H5N1

Cuba, gripped by unrest, battles highest COVID caseload in the Americas

Credit: Our World in Data

Via Reuters: Cuba, gripped by unrest, battles highest COVID caseload in the Americas. Excerpt:

HAVANA, July 19 (Reuters) - Cuba, which kept coronavirus infections low last year, now has the highest rate of contagion per capita in Latin America. That has strained its healthcare sector and helped stoke rare protests that have roiled the Communist-run island. 

The Caribbean nation of 11 million people reported nearly 4,000 confirmed cases per million residents over the last week, nine times more than the world average and more than any other country in the Americas for its size. 

The outbreak, fueled by the arrival of the more contagious Delta variant first identified in India, has pushed hospitals at the virus epicenter in the province of Matanzas to the brink. State media has shown rare images of patients in beds in corridors and doctors complaining of a lack of oxygen, ventilators and medicines. 

Cuba's handling of the pandemic was one of the issues that propelled thousands to take to the streets nationwide last Sunday in unprecedented anti-government demonstrations in a country where public spaces are tightly controlled. read more Demonstrators also protested shortages of food and medicines and curbs on civil liberties. 

Cuba is not alone in struggling under new waves of the pandemic. But the political implications of such a crisis are greater in a country where healthcare is considered one of the pillars of legitimacy of its "revolutionary" one-party system. 

Moreover the outbreak and subsequent lockdown and reduction in numbers of flights has taxed an already bankrupt economy where many work in tourism and others rely on travelers to bring in remittances and goods including medicine. 

"The government has consistently made the case that one of the main accomplishments of the revolution is its world-class medical sector," said Cuban American historian Daniel Rodriguez, author of a book on medical politics in post-independence Havana. 

Rodriguez said the exacerbation of food and medicine shortages over the past year due to the pandemic-related economic crisis had already broken Cuba's social pact.

"When the pandemic began spiraling out of control a couple of weeks ago, it appeared increasingly the revolutionary government was no longer able to protect Cuban lives, and the result was an extraordinary repudiation of the revolution itself."

WHO, at heart of world's sluggish COVID response, could face shake-up

Via Reuters: WHO, at heart of world's sluggish COVID response, could face shake-up. Excerpt:

The World Health Organization, at the heart of the world's sluggish handling of the COVID-19 pandemic, faces a potential shake-up to prevent future outbreaks as a top official warned that "the pathogens have the upper hand". 

Health ministers agreed on Monday to study recommendations for ambitious reforms made by independent experts to strengthen the capacity of both the U.N. agency and countries to contain new viruses. 

Under the resolution submitted by the European Union, and adopted by consensus, member states are to be firmly in the driver's seat of the reforms through a year-long process. 

The new virus has infected more than 170 million people and killed nearly 3.7 million, according to a Reuters tally of official national figures. 

Health ministers from WHO's 194 member states will also meet from Nov. 29 to decide whether to launch negotiations on an international treaty aimed at boosting defences against any future pandemic. 

WHO's emergencies director, Mike Ryan, welcomed the decisions, telling its annual ministerial assembly: "Right now the pathogens have the upper hand, they are emerging more frequently and often silently in a planet that is out of balance. 

"We need to turn that very thing that has exposed us in this pandemic, our interconnectedness, we need to turn that into a strength," he said. The decisions were adopted in a plenary session on Monday at the end of its week-long assembly. 

"A pandemic treaty under the roof of the WHO is the preferred way forward to strengthen the multilateral health architecture including the IHR (International Health Regulations) and to heed the call by so many experts to reset the system," Chile's ambassador Frank Tressler Zamorano said on behalf of 60 countries. 

One panel, headed by former New Zealand Prime Minister Helen Clark and Ellen Johnson Sirleaf, a former president of Liberia, said that a new global system should be set up to respond faster to disease outbreaks to help ensure no future virus causes a pandemic as devastating as COVID-19.

The experts, who found crucial failures in the global response in early 2020, said that the WHO should be given the power to send investigators swiftly to chase down new disease outbreaks and to publish their full findings without delay. 

They also called for setting up a Global Health Threats Council to maintain high-level political commitment to pandemic preparedness. 

"The world was hit by this virus unprepared. And if another virus emerged tomorrow this would be still be the case," Björn Kümmel, of Germany's federal health ministry, said last week. 

