H5N1

COVID-19: World Health Organisation reverses course, now supports wearing face masks in public

Via the South China Morning Post: Coronavirus: World Health Organisation reverses course, now supports wearing face masks in public. Excerpt and then a comment:

The World Health Organisation says it supports government initiatives that require or encourage the public wearing of masks, marking a major shift from previous advice amid the Covid-19 pandemic. 

The WHO added that surgical masks should be reserved for medical professionals, while the public should use mainly cloth or home-made face coverings. 

The updated stance comes as more scientific research points to the positive effect of wearing masks in preventing the spread of the coronavirus, with more governments in Europe requiring people to cover their noses and mouths in public. 

“We can certainly see circumstances on which the use of masks, both home-made and cloth masks, at the community level may help with an overall comprehensive response to this disease,” Dr Michael Ryan, executive director of the WHO’s health emergencies programme, said on Friday. 

“There may be situations where the wearing of masks may reduce the rate at which infected individuals may infect others,” Ryan said. “We will support governments who wish to have a measured approach to the use of masks and who include that as part of the comprehensive strategy to control this disease.” 

By comprehensive strategy, the WHO means measures such as encouraging washing of hands, physical distancing and rapid testing to identify and quarantine those who are infected.

The WHO has long been concerned about encouraging the use of masks, as that could result in stockpiling of the already limited supply. 

“Surgical and medical masks and masks like N95 are for the medical systems and we must prioritise their use for the front line,” Ryan said, adding that a group of experts are assessing the use of masks and will look at every single research paper.

The Great Mask Debate of 2020 must remind every English major of the vicious dispute in Gulliver's Travels between the Lilliputians, who insist one's boiled eggs should be broken at the little end, and their enemies in Blefuscu, who prefer breaking eggs at the big end.

I also recall a recent video clip in which a Chinese grannie, venturing out without a mask, is admonished via drone to totter home and don one before going out again. Orwell and Vonnegut would have laughed and laughed.

 

That said, I can see a case for masks if only as a way for ordinary people to gain a sense of control over events, which in itself is a goal worth striving for. Masks are a way of announcing "I'm doing my bit."

COVID-19 in Ecuador: Rights commission feels 'profound consternation' at difficulties reported in management of bodies in Guayaquil amid pandemic

Via El Universo, a Guayaquil newspaper: Rights commission feels 'profound consternation' at difficulties reported in management of bodies in Guayaquil amid COVID-19 pandemic. Presumably this follows reports of bodies being left in the streets of Guayaquil. Excerpt, with my translation:

La Comisión Internamericana de Derechos Humanos (CIDH) señala que observa con profunda consternación las dificultades reportadas en Guayaquil para trasladar, cremar y sepultar los cuerpos de las personas que han muerto durante la pandemia del COVID-19. 

The Inter-American Human Rights Commission (CIDH) says it observes with profound consternation the difficulties reported in Guayaquil with movement, cremation, and burial of bodies of persons who have died during the COVID-19 pandemic.

El organismo interamericano agrega que "toma nota del acuerdo interministerial que establece el protocolo para manejo de cadáveres en Ecuador y recuerda a los Estados que "el cuidado de restos mortales de personas es una forma de observancia del derecho a la dignidad humana".  

The organization adds that it "takes note of the interministerial agreement establishing the protocol for treatment of bodies in Ecuador and reminds the States that "the care of human remains is a form of respecting the right to human dignity."

La CIDH estableció una Sala de Coordinación y Respuesta Oportuna e Integrada para "apoyar" a los pueblos de las Américas en la protección y defensa de los derechos humanos, durante el desarrollo de la pandemia en el continente.  

CIDH has established an Office of Coordination and Integrated Response to "support" the peoples of the Americans in the protection and defence of human rights during the pandemic on the continent.

Ayer, el presidente Lenín Moreno reconoció, por primera vez, que los registros oficiales sobre contagiados y fallecidos en el país se "quedan cortos", frente a la realidad y ratificó lo dicho por Jorge Wated, quien está al frente de la Fuerza de Tarea Conjunta, respecto a que en Guayaquil podrían existir entre 2500 y 3500 fallecidos en los próximos meses por COVID-19. 

Yesterday President Lenin Moreno admitted for the first time that official records of infections and deaths in the country have "fallen short" of reality, and confirmed the statement by Jorge Wated, head of the Joint Task Force, that Guayaquil in the coming months could see between 2,500 and 3,500 deaths from COVID-19.

