H5N1

The UK's COVID response: "Lies, deceptions and callous conceit"

Via The Lancet, editor Richard Horton studies the UK's dismal government response to COVID-19: Offline: “Laughing at the Italians”.

A former minister for health in England wrote to me that “The COVID-19 inquiry will make us the laughing stock in the eyes of the world.” But it is worse than that. The level of criminal incompetence exposed by recent witnesses to the UK COVID-19 Inquiry, chaired by Baroness Heather Hallett, has proven that many, if not most, of over 230 000 deaths were preventable. Amid the claims of extreme misogyny, profanity, and chaos that litter the evidence is a story of complete government breakdown.  

WHO declared a Public Health Emergency of International Concern on Jan 30, 2020. The UK Government was confident it could ride out the storm coming from China. Martin Reynolds, who was at the time Prime Minister Boris Johnson's Principal Private Secretary, believed “the system [was] gripping the challenge”. Lee Cain, who was Downing Street's Director of Communications, thought the outbreak was simply a matter for the Department of Health and Social Care. Chris Whitty, the Chief Medical Officer (CMO), briefed Johnson about the risk of a pandemic on Feb 4, 2020. Johnson expressed concern about over-reacting.  

The discussion focused on repatriating UK nationals from China, according to Imran Shafi, then Private Secretary to the Prime Minister for Public Services. Government committees were waking up to the threat. COBR (Cabinet Office Briefing Rooms), a group responsible for managing national crises, concluded that the UK's public health system lacked capacity for dealing with a pandemic.  

But the extent of the danger did not penetrate to the centre of government. The CMO reassured Downing Street that there was no sustained transmission outside Wuhan. Then something very strange took place. Johnson took a 2-week holiday. From Feb 14 to Feb 24, he absented himself from Cabinet and COBR meetings, and received little or no further information about the growing risk of COVID-19. Yet it was clear by mid-February that there was sustained coronavirus transmission in the UK.  

Matt Hancock, then Secretary of State for Health and Social Care, reassured colleagues that a plan was in place. By the time Johnson returned from his vacation, clusters of infection were being reported in Italy's Lombardy region. The “macho culture” of No 10 translated into politicians and their advisers “laughing at the Italians”, according to Helen MacNamara, who was Deputy Cabinet Secretary.  

They remained supremely confident that the UK would be world-beating at conquering COVID-19. A meeting of the Civil Contingencies Secretariat on Feb 28 concluded that a global pandemic was now likely (Shafi). Still Johnson and his closest advisers failed to engage.

Johnson chaired his first COBR meeting on March 2. A COVID-19 Action Plan appeared the next day but, according to Cain, it was nothing more than a “thin overview”. By the time Italy locked down on March 9, Reynolds readily agreed that the UK was “playing catch up”. But there was still no plan, no strategic direction, and no leadership. Instead, a debate raged about mitigation versus suppression. 

 

The evening of March 13 was the moment Downing Street realised that the NHS would be overwhelmed if it continued to pursue a policy of mitigation (herd immunity). Only now did the principals have NHS data showing that hospitalisations were rising faster than models predicted. Dominic Cummings, Johnson's main adviser, drew out the threat on a whiteboard that became the instrument for persuading politicians that lockdown was the only option. Treating coronavirus like influenza had been a monumental mistake—“something had gone horrifyingly wrong” (Cummings). “We were heading for a total disaster” (MacNamara). 

 

Yet Johnson still remained sceptical. In a meeting on March 19 between Johnson and Rishi Sunak, his Chancellor, Johnson said, “We’re killing the patient to tackle the tumour…Why are we destroying the economy for people who will die soon anyway” (Shafi). The UK Government finally locked the nation down on March 23. 

 

Officials who have given evidence looked wearily astonished as they described the country's biggest national crisis since World War 2. After Johnson's landslide election victory in December, 2019, they had expected to serve a two-term government. But as the pandemic spread, they admitted that “we weren’t ready for the crisis” (Reynolds). It was a “historic catastrophe” based on “disastrous groupthink” (Cummings). 

 

The lies, deceptions, and callous conceit that characterised the UK's initial response to COVID-19 must surely bring some kind of reckoning.

