COVID-19 Potpourri

COVID-19 Potpourri

The WHO declared that COVID-19 is now officially a “pandemic.

While this news came as a shock to some, many feel that the WHO should have made the announcement weeks ago. Things are moving fast and it can feel hard to keep up. While it can feel like everyone with an internet connection is suddenly an expert in public health, the truth is that we are all still struggling to make sense of what is happening.

This post is my own attempt to keep up with a fast changing situation. There is a bit of everything here: what I’ve learned about public health and the coronavirus, some reflections on my experience here in Taiwan, some thoughts on racism and xenophobia in the age of COVID-19, and even some practical information for those who need to start teaching courses online for the first time. At the bottom I’ve also included some other random links I couldn’t fit anywhere else. I hope others will join in the spirit of this grab bag and share what they can in the comments.

1. Do we really need to take such drastic actions? Isn’t it just like the flu?

When the virus broke out in China and people began to warn that we need to take drastic action, some well known scholars made light of these concerns, suggesting that it really was no worse than the flu and that the cure might be worse than the disease. With the numbers of dead piling up in Italy, Iran, and elsewhere we can see in retrospect how stupid this was. Yes, it may have been foolish to think that we could contain it. And yes, in the future we may come to live with COVID-19 like we do with many other diseases. But right now many lives can be saved by slowing things down as much as possible.

flatten the curve

As the above GIF makes clear, “the speed at which the outbreak plays out matters hugely for its consequences.”

What epidemiologists fear most is the health care system becoming overwhelmed by a sudden explosion of illness that requires more people to be hospitalized than it can handle. In that scenario, more people will die because there won’t be enough hospital beds or ventilators to keep them alive.

UPDATE: This article from the Washington Post offers a more in-depth discussion (with excellent graphics) of how social distancing works.

The virus is especially dangerous for older people and those with weakened immune systems. It is precisely because large sections of the population can be infected without suffering debilitating symptoms that COVID-19 is so difficult to manage, because those people can spread the virus to others!

Moreover, charts like the death rate image above are deceptive because we still lack a lot of information about just how deadly the virus is.

Early guesstimates, made before data were widely available, suggested that the fatality rate for the coronavirus might wind up being around 1 percent. If that guess proves true, the coronavirus is 10 times more deadly than the flu. . . But there is reason to fear the fatality rate could be much higher. According to the World Health Organization, the current case fatality rate—a common measure of what portion of confirmed patients die from a particular disease—stands at 3.4 percent.

Some evidence from Italy suggests that it could be even higher. But to get back to the first point, slowing the spread of the virus will allow people to better handle the effects. The stories coming out of Italy are tragic. They lack sufficient equipment to treat all the patients that are in critical condition and so have to make extraordinary choices about which patients to care for. This could have been avoided if proper action had been taken earlier.

2. What can we do?

The most important step we can take at the national or institutional level is to promote “social distancing,” meaning trying to limit large crowds, travel, etc. as much as possible.

timeline of events in Hubei

The above chart shows the virus spread in China before and after the government started implementing social distancing policies.

As individuals, the most important thing you should do is to wash your hands regularly with soap, and try not to touch your face so much. (If you want the science on why soap is so effective against viruses, read this article.)

Above is just one of the many viral videos sparked by Vietnam’s catchy coronavirus PSA song. (But they really shouldn’t be touching their face so much.)

One area which has been a matter of some debate is whether or not we should wear face masks. First of all, it is important to know when and how to wear masks correctly. I recommend this WHO website designed to provide exactly such information. Because many people wear face masks incorrectly, some experts (including those at the WHO, the Singapore CDC, and the CDCs of several other countries) have argued that one shouldn’t wear a face mask unless you are sick or are caring for infected patients.

“The average healthy person does not need to have a mask, and they shouldn’t be wearing masks,” Dr. Perencevich said. “There’s no evidence that wearing masks on healthy people will protect them. They wear them incorrectly, and they can increase the risk of infection because they’re touching their face more often.”

