Covid Lectures Part 7: Discipline & Punish

Part 7: Discipline & Punish

Suranya Aiyar

Contents:
7.1 The Tablighi Jamaat Affair in India; 7.2 The Shincheonji Church Affair in South Korea; 7.3 The myth of the "Super-Spreader"; 7.4 Pandemic of Stigma, Racism and Xenophobia; 7.5 The Trail of Death-by-Lockdown; 7.6 The reality of the WHO's "All-of-Society and All-of-Government" approach to Disease Containment; 7.7 Lockdown of Human Rights

We ended yesterday with a discussion of how non-pharmaceutical interventions for disease control create a hostile and stigmatizing environment. We also discussed how they become a weapon of state abuse. Today we will contine our survey of the injustice and violence of disease containment as a public health strategy. 

7.1 The Tablighi Jamaat Affair in India

In India, the cultivation of fear and suspicion in the name of disease-containment had an almost instant fallout on its beleaguered Muslim minority. First, sensing that they would be blamed for any Covid-19 outbreak in India, they voluntarily broke up a nationwide sit-in, the Shaheen Bagh Protests, that had been going on for three months against a discriminatory citizenship law passed by the Hindu-majoritarian government at the Centre. Then, four days into the lockdown, and despite all their efforts to prove themselves as “good citizens” by dispersing their hard-fought movement, Muslims found themselves being blamed nevertheless for Covid-19, based on some cases that were traced to a gathering of an obscure orthodox Muslim group called the Tablighi Jamaat. For India, this was a small gathering of some 1500 people. Big Hindu temples were attracting many more people all over the country, more by the tens of thousands, at the same time as the Tablighi Jamaat gathering.

But for four weeks, Covid-19 was treated as though it were an entirely Muslim problem, to a stream of abuse and taunts from the anti-Muslim sections of the Indian media and public. Even the liberal media started with a tut-tutting tone about the Jamaat. They had been zealously participating in the social distancing and community hygiene drive against Covid-19, seeing themselves as they do, as enlightened, public-health-conscious, globally aware liberals. They had followed people on camera on their morning walks and while buying vegetables from street hawkers, berating them for violating social distancing. So, running as they were full tilt on the momentum of hysteria over Covid-19, it took a few days of Muslim-bashing from the right-wing media before the liberal media realised on whose side it had landed in supporting social distancing. Then they changed tack, but it was too late. A vicious atmosphere had been created. Pretty soon we had reports from all over the country of Muslim men being set upon and thrashed by Corona vigilantes, of posters going up in colonies telling Muslim to keep out and all the ugliness of communal hatred in India that is always waiting in the corner to show itself (118).

Even the liberal media started with a tut-tutting tone about the Jamaat. They had been zealously participating in the social distancing and community hygiene drive against Covid-19, seeing themselves as they do, as enlightened, public-health-conscious, globally aware liberals. They had followed people on camera on their morning walks and while buying vegetables from street hawkers, berating them for violating social distancing. So, running as they were full tilt on the momentum of hysteria over Covid-19, it took a few days of Muslim-bashing from the right-wing media before the liberal media realised on whose side they had landed in supporting social distancing.

Members of the Tablighi Jamaat had been staying in a six-story building called ‘Markaz’ in New Delhi’s Nizamuddin Basti. The Nizamuddin Markaz functions as an institutional centre and board-and-lodge facility for Jamaat members visiting from outside Delhi. They come from India and all over the world. The Markaz accommodates several thousand people for night-stay on any given day. The ultra-orthodox Tablighi Jamaat is a fringe group. Their strict rules of conduct keep their members wrapped up in prayer and a generally monastic life. As a result, members keep to themselves, and very few cases spread out into Delhi from the Markaz, even in the cramped ghetto of Nizamuddin Basti, where the lanes are so narrow that you cannot even stretch your arms out fully from side-to-side as you walk through them.

After the Tablighi Jamaat cases were detected, Nizamuddin Basti was sealed off for 70 days, thousands of people were quarantined and tested, but, to the best of my knowledge, no cases were found there apart from those in the Markaz.

The Tablighi Jamaat story very clearly demonstrates the ways in which containment strategies of sealing off areas, contact tracing and quarantining can be used by governments to target and victimise people.

The Tablighi Jamaat story very clearly demonstrates the ways in which containment strategies of sealing off areas, contact tracing and quarantining can be used by governments to target and victimise people. The government had actually begun routine contact tracing of Tablighi Jamaat members in mid-March, before the lockdown. What appears to have happened was that one person who had visited the Nizamuddin Markaz from outside Delhi, early in March, had fallen ill and succumbed to Covid-19 on returning home. In the third week of March, on the eve of India's lockdown, the Central Government had written to state governments to contact trace Tablighi Jamaat members (115). All this was going on quietly in the background while the Indian public was rivetted by the migrant labour crisis, which had hit the news with a bang within days of the lockdown. For forty-eight hours the television and papers went cover-to-cover excoriating the government for having overlooked the devastating effect on India’s poor of the imposition of its shock lockdown. The Government had clearly been utterly unheeding of Indian realities in making its shock announcement of lockdown seeking, as it seems, only the approval of the WHO which, even while Covid-19 was showing itself to be the disease of the richest cities of Europe and the USA (Paris! Milan! London! New York!), was issuing press briefings all through late March invoking the world’s “poor” and “densely populated” countries as determining the course of this disease (36).

