H5N1

In Guatemala, COVID-19 shows its power to kill trust

Via The Tyee, my colleague Emi Sasagawa writes: In Guatemala, the Virus Shows Its Power to Kill Trust. Excerpt:

It’s the start of month six of the world living with the threat of coronavirus. While restrictions are easing in Canada, a first wave of COVID-19 cases is resurging just south of the border in the U.S.  

Further south, in many less-developed countries, the first wave is just now picking up speed. With fewer resources and restless populations, some of those nations’ governments are seeing their political lives put in danger by the coronavirus.  

As citizens are asked to endure lockdowns and economic deprivation as a result of pandemic measures, trust becomes a currency increasingly precious. Eroding it are doubts about the statistics their leaders share, what competence they show in managing the virus and the economy, and where government money flows. 

Guatemala is a case in point — one The Tyee is looking in on occasionally as part of a project in partnership with the TulaSalud Foundation, which funds rural public health work in that Central American country. Grassroots opposition to corruption in Guatemala has roiled the country for years, playing a key role in unseating the previous president who was replaced in January by Alejandro Giammattei, a right-wing former physician and director of the prison system. He, too, under the harsh glare of the pandemic, faces severe trust issues. 

 As July arrives, Guatemala is struggling to deal with a steepening infection curve and a health system leaning towards collapse. The reported numbers have soared from 644 cases and 16 deaths on May 1 to 20,072 cases and 843 deaths on July 2. There is no indication the curve with be flattened any time soon. What took months to unfold across Canada — the outbreaks, the overwhelmed health system in certain regions, the economic and financial repercussions of the pandemic — has been compressed into a matter of weeks. 

Still, there were months to prepare. Yet Giammattei’s government is taking fire for not yet managing to provide personal protective equipment for frontline workers.  

“At this point, doctors still don’t have the appropriate health equipment,” said Dr. Rubén Gonzalez, former vice-minister of health and one of the leading voices in an alternative COVID-19 response exercise. “Of the total budget assigned for this emergency, only a small fraction, less than five per cent is being used, because the government hasn’t been able to negotiate a price with providers and, as a result, all plans by the government collapse. In the meantime, our health-care workers suffer.”

Canada: All community outbreaks of COVID-19 in BC now declared over

Via dailyhive.com: All community outbreaks of coronavirus in BC now declared over. This is quite a contrast with our neighbours in Washington state, which currently reports 34,151 cases and 1,342 deaths.

With a COVID-19 community outbreak in Abbotsford now declared over, there are currently no other community outbreaks in the province. 

Provincial Health Officer Dr. Bonnie Henry provided the update on Thursday during a press conference. 

“There have been no new community outbreaks and the outbreak at New World Technologies has been declared over,” she confirmed. “This means there are no active community outbreaks in BC.” 

Despite the encouraging news, Henry said that health officials will still continue to “monitor [the situation] in all of our community settings.” 

She also noted that the province has “had a few small transmission events in some community settings and workplaces over the past number of weeks, and in addition we’ve had a number of exposure events.”  

There have also been no new health-care facility outbreaks, Henry said. However, a total of four long-term care or assisted-living facilities and one acute care facility are currently  dealing with active outbreaks.

As part of her Thursday update, Henry also said a total of 24 new coronavirus cases have now been confirmed in the province since Tuesday, along with three additional deaths related to the virus. 

Broken down further, Henry said there were 15 positive cases from Tuesday to Wednesday and nine new cases reported between Wednesday and Thursday. These new cases bring the total number of recorded cases in the province to 2,940. 

By specific health region, Henry said this equates to 989 known cases in Vancouver Coastal Health, 1,553 in Fraser Health, 132 on Vancouver Island, 201 in Interior Health, and 65 in Northern Health.

Overall, the number of active cases in province currently totals 160, with 17 of those cases in hospitals, with two of those in ICU. A total of 2,603 cases are now considered fully recovered, as well.  

“With each day we keep our curve flat, we can take confidence in knowing the people we care about the most are staying safe,” said Henry. “Whether from near or far, what we do makes a difference.”

Early lessons from a second COVID-19 lockdown in Leicester, UK

Via The Lancet: Early lessons from a second COVID-19 lockdown in Leicester, UK.

As the number of new cases of COVID-19 continues to decline in the UK, national lockdown measures are being cautiously relaxed. However, Leicester has become the first city in England to have lockdown measures re-imposed. There are growing concerns about further local outbreaks, with the potential to culminate in a second wave. 

