Germany: Ways out of the coronavirus crisis

‘Northeastern Germany has managed the crisis better than the rest of the country. As Rostock eases restrictions, it aims to be a model for other cities.’

View video here (DW, Feb 13, 2021) 

Medical services restored to pre-Covid-19 level in Uttar Pradesh

‘Following the continuous decline in the number of Covid-19 cases and active infections, the Uttar Pradesh government has directed state medical colleges and institutions to fully restore all outpatient and in patient services.

‘The order issued by the chief minister’s office on Friday has to be implemented with immediate effect. “Following the decline in the prevalence of coronavirus pandemic, all outdoor and inpatient services must be restored at the earliest so that people in need can have access to the required help.” 

Read here (Times of India, Feb 13, 2021)

Trust in Covid vaccines is growing

‘Attitudes towards COVID-19 vaccines seem to be improving in some parts of the world, a survey of thousands of people in 15 countries has found. Researchers have welcomed the results, which suggest that an increasing proportion of people are willing to be immunized. But they caution that some problems persist, such as concerns about vaccine safety. “For the first time since the pandemic began, I can sense that optimism is spreading faster than the virus,” says behavioural scientist Sarah Jones at Imperial College London, who co-led the global attitudes towards a COVID-19 vaccine survey.

‘The survey is part of the COVID-19 behaviour tracker, run by Imperial together with the UK market-research company YouGov.’

Read here (Nature, Feb 10, 2021)

Bhutan: The unlikeliest pandemic success story

‘On January 7, a 34-year-old man who had been admitted to a hospital in Bhutan’s capital, Thimphu, with preexisting liver and kidney problems died of COVID-19. His was the country’s first death from the coronavirus. Not the first death that day, that week, or that month: the very first coronavirus death since the pandemic began.

‘How is this possible? Since the novel coronavirus was first identified more than a year ago, health systems in rich and poor countries have approached collapse, economies worldwide have been devastated, millions of lives have been lost. How has Bhutan—a tiny, poor nation best known for its guiding policy of Gross National Happiness, which balances economic development with environmental conservation and cultural values—managed such a feat? And what can we in the United States, which has so tragically mismanaged the crisis, learn from its success?’

Read here (The Atlantic, Feb 10, 2021)

Tribal health providers have figured out the key to Covid-19 vaccine success. Here's their secret

‘It's important to note that there are 574 federally recognized tribes, making it difficult to broadly characterize how the vaccine rollout is going across Indian Country. Native people get their health care from a patchwork system of Indian Health Service facilities, tribally-operated clinics and urban Indian health centers, and vaccination efforts have varied from tribe to tribe and state to state.

Still, the successes of some tribal health providers offer lessons for communities struggling to vaccinate their populations efficiently. Here are some of them.

• They tailored their messaging to build trust
• They have the autonomy to decide who gets priority
• This health system is owned by its people
• They made big investments in health care
• Ultimately, success depends on the nation's vaccine supply

Read here (CNN, Feb 9, 2021)

Israel is the world’s most vaccinated country. Why are cases rising?

‘Rahav [Galia Rahav, the head of the infectious-disease unit at Tel Aviv’s Sheba Medical Center] attributes the soaring rate of infection in the general population to the weariness of Israelis — on their third or fourth lockdown, depending on how you count — with having their children at home, restrictions limiting them to 1,000 yards from their homes, and of the “politicization” of the ever-shifting rules of confinement.

‘Like many other countries, Israel launched its vaccination campaign with the two most vulnerable sectors: frontline medical workers and citizens over the age of 65. In January, as jubilant grandparents and ambulance drivers got vaccinated, and slowly stopped falling ill, younger and less cautious Israelis flouted caution — turning themselves into spreaders just as the highly infectious British mutation of the virus wafted into the country.’

Read here (New York magazine, Feb 7, 2021)

MCO 2.0 should have been tool of last resort, says ex-deputy defence minister Liew Chin Tong

‘The current movement control order (MCO) would not have to be implemented if the Health Ministry (MOH) had properly conducted Covid-19 tracing and screening as far back as April last year, according to deputy defence minister Liew Chin Tong. The DAP senator said a whole-of-government approach from the start, rather than one that placed the burden solely on the MOH, would have prevented the current high number of infections in the country.

“To put it into context, it doesn’t inspire confidence if halfway into a war, the army general (in this case, the Health DG) complained to the media that the air force (the other health institutions/labs) has forgotten to provide for air cover,” Liew said on his Facebook page today. He was referring to Health director-general Tan Sri Dr Noor Hisham Abdullah’s recent statement that MOH labs have nearly reached their maximum capacity of 76,000 Covid-19 tests daily, even as there is a need to increase screening to between 150,000 to 200,000 tests daily.

