The daily is supported by tedium Mary trade. Investing isn't one size fits all. Every investor has a unique style. That's why tedium air trade offers to different mobile apps. There's tedium eritrea a ball which lets you manage your portfolio with streamlined simplicity or think or swim mobile, which gives you the tools you need for more advanced grades and in depth. Analysis visit Td Ameritrade calm, slash, apps, to find the one. That's right for you once again: that's Tt America, trade, dot, com, slash apps from the New York Times. I, Mr Brunetta, Ferny, see This is the daily throughout the pandemic. The disease and death. One part of the world seems to have been mysteriously spared central and western Africa. My colleague

Stephanie Nolan travelled to Sierra Leone to investigate why that is and what it tells us about the future. Of the pandemic. It's Thursday April, seventh, the Stephanie, a global health reporter at the time, tell me about the kind of reporting that you've been doing during the pandemic, so generally a global health. Reporter looks at the big health problems that cut across as regions of the world things like infectious disease, malaria, tuberculosis, HIV, but, of course, in the covid ear. That's mostly meant reporting on Covid, and I, doing a lot of reporting, in particular on vaccination and on the efforts to try to vaccinate the world

and in February I took a trip in Sierra Leone, where I was hoping to figure out what was happening in some of the least vaccinated countries, and also to do some reporting on some of the other issues, we haven't paid much attention to in the pandemic so I rise in Freetown, the capital of Sierra Leone, what was the height of the army cron wave, and I was coming from Canada, which was in our country really in the grip of another way, but the pandemic, and I hired a vehicle with a driver, and I kid it out with masks and sanitizer in rapid test, and we headed up to the northwest of the country the first day I was there and it really startling saw. There was a big rock concert, in the town where we were staying. There was a big football tournament with people packed into watch it. Nobody had a mask on and.

It really seemed like covered- was just not a thing. people were thinking or talking about at all. When I wouldn't ask people, are you worried about covered that mean they knew what I was talking about, but they couldn't fathom why I would be concerned. It was like time, travel back two. Twenty nineteen like I had landed in a place before covered. Somehow and right away. I thought I need you're what's happening here. Is it that covered for some reason is just not here or it is here, but it's not making people sick? It's not killing. People and you know I had been reading debate about this in journals for months this question of What's happening with Covid in Africa, but until I saw it, I really didn't understand asked how puzzling this was, and I very quickly decided to put aside some

but I had come to Sierra Leone to report on the to try to really dig into this mystery. Seventy to that point, what's the big picture here mean tell me what's been happening in different parts of Africa during the pandemic? Catch me up on how is played out. so I'll start with South Africa, because that's the country in Sub Saharan Africa that we know the most about so South Africa of course has had a he rough time. The beat variant was first identified there, The only criterion was first identified there. They have caused bad waves. We know that there have been probably three hundred thousand deaths caused by it in South Africa. As you move through the continent, it gets. Murkier EAST Africa has reported some bad. waves in countries such as Kenya, Uganda. There have been reports of people having to leave bodies outside hospitals, because the morgues were full, but their rear stories

Is you move into central and western Africa there been, in fewer reports like this right, much much lower reports of death, Sierra Leone is it tree of eight million people, and they reported a total of seven thousand seven hundred kovac is and just one hundred and twenty five deaths that seems incredibly low. It really is so how'd. You start to answer that question Stephanie the question of why Sierra Leone seemed less affected by covet. What did you do first? So the first thing I wanted to try to understand ways: was happening with cases and the town, but I was in, come we happened to have. The regional covered we need her office there, so I went across town and walked into the office- and it was complete-

empty, except for district coordinator has a covid coordinator, who I found sitting behind his desk all alone in an otherwise completely empty office. He had a shiny, new laptop in front of him, but no internet connection. And indeed no power and When I asked him what he knew about cases, he told me really We proudly that they'd only had eleven since the start of the pandemic. Oh wow, eleven for roughly what kind of population is about one hundred and twenty five thousand people in this district? Well, so that was kind of shocking. but then the question was well. How do you know? So? I asked him what was happening with testing and he said the test what's happening over at the hospital

