Covid-19 — A reminder to reason

‘Thus far in the Covid-19 pandemic, we’ve observed that therapeutic management has often been initiated and altered on the basis of individual case reports and physician opinion, rather than of randomized trials. In these uncertain times, physicians fall prey to cognitive error and unconsciously rely on limited experiences, whether their own or others’, instead of scientific inquiry. We believe that physicians should be acting in concert with clinical equipoise. We should be skeptical of any purported therapeutic strategy until enough statistical evidence is gathered that would convince any “open-minded clinician informed of the results” that one treatment is superior to another.

‘We are living through an unprecedented biopsychosocial crisis; physicians must be the voice of reason and lead by example. We must reason critically and reflect on the biases that may influence our thinking processes, critically appraise evidence in deciding how to treat patients, and use anecdotal observations only to generate hypotheses for trials that can be conducted with clinical equipoise. We must act swiftly but carefully, with caution and reason.’

Read here (New England Journal of Medicine, April 28, 2020)

Unified in coronavirus lockdown, India splinters over reopening

‘For five weeks, Indians of all stripes have united to zealously conduct a nationwide lockdown, the largest and one of the most severe anywhere. But as the central government has started lifting restrictions in areas with few or no known cases of the coronavirus, officials are now facing a new challenge: persuading fearful residents, and their leaders, to consider a partial reopening.’

Read here (New York Times, April 28, 2020)

New antibody test ‘with 99 per cent accuracy’ approved for use across Europe

‘Global diagnostics specialists Abbott, which has a UK base in Maidenhead, has said it is expecting to have shipped millions of the laboratory based lab tests across Europe by the end of May.

‘The company’s diagnostic test has been given a CE mark showing it complies with EU safety rules and can now be used in labs across the UK to test for antibodies created when a person has been infected with Covid-19.’

Read here (The Independent, April 28, 2020?)

‘Calamitous’: Domestic violence set to soar by 20% during global lockdown

‘At least 15m more cases of domestic violence are predicted around the world this year as a result of pandemic restrictions, according to new data that paints a bleak picture of life for women over the next decade. The UN Population Fund (UNFPA) has also calculated that tens of millions of women will not be able to access modern contraceptives this year, and millions more girls will undergo female genital mutilation or be married off by 2030. Natalia Kanem, the fund’s executive director, called the findings “totally calamitous”.’

Read here (The Guardian, April 28, 2020)

Are you and your office ready for post-MCO? 18 questions from Dr Amar-Singh

We need to behave and act as though everyone around us is Covid-19 positive. We need to behave and act as though we have an asymptomatic infection of Covid-19 and can infect others. We need to protect all older persons as if they are our parents and all those vulnerable to Covid-19 as our sisters and brothers.

As you plan to return to the office, here is a checklist of some of the things you need to consider and prepare for:

1. How are you going to manage public transport?
2. Has your office prepared a clear standard operating policy (SOP) or checklist to minimise the risk of staff getting the virus or spreading it?
3. How is the office building going to limit the number of people who enter and leave when coming to work and going home?
4. Has your office thought about staggered working hours or work from home?
5. How is the office building going to handle lifts?
6. What are you going to do about the office air-conditioning?
7. How can we modify the open office environment?
8. How will you modify the office meeting?
9. How to avoid contamination of common used items?
10. How are you going to deal with the pantry, prayer areas and common staff areas?
11. Have you a plan for mask safety and changing masks?
12. What is the plan to limit staff socialising?
13. What is the policy for the toilets?
14. What is the new cleaning routine for the office?
15. How will we use gloves optimally?
16. What is the policy if someone is unwell?
17. How do we deal with travelling, site visits, conferences, etc?
18. Do you have a plan to minimise virus transmission to your family?

Read here (The Malay Mail, April 28, 2020)

How the face mask became the world’s most coveted commodity

‘No object better symbolises the pandemic than the mask, and no object better explains the world into which the pandemic arrived. Social distancing, at first, felt like a strange notion: the inaction of it, the vagueness of it. But the mask sang out to our deepest consumeristic impulses. In the absence of a drug or a vaccine, the mask is the only material protection we can buy; it’s a product, and we’ve been trained like seals to respond to products. As a result, in every corner of every country, the humble face mask – this assembly of inexpensive plastic – has been elevated into a fetishised commodity. One mask broker described it as “a madhouse”, another as “the craziest market I’ve ever seen”...

‘Whatever the new normal is after this pandemic, everyone I spoke with agreed on one thing: there will be masks. Lots and lots of masks. They’ll be handed out on airlines and at hotels; they’ll be stacked next to the till at Boots; they’ll be stashed in sock drawers and linen closets in practically every home. Every country will produce and stockpile its own supply, unwilling to rely any more on the vagaries of the international market; Germany, forever ahead of the curve, has already begun.’

Read here (The Guardian, April 28, 2020)

‘Very worried’: Britain issues alert as possible new coronavirus syndrome emerges in children

‘Health officials in Britain warn that a potential new coronavirus-related syndrome is emerging in children, with a rise in cases prompting an urgent alert to doctors across the country. The alert revealed an "apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the United Kingdom".’

Read here (The Sydney Morning Herald, April 28, 2020)

CDC confirms six coronavirus symptoms showing up in patients over and over

The Centers for Disease Control and Prevention added six symptoms of the novel coronavirus to its list, suggesting health experts are learning more about the growing number of ways physicians see the virus affecting patients. The symptoms, which the CDC reports could appear two to 14 days after exposure to the virus, are: (1) chills (2) repeated shaking with chills (3) muscle pain (4) headache (5) sore throat (6) new loss of taste or smell. Previously, the CDC listed just three known symptoms: shortness of breath, cough and fever.

Read here (Washington Post, April 28, 2020)

All-of-government, whole-of-society involvement needed to fight virus

‘To enhance efficacy and minimise disruptions, an ”all of government“ approach at all levels needs to be developed, involving much more than public health and police enforcement authorities. Human resource, social protection, transport, education, media, industry, fiscal and other relevant authorities need to be appropriately engaged to develop the various required transitions and to plan for the post-lockdown “new normal”.

‘Another condition for success is “whole of society” mobilisation and support. Government transparency and explanations for various measures undertaken are important for public understanding, cooperation, support and legitimacy. The authorities must also realise how measures will be seen. Singapore’s apparent early success, for example, was not what it seemed as it had overlooked official disincentives for possibly infected migrant workers to cooperate...’

Read here (IPS News, April 28, 2020)

Businesses allowed to operate during MCO can go full capacity tomorrow (April 29)

‘All economic sectors that have been allowed to operate during the movement control order (MCO) period can ramp up their operations to full capacity starting tomorrow, said International Trade and Industry Minister Datuk Seri Mohamed Azmin Ali. In a statement, Mohamed Azmin said this was decided in the National Security Council meeting today, which discussed the recommendations of the Economic Action Council following the latter's own meeting yesterday. The meeting yesterday reviewed the studies and recommendations by the Ministry of Finance, the Ministry of International Trade and Industry (MITI), Bank Negara Malaysia and national sovereign wealth fund Khazanah Nasional Bhd.’

Read here (The Edge, April 28, 2020)

Health and economy will suffer if MCO lifted too soon

‘Noor Hisham is straight forward about what is required to lift the MCO – six conditions to be fulfilled of which three have already been satisfied. The Academy of Medicine Malaysia concurs with him...

‘Detailed guidelines for a return to the workplace are necessary as well as the readiness of both employers and employees to abide by them. If, for instance, it is a crowded workplace, social distancing of a minimum one metre will be impossible to achieve unless, say only half the workforce or less, goes to work. As many people as possible still need to work from home...

‘Premature lifting of the lockdown can be disastrous. Let us spend some thought and effort into deciding what the new norm is, set clear unambiguous guidelines by professionals with no political doublespeak, announce them, and wait for feedback before implementation.’

Read here (FocusMalaysia, April 28, 2020)

Whose coronavirus strategy worked best? Scientists hunt most effective policies

‘Working out the effectiveness of the unprecedented measures implemented worldwide to limit the spread of the coronavirus is now one of scientists’ most pressing questions... But untangling cause and effect is extremely challenging, in part because circumstances differ in each country and because there is uncertainty over how much people adhere to measures, cautions Rosalind Eggo, a mathematical modeller at the London School of Hygiene and Tropical Medicine (LSHTM). “It’s really hard but it doesn’t mean we shouldn’t try,” she adds.

‘Efforts to tackle these questions will get a boost in the coming weeks from a database that brings together information on the hundreds of different interventions that have been introduced worldwide. The platform, being prepared for the World Health Organisation (WHO) by a team at the LSHTM, gathers data collected by ten groups already tracking interventions — including teams at the University of Oxford, UK, the Complexity Science Hub Vienna (CSH Vienna), and public-health organisations and non-profit organisations such as ACAPS, which analyses humanitarian crises.’

Read here (Nature, April 28, 2020)

Nurses are trying to save us from the virus, and from ourselves

‘We’re in this together, but some of us are more in this than others. People keep saying that nurses are on the front lines, but they are actually behind enemy lines, surrounded on all sides. They are trying to save us, and save us from ourselves. Nurses are protesting protesters, standing in their scrubs and masks to glare at “freedom-loving” citizens who spew insults as they rally for the economy to reopen. Nurses are taking to social media to convey the extremity of their situations: They talk about war zones, about titrating a dozen IV drips while troubleshooting fluky ventilators, all without reliable stockpiles of supplies.’

