H5N1

New findings on pandemic kids. And what they really tell us

The Tyee has published my article: New Findings on Pandemic Kids. And What They Really Tell Us. Excerpt:

A new report by Children First Canada takes a long and detailed look at the state of our kids in this second year of pandemic. Even if you don’t have children, but hope for a decent and dignified old age, you’d better take note the findings of Raising Canada 2021 — and take appropriate action in this and future elections. 

The report finds that COVID-19 has aggravated ten major threats to our children. Those threats have been still more aggravated by “cross-cutting themes”: access to education and child care, access to health care and social services, inequity and inequality, and climate change. 

The report points to a host of threats to children that are also threats to us all. And those threats are unlikely to be blunted short of the kind of social transformation we usually call a revolution. 

Let’s look at the threats first. Some are simply intensified forms of the pre-pandemic status quo. Kids are coming into emergency departments with opioid and other poisonings, and cannabis ingestions. Their parents’ attempts to cope with stress don’t work with the kids either. 

Pre-pandemic Canada was stressful enough, but the report finds that “the effects of school closures have accelerated this threat,” leading to more eating disorders, substance misuse and suicide attempts among adolescents.

Systemic racism and discrimination stress racialized families, and the pandemic has only stressed them more. So it should be no surprise that “status First Nations, Métis, Inuit and Black children are disproportionately overrepresented in the child welfare system.” 

So stressed parents with no support are taking it out on their kids: “In some jurisdictions, clinicians have seen twice as many infants for maltreatment-related concerns, specifically fractures and head trauma.” 

More work for the health-care system 

Meanwhile, even less-stressed parents have skipped routine childhood vaccinations, ensuring more work for our health-care system when kids start coming down with measles and other preventable diseases. While many Canadian and U.S. states try to vaccinate their kids from age 12 and up, the report says, for those under 12 “vaccines may not be available until 2022.” Cuba is already testing its homegrown vaccines on kids as young as three. 

The pandemic has worsened childhood poverty, notably in a third of female lone-parent families, and “households with children are more likely to face food insecurity compared to households without children.” In other words, kids aren’t getting enough to eat. We are “ranked 37th out of 41 countries when it comes to providing healthy food for children.” Failing to nourish our children today will have consequences for the rest of the century. 

Well, not for those who die in infancy. The report says, “Canada’s infant mortality rate has increased. It is now the second highest among 17 OECD countries, at approximately 4.4 infant deaths per 1,000 live births. This is a marked change from 1960, when Canada ranked fifth lowest.”

Health inequality and COVID-19

Via the American Economic Association: Health inequality and COVID-19.

Early in the COVID-19 pandemic, there was a sense that everyone was equally vulnerable. Anyone could catch the deadly virus. Nevertheless, it has disproportionately affected less advantaged groups.   

In a paper in the Journal of Economic Perspectives, authors Marcella Alsan, Amitabh Chandra, and Kosali Simon document the initial health effects of COVID-19 in the United States and discuss the challenges of assessing its mortality toll. 

One measurement they analyzed was a calculation of “excess deaths,” or the difference between deaths observed in a particular time period and the deaths expected based on prior trends. 

Panel B of Figure 4 from Alsan et al. (2021)

Panel B of Figure 4 from the authors’ paper compares the excess mortality rates in 2020 of minorities to non-Hispanic Whites grouped by age range.       

The chart reveals that Black and Hispanic groups suffered from higher rates of death than White and Asian Americans in every age group.  

Black Americans as a whole experienced excess mortality of 2.14 deaths per 1,000 population—a 25 percent increase relative to trend, while Hispanic Americans saw excess mortality of 1.44 deaths per 1,000 population—a nearly 40 percent rise relative to trend.  

By comparison, non-Hispanic Whites and Asians experienced increases in mortality of 1.29 and 0.58 deaths per 1,000 population, respectively, which are both increases of less than 15 percent relative to trend. 

The panel also shows that the Black–White and Hispanic–White ratios are higher at younger ages compared to older groups. 

According to the researchers, alternative concepts, such as “years of potential life lost,” may do a better job at capturing the true costs of the pandemic for disadvantaged groups.

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.

Job one: Vaccinate the world

The Tyee has published my article Job One: Vaccinate the World. Excerpt:

According to Our World in Data, as of early August, Canada ranked fourth in the world in regard to the percentage of its people vaccinated. Only the United Arab Emirates, Uruguay and Chile are ahead of us. Worldwide, about 15 per cent of the globe’s people are fully vaccinated and 17 per cent are partly vaccinated. 

