NZ suicide rates lower

New Zealand has had a major problem with deaths by suicide – they have risen to nearly double the road toll. There is a slight glimmer of hope, with the number and rate of suicides dropping slightly in the year to June 2020, both the lowest of the last three years.

There was unsubstantiated claims (via social media) that the Covid pandemic and lockdowns would increase the number of suicides but that appears to be false.

Stuff: Chief Coroner opposes rumours suicide rate increased during Covid-19 lockdown

Reports that New Zealand’s suicide rate increased during Covid-19 lockdown have been opposed by the Chief Coroner.

Judge Deborah Marshall noted the rumours – which were spread on social media by someone claiming to be in contact with a police officer – were “incorrect”.

“I can confirm based on the provisional numbers I have, this is incorrect,” she explained.

She labelled the reports of a reported rise in suicide rates in Alert Level 4 as “concerning”.

“The provisional trend suggests the suicide rate was lower during the Alert Level 4 period than the 33 days prior to it (22 February – 25 March 2020).

“The suicide rate during Alert Level 4 was also lower than the rate for the same period from 2008 to 2020.”

New Zealand Police and the Mental Health Foundation previously said there was no evidence to support such claims. The Foundation slammed the rumour as false and potentially dangerous.

The rumour stemmed from a tweet that claimed an unnamed police officer informed the account holder of a massive increase in suicides across the country. The tweet and account was later deleted.

Police Assistant Commissioner Sandy Venables told Stuff earlier in the month there was no official data released yet, and the number of mental health call-outs appeared steady.

Mental Health Foundation chief executive Shaun Robinson said there was “absolutely no truth” to the rumour and that it was “totally irresponsible and untrue”.

The statistics July-June (provisional, it can take coroners some time to determine causes of death) with rate per 100,000 in brackets:

  • 2007/2008 – 540 (12.20)
  • 2008/2009 – 531 (12.04)
  • 2009/2010 – 541 (12.16)
  • 2010/2011 – 558 (12.65)
  • 2011/2012 – 547 (12.34)
  • 2012/2013 – 541 (12.10)
  • 2013/2014 – 529 (11.73)
  • 2014/2015 – 564 (12.27)
  • 2015/2016 – 579 (12.33)
  • 2016/2017 – 606 (12.64)
  • 2017/2018 – 668 (13.67)
  • 2018/2019 – 685 (13.93)
  • 2019/2020 – 654 (13.01)

Source: Provisional figures – August 2020 [PDF, 880 KB]

Chief Coroner Releases Annual Provision Suicide Figures:

Chief Coroner Judge Deborah Marshall today released the annual provisional suicide statistics, which show the provisional suicide rate is at its lowest in three years.

In the year to 30 June 2020, 654 people died by suicide, compared to 685 the year before – a decrease of 31 deaths, and a drop in the suicide rate from 13.93 deaths per 100,000 to 13.01.

“While it is encouraging to see the suspected suicide rate and number drop for the past year, it’s important to remember that there are still more than 650 families who have lost someone in tragic circumstances,” Chief Coroner Judge Deborah Marshall says.

“My sincere condolences to the families and friends of those who died by suspected suicide in the past year.”

There was a decrease in the number of young people dying by suspected suicide, particularly in the 15-19 age range (down from 73 to 59) and the 20-24 age range (down from 91 to 60). Both rates decreased from 23.14 to 18.69 and from 26.87 to 17.77 respectively.

However, there was an increase in suspected suicides in the 80-84 age range, with 12 more people dying by suicide in the past year (18) than the year before (6). The rate increased from 6.49 to 19.48.

The Māori and Pacific Island suspected suicide rates both decreased over the past year, from 21.78 to 20.24 and from 8.91 to 7.07 respectively. The European rate also dropped from 13.02 to 12.08.

However, the Asian rate went up from 5.09 to 7.91 – an increase of 20 deaths.

“Throughout this year there has been unhelpful and irresponsible public commentary on the effect COVID-19 would have on the suicide rate,” Judge Marshall says. “During the first lockdown period I said it was unhelpful to release figures for such a short time frame, as it is nearly impossible to draw sound conclusions, nor do I believe such public discourse is helpful to people in distress.

“I’m encouraged by the work the Suicide Prevention Office has started and for the reliable, strong and hope-filled voice that director Carla na Nagara has added to the wider public discourse.”

