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.
GUBEI WATER TOWN, China (Reuters) – The mock Qing dynasty village nestled below the Great Wall would normally be teeming with tourists on Labour Day, but the thin crowds on Friday showed that while China’s coronavirus epidemic has subsided, people’s fears could take longer to fade.
During holidays, some 100,000 visitors a day would traipse round the quaint stone-paved streets of Gubei Water Town, 110 kilometres (68 miles) northeast of Beijing. Its marketing manager reckoned on getting just a tenth of that number this year.
“People have concerns about the virus and are unwilling to travel long distances,” said Guo Baorong. For a start, there will be no international tourists this time, he said, noting foreigners would normally make up around 15% of visitors.
About 70% of China’s tourist attractions had reopened as of Thursday, according to China’s Ministry of Culture and Tourism, but all sites have had to cap visitors to 30% of designed capacity.
More sites, including the Forbidden City in Beijing, were set to reopen Friday.
Staff at the entrance to Gubei Water Town checked visitors’ temperatures and health tracking codes. And inside, lines on the ground directed tourists to stand one meter apart and stores used ropes to keep crowds from forming. Like everywhere in China since the lockdowns were imposed to stem the epidemic, everyone wore masks.
Still, in places where tourists squeezed together as the streets narrowed, staff shouted at them to spread out.
Some tourists enjoyed the smaller crowds.
Xiao Chen, a 24-year-old student wearing traditional Chinese garb known as “Hanfu” came to Gubei to take pictures around ancient architecture.
“It’s good to come out of the city. There was barely anyone in Gubei Water Town yesterday, and even today, it’s not crowded,” she said.
The tranquility may not last. Room bookings jumped on Thursday after Beijing and nearby areas began easing coronavirus restrictions, with about 90% of accommodation now reserved.
“We were not expecting that many people to come in,” said Guo.
SHENYANG, April 23 (Xinhua) — With trucks standing bumper to bumper and large cranes loading containers on the train, work returned to normal at a logistics base in northeast China’s Liaoning Province.
The base, where the China-Europe freight trains are set to depart in Shenyang, the provincial capital, has seen stable departures since early April as the novel coronavirus epidemic ebbs away.
With the global supply chain being affected by restrictions in air, land, and port travel due to the global pandemic, China-Europe railway has been playing a more important role, experts say.
“The train was operated by staff in different sections, which means it does not require cross-border personnel health inspections, giving it advantages during the pandemic,” said Shan Jing, an industry insider who wrote a book on China-Europe freight trains.
In March, a total of 809 China-Europe freight trains carrying 73,000 containers were sent across China. Both numbers hit a monthly record.
At the Shenyang logistics base, trains depart to travel through Russia, Belarus, Poland and finally reach Germany in around 18 days. As of April 13, a total of 130 trains carrying 11,200 standard containers had departed from the base.
“The province sends a stable number of five trains each week,” said He Ruofan, a business manager with the Shenyang branch of China Railway Container Transport Corp., Ltd, operator of the trains.
The stable operation has made the route a top choice for many Chinese enterprises, said Yao Xiang, a manager with logistics group Sinotrans’s northeast company.
“Many shipping routes have been canceled, and the rest are more and more expensive amid the epidemic,” said Yao, noting the price for air cargo surged 5 to 10 times the normal price as flights decreased from China to Europe.
With increasing departing trains, returning trains on the route have also been increasing, Yao said.
Among the 130 trains that have been sent from the Shenyang base so far this year, 33 returned, carrying construction materials, car parts, mechanical equipment, and daily products.
“These goods provide supplies to large companies like BMW and Michelin’s Shenyang factories,” Yao said.
Medical supplies have also been sent to hard-hit Europe to fight against the coronavirus pandemic.
As of April 18, a total of 448,000 pieces of medical supplies weighing 1,440 tonnes had been sent to European countries via the route, according to China State Railway Group Company, Ltd.
“China-Europe freight trains have shown great service capabilities during the epidemic,” said Shan, the industry insider. “It serves as a new choice for European enterprises, and I believe more people will come to realize the importance of the route.”
SEOUL/BEIJING (Reuters) – China has allowed 200 employees from South Korea’s Samsung Electronics Co Ltd (005930.KS) to enter the country to work on an expansion of the firm’s NAND memory chip factory, the company said on Wednesday.
The move came after China said on Tuesday that it was in talks with some countries to establish fast-track procedures to allow travel by business and technical personnel to ensure the smooth operation of global supply chains.
China said it has reached a consensus on such an arrangement with South Korea, without elaborating on the terms, including whether individuals entering China will be subject to quarantine.
China, where the virus first emerged late last year, blocked entry last month for nearly all foreigners in an effort to curb risks of coronavirus infections posed by travellers from overseas. After bringing the local spread under control with tough containment measures, it is trying to restart its economic engines after weeks of near paralysis.
