H5N1

'It's positively alpine!': Disbelief in big cities as air pollution falls

Via The Guardian, some good news: 'It's positively alpine!': Disbelief in big cities as air pollution falls. The before-and-after photos are, un, breathtaking. Excerpt and then a comment:

The screenshots began to circulate on Delhi WhatsApp groups last week, captioned with varying expressions of disbelief. Having checked the air quality index, something of a sadistic morning ritual among residents of India’s capital, most could not believe their eyes. 

Gone was the familiar menacing red banner, indicating how each intake of breath is really just a toxic blast on the lungs, replaced instead by a healthy, cheerful green. Could it really be that Delhi’s pollution levels now fell into the category of … “good”? “It’s positively alpine!” exclaimed one message.  

A nationwide lockdown imposed across India almost two weeks ago to stop the spread of the coronavirus – the largest lockdown of its kind attempted anywhere – has led to widespread chaos and suffering, especially among the country’s 300 million poor. Yet in Delhi, the world’s most polluted city, it has also resulted in some of the freshest air the capital has seen in decades. 

It is a lockdown silver lining being repeated across the world, as toxic megacities such as Bangkok, Beijing, São Paulo and Bogotá, where varying coronavirus restrictions have been imposed, all reported an unprecedented decline in pollution. Yet it is countered with one cruel irony: with most residents of these cities strictly confined to their homes, few have any way to appreciate this newly fresh air, except through an open window or a during speedy trip to the supermarket. 

In Delhi, air quality index (AQI) levels are usually a severe 200 on a good day (anything above 25 is deemed unsafe by World Health Organization). During peak pollution periods last year they soared well into a life-threatening 900 and sometimes off the measurable scale. But as Delhi’s 11m registered cars were taken off the roads and factories and construction were ground to a halt, AQI levels have regularly fallen below 20. The skies are suddenly a rare, piercing blue. Even the birdsong seems louder.  

Dr Shashi Tharoor, a politician and author who has been vocal on environmental issues, said he hoped that it was a wake-up call. “The blissful sight of blue skies and the joy of breathing clean air provides just the contrast to illustrate what we are doing to ourselves the rest of the time,” said Tharoor. “Today the typical Delhi AQI hovers around 30 and one blissful afternoon, after a spurt of rain, it dropped to 7.” 

“Seven,” Tharoor exclaimed again in disbelief. “In Delhi! Pure joy!”.

But curb your enthusiasm: As of 8:00 p.m. Saturday, local time, Current Delhi AQI is the moderate to unhealthy range.

US: Nurses say hospital risks infecting patients with COVID-19

Via The Washington Post: Nurses say hospital risks infecting patients with coronavirus. Excerpt:

The nurse was pregnant — and worried. But in mid-March, early in the covid-19 crisis, a manager at Moses Taylor Hospital in Scranton, Pa., assured her she would not be sent to the floor for patients infected with the deadly virus. The risks for expectant mothers were too uncertain. 

Two days later, she says, the administration changed course, saying the hospital needed “all hands on deck.” The pregnant nurse said she was sent back and forth between the “covid floor” and the neonatal intensive care unit, known as the NICU, where she normally treated vulnerable newborns and recovering mothers. 

It wasn’t just her baby she was worried about, she said, but the immunocompromised newborns and mothers who she was treating without informing them that she was also working on the covid floor. Even as she cared for patients symptomatic of covid-19, administrators provided her with crucial protective gear only after tests came back positive, usually several days after she first attended to the infected patients. 

The nurse was one of 11 medical staff and union representatives who described from the inside how a hospital in a small Pennsylvania city struggled to protect medical staff and patients during the chaotic early days of the crisis. Seven of the nurses, who work at two sister hospitals in Scranton, spoke on the condition of anonymity for fear of reprisals by the Tennessee-based company that owns their hospitals, Community Health Systems.

Like many hospitals across the country, Moses Taylor wasn’t prepared for the influx of highly contagious patients in the absence of vast quantities of protective gear. But measures taken by CHS to cope with the crisis stand out. The shortage led administrators to initially order staff to work with suspected covid-19 patients without adequate protection and to shuttle back and forth between floors where they feared they would infect cancer patients and babies, nurses say. 

Staff interviewed by The Washington Post said that they were speaking up out of concern for what they see as a perilous situation and out of anger over the disorganization, carelessness and greed that they say flows from a distant corporate owner.