Covid-19 compared to other pandemics this century

According to microbiologist Siouxsie Wiles, compared to other pandemics this century Covid-19 is a bad roll of the dice.

Stuff: We lost this round of pandemic dice

I think it helps to think of these outbreaks and pandemics as a handful of dice.

The dice represent:

  • The microbe and how it spreads.
  • What symptoms it causes.
  • How it can be treated and prevented.
  • How each dice falls influences how the outbreak plays out.

With Covid-19, we’ve rolled almost the worst possible combination, with a collection of ones.

Covid isn’t as lethal as the likes of Ebola, but as symptoms are often not noticed or mild, and take time to present, Covid can spread before it is discovered.

Wiles details the other pandemics in the last 20 years, and compares aspects of them to Covid.

Sars (2002-2004)

Sars appeared in late 2002, also caused by a coronavirus that spreads through the respiratory route. Unlike Covid-19, people with Sars had a high fever early in their infection. That made it easier to identify infected people and stop human-to-human transmission.

By mid-2004, Sars was gone and hasn’t been seen since. By then 8000 people had been infected and over 800 had died. Cases had spread to almost 30 countries and territories.

Covid-19 also emerged in a globally connected part of the world and at a time of year when lots of people were moving about.

H1N1 (early 2009 to August 2010)

H1N1 was a variant of the influenza viruses from humans, birds, and pigs that caused a pandemic from early 2009 to August 2010. Like normal seasonal flu, H1N1 spread through the respiratory route. But unlike normal flu, it was more likely to cause breathing difficulties in young, healthy people. Thankfully, a vaccine was available by late 2009. It’s thought H1N1 caused about 500,000 deaths. 

That was over about 18 months.

Ebola (December 2013-June 2016)

The largest Ebola outbreak began in Guinea, West Africa in December 2013 and spread to Liberia and Sierra Leone. Ebola transmits through bodily fluids from symptomatic people. That means it’s easier to stop than Covid-19, in which people are infectious before they realise they have the virus.

While vaccines were in clinical trials by mid-2015, the Ebola outbreak was mainly brought under control by stopping human-to-human transmission. It also helped that it was in a part of the world that isn’t quite so globally connected. The outbreak was officially declared over in June 2016. By then over 28,000 people had been infected and over 11,000 had died.

Ebola had a very high death rate for those infected, but was much more easily contained.

Zika (2015-2016)

Zika is the virus that causes babies to be born with small heads. It’s spread by mosquito bite and caused an outbreak in the Americas, Pacific, and Southeast Asia in 2015 and 2016. In many mosquito species, the females feed on people one time before laying their eggs. Zika is carried by mosquitoes that feed more than once. As a result, they spread the virus from infected to uninfected people as they ate. The outbreak was largely controlled by getting rid of mosquitoes carrying the virus.

Current Covid totals (Worldometer):

  • Total detected cases – 25 million
  • Total attributed deaths – 848,925

The closest comparison is H1N1, with about half the deaths. A vaccine was available within the year it began but it still nearly a year to eliminate it.

New Zealand has got off lightly so far, with just 1,729 cases and 22 deaths.

Initially Australia had a comparable result but after a big outbreak in Victoria cases have jumped to 25,166 and deaths to 611.

We have been mostly successful at containing Covid but the current outbreak in Auckland is a concern. It shows how quickly things can change.

Wearing face masks to reduce the spread of Covid-19?

The wearing of face masks has been a contentious issue around the world since the Covid-19 pandemic started to spread early this year. It’s easy to cherry pick advice or research that supports or advises against the wearing of masks by the general public. Here’s a series of items that show how advice varies and has changed over the last few months.

Picking up on some links posted from here – Perhaps we should check the science on masks I did some checking.

18 October 2016: Why Face Masks Don’t Work: A Revealing Review

Studies of recent diseases such as Severe Acute Respiratory Syndrome (SARS), Middle Eastern Respiratory Syndrome (MERS) and the Ebola Crisis combined with those of seasonal influenza and drug resistant tuberculosis have promoted a better understanding of how respiratory diseases are transmitted. Concurrently, with this appreciation, there have been a number of clinical investigations into the efficacy of protective devices such as face masks. This article will describe how the findings of such studies lead to a rethinking of the benefits of wearing a mask during the practice of dentistry. It will begin by describing new concepts relating to infection control especially personal protective equipment (PPE).

