The New Unnormal – EOH 10/21

We are told that we are going to have to accept a “new normal” but what if that “new normal”, is just a slogan for completely restructuring society? Across the world, the “new normal” appears just to be a new blend of  authoritarianism and limiting civil liberties. In the UK, the government plans to give contact tracing data to the police. In countries like Uganda, COVID-19 has proven to be a great excuse to go in prison political opponents. “COVID-19” policies are not based on data or really related to COVID rather they are deep pathological expressions of unfettered government control and a fearful, willing populace. 

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As Virus Hits Rural U.S., Numbers May Be Small, but the Impact Is Not

Little media coverage, but not out of mind.

The spread of the coronavirus in the United States in recent weeks has been worse than it seems, not because of how it has been spreading but where. The virus has been pummeling some of the least populous states in the country, but the relatively low numbers can be deceptive. The surges in rural areas have been just as severe as the spikes in densely populated cities in the Sun Belt over the summer. North Dakota, South Dakota and Montana, for example, have announced the country’s highest number of cases on a per capita basis. Already, the North Dakota and South Dakota numbers exceed the per capita figures seen at the peak of summer surges in the Sun Belt. Other states with large rural areas — including Wyoming, Idaho, West Virginia, Nebraska, Iowa, Utah, Alaska and Oklahoma — have recently recorded more cases in a seven-day stretch than in any other week of the pandemic. “We, as North Dakotans, find ourselves in the middle of a regional Covid storm,” Gov. Doug Burgum said Wednesday. But population can skew perspective. Wessington Springs, S.D., or Shelby, Mont., are unlikely to produce the same alarming imagery amid a pandemic as New York City or Houston, where mobile morgues and packed E.R. hallways became icons of suffering. In the last seven days, Florida had the highest number of virus-related deaths in the nation, 764. But the state has more than 21 million residents. North Dakota had only 78 deaths — but it has a population of 762,000. Governor Burgum warned of “additional adversity and perhaps deadlier outcomes” after months of watching from afar as other places faced large outbreaks. “And,” he said, “we’re doing this at a time when perhaps our citizens and parents and many are fatigued at the stress of managing this for so long.” It is hardly just the country’s less populated regions that have health experts worried. Numbers are up across the country, and around the world. “I don’t know why anybody would think it’s not so bad,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and an expert on contagious diseases. “We went to a low of around 35,000 cases per day late in the summer. Now we’re up to over 50,000, with those numbers climbing every day. Nationally, it’s going back up, and I’m really worried that we’re seeing a big increase.” But the pattern appears to be shifting.

Coronavirus Cases Rise To Highest Level Since Late July

Testing increases, younger populations, and previously low prevalence pockets.

With coronavirus outbreaks picking up speed in dozens of states, the U.S. is now climbing steadily toward a new peak in cases that may soon rival the summer surge — when the country hit more than 60,000 infections on average a day for weeks in a row. On Friday, U.S. cases surged higher than they had since late July, hitting nearly 70,000 in one day. The seven-day daily average is now more than 56,000 cases a day. New cases have gone up by 30% from two weeks ago.Last week, 17 states — primarily in the Midwest and Great Plains — posted new daily records, according to the COVID Tracking Project. Hospitalizations also increased in more than 40 states, with the numbers of people currently hospitalized reaching more than 36,000, which is more than half the highs recorded during the spring and summer surges. Unlike during the summer, when a handful of larger states drove up the numbers, the current growth is diffused across many states. “It’s just these roving hot spots in a country that’s big, and different areas are on different clocks,” says Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security. The summer may have acted as a kind of buffer, he says, for the middle of the country, keeping the virus at lower levels in the community because people spent more time outside.But Adalja says more people congregating indoors, including students returning to schools and college campuses, and general fatigue around pandemic precautions are all likely propelling this latest growth in cases. “There may be places that were not hit hard early on where the virus finds it very hospitable because people are complacent,” Adalja says.

The Post-Pandemic ‘New Normal’ Looks Awfully Authoritarian

A synonym for the “new normal” is authoritarianism. 

