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Javier E

Epidemics expert Jonathan Quick: 'The worst-case scenario for coronavirus is likely' | ... - 0 views

  • n 2018 global health expert Jonathan D Quick, of Duke University in North Carolina, published a book titled The End of Epidemics: The Looming Threat to Humanity and How to Stop It. In it he prescribed measures by which the world could protect itself against devastating disease outbreaks of the likes of the 1918 flu, which killed millions and set humanity back decades. He is the former chair of the Global Health Council and a long-term collaborator of the World Health Organization (WHO).
  • The worst case is that the outbreak goes global and the disease eventually becomes endemic, meaning it circulates permanently in the human population.
  • If it becomes a pandemic, the questions are, how bad will it get and how long will it last? The case fatality rate – the proportion of cases that are fatal – has been just over 2%, much less than it was for Sars, but 20 times that of seasonal flu.
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  • If the worst-case scenario comes true, are there still things we can do to minimise the pandemic’s impact?Absolutely. We can mobilise more health officials and keep engaging the public, implementing sensible travel controls and ensuring that frontline health workers have ready access to diagnostic tests and are vigilant – that they don’t send anyone who may have been exposed home without testing them, for example
  • Was an epidemic like that of Covid-19 inevitable?From a biological standpoint an outbreak of a novel pathogen was inevitable, but this one happened in the worst place at the worst time. Wuhan is a big city and a crossroads,
  • is in people’s minds – even though the risk of another one is real. I’ve written about a hypothetical situation in which a new and dangerous pathogen emerges, a vaccine is developed, and you still get a pandemic, because large numbers of millennials refuse the vaccine. In the US, 20% of millennials believe that vaccines cause autism.
  • The problem is bad information. As my students often remind me, news tends to be behind paywalls, while fake news is free.
  • You have said that time and trust are critical to good epidemic management. What do you mean?The delay between the frontline health workers noticing something unusual, in the form of an emerging disease, and that information travelling up the line to central decision-makers is critical. To illustrate that, a 2018 simulation that the Gates Foundation conducted of a flu pandemic estimated that there would be 28,000 after one month, 10 million after three months, and 33 million after six months. The virus used in that simulation was more contagious and deadly than Covid-19 – though they are both respiratory viruses – but the example shows how all epidemics grow exponentially. So if you can catch an epidemic in the first few weeks, it makes all the difference.
  • y (GHS) Index – that scores countries on six dimensions: prevention, detection, response, health system, risk environment and compliance with international standards. No country scores perfectly on all six. China has detected and responded to this epidemic pretty well, though its health system is now stretched beyond capacity, but it is weak on prevention
  • How well is the US prepared?The US ranks high on the GHS index, but is still unprepared for a severe pandemic, should one happen. Malfunctioning coronavirus tests have frustrated public health labs and delayed outbreak monitoring. Supplies of masks, suits and other protective material for health workers are running low in the midst of a moderately severe flu season.
  • Since the creation of a much-needed public health emergency preparedness fund in the aftermath of 9/11, its budget and the public health functions it supports have been steadily reduced. This is the mentality that left the world vulnerable to the devastating 2014 outbreak of Ebola in west Africa – that is, close the fire department and cancel the fire insurance as nobody’s house or factory has burned down lately. It’s time we learned that the bugs never stop mutating and crossing over to humans.
  • What exactly should we be doing faster?Fewer than one in three countries are close to being prepared to confront an epidemic, which leaves the vast majority of the world’s population vulnerable.
Javier E

