“When Great Britain returned control of Hong Kong to China in 1997, a condition of the transfer was that Beijing would allow the territory to maintain its own government until 2047. The Chinese Communist Party (CCP) has never liked this agreement, and the COVID-19 pandemic provided the excuse to all but erase the “one country, two systems” distinction.
The CCP began its authoritarian assimilation of Hong Kong in 2019, when Beijing encouraged CCP loyalists in Hong Kong’s legislature to pass a law allowing extradition of residents to mainland China. That proposal sparked pro-democracy protests and a police crackdown in Hong Kong, which captured the world’s attention.
In June 2020, Beijing responded to the pro-democracy movement by requiring Hong Kong to implement a national security law that “introduc[ed] ambiguously defined crimes such as separatism and collusion that can be used to stifle protest,” as The New York Times put it. But the pandemic provided Beijing with an even bigger opportunity to suppress dissent.
Citing public health concerns, Hong Kong postponed its Legislative Council (LegCo) elections for a year. In the interim, Beijing changed LegCo election rules to reduce the number of directly elected seats and to require that candidates pledge their loyalty to mainland China.
With only Beijing-aligned “patriots” on the ballot, CCP loyalists swept the 2021 LegCo elections. Many leading opposition politicians went into exile, while others were jailed. Voter turnout was a paltry 30 percent—the lowest since the handover in 1997. By comparison, a record 71 percent of registered voters cast ballots in the 2019 district council elections. The high turnout was reportedly driven by opposition to the extradition treaty, and pro-democracy candidates won 85 percent of the available seats.
The pandemic also has facilitated suppression of pro-democracy protests. Every June since 1990, residents of Hong Kong had marched and held a vigil in memory of the Tiananmen Square dead. But in 2020, Hong Kong announced that it would extend social distancing restrictions until June 5, the day after the massacre’s anniversary.
Hong Kong’s COVID-19 rules banned public meetings of more than eight people, with a potential penalty of six months in jail. As a result, only a small vigil was held. Organizers nevertheless were arrested and sentenced to up to 14 months in jail. The sentencing judge remarked that they had “belittled a genuine public health crisis.””
“More than a million Americans have died of Covid-19, and the World Health Organization estimated this Thursday that the global death toll is around 15 million — a horrifying, and largely unnecessary, tragedy.
But for all that the world has lost in the last few years, the history of infectious disease has a grim message: It could have been even worse. That appalling death toll resulted even though the coronavirus kills only about 0.7 percent of the people it infects. Imagine instead that it killed 30 percent — and that it would take centuries, instead of months, to develop a vaccine against it. And imagine that instead of being deadliest in the elderly, it was deadliest for young children.
That’s smallpox.”
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“Before modern vaccine development, humans had to get creative in slowing the spread of infectious disease. It was known that people who’d survived smallpox didn’t get sick again. In China, as early as the 15th century, healthy people deliberately breathed smallpox scabs through their noses and contracted a milder version of the disease. Between 0.5 percent and 2 percent died from such self-inoculation, but this represented a significant improvement on the 30 percent mortality rate of the disease itself.
In England, in 1796, doctor Edward Jenner demonstrated that contracting cowpox — a related but much milder virus — conferred immunity against smallpox, and shortly after that, immunization efforts began in earnest across Europe. By 1813, the US Congress passed legislation to ensure the availability of a smallpox vaccine that reduced smallpox outbreaks in the country throughout the 1800s.”
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“By 1900, smallpox was no longer quite as much of a scourge in the world’s richest countries. In the 1800s, about 1 in 13 deaths in London were caused by smallpox; by 1900, smallpox caused only about 1 percent of deaths. Several countries in Northern Europe had also declared the disease eradicated. Over the next few decades, more of Europe, and then the US and Canada, joined them.
But as long as smallpox ravaged other parts of the globe, continual vaccination was necessary to make sure it wasn’t reintroduced, and millions of people continued to die of it. Data is spotty — this is before there was any international authority on infectious disease statistics worldwide — but it is estimated that 10 to 15 million people caught smallpox annually, with 5 million dying of it, during the first half of the 20th century.
It was not until the 1950s that a truly global eradication effort began to appear within reach, thanks to new postwar international institutions. The World Health Organization (WHO), founded in 1948, led the charge and provided a framework for countries that were not always on friendly terms to collaborate on global health efforts.”
