H5N1

Canada: Luck and early preparation flattening BC's COVID-19 curve, but officials urge residents to 'not let up'

Via CBC News: Luck and early preparation flattening B.C.'s COVID-19 curve, but officials urge residents to 'not let up'. Excerpt:

B.C.'s provincial health officer announced 63 new coronavirus cases in the province on Monday, bringing the total number of identified cases to 1,266.  

The update reflects two 24-hour time periods, with 26 new cases recorded between Saturday and Sunday, and 37 new cases recorded between Sunday and Monday. 

One more person has died, said Dr. Bonnie Henry, bringing the total number of dead from the virus to 39.  There are currently 140 people in hospital in B.C., with 72 people in intensive care. 

Henry said that B.C.'s curve, which appears to be flattening in comparison to provinces like Ontario and Quebec, is tentatively on the right track, thanks to luck, timing, and measures implemented early on. 

"We were one of the first provinces to have cases. We spent a lot of time doing wide testing. Some parts of it are luck, some parts of it are being prepared," she said. 

But Health Minister Adrian Dix urged that with a number of religious holidays coming up, it's key that people remain diligent with physical distancing.  

"We have to be 100 per cent all in. We say it on a regular basis … but we simply cannot let up now," he said.  

Hotspots could challenge response 

Henry said 210 cases are linked to outbreaks in long-term care homes. Three of the outbreaks have been declared over, meaning there have been no new cases over two successive incubation periods.  

There is also a third outbreak in a federal correctional facility. 

"These hotspots are concerning. They can quickly challenge our response," said Henry. "We must be steadfast in holding the line."  

B.C. currently has 620 ventilators distributed across the province, with 55 additional ventilators acquired from the federal supply.  

Dix said the province has received a "small supply" of personal protective equipment from a new supplier, and that it is currently undergoing testing.

COVID-19 in Canada: Ontario has only 1 week supply of 'critical' protective equipment left, premier says

Via CBC News: Ontario has only 1 week supply of 'critical' protective equipment left, premier says. Excerpt:

Ontario currently has just one week's worth of critical personal protective equipment for front-line health-care workers stockpiled, Premier Doug Ford said Monday. 

Ford said American officials recently stopped an order of around three million masks from coming to Ontario, but 500,000 N95 masks are being released today. 

Those 500,000 masks "will buy us another week," Ford said to reporters Monday. 

"The hard truth is, our supplies in Ontario are getting very low," he said. 

Last week, U.S. President Donald Trump and his administration ordered key suppliers based in the U.S. to stop exporting protective equipment, drawing backlash from other leaders and from 3M, which produces N95 masks. 

Ford said he's feeling more optimistic that Canada will be exempted from Trump's order, after recent conversations with the U.S. Ambassador Robert Lighthizer and Deputy Prime Minister Chrystia Freeland. 

"We're putting pressure on the U.S. government from all sides," said Ford, who says they are "reaching out to everyone in the world" to try to secure equipment. 

The premier said they are "grateful for anything we can get out of the U.S."  

Mask production approved in Vaughan, Ont. 

Ford also said Health Canada has approved Woodbridge Auto in Vaughan, Ont. to produce N96 respirator masks  calling it "good news." He did not have a date for when they would be ready, but said production would be "ramping up." 

In an earlier statement, Ford said while Ontario-based manufacturers have started focusing on making personal protective equipment (PPE), much of it is still "weeks away" from being in the hands of health-care workers.

US death toll nears 10,000 as hospitals run low on supplies

Via The New York Times: Coronavirus Live Updates: U.S. Death Toll Nears 10,000 as Hospitals Run Low on Supplies.

Hospitals continue to confront severe shortages in testing and protective equipment for medical staff working to combat the coronavirus outbreak, according to a government watchdog report released on Monday that appears to undercut President Trump’s assurances that states have sufficient resources. 

Staff and patients alike are put at risk by the lack of available protective gear, according to the report by the inspector general of Health and Human Services. 

Hospital administrators are forced to grapple with “sharp increases” in prices for items such as masks, gloves and face shields from vendors, the report continues.  

The lack of testing has forced hospitals to extend the stays of patients, pushing the facilities even farther beyond their capacities. Hospitals are also in need of thermometers, disinfectants, medical gas, linens, toilet paper and food. And doctors around the United States are still pleading for ventilators, even as the federal government has limited the number of lifesaving devices issued to states.  

