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COVID-19

Religion as an Impediment for Social Distancing in Bangladesh

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by Shuva Das

Thousands of Bangladeshi Muslims gather for the funeral of a popular Islamic preacher on Saturday, April 18, 2020. (Image credit: CNN)

For a few months now, countries from across the globe sustained lockdowns in various forms to slow the spread of the novel coronavirus known as the SARS-CoV-2. This development exposed a clash between some requirements of the prescribed measures for social distancing and the traditions of major religions such as Christianity, Islam, and Hinduism. In the world’s eighth-most populous country, Bangladesh, as elsewhere, the pandemic keeps the entire nation at high risk with a persistent rise of cases from 8 March 2020 onwards. In April, the United Nations issued a warning to Bangladesh, arguing that the country could face two million deaths from the fatal virus.

Yet the measures that Bangladesh adopted so far to maintain social distancing in its ongoing lockdown have remained ineffective at best. Several reasons stand out, yet chief among these are daily shopping, financial considerations, and religious commitments. In the densely populated country, daily gatherings of people effectively emasculated the social distancing measures, with crowds coming together in markets without virtually any caution. Besides, since scores of people live hand to mouth, the allegedly corrupted government system for relief distribution and the uncooperative stance of many private industries including the monumental garment sector further aggravated the poor implementation of the lockdown; and with it, the plight of the country’s citizens. Thus, people of this economic line cannot but attend to their work.

Moreover, religion also appeared as a significant hurdle and concern for social distancing measures in the majority Muslim country because of certain sensitive issues pertaining to the (observation of) religion. In this article, I will explain this particular aspect.

Islamic preachers of Bangladesh in Waz Mahfils (instructive and explanatory Islamic discussion) presented outlandish divine conspiracy theories for the outbreak of coronavirus. Their coronavirus-related speeches are widely shared sensations on social media pages of Bengali speaking people around the world. Over the eruption of the coronavirus in China, Kazi Ibrahim, a prominent Islamic preacher, claimed that an Italian Muslim resident held a heavenly conversation with the virus in his dream. According to Ibrahim, the coronavirus told the dreamer that the almighty Allah sent it as soldier to attack the Chinese for repressing and harassing the Uyghur Muslim population.

Another popular Islamic scholar Tarek Monowar told in a speech that a singer execrating Azan (prayer) has lately visited Bangladesh and performed at a stadium. Monowar then vented the coronavirus was looking for enemies of Islam to terminate them. Another cleric came up with an idea that except for adherents of Islam, the rest of the world would soon be infected by the virus. Other similarly invented tricky statements after the virus spread in Iran and also other Muslim countries including Bangladesh. Iran is supposedly paying dearly for its presumed distortion of the Islamic faith, while Muslims of other countries must not be pious enough to be saved.

Such kind of remarks by these so-called religious scholars injects blind faith among the laity and was lambasted by renowned atheist scholars like Richard Dawkin and Christopher Hitchens for long. A professor of Islamic Studies at Dhaka University, Bangladesh, said to the New Age, a national daily newspaper, those spurious speeches of the clerics ─ who, without any expertise nor knowledge about the disease gave an expert opinion on the matter ─ wrongfully represented Islam, a religion of peace and harmony.

What the Islamic pundits of Bangladesh try to establish through their lectures filled with manipulation and bigotry is to erroneously show the superiority of Islam and to increase their followers. In this regard, there is an indirectly substantial resemblance between Bangladeshi Islamic scholars and India’s Hindu nationalists belonging to Bharatiya Janata Party (BJP), the present ruling party of India. Some leaders of the BJP have prescribed cow urine and dung for the prevention and remedy of the coronavirus. Not surprisingly, cow urine drinking party was arranged by Hindu hardliners on 14 March 2020, to seek divine intervention against the scourge of the virus. Also, they boast that the traditional greeting system with “Namaste”, vegetarian eating culture, and traditional treatment of medicine (Ayurveda) of Hinduism have protected India from any epidemic.

In reality, India, however, experienced several pandemics, namely cholera, dengue fever, and malaria. Through such false, irrational narratives, the messages of Indian Hindu nationalists are generating intolerance and religious hatred among Hindus against the Muslim minority in the country. Similarly, the Muslim preachers of Bangladesh can breed the same bigotry sentiments among Muslims to the other religious groups. Such groundless statements by the Bangladeshi Islamic scholars are a looming threat to the social distancing measures of the country. Its population has a very tender mindset and they are highly gullible to religious teachings by the clerics. In so doing, social distancing measures are ignored by a vast number of Muslims, with many people prioritising their religious practices above safety measures against the virus to score more “points” in securing their ticket to Paradise.

On 18 April 2020, after defying the lockdown order of government, around 100,000 people participated in the funeral of a famous Islamic preacher in eastern Bangladesh, this against the backdrop of the ongoing outbreak in the country. The swarmed event caught the attention of the international media and rightfully drew a lot of criticism. The police could not do anything to prevent the unexpected flood of the mass. In turn, the government immediately tried to exonerate themselves by withdrawing several important police officers from the region. It is a method similarly used by the authoritarian Chinese government to uphold their positive image during a bad situation, by blaming or suspending responsible government officials.

