COVID 9: Why some countries did better?

 A year has gone by and the devastating impact of the Covid pandemic is still going on with over 100 million infections worldwide and over 2.1 million deaths we know the pandemic is far from over. The pandemic, from its source of origin, its widespread infections across the globe, to the debate over how best to combat it remains an ever present topic of our daily lives. As the roll out of various possible vaccines occurs the virus, to make its point, surges ahead in a third wave which, with reported new variants of the Covid 19 virus, reminds us the battle is far from over.

Eventually the human race will over come this deadly virus, whether through its myriad of strategies and vaccines or the virus will just mutate itself into non existence, as did SARS, remains to be seen. A year down the deadly combat with this virus it seems less likely that self mutation of the virus into non existence is a possibility. Yet we have to wonder why some countries fared better than others. 

We can look at the statistical data and come to various conclusions but the debate then gets furious as we can argue about how the death rates are determined, the relationship of testing to over all performance, the importance of recovery rates, and hospitalisation rate to positive test ratios. Either way we see it on a statistical basis countries the USA, UK, Italy, and Brazil do not come out well on the death per million criteria. Same is true for infections per million where the USA fares the worst (78,000) but India comes in with only 111 per million, highlighting that testing is important as India has only tested 13% of its population compared to the US which has 91% tests including repeat tests. Some countries like UAE have crossed 242% tests as a result of strict internal testing protocols resulting in repeat tests. Israel, Australia Iceland and Denmark have all shown over 100% test numbers following the dictum that till you do not test you don’t know the impact of the virus.

However, data is a bit confusing as some countries with high testing still have high death rates compared to others who show that high testing resulted in better identification of the spread and resulted in lower death rates. In some cases the death rate only applies to people who died within 28 days after testing positive thus ignoring people who may have died from complications arising from COVID-19 after the 28 days as is the case in UK. Thus one can argue the UK numbers are understated. 

Moving away from the debate over the statistical data one can appreciate that while no single strategy can be earmarked as successful in the fight against  the COVID-19 virus it is clearly evident that both macro and micro strategies in combination achieved a higher level of success. 

New Zealand is highlighted as a country that has successfully contained the virus thus far. Admittedly with a smaller population of 5 million some would argue it could have been easier to tackle the pandemic. Indeed a smaller population in an island country is an advantage but still the country has a few major cities with concentration of the population and to record only 25,000 cases with only 25 deaths is remarkable. Testing is high, 300% test rate, but then a lot of things were done right from the beginning.

One of the strongest factors for New Zealand was and is its leadership under Prime Minister Jacinda Arden. A key factor was communication and transparency by the prime minister herself leading the daily briefings and in a very personal style calling the 5 million people “the team” that will fight the virus. This created a togetherness with the community and backed with honest communication the harder measures were understood and accepted by New Zealanders. Last year in mid March a strict lockdown was imposed across the country with social distancing and masking compulsory when the lockdowns were eased. A state of the art contact tracing was implemented and where localised outbreaks happened curfews and lockdowns in those areas followed. The contact tracing was believed to be so good that in one case the virus was tracked to a garbage bin in a particular neighbourhood!

Indeed a complete lockdown and no entry or exit from the country all had a massive economic impact on the economy but the calculation  was that  30 to 60 days of strict measures will allow a return to normalcy faster that otherwise. This proved right and by July of last year a graduated return to normal life was seen and now with the second surge the measures from the start showed the protocols were robust. In New Zealand’s case a central policy was possible from the prime ministers office unlike say in the United States where a federal policy cannot apply uniformly in all 50 states, even though there are ways to invoke an emergency nation wide. 

