“The aim of art is to represent not the outward appearance of things, but their inward significance.”

“Art is the lie that enables us to realize the truth.”
Pablo Picasso

“I dream my painting and I paint my dream.”
Vincent Van Gogh

“The painter has the Universe in his mind and hands.”
Leonardo da Vinci

“Art is not what you see, but what you make others see.”
Edgar Degas

“Art is what you can get away with.”
Andy Warhol

Poems inspired by great works of art

I have been inspired by paintings all my life. Traveling around the world has given me the opportunity to visit some of the world’s famous galleries and museums to admire the work of the great masters at first hand.
These works of art have also inspired poets and I have collected together a series of poems and the paintings that inspired them.
Many of you will recognise the majority of these paintings which span a time starting at the renaissance and finishing mid 20th Century
We start with one on my heroes, the brilliant and innovative, Rembrandt van Rijn. He painted more self-portraits than any other artist and these paintings give us an extraordinary insight into the man himself and the impact that the ravages of time and misfortune had on him.

Rembrandt: Self-Portrait at the Age of 63 (1669)
Rembrandt was a draughtsman, painter, and printmaker. An innovative and prolific master in three media, he is generally considered one of the greatest visual artists in the history of art and the most important in Dutch art history
Self-Portrait at the Age of 63. One of three dating to 1669, it was one of the last in his series of around 80 self-portraits, painted in the months before his death in October 1669. By this time, he was once again a widower, his son Titus was dead and he had been declared bankrupt. He appears old for his age and we are left looking a sad broken man.

Rembrandt’s Late Self-Portraits, Elizabeth Jennings (1975)
Elizabeth Jennings CBE was an English poet. She is known for her lyric poetry. Her work displays a simplicity shared with people like Philip Larkin and other poets in England known as The Movement.

Rembrandt’s Late Self-Portraits

You are confronted with yourself. Each year
The pouches fill, the skin is uglier.
You give it all unflinchingly. You stare
Into yourself, beyond. Your brush’s care
Runs with self-knowledge. Here

Is a humility at one with craft.
There is no arrogance. Pride is apart
From this self-scrutiny. You make light drift
The way you want. Your face is bruised and hurt
But there is still love left.

Love of the art and others. To the last
Experiment went on. You stared beyond
Your age, the times. You also plucked the past
And tempered it. Self-portraits understand,
And old age can divest,

With truthful changes, us of fear of death.
Look, a new anguish. There, the bloated nose,
The sadness and the joy. To paint’s to breathe,
And all the darknesses are dared. You chose
What each must reckon with.

Rembrandt, Self-Portrait

Leonardo da Vinci, Mona Lisa (c.1503)
Leonardo da Vinci was an Italian polymath of the High Renaissance who is widely considered one of the greatest painters of all time. The Mona Lisa is the most famous of Leonardo’s works and the most famous portrait ever made. I don’t have to introduce this painting. The world has been mesmerised by that enigmatic smile.

John Stone: Three for the Mona Lisa (1982)
John Stone is the author of four volumes of poetry–In All This Rain, Renaming the Streets, and The Smell of Matches–and In the Country of Hearts: Journeys in the Art of Medicine. He is a cardiologist and professor at Emory University School of Medicine

Three for the Mona Lisa

1. It is not what she did
at 10 o’clock
last evening
accounts for the smile
It is
that she plans
to do it again

2. Only the mouth
all those years
letting on.

3. It’s not the mouth
it’s not the eyes
exactly either
it’s not even
exactly a smile
But, whatever,
I second the motion.

Leonardo, The Mona Lisa — in the Renaissance and today

Landscape with the Fall of Icarus, Pieter Bruegel the Elder (1558)
Pieter Bruegel the Elder was the most significant artist of Dutch and Flemish Renaissance painting, a painter and printmaker, known for his landscapes and peasant scenes.
Landscape with the Fall of Icarus is a painting in oil on canvas measuring 73.5 by 112 centimetres in the Royal Museums of Fine Arts of Belgium in Brussels.
The painting is obviously a vehicle to display his virtuosity as a landscape painter but if you look carefully you can see the unfortunate Icarus’ legs as he hits the water.

Musée des Beaux Arts, W. H. Auden (1938)
English poet, playwright, critic, and librettist Wystan Hugh Auden exerted a major influence on the poetry of the 20th century. Auden grew up in Birmingham, England and was known for his extraordinary intellect and wit. He emigrated to the USA where he became a citizen. He also mentions in passing those incidental legs in the water!

Musée des Beaux Arts

About suffering they were never wrong,
The Old Masters: how well they understood
Its human position; how it takes place
While someone else is eating or opening a window or just walking dully along;
How, when the aged are reverently, passionately waiting
For the miraculous birth, there always must be
Children who did not specially want it to happen, skating
On a pond at the edge of the wood:
They never forgot
That even the dreadful martyrdom must run its course
Anyhow in a corner, some untidy spot
Where the dogs go on with their doggy life and the torturer’s horse
Scratches its innocent behind on a tree.
In Brueghel’s Icarus, for instance: how everything turns away
Quite leisurely from the disaster; the plowman may
Have heard the splash, the forsaken cry,
But for him it was not an important failure; the sun shone
As it had to on the white legs disappearing into the green
Water; and the expensive delicate ship that must have seen
Something amazing, a boy falling out of the sky,
Had somewhere to get to and sailed calmly on.

The fall of Icarus by the dutch painter Pieter Bruegel

Diana and Actaeon, Titian, (1556-59)
Tiziano Vecelli or Vecellio, known in English as Titian, was an Italian painter during the Renaissance, considered the most important member of the 16th-century Venetian school. He was born in Pieve di Cadore, near Belluno. During his lifetime he was often called da Cadore, ‘from Cadore’, taken from his native region. His influence across Europe was immense, inspiring painters such as Rubens, Velasquez, Tintoretto and many more
Diana and Actaeon was finished in 1556–1559 and one of 7 mythological canvases that he painted as a series for Philip ll of Spain. It portrays the moment in which the hunter Actaeon bursts in where the goddess Diana and her nymphs are bathing. The outraged goddess ensured that Actaeon could never tell what he has seen by changing him into a deer to be killed by his own hounds.