 

Surveillance for violent deaths — National Violent Death Reporting System, 48 states, the District of Columbia, and Puerto Rico, 2020

Via MMWR, a long, grim report: Surveillance for Violent Deaths — National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020. Excerpt:

The COVID-19 Pandemic and Homicide

Research using NVDRS data to examine the circumstances of COVID-19 pandemic–related homicides are ongoing, but studies have already underscored the changes in homicide rates. The overall firearm homicide rate in 2020 was higher than it has been in the last 20 years. 

This increase was disproportionately experienced by AI/AN and Black persons. The increased social and economic stressors attributable to the COVID-19 pandemic and associated mitigation measures (e.g., job loss and disruptions in emergency services) might have exacerbated the systemic inequities that have been found to increase risk for experiencing violence. 

These stressors might also have increased risk for intimate partner violence and child abuse and neglect. Early pandemic reports indicated increased arrests and police calls related to intimate partner violence, and despite fewer visits, a higher proportion of emergency department visits were child abuse and neglect related. 

Additional research on the impact that the COVID-19 pandemic and mitigation measures might have had on increases in homicide rates and potential changes in the contextual factors and characteristics of these fatal incidents is needed.

Bird flu could become the next human pandemic – and politicians aren’t paying attention

Via The Guardian, an op-ed: Bird flu could become the next human pandemic – and politicians aren’t paying attention. Excerpt:

Since November, the signals emerging across the world continue to be worrying. In January and February this year, more than 3,000 sea lions died of bird flu in Peru (where the death toll in wild birds reached an estimated 50,000). In Russia, 700 Caspian seals died. Then several dolphins in Britain and the US died of H5N1. Normally, even if an animal catches H5N1 from a bird, it can’t pass it to other mammals. This limits its spread. But the large number of cases in these outbreaks suggest the possibility of mammal-to-mammal transmission, although this hasn’t been confirmed yet by genetic sequencing. A more likely hypothesis is that these outbreaks are groups of animals feeding on infected birds. It is not yet 100% clear what’s happening.  

But the risk of spread among mammals is ever-present. A new research pre-print from Canada showed that H5N1 samples could spread efficiently between ferrets with fatal outcomes. In order to spread efficiently to humans, H5 would need three major categories of genetic changes, according to bird flu expert Prof Richard Webby. So far, the virus has been able to make one of these changes, but not the other two. 

So right now, H5N1 is a theoretical risk for the next human pandemic, rather than one requiring urgency in response today. And a prime minister or health secretary might say, “Why prepare for something that might never happen?” 

To those of us scientists working in global health, there are enough concerning signals that action should already be happening. So that if a certain set of mutations do occur and we see an outbreak in humans in Peru or China or Britain, that the harm it could cause is minimal. This is a disease with an estimated 50-60% fatality rate in humans, including children.  

The cornerstone of infectious disease preparedness is in: surveillance (to know what strain is spreading and where in birds); testing (to identify disease quickly in humans); vaccines (for protection against disease and death); and antivirals (to improve clinical outcomes). The US government is already moving in this direction. Rebecca Katz, professor at Georgetown University Medical Center, has noted that a H5 candidate vaccine virus recently produced by the US Centers for Disease Control and Prevention is likely to provide good protection against the circulating H5N1 viruses.  

The information has been shared with vaccine manufacturers to start the process of stockpiling adequate doses. But this is a challenge because most influenza vaccines are created by incubating doses in chicken eggs (called egg-based production). If bird flu has killed off many of the chickens, then egg shortages are likely. There’s another H5N1 vaccine which is non-egg based, but they could have a maximum of 150m doses ready within six months. The world’s population is almost 8 billion.  

In addition, the FDA-approved antiviral treatments for seasonal influenza could also work against bird flu. But again, getting doses to all parts of the world is a challenge given shortages. Preparation must also involve appropriate PPE for healthcare workers to protect against a respiratory disease (flu) and diagnostics to quickly identify if someone is infectious in hospitals.  

All of these issues are solvable with precise planning, collaboration across countries, scientific ingenuity and good leadership. With post Covid-19 fatigue, the bigger problem is bringing the public along and communicating the facts so that they are trusted and believed. With so much – often understandable – mistrust in our current political leadership, authorities like chief medical officers and independent government advisers become crucial.

Research: 1 in 8 adult Canadians experienced depression for first time during pandemic

Via the Helsinki Times: Research: 1 in 8 adult experienced depression for first time during pandemic. Excerpt:

One in eight older persons in Canada, according to recent large-scale research that included more than 20,000, experienced their first episode of depression during the epidemic.  

