Archive for ‘professor of epidemiology’

22/03/2020

Coronavirus: Why India’s busiest rail network is being shut down

Passengers on a train in MumbaiImage copyright GETTY IMAGES
Image caption Many passengers have been wearing masks while travelling on the network

One of the world’s busiest urban rail systems will be shut down for ordinary commuters from Monday morning to prevent the spread of coronavirus infection in Mumbai, one of India’s most populous cities. Only government workers in “essential services” will be allowed to travel on a truncated service.

This was waiting to happen.

Consider this. Eight million people take Mumbai’s crowded suburban train network every day. Packed to nearly three times its capacity, this is one of the busiest railway systems in the world.

The 459km (285-mile) network is the lifeline of India’s financial and entertainment capital, accounting for nearly 80% of all commuting trips in the populous western city. The suburban trains “cover almost the distance up to [the] moon in one week,” the network’s website says.

The 66-year-old network carries 60,000 passengers per km per day, the highest among all the leading commuter rail systems in the world, say officials. The coaches are sturdy enough to carry a “super dense crush load”, a phrase coined by the railways to describe the intense crowding on Mumbai’s trains. This means that a nine-car train designed for 1,800 standing passengers will often carry up to 7,000 passengers, according to Monisha Rajesh, author of Around India in 80 Trains. “Mumbai’s local trains were certainly not for the fainthearted,” she wrote.

People travel in Central Railway's first air-conditioned EMU local train, on January 30, 2020 in Mumbai, India.Image copyright GETTY IMAGES
Image caption Mumbai’s suburban train network carries eight million passengers every day

Now consider this. The western state of Maharashtra, of which Mumbai is the capital, has confirmed more than 60 coronavirus infections, the highest in India so far. Scores of long distance trains out of the city have been cancelled, but the suburban network has continued to rumble on, raising fears of the mass spread of the virus on these packed trains. The crowded service was an easy target of a terror attack in 2006 when serial blasts ripped though a number of trains. At least 180 people were killed and more than 800 injured – the high casualty figure was attributed to overcrowding.

It is intuitively obvious that there’s a link between commuting with a lot of people and catching respiratory diseases. During the 1918 Spanish flu pandemic, which killed some 18 million Indians, the railways “played a prominent part [in aiding the spread of the disease] as was inevitable,” according to an official report.

“From ports and landing places the local transport networks, particularly the railways, carried the virus from large cities to the smallest, remotest settlements,” said a report on the spread of the flu in Britain in 1918-1919.

So should one of the world’s busiest rail networks be shut down to stop a possible spread of the virus in a city that many fear could turn into a coronavirus hotspot?

A passenger is seen wearing a protective mask as a precaution from coronavirus in the local train at CST railway station, on March 14, 2020 in Mumbai, India.Image copyright GETTY IMAGES
Image caption Officials say ridership on the trains has dropped by 17% after the coronavirus scare

Economists like Shruti Rajagopalan believe so.

“India is conducting the fewest tests per million at the moment. If the virus is truly within the community, then given these two issues, the Mumbai outbreak cannot be contained and people will die without healthcare.

“Mumbai trains are the fastest and surest way to spread the virus (if it is within the community) to the densest parts of the city,” she told me.

There is enough precedent: China stopped trains, ferries, planes and buses from leaving the city of Wuhan; and on Thursday, London officials announced that up to 40 stations on the London Underground network are to be shut as the city attempts to contain the outbreak.

Others are not so sure about linking the spread of a pandemic to public transport systems. One study does not support the effectiveness of suspending mass urban transport systems to reduce or slow down a pandemic because, “whatever the relevance of public transport is to individual-level risk, household exposure most likely poses a greater threat”.

“I have not seen any data on the relative risk of public transportation compared with [dense places like] workplaces or schools,” Timothy Brewer, a professor of epidemiology at the University of California Los Angeles told Vox.com.

He said data from China suggested that “household contact was an important means of transmission outside of Wuhan, suggesting that prolonged contact [with a sick person] increases the risk of transmission”.

“If correct, then the time spent commuting and the density of people commuting could be important factors in assessing if public transportation is a risk factor for the disease’s transmission.”

Trains being cleaned in MumbaiImage copyright GETTY IMAGES
Image caption Trains on the network are being scrubbed clean to avoid the spread of infection

Shivaji Sutar, a senior communications officer of the railways, told me that the network was running an aggressive campaign to ease the rush: awareness announcements, posters and videos containing virus information.

They were also monitoring crowds, scrubbing the trains, taking the temperature of willing passengers and embarking on a drive against public spitting, he said.

A combination of awareness and panic has already led to a 27% drop in traffic on the network. But millions of people continue to take the train to work and home every day.

“This is more because of fear than anything else. Most of us have to take the network because we have to come to work. There is still no government directive to all companies to work from home. And apart from passengers wearing masks, I haven’t seen any other precautions being taken,” Rekha Hodge, who has been using the network for three decades, told me. That is bad news.