Now the Indian government, after getting a star and smiley face from the WHO for locking down, suddenly found itself being stood in the corner by the Indian public that it had forgotten about. This is when the Tablighi Jamaat story which had begun before the lockdown, suddenly entered the news (115). A slick move, indeed, as overnight the main news story changed from the migrant labour crisis to Muslim “super-spreaders”. While Donald Trump was tweeting about the “Wuhan-virus”, hashtags like “CoronaJihad” were trending in India.

The Tablighi Jamaat were shown on live television being taken under police escort from the Markaz where they had been quarantining themselves, to another place where they would be quarantined by their caring Government, and given a “medical check-up” of whose intimidating and humiliating nature no one was in any doubt. One Jamaati was so scared that he attempted suicide (37).

It was an absolutely perfect opportunity for a certain quarter in India to give free reign to all its malice against Muslims. Jamaatis were accused of “spitting”, a high crime under the reign of Covid-19.  In reality, spitting is a common Indian habit, especially among the poor who are great fans of the betel nut, which is enjoyed by tucking it into a corner of the mouth, where it generates copious amount of saliva, which is then spat out expertly in bright-red jets. The corners of government offices and law courts in North India are often stained red from expectorated betel juice. But this commonplace indulgence gave great scope for those with a grudge against Muslims to accuse them of deliberately spreading Covid-19. Riled up residents of the neighbourhoods to which they were bused for quarantine, claimed the Jamaatis spat on the road, “deliberately” (116)! It would have been better to have left the Jamaatis to quarantine in the Markaz where they were found, but riling people up is just what was wanted.

Delhi’s Chief Minister, who is a great fan of the Northern European welfare state model, and, along with other public health enthusiasts, sees Covid-19 primarily as a challenge to keep numbers down, lashed out at the Jamaatis. The previous week he had issued an order restricting the size of public gatherings which no one, not just the Jamaatis, had heeded. He dug up the order at a press conference to show how he was being a good boy about Covid-19 when the Jamaatis did their “harkat” or “mischief”, and spoilt everything (117). No one asked him about the millions who had been circulating all around Delhi at the same time on crowded public transport and other places. No one asked him about the festival of Holi that had just been played by many Hindus in Delhi, including this writer, with throwing coloured water on each other and generally engaging in Covid-enhancing behaviour.

7.2 The Shincheonji Church Affair in South Korea

The Tablighi Jamaat affair was only one of many examples of discrimination from around the world against minorities in the toxic social distancing atmosphere that was encouraged in response to Covid-19. In South Korea, an early Covid-19 outbreak was traced to a small Christian sect called Shincheonji. Even though South Korea made not locking down a matter of pride in their Covid-19 response, the Church’s members were blamed for gathering despite the Covid-19 threat, and, as is typical in all religious targeting for the epidemic, portrayed as holding themselves above the risk of infection, because of their blind faith in God.

This was the story. But a White Paper on this episode by a number of European human rights groups, including a body called Human Rights Without Frontiers and some international groups speaking for Christian minorities worldwide, painted a very different picture (119). The Shincheonji sect was deeply unpopular in South Korea and had a history of discrimination there. The woman from this Church who was said to have infected others, had been hospitalized in February after being involved in a minor car accident. She had been diagnosed with a cold and sent home. Thereafter, she went about her normal life, including attending the Shincheonji gatherings. She was diagnosed with Covid-19 only several days later, when her condition worsened and she had had to go to hospital again. The woman said that she had not refused to be tested for Covid-19 and that doctors were making these claims to cover their own mistake in missing her infection previously.

The White Paper conceded that some people had tried to hide their association with Shincheonji when the contact tracing exercise was undertaken, but this was because the Church was so unpopular that they feared repucussions, including losing their jobs if their association with it was disclosed.

So once again, you have the same pattern of stigma, finger-pointing and fear generated by containment measures. The White Paper on the Shincheonji episode also gives some interesting information on how religious minorities have historically been targeted during epidemics. Even during Covid times the Wall Street Journal ran a story luridly titled “Coronavirus is spreading at religious gatherings, ricocheting across nations” (120). Actually, what is abundantly clear is that it was international travel and trade by the sort of reader who takes the Wall Street Journal that was making Covid -19 “ricochet across nations”.

If you follow countries as they trace back their outbreaks you will see that Covid-19 spread in diverse settings and from diverse vectors of transmission all at once – travel, sports events (like a big football match in Italy against a Spanish team), festive family reunions (in China over their annual Spring festival), social events at exclusive clubs (in Rio de Janeiro) and bars (in Japan and South Korea), big street celebrations (like Mardi Gras in Louisiana and beer festivals in Germany), choir groups (in Washington State), from doctors, in hospitals, in communal settings like old age homes and even International Women’s Day parades held in early March in Paris and Madrid.