"A green light for this treaty process is the greatest commitment to learn from this crisis that this Assembly could have sent out. It is the most effective way to make sure that the global health crisis becomes the final one."

'Like hell:' As Olympics loom, Japan health care in turmoil

A report from The Associated Press: 'Like hell:' As Olympics loom, Japan health care in turmoil. Excerpt:

TOKYO (AP) — As she struggled to breathe, Shizue Akita had to wait more than six hours while paramedics searched for a hospital in Osaka that would treat her worsening COVID-19. 

When she finally got to one that wasn’t overwhelmed with other patients, doctors diagnosed severe pneumonia and organ failure and sedated her. Akita, 87, was dead two weeks later. 

“Osaka’s medical systems have collapsed,” said her son, Kazuyuki Akita. He has watched from his home north of Tokyo as three other family members in Osaka have dealt with the virus, and with inadequate health care. “It’s like hell.” 

 Hospitals in Osaka, Japan’s third-biggest city and only 2 1/2 hours by bullet train from Summer Olympics host Tokyo, are overflowing with coronavirus patients. About 35,000 people nationwide — twice the number of those in hospitals — must stay at home with the disease, often becoming seriously ill and sometimes dying before they can get medical care. 

As cases surge in Osaka, medical workers say that every corner of the system has been slowed, stretched and burdened. And it’s happening in other parts of the country, too. 

The frustration and fear are clear in interviews by The Associated Press with besieged medical workers and the families of patients in Osaka. It’s in striking contrast with the tone in the capital Tokyo, where Olympic organizers and government officials insist the July Games will be safe and orderly even as a state of emergency spreads to more parts of the country and a growing number of citizens call for a cancellation. 

Some see Osaka as a warning for what could happen to the rest of Japan if the crisis worsens at a time when officials — and the world — are focused on the Olympics.

Nurse who cared for Boris Johnson resigns over ‘lack of respect’ for NHS workers

Via The Guardian: Nurse who cared for Boris Johnson resigns over ‘lack of respect’ for NHS workers. Excerpt:

A nurse who cared for Boris Johnson when he was gravely ill with Covid-19 says she has handed in her resignation, such is her disillusionment with the “lack of respect” shown by the government for the NHS and healthcare workers. 

Jenny McGee, who kept vigil by the prime minister’s bedside for two days when he was in intensive care, also revealed that his staff had later attempted to co-opt her into a “clap for the NHS” photo opportunity with him during what she thought would be a discreet thank you visit to Downing Street. 

“We’re not getting the respect and now pay that we deserve. I’m just sick of it. So I’ve handed in my resignation,” said McGee, referring to the government’s proposed 1% pay rise for NHS staff, which unions have described as a “kick in the teeth”. 

She was also critical of the government’s handling of the Covid crisis, adding: “Lots of nurses felt that the government hadn’t led very effectively – the indecisiveness, so many mixed messages. It was just very upsetting.” 

McGee made the comments in a Channel 4 documentary to be broadcast on 24 May about the 15 months of Covid in Britain.

It coincides with the first anniversary of when the Guardian and Daily Mirror revealed Dominic Cummings’ breach of lockdown rules. The documentary pinpoints the revelation as a turning point for when the resolve and sense of togetherness that had manifested in the UK throughout the first lockdown began to fray. 

McGee, a lead intensive care nurse at St Thomas’ hospital in London, described how she found the prime minister when she arrived for work: “All around him there was lots and lots of sick patients, some of whom were dying. I remember seeing him and thinking he looked very, very unwell. He was a different colour really.”

But in the documentary, The Year Britain Stopped, she told of how she felt deeply disappointed in the government’s treatment of healthcare workers – particularly over nurses’ pay.

Explained: How Indian states are able to misreport the Covid-19 death toll

Via Scroll.in: Explained: How Indian states are able to misreport the Covid-19 death toll. Excerpt:

“My 69-year-old uncle died on April 22 in Varanasi’s ESIC Hospital,” said Gaurav Srivastava, a 30-year-old resident of Varanasi. “He had tested positive for Covid-19 10 days before that. The documents the hospital gave us mentioned that he died of a cardiac arrest and not Covid-19. Even if it was cardiac arrest, it was induced by Covid-19 as he had no history of heart-related ailments. 

“And yet he was cremated in a crematorium set aside for Covid-19 deaths,” he added. 

Srivastava was witness to one among maybe lakhs of such cases where death certificates of Covid-19 patients do not have the virus as the cause of death. Such deaths are then not recorded in the numbers the state or the Centre are releasing. 

