Corona Daily 111: Pandemic’s Huge Baby Bust

With couples locked down everywhere last April, the world expected a baby boom nine months later. 2021 will bring in millions of lockdown babies, cheerfully announced the social media experts.

That was a misconception. A year later, America and Europe are looking at an unprecedented baby bust. USA faces the biggest birth slump in 100 years. Brookings institute projected US births would fall by 300,000 - 500,000 this year. It’s a double whammy – covid is taking people away, and fewer babies are replacing them.

China had 11.8 million births in 2019, but only 10 million in 2020. (12% decline).

December and January statistics are out for most developed nations. Births have fallen between 7% and 22%. North America, Europe and rich Asian nations are likely to see a 15% decline in births in 2021. P&G, Nestle and Reckitt Benckiser are already revising their sales forecasts for diapers and baby formulas.

Google search provides collateral evidence. The search for ultrasound, morning sickness, Clearblue (pregnancy test) has fallen since the pandemic began.

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There are several reasons given:

Economic uncertainty and the challenges of lockdown parenting have dissuaded 34% of American women. They have either postponed the thought of children or reduced the number of children they expected to have.

The hardest virus-hit areas show the largest declines. Fear and stress resulting from a disaster can discourage pregnancies across national borders. The 1986 Chernobyl accident resulted in an unusually low birthrate in Italy nine months later.

Domestic violence made abused women choose abortion.

Levels of sexual activity have fallen. Those with young children and particularly school-age children report the largest declines in sex. There is a lack of opportunity, particularly for polyamorous active young people. Some people fear being unable to safely access pre-natal care or hospitals for deliveries.

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Will this bust be followed by a boom once the pandemic is over? Analysts look at history for clues.

Indeed, the Spanish flu pandemic, the Great Depression and the Second World War were followed by a baby boom, the last one giving us the term baby boomers. There are a few noteworthy differences, though.

In WWII, men had gone away on war. After the war, they reunited with their wives/partners and the boom happened. In the coronavirus pandemic, many couples were together, in fact locked in 24 hours.

Second, the 1918-1920 Spanish flu pandemic happened before contraceptives were born. Now in developed nations, most pregnancies are a choice rather than a surprise.

Third, Spanish flu pandemic was a health crisis. There is no record of it devastating economies. (Also because it coincided with the First World War, it was difficult to separate the economic impact of the pandemic and the war). The Great Depression, on the other hand, was an economic crisis. The current pandemic combines a health and an economic crisis. Its impact on reduced fertility is likely to be greater.

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It is not by chance that Joe Biden has included significant incentives for children in the latest stimulus package. Every year, each American child under six will receive an allowance of $3600 and there onwards $3000 annually until the 18th birthday. America and Europe already have declining populations. They can’t afford a baby bust.

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The picture in developing and poor nations is different. UN says the pandemic has caused 12 million women in 115 countries lose access to family planning services. This may result in 1.4 million unintended pregnancies.

India’s abrupt announcement of a national lockdown last year made migrants flee to their villages. They were united with their wives. Indian migrants usually meet their families once a year, for a month or so. India has never seen so many couples together for such a long time. Access to contraception, abortion and family planning was cut off.  The data is not yet out, but India is likely to have a baby boom.

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The potential simultaneous bizarre outcome of a baby bust in rich nations and an unwanted baby boom in poor nations will further change the demographic composition of the world.

Ravi  

Corona Daily 112: Your Social Network

Dr Sheldon Cohen is a professor of psychology at Carnegie-Mellon. His specialization is studying the link between social ties and health. When the pandemic and the lockdown began, he looked at his phone. Out of the 800 contacts, he made a shortlist of 50, and ranked them according to how often he would like to interact with whom. The ranking was based on how meaningful the person was to him.

Not everyone is as systematic as Dr Cohen, but social circles are shrinking for all of us, says writer Kate Murphy in the NYT.

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Friend is a loosely used term, particularly since the birth of social media. There are people who don’t recognize their own friends from the Facebook list. Some people collect friends like my generation collected postal stamps in childhood, for eg0 satisfaction and show-off.

