2021
By : Anna Dziubinska (Unsplash)
Present day partisanship and the legacy of structural inequality has helped fuel the spread of COVID-19 in Native nations
The pandemic has had a disproportionate impact on Native nations in the US with COVID-19 rates 350 percent higher among Native Americans compared to whites. In new research Raymond Foxworth, Laura E. Evans, Gabriel R. Sanchez, Cheryl Ellenwood, and Carmela M. Roybal contextualize the history of colonization and policy neglect by federal and state governments to explain the unequal impact of the pandemic. They find that this disparity is related to a lack of basic infrastructure like safe running water, a shortage of health information available in Native languages, and the high rate of non-tribal members visiting tribal lands during the pandemic. State-level partisanship also plays an important role; Republican dominated states were less likely to implement pandemic mitigation policies such as mask mandates, which in turn has put Native American lives in danger.
The first large-scale COVID-19 outbreak in a Native American community originated from a large church gathering around March 7, 2020 in the small community of Chilchinbeto, Arizona on the Navajo Nation. Like many other Native nations across the US, the Navajo Nation responded to the COVID-19 outbreak by issuing a state of emergency and closing tribal offices and businesses in an effort to stop the spread of COVID-19. By spring 2020, new cases of the coronavirus began to emerge in other Native nations across the US, and by August 2020, the US Centre for Disease Control and Prevention (CDC) reported that Native Americans had 3.5 more COVID-19 cases than White Americans and hospitalization rates five times that of White Americans.
To understand the disproportionate impact of the pandemic on Native communities, our research contextualizes the history of colonization and policy neglect by federal and state governments to show the compounding effects of COVID-19 on Native peoples. Our work provides insight into the structural and partisan causes of COVID-19 spread across Native communities during the early days of the COVID-19 pandemic in 2020.
Understanding Native Nations in the US
There are 6.9 million American Indians and Alaska Natives in the US and 574 federally recognized Native nations. Native nations are sovereign governments that vary in size, geographic location, economies, and government structure. Likewise, all Native nations vary by culture, language, and religion. Tribal homelands once spanned across all 50 states. Today Native nations have landholdings in 34 states, encompassing 56.2 million acres held in trust by the US government and another 43 million acres in Alaska under the Alaska Native Land Claim Settlement Act. As sovereign nations, Native nations have distinct relationships with other American governments. The federal government is legally defined as a trustee of Native nations and has a responsibility to provide social services, healthcare, education, public safety, and land, while recognizing inherent sovereignty of Native nations.
But the federal government has failed to fulfill its trust responsibilities jeopardizing the health and well-being of Indigenous people across the North American continent. Consequently, Native Americans are disproportionately affected by high rates of poverty, unemployment, and health disparities resulting from centuries of harmful federal and state policies. Structural inequities like poor infrastructure, food insecurity, a lack of internet access, trauma, and health interventions not adapted to local context are well documented and continue to effect Native nations today.
A history of colonialism and epidemics for Native Americans
The coronavirus is a repeat of prior disease outbreaks on tribal lands. In fact, colonization is the largest health epidemic that has led to the greatest loss of Indigenous life across the Americas. For example, 90 percent of Indigenous life was lost across the Americas during the first century of European contact and death was incited by disease, starvation, and extreme poverty. Native American communities have also been disproportionately affected during more traditionally defined health epidemics. During the influenza outbreak of 1918–1919, nearly 25 percent of Native Americans caught the flu and were four times more likely to die from it compared to those living in urban areas. Similarly, in 1993, the first victims of the hantavirus outbreak in the southwestern United States were Navajo. Reflecting the racialization of health inequalities facing tribes, news agencies’ stoked fears of the unknown virus, commonly referring to it as the “Navajo flu.” During the 2009 H1N1 outbreak, American Indian and Alaska Natives’ death rates were four times greater than all other racial and ethnic groups combined in states with high Native populations.
Structural Inequalities and Partisanship Impact the Spread of COVID-19 in Native Nations
We used data from a variety of sources to examine the Native American community-level and state-contextual factors associated with the spread of COVID-19 in Native communities in the continuous US. We find that measures of political and policy marginalization, including the absence of household plumbing and access to culturally relevant public health information helped fuel the spread of COVID-19 in Native nations. Our findings accord with existing scholarship on Native and health politics in the US federalist system more broadly. Native American health outcomes are shaped by multiple layers of inequality.
Adequate access to household water remains a significant challenge for many Native nations. A lack of basic infrastructure makes it difficult to deliver both running water and safe and clean groundwater. 13 percent of Native American households in Native nations lack safe water and many others lack solid waste disposal and sewers.
A shortage of health information available in Native languages adds another layer. The lack of lifesaving information about the severity of COVID-19’s health threats, as well as best practices to reduce the spread of the virus and manage infections but English only dissemination produce language barriers. A large segment of the US population who speak a language other than English at home includes Native people who speak over 169 Indigenous languages. Over 25 percent of Native people report speaking a Native language.
Our research also identifies that the high rate of non-tribal members visiting tribal lands during the pandemic endangered the health and safety of tribal people on their homelands. As Katherine Florey of UC Davis has documented, COVID-19 has exposed the consequences of longstanding federal limits on tribal governments’ ability to regulate non-tribal members when they endanger health and safety on tribal lands.
Beyond community factors, we find that state-level partisanship is associated with COVID-19 spread in Native nations: Native nations in Republican states experience higher COVID-19 infection rates, as do states with higher ratios of Trump voters in their borders. Policy differences based on partisanship at the state and local level are well established. For example, as of early August 2020, 32 US states required face coverings statewide: 24 were led by Democratic governors who have issued a mask mandate and only eight states run by Republicans implemented a mask mandate. Furthermore, Democratic states were quicker to implement mask wearing policies, with half of the Democratic-led states having mandates in place by March 2020. Former President Trump consistently downplayed the dangers of COVID-19, disparaged public health policies that can reduce the spread of the disease, and pressured Republican governors to avoid utilizing their powers to protect public health. Combined, we find that these behaviors endangered Native American lives and furthered the spread of the virus.
More investment in infrastructure and healthcare in Native Nations is needed
A number of policy recommendations emerge from our research. There must be greater prioritization and investment in infrastructure on tribal lands (i.e., safe drinking water, quality housing, electricity, broadband) by the federal government. This has been a consistent call by bipartisan federal commissions. Greater investment must also be made in growing the healthcare capacity of Native nations including investment in greater quality access, culturally relevant healthcare practices, capacity to respond to health crises and increasing tribal stockpiles for lifesaving equipment and personal protective equipment. The right to quality healthcare is a treaty right of Native nations and the federal government must honor these treaties and their relationship with Native nations in the US. Finally, both federal and state governments, as well as American citizens, must recognize the inherent sovereign rights of Native nations and respect their policy decisions passed to protect their tribal citizens.
This article is based on the paper, ‘“I Hope to Hell Nothing Goes Back to The Way It Was Before”: COVID-19, Marginalization, and Native Nations’ in Perspectives on Politics.
By : Raymond Foxworth – First Nations Development Institute
Laura E. Evans – University of Washington
Gabriel R. Sanchez – University of New Mexico
Cheryl Ellenwood – Washington State University
Carmela M. Roybal – University of New Mexico
Date : July 7, 2021
Source : LSE Phelan US Centre
https://blogs.lse.ac.uk/usappblog/2021/07/07/present-day-partisanship-and-the-legacy-of-structural-inequality-has-helped-fuel-the-spread-of-covid-19-in-native-nations/
The Simple Rules of Wealth Inequality
The rich won’t be paying their fair share of taxes as long as our tax system speeds wealth’s concentration.
A great deal of confusion surrounds America’s extreme inequality, what causes this inequality, and how we can check and then reverse it.
That needn’t be. Ultimately, economic inequality comes down to the concentration of wealth at the top, and we can explain the dynamics of that concentration in a few simple rules — and one not so simple, but understandable, computation.
Rule One: For those at the top, every tax is a wealth tax.
In America, we have many types of taxes. We have income taxes, sales taxes, excise taxes, property taxes, and estate taxes. For most of us, how we’re taxed matters. Sales taxes impact our spending decisions. Income taxes impact how hard we work, how much we save, and when we retire.
For those at the top, the type of tax doesn’t matter so much. From the perspective of the wealthy, every tax amounts to a wealth tax. Why should that be the case? Income, sales, and other existing taxes don’t particularly influence the spending decisions the wealthy make or such mundane judgments — to them — as how many hours they work, when they may be able to retire, or whether they need the additional income from a spouse’s job.
Our existing taxes only impact the wealth of our ultra-wealthy. Tax payments, to be more specific, only determine how fast or how slow the wealth of the wealthy grows.
Rule Two: Wealth concentrates at the top when we have insufficiently taxed wealth.
Thomas Piketty’s best-selling book, Capital in the Twenty-First Century, has one core takeaway, the simple notion that the wealth of those at the top will grow at a rate faster than the rate of growth for a nation’s overall wealth, unless taxes on the wealthy reach a sufficiently high level.
The reason? The super-wealthy have built-in advantages over the rest of us when it comes to growing wealth. They hire professionals to manage their investments. They have the financial wherewithal to make high-yielding investments — provide the seed money for a promising start-up, for instance — that the rest of us don’t have the resources to make. And the living expenses of the ultra-wealthy consume only a tiny portion of their wealth compared to the rest of us.
Only stiff taxation on the rich can level the wealth accumulation playing field.
Rule Three: Wealth doesn’t concentrate when the rich pay their fair share of taxes.
Politicians and pundits often tell us that the rich must pay their fair share of tax. Nobody disputes that point. The dispute centers on how we define “fair share.”
Let’s start our defining here: Society suffers when wealth continually concentrates at the top. If the rich are increasing their wealth at a rate faster than society at large, the concentration will continue. Inequality will become more extreme, to the detriment of most all members of that society.
So when are the rich paying their fair share in tax? They’re paying that fair share when wealth is no longer concentrating at the top. Over the past four decades, unfortunately, American tax policy has offered a shining example of the exact opposite. We’ve had a tax system that has sped the concentration of wealth. Since 1980, our tax policy in the United States has taxed work more and wealth less. As a direct result, taxes on America’s wealthy have declined dramatically.
A recent Institute for Policy Studies briefing paper estimates that billionaire tax payments, as a percentage of their wealth, have dropped by an astounding 79 percent since 1980.
We can, fortunately, measure how tax policy is impacting wealth concentration and, in the process, estimate how far short of “fair share” the taxes rich people pay end up falling.
Suppose the aggregate wealth of a nation doubles over a given period and, during that same period, the wealth of the nation’s topmost group — say the top .01 percent — quadruples. Without knowing anything else, we’d know that the top .01 percent’s share of that nation’s wealth has doubled over that period. Similarly, if the wealth of the nation’s top .01 percent had increased eight-fold while the country’s aggregate wealth merely doubled, we’d know that the wealth share of that nation’s top .01 percent had quadrupled.
That’s roughly what happened in America over the last four decades. In 2018, the wealth of the average American ran about 8.4 times the wealth of the average American in 1980. But the wealth of the average top .01 percenter in 2018 ran 35 times the top .01 percenter average in 1980. Do the division: 35 divided by 8.4 matches up to slightly more than a four-fold increase in the wealth share of the top .01 percent: from 2.3 percent in 1980 to 9.6 percent in 2018.
That’s runaway wealth concentration — and increasingly extreme inequality — in action.
