H5N1

How Canada has bungled the COVID-19 endgame

Via Macleans.ca, Amir Attaran describes How Canada has bungled the COVID-19 endgame. Excerpt and then a comment:

About two months ago, as Canada was thrust into a terrifying lockdown, I wrote a piece in Maclean’s asking “What does the COVID-19 endgame look like?”  As a scientist I offered a roadmap for returning Canada to normalcy, and explained that it would be a long but predictable slog: first riding the lockdown to the point of bringing disease transmission to virtually nil, followed by a series of staged reopenings, monitored throughout by extensive COVID-19 testing and contact tracing to detect minor outbreaks quickly and squash them. 

That approach is now so uncontroversial that no serious experts disagree. 

But since then, it has become apparent that some provinces are not following that approach, and that Canada is stumbling through the endgame. 

Our progress on “bending the curve” is halting and unimpressive compared to Europe and Asia. Our testing is so broken down that it lags behind Rwanda’s and Ethiopia’s. Our epidemiological data is so inadequate that even if we wanted to conduct the endgame well, often we cannot. Places like Toronto and Quebec are reopening too soon, risking to sicken—and kill—people needlessly, while the Maritimes and Prairies are reopening too slowly, strangling the economy. 

Simply put, Canada is bungling its most significant peacetime crisis in a century.  That is why I am writing this sequel not just as a health scientist, but also as a constitutional lawyer—because the seeds of our failure are everywhere. 

Canada’s failing disease control 

Let’s start with the big question: is Canada really “bending the curve”? 

 The answer is, “not much”. Many Canadians think we have because we are doing better than the United States—a country having no public health care, vocal COVID-19 deniers, and a president who recommends injecting bleach.  The Americans are obviously not the right comparators.  Better to compare Canada with other wealthy countries, especially confederations having federal-provincial complications like our own. 

The graph below shows confirmed COVID-19 cases, averaged every seven days, and adjusted for population size. Each country’s line starts on the day that it crosses the threshold of 1 case per million persons, just before a runaway climb. 

 Canada (the black line) was the last country to cross that threshold.  That lucky turn gave us extra time to prepare, and the benefit of learning from others before us, which we could have parlayed into a lower infection peak.  

Except our governments blew it fantastically. 

Instead of the successful nosedive in France, Germany, Spain, or Switzerland—a feat their governments achieved despite a faster climb and higher peak—Canada’s curve resembles an undulating plateau or bunny ski hill.  By May 25, Canada was in the same place as April 4—fully seven wasted weeks, littered with thousands of dead.  

We could have been like Australia. It is a large, sparsely populated, regionalized confederation of states, much like our own provinces. Australia crossed the threshold of 1 case per million just a day before us—we were tied in mid-March. But instead of dithering, Australia’s endgame smashed the curve hard and fast. Its results are almost as impressive as South Korea’s, but with less authoritarianism, in a society very much like our own.  

Now Australia’s reopening, confidently, and we are not. Through it, they suffered barely 100 dead. We are nearing 7,000 dead—which works out to a per capita death rate only a little better than Donald Trump’s United States. 

Testing is failing  

Let’s next talk about COVID-19 testing. Nobody disagrees that Canada needs more, faster testing. The scientific goal is not simply testing the sick, but tracing and over-testing the healthy around them, so as to isolate the positives for 14 days and nip new outbreaks in the bud. Do that enough, and it’s possible to drive COVID-19 down to virtually nil like in Australia.  This is the so-called “testing and tracing” strategy.  

Yet Canada’s testing remains awful, especially in Ontario and Quebec.

According to Covidly.com, Canada tonight reports 91,451 cases and 7,231 fatalities. BC has done relatively well, but only compared to Ontario and Quebec. Our national numbers are worse than an embarrassment. The country is now beginning to open up, and I will not be surprised if we see a spike in cases.

COVID-19 updates from The Washington Post

Coronavirus Updates from The Washington Post. Click through for many links. Excerpt:

The latest 

“We’re millennials, we’re healthy,” a young woman told The Washington Post as she sat with her friends outside a bustling lakeside grill in Missouri this weekend.  

“The pandemic is made up,” said a man in line with his daughter, grandson and hundreds of strangers at a North Carolina speedway. 

“I can't breathe!” chanted demonstrators who gathered by the thousands in cities across the country, quoting from George Floyd's final words as he lay dying under the weight of a Minneapolis police officer last week.  

