H5N1

South Korea reports 376 new COVID-19 cases, total tops 3,500

Via KBS World Radio, a March 1 report: S. Korea Reports 376 New COVID-19 Cases, Total Tops 3,500.

South Korea reported 376 new cases of the novel corona virus since Saturday afternoon, bringing the total number of infections in the country to three-thousand-526.   

The Korea Centers for Disease Control and Prevention said on Sunday morning that 333 cases were reported in Daegu and 26 new infections were reported in neighboring North Gyeongsang Province overnight, accounting for 87 percent of the 376 new cases.   

All other major cities and provinces reported less than ten new cases each, with Seoul and South Chungcheong Province reporting five additional cases, respectively.   

The country's COVID-19-related death remained unchanged at 17.   

Over 61-thousand people have tested negative for the virus, with about 32-thousand-400 people awaiting results.

In bid to rapidly expand coronavirus testing, US agency abruptly changes rules

Via Science: In bid to rapidly expand coronavirus testing, U.S. agency abruptly changes rules. Excerpt and then a comment:

The Food and Drug Administration (FDA) today recommended a dramatic shift in how it implements regulations that control whether laboratories can use diagnostic kits created in-house to test for infections of coronavirus-2019 (COVID-19). 

“We issued a policy this morning that allows us to have a lot of flexibility around the development of diagnostic tests,” said FDA Commissioner Stephen Hahn at a White House briefing with President Donald Trump this afternoon. “We expect this policy to have a significant impact.” The change could greatly expand the number of laboratories able to do coronavirus testing. 

The U.S. government has come under severe criticism for not providing nearly enough tests needed to understand the extent of spread in the population. A test kit produced and distributed by the U.S. Centers for Disease Control and Prevention (CDC) was shelved after state and local lab trying it out discovered that it contained a faulty reagent. As a result, many labs that have the capability to test themselves have not been allowed to do so.  

The new recommendations focus on “high-complexity testing laboratories” that are certified under federal rules known as Clinical Laboratory Improvement Amendments. This group of facilities includes many hospital labs, like the one that epidemiologist Michael Mina works at Brigham and Women’s Hospital in Boston. “Essentially it’s opening up a clear and concise avenue for labs like the one at Brigham and Women’s,” says Mina. “It’s what I’ve been advocating for a month now.”

If these labs want to make and use their own tests, FDA says, they should send five positive and five negative samples, as determined by their protocols, to another qualified lab for confirmation. The FDA still requires labs to submit what’s known as an emergency use authorization (EUA) application to the agency. 

“For a reasonable period of time after validation and while they are preparing their EUA requests, FDA does not intend to object to the use of these tests for specimen testing,” the recommendations state. 

“It’s their method of saying just go ahead and start doing the testing, it’s sort of got out of hand, and if you don’t hear from us in a year, just keep testing,” says Mina. 

Scott Becker, the CEO of the Association of Public Health Laboratories, praised the FDA decision in a statement. “We are greatly encouraged by expanding the testing capacity to the clinical laboratory community,” said Becker. 

Together with an earlier recent decision to change the recommended coronavirus testing protocol to steer around the reagent problem in CDC kits that were distributed to public health labs, Becker said “these steps will jumpstart testing and surveillance capabilities and greatly enhance our efforts to protect the health of individuals and communities across the country.” He anticipates that public health labs will be able to run 10,000 tests a day by the end of next week.

You always need surveillance long before you think you need surveillance. And when you do start looking, you're going to find a whole lot of cases in a whole lot of places.

Coronavirus stopped exporting Iran's oil: Official

Via ILNA, the Iranian Labour News Agency: Coronavirus stopped exporting Iran's oil; official.

Member of the Chamber of Commerce and Spokesman of Iran's Oil, Gas and Petrochemical Products Exporters' Union, Seyyed Hamid Hosseini told that countries like Turkey, Afghanistan, Turkmenistan, and the Iraqi central government have stopped importing oil from Iran.  

Speaking to ILNA news agency, the Iranian official added “Exports are now at a minimum level due to the cold weather and domestic demand.”  

He further explained that of course, Iraqi Kurdistan restricted imports from Iran for a few days due to the coronavirus, but as prices rose, they were forced to re-import from Iran. 

As coronavirus fears rattle global markets, the oil industry is facing up to an uncomfortable truth: things are likely to get worse before they get better.  