A Deadly Coronavirus Was Inevitable. Why Was No One Ready? - WSJ - 0 views

  • When Disease X actually arrived, as Covid-19, governments, businesses, public-health officials and citizens soon found themselves in a state of chaos, battling an invisible enemy with few resources and little understanding—despite years of work that outlined almost exactly what the virus would look like and how to mitigate its impact.
  • Governments had ignored clear warnings and underfunded pandemic preparedness. They mostly reacted to outbreaks, instead of viewing new infectious diseases as major threats to national security. And they never developed a strong international system for managing epidemics, even though researchers said the nature of travel and trade would spread infection across borders.
  • Underlying it all was a failure that stretches back decades. Most everyone knew such an outcome was possible. And yet no one was prepared.
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  • Last year, a Chinese scientist he worked with published a specific forecast: “It is highly likely that future SARS- or MERS-like coronavirus outbreaks will originate from bats, and there is an increased probability that this will occur in China.”
  • Humans today are exposed to more deadly new pathogens than ever. They typically come from animals, as global travel, trade and economic development, such as meat production and deforestation, push people, livestock and wildlife closer together
  • Scientists knew infectious disease outbreaks were becoming more common, with 2010 having more than six times the outbreaks of pathogens from animal origins than in 1980, according to data in a study by Brown University researchers.
  • Yet plenty was left undone, in areas including funding, early-warning systems, the role of the WHO and coordination with China. A big chunk of U.S. funding went toward protecting Americans against a bioterror attack. Government funding for pandemics has come largely in emergency, one-time packages to stop an ongoing outbreak.
  • She said a better solution would be to fund public health more like national defense, with much more guaranteed money, year in, year out.
  • “Will there be another human influenza pandemic?” Dr. Webster asked in a paper presented at an NIH meeting in 1995. “The certainty is that there will be.”
  • Experts including Dr. Webster were particularly concerned about the potential for spillover in southern China, where large, densely populated cities were expanding rapidly into forests and agricultural lands, bringing people into closer contact with animals. Two of the three influenza pandemics of the 20th century are thought to have originated in China.
  • Dr. Webster and others warned it could re-emerge or mutate into something more contagious. With U.S. funding, he set up an animal influenza surveillance center in Hong Kong. The WHO, which hadn’t planned for pandemics before, started compiling protocols for a large-scale outbreak, including contingency plans for vaccines.
  • At a dinner back in the U.S., he remembers one guest saying, “Oh, you really needed to have someone in the U.S. to be impacted to really galvanize the government.”
  • That “drove home the reality in my own mind of globalization,” said Dr. Fukuda. SARS showed that viruses can crisscross the globe by plane in hours, making a local epidemic much more dangerous.
  • The WHO’s director-general, Gro Harlem Brundtland, publicly criticized China. The government under new leaders reversed course. It implemented draconian quarantines and sanitized cities, including a reported 80 million people enlisted to clean streets in Guangdong.
  • By May 2003, the number of new SARS cases was dwindling. It infected around 8,000 people world-wide, killing nearly 10%.
  • After SARS, China expanded epidemiologist training and increased budgets for new laboratories. It started working more closely in public health with the U.S., the world’s leader. The U.S. CDC opened an office in Beijing to share expertise and make sure coverups never happened again. U.S. CDC officials visiting a new China CDC campus planted a friendship tree.
  • In Washington in 2005, a powerful player started driving U.S. efforts to become more prepared. President George W. Bush had read author John M. Barry’s “The Great Influenza,” a history of the 1918 flu pandemic
  • Mr. Bush leaned toward the group of 10 or so officials and said, “I want to see a plan,” according to Dr. Venkayya. “He had been asking questions and not getting answers,” recalled Dr. Venkayya, now president of Takeda Pharmaceutical Co. ’s global vaccine business unit. “He wanted people to see this as a national threat.”
  • Mr. Bush launched the strategy in November, and Congress approved $6.1 billion in one-time funding.
  • The CDC began exercises enacting pandemic scenarios and expanded research. The government created the Biomedical Advanced Research and Development Authority to fund companies to develop diagnostics, drugs and vaccines.
  • A team of researchers also dug into archives of the 1918 pandemic to develop guidelines for mitigating the spread when vaccines aren’t available. The tactics included social distancing, canceling large public gatherings and closing schools—steps adopted this year when Covid-19 struck, though at the time they didn’t include wide-scale lockdowns.
  • A year after the plan was released, a progress report called for more real-time disease surveillance and preparations for a medical surge to care for large numbers of patients, and stressed strong, coordinated federal planning.
  • A European vaccine makers’ association said its members had spent around $4 billion on pandemic vaccine research and manufacturing adjustments by 2008.
  • The $6.1 billion Congress appropriated for Mr. Bush’s pandemic plan was spent mostly to make and stockpile medicines and flu vaccines and to train public-health department staff. The money wasn’t renewed. “The reality is that for any leader it’s really hard to maintain a focus on low-probability high-consequence events, particularly in the health arena,” Dr. Venkayya said.
  • In the U.S., President Barack Obama’s administration put Mr. Bush’s new plan into action for the first time. By mid-June, swine flu, as it was dubbed, had jumped to 74 countries. The WHO officially labeled it a pandemic, despite some evidence suggesting the sickness was pretty mild in most people.
  • That put in motion a host of measures, including some “sleeping” contracts with pharmaceutical companies to begin vaccine manufacturing—contracts that countries like the United Kingdom had negotiated ahead of time so they wouldn’t have to scramble during an outbreak.
  • In August, a panel of scientific advisers to Mr. Obama published a scenario in which as many as 120 million Americans, 40% of the population, could be infected that year, and up to 90,000 people could die.
  • H1N1 turned out to be much milder. Although it eventually infected more than 60 million Americans, it killed less than 13,000. In Europe, fewer than 5,000 deaths were reported.
  • The WHO came under fire for labeling the outbreak a pandemic too soon. European lawmakers, health professionals and others suggested the organization may have been pressured by the pharmaceutical industry.
  • France ordered 94 million doses, but had logged only 1,334 serious cases and 312 deaths as of April 2010. It managed to cancel 50 million doses and sell some to other countries, but it was still stuck with a €365 million tab, or about $520 million at the time, and 25 million extra doses.
  • The WHO had raised scares for SARS, mad-cow disease, bird flu and now swine flu, and it had been wrong each time, said Paul Flynn, a member of the Council of Europe’s Parliamentary Assembly and a British lawmaker, at a 2010 health committee hearing in Strasbourg.
  • Ultimately, an investigation by the council’s committee accused the WHO and public-health officials of jumping the gun, wasting money, provoking “unjustified fear” among Europeans and creating risks through vaccines and medications that might not have been sufficiently tested.
  • “I thought you might have uttered a word of regret or an apology,” Mr. Flynn told Dr. Fukuda, who as a representative of the WHO had been called to testify.
  • Back in Washington, scientist Dennis Carroll, at the U.S. Agency for International Development, was also convinced that flu wasn’t the only major pandemic threat. In early 2008, Dr. Carroll was intrigued by Dr. Daszak’s newly published research that said viruses from wildlife were a growing threat, and would emerge most frequently where development was bringing people closer to animals.
  • If most of these viruses spilled over to humans in just a few places, including southern China, USAID could more easily fund an early warning system.
  • “You didn’t have to look everywhere,” he said he realized. “You could target certain places.” He launched a new USAID effort focused on emerging pandemic threats. One program called Predict had funding of about $20 million a year to identify pathogens in wildlife that have the potential to infect people.
  • Drs. Daszak, Shi and Wang, supported by funds from Predict, the NIH and China, shifted their focus to Yunnan, a relatively wild and mountainous province that borders Myanmar, Laos and Vietnam.
  • One key discovery: a coronavirus resembling SARS that lab tests showed could infect human cells. It was the first proof that SARS-like coronaviruses circulating in southern China could hop from bats to people. The scientists warned of their findings in a study published in the journal Nature in 2013.
  • Evidence grew that showed people in the area were being exposed to coronaviruses. One survey turned up hundreds of villagers who said they recently showed symptoms such as trouble breathing and a fever, suggesting a possible viral infection.
  • Over the next several years, governments in the U.S. and elsewhere found themselves constantly on the defensive from global viral outbreaks. Time and again, preparedness plans proved insufficient. One, which started sickening people in Saudi Arabia and nearby
  • On a weekend morning in January 2013, more than a dozen senior Obama administration officials met in a basement family room in the suburban home of a senior National Security Council official. They were brainstorming how to help other countries upgrade their epidemic response capabilities, fueled by bagels and coffee. Emerging disease threats were growing, yet more than 80% of the world’s countries hadn’t met a 2012 International Health Regulations deadline to be able to detect and respond to epidemics.
  • The session led to the Global Health Security Agenda, launched by the U.S., the WHO and about 30 partners in early 2014, to help nations improve their capabilities within five years.
  • Money was tight. The U.S. was recovering from the 2008-09 financial crisis, and federal funding to help U.S. states and cities prepare and train for health emergencies was declining. Public-health departments had cut thousands of jobs, and outdated data systems weren’t replaced.
  • “It was a Hail Mary pass,” said Tom Frieden, who was director of the CDC from 2009 to 2017 and a force behind the creation of the GHSA. “We didn’t have any money.”
  • At the WHO, Dr. Fukuda was in charge of health security. When the Ebola outbreak was found in March 2014, he and his colleagues were already stretched, after budget cuts and amid other crises.
  • The United Nations created a special Ebola response mission that assumed the role normally played by the WHO. Mr. Obama sent the U.S. military to Liberia, underscoring the inability of international organizations to fully handle the problem.
  • It took the WHO until August to raise an international alarm about Ebola. By then, the epidemic was raging. It would become the largest Ebola epidemic in history, with at least 28,600 people infected, and more than 11,300 dead in 10 countries. The largest outbreak before that, in Uganda, had involved 425 cases.
  • Congress passed a $5.4 billion package in supplemental funds over five years, with about $1 billion going to the GHSA. The flood of money, along with aggressive contact tracing and other steps, helped bring the epidemic to a halt, though it took until mid-2016.
  • Global health experts and authorities called for changes at the WHO to strengthen epidemic response, and it created an emergencies program. The National Security Council warned that globalization and population growth “will lead to more pandemics,” and called for the U.S. to do more.
  • r. Carroll of USAID, who had visited West Africa during the crisis, and saw some health workers wrap themselves in garbage bags for protection, started conceiving of a Global Virome Project, to detect and sequence all the unknown viral species in mammals and avian populations on the planet.
  • Billionaire Bill Gates warned in a TED talk that an infectious disease pandemic posed a greater threat to the world than nuclear war, and urged world leaders to invest more in preparing for one. The Bill & Melinda Gates Foundation helped form a new initiative to finance vaccines for emerging infections, the Coalition for Epidemic Preparedness Innovations.
  • Congress established a permanent Infectious Diseases Rapid Response Fund for the CDC in fiscal 2019, with $50 million for that year and $85 million in fiscal 2020.
  • In May 2018, John Bolton, then President Trump’s national security adviser, dismantled an NSC unit that had focused on global health security and biodefense, with staff going to other units. The senior director of the unit left.
  • It pushed emerging disease threats down one level in the NSC hierarchy, making pandemics compete for attention with issues such as North Korea, said Beth Cameron, a previous senior director of the unit. She is now vice president for global biological policy and programs at the Nuclear Threat Initiative.
  • Deteriorating relations with China reduced Washington’s activities there just as researchers were becoming more certain of the threat from coronaviruses.
  • Dr. Carroll had earlier been ordered to suspend his emerging pandemic threats program in China.
  • Dr. Carroll pitched to USAID his Global Virome Project. USAID wasn’t interested, he said. He left USAID last year. A meeting that Dr. Carroll planned for last August with the Chinese CDC and Chinese Academy of Sciences to form a Chinese National Virome Project was postponed due to a bureaucratic hang-up. Plans to meet are now on hold, due to Covid-19.
fischerry

Hillary Clinton warns of 'fake news epidemic' - BBC News - 0 views

  • Hillary Clinton warns of 'fake news epidemic'
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    Propaganda is something that is all around us more than ever. It's on our phones, laptops, and tvs, and in music and movies, it really does seem like an epidemic.
Javier E

How to evaluate and eventually ease coronavirus restrictions - The Washington Post - 0 views

  • In recent days, epidemiologists and infectious disease specialists, as well as former top agency officials, have rushed to put out their own plans — by publishing preprint papers online and sharing ideas on Twitter and in op-eds
  • a consensus of sorts has begun to coalesce around several key ingredients for an American strategy to move forward while minimizing human and economic casualties. They include mounting a large-scale contact tracing effort, widespread testing, building up health care capacity before easing restrictions, making future quarantines more targeted, and allowing those who have recovered and have some immunity to go back to work.
  • While overall the peak of the epidemic may occur in late April or early May, the timing may be different in different states.
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  • The plan was published Sunday by the American Enterprise Institute. Its lead author — Scott Gottlieb, former Food and Drug Administration commissioner in the Trump administration
  • “The goal is to outline a plan that will allow a gradual return to a more normal way of life without increasing the risk” that the epidemic will resurge.
  • Most economists and health experts say there is no way to restart the economy without addressing the underlying problem of the coronavirus. As long as the pandemic continues to spread, the markets will be in turmoil and any businesses will struggle to stay open, they say.
  • instead of giving false reassurances and deadlines, the White House should tell people the hard truth about the current situation and a coherent strategy they can work toward. “The social distancing, being stuck at home, the deaths we’re going to be seeing. People want to know what it’s for. That there’s a plan.”
  • the road map Gottlieb’s group outlined stresses the need to move away from the current decentralized system and “toward more coordinated execution of response.”
  • The plan divides coming months into four phases and sets “triggers” for states to move from one phase to the next.
  • The latest proposal is a 19-page plan with a step-by-step timeline, with clear benchmarks states and regions would need to meet to safely move forward to the next step
  • With most of the nation now in phase one of the epidemic, the goal should be a sharp increase in hospital critical care beds and an increase of testing to 750,000 people a week to track the epidemic — a number Gottlieb said could be achieved in the next week or two.
  • For a state to move to phase two, it should see a sustained reduction in new cases for at least 14 days, and its hospitals need to be able to provide care without being overwhelmed.
  • “The reason we set it at 14 days is that’s the incubation period of the virus,” said Rivers of Johns Hopkins. “That way you know the downward trend is certain and not because of a holiday or blip or some other delay in reported cases.”
  • States that have moved into phase two would begin gradually lifting social distancing measures and opening schools and businesses, while increasing surveillance.
  • The key goals thereafter would be accelerating the development of new treatments and deploying tests to determine who has recovered from infection with some immunity and could rejoin the workforce.
  • Phase 3 occurs when the nation has a vaccine or drugs to treat covid-19 in place and the government launches mass vaccinations
  • For weeks, World Health Organization officials have stressed such lockdowns are only helpful for slowing down the virus and buying time to deploy more targeted and comprehensive measures, which the U.S. has not yet done.
  • Trump has repeatedly returned to strategies of bans and movement restriction
  • Phase 4 involves rebuilding the nation’s capacity to deal with the next pandemic by building up its scientific and public health infrastructure.
  • Mike Ryan, WHO head of emergency programs, recently urged countries to focus on finding and isolating infected people and their contacts. “It’s not just about physical distancing, it’s not just about locking down,”
  • Many experts’ recent proposals for a U.S. strategy have similar stressed the importance of large-scale contact tracing — because it was a cornerstone for successful efforts like South Korea and Singapore.
  • as countries have shown success with it against this coronavirus, that thinking has changed.
  • such contact tracing is “impractical now in many places but more practical once case numbers have been reduced and testing scaled up” and “could alleviate the need for stringent social distancing to maintain control of the epidemic.”
  • Rapidly building up that capacity — either with community volunteers or short-term hires — will be crucial in coming months, said Rivers of Johns Hopkins. “If you build capacity up and bring cases down, it starts looking a lot more possible.”
  • Many proposals tackle the problem of the tanking economy.
  • Gottlieb-Johns Hopkins plan, for example, calls for widespread use of blood tests to identify people who have had the infection and now are immune — called serology testing
  • People who are immune could return to work, or take on high-risk roles in the health care system and help people, especially the elderly, who are still quarantined at home.
  • Such serology tests have not been deployed before like this on such a large scale
  • during Ebola outbreaks in Africa, survivors were often the ones who provided care, watched over the children of sick patients and buried the dead.
  • One challenge unaddressed by most proposals and op-eds, however, is how to get such detailed plans adopted by the White House, whose response has weighed down by infighting and unclear leadership ping-ponging in recent weeks among Trump, Pence and health advisers like Anthony S. Fauci and Deborah Birx and others.
  • Health officials and scientists involved in the federal response, especially from the Centers for Disease Control and Prevention, have fought to be heard while straining to avoid offending Trump, who bristles at being publicly contradicted, undercut or overshadowed by praise for ideas or people beside himself, according to people who spoke on the condition of anonymity about sensitive deliberations.
  • On Thursday, Trump unveiled a plan of his own, though scarce in detail. He said he planned to help communities ease their restrictions and reopen for business by using on “robust” surveillance and categorizing counties across America into three “risk levels” — low, medium and high. More details are likely in coming days, White House officials said.
Javier E

