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)

What history can teach us about building a fairer society after coronavirus

‘In recent weeks, some people have optimistically predicted that the Covid-19 outbreak will force governments to build fairer economic systems. But the peasants’ story reminds us that change isn’t automatic, and Spain’s history shows that the bad guys can take advantage of a crisis, too. Look at the Hungarian prime minister, Viktor Orbán, seizing the right to rule by decree while citing Covid-19 as his excuse.

‘There are great strategic challenges ahead. Lockdown gives workers and renters power – the government has to pay people not to work, and landlords are struggling to evict tenants or get new ones – but it will not last. While previous pandemics cut the labour force, this crisis will increase unemployment, perhaps to levels unknown for centuries, and bosses will exploit workers’ desperation so that they can keep wages low and conditions poor.’

Read here (The Guardian, April 18, 2020)

Stanford study finds presence of Covid-19 may be 50 to 85 times higher than official figures

‘The study [not peer reviewed yet] has been interpreted by some to mean we are closer to herd immunity – the concept that if enough people in a population have developed antibodies to a disease that population becomes immune – than expected. This would allow some to more quickly get back to work, a strategy currently being deployed in Sweden. But researchers behind the study said not to jump to conclusions or make policy choices until more research has been done.

‘The study confirms the widely-held belief that far more people than originally thought have been infected with the coronavirus, said Arthur Reingold, an epidemiology professor at UC Berkeley who was not involved in the study, but it doesn’t mean the shelter-in-place order will be lifted any time soon.’

Read here (The Guardian, April 17, 2020)

Trump fans protests against Democrat governors

‘Groups rallied in at least six states this week, and protests are planned in four more in coming days. On Friday, President Trump encouraged protesters in Michigan, Minnesota and Virginia who this week violated stay-at-home orders and social distancing guidelines to march against Democratic governors.

‘LIBERATE MICHIGAN!’ Trump tweeted. ‘LIBERATE MINNESOTA,’ he continued. ‘LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!’

Read here (Washington Post, April 17, 2020)

Public health principles for a phased reopening during COVID-19: Guidance for US governors

‘This document provides an assessment of the risk of SARS-CoV-2 transmission in a variety of organisations and settings that have been closed. We outline steps to reduce potential transmission during the reopening of these organisations and settings, building on the proposed phased approach from the National Coronavirus Response: A Road Map to Reopening. Reopening businesses and other sectors represents one of many steps that will need to be taken to revitalise communities recovering from the pandemic, restore economic activity, and mitigate the unintended public health impact of the distancing measures that were necessary to confront the epidemic of COVID-19. A discussion of larger community-wide considerations for holistically enhancing recovery can be found in the Appendix.’

Download here (John Hopkins Center for Health and Security, April 17, 2020)

How Covid-19 immunity compares to other diseases

If you get Covid-19 and recover does that mean you are immune to the virus? If you become immune, how long does that immunity last? We are still looking for answers to many of these questions. In the meantime, Dr. Seema Yasmin takes a look at the human body's immunity to some other viral infections such as chickenpox, HIV and the common cold.

View here (Wired, 9-minute video, April 17, 2020)

Transmission of Covid-19 to health care personnel during exposures to a hospitalised patient

What is already known about this topic? ‘Health care personnel (HCP) are at heightened risk of acquiring COVID-19 infection, but limited information exists about transmission in health care settings.’

What is added by this report? ‘Among 121 HCP exposed to a patient with unrecognised COVID-19, 43 became symptomatic and were tested for SARS-CoV-2, of whom three had positive test results; all three had unprotected patient contact. Exposures while performing physical examinations or during nebuliser treatments were more common among HCP with COVID-19.’

What are the implications for public health practice? ‘Unprotected, prolonged patient contact, as well as certain exposures, including some aerosol-generating procedures, were associated with SARS-CoV-2 infection in HCP. Early recognition and isolation of patients with possible infection and recommended PPE use can help minimise unprotected, high-risk HCP exposures and protect the health care workforce.’

Read here (US CDC, April 17, 2020)

Coronavirus outbreak may have started as early as September 2019

‘Based on the data Forster and his colleagues have collected, the coronavirus outbreak appears to have started between September 13 and December 7. “This assumes a constant mutation rate, which is admittedly unlikely to be the case, and the time estimate could therefore be wrong,” he told Newsweek. “But it is the best assumption we can make at the moment, pending analysis of further patient samples stored in hospitals during 2019”.’

