Sunday, 31 May 2020

Coronavirus death rates – why some countries are doing so well and others so badly

Last week I was on a conference call with 35 Christian doctors and dentists in our East Asia network. We reviewed the status of the COVID-19 pandemic in each country. The figures are really illuminating.

Taiwan has had a total of 7 deaths, Hong Kong 4 and Mongolia 0. In China, Japan and South Korea the total deaths are much higher at 4,634, 874 and 269 respectively.

But even these latter numbers are tiny when considered on a population basis. China has had 3 deaths per million people, Japan 7 and South Korea 5.

By contrast the UK has had over 38,000 deaths – equivalent to 566 for every million people. This is a hundred times the number of deaths per million in South Korea and over 1,000 times that in Hong Kong. 

For the US the equivalent figures are 103,000 and 319. Again astronomical.

Overall, the US and Europe have been the worst in handling this pandemic thus far. If we disregard those countries with tiny populations less than 200,000 people (St Maartens, Andorra, San Marino, Isle of Man and Channel Islands) the ten countries with the highest covid deaths per million population are all European or North American.

Leading the list is Belgium with 816 death per million followed by Spain (580), UK (566), Italy (551), France (441) and Sweden (435). The next five are Netherlands (347), Ireland (335), USA (319) and Switzerland (222).

Following closely behind them are the rest of the Americas – Ecuador (189), Canada (188), Peru (133) and Brazil (132).

It is now simply impossible to ignore the conclusion that the Far East along with New Zealand and Australia - which have both had only 4 deaths per million population – have handled this crisis far, far better than the Old World.

Furthermore, it has all to do with decisions that leaders in these successful countries have made which those of unsuccessful countries have not made.

What did the successful countries do?

First, they acted quickly, immediately closing their borders, quarantining every suspected case and tracing and testing every contact. They knew exactly how many cases they had in the country and where they were. They identified case clusters and wrestled them to the ground.

Lockdown, along with handwashing and social distancing, helped to limit the spread, but it was the early closing of borders, quarantine and test and trace that contained the virus.

Hong Kong and Taiwan immediately closed their borders because of their past experience with SARS. New Zealand and Australia rapidly followed suit. By contrast official Home Office figures reveal that at least 20,000 people infected with coronavirus entered the UK before lockdown, but fewer than 300 were quarantined. These arrivals would have infected some 50,000 more people given the World Health Organisation’s assessment of an average transmission rate at the start of March of between 2 and 2.5.

Between 1 January and the end of March 18.1 million people entered the UK without any health checks including from coronavirus hotspot countries. Of these, just 273 were quarantined.

Subsequently 15,000 to 20,000 people a day returned to the UK up to the end of April without being subject to the enforced quarantine that had operated in successful countries virtually from day one.

China got quickly on top of their outbreak through a vigorous programme of widespread testing followed by isolation of those affected, backed up by travel restrictions. In Wuhan, where the pandemic started, more than 1,800 teams of epidemiologists, with a minimum of 5 people/team, traced tens of thousands of contacts a day. New Zealand similarly tracked down every single case such that by 30 May there was only one active case left in the country.

Compare this with the UK where testing was abandoned in early March because the number of cases had overwhelmed our meagre testing facilities. With a doubling time of three days the number of cases in the country is estimated to have increased from 11,000 to 1.5 million in the 20 days between 3 and 23 March while the government dithered and talked about ‘herd immunity’ and handwashing.

Second, successful countries protected their vulnerable populations. New Zealand’s total of 22 deaths occurred mainly in two care homes; yes remarkably the disease got into only two care homes. By contrast on 12 May it was reported that more than 8,300 deaths in UK care homes had been linked to the virus since the epidemic started.

We now know that this was because suspected cases in many UK care homes were not even tested, staff were not supplied with PPE and hundreds of people were discharged from hospitals into care homes taking the virus with them. And so British care homes became incubators for COVID-19.

Third, successful countries employed sensible exit strategies. Lockdown measures were not relaxed until the disease had been virtually eliminated and test and trace techniques were sufficient to locate and isolate those few cases which remained.

Again, by contrast, lockdown measures have been lifted when there are still ten of thousands of active cases in European countries including the UK. According to John Edmunds, a professor of infectious disease modelling at the London School of Hygiene and Tropical Medicine, there are still 8,000 new infections every day in England without counting those in hospitals and care homes.

Given that in many people the infection lasts for three weeks (say 20 days) that would mean over 160,000 active cases in the UK at any one time. In China the epidemic peaked at 3,000 cases a day (see p29 here) so we are still over double the number of new cases per day at China’s peak in a country with less than 5% of China’s population.

Worldwide the last three days (28, 29 and 30 May) have seen the largest number of new cases since the pandemic began (116,000, 125,000 and 124,000 – see chart at top of this article).

Test and trace strategies worked in China and New Zealand with hundreds of active cases – but the manpower and organisation required to make them work with over 100,000 active cases in the UK are much higher and our test and trace workforce is not even yet up and running.

Remember that the UK’s coronavirus cases went from 11,000 to 1.5 million in 20 days between 3 and 23 March this year. We are still at the equivalent of 15 March even now. Understandably several advisors of the Sage committee have expressed concern that we are taking our foot off the brake too early and risking a second spike in cases.

