Archive for ‘shared’

31/05/2020

India coronavirus: Why is India reopening amid a spike in cases?

A rush of people and motorists in a marketplace area as shops start opening in the city under specific guidelines, on May 20, 2020 in Jammu, IndiaImage copyright GETTY IMAGES
Image caption Within a week of reopening, India has seen a sharp spike in cases

India is roaring – rather than inching – back to life amid a record spike in Covid-19 infections. The BBC’s Aparna Alluri finds out why.

On Saturday, India’s government announced plans to end a national lockdown that began on 25 March.

This was expected – the roads, and even the skies, have been busy for the last 10 days since restrictions started to ease for the first time in two months. Many businesses and workplaces are already open, construction has re-started, markets are crowded and parks are filling up. Soon, hotels, restaurants, malls, places of worship, schools and colleges will also reopen.

But the pandemic continues to rage. When India went into lockdown, it had reported 519 confirmed cases and 10 deaths. Now, its case tally has crossed 173,000, with 4,971 deaths. It added nearly 8,000 new cases on Saturday alone – the latest in a slew of record single-day spikes.

A worker cleans the mascot of fast-food company McDonald's for the reopening of the outlet in Hyderabad on May 20.Image copyright GETTY IMAGES
Image caption Fast food chains like McDonald’s have begun reopening outlets in parts of India.

So, why the rush to reopen?

The lockdown is simply unaffordable

“It’s certainly time to lift the lockdown,” says Gautam Menon, a professor and researcher on models of infectious diseases.

“Beyond a point, it’s hard to sustain a lockdown that has gone on for so long – economically, socially and psychologically.”

From day one, India’s lockdown came at a huge cost, especially since so many of its people live on a daily wage or close to it. It put food supply chains at risk, cost millions their livelihood, and throttled every kind of business – from car manufacturers to high-end fashion to the corner shop selling tobacco. As the economy sputtered and unemployment rose, India’s growth forecast tumbled to a 30-year-low.

Raghuram Rajan, an economist and former central bank governor, said at the end of April that the country needed to open up quickly, and any further lockdowns would be “devastating”.

The opinion is shared by global consultant Mckinsey, whose report from earlier this month said India’s economy must be “managed alongside persistent infection risks”.

Passengers maintaining social distance as they are on board in a DTC Bus after government eased lockdown restriction, at AIIMS on May 20, 2020 in New Delhi, India.Image copyright GETTY IMAGES
Image caption As restrictions ease, Indians are slowly getting used to the new normal

“The original purpose of the lockdowns was to delay the spike so we can put health services and systems in place, so we are able handle the spike [when it comes],” says Dr N Devadasan, a public health expert. “That objective, to a large extent, has been met.”

In the last two months, India has turned stadia, schools and even train coaches into quarantine centres, added and expanded Covid-19 wards in hospitals, and ramped up testing as well as production of protective gear. While grave challenges remain and shortages persist, the consensus seems to be that the government has bought as much time as possible.

“We have used the lockdown period to prepare ourselves… Now is the time to revive the economy,” Delhi Chief Minister Arvind Kejriwal said last week.

The silver lining

For weeks, India’s relatively low Covid-19 numbers baffled experts everywhere. Despite the dense population, disease burden and underfunded public hospitals, there was no deluge of infections or fatalities. Low testing rates explain the former, but not the latter.

In fact, India made global headlines not for its caseload but for its botched handling of the lockdown – millions of informal workers, largely migrants, were left jobless overnight. Scared and unsure, many tried to return home, often desperate enough to walk, cycle or hitchhike across hundreds of kilometres.

Perhaps the choice – between a virus that didn’t appear to be wreaking havoc yet, and a lockdown that certainly was – seemed obvious to the government.

But that is changing quickly as cases shoot up. “I suspect we will keep finding more and more cases, but they will mostly be asymptomatic or will have mild symptoms,” Dr Devadasan says.

The hope – which is also encouraging the government to reopen – is that most of India’s undetected infections are not severe enough to require hospitalisation. And so far, except in Mumbai city, there has been no dearth of hospital beds.

India’s Covid-19 data is spotty and sparse, but what it does have suggests that it hasn’t been as badly hit by the virus as some other countries.

The government, for instance, has been touting India’s mortality rate as a silver lining – at nearly 3%, it’s among the lowest in the world.

