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Throughout the world, overworked health care professionals are being infected with Covid-19, yet the Lion City has kept numbers low
Preparation, planning, patient ratios and protective equipment have all played a part. Still, even the best gear cannot guard against discrimination
Medical staff walk to the National Centre for Infectious Diseases building at Tan Tock Seng Hospital in Singapore. Photo: AFP
Uncooperative patients, long hours and a lack of protective equipment are hampering health care workers across the world as they take the fight to the coronavirus, leading many to fall sick themselves.
In Malaysia, a pregnant woman who did not disclose that her father was infected tested positive after giving birth, leading to the shutdown of the entire hospital for cleaning. In the Philippines, nine doctors have died, two of whom had dealt with a patient who lied about her travel history.
In Spain, where more than 5,400 health care workers have been infected, accounting for about 14 per cent of the country’s patients, there are no longer enough workers to care for patients.
In Italy, which has more than 69,000 patients, the virus killed a doctor who had no choice but to work without gloves.
In the United States, which has surpassed China to become the world’s most infected nation with more than 83,000 people testing positive for Covid-19, hospitals are being overrun with patients.
Health care staff in the country say patients are packed into emergency wards and intensive care units (ICUs), further raising the risk of infections. They also report shortages of ventilators, face masks, gowns and shields.
The US Centres for Disease Control and Prevention on March 7 released interim guidelines saying health care workers exposed to the coronavirus could be asked to return to work as long as they wore face masks and were not showing symptoms, if their employers had no other manpower available.
Malaysian health workers at Kuala Lumpur International Airport. Photo: AFP
A REASON FOR OPTIMISM
However, amid all the gloom, Singapore’s experienceis being held up as a reason for optimism. The city state has reported more than 630 cases of infection, all of which are being treated in hospital, yet only a handful of its health care professionals have been infected. What’s more, even these cases, according to Vernon Lee, director of communicable diseases at the Ministry of Health, are thought to have been infected outside the health care setting.
Experts suggest this has been more than just luck, pointing to a case in which 41 health workers were exposed to the coronavirus in a Singapore hospital yet evaded infection.
The workers had all come within two metres of a middle-aged man with Covid-19 who was being intubated, a procedure which involves a tube being inserted into the patient’s trachea. The procedure is seen as being particularly hazardous for health workers as it is “aerosol generating” – patients are likely to cough.
The workers had not known at the time that the man had the virus and all were quarantined after he tested positive. However, on their release two weeks later, none of them had the virus.
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The case has come to widespread attention partly because the workers were wearing a mix of standard surgical masks and the N95 mask, which doctors see as the gold standard as it filters out 95 per cent of airborne particles.
The conclusion, published in The Annals of Internal Medicine this month, was this: “That none of the health care workers in this situation acquired infection suggests that surgical masks, hand hygiene, and other standard procedures protected them from being infected.”
Surgeon and writer Atul Gawande mentioned the case in an article for The New Yorker on how health care workers could continue seeing patients without becoming patients. He said there were things to learn from Asia and that some of the lessons came out of the “standard public health playbook”. In other words, there is much to be said for social distancing, basic hand hygiene and cleaning regimens.
A health worker in protective gear walks into a quarantine room at a hospital in Banda Aceh, Indonesia. Photo: AFP
COMING TOGETHER
With critical supplies running short in many countries, experts say it is increasingly vital that countries share both knowledge and resources.
To this end, China has been donating personal protective equipment to places including the Philippines, Pakistan and Europe. China’s richest man Jack Ma is donating 1.8 million masks, 210,000 Covid-19 test kits and 36,000 pieces of protective clothing to 10 countries in Asia.
At the same time, doctors are encouraging the Western world to learn from Asia.
Infectious diseases expert Leong Hoe Nam said that being “bitten by Sars” (severe acute respiratory syndrome) in 2003 had prepared Asia for Covid-19, while Western countries were not similarly prepared and hence lacked sufficient protective equipment.
He pointed to how about 2,000 health care workers had fallen sick in China early in the outbreak because workers did not initially have protective gear. The trend reversed as equipment became available.
“Once the defences were up, there were very few health care workers who fell sick at work. Rather, they fell sick from contact with sick individuals outside the workplace,” he said.
Malaysia is a case in point. While it has reported 80 health care workers falling ill, most are thought to be community infections.
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In a webinar organised by Caixin Global on Thursday night, Peng Zhiyong, an intensive care specialist at Zhongnan Hospital of Wuhan University, shared how they managed a shortage of personal protective equipment early on in the outbreak by rationing workers to two sets of gear per shift.
Meanwhile, in the Philippines, doctors from Manila’s Chinese General Hospital held a video conference call with doctors in Zhejiang to learn from China’s experience of treating Covid-19 patients.
Crowdsourcing platforms have also been created to share advice. The Brigham and Women’s Hospital in Boston has released guidelines for treating critically ill patients and its website includes information from Chinese doctors.
