Tag Archives: Disease

WHO warns to prepare for an even deadlier disease

Pamdemic Threats

Luke 21:11 There will be great earthquakes, and in various places famines and pestilences. And there will be terrors and great signs from heaven.

Important Takeaways:

  • Prepare for a disease even deadlier than Covid, WHO chief warns
  • The planet should be ready for a disease even deadlier than Covid, the head of the World Health Organization warned yesterday.
  • Dr Tedros Adhanom Ghebreyesus told the World Health Assembly forum that the threat of another public health crisis could not be kicked ‘down the road’.
  • He also claimed that, despite the darkest days of the pandemic being consigned to history, a doomsday Covid variant with the power to send the world back to square one could still spawn.
  • The WHO has identified nine priority diseases that pose the biggest risk to public health. They were deemed to be most risky due to a lack of treatments or their ability to cause a pandemic.
  • Covid is on the list, along with Crimean-Congo hemorrhagic fever, a disease transmitted by ticks which kills 30 per cent of those it hospitalizes.
  • Ebola, which kills around half of those it infects, is another
  • Marburg, one of the deadliest pathogens ever discovered
  • The UN health agency has also warned about ‘Disease X’, reflecting the fact that the next pandemic could be caused by a pathogen currently unknown to cause human disease.
  • WHO officials are currently working on an updated list.

Read the original article by clicking here.

Western nations race to complete Afghan evacuation as deadline looms

(Reuters) – Western nations rushed to evacuate people from Afghanistan on Wednesday as the Aug. 31 deadline for the withdrawal of foreign troops drew closer and fears grew that many could be left behind to an uncertain fate under the country’s new Taliban rulers.

In one of the biggest such airlifts ever, the United States and its allies have evacuated more than 70,000 people, including their citizens, NATO personnel and Afghans at risk, since Aug. 14, the day before the Taliban swept into the capital Kabul to bring to an end the 20-year foreign military presence.

U.S. President Joe Biden said U.S. troops in Afghanistan faced mounting danger, while aid agencies warned of an impending humanitarian crisis for those left behind.

Biden has spurned calls from allies to extend the deadline, set under an agreement struck by the previous administration of Donald Trump with the hardline Islamist group last year. But he said on Tuesday the deadline could be met.

“The sooner we can finish, the better,” Biden said. “Each day of operations brings added risk to our troops.”

Two U.S. officials, speaking on condition of anonymity, said there was growing concern about the risk of suicide bombings by Islamic State at the airport.

British foreign minister Dominic Raab said the deadline for evacuating people was up to the last minute of the month.

France said it would push on with evacuations as long as possible but it was likely to end these operations in the coming hours or days.

Chancellor Angela Merkel said Germany would try to help Afghans who worked with its soldiers and aid organizations and wished to leave Afghanistan after the deadline expires.

“The end of the air bridge in a few days must not mean the end of efforts to protect Afghan helpers and help those Afghans who have been left in a bigger emergency with the takeover of the Taliban,” she told the German parliament.

Tens of thousands of Afghans fearing persecution have thronged Kabul’s airport since the Taliban takeover, the lucky ones securing seats on flights.

On Wednesday, many people milled about outside the airport – where soldiers from the United States, Britain and other nations were trying to maintain order amid the dust and heat – hoping to get out.

They carried bags and suitcases stuffed with possessions, and waved documents at soldiers in the hope of gaining entry. One man, standing knee-deep in a flooded ditch, passed a child to a man above.

“I learned from an email from London that the Americans are taking people out, that’s why I’ve come so I can go abroad,” said one man, Aizaz Ullah.

While the focus is now on those trying to flee, the risk of starvation, disease and persecution is rising for the rest of the population, aid agencies say.

“There’s a perfect storm coming because of several years of drought, conflict, economic deterioration, compounded by COVID,” David Beasley, executive director of the U.N. World Food Program, told Reuters in Doha, saying that about 14 million people were threatened with starvation.

The U.N. human rights chief said she had received credible reports of serious violations by the Taliban, including “summary executions” of civilians and Afghan security forces who had surrendered. The Taliban have said they will investigate reports of atrocities.

The Taliban’s 1996-2001 rule was marked by harsh sharia law, with many political rights and basic freedoms curtailed and women severely oppressed. Afghanistan was also a hub for anti-Western militants, and Washington, London and others fear it might become so again.

LAND ROUTES

The Taliban said all foreign evacuations must be completed by Aug. 31. It has asked the United States to stop urging talented Afghans to leave while also trying to persuade people at the airport to go home, saying they had nothing to fear.

“Foreign troops should withdraw by the deadline. It will pave the way for resumption of civilian flights,” Taliban spokesman Suhail Shaheen said on Twitter.

