Covid Lectures Part 9: Why Not Pharmaceutical Intervention and Other Unanswered Questions

Part 9: Why Not Pharmaceutical Intervention and Other Unanswered Questions

The epidemiologists told us that if Covid-19 was allowed to spread unchecked, then billions would be infected, and millions would die. The World Health Organisation and public health experts told us that, therefore, we had to have a disease-containment strategy that would stop the virus from spreading. On this basis, the epidemiologists and public health fraternity told us to “flatten the curve!” The idea, they said, was to bring the number of infections to within manageable levels. 

But Covid-19 proved to be unmanageable whether you had one case or a billion. For reasons that we do not, as yet, understand, Covid can be mild and clear up in a few days, or have you choking to death in 9 days flat. No amount of flattening the curve can solve this problem. And it is a problem of some significance if you or a loved one are on the curve, however flat it may be. But this is a problem not of containment, but of treatment.

Why, when anti-virals, were known to be effective in reducing the severity of viral infections, was the WHO and public health field in general so focused on “non-pharmaceutical” interventions? Because we do have medicines for viral diseases. This is how AIDS was brought under control. With anti-viral drugs you can be HIV-positive for years, for decades even, without falling ill.

Anti-virals and medicines like hydroxychloroquine do not “cure” viral disease, in the sense of eliminating them from the body, but they are well-known to reduce the severity of infection, which can also be life-saving. 

In epidemiological work on pandemic influenza, the assumption is that anti-virals can be given for viral infections, both as a preventive and as treatment. For instance, writing in the journal Nature in the year 2006, Neil Ferguson and colleagues say that: “prompt treatment with antivirals reduces clinical severity and infectiousness” (11). Even the WHO has acknowledged the efficacy of anti-viral drugs and medicines like hydroxychloroquine in retarding the progress of viral infections (19). 

So we need to turn away from those hypnotising exponential graphs of the epidemiologists, and look into why disease containment rather than treatment has become the guiding principle of public health interventions for epidemics, despite the availability of medicines. The formal name for disease containment is “Non-Pharmaceutical Measures”. This gives us some hint of what might be going on. The negation implied in this expression is of Pharmaceutical Measures, i.e., medicines. So the question that arises is this: Did the idea of disease containment arise as an alternative to, or perhaps even in opposition to, pharmaceutical measures?

Writing in 2006 about non-pharmaceutical interventions for pandemic influenza, the WHO Writing Group rejects pharmaceutical interventions saying that the availability of antiviral agents is “insufficient” and that while pandemic preparedness “ideally would include pharmaceutical countermeasures (vaccine and antiviral drugs), but for the foreseeable future, such measures will not be available for the global population [of more than] 6 billion” (20).

But this was clearly a huge underestimation of the capacity of countries to deploy anti-virals. We saw earlier that it was the poorer countries in Asia and Africa that were the first to use anti-virals, viral inhibitors and other therapies like hydroxychloroquine, ivermectin, plasma therapy and faviparivir for Covid-19 treatment. It was Bangladesh that led the way with the ivermectin and doxycycline treatment protocol. If anything, it was rich countries with their, in the case of Continental and Nordic Europe, total lack of innovation in pharmaceuticals, and, in the case of the USA, cumbersome clinical trials, that fell behind in the race for pharmaceutical interventions for Covid-19.While it may be impossible to produce drugs for all the 7 or 8 billion people in the world in a short time, this is not the way any disease progresses. You will not have all these people falling ill at once; and given the vast numbers of mild cases for Covid-19, not even all those who do fall ill will need pharmaceutical intervention.

If you think about it, this was surely something that the WHO knew very well already. Could the truth lie in the fact that no one wanted to encourage the idea of drugs when this might have meant footing the bill (or giving up patents) for drugs for infectious diseases which, until Covid-19, were really only a problem for low-income countries in Africa? As we discussed in yesterday’s lecture, high income countries have a tiny disease burden from infectious disease compared with non-infectious disease, and middle income countries show epidemiological transition, with a reducing burden of infectious disease, and an increasing one under the head of non-infectious disease.