7.3 The Myth of the "Super-Spreader"

At the start of an outbreak, no one knows where a disease is going to come from. It takes weeks of painstaking contact-tracing to build up a picture of the transmission-routes of a disease. But religious gatherings are easy to spot; and an easy target for blame. Take, for instance, what happened when the first cases were detected in Free State in South Africa. Among the first cases, five were traced to a church gathering. It looks as though the church gathering was responsible, but the people coming there had caught the infection from many different parts of the world - the USA, France and Israel. So foreign travel played as much of a role here as attending church (121). On the same day as these cases were found, South Africa’s “Patient Zero”, who had imported the infection from Italy, was reported to have recovered. But despite this vigilance with early tracing and quarantining of cases, South Africa went on to have a substantial Covid-19 outbreak. So even the identification of Patient Zero and of public gatherings with infected patients, has limited value in actually containing a disease that is coming into a country from everywhere (122).

Identification of “super-spreaders” has to be understood with a little less of the “gotcha” attitude.

This is why the identification of “super-spreaders” has to be understood with a little less of the “gotcha” attitude. You can have no super-spreaders, no patient zero and still have a massive outbreak, as in Paris or New York. Or, as in New Delhi, you can find and isolate super-spreaders like the Tablighi Jamaat, and still have a massive outbreak months later. In late June, the super-rich New Delhi colony of Jor Bagh was sealed after a sudden outbreak of Covid-19. There is no question of any Jamaati ever having met a single person from there.

There are no clear figures on how many cases were eventually traced back to the Tablighi Jamaat. The Health Ministry claimed in mid-April that over 4000 cases were linked to the event, but while the controversy was raging, the Central Government insisted on taking over publication of Covid data from the autonomous Indian Council of Medical Research (ICMR). There are no details as to how cases were attributed to the Tablighi Jamaat, whether they were linked to any Jamaat event in the Nizamuddin Markaz, or merely people who had stayed or passed through the building, whether the figure quoted refers to contacts, i.e., suspects or confirmed cases, and so on.  Even assuming the Government’s figures attributed to the Tablighi Jamaat are fair and correct, today, just three months on, with India at over 10 lakh cases and more than 26,000 deaths, the Jamaat event is so small as to be invisible in the full picture of its Covid-19 outbreak.

Super-spreaders are not those who drive disease outbreak, they are simply those who are most easily identified as spreaders by contact tracers.

Super-spreaders are not those who drive disease outbreak, they are simply those who are most easily identified as spreaders by contact tracers. We should stop using this stigmatising expression. This has already been recommended by UNAIDS which, based on its experience with AIDS, published a paper early in the Covid-19 pandemic warning that expressions like super-spreader should not be used (123).   

7.4 Pandemic of Stigma, Racism and Xenophobia

South Korea attracted widespread praise for keeping its Covid-19 numbers low using vigorous testing and contact tracing. But we also need to take note of the discrimination and blaming of those who fell sick, that ran in parallel with these containment efforts. After several weeks free of Covid-19 cases, there was a second outbreak in South Korea which was traced to an area said to have a number of gay night clubs. Hostile remarks targeting gays were made on videos of the night clubs and, as in the case of the Shincheonji Church, people were driven underground to avoid testing and quarantine. There were also stories from South Korea of establishments putting up posters barring Chinese or all foreigners from entry.

Chinese people abroad, and people with racial features similar to theirs, were targeted all over the world, from India to the USA. At the same, time there were reports of racism in China against Africans who were being thrown out of their rented accommodations and denied entry into restaurants owing to fear of “imported cases” of Covid-19. This attracted sharp rebuke from the African Union (124). The list of xenophobia, racism and discrimination sparked by Covid-19 goes on and on. It got so bad, that Wikipedia has taken out a separate page dedicated to such incidents under the title “List of Incidents of Xenophobia and Racism related to the Covid-19 pandemic” (125).

7.5 The Trail of Death-by-Lockdown

Some countries like Bangladesh, and many in Africa, went to the extremes of deploying their armies to enforce disease containment measures (126). In Bangladesh, the Army Chief claimed that his troops patrolling the streets made the populace “mentally relieved” and had “highly energized” them! Human Rights Watch claimed that civilians, including academics and Opposition party workers, had been arrested for posting social media messages on Covid-19 that the Bangladesh Government called “rumours” and “propaganda” (127).

In Nigeria, by the middle of April, eighteen people had been killed by armed forces and police in the enforcement of lockdown. More than the total number of people dead of Covid-19 in Nigeria by that time (128). In Kenya, a 13-year old boy was killed by a bullet fired in the air by the police to impose Covid-19 curfew (109).