But countries like Afghanistan, Sudan, Mozambique and Haiti have been unable to vaccinate more than a small fraction of their populations. COVID-19 variants still have some five billion people to infect globally — not to mention the vaccinated people they may be able to reinfect. 

So while Canada and other rich nations define “success” as getting their own people vaccinated, COVID-19 thrives in the poor countries, spinning off variants that will eventually outwit our vaccines. 

Dr. Tedros Adhanom Ghebreyesus, head of the World Health Organization, has called out wealthy countries on this inequity. While he understands why sovereign nations want to take care of their own, Ghebreyesus says a shift in priorities is crucial in the fight against the coronavirus. 

“We cannot accept countries that have already used most of the global supply of vaccines using even more of it, while the world’s most vulnerable people remain unprotected,” he said. “We need an urgent reversal, from the majority of vaccines going to high-income countries, to the majority going to low-income countries.”

Latin America and the Caribbean surpass 1 million COVID deaths

A news release from PAHO: Latin America and the Caribbean surpass 1 million COVID deaths. Excerpt:

Washington, D.C., May 21, 2021 (PAHO) — Pan American Health Organization Director Carissa F Etienne of the Pan American Health Organization (PAHO) reported today that more than one million people in Latin America and the Caribbean have died from the disease and called on the world to intensify efforts to improve the region’s access to vaccines.   

“More than one million lives have been cut short because of COVID-19. This is a tragic milestone for everyone in the region,” said Dr. Etienne. “This pandemic is far from over, and it is hitting Latin America and the Caribbean severely, affecting our health, our economies, and entire societies. Yet only about 3% of our citizens have been vaccinated.”   

According to figures reported by countries as of May 21, 2021, 1,001,781 people have died as a result of the SARS-CoV-2 virus in Latin America and the Caribbean. Almost 89% of the deaths occurred in five countries: Brazil (44.3%), México (22.1%), Colombia (8.3%), Argentina (7.3) and Peru (6.7%). Three percent of the deaths were concentrated in Central America and 1% in the Caribbean.   

“The region is an epicenter for COVID-19 suffering. It should be an epicenter for vaccination, too,” Dr Etienne said. More than 153.5 million people have been immunized in the Americas, but only 21.6% of these are in Latin America and the Caribbean.   

In contrast, in the United States, vaccination has been widespread, and marked improvements are already being observed, Dr. Etienne pointed out. Almost half of Americans have received at least one COVID vaccine dose and nearly 85% of those over the age of 85 are fully protected, and the result has been a sharp reduction in COVID-19 infections, deaths and hospitalizations, she said.   

“The progress we’re seeing in the U.S. is a testament to the power of safe and effective COVID vaccines, but it underscores the vital importance of accelerating access to vaccines throughout our region, so that other countries can fully immunize their populations,” she continued. 

“We urgently need more vaccines for Latin America and the Caribbean, a region which has been sorely tested by this pandemic.” 

She has congratulated countries that have indicated a willingness to donate tens of millions of excess vaccine doses and called on other countries to follow suit. 

“We urge countries with extra doses to consider donating a significant portion of these to the Americas, where these life-saving doses are desperately needed and will be promptly used,” she has said.   

PAHO has delivered more than 12 million COVAX-procured vaccine doses to countries in Latin America and the Caribbean. Another 770,000 doses are on the way to Central American and Caribbean countries.

Stark racial disparities persist in vaccinations, state-level CDC data shows

Thanks to Lauren Weber for alerting me to this report in Kaiser Health News: Stark Racial Disparities Persist in Vaccinations, State-Level CDC Data Shows. Excerpt:

Black Americans’ covid-19 vaccination rates are still lagging months into the nation’s campaign, while Hispanics are closing the gap and Native Americans show the highest rates overall, according to federal data obtained by KHN. This story also ran on CNN. It can be republished for free. 

The data, provided by the Centers for Disease Control and Prevention in response to a public records request, gives a sweeping national look at the race and ethnicity of vaccinated people on a state-by-state basis. Yet nearly half of those vaccination records are missing race or ethnicity information. 

KHN’s analysis shows that only 22% of Black Americans have gotten a shot, and Black rates still trail those of whites in almost every state.  