Read here (Newsweek, April 17, 2020)

Related

• Cambridge researchers identify 3 variants of Covid-19, say their methods could be used to help identify undocumented infection sources. Read here
• First case of Covid-19, presumably Type A, occurred ‘no earlier than September 13, 2019 and no later than December 7, 2019’. View here

Characteristics of health care personnel with Covid-19: A US CDC profile from Feb 12 to Apr 9, 2020

What is added by this report? ‘Of 9,282 US Covid-19 cases reported among HCP, median age was 42 years, and 73% were female, reflecting these distributions among the HCP workforce. HCP patients reported contact with COVID-19 patients in health care, household, and community settings. Most HCP patients were not hospitalised; however, severe outcomes, including death, were reported among all age groups.

What are the implications for public health practice? ‘It is critical to ensure the health and safety of HCP, both at work and in the community. Improving surveillance through routine reporting of occupation and industry not only benefits HCP, but all workers during the COVID-19 pandemic.’

Read here (US CDC, April 17, 2020)

Our front-liners deserve better

Suddenly, as we need them most, we see cracks in a system that ought to take care of them more than ever... Letter to The Star describes the ‘bitter truth for medical staff claiming allowance’.

Read here (The Star, April 17, 2020)

The Malaysian Health Coalition (MHC), representing 44 member societies and 16 individuals, calls for four measures to effect a rationalised opening-up

They are (please look at letter for full text}:

1. Decision-making on a phased restart that includes MOH, other relevant ministries or agencies and relevant medical health experts.
2. An exit strategy for the post-MCO period based on the advice of medical health and public health experts with guidelines according to the colour-coded zoning system: green, yellow and red.
3. Large-scale disinfection and sanitisation efforts that follow evidence-based procedures.
4. Work with religious authorities to adapt upcoming religious and cultural traditions to prevent mass gatherings that would further spread Covid-19.

Read here (The Star, April 17, 2020)

Musim Sengsara or The Season of Suffering

Heritage activist Khoo Salma has written an inspirational song dedicated to frontline health workers against Covid-19 in Malaysia. Sung by Ayie, it is entitled ‘The Season of Suffering’ or ‘Musim Sengsara’

View here (Youtube, April 17, 2020)

Expanding the military’s role?

The MAF has been deployed since 21 March to help patrol and enforce the MCO in response to COVID-19. At the time of writing, the MCO has been extended twice and is now set to end on 28 April 2020. During this prolonged period, some thought should be given to the possibility of the MAF’s expanded role in the crisis.

Read here (ISIS Malaysia, April 17, 2020)

Digital trade: A boon during the MCO and beyond

Throughout the Covid-19 MCO, digital trade has been a boon in not only connecting businesses to consumers, but also serving as a lifeline for MSMEs and informal workers. Given that digital trade is beneficial in maintaining employment and livelihood in crucial times of emergency, on top of its benefits during “ordinary” times, the government needs to rethink – or better yet, strike while the iron is hot – on how to further encourage digital trade among MSME entrepreneurs in the country.

Read here (ISIS Malaysia, April 17, 2020)

Malaysia already has a contact tracing app (Gerak Malaysia) and it’s downloadable now

‘The Malaysian Communications and Multimedia Commission is testing a beta app called Gerak Malaysia that can do just that and it uses location tracking...

‘At hospitals, the QR code can be used to determine your risk level and it will allow frontliners to assign you to the right queue. For example, if you’ve been to an area that was visited by a confirmed Covid-19 case, you will be flagged as a high-risk...

‘The QR code can also assist the police and armed forces at the roadblocks as they can determine whether you’re travelling within the permitted radius. This feature can potentially replace the approval letters that are required to be presented to the police. As a result, this feature can help speed up the checks and reduce congestion...’

Read here (The Malay Mail, April 17, 2020)

Swedish epidemiologist Johan Giesecke‘s forthright views on Covid-19

In this 34-minute interview, Professor Johan Giesecke, one of the world’s most senior epidemiologists, advisor to the Swedish Government, lays out with typically Swedish bluntness why he thinks:

1. UK policy on lockdown and other European countries are not evidence-based 
2. The correct policy is to protect the old and the frail only 
3. This will eventually lead to herd immunity as a “by-product” 
4. The initial UK response, before the “180 degree U-turn”, was better 
5. The Imperial College paper was “not very good” and he has never seen an unpublished paper have so much policy impact 
6. The paper was very much too pessimistic 
7. Any such models are a dubious basis for public policy anyway 
8. The flattening of the curve is due to the most vulnerable dying first as much as the lockdown 
9. The results will eventually be similar for all countries 
10. Covid-19 is a “mild disease” and similar to the flu, and it was the novelty of the disease that scared people. 
11. The actual fatality rate of Covid-19 is the region of 0.1% 
12. At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available

View here (LockdownTV, Youtube, April 17, 2020)

Manifesto for post-neoliberal development: Five policy strategies for the Netherlands after the Covid-19 crisis

‘The Manifesto calls the Dutch Government to implement five key policy strategies for moving forward during and after the Covid-19 crisis:

• A move away from “development” focused on aggregate GDP growth;
• An economic framework focused on redistribution;
• Transformation towards regenerative agriculture;
• Reduction of consumption and travel; and
• Debt cancellation.