The case of Africa as a whole is  more interesting with 17% of the world population only 3.5 m cases have been reported with 87,043 deaths. One could argue that low testing levels (South Africa is the highest with 13%) suggests less detection of cases. But then death rates in general on the African continent have not gone up suggesting that impact on the over all death rate since the pandemic started is negligible. It is possible that given the past experience to pandemics like Ebola some countries in Africa were better prepared and while testing may not have been widespread at ports of entry the measures were strict. In the case of Nigeria, for instance, a strict lockdown was imposed a couple of weeks before the first case was reported. Researchers also suggest that given the average age of the population to be a low 18 years, resilience to the virus could be better. (In Germany the average age of population is 40 years). An additional factor could well be that a large proportion of the population spend their time outdoors thereby reducing the spread of the virus.

The United Arab Emirates was also one of the countries that showed a remarkable response to the virus. With a population of 9.7 million it acted quickly to force a lockdown and for a few weeks a nightly curfew  during which period streets and public places were disinfected regularly. While limited flights in and out were allowed there were protocols for testing and tracing. Masking and social distancing were quickly implemented and remain in force even a year later. While in December 2020 there has been an uptick in the numbers it has been accompanied by higher recoveries and mass roll out of vaccinations. 

Across Asia results of strategies against the virus vary. China, given its highly centralised government, initially may not have been forth coming about its numbers, even though it was quick to share the genetic structure of the virus with scientists around the world, it nevertheless enforced a total curfew in Wuhan, the source of the virus, and across much of China. It’s contact tracing systems remain one of the best and it would seem they have contained the virus. Mass roll out of their vaccine has been going on for a couple of months and cooperation with other countries is in the rise. South Korea, Taiwan, Vietnam and Japan all have fared better then their western counterparts as their is a better level of acceptance of government policies on the pandemic. In addition face masks have been long accepted in some of these societies since over two decades which could explain why infection rates were relatively low in their countries even though lockdowns were not that severe. 

Elsewhere in Asia both India and Pakistan seem still to develop a comprehensive strategy against the pandemic. Low levels of testing, 13% and 3.4% respectively suggests either a lack of resources or willingness to examine the extent of the pandemic. With the availability of the vaccine both governments seem to follow a strategy of vaccinations to cover as many people as they can. Mask wearing has been only successful in a limited sense and mass gatherings have not been curtailed. It would seem their best bet is in the vaccine now with a acceptance that the vaccine may prevent the spread of the virus as government policy was an abysmal failure.

In the West the United Kingdom and the United States both present interesting case studies. 

In the UK the strategy has been a mixed confusion of decisions aimed to sound politically correct and the resulting measures have been ill conceived and ineffective. A year ago the government tried to calm nerves by insisting they had a strategy in place when in fact all Boris Johnson wanted was to avoid a lockdown that would effect the economy. Measure like social distancing and face masks were more suggestions then mandatory policies. Contact tracing was considered a violation of civil liberties and never really implemented. The NHS was not given the equipment and resources in time to deal with the first wave of infections and a year on some doctors complain of shortages of key supplies. 

When lockdowns did finally c9me into place, some ten months into the pandemic, they were tiered into different levels, a good thing, but then no testing for people moving from one tier to the other. The government has tried to be transparent but is briefings seem to just present the statistics but not explain the effect of the measures and why some are working and some are not. Ministers who have appeared in the media have not been able to defend  their policy and worse not been able to answer the most basic questions.

The United States response, for a leading western nation, has been far short of any expectations. A lack of leadership was compounded by the politicalisation of the Covid 19 issue with the then President, Donald Trump, not taking the lead to fight the pandemic. No effort was made to make social distancing and face masks a policy priority so much so that the President himself did not wear masks and encouraged events that contributed to the spread of the virus. Politics rather than science governed the response and supporters of the President took pride in not wearing the mask. 

Given the size of the country and the complex demographics one would have expected more coordinated policies between the various states under a federal government umbrella. States like New York and California while implementing reasonably sound strategies the lack of a national policy on testing inter state travel or have contact tracing meant that efforts of state governments were constantly eroded. Perhaps the greatest short  coming in the United States was not only the lack of transparency but the conspiracy theories about the virus and misinformation from the highest levels of public office. 

