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 Total deaths
21/03/2020 1,600 13,000
22/03/2020 1,760 14,760
23/03/2020 1,936 16,696
24/03/2020 2,130 18,826
25/03/2020 2,343 21,168
26/03/2020 2,577 23,745
27/03/2020 2,834 26,579
28/03/2020 3,118 29,697
29/03/2020 3,430 33,127
30/03/2020 3,773 36,900
31/03/2020 4,150 41,050
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

Thursday, 19 March 2020

COVID-19 – What does the Bible say about epidemics? Some uncomfortable truths



There have been many excellent prayers spoken and sermons preached on the COVID-19 pandemic in the last few weeks.

They have emphasised such themes as the sovereignty of God, the frailty of man and the call for Christians not to fear but rather to be good citizens, voices of calm and agents of compassion in the crisis.

As the Bible tells us we need to keep things in an eternal perspective through these ‘light and momentary troubles’ (2 Corinthians 4:17) and remember that our true treasure is in heaven not on earth. (Matthew 6:19-21)

This is not easy to hear for those of us who are sitting in our self-isolation bunkers watching 20 years of savings disappearing in two weeks and wondering if the company which employs us will even exist in two months’ time.

It’s not just the physical threat of the virus but the fact that this is hitting a world which, even before this pandemic surfaced, was already mired in debt (global debt is now a record 322% of GDP) and had already used all its fiscal ammunition.

Most of us have never encountered an event causing such widespread social and financial devastation before.

This is why it is essential that as Christians we keep our cool and act as the agents of Christ in what we say and do.

After all, we know that God will never leave us or forsake us (Hebrews 13:5) and that nothing can separate us from the love of God that is in Christ Jesus our Lord (Romans 8:38, 39). To live is Christ and to die is gain, as the Apostle said. (Philippians 1:21)

But we also need to do some hard thinking about our global predicament – perhaps starting with asking what the Bible teaches about epidemics.

We know from science that epidemics are caused by infective agents (bacteria and viruses) that are passed from one person to another and from history that they are not uncommon occurrences.

Wikipedia documents hundreds that have occurred throughout history – resulting in hundreds to millions of death. This history of epidemics page illustrates this graphically. Epidemics are nothing new.

Just how deadly they are will depend on a variety of factors – the severity of the illness they cause, the infectiousness of the agent, the level of immunity in the population and the existence of vaccines and treatments.

Coronavirus is neither the worst nor the least we have encountered. But it is nonetheless very serious.

It causes an illness that requires hospitalisation in about 20% of people, of whom about a quarter will require ventilation. Its mortality cannot be known with certainly yet but is probably somewhere between 1 and 4%. 

It is moderately infectious (as easy as Ebola to catch) and there is no pre-existing immunity in the human population and as yet no vaccine. Nor is there any specific curative treatment – just symptomatic treatments like pain relief (if you can find any paracetamol in the shops) and supportive treatments like oxygen and ventilation/ECMO. It has a particular predilection for the old and infirm.

Thus far it has killed over 10,000 people worldwide, but the numbers are rising rapidly as we all know. 

However, it still ranks far below the worst epidemics in history listed below, all of which killed over one million people.


As you can see, the four worst epidemics in history in terms of lives lost were the Plague of Justinian, the Black Death, the Spanish Flu and the AIDS Epidemic, all of which claimed over 20 million lives. 

So we have quite some way to go yet.

So what does the Bible teach us about epidemics? And how should this shape our response as believers?

To understand this we need to look past viruses and bacteria to the spiritual realities that lie beyond.

We know that God is utterly sovereign over everything that happens in the universe. As the book of Daniel reminds us, Kings cannot rule, lions cannot bite and fire cannot burn without his permission.

God is sovereign over all things human, biological and physical and especially the rise and fall of nations (Daniel 2:21, 4:25, 5:21).

God was the author of the plagues of Egypt in Exodus 7-12 and is equally the author of the plagues described in the book of Revelation.

God is our Saviour but he is also our judge and his judgement is played out not just at the end of time but during the course of history.

Through the prophet Ezekiel God speaks of his ‘four dreadful judgements’ (14:21) – sword, famine, wild beasts and plague – which he sends both against Jerusalem (14:21) and ‘any country’ which sins against him (14:13).

