Wednesday, April 29, 2020

COVID-19 - Truth, lies and uncertainty

It's often said that truth is the first casualty of war. And in the war against the COVID-19 coronavirus, truth has also been a casualty with lies, half truths and conspiracy theories circulating wildly both on mainstream media and on social media.

Learning curves

Not even scientists say they fully understand the epidemiology of the virus and that there is much still to be learned. However, from presidents to the lay person in the street, everyone suddenly thinks themselves an expert.

Spreading false information, and even false hope, can do much harm. Indeed, whilst president Trump points a finger of blame at both China and the WHO in failing to share information about the virus, Trump's own dismissal of the risk lulled much of America into a false sense of complacency.

From assertions that the virus was "a hoax" to little more risk than the flu, Trump not only wasted valuable time in preparing for the pandemic but also failed to prepare the public for the crisis.

Trump wasn't the only leader failing to heed the warnings. In Britain, the prime minister Boris Johnson was so focused on Brexit that the growing crisis in China failed to register.

Of course there has been much made of the fact that China failed to warn the world of the dangers and the WHO also were too slow to declare a pandemic.

But it was all too clear that the situation in China was serious. Whilst it is extremely likely that the numbers of infections and those dying, as well as the exact data concerning the epidemiology of the disease was being controlled and even stifled, the very fact that China had locked down entire cities should have been warning enough.

Wasted time

Many countries did not need direct warnings to see the potential crisis that might unfold. The first case of the COVID-19 coronavirus in Taiwan was announced on 21st January 2020. Immediately after the Taiwanese government announced a temporary ban on the export of face masks for a month on 24th January to secure a supply of masks for its own citizens. It also began ramping up the production of alcohol for disinfection as well as increasing the manufacture of PPE - protective gowns, gloves and masks [Wikipedia-Taiwan response].

Even before the first case was identified, the Taiwan Centers for Disease Control (CDC) implemented inspection measures for inbound flights from Wuhan, China in response to reports of an unidentified outbreak of a strange pneumonia.

Such reports were published in many news outlets [SCMP]. And while news was certainly censored within China, anyone outside of China's censorship machine could have reacted just as swiftly as Taiwan and other countries which have kept both the numbers of those infected and deaths to extremely small numbers.

By 29th of April Taiwan had a total of only 429 cases with only 6 deaths. Hong Kong also reacted swiftly to learning of the potential SARS like outbreak in Wuhan and to date has only 4 deaths and around 1038 cases [Wikipedia-Hong Kong response].

Of course not all countries that acted early have kept deaths to single digits. South Korea also saw its first identified case on the 20th January. However, testing, contact tracing and appropriate quarantining has kept the death toll to 246 as of the 29th of April. One problem South Korea encountered was that many members of the Shincheonji Church of Jesus were uncooperative with Centers for Disease Control and Prevention Korea and could not be contacted. An outbreak was linked with the church, and its failure to cooperate with authorities hampered efforts to contain the disease [Wikipedia-Sth Korean response].

The list of other Asian countries that have, by acting early with testing and contact tracing, kept deaths down include Singapore [Wikipedia-Singapore response] which to date have 14 deaths and a total of 15,641 cases. Meanwhile as of 20th April 2020, there were only 268 confirmed cases in Vietnam, 214 recoveries, and no deaths. This success has again been put down to widespread testing as well as mandating the use of masks.

It hasn't just been Asian counties that have kept the numbers down. European counties that acted swiftly and decisively on seeing the first positive cases have kept deaths extremely low. Portugal for example has a little under 1,000 deaths [Guardian]. Meanwhile Iceland has kept numbers even smaller with the numbers of cases at 1,797 and only 10 deaths.

[Note: All figures cited are as published on 29th April 2020]

Misinformation concerning masks

There has been much talk over the use of masks in recent weeks in the West with many health experts and politicians discouraging their use claiming there was little or no efficacy in preventing an individual from catching the virus by wearing a mask.

However, whilst partly true, the wearing of masks can prevent the spread significantly. But when PPE and masks are in short supply for those that arguably need it more, such as health workers, it is perhaps unsurprising that there has been a certain amount of disinformation disseminated.

The WHO has previously recommended the use of masks to prevent the spread of a virus during "severe epidemics or pandemics" especially if asymptomatic people can transmit the virus. However, the shortage of PPE has affected both their position and that of many governments [WHO].

In a document published in 2019 the WHO says, "Face masks worn by asymptomatic people are conditionally recommended in severe epidemics or pandemics, to reduce transmission in the community. Although there is no evidence that this is effective in reducing transmission, there is mechanistic plausibility for the potential effectiveness of this measure."  