I have already described the killing of people in the poor, black neighbourhoods of South Africa by the Army and police while enforcing lockdown. There were 3 deaths in South Africa in the first 3 days of lockdown. The number grew to 8 in the following week (28). By this time, the lockdown mentality had taken such firm hold that even the BBC, which has positioned itself as the voice of social justice around the world, published laudatory reports praising “South Africa’s ruthlessly efficient fight against coronavirus” and President Cyril Ramaphosas’s “formidable leadership”. While young men were being shot to death in front of their children for drinking beer by the South African Army, which had been unleased on the country to enforce lockdown by Ramaphosa, the BBC described him as “composed” and “compassionate”. The shooting of civilians was brushed off as the mistakes and thuggery of the police alone (129). Ramaphosa even claimed that the WHO had commended South Africa for “acting swiftly and for following scientific advice to delay the spread of the virus” (130).

People of the developing world, especially coloured people, should take note of how quickly the West forgot about human rights and civil liberties, the things they keep lecturing us about and claim to have gifted to us.

People of the developing world, especially coloured people, should take note of how quickly the West forgot about human rights and civil liberties, the things they keep lecturing us about and claim to have gifted to us. The biggest irony of all, is the way in which the Western press began in January and February with criticism of China for its harsh measures against Covid-19, and then proceeded to vigorously advocate them itself.

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The trail of death-by-lockdown was not limited to shootings by security forces in Africa. In India, the government responded to the news of migrant workers streaming out on the highways by putting the police there to stop them, and send them back to the cities. After a good beating, of course. So the migrant workers began to take off-highway routes out of the cities. The trains had been stopped for lockdown, but the tracks provided a clear open route back home. With the authorities focused on the highways, there was a good chance of making it home without being caught. It worked, no one knew this was going on until one early morning, in the first week of May, when a group of migrant workers who had camped along the tracks for the night were run over by a goods train. Sixteen of the group were cut to shreds by the train (131). Since passenger trains had been stopped by lockdown, some goods trains were being run, at double the usual speed, on passenger routes. But the public hadn’t known about this.

By the time of writing, road accidents, heat stroke, exhaustion and hunger had taken hundreds of lives among the migrant workers, and their children and babies on the journey home (132). Hundreds, that is, were identified. We will never really know the full extent of the numbers who fell victim to this perilous and unnecessary, but for lockdown, journey. These were informal, undocumented workers, making an informal, undocumented journey; forced to run from hunger, while hiding from the authorities who were flattening the curve and being responsible public health administrators according to the expert advice of the WHO, and such eminences as Richard Horton, editor of The Lancet. Horton wanted a 10-week lockdown for India (133). 

The adoption of containment measures is phrased by epidemiologists like the Covid Experts Group as a false choice between saving lives and saving the economy. In their report of March 26^th, the Covid Experts Group says, “We do not consider the wider social and economic cost of suppression, which will be high….Our analysis highlights the challenging decisions faced by all governments in the coming weeks and months, but demonstrates the extent to which rapid, decisive and collective action now could save millions of lives” (7). 

But while epidemiologists talk of a choice between the economy and saving lives, in its Guidance for Managing Ethical Issues in Infectious Disease Outbreaks of 2016, the WHO itself shows that it was, at least at that time, alive to the fact that the two are not separate: “Even short term restrictions on freedom of movement can have significant – and possibly devastating – financial and social consequences for individuals, their families, and their communities.”

Governments have finally woken up to what was obvious all along, which is that the economy and health are inextricably tied up with each other. So even though the Covid Experts Group and other epidemiologists wanted indefinite lockdown till drugs or vaccines were found, governments everywhere are scaling back their containment measures. This is not a “choice” between health and the economy. Lockdown was affecting health too. And killing people.

Governments have finally woken up to what was obvious all along, which is that the economy and health are inextricably tied up with each other. So even though the Covid Experts Group and other epidemiologists wanted indefinite lockdown till drugs or vaccines were found, governments everywhere are scaling back their containment measures. This is not a “choice” between health and the economy. Lockdown was affecting health too. And killing people.

For the WHO to have advocated a strategy that imperilled the lives of so many, and put so many more through hunger and deprivation, is all the more outrageous when you consider that death from accidents (“unintentional injuries”) and malnourishment are actually declared as heads of disease in its Global Burden of Disease profile. By the WHO’s own logic, therefore, no excuses are allowed for anything, not even fate, when assessing the health of a people. This is the only logic for the WHO to have included things like death by “unintentional injuries” are included in the WHO Global Burden of Disease listings. By including malnourishment in its Global Burden of Disease profile, it is the WHO that tells us that there is no choice between the economy and lives. So how could the WHO have advocated and supported disease containment measures when they put people in the way of the very deprivations and accidental deaths that the WHO itself says have to be eliminated from life? What has the WHO gained, other than its own aggrandizement, by making a global project of these universalist and totalizing claims about health, disease and death?

 

7.6 The Reality of the WHO's "All-of-Society and All-of-Government" Approach to Disease Containment

For the WHO to have advocated a strategy that imperilled the lives of so many, and put so many more through hunger and deprivation, is all the more outrageous when you consider that death from accidents (“unintentional injuries”) and malnourishment are actually declared as heads of disease in its Global Burden of Disease profile. By the WHO’s own logic, therefore, no excuses are allowed for anything, not even fate, when assessing the health of a people. This is the only logic for the WHO to include that things like death by “unintentional injuries” are included in its Global Burden of Disease listings. By including malnourishment in its Global Burden of Disease profile, it is the WHO that tells us that there is no choice between the economy and lives. So how could the WHO have advocated and supported disease containment measures when they put people in the way of the very deprivations and accidental deaths that the WHO itself says have to be eliminated from life? What has the WHO gained, other than its own aggrandizement, by making a global project of these universalist and totalizing claims about health, disease and death?