Read here (The Washington Post, April 28, 2020)

How India will play a major role in a Covid-19 vaccine

‘US Secretary of State Mike Pompeo said last fortnight that India and the US were working together to develop vaccines against the coronavirus. Mr Pompeo's remark didn't entirely come as a surprise. The two countries have run an internationally recognised joint vaccine development programme for more than three decades.

‘India is among the largest manufacturer of generic drugs and vaccines in the world. It is home to half a dozen major vaccine makers and a host of smaller ones, making doses against polio, meningitis, pneumonia, rotavirus, BCG, measles, mumps and rubella, among other diseases.’

Read here (BBC, April 27, 2020)

We are living in a failed state: The coronavirus didn’t break America; it revealed what was already broken

'When the virus came here, it found a country with serious underlying conditions, and it exploited them ruthlessly. Chronic ills—a corrupt political class, a sclerotic bureaucracy, a heartless economy, a divided and distracted public—had gone untreated for years. We had learned to live, uncomfortably, with the symptoms. It took the scale and intimacy of a pandemic to expose their severity—to shock Americans with the recognition that we are in the high-risk category...

‘We can learn from these dreadful days that stupidity and injustice are lethal; that, in a democracy, being a citizen is essential work; that the alternative to solidarity is death. After we’ve come out of hiding and taken off our masks, we should not forget what it was like to be alone.’

Read here (The Atlantic, June 2020, preview issue)

Higher transmission rate among household contacts and individuals traveling with infected people

‘The researchers found that household contacts of COVID-19 cases and individuals traveling with cases were both at elevated risk of infection. Additionally, the secondary “attack rate” (percentage of contacts who tested positive for SARS-CoV-2 infection) among household contacts was at least 11.2%. While attack rates were higher among older adults, the value for children—7.4% and 7.1% for children aged 0-9 years and 10-19 years, respectively—was higher than in younger and middle-aged adults—4.9%-6.1% for adults aged 20-29 years, 30-39 years, and 40-49 years. Individuals aged 0-39 years exhibited lower risk of severe COVID-19 than adults aged 40 years and older.’

Read here (The Lancet, April 27, 2020)

US deaths soared in early weeks of pandemic, far exceeding number attributed to covid-19

‘In the early weeks of the coronavirus epidemic, the United States recorded an estimated 15,400 excess deaths, nearly two times as many as were publicly attributed to covid-19 at the time, according to an analysis of federal data conducted for The Washington Post by a research team led by the Yale School of Public Health.

‘The excess deaths are not necessarily attributable directly to covid-19, the disease caused by the coronavirus. They could include people who died because of the epidemic but not from the disease, such as those who were afraid to seek medical treatment for unrelated illnesses, as well as some number of deaths that are part of the ordinary variation in the death rate. The count is also affected by increases or decreases in other categories of deaths, such as suicides, homicides and motor vehicle accidents.’

Read here (Washington Post April 27, 2020)

Many US states are far short of Covid-19 testing levels needed for safe reopening, new analysis shows

‘More than half of US states will have to significantly step up their Covid-19 testing to even consider starting to relax stay-at-home orders after May 1, according to a new analysis by Harvard researchers and STAT.

‘The analysis shows that as the US tries to move beyond its months-long coronavirus testing debacle — faulty tests, shortages of tests, and guidelines that excluded many people who should have been tested to mitigate the outbreak — it is at risk of fumbling the next challenge: testing enough people to determine which cities and states can safely reopen and stay open. Doing so will require the ability to catch reappearances of the coronavirus before it again spreads uncontrollably.’

Read here (STAT News, April 27, 2020)

Sunlight does kill the coronavirus. But not in the way Trump suggested

‘Half the virus may be killed in as little as two minutes if it’s on a surface exposed to sunlight and high humidity at room temperature. That's according to lab studies conducted the Department of Homeland Security and detailed at a White House coronavirus briefing last week. Under drier, shady conditions, the virus’s half-life is far greater — around 18 hours.’

Read here (Washington Post, April 27, 2020)

Italy's PM outlines lockdown easing measures

Speaking on television on Sunday, Prime Minister Giuseppe Conte outlined how the country would begin "Phase Two" of lifting its coronavirus lockdown. The measures include:

1. People will be allowed to move around their own regions - but not between different regions
2. Funerals are set to resume, but with a maximum of 15 people attending, and ideally to be carried out outdoors
3. Individual athletes can resume training, and people can do sports not only in the vicinity of their homes but in wider areas
4. Bars and restaurants will reopen for takeaway service from 4 May - not just delivery as now - but food must be consumed at home or in an office
5. Hairdressers, beauty salons, bars and restaurants are expected to reopen for dine-in service from 1 June
6. More retail shops not already opened under the earliest easing measures will reopen on 18 May along with museums and libraries
7. Sports teams will also be able to hold group training from 18 May
8. There was no announcement on the possibility of Italy's premier football league Serie A resuming, even behind closed doors.

Read here (BBC, April 27, 2020)

Is it too early to expand our ‘social bubbles’?

‘Drastically limiting people's contact with others seems to be helping many countries stem the spread of the coronavirus. But as economies slump and people become fatigued with rules, governments are weighing up how to ease lockdowns without risking a second wave of infections.

‘One option being touted is to allow people to slightly expand the "social bubbles" - meaning they'd be able to see a select few friends and family.’

Read here (BBC, April 27, 2020)

WHO chief says pandemic 'far from over', worried about children

“We have a long road ahead of us and a lot of work to do,” WHO Director-General Tedros Adhanom Ghebreyesus told a virtual news conference in Geneva, adding that a second wave of infections could be prevented with the right actions.

He also expressed ‘concern that the health of children was being threatened by the impact of the coronavirus emergency on vaccination programmes for other diseases.’

“Children may be at relatively low risk from severe disease and death from COVID-19 - the respiratory illness caused by the novel coronavirus - but can be at high risk from other diseases that can be prevented with vaccines.”

Read here (Reuters, April 27, 2020)

Secret group of scientists and billionaires pushing a Manhattan Project for Covid-19

‘They are working to cull the world’s most promising research on the pandemic, passing on their findings to policy makers and the White House...

‘They call themselves Scientists to Stop Covid-19, and they include chemical biologists, an immunobiologist, a neurobiologist, a chronobiologist, an oncologist, a gastroenterologist, an epidemiologist and a nuclear scientist... This group, whose work hasn’t been previously reported, has acted as the go-between for pharmaceutical companies looking for a reputable link to Trump administration decision makers...

‘The group has compiled a confidential 17-page report that calls for a number of unorthodox methods against the virus. One big idea is treating patients with powerful drugs previously used against Ebola, with far heftier dosages than have been tried in the past.’

Read here (Wall Street Journal, April 27, 2020)

Bill Gates explains his plan to beat Covid-19

In an interview with Vox's editor-at-large Ezra Klein, Bill Gates covers a wide-ranging number of subjects on his interest and involvement in the prevention of pandemics; from history to the current issues of testing, treatments and vaccines, and from his current work to the conspiracy theories that surround it.

Read here (Vox, April 27, 2020)

Inc.'s essential business survival guide for the Covid-19 crisis

‘Inc.'s solutions center offers expert advice on handling panicked customers, interrupted supply chains, webinars, Zoom meetings, hyper kids, and a work environment that changes by the hour.” America-oriented, however, there many generic lessons that businesses anywhere can learn from. More specifically, for example, tips on working from home:

• The right way to keep your remote team accountable
• Some jobs can't be done remotely. Here's what business owners are doing to keep those employees safe
• Working from home? Here are 7 things you should start doing today
• A beginner's guide to working from home without driving yourself and your family crazy
• 23 essential tips for working remotely
• How to avoid loneliness and isolation when you live alone and work from home’

Read here (Inc, April 27, 2020)

Malaysia not ready to lift MCO, says medical expert

‘Malaysia is not ready to lift the movement control order (MCO), implemented to contain the spread of Covid-19, in the near future due to many issues that still need to be addressed, said senior consultant paediatrician Datuk Dr Amar Singh HSS.

‘According to the former head of the paediatric department at the Raja Permaisuri Bainun Hospital in Ipoh, Perak, out of the six criteria listed by the World Health Organisation (WHO) with regard to lifting the movement order, Malaysia was still lacking in four aspects—testing and screening, health system capacity, contact tracing and, most importantly, community’s mindset.

‘(The six criteria listed by WHO are transmission is under control; health systems are able to detect, test, isolate and treat every case and trace every contact; hot spot risks are minimised in vulnerable places, such as nursing homes; schools, workplaces and other essential places have established preventive measures; the risk of importing new cases can be managed; and communities are fully educated, engaged and empowered to live under a new normal.)’

Read here (The Malay Mail, April 26, 2020)

In Taiwan’s ‘container houses’ for migrant workers, coronavirus not the only health risk

‘While Taiwan has avoided a huge outbreak, activists doubt the government’s readiness to protect migrant workers, some of whom live in dorms of 30 people a room. Aside from the coronavirus, packed dorms located within factory grounds leave workers at risk of fire hazards.

