Covid Lectures Part 5: Old Age & Old Truths Revealed by Covid-19

Part 5: Old Age & Old Truths Revealed by Covid-19

In The Birth of the Clinic Foucault describes how hospitals in 18th century France had become such a hub of disease that people, especially the poor, came to see them as places of contagion where people went to die. Two hundred years later, exactly the same thing happened in Covid-struck countries around the world. In China, Italy, France, the UK, USA, Russia and many other countries it was doctors, nurses and hospitals that became the first great spreaders of Covid-19, catching it unawares from early patients who came in for treatment with flu-like symptoms. A big chunk of Covid-19 in Lombardy in Italy, New York in the USA and England in the UK was found to be from hospital infection (33, 45).

The Birth of the Clinic also describes how the phenomenon of hospital-acquired infections led to a discussion of “de-hospitalisation”. People began to advocate for patients to be treated in their homes. This was said to have the double benefit of keeping the patient in the more affectionate environment of his family, as well as preventing his illness from being complicated by hospital infections. Two hundred years later, Italian doctors from the Covid-struck hospitals of Northern Italy echoed these ideas: “a factory-like hospital is intuitively far from the ideal of personalized medicine, and such a system may prove incapable of providing specific, personalized contact with caregivers, a point that is often important for chronic patients” (24); “we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients…. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.” (23); “In Lombardy [Northern Italy] Sars-CoV-2 became largely a nosocomial [hospital acquired] infection…..The lessons relevant to other countries are the need to avoid bringing patients with suspected Sars-Cov-2 infection to the hospital, except when they clearly require hospital care” (25).

Countries like Japan and South Korea who were conscious of the tendency of hospitals to become hubs of disease in epidemics, built into their disease-response strategy the prevention of Covid-19-spread through hospitals. In Japan, to keep hospitals clear of infections, municipal authorities were asked to set up specialised consultation centres for testing. Experts early on expressed a concern that hospitals were at the risk of becoming contaminated from too many people with symptoms of cold coming in for testing. People were requested not to over-crowd hospitals and to quarantine and take treatment at home for the first few days if they developed cold or fever. They were advised to report for testing only after they had had symptoms for four days (62). In Japan there was also, unlike countries in the West, early recognition of the danger of spread of infection in old age facilities (63).

To keep hospitals clear of infection, the South Koreans made wide use of telemedicine and testing outside of the hospital setting, such as with drive-by tests. They set up digital apps for communicating tests results and prescriptions, and organising home-delivery of medicines (46). Though Japan and South Korea did have Covid-19 outbreaks in some of their hospitals, the overall size of the outbreak in these countries was smaller than in other places.

Fear of hospitals gripped the populace wherever it was hit by Covid-19. We did not attempt to understand the effect on the people of the policing role that healthcare workers and hospitals take on under a policy that emphasizes disease control over treatment of the sick.

As in 18th century France, the fear of hospitals gripped the populace wherever it was hit by Covid-19. The Chinese government had adopted a policy of putting everyone suspected of Covid-19 into hospital isolation. Covid-19 suspects in Wuhan were “cohorted” in isolation wards with others where infection might have spread (13,64). Videos surfaced on social media of people in China being dragged, kicking and screaming, to forced hospital isolation (65).

There were stories of Covid-19 patients running away from hospitals in Russia and Iran; and screaming to be let go of when being admitted to hospitals in New York. Quarantine centres in India came to be feared equally for their squalid conditions, as for the risk of infection.

If we had not been so fixated on epidemiologists’ reports, a historical survey of epidemics past could have helped us to anticipate the vulnerabilities of hospitals during epidemics. We would not have had to go so far back as 18th century France to learn about this. A deep fear and resentment of hospitals and quarantine centres have been a running theme in each and every one of the five Ebola outbreaks in West Africa since the mid-1970s. The WHO is so disliked there, that it has had to advise its workers not to wear its logo when doing community outreach (66).

But we did not even think to look at the material on hand about epidemics. We did not attempt to understand the effect on the people of the policing role that healthcare workers and hospitals take on under a policy that emphasizes disease control over treatment of the sick. Instead, led by the dehumanized, decontextualized, de-historicized containment approach of the WHO, we terrorized and alienated people, we used force on them, and exposed them to infection in the name of “protecting” them from it.

There is no escaping the chaos of the epidemic.

Awareness of hospital infections would not in of itself have protected from its happening. As we saw, even countries that had anticipated it and took prevention measures, had hospital outbreaks. There is no escaping the chaos of the epidemic.

Even de-hospitalisation creates problems. In Japan, the focus on keeping people away from hospitals left them feeling vulnerable and neglected. The specialised testing centres had waiting queues and the system was criticised for missing people with Covid-19 pneumonia who needed urgent help. This brings us back to what I said earlier about there being no neat solutions in an epidemic.

5.2 Covid-19 Exposed the Truth about Growing Old in Wealthy Countries

Another problem with de-hospitalisation is that in developed countries there may be no home and no family to de-hospitalise into. In Sweden, 40% of households are single-person without children (67). Where is the family that 18th century French doctors spoke of to care for the ill, as described in The Birth of the Clinic? Can you send a sick person to his house alone? What about the fact that so many of the elderly in developed countries are not living with their families, but in care homes?

In a telling passage in one of its reports, the Covid Experts Group writes: “The average size of households that have a resident over the age of 65 years is substantially higher in countries with lower income compared with middle- and high-income countries….Contact patterns between age-groups also differ by country; in high-income settings contact patterns tend to decline steeply with age. This effect is more moderate in middle-income settings and disappears in low-income settings…indicating that elderly individuals in these settings [lower-income and middle-income countries] maintain higher contact rates with a wide range of age-groups compared to elderly individuals in high-income countries” (7).

We should have paid attention, not just to the entry of contagion, but also to dispersing it once it took root, instead of, as in the case of old age homes, actually assisting the further spread of disease by locking residents in place, rather than allowing them to leave, where feasible.

The Covid Experts Group uses this to argue, in its usual jaundiced way, that this makes the elderly less vulnerable to infection in high income settings. They were completely wrong, as they failed to account for the increased exposure of the elderly to infection in the communal setting of the care home. This reveals one of the mistakes of only thinking in terms of “flattening the curve” by locking down to stop the entry of the virus. The virus inexorably found its way to wherever people were to be found. There was a recklessness in thinking, knowing what we did from the start about the highly contagious nature of Sars-Cov-2, that suppression would work. We should have paid attention, not just to the entry of contagion, but also to dispersing it once it took root, instead of, as in the case of old age homes, actually assisting the further spread of disease by locking residents in place, rather than allowing them to leave, where possible.

The risk of infection from communal living arrangements in old age and nursing homes was exacerbated by the fact that owing to the “flatten the curve” focus on hospitals, the risk of the spread of infection in these facilities was overlooked. Care home staff were not a priority for the allocation of personal protective equipment (PPE). With the culture of lockdown taking hold everywhere, the sole Covid-19 response of many old age homes was to stop families from visiting their residents, leaving them ever more alone and unspoken for. In many states in the USA, a further layer of risk was added by nursing homes being requisitioned to house convalescing Covid-19 patients, who might have still been infectious. New York’s Governor Andrew Cuomo and other state governors have come under attack for sending elderly Covid-19 patients to nursing homes from hospitals for recovery (69).

De-hospitalisation can only work in a society that has multigenerational homes, where caring for the sick and elderly is woven into the fabric of family life, and not considered purely a matter of care homes, and hospital beds and machines. Western epidemiologists were right to the extent that they were operating on the very real premise for them, that in their societies the ailing often have nothing but machines and beds to serve them. But these are not conditions that apply in developing countries, at least not in Asia and Africa. This is something that the WHO as a world health organisation ought to have appreciated before sentencing us all to lockdown. News reports of old people found dead in their beds by the army in Spain, of old people in the UK found starving alone at home under lockdown, of no one coming to claim the bodies of the Covid-19 dead in New York, give us hints of something much wider and longer-standing than the outbreak of Covid-19 being at play.


The description of old age in high income countries by the Covid Experts Group, wrong as their inferences were, is very revealing of the isolation and lack of options for being nursed in the family home for those living in rich countries. De-hospitalisation can only work in a society that has multigenerational homes, where caring for the sick and elderly is woven into the fabric of family life, and not considered purely a matter of care homes, and hospital beds and machines. Western epidemiologists were right to the extent that they were operating on the very real premise for them, that in their societies the ailing often have nothing but machines and beds to serve them. But these are not conditions that apply in developing countries, at least not in Asia and Africa. This is something that the WHO as a world health organisation ought to have appreciated before sentencing us all to lockdown.

News reports of old people found dead in their beds by the army in Spain, of old people in the UK found starving alone at home under lockdown, of no one coming to claim the bodies of the Covid-19 dead in New York, whose burial in marked mass graves was relayed across the world by the international news media, give us hints of something much wider and of longer-standing than the outbreak of Covid-19 being at play (68). How alone must these people have been, and for how long? They did not simply happen to die alone in the midst of a lockdown; they were already alone when they fell ill; they already had no one to call them when they took to their beds. These deaths were not just an accident of the Covid-19 epidemic. They tell us something about the anomie life in advanced societies, and of the price they pay individualistic values.

The loneliness of life in Sweden with 40% of households comprising just one person, casts its much remarked upon “no lockdown” policy in a new light. Isolation is so woven into the fabric of life there, that it did not need official imposition.

The loneliness of life in Sweden with 40% of households comprising just one person, casts its much remarked upon “no lockdown” policy in a new light. Isolation is so woven into the fabric of life there, that it did not need official imposition. At least the Swedes showed a greater self-awareness than other Western countries, by intervening to mediate this isolation by facilitating a limited social life, even under the spreading Covid-19 disease. We, in the developing world, also need a lesson in awareness. We need to be more aware of the differences between life here and in the West, before adopting Western models for our societies.

Part of the problem with Covid-19 spreading amongst the elderly in developed countries arose, in a sad irony, from the better health standards in these places. These societies have greater longevity and widely available sophisticated operations for advanced cancers and other non-communicable diseases. This means that a lot of older people can get life-saving medical interventions, like tracheostomies. But these complex operations also leave them in need of special care for the remainder of their lives. Some of these people have to be kept in nursing homes, with advanced medical equipment and trained staff.

In the end, Covid-19 ravaged old age homes in Europe and the Northern America. In Canada, this has been the disease of the old age homes, with an estimated 85% of Covid-19 deaths by late June having been of residents of long-term care, retirement homes and assisted living facilities. By mid-May in France, Ireland, Belgium, the United Kingdom, Spain and the USA, over half the deaths were said to be of care home residents, who died either in care homes, or in hospitals and nursing homes. These figures had changed somewhat by early July to 49% in France, 63% in Ireland, 64% Belgium, 41% in England and Wales, 52% in Northern Ireland, 44% in Scotland, 34% (confirmed) to 68% (confirmed + probable from Covid-19) in Spain and 45% in the USA. In the USA, in some states, the proportion of deaths from nursing homes and long term care facilities reported by mid-May was even higher – 81% in Minnesota, 78% in Rhode Island, 77% in New Hampshire, 70% in Connecticut and 60% and over in Massachusetts, Delaware and Kentucky, among others. By late-May, New York, which was among the early hotspots in the USA, was showing 20% deaths from this category, but it was probably much higher earlier in the epidemic. It was 51% in neighbouring New Jersey by late-May. Even in countries with relatively lower Covid-19 deaths in Europe, such as Germany, Sweden and Norway, old age home deaths were a high proportion of the total. By the third week of June, 39% of the Covid-19  deaths in Germany were reported in communal settings, including prisons and nursing homes; in Sweden nearly 47 % Covid-19 deaths were of care home residents; and in Norway 59% of Covid-19 deaths were of residents of care homes and other institutions (70).