The above-mentioned gathering was a follow-up of a recent mass prayer in Bangladesh where an estimated thirty thousand Muslims attended to seek holy intercession against the virus. Two big consecutive failures of the government to prevent the mass religious gatherings indicate not only their haplessness but a form of appeasement policy to Islamic groups. Yet it is an old pain. Every ruling government of Bangladesh maintains such a policy in order to secure Muslim votes and regime support.

In addition, though the Bangladesh Islamic Foundation, a government organisation affiliated with the Ministry of Foreign Affairs, urged people not to take prayer in mosques with more than five to ten people. This specific order has been breached in many places, even with several violent incidents. One person has recently died and several others got injured in a violent clash over who could pray at the mosque. Here, it is important to mention that general people of the country have seemingly nothing but God for their mental gratification and their battle against the pandemic.

As per Islamic instructions, if any persons including the sick could get affected by a risk of death or epidemic, it is allowed to pray at home. The Prophet Muhammad also gave clear instructions to Muslims in quarantine: ‘If you hear of an outbreak of plague in a land, do not enter it; if the plague breaks out in a place while you are in it, do not leave that place’. Islamic instructions like this ought to be reiterated by religious scholars; to prevent a massive number of people from attending a funeral, a religious gathering, or prayer places amid the epidemic.

The failure of the Bangladesh government to address religious gatherings, fanaticism, propaganda, and religious manipulation led to an ineffective implementation of social distancing measures. It was reported earlier that unchecked religious practices triggered infection considerably in some countries: in Korea by Shincheonji Church; in India by Tablighi Jamaat; in Israel by Ultra-Orthodox Communities; and so on. Bangladeshi people and its government ought to learn from these countries. The government should also counter those lockdown-disrupting clerics by legal decrees and establish a strong monitoring system to filter out any misinformation from social media. As always, it will remain true that ‘religion is for individuals while the pandemic can be for all’.

Shuva Das holds a BSS (Hons) degree in International Relations from Bangabandhu Sheikh Mujibur Rahman Science and Technology University in Gopalganj, Dhaka, Bangladesh. His articles have appeared in Synergy: The Journal of Contemporary Asian Studies and in The Oxford University Politics Blog, among others.

 

The Myth of European Solidarity in the Face of COVID-19

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by Pezhman Mohammadi

Aid material at the international airport of Hangzhou in Zhejiang, being prepared to help Italy with its outbreak of COVID-19 (Image credit: China Daily/Reuters)

With just over 1.8 million active cases at the time of writing, COVID-19 continues to wreak havoc across the globe, rapidly changing the world we once knew. Among many other things, this pandemic has exposed the lack of solidarity and coordination within the European Union (EU), putting its future at risk. This article will look into how the EU failed to assist Italy in its hour of need.

Responsible for monitoring natural and manmade disasters, the Emergency Response Coordination Centre (ERCC) is the EU’s crisis hub. It operates by forwarding any appeals for help by member states to others in order to find volunteers that are willing to assist. However, when COVID-19 broke out in Italy, calls for help by one of the EU’s most severely hit members were widely ignored. For weeks, not a single member state provided Italy with the critical supplies it needed to combat the virus. In the face of such inaction, help arrived from non-EU states: including China and Russia. The first batch of Chinese supplies arrived in Rome on March 12. It contained over thirty tons of Intensive Care Unit equipment, as well as medical and protective supplies. Just days after, Pratica di Mare, an Italian Air Force Base, received seven Russian military aircraft loaded with medical supplies to assist Italy. Even Cuba and Albania scrambled to help.

Signs of Italian discontent with the EU came into light following a survey in late March, in which only 49% of participants claimed to be ‘pro-EU’. This figure was 64% before the pandemic hit the country. The survey also concluded that 72% of participants believed the EU had failed them in this crisis, while 77% stated that they expect a rocky relationship with Brussels in the future.

The EU’s lack of assistance, however, was not merely limited to not providing essential supplies. Following a Eurogroup meeting on 9 April, it was effectively decided that economically, too, Italy was on its own. Instead of sharing the burden of the catastrophic economic effects, the EU provided a loan from the European Stability Mechanism (MSM) to Italy which is merely dedicated to coronavirus-related health care spending. As a country on the verge of an economic collapse, this was not the concession Italy had hoped for.

The shocking numbers coming out of Italy are also a direct result of the EU enforced austerity measures on the country’s economy following the 2008 financial crisis. Italy merely lacked the funds to invest in its health care system. This, coupled with the lack of support from other member states, especially the rich Northern ones who refused to agree to the so-called ‘corona-bonds’ to mitigate the economic costs of the pandemic, will have its geopolitical and strategic implications in the long run. Italy will not forget how the Chinese and the Russians came to the rescue when its allies turned their backs. Adding insult to the injury, the US’ absence from the international arena during this crisis compounded the massive void in Europe that China and Russia have successfully filled.