A chartered China Air Ltd (601111.SS) plane flew in the Samsung Electronics employees on Wednesday, a company spokeswoman said.
Samsung said its employees will follow the local government’s policy upon arrival, without elaborating.
Shaanxi province, where Samsung’s NAND memory chip plant is located, requires people travelling from overseas to undergo a 14-day quarantine, according to South Korea’s foreign ministry.
“Samsung employees will not be exempted from the 14-day quarantine rule imposed by the Shaanxi province. They will get coronavirus tests at the airport upon arrival and will be transported to a local hotel designated by Chinese authorities,” an official at the Consulate General of South Korea in Xi’an told Reuters.
Samsung Electronics in December increased investment at its chip factory in China by $8 billion to boost production of NAND flash memory chips.
BEIJING (Reuters) – For Zhang Yu, who runs a cafe in one of Beijing’s top tourist spots, business has never been so bad.
To contain the spread of the coronavirus, bars and cafes in the Wudaoying hutong – a top Lonely Planet destination built around a narrow lane – are permitted to provide take-away services only. Non-residents must show proof they have an appointment to enter the area.
Added to which, tourism has plummeted.
“Don’t mention it! This is supposed to be the peak season,” said Zhang, who has run her cafe for five years. “But there are almost no customers as they (authorities) don’t want to have people hanging around here.”
While China’s manufacturing and retail sectors are starting to get back to work as the pace of new infections slows sharply, tourism sites in Beijing remain a shadow of their former and bustling self.
China’s capital city has maintained the highest level of emergency response to the outbreak, so tourist attractions like the Forbidden City remain closed. A 14-day quarantine for new arrivals has stifled travel.
As a result, small business owners running restaurants, souvenir shops and tourism agencies are struggling.
Only a little over 20% of tourism-related businesses in Beijing had resumed operation as of the three-day Qingming national holiday in early April, a survey by on-demand delivery service giant Meituan Dianping showed.
HANGING ON
The only people present in Wudaoying on a recent afternoon were a few elderly residents sitting outside to enjoy the spring sunshine. A cat made its way lazily through empty rooftop bars.
“We used to see more customers in one hour in pre-virus days than we see in a whole day right now,” said a worker at a sandwich restaurant in Wudaoying.
In another popular area, Khazzy, a 32-year-old doctoral student who opened a restaurant last October, has had only four customers all day.
“There are almost no tourists coming to Beijing and the remaining locals have concerns about eating out,” Khazzy said as sunset approached.
Khazzy said he has let five of his 13 staff go and has no idea how long he can stay afloat financially even though his landlord has agreed to waive one month’s rent on the property in Qianmen, near Beijing’s Tiananmen Square.
More than half of the shops in Qianmen remain closed. The manager of a state-backed noodle restaurant said most of the closed stores are privately owned small businesses that can’t secure enough business to support their daily operations.
She said revenues at the noodle restaurant have plunged more than 80%, but staff salaries have not been cut.
Zhang, the cafe owner in Wudaoying, reckoned small businesses could hold on for the next three months.
Some 460,000 Chinese firms shut in the first quarter amid fallout from the coronavirus
Registration of new firms between January and March fell 29 per cent from a year earlier
Many Chinese businesses are struggling from the economic fallout of the coronavirus. Photo: Reuters
More than 460,000 Chinese firms closed permanently in the first quarter as the coronavirus pandemic pummeled the world’s second largest economy, with more than half of them having operated for under three years, corporate registration data shows.
The closures comprised of businesses whose operating licenses had been revoked, as well as those who had terminated operations themselves, and included 26,000 in the export sector, according to Tianyancha, a commercial database that compiles public records.
At the same time, the pace of new firms being established slowed significantly. From January to March, around 3.2 million businesses were set up, a 29 per cent drop from a year earlier.
Most of these new companies were in traditional centres of economic power, such as Guangdong province in southern China, and close to half of them were in distribution or retail.
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The number of business closures underlines the challenges facing China as it tries to revive its economy, which is at risk of a contraction in the first quarter for the first time since 1976.
“China has managed to get the Covid-19 outbreak largely under control and domestic supply disruptions have now mostly dissipated,” Yao Wei and Michelle Lam, economists from French bank Societe Generale, said in a recent note.
“However, there are signs of lasting damage to domestic demand, and on top of that the external shock resulting from widespread lockdowns in other major economies is arriving fast and furious.”
In Dongguan, a once thriving industrial hub in the Pearl River Delta, rows of empty shops and closed factories are becoming a noticeable feature of the landscape as companies grapple with slumping international demand.