The nurses and representatives of their union said that many of their safety concerns were dismissed as recently as last Friday, April 3, during a meeting with the hospital administration. But on Tuesday, after CHS was contacted by The Post, the hospital announced several changes in policy to prevent the spread of infection. 

The hospital’s chief executive, Michael Brown, said in a statement that covid-19 has been an unprecedented challenge that required frequent changes and that the hospital is following guidelines from the Centers for Disease Control and Prevention. 

“None of us has experienced a health crisis of this magnitude before,” he said. “We are adjusting and improving our response every day, and I am incredibly proud of all of the ways our physicians, nurses and team members are working together to care for our patients and each other.”  

Matthew Yarnell, the president of Service Employees International Union Healthcare PA, the state’s largest union of nurses and health workers, welcomed the changes announced this week, which include designating an employee entrance to the building and screening staff members for fevers before entering and leaving the 214-bed hospital. 

But he added in a statement: “It shouldn’t take attention from a national media outlet to move CHS to put the safety of patients and frontline caregivers first."

Canadian doctor once posted to Beijing ignored by Ottawa after offering help with COVID-19 response

Via The Globe and Mail: Canadian doctor once posted to Beijing ignored by Ottawa after offering help with COVID-19 response. Excerpt:

For seven years, Felix Li served on the distant front lines of Canadian public health, in China. As a doctor posted to Beijing, he fostered ties with health authorities that let him peer beneath the official rhetoric of a country that has been the source of multiple viral epidemics in recent decades.  

When Dr. Li returned to Canada in 2015 and retired from the Public Health Agency of Canada (PHAC) after 23 years, he was not replaced. 

But he retained his contacts inside the Chinese public health system and was keen to help when another outbreak began to emerge.  

So, a few days after the Jan. 23 lockdown of Wuhan, he sent an e-mail to the PHAC, including Chief Public Health Officer Theresa Tam, offering his expertise.

“I offered to go back to Ottawa to work with them on this. I needed to help, to save lives,” Dr. Li said in an interview.  

In the e-mail, he described his knowledge of the Chinese system and the contacts he maintains there.  

“I got an e-mail back saying, ‘We’ll talk about it and let you know.’ But I never had any response after that.” 

Instead, the PHAC has relied heavily on the World Health Organization for information and guidance in its response to the rapid spread of the deadly new virus.  

But critics have questioned the relationship between the WHO and China, whose response the WHO has praised effusively. The health organization has raised few public concerns about the reliability of information provided by Beijing, despite evidence suggesting Chinese authorities have significantly underreported the death toll from the outbreak. 

Dr. Li said that, during his time in China, there was a difference in “the quality of the information” he was able to obtain by communicating directly with people at China’s Ministry of Health and the Chinese Centre for Disease Control and Prevention. During the 2013 H7N9 avian influenza outbreak, for example, he received updates directly from Chinese officials.

Were he working now, he’d “probably get a lot more timely and accurate information on things,” he said.  

There is good reason to seek more sources of information, public health experts say.

“In any acute emergency, there is always benefit of ‘on the ground’ expertise and contacts in getting access to data and understanding the nuances of actual context. There is also always value in having multiple sources of data, information or intelligence, and it would be wise to have as many sources as possible,” said James Orbinski, director of York University’s Dahdaleh Institute for Global Health Research.  

“Relying on one source of information for critical decision making leaves you open to all of its biases and limitations, and every source – even ‘official’ ones, like the WHO, the government of China, the CIA, the government of the United States, the government of Canada – has biases and limitations.”

As health experts urge caution, Trump eyes the calendar

Via The New York Times: Coronavirus Live Updates: As Health Experts Urge Caution, Trump Eyes the Calendar.

The United States was on track on Saturday to surpass Italy in the total number of confirmed deaths from the coronavirus, reaching its deadliest day on Friday with 2,057 deaths. 

Already the pandemic has killed more than 18,000 Americans and put more than 16 million out of work, forcing President Trump into the difficult choice of reopening the country as the country reels economically from the coronavirus pandemic. 

“I’m going to have to make a decision, and I only hope to God that it’s the right decision,” Mr. Trump said on Friday in his daily news briefing on the coronavirus. The country’s death toll, which has more than doubled over the past week, is now increasing by nearly 2,000 most days. The previous high in the United States was 1,997 on April 7. As of Saturday morning, Italy had reported 18,849 deaths.  

As Mr. Trump grapples simultaneously with the most devastating public health and economic crises of a lifetime, he finds himself pulled in opposite directions. Bankers, corporate executives and industrialists are pleading with him to reopen the country as soon as possible, while medical experts beg for more time to curb the coronavirus.