FGE, an energy consultancy, is now forecasting that global demand growth for oil will be essentially zero in 2020, failing to rise for the first time since the financial crisis.  

Significant numbers of cases in Iran, South Korea and Italy have increased the chances that the virus will spread further, constraining oil demand as countries move to isolate affected areas and restrict travel. 

Iran is one of the recent countries affected by the rapidly-spreading coronavirus. According to recent reports from the Iranian officials, over 338 people have been infected, 34 people have already died. 

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, told a news conference in Geneva on Friday that WHO is sending a team to Iran, due to arrive on Sunday at the earliest or on Monday.

Inside Trump's frantic attempts to minimize the COVID-19 coronavirus crisis

Via the failing, no good, very bad, terrible Washington Post: Inside Trump's frantic attempts to minimize the coronavirus crisis. Excerpt:

Minutes before President Trump was preparing Wednesday to reassure a skittish nation about the coronavirus threat, he received a piece of crucial information: The Centers for Disease Control and Prevention had identified in California the first U.S. case of the illness not tied to foreign travel, a sign that the virus’s spread in the United States was likely to explode.  

But when Trump took to the lectern for a news conference intended to bring transparency to the spiraling global crisis, he made no explicit mention of the California case and its implications — and falsely suggested the virus might soon be eradicated in the United States. 

“And again, when you have 15 people — and the 15 within a couple of days is going to be down to close to zero — that’s a pretty good job we’ve done,” he said.  

Trump’s playing down of the California patient at his news conference underscores the administration’s slapdash and often misleading attempts to contain not just the virus, but also potential political damage from the outbreak — which has tanked financial markets, slowed global commerce and killed some 3,000 people worldwide, including the first U.S. death, announced Saturday.   

Since Trump touched down from a two-day trip to India early Wednesday morning, the administration struggled to cope with the fallout from the crisis — shaking up and centralizing its coronavirus response team under the leadership of Vice President Pence, floating plans to stabilize the markets and publicly seeking to minimize the threat posed by the potential pandemic.  

Interviews with nearly two dozen administration officials, former White House aides, public health experts and lawmakers — many speaking on the condition of anonymity to share candid assessments and details — portray a White House scrambling to gain control of a rudderless response defined by bureaucratic infighting, confusion and misinformation.  

“It’s complete chaos,” a senior administration official said. “Everyone is just trying to get a handle on what the [expletive] is going on.”

Opinion: Five lessons for other nations from China’s fight against Covid-19

Via Caixin Global: Opinion: Five Lessons for Other Nations from China’s Fight Against Covid-19.

The novel coronavirus outbreak will soon become a pandemic. China has paid a heavy price to learn five key lessons in trying to control Covid-19, which could help inform other countries' own efforts. They include the use of shelter hospitals for mild cases, and the need for total transparency. Here they are:  

1. Prioritize prevention of hospital infections 

Hospital infections are the biggest threat. Hospitals are the best place for the virus to easily infect a great number of people. This can turn healthcare workers into nodes of infection and break down the system’s ability to treat patients. Preventing hospital infections is of the utmost importance; if you cannot prevent hospital infections then nothing else is worth discussing. 

When the initial situation is unclear, hospital infections come mostly from pneumonia-related departments, and once the risk is clear, everybody from the fever clinic to specialized centers should be ready. At this point, other hospital departments may become the weak link. Guard against hospital infections, don’t let them get out of hand. 

2. Without a cure, intensive care beds save lives  

Between 10% and 15% of Covid-19 patients will develop into severe cases. Patients with severe illness must be hospitalized, or they risk falling critically ill and dying. There is not yet any specific treatment for the Covid-19 virus; intensive care means providing patients with life-sustaining equipment, giving the body the time it needs to fight off the virus. Ventilators, iron lungs and other equipment are very important. They could be the difference between life and death. Life is that fragile.  

3. Low-tech “shelter hospitals” help prevent spread  

Shelter hospitals are an important new development in the prevention and control of the coronavirus. Patients with mild symptoms do not need much treatment, and there is no effective treatment to give them. If these mild cases pile up in hospitals, not only will they take up medical resources needed by the seriously ill, they will also increase the risk of hospital infections.  

Sending them home for isolation and observation can have consequences: they may infect family members or others on the way between their homes and the hospital, spreading the disease in transit. If they take a turn for the worse, their access to treatment may be delayed. 

Concentrating patients with mild symptoms in a shelter hospital solves two major problems. It gathers and quarantines all patients to reduce transmission and facilitates care by medical staff, while also allowing patients to be rapidly transferred to a fully equipped hospital if their condition deteriorates.  

