Therapies and vaccines will come, but not for many months. Until then, politicians will have to work on the basics
Sep 26th 2020 edition
Sep 26th 2020
Within the next few days the global recorded deaths from covid-19 will surpass 1m. Perhaps another 1m have gone unrecorded. Since the start of the pandemic, nine months ago, the weekly cases logged by the World Health Organisation have been trending very slowly upwards and, in the seven days to September 20th, breached 2m for the first time. The virus is burning through parts of the emerging world. India has been registering over 90,000 cases a day. Some European countries that thought they had suppressed the disease are in the throes of a second wave. In America the official death toll this week exceeded 200,000; the seven-day case total is rising in 26 states.
Those figures represent a lot of suffering. Roughly 1% of survivors have long-term viral damage such as crippling fatigue and scarred lungs. In developing countries, especially, bereavement is compounded by poverty and hunger (see article). The northern winter will force people indoors, where the disease spreads much more easily than in the open air. Seasonal flu could add to the burden on health systems.
Amid the gloom, keep three things in mind. The statistics contain good news as well as bad. Treatments and medicines are making covid-19 less deadly: new vaccines and drugs will soon add to their effects. And societies have the tools to control the disease today. Yet it is here, in the basics of public health, where too many governments are still failing their people. Covid-19 will remain a threat for months, possibly years. They must do better.
Start with the numbers. The increase in Europe’s diagnosed cases reflects reality, but the global effect is an artefact of extra testing, which picks up cases that would have been missed. As the Briefing in this issue explains, our modelling suggests that the total number of actual infections has fallen substantially from its peak of over 5m a day in May. Extra testing is one reason why the fatality rate of the disease appears to be falling. In addition, countries like India, with an average age of 28, suffer fewer deaths because the virus is easier on the young than the elderly.
The fall in fatalities also reflects medical progress. Doctors now understand that organs other than the lungs, such as the heart and kidneys, are at risk and treat symptoms early. In British intensive-care wards, 90% of patients were on ventilators at the start of the pandemic; in June just 30% were. Drugs, including dexamethasone, a cheap steroid, reduce deaths in seriously ill patients by 20-30%. Fatalities in Europe are 90% lower than in the spring, though this gap will narrow as the disease spreads back into vulnerable groups.
More progress is in store. Monoclonal antibodies, which disable the virus, could be available by the end of the year. Although they are expensive, they promise to be useful after someone is infected or, for the high-risk, prophylactically. Vaccines will almost certainly follow, possibly very soon. As different medicines use different lines of attack, the benefits can be cumulative.
Yet, in the best of all possible worlds, the pandemic will remain a part of daily life well into 2021. Even if a vaccine emerges, nobody expects it to be 100% effective. Protection may be temporary or weak in the elderly, whose immune systems are less responsive. Making and administering billions of doses will take much of next year. Early vaccines may well need two shots, and complex “cold chains” to keep fresh. Medical glass could run short. There may be fights over who gets supplies first, leaving pools of infection among those who cannot elbow their way to the front of the queue. Multi-country polls suggest that a quarter of adults (including half of Russians) would refuse vaccination—another reason why the disease may persist.
Hence for the foreseeable future the first line of defence against covid-19 will remain testing and tracing, social distancing and clear government communication. There is no mystery about what this involves. And yet countries like America, Britain, Israel and Spain persist in getting it disastrously wrong.
One problem is the desire to escape a trade-off between shutting down to keep people alive and staying open so that life goes on. The right lauds Sweden for supposedly letting the virus rip while it makes a priority of the economy and liberty. But Sweden has a fatality rate of 58.1 per 100,000 and saw gdp fall by 8.3% in the second quarter alone, worse on both counts than Denmark, Finland and Norway. The left lauds New Zealand, which has shut down to save lives. It has suffered only 0.5 deaths per 100,000, but in the second quarter its economy shrank by 12.2%. By contrast, Taiwan remained more open but has seen 0.03 deaths per 100,000 and a 1.4% fall in gdp.
Blanket lockdowns like the new one in Israel are a sign that policy has failed. They are costly and unsustainable. Countries like Germany, South Korea and Taiwan have used fine-grained testing and tracing to spot individual super-spreading venues and slow the spread using quarantines. Germany identified abattoirs; South Korea contained outbreaks in a bar and churches. If testing is slow, as in France, it will fail. If contact-tracing is not trusted, as in Israel, where the job fell to the intelligence services, people will evade detection.
Governments must identify the trade-offs that make most economic and social sense. Masks are cheap and convenient and they work. Opening schools, as in Denmark and Germany, should be a priority; opening noisy, uninhibited places like bars should not. Governments, like Britain’s, that bark out a series of ever-changing orders which are broken with impunity by their own officials will find that compliance is low. Those, like British Columbia’s, that set principles and invite individuals, schools and workplaces to devise their own plans for realising them, will be able to sustain the effort in the months ahead.
When covid-19 struck, governments were taken by surprise and pulled the emergency brake. Today they have no such excuse. In the rush to normality, Spain let down its guard. Britain’s testing is not working, though cases have been climbing since July. America’s Centres for Disease Control and Prevention, once the world’s most respected public-health body, has been plagued by errors, poor leadership and presidential denigration. Israel’s leaders fell victim to hubris and infighting. The pandemic is far from over. It will abate, but governments must get a grip. ■
This article appeared in the Leaders section of the print edition under the headline "Why governments get it wrong".