‘In Taiwan, there are more than 718,000 blue-collar migrant workers. The highest number – nearly 280,000, or about 40 per cent of the migrant worker community – comes from Indonesia, followed by Vietnam (221,400), the Philippines (158,700) and Thailand (58,700). They mostly work in the manufacturing and caregiving sectors, as well as agriculture, forestry and fishing.’

Read here (South China Morning Post, April 26, 2020)

Young and middle-aged people, barely sick with covid-19, are dying of strokes

‘Reports of strokes in the young and middle-aged — not just at Mount Sinai, but also in many other hospitals in communities hit hard by the novel coronavirus — are the latest twist in our evolving understanding of the disease it causes. The numbers of those affected are small but nonetheless remarkable because they challenge how doctors understand the virus.’

Read here (Washington Post, April 26,2020)

Kerala's unique way to promote social distancing: Use umbrellas

‘Amid the outbreak of novel coronavirus in India, the government and state authorities have been rigorously urging the citizens to ensure social distancing among one another. In a similar manner, the Thanneermukkom gram panchayat in Alappuzha has come up with a unique idea to enforce social distancing in the area. The authorities have mandated everyone residing there to hold an umbrella when they go out. “Two opened umbrellas, not touching each other, will ensure minimum distance of 1 meter from one another,” said state finance minister Thomas Isaac.’

Read here (Live Mint, April 26, 2020)

Global coronavirus death toll could be 60% higher than reported

‘To calculate excess deaths, the FT has compared deaths from all causes in the weeks of a location’s outbreak in March and April 2020 to the average for the same period between 2015 and 2019. The total of 122,000 amounts to a 50 per cent rise in overall mortality relative to the historical average for the locations studied.’

Read here (Financial Times, April 26, 2020)

‘Our correspondent’ on ‘Malaysia’s health czar under fire’: In an age of misinformation and half-truths, judging the authenticity of an online news publication has never been easy

‘News publication Asia Sentinel (AS) on Thursday (April 23) ran a contentious article on Health Ministry director-general (DG) Noor Hisham Abdullah under the headline “Malaysia’s health czar under fire” with a standfirst that read: “Critics charge mismanagement, authoritarian behaviour...’

This article questions the professionalism of the unnamed writer, pointing to doubts about his or her research, lack of first-hand sources and documents to support the story.

Read here (The Malaysianist, April 26, 2020)

Seattle’s leaders let scientists take the lead. New York’s did not

‘Today, New York City has the same social-distancing policies and business-closure rules as Seattle. But because New York’s recommendations came later than Seattle’s—and because communication was less consistent—it took longer to influence how people behaved. According to data collected by Google from cell phones, nearly a quarter of Seattleites were avoiding their workplaces by March 6th. In New York City, another week passed until an equivalent percentage did the same.

‘More than fifteen thousand people in New York are believed to have died from covid-19. Last week in Washington State, the estimate was fewer than seven hundred people.’

Read here (New Yorker, April 26, 2020)

MMA voices concern on discrimination against healthcare workers

‘The Malaysian Medical Association (MMA) has raised concerns over what it says are discriminatory practices against healthcare workers due to Covid-19. The MMA said it was informed that a condominium in Petaling Jaya had segregated the use of its lifts to "protect other residents from getting infected with Covid-19".

‘While we welcome the regular cleaning of common areas and temperatures of residents being taken upon entry as precautionary steps, the segregation of residents for shared facilities such as lifts is unnecessary and smacks of discrimination against our healthcare workers,’ says MMA president Dr N Ganabaskaran said in a statement.

Read here (Malaysiakini, April 25, 2020)

When will COVID-19 end? Data-driven estimation of end dates (as of April 25, 2020, daily updated)

‘This site provides continuous predictive monitoring of COVID-19 developments as a complement to monitoring confirmed cases. SIR (susceptible-infected-recovered) model is regressed with data from different countries to estimate the pandemic life cycle curves and predict when the pandemic might end in respective countries and the world, with codes from Milan Batista and data from Our World in Data. Given the rapidly changing situations, the predictive monitors are updated daily with the latest data.’

Read here (Singapore University of Technology and Design, April 25, 2020)

Leading vaccine expert shares wide-ranging views on the nature, development, trials and use on human populations

Dr Jerome Kim, the Director General of the International Vaccine Institute (IVI) and one of the world’s leading vaccine expert about COVID-19 vaccine, shares his insight on vaccines, their development and how they would be distributed. This video is 43 minutes.

View here (Asian Boss, YouTube, April 25, 2020)

Inside a COVID-19 lab and why more people return inconclusive tests

The head of NSW’s busiest COVID-19 testing lab says rising numbers of people will return undefined coronavirus results as the testing blitz picks up cases that shed the virus weeks ago. According to Professor Bill Rawlinson, director of Serology, Virology and OTDS Laboratories (SAViD), NSW Health Pathology based at Prince of Wales Hospital, “We are at the stage when individuals may only be positive for one of the several targets that PCR tests pick up,” he said, referring to the molecular testing performed samples collected by the nasal and throat swabs at COVID clinics. “These indeterminate results are going to increase because there will be people who had [the virus] a long time ago and still have some residual RNA [ribonucleic acid].”

Read here (The Sydney Morning Herald, April 25, 2020)

Time to wake up to Western media bias

‘Anyone without scales over his eyes and who has not succumbed to cerebral shampooing by the West will have realised by now that large parts of its media are biased, if not outright antagonistic, in their reporting of China.

‘Admittedly, Al Jazeera and CGTN are nowhere near CNN or the BBC in reach and brand value but any fair-minded reader/viewer who has followed their work for a sustained period knows their products are nothing to sniff at.

‘And not to forget: their own English language national or regional media too - whether it be the South China Morning Post, The Star in Malaysia, or The Straits Times and Channel NewsAsia in Singapore. They make no self-glorifying claims to being the gold standard for good journalism but they do try to be objective, fair and balanced.’

Read here (Straits Times, April 25, 2020)

Immunity passports 'could increase virus spread': WHO

‘Governments should not issue so-called "immunity passports" or "risk-free certificates" as a way of easing lockdowns, the World Health Organization (WHO) says... It said there was "no evidence" that people who had developed antibodies after recovering from the virus were protected against a second infection... Such a move could actually increase virus transmission, it warned... People who assumed they were immune might stop taking precautions, it said.'

Read here (BBC, April 25, 2020)

US says will not take part in WHO global drugs, vaccine initiative launch

‘The United States will not take part in the launching of a global initiative on Friday to speed the development, production and distribution of drugs and vaccines against COVID-19, a spokesman for the U.S. mission in Geneva told Reuters.

“There will be no US official participation”, he said in an email reply to a query. “We look forward to learning more about this initiative in support of international cooperation to develop a vaccine for COVID-19 as soon as possible.”

Read here (Reuters, April 25, 2020)

Related:

• WHO initiates ACT (Access to Covid-19 Tools) Accelerator. Read here

McKinsey & Co: The phase of Return is in sight. But rapid Return comes with higher risk, and a new reality

Pages 29 to 55 of this 63-page McKinsey & Co report start with the following introduction:

• Weeks of shelter-in-place provisions globally have caused a deep economic challenge, straining governments’ ability to save lives while safeguarding livelihoods
• Governments are now considering options and timing for a gradual re-opening, with the US being the most recent announcement.
• Many of these re-openings are occurring in very different environments. Some geographies are considering opening after they have plateaued, while others are seeking to return after additional verifications are complete (e.g., hospital capacity, testing capacity, other)
• These variations are driving concerns within businesses around risks associated with a return-to-work, and whether these risks can be adequately managed
• Additionally, COVID-19 has changed many realities for businesses. Remote first may be a goal achievable in months, consumers have structurally adopted digital channels, and the prospect of the largest economic recession since the second World War could quickly challenge the business

The section goes on to discuss ‘Return planning’ which is relevant to all Malaysians as we enter the phase of conditional MCO.

Download the report here (McKinsey & Co, April 24, 2020)

The architect of Sweden’s controversially lax coronavirus response says he thinks it’s working

‘Anders Tegnell, Sweden’s state epidemiologist, has defended his country’s unusually lax response to the coronavirus. Sweden has encouraged social distancing but has not forced businesses, restaurants, or schools to close. Tegnell said the strategy had achieved its goal of defending the health service and that Stockholm was showing signs of herd immunity. Its case numbers are comparable to neighbouring countries, but the death rate is much higher. Tegnell said it was “very difficult” to know if a lockdown could have prevented more deaths, particularly in care homes.’

Read here (Business Insider, April 24, 2020)

Health D-G: Malaysia now in recovery phase

‘Based on the various modelling that we have done, we realise that when we look into the data, April 3, when we had 217 new cases, was the peak then.

‘ “Then, we were expecting a peak on April 14, so much so that the prediction was 6,300 total cases. But we did not see that peak. We thought perhaps Phases 1 and 2 of the movement control order (MCO) had flattened the curve. Now, we have come to realise that we are in the recovery phase,” Noor Hisham said during his daily press briefing on the Covid-19 situation in the country today.