De acuerdo con el último informe del Gobierno, con corte a las 11:00 de este jueves, 2 de abril, existían 3163 contagiados y 120 fallecidos. Además de 78 fallecidos probables y las pruebas de detección rápida aún no llegan al país. Solo en la ciudad de Guayaquil 1520 contagios y, en total, en la provincia del Guayas 2243 contagios.

According to the latest government report, as of 11:00 a.m. Thursday, April 2, there were 3,163 cases and 120 deaths. As well, 78 probable deaths have been identified, and rapid testing kits have not yet arrived in the country. In the city of Guayaquil alone there are 1,520 cases and in Guayas province there are 2,243 cases.

Worldometer: COVID-19 on Friday morning

A screenshot: Coronavirus Update (Live): 1,074,487 Cases and 56,989 Deaths from COVID-19 Virus Outbreak. The numbers speak for themselves:

COVID-19: Lethality in Italy, between appearance and reality

Via Istituto per gli Studi di Politica Internazionale, the article by Matteo Villa mentioned in the preceding blog post. It first appeared on the ISPI website on March 27: Coronavirus: lethality in Italy, between appearance and reality. The Google translation of the conclusion:

First of all, the good news: in Italy there does not seem to be a much more lethal strain of coronavirus than in the rest of the world. The plausible lethality of the virus varies with the age structure and its spread in the population: with the same number of infected people, it is natural to expect a higher number of deaths in Italy than in China because the Italian population is clearly older than the Chinese one and the virus affects the most advanced age groups more severely. 

Only in the coming months and years will it be possible to investigate any variations between countries with respect to this central estimate: but it is difficult to expect very large effects compared to the average "strength" of the virus. In short, it will probably be difficult to demonstrate that in Italy more people die because the twenty-year-olds still live in the family and have more frequent contacts with their grandparents,  

A second good news is that by comparing apparent lethality with plausible lethality, it is possible to estimate the number of people infected and, at the same time, to observe the trend of the epidemic more correctly. Official cases do not in fact offer a good indication of what is really happening, while our estimate of plausible active cases allows us to do so (and to take into account the uncertainty around the central figure). 

But there is also bad news. The first, connected to the previous one, is that we have now lost contact with the spread of the virus in the general population. It is not uncommon for this to happen during the exponential phase of contagion, in which the available resources are mostly directed towards dealing with the health emergency here and now, rather than studying the distribution of the infected. In the meantime, lockdown measures are equally inevitable to prevent the many sick and unmonitored people from infecting a large number of healthy people. 

But to be able to imagine the post-emergency period, it will be necessary to adopt methods to track potentially contagious people, whether they have noticed it or not, and try to censor them to keep the epidemic under control. 

The second bad news is that if the virus is certainly less lethal than we could have imagined, its danger remains unchanged. On the one hand, lethality is lowered only because the plausible number of infected people increases, but unfortunately the trend of deaths remains the same. 

On the other hand, even imagining that the virus infected 1.2 million people, it would still be only 2% of the Italian population. We would therefore still be very far from spreading the virus in the general population large enough to approach the famous "herd immunity", obtaining the effect of slowing down new infections (this happens when there is a sufficient number of people around a contagious person healed and - partially or totally - immune, which act as a barrier). 

A final clarification, which applies to all countries, is that especially in regions where the health stress will be higher it is plausible to expect that a share of deaths will not be registered among coronavirus-positive people, because there will not be time and resources to do even a post-mortem swab. This does not invalidate our general reasoning, but will require revising upwards our estimate of plausible cases of contagion in the most affected areas.  

The fight against the virus will still be a long struggle. With this study we have tried to provide some more tools to deal with it.

What's the problem with Italy's official COVID-19 numbers?

Via TheLocal.it: What's the problem with Italy's official coronavirus numbers? Excerpt:

There is growing evidence that the death toll and infection rate figures being reported daily by Italian officials may be much lower than the reality.  

Since the coronavirus outbreak began in Italy in late February, the public has been relying on official government data for a picture of how many deaths, cases, and recoveries there have been in each part of the country, and how things are changing.  

Italy's Department for Civil Protection releases these statistics daily at around 6pm. The data is then pored over by experts worldwide, looking for evidence that Italy's quarantine measures are containing the spread as hoped – and that other countries can confidently follow its example.  

