins, 2020. My review: https://thetyee.ca/Culture/2020/05/27/Wuhan-Diary-Book/

Richard Horton, The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again. Polity Press, 2020. My review: https://thetyee.ca/Culture/2020/06/22/Only-Newly-Vigilant-Society-Can-Stop-Next-Pandemic/

Colin Kahl & Thomas Wright, Aftershocks: Pandemic Politics and the End of the Old International Order. St. Martin’s Press, 2021.

Michael Lewis, The Premonition. W.W. Norton, 2021. My review: https://thetyee.ca/Culture/2021/05/18/Hot-Pandemic-Book-Poses-Danger/

Rupa Marya & Raj Patel, Inflamed: Deep Medicine and the Anatomy of Injustice. Farrar, Straus & Giroux, 2021.

Jon Sternfeld, Unprepared: America in the Time of Coronavirus. Bloomsbury, 2021. My review: https://thetyee.ca/Culture/2020/12/22/Unprepared-America-Time-Coronavirus-Book/

Steven Taylor: The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. Cambridge Scholars Publishing, 2019. My review: https://thetyee.ca/Culture/2020/07/10/Mental-Toll-Covid-Doctors-Saw-Coming/

Adam Tooze, Shutdown: How Covid Shook the World’s Economy. Viking 2021.

Lawrence Wright, The Plague Year: America in the Time of COVID. Alfred A. Knopf, 2021.

Covid recovery poses dire climate, health risks: Lancet

Via The Times of India, an AFP report: Covid recovery poses dire climate, health risks: Lancet. Excerpt:

PARIS: Countries' fossil-fuel powered Covid-19 recoveries will have long-lasting consequences on human health and risk worsening the food and water insecurity, heatwaves and infectious diseases already threatening billions globally, a major assessment warned Thursday.  

The Lancet Countdown is the largest annual study of the impacts of climate change on human health.  

It found that up to 19 percent of Earth's land mass was affected by extreme drought in 2020 and warned that climate change posed a major threat to food security, which already affects more than two billion people.  

Compared with the historic average, the global population of over-65s lived through 3.1 billion additional extreme heat days last year, it found.  

Populations of 134 countries are now at greater threat from wildfires than at any time previously, and millions of farmers and construction workers are losing income because of the rising number of extremely hot days.  

And climate change is creating ideal conditions for infectious diseases such as dengue fever, Zika virus, cholera and malaria across a far larger span of the globe than just a few decades ago and including Europe, it said.  

"Climate change is here and we're already seeing it damaging human health across the world," said Anthony Costello, executive director of the Lancet Countdown.  

"As the Covid-19 crisis continues, every country is facing some aspect of the climate crisis too."  

The assessment found that the five years with the most areas affected by extreme drought have all occurred since 2015.  

Disruption to the water cycle due to global heating shortens the time in which plants reach maturity, resulting in small yields putting ever-greater stress on food production.  

The Lancet said that yield potential for maize -- a global staple -- had already declined 6 percent compared with 1981-2010 levels.  

Wheat has seen a 3-percent yield potential fall, and rice a 1.8-percent fall, it found.  

And the marine food upon which 3.3. billion people depend on for either sustinence or income is under "increasing threat", with average sea temperature rising in nearly 70 percent of territorial waters compared with just 15 years ago.  

The report also warned that nearly three quarters of countries surveyed said they believed they could not afford an integrated national health and climate strategy.  

"This year we saw people suffering intense heatwaves, deadly floods and wildfires," said lead author Maria Romanello.  

"These are grim warnings that, for every day that we delay our response to climate change, the situation gets more critical.  

"It's time to realise that no one is safe from the effects of climate change."  

In an editorial, the Lancet called on world leaders at the forthcoming COP26 summit to divert some of the trillions they are spending on Covid-19 recovery to reduce inequality and safeguard health.  

"This year's indicators give a bleak outlook: global inequities are increasing, and the direction of travel is worsening in all health outcomes."

COVID-19 hospital stays cost 3 times more than a stay for heart attack

A news release from the Canadian Institute for Health Information: COVID-19 hospital stays cost 3 times more than a stay for heart attack.

The estimated average cost of a hospital stay for COVID-19 is more than $23,000 [US$18,145]. This includes both intensive care unit (ICU) and non-ICU admissions. New data from the Canadian Institute for Health Information (CIHI) shows that a COVID-19 hospital stay costs about 3 times more than for heart attack ($7,000) or pneumonia ($8,000), 4 times more than the cost of a stay for influenza (approximately $5,000) and almost as much as a kidney transplant ($27,000).   

