A differentiated, responsibilities-based approach to living with the Covid-19 pandemic

Rosa Graham Thomas – in UK lockdown

The United Kingdom has among the worst COVID-19 infection and death rates in the world (see Financial Times, 28th May 2020).  This is in part because of very serious errors of judgement made by the UK Government (see my list of questions to which they must answer, 27th April 2020), but it is also a result of the behaviour of substantial numbers of UK citizens during “lockdown” who, for whatever, chose not to self-isolate  (including the Prime Minister’s Senior Advisor, Dominic Cummings).  The UK government at the end of May also made another serious error of judgement, relaxing the restrictions, even for those who had previously been told to shield themselves, when  daily numbers of new infections and deaths were very much higher than they were when other countries had begun to “open up” (BBC, 31st May 2020).  This is despite the advice of many senior scientists who said that it was too early to relax the restrictions (BBC, 30th May 2020).  Estimates by the Office for National Statistics (28th May 2020) suggested that there were then at least 8000 new cases a day in England, excluding those in care homes or hospitals.  The daily average number of deaths from COVID-19 in the UK to the week ending 31st May was 242 (gov.uk, 31st May 2020).

Countries cannot stay locked down for ever, though, and it is essential for people to go back to work; indeed, it may well be that a vaccine or cure for COVID-19 will not be found in the short term, and societies may have to learn to live with this coronavirus for the foreseeable future.  Difficult decisions will therefore need to be made about how to manage daily life and reduce the number of deaths caused by SARS-Cov-2.  These decisions will need to vary depending on the specific contexts of each country, including its demographics (see my post of 7th May 2020) and environmental factors (see my post of 3rd May 2020).  In the UK, the government has used fairly crude measures, trying to ensure that large numbers of people stayed at home (even though most of them would not be seriously ill if they caught COVID-19), rather than varying the strategy according to risk.  Most actions and discussions have also adopted a human rights based approach to considering how decisions should be made (see for example Morley et al.’s paper on the ethics of tracing apps, or Lord Sumpton’s discussion of why lockdown is despotic).  Instead, I suggest here that we need to adopt highly differentiated strategies, based on our responsibilities (or obligations, as Onora O’Neill suggests in her 2016 book Justice Across Boundaries).

Differentiated risks of COVID-19

There is increasingly sophisticated analysis in various parts of the world to suggest that different groups of people have substantially different risk factors.  While anyone can die from COVID-19, the following generalisations about who is most likely to die seem to have widespread support:

• Older people are more at risk of having serious complications or dying from COVID-19.  Public Health England (PHE) in their early June 2020 report on disparities in the risk and outcomes of COVID-19, showed that “Among people with a positive test, when compared with those under 40, those who were 80 or older were seventy times more likely to die”.   Dowd et al. (2020) likewise show that “Currently, COVID-19 mortality risk is highly concentrated at older ages, particularly those aged 80+”.  Case Fatality Rates (CFRs) generally increase significantly with age, especially for those over 60; in Italy 96.9% of deaths by the end of March were for those over 60 (Istituto Superiore di Sanità, 2020).  In South Africa 80% of the COVID-19 deaths reported by 2nd May were for people over 50, with a quarter of deaths being in the 60-69 age group.  There is, though, still uncertainty as to whether there is something specific about age itself, or whether these figures are because older people are more likely to have other comorbidities.  It is also interesting to note that the UK’s Office of National Statistics (ONS) Infection Survey pilot suggested that the highest percentage of those testing positive in the UK between 26th April and 24th May were in the 20-49 year age group.
• Men are more vulnerable than women.  This may well be because women have two X chromosomes (The Guardian, 7th June 2020), although there remains some dispute about the influence of gender on infection and mortality.  The PHE report cited above shows that in England “Working age males diagnosed with COVID-19 were twice as likely to die as females”.  Most surveys seem to suggest that men are more at risk than women, but the ONS survey of those testing positive interestingly indicated that “there is no evidence of differences in the proportions of men or women testing positive for COVID-19”.
• People with comorbidities are much more likely to be seriously ill or die from COVID-19 than are those who are otherwise healthy.  Data for March reported by the US CDC indicates that almost 90% of all patients hospitalised that month had one or more underlying conditions, with 49.7% having hypertension, 48.3% being obese, 34.6% having chronic lung disease,  28.3% having Type 2 diabetes, and 27.8% having cardiovascular disease.  These five health problems are associated with higher death rates in most places where the data have been studied, although precise percentages vary quite considerably between populations (for a review of underlying metabolic health see Lancet, 2020; for a useful South African perspective, see Cullinan, 2020).  The UK authorities have defined clinically vulnerable people as follows:
  • “aged 70 or older (regardless of medical conditions)
  • under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab as an adult each year on medical grounds):
    • chronic (long-term) mild to moderate respiratory diseases, such asasthma,chronic obstructive pulmonary disease (COPD), emphysema orbronchitis○chronic heart disease, such asheart failure
    • chronic kidney disease
    • chronic liver disease, such ashepatitis○chronic neurological conditions, such asParkinson’s disease,motor neurone disease,multiple sclerosis (MS), or cerebral palsy
    • diabetes
    • a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets
    • being seriously overweight (a body mass index (BMI) of 40 or above)
    • pregnant women
  • As above, there is a further category of people with serious underlying health conditions who are clinically extremely vulnerable, meaning they are at very high risk of severe illness from coronavirus”
• Ethnicity does appear to have an effect on the seriousness of health impacts of COVID-19, even taking other factors into consideration, but the precise reasons for this are not yet known.  In the UK, more people from Black, Asian and Minority Ethnic (BAME) backgrounds have been seriously ill or died from COVID-19 than have people of white ethnicity, but this could be partly explained by deprivation, cultural factors (such as religious and family interactions), and comorbidities (such as obesity, hypertension and diabetes).  England’s PHE report concludes that “An analysis of survival among confirmed COVID-19 cases and using more detailed ethnic groups, shows that after accounting for the effect of sex, age, deprivation and region, people of Bangladeshi ethnicity had around twice the risk of death than people of White British ethnicity. People of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity had between 10 and 50% higher risk of death when compared to White British”.  More recently, the ISARIC CCP-UK study has shown convincingly that: (i) “Ethnic Minorities in hospital with COVID-19 were more likely to be admitted to critical care and receive IMV than Whites”, and (ii) “South Asians are at greater risk of dying, due at least in part to a higher prevalence of pre-existing diabetes” (see Harrison and Docherty, 17th June 2020).  Insufficient detailed studies have yet been undertaken in other parts of the world, particularly in Africa and Asia, to see whether ethnicity is indeed also a risk factor there.
• The risk of being infected is higher indoors than out of doors.  This is mainly because there is generally more air movement to disperse SARS-Cov-2 outdoors (although air conditioning systems indoors do spread it in the direction blown by a fan), and people are usually in closer juxtaposition for longer indoors than outside.  It is also easier to maintain sufficient distance between people outdoors than indoors (see inews, 11th May 2020).  However, there is still some uncertainty about this.  Thus, the UK ONS survey claimed in late May 2020 that “Individuals working outside the home show higher rates of positive tests than those who work from home”.  This is, though, probably because those self-isolating and working at home simply don’t come into as much contact with potentially infectious people outside the home.

Much of the research on which these conclusions are drawn is based on early evidence from China, as well as more recent evidence from Europe and the USA where the infection and death rates have been so high.  A particularly interesting issue is therefore whether these generalisations may also apply in other parts of the world, and especially in countries in Africa and South Asia which have yet to experience very serious rates of infection (see my previous post on On ageing populations, “development” and Covid-19).  It may well be that their governments could learn from the mistakes made in the UK and the USA and develop a more nuanced approach as outlined below.

A differentiated risk- and responsibilities-based approach to managing COVID-19

This post makes two core suggestions: states need to adopt nuanced and differentiated responses to living with COVID-19 in the foreseeable future, and that human rights considerations should be balanced by a responsibilities agenda.

A differentiated risk-based approach to COVID-19

Most governments have adopted stringent lockdown policies in response to COVID-19 that have been applied to everyone, regardless of their health risks.  This has caused considerable damage to their economies, as well as other serious health issues.  Many deaths resulting from the existence of COVID-19 are thus not actually being caused by the SARS-COV-2 coronavirus.  Numerous businesses are failing, and fit elderly people have complained vociferously about not being permitted to partake fully in “normal” society.

Now that more is known about the health risks of COVID-19, it makes considerable sense to develop context specific solutions that take into accont the risk factors noted above.  Governments must first ensure that they have an adequate and robust health service capable of dealing with the number of people who are likely to get infected, but wasteful fiascos such as the construction of new Nightingale Hospitals in the UK that were never really needed, or the numerous projects across the world to create novel designs for new venitlators for which not enough nursing staff are available (and when many people on ventilators actually die), must not be repeated.  The hospital services in some countries will come near to being overwhelmed (as in Italy), or may indeed collapse (see recent reports from Brazil, India and Pakistan which seem near this point).  However, even where countries are unable to manage the health requirements of the majority of people affected, it is still vital that what services are available are used to treat those most in need and most likely to survive treatment.  Is is also crucial that a responsibilities approach is inculcated and adopted at all scales from the state to the individual if the impact of the pandemic is to be mitigated.

It would thus seem wise to introduce comprehensive risk-based schemes through which everyone can evaluate their likelihood of being seriously ill from COVID-19 and their risk of infecting other vulnerable people, so that they can take appropriate actions to reduce such risk.  At present, and as noted above, the key risk factors seem to be:

• age,
• gender,
• comorbidities,
• ethnicity, and
• location

Put simply, and based largely on European and North American evidence, elderly men with comorbidities from BAME backgrounds spending all their time indoors would seem to be most at risk, and we should all do what we can to help protect them.  Young, fit, active white women spending most of their time outdoors would seem to be least at risk.

This has implications for work, transport, and social life, and carefully nuanced schemes should be introduced to enable as many people as possible to live the lives that they wish to.  For example, where resources are constrained, working-at-home policies could first be made available to the most at risk, encouraging those least at risk to stay at work, or indeed to return to work as previously.  Tourism, travel and entertainment is much less risky for the fit and young, so they should be allowed to take those risks if they want to, while alternative arrangements are put in place for the most vunerably elderly Bangladeshi men (such as support for online tourism or special take-away meals for celebratory occasions).

Responsibilities- rather than rights-based approaches

For too long, rights-based approaches have dominated global and national policies, and insufficient attention has been paid to the responsibilities that are essential to ensure the extstence of well-functioning societies  (see my Prolegomena on Human Rights and Responsibilities).  All too often when a “right” is claimed, it is uncertain who has the “responsibility” to deliver it.  Many, for example, have commented on the human rights aspects of COVID-19 (see Human Rights Watch, 19th March 2020; Bonavero Institute of Human Rights, 6th May 2020; The Guardian, 29th April 2020) , but rather fewer on the human responsibilities dimension.

This is particularly reflected in the tension between individual privacy rights and communal responsibilities in terms of the imposition and use of tracking apps to identify COVID-19 contacts (Human Rights Watch, 13th May 2020; Privacy International, no date; Morley et al., 2020).  However, it also lies at the heart of discussions about wearing masks: all to often such usage is criticised for not really protecting the individual, which completely misses the point that their main use is to protect the community from infected individuals.  People thus have a responsibility to wear masks so that if they are asymptomatic their chances of infecting many others are reduced (see my Face masks and Covid-19: communal not individual relevance).