However, in East Asia it is common to wear masks even if you aren’t sick and some experts have argued that this might be a good model to follow. This is especially true due to the risk of asymptomatic transmission. Moreover, as the article points out, everyone wearing masks in public helps remove the stigma associated with such behavior. Such stigma might prevent people who are sick from wearing masks.

face alien
Image by surrealhk.

Wearing a mask is also a “symbol and a tool of protection and solidarity”:

“Mask wearing is not always a medical decision for many people, but bound up in sociocultural practice,”

But these different social-cultural practices can have consequences in a climate of racism and xenophobia, something I’ll return to below.

Finally, if you suspect you might be infected, be sure to limit contact with others and check your own institution or country’s policies regarding testing.

3. My experience in Taiwan

I’m fortunate to be in Taiwan which is one of the best prepared places in the world for tackling pandemics. “Taiwan has millions of visitors from China and only 45 coronavirus cases.” (UPDATE: now 50 confirmed cases.) According to the author of a recent paper on Taiwan’s response:

the response started in 2004, after the last SARS epidemic. The most important thing about crisis management is to prepare for the next crisis. And so they started to do that. They set up a command center, the National Health Command Center, and integrated different agencies.

Taiwan has been very effective at doing things like fighting fake news, generating a new test that can work in 15 minutes, making masks available for all residents through rationing, increased production, and a new online distribution system, etc.

people wearing masks on MRT

Education is especially important:

The government also asked television and radio stations to broadcast hourly public service announcements on how the virus is spread, the importance of washing hands properly, and when to wear a mask. . . Residents learned that most patients had mild or no symptoms, so the death rate could be lower than what was reported. They also understood that a person’s travel history or contact with infected individuals determined their risk level, not their nationality or race. That understanding helped reduce discrimination.

At my university we started classes two weeks later than usual, but classes are now proceeding as normal, without any need to resort to online classes. (Although I think some arrangements may have been made for students from Hong Kong and other affected places who can’t return to classes due to travel restrictions.) Everyone on campus has been given a small card that fits in your wallet that works as a thermometer when pressed against the forehead for fifteen seconds.

temp card

If you have an elevated temperature you can report it immediately by scanning the QR code on the back of the card.

qr codes on back of card

In higher risk areas, like the gym, a staff member checks everyone’s temperature whenever they enter. (UPDATE: As I write this an announcement went out stating that temperature will be taken at the entrance to all buildings starting next week.)

We are also taking pictures of our classes each day so that if someone is sick the school can followup with those sitting next to them in class. We also have student workers disinfecting all surfaces on a regular basis. Finally, for the first time in fourteen years of teaching here, there is finally soap in all the bathrooms!

4. Some Reflections on Taiwan’s Experience

First of all, Taiwan was able to learn from experience, despite the fact that the political party in charge has changed since the SARS epidemic. This is a far cry from the US where Trump fired all the staff Obama had hired in the wake of the Ebola outbreak. One area where these differences can be seen in stark contrast is in the different rates of testing in each country:

COVID Testing

Despite having weeks to prepare, the US was still unprepared. While some of the drastic steps that were taken in China could never work in the US, Taiwan has been upheld as a model for how to take action without having to give up individual rights.

Second, Taiwan has nationalized medicine. In a pandemic you can’t have a health system where only the wealthy get adequate care.

The way to avoid rapid spread of the virus is to make sure that people who need access to care get it as soon as possible. But in this country, 30 million people are uninsured and 44 million more are under- insured because they can barely afford to pay the high deductibles and out-of-pocket costs in their plans.

It is especially dangerous of people are afraid to get tested because of out of control hospital bills or questions about their immigration status. I’m sorry to say that Taiwan is not doing such a great job with undocumented migrants, as this petition makes clear:

“undocumented migrant workers” had already been pushed to the margins of society for a long time, due to lack of government protections and lack of understanding among the broader Taiwanese society. If at this time measures like “increasing search and arrests,” “encouraging people to report,” etc., are used, which are aimed at “dragging out” more “undocumented migrant workers,” not only is it “climbing a tree to catch fish,” it will push these people at the bottom of society even further into unseen corners, including those who may be sick or contagious. To put it simply, at this time, the harsher the government policies, the larger the gaps in epidemic prevention.