and from there a couple of miles away to the hospital thinking. Okay, maybe somebody else can tell me more about testing. This is the hospital of the same region. It's the district hospitals bring those hundred and twenty five thousand people and there's a lab, and there were three busy technicians in that lab and when I said you know what are you doing in terms of covert testing? They were pretty blood there's not a lot of resources in this hospital, so what they do will come in as they tree eyes. They test. First, for malaria, and if you do, Have malaria veil test you for typhoid and if you don't have typhoid, then they'll test you for cover and so they never really need to test anyone for Covid, because before they get to that point, they figured out what they have to Stephanie. It sounds like from your reporting

What you're finding is that number one? The regional coordinator is not doing the testing and number two at the hospital they have so many other urgent diseases. Malaria, for example, Covid is just really the last thing I'm going to list exact, there was no way talking to these regional authorities that I was going to be able to get a good sense of the actual scale of covert infection in the country, so I went back down so for two freetown to the capital and I went to see Doktor Ostend dummy who is the health Minister of Sierra Leone and then went into his office in the ministry. So I can have global health for the times and I meant to travel the world, although obviously the last couple of years, that is

What the f c c and told him. You know why I was in Sierra Leone. I would love to hear from you how it's been going and what the challenges are. So so. Thank you very much by the way, he told me about how he used to work for the CDC in the United States, and he came home just a year ago to take up, the job of Minister is appointed on the tenth of February last year. And you know that was peak pandemic to no vaccination at hand. in Sierra Leone at that point, but also among the fourteen Gimme, the club and the boulevard five days after Doktor Denby came back to take up this job and a bull outbreak was cleared a well. So you know this is a guy who really knows a thing or two about penance the lessons learned from Ebola, Bullough extremely helpful, I

and we started off by talking a little bit about twenty fourteen fifteen. Sixteen, when that last really people are out break. You may remember, went through this region, eleven thousand people died. It was really devastating for Sierra Leone, where we have a bullet here. People knew would answer as it was before you about giving ground water social distancing people knew about care, and so they had all to draw on when they first got the news about covered, so that was stopped and what that was earlier was the last country in Africa to report a case, and Sierra Leone is constantly reported. Very very low numbers were all of this outbreak

and when I started asking Dr Dot about be about, he attributed some of their blow case numbers to the fact that they've been able to very quickly a strong response. But then how does doctor Denby explain the things that you were seeing in your reporting? Stephanie I mean in the regional coordinators office in the hospital this fact that it didn't seem to be doing any testing race. So I asked him about that because it is quite extraordinary for me to come. I live in Canada and to travel from a place where people are pandemic obsessed raised to a place where it's clearly not on people's minds. How confident are you in

your surveillance. If I said you know what do we actually know about how much covered there is here? How much are your testing? How much are you looking so so that's that's really interesting point in the game cause be careful with this. No, but I think most of the testing that's occurring. It's occurring at the airport is more entry and exit. You know she acknowledged very little testing happening, and so when we say we have silent districts, you know this silent either because there are no cases or because we're not testing yeah, but I have a feeling that there's a lot of transmission going on in here, so it sounds like the health Minister of Sierra Leone is confirming the theory.

The cases are being severely undercounted yeah. Definitely it was a surgery that was a while back that indicated, the fifty percent of people have been exposed. Oh yeah, I mean this is a study that was done by Tulane, yet and in fact he told me about some research that had looked for anti body levels in the population and had found that probably half the people in Sierra Leone when that study was done, had already been exposed to cover it up. It will look, add doing another survey now to look at the anybody levels in the country, but I would not be surprised if it's very, very hot. Is there other data to back that up while there is actually there is. Really interesting data from the World Health organization that just came out that shows that two thirds of people across Sub Saharan Africa have co antibodies there's other data sources

