The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

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  • arno
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The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

Note by moderator (EvM) added on 28 April 2020: This thread is an exception to our rule of "WASH content only" (see Rule 8 here ) due to the gravity of the Covid pandemic. This thread's title has been adapted several times to reflect the course of the discussion. The initial discussion around risks (as raised by Arno) later developed into a discussion around impacts on livelihoods due to the lockdown situation. Some of the posts in this thread caused some controversies but the forum moderators decided that the thread is allowed to stay. 

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The risks surrounding COVID-19 may be grossly over-exaggerated. Reporting of fatalities due solely to COVID is lacking. Result is an embellishment of the true risk by several fold. Even WHO is publishing these misleading data.

www.spectator.co.uk/article/The-evidence...qedvQRydP8-LjdNcy0AI

eg Quote: "The United States Centers for Disease Control, for example, publishes weekly estimates of flu cases. The latest figures show that since September, flu has infected 38 million Americans, hospitalised 390,000 and killed 23,000. This does not cause public alarm because flu is familiar."

spectator.org/coronavirus-we-should-follow-swedens-example/
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

Hi Arno,
Sorry, but you are misleading into generalizations which are very dangerous.
The cited articles mention that Sweden tested early and sufficiently. That is certainly a right strategy, but unfortunately not the reality in the rest of theworld. I live in Brazil and I can tell you that there are not even enough tests for those who come to the hospital with acute Corona symptoms. The relative death rate is high if onlythe worst cases are tested, it is a simple math equation. But the more acute risk is not about the relative death rate, but about a collapsing health system due to too many intensive patients at the same time. And this is really different from the flu! Or, do you see every year reports like that from China, Italy and Spain or now from New York?
This is exactly what led to the measures that may appear "exaggerated" to Sweden. I do not know the Swedish health system, but I suspect it has more capacity than most of the countries of Latin America, Africa, Southeast Asia and maybe more than the United States as well.
In Brazil, for example, the public health system is already burdened with diseases such as dengue, yellow fever or HIV and associated infections and so on and so on. Every government knows best the capacity of its health care system and only that has to be the basis for appropriate and responsible measures.
After the crisis, we can discuss what we could have learned from Sweden or other countries. But at the moment such unreflected statements are really not helpful and dangerous.
Good Health, Heike
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

These articles are political, despite the veneer of statistics - the newspaper quoted is strongly associated with influential right-wing ideologues.  
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  • Elisabeth
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

Thanks for raising this, Arno (in my role as moderator: while your post is not specifically about sanitation, I think it should be allowed on this Forum nevertheless; WASH and COVID-19 are related, if not via the handwashing link).

About the response in Sweden compared to other countries. I think it is really hard to compare one country to another. What else could Italy have done in the end than to "overreact" and go into total lockdown? If they had taken the more gentle laissez-faire approach like in Sweden, wouldn't that have resulted in many more deaths? Social distancing measures probably work differently in different countries (Sweden being less densely populated than Italy).

I have to admit that when COVID-19 first hit the news I didn't take it real seriously at first because I was comparing the numbers to all the other preventable deaths in developing countires we know about (and which get so little media attention!), in particular the figure of children under 5 dying from diarrhea each day. I don't have the most recent data at my fingertips but a quick look on Wikipedia told me:

Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011. [56] [102]
https://en.wikipedia.org/wiki/Diarrhea#Epidemiology

That's about 2000 per day! 

Still, this disease is different because it is "new" and it also results in deaths in countries with normally good healthcare systems. That's why it got more attention and rightly so.

But I can't get my head around what all this means for developing countries. How can African and Asian countries have any hope in hell to flatten the curve without at the same time destroying livelihoods of those employed in the informal sector? One day without income could mean a hungry child at the end of the day there. 

I came across this article:
"Why a one-size-fits-all approach to COVID-19 could have lethal consequences"
theconversation.com/why-a-one-size-fits-...-consequences-134252

It says:

Right now we are facing a choice between more or less drastic measures to slow the spread of COVID-19, a virus which, at time of writing,  has yet to claim a life under 10, and claims very few lives under 30 , with the risk rising exponentially with age. We are putting in place measures that will lead to malnutrition and starvation for millions of people, and for these horrors,  children and especially infants are the most at risk . And very many of those infants are born, and will die, in Africa.

and

After the 2008 recession, 1 billion people were malnourished, and  5 million more children were hungry in 2010  than they would have been if the recession had not happened. We are only seeing the start of the economic disaster, and therefore the health disaster, that is going to engulf us as a consequence of social distancing measures.