“Dr Noor Hisham lamented that so far the testing capacity at university hospitals was at 27 per cent, private laboratories (31 per cent) and laboratories in the Malaysian Armed Forces hospitals (24 per cent). These facilities are underutilised and could increase their capacity up to 100 per cent to achieve the daily test target.’

Read here (Malay Mail, Feb 7, 2021)

Lancet editor says inequality and Covid-19 have converged to create a ‘syndemic’

‘In his new book "The COVID-19 Catastrophe: What's Gone Wrong and How to Stop It Happening Again," Dr. Richard Horton does more than trace the history of the COVID-19 pandemic and explain how we should listen to scientific experts in confronting this global scourge.

‘He does this, of course, but Horton is more ambitious than that. As editor-in-chief of "The Lancet" — one of the world's oldest, most famous and most prestigious medical journals — Horton has overseen the publication of countless articles on a variety of medical subjects. Hence, one can sense in his book a desire to apply the full breadth of his knowledge and experience to this problem. His conclusion is both fascinating and extremely relevant, even urgent.

‘As Horton explains, the COVID-19 pandemic was unnecessarily worsened by deeper social problems, from economic policies that left millions upon millions of people especially vulnerable to Western governments who made political assumptions about the virus that proved to be gravely mistaken. Speaking with Salon, Horton discussed everything from President Donald Trump's failure to address the pandemic (as well as President Joe Biden's early successes) to an intriguing thought experiment on what would have happened if the governments the world could have simply paid people to stay home.’

Read here (Salon, Feb 6, 2021)

The play cure: In a clinical setting, playful activities are not distractions; they take patients deep into trauma – and out the other side...

‘Take a pen. Place it on the paper. Draw wherever you want. However you want. You know, Paul Klee said: “Drawing is like taking a line for a walk.”’ In the hospital workshop, I turn towards a patient, smile and continue: ‘So, let’s draw together. We could draw houses, and draw a path between our homes. Let’s grab paints. Turn the paper around. Upside down. If you don’t mind, I can paint your sky and you can paint mine… We can play and make…’

‘For more than 20 years, I’ve been saying these sentences, playing and making, as a clinical arts therapist, specialising in mental health, and as a lecturer and consultant using creative techniques with doctors, hospital directors, nursing managers and entrepreneurs. Guided by artists such as Louise Bourgeois and Jackson Pollock, and by Plato, I spend my days tapping into what the phenomenologist and philosopher of play Eugen Fink calls the ‘peach skin of things’. It glows.’

Two paragraphs that may interest you to read the whole story

• ‘Play, as Fink writes, unites ‘the highest desire and the deepest suffering’. For years, I worked with teenagers diagnosed with psychosis. A highlight of our work was a short surrealist play, ‘The Lost Potato Masher’, which they devised based around kitchen objects. The main roles were taken by a fridge, a cupboard, a toaster, a cooker, a table and chairs, and the lost potato masher. The text dealt with parental abandonment, despair, solitude, violence, fate and hope. In a training context, a hospital manager, in an improvisation, once acted the role of the file of a dead patient that had been thrown into a bin. Both of these examples show the cathartic effect of play, allowing us to sit with our shadows...
• ‘A recent study by the psychologists Maja Stanko-Kaczmarek and Lukasz Kaczmarek at the Adam Mickiewicz University in Poland found that the tactile sensations of finger-painting provoked a state of mindfulness connected with wellbeing. As we paint, we’re present in the moment, and we have a broader attention. This can be contrasted with the ‘mindlessness’ state, often a symptom of mental illness, characterised by past or future ruminations. The physical nature of play and making locates us in the here and now: it centres us in ourselves, mobilising an embodied cognition that’s important in skill learning. At all stages of life, Lego-making, knitting, embroidery and painting can contribute to psychological wellbeing.’

Read here (Aeon, Feb 4, 2021)

Covid-19: Social murder, they wrote — elected, unaccountable, and unrepentant

‘After two million deaths, we must have redress for mishandling the pandemic... Murder is an emotive word. In law, it requires premeditation. Death must be deemed to be unlawful. How could “murder” apply to failures of a pandemic response? Perhaps it can’t, and never will, but it is worth considering. When politicians and experts say that they are willing to allow tens of thousands of premature deaths for the sake of population immunity or in the hope of propping up the economy, is that not premeditated and reckless indifference to human life? If policy failures lead to recurrent and mistimed lockdowns, who is responsible for the resulting non-covid excess deaths? When politicians wilfully neglect scientific advice, international and historical experience, and their own alarming statistics and modelling because to act goes against their political strategy or ideology, is that lawful? Is inaction, action?1 How big an omission is not acting immediately after the World Health Organization declared a public health emergency of international concern on 30 January 2020?