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The Jack Ma Foundation has also launched an online platform for doctors and nurses around the world to share knowledge on fighting the virus. “One world, one fight,” it said in a tweet.
Associate Professor Jeremy Lim from the global health programme at the Saw Swee Hock School of Public Health said it was crucial for countries to work together.
“Viruses don’t respect borders. Countries have to share information and help each other as we are only as strong as the weakest link. Any country can become a reservoir of disease and the world may then be forced to endure a ping-pong of outbreaks over and over again.”
And the advice of Lee, at Singapore’s Ministry of Health? “Practise good hygiene and wash hands regularly.”
Indonesian medical staff administer mass testing for Covid-19 in Bekasi, West Java. Photo: AFP
SINGAPORE, A CASE STUDY
Amid this sharing of advice, it is often Singapore that is held up as an example to replicate. Despite the country grappling with a rising load of Covid-19 patients, most of whom have recently returned to the city state from abroad, its health care system has continued to run smoothly. Doctors say this is because it has been preparing for a pandemic ever since Sars caught it by surprise. During the Sars outbreak, health care workers accounted for 41 per cent of Singapore’s 238 infections.
Consequently its hospitals swung into contingency planning mode early on in the coronavirus outbreak, telling staff to defer leave and travel plans after its first cases emerged.
Meanwhile, its hospitals swiftly split their workforces into teams to ensure there were enough workers if the outbreak worsened, and to ensure workers got enough rest.
Singapore has 13,766 doctors, or 2.4 doctors for every 1,000 people. That compares to 2.59 in the US, 1.78 in China and 4.2 in Germany. Places like Myanmar and Thailand have fewer than one doctor for every 1,000 people.
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“The objective is that you can run essential services with the greatest amount of security. Make sure functional units have redundancy built in, and are separate from each other. It depends on what you feel is sufficient to carry on services if one team is affected, factoring in rest periods and some system of rotation,” said Chia Shi-Lu, an orthopaedic surgeon.
The key is to ensure a good doctor-to-patient ratio and ensure there are enough specialists for the critical work, such as doctors and nurses who can provide intensive care, and know how to operate mechanical ventilators or machines to pump and oxygenate a patient’s blood outside the body.
At the emergency department where paediatrics emergency specialist Jade Kua treats Covid-19 cases in addition to regular emergencies, doctors are split into four teams of 21. Each team takes alternate 12-hour shifts and does not interact with other teams.
“We are in modular teams so the teams move together. So you and I would both do morning, off, night, off, morning off. Together. And then the other teams would do the same and we don’t intermingle,” said Kua.
US now has world’s most coronavirus cases, surpassing China
Chia, who works at the Singapore General Hospital, said doctors had been split up according to their functions.
“We try not to meet at all with the other teams as much as possible. We’ll just say hi from across the corridor. Meals are the same. All our cafeterias and everything have got social distancing spaced in already,” said Chia, who is also a member of parliament and chairs a shadow committee on health.
Chia said the health care system could also tap on doctors in the private sector.
Not every country has a plan like this. Last year’s Global Health Security Index by the Economist Intelligence Unit found that 70 per cent of 195 countries scored poorly when it came to having a national plan for dealing with epidemics or pandemics. Almost three in 10 had failed to identify which areas were insufficiently staffed. In India, with a population of 1.3 billion, only about 20,000 doctors are trained in key areas such as critical care, emergency medicine and pulmonology.
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In contrast, Singapore published its first Influenza Pandemic Preparedness and Response Plan in June 2005 and has since honed it to a tee. Hospitals regularly war-game scenarios such as pandemics or terrorist attacks and the simulations are sometimes observed by the Ministry of Health, which grades the performance and recommends areas for improvement.
The plan also covers the need to stockpile equipment to avoid the sort of shortages many countries are now facing, another lesson inspired by Sars when masks, gloves and gowns were in short supply.
In a pandemic preparation paper published in 2008, Singapore public health specialist Jeffery Cutter wrote that Singapore’s stockpile was sufficient to cover at least 5 to 6 months’ use by all front-line health care workers.
During the Covid-19 outbreak, it has also told citizens to not wear masks so it can conserve supply for medical staff.
Having enough protective gear has reassured Singapore’s health care workers such as Kua, a mother of six who blogged about her experience fighting Covid-19. Kua said: “I’m safe and my family is safe.”
India’s poor hit hard by 21-day nationwide lockdown amid the coronavirus pandemic
SOMETHING YOU CAN’T GUARD AGAINST
Despite the many positives to emerge from the Lion City, its health care workers are struggling with another problem: discrimination.
While in France, Italy and Britain, residents cheer health care workers from their windows, in Singapore health care workers are seen by some people as disease carriers.
“I try not to wear my uniform home because you never know what kind of incidents you may encounter,” said one Singapore nurse. “The public is scared and wearing our uniforms actually causes quite a bit of inconvenience. One of my staff tried to book a private-hire car to the hospital for an emergency and she was rejected by five drivers.”