The statistics were significantly worse for people who had previously struggled with depression. Nearly half (45 per cent) of this population reported having depression by the fall of 2020.  

The analysis of responses from the Canadian Longitudinal Study on Aging, which gathered information from participants for an average of seven years, was published in the International Journal of Environmental Research and Public Health.  

"The high rate of first-onset depression in 2020 highlights the substantial mental health toll that the pandemic caused in a formerly mentally healthy group of older adults." says first author, Andie MacNeil, a recent Master of Social Work graduate from the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging, University of Toronto.  

Although it is well known that depression among older adults increased during the pandemic, few studies have examined the proportion of people who developed the disorder for the first time or the proportion of people with a history of the condition who had a relapse.  

"The devastation of the pandemic which upended so many aspects of daily life hit those with a history of depression particularly hard," said co-author Sapriya Birk, a researcher formerly based in the Department of Neuroscience, Carleton University, Ottawa who is currently a medical student at McMaster University, Hamilton, Canada, adding, "Health professionals need to be vigilant in screening their patients who had mental health problems at an earlier time in their life."  

The researchers determined that a number of factors, such as low income and savings, loneliness, chronic pain, difficulty accessing healthcare, a history of traumatic childhood experiences, and family conflict, were linked to depression in older adults during the pandemic.

The next pandemic? More likely a polydemic

Last week The Tyee published my article The Next Pandemic? More Likely a Polydemic. After going through a number of unpleasant problems in global health, I concluded:

These are just some of the threats in the present polydemic, which itself is part of the present hot mess of economic decline, rising prices, war, climate change and political polarization that writers like Adam Tooze are calling a polycrisis. And it’s precisely now that Canadian health spending should be rising to support pandemic preparation and prevention, not levelling off.  

From a political point of view, lower spending makes sense. The system is still trying to catch up with all the knee and hip replacements postponed for the last two years. Inflation makes it impossible to raise taxes, and the deficit spending that kept everyone afloat in 2020 and 2021 is now politically unacceptable.  

Besides, governments have learned that they don’t have to take pandemics as seriously as they once did. Provincial governments that let COVID-19 rip have been re-elected. Public health measures like masks and vaccine mandates have triggered a populist backlash that some politicians are exploiting. Health-care workers are exhausted, underpaid and embittered.

So even if a government wanted to take the polydemic seriously, and to build up the system against future pandemics, it would face serious resistance from many voters, not to mention the business sector. Rebuilding health-care staff numbers and infrastructure would take billions, spent over more years than any government is likely to survive. Short-term emergencies would always take priority over long-term needs.  

And when the next pandemic arrived and became a short-term emergency, neither governments nor the governed would implement or accept even proven measures to protect public health. They’d recycle COVID-19 misinformation as precedent: “It was mostly mild, it only killed old people, we got through it.”  

But if it’s a pandemic as lethal as H5N1 or Ebola, which has an average case fatality rate of 50 per cent, the survivors will think otherwise.

Before 2020, the pandemic anticipators I called Flublogia were certainly worried about the impact of a new influenza or other virus. But we still had a naive faith that while it would be bad, we in North America and western Europe and Japan would have the technology and the experts to deal with it.

The response of the western nations, and especially the US, was and is a disgrace and a revelation: just as the fearsome Russian army turned out to be stupid and incompetent, so have the health systems and politicians of the "advanced" nations. If the next virus turns serious, I really doubt whether the public will listen to the advice of the health experts. Nor will healthcare workers be willing to resist another onslaught. And that, of course, will only make matters much, much worse,

Next pandemic may come from melting glaciers, new data shows

Via The Guardian: Next pandemic may come from melting glaciers, new data shows. Excerpt:

The next pandemic may come not from bats or birds but from matter in melting ice, according to new data.  

Genetic analysis of soil and lake sediments from Lake Hazen, the largest high Arctic freshwater lake in the world, suggests the risk of viral spillover – where a virus infects a new host for the first time – may be higher close to melting glaciers.  

The findings imply that as global temperatures rise owing to climate change, it becomes more likely that viruses and bacteria locked up in glaciers and permafrost could reawaken and infect local wildlife, particularly as their range also shifts closer to the poles.  