But a growing number of Italian experts have now said these numbers may not be reliable.   

“For sure, the figures are wrong,” said Matteo Villa, a researcher at the Italian Institute for Political Studies and author of a new study (in Italian) titled ”Coronavirus: Lethality in Italy, between appearance and reality." 

He that the death toll may have been underestimated by up to 6,000, or a third of the official total. 

In total, Italian authorities have recorded 115,242 cases and 13,915 deaths as of Thursday, April 2nd. 

Authorities acknowledge that the data are incomplete, as the death toll doesn't include people who died at home, or in nursing homes, or those who were infected by the virus but not tested.   

"It is plausible that deaths are underestimated," Higher Health Institute president Silvio Brusaferro stated. "We report deaths that are signalled with a positive swab. Many other deaths are not tested with a swab."  

The possible scale of the disparity showed up this week when death records for the month of March from different years were compared. 

The data showed a very large difference between the number of Covid-19 deaths reported by authorities, and the total death toll in different Italian regions.  

Experts have said the only explanation is that coronavirus deaths have been under-reported.  

The deaths were “mostly attributable to the virus”, said Villa. 

“Some of the increase will be people who die of other illnesses, because they cannot find a hospital bed due to the crisis,” Villa explained, “but that will be partly offset by the decline in road fatalities due to Italy’s lockdown.”

"For every two sufferers in Italy there is another one you can’t see,” he added.

A small trial finds that hydroxychloroquine is not effective for treating COVID-19

Via The Conversation, an article by Dr. Katherine Seley-Redtke: A small trial finds that hydroxychloroquine is not effective for treating coronavirus. Excerpt:

On Saturday the Food and Drug Administration approved the use of two antimalarial drugs, hydroxychloroquine and a related medication, chloroquine, for emergency use to treat COVID-19. The drugs were touted by President Trump as a “game changer” for COVID-19. 

However, a study just published in a French medical journal provides new evidence that hydroxychloroquine does not appear to help the immune system clear the coronavirus from the body. The study comes on the heels of two others - one in France and one in China - that reported some benefits in the combination of hydroxychloroquine and azithromycin for COVID-19 patients who didn’t have severe symptoms of the virus.  

I am a medicinal chemist who has specialized in discovery and development of antiviral drugs for the past 30 years, and I have been actively working on coronaviruses for the past seven. I am among a number of researchers who are concerned that this drug has been given too much of a high priority before there is enough evidence to show it is indeed effective. 

There are already other clinical studies that showed it is not effective against COVID-19 as well as several other viruses. And, more importantly, it can have dangerous side effects, as well as giving people false hope. The latter has led to widespread shortages of hydroxychloroquine for patients who need it to treat malaria, lupus and rheumatoid arthritis, the indications for which it was originally approved.

COVID-19: 'Captain Crozier! Captain Crozier!': Videos show sailors sending off ousted USS Roosevelt commander with cheers

Via Stars and Stripes: 'Captain Crozier! Captain Crozier!': Videos show sailors sending off ousted USS Roosevelt commander with cheers. Click or tap through for graphics and some videos showing dangerous crowding.

A cheering and applauding crowd of sailors aboard the aircraft carrier USS Theodore Roosevelt wished farewell to their captain, whom the Navy relieved of command after he raised concerns about the spreading coronavirus on his ship in a letter that was leaked to the media.  

Hundreds were pictured in the gathering in the ship’s hangar deck and many chanted Capt. Brett Crozier’s name in multiple videos posted to social media.   

In a video posted Friday to the Facebook page of Michael Washington, with the hashtag #MYCO and #WEARETRSTRONG.

"That’s how you send out one of the greatest captains you ever had,” someone says in the video, then using an acronym for greatest of all time, adds: “The GOAT, the man for the people.”  

Crozier was dismissed Thursday due to a loss of confidence in his ability to command and for not using his chain of command to make service leaders aware of his concerns about the virus outbreak that had infected more than 100 sailors on the ship, acting Navy Secretary Thomas Modly said at the Pentagon.  

Another video shows the career naval officer walk to the brow of the ship. He waves to the crowd, salutes and waves again before turning and walking down the gangway — alone — to the pier.   

Crozier’s pained letter, which was leaked to San Francisco Chronicle and published Tuesday, “created a … little bit of panic on the ship,” Modly said. 