There is a similar stigma in India, where the All India Institute of Medical Sciences has appealed to the government for help after health workers were forced out of their homes by panicked landlords and housing societies.
“Many doctors are stranded on the roads with all their luggage, nowhere to go, across the country,” the institute said in a letter.
Lim, from the Saw Swee Hock School of Public Health, said the worst human impulses and “every man for himself” attitudes could emerge in crises and “that is exactly why governments have to step in”.
Discrimination could affect both the performance and motivation of health care workers, Lim warned.
Meanwhile, when health care workers are infected, it creates a “triple whammy” threat.
“It means one fewer professional in an already-strained system, another patient to care for and, potentially, a team of colleagues who need to be quarantined,” said Lim.
“We must do everything possible to keep our health care workforce safe and free from Covid-19.” ■
NEW YORK (Reuters) – The number of U.S. coronavirus infections climbed above 82,000 on Thursday, surpassing the national tallies of China and Italy, as New York, New Orleans and other hot spots faced a surge in hospitalizations and looming shortages of supplies, staff and sick beds.
With medical facilities running low on ventilators and protective masks and hampered by limited diagnostic testing capacity, the U.S. death toll from COVID-19, the respiratory disease caused by the virus, rose beyond 1,200.
“Any scenario that is realistic will overwhelm the capacity of the healthcare system,” New York Governor Andrew Cuomo told a news conference. He described the state’s projected shortfall in ventilators – machines that support the respiration of people have cannot breathe on their own – as “astronomical.”
“It’s not like they have them sitting in the warehouse,” Cuomo added. “There is no stockpile available.”
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At least one New York City hospital, New York-Presbyterian/Columbia University Medical Center in Manhattan, has begun a trial of sharing single ventilators between two patients.
While New York was the coronavirus epicenter in the United States this week, the next big wave of infections appeared headed for Louisiana, where demand for ventilators has already doubled. In New Orleans, the state’s biggest city, Mardi Gras celebrations late last month are believed to have fueled the outbreak.
Louisiana Governor John Bel Edwards said New Orleans would be out of ventilators by April 2 and potentially out of bed space by April 7 “if we don’t flatten the infection curve soon.”
“It’s not conjecture, it’s not some flimsy theory,” Edwards told a press conference. “This is what is going to happen.”
About 80% of Louisiana’s intensive care patients are now on breathing machines, up from the normal rate of 30-40%, said Warner Thomas, chief executive of Ochsner Health System, the state’s hospital group.
Scarcities of protective masks, gloves, gowns and eyewear for doctors and nurses – reports abound of healthcare workers recycling old face masks, making their own or even using trash bags to shield themselves – have emerged as a national problem.
“Our nurses across the country do not have the personal protective equipment that is necessary to care for COVID patients, or any of their patients,” Bonnie Castillo, head of the largest U.S. nurses union, National Nurses United, told MSNBC.
In an ominous milestone for the United States as a whole, at least 82,153 people nationwide were infected as of Thursday, according to a Reuters tally from state and local public health agencies. China, where the global pandemic emerged late last year, had the second highest number of cases, 81,285, followed by Italy with 80,539.
At least 1,204 Americans have died from COVID-19, which has proven especially dangerous to the elderly and people with underlying chronic health conditions, Reuters’ tally showed.
MORE BEDS NEEDED
For New York state, Cuomo said a key goal was rapidly to expand the number of available hospital beds from 53,000 to 140,000.
New York hospitals were racing to comply with Cuomo’s directive to increase capacity by at least 50%. At Mount Sinai Hospital’s Upper East Side location, rooms were being constructed within an atrium to open up more space for beds.
At Elmhurst Hospital in New York’s borough of Queens, about a hundred people, many wearing masks with their hoods pulled up, lined up behind barriers outside the emergency room entrance, waiting to enter a tent to be screened for the coronavirus.
The city coroner’s office has posted refrigerated trucks outside Elmhurst and Bellevue Hospital to temporarily store bodies of the deceased.
Deborah White, vice chair of emergency medicine at Jack D. Weiler Hospital in the city’s Bronx borough, said 80% of its emergency room visits were patients with coronavirus-like symptoms.
A ventilator shortfall and surge in hospitalizations has already raised the prospect of rationing healthcare.
Asked about guidelines being drafted on how to allocate ventilators to patients in case of a shortage, New Jersey Governor Phil Murphy told reporters such bioethical discussions “haunted him” but were unavoidable.
Outside New York and New Orleans, other hot spots appeared to be emerging around the country, including Detroit.
Brandon Allen, 48, was buying groceries in Detroit for his 72-year-old mother, who has tested positive and was self-quarantining at home.
“It’s surreal,” Allen said. “People around me I know are dying. I know of a couple people who have died. I know a couple of people who are fighting for their lives. Everyday you hear of another person who has it.”