Actaeon, George Szirtes (2012)
George Szirtes is a British poet and translator from the Hungarian language into English. Originally from Hungary, he has lived in the United Kingdom for most of his life after coming to the country as a refugee at the age of eight.


O, my America, my Newfoundland
John Donne, “Elegy 20”
O, my America, discovered by slim chance,
behind, as it seemed, a washing line
I shoved aside without thinking –
does desire have thoughts or define
its object, consuming all in a glance?
You, with your several flesh sinking
upon itself in attitudes of hurt,
while the dogs at my heels
growl at the strange red shirt
under a horned moon, you, drinking
night water – tell me what the eye steals
or borrows. What can’t we let go
without protest? My own body turns
against me as I sense it grow
contrary. Whatever night reveals
is dangerously toothed. And so the body burns
as if torn by sheer profusion of skin
and cry. It wears its ragged dress
like something it once found comfort in,
the kind of comfort even a dog learns
by scent. So flesh falls away, ever less
human, like desire itself, though pain
still registers in the terrible balance
the mind seems so reluctant to retain,
o, my America, my nakedness!

‘Diana and Actaeon’ and ‘Diana and Callisto’ by Titian

The Starry Night, Van Gogh (1889)
Vincent Willem van Gogh was a Dutch post-impressionist painter who is among the most famous and influential figures in the history of Western art. In just over a decade, he created about 2,100 artworks, including around 860 oil paintings, most of which date from the last two years of his life.
The Starry Night was painted in June 1889, it depicts the view from the east-facing window of his asylum room at Saint-Rémy-de-Provence, just before sunrise, with the addition of an imaginary village.

The Starry Night, Anne Sexton (1961)
Anne Sexton was an American poet known for her highly personal, confessional verse. She won the Pulitzer Prize for poetry in 1967 for her book Live or Die

The Starry Night
The town does not exist
except where one black-haired tree slips
up like a drowned woman into the hot sky.
The town is silent. The night boils with eleven stars.
Oh starry starry night! This is how
I want to die.
It moves. They are all alive.
Even the moon bulges in its orange irons
to push children, like a god, from its eye.
The old unseen serpent swallows up the stars.
Oh starry starry night! This is how
I want to die:
into that rushing beast of the night,
sucked up by that great dragon, to split
from my life with no flag,
no belly,
no cry.

Vincent van Gogh – The Starry Night (1889)

Jackson Pollock, Number 1 (1948)
Paul Jackson Pollock was an American painter and a major figure in the abstract expressionist movement. He was widely noticed for his technique of pouring or splashing liquid household paint onto a horizontal surface, enabling him to view and paint his canvases from all angles.
Number 1, 1948 is a masterpiece of the “drip,” or pouring, technique, the radical method that Pollock contributed to Abstract Expressionism. Moving around an expanse of canvas laid on the floor, Pollock would fling and pour ropes of paint across the surface.

Nancy Sullivan, No name but a number.
Nancy Sullivan, American literature educator, poet. Poetry fellow National Endowment for the Arts, 1976-1977; named to Hunter College Hall of Fame, New York City, 1998. Member Poets House, Poetry Society of America, Humanities Forum Rhode Island.

No name but a number

No name but a number.
Trickles and valleys of paint
Devise this maze
Into a game of Monopoly
Without any bank. Into
A linoleum on the floor
In a dream. Into
Murals inside of the mind.
No similes here. Nothing
But paint. Such purity
Taxes the poem that speaks
Still of something in a place
Or at a time.
How to realize his question
Let alone his answer?

Se Pollock painting

Grant Wood, American Gothic (1930)
Grant DeVolson Wood was an American painter best known for his paintings depicting the rural American Midwest, particularly American Gothic, which has become an iconic painting of the 20th century.
American Gothic was painted in 1930 and is in the collection of the Art Institute of Chicago. Wood was inspired to paint what is now known as the American Gothic House in Eldon, Iowa, along with “the kind of people [he] fancied should live in that house”.

John Stone, American Gothic after the painting 1930
John Stone is the author of four volumes of poetry–In All This Rain, Renaming the Streets, and The Smell of Matches–and In the Country of Hearts: Journeys in the Art of Medicine. He is a cardiologist and professor at Emory University School of Medicine

American Gothic after the painting
Just outside the frame
there has to be a dog
chickens, cows and hay
and a smokehouse
where a ham in hickory
is also being preserved
Here for all time
the borders of the Gothic window
anticipate the ribs
of the house
the tines of the pitchfork
repeat the triumph
of his overalls
and front and center
the long faces, the sober lips
above the upright spines
of this couple
arrested in the name of art
These two
by now
the sun this high
ought to be
in mortal time
about their businesses
Instead they linger here
within the patient fabric
of the lives they wove
he asking the artist silently
how much longer
and worrying about the crops
she no less concerned about the crops
but more to the point just now
whether she remembered
to turn off the stove.

Wood, American Gothic

Katsushika Hokusai, The Great Wave at Kamagawa (1823-29)
Katsushika Hokusai, known simply as Hokusai, was a Japanese artist, ukiyo-e painter and printmaker of the Edo period. Born in Edo, Hokusai is best known as author of the woodblock print series Thirty-six Views of Mount Fuji which includes the internationally iconic print, The Great Wave off Kanagawa.
The Great Wave off Kanagawa, also known as The Great Wave or simply The Wave, is a woodblock print. It was published sometime between 1829 and 1833 in the late Edo period as the first print in the series Thirty-six Views of Mount Fuji.