That’s specific to dentistry and nearly four years ago so not referring to Covid.

That’s from 12 March. It’s easy to cherry pick mask wearing advice, but it’s far from clear what is best.

From 23 April: Face masks could increase risk of infection, medical chief warns

England’s deputy chief medical officer, Dr Jenny Harries, said the issue of whether members of the public should wear face masks was “difficult”.

Dr Harries told ITV’s Good Morning Britain that “the fact that there is a lot of debate means that the evidence either isn’t clear or is weak.

“The points where we are absolutely clear that face masks are needed are if you are a patient and are symptomatic -that’s stopping the infection at source from moving on to other people – and if you’re a healthcare worker and social care worker we must preserve our face masks particularly for them, to protect them.

“But when it comes to the general public it starts to get much more difficult.

“In some countries where the public are using them they are nearly always alongside other social distancing measures so it is quite difficult to tease out what the effect of the mask might be.”

Asked whether the public should be wearing them, Dr Harries said: “The number one thing is we must leave our medical masks, if you like, for those people that need them at the front line because there is clear evidence that that is beneficial.”

From 23 April: Use of face masks by general public perfectly reasonable, says GP leader

Wearing face masks or face coverings in public is “perfectly reasonable”, a GP leader has said as England’s deputy chief medical officer admitted it was a “difficult issue”.

Ministers have so far rejected calls for face masks or face coverings to be used outside healthcare settings despite other countries, including the US and Germany, recommending them.

England’s deputy chief medical officer, Dr Jenny Harries, said the issue of whether members of the public should wear face masks was “difficult”.

Dr Harries told ITV’s Good Morning Britain that “the fact that there is a lot of debate means that the evidence either isn’t clear or is weak.

“The points where we are absolutely clear that face masks are needed are if you are a patient and are symptomatic -that’s stopping the infection at source from moving on to other people – and if you’re a healthcare worker and social care worker we must preserve our face masks particularly for them, to protect them.

“But when it comes to the general public it starts to get much more difficult.

“In some countries where the public are using them they are nearly always alongside other social distancing measures so it is quite difficult to tease out what the effect of the mask might be.”

Asked whether the public should be wearing them, Dr Harries said: “The number one thing is we must leave our medical masks, if you like, for those people that need them at the front line because there is clear evidence that that is beneficial.”

From 6 May: Top scientific advisers quizzed by MPs on immunity, face masks, testing and lockdown

He and Deputy Chief Medical Officer for England Dr Jenny Harries faced a grilling from MPs during the lengthy committee appearance which offered up some revealing details, but raised more questions than answers.

Sir Patrick said the evidence of the effectiveness of wearing face coverings in public was “not straightforward” but added they could have a “marginal but positive” impact on reducing the spread of the virus.

From 29 May: Face masks essential in combating asymptomatic spread of SARS-CoV-2 aerosols and droplets

Wearing masks can reduce the airborne transmission of the novel coronavirus, a new study finds. The research is published in the journal Science.

The team of researchers at the University of California San Diego and the National Sun Yat-sen University in Kaohsiung, Taiwan, identified that wearing masks is essential to combat the asymptomatic spread of aerosols and droplets.

Masks are effective in reducing the airborne transmission of SARS-CoV-2. Properly fitted masks provide an effective physical barrier to reduce the number of viruses in the exhaled breath of asymptomatic carriers or the “silent shedders.”

“Infectious aerosol particles can be released during breathing and speaking by asymptomatic infected individuals. No masking maximizes exposure, whereas universal masking results in the least exposure,” the researchers explained.

The U.S. Centers for Disease Control and Prevention (CDC)recommends wearing cloth face coverings in public settings where other social distancing measures are hard to maintain, including pharmacies and grocery stores.

“It is critical to emphasize that maintaining 6-feet social distancing remains important to slow the spread of the virus.  CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.  Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure,” the CDC said on its website.

From 29 May:  The Right-Wing Masks Theory That Lives On in Colorado

Wearing masks in Colorado during the COVID-19 pandemic has become thoroughly politicized, with those loyal to conservative beliefs in the state infinitely more likely to follow President Donald Trump’s lead in declining to don facial coverings.