Be it from outrage, apathy or simple contrarianism, social distancing strictures are rapidly dissolving as crowds party, protest or riot in American cities that just days earlier resembled ghost towns. The coronavirus is almost certainly spreading among them, and already appears to be staging a national comeback. “Arizona, Mississippi, South Carolina, Utah and Wisconsin all set record highs for new cases reported Friday,” The Post wrote, noting that all those states relaxed their quarantine rules this month.    

“There’s going to be a lot of issues coming out of what’s happened in the last week, but one of them is going to be that chains of transmission will have become lit from these gatherings,” former Food and Drug Administration commissioner Scott Gottlieb told CBS News on Sunday.   

At the same time, the disorder is making it harder for health officials to track and suppress new outbreaks. In Los Angeles, for example, uncontrolled protests caused the mayor to close all coronavirus testing centers in the city. 

No one seems to be in control, or even trying to abate the chaos, our political desk wrote: In Minneapolis, “businesses burned to the ground. The nation watched on live TV as crowds looted liquor stores and other shops, with no pushback from the authorities.”  

President Trump, who has repeatedly encouraged people to defy his own administration's quarantine guidelines, seemed to savor the idea of protesters and counterprotesters facing off in the streets. “Tonight, I understand, is MAGA NIGHT AT THE WHITE HOUSE???” he tweeted Saturday after Floyd demonstrators attacked Secret Service agents outside his residence.

'People are going to go hungry': COVID-19 pandemic effects could leave 54 million Americans without food

Via The Guardian: 'People are going to go hungry': pandemic effects could leave 54m Americans without food. Excerpt:

A record number of Americans face hunger this year as the catastrophic economic fallout caused by the coronavirus pandemic looks set to leave tens of millions of people unable to buy enough food to feed their families. 

Nationwide, the demand for aid at food banks and pantries has soared since the virus forced the economy to be shutdown, resulting in more than 40m new unemployment benefit claims, according to the latest figures. 

As a result, an estimated one in four children, the equivalent of 18 million minors, could need food aid this year – a 63% increase compared to 2018.  

Overall, about 54 million people across the US could go hungry without help from food banks, food stamps and other aid, according to an analysis by Feeding America, the national food bank network.  

Credit: Feeding America 

America’s food insecurity crisis was dire even before the Covid-19 pandemic, when at least 37 million people lived in households without adequate resources to guarantee consistent access to enough food for an active, healthy life.

Food insecurity varies vastly from state to state, and county to county, and had only recently fallen to pre-Great Recession levels. The current crisis will almost certainly reverse hard-fought for improvements, and exacerbate existing inequalities.  

It’s the deep south where the economic impact and food insecurity will probably penetrate deepest: more than 11 million people in the states of Louisiana, Arkansas, Alabama, Mississippi, New Mexico, Texas and Tennessee are projected to suffer food insecurity in 2020. 

The projections assume a national annual unemployment rate of 11.5% – 7.6 percentage points higher than 2018 – and a national annual poverty rate of 16.6% – 4.8 points higher than 2018. 

In Mississippi, proportionately the worst-affected state before and since the pandemic, almost three-quarters of a million people could need food aid this year, including one in every three children. 

Two crises convulse a nation: A COVID-19 pandemic and police violence

Via The New York Times: Two Crises Convulse a Nation: A Pandemic and Police Violence. Excerpt:

They are parallel plagues ravaging America: The coronavirus. And police killings of black men and women.  

Jimmy Mills’s life has been upended by both. His barbershop in Midtown Minneapolis was one of many small, black-owned businesses that have struggled to survive the pandemic. But Mr. Mills was hopeful because, after two months shut down, he was due to reopen next week.  

Then early on Friday, the working-class neighborhood where Mr. Mills has cut hair for 12 years went up in flames as chaotic protests over the death of George Floyd and police killings of African-Americans engulfed Minneapolis and cities across the country. 

“To have corona, and then this — it’s like a gut shot,” Mr. Mills, 56, said.  

The upheaval sparked by a video capturing Mr. Floyd’s agonizing last minutes as a white police officer kneels on his neck is pulsing through an America already ragged with anger and anxiety. Emotions are raw over the toll of a pandemic that has killed more than 100,000 people across the country and cost millions of jobs.  