Things didn’t have to work out that way. They would have not worked out that way if we taxed the wealthy more heavily.
Between 1950 and 1980, we did tax the wealthy more heavily. The wealth of the average American in 1980 ran approximately five and a half times the wealth of the average American in 1950. The wealth of the average top .01 percenter in 1980, meanwhile, also ran about five and a half times the wealth of the average top .01 percenter in 1950. The end result: Top .01 percenters had the same share of the nation’s wealth in 1980 as they had in 1950: 2.3 percent.
At that level of wealth concentration, the average top .01 percenter held about 230 times as much wealth as the average American. In dollar terms today, a 2.3 percent wealth share for the top .01 percent would have fewer than 13,000 households sharing over $2.5 trillion in wealth, an average wealth of approximately $200 million per household.
American society found that level of wealth concentration far from ideal, but tolerable. The more than four-fold increase in wealth concentration since 1980, by contrast, has been intolerable.
How did that transformation occur? America’s tax policy changed radically. After three full decades at the “fair share rate”, the tax payments required of America’s wealthiest dropped precipitously. The taxes paid by top .01 percenters, as a percentage of their wealth, dropped more than four percentage points below the fair share rate — the rate that would have prevented American wealth from concentrating at the top.
Put another way, tax policy in America between 1950 and 1980 kept wealth of the average member of the top .01 percent at 230 times the net worth of the average American. Then, changes in tax policy allowed the wealth of America’s average top .01 percenter to increase to 960 times the wealth of the average American.
If we’re ever going to stop — and reverse — America’s extreme inequality, the radical tax policies of the past four decades must change and must change soon.
Phoenix attorney Bob Lord, an Institute for Policy Studies associate fellow, has practiced tax law for most all of the years since 1980.
By : Bob Lord
Date : March 11, 2021
Source : Inequality.Org
https://inequality.org/great-divide/the-simple-rules-of-wealth-inequality/
Green infrastructure can limit but not solve air pollution injustice
Outdoor air pollution contributes to millions of deaths worldwide yet air pollution has differential exposures across racial/ethnic groups and socioeconomic status. While green infrastructure has the potential to decrease air pollution and provide other benefits to human health, vegetation alone cannot resolve health disparities related to air pollution injustice. We discuss how unequal access to green infrastructure can limit air quality improvements for marginalized communities and provide strategies to move forward.
Outdoor air pollution is a leading contributor to the environmental burden of disease and linked to over four million deaths worldwide each year1. The World Health Organization (WHO) reports that almost half of cities with more than 100,000 residents, and most (97%) cities in low- and middle-income countries of that size, do not meet WHO air quality guidelines2. From 1960 to 2009, global levels of fine particulate matter increased by 38% leading to a greater health burden from polluted air3. Even in the midst of the current pandemic, evidence of higher COVID-19 deaths among people with pre-existing conditions was linked to elevated air pollution exposure4,5 and/or residing in areas with historically higher levels of air pollution6. Exposure to air pollution, however, is not evenly distributed, especially within cities. Many studies document differential exposure to air pollution by race/ethnicity7,8 and socio-economic status8,9,10 in cities across the world. Neighborhoods segregated by race and class often have less political and economic power, and are often neglected by government institutions such that they receive fewer resources compared to privileged communities11. This predicament results in disproportionate and overlapping exposures to environmental burdens11. Through the years, some approaches to decrease outdoor pollution include regulation of air pollution sources, emission controls on personal vehicles, and—more recently—the expansion of green infrastructure. The expansion of green infrastructure can mitigate urban air pollution to some extent. Yet, urban greening cannot compensate for systemic injustices that lead to disproportionate burdens in environmental health, and therefore, green infrastructure investments need to be balanced with other efforts to ameliorate air pollution injustices.
Green infrastructure for air pollution mitigation
Many cities have explored the potential of green infrastructure to mitigate urban air pollution and studies estimate that the value of this ecosystem service is worth about $3.8 billion dollars in the United States alone12. The definition of green infrastructure varies by discipline and scope. In this article, we focus on the broader role of all urban vegetation that provides ecosystem services via the mitigation of air pollution. For example, roadside green barriers can block the movement of traffic pollution into surrounding communities, mitigating some air pollution exposure and its resulting negative health effects13.
Green infrastructure is one variable that makes up the collective infrastructure that supports city dwellers. While the extent of air pollution removal by green infrastructure can vary14, many researchers note the benefits of green infrastructure to a city’s ambient environment12,15. In some cases, increased tree density and leaf area index are associated with a variety of health benefits including fewer cases of respiratory illness16. The net benefits of green infrastructure, however, should be balanced with their potential to increase pollen and other compounds that contribute to air pollution17. Special attention to tree size, condition, density, and species is also needed to increase a tree’s capacity to provide benefits and decrease disservices14. Although green infrastructure can provide benefits to urban air, urban settings have their own stressors (e.g., compaction, high levels of air pollution) that can impede the ability of green infrastructure to provide ecosystem services. For example, factors such as meteorology, mixture of air pollution, and urban layout can affect the ability of green infrastructure to remove air pollution18. Along with ecosystem services related to air pollution removal, mounting studies document various physical and mental health benefits related to green spaces19,20,21,22,23. Green infrastructure in the form of parks, street trees, and other urban vegetation can also buffer against health disparities for conditions such as obesity, cardiovascular disease, psychological distress, and heat-related illness24.
Unequal access to green infrastructure
While there is ample evidence for health benefits of vegetation, widespread inequities in urban vegetation by race and income25,26 prompt concerns of limited ecosystem services from green infrastructure in marginalized communities around the world. For example, findings of disparate access to green infrastructure are documented in parts of Canada27, South Africa28,29, the United Kingdom30, China31, and Colombia32. Many underlying drivers (e.g., exclusionary practices) that result in unequal exposure to environmental burdens reflect factors that also lead to unequal access to green infrastructure33. Systemic racism prompted practices such as residential segregation in various locations34. Residential segregation can force racial and ethnic populations to be located in areas with limited resources, greater community stressors, and exposure to pollutants that contribute to environmental health disparities35. To illustrate, the report ‘Toxic Waste and Race at Twenty,’ found that race continues to be the most important factor determining hazardous waste facility siting in the U.S36. Also, scholars describe how the legacy of apartheid and segregation negatively influenced the availability and access to urban green infrastructure in South Africa today29. Another example of this was redlining—a discriminatory mortgage appraisal process that began in the 1930s in the U.S36—which has been linked to disparate air pollution exposures34, health disparities37, and inequitable access to green infrastructure36,38. For example, Schell et al.34 describes how redlined neighborhoods have on average twenty-one percent less tree canopy compared to other communities. A study in Baltimore, Maryland observed that patterns of residential segregation contributed to the unequal distribution of green infrastructure and greater presence of stressors such as pollution, flooding, and urban heat islands39. Variations of green infrastructure access can also relate to the type of vegetation, urban form, and methodological approach being explored30. Therefore, unequal access to green infrastructure and its ecosystem services can have various implications in environmental health.
Part of the solution, but not a panacea
Given the range of benefits from green infrastructure, more attention should be directed to sustainably increase the presence of and access to it within vulnerable urban communities. We acknowledge, however, that the strategy to reduce air pollution’s inequitable health impacts should not rest solely on the effectiveness of green infrastructure. Multiple systematic and long-lasting processes of discrimination (e.g., inequitable citing of industrial facilities and high traffic roads33,34,35,36,37,38) have resulted in unequal exposure to air pollution. Therefore, one strategy alone cannot solve the associated problems of inequitable exposure to air pollution. Without addressing these persistent and structural factors, green infrastructure can only taper air pollution injustice, without solving it sustainably.
Similar to other environmental perils, air pollution in disadvantaged communities must be mitigated at the source—through regulating pollution emissions equitably and dismantling systems that lead to disproportionate exposures in the first place. Improving management strategies also applies to other sectors of the environmental field. Comparable to the sentiment expressed in Hardin’s Tragedy of the Commons37, underestimating the importance of sustainable stewardship of natural resources will lead to environmental and health burdens. The idea that the social forces that lead to inequitable systems should then govern and allocate the benefits that nature offers perpetuates environmental injustice. For example, developing cities in a way that regards vegetation as merely an aesthetic accessory instead of a key part of its ecological backbone can be detrimental in many ways. On the other hand, increasing natural amenities in disadvantaged communities can result in gentrification if housing protections are not put into place38. Solutions are needed that relieve the burden that air pollution has on public health through green infrastructure while not inducing further harm to environmental justice communities. A key component of this is the comprehensive inclusion of affected communities at all levels of decision-making.
Making green infrastructure work to promote air pollution justice
Given these systemic issues, we suggest that green infrastructure development be partnered with actions to ensure equity and environmental justice. First of all, environmental justice calls for the involvement of diverse residents in environmental decision making. With concerns that urban green space development may lead to population displacement (i.e., green gentrification)39,40 and strains to public health41, re-engaging community members and professionals in this arena is imperative. Surface level involvement of local communities is not sufficient to mitigate such effects25. Therefore, we suggest that community inclusion be placed at the center of green infrastructure development. Also, urban foresters, planners, and dendrologists that participate in green infrastructure projects should be trained in inclusive community engagement to secure beneficial outcomes for residents.
In order for communities to be engaged in air pollution mitigation in a meaningful way, they need access to inventories of emissions data and ambient air quality monitoring in formats that are user-friendly and publicly available. This is essential for affected communities, researchers, and other stakeholders to have accurate data for mitigation measures like green infrastructure. Recognizing that air pollution can negatively impact health at multiple scales, mitigation strategies must note the importance of green infrastructure policies at larger (e.g., regional) geographic levels42. Likewise, infrastructure to monitor air pollution should be refined at smaller geographic scales, such as census block groups or city blocks, that more accurately reflect community demographics. Current regulatory monitoring does not adequately represent disparate air pollution exposures at the community scale, particularly for low-income and communities of color43. Accounting for these challenges relates to quantifying air pollution exposure in different locations44 and understanding spatial patterns of air quality.
While we acknowledge the importance of equal access to green infrastructure, it is crucial to ensure that related professionals uphold ethical practices and dismantle further marginalization. Many organizations have standards related to justice and fair treatment of all people in their mission41,42, but the actual implementation of these standards in green infrastructure projects needs to be evaluated. A code of ethics is shortsighted without objective oversight in place to verify that it is being practiced. Therefore, we suggest more emphasis on how environmental, urban planning, and public health professionals are evaluated on their ethical practices.
In many sectors of society, marginalized people and communities are treated without the value and significance that they inherently possess. To actualize equitable policies on green infrastructure and air pollution, we must honor the moral and ethical tenets of equal protection under our laws (and create those that do not exist). This means reducing pollution exposure and repositioning vulnerable populations to receive ecosystem services. Although scholars have long expressed how systemic racism and disenfranchisement create health disparities45,46, the seeds of inequality planted centuries ago have perpetuated unequal exposure to environmental hazards and access to environmental benefits. Developing green infrastructure projects can bring great benefits to marginalized communities, but cannot on its own solve historical and systemic inequality. In the same way that we invest to protect ecological diversity, we must act to eliminate inequity for marginalized people by effectively partnering nature with all of the people that it supports.
Jennings, V., Reid, C.E. & Fuller, C.H. Green infrastructure can limit but not solve air pollution injustice. Nat Commun 12, 4681 (2021). https://doi.org/10.1038/s41467-021-24892-1
Nature Communications: https://www.nature.com/articles/s41467-021-24892-1#citeas
Income-related health inequalities associated with the coronavirus pandemic in South Africa: A decomposition analysis
Abstract
Background
The coronavirus disease 2019 (COVID-19) has resulted in an enormous dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the pandemic, chief being a nationwide lockdown. This has resulted in income loss for individuals and firms, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor.