Two main implications of a shift to a more responsibilities-based approach are important:

• The first is that governments have a fundamental responsibility to care for their most vulnerable and at risk citizens.  The shocking way in which the UK government placed its focus on “saving the NHS” above “saving vulnerable people” is an all-too-visible example of a failure to adhere to such a principle.  It was a serious injustice for UK policy to have sent elderly people with COVID-19 back into care homes and the community from hospital, as a result of which many of them died, many others were infected, and many more certainly died sooner than they would otherwise have done.  This principle, though, is also of crucial importance in countries where the health services have difficulty, or will have difficulties in the future, in coping with the COVID-19 crisis.  It is absolutely the responsibility of governments to recognise that many low-risk people will survive COVID-19 with little or no lasting health implications, and that they should be allowed to continue if they wish to in the productive economy.  However, at the same time, governments must put in measures whereby those at risk are protected, and given the wherewithall to sustain themselves.
• The second, and closely related principle is that individuals also have fundamentally important responsibilities to others.  Some positive evidence of communal responsibility and action has been visible in countries across the world during COVID-19, but support for at-risk people has been less than many had hoped for or expected.  Moreover, there have also been substantial numbers of explicitly negative communal actions: digital-attacks on health care organisations have proliferated during the pandemic, and doctors and nurses have been victimised for spreading the coronavirus in countries as diverse as Mexico and Pakistan.  Almost always, the emphasis has been on the rights of the individual (to enjoy the beach or to party) rather than on their responsibilites to others (to protect others from the actions of the self).  Put simply, all of us have responsibilities to protect everyone else from being infected, and to enable as many people as possible to continue to live active and fulfilled lives.

Is it too much to hope for that one of the results of COVID-19 may be the creation of societies where we shift the focus more to our responsibilities towards others than attention on ourselves?  In the short term, this would mean that we should all be:

• Thinking that we could be asymptomatic carriers of COVID-19, and take actions to prevent us from infecting others;
• Caring for and serving vulnerable neighbours who cannot benefit from the freedoms that we enjoy; and
• Taking action to self-isolate and get tested immediately we think we might be infected with COVID-19.

Whilst this is written primarily from the perspective of someone living in a country that is now coming out of lockdown, these principles apply globally, and if adopted in countries that have not yet encountered serious outbreaks of COVID-19 might help them escape some of the more serious impacts of economic shutdown.

Masai children learning in Tanzania

[Updated 19th June 2020]

 

On ageing populations, “development” and Covid-19

There is increasingly clear evidence that older people are more likely to die from Covid-19 than are younger people: on 17th February,  the China CDC weekly report showed that among the cases known in China by then, the ≥80 age group had the highest case fatality rate at 14.8% (with the 70-79 age group being 8% and the 60-69% age group being 3.6%); and in early April, the WHO Regional Director for Europe highlighted that over 95% of Covid-19 deaths occurred in those over 60, with more than 50% in those aged 80 years or older.  In the UK, the Office for National Statistics (ONS) reported in mid-April that mortality from Covid-19 increased consistently with age, with only about 13% of deaths being of people under 65.  Significantly, though it noted that men had a death rate double that of women; more recent ONS reports have also shown that (when taking into account age) Black men and women were more than four times as likely to die from Covid-19 then were those of White ethnicity, and that such differences in mortality were partly a result of socio-economic disadvantage.  These data are stark, and are as yet still not fully explained.  As people grow older, they generally have greater comorbidities, and it may be the impact that Covid-19 has on these other health problems that is more significant than age itself.

However, this is an important reminder that Covid-19 is primarily an old-people’s disease.  It is striking to recall that in 1951 life expectancy at birth in England and Wales was only 66.4 for men and 71.5 for women; in 1901 the figures were 48.5 and 52.4 respectively (ONS, 2015).  Put simply, people born 70 years ago were not expected to live to the age at which most people are now dying from Covid-19.  This has important ramifications, and raises very difficult questions.  Have people, perhaps, become over expectant about longevity?  Will Covid-19 temper our aspirations to live for ever?  Will it be a check on the ambitions of companies such as Novartis, Alphabet and Illumina to extend life well beyond 100 years (CNBC, 2019)?  Is the main problem of Covid-19 that most people living in the richer countires of the world have become too cosy in their expectations of living to a ripe old age?

Implications for Europe and north America: too many old people

Thought experiments can be a helpful means of highlighting challenging issues.  Suppose, for example, that there had been no lockdowns in Europe and North America.  It seems very likely that substantial numbers of elderly people would have died already (see projections by epidemiologists at Imperial College which suggested that without mitigation strategies Covid-19 would have resulted in 40 milllion deaths globally in 2020).  If a vaccine or cure is not found, then it still seems likely that large numbers of elderly people will indeed die in Europe at an age well short of what they and their families have grown accustomed to expecting.

However, think of the impact that this will have on the economy and health services.  Once large numbers of elderly people have died, national pension bills will fall, the burden on health services will be reduced, the percentage of people within the economically productive age range will increase, and the economic vitality of their countries will be revitalised.  If Covid-19 (or its successors) become an everyday part of life, the economic “burden” of older people will be dramatically reduced.  It is scarcely surprising that rumours  circulated about the intentions of UK government policy in early- to mid-March.  As Martin Shaw noted at the time, it had been credibly reported that the “Government’s strategy was ‘herd immunity, protect the economy and if that means that some pensioners die, too bad’; or as summed up even more succinctly by a senior Tory, ‘Herd immunity and let the old people die’”.  Whilst the government strenuosly denied this, there is a realistic logic to the idea that letting large numbers of old people die would have clear economic benefits, and would avoid the very considerable costs that are accruing as a result of economic shutdown.

I should stress that this is definitely not a scenario that I would want to encourage or endorse, but in the early part of May, the balance of popular opinion (or the influence of the business community and mainstream media in the UK) does seem to be swinging towards a view that the costs of lockdown are too high to continue to protect the elderly, especially in those countries where there have already been very high death rates (as in Belgium, the UK, France, Italy, Spain and the USA).  Yet, the 20th and latest Imperial College Covid-19 report  concludes for Italy that “even a 20% return to pre-lockdown mobility could lead to a resurgence in the number of deaths far greater than experienced in the current wave in several regions”.

Implications for Africa and South Asia: youthful countries

The real purpose of this reflection, though, is to consider the implications of the above arguments for some of the economically poorest countries in the world.  Data about Covid-19 infections and deaths in Africa and Asia are likely to be even less reliable than they are in Europe, and the countries in these continents are in any case much earlier in their encounters with Covid-19 than are those of Europe.  Recent reports, for example, suggest that the real number of deaths related to Covid-19 may be many times the number that are currently reported (see The Guardian‘s recent report on Somalia).  Nevertheless, we do have relatively accurate data about the demographic structures of most countries in the world.  The chart below therefore shows the relationships between current density of Covid-19 deaths and the percentage of population aged ≥65 for a sample of countries.[i]

This graph is striking, but difficut to interpret (and can be misleading), mainly because most countries in Africa and Latin America are only at an early stage in their Covid-19 outbreaks.  We simply do not know how many deaths they are likely to witness, and few models have yet been published that predict the likely outcomes.   However, with the very notable exceptions of Japan, Greece and Germany, it re-emphasises that high percentages of Covid-19 deaths are mainly found in those countries that have more than 15% of their populations aged ≥65.  Even Brazil, where the death rate is currently growing rapidly, is still nowhere near at the level of mortality that has occurred in Europe and the USA.  The quite remarkable achievement of Greece, with only 147 deaths by 7th May, is also highly noteworthy because despite a fragile health service and an elderly population it has managed to achieve something that most other European countries have been unable to do.  Most commentators suggest that this is mainly because it imposed a dramatic lockdown even before the first deaths were recorded.

Most countries of the world have intiated lockdowns, and these are having particularly significant impacts on the poorest and most marginalised who can least afford it. An obvious question therefore arises: if Covid-19 mainly affects the elderly, should countries with young populations (such as most of those of Africa, Asia and Latin America) follow the “older” countries in imposing strict lockdowns that will have damaging effects on their economies and the livelihoods of those who can least afford it?  Put another way, are the mitigating actions of European and North American countries, where more than 15% of their populations are ≥65, relevant to economically poorer countries with less than 10% of their populations in this age group?

It is far from easy to answer this.  Perhaps the very small numbers of people reportedly dying in Africa at present is only because the coronavirus has not yet gained a grip, and any loosening of the mitigating measures would unleash the pandemic at a scale similar to that seen in Europe.  The WHO, for example, has warned  that the Covid-19 pandemic might kill as many as 190,000 people in Africa in the year ahead (Al Jazeera, 8th May), with many more dying subsequently.  This may well be true, but there is at least a chance that the youthful populations of Africa will be better able to deal with Covid-19 than have done the older populations of Europe.  It must, though, be emphasised that many younger people who are infected with Covid-19 do indeed have serious illnesses, and some die.  We also do not yet know the long-term health impacts of this coronavirus.  Moreover, the evidence that socially disadvantaged people are also more likely to die than their more affluent neighbours further suggests that the poorest and most marginalised in these countries may well have higher death rates.

As I have illustrated elsewhere, there is some (but by no means conclusive) evidence that environmental factors may also play a role in limiting the spread of Covid-19.  If the environments of Africa and South Asia are indeed not particularly conducive to the spread of Covid-19, then their youthful populations might not need to endure the very tight lockdowns imposed in many European countries. That having been said, the rapidly increasing number of infections and deaths in Brazil (with 121,600 cases and 8,022 deaths as of 7th May), which has physical environments and climates similar to many parts of western and southern Africa, does not bode well for the future spread of Covid-19 in Africa.

Conclusions

In conclusion, there remains much that is unknown about how Covid-19 spreads and who it affects most damagingly.  The evidence from Japan, Greece and Germany shows that even when countries do have a high percentage of elderly people, it is still possible to contain and limit the spread of Covid-19, thereby preventing very large numbers of deaths.  The abject failures of governments in countries such as the UK and Belgium to manage the pandemic and save lives likewise indicate how not to respond to the pandemic.  The governments of African and South Asian countries, with their youthful populations who appear less likely to suffer severe symptoms, may well therefore have an advantage over their European counterparts.  If they can draw lessons about what has worked and what has failed, then they are also in a good position to bounce back swiftly from the economic harm caused by economic and social lockdowns.

 

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[i] The selected countries included the ten most populous countries in the world (in descending order of total population, China, India, USA, Indonesia, Pakistan, Brazil, Nigeria, Bangladesh, Russia, Mexico), a selection of European countries with mixed trajectories (listed alphabetically, Belgium, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, Switzerland), and a diverse sample of African (alphabetically, DRC, Egypt, Kenya, Rwanda, South Africa, Tanzania), and other (alphabetically, Iran, Japan, South Korea, Turkey) countries.

The influence of environmental factors on Covid-19: towards a research agenda

Considerable attention was paid in the early days of the Covid-19 pandemic to its spatial distribution in the hope that environmental factors might be found to play a key role in influencing its spread in two ways: by restricting it to a narrow band of countries with specific environmental factors; and hoping that a rise in temperature in the summer would kill it off.