To really place the Covid-19 saga in context, we have to get a full understanding of how the WHO and public health thinking in general have cultivated a global culture of health extremism, without, as it turns out, actually believing in it themselves. 

This was how it went: dealing with sickness and death was not enough to contain the big bleeding hearts of the WHO and the public health field. So they made longevity into an index of national health. Now societies were declared to be callous and irresponsible if they did not manage to make their people survive till past 80. Because endless lonely years in an old age home is, obviously, the end that everyone desires and deserves. There are no marks here for poorer countries having, as the Covid Experts Group noted, much wider social contact and integration of the elderly, than in richer countries.

Even this was not enough to satisfy the all-encompassing and infinite concern of the public health policy field. They evolved the concept of DALY – Disability-Adjusted Life Years. Life was to be measured not in years, but in time lived without disease or pain of any kind. In this way, health became no mere matter of disease and injury but a bizarre ideal where there would be no sickness or accident, and, it seems even death would be indefinitely postponed, if not eliminated altogether. I alternate between finding this comical and deeply unsettling. Who are these weirdos at the WHO to whom we have outsourced thinking about so important and personal a matter as our health, and that of our children?

The Misery and Failure of Disease Containment for Ebola

Even though the WHO led with a containment approach for Covid-19, there was already a lot of evidence that this was not working very well, from the Ebola epidemics of West Africa. Contact tracing made people feel victimized for falling ill, and resentful of health officials. 
Foreign funds given to hygiene “sensitizing” campaigns came to be seen as nothing more than a money-making racket (29). West African governments have been accused of using Ebola, and now Covid-19, outbreaks as an excuse to postpone elections and target opposition strongholds (134). Contact tracing, identifying “super-spreaders”, attributing the spread of infection to age-old food habits or burial rituals, which epidemiologists and the WHO see as benign processes to help contain epidemics, all make people feel targeted and alienated (135). Mandatory quarantine in government centres without basic facilities and the insistence on bringing victims for treatment in designated hospitals, where they are completely isolated from their loved ones, is traumatizing for both patient and family (30).

A 1995 report from the Ebola outbreak in the Democratic Republic of Congo (then known as Zaire) describes people running away from quarantine with help from the community, and of villagers resisting Red Cross trucks that came to take the sick away for treatment (31). 25 years and four outbreaks later, the same scenes are described by Human Rights Watch in the 2020 Ebola-gripped Democratic Republic of Congo. Resentment has spilled into hatred, with cases of health workers being murdered by local militias (134).

The freezing of borders in West Africa and designating so-called “containment zones” cuts off villages and towns, leaving people short of medicine, food and other supplies. There is economic damage from weeks and months of lockdown. The closure of international borders between Ebola-affected West African nations in the 2014-16 outbreak is said to have grossly interfered with the dense historical social, filial and economic links between these nations, making the breaches by the public of border restrictions inevitable, and even necessary (29).

All measures of disease containment, which the WHO believe are routine and beneficial, cause immense suffering to the people. They also appear to have little effect. There have been five Ebola outbreaks in West Africa since 1976; each outbreak reads like a repeat of the previous one, with the disease inexorably raging through small clusters in villages and cities, and then abruptly stopping, regardless of containment measures.

In this way, all the measures of disease containment, which the WHO believe are routine and beneficial, cause immense suffering to the people. They also appear to have little effect. There have been five Ebola outbreaks in West Africa since 1976; each outbreak reads like a repeat of the previous one, with the disease inexorably raging through small clusters in villages and cities, and then abruptly stopping, regardless of quarantine measures, contact tracing, locking the borders, PPE kit supplies and so on.

Hospitals have been the origin of Ebola outbreaks on successive occasions despite all the forewarning and preparedness about this. What more proof do we need that containment does not work for a sufficiently contagious virus?

Each Ebola outbreak has been bigger and lasted longer than the last, and yet the WHO has applied the same containment approach each time, without questioning whether it may be ineffective, or worse, contributing to the successive rise in epidemic size.Instead of introspecting, the WHO makes a big song-and-dance about “communicating” the importance of measures to the people. Maybe the WHO should start communicating by 

Each Ebola outbreak has been bigger and lasted longer than the last, and yet the WHO has applied the same containment approach each time, without questioning whether it may be ineffective, or worse, contributing to the successive rise in epidemic size.

The Army is routinely called out in West Africa to enforce containment. In 2014, Sierra Leone passed a law making it a crime, punishable with 2 years’ imprisonment, to shelter Ebola patients (134).In this manner, since the 1970s, when the WHO first instituted containment measures as an Ebola response, more and more force has had to be used in West Africa to make people adhere to them. This is at least an indication that they are not working. But no one asks why people resist containment measures if it is so clear that they are working for them. Instead of introspecting, the WHO makes a big song-and-dance about “communicating” the importance of measures to the people. Maybe the WHO should start communicating by listening to the people whom it is supposed to be saving.