‘This Manifesto brings to the forefront some fundamental concerns of degrowth scholars and activists, and shows that these concerns are close to the hearts and minds of many academics who may not (yet) see themselves as part of the degrowth community. Particularly relevant is the link between economic development, the loss of biodiversity and important ecosystem functions, and the opportunity for diseases like COVID-19 to spread among humans. The Manifesto proposes policies that, as research tells us, are critical for a more sustainable, equal and diverse society - one that can better prevent and deal with shocks, including climate change related ones, and pandemics to come.’

Read here (Ontgroei, April 16, 2020)

Related:

Use crisis to make post corona society fairer and sustainable, say scientists. Read here

Covid-19 & China: A View from Asia -- George Yeo

‘In China, national interest comes before human rights. In the liberal west, there is continuous tension between the two which is the source of western creativity from the time of Greece and Rome. It is interesting to compare the national reaction to two whistleblowers - China’s Dr Li Wenliang who first sounded the alarm in Wuhan and Captain Brett Crozier who publicised the deteriorating situation onboard USS Theodore Roosevelt. Both men came down with the virus.

‘In Dr Li’s case, he has been officially vindicated after his death and the dossier is closed by central edict. In Captain Crozier’s case, the debate will never cease whatever the White House might say. China and the US are built on different foundations, each having the weakness of its strength. Global cooperation requires each to accept the other for what it is.’

Read here (Brunswick Group, April 16, 2020)

Consider 10-year contract extension for public medical officers: MMA

‘The government is urged to consider the contract extension of up to 10 years for the Health Ministry’s medical officers to facilitate absorption as permanent staff... The Malaysian Medical Association (MMA) is asking for the extension “to allow for specialisation and gazettement before absorption as permanent staff for successful specialists to provide the much-needed services to the country.”

Read here (Malaysiakini, April 16, 2020)

Is China winning? Economist special on China & Covid-19

‘China’s rulers combine vast ambitions with a caution born from the huge task they have in governing a country of 1.4bn people. They do not need to create a new rules-based international order from scratch. They might prefer to keep pushing on the wobbly pillars of the order built by America after the second world war, so that a rising China is not constrained.

‘That is not a comforting prospect. The best way to deal with the pandemic and its economic consequences is globally. So, too, problems like organised crime and climate change. The 1920s showed what happens when great powers turn selfish and rush to take advantage of the troubles of others. The covid-19 outbreak has so far sparked as much jostling for advantage as far-sighted magnanimity. Mr Trump bears a lot of blame for that. For China to reinforce such bleak visions of superpower behaviour would be not a triumph but a tragedy.’

Read here (The Economist, April 16, 2020)

The number of new cases of Covid-19 in US has plateaued: Is this a good sign?

‘But there is another way to interpret the decline in new cases: The growth in the number of new tests completed per day has also plateaued. Since April 1, the country has tested roughly 145,000 people every day with no steady upward trajectory. The growth in the number of new cases per day, and the growth in the number of new tests per day, are very tightly correlated.

‘This tight correlation suggests that if the United States were testing more people, we would probably still be seeing an increase in the number of COVID-19 cases. And combined with the high test-positivity rate, it suggests that the reservoir of unknown, uncounted cases of COVID-19 across the country is still very large.

‘Each of those uncounted cases is a small tragedy and a microcosm of all the ways the U.S. testing infrastructure is still failing...’

Read here (The Atlantic, April 16, 2020)

Finding effective treatments for COVID-19: Scientific integrity and public confidence in a time of crisis

‘Everyone wants new treatments and vaccines to address the devastation of coronavirus disease 2019 (COVID-19). But, currently, under intense pressure and based on hope and limited data from poorly conducted clinical trials and observational data, many clinicians are embarking on ill-advised and uncontrolled human experimentation with unproven treatments.’

This paper calls for three important considerations:

1. ‘First, the regulatory and research communities owe it to patients, families, and clinicians to quickly learn what treatments are effective... 
2. ‘Second, it is important to optimise treatments that already exist, including supportive critical care. As learned from the Ebola outbreak, mortality can be reduced through identifying best practices...
3. ‘Third, and most important, it is critical to protect the integrity of and resulting public trust in the scientific and regulatory agencies and their advice and decisions. That trust will be needed once vaccines against COVID-19 become available and in future public health emergencies.’