But in February 2020, likely influenced by a global shortage of masks, the WHO said that, "For asymptomatic individuals, wearing a mask of any type is not recommended. Wearing medical masks when they are not indicated may cause unnecessary cost and a procurement burden and create a false sense of security that can lead to the neglect of other essential preventive measures."

Whilst it is true to say that a mask may well "create a false sense of security" there is a growing amount of evidence that the spread of a respiratory virus can be reduced by the use of even the most rudimentary mask.

As regards protection, even the best PPE is not foolproof. A basic surgical mask is only likely to give a minimal amount of protection, as it is not tight fitting. Even a properly fitted N95 [or PPF3] mask is only good for 2-3 hours. Furthermore failing to remove and dispose of it correctly could result in self-contamination [WHO-How to use masks] .

The truth is, that only a full biohazard suit with appropriate breathing apparatus or similar would be likely to prevent exposure. But few of us could even afford such kit nor would we likely want to stroll to the shops in it. After all, who wants to walk around town looking like Dustin Hoffman in the film Outbreak?

That said, the wearing of a facial covering could well slow the spread of the spread of the virus [Science Media CentreWashington Post].

Social Distancing, herd immunity & the future

Much emphasis has been put on social distancing in order to contain or slow the spread of the virus. But prior to implementing a lockdown in Britain, Boris Johnson was openly talking of herd immunity and saying that 'loved ones would die' [Guardian].

Sadly, it has to be said that with all the best efforts most people will contract the virus, and that some will become seriously ill and die.

A vaccine, which will be the only surefire way of eradicating the threat, will be unlikely to surface for at least 12 to 18 months. Given this, and the fact that lockdowns are likely to be eased as time goes on, there will be many more people who will contract the virus over time.

Thus far, it is unclear whether individuals who have recovered from the virus are immune. Indeed there is some indication that some people might have caught COVID-19 twice. But it is believed that most of those who have recovered have at least some immunity from the virus.

Whilst the WHO has said there is "no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection," there's a consensus that the key to ending the coronavirus pandemic is establishing co-called herd immunity. But there are many unknowns, and only time will tell [TIME].  

One big unknown is how long the lockdowns will go on for, how they'll be relaxed and if there'll be secondary waves, as was seen in the 1918 pandemic.

Robert Redfield the CDC director, has warned that a secondary wave in the autumn could be much worse, compounded by the seasonal flu [Washington Post]. However his outspoken statement was almost immediately downplayed by the US president Donald Trump.

The "CDC Director was totally misquoted by Fake News @CNN on Covid 19," Trump said on Twitter [CNN]. Except of course, he was not misquoted, as he later confirmed in a subsequent press conference.

Other misleading claims

President Trump seems to have the monopoly when it comes to lies and misleading claims. Indeed a whole post could be written just covering the waffle, lies and obfuscation emanating from the US president.

But perhaps the real clangers have been Trump's pushing dangerous cures for COVID-19 including Hydroxychloroquine, Chloroquine and more recently the ingestion of household disinfectants or bleach. The latest blunder even prompted manufacturers to issue statements saying that under no circumstances should bleach or disinfectants be injected or taken internally [BBC]. Despite such warnings there has been a spike in the numbers of calls to poison control centers in the US concerning the use of bleach and disinfectants [Daily Mail].

Whilst there have been no actual cases reported of people actually drinking bleach there was a report of one person garling a diluted mixture in mouthwash [The Hill]. Meanwhile doctors and public health officials fear the attention could boost purveyors of dangerous elixirs who push 'miracle cures' with no basis in science [NYT].

Some people have already touted the misnomer that eating garlic or drinking copious amounts of water could promise a cure.

And it's not just Donald Trump endangering people's lives with fake or dangerous cures. Conspiracy theorist Alex Jones has been forced to stop selling a toothpaste which could literally turn users permanently blue [NYT].

The New York State attorney general issued a cease-and-desist order to Alex Jones, the conservative radio host, alarmed by false claims on his website that his diet supplements and toothpaste could be used to fight the coronavirus.

Jones has made much from previous crises. From Y2K to the current pandemic, the radio host has profited a great deal from revenue in the form of online ads and gained a reputation amongst some as being a snake-oil salesman [New Yorker].

The "nano-silver" toothpaste, which Jones said "kills the whole SARS-corona family at point-blank range" appears to be in a league of its own. While perhaps not as dangerous as drinking bleach, using too much of the product could lead to the users' skin turning blue due to the colloidal silver contained in the product.