The Pattern That Epidemics Always Follow - The Atlantic - 0 views

  • More Homo sapiens have probably died from infectious disease than all other causes combined
  • Only in the past 150 years, owing to nutritional and medical advances, have we emerged from living in constant worry that a cough or fever or scrape might be a death sentence. But that fear of infectious disease remains embedded in the brain, as visceral as our sudden alarm when encountering a snake in the wild.
  • I have noticed a pattern in how the media, governments, and public-health systems respond to infectious-disease outbreaks. There are four stages of epidemic grief: denial, panic, fear, and if all goes well, rational response.
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  • According to Cirium, an aviation-industry consulting firm, more than 200,000 flights in and out of China have been canceled, a 60 percent decline. In 2003, in the midst of SARS, global air travel was down 25 percent.
  • Fear dissipates eventually, replaced by a more realistic sense of the risks. An epidemic, even one of a disease as seemingly easy to transmit as COVID-19, while burdening public-health systems and potentially deadly for the elderly and those with compromised immune systems, is eminently survivable by the majority of the population
  • Which brings us to the last stage of epidemic grief: rational response. After denial, panic, and fear, we can finally get down to the business of basic sanitary measures and infection protocols
  • there are only four things you need to know about a virus: “What is it? What does it do? Where does it come from? And how do you kill it?”
  • We never did develop a vaccine. With SARS, infections peaked sometime in May 2003, at about 9,000 cases. By then, the daily rate of new infections had dipped below the number declared cured or dead
  • That is the inflection point of any outbreak, the point at which the worst is over.
  • Why did the rate of transmission slow? Part of the answer is seasonality: The Northern Hemisphere’s virus season tends to run from winter to mid-spring, perhaps because people aren’t clustered indoors and so are less contagious, or because viruses might weaken in lower relative humidity or direct sunlight. (Nobody actually knows.)
  • In the antibiotic era, infection control has been largely delegated to IV drips rather than sanitary cordons. With respiratory diseases like SARS, MERS, and COVID-19, 19th-century medical techniques and equipment—masks, gloves, galoshes, sealed wards, quarantines, and ventilation—are what comprise a rational response.
Javier E

How Will the Coronavirus Change Us? - The Atlantic - 0 views

  • Although medical data from the time are too scant to be definitive, its first attack is generally said to have occurred in Kansas in March 1918, as the U.S. was stepping up its involvement in the First World War.
  • Estimates of the final death toll range from 17 million to 100 million, depending on assumptions about the number of uncounted victims. Almost 700,000 people are thought to have died in the United States—as a proportion of the population, equivalent to more than 2 million people today.
  • Garthwaite matched NHIS respondents’ health conditions to the dates when their mothers were probably exposed to the flu. Mothers who got sick in the first months of pregnancy, he discovered, had babies who, 60 or 70 years later, were unusually likely to have diabetes; mothers afflicted at the end of pregnancy tended to bear children prone to kidney disease. The middle months were associated with heart disease.
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  • Other studies showed different consequences. Children born during the pandemic grew into shorter, poorer, less educated adults with higher rates of physical disability than one would expect
  • the microorganisms likely killed more people than the war did. And their effects weren’t confined to European battlefields, but spread across the globe, emptying city streets and filling cemeteries on six continents.
  • Unlike the war, the flu was incomprehensible—the influenza virus wasn’t even identified until 1931. It inspired fear of immigrants and foreigners, and anger toward the politicians who played down the virus
  • killed more men than women, skewing sex ratios for years afterward. Can one be sure that the ensuing, abrupt changes in gender roles had nothing to do with the virus?
  • the accompanying flood of anti-Semitic violence. As it spread through Germany, Switzerland, France, Spain, and the Low Countries, it left behind a trail of beaten cadavers and burned homes.
  • In northern Italy, landlords tended to raise wages, which fostered the development of a middle class. In southern Italy, the nobility enacted decrees to prevent peasants from leaving to take better offers. Some historians date the separation in fortunes of the two halves of Italy—the rich north, the poor south—to these decisions.
  • When the Black Death began, the English Plantagenets were in the middle of a long, brutal campaign to conquer France. The population losses meant such a rise in the cost of infantrymen that the whole enterprise foundered. English nobles did not occupy French châteaus. Instead they stayed home and tried to force their farmhands to accept lower wages. The result, the Peasants’ Revolt of 1381, nearly toppled the English crown. King Richard II narrowly won out, but the monarchy’s ability to impose taxes, and thus its will, was permanently weakened.
  • The coronavirus is hitting societies that regarded deadly epidemics as things of the past, like whalebone corsets and bowler hats.
  • The American public has not enjoyed its surprise reentry into the world of contagion and quarantine—and this unhappiness seems likely to have consequences.
  • People sought new sources of authority, finding them through direct personal experience with the world and with God.
  • With the supply of European workers suddenly reduced and the demand for labor relatively unchanged, medieval landowners found themselves in a pickle: They could leave their grain to rot in the fields, or they could abandon all sense of right and wrong and raise wages enough to attract scarce workers
  • Within a few decades, Cohn wrote, hysteria gave way to sober observation. Medical tracts stopped referring to conjunctions of Saturn and prescribed more earthly cures: ointments, herbs, methods for lancing boils. Even priestly writings focused on the empirical. “God was not mentioned,” Cohn noted. The massacres of Jews mostly stopped.
  • the lesson seems more that humans confronting unexpected disaster engage in a contest for explanation—and the outcome can have consequences that ripple for decades or centuries.
  • Columbus’s journey to the Americas set off the worst demographic catastrophe in history
  • Somewhere between two-thirds and nine-tenths of the people in the Americas died. Many later European settlers, like my umpteen-great-grandparents, believed they were coming to a vacant wilderness. But the land was not empty; it had been emptied—a world of loss encompassed in a shift of tense.
  • Absent the diseases, it is difficult to imagine how small groups of poorly equipped Europeans at the end of very long supply chains could have survived and even thrived in the alien ecosystems of the Americas
  • “I fully support banning travel from Europe to prevent the spread of infectious disease,” the Cherokee journalist Rebecca Nagle remarked after President Trump announced his plan to do this. “I just think it’s 528 years too late.”
  • For Native peoples, the U-shaped curve was as devastating as the sheer loss of life. As an indigenous archaeologist once put it to me, the epidemics simultaneously robbed his nation of its future and its past: the former, by killing all the children; the latter, by killing all the elders, who were its storehouses of wisdom and experience.
  • The result will be, among other things, a test of how much contemporary U.S. society values the elderly.
  • The speed with which pundits emerged to propose that the U.S. could more easily tolerate a raft of dead oldsters than an economic contraction indicates that the reservoir of appreciation for today’s elders is not as deep as it once was
  • the 2003 SARS epidemic in Hong Kong. That epidemic, which killed about 300 people, was stopped only by heroic communal efforts. (As a percentage of the population, the equivalent U.S. death toll would be about 15,000.)
  • a possible legacy of Hong Kong’s success with SARS is that its citizens seem to put more faith in collective action than they used to
  • Past societies mourned the loss of collective memory caused by epidemics. Ours may not, at least at first.
anonymous