Why? The most common refrain is that mask use infringes on individual choice. But it’s often accompanied by claims that facial coverings are actually dangerous to those wearing them, complete with medical assertions that may actually sound reasonable to those of us who aren’t doctors or play one on TV. And indeed, assorted officials and physicians have offered occasional support for the theory over recent months.

Trouble is, according to the Colorado Department of Public Health and Environment, it’s utter bullshit.

Cut to mid-March, when Dr. Jenny Harries, England’s deputy chief medical officer, contended that wearing face masks can increase an individual’s viral load whether one is symptomatic or not. “For the average member of the public walking down a street, it is not a good idea,” she argued.

What tends to happen is people will have one mask. They won’t wear it all the time, they will take it off when they get home, they will put it down on a surface they haven’t cleaned,” and if they don’t clean their hands often enough, they can get infected by touching either the mask or parts of their face around it.

Of course, washing a cloth mask daily largely eliminates this issue — and that’s precisely what Governor Jared Polis recommended on April 3, when he encouraged Coloradans to wear a facial covering whenever they leave home — shortly before the federal Centers for Disease Control and Environment did likewise for the country as a whole.

Nonetheless, the suggestion that mask wearers are slowly killing themselves lives on. But the CDPHE’s response to Westword on the subject makes it clear that the department thinks it has approximately zero credibility.

“Masks do not increase the viral load for people who wear them,” states spokesperson Ian Dickson. “If you are infected with the virus that causes COVID-19, that means the virus has already made a home for itself in your cells and is busy making more of the virus. ‘Shedding’ is just a byproduct of that infection.”

Dickson adds: “Once you are infected, breathing doesn’t result in an increase in the amount of virus in your body, whether you have a mask on or not. Wearing a face mask helps minimize the spread of the virus, so everyone should wear a mask when out in public.”

3 June: Mixed messaging on wearing masks is a major public health failure

The World Health Organization (WHO) unequivocally warns against wearing face masks, unless you are either displaying symptoms or taking care of a patient infected with COVID-19. Full stop. No face masks. No grey area.

An April 17 article in the Journal of the American Medical Association (JAMA) advises, “ … nonmedical masks may not be effective in preventing infection for the person wearing them.”

Clinical evidence suggests that cloth masks contribute to viral infection, a study of non-medical masks by the University of New South Wales reported in Science Daily. “The widespread use of cloth masks by health-care workers may actually put them at increased risk of respiratory illness and viral infections and their global use should be discouraged. The penetration of cloth masks by particles was almost 97 per cent compared to medical masks with 44 per cent.”

The WHO cautions against wearing face masks, the CDC recommends them; “CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”

The deputy chief medical officer of England advises against, Health Canada recommends for; “Wearing a homemade non-medical mask/facial covering in the community is recommended for periods of time when it is not possible to consistently maintain a two-metre physical distance from others, particularly in crowded public settings, such as stores, shopping areas and public transit.”

Who to believe, then?

From 12 June:  Compulsory use of facemasks in shops and public transport can slash spread of coronavirus by 40%, study claims

Making face masks compulsory could slow the spread of Covid-19 by as much as 40 per cent, a study suggests.

Researchers assessed the effect face coverings had on regional epidemics in Germany when they were made mandatory in shops and public transport in April.

The move slashed the number of new infections over the next 20 days by almost a quarter, rising to 40 per cent after two months.

The scientists said their study provided ‘strong and convincing statistical support’  that masks ‘strongly reduced the number of incidences’.

Writing in the study, published as a discussion paper for the Institute of Labour Economics, the scientists write: We believe that the reduction in the growth rates of infections by 40 per cent to 60 per cent is our best estimate of the effects of face masks.

It is the most compelling evidence yet for mandatory mask-wearing in the UK, where the Government is still concerned face coverings might do more harm than good.

The UK Government’s scientists insisted throughout the crisis there is no evidence face masks prevent the spread of the virus.

But they changed their tune last week and made it compulsory for people to wear masks on public transport in England, threatening to dish out fines to those who don’t comply.