We’re told that life is never getting back to normal, so we need to suck it up and accept a world of mask-wearing, economic disruption, and social distancing. It’s a denatured echo of the warnings we’ve heard before that government responses to COVID-19 are pushing the world toward authoritarianism—but dressed up as if that’s a good thing. That’s unfortunate, given that less-intrusive responses to the pandemic are proving at least as effective as heavy-handed ones. And that’s before we even discuss the inherent value of the freedom that looks destined to be pushed aside by public health concerns  and by disingenuous government officials. “As 2020 slides into and probably infects 2021, try to take heart in one discomfiting fact: Things are most likely never going ‘back to normal,'” wrote CNN International Security Editor Nick Paton Walsh last week. In his piece he discusses the likely permanency of mask mandates, telecommuting, reduced physical contact, and similar changes to life. Some of the alterations Walsh mentions may be matters of personal choice, but a good many of them are imposed by “politicians who pretend that ‘normal’ is just around the corner,” as Babson College’s Thomas Davenport says in the article. We’re supposed to accept our newly constrained lives as “the new normal”—in a phrasing that’s already very tired, indeed. Actually, repeated references to a “new normal” aren’t just tired; they’re ominous. “As the need for an extension of quarantine into the summer or beyond seems likelier, the new normal will certainly include unanticipated trade-offs,” Andy Wang warned in May in the Harvard International Review. “The central irony of the crisis may be that the very methods that liberal democracies are currently using to effectively fight the virus are the same tactics that authoritarian leaders use to dominate their people. While the world is not sinking into authoritarianism, a post-quarantine world could be less democratic than its previous iteration; the tools that have been temporarily deployed in the fight against a once-in-a-lifetime disease may become permanent.” These authoritarian tools may become permanent because government officials are rarely punished for doing something, even if the something is awful and counterproductive. It’s leaving things alone to be worked out by individuals according to their own priorities and preferences for which politicians get called out.

The Long Shadow of the Pandemic: 2024 and Beyond

1,460 days to slow the spread.. 

While the rest of the natural world reasserted itself, however, we humans continued to suffer. We reshaped our way of life to slow the spread of the virus. But our interventions have only been able to mitigate, not stop, the pandemic. Once the SARS-CoV-2 virus had established itself in our species, after emerging in China in November 2019, the outcome was inevitable: It would spread across the whole planet—and linger among us forever. Many hope and expect that a vaccine will save us. But a vaccine won’t give us an early exit. With all the disparate vaccine trials under way, we will eventually invent several vaccines, of varying effectiveness—just not in time to make a major difference in the primary course of the pandemic. After all, invention of a vaccine is just the first step. The pharmaceutical must then be manufactured, distributed and—most important—accepted by substantial numbers of people world-wide. But vaccine uptake may not be rapid or widespread, especially if its safety is in doubt. A vaccine will probably not be widely deployed before the U.S. achieves herd immunity—a level of infection in a population, roughly 40% for SARS-CoV-2, that limits the further epidemic potential of a pathogen. We are likely to reach that point by 2022 no matter what we do. To be clear, however, vaccines would still be enormously valuable to protect uninfected people even then. Either way, with a good vaccine or without one, Americans will live in an acutely changed world until 2022—wearing masks, avoiding crowded places and limiting travel, at least if they wish to avoid getting or spreading the virus. This is the immediate pandemic period. For some time after we reach either herd immunity or have a widely distributed vaccine, people will still be recovering from the overall clinical, psychological, social and economic shock of the pandemic and the adjustments it required, likely through 2024. This lingering response, typical of past serious epidemics, will demarcate the intermediate period. Then, gradually, things will return to “normal,” albeit in a world with some persistent changes. Around 2024, the post-pandemic period will begin.


The BMJ Interview: Tim Spector on how data can arm us against covid-19

How the UK government ignores its own contact tracing app data.

The epidemiologist and popular science author whose symptom tracker app has revealed some vital information about the virus tells Rebecca Coombes about opportunities to use data better—and how he thinks the UK’s leadership failed in the pandemic It’s the sleeper hit of the covid-19 pandemic in the UK, even though its creator thought that it might be shut down after a week. More than four million people use the Covid Symptom Study app, a symptom reporter designed by doctors and scientists at King’s College, London, and the health science company Zoe. Data generated over nearly eight months, from users regularly logging their health and reporting their symptoms, have created the closest thing to a national covid-19 registry. The smartphone app has made a household name of its genial and wiry leader, Tim Spector, professor of genetic epidemiology at King’s. Previously better known for his nutrition research and popular science books, Spector is highly visible and eager to share emerging findings from the study. The research group was the first to identify loss of smell as a leading symptom of covid, to spot that children with covid often present differently from adults, and to show that delirium is a key sign in older, frail people. Although the app is now partly funded by government, Spector is clearly frustrated by the speed at which government guidelines have reflected the research findings generated by its data. It took Public Health England (PHE) until May to add anosmia as a symptom despite the app gathering good data early in the epidemic that loss of smell was “probably 90%” predictive of a positive covid test. “Most other countries had acted by May,” he says. “I had dealt with six different government bodies; nobody knew who was in charge.” He adds that it was impossible to speak directly with PHE. “I was sceptical that they had public health interests at heart: they didn’t seem to want to engage with the public, to speak with doctors,” he explains. “As with nutrition, they have behaved with covid—like a secret society that makes decisions behind closed doors.” When the study was launched at the end of March, after a sleepless week of engineering during the height of the pandemic, Spector feared that it would have to be handed over to the NHS within a week. It wasn’t—and today he’s lobbying for its data to inform an algorithm to help triage the patients most in need of a test.

