🦠Covid-19 - 03/03/20 It's the public health stupid! | 🤕 93,526 | Deaths 3,204

📊 Daily Data Brief:

93,526 cases

New Cases outside China: 2,453 (+719)

New Cases in China:  131

Total Death: 3,204 (+84)

Serious or Critical Cases:   6,771  (-327)

Source: https://www.worldometers.info/coronavirus/

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How long before a candidate exclaims “It’s the public health stupid!”. The US Central Bank certainly could have started yesterday when it cut interest rates 0.5%. This was the first Fed cut inter-meeting since the 2008 financial crisis. It looks like the concept of “Medicare for all”, until yesterday a heavily Democrat idea, is also gaining ground - at least for emergency situation like the coronavirus outbreak, amongst the Republicans and Trump - US’s Chief Index Officer. Human rights and civil liberties lawyers are even scrutinising what is and is not in the public interest when it comes to public health. Weak public health has a huge economic cost and the novel coronavirus is making this increasingly clear. We should expect more of this also when the WHO publishes its report when it comes back from Iran.

🏛 In the 3rd edition of the Corona Daily, I had linked two stories from the New York Times highlighting that weak health benefits and sick pay leave in the US might impact for financial reasons behaviour of citizens infected with COVID19 and therefore undermine containment strategies. The next day the flurry of articles on this issue continued, with two further articles in the Washington Post (“The coronavirus could hit the U.S. harder than other wealthy countries”) and The Atlantic (“Epidemics Reveal the Truth About the Societies They Hit”).

Democrats had been a bit slow to seize the narrative and yesterday the Wall Street Journal came up with a ‘News Exclusive” (“U.S. Weighs Paying Hospitals for Treating Uninsured Coronavirus Patients”) and the HuffPost came back later with a good coverage of the developing story . It was clearly a concerted and well-orchestrated effort from Trump and his party. This issue had become a thorny conundrum for them. How do they let go of an ideological belief while doing what’s right in the coronavirus outbreak circumstances. They made sure to highlight that “socialised medicine” is not an option but that Trump could make an exception in the public interest. As the article outlined, even staunch and career opponents of Obamacare were not opposed to it. They found the legislative tool to implement it: “under the Stafford Act, the president can mobilise federal resources by declaring an emergency or a disaster”.

The Republicans understood that the best and most cost effective for the economy, public finances and the S&P500 was to implement temporary “Medicare for all” without naming it. “What’s your options” one Republican asked. They had found the narrative and the way to implement the right policy. In one stroke, they took the rod out of the Democratic candidates’ hands and pulled the carpet under their feet. It was almost as if it didn’t matter whether Biden or Sanders would win Super Tuesday. It was a master stroke. Everybody knew it, the only thing that was left for the Huffpost was to put an embarrassing, cheeky and unrelated video to embarrass Trump to headline the article. (Link)

🤬 Now censorship is also increasingly seen to have public health repercussions from the early beginning of the COVID19 outbreak in Wuhan. Would we be in the current predicament, if China had not censored doctors telling the truth about this SARS-like virus that patients were coming to hospitals with and told the world about it? In an extremely powerful and wonderful piece of investigative journalism, The Citizen lab exposes how China has censored conversations on social media since the beginning of the outbreak. It makes Laurie Garrett (a Pulitzer Prize winner) story on how China’s behaviour on COVID19 is criminal (“How China’s Incompetence Endangered the World”) stand the test of times better than acclaimed academic Zeynep Tufekci’s hypothesis that Xi Jinping might have not known (“How the Coronavirus Revealed Authoritarianism’s Fatal Flaw”). Both are exceptional and insightful stories.

The work by Lotus Ruan, Jeffrey Knockel, and Masashi Crete-Nishihata in their article “Censored Contagion” goes further by exposing how from the early days of the outbreak, in fact the day after the late whistleblower Li Wenliang rang the alarm bell, the Chinese authorities started deliberate and sophisticated digital censorship which suppressed critical and neutral information in order to protect the regime instead of the public. Furthermore this was done in partnership with “private companies” YY and WeChat and the censorship was broad, blind and contrary to the interest of the public health both in China and abroad. It limited the flow of information and in doing so allied itself with the flow of the virus. It was a criminal act which will cost lives. As the article highlights it “censored content included criticism of government, rumours and speculative information on the epidemic, references to Dr. Li Wenliang, and neutral references to Chinese government efforts on handling the outbreak that had been reported on state media.”