For instance, in 2016 an outbreak of anthrax in northern Siberia that killed a child and infected at least seven other people was attributed to a heatwave that melted permafrost and exposed an infected reindeer carcass. Before this, the last outbreak in the region had been in 1941.  

To better understand the risk posed by frozen viruses, Stéphane Aris-Brosou and her colleagues at the University of Ottawa in Canada collected soil and sediment samples from Lake Hazen, close to where small, medium and large amounts of meltwater from local glaciers flowed in.  

Next, they sequenced RNA and DNA in these samples to identify signatures closely matching those of known viruses, as well as potential animal, plant or fungal hosts, and ran an algorithm that assessed the chance of these viruses infecting unrelated groups of organisms.  

The research, published in Proceedings of the Royal Society B, suggested that the risk of viruses spilling over to new hosts was higher at locations close to where large amounts of glacial meltwater flowed in – a situation that becomes more likely as the climate warms.  

The team did not quantify how many of the viruses they identified were previously unknown – something they plan to do in the coming months – nor did they assess whether these viruses were capable of triggering an infection.  

However, other recent research has suggested that unknown viruses can, and do, loiter in glacier ice. For instance, last year, researchers at Ohio State University in the US announced they had found genetic material from 33 viruses – 28 of them novel – in ice samples taken from the Tibetan plateau in China. Based on their location, the viruses were estimated to be approximately 15,000 years old.  

In 2014, scientists at France’s National Centre for Scientific Research in Aix-Marseille managed to revive a giant virus they isolated from Siberian permafrost, making it infectious again for the first time in 30,000 years. The study’s author, Jean-Michel Claverie, told the BBC at the time that exposing such ice layers could be “a recipe for disaster”. 

Even so, Aris-Brosou’s team cautioned that predicting a high risk of spillover was not the same as predicting actual spillovers or pandemics. “As long as viruses and their ‘bridge vectors’ are not simultaneously present in the environment, the likelihood of dramatic events probably remains low,” they wrote.  

On the other hand, climate change is predicted to alter the range of existing species, potentially bringing new hosts into contact with ancient viruses or bacteria.  

“The only take-home that we can confidently put forward is that as temperatures are rising, the risk of spillover in this particular environment is increasing,” said Aris-Brosou. “Will this lead to pandemics? We absolutely don’t know.”

World in no better place to fight pandemics than before COVID

Via Reuters: World in no better place to fight pandemics than before COVID - review. Excerpt:

LONDON, May 18 (Reuters) - The world is no better prepared for a new pandemic than it was when coronavirus emerged in 2019 and may actually be in a worse place given the economic toll, according to a panel set up by the World Health Organization (WHO) to evaluate the global response.  

A lack of progress on reforms such as international health regulations means the world is as vulnerable as ever, the Independent Panel for Pandemic Preparedness and Response said in its report.  

The authors, led by former New Zealand prime minister Helen Clark and former president of Liberia Ellen Johnson Sirleaf, acknowledged some progress, including on more robust funding for the WHO, but said the process was going far too slowly.  

"We have right now the very same tools and the same system that existed in December 2019 to respond to a pandemic threat. And those tools just weren't good enough," Clark told reporters.  

"If there were a new pandemic threat this year, next year, or the year after at least, we will be largely in the same place ... maybe worse, given the tight fiscal space of many, if not most, countries right now."  

Wednesday's report comes ahead of next week's World Health Assembly in Geneva, the WHO's annual decision-making forum, which is expected to address some of the issues raised.

Global Health Security Index: We haven't learned a damn thing

The Global Health Security Index came in for some deserved ridicule in 2020 when it declared the US health system as the best-prepared for a pandemic. But its latest report heaps scorn back on almost everyone, especially wealthy nations. As we stumble into the third year of this pandemic, such failure to prepare is inexcusable. An excerpt from its latest Report & Data:

Overall Finding

Although many countries were able to quickly develop capacities to address COVID-19, all countries remain dangerously unprepared for meeting future epidemic and pandemic threats. A great opportunity exists, however, to make new capacities more durable to further long-term gains in preparedness.

Additional Findings

Most countries, including high-income nations, have not made dedicated financial investments in strengthening epidemic or pandemic preparedness. 

• The overall average score for national-level financing is 35.2 out of 100.  