These concerns are amplified when we consider that recent studies have shown that, although all those who have had the virus will have antibodies to it, only 5% of Spanish people and 7% of UK people on recent studies have antibodies now.

In other words, 95% of the Spanish population and 93% of the British population are still susceptible to coronavirus infection, at a time when we still have no treatment and no vaccine.

And yet according to official figures there have already been 38,000 deaths in the UK and 27,000 in Spain. If the whole population of both countries were to be infected these figures could rise as much as 15 to 20 times. And as these figures only include those cases proven by test to have the virus the real numbers could be considerably higher.  

This has led Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh, to suggest that intensive surveillance, large-scale screening, effective contact tracing, isolation of cases, quarantine for international arrivals and some residual physical distancing ‘is a possible new normal’.

It is perhaps easy to be wise in retrospect, but for many countries in the developed world this crisis is far from over. Lockdown has flattened the curve but prolonged the agony and we may only have witnessed the first act of a very long play.

But the lessons are clear – the trajectory of COVID-19 in any given country is largely a product of how that country handles it. Some countries have done incredibly well – and others incredibly badly.

The important thing is that we learn the lessons for next time. We can be thankful that COVID-19 is only moderately infectious and carries an overall mortality rate of only about 1%. Imagine if it was as lethal as Ebola and as easy to catch as chicken pox. Or perhaps try not to imagine.

Monday, 13 April 2020

Trusting God through difficulties – five keys to resilience and perseverance

We all face difficulties in life. What is unique about the coronavirus pandemic is that we are all facing the same difficulty at the same time – although its effect on each one of us is different.

But each family has its own story of illness – mental and physical, chronic or terminal. Each family at some time will face loss – of money, possessions, hopes and dreams. Bereavement, failure and disappointment is part of life for all of us at some point. And we all eventually know the pain of broken relationships or loneliness and isolation – be it temporary or permanent. In addition, for Christians there is the promise that in some way or another we will face persecution (2 Timothy 3:12).

People of various worldviews and faiths all have their explanations for suffering. For Muslims it’s about the will of Allah – it’s all fate. For Buddhists, it has to do with unsatisfied desire – it’s in the mind. For Hindus it is payback for past lives - it’s all karma. And for atheists it’s the product of time and chance – it’s just random molecules.

But for Christians who believe in a God who is at once all-powerful, all-knowing and all-loving – the question is often raised – why doesn’t he do something about it? Surely, he must know and care and be able to deal with it?

Philosophers and theologians throughout the ages have grappled with this question by devising ‘theodicies’ - explanations for why God might allow suffering.

At one level these usually fall in the category of one of four F’s.

First, we live in a fallen world which is damaged by sin. The breaking of God’s relationship with human beings (through our rebellion and indifference) has led also to a breaking of our relationships with each other and with the planet. War, disease and natural disasters are to be expected in such a world. The whole world is ‘groaning’ (Romans 8:22).

Next is the effect of free will. God has granted human beings, and indeed the devil himself, the ability to make choices. How much of the difficulty in our world results from people (or demons) making bad choices or failing to make good ones?

Third, we need to see difficulties through the eyes of faith. God has higher purposes in suffering which we, from our limited human perspective, may be unable to discern. Suffering produces perseverance and perseverance produces character, as the Apostle Paul reminds us. (Romans 5:3, 4).

Finally, we need to see suffering in the light of the future. God has unfinished business with this planet and its inhabitants and his intention is to create a new heaven and new earth where there is no suffering (Revelation 21:1-4). Everything will eventually be put right. But he is in no hurry as he wants to give people a chance to turn to him before it is too late. (2 Peter 3:9) And pain and difficulties, as CS Lewis reminds us, are his megaphone to a deaf world.

But the Bible is also a book for life travellers more than armchair philosophers; and travellers ask different questions: How do I get over this next hill or obstacle? Which route do I take at this fork? Don’t expect to know the answers to all life’s mysteries and especially what God’s purposes might be for you personally through them.

And so, we would expect Scripture to be replete of practical advice for travellers – and it is. 

Psalm 13 is a great example, worthy of thousands of words. Facing problems? Keep praying (Psalm 13:1-4), trust in his unfailing love (5), rejoice in his salvation (5) and sing the Lord’s praise (5). All of these are life-transforming exhortations.

But in this post, I want to draw to your attention five keys to resilience and perseverance from one of my favourite chapters in the Bible – Hebrews 12. I hope they will be as much help to you as they have been for me when I need something a little more. Hebrews 12 is a feast of practical instruction – and its appeal is to use our minds to think our way out of bitterness, despair and self-pity.

1.Consider those who have gone before (Hebrews 12:1-4)

The chapter starts with the word ‘therefore’ calling us to look back at what has just been said:

‘Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us’ (Hebrews 12:1,2)

Who is this great cloud of witnesses? They are the heroes of faith whose names are listed in Hebrews 11 – Abel, Noah, Abraham, Isaac, Jacob, Moses, Gideon, David, Samuel and the prophets. Many of them won great victories – but none had a life devoid of suffering and struggle.
Some of them, we are told, were ‘tortured… faced jeers and flogging, chains and imprisonment. They were put to death by stoning… sawn in two, killed by the sword… persecuted and mistreated.’ (Hebrews 11:35-37).

