H5N1

COVID-19: A heavy toll on health-care workers

An important comment in The Lancet Respiratory Medicine: COVID-19: a heavy toll on health-care workers. Excerpt:

Health-care workers are known to be at risk for anxiety, depression, burnout, insomnia, moral distress, and post-traumatic stress disorder. Under usual working conditions, severe burnout syndrome affects as many as 33% of critical care nurses and up to 45% of critical care physicians. Extrinsic organisational risk factors—including increased work demands and little control over the work environment—and the trauma of caring for patients who are critically ill have been heightened by the COVID-19 pandemic and represent important exacerbating factors for poor mental health among health-care workers. 

Following the outbreak of severe acute respiratory syndrome in 2003, health-care workers reported chronic stress effects for months to years. Among health-care workers treating patients with COVID-19, a Chinese study reported high rates of depression (50%), anxiety (45%), insomnia (34%), and distress (72%). These findings were supported by a systematic review of 13 studies including more than 33 000 participants. 

Studies from Italy and France reported a high prevalence of depressive symptoms, post-traumatic stress disorder, and burnout; risk factors for adverse psychological outcomes included younger age, female sex, being a nurse, and working directly with patients with COVID-19. The long-term effect on the health of those working in health care remains to be seen. 

The COVID-19 pandemic is a stark reminder of racial and socioeconomic disparities, with disproportionate infection and death rates among migrants, the poor, and racialised groups. COVID-19 has also had a disproportionate effect on women health-care workers. Women comprise 70% of the global health and social care workforce, putting them at risk of infection and the range of physical and mental health problems associated with their role as health professionals and carers in the context of a pandemic. The pandemic exacerbated gender inequities in formal and informal work, and in the distribution of home responsibilities, and increased the risk of unemployment and domestic violence. 

While trying to fulfil their professional responsibilities, women had to meet their families' needs, including childcare, home schooling, care for older people, and home care. Burdened by these obligations, women had reduced academic productivity relative to men, as evidenced by fewer women being part of the cohort producing new knowledge about the pandemic. There was a disconnect between the demands of parenting and the expectations of the scientific community, as shown by ultra-short timelines for COVID-19-related grant proposals, which further deepened the divide between women and men. 

During the pandemic, there have been glimmers of hope and solace. We were buoyed by support from institutional and government leadership, the spirit of teamwork, the celebration of lives saved, and the acknowledgement of our value by the public. Social media was a venue for health-care workers to share their anxiety, insomnia, and fatigue, which reduced the sense of isolation and normalised conversations about mental health. 

To effectively support health-care workers—the greatest assets of our health-care systems—we must understand their challenges and needs. Burnout and other forms of work-related psychological distress are unavoidable occupational health issues. By acknowledging the commonality of psychological distress related to caring for patients with COVID-19, we can destigmatise work-related mental health issues and appropriately attend to the mental health needs of all health-care workers affected by the pandemic. 

Finally, we hope that the COVID-19 pandemic will prompt a redefinition of essential support workers, with recognition of the contribution of all health-care workers and appropriate education, protection, and compensation.

Deaths of despair and the incidence of excess mortality in 2020

Via the National Bureau for Economic Research: Deaths of Despair and the Incidence of Excess Mortality in 2020. The abstract, with my bolding:

Weekly mortality through October 3 is partitioned into normal deaths, COVID, and nonCOVID excess deaths (NCEDs). Before March, the excess is negative for the elderly, likely due to the mild flu season. From March onward, excess deaths are approximately 250,000 of which about 17,000 appear to be a COVID undercount and 30,000 non-COVID. 

Deaths of despair (drug overdose, suicide, alcohol) in 2017 and 2018 are good predictors of the demographic groups with NCEDs in 2020. The NCEDs are disproportionately experienced by men aged 15-55, including men aged 15-25. 

Local data on opioid overdoses further support the hypothesis that the pandemic and recession were associated with a 10 to 60 percent increase in deaths of despair above already high pre-pandemic levels.

Horton: COVID-19 is not a pandemic

In The Lancet, editor Richard Horton makes an important point: Offline: COVID-19 is not a pandemic.