• 90 countries have not fulfilled their full commitment to contribute to the WHO; of those, 14 are high-income countries.  

• 66 countries have not identified special emergency public financing mechanisms and funds that the country can access in the face of a public health emergency; of those, 32 are high-income countries.  

• 155 countries have not allocated nonemergency national funds within the past three years to improve their capacity to address epidemic threats; among those, only two low-income countries have evidence of allocated funds.  

• The average score for national financing for epidemic preparedness is 21 out of 100; low-income countries have an average score of 7 out of 100.  

• Financing for emergency response has a global average score of 66.  

• High-income countries have the lowest average score of 46; low-income countries have the highest average, with 93.  

• Only four countries (Eritrea, Indonesia, Liberia, and Timor-Leste) have a JEE or NAPHS that describes specific funding from the national budget to address previously identified gaps.  

• High-income and upper-middle-income countries receive the lowest scores for financing when reviewed under the JEE and OIE Performance of Veterinary Services (PVS) Pathway assessments and related to financing for emergency response.  

• The average score for financing under the JEE and PVS report is 1 out of 100; this score reflects the provisions for funding IHR implementation through the national budget or other mechanisms.

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.

A new study ties lifespans to wealth gaps in Greater Vancouver

The Tyee has published my latest article: A New Study Ties Lifespans to Wealth Gaps in Greater Vancouver. Excerpt:

We like to think of Greater Vancouver as one of the best places to live in Canada, if not in the world. Yes, it is — especially for those of us living in the most affluent neighbourhoods. Those in the poorest neighbourhoods, however, are dying younger than their rich neighbours, sometimes by many years. And the gap between them was getting wider even before the opioid-overdose crisis and the COVID-19 pandemic became twin health emergencies. 

That’s an easy conclusion to draw from a recent study published in the journal Health & Place. Of course it’s more complicated than that, but it still seems paradoxical that a region as prosperous as Greater Vancouver should see some people die years younger than others living just a few kilometres away.  

The study involved UBC researchers working with the Institute for Health Metrics and Evaluation at the University of Washington and with Imperial College, London. Its ambitious goal was to track life expectancy and major causes of deaths in Greater Vancouver over a quarter-century, from 1990 to 2016. Moreover, they broke the numbers down to the census-tract-level — in effect, neighbourhood by neighbourhood. Overall, the study offers an invaluable portrait of our collective health before the pandemic.  

In some ways, it’s a very flattering portrait. Even the poorest males, in the tenth percentile, had a median life expectancy in 2016 of 77.6; that is, half died before that age and half later. For tenth-percentile females, median life expectancy was 82.5.  

But in the 95th percentile, the richest five per cent of our population, median male life expectancy was 87.1. For females in the 90th percentile, it was 90.8. The poor were paying with almost a decade of their lives for the privilege of living here. 

 The study makes a striking observation: “Between 1991 and 2016, there was a downward trend in the LE [life expectancy] gap, whereby the lowest gap was observed in 2001 (6.9 years for females and 7.9 for males), but this reversed and increased by 1.4-1.6 years between 2001 and 2016.” By a wild coincidence, 2001 was the year the BC Liberals won a huge majority over the NDP and ran the province under Gordon Campbell and then Christy Clark until 2017.  

British researchers noticed a very similar effect during Margaret Thatcher’s years in power: Around 1980, British and Japanese life expectancy were about the same, but then, as the U.K. income gap widened, British lives grew shorter. In Japan, with a much narrower income gap, life expectancy rose to among the highest on the planet.  

What we’re dying of  

And what have Greater Vancouver residents been dying of? Between 1990 and 2016, deaths from cardiovascular diseases, neoplasms (cancers) and unintentional injuries dropped sharply. Clearly, we’ve been exercising more, smoking less, and taking care of ourselves, at least up to a point.  

But we’ve also seen a 10 per cent increase in neurological disorders, a catch-all term that can include everything from Alzheimer’s to eating disorders to meningitis. Other noncommunicable diseases like diabetes mellitus and kidney disease rose by almost four per cent.  

And while the richest of us had little to fear from infectious diseases in 1991, the poorest were already contending with (and dying from) HIV-AIDS and sexually transmitted infections at 12 times the rate as the richest. The poorest faced seven times the rate of maternal and neonatal disorders. They died of neoplasms at over four times the rate of the richest.