Certainly, in the before-mask era, we interacted with hundreds of people. Ten years ago, I went to a gym every morning, learnt ballroom dancing in the evenings, attended a writer’s club and a readers’ club every month, and socialized every Sunday with my fellow marathon runners. My life was exhausting and full of people. Now, ten years later, I am in touch with very few of those hundreds of “friends”. Most of them were activity friends – the activity over, the friendship was over.

Similarly, last few years, whenever my daughter’s school summoned us, I met the other school parents. Every now and then, we had a parents’ get-together over lunch. Since last March, my daughter’s school has been online. I have not met a single parent from the school. I am not a WhatsApp person, so that interaction is completely severed. It was situational and superficial.

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In a study, a psychologist Robin Dunbar claimed that human beings have the cognitive capacity to accommodate four to six close friends. That’s all. It is the top tier of your social network with whom you have a daily or weekly interaction.

Regular contact is important. Without that, friends can get demoted to acquaintances. Another study found that every five to seven years, we replace as much as half of our social network. Social networking is a zero-sum game. When we add a friend, another one drops out. (Of course, one may forward a message to 100 people. I don’t think belonging to a WhatsApp group by itself constitutes friendship).

The pandemic is clarifying whom we really like and dropping those with whom our relations were situational, convenient or superficial. A major reason for discontinuing relationships is the lack of meeting opportunities.

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Friendship is not always reciprocal. One study asked 84 undergraduates to score others on a 0-5 scale: I don’t know this person (0)/ friend (3)/ one of my best friends (5). They were also asked to “predict” the scores of others about them. The conclusion was that almost 50% of the friendships were not reciprocal. Only when both identified each other as “friend” (3 or above), the friendship was considered reciprocal. In Bollywood films and in real life, many of us have experienced this with love. The person we fall (deeply) in love with falls (even more deeply) in love with someone else.

It hurts our ego to accept the possibility that some of our close friends may not feel as close to us as we to them.

The pandemic year offers an acid test. If you consider someone a close friend or one of your best friends, and have had no contact with that person for a whole year, you may have been mistaken.

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Unlike Dr Cohen who made the short list at the beginning, we can now evaluate our true close social circle. If what the cognitive psychologists say is true and we can have only a handful of close friends, the pandemic has probably given us enough evidence to know who they are.

Ravi 

Corona Daily 113: Criminalising Bladders

United Kingdom has done an excellent job with vaccinations. This month London had some days without a single covid-19 death. Weather is improving - time to go to beaches and parks. But some Brits will continue to wear masks for quite a different reason.

On 21 April, residents of Tooting officially lodged complaints demanding more public toilets. In the pandemic, public toilet access has been severely restricted. To save money, UK councils have been reducing the number of public toilets over the years, delegating the function to McDonalds, Starbucks, and other pubs and bars. This may create the ridiculous situation of having to buy a drink in order to go to the bathroom; but desperate people at least had an expensive solution. Now police patrols have a special duty to deter people from peeing and pooing in bushes, on beaches, in private spaces.

Many public toilets were closed last year because of the “covid-says-no” attitude. Newspapers talked about toilet plume in public loos. Sometimes cleaners were not available in lockdown times. Some restrooms blocked off every other urinal, a tactic that was named “social piss-tancing”.

Because the English love systems and queues, in parks certain bushes get designated as loos, and people queue up at those bushes. Two brothers have launched a website for “loo-cation” updates. People finding an open loo feed the information on the app, and people wanting to relieve themselves try to find the nearest place. A bit like finding the nearest Chinese restaurant on your Google maps.

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A pregnant woman from London developed a urinary tract infection after being unable to find a toilet on a trip to Hyde Park. Another woman suffering from a bowel condition was barred from using the loo at her local GP surgery. One woman from west London couldn’t visit her daughter’s grave as the loos on the way and at the cemetery were all shut. Another woman resorted to taking Imodium (medicine to treat diarrhea) before going shopping, and taking a laxative on returning home.

Dylan, 28, was trying to use the bushes when the park officers caught him and fined £195. When he sobbed and said he was out of work, they reduced it to £95. When he complained, the council said it’s not their responsibility to provide the public with a place to urinate. Pre-pandemic England had one public toilet per 12,500 residents.

One American professor calls it “criminalizing having a bladder”. Some American state laws specify that if the police catch people relieving themselves in public places and ticket them, they have to register as sex offenders.

