Covid-19 and Other Diseases

Sophie Cousins

As the world continues to grapple with the Covid-19 pandemic, it can be difficult to remember that there are other pressing global health issues. Age-old diseases like tuberculosis don’t get the widespread attention they deserve because they don’t disrupt the lives of the wealthy. But even in a global pandemic, as almost everyone’s lives have been affected in one way or another, there are stark inequalities in the distribution and outcome of infectious diseases.

The new coronavirus is a threat to billions of people around the world, but the risk is compounded for people who live in overcrowded homes; who don’t have access to safe drinking water or nutritious food; or who rely on the provision of mosquito nets to protect themselves from malaria.

According to figures compiled by researchers at McGill University, the Covid-19 pandemic is predicted to cause an additional 400,000 malaria deaths this year; an additional 700,000 HIV-related deaths in Africa alone; 15 million unintended pregnancies; and up to 1.4 million additional tuberculosis deaths by 2025. The list continues: at least 80 million children under one are at risk of vaccine-preventable diseases such as measles, rubella and polio, as routine immunisation services have been disrupted in almost 70 countries. There could be an additional 113,000 maternal deaths in the next 12 months because of disruption to care before, during and after childbirth. Global poverty, a major driver of poor health, is set to worsen. Mathematical modelling can only describe a range of possibilities – possibilities that are highly sensitive to our actions. But these numbers should nevertheless give us pause.

In 2015, all United Nations member states adopted the 2030 Agenda for Sustainable Development, making a commitment to work together to end poverty, improve health and education, reduce inequality, spur economic growth and take action on climate change. One of the targets is to eradicate TB, HIV, malaria and a host of other communicable diseases. Already elusive before the pandemic, it seems even more unattainable today.

Do these goals – which also aim to end poverty and hunger by 2030 – need to be rethought and rewritten in the face of the crisis confronting us right now? (And what about future crises, that we cannot yet see or imagine?) Or do we need such ambitious targets to help us keep in view how the world could be remade after the pandemic?

As Covid-19 continues to wreak havoc on our societies, old threats – from unsafe childbirth to neglected tropical diseases – remain. If we shift all our resources and attention to the pandemic, we risk undoing all the extraordinary progress that has been made in global health. To aim to eradicate HIV without a vaccine, less than fifty years after the first Aids cases were reported, is testament to how powerful – and transformative – global public health measures can be.

In The White Plague: Tuberculosis, Man and Society (1952), Jean-Baptiste and René Dubos describe TB as ‘the first penalty that capitalistic society had to pay for the ruthless exploitation of labour’. How will Covid-19 and its aftermath be remembered?


  • 10 July 2020 at 8:33pm
    Charlie says:
    I work in a respite service for adults with learning disabilities. The first thing that happened is that people with learning disabilities and their carers were risk-assessed out of receiving the services they were formerly assessed as requiring. Day centres closed. The statutory obligation to provide these services was removed to ensure local authorities weren't breaking the law via "easements" to the Care Act. This situation is ongoing. The emphasis is now on how to resume providing these services "safely" but the upshot is provision cannot return to previous levels due to the requirements of social distancing etc. The most vulnerable people have either been "protected" by isolation and removal of services, or "protected" in old people's homes by the removal of visits from friends or family where the so-called self-isolating of others with symptoms has amounted to a death warrant for many (PPE is irrelevant here: an outbreak in a care home isn't contained by staff wearing masks). Tens of thousands have died frightened and lonely deaths and their bereaved have suffered the trauma of not being allowed to be with them. At their funerals they have been told to socially distance.

    The blog post above puts this same reality in a global context, but avoids the obvious conclusion: what is being perpetrated in the name of saving lives is in fact a crime against humanity, and only just beginning. Average age of death "involving" Covid-19 in the UK is 80. Average number of chronic health conditions of those dying is 2.3. Life expectancy in the UK is 81. Measures imposed to control this risk projected to cause an additional 400,000 deaths from Malaria this year, an additional 700,000 HIV-related deaths in Africa alone, etc. If these projections are even halfway accurate, the numbers speak for themselves.