Methods
Using the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/June 2020, this paper estimated income-related health inequalities in South Africa before and during the COVID-19 pandemic. Health was a dichotomized self-assessed health measure, with fair and poor health categorized as “poor” health, while excellent, very good and good health were categorized as “better” health. Household per capita income was used as the ranking variable. Concentration curves and indices were used to depict the income-related health inequalities. Furthermore, we decomposed the COVID-19 era income-related health inequality in order to ascertain the significant predictors of such inequality.
Results
The results indicate that poor health was pro-poor in the pre-COVID-19 and COVID-19 periods, with the latter six times the value of the former. Being African (relative to white), per capita household income and household experience of hunger significantly predicted income-related health inequalities in the COVID-19 era (contributing 130%, 46% and 9% respectively to the inequalities), while being in paid employment had a nontrivial but statistically insignificant contribution (13%) to health inequality.
Conclusions
Given the significance and magnitude of race, hunger, income and employment in determining socioeconomic inequalities in poor health, addressing racial disparities and hunger, income inequality and unemployment will likely mitigate income-related health inequalities in South Africa during the COVID-19 pandemic.
Nwosu, C.O., Oyenubi, A. Income-related health inequalities associated with the coronavirus pandemic in South Africa: A decomposition analysis. Int J Equity Health 20, 21 (2021). https://doi.org/10.1186/s12939-020-01361-7
International Journal for Equity in Health : https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-01361-7#citeas
How research covering more than 5,000 years sheds light on income inequality today
Analysis based on data spanning millennia reveals link between when governments were established and income inequality.
King Menes unified Egypt around 5,000 years ago, making it among the world’s first central governments.
Millennia later, Namibia, on the southwest coast of Africa, was under German then South African rule until 1990, when its independent government was formed.
Egypt’s history of statehood is old and Namibia’s is new, yet both countries have this in common: relatively high levels of income inequality today.
Central governments that are very old or new tend to have higher inequality than those in the middle — a “just right” Goldilocks zone of lower inequality for countries with governments established sometime between Egypt and Namibia.
That’s the essential finding from a recent paper in Economic Modelling, “Statehood experience and income inequality: A historical perspective,” based on data covering more than 5,000 years.
“A key argument is that both newly established and older states tend to suffer from the persistence of poor governance, making it difficult to establish an egalitarian society,” author Trung Vu, a doctoral researcher in economics at the University of Otago in New Zealand, explained by email.
Countries in the Goldilocks zone, with intermediate statehood experience and relatively low levels of inequality, include Austria, Belgium, Germany, Japan and Switzerland
Vu’s U: Statehood and inequality
Vu uses historical data spanning 3500 B.C. to the year 2000 to determine when 128 countries developed statehood.
Statehood happens when a central government is established that has the power to enforce laws and regulations, collect taxes, and perform other functions on behalf of a large number of people.
Some modern countries have had many kinds of central governments over the years — monarchies, dictatorships, representative democracies.
But statehood is not about what kind of government a territory has or had. It’s simply about the existence of centralized governance.
Vu then takes an average of Gini coefficients, a widely used measure of income distribution, for those 128 countries from 1960 to 2015. Italian statistician Corrado Gini developed the measure in 1912. It’s often produced on a 0 to 100 scale. A score closer to 0 indicates less inequality while a score closer to 100 indicates more inequality.
For Vu, a U-shaped relationship between historical statehood and income inequality emerges.
Central governments that are very old or new tend to have higher inequality than those in the middle. There are outliers. Peru, Guatemala and Mexico have relatively high inequality but are in the intermediate, Goldilocks zone. Slovakia and Finland have relatively little experience with statehood and relatively low inequality, according to Vu’s analysis.
The U.S., too, has a relatively new central government. Although income inequality in the U.S. has risen in recent decades, it’s still lower than in many other countries.
Still, the overall trend goes high-low-high, like a U.
“Understanding whether history casts a long shadow on current development outcomes is the first step toward managing the long-term legacy of history,” Vu wrote by email.
Institutions and income distribution
Separate researchers developed the historical data on statehood Vu uses, publishing their findings in a 2017 paper in the Journal of Economic Growth. Those researchers used a variety of secondary sources, including the Encyclopedia Britannica, academic journal articles and books, to determine when places established statehood.
Newer and older states tend to have higher income inequality because they lack institutional quality and stability, according to Vu.
Long-standing governments may suffer from institutional stagnation, he explained. Powerful bureaucrats emerge who manipulate established systems to their benefit, increasing inequality.
Newer governments, meanwhile, are susceptible to regime change, outside attack and internal corruption from officials who take advantage of laws that are not well established. Steady economic growth and equitable income distribution are difficult in a nation that is political unstable.
Countries in the Goldilocks zone tend to be more stable and less corrupt: “A unified society reduces conflicts and political instability, thus improving income distribution,” Vu writes in his paper.
Upending Kuznets?
Russian-American economist Simon Kuznets, writing in The American Economic Review in March 1955, offered a theory of a frown-shaped, or inverted-U relationship between economic development and income inequality.
The theory goes that income inequality in a country starts low, rises as economic development continues, then settles down again when the country develops a mature economy.
Today, the inverted-U is known as the Kuznets curve.
Kuznets wrote in his paper that his theory was based on “perhaps 5% empirical information and 95% speculation, some of it possibly tainted by wishful thinking.” (He went on to win the Nobel Prize in economics in 1971 for his work on how national economies grow.)
The Kuznets curve is “a story of adjustment over time, even though many of the empirical studies on [it] rely on cross-sectional data — a snapshot of cross-country variation at a particular time,” Dorian Owen, Vu’s academic advisor, explained by email. “Increases in inequality in developed economies post-1960 and the East Asian growth experience — with both increasing income per capita levels and reduced inequality — are often cited as counterexamples to the dynamics of adjustment assumed by the Kuznets curve, so the relevance of the Kuznets curve is contested.”
Vu noted by email that his findings do not necessarily contradict recent research supporting the Kuznets curve, adding that “there are many factors shaping the evolution of income inequality.”
Also, Vu’s research looks specifically at statehood as a driver of inequality. He weighed experience with statehood for recent 50-year periods more heavily into the analysis than distant periods, because recent events are more likely than ancient history to affect today’s economies.
Vu also controlled for geographic characteristics as well as recent income levels, trade openness, development of governmental and financial institutions and human capital.
Those indicators are associated with a country’s economic development. But Vu is examining the relationship between statehood and inequality, not economic development and inequality.
Though Vu noted there is no way to rule out every factor other than statehood that affects inequality today, there is no other variable he considers that “completely absorbs the effects of state history on income inequality.”
For government officials and others working to reduce disparities, “curtailing income inequality requires treating the disease not just its symptoms,” Vu writes in his paper.
“Policymakers need to recognize the historical legacy that has a persistent influence on the environment within which current policies are designed, including, in some countries, potential resistance to reducing inequality,” Owen explained.
Clark Merrefield joined The Journalist’s Resource in 2019 after working as a reporter for Newsweek and The Daily Beast, as a researcher and editor on three books related to the Great Recession, and as a federal government communications strategist. He was a John Jay College Juvenile Justice Journalism Fellow and his work has been awarded by Investigative Reporters and Editors. @cmerref
By : Clark Merrefield
Date : April 26, 2021
Source : The Journalist's Resource
https://journalistsresource.org/home/income-inequality-5000-years/
Photo by: Zhang Kenny (Unsplash)
Opioid overdoses spiked during the COVID-19 pandemic, data from Pennsylvania show
Since the first diagnosed case of COVID-19 in the United States on Jan. 20, 2020, news about infection rates, deaths and pandemic-driven economic hardships has been part of our daily lives.
But there is a knowledge gap in how COVID-19 has affected a public health crisis that existed before the pandemic: the opioid epidemic. Prior to 2020, an average of 128 Americans died every day from an opioid overdose. That trend accelerated during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.
We are a team of health and environment geography researchers. When social distancing began in March 2020, addiction treatment experts were concerned that shutdowns might result in a spike in opioid overdose and deaths. In our latest research in the Journal of Drug Issues, we take a closer look at these trends by examining opioid overdoses in Pennsylvania prior to and following the statewide stay-at-home order.
Our findings suggest that this public health response to COVID-19 has had unintended consequences for opioid use and misuse.
History of the opioid epidemic
Opioid misuse has been a major U.S. health threat for over two decades, largely affecting rural areas and white populations. However, a recent shift in the drugs involved, from prescription opioids to illegally manufactured drugs such as fentanyl, has resulted in an expansion of the epidemic in urban areas and among other racial and ethnic groups.
From 1999 to 2013, increasing death rates from drug abuse, primarily for those from 45 to 54 years of age, contributed to the first decline in life expectancy for white non-Hispanic Americans in decades.
There was a modest national decline in overdose mortality from prescription opioids from 2017 to 2019, but the COVID-19 pandemic has upended many of these advances. As one of our public health partners explained to us, “We were making progress until COVID-19 hit.”
We believe this presents an urgent need for research on the relationships between COVID-19 policy responses and patterns of opioid use and misuse.
Opioid use increases during the pandemic
Pennsylvania has been among the states hardest hit by the opioid epidemic. It had one of the highest rates of death due to drug overdose in 2018, with 65%, a total of 2,866 fatalities, involving opioids.
The state’s stay-at-home order, implemented on April 1, 2020, mandated that residents stay within their homes whenever possible, practice social distancing and wear masks when outside the home. All schools shifted to remote learning, and most businesses were required to operate remotely or close. Only essential services were allowed to continue operating in person.
In the following months, the public’s overall cooperation with these mandates contributed to measurable declines in coronavirus infection rates. To learn how these mandates also affected people’s use of opioids, we assessed data from the Pennsylvania Overdose Information Network for changes in monthly incidents of opioid-related overdose before and after April 1, 2020. We also examined the change by gender, age, race, drug class and doses of naloxone administered. (Naloxone is a drug widely used to reverse the effects of overdose.)
Our analysis of both fatal and nonfatal cases of opioid-related overdose from January 2019 through July 2020 revealed statistically significant increases in overdose incidents for both men and women, among whites and Blacks, and across several age groups, most notably the 30-39 and 40-49 groups, following April 1. This means there was an acceleration of overdoses within some of the populations most affected by opioids prior to the COVID-19 pandemic. But there were also uneven increases among other groups, such as Black people.
We found statistically significant increases in overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids and carfentanil. This is consistent with previous research on the main opioid classes contributing to increases in drug overdose and death. The results also affirm that heroin and synthetic opioids such as fentanyl are now the major threats in the epidemic.
When a pandemic and an epidemic collide
While we found significant change in opioid overdoses during the COVID-19 pandemic, the findings say less about some of the driving factors. To better understand these, we have been interviewing public health providers since December 2020.
Among the important factors they highlight as contributing to increased opioid use are pandemic-driven economic hardship, social isolation and the disruption of in-person treatment and support services.
From March to April 2020, unemployment rates in Pennsylvania shot up from 5% to approximately 16%, resulting in a peak of more than 725,000 unemployment claims filed in April. As workplace shutdowns made it harder to pay for housing, food and other needs, and the opportunities for in-person support disappeared, some people turned to drugs, including opioids.
