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.
The PAGEs (see Tabs, above) attempt to make the information more meaningful by putting some structure to the information we have researched and assembled since 2006.
Beijing’s Chaoyang district remains the last high-risk area in China, with virus preventive measures continuing to impact on travel and shopping plans
China faces the dilemma of preventing a re-emerge of the pandemic, while also pushing to get its economy back to normal
China’s continued pandemic prevention measures, coupled with still hesitant consumer demand, will inevitably lead to persistent limitations on the nation’s economic recovery, analysts said. Photo: Bloomberg
After nearly three months of being quarantined by herself in Beijing, Mary Zhao was looking forward to the upcoming long weekend at the start of May to be able to finally reunite with her parents.
But Zhao was forced to abandon her plan for the Labour Day holidays as Beijing’s upmarket Chaoyang district, where she lives, remains the only high-risk zone for coronavirus in the entire country.
If she travelled the five hours by car, or two hours via bullet train, to the neighbouring Hebei province, she would first have to undergo a 14-day quarantine before seeing her parents. Her parents would also have the same two week quarantine to look forward to once they returned home if they came to visit their daughter in Beijing.
These strict controls to prevent a re-emergence of the coronavirus outbreak are making a return to normal life impossible for many, and mean the final economic and social cost
from China’s draconian preventive measures could be much larger than expected.
Wuhan declares ‘victory’ as central Chinese city’s last Covid-19 patients leave hospital
It underscores the dilemma facing China’s leaders on how to balance the need to
and to avoid a fresh outbreak. On the surface, China may be able to declare victory as even Wuhan, the city where the virus was first detected, announced that the last Covid-19 patient had left hospital on Sunday. But fears of a renewed outbreak have kept the country’s cinemas and most schools closed, with travel between provinces discouraged.
China’s national borders also remain largely closed, with flights being cut to a minimum, and a mandatory 14-day quarantine for every arrival. In the number of places where new cases have been reported, quarantine requirements have been tightened, including Harbin and a few other cities near the border with Russia.
Chaoyang, the home to one of Beijing’s main business districts and most foreign embassies, changed its risk rating to high from low in the middle of April after three new cases were reported, dealing a fresh blow to the district’s
and forcing many of the 3.5 million residents to cancel their travel plans.
On the outskirts of Beijing, near Beijing Capital International Airport, returning migrant workers to Picun village were ordered to stop at entrance and could only be escorted inside by their landlord, with many villages and residential compounds remaining closed to outsiders.
In the high-end shopping district of Guomao, some shops also remain closed as there are few potential customers, while over in the popular Sanlitun area, metal barriers restrict access and temperature checkpoints are still required.
The landmark Apple Store in the popular Taikoo shopping centre is open, but with limited customers allowed inside, there are long queues outside. Customers are required to scan a QR code to check their movements over the last few days before entering.
Coronavirus: More schools reopen in China for students preparing for university entrance exams
“Why do I have to spend 20 minutes just to get into the Apple Store? The sun has almost melted me down,” one visitor complained to the security guards at the front of the shop.
China’s continued pandemic prevention measures, coupled with still hesitant consumer demand, will inevitably lead to persistent limitations on the nation’s economic recovery, analysts said.
Ernai Cui, an economist at research firm Gavekal Dragonomics, said on Monday that China’s cautious approach to lifting restrictions “points to a weak second quarter for consumer services”, adding additional pressure to the economic recovery.Mao Zhenhua, a researcher at the China Institute of Economics at Renmin University, said China’s preventive measures will inevitably be a drag on production, employment and exports.
The patients were all returning Chinese citizens who had flown from Moscow to Vladivostok, a Russian city around 100 miles south.
All the new patients were taken to hospital, with two in a serious condition.
In addition, another 86 people in Suifenhe – who came via the same route – were classed as “asymptomatic” but positive for the virus, which China counts separately.
What has Suifenhe done?
The border was closed to people on Tuesday, the local government said, although cargo can continue. Russia closed its border with China in February.
People in the city have been told to stay at home, although the lockdown isn’t as severe as Hubei province experienced. One person per house can shop for essentials every three days.
At the same time, the new hospital – in an existing building – is due to open this weekend, intended for patients with mild symptoms.
“Of course I’m very scared,” one woman who runs a bakery shop told the BBC.
“We don’t leave the house now. Many people already left the city. But we can’t do that, because we have a shop need to take care of.”
Image copyright SOVFOTOImage caption This picture from 2005 showed the extent of Russian timber exports passing through Suifenhe railway station
Meanwhile, a member of staff at a restaurant in the city said it was normally their high season, with around 1,000 customers a day.
Instead, they were told to close earlier this week, with “no idea” when they can open again.
But the staff member was not critical of the government. He said the lockdown made him feel “secure” – and that he was “very confident” the government would look after the situation.
What is the situation in the rest of China?
China’s recorded rate of Covid-19 infections has slowed dramatically in recent weeks.
On Wednesday, people were allowed to leave Wuhan – where the outbreak emerged – for the first time in 11 weeks if they were deemed virus-free.
There were 221 inbound and outbound flights, with more than 7,000 people leaving and 4,500 arriving. More than half a million used public transport, state media reported.
But although people from Wuhan can leave, they still face restrictions in other cities. In Beijing, for example, they will be tested upon arrival, according to local media.
Even if they pass, they will then be quarantined for 14 days – and tested again – before being released.
