H5N1

COVID-19 live news: Boris Johnson, health secretary both test positive

Via The Guardian: Coronavirus live news: Spain records highest single-day death toll and withdraws 'inaccurate' testing kits. Excerp:

4m ago 09:19 Researchers in Germany, where the number of confirmed infections is at over 47,400 and 286 deaths by lunchtime, have proposed a mass study into how many people are immune to the Covid 19 virus, in an effort to allow those for whom it is safe to do so, to return to leading a normal life.  

According to Spiegel magazine, which has seen the preparations for the study, which is awaiting the approval of authorities, researchers hope to be able to test the blood of more than 100,000 volunteers for Covid 19 antibodies from mid-April.  

The test would be repeated on the same volunteers and expanded to use different groups, at regular intervals, in order to oversee how the pandemic is progressing. The scientists - a team compiled from various bodies, including the government’s leading public health body, the Robert Koch Institute, the German Centre for Infection Research, blood donation services, and the Institute for Virology at the Charite hospital in Berlin - hope to discover the extent to which Covid 19, or Sars-CoV-2 has already spread, and how many infected people it really kills. 

The results of the study would make it easier to decide for instance, when schools should reopen, and large-scale events be allowed to take place, the authors say. If everything goes to plan, the first results would be available by the end of April.  

“Those who are immune could be issued with a sort of ‘Immune pass’ that would allow people to be excluded from the restrictive measures currently in place”, Gérard Krause, an epidemologist from the Helmholtz Centre for Infection Research in Braunschweig, told Der Spiegel. 

4m ago 09:16 A short while ago, Associated Press filed this troubling report from Tehran, the Iranian capital where people are drinking toxic methanol in the mistaken belief it will combat the coronavirus. 

Standing over the still body of an intubated 5-year-old boy wearing nothing but a plastic diaper, an Iranian health care worker in a hazmat suit and mask begged the public for just one thing: Stop drinking industrial alcohol over fears about the new coronavirus.  

The boy, now blind after his parents gave him toxic methanol in the mistaken belief it protects against the virus, is just one of hundreds of victims of an epidemic inside the pandemic now gripping Iran.  

Iranian media reports nearly 300 people have been killed and more than 1,000 sickened so far by ingesting methanol across the Islamic Republic, where drinking alcohol is banned and where those who do rely on bootleggers. It comes as fake remedies spread across social media in Iran, where people remain deeply suspicious of the government after it downplayed the crisis for days before it overwhelmed the country. 

“The virus is spreading and people are just dying off, and I think they are even less aware of the fact that there are other dangers around,” said Dr. Knut Erik Hovda, a clinical toxicologist in Oslo who studies methanol poisoning and fears Iran’s outbreak could be even worse than reported. “When they keep drinking this, there’s going to be more people poisoned.”  

11m ago 09:09 In the UK, after prime minister Boris Johnson tested positive for coronavirus, it now emerges that health secretary Matt Hancock has COVID-19 too.

Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China

Via The Lancet Infectious Diseases: Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. The summary:

Background 

Since December, 2019, an outbreak of coronavirus disease 2019 (COVID-19) has spread globally. Little is known about the epidemiological and clinical features of paediatric patients with COVID-19. 

Methods 

We retrospectively retrieved data for paediatric patients (aged 0–16 years) with confirmed COVID-19 from electronic medical records in three hospitals in Zhejiang, China. We recorded patients' epidemiological and clinical features. 

Findings 

From Jan 17 to March 1, 2020, 36 children (mean age 8·3 [SD 3·5] years) were identified to be infected with severe acute respiratory syndrome coronavirus 2. The route of transmission was by close contact with family members (32 [89%]) or a history of exposure to the epidemic area (12 [33%]); eight (22%) patients had both exposures. 19 (53%) patients had moderate clinical type with pneumonia; 17 (47%) had mild clinical type and either were asymptomatic (ten [28%]) or had acute upper respiratory symptoms (seven [19%]). Common symptoms on admission were fever (13 [36%]) and dry cough (seven [19%]). Of those with fever, four (11%) had a body temperature of 38·5°C or higher, and nine (25%) had a body temperature of 37·5–38·5°C. 

