H5N1

COVID-19: Belgrade protesters storm Serb parliament over curfew

Via BBC News: Coronavirus: Belgrade protesters storm Serb parliament over curfew. Excerpt:

Dozens of police and protesters have been hurt in riots that broke out outside the National Assembly in the Serbian capital Belgrade.  

The protests began peacefully on Tuesday evening and included students and families, angered by a move to re-impose a weekend curfew because of a rise in coronavirus infections. 

Protesters broke into the assembly, prompting police to intervene. 

Clashes erupted and police fired tear gas to disperse the protesters. 

Far-right nationalists have been blamed for stirring up the unrest and storming the assembly building. Serbian media said they included an MP who has pushed anti-vaccine and anti-5G conspiracy theories. 

Serbian President Alexander Vucic on Wednesday condemned what he described as the most brutal political violence for years and appealed for the protests to end, citing the risk of increased infection. 

On Wednesday evening police again clashed with protesters, firing teargas as bottles, stones and flares were thrown from the crowd.

Why the protests began 

Serbia saw its deadliest day so far in the pandemic on Tuesday. President Vucic announced in a televised address that there had been 13 further deaths and 120 people were on ventilators, with 4,000 people being treated in hospital. 

The situation was most alarming in Belgrade, he said, before imposing a ban on gatherings of more than five people from Wednesday, with a curfew in force from 18:00 local time (16:00 GMT) on Friday until 05:00 on Monday morning.  

Mr Vucic said on Tuesday the curfew would apply only to the capital, but he was keen for it to be extended nationally.  

However, in a sign that situation was being reassessed on Wednesday, Serbia's chief epidemiologist, Predrag Kon, said later that Belgrade was improving and a lockdown in the city was "unlikely".  

In a further TV address on Wednesday, President Vucic said a curfew would probably not be imposed on the capital, but stricter measures would be announced. A decision will now be taken by the Covid-19 crisis response team on Thursday.

Serbia has seen a dramatic rise in cases and authorities have announced a state of emergency in several towns and cities. 

Opponents accuse the president of lifting the lockdown far too early, in May, allowing football matches with spectators and few limitations on movement ahead of elections on 21 June that Mr Vucic's party won by a landslide. 

Critics also accuse the government of not giving the true number of deaths during the initial weeks of the pandemic. Serbian authorities say there have been 341 deaths and 17,076 cases. Some 300 new infections are being reported daily.

WHO: Countries complaining about contact tracing are 'lame'

Via an AP report in The New York Times, Dr. Tedros shows that even teddy bears have sharp teeth: WHO: Countries Complaining About Contact Tracing Are 'Lame'. Excerpt:

LONDON — The head of the World Health Organization on Monday dismissed complaints from countries complaining that contact tracing is too difficult to implement as a control strategy for the coronavirus pandemic as “lame.” 

The U.N. health agency has repeatedly advised countries that shutting down their COVID-19 outbreaks requires having a strong contact tracing program in place, a labor-intensive process of tracking down contacts of people with coronavirus to ensure those at risk isolate themselves.  

In recent months, countries with large outbreaks of COVID-19, including Britain and the U.S., have said there are simply too many contacts to trace for an effective system to be put into place.  

Britain had vowed to have a “world-class” contact tracing system in place earlier this month. But the U.K. ultimately ditched the digital app it developed for that purpose and politicians have acknowledged the program is not yet running at full strength despite recruiting thousands of workers. In recent weeks, British health officials have said their contact tracers are failing to reach about one quarter of people with the virus — leaving thousands of people free to pass on COVID-19.  

At a media briefing on Monday, WHO Director-General Tedros Adhanom Ghebreyesus pointed to his emergencies director Dr. Michael Ryan as an example of someone willing to go to extraordinary lengths to conduct contact tracing, citing Ryan’s work — while wearing a bulletproof helmet and vest — during an Ebola outbreak in a part of Congo where armed groups had attacked and killed health workers.  

“He believed he had to do everything to stop Ebola and to show that saving lives actually requires that level of commitment,” Tedros said. 

Tedros said it wasn't acceptable that some countries claimed there were too many contacts to trace and that the process itself was too difficult. He has previously lauded the contact tracing programs adopted by countries like South Korea, Singapore and China, which involved teams of health workers tracing tens of thousands of people and ensuring that those exposed to the virus were isolated. 

Tedros said that well-resourced countries that aren't fighting wars have little excuse for not carrying out good contact tracing.  

“If contact tracing helps you to win the fight, you do it, even (when) risking your life," he said. “If any country is saying contact tracing is difficult, it is a lame excuse.”