GENEVA (Reuters) – World Health Organization officials on Wednesday denied that the body was “China-centric” and said that the acute phase of a pandemic was not the time to cut funding, after U.S. President Donald Trump said he may put contributions on hold.
The United States is the top donor to the Geneva-based body which Trump said had issued bad advice during the new coronavirus outbreak.
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U.S. contributions to WHO in 2019 exceeded $400 million, almost double the 2nd largest country donor, according to figures from the U.S. State Department. China contributed $44 million, it said.
“We are still in the acute phase of a pandemic so now is not the time to cut back on funding,” Dr Hans Kluge, WHO regional director for Europe, told a virtual briefing when asked about Trump’s remarks.
Trump told a news conference on Tuesday that the United States was “going to put a hold on money spent to the WHO,” however, he appeared to backtrack later when in response to questions he said: “We’re going to look at it.”
It was not immediately clear how Trump could “block” funding for the organization. Under U.S. law, Congress, not the president, decides how federal funds are spent.
Dr Bruce Aylward, senior advisor to the WHO Director-General, also defended the U.N. agency’s relationship with China, saying its work with Beijing authorities was important to understand the outbreak which began in Wuhan in December.
“It was absolutely critical in the early part of this outbreak to have full access to everything possible, to get on the ground and work with the Chinese to understand this,” he told reporters.
“This is what we did with every other hard-hit country like Spain and had nothing to do with China specifically.”
Aylward, who led a WHO expert mission to China in February, defended WHO recommendations to keep borders open, saying that China had worked “very hard” to identify and detect early cases and their contacts and ensure they did not travel.
“China worked very, hard very early on, once it understood what it was dealing with, to try and identify and detect all potential cases to make sure that they got tested to trace all the close contacts and make sure they were quarantined so they actually knew where the virus was, where the risk was,” he said.
“Then they made it very clear that these people would not and could not travel within the country, let alone internationally,” he added.
WHO Director-General Tedros Adhanom Ghebreyesus has been lavish in his praise of China from early in the outbreak, praising President Xi Jinping’s “rare leadership”.
David Heymann, a professor at the London School of Hygiene & Tropical Medicine who led WHO’s response to the 2003 SARS outbreak, said that any U.S. funding cut would be a huge blow.
“If the WHO loses its funding it cannot continue to do its work. It works on a shoe-string budget already,” Heymann said in London. “Of course it would be disastrous for the WHO to lose funding.”
US$2 trillion rescue package passes US Senate, heads to House
Malaysia’s king and queen in ‘self-quarantine’ after staff test positive
Police commandos in Sri Lanka hand out food to homeless people during a nationwide curfew against the spread of coronavirus. Photo: AFP
More than three billion people are living under lockdown measures as soaring death tolls in Europe and the US underlined a United Nations warning that the coronavirus, which has now infected nearly half a million people globally, threatens all of humanity.
The global death toll from the virus now stands at more than 21,000, with Spain joining Italy in seeing its number of fatalities overtake China, where the virus first emerged just three months ago.
“Covid-19 is threatening the whole of humanity – and the whole of humanity must fight back,” UN Secretary General Antonio Guterres said, launching an appeal for US$2 billion to help the world’s poor.
“Global action and solidarity are crucial. Individual country responses are not going to be enough.”
The G20 major economies will hold an emergency videoconference on Thursday to discuss a global response to the crisis, as will the 27 leaders of the European Union, the outbreak’s new epicentre.
The economic damage of the virus – and the lockdowns – could also be devastating, with fears of a worldwide recession worse than the financial meltdown more than a decade ago.
Here are the developments:
US$2 trillion rescue package passes US Senate
The US Senate passed the nation’s largest-ever rescue package late Wednesday, a US$2 trillion lifeline to suffering Americans, depleted hospitals and an economy all ravaged by a rapidly spreading coronavirus crisis.
The monster deal thrashed out between Republicans, Democrats and the White House includes cash payments to American taxpayers and several hundred billion dollars in grants and loans to small businesses and core industries. It also buttresses hospitals desperately in need of medical equipment and expands unemployment benefits.
The measure cleared the Senate by an overwhelming majority and was headed next to the House of Representatives, which must also pass it before it goes to President Donald Trump for his signature.
US President Donald Trump has voiced hope the US will be “raring to go” by mid-April, but his optimism appeared to stand almost alone among world leaders.
Unemployment benefit filings by Americans workers to surge to 3.3 million last week – the highest number ever recorded, the Labour Department reported on Thursday.
The normally routine report is at the front lines of the economic crisis caused by the outbreak, which has forced widespread closures of restaurants, shops and hotels, and brought airline travel to a virtual halt, prompting the stunning increase in people filing for benefits nationwide in the week ending March 21.
Nearly every state cited Covid-19 for the jump in initial jobless claims, with heavy impacts in food services, accommodation, entertainment and recreation, health care and transport, the report said.
Malaysia’s king and queen in quarantine after staff test positive
The official residence of Malaysia’s monarchy on Thursday confirmed seven of its staff have tested positive for Covid-19 and are currently receiving treatment at the Kuala Lumpur Hospital.
Malaysia’s king, Sultan Abdullah Sultan Ahmad Shah and queen, Tunku Azizah, have also been tested, but their results showed a clean bill of health, a spokesman for the Istana Negara said in a statement.