    • 11 July 2020 at 9:04am
      neddy says: @ Charlie
      Thank you for that post. I, for one, couldn't, I simply couldn't, agree more.

    • 15 July 2020 at 1:57pm
      David Bevan says: @ Charlie
      Average life expectancy at birth in the UK might be 81 years, but for someone who has already reached the age of 80 it is considerably longer: up to nine years by some estimates ( ). The excess deaths in older persons in the UK accordingly amount to hundreds of thousands of life-years lost. I am suspicious of the argument that 'they would have died soon anyway', particularly since John Crace described this in the Guardian as "the Shipman Defence". No ' life unworthy of life' here, please...

      It would have been possible to protect the older citizens of this country without destroying the economy or interrupting general healthcare if the UK Government had reacted properly when it had all the required information, and examples of how to do it, from elsewhere. I absolutely dispute that any 'crime against humanity' has been committed by South Korea, Taiwan, Vietnam, Japan or New Zealand...The McGill study should be taken as a warning of what will happen if the SARS-CoV2 pandemic is allowed by venal and incompetent governments to overwhelm health systems. Examples from Cuba and Sub-Saharan Africa are already showing a different way forward.

    • 17 July 2020 at 12:08pm
      Charlie says: @ David Bevan
      Hi David, thanks for your response. I'm sorry you thought what I was advocating was letting old people die. I wasn't. What I'm saying is nothing that is being done supposedly to save the lives of old people can be reasonably argued to be doing this, while the other costs (economic, social, in excess deaths, or any which way you want to frame it) are quite clearly an order of magnitude larger, both domestically and globally. I don't know enough about the reality of life in New Zealand, Japan and the other countries you have listed in the aftermath of measures taken to argue the toss on this - we can agree that the UK approach constitutes the worst of all possible worlds – but the strictures on social distancing as a necessary part of containing this or future pandemics, even before we get onto masks, can only amount to the destruction of public life as we know it. When you then look at detail at what it means in terms of the provision of vital services, we are looking at something truly dystopian - hence why I consider what is happening to be a crime against humanity. This is also the reason to remind people that the average age of death is over 80 and I should have added that those dying in the UK have on average had 2.3 chronic health conditions. I believe the average life expectancy for people who move into old people's homes is 2-3 years, but I don't have a source for this. We are used to being told "we can't afford it" whenever measures are proposed that would improve people's lives in general, and this has been especially true in relation to the dire state of care for the elderly. Now there is apparently no end to the money we are willing to spend and collateral damage we should be willing to accept, supposedly in the name of saving these people's lives but in practice killing them off in greater numbers than ever before. Meanwhile hospitals, far from being overwhelmed, are empty. I suppose this must be what is meant by "protecting the NHS"...

    • 19 July 2020 at 6:18pm
      ralph wortley says: @ Charlie
      I can only cite the one old-age home, or "retirement estate" that I know personally, where the longest-standing resident is healthy and mobile after 30 years' residence. I don't know the average age at entry (probably around 60 to 65) but there are many women - fewer men - well into their nineties. Perhaps the fact that this is a middle-class paying establishment may be relevant: I know nothing at all of UK retirement or "care" homes.

    • 19 July 2020 at 6:21pm
      Charlie says: @ ralph wortley
      Different kettle of fish, I'm afraid.

  • 11 July 2020 at 9:04am
    neddy says:
    Many thanks for your post Ms Cousins.

  • 15 July 2020 at 11:32am
    Jesper Melbye-Hansen says:
    In Denmark, where I live, 24 people who were under 75 and didn’t suffer from other diseases have died from corona.
    Why almost nobody talks about this, and why the World is going mad because of corona is hard to understand. I think it tells us something about the State of our minds. I don’t think your respons in England (or in the USA) have been clever and I don’t know the Way we should have dealt with the disease, but the Way people have been treated for even starting the discussion about the matter is frightening.