4. Suspected cases must be quarantined 

The gold standard for diagnosis is a positive nucleic acid test. However, test kits range in quality and this, combined with sampling errors, means a considerable number result in false negatives. If the patient is symptomatic but the nucleic acid test comes back negative, they are initially classified as suspected and could later be diagnosed. They should be quarantined regardless of how they are categorized. 

Home isolation is easy to execute and low cost. But the risks of home isolation for suspected cases are basically as high as for confirmed patients with mild symptoms. From the perspective of epidemic prevention, designated special quarantine centers are more effective. 

Unlike mild cases, which have been confirmed and can be brought together for treatment, suspected cases are uncertain. To prevent cross-infection, quarantine measures for patients suspected of having the virus must be more detailed and demanding, as they must be isolated both from the rest of society and from each other. 

It is not easy to put adequate, reliable isolation arrangements in place on short notice, so good preparations should be made in advance. 

5. Total transparency is needed 

Transparency comes last — not because it is the least important, but because it is the most important.  

In fact, the above set of prevention and control lessons, although all linked to each other, are just a framework. Each country must make its own choices according to its own situation, including whether to use shelter hospitals and isolate suspected cases.  

The Japanese government, for instance, may have confidence in its people’s self-discipline, and let both mild and suspected cases perform home isolation and self-observation. Personally, I think it is risky, but these things must be judged by the results. It goes without saying, but controlling the impact of the epidemic in Japan to an endurable level will come down to the choices of the Japanese government and people.  

The Japanese government’s plan is transparent. The government has clearly announced what it will do, explained why, provided suggestions and advice on how to live at home, how to observe, and when to go to the hospital. The whole process is transparent, which can slow the rate of transmission, reduce public panic, and reduce pressure on the medical system.  

Understanding its people, trusting its people, informing its people, and crafting prevention and control strategies on that basis is what a government should do. I wish Japan success.

Obama ‘Ebola czar’ delivers scathing assessment of Donald Trump’s COVID-19 response

Via HuffPost Canada: Obama ‘Ebola Czar’ Delivers Scathing Assessment Of Donald Trump’s Coronavirus Response. Excerpt:

Ronald Klain, whom former President Barack Obama appointed to lead the U.S. response to the Ebola epidemic, on Friday ripped President Donald Trump and his administration’s messy handling of the coronavirus outbreak.  

Klain — who was dubbed the “Ebola czar” — told MSNBC’s Ali Velshi there was a “crisis of both confidence and competence” in the way Trump’s White House was tackling the spread of the virus, which causes the COVID-19 respiratory disease. 

“On the confidence side, anyone at this point in time who believes what Donald Trump says kind of gets what they deserve at this stage of the game,” said Klain.  

Trump has told more than 16,000 lies during his time in office, according to The Washington Post. 

“But the problem is that the administration has silenced the people we can trust,” Klain added, noting how top officials from the Centers for Disease Control and Prevention had essentially “been gagged” and stopped from talking in public about the outbreak, which he claimed added to the level of confusion and panic that it is causing. 

“We can’t trust our president, and the people we can trust aren’t being allowed to tell us the truth,” he added.

US: Statement from Life Care Center of Kirkland regarding COVID-19

Published today: Statement from Life Care Center of Kirkland regarding COVID-19. This sounds like self-quarantine, and it's unlikely to be the last such facility to seal itself off.

Residents are our highest priority at Life Care Center of Kirkland. Their safety and well-being are our primary concerns.  

Recently, one of our associates and one of our residents were diagnosed with coronavirus (COVID-19) while receiving care in local hospitals. We only have those two confirmed cases at this time. 

Current residents and associates are being monitored closely. As is normal this time of year, there are various cold and flu-like symptoms being exhibited from residents and associates. The health department has advised us to monitor for an elevated temperature, cough and shortness of breath. We're consulting with the health department and possibly sending patients to a local hospital for formal COVID-19 testing. That testing is not performed in our facility. 

As precaution, all visits to the facility from families, volunteers or vendors are not allowed. Concerned family members or responsible parties may call our facility. The facility is currently placing a hold on admissions as well to fully focus on our current residents and associates.  

We take the event very seriously and have members of our corporate clinical team on-site to provide extra assistance. We are in contact with the Centers for Disease Control and Prevention as well as the Washington Health Department. We are following their guidance exclusively and will continue to take all precautions necessary for our residents, staff and the community at large.