To date there are no cures for COVID-19. Indeed, the FDA, prompted by Alex Jones' promotion of the Super Silver Toothpaste and related products released a statement saying, "There currently are no vaccines, pills, potions, lotions, lozenges or other prescription or over-the-counter products available to treat or cure coronavirus disease."

Pets & animals

There are many other conspiracy theories circulating about COVID-19. And one particular issue concerns our pets. There has been a worry that cats and dogs can catch the virus with the added concern that they in turn could pass it on.

Thus far there is only anecdotal evidence that pets can contract the virus. But there is no evidence the virus can be passed back to humans. However, there is a potential risk that pets could pass the virus on by touch. In other words a pet could come into contact with contaminated surfaces and bring the virus back to its owner.

Another conspiracy doing the rounds concerns the risk of pets dying from ingestion of hand sanitiser. However, the amounts a cat or dog might encounter from contact with humans would be so small as not to cause any harm [Factcheck AFP].

Bio-weapons, bats and wet markets

As has been discussed in previous posts, one of the biggest conspiracies concerns over where the originated. Some people believe the germ escaped from the Wuhan Institute of Virology or had even been developed as a bio-weapon. It has even been suggested the US released the virus in China itself [SCMP].

While there are many unexplained factors concerning how the virus came about. But the truth is likely to be rather mundane and be more connected to man's exploitation of animals, bad animal husbandry and a failure to observe appropriate hygiene practices. 

The way Trump uses the phrase the Chinese virus, certainly encourages a certain hostility towards Chinese and Asian people, especially those who would grab any excuse to embolden their own prejudice and racism. However, in itself calling a virus after its origins is not necessarily new. Comedian and chat show host highlighted this in a recent monologue in which he pointed to the Zika virus named after Zika forest of Uganda, where the virus was first isolated in 1947. Ebola named after the Ebola river Hantavirus named after the Hantan river. The list is almost endless. To call COVID-19 the Wuhan virus is essentially factual, at least in terms of its origins - unless the bat in question did come from Yunnan, in which case it could be called the Yanzidong virus [see previous post*]!

As Bill Maher states, "This isn't about vilifying a culture, it's about facts." To criticise another culture for bad practices should not be considered racist, Maher asserts. "It's not racist to say that eating bats is batshit crazy." Some of what Maher has to say is indeed hard hitting, but one cannot hold back if bad sanitary practice and animal husbandry in any country can create the devastation the COVID-19 virus has caused thus far.

Of course, whilst fingers should quite rightly point to China concerning this pandemic, things could have been so very different and might have pointed elsewhere due to bad practices in other countries. AIDS, BSE [Bovine Spongiform Encephalopathy or Mad Cow Disease] and Swine Flu [H1N1] came from Africa, Britain and North America respectively. AIDS has killed countless millions. BSE resulted in only a couple of hundred deaths in the form of CJD. And the 2009 Swine Flu pandemic resulted in at least 18,000 deaths although 2012 research showed that as many as 579,000 people could have been killed by the disease worldwide.

Of course, many blindly ignore bad farming practices in the West. From battery hens, to intensely reared pigs or cows pumped with hormones, such practices are no less dangerous than the ticking time bombs of China's wet markets as was warned in papers published as far back as 2007 [CMR / The Print]. In a follow-up to his lambasting China's wet markets, Maher points a finger closer to home, criticising Western farming practices that could well come back to bite us [You Tube].

Dangerous conspiracies

Perhaps one of the most dangerous conspiracies being disseminated is the assertion by the likes of David Icke that the virus doesn't even exist.

Icke, well known for his conspiracies, was recently featured in a documentary broadcast on the TV channel London Live in which he claimed the pandemic was cover for a supposed global world order to purposefully crash the economy, end the use of cash payments, and track every individual [Guardian].

Whilst it might be true to say there will be some governments, institutions and individuals capitalising or exploiting the pandemic for their own nefarious ends, to claim the virus itself is a hoax foisted on mankind by 'the new world order' is stretching things a little far.

Conspiracy theories put lives at risk. But how much do Google, Facebook and other social networks care? Perhaps driven more by the fact that there will be little advertising revenue to be made from fake news being spread on social media, many networks have been proactive in stemming the flow of fake news.

Facebook said it was "committed to removing misinformation which could contribute to physical harm" as it took down the interview with Icke and the London Real conspiracist site. The social network has reportedly also removed countless other posts disseminating false information about the virus or encouraging people to hold gatherings that break social distancing rules [Guardian].