RECORD UNEMPLOYMENT CLAIMS
Desperate to slow virus transmissions by limiting physical contact among people, state and local governments have issued stay-at-home orders covering about half the U.S. population. A major side effect has been the strangulation of the economy, and a wave of layoffs.
The U.S. Labor Department reported Thursday the number of Americans filing claims for unemployment benefits last week soared to a record of nearly 3.28 million – almost five times the previous weekly peak of 695,000 during the 1982 recession.
Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said warmer weather may help tamp down the U.S. outbreak as summer approaches, though the virus could re-emerge in the winter.
“We hope we get a respite as we get into April, May and June,” Fauci said on WNYC public radio.
Washington state Governor Jay Inslee said he may extend a stay-at-home order tentatively set to expire April 6, encouraged by what he called a “very modest improvement” in the Seattle area.
Washington experienced the first major U.S. outbreak of COVID-19 and has been among the hardest-hit states. As of Thursday the state reported about 3,200 cases and 147 deaths.
In California’s Coachella Valley, a region rife with retirees who are especially vulnerable, 25 members of the state’s National Guard helped a non-profit distribute food to people stuck in their homes, as most of the regular volunteers are senior citizens.
More than 10,000 troops have been deployed in 50 states to provide humanitarian aid during the pandemic.
Image copyright NATIONAL MUSEUM OF HEALTH AND MEDICINEImage caption The 1918 flu pandemic is believed to have infected a third of the population worldwide
All interest in living has ceased, Mahatma Gandhi, battling a vile flu in 1918, told a confidante at a retreat in the western Indian state of Gujarat.
The highly infectious Spanish flu had swept through the ashram in Gujarat where 48-year-old Gandhi was living, four years after he had returned from South Africa. He rested, stuck to a liquid diet during “this protracted and first long illness” of his life. When news of his illness spread, a local newspaper wrote: “Gandhi’s life does not belong to him – it belongs to India”.
Outside, the deadly flu, which slunk in through a ship of returning soldiers that docked in Bombay (now Mumbai) in June 1918, ravaged India. The disease, according to health inspector JS Turner, came “like a thief in the night, its onset rapid and insidious”. A second wave of the epidemic began in September in southern India and spread along the coastline.
The influenza killed between 17 and 18 million Indians, more than all the casualties in World War One. India bore a considerable burden of death – it lost 6% of its people. More women – relatively undernourished, cooped up in unhygienic and ill-ventilated dwellings, and nursing the sick – died than men. The pandemic is believed to have infected a third of the world’s population and claimed between 50 and 100 million lives.
Gandhi and his febrile associates at the ashram were lucky to recover. In the parched countryside of northern India, the famous Hindi language writer and poet, Suryakant Tripathi, better known as Nirala, lost his wife and several members of his family to the flu. My family, he wrote, “disappeared in the blink of an eye”. He found the Ganges river “swollen with dead bodies”. Bodies piled up, and there wasn’t enough firewood to cremate them. To make matters worse, a failed monsoon led to a drought and famine-like conditions, leaving people underfed and weak, and pushed them into the cities, stoking the rapid spread of the disease.
Image copyright PRINT COLLECTORImage caption Bombay was one of the worst hit cities by the 1918 pandemic
To be sure, the medical realities are vastly different now. Although there’s still no cure, scientists have mapped the genetic material of the coronavirus, and there’s the promise of anti-viral drugs, and a vaccine. The 1918 flu happened in the pre-antibiotic era, and there was simply not enough medical equipment to provide to the critically ill. Also western medicines weren’t widely accepted in India then and most people relied on indigenous medication.
Yet, there appear to be some striking similarities between the two pandemics, separated by a century. And possibly there are some relevant lessons to learn from the flu, and the bungled response to it.
The outbreak in Bombay, an overcrowded city, was the source of the infection’s spread back then – this something that virologists are fearing now. With more than 20 million people, Bombay is India’s most populous city and Maharashtra, the state where it’s located, has reported the highest number of coronivirus cases in the country.
By early July in 1918, 230 people were dying of the disease every day, up nearly three times from the end of June. “The chief symptoms are high temperature and pains in the back and the complaint lasts three days,” The Times of India reported, adding that “nearly every house in Bombay has some of its inmates down with fever”. Workers stayed away from offices and factories. More Indian adults and children were infected than resident Europeans. The newspapers advised people to not spend time outside and stay at home. “The main remedy,” wrote The Times of India, “is to go to bed and not worry”. People were reminded the disease spread “mainly through human contact by means of infected secretions from the nose and mouths”.
“To avoid an attack one should keep away from all places where there is overcrowding and consequent risk of infection such as fairs, festivals, theatres, schools, public lecture halls, cinemas, entertainment parties, crowded railway carriages etc,” wrote the paper. People were advised to sleep in the open rather than in badly ventilated rooms, have nourishing food and get exercise.