‘At the very least, covid-19 might be classified as “social murder,” as recently explained by two professors of criminology. The philosopher Friedrich Engels coined the phrase when describing the political and social power held by the ruling elite over the working classes in 19th century England. His argument was that the conditions created by privileged classes inevitably led to premature and “unnatural” death among the poorest classes. In The Road to Wigan Pier, George Orwell echoed these themes in describing the life and living conditions of working class people in England’s industrial north. Today, “social murder” may describe the lack of political attention to social determinants and inequities that exacerbate the pandemic. Michael Marmot argues that as we emerge from covid-19 we must build back fairer...

Getting redress

‘Where then should citizens turn for accountability, if they don’t find it in their leaders and feel unsupported by experts and the media? The law remains one form of redress, and indeed some legal avenues, including criminal negligence and misconduct in public office, are being explored, although proving any such claims will be difficult and drawn out. But the notion of murder, at least “social murder,” is hard to shake emotionally, and strengthens with every denial of responsibility and every refusal to be held accountable or to change course.

‘That leaves three options. The first is to push for a public inquiry, as The BMJ and others argued for in the summer of 2020—a rapid, forward looking review rather than an exercise in apportioning blame that will identify lessons and save lives. The second is to vote out elected leaders and governments that avoid accountability and remain unrepentant. The US showed that a political reckoning is possible, and perhaps a legal one can follow, although research suggests that mishandling a pandemic may not lose votes.21 The third is for mechanisms of global governance, such as the International Criminal Court, to be broadened to cover state failings in pandemics...

‘The “social murder” of populations is more than a relic of a bygone age. It is very real today, exposed and magnified by covid-19. It cannot be ignored or spun away. Politicians must be held to account by legal and electoral means, indeed by any national and international constitutional means necessary. State failures that led us to two million deaths are “actions” and “inactions” that should shame us all.’

Read here (British Medical Journal, Feb 4, 2021)

Why has Britain failed on Covid? | Richard Horton, editor, The Lancet

‘A year after the World Health Organisation declared Covid-19 a pandemic, with Britain enduring more than a 100,000 deaths since, a number of major questions remain unanswered. Why was the response of the UK among the worst in the world? How is it possible that the death toll of countries in Europe and North America is so much higher than poorer countries in Asia such as Thailand and Vietnam? And when will things go ‘back to normal’? Discussing that, and more, is Richard Horton – editor of the prestigious medical journal The Lancet and author of ‘The Covid-19 catastrophe, what’s gone wrong and how to stop it happening again’.

View here (Novara Media, Feb 2, 2021)

Coronavirus: After Wuhan, it’s time for global response reset, says Covid-19 probe chief

‘Covid-19 has exposed global deficiencies in the response to dangerous infectious diseases and the international system will need to be strengthened to raise alerts and deal with future outbreaks, according to Helen Clark, co-head of an international panel investigating the pandemic.

‘Despite the novel coronavirus emerging in a world with rapid communication services, it was notable how slow the global response to the outbreak was after it was first detected in China, said Clark, a former prime minister of New Zealand and one-time head of the United Nations Development Programme.

“Every day counts if you are trying to stop an infectious disease of unknown origin,” she said in an interview with the South China Morning Post. “There just doesn’t seem to be enough happening quickly enough, from the time of first awareness of the cluster onwards, and here we are.

“The WHO didn’t have all the information it needed, and – let’s be fair here, we are still discovering things about Covid-19 every day, we are on a very steep learning curve – but all the more reason, I would think, for applying a precautionary principle. If it smells bad, it may well be bad,” she said, referring to the early days of the pandemic.’

Read here (South China Morning Post, Feb 1, 2021)

Covid-19: It’s all doom and gloom unless… — Dr Musa Mohd Nordin

‘There is much misunderstanding about the Covid-19 situation in the country. In particular, the high rates in the Klang Valley and the role of the only state task force, the Selangor Task Force on Covid-19 (STFC)...

‘In many ways, if the STFC had not stepped in, did mass testing, rolled out POIS (Prevention of Outbreaks at Ignition Sites), allocated Z millions for FTTIS (find, test, trace, isolate, and support), the situation in Selangor would be far worse, critical even...