3 July: Coronavirus: where and when do you need a face covering?

  • Face coverings to become mandatory in shops in Scotland from 10 July. They are already mandatory on public transport.
  • Face covering to become mandatory on public transport in Northern Ireland form 10 July.
  • Wearing a face covering is already mandatory in hospitals and on public transport in England.
  • Ride-sharing company Uber has made face coverings mandatory for both passengers and drivers across the UK.
  • Separately, the World Health Organisation (WHO) has changed its global guidance on face masks, suggesting that in circumstances where social distancing is difficult – such as public transport, shops etc – basic medical masks (not respirator masks) should be worn by the over 60s, and homemade three-layer masks should be worn by the general public.

Elsewhere, many countries have encouraged or made mandatory the wearing of face masks by the public.

Some, such as Austria, Slovenia, Bulgaria, Poland, Singapore, and Turkey – have made wearing face masks mandatory in public.

In the US, China, Japan, France, India, Canada, Germany and Brazil, wearing homemade masks in public or in certain situations, such as on public transport, is encouraged but not enforced.

The World Health Organisation (WHO) originally said that healthy people only needed to wear a mask if they were taking care of a person with COVID-19, and cautioned about the risks of mask-wearing instilling a false sense of security in the wearer and leading to them becoming lax about crucial measures such as social distancing and handwashing.

It also said that ‘non-medical or cloth masks could increase potential for COVID-19 to infect a person if the mask is contaminated by dirty hands and touched often, or kept on other parts of the face or head and then placed back over the mouth and nose.’

But it has now updated its advice on face masks, saying that governments should encourage the general public to wear masks in situations where social distancing isn’t possible, such as on public transport and in shops. It advises a home-made three-layer mask for most people, and that the over-60’s consider wearing ‘medical’ masks in areas with high rates of community transmission.

The European Centre for Disease Control (ECDC) suggests that homemade masks may be useful to help prevent the spread of coronavirus by asymptomatic people in confined spaces, but acknowledges the evidence for this is currently weak.

All are clear that higher-grade medical respirator masks should be reserved for frontline health workers, where they are needed most.

Face masks: what’s the evidence for them?

A meta-analysis of nearly 1,000 studies around influenza transmission by Professor Ben Cowling, Head of Epidemiology and Biostatistics at Hong Kong University, found that the use of face masks, in combination with hand hygiene, was more effective against laboratory-confirmed influenza than hand hygiene alone.

Dr Christopher Hui, Clinical Assistant Professor at Hong Kong University and Honorary Consultant in Respiratory and Critical Care Medicine at the Royal Free Hospital London, says: ‘We believe that face masks help prevent droplet and aerosol spread primarily by capturing the droplets as they exit our airways at velocity when coughing, sneezing or talking at volume.’

The change in UK government advice has come after ‘careful consideration of the latest scientific evidence from the Scientific Advisory Group for Emergencies (SAGE).’

Previously, Deputy Chief Medical Officer Jenny Harries said the fact that the issue has been debated at length by the UK government’s scientific advisors suggests that the evidence isn’t quite so clear, whereas the evidence for measures such as hand hygiene and social distancing is more solid.

Hand washing and social distancing remain the most important actions to take to protect yourself and others from coronavirus.

This all doesn’t matter here in New Zealand for the general public in public places, as we don’t have any detected community transmission.

Current Ministry of Health advice: COVID-19: Use of face masks in the community

Face masks are one part of Infection Prevention and Control (IPC) measures used in health care settings.

There is no convincing evidence one way or other to require the use of non-medical face masks for healthy people in the community to protect from COVID-19. There are potential benefits and potential risks with such use. Countries are taking different approaches based on their current COVID-19 context.

Non-medical masks could provide an additional element of protection in preventing someone who is infectious with COVID-19 spreading this infection to others.

Non-medical masks are not proven to effectively protect the person wearing them from becoming infected by others. They are therefore not a substitute for basic hygiene measures and physical distancing, where possible and practical. Some of the reasons for this include the types of materials used for the masks and how they are worn.

Going by the above evolution of advice this sounds a bit dated. If Covid starts to spread here again this may change.

This post is not intended to be advice on whether to wear a face mask or not, it was an exercise in how research and advice has varied and changed over the last four months.

All but the first and last links above were found via Google searching for: Jenny Harries face masks

Valuable lessons learned in pandemic response

The Government and Ministry of Health handling of the Covid-19 was also generally very good in the circumstances. For various reasons New Zealand was also quite lucky to avoid having many infections and deaths compared to many other countries.