Mondragone and COVID-19: Clashes in the night, the army asked by De Luca arrives

Via Corriere della Sera: Mondragone and Covid: clashes in the night, the army asked by De Luca arrives. Mondragone is a town near Naples, which suggests the pandemic may have migrated south from Lombardy. A lightly edited Google translation:

"If we were to have 100 positives after 3/4 thousand screening swabs, all Mondragone will be closed. Have I been clear? I am used to speaking clearly," said Vincenzo De Luca, president of the Region, last night at the microphones of TGR Campania. 

“We have quarantined all the buildings. Now everyone must stay at home, the rules must be respected: for 15 days no one must enter or leave those buildings. This Mondragone situation has existed for years and years. But among interior ministers, prefects and mayors, nobody has noticed. I am used to speaking clearly and I asked for strict 24-hour checks of the army, police and carabinieri to start," he added. 

In the evening, the Minister of the Interior Luciana Lamorgese sent a contingent of 50 soldiers. 

Still tension in the night in the area of ​​the former Cirio buildings, which since Monday has been a red zone due to about fifty coronavirus infections, widespread in particular in the Bulgarian community that lives there. Around 2 o'clock the firefighters intervened for the fire of a van in Viale Margherita, near the buildings. The vehicle was owned by a Bulgarian man. From the first investigations it seems that the cause is painful and that an incendiary bottle was used. 

 After the tensions, 730 swabs were taken to contain the infection of the people of the former Cirio buildings: the staff of the ASL of Caserta moved to Piazza Crocelle and Piazza Falcone to offer tests to citizens on a voluntary basis. 

In Piazza Falcone, near the town of the town at the center of controversy for the new outbreak, a hundred people are ready to undergo the test. "Our daughter has to give birth," says an elderly man, "so we decided to swab for safety."

COVID-19: Amid threats and political pushback, public health officials are leaving their posts

This is appalling. Via The Washington Post: Amid threats and political pushback, public health officials are leaving their posts. Excerpt:

For Lauri Jones, the trouble began in early May. The director of a small public health department in western Washington State was working with a family under quarantine because of coronavirus exposure. When she heard one family member had been out in the community, Jones decided to check in.  

The routine phone call launched a nightmare.  

“Someone posted on social media that we had violated their civil liberties [and] named me by name,” Jones recalled. “They said, ‘Let’s post her address . . . Let’s start shooting.’ ” 

People from across the country began calling her personal phone with similar threats.  

“We’ve been doing the same thing in public health on a daily basis forever. But we are now the villains,” said Jones, 64, who called the police and set up surveillance cameras at her home. 

Public health workers, already underfunded and understaffed, are confronting waves of protest at their homes and offices in addition to pressure from politicians who favor a faster reopening. Lori Tremmel Freeman, chief executive of the National Association of County and City Health Officials, said more than 20 health officials have been fired, resigned or have retired in recent weeks “due to conditions related to having to enforce and stand up for strong public health tactics during this pandemic.”  

Although shutdown measures are broadly popular, a vocal minority opposes them vociferously. There have been attacks on officials’ race, gender, sexual orientation and appearance. Freeman said some of the criticisms “seem to be harsher for women.”  

Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, said attacks on health officials have been particularly awful in California, Colorado, Georgia, Ohio and Pennsylvania.  

This month in California, Nichole Quick, Orange County’s chief health officer, stepped down after she faced threats and protests at her home for requiring face coverings in many businesses as cases rose. The mandate, issued May 23, was softened to a recommendation a week later.  

Andrew Noymer, a professor of public health at the University of California at Irvine who is part of a county task force, said it was not the first time Quick had been undermined.  

On March 17, Quick issued a strict lockdown order; a day later it was amended to add exceptions.  

“It was couched as a clarification, but it was a walk back,” Noymer said, because of pressure from business leaders.  

Quick’s departure is part of an exodus of public health officials across the country who have been blamed by both citizens and politicians for the disruptions caused by the coronavirus pandemic.  

“I don’t think I’ve ever seen anybody resign for the kinds of reasons we’ve seen recently,” Plescia said. “We are very concerned that if it continues to get worse it’s going to have major implications for who will be willing to have these jobs.”  

Ohio’s public health director, Amy Acton, shifted to an advisory role after enduring months of anger against the state’s preventive measures, including armed protesters at her home bearing messages including anti-Semitic and sexist slurs. One Republican lawmaker linked Acton, who is Jewish, to Nazi Germany; another called her a dictator.  