• Researchers at Maryland University (Sajadi, M.M. et al., 2020) thus used maps of the early stages of Covid-19 to suggest that it spreads more easily in cold, damp climates, and that its highest incidence would be between latitudes 30-50 N.  At the time, I suggested on 3rd April that there were too many anomalies for this to be valid, that it was only based on limited data (where the coronavirus had spread by early March 2020) and that it was necessary to understand better the actual physical processes involved.  However, the idea that there might be environmental factors that will control Covid-19 still persists.
• Likewise, in the early days of the pandemic there was much optimism that the new coronavirus might act in similar ways to some of its predecessors and be seasonal in character, waning in the summer months when it gets warmer.  Again, this was in part based on the timing of its outbreak (in China in December 2019 ) and its rapid spread through Europe with an approximately similar timing to seasonal flu.  However, many experts were cautious about this possible scenario (see Jon Cohen in Science, 13th March 2020, and Alvin Powell in the Harvard Gazette, 14th April 2020).

Nevertheless, the much more rapid spread of Covid-19 in Europe and North America than in Africa and South Asia has led some to continue to argue that the devastating impact of lockdown in countries nearer the equator, particularly on the lives of some of the poorest people living there, may be un-necessary if this pattern can indeed be explained by environmental factors.  The lockdown has already been partially rolled back, for example, in countries such as Pakistan (with some factories reopening on 12th April , and congregational prayers at mosques durong Ramadan being permitted from 21st April) and South Africa (with initial steps being taken to reopen the economy on 1st May).  Clearly, the rate and distribution of the spread of Covid-19 is influenced by many factors, including government policies (with the UK performing especially badly, see my recent post),  demographic characteristics (with the elderly being particularly vulnerable), population distribution (spreading slower in sparsely settled areas), characteristics of the several strains and mutations of the Sars-Cov-2 coronavirus (summary in EMCrit), and the inaccuracy and unreliability of reported data about infections and deaths (see my comments here).

The role of environmental factors remains uncertain, despite a considerable amount of research (see systematic review by Mecenas, P. et al., 2020 – thanks to Serge Stinckwich for sharing this) which has sought to draw conclusions from the distribution of cases in parts of the world with different climates, and has suggested that cold and dry conditions helped the spread of the virus whereas warm and wet climates seem to reduce its spread.  A more recent study by Jüni et al. (8th May 2020) has claimed that epidemic growth has little or no association with latitude and temperature, although it has weak negative associations with relative and absolute humidity.  Unfortunately, very few studies have yet sought to do experimental research that actually measures the survivability and ease of spread of Sars-Cov-2 under different real-world environmental conditions.  Moreover, if as appears likely, most infections actually occur indoors, it is not the external climatic conditions that will influence rates of infection but rather the artifical environments created indoors through heating and ventlaltion systems that will be of most significance in influencing its spread.

Two related approaches to this challenge are necessary: identifying its survivabililty in a range of different environments (and surfaces), and analysis of the effect of different environments on the distance that it can be spread by infected people.

Research on the survivability of Sars-Cov-2 in different contexts

Several reported studies have explored the stability of the new coronavirus on different surfaces.  In a widely cited study, van Doremalen et al. (13th  March 2020) suggested that the stability of HCov-19 (Sars-Cov-2) was very similar to that of Sars-Cov-1 (the SARS outbreak in 2003), and that viable virus could be detected as follows:

• in aerosols up to 3 hours after aerosolization
• up to 4 hours on copper
• up to 24 hours on cardboard and up to 47-72 hours on plastic and stainless steel.

This important study has subsequently been used as the standard estimate for the survivability of the coronavirus.  However, it was undertaken in the USA under very specific relatively humidity (for aerosols at 65%; for surfaces at 40%) and temperature conditions (for both at 21-23^o C) (See also more recently, van Doremalen et al. 16 April 2020).  A rapid expert review of Sars-Cov-2’s survivability under different conditions (Fineberg, 7th April 2020) notes that the number of experimental studies remains small, but that elevated temperatures seem to reduce its survivability, and that this varies for diffferent materials.  Nevertheless, Fineberg emphasises that laboratory conditions do not necessarily accurately reflect real-world conditions.  In referrring to natural history studies, he also emphasises, as noted above, that conflicting results have emerged because such studies are “hampered by poor quaity data, confounding factors, and insufficient time since the beginning of the pandemix from which to draw conclusions” (p.4).

If a better understanding of Sars-Cov-2’s survivability in different parts of the world is to be gained, it is therefore essential urgently to undertake real world studies of its viability on similar surfaces in various places with different temperature and humidity profiles.

The dispersal distance of Sars-Cov-2

The standard advice across many countries of the world is that people should maintain a minimum distance of 2 m (in some countries 1.5 m) between each other to limit the spread of Covid-19 (see, for example, Public Health England).  This is double the WHO’s advice for the public, which is to “Maintain at least 1 metre (3 feet) distance between yourself and others. Why? When someone coughs, sneezes, or speaks they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person has the disease“.  The 2 m figure was adopted early by some CDCs, and appears to be more of an approximate early guess (based on the previous Sars-Cov-1 outbreak) that has taken root, rather than an accurate scientifically based figure.

Since then, more rigorous research has been undertaken, much of which suggests that 2 m may not be enough. Setti et al. (23rd April) thus note that Sars-Cov-2 has higher aerosol survivability than did its predecessor, and that a growing body of literature supports a view that “it is plausible that small particles containing the virus may diffuse in indoor environments covering distances up to 10 m from the emission sources”.  They also conclude that “The inter-personal distance of 2 m can be reasonably considered as an effective protection only if everybody wears face masks in daily life activities”. A particularly interesting laboratory based study a month previously by Bourouiba (26th March 2020) provides strong evidence that the turbulent gas clouds formed by sneezes and coughs provide conditions that enable the coronavirus to survive for much longer at greater distances: “The locally moist and warm atmosphere within the turbulent gas cloud allows the contained droplets to evade evaporation for much longer than occurs with isolated droplets“.  She concludes that the “gas cloud and its payload of pathogen-bearing droplets of all sizes can travel 23 to 27 feet (7-8 m)”.  Furthermore, another study by Blocken et al. (9th April) noted that the 1.5 m – 2 m distance was based on people who were standing still, and that there could be a potential aerodynamic effect for people cycling and running.  For someone running at 14.4 km/hr the social distance in the slipstream might be nearer 10 m.

Such studies have been controversial (for a summary, see Eric Niiler in Wired, 14th April), but they highlight that in practice:

• the “safe’ distance between people is unknown;
• there is little strong scientific evidence for the 1 m – 2 m recommendations for social distancing; and
• this distance is highly likely to vary in different environmental contexts.

Not enough conclusive reseach has yet been undertaken on the extent to which environmental factors, such as humidity, pressure, altitude, wind and temperature actually affect how far Sars-Cov-2 will disperse, and at what infectious dose (see Linda Geddes, NewScientist, 27th March 2020, where viral load is also discussed; see also ECDC, 25th March 2020).  It seems likely, though, that dispersal will indeed vary in different conditions, and thus in different parts of the world.  We just don’t yet know how great such variability is.

The latest systematic review published in The Lancet, and cited in The Guardian (2nd June 2020) sugggests that distance does matter, and that not only is 2 m safer than less than 1 m, but also that face masks can indeed reduce substantuially the risk of infection.

Towards a research agenda

This post has emphasised that we actually know remarkably little with certainty about how Sars-Cov-2 physically survives and disperses in different environmental contexts.  This has hugely important ramifications for the spread of Covid-19 in different parts of the world, and thus the mitigating policies and actions that need to be taken.  If, for example, Covid-19 does not survive in hot humid conditions, and is also dispersed over shorter distances in such circumstances, then it might be possible for governments of countries where such conditions prevail not to have to impose such stringent social distancing requirements as those that have been put in place in Europe.

Urgent experimental research is therefore required in real-world environments on:

• the survivabililty of Sars-Cov-2 in a range of different physical environments (and surfaces), and
• the effects of different environments on the distance that it can be spread by infected people.

A standard protocol and methodology for such research should be created that could then be used collaboratively by scientists working in different parts of the world to address these crucial issues.  Contrasting environments that would warrant the earliest such research (given the high number of economically poor countries therein) would include: high altitude savanna (as in the Bogotá savanna, and the much lower montane Savanna of the Angolan scarp), tropical and subtropical savanna (as in parts of Brazil and Kenya), tropical rainforests (as in Indonesia and Brazil), semi-arid and arid landscapes (as in much of northern and south-west Africa, the Arabian peninsula, and parts of South Asia).  It is also very important to undertake such resaerch both in urban and rural areas, and indoors as well as outside.  If scientists can indeed co-operate to provide a swift answer to the questions raised in this post, then it would be possible to provide much more tailored advice to governments concerning the mitigating measures (including the use of masks) that they should be taking to protect the highest number of people while also maintaing essential economic activity.

[Updated 8th May, 12th May, 30th May 2020 and 2nd June]

Digital-political-economy in a post-Covid-19 world: implications for the most marginalised

Now is the time to be thinking seriously about the kind of world that we wish to live in once Covid-19 has finished its rampage across Europe and North America.[i] Although its potential direct health impact in Africa and South Asia remains uncertain at the time of writing, countries within these continents have already seen dramatic disruption and much hardship as well as numerous deaths having been caused by the measures introduced by governments to restrict its spread.  It is already clear that it is the poorest and most marginalised who suffer most, as witnessed, for example, by the impact of Modi’s lockdown in India on migrant workers.[ii]

This post highlights five likely global impacts that will be hastened by Covid-19, and argues that we need to use this disruption constructively to shape a better world in the future, rather than succumb to the potential and substantial damage that will be caused, especially to the lives of the world’s poorest and most marginalised.  It may be that for many countries in the world, the impact of Covid-19 will be even more significant than was the impact of the 1939-45 war.  Digital technologies are above all accelerators, and most of those leading the world’s major global corporations are already taking full advantage of Covid-19 to increase their reach and their profits.[iii]

The inexorable rise of China and the demise of the USA

Source: Hiram1555.com

I have written previously about the waxing of China and the waning of the USA; China is the global political-economic powerhouse of the present, not just of the future.[iv]  One very significant impact of Covid-19 will be to increase the speed of this major shift in global power.  Just as 1945 saw the beginning of the final end of the British Empire, so 2020 is likely to see the beginning of the end of the USA as the dominant global (imperial) power.  Already, even in influential USAn publications, there is now much more frequent support for the view that the US is a failing state.[v] This transition is likely to be painful, and it will require world leaders of great wisdom to ensure that it is less violent than may well be the case.

The differences between the ways in which the USA and China have responded to Covid-19 have been marked, and have very significant implications for the political, social and economic futures of these states.  Whilst little trust should be placed on the precise accuracy of reported Covid-19 mortality rate figures throughout the world, China has so far reported a loss of 3.2 people per million to the disease (as of 17 April, and thus including the 1290 uplift announced that day), whereas the USA has reported deaths of 8.38 per 100,000 (as of that date); moreover, China’s figures seem to have stabilised, whereas those for the USA continue to increase rapidly.[vi]  These differences are not only very significant in human terms, but they also reflect a fundamental challenge in the relative significance of the individual and the community in US and Chinese society.