As the world approaches 1 million deaths from COVID-19, we must confront the fact that we are taking a far too narrow approach to managing this outbreak of a new coronavirus. We have viewed the cause of this crisis as an infectious disease. All of our interventions have focused on cutting lines of viral transmission, thereby controlling the spread of the pathogen. The “science” that has guided governments has been driven mostly by epidemic modellers and infectious disease specialists, who understandably frame the present health emergency in centuries-old terms of plague. 

But what we have learned so far tells us that the story of COVID-19 is not so simple. Two categories of disease are interacting within specific populations—infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and an array of non-communicable diseases (NCDs). These conditions are clustering within social groups according to patterns of inequality deeply embedded in our societies. The aggregation of these diseases on a background of social and economic disparity exacerbates the adverse effects of each separate disease. 

COVID-19 is not a pandemic. It is a syndemic. The syndemic nature of the threat we face means that a more nuanced approach is needed if we are to protect the health of our communities. 

The notion of a syndemic was first conceived by Merrill Singer, an American medical anthropologist, in the 1990s. Writing in The Lancet in 2017, together with Emily Mendenhall and colleagues, Singer argued that a syndemic approach reveals biological and social interactions that are important for prognosis, treatment, and health policy. Limiting the harm caused by SARS-CoV-2 will demand far greater attention to NCDs and socioeconomic inequality than has hitherto been admitted. 

A syndemic is not merely a comorbidity. Syndemics are characterised by biological and social interactions between conditions and states, interactions that increase a person's susceptibility to harm or worsen their health outcomes. In the case of COVID-19, attacking NCDs will be a prerequisite for successful containment. As our recently published NCD Countdown 2030 showed, although premature mortality from NCDs is falling, the pace of change is too slow. The total number of people living with chronic diseases is growing. Addressing COVID-19 means addressing hypertension, obesity, diabetes, cardiovascular and chronic respiratory diseases, and cancer. 

Paying greater attention to NCDs is not an agenda only for richer nations. NCDs are a neglected cause of ill-health in poorer countries too. In their Lancet Commission, published last week, Gene Bukhman and Ana Mocumbi described an entity they called NCDI Poverty, adding injuries to a range of NCDs—conditions such as snake bites, epilepsy, renal disease, and sickle cell disease. For the poorest billion people in the world today, NCDIs make up over a third of their burden of disease. The Commission described how the availability of affordable, cost-effective interventions over the next decade could avert almost 5 million deaths among the world's poorest people. And that is without considering the reduced risks of dying from COVID-19.

The most important consequence of seeing COVID-19 as a syndemic is to underline its social origins. The vulnerability of older citizens; Black, Asian, and minority ethnic communities; and key workers who are commonly poorly paid with fewer welfare protections points to a truth so far barely acknowledged—namely, that no matter how effective a treatment or protective a vaccine, the pursuit of a purely biomedical solution to COVID-19 will fail. 

Unless governments devise policies and programmes to reverse profound disparities, our societies will never be truly COVID-19 secure. As Singer and colleagues wrote in 2017, “A syndemic approach provides a very different orientation to clinical medicine and public health by showing how an integrated approach to understanding and treating diseases can be far more successful than simply controlling epidemic disease or treating individual patients.” 

I would add one further advantage. Our societies need hope. The economic crisis that is advancing towards us will not be solved by a drug or a vaccine. Nothing less than national revival is needed. 

Approaching COVID-19 as a syndemic will invite a larger vision, one encompassing education, employment, housing, food, and environment. Viewing COVID-19 only as a pandemic excludes such a broader but necessary prospectus.

Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic

Via JAMA Network: Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. The key points and abstract:

Key Points

Question  What is the burden of depression symptoms among US adults during the coronavirus disease 2019 (COVID-19) pandemic compared with before COVID-19, and what are the risk factors associated with depression symptoms?  

Findings  In this survey study that included 1441 respondents from during the COVID-19 pandemic and 5065 respondents from before the pandemic, depression symptom prevalence was more than 3-fold higher during the COVID-19 pandemic than before. Lower income, having less than $5000 in savings, and having exposure to more stressors were associated with greater risk of depression symptoms during COVID-19.  

Meaning  These findings suggest that there is a high burden of depression symptoms in the US associated with the COVID-19 pandemic and that this burden falls disproportionately on individuals who are already at increased risk.  

Abstract 

Importance  The coronavirus disease 2019 (COVID-19) pandemic and the policies to contain it have been a near ubiquitous exposure in the US with unknown effects on depression symptoms. 