The national strategy for managing, if not mitigating, these risks has been centralised and primarily focused on so-called pillar 2 community-based swab testing completed by remote lighthouse laboratories and contact tracing. This is supported by continued pillar 1 testing, in National Health Service hospital laboratories, of patients admitted to hospital.1 Here we report our early experience of the second spike in COVID-19 cases in Leicester. 

The ethnic pluralism and cultural diversity celebrated by the city now presents complex and considerable public health challenges. As the city enters a local lockdown, we consider whether lessons should be learnt to avoid or better manage similar inevitable surges across other areas of the UK. 

News of this outbreak, first announced by the Health Secretary on June 18, 2020, based on pillar 2 data, was a surprise to local health organisations. These local services only had access to pillar 1 data, which showed that the number of new cases per day was low through the first half of June, 2020. It was subsequently reported that a quarter of all cases in Leicester were confirmed between June 1 and June 15, 2020. Most of these new cases were reportedly concentrated in ten wards in the east of the city (appendix). 

Census results and official estimates of populations of local wards in Leicester show that 72·5% of the population of these wards are from Black, Asian, and Minority Ethnic backgrounds, mostly of South Asian ethnicity, who are disproportionately affected by adverse outcomes of COVID-19.

As the situation continues to rapidly evolve, this second spike in COVID-19 cases in Leicester has exposed key problems that must be urgently addressed. In particular, the opportunity to escalate interventions locally has been stymied by the inadequacy of information sharing. Pillar 2 data, which indicated this ongoing spike, were not communicated in a timely manner to the local authority and local health organisations that had been tasked with local public health preparedness, and they did not contain full information on key demographics (age, address, place of work, and ethnicity). 

Instead, a nationally mandated increase in pillar 2 testing capacity, including mobile testing units run by the Ministry of Defence, was introduced. This was ineffective in the absence of a locally directed coordinated response, leading to lockdown measures being reintroduced on June 30, 2020. 

What can be done to improve the management of local outbreaks? The current centralised platform cannot function effectively in isolation and must be revised to adopt a network structure that integrates with the local authority and local health services in every region. 

In this respect, the success of the multi-disciplinary network structure of the National Tuberculosis control strategy to manage the growing epidemic of another deadly airborne infection offers an effective precedent. We know that health-care needs can vary widely between regions, influenced by demography, deprivation, and other socioeconomic parameters. A one-size-fits-all approach is myopic—local authorities, public health teams, and clinicians are best placed to understand the needs of their communities and should be empowered to implement context-specific and area-specific interventions developed within existing programmes. 

For Leicester, the relationships established with community leaders and services to tackle inequality of health provision in ethnic minority groups are acutely relevant to support measures for effective control. These includes culturally appropriate implementation of the test, track, and trace programme, alongside public health messaging that these communities can easily access. 

Although increased local lockdown restrictions are being imposed in Leicester, we must be careful to consider whether this will necessarily have the desired impact in areas of high ethnic diversity. An area-specific imposition will necessarily target and disproportionately affect ethnic minority communities, many of whom live in areas of high social deprivation and work in care, health, and transport sectors. Their support will be needed for adherence to any proposed measures, and this will require effective community engagement. We should remain mindful that lockdown is a blunt and damaging tool of last resort that represents a failure of timely intervention. 

Our experience brings into sharp focus the shortfalls in the current identification and management of local COVID-19 outbreaks. As we enter the second phase of the COVID-19 pandemic, we all remain in this together. This philosophy needs now to be applied to tackling the challenges ahead with an inclusive and coordinated public health response that is locally led, agile, and responsive to prevent unnecessary morbidity and mortality.

Social divisions drive astronomical COVID-19 rate in Chile

Via NPR's Goats and Soda blog: Social Divisions Drive Astronomical COVID-19 Rate In Chile. Chile's COVID-19 case count is here. Excerpt:

Chile looked as if it were well prepared to deal with the new coronavirus. 

It's a rich country — classified as high income by the World Bank. Life expectancy is roughly 80 years — better than the United States'. It has a solid, modern health care system, and when the outbreak began spreading, officials made sure they had plenty of ventilators and intensive care beds at the ready.  

But the virus exploited the cracks in Chilean society. The country now has the highest per capita infection rate of any major country — 13,000 cases for every 1 million people. That's more than 10 times the rate in neighboring Argentina and twice the rate in Brazil.  

Like many well-to-do countries, Chile saw its first cases of COVID-19 among its elite — people who'd recently traveled to Europe and the United States. That was in April. The government quickly rolled out a plan to provide testing and treatment. Health officials quarantined hard-hit neighborhoods. Residents had to apply for a pass online before they could go out of their homes even to buy groceries. In late April, things were going so well that Chile was starting to talk about reopening. 