“People with legal documents can travel through commercial flights after Aug. 31.”

The Dutch government said it was all but certain that many people eligible for asylum would not be taken out in time.

Dutch troops had managed to get more than 100 people to Kabul airport, Foreign Minister Sigrid Kaag said, but hundreds of others risked being left behind.

The U.S.-backed government collapsed as the United States and its allies withdrew troops two decades after they ousted the Taliban in the weeks after the Sept. 11, 2001, attacks on the United States by al Qaeda, whose leaders had found safe haven in Taliban-ruled Afghanistan.

The Taliban were also switching focus from their military victory to how to run a country in crisis. They have appointed veteran figures to the posts of finance minister and defense minister since wresting control of all government offices, the presidential palace and parliament, two Taliban members said.

Afghanistan’s Pajhwok news agency said Gul Agha had been named as finance minister and Sadr Ibrahim acting interior minister. Former Guantanamo detainee Mullah Abdul Qayyum Zakir was named acting defense minister, Al Jazeera news channel reported, citing a Taliban source.

(Reporting by Reuters bureaus; Writing by Lincoln Feast, Editing by Simon Cameron-Moore, Angus MacSwan, Giles Elgood and Nick Macfie)

U.S.-bound migrants fill Colombia town as COVID-19 border closures lifted

By Steven Grattan

NECOCLI, Colombia (Reuters) – After traveling for more than a year by ship, bus and car from Africa in hope of reaching the United States, Simon Gyamfi found himself stuck in a remote tourist resort on the coast of Colombia with thousands of other migrants.

The 42-year-old carpenter, a Christian, fled his home in Ghana because of a dispute with his late wife’s Muslim family, he said, and took a month-long ocean voyage to Brazil. The closure of borders due to the coronavirus pandemic left him stranded there for months.

Now, after the frontiers finally reopened, he has made his way by road to the northern Colombian town of Necocli, a gateway for migrants heading northward into Central America.

Every year, thousands of migrants pass through the small town, looking to catch a boat across the Gulf of Uraba toward the jungles of the Darien Gap on the isthmus of Panama.

There, people smugglers guide groups across the wild, road-less region, one of the most treacherous barriers on the clandestine route to the United States.

Now borders closures have lifted, the number of migrants arriving in Necocli is soaring.

In a typical year, an estimated 30,000 migrants pass through Necocli. But by August of this year, 25,000 have already been through, according to Colombian government figures.

Panama’s Foreign Affairs ministry said it expects to receive over 70,000 migrants crossing the country en route to the U.S. by the end of 2021, an unprecedented number in the country’s history.

The town has been struggling to accommodate migrants from Latin America and beyond – many of them driven by the economic hardship worsened by the pandemic – clamoring for scarce places on boats across the Gulf. Thousands crowd hotels and the beach as they wait weeks for a spot.

Colombia and Panama vowed last week to impose order on the migrant flows as they seek support from allies, including the United States, after the number of travelers stranded in Necocli topped 10,000.

The majority of the migrants moving through Necocli are Haitian or Cuban, fleeing dire economic circumstances in their homelands. But Reuters spoke to several others from further afield, including African nations such as Ghana and Mali.

Gyamfi had been in Necocli for almost a week, paying $7 a night for a hotel room.

“The journey has been hard and full of surprises. Last month, a friend of mine died on the road,” said the widowed carpenter, who hopes to save enough to bring his young daughter to join him if he reaches the United States.

“It takes a lot of money to get here and great risks.”

Necocli became a staging area for migrants just five years ago. Though it has thrived by charging migrants in dollars, not Colombian pesos, local officials say public services and housing in the town of 20,000 are not robust enough to cope with recent numbers.

DANGEROUS CROSSING

More migrants has meant increased profits for many in Necocli: especially for the guides, called coyotes, who take people on the week-long trek through the Darien Gap.

“Everyone here is benefiting from the migrant issue,” said a local guide leader, a man in his early 40s, who asked to remain anonymous for fear of attracting the attention of the authorities.

Colombia’s government has warned of criminal dangers to migrants moving through Darien, as well as the risk of injury or disease.

The man acknowledged some groups – usually comprising 20 migrants and a guide – have been robbed and women sometimes suffer rape.

The guides have increased the size of their groups to meet recent demand, but the man denied any criminal connections.

“People look at us like the monsters of this place. They think we are rich,” he said. “Those who do this make a living day to day. The coyotes aren’t millionaires.”

At 6 a.m. the sound of adhesive tape being ripped from its rolls sounded around Necocli’s port, as migrants with spots on that day’s boat frantically sealed their possessions into plastic trash bags for the 2.5-hour, $50 boat ride across the Gulf of Uraba.