“Nevertheless, Their Majesties are now observing a 14-day self-quarantine, starting yesterday, ” he said.
Meanwhile, Prime Minister Muhyiddin Yassin, along with all federal ministers and their deputies, announced they will take a two-month pay cut, with the savings to be donated to Putrajaya’s Covid-19 fund.
The Prime Minister’s Office said the decision was made during a cabinet meeting and showed the government’s sincerity in helping those affected by the pandemic.
“The Covid-19 fund was launched on March 11 as part of the government’s efforts to help those who were affected by the disease outbreak,” the office said, adding that 8.5 million ringgit (US$1.97 million) has been collected, including government grants.
Malaysia on Wednesday announced a two-week extension of a national lockdown as part of stepped-up measures to contain the coronavirus outbreak.
The “movement control order,” which requires people to stay home and was originally set to expire on March 31, will now continue until April 14.
Moscow monitors people in coronavirus quarantine with 100,000 ‘under the skin’ surveillance cameras
Russia to ground international flights
Russia will halt all international flights from midnight on Friday under a government decree listing new measures against the coronavirus outbreak.
The decree published on Thursday orders aviation authorities to halt all regular and charter flights, with the exception of special flights evacuating Russian citizens from abroad.
The announcement came after Russia on Wednesday recorded its biggest daily spike in confirmed coronavirus infections so far, with 163 new cases for a total of 658 across the country.
Denis Protsenko, head doctor of Moscow’s new hospital treating coronavirus patients, told President Vladimir Putin that Russia needed to be ready for an “Italian scenario”, referring to what is now the hardest-hit country in the world in terms of deaths.
Singapore boosts stimulus package to 11 per cent of GDP
Singapore reported 52 new coronavirus cases on Thursday, taking its tally to 683 infections.
The health ministry said that out of the 52, 28 were imported while 24 were locally transmitted.
Drawing on national reserves for the first time since the global financial crisis to support an economy heading for recession, the additional spending will push up the government’s virus-related relief to almost S$55 billion, or 11 per cent of gross domestic product, Finance Minister Heng Swee Keat said in a speech in parliament Thursday. It also will widen the budget deficit for the financial year starting April 1 to 7.9 per cent of GDP, from a previous target of 2.1 per cent.
“This extraordinary situation calls for extraordinary measures,” Heng said. “We have saved up for a rainy day. The Covid-19 pandemic is already a mighty storm, and is still growing.”
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‘If you catch it, don’t spread it to others’, 1949 flu advice still applies to coronavirus pandemic
Imported cases rise in China
Mainland China reported a second consecutive day of no new local coronavirus infections as the epicentre of the epidemic Hubei province opened its borders, but imported cases rose as Beijing ramped up controls to prevent a resurgence of infections.
A total of 67 new cases were reported as of end-Wednesday, up from 47 a day earlier, all of which were imported, China’s National Health Commission said in a statement on Thursday.
The total number of cases now stands at 81,285.
The commission reported a total of 3,287 deaths at the end of Wednesday, up six from the previous day.
All of the new patients were travellers who came to China from overseas, with the mainland reporting no locally transmitted infections on Wednesday.
Fearing a new wave of infections from imported cases, authorities have ramped up quarantine and screening measures in other major cities including Beijing, where any travellers arriving from overseas must submit to centralised quarantine.
Coronavirus could become seasonal
There is a strong chance the new coronavirus could return in seasonal cycles, a senior US scientist said Wednesday, underscoring the urgent need to find a vaccine and effective treatments.
Anthony Fauci, who leads research into infectious diseases at the National Institutes of Health, told a briefing the virus was beginning to take root in the southern hemisphere, where winter is on its way.
“What we’re starting to see now … in southern Africa and in the southern hemisphere countries, is that we’re having cases that are appearing as they go into their winter season,” he said.
“And if, in fact, they have a substantial outbreak, it will be inevitable that we need to be prepared that we’ll get a cycle around the second time.
“It totally emphasises the need to do what we’re doing in developing a vaccine, testing it quickly and trying to get it ready so that we’ll have a vaccine available for that next cycle.”
There are currently two vaccines that have entered human trials -one in the US and one in China – and they could be a year to a year-and-a-half away from deployment.
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Spain extends emergency by two weeks
Spain’s parliament has voted in favour of the government’s request to extend the state of emergency by two weeks that has allowed it to apply a national lockdown in hopes of stemming its coronavirus outbreak.
The parliamentary endorsement will allow the government to extend the strict stay-at-home rules and business closings for a full month. The government declared a state of emergency on March 14. It will now last until April 11.
Spain’s government solicited the two-week extension after deaths and infections from the Covid-19 virus have skyrocketed in recent days. Spain 47,600 total cases. Its 3,434 deaths only trail Italy’s death toll as the hardest-hit countries in the world.
The parliament met with fewer than 50 of its 350 members in the chamber, with the rest voting from home to reduce the risk of contagion.
Greece locks down Muslim towns
Greek authorities have quarantined a cluster of Muslim-majority towns and villages in the country’s northeast after several cases and a death from the new coronavirus in the area.
The area in Xanthi prefecture was placed in lockdown as of Wednesday evening as nine people in the region overall have tested positive for the virus over the past six days, civil protection deputy minister Nikos Hardalias told reporters.
“All residents have been temporarily confined at home. No exceptions are allowed,” Hardalias said.