Undoubtedly, the EU’s future will be questioned once this pandemic is over. The fact that Germany, as the EU’s powerhouse, and other states neglected countries like Italy will have its unintended consequences. The EU was built on the premise of avoiding conflicts and economic nationalism. The negligence that was witnessed will certainly give rise to far-right nationalist and Eurosceptic factions within the EU, which will eventually leave their marks in European politics. Putting Eurosceptics aside, concerns about the future of the Bloc have been voiced by leading Europhiles such Jacques Delors who warned of a break-up. In addition, in an interview with the BBC, Giuseppe Conte, the Italian Prime Minister, issued a stark warning. Conte stated that the European leaders were ‘facing an appointment with history’. He also added that ‘if we do not seize the opportunity to put new life into the European project, the risk of failure is real.’

Pro-EU advocates have, too, concluded that Europe’s response was selfish, imprudent, and morally questionable. In his resignation letter, Mauro Ferrari, the former president of the European Research Council (ERC) observed that ‘the COVID-19 pandemic shone a merciless light on how mistaken I had been. In a time of emergency, people, and institutions, revert to their deepest nature and reveal their true character.’ Ferrari, an idealist who once supported and cherished the idea of a United Europe, was forced out of the office by the ERC’s Scientific Council as they opposed his efforts to create a coordinated science-led response to combat COVID-19.

Nonetheless, If Italy falls, it will take its friends down with it. After all, misery loves company. However, Europe’s response to Italy or Spain brings to light a much bigger, more serious issue. How would Europe respond in the face of a bigger crisis or threat? Can member states really trust one another and rely on each other’s assistance at times of major crisis? The Head of the European Commission, Ursula von der Leyen, apologised to Italy for the lack of support and solidarity - but considering the extent of the devastation caused, it is doubtful Italians will forget Europe’s cold response any time soon.

Pezhman Mohammadi studied Intelligence and International Security (MA) at King’s College London. Following graduation, he worked within the law enforcement field for over four years. Mohammadi now works in the financial industry.

Israel’s Electoral Standoff: Challenges in Securing Centre-Left Governance

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by Kevin Nolan

Prime Minister Benjamin Netanyahu, here pictured with Blue and White party leader Benny Gantz, while meeting with President Reuven Rivlin in Jerusalem, September 2019 (Image Credit: Haim Zach/GPO)

The State of Israel, even prior to the Coronavirus outbreak, was a nation in crisis. Since April 2019, the political deadlock between Benjamin Netanyahu, the incumbent Prime Minister’s centre-right Likud party and Benny Gantz’s centre-left Blue and White alliance has subjugated its citizens to three national elections. The ensuing breakdown of Gantz’s opposition alliance during unity government negotiations in March 2020 enabled short-term electoral gains for leftist politics at the potential expense of its long-term prosperity. However, irrespective of the eventual tenure of the new unity administration, struggles with policy differentiation, fragmented political structures, and growing sectarian politics linked with changing demographics ultimately pose the greatest threat to a revival of leftist governance within Israel for the foreseeable future. Nevertheless, until these barriers can be overcome a power-sharing agreement offers the most realistic opportunities for nationwide policy influence and implementation.

Lack of Differentiation

Despite the international perception that Israel’s leftist movement was experiencing a revival under the Blue and White alliance before its implosion, its leadership had aligned many of its policies, barring minor caveats, with the incumbent administration. For instance, despite its controversial coverage over the status of Jerusalem and annexation of large sections of the West Bank, both Netanyahu and Gantz have endorsed the 2020 Trump Peace plan. Even Gantz’s only major point of contention, the inclusion of Palestinian leadership into discussions, has been weakened through subsequent dialogue.

Indeed, whilst it does espouse several leftist policies, since its founding as the de facto anti-Bibi alliance, Blue and White’s core policies were almost entirely focused on ousting the Netanyahu administration from power either through the ballot box or via retrospectively binding legislation.[1] Such initiatives would involve enforcing term limits and preventing indicted politicians from serving as premier, thus disqualifying Netanyahu who currently awaits trial over allegations of corruption. Thus, despite overall having a more leftist platform than Likud, Netanyahu’s removal from office would be one of the only significant measures of differentiation imposed by a Gantz administration. As such, the emphasis on a political rather than ideological platform will likely struggle to attain broader support outside of a single-issue voter base in future elections.

A Fragmented Opposition

Fragmentation among oppositional factions threatens to impede their capability to govern as a genuine alternative to Likud in future electoral contests. Despite the limitations of a single-issue platform, Gantz was capable of attaining a broad array of support from multiple political factions, including the first endorsement of a Jewish politician from an Arab dominated party since 1992 via the Joint List. However, despite possessing a larger backing then Netanyahu to become the newest premier following the latest election, the misinterpreted strength of Gantz’s position made him incapable of translating this into a viable coalition government due to alliance factionalism.