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Some novel products have appeared. Peebol is a pocket sized toilet. It is a bag filled with rapidly absorbing granules, which converts urine into solid, non-odour, non-spill gel. You could quickly get inside your car, use Peebol. Then at home throw its contents, which are biodegradable, on the compost heap.

Sheewee is a device that helps women to pee standing up without exposing themselves. Its sales went up by 700%. Sales of urine funnels, adult diapers, and external catheters have all skyrocketed.

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Amazon first denied and later acknowledged their workers using glass bottles and plastic bags to relieve themselves. Lack of restrooms has become an unbearable issue for delivery workers, taxi drivers, police and others who work outside their home.

Homeless people have nowhere to go. Menstruating women have no place to change their sanitary wear. People with Crohn’s disease, irritable bowel syndrome always mentally map the toilets on the route before leaving home. Now, they have become disabled. Only those with strong bladders and bowels can venture out. Women have started dehydrating themselves before going out.

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UN has named 19 November as the annual “World toilet day”. 4.2 billion people in the world live without safe sanitation. 700 million, including 500 million in India, defecate in the open. As a result of this lack of sanitation, more than a million children under five die of diarrhea every year.

The pandemic has now made Europe and the USA more aware of this issue. In the post-pandemic action plan, access to safe sanitation must be on the first page.

Ravi 

Corona Daily 114: Hair We Share

In pandemic times, even those who are struggling financially have one asset that grows every day.

In the lockdown last year, most men and women missed their usual scheduled trip to the hairdresser. Some used the rare opportunity to grow ponytails or long hair. When salons began to open, the risk of exposure prevented people from rushing for a haircut. In the USA and UK, some women with 14 inch braids are now fully vaccinated. They are looking forward to getting rid of their burden, and head to the beach with new summer cuts.

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On Long Island, Suzanne Chimera runs a company called “Hair We Share”. She asks people to donate their long hair. Wigs made of donated hair are given free to adults and children with medical hair loss. Cancer patients undergoing chemotherapy need wigs. Wigs are expensive everywhere, a good wig with human hair can easily cost between $1000 and $3000. This expense added to the cost of the treatment is an unfair burden on a cancer patient.

Suzanne encourages potential donors to keep growing their hair before donating. In the pandemic, her donor base has increased by 230%. Men ask her how they can donate their wild, unkempt hair. The minimum length for donation is 8 inches long. With eight inches of hair, wig makers end up making a 4-6 inch wig. Majority of those needing wigs are women, who prefer long hair. Many men agreed to wait until their hair was sufficiently long.

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In the pandemic, organizations such as Hair We Share are making compromises, such as accepting grey or highlighted hair. Jerika Nguyen, 28, managed to grow hair till her haunches. Last month, she donated nine inches of her hair to Children With Hair Loss, one of the few charities that accepted her highlighted hair. Jerika compared her experience to blood donation. You give up something knowing you are going to get it back, and what you give up helps the one who receives it.

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Locks of Love, one of the better known charities, tells us that as much as 80% of the hair donated may by unusable for wigs. Many people don’t read the guidelines, and send in hair that is wet, moldy, short, gray, or too processed. This has to be thrown away.

Donors ask if they could see the photo of a person who is wearing the wig made of their hair. Usually the recipients prefer to be anonymous. Even if they allow, the logistics make it difficult to identify which hair is part of which wig. To make a nice, thick wig the manufacturers may look for 20 identical ponytails, each at least eight inches long, and combine these to make a wig.

Paul Frasca, co-founder of Sustainable Salons, in Australia, said hair donations were down almost 70% last year. But a welcome surprise this year is receiving high quality “virgin” long hair coming from men.

In India, at least Hyderabad and Mumbai have hair-wig double donation agencies.

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In China, the wig industry market is booming. USA is China’s largest export destination for wigs. Every time the Trump administration sent stimulus checks to American families, wig exports from China to the USA grew. China prefers to import human hair from India, it is cheaper. And Indians seldom dye their hair, so the quality of hair is good.

In Japan, the demand for men’s wigs has grown nearly three times during the pandemic. While no large scale study is available, wig makers believe the Zoom conferencing is responsible. Japanese men watch themselves endlessly during the Zoom call, feel restless about the image of their crown, and order a nice expensive wig before the next meeting.