The letter had warned that the outbreak could kill sailors, saying that “if we do not act now, we are failing to properly take care of our most trusted asset — our sailors.” 

The ship, now docked in Guam, was on a scheduled deployment to the Pacific region before it was forced to divert to the island after several initial virus cases were reported aboard the ship last week. Crozier had asked in his letter to have almost the entire crew removed to slow the spread of the outbreak. 

The Navy has already moved some 1,000 sailors off the ship and was working to remove another 2,700 by Friday. 

Capt. Daniel Keeler, the ship’s executive officer, is serving as acting commander while Capt. Carlos Sardiello, from whom Crozier had assumed command of the aircraft carrier in November, was traveling to Guam to take the helm again, Modly said.  

Adm. Robert Burke, vice chief of naval operations, will conduct an investigation into the matter and the command climate of Pacific Fleet to determine why there was a breakdown of the chain of command, Modly said.  

Regarding Crozier, he had “allowed the complexity of his challenge with the [coronavirus] breakout on the ship to overwhelm his ability to act professionally,” Modly said. “It creates a panic and creates the perception that the Navy is not on the job, the government’s not on the job, and it’s just not true.” 

In the hours since Crozier’s dismissal was announced, the backlash online has been swift, with more than 67,000 people signing a Change.org petition calling for his reinstatement.  

On the Reddit social media site, memes began to pop up in the Navy channel expressing support for the captain and distrust of higher-level officials.

US: As global COVID-19 infections soar, guidance on masks is reversed

Via The New York Times: As global infections soar, guidance on masks is reversed.

For months, health officials have been walking an awkward line on masks, saying they offered little or no protection to the public and should be reserved for health care workers.  

That contradiction seems close to resolution now.  

The White House, while stopping short of declaring an official policy, joined the mayors of Los Angeles and New York, several European nations and much of Asia in recommending that people wear cloth face masks in public, even if they have no symptoms.

That may help stop people from transmitting the coronavirus, but social distancing remains the best way to slow the spread, health officials say. Nearly four billion people on the planet — half of humanity — found themselves on Friday under some sort of order to stay in their homes. 

But some U.S. states were still resisting such measures. 

The lockdowns have led to a collapse of the global economy, vaporizing 10 million jobs in the United States in just two weeks. Global stocks, which had surged on Thursday after a wishful tweet from President Trump about the oil markets, dipped again on Friday amid growing fears that the pain will be profound and prolonged. 

Governments have promised trillions of dollars in a desperate effort to limit the damage. 

None of that has stopped the virus’s ferocious global assault. At least one million infections have been detected worldwide, but experts suspect the true number is far larger because of asymptomatic cases and delays in widespread testing. The Australian medical chief estimated that there are between five million and 10 million cases.  

As Beijing and Washington declared a détente in their sniping, it emerged that the C.I.A. had been warning the White House since at least February that China was vastly underestimating the scale of the crisis, limiting the usefulness of its data in predictive models.  

Model makers are now being guided by other grim data, most of it coming from Europe.  

The staggering death tolls in Italy and Spain, accounting for nearly half of the 53,000 deaths worldwide, rose yet again. But the crisis is deepening across the continent, with more than 5,000 deaths in France, nearly 3,000 in Britain, and more than 1,000 in both Germany and Belgium.  

The number of recorded deaths in the United States topped 1,000 in a single day for the first time. In New York City, the center of the country’s outbreak, both hospitals and morgues struggled to meet surging demand. 

Gov. Andrew M. Cuomo warned on Thursday that time was running out to find critical supplies, including the ventilators needed to sustain the most critically ill patients. 

“If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies,” Mr. Cuomo said at his daily briefing in Albany. “That’s the blunt equation here. And right now we have a burn rate that would suggest we have about six days in the stockpile.”

Branswell: Americans are underestimating duration of COVID-19 crisis, experts say

Via STAT, Helen Branswell writes: Americans are underestimating duration of coronavirus crisis, experts say. Excerpt:

Public health experts are increasingly worried that Americans are underestimating how long the coronavirus pandemic will disrupt everyday life in the country, warning that the Trump administration’s timelines are offering many a false sense of comfort.  

Coronavirus cases are expected to peak in mid-April in many parts of the country, but quickly reopening businesses or loosening shelter-in-place rules would inevitably lead to a new surge of infections, they said. 

