H5N1

COVID-19 hospital stays cost 3 times more than a stay for heart attack

A news release from the Canadian Institute for Health Information: COVID-19 hospital stays cost 3 times more than a stay for heart attack.

The estimated average cost of a hospital stay for COVID-19 is more than $23,000 [US$18,145]. This includes both intensive care unit (ICU) and non-ICU admissions. New data from the Canadian Institute for Health Information (CIHI) shows that a COVID-19 hospital stay costs about 3 times more than for heart attack ($7,000) or pneumonia ($8,000), 4 times more than the cost of a stay for influenza (approximately $5,000) and almost as much as a kidney transplant ($27,000).   

People who have COVID-19 remain in the hospital about twice as long as the average pneumonia patient (15 days and 7 days, respectively), and a larger proportion of them are admitted to the ICU and ventilated.  

Estimated costs for COVID-19 hospital stays  

The estimated total cost of COVID-19 hospital stays in Canada (excluding Quebec) was almost $1 billion in 2020–2021, tripling between November 2020 and March 2021.  

A COVID-19–related hospitalization with ICU admission is estimated to cost over $50,000 — more than 3 times the cost of a stay without ICU admission ($15,000). By comparison, the average cost of an ICU admission for pneumonia is $22,000 and for heart attack is $8,400.  

More detailed information about COVID-19 hospitalizations and emergency department visits is also available.   

Hospital spending last year  

Before the pandemic began, Canadian hospitals (excluding Quebec and Nunavut) spent more than $55 billion in 2019–2020. Compensation was the largest spending area at 64%, followed by supplies (11%). You can find more information on hospital spending in 2019–2020, including per capita data and provincial/territorial breakdowns, on our website.  

These figures reflect the most recent information available from April 1, 2019, to March 31, 2020. Cost estimates for COVID-19 and other common hospitalizations are forecasted values.

Taiwan reports widening income gap amid COVID-19 pandemic

Via FocusTaiwan.tw: Taiwan reports widening income gap amid COVID-19 pandemic.

Taipei, Aug. 22 (CNA) The COVID-19 pandemic had changed the lifestyles of people in Taiwan dramatically and has led to a sharp rise of income inequality, the Directorate-General of Budget, Accounting and Statistics (DGBAS) said Sunday, citing 2020 data. 

Since COVID-19 was first confirmed to have spread to Taiwan in January last year, it has disrupted the country's manufacturing operations, hurt consumer confidence and dealt a blow to the service industry, the DGBAS said. 

While average household savings grew by a record annual 14.8 percent last year to NT$265,000 (US$9,461) since 1994, the income gap between rich and poor households widened, the DGBAS said, citing its 2020 Survey of Family Income and Expenditure. 

In 2020, income inequality in Taiwan was the highest in eight years, with the top 20 percent of households earning 6.13 times the bottom 20 percent, according to the DGBAS. 

Chu Tzer-ming (朱澤民), head of the DGBAS, attributed the sharp rise income inequality to the fact that disadvantaged employees have been hit harder by the economic fallout from the COVID-19 pandemic, as many of them have been asked to take unpaid leave, for example. 

Meanwhile, the DGBAS survey showed that average household spending in Taiwan fell by an annual 1.7 percent in 2020 to NT$815,000 (US$29,107), registering the biggest drop on record. 

Dachrahn Wu (吳大任), director of the Research Center for Taiwan's Economic Development at National Chengchi University, said the threat of new COVID-19 variants might take a toll on Taiwan's job market this year, dimming the prospects of a reduction of income inequality. 

The COVID-19 outbreak has ravaged Taiwan's economy more heavily this year than in 2020, when compensatory consumption surged in the second half of the year after the government eased some its disease prevention restrictions, he said. 

Taiwan's manufacturing capacity and exports, however, have grown sharply this year, bringing benefits to shareholders and employees of companies in the manufacturing and high tech sectors, he said. 

In comparison, employees in the service industry saw their earnings drop due to job loss or furloughs, as economic activity declined due to the COVID-19 outbreak, Wu said. 

The government should do more to provide relief to economically and socially disadvantaged people affected by the COVID-19 outbreak, Wu said, noting that property sales were brisk in the first half of 2021 and the domestic economy will grow robustly for the whole of the year.

In Iran, slow vaccinations fuel anger in unending pandemic

Via The Associated Press: In Iran, slow vaccinations fuel anger in unending pandemic. Excerpt:

DUBAI, United Arab Emirates (AP) — Iranians are suffering through yet another surge in the coronavirus pandemic — their country’s worst yet — and anger is growing at images of vaccinated Westerners without face masks on the internet or on TV while they remain unable to get the shots. 