Targeted efforts have raised vaccination rates among other minority groups. Hispanics in eight states, the District of Columbia and Puerto Rico are now vaccinated at higher rates than non-Hispanic whites. Yet 29% of Hispanics are vaccinated nationally, compared with 33% of whites. 

While 45% of Native Americans have received at least one dose, stark differences exist depending on where they live. And Asian vaccination rates are high in most states, with 41% getting a shot. 

The analysis underscores how vaccine disparities have improved as availability has opened up and Biden administration officials have attempted to prioritize equitable distribution. Still, gaps persist even as minority groups have suffered much higher mortality rates from the pandemic than whites and are at risk of infection as states move to reopen and lift mask mandates.

‘Entire families’ wiped out by Covid’s carnage in rural India

Via The Times of India: ‘Entire families’ wiped out by Covid’s carnage in rural India. Excerpt:

NEW DELHI: After devastating India’s biggest cities, the latest Covid-19 wave is now ravaging rural areas across the world’s second-most populous country. And most villages have no way to fight the virus. 

In Basi, about 1.5 hours from the capital New Delhi, about three-quarters of the village’s 5,400 people are sick and more than 30 have died in the past three weeks. It has no health-care facilities, no doctors and no oxygen canisters. And unlike India’s social-media literate urban population, residents can’t appeal on Twitter to an army of strangers willing to help. 

“Most deaths in the village have been caused because there was no oxygen available,” said Sanjeev Kumar, the newly elected head of the farming community. “The sick are being rushed to the district headquarters and those extremely sick patients have to travel about four hours,” he said, adding that many don’t make it in time. 

It’s a scenario playing out all over India. In interviews with representatives from more than 18 towns and villages in different parts of the country, officials outlined the scale of the carnage — from entire families wiped out to bloated bodies floating down the Ganges River to farmland left untended due to a lack of workers. 

Many people said the scale of the crisis is much bigger than official numbers reveal, with villagers afraid to leave their homes even if they have fevers and local authorities failing to properly record virus fatalities. India reported 274,390 deaths since the start of the pandemic, according to figures from the health ministry. 

Anger is building both at Prime Minister Narendra Modi’s administration and local authorities for failing to bolster medical infrastructure following a virus wave last year, including securing sufficient supplies of oxygen and vaccines. The ruling Bharatiya Janata Party last month lost local elections in Basi and other parts of Uttar Pradesh — India’s most populous state — just as the country started recording almost 400,000 new cases a day. 

The sentiment on the ground suggests broader troubles for Modi and fellow BJP leader Yogi Adityanath, the chief minister of Uttar Pradesh who has been mentioned as a possible successor to the prime minister. The state holds elections next year.

Postoperative outcomes for Indigenous Peoples in Canada: A systematic review

Via CMAJ: Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. The abstract:

Background: Substantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized. 

Methods: We searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Métis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool. 

Results: Twenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Métis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09–1.54; I2 = 81%). Complications were also higher for Indigenous Peoples, including infectious complications (adjusted OR 1.63, 95% CI 1.13–2.34) and pneumonia (OR 2.24, 95% CI 1.58–3.19). Rates of various surgical procedures were lower, including rates of renal transplant, joint replacement, cardiac surgery and cesarean delivery. 

Interpretation: The currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes.

Rich countries close their eyes to the global Covid surge at their own peril

Via The Guardian, an op-ed by Laura Spinney: Rich countries close their eyes to the global Covid surge at their own peril. Excerpt:

Is there one pandemic, or two? That was a question being asked a year ago, when wealthy countries accounting for only 15% of the global population had 80% of the Covid deaths. Could it be that the rich world was more vulnerable, somehow, because its populations were older, or more individualistic, or had forgotten to be scared of infectious disease? 

Even then, some were warning that the worst was yet to come, once the disease took hold in poorer countries. World Bank analysts Philip Schellekens and Diego Sourrouille, for example, predicted a “massive shift” in disease burden to the developing world. Just in terms of demography, they said, you’d expect those countries to account for around 70% of deaths. As things stand they account for a little over half of it, which is probably an underestimate due to variations in data quality – and the pandemic is far from over. 

Last week saw more than 5.8 million new cases of Covid globally, the highest number yet. More than 3 million people have now died from Covid, according to the World Health Organization (WHO), which also reports that infections and hospitalisations in those aged 25 to 59 are increasing at an alarming rate. “It took nine months to reach 1 million deaths, four months to reach 2 million, and three months to reach 3 million,” WHO director general, Tedros Adhanom Ghebreyesus, said last week. 