Meanwhile, other parts of the country are only now implementing restrictions and others have not yet ordered the closure of non-essential businesses, creating a patchwork response that will slow progress toward the goal of driving down transmission of the SARS-CoV-2, the virus that causes Covid-19. 

“The administration has consistently shown a desire to underplay the severity of whatever is coming. And they’re constantly adjusting that — as it becomes harder to deny the reality will be worse than what they’ve conditioned people for,” said Jeremy Konyndyk, a senior policy fellow at the Center for Global Development. 

Konyndyk said he and other experts he’s discussed the matter with believe an “intensive period of social distancing and a national semi-voluntary lockdown” will last for months.   

President Trump, after signaling that he may try to restore some sense of normalcy in the country by Easter, has acknowledged that difficult times are ahead and that restrictions should remain in place until the end of April. 

But experts say that, even if some restrictions are relaxed, it’s unlikely life as normal will resume in early May.  

A former director of the Centers for Disease Control and Prevention, Thomas Frieden, said this week that it’s understandable that people want to know when businesses can reopen and some facets of life can resume. But he said the focus of public discourse now needs to be on the public health response, not the question of when restrictions can be lifted.  

“Decisions to reopen society should not be about a date, but about the data,” Frieden, now president and CEO of the global public health initiative Resolve to Save Lives, said during a briefing Wednesday for journalists. “How well and how quickly we do these things will determine how soon and how safely we can reopen.”  

He and others have outlined steps that should be taken before restrictions are lifted to ensure new cases do not continue to grow exponentially, collapsing health care systems under their weight. Frieden stressed the importance of expanded testing to know where the virus is transmitting as well as setting up public health infrastructures to trace the contacts of cases and monitor them in quarantine.  

“We need an army of contact tracers in every community in the U.S. to be ready to find every contact and warn them to care for themselves and stop spreading it to others,” he said.

Those resources do not current exist, said Konyndyk, who also noted that hospital capacity across the country needs to be expanded and protective equipment for health workers restocked. There are currently global shortages. 

“If we want to be able to — as I think we need to — turn our economy back on in a safe way, we need to be able to do that sort of thing at scale,” Konyndyk said. “And we do not have anywhere close to the public health infrastructure that’s needed to pull that off.”  

“That’s fundamental to getting us out of this lockdown phase. And the government’s not talking about it, much less acting on it,” he said.

Singapore to close schools, most workplaces from next week as ‘circuit breaker’ to stop COVID-19

Via the South China Morning Post: Singapore to close schools, most workplaces from next week as ‘circuit breaker’ to stop virus. Excerpt:

Singapore will close schools from April 8 and most workplaces from April 7, to be opened again on May 5, its strictest measures yet to battle the Covid-19 pandemic that has led to more than 1,100 confirmed cases in the city state. 

Essential services such as markets and supermarkets, clinics, hospitals, utilities, transport and banking services will remain open. While food establishments will remain open, diners can no longer eat at restaurants and will have to bring their food home. 

All amusement parks, museums and casinos will also be closed, along with sports and recreation facilities such as public swimming pools, country clubs, gyms and fitness studios. All recreational facilities in hotels will also be closed. 

Prime Minister Lee Hsien Loong on Friday said instead of tightening measures incrementally over the next few weeks, Singapore should “make a decisive move now, to pre-empt escalating infections”. 

“Looking at the trend, I am worried that unless we take further steps, things will gradually get worse, or another big cluster may push things over the edge,” Lee said, describing the new measures as a “circuit breaker”. 

“It will help reduce the risk of a big outbreak occurring and it should also help to gradually bring our numbers down,” he said in a national address, his third since the Covid-19 outbreak. 

Lee said more support for households and businesses was on the way, “over and above what was provided in the two earlier budgets”. The new stimulus measures will be announced by Deputy Prime Minister Heng Swee Keat in parliament on Monday. 

Singapore will also no longer discourage people from wearing face masks, Lee said. This is a reversal of the city state’s earlier advice that masks should only be used when a person is sick and on his or her way to seek medical attention. The policy change comes from evidence that an infected person can show no symptoms but still pass on the virus to others. 

Lee said the government would distribute reusable masks to all households from April 5, while conserving surgical masks for health care workers. Singapore had previously distributed four masks to each household but told residents to only use them if sick.