Charts and Graphics

Contrasting Experiences of The Pandemic in the US

Regions in the US with the most restrictions are cities despite the lowest comparative prevalence.

Daily New Cases Per 1m (Czech Republic vs Sweden)

Masks work… oh, wait.

Not a Good Year

COVID brain moves the world away from democracy.

WisconsinCases,Test Positivity, and Masks

A little too late. 

International News

No vaccine for cruelty the pandemic has eroded democracy and respect for human rights

COVID lockdowns ended over 40 years of the world moving towards more human freedom. 

PEOPLE WERE hungry during lockdown. So Francis Zaake, a Ugandan member of parliament, bought some rice and sugar and had it delivered to his neediest constituents. For this charitable act, he was arrested. Mr Zaake is a member of the opposition, and Uganda’s President Yoweri Museveni has ordered that only the government may hand out food aid. Anyone else who does so can be charged with murder, Mr Museveni has threatened, since they might do it in a disorderly way, attract crowds and thereby spread the coronavirus. Mr Zaake had been careful not to put his constituents at risk. Rather than having crowds converge on one place to pick up the food parcels, he had them delivered to people’s doors by motorbike-taxi. Nonetheless, the next day police and soldiers jumped over his fence while he was showering and broke into his house. They dragged him into a van and threw him in a cell. He says they beat, kicked and cut him, crushed his testicles, sprayed a blinding chemical into his eyes, called him a dog and told him to quit politics. He claims that one sneered: “We can do whatever we want to you or even kill you…No one will demonstrate for you because they are under lockdown.” The police say he inflicted the injuries on himself and is fishing for sympathy with foreign donors. The charges against him were eventually dropped, but the message was clear. “The president doesn’t want the opposition to give out food,” says Mr Zaake, who walks with crutches and wears sunglasses to protect his eyes. “He knows that people will like us [if we do].” The pandemic has been terrible not only for the human body but also for the body politic. Freedom House, a think-tank in Washington, counts 80 countries where the quality of democracy and respect for human rights have deteriorated since the pandemic began. The list includes both dictatorships that have grown nastier and democracies where standards have slipped. Only one country, Malawi, has improved (see map). Covid-19 “has fuelled a crisis for democracy around the world,” argue Sarah Repucci and Amy Slipowitz of Freedom House. Global freedom has been declining since just before the financial crisis of 2007-08, by their reckoning. Covid-19 has accelerated this pre-existing trend in several ways.

Exclusive: Police given access to Test and Trace data on those told to self-isolate

The UK is an official police state. 

The contact details of those who have been instructed to self-isolate by NHS Test and Trace are to be passed to the police on request, in a move that has alarmed senior health figures who are concerned it will undermine confidence in and co-operation with the testing regime, HSJ has learned. The Department of Health and Social Care updated its online guidance on how coronavirus test information will be treated late last night. The new guidance reveals how information about those who are told to self-isolate because they have tested positive for coronavirus or are the close contact of someone who has tested positive will be handled (see box below). This includes details on how police forces will be able to access contact details of those told to self-isolate. This aspect of the guidance applies only to England, not the devolved UK nations. HSJ has learned the updated guidance followed the signing of a memorandum of understanding governing the sharing of the data between the DHSC and the National Police Chiefs Council, acting on behalf of local police forces, last weekend. A senior source close to the issue told HSJ the MoU had been put in place after health secretary Matt Hancock made an “incredibly forceful” intervention to ensure that data sharing arrangements were clarified. HSJ understands an MoU was necessary as there is no statutory basis on which the information could be shared. The information is to be supplied via Public Health England, which reports directly to the health secretary, rather than via arm’s-length body NHS Digital. PHE holds the information on who has been told to self-isolate, but data sharing is usually facilitated by NHS Digital in its role as the “national data guardian”. HSJ understands the office of chief medical office Chris Whitty, while not providing formal or informal advice on the move, has significant reservations about the move, fearing that it would discourage people from being tested.

Covid-19 kills – but so does lockdown

The debate about lockdowns is about life on both sides. 