In comparison many of own burdens pale into insignificance.

But most of all the author bids us to consider Jesus Christ himself, who ‘endured the cross, scorning its shame’ in order to win our salvation. In fact, he put himself through this ordeal for ‘the joy that was set before him’ – the joy of saving us, and of winning us for himself.

Jesus, in his struggles on our behalf, always had the end in view and this is what encouraged him to press on. In the same we need to remember that nothing done in the Lord’s service is ever in vain (1 Corinthians 15:58) and that our labours for him are fruitful (Philippians 1:22) even if there are times when we cannot imagine the fruit, let alone see it with our own eyes.

‘Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up.’ (Galatians 6:9)

Have we ‘resisted to the point of shedding our blood’? (12:4) Not many of us. So, let us consider those who have gone before – especially Jesus Christ – and think about what they went through before feeling too sorry for ourselves. Let’s instead ‘throw off everything that hinders and the sin that so easily entangles’. (12:2)

2.Endure hardship as discipline (12:5-12)

‘Endure hardship as discipline; God is treating you as his children. For what children are not disciplined by their father?’ (Hebrews 12:7)

God uses the hardships we face to build into us the qualities we need to be his effective disciples. ‘Perseverance produces character’ says Paul (Romans 5:4). ‘Consider it pure joy when you face trials of many kinds, because you know that the testing of your faith produces perseverance’, says James. (James 1:2,3)

Just as training hones the athlete and grit produces a pearl in an oyster, so God uses trouble and difficulty to shape and improve us, so that we are more useful to him. This is a mark of his love for us.

So, ‘do not lose heart when he rebukes you, because the Lord disciplines the one he loves’. (12:5). Just as our parents’ discipline is a mark of their love for us, so when God brings hardship into our lives it is with a higher purpose of moulding us into his image.

‘No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it.’ (Hebrews 12:11)

Often if we are honest, we find ourselves taking exactly the opposite view and assuming that God cannot love us because of what he has allowed us to go through – but in fact he never promised us that life would be easy. Rather Jesus said to his disciples, ‘In this world you will have trouble’. (John 16:33)

How we love to hear the tender words of Jesus, ‘Come to me, all you who are weary and burdened, and I will give you rest’ (Matthew 11:28). But sometimes we actually need him to be tougher with us. Jesus said some unbelievably tough things to his disciples, which they badly needed to hear for their own good.

When Jeremiah was complaining to the Lord about how difficult things were for him as the Lord’s prophet he received a salutary telling off:

‘If you have raced with men on foot and they have worn you out, how can you compete with horses? If you stumble in safe country, how will you manage in the thickets by the Jordan?’ (Jeremiah 12:5)

Effectively God is saying, ‘toughen up. If you think this is bad how are you going to cope with what is coming?’

God disciplines us through the hardships we face in order that he can use us more effectively in the future.

No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it.’ (12:11)

So, when we face difficulty a good question to ask is, ‘What is God teaching me through this? What qualities is he building into me as I rise to this occasion?’

3.Make every effort to live in peace and be holy (12:13-17)

Sometimes we can be tempted to grumble against God when we face difficulties. In the Book of Malachi God accuses his people of saying ‘harsh things’ against him. (Malachi 3:13). ‘What are these harsh things?’ they ask. God replies that it is when they say, ‘it is futile to serve God. What did we gain from carrying out his requirements’?

How often we fall prey to this – pouring scorn upon our Lord and Saviour because we don’t like our personal circumstances.

This part of Hebrews 12 warns us of the danger of using hardship as an excuse to stop being serious about our discipleship. Esau is cited as a sobering example in throwing away his inheritance just because he was tired and hungry after a hard day’s work. (12:16)

We need to ensure that we do not fall into bitterness, sexual immorality of fighting with others out of spite for God or because we think that what we are going through gives an excuse for such behaviour.

Living holy lives and living in peace with others are no less our duty when times are tough.
As Peter reminds us, we ‘ought to live holy and godly lives’ as we ‘look forward to the day of God and speed its coming’. (2 Peter 3:13)

This is crucial if we are to commend the Gospel to others. Let’s not use tough times as an excuse for sin.

4.Remember what you have been saved to (12:18-24)

The writer here draws a contrast between the Old Covenant made by the Israelites on Mt Sinai and the New Covenant sealed with the blood of Christ on the mount of crucifixion.

The promised rewards of the former were dependent on obedience to God’s commands (Exodus 19:5, 6) and there were accordingly warnings, commands and punishments for disobedience (Deuteronomy 28:15-68). But there is no condemnation for those who are in Christ Jesus (Romans 8:1).

By contrast, the New Covenant is based on God’s grace – his unmerited favour to us through Jesus paying the price for our sins on the cross.

We look forward to the ‘heavenly Jerusalem’ (12:22) and a glorious eternity with God. Christians often forget that the rewards in the Christian life are almost entirely in the future.

And it is the glories and delights of heaven that put the sufferings of this life into perspective.