"And then May started bringing more cases and more cases. Currently we have, in my opinion, more cases than we are able to handle," says Thomas Leisewitz, a physician in Santiago. Leisewitz is a professor at Pontificia Universidad Católica de Chile and heads up strategic development at Red de Salud UC Christus, a nonprofit Catholic health care network. 

Since May, the number of cases has been rising steadily, with the country recording at one time 5,000 to 6,000 new cases a day in June. The virus spread out of the affluent parts of Santiago to low-income neighborhoods where many residents don't have the luxury of being able to work from home.  

And the high numbers are not just a reflection of an efficient testing infrastructure. Chile's per capita testing rate is lower than most European nations' and almost half the rate in the United States. 

So how did this particular virus come to spread incredibly rapidly in wealthy, well-prepared Chile? 

Andrea Insunza, a journalist in Santiago, says the reason is something unrelated to the virus itself. That something is social inequity. 

"In Chile, there are two countries," says Insunza, who runs the center for investigative journalism at Universidad Diego Portales. "There's a country for people like me. I have a good education. I have a good salary, and all my social security is privatized."  

By this she means she has access to high-quality private hospitals and clinics. 

But there's another Chile.  

"And that Chile is poor and you depend on the public health [system]," says Insunza. 

Last October, violent street protests erupted in Santiago over a fare hike on the subway of 30 pesos, or less than 5 U.S. cents. The protests became about far more than the price of a subway ride. 

Chile is one of the most unequal countries in Latin America, according to the World Bank. The elite, the top 10%, controls more than half the country's wealth. And while extreme poverty has been driven down significantly over the last decade, the social unrest in October centered on the frustrations of lower- and middle-class Chileans who view their economic opportunities as unfairly limited. 

Insunza says part of the frustration is driven by the elite often not even seeming to recognize their privileged lifestyles. 

"Santiago, it's a very segregated place," Insunza says. "You can actually live your whole life and not see poverty. Never."  

Chile's initial plan to deal with the coronavirus outbreak — which at first affected mainly the elite in Santiago — failed to recognize that the affluent have maids, gardeners and cooks who might also get infected.  

The country's response went well in those early weeks. Case numbers were holding steady. The fatality rate was low. 

Then the virus started spreading in lower-income neighborhoods and quickly got out of control.

Hollowed-out public health system faces more cuts amid COVID-19 pandemic

Many thanks to Lauren Weber for sending this major report by Kaiser Health News and The Associated Press: Hollowed out public health system faces more cuts amid virus. Here's an excerpt and then a comment, but you should just click through and read the whole long, grim story. Don't let it depress you, but do let it enrage you.

The U.S. public health system has been starved for decades and lacks the resources to confront the worst health crisis in a century. 

Marshaled against a virus that has sickened at least 2.6 million in the U.S., killed more than 126,000 people and cost tens of millions of jobs and $3 trillion in federal rescue money, state and local government health workers on the ground are sometimes paid so little, they qualify for public aid.  

They track the coronavirus on paper records shared via fax. Working seven-day weeks for months on end, they fear pay freezes, public backlash and even losing their jobs.  

Since 2010, spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%, according to a KHN and Associated Press analysis of government spending on public health. At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce for what was once viewed as one of the world’s top public health systems. 

An Associated Press-KHN investigation has found a skeletal workforce facing more possible county budget cuts. KHN, also known as Kaiser Health News, and AP interviewed more than 150 public health workers, policymakers and experts, analyzed spending records from hundreds of state and local health departments, and surveyed statehouses. On every level, the investigation found, the system is underfunded and under threat, unable to protect the nation’s health.  

Robert Redfield, the director of the Centers for Disease Control and Prevention, said in an interview in April that his “biggest regret” was “that our nation failed over decades to effectively invest in public health.”  

So when this outbreak arrived — and when, according to public health experts, the federal government bungled its response — hollowed-out state and local health departments were ill-equipped to step into the breach.

Over time, their work had received so little support that they found themselves without direction, disrespected, ignored, even vilified. The desperate struggle against COVID-19 became increasingly politicized and grew more difficult. 

States, cities and counties in dire straits have begun laying off and furloughing their limited staff, and even more devastation looms, as states reopen and cases surge. Historically, even when money pours in following crises such as Zika and H1N1, it disappears after the emergency subsides. Officials fear the same thing is happening now. 

“We don’t say to the fire department, ‘Oh, I’m sorry. There were no fires last year, so we’re going to take 30% of your budget away.’ That would be crazy, right?” said Dr. Gianfranco Pezzino, the health officer in Shawnee County, Kansas. “But we do that with public health, day in and day out.”