The centre of the outbreak appears to be the small Pomak town of Ehinos, a community of about 2,500.
“Ehinos residents will be provided with food and medicine,” Hardalias said.
Police were deployed on Thursday on a bridge leading into town to enforce the lockdown, television footage showed.
One 72-year-old Ehinos man has died from the virus, local mayor Ridvan Deli Huseyin told Antenna television.
“It’s better to take some measures now than to cry about this later,” said Huseyin, the mayor of the local administrative centre of Miki.
The Pomaks are a Muslim group of Slavic origin who live mainly in neighbouring Bulgaria.
They make up part of Greece’s roughly 110,000-strong Muslim minority in the country’s northeast bordering Turkey.
Many of them work as migrant industrial workers in other European countries.
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Colombia goes into lockdown, Chile extends schools closures
Countries across Latin America tightened measures on Wednesday to halt the spread of the deadly novel coronavirus, with more lockdowns, border closings and school closures as well as increased aid to the region’s poorest.
As cases of Covid-19 cases continue to rise – more than 7,400 and 123 deaths up to now – Bolivia and Colombia became the latest countries to impose a total lockdown, while Chile extended its schools closures until the end of April.
Brazil’s President Jair Bolsonaro has warned of possible “chaos” and the “looting” of supermarkets if state shutdowns ordered by the governors of Sao Paulo and Rio de Janeiro aren’t ended.
Bolsonaro, who has repeatedly scoffed at the severity of the deadly pandemic, had previously criticised the closing of schools and businesses in Sao Paulo and Rio states, two of the country’s most populous states.
Germany ramps up testing, approves huge bailout
Germany has boosted its coronavirus test rate to 500,000 a week, Christian Drosten, who heads the Institute of Virology at Berlin’s Charite University Hospital, said on Thursday, adding that early detection has been key in keeping the country’s death rate relatively low.
Drosten also highlighted Germany’s dense network of laboratories spread across its territory as a factor contributing to early detection.
The news came after Chancellor Angela Merkel’s government secured emergency spending, unlocking a historic rescue package designed to cushion the blow of the coronavirus pandemic.
A majority of lawmakers in the Bundestag voted on Wednesday to allow additional borrowing to combat the crisis, according to the legislature’s president. The Bundesrat, or upper house of parliament, will vote on Friday.
The extraordinary authorisation is part of a packet of legislation aimed at protecting German jobs and businesses. The new borrowing of €€156 billion (US$169 billion) is equivalent to half of the country’s normal annual spending.
The country, which tightened lockdown measures this week, has about 32,700 cases and more than 150 deaths.
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Ukraine declares ‘emergency situation’
Ukraine on Wednesday declared a month-long “emergency situation” to slow the coronavirus outbreak, as the number of confirmed cases jumped to 113.
Ukraine has already closed schools, universities and public spaces to stem the spread of the disease, but the measures were due to expire at the beginning of April.
The emergency situation announced on Wednesday effectively extends existing measures for 30 days until April 24, a government spokesperson said.
“We are extending quarantine and imposing an emergency situation in Ukraine,” Prime Minister Denys Shmygal said.
Unlike an official state of emergency, the initiative announced by the prime minister does not have to be rubber stamped by both the parliament and president. Ukraine has confirmed 113 cases of Covid-19 and four deaths, according to official statistics.
Prince Charles tests positive for coronavirus
Mexican governor says poor are ‘immune’
The governor of a state in central Mexico is arguing that the poor are “immune” to the new coronavirus, even as the federal government suspends all non-essential government activities beginning Thursday in a bid to prevent the spread of the virus.
Puebla Governor Miguel Barbosa’s comment on Wednesday was apparently partly a response to indications that the wealthy have made up a significant percentage of Mexicans infected to date, including some prominent business executives.
Officials say three-quarters of Mexico’s 475 confirmed cases are related to international travel, and the poor do not make many international trips. Some people apparently caught the virus on ski trips to Italy or the United States. The country has seen six deaths so far.
“The majority are wealthy people. If you are rich, you are at risk. If you are poor, no,” Barbosa said of the coronavirus. “We poor people, we are immune.”
Barbosa also appeared to be playing on an old stereotype held by some Mexicans that poor sanitation standards may have strengthened their immune systems by exposing them to bacteria or other bugs.
There is no scientific evidence to suggest the poor are in any way immune to the virus that is causing Covid-19 disease around the world.
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Japan belatedly bans entry from Europe, Iran
Japanese Prime Minister Shinzo Abe has established a task force under the country’s revised emergency law to deal with the global rise in coronavirus infections and deaths.
In Tokyo on Thursday, Abe said it was necessary for people to act as one to overcome what can be described as a national crisis.
Japan will ban entry from 21 European countries as well as Iran, to take effect from Friday, he added.
The country has already begun asking visitors and its nationals arriving from some countries in Southeast Asia, the Middle East and Africa to self-quarantine for 14 days.
Arrivals from a total of seven Southeast Asian countries and four in the Middle East and Africa are also asked to refrain from using public transport.
Similar steps are in place for visitors from China, South Korea, most of Europe and the United States.
Malaysia to lock down two communities to curb spread
Malaysia on Thursday announced that 3,570 residents in two communities in the country’s south will be placed under complete lockdown due to their high coronavirus infection rates.
Defence Minister Ismail Sabri Yaakob said in a statement that the residents in Kluang district of Johor state are banned from leaving home for two weeks beginning Friday, to enable the health authorities to conduct door-to-door screening.