No eye has seen, no ear has heard, and no human mind has conceived what God has prepared for those who love him. (1 Corinthians 2:9) In the light of the eternal glory that is coming, our troubles on earth, however bad, are but ‘light and momentary’ when seen from this perspective. (2 Corinthians 4:17)

5. Remember what you have been saved from (12:25-29)

Keeping our troubles in perspective against the joys of heaven is sobering, but so also is seeing them against the horrors of hell, eternal separation from God.

If God was simply a God of justice, then he would have eliminated humankind at the moment Adam and Eve first sinned. But he is thankfully also a God of mercy, who delays the judgment we all deserve to enable us to repent.

We cannot stand safely in his presence unless we are clothed with the ‘righteousness of Christ’ (2 Corinthians 5:21) because ‘God is a consuming fire’. (12:29)

The author of Hebrews here reminds us about the fate of people at the time of the Exodus who turned their backs on God.

How much worse will it be if we reject him now, after the coming of Christ.

The threat of coronavirus is nothing compared to facing Jesus Christ unforgiven on the day of judgement so we need to be thankful, reverent and humble before him. (12:28, 29)


Are you tempted to fear, despair or give up? Consider those who have gone before. Endure hardship as discipline. Make every effort to live in peace and be holy. And see things in an eternal perspective – always remember what you have been saved to and what you have been saved from.
Let’s take these five keys to resilience and perseverance to heart as we negotiate these current difficulties.   

Wednesday, 1 April 2020

‘Green zones’ for the vulnerable may be a cheap and effective option for preventing coronavirus spread in low-resource settings

US and Western Europe have so far been the hardest hit by the coronavirus with over 80% of cases worldwide - but there’s good reason to think that the Developing World will ultimately suffer most. 

According to a recent report, 40 million lives may be at risk this year (see my previous post here).

Controlling spread of the virus there will be a very different prospect in low-resource settings. What techniques are likely to work best?

A new paper from the London School of Hygiene and Tropical Medicine (LSHTM) is advocating so-called green zoning – rather than quarantining those already infected by the virus (red zoning), those individuals who are both unaffected and vulnerable are protected by being separated off from the rest of the population.

This may appear counterintuitive – after all developing countries have a much lower proportion of older people – in Wales, for example 21% are over 65 whereas in Ethiopia only 3% are.

But the authors identify three reasons why populations in the developing world are likely to be more vulnerable to COVID-19.

First is reduced social distance. Larger intergenerational households, intense social mixing between the young and elderly, overcrowding in urban slums and displaced people’s camps, and specific cultural and faith practices such as mass prayer gatherings, large weddings and funerals – all lead to higher transmissibility of the virus.

Second is high numbers of vulnerable patients. Non-communicable diseases (NCDs), like diabetes, hypertension and chronic respiratory disease, undernutrition, tuberculosis and HIV all make it more likely that coronavirus infection will push people over the edge.

Third is weaker health services. Fewer hospital beds, fewer health professionals, less intensive care facilities and poorer infrastructure and healthcare delivery systems. Inadequate water and sanitation make it worse.

The strategies that have worked so effectively in containing the virus in East Asian countries like Singapore, Hong Kong and South Korea – widespread testing and meticulous contact tracing – are very resource-intensive and less easily replicable in low-income and crisis settings.

Lockdowns are also likely to be very harmful for societies in which most live from hand to mouth and have little if any savings. And when people are stretched beyond their ability to cope they are less likely to comply with control measures.

There is also little prospect of scaling up intensive care to the levels required and isolation of cases in dedicated high-intensity wards might offer little benefit as most transmission would still be due to mildly unwell people spreading the virus to close contacts and family members.

For all these reasons, it may be therefore a better use of resources to focus on protecting the vulnerable.

In Ebola epidemics, the aim of isolating the ill into a contaminated ‘red zone’ is primarily to protect the healthy. But with COVID-19, the red zone is everywhere, so it makes more sense to protect those more likely to suffer fatal illness from the rest of the population who are much more likely to survive the infection.

The risk of coronavirus infection increases with age with a particularly high risk among those aged over 70 (or even 60 in low-resource settings) and/or living with NCDs and other immuno-suppressing conditions.

The authors suggest three options for shielding high-risk community members – house-hold level, street-level and neighbourhood or sector level. In the first two arrangements healthier members of the high-risk group could care for those with disabilities.

Stringent infection control measures should operate with all options. The green zone’s boundaries should probably remain virtual, but a single physical entry point, with handwashing facilities, should be established and food and other provisions should only be exchanged through this point.

Given that it may be difficult to isolate at-risk people for long periods the strategy should be discontinued as soon as safe to do so. This could be ascertained by serological testing, which is likely to be very cheap once widely available.

Detailed guidelines need to be developed and other feasible, high-yield interventions should be undertaken simultaneously (eg. staying home if sick, limiting public transport use, reducing super-spreading events at funerals or other mass gatherings, promoting hand-washing, soap distribution).

In the meantime, those who develop symptoms of COVID-19 (fever, continuous cough) would be tested (if possible), isolated and quarantined for 14 days in the usual way (red-zoned), along with their close contacts (family members).

This approach would enable the rest of the community to carry on with normal life with frequent handwashing etc (maybe we could call this the blue zone!), knowing that if they did catch the virus they would be very unlikely to suffer serious symptoms or die. Meanwhile, immunity would build up gradually in the general population.