9.2 The Curious Case of ZMapp

For many years there has been something dysfunctional in the entire approach of rich countries to drugs. A particularly sordid episode occurred during the Ebola outbreak of 2014-16 in West Africa. Some European and American health workers who caught Ebola there, were flown back home for treatment. Most of them were cured after being given a cutting-edge medication called ‘ZMapp’. There was outrage in West Africa where people had been told for decades that Ebola had no cure.

The extent of the betrayal of the West African people by this is underscored by the role played by Europeans in the two previous Ebola outbreaks. In the 1976 outbreak, it was Belgian nuns acting as nurses who spread the disease with contaminated needles used on pregnant women who had been encouraged to come in for iron shots. In the 1995 outbreak, a badly botched operation at a Missionary-run hospital set off a chain of transmission involving Italian nuns who were evacuated for special treatment to a bigger hospital in another area, unlike the locals who did not have these special privileges (31, 151).

Initially it was claimed in America that only 7 doses of ZMapp were available, which had all been used up, and so nothing remained to be sent to West Africa. But there was widespread speculation that ZMapp was still being sent to Spain and other places for repatriated European health workers. The governments of Nigeria and Liberia immediately requested the medicine to be sent to them, even while Western commentators were delivering sermons on the indispensability of clinical trials. The WHO stepped in to say that given the emergency situation, the experimental use of the drug should be allowed in West Africa (152).

This led to an outcry from academics sitting in the UK and Australia against the use of medicines for Ebola. Writing in The Lancet and the BMJ Journal of Medical Ethics these experts made the argument that looking merely at medicines to cure a few patients was “individualistic” or that this somehow betrayed what they saw as being wider community good of disease-containment measures (152, 153). This is where we get some hints of where the thrust for disease-containment is coming from among public health experts. They see disease-containment as a form of socialist, communally-minded medicine, and a moral victory over free market principles. There are certainly obvious dangers with allowing an unregulated free market circus in the medical sector. But prioritising medieval disease containment measures over medication for novel diseases is taking things a bit too far. Even with the best containment, those who fall ill want to be cured. Containment is not a cure, but medicines are. It is outrageous for public health experts to be opposing pharmaceutical interventions in poor countries as they write their papers from the richest countries of the world, with every medical facility at hand.

Luckily, common sense prevailed over these academic fulminations, and ZMapp was sent to Liberia and Nigeria. So much for the claim that “only 7” doses were available (154). Old hands at the Ebola game in West Africa, Peter Piot and David Heymann, stepped in to say that given the severity of Ebola, they themselves would have been happy to try experimental drugs for it, had they contracted the disease. They also said, pointedly, that if Ebola had broken out in the West then it was “highly likely” that the authorities would have speeded up the testing of experimental drugs for it (150). This turned out to be prescient going by the promptness with which remedisivir was put to trial in the USA after it was hit by Covid-19.

The West owes a debt to Ebola and West Africa. It was only after West Africans insisted on access to experimental drugs that attention was finally given to working on Ebola drugs, and it is in the course of this work that remedisivir was developed (154, 155). If the Lancet and other journals who had opposed experimental drugs for Ebola had prevailed, there would be no remedisivir today.

9.3 The Curious Case of Hydroxychloroquine

There have been similar controversies over pharmaceutical interventions in Covid times. We are all familiar with the controversy over hydroxychloroquine which also seems to be at least as political as it is scientific. As discussed above, hydroxychloroquine is an anti-malaria drug widely used in many developing countries. It was deployed, “off label”, meaning without clinical trials, in places like India as a prophylactic and treatment for Covid-19 as it was considered by experienced clinicians to have some therapeutic use with viral infections. This was considered routine in developing countries, but the endorsement of the drug by polarizing leaders like Donald Trump and Jair Bolsonaro led to a lot of controversy around it (156). Media outlets such as CNN and the BBC led a sustained media campaign against hydroxychloroquine, which reached its zenith when Donald Trump announced in late May that he had actually taken the drug. Days later, on May 22nd, The Lancet published a paper claiming that data showed hydroxychloroquine to be ineffective, and even harmful. Three days later, on May 25th, the WHO suspended its Solidarity trial on hydroxychloroquine, citing this paper. Doctors all over the world, including Dr Mande, the head of India’s Centre for Scientific and Industrial Research were extremely critical of this move (157). 140 scientists issued a letter refuting the claims of The Lancet article. Dr Mande described it as a “knee jerk” response by the WHO.