Can someone help me make sense of this? What are countries like South Africa and India hoping to achieve with their drastic 21-day lockdowns? Maybe it will buy enough time to at least buy enough PPEs for the hospitals or for a miracle medicine to hit the market? Or to be seen as "doing something" which might be better than doing nothing?

Regards,
Elisabeth

P.S. About WHO data, I wanted to point out that the useful website "Our World in Data" mentions some problems with WHO data on their website here:  https://ourworldindata.org/coronavirus  

Scroll down towards the bottom where it says:

Why we stopped relying on data from the World Health Organization

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  • arno
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

I guess what concerns me most are the extreme responses various countries have been taking - with highly destabilising impacts on the globally economy and people's health and welfare. And all based on the varied available data and prognoses therein. To lock down using war measures as in France, India, Spain, Italy and China may appear draconian and at least on the surface absolutely necessary. Hungary's reaction this week to create a permanent dictatorship overnight is beyond extreme. 

As Noam Chomsky puts it (and not at all lightly), the corona crisis is a result of a mammoth system failure at the hands of "sociopathic buffoons" morningstaronline.co.uk/article/oo/human...hic-buffoons-control   (like Bolsonaro, Lukasjenko and Trump). Chomsky speaks of the dire "need for an informed, engaged and involved public taking control of their fate".

So amidst all this fury, the interpretation of the corona data (Ro, CRF, etc.) then becomes an Internet beehive of activity (a tug-of-war of sorts) trying to piece together truth in this ever-growing puzzle. When the pandemic starts easing off (and this could happen rather quickly), will we have learned anything? Will we choose better political and economic systems that acknowledge our vulnerabilities as a species? Or will we continue to succumb to the growing trend in mindless populism? 

In another thread I'll focus more on the corona risks surrounding the world's highly dysfunctional sewage and wastewater systems - planting a long-term inoculum under the cities of the world (see here:   forum.susana.org/covid-19-corona-virus-p...a-wake-up-call#29400 ).

Regards
Arno Rosemarin PhD
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  • joeturner
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

There is no reason for anyone to listen to me, but I would note that there is something if an irony in listening on the one hand to The Spectator (extreme Right-wing newspaper whose editor was Boris Johnson who is now the most right-wing Prime Minister the UK has had in a long time) and Noam Chomsky (extreme left-wing commentator, as often correct as completely wrong in his analysis).

One should be very wary about having one's thoughts directed by either of these extremes, in my opinion.

--

That said. I think there is an issue in that this damage from this virus is likely to be greatest in (let's say) countries that already have effective sanitation and so far has been extremely limited in developing countries - where the fallout is likely to be greater than the actual direct health damage of the virus. Maybe.

Take South Africa as an example: several thousand covid 19 cases but very few attributed deaths. If that is anything other than a problem of identification, it suggests that it is not very lethal. And yet the country is in lockdown. Which has direct impacts on money earned by the poorest and therefore how much is available to be spent on AIDS medication and everything else. If the virus doesn't kill them, everything else might.

But then I don't think we can necessarily conclude that this virus is of little importance in these contexts - it is hard to tell at the moment. Given how quickly it is spread and the kinds of pressures it puts onto already stretched medical services, it is entirely possible that it could become deadly in places where (for example) handwashing facilities are poor quality. 
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

Arno - Forgive me if I'm overlooking something, but I think you are confusing risk of fatal outcome with the risk to public health. It's the latter which is the serious problem since corona overwhelms healthcare systems (particularly the absurd system we have in my country of birth - U.S.A.) which, in turn, leads to a high percentage of fatalities among folks who would otherwise survive infection (assuming they had ready access to high quality care and, in particular, ICU beds and ventilators) and a high percentage of fatalities among those facing non-corona related health crises (who, in the face of an overwhelmed healthcare system overrun by corona cases, won't be able to access the care they need). On top of that, our for-profit system routinely results in scores of fatalities simply as a function of millions of people who are unable to afford appropriate medical care. Corona's worst aspect is how it exploits all the deficiencies in ill-conceived and poorly-managed healthcare systems. The U.S. human population currently stands at around ~327 million. At its current trajectory, it's very likely that over two million people will perish as a direct result of this brutal nexus.     
Kai Mikkel Førlie

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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

Arno, sorry again, but your statements are too confusing for me. By the way,  your rejection of the lock down is shared in Latin America by some of the "right wings" but also some of the "left wings" parties and presidents, but all countries are fare away from the conditions of the Swedish healthcare system. Maybe Cuba has the "best" system in Latin America, at least they help in other countries, but Cuba also is under lock down. I think it is responsibility towards their citizens, they know their capacities.

Elisabeth, the measures are actually about not having too many new infections and therefore too many intensive patients at the same time. Because in this case someone has to carry out a "triage", which means refusing treatment to the patients who seem have a lower chance of survival than others. Age can then be decisive, but also previous diseases or maybe disabilities....
 