People in the early stages of treatment or recovery from opioid addiction may be particularly vulnerable to relapse, suggested one of our public health partners. “They might be working in industries that are closed down, so they have financial problems … [and] they have their addiction issues on top of that, and now they can’t like go to meetings, and they can’t make those connections.” (Under our clearance with Penn State for doing research with human subjects, our public health informants are kept anonymous.)
An addiction treatment counselor told us that especially for those with past or present opioid use problems, or histories of mental health issues, “It’s not a good thing to be alone in your own thoughts. And so, once everybody was kind of locked down … the depression and anxiety hit.”
Another counselor also pointed to depression, anxiety and isolation as driving increased opioid misuse. The pandemic “just spun everything out of control,” they said. “Overdoses up, everything up, everything.”
One question is whether states like Pennsylvania will continue to support telehealth in the future. While the transition from in-person to telehealth services has increased access to treatment for some, it has raised challenges for populations like the rural and elderly. As one provider explained, “it’s really hard for that [rural] population out there” to utilize telehealth services due to limited internet and broadband connection. In other words, flexible modes of addiction treatment might work for some but not others.
The goal of our research is not to criticize efforts to mitigate the spread of COVID-19. Without the mandatory stay-at-home order in Pennsylvania, both infection and death rates would have been worse. However, our research shows that such measures have had unintended consequences for those struggling with addiction and emphasizes the importance of taking a holistic approach to public health as policymakers work to confront both COVID-19 and the addiction crisis in America.
By : Brian King (Professor, Department of Geography, Penn State)
Andrea Rishworth (Postdoctoral Fellow in Geography, McMaster University)
Ruchi Patel (Ph.D. Student in Geography, Penn State)
Date : June 14, 2021
Source : The Conversation
https://theconversation.com/opioid-overdoses-spiked-during-the-covid-19-pandemic-data-from-pennsylvania-show-161635
Household COVID-19 risk and in-person schooling
Abstract
In-person schooling has proved contentious and difficult to study throughout the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Data from a massive online survey in the United States indicate an increased risk of COVID-19–related outcomes among respondents living with a child attending school in person. School-based mitigation measures are associated with significant reductions in risk, particularly daily symptoms screens, teacher masking, and closure of extracurricular activities. A positive association between in-person schooling and COVID-19 outcomes persists at low levels of mitigation, but when seven or more mitigation measures are reported, a significant relationship is no longer observed. Among teachers, working outside the home was associated with an increase in COVID-19–related outcomes, but this association is similar to that observed in other occupations (e.g., health care or office work). Although in-person schooling is associated with household COVID-19 risk, this risk can likely be controlled with properly implemented school-based mitigation measures.
By : Justin Lessler1, Kate Grabowski, Kyra H. Grantz, Elena Badillo-Goicoechea, C. Jessica E. Metcalf, Carly Lupton-Smith, Andrew S. Azman,Elizabeth A. Stuart
Date : June 4, 2021
Source : Science 04 Jun 2021
Vol. 372, Issue 6546, pp. 1092-1097
DOI: 10.1126/science.abh2939
https://science.sciencemag.org/content/372/6546/1092
CDC Reports 51% Increase in Suicide Attempts Among Teenage Girls
Newly released data from the US Centers for Disease Control and Prevention reveal a surge in self harm and hospitalizations from poor mental health among teens in 2020.
Beth Palmer was 17 and dreaming of becoming a singer in March 2020 when the United Kingdom went into lockdown because of the coronavirus. One month later, she was dead.
"She was a wonderful, wonderful daughter. She was just funny, she lit up the room.," said Mike Palmer, Beth’s father. "She was so affectionate and loving as well. She basically had the world at her feet. She had everything, everything to live for.”
Palmer didn’t die of the coronavirus. She took her own life.
An aspiring singer and vocal student at the Access Creative College in Manchester, Palmer crumbled in isolation. Her family states that she had previously shown no signs of struggling with her mental health. However, she claimed the mandated stay-at-home order felt like centuries.
"She couldn't finish college, she couldn't go out and see her friends. She felt as though this three-month lockdown was to her 300 years,” her father said in a video that went viral last year.
Unable to finish college, see her friends, or pursue her passion, the usually vivacious and affectionate Palmer became obsessive in her fear that the lockdown would never end.
In the weeks following her death, Palmer’s family spoke out on the implications of the stay-at-home order and to warn parents of the struggles their children might be facing, saying “no one should feel isolated enough to do this.”
Tragically, new government data show Palmer’s death is part of a global trend of teen’s seeking to escape the toll of government lockdown.
Troubling CDC Data
Newly released data from the US Centers for Disease Control and Prevention reveal a surge in self harm and hospitalizations from poor mental health among teens in 2020.
Overall, the number of psychiatric-related hospital visits among young people increased 31 percent last year. For young women like Palmer, this number was far more grievous. Suspected suicide attempts in girls increased 50.6 percent, compared to a 3.7 percent increase in young men.
As the report concludes, the implications of lockdowns, such as “physical distancing; barriers to mental health treatment; increases in substance use; and anxiety about family health and economic problems” all particularly affected children, contributing to a widespread increase in suicidal thoughts.
A recent Wall Street Journal article completes the picture painted by the CDC by revealing that in California, teenage sucide increased 24 percent, leading to 134 deaths in 2020. In contrast, only 23 California minors died of Covid-19.
Specifically in Oakland, California, hospitals saw a 66 percent increase in teenagers screening positive for suicidal ideation between March and October of 2020.
In light of these alarming numbers, California public-health officials are finally beginning to speak out about this issue.
For over a year while mental illness and suicide skyrocketed, these same politicians and health experts continuously disregarded valid concerns over the dire implications of lockdowns.
It’s clear that though they were not generally at risk for Coronavirus, young people, like Palmer, were a high suicide risk group, and governmenent failed to pay attention.
A Brutal Teacher
“Experience,” the French economist Frédéric Basiat (1801-1850) once wrote, “teaches effectually, but brutally.” Tragically, this seems to be the case with the unintended consequences of COVID-19 lockdowns.
The surge in teen suicide is just one example of collaternal damage from lockdowns—others include surges in child poverty, drug overdoses, and unemployment, as well as a sharp decline in cancer screenings—and should come as no surprise.
Back in April of 2020, JAMA Psychiatry published a report on the possible consequences of quarantine orders, stating that while they might help quell new infections, “the potential for adverse outcomes on suicide risk is high.”
Despite these warnings, public health officials pressed on, believing their policies would protect people from COVID-19. An abundance of empirical evidence, however, suggests these efforts failed.
The road to hell, they say, is paved with good intentions. And for good reason. The world is complex, and efforts to reshape it often achieves results other than that which was intended. This is precisely why Bastiat taught about the importance of exercising restraint and foresight while implementing policy, so that we do not pursue “a small present good, which will be followed by a great evil to come.”
This was something governments didn’t do in 2020.
Beth Palmer had a promising life ahead of her. She and the other teenagers who struggled to cope with state-enforced isolation deserved better. So let us at least learn something from the brutal experience of lockdowns.
Brett Cooper is a professional actress and a Libertarian-Conservative writer. She’s an ambassador for PragerU and TurningPoint USA and content manager at Unwoke Narrative.
By : Brett Cooper
Date : June 25, 2021
Source : Foundation for Economic Education
https://fee.org/articles/cdc-reports-51-increase-in-suicide-attempts-among-teenage-girls/
How does globalization affect COVID-19 responses?
Background
The ongoing COVID-19 pandemic has highlighted the vast differences in approaches to the control and containment of coronavirus across the world and has demonstrated the varied success of such approaches in minimizing the transmission of coronavirus. While previous studies have demonstrated high predictive power of incorporating air travel data and governmental policy responses in global disease transmission modelling, factors influencing the decision to implement travel and border restriction policies have attracted relatively less attention. This paper examines the role of globalization on the pace of adoption of international travel-related non-pharmaceutical interventions (NPIs) during the coronavirus pandemic. This study aims to offer advice on how to improve the global planning, preparation, and coordination of actions and policy responses during future infectious disease outbreaks with empirical evidence.
Methods and data
We analyzed data on international travel restrictions in response to COVID-19 of 185 countries from January to October 2020. We applied time-to-event analysis to examine the relationship between globalization and the timing of travel restrictions implementation.
Results
The results of our survival analysis suggest that, in general, more globalized countries, accounting for the country-specific timing of the virus outbreak and other factors, are more likely to adopt international travel restrictions policies. However, countries with high government effectiveness and globalization were more cautious in implementing travel restrictions, particularly if through formal political and trade policy integration. This finding is supported by a placebo analysis of domestic NPIs, where such a relationship is absent. Additionally, we find that globalized countries with high state capacity are more likely to have higher numbers of confirmed cases by the time a first restriction policy measure was taken.
Conclusions
The findings highlight the dynamic relationship between globalization and protectionism when governments respond to significant global events such as a public health crisis. We suggest that the observed caution of policy implementation by countries with high government efficiency and globalization is a by-product of commitment to existing trade agreements, a greater desire to ‘learn from others’ and also perhaps of ‘confidence’ in a government’s ability to deal with a pandemic through its health system and state capacity. Our results suggest further research is warranted to explore whether global infectious disease forecasting could be improved by including the globalization index and in particular, the de jure economic and political, and de facto social dimensions of globalization, while accounting for the mediating role of government effectiveness. By acting as proxies for a countries’ likelihood and speed of implementation for international travel restriction policies, such measures may predict the likely time delays in disease emergence and transmission across national borders.
By : Steve J. Bickley, Ho Fai Chan, Ahmed Skali, David Stadelmann & Benno Torgler
Date : May 20, 2021 (Published)
Source : Bickley, S.J., Chan, H.F., Skali, A. et al. How does globalization affect COVID-19 responses?. Global Health 17, 57 (2021). https://doi.org/10.1186/s12992-021-00677-5
https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00677-5#citeas
Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data
Abstract
Objective
To estimate changes in life expectancy in 2010-18 and during the covid-19 pandemic in 2020 across population groups in the United States and to compare outcomes with peer nations.
Design
Simulations of provisional mortality data.
Setting
US and 16 other high income countries in 2010-18 and 2020, by sex, including an analysis of US outcomes by race and ethnicity.
Population
Data for the US and for 16 other high income countries from the National Center for Health Statistics and the Human Mortality Database, respectively.
Main outcome measures
Life expectancy at birth, and at ages 25 and 65, by sex, and, in the US only, by race and ethnicity. Analysis excluded 2019 because life table data were not available for many peer countries. Life expectancy in 2020 was estimated by simulating life tables from estimated age specific mortality rates in 2020 and allowing for 10% random error. Estimates for 2020 are reported as medians with fifth and 95th centiles.
Results
Between 2010 and 2018, the gap in life expectancy between the US and the peer country average increased from 1.88 years (78.66 v 80.54 years, respectively) to 3.05 years (78.74 v 81.78 years). Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively. Progress since 2010 in reducing the gap in life expectancy in the US between Black and White people was erased in 2018-20; life expectancy in Black men reached its lowest level since 1998 (67.73 years), and the longstanding Hispanic life expectancy advantage almost disappeared.
Conclusions
The US had a much larger decrease in life expectancy between 2018 and 2020 than other high income nations, with pronounced losses among the Hispanic and non-Hispanic Black populations. A longstanding and widening US health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism.