But the pandemic exposed a lack of preparedness. Testing for the virus, border controls and contact tracing systems were all inadequate. There were significant problems sharing health data between regions and collating data for analysis – some data was still being distributed by fax. There were problems distributing the influenza vaccine.

Normal health care was interrupted and disrupted too much when many resources were allocated to dealing with Covid that were not required. Our health systems should be able to continue as much as possible as normal as well as being prepared for any sort of abnormal rush of infections.

Some of our hospitals and health systems are in poor condition, this is something that should be given urgent attention and funding.

Valuable lessons should have been learned, and improvements either made or planned.

This is important for future viruses, which are inevitable, but especially for avoiding as much second wave infections as possible from Covid. It seems inevitable that Covid will be back here, but if limited and controlled it shouldn’t become a big problem here.

What the Government does about the economic effects over the next few months and also the next year or two will be important.

here has also been a major business, employment and economic impact. Large amounts of money were quickly allocated to save as many businesses and jobs as possible. How successful this has been won’t be known for months at least. At this stage we simply don’t know what the medium term economic effects will be.

There is also a lot of debt that will hang over the country for years, decades.

Lessons should also be learned from the economic measures taken, but it may be had to undo or rectify some of these.

On top of this are international economic effects that are largely out of our hands but unavoidable in New Zealand. Huge debts have been racked up around the world. Trade has been badly disrupted. Tourism, a major factor in economic activity for many countries, including New Zealand.

Lessons should have been learned but there is a lot more to be learned as we go.

While typing this post I have heard there is a report out today on the condition of our hospitals and health systems. See Hospital assessment report highlights dire problems

Pandemics and their ends

When will the Covid-19 pandemic end? It depends on what sort of end.

A social end to a pandemic is when people grow tired of panic mode and learn to live with a disease. There are signs of reaching this point in New Zealand now, but that doesn’t rule out a resurgence at some time in the future.

A medical end can be difficult to determine, and only after it has ended. Id it ends at all, some diseases just carry on, like the common flu.

MSN/New York Times: How Pandemics End

According to historians, pandemics typically have two types of endings: the medical, which occurs when the incidence and death rates plummet, and the social, when the epidemic of fear about the disease wanes.

Endings “are very, very messy,” said Dora Vargha, a historian at the University of Exeter. “Looking back, we have a weak narrative. For whom does the epidemic end, and who gets to say?”

Will that happen with Covid-19?

One possibility, historians say, is that the coronavirus pandemic could end socially before it ends medically. People may grow so tired of the restrictions that they declare the pandemic over, even as the virus continues to smolder in the population and before a vaccine or effective treatment is found.

“I think there is this sort of social psychological issue of exhaustion and frustration,” the Yale historian Naomi Rogers said. “We may be in a moment when people are just saying: ‘That’s enough. I deserve to be able to return to my regular life.’”

It is happening already; in some states, governors have lifted restrictions, allowing hair salons, nail salons and gyms to reopen, in defiance of warnings by public health officials that such steps are premature. As the economic catastrophe wreaked by the lockdowns grows, more and more people may be ready to say “enough.”

To extent that has been happening in New Zealand over the last two weeks. Reports of a rush back to shopping yesterday, the start of the first weekend since we lowered to Level 2 restrictions that allowed all shops to re-open, suggest a getting back to normal. I drove through town yesterday and traffic was a busier than a normal Saturday, And I went for a trip right along the west side of Otago Harbour. It was quiet mid-morning but it was busier than normal by the middle of the day.

“There is this sort of conflict now,” Dr. Rogers said. Public health officials have a medical end in sight, but some members of the public see a social end.

The challenge, Dr. Brandt said, is that there will be no sudden victory. Trying to define the end of the epidemic “will be a long and difficult process.”

Many attempts are being made to have a vaccine ready by the end of the year, but it’s like to be months away at least. The Covid-19 virus is certain to continue, even if the fears subside.

Pandemics from history

Bubonic Plague

Historians describe three great waves of plague, said Mary Fissell, a historian at Johns Hopkins: the Plague of Justinian, in the sixth century; the medieval epidemic, in the 14th century; and a pandemic that struck in the late 19th and early 20th centuries.