Sep 26th 2020
Within the next few days the global recorded deaths from covid-19 will surpass 1m. Perhaps another 1m have gone unrecorded. Since the start of the pandemic, nine months ago, the weekly cases logged by the World Health Organisation have been trending very slowly upwards and, in the seven days to September 20th, breached 2m for the first time. The virus is burning through parts of the emerging world. India has been registering over 90,000 cases a day. Some European countries that thought they had suppressed the disease are in the throes of a second wave. In America the official death toll this week exceeded 200,000; the seven-day case total is rising in 26 states.
Those figures represent a lot of suffering. Roughly 1% of survivors have long-term viral damage such as crippling fatigue and scarred lungs. In developing countries, especially, bereavement is compounded by poverty and hunger (see article). The northern winter will force people indoors, where the disease spreads much more easily than in the open air. Seasonal flu could add to the burden on health systems.
Amid the gloom, keep three things in mind. The statistics contain good news as well as bad. Treatments and medicines are making covid-19 less deadly: new vaccines and drugs will soon add to their effects. And societies have the tools to control the disease today. Yet it is here, in the basics of public health, where too many governments are still failing their people. Covid-19 will remain a threat for months, possibly years. They must do better.
Start with the numbers. The increase in Europe’s diagnosed cases reflects reality, but the global effect is an artefact of extra testing, which picks up cases that would have been missed. As the Briefing in this issue explains, our modelling suggests that the total number of actual infections has fallen substantially from its peak of over 5m a day in May. Extra testing is one reason why the fatality rate of the disease appears to be falling. In addition, countries like India, with an average age of 28, suffer fewer deaths because the virus is easier on the young than the elderly.
The fall in fatalities also reflects medical progress. Doctors now understand that organs other than the lungs, such as the heart and kidneys, are at risk and treat symptoms early. In British intensive-care wards, 90% of patients were on ventilators at the start of the pandemic; in June just 30% were. Drugs, including dexamethasone, a cheap steroid, reduce deaths in seriously ill patients by 20-30%. Fatalities in Europe are 90% lower than in the spring, though this gap will narrow as the disease spreads back into vulnerable groups.
More progress is in store. Monoclonal antibodies, which disable the virus, could be available by the end of the year. Although they are expensive, they promise to be useful after someone is infected or, for the high-risk, prophylactically. Vaccines will almost certainly follow, possibly very soon. As different medicines use different lines of attack, the benefits can be cumulative.
Yet, in the best of all possible worlds, the pandemic will remain a part of daily life well into 2021. Even if a vaccine emerges, nobody expects it to be 100% effective. Protection may be temporary or weak in the elderly, whose immune systems are less responsive. Making and administering billions of doses will take much of next year. Early vaccines may well need two shots, and complex “cold chains” to keep fresh. Medical glass could run short. There may be fights over who gets supplies first, leaving pools of infection among those who cannot elbow their way to the front of the queue. Multi-country polls suggest that a quarter of adults (including half of Russians) would refuse vaccination—another reason why the disease may persist.
Hence for the foreseeable future the first line of defence against covid-19 will remain testing and tracing, social distancing and clear government communication. There is no mystery about what this involves. And yet countries like America, Britain, Israel and Spain persist in getting it disastrously wrong.
One problem is the desire to escape a trade-off between shutting down to keep people alive and staying open so that life goes on. The right lauds Sweden for supposedly letting the virus rip while it makes a priority of the economy and liberty. But Sweden has a fatality rate of 58.1 per 100,000 and saw gdp fall by 8.3% in the second quarter alone, worse on both counts than Denmark, Finland and Norway. The left lauds New Zealand, which has shut down to save lives. It has suffered only 0.5 deaths per 100,000, but in the second quarter its economy shrank by 12.2%. By contrast, Taiwan remained more open but has seen 0.03 deaths per 100,000 and a 1.4% fall in gdp.
Blanket lockdowns like the new one in Israel are a sign that policy has failed. They are costly and unsustainable. Countries like Germany, South Korea and Taiwan have used fine-grained testing and tracing to spot individual super-spreading venues and slow the spread using quarantines. Germany identified abattoirs; South Korea contained outbreaks in a bar and churches. If testing is slow, as in France, it will fail. If contact-tracing is not trusted, as in Israel, where the job fell to the intelligence services, people will evade detection.
Governments must identify the trade-offs that make most economic and social sense. Masks are cheap and convenient and they work. Opening schools, as in Denmark and Germany, should be a priority; opening noisy, uninhibited places like bars should not. Governments, like Britain’s, that bark out a series of ever-changing orders which are broken with impunity by their own officials will find that compliance is low. Those, like British Columbia’s, that set principles and invite individuals, schools and workplaces to devise their own plans for realising them, will be able to sustain the effort in the months ahead.
When covid-19 struck, governments were taken by surprise and pulled the emergency brake. Today they have no such excuse. In the rush to normality, Spain let down its guard. Britain’s testing is not working, though cases have been climbing since July. America’s Centres for Disease Control and Prevention, once the world’s most respected public-health body, has been plagued by errors, poor leadership and presidential denigration. Israel’s leaders fell victim to hubris and infighting. The pandemic is far from over. It will abate, but governments must get a grip. ■
This article appeared in the Leaders section of the print edition under the headline "Why governments get it wrong".
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