H5N1

Canada: New data shows COVID-19 pandemic now 'completely out of control' in Ontario, key scientific adviser says

Via CBC News: New data shows COVID-19 pandemic now 'completely out of control' in Ontario, key scientific adviser says. Excerpt:

A new briefing note from a panel of science experts advising the Ontario government on COVID-19 shows a province at a tipping point. 

Variants that are more deadly are circulating widely, new daily infections have reached the same number at the height of the second wave, and the number of people hospitalized is now more than 20 per cent higher than at the start of the last provincewide lockdown, states an analysis from Ontario's COVID-19 science advisory table published on Monday night. 

"Right now in Ontario, the pandemic is completely out of control," Dr. Peter Juni, the table's scientific director and a professor of medicine and epidemiology with the University of Toronto, said in an interview prior to the briefing note's publication. 

That stark assessment follows weeks of warnings from medical professionals in Ontario over rising case counts and fast-spreading variants. It comes the same day B.C. announced it will be implementing a three-week "circuit breaker"-style lockdown, with sweeping new restrictions on indoor dining in restaurants, group fitness and worship services.

Juni said for Ontario, there is now "no way out" of the dire scenario that's set to unfold over the next few weeks without a widespread lockdown as well — coupled with other measures, including the province providing paid sick leave to essential workers, encouraging Ontarians to avoid movement between regions, and ensuring residents have access to lower-risk outdoor activities.  

"There is no such thing as winning this race with just vaccinations," Juni stressed. "That's impossible."

COVID-19 in Brazil: 38,927 new cases, 1,660 deaths today

A screenshot from the National Council of State Health Secretaries' CONASS PANEL  dashboard:

The numbers are half what they were last week. I don't know if this is a trend, or just an artifact of light weekend testing and counting.

Amazonas: Governor Wilson Lima receives equipment from Germany to combat Covid-19

Via The National Council of Health Secretaries: Governor Wilson Lima receives equipment from Germany to combat Covid-19. Excerpt from the Google translation:

The governor of Amazonas, Wilson Lima, received 80 lung ventilators and hospital accessories donated by the Government of Germany, this Saturday (03/27). This non-invasive equipment will reinforce the care of patients diagnosed with Covid-19, in the health units in Amazonas. The holder of the German embassy in Brasilia, Heiko Thoms, delivered the equipment to the State Government. 

In thanking the help of the German government, Wilson Lima explained how the devices will be used. “This equipment will be distributed on our network. It will be important to reinforce the care for patients who still need this support from the State, but also to attend to our brothers from other states, mainly from Rondônia, Roraima and Acre who, at that moment, are going through a complicated situation,” said the governor. 

The donation meets the request for help from the Government of Amazonas, made through an open letter addressed to the international community, in January this year. The equipment will be used in units that act as the entrance door, in wards and outpatient clinics. They do not replace intensive care unit (ICU) lung ventilators. 

The equipment arrived in Brazil brought by a German air force aircraft and disembarked at Eduardo Gomes International Airport, in Manaus. 

“Amazonas, like Brazil, is a strategic partner for Germany. We have a very deep cooperation with Brazil, we have a cooperation with the State of Amazonas. We know that this pandemic is a global phenomenon and no one is safe until everyone is safe. We need to help each other in this situation,” said the ambassador.

Covid-19 in Brazil: Without help from the government, Kuikoro Indians won the pandemic based on science and crowdfunding aid

Via BBC News Brasil, a report that sounds like many of our own Indigenous peoples' responses: Covid-19: Helpless by the government, Kuikoro Indians won the pandemic based on science and crowdfunding aid. Excerpt from the Google translation:

While Brazil is experiencing its worst moment of the pandemic, a small indigenous community in the upper Xingu managed to win the covid-19 even without the support of the federal government or local authorities. 

Last year, while the seriousness of the pandemic was denied by the government and underestimated by many people in the rest of Brazil, the Kuikuro Indians locked down in their villages, made kitties to raise money for medical supplies and used their experience with a measles outbreak to face the coronavirus. 

More than 45,000 cases of covid-19 and 622 deaths have been recorded among indigenous people in Brazil, according to official data from Sesai (the indigenous health secretariat). But the APIB (Articulation of Indigenous Peoples of Brazil) says that the numbers are much higher and accounted for 1022 deaths and at least 51 thousand cases until Tuesday (23/03). 