We should not let these rich countries off the hook by allowing them to point to age and “comorbidities” as excusing the deaths of the elderly from Covid-19.

We should not let these rich countries off the hook by allowing them to point to age and “comorbidities” as excusing the deaths of the elderly from Covid-19. Firstly, the fact that the vulnerability of care homes was not anticipated, points to a high degree of neglect of these homes. In Sweden, while all the attention was on what competing epidemiologists were saying and whether the limited public and school activity permitted there was right or wrong, it was the elderly in care who were dying, overwhelmingly, by the largest numbers. There were some very worrying reports in the press of the elderly being ignored, or even being denied oxygen and other treatment in Sweden (174). Even prisons received more attention on this point, with prisoners in Norway and the USA, among other places, being released in order to reduce crowding and the risk of infection.

“Co-morbidities” sounds less like an authentic clinical description, and more like the finessing of a lawyer or insurance company.

Secondly, the whole idea of “comorbidities” has to be vigorously interrogated. You see this expression in all the medical literature on Covid-19, starting with Chinese journal publications. But what are these so-called co-morbidities? Cardiovascular disease, diabetes and high blood pressure are really just concomitants of increasing age. They are not comorbidities in any useful sense, because almost any person above the age of 50 starts developing some degree of these. Those in their 70s and 80s would generally have some degree of all three conditions. “Co-morbidities” sounds less like an authentic clinical description, and more like the finessing of a lawyer or insurance company to make excuses for lost patients, and in all likelihood has its origins as a concept from there. All these questions should be actively pursued, now that it seems that the age of infectious disease is back upon us.

5.3 The Horror of Hospital Isolation

One of the most alarming stories to emerge over Covid-19 was the mandatory isolation of hospitalised patients from their family. We read in horror, reports of the elderly in Italy dying absolutely alone in claustrophobic plastic-encased hospital chambers (71). Once the epidemic reached India, the families of the dead began to report of the neglect and utter isolation of their relatives in the country’s designated Covid-19 hospitals. Families who had mobile phones tried to stay in touch with their hospitalized relatives in that way. One family had to call the nursing station for hours before their son was given a glass of water; he died alone a few days later (72).

The idea of hospital isolation completely misses the fact that the family attendant is a key link in the chain of modern hospital care. In 21st century hospitals, the “medical gaze” is split between family attendant, machine, nurse and doctor. Like a cockroach’s vision, the complete picture is formed only by the coming together of the separate fragments recorded by each part of the composite eye. Take away any part, and the picture has a blind spot. The presence of the family attendant, therefore, is not merely a sentimental matter for patient and family.

The idea of hospital isolation completely misses the fact that the family attendant is a key link in the chain of modern hospital care. At the time of which Foucault wrote, the direct observation of the patient was the centrepiece of the physician’s work. This was the starting point for Foucault’s discussion of the so-called “medical gaze”. But in the modern hospital, without a family attendant, the only “gaze” a patient is under is that of his monitoring machines. Nurses look-in every so many hours, and doctors do the rounds, not more frequently than once-a-day, stopping at each patient for not more than a few minutes.

In 21st century hospitals, the “medical gaze” is split between family attendant, machine, nurse and doctor. Like a cockroach’s vision, the complete picture is formed only by the coming together of the separate fragments recorded by each part of the composite eye. Take away any part, and the picture has a blind spot. The presence of the family attendant, therefore, is not merely a sentimental matter for patient and family. For those immobilized by sickness, it is the family attendant who does the nursing and acts as the patient’s eyes, ears and limbs for everything from visiting the toilet, to discussing treatment with the doctors. Without this key mediation, the patient is only incompletely attended and spoken for. This places the patient, especially a critically ill one, at grave risk, even with the best of efforts of the hospital, doctors and nurses.

We should have been aware of this, and accounted for it in designing the scheme of treatment for hospitalized Covid-19 patients. No doubt, there are practical difficulties with allowing family attendants into Covid-19 wards. There is the question of limited PPE kits, and preventing family attendants from spreading infection in the community. But their place in the scheme of hospital care was not even recognized in the panicked and mindless response to the Covid-19 pandemic.

Mike Ryan of the WHO showed himself to be a great fan of hospital isolation, infamously saying that since, with lockdown, transmission had been taken off the streets and pushed into families “now we need to go and look in families to find those people who may be sick and remove them and isolate them in a safe and dignified manner”. How can the WHO as health body be so insensitive to the impact of such statements and policies on people?

All these are things that the WHO, in its role as the world’s overseer of medical practice, should have been aware of, and highlighted. But Mike Ryan of the WHO showed himself to be a great fan of hospital isolation, even going so far as to say that the reason the European outbreaks were larger than the Chinese ones, was that in Wuhan, containment was not confined to lockdown or physical distancing, and that along with lockdown the Chinese authorities “continued to detect cases and isolate all cases including mild cases away from the family”. Mike Ryan then made his now infamous observation that since, with lockdown, transmission had been taken off the streets and pushed into families “now we need to go and look in families to find those people who may be sick and remove them and isolate them in a safe and dignified manner” (19).

Clearly, WHO officials, like epidemiologists, think only of numbers and not of people. The question is: how can the WHO as health body be so insensitive to the impact of such statements and policies on people? How could it have endorsed the incarceration and endangerment of people by forcibly concentrating them in hospital as was done by the Chinese government? Does the WHO remember the last time that concentration was used as a state policy?

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5.4 Traditional Medicine: Eastern Pride & Western Prejudice

One of the many useful perspectives that Foucault gives us about changes in medical science in The Birth of the Clinic is the way in which choices are made over time among competing perspectives of the body and disease. He gives the example of the emergence of tissue-analysis in diagnosing illness, as a change from the clinical method of observing the symptoms and inquiring about the history of the illness from the patient. This was a shift in attention to the tissues, i.e., to an inquiry of what lies below the surface of the body, from what can be seen on the surface of the body, i.e., the symptoms. 

Foucault says that medical historians were wrong to attribute this shift in focus to the freeing of taboos on autopsies which then allowed the medical gaze to finally penetrate below the surface of the body. He says that autopsies were common before tissue-analysis became popular and that some practitioners had even published work that was based on autopsy-studies of the inner organs of the body.

Foucault says that this work remained in the background owing to pitched arguments taking place around the time of the French Revolution in the medical field regarding the abolition of hospitals. Hospitals had become so unpopular as a hub of disease where it was felt that the poor went only to die, that the cry that went up was “No more alms! No more hospitals!”. It was argued that if the Revolution were true to its principles of egalitarianism then there would be no disease, and hence no need for hospitals. There was also a demand to liberalise medical practice by doing away with licensing and allowing anyone who so wished to practice medicine. It was said that licensing was merely a way of preserving the privileges of the medical guilds.

Moves to abolish hospitals and licensing, however, led to a proliferation of quacks and masses of people being left with nowhere to go for treatment. As a compromise, the idea of the clinic was evolved, from which, incidentally, the book gets its title. It was said that in the clinic, doctors and medical students would be immersed in the actual observation and treatment of the sick, and be trained by the direct study of disease among the people and, not, as earlier, in the study of esoteric medical theory which had served merely to keep the privileges of medical practice to the few. In this way, it was argued, the clinic would be true to the principles of the Revolution.

So the return of the hospital was, according to Foucault, deeply caught up in being justified in terms of the observation of the sick, and in training the eye to observe knowingly. For this reason, Foucault argues, for a long time, medicine remained focused on the signs and symptoms of disease, i.e., on the surface of the body.

He says that it was a while before the practice of clinical observation led to thinking about what might be going on inside the body. Over time, clinics began to conduct autopsies to confirm their diagnosis when a patient died and this led to more and more study backwards from autopsied bodies about the origins and progress of disease. Interestingly, the medical gaze, having penetrated the body and fixed upon organs, and then the tissues for analysis, moved back to the surface of the body and beyond as the conversation moved on to whether lesions in tissues were the result of disease or the manifestation of it; and the observation of generalized symptoms such as fevers, which are not organ-specific, and brought doctors back to thinking in a less localized way about disease.

What this survey of the changing medical gaze tells us, is that the medical field witnesses the abandonment of forms of treatment; or categories of disease; or ways of understanding the body, not because they were wrong, but simply because another perspective of the body or disease comes to the fore. And this change of attention to new treatments or perspectives occurs for external reasons (political, cultural, even coincidental) that do not exist within the logic of medical science, without making them any less valid as science. This understanding of progress in medical science as not so much an inexorable advance onwards and upwards to wider and better levels of knowledge, but of a movement back and forth, and laterally, between different ways of looking at the body and disease, is something that is especially relevant today. Covid-19 has brought us to the limits of the current state of science and medical practice, and so we need to see if there are other systems of medicine that can come to our aid.

This understanding of progress in medical science as not so much an inexorable advance onwards and upwards to wider and better levels of knowledge, but of a movement back and forth, and laterally, between different ways of looking at the body and disease, is something that is especially relevant today. Covid-19 has brought us to the limits of the current state of science and medical practice, and so we need to see if there are other systems of medicine that can come to our aid.

Before allopathic medicine as we know it today, there were other systems of treatment, and other ways of categorizing the organs and functions of the body. In traditional medicine in South Asia and China, for instance, there is the idea of heat and cold. Some diseases create too much heat in the body, while others too much coolness. Treatments are given that will increase or decrease the heat, as needed. These treatments take the form of herbs, minerals, exposure to different airs, more or less sunlight and the prescription of special dietary regimens. Ancient systems like Ayurveda and Chinese traditional medicine are no less systematic than the nosologies of 18th century France, or any modern Encyclopaedia of Medicine. In the West, there was the idea of the “humours” of the body whose disturbed balanced had to be restored by treatment. A more modern non-allopathic system is homeopathy (only relatively speaking, as homeopathy is 200 years old). Though this developed in Germany, it is wildly popular in India, and I suspect in other parts of South Asia. I am among the millions of Indians who rushed to their homeopaths for Covid-19 preventive medicines, as soon as the first face masks began to be worn. Some state governments here have been prescribing it for Covid-19 prevention.

The medical profession almost universally scoffs at traditional remedies and mutters about clinical trials at their mention. But, as we have seen, the medical establishment is itself working with drugs that have not passed the gold standard of the clinical trial.

The medical profession almost universally scoffs at traditional remedies and mutters about clinical trials at their mention. But, as we have seen, the medical establishment is itself working with drugs that have not passed the gold standard of the clinical trial. We are at a moment where the medical establishment has to climb down from its high horse over traditional remedies and natural medicine. Clinical trial or not, natural remedies have been tried and tested over thousands of years, and found to be effective for a host of ailments. Surely, even for the most obstinately statistically-minded, 1000 years of unbroken and unforced use is at least something like a randomized placebo trial. For those who need the imprimatur of modern science, from time to time you see scientific research confirming the therapeutic qualities of products commonly used in traditional medicine, like turmeric. These are things that anyone in developing countries, rich or poor, educated or not, has known about and used for generations. Scientifically identifying the therapeutic qualities of traditional medicine merely confirms what has been seen and known for millennia. This is not an act of scientific discovery, but of trying to fit what is already well-known into the narrative of science.  

Surely, even for the most obstinately statistically-minded, 1000 years of unbroken and unforced use is at least something like a randomized placebo trial.

Admittedly, there is nothing in natural medicine to beat the power of allopathic drugs. But for Covid-19 these drugs are yet to be found. It is also worth bearing in mind, that the subordination of traditional medicine to allopathic medicine has at least something to do with the fact that properly used, traditional medicine requires all manner of dietary and physical discipline, which people are glad to avoid if they can just pop a pill instead. So the decline of natural medicine is not entirely due to the surer and quicker results of allopathic medicines.

In Covid times, we have to remind ourselves of the link between natural and allopathic medicine. A link that has never been entirely broken.