Georgia’s public health director said last month that she receives threats daily and now has an armed escort. 

Pennsylvania’s secretary of health, who is transgender, has come under fire for the state’s handling of the pandemic, including from a county official who resigned after saying at a recent meeting that he was “tired of listening to a guy dressed up as a woman.” 

Four public health officials in Colorado have left their jobs recently.  

A day after telling political leaders in Weld County, Colo. that their insistence on a speedy reopening despite a high case rate and widespread transmission was giving him “serious heartburn,” Public Health Director Mark Wallace got a 7:30 p.m. email: He had until 9 a.m., it said, to weigh in on guidelines for reopening businesses — “churches, salons, restaurants, etc.” They would go public an hour later.  

Wallace, who declined to comment for this article, retired soon after. 

Theresa Anselmo, executive director of the Colorado Association of Local Public Health Officials, said 80 percent of members had reported being threatened and more than that were at risk of termination or lost funding.

Racism, the public health crisis we can no longer ignore

Correspondence in The Lancet: Racism, the public health crisis we can no longer ignore.

Extraordinary times call for extraordinary measures. We are facing a global pandemic, a climate catastrophe, an imminent recession, and possibly depression. The health of the most vulnerable and all of humanity is at stake. Yet there is nothing new, extraordinary, or unprecedented about racism, xenophobia, and discrimination. The killing of Mr George Floyd, on the back of numerous other deaths of Black Americans at the hands of the police, and the two–four times increased mortality risk from COVID-19 for minority ethnic groups have brought to light social and structural injustices that have existed for centuries and are derived from the same intersecting systems of oppression. 

When a single act of violence is captured and amplified on social media, much like the televised US civil rights protests of the 1960s, it brings police brutality into the consciousness of people across the world. It elicits a visceral response, and humanity joins together in condemning racism.  

However, police homicides are a daily occurrence in parts of the world, and the people who die are usually poor, young men from othered groups. When it comes to violence, race and gender intersect. This means that Black and minoritised women are at higher risk of sexual and intimate partner violence, and Black trans women are over-represented in hate crime murders. Society is built on racial hierarchies, established through colonisation, that pervade structures, histories, politics, and, ultimately, minds. Overt acts of violence are surface-level symptoms of structural and cultural forms of racism that extend far deeper. Under this lies a pyramid of abuse, marginalisation, and injustice that exists in every society. 

The forms of discrimination and the targets might vary: in some societies they are based on race or ethnicity; in others, colour, caste, religious beliefs, Indigeneity or someone's migratory status. However, the underlying oppression that caused these injustices to occur are largely similar. Racism and xenophobia are about division and control, and ultimately power. Together they constitute a structural form of violence that results, at the extreme, in innocent people being murdered. 

The COVID-19 outbreak has uncovered a crisis in our social and political fabric extending beyond the outbreak itself: an uncomfortable propensity towards racism, xenophobia, and intolerance exacerbated by transnational health challenges and national politics. Internationally, we have witnessed the vilification of particular nationalities, with overt forms of sinophobia. Politically, xenophobia has been weaponised to enforce border controls against particular nationalities and undermine migrant rights. In the UK, minoritised ethnic groups are more likely to contract a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and, subsequently, face a higher risk of a severe form of illness. 

Why is this? People from minoritised ethnic groups are more likely to work as key workers in frontline jobs that expose them to SARS-CoV-2, and are more likely to live in overcrowded accommodation, meaning social distancing is not an option. They are then more likely to have barriers to accessing health services, meaning that they present late in a worse condition, and with a higher probability of underlying illnesses that put them at greater risk of death. In some cases, the existence of these comorbidities lowers the chances for intubation and ventilation, resulting in a double burden of being more prone to be severely unwell and less likely to receive intensive care.

Beyond these proximal causes of ill health lie racism and structural forms of discrimination. Marginalised groups are disadvantaged in all the social determinants of health. However, racism is more than this, it is a fundamental cause of ill health. At all socioeconomic levels, people of colour have poorer health outcomes. Racism cumulates over the lifecourse, leading to activation of stress responses and hormonal adaptations, increasing the risk of non-communicable diseases and biological ageing. This trauma is also transmitted intergenerationally and affects the offspring of those initially affected through complex biopsychosocial pathways. The root of these so-called biological causes is racism, not race itself. 

Society is unwell. The symptoms—racialised violence, and excess morbidity and mortality in minority ethnic populations—reflect the cause: an unjust and unequal society. Scientists and doctors, by remaining technocratic and apolitical, are complicit in perpetuating discrimination. As a health community, we must do more than simply describing inequities in silos, we must act to dismantle systems that perpetuate the multiple intersecting and compounding systems of oppression that give rise to such inequities and injustices. 