“Hospitals reported an uncertain supply of standard, full-feature ventilators and in some cases used alternatives to support patients, including adapting anesthesia machines and using single-use emergency transport ventilators,” according to the report. “Hospitals anticipated that ventilator shortages would pose difficult decisions about ethical allocation and liability.”  

The report was based on interviews conducted March 23 through March 27 with more than 320 hospitals across 46 states, as well as the District of Columbia and Puerto Rico. 

The findings are in line with pleas made by governors, medical workers and hospital administrators, but they contrast sharply with statements made by Mr. Trump, who said this weekend that hospital administrators were “thrilled to be where they are.”  

“Whenever local shortages are reported, we’re asking states to immediately meet the demand. And we’re stockpiling large amounts in different areas — in different areas,” Mr. Trump said at a White House news briefing on Saturday.  

The report was issued days after reports that protective equipment in the government’s strategic national stockpile was nearly depleted, forcing the Federal Emergency Management Agency to conduct an international search for such equipment. Those efforts have also increased competition for states and localities. FEMA has also had to ration the ventilators it has, issuing them to hospital systems that have patients at risk of death within 72 hours without such equipment.  

In a statement, a spokeswoman for the Department of Health and Human Services said that Alex Azar, the secretary of the agency, had already accepted recommendations from the report, including allowing governors to let health care providers practice across state lines. The agency is also recommending that states reactivate licenses for retired health care providers.

COVID-19 in the US: New York governor Andrew Cuomo says 'this is war time'

Via The Guardian: US coronavirus live: New York governor Andrew Cuomo says 'this is war time'. Excerpt:

Summary 

Contrary to the initial schedule, there will be a White House coronavirus task force briefing at the top of the hour. Here’s a summary of the latest events: 

• US surgeon general warns of ‘Pearl Harbor moment’ as Americans face ‘hardest week’. “The next week is going to be our Pearl Harbor moment. It’s going to be our 9/11 moment,” Jerome Adams told NBC News’ Meet the Press. 

• Fauci says no evidence anti-malaria drug Trump pushes works against virus. Donald Trump’s top coronavirus adviser has warned again that there is no scientific evidence to support the use of an unproven anti-malaria drug the president has been pushing as a possible remedy for Covid-19. 

• Boris Johnson admitted to hospital with coronavirus. The British prime minister has been admitted to hospital with coronavirus after suffering persistent symptoms for 10 days. 

• Biden floats proposal for ‘virtual convention’. Prospective presidential nominee Joe Biden has floated a proposal for a ‘virtual’ national Democratic party convention this summer. 

• Illinois governor challenges White House on ventilators. JB Pritzker, the Illinois governor, is challenging Mike Pence’s calculations that his state needs only 1,400 ventilators.

COVID-19 pandemic: Confirmed cases surge past 3,000 in Pakistan

Via The News International: Coronavirus pandemic: Confirmed cases surge past 3,000 in Pakistan.

The number of confirmed cases in Pakistan rose to 3,124 on Sunday after more cases were reported across the country.  

In Punjab, more than 100 new cases were reported across the province, taking the the provincial tally to 1,380. 

Balochistan reported three new cases, taking the provincial tally to 189.  

“We took 43 samples, of which three came back positive, the rest negative,” Balochistan government spokesperson said. 

The spokesperson added 32 patients have recovered from the virus in the province so far. 

On the other hand, SIndh's tally of confirmed cases rose to 881 after 37 new cases were reported in the province . 

On Sunday, new cases were also reported in Gilgit Baltistan and Azad Jammu and Kashmir. According to officials, four new cases were reported n GB taking its tally to  210, while AJK reported two new cases taking its tally to  14. 

The country also reported two new deaths, one in Sindh and the other in Khyber Pakhtunkhwa, taking the nationwide toll to 45. 

Chinese doctors hail steps taken by Punjab govt 

Chinese health experts have hailed the steps taken by the Punjab government to curb the spread of the virus in the province.  

The remarks were made by a delegation of Chinese doctors, which  met Chief Minister Usman Buzdar in Lahore today.  

The Chinese health experts also advised the Punjab government to ensure lockdown for at least 28 days in the province before relaxing it in a phased manner. 

"Social distancing is the key to stop the spread of the virus and authorities should ensure lockdown for 28 days," the experts recommended CM Buzdar. 

The Punjab government had imposed a lockdown on March 23 for 14 days after a spike in the cases but restrictions were later relaxed to ensure smooth supply of essential items. 