Curioser and Curioser

Two weeks later, The Lancet paper was discredited; basic weaknesses in the data used by it were revealed. There was also some doubt as to the credentials of those who had written the paper. The Lancet was forced to retract the paper, and similar work was retracted by the New England Journal of Medicine, and the WHO resumed trial of hydroxychloroquine.

There are two things here. One is the unreliability of stalwarts in the medical field such as The Lancet and New England Journal of Medicine, showing us once again that Covid-19 challenges all the established authorities in the medical field and that the need of the hour is new thinking, questioning and not blind conformity with what the supposed experts are saying. But what should concern the lay public even more, is how politicised science and medicine have become in the tensions that have arisen around Covid-19 (156). This is the nub of the issue for us as the lay public – we need to facilitate a cooling down of the atmosphere. If we are poised and patient ourselves, then perhaps it will open the way to a fair and open scientific investigation of all things related to Covid-19. Otherwise we will just keep sinking into the vortex of confusion that has been created by the experts who are, quite frankly, running around like chickens with their heads cut off.

9.4 The Discovery of Penicillin in Happier Times

The public also needs to better understand the role played by mistakes and sheer chance in scientific discoveries. Penicillin was discovered when some bacteria cultures were accidentally left exposed near an open window by Alexander Fleming, when he went abroad for his annual vacation. Mould formed on the open bacteria cultures. When Fleming returned, he noticed that the mould seemed to have inhibited the growth of the bacteria, and thereby hangs the tale of the discovery of penicillin.

In today’s culture of hyper-concern about safety standards, Fleming would probably never have gotten the chance to check out his mouldy petri-dishes. He would have been hauled off from his vacation to a committee of investigation for being careless about his laboratory, never to be seen again.


9.5 Why the Exclusive Focus on Severe Cases?

 

Another mistake that is being made in the response to Covid-19 is the exclusive focus on severe cases for treatment. The drugs that we have are better suited for early onset of the infection. As we just discussed what hydroxychloroquine and anti-virals do, is to inhibit viral replication in the body. It is, therefore, important to intervene early with patients. There are studies to show that each day’s delay after the onset of symptoms reduces the effectiveness of antiviral drugs. As these drugs are only able to inhibit virus-replication, they are of less use when the virus has already exploded in the body.

This is recognized even by the WHO. Mike Ryan, WHO's Executive Director of Health Emergencies, when questioned about hydroxychloroquine, said: “no one here is actually talking about cure…..Some drugs may actually prevent the virus replicating early in the disease and therefore shorten the length of the illness and reduce the progression to severe disease. 

“Once the disease is very well-established and in the later stage of the disease a lot of the damage that’s being caused by the virus is not necessarily being caused by the virus itself but all of the secondary effects; the inflammation, the organ failure and other things that happen. So a lot of antiviral therapies are focused on getting  a person with the disease treated at an earlier stage of the disease and if you look at a lot of the anti-flu medications like Tamiflu and others, the main benefit that has been found for those again has been shortening the course of illness” (19).

But treatment, and even many clinical trials for Covid-19, are overly focused on severe cases. In India, the medical advisory for hydroxychloroquine and azithromycin is confined to the severely ill. But we should be using these and other drugs early on patients to reduce severity and help avoiding the stage where the secondary effects of the disease overtake the damage caused by the virus. We should not be waiting till people need to be hospitalized, by which point we can offer them little more than supportive treatment. While testing may be useful for contact tracing, if we are not treating patients as soon as they test positive, then tests are of scant comfort to the patients themselves.

Despite all the information available on antivirals and hydroxychloroquine, the attitude of many doctors in Delhi is to say they do not know anything about that. The only advice is to report to a Covid-designated hospital in case the patient tests positive. But there are waiting lines for testing and several days can be lost, especially if you fall ill over the weekend, just waiting for the test results to come in. This is not an optimal way of combatting a galloping disease like Covid-19 that can get critical in merely nine days. This is also very different to how doctors typically function in India, where they pride themselves in their ability to diagnose clinically without asking for a battery of expensive tests. Doctors who keep sending patients for tests are considered to be incompetent at clinical diagnosis and in cahoots with testing laboratories making money off people. We need to reinstate some of this approach in India for Covid-19. The Indian Council of Medical Research should look into issuing a treatment protocol for early stages of Covid-19, instead of leaving early onset Covid-19 patients with nothing but paracetamol and luck until they turn severe.