    • 17 July 2020 at 1:38pm
      Charlie says: @ Jesper Melbye-Hansen
      This is the key point, yes. We can now see this in action re masks even clearer than we could with lockdown: the mockery and demonisation of anyone querying the efficacy of these measures and pointing to the other hazards introduced or exacerbated by them, which were and are easy to foresee. Regarding compulsory mask-wearing in all shops and most workplaces and interior public spaces, the insistence that this doesn't have profound implications (and that anyone who says it does must be a redneck or white van man) is bizarre. When we remember the furore over appropriate PPE in hospitals (i.e. not crappy paper masks), people's willingness to ignore the absence of scientific evidence that wearing masks reduces the risk of asymptomatic transmission is also astonishing.

      An interesting thought experiment. In an alternative 2020 where there was no pandemic, Boris Johnson's government pass a law to ban the wearing of a burka in all the places it is soon to be compulsory to wear a mask in our reality. The media unites as one not only to support this policy, but aggressively to ridicule those who object. People considering flouting the new rules are put off not only by the threat of a fine (which there could never be the resources consistently to enforce) but the response of the general public who have been propagandized into believing that people wearing a burka are a threat to them. What name would we give this political system?

  • 15 July 2020 at 5:01pm
    Graucho says:
    There is no easy painless way out of this misery. One has heard the argument that 75% of the fatalities were "old" anyway. Apart from that still having robbed them of a good many years it also means that 25% of fatalities weren't. In the case of the U.K. that equates to well over 10,000 death and counting.

    • 17 July 2020 at 2:14pm
      Charlie says: @ Graucho
      Hi Graucho, you might be interested in this bar chart from the ONS which shows the deaths per capita across different age ranges in England and Wales. I wouldn't want to get into what constitutes the threshold for "old" and I'm not stressing the age of those dying as an argument for just letting old people die. The point is that effective measures to protect old people and other vulnerable groups didn't and don't require a lockdown (which in its dysfunctional fear-addled "late" UK version has undoubtedly increased the death toll). Usually such measures would be dismissed as too expensive, but they would of course cost a fraction of what has been spent "keeping the economy on life support" - and we're yet to experience removing the life support, which may (as we know from our recent crash course in ventilators) result in the economy dying anyway. How this will then play out in terms of care for the elderly isn't difficult to imagine, and sadly won't be offset by the fact that there's now fewer of them....

    • 17 July 2020 at 3:09pm
      Graucho says: @ Charlie
      Thank you for the bar charts. If only such measures had been taken. This thing started killing people in care homes in Italy late February, so it's not as though it should have come as a surprise to HMG and the health authorities here. Sweden of course didn't lock down and now sit number 7 in the league table of deaths per million population. Their care homes bore the brunt of the casualties in spite of the authorities saying that they would protect them. The principal Swedish epidemiologist stated that protecting the aged was more difficult than they had imagined. The government's cop out here has been that they didn't know about asymptomatic transmission. Well they and their advisors should have. Asymptomatic transmission is the rule, not the exception with successful viruses. It's their window of opportunity to jump from host to host before laying the current victim low. In the last pandemic with HIV we had asymptomatic transmission with a window of opportunity of around 5 years and it has gone on to kill around 30 million people. The bigger the window, the more infectious the disease. The rate of spread of covid should have been a clue. My personal view on covid lockdowns in general is that the jury is still out. I am, however, firmly of the opinion that the U.K. and the U.S. have provided case studies in how not to go about them.