In conclusion the following are the lessons we have learned thus far from the way various countries have responded to the virus.

• Quick and early governmental action on lockdowns, face masks and social distancing.
• Honest and transparent communication on the virus, the measures being taken and possible outcomes. Such communication directly from the head of government and senior ministers was essential in building trust.
• Establishing a social mandate of trust and confidence with the community.
• Follow the science and not the politics.
• Establishing contact tracing so that the spread of the virus can be monitored and then contained.
• Widen the testing regime.
• Where a tier system of lockdowns are implemented testing of people moving between different tiers  to be obligatory.
• International travel to be eased in phased manner between countries with similar success rate in fighting the pandemic.
• As vaccinations roll put so too should the state of preparedness be improved as most likely a new variant of the Covid-19 will emerge or in a few years a new coronavirus will spread.

 

 

The Biden Presidency: the challenges

 Joe Biden’s Presidency commences at a moment of US history where it’s social and political fabric has pretty much been shredded through the divisive creed and politics of hate of the last four years. Donald Trump leaves the White House in the back drop of a violent insurrection he purportedly inflamed and epitomises the legacy of Trump as a narcissist, egotist to whom his own survival matters the most. The road ahead for the Biden administration is not going to be easy as the United States faces some unique challenges, some created by the Trump presidency, others resulting from global issues. Joe Biden has tried to talk positively on the issues and yet tempered expectations knowing that the challenges ahead are enormous.

While technocrats will welcome the Biden presidency as it might be return to process and plann8ng in tackling some of the key issues. The challenges for Joe Biden can best be summed up as :

Covid-19 response.

In as much as the COVID-19 pandemic and the way the Trump administration handled it was their undoing, how Joe Biden tackles this enormous threat will define the seriousness of his tenure. While Trump can be partially thanked for one of the two vaccines that have come out the lack of a cohesive response to the pandemic by the Trump team is the legacy that Biden inherits. On the one hand is the logistic challenge of getting the vaccines out to the American public there is the more touchy issue that many Americans, mostly Trump diehards, will refuse the vaccine. 

Vaccines alone will not roll back the pandemic and measures such as masking and social distancing, including selective lock downs will need to be considered. With close to 400,000 dead the impact of this pandemic has been devastating, therefore, building trust and acceptance into any plan that Biden has is vital. On a broader front the economic impact of the pandemic needs to be addressed more comprehensively. Biden has already announced a $1.9 trillion relief package which certainly will be welcomed but this is really a first significant step to a broader solution to the economic imp@ct of the pandemic.

The Economy.

The state of the US economy is far from healthy, whether due to the ravages of the Covid 19 pandemic or some misplaced economic  policies the reality is that US public debt is at an all time high, unemployment is rising and in the face of a global slow down it is clear that for Biden and his team the economy is going to be a major challenge. Indeed prior to the pandemic the employment data was very healthy and in step with the trend of the past eight odd years. Had the pandemic not over taken events it is unclear whether Trumps tax breaks, increased government borrowing and the trade war with China would in the end result in a better economy. 

For the Biden administration while providing the stimulus to the economy and helping Americans with one time payments seems a priority. However, they need to see further down the road and draw up an economic plan that restores health to the economy. Reigning in the debt is not going to be easy as initially further public debt will be needed to kick start the economy. It is unlikely that the trade war with China will be rolled back in one sweep and Biden may want to use the leverage of a roll back to have a reset in trade relations to be more balanced. 

Charter of Trust with American Society.

One of the most important tasks for the Biden administration will be to rebuild trust within American society. One of the legacies of the Trump presidency has been his strategy to create and alternate narrative that rejects any fact that does not please him and to advance a militant nationalism embedded into a segment of his supporters who will not see facts other than the way Trump wants to. The recent attack in the Capitol highlights this alternate agenda and its far reaching consequences for US politics.  