According to a new analysis released by the University of Washington’s Institute for Health Metrics and Evaluation, the actual number of Covid-19 deaths in India by May 5 could have been as high as 654,395. This is when the official number was 221,181, so a third of what the Institute for Health Metrics and Evaluation says. 

The Telangana High Court too recently refused to believe the state’s statistics on Covid-19 deaths and asked that real numbers be released. The bench even instructed the state to install display boards in crematoriums and burial grounds to depict the true picture. 

The under-reporting of Covid-19 deaths is a layered matter. The system of data reporting set up by state and Centre is not flawed on one level but all, found FactChecker when we spoke to patients’ kin, public health experts and volunteers. 

First of all, let us be clear on the protocol on recording deaths during the current pandemic set by the Indian Council of Medical Research. 

• Even if a Covid positive person dies without symptoms of the disease, the death should be recorded as a Covid-19 death under U07.1, World Health Organization’s International Classification of Diseases (ICD-10) code for a confirmed Covid-19 death. 

• Even if a Covid positive patient appears to die of respiratory failure, the underlying cause of death should be listed as Covid-19. 

• If a Covid-positive person has co-morbidities, the patient has a higher risk of dying due to respiratory failure. But the co-morbidities should not be listed as the underlying cause of death. Covid-19 still remains the cause of death. 

• If a person dies without being tested for Covid or had tested negative, but displayed Covid-19 symptoms, the death should be classified as a suspected or probable Covid-19 death.

Branswell: New analysis finds global Covid death toll is double official estimates

Via STAT, Helen Branswell writes: New analysis finds global Covid death toll is double official estimates. Excerpt:

A new analysis of the toll of the Covid-19 pandemic suggests 6.9 million people worldwide have died from the disease, more than twice as many people as has been officially reported. 

In the United States, the analysis estimates, 905,000 people have died of Covid since the start of the pandemic. That is about 38% higher than the current death estimate from the Centers for Disease Control and Prevention, 561,594. The new figure also surpasses the estimated number of U.S. deaths in the 1918 flu pandemic, which was estimated to have killed approximately 675,000 Americans. 

The analysis was conducted by scientists at the University of Washington’s Institute for Health Metrics and Evaluation. 

“We’re probably not yet at the global toll of Spanish flu and certainly not at the death rate from Spanish flu. But given what’s unfolding in India right now, given our expectation of continued deaths, Covid is going to rival Spanish flu at the global level in terms of the count, likely, before we see the end of this epidemic,” the institute’s director, Christopher Murray, told reporters in a briefing. 

Most countries have underreported deaths, Murray said. In many cases, the under-estimates seem to be a result of health systems being overwhelmed, and of insufficient testing. 

But in several cases it appears something else would have to account for the scale of the differences between the deaths countries are reporting and the excess mortality they have experienced during the pandemic, he said, pointing to countries like the Russian Federation and Egypt, where the estimated deaths, 170,000, are 13 times higher than the country’s official death toll, 13,529. 

Murray’s group estimates that by September, the global death toll from Covid-19 will reach 9.4 million, with India at that point surpassing the United States as the country with the highest toll. By September, the group’s models suggest that India’s Covid death toll will be 1.4 million people, and the U.S. toll will be 949,000. 

The estimates are of deaths directly related to Covid, and do not include deaths that resulted from the pandemic’s disruption of health care — for example, people who did not seek care for heart attacks because they were afraid to go to Covid-swamped hospitals.

India is hiding its Covid crisis – and the whole world will suffer for it

Via The Guardian: India is hiding its Covid crisis – and the whole world will suffer for it. Excerpt:

A few years ago, as Narendra Modi came into power, I worked on an investigative report about India hiding its malaria deaths. In traveling from tribal Odisha to the Indian national health ministry in New Delhi, my colleague and I watched thousands of cases disappear: some malaria deaths, first noted in handwritten local health ledgers, never appeared in central government reports; other malaria deaths were magically transformed into deaths of heart attack or fever. The discrepancy was massive: India reported 561 malaria deaths that year. Experts predicted the actual number was as high as 200,000. 