This simultaneous green zone/red zone approach also has the advantage of avoiding the negative effects of lockdown on the economy and normal life, whilst protecting those most vulnerable, until a time when a vaccine is available to confer longer-lasting protection.

Longer-term, as with other viral illnesses like influenza or HIV, it will be vaccines or antiviral therapies that will best protect people in low-resource settings – but in the meantime, in the absence of these, protection in green zones seems a sensible, practical and low-cost option for reducing mortality.

The protection of the vulnerable resonates well with Christian ethics – and green zones operate on the ‘Passover principle’ where those located in safe places (marked by blood on the lintel) were kept from harm. With Easter coming up soon – this may be a good way to motivate faith leaders, who are often the most trusted voices in developing world communities, to protect their flocks.  

Saturday, 28 March 2020

The Developing World and not the West will bear the brunt of coronavirus – but acting quickly could save over 30 million lives this year

With 80% of coronavirus deaths in Western Europe the focus of the world’s media has understandably been there. The UK had 260 deaths today and has had over 1,000 deaths overall.

But COVID-19 is affecting 199 countries and territories around the world.

Among these are 27 countries with between 3 and 40 deaths today (where the UK was on 14-19 March) and 28 countries with 1 to 2 deaths today (where the UK was on 5-13 March) – so that’s another 55 countries that on deaths per day are only 9-23 days behind us.

Of those 55 countries over 20 are in the developing world. At the current rate of spread – a 12% increase in global deaths per day - we would expect to hit 100,000 total global deaths by 7 April, 500,000 by 21 April and 1 million by 28 April.

But if we were to run this forward to the end of the year what would we find?

A new report this week claimed that doing nothing to combat the virus would leave the world facing around 40 million deaths this year.

But they also claimed that up to 95% of these could be saved if countries act quickly.

Researchers from Imperial College in London have looked at the impact of the pandemic in 202 countries using different scenarios based on data from China and Western countries.

Their conclusions?

If countries adopt strict measures early (at a stage where there are only 2 deaths per 1,000,000 population per week) - such as testing, isolating cases and wider social distancing to prevent transmission to more people - 38.7 million lives could be saved.

But if these measures are introduced later (at 16 deaths per 1,000,000 population per week) the figure could drop to 30.7 million.

On the other hand, social distancing alone would save only 20 million lives.

The effects of the pandemic are likely to be most severe in developing countries – communication is worse, health facilities are poorer, there are fewer health professionals and a high incidence of chronic infections (like TB) and noncommunicable diseases (heart disease, lung disease and diabetes).

Different demographics mean that older people make up a smaller proportion of the population (21% of people in Wales are in the vulnerable over 65 age-group but only 3% in Ethiopia) but this is more than compensated for by the larger populations and the increased risk posed by larger multi-generation households.

The ten most populous countries in the world include India (with 1,380 million people), Indonesia (273m), Pakistan (220m), Nigeria (206m), Bangladesh (164m) and Mexico (128m). That’s 2,371 million people – about a third of the world’s total population – in just six countries.

The ten next most populous countries include Philippines, Egypt, Vietnam and Democratic Republic of Congo (DRC) with a combined population of over 400 million.

This Is over twice the population of Western Europe (currently 195m).

There will be 25 times more patients needing critical care than beds available, compared to seven times more in high-income countries, the report says.

Seeking people’s compliance with infection reducing measures like social distancing in a wealthy and technologically advanced country like the UK where education levels are high and communication easy - everybody can be reached easily by text and social media - is one thing.

Achieving this in many developing countries where infrastructure, transport and communication systems are poor by comparison, literacy levels relatively low and where governments and police are more likely to be corrupt, unaccountable, under-resourced and unmotivated is another prospect altogether.

According to the BBC, after the lockdown was announced in India this week, people in Delhi and the financial capital, Mumbai, quickly thronged shops and pharmacies amid fears of shortages. 

Meanwhile, millions have been left jobless and without money as a result of the shutdown.

It has also sparked an exodus from major cities, where thousands of migrant workers are setting out on long journeys back to their home villages after transport was stopped.

India ranked only 80th in Transparency International’s world corruption perception index in 2019. Indonesia, Pakistan, Mexico, Nigeria and Bangladesh ranked even lower at 85th, 120th, 130th and 146th equal respectively among the 180 countries included.

Corruption means that nothing can be achieved quickly and efficiently. But as the virus spreads, only the most draconian measures will lessen the impact and the countries least able to protect themselves will be among the hardest hit.

Prof Neil Ferguson, from Imperial College London and author of the report, said: ‘Our research adds to the growing evidence that the COVID-19 pandemic poses a grave global public health threat.’

He adds that ’sharing both resources and best practice is critically important if the potentially catastrophic impacts of the pandemic are to be prevented at a global level.’

Strategies to suppress the virus will need to be maintained in some way until vaccines or effective treatments become available to avoid the risk of another epidemic.

The West has huge expertise and now experience in battling COVID-19. But what will we do to help the less-advantaged global south as they face an even bigger challenge?

One thing is clear – if interventions are to have an impact and go any way to saving 95% of the 40 million who could die this year then we must act quickly. In a matter of weeks, it could be too late.