Deuteronomy 28 lists the curses of disobedience which the Lord warns will strike Israel if she falls into apostasy and these include infectious diseases (28:21-22, 58-63).

The books of the Prophets in the Old Testament outline in great detail what will happen to each nation and empire in the course of history as a result of societal sin (yes nations, as well as individuals, will be judged) and in passages like Amos 4 God makes it very clear that he himself was the source of the famine, drought, blight, locusts and plague (4:10) which Israel had suffered. God is sovereign.

‘When disaster comes to a city has not the Lord caused it?’ (Amos 3:6)

When Solomon prays to the Lord in 2 Chronicles 6:12-42 asking him to deliver Israel from war, drought, famine and plague (28-31) God in his reply (7:13) makes it very clear that he himself is the author of these afflictions:

‘When I shut up the sky so that there is no rain, or command locusts to devour the land or send a plague among my people…’ (2 Chronicles 7:13)

Jesus makes it very clear that the time between his first and second comings will be characterised by war, earthquakes, famines and also ‘pestilences’ (Luke 21;10-11).

The fourth horse of the apocalypse and its rider, named Death and Hades, were given power ‘to kill by sword, famine and plague and by wild beasts of the earth’. (Revelation 6:8)

All four horses of the apocalypse and indeed all the plagues described in the book of Revelation are released by Jesus Christ himself. It is the Lamb of God himself, who opens the seven seals (Revelation 6:1), orders the blowing of the seven trumpets (8:1,2) and orders the pouring out of the seven bowls of God’s wrath (16:1).

Many Christians today prefer to blame human beings or Satan for these kinds of cosmic events – but whilst they are most definitely involved – it is God himself who is both author and judge. Satan has to ask God’s permission to afflict Job (Job 2:4-8) or to sift Peter (Luke 22:31) – he is like a dog on a leash.

So it should not surprise us when we look at the epidemics described in the Bible - those events which seem most likely to be caused by infective agents like viruses and bacteria – that it is God, or one of his angels, who invariably is named as the active agent.

I have listed below seven major plagues described in the Old Testament. You will observe that in each case God or the Angel of the Lord is described as the active agent. Furthermore, in five of the seven it is Israel which is the object of judgement. The Assyrians and Philistines fill the other two slots.



Furthermore, each plague constitutes retribution for some specific national sin – be it insubordination, sexual immorality, idolatry or something else.

So, how should we respond as Christians to the coronavirus?

We must pray of course for the Lord's wisdom: for faith to see God's plan through it all, for hope in our security in Christ Jesus, and for strength to be the body of Christ in ministering to those in need.

There are great opportunities to show compassion to those who are suffering and many churches are already leading the way in this.  

But if we fail to see that God is also sovereign over this event – that he has not only allowed it but also caused it and that this ‘plague’ is an act of judgement and a mark of our sin as nations – we will have badly misunderstood.

‘I am the Lord, and there is no other. I form light and create darkness, I make weal and create woe; I the Lord do all these things.’ (Isaiah 45:6,7)

Yes, God is our healer. He will bind us up. He is loving and compassionate. But he is also the ultimate author of human suffering because he is also our judge and uses it to wake us up from our spiritual slumber. As CS Lewis said:

‘We can ignore even pleasure. But pain insists upon being attended to. God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is his megaphone to rouse a deaf world.’

How are we deaf? It is interesting that this epidemic seems to be hurting rich Western countries the most. That, in general terms the oldest and most wealthy of us on the planet are currently being hit the hardest.

This virus threatens to outsmart us and overwhelm even our incomparably vast medical, financial and social resources. We are fighting it with all our wealth, ingenuity and scientific knowledge – and it is right to do so – but we are ultimately in God’s hands. It is he who by a subtle turn of the screw can choose to contain it or let it loose. We are putty, or dust, in his hands.

And so alongside all the good things we are doing and must do to contain, mitigate and turn back this virus, we need to ask what God might be saying to us as the wealthy and profligate post-Christian West – an end-stage culture which has turned its back on God and gone its own way.