Donald Finkel: The Great Wave: Hokusai
Donald Alexander Finkel was an American poet best known for his unorthodox styles and “curious juxtapositions

But we will take the problem in its most obscure manifestation, and suppose that our spectator is an average Englishman. A trained observer. carefully hidden behind a screen, might notice a dilation in his eyes, even an intake of his breath, perhaps a grunt. (Herbert Read, The Meaning of Art)
It is because the sea is blue,
Because Fuji is blue, because the bent blue
Men have white faces, like the snow
On Fuji, like the crest of the wave in the sky the colour of their
Boats. It is because the air
Is full of writing, because the wave is still: that nothing
Will harm these frail strangers,
That high over Fuji in an earth coloured sky the fingers
Will not fall; and the blue men
Lean on the sea like snow, and the wave like a mountain leans
Against the sky.
In the painter’s sea
All fishermen are safe. All anger bends under his unity.
But the innocent bystander, he merely
‘Walks round a corner, thinking of nothing’: hidden
Behind a screen we hear his cry.
He stands half in and half out of the world; he is the men,
But he cannot see below Fuji
The shore the color of sky; he is the wave, he stretches
His claws against strangers. He is
Not safe, not even from himself. His world is flat.
He fishes a sea full of serpents, he rides his boat
Blindly from wave to wave toward Ararat.
Ukiyoe EDO LIFE: The Great Wave off Kanagawa by Katsushika Hokusai

Many of you will know Roger and Sarah Strasser, who are moving to New Zealand. I asked Roger whether he would tell us about this exciting move. We wish them both good fortune in their new posts.
Rural Health, New Zealand, and Covid-19
Last week, Sarah (Professor Sarah Strasser) and I relocated to New Zealand. Several months ago, we took up our new positions with the University of Waikato in Hamilton, New Zealand and have been “working from home” at the house we bought in 1986 in Gippsland, two hours east of Melbourne, Australia. Sarah is Dean of the Te Huataki Waiora School of Health and I am Professor of Rural Health. My job description includes “public engagement” which means education about and advocacy for rural health, as well as community engagement through developing interdependent partnerships between the School and rural communities. In addition, my role has a focus on building rural health research capacity across New Zealand. The University of Waikato will be seeking government approval to establish a new and different kind of medical school for New Zealand drawing on our experiences with the Northern Ontario School of Medicine (NOSM) in Canada and the Flinders University Northern Territory Medical Program (NTMP) in Australia.
When we signed contracts in January, Sarah and I had no idea that the whole world would soon change because of the Covid-19 pandemic. Covid-19 has brought into sharp focus existing disparities and inequities including the relative lack of resources and access to health care for people in remote, rural, and Indigenous communities around the world. The pandemic has highlighted the importance of self-sufficiency, self-reliance and resourcefulness that provides the basis to advocate for meaningful new resource allocation to rural communities and rural health services. Also, the pandemic has made the impossible possible. Previously, city people and organisations saw meeting by web-based video, delivering education totally online, and telehealth care as “impossible”, or at least substandard. Now, they are part of the “new normal” that opens exciting opportunities for rural health worldwide.

Today’s Posts
1. The Lancet: Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO’s Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries’ health profiles and are of sufficient quality to produce health gains for populations of all ages.
The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world’s evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC.

2. India: CNBC News: India crosses 4 million coronavirus cases with record surge
India’s total coronavirus cases surged beyond 4 million with a record rise on Saturday, making it the third country in the world to surpass that mark, following the United States and Brazil. India added 86,432 cases of the new virus on Saturday, a global daily record, according to data from the federal health ministry.
Infections rose across the country, including in the capital New Delhi and the large states of Maharashtra and Karnataka.The jump to more than 4 million cases comes only 13 days after India reached 3 million cases, accelerating sharply from the more than 100 days it took to increase by the previous 1 million. India has logged the world’s largest daily coronavirus caseload for almost a month, as its government pushes the opening up of businesses to revive a sharply contracting economy. The number of deaths in India from the COVID-19 rose by more than 1,000 to 69,561 on Saturday.

3. UK: UK Government: £500 million funding for quick result COVID-19 test trials
A new £500 million funding package will be invested in next generation testing technology and increased testing capacity.
Government commits £500 million for COVID-19 test trials using latest technology
New community-wide testing pilot launched in Salford and existing pilots expanded in Southampton and Hampshire Funding will also support the scaling up of testing capacity ahead of winter. A new £500 million funding package will be invested in next generation testing technology and increased testing capacity, the Health and Social Care Secretary announced today. To date, our large-scale COVID-19 testing system has carried out more than 16 million tests and this new funding for quick result test trials and repeat population testing will help take the programme to the next level.

4. The Lancet: The universal health coverage ambition faces a critical test
Universal health coverage (UHC) has been a focus of the global development conversation over the past decade and, increasingly, of national policy making in countries across a wide range of income levels. The political salience of UHC is rooted in its attractive value proposition: to provide good quality health-care services to all citizens who need them without causing financial hardship.
However, comparing progress towards UHC across countries is exceedingly challenging given the wide variations in national resources, health systems, epidemiological and policy priorities, and availability (or unavailability) of reliable, recent data among countries. In The Lancet, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 Universal Health Coverage Collaborators tackle this challenge by constructing a weighted mean of the effective coverage of 23 health services in 204 countries.
This is an improvement over past measures of service coverage (eg, contact with the health system) because coming to the clinic does not always improve a person’s health when the care is of low quality or available services do not match the patient’s needs. Effective coverage, by contrast, captures the proportion of possible health gains people receive from interacting with the health system

5. The Lancet: Video: IHME | Introducing the 2020 Universal Health Coverage Study

S ED Video

6. India: The Lancet: Is India missing COVID-19 deaths?
Experts have questioned shortcomings and lack of clarity in vital registration, testing practices, and classification of COVID-19 deaths. Patralekha Chatterjee reports from New Delhi. India has had 3·6 million cases of COVID-19, the third most in the world after the USA and Brazil, with 65 288 officially confirmed deaths from the disease as of Sept 1, 2020. The Indian Government says that the national recovery rate has reached 77% and the case fatality rate is down to 1·8%, due to “timely and effective clinical management of the patients in critical care” according to an official statement on Aug 30. However, experts who spoke with The Lancet have pointed to several sources of uncertainty in India’s COVID-19 mortality data.
It is unclear how suspected or probable COVID-19-attributable deaths are being included in mortality estimates. Indian Council of Medical Research (ICMR) guidelines stipulate that deaths of people with suspected or probable COVID-19 should be included in mortality data, based on WHO ICD-10 codes for COVID-19-related deaths. However, the guidelines are advisory. Information about whether state data on deaths include suspected and probable cases is not in the public domain and the Indian Ministry of Health and Family Welfare did not respond to The Lancet’s requests for clarification.