The day Reuters visited, the mayor of Acandi – which lies on the other side of the Gulf, near the Panama border – decided to let just 200 of the usual 1,000 migrants cross because of what he said were environmental and security concerns.

The decision caused chagrin among local Colombian officials and nonprofits – who feared some migrants might make a dangerous informal crossing at night. In Necocli, angry migrants who had paid days in advance for boat tickets protested in the streets.

In Capurgana, 44-year-old Haitian Lenos Dorvilien, was frustrated after he had traveled across the Gulf ahead of his wife and 12-year-old daughter, who were now stuck in Necocli.

The family had left their homeland for Chile in 2016, but found work there was badly paid. They had planned to leave sooner but were delayed by coronavirus and finally left two weeks ago by bus.

Chile – which has one of the highest levels of income per capita in Latin America – is a popular destination for Haitians, but migrants there regularly complain of experiencing xenophobia.

“I put up with living in Chile but it’s a racist country,” said Dorvilien. “I had to work hard like the devil to be able to leave.”

Dorvilien eventually took another boat back to be with his family. Their money for hotels exhausted, they slept on the beach.

(Reporting by Steven Grattan, additional reporting by Aislinn Laing in Santiago; Editing by Julia Symmes Cobb, Aurora Ellis and Daniel Flynn)

Special Report: As world approaches 10 million coronavirus cases, doctors see hope in new treatments

By Nick Brown, Deena Beasley, Gabriela Mello and Alexander Cornwell

(Reuters) – Dr. Gopi Patel recalls how powerless she felt when New York’s Mount Sinai Hospital overflowed with COVID-19 patients in March.

Guidance on how to treat the disease was scant, and medical studies were being performed so hastily they couldn’t always be trusted.

“You felt very helpless,” said Patel, an infectious disease doctor at the hospital. “I’m standing in front of a patient, watching them struggle to breathe. What can I give them?”

While there is still no simple answer to that question, a lot has changed in the six months since an entirely new coronavirus began sweeping the globe.

Doctors say they’ve learned enough about the highly contagious virus to solve some key problems for many patients. The changes could be translating into more saved lives, although there is little conclusive data.

Nearly 30 doctors around the world, from New Orleans to London to Dubai, told Reuters they feel more prepared should cases surge again in the fall.

“​We are well-positioned for a second wave,” Patel said. “We know so much more.”

Doctors like Patel now have:

*A clearer grasp of the disease’s side effects, like blood clotting and kidney failure

*A better understanding of how to help patients struggling to breathe

*More information on which drugs work for which kinds of patients.

They also have acquired new tools to aid in the battle, including:

*Widespread testing

*Promising new treatments like convalescent plasma, antiviral drugs and steroids

*An evolving spate of medical research and anecdotal evidence, which doctors share across institutions, and sometimes across oceans.

Despite a steady rise in COVID-19 cases, driven to some extent by wider testing, the daily death toll from the disease is falling in some countries, including the United States. Doctors say they are more confident in caring for patients than they were in the chaotic first weeks of the pandemic, when they operated on nothing but blind instinct.

In June, an average of 4,599 people a day died from COVID-19 worldwide, down from 6,375 a day in April, according to Reuters data.

New York’s Northwell Health reported a fatality rate of 21% for COVID-19 patients admitted to its hospitals in March. That rate is now closer to 10%, due to a combination of earlier treatment and improved patient management, Dr. Thomas McGinn, director of Northwell’s Feinstein Institutes for Medical Research, told Reuters.

“I think everybody is seeing that,” he said. “I think people are coming in sooner, there is better use of blood thinners, and a lot of small things are adding up.”

Even nuts-and-bolts issues, like how to re-organize hospital space to handle a surge of COVID-19 patients and secure personal protective equipment (PPE) for medical workers, are not the time-consuming, mad scrambles they were before.

“The hysteria of who’d take care of (hospital staff) is not there anymore,” said Dr. Andra Blomkalns, head of emergency medicine at Stanford Health Care, a California hospital affiliated with Stanford University. “We have an entire team whose only job is getting PPE.”

To be sure, the world is far from safe from a virus that continues to rage. It is expected to reach two grim milestones in the next several days: 10 million confirmed global infections and 500,000 deaths. As of Thursday evening, more than 9.5 million people had tested positive for the coronavirus, and more than 483,000 had died, according to Reuters data. The United States remains the epicenter of the pandemic, and cases are rising at an alarming pace in states like Arizona, Florida and Texas.

There is still no surefire treatment for COVID-19, the disease caused by the new virus, which often starts as a respiratory illness but can spread to attack organs including the heart, liver, kidneys or central nervous system. Scientists are at least months away from a working vaccine.