It was Ezekiel who said of his own people many centuries ago:

‘Now this was the sin of your sister Sodom: She and her daughters were arrogant, overfed and unconcerned; they did not help the poor and needy. They were haughty and did detestable things before me. Therefore, I did away with them as you have seen.’ (Ezekiel 16:49,50)

These words could equally well describe the Western world today.

One of the most interesting of the plague accounts listed above is that surrounding the census, described in 2 Samuel 24 and 1 Chronicles 21.

King David takes a census of the fighting men of Israel contrary to God’s command. As a result, God sends an angel to bring a plague upon Israel. 70,000 people die throughout the length and breadth of the country – from Dan to Beersheba (2 Samuel 24:15).

But when the angel is about to destroy Jerusalem itself God calls a halt, and says ‘Enough! Withdraw your hand’. (24:16)

David sees the angel who is at that time at the threshing floor of Araunah the Jebusite and asks that God punishes him instead of the people (given that the census was his fault).

God’s response is to ask David to build an altar on the site, which he then purchases for 50 shekels, and sacrifices burnt offerings, fellowship offerings and prayers which leads God to call off the plague.

The place where these events happen is deeply significant.  We are told in 2 Chronicles 3:1-2 that the threshing floor of Araunah was on Mount Moriah – the place where God provided a ram substitute to Abraham for his son Isaac and where David’s son Solomon would later build the Temple. We know it as the Temple Mount today.

On Mount Moriah a ram dies in place of Isaac. On the threshing floor of Araunah animals are sacrificed in place of the people of Jerusalem. On the Temple Mount sheep and goats are later sacrificed in place of the people of Israel. Each substitutionary death averts the wrath of God.

All of these three events point forward prophetically to Jesus’ death on the cross for our sins, taking the punishment that we deserved.

The Lamb of God – Jesus Christ - becomes our Saviour dying in our place.

What will happen with the coronavirus epidemic is in God’s hands. We do not know at this point how many lives it will claim and if we will personally be included in that number.

But we need to remember that the Lamb who gave his life in order that we might stand before God with confidence on the day of judgement, is the same Lamb who pulls off the seals of judgement in the book of Revelation to unleash the four horsemen of the apocalypse.

We know that, regardless of how serious it is and how many people die, the coronavirus plague will eventually pass and become just another event in history. But are we reading the signs?

Sadly, in the context of Revelation most people on earth missed the signs. We are told that in the face of these warnings they failed to repent:

The rest of mankind who were not killed by these plagues still did not repent of the work of their hands; they did not stop worshiping demons, and idols of gold, silver, bronze, stone and wood—idols that cannot see or hear or walk. Nor did they repent of their murders, their magic arts, their sexual immorality or their thefts.’ (Revelation 9:20,21)

Murders, magic arts, sexual immorality and thefts. It is not difficult to see how these descriptions might apply today in our post-Christian West in the shadow of the sexual revolution and all its societal consequences.

Not only did they fail to repent but later, when things got worse, they like the Egyptians before them, ‘cursed the name of God, who had control over these plagues’. (Revelation 16:9)

Yes, we must do all we can humanly do to constrain and mitigate this epidemic (see my recent blog post on how fundamental proper virus testing is to this) but if we do this without reading this event as a warning from God we will have missed the point. We need to see it through the eyes of Scripture as well as through the eyes of science.

God’s words to Solomon were very clear:

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

That is what we need to do as a church and as a nation – humble ourselves, pray, seek the face of God and turn from our sins. We are living in an end-stage culture and this is only the beginning of what will befall us if we close our ears and eyes to the signs. It is not too late but we need to act now before it is.

In Matthew’s Gospel we are told, that Jesus began to preach with the words, ‘Repent for the Kingdom of heaven is near.’ It has never been nearer than now. It is time to repent.

Wednesday, 18 March 2020

'Test, test, test' is the key to coronavirus epidemic control - the clear lesson from East Asia

How many people will die in the UK as a result of the COVID-19 pandemic? According to the scientists it will be between 20,000 and 500,000 depending very much on how we respond.

A team at Imperial College has produced a paper which this week has prompted the government to embark upon a range of new measures to stop the spread of the disease.

If we do nothing and just let the virus pass through the population unhindered – in the hope of producing so-called ‘herd immunity’ - then 81% of people would be infected and 510,000 would die from coronavirus by August.

