Governments are at a nebulous stage: past the initial shocks but still without a clear end in sight
Nobody is clapping any more. Six months since Covid-19 registered as an urgent threat, and one country after another spiralled into lockdown, the nightly outpourings of solidarity with essential workers have petered out.
Governments behind which people rallied earlier in the outbreak are again facing criticism and scorn. Panic at the scenarios that filled imaginations in those first weeks – of millions of imminent deaths, medical systems buckling and food supplies running scarce – has largely abated.
But the virus has not. More than 200 days since coronavirus was first detected, public health authorities say the number of infections is accelerating and the peak still lies ahead. In early August, the world finds itself at a nebulous stage: past the shock of the pandemic but without a clear end in sight.
It is a period of grinding negotiation between a virus whose dynamics are still mysterious and the increasingly pressing need to earn incomes, educate children and connect with one another. It will go on until a vaccine can be found and distributed on a mass scale, or lasting immunity is possible and built at great human cost.
“At the beginning of this outbreak we were saying this is a marathon, not a sprint,” says Alexandra Phelan, an associate professor at the Center for Global Health Science and Security in Georgetown University, Washington DC. “Now it’s becoming evident this is more of an ultramarathon. This is going to be an incredibly long slog.”
It was estimated in March that half of humanity was under some form of lockdown. Months later, the world’s experience has fractured. Living in a pandemic has become normal – but what normal looks like varies dramatically.
Living with the virus
The beaches near Lisbon have been “absolutely rammed” this summer, says Julia Georgallis, and live music has sounded from her restaurant to tables spilling into the street.
A few miles away, five working-class neighbourhoods on the outskirts of the Portuguese capital spent most of July in lockdown, with residents allowed to leave their homes only for food, medicine or work.
Terrified by scenes of overwhelmed hospitals in Italy and Spain, countries such as Portugal locked down hard in March and infection rates fell. What has followed is an experiment in how much of normal life the coronavirus permits.
Lisbon has relaxed and reimposed restrictions in fits and starts. “After a month of reopening, because everyone was partying – there were just so many parties, people drinking in the streets – there was another spike, so the government imposed more measures,” Georgallis says.
Masks are ubiquitous, and business owners and customers must navigate a maze of frequently shifting rules. Everything shuts by 11pm. “It’s weird for a country that eats at 9pm and goes out at 2am,” she says.
These limits may not be enough. As one-time success stories such as Hong Kong, Melbourne or India’s Kerala state can attest, victories against the virus are fragile. Cases are climbing again in Australia, the Middle East and Europe – including by hundreds every day in Portugal.
For countries that have slowed the spread of the virus, this stage of the pandemic presents difficult choices, says Babak Javid, an infectious disease specialist at the University of California, San Francisco.
“Short of complete suppression and locking your borders, you’re always going to get an increase in cases as you ease up,” he says. “The question becomes: can you live with it or not?”
That means striking bargains with the virus: shutting risky industries such as nightclubs, mandating masks and testing widely, but accepting that limited spread will not be stopped – and that it would be too costly to other public health priorities to do so.
In Lisbon, the pandemic has thinned the ranks of tourists and locals are enjoying the extra room and cheaper holiday homes to rent. “People are saying we’ve got the city back,” Georgallis says. “But come winter, it’s going to be a struggle because people haven’t made the money they would have in the summer.”
About one in five workers in the country have been laid off since the start of the pandemic. Around the world, the virus has triggered an economic crisis “like no other”, according to the International Monetary Fund, which has repeatedly revised up its estimate of the impact. The equivalent of nearly 400m full-time jobs have been lost, the UN’s labour agency says.
The blow has been cushioned somewhat in countries such as France, the UK and Australia, which learned from the 2008 crash that it was cheaper in the long run to pay for businesses to furlough workers in order to speed up recovery when the crisis ebbs. The US is among those that instead paid individuals directly, with about 30 million people – one in five of the workforce – now on the dole.
In early August, it is not just savings running low in many countries but also morale. “People are very much over this,” Georgallis says. “No one’s really scared any more … They are just getting on with it.”
