Thursday, February 27, 2020

The latest coronavirus outbreak in China: from epidemic to pandemic? (updated links)


In an earlier post based on the work of Jean Drèze and Amartya Sen, I made an analogical argument from China’s experience with the Great Chinese Famine (1958-1961) in order to highlight at least two factors relevant to the manner in which the Chinese government under President Xi Jinping has handled the COVID-19 (2019-nCoV) outbreak: “the absence of adversarial politics and open journalism” in contemporary China. At least some of the shortcomings of China’s handling of this latest viral disease can be traced to the authoritarian government’s failure to establish (institutionalize) at least these two components of any healthy democratic polity: freedom of the press and political opposition (the former perhaps more pressingly relevant that the latter). Here I want to broaden the examination of this coronavirus epidemic beyond China. After observations from yours truly, there are links to some articles and posts I’ve found helpful in attempting to understand the many questions and topics broached by this latest viral disease bordering on a pandemic.

It is rather disconcerting that one cannot find substantive analysis of the coronavirus (COVID-19) outbreak that speaks from the vantage points provided by global health law (or international public health law, including international law and infectious diseases), the modern history of epidemics and pandemics, and an integrative biomedical and social determinants epidemiological model that goes beyond exclusive focus on disease (this might help explain various things, including why the disease has spread to certain countries rather than others: at one level, this has an obvious explanation, but I think there’s more to be said here; as well as why it appears, to date at least, it is more virulent in some countries rather than others) [a partial exception to this complaint is found here]. We might also attempt to explain why this new coronavirus broke out where it did and ask to what extent these same social, economic, and health conditions are more or less replicated elsewhere. There are of course other questions to be asked, but it seems there’s a dearth of needed analysis (however provisional or tentative) and comments from the relevant experts in these fields, at least in public fora (are the mass media in part responsible for this state of affairs?). Perhaps it is because they don’t want to be seen as interfering with or even contradicting public statements issued by the World Health Organization (WHO) and/or domestic government health agencies like the U.S. Center for Disease Control (CDC). Be that as it may, it would seem these experts have an indispensable role to play in spreading requisite information and knowledge that can aid both citizens and government officials in deliberative discussions (and as part of planning) that are a prelude to or explain probable or possible executive, administrative, and judicial decision-making of one kind or another tied to this viral outbreak. 

More pressing, we have a Presidential administration that, at bottom, does not have genuine respect for and understanding of the various roles and functions of modern Liberal democratic government and administration (hence the routine campaign rhetoric demonizing those who ‘work in Washington’), including the various regulatory agencies and bureaucracies. In effect, this has led to fundamental and alarming failure—a clusterf*ck if you will—to grasp what it means to have the requisite competence and expertise in place within the respective domains of the federal bureaucracy and these agencies. (In fact, this administration has been hollowing out these agencies—including those relevant to the public health crisis—in favor of private, high finance, and corporate power.) This is glaringly and painfully obvious in the manner in which the President and his administration has handled the coronavirus outbreak: the lack of basic knowledge and understanding among official spokesperson (including those testifying to Congress), the inability to deal with unreasonable fears and rumors and properly inform the public of basic facts and statistics (involving as well how to interpret those), the failure to timely or properly coordinate agencies and officials with the national government and, in turn, with state governments and international bodies as well (such as WHO in the first instance) and, closely related to the foregoing, their conspicuous ineptitude when it comes to availing itself of the powers of public speech or democratic rhetoric. Proper appreciation of both democratic deliberative governance and government administrative power as two distinct yet necessarily linked political phenomena is absolutely essential in dealing with a public health crisis of this kind. To date, Trump and his administration has demonstrated utter incompetence in handling public health matters arising from the coronavirus outbreak. Trump’s naming Vice President Mike Pence to lead the country’s response to the coronavirus does not inspire confidence, indeed, I think it’s symptomatic of the regnant incompetence: “Pence once called global warming a ‘myth,’ downplayed the health risks of smoking, and as governor of Indiana, led his state into an HIV crisis by cutting funding to Planned Parenthood and initially opposing needle exchange programs. The vice president also has no medical experience.”
*          *          *
The US Center for Disease Control and Prevention (CDC) has warned that the coronavirus outbreak could cause ‘severe disruption’ to the lives of ordinary Americans, and urged families and communities to start making preparations. The extent of the spread of the virus in the US is uncertain, as the CDC stopped the distribution of coronavirus testing kits after they were found to be flawed. Working testing kits are now available in only a handful of states, and it is not clear when new kits will be ready. Donald Trump told journalists in India on Tuesday that coronavirus is ‘very well under control in our country’ and ‘is going to go away.’ However, the head of immunization at the CDC, Nancy Messonnier, said that disruption to everyday life may be severe as the virus spreads among local communities. ‘As more and more countries experience community spread, successful containment at our borders becomes harder and harder,’ Messonnier said in a telephone press briefing. ‘Ultimately, we expect we will see community spread in this country. It’s not so much a question of if this will happen anymore, but rather more exactly when this will happen, and how many people in this country will have severe illness.’ 