‘Nevertheless, he did not rule out the possibility that a surge in new cases may occur if the precautions undertaken during Phases 1 and 2 of the MCO are not continued.’

Read here (The Edge, April 24, 2020)

MCO extension has grave consequences, UOB Kay Hian warns

‘The government’s direct fiscal injection, which amounts to about 2.4% of gross domestic product, already pales in comparison to many developed countries, which have shorter lockdown periods. We can no longer safely assume a U-shaped economic recovery and near-full recovery in the fourth quarter of 2020 even if the government were to throw in more financial lifelines for the deeply wounded small and medium enterprises – we fear it would be “too little, too late”.

‘“We also fear that the country’s unemployment rate will spike well beyond the 4% baseline assumed by the government.”

Read here (The Edge, April 24, 2020)

The architect of Sweden’s controversially lax coronavirus response says he thinks it’s working

‘Anders Tegnell, Sweden’s state epidemiologist, has defended his country’s unusually lax response to the coronavirus. Sweden has encouraged social distancing but has not forced businesses, restaurants, or schools to close. Tegnell said the strategy had achieved its goal of defending the health service and that Stockholm was showing signs of herd immunity. Its case numbers are comparable to neighbouring countries, but the death rate is much higher. Tegnell said it was “very difficult” to know if a lockdown could have prevented more deaths, particularly in care homes.’

Read here (Business Insider, April 24, 2020)

Japan to subsidise 100% of salaries at small companies

‘Japan is working on a subsidy to ensure that temporarily idled small-business employees receive 100% of their wages during the current state of emergency, Nikkei has learned... The Ministry of Health, Labor and Welfare plans to use an existing employment adjustment subsidy, which helps enterprises seeing no choice but to temporarily lay off workers continue to pay them, at least in part... As things stand, laid-off workers at companies that have halted operations are entitled to at least 60% of their regular pay. The government shoulders up to 90% of this to keep them from being dismissed outright, with the company chipping in the other 10%.’

Read here (Nikkei, April 24, 2020)

WHO and ”immunity passports”: No clear evidence people who have recovered cannot be reinfected

‘Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an “immunity passport” or “risk-free certificate” that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.’

Read here (WHO, April 24, 2020)

In Italy, home is also a dangerous place that may be propping up the infection curve the lockdown was meant to suppress

‘Italy’s leading virologists now consider home infections, alongside clusters in retirement homes, to be a stubborn source of the country’s contagion. Living together in close quarters and the failure to move the infected into dedicated quarantine facilities have, they say, paradoxically propped up the curve of infections that “stay home” measures were designed to suppress.

‘The problem is one the Chinese government bludgeoned quickly. It ordered the roundup of all residents in Wuhan infected with the coronavirus, warehousing them in quarantine camps, sometimes with little care. While that approach may have helped contain the virus, ripping people apart from their homes is anathema to Western democracies, especially Italy, where tight-knit families are the rule.’

Read here (New York Times, April 24, 2020)

Covid-19 pandemic: A perfect ecosystem for fraudsters to operate in

‘In fact, Carpenito and Merrill say that with the massive $2 trillion economic relief package beginning to be doled out, they expect to see even more fraud in the weeks and months ahead.

‘"What we're worried about is that not only do we have these existing conditions, but we are awaiting — like everybody in the country — the arrival of $2 trillion to hit the streets," Merrill said. "And anytime there's that much money out there, you can just multiply the amount of frauds that are going to take place. So we're preparing for many more complaints to come in and new schemes to arrive on a daily basis."’

Read here (NPR, April 24, 2020)

The results of coronavirus ‘serosurveys’ are starting to be released. Here’s how to kick their tires

‘Results from the first studies designed to determine how widely the coronavirus has spread in communities have started to trickle in, drawing immense attention. These studies, after all, are seen as critical indicators of when it might be safe to lift movement restrictions.

‘Already, though, experts are raising concerns about the validity of some of the studies and cautioning officials and the general public not to put too much weight on any one finding.

‘Known as serological surveys, the studies involve testing the blood of people not diagnosed with Covid-19 to determine whether they had previously been infected by the SARS-CoV-2 virus. They are important because they can flesh out the picture of how many people in any given community may have had Covid-19, even if they were unaware they were infected.‘

Read here (STAT News, April 24, 2020)

Download here Q&A from The Wadsworth Center (WC), the public health laboratory of the New York State Department of Health (NYSDOH)

Malaysia almost reaching target test capacity of 16,500 samples per day, says Health DG

‘Malaysia is edging closer towards its aim of conducting 16,500 Covid-19 tests in a day, says the Health Ministry. Health director-general Datuk Dr Noor Hisham Abdullah said the country managed to test 13,614 samples on Thursday (April 23) alone.

“We are also looking to optimise our labs with the installation of automated testing devices from the Beijing Genomics Institute (BGI). This will increase our testing capacity... The BGI automated testing device at IMR will increase our testing capacity by another 5,000 a day, while in Sabah, it would give us another 1,000 tests in a day.”

Read here (The Star, April 24, 2020)

The pandemic shows what cars have done to cities

Along streets suddenly devoid of traffic, pedestrians get a fresh look at all the space that motor vehicles have commandeered...

‘The single-occupancy car itself is the original social-distancing machine. Knoflacher has likened it to a virus—a pathogen that has infiltrated its host (the city) and hijacked its molecular infrastructure to create a more welcoming environment for its own replication. “Normal human social behavior,” he writes, is transformed “into the rules of road traffic regulations in which car traffic [has] advantages in relation to all other users of public space.” We have laws to ensure sufficient parking, but no laws to ensure sufficient parks. So complete is the viral takeover that when President Donald Trump and others seek to minimize the severity of the COVID-19 pandemic, they equate its number of victims with the largely preventable death toll from traffic crashes—as if losing tens of thousands of Americans in that way every year were perfectly acceptable.’

Read here (The Atlantic, April 24, 2020)

WHO/Europe publishes considerations for gradual easing of COVID-19 measures

‘WHO guidance includes 6 criteria for moving to ease lockdown restrictions. Countries must ensure that:

1. Evidence shows COVID-19 transmission is controlled;
2. Public health and health system capacities are in place to identify, isolate, test, trace contacts and quarantine them;
3. Outbreak risks are minimised in high-vulnerability settings, particularly in homes for older people, mental health facilities and crowded places of residence;
4. Workplace preventive measures are established, including physical distancing, handwashing facilities and respiratory etiquette;
5. Importation risks can be managed; and
6. Communities have a voice and are aware, engaged and participating in the transition.

‘Due to the complex nature of the COVID-19 situation, countries are at different stages. Some are beginning to ease restrictions while others are choosing to continue strict lockdown measures.’

The WHO also called for adaptability and a staggered approach.

Read here (WHO/Europe, April 24, 2020)

Work smart, travel alone, eat out fast: South Korea's prescription for coronavirus recovery

‘South Korea outlined guidelines on Friday for a two-year return to a post-coronavirus normality including flexible working, bookings on public transport and quick restaurant meals in a country that has been a role model in containing COVID-19.

“Some experts predict COVID-19 will stay for as long as two years, and we have to accept the reality that we can’t go back to pre-COVID-19 life during that time,” Vice Health Minister Kim Gang-lip told a briefing.

‘The guidelines detail a code of conduct in areas including workplaces, transport, restaurants, shopping and sporting fixtures, starting with general rules such as washing hands, maintaining distance and regular temperature checks and disinfection.’

Read here (Reuters, April 24, 2020)

392 NGOs call on WHO to operationalise fair and equitable benefit sharing of Covid-19 medical products

The NGOs are referring to the benefits arising from the sharing of SARS-CoV-2 digital sequence information and samples as recognised by the Convention on Biological Diversity (which has 196 Parties) and its Nagoya Protocol (which has 123 Parties).

Specifically, they have asked WHO to urgently:

1. Secure binding commitments from biopharmaceutical companies and other manufacturers for the rapid supply of existing and future medical products, especially diagnostics, therapeutics and vaccines to developing and least developed countries at an affordable price.
2. Organise open platforms for the widespread and unconditional sharing of technology and knowledge including technical specifications, designs, blueprints and any other know-how to scale-up local/regional manufacturing of medical products required for COVID-19 response including diagnostics, therapeutics and vaccines; and towards that end to secure binding commitments from biopharmaceutical companies and other medical product manufacturers.
3. Proactively coordinate and direct COVID-19 R&D by setting up an open innovation platform for the rapid public sharing of all research outcomes, knowledge gaps and problem solving, and towards that end secure binding commitments from entities and individuals engaged in the R&D.
4. Ensure that intellectual property rights do not affect or hinder efforts to curb the Covid outbreak.

Download here (Third World Network, letter dated April 24, 2020)

Republican Party memo urges anti-China assault over coronavirus

‘The National Republican Senatorial Committee has sent campaigns a detailed, 57-page memo authored by a top Republican strategist advising GOP candidates to address the coronavirus crisis by aggressively attacking China.

‘The memo includes advice on everything from how to tie Democratic candidates to the Chinese government to how to deal with accusations of racism. It stresses three main lines of assault: That China caused the virus “by covering it up,” that Democrats are “soft on China,” and that Republicans will “push for sanctions on China for its role in spreading this pandemic.”’