If we adopt a mitigation strategy - trying to slow its spread to prevent a massive peak in cases that would overwhelm the NHS many time overs – we can expect 250,000 deaths.

But a suppression approach – breaking the chains of transmission in order to stop the epidemic in its tracks – would reduce total deaths to thousands or tens of thousands.  

The government has now concluded that suppression is the only viable line of approach. Their chief scientific adviser Patrick Vallance told a committee of lawmakers this week that 20,000 deaths would then be ‘a good outcome in terms of where we would hope to get to with this outbreak’.

Why has China done so much better than us?

But this raises a huge question. If 20,000 deaths is a ‘good outcome’, and the best we can hope to achieve, then why have there been only 3,000 deaths in China where the outbreak actually started?

On a population basis (the UK has 67 million people and China 1,435 million) the UK equivalent deaths to that in China would be just 140 had we handled it as successfully as them. 20,000 is over 140 times this figure.

So, what have the Chinese done differently? And what, by implication, have we failed to do?

The control of the spread of coronavirus in China is remarkable but real. Today’s figures show a total of 80,000 cases but only 10-20 new cases a day. There are still also 10-20 deaths a day from the virus in China but these are almost all people who were infected weeks ago. Things have tailed off massively.

But China has also achieved this fall-off much more quickly than other countries. 80,000 cases in China amounts to 56 cases per million population which is a better measure of how badly the virus has affected any given country.

By contrast Italy, with 31,000 cases to date, has 521 cases per million, almost ten times the China figure.

In fact, today on 18 March (and these figures are obviously increasing daily) there are 32 countries or territories with a higher density of cases than China. Some of these are small population states like Luxembourg, Andorra and San Marino, but others include Spain, Germany, France, Switzerland, Netherlands, Norway, Austria, Belgium and Denmark.

The two anomalies are the US and UK – today with 20 and 29 cases per million population respectively – but we know from the number of deaths alone in these two countries that the true number of those infected is much higher than this. Vallance said yesterday that a ‘reasonable ballpark’ current figure for the UK was 55,000 cases, not the 1,900 actually reported.

The reason the US and UK total case figures are so low is because we are doing so few tests for the virus. I’ll come back to that.

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.

The diagram reproduced below from page 29 of the report (you can view it more easily here) shows the number of cases against time in China along with the major interventions made to try and slow the disease.



The outbreak was first announced on 30 December and the new coronavirus was isolated on 7 January and its gene sequence publicly shared on 10 January. The number of new cases per day peaked at around 3,000 just over two weeks later on 26 January but had fallen to fewer than 500 cases daily by 14 February.

A paper published on 16 March in Science shows that the virus first got away on the Chinese because they were unable to identify and isolate the very early cases.

They estimated that 86% of all infections were undocumented prior to the 23 January 2020 travel restrictions. The transmission rate of undocumented infections was only 55% of documented infections, presumably because those affected had less severe symptoms, yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the initial rapid geographic spread of the virus.

However, after the initial stage China got quickly on top of the outbreak through a vigorous programme of widespread testing followed by isolation of those affected, backed up by travel restrictions.

Testing for coronavirus in China and the UK

China has a policy of meticulous case and contact identification for COVID-19. For example, in Wuhan more than 1,800 teams of epidemiologists, with a minimum of 5 people/team, traced tens of thousands of contacts a day. Contact follow up was painstaking, with a high percentage of identified close contacts completing medical observation. Between 1% and 5% of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location.

But the effort outside of Wuhan was also huge. In Shenzhen, for example, the infected named 2,842 contact persons, all of whom were found, when testing was completed for 2,240 it was found that 2.8% of those had contracted the virus. 

Within weeks following the identification of the virus, a series of reliable and sensitive diagnostic tools were developed and deployed. By 23 February, there were ten kits for detection of COVID-19 approved in China by the NMPA and several other tests had been entered in the emergency approval procedure. Overall, producers have the capacity to produce and distribute as many as 1,650,000 tests/week.

In stark contrast, based on figures available on 13 March, the UK had carried out around 30,000 Covid-19 tests, at a median of 1,600 tests per day so far in March. 

The World Health Organization director-general, Tedros Adhanom Ghebreyesus, said this week that he had a simple message to countries on how to deal with the coronavirus outbreak sweeping the globe: ‘Test, test, test.’