To this end, we are producing a series of academic papers to centre the complex challenges of racism and xenophobia in the health discourse. We are working with a diverse team of academics and activists globally to highlight injustices, identify solutions, and enact change. Alongside this, we are launching the Race & Health movement, a multi-disciplinary community of practice that will continue beyond the social media. 

Our vision is to provide a catalyst in tackling the adverse health effects of racism, xenophobia, and discrimination. Academic outputs on their own are irrelevant. We must use the evidence to advocate for change and improvements in health. In this spirit, we are launching a global consultation, asking: what should we do, and how should we do it? 

Racism kills, and this is a public health crisis we can no longer ignore. As a health community, where were we? As the hashtags disappear and we start to emerge from the pandemic, even in ordinary times, we need extraordinary measures.

COVID-19 updates from The Washington Post

Coronavirus Updates from The Washington Post. Click through for many links. Excerpt:

The latest 

“We’re millennials, we’re healthy,” a young woman told The Washington Post as she sat with her friends outside a bustling lakeside grill in Missouri this weekend.  

“The pandemic is made up,” said a man in line with his daughter, grandson and hundreds of strangers at a North Carolina speedway. 

“I can't breathe!” chanted demonstrators who gathered by the thousands in cities across the country, quoting from George Floyd's final words as he lay dying under the weight of a Minneapolis police officer last week.  

Be it from outrage, apathy or simple contrarianism, social distancing strictures are rapidly dissolving as crowds party, protest or riot in American cities that just days earlier resembled ghost towns. The coronavirus is almost certainly spreading among them, and already appears to be staging a national comeback. “Arizona, Mississippi, South Carolina, Utah and Wisconsin all set record highs for new cases reported Friday,” The Post wrote, noting that all those states relaxed their quarantine rules this month.    

“There’s going to be a lot of issues coming out of what’s happened in the last week, but one of them is going to be that chains of transmission will have become lit from these gatherings,” former Food and Drug Administration commissioner Scott Gottlieb told CBS News on Sunday.   

At the same time, the disorder is making it harder for health officials to track and suppress new outbreaks. In Los Angeles, for example, uncontrolled protests caused the mayor to close all coronavirus testing centers in the city. 

No one seems to be in control, or even trying to abate the chaos, our political desk wrote: In Minneapolis, “businesses burned to the ground. The nation watched on live TV as crowds looted liquor stores and other shops, with no pushback from the authorities.”  

President Trump, who has repeatedly encouraged people to defy his own administration's quarantine guidelines, seemed to savor the idea of protesters and counterprotesters facing off in the streets. “Tonight, I understand, is MAGA NIGHT AT THE WHITE HOUSE???” he tweeted Saturday after Floyd demonstrators attacked Secret Service agents outside his residence.

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.

Minneapolis unrest expected to lead to more COVID-19 cases

Via The Washington Post: Minneapolis unrest expected to lead to more COVID-19 cases.

Demonstrations in Minneapolis and St. Paul, sparked over the death of George Floyd, could lead to a rise in coronavirus cases, a health official said. 

This week, peaceful and violent protests have occurred in the Twin Cities after Floyd, an unarmed black man, died after a white police officer knelt on his neck. While images of masked protesters have emerged, Minnesota Department of Health Commissioner Jan Malcolm projected the large gatherings will create a surge of positive coronavirus test results.  

“It’s certainly going to be a factor in what happens in our outbreak and our case counts,” Malcolm said, according to MPR News.  

On Thursday, the health department reported 493 new cases, with nearly 30 percent of those positive tests coming from the county of the Twin Cities. The state also reported 35 additional deaths for a total of 967, the vast majority belonging to residents in long-term care or assisted-living facilities.  

Though Minneapolis Mayor Jacob Frey (D) has declared a state of emergency, more protests are expected. 

“I’m understanding the forecast is for very large protests this weekend, with a lot of people coming in from across the state and around the country and gathering in large groups,” Malcolm said. “That’s almost sure to have an impact on furthering spread.”

COVID-19: A public health approach to manage domestic violence is needed

Via The Lancet Public Health: COVID-19: a public health approach to manage domestic violence is needed.

The negative consequential effects of the measures adopted by the UK and other countries to tackle the spread of coronavirus disease 2019 (COVID-19) on society are beginning to unfold. An area of concern is the impending crisis of domestic violence—gender-based violence and child abuse and neglect, due to movement restrictions, loss of income, isolation, overcrowding, and stress and anxiety, all which put women and children at a disproportionally increased risk of harm. 