Read here (Politico, April 24, 2020)

WHO initiates ACT (Access to Covid-19 Tools) Accelerator

‘Our mission is not only accelerated development and availability of new COVID-19 tools – it is to accelerate equitable global access to safe, quality, effective, and affordable COVID-19 diagnostics, therapeutics and vaccines, and thus to ensure that in the fight against COVID-19, no one is left behind.’

Download here (WHO, April 24, 2020)

Lift MCO on areas without new Covid-19 cases over 28 days: Ex-MOH official

‘The MCO can be lifted in white areas without testing, while maintaining strict border control, such as prohibiting entry to people from red or yellow zones, and preventing residents of white areas from visiting red or yellow zones. Covid-19 testing in white areas is unnecessary, Dr Lokman said, as the assumption is that the virus transmission has been broken. “In any scenario, you have got to make certain assumptions, i.e. the likelihood of transmission is active. When you test a person negative, you have to make the assumption that the likelihood that he is positive is very, very, very low, otherwise you will end up with testing all the time, which is ridiculous,” Dr Lokman told CodeBlue in an interview.’

Read here (Code Blue, April 24, 2020)

The COVID-19 paradox in South Asia: It is surprising that the region has far fewer infections and deaths compared with North America and Western Europe

‘The oldest and largest democracies in the world are often compared. This time is different. The first person tested positive for COVID-19 on January 21 in the United States and on January 30 in India. Roughly three months later, on April 20, the total number of infections was 7,23,605 in the U.S. and 17,265 in India, accounting for 31.2% and 0.75% of the world total, while the number of COVID-19 deaths was 34,203 in the U.S. and 543 in India, making up 21.7% and 0.33% of the world total. The share of the two countries in world population, by contrast, is about 4% and 18%, respectively.’

Read here (The Hindu, April 24, 2020)

How would the property sector fare against the Covid-19?

EdgeProp.my speaks to industry veterans who have experienced previous crises. 13-page free pullout.

Download here (The Edge, April 24, 2020)

Lockdown, vaccine, herd immunity. Can there be a winning exit strategy?

‘Lockdowns buy precious time but are not a strategy. The immediate fire is extinguished but the population remains vulnerable as large numbers lack any immunity to Covid-19 – akin to a forest-full of combustible material. It will only take a spark. Exit strategies for Covid-19 must consider this longer perspective, but the following charts explain why there will be no easy solutions and many ethical dilemmas lie ahead.’

NOTE: Dr Yap Wei Aun is a health systems specialist and adviser to the former Malaysian Minister of Health

Read here (South China Morning Post, April 24, 2020)

Learning how to dance - Part 2: The basic dance steps everybody can follow. Tomas Pueyo

‘Any country can follow a series of measures that are very cheap and can dramatically reduce the epidemic: mandate wearing home-made masks, apply physical distancing and hygiene everywhere, and educate the public.

‘It’s time to dive deep into all these possible measures, to understand them really well and decide which ones we should follow. We can split them into 4 blocks:

• Cheap measures that might be enough to suppress the coronavirus, such as masks, physical distancing, testing, contact tracing, quarantines, isolations, and others
• Somewhat expensive measures that might be necessary in some cases, such as travel bans and limits on social gatherings
• Expensive measures that might not always be necessary during the dance, such as blanket school and business closures
• Medical capacity

Read here (Medium, April 23, 2020)

UN chief: Pandemic is fast becoming 'human rights crisis'

UN Secretary-General Antonio Guterres warns about ‘rising ethno-nationalism, populism, authoritarianism and a pushback against human rights’ in many nations as a result of the coronavirus pandemic. ‘The crisis can provide a pretext to adopt repressive measures for purposes unrelated to the pandemic,’ he added. The UN chief's remark comes as governments around the world carry out extraordinary measures to deal with the pandemic and as activists have denounced state violence, threats to press freedom, arrests and smartphone surveillance, as many of the alleged abuses regimes have implemented to fight COVID-19.

Read here (DW, April 23, 2020)

UrbanFutures: The marathon fight against Covid-19 and beyond

• ‘By all accounts, it looks highly probable that the pandemic and its direct consequences will be with us for a while, possibly for another 12 to 18 months, and its social, cultural and economic impact will be felt many years after...
• ‘To face this challenge, unified public health strategies should be implemented so that risks can be managed and, with a degree of regularity, brought into everyday life...
• ‘The Covid-19 crisis is going to redefine our lives, our economy and our future. We are in the early phase of a protracted slowdown and there is discussion in the international media about the possibility of global depression. The challenge is managing the economic shock and slowdown...
• ‘We should all be thinking about and having conversations around the type of future we want — not just for ourselves and our children, but for our friends, neighbours and fellow humans. More importantly, we need to have this conversation today, even as we manage the complexity of the first wave and its fallout.’ 

Read here (The Edge, April 23, 2020)

Coronavirus: Charting the way forward for Malaysia (Jeyakumar Devaraj)

‘The question is how can we weather these changes with minimum damage to our economy, to our society and to peace and stability in our country? This is what we need to focus our discussions on. He discuses the following: (1) Contain Covid-19 epidemic (2) Ensure basic needs of entire population are met (3) Enhance food security (4) Preserve the nation’s productive capacity (5) Consider heterodox economic policies like allow a much larger budget deficit, consider quantitative easing for the rakyat, use a consumption tax to combat inflation, and ban short-selling of currency (6) Green the nation and improve living conditions.

Read here (Aliran, April 23, 2020)

The Oxford Vaccine Centre COVID-19 Phase I clinical trial explained

‘The purpose of this study is to test a new vaccine against COVID-19 in healthy volunteers. This study aims to assess whether healthy people can be protected from COVID-19 with this new vaccine called ChAdOx1 nCoV-19. It will also provide valuable information on safety aspects of the vaccine and its ability to generate good immune responses against the virus.’

Read here (The Oxford Vaccine Centre, April 23, 2020)

A WORD OF CAUTION: ‘News about trial progress - We are aware there have been and will be rumours and false reports about the progress of the trial. We urge people not to give these any credibility and not to circulate them.  We will not be offering a running commentary about the trial but all official updates will appear on this site.’

Read here (The Oxford Vaccine Centre, April 26, 2020)

Congested Milan to turn roads into cycle lanes after drop in air pollution due to lockdown

‘Milan is preparing to launch an ambitious scheme to reallocate street space from cars to cyclists and pedestrians when it begins to exit its months-long coronavirus lockdown. The Italian city, which is in the hard-hit region of Lombardy, has some of the worst pollution in Europe and introduced a temporary daytime car ban earlier this year in an attempt to reduce high levels of smog. Motor traffic congestion has dropped by 30-75 per cent during Italy’s lockdown and officials in Milan hope to use the reopening of the city as an opportunity to turn residents away from car use.’

Read here (The Independent, April 23, 2020)

Invest in the overlooked and unsung: Build sustainable people-centred long-term care in the wake of COVID-19

‘This pandemic has shone a spotlight on the overlooked and undervalued corners of our society. Across the European Region, long-term care has often been notoriously neglected. But it should not be this way. Looking to the future, transitioning to a new normal, we have a clear investment case for setting up integrated, person-centred long-term care systems in each country.

‘We have inherited the European rights, values and opportunities that define us from the generations that came before – so we must care for them. It is our duty to leave no-one behind. We must step up. So what must we do? (1) Empower care workers (2) Change how long-term care facilities operate and (3) Build systems that prioritise people’s needs.’

This is a press statement by Dr Hans Henri P Kluge, WHO Regional Director for Europe.

Read here (WHO, April 23, 2020)

Health service disruptions due to drug shortage could lead to 769,000 malaria deaths in Sub-Saharan Africa

‘A new modelling analysis by WHO and partners considers nine scenarios for potential disruptions in access to core malaria control tools during the pandemic in 41 countries, and the resulting increases that may be seen in cases and deaths.

‘Under the worst-case scenario, in which all insecticide-treated net campaigns are suspended and there is a 75% reduction in access to effective antimalarial medicines, the estimated tally of malaria deaths in sub-Saharan Africa in 2020 would reach 769 000, twice the number of deaths reported in the region in 2018. This would represent a return to malaria mortality levels last seen in the year 2000.’

Read here (WHO, April 23, 2020)

Coronavirus is not an enemy rather a courier

‘The Dao philosophical and medicinal way of tackling Covid-19 has been effective in China and need to be widely adopted...

‘If we regard COVID-19 as an ecological crisis, it requires a brand new thinking, a comprehensive, organic thinking which treats COVID-19 as political, economic, philosophical, ethical, and psychological issue.

‘We recommend Dao thinking. According to Dao or process-relational thinking, everything is closely related to one another. The COVID-19 crisis is a result of many causes. This means that tackling COVID-19 should be carried out in a multi-faceted way. Therefore it will require everybody’s active participation, and everyone including scientists, economists, educators, philosophers, government officials, ordinary people should take some responsibilities. We should rethink our development model, our way of thinking, our way of living, our way of consumption, our way of production, our dietary habits, and our education system, etc. All of them are closely related to the cause and cure of COVID-19.’

Read here (MR Online, Apr 23, 2020)

Could it be time to swop fast car for slower, sturdier one?