Objective  To estimate the prevalence of and risk factors associated with depression symptoms among US adults during vs before the COVID-19 pandemic. 

Design, Setting, and Participants  This nationally representative survey study used 2 population-based surveys of US adults aged 18 or older. During COVID-19, estimates were derived from the COVID-19 and Life Stressors Impact on Mental Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. Before COVID-19 estimates were derived from the National Health and Nutrition Examination Survey, conducted from 2017 to 2018. Data were analyzed from April 15 to 20, 2020. 

Exposures  The COVID-19 pandemic and outcomes associated with the measures to mitigate it.  

Main Outcomes and Measures  Depression symptoms, defined using the Patient Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms were defined as none (score, 0-4), mild (score, 5-9), moderate (score, 10-14), moderately severe (score, 15-19), and severe (score, ≥20). 

Results  A total of 1470 participants completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being survey (completion rate, 64.3%), and after removing those with missing data, the final during–COVID-19 sample included 1441 participants (619 participants [43.0%] aged 18-39 years; 723 [50.2%] men; 933 [64.7%] non-Hispanic White). The pre–COVID-19 sample included 5065 participants (1704 participants [37.8%] aged 18-39 years; 2588 [51.4%] women; 1790 [62.9%] non-Hispanic White). 

Depression symptom prevalence was higher in every category during COVID-19 compared with before (mild: 24.6% [95% CI, 21.8%-27.7%] vs 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 12.6%-17.4%] vs 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 6.3%-9.8%] vs 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs 0.7% [95% CI, 0.5%-0.9%]). 

Higher risk of depression symptoms during COVID-19 was associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]). 

Conclusions and Relevance  These findings suggest that prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. 

Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms. Post–COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.

COVID-19: From a PHEIC to a public mental health crisis?

An editorial in The Lancet Public Health: COVID-19: from a PHEIC to a public mental health crisis?

On Jan 30, 2020, the WHO declared the outbreak of COVID-19 a public health emergency of international concern (PHEIC). 6 months later, more than 14 million confirmed cases, more than 600 000 deaths, and unprecedented public health measures are impacting the lives of billions of individuals around the world and all aspects of society. While the focus has been—understandably—on the physical health crisis, the direct and indirect psychological and social effects of the pandemic could be all-pervading. Will the public health emergency of international concern morph into a public mental health crisis? 

Several surveys are capturing the immediate mental health impacts of the pandemic. Findings from the University College London revealed that of 44 000 people surveyed, 18% reported thoughts of self-harm or suicide during lockdown. Matthias Pierce and colleagues' large survey of UK households in The Lancet Psychiatry showed that mental health declined substantially after the first month of COVID-19 lockdown. More than one quarter reported clinically relevant levels of mental distress in late April, 2020, compared with one in five before the lockdown. Women, young people, and those living with pre-school children were the most affected. 

The COVID-19 and the nation's mental health: forecasting needs and risks in the UK report from the Centre for Mental Health released on July 17, lays out the need to prepare for a rising tide of mental health difficulties in the coming months. This follows the Centre's previous briefing, which projected that about half a million people in the UK could experience a mental health difficulty over the next year as a result of the pandemic. The Centre's latest assessment reviews the evidence on the impact of COVID-19 on mental health. In particular, the report identifies that children and young adults are at high risk and that the impact of the pandemic on children and young people's mental health is greater in areas and communities hardest hit by the virus and by lockdowns. 

Children from low-income families, from Black, Asian, and minority ethnic communities, and young carers are all more likely to experience poor mental health. Children's wellbeing has been affected by large and sustained disruptions to their education and environment. For young adults, the deterioration of the economy is of particular concern. Youth unemployment has both short-term and long-term consequences for mental health and there is a high risk that young people will be particularly affected by the economic recession. The economic consequences of COVID-19 could further exacerbate and entrench inequalities. 

Moreover, the impact of loneliness and isolation on the mental health and morbidity of the elderly should also be a source of concern. A survey from the Office of National Statistics showed that more than 70% of people aged over 70 years in the UK are concerned about the impact of COVID-19 on their lives and 20% said that their mental health had been affected. 