Ravi                                                          

Corona Daily 115: Running on Empty Cylinders

India reported 315,000 new cases yesterday, a pandemic record. More than 2100 officially died of covid-19, an Indian record. Many deaths are attributed to the shortage of oxygen. Doctors are required to play god by choosing whom to give oxygen to and letting the others die.

On 16 April, Vijay Shrivastava, 65, a journalist, posted on twitter a photo of his oxymeter showing 52, instead of the required 90 plus. The Uttar Pradesh Chief Minister’s advisor replied asking him to provide full details. By then his oxygen level had fallen to 31. On 17 April, he died. His son said he tried to get an oxygen cylinder everywhere but couldn’t.

Yesterday, in a city of Maharashtra, at least 24 patients died in a matter of minutes when the oxygen supply to their ventilators suddenly stopped due to a leak.

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Six hospitals have gone to the Delhi High court. On 21 April, the high court judge said, “this is ridiculous. We want to know what the center is doing with regard to oxygen supply across India.”

Today, India’s Supreme Court has entered the battleground. Beg, borrow, steal but get the oxygen, a judge reportedly said to the government. The court wants the government to show the national plan for oxygen supply.

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Oxygen is used in industries. It is used in hospitals. We are familiar with oxygen cylinders traditionally used in hospitals. But there is a relatively modern technology called “pressure swing adsorption (PSA)”. Broadly speaking, this production process uses the normal air, and by applying changes in pressure separates the oxygen. This oxygen is supplied continuously to the hospital through pipes. The technology avoids the complications of storage and transport of liquid oxygen. The PSA plants are built close to a hospital or are attached to it.

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Last year, on 14 March, India declared covid-19 to be the national health emergency. It was known India was likely to experience huge shortages of beds, PPE, ventilators and oxygen. The central government decided to build 162 Pressure Swing Adsorption Oxygen plants in 162 district hospitals across the country. India then went into a national lockdown.

For reasons never explained, the tender was issued on 21 October. It took more than seven months to prepare a tender in a national emergency.

These plants are relatively inexpensive. The 162 plants would cost Rs 200 crore ($27 million). They were going to be financed by the PM-CARES fund, an opaque instrument that uses the photo of the prime minister, government website domain, but is kind of private, not open to public scrutiny. Indians had donated Rs 3,000 crore ($400 million) to that fund in the first four days. Money, therefore, was not a problem to build the oxygen plants.

The website of the PM-CARES fund, till today, doesn’t mention how the collected funds have been allocated. It doesn’t mention the plan to build the PSA oxygen plants.

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Scroll, an independent online newspaper carried out an independent investigation by calling the potential hospitals. They called over 60 hospitals across 14 states, and found that only 11 units were installed, and five were operational.

After Scroll’s article was published, India’s health ministry hurriedly issued a series of tweets. They confirmed that out of 162 planned oxygen plants, 33 have been installed. Before May-end, the plan is to install another 47.

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India has now gone into management by crisis mode. Production and supply need to match. A big state like Madhya Pradesh has no oxygen manufacturing. More cryogenic tankers will need to be produced. Their production can take up to four months. Though an oxygen exporter, India plans to import 50,000 MT of oxygen. The logistics of import and distribution around the country are challenging. Industries have been asked to divert oxygen to hospitals.

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Journalist Shrivastava who died on 17 April lived seven km from the Shyama Prasad Mukherjee Civil hospital. It was one of the 162 hospitals waiting for the oxygen generation plant. Had it got one as was planned a year ago, Mr Shrivastava might be alive today. Along with thousands of others.

Ravi 

Corona Daily 116: Haredi Jews: Out for Change (Yotzim)

21 year old Racheli Ohayon worked in a Jerusalem phone center. She was raised in an ultra-orthodox household. Even at work, she wore the most conservative black dress, and strictly observed the religious directives, no matter how stifling. With the onset of the pandemic, she was off work, crammed in the house with seven siblings. She had a lot of time to think. With what was happening around her, she realized rabbis were no doctors. In a few weeks, she took a decision, the most shocking in the Haredi community, to quit the community and go out in search of a secular lifestyle.

