Chindia Alert: You’ll be Living in their World Very Soon
aims to alert you to the threats and opportunities that China and India present. China and India require serious attention; case of ‘hidden dragon and crouching tiger’.
Without this attention, governments, businesses and, indeed, individuals may find themselves at a great disadvantage sooner rather than later.
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Indian defence officials have reported a coronavirus outbreak at a key naval base in the western city of Mumbai.
Twenty-one personnel have tested positive for Covid-19 at INS Angre, which is the seat of the force’s western command, the navy said in a statement on Saturday.
It added that there are no infections aboard any ships or submarines.
India has 11,906 active infections and 480 deaths, according to the latest data from the ministry of health.
The Navy said that they had tested a number of personnel who had come into contact with a soldier who had tested positive earlier this month. Many of those who had tested positive for the virus, the statement added, were asymptomatic.
All 21 personnel live in the same residential block, which has been declared a containment zone and has been placed under lockdown.
In a video message to personnel last week, Navy Chief Admiral Karambir Singh stressed the importance of keeping ships and submarines free of the virus.
“The coronavirus pandemic is unprecedented and it has never been seen before. Its impact has been extraordinary across the globe, including India,” he said.
The navy has been playing an active role in India’s response to the Covid-19 outbreak.
It has set up isolation facilities to treat patients at one of its premier hospital units and is also running quarantine camps.
The outbreak aboard the Indian naval base follows reports of outbreaks aboard vessels belonging to other nations.
More than 500 sailors on the USS Roosevelt have tested positive for the virus and one of them died earlier this week. And nearly a third of the sailors serving with France’s aircraft carrier Charles de Gaulle – 668 out of nearly 2,000 – have been infected with coronavirus.
Image copyright GETTY IMAGESImage caption Indore is a bustling commercial city
In early March, 40-year-old Ravi Dosi, a chest specialist in India, saw a baffling surge in patients with respiratory problems at outpatient clinics.
“There was almost a 50% jump in patients with upper respiratory issues and sore throat. They were not responding to antibiotics. Testing was still low and we didn’t really know what was going on,” Dr Dosi, who works at Sri Aurobindo Institute of Medical Sciences, a 1,156-bed private medical college in the central city of Indore, told me.
Less than a fortnight later, Dr Dosi began seeing an uptick in admissions of Covid-19 patients. Around the end of March, the hospital was receiving 28 infected patients every day.
They had dry cough, fever, and difficulty breathing. Their blood oxygen levels were low. They were reporting loss of taste and smell.
In the first wave of patients, nearly a dozen came from far-flung districts, more than 150km (93 miles) from Indore, a bustling commercial city in Madhya Pradesh state. The state has now become a hotspot, with nearly 400 confirmed infections out of the more than 6,400 infections and nearly 200 deaths across the country so far.
By the second week of April, Dr Dosi and his team of 100 doctors and nearly an equal number of nursing staff working 24/7 in three shifts, were treating 144 Covid-19 patients. (Thirty-one had been treated and sent home already.)
A total of 38 patients were in intensive care. Twenty-one of them were critical. There had been seven deaths. “We are handling the largest number of Covid-19 patients in India,” Vinod Bhandari, a surgeon and chairman of the hospital, told me.
Doctors now believe that the infection was spreading in the community long before the government admitted to it, and testing slowly ramped up. Until two weeks ago, Indian health authorities had been denying community transmission.
Image caption The hospital in Indore has more than 140 patients
Now a new study by Indian Council of Medical Research (ICMR) using surveillance data from 41 labs in the country has hinted at community transmission: 52 districts in 20 states and union territories reported Covid-19 patients. Some 40% of the cases did not report any history of international travel or contact with a known case. (The survey was based on swabs collected from nearly 6,000 patients who tested positive between 15 February and 19 March.)
Back in the hospital in Indore, the doctors are battling the surge in infections.
Three isolation wards spread over two floors floors are stacked with patients. (The hospital has earmarked 525 beds for Covid-19 patients.) Isolation wards have younger patients with mild infection, while elderly patients with more severe symptoms are in intensive care. The oldest patient is a 95-year-old man, and the youngest is a four-month-old boy.
The team of doctors handling patients includes chest specialists, anaesthetists, microbiologists, and dermatologists. There are patients with a lot of underlying medical conditions – diabetes, hypertension, even cancer – so all the specialists have been called in to help with the treatment.
Dr Dosi wakes up early, puts on protective gear – scrubs, face masks and shields, N95 masks, gowns, double gloves and shoe covers – before going on his rounds of the patients. Doctors say they are not facing a shortage of gear yet.
They are using 22 ventilators to help the critical patients breathe, and also providing oxygen supplies to others using nasal cannulas (nose prongs).
In the isolation wards, patients are given oral medication – antibiotics and hydroxychloroquine (commonly known as HCQ), an anti-malarial drug – and directed to maintain social distancing and wash their hands regularly.
Image caption The isolation wards are packed with patients
“I have never seen a challenge and crisis like this in my career. I have heard stories about an outbreak of plague in Surat [in 1994]. But this seems to be much bigger. The biggest challenge is to keep hopes alive and be positive,” says Dr Dosi.