9.6 Could there be Viral Burn-Out? 

The focus on containment has also led to attention being trained away from the virus itself. It is a mystery that cries out for investigation how each time there has been an Ebola outbreak in West Africa, it has died out even though there has been (till recently) no medicine or vaccination for it. The same phenomenon of viral diseases dying out inexplicably has been observed in the case of other infections, such as SARS (38). There has been speculation that the Ebola virus weakens dramatically and peters out after four rounds of transmission (31). Similar claims that the Covid-19 virus has lost its potency, or that it may peter out on its own, have surfaced from experts in Italy and the United Kingdom.

WHO’s Mike Ryan lost no time to intervene to rebuff any such speculation. In a press briefing he said sarcastically that it could not be that the virus “all of a sudden of, its own volition, has decided to become less pathogenic” (158). But the gentleman doth protest too much. This is hardly a fair representation of what the Italian doctors were saying, which was that the viral load observed in patients was much smaller than earlier in the epidemic, and that, clinically, Covid-19 appears to no longer be the same disease. The British doctor who suggested the possibility of the virus petering out over time is himself a former WHO Director.

Viral burn-out is at least as scientific a possibility as that of finding a vaccine for Covid-19, which Mike Ryan has been insisting is the only solution, the “one great hope”, for this disease (159). But there has not been much success with finding a vaccine for coronaviruses so far. Vaccination has been elusive even for other viruses. None was found for AIDS despite vast sums of money being pumped into AIDS research.                                     

9.7 Did China and Italy lockdown after they had peaked?

There are indications that we might be wrong on some very basic things about Covid-19. One puzzling set of facts needs us to go back to where we began with the outbreak in China. The Chinese asserted, and the WHO unquestioningly agreed, that it was restrictive measures that drove down the Covid-19 epidemic in China. But the facts as narrated by the Chinese themselves cast doubt on this understanding. The Chinese are on record in the WHO-China Joint Mission Report saying that their “cases peaked and plateaued between 23 January and 27 January, and have been steadily declining since then, apart from a spike that was reported on February 1” (13).

In this report, the Chinese were able to tabulate the daily number of cases both by date of onset of illness and date of laboratory test results (Figures in the WHO-China Joint Mission Report reproduced at App-A and B below). As would be expected, there is a time lag between the date of symptom onset and the date of laboratory test results. The figures for China show that while laboratory reports began to come in around January 20th and peaked between February 4th and 10th, the peak of onset of symptoms, i.e. the highest numbers of people falling ill per day, was on January 23rd, after which it plateaued for about 5 days and then went into a steady downward trend, (save for a spike on February 1st which appears to be the result of a reporting anomaly that was discovered sometime around February 12th ).

The reason why this puts into question the idea that containment measures brought down cases in China, is that lockdown was implemented in Wuhan/Hubei Province only on January 23rd and measures were triggered in other provinces of China only later in January (160). There are reports of fairs, public feasts and a local Communist Party cadre meeting attended by tens of thousands of Wuhanese in the days of Janury just before the lockdown, as this period coincided with the festival time of the Chinese New Year and Spring Week celebrations (161). With an incubation period of 14 days, it is highly unlikely that lockdown would affect the growth of Covid-19 cases the very day that it was implemented, especially considering all the activity I have just described that occurred in Wuhan in the weeks immediately preceding lockdown.

Also, there was very high traffic in all of China in the weeks before the lockdown, owing to the approaching Chinese New Year. This is popularly called the period of “Chunyun” where millions of Chinese travel from back home to their native towns and cities in the lead-up to the Chinese New Year, which fell this year on January 25th, followed by the annual Spring Festival holiday week. This was also a period when University students were going home for the holidays. Every year, over 3 billion trips are estimated to be made during Chunyun (literally translated as “Spring Travel”) with immigrant labour laying out on the corridors in trains in the rush to get home. Who knew then the scenes that were going to be played out in India two months later with its own immigrant-labour walking to their native villages on foot for thousands of kilometres, fleeing the hunger and penury of the cities caused, by the Chinese-inspired lockdown.