in particular it West Africa than that, show that seventy five percent of people have got covert antibodies. and remember when these studies done only three four or five percent if people had had access to vaccination, so if you ve got antibodies. It's because you had an infection, so that kind of answers. Your original question, and write. Clearly, a lot of people in Sierra Leone did have covered yeah lately- and in fact, Doktor Denby, said this to me pretty much point blank in our conversation, They know lots of people have been infected, have a boy by the fact that no matter what there is is no evidence. Excess deaths are occurring, that's very visible, but he also talked about something else: they're seeing or actually what

they're not seeing. He was just totally adamant that they're not seeing the death rates that we ve seen in other parts of the world. Everybody s, multiple ways: ITALY, Germany everywhere else in other words, still die you as you know. But when you look here, you see that people are still getting sick who still getting cases or you don't get the kind of enormous, others see, and he now remember. Sierra Leone has This surveillance system that a legacy of that terrible Ebola outbreak things we also have a very active is: every week we got reports of all the deaths and he says look if was a spike in deaths in one region of this country, anywhere, You would know about it and it's just not happening. We ever see any excess mortality that could alert us that there's something going on hmm interesting

so it sounds like Stephanie from what you're saying Sierra Leone and a lot of Sub Saharan Africa reported really low case counts during the pandemic, but data suggests that a lot of people actually have the antibodies had covered, and if we follow what happened in the? U S, they should have a lot of deaths right, but with administers telling use that very few people in Sierra Leone died while so there I am with a whole new mystery right if lots of people have covered, but they don't have deaths to report. What's going on, The hmm

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my name- is a poor via Monday Vallely. I am a science and global health reporter at the New York Times my job is to talk to scientists to speak their language, to go deep with them and then figure out how it is relevant to the everyday reader. Put it on scientific concepts for about twenty years. Everything have learned up to this point has helped me deliver stories about covered, I feel just an enormous responsibility to it makes sense of what we're learning about iris. How to protect ourselves. I feel like and training for the sharp. My entire life everybody at the New York Times is cons, and thinking about asking the tough questions and making sure that our readers have all the information they need, but this relies on you our subscribers? We need you on board to keep the times as a resource for everyone. If you're not, you can become one by going to

hightimes dot com subscribe to Stephanie. How did you go about digging into this other part of the mystery, It had to do with how many people in Sierra Leone actually died of covered. So started calling up epidemiologists in all different parts of Sub Saharan Africa. People I've known for a long while- and I started asking them this question of what do you think is happening? and after a lot of conversations, I kind of was left with two really different theories that would explain how, even though, I know there are lots of covert infections in Sierra Leone and other countries in the region how it could be that people don't seem to be dying in one of those theories lay those out for me Well, the first one is that there is no mystery. There's just

lousy data on deaths. There's not some miraculous thing happening in West and Central Africa or in regions. That's report lower covered deaths, the reason that they would be reporting fewer people dying of cover. It is just that we do a really bad job of count, and the second theory is that in fact, there's no way thousands and millions of deaths have been missed, something else is protecting people. Something else is going on. That means people are getting infected with covered, but they don't get sick or they don't die at the same rates. Ok, let's start with the first theory, because that one seems pretty logical to me. I mean, if its clear that cases were being under counted

Probably deaths were being under counted great yeah. I think this is a really strong argument. We know that death registration in much of Sub Saharan Africa is really really poorly done. There are a lot of countries were only five or six percent of deaths are ever registered with a civil authority, while people don't typically die in medical facility he's or hospitals they most often will die at home and they get there in a small village graveyard and so that death never gets reported an axe in zambian public health researcher I spoke to told me about a study, he's been doing that found that nearly ninety percent of the bodies in the main morgue in Zambia were positive for covered. This was at the height of the Delta wave and he said, look there's just no reason. I think that fewer Zambians would be dying or Ethiopians or Sierra only ends right. There's, no inherent reason why there would be

You were des here, just the record, keeping is really weak and there's a model that draws together lots and lots of different data sets that the economist has been running that says there could be up to three million covered excess. in Sub Saharan Africa, oh well, so three million deaths that basically have been uncounted. That's the argument now look to be clear. That model says the deaths have been under counted all over the world. We know that that's true, but according to this model, the problem of under counting is the most severe in Africa in does not hold water. Well, you know a lot of people that I spoke to say. There is no question. Some deaths have been missed by their really not buying it, and that includes the chief of the covered response for the W.