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In March, a local export-oriented manufacturer of tote bags and toys in the city, Dongguan Fantastic Toy Company, collapsed after overseas orders dried up, leaving some workers with unpaid salaries, the local labour authority said last month. The government has ordered the factory’s landlord to pay the outstanding wages.
Chinese business owners who can no longer afford to maintain operations face a number of hurdles before they can walk away from a company.
If an insolvent firm wants to cancel its company registration, it needs to go through bankruptcy procedures or show a liquidation report confirming it had no unpaid debt or other obligations.
Once shareholders or creditors file for bankruptcy, it can take months for courts to accept the case, followed by a long process of verification, creditors’ meetings and asset sales, said Li Haifeng, a partner at Baker McKenzie FenXun.
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“I expect a surge shortly after the situation settles down. We know many enterprises are already on the verge of bankruptcy. It’s just that they don’t have to declare or file for bankruptcy immediately,” Li said, adding he had received many queries on the matter in recent months.
Given the costly nature of bankruptcy proceedings, particularly for small businesses
struggling with cash flow or without sufficient assets, the number of bankruptcy filings this year would not be high, said Zhu Bao, a Beijing-based lawyer.
Fears over a growing number of companies going bust also appears to have played some part in Chinese courts rejecting and delaying bankruptcy filings, according to lawyers and official documents.
Creditors who filed on behalf of suppliers that helped contain the coronavirus or companies on the brink of bankruptcy as a direct result of the pandemic usually had their claims knocked back, dozens of court documents filed over the past two months showed.
We know many enterprises are already on the verge of bankruptcy. It’s just that they don’t have to declare or file for bankruptcy immediately – Li Haifeng
The courts in these cases encouraged the creditors to reconcile with the struggling firms and ride out the difficulties.
This – along with disruptions to court proceedings due to virus lockdowns – helped slow the review of bankruptcies in Chinese courts to 1,770 in February and March, from 2,160 filings in January, according to the national enterprise bankruptcy information disclosure platform.
“The delay and rejection of taking corporate bankruptcy cases is certainly intended to keep the economy going. Too many bankruptcies cases do not do much to help economic recovery,” Zhu said.
China’s central leadership has maintained it wants to hit economic targets for this year, even as the country braces for a possible second wave virus outbreak.
The delay and rejection of taking corporate bankruptcy cases is certainly intended to keep the economy going – Zhu Bao
The odds of a first quarter economic contraction for China are growing, however, and economists are debating whether it still makes sense for Beijing to set a specific gross domestic product (GDP) growth target for 2020.
Ma Jun, an academic member of the People’s Bank of China’s monetary policy committee, is one prominent voice that has suggested Beijing drop a set target amid the uncertainty caused by the virus outbreak.
However, others like Yu Yongding, an economist from Chinese Academy of Social Sciences, said it was necessary to anchor the country’s economic expansion, though the government should be realistic about the goal, reported the Beijing-based financial media group Caixin.
Image copyright GETTY IMAGESImage caption Staff film a tomb sweeping ceremony for a customer
People in China are paying their respects to dead ancestors digitally as the country continues to face the coronavirus outbreak.
The Qingming festival, also known as Tomb Sweeping Day, is usually a time when people visit the graves of friends and family, sprucing up the area and making offerings to their spirits.
But amid fears of another outbreak, the government has advised people to stay away and maintain social distancing.
That’s led to some cemeteries allowing people to come as long as they’ve booked a slot, while others are banning visits completely.
But other companies and burial places have turned to modern technology as they look for ways for families to continue the centuries-old tradition.
Li Quanxi, an official at Beijing’s civil affairs bureau, said: “We want to encourage people to transform social traditions amid the coronavirus outbreak.”
What is Qingming festival?
Qingming festival is one of the most important events in the calendar to commemorate ancestors who are no longer with you.
People clean the graves and burn items such as joss sticks and paper offerings – sometimes quite large ones – to honour the dead and transmit money and other goods to loved ones in the afterlife.
Image copyright AFPImage caption A woman burns incense ahead of the tomb sweeping festival
The tomb sweeping period falls between 28 March and 12 April.
Making offerings online
It is not completely unknown for pay their respects online, however, with the spread of Covid-19, there are now people who have no other option.
“Cloud tomb sweeping” allows people to “virtually” clean graves and make offerings to spirits.
One website providing this service is Heavenly Cemetery. On the surface, the website looks like any usual shopping site, although it also allows people to have their own memorial halls for their loved one so family and friends can join.
Relatives can light a candle, burn money and offer objects such as Chinese rice wine and beer. There is even an option for online tomb cleaning.
Media caption Watch: People pay respect to their deceased pets ahead of Tomb Sweeping Day
Funeral company Fu Shou Yuan International launched its own online tomb sweeping service on 12 March. It operates in more than 30 Chinese cities. In its first week, its website had about 87,000 visitors.