The traffic rush of Chunyun took place in the early weeks of January; and press reports from the time show photographs of massive crowds in Chinese trains and transport stations at this time (162). Wuhan is a transport hub for Hubei, which employs many industrial workers. The Chinese estimated that 50 lakh people travelled out of Wuhan to other provinces of China in this period. So travel was high in the run up to the lockdown, albeit with many wearing facemasks, and screening at bus- and train-stations for fever. Fever-screening was used in China for SARS, but unlike that disease we now know that people with Covid-19 can be infectious even if they are asymptomatic or before they develop fever (10). Clinical research papers by Chinese doctors that trace the history of cases in January show that people travelled thousands of kilometres across provinces to reunite with their families, and that people were meeting socially right until the time of lockdown (163). A German study of transmission of Covid-19 by asymptomatic persons in late January shows business travel out of China days before the lockdown (164). 

Given these facts, it is an open question which must receive more scientific attention as to why Covid-19 cases in China plateaued from January 23rd onwards, and trended downwards from the end of that month.

A similar pattern can be seen in Italy, which has also been publishing data on the date of onset of Covid cases (App-C). Like in China, there is a lag between the date of case onset and the date of diagnosis. Even WHO officials accept that we have to work backwards from the date of cases as reported, to get a correct picture of how the disease is spreading. Mike Ryan said at a WHO press briefing in late March that, “the cases we see today really reflect exposures two weeks ago….The cases you see today are almost historical in the same way as we’re told when we’re looking at galaxies through a telescope that we’re seeing light from a billion years ago, we’re seeing a reality that existed before. When you count your cases on a daily basis in an epidemic it reflects a reality of transmission and risk two weeks ago” (19). 

In Italy, the lockdown was imposed in its Northern provinces on March 8th, and extended to the rest of Italy on March 10th.  According to the date of onset data, daily case onset peaked on March 10th, remained high at between 4000 to 6000 cases for the next ten days, though trending downwards from March 14th, apart from a spike on March 20th, after which cases trend more consistently downwards (App-C).

Again, these downward trends are too near to the lockdown for any easy assumption to be made about their having been impacted by it. These are questions that we should be asking about, and investigating. This is what I meant when I said at the start, about the pandemic being partly the fantasy of epidemiologists. It is not that there is no Covid-19, but we are only seeing it in the way the epidemiologists made it up. We need to start looking at it for what it is.

The date of onset data from China shows that in January, when the Covid Experts Group was estimating case numbers in China at 4000, these estimates did not come anywhere near the cases that had onset by then which, extracting roughly from Appendix A and B below, show that cases went from over 12,000 on January 23rd to nearly 40,000 by the end of January. So the Covid Experts Group’s estimation of cases in Wuhan in January was wildly off the mark, and they also did not know that at the time when they were making their estimates, the cases were actually peaking in China. During the same period when, on January 23rd, Tedros Adhanom was saying that it was too early to call a PHEIC as there were only 575 cases in China, this was based only on the laboratory results that had come in by then. Similarly, on January 30th, when the WHO finally declared Covid-19 to be a PHEIC, Tedros Adhanom only had partial figures when he said there were 7736 cases in China. The case onset data published in February in the WHO-China Joint Mission report, showed over 40,0000 cases by then (App-A and B). So the scale of the outbreak was much bigger than the WHO or even perhaps the Chinese had realized in January.

If the WHO had realized the full extent of the outbreak in China, they might not have been so confident of its controllability and the conversation over what measures were feasible and optimal might have taken a different route. These are questions that we should be asking the WHO. We should also ask the WHO to explain why it did not bring attention to the difference in case estimations between what they said in January and what they said in the February WHO-China Joint Mission report.  