Few apart from hardline Republicans in the USA now doubt the failure of the Trump regime politically, socially, economically and culturally. This has been exacerbated by the US government’s failure to manage Covid-19 effectively (even worse than the UK government’s performance), and its insistent antagonism towards China through its deeply problematic trade-war[vii] even before the outbreak of the present coronavirus. Anti-Chinese rhetoric in the USA is but a symptom of the realisation of the country’s fundamental economic and policial weaknesses in the 21^st century.   President Trump’s persistent use of the term “Chinese virus” instead of Covid-19[viii] is also just a symptom of a far deeper malaise.   Trump is sadly not the problem; the problem is the people and system that enabled him to come to power and in whose interests he is trying to serve (alongside his own).  China seems likely to come out of the Covid-19 crisis much stronger than will the USA.[ix]

Whether people like it or not, and despite cries from the western bourgeoisie that it is unfair, and that the Chinese have lied about the extent of Covid-19 in their own country in its early stages, this is the reality.  China is the dominant world power today, let alone tomorrow.

An ever more digital world

Source: Forbes.com

The digital technology sector is already the biggest winner from Covid-19.  Everyone with access, knowledge and ability to pay for connectivity and digital devices has turned to digital technologies to continue with their work, maintain social contacts, and find entertainment during the lockdowns that have covered about one-third of the world’s population by mid-April.[x]  Those who previously rarely used such technologies, have overnight been forced to use them for everything from buying food online, to maintaining contacts with relatives and friends.

There is little evidence that the tech sector was prepared for such a windfall in the latter part of 2019,[xi] but major corporations and start-ups alike have all sought to exploit its benefits as quickly as possible in the first few months of 2020, as testified by the plethora of announcements claiming how various technologies can win the fight against Covid-19.[xii]

One particularly problematic outcome has been the way in which digital tech champions and activists have all sought to develop new solutions to combat Covid-19.  While sometimes this is indeed well intended, more often than not it is primarily so that they can benefit from funding that is made available for such activities by governments and donors, or primarily to raise the individual or corporate profile of those involved.  For them, Covid-19 is a wonderful business opportunity.  Sadly, many such initiatives will fail to deliver appropriate solutions, will be implemented after Covid-19 has dissipated, and on some occasions will even do more harm than good.[xiii]

There are many paradoxes and tensions in this dramatically increased role of digital technology after Covid-19. Two are of particular interest.  First, many people who are self-isolating or social distancing are beginning to crave real, physical human contact, and are realising that communicating only over the Internet is insufficiently fulfilling.  This might offer some hope for the future of those who still believe in the importance of non-digitally mediated human interaction, although I suspect that such concerns may only temporarily delay our demise into a world of cyborgs.[xiv] Second, despite the ultimate decline in the US economy and political power noted above, US corporations have been very well placed to benefit from the immediate impact of Covid-19, featuring in prominent initiatives such as UNESCO’s Global Education Coalition,[xv] or the coalition of pharmaceutical companies brought together by the Gates Foundation.[xvi]

Whatever the precise details, it is an absolute certainty that the dominance of digital technologies in everyone’s lives will increase very dramatically following Covid-19 and this will be exploited by those intent on reaping the profits from such expansion in their own interests.

Increasing acceptance of surveillance by states and companies: the end of privacy as we know it.

Source: Wired.com

A third, related, global impact of Covid-19 will be widely increased global acceptance of the roles of states and companies in digital surveillance.  Already, before 2020, there was a growing, albeit insufficient, debate about the ethics of digital surveillance by states over issues such as crime and “terrorism”, and its implications for privacy.[xvii]  However, some states, such as China, South Korea, Singapore and Israel, have already used digital technologies and big data analytics extensively and apparently successfully in monitoring and tracking the spread of Covid-19,[xviii] and other coalitions of states and the private sector are planning to encourage citizens to sign up to having fundamental aspects of what has previously been considered to be their private and personal health information made available to unknown others.[xix]

One problem with such technologies is that they require substantial numbers of people to sign up to and then use them.  In more authoritarian states where governments can make such adherence obligatory by imposing severe penalties for failure to do so, they do indeed appear to be able to contribute to reduction in the spread of Covid-19 in the interests of the wider community.  However, in more liberal democratic societies, which place the individual about the community in importance, it seems less likely that they will be acceptable.

Despite such concerns, the growing evidence promoted by the companies that are developing them that such digital technologies can indeed contribute to enhanced public health will serve as an important factor in breaking down public resistance to the use of surveillance technologies and big data analytics.  Once again, this will ultimately serve the interest of those who already have greater political and economic power than it will the interests of the most marginalised.

Online shopping and the redesign of urban centres.

Source: Independent.co.uk

Self-isolation and social distancing have led to the dramatic emptying of towns and cities across the world.  Businesses that have been unable to adapt to online trading have overnight been pushed into a critical survival situation, with governments in many of the richer countries of the world being “forced” to offer them financial bail-outs to help them weather the storm.  Unfortunately, most of this money is going to be completely wasted and will merely create huge national debts for years into the future.  People who rarely before used online shopping are now doing so because they believe that no other method of purchasing goods is truly safe.

The new reality will be that most people will have become so used to online shopping that they are unlikely to return in the future to traditional shopping outlets. Companies that have been unable to adjust to the new reality will fail.  The character of our inner-city areas will change beyond recognition.  This is a huge opportunity for the re-design of urban areas in creative, safe and innovative ways.  Already, the environmental impact of a reduction in transport and pollution has been widely seen; wildlife is enjoying a bonanza; people are realising that their old working and socialising patterns may not have been as good as they once thought.[xx]  Unfortunately, it is likely that this opportunity may not be fully grasped, and instead governments that lack leadership and vision will instead seek to prop up backward-looking institutions, companies and organisations, intent on preserving infrastructure and economic activities that are unfit for purpose in the post-pandemic world.  Such a mentality will lead to urban decay and ghettoization, where people will fear to tread, and there is a real danger of a downward spiral of urban deprivation.

There are, though, many bright signs of innovation and creativity for those willing to do things differently.  Shops and restaurants that have been able to find efficient trustworthy drivers are now offering new delivery services; students are able to draw on the plethora of online courses now available; new forms of communal activity are flourishing; and most companies are realising that they don’t actually need to spend money on huge office spaces, but can exploit their labour even more effectively by enabling them to work from home.

We must see the changes brought about by responses to Covid-19 as important opportunities to build for the future, and to create human-centred urban places that are also sensitive to the natural environments in which they are located.

Increasing global inequalities

Source: Gulfnews.com

The net outcome of the above four trends will lead inexorably to a fifth, and deeply concerning issue: the world will become an even more unequal place, where those who can adapt and survive will flourish, but where the most vulnerable and marginalised will become even more immiserated.

This is already all too visible.  Migrant workers are being ostracised, and further marginalised.[xxi]  In India, tens of thousands of labourers are reported to have left the cities, many of them walking home hundreds of kilometres to their villages.[xxii] In China, Africans are reported as being subjected to racist prejudice, being refused service in shops and evicted from their residences.[xxiii]  In the UK, many food banks have had to close and it is reported that about 1.5. million people a day are going without food.[xxiv]  The World Bank is reporting that an extra 40-50 million people across the world will be forced into poverty by Covid-19, especially in Africa.[xxv]  People with disabilities have become even more forgotten and isolated.[xxvi]  The list of immediate crises grows by the day.

More worrying still is that there is no certainty that these short-term impacts will immediately bounce-back once the pandemic has passed.  It seems at least as likely that many of the changes will have become so entrenched that aspects of living under Covid-19 will become the new norm.  Once again, those able to benefit from the changes will flourish, but the uneducated, those with disabilities, the ethnic minorities, people living in isolated areas, refugees, and women in patriarchal societies are all likely to find life much tougher in 2021 and 2022 even than they do at present.   Much of this rising inequality is being caused, as noted above, by the increasing role that digital technologies are playing in people’s lives.  Those who have access and can afford to use the Internet can use it for shopping, employment, entertainment, learning, and indeed most aspects of their lives.  Yet only 59% of the world’s population are active Internet users.[xxvii]

Looking positively to the future.

People will respond in different ways to these likely trends over the next few years, but we will all need to learn to live together in a world where:

• China is the global political economic power,
• Our lives will become ever more rapidly experienced and mediated through digital technology,
• Our traditional views of privacy are replaced by a world of surveillance,
• Our towns and cities have completely different functions and designs, and
• There is very much greater inequality in terms of opportunities and life experiences.

In dealing with these changes, it is essential to remain positive; to see Covid-19 as an opportunity to make the world a better place for everyone to live in, rather than just as a threat of further pain, misery and death, or an opportunity for a few to gain unexpected windfall opportunities to become even richer.  Six elements would seem to be important in seeking to ensure that as many people as possible can indeed flourish once the immediate Covid-19 pandemic has dissipated:

• First, these predictions should encourage all of us to prioritise more on enhancing the lives of the poorest and the most marginalised, than on ensuring economic growth that mainly benefits the rich and privileged. This applies at all scales, from designing national health and education services, to providing local, community level care provision.
• This requires an increased focus on negotiating communal oriented initiatives and activities rather than letting the greed and selfishness of individualism continue to rule the roost.
• Third, it is essential that we use this as an opportunity to regain our physical sentient humanity, and reject the aspirations of those who wish to create a world that is only experienced and mediated through digital technology. We need to regain our very real experiences of each other and the world in which we live through our tastes, smells, the sounds we hear, the touches we feel, and the sights we see.
• Fourth, it seems incredibly important that we create a new global political order safely to manage a world in which China replaces the USA as the dominant global power. The emergence of new political counterbalances, at a regional level as with Europe, South Asia, Africa and Latin America seems to be a very important objective that remains to be realised.  Small states that choose to remain isolated, however arrogant they are about the “Great”ness of their country, will become ever more vulnerable to the vagaries of economic, political and demographic crisis.
• Fifth, we need to capitalise on the environmental impact of Covid-19 rapidly to shape a world of which we are but a part, and in which we care for and co-operate with the rich diversity of plant and animal life that enjoys the physical richness of our planet. This will require a comprehensive and rigorous evaluation of the harm caused to our world by the design and use of digital technologies.[xxviii]
• Finally, we need to agree communally on the extent to which individual privacy matters, and whether we are happy to live in a world of omnipresent surveillance by companies (enabling them to reap huge profits from our selves as data) and governments (to maintain their positions of power, authority and dominance). This must not be imposed on us by powerful others.  It is of paramount importance that there is widespread informed public and communal discussion about the future of surveillance in a post-Covid-19 era.

I trust that these comments will serve to provoke and challenge much accepted dogma and practice.  Above all, let’s try to think of others more than we do ourselves, let’s promote the reduction of inequality over increases in economic growth, and let’s enjoy  an integral, real and care-filled engagement with the non-human natural world.

---

Notes:

[i] For current figures see https://coronavirus.thebaselab.com/ and https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6, although all data related with this coronavirus must be treated with great caution; see https://unwin.wordpress.com/2020/04/11/data-and-the-scandal-of-the-uks-covid-19-survival-rate/

[ii] Modi’s hasty coronavirus lockdown of India leaves many fearful for what comes next, https://time.com/5812394/india-coronavirus-lockdown-modi/

[iii] Jack Dorsey, the founder of Twitter and Square, might well be an exception with his $1 billion donation to support Covid-19 relief and other charities; see https://www.theverge.com/2020/4/7/21212766/jack-dorsey-coronavirus-covid-19-donate-relief-fund-square-twitter

[iv] See, for example, discussion in Unwin, T. (2017) Reclaiming ICT4D, Oxford: Oxford University Press.  I appreciate that such arguments infuriate many people living in the USA,

[v] See, for example, George Parker’s, We Are Living in a Failed State: The coronavirus didn’t break America. It revealed what was already broken, The Atlantic, June 2020 (preview) https://www.theatlantic.com/magazine/archive/2020/06/underlying-conditions/610261/.

