Lives v livelihoods: Africa’s covid-19 tradeoffs

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Hello and welcome to the Intelligence on Economist Radio. I'm your host Jason Palmer. Every weekday we provide a fresh perspective on the events shaping your world. An intriguing pattern has been spotted among the most severe cases of COVID 19. There aren't as many smokers as you'd expect to see. Something in tobacco smoke may be providing protection and studies into that just might lead to treatments. And tonight would have been the annual gathering of a Listers at New York's Metropolitan Museum of Art. The Met Gala's postponement allows time to reflect on the museum's history, its troubled finances, and whether it serves all art lovers equally. First up, though, over the past week, Nigeria has seen a sharp rise in coronavirus infections. Nevertheless, today Africa's biggest economy will start lifting some of the strict lockdown measures put in place. A month ago, President Muhammadu Buhari said that while the country's shutdown had been effective at containing the spread, it's come with a heavy economic cost.

No country can afford the full impact.

Of a sustained lockdown while awaiting the development of vaccines.

Many African leaders face trade offs that differ from those governing policies elsewhere, determining whether flattening the curve flattens economies in a way that's more harmful even than the pandemic.

Nigeria is quite complicated.

Jonathan Rosenthal is our Africa editor.

When it first went into its COVID lockdowns. It only imposed it on two of the major cities and those were Lagos, which is this bustling commercial capital on the coast of about 21 million people, and then on the political capital, Abuja, which is where all the politicians are. It's a bit of a mixed picture in that it is now beginning to ease some restrictions on those two big cities, but is finding unexplained deaths in other parts of the country, in particular some northern cities. Kano is one of the main former industrial heartlands of Nigeria.

And.

And there've been a lot of unexplained cases there, or at least a lot of unexplained deaths that are not necessarily being tested for Covid or showing up for Covid. And the government at the same time is easing in the south, in the centre, is having to tighten restrictions up in the north.

So this is a bit of a confusing picture in that this is not a national lifting of lockdown. It's sort of piecemeal. Numbers seem to be going up in some places, but down in others, and indeed lock Lagos as the big city with the lowest numbers remains a confusing case.

What this tells us is simply that there are not enough tests being done, that the data are just not there to be making any kind of broad policy decisions for the country as a whole or even for its biggest cities. The number of deaths in Nigeria, and that's recorded deaths, before we even get into these unexplained ones, the recorded confirmed COVID deaths at the moment are doubling roughly every five days. So if you look at where Nigeria is compared with sort of elsewhere on the curve, other countries, at least it is still in that rapidly increasing part of the curve. And yet at the same time, the government is saying that it's had a relatively low number of deaths. The number is currently at 87 and a relatively low number of confirmed infections below 3,000. But what it is also saying is that it has done fewer than 20,000 tests. So if you just look at those two numbers, 20,000 tests, close to 3,000 confirmed cases. That's a pretty high percentage of tests to confirmed cases. And it seems quite risky right now to be lifting restrictions based on those numbers.

And so why do it then? Why not try to continue with lockdowns until at least the testing numbers get up to scratch?

I think the question here is there are two issues. The one is just that rich and developed countries with advanced medical systems, you can talk about flattening the curve in such a way that your health System has capacity, but in a place like Nigeria, you rarely have to crush that curve to get it down to the small number of intensive care beds. And the second issue is that Nigeria is facing a very deep economic crisis right now. Its main and almost only export is oil, and the price of that has collapsed. The virtually only source of government revenue is also oil. So you've got a government that is going bankrupt and you then have millions of people in the north of the country who rely on food assistance. So to shut down that economy and sort of say, well, people just need to stay at home for several weeks and not be earning income and not have the social safety nets to support them is really untenable. And we've already seen social unrest happening in Nigeria in the early days of the lockdown. More people died in Nigeria because they were killed by the police enforcing the lockdown than were dying of the disease. And we're seeing sort of riots and looting of food trucks trying to deliver food that are being stopped and looted because people really are on the edge of starvation.

And Nigeria isn't the only populous country in Africa that is easing its restrictions. South Africa doing the same thing, perhaps to outside eyes a little early in the game. I mean, how would you compare those two examples?

South Africa is beginning to ease up. It's going from what was one of the strictest lockdowns almost anywhere to an incremental easing. And I guess where South Africa differs certainly from Nigeria, but many other parts of Africa is it has been successful in getting out and doing very large numbers of tests. And it's been doing those tests in quite an innovative way. South Africa's long had a very high disease burden of HIV and AIDS and tuberculosis. And the way it dealt with those was by establishing this community outreach of about 30,000 people who would go out into the communities and knock on doors and test people for those diseases. They figured, you know, you can't wait for people to come into the clinics and ask to be tested. And they've now deployed that, you know, it's a huge resource and are sort of knocking on doors and tracing contacts. So South Africa does have a hope that with this kind of infrastructure and testing, that it is going to be able to ease things up a bit and at the same time identify cases and then do targeted kind of isolation, tell people to stay at home and test their neighbors and see sort of how far that kind of stay at home order needs to go.