In the absence of a vaccine or medicines, other methods would be needed to contain the spread of the disease, including possible school closures, and telecommuting where possible instead of travelling to workplaces. ‘I understand this whole situation may seem overwhelming, and that disruption to everyday life may be severe. But these are things that people need to start thinking about now,’ Messonier said. ‘I had a conversation with my family over breakfast this morning, and I told my children that – while I didn’t think they were at risk – right now, we as a family, need to be preparing for significant disruption of our lives.’ 

The CDC acknowledged that the test kits it began distributing to state authorities earlier this month have been found to be faulty. The agency said in a statement that ‘performance issues were identified related to a problem in the manufacturing of one of the reagents which led to laboratories not being able to verify the test performance.’”
*    *    *
[Bruce] Aylward [a World Health Organization expert] said that across China, about 80% of cases are mild, about 14% are severe, and about 6% become critically ill. The case fatality rate — the percentage of known infected people who die — is between 2% and 4% in Hubei province, and 0.7% in other parts of China, he said. The lower rate outside of Hubei is likely due to the draconian social distancing measures China has put in place to try to slow spread of the virus. Other parts of China have not had the huge explosion of cases seen in Hubei, Aylward said. 

A case fatality rate of between 2% to 4% rivals and even exceeds that of the 1918 Spanish Flu pandemic, which is estimated to have killed upwards of 50 million people. A case fatality rate of between 2% to 4% rivals and even exceeds that of the 1918 Spanish Flu pandemic, which is estimated to have killed upwards of 50 million people. Even a case fatality rate of 0.7% — which means 7 out of every 1,000 infected people would die — is sobering. It is seven times the fatality rate for seasonal flu, which is estimated to kill between 290,000 and 650,000 people a year globally.”
Essential Reading:
  • Anand, Sudhir, Fabienne Peter, and Amartya Sen, eds. Public Health, Ethics, and Equity. New York: Oxford University Press, 2004.
  • Fidler, David P. International Law and Public Health: Materials on and Analysis of Global Health Jurisprudence. Ardsley, NY: Transnational Publishers, 2000.
  • Fidler, David P. International Law and Infectious Diseases. New York: Oxford University Press, 1999.
  • Fidler, David P. SARS, Governance and the Globalization of Disease. New York: Palgrave Macmillan, 2004.
  • Gostin, Lawrence O. Public Health Law: Power, Duty, Restraint. Berkeley, CA: University of California Press, 2000.
  • Gostin, Lawrence O. Global Health Law. Cambridge, MA: Harvard University Press, 2014.
  • Gostin, Lawrence O., ed. Public Health Law and Ethics: A Reader. Berkeley, CA: University of California Press, 2002.
  • Preston, Richard. Crisis in the Red Zone: The Story of the Deadliest Ebola Outbreak in History, and of the Outbreaks to Come. New York: Random House, 2019.
  • Quammen, David. Spillover: Animal Infections and the Next Human Pandemic. New York: W.W. Norton & Co., 2012.
  • Venkatapuram, Sridhar. Health Justice: An Argument from the Capabilities Approach. Cambridge, UK: Polity Press, 2011.
  • Wallace, Rob. Big Farms Make Big Flu: Dispatches on Infectious Disease, Agribusiness, and the Nature of Science. New York: Monthly Review Press, 2016.
  • Watts, Sheldon. Epidemics and History: Disease, Power and Imperialism. New Haven, CT: Yale University Press, 1997.
Image: Feature China/Barcroft Media/Getty Images


Post a Comment

<< Home