[vi] Based on figures from https://coronavirus.thebaselab.com/ on 15^th April 2020.  For comparison, Spain had 39.74 reported deaths per 100,000, Italy 35.80, and the UK 18.96.

[vii] There are many commentaries on this, but The Wall Street Journal’s account on 9 February 2020 https://www.wsj.com/articles/u-s-china-trade-war-reshaped-global-commerce-11581244201 is useful, as is the Pietersen Institute’s timeline https://www.piie.com/blogs/trade-investment-policy-watch/trump-trade-war-china-date-guide.

[viii] For a good account of his use of language see Eren Orbey’s comment in The New Yorker, Trump’s “Chinese virus” and what’s at stake in the coronovirus’s name,  https://www.newyorker.com/culture/cultural-comment/whats-at-stake-in-a-viruss-name

[ix] China’s massive long-term strategic investments across the world, not least through its 一带一路 (Belt and Road) initiative, have placed it in an extremely strong position to reap the benefits of its revitalised economy from 2021 onwards (for a good summary of this initiative written in January 2020 see https://www.cfr.org/backgrounder/chinas-massive-belt-and-road-initiative)

[x] Kaplan, J., Frias, L. and McFall-Johnsen, M., A third of the global population is on coronavirus lockdown…, https://www.businessinsider.com/countries-on-lockdown-coronavirus-italy-2020-3?r=DE&IR=T

[xi] This is despite conspiracy theorists arguing that those who were going to gain most from Covid-19 especially in the digital tech and pharmaceutical industry had been active in promoting global fear of the coronavirus, or worse still had actually engineered it for their advantage.  See, for example, The New York Times, https://www.nytimes.com/2020/04/17/technology/bill-gates-virus-conspiracy-theories.html, or Thomas Ricker, Bill Gates is now the leading target for Coronavirus falsehoods, says report, https://www.theverge.com/2020/4/17/21224728/bill-gates-coronavirus-lies-5g-covid-19 .

[xii] See, for example, Shah, H. and Kumar, K., Ten digital technologies helping humans in the fight against Covid-19, Frost and Sullivan, https://ww2.frost.com/frost-perspectives/ten-digital-technologies-helping-humans-in-the-fight-against-covid-19/, Gergios Petropolous, Artificial interlligence in the fight against COVID-19, Bruegel, https://www.bruegel.org/2020/03/artificial-intelligence-in-the-fight-against-covid-19/, or Beech, P., These new gadgets were designed to fight COVID-19, World Economic Forum, https://www.weforum.org/agenda/2020/04/coronavirus-covid19-pandemic-gadgets-innovation-technology/. It is also important to note that the notion of “fighting” the coronavirus is also deeply problematic.

[xiii] For my much more detailed analysis of these issues, see Tim Unwin (26 March 2020), collaboration-and-competition-in-covid-19-response, https://unwin.wordpress.com/2020/03/26/collaboration-and-competition-in-covid-19-response/

[xiv] For more on this see Tim Unwin (2017) Reclaiming ICT4D, Oxford: Oxford University Press, and for a brief comment https://unwin.wordpress.com/2016/08/03/dehumanization-cyborgs-and-the-internet-of-things/.

[xv] Although, significantly, Chinese companies are also involved; see https://en.unesco.org/covid19/educationresponse/globalcoalition

[xvi] For the work of the Gates Foundation and US pharmaceutical companies in fighting Covid-19 https://www.outsourcing-pharma.com/Article/2020/03/27/Bill-Gates-big-pharma-collaborate-on-COVID-19-treatments

[xvii] There is a huge literature, both academic and policy related, on this, but see for example OCHCR (2014) Online mass-surveillance: “Protect right to privacy even when countering terrorism” – UN expert, https://www.ohchr.org/SP/NewsEvents/Pages/DisplayNews.aspx?NewsID=15200&LangID=E; Privacy International, Scrutinising the global counter-terrorism agenda, https://privacyinternational.org/campaigns/scrutinising-global-counter-terrorism-agenda; Simon Hale-Ross (2018) Digital Privacy, Terrorism and Law Enforcement: the UK’s Response to Terrorist Communication, London: Routledge; and Lomas, N. (2020) Mass surveillance for national security does conflict with EU privacy rights, court advisor suggests, TechCrunch, https://techcrunch.com/2020/01/15/mass-surveillance-for-national-security-does-conflict-with-eu-privacy-rights-court-advisor-suggests/.

[xviii] Kharpal, A. (26 March 2020) Use of surveillance to fight coronavirus raised c oncenrs about government power after pandemic ends, CNBC, https://www.cnbc.com/2020/03/27/coronavirus-surveillance-used-by-governments-to-fight-pandemic-privacy-concerns.html; but see also more critical comments about the efficacy of such systems as by Vaughan, A. (17 April 2020) There are many reasons why Covid-19 contact-tracing apps may not work, NewScientist, https://www.newscientist.com/article/2241041-there-are-many-reasons-why-covid-19-contact-tracing-apps-may-not-work/

[xix] There are widely differing views as to the ethics of this.  See, for example, Article 19 (2 April 2020) Coronavirus: states use of digital surveillance technologies to fight pandemic must respect human rights, https://www.article19.org/resources/covid-19-states-use-of-digital-surveillance-technologies-to-fight-pandemic-must-respect-human-rights/ ; McDonald, S. (30 March 2020) The digital response to the outbreak of Covid-19, https://www.cigionline.org/articles/digital-response-outbreak-covid-19. See also useful piece by Arcila (2020) for ICT4Peace on “A human-centric framework to evaluate the risks raised by contact-tracing applications” https://mcusercontent.com/e58ea7be12fb998fa30bac7ac/files/07a9cd66-0689-44ff-8c4f-6251508e1e48/Beatriz_Botero_A_Human_Rights_Centric_Framework_to_Evaluate_the_Security_Risks_Raised_by_Contact_Tracing_Applications_FINAL_BUA_6.pdf.pdf

[xx] See, for example, https://www.bbc.com/future/article/20200326-covid-19-the-impact-of-coronavirus-on-the-environment, https://www.msn.com/en-gb/news/world/the-environmental-impact-of-covid-19/ss-BB11JxGv?li=BBoPWjQ, https://www.theguardian.com/world/2020/mar/26/life-after-coronavirus-pandemic-change-world, and https://www.scientificamerican.com/article/how-the-coronavirus-pandemic-is-affecting-co2-emissions/.

[xxi] See The Guardian (23 April 2020) ‘We’re in a prison’: Singapore’s million migrant workers suffer as Covid-19 surges back, https://www.theguardian.com/world/2020/apr/23/singapore-million-migrant-workers-suffer-as-covid-19-surges-back

[xxii] Al Jazeera (6 April 2020) India: Coronavirus lockdown sees exodus from cities, https://www.aljazeera.com/programmes/newsfeed/2020/04/india-coronavirus-lockdown-sees-exodus-cities-200406104405477.html.

[xxiii] Financial Times (13^th April) China-Africa relations rocked by alleged racism over Covid-19, https://www.ft.com/content/48f199b0-9054-4ab6-aaad-a326163c9285

[xxiv] Global Citizen (22 April 2020) Covid-19 Lockdowns are sparking a hunger crisis in the UK, https://www.globalcitizen.org/en/content/covid-19-food-poverty-rising-in-uk/

[xxv] Mahler, D.G., Lakner, C., Aguilar, R.A.C. and Wu, H. (20 April 2020) The impact of Covid-19 (Coronavirus) on global poverty: why Sub-Saharan Africa might be the region hardest hit, World Bank Blogs, https://blogs.worldbank.org/opendata/impact-covid-19-coronavirus-global-poverty-why-sub-saharan-africa-might-be-region-hardest

[xxvi] Bridging the Gap (2020) The impact of Covid-19 on persons with disabilities, https://bridgingthegap-project.eu/the-impact-of-covid-19-on-people-with-disabilities/

[xxvii] Statista (Januarv 2020) https://www.statista.com/statistics/269329/penetration-rate-of-the-internet-by-region/

[xxviii] For a wider discussion of the negative environmental impacts of climate change see https://unwin.wordpress.com/2020/01/16/digital-technologies-and-climate-change/.

Collaboration and competition in Covid-19 response

A week ago, I wrote a post about the potential of crowdsourcing and the use of hashtags for gathering enhanced data on infection rates for Covid-19.  Things have moved rapidly since then as companies, civil society organisations, international organisations, academics and donors have all developed countless initiatives to try to respond.  Many of these initiatives seem to be more about the profile and profits of the organisations/entities involved than they do about making a real impact on the lives of those who will suffer most from Covid-19.  Yesterday, I wrote another post on my fears that donors and governments will waste huge amounts of money, time and effort on Covid-19 to little avail, since they have not yet learnt the lessons of past failures.

I still believe that crowdsourcing could have the potential, along with many other ways of gathering data, to enhance decision making at this critical time. However the dramatic increase in the number of such initiatives gives rise to huge concern.  Let us learn from past experience in the use of digital technologies in development, and work together in the interests of those who are likely to suffer the most.  Eight issues are paramount when designing a digital tech intervention to help reduce the impact of Covid-19, especially through crowdsourcing type initiatives:

• Don’t duplicate what others are already doing
• Treat privacy and security very carefully
• Don’t detract from official and (hopefully) accurate information
• Keep it simple
• Ask questions that will be helpful to those trying to respond to the pandemic
• Ensure that there are at least some questions that are the same in all surveys if there are multiple initiatives being done by different organisations
• Work with a globally agreed set of terminology and hashtags (#)
• Collaborate and share

Don’t duplicate what others are already doing

As the very partial list of recent initiatives at the end of this post indicates, many crowdsourcing projects have been created across the world to gather data from people about infections and behaviours relating to Covid-19.  Most of these are well-intentioned, although there will also be those that are using such means unscrupulously also to gather data for other purposes.  Many of these initiatives ask very similar questions.  Not only is it a waste of resources to design and build several competing platforms in a country (or globally), but individual citizens will also soon get bored of responding to multiple different platforms and surveys.  The value of each initiative will therefore go down, especially if there is no means of aggregating the data.  Competition between companies may well be an essential element of the global capitalist system enabling the fittest  to accrue huge profits, but it is inappropriate in the present circumstances where there are insufficient resources available to tackle the very immediate responses needed across the world.

Treat privacy and security very carefully

Most digital platforms claim to treat the security of their users very seriously.  Yet the reality is that many fail to protect the privacy of much personal information sufficiently, especially when software is developed rapidly by people who may not prioritise this issue and cut corners in their desire to get to market as quickly as possible.  Personal information about health status and location is especially sensitive.  It can therefore be hugely risky for people to provide information about whether they are infected with a virus that is as easily transmitted as Covid-19, while also providing their location so that this can then be mapped and others can see it.  Great care should be taken over the sort of information that is asked and the scale at which responses are expected.  It is not really necessary to know the postcode/zipcode of someone, if just the county or province will do.