The medieval pandemic began in 1331 in China. The illness, along with a civil war that was raging at the time, killed half the population of China. From there, the plague moved along trade routes to Europe, North Africa and the Middle East. In the years between 1347 and 1351, it killed at least a third of the European population. Half of the population of Siena, Italy, died.

That pandemic ended, but the plague recurred.

One of the worst outbreaks began in China in 1855 and spread worldwide, killing more than 12 million in India alone.

It is not clear what made the bubonic plague die down.


Among the diseases to have achieved a medical end is smallpox. But it is exceptional for several reasons: There is an effective vaccine, which gives lifelong protection; the virus, Variola minor, has no animal host, so eliminating the disease in humans meant total elimination; and its symptoms are so unusual that infection is obvious, allowing for effective quarantines and contact tracing.

But while it still raged, smallpox was horrific. Epidemic after epidemic swept the world, for at least 3,000 years.

It is thought to have been present in India as early as 1500 BCE, China 1122 BCE and Egypt 1145 BCE.

In 18th-century Europe it is estimated 400,000 people per year died from the disease, and one-third of the cases resulted in blindness.

It is estimated to have killed up to 300-500 million people in the 20th century. Two million died from smallpox in 1967.

The last naturally occurring case was diagnosed in October 1977.

1918 (Spanish) Flu

This raced around the world at the end of Word War 1, killing 50-100 million people.

After sweeping through the world, that flu faded away, evolving into a variant of the more benign flu that comes around every year.

There were about 9,000 deaths in New Zealand, 2.500 of them Māori.

Hong Kong Flu

In the Hong Kong flu of 1968, one million people died worldwide, including 100,000 in the United States, mostly people older than 65. That virus still circulates as a seasonal flu, and its initial path of destruction — and the fear that went with it — is rarely recalled.

Swine flu

This was a variant strain of the 1918 Spanish flu. It is estimated to have caused somewhere between 150,000 and 575,000 deaths, and it is estimated that 700-1500 million were infected. Fortunately most people were only mildly affected.


In 2014 more than 11,000 people in West Africa had died from Ebola, a highly infectious viral disease that was often fatal.


This has spread around the world and in about five months over 308,000 people have died, but this total is likely to grow quite a bit yet – the death toll has doubled over the last month.

In New Zealand the last of 21 deaths was on 6 May, and cases have just about stopped – the peak daily cases were from 24 March and had dropped to 29 by 11 April.

Virtually shutting down the borders has stopped the re-introduction of Covid. But how long will we keep our borders closed? While we may socially think the health problem is over some significant restrictions could persist for months.

We are no longer shut in our homes but we remain shut in our country.

But we have the benefit of modern health care and modern science.

Covid-19 now designated a pandemic

The World Health Organisation has declared the Covid-19 coronavirus a pandemic.

Current WHO global phase of pandemic alert: Avian Influenza A(H5N1)

Current phase of global alert according to criteria described in the WHO Pandemic Influenza Risk Management Interim Guidance

The pandemic influenza phases reflect WHO’s risk assessment of the global situation regarding each influenza virus with pandemic potential that is infecting humans. These assessments are made initially when such viruses are identified and are updated based on evolving virological, epidemiological and clinical data. The phases provide a high-level, global view of the evolving picture.

As pandemic viruses emerge, countries and regions face different risks at different times. For that reason, countries are strongly advised to develop their own national risk assessments based on local circumstances, taking into consideration the information provided by the global assessments produced by WHO. Risk management decisions by countries are therefore expected to be informed by global risk assessments, but based on local risk assessments.

The current WHO phase of pandemic alert for avian influenza A(H5N1) is: ALERT

Alert phase: This is the phase when influenza caused by a new subtype1 has been identified in humans. Increased vigilance and careful risk assessment, at local, national and global levels, are characteristic of this phase. If the risk assessments indicate that the new virus is not developing into a pandemic strain, a de-escalation of activities towards those in the interpandemic phase may occur.

Please consult the interim guidance document for complete information on pandemic phases:

More information on avian influenza H5N1 in humans can be found at the:

1 The IHR (2005) Annex 2 includes “human influenza caused by a new subtype” among the four specified diseases for which a case is necessarily considered “unusual or unexpected and may have serious public health impact, and thus shall be notified” in all circumstances to WHO.

On Tuesday Wall Street partly recovered from Monday’s large decline, but so far Wednesday it is sliding again, so far down by 5%.