Although the Joint List lent Blue and White their support for the preferred Premier, their anti-Zionist platform and fragile political formation prevents them from participating within any formal coalition government propagating Zionist ideals. Similarly, cultural apprehension among the Jewish factions against coalitions with Arab parties has permeated since the foundation of the state in 1948.[2] Irrespective of the accuracy of their assumptions, questions involving the ultimate loyalty of Arab parties and their lack of support of Zionism has resulted in the leaders of most Jewish factions, including Gantz, from opposing such an arrangement ever occurring. While Arab politicians have never served in any Israeli government, if the Joint List continues to remain the third-largest party in the Knesset, leftist parties will increasingly need to identify methods for overcoming these barriers in order to successfully challenge perpetual right-wing governance.

Additionally, regardless of their intentions behind doing so, the divisions generated among rival Blue and White factions following the initiation of unity government negotiations with Likud have damaged the cohesion of the opposition for the foreseeable future. National unity governments are not unprecedented within Israel, particularly during periods of national crisis. However, given that Blue and White’s platform was primarily based on ousting Netanyahu from power, the initiation of dialogue over any form of power-sharing agreement was enough to result in the formal exit of the Yesh Atid and Telem factions. Whilst Gantz has continued to keep the Blue and White name for his sole remaining political faction, Israel Resilience, the capitulation of the broader alliance may make it increasingly difficult for the opposition to reunify once the tenure of the unity government lapses.

Long-term Demographic Struggles

In addition to these immediate obstacles to securing governance, long-term demographic changes are likely to increasingly marginalise the capability of centre-left parties from beating right-wing blocs in elections within the next half-century. Historically, the vast majority of citizenry have voted for parties which represent their religious or cultural beliefs, irrespective of the benefits, economic or otherwise, which may be better offered by rival factions.[3] For instance, the nation’s fastest-growing Jewish demographic, the religiously hard-line ultra-orthodox sect, are predicted to nearly double from thirteen to twenty-seven percent of the total population by 2059. Within this constituency voting patterns overwhelmingly align with their particular ethnicity, with those of Sephardic origin generally endorsing the Shah party, whilst those of Ashkenazi descent tending to favour United Torah Judaism. These allegiances transcend basis cost-benefit analyses since centre-left policies generally offer better subsidy packages for the ultra-orthodox, among whom nearly forty percent continue to live below the poverty line.

Similarly, nearly ninety percent of Arab-Israeli’s votes go to the Joint-List, despite its four factions, Hadash, Ta’al, United Arab List and Balad representing a large cross-section of differing ideologies, from socialism to Pan-Arabism. Yet while its population is also set to markedly increase from fifteen to twenty percent of the total population, unless the aforementioned tensions between Jewish and Arab political parties can be resolved they will remain outside the corridors of power indefinitely. Consequently, given the sectarian nature of a large part of Israel’s electorate, the rapid growth of the predominately right-wing Haredi threatens to increasingly undermine the long-term prospects of leftist parties securing governance throughout the next half-century, regardless of the policies which they propose.

Silver Lining

The centre-left has a long way to go before they will be able to reconcile the variety of challenges standing in its way of wresting control from Likud. Nonetheless, the current unity administration presently offers the greatest opportunity for leftist ideals to influence national policies. Despite the division of influence varying widely in prior scenarios, Gantz has successfully attained control over the influential Defence and Justice ministries, while temporarily delaying annexation plans within the West Bank. Consequently, despite the challenges which the centre-left will face in future elections, so long as the current unity arrangement is maintained in a fair and proportionate manner, leftist politics will remain capable of exercising some form of influence on federal policies within the current Likud administration.

[1] Kaḥol Lavan. 2019. “Blue And White 2019 Platform”. https://en.idi.org.il/media/12312/%D7%9B%D7%97%D7%95%D7%9C-%D7%9C%D7%91%D7%9F-%D7%9E%D7%A6%D7%A2.pdf.

[2] Tessler, Mark. 2019. “Israel’S Arabs And The Palestinian Problem (1977)”. Religious Minorities In Non-Secular Middle Eastern And North African States, 325-344. doi:10.1007/978-3-030-19843-5_12.

[3] Mathie, Nicola. 2016. “‘Jewish Sectarianism’ And The State Of Israel”. Global Discourse 6 (4): 601-629. doi:10.1080/23269995.2016.1259284.

Kevin is a MA student in Conflict, Security and Development within the Department of War Studies at King’s College London. A Series Editor for Strife, his research interests are primarily focused on the Indo-Pacific region, State building within post-conflict zones, and combating technological challenges to regional security concerns. Additionally, serving as King’s mature student officer, he is a strong advocate for exploring the correlation between the psychological impact of mental health degradation on academic well-being. Readers who identify as mature students and experience difficulties relating to any aspect of university life are encouraged to contact him at [email protected]

 

 

War’s Invisible Killer: We Must Not Forget Populations Affected by Conflict during COVID-19

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by Charlotte Hooker

A Syrian boy poses for a picture during an awareness workshop on coronavirus at a camp for displaced people in Atme town in Syria’s northwestern Idlib province (Image Credit: Aaref Watad/AFP)

 

Governments across the globe are acting on the informed assumption that deaths related to COVID-19 will rise so long as the number of cases exceeds the capacity of domestic healthcare services. The necessary response is compulsory social isolation and strict hygiene measures. In China, Europe, and the US, public places have been closed, mass gatherings banned, and public awareness campaigns have been initiated to offer guidance on how to wash one’s hands effectively. But in war-torn countries, where governments and healthcare systems have collapsed, running water is scarce, and soap is an unaffordable luxury, these measures are near impossible to implement. COVID-19, just like the countless diseases before it, will “ruthlessly exploit the conditions created by war.” Without a collective global response that accounts for the needs of conflict states and its displaced populations, the consequences of COVID-19 could be catastrophic.