And while medical knowledge has improved, doctors continue to emphasize that the best way for people to survive is to avoid infection in the first place through good hygiene, face coverings and limited group interaction.

Dr. Ramanathan Venkiteswaran, medical director of Aster Hospitals in the United Arab Emirates, said COVID-19 will likely result in permanent changes in medicine and for the general public on “basic things like social distancing, wearing of masks and hand washing.”

LEARNING ON THE FLY

In the medical field, change can be slow, with years-long studies often needed before recommendations are altered. But protocols for COVID-19 have evolved at lightning speed.

In Brazil, São Paulo-based Hospital Israelita Albert Einstein, one of the country’s leading private hospital networks, has updated its internal guidelines for treating coronavirus patients some 50 times since the outbreak began earlier this year, according to Dr. Moacyr Silva Junior, an infectious disease specialist at the center. Those guidelines govern questions such as which patients are eligible for which drugs, how to handle patients with breathing problems, and the use of PPE like masks, gowns and gloves.

“In only three months, a resounding amount of scientific work on COVID-19 has been published,” he said.

At Stanford Health Care, treatment guidelines changed almost daily in the early weeks of the pandemic, Blomkalns said. She described a patchwork approach that began by following guidelines established by the U.S. Centers for Disease Control and Prevention, then modifying them to reflect a shortage of resources, and finally adding new measures not addressed by the CDC, such as how to handle pregnant healthcare workers.

The new coronavirus has been particularly vexing for doctors because of the many and often unpredictable ways it can manifest. Most people infected experience only mild flu-like symptoms, but some can develop severe pneumonia, stroke and neurological disease. Doctors say the biggest advance so far has been understanding how the disease can put patients at much higher risk for blood clots. Most recently, doctors have discovered that blood type might influence how the body reacts to the virus.

“We developed specific protocols, such as when to start blood thinners, that are different from what would be done for typical ICU patients,” said Dr. Jeremy Falk, pulmonary critical care specialist at Cedars-Sinai Medical Center in Los Angeles.

Around 15% of COVID-19 patients are at risk of becoming sick enough to require hospitalization. Scientists have estimated that the fatality rate could be as high as 5%, but most put the number well below 1%. People with the highest risk of severe disease include older adults and those with underlying health conditions like heart disease, diabetes and obesity.

While rates of COVID-19 infection have recently been rising in many parts of the United States, the total number of U.S. patients hospitalized with COVID-19 has been steadily falling since a peak in late April, according to the CDC.

Many hospitals report success with guidelines for “proning” patients – positioning them on their stomachs to relieve pressure on the lungs, and hopefully stave off the need for mechanical ventilation, which many doctors said has done more harm than good.

“At first, we had no idea how to treat severely ill patients when we (ventilate),” said Dr. Satoru Hashimoto, who directs the intensive care division at Kyoto Prefectural University of Medicine in Japan. “We treated them in the fashion we treated influenza,” only to see those patients suffer serious kidney, digestive and other problems, he said.

Hospitals say increased coronavirus testing – and faster turnaround times to get results – are also making a difference.

“What has really helped us triage patients is the availability of rapid testing that came on about six weeks ago,” said Falk of Cedars-Sinai. “Initially, we had to wait two, three or even four days to get a test back. That really clogged up the COVID areas of the hospital.”

Faster, wider testing also helps conserve PPE by identifying the negative patients around whom doctors don’t have to wear as much gear, said Dr. Saj Patel, who treats non-critical patients at the University of California San Francisco Medical Center. “You can imagine how much PPE we burned through” waiting for test results, he said.

Hospitals around the world acted early to restructure operations, including floor layouts, to isolate coronavirus patients and reduce exposure to others. It wasn’t always smooth, but doctors say they’re figuring out how to do it more efficiently.

“Our hospital infrastructure, and the way that we … manage people coming through the door is a lot slicker than it was earlier in the epidemic,” said Dr. Tom Wingfield, a clinical lecturer at the Liverpool School of Tropical Medicine in Liverpool, England.

USING WHAT’S AT HAND

But even if hydroxychloroquine looks unlikely as an effective COVID-19 treatment, hospitals continue to try new medications – both by repurposing older drugs and exploring novel therapies. Patients are being enrolled in hundreds of coronavirus clinical trials launched in the past three months.

Many hospitals said they are seeing success with the use of plasma donated by survivors of COVID-19 to treat newly infected patients.

People who survive an infectious disease like COVID-19 are generally left with blood containing antibodies, which are proteins made by the body’s immune system to fight off a virus. The blood component that carries the antibodies, known as convalescent plasma, can be collected and given to new patients.