George Chen, whose grandparents are buried in Shanghai, visits their tombs every year but will be marking this year’s Tomb Sweeping Day online for the time being.
He told Shanghai Daily: “Old traditions are deeply rooted, but it is quite understandable because it is a special period. I will pay virtual respect and visit the scene once the epidemic ends.”
Getting someone to do it for you via livestream
While taking part in “cloud tomb sweeping” does mean you get to send offerings, it does not include the physical cleaning of a loved one’s tomb.
So some burial spots are now offering relatives a chance to watch a member of staff clean the tomb via a live stream. Others will send you photographs of the cleaned grave.
One cemetery in Shanghai is offering packages where a “valet sweep” starts from as little as 35 yuan (£4).
Image copyright GETTY IMAGESImage caption Staff hold a ceremony on behalf of a customer
Babaoshan funeral parlour, in Beijing, also offers live stream services.
Zhou Weihua, deputy director of the parlour, told Chinese news agency Xinhua that live streaming could become a future trend.
“Helping clients sweep tombs and holding online commemorative activities not only meets the demand in this special period but also offers more options for people to remember their deceased family members in the future.”
What about Wuhan?
China reported 3,199 deaths from coronavirus with 2,559 of those in Wuhan, where the first cases were recorded late last year.
The city is still in a lockdown which is expected to end on 8 April, and the government has announced that cemeteries will remain closed until 30 April.
Wuhan’s civil affairs department said it would make “unified arrangements to organise staff at cemeteries to hold a collective ceremony to pay tribute to the deceased”.
SHENYANG, April 5 (Xinhua) — Huo Chunlei, who runs a hotpot restaurant in Shenyang, capital of northeast China’s Liaoning Province, said he did not lay off any of his staff, although the restaurant is having difficulties for reopening after two months of closure in China’s nationwide measures of coronavirus control.
A few weeks after Chinese provincial-regions with low risk of the novel coronavirus gradually resumed work and production, shops and eateries have reopened, and roads become bustling again, as hundreds of millions of people confined at home for weeks in compliance with epidemic prevention rules get back to a normal life.
Huo’s restaurant has been in operation for a week. Only half of the tables are filled at dinnertime. The revenue is barely enough to cover the expenses of the house rent and employee wages, he said.
However, he said his business is able to survive because of the government’s bailout policies. For example, the approval of deferred payment of social insurance premiums for his employees alone can save him 80,000 yuan (about 11,250 U.S. dollars) a month.
“The staff are willing to stay, as we are all confident in tiding over the difficulties together,” he said.
The local governments at all levels have rolled out a slew of measures to shore up the catering business, including cutting taxes, reducing house rent as well as water and electricity fees.
The governments in Liaoning, Shandong, Jiangsu and Zhejiang provinces have issued coupons with a value ranging from 10 million yuan to 100 million yuan to encourage people to spend on dining out.
Before the production resumption, there were some consumer councils’ surveys showing that consumers had suppressed consumption desire for dining out and shopping as well as going to movie theaters, gymnasiums and tourist spots after the epidemic crisis ends.
“The so-called retaliatory consumption has not yet appeared in the catering industry, as people are still wary about the infection risk, but there will be a gradual recovery growth,” said Chen Heng, executive director of Hainan Hotel and Catering Industry Association in the southernmost Chinese province of Hainan.
“Before reopening, we increased the distances between tables, but with reduced tables, there are still many empty tables at dinner time. My restaurant used to have all seats full and even queues,” said Huo.
Like Huo, Lin Lunheng, founder of the Fuzhou Super Dinner Co. Ltd. in southeast China’s Fujian Province, is also worried about business.
“Although the chain stores have reopened, revenues have decreased by 70 percent compared with that before the epidemic. This is a big blow to restaurants,” said Lin.
The Italian style chain restaurant has offered e-coupons to draw customers.
As the spring weather is getting more and more pleasant, consumers’ desire for dining out and travel is growing. According to a survey report jointly released by the China Travel Academy and Trip.com Group on March 19, Chinese are longing for tours across the country, with Yunnan, Hainan and Shanghai among the top destinations.
Throughout the world, overworked health care professionals are being infected with Covid-19, yet the Lion City has kept numbers low
Preparation, planning, patient ratios and protective equipment have all played a part. Still, even the best gear cannot guard against discrimination
Medical staff walk to the National Centre for Infectious Diseases building at Tan Tock Seng Hospital in Singapore. Photo: AFP
Uncooperative patients, long hours and a lack of protective equipment are hampering health care workers across the world as they take the fight to the coronavirus, leading many to fall sick themselves.
In Malaysia, a pregnant woman who did not disclose that her father was infected tested positive after giving birth, leading to the shutdown of the entire hospital for cleaning. In the Philippines, nine doctors have died, two of whom had dealt with a patient who lied about her travel history.