    • 18 July 2020 at 6:12pm
      Charlie says: @ Graucho
      Lack of concrete data about asymptomatic transmission is definitely the problem, and this lack, after so many months of the virus turning our world upside down, apparently on a permanent basis, makes no sense to me. Lockdowns, social distancing, masks, all of which lack an evidence base in terms of their efficacy – none of these would be necessary if we knew that, say, asymptomatic transmission accounted for only 20% of infections. All that would be necessary is a strict policy of self-isolating with symptoms, and also a recommendation to self-isolate if living with those with symptoms, and the spread of infection amongst the general population should be under control. Of course no one ever self-isolated with a cough prior to March 2020, peak deaths was reached in early April so I assume this means peak infections was a few weeks before - it's therefore quite possible this measure, introduced too late, did indeed play the decisive role. What remains would be a strategy for what to do about symptomatic people who are supposed to self-isolate who are living with vulnerable people, which is indeed far from simple. But requisitioning hotels and private hospital beds for these people might have been the way to go – or perhaps using the empty Nightingale hospitals? Unsurprisingly it seems early treatment, as per most medical problems, leads to better outcomes for patients, so this would save lives both directly (by reducing the IFR) and indirectly (by reducing the R0).

      But as you say, this depends on the degree of asymptomatic transmission. For what it's worth (maybe not much), both the UK government and the WHO suggest that people are most infectious upon the onset of symptoms, and make no firm claims in relation to asymptomatic transmission:

      It's troubling to say the least that, if this is broadly correct, the guidance and policies issued by the same entities do not make sense.

    • 18 July 2020 at 10:30pm
      Graucho says: @ Charlie
      Well lockdowns will certainly get rid of the disease if you live on an island and apply them early and brutally. The Isle of Man, Hawaii, the Channel Isles, Taiwan and New Zealand are a testament to that. In IoM for example people were sent to jail for breaking the regs, Mr. Cummings please note. I say that the jury is out because if the lockdown doesn't eliminate the virus and it resurges the economic damage will have been to no avail.
      One uncomfortable fact which has been glossed over in the debate is that the modellers actually got the epidemic in the U.K. roughly right. There are around 50 million adults in the U.K. and it would appear that somewhere between 5 and 10% of them have been exposed to the virus. that pool of infected persons has generated around 50,000 deaths. This gives a death rate of between 0.5% and 1%. So if the virus is allowed to work its way through the U.K. population you are looking at between 250,000 and 500,000 deaths. I believe that the modellers gave HMG a projected figure of 400,000 deaths when they decided to impose the lockdown.
      The lockdown undoubtedly reduced the number of fatalities here in the short run. At the risk of repeating myself, take a look at what is happening in the southern states of the U.S. and Latin America. In the former because too many citizens foolishly believed it was all over and in the latter because the poor can't afford to stay at home and don't even have fridges, let alone the capital to stock up on 2 months of groceries. The big question on the U.K. lockdown is has it merely served to put off the evil day or evil months.
      One other thing, as I read the blog it was in part about how the pandemic was causing colateral damage because other deadly diseases weren't being treated. As I watch reports of tents being erected outside hospitals in Florida and Texas because they have run out of bed space and listen to despairing medical staff about how they are running out ICU units and ICU staff, I am not sure that the collateral damage of the pandemic in preventing the treatment of other diseases wouldn't have been even worse without a lockdown.

    • 19 July 2020 at 7:12pm
      Charlie says: @ Graucho
      One way of assessing whether the Imperial College model was accurate is to look at Sweden, where as of today there have been 5,619 deaths in a population of 10m, but where excess death has been about three times lower than the UK. When this is mentioned, people rightly point out that there will be differences in demographics, it's less densely populated, etc. But I assume the majority of the population live in cities nonetheless (Stockholm and Gothenburg have approx 1m each) and the awkward fact remains: no lockdown. Which surely means - if a lockdown controls the spread of infection - that a much higher proportion of the population has had the virus than in Sweden than in the UK. An IFR in the range of 0.5 to 1% is therefore unlikely: if the IFR was 0.5%, it would require only 1.1m Swedes to have had the virus. This isn't impossible, but it would either mean that the virus is a lot less infectious than thought, or that herd immunity, perhaps due to significant background immunity from contact with milder coronaviruses, is reached at a much lower threshold than predicted. In either case, I can see no evidence for the accuracy of the Imperial College models whatsoever.