Corona does not only affect old people and even if would, who wants decide to deny someone the hospital because it is full? Governments who take the lock down measures want to prevent this decision but also all the associated social risks. I think that is not so difficult to accept and it is  not an abstract game with numbers,  is just happening in the hospitals of the most affected countries.
 
Of course, the virus will have economic consequences. Of course, the virus also highlights unresolved problems worldwide.
But, I would like to emphasize again: it is not the moment to question political decisions of other states.

For me and in this moment "social distance" is  simply an act of social responsibility and solidarity. And I would expect to discuss in SuSanA for instance, how people without adequate water supply can protect themselves. A very practical question is, for example: Is it justifiable to use the same bucket of water with which hands have already been washed several times, again and again with the same soapsuds? Can I assume that the virus has been killed by this? Are there any investigations into this? If so, which ones?
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

Soap chemically destroys the virus, but the WHO advice is to wash hands thoroughly in running water. It would therefore appear that washing hands in a shared bowl of water is not following the WHO recommendations.

I am not a virologist but it seems like they are less worried about the persistence in water than on other surfaces. 
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

The Netherlands published some official first data on excess mortality in March:

RIVM National Institute for Public Health and the Environment is receiving information on the outbreak of the novel coronavirus from multiple sources. The daily data reports from the National Intensive Care Evaluation (NICE) Foundation are now also included in the reports on coronavirus data in the Netherlands (only in Dutch). These figures are continuously updated by the NICE Foundation. For that reason, the figures in this report have a slight delay compared to the real-time situation.

Excess mortality

Since the flu epidemic in 2009, RIVM has been monitoring the number of deceased people every week in collaboration with Statistics Netherlands (CBS). The CBS figures show all deaths in the Netherlands, regardless of the cause of death. At this time of year, there are usually between 2700 and 3000 deaths per week. The most recent mortality figures in the Netherlands show that some 870 and 1181 more people died in the week between 19 and 25 March 2020 than expected in this week. A significant part of the mortalities is expected to be related to COVID-19. Exactly which part will only become apparent later from the cause of death registrations. For more information:  https://www.rivm.nl/monitoring-sterftecijfers-nederland
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

I find this headline so "clickbaitish" it makes me want to leave the forum. *

The Spectator is a well-known right-wing paper. Whatever your politics, it's abundantly clear that their version of capitalism is not coping with Covid 19.

Profiteering, cowardly lack of targeted laws that should protect the weak, and outright denial on a scale of stupid to be almost admirable.

The prime minister shakes hands with infected patients and boasts. His associates in the US administration can't even understand basic science.  One suspects they all believe it's a "God given weapon to rid society of the weak".

Are you seriously using this as a way of getting me to stay?

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* Note by moderator: thread title has been changed now, see next post
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  • Elisabeth
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Re: The bigger picture - how Corona virus impacts go beyond human health care systems and into the life-critical systems - safe water, sanitation and hygiene

Hi Jo (and all),

In my role as moderator I have now changed the thread title to a more neutral: "Risks surrounding COVID-19 may be exaggerated" - which I think cannot be accused of "click baiting" (it can be changed further if needed to reflect the course that this discussion is taking).

In my role as forum contributor:
Anyone who has been in this forum for a while knows Arno as a deep thinker who has made over 300 very high quality posts to this forum, so I think he should be allowed to start a thread on this forum which might go against mainstream and might even rub us the wrong way but there is nothing wrong with thinking about different aspects of this crisis. For example, I liked the questions that he asked in his last post:

When the pandemic starts easing off (and this could happen rather quickly), will we have learned anything? Will we choose better political and economic systems that acknowledge our vulnerabilities as a species? Or will we continue to succumb to the growing trend in mindless populism? 

Also we are yet to hear from some forum users who live in country that could be terribly affected in weeks to come, i.e. some of the developing countries. I really worry about South Africa for example (I agree with Joe's comments about South Africa as well). The government is trying to curb the spread by having imposed a 21-day lockdown which is extremely strict.
Edit on 20 April: I have deleted some sentences here that gave an example of police force but without reputable sources.

And what exactly happens to all the people who live from a day to day income to feed their kids if they can no longer go out and find work? Will the government be willing and able to support them financially like the wealthier governments are trying to do with their cititzens.

What if the increased poverty and hunger ends up killing more children than lives saved from a COVID death? I am not saying I have any answers at all, and please don't accuse me of questionig political decisions in other countries. I am just worried and wondering if there are any other alternatives that could be helpful. The best thing would of course be some medication that works or even a vaccine.

Regards,
Elisabeth
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