7. South Africa: BBC: Coronavirus in South Africa: Scientists explore surprise theory for low death rate
Infection and death rates in many African countries have turned out to be much lower than initially feared. As the number of infections dips sharply in South Africa, experts there are exploring a startling hypothesis, as our Africa correspondent Andrew Harding reports from Johannesburg.
Crowded townships. Communal washing spaces. The impossibility of social distancing in communities where large families often share a single room…
For months health experts and politicians have been warning that living conditions in crowded urban communities in South Africa and beyond are likely to contribute to a rapid spread of the coronavirus.
“Population density is such a key factor. If you don’t have the ability to social distance, the virus spreads,” said Professor Salim Karim, the head of South Africa’s ministerial advisory team on Covid-19.
But some experts are now posing the question, what if the opposite is also true? What if those same crowded conditions also offer a possible solution to the mystery that has been unresolved for months? What if those conditions – they are asking – could prove to give people in South Africa, and in similar settings globally, some extra protection against Covid-19?

8. USA: Reuters: Fauci warns COVID-19 vaccine may be only partially effective, public health measures still needed
An approved coronavirus vaccine could end up being effective only 50-60% of the time, meaning public health measures will still be needed to keep the pandemic under control, Dr. Anthony Fauci, the top U.S. infectious diseases expert, said on Friday.
“We don’t know yet what the efficacy might be. We don’t know if it will be 50% or 60%. I’d like it to be 75% or more,” Fauci said in a webinar hosted by Brown University. “But the chances of it being 98% effective is not great, which means you must never abandon the public health approach.”
The novel coronavirus has infected nearly 5 million people in the United States and killed more than 160,000.
Lockdown measures imposed to keep the virus from spreading have devastated the economy, which suffered its biggest blow since the Great Depression in the second quarter, with gross domestic product dropping at its steepest pace in at least 73 years.

9. International: Will the COVID-19 pandemic threaten the SDGs?
The UN’s Sustainable Development Goals (SDGs), adopted in 2015, provide an international framework to move by 2030 toward more equitable, peaceful, resilient, and prosperous societies—while living within sustainable planetary boundaries. As the UN celebrates its 75th anniversary and a third of the SDG timeline has passed, The Sustainable Development Goals Report 2020—prepared by the UN Department of Economic and Social Affairs in collaboration with experts and international agencies— tells a story of tentative but insufficient progress, and warns of the regressive impact of the coronavirus pandemic.
According to the report, COVID-19 threatens to reverse the progress of SDG 3, which aims to ensure healthy lives and wellbeing for all. During the crisis, 70 countries have halted childhood vaccination programmes, and in many places, health services for cancer screening, family planning, or non-COVID-19 infectious diseases have been interrupted or are being neglected. Health service disruptions could reverse decades of improvement, warns the report. Allowing people to slip through these service gaps could affect population health for years to come.

10. USA: NBC: Video: Former coronavirus skeptics describe how contracting COVID-19 changed their perspective
NBC News speaks to former COVID-19 skeptics who, after catching the virus, now want others to know that it’s all too real. This episode of Global Hangout was taped on August 5, and first published on NBC Facebook channels on August 6.
S ED Video

11. The Lancet: COVID-19: a new lens for non-communicable diseases
On Sept 19, 2011, global leaders met at the UN in New York, USA, to set an international agenda on non-communicable diseases (NCDs), which cause three-quarters of global deaths. This was only the second time in history that the UN General Assembly had met to discuss a health issue (the first was for HIV/AIDS in 2016). In 2015, Sustainable Development Goal 3.4 set the ambitious target for countries to reduce their risk of premature mortality from NCDs by a third relative to 2015 levels by 2030. The Lancet NCD Countdown 2030, published on Sept 3, reveals that, among high-income countries, only Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea are on track to meet this target for both men and women if they maintain or surpass their 2010–16 average rates of decline. We know how to reduce the risk of NCDs—for the most part through a combination of effective tobacco and alcohol control, and well understood health interventions for hypertension, diabetes, and cancer. But addressing the broader determinants of NCDs is difficult without more robust fiscal measures. Although NCDs have received plenty of political attention, action has clearly been inadequate.
A modelling study published in The Lancet Global Health suggests that, worldwide, one in five people are at an increased risk of severe COVID-19 should they become infected, mostly as a result of underlying NCDs. The enormous efforts to deal with COVID-19 have also disrupted the regular care often required by patients with NCDs. WHO completed a rapid assessment survey in May, 2020, and found that 75% of countries reported interruptions to NCD services. Among the most hard hit were public health campaigns and NCD surveillance efforts. Excess deaths from the disruption caused by COVID-19 might make any gains against the virus a pyrrhic victory. COVID-19 and NCDs form a dangerous relationship, experienced as a syndemic that is exacerbating social and economic inequalities. The Lancet NCDI Poverty Commission: bridging a gap in universal health care for the poorest billion, will be published later this month and will explore the relation between poverty and NCDs in more detail. COVID-19 also provides a new lens through which to view NCDs.

12. Nature: How many people has the coronavirus killed?
Researchers are struggling to tally mortality statistics as the pandemic rages. Here’s how they gauge the true toll of the coronavirus outbreak.
At the beginning of March, Andrew Noymer felt a familiar twinge of doubt. He was watching countries across Europe and North America begin to record their first deaths from COVID-19, and he knew there could be problems with the data. Even in a normal winter, some deaths caused by influenza get misclassified as pneumonia. If that can happen with a well-known disease, there were bound to be deaths from COVID-19 going unreported, thought Noymer, a demographer at the University of California, Irvine. “I just remember thinking, ‘this is going to be really difficult to explain to people’,” he recalls.
And in March and April, when national statistics offices began to release tallies of the number of deaths, it confirmed his suspicions: the pandemic was killing a lot more people than the COVID-19 figures alone would suggest.