The connection between war and disease is well documented in history. Before the 20th Century, combatants were more likely to die from disease than they were from battle wounds. In the Crimean War, for example, British soldiers died from sickness almost eight times more than they did from conflict-induced injuries (Pennington, 2019). As medicine advanced and basic hygiene practices improved, the emergence and spread of infectious disease amongst combatants was curbed considerably. However, this did little to contain the influenza pandemic of 1918–1919. The pandemic coincided with the mass migration of soldiers back to their home countries and resulted in the death of between 20 million–100 million people worldwide. This highlighted the burden that war placed on the health of civilian populations, which has only worsened as densely populated urban settings have become the primary hosts of major hostilities (Haraoui, 2018).

In Syria, healthcare services became an integrated part of the conflict. Between 2011 and 2014 alone, 57% of public hospitals were damaged and 160 doctors were jailed or killed. Vaccination coverage fell from 91% in 2010 to 45% in 2013 contributing to the re-emergence of polio, measles, and cutaneous leishmaniasis in Syria and neighbouring countries, particularly amongst displaced populations. COVID-19 presents the greatest threat to these people.

According to the UN High Commission on Refugees, there are currently 70.8 million forcibly displaced people worldwide, most of whom live in deplorable living conditions. On the Greek island of Lesbos, the Moria refugee camp “has one water point for every 1,300 people and one toilet for every 200 people,” says Apostolos Veizis, Director of Medical Operational Unit at Doctors Beyond Borders for Greece. In Idlib, refugee camps in north-western Syria, there are 1.4 doctors per 10,000 people, only 100 adult ventilators and fewer than 200 intensive care unit beds. Fatima Um Ali, a Syrian refugee, and her family have avoided death on multiple occasions since fleeing the Syrian conflict, “but what now,” she says, “we are going to be afraid of [COVID-19].” Without running water and soap, and no chance of isolating her family of 16 in the crowded settlements of Idlib, it will be difficult for Fatima’s family to dodge death once more.

Displaced populations are often dependent upon humanitarian assistance for survival. This is because healthcare services in conflict zones have long since collapsed, and any remaining government regime usually lacks funds or geographic reach to mobilise the necessary health, food, or economic resources. Bangladesh, for example, relies upon youth activists to educate Rohingya refugees from Myanmar on the importance of proper hygiene. Even in camps that are better off, conditions are ripe for COVID-19 to run rampant. According to Muriel Tschopp, Jordan Country Director at the Norwegian Refugee Council, the quasi-lockdown in Jordan in response to COVID-19 has grounded all Non-Governmental Organizations (NGOs), preventing them from providing daily service assistance, and reducing cash opportunities for refugees as local organisations are forced to halt business.

That is not to say that action has stopped entirely. In a recent interview, Muriel Tschopp explains that they have been using existing mechanisms, such as their database of refugee contact details, to contact those living in temporary settlements to provide guidance on how to limit the spread of disease. Similar action has to be taken by other NGOs. Doctors Beyond Borders representatives explain that they have been working with displaced peoples living in the camps to ensure the populations have access to information that will prevent disease spread and reduce panic. But this is not enough.

What is required is an international commitment to the protection of basic needs and care of conflict-affected populations. In a virtual press conference on March 23, 2020, the UN Secretary-General António Guterres called for “an immediate global ceasefire in all corners of the world.” Warring parties in some states, including Yemen and Cameroon, have agreed to the ceasefire in order to allow focus on the fight against COVID-19. This is a good start. Now, states across the world must mobilise funds to support the provision of basic resources such as water sanitation systems, hygiene kits, and food over the coming months, with immediate effect—if there is one lesson the world can learn from the 1918 flu, it is that early and sustained action saves lives.

Some believe that it is the duty of the government to prioritise its own citizens. The Trump Administration is proposing a USD$3 billion cut in funding for global health programmes, including halving its funding for the World Health Organisation who currently leads the fight against COVID-19. But if we turn our focus inward, and let fear be used as ammunition to stigmatise those who are not ‘one of us,’ we will have failed the test of humanity. A failure to address the basic needs of conflict-affected populations will mean thousands of needless deaths and this will not be contained to displaced populations. Disease knows no borders, so the only way to prevent the spread across temporary settlements, neighbouring states, and beyond is to ensure universal preparedness. A collective global response that accounts for all human life is crucial in the fight against COVID-19. The world has come together in the past to fight common evils. We can do it again.