Racheli had attended an ultra-orthodox girls’ school where the only history taught was Jewish history. Her school had computers, but they were not linked to the internet. Chief Rabbis had prohibited it. She had never seen a movie, and never worn a pair of jeans. For the first time, she bought a smartphone and started browsing Google and listening to music on YouTube. She joined the local library in Petah Tikva and started reading secular literature, novels which were off-limits for her. Earlier, Racheli had thought Haredim were special and different people. She found out she was not different. She feels her decision to leave was absolutely right.

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In the Haredi community, marriages are arranged. Dedi Rotenberg and his wife Divan had one such marriage. They soon realized both felt this particular type of religion was suffocating them. In 2020, they took the decision to move out of Bnei Brak for a secular life in the south of Israel. Dedi said it took him many months to adapt to his new friends and neighbours. Their slang, the subject matter were different. For a few weeks, he had no idea what people were talking about, though they shared a common language.

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They are called Yotzim (those who leave). In the ultra-orthodox community, there is no question of being able to stay at your home after giving up the orthodoxy. In extreme cases, parents of those who leave sit shiva, meaning observe the traditional mourning as if their children were dead.

Many leavers don’t wish to abandon Judaism, but are seeking individualism, and freedom to make their own choices in life. But leaving their family, community and lacking any secular education, they are not equipped to adapt to the new world. As mentioned yesterday, Haredi boys are not taught math, science or English. Many of them study Torah full time and rely on government aid. Most Haredi women work in low-grade jobs to support their families. They are responsible for raising the large number of children as well.

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There are two major organizations in Israel that take care of the leavers: Hillel and Out for Change.

Hillel empowers the leavers to build meaningful self-determined lives. Their dedicated staff provides full assistance during the first critical 3-5 years in the transition period. They  offer hotline and drop-in services, counselling and treatment, transitional housing, housing subsidies, education and employment help, free legal aid, emergency shelter, care for single parents and children.

During the pandemic, Hillel noted a 50% increase in the number of leavers. Experts attribute the increase to a breakdown of supervision and routine, disillusionment with the community leaders, a rise in internet use, and more time for questioning and self-discovery.

Out for Change offered leavers the option of formal registration, so as to legalise their status with the authorities. The labor and social affairs ministry recently began defining ex-haredim as a special category eligible to receive vouchers for special vocational training courses. During the pandemic, though traumatized by the break-up from the family, more than 1300 leavers signed up.

This was something that the rabbis had feared. This was one of the reasons why they were insistent on keeping the religious schools open no matter what. A leading rabbi said boredom leads to sin and puts girls in severe spiritual danger.

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Under a different name, and different religion, each country has such communities whose decrepit old male leaders trap its members into extreme orthodoxy. Israeli organisations such as Hillel and Out for Change are good role models that show how to bring those people back into civilization.

Ravi 

Corona Daily 117: Haredi Jews: State within a State

The Israel-Palestine hostility is well known. A lesser known conflict is the one between secular Israelis and Israel’s Haredi Jews. Haredim are ultra-orthodox, custodians of traditional Judaism. They consider themselves to be the truer Jews. They believe in the strictly orthodox Rabbi leaders, many of whom are above 90, and in the Torah, Hebrew Scriptures.

David Ben-Gurion, the founding prime minister of Israel, had the difficult job of negotiating between the proposed secular state and the Haredi community. From Ben-Gurion to Netanyahu, every prime minister has pandered to the community for political support. To please them, Ben-Gurion exempted them from military service, made Saturday the official weekly holiday, made kosher food mandatory in state canteens, and forbade civil marriages in Israel. Haredi communities are allowed to run Yeshiva, their own religious schools, funded by the state, which don’t teach core subjects like mathematics, science or the English language.

Nearly half of Haredi males choose not to work at all, relying on state funding and philanthropic aid to feed their large families. About 42% of Haredim live below the poverty line.

Haredi Jews make up 13% of the Israeli population. But the percent will grow because Haredi women have on average 6.6 children, secular women 2.2.  60% of Haredi Jews are under 20, at least ten years younger than the national average. Believe it or not, many Haredim call Israel an anti-Semitic state.