“Above all,” The Times of India added, “do not worry too much about the disease”.
Image copyright PRINT COLLECTOR
Colonial authorities differed over the source of infection. Health official Turner believed that the people on the docked ship had brought the fever to Bombay, but the government insisted that the crew had caught the flu in the city itself. “This had been the characteristic response of the authorities, to attribute any epidemic that they could not control to India and what was invariably termed the ‘insanitary condition’ of Indians,” observed medical historian Mridula Ramanna in her magisterial study of how Bombay coped with the pandemic.
Later a government report bemoaned the state of India’s government and the urgent need to expand and reform it. Newspapers complained that officials remained in the hills during the emergency, and that the government had thrown people “on the hands of providence”. Hospital sweepers in Bombay, according to Laura Spinney, author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World, stayed away from British soldiers recovering from the flu. “The sweepers had memories of the British response to the plague outbreak which killed eight million Indians between 1886 and 1914.”
Image copyright PRINT COLLECTORImage caption The hospitals in Bombay were overwhelmed by patients
“The colonial authorities also paid the price for the long indifference to indigenous health, since they were absolutely unequipped to deal with the disaster,” says Ms Spinney. “Also, there was a shortage of doctors as many were away on the war front.”
Eventually NGOs and volunteers joined the response. They set up dispensaries, removed corpses, arranged cremations, opened small hospitals, treated patients, raised money and ran centres to distribute clothes and medicine. Citizens formed anti-influenza committees. “Never before, perhaps, in the history of India, have the educated and more fortunately placed members of the community, come forward in large numbers to help their poorer brethren in time of distress,” a government report said.
Now, as the country battles another deadly infection, the government has responded swiftly. But, like a century ago, civilians will play a key role in limiting the virus’ spread. And as coronavirus cases climb, this is something India should keep in mind.
WUHAN/SHANGHAI, Feb. 16 (Xinhua) — Twenty recovered coronavirus patients donated their plasma to those in severe condition in Wuhan, capital of the hard-hit province of the novel coronavirus disease (COVID-19), said the province’s COVID-19 scientific research team Sunday.
The donors are doctors and nurses who have recovered from the disease for 10 days at the Jiangxia District’s No. 1 people’s hospital and traditional Chinese medicine hospital.
Twelve patients in severe condition have received the plasma treatment. An expert with Jiangxia District’s No. 1 people’s hospital said that the patients have shown improved clinical symptoms about 12 to 24 hours after they received the treatment.
“We are observing the therapeutic results and improving our treatment plans,” the expert said, adding that plasma donation won’t hurt the donor once he or she has been cured for 10 days.
Zhang Dingyu, head of Wuhan Jinyintan Hospital, a major designated hospital to admit confirmed cases in Wuhan, called upon cured patients who were infected with COVID-19 to donate plasma as initial results had indicated the effectiveness of convalescent plasma-derived therapeutic products in curing infected patients in severe and critical conditions.
In Shanghai, official data showed 124 patients have recovered from COVID-19 and discharged from hospitals by Saturday afternoon, of whom 14 have shown willingness to donate their plasma to assist coronavirus research and treatment.
Some recovered patients regard the donation as a way to pay back to the society after they received timely and effective treatment.
“Before being discharged from the hospital, I learned from the nurses that I can donate plasma, which I think is very helpful,” said a recovered patient surnamed Liu who is willing to become a donor.
“We were helped by others and we want to help other patients as well,” Liu said.
Media caption Americans are taken from the docked ship to Haneda airport in Tokyo
Two planes carrying hundreds of US citizens from a coronavirus-hit cruise ship have left Japan, officials say.
One plane has landed at a US Air Force air base in California, and its passengers will be isolated at military facilities for 14 days.
There were some 400 Americans on board the Diamond Princess. The ship with some 3,700 passengers and crew has been in quarantine since 3 February.
Meanwhile, China reported a total of 2,048 new cases on Monday.
Of those new cases, 1,933 were from Hubei province, the epicentre of the outbreak.
More than 70,500 people across China have been infected by the virus. In Hubei alone, the official number of cases stands at 58,182, with 1,692 deaths. Most new cases and deaths have been reported in Wuhan, Hubei’s largest city.
In other developments:
In Japan, a public gathering to celebrate the birthday of new Emperor Naruhito later this week has been cancelled, due to concerns over the spread of the virus while organisers of the Tokyo marathon due to take place on 1 March are considering whether to cancel the amateur part of the race, reports say
In China, the National People’s Congress standing committee said it would meet next week to discuss a delay of this year’s Congress – the Communist Party’s most important annual gathering – because of the outbreak
At the weekend, an American woman tested positive for the virus in Malaysia after leaving a cruise liner docked off the coast of Cambodia
A Russian court has ordered a woman who escaped from a quarantine facility to go back and stay there until she is confirmed to be disease-free, Fontanka news agency reports. Alla Ilyina has until Wednesday to return
What’s happening on the Diamond Princess?