Tens of thousands more people could die. Millions more could lose their jobs. And his handling of the crisis appears to be hurting his political support in the run-up to November’s election. Yet the decision on when and how to reopen is not entirely his. The stay-at-home edicts keeping most Americans indoors were issued by governors state by state.  

The president did issue nonbinding guidelines urging a pause in daily life through the end of the month. And if he were to issue new guidance outlining a path toward reopening, many states would probably follow or feel pressure from businesses and constituents to ease restrictions.  

But the central question is how long it will be until the country is fully back up and running. Gov. Andrew M. Cuomo of New York, the hardest-hit state, said any easing of restrictions would require widespread testing to cover millions of workers first, and Christopher Murray, the director of the Institute of Health Metrics and Evaluation at the University of Washington, which has created a model for Covid-19 deaths, told CNN that the latest data suggested caution was the right course.  

He predicted that a premature lifting of social distancing restrictions — which Mr. Trump seems eager to approve, perhaps by May 1 — could cause infections and deaths to surge.

“If we were to stop at the national level May 1,” Dr. Murray said, “we’re seeing a return to almost where we are now sometime in July.”

Sweden: Latest COVID-19 report - Public Health Authority

Via Folkhälsmyndigheten, an April 10 report: Latest covid report - Public Health Authority. Excerpt from the Google translation, which I think uses "falls" for "outbreaks":

The number of confirmed cases in Sweden is constantly changing, for the current number see the daily update on the website of the Public Health Authority.  

Between weeks 13 and 14, the number of sampled individuals increased from about 12,300 to about 17,700. At the same time, the number of confirmed cases of covid-19 in Sweden increased by 3,208, which is an increase of 65 percent compared to the previous week. The proportion of positive samples in laboratory reporting increased slightly from 16 to 18 percent. 

In sentinel surveillance, the proportion of positive samples increased after being unchanged for two weeks in a row. Sentinel surveillance is a sample of individuals seeking outpatient care with ongoing respiratory infection. As sentinel surveillance catches cases with a milder degree of morbidity, the increase indicates that the spread in the community increased between week 13 (7.2 percent positive) and 14 (13.5 percent positive), and especially in some regions. 

The percentage of positives was highest in the Uppsala region (37%), the Stockholm region (35%) and the Region Halland (19%). The proportion of positives in Region Skåne and the Västra Götaland region was 5 and 4 per cent respectively, which indicates a lower spread of covid-19, which is also seen in the statistics of reported cases. However, as the number of submitted samples and participating units varies across regions, comparisons between regions provide limited information. In several regions, no samples have been submitted yet, which makes it impossible to draw conclusions about the situation in these regions based on sentinel monitoring.  

During week 14, many regions reported continued falls on special housing for the elderly, which was reflected in the age distribution among the cases. So far during the epidemic, the age group 90 years and older has had the highest incidence, followed by the age group 80-89 years. Among people reported to have died with covid-19, the mean age was 81 years. The age group 70 years and older accounted for 87 per cent of the deceased until week 14. There is a continuing lag in reporting. 

The number of patients with covid-19 who started intensive care was slightly higher week 14 (260) than the previous week (238) and increased by approximately 37 per day. Among the intensive care cases, the average age was 60 years. Many more men (75.5%) continued to receive intensive care than women. Among intensive care patients and deceased, people with underlying illnesses such as chronic heart disease including hypertension, chronic lung disease, chronic renal failure and diabetes were overrepresented.

Worldometer: COVID-19 on Saturday morning

Two screenshots: Coronavirus Update (Live): 1,722,850 Cases and 104,775 Deaths from COVID-19 Virus Pandemic.

Beni: Civil society demands the unearthing of the new confirmed Ebola case 'for testing in three laboratories'

Via 7sur7.cd: Beni-Ebola: Civil society demands the unearthing of the new confirmed case "for testing in three laboratories". "Civil society" in the DR Congo means municipal authorities. The Google translation:

Beni's president of civil society, Kizito Bin Hangi has stepped up to the plate after the declaration of the new case of Ebola in the region, two days before the end of the epidemic in the Democratic Republic of Congo.  

Local civil society demands re-examining the samples to put an end to rumors of a case being created. “

We have received lamentations and complaints from both sides of the population, even the doctors and even the family of the deceased after the new case of Ebola in Beni. The body must be dug up at the expense of the response, the samples taken must be sent to three laboratories for comparison, including that of Mangina, Butembo and Katwa in order to be reassured that this is indeed the confirmed case,” he wished.  