Attacks Blaming Asians For Pandemic Reflect Racist History Of Global Health : Goats and... - 0 views

  • The pandemic has been responsible for an outbreak of violence and hate directed against Asians around the world, blaming them for the spread of COVID-19. During this surge in attacks, the perpetrators have made their motives clear, taunting their victims with declarations like, "You have the Chinese Virus, go back to China!" and assaulting them and spitting on them.
  • The numbers over the past year in the U.S. alone are alarming. As NPR has reported, nearly 3,800 instances of discrimination against Asians have been reported just in the past year to Stop AAPI Hate, a coalition that tracks incidents of violence and harassment against Asian Americans and Pacific Islanders in the U.S.
  • Then came mass shooting in Atlanta last week, which took the lives of eight people, including six women of Asian descent. The shooter's motive has not been determined, but the incident has spawned a deeper discourse on racism and violence targeting Asians in the wake of the coronavirus.
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  • This narrative – that "others," often from far-flung places, are to blame for epidemics – is a dramatic example of a long tradition of hatred. In 14th-century Europe, Jewish communities were wrongfully accused of poisoning wells to spread the Black Death. In 1900, Chinese people were unfairly vilified for an outbreak of the plague in San Francisco's Chinatown. And in the '80s, Haitians were blamed for bringing HIV/AIDS to the U.S., a theory that's considered unsubstantiated by many global health experts.
  • Some public health practitioners say the global health system is partially responsible for perpetuating these ideas.According to Abraar Karan, a doctor at the Brigham and Women's Hospital and Harvard Medical School, the notion persists in global health that "the West is the best." This led to an assumption early on in the pandemic that COVID-19 spread to the rest of the world because China wasn't able to control it.
  • China's response was not without fault. The government's decision to silence doctors and not warn the public about a likely pandemic for six days in mid-January caused more than 3,000 people to become infected within a week, according to a report by the Associated Press, and created ripe conditions for global spread. Some of the aggressive measures China took to control the epidemic – confining people to their homes, for example — have been described as "draconian" and a violation of civil rights, even if they ultimately proved effective.
  • But it soon became clear that assumptions about the superiority of Western health systems were false when China and other Asian countries, along with many African countries, controlled outbreaks far more effectively and faster than Western countries did, says Karan.
  • Some politicians, including former President Donald Trump publicly blamed China for the pandemic, calling this novel coronavirus the "Chinese Virus" or the "Wuhan Virus." They consistently pushed that narrative even after the World Health Organization (WHO) warned as early as March 2020, when the pandemic was declared, that such language would encourage racial profiling and stigmatization against Asians. Trump has continued to use stigmatizing language in the wake of the Atlanta shooting, using the phrase "China virus" during a March 16 call to Fox News.
  • A report by researchers at the University of California at San Francisco (UCSF), released this month, directly linked Trump's first tweet about a "Chinese virus" to a significant increase in anti-Asian hashtags. According to a separate report by the Center for the Study of Hate and Extremism, anti-Asian hate crimes in 16 U.S. cities increased 149 percent in 2020, from 49 to 122.
  • Suspicion tends to manifest more during times of vulnerability, like in wartime or during a pandemic, says ElsaMarie D'Silva, an Aspen Institute New Voices fellow from India who studies violence and harassment issues. It just so happened that COVID-19 was originally identified in China, but, as NPR's Jason Beaubien has reported, some of the early clusters of cases elsewhere came from jet setters who traveled to Europe and ski destinations.
  • the West is usually regarded as the hub of expertise and knowledge, says Sriram Shamasunder, an associate professor of medicine at UCSF, and there's a sense among Western health workers that epidemics occur in impoverished contexts because the people there engage in primitive behaviors and just don't care as much about health.
  • In the early days of COVID-19, skepticism by Western public health officials about the efficacy of Asian mask protocols hindered the U.S.'s ability to control the pandemic. Additionally, stereotypes about who was and wasn't at risk had significant consequences, says Nancy Kass, deputy director for public health at the Johns Hopkins Berman Institute of Bioethics.
  • According to Kass, doctors initially only considered a possible COVID-19 diagnosis among people who had recently flown back from China. That narrow focus caused the U.S. to misdiagnose patients who presented with what we now call classic COVID symptoms simply because they hadn't traveled from China.
  • It's reminiscent of the HIV/AIDS epidemic in the 1980s, Kass says. Because itwas so widely billed as a "gay disease," there are many documented cases of heterosexual women who presented with symptoms but weren't diagnosed until they were on their deathbeds.
  • That's not to say that we should ignore facts and patterns about new diseases. For example, Kass says it's appropriate to warn pregnant women about the risks of traveling to countries where the Zika virus, which is linked to birth and developmental defects, is present.
  • But there's a difference, she says, between making sure people have enough information to understand a disease and attaching a label, like "Chinese virus," that is inaccurate and that leads to stereotyping.
  • Karan says we also need to shift our approach to epidemics. In the case of COVID-19 and other outbreaks, Western countries often think of them as a national security issue, closing borders and blaming the countries where the disease was first reported. This approach encourages stigmatization, he says.
  • Instead, Karan suggests reframing the discussion to focus on global solidarity, which promotes the idea that we are all in this together. One way for wealthy countries to demonstrate solidarity now, Karan says, is by supporting the equitable and speedy distribution of vaccines among countries globally as well as among communities within their own borders.Without such commitments in place, "it prompts the question, whose lives matter most?" says Shamasunder.
  • Ultimately, the global health community – and Western society as a whole – has to discard its deep-rooted mindset of coloniality and tendency to scapegoat others, says Hswen. The public health community can start by talking more about the historic racism and atrocities that have been tied to diseases.
  • Additionally, Karan says, leaders should reframe the pandemic for people: Instead of blaming Asians for the virus, blame the systems that weren't adequately prepared to respond to a pandemic.
  • Although WHO has had specific guidance since 2015 about not naming diseases after places, Hswen says the public health community at large should have spoken out earlier and stronger last year against racialized language and the ensuing violence. She says they should have anticipated the backlash against Asians and preempted it with public messaging and education about why neutral terms like "COVID-19" should be used instead of "Chinese virus."
Javier E

How Will the Coronavirus End? - The Atlantic - 0 views

  • A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk.
  • We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.
  • “No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems,”
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  • To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.
  • That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,”
  • The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases.
  • None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country.
  • With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency.
  • That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition
  • Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear.
  • Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,”
  • “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”
  • it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April
  • A “massive logistics and supply-chain operation [is] now needed across the country,” says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That can’t be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agency—a 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.
  • The first and most important is to rapidly produce masks, gloves, and other personal protective equipment
  • it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems.
  • This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests.
  • These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its course—and the nation’s fate—now depends on the third need, which is social distancing.
  • There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether that’s treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now “flatten the curve” by physically isolating themselves from other people to cut off chains of transmission.
  • Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, before they feel proportionate, and they must continue for several weeks.
  • Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps.
  • when the good of all hinges on the sacrifices of many, clear coordination matters—the fourth urgent need
  • Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a person’s risk, and to somehow wall off the ‘high-risk’ people from the rest of society. It underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.
  • A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care.
  • There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.
  • If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Fauci said, “but I don’t have great confidence in that range.”
  • there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.
  • The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.
  • The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting
  • The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one.  By the end of the summer, the pandemic will have directly killed 2.2 million Americans,
  • The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.
  • there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch.
  • The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.
  • The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.
  • No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.
  • as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard.
  • First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect.
  • Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer.
  • scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.
  • Aspects of America’s identity may need rethinking after COVID-19. Many of the country’s values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs.
  • “We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”
  • The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,”
  • After infections begin ebbing, a secondary pandemic of mental-health problems will follow.
  • But “there is also the potential for a much better world after we get through this trauma,”
  • Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be.
  • Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements.
  • Perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.
  • Attitudes to health may also change for the better. The rise of HIV and AIDS “completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic,”
  • Years of isolationist rhetoric had consequences too.
  • “People believed the rhetoric that containment would work,” says Wendy Parmet, who studies law and public health at Northeastern University. “We keep them out, and we’ll be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, you’re especially vulnerable when a pandemic hits.”
  • Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.
  • After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies.
  • The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audience’s preconceptions.
  • “The transitions after World War II or 9/11 were not about a bunch of new ideas,” he says. “The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.”
  • One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero.
  • One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation
  • The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.
  • In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.
  • On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.
Javier E

British coronavirus study helped upend epidemic strategies in U.S. and U.K. - The Washi... - 0 views