Keeping hopes up for patients in isolation can be taxing. Three tests, say doctors, are being done for the infection – if the first test comes out positive, the patient remains in isolation for two weeks, and is tested twice on two days after the quarantine period. If the last two tests come back negative, the patient is discharged. If not, the patient has to stay in isolation for another two weeks. “It is a tough grind, mentally,” says one doctor.
For the last three weeks, Dr Dosi has been living in the hospital, away from his wife, two sons and parents. His father is a retired pathologist. They communicate via hurried video calls, between his frantic trips to the isolation wards and intensive care.
I ask him when does he expect this to “get over”, so that he can go home.
“In a couple of weeks,” he says. “The lockdown should have helped to slow down the infection.”
Dr Dosi is alluding to the strict 21-day lockdown India imposed on 24 March to halt the spread of the infection.
Image copyright GETTY IMAGESImage caption Health officials have been denying community transmission
Things are getting better, he says.
“I am getting 10 patients for admission in isolation wards, and two patients severe enough for intensive care every day now. Earlier this week, it was 50:50.”
It is possibly too early to hazard a guess about when admissions will slow down to single digits. As more people are tested, the number of patients can easily rise again.
It’s been unrelenting, Dr Dosi says.
Early, on Friday, I sent him a text to find out what was going on.
BEIJING (Reuters) – As the world grapples with the escalating coronavirus pandemic, China reopened the city of Wuhan on Wednesday, allowing its 11 million residents to leave for the first time in over two months, a milestone in its effort to combat the outbreak.
But while the operation to contain Wuhan’s coronavirus outbreak has been hailed as a success by China and many international health experts, it didn’t come easy.
Using virus , official reports and over a dozen interviews with officials, residents and scientists in Wuhan, Reuters has compiled a comprehensive account of how the military-style quarantine of the city unfolded.
SCIENTIST TOUR
Wuhan health authorities reported the first case of what turned out to be the new coronavirus in December, and the first known death linked to the virus in early January.
City officials insisted the situation was under control for the first two weeks of January, downplaying the possibility of human-to-human transmission as they focused on a seafood and wildlife market where the outbreak was believed to have started.
But troubling signs were emerging.
Hospital respiratory wards began reaching capacity by around Jan 12, and some people were being turned away, a half dozen Wuhan residents told Reuters.
But at least up to Jan. 16, Wuhan’s government said that no new cases of the disease had occurred for about two weeks, and the city continued as normal. Diners packed restaurants, shoppers flocked to commercial districts, and travellers headed to train stations and airports for their Lunar New Year holidays.
Minimal measures were put in place to take the temperatures of residents in public places, or encourage them to wear protective masks, residents said.
“We ordinary people did not know that we needed to take protective measures,” said Wang Wenjun, whose uncle died of the coronavirus on Jan 31.
But that changed after Jan 18, when a team of scientists sent by the central government in Beijing arrived in Wuhan.
Leading the group was 83-year-old Zhong Nanshan, an epidemiologist credited with raising the alarm in China about the spread of another coronavirus, SARS, in 2003. Over two days, the team investigated the source and scale of Wuhan’s outbreak, inspecting the seafood and wildlife market and other sites.
As the scientists toured Wuhan, their mood darkened as the scale of the crisis became clear, said a source familiar with the trip.
A day before the scientists arrived, four new cases were confirmed in Wuhan, none of which had apparent links to the market.
That cast doubt over local authorities’ previous assertions that there was no substantial evidence of human-to-human transmission, which would have required them to impose drastic containment measures on the city.
The scientists’ visit was the third by an expert group since the end of December as suspicion in Beijing grew that the virus was transmissible and local officials had concealed the challenges they faced containing the disease, according to an academic on the Jan 18 trip and a scientist who visited on Jan 2. Another trip took place on Jan 8.
During the Jan 18 visit, the team made several discoveries that had been previously undisclosed to the public by local officials.
Over a dozen healthcare workers had been infected, efforts to track close contacts with other confirmed cases had dwindled, and hospitals had not conducted a single test before Jan. 16, Zhong and other experts on the team announced a few days after their trip to Wuhan.
On Jan 19, the group of about a half dozen scientists returned to Beijing, where they reported their findings to the National Health Commission, which formulates China’s health policy.
The experts recommended that Wuhan be put under quarantine and that hospital capacity be rapidly expanded, according to two sources who were briefed on the discussions. Zhong himself had suggested the lockdown measures, they said. Zhong and the commission did not respond to requests for comment.
One of the sources said the proposal was initially rejected by Wuhan government officials because they feared the economic impact, but they were overruled by the central authorities.
On the evening of Jan 20, the central government set up a taskforce in Wuhan to spearhead the fight against the epidemic.
The lockdown of Wuhan had been put in motion.
Ye Qing, deputy chief of the statistics bureau in Hubei province, where Wuhan is located, said it was only when Zhong announced his findings that he began to realize the seriousness of this epidemic.