People who have COVID-19 remain in the hospital about twice as long as the average pneumonia patient (15 days and 7 days, respectively), and a larger proportion of them are admitted to the ICU and ventilated.  

Estimated costs for COVID-19 hospital stays  

The estimated total cost of COVID-19 hospital stays in Canada (excluding Quebec) was almost $1 billion in 2020–2021, tripling between November 2020 and March 2021.  

A COVID-19–related hospitalization with ICU admission is estimated to cost over $50,000 — more than 3 times the cost of a stay without ICU admission ($15,000). By comparison, the average cost of an ICU admission for pneumonia is $22,000 and for heart attack is $8,400.  

More detailed information about COVID-19 hospitalizations and emergency department visits is also available.   

Hospital spending last year  

Before the pandemic began, Canadian hospitals (excluding Quebec and Nunavut) spent more than $55 billion in 2019–2020. Compensation was the largest spending area at 64%, followed by supplies (11%). You can find more information on hospital spending in 2019–2020, including per capita data and provincial/territorial breakdowns, on our website.  

These figures reflect the most recent information available from April 1, 2019, to March 31, 2020. Cost estimates for COVID-19 and other common hospitalizations are forecasted values.

Taiwan reports widening income gap amid COVID-19 pandemic

Via FocusTaiwan.tw: Taiwan reports widening income gap amid COVID-19 pandemic.

Taipei, Aug. 22 (CNA) The COVID-19 pandemic had changed the lifestyles of people in Taiwan dramatically and has led to a sharp rise of income inequality, the Directorate-General of Budget, Accounting and Statistics (DGBAS) said Sunday, citing 2020 data. 

Since COVID-19 was first confirmed to have spread to Taiwan in January last year, it has disrupted the country's manufacturing operations, hurt consumer confidence and dealt a blow to the service industry, the DGBAS said. 

While average household savings grew by a record annual 14.8 percent last year to NT$265,000 (US$9,461) since 1994, the income gap between rich and poor households widened, the DGBAS said, citing its 2020 Survey of Family Income and Expenditure. 

In 2020, income inequality in Taiwan was the highest in eight years, with the top 20 percent of households earning 6.13 times the bottom 20 percent, according to the DGBAS. 

Chu Tzer-ming (朱澤民), head of the DGBAS, attributed the sharp rise income inequality to the fact that disadvantaged employees have been hit harder by the economic fallout from the COVID-19 pandemic, as many of them have been asked to take unpaid leave, for example. 

Meanwhile, the DGBAS survey showed that average household spending in Taiwan fell by an annual 1.7 percent in 2020 to NT$815,000 (US$29,107), registering the biggest drop on record. 

Dachrahn Wu (吳大任), director of the Research Center for Taiwan's Economic Development at National Chengchi University, said the threat of new COVID-19 variants might take a toll on Taiwan's job market this year, dimming the prospects of a reduction of income inequality. 

The COVID-19 outbreak has ravaged Taiwan's economy more heavily this year than in 2020, when compensatory consumption surged in the second half of the year after the government eased some its disease prevention restrictions, he said. 

Taiwan's manufacturing capacity and exports, however, have grown sharply this year, bringing benefits to shareholders and employees of companies in the manufacturing and high tech sectors, he said. 

In comparison, employees in the service industry saw their earnings drop due to job loss or furloughs, as economic activity declined due to the COVID-19 outbreak, Wu said. 

The government should do more to provide relief to economically and socially disadvantaged people affected by the COVID-19 outbreak, Wu said, noting that property sales were brisk in the first half of 2021 and the domestic economy will grow robustly for the whole of the year.

In Iran, slow vaccinations fuel anger in unending pandemic

Via The Associated Press: In Iran, slow vaccinations fuel anger in unending pandemic. Excerpt:

DUBAI, United Arab Emirates (AP) — Iranians are suffering through yet another surge in the coronavirus pandemic — their country’s worst yet — and anger is growing at images of vaccinated Westerners without face masks on the internet or on TV while they remain unable to get the shots. 

Iran, like much of the world, remains far behind countries like the United States in vaccinating its public, with only 3 million of its more than 80 million people having received both vaccine doses. But while some countries face poverty or other challenges in obtaining vaccines, Iran has brought some of the problems on itself. 

After Iran’s Supreme Leader Ayatollah Ali Khamenei refused to accept vaccine donations from Western countries, the Islamic Republic has sought to make the shots domestically, though that process lags far behind other nations. 