Moreover, in Covid times when medicines have failed to do their usual magic, we have to remind ourselves of the link between natural and allopathic medicine. A link that has never been entirely broken. The therapeutic agent in many chemical drugs can be traced back to natural sources, and their discovery to their popular use in traditional medicine. One such example is quinine, used to treat malaria. It was developed from the bark of the cinchona tree that grows in South America and Western Africa, where European colonials found the natives using it as medicine. Everyone knows the story of how the gin-and-tonic was invented by British colonials in India who added gin to their daily dose of quinine tonic, to make it more palatable. Asprin was developed after studying the leaves of the willow tree, which had been used in Europe for thousands of years for fever and inflammation.

Quinine looms large over the medical landscape right down to the present Covid times. Chloroquine and hydroxychloroquine are synthetic forms of quinine. Another traditional herbal remedy is artemisia from plants found in the Far East and in Africa. Artemisinin is a synthetic form of artemisia, which is the current WHO-recommended malaria drug, that replaced quinine and chloroquine (149).

In their raw form, natural medicines can produce harsh side effects, so the work of science has been to find chemicals to mimic their therapeutic quality, while reducing the side effects. But the natural remedy is nevertheless the starting point for the search for the drug and remains at the core of the drug as treatment. This is not even in dispute in scientific research. There are volumes of scientific papers on the natural origins of drugs.

In this way we can see medicine as a system that emerges out of the general body of knowledge that we humans develop as a society. This is something that has been discussed for centuries in the medical field. Drawing from leading thinkers in the medical field in late 18th century France, Foucault sums up this proposition in The Birth of the Clinic in this way: “At the dawn of mankind, prior to …every system, medicine in its entirety consisted of an immediate relationship between sickness and that which alleviated it. This relationship was one of instinct and sensibility….multiplied by itself, transmitted from one to another, it becomes a general form of consciousness…. ‘Everyone, without distinction, practiced this medicine….each person’s experiences were communicated to others….and this knowledge passed from father to children’ ”.

Foucault is somewhat sceptical of the use of this argument to explain the clinical observation-based method as an egalitarian system that took medicine back to its true original form, but this need not concern us here. These strands of medical thought that point to the ancestry of medical thinking in traditional remedies need to be revisited in the present times when allopathic medicine is admittedly at a loss with Covid-19.

The Chinese were unabashed about using traditional Chinese medicine during their Covid-19 epidemic. But instead of encouraging countries to apply their knowledge of traditional medicine in the search for cures for Covid-19, the WHO discouraged the idea of traditional remedies.

The Chinese were unabashed about using traditional Chinese medicine during their Covid-19 epidemic. They reported the “widespread” use of Chinese Traditional Medicine among other treatments in the WHO-China Joint Mission Report. They opened hospital centres in Wuhan where people were treated with traditional herbal brews and the world famous traditional Chinese therapies of acupressure and acupuncture. But instead of encouraging countries to apply their knowledge of traditional medicine in the search for cures for Covid-19, the WHO discouraged the idea of traditional remedies (144). The WHO even issued a statement against the use of herbal remedies from the artemisia plant when the Madagascans claimed to have found a therapy based on it which they called “Covid Organics” (145).

The energetic Madagascan President, Andry Rajoelina, went on French radio to denounce the WHO for rejecting Covid Organics out of hand, saying that the West could not accept that a poor country like his might have found a treatment for Covid-19.

Regardless of WHO’s arrogant dismissal of Covid Organics, African countries queued up to purchase Covid Organics, and researchers from all over Europe initiated collaboration with the Madagascans to trials it (147). The energetic Madagascan President, Andry Rajoelina, went on French radio to denounce the WHO for rejecting Covid Organics out of hand, saying that the West could not accept that a poor country like his might have found a treatment for Covid-19 (148). With all this pressure, the WHO was forced to agree to co-operate with the Madagascans to start trialling Covid Organics (146). 

The WHO has a history of resisting natural therapies, which is unfair and unhelpful in of itself. If its concern is poor countries, then natural remedies are a relatively inexpensive and widely accessible form of medicine. But the resistance to Covid Organics, which is based on naturally-found artemisia, is particularly surprising given that the WHO itself recommends artemisinin, the synthetic form of this same compound, for other treatments. Why could not the WHO have looked at the Madagascan claims about Covid Organics as a form of repurposing of drugs that is routine and permitted in the field of pharmacy? Why the dogmatic refusal to consider anything that does not come in the form of a synthetic drug? And is this merely dogma, or does the explanation for this resistance lie in competition from pharmaceutical companies who manufacture artemisinin?

The WHO fails and fails again as the world’s leading health authority to demonstrate the imagination and boldness required to, first, admit the defeat of medical practice in its current state against Covid 19, and, then, more importantly, to look for new ideas and lines of research that might lead us to therapies for this disease. All countries with a history of traditional medicine should look into its use for Covid-19.

....To be continued

Suranya Aiyar is trained in mathematics at St. Stephen’s College, India and law at Oxford University, UK and New York University, USA. She lives in New Delhi, India, with her husband and two children.

This was presented live on Facebook on July 17th, 2020. Watch the video here. Listen to the podcast here.

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Read the full paper here.

NOTES AND REFERENCES

a. 1 lakh = 100,000; 1 crore = 10 million

(1) Report 1: Estimating the potential total number of novel Coronavirus (2019 n-CoV) cases in Wuhan City, China, COVID -19 Response Team, 17 January 2020. Link: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-1-case-estimates-of-covid-19/

(2) Report 2: Estimating the potential total number of novel Coronavirus cases in Wuhan City, China, COVD -19 Response Team,  22 January 2020. Link: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-2-update-case-estimates-covid-19/

(3) Report 3: Transmissibility of 2019-nCoV, COVID -19 Response Team, 25 January 2020. Link: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-3-transmissibility-of-covid-19/

(3A) Report 5: Phylogenetic analysis of Sars-CoV-2, COVID -19 Response Team, 15 February 2020. Link: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-5-phylogenetics-of-sars-cov-2/

(4) Report 7: Estimating infection prevalence in Wuhan City from repatriation flights, COVID -19 Response Team, 9 March 2020. Link: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-7-repatriation-flights-covid-19/

(5) Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand, COVID -19 Response Team, 16 March 2020. Link: https://www.imperial.ac.uk/mr-global-infectious-disease-analysis/covid-19/report-9-impact-of-npis-on-covid-19/

(6) Report 11: Evidence of initial success for China exiting COVID-19 social distancing policy after achieving containment, COVID -19 Response Team, 24 March 2020. Link: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-11-china-exiting-social-distancing/

(7) Report 12: The Global Impact of COVID-19 and Strategies for Mitigation and Suppression, COVID -19 Response Team, 26 March 2020. Link: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-12-global-impact-covid-19/

(8) Report 13: Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in 11 European countries, COVID -19 Response Team, 30 March 2020. Link: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-13-europe-npi-impact/

 (9) Estimates of the severity of coronavirus disease 2019: a model-based analysis, Verity et al., Lancet Infect. Dis. 2020, published online on 30 March 2020, pre-review published 9 March 2020 on www.medrxiv.org). Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext

(10) Factors that make an infectious disease outbreak controllable, Frazer et al., PNAS, Vol. 101, No. 16, pp. 6146-51, 20 April 2004. Link: https://www.pnas.org/content/101/16/6146

(11) Strategies for mitigating an influenza pandemic, Ferguson et al., Nature, Vol 442, pg. 448, 27 July 2006. Link: https://www.nature.com/articles/nature04795

(12) Modeling targeted layered containment of an influenza pandemic in the United States, Halloran et al., PNAS, Vol 105, No. 12, pg. 4639, 25 March 2008. Link: https://www.pnas.org/content/105/12/4639.short

(13) Report of the WHO-China Joint Mission on Coronavirus Disease 2019 published on 28 February 2020. Link: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

(14) International Health Regulations Emergency Committee on novel coronavirus on China, WHO Press Briefing, 23 January 2020. Link: https://www.who.int/docs/default-source/coronaviruse/transcripts/ihr-emergency-committee-for-pneumonia-due-to-the-novel-coronavirus-2019-ncov-press-briefing-transcript-23012020.pdf?sfvrsn=c1fd337e_2

(15) Novel coronavirus press conference at United Nations of Geneva, WHO Press Briefing, 29 January 2020. Link: https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-script-ncov-rresser-unog-29jan2020.pdf?sfvrsn=a7158807_4

(16) WHO Emergencies Coronavirus Emergency Committee Second Meeting, WHO Press Briefing, 30 January 2020. Link: https://www.who.int/docs/default-source/coronaviruse/transcripts/ihr-emergency-committee-for-pneumonia-due-to-the-novel-coronavirus-2019-ncov-press-briefing-transcript-30012020.pdf?sfvrsn=c9463ac1_2

(17) WHO Emergencies Coronavirus Press Conference, 9 March 2020. Link: https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-09mar2020-(1).pdf?sfvrsn=d2684d61_2

(18) Virtual press conference on COVID-19, WHO, 11 March 2020. Link: https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-and-final-11mar2020.pdf?sfvrsn=cb432bb3_2

(18A) WHO Press Conference 16 March 2020. Link: https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-16mar2020.pdf?sfvrsn=7c0c37bf_2

(19) COVID-19 - virtual press conference, WHO, 30 March 2020. Link: https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-30mar2020.pdf?sfvrsn=6b68bc4a_2

(20) Nonpharmaceutical Interventions for Pandemic Influenza, International Measures, World Health Organisation Writing Group, Centres for Disease Control and Prevention Vol 12 Number 1, January 2006. Link: https://wwwnc.cdc.gov/eid/article/12/1/05-1370_article.

(21) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Zhou et al., The Lancet, Vol 395, 1054, 28 March 2020, first published on 9 March 2020. Link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext.

(22) Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-infected Pneumonia in Wuhan, China, Wang et al., JAMA 2020; 323 (11): 1061-1069, 7 February 2020. Link: https://jamanetwork.com/journals/jama/fullarticle/2761044.

(23) At the Epicentre of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation, Nacoti et al., NEJM Catalyst, 21 March 2020. Link: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0080.

(24) Hospitals as health factories and the coronavirus epidemic, Giorgina Barbara Piccoli, Journal of Nephrology (2020) 33: 189-191, 21 March 2020. Link: https://paperity.org/p/237906528/hospitals-as-health-factories-and-the-coronavirus-epidemic

(25) What Other Countries can learn from Italy during the COVID-19 Pandemic, Boccia et al., JAMA Intern. Med., 7 April 2020. Link: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2764369

(26) In fight against Covid, Dharavi grapples with sanitation, health, poverty, Kavitha Iyer, Indian Express, 31 May 2020. Link: https://indianexpress.com/article/cities/mumbai/dharavi-slum-coronavirus-covid-19-cases-6434996/

(27) Police use sjamboks and rubber bullets to enforce Hillbrow lockdown, Micah Reddy & Simon Allison, Mail & Guardian, 31 March 2020. Link: https://mg.co.za/article/2020-03-31-police-use-sjamboks-and-rubber-bullets-to-enforce-hillbrow-lockdown/

(28) Police kill three people in three days of lockdown. This is normal for South Africa, GroundUp, 1 April 2020. Link: https://www.groundup.org.za/article/police-kill-three-people-three-days-lockdown-normal-south-africa-data-reveals/

(29) Ebola – Myths, Realities and Structural Violence, Annie Wilkinson and Melissa Leach, African Affairs, pp.1-13, 4 December 2014. Link: http://www.ebola-anthropology.net/wp-content/uploads/2014/12/Briefing-Ebola-Myths-Realites-and-Structural-Violence.pdf

(30) Barriers to supportive care during the Ebola virus disease outbreak in West Africa: Results of a qualitative study, Loignon et al., PLOS ONE, 5 September 2018. Link: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201091

(31) Plague Warriors: The Deadly Ebola Outbreak in Zaire, Laurie Garret, Vanity Fair 1 August 1995. Link: https://archive.vanityfair.com/article/1995/8/plague-warriors.