Early results from a study at New York’s Mount Sinai Hospital found that patients with severe COVID-19 who were given convalescent plasma were more likely to stabilize or need less oxygen support than other similar hospital patients. But results from other studies have been mixed, and doctors still await findings from a rigorously-designed trial. And availability of plasma varies between regions.

At Henry Ford Hospital in Detroit, Michigan, “anecdotally everyone can provide stories” of the benefits of plasma, said Dr. John Deledda, the hospital’s chief medical officer.

But in rural New Mexico, hospitals that care for largely underserved populations struggle to find it. “There’s a limited number of blood centers” that can provide plasma, said Valory Wangler, chief medical officer at Rehoboth McKinley Christian Health Care Services, in Gallup, New Mexico. Until trial data is more conclusive, plasma is “not something we’re pursuing actively,” she said.

Dr Abdullatif al-Khal, head of infectious diseases at Qatar’s Hamad Medical Corporation and a co-chair of the country’s pandemic preparedness team, said he saw patients improve after he started using donated plasma early in the course of COVID-19 before the patients deteriorated.

Qatar is also assessing a steroid known as dexamethasone to treat COVID-19. But Khal says he wants to wait for publication of clinical data behind a recent UK study suggesting that the steroid reduced death rates by around a third among the most severely ill COVID-19 patients.

In patients with severe COVID-19, the immune system can overreact, triggering a potentially harmful cascade. Steroids are an older class of drugs that suppress that inflammatory response. But they can also make it easier for other viral or bacterial infections to take hold – making doctors leery of their use in a hospital setting or in patients with early-stage COVID-19.

Some countries, including Bahrain and the United Arab Emirates, reported using HIV drugs lopinavir and ritonavir with some success. Clinical trials, though, have suggested little benefit, and they aren’t widely used in the United States.

MIDNIGHT DELIVERY

Many of the doctors who spoke with Reuters were bullish on the use of remdesivir, the only drug so far shown to be effective against the coronavirus in a rigorous clinical trial. The antiviral developed by California-based Gilead Sciences Inc <GILD.O> was shown to reduce the length of hospital stays for COVID-19 patients by about a third, but hasn’t been proven to boost survival.

Remdesivir is designed to disable the mechanism by which certain viruses, including the new coronavirus, make copies of themselves and potentially overwhelm their host’s immune system.

It is available under emergency approvals in several countries, including the United States. But Gilead’s donated supplies are limited, and distribution and availability are uneven.

Dr. Andrew Staricco, chief medical officer at McLaren Health Care, which operates 11 hospitals across Michigan, recalls the urgency to obtain remdesivir early on. He got an email from Michigan’s health department on May 9, a week after the U.S. Food & Drug Administration authorized the drug for use in treating COVID-19. The health department said it had received a small batch from the federal government, and planned to dole it out to local hospitals based on need. Staricco wrote back, saying he had 15 to 18 critically ill patients, but was given enough to treat just four.

The drug was so precious, he said, that state police troopers were responsible for transporting it to the hospital – which they did, dropping it off around 1 a.m. the next morning.

Health officials originally directed remdesivir for use on the most critically ill patients. But doctors later found they got the best results administering it earlier.

“We started finding that, actually, the sooner you get treated with it, the better,” Staricco said. “We’ve revisited our criteria for giving it to patients three different times.”

Data on the drug, he said, is still scarce. But his anecdotal observations on the benefits of early treatment were echoed by several U.S. doctors.

‘COPY-CATTING’

Gilead on Monday said it aims to manufacture another 2 million courses of remdesivir this year, but did not comment on how it plans to distribute, or sell, those supplies for use by hospitals. The company has licensed the antiviral to several generic drugmakers, who will be allowed to sell the medication in over 100 low-income nations.

Although much about the coronavirus remains unknown, a key reason hospitals say they now are more prepared owes to teamwork.

Many doctors described a kind of unofficial network of information sharing.

In hard-hit Italy, Dr. Lorenzo Dagna of the IRCCS San Raffaele Scientific Institute in Milan, organized conference calls with institutions in the United States and elsewhere to share experiences and anecdotes treating COVID-19 patients.

McLaren’s Staricco said the Michigan hospital chain adopted its policy on use of blood thinners by looking at peers at Detroit Medical Center and Vanderbilt University Medical Center.

As more institutions put their guidelines online, he said, there was “lots of copy-catting going on.”

(Reporting by Nick Brown in New York, Deena Beasley in Los Angeles, Gabriela Mello in São Paulo and Alexander Cornwell in Dubai.; Additional reporting By Alistair Smout in London, Matthias Blamont in Paris, Emilio Parodi in Milan, Lisa Barrington in Dubai, Rocky Swift in Tokyo and Sangmi Cha in Seoul.; Editing by Michele Gershberg and Marla Dickerson)

 

Explainer: Are asymptomatic COVID-19 patients safe or silent carriers?