However, among the 900 or so Kuikuro who live in eight villages in the upper Xingu, there were no deaths, and only 160 people were infected. And now everyone has been vaccinated. 

 The success is in contrast to the rest of the country - the death toll has already exceeded 300,000 and the moving average of deaths in the past few days has even exceeded 3,000 in a single day.

The indigenous leader Yanamá Kuikuro gave a testimony to the BBC about how the community managed to face the virus successfully: 

Yanamá Kuikuro, president of the Upper Xingu Indigenous Kuikuro Association (Aikax) 

"The Ipatse village, where I am, is the main village. Only here there are 390 people, including children. Here our speech and our culture are alive. Although a little non-indigenous culture has entered and the internet is already here, that’s not why we forget our culture. The technology that came in facilitated our communication. 

"Last year I traveled to Brasilia and saw an increase in cases of covid throughout Brazil. When I arrived in the village, I talked to my brother Afukaká Kuikuro, chief of the Ipatse village, who was also following the spread of the virus. He also understood the danger.

"We brought the community together in the center of the village several times before the virus got here. What we thought together with the community: how can we face this new virus that is coming? Who can help us? 

"When I was a child, my father said he had a measles epidemic here in Xingu and many people died. The Kalapalo, the Kamaiurás, many people from the Upper Xingu died. So when we saw this new virus, the elders immediately remembered it. When we saw on the television news that the virus was killing many people, we thought: 'We have to organize, we have to do a lockdown'. 

"We thought about the government. But if we asked for support from the government, it would not arrive soon, it would not happen. And what did we do, ourselves? First step: we built an isolation house."

COVID-19 in Brazil: 44,326 new cases, 1,656 deaths today

A screenshot from today's CONASS PANEL update:

Low Sunday case counts seem to be typical in many countries. I expect Monday's numbers will be sharply higher again.

Mexico Covid-19 death toll leaps 60% to reach 321,000

Via The Guardian, a report by The Associated Press: Mexico Covid death toll leaps 60% to reach 321,000.

Mexico’s government has acknowledged that the country’s true death toll from the coronavirus pandemic now stands above 321,000, almost 60% more than the official test-confirmed number of 201,429. 

Mexico does little testing, and, because hospitals were overwhelmed, many Mexicans died at home without getting a test. The only way to get a clear picture is to review “excess deaths” and review death certificates. 

On Saturday, the government quietly published a report based on those figures, which found there were 294,287 deaths linked to Covid-19 from the start of the pandemic through 14 February. Since 15 February there have been an additional 26,772 test-confirmed deaths. 

The higher toll would exceed that of Brazil, which has the world’s second-highest number of deaths after the US. 

The Johns Hopkins coronavirus tracker puts Brazil’s toll at about 307,000 and the United States’ at 548,000, but Mexico’s population of 126 million is far smaller than those of either of those countries. 

Around 127,000 people have died with Covid-19 in the UK, according to Johns Hopkins. 

The new report also confirms just how deadly Mexico’s second wave in January was. At the end of December, excess death estimates suggested a total of about 220,000 deaths related to Covid-19 in Mexico. That number jumped by around 75,000 in just a month and a half. 

Also suggestive were the overall number of “excess deaths” since the pandemic began, around 417,000. Excess deaths are determined by comparing the deaths in a given year to those that would be expected based on data from previous years. 

A review of death certificates found about 70.5% of the excess deaths were Covid-19 related, often because it was listed on the certificates as a suspected or contributing cause of death. But some experts say Covid-19 may have contributed to many of the other excess deaths because many people couldn’t get treatment for other diseases because hospitals were overwhelmed. 

Former president Felipe Calderón wrote in his Twitter account Saturday that “more than 400,000 Mexicans have died, above the average for previous years ... probably the highest figure in the world”.

Deaths in queues due to ICU, lack of medicines and anguish: The desperate reports of doctors in the interior of Pará

Via BBC News Brasil: Deaths in queues due to ICU, lack of medicines and anguish: the desperate reports of doctors in the interior of Pará.

People with covid-19 dying in line waiting for an ICU bed, lack of medication and an explosion of new cases with nowhere to treat them. This is how doctors described the "collapse" scenario at the Regional Public Hospital of Transamazônica (HRPT), in Altamira, in the interior of Pará. 