And presumably South Africa, like Nigeria, is facing up to that trade off between the risks presented by COVID 19 and the risks of keeping an economy shut down.

The really difficult question facing South Africa and many other African countries is that it's not at all easy to balance the economy against saving lives from the virus. And the reason there is just that there are large numbers of very poor people working in the informal economy. Cyril Ramposa has grappled with this and talked about the hardship that's being imposed. While a nationwide lockdown is probably the most effective means to contain the spread of the virus, it cannot be sustained indefinitely. Our people need to eat. They need to earn a living. I think that many other African leaders are wrestling with the same issue, as are people in slums in Kenya and Uganda who've told us that they don't think the virus is going to kill them. They're more worried about hunger getting them first.

Jonathan, thank you very much for your time.

Thank you.

For a lot more analysis like this, subscribe to the economist. To get 12 issues for just $12 or 12 pounds, go to economist.com radioffer.

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Smokers don't get a lot of good news these days, for good reason. That's why a recent report came as such a surprise. Researchers at a major Paris hospital found that smokers seem to be much less likely than non smokers to develop severe symptoms from the coronavirus. Perhaps it's only fitting that the study came out of France.

France really is a smoking culture. A quarter of all adults smoke cigarettes. In fact, it's quite common and acceptable for people to bump cigarettes on the street. As the French put it, they say, can I tax you a cigarette?

Benjamin Sutherland writes for the Economist.

Considering the smoking culture in France, it was kind of appropriate or ironic that at the end of April, researchers shocked the world with some dramatic numbers. Only about 5% of COVID 19 patients in a big Paris hospital known as PTA Salpetriere were smokers, so a dramatically lower number than in the population at large.

And is that just a statistical fluke? Has that pattern been seen elsewhere?

No, that Pattern has been seen elsewhere. Numbers had been trickling out of China, United States, some other places where researchers were tallying the percentage of smokers in various hospital systems. But the French study really kind of captured the world's attention.

And so what do you think is actually going on here?

Well, almost no one thinks that the cigarettes are somehow protecting smokers from getting infected. In fact, it's quite likely that smokers are becoming infected a little bit more than the general population because they handle cigarettes and then put them in their mouth and the virus can enter the system through mucous membranes. What most researchers think, but still needs to be demonstrated, is that nicotine in the tobacco is somehow lessening the symptoms from COVID 19.

And what's the guess on why that might be?

Well, there are a few different hypotheses. One is that the nicotine is somehow binding with an enzyme known as ACE2 that is the gateway into cell which the coronavirus passes. And by binding with that enzyme, it could make it impossible or more difficult for the virus to slip through and get inside the cell. That's one option. Another is that nicotine is known to reduce inflammation. In fact, it's sometimes used to treat inflammation of the bowels. And inflammation is a problem with COVID 19. And so it may be what is playing a role. A third option is that COVID 19 is often accompanied by a hyperactive immune response known as a cytokine storm, in which you have too many white blood cells that are sent to fight off an infection. And nicotine is thought to perhaps act as an immunosuppressant. And so by lessening that immune reaction, it could kind of paradoxically improve patient outcomes.

And so if nicotine is the active agent here, you might expect to see the same thing in vapors. Are there any data on vaping?

I haven't seen any important studies on vaping, but basically what researchers think is that nicotine is the active ingredient. So however you're able to get your nicotine would work. You could get it through a patch, through vaping, through nicotine gum, through a nasal spray.

So, I mean, this is practically suggesting itself for an experiment to see if nicotine, or if smoking anyway, is actually having this effect.

Absolutely. In fact, the health minister of France encouraged the researchers to put together a follow on study. Money's being organized for that. They expect to begin in about three weeks. And the idea is to give nicotine patches to patients, to frontline workers, to ordinary citizens, and of course to give placebos to control groups at a time.

When People are looking for a quick fix, a magic pill. People might see in nicotine, in smoking something worth going and stocking up on.

Well, absolutely. In fact, news of the study spread like wildfire. And shortly thereafter, France's health ministry put out a decree banning online sales of nicotine and limiting pharmacy sales to a one month supply for people trying to quit. They've just been worried that there's going to be a run on supplies and they want there to be enough to treat patients and for people trying to quit to be able to continue that treatment. Especially if future results show that nicotine really is helping treat COVID 19.

Is there a risk that people might.

Even go as far as taking up smoking?