However, the company has nonetheless come under criticism for not being proactive enough especially concerning false posts in languages other than English [BBC].

Twitter too has made attempts to remove harmful posts [Guardian]. However, there have been reports of fake Twitter accounts appearing on the social network with some suggesting the government might themselves be behind the accounts [Twitter] something denied by the government themselves [Twitter]. Indeed the government themselves say they are actively trying to stop the flow of fake news on the Internet [BBC].

But it's the apparent politicisation of the crisis that has also worried many. Even mainstream media from LBC in Britain to CNN in America has raised concerns over the politicisation of the crisis.


President Trump in America has used the coronavirus press conferences as a staging post for his own propaganda and attempted to divert attention from his own mistakes at handling the crisis by blaming the WHO and withdrawing funding at a crucial time [BBC].

There will be more to come. Not only from the US but in Britain, Europe and to the East. A disastrous Brexit will no doubt be blamed on the pandemic and in turn China. And China too will likely blame the West for a second wave of infections as its lockdown recedes. Even within the EU there will likely be repercussions as countries more affected by the crisis call on the European Parliament for help.

And as the global recession - that will surely come - bites hard, politicians will look anywhere but at their own front door for a scapegoat.

As the world eventually breaks through to the other side of this pandemic, which is some way off yet, finding truth will be even harder as we are bombarded with yet more lies, half truths, misinformation and fake news.

tvnewswatch, London, UK

Tuesday, April 07, 2020

Who was patient zero? And does it matter?

Since the outbreak of the COVID-19 coronavirus there has been much speculation as to where it came from. Most scientists are in general agreement that the virus resulted from a process known as zoonosis whereby a virus jumps from animals to humans. But there has also been wild speculation, amongst netizens both in China and the West as to the specifics.

The original source

Bats are widely believed to be the original source of the COVID-19 coronavirus. Research carried out by at least one team, based at the Wuhan Institute of Virology, indeed seems to point to at least one species of bat, the horseshoe bat found and collected in two caves - Yanzi and Shitou in Yunnan province - as to being reservoirs of a multitude of coronaviruses, some of which bear strong similarities to COVID-19 [NCBI / NYT].

But what remains unclear at the moment is how the virus jumped from the bats to humans. Some scientists believe that the virus jumped from bats to a second animal which in turn was transported to the Wuhan wet market and from which it then crossed to humans.

This is of course entirely plausible. Whilst there are examples of people in China using bats in Traditional Chinese Medicine, the bats used are often sold dried and would be unlikely to harbour viruses for any length of time having been killed and dried. Therefore any zoonosis would likely require a live bat infecting another animal which in turn might be taken to market.

Intermediate host
A whole number of potential candidates exist, though there has been much focus on the pangolin, a rare, exotic and scaled mammal which is prised for its meat as well as its scales, which again are used in Traditional Chinese Medicine. However, less exotic animals such as pigs could also have facilitated the jump from bats to humans.

But there has been wild speculation that the virus might have leaked directly from the Wuhan Institute of Virology itself where the bats were being studied.

Conspiracy theories

One particular piece of information that has fuelled such rumours is the apparent disappearance of Huang Yanling [黄燕玲] who worked out of the laboratory. Whilst it is not denied that Huang Yanling once worked at the institute, official accounts insist she moved on from her post in 2015 [Xinhuanet - Chinese]

However there remains much suspicion about her potential involvement as much information about her has been scrubbed from the Internet. Nor has anyone managed to locate her.

Another anecdote that has also fuelled the theory that the virus came from the Wuhan Institute of Virology is a quote from one of the team who made significant discoveries about coronaviruses in bats.

Shi Zhengli [石正丽], a virologist at the WIV, and a world expert on bat viruses, and known as 'China's Bat Woman', wrote in Scientific American in March this year that when she was urgently contacted by the head of the Wuhan Institute of Virology on 31st December 2019 to investigate coronavirus samples found in two patients with atypical pneumonia, she remembers thinking "If coronaviruses were the culprit, could they have come from our lab?"

Of course, such thoughts might well run through the minds of a scientist working closely with coronaviruses that are later found to have been responsible for starting a pandemic. But feelings or concerns are not proof.


Shi was the focus of personal attacks in Chinese social media who claimed the Wuhan Institute of Virology was the source of the virus, leading Shi to post, "I swear with my life, [the virus] has nothing to do with the lab."