We cannot wait as long as we did in the West before acting – as developing countries do not have enough hospital beds and oxygen, let alone ventilators to provide back up if prevention of spread of the virus is unsuccessful.

Thursday, 26 March 2020

Our prayers against coronavirus are being answered in amazing ways but one essential element is still missing

Last Sunday night we lit a candle in our front window and joined hundreds of thousands of other Christians up and down the country and throughout the world to pray about the Coronavirus pandemic.

We followed the #Praytoendcovid19 prayer points as follows.

For God to intervene to stop the spread of the coronavirus from this day forward
       For those who are sick, that they will have access to the care and treatment they need
For protection and stamina for the health workers who are caring for those with the virus
For grieving families who have lost loved ones to know God’s nearness and comfort
For pastors serving their communities and nations to have the right words and actions
For Christ’s body worldwide to support those suffering in prayer and in sacrifice
For government officials and decision-makers to mobilise resources quickly and effectively
For those waking up to societal and economic fallout from COVID-19 to reach out to God
For mission workers worldwide especially those impacted by COVID-19 to continue their work
For those who live and die without the knowledge of Jesus to hear about him and respond

Over the last week, we have seen these prayers answered in wonderful ways but most of all in the extraordinary mobilisation of people and resources.

About 12,000 former staff in the UK have come forward, including 2,600 doctors and more than 6,000 nurses.

More than 18,700 student nurses and 5,500 final year medics will also join the NHS workforce.

A call for 250,000 NHS volunteers to deliver food and medicines to 1.5 million vulnerable people was answered within 24 hours by more than 500,000 people coming forward to offer their services.

Work is also well underway to set up the 4,000 bed 'Nightingale Hospital' in London’s Excel Centre and the number of ventilators in the country has been doubled from 4,000 to 8,000.

A nation is willingly complying with measures on social distancing and quarantine and applauding health workers. And those of all political parties are standing united to counter the threat.

This has all been accompanied by the most extraordinary financial package in peacetime to help businesses survive the lockdown and workers to make it through the crisis.

Britain is preparing for a literal tsunami of need on the near horizon and through it all the government has opened itself up to media and public scrutiny to keep people informed and to build confidence and unity. Our country is rising to the challenge.

Tonight a new report from Imperial College urges countries around the world to act quickly to save 30 million lives, stressing that those most vulnerable are the elderly in developing countries which do not have the resources we do.

Everyone has a different story to tell – for me as CEO of ICMDA, with my next ten trips in March, April and May cancelled, I am asking how best to use these weeks (and maybe months) to serve our 80 national associations of Christian doctors and dentists around the world as they respond to this crisis.

My son and daughter in law, both doctors, are back at work now that their one year old has tested negative for the virus (saving them 14 days of quarantine and underlining how important testing is) and my wife is doing virtual paediatric clinics from home.

At ICMDA, we are laying other plans aside to support the thousands of Christian doctors on the frontline.

I have been amazed at how quickly resources have been produced (see some linked here) to establish treatment protocols for diagnosis and treatment, not just in the West but in resource poor settings all over the world - ensuring that everyone is working in a way that is led by the very best scientific evidence.

Our social media groups – especially WhatsApp and Facebook – are buzzing with suggestions and advice as doctors and dentists from all over the world share their expertise.

E-books, on-line courses, protocols, manuals – even a handbook for Christian healthcare workers – are being rushed out at breakneck speed. A manual for emergency care of COVID-19 patients in low-resource settings from Africa, a 68-page handbook of COVID-19 prevention and treatment from China, resources on palliative care for COVID-19 patients from Asia-Pacific.

All this activity from governments, NGOs and ordinary people is a massive answer to prayer and great cause for rejoicing.

It is right both to come to God on our knees and then to act as best we can to do what each of us can with the gifts, skills and influence that God has given us. All this is essential.

But one little thing still nags me – something still seems lacking.

My wife and I have been reading through some of the great prayers of Scripture over the past week – and were struck particularly by those of Nehemiah and Daniel – two of the most skilled and gifted leaders and administrators in Jewish history. These men were great activists who got things done – but they were also great men of prayer.

Can I encourage you to read (or reread) their prayers in Nehemiah 1:5-11 and Daniel 9:4-19?

When Nehemiah heard of the plight of Jerusalem we are told that he ‘sat down and wept’ then ‘mourned and fasted and prayed’ (Nehemiah 1:4). His prayer was one of confession and repentance:

‘I confess the sins we Israelites, including myself and my father’s house. have committed against you. We have acted very wickedly towards you. We have not obeyed the commands, decreases and laws you gave your servant Moses.’ (Nehemiah 1:6,7)

When Daniel learned from the Scriptures that Judah’s 70-year captivity in Babylon was coming to an end he ‘turned to the Lord and pleaded with him in prayer and petition, in fasting and in sackcloth and ashes’. (Daniel 9:3) Again his prayer was one of prayer and repentance:

‘Lord you are righteous but this day we are covered with shame… because of our unfaithfulness to you… we have not obeyed the Lord or kept the laws he gave us through his servants the prophets…’ (Daniel 9:7-10).