Read here (JamaNetwork, April 16, 2020)

Dutch study suggests 3% of population may have coronavirus antibodies

“This study shows that about 3% of Dutch people have developed antibodies against the coronavirus,” Van Dissel said. “You can calculate from that, it’s several hundred thousand people” in a country of 17 million. The blood donation service Sanquin announced it would begin testing on 10,000 samples weekly on March 19, but later said it would only disclose results to the RIVM.’

The confirmed cases in Netherlands as of April 18 (Wikipedia) was 32,655 with 3,684 deaths

Read here (Reuters, April 16, 2020)

WHO's new strategy update outlines six factors for countries as they consider lifting restrictions

1. First, that transmission is controlled; 
2. Second, that health system capacities are in place to detect, test, isolate and treat every case and trace every contact;  
3. Third, that outbreak risks are minimised in special settings like health facilities and nursing homes; 
4. Fourth, that preventive measures are in place in workplaces, schools and other **places where it’s essential for people to go; 
5. Fifth, that importation risks can be managed; and 
6. Sixth, that communities are fully educated, engaged and empowered to adjust to the “new norm”

Read here (WHO, April 16, 2020)

Dow futures rally 700 points after Gilead drug reported shows effectiveness. There are reservations about the report and clinical trials funded by Gilead

Dow futures rally. Read here (CNBC, April 16, 2020)

‘Gilead’s severe Covid-19 study includes 2,400 participants from 152 different clinical trial sites all over the world. Its moderate Covid-19 study includes 1,600 patients in 169 different centers, also all over the world.

‘The trial is investigating five- and 10-day treatment courses of remdesivir. The primary goal is a statistical comparison of patient improvement between the two treatment arms. Improvement is measured using a seven-point numerical scale that encompasses death (at worst) and discharge from hospital (best outcome), with various degrees of supplemental oxygen and intubation in between.

‘The lack of a control arm in the study could make interpreting the results more challenging.’

Read here (STAT News, April 16, 2020)

China's post-lockdown monitoring rides on existing hi-tech finance and social media platforms

‘The Chinese government has enlisted the help of the country's two internet giants — Alibaba (BABA) and Tencent (TCEHY) — to host the health code systems on their popular smartphone apps. Alibaba's mobile payment app Alipay and Tencent's messaging app Wechat are both ubiquitous in China, each used by hundreds of millions of people. Placing the health codes on these platforms means easy access for many...

‘Within a week of its launch, the Alipay health codes were rolled out in more than 100 cities across the country, the state-run Xinhua news agency reported. By late February, more than 200 cities had adopted these QR codes, according to Alipay... Tencent's health code system had also expanded to more than 300 cities as of last month, according to the state-run Science and Technology Daily."

Read here (CNN, April 16, 2020)

Twelve lessons from countries that have ameliorated the effects of Covid-19

Taiwan, Iceland, South Korea and Germany, according to this CNN article, have succeeded so far in ameliorating the effects of Covid-19. There are 12 lessons to be learned from them:

Lesson #1: Be prepared
Lesson #2: Be quick
Lesson #3: Test, trace and quarantine
Lesson #4: Use data and tech
Lesson #5: Be aggressive
Lesson #6: Get the private sector involved 
Lesson #7: Act preventatively
Lesson #8: Use tech, but respect privacy
Lesson #9: You can drive-through test
Lesson #10: Learn from the past
Lesson #11: Test more as restrictions ease
Lesson #12: Build capacity at hospitals

Read here (CNN, April 16, 2020)

For the record -- Beyond containment: Health systems responses to COVID-19 in the OECD

‘Health systems are facing the most serious global pandemic crisis in a century. Containing and mitigating the spread and infection rate of the coronavirus SARS-CoV-2 is the first priority of public health authorities to distribute the number of infections over time and, if possible, reduce the incidence of the disease it causes (COVID-19). However, beyond containment, additional measures - operational, financial, and R&D - are needed to provide effective patient care and reduce the pressure on health systems to manageable levels. The main focus of this brief is on the policies aimed at providing effective care and managing the pressure on health systems.

‘Four key measures health systems are putting in place in response to the epidemic are considered: 1) ensuring access of the vulnerable to diagnostics and treatment; 2) strengthening and optimising health system capacity to respond to the rapid increase in caseloads; 3) how to leverage digital solutions and data to improve surveillance and care; and 4) how to improve R&D for accelerated development of diagnostics, treatments and vaccines.’

https://oecd.dam-broadcast.com/pm_7379_119_119689-ud5comtf84.pdf

Download here (OECD, April 16, 2020)

Ensuring safe environment for primary healthcare settings — Dr Amar-Singh HSS, Dr Lee Chee Wan, Dr Paranthaman and Dr Timothy William

‘This guideline is written to offer ideas to general practitioners (GP) and those working in out-patient clinic settings (OPD) on what precautionary measures to take to curb the spread of Covid-19 disease and protect themselves when the relevant government authorities ease our lockdown.