By Cate Cadell and Roxanne Liu

BEIJING (Reuters) – China said 300 symptomless carriers of the novel coronavirus in Wuhan, the epicenter of the pandemic, had not been found to be infectious, in a bid to reassure people as countries ease restrictions. But some experts say asymptomatic infections are common, presenting a huge challenge in the control of the disease.

WHAT IS ASYMPTOMATIC AND PRE-SYMPTOMATIC?

The World Health Organization (WHO) defines https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200402-sitrep-73-covid-19.pdf asymptomatic cases as those who don’t show symptoms but have been confirmed infected through a lab test. WHO notes there are few reports of truly asymptomatic cases.

The incubation period, or the time a person takes to show symptoms after getting infected, is the pre-symptomatic phase, the WHO says. Carriers can infect others during this period.

Health experts are not yet sure whether asymptomatic or pre-symptomatic cases are infectious. Some say data so far suggests those cases are probably equally likely to be able to spread infection.

The WHO agrees that pre-symptomatic carriers are infectious, and adds that there is also a possibility – although little evidence so far – that people who are asymptomatic may also transmit the virus. The WHO had said in early April that there had been no documented asymptomatic transmissions.

WHAT ELSE DOES CHINA SAY?

China has reported around 83,000 cases of COVID-19, the disease caused by the new coronavirus. It does not include asymptomatic cases in that total official count, but began reporting them separately on a daily basis on March 31.

That has raised concerns about Beijing’s commitment to transparency, and some experts say it could also paint a misleading picture of how the virus spreads.

“If you watch (such asymptomatic cases) really closely, you would see something … that probably fits with a more realistic mild disease than a complete asymptomatic,” Ian Mackay, a virologist at the University of Queensland said.

“But the term is around now and it’s going to stick. It’s a nice piece of theatre, but I don’t think it’s going to give useful information.”

Asymptomatic cases under medical observation in China dropped to 357 as of Tuesday from 1,541 as of March 30.

Wuhan has tested almost its entire population of 11 million and found no new COVID-19 cases.

Wuhan’s low rate of symptomless carriers is in line with China’s previous reporting, said Zhong Nanshan, the government’s senior medical adviser, adding that the result showed that the country didn’t cover up the epidemic as some U.S. politicians claimed.

HOW ABOUT REST OF ASIA?

Some countries in Asia include asymptomatic carriers in their total confirmed cases.

In Vietnam, which has just over 300 COVID-19 cases, almost 37% were symptomless, according to health ministry data.

Researchers concluded that asymptomatic infection was common and found two asymptomatic patients had infected at least four other people.

South Korea, which had early success in taming the outbreak through aggressive testing, said 20%-30% were asymptomatic. A senior health official said the virus could be widely transmitted during the incubation period, but asymptomatic patients were less likely to transmit it.

Singapore, which has the highest number of cases in Southeast Asia, does not give data on asymptomatic cases but has said an overwhelming majority of positive cases in its crowded migrant workers’ dormitories show mild or no symptoms.

The Philippines said about 13% of its nearly 19,000 cases were asymptomatic. In India, some 28% of 40,184 people who tested positive between Jan. 22 and April 30 were asymptomatic, according to a study.

(Reporting by Cate Cadell and Roxanne Liu in Beijing; Additional reporting by Kate Kelland in London, John Mair in Sydney, James Pearson in Hanoi, John Geddie in Singapore, Neil Jerome Morales in Manila, Sangmi Cha in Seoul, Rocky Swift in Tokyo and Miyoung Kim in Singapore; Writing by Sayantani Ghosh in Singapore; Editing by Kim Coghill)

Your COVID-19 questions, answered

Your COVID-19 questions, answered
There is a lot of misinformation circulating about the coronavirus, so we took to Instagram, Twitter and Reddit to see what questions have been bugging you, our readers.Below are answers from several healthcare experts who have been following the outbreak. Please note that there is much we still don’t know about the new virus, and you should reach out to your own healthcare provider with any personal health concerns.

LIVING UNDER LOCKDOWN

What are good ways to maintain your mental health?

I would recommend the following:

1. Maintain a normal schedule if possible

2. Exercise (go for walk or run, do an online video)

3. Maintain social connections via FaceTime, Skype or phone calls

4. Limit time spent on the Internet and connected to the news

5. Have “virtual” dates with family and friends.

— Dr. Krutika Kuppalli, infectious disease researcher

How long will the U.S. really have to be on lockdown to successfully flatten the curve?

