H5N1

Canada: Hospitals in COVID-19 hot spots warn situation is about to become even more dire

As 2020 concludes, Canada's healthcare system is feeling the strain. Via The Globe and Mail, a report by The Canadian Press: Hospitals in COVID-19 hot spots warn situation is about to become even more dire. Excerpt:

Hospitalizations from COVID-19 are increasing sharply in several provinces, pushing health care facilities beyond capacity even in places that have had recent success in bringing down infections. 

There were more patients in Canada in intensive care this week than at any other point in the pandemic, according to data compiled by The Globe and Mail, and experts are expecting hospitalizations to continue increasing well into the new year. 

Ontario set a single-day record for both COVID-19 cases and number of people hospitalized on Thursday. Hospitalizations in Quebec have doubled in a little more than a month. In Alberta, which has the highest hospitalization rates in the country, more people were admitted but the province did not provide specifics because of the holidays. Hospitals in Saskatchewan are at or above capacity as the province’s record-setting infections from two weeks ago translate to more emergency room visits. 

“It seems like every day we reach a new kind of threshold that maybe a few months ago we thought was impossible,” said Anthony Dale, president and chief executive officer of the Ontario Hospital Association. “This pandemic is accelerating. We’re not peaking, we’re not at the downward slope, so these numbers are going to get a heck of a lot worse, in all probability.”  

Provinces hardest hit by COVID-19 in the second wave have had to scramble to increase bed capacity and cancel surgeries and other procedures to keep up with the workload. Those same hospitals are also now taking on a significant role in administering vaccines, particularly the one from Pfizer-BioNTech that cannot be easily stored and transported. 

Across the country, there were more than 4,000 people in hospital with COVID-19 as of Wednesday, including 769 in intensive-care units, according to The Globe’s data. That is the highest number of COVID-19 ICU admissions recorded.  

In Ontario, one in five patients in intensive care has COVID-19. In some hospitals, such as Credit Valley Hospital in Mississauga, more than half of the ICU beds hold COVID-19 patients.  

“This comes at a huge cost of cancelled elective surgery. ... Elective includes cancer care, cardiac care, even organ transplants,” Mr. Dale said. 

Staffing has also been a challenge for some hospitals, where Mr. Dale said vacancy rates are likely at a “historic high” at as much as 10 per cent. Hospitals are seeing high levels of early retirement in the second wave, and younger health care workers haven’t always been able to replace retiring colleagues.  

Some patients in overcrowded hospitals are being treated in “unconventional spaces” such as sun rooms, said Gerald Evans, an infectious-diseases physician at Kingston General Hospital. He added there is not always enough staff to properly care for the extra patients. 

“Instead of it being three or four patients for one nurse, now a nurse may be taking care of eight or nine patients,” said Dr. Evans. “It doesn’t take a lot of science to figure out that could be really dangerous, especially if one or two of those patients is very ill and requires a lot of attention.”

One year's toll of COVID-19: 82,891,737 cases, 1,808,450 deaths

A screenshot from the Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard:

After a relative drop in new cases for a couple of days, yesterday's case count rose sharply to 756,435.

COVID-19: Thoughts at the end of Year 1

Precisely one year ago today, to the hour, I was sitting here at the kitchen table doing my usual morning scan of Google alerts, email, and new posts from other bloggers. After a few minutes, at 7:48 a.m. I made my first post about what became known as COVID-19:

Hong Kong: CHP closely monitors cluster of pneumonia cases on Mainland

Thanks to Mike Coston, Giuseppe Michieli, and Ian Mackay for alerting me to this report by the Centre for Health Protection: CHP closely monitors cluster of pneumonia cases on Mainland. Excerpt: 

The Centre for Health Protection (CHP) of the Department of Health is today (December 31) closely monitoring a cluster of pneumonia cases in Wuhan, Hubei Province, and has contacted the National Health Commission for further information.

According to an announcement from the Health Commission of Hubei Province, a number of pneumonia cases related to a local seafood market was recently reported in Wuhan. The Wuhan Municipal Health Commission has commenced investigation and so far identified 27 cases. Among them, seven cases were serious and the remaining were stable. Symptoms were mainly fever while a few had presented with shortness of breath. All patients are isolated and receiving treatment. Contact tracing of close contacts and medical surveillance are ongoing.

The Wuhan Municipal Health Commission announced that assessment by relevant experts revealed that the cases were compatible with viral pneumonia. For the time being, no obvious human-to-human transmission has been observed and no healthcare workers have been infected. The causative pathogen and cause of infection are still under investigation.