By : Steven H Woolf, Ryan K Masters and Laudan Y Aron
Date : May 24, 2021 (Accepted)
Source : BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1343 (Published 24 June 2021)
https://www.bmj.com/content/373/bmj.n1343
Photo by : Spencer Davis (Unsplash)
Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile
Structured Abstract
INTRODUCTION
The COVID-19 crisis has exposed major inequalities between communities. Understanding the societal risk factors that make some groups particularly vulnerable is essential to ensure more effective interventions for this and future pandemics. Here, we focus on socioeconomic status as a risk factor. Although it is broadly understood that social and economic inequality has a negative impact on health outcomes, the mechanisms by which socioeconomic status affects disease outcomes remain unclear. These mechanisms can be mediated by a range of systemic structural factors, such as access to health care and economic safety nets. We address this gap by providing an in-depth characterization of disease incidence and mortality and their dependence on demographic and socioeconomic strata in Santiago, a highly segregated city and the capital of Chile.
RATIONALE
Combining publicly available data sources, we conducted a comprehensive analysis of case incidence and mortality during the first wave of the pandemic. We correlated COVID-19 outcomes with behavioral and health care system factors while studying their interaction with age and socioeconomic status. To overcome the intrinsic biases of incomplete case count data, we used detailed mortality data. We developed a parsimonious Gaussian process model to study excess deaths and their uncertainty and reconstructed true incidence from the time series of deaths with a new regularized maximum likelihood deconvolution method. To estimate infection fatality rates by age and socioeconomic status, we implemented a hierarchical Bayesian model that adjusts for reporting biases while accounting for incompleteness in case information.
RESULTS
We find robust associations between COVID-19 outcomes and socioeconomic status, based on health and behavioral indicators. Specifically, we show in lower–socioeconomic status municipalities that testing was almost absent early in the pandemic and that human mobility was not reduced by lockdowns as much as it was in more affluent locations. Test positivity and testing delays were much higher in these locations, indicating an impaired capacity of the health care system to contain the spread of the epidemic. We also find that 73% more deaths than in a normal year were observed between May and July 2020, and municipalities at the lower end of the socioeconomic spectrum were hit the hardest, both in relation to COVID-19–attributed deaths and excess deaths. Finally, the socioeconomic gradient of the infection fatality rate appeared particularly steep for younger age groups, reflecting worse baseline health status and limited access to health care in municipalities with low socioeconomic status.
CONCLUSION
Together, these findings highlight the substantial consequences of socioeconomic and health care disparities in a highly segregated city and provide practical methodological approaches useful for characterizing the COVID-19 burden and mortality in other urban centers based on public data, even if reports are incomplete and biased.
By : Gonzalo E. Mena, Pamela P. Martinez, Ayesha S. Mahmud, Pablo A. Marquet, Caroline O. Buckee, Mauricio Santillana
Date : May 28, 2021
Source : Science
https://science.sciencemag.org/content/372/6545/eabg5298.abstract
Demand for longer quarantine period among common and uncommon COVID-19 infections: a scoping review
Abstract
Background
As one of the non-pharmacological interventions to control the transmission of COVID-19, determining the quarantine duration is mainly based on the accurate estimates of the incubation period. However, patients with coarse information of the exposure date, as well as infections other than the symptomatic, were not taken into account in previously published studies. Thus, by using the statistical method dealing with the interval-censored data, we assessed the quarantine duration for both common and uncommon infections. The latter type includes the presymptomatic, the asymptomatic and the recurrent test positive patients.
Methods
As of 10 December 2020, information on cases have been collected from the English and Chinese databases, including Pubmed, Google scholar, CNKI (China National Knowledge Infrastructure) and Wanfang. Official websites and medias were also searched as data sources. All data were transformed into doubly interval-censored and the accelerated failure time model was applied. By estimating the incubation period and the time-to-event distribution of worldwide COVID-19 patients, we obtain the large percentiles for determining and suggesting the quarantine policies. For symptomatic and presymptomatic COVID-19 patients, the incubation time is the duration from exposure to symptom onset. For the asymptomatic, we substitute the date of first positive result of nucleic acid testing for that of symptom onset. Furthermore, the time from hospital discharge or getting negative test result to the positive recurrence has been calculated for recurrent positive patients.
Results
A total of 1920 laboratory confirmed COVID-19 cases were included. Among all uncommon infections, 34.1% (n = 55) of them developed symptoms or were identified beyond fourteen days. Based on all collected cases, the 95th and 99th percentiles were estimated to be 16.2 days (95% CI 15.5–17.0) and 22.9 days (21.7?24.3) respectively. Besides, we got similar estimates based on merely symptomatic and presymptomatic infections as 15.1 days (14.4?15.7) and 21.1 days (20.0?22.2).
Conclusions
There are a certain number of infected people who require longer quarantine duration. Our findings well support the current practice of the extended active monitoring. To further prevent possible transmissions induced and facilitated by such infectious outliers after the 14-days quarantine, properly prolonging the quarantine duration could be prudent for high-risk scenarios and in regions with insufficient test resources.
By : Zhi-Yao Li, Yu Zhang, Liu-Qing Peng, Rong-Rong Gao, Jia-Rui Jing, Jia-Le Wang, Bin-Zhi Ren, Jian-Guo Xu & Tong Wang
Published by : April 26, 2021
Source : Infectious Diseases of Poverty
https://doi.org/10.1186/s40249-021-00847-y
https://idpjournal.biomedcentral.com/articles/10.1186/s40249-021-00847-y#citeas
Why health experts say you need vaccinated even if you’ve had COVID-19
While some who have had COVID-19 might not have an interest in getting vaccinated, a growing body of evidence and cautionary tales from other countries indicate that natural immunity won’t be the answer to beating the pandemic.
The most vulnerable people are those with no previous infection or vaccine, but new studies on vaccines and variants show that people who have had the virus but no vaccine are at more risk than those who are fully vaccinated.
“The notion that you’ve had the virus before and you’re protected: we’re seeing time and again now that that’s untrue,” said Dr. Vin Gupta, a physician and professor at the Institute for Health Metrics and Evaluation at the University of Washington. “We don’t have robust protection because of prior infection particularly because of transmission of these variants.”
The variant that originated in the United Kingdom, the B.1.1.7 variant, is the most common circulating in Washington state, and it has thus far been associated with more transmission and in some cases, more severe disease.
The U.K. variant is also associated with the highest number of breakthrough cases in the state so far, with 98 recorded cases of people who’ve been fully vaccinated testing positive with the variant.
People testing positive for the virus in recent months are, in essence, experiencing a different COVID-19 infection than those who were infected a year ago. Viruses mutate, and the more people don’t get vaccinated, the more opportunities the virus has to change its form, getting better in some mutations at evading antibody treatments or spreading faster.
Currently, the available vaccines in the United States are performing well against the variants, so much so that immune responses seen in fully vaccinated people are stronger than those who have had previous COVID-19 infection, experts say.
Gupta said he has been explaining this to his patients, especially those who have had COVID-19 and think they are immune. If the coronavirus hadn’t changed or evolved, their immunity might be stronger, but that’s not the reality.
“The antibodies you develop from infection from the original virus aren’t as useful,” Gupta said.
Vaccines are producing a more robust response at the biological level, he added.
Studies that measure antibodies in people who have had previous COVID infection have varied results, and scientists don’t yet know how long natural immunity lasts. Furthermore, some research has shown that antibody responses might be correlated with how severe a person’s disease was.
While some studies say a person who had the virus will have antibodies for months following infection, other studies show that variants can change that trajectory.
A May 2020 study from a placebo-controlled vaccine trial found that people who had had an older strain of COVID-19, before the South African variant was circulating, did not have reduced risk for getting infected again with the South African variant.
“The weakest form of protection looks like natural immunity,” Mike Famulare, a modeler with the Institute for Disease Modeling, said. “So the vaccines look as effective or better in terms of protecting you over a six-month time horizon of getting infected.”
On the opposite end of the spectrum, a person who has had COVID-19 and is fully vaccinated is likely the most protected a person can be against the virus.
“Having COVID plus vaccine is the most protected you can be,” Famulare said.
The Centers for Disease Control and Prevention changed its guidance for when people who tested positive for COVID-19 can be vaccinated in recent months. As soon as a patient with COVID-19 has resolved their symptoms and finished their isolation period, they can get vaccinated. The one exception to this rule is if a patient was treated in a hospital with monoclonal antibodies or convalescent plasma, the CDC recommends those patients wait 90 days before getting a vaccine.
Addressing ‘herd immunity’
To get to a level of immunity that will drive down the reproductive rate of the virus, health experts add together the number of people who have naturally acquired immunity to COVID-19 and the immunity gained by those who get vaccines.
In Washington, natural immunity is quite a bit lower than other parts of the country because residents here adhered to guidance so well. Lives were saved as a result, and now that means the state likely has more people vulnerable to the virus than other states with larger outbreaks or higher infection rates.
The Institute for Disease Modeling estimates that between 10% and 15% of Washington residents have natural immunity to COVID-19 from prior infection, according to Famulare.
If this is correct, combined with the 41% of Washington residents who have been fully vaccinated, a little more than 50% of the total state population has reached immunity status. This isn’t good enough for herd immunity levels, and health officials are now aiming for adequate vaccine coverage instead, with a goal of getting more than 70% of Washington residents the ages of 16 and over vaccinated in order to really keep the virus at bay.
The actual herd immunity threshold, Famulare said, is difficult to calculate due to the ever-changing nature of the virus, and even if we hit that magical threshold, COVID-19 won’t disappear immediately.
“What is herd immunity today may not be herd immunity tomorrow, so there will be a cat and mouse game we’ll play with this virus for many months,” he said.
What the future holds
COVID-19 won’t disappear when vaccination rates are higher, particularly in communities with low vaccination rates. There’s also the likelihood that we haven’t seen the end of the vaccine campaign either.
The idea of an annual vaccination or booster shot is definitely still on the table, Dr. John Lynch, infectious disease specialist at the University of Washington, said this month.
The danger remains for people and communities who do not get vaccinated, however, and in these nonimmune environments, variants will continue to mutate. So far, the vaccines have held up against variants, but if that is to change in the coming months or year, things could get a lot more challenging.
“Is it theoretically possible that a variant can get past vaccine immunity? I think it’s a theoretical concern,” Lynch said.
Gupta thinks it is possible that this coming fall and winter could be a “dangerous scenario” especially with seasonal changes, people gathering indoors and the lack of herd immunity. Hospitalizations could surge again.
“There’s a clear worry that that’s going to happen,” Gupta said.
The future Gupta is worried about is already happening on a smaller scale in some places with low vaccination rates today. Just ask health officials in northeastern Washington where an outbreak overwhelmed Republic’s critical access hospital after a superspreader event.
Roughly 30% of each county in northeastern Washington is fully vaccinated, leaving the majority of people vulnerable to the virus. And while local health officials don’t have a good indicator of how many people might have had the virus and now have some level of immunity, it likely isn’t so many people that there is more than 50% immunity in the region.
“In Eastern Washington we’re in this funny position where I think we’re going to deal with this longer than the West Side that has more people vaccinated, and our situation is reflected right now in our numbers,” Dr. Sam Artzis, health officer of the Northeast Tri County Health District, said earlier this month.
Ultimately, there is not going to be a hard stop to the pandemic where the virus just disappears, and Famulare thinks this coming year will likely bring a sort of adjustment to the virus in our lives instead of the pandemic suddenly being over. What that looks like depends a lot on vaccination rates.