  • The Imperial College London group reported that if nothing was done by governments and individuals and the pandemic remained uncontrolled, 510,000 would die in Britain and 2.2 million in the United States over the course of the outbreak.
  • These kinds of numbers are deeply concerning for countries with top-drawer health-care systems. They are terrifying for less-developed countries, global health experts say.
  • If Britain and the United States pursued more-ambitious measures to mitigate the spread of the coronavirus, to slow but not necessarily stop the epidemic over the coming few months, they could reduce mortality by half, to 260,000 people in the United Kingdom and 1.1 million in the United States.
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  • Finally, if the British government quickly went all-out to suppress viral spread — aiming to reverse epidemic growth and reduce the case load to a low level — then the number of dead in the country could drop to below 20,000. To do this, the researchers said, Britain would have to enforce social distancing for the entire population, isolate all cases, demand quarantines of entire households where anyone is sick, and close all schools and universities — and do this not for weeks but for 12 to 18 months, until a vaccine is available.
  • “We might be living in a very different world for a year or more,” Ferguson told reporters.
  • The modelers did not give numbers for the United States for the most intense suppression efforts.
  • Johnson said the virus “would overwhelm any health system in the world” if quarantines and limits on social contact are not taken.
  • “Although the measures we have already announced are extreme, we may have to go further in the coming days,” the prime minister said Tuesday.
  • Roy Anderson, an infectious disease specialist at Imperial College, who was not a part of the study, said Britain probably had much more to do. “I don’t know if these measures are enough yet,” he said. “And I wish we had done them last week.”
  • There are currently 7,000 ventilators available for all of England, the largest nation within the United Kingdom, with a population of 56 million
  • “The major challenge of suppression is that this type of intensive intervention package . . . will need to be maintained until a vaccine becomes available (potentially 18 months or more), given that we predict that transmission will quickly rebound if interventions are relaxed,” the study concludes.
Javier E

I have helped control health epidemics for 25 years. There is a way to stop coronavirus... - 0 views

  • Australia is in the position to go in early to help control coronavirus. But social distancing is key.
  • We as individuals must do two things now – strict social distancing and practising good hygiene.
  • A virus needs contact between people to spread, so strict social distancing – staying away from other people – is the most powerful weapon against coronavirus we have as a community. The main way to do this is by staying at home.
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  • If we wait until then to take strong action then we risk overwhelming our health system as we have seen happen in Italy, and is now happening in other parts of Europe and the United States, and that risks many thousands, if not hundreds of thousands of people dying unnecessarily
  • The other thing we can do is not overwhelm the health system. If we get a lot of infections at once, our health system will be under pressure and grandmothers and grandfathers who need care won’t get it. It also means looking after our nurses and doctors. They take care of us when we are sick. It is time to take care of them.
  • Places that have controlled the spread of the virus have used strict containment and social distancing, with a framework of other actions, as early as possible in the epidemic.
  • Every single member of the community has an important part to play, including doing everything we can to make sure we protect the most vulnerable people who are likely to get very sick or die.
Javier E

Andrew Sullivan: How to Survive the Coronavirus Pandemic - 1 views

  • this will change us. It must. All plagues change society and culture, reversing some trends while accelerating others, shifting consciousness far and wide, with consequences we won’t discover for years or decades. The one thing we know about epidemics is that at some point they will end. The one thing we don’t know is who we will be then.
  • the living with it, while fighting it, is what changes you over time; it requires more than a little nerve and more than a little steel. Plague living dispenses with the unnecessary, lays bare whom you can trust and whom you can’t, and also reveals what matters.
  • I know also that the AIDS epidemic, more than any other single factor, transformed the self-understanding of gay men and lesbians, opened the eyes of our fellow citizens, and revolutionized the world of gay rights. It showed us, with blinding clarity, what we had hitherto not seen: the ubiquity and humanity and dignity of homosexuals.
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  • Plagues destroy so much — but through the devastation, they can also rebuild and renew.
  • I suspect that those who think COVID-19 all but kills Donald Trump’s reelection prospects are being, as usual, too optimistic. National crises, even when handled at this level of incompetence and deceit, can, over time, galvanize public support for a national leader. As Trump instinctually finds a way to identify the virus as “foreign,” he will draw on these lizard-brain impulses, and in a time of fear, offer the balm of certainty to his cult and beyond. It’s the final bonding: blind support for the leader even at the risk of your own sickness and death.
  • in emergencies, quibbling, persistent political opposition is always on the defense, and often unpopular. It requires pointing out bad news in desperate times; and that, though essential, is rarely popular.
  • the huge sums now being proposed by even the GOP to shore up the economy and the stock market at a time of massive debt, as well as the stark failures of our public-health planning, could make an activist government agenda much more politically palatable to Americans. “You never want a serious crisis to go to waste,”
  • if a public-health catastrophe doesn’t bring home the need for effective universal health care, what could?
  • This virus is also an opportunity for the left to move away from its unpopular woke identity obsessions toward a case for structural economic change fitting for the scale of the epidemic
  • Maybe our comparative loneliness saved us some lives this time, and this plague’s “social distancing” will permanently and tragically entrench an American way of life that has already stripped so many of community and connection
  • in this sudden stop, we will also hear the sounds of nature — as our economic machine pauses for a moment and the contest for status or fame or money is canceled for just a while. “All of humanity’s problems stem from man’s inability to sit quietly in a room alone,” Pascal said
  • I learned one thing in my 20s and 30s in the AIDS epidemic: Living in a plague is just an intensified way of living. It merely unveils the radical uncertainty of life that is already here, and puts it into far sharper focus.
  • The trick, as the great religions teach us, is counterintuitive: not to seize control, but to gain some balance and even serenity in absorbing what you can’t.
aleija

A Mathematical Challenge to Obesity - The New York Times - 0 views

  • Since the 1970s, the national obesity rate had jumped from around 20 percent to over 30 percent.
  • “Why is this happening?”
  • Why would mathematics have the answer? Because to do this experimentally would take years. You could find out much more quickly if you did the math. Now, prior to my coming on staff, the institute had hired a mathematical physiologist, Kevin Hall. Kevin developed a model that could predict how your body composition changed in response to what you ate. He created a math model of a human being and then plugged in all the variables — height, weight, food intake, exercise. The model could predict what a person will weigh, given their body size and what they take in. However, the model was complicated: hundreds of equations. Kevin and I began working together to boil it down to one simple equation. That’s what applied mathematicians do. We make things simple. Once we had it, the slimmed-down equation proved to be a useful platform for answering a host of questions.
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  • Well, what do people do when there is extra food around? They eat it! This, of course, is a tremendously controversial idea. However, the model shows that increase in food more than explains the increase in weight.
  • The epidemic was caused by the overproduction of food in the United States. Beginning in the 1970s, there was a change in national agricultural policy. Instead of the government paying farmers not to engage in full production, as was the practice, they were encouraged to grow as much food as they could. At the same time, technological changes and the “green revolution” made our farms much more productive. The price of food plummeted, while the number of calories available to the average American grew by about 1,000 a day.
  • With such a huge food supply, food marketing got better and restaurants got cheaper. The low cost of food fueled the growth of the fast-food industry. If food were expensive, you couldn’t have fast food.
  • There’s no magic bullet on this. You simply have to cut calories and be vigilant for the rest of your life.
  • Americans are wasting food at a progressively increasing rate. If Americans were to eat all the food that’s available, we’d be even more obese.
  • weight change, up or down, takes a very, very long time. All diets work. But the reaction time is really slow: on the order of a year.
  • People don’t wait long enough to see what they are going to stabilize at. So if you drop weight and return to your old eating habits, the time it takes to crawl back to your old weight is something like three years. To help people understand this better, we’ve posted an interactive version of our model at bwsimulator.niddk.nih.gov.
  • we should stop marketing food to children.
  • What new information did your equation render? That the conventional wisdom of 3,500 calories less is what it takes to lose a pound of weight is wrong. The body changes as you lose. Interestingly, we also found that the fatter you get, the easier it is to gain weight. An extra 10 calories a day puts more weight onto an obese person than on a thinner one. Also, there’s a time constant that’s an important factor in weight loss. That’s because if you reduce your caloric intake, after a while, your body reaches equilibrium. It actually takes about three years for a dieter to reach their new “steady state.” Our model predicts that if you eat 100 calories fewer a day, in three years you will, on average, lose 10 pounds — if you don’t cheat. Another finding: Huge variations in your daily food intake will not cause variations in weight, as long as your average food intake over a year is about the same. This is because a person’s body will respond slowly to the food intake.
  • I could see the facts on the epidemic were quite astounding. Between 1975 and 2005, the average weight of Americans had increased by about 20 pounds
  • People think that the epidemic has to be caused by genetics or that physical activity has gone down. Yet levels of physical activity have not really changed in the past 30 years. As for the genetic argument, yes, there are people who are genetically disposed to obesity, but if they live in societies where there isn’t a lot of food, they don’t get obese. For them, and for us, it’s supply that’s the issue.
  • I think childhood obesity is a major problem. And when you’re obese, it’s not like we can suddenly cut your food off and you’ll go back to not being obese. You’ve been programmed to eat more. It’s a hardship to eat less. Michelle Obama’s initiative is helpful. And childhood obesity rates seem to be stabilizing in the developed world, at least. The obesity epidemic may have peaked because of the recession. It’s made food more expensive.
  • I think the food industry doesn’t want to know it. And ordinary people don’t particularly want to hear this, either. It’s so easy for someone to go out and eat 6,000 calories a day.
Javier E