We’re still learning on a daily basis what the case count looks like in the U.S. We also need to consider that there could be a resurgence of cases once public health measures are loosened up.

— Dr. Krutika Kuppalli, infectious disease researcher

I defer to the epidemiologists here, but National Institute of Allergy and Infectious Diseases Director Anthony Fauci recently said that he’s confident in a range of four to six weeks to 3 months.

— Dr. Angela Rasmussen, virologist at Columbia University

Do I actually need to wear a mask?

The WHO advises that if you’re healthy, you need to wear a mask only when caring for an infected person or if you’re coughing, sneezing or showing symptoms.

TRANSMISSION

Is it fair to assume every American will be exposed to the coronavirus this year?

No, which is one of the reasons we have these current public health measures in place. We are trying to prevent further onward transmission of the disease.

— Dr. Krutika Kuppalli, infectious disease researcher

Is the coronavirus airborne in normal settings and if so, for how long?

According to our knowledge, it does not stay in the air in normal settings. Most evidence directs us to droplet transmission. Airborne precautions are required only for healthcare workers when undertaking aerosol producing procedures such as bronchoscopy/intubation.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Is there potential exposure in elevators?

Coronavirus guidelines by the CDC are based on the fact that the virus is transmitted primarily via respiratory droplets, like a cough or sneeze. In droplet form, it’s airborne for a few seconds, but is only able to travel a short distance. In elevators, social distancing measures should be implemented with a max number of people inside at a time.

— Infectious Diseases Society of America

How worried should we be about fomite transmission?

We are still learning about fomite transmission. We know from an article in the New England Journal of Medicine that the virus is viable up to four hours on copper, 24 hours on cardboard, and two to three days on plastic and stainless steel.

— Dr. Krutika Kuppalli, infectious disease researcher

Can you spread the virus if you’re asymptomatic?

Yes, but it isn’t the main driver of transmission. This is also why it is extremely important to ensure you have washed hands before touching your face.

— Dr. Krutika Kuppalli, infectious disease researcher

What’s the typical timeline of symptoms?

From the time of exposure to symptoms it may take on average three to six days, which may be longer/shorter in some patients. Typically it starts with fever, dry cough, myalgia and flu-like illness, then progresses to shortness of breath and pneumonia in some patients.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Is it possible that an infected person only has a mild cold before recovering?

Yes. The most common symptoms a person will have are fever, dry cough and muscle aches/fatigue.

— Dr. Krutika Kuppalli, infectious disease researcher

Should people be more concerned about eye protection?

We certainly use face shields to protect our eyes when in contact with patients.

— Dr. Isaac Bogoch, infectious disease researcher and scientist

Does getting vaccines increase your risk?

Getting any vaccines would not increase your risk for COVID-19. We’re recommending getting needed vaccines. We want people to get their influenza vaccines so they don’t end up with the flu and in the hospital.

— Dr. Krutika Kuppalli, infectious disease researcher

Do people have a natural immunity to this virus?

I am not aware of “natural immunity” since it is a new virus. We might find as serology testing is rolled out that people have been exposed and developed antibodies without having symptoms.

— Dr. Krutika Kuppalli, infectious disease researcher

Is it possible to get reinfected?

We’re not sure how immunity works or how long it lasts. The best guess is that people who are infected are likely to be protected over the short-to-medium term. We don’t know about longer yet.

— Dr. Eric Rubin, editor-in-chief, New England Journal of Medicine

TREATMENT

Is there a team working on an antibody test for the virus? If so, when might it be ready?

There are teams working on serological tests . Rolling out on a population scale will be an essential part of the long-term answer, but we need to get through the next month.

— Bill Hanage, associate professor at the Harvard T. H. Chan School of Public Health

When will a vaccine be ready?

Vaccine trials may take as long as 12 months. There are multiple clinical trials looking at different treatment options, but we currently don’t know whether this combination is effective and safe for patients.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Scientists in Singapore are trying to fast-track the process.

What impact will warmer weather have on the spread?

I have yet to see convincing evidence on this, one way or the other. We are all hoping transmission will slow down with warmer weather in the northern hemisphere, and that warmer countries will be spared the worst. Not enough data yet to conclude.

— Dr. Suerie Moon, director of research at the Global Health Centre

I’ve seen several news sources report that experts from Johns Hopkins and other medical colleges are saying the virus can become less deadly as it spreads. Can you explain this phenomenon?

Yes, one theory for why many viruses become weaker over time is that viruses that kill their host don’t get very far. This pattern of weakening is seen with flu viruses, and many others, but not all. We’re not there yet with the current outbreak. Whether it’s weaker three or 10 years from now doesn’t change anything about today’s situation.