The one prayer in the list above that God has not yet shown signs of answering is to stop the spread of the coronavirus ‘from this day forward’. The numbers of those affected and dying grow daily before our eyes and all the data indicates that the worst is yet to come.

The apostle Peter tells us that repentance starts with us Christians. It is up to us to lead the way.

‘For it is time for judgment to begin with God's household; and if it begins with us, what will the outcome be for those who do not obey the gospel of God?’ (1 Peter 4:17)

I have in a previous post looked at what the Bible says about plagues. There is not the space to recount those lessons here but the bottom line is that plagues happen under the sovereign will of God and they are a warning to us, a sign of judgment, a call to repentance. (1 Kings 8:37-40)

When Joshua fell before God to plead for his help after the Israelites had been routed by the men of Ai God asked him what he was doing and ordered him to ‘stand up’. (Joshua 7:10-12)

Israel had sinned. It was no good asking for God’s help. They needed first to repent.

I wonder if that is the fundamental problem here – we live in a world that has turned its back upon God the Father and its Lord and Saviour Jesus Christ. But we also, as God’s people, are seriously compromised. To a large extent, the nation’s sins are also our own.

We are asking for his help in this crisis and he is answering our prayers in many ways as outlined above. But he has not stopped the plague. In fact, if anything it is accelerating. Perhaps it is because as a nation, and first as God’s people in this nation – alongside all our other prayers and actions - we need to repent.

‘If I close the sky so there is no rain, or if I command the locust to devour the land, or if I send a plague among My people,  and My people who are called by My name humble themselves and pray and seek My face and turn from their wicked ways, then I will hear from heaven, forgive their sin, and heal their land.’ (2 Chronicles 7:13,14)

Sunday, 22 March 2020

Most European countries are on a similar coronavirus trajectory to Italy and the projected numbers of deaths world-wide are deeply sobering

If you are in any doubt that coronavirus is a very serious problem then please read this. 

One of the striking features of the COVID-19 pandemic has been the different trajectories of spread in different countries.  

The epidemic started in China but after 81,000 cases and just over 3,200 deaths there have been no domestically acquired cases there in the last three days. The danger now for China is for the virus to come back to the country from overseas but it seems to have the virus well under control.

China’s remarkable success in controlling the virus is documented in the Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) dated 16-24 February. You can read the whole report here but there is an excellent summary here (much more detail in my previous post here).

By contrast, in Italy the number of new cases is increasing exponentially. Italy has 7,500 deaths to China’s 3,200 but on a population basis Italy has 1,230 cases per million population to China’s 56.

In fact, of the 198 countries and territories now with coronavirus, 72 of them have more cases than China when measured in cases per million population. This 72 includes most of the countries in Europe.

Eastern countries like Singapore, Taiwan, South Korea, Hong Kong and Japan are on a similar trajectory to China (see blue lines in graph below) – but most Western countries are following the pattern of Italy (see also here). The Financial Times has an illuminating series of graphs demonstrating this. 

The World Health Organisation’s top emergency expert, Mike Ryan, speaking on 22 March on the BBC’s Andrew Marr Show, said that movement restrictions and lockdowns are not enough to control spread of the virus (video here).

‘What we really need to focus on is finding those who are sick, those who have the virus, and isolate them, find their contacts and isolate them,’ Ryan told Marr (see my previous post on the importance of testing here).

Much of Europe and the US, have introduced drastic restrictions on travel for non-essential workers, many of whom are now working from home, while schools, bars, pubs and restaurants have also been closed.

However, Mr Ryan said he believed these countries need to follow the example of countries like China, Singapore and South Korea, where these restrictions had been coupled with rigorous measures to test people suspected of having the virus.

‘Once we've suppressed the transmission, we have to go after the virus. We have to take the fight to the virus,’ Mr Ryan added.

As I argued last week, the failure of countries like the US and UK, has been not having enough testing kits to identify those infected. The UK is testing about 10,000 people a day while China was producing 1.6 million testing kits per week at the height of their crisis.

Singapore, like China, has a sophisticated and extensive contact tracing programme, which follows the chain of the virus from one person to the next, identifying and isolating those people - and all their close contacts - before they can spread the virus further.

As of 26 March, Singapore had confirmed 631 cases and no deaths. For about 40% of those people, the first indication they had was the health ministry telling them they needed to be tested and isolated.

In total, 6,000 people have been contact-traced to date, using a combination of CCTV footage, police investigation and old fashioned, labour-intensive detective work - which often starts with a simple telephone call.

By contrast, in the UK, we failed to do this in the early stages allowing the virus to steal a march on us.

Now, because of the lack of resources to check anyone other than hospitalised cases, we have junior doctors being quarantined at home for two weeks simply because their child has a cold – when a simple test could clear them to go back to work.

Similarly, potentially infected healthcare staff, who haven’t been tested because we lack the resources to test them, are at risk of spreading the virus around the wards.

We also have no way of knowing (because we are not testing) just how many cases there are in the UK overall or who has it and who doesn’t. Official figures show around 9,500 but government advisor Patrick Vallance admitted last week that the real number was closer to 55,000. Given the number of deaths in the UK already it may be much higher.