This is not just a Republican failure; the Democrats are equally to blame. Both parties, since about 1980, have presided over an enormous project of social engineering: the transfer of wealth from working people and the middle class to the 0.1%.

"Government is the problem" was Reagan's mantra, and as people began to notice that their incomes couldn't quite cover all their bills any more, they were taught to blame government spending for their suddenly heavy taxes. (Never mind that Americans were already among the most lightly taxed citizens of any industrialized country.)

 

So tax cut after tax cut came from Republican and Democratic administrations alike, on all levels of government. Somehow the taxes were always too burdensome, the government spending too wasteful. Universal health care was for those overtaxed "socialist" Europeans and Canadians, and a little grudging support for public health came only to provide symptomatic relief—to provide a Band-Aid, not to prevent the cut in the first place.

 

"We're all in this together" rings hollow in a country that's been taught for 40 years that everyone is personally responsible for his or her success or failure, health or sickness. And now that the consequences of 40 years of wealth transfer are manifest, 126,000 rugged American individualists are dead, 2.6 million have been sickened (so far), and everyone but the 0.1% have been further impoverished. (The 0.1% have been doing just fine, thanks.)

 

It will take more than yet another transfer of power from Republicans to Democrats to roll back COVID-19. It will take a rollback of 40 years of systemic theft from the 99%.

Dr. Tedros on COVID-19: 'This is not even close to being over'

A WHO transcript: WHO Director-General's opening remarks at the media briefing on COVID-19 - 29 June 2020. Excerpt:

WHO will continue to do everything in our power to serve countries with science, solidarity and solutions. The critical question that all countries will face in the coming months is how to live with this virus. That is the new normal.  

Many countries have implemented unprecedented measures to suppress transmission and save lives. These measures have been successful in slowing the spread of the virus. But they have not completely stopped it.

Some countries are now experiencing a resurgence of cases as they start to re-open their economies and societies. Most people remain susceptible. The virus still has a lot of room to move.

We all want this to be over. We all want to get on with our lives.  But the hard reality is: this is not even close to being over.  Although many countries have made some progress, globally the pandemic is actually speeding up.

We’re all in this together, and we’re all in this for the long haul. We will need even greater stores of resilience, patience, humility and generosity in the months ahead.  We have already lost so much – but we cannot lose hope.

This is a time for renewing our commitment to empowering communities, suppressing transmission, saving lives, accelerating research and political and moral leadership. 

But it’s also a time for all countries to renew their commitment to universal health coverage as the cornerstone of social and economic development – and to building the safer, fairer, greener, more inclusive world we all want. 

COVID-19: What did people know, and when did they know it?

Thanks to James Fallows for providing the link in his excellent Atlantic article to a very helpful timeline in PDF on how COVID-19 came to the world's attention:

Download Covid19 and China.

In the same article, Fallows also links to the Obama administration's Pandemic Playbook, which the Trump administration dismissed and ignored:

Download Pandemic-Playbook.

 

New analysis paints international picture of COVID-19’s long-term care impacts

Via the Canadian Institute for Health Information: New analysis paints international picture of COVID-19’s long-term care impacts. This does not make us look good. Click or tap through for more information:

New analysis paints international picture of COVID-19’s long-term care impacts 

June 25, 2020 —  A new analysis released today by the Canadian Institute for Health Information (CIHI) shows that while Canada’s COVID-19 death rate is relatively low compared to other OECD countries, the proportion of deaths occurring in long-term care (LTC) is double the OECD average. 

As of May 25, at the country level, LTC residents accounted for 81% of all reported COVID-19 deaths in Canada, compared with an average of 42% in 16 other OECD countries (ranging from less than 10% in Slovenia and Hungary to 66% in Spain).  

This analysis examines Canada’s pandemic experience in LTC and that of other countries in the Organisation for Economic Co-operation and Development (OECD), focusing on 3 areas: cases and deaths, baseline health system characteristics and policy responses. Please note that there are data limitations when it comes to international comparisons due to differences in COVID-19 testing and reporting practices across countries, as well as in definitions of long-term care. 

Key findings:   

• Compared with the OECD average, Canada had fewer health care workers (nurses and personal support workers) per 100 senior residents of LTC homes in 2017–2018. 

• Countries with centralized regulation and organization of LTC (Australia, Austria, Hungary, Slovenia) were generally associated with lower numbers of COVID-19 cases and deaths.  