This increased risk is not surprising. Previous epidemics, such as the Ebola virus disease outbreak in west Africa, but also cholera and Zika virus disease outbreaks, led to regional environments where domestic violence became more prevalent; there were reductions in funding for specialist gender-based violence public health services; and, for survivors of gender-based violence, there was reduced access to health-care services. 

Although we are not aware of published studies to date that have tracked the national trends in gender-based violence related to COVID-19, initial reports from UK support services such as the National Domestic Abuse helpline have already shown increases in service use, a pattern seen elsewhere (with notable examples in China, Spain, and France). 

In the UK, before the coronavirus crisis, gender-based violence was already deemed as highly prevalent, associated with substantial negative downstream social, psychological, and physical outcomes. Therefore, any resultant increases in the rates of domestic violence would not only be a further travesty of human rights but also be associated with further long-term costs to society, which might be irreparable beyond the immediate threat of COVID-19. It has never been more important than now to implement a public health approach to gender-based violence in the UK.

Similar to an approach that has been put in use to improve the management of physical violence in cities such as Cardiff, Glasgow, and London, the principles of a public health approach should be implemented to support survivors of gender-based violence. The WHO public health approach consists of four steps, which we have suggested the adaptation of to aid in the prevention of domestic violence during this pandemic (appendix). 

Without adequate surveillance, it is not possible to capture the burden of domestic violence during this pandemic. Because of selection biases, administrative datasets have consistently shown underestimates in the expected rates of domestic violence. Potential approaches to improve the surveillance of domestic violence could include the routine inquiry (feasibly integrated into remote primary care consultations or active syndromic surveillance from local health protection teams) and the urgent implementation of linked datasets between police and health records datasets to identify individuals at risk. Enhancing surveillance would also provide the opportunity to offer targeted support and interventions. 

Though formal evaluations of current interventions have not yet taken place during the pandemic, national charities (such as, but not limited to, Women's Aid, Safelives, and the National Society for the Prevention of Cruelty against Children) have produced guidance for how survivors can both report violence, abuse, and neglect and keep themselves safe, including information on remote reporting and support mechanisms. 

There are substantial gaps in the literature relating to the surveillance and evaluation of effective interventions to support those at risk of domestic violence, child abuse and neglect during this pandemic. The medical profession has a duty to provide support in overcoming these problems—to provide a public health approach to supporting those most vulnerable in society.

Escaped Ebola patient hiding in DR Congo militia-held area: Officials

Via Thomson Reuters: Escaped Ebola patient hiding in Congo militia-held area - officials.

BENI, Democratic Republic of Congo, April 28 (Reuters) - An Ebola patient who escaped from a treatment centre in eastern Congo earlier this month has been hiding in an area controlled by local militia groups, local authorities and a World Health Organization (WHO) official said on Tuesday. 

A cluster of new Ebola infections emerged on April 10 in the town of Beni, two days before the Democratic Republic of Congo was due to declare the end of the world's second-largest Ebola epidemic, which has killed more than 2,200 people since it started in August 2018. 

On April 17, a 28-year-old motorbike taxi-driver who had tested positive for Ebola ran away from the centre where he was being treated in the town of Beni. 

Health workers had been unable to locate him. But local authorities on Tuesday said he was living in an area controlled by a number of armed militias. 

"His location poses a real problem at a time when the area is facing several scourges, including armed groups," said Beni's deputy mayor Muhindo Bakwanamaha.  

Boubacar Diallo, deputy incident manager for the WHO's Ebola response operation, said the hidden confirmed case was believed to be in the Beni area controlled by Mai-Mai armed groups. 

The WHO confirmed a seventh new case on Tuesday, a 39-year-old woman who had been in confinement since her daughter died from the disease on April 20. 

Small outbreaks are common towards the end of an Ebola epidemic, but health workers need to ensure the virus is contained by tracking, quarantining and vaccinating the contacts of new cases.  

Two new vaccines have had a major impact in containing Ebola, but deep public mistrust and militia attacks have prevented health workers from reaching some areas hit by the epidemic. 

Three-quarters of the 971 known contacts from the latest flare-up have been vaccinated so far, according to an internal WHO report shared with Reuters.  

Congo's health system, which has suffered from decades of war, under-funding and mismanagement, is simultaneously fighting measles and cholera epidemics, as well as the global coronavirus pandemic. The country has recorded 471 cases of COVID-19 and 30 deaths.