Wuhan officials, he said, reacted far too late. “If the government had sent out a notice, if they had asked everyone to wear masks, to do temperature checks, maybe a lot fewer people would have died.”
He added: “It’s a painful lesson with blood and tears.”
Later tracing of virus patients showed that people confirmed to have the virus travelled from Wuhan to at least 25 provinces, municipalities and administrative regions across China before the lockdown plan went into action.
The Wuhan government and the National Health Commission in Beijing did not respond to requests for comment.
LOCKDOWN
The ripple effects of events in Beijing were soon felt in Wuhan.
On Jan 22, senior officials in Wuhan received a written government notice telling them not to leave the city, or report their whereabouts if they had, according to two local government sources.
The directive offered no further details, but at about 8 p.m. that night, some officials received notice by telephone that the city would be shut off the next morning, the sources said.
The lockdown was publicly announced at 2 a.m., sending thousands of Wuhan residents scrambling to find a way out.
But access into and out of the city was quickly closed off, with public transportation shut down and the use of private cars banned. Residents were soon after restricted to their homes.
Having seized control of the crisis, Beijing also removed a number of key officials from Wuhan and Hubei province.
Wuhan’s mayor, Zhou Xianwang, who kept his job, made a frank admission in an interview with state media a few days later that party-reporting mechanisms had stifled early action.
“Information should have been released more quickly,” he said. The process had been slowed by officials in Wuhan being “obliged to seek permission” before fully disclosing information to the public, he said.
‘NEW NORMAL’
Almost two months after the lockdown was imposed, China has started allowing residents to leave the city, as well as permitting domestic flights and inter-city trains. Wuhan has reported just one new case in the past week, and around 93% of all cases have recovered, according to official data.
As other countries consider Wuhan-style quarantines, those numbers have come under increased scrutiny, however. U.S. President Donald Trump said last week that China’s numbers were “on the light side,” drawing the ire of Beijing.
China has also only just begun reporting data on asymptomatic cases – those in which carriers can transmit the disease without feeling symptoms – in the past week. That followed a public backlash on social media in China that the key numbers had been omitted from the official tally, raising concerns that such cases could lead to a second wave of infections.
Xue Lan, a professor at Tsinghua University who is a member of a government coronavirus task force, said precautions put in place for the lockdown – like social distancing – would likely become a part of life in the future in China.
“From now on our social lives will enter a new normal,” Xue said.
Photo taken with a mobile phone shows cured patients waving goodbye to medical workers before leaving the Leishenshan hospital in Wuhan, central China’s Hubei Province, April 4, 2020. On Sunday, 17 coronavirus-infected patients recovered and were discharged from the hospital. (Photo by Gao Xiang/Xinhua)
The philanthropic foundations of Jack Ma and Joe Tsai, two of China’s wealthiest technology entrepreneurs, have donated 23 million face masks, 2,000 ventilators and 170,000 pieces of protective gear to New York
The donation, the biggest by private citizens to the epicentre of the global coronavirus pandemic, was described by New York Governor Andrew Cuomo as ‘really good news’
A shipment of 1,000 ventilators donated by Jack Ma Foundation and Joe Tsai Foundation, has arrived in New York. Photo: Handout
Chinese philanthropists are stepping up their donation of protective gear, essential medical and diagnostic kits to the United States, Europe and Asian countries, despite rising acrimony between diplomats and government officials looking to pin blame amid the world’s worst pandemic in decades.
The private foundations of Jack Ma and Joe Tsai, co-founders of this newspaper’s owner Alibaba Group Holding and two of China’s wealthiest technology entrepreneurs, have donated a combined 23 million face masks, 2,000 medical ventilators and 170,000 pieces of protective gear to New York city.
The first 1,000 medical ventilators arrived today, with another 1,000 on the way, for a total donation valued at US$50 million, according to a person familiar with the matter.
Delivery of the essential materials, made possible by behind-the-scene manoeuvres by the donors and officials from both the Chinese and US sides due to import and export regulatory hurdles, highlights the role of civil diplomacy in dealing with the global public health crisis.
New York Governor Andrew Cuomo thanks the Chinese government for the 1,000 ventilators donated by Jack Ma Foundation and Joe Tsai Foundation, which arrived in New York on Saturday. Photo: Handout
The gesture comes as diplomats of both countries, and even government officials including the US president and his secretary of state, have engaged in a tit-for-tat war of words, as they attempt to pin the blame for the worlds worst pandemic in decades on each other.
Confirmed cases in the US have soared and surpassed China as the new global epicentre. In the US there are nearly 310,000 cases and nearly 8,500 people have died so far from the Covid-19 disease.
Jack Ma is a friend of mine and he’s made it very possible to get about 1,000 ventilators from China. But that was from him and my other friend [Tsai] that was really a gift – Andrew Cuomo, governor of New York
Andrew Cuomo, governor of New York, thanked the Chinese government for easing the transfer of the ventilators to the hard-hit state, the current epicentre of the coronavirus outbreak in the US.
He said the donations were “really good news”, as the state pushes up against the apex of the outbreak, which is likely to hit in about seven days.