Minneapolis residents said outrage and protests in the aftermath of the killing of George Floyd were a result of a community being tested repeatedly in recent weeks by both police violence and the virus — and in ways that put America’s deep racial inequalities in stark relief. 

The outbreak has inflicted disproportionate economic and health tolls on racial minorities and immigrants in Minneapolis and beyond. Black and Latino workers have been more likely to have lost their jobs. Many others are among the low-paid hourly workers who risk their health by going to work at grocery stores, nursing homes, factories, slaughterhouses and other jobs that cannot be done remotely. 

The black community in Minnesota has also been hit hard by cases of the virus, just as African-Americans across the country are being infected and dying at higher rates. 

By one estimate, black people accounted for at least 29 percent of known Covid-19 cases in Minnesota, despite making up about 6 percent of the state’s population. African-Americans make up 35 percent of coronavirus cases in Minneapolis, though they are less than 20 percent of the city’s population.

South Korea's new COVID-19 cases drop to 27, continuing downward trend

Via Yonhap: S. Korea's new virus cases drop to 27, continuing downward trend. Excerpt:

SEOUL, May 31 (Yonhap) -- South Korea reported 27 new cases of the coronavirus Sunday, the lowest since a logistics center-linked cluster infection brought the daily new cases to nearly a two-month high last week, as health officials kept up efforts to prevent similar collective infections. 

The new cases, 15 of them local infections, raised South Korea's total coronavirus caseload to 11,468, according to the Korea Centers for Disease Control and Prevention (KCDC).  

It marks the first time in five days that the daily number of virus cases was below 30. The daily rise of new virus cases reached nearly a two month-high of 79 on Thursday, then declined to 58 Friday and 39 Saturday. 

But health authorities remain on high alert amid concerns recent cluster infections could develop into another wave of massive infections amid school reopenings. 

Of the new cases, six were in Seoul. Nearby Gyeonggi Province and Incheon accounted for 12 and three cases, respectively. 

A distribution facility run by e-commerce leader Coupang Inc. in Bucheon, just west of Seoul, has emerged as a cluster infection as health authorities have been grappling with mass infections tied to nightclubs and bars in Seoul's nightlife neighborhood of Itaewon earlier this month. 

As of noon, 111 cases have been traced to the distribution center, up three from the previous day, according to the KCDC. The first patient from the distribution center was confirmed on May 23.  

So far, 270 cases have been linked to the Itaewon cluster, the KCDC added, with nearly half of them identified in Seoul. 

Health authorities are also keeping a watchful eye on sporadic outbreaks in the nation's capital area, including cases coming from Campus Crusade For Christ and an announcer academy in Seoul. 

Of the 12 new imported cases, half of them were from the United States.

MSF opens coronavirus COVID-19 centre in Venezuela

Via MSF.org: MSF opens coronavirus COVID-19 centre in Venezuela.

More than 100 professionals from different disciplines have set up a specialist COVID-19 centre in a wing of the Ana Francisca Pérez de León II hospital in Petare, northeast Caracas, Venezuela. 

The plan to rehabilitate the hospital’s infrastructure and create an inpatient unit, including intensive care beds, where COVID-19 patients can receive medical and psychological care, is being carried out by Médecins Sans Frontières (MSF) in collaboration with Venezuelan authorities and the hospital's management team. Hospital staff have also received personal protective equipment (PPE) and training.    

MSF staff working with hospital staff across disciplines 

A team, made up of MSF and hospital staff and including doctors, nurses, epidemiologists, psychologists, technicians and transport and maintenance staff, has already begun caring for patients with COVID-19 symptoms. 

“It has been hard work and not without its challenges, due to the urgency of the situation and the need to adapt the hospital structure to the biosecurity measures, without compromising the rest of its emergency activities,” says Isaac Alcalde, coordinating MSF's emergency responses in Caracas and Miranda. “This has been possible thanks to the willingness of MSF staff and the hospital’s management team to find the best solutions for patients. It's a new situation for everyone.” 

Challenges in providing protective equipment 

So far, one of the biggest challenges for MSF in our global response to COVID-19 has been the shortage of PPE for our medical teams.

“We know that, in many countries, health workers have been exposed to risk, and there have been many infections due to the lack of PPE,” says Alcalde. “We will do our best to ensure that this does not happen here.”  