The tough measure was taken after 73 per cent of the 83 infection cases found in the district were traced to the two small communities of Kampung Dato Ibrahim Majid and Bandar Baru Dato Ibrahim Majid.
Ismail said the residents cannot leave home, not even to buy food, as the welfare department will supply them with two weeks’ worth of food. All businesses must close and all access into the two areas will be sealed. The police and army have been deployed to ensure compliance.
The Australian government scrapped a time limit on haircuts following a backlash.
The government had imposed a rule on hairdressers and barbers on Tuesday that haircuts should take less than 30 minutes, as part of social distancing restrictions to deal with the coronavirus outbreak.
The restriction put around 40,000 hairdressers at risk, the Australian Hairdressing Council said in response.
“This decision is outrageous,” the council’s chief executive Sandy Chong said in a statement.
“Whilst many barbers can do a male haircut within that time frame, it really isn’t feasible for a majority of hairdressing salons.”
Australian Prime Minister Scott Morrison issued a statement Thursday saying the policy would be reversed with immediate effect.
But salons and barbers must still strictly observe new rules that there may only be one person per four square metres within the premises, Morrison said.
India unveils US$22.6 billion stimulus package
India’s government announced a 1.7 trillion rupee (US$22.6 billion) stimulus package, as it stepped up its response to the coronavirus pandemic.
The measures will include cash transfers as well as steps on food security, Finance Minister Nirmala Sitharaman said in New Delhi on Thursday, adding that the package will benefit migrant workers.
Asia’s third-largest economy joins countries from the US to Germany that have pledged spending to contain the economic fallout of the pandemic. India is on a total lockdown for three weeks from Wednesday in the world’s biggest isolation effort, as Prime Minister Narendra Modi seeks to prevent the virus from spreading locally.
The government will also provide an insurance cover of 5 million rupees to medical workers, Sitharaman said.
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.
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.
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The Jack Ma Foundation has also launched an online platform for doctors and nurses around the world to share knowledge on fighting the virus. “One world, one fight,” it said in a tweet.
Associate Professor Jeremy Lim from the global health programme at the Saw Swee Hock School of Public Health said it was crucial for countries to work together.
“Viruses don’t respect borders. Countries have to share information and help each other as we are only as strong as the weakest link. Any country can become a reservoir of disease and the world may then be forced to endure a ping-pong of outbreaks over and over again.”
And the advice of Lee, at Singapore’s Ministry of Health? “Practise good hygiene and wash hands regularly.”
Indonesian medical staff administer mass testing for Covid-19 in Bekasi, West Java. Photo: AFP
SINGAPORE, A CASE STUDY
Amid this sharing of advice, it is often Singapore that is held up as an example to replicate. Despite the country grappling with a rising load of Covid-19 patients, most of whom have recently returned to the city state from abroad, its health care system has continued to run smoothly. Doctors say this is because it has been preparing for a pandemic ever since Sars caught it by surprise. During the Sars outbreak, health care workers accounted for 41 per cent of Singapore’s 238 infections.
Consequently its hospitals swung into contingency planning mode early on in the coronavirus outbreak, telling staff to defer leave and travel plans after its first cases emerged.
Meanwhile, its hospitals swiftly split their workforces into teams to ensure there were enough workers if the outbreak worsened, and to ensure workers got enough rest.
Singapore has 13,766 doctors, or 2.4 doctors for every 1,000 people. That compares to 2.59 in the US, 1.78 in China and 4.2 in Germany. Places like Myanmar and Thailand have fewer than one doctor for every 1,000 people.
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“The objective is that you can run essential services with the greatest amount of security. Make sure functional units have redundancy built in, and are separate from each other. It depends on what you feel is sufficient to carry on services if one team is affected, factoring in rest periods and some system of rotation,” said Chia Shi-Lu, an orthopaedic surgeon.
The key is to ensure a good doctor-to-patient ratio and ensure there are enough specialists for the critical work, such as doctors and nurses who can provide intensive care, and know how to operate mechanical ventilators or machines to pump and oxygenate a patient’s blood outside the body.
At the emergency department where paediatrics emergency specialist Jade Kua treats Covid-19 cases in addition to regular emergencies, doctors are split into four teams of 21. Each team takes alternate 12-hour shifts and does not interact with other teams.
“We are in modular teams so the teams move together. So you and I would both do morning, off, night, off, morning off. Together. And then the other teams would do the same and we don’t intermingle,” said Kua.
US now has world’s most coronavirus cases, surpassing China
Chia, who works at the Singapore General Hospital, said doctors had been split up according to their functions.
“We try not to meet at all with the other teams as much as possible. We’ll just say hi from across the corridor. Meals are the same. All our cafeterias and everything have got social distancing spaced in already,” said Chia, who is also a member of parliament and chairs a shadow committee on health.
Chia said the health care system could also tap on doctors in the private sector.
Not every country has a plan like this. Last year’s Global Health Security Index by the Economist Intelligence Unit found that 70 per cent of 195 countries scored poorly when it came to having a national plan for dealing with epidemics or pandemics. Almost three in 10 had failed to identify which areas were insufficiently staffed. In India, with a population of 1.3 billion, only about 20,000 doctors are trained in key areas such as critical care, emergency medicine and pulmonology.