In Spain, where more than 5,400 health care workers have been infected, accounting for about 14 per cent of the country’s patients, there are no longer enough workers to care for patients.
In Italy, which has more than 69,000 patients, the virus killed a doctor who had no choice but to work without gloves.
In the United States, which has surpassed China to become the world’s most infected nation with more than 83,000 people testing positive for Covid-19, hospitals are being overrun with patients.
Health care staff in the country say patients are packed into emergency wards and intensive care units (ICUs), further raising the risk of infections. They also report shortages of ventilators, face masks, gowns and shields.
The US Centres for Disease Control and Prevention on March 7 released interim guidelines saying health care workers exposed to the coronavirus could be asked to return to work as long as they wore face masks and were not showing symptoms, if their employers had no other manpower available.
Malaysian health workers at Kuala Lumpur International Airport. Photo: AFP
A REASON FOR OPTIMISM
However, amid all the gloom, Singapore’s experienceis being held up as a reason for optimism. The city state has reported more than 630 cases of infection, all of which are being treated in hospital, yet only a handful of its health care professionals have been infected. What’s more, even these cases, according to Vernon Lee, director of communicable diseases at the Ministry of Health, are thought to have been infected outside the health care setting.
Experts suggest this has been more than just luck, pointing to a case in which 41 health workers were exposed to the coronavirus in a Singapore hospital yet evaded infection.
The workers had all come within two metres of a middle-aged man with Covid-19 who was being intubated, a procedure which involves a tube being inserted into the patient’s trachea. The procedure is seen as being particularly hazardous for health workers as it is “aerosol generating” – patients are likely to cough.
The workers had not known at the time that the man had the virus and all were quarantined after he tested positive. However, on their release two weeks later, none of them had the virus.
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The case has come to widespread attention partly because the workers were wearing a mix of standard surgical masks and the N95 mask, which doctors see as the gold standard as it filters out 95 per cent of airborne particles.
The conclusion, published in The Annals of Internal Medicine this month, was this: “That none of the health care workers in this situation acquired infection suggests that surgical masks, hand hygiene, and other standard procedures protected them from being infected.”
Surgeon and writer Atul Gawande mentioned the case in an article for The New Yorker on how health care workers could continue seeing patients without becoming patients. He said there were things to learn from Asia and that some of the lessons came out of the “standard public health playbook”. In other words, there is much to be said for social distancing, basic hand hygiene and cleaning regimens.
A health worker in protective gear walks into a quarantine room at a hospital in Banda Aceh, Indonesia. Photo: AFP
COMING TOGETHER
With critical supplies running short in many countries, experts say it is increasingly vital that countries share both knowledge and resources.
To this end, China has been donating personal protective equipment to places including the Philippines, Pakistan and Europe. China’s richest man Jack Ma is donating 1.8 million masks, 210,000 Covid-19 test kits and 36,000 pieces of protective clothing to 10 countries in Asia.
At the same time, doctors are encouraging the Western world to learn from Asia.
Infectious diseases expert Leong Hoe Nam said that being “bitten by Sars” (severe acute respiratory syndrome) in 2003 had prepared Asia for Covid-19, while Western countries were not similarly prepared and hence lacked sufficient protective equipment.
He pointed to how about 2,000 health care workers had fallen sick in China early in the outbreak because workers did not initially have protective gear. The trend reversed as equipment became available.
“Once the defences were up, there were very few health care workers who fell sick at work. Rather, they fell sick from contact with sick individuals outside the workplace,” he said.
Malaysia is a case in point. While it has reported 80 health care workers falling ill, most are thought to be community infections.
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In a webinar organised by Caixin Global on Thursday night, Peng Zhiyong, an intensive care specialist at Zhongnan Hospital of Wuhan University, shared how they managed a shortage of personal protective equipment early on in the outbreak by rationing workers to two sets of gear per shift.
Meanwhile, in the Philippines, doctors from Manila’s Chinese General Hospital held a video conference call with doctors in Zhejiang to learn from China’s experience of treating Covid-19 patients.
Crowdsourcing platforms have also been created to share advice. The Brigham and Women’s Hospital in Boston has released guidelines for treating critically ill patients and its website includes information from Chinese doctors.
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The Jack Ma Foundation has also launched an online platform for doctors and nurses around the world to share knowledge on fighting the virus. “One world, one fight,” it said in a tweet.
Associate Professor Jeremy Lim from the global health programme at the Saw Swee Hock School of Public Health said it was crucial for countries to work together.
“Viruses don’t respect borders. Countries have to share information and help each other as we are only as strong as the weakest link. Any country can become a reservoir of disease and the world may then be forced to endure a ping-pong of outbreaks over and over again.”