“But even with sufficient protection, the medical teams will face very difficult situations, both personally and professionally,” continues Alcalde. “We will make sure to provide them with all the support they need, including psychological support, to minimise the impact of this extraordinary situation.”   

MSF providing contact tracing, psychological care 

People arriving at the Ana Francisca Pérez de León II hospital with suspected COVID-19 are received by a medical team and questioned about their symptoms before being tested, either with a rapid test or with a polymerase chain reaction (PCR) test. Those who test positive are taken to the isolation area to be stabilised and to receive medical and psychological care. 

An MSF team visits patients’ families to provide health information and psychological support, while actively tracing the patient’s contacts and searching for other people with symptoms within their community. 

The COVID-19 centre has 22 beds, including 16 inpatient beds and 6 intensive care beds. We are also operating three ambulances, and have rehabilitated a further five public ambulances, for transporting patients between hospitals and between local diagnosis centres and hospitals. These are available not only for coronavirus patients but for patients suffering from other medical emergencies.

COVID-19: Projections for 4 Canadian provinces

Via COVID-19 Projections Using Machine Learning:

May 27: We added 7 new countries (Australia, Belarus, Bolivia, Cuba, Honduras, Kuwait, UAE), 2 Canadian provinces (Alberta and British Columbia), and 20 US counties. We now have projections for 71 countries (>99% of all global COVID-19 deaths), 4 Canadian provinces (99% of Canadian COVID-19 deaths), 56 US states and territories, and 34 US counties (including the top 30 most populous counties).

The projections for Canada's 4 provinces are dramatically different:

Hong Kong: Fears over workplace transmission as Hong Kong woman, husband confirmed with COVID-19 and two of her colleagues test positive

Via the South China Morning Post: Coronavirus: fears over workplace transmission as Hong Kong woman, husband confirmed with Covid-19 and two of her colleagues test positive. Excerpt:

Health authorities in Hong Kong are investigating a possible workplace transmission of Covid-19 after a woman employed at an imported food warehouse was confirmed with the coronavirus on Sunday, while two of her colleagues tested weak positive. 

The husband of the 34-year-old woman was also confirmed with the disease on Sunday, ending the city’s more than two-week run without a local coronavirus infection. Hong Kong’s tally of confirmed cases now stands at 1,084. 

Speaking at a daily press briefing, Dr Chuang Shuk-kwan, head of the Centre for Health Protection’s communicable disease branch, said the two other women who tested weak positive had been sick much earlier, between April 25 and 27, and did not rule out the possibility of workplace transmission. Neither of them had any travel history. 

“As the two women who tested weak positive had symptoms earlier than the confirmed patient, there is a chance of a transmission chain within the warehouse,” Chuang said. “But we are still investigating the exact path the virus was passed.” 

The three women worked the night shift at a Kerry Logistics warehouse in Kwai Chung labelling pre-packaged fruit and vegetables from the United Kingdom. Their other 25 colleagues will be sent to quarantine centres. 

Up to 100 other people who worked in the same building will also be asked to give samples for testing.  

Meanwhile, Dr Sara Ho Yuen-ha, the Hospital Authority’s chief manager for patient safety and risk management, revealed at the briefing that three of the emergency medical staff who attended to the woman when she was first sent to hospital had not been wearing the full set of protective clothing. 

“The patient was already in critical condition when she first arrived at the accident and emergency department and was losing consciousness, so some medical staff volunteered to help,” she said. It was later discovered that a doctor, a nurse and a medical assistant had not worn protective gowns. Ho said they would be quarantined for 14 days as close contacts of the confirmed patient. 

The last time a local infection – a patient with no recent travel history – was reported was on May 14.

The husband, 56, and wife in the newest case live in the Lek Yuen Estate in Sha Tin with the husband’s sister, Chuang said. The woman is on a ventilator in the intensive care unit of the Prince of Wales Hospital in Sha Tin. The sister, who has shown no symptoms, has been sent to a quarantine centre.

The wife had visited a private doctor in Lek Yuen estate three times before she began feeling chest pains and was sent to the hospital on Saturday. The doctor was treating her for an upper respiratory tract infection as she did not have any travel history, Chuang said.

The general practitioner and his staff will now be asked to give throat samples, while Chuang has reminded private clinics not to let their guard down with patients with respiratory symptoms, saying they should arrange for them to be tested for Covid-19.