Don’t detract from official and (hopefully) accurate information

Use of the Internet and digital technologies have led to a plethora of false information being propagated about Covid-19.  Not only is this confusing, but it can also be extremely dangerous.  Please don’t – even by accident – distract people from gaining the most important and reliable information that could help save their lives.  In some countries most people do not trust their governments; in others, governments may not have sufficient resources to provide the best information.  In these instances, it might be possible to work with the governments to ehance their capacity to deliver wise advice.  Whatever you do, try to point to the most reliable globally accepted infomation in the most appropriate languages (see below for some suggestions).

Keep it simple

Many of the crowdsourcing initiatives currently available or being planned seem to invite respondents to complete a fairly complex and detailed list of questions.  Even when people are healthy it could be tough for them to do so, and this could especially be the case for the elderly or digitally inexperienced who are often the most vulnerable.  Imagine what it would be like for someone who has a high fever or difficulty in breathing trying to fill it in.

Ask questions that will be helpful to those trying to respond to the pandemic

It is very difficult to ask clear and unambiguous questions.  It is even more difficult to ask questions about a field that you may not know much about.  Always work with people who might want to use the data that your initiative aims to generate.  If you are hoping, for example, to produce data that could be helpful in modelling the pandemic, then it is essential to learn from epidemiologists and those who have much experience in modelling infectious diseases.  It is also essential to ensure that the data are in a format that they can actually use.  It’s all very well producing beautful maps, but if they use different co-ordinate systems or boundaries from those used by government planners they won’t be much use to policy makers.

Ensure that there are at least some questions that are the same in all surveys if there are multiple initiatives being done by different organisations

When there are many competing surveys being undertaken by different organisations about Covid-19, it is important that they have some identical questions so that these can then be aggregated or compared with the results of other initiatives.   It is pointless having multiple initiatives the results of which cannot be combined or compared.

Work with a globally agreed set of terminology and hashtags (#)

The field of data analytics is becoming ever more sophisticated, but if those tackling Covid-19 are to be able readily to use social media data, it would be very helpful if there was some consistency in the use of terminology and hashtags.  There remains an important user-generated element to the creation of hashtags (despite the control imposed by those who create and own social media platforms), but it would be very helpful to those working in the field if some consistency could be encouraged or even recommended by global bodies and UN agencies such as the WHO and the ITU.

Collaborate and share

Above all, in these unprecendented times, it is essential for those wishing to make a difference to do so collaboratively rather than competitively.  Good practices should be shared rather than used to generate individual profit.  The scale of the potential impact, especially in the weakest contexts is immense.  As a recent report from the Imperial College MRC Centre for Global Infectious Disease Analysis notes, without interventions Covid-19 “would have resulted in 7.0 billion infections and 40 million deaths globally this year. Mitigation strategies focussing on shielding the elderly (60% reduction in social contacts) and slowing but not interrupting transmission (40% reduction in social contacts for wider population) could reduce this burden by half, saving 20 million lives, but we predict that even in this scenario, health systems in all countries will be quickly overwhelmed. This effect is likely to be most severe in lower income settings where capacity is lowest: our mitigated scenarios lead to peak demand for critical care beds in a typical low-income setting outstripping supply by a factor of 25, in contrast to a typical high-income setting where this factor is 7. As a result, we anticipate that the true burden in low income settings pursuing mitigation strategies could be substantially higher than reflected in these estimates”.

 

Resources

This concluding section provides quick links to generally agreed reliable and simple recommendations relating to Covid-19 that could be included in any crowdsourcing platform (in the appropriate language), and a listing of just a few of the crowdsourcing initiatives that have recently been developed.

Recommended reliable information on Covid-19

• WHO resources
  • Protect yourself
  • Country and technical guidance
• Chinese Centre for Disease Control and Prevention
• Africa Centres for Disease Control (very slow to download – can someone urgently please help them get better connectivity)
• European Centre for Disease Prevention and Control
• UK National Health Service Advice for Everyone – and good graphics from the BBC
• Survey instrument questions developed and shared by Imperial College MRC Centre for Global Infectious Disease Analysis (UK)

Remember the key WHO advice adopted in various forms by different governments:

• Wash your hands frequently
• Maintain social distancing
• Avoid touching eyes, nose and mouth
• If you have fever, cough and difficulty breathing, seek medical care early

A sample of crowdsourcing initiatives

Some of the many initiatives using crowdsourcing and similar methods to generate data relating to Covid-19 (many of which have very little usage):

• Global/Generic
  • Redaktor (mainly European)
  • Folding@Home
  • Safecast – an international volunteer driven non-profit organization whose goal is to create useful, accessible, and granular environmental data
    • Covid-19 testing map
  • WhatsApp Coronoavirus Information Hub
  • Good Judgement Open Platform
  • Metaculus
• Argentina
  • Coronavirus Argentina (very little usage)
• France
  • Coronavirus in Toulouse (very little usage)
•  Italy
  • Anpas
• India
  • Covid-19 in India (press report)
•  Kenya
  • KEPSA and Liquid Telecom
• Madagascar
  • MDG – Covid 19 (very little usage)
• Nigeria

  • Supporting Response Effort to the Corona Virus (COVID-19) in Nigeria

•  Singapore
  • covid19 SG
• South Africa
  • Chatsworth (very litte usage)
•  Spain
  • Frena La Curva
  • coronavirusmakers  (very little usage)
• Sweden
  • Corona Help (very little usage)
• Switzerland
  • Corona-Work
• UK
  • Let’s Beat Covid-19 – a million doctors need your help (anonymous survey)
  • Covid Symptom Tracker – Guy’s and St Thomas’ Biomedical Research Centre
  • Public Health England – UK Covid-19 update maps
• USA
  • Covid 19 Connectus (very little usage)
  • Covid Near You
  • Opendemic (by students at Harvard and MIT)

Lists by others of relevant initiatives:

• Open Gov Partnership: Collecting open governments approaches to COVID-19
• NESTA: Mobilising collective inetlligence to tackle the COVID-19 threat
• Noel Patel’s (MIT) listing of 10 coronavirus dashboards

 

Global Covid-19 mapping and recording initiatives

The following are currently three of the best sourcs for global information about Covid-19 – although I do wish that they clarified that “infections” are only “recorded infections”, and that data around deaths should be shown as “deaths per 1000 people” (or similar density measures) and depicted on choropleth maps.

• thebaselab
• Johns Hopkins University CSSE
• Worldometer

 

Donor and government funding of Covid-19 digital initiatives

We are all going to be affected by Covid-19, and we must work together across the world if we are going to come out of the next year peacefully and coherently.  The world in a year’s time will be fundamentally different from how it is now; now is the time to start planning for that future. The countries that will be most adversely affected by Covid-19 are not the rich and powerful, but those that are the weakest and that have the least developed healthcare systems.  Across the world, many well-intentioned people are struggling to do what they can to make a difference in the short-term, but many of these initiatives will fail; most of them are duplicating ongoing activity elsewhere; many of them will do more harm than good.

This is a plea for us all to learn from our past mistakes, and work collaboratively in the interests of the world’s poorest and most marginalised rather than competitively and selfishly for ourselves.

Past mistakes

Bilateral donors and international organisations are always eager to use their resources at times of crisis both to try to do good, but also to be seen to be trying to do good.  Companies and civil society organisations also often try to use such crises to generate revenue and raise their own profiles.  As a result many crises tend to benefit the companies and NGOs more than they do the purportedly intended beneficiaries.

This was classically, and sadly, demonstrated in the Ebola outbreak in West Africa in 2014, especially with the funding of numerous Internet-based initiatives – at a time when only a small fraction of the population in the infected countries was actually connected to the Internet.  At that time, I wrote a short piece that highlighted the many initiatives ongoing in the continent.  Amongst other things this noted that:

• “A real challenge now, though, is that so many initiatives are trying to develop digital resources to support the response to Ebola that there is a danger of massive duplication of effort, overlap, and simply overload on the already stretched infrastructure, and indeed people, in the affected countries”, and
• “Many, many poor people will die of Ebola before we get it under control collectively. We must never make the same mistakes again”.

I have not subsequently found any rigorous monitoring and evaluation reports about the efficacy of most of the initiatives that I then listed, nor of the countless other digital technology projects that were funded and implemented at the time.  However, many such projects hadn’t produced anything of value before the crisis ended, and most failed to many any significant impact on mortality rates or on the lives of those people affected.

In the hope of trying not to make these same mistakes again, might I suggest the following short-term and longer-term things to bear in mind as we seek to reduce the deaths and disruption caused by Covid-19.

Short-term responses

The following five short-term issues strike me as being particularly important for governments and donors to bear in mind, especially in the context of the use of digital technologies:

• Support and use existing technologies.  In most (but not all) instances the development and production of new technological solutions will take longer than the immediate outbreak that they are designed to respond to.  Only fund initiatives that will still be relevant after the immediate crisis is over, or that will enable better responses to be made to similar crises in the future.  Support solutions that are already proven to work.
• Co-ordinate and collaborate rather than compete. Countless initiatives are being developed to try to resolves certain aspects of the Covid-19 crisis, such as lack of ventilators or the development of effective testing kits (see below).  This is often because of factors such as national pride and the competitive advantage that many companies (and NGOs) are seeking to achieve.  As a result, there is wasteful duplication of effort, insufficient sharing of good practice, and the poor and marginalised usually do not receive the optimal treatment.  It is essential for international organisations to share widely accepted good practices and technological designs that can be used across the world in the interests of the least powerful.
• Ensure that what you fund does more good than harm.  Many initiatives are rushed onto the market without having been sufficiently tried and tested in clinical contexts.  Already, we have seen a plethora of false information being published about Covid-19, some out of ignorance and some deliberate falsification.  It is essential that governments and donors support reliable initiatives, and that possible unintended consequences are thorouighly considered.
• Remember that science is a contested field.  Value-free science does not exisit.  Scientists are generally as interested in their own careers as anyone else.  There is also little universal scientific agreement on anything.  Hence, it is important for politicians and decision makers carefully to evaluate different ideas and proposed solutions, and never to resort to claiming that they are acting on scientific advice.  If you are a leader you have to make some tough decisions.
• Ensure that funding goes to where it is most needed.  In many such crises funding that is made available is inappropriately used, and it is therefore essential for governments and donors to put in place effective and robus measures to ensure transparency and probity in funding.  A recent letter from Transparency International to the US Congress, for example, recommends 25 anti-corruption measures that it believes are necessary to ” help protect against self-interested parties taking advantage of this emergency for their own benefit and thereby undermining the safety of our communities”.