(32) Ebola and Learning Lessons from Moral Failures: Who cares about Ethics? Maxwell J. Smith and Ross E.G. Upshur, Public Health Ethics, Vol 8, No. 3, 305, 17 October 2015. Link: https://academic.oup.com/phe/article/8/3/305/2362913

(33) Doctor’s death from coronavirus sparks a digital uprising, rattling China’s leaders, Washington Post, 7 February 2020. Link:  https://www.washingtonpost.com/world/asia_pacific/doctors-death-from-coronavirus-sparks-a-digital-uprising-rattling-chinas-leaders/2020/02/07/a4cb3492-4998-11ea-8a1f-de1597be6cbc_story.html; Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19), Wang et al., Journal of Hospital Infection, March 2020. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134479/

(34) 80% of New York’s coronavirus patients who are put on ventilators ultimately die, and some doctors are trying to stop using them, Business Insider, Sinead Baker, 9 April 2020. Link: https://www.businessinsider.in/science/news/80-of-new-yorks-coronavirus-patients-who-are-put-on-ventilators-ultimately-die-and-some-doctors-are-trying-to-stop-using-them/articleshow/75065623.cms

(35) Italian mayor claims the true death toll from Covid-19 likely to be much higher, euronews.com, 21 March 2020. Link:   https://www.euronews.com/2020/03/21/italian-mayor-claims-the-true-death-toll-from-covid-19-likely-to-be-much-higher

(36) ‘India has tremendous capacity to combat Covid-19’: WHO Executive Director, 24 March 2020. Link: https://www.youtube.com/watch?v=bydILYTQUsA

(37) Covid 19: Tablighi Jamaat attendee attempts suicide from 6th floor of Delhi Hospital, PTI, Deccan Herald, 2 April 2020. Link: https://www.deccanherald.com/national/covid-19-tablighi-jamaat-attendee-attempts-suicide-from-6th-floor-of-delhi-hospital-820254.html

(38) Problems in identifying the origins of an outbreak, Tom Jefferson & Carl Heneghan, 3 April 2020, https://www.cebm.net/covid-19/problems-in-identifying-the-origins-of-an-outbreak/; Global experts go head-to-head over claims the coronavirus ‘no longer exists clinically’, CNBC Report, 2 June 2020. Link https://www.cnbc.com/2020/06/02/claim-coronavirus-no-longer-exists-provokes-controversy.html?__source=iosappshare%7Ccom.apple.UIKit.activity.CopyToPasteboard&fbclid=IwAR2vY80wwIBIiCGbFawFU-75UoYf_junth2xy4ogfbQ8ZKaJqmfX1-YM0Lc; Coronavirus could ‘burn out’ on its own before we have a working vaccine: Former WHO chief, Firstpost, 20 May 2020. Link: https://www.firstpost.com/health/coronavirus-could-burn-out-on-its-own-before-we-have-a-working-vaccine-former-who-chief-8387911.html

(39) Kya WHO ne lockdown ka sujhav diya hai? Prime Time with Ravish Kumar, 1 May 2020 (in Hindi). Link: https://www.youtube.com/watch?v=FNzlq1whlq4

(40) Doxycycline and ivermectin combo may be new effective Covid-19 treatment, Medical Dialogues, 18 May 2020. Link: https://medicaldialogues.in/medicine/news/doxycycline-and-ivermectin-combo-may-be-new-effective-covid-19-treatment-65868

(41) Unexpected cause of death in younger Covid-19 patients is related to blood clotting, BioSpace, 28 April 2020. Link: https://www.biospace.com/article/covid-19-increases-risk-of-heart-attacks-and-stroke/?fbclid=IwAR3wum5CgAyBrlCQ2eBwQCy_sU2Evq4iuyV4dqhT7ZP5efdSOVb_KWPkUnw

(42) Revised Guidelines on Clinical Management of Covid-19, Government of India, Ministry of Health & Family Welfare, 31 March 2020. Link:  https://www.mohfw.gov.in/pdf/RevisedNationalClinicalManagementGuidelineforCOVID1931032020.pdf

(43) Avigan trials will continue in Japan with drug efficacy unclear, Nikkei Asian Review, 21 May 2020. Link: https://asia.nikkei.com/Business/Pharmaceuticals/Avigan-trials-will-continue-in-Japan-with-drug-efficacy-unclear ;Wanted Covid-19 patients in Japan…..for clinical trials, The Japan Times, 24 June 2020. Link:  https://www.japantimes.co.jp/news/2020/06/24/national/science-health/japan-coronavirus-patients-vaccine-trials/;Bangladesh Medical College Hospital Physician see ‘astounding results’ with drug combination targeting Covid-19, Trial Sites News, 18 May 2020. Link:   https://www.trialsitenews.com/bangladesh-medical-college-hospital-physician-see-astounding-results-with-drug-combination-targeting-covid-19/; CSIR identifies top 25 drugs/drug candidates for repurposing, Ministry of Science & Technology, 30 April 2020. Link: https://pib.gov.in/PressReleasePage.aspx?PRID=1619671.

(44) Sermo website: https://www.sermo.com/methodology/

(45) Protecting health-care workers from subclinical coronavirus infection, Chang et al., The Lancet, Correspondence, Vol. 8, March 2020, published online 13 February 2020. Link: https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30066-7.pdf; Fewer deaths in Veneto offer clues for fight against virus, Financial Times, April 5, 2020. Link: https://www.ft.com/content/9c75d47f-49ee-4613-add1-a692b97d95d3; Offline: COVID-19 and the NHS – “a national scandal”, Richard Horton, Comment, The Lancet, Vol. 395, 28 March  2020. Link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30727-3/fulltext; Italian doctors warned hospitals are coronavirus vectors. One Russian region proves their point, The Moscow Times, 9 April 2020. Link: https://www.themoscowtimes.com/2020/04/09/italian-doctors-warned-hospitals-are-coronavirus-vectors-one-russian-region-proves-their-point-a69924

Woman is first UK victim to die of coronavirus caught in hospital, The Guardian, 24 March 2020. Link: https://www.theguardian.com/world/2020/mar/24/woman-first-uk-victim-die-coronavirus-caught-hospital-marita-edwards, We’ve become the ‘super-spreaders’: NHS doctor pleads for more protective equipment, Yahoo News, UK, 18 March 2020. https://sports.yahoo.com/dr-nishant-joshi-coronavirus-protective-masks-equioment-130525108.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAEPC0bVREj6Nbb_kjlYlxY4XDEKlAUxdxO1HO__5G858semg6WxHnPlD7Q4diQV6TpI82OS_uTKs5wS1I61YuMVQ_ksQuyYW7DZr-_6ZVIDiX81iyLXNxxFPdub8AyM-safropIQ1qHKVzeWiyGrQWh0LGZScW0Yy5nd2tFUdvtE ; When our hospitals are the pandemic superspreaders, The American Conservative, 20 April 2020. Link: https://www.theamericanconservative.com/articles/when-our-hospitals-are-the-pandemic-superspreaders/

(46) “Flattening the curve on COVID-19: How Korea responded to a pandemic using ICT”, publication of the Government of the Republic of Korea dated 11 May 2020.

(47) Blood clots in severe Covid-19 patients leave their clinicians with clues about the illness – but no proven treatments, statnews.com, 16 April 2020. Link:  https://www.statnews.com/2020/04/16/blood-clots-coronavirus-tpa/; Doctors are discovering coronavirus causes blood clots harming organs from brains to toes, The Print, 5 May 2020. Link: https://theprint.in/health/doctors-are-discovering-coronavirus-causes-blood-clots-harming-organs-from-brain-to-toes/414479/

(48) Prince Charles to open NHS Nightingale to treat Covid-19 patients, The Guardian, 3 April 2020. Link: https://www.theguardian.com/world/2020/apr/03/prince-charles-to-open-nhs-nightingale-to-treat-covid-19-patients

(49) US Field Hospitals stand down, most without treating any Covid-19 patients, npr.org, 7 May 2020. Link:  https://www.npr.org/2020/05/07/851712311/u-s-field-hospitals-stand-down-most-without-treating-any-covid-19-patients; London NHS Nightingale hospital will shut next week, The Guardian, 4 May 2020. Link: https://www.theguardian.com/world/2020/may/04/london-nhs-nightingale-hospital-placed-on-standby

(50) Covid-19: Nightingale hospitals set to shutdown after seeing few patients, BMJ 2020; 369, 7 May 2020. Link: https://www.bmj.com/content/369/bmj.m1860

(51) Improvisation and retraining may be key to saving patients in New York’s ICUs, npr.org, 8 April 2020. Link: https://www.npr.org/sections/health-shots/2020/04/08/830153837/improvisation-and-retraining-may-be-key-to-saving-patients-in-new-yorks-icus

(52) Why ventilators may not be working as well for Covid-19 patients as doctors hoped, Time, 16 April 2020. Link: https://time.com/5820556/ventilators-covid-19/

(53) From NYC ICU, Cameron Kyle-Sidell, 31 March 2020. Link:  https://www.youtube.com/watch?v=k9GYTc53r2o

(54) Webinar on avoiding intubation and initial ventilation in Covid-19, EMCrit, 4 April 2020. Link: https://www.youtube.com/watch?v=mZqNiQxJLSU

(55) Management of Covid-19 respiratory distress, John J. Marini and Luciano Gattinoni, JAMA Insights, Clinical Update, 24 April 2020. Link: https://jamanetwork.com/journals/jama/fullarticle/2765302

(56) Do Covid-19 vent protocols need a second look? https://www.webmd.com/coronavirus-in-context/video/coronavirus-in-context-cameron-kyle-sidell

(57) NHS Nightingale chief says NHS must ‘never go back’ to old bureaucratic ways, The Independent, 28 April 2020. Link: 

https://www.independent.co.uk/news/health/coronavirus-nightingale-nhs-intensive-care-nurses-hospitals-a9487946.html?fbclid=IwAR2yhpcIIQnH_qrV3LG4DGftW8OCXbNcaileotmM1ywDGXGISnINtB9IlSg

(58) Doctors face troubling question: are they treating coronavirus correctly? The New York Times, 14 April 2020. Link: https://www.youtube.com/watch?v=bp5RMutCNoI. Note that the doctors’ research referred to as an “editorial” in this report was published in a number of formal papers subsequently and can be accessed here: Covid-19 pneumonia: different respiratory treatments for different phenotypes? Gattinoni et al., Intensive Care Medicine, 46, pg. 1099, 14 April 2020. https://link.springer.com/article/10.1007/s00134-020-06033-2?tk=eo_8ec810cc-57e5-4bc1-bb85-e22b9e068904_JOUOgWdVMbWC4XIzzfHwSizVS09ocy3MoJOK and Management of Covid-19 respiratory distress, John J Marini and Luciano Gattinoni, JAMA Insights, Clinical Update, 24 April 2020. Link:  https://jamanetwork.com/journals/jama/fullarticle/2765302

(59) Advisory on the use of hydroxy-chloroquine as prophylaxis for SARS-CoV-2 infection, Indian Council of Medical Research, 22 March 2020. Link:  https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloroquinasprophylaxisforSARSCoV2infection.pdf

(60) https://www.history.com/news/black-holes-albert-einstein-theory-relativity-space-time

(61) https://hsm.stackexchange.com/questions/5937/why-did-einstein-oppose-quantum-uncertainity