“This is a big deal, and this is going to make a significant difference for us,” Governor Andrew Cuomo said on Saturday.
“Jack Ma is a friend of mine and he’s made it very possible to get about 1,000 ventilators from China. But that was from him and my other friend [Tsai] that was really a gift. And we appreciate it very much.”
One of the challenges in making the donation possible was the fact that the US had previously blocked China-made “KN95” standard masks, only allowing “3M N95” masks to be used. Although the two masks have different standards, they essentially have the same performance. On Friday, the US Food and Drugs Administration issued an emergency use authorisation for KN95 masks.
Alfred Wu, associate professor in Lee Kuan Yew School of Public Policy at National University of Singapore, said that what China is doing with its so-called masks diplomacy is very clear. “But given the emergency situation in New York, whatever channel – private or public sources – the equipment comes from, should not matter, especially those for medical workers,” he said.
Separately, the western state of Oregon has also said that it would send 140 ventilators to New York.
The state, like other areas of the US, is facing shortages of medical gear, including masks and ventilators.
“We are not yet at the apex. We are getting closer,” Cuomo said, adding that this was good as it gave the authorities more time to prepare.
A tweet from New York Governor Andrew Cuomo thanking the Chinese government for the 1,000 ventilators donated by Jack Ma Foundation and Joe Tsai Foundation. Photo: Twitter
Cuomo said 113,704 people in New York have tested positive for the coronavirus, with 15,000 having been hospitalised The state’s death toll saw a significant spike on Saturday to reach 3,565, up from 2,935 the previous day.
The White House has been criticised for not better coordinating the supply of medical goods to states, who are competing with each other on the open market.
NUS’ Wu said that tussle between the federal and state governments in the US on key decisions on acquiring medical supplies was not helping the fight against the pandemic. “Unlike in China, where the central government has the say over local governments, in the US, when it comes to public health provision, the power belongs to the state,” he said.
Meanwhile, Cuomo acknowledged that he asked the White House and others for help negotiating the ventilators.
Trump said he would like to hear a more resounding “thank you” from Cuomo for providing medical supplies and helping quickly to add hospital capacity.
Image copyright MAJORITY WORLDImage caption Indian doctors have been working extra hours to halt the spread of the coronavirus
Several healthcare workers in India have been attacked as they battle to stop the spread of the coronavirus.
Reports say doctors have been spat at and chased away from homes, and that in one case patients directed abusive and vulgar language towards female nurses.
Some physicians and their families have also been ostracised by their neighbours because of their exposure to patients infected with Covid-19.
India has reported more than 2,300 cases and at least 50 people have died.
One video, which has gone viral, showed a mob throwing stones at two female doctors wearing personal protective equipment in the central city of Indore.
The doctors had gone to a densely-populated area to check on a woman suspected of having Covid-19 when they came under attack.
Despite being injured, one of the doctors seen in the video, Zakiya Sayed, said the incident “won’t deter me from doing my duty”.
“We were on our usual round to screen suspected cases,” she told the BBC. “We never thought that we would be attacked.”
“I had never seen scenes like that. It was frightening. We somehow fled from the mob. I am injured but not scared at all.”
Dr Sayed added: “We had no reason to suspect that people would be agitated against medical teams.”
“We are working to keep people safe. We had information about a person coming in contact with a Covid-19 patient. We were talking to the person when residents got agitated and attacked us.”
Image copyright HINDUSTAN TIMESImage caption Doctors have been abused and attacked in different parts of India
Seven people have been arrested in connection with the incident.
Dr Anand Rai, who is also a part of the Covid-19 taskforce in Indore, told the BBC: “Nothing can justify the attack against medical team. But it happened in a Muslim-dominated area where there is general distrust against the government.”
“So that anger spilled over and took the form of this attack. But whatever maybe the reason, nothing can justify violence, especially against doctors during a national health emergency,” he added.
Thousands who attended the gathering in Delhi, organised by Islamic preaching group Tablighi Jamaat, have been put in quarantine, and authorities are still tracing others. It is believed that the infections were caused by preachers who attended the event from Indonesia.
At the Ghaziabad hospital, some of the quarantined attendees allegedly used abusive and vulgar language against members of staff.
Image copyright GETTY IMAGESImage caption Almost 400 cases of Covid-19 have been traced to a Tablighi Jamaat event in Delhi
“Some were walking naked in the hospital ward and harassing women doctors and nurses,” a doctor who works at the hospital told the BBC. “They kept asking for cigarettes and tobacco.”
A senior police officer in the city told the BBC that cases had been registered against some people after doctors filed a complaint.
“Registering cases was the last resort. Police are still trying to make them understand the severity of the situation,” he said.
Image copyright SOPA IMAGESImage caption Doctors and nurses have asked people to follow their advice and not panic
Similar incidents have been reported in neighbouring Delhi.
Some attendees of the Tablighi Jamaat event who are being held in a quarantine facility run by the railways are said to have spat at doctors and misbehaved.
Deepak Kumar, spokesman for Northern Railways, said the situation there was now under control.