13. USA: Bloomberg: Advisers See No Data Favouring Trump-Touted Plasma Therapy
A panel of experts convened by the National Institutes of Health undercut an emergency authorization issued just days ago by U.S. regulators, saying there’s not enough evidence to recommend use of convalescent plasma for hospitalized coronavirus patients.
In an escalation of a dispute between federal agencies, the NIH advisers said an analysis of a study showed “no difference in 7-day survival overall” among those who received plasma containing high amounts of antibodies.
The statement contradicts inflated claims made at an unusual Sunday night press conference at the White House a week ago, where Food and Drug Administration Commissioner Stephen Hahn and President Donald Trump said convalescent plasma could cut deaths from coronavirus by 35%.
Hahn subsequently apologized for mischaracterizing the benefits of the therapy, which takes infection-fighting antibodies from the blood of patients who have survived the infection and infuses it into those who are suffering with coronavirus.

14. The Lancet: Vitamin D for COVID-19: a case to answer?
Interest in a potential role for vitamin D in the prevention or treatment of acute respiratory infections dates back to the 1930s, when cod liver oil was investigated as a means to reduce industrial absenteeism due to the common cold. Meta-analyses of randomised controlled trials conducted from 2007–20 reveal protective effects of vitamin D against acute respiratory infections, albeit these effects were of modest size and with substantial heterogeneity.
The striking overlap between risk factors for severe COVID-19 and vitamin D deficiency, including obesity, older age, and Black or Asian ethnic origin, has led some researchers to hypothesise that vitamin D supplementation could hold promise as a preventive or therapeutic agent for COVID-19.
From a mechanistic angle, there are good reasons to postulate that vitamin D favourably modulates host responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), both in the early viraemic and later hyperinflammatory phases of COVID-19. Vitamin D metabolites have long been known to support innate antiviral effector mechanisms, including induction of antimicrobial peptides and autophagy. Laboratory data relating to effects of vitamin D on host responses to SARS-CoV-2 specifically are scarce, but one study that screened four compound libraries for antiviral activity has reported an inhibitory effect of the active vitamin D metabolite 1,25-dihydroxyvitamin D (the steroid hormone and biologically active vitamin D metabolite) in human nasal epithelial cells infected with SARS-CoV-2.
Vitamin D has also been shown to regulate immunopathological inflammatory responses in the context of other respiratory infections. The finding that these effects were mediated via regulation of the renin-angiotensin system (RAS) in an animal model
has particular relevance in the context of severe COVID-19, where overactivation of RAS associates with poor prognosis.

15. International: The Lancet: COVID-19 exacerbates violence against health workers
Hundreds of incidents of violence and harassment have been recorded, but these are likely to be just the tip of the iceberg. Sharmila Devi reports.
More than 600 incidents of violence, harassment, or stigmatisation took place against health-care workers, patients, and medical infrastructure in relation to the COVID-19 pandemic, the International Committee of the Red Cross (ICRC) said in a statement on Aug 18.
These incidents were probably only the “tip of the iceberg”, with many others unrecorded, Maciej Polkowski, the head of the ICRC’s Health Care in Danger initiative, told The Lancet. “Unfortunately, these figures were not a surprise because violence is often exacerbated by emergencies”, he said. “We know from cross-sectional studies that the majority of health workers have experienced violence in the workplace that varies from country to country and their thresholds of violence.”
The ICRC said that 611 incidents were recorded between Feb 1 and July 31, 2020. Although patients and medical infrastructure were often targeted, 67% of incidents were directed at health-care workers. More than 20% involved physical assaults, 15% were incidents that the ICRC classed as fear-based discrimination, and 15% were verbal assaults or threats.
The incidents included doctors at a hospital in Pakistan being verbally and physically attacked after a patient died of COVID-19 and relatives entered a high-risk area while shouting that coronavirus was a hoax. In Bangladesh, bricks were thrown at the house of a doctor after he tested positive for COVID-19 in a bid to force him and his family from the area.

16. Middle East: Norwegian Refugee Council: Stressed: Special report: An NRC investigation finds that the fear of Covid-19 is leading to an alarming rise in stress levels amongst refugee and displaced children in the Middle East.
Through a regional survey, qualitative research, expert testimony, and on-the-ground reporting, we have unearthed that children who were once forced to flee hunger, bombs, and bullets, now face an epidemic of fear caused by the global coronavirus. With no end to the outbreak in sight, toxic stress poses a major health threat to the Middle East’s most vulnerable children.

17. USA: Washington Post: The recession is over for the rich, but the working class is far from recovered
The stock market and home values are back at record levels, while jobs remain scarce for those earning less than $20 an hour
U.S. stocks are hovering near a record high, a stunning comeback since March that underscores the new phase the economy has entered: The wealthy have mostly recovered. The bottom half remain far from it.
This dichotomy is evident in many facets of the economy, especially in employment. Jobs are fully back for the highest wage earners, but fewer than half the jobs lost this spring have returned for those making less than $20 an hour, according to a new labor data analysis by John Friedman, an economics professor at Brown University and co-director of Opportunity Insights.
Though recessions almost always hit lower-wage workers the hardest, the pandemic is causing especially large gaps between rich and poor, and between White and minority households. It is also widening the gap between big and small businesses. Some of the largest companies, such as Nike and Best Buy, are enjoying their highest stock prices ever while many smaller businesses fight for survival.

18. International: UBS: What is COVID-19’s economic impact?
While certain epidemiologists were confident a global pandemic would hit, the details of when, what and where were unpredictable.
Individuals 2020, companies and governments were largely unprepared for the sheer magnitude of COVID-19, a virus that has both mirrored other crises and been completely different all at once. Four Nobel economists discuss the impact, lessons learned thus far, and what life may look like post the coronavirus.
While crises of the past like the Great Depression or the 2008 financial crash had universally catastrophic days, COVID-19 slowly swept its way across the globe impacting different countries and their economies at different times. Neighboring countries with similar economic structures have seen vastly different infection and survival rates. Because of this disparity, the natural feelings of uncertainty and fear can last longer, according to Michael Spence.
“In some ways it is more like the shock of 9/11, at least in the US, where for a relatively short period, people just stopped doing and buying certain things,” says the Nobel Laureate. “A pandemic hits much more than the economy though, and the uncertainty, fear, and risk aversion last longer.”