(62) Announcement of New Coronavirus Infectious Disease Control Experts Meeting dated 24 February 2020 (in Japanese): https://www.mhlw.go.jp/stf/seisakunitsuite/newpage_00006.html ; Prevention Measures against Coronavirus Disease, Japan, 25 February 2020 (in Japanese): https://www.mhlw.go.jp/content/10900000/000607629.pdf

(63) Early state of a Japan outbreak: The policies needed to support coronavirus patients, Saito Katsuhisa, Nippon.com, 19 February 2020. Link: https://www.nippon.com/en/news/l00267/early-stage-of-a-japan-outbreak-the-policies-needed-to-support-coronavirus-patients.html

(64) China coronavirus: Wuhan medical staff being infected at much faster pace than reported as national death toll hits 26, South China Morning Post, 24 January 2020. Link: https://www.scmp.com/news/china/society/article/3047441/wuhan-medical-staff-being-infected-virus-much-faster-pace

(65) Coronavirus: shocking footage shows Chinese family being forced into quarantine by police, Evening Standard, 8 February 2020. Link to video:  https://www.youtube.com/watch?v=nNeTWX7WgwA

(66) Ebola community health workers trained for the future, 10 March 2020. Link:  https://www.afro.who.int/news/ebola-community-health-workers-trained-future?fbclid=IwAR2zmg7cus3tbD8LCJZCzCsjFXM_BuQ9o9dhYxNx7z6u7X_cUR0DPwMNkVQ

(67) Sweden’s relaxed approach to the coronavirus could already be backfiring, Time, 9 April 2020. Link: https://time.com/5817412/sweden-coronavirus/

(68) Spanish soldiers find elderly patients ‘abandoned’ in retirement home, France 24, 24 March 2020. Link: https://www.france24.com/en/20200324-spanish-soldiers-find-elderly-patients-abandoned-in-retirement-homes ; ‘Just sedate old people, pray they live’: with nearly 12k deaths in Spain, Covid-19 suffocates hospitals, News19=8.com, 5 April 2020. Link:   https://www.news18.com/news/world/they-just-sedate-old-people-pray-they-live-with-nearly-12k-deaths-in-spain-covid-19-suffocates-hospitals-2564945.html; Pensioner, 84, on lockdown due to coronavirus….Daily Mail, 8 April 2020. Link: https://www.dailymail.co.uk/news/article-8201815/Pensioner-84-lockdown-coronavirus-forced-eat-old-food-BIN.html; Burials on New York island are not new but are increasing during pandemic, npr.org, 10 April 2020. Link: https://www.npr.org/sections/coronavirus-live-updates/2020/04/10/831875297/burials-on-new-york-island-are-not-new-but-are-increasing-during-pandemic ; Mass graves for coronavirus victims shouldn’t come as a shock, The Conversation https://theconversation.com/mass-graves-for-coronavirus-victims-shouldnt-come-as-a-shock-its-how-the-poor-have-been-buried-for-centuries-136655; ‘This whole corridor is dead’: Europe’s coronavirus care home disaster, The Irish Times, 19 May 2020. Link: https://www.irishtimes.com/news/world/europe/this-whole-corridor-is-dead-europe-s-coronavirus-care-home-disaster-1.4256568 ; Coronavirus: Europe’s care homes struggle as deaths rise, BBC, 3 April 2020. Link: https://www.bbc.com/news/world-europe-52147861 ; A deluged system leaves some elderly to die, rocking Spain’s self-image, New York Times, 25 March 2020. Link: https://www.nytimes.com/2020/03/25/world/europe/Spain-coronavirus-nursing-homes.html

(69) New York Governor Andrew Cuomo criticised over highest nursing home death toll, The New Indian Express, 10 May 2020. Link:  https://www.newindianexpress.com/world/2020/may/10/new-york-governor-andrew-cuomo-criticised-over-highest-nursing-home-death-toll-2141550.html

(70) Nation-wise data from the International Long Term Care Policy Network, “Mortality associated with COVID among people who use long term care”, updates of 21 May 2020 and 26 June 2020. Link to 26 June 20202 update here: https://ltccovid.org/wp-content/uploads/2020/06/Mortality-associated-with-COVID-among-people-who-use-long-term-care-26-June-1.pdf; State-wise data for the USA from Covid-19 brutal on NY long-term care facilities, The Buffalo Post quoting Kaiser Family Foundation data, 26 May 2020. Link: https://buffalonews.com/business/local/covid-19-brutal-on-ny-long-term-care-facilities-nationwide-its-worse/article_739b408b-5d34-5b8d-be83-124047368d2b.html

(71) A deluge of death in Northern Italy, 25 March 2020. Link: https://graphics.reuters.com/HEALTH-CORONAVIRUS-LOMBARDY/0100B5LT46P/index.html; ‘We take the dead from morning till night’, The New York Times, 27 March 2020. Link:   https://www.nytimes.com/interactive/2020/03/27/world/europe/coronavirus-italy-bergamo.html?auth=login-email&login=email

(72) Mumbai: 25-year-old with no conditions dies after 3 days in hospital, Time of India, 21 April 2020. Link: https://timesofindia.indiatimes.com/city/mumbai/mumbai-25-year-old-with-no-conditions-dies-after-3-days-in-hospital/articleshow/75262442.cms

(73) Coronavirus: with SP and RJ from this Tuesday, all capitals stop trade to reduce the risk of contagion, globo.com, 24 March 2020 (in Brazilian Portuguese). Link: https://g1.globo.com/economia/noticia/2020/03/24/cidades-fecham-comercio.ghtml; Bolsonaro says he ‘wouldn’t feel anything if infected with Covid-19 and attacks state lockdowns, The Guardian, 25 March 2020. Link: https://www.theguardian.com/world/2020/mar/25/bolsonaro-brazil-wouldnt-feel-anything-covid-19-attack-state-lockdowns; Bolsonaro and governors on a collision course, The Brazilian Repot, 26 March 2020. Link:  https://brazilian.report/newsletters/brazil-daily/2020/03/26/governors-in-brazil-on-a-collision-course-with-president-bolsonaro/; Rio and 5 other municipalities in the state declare an emergency to contain the coronavirus, g1.globo.com, 18 March 2020 (in Brazilian Portuguese). Link: https://g1.globo.com/rj/rio-de-janeiro/noticia/2020/03/18/prefeitura-do-rio-declara-situacao-de-emergencia.ghtml; https://g1.globo.com/rj/rio-de-janeiro/noticia/2020/03/17/governo-do-rj-determina-reducao-de-50percent-da-capacidade-de-lotacao-dos-transportes-publicos.ghtml

(74) Data from catcomm.org/favela-facts.

(75) Brazil’s super-rich and the exclusive club at the heart of a coronavirus hotspot, The Guardian, 4 April 2020. Link: https://www.theguardian.com/world/2020/apr/04/brazils-super-rich-and-the-exclusive-club-at-the-heart-of-a-coronavirus-hotspot

(76) Rio’s favela’s count the cost as deadly spread of Covid-19 hits the city’s poor, The Guardian, 25 April 2020. Link: https://www.theguardian.com/world/2020/apr/25/rio-favelas-coronavirus-brazil

(77) Brazil Covid-19 data from https://disasterresponse.maps.arcgis.com/apps/dashboards/b16474584d1b43948955ca1462b9e998

(78) Data from https://painel.vozdascomunidades.com.br/

(79) How one of Brazil’s largest favelas confronts coronavirus, Bloomberg, 3 May 2020. Link:  https://www.bloomberg.com/news/features/2020-05-03/how-one-of-brazil-s-largest-favelas-confronts-coronavirus?fbclid=IwAR2L1GWPMDyUgtXBdQGbcEYPbcOQ9jTccTaZiCJHH4GsmHgvshvVUAXS3fg

(80) Brazil’s favelas forced to fight coronavirus alone, DW, 2 July 2020. Link: https://www.dw.com/en/brazils-favelas-forced-to-fight-coronavirus-alone/a-54031886; Data on favelas from https://painel.vozdascomunidades.com.br/ and state-wise Brazil data from  https://www.statista.com/statistics/1103791/brazil-coronavirus-cases-state/

(81) Malabar Hill resident among 5 new cases, Mumbai Mirror, 21 March 2020. Link:  https://mumbaimirror.indiatimes.com/coronavirus/news/malabar-hill-resident-among-5-new-cases/articleshow/74740898.cms

(82) Asia’s largest slum Dharavi reports first Covid-19 case, Economic Times 2 April 2020. Link: https://economictimes.indiatimes.com/news/politics-and-nation/asias-largest-slum-dharavi-reports-first-case-of-coronavirus/articleshow/74937159.cms ; Number of coronavirus cases in Maharashtra rises to 335, LiveMint, 1 April 2020. Link: https://www.livemint.com/news/india/number-of-coronavirus-cases-in-maharashtra-rises-to-335-11585749948541.html

(83) Mumbai becomes epicentre of Covid-19 positive cases and death reports, The New Indian Express, 5 April 2020. Link:  https://www.newindianexpress.com/cities/mumbai/2020/apr/05/mumbai-becomes-epicentre-of-covid-19-positive-cases-and-death-reports-2126173.html

(84) Maharashtra nears 10,000 mark.., NDTV, 29 April 2020. Link: https://www.ndtv.com/india-news/maharashtra-nears-10-000-mark-mumbai-has-6-644-coronavirus-cases-2220609

(85) Mumbai Covid19 Tracker: 12 BMC wards report over 1500 positive cases, Mumbai Mirror, 31 May 2020. Link: https://mumbaimirror.indiatimes.com/coronavirus/news/mumbai-covid-19-tracker-12-bmc-wards-report-over-1500-positive-cases-dharavi-dadar-and-mahim-among-citys-worst-hit/articleshow/76120988.cms

(86) Mumbai: In Dharavi 75% infected are frontline workers, Indian Express, 23 May 2020. Link: https://indianexpress.com/article/cities/mumbai/in-dharavi-75-infected-are-frontline-workers-6423111/

(87) In the week funk dances returned to communities, favelas recorded more than 100 deaths from Covid-19, OGlobo, 8 June 2020 (in Brazilian Portuguese). Link: https://oglobo.globo.com/rio/na-semana-em-que-bailes-funks-voltaram-comunidades-favelas-registram-mais-de-cem-mortes-por-covid-19-1-24468827

(88) In Delhi slums people queue for drinking water ignoring social distancing norms, Business Insider, 18 April 2020. Link: https://www.businessinsider.in/india/news/in-delhi-slums-people-queue-for-drinking-water-ignoring-social-distancing-norms/articleshow/75218038.cms

(89) Ramaphosa announces 21day coronavirus lockdown for South Africa, BusinessTech, 23 March 2020. Link: https://businesstech.co.za/news/government/383927/ramaphosa-announces-21-day-coronavirus-lockdown-for-south-africa/

(90) Mzansi reacts to police & army ‘brutality’ during lockdown, TimesLive, South Africa, 31 March 2020. Link: https://www.timeslive.co.za/news/south-africa/2020-03-31-mzansi-reacts-to-police-army-brutality-during-lockdown-they-must-respect-the-law/

(91) UN Raises alarm about police brutality in Covid-19 lockdowns, Al Jazeera, 28 April 2020. Link: https://www.aljazeera.com/news/2020/04/raises-alarm-police-brutality-covid-19-lockdowns-200428070216771.html?fbclid=IwAR0luxsHfBtWv1GuDp46YitHRZi5ER3xjfplukqDrK7Hjb5KY5bxSOiUWAE

(92) Maharashtra government seals all hotspots including Dharavi, LiveMint, 9 April 2020. Link:  https://www.livemint.com/news/india/mumbai-seals-parts-of-dharavi-11586437129347.html

(93) Coronavirus fallout: From Maharashtra an exodus of migrant workers with no work, The Wire: Science, 22 March 2020. Link: https://science.thewire.in/health/coronavirus-maharashtra-migrant-workers/