Canada: Ontario confirms 3 new positive cases of COVID-19 coronavirus

Thanks to Len Sisson for alerting me to this story. Via CBC News: Ontario confirms 3 new positive cases of coronavirus. With more cases coming out of Iran, it really does look as if Tehran is seriously undercounting the number of cases it must have. Excerpt:

Ontario has confirmed three new positive cases of coronavirus, bringing the total number of confirmed cases in the province to 11. 

The new cases involve a woman, 34, in York Region, and another woman, 51, and her husband, 69, in Durham region. Both women had just returned from Iran. 

York Region public health officials have begun a search for anyone who might have come in contact with one of the cases, either in the air or on a GO bus to Richmond Hill. 

As of Saturday, there were 20 confirmed coronavirus cases in Canada. The number includes eight in B.C. and one in Quebec. There have been no deaths.  

Dr. David Williams, Ontario's chief medical officer of health, said in a news release on Saturday that the first three cases of coronavirus found in Ontario have been resolved, with each of those patients having had two consecutive negative tests at least 24 hours apart.

Of the cases announced on Saturday, the 34-year-old woman "with a travel history to Iran" went to Mackenzie Health, a Richmond Hill, Ont., hospital, on Thursday. York Region Public Health had contacted the hospital and arranged a time for the woman to go to its emergency department.  

She was wearing a mask when she arrived at the hospital.  

Patients now in self-isolation 

Williams said the woman arrived at the hospital with a dry cough, runny nose, shortness of breath and headache and was put on "airborne/droplet/contact" precautions.  

"Due to the low severity of symptoms and the condition of the patient, the patient was not admitted to hospital. The patient is in self-isolation, per protocols, where she remains," Williams said in a news release on Saturday.  

In the second case announced on Saturday, the 51-year-old woman returned from Iran on Feb. 22 and went to an Ajax clinic on Friday with a cough, body aches and chills. She was masked and isolated. 

Durham Region Health Department contacted Lakeridge Health Ajax Pickering hospital and arranged for a time for the woman to arrive. 

She arrived at the hospital wearing a mask and was tested for the virus. She was discharged from the hospital, sent home and went into self-isolation, where she remains. 

Her 69-year-old husband, meanwhile, also tested positive for the virus on Friday. He had a cough, but did not go to Iran. He accompanied his wife to the Ajax clinic and Lakeridge Health Ajax Pickering, where he was given a mask and isolated. He was tested for the virus, discharged and sent home.  

He has also been put in self-isolation, where he remains.

Millions of uninsured Americans like me are a COVID-19 timebomb

An opinion piece in The Guardian: Millions of uninsured Americans like me are a coronavirus timebomb.

Like 27.5 million other Americans, I don’t have health insurance. It’s not for a lack of trying – I make too much to qualify for Medicaid, but not enough to buy a private health insurance plan on the Affordable Care Act exchanges. Since I can’t afford to see a doctor, my healthcare strategy as a 32-year-old uninsured American has been simply to sleep eight hours, eat vegetables, and get daily exercise. But now that there are confirmed coronavirus cases in the United States, the deadly virus could spread rapidly, thanks to others like me who have no feasible way to get the care we need if we start exhibiting symptoms.

According to the Centers for Disease Control and Prevention, there are confirmed coronavirus cases in at least 50 countries on six continents, and more than 2,800 patients have died from the virus. This certainly qualifies as a pandemic under the World Health Organization’s (WHO) definition of the term, which, under a typical presidency, should necessitate a swift response from US health officials. However, the Trump administration appears to still be prioritizing the profit margin of the healthcare industry over preventing the spread of a deadly pandemic. 

Earlier this week, the Department of Health and Human Services secretary, Alex Azar, (a former senior executive at pharmaceutical manufacturer Eli Lilly) refused to commit to implementing price controls on a coronavirus vaccine “because we need the private sector to invest … price controls won’t get us there”. Even the House speaker, Nancy Pelosi, notably didn’t use the word “free” when referring to a coronavirus vaccine, and instead used the word “affordable”. 

What may be considered affordable for the third-most powerful person in the US government with an estimated net worth of $16m may not be affordable for someone who can’t afford a basic private health insurance plan that still requires a patient to pay thousands of dollars out of pocket.  