Third, as stated above, Taiwan has sought to reduce the risk of discrimination. Many people are making an active effort to follow the government’s lead in calling it the “New Corona Virus” 新型冠狀病毒 (or 新冠病毒 for short) rather than the “Wuhan Virus” 武漢肺炎. Unfortunately many news outlets still haven’t changed their practices. This is a far cry from the US where the president is still calling it a “foreign virus.”

UPDATE: Excellent piece by Andrew Leonard in Wired about why democracy, not “Asian values” are responsible for Taiwan’s success:

But the truth is that Taiwan, one of Asia’s most vibrant and boisterous democracies, is a terrible example to cite as a cultural other populated by submissive peons. A closer look reveals that Taiwan’s success containing Covid-19 can be explained by the unique historical contingencies that have shaped this young nation. Taiwan’s self-confidence and collective solidarity trace back to its triumphal self-liberation from its own authoritarian past, its ability to thrive in the shadow of a massive, hostile neighbor that refuses to recognize its right to chart its own path, and its track record of learning from existential threats.

5. Racism

I have so far only personally encountered one experience of racism related to the coronavirus, and that was while I was on vacation in Malaysia over the lunar new year holiday. A Chinese family was at the hotel we were staying in by the beach on Langkawi and they were upset that the kitchen staff still hadn’t served breakfast long after the supposed start time. Rather than apologizing, the cook used the opportunity to berate the guests for exposing everyone to the risk of the virus, pointing out that the family’s children were coughing. I had to intervene because the father, a school teacher from Chengdu, had limited English ability. I helped him explain to the cook that his family (a) lived far away from Wuhan, and (b) had been traveling since before the virus broke out. But it was to no avail. I tried taking it up with the hotel owner, but he was more worried that his staff my quit on him if they had to serve Chinese customers than their attitude towards his guests.

As I discussed above, the East Asian habit of wearing a mask can mark wearers out as a target for racist violence:

A Hong Kong native who lived through the 2003 SARS outbreak, she understood wearing the mask to be more than a simple precaution.

“When you wear a mask, it’s a symbol of solidarity to other people,” Eunice, who asked to be identified only by her first name, told us. “It’s [a way of] saying, ‘I understand that things are scary, but here is a thing that I’m going to do to protect myself and to protect all of you.’”

Not everyone around her, however, shared this understanding. In the weeks that followed, Eunice said she began experiencing multiple forms of xenophobia, such as people overtly distancing themselves from her on public transit or making racist comments—including a death threat. “Every time something like this happens to me, I always have a fleeting thought of, like, Should I not go out in a mask anymore?” she said. “I should not have to choose my safety over my health.”

Even China was not immune to discrimination targeted at natives of Hubei:

Wang, the migrant worker in Shenzhen, said he had suffered “unprecedented” discrimination over the past few weeks. “Many people on the internet would call us batman,” he said, a reference to speculation among some scientists that bats were the source of the coronavirus.

Wang was kicked out by his landlord even though he explained to people that he did not return to Hubei for the Lunar New Year.

And lately “Chinese officials and news outlets have floated unfounded theories that the United States was the source of the virus“!

In a world that was already drawing in on itself, the virus has made us even more isolationist. I fear it will get worse before it gets better.

6. Teaching online

Finally, even though classes here in Taiwan are going on as usual, I wanted to share some resources for teachers struggling to go online for the first time. Here is a direct link to the Google Document in Jacqueline Wernimont’s post: Teaching in the context of COVID-19.

teaching in 2020

Although others have suggested that we might want to be cautious about getting too good at teaching classes online, lest it become the new normal – another encroachment into our classrooms by the neoliberal university. One goes so far as to suggest that everyone should “do a bad job of putting your courses online

And there is also “Sick Faculty Guest Lecture Exchange for Anthropology” going around on Facebook.

7. Additional links and resources I wasn’t able to fit in above:

That’s all for now, but be sure to check out some of the other links and resources I’ve listed below:

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