She went further in a follow up statement, saying, "The novel 2019 coronavirus is nature punishing the human race for keeping uncivilized living habits. I, Shi Zhengli, swear on my life that it has nothing to do with our laboratory."

Of course, it might be possible that Huang Yanling was infected whilst working at the laboratory and later infected people in and around the wet market in Wuhan only to be 'disappeared' in order to 'hide the truth'. The police action, early on in the outbreak, against a doctor who tried to bring attention to the new deadly virus does nothing to quell such conspiracy theories. Dr Li Wenliang had, in December 2019, attempted to bring attention to colleagues of a possible outbreak of an illness that resembled severe acute respiratory syndrome [SARS], later acknowledged as COVID-19. However, on 3rd January 2020, Wuhan police summoned and admonished him for "making false comments on the Internet." Li later died from complications after contracting the virus himself. 

Scapegoats and inaction

It is clear that the Communist Party of China manipulated information, silenced individuals and potentially risked more lives by not being upfront with both its own people and the world in general. But even if there were cover-ups, it was clear by mid to late January as stringent lockdowns were implemented and temporary hospitals were constructed, that the situation was serious. To blame China for the West's complacency is merely looking for a scapegoat.

Indeed many countries close to China reacted far swifter and decisively in the face of the spread of the virus. Taiwan, for example, employed temperature and other health checks on all people arriving early on, conducted widespread testing as well as contact tracing and quarantines. As such there are only a little over 300 cases in the region and only 5 deaths amongst a population of over 23 million. Similar procedures in Hong Kong, South Korea and Iceland has also kept the numbers of cases and deaths relatively low.

The first cases appeared in the UK on 31 January, but it was not until the 23rd of March that a lockdown was implemented following a closure of schools and an order that pubs, clubs, restaurants and other public places be shut. In that time there was no widespread testing, people arriving from abroad were not subject to temperature or health checks and there was little effort to perform contact tracing [Wikipedia].

The same was true of the US. On the 19th January 2020, a 35-year-old man presented himself to an urgent care clinic in Snohomish County, Washington having returned from Wuhan [NEJM / NYT]. Having seen a health alert from the US Centers for Disease Control and Prevention [CDC] about the novel coronavirus outbreak in China and suffering from a cough and fever he had decided to seek medical help. The man later recovered. However, it is likely that many others, perhaps asymptomatic, also arrived in the US around this time or before and began to spread the infection. Yet once again, the US dragged its feet in terms of checking arrivals from other countries, delaying testing, and failed to prepare for what later proved to be a major health emergency, though a ban on individuals travelling from China was implemented on the 31st of January.

Learning lessons

Whilst this pandemic is far from over, one can only hope lessons are learnt. All countries must prepare for any future pandemics. The WHO along with governments from all countries must draw up plans and procedures to curtail the spread early on. And information must be freely shared, not only between scientific bodies and governments, but also to the general population.

Many countries around the world are at fault concerning the spread of the COVID-19 coronavirus. China's ruling communist party failed to share and even stifled the flow of information. Many other countries failed to act quickly enough, despite warnings from China and the WHO as early as the 30th of January when the WHO declared a global health emergency.

First world countries in particular could be rightly criticised for maintaining their public health service and for mothballing preparations for future pandemics including the failure to maintain equipment and failing to store Personal Protection Equipment [PPE] appropriately.

As such, in many countries there is a clear shortage of ventilators, PPE and other important equipment, as well as a shortage of properly trained staff, nurses and doctors.

More pandemics to come

This won't be the last pandemic and as Dr Shi Zhengli says, "the mission must go on" to find and identify other coronaviruses. "What we have uncovered is just the tip of an iceberg."

Disease ecologist Peter Daszak, who has collaborated with Shi over many years, says there are as many as 5,000 coronavirus strains waiting to be discovered in bats globally. As far back as 2013 he warned that bats and other animals, through zoonosis, pose a risk to us all [Wired]. 

So who was patient zero?

So, was Huang Yanling patient zero? It is perhaps of little consequence. Whether she was the first person to begin the spread, or whether is was a pangolin or pig that was the first carrier, it is zoonosis that is the driving factor. 

Indeed, it is not the fault of a virology lab or its workers. It isn't the fault of the bats either per se. It is the fault of humans for failing to heed the warnings from scientists.

As Daszak said only this week, "We need to be thinking about pandemics in the same way we think about climate change – it's an existential threat to us, but it's one we can actually control, because we're the drivers of it." [SCMP]

"Bat-borne coronaviruses will cause more outbreaks," says Dr Shi, "We must find them before they find us."  

tvnewswatch, London, UK