The hospital is a reference in the region and serves more than 500 thousand people living in nine cities. Today, however, the unit is saturated, unable to care for anyone else and already transferring patients to other states on trips that last for hours. 

A report released based on information released by city halls and health departments in the Xingu region pointed out that 14 people were in line for a place in the ICU at 10 pm on Wednesday (3/24). Five people died and another 200 were infected with covid-19 in the past 24 hours. 

On Tuesday (23/3), the City of Altamira decreed a public calamity for the next three months. The intent of the city hall is to streamline the purchase of supplies and equipment for hospitals in the region, without the need for a bidding process. But for it to be legally valid it still needs to be approved by the Legislative Assembly of Pará (Alepa). 

Despite the doctors' reports and the desperation of the city hall, the State Health Secretariat of Pará says that everything is under control.

A doctor who works at the hospital told BBC News Brasil, under the condition of anonymity, that, in addition to the lack of vacancies, patients have increasingly severe conditions. 

"The cases have increased a lot since the beginning of the year. The disease is more serious as well. Before, it took a week for pneumonia to appear. Now, the patient is admitted and this happens after four days. A faster and more serious evolution , with longer hospital stay." he explained. 

He said that the Santo Agostinho hospital, also in Altamira, is full. The doctors heard by BBC News Brasil say that several people died in Altamira without the chance to receive intensive treatment or to be intubated in an ICU.

Paris doctors sound alarm, warn of catastrophic overload of Covid-19 cases

Via France24: Paris doctors sound alarm, warn of catastrophic overload of Covid-19 cases. Excerpt:

Critical care doctors in Paris say surging coronavirus infections could soon overwhelm their ability to care for the sick in the French capital's hospitals, possibly forcing them to choose which patients they have the resources to treat. 

The sobering warning was delivered Sunday in a newspaper opinion signed by 41 Paris-region doctors. Published by Le Journal du Dimanche newspaper, it comes as French President Emmanuel Macron has been vigorously defending his decision not to completely lockdown France again as he did last year. Since January, Macron's government has instead imposed a nationwide overnight curfew and followed that with a grab-bag of other restrictions. 

But with coronavirus infections soaring and hospitals increasingly running short of intensive care beds, doctors have been stepping up the pressure for a full French lockdown. 

The Paris-region doctors who wrote in Le Journal du Dimanche said: “We have never known such a situation, even during the worst (terror) attacks” that targeted the French capital, notably assaults by Islamic State extremists in November 2015 at the Bataclan concert hall and other locations that killed 130 people and filled Paris emergency wards with the wounded. 

The doctors predicted that softer new restrictions imposed this month on Paris and some other regions won't quickly bring the resurgent epidemic under control. They warned that hospital resources won't be able to keep pace with needs, forcing them to practice “catastrophe medicine" in the coming weeks as cases peak.

A collapse foretold: How Brazil’s Covid-19 outbreak overwhelmed hospitals

Via The New York Times: A Collapse Foretold: How Brazil’s Covid-19 Outbreak Overwhelmed Hospitals. Excerpt:

PORTO ALEGRE, Brazil — The patients began arriving at hospitals in Porto Alegre far sicker and younger than before. Funeral homes were experiencing a steady uptick in business, while exhausted doctors and nurses pleaded in February for a lockdown to save lives. 

But Sebastião Melo, Porto Alegre’s mayor, argued there was a greater imperative. 

“Put your life on the line so that we can save the economy,” Mr. Melo appealed to his constituents in late February. 

Now Porto Alegre, a prosperous city in southern Brazil, is at the heart of a stunning breakdown of the country’s health care system — a crisis foretold. 

More than a year into the pandemic, deaths in Brazil are at their peak and highly contagious variants of the coronavirus are sweeping the nation, enabled by political dysfunction, widespread complacency and conspiracy theories. 

The country, whose leader, President Jair Bolsonaro, has played down the threat of the virus, is now reporting more new cases and deaths per day than any other country in the world.

“We have never seen a failure of the health system of this magnitude,” said Ana de Lemos, the executive director of Doctors Without Borders in Brazil. “And we don’t see a light at the end of the tunnel.” 

On Wednesday, the country surpassed 300,000 Covid-19 deaths, with roughly 125 Brazilians succumbing to the disease every hour. Health officials in public and private hospitals were scrambling to expand critical care units, stock up on dwindling supplies of oxygen and procure scarce intubation sedatives that are being sold at an exponential markup. 