And the advice of Lee, at Singapore’s Ministry of Health? “Practise good hygiene and wash hands regularly.”
Indonesian medical staff administer mass testing for Covid-19 in Bekasi, West Java. Photo: AFP
SINGAPORE, A CASE STUDY
Amid this sharing of advice, it is often Singapore that is held up as an example to replicate. Despite the country grappling with a rising load of Covid-19 patients, most of whom have recently returned to the city state from abroad, its health care system has continued to run smoothly. Doctors say this is because it has been preparing for a pandemic ever since Sars caught it by surprise. During the Sars outbreak, health care workers accounted for 41 per cent of Singapore’s 238 infections.
Consequently its hospitals swung into contingency planning mode early on in the coronavirus outbreak, telling staff to defer leave and travel plans after its first cases emerged.
Meanwhile, its hospitals swiftly split their workforces into teams to ensure there were enough workers if the outbreak worsened, and to ensure workers got enough rest.
Singapore has 13,766 doctors, or 2.4 doctors for every 1,000 people. That compares to 2.59 in the US, 1.78 in China and 4.2 in Germany. Places like Myanmar and Thailand have fewer than one doctor for every 1,000 people.
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“The objective is that you can run essential services with the greatest amount of security. Make sure functional units have redundancy built in, and are separate from each other. It depends on what you feel is sufficient to carry on services if one team is affected, factoring in rest periods and some system of rotation,” said Chia Shi-Lu, an orthopaedic surgeon.
The key is to ensure a good doctor-to-patient ratio and ensure there are enough specialists for the critical work, such as doctors and nurses who can provide intensive care, and know how to operate mechanical ventilators or machines to pump and oxygenate a patient’s blood outside the body.
At the emergency department where paediatrics emergency specialist Jade Kua treats Covid-19 cases in addition to regular emergencies, doctors are split into four teams of 21. Each team takes alternate 12-hour shifts and does not interact with other teams.
“We are in modular teams so the teams move together. So you and I would both do morning, off, night, off, morning off. Together. And then the other teams would do the same and we don’t intermingle,” said Kua.
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Chia, who works at the Singapore General Hospital, said doctors had been split up according to their functions.
“We try not to meet at all with the other teams as much as possible. We’ll just say hi from across the corridor. Meals are the same. All our cafeterias and everything have got social distancing spaced in already,” said Chia, who is also a member of parliament and chairs a shadow committee on health.
Chia said the health care system could also tap on doctors in the private sector.
Not every country has a plan like this. Last year’s Global Health Security Index by the Economist Intelligence Unit found that 70 per cent of 195 countries scored poorly when it came to having a national plan for dealing with epidemics or pandemics. Almost three in 10 had failed to identify which areas were insufficiently staffed. In India, with a population of 1.3 billion, only about 20,000 doctors are trained in key areas such as critical care, emergency medicine and pulmonology.
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In contrast, Singapore published its first Influenza Pandemic Preparedness and Response Plan in June 2005 and has since honed it to a tee. Hospitals regularly war-game scenarios such as pandemics or terrorist attacks and the simulations are sometimes observed by the Ministry of Health, which grades the performance and recommends areas for improvement.
The plan also covers the need to stockpile equipment to avoid the sort of shortages many countries are now facing, another lesson inspired by Sars when masks, gloves and gowns were in short supply.
In a pandemic preparation paper published in 2008, Singapore public health specialist Jeffery Cutter wrote that Singapore’s stockpile was sufficient to cover at least 5 to 6 months’ use by all front-line health care workers.
During the Covid-19 outbreak, it has also told citizens to not wear masks so it can conserve supply for medical staff.
Having enough protective gear has reassured Singapore’s health care workers such as Kua, a mother of six who blogged about her experience fighting Covid-19. Kua said: “I’m safe and my family is safe.”
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SOMETHING YOU CAN’T GUARD AGAINST
Despite the many positives to emerge from the Lion City, its health care workers are struggling with another problem: discrimination.
While in France, Italy and Britain, residents cheer health care workers from their windows, in Singapore health care workers are seen by some people as disease carriers.
“I try not to wear my uniform home because you never know what kind of incidents you may encounter,” said one Singapore nurse. “The public is scared and wearing our uniforms actually causes quite a bit of inconvenience. One of my staff tried to book a private-hire car to the hospital for an emergency and she was rejected by five drivers.”
There is a similar stigma in India, where the All India Institute of Medical Sciences has appealed to the government for help after health workers were forced out of their homes by panicked landlords and housing societies.
“Many doctors are stranded on the roads with all their luggage, nowhere to go, across the country,” the institute said in a letter.
Lim, from the Saw Swee Hock School of Public Health, said the worst human impulses and “every man for himself” attitudes could emerge in crises and “that is exactly why governments have to step in”.