This is said to be partly in reaction to the announcement, and partly due to the muddled messages and slow reaction by the Trump administration.

MarketWatch: Dow tumbles 1,200 points, stocks extend slide after WHO declares coronavirus a pandemic

Stocks extended losses Wednesday after the World Health Organization designated the global spread of COVID-19 a pandemic, building on declines attributed partly to disappoint over prospects for a quick round of fiscal stimulus to cushion the U.S. economy from the effects of the outbreak.

U.S. Treasury Secretary Steven Mnuchin said Wednesday a robust economic stimulus won’t be able to pass Congress quickly and he threw his support behind a smaller measure designed to help small businesses and workers grappling with the coronavirus.

Meanwhile, policy makers abroad have begun to take action to ease the pressure on businesses, with the Bank of England delivering an emergency interest rate cut and the U.K. government pledging fiscal stimulus in its budget Wednesday, while German Chancellor Angela Merkel promised to do “whatever is necessary” and the European Central Bank’s president warned of an economic shock like the 2008 financial crisis.

Investors have called for more focused measures by the U.S. Congress and the White House to support businesses and corporations that could suffer a sharp decline in revenues if consumer spending drops. Until Wall Street gains clarity on what a spending package might look like, investor sentiment could remain shaky, analysts said.

Clarity is not one of Trump’s strengths. Of course tyhere is a tweet from Trump praising what he uis doiung.


Publicly, he sees it as yet another (“Fake News”) media war; privately, he worries about virus-carrying journalists on Air Force One. But cancel his rallies?

Ever since the coronavirus exploded outside of China at the end of January, Donald Trump has treated the public health crisis as a media war that he could win with the right messaging. But with cases now documented in 34 states and markets plunging, Republicans close to Trump fear his rosy assessments are fundamentally detached from reality in ways that will make the epidemic worse. “He is trying to control the narrative and he can’t,” a former West Wing official told me.

The problem is that the crisis fits into his preexisting and deeply held worldview—that the media is always searching for a story to bring him down. Covid-19 is merely the latest instance, and he’s reacting in familiar ways. “So much FAKE NEWS!” Trump tweeted this morning. “He wants Justice to open investigations of the media for market manipulation,” a source close to the White House told me. Trump is also frustrated with his West Wing for not getting a handle on the news cycle. “He’s very frustrated he doesn’t have a good team around him,” a former White House official said. On Friday he forced out acting chief of staff Mick Mulvaney and replaced him with former House Freedom Caucus chair Mark Meadows. Trump thought the virus was “getting beyond Mick,” a person briefed on the internal discussions said. Trump has also complained that economic adviser Larry Kudlow is not doing enough to calm jittery markets.

I don’t know if it can be called a meltdown, it looks like normal Trump – too easily distracted by petty attacks.

He shouldn’t be wasting time on stuff like that, but he is unlikely to stop obsessing about and ranting about the media.

Reuters: White House told federal health agency to classify coronavirus deliberations

The White House has ordered federal health officials to treat top-level coronavirus meetings as classified, an unusual step that has restricted information and hampered the government’s response to the contagion, according to four Trump administration officials.

After a rise the NZX ended up slightly down yesterday and will likely follow the US market down again today.

No official releases from the New Zealand Government (Beehive) on the virus yesterday.

Reuters: WHO calls coronavirus a pandemic as Britain, Italy shore up defenses

“We are deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction,” Director General Tedros Adhanom Ghebreyesus told reporters in Geneva.

“We have therefore made the assessment that COVID-19 can be characterized as a pandemic,” he said, using the formal name of the coronavirus.

There are now more than 118,000 infections in 114 countries and 4,291 people have died of the virus, with the numbers expected to climb, Tedros said.

Before the WHO’s comments, Italy – the European country worst hit by the virus – and Britain announced they were setting aside large sums to fight the flu-like disease.

Britain launched a 30-billion-pound ($38.54 billion) economic stimulus plan as new finance minister Rishi Sunak said the economy faced a “significant impact” from the spread of the virus, even if it was likely to be temporary.

“Up to a fifth of the working-age population could need to be off work at any one time. And business supply chains are being disrupted around the globe,” Sunak said in an annual budget speech to parliament.

It looks to be a long way from over.