Charlotte is studying for a MA in International Relations at the Department of War Studies, King’s College London. Prior to postgraduate study, Charlotte studied Politics and Economics BSc at the University of Southampton where she was awarded the highest dissertation mark in the discipline. During her undergraduate studies, she completed a Year in Employment at Ofgem, supporting work on domestic energy policy. Her research interests include space security, cybersecurity, energy security and the role of industry in the fight against climate change, and the international political economy and security implications of a rising China.

UK Government Policy in Facing the Coronavirus Threat: An Interview with Professor Calum Semple

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by Timothy Moots

As we are all acutely aware, on 24 March 2020 the Prime Minister announced restricted movement on the UK population to prevent the spread of the coronavirus. As students of war, we have much to learn from observing how governments respond to the pandemic. Like on the battlefield, public health officials today are grappling with how they defeat this potent adversary. Last week I was fortunate enough to get insights into the processes that helped develop UK strategy leading to the situation we are in today in an interview with a world expert on pandemics who is leading research into the battle against the coronavirus.

The expert I sat down with is Professor Calum Semple, Professor of Child Health and Outbreak Medicine at the University of Liverpool, and a member of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) to discuss his role in outbreak medicine, the coronavirus outbreak, and UK Government strategy.

TJM: What is your role in dealing with the coronavirus?

CS: I am the Chief Investigator on a study called Pandemic Influenza Community Assessment Tools, which is the process of getting data to validate triage tools in the community. I am also the Chief Investigator on the Clinical Characterisation Protocol, which is a much larger research project. It is a very different type of research as it feeds information into various government departments and agencies. It is not research conducted for a paper in six month’s time, rather Urgent Public Health Research is delivered now to inform policy decisions tomorrow.

This involves working out your data collection tools in advance and so when the outbreak happens the nurses and medics can collect information when it comes to the hospital, pass it back to the research team, update to data entry systems, and have an analysis which in an automatic fashion presents it to a dashboard for policymakers. This data can include anything from the length of stay of a patient in hospital to the proportion of patients under the age of 18. Upon uploaded by a nurse say in Devon, policymakers can get this data within 30 minutes allowing quick decisions made in real-time. This has never been done before. I am also a member of NERVTAG, an advisory group set up to advise the government on new and emerging respiratory viruses.

TJM: How did you come to specialise in outbreak medicine?

CS: The very first outbreak I was involved with was the HIV epidemic in the 1980s. This was during my PhD which was researching HIV. The outbreak evolved while I was working on the thesis, and this was my first experience of research taking a U-turn, which resulted in diverting resources and activity to focus on the pressing question at the current moment. This question was the need to identify a surrogate marker of drug efficacy and a surrogate marker of progression of the disease. This led to my PhD focusing on the development of quantitative viral load, which we patented and were the first people to publish on this. Today quantitative PCR for viral load is the most commonly used way of measuring disease progression and drug efficacy of HIV in the world.

The next outbreak was the Respiratory Syncytial Virus (RSV), which is a very regular and predictable outbreak every winter. However, I moved into influenza, where there was greater scope for public policy and public impact. Working as a government advisor on influenza and running multiple research projects, I learnt a lot about working in outbreak situations. It is no surprise that a lot of those involved had worked alongside or in the military. It provided better discipline in focusing not so much on the interesting science, but in an outbreak scenario what is the question that needs to be answered over the next two-three weeks which will change decisions about how we manage patients and implement policy decisions.

This brings me to the 2009 H1N1 outbreak, which caused a lot of frustration in that we could not get our studies running as fast as we wanted. So, a group of us set up the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). Our mantra was to prepare for the next outbreak. This was done by producing the counter-studies you would want to run in an outbreak situation, which turns out to be quite a shortlist. Here you may want to run a clinical characterisation study (the who; what; where; when; and why), a drug trial, a vaccine study, a study on triage. We designed protocols for studies that didn’t name a particular pathogen, as it didn’t matter what the pathogen was, but it did contain sampling schedules, data schedules, and from this we developed the protocols. From here we took it to the World Health Organisation (WHO), which was subsequently taken on by them, as it would enable rapid research for a fast-developing outbreak.

This meant that when the Ebola outbreak came, we were able to conduct the research in West Africa in a matter of weeks and this totally changed the paradigm. The same group was more than ready to set up the research during the coronavirus outbreak. As soon as we got wind that cases were likely to come to Britain, research protocols were activated to gather data and process the first admissions in the UK.

TJM: You previously worked on the Ebola epidemic. What made the Ebola so unique in its transmissibility?

CS: Regarding transmission, what happened in West Africa was part of a burial ritual called “laying out”. Once you would die, your friends and relatives would wash you down, dress you up, put you in a coffin and have a ceremony. It actually was still going on in Britain as recent as 30-40 years ago, and it is still a tradition in isolated parts of Europe where there are not enough undertakers to deal with the dead. In West Africa they take this very seriously.