The experts also endorsed the SOPs of the Punjab government to contain the virus and for the treatment of patients.  

CM Buzdar thanked the support and assistance provided by the Chinese government to Pakistan in time of need and said the friendship between the two countries has stood the test of time. 

"The efficiency with which Chinese authorities have fought the battle against the epidemic is an example for the whole world and Pakistan would learn lessons from your experiences," Buzdar said.

COVID-19: Finland, a 'prepper nation,' has an enviable supply of masks

A noted statue in central Helsinki has been refashioned with a coronavirus theme. Credit...Kimmo Brandt/EPA, via Shutterstock

Via The New York Times: Coronavirus Live Updates: Finland, a 'prepper nation,' has an enviable supply of masks.

As some nations scramble to find protective masks, ventilators and gowns to fight the coronavirus, one Nordic country is confronting the pandemic with a large network of medical supplies: Finland.  

The stockpile, considered one of Europe’s best and built up over years, has cast a spotlight on Finland’s preparedness and exposed the vulnerability of other nations that lack their own. 

Finland’s system has been in place since the 1950s, the authorities said. Norway, Sweden and Denmark also amassed large stockpiles of medical and military equipment, fuel and food during the Cold War era. Later, most of them all but abandoned those stockpiles. But Finland did not.  

Its history, including fighting off a Soviet invasion in 1939, has taught the nation of 5.5 million to prepare for the worst, said Tomi Lounema, the chief executive of Finland’s National Emergency Supply Agency. 

“Finland is the prepper nation of the Nordics, always ready for a major catastrophe or a World War III,” said Magnus Hakenstad, a scholar at the Norwegian Institute for Defense Studies.  

When the coronavirus hit, Finland’s government tapped into its supply of medical equipment for the first time since World War II. Two weeks ago, as the country’s coronavirus cases ticked up — by Sunday, the country had recorded more than 1,880 cases and 25 deaths — the health ministry ordered that stored masks be sent to hospitals around the country.

“The masks are old, but they are still functioning,” Mr. Lounema said this weekend. As for how many masks are being stored and where, he said that information was classified.

Q&A: New York emergency room doctor says it’s just getting 'worse and worse’

Via Caixin Global: Q&A: New York Emergency Room Doctor Says It’s Just Getting 'Worse and Worse’. Note the reference to a doctor becoming reinfected; I haven't heard of that before. Excerpt:

Nineteen shifts in 22 days. 

That’s what New York City emergency room (ER) doctor Calvin Sun has worked since the Covid-19 outbreak began in the city. As a per-diem doctor, Sun works on something like a freelance basis, picking up shifts at whichever hospital in the city has a 10- to 12-hour hole to fill in its ER schedule. This experience has given him a broad perspective about the state of the city’s emergency rooms as New York has become the epicenter of the U.S. outbreak. On Thursday, the day Sun spoke with Caixin, the state of New York recorded 562 deaths from Covid-19. 

Sun described the increasingly desperate-looking situation at New York City ERs, as younger, sicker patients seek treatment in droves even as the local health care system strains under the pressure. Some hospitals are setting up tents outside to handle surging patient numbers, while personal protective equipment (PPE) is in short supply that Sun has been taking donations to keep himself kitted out in “cobbled together” gear. 

This interview has been edited for length and clarity.  

Caixin: When did you start dealing with Covid-19? 

Dr. Calvin Sun: I started working at exactly 7 a.m. on March 8. I was co-leading a trip in Angola up until March 7 at 6 p.m. And then my first shift was 7 a.m. the next morning. So, once I landed, I got immediately straight to work and I haven’t stopped since. 

I think I’ve worked 19 shifts in the last 22 days. So tomorrow will be my 20th shift — I just picked it up five minutes ago because a doctor just got reinfected with Covid-19. And Saturday, I just picked up another shift for another doctor that got infected with Covid-19. 

How many hours can you rest in between shifts? 

I’m a per-diem, so I work however much as I want. I usually do 10- to 12-hour shifts — tomorrow’s is 10 hours, Saturday is nine hours, yesterday’s was 12 hours. But when I go home, I go home — you know, go to sleep.  

How has the situation changed in the past month or so? 

It has just been getting worse and worse. The patients are coming in sicker. They are coming in younger. More patients are coming in. The volume is higher. And more field tents are being set out outside the hospitals to manage the surge capacity. And we’re running low on resources. It was already understaffed and difficult before this pandemic.  