The sharpest upticks in recent weeks have been seen in south-east Asia – driven in large part by India – and the eastern Mediterranean and western Pacific regions, but the situation is also very bad in Latin America. People who migrated to Brazil in search of work are now reported to be fleeing the humanitarian catastrophe that is unfolding there. 

Infection rates are still high in many wealthy countries – including the US and much of Europe – but the mood is more upbeat: as vaccines roll out, many people feel the worst is behind them. Some US states have rashly lifted their mask mandates. The British government gave the most optimistic signal it could think of earlier this month, when it reopened pubs. 

And Covid-19 is slipping down the headlines, reflecting not just fatigue at having to respect the rules, but fatigue at the very mention of the disease. Fear concentrates the mind, but fear is dissipating; we’d rather read about Tory sleaze, or the doomed European Super League. 

Again, you could be forgiven for asking, is there one pandemic or two? Only now the question has an entirely different meaning. The tables have turned. 

In reality, there was only ever one pandemic. We tend to think of it in terms of national impacts and responses, at best regional ones, but for it to make sense you have to stand back and look at it globally. For all its idiosyncrasies, Covid will stay true to type in at least one way: like pandemics throughout history, it will hammer the poorest hardest.

India’s Covid death toll at record high, but true figure likely to be worse

Via The Guardian: India’s Covid death toll at record high, but true figure likely to be worse. Excerpt:

India’s daily Covid deaths and infections hit new records on Saturday, but doctors and bereaved families have warned that even these bleak official statistics are seriously underestimating the scale of the country’s tragedy. 

As a court in Delhi said India is facing not just a second wave but a “tsunami”, and hospitals had to turn patients away as they ran out of both beds and oxygen, people in many parts of India are still avoiding testing or struggling to access it. 

“The figures on Covid infections that the government is releasing are actually an underestimate,” Dr Manas Gumta, general secretary of the Association of Health Service Doctors in West Bengal, told the Observer. 

“A huge suspected Covid-positive population is certainly staying away from the tests. I believe the actual number of people dying of Covid is two to three times higher than what the government is reporting. And the number of infections could be up to five times than what is being reported by the Indian authorities.” 

Saturday’s official toll recorded another 2,600 deaths and 340,000 new infections, bringing the total number of cases to 16.5 million, second only to the US. There have been 190,000 deaths attributed to Covid in India since the start of the pandemic. 

But those figures don’t capture casualties like Nurul Amin, who ran a pharmacy in his village of Rajgram. He knew the warning signs for Covid, but when he developed fever and a cough as a second wave of the pandemic was crashing across India earlier this month, he refused to get tested. 

“He insisted it was just an ordinary fever and he would get better with some medication,” his sister-in-law Zainab Begum said. “He told me the hospital was full of Covid patients and he would catch the disease if he went there.” 

Five days later, when the 58-year-old began struggling to breathe, his family raced him to a hospital but he died before he could be admitted, and was buried without ever being tested for the disease. 

He is one of 10 people in the village suspected to have been killed by the disease, but never tested, while five people died after testing positive. Those figures suggest official data will be missing up to two thirds of Rajgram’s Covid losses. 

“It appeared from their symptoms that those 10 were infected with Covid,” said Begum, a school teacher. “However in the official records, none of those deaths was identified as a Covid death.” 

That rate of undetected Covid deaths is likely to be repeated across urban slums and poor rural areas, where the risks from Covid have not been well communicated, Gumta said. 

Suspected cases could be counted in official statistics, under guidelines from the Indian Council of Medical Research, which allow diagnosis just by symptoms, Gumta said. But that discretion is rarely used to register cases, and there are also many who fall ill and don’t go to see a doctor. 

“A small section of these people have access to proper health facilities or hospitals. But most patients with Covid-like symptoms here, and that is a huge number right now, just stay at home and try to treat themselves,” he said. “They are not reflected in any official figures.” 

Rajgram is one of those places. The village was spared in the first wave of the pandemic, and did not lose any residents, which may also have contributed to complacency

While Begum’s family have been scarred by their loss, and now wear masks and practise social distancing, that is unusual. “There is no awareness about Covid in our area. Villagers are not taking precautions, even in the crowded village market around 80% of people just roam around without masks,” she said. Those behaviour patterns, and the scale of the current outbreak, mean both the official and hidden daily toll from Covid is likely to get worse before it gets better, experts say. The current wave is not expected to peak for two to three weeks.