Typical abnormal laboratory findings were elevated creatine kinase MB (11 [31%]), decreased lymphocytes (11 [31%]), leucopenia (seven [19%]), and elevated procalcitonin (six [17%]). Besides radiographic presentations, variables that were associated significantly with severity of COVID-19 were decreased lymphocytes, elevated body temperature, and high levels of procalcitonin, D-dimer, and creatine kinase MB. All children received interferon alfa by aerosolisation twice a day, 14 (39%) received lopinavir–ritonavir syrup twice a day, and six (17%) needed oxygen inhalation. Mean time in hospital was 14 (SD 3) days. By Feb 28, 2020, all patients were cured. 

Interpretation 

Although all paediatric patients in our cohort had mild or moderate type of COVID-19, the large proportion of asymptomatic children indicates the difficulty in identifying paediatric patients who do not have clear epidemiological information, leading to a dangerous situation in community-acquired infections.

BC recommends against all non-essential travel outside of Canada as 7 new cases of COVID-19 detected

Via CBC News: B.C. recommends against all non-essential travel outside of Canada as 7 new cases of COVID-19 detected. Excerpt with my bolding, and then a comment:

B.C. has announced seven new cases of COVID-19, including an outbreak at a second care home on Vancouver's North Shore, and is calling for strict limits on travel and public gatherings.

 Provincial health officer Dr. Bonnie Henry said Thursday that she is recommending against all non-essential travel outside of Canada, and calling for the cancellation of any gatherings of more than 250 people. 

"It's become apparent that this is a rapidly changing situation and the risk for us in B.C., while it hasn't changed a lot here, the risk has increased all around us. Our understanding of the situation has also changed," Henry said. "We are strongly advising people not to travel."  

Henry said the advice against international travel extends to the U.S., and that anyone who chooses to leave the country should stay home from work or school for 14 days. That includes people who are currently in the U.S. and will be returning in the days ahead.  

"That means no milk runs to Bellingham [in Washington state]," Health Minister Adrian Dix told a news conference.  

He said the period of self-isolation is voluntary, though it will be required for all government employees. 

B.C. is not following the lead of other provinces in closing schools, Henry added.  

"They are a place where young people can be kept safe from a lot of things. They can learn about social distancing," she said.  

"The impacts of closing schools, especially abruptly, can cause social disruptions."  

She said that if risks are detected in B.C. schools, however, the province will close them.

When Singapore closed its schools during SARS, the kids—herd animals that they are—swarmed into the malls to socialize, hang out, and generally miss the point. School closures make much more sense when parents are also home to keep an eye on the children.

Why doesn’t coronavirus make kids sick with covid-19?

Via The Washington Post: Why doesn’t coronavirus make kids sick with covid-19? Excerpt:

One of the few mercies of the spreading coronavirus is that it leaves young children virtually untouched — a mystery virologists say may hold vital clues as to how the virus works. 

In China, only 2.4 percent of reported cases were children and only 0.2 percent of reported cases were children who got critically ill, according to the World Health Organization. China has reported no case of a young child dying of the disease covid-19. 

Meanwhile, the new coronavirus has proved especially deadly on the other end of the age spectrum. The fatality rate in China for those over 80 is an estimated 21.9 percent, per the WHO. For ages 10 to 39, however, the fatality rate is roughly 0.2 percent, according to a separate study drawing on patient records of 44,672 confirmed cases. And fatalities and severe symptoms are almost nonexistent at even younger ages.  

That means the new coronavirus is behaving very differently from other viruses, like seasonal influenza, which are usually especially dangerous for the very young and very old. 

“With respiratory infections like this, we usually see a U-shaped curve on who gets hits hardest. Young children at one end of the U because their immune systems aren’t yet developed and old people at the other end because their immune systems grow weaker,” said Vineet Menachery, a virologist at the University of Texas Medical Branch. “With this virus, one side of the U is just completely missing.” 

Figuring out why children are so unaffected could lead to breakthroughs in understanding how and why the virus sickens and kills other age groups, said Frank Esper, a pediatric infectious disease specialist at Cleveland Clinic Children’s. Among the questions Esper and others are exploring: Is the severity of infection related to what patients were exposed to previously? Does it have to do with how our immune systems change with age? Or could it be due to pollution damage in the lungs that people accumulate over years?  