The cruise ship was put in quarantine in Japan’s port of Yokohama after a man who disembarked in Hong Kong was found to have the virus.
On Monday, Japanese officials said there were 99 new cases of infections on board the ship, bringing the total to 454 confirmed cases. It is the largest cluster of cases outside China.
A Russian woman who was on board and tested positive is thought to be the first Russian national to contract the virus after the two previous cases found in Russia were Chinese nationals, Reuters news agency reports.
She will be taken to a hospital for treatment, the Russian embassy in Japan said.
At least 40 US citizens who were on board are infected and will be treated in Japan, Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases told US broadcaster CBS.
Image copyright AFPImage caption Those bound for the US left from Tokyo’s Haneda Airport
The two aircraft chartered by the US government left Tokyo’s Haneda Airport in the early hours of Monday. The second flight was due to land at another base in Texas.
More than 300 passengers are being repatriated voluntarily, the US state department said. Fourteen of them were reported during transit to have tested positive for the virus and were being kept separate from the other passengers, it said.
we would like to just finish the quarantine on the ship as planned, decompress in a non-quarantine environment in Japan for a few days, then fly back to the U.S. pursuant to our own arrangements. What’s wrong with that?
The smartphones were distributed so people could use an app, created by Japan’s health ministry, which links users with doctors, pharmacists and mental health counsellors. Phones registered outside of Japan are unable to access the app.
Other evacuation flights have been arranged to repatriate residents of Israel, Hong Kong and Canada. On Monday, Australia announced that it would evacuate 200 of its citizens too.
What is happening in China?
According to official figures for 16 February, 100 people died from the virus in Hubei, down from 139 on Saturday.
The Chinese authorities are tightening curbs on movement to combat the outbreak. People in Hubei province, which has 60 million people, have been ordered to stay at home, though they will be allowed to leave in an emergency.
In addition, a single person from each household will be allowed to leave the building or compound they live in every three days to buy food and essential items.
On housing estates, one entrance will be kept open. It will be guarded to ensure that only residents can enter or leave.
All businesses will stay closed, except chemists, hotels, food shops and medical services.
“The effects of epidemic prevention and control in various parts of the country can already be seen.”
The proportion of infected patients considered to be in a “serious condition” has dropped nationwide from more than 15% to just over 7%, according to China’s State Council.
Taiwan has reported a death from the illness – a taxi driver, 61, who had not travelled abroad recently but had diabetes and hepatitis B, Health Minister Chen Shih-chung said.
The minister said many of his passengers had come from China.
Outside China, there have been more than 500 cases in nearly 30 countries. Four others have died outside mainland China – in France, Hong Kong, the Philippines and Japan.
Meanwhile, a plane carrying 175 evacuated Nepalis, mostly students, has arrived in Kathmandu from Wuhan.
Image copyright GETTY IMAGESImage caption India’s armed forces began inducting women officers in 1992
Last month, India’s Supreme Court appeared to nudge the government to consider lifting the military’s official ban on women in combat roles – and to give them commanding roles.
“Test them on [the] same footing as men. Do not exclude them [women officers] as a class. [A] change of mindset is required,” the court said.
Earlier this week, the government responded. Its lawyers told the top court that women were not fit to serve in ground combat roles. For one, male soldiers are not “yet mentally schooled to accept women officers in command”. Then there were the “challenges of confinement, motherhood and childcare”.
This, according to military historian Srinath Raghavan, is an “extraordinary and regressive” claim, reminiscent of the claims of colonial rulers that Indian soldiers would never accept Indian commanders. “Military training is about fundamentally reshaping norms and attitudes that soldiers bring from their social backgrounds,” he says.
India’s armed forces began inducting women officers in 1992. Over the decades, they have been given combat roles in the air force. Women have been inducted as fighter pilots and have flown sorties into combat zones; they will be inducted as sailors as soon as ships that can accommodate them are ready. Last year, a 24-year-old became the navy’s first woman maritime reconnaissance pilot.
The army is a striking exception. Women have worked here as doctors, nurses, engineers, signallers, administrators and lawyers. They have treated soldiers on battlefields, handled explosives, detected and removed mines, and laid communication lines. Women officers have also been given permanent commission – a 20-year service, depending on eligibility and rank. Last year, women were cleared to join the military police.
Image copyright GETTY IMAGESImage caption Namrita Chandi Naidu is a senior woman pilot in India’s air force
So they have ended up doing almost everything except combat roles: women are still not allowed to serve in infantry and the armoured corps. According to 2019 figures, women comprise only 3.8% of the world’s second-largest army – compared to 13% of the air force and 6% of the navy. There are some 1,500 female officers compared to more than 40,000 male officers.