“The attendees have been counselled and they are now co-operating with the staff,” he said.
Delhi’s state government has reportedly written to the police, requesting more security for medical staff.
Reports of attacks on doctors and nurses have also come from the southern city of Hyderabad and the western city of Surat.
A doctor who was treating coronavirus patients is Hyderabad’s Gandhi Hospital was attacked on Wednesday.
Police have promised the doctor that “strict action will be taken against the culprits”.
Image copyright NARINDER NANUImage caption Prime Minister Narendra Modi has said that doctors are “front-line soldiers”
But it is not just a work where medical workers are facing discrimination. It has followed them home.
One doctor, who did not wish to be identified, said she felt “extremely disheartened when I learnt that even my neighbours think that me and my family shouldn’t be allowed to live in the building”.
“We want our families to be safe. But we are being discriminated for doing our job.”
“A number of doctors have tested positive across India and that shows how tough our job is at the moment. And that is why we need everybody’s support to win this war against coronavirus.”
She added: “We are following all safety protocols. We are not meeting even our families and that is stressful.”
“But seeing this open discrimination just breaks my heart. But we will go on because there is really no other option.”
US death toll passes 3,000 as New York’s hospitals are pushed to breaking point
Italy extends lockdown as cases exceed 100,000; UN Security Council votes by email for first time
The USNS Comfort passes the Statue of Liberty as it enters New York Harbour on Monday. Photo: Reuters
Harsh lockdowns aimed at halting the march of the coronavirus pandemic extended worldwide Monday as the death toll soared toward 37,000 amid new waves of US outbreaks.
The tough measures that have confined some two-fifths of the globe’s population to their homes were broadened. Moscow and Lagos joined the roll call of cities around the globe with eerily empty streets, while Virginia and Maryland became the latest US states to announce emergency stay-at-home orders, followed quickly by the capital city Washington.
In a symbol of the scale of the challenge facing humanity, a US military medical ship sailed into New York to relieve the pressure on overwhelmed hospitals bracing for the peak of the pandemic.
France reported its highest daily number of deaths since the outbreak began, saying 418 more people had succumbed in hospital.
Spain, which announced another 812 virus deaths in 24 hours, joined the United States and Italy in surpassing the number of cases in China, where the disease was first detected in December.
On Tuesday, mainland China reported a rise in new confirmed coronavirus cases, reversing four days of declines, due to an uptick in infections involving travellers arriving from overseas.
Mainland China had 48 new cases on Monday, the National Health Commission said, up from 31 new infections a day earlier.
All of the 48 cases were imported, bringing the total number of imported cases in China to 771 as of Monday.
There was no reported new case of local infection on Monday, according to the National Health Commission. The total number of infections reported in mainland China stood at 81,518 and the death toll at 3,305. Globally, more than 760,000 have been infected, according to official figures.
Here are the developments:
Hospital ship arrives in New York
New York’s governor issued an urgent appeal for medical volunteers Monday amid a “staggering” number of deaths from the coronavirus, saying: “Please come help us in New York, now.”
The plea from Governor Andrew Cuomo came as the death toll in New York State climbed past 1,200 – with most of the victims in the big city – and authorities warned that the crisis pushing New York’s hospitals to the breaking point is just a preview of what other cities across the US could soon face.
Cuomo said the city needs 1 million additional health care workers.
“We’ve lost over 1,000 New Yorkers,” he said. “To me, we’re beyond staggering already. We’ve reached staggering.”
The governor’s plea came as a 1,000-bed US Navy hospital ship docked in Manhattan on Monday and a field hospital was going up in Central Park for coronavirus patients.
New York City reported 914 deaths from the virus as of 4:30pm local time Monday, a 16 per cent increase from an update six hours earlier. The city, the epicentre of the US outbreak, has 38,087 confirmed cases, up by more than 1,800 from earlier in the day.
Coronavirus field hospital set up in New York’s Central Park as city’s health crisis deepens
Gloom for 24 million people in Asia
The economic fallout from the coronavirus pandemic will prevent almost 24 million people from escaping poverty in East Asia and the Pacific this year, according to the World Bank.
In a report released on Monday, the Washington-based lender also warned of “substantially higher risk” among households that depend on industries particularly vulnerable to the impact of Covid-19. These include tourism in Thailand and the Pacific islands; manufacturing in Vietnam and Cambodia; and among people dependent on “informal labour” in all countries.
The World Bank urged the region to invest in expanding conventional health care and medical equipment factories, as well as taking innovative measures like converting ordinary hospital beds for ICU use and rapidly trining people to work in basic care.
Billionaire blasted for his Instagram-perfect isolation on luxury yacht
31 Mar 2020
Indonesia bans entry of foreigners
Indonesia barred foreign nationals from entering the country as the world’s fourth-most populous country stepped up efforts to contain the spread of the coronavirus pandemic.
The travel ban, to be effective soon, will also cover foreigners transiting through the country, Foreign Minister Retno Marsudi said after a cabinet meeting in Jakarta Tuesday. The curbs will not apply to holders of work permits, diplomats and other official visitors, she said.