Locally, while surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.

The CHP's Port Health Division conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases with serious infectious diseases identified will be immediately referred to public hospitals for isolation, treatment and follow-up. The CHP has also informed the Hospital Authority about the cluster of pneumonia cases in Wuhan.

Travellers are reminded to wear surgical masks and seek medical attention if they present with respiratory symptoms, and reveal their travel history to doctors. The CHP will continue to closely monitor the latest situation of the cluster of pneumonia cases in Wuhan and update the surveillance criteria and testing strategies accordingly. 

Mike Coston has three posts on the outbreak and the response in Hong Kong and Taiwan. A quick check of Wuhan media didn't turn up anything, but I'll keep looking around.

I posted several items that morning. Far more knowledgeable people than I were clearly worried, and this "unxplained pneumonia" stirred echoes of SARS—the outbreak that first got me interested in emerging diseases and blogging. If this was like H5N1, H1N1, H7N9, cholera, MERS, and Ebola, the Wuhan outbreak would tell us a lot about the society dealing with it. China had tried to suppress news of SARS, and suffered for it. Its response to H7N9 avian flu had been far more open, and earned China new respect as a country with a vastly better public health system. 

Well, we learned China will still suppress news when it wants to, and will respond with breathtaking decisiveness when it wants to. And we've also learned that a real pandemic tells us a lot about every society it affects—including our own. These have been unpleasant insights, especially into those countries that fancy themselves "advanced." 

Now we begin Year 2 of COVID-19, and I do not expect a sudden news story to announce its end. It will go on for a long time, driven into corners and then resurging again and again—not because it's so malevolent, but because we are so stupid, and we insist on paying high tuition fees for very simple lessons.

25 days that changed the world: How Covid-19 slipped China’s grasp

A must-read from The New York Times: 25 Days That Changed the World: How Covid-19 Slipped China’s Grasp. Excerpt:

The most famous doctor in China was on an urgent mission. Celebrated as the hero who helped uncover the SARS epidemic 17 years ago, Dr. Zhong Nanshan, now 84, was under orders to rush to Wuhan, a city in central China, and investigate a strange new coronavirus. His assistant photographed the doctor on the night train, eyes closed in thought, an image that would later rocket around China and burnish Dr. Zhong’s reputation as the nation’s medic riding to the rescue. 

China’s official history now portrays Dr. Zhong’s trip as the cinematic turning point in an ultimately triumphant war against Covid-19, when he discovered the virus was spreading dangerously and sped to Beijing to sound the alarm. Four days later, on Jan. 23, China’s leader, Xi Jinping, sealed off Wuhan. 

That lockdown was the first decisive step in saving China. But in a pandemic that has since claimed more than 1.7 million lives, it came too late to prevent the virus from spilling into the rest of the world. 

The first alarm had actually sounded 25 days earlier, exactly a year ago, last Dec. 30. Even before then, Chinese doctors and scientists had been pushing for answers, yet officials in Wuhan and Beijing concealed the extent of infections or refused to act on warnings.  

Politics stymied science, in a tension that would define the pandemic. China’s delayed initial response unleashed the virus on the world and foreshadowed battles between scientists and political leaders over transparency, public health and economics that would play out across continents. 

This article — drawing on Chinese government documents, internal sources, interviews, research papers and books, including neglected or censored public accounts — examines those 25 days in China that changed the world.

COVID-19 on Wednesday morning: 82,115,011 cases, 1,793,368 deaths

A screenshot from the Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard:

After a couple of days of case counts below 500,000, 665,098 cases were reported worldwide yesterday.

Los Angeles: Our century-old mask wars

Via The Los Angeles Times: Coronavirus Today: Our century-old mask wars. Excerpt:

Good evening. I’m Amina Khan, and it’s Tuesday, Dec. 29. Here’s what’s happening with the coronavirus in California and beyond. 

The pitched political battle over masks may feel like a quintessentially 2020 kind of conflict. But as it turns out, the anti-mask movement is more than a century old. Columnist Gustavo Arellano takes us back to 1919, when the world was facing another devastating global outbreak: the so-called Spanish flu, which is estimated to have infected a third of the world’s population and killed at least 50 million.  

Back then, more than 700 concerned citizens and doctors signed a petition asking the Los Angeles City Council to enact a mask mandate to combat the pandemic, or “the disease will come back again, and will exact a heavier toll than ever.” 