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In contrast, Singapore published its first Influenza Pandemic Preparedness and Response Plan in June 2005 and has since honed it to a tee. Hospitals regularly war-game scenarios such as pandemics or terrorist attacks and the simulations are sometimes observed by the Ministry of Health, which grades the performance and recommends areas for improvement.
The plan also covers the need to stockpile equipment to avoid the sort of shortages many countries are now facing, another lesson inspired by Sars when masks, gloves and gowns were in short supply.
In a pandemic preparation paper published in 2008, Singapore public health specialist Jeffery Cutter wrote that Singapore’s stockpile was sufficient to cover at least 5 to 6 months’ use by all front-line health care workers.
During the Covid-19 outbreak, it has also told citizens to not wear masks so it can conserve supply for medical staff.
Having enough protective gear has reassured Singapore’s health care workers such as Kua, a mother of six who blogged about her experience fighting Covid-19. Kua said: “I’m safe and my family is safe.”
India’s poor hit hard by 21-day nationwide lockdown amid the coronavirus pandemic
SOMETHING YOU CAN’T GUARD AGAINST
Despite the many positives to emerge from the Lion City, its health care workers are struggling with another problem: discrimination.
While in France, Italy and Britain, residents cheer health care workers from their windows, in Singapore health care workers are seen by some people as disease carriers.
“I try not to wear my uniform home because you never know what kind of incidents you may encounter,” said one Singapore nurse. “The public is scared and wearing our uniforms actually causes quite a bit of inconvenience. One of my staff tried to book a private-hire car to the hospital for an emergency and she was rejected by five drivers.”
There is a similar stigma in India, where the All India Institute of Medical Sciences has appealed to the government for help after health workers were forced out of their homes by panicked landlords and housing societies.
“Many doctors are stranded on the roads with all their luggage, nowhere to go, across the country,” the institute said in a letter.
Lim, from the Saw Swee Hock School of Public Health, said the worst human impulses and “every man for himself” attitudes could emerge in crises and “that is exactly why governments have to step in”.
Discrimination could affect both the performance and motivation of health care workers, Lim warned.
Meanwhile, when health care workers are infected, it creates a “triple whammy” threat.
“It means one fewer professional in an already-strained system, another patient to care for and, potentially, a team of colleagues who need to be quarantined,” said Lim.
“We must do everything possible to keep our health care workforce safe and free from Covid-19.” ■
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.
BEIJING (Reuters) – About a quarter of China’s new confirmed cases and almost all of those outside the epidemic’s epicentre in Wuhan originated outside the country on Friday, according to official data.
Most of these cases, which include infections of Chinese nationals who caught the virus abroad, were in China’s northwestern Gansu province, among quarantined passengers who entered the provincial capital of Lanzhou on commercial flights from Iran between March 2 and March 5.
Mainland China had 99 new confirmed cases of coronavirus infections on Friday, the country’s National Health Commission (NHC) said on Saturday, down from 143 cases a day earlier and marking the lowest number since Jan. 20, when the NHC started to publish nationwide figures.
Outside of central China’s Hubei province, there were 25 new confirmed cases reported on March 6, of which 24 came from outside China.
The capital Beijing reported four new cases on Friday, of which three came from Italy, according to a notice from the Beijing health commission posted on its official Weibo account on Saturday.
There were also three cases in Shanghai that originated abroad, and one in Guangdong province on Friday, according to the National Health Commission.
The total nationwide number of cases that originated outside China reached 60 as of the end of Friday.
For the second day in a row, there were no new infections in Hubei outside of the provincial capital of Wuhan, where new cases fell to the lowest level since Jan. 25.
Special institutions like prisons, detention centres and nursing homes in Wuhan, which have seen nearly 1,800 confirmed cases as of March 5, still have potential risks in virus control and prevention, the Communist Party’s Politics and Law Commission said on Saturday.
The total number of confirmed cases in mainland China so far is 80,651.
Image copyright GETTY IMAGESImage caption Authorities are also asking overseas Chinese to reconsider travel plans
Travellers from countries with severe coronavirus outbreaks who arrive in some parts of China will have to undergo a 14-day quarantine, state media say.
Travellers from the virus hotspots of South Korea, Japan, Iran and Italy arriving in the capital will have to be isolated, a Beijing official has said.
Shanghai and Guangdong announced similar restrictions earlier.
Authorities are worried the virus might be imported back into the country.
Although most virus deaths have been in China, Monday saw nine times more new infections outside China than in.
Shanghai said it would require new arrivals from countries with “relatively serious virus conditions” to be isolated, without naming the countries.
Authorities are also asking overseas Chinese to reconsider travel plans.
“For the sake of your family’s health and safety, please strengthen your precautions, carefully decide on your travel plans and minimise mobility,” officials in one southern Chinese province said.
China reported 125 new virus cases on Tuesday – the lowest number of new daily infections in six weeks. There were also 31 more deaths – all in Hubei province, where the virus emerged.
In other developments:
Finance ministers from the G7 countries have said they are “ready to take action”, including fiscal measures to aid the response to the virus and support the global economy
The Pope, who had cancelled a Lent retreat for the first time in his papacy because he was suffering from a cold, has tested negative for the virus, Italian media report
South Korean President Moon Jae-in has put the country into a “state of war” and ordered all government departments to shift to a 24-hour emergency system
Jailed British-Iranian woman Nazanin Zaghari-Ratcliffe is in good health, Iran’s judiciary has said. She was assessed after her husband said she was showing symptoms of Covid-19
Media caption Julie, who lives in Singapore, was diagnosed with coronavirus and then put into isolation
How are different countries affected?