The curbs on foreign citizens is the latest in a raft of measures taken by Indonesia to combat the deadly virus that’s sickened more than 1,400 people and killed 122. President Joko Widodo’s administration previously banned flights to and from mainland China and some of the virus-hit regions in Italy, South Korea and Iran. The president on Monday ordered stricter implementation of social distancing and health quarantine amid calls for a lockdown to contain the pandemic.
Indonesia has highest coronavirus mortality rate in Southeast Asia
First US service member dies
The first US military service member has died from the coronavirus, the Pentagon said on Monday, as it reported another sharp hike in the number of infected troops.
The Pentagon said it was a New Jersey Army National Guardsman who had tested positive for Covid-19 and had been hospitalised since March 21. He died on Saturday, it said.
Earlier on Monday, the Pentagon said that 568 troops had tested positive for the coronavirus, up from 280 on Thursday. More than 450 Defence Department civilians, contractors and dependents have also tested positive, it said.
US military has decided to stop providing more granular data about coronavirus infections within its ranks, citing concern that the information might be used by adversaries as the virus spreads.
The new policy, which the Pentagon detailed in a statement on Monday, appears to underscore US military concerns about the potential trajectory of the virus over the coming months – both at home and abroad.
School to resume in South Korea … online
South Korean children will start the new school year on April 9 with only online classes, after repeated delays due to the outbreak of the new coronavirus, the government said Tuesday.
Prime Minister Chung Sye Kyun said that despite the nation’s utmost efforts to contain the virus and lower the risk of infection, there is consensus among teachers and others that it is too early to let children go back to school.
The nation’s elementary schools, and junior and senior high schools were supposed to start the new academic year in early March, but the government has repeatedly postponed it to keep the virus from spreading among children.
The start was last postponed until April 6, but has now been delayed three more days to allow preparations to be made for online classes.
The nation now has 9,786 confirmed cases in total, with 162 deaths.
Italy extends lockdown as cases exceed 100,000
Italy’s government on Monday said it would extend its nationwide lockdown measures
against a coronavirus outbreak, due to end on Friday, at least until the Easter season in April.
The Health Ministry did not give a date for the new end of the lockdown, but said it would be in a law the government would propose. Easter Sunday is April 12 this year. Italy is predominantly Roman Catholic and contains the Vatican, the heart of the church.
Italians have been under lockdown for three weeks, with most shops, bars and restaurants shut and people forbidden from leaving their homes for all but non-essential needs.
Italy, which is the world’s hardest hit country in terms of number of deaths and accounts for more than a third of all global fatalities, saw its total death tally rise to 11,591 since the outbreak emerged in northern regions on February 21.
The death toll has risen by 812 in the last 24 hours, the Civil Protection Agency said, reversing two days of declines, although the number of new cases rose by just 4,050, the lowest increase since March 17, reaching a total of 101,739.
Deadliest day in Italy and Spain shows worst not over yet
28 Mar 2020
Women stand near the body of a man who died on the sidewalk in Guayaquil, Ecuador. Photo: Reuters
Ecuador struggles to collect the dead
Ecuadorean authorities said they would improve the collection of corpses, as delays related to the rapid spread of the new coronavirus has left families keeping their loved ones’ bodies in their homes for days in some cases.
Residents of Guayaquil, Ecuador’s largest city, have complained they have no way to dispose of relatives’ remains due to strict quarantine and curfew measures designed to prevent spread of the disease. Last week, authorities said they had removed 100 corpses from homes in Guayaquil.
But delays in collecting bodies in the Andean country, which has reported 1,966 cases of the virus and 62 deaths, were evident midday on Monday in downtown Guayaquil, where a man’s dead body lay on a sidewalk under a blue plastic sheet. Police said the man had collapsed while waiting in line to enter a store. Hours later, the body had been removed.
More than 70 per cent of the country’s coronavirus cases, which is among the highest tallies in Latin America, are in the southern province of Guayas, where Guayaquil is located.
Panama to restrict movement by gender
The government of Panama announced strict quarantine measures that separate citizens by gender in an effort to slow the spread of the novel coronavirus.
From Wednesday, men and women will only be able to leave their homes for two hours at a time, and on different days. Until now, quarantine regulations were not based on gender.
Men will be able to go to the supermarket or the pharmacy on Tuesdays, Thursdays and Saturdays, and women will be allowed out on Mondays, Wednesdays and Fridays.
No one will be allowed to go out on Sundays. The new measures will last for 15 days.
Police in Kenya use tear gas to enforce coronavirus curfew
Remote vote first for UN Security Council
The UN Security Council on Monday for the first time approved resolutions remotely after painstaking negotiations among diplomats who are teleworking due to the coronavirus pandemic.
The Security Council unanimously voted by email for four resolutions, including one that extended through April 2021 the expiring mandate of UN experts who are monitoring sanctions on North Korea, diplomats said.
The UN mission in Somalia was also prolonged, until the end of June, and the mission in Darfur until the end of May – two short periods decided due to uncertainty over the spread of the pandemic.
The Council also endorsed a fourth resolution aimed at improving the protection for peacekeepers.