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The coronavirus pandemic reveals and highlights many conflicts. Since the first lockdown, Haredi Jews refused to wear masks. Religious schools continued teaching when all other schools were shut. Yaakov Litzman, Israel’s health minister a year ago, is himself a Hasidic Jew. When Netanyahu first ordered a shutdown of public gathering places including yeshivas and ritual bathhouses, Litzman persuaded Netanyahu to exempt the Haredim from the general lockdown. He argued that there was a higher law to consider. Netanyahu agreed because another election was looming in a few months.

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 Bnei Brak, just east of Tel Aviv, is a concentration of Haredi Jews. It is the poorest and most densely populated city in Israel.

Last April, it became clear Bnei Brak enjoyed no divine protection from covid-19. The crowded study halls in the yeshivas and jam packed ritual public baths turned Bnei Brak and other Haredi concentrations into hot zones.

Keeping kosher in quarantine was a challenge. The Israeli government tried to isolate coronavirus patients by carrying them in ambulances to designated hotels. The residents of Bnei Brak refused to be evacuated. They demanded written proof that food in the hotels would be kosher as certified by their trusted rabbi.

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On 31 January, during Israel’s third lockdown, Rabbi Meshulam Dovid Soloveitchik, 99 years old, died of covid. He was the head of an elite school for ultra-orthodox Jews. A grand funeral was arranged. Later on the same day, Rabbi Yitzchok Scheiner, 98 years old, also succumbed to the virus. Another mass procession followed through Jerusalem.

Chaim Kanievsky, 93 years old, is another prominent rabbi. He refused to shut the religious schools and reportedly said: we don’t care what the law says, we are not going to obey.

Earlier the secular and Haredi communities lived as if on two islands, each in their areas, rarely mixing. Bnei Brak was closed for Sabbath, and a Gay Pride parade could happen in Tel Aviv. The infectious disease showed Israel has no islands, everyone is connected and can affect one another.

Haredi Jews are 13%, but had 36% of the infections. One out of every 100 ultra-orthodox Jew over 60 died from covid, three and a half times more than the general population. This was not a chance event. London has 23,000 ultra-orthodox Jews. In London, the community had 64% infections, one of the world’s highest rates of covid-19 infection. UK average was 7%.

What was the positive impact of the pandemic on some of the younger Haredi Jews? I will discuss that tomorrow.

Ravi                                                                                                               

Corona Daily 118: A Day in the Life of Alison Forde

Alison Forde checked the latest figures before leaving for the Royal London Hospital. At 6 am, 30 patients in a&e (accident and emergency) required a bed, half of them covid patients. Six people had been waiting for more than four hours. An 82 year old man arrived yesterday was waiting for 15 hours. The risk of dying increases if a patient is not treated inside six hours.

Alison’s team was shrinking. Out of her core team of eleven, three were off sick, and one was isolating with covid symptoms. In the early months, the hospital had suspended all routine work, including cancer treatment. In January, the sickest covid patients were earmarked for Royal London.

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As the Head of Site Operations, Alison’s main job is to allocate patients to key areas of the hospital. A&E is the clearing house for admissions. From there, she moves patients to respiratory wards to give oxygen via masks or nasal tubes. Or to intensive care which now has three floors (earlier one). Every day Alison was confronted with a brutal fact. There weren’t enough beds. The hospital chain had only ten spare intensive care beds. The entire system was on the verge of grinding to a halt. People who could be cured in pre-pandemic time may not survive now.

After ten months, survival rates had improved, which had aggravated the situation. People now stayed on life support for long, which made intensive care beds scarcer. Earlier, death was the primary mechanism of discharge.

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08.30 am was huddle time for Alison’s team. Here they planned the day. Now, with social distancing, the team occupied the entire corridor. Some members struggled to hear what was being said.

NHS in general, and Royal London in particular, has set capacity benchmarks. The number of ambulances waiting to offload patients, waiting patients, bed occupancy, staffing rates and such. The system triggers alarms. For example, a patient waiting beyond certain time will be sent to another hospital. But now, with all hospitals overflowing, those alarms made no sense. Alison had simply changed the parameters.

The 82-year old fortunately got a bed at 07.15 after waiting for 16 hours.

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Novel tasks were added as a result of covid precautions. Every day, piles of clinical waste from intensive care, including heaps of soiled personal protective equipment had to be disposed. They packed the store rooms to the ceiling. The logistics of disposing the waste mountains was looked over by Alison.