There have been reports of shortages of PPE and medical workers. Have you seen improvement on these fronts?  

Everything is a sign of progress in terms of effort, and trying to fill in the holes … We need to fight this pandemic as a warlike effort, but it’s just that I think there was a difficulty in the supply chain in getting us equipment because the other countries that were (producing) this personal protective equipment were shut down because they were also fighting this pandemic … We’re just doing our best right now by the ingenuity of the people who are staying at home, who are not working. They’re creating masks. They’re trying to give donations. They donating to the right people. And I’m accepting personal private donations. I’m distributing to my friends if I have too much of anything. And yeah, we’re just making a huge effort right now to make sure everyone is adequately protected. 

My PPE is cobbled together for the many different emergency rooms that I work in. I’m lucky — if that’s even a word I can use nowadays — to be per diem, so I have access to different emergency rooms and their equipment. But every emergency room is always lacking something. It’s always something different. But I put something together for myself and have been getting by until my family and loved ones were able to donate something that was a little more comprehensive. 

Are many medical workers getting sick?  

It’s part of the nature of our work that we get sick … Every patient that we take care of — we’re exposed to what they have, and sometimes we get sick.  

This is a little scarier because we’re getting sick with a virus that we know very little about. And it kills people very quickly. Unlike cancer or heart attacks — more people die from those — but people die in a more drawn out setting — a few heart attacks a day. But with Covid-19, you get infected really, really quickly because it is so contagious … It’s like, McDonald’s sells 2.5-3 billion hamburgers every year. That’s a lot, but they can handle it, right? But imagine you drive up to a McDonald’s and ask for 50,000 burgers in one day. That’s going to overwhelm the system, and that’s what we’re dealing with right now.

How are the emergency rooms operating right now?

Just because you have a quarantine doesn’t mean the rates of heart attacks are less. Maybe (there is) less trauma because there are fewer people outside, but every now and then I still get the occasional motor vehicle accident that comes into the emergency room, and we have to take care of them too. And when they come in, they may get exposed to Covid-19 just simply because a lot of our emergency rooms are structured as one giant room where patients are separated by curtains. Instead of every patient getting their own rooms. We just don’t have that space in a place like New York City.

What are you thinking every time you go to a shift?

It is scary. You’re battling a virus that you don’t know, that’s an invisible enemy, that’s very infectious — and you can bring that home.

I can imagine it being daunting for anyone in our shoes to rush, you know, into a burning building, fighting a fire that you cannot see. Inhaling all that smoke. Not adequately protected — naked — as the building is about to collapse on you. And your job is to try to get everyone outside of this burning building before it completely collapses, but you’re also trapped inside. That’s how I usually feel.

But personally, I’m trained for this … Disaster medicine is my thing … But I can’t speak on behalf of my colleagues who may not have signed up for things like that and may not be interested in that area of emergency medicine. So, it is something that a lot of us are adjusting to.

Focus turns to US as COVID-19 continues to spread around world

Via The Guardian: Focus turns to US as coronavirus continues to spread around world. Excerpt:

The focus of the coronavirus crisis has switched decisively from continental Europe to the US, with the country reporting the highest daily death toll of any nation so far.  

The number of Americans killed by Covid-19 was 1,169 on Thursday, while the US’s total of 245,000 confirmed cases is also by far the highest recorded by any country worldwide.  

The pandemic continues to spread rapidly around the globe, infecting more than 1 million people and killing nearly 55,000.  

Italy has suffered the most deaths with a tally of 14,681, followed by Spain with 10,935, but the toll in the US – which now accounts for about a quarter of the world’s known infections – is rising fast and has topped 6,000.  

Hospitals and morgues in New York struggled to treat or bury casualties as the state governor, Andrew Cuomo, predicted similar misery for the rest of the country. New York suffered its deadliest single day on Friday, with 562 additional deaths across the state for a total of 2,935, Cuomo said, with 102,863 confirmed cases. 

He warned that people were going to die in the near term due to a lack of ventilators, adding that he would use his authority to take ventilators and protective gear from private hospitals and companies that are not using them. 

“If they want to sue me for borrowing their excess ventilators to save lives, let them sue me,” Cuomo said. 