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“A 1947 outbreak in New York City, traced back to a traveler from Mexico, resulted in a frantic effort to vaccinate 6 million people in four weeks. Europe, Henderson says, repeatedly saw the virus reintroduced by travelers from Asia, with 23 distinct importations (different occasions of someone bringing smallpox into the country) in five years.
As we face down Covid-19, with effective vaccinations finally in hand, we’re encountering the same challenge that the world faced with smallpox in the 1950s: It doesn’t matter if a vaccine exists unless there also exists the international will and creativity to get it to all the people who need it, many of whom will be reluctant and skeptical.”
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“features of smallpox made it easier to eradicate than many other diseases. For one thing, it didn’t have animal reservoirs; that is, unlike diseases like Ebola, smallpox doesn’t live in animal populations that can reintroduce the disease in humans. That meant that once it was destroyed in humans, it would be gone forever. And, once a person has survived it, they are immune for life. Only one vaccine is needed for immunity in almost all cases.
Additionally, it largely doesn’t have asymptomatic transmission and has a fairly long incubation period of about a week. That made it possible for public health officials to stay on top of the disease with a strategy of “ring vaccination” — whenever a case was reported, vaccinating every single person who may have come into contact with the affected person, and ideally everyone in the community could keep the disease at bay.”
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“Humanity’s triumph over smallpox should stand out as one of our proudest moments. It called on scientists and researchers from around the world, including collaborations between rival countries in the middle of the Cold War.
Unfortunately, we’ve never replicated that success against another virus that affects humans. With some, such as polio, we’re drawing close. Wild polio has been eradicated in Africa and remains only in conflict-torn regions of Afghanistan and Pakistan. “Ring vaccination,” as practiced in the smallpox battle, has been successfully used in public health efforts against other diseases, most recently with the new Ebola vaccine, used against outbreaks in the Democratic Republic of Congo.
But in other cases, like HIV and Covid-19, we’ve let new diseases grow to pandemic proportions. And while those diseases have had devastating effects, it’s worth keeping in mind that they could have been even worse. Some viruses with the potential to escape laboratories or make the jump from animals to humans are as deadly and transmissible as smallpox, and Covid-19 has made it clear that we’re not prepared to handle them.”
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“The devastation of Covid-19 has hopefully made us aware of the work public health experts and epidemiologists do, the crucial role of worldwide coordination and disease surveillance programs (which are still underfunded), and the horrors that diseases can wreak when we can’t control them.
We have to do better. The history of the fight against smallpox proves that we’re capable of it.”
“Over 1 million Americans have now died from Covid-19. It isn’t a random group of people: one preprint paper found that working-class Americans were five times more likely to die from Covid-19 than college-educated Americans. Working-class Hispanic men had a mortality rate 27 times higher than white college-educated women. Another study analyzed Covid-19 mortality rates in over 219 million American adults and found that if racial and ethnic minorities between 25 to 64 years old had faced the same mortality rate as college-educated white Americans, there would have been 89 percent fewer deaths.”
“Critics — including researchers who study biosecurity and biosafety — argue it doesn’t really pass a cost-benefit analysis. In some ways, virus hunting is looking for a needle in a haystack — the handful of viruses that might cross over to humans amid tens of thousands that won’t — when we don’t even know how to tell needles from hay, or what to do with a needle once we identify one.
And some experts are raising another, even sharper question: What if viral discovery is not just an ineffective tactic but a terrible idea, one that might not only fail to prevent the next pandemic but potentially even make it more likely?”
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“Monitoring the interface between humans and animals for pandemic prevention has value, particularly when the programs are narrowly targeted at certain objectives: say, a focus on reducing spillover, or surveillance of potential animal infections, or studying viruses that have already spilled over into humans. Research published last month in Nature projects that global warming could drive 4,000 viruses to spread for the first time between mammals, including potentially humans and animals, by 2070, underscoring the changing threat from zoonotic spillovers.
But if the risks of virus hunting are higher than the odds of a virus crossing over into humans and sparking a pandemic naturally, then viral discovery doesn’t just look inefficient. It looks like a bad idea.”
“In the middle of a pandemic that has killed roughly 1 in every 1,020 Black Americans — a disproportionate death toll likely to worsen as coronavirus cases spike in much of the country — it’s not just lives that are being imperiled. Racial wealth gaps are worsening, and progress towards economic equity is being undone.”