At lunchtime, Alison felt overwhelmed. She sat in the corner and cried a little. Her team was a little surprised to see her state. She is known as the cool cucumber.

When the pandemic started, Alison was extremely worried about contracting coronavirus. Every day, each doctor would visit her office to get three or four death certificates signed. Some hospital employees died as well. Every time she coughed, she thought she had covid. To avoid the Tube, she started cycling to the hospital. She fell off, fractured her jaw, cut her lip, ligament and wrist, and needed two operations. But her fear of covid disappeared since.                                                                                                                                                                                                                                                                                                                                                                                                                                                            

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The hospital is considering adding another unit. That would mean diluting the nurse-patient ratio further. Normally one nurse for two is the maximum allowed; now one nurse takes care of four.

At 4.30 pm, 31 patients were waiting for more than four hours in a&e. By 8 pm, more than sixty.

Alison’s 12 hour shift finished at 08.30 pm, but she can never leave before 9 pm. She caught the bus home, had a cup of tea, a quick cold sandwich. She did a bit of cleaning, more to distract herself. After checking the morning alarm, she went to bed.

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P.S. For 1843 magazine, Simon Akam interviewed Alison Forde, who described her 15 January 2021. This article presents it in a compressed form. For health administrators in Brazil, India and other developing countries, working days are even more terrible. Fortunately for Alison, the situation in London has now improved.  

Ravi 

Corona Daily 119: The Unusual Royal Funeral

British planners excel at contingency planning for the death of a Royal. When the Queen eventually passes away, the Prime Minister will get a code-worded call saying “London Bridge is down” which will trigger press releases, BBC protocols, the lowering of flags in Canada and New Zealand, and detailed funeral arrangements. Loyal watchers of The Crown know this. The code for Prince Philip’s death was “operation Forth Bridge”. Had the British planners shown such zeal and meticulousness during Brexit or Covid-19 planning, Britain would be a much better place now.

Unfortunately, the best-laid plans of men often go awry in a pandemic.

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The original plan called for the coffin of the Duke of Edinburgh to move through the streets of London on a gun carriage with hundreds of thousands lining up on both sides to bid goodbye. This is normally a journey of 22 miles from Buckingham palace to Windsor castle. Instead, Prince Philip’s converted Land Rover made a trip of only a few hundred yards.

The protocol number of attendees is 800. The pandemic reduced it to 30. That meant mainly the immediate family. Queen Elizabeth and Prince Philip are third cousins, with Queen Victoria as their common great-great-grandmother. That could have eased some pressure on the list. Boris Johnson wisely withdrew, and pregnant Meghan was advised not to travel by her doctors and counsellors. The vacant seats allowed the Queen to invite the German relatives of Philip (his mother was German). In 1947, as a consequence of WWII, Germans could not be invited to the royal wedding. The German royals and Harry flying from abroad went into quarantine. There were enough palaces for each of them to isolate in. A small print exception allows mourners to exit quarantine on the funeral day.

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The Queen had to decide on the dress code. Usually, male royals wear military uniforms. The Queen opted for civilian clothes. Black. Black. Black. Queen Victoria, after her husband’s death wore black every day for forty years.

Avoiding military uniforms, though prescribed in the planning book, was a shrewd decision. Harry has sort of renounced royal life, so despite serving in Afghanistan he was no longer eligible. And Prince Andrew exiled for his association with a sex predator didn’t qualify either.

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When operation Forth Bridge was activated, on BBC, presenter Martine Croxall interrupted the programme to announce the Duke’s death. While the channel showed his photographs, she quickly removed her necklace, and changed into a black dress.

Over the next week, you could switch from one BBC channel to another, but couldn’t escape knowing more about the life of the Royal Consort. The civilized kingdom has a platform for people to complain about BBC. This week BBC received more than 100,000 complaints, an all time record, for its wall-to-wall coverage. Some people, presumably anti-monarchists, likened the programming to what might be expected in North Korea.

This is surprising. The Duke’s death was a respite from the wall-to-wall coronavirus coverage. Like sport events played to empty stadiums, but televised worldwide, the BBC coverage offered the worldwide mourners a live viewing opportunity.  

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Inside the castle’s St George’s chapel, every attendee was required to wear a black mask, and not sing. They needed to keep a gap of two meters. The queen dressed in black, wearing a mask, sitting alone in a corner, looked more a widow than a queen.