“(Either) the way we live with the virus is different and better because everyone has gotten vaccinated or ugly because more people will die because they aren’t vaccinated,” he said.
***
Arielle Dreher's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community.
By : Arielle Dreher
Date : May 27, 2021
Source : The Spokesman Review
https://www.spokesman.com/stories/2021/may/27/why-health-experts-say-you-need-a-vaccine-even-if-/
The use of medicinal plants to prevent COVID-19 in Nepal
Abstract
Background
Medicinal plants are the fundamental unit of traditional medicine system in Nepal. Nepalese people are rich in traditional medicine especially in folk medicine (ethnomedicine), and this system is gaining much attention after 1995. The use of medicinal plants has increased during the COVID-19 pandemic as a private behavior (not under the control of government). A lot of misinterpretations of the use of medicinal plants to treat or prevent COVID-19 have been spreading throughout Nepal which need to be managed proactively. In this context, a research was needed to document medicinal plants used, their priority of use in society, their cultivation status, and the source of information people follow to use them. This study aimed to document the present status of medicinal plant use and make important suggestion to the concerned authorities.
Methods
This study used a web-based survey to collect primary data related to medicinal plants used during COVID-19. A total of 774 respondents took part in the survey. The study calculated the relative frequencies of citation (RFC) for the recorded medicinal plants. The relationship between plants recorded and different covariates (age, gender education, occupation, living place, and treatment methods) was assessed using Kruskal-Wallis test and Wilcoxon test. The relationship between the information sources people follow and the respondent characteristics was assessed using chi-square test.
Results
The study found that the use of medicinal plants has increased during COVID-19 and most of the respondents recommended medicinal plants to prevent COVID-19. This study recorded a total of 60 plants belonging to 36 families. The leaves of the plants were the most frequently used. The Zingiber officinale was the most cited species with the frequency of citation 0.398. Most of the people (45.61%) were getting medicinal plants from their home garden. The medicinal plants recorded were significantly associated with the education level, location of home, primary treatment mode, gender, and age class. The information source of plants was significantly associated with the education, gender, method of treatment, occupation, living with family, and location of home during the lockdown caused by COVID-19.
Conclusions
People were using more medicinal plants during COVID-19 claiming that they can prevent or cure COVID-19. This should be taken seriously by concerned authorities. The authorities should test the validity of these medicinal plants and control the flow of false information spread through research and awareness programs.
By : Dipak Khadka, Man Kumar Dhamala, Feifei Li, Prakash Chandra Aryal, Pappu Rana Magar, Sijar Bhatta, Manju Shree Thakur, Anup Basnet, Dafang Cui & Shi Shi
Published by : April 8, 2021
Source : Journal of Ethnobiology and Ethnomedicine
https://doi.org/10.1186/s13002-021-00449-w
https://ethnobiomed.biomedcentral.com/articles/10.1186/s13002-021-00449-w#citeas
COVID-19: which countries will be the next to see a big spike in cases?
Beneath the many complexities of the marathon that is the COVID-19 pandemic, there is a simple hypothesis: if the coronavirus is introduced into a susceptible population, and those people are able to mix, then there will be significant community transmission. Across 2020 and 2021, we have seen this happen around the world, including, recently, in India.
Could we see further situations like those in India, with cases rapidly spiking and health systems being overwhelmed? The short answer, sadly, is yes.
Globally, there’s been an encouraging downturn in daily new cases in May 2021, but despite this, cases are still at a very high level overall, with worldwide statistics masking huge differences across countries and areas. The global vaccine rollout is also progressing slowly, with most of the world still susceptible to COVID-19. These factors mean there’s potential for further spikes like those seen in India.
We only need look to Nepal to see a similar situation unfolding. Other countries have rising caseloads too, with many eyes looking nervously at Latin America, south-east Asia and some of the smaller island nations.
Who else is at risk?
In terms of where cases are increasing most quickly (at time of publication), the website Our World in Data highlights Laos, Timor, Thailand, Cambodia, Fiji and Mongolia as the countries where numbers have recently doubled in the shortest period of time (ranging from 16 to 23 days for these countries; for comparison, the doubling rate for India ahead of its second wave was 43 days). When looking at the countries whose reported deaths are currently doubling most quickly, it’s Timor, Thailand, Mongolia, Cambodia and Uruguay (range: four to 31 days).
For countries such as Laos, Thailand, Cambodia and also Vietnam (highly praised so far), it’s high susceptibility to COVID-19 that’s the problem. They’ve had few cases in the past, so there’s little natural immunity, and they’re now experiencing outbreaks amid an inability to procure a large vaccine supply. Vaccine coverage therefore is low. Thailand and Vietnam have given a first dose to just 2% and 1% of their populations respectively.
Elsewhere, it’s the mixing part of the equation that’s more of a concern. Japan, for example, is soon to host the Olympics, attracting athletes, dignitaries, coaches and media from every corner of the globe. Despite a ramping up of vaccine distribution over the past month, the programme has been sluggish, with less than 4% of the population having received a first dose. In this author’s view, the Olympics should not go ahead this year.
Latin America continues to experience a huge burden of COVID-19 disease and so is also at risk. Argentina, Uruguay, Costa Rica and Colombia are all still in the top ten countries in terms of daily new confirmed cases per million people. On the other hand, sub-Saharan Africa has on the face of it – with some exceptions – handled the pandemic relatively well, with countries praised for an early and decisive response, having learned lessons from the west African Ebola outbreak of 2013-16.
Working with uncertain data
Of course, our conclusions must be cautious. Creating high-quality real-time data during a public health emergency is complicated, and data is patchy and slow in most parts of the world. The extent of transmission within refugee camps and in conflict settings, for instance, is very much unknown. Some vulnerable areas may slip under the radar.
The reporting of data may also be influenced by local politics. Some countries, such as Tanzania, have chosen to downplay the severity of COVID-19. The former Tanzanian president, John Magufuli, died in March 2021 – and news coverage suggested he may have died of COVID-19 amid reports of uncontrolled outbreaks around the country and sharp increases in deaths. However, officially the impact of COVID-19 in Tanzania has been low.
Similarly, Belarus is reporting low death rates (27.8 per 100,000), having refused to consider COVID-19 a serious threat. But the Institute for Health Metrics and Evaluation (IMHE) has modelled the country’s actual death rate to be one of the highest in the world, at 472.2 per 100,000 people. IHME modelling puts Azerbaijan at the top of that list, with a death rate of 672.7 compared with official numbers of 46.3 per 100,000.
Politics and mixing
The timing of elections and volatility of political governance may be interesting factors to observe when trying to predict future spikes in cases. Political mass gatherings in India are likely to have contributed to the extensive recent transmission. The prime minister and health minister encouraged people to attend, wrongly believing earlier in the spring that India had reached the end stages of the pandemic.
Elsewhere, Donald Trump’s campaigning events caused numerous super-spreading events in the US, while in Myanmar there were reported breaches of COVID-19 protocols due to electioneering and mass gatherings. Myanmar’s elections in October 2020 were preceded by the highest spike in cases the country had experienced. Soon after the election, stricter policies were put in place and case rates lowered. Countries that engage in similar behaviour – or, like India, declare success too early – could well be the next hotspots.
Of course, the next outbreak may prove difficult to spot. Few of us could easily point to Timor on a map. This lack of knowledge influences our perception over local situations and also the news coverage that countries get. Compare Nepal and Timor to Brazil and India, on which public reporting has been extensive. Plus, some countries might not be reporting good-quality data – Belarus, Azerbaijan or indeed Russia may have much bigger burdens of COVID-19 than appears to be the case.
The “next big outbreak” will be reliant on a perfect storm of a few variables coming together. At the core of this storm will be a slow vaccine rollout and susceptible populations mixing freely. Political rallies, large-scale festivals and protests are examples of mass gatherings that can seed new outbreaks and facilitate sufficient spread to rapidly overwhelm a health system. But depending on where this happens, we may not even notice.
By : Michael Head (Senior Research Fellow in Global Health, University of Southampton)
Date : May 20, 2021
Source : The Conversation
https://theconversation.com/covid-19-which-countries-will-be-the-next-to-see-a-big-spike-in-cases-160914
Photo: Markus Winkler (Unsplash)
A Story of Nightmare for Patients in India's Government-Run COVID-19 Hospital
NEW DELHI (IDN) — The healthcare staff at Guru Teg Bahadur (GTB) Hospital in Delhi frantically clear the facility of bodies. One of the biggest government-run COVID-19 hospitals in the national capital, it is swamped by patients, triggering chaotic situations for doctors and paramedics who are scrambling to cope with the virulent infection amid a shortage of beds, oxygen, ventilators, doctors and other medical professionals.
People can be seen wailing to be admitted into the hospital, which is already full to its capacity. Doctors and other medical staff are overwhelmed. The ill have even spilled out on the pavement outside.
The emergency room of the hospital appears to be at the edge of a disaster. The last few breaths taken by a man came after his brother begged for oxygen for him for six hours. Barely able to walk on foot, another critically ill man in his early 50s was brought to the hospital on an e-rickshaw and put on a stretcher. The family had to turn back immediately after being told that he be taken elsewhere.
A brother and sister lost their mother minutes after reaching the hospital. She was brought in a critical condition but was left in the premises unattended on a stretcher. “This hospital is useless,” the inconsolable daughter shouted, while repeatedly shaking her mother’s body and pleading her to open eyes.
The relatives and attendants of the sick are doing everything to keep their near and dear ones alive.
Heena is begging for admission of her father, a rickshaw driver who is the lone breadwinner of her family. He spent his three-month wage on a jumbo oxygen cylinder, which he bought from a legal market.
A young man was seen lying on the ground in the waiting area, gasping for air. Another woman arrived and within minutes, she was declared dead. One of her attendants said they were turned away by four hospitals before reaching GTB Hospital.
Unable to get an ambulance, another family takes their brother to the hospital in a rickshaw. But the facility has no available bed, let alone enough oxygen. “I tried all the hospitals on the way from Ghaziabad to northeast Delhi. Everyone told me they had no oxygen supply. But the doctors here also did not admit my patient,” he told NewsClick, his voice breaking down.
Their wait outside was excruciating, but help never came. He started shaking his brother, but it was already too late.
Rich or poor, people are doing everything they can to keep breathing. All across the city and the country, the virus is leaving a scar on the people. With over 4 lakh new cases and over 4,000 deaths in the last 24 hours, India has topped the world in terms of the daily reported COVID-19 cases.
Hospital staff helpless amid oxygen shortage
Amid this, acute shortage of oxygen across the country has emerged as the main reason of deaths in hospitals which are turning away as they are already overburdened.
While Prime Minister Narendra Modi referred to the second wave of COVID-19 as a storm that has shaken the country and announced the construction of 500 oxygen generation plants, it has brought little relief for the families of those suffering. The feeling that the government has abandoned them and left them to fight the pandemic on their own seems to be a common understanding.
It has been reported that despite severe warnings by healthcare experts, the government went ahead with social gatherings, religious festivals and political rallies—some of which were attended by the prime minister himself, instead of preparing for the disaster which is unfolding now.
Back at the GTB hospital, another patient is brought in. He is hardly breathing and the nurses try to get him to respond. At that moment, an even more critical patient arrives. One of the nurses rushes to help. But they fail to revive him.
In order to deal with the shortage of beds, the hospital authorities have arranged as many stretchers and wheelchairs as they can. But the first line of treatment against COVID-19 is oxygen, they say, which has almost run out. The staff add that only they know how many lives are hanging in balance.