But what complicated this in West Africa is the “secret society culture”. This is much more than the Masons in the UK. These societies are very important in where you go to school to getting your job and promotions at work. Often you will find that departments in organisations have a large number of members that are part of one secret society, whereas hospitals may have large numbers of members from other secret societies. Members of a secret society, who are typically your peers, will be involved in laying your body out. They will wash you down very carefully, with great care, love, and attention, and it is a very important part of the grieving process.

However, the exposure to the human body fluids meant that everyone who was involved in laying out the body was exposed to catching Ebola. What complicated things is if you were very important you might have over 200-300 people attend outside your house wanting to be involved in the process. The body fluids that had been washed down would be taken outside and distributed amongst the people – some people would dip their fingers in it, others would have it sprayed in faces – and this was a part of associating themselves with the deceased and their spirits. One example is we have one healer who died and at their funeral around 360 people contracted the virus from direct exposure to the body fluids. It was not limited to burial rituals, however. Other examples include in the hospital where you can catch it from a woman giving birth or someone vomiting. The virus spread very quickly and hit very hard.

TJM: What is the difference between the coronavirus and Ebola?

CS: Well Ebola is what we call a viral haemorrhagic fever. This is because the virus gives you a fever and it can make you bleed. But bleeding isn’t the most common symptom, it is actually vomiting and diarrhoea. Ebola can spread from blood, sweat, tears, diarrhoea, and lots of different body fluids. It does not have a clear respiratory spread and people don’t tend to cough and sneeze the virus up. For Ebola its actually profuse production of body fluids where the virus is and where it is coming from. Ebola is actually relatively easy to contain. Once you have identified someone who has been sick you can isolate and prevent contact.

Whereas with the coronavirus you cough, sneeze, and splutter. You do this for possibly 5-7 days before you take yourself out of society because you are feeling unwell or because you are recovering. People infected with coronavirus can walk around for 7 days incubating the virus and then have another 5 days where they have what is called a prodrome (an early symptom indicating the onset of a disease) and during that time remain active in the community spreading the virus, but not so sick that they take themselves to bed or get admitted to hospital. This makes the virus far more transmissible in a community. The virus survives on surfaces, in the house, outside. In dry air it survives for around fifteen minutes. Then people touch the surfaces, then touch their mouths, pick their noses, scratch their eyes. We all do this about twenty times an hour. This brings the virus to the respiratory tract where again it is perfectly suited to taking hold. It’s a very different virus to Ebola. And the transmissibility of corona is far greater than that of Ebola.

TJM: What have we learnt from military command and control structure that can be applied to Corona?

CS: A lot was learned from how the British Army and Relief Agencies interacted with society in Sierra Leone. The sort of planning instigated by the military created a very clear line of what needs to be delivered and what needs to be changed within the community, and it was absolutely critical to delivering rapid research and achieving rapid outcomes. It’s a very different method of patient management. You’re not just thinking about the individual patient – the individual patient is very important – what you’re thinking about is the message you are sending out in managing these patients. Do your messages encourage people in the community to come forward and seek appropriate healthcare, or will it encourage people to avoid the appropriate healthcare and seek traditional healers and ministries?

This is very much the same way in how you engage with the British public and pressing upon them the importance now of not going to the pub and staying at home. Because the reality is staying at home will saves lives. An issue is people thinking that the coronavirus does not affect them, and don’t immediately understand that going out and socialising will mean the virus will spread and people will die. This is because there will be fewer people around to care for people with other diseases. Car crashes, heart attacks, difficult pregnancies still happen. The reality is an overwhelming impact on health resources and general population health means that the doctors and nurses don’t have the scope to care for everyone they want to. This is just part of the medical aspect. If the approach was not taken you may end up with societal effects that have far greater secondary impact then we could have predicted and could have far more reaching impact than the health impact.

TJM: Is the UK really taking a different approach to other countries? If so why?

CS: The UK certainly did take a different approach in the lead up to the shutdown. I am quite pleased that we did not go for a kneejerk shutdown in the 3-4 weeks before we did. That period allowed a degree of calmness and preparation to go on at a very important stage. Where otherwise we could have had a huge, essentially, “phony war”. There was a phony war during the 2009 outbreak, where we saw a spike in GP attendances and health-seeking behaviour that arrived 3-4 weeks before the real flu arrived. This overwhelmed GPs who were prevented from doing their regular work and providing standard healthcare for those who needed it. The way the government policy managed information and society this time was far more sophisticated and prevented a phony war.

The careful considered management by the Chief Medical Officer (CMO) Professor Chris and Chief Scientific Officer (CSO) Sir Patrick Vallance in the month leading up to the lockdown prevented the excessive health-seeking behaviour that could have caused an earlier overwhelming of GPs and A&E practitioners.

TJM: Do you think the government has done a good job so far?

CS: I think the government has done a good job in cautiously and systematically raising fear in a controlled manner, and this can be seen from the very careful messaging from the CMO and CSO. You can work this out from the press conferences and news clips, which were deliberately telling people about the severity of the crisis. It was realistic and conducted sensibly.