Iran, like much of the world, remains far behind countries like the United States in vaccinating its public, with only 3 million of its more than 80 million people having received both vaccine doses. But while some countries face poverty or other challenges in obtaining vaccines, Iran has brought some of the problems on itself. 

After Iran’s Supreme Leader Ayatollah Ali Khamenei refused to accept vaccine donations from Western countries, the Islamic Republic has sought to make the shots domestically, though that process lags far behind other nations. 

The supply of non-Western shots remains low, creating a black market offering Moderna and Pfizer-BioNTech shots for as much as $1,350 in a country where the currency, the Iranian rial, is on the verge of collapse. Meanwhile, U.S. sanctions imposed on Iran mean the cash-strapped government has limited funds to purchase vaccines abroad. 

And even as the delta variant wreaks havoc, filling the country’s already overwhelmed hospitals, many Iranians have given up on wearing masks and staying at home. 

The need to earn a living trumps the luxury of social distancing. 

“What is next? A sixth wave? A seventh wave? When is it going to end?” asked Reza Ghasemi, a 27-year-old delivery man without a face mask, smoking a cigarette next to his motorbike on a recent day in Tehran. “It is not clear when this situation will change to a better one.” 

Since the start of the pandemic, Iran has recorded nearly 4 million COVID-19 cases and more than 91,000 deaths — the highest numbers across the Middle East. 

In a video message broadcast Wednesday on state TV, Iran’s supreme leader Ayatollah Ali Khamenei described the skyrocketing death toll as “very painful,” urging officials to roll out free virus tests and the fatigued public to follow health measures. 

The true count is believed to be much higher. In April 2020, Iran’s parliament warned its case number was “eight to 10 times” higher than the reported figures, due to undercounting. While coronavirus testing capacity has surged since then, officials repeatedly have suggested the case count remains far off. The death toll is likely three times higher, officials say, as Iran only counts those who die in a hospital while being treated for coronavirus.

Iran at risk of fifth COVID-19 wave as Delta variant spreads - Rouhani

Via Reuters: Iran at risk of fifth COVID-19 wave as Delta variant spreads.

DUBAI, July 3 (Reuters) - Iran may face a fifth wave of COVID-19 infections as the highly contagious Delta variant of the coronavirus spreads through the Middle East's worst-hit country, President Hassan Rouhani warned on Saturday. 

"There are concerns that the whole country may enter a fifth wave if enough care is not taken in following health protocols. Today, reports are that just 69% of the people are observing the precautions," Rouhani said in remarks broadcast on state TV. 

"The Delta variant entered the country from the south and southeast, and we should have been careful to prevent its spread in the country. All health regulations... must be fully observed, otherwise we will have a problem," Rouhani said. 

Iran, with a population of 83 million, has recorded 84,627 deaths from coronavirus, the highest toll in the Middle East. 

Health authorities have declared the capital Tehran and 91 other cities and towns as high-risk "red" zones, 30 more than a week ago. They are ordering internal travel restrictions, the closure of non-essential businesses and limiting work attendance to 30 percent of employees in the capital. 

 The government has blamed a slow vaccination drive on U.S. sanctions hampering efforts to buy foreign vaccines and on delays in deliveries. Rouhani said Iran has received a small portion of the 16.8 million vaccines it has ordered from the COVAX global vaccine-sharing program. 

A spokesman for the coronavirus taskforce told state TV that 7 million doses of vaccines have been distributed, with 2 million people receiving both doses and 4 million just one. 

Iran has licensed for public use two locally produced vaccines, including one together with Cuba, and is working on five more homegrown vaccines. Tehran is also cooperating with Russia on producing the Sputnik V jab. 

Food, medicine and other humanitarian supplies are exempt from U.S. sanctions reimposed on Tehran in 2018 after President Donald Trump walked away from a 2015 international deal over Iran’s nuclear program. 

But the U.S. measures, which target sectors including oil and financial activities, have deterred some foreign banks from processing financial transactions with Iran. Tehran says this has frequently disrupted efforts to import essential medicines and other humanitarian items.

Air pollution impacts of COVID-19–related containment measures

Via Science Advances: Air pollution impacts of COVID-19–related containment measures. The abstract: 

Responses to the COVID-19 outbreak resulted in one of the largest short-term decreases in anthropogenic emissions in modern history. To date, there has been no comprehensive assessment of the impact of lockdowns on air quality and human health. 

Using global satellite observations and ground measurements from 36 countries in Europe, North America, and East Asia, we find that lockdowns led to reductions in NO2 concentrations globally, resulting in ~32,000 avoided premature mortalities, including ~21,000 in China. However, we do not find corresponding reductions in PM2.5 and ozone globally. 