Danny Quah, dean, and Li Ka Shing Professor in Economics, Lee Kuan Yew School of Public Policy, addresses the questions: How should the world change post Covid-19? Will we all just go back to business as usual? What lessons do we need to learn from this pandemic?

Upclose and personal: “Post-Covid-19, the new focus will concentrate more sharply on individual well-being and individual responsibility. Old political dogmas about individual rights and state surveillance and control need to be recalibrated. In a world of spillovers, individual rights are immediately social ones too. Covid-19 has shown how our economic world is rife with externalities, where we ourselves rise by lifting others around us."

Two paradigms: The overall tradeoff involves two paradigms of development. Comparing a highly souped-up car with a slower sturdier one, he concluded: “The critical trade-off is between driving an economic system to maximal efficiency and building in redundancies and resilience through spare back-up capacity. Government intervention is needed to repair the problems created by externalities in health systems.”

Read here (Straits Times, April 23, 2020)

Seniors with Covid-19 show unusual symptoms, doctors say

‘Covid-19 is typically signaled by three symptoms: a fever, an insistent cough and shortness of breath. But older adults — the age group most at risk of severe complications or death from this condition ― may have none of these characteristics. Instead, seniors may seem “off” — not acting like themselves ― early on after being infected by the coronavirus. They may sleep more than usual or stop eating. They may seem unusually apathetic or confused, losing orientation to their surroundings. They may become dizzy and fall. Sometimes, seniors stop speaking or simply collapse.’

Read here (CNN, April 23, 2020)

Finland considers controlled herd immunity: HUS infections chief calls for healthy groups to be exposed to virus to spread immunity

‘We should try and allow exposure to the virus by those in the population for whom it is least likely to be dangerous, such as children, young people and adults. And try and keep older sections of the population away from the illness,’ Järvinen said. Without immunity building, Järvinen warned that the health system could be overwhelmed if restrictions continue into the autumn.

Read here (Utiset, April 23, 2020)

Covid-19 crisis forces Penang to review PSP, Penang 2030 vision

‘The Penang government will review the Penang Structure Plan (PSP) 2030 and Penang 2030 vision as it grapples with fallout from the Covid-19 pandemic.

‘State Local Government, Housing Development and Town and Country Planning Committee chairman Jagdeep Singh Deo said that both documents are crucial to map out the future of Penang – however, current circumstances have affected their implementation.’

View here (New Straits Times, April 23, 2020)

No benefit, higher death rate for malaria drug in coronavirus study

‘A malaria drug [hydroxychloroquine] widely touted as a potential cure for Covid-19 showed no benefit against the disease over standard care - and was in fact associated with more deaths, the biggest study of its kind showed on Tuesday (April 21). The US government funded analysis of how American military veterans fared on hydroxychloroquine was posted on a medical preprint site and has not yet been peer reviewed.’

Read here (Straits Times, April 22, 2020)

Amar Singh and other doctors offer guidelines for supermarkets

‘Supermarkets play an important role in Covid-19 prevention. Many supermarkets have put in place measures to limit the spread of Covid-19 at their premises. However, as the movement control order is relaxed, and client numbers increase, supermarkets will have to be even more vigilant.

We offer here a “Guide for Supermarkets to Standardise Covid-19 Prevention”: The “new normal” for supermarkets. This guide aims to help standardise the measures to be taken by all supermarkets, as well as offer ideas and initiatives that could be taken.’

Read here (The Malay Mail, April 22, 2020)

Amar Singh and other doctors offer guidelines for supermarkets under new normal

‘Supermarkets play an important role in Covid-19 prevention. Many supermarkets have put in place measures to limit the spread of Covid-19 at their premises. However, as the movement control order is relaxed, and client numbers increase, supermarkets will have to be even more vigilant.

‘We offer here a “Guide for Supermarkets to Standardise Covid-19 Prevention”: The “new normal” for supermarkets. This guide aims to help standardise the measures to be taken by all supermarkets, as well as offer ideas and initiatives that could be taken.’

Read here (The Malay Mail, April 22, 2020)

“Hammer and the dance” in Bahasa Malaysia

A UPM medical student translated Tomas Pueyo's The Hammer and The Dance into BM.

Read here (Medium, March 22, 2020)

Potential to develop a more effective cloth mask with finer weave, more layers and a better fit

This study, which compares the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs), says the following: ‘Cloth masks are used in resource-poor settings because of the reduced cost of a reusable option. Various types of cloth masks (made of cotton, gauze and other fibres) have been tested in vitro in the past and show lower filtration capacity compared with disposable masks.

‘The protection afforded by gauze masks increases with the fineness of the cloth and the number of layers, indicating potential to develop a more effective cloth mask, for example, with finer weave, more layers and a better fit.

‘Pandemics and emerging infections are more likely to arise in low-income or middle-income settings than in wealthy countries. In the interests of global public health, adequate attention should be paid to cloth mask use in such settings. The data from this study provide some reassurance about medical masks, and are the first data to show potential clinical efficacy of medical masks.’

Read here (NCBI, April 22, 2015)

UChicago Medicine doctors see 'truly remarkable' success using ventilator alternatives to treat COVID-19

‘Doctors at the University of Chicago Medicine are seeing “truly remarkable” results using high-flow nasal cannulas rather than ventilators and intubation to treat some COVID-19 patients. High-flow nasal cannulas, or HFNCs, are non-invasive nasal prongs that sit below the nostrils and blow large volumes of warm, humidified oxygen into the nose and lungs. A team from UChicago Medicine’s emergency room took dozens of COVID-19 patients who were in respiratory distress and gave them HFNCs instead of putting them on ventilators. The patients all fared extremely well, and only one of them required intubation after 10 days.’

Read here (UChicago Medicine, April 22, 2020)

US CDC, in the face of personal protection equipment (PPE) shortages, issues strategies to optimise the supply of PPEs

The strategies of the US Centers for Disease Control and Prevention (CDC) cover eye protection gear, isolation gowns, face masks, N95 respirators and reuse of filtering face respirators and ventilators.

‘CDC’s optimisation strategies for PPE offer options for use when PPE supplies are stressed, running low, or absent. Contingency strategies can help stretch PPE supplies when shortages are anticipated, for example if facilities have sufficient supplies now but are likely to run out soon. Crisis strategies can be considered during severe PPE shortages and should be used with the contingency options to help stretch available supplies for the most critical needs. As PPE availability returns to normal, healthcare facilities should promptly resume standard practices.’

Read here (CDC, April 22, 2020)

We should applaud the Cuban health system — and learn from it

‘Like most of the world, Cuba is now grappling with coronavirus. As of April 20, there were 1,137 confirmed cases, with 38 deaths. But Cuba’s free and universal health care system, including a robust cadre of health professionals, puts the island in a better position to deal with this crisis than most countries. With its intense focus on training health professionals, Cuba has the highest density of physicians in the world. Its ratio of medical professionals to patients is roughly three times higher than in the United States.’

Read here (Jacobin, April 22, 2020)

Leaked study data finds no benefits of Remdesivir on coronavirus patients, sending Gilead stock tumbling

‘The World Health Organisation prematurely posted a draft summary of the China-based trial that was seen by STAT News before it was removed, with a WHO spokesperson telling the publication it's still being peer reviewed and finalised.

‘Gilead challenged the results in an emailed statement, however, deeming them "inconclusive" given the clinical trial was ended early resulting in low enrollment, though it noted there were trends suggesting potential benefit for patients who received treatment early.

‘That didn't stop Gilead's stock from diving down 8% to $75.37 a share in the afternoon before recovering slightly to $77.78.’

Read here (Forbes, April 22, 2020)

Developing a National Strategy for Serology (antibody testing) in the United States: Publication by John Hopkins

‘Serology tests will be an important tool for public health workers to estimate the prevalence of disease. These tests will be in high demand by individuals who hope to assess their risks of immunity to SARS-CoV-2. Serology testing, among other nonpharmaceutical interventions, can help to bridge the time before a vaccine is available. However, validated, accurate tests are currently in short supply. In this report, we seek to draw attention to the options for expanding access so that the potential benefits of serology tests can be realised as soon as practicable.’

Download here (John Hopkins Center for Health and Security, April 22, 2020)

Children and Covid-19: Systematic review of 18 studies

A systematic review of 18 studies shows most children had mild symptoms, if any, and generally required supportive care only. Typically, they had a good prognosis and recovered within 1 to 2 weeks. ‘In this systematic review of 18 studies with 1065 participants, most pediatric patients with SARS-CoV-2 infection presented with fever, dry cough, and fatigue or were asymptomatic; 1 infant presented with pneumonia, complicated by shock and kidney failure, and was successfully treated with intensive care. Most pediatric patients were hospitalised, and symptomatic children received mainly supportive care; no deaths were reported in the age range of 0 to 9 years.’

Read here (JamaNetwork, April 22, 2020)

Yuval Noah Harari on COVID-19: ‘The biggest danger is not the virus itself’

A crisis can be a turning point for a society. Which way will we go now? Harari says many trends are not inevitable. He gives two examples: (1) Surveillance technology can be centralised or decentralised -- one supports authoritarianism, the other devolution (2) The crisis could accelerate the creation of a ‘useless’ class of people displaced by robots and other technologies but it need not be. Political decisions could be made to let them remain useful.