“Or maybe it has nothing to do with the virus and has to do with host, like underlying conditions in the lungs, diabetes or hypertension. After all, few 7-year-olds or newborns have hypertension,” said Esper, who studies viral respiratory infections and new diseases. “Figuring out what’s at play here could be helpful in so many ways."

COVID-19 latest: Children are as susceptible as adults, study suggests

Via Nature.com: Coronavirus latest: children are as susceptible as adults, study suggests. Excerpt and then a comment:

Here’s the latest news on the outbreak.  

5 March 15:30 GMT — China study suggests children are as likely to be infected as adults  

Children are just as likely to get infected with the new coronavirus as adults, finds one of the most detailed studies yet published on the spread of the virus, known as SARS-CoV-2. The analysis — based on data from Shenzhen, China — provides a partial answer to one of the most pressing questions surrounding the outbreak: the role of children.  

Previous studies have suggested that kids were far less likely to develop severe symptoms when infected by the coronavirus, compared with other age groups. But it was not clear if it was because they weren’t getting infected or if they were fighting off the infection more effectively than others.  

“Kids are just as likely to get infected and they’re not getting sick,” says Justin Lessler, an infectious-disease epidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. He co-led the study with Johns Hopkins epidemiologist Qifang Bi, and epidemiologists Ting Ma, at the Harbin Institute of Technology in Shenzhen, and Tiejian Feng, of the Shenzhen Center for Disease Control and Prevention. They posted the analysis to the medRxiv preprint server on 4 March.  

The study is unique in that it looked at not only people who were infected with the virus, but also large numbers of their close contacts, some of whom were infected and many who were not. The researchers followed 391 people who were diagnosed based on their symptoms, and 1,286 of their close contacts to see whether they tested positive for the virus even if they didn’t show symptoms. Overall, the team found that children under 10 who were potentially exposed to the virus were just as likely to become infected as other age groups, with about 7 and 8% of contacts of known cases later testing positive. 

They also found that people who lived in the same household as an someone infected with the virus — and came into close contact with them — were about six time mores likely get infected, compared with people who made contact with an infected person in other settings. 

“This may be the first clear evidence that children are as susceptible as adults to SARS-CoV-2 infection,” says Ben Cowling, an infectious-disease epidemiologist at the University of Hong Kong. He now wonders whether the fact that outbreaks haven’t been observed in schools could be down to the fact that children’s symptoms are mild. 

Lessler says it’s still not clear whether children are important in transmitting the virus, as they are with influenza, where children routinely develop symptoms and are common hubs in chains of transmission. “That’s one of the current critical remaining questions and we’re trying to figure out how to answer,” he says. “I have a 7-month-old and a 6-year-old and I can’t imagine that, if they have any virus at all, they're not getting it on somebody.”

This reminds me of the days when I used to teach students in my college's early childhood education program. The students spent their days in daycares and their evenings in class, and they often came in with terrible colds—a well-understood occupational hazard of the profession. The idea of toddlers and other children as efficient COVID-19 spreaders is not a reassuring one.

Five new COVID-19 cases confirmed in Finland

Via Yle Uutiset: Five new coronavirus cases confirmed in Finland.

Finnish authorities said on Thursday that five people have been confirmed as novel coronavirus cases.  

Three of the cases are in the Helsinki and Uusimaa hospital district, one is in Pirkanmaa and one in Kanta-Häme. 

In the capital city region one of the patients is a working-age woman and two are working-age men. The woman’s infection is linked to a previously-confirmed case, while the men’s cases are linked to travel to northern Italy.  

According to HUS the patients in the capital city region are in good condition and returned home after samples had been taken. They have been advised on how to quarantine themselves.  

The case in Kanta-Häme is a child in Hämeenlinna who had returned from northern Italy with their family on Tuesday. They gave samples for testing on Tuesday. 

In Pirkanmaa the patient is 44-years-old and is at home, in quarantine and relatively healthy. Three close contacts to that patient have been identified.

In related news, another Yle report says Finland is ready to spend more money if COVID-19 hurts the national economy.