Using satellite measurements, we show that the disconnect between NO2 and ozone changes stems from local chemical regimes. The COVID-related lockdowns demonstrate the need for targeted air quality policies to reduce the global burden of air pollution, especially related to secondary pollutants.

SARS-CoV-2 elimination, not mitigation, creates best outcomes for health, the economy, and civil liberties

Via The Lancet: SARS-CoV-2 elimination, not mitigation, creates best outcomes for health, the economy, and civil liberties.

The trade-off between different objectives is at the heart of political decision making. Public health, economic growth, democratic solidarity, and civil liberties are important factors when evaluating pandemic responses. There is mounting evidence that these objectives do not need to be in conflict in the COVID-19 response. Countries that consistently aim for elimination—ie, maximum action to control SARS-CoV-2 and stop community transmission as quickly as possible—have generally fared better than countries that opt for mitigation—ie, action increased in a stepwise, targeted way to reduce cases so as not to overwhelm health-care systems. 

We compared COVID-19 deaths, gross domestic product (GDP) growth, and strictness of lockdown measures during the first 12 months of the pandemic for Organisation for Economic Co-operation and Development (OECD) countries that aim for elimination or mitigation (figure). Although all indicators favour elimination, our analysis does not prove a causal connection between varying pandemic response strategies and the different outcome measures. 

COVID-19 deaths per 1 million population in OECD countries that opted for elimination (Australia, Iceland, Japan, New Zealand, and South Korea) have been about 25 times lower than in other OECD countries that favoured mitigation (figure). Mortality is a proxy for a country's broader disease burden. For example, decision makers should also consider the increasing evidence of long-term morbidities after SARS-CoV-2 infection. 

There is also increasing consensus that elimination is preferable to mitigation in relation to a country's economic performance.6 One study quantified the optimal basic reproduction number so that elimination is achieved at minimal economic cost. To this end, consider weekly GDP growth with respect to 2019 for the OECD countries that opted for elimination or mitigation (figure). Elimination is superior to mitigation for GDP growth on average and at almost all time periods. GDP growth returned to pre-pandemic levels in early 2021 in the five countries that opted for elimination, whereas growth is still negative for the other 32 OECD countries. 

Despite its health and economic advantages, an elimination strategy has been criticised for restricting civil liberties. This claim can be challenged by analysing the stringency index developed by researchers at the University of Oxford. This index measures the strictness of lockdown-style policies that primarily restrict people's behaviour by combining eight indicators of containment and closure policies, eight indicators of health system policies, and one indicator of public information campaigns. 

Among OECD countries, liberties were most severely impacted in those that chose mitigation, whereas swift lockdown measures—in line with elimination—were less strict and of shorter duration (figure). Importantly, elimination has been framed as a civic solidarity approach that will restore civil liberties the soonest; this focus on common purpose is frequently neglected in the political debate. 

Evidence suggests that countries that opt for rapid action to eliminate SARS-CoV-2—with the strong support of their inhabitants—also better protect their economies and minimise restrictions on civil liberties compared with those that strive for mitigation. Looking ahead, mass COVID-19 vaccination is key to returning to usual life, but relying solely on COVID-19 vaccines to control the pandemic is risky due to their uneven roll-out and uptake, time-limited immunity, and the emergence of new SARS-CoV-2 variants. 

History shows that vaccination alone can neither single-handedly nor rapidly control a virus and that a combination of public health measures are needed for containment. The eradication of smallpox required concerted, decades-long efforts, including vaccination; communication and public engagement; and test, trace, and isolate measures. Even at the end of vaccination campaigns, such public health measures must be maintained to some extent or new waves of infections might lead to increased morbidity and mortality. 

With the proliferation of new SARS-CoV-2 variants of concern, many scientists are calling for a coordinated international strategy to eliminate SARS-CoV-2. Moreover, the US Department of State declared in April, 2021, that stopping COVID-19 is the Biden–Harris administration's number one priority and highlighted that “this pandemic won't end at home until it ends worldwide”. 

National action alone is insufficient and a clear global plan to exit the pandemic is necessary. Countries that opt to live with the virus will likely pose a threat to other countries, notably those that have less access to COVID-19 vaccines. The uncertainty of lockdown timing, duration, and severity will stifle economic growth as businesses withhold investments and consumer confidence deteriorates. Global trade and travel will continue to be affected. 

Political indecisiveness and partisan policy decisions reduce trust in government. This does not bode well in those countries that have seen a retraction of democracy. Meanwhile, countries opting for elimination are likely to return to near normal: they can restart their economies, allow travel between green zones, and support other countries in their vaccination campaigns and beyond. 

The consequences of varying government COVID-19 responses will be long-lasting and extend beyond the end of the pandemic. Early economic and political gains made by countries aiming to eliminate SARS-CoV-2 will probably pay off in the long run.