The social divisions are glaring and racism is an issue as is political violence. Social reforms may achieve a better standard of health care, education and justice but uniting the country and creating a more tolerant society are going to be considerable challenges. One would imagine that with Trump no more the President some of the fuel to the fire of divisiveness will die down. However Trump will do everything to try and remain relevant and it would do the Biden administration good to ignore citizen Trump.

On a broader front the Biden platform has been put together with the support of the progressive elements of the Democratic Party and they have expectations of their own. Managing those expectations is going to be a challenge, however, it is more likely that Biden’s social and economic policies will be more in line with the progressive agenda. Building confidence in state institutions and the process of democracy will be a bigger challenge. America is a currently a fractured society and it’s the healing of its soul that is the biggest task ahead.

Obituary: Irfan Husain.

 I first met Irfan Husain in the early 1970s when he was courting my eldest sister, Ferida Sher, his first wife and mother to his only child Shakir. We lived on our farm and it was in the summer during the wheat harvest that this well spoken man turned up at the farm. Whether he was being polite or serious he offered to help in the harvest and my brother, Moody, and I planned to have the city boy carry the 50 kg bags of wheat up onto the loading ramp. We both wanted to put Irfan to the test and next day were surprised to see Irfan turn up at 6 AM knowing his offer was perhaps sincere to build a relationship with us. 

Irfan ended up driving the harvester and in the hot summer sun of Lahore he fared well putting in six hours of bone jarring driving. He offered with the wheat bags but we told him we had it under control. In short Irfan seemed good enough for the first test. A few weeks later he walked upon us axing away at guava trees as we pruned the guava orchid, Irfan being Irfan offered to help and after an hour of hacking with an axe my brother and I realised our sister would not be impressed with blisters on her bridegroom’s hands. Both Moody and I concluded Irfan was a cool guy, he did not talk down to us on account of his education and intelligence and certainly deserved a warm welcome. 

A few months later we had an amazing wedding in the farm, we spent weeks cutting trees and stacking them in a large field near the house and after the formalities of the wedding we lit a bon fire that actually was still smouldering a few days later. At some point of the night Irfan walked up to us brothers and thanked us saying  that  it was a “lovely gesture of the bonfire that made it all special”. 

Later as I finished my Masters in Islamabad Irfan and my sister were in the same city and I got to see more of Irfan and we often talked of politics and books. I was then writing for Viewpoint and Irfan always had some good advice and perspective that I appreciated. Sometimes he would simply ask if I had read a particular book or article usually we would have a discussion that followed. 

Irfan was a gentle soul and while not overtly emotional he was in a quiet way sensitive about all that happened around him. Later when my sister and Irfan divorced there was no drama and both seemed to focus on their son Shakir and giving him the best of both parents. The fact that Shakir turned out to be a fine man is a testimony to the care and concern of both parents not to burden their son with the weight a divorce. Irfan remained Irfan Bhai within our household and till his final days my elder sister (not the one who was married to Irfan) would give me twice a day updates on Irfan Bhai. 

When Shakir worked with me in Abu Dhabi, Irfan visited me and it was lovely seeing him. My only regret remains that it was at a time I was experimenting with micro wave cooking and the meal I prepared was perhaps the worst ever with the meat as hard as leather. Irfan politely chewed his way, painfully, through the evening putting aside my apologies. I promised myself that when Irfan came around next I would prepare him a perfect meal, needless to say that evenings meal remains the last I ever used a micro wave for. 

Sadly we never got to meet again but barring a call some years back I got regular news on Irfan from his son and my sisters. I also was an avid reader of his columns in Dawn and enjoyed his perspective on things. While I may not have agreed with his views all the time I admired his conviction and courage to express them. Irfan was always true to his beliefs which was a welcome quality in a country like Pakistan were journalists with conviction bore the brunt of governments not very tolerant of men who wielded a pen. 

Rest in Peace Irfan, you had a good innings and enriched the lives of many, you will always be remembered fondly and when we meet on the other side I will cook you the meal I planned, sans the micro wave.