19. Nature: A look within cytokine storms
Monitoring the host immune response could be key to treating patients suffering with COVID-19 and a number of other infectious or autoimmune diseases.
Since the virus SARS-CoV-2 was identified as the cause of the COVID-19 pandemic, scientists have focused on finding drugs and vaccines to treat and prevent disease.
No targeted therapeutics against SARS-CoV-2 presently exist. While previously approved antivirals are being trialled in infected patients, promising results are emerging from drugs that modulate the host’s immune response.
One of the most severe manifestations of COVID-19 is Acute Respiratory Distress Syndrome (ARDS), a life-threatening condition in which the lungs can’t provide enough oxygen to the body’s vital organs. A subgroup of COVID-19 patients sustain a dangerous inflammatory response known as a ‘cytokine storm’ that causes ARDS and damage to other organs.
“Cytokine storms likely contribute to a substantial portion of those infected who require hospitalization for respiratory distress, and certainly those with multi-organ dysfunction,” says Randy Cron, a rheumatologist at the University of Alabama at Birmingham, USA.

20. UK: Public Health England: COVID-19: Guidance for the remobilisation of services within health and care settings
Infection prevention and control recommendations
The guidance is issued jointly by the Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS)/National Services Scotland, Public Health England (PHE) and NHS England as official guidance.
Whilst this guidance seeks to ensure a consistent and resilient UK wide approach, some differences in operational details and organisational responsibilities may apply in Northern Ireland, England, Wales and Scotland.
Please note that this guidance is of a general nature and that an employer should consider the specific conditions of each individual place of work and comply with all applicable legislation, including the Health and Safety at Work etc. Act 1974.

21. Nature: More testing alone will not get us out of this pandemic
Inequities and other social realities must be factored into diagnoses and tracing of COVID-19
In the past few weeks, public-health experts were rightfully outraged at moves by the US Centers for Disease Control and Prevention (CDC) to discourage testing for asymptomatic people exposed to COVID-19. Expanding diagnostic testing is essential to inform public-health policies, education campaigns and containment strategies. But, as I’ve investigated testing approaches around the world, I worry that a narrow focus on more, and more-sophisticated, tests will divert attention from other crucial issues in testing and diagnosis.
Many governments are pinning their hopes on tests. The UK government plans to administer 500,000 tests daily by the end of October, more than double the current number; India’s Ministry of Health and Welfare has announced a goal of one million daily tests. Policymakers are also trying to innovate their way out of the problem: the US National Institutes of Health (NIH) has launched a US$1.5-billion funding initiative, Rapid Acceleration of Diagnostics (RADx), to do so.
Broader testing proffers a seductively straightforward technological remedy. But these solutions can fail when they run into messy, complex and unequal social realities.

22. Brazil: Revista Brasileira de Enfermagem: Nursing practice environment in Primary Health Care: a scoping review
Ambiente de la práctica de enfermería en Atención Primaria a la Salud: revisión de alcance (scoping review)
Objective: To examine the scientific evidence about the nursing practice environment in Primary Health Care.
Methods: Three-step scoping review. 1) An initial research on CINAHL and MEDLINE. 2) A broader search using the same keywords and search terms in the remaining EBSCOHost platform databases. 3) Search the bibliographical references of the selected articles. The studies selected were from 2007 to 2018.
Results: 19 articles were included, most reported findings of the nursing practice environment and results for clients, nurses, nurse managers and the efficiency of organizations, in Primary Health Care.
Conclusion: Improving the environment of nursing practice has consequences on the quality of nursing care, with increased results for clients, nursing and Primary Health Care.
Descriptors: Nursing; Health Services Administration; Work Environment; Primary Health Care; Review

23. USA: Journal of Endourology Urologic Surgery and COVID-19: How the Pandemic Is Changing the Way We Operate
The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of health care, including surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients preoperatively, intraoperatively, and postoperatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. Patients with advanced age and comorbidities have a higher incidence of mortality. Routine preoperative testing and symptom screening is recommended to identify those with COVID-19. Adequate personal protective equipment (PPE) for the surgical team is essential to protect health care workers and ensure an adequate workforce. For COVID-19 positive or suspected patients, the use of N95 respirators is recommended if available. The anesthesia method chosen should attempt to minimize aerosolization of the virus. Negative pressure rooms are strongly preferred for intubation/extubation and other aerosolizing procedures for COVID-19 positive patients or when COVID status is unknown. Although transmission has not yet been shown during laparoscopic and robotic procedures, efforts should be made to minimize the risk of aerosolization. Ultra-low particulate air filters are recommended for use during minimally invasive procedures to decrease the risk of viral transmission. Thorough cleaning and sterilization should be performed postoperatively with adequate time allowed for the operating room air to be cycled after procedures. COVID-19 patients should be separated from noninfected patients at all levels of care, including recovery, to decrease the risk of infection. Future directions will be guided by outcomes and infection rates as social distancing guidelines are relaxed and more surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data become available, the shortage of testing and PPE is resolved, and a vaccine and therapeutics for COVID-19 are developed.

24. USA: JAMA: Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial
Does remdesivir provide a benefit on clinical status for patients hospitalized with moderate coronavirus disease 2019 (COVID-19) pneumonia?
Findings: In this randomized, open-label, phase 3 trial that included 584 patients with moderate COVID-19, the day 11 clinical status distribution measured on a 7-point ordinal scale was significantly better for those randomized to a 5-day course of remdesivir (median length of treatment, 5 days) compared with those randomized to standard care. The difference for those randomized to a 10-day course (median length of treatment, 6 days) compared with standard care was not significantly different.
Meaning: Hospitalized patients with moderate COVID-19 randomized to a 5-day course of remdesivir had a statistically significantly better clinical status compared with those randomized to standard care at 11 days after initiation of treatment, but the difference was of uncertain clinical importance.

