Thread by @ID_ethics

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden Regarding India, I first noted in July 2020 that we would eventually see bad news due to comorbidites (in the context of poverty and inequality), but that overall deaths per capita would be limited by the low population age - similar to current events

https://twitter.com/ID_ethics/status/1288287682389393408?s=20

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden It is a tragedy, in the sense of the "remorseless working" of well-understood factors underlying public health in general, e.g. poverty

India spends <$30 AUD per capita on health

Australia spends >$7000 per capita

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden Few people cared about the inequitable infectious disease burden in poor countries until it became fear pornography in the media

I have written, for example, about how deaths due to drug resistance are massively underestimated in countries like India

link.springer.com/chapter/10.100…

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden Life expectancy in India is ~69 years, and many people die with poor health for multiple reasons

Worse still, young people die of drug resistant infections and tuberculosis en masse

E.g. ~50,000 newborns of resistant sepsis per year

sciencedirect.com/science/articl…

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden In this context, I know #covid19 seems more urgent, but it remains a disease that mainly kills older members of the population (India vs. US data below, from July 2020)

medrxiv.org/content/10.110…

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden My own view is that public health should aim to maximize public health, broadly conceived and in the long term

Short term thinking often harms public health in the long term, and India has many public health issues that will outweigh #covid19 in the long term

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden I find it particularly unacceptable when commentators:

- racialise #covid19 (e.g. Indian double mutant)

- claim that poor countries are a melting pot for dangerous variants that could harm rich countries

- claim that #zerocovid was ever a realistic strategy in India

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden Despite the enormous death toll in India, the country is not even in the top 50 in terms per capita deaths

This is not to minimize the awful human consequences, but to put them in context, which is difficult when watching current news reports

statista.com/statistics/110…

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden Meanwhile, Indian children have been out of school for over a year

Child marriages have dramatically increased due to the response to #covid19

This is is a long term public health catastrophe on a massive scale

https://twitter.com/ID_ethics/status/1376374950416707584?s=20

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden I strongly support global action by rich countries to support poor countries, but not just for #COVID19 - we should focus on helping improve global public health in the long term

In my view, we should also prioritize children, who have their whole lives ahead of them

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden We should not focus on providing things like ventilators for the current crisis, which might sound like a good idea, but will achieve little benefit - among other things due to lack of staffing and resistant bacterial ventilator-associated pneumonia

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden On lack of staffing, there is an enormous "brain drain" of many (though by no means all) Indian scientists, doctors, and nurses who move to rich countries for a better life after being educated in India

This, too, is a tragedy - and by no means the fault of these individuals

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden On #covid19, if we had to pick one intervention, it would be providing vaccines to older people or those with commodities everywhere in the world - rather than vaccinating young healthy people in richer countries before older people in poorer countries

This was predictable.

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden The spread of the false and unscientific message that young healthy people face high risks due to #covid19 arguably undermined global equitable vaccine provision, especially once effectiveness in risk groups was known.

This, too, was a predictable tragedy.

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden As I mentioned earlier, India spends around 1,600 rupees (<$30) per capita on health/year

A #covid19 test often costs over 1,000 rupees

Think about what appropriate long-term health resource allocation would look like for these >1.3 billion human beings

indianexpress.com/article/india/…

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden I am done talking about India for now, suffice it to say that I think we should prioritize:

- the whole of public health > one cause of harm
- long term > short term
- children > older adults
- global mutual aid > fearmongering & xenophobia
- science > magical thinking