Every time there has been an Ebola outbreak in West Africa since the 1990s, scholarly articles have been written on the need to build trust in the community, to engage the public in agreeing to changes to their burial rituals, on the need for general improvement in West African health infrastructure, on whether the blame lies with the colonial legacy or global disparities, whether it is right to blame the consumption of bushmeat for the spread of the disease, and whether, even if this is responsible, it is the result of ecological damage, and so on (29, 32).While all of this is well-meant and correct in its way, it completely ignores a more prosaic and, perhaps for Western commentators, less exotic reason, for the resistance from the general public to non-pharmaceutical interventions. This being that they are oppressive, ineffective and do harm beyond the disease itself. As Ignace Gata Mavita, the Mayor of Kikwit, the epicentre of the 1995 Ebola outbreak in Zaire said to an American reporter “It’s good to issue a quarantine, but they have to find another solution or we will have dire economic circumstances….If the quarantine continues much longer the world may have its solution, but we will starve. When people don’t eat well, their health suffers, and they will create another crisis. Here in Kikwit we know the link between hunger and disease” (31).

Similar frustration is expressed by people in the poultry business in India, Vietnam and other Asian countries where the WHO insists on their changing age-old informal home-based poultry rearing based on scanty scientific evidence, and demands widespread culling of poultry after a few cases of illness. Again, instead of reconsidering its kill-and-contain policy, the WHO accuses the locals of being ignorant, irresponsible and so on (136).

What Fraction of n=1 Were India's Dead Migrant Workers? 

The WHO’s single-minded focus on disease containment as a public health strategy misses the fact that disease sits inside people. Its war on disease becomes a war on the people. The blindness of the WHO and public health field in general to the obvious failures of non-pharmaceutical measures in West Africa speaks to the extent to which the dogma of disease containment has taken hold of them. The way in which the WHO and public health policy have extended their reach into the depths of people’s lives by using stretched and abstract concepts of health, disease and death, while winking at the real ill-health, disease and death caused by their proposed containment measures, should be a standing lesson to the world of the insensitivity and arrogance of public health thinking. 

The way in which the WHO and public health policy have extended their reach into the depths of people’s lives by using stretched and abstract concepts of health, disease and death, while winking at the real ill-health, disease and death caused by their proposed containment measures, should be a standing lesson to the world of the insensitivity and arrogance of public health thinking.

While migrant workers in India were dying, their young wives becoming widows, their children orphaned, their ageing parents losing their only support in life, this is what Mike Ryan of the WHO had to say about India’s lockdown in late March: “society-wide measures are difficult, they are not easy and they are hurting people. But the alternative is even worse……But unfortunately in some situations right now they’re the only measures that governments can actually take to slow down this virus and that’s unfortunate but that is the reality and we need to continually explain the reasons for this to our communities” (19). That’s right, “explanation” is what was needed by the women giving birth in India on the sides of highways on the long escape from lockdown.

While migrant workers in India were dying, their young wives becoming widows, their children orphaned, their ageing parents losing their only support in life, this is what Mike Ryan of the WHO had to say about India’s lockdown in late March: “society-wide measures are difficult, they are not easy and they are hurting people. But the alternative is even worse……But unfortunately in some situations right now they’re the only measures that governments can actually take to slow down this virus and that’s unfortunate but that is the reality and we need to continually explain the reasons for this to our communities”.

When insisting on a containment approach to Covid-19 on March 9^th at an international press briefing, Mike Ryan sanctimoniously lectured the world about how while in epidemiology “we talk about the n, the size of the population we’re dealing with….Well, for me, as a medical professional, n equals one. Every person matters” (17). What happened to these lofty sentiments when Mike Ryan endorsed India’s lockdown three weeks later, despite what it was doing to its people? What fraction of n=1 were the dead migrant labourers, their women giving birth on the highway, their babies starving to death on the way home, and their orphaned children?

Two months later, in May, when stories of the plight of the poor in India under lockdown must have finally registered with the WHO, they tried to backtrack from it. They trotted out their Chief Scientist, Soumya Swaminathan, who luckily for them, happened to be an Indian.  In a television interview in early May, Soumya Swaminathan said, cool as a cucumber, that the WHO had never recommended lockdown (39). Given the things that the WHO was saying in March about India, which I have quoted above, this is stretching the truth as far as any smooth-tongued WHO bureaucrat can make it go.

From the start the WHO has insisted on a containment strategy for Covid-19, insisting that even mitigation will not do. Mitigation being measures to contain the virus within cluster outbreaks, instead of what Mike Ryan calls “society-wide” measures. The Director General of the WHO, Tedros Adhanom, repeatedly insisted that there must be an “all-of-society” and “all-of-government” approach “built around a comprehensive strategy to prevent infections” (18, 17). He said that he wanted to have an approach that mobilized “the whole society” and made “the response everybody’s responsibility” (18). Maria Van Kerkhove, the WHO’s Covid-19 Technical Lead, said that what was required was “repurposing your government to tackle this one virus” (18). 