There are now almost 90,000 cases worldwide in about 70 countries, although the vast majority – just under 90% – remain in China, and most of those are in Hubei province where the virus originated late last year.
Of the nearly 8,800 cases outside China, 81% are in four countries – Iran, South Korea, Italy and Japan.
One of the countries worst affected outside China – Italy – said on Monday that the death toll there had risen by 18 to 52. There are 1,835 confirmed cases, most of them in the Lombardy and Veneto areas of the north. Nearly 150 people are said to have recovered.
However, the country is seeing a slowdown in new cases. On Monday, the authorities said there were 258 new cases of the virus – a 16% increase on the previous day – after new cases spiked by 50% on Sunday.
On Tuesday, Iran said the latest death toll from the virus was 77 – although the real figure is believed to be much higher. More than 2,300 people are said to be infected, including senior political figures. The head of Iran’s emergency medical services, Pirhossein Kolivand, was one of them, the Ilna news agency reported on Tuesday.
Some 23 MPs are also reported to have tested positive for the virus, and an official close to the Supreme Leader, Ayatollah Ali Khamenei, was reported on Monday to have died of the disease.
Health officials in the US state of Washington said on Monday that four more people had died, bringing the total there to six. They are the only deaths in the US so far. Local officials say they are buying a hotel to convert it into an isolation hospital.
On Tuesday, Ukraine confirmed its first case of coronavirus, while Portugal, Iceland, Jordan, Tunisia, Armenia, Latvia, Senegal, Morocco and Andorra confirmed their first cases on Monday.
How deadly is Covid-19?
The WHO says the virus appears to particularly affect those over 60, and people already ill.
In the first large analysis of more than 44,000 cases from China, the death rate was 10 times higher in the very elderly compared to the middle-aged.
Most patients have only mild symptoms and the death rate appears to be between 2% and 5%, the WHO said.
By comparison, seasonal flu has an average mortality rate of about 0.1%, but is highly infectious – with up to 400,000 people dying from it each year.
Other strains of coronavirus, such as Severe Acute Respiratory Syndrome (Sars) and Middle East Respiratory Syndrome (Mers), have much higher death rates than Covid-19.
In the Chinese city of Wuhan, where the virus emerged, the authorities earlier announced that some non-residents would be allowed to leave if they showed no symptoms of the virus.
However, local officials now say that order was made without authorisation and has been revoked.
The city has been in lockdown since January 23, with authorities cutting off transport links in and out of the city.
More than 2,500 people have died from the virus in mainland China, with some 77,150 cases confirmed cases reported.
Image copyright AFPImage caption A worker sprays disinfectant to help prevent the spread of the novel coronavirus at a market in Seoul
What is the situation in North Korea?
North Korea has not confirmed any cases but the country shares a long and often porous border with China. There are concerns that North Korea, which is subject to international sanctions, lacks the health infrastructure to test and treat those infected and that any outbreak could quickly spread unchecked.
At the moment, all foreigners coming into the country must be quarantined for 30 days.
There are relatively few foreigners in North Korea, and only around 200 Westerners, according to one expert.
North Korean authorities have also cancelled the annual Pyongyang marathon, which typically sees people from all over the world participating.
Around 3,000 people in North Pyongan province – a north-western region bordering China – are also now under monitoring for reportedly showing suspected symptoms, said state media.
What about South Korea?
Media caption People in Daegu have voiced concern over the spread of the virus
South Korea has the largest number of confirmed cases outside China, after a huge spike in the past week.
Before last Wednesday, the country had recorded just 31 cases. That number has now jumped to 763.
Eight new cases of the virus have been reported in the army, and one in the navy, air force and marine corps – bringing the number to 11.
But the biggest virus clusters have been linked to a hospital and a religious group near the south-eastern city of Daegu.
A handful of South Korea airlines, including Korean Air Lines – the country’s biggest airline – has suspended flights going to Daegu, which has a population of around 2.5m.
Korean Air says the suspension will last until March 27
What’s happening in Italy?
Italian officials have introduced sweeping measures to control what is now the worst outbreak of the coronavirus in Europe – at least three people have died and more than 150 cases confirmed.
In the regions of Lombardy and Veneto, a lock-down is in place in several small towns. For the next two weeks, 50,000 residents will not be able to leave without special permission.
Even outside the zone, many businesses and schools have suspended activities, and sporting events have been cancelled – including several top-flight football matches.
Officials have yet to find the first carrier of the virus in the country.
World edges closer to coronavirus pandemic
Analysis by Fergus Walsh, medical correspondent
The combined situation in South Korea, Iran and Italy points to the early stages of pandemic. This means a global outbreak, with the coronavirus spreading in the community in multiple parts of the world.
In each of these countries we are seeing spread of the virus with no connection to China. The lockdown efforts in Italy mirror those that have happened in China.
The situation in Iran is especially worrying, because the health authorities have reportedly said the virus has spread to multiple cities, and it appears the first case in Lebanon is linked to a traveller from Iran.
If we have a pandemic, it will still be important to limit the speed of spread of the virus.
If countries could hold it somewhat at bay until the end of winter, there is a hope that warmer temperatures will reduce the time the virus can survive in the air, as we see with seasonal flu. But this may not be certain.