There was no eulogy and no sermon. A choir of four, the number cut seriously by the pandemic, standing far from the attendees, sang hymns.

Viewers glued to their TVs scrutinised the royal family members to see how much each of them was faithful to the Netflix series.

Prince Philip’s casket was lowered in the royal vault. Only a living royal or a dead royal is allowed to enter the vault. This is a transit stop for Philip. When his wife dies, he will be moved and the couple will be buried side-by-side at the King George VI memorial.

Ravi 

Corona Daily 120: Patents Kill Millions

In 2021, the USA would have produced and reserved one billion doses to vaccinate its 260 million adults. Biden administration has said such large quantities are essential to have vaccines for children, booster doses for variants, and any unforeseen events.

Currently USA is holding 30 million doses of AstraZeneca, not even approved yet. To its south, Brazil is losing 4000 people daily to covid-19, and has approved AstraZeneca, but has no access to these doses.

Of the vaccine doses given globally, 75% have gone to 10 countries. Africa has 17% of the world’s population, and has barely administered 2% of vaccine doses. A healthy 20-year old American can soon be fully vaccinated; whereas hundreds of unvaccinated doctors and nurses have died in Kenya, Mozambique, Nigeria and Zimbabwe.

All this can be understood, if not admired. America’s vaccine nationalism wants to make America absolutely safe, before doing anything for outsiders.

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Poor countries will not be able to vaccinate their populations before 2023 or 2024. And if vaccination becomes an annual requirement, it will be a race that can never be won.

What is less known is that vaccine production can be dramatically expanded across the world. Millions of vaccines can be produced in Bangladesh, African countries or developed countries like Canada. Over the years, Asia and Africa can produce enough vaccines to vaccinate their entire populations. Why is this not done?

Because Pfizer, Moderna and other vaccine manufacturers refuse to share their patented technology and know-how. Their patent restrictions prevent other countries from producing their vaccines.

This is usually justifiable because innovation is rewarded by legally enforceable patents. But in this case, the US and the European governments gave those pharma companies billions of dollars. These were not loans, but grants. If the vaccines had failed, the governments couldn’t recover that money. The sponsoring governments should have either kept the patents to themselves, or included a clause in the contracts making them available equitably. When the Gates foundation gives grants, it includes such clauses. Moncef Slaoui, the head of Operation Warp Speed said the program was US-centric. Patent sharing was never discussed.

Last year, WHO tried to create a “Covid-19 technology access pool”, a platform to help developing countries make coronavirus vaccines. Not a single vaccine manufacturer agreed to join it. Albert Bourla, the CEO of Pfizer, called the concept “nonsense”.

India and South Africa have pushed for patent waivers. Biden has sided with the drug companies. In March; USA, Britain, the EU and Switzerland rejected the push for waivers.

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In effect, you have rich nations investing billions in Pharma companies, letting them retain the patents and block production expansion around the world; and allowing them to reap profits year after year. Moderna was entirely funded by taxpayers’ money, but is most restrictive on sharing knowhow. The Trump administration’s badly drafted contracts allowed this.

US federal law permits the president to seize patents and use them as it sees fit. Last month, Biden “persuaded” Merck to make Johnson and Johnson vaccines. He used wartime procurement powers. Of course, this was done because Merck was American. But if Biden wishes to think globally, he can apply the same powers to let a Bangladeshi factory acquire the knowhow free, and produce American vaccines.

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This week, dozens of Nobel Laureates and former heads of states have written an open letter to President Biden urging him to waive IP rules for covid vaccines. Hundreds of thousands of African lives were lost because of patents on HIV lifesaving drugs. In 2001, WHO had successfully managed to procure an exemption for public health emergencies. That was in the context of HIV.

Is Covid-19 not a grave enough public health emergency? It is equivalent to a World War. And in World Wars, nobody should talk about patents. Does America really think it will remain absolutely safe, while the rest of the world remains unvaccinated? American Pharma giants wish to protect American innovation. They should note that most innovators of the current vaccines are immigrants. (Pfizer’s Bourla who called patent waivers nonsense is also an immigrant).

If nothing is done, just like the coronavirus, American patent laws are likely to kill millions in the pandemic.

Ravi