It raises deeper questions on filtering of information in the age of social media whether state-led or algorithmically-led. I first came across Zeynep work in 2014 post the Ferguson shooting in which she showed how algorithmic filtering had mis-informed the then 40% of American getting their news from Facebook (this was just after I co-founded Cronycle to address the dangers of publisher-side algorithmic filtering) . This piece (“What Happens to #Ferguson Affects Ferguson”) has aged very well and in light of the Chinese digital censorship should put social media’s business model and power through its sheer platform scale at the centre of public policy around the world. (Citizen Lab’s story Link)

🏛 Continuing on this is an article published in The Croakley, where Melissa Sweet looks at the intersection of human rights and public health. “Compulsory isolation in the fight against coronavirus: a clash of human rights and public health” follows on the heels of 450 public health, human rights and legal experts and organisations signing an open letter calling for “a fair and effective” response to COVID-19. This is a tricky area given how little we know about COVID19 at this stage. The article (“Are Quarantines a Proportionate Response to the Coronavirus?”) by Jacob Sullum on this same subject has the merit of outlining how a human rights lawyer would look at the problems by first laying out the facts about COVID19 and then weighing the proposed quarantine/isolation public health measures against human rights / civil liberties. The article has the merit of outlining what is the current legal authority in this instance but scientists and academic could already contest some of the “facts” laid out about COVID19 and which a judge would have to consider in any ruling.

It’s an important and complicated issue, particularly in the case temporary measures become permanent and when your knowledge of COVID19 remains in its infancy. This was an issue I highlighted in the Corona Daily yesterday with regards to the tech surveillance apparatus which China has built to enforce its containment and whether they would shut it once the virus is gone for the season. (Link)

🦠 Dr Francis Collins, the current NIH Director, wrote a blog giving a current update on vaccines and treatment in which the NIH is involved. In particular, it outlines how the crystallographic structure of COVID19 and in particular the distinctive spike on the surface of the virus is a focus for both vaccine developers, researchers and drug companies looking for a treatment against it. It's quite a scientific feat that we are already able to have such a detailed structure for vaccine research or drug discovery, and it is therefore no surprise that the lead researchers from the University of Texas which elucidated COVID19’s structure had their findings published in Science one of the most sought-after scientific journal. Dr Collins highlights the vaccine effort from Moderna Therapeutics in partnership with the NIAID which are soon to start clinical trials on its candidate (the whole regulatory approval is likely to take over 12 months with further delay expected in implementing its safe production at scale). With regards to treatment, Dr Collins also outlines the first clinical trial in the U.S. to evaluate an experimental treatment for COVID-19 with the existing anti-viral drug remdesivir. The fact that this anti-viral is already prescribed for another viral indication, will mean that the FDA regulatory process would be shorter as the regulator will “only” need to focus on efficacy given that it went through other parts of the approval process for other medical conditions (Link)

💰 Kenneth Rogoff, Professor of Economics and Public Policy at Harvard University and former chief economist at the IMF, looks at how coronavirus might trigger a supply-side led recession as opposed to a demand-side one. This would be the first supply-side driven downturn since the last oil shock of 1973 (hence the article title -”That 1970s Feeling” ) given that both previous recessions were demand-side driven. The disruption to the supply chain from the containment measures and also possibly from employees having to take sick leave (in its action plan yesterday, the UK government acknowledged that up to 20% of the UK workforce could be sick at the same time with the novel coronavirus). This disruption to the supply-side (the production of goods and services in the economy) could also create shortages and drive up inflation. COVID19 would also trigger a downturn on the demand-side (the consumption side of the economy), but the supply-side might be the dominant force in the downturn. Hence the exceptional 0.5% rate cute by the US Federal Reserve yesterday (Link)

🤕 In a short and informative piece Sharon Begley at STAT news is looking at which categories are most at risk during the COVID19 outbreak. As has been widely reported, even though it’s highly contagious across age and sex groups, it’s fatality rate s significantly higher for the elderly and in particular if they’re suffering from another condition: “Overall, China CDC found, 2.3% of confirmed cases died. But the fatality rate was 14.8% in people 80 or older, likely reflecting the presence of other diseases, a weaker immune system, or simply worse overall health. By contrast, the fatality rate was 1.3% in 50-somethings, 0.4% in 40-somethings, and 0.2% in people 10 to 39.” It’s still early days in this outbreak and data might evolve as it did with SARS, but that’s the current understanding of the risk factors depending on your age group (Link)

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📊 A picture is worth a thousand words

1. This is a data visualisation page by John Selanikio (MD) on COVID19 (Link)

2. This is the New York Times data and graph page on COVID19 with an update map of the US alone (Link)

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🎬 As noted above, the video of the day today is the one posted by the HuffPost showing Trump being contradicted by his team in front of the press and also suggesting that we use a strong flu vaccine to combat COVID19. (Link)

PLEASE DO COMMENT ALWAYS AND IN PARTICULAR ON SOME OF THE PUBLIC HEALTH AND CENSORSHIP ISSUES IN THE COMMENT SECTION BELOW AS THESE ARE IMPORTANT ISSUES TO DEBATE