Crucially for health-care workers and the social care workforce, data from previous pandemics show clear mental health effects and early reports of frontline health-care workers experiencing a variety of mental health challenges, especially burnout and fear, are emerging. 

Some will dispute the use of mental health to discuss an understandable response to stressors such as isolation and poverty. What is important, however, is the accurate monitoring of the distress and the loss of function that individuals experience in the wake of COVID-19, and the provision of appropriate support. If health professionals, as well as individuals with lived experience, can help the population as a whole, this should be facilitated by policymakers. 

The COVID-19 pandemic presents a public mental health challenge. As Jonathan Campion and colleagues noted in The Lancet Psychiatry, it will be key for countries to prevent an increase in mental issues and a reduction in mental wellbeing across populations, as well as to provide appropriate public mental health interventions. Despite the existence of effective public mental health interventions, implementation is far from adequate. Public mental health interventions will need to be proportionately targeted to groups at a high risk of mental disorder and poor mental wellbeing. 

The unequal impacts of COVID-19, the lockdown, and its socioeconomics consequences are putting greater pressure on groups whose mental health was already more precarious before the pandemic. The COVID-19 pandemic is a public mental health emergency that could exacerbate inequalities in mental health—unless concerted actions are urgently taken.

Did COVID-19 skip Vancouver's poorest neighbourhood? Antibody testing might have the answer

Via CBC News: Did COVID-19 skip Vancouver's poorest neighbourhood? Antibody testing might have the answer. Excerpt:

When the COVID-19 pandemic hit Canada mid-March, health experts feared Vancouver's impoverished Downtown Eastside would be decimated — the coronavirus expected to tear through its vulnerable population. 

That didn't happen, and now a B.C. medical sleuth is trying to find out why only a handful of residents have tested positive for the virus in one of Canada's poorest neighbourhoods.  

It's a medical mystery given there are an estimated 15,000 people crammed into 30 square blocks around Vancouver's infamous Main and Hastings intersection. 

Many residents have mental health issues, are infected with HIV or hepatitis C, and have compromised immune systems. 

The answer to the apparent low infection count could benefit all Canadians in the fight against the spread of the coronavirus, says Dr. Brian Conway, medical director of the Vancouver Infectious Diseases Centre. 

"The thrill of the chase is exciting," says Conway. "The more we learn, the more we will be able to help." 

'Pop-up clinics' test for antibodies 

Conway has launched a series of free community "pop-up clinics" to test blood for telltale coronavirus antibodies among Downtown Eastside (DTES) residents.   

Antibodies are formed when a person's body attempts to fight off infection. 

They are an indication that the individual was, at some point, infected with the virus, even if there were no symptoms of illness or only mild symptoms.  

Conway says if antibodies are found in a large percentage of volunteer test subjects, that would mean the virus has been more common in the Downtown Eastside than previously thought. 

Symptoms of COVID-19, the illness caused by the virus, could have been masked by underlying health and addiction issues. 

"It is possible that certain cases were missed since opioid withdrawal might look a little bit like an acute [coronavirus] infection," Conway said. "So we want to just make sure that we understand exactly what happened in that community since the middle of March."  

'Is there something here ... protecting them?' 

If antibodies aren't found, Conway says, that could mean the coronavirus has skipped over an easy target, perhaps due to the community's social isolation from the rest of the Vancouver area. 

There's another intriguing possibility: that Downtown Eastside residents have some form of resistance to the potentially deadly virus.

Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: A cross-sectional observational study

Via The Lancet Global Health: Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. The summary:

Background 

Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms. 

Methods 

We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. 

Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics: Branco (White), Preto (Black), Amarelo (East Asian), Indígeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation. 

Findings 

Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82·0%) of these patients were from the central-south region, and 2043 (18·0%) were from the north region. 

Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1·45, 95% CI 1·33–1·58 for Pardo Brazilians; 1·32, 1·15–1·52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states. 

Interpretation 

We found evidence of two distinct but associated effects: increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. 

The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19.

COVID-19 responses highlight how humans are hardwired to dismiss facts that don't fit their worldview

Via The Conversation: Coronavirus responses highlight how humans are hardwired to dismiss facts that don't fit their worldview. The author is a professor of philosophy at Wake Forest University. Excerpt:

Bemoaning uneven individual and state compliance with public health recommendations, top U.S. COVID-19 adviser Anthony Fauci recently blamed the country’s ineffective pandemic response on an American “anti-science bias.” He called this bias “inconceivable,” because “science is truth.” Fauci compared those discounting the importance of masks and social distancing to “anti-vaxxers” in their “amazing” refusal to listen to science. 

