Water, Women & Wisdom

1. WATER: Children carrying a water container in Jowhar, Somalia (photo UN/Tobin Jones)

2. WOMEN: Women from all over Côte d'Ivoire gather to celebrate International Women's Day at the Palais de la Culture in Abidjan (UN Photo/Ky Chung)

3. WISDOM: “The 70% Solution”

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Halo/Hola/Salama/Bonjour/Hello GHAP Partner Leader,

1. Water: Over 70% of the Earth is covered with Water

Despite this, 1 out of 3 people lack safe drinking water and 3 out of 5 lack safe sanitation (WHO). We need water to live.

This month we recognize World Water Day on March 22. In order to accelerate efforts towards meeting water-related challenges, the United Nations General Assembly declared 2018-2028 as the International Decade for Action “Water for Sustainable Development”.

A core focus of World Water Day is to support the achievement of Sustainable Development Goal 6: water and sanitation for all by 2030.

Because Hand hygiene is essential to containing the spread of COVID-19, as well as other infectious diseases, we use water and soap - or a 70%solution of isopropyl alcohol

2. Women: Over 70% of healthcare workers are Women

Women play a disproportionate role in responding to the virus, including as frontline healthcare workers and careers at home. Women’s unpaid care work has increased significantly as a result of school closures and the increased needs of older people. Women are also harder hit by the economic impacts of COVID-19, as they disproportionately work in insecure and informal labor markets, which puts them at greater risk of falling into poverty.

The pandemic has also led to a steep increase in violence against women and girls. This “shadow pandemic” is highlighted in this 1 minute UN video https://youtu.be/llNP__bW-o0

This month, we celebrate International Women's Day (IWD) on March 8. IWD is a day dedicated to honoring the achievements of women throughout history and all across the globe and also marks a call to action for accelerating women's equality as described in SDG 5 Gender Equality: "Achieve gender equality and empower all women and girls." The 2021 theme is “Women in leadership: Achieving an equal future in a COVID-19 world.”

Growing up with 7 sisters (and 2 brothers), working in healthcare for over three decades, and partnering with my bride to raise three daughters (and 1 son) have disproportionately shaped my perspective on this topic.

3. Wisdom: “The 70% solution”

The Bad News: COVID-19 won’t go away.

In a survey last month published in Nature of over 100 immunologists, infectious-disease researchers and virologists working on the coronavirus, 9 out of 10 believe the SARSCoV-2 virus will continue to circulate in most local populations, i.e., it will become endemic like the seasonal flu https://www.nature.com/articles/d41586-021-00396-2

Unlike the smallpox variola virus which was eradicated in 1980 (~180 years after Jenner came up with a vaccine), the SARSCoV-2 virus is a zoonoticinfection, meaning it resides in animal reservoirs and cannot be eradicated.

The Good News: COVID-19 can be managed.

Globally, seasonal flu still claims roughly 650,000 lives per year. The influenza A virus, which originated in birds, killed between 50-100 million people in the 1918 flu pandemic. Descendants of this virus have changed rapidly (faster than it appears that SARSCoV-2 is evolving) to evade our immune system’s defenses, which is why flu vaccines need to be reformulated each year.

To be clear: about 14 times as many people in the U.S. died in 2020 to COVID-19 vs the average annual deaths over the past decade for the seasonal flu. But scientists say that when herd immunity is reached (by natural infections and vaccinations), then COVID-19 infections can NOT be reduced to zero, but CAN be reduced to a manageable level. Just as the flu no longer brings life to a halt, it is believed that going to school, visiting friends, eating in restaurants and air travel can happen when COVID-19 is managed well. “Managed well” includes reaching herd immunity.

Science says that at least 70%* of people need vaccination to reach herd immunity

* (this percentage is dependent on many factors, including the speed of virus mutation and use of other measures such as mask-wearing).

Lessons for Global Health Leaders:

I was on a conference this week where officials echoed their government’s hesitancy to vaccinate because, citing the virus variants, they weren’t sure which strain to vaccinate against.

The United States Marine Corps teaches its young leaders about making decisions with imperfect information when time is critical.

“The 70% solution” reflects the notion that, in environments where conditions can change quickly, “fast is better than perfect.” As a colonel explains, "If you strive for low uncertainty, you'll have a longer decision-making process that is more likely to be driven to big, win-or-lose decisions. Small, frequent, rapid decisions will save you from having to come up with a big decision at the 11th hour." Contrary to appearance, the 70%solution is the opposite of a “shoot from the hip” approach and is actually a risk reduction strategy. Ironically, waiting for perfect (100%) information, resources and confidence is typically a much riskier path than making more manageable decisions with sufficient (70%) information.

When one waits to have (the illusion of) 100% certainty, then leadership is not needed as there really is no decision to make - it is formulaic. But is that reality?

Leaders define, and help others confront, reality.

As Global Health Leaders, we recognize that life and COVID-19 are dynamic and we cannot eliminate risk. But we CAN take steps now to help prevent, communicate and manage that risk.

Asante/Gracias/Misaotra/Merci/Thank you for being proactive in managing health risks for your communities!

Sincerely,

- Rob

Update on The Race between COVID-19 and Vaccine Administration

WATCH: Brazil variant rampage – on March 2, Brazil recorded the highest single-day death toll of the COVID-19 pandemic and the spread of a more contagious coronavirus variant that may cause reinfection.

Globally, according to Bloomberg Vaccine Tracker on March 2., 2021 (FYI - Brazil still has not published any national vaccine data):

• Doses: 265 Million doses of vaccine for COVID-19 have been given; doses/day = 6.14 million (about 50% higher than last month)

• Countries: in 108 countries (about one-half of all countries, up from 1/3 last month); countries with the highest doses per 100 population include Israel (~91), Seychelles (~83), UAE (~57), Maldives (~33), UK (~32), U.S. (~24) (these are total doses - recall that currently 2 doses are required per person)

• Time to “Community Immunity” (~75% of the population): At this current daily rate, it would take 7 months to reach “Herd Immunity” in the U.S. (favorable from 11 last month); however, it would take 5 years to reach global herd immunity at the current per day rate (favorable from 7 years at the rate last month).

• Vaccines: seven vaccines are available to the public globally; three are approved by the U.S FDA (J&J single dose vaccine just approved since last month); and 66 more are in clinical trials testing (2 are believed to be nearing FDA approval).

As of 2 March, the global COVID-19 infection reported count is still increasing but at a slower rate:

• Nearly 115M cases – an increase of 11% since last month’s email; the U.S., India, Brazil, Russia and the U.K. account for over one-half; and

• Over 2.55M deaths – an increase of 12% since last month’s email; the U.S., Brazil, Mexico, India, and the U.K. account for nearly one-half

The biggest factor that would drive SARS CoV-2 circulation in people if it became endemic?

More than 70% of the researchers surveyed by Nature think that immune escape (a term for when the immune system is unable to respond to an infectious agent) will be the top driver of the virus’s continuing circulation.

Robert P. Thames, FACHE, FHFMA

Director, Global Health Administration Partners (GHAP)

GLOBAL HEALTH MINISTRIES

“HELPING THE HANDS THAT HEAL”