This approach got people to start stocking up – and yes some people were panic buying – but most people stocked up. Over the last 3 weeks of stocking up to the situation we are in now, it has made the lockdown a lot more manageable. Most people have filled their larders, and no one can say they weren’t warned about it. Supermarkets have been warned in advance and are able to cope with the disruptions in demand.

Think about how you manage and keep an army in readiness. There is a level of preparation, training, regular exercises to keep the army in readiness. Equipment, which is not used is checked, serviced to ensure it actually works. And this is the same for us. We have a stockpile of medication and a stockpile of masks, the equivalent to the beans and bullets in the depots.

TJM: Is “herd immunity” Government policy?

CS: It was never policy. It was an assumption by lots of speculators from the side-lines. I never saw a concept that we are going for herd immunity – this is not the case. The terminology used by Prime Minister Boris Johnson was “flattening the sombrero”. It sounds rather crude, but it is not a bad way of explaining how you flatten an epidemic curve. It is unavoidable that we will get exposure. But what is going to cause greater societal disruption is a sharp spike in epidemic activity that will overwhelm services. And this is not just about health services but also national services. [The minutes of NERVTAG are publicly available.]

TJM: Were we really unprepared by not investing in ventilators?

CS: At what point in the last 100 years would you have predicted the global healthcare systems would have needed an extra X amount of ventilators? Even if you wanted to buy an extra hundred, rather than the 10,000 quoted in the press, it would have been impossible to predict this. Ventilators are not household items like microwaves, they are not made in mass in a factory, and nor are we able to go out and shop for them on the market. They are complicated sets of equipment that are bought on a well-resourced planned renewal project. At the same time, there is no way that any advisor to a government would say let us keep X amount of excessive numbers of ventilators in a warehouse, requiring them to be switched on every several months to check they work, service them, and replace parts. It is far beyond any policymaker’s capability to do that.

However, the irony to that is, that it would have been in our interests to do it with the economic effect on businesses over the next few months. If I was a politician, I would not have had warehouses with ventilators. But what we do have, are warehouses stocked with PPE, anti-biotics, anti-virals, which are essential and can be maintained.

TJM: What about PPE?

CS: Local supply issues. There are different types of PPE. Now the PPE you have for the higher risk procedure is different to the PPE for standard procedures. Human nature is to grab the one considered to give the highest level of protection regardless of whether you need that or not. Infections do not work that way. If you are not treating a patient needing to have their lungs washed out, or a tube put down their throat with your face twenty cm away from their mouth while doing it, then you do not need the protection offered by an FFP3 respirator with face shield. If you are doing simple straight forward care you will be fine with a face shield and standard mask.

But that’s not what people do they tend to grab respirator because they perceive it for greater protection. You don’t need a bulletproof vest to go down to the shops, you only need the bulletproof vest if bullets are flying. You only need the FFP3 masks for aerosol-generating procedures, where one gets up close and personal to the aerosols. But people pick these masks thinking it gives them greater protection. But it’s not, it is simply preventing someone who needs that mask from having it. We have kept a huge number of FFP3 masks in reserve for years, but at the current rate, they are being consumed too quickly as people are using them inappropriately. And this is a difficult message to get across.

There may be local supply cases, but the idea we are somehow negligent is very different. Junior doctors have been very good at communicating these shortfalls using the various social media tools to share this. At most places, we do have the equipment but it needs to be used appropriately. The right level of PPE needs to be used for the right circumstances.

TJM: In your experience, what kinds of communications are most effective when engaging populations and getting them to do things – rational or emotive?

CS: Are all people the same? Some people are young, some people are old, some work on emotion prompts, some people work on facts. The biggest mistake is that one communication strategy will work. Instead, what you need is a blend – everything from the Twitterati to the Radio 4 audience. Some people don’t listen to the radio, they rely on social media like Facebook and other sources. I think that clever messaging is blended. A lot of people like the CMO Professor Whitty, as he is seen as the nation’s doctor. But at the same time, he is not going to be everyone’s cup of tea. He may be seen as a “pale male”. Is he going to engage a young ethnic minority male in a deprived inner-city London? Will he reach out to a single mother in Birkenhead?

The way you reach out to these parts of the population is through using a mix of social influences, various magazines, and social media apps like Instagram. This is a very different messaging style to what the Radio 4 generation is used to. The government needs to learn more sophisticated communication strategies that are involving social influencers to make sure its message is being read by all corners of the population. In my personal opinion there is a big scope for improvement. Public health messaging has to change, especially to adapt to this.

TJM: Finally, how can governments prepare themselves for pandemics?

CS: Set up advisory groups like the New and Emerging Respiratory Virus Threats Advisory Group. The reason it is called that is that it does exactly what is say on the tin, advises on new and emerging respiratory virus threats. The group is tasked with questions such as what is coming, and if it is coming what it might look like, and how can we prepare. And it is exactly what we did.

Professor Calum Semple, Professor of Child Health and Outbreak Medicine at the University of Liverpool, and a member of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG)

Timothy Moots is a Senior Editor at Strife and a PhD Candidate at the Department of War Studies, King’s College London.