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““When the pandemic translates into a disproportionate burden on low-wealth households, that is correlated with race,” says Jones. “The median wealth of white households is between 9 and 10 times as much as the median black household. And during this pandemic, the people with the lowest level of the wealth don’t have the emergency savings to hold themselves over.”
At the same time, Black and Latino workers are more likely to have “frontline” jobs that put them at heightened risk of Covid infection. For many, it’s a bind: You have less of a financial cushion to fall back on and need the work. But the job itself puts you at heightened risk of Covid infection, your health insurance is generally tied to your job, and if you lose it and catch Covid, you face potential financial ruin. Even when the pandemic ends, Jones expects that Black and Latino households will be “worse off, relative to white households, than when it began.””
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“For years, workers have had a continually eroding level of leverage in the workplace. The ways companies have redefined labor as “external contractors” basically causes more and more people to not be covered by workplace protections. During this pandemic, those people couldn’t get unemployment insurance at all. It’s indicative of a larger problem: The labor market is being reoriented in a way where workers have less and less power. One reason that’s important is that if you don’t have a lot of say, you’re going to be stuck between a rock and a hard place: forced to either not work, or to go to work under far less-than-ideal circumstances in terms of protections from Covid infection and other health problems. Do they have the right protective equipment? Do they have sick leave? Probably not.
Related to health care, we have health insurance driven by where you’re employed. During a time like this — a pandemic with acute and chronic health implications and high rates of unemployment — going in and out of access to health care is particularly devastating. In the long run, we need some form of universal health care access to offset this problem of people losing their access to health care if they lose their jobs.”
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” We found that people are sensitive to changes in their paychecks from month to month, and that’s particularly true for Black and Latinx households and households with a low level of liquid assets. What I mean by liquid assets are savings and other assets that are either cash or which can be quickly converted into cash — so your bank account, your savings account, and some investments you can quickly cash out. The households with the lowest level of liquid assets had the most vulnerability. When there were changes in their income, they had to make bigger adjustments, or adjustments that were going to be more painful. Relative to white households, Black and Latino households were more sensitive to those fluctuations, and that seems to be a result of the fact those households generally have less in terms of liquid assets, which is related to broader racial wealth gaps driven by a number of factors”
“On average, people with the coronavirus infect about two other people; most pass the virus to just one other person, or to no one else at all.
But some people go on to infect many more — often before they even get symptoms. Many of these transmission chains begin with superspreading events, where one person (usually in a crowded indoor space) passes the virus to dozens of others. Early contact tracing studies suggest these events have been a large driver of transmission around the world. By some estimates, 10 percent of people have been causing 80 percent of new infections.”
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“To understand what might kick off a superspreading event, let’s review some basics about how this virus, SARS-CoV-2, spreads. Researchers have found that it often spreads through microscopic droplets created when an infected person coughs or sneezes — or even speaks — and another person breathes them in. These disease-containing droplets are a large part of the reasoning behind staying at least 6 feet away from people and wearing a mask in public.
But scientists are finding that the virus likely also spreads through even tinier, longer-lasting particles from breathing or speaking (or flushing a toilet) called aerosols. These are so small they can linger in the air after an infectious person has left — and may contain infectious virus particles for up to three hours. And they may be a key element to superspreading events: An infected person could seed a poorly ventilated indoor space with virus without even getting physically close to all the people they end up infecting.
Superspreading also appears to be more likely with SARS-CoV-2 because people typically have the highest level of the virus in their system (making them infectious) right before they develop symptoms. (This is very different from other severe coronaviruses like SARS and MERS, where people were most infectious seven to 10 days after they started feeling sick, when they were more likely to be in isolation or in medical care.) So thousands of people with active Covid-19 infections continue to go about their lives not knowing that they could be spreading the disease.”
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“Some individuals seem to develop higher amounts of the virus in their system, upping their odds of transmitting it to others.
And given that the amount of virus in the body tends to shift over the duration of infection — rising until around the onset of symptoms, then declining — the chance that someone is a likely superspreader changes over time.”
“For years, urban planners have been singing the praises of population density.”
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“”Density is a factor in this pandemic, as it has been in previous ones,” wrote Richard Florida in the CityLab website. “The very same clustering of people that makes our great cities more innovative and productive also makes them, and us, vulnerable to infectious disease.” Some big cities have handled the crisis better than others. Some rural areas have high infection rates, too. But, as an urban studies professor, he’s distressed at big-city vulnerability.”