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.

Brazil: Harsh letter from bankers and economists criticizes Bolsonaro and offers proposals for the pandemic

Via BBC News Brasil: In full: that says the harsh letter from bankers and economists criticizing Bolsonaro and proposals for a pandemic. Excerpt from the Google translation:

In an open letter, more than 200 economists, bankers, businessmen and former public sector officials criticized the Bolsonaro government's actions in the pandemic, demanded more vaccines, free masks and social distance measures and refuted the "false dilemma between saving lives and guarantee the livelihood of the vulnerable population."

"Preliminary data on deaths and economic performance suggest that the countries with the worst economic performance had more deaths from covid-19", says the document, signed by names such as bankers Roberto Setubal and Pedro Moreira Salles (Itaú), former ministers Pedro Malan and Rubens Ricupero and economists such as Laura Carvalho, Elena Landau and Affonso Celso Pastore, this former president of the Central Bank. 

The almost 2,700-word letter can be divided into two: a diagnosis of the country's alarming health and economic situation today and a defense of four major measures against the spread of the disease. 

"There is no more time to waste on sterile debates and false news. We need to be guided by successful experiences, by low-cost, high-impact actions, by initiatives that can actually reverse the unprecedented situation that the country is experiencing."

In the last three weeks, Brazil has been beating successive records of deaths registered in a 24-hour period every day. Currently, the daily average is 2,255 deaths, but the trend is upward, and some researchers do not rule out that this number may even double soon.

'Falling off a cliff': Pandemic crippling world's most fragile states, finds report

Via The Guardian: 'Falling off a cliff': pandemic crippling world's most fragile states, finds report. Excerpt:

Thousands could starve in the world’s most fragile states as the pandemic comes on top of existing crises, warns a new report today which found aid workers are deeply pessimistic about the coming year. 

The survey of aid workers by the Disaster Emergency Committee (DEC) found that they believed humanitarian conditions were at their worst in a decade. 

The chief executive of the DEC, Saleh Saeed, said reduced funding could force aid providers to prioritise some populations and services over others. 

“People living in places made perilous by conflict, violence and climate disasters are coping with the coronavirus pandemic as best they can, but the odds are stacked against them. The knock-on effects of the pandemic have crippled economies, making the world’s poorest people even poorer,” said Saeed. 

The report focused on Syria, Yemen, Somalia, South Sudan, the Democratic Republic of the Congo and Afghanistan, as well as the Rohingya refugee camps in Bangladesh.

It said there had been a significant economic impact in all of these countries, but that the direct health impact of the coronavirus had also been underestimated because of insufficient testing capacity. 

Ahmed Khalif, country director for the charity Action Against Hunger in Somalia, said livelihoods had been damaged by drops in crucial livestock exports and remittances sent from the diaspora, coming alongside conflict, locust infestations and drought.

African swine fever mutation spreads in China, sparking new control fears

Via Caixin Global: African Swine Fever Mutation Spreads in China, Sparking New Control Fears. Excerpt:

Chinese scientists have discovered a milder but harder-to-detect mutation of the African swine fever virus has been spreading in China, posing new challenges to the prevention and control of the highly infectious disease which swept the country in 2018. 

Researchers from the Harbin Veterinary Institute said they had documented new strains of the disease and warned that the mutations might already be prevalent among pig populations in fields, a report published in the academic journal Science China Life Sciences on Feb. 24. It confirmed a similar report published by the Military Veterinary Institute early last month. 

Compared to pigs infected with classic African swine fever, animals infected with the new strains experience a longer period of disease, milder symptoms and ones which are more easily misdiagnosed. Failure to diagnose contaminated pigs at an early stage can lead to mass infection in farms and irrecoverable loss, multiple pig farming industry insiders said. 

With milder clinical symptoms, the new strains are more difficult to detect in livestock while remaining highly transmissible, making early diagnosis more challenging, they said. While not dangerous to humans, the disease can cause up to 100% fatality in pigs, leading to severe economic losses to the pig sector. 

China consumes more than half of the world's pork production. An estimated 30% of Chinese pork production is by small-scale farmers who may lack the expertise or funds to protect their animals from the disease, according to health experts. 

There are no commercialized vaccines or specialized treatment for the virus. Controlling the pandemic relies on swift diagnosis and extermination of infected animals. A swine fever virus vaccine developed by the Harbin Veterinary Institute is currently in its second stage of clinal trials. 

Multiple industry professionals told Caixin, speaking on condition of anonymity, that although there is no approved vaccine to date, many pig farms have used “underground vaccines” from unknown sources to mitigate losses. Professionals worry that these unregulated vaccines may cause the virus to mutate, thereby exacerbating the crisis.