But councilmembers wouldn’t budge. One said the masks left the wearer “breathing in the foul air which they exhale.” Another snarked that he might have been more sympathetic “if the doctors would come through and agree on some one thing, or if any of them could agree at all.” A third said he would “not propose to take the advice of a lot of outsiders.”  

L.A. weathered the flu pandemic better than most major American cities, largely thanks to City Health Commissioner Dr. Luther Powers, who shut down businesses and schools early on, even when others did not. But Powers had a chance to save even more lives by implementing a mask ordinance — and he didn’t. 

If Powers had required everyone to wear masks in public, that “would’ve had an impact,” said J. Alexander Navarro, a medical historian at the University of Michigan.

Widespread mask use in L.A. seemed imminent when the Spanish flu hit California in the fall of 1918, Arellano writes. San Francisco issued an order for people to wear them outside their homes, and San Diego required them for anyone serving the public. Gov. William D. Stephens urged Californians to wear masks, saying they offered “but little discomfort and means a service rendered to our fellow-men and to our country.” 

These messages appear to have had an effect: The Times reported on Oct. 23 that masks in L.A. “were quite common in large offices ... where the general public is coming and going all day in numbers.” 

Mayor Frederick Woodman even brought a resolution to the City Council to enforce mask wearing, but Powers balked and the enforcement measure failed. Instead, the council passed a measure advising the public to wear masks, but not requiring it.  

The window of opportunity, it seemed, had closed. The council soon became hostile to a mask mandate. This paper openly called masks “muzzles” and published editorial cartoons mocking their advocates. In a Dec. 1, 1918, editorial titled “Adios ‘Flu’ Scare!” the paper’s editorial board wrote that “the real sufferers are the men and women whose incomes have been stopped, whose businesses have been all but ruined.” Sound familiar? 

Little did they know that the city was about to be overwhelmed by a second wave of influenza. In January, Powers finally wrote up a mask mandate but ultimately did not back its passage.

Vietnam: A curious case of COVID-19

In his Substack newsletter Vietnam Weekly, Michael Tatarski writes: A Curious Case of COVID-19.

On Saturday, news broke that a 32 year-old Vietnamese man had tested positive for COVID-19 in Vinh Long Province, in the Mekong Delta. A complex travel history was then uncovered: the individual had traveled from Myanmar, where he was working, to Thailand by truck on December 15. 

On December 22, he boarded a truck for Cambodia with six other people, and on December 24 they arrived at the border with Vietnam, which they crossed illegally. He went on to his mother’s house in Vinh Long, and she promptly reported him to local authorities so that he could be quarantined and tested. (Go mom!)  

It appears that all of these borders crossings were illegal, which highlights how worryingly porous borders are in mainland Southeast Asia. It’s also impossible to know exactly where the point of infection occurred, given that this person crossed three countries overland. 

Contact tracing proved difficult, as the individual in question apparently didn’t know exactly where he crossed the border, or what bus/truck companies he used after entering Vietnam.  

Eventually, health officials figured out that he had crossed into the country with five other Vietnamese people by boat. On Monday, another member of the group tested positive, this time in Ho Chi Minh City’s District 5.  

He was taken to quarantine for treatment, while his apartment building was locked down.  

And yesterday, two more members of the group tested positive for COVID-19: a 32-year-old woman in Dong Thap Province, and a man in District 9 (who took a while to find - he claimed he hadn’t looked at the news at all this week and didn’t know officials were looking for him). The two final members of the group of six have tested negative. 

As expected, detailed contact tracing began for all of these cases, with the names of specific bus stations, rest stops, and businesses published, and testing of known contacts is underway, with no further reported cases at the time of writing (Wednesday morning). 

Thankfully, it appears that these four infections occurred outside of Vietnam, though this raises the question of where exactly along their extended multi-national trek they picked it up. (Is COVID-19 rampant along illegal migration pipelines right across Southeast Asia?)  

Local media has been filling in some more details on this journey, and it seems rather odd that someone would leave Vietnam, a vibrant economy, for illegal work in Myanmar, but there are obviously lots of dynamics at work here. This morning it was reported that the man in Vinh Long paid VND50 million (borrowed from his family) to various brokers to get across borders.  

In response to all of this, officials have warned that many Vietnamese will try to return home for the Lunar New Year (which falls on February 12), and people working as laborers elsewhere likely don’t have the means for a repatriation flight or paid quarantine. (Or, if they are working illegally, the recognized status to return legitimately.)  