The WHO got what it asked for. I first came across this phrase “all-government, all-of-society response” in the WHO-China Joint Mission Report on Covid-19. At the time I rolled my eyes at this as something the Chinese must surely have put in. Then I read Tedros Adhanom repeatedly use this ominously Great Dictator-like expression at his Covid-19 press briefings, where it was faithfully echoed by his officials, Mike Ryan and Maria Van Kerkhove. 

Let us pause a moment and ask ourselves what does an “all-of-government, all-of-society response” mean? All the people who bore the brunt of Covid-19 discrimination, racism, stigma and bigotry around the world could tell us a lot about this.

Let us pause a moment and ask ourselves what does an “all-of-government, all-of-society response” mean? All the people who bore the brunt of Covid-19 discrimination, racism, stigma and bigotry around the world could tell us a lot about this. Tedros Adhanom should ask the Tablighi Jamaat members and their families how they felt about all-of-Indian-society hunting them down them with all-of-the-Indian-government for Covid containment. Maria Van Kerkhove should ask Indian migrant workers how they feel about the entire government “repurposing to tackle this one virus”. When the dead workers’ orphans grow up Mike Ryan should ask them how they feel about their parents who were flattened by trucks and trains as they were forced to walk home from lockdown-induced famine in the cities where everyone was following his global directives to “flatten the curve”.

In a way, Soumya Swaminathan was correct, the WHO did not specifically recommend lockdown. Even the Chinese do not mention this word anywhere in the WHO-China Joint Mission Report. Going by this Report, even social distancing appears to have been marginal to the Chinese strategy on Covid-19. The main intervention of the Chinese for disease containment was to effectively imprison all Covid-19 suspects in hospital. By hunting the sick down in their homes, going door-to-door through their Communist Party cadres and by sniffing out Covid suspects using GPS-tracking, and dragging them all to compulsory hospital confinement. This is what was the “all of society, all of government approach” that Tedros Adhanom so fulsomely praised in his January briefings was all about. This is not what we can or should have.

Where, in any open and democratic society, is the uniformity, obedience and single-mindedness that is implied in the phrase “all-of-society, all-of-government”? In truth it does not exist anywhere, except where it is rammed down the throats of the people by totalitarian and abusive regimes. 

Mistrust of authorities is our shield against government intrusion and incompetence. Where, in any open and democratic society, is the uniformity, obedience and single-mindedness that is implied in the phrase “all-of-society, all-of-government”? In truth it does not exist anywhere, except where it is rammed down the throats of the people by totalitarian and abusive regimes. 

As an African, Adhanom should feel ashamed for what he has brought upon his compatriots with Covid-19 containment. He should have known that some African governments would be trigger- happy with calling out their armies to enforce containment, and that in places like South Africa, poor blacks would be at risk of being shot at. As an Indian, Soumya Swaminathan should likewise be ashamed of what the WHO has brought upon India. She should have anticipated the communal forces that would be unleashed, the stigma that would have followed all the social distancing propaganda and the hunger and deprivation that would follow lockdown. If public health officials don’t know their people, then what good are they? Why do we have a concept of public health if it does not consider the people, their culture, their weaknesses and strengths? If the WHO feels that taking these factors into consideration is “political”, then it should stay its hands and not recommend any measures at all. Because it is always political.

7.7 Lockdown of Human Rights

In a paper published on March 20^th called “Rights in the time of COVID-19”, UNAIDS sets out step-by-step the inherent danger, injustice and futility of this approach, predicting with devastating accuracy the wrongs of each type, petty and profound, that came to pass under the reign of WHO-prescribed Covid-19 containment measures.

Even while the public was being hustled into accepting lockdown and containment measures, some experts, like UNAIDS, tried to warn the world of exactly these things. In a paper published on March 20^th called “Rights in the time of COVID-19”, UNAIDS starts by picking up on Adhanom’s repeated exhortation for countries to respond to the Covid-19 pandemic with “containment as the central pillar”. UNAIDS says: “Countries are being requested to take a comprehensive approach…with containment as the central pillar. However, as in all acute epidemics, especially where causal person-to-person transmission occurs, there is a need to ensure that the response is grounded firmly in human rights.” Drawing from its own, and incidentally also the WHO’s experience, of years fighting AIDS, UNAIDS then sets out step-by-step the inherent danger, injustice and futility of this approach, predicting with devastating accuracy the wrongs of each type, petty and profound, that came to pass under the reign of WHO-prescribed Covid-19 containment measures:

“Forty years of responding to the HIV epidemic has generated significant experience and lessons learnt on the importance of a human-rights based approach to ensuring effective and proportionate responses to epidemics…..swift action must not be rendered ineffective by existing inequalities…..and barriers related to cost, stigma, privacy and concerns around employment and livelihoods….