(94) Quarantine puts at risk the income of Brazilian slum dwellers, says research, globo.com, 24 March 2020 (in Brazilian Portuguese). Link: https://g1.globo.com/bemestar/coronavirus/noticia/2020/03/24/quarentena-poe-em-risco-a-renda-de-moradores-de-favelas-brasileiras-diz-pesquisa.ghtml

(95) Coronavirus fallout: From Maharashtra an exodus of migrant workers with no work, The Wire: Science, 22 March 2020. Link: https://science.thewire.in/health/coronavirus-maharashtra-migrant-workers/

(96) Ground Report: Chaos at Anand Vihar as buses prepare to take migrant workers home, The Wire, 28 March 2020. Link: https://www.youtube.com/watch?v=gW61drhb8FE; India lockdown: Migrant workers in very large numbers at Delhi’s Anand Vihar bus terminal, The Economic Times, 28 March 2020. Link: https://economictimes.indiatimes.com/news/politics-and-nation/india-lockdown-migrant-workers-in-very-large-numbers-at-delhis-anand-vihar-bus-terminal/videoshow/74865929.cms?from=mdr; Watch: Thousands of migrant workers crowd Anand Vihar Bus Terminal amid lockdown, Times of India, 28 March 2020. Link: https://timesofindia.indiatimes.com/videos/city/delhi/watch-thousands-of-migrant-workers-crowd-anand-vihar-bus-terminal-amid-lockdown/videoshow/74865108.cms; Covid 19 Lockdown: Hungry Helpless Migrant Workers Flee Cities, 29 March 2020, India Today (Video). Link: https://www.youtube.com/watch?v=lUVGVBNWDZ0; Stranded Migrant workers walk for days to reach home amidst lockdown, CNN News18, 27 March 2020. Link: https://www.youtube.com/watch?v=PgIbqEzdPyg

(97) My kids are hungry, you think Covid-19 is what I fear? News18.com, 29 March 2020. Link: https://www.news18.com/news/india/my-kids-are-hungry-you-think-covid-19-is-what-i-fear-thousands-of-migrant-workers-flee-amid-lockdown-2555453.html

(98) Covid 19 lockdown triggers massive exodus of migrant workers Noida-Agra Highway, CNN News18, 28 March 2020. Video link: https://www.youtube.com/watch?v=tt8e8owMTGY; Migrant Workers Walking their ways back home say hunger will get them before the virus, CNN News18, 27 March 2020. Video link: https://www.youtube.com/watch?v=-PBD4yBJlJQ; Stranded Migrant workers walk for days to reach home, CNN-New18, 26 Mach 2020. Video link: https://www.youtube.com/watch?v=PgIbqEzdPyg

(99) Des ki baat Ravish Kumar ke saath: Mazdooron ki Majboori, NDTV India, 6 May 2020 (in Hindi), https://www.youtube.com/watch?v=lfdmcaOeWmY;  Des ki baat Ravish Kumar ke saath: Mazdooron ki Ghar Waapsi ki Jaddojehad, NDTV India, 11 May 2020 (in Hindi). Link: https://www.youtube.com/watch?v=ovbpvCLaYL8

(100) Des ki baat Ravish Kumar ke saath: Mazdooron ki Ghar Waapsi ki Jaddojehad, NDTV India, 11 May 2020 (in Hindi). Link: https://www.youtube.com/watch?v=ovbpvCLaYL8

(101) Des ki baat Ravish Kumar ke saath: Mazdooron ki Majboori, NDTV India, 6 May 2020, (in Hindi) https://www.youtube.com/watch?v=lfdmcaOeWmY

(102) Uddhav Thackrey appeals to migrant workers to stay put, The Hindu Business Line, 28 March 2020. Link: https://www.thehindubusinessline.com/news/uddhav-thackeray-appeals-to-migrant-workers-in-maharashtra-to-stay-put/article31189724.ece

(103) How the coronavirus is impacting favelas in Rio de Janeiro, Forbes, 29 April 2020. Link:  https://www.forbes.com/sites/joshualaw/2020/04/29/how-the-coronavirus-is-impacting-favelas-in-rio-de-janeiro/#3023c783ee39

(104) Daulatdia brothel: as clients disappear hunger sets in, The Business Standard, Bangladesh, 8 April 2020. Link: https://tbsnews.net/panorama/daulatdia-brothel-clients-disappear-hunger-sets-66586

(105) ‘This is what happens to us’, The Washington Post, 3 June 2020. Link:  https://www.washingtonpost.com/graphics/2020/politics/coronavirus-race-african-americans/

(106) The social inequalities that the Covid-19 pandemic shows us, Brasil de Fato, 4 April 2020 (in Brazilian Portuguese). Link: https://www.brasildefato.com.br/2020/04/04/artigo-as-desigualdades-sociais-que-a-pandemia-da-covid-19-nos-mostra

(107) To contain coronavirus, residents negotiate end of funk balls in Rocinha, midiamax, 9 June 2020 (in Brazilian Portuguese). Link: https://www.midiamax.com.br/brasil/2020/para-conter-coronavirus-associacao-de-moradores-negociou-fim-dos-bailes-funk-na-rocinha

(108) 1 million Bangladeshi garments workers lose jobs amid Covid-19 economic fallout, mpr.org, 3 April 2020. Link: https://www.npr.org/sections/coronavirus-live-updates/2020/04/03/826617334/1-million-bangladeshi-garment-workers-lose-jobs-amid-covid-19-economic-fallout

(109) Fury in Kenya over police brutality amid coronavirus curfew, Al Jazeera, 2 April 2020. Link: https://www.aljazeera.com/news/2020/04/fury-kenya-police-brutality-coronavirus-curfew-200402125719150.html?utm_source=website&utm_medium=article_page&utm_campaign=read_more_links

(110) Lockdown: cops, metro cop face 3 counts of murder and other serious charges, news24.com, 31 March 2020. Link: https://www.news24.com/news24/southafrica/news/cops-face-3-counts-of-murder-and-other-serious-charges-amid-lockdown-20200331; Police brutality on the rise during lockdown, IOL, South Africa, 5 April 2020. Link: https://www.iol.co.za/news/south-africa/police-brutality-on-the-rise-during-lockdown-46250431; SANDF issues stern warning after soldiers accused of beating Alexandra man to death, IOL, 12 April 2020. Link: https://www.iol.co.za/news/south-africa/gauteng/sandf-issues-stern-warning-after-soldiers-accused-of-beating-alexandra-man-to-death-46625061?fbclid=IwAR3j00XAzYI5j6rOLwEe5k_VoWiRQYeh4reKfCNLINELcc4JHVRSVt5S8tQ. Also see (28).

(111) Covid-19: Security forces in Africa brutalizing civilians under lockdown, DW, 20 April 2020. Link: https://www.dw.com/en/covid-19-security-forces-in-africa-brutalizing-civilians-under-lockdown/a-53192163?fbclid=IwAR1zWI6PygaOesr1Ntw32ShrUyRS2pgbYD7G_E1OCe44d1dnlK0

(112) Court orders suspension of South African soldiers over death of man in lockdown, Reuters, 15 May 2020. Link: https://www.reuters.com/article/us-health-coronavirus-safrica-military/court-orders-suspension-of-south-african-soldiers-over-death-of-man-in-lockdown-idUSKBN22R24O

(113) We’ll keep enforcing lockdown, says French Minister amid unrest, Reuters, 22 April 2020. Link: https://www.reuters.com/article/us-health-coronavirus-france-security/french-motorcyclist-whose-crash-fuelled-riots-urges-calm-amid-more-unrest-idUSKCN2240DC

(114) Containment Measures: Police checks must not be abusive, violent or discriminatory, Human Rights League and Others, France, 27 March 2020 (in French). Link:  https://www.ldh-france.org/mesures-de-confinement-les-controles-de-police-ne-doivent-etre-ni-abusifs-ni-violents-ni-discriminatoires/

(115) The Religious Retreat that sparked India’s Major Coronavirus Manhunt, Reuters, 2 April 2020. Link: https://www.reuters.com/article/us-health-coronavirus-india-islam-insigh/the-religious-retreat-that-sparked-indias-major-coronavirus-manhunt-idUSKBN21K3KF

(116) Tabligh members undergoing treatment…The Economic Times, 3 April 2020. Link: https://economictimes.indiatimes.com/news/politics-and-nation/tabligh-members-undergoing-treatment-not-cooperating-doctors-to-delhi-govt/articleshow/74969727.cms?from=mdr

(117) Tablighi Jamaat par bole CM Arvind Kejriwal, Navbharat Times, 31 March 2020 (in Hindi). Link: https://www.youtube.com/watch?v=yNA_OKk4IKE

(118) Coronavirus conspiracy theories targeting Muslims spread in India, The Guardian, 13 April 2020. Link: https://www.theguardian.com/world/2020/apr/13/coronavirus-conspiracy-theories-targeting-muslims-spread-in-india ; ‘Muslim traders not allowed’, reads poster in Indore village, Scroll.in, 3 May 2020. Link: https://scroll.in/latest/960924/muslims-not-allowed-reads-poster-in-indore-village-police-file-case; Gurugram: Youths assault neighbour, 6 of them arrested, Times of India, 7 April 2020. Link:  https://timesofindia.indiatimes.com/city/gurgaon/youths-assault-neighbour-6-of-them-arrested/articleshow/75018533.cms

(119) Press Release: International Institute for Religious Freedom and Human Rights Without Frontiers. Link: https://www.iirf.eu/news/other-news/cesnur-and-human-rights-without-frontiers-release-white-paper-on-shincheonji-and-coronavirus/ ; Shincheonji & Coronavirus in South Korea: Sorting Fact from Fiction, Human Rights Without Frontiers et al.. Link: https://drive.google.com/file/d/1DRcWhbQ1xoJRs-tkAFp38IWi-3QB8qJX/view

(120) Coronavirus is spreading at religious gatherings, ricocheting across nations, The Wall Street Journal, 18 March 2020. Link: https://www.wsj.com/articles/coronavirus-is-spreading-at-religious-gatherings-ricocheting-across-nations-11584548174

(121) 202 confirmed coronavirus cases in South Africa, BusinessTech, South Africa, 20 March 2020. Link: https://businesstech.co.za/news/lifestyle/383455/202-confirmed-coronavirus-cases-in-south-africa/

(122) Coronavirus: SA’s patient zero and one other are home and all clear, IOL, South Africa, 20 March 2020. Link: https://www.iol.co.za/news/south-africa/kwazulu-natal/coronavirus-sas-patient-zero-and-one-other-are-home-and-all-clear-45296869

(123) Rights in the time of Covid-19, UNAIDS, 20 March 2020. Link: https://www.unaids.org/en/resources/documents/2020/human-rights-and-covid-19

(124) African countries respond to Guangzhou’s ‘Anti Epidemic Measures’, The Diplomat, 27 April 2020. Link: https://thediplomat.com/2020/04/african-countries-respond-to-guangzhous-anti-epidemic-measures/

(125) List of incidents of xenophobia and racism related to the Covid-19 pandemic, Wikipedia.  https://en.wikipedia.org/wiki/List_of_incidents_of_xenophobia_and_racism_related_to_the_COVID-19_pandemic

(126) Covid-19: Bangladesh Army says troops will be on streets until govt recalls, PTI, The Hindu, 29 March 2020. Link: https://www.thehindu.com/news/international/covid-19-bangladesh-army-says-troops-will-be-on-streets-until-govt-recalls/article31197469.ece

(127) Bangladesh: End wave of Covid-19 ‘rumour’ arrests, Human Rights Watch, 31 March 2020. Link: https://www.hrw.org/news/2020/03/31/bangladesh-end-wave-covid-19-rumor-arrests?fbclid=IwAR0ZW3igg-DHw24SfVWvAdgC-bckCRRaANzt7YQf4fpcSSkdIhFW5G7IOnU