Show the World Health Organization in Sub Saharan Africa. He said to me: there's just no way, there's just no way that we have missed millions of deaths. You know models are useful to appoint, but there are lots of other ways of seeing Steph's right when Zambia had a bad delta wave, there were bodies stacked. sighed the morgue I mean a place like Sierra Leone holds really really big funerals. People say there's just no way that there could be hundred. the thousands or even millions of deaths, and that we ve just missed them in Stephanie. If it were true that there were high case numbers, but low deaths from covered in Sierra Leone would explain that. Well, it is an excellent question. So again, there are lots of theory.

The leading one, and I think that whatever else is true- this is a part of it is age range sub Africa has a median age of nineteen. Sir Leon is rate around that as well, and that compares with forty three in Europe. Thirty, eight in the United States and sue we know. We know that covered is much more deadly for older people who have lived long enough to have developed the home were bidden to use such as diabetes. That makes covert really deadly. The virus is far less likely to kill young people and their often asymptomatic altogether, another argument that I heard quite a bit had to do with temperature. The fact that it's obviously really quite warm and all of these countries, and people mostly live their life outdoors. Obviously, if you're talking about people who are like in Sierra Leone, primarily subsistence farmers spending the day in their fields, they're not getting exposed

over the way they would on a crowded, subway train, although of course now we know that huge numbers of people actually have been infected. So that theories a bit bull and then. Finally, the last argument that I heard quite a bit had to do with other pathogens, that people have either been exposed to, so many other corona viruses that they had protection against Covid, or just that you know, if you make it into childhood in a place like Sierra Leone. You've had repeated about, of malaria. You've been exposed to lots of other infectious disease that may be people I have a level of immunity that has helped blunt the effect of covert hm that's interesting, and how do these three facts yours hold up when you compare Sierra Leone to another, similar country that had a really bad time with curve it. Well, we can

talk about? India, India has reported half a million covid deaths, but it's pretty widely accepted that the real number is probably closer to four million people. Who've died of the virus, so India, also has a young population rate there. The median age is about twenty eight, it's also a really warm place where much of life is lived outdoors and throws regions of India, but have very high rates of infection with malaria. There a lots of other pathogens in the circulation that so people would have had prior exposure to lots of things. So we know that those factors were not protective and India. On the other hand, India is a much more dense place, it's much more connected to has much better transportation, it's not a street comparison to Sierra Leone, but it's enough to suggest that those three things alone dont cover it as an explanation, so that liquid in

is showing us. Is that these factors you're talking about their all playing something of a role, but there's not a single one of them that solves the mystery entirely yeah, it's exactly right, so I'm wondering Stephanie all the reporting you've done. How do you even begin to figure out? What's true, I mean? Is it that Kova deaths in Africa are really being undercounted or that Africans have this really unique immunity covered? you know where I wound up- is that the truth is probably so. where, in the middle, if you're in a place, play Sierra Leone that has incredibly high infant mortality. It has the highest maternal mortality in the world, people die. Is malaria, there was all kinds of other infectious diseases that people are prey to. It is possible that Covid could cause a rise in the number of deaths that wouldn't necessarily

you show up the way would in a country with overall lower mortality figures on the other hand, I believe people in Sierra when they say to me there. I've been no extra deaths in my village this year one person died. Two people died, it's just like all the other years. Nothing on you What has happened here right? What I can also tell you is that I was able to sit down and read all of the serious research on the topic in a single morning. It's not anywhere near the level of attention that I feel like it should, because it really matters I like it. It matters for Sierra Leone for Sub Saharan Africa, but it also matters to everybody else. What are the stakes Stephanie? Why does it matter? Well, it matters for a couple of reasons in terms of why it matters for the world