Where the curves never flattened
Coronavirus first hit home for Robin Neely when he read an obituary for a fellow teacher. “I thought, OK, it’s not a distant other-person problem,” he says. “It’s an ‘us’ problem. It’s here.”
Over the next months the outbreak in his state, Arizona, would become the largest per capita in the world, with the most deaths per person of any US state. While most of Europe is extinguishing small outbreaks, the US is among several large countries including Brazil and India that have failed to flatten their curves.
“We don’t have sufficient testing in place, and we don’t have contact tracing sufficiently in place,” Neely says. “So we’re still shadow boxing, we’re still fighting a ghost. We don’t know where this thing is.”
Arizona has confirmed more than 160,000 infections, and cases are growing by more than 1,000 a day. Shopping, meeting friends and taking public transport are fraught with risk. “I know not quite a dozen people who have it, and the number is rising by the day,” Neely says. “Almost everyone I know knows someone or a few people who have contracted Covid.”
The south-western state locked down in March but was one of a wave that reopened less than two months later as the virus increasingly became a partisan issue. Its Republican governor, Doug Ducey, banned city mayors from requiring residents to wear masks. Donald Trump defied public health advice to speak to a crowd of 3,000 people at a Phoenix megachurch.
Similar responses across the US have shaken faith in the superpower and accelerated China’s challenge to the global order.
The bitter division was reflected in the community, too, Neely says. “I’ll be talking with a friend and say this is a problem, and they’ll say no, it’s a Democratic hoax, it’s an election year,” he says.
The virus preys on this uncertainty; even the way it spreads is unclear. Droplets sprayed from the mouth are regarded as the main culprit for new infections, though some evidence suggests people can expel even tinier virus particles that linger in the air. The vast majority of carriers appear to infect few or no people, while rare so-called super-spreaders could be behind 80% of cases. Early hopes that the virus would relent, like flu, in the summer months have been dashed.
If immunity exists, it may prove short-lived – but as with much else, it is too early to say for sure. “We are only about eight months into this outbreak,” says Krutika Kuppalli, an infectious disease specialist. “That is still the infancy of an infection. We’ve known about HIV for over 40 years and we’re still learning new things about it every day.”
The death rate has slowed in the US, mirroring a fall in mortality rates around the world. Angela Rasmussen, a virologist at Columbia University’s Mailman School of Public Health, says that rather than the virus becoming less deadly, it is more likely that we are getting better at treating it and, after watching Covid-19 rip through nursing homes in New York and New Jersey, learning to protect the most vulnerable communities.
Meanwhile, the lasting impact of the disease among survivors is coming into view, with evidence of potentially serious damage to hearts, brains and lungs.
With cases rising, Arizona has struck an uneasy compromise: allowing local administrations to make masks mandatory, reclosing gyms, bars and theatres, and allowing places of worship to operate freely but suggesting attendees socially distance.
The return to school this month is the latest issue to turn divisive. Studies in several countries have suggested young children are less susceptible to catching and spreading the disease. “That’s good news,” Neely says. “But kids can still get sick and kids can still die.”
So can teachers. Soon Neely may need to decide whether he feels safe enough to return to the classroom. “It’s a really hard choice to make,” he says. “I have no intention or desire to leave the job I have. I’ve considered the implications if I get sick. I’m 33 years old and an asthmatic, so it might not go well.”
Where quarantine is a luxury
When his symptoms appeared, Zulqarnain Mengal was not surprised. The accountant in the Pakistani city of Quetta had watched fevers, chills and coughs spread throughout his extended family in the weeks before. None were tested.
“One of my uncles said if anyone from our family got tested there would not be an angrier person than him,” Mengal says. “It will bring a bad name for us in society.”
Pakistan is one of the most prominent among developing countries to have thrown up its hands in the face of the virus. Masks are mandatory and lockdowns are being declared in small hotspots, but leaders have been adamant from the beginning: in a country without a welfare system, and where one in four people live in poverty, quarantine poses a greater risk to life than the coronavirus.
It will not dodge the economic blow. This year is the first that will register an increase in global poverty rates since 1998, with at least 68 million expected to be pushed below the benchmark of living on less than $1.90 per day.