(128) Nigerian security forces kill 18 during curfew enforcement, AL Jazeera, 16 April 2020. Link: https://www.aljazeera.com/news/2020/04/nigerian-security-forces-kill-18-curfew-enforcement-200416142503603.html?utm_source=website&utm_medium=article_page&utm_campaign=read_more_links

(129) South Africa’s ruthlessly efficient fight against coronavirus, BBC, 3 April 2020. Link: https://www.bbc.com/news/world-africa-52125713?fbclid=IwAR3z4vjmq_PPI2_GB3divYSX3_UKODdSMa6DARgbsLFhHkRm0B8LtjJIyFs

(130) Statement by President Cyril Ramaphosa, 23 April 2020. Link: https://sacoronavirus.co.za/2020/04/23/statement-by-president-cyril-ramaphosa-on-south-africas-response-to-the-coronavirus-pandemic-union-buildings-tshwane/

(131) Des Ki Baat Ravish Kumar ke Saath, Patri par zindagi lautti hai, yahan majdooron ko mili maut, NDTV India, May 8, 2020, ; Des ki Baat Ravish Kumar ke Saath: Rail ki patriyon par chalta desh, NDTV India, 8 May 2020. Link: https://www.youtube.com/watch?v=K2W2Fq2-BTs&list=PLpSN4vP31-KuS06SnZK5As7hprxvALTQ8&index=59&t=0s; Des ki Baat Ravish Kumar ke Saath Media ko majdooron ki bebassi dikhane se prashasan ki taraf se roka gaya, NDTV India, 8 May 2020. Link: https://www.youtube.com/watch?v=og-wP1VqRQY&list=PLpSN4vP31-KuS06SnZK5As7hprxvALTQ8&index=57; Migrant workers: Maharashtra accident victims were battling hunger; The Hindu, 8 May 2020. Link: https://www.thehindu.com/news/national/other-states/maharashtra-train-accident-victims-were-battling-hunger/article31538217.ece

(132) Mapping accidents that killed over 100 migrant workers on the way home during lockdown, New18.com, 20 May 2020. Link: https://www.news18.com/news/india/mapping-accidents-that-killed-over-100-migrant-workers-on-their-way-to-home-during-nationwide-lockdown-2627947.html; UP migrant walking home dies allegedly of hunger, The Hindu, 17 May 2020. Link: https://www.thehindu.com/news/national/other-states/up-migrant-walking-home-dies-allegedly-of-hunger/article31609993.ece; Coronavirus lockdown: The Indian migrants dying to get home, BBC, 20 May 2020. Link: https://www.bbc.com/news/world-asia-india-52672764; 22 migrant workers, kin have died trying to return home since the lockdown started, The Wire, 30 March 2020. Link: https://thewire.in/rights/coronavirus-national-lockdown-migrant-workers-dead; 198 migrant workers killed in road accidents during lockdown: Report, Hindustan Times, 2 June 2020. Link: https://www.hindustantimes.com/india-news/198-migrant-workers-killed-in-road-accidents-during-lockdown-report/story-hTWzAWMYn0kyycKw1dyKqL.html; Walking home, migrant worker dies of sunstroke in Andhra Pradesh, The New Indian Express, 22 May 2020. Link: https://www.newindianexpress.com/cities/vijayawada/2020/may/22/walking-home-migrant-worker-dies-of-sunstroke-in-andhra-pradesh-2146527.html; 378 die on the way home according to this report11 May Des ki Baat Mazdooron ki ghar wapsi ki jaddojehad. Coronavirus lockdown: Deaths in Shramik trains not due to lack of food, water, says government, The Hindu, 5 June 2020. Link: https://www.thehindu.com/news/national/coronavirus-lockdown-deaths-in-shramik-trains-not-due-to-lack-of-food-water-says-government/article31759464.ece

(133) India should aim for 10-week total lockdown…India Today, 22 April 2020. Link: https://www.indiatoday.in/india/story/india-should-aim-for-10-week-total-lockdown-not-rush-exit-top-health-journal-editor-1669917-2020-04-22

(134) Congo’s Ebola fight has lessons for Covid-19, Human Rights Watch, 26 March 2020. Link:  https://www.hrw.org/news/2020/03/26/congos-ebola-fight-has-lessons-covid-19; Was DR Congo’s Ebola virus outbreak used as a political tool? The Lancet, Editorial, Vol. 393, 12 January 2019. Link: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2930002-9 ;191 Biosocial approaches to the 2013-2016 Ebola Pandemic, Richardson et al., Health and Human Rights Journal, June 2016, 18(1): 115-128.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070685/.

(135) Ebola and the narrative of mistrust, Richardson et al., BMJ Glob Health 2019 4(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936462/

(136) Bulletin of the World Health Organisation, Jane Parry, 12 December 2005. Link:  https://www.who.int/bulletin/volumes/83/12/news21205/en/; Risky Zoographies: The limits of place in Avian Flu management, Natalie Porter, Environmental Humanities (2012) 1 (1): 103-121. Link https://read.dukeupress.edu/environmental-humanities/article/1/1/103/8073/Risky-Zoographies-The-Limits-of-Place-in-Avian-Flu

(137) China sends medical aid to Pakistan via PoK…HT, 28 March 2020. Link: https://www.hindustantimes.com/world-news/china-sends-medical-aid-to-pakistan-via-pok-dispatches-team-of-experts-to-help/story-K5tpx8meEnXNQ8Q9ITNxGL.html; Doxycycline and Ivermectin combo may be new effective Covid-19 treatment, Medical Dialogues, 18 May 2020. Link: https://medicaldialogues.in/medicine/news/doxycycline-and-ivermectin-combo-may-be-new-effective-covid-19-treatment-65868; 215 Pakistan to start manufacturing Covid-19 treatment drug, Gulf Today, 15 May 2020. Link: https://www.gulftoday.ae/en/news/2020/05/15/pakistan-to-start-manufacturing-covid19-treatment-drug; Bangladesh Medical College Hospital physician see ‘astounding results’ with drug combination targeting Covid-19, TrialSite News, 18 May 2020. Link:  https://www.trialsitenews.com/bangladesh-medical-college-hospital-physician-see-astounding-results-with-drug-combination-targeting-covid-19/

(138) Physicians to population ratios reference: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS

(139) For 2019 World Bank thresholds for income classification see https://blogs.worldbank.org/opendata/new-country-classifications-income-level-2019-2020); Data for beds-per-1000-of-population and percentage of ICU beds taken from the Covid Expert Group’s Report No. 12, dated 26 March 2020 (at (7)). According this report, Lower Income Countries have 1.24 beds per 1000 population on average and High Income Countries have 4.82 beds per 1000 population on average.

(139A) Source: https://www.who.int/healthinfo/global_burden_disease/estimates_country_2004_2008/en/ . In general, I have preferred using WHO data from this year, which was updated in 2011, as this appears to be the last year for which the WHO has received and incorporated comments from other countries.

(140) These calculations are based on WHO mortality estimates for 2008 at https://www.who.int/healthinfo/global_burden_disease/estimates_country_2004_2008/en/ .

(140A) These percentages are NOT from the WHO, they are my calculations are based on WHO estimates for 2008 of tuberculosis incidence here: https://apps.who.int/gho/data/view.main.57040ALL?lang=en and number of tuberculosis deaths) here (see under “by sex”): https://www.who.int/healthinfo/global_burden_disease/estimates_country_2004_2008/en/. The underlying data used by me is in the table below:

Country

Tuberculosis Incidence

Tuberculosis Deaths

India

31,40,000

2.7 lakh (approx.)

Italy

4700

400

Germany

4800

400

France

6600

700

USA

15,000

700

UK

9300

400

Kenya

2.25 lakh (approx.)

9700

South Africa

4.86 lakh (approx..)

19,500

Mexico

24,000

2700

Sweden

590

100

 

(140B) For tuberculosis incidence in Norway see https://apps.who.int/gho/data/view.main.57040ALL?lang=en . 2002 was a terrible year for tuberculosis in Norway with 100 deaths estimated in that year to this disease against an incidence estimate of 280 cases, giving a crude fatality rate of over 35%. Again this percentage is NOT from the WHO, it is my calculation based on WHO estimates for tuberculosis incidence here: https://apps.who.int/gho/data/view.main.57040ALL?lang=en  and for mortality here: https://www.who.int/healthinfo/global_burden_disease/estimates_2000_2002/en/.

(140C) Source: WHO malaria figures for 2016  from here: https://apps.who.int/gho/data/node.main.A1364?lang=en (incidence) and here: https://www.who.int/healthinfo/global_burden_disease/estimates/en/ (mortality) click under ‘By Country WHO Member States, 2016.

(140D) Source: https://apps.who.int/gho/data/node.main.620?lang=en. HIV positive and AIDS cases for US for the year 2010 (later year case incidence is not available) and for other countries for the years 2018.

(140E) Ebola figures from https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease

(140F) “Mortality and Burden of Disease Estimates for WHO Member States” issued by WHO’s Department of Measurement and Health Information and “WHO Methods and data Sources for Country-Level Causes of Death 2000-2016” dated 2018.

(140G) Testing data from Worldometer.

(141) AIIMS data from https://www.aiims.edu/images/pdf/annual_reports/annual%20report19-e-20-1-20.pdf

(142) Becker’s Hospital Review data https://www.aiims.edu/images/pdf/annual_reports/annual%20report19-e-20-1-20.pdf

(143) ‘Doctor diplomacy’: Cuba seeks to make its mark in Europe amid Covid-19 crisis, The Guardian, 6 May 2020. Link:   https://www.theguardian.com/world/2020/may/06/doctor-diplomacy-cuba-seeks-to-make-its-mark-in-europe-amid-covid-19-crisis

(144) WHO says Madagascar’s herbal tonic against Covid-19 is not a cure, AL Jazeera, 4 May 2020. Link: https://www.aljazeera.com/news/2020/05/madagascars-herbal-tonic-covid-19-cure-200504081212753.html?xif= ; Coronavirus: What is Madagascar’s ‘herbal remedy’ Covid-Organics? Al Jazeera, 6 May 2020. Link: https://www.aljazeera.com/news/2020/05/coronavirus-madagascar-herbal-remedy-covid-organics-200505131055598.html

(145) The use of non-pharmaceutical forms of Artemisia, WHO, 10 October 2019. Link: https://www.who.int/publications/i/item/the-use-of-non-pharmaceutical-forms-of-artemisia

(146) ‘WHO commends Madagascar’s fight against Covid-19’, AA.com, Africa, 21 May 2020. Link:  https://www.aa.com.tr/en/africa/who-commends-madagascars-fight-against-covid-19/1848550

(147) Covid-19: Tests for miracle cure’ herb Artemisia begin, DW, 15 May 2020. Link: https://www.dw.com/en/covid-19-tests-for-miracle-cure-herb-artemisia-begin/a-53442366

(148) Madagascar slams WHO for not endorsing its herbal cure, AA.com, Africa, 11 May 2020. Link: https://www.aa.com.tr/en/africa/madagascar-slams-who-for-not-endorsing-its-herbal-cure/1836905

(149) Overview of malaria treatment, WHO, 18 January 2018. Link: www.who.int/malaria/areas/treatment/overview/en/

(150) Africans, three Ebola experts call for access to trial drug, Los Angeles Times, 6 August 2014. Link:  https://www.latimes.com/world/africa/la-fg-three-ebola-experts-release-drugs-20140806-story.html

(151) Discovery and description Zaire Virus in 1976…, Breman et al., The Journal of Infectious Disease, October 2016, 15; 214 (Suppl 3): S93-S101. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050466/#JIW207C1; Ebola haemorrhagic fever in Zaire, 1976, Report of an International Commission. Link:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395567/pdf/bullwho00439-0113.pdf