if there is something going on, that means people really aren't getting sick with covered or aren't dying from covert at the same rate in west and central. Africa in Sub Saharan Africa as a whole, understood in that protection, where that immunity is coming from that could help us in lots of ways it could help develop better treatment. It could help with another generation of vaccines, so it matters for protecting the world, but it also matters for Sub Saharan Africa. For Sierra Leone. There is a goal: from the World Health Organization and the African Union to vaccinate. Seventy percent of people and Sierra is scrambling to do that. What you have now the situation where Kovacs came through the World Bank came through with funding that allowed us to buy about four million dollars worth of you know. When I spoke to the health Minister Doktor Denby, he was

talking about how there's a lot of resources coming, into the country right now to do covert vaccination, but at the same time we have the Ebola vaccination going on. There was a polio outbreak, so all of this was going on at the same time, not the same staff was doing all of this. That is an enormous challenge in a place like Sierra Leone, with a health system that was already really struggling to respond to what people needed, and not only that you have to raise awareness, bring people in and vaccinate them and then trying to convince young, healthy people.

to get a shy for a disease bad, as we have just been talking of how they really dont think as a risk to them and becomes a real burden when people are sick. So it sounds like there's this attention here. Right I mean public health authorities had been trying to vaccinate seventy percent of Africa, but Doktor Denby is finding that that's a really complicated thing to do, and especially complicated when- not even clear how much of a threat covid is DES country. I think there is a growing you know it start. it as a whisper and then a mother, and now it's a kind of out loud conversation about weather, getting to seventy four in Sub Saharan Africa, make sense weather pouring resources into vaccination in a place like Sierra Leone really is the best use of those resources. My response

how do I utilize the services that I intended for Kobe to address? Global but at the same time be a resource for rebuilding houses, You know, I think all things being equal Denby would really like for his people to be protected from covered, because even if the virus, killing people now the next variant might be deadly, but The other disease are not going to wait for you to resolve these issues. We don't know for too long. He also has hospital words that are full of people with malaria and the highest maternal mortality rate in the world and because Sierra Leone gets nowhere near the amount of support that it needs to try to build a really functional health system. He's facing these tradeoffs. I would see their artificial trade offs between addressing one disease or another.

he's in this position. Where he's having to really ask himself what should he do with the live? did resources that he has Stephanie. Thank you. It's a pleasure, we'll be right back inspired by the story that shocked the nation. The girl from plain veil is a new Hulu. Everyone. Series exploring complex personal relationships weaved through the power of technology, the show looks into the relationship between Michel Carter and Conrad Boy, the third, the events leading up to his death and the unprecedented child. Examining the countless text messages, starring, L, fanning the girl from Plainsville is now streaming only on Hulu here's. What else do you do know today

on Wednesday in response to atrocities in the war in Ukraine, the United States and its allies moved to impose for sanctions against Russia's largest financial institutions. The Biden administration, together with the European Union, imposed strict sanctions against spare Bank, the largest financial institution in Russia, which holds over a third of the country's financial assets and alphabet. What of the country's largest private banks? The administration also announced they would block access to. U S held financial assets for family members and close associates of russian President Vladimir Putin, including Putin's to adult daughters and pending on officials, said that Russia has withdrawn all of its troops from the territory around Keith. Ukraine's capital and journey have a major city in the north, Russia that it would do so more than two,

ex ago, but Pentagon officials had expressed scepticism that the self proclaimed pull out could be a ruse as many as forty thousand russian troops have now left the territory and a real meaning and resupply before launching what western officials believe will be renewed focus on Ukraine's EAST and south. Meanwhile of YO posted on line and verified by the New York Times, to show ukrainian mistreatment of russian prisoners in the video. A russian soldier can be seen with a jacket pulled over his head. testing for air before he is shot by ukrainian soldier at least we other men believed to be russian soldiers, lay dead beside him, one with his hands tied behind his back

Today's episode was produced by Russia, buncher rigging of asking and Rob Zip code with help from Michael Simon Johnson. It was edited by Anita contains original music by Marian Lozano engineered by Chris Wood. Our theme, music, is by Jim Romberg and then Landsberg of Wonderly The That it for the daily I'm serenest, haven't you see, see you tomorrow. Have you heard of not M hard to pronounce easy to put on naming the world's ferris cashmere? That's ethically sourced, sustainable and supervision

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