America's Racial Contract Is Showing - The Atlantic - 0 views

  • To see the sequence of events that led to Arbery’s death as benign requires a cascade of assumptions. One must assume that two men arming themselves and chasing down a stranger running through their neighborhood is a normal occurrence. One must assume that the two armed white men had a right to self-defense, and that the black man suddenly confronted by armed strangers did not. One must assume that state laws are meant to justify an encounter in which two people can decide of their own volition to chase, confront, and kill a person they’ve never met.
  • Barnhill’s leniency is selective—as The Appeal’s Josie Duffy Rice notes, Barnhill attempted to prosecute Olivia Pearson, a black woman, for helping another black voter use an electronic voting machine. A crime does not occur when white men stalk and kill a black stranger. A crime does occur when black people vote.
  • The underlying assumptions of white innocence and black guilt are all part of what the philosopher Charles Mills calls the “racial contract.”
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  • the racial contract is a codicil rendered in invisible ink, one stating that the rules as written do not apply to nonwhite people in the same way.
  • The Declaration of Independence states that all men are created equal; the racial contract limits this to white men with property
  • The law says murder is illegal; the racial contract says it’s fine for white people to chase and murder black people if they have decided that those black people scare them.
  • “The terms of the Racial Contract,” Mills wrote, “mean that nonwhite subpersonhood is enshrined simultaneously with white personhood.”
  • as the process in the Arbery case shows, the racial contract most often operates unnoticed, relying on Americans to have an implicit understanding of who is bound by the rules, and who is exempt from them.
  • Donald Trump’s 2016 election campaign, with its vows to enforce state violence against Mexican immigrants, Muslims, and black Americans, was built on a promise to enforce terms of the racial contract that Barack Obama had ostensibly neglected, or violated by his presence.
  • Struggling white farmers in Iowa taking billions in federal assistance are hardworking Americans down on their luck; struggling single parents in cities using food stamps are welfare queens.
  • Black Americans struggling in the cocaine epidemic are a “bio-underclass” created by a pathological culture; white Americans struggling with opioid addiction are a national tragedy.
  • Poor European immigrants who flocked to an America with virtually no immigration restrictions came “the right way”; poor Central American immigrants evading a baroque and unforgiving system are gang members and terrorists.
  • The coronavirus epidemic has rendered the racial contract visible in multiple ways. Once the disproportionate impact of the epidemic was revealed to the American political and financial elite, many began to regard the rising death toll less as a national emergency than as an inconvenience.
  • The lives of workers at the front lines of the pandemic—such as meatpackers, transportation workers, and grocery clerks—have been deemed so worthless that legislators want to immunize their employers from liability even as they force them to work under unsafe conditions.
  • In East New York, police assault black residents for violating social-distancing rules; in Lower Manhattan, they dole out masks and smiles to white pedestrians.
  • The implied terms of the racial contract are visible everywhere for those willing to see them. A 12-year-old with a toy gun is a dangerous threat who must be met with lethal force; armed militias drawing beads on federal agents are heroes of liberty.
  • the pandemic has introduced a new clause to the racial contract. The lives of disproportionately black and brown workers are being sacrificed to fuel the engine of a faltering economy, by a president who disdains them. This is the COVID contract.
  • by mid-April, conservative broadcasters were decrying the restrictions, small bands of armed protesters were descending on state capitols, and the president was pressing to lift the constraints.
  • In the interim, data about the demographics of COVID-19 victims began to trickle out. On April 7, major outlets began reporting that preliminary data showed that black and Latino Americans were being disproportionately felled by the coronavirus. That afternoon, Rush Limbaugh complained, “If you dare criticize the mobilization to deal with this, you’re going to be immediately tagged as a racist.”
  • That night, the Fox News host Tucker Carlson announced, “It hasn’t been the disaster that we feared.” His colleague Brit Hume mused that “the disease turned out not to be quite as dangerous as we thought.” The nationwide death toll that day was just 13,000 people; it now stands above 70,000, a mere month later.
  • That more and more Americans were dying was less important than who was dying.
  • The disease is now “infecting people who cannot afford to miss work or telecommute—grocery store employees, delivery drivers and construction workers,”
  • Containing the outbreak was no longer a question of social responsibility, but of personal responsibility. From the White House podium, Surgeon General Jerome Adams told “communities of color” that “we need you to step up and help stop the spread.”
  • Public-health restrictions designed to contain the outbreak were deemed absurd. They seemed, in Carlson’s words, “mindless and authoritarian,” a “weird kind of arbitrary fascism.” To restrict the freedom of white Americans, just because nonwhite Americans are dying, is an egregious violation of the racial contract.
  • majority-black counties “account for more than half of coronavirus cases and nearly 60 percent of deaths.” The disproportionate burden that black and Latino Americans are bearing is in part a direct result of their overrepresentation in professions where they risk exposure, and of a racial gap in wealth and income that has left them more vulnerable to being laid off. Black and Latino workers are overrepresented among the essential, the unemployed, and the dead.
  • “Due to the meatpacking, though, that’s where Brown County got the flare,” Roggensack interrupted to clarify. “It wasn’t just the regular folks in Brown County.”
  • Roggensack was drawing a line between “regular folks” and the workers who keep them fed, mobile, safe, and connected. And America’s leaders have treated those workers as largely expendable, praising their valor while disregarding their safety.
  • In South Dakota, where a Smithfield plant became the site of an outbreak infecting more than 700 workers, a spokesperson told BuzzFeed News that the issue was their “large immigrant population.”
  • “We can’t keep our country closed down for years,” Trump said Wednesday. But that was no one’s plan. The plan was to buy time to take the necessary steps to open the country safely. But the Trump administration did not do that, because it did not consider the lives of the people dying worth the effort or money required to save them.
  • the only tension between stopping the virus and reviving the economy is one the Trump administration and its propaganda apparatus have invented. Economists are in near-unanimous agreement that the safest path requires building the capacity to contain the virus before reopening the economy—precisely because new waves of deaths will drive Americans back into self-imposed isolation, destroying the consumer spending that powers economic growth
  • The frame of war allows the president to call for the collective sacrifice of laborers without taking the measures necessary to ensure their safety, while the upper classes remain secure at home.
  • But the workers who signed up to harvest food, deliver packages, stack groceries, drive trains and buses, and care for the sick did not sign up for war, and the unwillingness of America’s political leadership to protect them is a policy decision, not an inevitability
  • Trump is acting in accordance with the terms of the racial contract, which values the lives of those most likely to be affected less than the inconveniences necessary to preserve them.
  • Collective solidarity in response to the coronavirus remains largely intact—most Americans support the restrictions and are not eager to sacrifice their lives or those of their loved ones for a few points of gross domestic product. The consistency across incomes and backgrounds is striking in an era of severe partisan polarization
  • But solidarity with the rest of the nation among elite Republicans—those whose lives and self-conceptions are intertwined with the success of the Trump presidency—began eroding as soon as the disproportionate impact of the outbreak started to emerge.
anonymous

The killer disease with no vaccine - BBC News - 0 views

  • Since the beginning of the year, Nigeria has been gripped by an outbreak of a deadly disease. Lassa fever is one of a number of illnesses which can cause dangerous epidemics, but for which no vaccine currently exists.
  • Lassa fever is not a new disease, but the current outbreak is unprecedented, spreading faster and further than ever before. Health workers are overstretched, and a number have themselves become infected and died.
  • About 1% of cases are thought to be fatal, but women who contract the disease late in pregnancy face an 80% chance of losing their child, or dying themselves. 1081 suspected cases (1 January - 25 February) 317 confirmed cases 14 health care workers affected in six states
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  • Outbreaks can be influenced by seasonal weather conditions, which affect the numbers of the virus's natural host - the multimammate rat.
  • Most people catch Lassa fever from anything contaminated with rat urine, faeces, blood or saliva - through eating, drinking or simply handling contaminated objects in the home.
  • It is likely that a vaccine could be found for Lassa - reducing the possibility of an outbreak becoming a global health emergency - but as with other epidemic diseases that mainly affect poorer countries, progress has stalled.
  • Vaccine development is a long, complex and costly process. This is especially true for emerging epidemic diseases, where a prototype vaccine can usually only be tested where there is an outbreak.
brookegoodman

Coronavirus vaccine: when will it be ready? | World news | The Guardian - 0 views