• Countries that implemented specific prevention measures targeted to the LTC sector at the same time as their stay-at-home orders and closure of public places (Australia, Austria, the Netherlands, Hungary, Slovenia) had fewer COVID-19 infections and deaths in LTC.

Live global COVID-19 news: US sets a daily record for new cases

Via The New York Times: Live Global Coronavirus News: U.S. Sets a Daily Record for New Cases. Excerpt:

Nearly 37,000 infections were reported as the virus surged in the South and West. Pregnant women who contract the illness wind up in hospitals and I.C.U.’s at higher rates, a federal study suggested. 

RIGHT NOW Gov. Greg Abbott of Texas issued an executive order suspending elective procedures in hospitals in four counties to free up space for virus patients. 

Here’s what you need to know: 

• Four states, including Florida and Texas, report highest single-day totals as the U.S. reopens. 

• Here’s how the virus stayed a step ahead of the American authorities. 

• Europe sees a ‘significant resurgence’ of cases, a W.H.O. official warns. 

• A C.D.C. study overlooks an important factor as it measures the effects of pregnancy on Covid-19 patients. 

• France plans regional testing, and the Eiffel Tower reopens. 

• In Guatemala and Honduras, the virus has riddled the corridors of power. 

• More than 1 million people in the U.S. seek state jobless benefits for the 14th week in a row.

Four states, including Florida and Texas, report highest single-day totals as the U.S. reopens. 

The United States reported 36,880 new coronavirus cases on Wednesday, the largest one-day total since the start of the pandemic and more than two months after the previous high. 

The number of infections indicated that the country was not only failing to contain the virus, but also that the caseload was worsening — a path at odds with many other nations that have seen steady declines after an earlier peak. Cases in the United States had been on a downward trajectory after the previous high of 36,739 cases on April 24, but they have roared back in recent weeks.  

The resurgence is concentrated largely in the South and West. Florida, Oklahoma, South Carolina and Texas reported their highest single-day totals on Wednesday, but case numbers have been rising in 29 states. 

The tally of new cases, based on a New York Times database, showed that the outbreak was stronger than ever. The elevated numbers are a result of worsening conditions across much of the country, as well as increased testing — but testing alone does not explain the surge. The percentage of people in Florida who have tested positive for the virus has risen sharply. Increases in hospitalizations also signal the virus’s spread.

The COVID-19 Catastrophe: Richard Horton's short, angry, and powerful book

The Tyee has published my review of Richard Horton's new book The COVID-19 Catastrophe: What's Gone Wrong and How to Stop It Happening Again: Only a Newly ‘Vigilant Society’ Can Stop the Next Pandemic. Excerpt:

Feeling a bit under the weather, you go to your doctor. He knows your medical history, he checks your symptoms, he comes up with a diagnosis, and then he chews you out for behaving precisely as you’re not supposed to, thereby making yourself sick. What’s worse, you’re now a menace to the health of everyone around you. If you don’t shape up, you’ll ship out — in a body bag.  

That’s the structure of this short, angry, and powerful book, written while the author was in lockdown in the U.K. Richard Horton is a doctor, but for a quarter-century he has been editor-in-chief of The Lancet, flagship of a fleet of important medical journals. As such, he has monitored global health through outbreaks of Ebola, SARS, MERS, cholera, H1N1 influenza, Zika, and the steady, deadly background noise of malaria, measles, and other diseases. 

While locked down and dealing with a flood of incoming reports on COVID-19, Horton has also managed to write a clear, concise account of our own incompetence and folly — both in preparing for a pandemic everyone knew was coming, and in responding to it once it arrived. While politicians and bureaucrats take much of the blame, so do scientists. And so does everyone else. 

 His summary of the emergence of COVID-19 covers the key points and the questions they raise. If the first cases were noted at the beginning of last December, why wasn’t World Health Organization notified until New Year’s Eve? And once notified, why didn’t WHO respond more quickly, and why didn’t it engage health scientists from around the world in learning about the new virus from their Chinese colleagues? 

Slow and confused 

The world’s response to clear signs of impending disaster was woefully slow and confused. Governments, especially those of the U.K. and the U.S., come in for Horton’s condemnation: “The science and politics of COVID-19 became exercises in radical dehumanization.… At press conference after press conference, government ministers and the medical and scientific advisors described the deaths of their neighbours as ‘unfortunate.’ But these were not unfortunate deaths. They were not unlucky, inappropriate, or even regrettable. Every death was evidence of government misconduct — reckless acts of omission that constituted breaches in the duties of public office.… Missed opportunities and appalling misjudgments were leading to the avoidable deaths of tens of thousands of citizens.”