25. WHO: Secretary-General’s remarks at opening of the Inter-Parliamentary Union’s World Conference of Speakers of Parliament [as prepared for delivery]
We face an unprecedented disaster, from economic wreckage to an education deficit imperiling an entire generation, from the aggravation of humanitarian crises to the deepening of already troubling infringements of human rights.
We have surpassed 21 million cases and 770,000 deaths – and the toll continues to grow and even accelerate in some places.
The United Nations family is working across many fronts to save lives, control transmission of the virus, ease the fallout and recover better.
We have shipped personal protective equipment and other medical supplies to more than 130 countries.
We continue to press for a global ceasefire and to fight the plague of misinformation.
Across the weeks, we have issued analysis and policy recommendations spanning the full range of affected countries, sectors, issues and populations.
From the beginning, the United Nations has been calling for massive global support for the most vulnerable people and countries – a rescue package amounting to at least 10 per cent of the global economy.
We are also supporting work to accelerate research and development for a people’s vaccine, affordable and accessible to all.

26. Africa: WHO: COVID-19: African countries urged to promote a safe return to school
School closures implemented to protect students from COVID-19, are hurting them in other ways, while the long-term impact of this disruption to education could create a “lost generation” in Africa, two UN agencies said on Thursday.
The World Health Organization (WHO) and UNICEF urged governments on the continent to promote a safe return to the classroom while also limiting spread of the virus.
“Schools have paved the way to success for many Africans. They also provide a safe haven for many children in challenging circumstances to develop and thrive,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.
“We must not be blind-sided by our efforts to contain COVID-19 and end up with a lost generation. Just as countries are opening businesses safely, we can reopen schools. This decision must be guided by a thorough risk analysis to ensure the safety of children, teachers and parents and with key measures like physical distancing put in place.”

27. USA: Washington Post: Evidence grows that children may play a larger role in transmission than previously believed
Latest study is small but shows that kids’ rates of infection and viral loads may make them silent spreaders.
“Some people thought that children might be protected,” Fasano said. “This is incorrect. They may be as susceptible as adults — but just not visible.”
The study in the Journal of Pediatrics comes on the heels of two others that offer insights about children and coronavirus transmission. On July 30, researchers reported in JAMA Pediatrics that children younger than 5 with mild or moderate illness have much higher levels of virus in the nose, compared with older children and adults. Shortly before that, investigators in South Korea published a household study that some believed implied older children could spread the virus as readily as adults, while younger children less so. But researchers later clarified that it was unclear whether the transmission came from the older children or from contacts that they shared with other family members.

28. USA: Washington Post: The centers helping child abuse victims have seen 40,000 fewer kids amid the pandemic
Since the beginning of the coronavirus pandemic, advocates and educators have warned that the closures of schools would make it terrifyingly difficult to keep a watchful eye on children who are being abused.
Child abuse reports began to plummet across the country — not because it wasn’t happening, but because teachers, doctors and others had fewer ways of catching it. Now, a new survey of children’s advocacy centers across the country offers some of the clearest data yet on the scope of this gap in child abuse reporting.
The centers, which provide support for families and children as abuse cases move through the justice system, reported serving 40,000 fewer children nationwide between January and June of this year than the same period last year, from 192,367 children in 2019 down to 152,016 this year, a 21 percent drop, according to the National Children’s Alliance, an accrediting body for a network of 900 children’s advocacy centers.

29. USA: National Geographic: What ‘airborne coronavirus’ means, and how to protect yourself
The COVID-19 pandemic has revived a decades-old debate about how respiratory diseases travel—which affects the safety practices experts recommend.
READ THIS SENTENCE aloud: With every passing word, an expanding blast of spittle spews from your mouth—the more emphatic the speech, the greater the spray.
This mouth-made mist is the subject of a great debate about how the coronavirus hitches a ride from person to person. Virus-riddled globs can be inhaled, or even land in the eyes, potentially sparking infections in others. But for respiratory diseases like coronavirus, it’s long been thought these droplets are so large they will fall rapidly to the ground, inspiring public health recommendations such as cleaning surfaces and keeping six feet of social distance.
Other scientists, however, have become increasingly concerned that the novel coronavirus spreads through a more insidious route—as an airborne pathogen. Every sneeze, cough, spoken word, or even exhaled breath expels droplets in a continuum of sizes. The worry is whether the tiniest—called aerosols—can harbor the SARS-CoV-2 virus and allow it to linger or float across a room, causing new infections.

30. USA: Washington Post: Traveling was once social currency. Now it might get you shamed.
The pandemic has ushered in a new era of shaming. There’s mask shaming, when someone is criticized for wearing or not wearing a mask; social distance shaming, when people are criticized for being too close; even virus shaming, when someone is criticized for getting the coronavirus.
And there’s travel shaming.
Before the coronavirus, travel was social currency. We asked friends and new people we met (remember meeting new people?) where they’d been and what was on their bucket list. Travel shaming back then referred to shaming someone for not traveling enough. People shared their travel experiences proudly, like a badge of honor.

31. Africa: Nature: Africa declared free from wild polio — but vaccine-derived strains remain
No new cases of wild poliovirus have been recorded on the continent since 2016, but other types of the virus persist.
Africa is free from wild poliovirus, the World Health Organization (WHO) announced on 25 August — leaving just two countries where the virus remains endemic, Afghanistan and Pakistan.
The Africa Regional Certification Commission, an independent body responsible for overseeing the eradication of polio, has certified that all 47 countries in the WHO’s Africa Region have eradicated the virus after a long programme of vaccination and surveillance. There is no cure for the disease, which can cause irreversible paralysis and can be fatal if breathing muscles are affected, but vaccination can protect people for life.
The certification is a “historic” achievement, says Pascal Mkanda, coordinator of the polio-eradication programme at the WHO Regional Office for Africa in Brazzaville, Republic of Congo.