Read here (DW, April 22, 2020)

Sweden health agency withdraws controversial coronavirus report

‘The Swedish Public Health Agency made international headlines yesterday by estimating that one-third of Stockholm residents would be infected with the coronavirus by May 1. Less than 24 hours later, the Agency has taken a dramatic u-turn and withdrawn the report.

‘The decision was announced via Twitter: “We have discovered an error in the report and so the authors are currently going through the material again. We will republish the report as soon as it is ready”.’

Read here (Forbes, April 22, 2020)

Stiglitz: US coronavirus response is like 'third world' country

“The numbers turning to food banks are just enormous and beyond the capacity of them to supply. It is like a third world country. The public social safety net is not working.”

Stiglitz, a long-term critic of Trump, said 14% of the population was dependent on food stamps and predicted the social infrastructure could not cope with an unemployment rate that could hit 30% in the coming months.

Read here (The Guardian, April 22, 2020)

World risks ‘biblical’ famines due to pandemic, says the UN

‘A report estimates that the number suffering from hunger could go from 135 million to more than 250 million. Those most at risk are in 10 countries affected by conflict, economic crisis and climate change, the WFP says. The fourth annual Global Report on Food Crises highlights Yemen, the Democratic Republic of the Congo, Afghanistan, Venezuela, Ethiopia, South Sudan, Sudan, Syria, Nigeria and Haiti.’

Read here (BBC, April 21, 2020)

Give me liberty and give me death: Paul Krugman

‘…But Trump being Trump, he’s disavowing any responsibility, instead pressuring states to ignore the health risks and abandon the social distancing that has blunted the pandemic.

‘If you ask me, this isn’t just cruel, it’s politically stupid. As we’ve just seen, viruses move fast. A few days ago we were starting to see signs that Covid-19 might be peaking. But relax our vigilance, even a bit, and a second, bigger wave of deaths could easily happen well before the election.

‘But Trump and his allies don’t seem able to wrap their minds around the idea that it’s their job to solve problems, not shift the blame. And I don’t know about you, but I’m getting even more scared than I was.’

Read here (New York Times, April 21, 2020)

America isn't just a failing state, it is a failed experiment. And the mishandling of the coronavirus pandemic is just another proof

‘Sometime in the future, maybe two or three centuries from now, when historians and other social scientists begin to write the first books about the failures of the defunct American experiment, they will all confront a basic truth: That despite American proclamations of freedom and equality, the realities of racism, misogyny, homophobia, xenophobia and gross economic inequalities as practised in American society constantly belied these ideals.’

Read here (Aljazeera, April 21, 2020)

MOH Malaysia lists six criteria for lifting MCO and help develop a ‘soft landing’ exit strategy

The Ministry of Health Malaysia (MOH) has listed six criteria to lift the MCO and help achieve a ‘soft landing’ for the nation amidst the Covid-19 crisis:

1. Strict border control: “If we open our borders then people will start coming in and there’s a big possibility they may have the virus.”
2. Single-digit number of cases: Only when cases start to fall in the single-digit can the government seriously consider lifting the MCO
3. Having a good health system and improving testing standards: Look carefully at e.g. (a) testing capability of labs (b) if we have enough wards and intensive care units. Raise the detection standards from say 48 hours to 24 hours or less.
4. Capability to look after high-risk groups — the handicapped, elderly, and those with co-morbidity illnesses, including patients receiving hospital treatment like chemotherapy
5. (5) Adherence to new social norms: “Putrajaya needs to study this and instil in Malaysians’ minds that following social distancing, washing hands frequently and avoiding crowding around each other is the way to go moving forward.”
6. (6) Community cooperation in infected areas: Identify infected areas and get their communities to work with MOH and the relevant authorities to make sure the virus doesn’t spread again.

Read here (The Malay Mail, April 21, 2020)

Has the pandemic accelerated the growth of technology?

The global health crisis has opened the door for a bigger role of technology, assisting efforts in fighting COVID-19 and helping citizens adapt to a new way of life. As opportunities unfold, technology – being a double-edged sword – is also acting as a conduit for those wanting to take advantage of the crisis. Moving forward, cautious steps are vital as technological emergency measures could also expose citizens to vulnerabilities that violate human rights and privacy.

Read here (ISIS Malaysia, April 21, 2020)

Undaunted by COVID-19 and border controls, Malaysian mums in Singapore send around 3,000kg of breast milk to babies back home

‘Just as the women exhausted all possible channels and nearly lost hope in late March, a Malaysia-based forwarder agreed to help them, first with 20 boxes of frozen breast milk from Singapore to Johor at a small fee of S$10 on Mar 29, and then another 20 boxes to states farther away two days later. The maximum weight for each box is 20kg... The mums were elated, and at the same time anxious about when their turn would come. Luck was on their side when one of them approached Johor’s Stulang assemblyman Andrew Chen Kah Eng for help... Never in history has a large quantity of frozen breast milk been brought over the Causeway in such a manner, the Democratic Action Party politician claimed. Usually, mothers just bring their own breast milk across the border as part of their personal luggage.’

Read here (Channel News Asia, April 21, 2020)

The role of banks in a pandemic

Piyush Gupta, Group CEO, DBS Bank: ‘The scale of the pandemic is such that it cannot be left to governments to find resolution on their own. And the truth is that private sector corporations are some of the biggest actors on the world stage, and have an ability to carry influence across borders. There is also no real conflict between shareholder and stakeholder interests. The issue is one of timeframes. While there may be some trade-offs between maximising shareholder returns and providing societal benefits in the short term, addressing broader issues in society is completely consistent with shareholder interests in the long term.’

Read here (LinkedIn, April 21, 2020)

Covid-19 has a grandma, grandpa and great grandpa. Where are they?

‘In an unusual move last weekend, China’s envoy to Moscow, Zhang Hanhui highlighted that the whole story about Covid-19 is only unfolding and there are surprises in store for the world community.  It is inconceivable that Ambassador Zhang spoke without the knowledge of Beijing. Significantly, the Chinese envoy chose the Russian state news agency Tass for making some startling disclosures.’ The Tass story is entitled “Ambassador says coronavirus imported to China, points to genetic sequence as proof”.

Read here (Indian Punchline, April 21, 2020)

County of Santa Clara identifies three additional early COVID-19 deaths -- much earlier than the one on March 9, 2020, originally thought to be the first in the US

‘The County of Santa Clara Medical Examiner-Coroner has identified three individuals who died with COVID-19 in Santa Clara County before the COVID-19 associated death on March 9, 2020, originally thought to be the first death associated with COVID-19 in the county.

‘The Medical Examiner-Coroner performed autopsies on two individuals who died at home on February 6, 2020 and February 17, 2020. Samples from the two individuals were sent to the Centers for Disease Control and Prevention.  Today, the Medical Examiner-Coroner received confirmation from the CDC that tissue samples from both cases are positive for SARS-CoV-2 (the virus that causes COVID-19).’

Read here (Santa Clara County Public Health, April 21, 2020)

Coronavirus is accelerating eight challenging mega trends

‘...be in no doubt, as the long days at home seem to pass ever so slowly: in its effect on societies, politics and the distribution of power in the world, COVID-19 is on track to be the Great Accelerator.’

1. Eurozone existential crisis: ‘To put it crudely, Italians will not work as productively as Germans, and Germans will not agree to pay off the debts of Italians.’ 
2. Trans-Pacific tensions: ‘...the process of “deglobalisation” - more of what we consume being made closer to home, even if it is more expensive - will accelerate.
3. Greater rise of the Asian tigers: ‘[Asia] was already going to account for 90 per cent of new middle-class people in the next decade. Perhaps we can revise that up to 95 per cent now.’
4. Oil price volatility: ‘Countries dependent on oil production already faced forecasts that petroleum demand would peak and fall before 2030.’ We have in recent days seen negative oil prices.
5. Politics of inequality: ‘It will push to the forefront of politics fundamental issues about the taxation of wealth, the case for basic incomes provided by governments, and the responsibility of companies for their employees.’
6. Debts: ‘Political parties will campaign for debt forgiveness and write-offs, and for the cancelling by central banks of money borrowed by governments, with inflationary consequences.’
7. Data: ‘Once we are all carrying around an app on our phones to show where we have been and who we have met, pressure will grow to use that information for other purposes.’
8. Crisis as the mother of innovation: ‘More optimistically, they have one positive companion - the massive incentive this crisis provides for innovation’

Read here (The Age, April 21, 2020)

Everything we know about coronavirus immunity and antibodies — and plenty we still don’t

‘But as the tests roll out, some experts are trying to inject a bit of restraint into the excitement that the results of these tests could, for example, clear people to get back to work. Some antibody tests have not been validated, they warn. Even those that have been can still provide false results. And an accurate positive test may be hard to interpret: the virus is so new that researchers cannot say for sure what sort of results will signal immunity or how long that armor will last.

‘They caution that policymakers may be making sweeping economic and social decisions — plans to reopen businesses or schools, for example — based on limited data, assumptions, and what’s known about other viruses. President Trump last week unveiled a three-phased approach to reopen the country; he said some states that have seen declining case counts could start easing social distancing requirements immediately. And some authorities have raised the idea of granting “immunity passports” to people who recover from the virus to allow them to return to daily life without restrictions.’