But some are unconvinced by that. Dr Jacob John, a prominent virologist, says India has never had, and still doesn’t have, a robust system for recording deaths – in his view, the government is certainly missing Covid-19 deaths because they have no way of knowing of every fatality.

A woman jogs at Lodhi Garden after the local government eased restrictions imposed as a preventive measure against the spread of the COVID-19 coronavirus in New Delhi on May 21, 2020.Image copyright GETTY IMAGES
Image caption Indians are venturing out again but it’s unclear how many of them are asymptomatic.

And, he says, “what we must aim for is flattening the mortality curve, not necessarily the epidemic curve”.

Dr John, like several other experts, also predicts a peak in July or August, and believes the country is reopening so quickly because the “government realised the futility of such leaky lockdowns”.

A shift in strategy

So is the government gearing up for another lockdown when the peak comes?

While Dr Menon believes the lockdown was well-timed, he says it was too focused on cases coming from abroad.

“There was a hope that by controlling that, we could prevent epidemic spread, but how effective was our screening [at airports]?”

Now, he adds, is the time for “localised lockdowns”.

Media caption Coronavirus: Death and despair for migrants on Indian roads

The federal government has left it to states to decide where, how and to what extent to lift the lockdown as the virus’ progression varies wildly across India.

Maharashtra alone accounts for more than a third of India’s active cases. Add Tamil Nadu, Gujarat and Delhi, and that makes up 67% of the national total.

But other states – such as Bihar – are already seeing a sharp uptick as migrant workers return home.

“Initially, most of your cases were in the cities,” Dr Devadasan says. “But we kept the migrant workers in cities and didn’t allow them to go home. Now, we are sending them back. We have facilitated transporting the virus from urban areas to rural areas.”

While the government has said how many infections have been avoided – up to 300,000 – and lives saved – up to 71,000 – by the lockdown, there is no indication of what lies ahead.

There is only advice: The day the government began to ease restrictions, Mr Kejriwal tweeted, urging people to “follow discipline and control the coronavirus disease” as it was their “responsibility”.

The famous Paranthe wali gali (bylane of fried bread) in Chandni Chowk, on August 20, 2014 in New Delhi, India.Image copyright GETTY IMAGES
Image caption Social distancing will prove to be India’s biggest post-lockdown challenge

Because the alternative – of curfews and constant policing – is unsustainable.

“My worry is more the circumstances of people – it’s not as though they have an option to practise social distancing,” Dr Menon says.

And they don’t – not in joint family homes or one-room hovels packed together in slums, not in crowded markets or busy streets where jostling is second nature, or in temples, mosques, weddings or religious processions where more is always merrier.

The overwhelming message is that the virus is here to stay, and we have to learn to live with it – and the only way to do that, it appears, is to let people live with it.

Source: The BBC

15/04/2020

Coronavirus: China launches study into asymptomatic cases and shared immunity

  • Residents of nine regions, including Wuhan, Beijing and Shanghai, to be sampled using both nucleic acid and antibody tests, state media reports
  • Research ‘very important as it will help us to direct our countermeasures in the future’, molecular virologist says
China is using dual testing to determine how many people have been infected with Covid-19 but recovered without showing symptoms. Photo: AP
China is using dual testing to determine how many people have been infected with Covid-19 but recovered without showing symptoms. Photo: AP
China has begun a major survey to determine how many people might have been infected with the coronavirus and then recovered without ever showing symptoms, while also assessing immunity levels within different communities, state media reported.

The research will be conducted in six provinces, including Hubei which was the focus of the initial outbreak, as well as Beijing, Shanghai and Chongqing.

Wuhan

, the capital of Hubei and home to about 60 per cent of all infections reported in mainland China, is taking the lead in the study, which involves giving both nucleic acid and antibody tests to 11,000 of its 11 million residents, state news agency Xinhua reported on Wednesday.

Health workers collected throat swabs and blood samples from about 900 people randomly selected from eight subdistricts of the city on Tuesday, Ding Gangqiang, head of the Wuhan epidemiological survey team, was quoted as saying.

“The purpose is to learn about the immunity level in communities and provide scientific support on how we should adjust our disease control strategies,” he said.

Professor Lu Hongzhou, a specialist in infectious diseases who heads the Shanghai Public Health Clinical Centre where Covid-19 patients are being treated, said he supported the research though the collection of samples had yet to start in the city.

“We haven’t received notification from the top [to start],” he said. “The number of infections [in Shanghai] is not very big, but I think we’d better do this so as to have an idea of the scale of asymptomatic carriers.”

