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With the focus fixed firmly on coronavirus, important and urgent issues in healthcare are going under the radar. In this week’s HSJ Health Check, we look at those things which are going unnoticed, or under-noticed. You can listen below, or subscribe on Spotify, Apple Podcasts, and all the other popular podcast platforms. Four of HSJ’s expert journalists — Annabelle Collins, Rebecca Thomas, Matt Discombe and Dave West — discuss issues including: NHS finances, including mental health trusts, unusually, missing their surplus target; The quality of care for covid-19 and other patients, with most independent inspections on hold; Persisting problems with medical consultants refusing to do extra work, due to pensions changes, as the elective waiting list grows
At times of crisis, expert opinion is crucial to formulate policy and direction. The Covid-19 pandemic has demonstrated the life-saving importance of medical leadership at national as well as operational levels. Innovation and rapid re-organisation have enabled healthcare systems to cope with the unprecedented demands placed on services in both primary and secondary care settings. While there have been genuine issues picked up in the media, this should not detract from the enormous value gained from medical engagement and the real and present opportunity to capture and change the way we lead healthcare over the coming months.
A shadow hangs over the struggle to understand the COVID-19 pandemic’s different problems – a shadow of necropolitics that puts some people and risks in the obscure background, while others are highlighted, in the foreground. Social activists and primary care professionals are working hard to help people stay safe and providing basic necessities like food, water or soap. Meanwhile, far-right protesters, some from the better-off classes who protest from the safety of their cars, but also daily workers, Uber drivers and street traders are out against the lockdown, in protests described as nearing a military coup. They want workers to get back to work, contrary to public health recommendations. The elites want the economy to be re-opened, so they can go back to profiting, while the precariously-employed are torn between the need to stay safe and the need to return to work in the absence of alternative means of survival. The question of survival marks the ‘edges’ of the pandemic. ‘Edges’ or borders (Bhattarcharya 2018) are where rights and freedoms are differentiated for different groups of people. Bordering is not only about the control of migration, or about the differences between the ‘global north’ and the ‘global south’. Bordering takes place within states, within public institutions and even within the public sphere. Brazil is rapidly becoming a front-runner in the horrible reversal of the ideal of justice playing out across the world – the last are coming first in experiencing the brunt of mass ill-being, fear, insecurity, and death. Necropolitical assumptions run through current ‘scientific’ models and conceptions of society, especially those that model society as synonymous with ‘economy’. The aggregated statistics of pandemic monitoring offer an impersonal universalizing language of a single ‘population’ or ‘economy’. Science, law and ethics are complicit when they universalize in ways that disguise
During the 20 years that Alejandro Carrillo has worked in the United States, he has always sent money home. Earnings from his time with construction crews in Florida were enough to provide food and an education to each of his seven children and to build his wife a house in which to raise them. It was also enough to later help his 33-year-old son, José Carrillo, purchase a small, green car to start a taxi business. Funds sent back to Central America from migrants who work in economically developed countries are a lifeline to families like the Carrillos. Remittances represent a steady cash flow which keeps receivers out of poverty and provides a safety net in times of crisis.
Two McMaster University professors have received research funding to boost their work to identify COVID-19 infection rates and to understand why some people are more susceptible to the virus. Dawn Bowdish, professor of pathology and molecular medicine and the Canada Research Chair in Aging and Immunity, and Michael Surette, professor of medicine and the Canada Research Chair in Interdisciplinary Microbiome Research, are receiving $300,000 for two studies from The W. Garfield Weston Foundation through its Weston Family Microbiome Initiative. The funds are in addition to a three-year, $1 million grant from the Foundation awarded to the duo earlier this year. The original funding supports a study focused on identifying and isolating the members of the airway microbiome – which consists of microbes like bacteria, fungi, and viruses – that protect older adults from respiratory infection. “This additional funding will help us answer two important questions related to COVID-19,” said Bowdish. “One is a better understanding of what the actual infection rate is in the Hamilton community. The second is whether there are differences in the immune responses or the airway microbiomes of those who get sick and those who don’t, or in those who have symptoms versus those who don’t.”
Sweden has now overtaken the UK, Italy and Belgium to have the highest coronavirus per capita death rate in the world, throwing its decision to avoid a strict lockdown into further doubt. According to figures collated by the Our World in Data website, Sweden had 6.08 deaths per million inhabitants per day on a rolling seven-day average between May 13 and May 20. This is the highest in the world, above the UK, Belgium and the US, which have 5.57, 4.28 and 4.11 respectively. However, Sweden has only had the highest death rate over the past week, with Belgium, Spain, Italy, the UK and France, still ahead over the entire course of the pandemic. State epidemiologist Anders Tegnell, the spokesman for Sweden’s outlier coronavirus strategy, dismissed the figures on Tuesday night, arguing that it was misleading to focus on the death toll over a single week.
Analysts are tracking false rumours about COVID-19 in hopes of curbing their spread. In the first few months of 2020, wild conspiracy theories about Bill Gates and the new coronavirus began sprouting online. Gates, the Microsoft co-founder and billionaire philanthropist who has funded efforts to control the virus with treatments, vaccines and technology, had himself created the virus, argued one theory. He had patented it, said another. He’d use vaccines to control people, declared a third. The false claims quietly proliferated among groups predisposed to spread the message — people opposed to vaccines, globalization or the privacy infringements enabled by technology. Then one went mainstream.
If President Trump sidelines the World Health Organization, experts foresee incoherence, inefficiency and resurgence of deadly diseases. Experts in health policy are contending with the real possibility that the United States will pull away from the World Health Organization (WHO), fracturing a relationship that began in the wake of the Second World War. They say that the repercussions could range from a resurgence of polio and malaria, to barriers in the flow of information on COVID-19. Scientific partnerships around the world would also be damaged, and the United States could lose influence over global health initiatives, including those to distribute drugs and vaccines for the new coronavirus as they become available, say researchers.
The World Bank Group and International Monetary Fund today convened African leaders, bilateral partners, and multilateral institutions to spur faster action on COVID-19 response in African countries. H.E. Cyril Ramaphosa of South Africa, United Nations Secretary General Antonio Guterres, Director General of the WHO Dr. Tedros Adhanom Ghebreyesus, Africa Union Commission Chairperson Moussa Faki Mahamat, and officials of individual countries outlined their policy plans for effective use of resources, multilateral organizations including the United Nations pledged their continued support, and bilateral partners reemphasized their commitment to a debt standstill beginning May 1, 2020. This comes in response to calls from the World Bank Group President Malpass, International Monetary Fund Managing Director Georgieva, and other partners for creditors to suspend debt repayments in order to provide much-needed support to the poorest countries.

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