Mitigate the effects of home confinement on children during the COVID-19 outbreak

Via The Lancet: Mitigate the effects of home confinement on children during the COVID-19 outbreak. Excerpt:

In response to the coronavirus disease 2019 (COVID-19) outbreak, the Chinese Government has ordered a nationwide school closure as an emergency measure to prevent spreading of the infection. Public activities are discouraged. The Ministry of Education estimates that more than 220 million children and adolescents are confined to their homes; this includes 180 million primary and secondary students and 47 million preschool children). 

Thanks to the strong administrative system in China, the emergency home schooling plan has been rigorously implemented. Massive efforts are being made by schools and teachers at all levels to create online courses and deliver them through TV broadcasts and the internet in record time. The new virtual semester has just started in many parts of the country, and various courses are offered online in a well organised manner. These actions are helping to alleviate many parents' concerns about their children's educational attainment by ensuring that school learning is largely undisrupted. 

Although these measures and efforts are highly commendable and necessary, there are reasons to be concerned because prolonged school closure and home confinement during a disease outbreak might have negative effects on children's physical and mental health. Evidence suggests that when children are out of school (eg, weekends and summer holidays), they are physically less active, have much longer screen time, irregular sleep patterns, and less favourable diets, resulting in weight gain and a loss of cardiorespiratory fitness. Such negative effects on health are likely to be much worse when children are confined to their homes without outdoor activities and interaction with same aged friends during the outbreak. 

Perhaps a more important but easily neglected issue is the psychological impact on children and adolescents. Stressors such as prolonged duration, fears of infection, frustration and boredom, inadequate information, lack of in-person contact with classmates, friends, and teachers, lack of personal space at home, and family financial loss can have even more problematic and enduring effects on children and adolescents. 

For example, Sprang and Silman showed that the mean posttraumatic stress scores were four times higher in children who had been quarantined than in those who were not quarantined. Furthermore, the interaction between lifestyle changes and psychosocial stress caused by home confinement could further aggravate the detrimental effects on child physical and mental health, which could cause a vicious circle. 

To mitigate the consequences of home confinement, the government, non-governmental organisations (NGOs), the community, school, and parents need to be aware of the downside of the situation and do more to effectively address these issues immediately. Experiences learned from previous outbreaks can be valuable for designing a new programme to tackle these issues in China. 

The Chinese Government needs to raise the awareness of potential physical and mental health impacts of home confinement during this unusual period. The government should also provide guidelines and principles in effective online learning and ensure that the contents of the courses meet the educational requirements. 

Yet it is also important not to overburden the students. The government might mobilise existing resources, perhaps involving NGOs, and create a platform for gathering the best online education courses about healthy lifestyle and psychosocial support programmes available for schools to choose from. For example, in addition to innovative courses for a better learning experience, promotional videos can be useful to motivate children to have a healthy lifestyle at home by increasing physical activities, having a balanced diet, regular sleep pattern, and good personal hygiene. 

To make these educational materials truly effective, they must be age-appropriate and attractive. They require professional expertise and real resources to create.

COVID-19 in Australia: Containment is now 'unlikely', says NSW health minister

Australia can't catch a break. Via The Guardian: Coronavirus: containment is now 'unlikely', says NSW health minister. Excerpt:

Authorities in New South Wales are searching for 70 doctors who attended a radiology conference with two people affected by Covid-19 and assessing more than a dozen children who visited a Sydney nursing home where four people have been diagnosed with the virus. 

“I think at this point it is fair to say that we do have an evolution happening in the spread of this virus,” New South Wales health minister Brad Hazzard said.

“We do know that containment is likely to be an unlikely outcome, so we need to work constructively with the community to continue our effort to emphasise to the community that [controlling the virus] is a partnership … Our community has to be doing everything they can do to support us in defeating what has really become a war in defeating this coronavirus.”  

Four people at the Dorothy Henderson Lodge aged care facility in northern Sydney – a 95-year-old woman who has since died, a 82-year-old man, a 70-year-old man and an aged care worker in her 50s – have so far tested positive to Covid-19.  