  • Even at their most effective – and draconian – containment strategies have only slowed the spread of the respiratory disease Covid-19. With the World Health Organization finally declaring a pandemic, all eyes have turned to the prospect of a vaccine, because only a vaccine can prevent people from getting sick.
  • This unprecedented speed is thanks in large part to early Chinese efforts to sequence the genetic material of Sars-CoV-2, the virus that causes Covid-19. China shared that sequence in early January, allowing research groups around the world to grow the live virus and study how it invades human cells and makes people sick.
  • Coronaviruses have caused two other recent epidemics – severe acute respiratory syndrome (Sars) in China in 2002-04, and Middle East respiratory syndrome (Mers), which started in Saudi Arabia in 2012. In both cases, work began on vaccines that were later shelved when the outbreaks were contained. One company, Maryland-based Novavax, has now repurposed those vaccines for Sars-CoV-2, and says it has several candidates ready to enter human trials this spring. Moderna, meanwhile, built on earlier work on the Mers virus conducted at the US National Institute of Allergy and Infectious Diseases in Bethesda, Maryland.
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  • All vaccines work according to the same basic principle. They present part or all of the pathogen to the human immune system, usually in the form of an injection and at a low dose, to prompt the system to produce antibodies to the pathogen. Antibodies are a kind of immune memory which, having been elicited once, can be quickly mobilised again if the person is exposed to the virus in its natural form.
  • Cepi’s original portfolio of four funded Covid-19 vaccine projects was heavily skewed towards these more innovative technologies, and last week it announced $4.4m (£3.4m) of partnership funding with Novavax and with a University of Oxford vectored vaccine project. “Our experience with vaccine development is that you can’t anticipate where you’re going to stumble,” says Hatchett, meaning that diversity is key. And the stage where any approach is most likely to stumble is clinical or human trials, which, for some of the candidates, are about to get under way.
  • An illustration of that is a vaccine that was produced in the 1960s against respiratory syncytial virus, a common virus that causes cold-like symptoms in children. In clinical trials, this vaccine was found to aggravate those symptoms in infants who went on to catch the virus. A similar effect was observed in animals given an early experimental Sars vaccine. It was later modified to eliminate that problem but, now that it has been repurposed for Sars-CoV-2, it will need to be put through especially stringent safety testing to rule out the risk of enhanced disease.
  • Once a Covid-19 vaccine has been approved, a further set of challenges will present itself. “Getting a vaccine that’s proven to be safe and effective in humans takes one at best about a third of the way to what’s needed for a global immunisation programme,” says global health expert Jonathan Quick of Duke University in North Carolina, author of The End of Epidemics (2018). “Virus biology and vaccines technology could be the limiting factors, but politics and economics are far more likely to be the barrier to immunisation.”
  • Because pandemics tend to hit hardest those countries that have the most fragile and underfunded healthcare systems, there is an inherent imbalance between need and purchasing power when it comes to vaccines. During the 2009 H1N1 flu pandemic, for example, vaccine supplies were snapped up by nations that could afford them, leaving poorer ones short. But you could also imagine a scenario where, say, India – a major supplier of vaccines to the developing world – not unreasonably decides to use its vaccine production to protect its own 1.3 billion-strong population first, before exporting any.
  • • This article was amended on 19 March 2020. An earlier version incorrectly stated that the Sabin Vaccine Institute was collaborating with the Coalition for Epidemic Preparedness Innovations (Cepi) on a Covid-19 vaccine.
katherineharron

Covid-19: Why America has the world's most confirmed cases (opinion) - CNN - 0 views

  • On Thursday, we hit a grim watershed. The US overtook Italy and China as the country with the highest number of confirmed Covid-19 cases. This is a dire crisis and an extraordinary failure of President Donald Trump. Americans are suffering and dying because the Trump administration failed to act quickly and decisively to prevent the virus' spread. The US has now seen about 1,195 deaths and the number is rising rapidly.
  • On Thursday, the US saw an increase of more than 15,000 cases in one day -- a shocking surge that can be explained by both the spread of the virus and increased testing after weeks of shortages -- pushing the total number of confirmed cases over 82,000. China, in comparison, has reported 81,285 cases.
  • Trump bears direct responsibility for America's unpreparedness and failed response to the epidemic. Since Trump came into office, he has systematically taken apart our protective public health system. The pandemic unit at the National Security Council was dismantled in 2018 under his watch. Trump slashed the CDC's epidemic control teams in 39 countries, including China. And when the epidemic hit, Trump ignored it, downplayed it, and made repeated false claims. Even now, he spouts vulgar nonsense about restarting the economy by Easter when public health experts say the threat is going to persist for far longer.
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  • On Thursday, we hit a grim watershed. The US overtook Italy and China as the country with the highest number of confirmed Covid-19 cases. This is a dire crisis and an extraordinary failure of President Donald Trump. Americans are suffering and dying because the Trump administration failed to act quickly and decisively to prevent the virus' spread. The US has now seen about 1,195 deaths and the number is rising rapidly.
Javier E

We scientists said lock down. But UK politicians refused to listen | Helen Ward | Opini... - 0 views

  • It’s now clear that so many people have died, and so many more are desperately ill, simply because our politicians refused to listen to and act on advice. Scientists like us said lock down earlier; we said test, trace, isolate. But they decided they knew better.
  • it is the role of policymakers to act on the best available evidence. In the context of a rapidly growing threat, that means listening to experts with experience of responding to previous epidemics.
  • When I say that politicians “refused to listen”, I am referring to the advice and recommendations coming from the World Health Organization, from China and from Italy. The WHO advice, based on decades of experience and widely accepted by public health leaders and scientists around the world was clear – use every possible tool to suppress transmission. That meant testing and isolating cases, tracing and quarantining contacts, and ramping up hygiene efforts
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  • Neither the advice nor the science were followed that week. My colleagues, led by Neil Ferguson, published a report on 16 March estimating that without strong suppression, 250,000 people could die in the UK. The government responded that day with a recommendation for social distancing, avoiding pubs and working from home if possible. But there was still no enforcement, and it was left up to individuals and employers to decide what to do. Many people were willing but unable to comply as we showed in a report on 20 March. It was only on 23 March that a more stringent lockdown and economic support was announced.
  • etween 12 and 23 March, tens, if not hundreds of thousands, of people will have been infected.
  • The current best estimate is that around 1% of those infected will die.
  • So where to now? Once again, public health experience, including modelling, leads to some very clear recommendations. First, find cases in the community as well as hospitals and care homes; isolate them, and trace their contacts using a combination of local public health teams and digital tools.
  • Second, know your epidemic. Track the epidemic nationally and locally using NHS, public health and digital surveillance to see where cases are continuing to spread
  • Build community resilience by providing local support for vulnerable people affected by the virus and the negative impact of the control measures.
  • Third, ensure transmission is suppressed in hospitals, care homes and workplaces through the right protective equipment, testing, distancing and hygiene
  • Fourth, ensure that the most vulnerable, socially and medically, are fully protected through simple access to a basic income, rights for migrants, and safety for those affected by domestic violence.
  • I am not looking to blame – but for scrutiny so that lessons can be learned to guide our response. We need to avoid further mistakes, and ensure that the government is hearing, and acting on, the best advice.
Javier E

How did Britain get its response to coronavirus so wrong? | World news | The Guardian - 0 views

  • When the investigations into the UK’s response to Covid-19 come to be written, there is widespread recognition among experts that this lack of long-term strategic planning will be at the centre of it.
  • So too should be the need to ensure that the views of experts are fed into government more efficiently and widely.
  • “Given the continual emergence of new pathogens ... and the ever-increasing connectedness of our world, there is a significant probability that a large and lethal pandemic will occur in our lifetime,” Bill Gates predicted several years ago. “And it will have the impact of a nuclear war,” he warned, while urging nations to start stockpiling antiviral drugs and therapies. If only.
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  • As to the most likely nature of that mysterious virus, most modelling assumed that disease X would be flu-like in behaviour, says Dr Josie Golding, the epidemics lead at the Wellcome Trust. After all, influenza had caused so many deadly global outbreaks in the past. As a result, a lot of investment went into making influenza vaccines in preparation, she says. “But have we been thinking about diseases other than influenza that might become pandemics? I don’t think we have. There has been a real gap in our thinking.”
  • “The report that really grabbed my attention came out in mid-January,” says epidemiologist Professor Mark Woolhouse at Edinburgh University. “It said 41 cases of this new respiratory illness had now been diagnosed in one small area of China, around Wuhan. And that set the alarm bells ringing for me.”
  • But helped perhaps by having an epidemiologist as vice-president, the government set up a gold standard regime of testing and contact tracing that means that nearly three months on from its first confirmed infection, it has registered fewer than 400 cases and six deaths.
  • In February, sporadic cases of Covid-19 were appearing round the country, recalls Tom Wingfield, a clinician and infectious disease expert based at the Liverpool School of Tropical Medicine. “These were cases that had been brought into the country, mainly from China or Italy. Then there was an outbreak in Brighton and I realised that the virus had established itself in a community there. It was a turning point.”
  • “Perhaps some of us should have got up in front of BBC News and said you lot ought to be petrified because this is going to be a pandemic that will kill hundreds of thousands of people,” adds Ball. “None of us thought this was a particularly constructive thing to do, but maybe with hindsight we should have. If there had been more voices, maybe politicians would have taken this a bit more seriously.”
  • “He had just received a text message from a colleague about the outbreak and we started to discuss the implications,” Nurse recalls. “It did not take us long for us both to realise this was going to be very significant. It took another two or three weeks to confirm these worst fears – by mid-February.”
  • Taiwan could have been at high risk of a major Covid-19 epidemic. Tourists and business people travelled regularly back and forth.
  • Taiwan’s extensive testing and thorough contact tracing are precisely the kind of action that the former health secretary Jeremy Hunt is demanding before the UK lockdown is lifted. Hunt points out that it is one of the essential conditions set by the WHO to avoid a second wave resulting from an easing of restrictions.
  • Hong Kong, which also suffered from the Sars crisis, also moved early to enforce quarantine and social distancing, as well as widespread mask wearing, and today has registered just over 1,000 cases and only four deaths.
  • South Korea looked like it was on a trajectory to disaster, with the highest number of confirmed cases outside China, and numbers rising rapidly. But after the country’s first infection, the government met medical companies and urged them to start developing coronavirus test kits on a massive scale. The results were impressive. When the epidemic hit, it was ready to deploy largescale testing. Its measures allowed South Korea to become the second country to flatten its coronavirus curve, without the sweeping shutdowns of society and economic activity that China had pioneered and the west would be forced to adopt.
  • If the UK has serious questions to answer, the country that so far has seen the worst of the outbreak, the United States, was slowest of all to act. Trump for months ignored, played down or lied about the threat posed by coronavirus, leaving individual states to act unilaterally as it became clear it had already taken hold on US soil.
  • in the UK the attitude among politicians and also scientists was that it was really just some form of a flu. All the government’s pandemic planning was based on a flu scenario. And then it turned out to be something different and far, far worse and the response was completely inadequate.”
  • Don’t expect a vaccine to come to the rescue in the short term, says Nabarro. “For the foreseeable future, we are going to have to find ways to go about our lives with this virus as a constant threat to our lives. That means isolating those who show signs of the disease and also their contacts. Older people will have to be protected. That is going to be the new normal for us all.”
Javier E