It is Fauci’s profession of amazement that amazes me. As well-versed as he is in the science of the coronavirus, he’s overlooking the well-established science of “anti-science bias,” or science denial. 

Americans increasingly exist in highly polarized, informationally insulated ideological communities occupying their own information universes.  

Within segments of the political blogosphere, global warming is dismissed as either a hoax or so uncertain as to be unworthy of response. Within other geographic or online communities, the science of vaccine safety, fluoridated drinking water and genetically modified foods is distorted or ignored. There is a marked gap in expressed concern over the coronavirus depending on political party affiliation, apparently based in part on partisan disagreements over factual issues like the effectiveness of social distancing or the actual COVID-19 death rate. 

In theory, resolving factual disputes should be relatively easy: Just present strong evidence, or evidence of a strong expert consensus. This approach succeeds most of the time, when the issue is, say, the atomic weight of hydrogen.  

But things don’t work that way when scientific advice presents a picture that threatens someone’s perceived interests or ideological worldview. In practice, it turns out that one’s political, religious or ethnic identity quite effectively predicts one’s willingness to accept expertise on any given politicized issue.  

“Motivated reasoning” is what social scientists call the process of deciding what evidence to accept based on the conclusion one prefers. As I explain in my book, The Truth About Denial, this very human tendency applies to all kinds of facts about the physical world, economic history and current events.

Denial doesn’t stem from ignorance 

The interdisciplinary study of this phenomenon has made one thing clear: The failure of various groups to acknowledge the truth about, say, climate change, is not explained by a lack of information about the scientific consensus on the subject. 

Instead, what strongly predicts denial of expertise on many controversial topics is simply one’s political persuasion.  

A 2015 metastudy showed that ideological polarization over the reality of climate change actually increases with respondents’ knowledge of politics, science and/or energy policy. The chances that a conservative is a climate science denier is significantly higher if he or she is college educated. Conservatives scoring highest on tests for cognitive sophistication or quantitative reasoning skills are most susceptible to motivated reasoning about climate science. 

Denialism is not just a problem for conservatives. Studies have found liberals are less likely to accept a hypothetical expert consensus on the possibility of safe storage of nuclear waste, or on the effects of concealed-carry gun laws.

Denial is natural

The human talent for rationalization is a product of many hundreds of thousands of years of adaptation. Our ancestors evolved in small groups, where cooperation and persuasion had at least as much to do with reproductive success as holding accurate factual beliefs about the world. Assimilation into one’s tribe required assimilation into the group’s ideological belief system – regardless of whether it was grounded in science or superstition. An instinctive bias in favor of one’s “in-group” and its worldview is deeply ingrained in human psychology.

A human being’s very sense of self is intimately tied up with his or her identity group’s status and beliefs. Unsurprisingly, then, people respond automatically and defensively to information that threatens the worldview of groups with which they identify. We respond with rationalization and selective assessment of evidence – that is, we engage in “confirmation bias,” giving credit to expert testimony we like while finding reasons to reject the rest.

Unwelcome information can also threaten in other ways. “System justification” theorists like psychologist John Jost have shown how situations that represent a perceived threat to established systems trigger inflexible thinking. For example, populations experiencing economic distress or an external threat have often turned to authoritarian leaders who promise security and stability.

In ideologically charged situations, one’s prejudices end up affecting one’s factual beliefs. Insofar as you define yourself in terms of your cultural affiliations, your attachment to the social or economic status quo, or a combination, information that threatens your belief system – say, about the negative effects of industrial production on the environment – can threaten your sense of identity itself. If trusted political leaders or partisan media are telling you that the COVID-19 crisis is overblown, factual information about a scientific consensus to the contrary can feel like a personal attack.

Two crises convulse a nation: A COVID-19 pandemic and police violence

Via The New York Times: Two Crises Convulse a Nation: A Pandemic and Police Violence. Excerpt:

They are parallel plagues ravaging America: The coronavirus. And police killings of black men and women.  