Just over six months ago Boris Johnson gave the British people one very clear instruction: ‘you must stay at home.’ It was impossible for anybody to anticipate the unintended consequences of those five words and quite how much pain and anguish they would unleash. Through a mixture of emotional coercion and relentless scaremongering millions of people in need of medical help followed the PM’s order to the letter. They stayed, many in intense pain, at home and didn’t seek the care they needed. Every Tuesday morning the Office for National Statistics release their weekly information on deaths. For months it has told the same story. Significant, sustained levels of excess deaths are happening in the home every week. There are repetitive and draining discussions about grand strategies wherever you look. But thousands more than usual are dying in their own homes and nobody raises an eyebrow. To avoid any more unnecessary deaths, we must start asking difficult questions. We can’t be afraid of the answer. Covid-19 kills, but so does lockdown. Politicians have been playing with forces that none of us fully understand. They claim to always be following ‘the science’, but let me assure you, there is no science behind effectively closing down cancer diagnostic pathways for 3 million people or delaying treatment for so many. Heart attacks and strokes have dramatically reduced in number over the last six months. The only way this could have happened is that people have chosen to stay at home rather than seek medical care. Mental health has been relentlessly ignored along with other serious illnesses. Deprivation, depression, loneliness, and suicidal ideation continues to spread like wildfire. Dr David Nabarro, WHO special envoy, puts it eloquently: ‘lockdowns just have one consequence that you must never, ever belittle, and that is making poor people an awful lot poorer.’ No computer model nor brilliant epidemiologist can fully estimate the sheer long-term destruction lockdowns have caused. I don’t think many have even bothered. Fear is a very difficult metric but if we could measure it with any precision, I’m sure all records would have been smashed this year. Other countries have struck a far better balance than we have. Death has always been a taboo subject here and evidently our collective ability to balance risk has been severely inhibited.

Turkey has been contact tracing for a century. That offers lessons and perils.

Lessons on contact tracing from Turkey.

On a sticky summer morning, the air thick with haze, Seher Odabaşı starts her work day in her office with the windows open. She turns on her computer and studies the screen, which displays row after row of names. Today’s chart contains about 50 cases, nearly 10 times as many as there were a couple months ago. For Odabaşı, the list fills her with anticipation and uncertainty about what the day will bring because she must track down these people who are scattered throughout their neighborhood. It’s her job to keep COVID-19 from spreading. As she heads out into the thrumming streets in the city’s Kadıköy District, Odabaşı scans the names on her electronic tablet, the connections, and the addresses. Before each visit, she pulls a white protective suit over her cat-print scrubs, trades her thick-rimmed glasses for goggles, and grabs her medical kit with her gloved hand. Odabaşı is a contact tracer, a member of one of roughly 9,300 teams that the Turkish government has deployed during the outbreak. Situated at the crossroads of Europe, the Caucasus, and the Middle East, Turkey seemed a likely hotspot for a disease spread by international travel and social mixing. But five months after a modest early surge, daily cases remain low and steady, and the nation doesn’t make the list of the top 100 in cases per capita. Part of this success stems from Turkey’s long legacy of contact tracing, one of the main tools public health officials use to contain outbreaks. While countries such as the United States have struggled to implement effective programs and often depend on volunteers, the contact tracing system in Turkey dates back nearly a century, when it was developed to fight measles and tuberculosis.

“There were able physicians working in the Ministry of Health responsible for controlling infectious diseases since the foundation of the Republic [in the] 1920s,” says Necati Dedeoğlu, a retired professor from the country’s School of Public Health, which was originally attached to the Ministry of Health.

Sweden: Why the ‘moral superpower’ dissented over COVID-19

Sweden dissented over COVID-19 hysteria and followed traditional public health strategies . 

A global crisis breaks with a particular focus on Europe. Nearly all countries act in unison except for Sweden. The solo approach of the Scandinavian country sparks international headlines asking why it stands out from the crowd. It could be a description of Sweden’s now infamous response to coronavirus and how it has avoided the formal lockdowns that the rest of Europe adopted. But it is also an account of what happened during the 2015 migration crisis when it accepted more asylum applications than any other EU country relative to the size of its population. “It’s striking that Sweden has taken a very different path [from others] on two international crises in the past five years,” said Nicholas Aylott, associate professor of political science at Sodertorn University. “It is a case of true Swedish exceptionalism.” That this rich Nordic country of 10 million people has stood out during the past two big international crises is striking. But is there anything that links its responses to the refugee crisis and COVID-19, making it Europe’s odd man out? Experts put forward a host of reasons but at the core is a sense that, despite its size, Sweden is a “moral superpower” that seeks to act rationally, whereas it perceives the behavior of other countries to be based on political calculations or emotions. That status is deeply rooted in Sweden’s long-held neutrality — it has not fought a war for more than two centuries — but political scientists say it can lead to it being slow to react.



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