Speaking during a news conference on Monday he urged countries to test more suspected cases, warning that they ‘cannot fight a fire blindfolded’. 

But fighting the fire blindfolded is essentially what the UK and US have been doing – simply because there are not enough testing kits. This was admitted by UK government adviser Professor Chris Whitty this week.

On 6 February, the World Health Organization said it had already shipped 250,000 tests to more than 70 laboratories around the world.

But as WHO shipped hundreds of thousands of tests, broader US testing struggled to begin. The US kits, developed by the CDC, were found not to be working as expected, which eventually required test kits to be re-manufactured. In fact, earlier this week it was reported that the US lags almost all developed countries in testing for the virus.

Whilst the abundance of testing kits in China meant that everyone with a fever or who had had contact with an infected person was tested, the shortage of testing kits in the UK has meant that tests are not even available for doctors on the frontline or for high-risk patients at risk. In fact, the only people being tested until very recently were those with severe symptoms admitted to hospital.

What this means is that those with less serious cases of COVID-19 have been able to roam free to spread disease, and frontline people (doctors and other health professionals), who are unwell but do not actually have the virus, are being unnecessarily quarantined for 14 days along with their families when they could be treating patients.

A pandemic out of control

It is now over two months since China initiated its control programme and countries seem now to be in two groups – those where the virus appears to be propagating largely out of control (mainly Western Europe) and those in East Asia where there has been success in getting on top of its spread.

The diagram (below) demonstrates this dramatically.

Cases (and deaths) in Europe and the US are spiraling out of control but in Singapore, Japan and Hong Kong – using more of a Chinese approach - the curve is considerably flattening over time.

Just today an article in Science attributed South Korea’s astounding success so far to the most expansive and well-organized testing program in the world, combined with extensive efforts to isolate infected people and trace and quarantine their contacts.

South Korea has tested more than 270,000 people, which amounts to more than 5,200 tests per million inhabitants. By contrast, the US has so far carried out 74 tests per 1 million inhabitants, data from the US Centers for Disease Control and Prevention show.

South Korea’s experience shows that ‘diagnostic capacity at scale is key to epidemic control,’ says Raina MacIntyre, an emerging infectious disease scholar at the University of New South Wales, Sydney.

Reports last week from Italy described doctors opting not even to assess high-risk patients, let alone tube and ventilate them, because they were simply overwhelmed by the numbers (see frightening twitter thread here and also Lancet paper from 13 March here). Spain is following closely but other countries including Germany, UK, Netherlands and Switzerland, are only a week or two behind.

It is a fundamental principle of medicine that there is no treatment without diagnosis. We need more testing kits rapidly deployed. It is incredible that even at this late stage we don’t really know who has the disease and who doesn’t.

There are already many types of testing kits available and capable of mass production (see also here). Can the UK government expedite the approval process as China so successfully did to bring them on stream?

Of course, all the other measures to prevent spread, which the UK has already implemented and with which we are well familiar, are absolutely necessary and right. And we need many more doctors, oxygen and ventilators to provide support for the rising tide of severe cases.

The figures for China are that 20% of all cases needed hospitalisation and oxygen often for weeks and 25% of these (5% overall) needed ventilation or ECMO. When we consider that the UK until recently only had 4,000 ventilators, 80% of which were already occupied, we can start to appreciate how serious this is.

But it is also clear that had we deployed more rigorous testing, contact tracing and isolation in the early stages of this pandemic we would not be in the position we are now.

We pride ourselves in the UK on both our standard of medicine and on the NHS. But we are lagging far behind those in China and other East Asian countries in our management of this crisis.

Whether it is too late to rectify this only time will tell. Will we end up in the UK with 20,000 deaths, 250,000 or 500,000?

What is clear is that many times more than 140 will die (the number of deaths the UK should have if equivalent to China on a population basis). That total will be passed in the next few days and advisors are predicting that new cases per day will not peak for another 10 to 14 weeks. The peak of the death rate will be two to three weeks after that.

It is clear that, as of this week, the UK government is now much better informed and pulling out all the stops to beat this challenge (helpful summary here). As we all work together we pray that these efforts will be successful and that the UK death toll is much closer to 20,000 than 500,000.