      But there is a simpler way of saying all this. If a lockdown was necessary to control the epidemic, why has the curve of deaths in Sweden plateaued just as in the UK? And why has there been no second wave, despite coming out of lockdown? This is the reason the media now focus on cases, never mentioning that we are currently testing 5-10 more people a day than we were during the peak. Nor asking the obvious question: if very few people are now dying, who cares about cases?

      As you mentioned previously, the Swedish government has apologised for its failure to adequately protect residents in old people's homes, which are apparently very large and have the same problems of zero-hours agency staff working across several services. The UK population is 66m: depending on which official figures are used (!), we have had about 10 times as many deaths attributed to Covid-19, which suggests the lockdown may be responsible for up to a third of the excess death seen in this country. And given the increasing evidence that some of these deaths may have been wrongly attributed (witness the Public Health England fiasco revealed recently whereby anyone who has tested positive since testing began will be automatically included in the figures, regardless of actual cause of death), it's possible the proportion of deaths caused by lockdown is even higher. It's strange that even writing this feels somehow illicit, when the reasons why this might be are obvious, and the fact that an extended lockdown will also cause has been acknowledged by the government.

    • 20 July 2020 at 2:22am
      Graucho says: @ Charlie
      The fact that Sweden does not have mega cities like New York or London where the population is highly dependent on overcrowded public transport is very relevant if you look at how this virus spreads. One could also mention the frequency of super spreader events like football matches, the Cheltenham Gold Cup, theatres, cinemas, concerts. Given all its advantages in dealing with the virus, comparing Sweden with any similar countries e.g. Finland, Norway, Denmark or any of the Baltic states shows just how this virus will flourish in even less than ideal conditions for its spread.

    • 20 July 2020 at 10:24am
      Charlie says: @ Graucho
      You are of course right about the particular difficulty of trying to control an outbreak in a city, especially a large and densely populated one. You might also have mentioned illegal levels of air pollution, which London, New York, Madrid and Wuhan all suffer from, as does Northern Italy, the first European hot-spot and one where deaths did not primarily occur in cities. The air population in this region is apparently the worst in Europe, the population the oldest, and a very high proportion of the older generations smoke. Clearly what transpired was widespread panic and chaos, many hospitals were indeed overwhelmed (and we were of course shown images from those which were and not those which weren't), and I don't pretend to know the ins and outs of what was and wasn't done, and how things might have been different and better.

      No doubt air quality is much better in Sweden. But given a highly infectious virus, no lockdown in place, a population of people whom grow old and at some point die like any other, a government that has acknowledged its errors in protecting the residents of old people's homes as the main reason for its high per capita death toll, an epidemic curve which has peaked and flattened in line with all other countries affected, and several times less excess death than in the UK, it seems a stretch to turn to the case of Sweden for evidence that our lockdown, albeit too late, was better than no lockdown at all.

      It's worth discussing New York. Along with the factors already cited, there is the probably much larger issue of massive health and wealth inequality, compounded not only by a notoriously dysfunctional healthcare system (reported last words of a man about to be put on a ventilator: "Who's going to pay for this?") but also the order by State Governor Andrew Cuomo that nursing homes accept patients being discharged from hospitals who had tested positive for the virus. Having done nothing to control the spread of infection before it took hold ("lockdown" is a huge basket of measures, many of which are known to be effective and can be implemented without a lockdown), this criminal act alone explains the extremely high death toll in New York, to the extent that it also skews the figures for the USA as a whole - 32,000 deaths is a quarter of the current US total, while per capita deaths are three times higher than the national average.

      (It's worth pointing out that Cuomo is a Democrat with strong presidential ambitions given our kneejerk tendency to blame anything dystopian about the US on Donald Trump.)

      While the situation has not been quite so diabolical in the UK, it's true that those discharged from hospital weren't tested for Covid-19 before being admitted to care homes. It's also true that those that developed symptoms were not admitted to hospital unless severely ill, which in many cases (young and old) was no doubt the cause of death, but in old people's homes was also a death warrant for large numbers of other residents.