Now, with Covid ravaging the country, desperate Indians have taken to Twitter to ask for oxygen cylinders or beg hospitals for an open bed. The crisis has been exacerbated by the government’s concealment of critical information. Between India’s long history of hiding and undercounting illness deaths and its much more recent history of restraining and suppressing the press, Modi’s administration has made it impossible to find accurate information about the virus’s hold in the country. Blocking that information will only hurt millions within the country. It will also stymie global efforts to stop the Covid-19 pandemic, and new variants of the virus, at India’s border. 

Epidemiologists in India and abroad estimate that the country’s official reported Covid-19 death toll – around 222,000 at time of publication – accounts for only a fraction of the real number. The director of the US-based Institute of Health Metrics and Evaluation has estimated that India is only detecting 3-4% of actual cases. Other experts point to total excess deaths in cities such as Mumbai as proof that there could be 60% to 70% more deaths from Covid-19 than the government is admitting to. 

There are various reasons India could be cooking the books on Covid deaths. For one, the utter failure of the public health system makes it difficult to account for the millions of bodies passing through hospitals, clinics and those dying in their own home. Despite having become one of the largest economies in the world, Indian state and federal governments spend a dismal amount on healthcare, with an investment of less than 1% of its GDP, one of the lowest rates in the world. 

But systemic failure is only one part of the puzzle. The reigning party of the Indian government touted its success in curbing the virus very early in the pandemic, and has never let go of that narrative. As bodies burned in funeral pyres across Uttar Pradesh in April, Yogi Adityanath – the state’s chief minister and a key Modi lackey – claimed that everything was under control and repeatedly refused to announce new lockdown measures, even as he himself contracted Covid-19. 

This denialist rhetoric is occurring at almost every level. Like India’s see-no-evil approach to malaria or tuberculosis, its Covid obfuscation suppresses “bad news” in order to buoy the country’s international image and the government party’s domestic standing. Not all countries with struggling health systems do this. Some actually at times overcount deaths from other viruses in order to get more humanitarian aid. But undercounting disease is, in many ways, far more sinister. Modi’s government had a choice between saving face and saving lives, and has chosen mass death.

How Senegal fought Covid-19 with lessons learned from Ebola and HIV/AIDS prevention

Via Vox.com: How Senegal fought Covid-19 with lessons learned from Ebola and HIV/AIDS prevention. Excerpt:

DAKAR, Senegal — Aissatou Diao talked about Covid-19 a lot. How to socially distance, what to do if you have a cough or a fever. But when the first coronavirus case arrived in Yeumbeul, a village outside Dakar where she does health outreach as a community relay, she couldn’t believe it. 

“I almost died when I heard I was on the list of people who were in contact with the Covid patient,” Diao recalls. 

That single contact brought Diao to Novotel, an upscale hotel in Dakar with Atlantic Ocean views. As part of its pandemic response, Senegal sought to provide a bed to everyone with Covid-19 — including mild or asymptomatic cases — and their direct contacts. In the spring of 2020, for about six months, Red Cross volunteers replaced hotel staff at Novotel, and rooms filled with people like Diao, exposed to Covid-19 and sent away to isolate. 

Her fellow community relays, who did Covid-19 outreach with her, kept calling and calling to check her status. They wanted to know if they’d be next. “We all got ready with our luggage, waiting for the results,” one of them said. 

Diao tested negative, twice, and she left quarantine after just four days. A year later, she calls it a funny story: a short stay in quarantine as she tries to make others aware of the seriousness of Covid-19. 

Diao’s experience captures both sides of Senegal’s Covid-19 response. The West African country used aggressive interventions like this isolation policy to slow transmission. At the same time, community and local health actors bolstered the public health response from the bottom up, relying on longstanding relationships and trust to convince people to wear masks, seek out testing, and get treatment.

“We have what we call a ‘chain of solidarity’: The nation joined hands together,” Moussa Seydi, chief of infectious disease service at Dakar’s University of Fann Hospital Center, said. “Religious leaders came to join the political decision-makers, and also, the community involved themselves in giving this response to Covid-19.”

India’s COVID-19 crisis is the world's crisis

Via The Atlantic: India’s COVID-19 Crisis Is the World's Crisis. Excerpt:

India considered itself to be “in the endgame” of the pandemic just a few weeks ago. Now it is the global epicenter. The country recently surpassed the devastating milestone of more than 345,000 new COVID-19 cases in a single day, the biggest total recorded globally since the pandemic began. 

What is taking place in India isn’t so much a wave as it is a wall: Charts showing the country’s infection rate and death toll, which has also reached record numbers in the country, depict curves that have shot up into vertical lines. Public-health experts aren’t optimistic that they will slope down anytime soon.