Intensive care units in Brasília, the capital, and 16 of Brazil’s 26 states report dire shortages of available beds, with capacity below 10 percent, and many are experiencing rising contagion (when 90 percent of such beds are full the situation is considered dire.)

In Rio Grande do Sul, the state that includes Porto Alegre, the waiting list for intensive care unit beds doubled over the past two weeks, to 240 critically ill patients. 

 At Hospital Restinga e Extremo Sul, one of the main medical facilities in Porto Alegre, the emergency room has become a crammed Covid ward where many patients received care in chairs, for lack of a free bed. Last week, the military built a tent field hospital outside the main entrance, but hospital officials said the additional bed space is of little use for a medical staff stretched beyond its limit. 

“The entire system is on the verge of collapse,” said Paulo Fernando Scolari, the hospital’s director. “People are coming in with more serious symptoms, lower oxygen levels, in desperate need of treatment.” 

The breakdown is a stark failure for a country that, in past decades, was a model for other developing nations, with a reputation for advancing agile and creative solutions to medical crises, including a surge in H.I.V. infections and the outbreak of Zika. 

Mr. Melo, who campaigned last year on a promise to lift all pandemic restrictions in the city, said a lockdown would cause people to starve. 

“Forty percent of our economy, our labor force, is informal,” he said in an interview. “They’re people who need to go out and work in order to have something to eat at night.” 

President Bolsonaro, who continues to promote ineffective and potentially dangerous drugs to treat the disease, has also said lockdowns are untenable in a country where so many people live in poverty. While several Brazilian states have ordered business shutdowns in recent weeks, there have been no strict lockdowns. 

Some of the president’s supporters in Porto Alegre have protested business shutdowns in recent days, organizing caravans that stop outside of hospitals and blast their horns while inside Covid wards overflow.

Sudden rise in COVID-19 case fatality among young and middle-aged adults in the south of Brazil (updated)

Via medRxiv.org: Sudden rise in COVID-19 case fatality among young and middle-aged adults in the south of Brazil after identification of the novel B.1.1.28.1 (P.1) SARS-CoV-2 strain: analysis of data from the state of Paraná. The abstract:

Brazil is currently suffering a deadly surge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, which has been attributed to the spread of a new strain known as P.1 (B.1.1.28.1). In this investigation, we analyzed coronavirus disease 2019 (COVID-19) public health data from Paraná, the largest state in southern half of Brazil, between September 1, 2020 and March 17, 2021, to evaluate recent trends in case fatality rates in different age groups. 

A total of 553,518 cases of SARS-CoV-2, 8,853 currently registered as fatal, were finally included in our analysis. All age groups showed either decline or stabilization of the case fatality rates (CFRs) between September 2020 and January 2021. In February 2021, an increase in CFR for almost all age groups could be instead observed. All groups above 20 years of age showed statistically significant increases in CFR when diagnosed in February 2021 as opposed to January 2021. 

Patients aged 20-29 years experienced a tripling of their CFR, from 0.04% to 0.13%, while those aged 30-39, 40-49, 50-59 experienced approximate CFR doubling. Individuals between 20 and 29 years of age whose diagnosis was made in February 2021 had an over 3-fold higher risk of death compared to those diagnosed in January 2021 (Risk Ratio (RR): 3.15 [95%CI: 1.52-6.53], p<0.01), while those aged 30-39, 40-49, 50-59 years experienced 93% (1.93 [95%CI:1.31-2.85], p<0.01), 110% (RR: 2.10 [95%CI:1.62-2.72], p<0.01), and 80% (RR: 1.80 [95%CI:1.50-2.16], p<0.01) increases in risk of death, respectively. Notably, the observed CFR increase coincided with the second consecutive month of declining number of diagnosed SARS-CoV-2 cases. 

Taken together, these preliminary findings suggest significant increases in CFR in young and middle-aged adults after identification of a novel SARS-CoV-2 strain circulating in Brazil, and this should raise public health alarms, including the need for more aggressive local and regional public health interventions and faster vaccination.

Update: A new report in The New York Times, while describing the pandemic in Rio Grande do Sul, mentions the youth of recent cases and fatalities. It also shows the disastrous effects of Bolsonaro's health populism.