Jimmy Mills’s life has been upended by both. His barbershop in Midtown Minneapolis was one of many small, black-owned businesses that have struggled to survive the pandemic. But Mr. Mills was hopeful because, after two months shut down, he was due to reopen next week.  

Then early on Friday, the working-class neighborhood where Mr. Mills has cut hair for 12 years went up in flames as chaotic protests over the death of George Floyd and police killings of African-Americans engulfed Minneapolis and cities across the country. 

“To have corona, and then this — it’s like a gut shot,” Mr. Mills, 56, said.  

The upheaval sparked by a video capturing Mr. Floyd’s agonizing last minutes as a white police officer kneels on his neck is pulsing through an America already ragged with anger and anxiety. Emotions are raw over the toll of a pandemic that has killed more than 100,000 people across the country and cost millions of jobs.  

Minneapolis residents said outrage and protests in the aftermath of the killing of George Floyd were a result of a community being tested repeatedly in recent weeks by both police violence and the virus — and in ways that put America’s deep racial inequalities in stark relief. 

The outbreak has inflicted disproportionate economic and health tolls on racial minorities and immigrants in Minneapolis and beyond. Black and Latino workers have been more likely to have lost their jobs. Many others are among the low-paid hourly workers who risk their health by going to work at grocery stores, nursing homes, factories, slaughterhouses and other jobs that cannot be done remotely. 

The black community in Minnesota has also been hit hard by cases of the virus, just as African-Americans across the country are being infected and dying at higher rates. 

By one estimate, black people accounted for at least 29 percent of known Covid-19 cases in Minnesota, despite making up about 6 percent of the state’s population. African-Americans make up 35 percent of coronavirus cases in Minneapolis, though they are less than 20 percent of the city’s population.

MSF opens coronavirus COVID-19 centre in Venezuela

Via MSF.org: MSF opens coronavirus COVID-19 centre in Venezuela.

More than 100 professionals from different disciplines have set up a specialist COVID-19 centre in a wing of the Ana Francisca Pérez de León II hospital in Petare, northeast Caracas, Venezuela. 

The plan to rehabilitate the hospital’s infrastructure and create an inpatient unit, including intensive care beds, where COVID-19 patients can receive medical and psychological care, is being carried out by Médecins Sans Frontières (MSF) in collaboration with Venezuelan authorities and the hospital's management team. Hospital staff have also received personal protective equipment (PPE) and training.    

MSF staff working with hospital staff across disciplines 

A team, made up of MSF and hospital staff and including doctors, nurses, epidemiologists, psychologists, technicians and transport and maintenance staff, has already begun caring for patients with COVID-19 symptoms. 

“It has been hard work and not without its challenges, due to the urgency of the situation and the need to adapt the hospital structure to the biosecurity measures, without compromising the rest of its emergency activities,” says Isaac Alcalde, coordinating MSF's emergency responses in Caracas and Miranda. “This has been possible thanks to the willingness of MSF staff and the hospital’s management team to find the best solutions for patients. It's a new situation for everyone.” 

Challenges in providing protective equipment 

So far, one of the biggest challenges for MSF in our global response to COVID-19 has been the shortage of PPE for our medical teams.

“We know that, in many countries, health workers have been exposed to risk, and there have been many infections due to the lack of PPE,” says Alcalde. “We will do our best to ensure that this does not happen here.”  

“But even with sufficient protection, the medical teams will face very difficult situations, both personally and professionally,” continues Alcalde. “We will make sure to provide them with all the support they need, including psychological support, to minimise the impact of this extraordinary situation.”   

MSF providing contact tracing, psychological care 

People arriving at the Ana Francisca Pérez de León II hospital with suspected COVID-19 are received by a medical team and questioned about their symptoms before being tested, either with a rapid test or with a polymerase chain reaction (PCR) test. Those who test positive are taken to the isolation area to be stabilised and to receive medical and psychological care. 

An MSF team visits patients’ families to provide health information and psychological support, while actively tracing the patient’s contacts and searching for other people with symptoms within their community. 

The COVID-19 centre has 22 beds, including 16 inpatient beds and 6 intensive care beds. We are also operating three ambulances, and have rehabilitated a further five public ambulances, for transporting patients between hospitals and between local diagnosis centres and hospitals. These are available not only for coronavirus patients but for patients suffering from other medical emergencies.