“In times of fear and panic, some countries may resort to politically driven, restrictive, stigmatizing and punitive measures. These may include compulsory blanket travel restrictions, quarantining large groups of people, combining people who have and people who do not have the virus, publishing the names and details of people who have the virus, using stigmatizing language such as “super-spreaders” or criminalizing people who may have breached restrictions or transmitted the virus to others.

“From the HIV epidemic we have learned that restrictive, stigmatizing and punitive measures can lead to significant human rights abuses, with disproportionate effects on already vulnerable communities…..

“Governments need to work to prevent the creation of stigmatizing view or attitudes…UNAIDS’ experience is that such stigma only serves to send people and communities underground and ultimately threatens the success of any response.

“Words matter The way governments, communities and the media speak about an epidemic, its modes of transmission and people who have the virus can all shape the way people and communities are perceived and treated. Avoiding phrases such as “super-spreader”…can make a difference as to whether people feel empowered and willing to be tested and self-isolate, or to provide help to others in need…

“Criminalisation is not the answer and can do more harm than good: ….Use of criminal laws in a public health emergency is often broad-sweeping and vague and they run the risk of being deployed in an arbitrary or discriminatory manner. People caught up in a criminal or punitive approach are also often the more vulnerable members of society.”

It was not just UNAIDS who had the knowledge and the experience that showed containment measures to be, in practice, unjust, discriminatory and stigmatising. The issues raised by UNAIDS are anticipated a document prepared in 2007 by the WHO called “Ethical considerations in developing a public health response to pandemic influenza”. About public health measures such as isolation, quarantine, social distancing and border control, this document says:

“Many critical ethical questions arise in pandemic influenza planning, preparedness and response. These include…….How can surveillance, isolation, quarantine and social-distancing measures be undertaken in a way that respects ethical norms? …The purpose of this document is to assist social and political leaders at all levels who influence policy decisions about the incorporation of ethical considerations into national influenza pandemic preparedness plans…

“While all of these measures can legitimately be attempted in order to delay the spread or mitigate the impact of an influenza pandemic, the burden they place on individual liberties requires that their use be carefully circumscribed and limited to circumstances where they can be reasonably expected to provide an important public health benefit…..policy makers should pay specific attention to groups that are the most vulnerable to discrimination, stigmatization or isolation, including racial and ethnic minorities, elderly people, prisoners, disabled persons, migrants and the homeless…..Plans related to isolation of symptomatic individuals and quarantine of their contacts should be voluntary to the greatest extent possible….ensure safe, habitable, and humane conditions of confinement….”.

Another WHO publication from 2016, “Guidance for Managing Ethical Issues in Infectious Disease Outbreaks” reiterates the immediate risk of discrimination and heightening of prejudices in an infectious disease outbreak:

“Members of socially disadvantaged groups often face considerable stigma and discrimination, which can be exacerbated in public health emergencies characterized by fear and distrust. Those responsible for infectious disease outbreak response should ensure that all individuals are treated fairly and equitably regardless of their social status or perceived “worth” to society. They should also take measures to prevent stigmatization and social violence…

“even when public health measures are designed with the best of intentions, they can inadvertently place a disproportionate burden on particular populations. For example, quarantine orders that require individuals to stay in their homes can have devastating consequences for persons who need to leave their homes to obtain basic necessities such as clean water or food….

“Infectious disease outbreaks can exacerbate social unrest…and induce violent behaviour, especially against vulnerable groups such as minority populations……

“Officials involved in outbreak planning and response efforts should be prepared for the possibility that specific populations may be targeted as being the cause of the outbreak or provoking transmission; strategies should be proactively designed to protect such groups from a heightened risk of violence.”

If all this work, some of it by the WHO itself, had been given its due, lockdown and containment would not have been so severe, brutal or overemphasised as it was. There might even have been a chance that we would have decided not to go for lockdown, and do what we are now doing, which is to keep the economy and social life going, while doing cluster containment where cases break out, but in a humane way, recognising the invasion of rights, the possibilities of government overreach, and giving people recourse against this. We have to recognise that containment measures are inherently unjust. Rather than demanding adherence to them as a matter of social responsibility, we should see them for the imposition that they are, applying them in as limited a manner as possible, and with procedures that give full scope for individuals to challenge them.

If all this work, some of it by the WHO itself, had been given its due, lockdown and containment would not have been so severe, brutal or overemphasised as it was by the current dispensation at the WHO. There might even have been a chance that we would have decided not to go for lockdown, and do what we are now doing, which is to keep the economy and social life going, while doing cluster containment where cases break out, but in a humane way, recognising the invasion of rights, the possibilities of government overreach, and giving people recourse against this. We have to recognise that containment measures are inherently unjust. Rather than demanding adherence to them as a matter of social responsibility, we should see them for the imposition that they are, applying them in as limited a manner as possible, and with procedures that give full scope for individuals to challenge them.

....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 19th, 2020. Watch the video here. Listen to the podcast here.

Follow the lectures everyday at 7pm India time (2.30pm London/9.30am New York) on Facebook Live @ Suranya Aiyar.

Read the full paper here.

NOTES AND REFERENCES

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

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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.