(152) Ethical considerations of experimental interventions in the Ebola outbreak, Annette Rid and Ezekiel J Emanuel, The Lancet, Vol. 384, 22 November 2014. Link: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)61315-5.pdf

(153) Ebola: What it tells us about medical ethics, Angus J. Dawson, The Journal of Medical Ethics 2015; 41: 107-110; Link: https://jme.bmj.com/content/41/1/107; Ebola and ethics: autopsy of a failure, Christian A Gericke, BMJ 2015; 350. Link: https://www.bmj.com/content/350/bmj.h2105

(154) Trial of Ebola drug ZMapp launches in Liberia, US, Centre for Disease Research & Policy, 27 February 2015. Link: https://www.cidrap.umn.edu/news-perspective/2015/02/trial-ebola-drug-zmapp-launches-liberia-us

(155) Ebola is now curable…wired.com, 8 December 2019. Link: https://www.wired.com/story/ebola-is-now-curable-heres-how-the-new-treatments-work/

(156) Politics around Hydroxychloroquine hamper science, npr.org, 21 May 2020. Link: https://www.npr.org/sections/health-shots/2020/05/21/859851682/politics-around-hydroxychloroquine-hamper-science?fbclid=IwAR3f9iSiYsnpSkaN7T-wauT0I0D3kWlyB-7_s5QkQhWIFdqhs0EW9xwqxDY)

(157) CSIR chief flays Hydroxychloroquine trial suspension, The Hindu, 30 May 2020. Link:   https://www.thehindu.com/sci-tech/health/coronavirus-csir-chief-flays-hcq-trial-suspension/article31712065.ece

(158) Global experts go head-to-head over claims the coronavirus ‘no longer exists clinically’, CNBC, 2 June 2020. Link: https://www.cnbc.com/2020/06/02/claim-coronavirus-no-longer-exists-provokes-controversy.html?__source=iosappshare%7Ccom.apple.UIKit.activity.CopyToPasteboard&fbclid=IwAR2vY80wwIBIiCGbFawFU-75UoYf_junth2xy4ogfbQ8ZKaJqmfX1-YM0Lc

(159) Coronavirus could ‘burn out’ on its own before we have a working vaccine: Former WHO chief, Firstpost, 20 May 2020. Link: https://www.firstpost.com/health/coronavirus-could-burn-out-on-its-own-before-we-have-a-working-vaccine-former-who-chief-8387911.html

(160) Indians in Wuhan say strict lockdown….The Economic Times, 9 April 2020. Link: https://economictimes.indiatimes.com/news/politics-and-nation/indians-in-wuhan-say-strict-lockdown-social-distancing-only-ways-to-contain-covid-19/articleshow/75064547.cms?from; China ends Wuhan lockdown…The New York Times, 7 April 2020. Link:  https://www.nytimes.com/2020/04/07/world/asia/wuhan-coronavirus.html

(161) Early missteps and state secrecy in China likely allowed coronavirus to spread farther and faster, The Washington Post, 1 February 2020. Link:  https://www.washingtonpost.com/world/2020/02/01/early-missteps-state-secrecy-china-likely-allowed-coronavirus-spread-farther-faster/

(162) People in China will make 3 billion trips in the next 40 days….Business Insider, 14 January 2020. Link: https://www.businessinsider.in/business/news/people-in-china-will-make-3-billion-trips-in-the-next-40-days-to-celebrate-lunar-new-year-the-worlds-largest-annual-human-migration/articleshow/73236413.cms#aoh=15910888889118&referrer=https%3A%2F%2Fwww.google.com&_tf=From%20%251%24s

(163) SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients, Zou et al., The New England Journal of Medicine 382: 12, 19 March 2020, first published on February 19, 2020. Link: https://www.nejm.org/doi/full/10.1056/NEJMc2001737

(164) Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany, Rothe et al., The New England Journal of Medicine 382; 10 March 5, 2020, first published on January 30, 2020). Link: https://www.nejm.org/doi/full/10.1056/NEJMc2001468

(165) The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Disease (COVID-19) – China 2002, China CDC Weekly Vol. 2 No. x, pg 1. Link: http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

(166) Bangladesh virus prayer gathering sparks outcry, Taipei Times, 20 March 2020. Link:  https://www.taipeitimes.com/News/world/archives/2020/03/20/2003733062; Brahmanbaria funeral crowd: Probe body starts investigation, Dhaka Tribune, 20 April 2020. Link: https://www.dhakatribune.com/bangladesh/nation/2020/04/20/probe-body-starts-working-over-brahmanbaria-funeral-crowd

(167) FranceInfo Survey: “The majority of people were infected”: from Corsica to overseas….franceinfo.com, 30 March 2020. Link: https://www.francetvinfo.fr/sante/maladie/coronavirus/video-coronavirus-le-nombre-de-contaminations-lors-du-rassemblement-evangelique-de-mulhouse-a-ete-largement-sous-evalue_3889133.html

(168) Back to the Future for Influenza Preimmunity – Looking Back at Influenza Virus History to Infer the Outcome of Future Infections, Francis et al., Viruses, 30 January 2019. Link: https://www.mdpi.com/1999-4915/11/2/122

(169) ‘A terrible price’: The deadly racial disparities of Covid-19 in America, The New York Times, 29 April 2020. Link: https://www.nytimes.com/2020/04/29/magazine/racial-disparities-covid-19.html

(170) Racial disparities in Louisiana’s Covid-19 death rate reflect systemic problems, 4WWL, 7 April 2020. Link:  https://www.wwltv.com/article/news/health/coronavirus/racial-disparities-in-louisianas-covid-19-death-rate-reflect-systemic-problems/289-bd36c4b1-1bdf-4d07-baad-6c3d207172f2

(171) We have an appointment with death, Slavoj Zizek, Kultur, 1 April 2020. https://www.welt.de/kultur/article207219549/Slavoj-Zizek-The-epidemic-as-a-date-with-death.html

(172) Debate Noam Chomsky & Michel Foucault, On Human Nature   https://www.youtube.com/watch?v=3wfNl2L0Gf8

(173) Noam Chomsky on Moral Relativism and Michel Foucault https://www.youtube.com/watch?v=i63_kAw3WmE

(174) Coronavirus: What’s going wrong in Sweden’s care homes, BBC, 19 May 2020. Link: https://www.bbc.com/news/world-europe-52704836

(175) Mumbai high rises report spike in Covid-19…..Firstpost, 22 June 2020. Link: https://www.firstpost.com/health/mumbai-high-rises-report-spike-in-covid-19-cases-but-implementation-of-sealing-norms-patchy-bmc-puts-onus-on-housing-societies-8509391.html and High rise in number of positive cases in Mulund, Mumbai Mirror, 13 June 2020. Link: https://mumbaimirror.indiatimes.com/mumbai/cover-story/high-rise-in-number-of-of-ve-cases-in-mulund/articleshow/76349782.cms

(176) More than 28,000 stranded Indians have landed in Mumbai since May, MumbaiLive.com, 4 July 2020. Link: https://www.mumbailive.com/en/transport/more-than-28000-stranded-indians-have-landed-in-mumbai-since-may-52292

(177) Updated list of containment zones or red zones in Mumbai as of July 2, Mumbai Live, 3 July 2020. Link: https://www.mumbailive.com/en/civic/containment-zones-list-mumbai-list-coronavirus-lockdown-52242

(178) Source: Mumbai Live Covid Updates

(179) Mumbai: Dharavi sees a drop in new Covid-19 cases and deaths, Mumbai Mirror, 30 June 2020. Link:  https://mumbaimirror.indiatimes.com/coronavirus/news/mumbai-dharavi-sees-a-drop-in-new-covid-19-cases-and-deaths/articleshow/76713018.cms

(180) BMC begins to withdraw after 90-day Covid-19 war in Dharavi, Mumbai Mirror, 3 July 2020. Link: https://mumbaimirror.indiatimes.com/coronavirus/news/bmc-begins-to-withdraw-after-90-day-covid-19-war-in-dharavi/articleshow/76769595.cms

(181) Cases as on July 2 https://www.freepressjournal.in/mumbai/coronavirus-in-mumbai-ward-wise-breakdown-of-covid-19-cases-issued-by-bmc-as-of-july-2

(182) Coronavirus: 21 cases found, building on Nepean Sea road sealed, Mumbai Live, 23 June 2020. Link: https://www.mumbailive.com/en/civic/the-bmc-sealed-an-entire-building-nestled-on-the-nepean-sea-road-after-21-cases-of-coronavirus-were-reported-from-the-society.-51737

(183) How Covid hotspot Dharavi, Asia’s largest slum, fought against all odds to flatten the curve, The Print, 14 June 2020 Link:  https://theprint.in/india/how-covid-hotspot-dharavi-asias-largest-slum-fought-against-all-odds-to-flatten-the-curve/441036/

(184) BMC has sealed 1,000 buildings in a week, Mumbai Live, 25 June 2020. Link: https://www.mumbailive.com/en/civic/the-surge-in-the-number-of-coronavirus-cases-in-the-suburbs-of-mumbai-has-led-to-the-sealing-of-1000-buildings-in-the-past-eight-days-51856

(185) Coronavirus UK map….BBC, 6 July 2020. Link: https://www.bbc.com/news/uk-51768274

(186) Tegnell: Italian travellers are not the main source of infection, Sweden, SVT Nyheter, 2 May 2020 (in Swedish). https://www.svt.se/nyheter/inrikes/tegnell-italienresenarerna-inte-storsta-kallan-till-smitta ; ‘Coronavirus came to Sweden from countries that were under our radar’: Public Health Agency chief, The Local, 11 June 2020. Link:  https://www.thelocal.se/20200611/public-health-agency-head-coronavirus-came-to-sweden-from-countries-that-were-under-our-radar

(187) Critics question Swedish approach as coronavirus death toll reaches 1,000, The Guardian, 15 April 2020. Link https://www.theguardian.com/world/2020/apr/15/sweden-coronavirus-death-toll-reaches-1000

(188) Large reduction in travel by public transport in the county, Sweden, KalmarPosten, 15 April 2020 (in Swedish). Link: https://www.kalmarposten.se/article/stor-minskning-av-resande-med-kollektivtrafik-i-lanet/ ; Travel halved at Skanetrafiken, Sweden, Aftonbladet, 25 March 2020 (in Swedish). Link:  https://www.aftonbladet.se/nyheter/a/Op7rjq/resandet-halverat-hos-skanetrafiken  ; West traffic takes the corona crisis very seriously, GT, expressen.se, Sweden, 8 April 2020 (in Swedish). Link: https://www.expressen.se/gt/debatt-gt/vasttrafik-tar-coronakrisen-pa-allra-storsta-allvar/

(189) Close to every third car away from Stockholm’s streets, Omni, Sweden (in Swedish). Link: https://omni.se/nara-var-tredje-bil-borta-fran-stockholms-gator/a/awQ7jL

(190) Stockholmers stay home at Easter,, SVT Nyheter, Sweden, 9 April 2020 (in Swedish). Link: https://www.svt.se/nyheter/snabbkollen/stockholmare-stannar-hemma-i-pask ; Travel from Stockholm during Passover, Telia.se, 9 April 2020 (in Swedish). Link: http://press.telia.se/pressreleases/svenskarna-stannar-hemma-under-paasklovet-2990179

(191) I call Foucault a “post-modernist” here with apologies to him. He famously disliked being called this. Certainly, his message was more profound and more delicate than the term allowed. In fact, Foucault was at his most Foucauldian when rejecting this label. Categorisation subtracts from the whole of what is being said. This is precisely the attitude we, especially scientists and doctors, need to adopt in the present crisis.

(192) Appendix-A & B; Appendix-C; Appendix-D; Appendix-E.

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