‘It may also be useful for other clinic settings like speciality clinics, antenatal clinics, dental clinics, etc. We are sharing it to the general public as it may be useful for patients and the community to think though some of these issues.’

Read here (The Malay Mail, April 15, 2020)

Circumventing catastrophes: ‘We will never know unless we try: again and again, and ever harder’

In the last paragraph of his 100-page book, ‘Does the richness of the few benefit us all?’, the highly distinguished sociologist, Zygmunt Bauman (1925-2017) wrote:

‘It seems that one needs catastrophes to happen in order to recognise and admit (retrospectively alas, only retrospectively...) their coming. A chilling thought if ever there was one. Can we ever refute it? We will never know unless we try: again and again, and ever harder.’

The following is a synopsis of the book published in 2013: ‘It is commonly assumed that the best way to help the poor out of their misery is to allow the rich to get richer, that if the rich pay less taxes then all the rest of us will be better off, and that in the final analysis the richness of the few benefits us all. And yet these commonly held beliefs are flatly contradicted by our daily experience, an abundance of research findings and, indeed, logic. Such bizarre discrepancy between hard facts and popular opinions makes one pause and ask: why are these opinions so widespread and resistant to accumulated and fast-growing evidence to the contrary?

‘This short book is by one of the world’s leading social thinkers is an attempt to answer this question. Bauman lists and scrutinises the tacit assumptions and unreflected-upon convictions upon which such opinions are grounded, finding them one by one to be false, deceitful and misleading.’

Purchase here (Amazon, undated)

Watch a video on making surgical masks as safe as N95 masks: Towards Surgical Mask Brace 2.0, a scalable, open source design by ex-Apple engineers

Why adapt surgical masks?

• ‘Safety: Surgical masks have a government standard that regulates their filtration efficiency. They are regulated to meet ASTM standard F2100 which guarantees filtering 95% or more of COVID-19 sized particles.
• ‘Accessible: Surgical masks are faster to manufacture and more readily available. Currently, of the 200 million masks China makes a day, only 600,000 are N95 standard masks. That means surgical masks can be made more than 300x faster than N95’s.’

Watch here (fixthemask.com, undated)

Down To Earth magazine's e-edition focuses on Covid-19

‘We believe our post-COVID-19 world is going to be different. But it is in our hands to make sure it is better. Given the urgency and the fact that we need to inform you about these developments as they happen, we decided to bring out the two April issues of our Down To Earth fortnightly English magazine in digital format only, as printing and distribution is a challenge in these days of lockdown. Our fortnightly Print editions will of course be back, once the lockdown is lifted.

‘DTEI am giving below a link to our latest issue of Down To Earth (DTE) magazine where you can read an in depth cover story on COVID-19, as well as all our normal coverage.’

Read here (DTEI, April 15, 2020)

The teenager in us re-emerges during the COVID-19 outbreak

‘Dr Frances Jensen, chair of the neurology department at the University of Pennsylvania’s Perelman School of Medicine and author of The Teenage Brain, says most of the behaviours we associate with teenagers—like video-game marathons and junk food feasts—relate to impulsivity and a desire for immediate gratification. Adults are displaying these same behaviours during the COVID-19 pandemic, but for different neurological reasons, Jensen says...

“Stress can increase impulsivity, and people are under a lot of stress” right now, Jensen says. “It’s a balance between the executive function parts of your brain and the ‘I want it, I want it, I want it!’ parts of your brain,” which are mainly housed in the limbic system. When you’re under stress, and “your barriers are down,” the limbic system may win out more than normal, giving rise to stereotypically teenage behaviours, she says.

Read here (Time, April 15, 2020)

Rotten: The highly unpalatable side of our food supply chains

Subscribers of Netflix can watch the two-season ‘Rotton’, a ‘docuseries [that] travels deep into the heart of the food supply chain to reveal unsavoury truths and expose hidden forces that shape what we eat.’ The reception to this series on Wikipedia: ‘Reaction to the series has been relatively positive, with a rating of 80% on Rotten Tomatoes. It is praised for its high-quality cinematography and compelling, human-centred narratives but criticised for focusing on particular issues rather than providing explanation for wider industry problems, or giving the viewer answers as to which brands and products are unaffected by the issues the series presents.’

Read here (Netflix)

Covid-19 and human rights: We are all in this together

Human rights are key in shaping the pandemic response, both for the public health emergency and the broader impact on people’s lives and livelihoods. Human rights put people centre-stage. Responses that are shaped by and respect human rights result in better outcomes in beating the pandemic, ensuring healthcare for everyone and preserving human dignity. But they also focus our attention
on who is suffering most, why, and what can be done about it. They prepare the ground now for emerging from this crisis with more equitable and sustainable societies, development and peace.