The 70-year-old man resided in a different area of the lodge and was cared for by different staff than the other affected residents, which Hazzard said suggested infection control protocols had not contained the spread. 

The aged care centre has since been isolated. 

NSW chief health officer Dr Kerry Chant said about 17 children from the Banksia Cottage childcare centre at Macquarie University visited the aged care home on 24 February, on a day when the infected aged care worker was not working. Health authorities are meeting with parents and children on Thursday night to conduct assessments. 

Hazzard said that as a precaution, childcare centres had been advised to suspend their regular visits to aged care homes until the risk of children being “super-spreaders” of the disease had been determined. 

He said that authorities had contacted 77 doctors who attended a radiology seminar on 18 February, which is being investigated as the possible source of infection for a 53-year-old doctor at Ryde hospital who tested positive to the virus this week. Another doctor at that seminar, a registrar in her 30s from Liverpool hospital, was diagnosed with Covid-19 this week. 

Neither doctor had travelled overseas or had contact with known coronavirus patients.  

Hazzard said the process of tracing back possible contact between infected people was “a bit like a police investigation in a sense, trying to track who is coming into contact with who and what possible associations there may have been”.  

Meanwhile, a tourist in Darwin in Australia’s Northern Territory has tested positive for coronavirus. It is the first confirmed case in the territory, which contains hundreds of remote communities.  

On Thursday NT Health said a 52-year-old man carrying the virus was in isolation in Royal Darwin hospital. 

The man recently arrived in Darwin from Sydney and has had limited contact with the local community, NT Health said. The department was undertaking contact tracing and would reach out to those who may have been in contact with the man. 

New South Wales confirmed overnight that the virus had spread to six new people in the state, bringing the number of cases to 22.  

The death of the woman in aged care is Australia’s second recorded coronavirus death, after a 78-year-old who had been evacuated from the Diamond Princess died in hospital in Perth. 

There have now been 52 confirmed cases of the virus in Australia since the outbreak began.

Finland: 130 in Helsinki face quarantine following exposure to COVID-19

Via Yle Uutiset: 130 in Helsinki face quarantine following exposure to coronavirus. Excerpt:

A total of 130 people, including students at Helsinki University’s Viiki teacher training school, face immediate quarantine following exposure last week to a pupil diagnosed with novel coronavirus. 

Health officials said at a press conference on Sunday evening that the infected youngster was one of two new novel coronavirus infections reported by Finnish public health authorities on Sunday morning. 

The other was an elderly man who officials said had also come into contact with a woman diagnosed with the disease last Friday. The woman had reportedly returned from northern Italy two days earlier on 26 February. 

Helsinki and Uusimaa hospital district medical chief Asko Järvinen said that the woman had come into close contact with 15 people, all of whom had been contacted. The elderly man had no close contacts, while the child is believed to have had close contact with about 130 others.  

He had reportedly gone to school while exhibiting mild symptoms. He had also attended football practice with the Helsinki team HJK in the city’s Töölö district. 

"Most of the names of the persons exposed are known to health authorities and they will all be contacted," Järvinen told reporters, according to daily Helsingin Sanomat.  

Schooling during quarantine 

School principal Tapio Lahtero said that school authorities had mapped the child’s movement at school during the past week and determined that students and teachers from classes 6A, 6B, 6C and 4B were exposed to the disease and should be placed in quarantine. 

The quarantine period began immediately from their most recent contact with the young child, Lahtero noted. 

"The quarantine should end around 11 March," he added. 

Health officials stressed that persons placed under quarantine should not leave their homes and should not come into contact with others. They said family members however could go about their daily business as usual.  

The school principal said that the institution would ensure that students received some form of schooling during the 14-day quarantine period. This would take the form of distance learning as well as independent study exercises. 

The school said that all teachers and parents had been informed of the situation and that teachers and parents of students who came into contact with the infected child had been contacted separately and advised how to proceed.

Living with coronavirus anxiety in Singapore

Via The New Yorker: Living with Coronavirus Anxiety in Singapore. Excerpt:

How does a virus take over a community? Slowly. Perniciously. Inconclusively. The first line of attack is not an aching body or a runny nose but an unease that seeps into every corner of life, and which is impossible to explain away because it is reasonable, even necessary. You must listen to this fear. You must calibrate your responses correctly. Otherwise, you are irresponsible, you are careless; in the body of the community, you are a failing organ.  