In the medium term…

Immediate action on Covid-19 is urgent, but a well thought-through and rigorous medium-term response by governments and donors is even more important, especially in the context of the use of digital technologies:

• We must start planning now for what the world will be like in 18 months time.  Two things about Covid-19 are certain: many people will die, and it will change the world forever.  Already it is clear that one outcome will be vastly greater global use  of digital technologies.  This, for example, is likely dramatically to change the ways in which people shop: as they get used to buying more of their requirements online, traditional suppliers will have to adapt their practices very much more rapipdly than they have been able to do to date.  Those with access to digital technologies will become even more advantaged compared with those who cannot afford them, do not know how to use them, or do not have access to them.
• Planning for fundamental changes to infrastructure and government services: education and health.  The impact of Covid-19 on the provision of basic government services is likely to be dramatic, and particularly so in countries with weak infrastructures and limited provision of fundamental services.  Large numbers of teachers, doctors and nurses are likely to die across the world, and we need to find ways to help ensure that education and health services can be not only restored but also revitalised.  Indeed, we should see this as an opportunity to introduce new and better systems to enable people to live healthier and more fulfilled lives.  The development of carefully thought through recommendations on these issues, involving widespread representative consultation, in the months ahead will be very important if governments, especially in the poorest countries, are to be able to make wise use of the opportunities that Covid-19 is creating.  There is a very significant role for all donors in supporting such initiatives.
• Communities, collaboration and co-operation.  Covid-19 offers an opportunity for fundamentally different types of economy and society to be shaped.  New forms of communal activity are already emerging in countries that have been hardest hit by Covid-19.  Already, there are numerous reports of the dramatic impact of self-isolation and reduction of transport pollution on air quality and weather in different parts of the world (see The Independent, NPR, CarbonBrief).  Challenges with obtaining food and other resources are also forcing many people to lead more frugal lives.  However, those who wish to see more communal and collaborative social formations in the future will need to work hard to ensure that the individualistic, profit-oriented, greedy and selfish societies in which we live today do not become ever more entrenched.  We need to grasp this opportunity together to help build a better future, especially in the interests of the poor and marginalised.

Examples of wasteful duplication of effort

Already a plethora of wasteful (in terms of both time and money), competitive and duplicative initiatives to tackle various aspects of the Covid-19 pandemic have been set in motion.  These reflect not only commercial interests, but also national pride – and in some instances quite blatant racism. Many are also very ambitious, planning to deliver products in only a few weeks.  Of course critical care ventilators, test kits, vaccines and ways of identifying antibodies are incredibly important, but greater global collaboration and sharing would help to guarantee both quantity and quality of recommended solutions.  International Organisations have a key role to play in establishing appropriate standards for such resources, and for sharing Open Source (or other forms of communal) templates and designs.  Just a very few of the vast number of ongoing initiatives are given in the reports below:

Critical care ventilators

• India
  • Why Ventilators are key to fighting the coronavirus battle
  • Bengaluru based Skanray starts work on new ventilator design that would speed up production locally
  • How India can combat the ventilator shortage? Bangalore-based Skanray Technologies plans to make 1 lakh locally sourced ventilators in 2-3 months to battle coronavirus. Shereen Bhan speaks to Vishwaprasad Alva of Skanray Tech
• Pakistan:
  • The first 3D-printed ventilator prototype in Pakistan could be ready within two weeks
  • Covid-19 ventilator hackathon
  • UPDATE: COVID-19 LOCAL VENTILATOR EFFORTS: HOW NOT TO BE AN INHIBITOR OF INNOVATION?
• Spain
  • OxyGEN, is a device that responds to the  lack of emergency respirators in the COVID-19 health crisis
• UK

  • Government chooses design of ventilators that UK urgently needs

  • Dyson draws up plan for ventilator
• USA

  • People Are Trying to Make DIY Ventilators to Meet Coronavirus Demand

  • Julian Botta (Johns Hopkins)

Testing kits

• Australia

  • Rapid Covid-19 testing kits receive urgent approval from Australian regulator

• Bangladesh
  • Bangladesh approves low-cost test kit to detect Covid-19
•  China/EU
  • New rapid test kit to detect COVID-19 soon available in EU
• India
  • Mylab receives approval for Covid-19 test kit
• Kenya

  • African Nations Try to Overcome Shortage of COVID-19 Test Kits

• South Africa

  • The race for COVID-19 local test kits

Despite criticisms of the replicative and wasteful nature of many such initiatives, there are a few initiatives at a global scale that do offer hope.  Prime among these must be Jack Ma’s donation of 20,000 testing kits to each of 54 African countries, which will go some way to reducing the need for these to be domestically produced across the continent.  But this is sadly only a small shower of rain on an otherwise parched continent.  Working together, we have much more to be achieved, both now and in the months ahead.

Crowdsourcing Covid-19 infection rates

Covid-19, 19 March 2020, Source: https://coronavirus.thebaselab.com/

I have become increasingly frustrated by the continued global reporting of highly misleading figures for the number of Covid-19 infections in different countries.  Such “official” figures are collected in very different ways by governments and can therefore not simply be compared with each other.  Moreover, when they are used to calculate death rates they become much more problematic.  At the very least, everyone who cites such figures should refer to them as “Officially reported Infections”

As I write (19th March 2020, 17.10 UK time), the otherwise excellent thebaselab‘s documentation of the coronavirus’s evolution and spread gives mortality rates (based on deaths as a percentage of infected cases) for China as 4.01%, Italy as 8.34% and the UK as 5.09%.  However, as countries are being overwhelmed by Covid-19, most no longer have the capacity to test all those who fear that they might be infected.  Hence, as the numbers of tests as a percentage of total cases go down, the death rates will appear to go up.  It is fortunately widely suggested that most people who become infected with Covid-19 will only have a mild illness (and they are not being tested in most countries), but the numbers of deaths become staggering if these mortality rates are extrapolated.  Even if only 50% of people are infected (UK estimates are currently between 60% and 80% – see the Imperial College Report of 16th March that estimates that 81% of the UK and US populations will be infected), and such mortality rates are used, the figures (at present rates) become frightening:

• In Italy, with a total population of 60.48 m, this would mean that 30.24 m people would be infected, which with a mortality rate of 8.34% would imply that 2.52 m people would die;
• In the UK, with a total population of 66.34 m, this would mean that 33.17 m people would be infected, which with a mortality rate of 5.09% would imply that 1.69 m people would die.

These figures are unrealistic, because only a fraction of the total number of infected people are being tested, and so the reported infection rates are much lower than in reality.  In order to stop such speculations, and to reduce widespread panic, it is essential that all reporting of “Infected Cases” is therefore clarified, or preferably stopped.  Nevertheless, the most likely impact of Covid-19 is still much greater than most people realise or can fully appreciate.  The Imperial College Report (p.16) thus suggests that even if all patients were to be treated, there would still be around 250,000 deaths in Great Britain and 1.1-1.2 m in the USA; doing nothing, means that more than half a million people might die in the UK.

Having accurate data on infection rates is essential for effective policy making and disease management.  Globally, there are simply not enough testing kits or expertise to be able to get even an approximately accurate figure for real infections rates.  Hence, many surrogate measures have been used, all of which have to make complex assumptions about the sample populations from which they are drawn.  An alternative that is fortunately beginning to be considered is the use of digital technologies and social media.  Whilst by no means everyone has access to digital technologies or Internet connectivity, very large samples can be generated.  It is estimated that on average 2.26 billion people use one of the Facebook family of services every day; 30% of the world’s population is a large sample.  Existing crowdsourcing and social media platforms could therefore be used to provide valuable data that might help improve the modelling, and thus the management of this pandemic.

Crowdsourcing

[Great to see that since I first wrote this, Liquid Telecom has used Ushahidi to develop a crowd sourced Covid-19 data gathering initiative]

The violence in Kenya following the disputed Presidential elections in 2007, provided the cradle for the development of the Open Source crowdmapping platform, Ushahidi, which has subsequently been used in responding to disasters such as the earthquakes in Haiti and Nepal, and valuable lessons have been learnt from these experiences.  While there are many challenges in using such technologies, the announcement on 18th March that Ushahidi is waiving its Basic Plan fees for 90 days is very much to be welcomed, and provides an excellent opportunity to use such technologies better to understand (and therefore hopefully help to control) the spread of Covid-19.  However, there is a huge danger that such an opportunity may be missed.

The following (at a bare minimum) would seem to be necessary to maximise the opportunity for such crowdsourcing to be successful:

• We must act urgently. The failure of countries across the world to act in January, once the likely impact of events in Wuhan unravelled was staggering. If we are to do anything, we have to act now, not least to help protect the poorest countries in the world with the weakest medical services.  Waiting even a fortnight will be too late.
• Some kind of co-ordination and sharing of good practices is necessary. Whilst a global initiative might be feasible, it would seem more practicable for national initiatives to be created, led and inspired by local activists.  However, for data to be comparable (thereby enabling better modelling to take place) it is crucial for these national initiatives to co-operate and use similar methods and approaches.  There must also be close collaboration with the leading researchers in global infectious disease analysis to identify what the most meaningful indicators might be, as well as international organisations such as the WHO to help disseminate practical findings..
• An agreed classification. For this to be effective there needs to be a simple agreed classification that people across the world could easily enter into a platform.  Perhaps something along these lines might be appropriate: #CovidS (I think I might have symptoms), #Covid7 (I have had symptoms for 7 days), #Covid14 (I have had symptoms for 14 days), #CovidT (I have been tested and I have it), #Covid0 (I have been tested and I don’t have it), #CovidH (I have been hospitalised), #CovidX (a person has died from it).
• Practical dissemination.  Were such a platform (or national platforms) to be created, there would need to be widespread publicity, preferably by governments and mobile operators, to encourage as many people as possible to enter their information.  Mutiple languages would need to be incorporated, and the interfaces would have to be as appealing and simple as possible so as to encourage maximum submission of information.

Ushahidi as a platform is particularly appealing, since it enables people to submit information in multiple ways, not only using the internet (such as e-mail and Twitter), but also through SMS messages.  These data can then readily be displayed spatially in real time, so that planners and modellers can see the visual spread of the coronavirus.  There are certainly problems with such an approach, not least concerning how many people would use it and thus how large a sample would be generated, but it is definitely something that we should be exploring collectively further.

Social media

An alternative approach that is hopefully also already being explored by global corporations (but I have not yet read of any such definite projects underway) could be the use of existing social media platforms, such as Facebook/WhatsApp, WeChat or Twitter to collate information about people’s infection with Covid-19. Indeed, I hope that these major corporations have already been exploring innovative and beneficial uses to which their technologies could be put.  However, if this if going to be of any real practical use we must act very quickly.

In essence, all that would be needed would be for there to be an agreed global classification of hashtags (as tentatively suggested above), and then a very widespread marketing programme to encourage everyone who uses these platforms simply to post their status, and any subsequent changes.  The data would need to be released to those undertaking the modelling, and carefully curated information shared with the public.

Whilst such suggestions are not intended to replace existing methods of estimating the spread of infectious diseases, they could provide a valuable additional source of data that could enable modelling to be more accurate.  Not only could this reduce the number of deaths from Covid-19, but it could also help reassure the billions of people who will live through the pandemic.  Of course, such methods also have their sampling challenges, and the data would still need to be carefully interpreted, but this could indeed be a worthwhile initiative that would not be particularly difficult or expensive to initiate if global corporations had the will to do so.

Some final reflections

Already there are numerous new initiatives being set up across the world to find ways through which the latest digital technologies might be used in efforts to minimise the impact of Covid-19. The usual suspects are already there as headlines such as these attest: Blockchain Cures COVID-19 Related Issues in China, AI vs. Coronavirus: How artificial intelligence is now helping in the fight against COVID-19, or Using the Internet of Things To Fight Virus Outbreaks. While some of these may have potential in the future when the next pandemic strikes, it is unlikely that they will have much significant impact  on Covid-19.  If we are going to do anything about it, we must act now with existing well known, easy to use, and reliable digital technologies.