The humanitarian catastrophe is coming into focus. More than 10,000 children were dying from hunger every month as a consequence of quarantines, the UN reported last week. Almost 40 million children in Pakistan missed their polio drops this year after coronavirus prompted the suspension of an immunisation scheme.
The prime minister, Imran Khan, says he is saving Pakistanis “from hunger and coronavirus simultaneously”. After recording more than 280,000 cases and about 5,700 deaths, the country is reducing its testing rate, which is muddying the picture of its outbreak.
Cases spiked after the Muslim festival of Eid-al-Fitr in May, says Shereen Khan, the head of pulmonology at Rehan hospital in Quetta. “Doctors did not have PPE,” he says. “We had no ventilator. We never realised so much oxygen would be required. We lacked doctors and nursing staff to deal with it. Our health system collapsed.”
Since then, Pakistan’s outbreak appears to be declining. Some of that trend is probably the result of misreporting and a stigma around testing. But Khan says his hospital has quieted, too.
Poor countries were expected to be smashed by the coronavirus, “because that’s what we saw with influenza,” says Javid. Total cases are high in Pakistan, and surging in neighbouring India, but mortality rates in both appear to be lower than in wealthier countries. Nigeria, the most populous country in Africa, has recorded fewer than 1,000 deaths.
“It could be that resource-poor countries get a lot of diseases that cause problems down the line, we just don’t know enough yet,” Javid says. “But we are not seeing their hospitals overwhelmed in the way that was predicted.”
Young populations and low obesity rates may be helping, doctors say. West African countries are especially battle-hardened, having fought cholera, measles and Ebola in past years.
“These are places that are used to dealing with infectious disease outbreaks,” says Kuppalli, who ran an Ebola hospital in Sierra Leone. “They are used to mobilising their limited resources and doing things we have only been talking about doing.”
It could also be a matter of time. This past weekend was Eid-al-Adha, another religious feast, and markets and mosques in Quetta were jammed with crowds. Khan is braced for the impact. “It might be one of the worst phases,” he says.
Safe, sealed off
Jordan’s prime minister, Omar Razzaz, remembers being presented with three charts. “We had a worst scenario, a medium scenario and a good scenario,” he says.
The small, resource-poor Middle Eastern kingdom’s health system could absorb, at most, about 200 new coronavirus cases a day, he says. An out-of-control outbreak would be expected to be produce about 600 new infections requiring treatment, the charts showed. “So we really needed to avoid that worst scenario,” he says.
Months from that moment, Jordan is among a lucky handful of countries – also including New Zealand and Thailand – that claim to have eliminated community transmission of the virus. The kingdom has had 11 deaths in total and is only reporting cases among new arrivals from overseas and the medical staff treating them.
By swiftly sealing its border and imposing one of the harshest lockdowns in the world, “we flattened the good scenario”, Razzaz says.
Life in the capital, Amman, is out of sync with the rest of the world: streets and restaurants are jostling with Jordanians enjoying cool summer nights. If masks are worn, they are often around the neck, and people again greet each other with a kiss.
“I was glad that in Jordan we stopped the kissing,” Razzaz says. “Just in the last week it came back. It’s hard to maintain that discipline when your numbers are zero, basically, inside the country. Which is good but dangerous.”
Staying sealed off until a vaccine is discovered is not an option. Scientists have broken records in terms of vaccine development over the past eight months, with at least five candidates progressing to the stage of mass human testing.
But even at this record-breaking rate, a vaccine is unlikely to be approved before the end of the year, and it would then need to be rolled out around the world. That is likely to take months at least, or longer if countries continue not to collaborate on their pandemic responses. “No country will be safe from these embers landing and sparking a new fire until the whole world has access to a vaccine,” Phelan says.
Jordan has been reluctant to reopen its airport quickly but finally set the date for Wednesday. Its seal to the world will be broken. Razzaz knows the risks that entails and says the country is ready.
“We’re constantly asking when, not if, the next wave is going to hit,” he says. “It would be foolish not to ask that question when you’re looking around you in the region.”
The blooming of life across Amman may be a picture of the future for hard-hit places such as Arizona. But it is clear by this point in the pandemic that it could be the other way around, too.
Michael Safi and Shah Meer Baloch
Courtesy The Guardian