I’m very interested to see how this plays out among regional governments. Yesterday, Cambodian police arrested seven Vietnamese nationals who had illegally entered the country from Thailand, and just today we learned that a Vietnamese-Canadian man illegally entered Vietnam from Cambodia last week - he has been quarantined and tested negative for COVID-19. Meanwhile, Prime Minister Nguyen Xuan Phuc has called on members of the public to report anyone they think may have entered the country illegally.  

There are problems on the (very mountainous and rugged) northern border as well, as police in Da Nang discovered two separate groups of Chinese nationals who had entered Vietnam without proper paperwork last week. In an extremely dark twist, the Vietnamese driver of one of those groups committed suicide at the hotel he had been quarantined in on Saturday. He had been paid US$260 per passenger to drive the Chinese from the border to central Vietnam, and had reportedly been facing dire financial problems. 

All of the above offers threads to a number of fascinating topics: why are so many Chinese nationals illegally entering Vietnam? (7,000 people were caught attempting to cross the border at one post in Ha Giang Province alone through the first 10 months of this year, though it’s not clear what the nationality breakdown is of that number.) Why are Vietnamese working illegally in Myanmar? And, despite the success of Vietnam’s pandemic response, a lot of people are making dangerous decisions out of economic desperation. 

I know this isn’t a pleasant way to end the newsletter in 2020, but it’s appropriate for this year, I suppose.

Even back in the days of H5N1, circa 2005-06, people were slipping across Vietnam's borders with cheap foreign poultry that sometimes carried the virus. The honest desire to buy cheap and sell dear has cost untold lives for thousands of years.

Amid COVID-19 surge, LA hospitals turn away ambulances

Via The Los Angeles Times, a grim report: Amid COVID-19 surge, L.A. hospitals turn away ambulances. Excerpt:

At Los Angeles County-USC Medical Center, the breaking point came Sunday night.  

There was not one available bed for at least 30 patients who needed intensive or intermediate levels of care, and the hospital had to shut its doors to all ambulance traffic for 12 hours. Some patients, including the very sick who required intensive oxygen, experienced wait times as long as 18 hours to get into the intensive care unit.  

The front entrance of Community Hospital of Huntington Park was closed to the public Monday; the back of the building saw a steady stream of ambulances over the weekend, with one security guard saying the vehicles arrived as frequently as every half hour.  

And Memorial Hospital of Gardena on Monday was running at 140% capacity, forcing officials to ask for a four-hour suspension of new ambulance calls so it could move patients. The hospital is struggling to keep enough oxygen and supplies on hand amid the crunch of COVID-19 patients who need it. 

 “It’s a crisis — there’s no doubt about it,” said Memorial Hospital Chief Executive Kevan Metcalfe. “And they just keep coming.” 

The crisis at Los Angeles County hospitals hit new levels as patients continued to stream in during the holiday weekend, and the medical system is bracing for a new wave of coronavirus spread arising from Christmas travel and gatherings. L.A. County’s cumulative COVID-19 death toll is expected to climb past 10,000 this week. 

Hospitals are so inundated that they’ve resorted to placing patients in conference rooms and gift shops. But even so, many facilities are running out of space. Virtually all hospitals in L.A. County are being forced to divert ambulances with certain types of patients elsewhere during most hours. On Sunday, 94% of L.A. County hospitals that take in patients stemming from 911 calls were diverting some ambulances away. 

“But soon, there won’t be any places for these ambulances to go,” said Dr. Christina Ghaly, the L.A. County health services director. “If every hospital is on diversion, then no hospital is on diversion.” 

The number of people with COVID-19 inside L.A. County’s ICUs has broken records for 16 consecutive days, rising to 1,449 on Sunday, the most recent data available. Every day over the last week, there has been a net daily increase of 35 COVID-19 patients in ICUs — down slightly from 44 in mid-December but at a pace that’s packing even more critically ill patients into crowded facilities. 

As of Monday morning, there were 54 available ICU beds across L.A. County, and half were for pediatric patients. Two-thirds of staffed ICU beds in L.A. County are filled with COVID-19 patients.

Spinney: The UK and the US need to learn from countries that better handled Covid-19

Via The Guardian, Laura Spinney—who wrote an excellent book about the 1918-19 pandemic—argues that The UK and the US need to learn from countries that better handled Covid-19. Excerpt:

In October 2019, in those halcyon pre-Covid-19 days, a chart was published that ranked 195 countries according to their capacity to deal with outbreaks of infectious disease. Drawn up by the Washington DC-based Nuclear Threat Initiative and the Johns Hopkins Center for Health Security in Baltimore, Maryland, the 2019 Global Health Security Index (GHSI) placed the US and UK first and second, respectively. South Korea came ninth, New Zealand 35th and China 51st, while a number of African countries brought up the rear.  