And to add: "I call all the people having been in direct contact with the deceased person to present themselves to the response teams in order to pass the test so as not to intensify the virus in the community".  

It should be recalled that a new case of Ebola was declared in the city of Beni on Friday, April 10. However, unofficial reports say there is a second case in the area.

Ebola patient dies in DR Congo, first case in 50 days

Via Reuters, some more details: Ebola patient dies in Congo, first case in 50 days. But we still have few facts about the new case, and a lot of spin and generic background information. Excerpt:

BENI (Reuters) - The first person to contract Ebola in Democratic Republic of Congo in more than 50 days has died, the government said on Friday, ending hopes that the second worst outbreak of the disease in history might be over. 

The Central African country planned to declare an end to the epidemic on Sunday, which would have allowed its overstretched health service to concentrate on containing the coronavirus, which has infected 215 and killed 20 there. 

The new Ebola case, the first since Feb. 17, was a 26-year-old man in the area of Beni, a town in eastern Congo. He developed symptoms on March 27 and died in hospital on Thursday morning, regional health authorities said in a statement.  

Ebola has killed more than 2,200 since August 2018 in a volatile area of the country where rebel attacks hobbled efforts to contain it. The country is also trying to bat back a measles epidemic. 

“This is now a triple emergency: vulnerable populations facing ongoing humanitarian crises, the spread of COVID-19, and now again potentially a re-emerging Ebola crisis,” said Kate Moger, International Rescue Committee’s Regional Vice President of the Great Lakes region.  

Ebola causes fever, bleeding, vomiting and diarrhoea and spreads among humans through bodily fluids. The current outbreak has killed about two thirds of those it infected. 

WHO ON ALERT 

The World Health Organization (WHO) had been expecting more cases to emerge in Congo, and was primed to respond, its head Tedros Adhanom Ghebreyesus said.  

The agency’s top emergencies expert, Mike Ryan, said health teams on the ground were continuing to investigate 2,600 Ebola alerts across the country’s two affected provinces. 

“We take thousands of samples every single week, and we will continue that active surveillance right the way through,” he told a news conference.

Worldometer: COVID-19 on Friday afternoon

Two screenshots: Coronavirus Update (Live): 1,696,284 Cases and 102,596 Deaths from COVID-19 Virus Pandemic:

So we have well over 100,000 deaths worldwide, and the US has exceeded half a million cases. We seem likely to reach 2 million cases worldwide by Monday, and 20,000 American deaths on Saturday or Sunday. 

Geographic differences in COVID-19 cases, deaths, and incidence — US, February 12–April 7, 2020

MMWR has published Geographic Differences in COVID-19 Cases, Deaths, and Incidence — United States, February 12–April 7, 2020. The summary and concluding paragraph:

What is already known about this topic?  

Community transmission of COVID-19 was first detected in the United States in February 2020. By mid-March, all 50 states, the District of Columbia, New York City, and four U.S. territories had reported cases of COVID-19. 

What is added by this report?  

As of April 7, cumulative incidence of COVID-19 ranged widely across U.S. jurisdictions (from 20.6 to 915.3 cases per 100,000) and 7-day increases in incidence varied considerably (from 8.3 to 418.0). This report highlights geographic differences in cases, deaths, incidence, and changing incidence.  

What are the implications for public health practice? 

Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding community risk and making decisions about community mitigation, including social distancing, and strategic health care resource allocation.

And some caveats near the end of the report:

The findings in this report are subject to at least three limitations. First, reported COVID-19 cases are likely underestimated because of incomplete detection of cases and delays in case reporting. Reported deaths are also likely underestimated because of incomplete follow-up on all reported COVID-19 cases as well as death among persons infected with SARS-CoV-2 who did not receive a COVID-19 diagnosis.

Second, the degree to which cases might go undetected or unreported varies across jurisdictions and might contribute significantly to the geographic variation observed in this analysis. Jurisdiction-level testing practices differ widely, and rapid increases in COVID-19 case detection have placed a high demand on health department infrastructure, leading to differential delays in case reporting.

Finally, estimates of incidence, case-fatality ratios, and changes in incidence at the state and territorial levels might not be directly comparable across jurisdictions; further, COVID-19 “hotspots” and the effects of community mitigation efforts occurring within smaller geographic areas might be muted at this higher level of analysis.