      For some reason we are all now angry at those that don't wish to wear masks in public - the one thing our UK experience has shown not to be necessary to control the epidemic - instead of demanding resignations from those in government who are responsible, perhaps along with reparations for the bereaved of those who died for this reason.

  • 19 July 2020 at 3:00pm
    David Ascher says:
    It amazes me that people today talk about "the elderly" as if this were 1956 instead of 2020. Most of the countries in the EU, the former Yugoslavia, and Asia, have populations with over 15% over 65. There are probably different reasons for the high percentage of 'elderly' people in different countries - better health care and public health in many (both life long and in aging populations) for some and loss of younger people who have emigrated elsewhere in others. In all of these nations - which represent a significant chunk of the world population, the potential loss of 15-28% (28% in Japan) of the population due to the pandemic should be a very serious concern. Fifty years ago, a 65-year old was "old". A large percentage of them had multiple health conditions - many of which were due to lifelong environmental exposure to toxins (like asbestos, now banned pesticides, leaded gasoline, etc.) as well as the toll taken by deprivations of the Great Depression and WWII. A much larger proportion of 65-year-olds today, are reasonably healthy with their underlying medical conditions managed by medication or treated with medical interventions. They are politically engaged, socially engaged, many working at (non-physically-demanding) part time or full time jobs and/or involved in caring for extended family including older parents, aunts/uncles, and grandchildren. They are hardly the decrepit cohort sitting in rocking chairs on the front porch waiting for Mr. Scratch to come and end their miserable lives on Earth.

    The loss of this section of these populations are spoken about as if the lost of 15-20 of the population will improve societies' balance sheets - those old folks are seen only as an 'expense' and a drag on the public purse (even in stingy countries like the US & UK) using funds that could be better invested in young peoples' education, maternal health, and other "social investments". Meanwhile most of the public purse in the US goes to building more weaponry that might have been useful in a World War II scenario but is of no use against terror bombings or other
    guerilla tactics.

    Much of the current planning in the US and UK is focussed on getting children back into schools - as if they don't get the virus, rather than that children are mostly asymptomatic but still able to spread the virus to their teachers and families who are more likely to have serious cases that end with their deaths or permanent disabilities.

    Meanwhile, most of the countries with over 15% of their populations 65 or older have not experienced the uncontrolled spread of the virus - the causes of which appear to be that the governments of those countries that have experienced ongoing high rates of infection and death (like say, the US and UK) have treated this pandemic as if they were in charge of a European in the 14th century confronting the Black Death. They have done little to implement what the medical and epidemiology communities have recommended, treating those recommendations as 'just opinions' that ignore the economic cost of an economic shutdown while giving more weight to their own 'opinions' which they change from week to week and which have been failures both in terms of controlling the virus' spread and reopening the economy. They are acting as if they can wish the virus away if people would just shut up, stop whining about some old people dying, and get to work. The similar approach in Europe decimated the population - resulting in the Renaissance. Perhaps Trump and Johnson are gambling our lives on a new Renaissance. They are both well known for their love of great art, aren't they?

    • 19 July 2020 at 8:20pm
      Charlie says: @ David Ascher
      There are different issues here. We agree that whether people dying are from the "decrepit cohort" or not is important, since it has to bear on an accurate assessment of risk for the many millions (in the UK alone) who have been told that they are in high risk groups, whether by virtue of their age and/or due to a chronic health condition. Living in fear isn't generally desirable. Giving up many aspects of life, but especially contact with friends and family, isn't something most people do willingly. And both fear and isolation are bad for your health.

      But decrepit or not, old or young, and regardless of the cause of death (others persist), the upsetting reality is that most of the people who have died since March of this year have done so frightened and alone. This matters, too.

      And it's also striking that when this is expressed, as I did in my first post, a common reaction is nonetheless to equate these points with a lack of care for those dying, and necessarily right-wing. This is quite obviously a consequence of our media: the Overton window is being heavily policed.

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