The supply of non-Western shots remains low, creating a black market offering Moderna and Pfizer-BioNTech shots for as much as $1,350 in a country where the currency, the Iranian rial, is on the verge of collapse. Meanwhile, U.S. sanctions imposed on Iran mean the cash-strapped government has limited funds to purchase vaccines abroad. 

And even as the delta variant wreaks havoc, filling the country’s already overwhelmed hospitals, many Iranians have given up on wearing masks and staying at home. 

The need to earn a living trumps the luxury of social distancing. 

“What is next? A sixth wave? A seventh wave? When is it going to end?” asked Reza Ghasemi, a 27-year-old delivery man without a face mask, smoking a cigarette next to his motorbike on a recent day in Tehran. “It is not clear when this situation will change to a better one.” 

Since the start of the pandemic, Iran has recorded nearly 4 million COVID-19 cases and more than 91,000 deaths — the highest numbers across the Middle East. 

In a video message broadcast Wednesday on state TV, Iran’s supreme leader Ayatollah Ali Khamenei described the skyrocketing death toll as “very painful,” urging officials to roll out free virus tests and the fatigued public to follow health measures. 

The true count is believed to be much higher. In April 2020, Iran’s parliament warned its case number was “eight to 10 times” higher than the reported figures, due to undercounting. While coronavirus testing capacity has surged since then, officials repeatedly have suggested the case count remains far off. The death toll is likely three times higher, officials say, as Iran only counts those who die in a hospital while being treated for coronavirus.

Iran at risk of fifth COVID-19 wave as Delta variant spreads - Rouhani

Via Reuters: Iran at risk of fifth COVID-19 wave as Delta variant spreads.

DUBAI, July 3 (Reuters) - Iran may face a fifth wave of COVID-19 infections as the highly contagious Delta variant of the coronavirus spreads through the Middle East's worst-hit country, President Hassan Rouhani warned on Saturday. 

"There are concerns that the whole country may enter a fifth wave if enough care is not taken in following health protocols. Today, reports are that just 69% of the people are observing the precautions," Rouhani said in remarks broadcast on state TV. 

"The Delta variant entered the country from the south and southeast, and we should have been careful to prevent its spread in the country. All health regulations... must be fully observed, otherwise we will have a problem," Rouhani said. 

Iran, with a population of 83 million, has recorded 84,627 deaths from coronavirus, the highest toll in the Middle East. 

Health authorities have declared the capital Tehran and 91 other cities and towns as high-risk "red" zones, 30 more than a week ago. They are ordering internal travel restrictions, the closure of non-essential businesses and limiting work attendance to 30 percent of employees in the capital. 

 The government has blamed a slow vaccination drive on U.S. sanctions hampering efforts to buy foreign vaccines and on delays in deliveries. Rouhani said Iran has received a small portion of the 16.8 million vaccines it has ordered from the COVAX global vaccine-sharing program. 

A spokesman for the coronavirus taskforce told state TV that 7 million doses of vaccines have been distributed, with 2 million people receiving both doses and 4 million just one. 

Iran has licensed for public use two locally produced vaccines, including one together with Cuba, and is working on five more homegrown vaccines. Tehran is also cooperating with Russia on producing the Sputnik V jab. 

Food, medicine and other humanitarian supplies are exempt from U.S. sanctions reimposed on Tehran in 2018 after President Donald Trump walked away from a 2015 international deal over Iran’s nuclear program. 

But the U.S. measures, which target sectors including oil and financial activities, have deterred some foreign banks from processing financial transactions with Iran. Tehran says this has frequently disrupted efforts to import essential medicines and other humanitarian items.

Air pollution impacts of COVID-19–related containment measures

Via Science Advances: Air pollution impacts of COVID-19–related containment measures. The abstract: 

Responses to the COVID-19 outbreak resulted in one of the largest short-term decreases in anthropogenic emissions in modern history. To date, there has been no comprehensive assessment of the impact of lockdowns on air quality and human health. 

Using global satellite observations and ground measurements from 36 countries in Europe, North America, and East Asia, we find that lockdowns led to reductions in NO2 concentrations globally, resulting in ~32,000 avoided premature mortalities, including ~21,000 in China. However, we do not find corresponding reductions in PM2.5 and ozone globally. 

Using satellite measurements, we show that the disconnect between NO2 and ozone changes stems from local chemical regimes. The COVID-related lockdowns demonstrate the need for targeted air quality policies to reduce the global burden of air pollution, especially related to secondary pollutants.