All this, says Akanksha Khullar, a researcher at Delhi’s Institute of Peace and Conflict Studies, cannot really be considered a “milestone for women empowerment, as the doors have opened up with an extremely limited capacity”. India’s national security narrative, she told me, is “shaped, limited, and permeated by ideas about gender – with an overt masculine predominance and the structural exclusion of women”.
Media caption The all-women crew from the Indian navy that is sailing around the world
She says the gender disparities are “well reflected in institutional attitudes right at the top” and that “patriarchal notions are probably more ingrained in the army” than the other forces.
She’s correct. In 2018, former army chief and the current Chief of Defence Staff Gen Bipin Rawat told a news network that there weren’t any women soldiers serving in front line combat positions because “a woman would feel uncomfortable at the front line”.
He said maternity leave was an issue, women need more privacy and protection, and that India was not yet ready to accept “body bags of women” killed in combat. He also said that women need to be “cocooned” from the eyes of subordinate soldiers. Mr Rawat’s comments had sparked considerable outrage.
Image copyright AFPImage caption A contingent of women belonging to the Indian navy march during a parade in Delhi
Around the world, getting women into combat roles has been a hard won battle. More than a dozen nations allow women in combat roles.
“While some can argue that women, in general, may not be able to cope with the rigour of combat due to the sheer physical strength required, why deny the opportunity to those who can? In my view, the right of a woman to serve in any role in the armed forces must be equal to a man’s as long as the physical and qualitative standards are not compromised,” says HS Panag, a retired Indian general.
In other words, patriarchy should not come in the way of equality and common sense.
The Lunar New Year’s Eve in Wuhan, ground zero of the novel coronavirus outbreak in central China, is nothing but special. Behind the seemingly quiet streets, people in all walks of life are racing against time to fight against the invisible enemy.
WUHAN, Jan. 25 (Xinhua) — There were far fewer cars on the streets and bustling crowds were not seen in the shopping malls in the central Chinese city of Wuhan on Jan. 24 — the Eve of the Chinese Lunar New Year.
The scene was quite different from the occasion in the previous years because of the novel coronavirus that has claimed over 40 lives and infected over a thousand nationwide. With a population of over 10 million, Wuhan, the capital city of Hubei Province, is the center of the epidemic.
Photo taken on Jan. 24, 2020 shows a medical aid team of Army Medical University leaving for Wuhan in southwest China’s Chongqing. On the Chinese Lunar New Year’s Eve, a group of 150 medical workers from the Army Medical University left for Wuhan, the center of the novel coronavirus (2019-nCoV) outbreak, to provide medical aid. (Xinhua)
Yang Yingchen, a volunteer of the Red Cross Society of China’s Wuhan branch, had a busy day answering calls.
“People from across the nation called to check on accounts and addresses to make donations,” said Yang. “Many would say ‘Come on, Wuhan’ to us, which makes me feel especially warm and deeply moved.”
Chen Li, a doctor in a Wuhan hospital, spent the Chinese Lunar New Year’s Eve at home to quarantine herself. She is a little bit worried about having had contact with infected patients, but luckily she has no signs of symptoms for the time being.
“Before joining the fight against the epidemic, I had sent my four-year-old son to my parents. I has disinfected all the articles in my house,” she said.
Chen’s husband is at the forefront of the fight against the epidemic. “We haven’t seen each other for over a week,” said Chen. On Saturday morning, she put on protective clothing again and returned to work.
“Actually, I can’t be isolated for too long. There’s still a lot of work to be done,” she said. “I just don’t know when I can see my boy again.”
Aerial photo taken on Jan. 24, 2020 shows mechanical equipment working at the construction site of a special hospital in the Caidian District of western suburb of Wuhan, central China’s Hubei Province. The central China metropolitan of Wuhan will follow Beijing’s SARS treatment model to build a special hospital for admitting patients infected in the outbreak of pneumonia caused by the novel coronavirus. (Xinhua/Xiao Yijiu)
The virus had resulted in 41 deaths in China by the end of Friday, mostly in Wuhan, according to the National Health Commission. Nationwide, a total of 1,287 cases were confirmed, including 237 in critical condition.
Confirmed cases were also reported in China’s Hong Kong, Macao and Taiwan, as well as Thailand, Japan, the Republic of Korea, the United States, Vietnam, Singapore, Nepal and France.
Wuhan is following Beijing’s SARS treatment model in 2003 to build a makeshift hospital with a capability of 1,000 beds for admitting infected patients. Construction on the facility began Thursday night. It will be completed and put into use prior to Feb. 3, less than 10 days away.
“It’s going to be another all-nighter. We need to speed up work and complete the hospital as soon as possible,” said Lyu Jun, a young truck driver at the construction site. This is his first Spring Festival away from home.
For ordinary people, this year’s Lunar New Year’s Eve lacks some gatherings but is still a time to extend greetings and wishes.
Yin Yeqiong, from Hunan Province, refunded her tickets back home after much debate. “I had it in my mind to still go home, but finally decided to stay in Wuhan,” she said. “Our stay will help reduce panic in other places.”