Staff at one Brooklyn medical centre were seen disposing of their protective gear in a street refuse bin after loading bodies into refrigerated trucks. Officials have said between 100,000 and 240,000 Americans could ultimately die from the virus. The US disaster response agency, Fema, has asked the US military for 100,000 body bags. 

About 90% of Americans are under some kind of stay-at-home order as the country tries to slow the spread by enforcing physical distancing guidelines, although a handful of governors are still resisting issuing statewide confinement orders. 

Donald Trump sparked fresh alarm when his son-in-law, Jared Kushner, said the president became concerned about a shortage of vital medical equipment after hearing about it from “friends of his in New York”, suggesting he was responding to anecdotes rather than the state governor or public health officials.

COVID-19: World Health Organisation reverses course, now supports wearing face masks in public

Via the South China Morning Post: Coronavirus: World Health Organisation reverses course, now supports wearing face masks in public. Excerpt and then a comment:

The World Health Organisation says it supports government initiatives that require or encourage the public wearing of masks, marking a major shift from previous advice amid the Covid-19 pandemic. 

The WHO added that surgical masks should be reserved for medical professionals, while the public should use mainly cloth or home-made face coverings. 

The updated stance comes as more scientific research points to the positive effect of wearing masks in preventing the spread of the coronavirus, with more governments in Europe requiring people to cover their noses and mouths in public. 

“We can certainly see circumstances on which the use of masks, both home-made and cloth masks, at the community level may help with an overall comprehensive response to this disease,” Dr Michael Ryan, executive director of the WHO’s health emergencies programme, said on Friday. 

“There may be situations where the wearing of masks may reduce the rate at which infected individuals may infect others,” Ryan said. “We will support governments who wish to have a measured approach to the use of masks and who include that as part of the comprehensive strategy to control this disease.” 

By comprehensive strategy, the WHO means measures such as encouraging washing of hands, physical distancing and rapid testing to identify and quarantine those who are infected.

The WHO has long been concerned about encouraging the use of masks, as that could result in stockpiling of the already limited supply. 

“Surgical and medical masks and masks like N95 are for the medical systems and we must prioritise their use for the front line,” Ryan said, adding that a group of experts are assessing the use of masks and will look at every single research paper.

The Great Mask Debate of 2020 must remind every English major of the vicious dispute in Gulliver's Travels between the Lilliputians, who insist one's boiled eggs should be broken at the little end, and their enemies in Blefuscu, who prefer breaking eggs at the big end.

I also recall a recent video clip in which a Chinese grannie, venturing out without a mask, is admonished via drone to totter home and don one before going out again. Orwell and Vonnegut would have laughed and laughed.

 

That said, I can see a case for masks if only as a way for ordinary people to gain a sense of control over events, which in itself is a goal worth striving for. Masks are a way of announcing "I'm doing my bit."

COVID-19 in the US: The federal government's supply of masks, gloves and gowns is nearly gone

Via The New York Times: The federal government's supply of masks, gloves and gowns is nearly gone. Excerpt:

The federal government has nearly emptied its emergency stockpile of protective medical supplies like masks, gowns and gloves as state governors continue to plea for protective gear for desperate hospital workers, according to a senior administration official. 

The official said the Federal Emergency Management Agency has delivered more than 11.6 million N95 masks, 5.2 million face shields, 22 million gloves and 7,140 ventilators, exhausting the emergency stockpile.  

The official said there was a “tiny slice” of personal protective equipment left over that is being preserved for emergency medical workers for the federal government.  

While there is no more personal protective equipment in the stockpile left over for the states, the senior official said the administration still has more than 9,400 ventilators ready to be deployed. 

The dwindling resources have forced the federal government to compete with states and private companies for valuable medical gear across the world. Governors, meanwhile, have continued to try to find ways to scavenge medical supplies for hospital workers exposed to the worsening pandemic. 

“Really, the only hope for a state at this point is the federal government’s capacity to deliver,” Gov. Andrew M. Cuomo of New York said Wednesday, going on to discuss the powers that the Defense Production Act, a Korean War-era law, gives the president to procure vital equipment.  

“The Defense Production Act gives the president of the United States power to say to a company: you make this,” Mr. Cuomo said, noting that while much of the discussion about the act had been about making ventilators, which are complex to build, it could also be used for other gear, including hospital gowns.

“Look, you have a shortfall on gowns,” he said. “American companies can make gowns — they’re not like wedding gowns, they’re like paper gowns. Make the gowns, make the gloves, make the masks. You know, why are we running out of these basic supplies?”