I fear that this will not happen.  I fear that we will see numerous companies and civil society organisations approaching donors with brilliant new innovative “solutions” that will require much funding and will take a year to implement.  By then it will be too late, and they will be forgotten and out of date by the time the next pandemic arrives.  Donors should resist the temptation to fund these.  We need to learn from what happened in West Africa with the spread of Ebola in 2014, when more than 200 digital initiatives seeking to provide information relating to the virus were initiated and funded (see my post On the contribution of ICTs to overcoming the impact of Ebola).  Most (although not all) failed to make any significant impact on the lives and deaths of those affected, and the only people who really benefitted were the companies and the staff working in the civil society organisations who proposed the “innovations”.

This is just a plea for those of us interested in these things to work together collaboratively, collectively and quickly to use what technologies we have at our fingertips to begin to make an impact.  Next week it will probably be too late…

Servants of the poor – WSIS TalkX

It was a great honour to have been invited – a few hours beforehand – to give one of the inaugural WSIS TalkX presentations last Thursday evening as WSIS 2019 drew towards its close.  Seven of us had been asked if we would like to talk about our lives in technology for around 5 minutes. I opted to go last – just before the closing cocktail party.  Several colleagues had to leave before the end to get to other commitments and so they spoke first; I knew I would be remaining to enjoy the wine.  Before me there were some amazing, inspirational speakers: Stephenie Rodriguez, Joel Radvanyi, Gloria Kimbwala, Ayanna T Samuels, Sebastian Behaghel and Ted Chen…

With little time to prepare it was difficult to know quite what to say.  We had been asked to tell our own stories, and so I chose five images as five “scenes” around which to tell my tale.  Posting the images on social media, I had hoped that people might be able to see them as I spoke…

In reality, I’m not sure that many people actually saw the pictures, and I know many were rather confused when I began and introduced myself in the persona of one of my aliases.  I had, though, been introduced by the Master of Ceremonies as someone learning from the life of Hassan-i Sabbah…

To see and hear what I had to say, click on the image above (or here).  Fully to understand it, though, you would need to listen to the other six talks, because I tried hard to link it to what the speakers had to say – especially, for example, about the best university in the world, and the SDGs!

The basic message is simple – if we really believe in empowering the poor and the marginalised through digital technologies we must become their servants…

Reflections on ICTs, the SDGs and innovation adoption

The contrast between attending a series of side events around the UN General Assembly in New York immediately following a marvellous two weeks in India has made me reflect again on the rhetoric and reality of using ICTs for development, especially in the interests of the poorest and most marginalised.

My latest book, Reclaiming Information and Communication Technologies for Development (OUP, 2017) provides an overview of the interests underlying the use of ICTs for “development”, and what needs to be done so that the poorest and most marginalised can indeed benefit from ICTs.  However, working in India, and then listening to the rhetoric of the rich and famous in New York makes me wonder whether I was sufficiently vehement in what I wrote in that book.  It also makes me return to thinking about the research I did 30 years ago on innovation adoption by farmers.  This convinced me that Rogers’ well accepted theoretical arguments around innovation adoption, the S-shaped curve (see below), and the classification of people into categories (innovators, early adopters, really majority, late majority and laggards) is fundamentally flawed.

There was very widespread agreement amongst the world’s leaders meeting in New York last week – and most other people as well – that ICTs can contribute very significantly to delivering the Sustainable Development Goals (SDGs), and that these will eliminate poverty.  The challenge, according to them, is how to connect the “next billion” to the Internet (mobile broadband), or in Rogers’ terminology the “late majority”.  As I have argued elsewhere, this will actually further increase global inequality, and most attention should instead be paid  to connecting the “first” (because they are most important) billion, or what Rogers termed the “laggards”.

The interests underlying connecting the next billion

The global focus on rolling out broadband to deliver the SDGs (even if that was possible) is not primarily in the interest of the world’s poorest people.  Instead it is mainly driven by:

• private sector corporations and companies, from ISPs and mobile operators to the powerful multi-service giants such as Facebook and Google, who are all primarily interested in expanding their markets and profits;
• national governments, eager to reduce costs through the use of digital technologies (although this is often a flawed assumption), as well as to control  “their” citizens;
• UN agencies, keen to have a role to play in delivering the SDGS; and
• NGOs, wanting to publicise their work more widely, and continue to receive project funding for their ICT-based initiatives.

These have little to do with the real interests and needs of the poorest and most marginalised.  The language of global corporations and governments is nearly always about providing access and creating demand for digital services.  But why should poor people necessarily want to go online?

Reasons not to be online…

I recall a wonderful conversation a couple of years ago with a Maasai chief in Tanzania. He was speaking with a group of techies about the use of mobile devices, and they were trying to persuade him of the value of mobile phones, even just to call his friends in a village the other side of the hills.  He, wisely, remained unconvinced.  For him, walking across the hills, enjoying the landscape, spending time experiencing the physicality of nature, and just thinking about life, were a crucial part of going to, and speaking with, his friend in the next village.

For the wise poor and marginalised, there are many reasons for not being connected:

• they remain outside a world where increasingly all human actions are monetised by  profit seeking corporations who use digital technologies to track their users and generate profit from selling such information;
• they remain free from the prying eyes of governments, whose actions may not be in their interests;
• there is little of interest to them in solving their real needs on the Internet;
• they do not have to spend large amounts of their very limited cash on paying for digital services that they do not really need;
• they do not suffer from the increasing amount of online abuse and harassment from trolls and others seeking to make them suffer;
• their small amounts of cash are not subject to online theft from hackers of mobile money systems;
• they do not become entrapped in a social media world, where every tweet or blog can adversely influence  their thoughts and senses of well-being;
• they do not suffer from endless messages or e-mails, the senders of which increasingly expect an immediate response; and
• they can enjoy being truly human in the analogue physical world (of all the senses), rather than trading this for the synthetic, and much less adequate digital virtual world (of mainly the two senses of sight and sound).

To be sure, there are many advantages of being connected, but the above list (and there are numerous other reasons that could be added) emphasises that there are also many negative aspects of Internet use, especially for the poor and marginalised.

The poor are not ignorant laggards who need to be convinced to go online…

One of the fundamental flaws of the widely accepted innovation adoption model proposed by Rogers is that it classifies people into “heroic” innovators and “ignorant” laggards; it is something about the people that influences whether or not they adopt an innovation, such as mobile broadband.  Such a view is held by many of those who seek to promote the global roll-out of the Internet: those who use the latest technologies are seen as being wise, whereas those who do not are seen as being lazy, ignorant laggards.

Rogers’ formulation is fundamentally problematic because it suggests that it is something about the people themselves that determine whether or not they are leaders or laggards.  This largely ignores the structural factors that determine whether people adopt something new.  With the adoption of agricultural innovations, for example, many poor people act perfectly rationally, and choose the option that they consider suits them best.  Poor people often make very rational, wise decisions not to adopt an innovation, often because the innovation increases the risks of crop failure, and they cannot afford this risk.  Moreover, if they do not have access to innovations it is scarcely surprising that they do not adopt them; the spatial distribution of outlets for herbicides, hybrid seeds or inorganic fertilizers is the main factor influencing whether people adopt them, rather than something about their propensity to innovate.  In the ICT sector, it is hardly surprising that people living in areas without electricity, let alone connectivity, do not see the need to have the latest generation of smartphone connected to the Internet.

If progress is to be made in helping poor and marginalised people benefit from the Internet, it is essential to do away with this flawed model of innovation adoption, and understand instead the structural factors and interests underlying why wise poor people, who know the contexts of their poverty very well, do not choose to adopt such technologies.  The rich elites of the world could begin by trying to understand the real conditions of poverty, rather than simply believing that ICTs can eliminate poverty through the SDGs.

Development in the interests of the poor

ICTs will never deliver on reducing inequalities in the world unless there is a fundamental sea-change in the attitudes of those leading the global private sector corporations that currently shape the world of the Internet.  It is perfectly logical for them to sign up to the SDGs formulated by the UN system, and to seek to show that expanding their digital empires will necessarily deliver the SDGs.  This is a powerful additional weapon in their armoury of market expansion and profit generation.  The problem is that these agendas will continue to increase inequality, and as yet remarkably little attention has been paid to how ICTs might actually help deliver SDG10.  Until corporations and governments really treat the link between ICTs and inequality seriously, peoples of the world will become every more divided, and if poverty is defined in a relative sense then poverty will actually increase rather than decrease as a result of roll out of the Internet.

 

Reclaiming Information and Communication Technologies for Development

It is always exciting to have finished the page proofs and done the index of a book, especially when this has to be completed between Christmas and the New Year as it was with Reclaiming ICT4D at the end of 2016! However, when the cover has been agreed and it appears on the publisher’s  website, then one knows that it is actually going to appear in several months time!

This is  OUP’s overview of the book:

• Combines understanding of both theoretical and practical aspects of ICT for development (ICT4D)
• Challenges existing orthodoxy and offers alternatives that can make a practical difference in the field
• Addresses the interests underlying the use of technology in development
• Wide ranging in coverage, including discussion of regulation, partnership, technological innovation, and the darker side of ICTs

I like being involved in the design of different aspects of my books, and I am so grateful to OUP for agreeing to publish Reclaiming ICT4D in two fonts, one to represent theory and the other practice.  I am also immensely happy that they were willing to use one of my pictures on the cover to represent much of what the book is about.  In case it is not immediately obvious, this picture taken a year ago in Murree (Pakistan) represents many things: a hope for the future, with the young boy vigorously hitting the ball way over his friends’ heads; cricket itself acknowledges the complex heritage of colonialism and imperialism; in the background is a telecommunications mast, providing the connectivity that has the potential to be used to reduce inequalities, but all too often increases them; the electricity so essential for powering ICTs is very visible;  and women are absent, representing another dimension of inequality that is addressed in the book.  It is also much more than this.  My father visited Murree 71 years ago, and may have walked along this street; I went there with friends, and the book is very much a personal story of how I have learnt from them and the many people who have shared their wisdom and experiences with me over the years; it is above all about how people like these boys, playing on the street, can use ICTs to transform their lives for the better, rather than becoming the cyborg cannon-fodder that global capitalism seeks to devour for the benefit of the rich and powerful.

A little more formally, this is how OUP describe the contents of the book on their website:

“The development of new Information and Communication Technologies (ICTs) has transformed the world over the last two decades. These technologies are often seen as being inherently ‘good’, with the ability to make the world better, and in particular to reduce poverty. However, their darker side is frequently ignored in such accounts.

ICTs undoubtedly have the potential to reduce poverty, for example by enhancing education, health delivery, rural development and entrepreneurship across Africa, Asia and Latin America. However, all too often, projects designed to do so fail to go to scale, and are unsustainable when donor funding ceases. Indeed, ICTs have actually dramatically increased inequality across the world. The central purpose of this book is to account for why this is so, and it does so primarily by laying bare the interests that have underlain the dramatic expansion of ICTs in recent years. Unless these are fully understood, it will not be possible to reclaim the use of these technologies to empower the world’s poorest and most marginalised.”

Its seven chapters are entitled as follows:

Preface
1: A critical reflection on ICTs and ‘Development’
2: Understanding the Technologies
3: The International Policy Arena: ICTs and Internet Governance
4: Partnerships in ICT4D: Rhetoric and Reality
5: From Regulation to Facilitation: The role of ICT and Telecommunication Regulators in a Converging World
6: Reflections on the Dark Side of ICT4D
7: …in the Interests of the Poorest and Most Marginalized.

It is also being made available as an Ebook, and publication date is estimated as 25th May 2017.

To request a review copy, do contact OUP directly using their request form.