The best indication we really have of the seriousness of coronavirus in any given country currently is the  number of deaths, but as death occurs on average 14 days after first symptoms (in those who die) this leaves us a long way behind the curve and means that any interventions we make may take some time to have effect.

The number of deaths so far may seem quite small - only 21,000 in total globally by 26 March - but as can be seen from the numbers opposite (source here) the number of deaths per day increased from 100 to 1,600 in sixteen days between 5 and 21 March. This amounts to a doubling of numbers every four days, or a 19% increase daily. From 21 to 26 March the average daily increase was 10%.

If this trend were to continue, and I realise this is a big if because of the large number of potentially confounding variables not least interventions by governments, then a 10% daily increase globally would result in 41,000 deaths worldwide by 31 March, 100,000 by 9 April, one million by 3 May, two million by 10 May, five million by 20 May, ten million by 27 May and 15 million by 31 May.

So it is May when the increase will really kick in if we fail to stop it. The increases beyond this do not bear thinking about. I have put the figures in a chart below. 

These numbers will of course be mitigated by preventive measures like rigorous testing, tracing and isolation - or by social distancing and lockdown - but this dramatic increase in numbers over time is the frightening effect of a 10% increase in daily death rates on the total number of deaths globally.

This is not scaremongering. This is simply what the maths shows – and is what happens when a virus that is as contagious as Ebola and 30 times more deadly than the flu (with a mortality rate of 3.0-3.4% according to the WHO – detail here) is allowed to establish itself in a population.

Unless curbed this will simply overwhelm our health systems with far more patients requiring oxygen and ventilators than we have capacity for.

This is why it is so crucial that we all play our part – for our leaders to get the policy right and resources right and for all of us to help make it work. But we are also going to need some supernatural help to beat this – more on that later.

The table below is based on a 10% daily increase in global deaths. The actual increase from 5 to 21 March was 19% daily and 10% daily from 21 to 26 March.

Date Daily deaths at 10% daily increase Total deaths at 10% daily increase  Actual Daily deaths Actual total deaths 
21/03/2020 1,600 13,000 1,634 13,013
22/03/2020 1,760 14,760 1,626 14,647
23/03/2020 1,936 16,696 1,873 16,154
24/03/2020 2,130 18,826 2,381 18,894
25/03/2020 2,343 21,168 2,390 21,284
26/03/2020 2,577 23,745 2,791 24,073
27/03/2020 2,834 26,579 3,217 27,344
28/03/2020 3,118 29,697 3,518 30,862
29/03/2020 3,430 33,127 3,105 33,966
30/03/2020 3,773 36,900 3,723 37,788
31/03/2020 4,150 41,050 4,535 42,309
01/04/2020 4,565 45,615    
02/04/2020 5,021 50,636    
03/04/2020 5,524 56,160    
04/04/2020 6,076 62,236    
05/04/2020 6,684 68,920    
06/04/2020 7,352 76,272    
07/04/2020 8,087 84,359    
08/04/2020 8,896 93,255    
09/04/2020 9,785 103,040    
10/04/2020 10,764 113,804    
11/04/2020 11,840 125,644    
12/04/2020 13,024 138,669    
13/04/2020 14,327 152,996    
14/04/2020 15,760 168,755    
15/04/2020 17,336 186,091    
16/04/2020 19,069 205,160    
17/04/2020 20,976 226,136    
18/04/2020 23,074 249,209    
19/04/2020 25,381 274,590    
20/04/2020 27,919 302,509    
21/04/2020 30,711 333,220    
22/04/2020 33,782 367,002    
23/04/2020 37,160 404,163    
24/04/2020 40,876 445,039    
25/04/2020 44,964 490,003    
26/04/2020 49,460 539,463    
27/04/2020 54,406 593,869    
28/04/2020 59,847 653,716    
29/04/2020 65,832 719,548    
30/04/2020 72,415 791,963    
01/05/2020 79,656 871,619    
02/05/2020 87,622 959,241    
03/05/2020 96,384 1,055,625    
04/05/2020 106,023 1,161,648    
05/05/2020 116,625 1,278,273    
06/05/2020 128,287 1,406,560    
07/05/2020 141,116 1,547,676    
08/05/2020 155,228 1,702,903    
09/05/2020 170,750 1,873,654    
10/05/2020 187,825 2,061,479    
11/05/2020 206,608 2,268,087    
12/05/2020 227,269 2,495,356    
13/05/2020 249,996 2,745,351    
14/05/2020 274,995 3,020,346    
15/05/2020 302,495 3,322,841    
16/05/2020 332,744 3,655,585    
17/05/2020 366,018 4,021,603    
18/05/2020 402,620 4,424,224    
19/05/2020 442,882 4,867,106    
20/05/2020 487,171 5,354,277    
21/05/2020 535,888 5,890,165    
22/05/2020 589,476 6,479,641    
23/05/2020 648,424 7,128,065    
24/05/2020 713,267 7,841,332    
25/05/2020 784,593 8,625,925    
26/05/2020 863,052 9,488,977    
27/05/2020 949,358 10,438,335    
28/05/2020 1,044,293 11,482,628    
29/05/2020 1,148,723 12,631,351    
30/05/2020 1,263,595 13,894,946    
31/05/2020 1,389,955 15,284,901