Professor Jin Dong-yan, a molecular virologist at the Li Ka Shing Faculty of Medicine at the University of Hong Kong, said that the use of both nucleic acid and antibody tests would enable scientists to determine those people who had been infected but recovered without medical aid and without showing symptoms.

The study into asymptomatic infections got under way in Wuhan in Tuesday. Photo: Simon Song
The study into asymptomatic infections got under way in Wuhan in Tuesday. Photo: Simon Song
If a person tested positive in a nucleic acid test, it meant they were carrying the virus, and if positive in an antibodies test, it meant that they had contracted the virus and had recovered, he told the South China Morning Post.

“This is very important as it will help us to direct our countermeasures in the future,” Jin said.

“If we find, say 60 per cent, of the population has acquired immunity, then lockdowns will no longer be meaningful. If it turns out that there are many people with a high viral load but without symptoms, then we should be on high alert and take stricter measures.

“For people in Hubei, the tests can also save them from discrimination when they get back to work – those who prove to have developed immunity are very unlikely to get infected [again] for at least a year,” he said.

Wuhan hotel owners say they’re on the brink of going bust

15 Apr 2020
Beijing began adding asymptomatic cases

to the nation’s daily infections tally at the start of April amid concerns that such people could trigger a second outbreak once the widespread lockdowns in cities like Wuhan and elsewhere were lifted.

China reported 103 new coronavirus infections on Wednesday, of which 39 were imported. Of the total, 57 people had no symptoms, including three of the imported cases.

Since the outbreak began, China has reported 82,295 cases, of which 95 per cent have recovered and been discharged from hospital.

Source: SCMP

09/04/2020

Pass the salt: The minute details that helped Germany build virus defences

MUNICH (Reuters) – One January lunchtime in a car parts company, a worker turned to a colleague and asked to borrow the salt.

As well as the saltshaker, in that instant, they shared the new coronavirus, scientists have since concluded.

That their exchange was documented at all is the result of intense scrutiny, part of a rare success story in the global fight against the virus.

The co-workers were early links in what was to be the first documented chain of multiple human-to-human transmissions outside Asia of COVID-19, the disease caused by the coronavirus.

They are based in Stockdorf, a German town of 4,000 near Munich in Bavaria, and they work at car parts supplier Webasto Group. The company was thrust under a global microscope after it disclosed that one of its employees, a Chinese woman, caught the virus and brought it to Webasto headquarters. There, it was passed to colleagues – including, scientists would learn, a person lunching in the canteen with whom the Chinese patient had no contact.

The Jan. 22 canteen scene was one of dozens of mundane incidents that scientists have logged in a medical manhunt to trace, test and isolate infected workers so that the regional government of Bavaria could stop the virus from spreading.

That hunt has helped Germany win crucial time to build its COVID-19 defences.

The time Germany bought may have saved lives, scientists say. Its first outbreak of locally transmitted COVID-19 began earlier than Italy’s, but Germany has had many fewer deaths. Italy’s first detected local transmission was on Feb. 21. By then Germany had kicked off a health ministry information campaign and a government strategy to tackle the virus which would hinge on widespread testing. In Germany so far, more than 2,100 people have died of COVID-19. In Italy, with a smaller population, the total exceeds 17,600.

CHART: Contrasting curves reut.rs/3c2UZA4

“We learned that we must meticulously trace chains of infection in order to interrupt them,” Clemens Wendtner, the doctor who treated the Munich patients, told Reuters.

Wendtner teamed up with some of Germany’s top scientists to tackle what became known as the ‘Munich cluster,’ and they advised the Bavarian government on how to respond. Bavaria led the way with the lockdowns, which went nationwide on March 22.

Scientists including England’s Chief Medical Officer Chris Whitty have credited Germany’s early, widespread testing with slowing the spread of the virus. “‘We all know Germany got ahead in terms of its ability to do testing for the virus and there’s a lot to learn from that,’” he said on TV earlier this week.

Christian Drosten, the top virologist at Berlin’s Charite hospital, said Germany was helped by having a clear early cluster. “Because we had this Munich cohort right at the start … it became clear that with a big push we could inhibit this spreading further,” he said in a daily podcast for NDR radio on the coronavirus.

Drosten, who declined to be interviewed for this story, was one of more than 40 scientists involved in scrutiny of the cluster. Their work was documented in preliminary form in a working paper at the end of last month, intended for The Lancet. The paper, not yet peer-reviewed, was shared on the NDR site.