Liu Jie, a dough sculptor, put on a New Year costume and watched the Spring Festival Gala with his family. “We’re now at a critical period, so I texted New Year wishes to friends and relatives this year. I believe this is the best way,” he said.
Liu Jiapeng, a children’s book editor, stayed in Wuhan during the Spring Festival for the past four decades. “I always stayed with my family, and we would have every meal together,” said Liu. “But this year, I haven’t had one meal with them.”
On the day of the Lunar New Year’s Eve, he and his wife bought some goods for their parents, brought them to their house and briefly chatted. As they were waiting for the elevator, Liu looked back and saw his father standing at the windowsill, watching them leave.
Medical workers of Army Medical University assemble before leaving for Wuhan in southwest China’s Chongqing, Jan. 24, 2020. On the Chinese Lunar New Year’s Eve, a group of 150 medical workers from the Army Medical University left for Wuhan, the center of the novel coronavirus (2019-nCoV) outbreak, to provide medical aid. (Xinhua)
China is mobilizing medical resources nationwide to aid Wuhan and control the epidemic. Doctors, nurses and experts from across the nation have been selected to join the battle, and manufacturers have restarted their plants to produce medical consumables that have been running short in many places.
A national research team of 14 experts, headed by renowned respiratory scientist Zhong Nanshan, has been set up to help prevent and control the outbreak on Friday.
“This is going to be an unforgettable Spring Festival,” said Chen Ying, a writer. “Because I feel that at this moment, there are so many families that I do not know, in every corner of this city, praying for our home.”
“My New Year wish is simple,” said Liu Jie. “I hope the virus will soon be conquered and everyone in Wuhan and the whole nation would be safe and healthy.”
NEW DELHI (Reuters) – Tens of thousands of runners have signed up for the Indian capital’s half marathon and other races on Sunday, officials said, despite the air quality hitting dangerous levels in one of the most heavily polluted cities in the world.
New Delhi’s air quality index was around 300 on Thursday, classified as very poor and meaning prolonged exposure can cause respiratory illness.
Delhi Chief Minister Arvind Kejriwal, who has described the city as a “gas chamber” in winter, has ordered emergency measures, including restricting the number of private vehicles on the roads under an “odd-even” scheme based on number plates.
Race organisers said pollution was a worry but they would take steps to reduce the impact on runners. Hours ahead of and throughout the race, the course will be sprayed with water.
“The air quality is a concern and will remain a concern, there is no question about it,” said Vivek Singh, joint managing director of Procam International that conducts the race sponsored by telecom operator Bharti Airtel.
“The measures that we take for those few hours to give our runners a good experience have worked in the past.”
The race has been moved this year to avoid a sharp rise in pollutants during Diwali, the Hindu festival of lights, when hundreds of thousands of firecrackers are lit.
But farmers burning crop stubble in the states north of Delhi have turned the air over Delhi toxic. The forecast for the next few days and into Sunday is “very poor”.
A record 40,633 people have signed up for the 21-km, 10-km and a 5-km races. Last year there were 34,916 runners, many of whom wore masks.
A former Olympic gold medallist, Carmelita Jeter of the United States, is the international event ambassador.
Doctors have advised citizens to restrict their outdoor activities and said runners must be made aware of the risks they are taking.
“Just two weeks before the odd-even scheme comes into play, how have the civic authorities allowed more than 30,000 people to expose themselves to toxic air?” asked said Desh Deepak, senior chest physician at the city’s Ram Manohar Lohia Hospital.
MACAO, April 30 (Xinhua) — China International Emergency Medical Team (Macao SAR) successfully passed the evaluation and certification of the World Health Organization (WHO) on Tuesday, becoming the fifth Chinese international emergency medical team, a WHO verification team said in the special administrative region (SAR).
Macao SAR Health Bureau held a press conference on Tuesday afternoon to introduce the preparation work of Macao’s international emergency medical team, and show its facilities and operation to local media.
Ian Norton, a representative from WHO Emergency Medical Team (EMT) Secretariat, told media that the Macao team not only meets the relevant WHO standards, but also has unique advantages in use of languages. Besides their mother tongue, the team members can also speak in English and Portuguese, and can be deployed to Portuguese-speaking countries.
He added that the Macao team will also bring back the experience and expertise they have learned from assistance missions, and better serve Macao and its residents.
The medical team members were drawn from the staff of Health Bureau and Fire Department of Macao SAR government. A total of 120 members were divided into four squads, each consisting of doctors, paramedics, pharmacists, engineers and logistics personnel.
The standard deployment of the whole team covers an area of 3,600 square meters with 41 tents, can diagnose and treat over 100 persons per day, and independently complete the clinical medical work for 14 days.
Macao’s international emergency medical team is the 25th in the world and the fifth in China certified by WHO.
CHINDIA ALERT: You'll be living in their world, very soon 