Discrimination could affect both the performance and motivation of health care workers, Lim warned.
Meanwhile, when health care workers are infected, it creates a “triple whammy” threat.
“It means one fewer professional in an already-strained system, another patient to care for and, potentially, a team of colleagues who need to be quarantined,” said Lim.
“We must do everything possible to keep our health care workforce safe and free from Covid-19.” ■
NEW YORK (Reuters) – The number of U.S. coronavirus infections climbed above 82,000 on Thursday, surpassing the national tallies of China and Italy, as New York, New Orleans and other hot spots faced a surge in hospitalizations and looming shortages of supplies, staff and sick beds.
With medical facilities running low on ventilators and protective masks and hampered by limited diagnostic testing capacity, the U.S. death toll from COVID-19, the respiratory disease caused by the virus, rose beyond 1,200.
“Any scenario that is realistic will overwhelm the capacity of the healthcare system,” New York Governor Andrew Cuomo told a news conference. He described the state’s projected shortfall in ventilators – machines that support the respiration of people have cannot breathe on their own – as “astronomical.”
“It’s not like they have them sitting in the warehouse,” Cuomo added. “There is no stockpile available.”
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At least one New York City hospital, New York-Presbyterian/Columbia University Medical Center in Manhattan, has begun a trial of sharing single ventilators between two patients.
While New York was the coronavirus epicenter in the United States this week, the next big wave of infections appeared headed for Louisiana, where demand for ventilators has already doubled. In New Orleans, the state’s biggest city, Mardi Gras celebrations late last month are believed to have fueled the outbreak.
Louisiana Governor John Bel Edwards said New Orleans would be out of ventilators by April 2 and potentially out of bed space by April 7 “if we don’t flatten the infection curve soon.”
“It’s not conjecture, it’s not some flimsy theory,” Edwards told a press conference. “This is what is going to happen.”
About 80% of Louisiana’s intensive care patients are now on breathing machines, up from the normal rate of 30-40%, said Warner Thomas, chief executive of Ochsner Health System, the state’s hospital group.
Scarcities of protective masks, gloves, gowns and eyewear for doctors and nurses – reports abound of healthcare workers recycling old face masks, making their own or even using trash bags to shield themselves – have emerged as a national problem.
“Our nurses across the country do not have the personal protective equipment that is necessary to care for COVID patients, or any of their patients,” Bonnie Castillo, head of the largest U.S. nurses union, National Nurses United, told MSNBC.
In an ominous milestone for the United States as a whole, at least 82,153 people nationwide were infected as of Thursday, according to a Reuters tally from state and local public health agencies. China, where the global pandemic emerged late last year, had the second highest number of cases, 81,285, followed by Italy with 80,539.
At least 1,204 Americans have died from COVID-19, which has proven especially dangerous to the elderly and people with underlying chronic health conditions, Reuters’ tally showed.
MORE BEDS NEEDED
For New York state, Cuomo said a key goal was rapidly to expand the number of available hospital beds from 53,000 to 140,000.
New York hospitals were racing to comply with Cuomo’s directive to increase capacity by at least 50%. At Mount Sinai Hospital’s Upper East Side location, rooms were being constructed within an atrium to open up more space for beds.
At Elmhurst Hospital in New York’s borough of Queens, about a hundred people, many wearing masks with their hoods pulled up, lined up behind barriers outside the emergency room entrance, waiting to enter a tent to be screened for the coronavirus.
The city coroner’s office has posted refrigerated trucks outside Elmhurst and Bellevue Hospital to temporarily store bodies of the deceased.
Deborah White, vice chair of emergency medicine at Jack D. Weiler Hospital in the city’s Bronx borough, said 80% of its emergency room visits were patients with coronavirus-like symptoms.
A ventilator shortfall and surge in hospitalizations has already raised the prospect of rationing healthcare.
Asked about guidelines being drafted on how to allocate ventilators to patients in case of a shortage, New Jersey Governor Phil Murphy told reporters such bioethical discussions “haunted him” but were unavoidable.
Outside New York and New Orleans, other hot spots appeared to be emerging around the country, including Detroit.
Brandon Allen, 48, was buying groceries in Detroit for his 72-year-old mother, who has tested positive and was self-quarantining at home.
“It’s surreal,” Allen said. “People around me I know are dying. I know of a couple people who have died. I know a couple of people who are fighting for their lives. Everyday you hear of another person who has it.”
RECORD UNEMPLOYMENT CLAIMS
Desperate to slow virus transmissions by limiting physical contact among people, state and local governments have issued stay-at-home orders covering about half the U.S. population. A major side effect has been the strangulation of the economy, and a wave of layoffs.