Download here (WHO, April 2020)

Media freedom and fake news during the time of Covid-19

The likening of the fight against Covid-19 to a war should neither be a rationale for war-time measures, nor a free hand to muzzle the media and impinge on individual free speech. With new normals being expected, these normals must include a free media coupled with better protected free speech rights.

Read here (ISIS Malaysia, April 15, 2020)

MySejahtera app to help Malaysians manage Covid-19 outbreaks

‘MySejahtera is an application developed by the Government of Malaysia to assist in managing the COVID-19 outbreaks in the country. It allows users to perform health self-assessment on themselves and their family members. The users can also monitor their health progress throughout the COVID-19 outbreak. Also, MySejahtera enables the Ministry of Health (MOH) to monitor users’ health condition and take immediate actions in providing the treatments required.’

• For IOS, click through here 
• For Android, here
• For Huawei, here

Eleven people died in Manaus, in the state of Amazonas, Brazil, during a study conducted with high doses of the drug chloroquine

‘Eighty-one patients participated in the research, 41 of whom received a high dose of chloroquine. After three days of treatment, those who received the highest dose of chloroquine began to have heart arrhythmias. On the sixth day of treatment, 11 of them died, leading the group of researchers to abandon the investigation.

‘The patients in the study were also given the antibiotic azithromycin, a drug that presents the same cardiac risk. The data is still preliminary, not conclusive, which means that more studies are needed on the relationship between the drug, the disease and the deaths.’

Read here (TeleSureTV, April 15, 2020)

Reflexivity in the age of pandemia: Adaptive policy making and the Covid-19 crisis

The authors argue that ’the current tendency of using the war metaphor is not the way to respond. Such a metaphor is useful to mobilise and rally people around a short-term external threat. But it is also the root cause for the chaos we are experiencing now – the lack of government preparedness despite having experienced similar events such as the ‘Spanish’ Flu, SARS or the Zika virus epidemic throughout the last century. The war metaphor masks the fact that the threat of pandemic is a long game requiring a more complex response at the local, national and global levels of society.

’We require far-reaching changes to the way we design and organise our cities and supply chains, and a rethinking of the way we interact and transact as a global society. Arundhati Roy wrote recently that, “Historically, pandemics have forced humans to break with the past and imagine their world anew.” In this paper, we argue that such a response would require reshaping policy making around the concept of reflexivity and made operational through an adaptive policy making approach.’

Read further and download here (Think City, April 2020)

‘Kerala model is nothing but focus on education and welfare’

This opinion piece covers (1) what Kerala did right in fighting coronavirus? (2) Kerala model: Left, right and centre (3) Kerala sticks to WHO guidelines & executes them efficiently (4) No time for political one-upmanship

Read here (The Quint, April 15, 2020)

Boris Johnson recovery shows need for rehabilitation after coronavirus

‘One answer is having more rehabilitation teams – comprising doctors, nurses, physiotherapists, occupational therapists, psychologists, social workers, pharmacists and dieticians – treat patients in their own homes. This can be done via telehealth and online platforms, which allows services to be delivered in a way that minimises risk to health professionals and doesn’t further deplete personal protection equipment.

‘Rehabilitation reduces bed block as patients are discharged more quickly. It also takes pressure off GPs and reduces re-presentations to emergency departments for issues that can be dealt with at home.’

Read here (The Sydney Morning Herald, April 15, 2020)

Could the next normal emerge from Asia?

This McKinsey & Co report talks about Asia’s resilience to disruption and focuses on four areas that will shape the next normal: (a) Rethinking social contracts (b) Defining the future of work and consumption (c) Mobilising resources at speed and scale (d) From globalisation to regionalisation. It concludes that the future global story starts in Asia.

Read here (McKinsey & Co, April 2020)

Google provides info on community mobility in response to Covid-19

‘As global communities respond to COVID-19, we’ve heard from public health officials that the same type of aggregated, anonymised insights we use in products such as Google Maps could be helpful as they make critical decisions to combat COVID-19.

‘These Community Mobility Reports aim to provide insights into what has changed in response to policies aimed at combating COVID-19. The reports chart movement trends over time by geography, across different categories of places such as retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential.’

Read here (Google, constantly updated)

China’s initial coronavirus outbreak in Wuhan spread twice as fast as we thought, new study suggests

‘Each carrier was infecting 5.7 people on average, according to US researchers, who say previous estimate had used incomplete data Latest data based on cases whose origin could be traced more clearly, in provinces that had test kits and ample health care capacity.’