‘And other states, industries, agencies, etc, are buying in STFC’s POIS programme and implementing it. This tripartite initiative between government-industry-NGOs pivots on three preventative strategies namely, enhanced public health measures, early detection testing regime and health education. So STFC doesn’t just talk but rolls out programmes, mass testing, POIS, procuring vaccines, etc, to end the pandemic...

‘At the end of the day, we are in it together. If we refuse to learn from each other and operationalise the best public health practices, we are in for a rough ride.

‘I hope the national task force, as petitioned by the 46 top physicians, is rapidly recognised, accepted, and formalised to empower it to immediately re-strategise and transform the mindset, and policy at the top end of the Health Ministry, so that the operations at ground zero will be a truly rapid-response FTTIS which has zero-tolerance for cases, clusters or outbreaks.

‘MCOs are the blunt tools of those who have failed to operationalise the back-to-basics of pandemic management and in my opinion, they should either seek a second opinion from the task force and/or gracefully exit to minimise further harm to the nation and allow the task force to steer the nation out of this Covid-19 conundrum and to protect the lives and livelihood of its rakyat.’

Read here (Malaysiakini, Jan 30, 2021) 

Habitual use of vitamin D supplements and risk of coronavirus disease 2019 (Covid-19) infection: A prospective study in UK Biobank

Abstract

Background: Previous studies have related vitamin D supplementation to a lower risk of acute respiratory tract infection. Emerging evidence suggests that vitamin D insufficiency is related to a higher risk of coronavirus disease 2019 (COVID-19) infection.

Objectives: We aimed to investigate the prospective association between habitual use of vitamin D supplements and risk of COVID-19 infection, and assess whether such an association differed according to the different levels of circulating and genetically predicted vitamin D.

Methods: This study included 8297 adults who have records of COVID-19 test results from UK Biobank (from 16 March 2020 to 29 June 2020). The use of vitamin D supplements, circulating vitamin D levels, and main covariates were measured at baseline (2006-2010). Genetically predicted vitamin D levels were evaluated by genetic risk score.

Results: After adjustment for covariates, the habitual use of vitamin D supplements was significantly associated with a 34% lower risk of COVID-19 infection (OR, 0.66; 95% CI, 0.45-0.97; P = 0.034). Circulating vitamin D levels at baseline or genetically predicted vitamin D levels were not associated with the risk of COVID-19 infection. The association between the use of vitamin D supplements and the risk of COVID-19 infection did not vary according to the different levels of circulating or genetically predicted vitamin D (P-interactions = 0.75 and 0.74, respectively).

Conclusions: Our findings suggest that habitual use of vitamin D supplements is related to a lower risk of COVID-19 infection, although we cannot rule out the possibility that the inverse association is due to residual confounding or selection bias. Further clinical trials are needed to verify these results.

Read here (American Journal of Clinical Nutrition, Jan 29, 2021)

Covid-19: Five days that shaped the outbreak

‘A year ago, the Chinese government locked down the city of Wuhan. For weeks beforehand officials had maintained that the outbreak was under control - just a few dozen cases linked to a live animal market. But in fact the virus had been spreading throughout the city and around China. This is the story of five critical days early in the outbreak.’

Read here (BBC, Jan 26, 2021)

Is govt doing enough about Covid-19? – P Gunasegaram

‘The warning to manufacturers by the International Trade and Industry Ministry (Miti) reported over the weekend raises very serious questions on the handling of the Covid-19 pandemic. According to reports, Miti is involved in 99 of the more than 300 Covid-19 clusters in the country. This makes the manufacturing sector the main source of Covid-19 infections. Also, Miti indicated that there would be a shutdown/strict lockdown if Covid-19 numbers did not improve...

‘First, if indeed manufacturing is the main source of infections – it is no secret that cramped living quarters are the main source of Covid-19 – why is there no public information on this? Why is the matter only between manufacturers and the government?...

‘There are other questions, too. With the rising cases and contact tracing, it should have been obvious that the hospital system would reach full capacity and be strained. Why was there not enough serious effort put in to ease the strain on hospitals? When did we know that hospitals were going to be strained? Why wait so long before we announce it and formulate measures to take care of that? Why did contact tracing break down? What do we do now? What is the alternative?...

‘And then, there is the matter of the vaccine. Why was Khairy Jamaluddin, minister of science, technology and innovation, appointed to lead our search and procurement of suitable vaccines? It should have been led by health authorities. Let’s get this right, because the success of Covid-19 containment finally depends on it. Why the seeming delay in getting our vaccine rolled out? Why is our vaccine not yet ready? Singapore has got theirs, even Ecuador and Indonesia have theirs.