Read here (STAT News, April 20, 2020)

When Americans go back to work, things won't be the same... and what can be done

‘Modern manufacturing plants are very capital-intensive enterprises with a lower population density. And a typical factory is used to putting a premium on controlled work processes that are safety-driven. Many could open now.’

‘For the record, Caulkins thinks restaurants should stay open, too. But, with more creativity and flexibility from governments, he sees a pathway for millions of additional workers to soon join cooks and cashiers back at work with even greater safety than we have today. Even furniture and electronics stores are potential candidates.’

Read here (Futurity, April 20, 2020)

Learning how to dance - Part 1: A dancing masterclass, or what we can learn from countries around the world. Tomas Pueyo

‘A month ago we sounded the alarm with “Coronavirus: Why You Must Act Now”. After that, we asked countries to buy us time with “Coronavirus: The Hammer and the Dance” and looked in detail at the US situation with “Coronavirus: Out of Many, One. Together”, these articles have been viewed by over 60 million people and translated into over 40 languages.

‘This article will explain when, and how, we will dance. Specifically, we will discover:

• What can we learn from the experiences of countries around the world?
• What measures will we need to implement during the dance, so we can get back to a new normal? At what cost?
• How can we make them a reality?’

Read here (Medium, April 20, 2020)

Distance learning isn’t working: Instead of trying to move classes online, schools should support parents in educating their children

‘And is this how families want to be spending the next months? Sitting inside staring at a computer screen for six hours a day? Most adults have a hard time in online meetings for that long for one day; it’s completely unreasonable to expect it of a child for months on end. And it’s leading to behavior issues, too...

‘Schools can still play a constructive role, even if they aren’t holding online classes for kids stuck in their homes. Instead of spending time on online lessons and hours of videochats, schools need to provide a crash course in education for parents, provide loose individual lesson plans and suggestions, and operate as a help line...’

Read here (The Atlantic, April 20, 2020)

China ever vigilant with ‘stronger, more rigorous’ testing

‘China’s health authority called for a stronger and more rigorous testing regime to ensure that the new coronavirus does not escape detection, whether in travellers arriving from abroad or from other parts of the country. All localities must improve their testing capabilities, including those at border crossings, and report any epidemic information in a timely manner, the National Health Commission cited its director Ma Xiaowei as saying. Ma made the comments on Saturday, but they were released by the ministry on Monday.

‘China, where the new virus emerged late last year, reported 12 new confirmed cases on April 19, the lowest since March 13. Despite the downtrend, officials remain concerned about the re-emergence of local transmissions in parts of the country, including Beijing, where a central district has been re-classified as high-risk following three recent local infections.’

Read here (Reuters, April 20, 2020)

The relation between media consumption and misinformation at the outset of the SARS-CoV-2 pandemic in the US

‘A US national probability-based survey during the early days of the SARS-CoV-2 spread in the US showed that, above and beyond respondents’ political party, mainstream broadcast media use (e.g., NBC News) correlated with accurate information about the disease’s lethality, and mainstream print media use (e.g., the New York Times) correlated with accurate beliefs about protection from infection. In addition, conservative media use (e.g., Fox News) correlated with conspiracy theories including believing that some in the CDC were exaggerating the seriousness of the virus to undermine the presidency of Donald Trump. Five recommendations are made to improve public understanding of SARS-CoV-2.’

Read here (Harvard Kennedy School Misinforrmation Review, April 20, 2020)

Download 24-page PDF here

Could the power of the sun slow the coronavirus?

‘Dr. Merow said that although the lethal effects of ultraviolet light on viruses are well-known, he and his colleague were surprised to find a seasonal drop evident on a global scale... Dr. Merow said he and his colleague had mined existing studies on how environmental and ecological factors correlate with virus infection rates and used them in ecological modeling of the global repercussions. Global data on temperatures, humidity, the penetration through the atmosphere of sunlight’s ultraviolet rays, population ages and densities, and Covid-19 infection counts were combined into a computer model that mapped out the seasonal trends, he said. Dr. Merow noted that the study’s range of uncertainty was considerable, such that, depending on the location within the United States, the chance of seeing no viral slowdown in the summer ranged from 20 percent to 40 percent.’

Read here (New York Times, April 20, 2020)

David Nabarro underscores and defends WHO's role in the pandemic

With nation states across the world struggling to contain the coronavirus pandemic, there is an urgent need for an internationally coordinated response. That is where the UN agency the World Health Organisation should have a vital role to play, but right now the WHO is at the centre of a political storm. Donald Trump has withdrawn US funding, accusing the agency of being China-centric. Stephen Sackur speaks to WHO special envoy for Covid-19 David Nabarro. Is his organisation failing its greatest test?

View here (BBC, Youtube, April 20, 2020)

Coronavirus’s ability to mutate has been vastly underestimated, and mutations affect deadliness of strains, Chinese study finds

• The most aggressive strains of Sars-CoV-2 could generate 270 times as much viral load as the least potent type
• New York may have a deadlier strain imported from Europe, compared to less deadly viruses elsewhere in the United States

“Drug and vaccine development, while urgent, need to take the impact of these accumulating mutations … into account to avoid potential pitfalls.”.

Read here (South China Morning Post, April 20, 2020)

‘There is a reason the rest of India cannot be Kerala’

This is not a Covid-19 story, however, it gives the social backdrop to the state’s successful response to the virus... ‘Modern India has been trying to be more like Mumbai. It is raising congested cities out of villages, shrinking homes, building amoeba-shaped golf courses for a few and calling it progress. Instead, maybe India should try to be a Kerala? Modern Kerala, which is misunderstood as a communist region, is in reality a post-capitalist state. A lot of things have gone into the making of its character. Mere policy cannot transform the rest of India into Kerala.’

Read here (Live Mint, April 19, 2020)

Covid-19, ‘silent hypoxia’ and a simple way to identify patients sooner (even do it at home with a ‘pulse oximeter’)

‘We are just beginning to recognise that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature...

‘There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter...

‘Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.’

Read here (New York Times, April 20, 2020)

The hammer and the dance -- What the next 18 months can look like, if leaders buy us time

This second article by Tomas Pueyo, a follow-up to his ‘Coronavirus: Why you must act now’, is summarised as follows: ’Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.’

In this article he deals with: (1) What’s the current situation? (2) What options do we have? (3) What’s the one thing that matters now: Time (4) What does a good coronavirus strategy look like? (4) How should we think about the economic and social impacts?

Read here (Medium, updated March 19, 2020)

Malaysia’s youth on the unemployed frontline: Five additional measures to effect reform

Story by Bridget Welsh & Calvin Cheng

‘These [existing] measures [to address the problems of youth unemployment] however are not enough. There is an urgent need to engage in meaningful reform to address underlying issues to ameliorate the negative impact of Covid-19. In keeping with our aim to offer constructive suggestions to address Covid-19, we offer five additional concrete ideas for consideration.

• First, the government can strengthen private-public sector partnerships through incentives to hire, retain and train young employees.
• Second, the government should consider ramping up training for younger Malaysians, not just those in the Klang Valley, but those in the states hardest hit by youth unemployment.
• Third, a rethink is needed on how to aid those young workers stuck in the low-paying jobs, with possible structured tax incentives for companies that offer training and advancement for employees to hire young workers who show promise.
• Fourth, while there have been important reforms in encouraging student debt repayment, including incentives for repayment, Covid-19 may provide an opportunity to consider broader measures of student debt relief based on need and debt restructuring.  
• Fifth, we need to appreciate that the social safety net in Malaysia is inadequate. The relief measures are tiny, compared to the scale of the economic downturn coming ahead, and the reality of being experienced now by those facing insecurity. 

Read here (Malaysiakini, April 18, 2020)

The Achilles heel of Malaysia’s Covid-19 battle

‘There is a major “Achilles Heel” in our Covid control programme that has yet not been addressed comprehensively – the six million or so migrant workers in our country, two-thirds of who are undocumented, and the majority of whom live in crowded unsanitary conditions.

‘The PSM has been advocating since March 19 that the government reaches out to this community and win their trust as our main weapons for containing Covid-19 – case identification, contact tracing, isolation of cases and contacts – will be resisted by the migrant community because they will be afraid that, after the two weeks of quarantine in a government facility, they might be charged for immigration violations, flogged, jailed and/or deported.’

Read here (Malaysiakini, April 18, 2020)

How did Britain get its coronavirus response so wrong? Three factors

Lack of long-term planning and ignoring experts: ‘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.

Going on its own: ‘Britain was still doing quite well in containing the disease by testing, tracing contact and setting up quarantine for those suspected of being infected with Covid-19 at this time [February]. “Then, in March, the government decided to abandon this approach and shift from containing the disease to delaying its progress,” says Wingfield. “I would really like to know why the decision to give up testing and contact tracing was taken.”

Absence of social memory of epidemics: ‘One conclusion that experts are already drawing is that it was those countries close to China, with memories of Sars, or cultural ties to their neighbour, which were much faster to act in response to Covid-19. Perhaps most notable in its success was Taiwan...’

Read here (The Guardian, April 18, 2020)