Read here (South China Morning Post, April 15, 2020)

Covid-19 is an opportunity for gender equality within the workplace and at home

‘Crisis can be an opportunity for gendered change: WW1 was a watershed moment for women’s emancipation with large swathes being added to the workforce, and the creation of women’s institutes, which latterly led to women’s suffrage. We hope that covid-19 can be another such movement for greater gender-equality in the workplace. To do so we need to stop apologising for personal lives, and let’s see more children on conference calls.’

Read here (BMJ Opinion, April 15, 2020)

Medical researchers have been studying everything we know about Covid-19. What have they learned – and is it enough to halt the pandemic?

‘Due to the unprecedented and ongoing nature of the coronavirus outbreak, this article is being regularly updated to ensure that it reflects the current situation as best as possible. Any significant corrections made to this or previous versions of the article will continue to be footnoted in line with Guardian editorial policy.’

Read here (The Guardian, April 15, 2020)

‘On cronies, cranks and the coronavirus’: Opinion piece by Paul Krugman

‘So where’s this [push to open up the economy quickly] coming from? I’ve seen some people portray it as a conflict between epidemiologists and economists, but that’s all wrong. No, this push to reopen is coming not from economists but from cranks and cronies. That is, it’s coming on one side from people who may describe themselves as economists but whom the professionals consider cranks...’

Read here (New York Times, April 14, 2020)

Vietnam winning new war against invisible enemy

‘While much more resource constrained, some key features of Vietnam’s response are similar to other much lauded East Asian responses, with its infection rates significantly lower than even Taiwan’s. For many other developing countries struggling to cope with the Covid-19 pandemic, key aspects of its response are very relevant.’

Read here (IPS News, April 14, 2020)

Up to 70% of those infected may show no symptoms, making coronavirus tough to tackle

‘Asymptomatic persons with the coronavirus disease are more common than was previously thought - some research says potentially as many as 55 per cent to 70 per cent of infections - and they can go on to infect others without anyone ever finding out. It is one of three reasons that make Covid-19 such a challenging disease to tackle, National Centre for Infectious Diseases executive director Leo Yee Sin told The Straits Times yesterday.’

The other two reasons: (1) high virus secretion at its onset (2) as Sars-CoV-2 is a novel pathogen, the whole of Singapore is susceptible to it.

Read here (Strait Times, April 14, 2020)

Intermittent social distancing may be needed through 2022 to manage Covid-19

‘On-and-off periods of social distancing will likely be needed into 2022 to ensure that hospitals have enough capacity for future Covid-19 patients in need of critical care, according to a new modeling study from researchers at Harvard TH Chan School of Public Health.

‘The research, published April 14, 2020 in the journal Science, predicted several scenarios for how the coronavirus might spread over the next five years, taking into account factors such as whether or not the virus will exhibit seasonality, whether people who are infected go on to develop short-term or long-term immunity, and whether people would get any cross-protective immunity from having been infected with other types of coronaviruses that cause common colds.’

Read here (Harvard School of Public Health, April 14, 2020)

First UN solidarity flight departs Addis Ababa carrying vital COVID-19 medical supplies to all African nations

‘The first United Nations “Solidarity Flight” is scheduled to leave Addis Ababa, Ethiopia, today [April 14] - from there, the aircraft will transport the vital medical cargo to all countries in Africa, where supplies are desperately needed to contain the spread of COVID-19. WHO cargo is being  transported by the United Nations World Food Programme (WFP), and includes face shields, gloves, goggles, gowns, masks, medical aprons and thermometers, as well as ventilators.’

Read here (WHO, April 14, 2020)

From ‘gold standard’ to a coronavirus ‘explosion’: Singapore battles new outbreak

‘There were warning signs before the new outbreak. On Feb. 10, after a Bangladeshi labourer became the first to be infected with the virus, lawyer Dipa Swaminathan, founder of It’s Raining Raincoats, an initiative that works with migrants, wrote a Facebook post warning that ‘the spread among them could be rapid, given the cramped conditions in which they live, work and are transported.’

‘Health officials said the man had visited Mustafa Center, a giant shopping complex in Singapore’s Little India district that is popular with foreign workers.

‘But as recently as two weeks ago, shoppers were going in and out of the building without temperature checks, and few employees were seen wearing masks. On Tuesday, the government said 86 infections had been linked to Mustafa Center.’

Read here (Los Angeles Times, April 14, 2020)

Will religion lead Covid reform? Joachim Ng

‘This original belief that God and nature are dual modes of one whole reality did not get lost but was preserved in many scriptures. An integral part of this belief is compassion for animals. Folks in Wuhan may be surprised to learn that China’s major indigenous religion, Confucianism, has strong reservations about meat-eating.