ELECTRONIC DIARIES

It was on Monday, Jan. 27, that Holger Engelmann, Webasto’s CEO, told the authorities that one of his employees had tested positive for the new coronavirus. The woman, who was based in Shanghai, had facilitated several days of workshops and attended meetings at Webasto’s HQ.

The woman’s parents, from Wuhan, had visited her before she travelled on Jan. 19 to Stockdorf, the paper said. While in Germany, she felt unusual chest and back aches and was tired for her whole stay. But she put the symptoms down to jet lag.

She became feverish on the return flight to China, tested positive after landing and was hospitalised. Her parents also later tested positive. She told her managers of the result and they emailed the CEO.

In Germany, Engelmann said he immediately set up a crisis team that alerted the medical authorities and started trying to trace staff members who had been in contact with their Chinese colleague.

The CEO himself was among them. “Just four or five days before I received the news, I had shaken hands with her,” he said.

Now known as Germany’s “Case #0,” the Shanghai patient is a “long-standing, proven employee from project management” who Engelmann knows personally, he told Reuters. The company has not revealed her identity or that of others involved, saying anonymity has encouraged staff to co-operate in Germany’s effort to contain the virus.

The task of finding who had contact with her was made easier by Webasto workers’ electronic calendars – for the most part, all the doctors needed was to look at staff appointments.

“It was a stroke of luck,” said Wendtner, the doctor who treated the Munich patients. “We got all the information we needed from the staff to reconstruct the chains of infection.”

For example, case #1 – the first person in Germany to be infected by the Chinese woman – sat next to her in a meeting in a small room on Jan. 20, the scientists wrote.

Where calendar data was incomplete, the scientists said, they were often able to use whole genome sequencing, which analyses differences in the genetic code of the virus from different patients, to map its spread.

By following all these links, they discovered that case #4 had been in contact several times with the Shanghai patient. Then case #4 sat back-to-back with a colleague in the canteen.

When that colleague turned to borrow the salt, the scientists deduced, the virus passed between them. The colleague became case #5.

Webasto said on Jan. 28 it was temporarily closing its Stockdorf site. Between Jan. 27 and Feb. 11, a total of 16 COVID-19 cases were identified in the Munich cluster. All but one were to develop symptoms.

All those who tested positive were sent to hospital so they could be observed and doctors could learn from the disease.

Bavaria closed down public life in mid-March. Germany has since closed schools, shops, restaurants, playgrounds and sports facilities, and many companies have shut to aid the cause.

HAMMER AND DANCE

This is not to say Germany has defeated COVID-19.

Its coronavirus death rate of 1.9%, based on data collated by Reuters, is the lowest among the countries most affected and compares with 12.6% in Italy. But experts say more deaths in Germany are inevitable.

“The death rate will rise,” said Lothar Wieler, president of Germany’s Robert Koch Institute for infectious diseases.

The difference between Germany and Italy is partly statistical: Germany’s rate seems so much lower because it has tested widely. Germany has carried out more than 1.3 million tests, according to the Robert Koch Institute. It is now carrying out up to 500,000 tests a week, Drosten said. Italy has conducted more than 807,000 tests since Feb. 21, according to its Civil Protection Agency. With a few local exceptions, Italy only tests people taken to hospital with clear and severe symptoms.

Germany’s government is using the weeks gained by the Munich experience to double the number of intensive care beds from about 28,000. The country already has Europe’s highest number of critical care beds per head of the population, according to a 2012 study.

Even that may not be enough, however. An Interior Ministry paper sent to other government departments on March 22 included a worst-case scenario with more than 1 million deaths.

Another scenario saw 12,000 deaths – with more testing after partial relaxation of restrictions. That scenario was dubbed “hammer and dance,” a term coined by blogger Tomas Pueyo. It refers to the ‘hammer’ of quick aggressive measures for some weeks, including heavy social distancing, followed by the ‘dance’ of calibrating such measures depending on the transmission rate.

The German government paper argued that in the ‘hammer and dance’ scenario, the use of big data and location tracking is inevitable. Such monitoring is already proving controversial in Germany, where memories of the East German Stasi secret police and its informants are still fresh in the minds of many.

A subsequent draft action plan compiled by the government proposes the rapid tracing of infection chains, mandatory mask-wearing in public and limits on gatherings to help enable a phased return to normal life after Germany’s lockdown. The government is backing the development of a smartphone app to help trace infections.