32. South Africa: ProfMoosa: South Africa endures coronavirus crisis as health services collapse – BBC News
Chronic failures in the health system of South Africa’s Eastern Cape have been exposed by the coronavirus pandemic. Key staff are on strike or sick with Covid-19 and there are reports of unborn babies dying in overcrowded, understaffed wards. A BBC investigation found exhausted doctors and nurses who say the province’s health system has collapsed under the strain. One doctor called it an “epic failure of a deeply corrupt system”. After initially controlling the virus South Africa is experiencing a sharp rise in infections – currently more than 10,000 new cases a day. Huw Edwards presents BBC News at Ten reporting from Andrew Harding in Port Elizabeth.

33. USA: Washington Post: Children and the virus: As schools reopen, much remains unknown about the risk to kids and the peril they pose to others
For months, parents and teachers, epidemiologists and politicians have chimed in with their views on the many still-unanswered questions about the extent to which the virus is a threat to children — and the extent to which they can fuel its spread.
A report from leading pediatric health groups found that more than 97,000 U.S. children tested positive for the coronavirus in the last two weeks of July, more than a quarter of the total number of children diagnosed nationwide since March. As of July 30, there were 338,982 cases reported in children since the dawn of the pandemic, according to data from the American Academy of Pediatrics and the Children’s Hospital Association.
Doctors are more confident that most children exposed to the virus are unlikely to have serious illness, a sentiment backed by a report published Friday by the Centers for Disease Control and Prevention that concluded children are far less likely to be hospitalized with covid-19, the illness caused by the virus, than adults. But when children do fall seriously sick, the burden of illness is borne disproportionately: That same CDC report concluded that Hispanic children are approximately eight times more likely and Black children five times more likely to be hospitalized with covid-19 than their White peers.

34. South Africa: ProfMoosa: Corruption wreaks healthcare services
As the country’s beleaguered healthcare sector battles to get a grip of the Covid-19 coronavirus epidemic and ramps up its bed and equipment capacity, corruption might be its very undoing. This is according to a new report released on Wednesday by anti-corruption and civil rights organisation, Corruption Watch, titled X-ray The Critical State of the Health Sector. The report, authored by Melusi Ncala, a researcher at the organisation, highlights almost 700 whistle-blower accounts received between 2012 and the end of last year

35. UK: Which Magazine: Loneliness is still a problem for older people as lockdown eases Social distancing measures can leave older people feeling lonely. Here’s how to avoid feeling isolated during the coronavirus crisis.

36. UK: Which Magazine: How older people can stay active during lockdown
With most older people confined to their homes during the coronavirus outbreak, we explore some simple ways for keeping active indoors

37. UK: Which Magazine: 8 ways older people can stay safer at home
The majority of people want to stay independent for as long as possible, but accidents can happen in the home. We explore the simple steps that could keep you safer in later life.

38. UK: The Lancet Psychiatry: Mixed signals about the mental health of the NHS workforce
In the past few months, media headlines regarding the mental health of the UK National Health Service (NHS) workforce during the COVID-19 pandemic have reported or predicted large-scale problems ahead—eg,”Coronavirus is whipping up a mental health storm for NHS workers, and forecasting a “tsunami” of mental health problems having “catastrophic consequences”. A 2020 systematic review of the mental health of health-care workers during previous pandemics also suggests an increase in distress and post-traumatic stress.
Anyone working in the health service at present has likely noticed another tsunami—a proliferation of surveys on health-care workers. If the generated evidence led to improved conditions and support for staff, multiple studies might be acceptable; however, concerns about the quality of some of these surveys mean that survey fatigue seems a more likely outcome.
Many studies lack explicit sample frames and appear to have very low response rates, making the representativeness of their results questionable—eg, a survey of health-care workers done in May, 2020, had a response rate of around 0·06% (868 responses from approximately 1·5 million NHS staff). Many surveys are cross-sectional, which, while potentially useful as snapshots, offer little to identify which factors might be predictive of mental health problems, and hence few possible foci for interventions. Also, we must remember that mental health questionnaires are not diagnostic. They overestimate rates of disorders when compared with gold standard structured psychiatric interviews, especially when completed by non-representative participants recruited through convenience sampling.

39. USA: Washington Post: To save education, we must fight the broader pandemic
Today, there are about 56.6 million primary and secondary school students in the United States, and about 20 million students are enrolled in colleges and universities. As the fall semester begins, they all stand at a precipice. We share the conviction of many educators, parents and public health experts that education must not be allowed to fall apart during the pandemic. But hopes are fast colliding with reality. Outbreaks at several universities suggest that schools everywhere must use extreme caution before going ahead with in-classroom schooling.
The experience of the University of North Carolina at Chapel Hill is instructive. The university, with nearly 30,000 students, started classes Aug. 10. By Monday, 177 students had been isolated after testing positive for the coronavirus and another 349 were in quarantine because of possible exposure. The university had a strict mask mandate and asked students to practice social distancing; residence halls were reduced to less than 60 percent capacity; and fewer than 30 percent of total classroom seats were filled. But, partly due to social gatherings of students, infections soared; the first week, the campus health clinic saw the test positivity rate rise from 2.8 percent to 13.6 percent.

40. USA: MEDOage Today: No Evidence That Doctor Group in Viral Video Got Near COVID Front Lines’
Who are the physicians behind America’s Frontline Doctors? The latest viral video promoting COVID-19 misinformation features a newly formed group called America’s Frontline Doctors. About 10 physicians, dressed in white coats with an embroidered America’s Frontline Doctors logo, spoke for 45 minutes in front of the Supreme Court on Monday on a range of COVID-19 talking points, from hydroxychloroquine (HCQ) being curative to the mental health effects of lockdown outweighing the toll of the virus itself.
But none of the most vocal members have practices that would place them on the actual front lines of the COVID-19 pandemic. Some don’t currently practice at all.
Two of those appearing at the Monday event are ophthalmologists, one of whom is no longer licensed.
The group’s website, which according to internet records was created on July 16, was de-activated on Tuesday (though past versions can be seen on web archives). Major social media platforms have sought to remove the video from their pages.
Late Tuesday, the group was delivering a second press conference as part of a two-day “summit.”

Best wishes to you all and stay safe
John Wynn-Jones