‘The Works of Mencius contain these verses: “Beasts devour one another, and people hate them for doing so” (Book 1, Pt1, Ch4, v.5). “So is the superior person affected towards animals, that, having seen them alive, he cannot bear to see them die; having heard their dying cries, he cannot bear to eat their flesh” (Ch7, v.8).

‘If religions continue their spiritual distancing from one another and from the original faith in nature, they will lose their relevance to society. This is the moment of truth: Will religion lead Covid reform?’

Read here (theSun Daily, April 14, 2020)

Coronavirus doubters follow climate denial playbook

‘For the climate community, observing US national political leaders’ responses to the coronavirus pandemic has been like watching the climate crisis unfold on fast-forward. Many – particularly on the political right – have progressed through the same five stages of science denial in the face of both threats.’

Read here (Yale Climate Change Connection, April 14, 2020)

The plague writers who predicted today

‘In uncertain – indeed, weird – times like these, as we increase our social isolation to ‘flatten the curve’, literature provides escape, relief, comfort and companionship. Less comfortingly, though, the appeal of pandemic fiction has also increased. Many pandemic titles read like guide books to today’s situation. And many such novels give a realistic chronological progression, from first signs through to the worst times, and the return of ‘normality’. They show us we’ve been through this before. We’ve survived.’

Read here (BBC, April 14, 2020)

‘Short-sighted.’ Health experts decry Trump’s freeze on US funding for WHO as world fights pandemic

‘Health scholars have long pointed out that the funding of WHO is not commensurate with the global role it is supposed to play. The agency’s overall spending is less than the budget of some major hospitals in the United States. Less than one-fifth of its budget comes from “assessed contributions,” essentially membership fees paid by the 194 countries that make up WHO. The rest of the organisation’s funding comes from donations, with the United States as the biggest donor. “As each outbreak shows, countries’ expectations for the WHO are not aligned with the limitations on funding, political, and legal authorities those same countries set on the organisation,” Phelan says.

‘In an interview in December 2019, Tedros told Science that WHO’s reliance on just a few donors left the organisation vulnerable. “If one of them refuses to continue funding,” he said, “WHO could get into a serious shock”.’

Read here (Science, April 14, 2020)

Singapore announces enhanced “circuit breaker”: Masks now mandatory in public places

‘Everyone must wear a mask when outside of their homes. This applies on public transport, taxis, private hire cars, walking to or at markets, and also for essential workers at all workplace premises, whether they are frontline staff (such as food handlers, cashiers and bus drivers) or performing back office functions (such as data entry personnel and payroll executives). Individuals may remove their mask while engaging in strenuous exercise outdoors (e.g. running/ jogging), but they must put it back on after completing exercise. Mask-wearing is not recommended for young children below the age of two for child safety reasons. Medical experts have also advised that some groups may have difficulties wearing a mask, including children with special needs and young children aged two and above, and we will exercise flexibility in enforcement for these groups.’

Read here (Ministry of Health, Singapore, April 14, 2020)

Coronavirus saliva test gets FDA emergency use approval, Rutgers University says

• The Food and Drug Administration granted emergency use authorisation for a coronavirus test relying on saliva samples developed by a Rutgers University-backed entity, Rutgers said Monday.
• The test could increase, by tens of thousands of tests per day, the number of screenings for Covid-19, Rutgers said.
• The test was developed by Rutgers’ RUCDR Infinite Biologics and its collaborators, Spectrum Solutions and Accurate Diagnostic Labs.

Read here (CNBC, April 13, 2020)

It is the math, stupid

‘Every nation is eagerly awaiting to lift its lockdown as soon as there are fewer cases. But when 15 cases become 460,000 in 6 weeks, how is it ok to lift a lockdown when we are down to, say, “only 100 new cases” in a given day? Once again, our human mind is incapable of thinking in exponentials. We will not have learned from history — a history that occurred just two months ago.

‘The real pandemic will start the day we start lifting the lockdown.’

Read here (Center for Inquiry, April 13, 2020)

Use crisis to make post corona society fairer and sustainable, say scientists

‘In a manifesto published in Trouw, a group of 170 sociologists and environmental scientists from eight Dutch universities said that the disruption of economic certainties caused by the pandemic offers a chance for radical reforms. These could include the introduction of a universal basic income and debt cancellation for poor countries, the scientists state.’

Read here (Dutch News, April 13, 2020)

Of haircuts, MITI website crashes and living with Covid-19

‘I really, really wish our backdoor ministers postpone their ambitions to exert the power in their hands to do things and instead seek the counsel of experienced and knowledgeable civil servants in their ministries before opening their mouths and coming up with ridiculous suggestions. It would not only save money but human lives in the current dire environment.’

Read here (Focus Malaysia, April 13, 2020)