Here in Singapore, we are perched awkwardly on the edge of the coronavirus crisis zone. As of this writing, ninety-two people on the island are known to have contracted the covid-19 disease. First, it was travellers who’d been to the Chinese city of Wuhan, the epicenter of the outbreak, but gradually the disease seeped into the community and began to spread. So far, no one in Singapore has died of the disease. 

But fear, it turns out, is also a virus. A low-level fright of this little-understood malady has taken hold in the international school where my children spend their days, and in the sprawling condominium complex where we live, along with a mix of Singaporean families and foreigners. This fear has the uncanny power to force out the uncomfortable questions that usually lurk unspoken in the communities it invades. You start out talking about the virus and end up picking apart parenting styles or foreign relations.  

The virus has become a little-understood variable in a sort of living laboratory experiment in extreme urban and social management. Singapore is home to a diverse population of 5.7 million, of whom nearly two million, like our family, have come to live or work here temporarily. Virtually every aspect of life here, from public-transport routes to political discourse, is carefully controlled by the government.  

The normal rhythms of the city are now punctuated by incessant virus-related announcements: emergency e-mails, stern notices on the bulletin board, and urgent WhatsApp messages from the government. Two more cases confirmed. School assemblies suspended. If you’ve been to mainland China in the past two weeks, stay home from school, church, and everything else. It’s worse than sars. Don’t panic. 

The frustrating truth is that we don’t know what we’re living through. Scientists are still scrambling to understand the fundamental facts about coronavirus, such as how it spreads and the length of its incubation period. In the absence of knowledge, we check constantly to see what everyone else is doing, having conversations that only lead to more uncertainty and judgment. In social circles that are preoccupied with family and schools, the coronavirus has become a microcosm of parenting itself: a crisis that compresses all the unease and distrust and self-doubt that lurk around the edges of child rearing into a slow-motion emergency that demands we all collaborate and follow orders.  

One morning, while my husband walked the kids out to the bus stop, I opened an e-mail from the school. It was a long message and, as I read, I set down my coffee. I had the sensation of vertigo, like I was tipping face first into my laptop screen. 

One of the teaching assistants in the Chinese-language program was a Wuhan native. His parents, who had come to visit over the Chinese New Year, had tested positive for the coronavirus. Happily, they were in stable condition, and the teacher himself did not appear to have the virus, but, then again, the long incubation period made it too soon to know for sure whether he’d been infected. His parents had been staying with him as he went back and forth to school. He’d been in the classroom and had performed in the Chinese New Year staff concert.  

If you want to overwhelm a communications network, here’s a good trick: compose an e-mail to thousands of Type A parents announcing that the deadly virus splashed all over the headlines has perhaps infiltrated their children’s school. Press Send just as school buses are heading off into morning traffic.  

“Good morning.” That was the first text from one of the second-grade moms: an opening line so barren of exclamation marks and emojis that, on a normal morning, it would imply a grave misdeed on the part of my child. “Saw the email?” she continued. We texted back and forth, and meanwhile I was texting with other parents and with two friends who are doctors in the United States. 

“It’s not very deadly,” my friend, who is a research doctor, wrote. “Though it does seem to be serious.” 

“Honestly, it’s less severe than influenza,” my emergency-room-doctor friend wrote. “Even if your kids get it they’ll be fine.” 

Here in Singapore, one mom was wondering whether the cafeteria food might be contaminated; another was taking pictures of the classroom where the teaching assistant had worked with the children. These calm assessments from America rendered all of that, somehow, ridiculous. I informed the first mom who’d texted that I knew a doctor who said we shouldn’t worry. She replied that she’d also spoken with a doctor and had been told not to worry. 

At that point, I assumed we’d reached a consensus. But just then she abruptly announced that her husband was headed to school to pick up their kid. “We’re not comfortable,” she wrote. “I understand,” I replied. Our fragile alliance had fractured, somehow, along lines that had to do with our tolerance for risk. We would not text each other for the rest of the week, while she kept her son at home and I sent mine to school.