I think what's more likely is you're gonna have some people who already smoke a bit using it as a bit of a license to justify smoking a bit more than they would normally do. But what the researchers stress is don't start smoking. If you wanna take nicotine, that's one thing, but take it in the form of a patch or a nasal spray. But don't start smoking, because smoking has all sorts of other negative effects. I think, though, it is kind of ironic at a time when a lot of people feel like the world is being turned upside down with the COVID pandemic, that suddenly something that has long been demonized as an unmitigated evil may turn out to actually be helping a percentage of the population. So there's some irony with that. Obviously, smokers haven't thought this out ahead of time and weren't expecting to be unwitting guinea pigs in an experiment like. But if that's the way things turn out, then perhaps that's all the better.

Benjamin, thank you very much for joining us.

Thank you. I've enjoyed it.

There isn't a single facet of life almost anywhere on the planet that has not been affected upended by the COVID 19 pandemic.

Things are getting pretty ugly. Investors are running away from assets they see as risky. There is the risk that skepticism and fear and mistrust kind of snowballs into something that becomes as big of a problem in the fight against Covid as Covid itself.

For the latest on the pandemic and more, join us on Economist Radio. Listen wherever you get your podcasts. Tonight, stars were set to take to the Metropolitan Museum of Art's steps in their absolute finest for the annual spectacle that is the Met Gala. It's been postponed. The theme was meant to be about time marking 150 years of the museum itself. That history reveals a long and intimate relationship with America's elite. A museum essentially built by the rich. But for everyone now there's a bit of a reckoning for an institution that proudly put America on the cultural map.

One of the Met's original founders actually compared it to American independence. He said he had hoped it would sever the provincial relation of America to Europe in respect to art.

James Waddell writes about culture for the Economist.

There's an anxiety in 19th century America about the fact that they didn't have big national museums along Western European lines. But what America after the Civil War does have in abundance is philanthropic industrialists with plenty of cash, many of whom are really quite unhappy with the sense that they are culturally less sophisticated than the Europeans.

And how did the Met progress from that idea that America needed that cultural tradition to being an actual bricks and mortar museum?

So in 1871, its collection consists of a total of one object, a sarcophagus. So it falls to these often quite eccentric, mostly extremely wealthy individuals to set about the business of acquiring a world class museum collection. So people like William Blodgett, owner of a varnish manufacturing company who heads to Europe just as the Franco Prussian War is kicking off and he manages to Hoover up 174 paintings from Spooked art dealers. Another character is this slightly roguish former Civil War mercenary, Luigi Parma di Cesnola Di Cesanola manages to get himself appointed United States Consul to Cyprus, where he promptly starts digging up temples and tombs and takes around 35,000 objects, many of which end up in the Met.

Well, you can imagine acquiring the early collection will have been pretty expensive, but.

Surely also making the building itself, it's an impressive piece of architecture.

Yeah. So in 1902, the Met gets this grand new building with a lovely Beaux Art facade that still stands on Fifth Avenue. And it's at that point that it really becomes the darling of America's tycoon class. This is all well and good, but I think the Met's institutional coziness and actually physical proximity with its well to do Upper east side neighbors, does create a growing sense of a disconnect from the American public who the museum was meant to serve. So infamously, in 1969, they run an exhibition on the history of Harlem featuring no artwork by black artists, which draws protests and kind of sums up this out of touch institution. And that lingering sense never really goes away. For all its many wonderful aspects, the Met does still stand accused of serving as a showcase for private wealth.

Well, it's a showcase for private wealth that, if the news stories are to be believed, has money problems of its own.

In the last few years, there were rumblings of financial trouble at the met. So in 2016, reports start emerging of worryingly high debt, high operating losses, and also pretty eyebrow raising levels of pay to the top executives. And then in 2018, in a deeply controversial move, the policy of free admission, which had been in place for a century, was overturned. Now the museum was managing to extricate itself from this financial spiral and had actually been on track to break even this year. And I think that's partly why the timing of the financial hit from the COVID 19 shutdown is so frustrating.

So what do you reckon the next 150 years hold for the Met?

I mean, on the face of it, the COVID 19 shutdown looks pretty catastrophic. But if there is a silver lining, I think it's that this period of enforced quiet offers a little bit of thinking space. You know, this is an institution which could probably do with a chance to think about its role and where it wants to go next. The top of that list should be reconnecting with the public. But, you know, I think these issues around donors, around historic acquisitions, around how to connect with local communities, these are issues that pretty much all big legacy museums are tackling at the moment. So, you know, the Met has a really unique past, but perhaps isn't quite so different in terms of the challenges it might face in the future.

Thank you very much for joining us, James.

Thanks very much, Jason.

That's all for this episode of the Intelligence. If you like us, give us a rating on Apple Podcasts and see you back here tomorrow.

Sam.