India’s outbreak is an enormous tragedy for its own people, but it’s also a catastrophe for the rest of the world. Ninety-two developing nations rely on India, home to the Serum Institute, the world’s largest vaccine maker, for the doses to protect their own populations, a supply now constrained by India’s domestic obligations. 

Meanwhile, the coronavirus is mutating. Reports of double- and even triple-mutant strains of the virus, which experts fear could be driving the country’s latest surge, have prompted concerns that what has started in India won’t end there. Despite efforts to restrict the spread of India’s new COVID-19 variant, called B.1.167, it has already been identified in at least 10 countries, including the United States and Britain.

If ever there were a time for intervention, it would be now. But world leaders, who have so far only paid lip service to the need for global cooperation, have mostly been preoccupied by their own internal situations. Although this approach may have served vaccine-rich countries such as the U.S. so far, India could prove its limits. 

How did India, which merely a month ago thought it had seen the worst of the pandemic, get to this point? Michael Kugelman, the deputy director of the Asia program at the Washington, D.C.–based Wilson Center, told me the answer comes down to a “perfect storm” of factors that includes new and existing variants (and a lack of robust genomic sequencing to track them), a continuous stream of widely attended political rallies and religious gatherings (with no social distancing or mask wearing), and a general complacency on the part of the Indian government, which was slow to respond to a crisis in which it had prematurely claimed victory. 

The result has been overwhelmed hospitals, depleted oxygen supplies, morgues that have run out of space, and crematoria that are melting from near-constant use. The country surpassed 2,000 deaths a day last week—and those are just the cases that have been recorded. This time next month, that figure could rise to as high as 4,500 daily deaths, Bhramar Mukherjee, a biostatician and epidemiologist at the University of Michigan who is tracking the situation in India, told me. Others warn that it could get as high as 5,500. Though the projections vary, the conclusions are largely the same. “All the arrows are pointing to real darkness,” Mukherjee said. 

The situation has become so dire that the Pune-based Serum Institute, the manufacturer of the AstraZeneca vaccine and a major contributor to the COVAX initiative to provide doses to low- and middle-income countries, said it will not be able to meet its international commitments amid India’s domestic shortage. Once considered the pharmacy of the world, India is now being forced to import doses.

Indian hospitals swamped by coronavirus as countries promise aid

Via Reuters: Indian hospitals swamped by coronavirus as countries promise aid. Excerpt:

India ordered its armed forces on Monday to help tackle surging new coronavirus infections that are overwhelming hospitals, as countries including Britain, Germany and the United States pledged to send urgent medical aid. In a meeting with Prime Minister Narendra Modi, the Chief of Defence Staff General Bipin Rawat said oxygen would be released to hospitals from armed forces reserves and retired medical military personnel would join COVID-19 health facilities. 

And where possible, military medical infrastructure will be made available to civilians, a government statement said, as new coronavirus infections hit a record peak for a fifth day. 

"Air, Rail, Road & Sea; Heaven & earth are being moved to overcome challenges thrown up by this wave of COVID19," Health Minister Harsh Vardhan said on Twitter. 

Modi on Sunday urged all citizens to get vaccinated and to exercise caution amid what he called a "storm" of infections, while hospitals and doctors in some northern states posted urgent notices saying they were unable to cope with the influx. 

In some of the worst-hit cities, bodies were being burnt in makeshift facilities offering mass cremations. 

 The southern state of Karnataka, home to the tech city of Bengaluru, ordered a 14-day lockdown from Tuesday, joining the western industrial state of Maharashtra, where lockdowns run until May 1, although some states were also set to lift lockdown measures this week. 

The patchy curbs, complicated by local elections and mass festival gatherings, could prompt breakouts elsewhere, as infections rose by 352,991 in the last 24 hours, with crowded hospitals running out of oxygen supplies and beds. 

"Currently the hospital is in beg-and-borrow mode and it is an extreme crisis situation," said a spokesman for the Sir Ganga Ram Hospital in the capital, New Delhi. 

FIRE 

Following a fire at a hospital in the western diamond industry hub of Surat, five COVID-19 patients died after being moved to other hospitals that lacked space in their intensive care units, a municipal official told Reuters. 

Television channel NDTV broadcast images of three health workers in the eastern state of Bihar pulling a body along the ground on its way to cremation, as stretchers ran short.