People are being turned away, but they don’t know where they will find a bed and oxygen. One of the attendants of a patient who was turned away, said, “We had taken her to AIIMS but were turned away. We have already been to five hospitals, where will poor people like us go?”
ICU beds unavailable
The intensive care unit (ICU) of the hospital is also full. “These patients in the ICU are in extremely critical condition. The situation is unthinkable and unimaginable. What you are seeing is the reality of the city. All hospital, doctors and nursing staff are overwhelmed and overworked. We have never felt as helpless as we are today. People are dying before us and we cannot do anything. We are running out of oxygen, which is the first line of treatment today,” a doctor told NewsClick.
“We are working day and night despite knowing the fact that if we or any member of our family contracts the virus, we will also struggle to find medical care,” he added.
There is helplessness and anger. “The government in some ways failed to estimate what was going to happen. The need that would arise if the numbers start rising. There was a sense of preparation during the earlier surge which seem to have disappeared in between. They did things such as allowing large gatherings, which were totally unacceptable. They perhaps believed that they had defeated the virus,” the doctor said, expressing his anger.
“My husband is a very bad state, let me get through,” urges a middle-aged woman while trying to wheel him into the casualty ward.
“Sir, come for one minute and look at my mother,” pleads a young man whose mother was gasping for air in an ambulance. A doctor follows him to the ambulance, prepared to say the words he has said over and over again in the past few days, “She is no more.”
Display Boards Outside Hospital Declare No Beds Available
The situation is no different at another major COVID-19 facility run by the Delhi government, the 1500-bedded Lok Nayak Jai Prakash Narayan (LNJP) Hospital. The emergency services in hospitals that cannot be shut have been closed here to tackle the huge rush of COVID-19 infected patients.
The display board installed in the hospital premises shows all beds are occupied and the facility can no more admit any patient.
Vijendra Arora has been knocking at the door of hospital after hospital for the past three hours for the admission of his wife who is critical. “I have come here from Shalimar Bagh. The Delhi government’s hospital at Ashok Vihar has no free beds or oxygen. They sent me to Lady Hardinge Hospital, but no beds are available there as well. The same is the case with the central government-run AIIMS, Safdarjang and Ram Manohar Lohia (RML) Hospital. I also went to Fortis and Max hospitals, but they also refused to admit her,” he said.
Lajwanti Devi’s blood oxygen saturation is falling. She is in critical condition. Her son Amit is desperate, helpless and broken. He told NewsClick that despite having money he does not have access to basic medical care. “I had a jumbo cylinder at home. After its oxygen drained out today, we failed to get it refilled. Therefore, we came here but are unable to get a bed. Where will I go, what will I do? I don’t have any idea,” he said, his voice choking with emotion.
Few metres away from the hospital is Bhajan Singh with his younger brother. This is the sixth hospital where he has come searching for a bed, he said. “We have been looking for a hospital bed for the past eight days. I have been standing here for the past three hours. First, I went to Lal Bahadur Shatri Hospital, which sent us to Lady Hardinge Hospital but that too had no beds. Then, I came here. We have brought our oxygen cylinder, which we purchased at Rs 25,000. On normal days, it costs below Rs 15,000. Doctors are not even willing to look at patients. They just look at the papers and turn us away,” Singh said.
Those struggling in an emergency till now are now collapsing at the gates of government hospitals. “First we went to private hospitals and they turned us away. Then, we went to a government hospital in Srinivaspuri. As asked, we spoke to the CMO but to no avail. LNJP staff told us they cannot do anything as they do not have beds. Where should we take her? She is a diabetic and her blood oxygen saturation has dropped to 57. We have been travelling to hospitals in auto since morning. Now the driver is not ready to take us anywhere,” claimed a man whose wife collapsed at the casualty gate of LNJP Hospital.
Manoj Kumar, 31, a tailor by profession who lives at Khajuri in Northeast Delhi, managed to get his mother, 52-year-old Tarawati Devi, admitted at LNJP on April 18 after she complained of breathlessness and developed a mild cough.
“Before her admission here, we were turned away by five hospitals. Both the governments (the Centre and the Aam Aadmi Party-led Delhi government) failed us,” he said, sitting in the parking lot outside the hospital.
Away from public view, Preeti was crying in a corner outside the hospital. Despite being on oxygen support for several days, her husband is not showing any improvement in his health, she said. She accused the doctors of not taking care of patients. “They are only changing his bed, patients are not given medicines properly. The hospital has been left at the mercy of junior doctors,” she complained. She also alleged that she was turned away by two hospitals before his admission at LNJP.
An estimate suggests, only one doctor is available for 200 patients in the country.
The medical superintendent of LNJP was not available for comments on the prevailing situation in his hospital. But a doctor, on condition of anonymity, told NewsClick that they are doing their best in their limited capacity.
“It’s true that the health infrastructure has collapsed. We are doing whatever we can do the best in our limited capacity. We the doctors and paramedical staff are working overtime. We are trying to save each and every life. But we are now helpless. In absence of oxygen, medicines and beds, we cannot do much. If a patient dies in a hospital gasping for air and medical facilities, it’s not simply death, but a murder,” he claimed.
The situation in Delhi, which is considered to have the best healthcare facility in the country, is a stark reminder of the collapse of the healthcare system in the rest of the country. It is a reminder of what the government failed to do in the past year and the grief that has engulfed the country because of it. [IDN-InDepthNews – 09 May 2021]
By : Tarique Anwar
Source : IDN
(https://www.indepthnews.net/index.php/the-world/south-asia/4431-a-story-of-nightmare-for-patients-in-india-s-government-run-covid-19-hospital)
Ivermectin: why a potential COVID treatment isn’t recommended for use
As the search continues for treatments for COVID-19, the results from a number of studies have led to changes in the advice on which drugs to give people who are suffering from the disease.
The European Medicines Agency and the United States National Institutes of Health have recently stated that one previously promising treatment – the antiparasitic drug, ivermectin – is not recommended for use in routine management of COVID-19 patients.
Despite these decisions, support for ivermectin has been circulating on social media and in WhatsApp groups, with rumours abounding that the drug is being blocked on purpose. Some have dubbed it the “new hydroxycholoroquine”, after a treatment that received a significant amount of online support but was found in trials to be ineffective against COVID-19.
So what is ivermectin, and why have national agencies ruled against it?
What is ivermectin?
Ivermectin was first developed in the 1970s from a bacterium in a soil sample collected from woods alongside a Japanese golf course (no other source has ever been found).
In the intervening years, the effectiveness of ivermectin and its derivatives in treating parasitic worm infections transformed human and veterinary medicine, leading to a Nobel Prize for its discoverers, William C Campbell and Satoshi Ömura.
In humans, ivermectin is currently prescribed in tablet form to treat certain roundworm infections that cause illnesses such as river blindness. It may also be applied as a cream to control the common inflammatory skin condition papulopustular rosacea.
But ivermectin is most commonly used for veterinary parasitic diseases, especially gastrointestinal worm infestations. Consequently, it is readily available and relatively inexpensive.
As ivermectin is more extensively used in veterinary than human medicine, however, the US Food and Drug Administration found it necessary to issue a warning in April 2020 against use of veterinary preparations in human patients with COVID-19.
Why might it be used to treat COVID?
How did a drug mainly used to treat intestinal parasites in cows come to be of interest to doctors treating humans with COVID-19?
In early 2020, a paper was made public (before it was reviewed by other scientists) which showed ivermectin suppresses the replication of the SARS-CoV-2 virus, which causes COVID-19, under laboratory conditions. This was one of many studies over the past 50 years to show that the antiparisitic drug could also have antiviral uses.
There appear to be two key ways in which the drug could prevent coronavirus replication. First, it could prevent the virus from suppressing our cells’ natural antiviral responses. Second, it’s possible the drug prevents the “spike” protein on the surface of the virus from binding to the receptors that allow it to enter our cells. Along with the anti-inflammatory actions apparent from ivermectin’s efficacy in rosacea, these may point towards useful effects in a viral disease that causes significant inflammation.
These initial findings were used as the basis of numerous recommendations for ivermectin’s use to treat COVID-19, particularly in Latin America, which were later retracted.
Why is it controversial?
Since then, there have been numerous studies into ivermectin as a potential treatment for COVID-19.
In late 2020, a research group in India was able to summarise the results of four small studies of ivermectin as an add-on treatment in COVID-19 patients. This review showed a statistically significant improvement in survival among patients who received ivermectin in addition to other treatments.
But the authors stated clearly that the quality of the evidence was low and that the findings should be treated with caution. As is frequently the case for reviews of multiple small studies, the paper suggested that further trials were needed to determine whether ivermectin was indeed clinically effective.
A controversy subsequently blew up over an article by the Front Line COVID-19 Critical Care Alliance, a group of doctors and researchers that lobbies for the use of ivermectin.
This article, summarising multiple small studies of the effects of ivermectin on COVID-19 patients, was provisionally accepted for publication in the journal Frontiers in Pharmacology in January 2021 but then rejected and removed from the journal’s website in March. The journal’s editor stated that the standard of evidence in the paper was insufficient and that the authors were inappropriately promoting their own ivermectin-based treatment.
One larger randomised clinical trial was published in March 2021. This showed no effect of ivermectin on duration of symptoms of adults with mild COVID-19. The authors stated that the findings did not support the use of ivermectin in these patients, but again highlighted that larger trials were needed to determine whether the drug had other benefits.
Why isn’t it recommended?
While some other studies did appear to show benefits of ivermectin, many did not. These were summarised by the National Institutes of Health, showing severe limitations arising from small sample sizes and problems with study design.
Both the National Institutes of Health and the European Medicines Agency judged, on the basis of these studies, that there is currently insufficient evidence to support the use of ivermectin in treatment of COVID-19.
More studies are underway. A large, multicentre trial began in February to determine the effectiveness of ivermectin as well as metformin (an anti-diabetes medication) and fluvoxamine (an antidepressant) in preventing COVID-19 disease progression.
It would therefore be premature to conclude absolutely that ivermectin has no place in COVID-19 treatment. On the basis of current evidence, however, its use cannot be recommended.
By : Gordon Dent (Senior Lecturer in Pharmacology, Keele University)
Date : April 20, 2021
Source : The Conversation
(https://theconversation.com/ivermectin-why-a-potential-covid-treatment-isnt-recommended-for-use-157904)
How to respond to Fiji’s COVID-19 health crisis
On 18 April 2021, Fiji marked 365 days since the last case of COVID-19 ‘outside of border quarantine transmission’. Just when the pandemic seemed to have come under control, a new positive case of a security personnel working in a border quarantine facility detected on 17 April 2021 has now led to a series of transmissions beyond the quarantine facility.
Mandatory quarantine for all returning travellers came into effect from 28 March 2020 and mandatory testing from 23 April 2020. By 17 April 2021, Fiji had recorded 72 positive cases in total, with 65 recoveries and two deaths since the first case was reported on 19 March 2020. Between the introduction of mandatory quarantine last year and 17 April this year, 54 positive cases were recorded as ‘border quarantine’ cases.
With 42 positive cases (9 border quarantine, 29 local transmission and 4 under investigation to determine the source of transmission) as at 6 May 2021, the functioning of the healthcare system and the capacity of the government to respond to this public health emergency are becoming crucial.