Experts fear coronavirus will become a pandemic - The Washington Post - 0 views

  • There are outbreaks. There are epidemics. And there are pandemics, where epidemics become rampant in multiple countries and continents simultaneously. The novel coronavirus that causes the disease named covid-19 is on the verge of that third, globe-shaking stage
  • Amid an alarming surge in cases with no clear link to China, infectious disease experts believe the flulike illness may soon be impossible to contain
  • the language coming from the organization’s Geneva headquarters has turned more ominous in recent days as the challenge of containment grows more daunting.
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  • “The window of opportunity is still there, but the window of opportunity is narrowing,” WHO Director General Tedros Adhanom Ghebreyesus said on Friday. “We need to act quickly before it closes completely.”
  • At the beginning of any disease outbreak, public health experts painstakingly trace the contacts of every person who becomes sick. The experts build a family tree of possible illness, with branches that include anyone who might have shaken hands with, or been sneezed on by an infected person
  • with confirmed infections approaching 80,000 people, contact tracing on a case-by-case basis could soon be impractical.
  • “What we find is that this virus is going to be very difficult to contain,” said Jeffrey Shaman, an infectious disease researcher at Columbia University and co-author of the study posted Monday. “Personally, I don’t think we can do it.”
  • The word ‘pandemic’ invokes fear, but it describes how widespread an outbreak may be, not its deadliness.
  • “I think we should assume that this virus is very soon going to be spreading in communities here, if it isn’t already, and despite aggressive actions, we should be putting more efforts to mitigate impacts,”
  • The virus would be easier to contain if people who are contagious were obviously so, as was the case with SARS, which started an outbreak that burned itself out in 2003. But the new virus appears to spread among people who in some cases are not noticeably sick.
  • among the more than 600 passengers from the Diamond Princess cruise ship who have tested positive, about half had no obvious symptoms.
  • If the coronavirus becomes a true pandemic, a large proportion of the human population — a third, a half, two-thirds even — could become infected
  • Harvard epidemiologist Marc Lipsitch estimates that 40 to 70 percent of the human population could potentially be infected by the virus if it becomes pandemic. Not all of those people would get sick
  • The novel coronavirus may be particularly suited for stealth community transmission since its symptoms can be indistinguishable from those of a cold or flu, and testing capabilities are still being ramped up.
  • Experts estimate it takes about a week for the number of people infected in a given community to double. Based on that, it would likely take several weeks for a new infection cluster to be picked up by a local health department
  • By mid-March, he estimated, officials should know if there is community transmission and a true pandemic.
  • “I want to be clear that we are not seeing community spread here in the United States yet,” she said Friday. “But it’s very possible, even likely, that may eventually happen.”
  • “If a large number of countries are unsuccessful in preventing sustained multi-generation transmissions, then we could witness the next pandemic.”
  • A pandemic is a line in the sand, and every expert has a slightly different definition for when an outbreak crosses it. Generally, it means that there are self-sustaining lines of infection in multiple countries and continents — where the family tree of possible illness begins to encompass the entire population.
  • I think we’re not in as dire straits as we might be, and that’s because everyone is pulling together internationally.”
  • Public health experts are devising strategies on how to conserve N95 respirators, specialized masks that are in a limited supply amid surging demand.
  • “Extrapolating from some of the numbers we’ve seen on the impact to the health care system in China, it means we’ll have to surge fast.”
Javier E

How U.S. can defeat coronavirus: Heed Asia?s lessons from epidemics past - The Washingt... - 0 views

  • in wealthy places on China's periphery — Hong Kong, Taiwan and South Korea — a rapid response swung into action.One reason was that they had learned from the past.
  • “We were all burned very badly with SARS, but actually it turned out to be a blessing for us.”
  • Political will, dedicated resources, sophisticated tracking and a responsible population have kept coronavirus infections and deaths in Taiwan, Hong Kong and Singapore relatively low. South Korea, with more deaths, has led the way in widespread testing.
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  • In Taiwan, officials boarded planes arriving from Wuhan and assessed passengers for symptoms before allowing anyone to disembark. Within days, Singapore, South Korea and other Asian states had implemented similar steps.
  • A year after SARS, Taiwan established a National Health Command Center that brought together all levels and branches of government, preparing for the possibility of another disease outbreak. Its interventions over the past two months have been decisive in keeping Taiwan ahead of the curve
  • They didn’t hesitate, they didn’t want to die,” Wang said. “The mortality rate was so high [during SARS] and they didn’t know how bad this one was going to be. Nobody thought it was like the flu.”
  • As early as Jan. 5, Taiwan was tracing people who had been in Wuhan in the previous 14 days. Those with symptoms of respiratory infections were quarantined.
  • In subsequent weeks, authorities used data and technology to identify and track cases, communicated effectively to reassure the public, offered relief to businesses and allocated medical resources where they were needed most — rationing face masks and dramatically increasing their production.
  • On Jan. 27, Taiwan combined the databases of its National Health Insurance Administration and National Immigration Agency, allowing it to track everyone who had been in Wuhan in the recent past and alert doctors to patients’ travel histories
  • Now, Taiwan is hoping to keep its infection numbers down and has asked residents not to travel abroad after its biggest single-day jump of cases — 23 — on Wednesday. It is also barring most noncitizens from entering.
  • South Korea, meanwhile, has become the poster child for testing. Its success is rooted in a previous failure: The limited availability of test kits was seen as having aggravated the 2015 MERS outbreak, when the country suffered the second-highest caseload after Saudi Arabia.
  • More than 260,000 people in South Korea have been tested for the virus, the highest per capita anywhere, with testing and treatment fees covered by the government and drive-through centers capturing global attention
  • Whereas the United States and Japan keep testing tightly controlled by a central authority, South Korea opened the process to the private sector, introducing a path to grant “emergency usage approval” to tests for pathogens of pandemic potential.
  • Singapore, too, benefited from its own capabilities to test, as did Hong Kong and Japan. All developed their own diagnostic tests when the covid-19 genome sequence was published.
  • Outside mainland China, the territory had been the biggest casualty of the Communist Party’s coverup of the SARS outbreak, with some 300 deaths and little clarity on what was unfolding until it was too late.
  • This time, though, and without needing to be told much, Hong Kong residents took matters into their own hands. The city’s financial district was reduced to a ghost town in early February as companies closed offices. Bakeries known for hour-long weekend lines were abandoned.
  • Parties, weddings and family gatherings were canceled — without any government order. Almost everyone rushed to ­procure masks; a recent study ­estimated that 74 percent to 98 percent of residents wore them when leaving their homes. Voluntary social distancing was hailed as a key reason for the lower rate of infections.
  • From electronic wristbands to smartphone trackers, Asian jurisdictions have pulled out all the stops to ensure that suspected patients comply with quarantine and isolation orders, monitoring that is backed by laws that were tightened post-SARS.
  • Singapore used its FBI equivalent, the Criminal Investigation Department, to effectively interrogate every confirmed case with stunning granularity — even using patients’ digital wallets to trace their footsteps. Those caught lying face fines and jail time.
  • In South Korea, information on the movements of infected people before they were tested is collected and relayed over smartphones, creating a real-time ma
  • Taiwan tracks infected people’s whereabouts via smartphones
  • In Hong Kong, everyone subject to a compulsory quarantine must activate real-time location-sharing on their phone or wear an electronic wristband.
  • These measures have been backed by local populations that lived through previous epidemics and have largely shed concerns about privacy and tracking.
  • Americans should not focus “only on the kind of high-profile displays of state power that have made headlines from China” but also look at countries such as South Korea that are “balancing Democratic openness with rapid, concerted public-health action.”
  • Experts agree, though, that Western governments must be prepared to limit their citizens’ movements, mandate isolation for positive cases and track contacts regardless of privacy concerns.
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