It’s not just Trump — Twitter fact-checking thousands of tweets, many about COVID-19

Via Global News, a Reuters report: It’s not just Trump — Twitter fact-checking thousands of tweets, many about coronavirus. Excerpt:

In addition to disputing misleading claims made by U.S. President Donald Trump about mail-in ballots this week, Twitter has added fact-checking labels to thousands of other tweets since introducing the alerts earlier this month, mostly on posts about the coronavirus. 

The company does not expect to need additional staff for the undertaking, Twitter spokeswoman Liz Kelley said on Saturday. Nor is it partnering with independent fact-checking organizations, as Facebook and Google have, to outsource the debunking of viral posts flagged by users.  

Social media platforms have been under fierce scrutiny over how they police rapidly spreading false information and other types of abusive content since Russia exploited the networks to interfere in the 2016 U.S. presidential election.  

Fact-checking groups said they welcomed Twitter’s new approach, which adds a “get the facts” tag linking to more information, but said they hoped the company would more clearly lay out its methodology and reasoning. 

On Friday, Chief Executive Jack Dorsey acknowledged the criticism, saying he agreed fact-checking “should be open source and thus verifiable by everyone.” In a separate tweet, Dorsey said more transparency from the company was “critical.” 

The company’s move to label Trump’s claims about mail-in ballots separates it from larger competitors such as Facebook , which declares its neutrality by leaving fact-check decisions to third-party partners and exempts politicians’ posts from review.

“To a degree, fact-checking is subjective. It’s subjective in what you pick to check, and it’s subjective in how you rate something,” said Aaron Sharockman, executive director of U.S. fact-checking site PolitiFact, who said Twitter’s process was opaque.  

Twitter telegraphed in May that its new policy of adding fact-checking labels to disputed or misleading coronavirus information would be expanded to other topics.  

It said this week — after tagging Trump’s tweets — that it was now labeling misleading content related to election integrity.

Twitter’s Kelley said the team is continuing to expand the effort to include other topics, prioritizing claims that could cause people immediate harm.

COVID-19 on Saturday afternoon: The failure of the proctocracies

A screenshot from Worldometer taken at 3:50 p.m. Pacific time: Coronavirus Update (Live): 6,146,622 Cases and 370,453 Deaths from COVID-19 Virus Pandemic.

Most media rely on the Johns Hopkins dashboard for their numbers. though it eventually catches up to Worldometer and Covidly.com within a day or less. So let's take Worldometer as a fairly reliable tally, though of course probably a serious undercount.

 

The US is at 1.8 million cases and 105,000 deaths, far ahead of everyone else. It is worth reflecting on the fact that a single man, elected to the presidency, could so effectively cripple the healthcare system of the world's richest country. 

 

Brazil will cross the half-million case count tonight, having just logged another record: 30,000 cases in the past 24 hours. Bolsonaro has certainly aggravated COVID-19 in Brazil, but so has the country's extreme inequality and an over-stretched healthcare system.

 

I take Russia's numbers as a really severe undercount, but even these numbers are bad. Putin has shown he can get away with murder even more gracefully than Saudi Arabia's Crown Prince Mohammed Bin Salman, but the pandemic seems to have caught him off balance.

 

Let's pause there, but look at all 15 countries at the top of the COVID-19 list. I would argue that 11 of them are run by demagogues or populists. France, Germany, and Canada are democracies with a good press; their numbers, however are not good at all. If Canada hadn't dithered back in February and March, we wouldn't have anything like 90,000 cases at the end of May.

 

New Zealand has been basking in the glory of just 1,504 cases and only 22 deaths, thanks to Prime Minister Jacinda Ardern's prompt closing of the country and her brilliant health communication.

 

Yet, Worldometer puts Vietnam (population 97 milllion) at #148 with 328 cases total and zero deaths. Every new case predictably comes off a plane carrying repatriated citizens, and is screened and quarantined while still on the tarmac. I'd have to check Wikipedia even to find out who the country's leader is; it's just another kinda-sorta Communist regime running sweatshops for Western corporations. 

 

If we can draw conclusions from today's numbers, it's that proctocracies (governments run by assholes) respond abysmally  to pandemics. Parliamentary democracies may or may not do well. But governments run by competent people, democracies or autocracies, can get their countries through the first wave with minimal casualties.