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.
The POSTs (front webpages) are mainly 'cuttings' from reliable sources, updated continuously.
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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.
Dutch inquiry follows recall of 600,000 face masks
Ambassador rejects concerns China has a political agenda alongside medical support
In early March, China’s daily output of face masks reached 116 million units. Photo: Xinhua
China’s embassy in the Netherlands said on Monday that it was closely following a Dutch investigation into reportedly defective masks imported from China and called for the issue not to be politicised.
Xu Hong, China’s ambassador to the Netherlands, made the comment after Dutch officials recalled more than 600,000 face masks which were found to be unsuitable for intensive care medical staff.
“The embassy paid high attention to the March 28 news about the ‘defective’ masks that Dutch government purchased from China, and contacted the Dutch Ministry of Foreign Affairs and the Ministry of Health in the first time to verify the information,” Xu said, according to a statement published on the embassy’s website.
Xu said he had spoken by telephone with the Dutch Minister for Medical Care and Sport Martin van Rijn, on Sunday about the issues and said “if necessary” China would help the Dutch investigation into the quality of the masks.
Netherlands recalls 600,000 face masks from China due to low quality
29 Mar 2020
According to the Dutch Ministry of Health, Welfare and Sport, the masks did not fit well and the filters did not function properly. It was not immediately clear whether the batch in question was given to the Netherlands as a donation or had arrived through a commercial transaction.
“The Netherlands is still looking into the situation, and if there is any further information, it will inform the Chinese side in the first time,” Xu said.
China has ramped up medical assistance abroad where the novel coronavirus pandemic has shown no signs of easing, but China’s efforts have run into rising concerns about the poor quality protective gear and test equipment it offered.
In early March, China’s daily output of face masks reached 116 million units. Picture: Xinhua
Xu also rejected concerns that China had a political agenda accompanying its medical support. He called for its assistance in not to be politicised.
“The reason why China supports the Netherlands and other countries to fight the pandemic is very simple: we are trying to save lives,” Xu said.
“There is no ‘geopolitical consideration’ as a few claimed. It is normal if some problems arise during the cooperation. These problems can be solved in an objective manner, but should not be politicised.”
It is not the first time European countries have had problems with coronavirus-related medical equipment manufactured in China.
Why China’s ‘mask diplomacy’ is raising concern in the West
The company said it would replace the test kits sent to Spain.
On Thursday, the Chinese embassy in Spain said on Twitter that the Bioeasy test kits had not been approved by China’s National Medical Products Administration and were not included in the medical supplies sent by the Chinese government to Spain.
Separately, the Philippines’ health department on Sunday apologised for comments it had made a day earlier that two batches of coronavirus test kits provided by China were substandard, and acknowledged that the quality of the test kits did meet global standards.
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.
Coronavirus: as Malaysia braces for third wave, doctors make their own face masks
27 Mar 2020
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.
Coronavirus: Doctor explains the proper way to wash your hands and put on a face mask
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.
Why Singapore’s coronavirus response worked – and what we can all learn
27 Mar 2020
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.
Coronavirus: Covid-19 could live on in Indonesia long after world recovers
22 Mar 2020
“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.
Singapore, Hong Kong, Taiwan: the real coronavirus world leaders
19 Mar 2020
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.” ■
Image copyright HAMPSTEAD THEATREImage caption “Speaking out cost me my job, my marriage and my happiness at the time,” Dr Wang said
A whistleblower who exposed HIV and hepatitis epidemics in central China in the 1990s, potentially saving tens of thousands of lives, has died aged 59.
Dr Shuping Wang lost her job, was attacked, and had her clinic vandalised after she spoke out.
She died in Utah in the US, where she moved after the scandal.
A play inspired by her life is currently running in London, with the playwright calling her a “public health hero”.
Dr Wang never returned to China after leaving, saying it did not feel safe.
Why did Dr Wang speak out?
In 1991 in the Chinese province of Henan, Dr Wang was assigned to work at a plasma collection station. At the time, many locals sold their blood to local government-run blood banks.
It wasn’t long before she realised the station posed a huge public health risk.
Poor collection practices, including cross-contamination in blood-drawing, meant many donors were being infected with hepatitis C from other donors.
Undeterred, she reported the issue to the Ministry of Health. As a result, the ministry later announced that all donors would need to undergo hepatitis C screening – reducing the risk of the disease being spread.
But because of her whistleblowing, Dr Wang said, she was forced out of a job.
Her seniors said her actions had “impeded the business”. She was transferred, and assigned to work in a health bureau. But in 1995, she uncovered another scandal.
Image copyright HAMPSTEAD THEATRE
Dr Wang discovered a donor who had tested HIV positive – but had still sold blood in four different areas.
She immediately alerted her seniors to test for HIV in all the blood stations in Henan province. Again, she was told this would be too costly.
She decided to take things into her own hands, buying test kits and randomly collecting over 400 samples from donors.
She found the HIV positive rate to be 13%.
She took her results to officials in the capital, Beijing. But back home, she was targeted. A man she described as a “retired leader of the health bureau” came to her testing centre and smashed her equipment.
When she tried to block him, he hit her with his baton.
‘I’m not a man. I’m a woman’
In 1996, all the blood and plasma collection sites across the country were shut down for “rectification”. When they re-opened, HIV testing was added.
“I felt very gratified, because my work helped to protect the poor,” she said. But others were not happy.
At a health conference later that year, a high-ranking official complained about that “man in a district clinical testing centre [who] dared to report the HIV epidemic directly to the central government”.
“I stood up and said I’m not a man. I’m a woman and I reported this.”
Later that year, she was told by health officials that she ought to stop work. “I lost my job, they asked me to stay home and work for my husband,” Dr Wang said.
Her husband, who worked at the Ministry of Health, was ostracised by his colleagues. Their marriage eventually broke down.
Image copyright HAMPSTEAD THEATREImage caption A scene from The King of Hell’s Palace
In 2001, Dr Wang moved to the US for work, where she took the English name “Sunshine”.
Henan, the province that Dr Wang had worked in, was one of the worst hit.
The government later announced that a special clinic had been set up to care for those suffering from Aids-related illnesses.
Several years later, Dr Wang re-married and moved with her husband Gary Christensen to Salt Lake City, where she began working at the University of Utah as a medical researcher.
But her past followed her. In 2019, she said, Chinese state security officers made threatening visits to relatives and former colleagues in Henan, in an attempt to cancel the production of a play inspired by her life.
She refused, and the play titled “The King of Hell’s Palace” premiered at London’s Hampstead Theatre in September.
Dr Wang died on 21 September while hiking in Salt Lake City with friends and her husband. It’s thought she may have had a heart attack.
Image caption Dr Wang with playwright Frances Ya-Chu
“Speaking out cost me my job, my marriage and my happiness at the time, but it also helped save the lives of thousands and thousands of people,” she had told the Hampstead Theatre website in an interview just one month before her death.
“She was a most determined, relentless optimistic and most loving woman,” wrote her friend David Cowhig after news of her death.
“She chose the English name Sunshine for a reason. Perhaps her exuberance and love for the outrageous – made possible [the] perseverance she had.”
Image copyright GETTY IMAGES
CHINDIA ALERT: You'll be living in their world, very soon 