What’s the latest from Iran?
Iran said on Sunday it had 43 confirmed cases of the virus, most of them in the holy city of Qom. Eight of those infected have died, the highest number of deaths outside China.
Iraq, Pakistan, Armenia and Turkey have closed their borders with Iran, and Afghanistan has suspended air and road travel to and from Iran.
What about China, where the outbreak started?
China’s President Xi Jinping has described the outbreak as the “largest public health emergency” in the country’s recent history.
Speaking on Sunday, he acknowledged “shortcomings” in China’s response and said lessons must be learned.
China reported 409 new infections on Monday, the bulk of which were from Wuhan.
But outside China, cases with no clear link to that country or other confirmed cases continue to rise, prompting concern from the World Health Organization (WHO).
BEIJING/SEOUL (Reuters) – Italy, South Korea and Iran reported sharp rises in coronavirus infections on Monday, triggering concern from the World Health Organization (WHO), but China relaxed some curbs on movement, including in Beijing, as the rate of new infections there eased.
The virus has put Chinese cities into lockdown, disrupted air traffic to the workshop of the world and blocked global supply chains for everything from cars and car parts to smartphones.
The surge of cases outside mainland China triggered steep falls in global share markets and Wall Street stock futures as investors fled to safe havens. Gold soared to a seven-year high, oil tumbled nearly 4% and the Korean won KRW= fell to its lowest level since August.[MKTS/GLOB]
But U.S. Treasury Secretary Steven Mnuchin cautioned against jumping to conclusions about the impact on the global economy or supply chains, saying it was simply too soon to know.
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The World Health Organization (WHO) said it no longer had a process for declaring a pandemic, but that the coronavirus outbreak remained an international emergency.
“We are specially concerned about the rapid increase in cases in … Iran, Italy and the Republic of Korea,” WHO head Tedros Adhanom Ghebreyesus told a news conference in Sweden via video link from Geneva.
South Korea reported 231 new cases, taking its total to 833. Many are in its fourth-largest city, Daegu, which became more isolated with Asiana Airlines (020560.KS) and Korean Air (003490.KS) suspending flights there until next month.
Iran, which announced its first two cases last Wednesday, said it had confirmed 43 cases and eight deaths. Most of the infections were in the Shi’ite Muslim holy city of Qom.
Elsewhere in the Middle East, Bahrain and Iraq reported their first cases and Kuwait reported three cases involving people who had been in Iran.
Saudi Arabia, Kuwait, Iraq, Turkey, Pakistan and Afghanistan imposed restrictions on travel and immigration from Iran. Afghanistan also reported its first case, officials said.
The WHO has been saying for weeks that it dreads the disease reaching countries with weak health systems.
Europe’s biggest outbreak is in Italy, with some 150 infections – compared with just three before Friday – and a fifth death.
‘SEVERE AND COMPLEX’
Scientists around the world are scrambling to analyze the virus, but a vaccine is probably more than a year away.
“Worryingly, it seems that the virus can pass from person to person without symptoms, making it extremely difficult to track, regardless of what health authorities do,” said Simon Clarke, an expert in cellular microbiology at the University of Reading in Britain.
China postponed the annual meeting of its parliament in Beijing.
But there was a measure of relief for the world’s second-largest economy as more than 20 province-level jurisdictions, including Beijing and Shanghai, reported zero new infections, the best showing since the outbreak began.
President Xi Jinping urged businesses to get back to work, though he said the epidemic was still “severe and complex, and prevention and control work is in the most difficult and critical stage”.
Excluding the central Hubei province, center of the outbreak, mainland China reported 11 new cases, the lowest since the national health authority started publishing nationwide daily figures on Jan. 20.
The coronavirus has infected nearly 77,000 people and killed more than 2,500 in China, most in Hubei.
Overall, China reported 409 new cases on the mainland, down from 648 a day earlier, taking the total number of infections to 77,150 cases as of Feb. 23. The death toll rose by 150 to 2,592.
Outside mainland China, the outbreak has spread to about 29 countries and territories, with a death toll of about two dozen, according to a Reuters tally.
Xi said on Sunday the outbreak would have a relatively big, but short-term, impact on the economy and the government would step up policy adjustments to help cushion the blow.
Mnuchin, speaking to Reuters in the Saudi city of Riyadh, said he did not expect the coronavirus to have a material impact on the Phase 1 U.S.-China trade deal.
“Obviously that could change as the situation develops,” he added.
In northern Italy, authorities sealed off the worst-affected towns and banned public gatherings across a wide area, halting the carnival in Venice, where there were two cases.
Austria briefly suspended train services over the Alps from Italy after two travelers coming from Italy showed symptoms of fever.
Both tested negative for the new coronavirus but Austrian Interior Minister Karl Nehammer said a task force would meet on Monday to discuss whether to introduce border controls.
Japan had 773 cases as of late Sunday, mostly on a cruise ship quarantined near Tokyo. A third passenger, a Japanese man in his 80s, died on Sunday.
In South Korea, authorities reported a seventh death and dozens more cases on Monday. Of the new cases, 115 were linked to a church in the city of Daegu.
Drone footage showed what appeared to be hundreds of people queuing in a neat line outside a Daegu supermarket under the winter sunshine to buy face masks. ( tmsnrt.rs/37WP6lA )
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