9.8 Do We Really Know All About how Covid-19 Transmits?

There are other anomalies in the Covid-19 data that are crying out for inquiry. Although early outbreaks in many places were attributed to large public events called “super-spreader events”, there is no consistency between the occurrence of public gatherings or crowded mass movement of people, and the appearance of a Covid-19 cluster. For instance, we already noted how 50 lakh people travelled out of Wuhan to places all over China in the weeks leading up to the lockdown there on January 23rd. Contact tracing began outside of Hubei only late in January. But you did not see anything like the outbreak in the rest of China as you saw in Hubei, which saw about three fourths of the cases overall (13, 165). This cannot be explained simply by the closure of the Hubei border or measures introduced outside Hubei by the Chinese government, as the time lag between people arriving from Wuhan in other places in China and the start of contact tracing and hospital isolation more than accounts for the 14-day incubation period for Covid-19. Not only were there disproportionately fewer cases outside of Wuhan, a published study of all cases until February 11th, showed that the lethality of the disease also changed as you moved away from Wuhan; the case fatality rate of patients in Hubei was said to be more than seven times as high as that of patients in other provinces (165).

The huge mingling of people from different provinces during the Chunyun travel should itself have made certain travel routes into hotspots or “hot-routes” for the disease. But there are no such reports from China, even though millions travelled in close contact, for 12 hours and more, on long journeys in over-crowded trains. There are no reports from any country or city of overcrowded bus, train or metro routes being especially associated with any Covid-19 outbreak. 

With mass gatherings there are other puzzles. Even though some big outbreaks were traced to large gatherings, not all gatherings in the same period sparked outbreaks. For example, although malls have huge footfalls, not a single outbreak in any country has been linked to gatherings here. This indicates that the sharing of public spaces as such is not in of itself resulting in significant transmission, and a more intense, intimate and prolonged interaction is required for transmission to occur. If this is true, then the whole idea of stopping public movement to contain Covid transmission is questionable.   

There were mass gatherings around the world in March and April that did not lead to a mass outbreaks. For example, there were two gatherings in Bangladesh, one in Lakshmipur District of a prayer meeting with an estimated 10 to 25,000 in mid-March, and a second, in mid-April, when 1 lakh people defied lockdown to attend the funeral of a popular political figure in Brahmanbaria District (166). However, even by early June, there were less than 200 cases in both these places (App-D). A month later, in early July, Brahmanbaria reported 733 cases and Lakshmipur district reported 929 cases, showing that the rise in cases here, which follows a general rise of cases in South Asia, was driven by other factors than the gatherings in March and April (App-E). In France, a large Church gathering in Mulhouse in Haut Rhin is thought by some to have resulted in 2000 infections, among the 2500 attendees (167). A nurse who attended the gathering from nearby Strasburg is said to have spread the virus to 250 colleagues in the hospital where she worked. But a pastor from Burkina Faso who also attended the gathering and is said to have been the first case, along with his wife, of Covid-19 in that country, spread the disease to only five other people. This is despite the fact that a pastor’s work involves contact with many people, and it was a good fortnight before he was diagnosed and placed in quarantine. A pastor from Guyana who also attended the Mulhouse gathering, was among those who unknowingly contracted the disease. But it is reported that he and his four travel companions did not pass it on to the over 80 people with whom they came into contact before discovering the infection, save for one child who had a mild illness (167). One of the most popular events of Louisiana’s Mardi Gras festival, the Zulu Ball, was held on February 21st with 20,000 people (169). One million people are said to have attended the Mardi Gras from around the world. But while Louisiana was an early Covid-19 hotspot in the USA, no hotspots in other countries have been identified, at least so far, linked to visitors at the festival.

Even when large gatherings resulted in outbreaks, chains of transmission did not radiate as widely as you would expect for a virus that does not burn out, but simply, as the epidemiologists presumed, endlessly propagates from person-to-person in the same line of contact, until you intervene to break the chain of contact. An example of this is the Tablighi Jamaat outbreak in New Delhi, which remained confined to people in the Markaz, and did not spread into the surrounding Basti.

...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 23rd, 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Country

Tuberculosis Incidence

Tuberculosis Deaths

India

31,40,000

2.7 lakh (approx.)

Italy

4700

400

Germany

4800

400

France

6600

700

USA

15,000

700

UK

9300

400

Kenya

2.25 lakh (approx.)

9700

South Africa

4.86 lakh (approx..)

19,500

Mexico

24,000

2700

Sweden

590

100

 

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

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

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

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

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

(140G) Testing data from Worldometer.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(178) Source: Mumbai Live Covid Updates

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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