‘But where is ours? Why is it later than others? Are we prepared to roll out the vaccines in time, or will it take till next year, when enough of us are inoculated? And, have all the concerns about vaccination been sufficiently addressed?’

Read here (The Vibes, Jan 26, 2021)

Vaccines have been oversold as the pandemic exit strategy

‘Covid will be around for a long time — virus suppression is the right policy...

‘If regions with raging transmission do act as breeding grounds for resistant variants, then failing to control spread will prolong the pandemic. Prof de Oliveira stresses that Taiwan, China, Australia and New Zealand, which have chased elimination, are the role models to follow. “This should be a wake-up call for all of us to control transmission, not just in our own regions but globally. This virus will keep outsmarting us if we don’t take it very seriously,” he says.

‘That means not just vaccinating but fast testing, accurate and quick contact tracing, quarantine and isolation. In short, vaccination must go hand-in-hand with virus suppression, not become a substitute for it. A successful vaccine rollout will count for little if the country then becomes a crucible for resistant variants.’

Read here (Financial Times, Jan 26, 2021)

The worst of Malaysia's Covid-19 measures is yet to come: Sin Chew Daily columnist (Straits Times, Jan 25, 2021)

‘According to the government, this is to prevent a full-fledged impact the lockdown will have on the country's economy. Finance minister Tengku Zafrul has said the first MCO imposed nationwide last year cost the country RM2.4 billion (S$787 million) a day, but only RM600 million a day this time. While allowing key economic sectors to operate as usual could help arrest the daily economic loss, there is nevertheless a hefty public health price to pay...

‘To break the infection chain, we cannot afford to take things for granted. If the government eventually decides to extend the current MCO, it must tighten the SOPs, even to the extent of locking down all economic activities, or we will stand to lose even more if MCO is extended over and again. The situation now is indeed alarming.

‘From infection clusters mostly linked to migrant workers, factories, shopping malls, prisons and detention centres, we now have new clusters emerging in workplaces and even medical centres. All this highlights the fact that the virus has not only penetrated our communities but is fast expanding its reach, and may soon come to you or your family members, colleagues and friends.’

Read here (Straits Times, Jan 25, 2021)

Malaysia's worsening Covid-19 situation exposes serious economic, political fault lines

‘The darkening economic clouds for Malaysia will also have serious implications for the country's already troubled politics. Opposition politicians are keen to point out that Malaysians are starting to focus on the government's failures in dealing with the pandemic amid questions about Mr Muhyiddin's move to seek a declaration of a state of emergency.

"People and businesses need… a blanket moratorium on loans and perhaps a targeted movement control order. Certainly not the emergency," said Mr Ronnie Liu Tian Khiew, a senior politician from the opposition Democratic Action Party and elected assemblyman to the Selangor state government.

Read here (Straits Times, Jan 25, 2021)

If it ain’t broke, don’t fix it — Musa Mohd Nordin

‘The data shows that the MOH is doing relatively well. The risk of a Covid-19 death per population n Malaysia is 1 per 50,000. This compares favorably against the Global average of 1 per 3,676.b It is worse in the UK and US, 1 per 700 and 781 respectively...

‘Despite the surging numbers of Covid-19 cases, the MOH infrastructure and services are holding up well and delivering good outcomes when compared to the US, UK and our southern neighbours. Therefore, if it ain’t broke, don’t fix it. It is in this context that the following suggestions are made:

1. The MOH should continue to operate with the 52 dedicated Covid Hospitals.
2. If these are inadequate to meet the current surge in Covid-19 cases, select private and government facilities can be transformed into dedicated Covid Hopsitals.
3. The concept and operations of Hybrid Hospitals should be avoided as much as possible. It compromises the Quality of Care, especially among the Category 4-5 patients, and the Safety of patients, HCW, other hospital staff and visitors, due to the real risk of nosocomial infection from this most transmissible coronaviruses.
4. The lay public is fast becoming very fearful of Covid and Hybrid hospitals and this has led to them shunning away from hospitals despite their need for regular hospital visits and review.
5. If they delay or miss their appointments, the management of Non-Covid illness eg NCD, Cancers, Immunization uptake, will be compromised.
6. The MOH has begun to decongest and create more empty General and ICU beds in Covid Hospitals by discharging Category 1&2 patients to Home Isolation with clear instructions on the use of Health Assessment Tools.’

Read here (Malay Mail, Jan 24, 2021)