The resolutions are the first approved by the Security Council since it began teleworking on March 12 and comes as Covid-19 rapidly spreads in New York, which has become the epicenter of the disease in the United States.
Congo ex-president dies in France
Former Republic of Congo president Jacques Joaquim Yhombi Opango died in France on Monday of the new coronavirus, his family said. He was 81.
Yhombi Opango, who led Congo-Brazzaville from 1977 until he was toppled in 1979, died at a Paris hospital of Covid-19, his son Jean-Jacques said. He had been ill before he contracted the virus.
Yhombi Opango was an army officer who rose to power after the assassination of president Marien Ngouabi.
Yhombi Opango was ousted by long-time ruler Denis Sassou Nguesso. Accused of taking part in a coup plot against Sassou Nguesso, Yhombi Opango was jailed from 1987 to 1990. He was released a few months before a 1991 national conference that introduced multiparty politics in the central African country.
When civil war broke out in Congo in 1997, Yhombi Opango fled into exile in France. He was finally able to return home in 2007, but then divided his time between France and Congo because of his health problems.
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EU asks Britain to extend Brexit talks
The European Union expects Britain to seek an extension of its post-Brexit transition period beyond the end of the year, diplomats and officials said on Monday, as negotiations on trade have ground to a halt due to the coronavirus pandemic.
Europe has gone into a deep lockdown in a bid to curb the spread of the disease, with more than 330,000 infections reported on the continent and nearly 21,000 deaths.
In Britain, Prime Minister Boris Johnson and his health minister have both tested positive for the virus and the prime minister’s senior adviser Dominic Cummings – one of the masterminds behind Britain’s departure from the EU earlier this year – was self-isolating with symptoms.
London and the EU have been seeking to agree a new trade pact by the end of the year to kick in from 2021, even though the bloc has long said that such a time frame was extremely short to agree rules on everything from trade to security to fisheries.
The pyramid of Khufu, the largest of the Giza pyramid complex. Photo: Reuters
Great Pyramid in Egypt lights up in solidarity
Egypt’s famed Great Pyramid was emblazoned Monday evening with messages of unity and solidarity with those battling the novel coronavirus the world over.
“Stay safe”, “Stay at home” and “Thank you to those keeping us safe,” flashed in blue and green lights across the towering structure at the Giza plateau, southwest of the capital Cairo.
Egypt has so far registered 656 Covid-19 cases, including 41 deaths. Of the total infected, 150 reportedly recovered.
Egypt has carried out sweeping disinfection operations at archaeological sites, museums and other sites across the country.
In tandem, strict social distancing measures were imposed to reduce the risk of contagion among the country’s 100 million inhabitants.
Tourist and religious sites are shuttered, schools are closed and air traffic halted.
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Saudi king to pay for all patients’ treatment
Saudi Arabia will finance treatment for anyone infected with the coronavirus in the country, the health minister said on Monday.
The kingdom has registered eight deaths among 1,453 infections, the highest among the six Gulf Arab states.
Health Minister Tawfiq Al Rabiah said King Salman would cover treatment for citizens and residents diagnosed with the virus, urging people with symptoms to get tested.
“We are all in the same boat,” he told a news conference, adding that Crown Prince Mohammed bin Salman was overseeing containment efforts “night and day”.
Denmark eyes gradual reopening after Easter
Denmark may gradually lift a lockdown after Easter if the numbers of coronavirus cases and deaths remain stable, Prime Minister Mette Frederiksen said on Monday.
The Nordic country, which has reported 77 coronavirus-related deaths, last week extended until after Easter a two-week lockdown to limit physical contact between its citizens that began on March 11.
The number of daily deaths slowed to five on Sunday from eight and 11 on Saturday and Friday respectively. Denmark has reported a total of 2,577 coronavirus infections.
“If we over the next two weeks across Easter keep standing together by staying apart, and if the numbers remain stable for the next two weeks, then the government will begin a gradual, quiet and controlled opening of our society again, at the other side of Easter,” Frederiksen said.
Image copyright GETTY IMAGESImage caption Hundreds have been leaving the mosque to be monitored or tested for the virus
Officials across India are searching for hundreds of people who attended a religious event in the capital that has set off several Covid-19 clusters.
At least six regions have reported cases that can be directly traced to the days-long congregation at a mosque.
Delhi officials are now clearing the building, where more than 1,000 people have been stranded since the government imposed a lockdown last week.
At least 24 have tested positive so far, the state health minister said.
They are among some 300 people who showed symptoms and have been moved to various hospital to be tested, he told the media. Another 700 have been shifted into quarantine centres, he added.
It is believed that the infections were caused by preachers who attended the event from Indonesia.
State officials have called for action to be taken against mosque officials, but they have denied any wrongdoing.
Local media reports say that Nizamuddin – the locality where the mosque is located – has been cordoned off and more than 35 buses carrying people to hospitals or quarantine centres.
The congregation – part of a 20th Century Islamic movement called Tablighi Jamaat – began at the end of February, but some of the main events were held in early March.