Source: The BBC

03/03/2020

Wuhan doctor who worked with whistle-blower Li Wenliang dies after contracting coronavirus on front line

  • Ophthalmologist Mei Zhongming, 57, said to have been infected after working long hours treating patients
  • He is the third doctor from the hospital to die from Covid-19
Mei Zhongming died at the age of 57 after contracting the virus while he was working at the Wuhan Central Hospital. Photo: Weibo
Mei Zhongming died at the age of 57 after contracting the virus while he was working at the Wuhan Central Hospital. Photo: Weibo

An ophthalmologist who worked with whistle-blower doctor Li Wenliang on the coronavirus front line in Wuhan has also died from Covid-19, the disease caused by the virus.

Mei Zhongming, 57, contracted the virus while he was working at the Wuhan Central Hospital and died on Tuesday.

His 34-year-old colleague Li – who was silenced by police for sounding the alarm about the new virus strain – also died from the pneumonia-like illness last month, prompting an outpouring of grief and anger in China.

Mei is the third doctor from the hospital to die from Covid-19. Two days ago, Jiang Xueqing, head of thyroid and breast surgery, also died from the disease at the age of 55.

The hospital expressed condolences to Mei’s family and praised his 30 years of service in a brief announcement on social network WeChat.

Public mourning in China after death of coronavirus whistle-blower doctor Li Wenliang
According to the official numbers, 13 doctors and nurses have died from Covid-19 and more than 3,000 have been infected in China since the epidemic began in the central city of Wuhan in December. Hospitals in Wuhan and across the province of Hubei have been swamped with tens of thousands of patients, and health care workers treating them have also had to cope with a shortage of protective gear and medical supplies.

Part of the Wuhan Central Hospital is located just 2km (1.2 miles) from the Huanan Seafood Wholesale Market – the place the first coronavirus patients were linked to.

The hospital started treating patients who had been in close contact with the market in the middle of December, the director of its emergency department Ai Fen told China News Weekly last month.

Doctors reported the cases to management but no action was taken to protect medical staff at first, and they were warned not to talk publicly about the respiratory illness, the report said.

The Chinese medical workers on the front line of the coronavirus fight in Wuhan
Ophthalmologist Li

posted a message to a closed group of medical school classmates on WeChat on December 30, warning them about an outbreak of a mysterious viral pneumonia at his hospital.

Two days later, Wuhan police announced that eight people had been punished for “spreading rumours”. It was later reported that they were all medical staff and one of them was Li.

The young doctor fell ill on January 10, later saying that he was probably infected by an 82-year-old glaucoma patient. “The patient did not have a fever, and I didn’t wear extra protection while taking care of her,” Li wrote in his blog. “I was careless.”

Li died from the illness on February 7, sparking widespread grief and fury over Beijing’s crackdown on “online rumours”, and calls for freedom of speech.

According to emergency department director Ai, staff on the front line at Wuhan Central Hospital began wearing N95 respirator masks and other protective gear in January as the number of virus cases jumped – but before authorities confirmed the virus was being transmitted between humans on January 20.

Despite the precautions, the first medical worker at the hospital was confirmed with the virus on January 10. More than 30 others from the emergency department alone have tested positive for Covid-19 since then, Ai told China News Weekly. The department has a staff of 200.

Jiang Xueqing, 55, head of thyroid and breast surgery at the hospital, died on Sunday. Photo: Weibo
Jiang Xueqing, 55, head of thyroid and breast surgery at the hospital, died on Sunday. Photo: Weibo
The hospital did not give details of how Mei contracted the virus. But a report from the Wuhan Committee of the Chinese People’s Political Consultative Conference on February 18 said he had been infected after working long hours on the coronavirus front line.

Similarly, little information was released about Jiang’s death on Sunday. His colleague Li Hai told official newspaper People’s Daily that Jiang had been exhausted after working “non-stop” treating coronavirus patients.

Wuhan, China scrambles to handle massive amount of medical waste during the epidemic
Ian Lipkin, John Snow professor of epidemiology at the Mailman School of Public Health at Columbia University, said the risks faced by health care workers were high, even with protective gear, as they had a very intimate relationship with their patients.
“In addition, those individuals who are working in hospital settings may be immunosuppressed because, frankly, they’re exhausted … the viral load that they receive may be larger,” Lipkin said in a briefing last month after visiting China at the invitation of the government.
The coronavirus has claimed the lives of several young medical workers. Among the youngest was 29-year-old respiratory and critical care doctor Peng Yinhua, who worked at the Jiangxia district People’s No 1 Hospital in Wuhan and died last month from the disease. Peng had planned to get married over the Lunar New Year holiday but postponed his wedding to help treat coronavirus patients.
Another 29-year-old, gastroenterologist Xia Sisi, also died last month after she became infected while working at the Union Jiangbei Hospital in Wuhan.
The coronavirus has killed more than 3,100 people and infected over 92,000, mostly in China, since the outbreak began, and it has spread to more than 50 countries in every continent except Antarctica.
Source: SCMP
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