Germany has said it will re-evaluate the lockdown after the Easter holiday; for the car parts maker at the heart of its first outbreak, the immediate crisis is over. Webasto’s office has reopened.

All 16 people who caught COVID-19 there have recovered.

Source: Reuters

17/11/2019

The truth behind India’s viral photo that got a girl into school

The viral photo in the newspaperImage copyright EENADU NEWSPAPER/A SRINIVAS
Image caption The photo that sparked an outcry

A five-year-old in the southern city of Hyderabad was enrolled in school after a photo of her peeking into a classroom sparked an outcry. BBC Telugu’s Deepthi Bathini reports on why the photo doesn’t tell the full story.

Divya is something of a local celebrity in the slum where she lives. The shy five-year-old was the subject of a recent photo which went viral – it showed her clutching a bowl and peeking into a classroom at the local government school.

The touching image was published in a Telugu newspaper on 7 November with a caption that translates from the Telugu as “hungry gaze”.

It quickly grabbed people’s attention: a children’s rights activist shared it on Facebook, lamenting that yet another child was being denied the right to food and education.

It had such an impact, the school enrolled Divya the following day.

But her father, M Lakshman, says the photo and the outcry it provoked was in fact unfair to him and his wife, Yashoda, who works as a sweeper.

Divya in school
Image caption Five-year-old Divya enrolled in school after a photo of her in a newspaper went viral

“I felt sad when I saw the photo,” he told the BBC. “Divya has parents and we are working so hard to give her a good future – but she was portrayed as a hungry orphan.”

Mr Lakshman says he was waiting for Divya to turn six so he could enrol her in a government hostel where his other two daughters are studying. The couple also have a son, who has finished school and is now applying to college while helping Mr Lakshman, who works as a rag picker.

Breaking the cycle

Divya and her parents live in a one-room hut in a shanty town in the heart of Hyderabad. The slum is about 100 metres from the government school, where Divya was photographed. Most of the 300 families living here are daily wage labourers and their children attend the school nearby.

The home is sparse and plastic and glass are piled outside, ready to be sold for recycling. He says between him and his wife, they earn about 10,000 rupees ($139; £108) a month, which pays for their food and clothes. Education, however, is free for the children, since they are all enrolled in government-run schools.

Mr Lakshman knows what it is to struggle: he himself grew up without parents and always battled to earn a decent living. “I never wanted my children to have the life I had. So I made sure they all go to school.”

The photo, he adds, was especially hurtful because he has also been taking care of his brother’s five children.

Divya with her father
Image caption Divya’s father said the outcry over the photo was “unfair” to his family

“My brother and sister-in-law passed away sometime ago. I didn’t want their five children to grow up as orphans. So, I enrolled all of them in a hostel and I take care of them.”

When asked why Divya had gone to the government school with a bowl in hand, Mr Lakshman explains that a lot of the younger children from the slum go there around lunch time to take advantage of the free midday meal – a government programme which provides cooked meals to children in more than a million schools – which they know about because their older brothers and sisters are already enrolled.

“Divya doesn’t go every day but she happened to go on that day and someone photographed her,” he explained.

This was confirmed by teachers at the school who told the BBC that some children brought lunch from home, so leftovers over from the free meal scheme would be given to the younger children who had not yet joined.

“Children are children. And there is no day-care centre, so a lot of these children hang around the school anyway,” says one teacher, who spoke on the condition of anonymity.

Divya in her new school
Image caption Divya says she’s excited to go to school

Mr Lakshman and his neighbours acknowledged the lack of an anganwadi, or government-sponsored day-care centre, in the neighbourhood was a major problem as parents had no place to leave their children so they could go to work.

The local school inspector, SU Shivram Prasad, says he hopes the attention generated by the Divya’s photo will hasten the process of setting up one up.

“It will help the parents and the children can eat a nutritious meal,” he adds.

Teachers at the school also hope that the media spotlight will improve facilities. They say there is an acute shortage of staff and teaching materials, and the school did not even have a compound wall, which meant they have to constantly watch the children during their breaks.

Divya, however, is excited to be going to school. She insists on taking her school bag with her everywhere, even to the playground. Other than saying her name, she does not answer any questions.

“She is a very calm child,” says Mr Lakshman, as his daughter holds his hand and kisses it.

And he admits that despite everything, the photo did do some good.

“Now other children who are Divya’s age are also enrolling in school. So that makes me happy.”

Source: The BBC

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