It’s unclear if the event was ticketed or even if the organisers maintained a roster of visitors as people attended the event throughout, with some staying on and others leaving. Even overseas visitors, some of them preachers, travelled to other parts of the country where they stayed in local mosques and met people.
Image copyright GETTY IMAGES
So officials have no easy way of finding out how many people attended the event or where they went. But they have already begun to trace and test.
The southern state of Telangana reported on Sunday night that six people who had attended the event died from the virus. The state’s medical officer told the BBC that more than 40 of Telangana’s 71 cases were either directly or indirectly linked to the event.
Indian-administered Kashmir reported its first death from the virus last week – a 65-year-old who had been in Delhi for the congregation. Officials told BBC Urdu that more than 40 of the region’s 48 cases could be traced back to that one patient.
A cluster has even appeared in the distant Andaman and Nicobar Islands, where six of the nine who have tested positive, had returned from the Delhi event.
The southern states of Tamil Nadu, Telangana and Andhra Pradesh have said more than 3,000 people from their states had attended the event, and Tamil Nadu has traced 16 positive patients to it.
States have also asked other people who attended to come forward for testing.
Delhi Chief Minister Arvind Kejriwal has asked for a police complaint to be registered against the head of the mosque.
However, the event’s organisers have issued a statement, saying they had suspended the event and asked everyone to leave as soon as Prime Minister Narendra Modi announced that there would be a day-long national curfew on 22 March.
While many were able to leave, they say, others were stranded because states began to seal their borders the following day, and two days later, India imposed a 21-day lockdown, suspending buses and trains.
The mosque’s premises include dormitories that can house hundreds of people.
The organisers say they informed the local police about all of this and continued to cooperate with medical officers who came to inspect the premises.
The mosque, the statement says, “never violated any provision of law, and always tried to act with compassion and reason towards the visitors who came to Delhi from different states. It did not let them violate the medical guidelines by thronging ISBTs (bus stops) or roaming on streets.”
This is not the first time religious congregations have been blamed for the spread of coronavirus.
Tablighi Jamaat events have also been blamed for spreading cases in Indonesia and Malaysia.
And in South Korea, many positive cases were linked to the Schincheonji church, a secretive religious sect, that has since apologised for its role in the outbreak.
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.
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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.”
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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.” ■
Image copyright EPAImage caption India has stopped exports of masks to make sure there are ample domestic supplies
A 68-year-old woman from Delhi has been confirmed as the second Indian to die from the coronavirus.
The woman, who had underlying health conditions, is thought to have been infected by her son who travelled to Switzerland and Italy last month.
India’s first fatality from the virus was confirmed on Thursday.
The 76-year-old man, from the southern state of Karnataka, died after returning from a month-long visit to Saudi Arabia on 29 February.
People who came in contact with the man are being traced and quarantined, the state’s health minister said. India has 82 confirmed cases of the virus, the health ministry says.
The Delhi woman’s son was “initially asymptomatic but developed a fever and cough after one day”, a government statement said. The family were then screened and the mother and son admitted to hospital.
The 76-year-old Karnataka man was screened at the airport on his return but showed no symptoms at the time. After he developed difficulties last week, he was taken to hospital. He died on Tuesday but it was not reported until Thursday.
India’s Supreme Court has said it will only hear urgent cases from Monday, and has restricted the number of people who can enter a courtroom.
Karnataka has banned all gatherings including weddings, sports events and conferences for a week as the country attempts to slow the spread of the virus.
Malls, movie theatres, pubs and night clubs have also been shut.
“The government will decide on further action after a week following a review,” the state’s chief minister BS Yediyurappa announced on Friday.
But he said that government offices would continue to function as normal.
India has taken a number of steps to halt the spread of Covid-19:
All visas, barring a select few categories, have been suspended for a month
Visa-free travel afforded to overseas citizens of the country has been suspended until 15 April and even those allowed in could be subject to 14 days of quarantine
Schools, colleges and movie theatres in the capital, Delhi, have been shut until 31 March
The Indian Premier League (IPL), featuring nearly 60 foreign players and scheduled to begin on 29 March, has been postponed to 15 April
Two one-day cricket matches between India and South Africa will be played behind closed doors
India’s health ministry says it was among the first countries in the world to prepare for an outbreak of the respiratory illness, and denied allegations that it was slow in testing suspected cases.
“Our surveillance system is strong and we are able to quickly identify any symptomatic patients,” RR Gangakhedkar from the Indian Council of Medical Research (ICMR) told reporters on Thursday.
However, there are concerns about whether the country will be fully equipped to prevent and treat an outbreak.
It would be near impossible for India to force its citizens into mass quarantine and hospitalise people in numbers like China, says the BBC’s Soutik Biswas.
Our correspondent says there are also concerns about the country’s poor healthcare data. India has a shoddy record in even recording deaths and disease – only 77% of deaths are registered, and doctors are more likely to get the cause of death wrong than right, according to a study the Toronto-based Centre for Global Research. There is patchy data for flu-related deaths.
Image copyright GETTY IMAGES
CHINDIA ALERT: You'll be living in their world, very soon 