Healthcare system
So far, the health authorities have done well in terms of managing the risks of community transmission through the implementation of health restrictions (such as social distancing, face masks and lockdowns), testing, contact tracing and mandatory isolation of positive cases. The fragile nature of the healthcare system meant that the health authorities had to take early measures to prevent large-scale community transmission, which would be challenging to handle at the level of medical services required to treat COVID-19 patients.
Nonetheless, with the recent surge in cases outside of border quarantine, the spotlight has shifted to the capacity of the healthcare system to respond effectively. The healthcare system in Fiji, similar to many other countries, was not designed to cope with this type of health shock. At the moment, Lautoka Hospital, Fiji’s major hospital in the Western division and the country’s second largest, is in lockdown after a doctor who treated a man who died of the virus tested positive for COVID-19. A health centre located in Suva subdivision was also temporarily closed after a positive case was detected in a health worker.
Fiji’s healthcare system with a health expenditure to GDP ratio of 2.8% (2019-2020) and a health expenditure to total government expenditure ratio of 9.1% (2019-2020), stands at a cliff edge. Moreover, with a reduced budgetary allocation in the 2019-2020 fiscal year compared to 2018-2019, clinical services have been affected with shortfalls in technology and equipment devoid of regular maintenance and upgrade. If the continued focus of COVID-19 containment intensifies and the pandemic’s worst-case scenario unfolds, remaining services will be severely impacted.
Dealing with the crisis
In dealing with the crisis and moving forward, continuation of suppression strategies is crucial. But additional measures will be needed:
- Integrate emergency response: a catastrophic freefall can be prevented if a multipronged bipartisan ‘all of society’ approach is substituted for the ‘command and order’ governance structure and the health system’s daily ‘knee-jerk’ responses. In addition, public awareness of COVID-19 restrictions must spread to the grassroots population through improvements in communication channels.
- Raise manpower: mobilise and upskill an additional workforce of nurses, paramedics, ambulance drivers and retired medical personnel in areas of public health containment. Methods to ‘gown up’ in Personnel Protection Equipment (PPE) are essential for a worst-case scenario. In this regard, there is a need to explore the possibility of engaging Fiji’s 160 private sector health practitioners into service delivery. This is a challenging time and some nurses and doctors have been in isolation for weeks. Thus, frontline workers need to be rewarded appropriately (such as through risk allowances) to keep them motivated.
- Audit all health facilities: activate the National Clinical Services Network to undertake urgent inhouse audits in the supply chain of pharmaceuticals, consumables and hospital equipment including oxygen supplies from suppliers, biomedical technologists and other health personnel. Functional ambulance services also need a priority audit and rectification. Divisional medical teams should audit subdivisional hospitals, health centres and nursing stations using a similar format. Hospital water supplies, generators and patients’ facilities and amenities should be assessed and alternatives such as field health facilities set up in the event of further lockdowns, as has happened in Lautoka.
- Stock coordination: decentralising PPE stock, pharmaceuticals, consumables, linen stock and intensive care equipment (ventilators/oxygen concentrator) out of the Fiji Pharmaceutical & Biomedical Services Centre (Vatuwaqa) to regional warehouse facilities will be important for logistics operations. Earmark and block alternative locations for the set-up of field hospitals (at short notice, using security forces) keeping in mind the urban poor (especially those in informal settlements). Seek support from the World Health Organization and other partners to establish comprehensive public health surveillance data. Surveillance activities can be supported by people working at the grassroots level such as community health workers and village headman.
- Emergency food provision: containments and lockdowns have led to a reduction or loss of income due to reduced hours. Inability to travel to work and loss of jobs have reduced households’ access to healthy diets. To support affected workers and households, the government must tap into intergovernmental cooperation with social welfare and poverty alleviation programs establishing food banks as a food security measure. In this regard, the government can also partner with civil society organisations (CSOs) to harness their knowledge and network base to reach households in need. Some CSOs have already been working to support vulnerable households since the pandemic’s initial impact. The private food manufacturing sector may additionally provide expertise and support in the short-term food supply chain. The government has already implemented a scheme to provide F$90 to households towards grocery purchases in containment areas in Nadi and Lautoka. Such schemes will need to continue as long as the containment areas are in place or lockdown remains. However, with an allocation of F$5 million, this will cover just over 55,000 households. Moreover, the aim of these schemes should be about quick disbursement, and adding unnecessary eligibility conditions will only delay the pace at which households in need are able to access food.
Fiji needs to be prepared, and it needs to act quickly. Time is of the essence.
By : Neelesh Gounder and Neil Sharma
Date : May 11, 2021
Source : Devpolicy Blog from the Development Policy Centre
(https://devpolicy.org/how-to-respond-to-fijis-covid-19-health-crisis-20210511-2/)
How will COVID-19 transform global health post-pandemic? Defining research and investment opportunities and priorities
COVID-19 represents the greatest threat to global public health and economies in the 21st century. To date, more than 100 million people have been infected and over 2.1 million died; likely the tip of the iceberg of this devastating pandemic [1]. The impact on other pandemics and health challenges is masked by the continued dominance of COVID-19 on our lives. The economic and social impact is formidable and growing. In the United States (US) alone, the pandemic’s total cost is estimated at more than US$16 trillion, or approximately 90% of the country’s annual gross domestic product [2]. No country or region has been spared; the crisis has laid bare stark weaknesses in almost every health care system. Within and between countries we have witnessed how already vulnerable and marginalized populations bear a disproportionate burden of infection, with reversal of the development gains made to date [3].
The pandemic has also highlighted our interdependence. To achieve a new normal requires a coordinated, coherent and cohesive response that is effective globally for sustainability. For decades to come, we will undoubtedly continue critical reflection on why some countries, including less-resourced countries, have been able to respond more effectively to COVID-19, while some well-resourced countries have struggled. For now, a high priority in ending the pandemic, as well as accelerating the post-COVID-19 recovery, must be determining what an effective global response to COVID-19 entails. The papers forming this PLOS Special Collection, Post pandemic: How will COVID-19 transform global health? were conceived as a road-map to catalyse a global health research and policy agenda necessary to end the pandemic, shape the post-COVID-19 global health recovery and lay the foundations for a more resilient global landscape to achieve the goals of sustainable development. While by no means comprehensive, we highlight several critical themes: investments in better pandemic preparedness; more invigorated efforts to address structural and systemic inequities within the sustainable development framework and universal health care; enhancing resilience of our health care delivery systems; and achieving greater accountability for our actions as a threat to one poses a threat to all.
As papers in this Collection outline, COVID-19 has underscored the need for sustained investment in global health research. The speed and scale of vaccine development efforts, the proliferation of diagnostic tools and the development of several proven and promising therapeutic agents, are all evidence of where global science has triumphed and reflect decades of investments in biomedical research that could be rapidly brought to bear in the face of this new threat. Nonetheless, SARS-CoV-2 was a virus we should have been ready for; after all, we have been planning and preparing since the 1918 influenza pandemic. We had already encountered the SARS and MERS pandemics: these coronaviruses were already on the WHO Blueprint program priority list, large-scale studies had already identified a broad range of SARS-like coronaviruses in the potential reservoirs [4], and tools for structural analysis and prediction of host-range were ready [5]. So why were we not better prepared for this pandemic and able to contain the global transmission or correctly predict host-range? At the global level, preparations were inadequate and fragmented. Moreover, coordinated, transparent and inclusive global research is critical to inform future pandemic preparedness. Translating and expanding our existing knowledge on reservoirs, viruses, and drivers for disease emergence into a program for early warning and predictive outbreak risk is likely to be challenging, but absolutely imperative to mitigate against future pandemics, and will demand coordinated, well-funded global health and resourced research efforts.
Second, COVID-19 has amplified long-standing systemic and structural global health inequities [6], including in poverty, access to health care, race, ethnicity, gender and social incohesion. Manuscripts in this Collection seek to highlight how addressing these inequities must be both a local and a global priority. While the consequences of deaths from COVID-19 in East Los Angeles are consequences for California, they are also consequences for the rest of the world, especially given the proclivity of this virus for mutation and transmission. Renewed attention must be focused on how global health efforts that address local health inequities are integral to addressing global disparities. Even before the coronavirus pandemic, social, economic and health inequities had become a prevailing global narrative, with increasing scholarly attention focused on how global health needed to be de-colonized to redress power imbalances that perpetuate these inequities within and between nations [7,8]. Citizens globally are more visibly expressing anger and intolerance of enduring health, social, and economic injustices. Structural inequities reproduced within the global health system itself highlight the lack of critical engagement with the political and social determinants of health disparities [9]. While the global response to COVID-19 has largely reinforced these injustices, post-COVID-19 there is an opportunity to transform global health through an agenda of repoliticising and rehistoricizing health, building on the renewed and critical awareness brought to attention by the current pandemic [8].
Third, COVID-19 has served as a ‘stress test’ for health systems the world over. Some resilient health systems have responded rapidly and effectively to the pandemic, while many others have not. The salutary performance of East Asian countries in responding to the current pandemic, explained in part by imprinting and learning from past outbreaks, may offer a model for how health security must be prioritized in the post-COVID-19 era. By contrast, the dysfunctional performance of a few high-income nations illustrates the perils of under-investing in public health systems to cope with health crises of this scale. Equitable access to vaccines in the recovery process will also be an important stress test of global collaboration in the face of rising vaccine nationalism [10]. Developing safe and effective vaccines alone will not be enough to end the pandemic, unless those vaccines can be delivered globally at a price affordable to all governments and allocated in a way that maximizes public health impact and achieves equity. This Collection will explore the role of the COVID-19 Vaccine Global Access Facility (COVAX) initiative in encouraging high-income nations to participate to avoid a ‘tragedy of the commons’ [11] by expanding global vaccine supply and delivery, while also generating other positive outcomes [12].
Achieving rapid pandemic control is possible but is predicated on decisive leadership and collaboration for COVID-19 responses—at global, national and local levels—and a commitment to leave no one behind. Global health diplomacy has a critical role to play in catalysing governments and non-state actors to enact effective, innovative and just policy solutions. An ‘every country for itself’ approach clearly does not hold up in this interdependent world, and we need reforms. In particular, the International Health Regulations, which govern all countries to have core health system capacities to detect future pandemics, need to be revitalized. More effective rules of the road are also needed to foster cooperation among countries seeking to manage future outbreaks and as a global trigger for the United Nations and other international organizations to take appropriate actions. A well-funded WHO is also essential to effective global health governance and offers a model for global collaboration. The WHO has a critical role to play in supporting all countries to prioritize universal health systems, not only because it will vastly improve health and be an important bulwark against future pandemics, but also to reap marked economic dividends.
Although we have much to learn about SARS-CoV-2, the epidemic and its consequences, the virus has made one thing clear: for any crisis that threatens the globe, the problems of any of us are the problems of all of us. Global post-pandemic recovery must therefore be coordinated and multi-dimensional. Governance systems that are inclusive, accountable and guided by approaches that prioritize transparent, multisectoral decision-making processes are urgently needed to respond effectively. Only a holistic response based on cross-sectoral collaboration at all levels of society can build the necessary resilience to respond to the immediate and long-term effects of COVID-19. The COVID-19 pandemic reminds us that no country acting alone can respond effectively to health threats in a globalized world [13]. The crisis has also created a unique opportunity to re-imagine and transform global health so that future pandemics are not nearly as devastating as this one, and that health gains made to date are sustained and strengthened rather than reversed.
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By : Michael Reid , Quarraisha Abdool-Karim, Elvin Geng, Eric Goosby
Date Published : March 11, 2021
Source : PLOS Medicine
(https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003564)