Given the high cost of healthcare in the US, I haven’t seen a doctor since 2013, when I visited an emergency room after being run off the road while riding my bike. After waiting for four hours, the doctor put my arm in a sling, prescribed pain medication and sent me home. That visit cost more than $4,000, and the unpaid balance eventually went to collections and still haunts my credit to this day, making it needlessly difficult to rent an apartment or buy a car. But even a low-premium bronze plan on the exchange comes with a sky-high deductible in the thousands of dollars, meaning even if I was insured, I’d have still paid for that ER visit entirely out of pocket. 

This system is exactly why a 2018 West Health Institute/NORC at the University of Chicago national poll found that 44% of Americans declined to see a doctor due to cost, and why nearly a third of Americans polled said they didn’t get their prescriptions filled due to the high cost of their medicine. 

This is the same system that killed 38-year-old Texas public school teacher Heather Holland, who couldn’t afford the $116 co-pay for her flu medication and later died from flu complications. It’s the same system that Guardian contributor Luke O’Neil refers to as “Go viral or die trying”, in which Americans who can’t afford life-saving healthcare procedures are forced to become their own advocate and PR agency by launching a viral GoFundMe campaign to ask strangers on the internet to save their lives.  

When you multiply my situation by 27.5 million, you end up with a country full of people who won’t see a doctor unless they’re extremely sick. And when you combine a for-profit healthcare system – in which only those wealthy enough to get care actually receive it – with a global pandemic, the only outcome will be unmitigated disaster. 

This could be somewhat remedied if the US had a single-payer, universal healthcare system, like every other industrialized nation. And as a team of Yale epidemiologists discovered in a study recently published in the Lancet, a single-payer healthcare system in the US could simultaneously save 68,000 lives and $450bn in taxpayer dollars each year.  

Yes, countries with single-payer systems still have coronavirus cases, Italy and Japan. But the spread of the virus in those countries would likely pale in comparison to the potential spread of coronavirus in the US, in which a significant portion of the population simply won’t go to the doctor if they’re sick. Coronavirus is a worldwide public health emergency, and massive profits for health insurers and pharmaceutical manufacturers shouldn’t come before the basic health and safety of human beings.

Washington state sees 1st COVID-19 death in US, declares emergency

Thanks to Helen Branswell for tweeting about this situation. Via seattlepi.com: Wash. state sees 1st virus death in US, declares emergency. Excerpt and then a comment:

The governor of Washington declared a state of emergency Saturday after a man died there of COVID-19, the first such reported death in the United States. More than 50 people in a nursing facility are sick and being tested for the virus.  

Gov. Jay Inslee directed state agencies to use “all resources necessary” to prepare for and respond to the coronavirus outbreak. The declaration also allows the use of the Washington National Guard, if necessary.  

“We will continue to work toward a day where no one dies from this virus," the governor vowed.  

Health officials in California, Oregon and Washington state are worried about the novel coronavirus spreading through West Coast communities because a growing number of people are being infected despite not having visited an area where there was an outbreak, nor apparently been in contact with anyone who had. 

The man who died was in his 50s, had underlying health conditions and no history of travel or contact with a known COVID-19 case, health officials in Washington state said at a news conference. A spokesperson for EvergreenHealth Medical Center, Kayse Dahl, said the person died in the facility in the Seattle suburb of Kirkland. 

 Dr. Frank Riedo, medical director of Infection Control at Evergreen, said local hospitals are seeing people with severe coronavirus symptoms but it’s probable that there are more cases in the community. 

“This is the tip of the iceberg,” he said.  

The health officials reported two cases of COVID-19 virus connected to a long-term care facility in the same suburb, Life Care Center of Kirkland. One is a Life Care worker, a woman in her 40s who is in satisfactory condition at a hospital, and the other is a woman in her 70s and a resident at Life Care who is hospitalized in serious condition. Neither had traveled abroad.  

“In addition, over 50 individuals associated with Life Care are reportedly ill with respiratory symptoms or hospitalized with pneumonia or other respiratory conditions of unknown cause and are being tested for COVID-19,” Seattle and King County officials said. “Additional positive cases are expected.” 

Amy Reynolds of the Washington state health department said in a brief telephone interview: “We are dealing with an emergency evolving situation.”

This is precisely the situation that worries me the most: COVID-19 breaking out in hospitals and care facilities full of older people with pre-existing conditions, and hitting both them and their caregivers. How do you explain to care-home residents with dementia why people are running around in white coveralls, spraying disinfectant everywhere?