Well, that was droll. Either the authors of the chart got their colour key inside out or our definition of health security needs an overhaul – and given all the fancy data visualisation software available these days it’s unlikely to be the former. Of course, the pandemic is not over. But back in March, when the index was already looking about as accurate as a 2016 US election poll, Johns Hopkins health policy analyst Sarah Dalglish wrote in the Lancet: “The pandemic has given the lie to the notion that expertise is concentrated in, or at least best channelled by, legacy powers and historically rich states.” And she hasn’t changed her view.  

Many factors contribute to good epidemic management, but perhaps what the sorry fate of the GHSI teaches us is that while many of them are measurable – disease surveillance arrangements, emergency response plans, intensive care unit capacity – some are more ephemeral, or hard to discern until the chips are down. And yet good leadership, public trust in government and experts, and a sense of solidarity also powerfully shape a population’s vulnerability to infectious disease.  

You may also need a dose of luck, such that all these things align in the moment, but that’s no reason to stint on praise for the countries that have come through well. Each one took different weapons into the fight: Vietnam is relatively poor but learned lessons from the 2003 epidemic of Sars (severe acute respiratory syndrome) and now has a world-beating epidemiological workforce; Senegal is even poorer but, remembering Ebola in 2014, used travel restrictions and testing well; New Zealand was untouched by both Ebola and Sars (apart from a single probable case of the latter) but had the competent and charismatic Jacinda Ardern in charge. 

One thing the leaders of all these countries have in common is that they know an outbreak can grow exponentially, and that their best hope of containing Covid-19 was therefore to act fast and in a coordinated, data-driven manner. In a sense, each government sacrificed its population’s present for its future, but only because it understood that the sooner the sacrifice was made, the smaller it would be. 

They spared themselves agonising dilemmas down the line, such as whether to let the elderly residents of care homes die of Covid-19 or loneliness, or what to do about the generation of young adults facing mass unemployment. The ones that did best knew that offering support to those hit hardest by the containment measures would require a much smaller investment than would be required to stimulate recovery if they didn’t put those measures in place.  

In contrast, the wealthy countries that topped the GHSI sacrificed their future for their present, arguing as US president Donald Trump did that the cure must not be worse than the disease, or in UK prime minister Boris Johnson’s immortal phrase, that “Our country is a freedom-loving country” – to which the only possible response is this line from Albert Camus’ The Plague: “They fancied themselves free, and no one will ever be free so long as there are pestilences.”

Russia admits to world's third-worst Covid-19 death toll

Via The Guardian, a report that somehow does not surprise: Russia admits to world's third-worst Covid-19 death toll. Excerpt"

Russia said on Monday that its coronavirus death toll was more than three times higher than it had previously reported, making it the country with the third-largest number of fatalities.  

For months, the Russian president, Vladimir Putin, has boasted about Russia’s low fatality rate from the virus, saying earlier this month that it had done a better job at managing the pandemic than western countries. 

But since early in the pandemic, some Russian experts have said the government was playing down the country’s outbreak. 

On Monday, Russian officials admitted that was true. The Rosstat statistics agency said that the number of deaths from all causes recorded between January and November had risen by 229,700 compared with the previous year. 

“More than 81% of this increase in mortality over this period is due to Covid,” said the deputy prime minister, Tatiana Golikova, meaning that more than 186,000 Russians have died from Covid-19.  

Russian health officials have registered more than 3m infections since the start of the pandemic, putting the country’s caseload at fourth-highest in the world.  

But they have only reported 55,265 deaths – a much lower fatality rate than in other badly hit countries.  

Russia has been criticised for only listing Covid deaths where an autopsy confirms the virus was the main cause. 

 Alexei Raksha, a demographer who left Rosstat in July, told AFP last week that the Russian health ministry and the consumer health ministry falsify coronavirus numbers.  

Rosstat’s new figures mean that Russia now has the world’s third-highest Covid-19 death toll behind the US with 333,140 and Brazil with 191,139, according to an AFP count. 

Russian authorities are holding out against reimposing a nationwide lockdown. The Kremlin hopes to buttress the struggling economy even as the country is battered by a second wave of infections. 

Russia’s government predicts the economy will shrink by 3.9% this year, while its central bank expects an even deeper decline.