The U.S. Labor Department reported Thursday the number of Americans filing claims for unemployment benefits last week soared to a record of nearly 3.28 million – almost five times the previous weekly peak of 695,000 during the 1982 recession.
Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said warmer weather may help tamp down the U.S. outbreak as summer approaches, though the virus could re-emerge in the winter.
“We hope we get a respite as we get into April, May and June,” Fauci said on WNYC public radio.
Washington state Governor Jay Inslee said he may extend a stay-at-home order tentatively set to expire April 6, encouraged by what he called a “very modest improvement” in the Seattle area.
Washington experienced the first major U.S. outbreak of COVID-19 and has been among the hardest-hit states. As of Thursday the state reported about 3,200 cases and 147 deaths.
In California’s Coachella Valley, a region rife with retirees who are especially vulnerable, 25 members of the state’s National Guard helped a non-profit distribute food to people stuck in their homes, as most of the regular volunteers are senior citizens.
More than 10,000 troops have been deployed in 50 states to provide humanitarian aid during the pandemic.
The spring session of China’s Canton Fair has been postponed due to fears about the spread of the coronavirus pandemic, authorities in Guangdong province say
Premier Li Keqiang had insisted early this month that the fair’s spring session would go ahead as it was crucial for efforts to ‘stabilise’ the global economy
The spring session of China’s Canton Fair has been postponed due to the coronavirus outbreak. Photo: Xinhua
The spring session of China’s largest trade expo, the Canton Fair, has been suspended over concerns about the spread of the coronavirus, Chinese authorities said on Monday.
The announcement comes amid reports that regular foreign buyers were scrapping plans to attend the event, which was due to open on April 15. The fair has held its spring session in Guangzhou, the capital of Guangdong province, between mid-April and early May since 1957.
The decision was made after considering the current development of the pandemic, especially the high risk of imported infections, Ma Hua, deputy director of Guangdong’s department of commerce, was quoted as saying on Monday by the official Nanfang Daily.
Guangdong will assess the epidemic situation and make suggestions to the relevant departments of the central government, Ma said at a press conference.
No new date for the fair was announced, but veteran traders who regularly attend the event said the Guangdong government is talking with Beijing about a new time, possibly in May.
Premier Li Keqiang had insisted early this month that the fair’s spring session would go ahead despite the virus outbreak, as it was an important part of Beijing’s efforts to
Authorities of Guangdong, China’s main export and manufacturing hub, joined other large cities, including Beijing and Shanghai, in introducing new restrictions on Saturday that require all foreign visitors be isolated for 14 days at their own expense.
The containment measures, which come as China braces for a second wave
of imported coronavirus cases, would have applied to tens of thousands of foreign merchants attending the fair.
Coronavirus: Chinese companies cut salaries and staff in industries hit hardest by Covid-19
The Canton Fair occurs twice a year and is China’s oldest and largest exhibition. The spring session last year attracted 195,454 foreign buyers from 213 countries and regions across the world. The top five sources of buyers were from Hong Kong, India, the United States, South Korea and Thailand.
But a growing number of regular attendees have recently cancelled plans to take part in this year’s spring session, Chinese exporters said, as concerns mount about possible infection and extra expenses due to a mandatory two week quarantine after arrival.
“About 80 per cent of our firm’s veteran clients told us last month they won’t come this time,” said Jason Liang, a sales manager at a Guangzhou-based exporter of electronic products, who did not want his company identified. “Plus with this new [quarantine], I think at least 90 per cent or almost all of them would drop the trip.
“The costs – time, security and expense – are totally uncontrollable for international travel currently. We also have no plans to attend any exhibition before the summer.”
About 80 per cent of our firm’s veteran clients told us last month they won’t come this time … The costs – time, security and expense – are totally uncontrollable for international travel currently. Jason Liang
Felly Mwamba, a leader of the Congolese community in Guangzhou who has been in the city since 2003, said China’s quarantine measures made it hard for people to visit Guangzhou.
Xie Jun, a furniture and fabric exporter from Zhejiang, said buyers from developing countries that were part of the Belt and Road Initiative would be hard hit if they were forced to pay for quarantine and treatment.
“In February before the pandemic occurred, to cushion the impact some local governments in China’s exporting trade hubs, such as Yiwu and Jinhua, introduced subsidies to attract foreign merchants,” he said. “But now all the subsidies policies are cancelled from what I know.”
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Chinese exporters, traders, and even local residents in Guangdong, have previously voiced concern about authorities’ decision to press on with the even due to the growing number of imported cases to China.
“We strongly call on the government to cancel the spring session of the Canton Fair,” said Zhu Yinghua, a retired teacher in Guangzhou, said before the announcement.
“It’s too dangerous for us local residents if dozens of thousands of foreigners to flock into Guangzhou.”
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