— Christine Soares, medical editor at Reuters

(Reporting by Lauren Young, Jenna Zucker, Beatrix Lockwood, Nancy Lapid, Christine Soares)

Arctic ‘doomsday’ food vault welcomes millionth seed variety

By Gwladys Fouche

OSLO (Reuters) – A vault in the Arctic built to preserve seeds for rice, wheat and other food staples contains one million varieties with the addition on Tuesday of specimens grown by Cherokee Indians and the estate of Britain’s Prince Charles.

The Svalbard Global Seed Vault, built on a mountainside in 2008, was designed as a storage facility to protect vital crop seeds against the worst cataclysms of nuclear war or disease and safeguard global food supplies.

Representatives from many countries and universities arrive in the Svalbard’s global seed vault with new seeds, in Longyearbyen, Norway February 25, 2020. NTB Scanpix/Lise Aserud via REUTERS

Dubbed the “doomsday vault”, the facility lies on the island of Spitsbergen in the archipelago of Svalbard, halfway between Norway and the North Pole, and is only opened a few times a year in order to preserve the seeds inside.

On Tuesday, 30 gene banks deposited seeds, also including offerings from India, Mali and Peru.

The Royal Botanical Gardens at Kew in Britain banked seeds harvested from the meadows of Prince Charles’ private residence, Highgrove.

The vault also serves as a backup for plant breeders to develop new varieties of crops. The world used to cultivate around 7,000 different plants but experts say we now get about 60% of our calories from three main crops – maize, wheat and rice – making food supplies vulnerable if climate change causes harvests to fail.

“The seed vault is the backup in the global system of conservation to secure food security on Earth,” Stefan Schmitz, executive director of the Crop Trust, the Bonn-based organization that manages the vault, told Reuters.

“We need to preserve this biodiversity, this crop diversity, to provide healthy diets and nutritious foods, and for providing farmers, especially smallholders, with sustainable livelihoods so that they can adapt to new conditions.”

One in nine people go to bed hungry globally, according to the United Nations’ World Food Programme, and scientists have predicted that erratic weather patterns could reduce both the quality and quantity of food available.

The vault was last opened in October. With Tuesday’s deposit, it contains one million different seeds, from almost all nations.

In 2015, researchers made a first withdrawal from the vault after Syria’s civil war damaged a seed bank near the city of Aleppo. The seeds were grown and re-deposited at the Svalbard vault in 2017.

In October, Norway completed an $11 million, year-long upgrade of the building, which was constructed at Svalbard because the Arctic’s cold climate means its contents will stay cool even if the power fails. But even the doomsday vault has been affected by climate change as an unexpected thaw of permafrost when it first opened let in water to the tunnel entrance, although no seeds were damaged.

(Additional reporting by Thin Lei Win in Rome; Editing by Susan Fenton and John Stonestreet)

Hunt on for ‘patient zero’ who spread coronavirus globally from Singapore

By John Geddie, Sangmi Cha and Kate Holton

SINGAPORE/SEOUL/LONDON (Reuters) – As lion dancers snaked between conference room tables laden with plastic bottles, pens, notebooks and laptops, some staff from British gas analytics firm Servomex snapped photos of the performance meant to bring good luck and fortune.

But the January sales meeting in a luxury Singapore hotel was far from auspicious.

Someone seated in the room, or in the vicinity of the hotel that is renowned for its central location and a racy nightclub in the basement, was about to take coronavirus global.

Three weeks later, global health authorities are still scrambling to work out who carried the disease into the mundane meeting of a firm selling gas meters, which then spread to five countries from South Korea to Spain, infecting over a dozen people.

Experts say finding this so-called “patient zero” is critical for tracing all those potentially exposed to infection and containing the outbreak, but as time passes, the harder it becomes.

“We do feel uncomfortable obviously when we diagnose a patient with the illness and we can’t work out where it came from…the containment activities are less effective,” said Dale Fisher, chair of the Global Outbreak Alert and Response Network coordinated by the World Health Organisation.

Authorities initially hinted at Chinese delegates, which included someone from Wuhan – the Chinese city at the epicentre of the virus that has killed over 1,350 people. But a Servomex spokesperson told Reuters its Chinese delegates had not tested positive.

Fisher and other experts have compared the Singapore meeting to another so-called “super-spreading” incident at a Hong Kong hotel in 2003 where a sick Chinese doctor spread Severe Acute Respiratory Syndrome around the world.

The WHO has opened an investigation into the Singapore incident, but said its “way too early” to tell if it is a super-spreading event.

SCARY AND SOBERING

It was more than a week after the meeting – which according to a company e-mail included Servomex’s leadership team and global sales staff – that the first case surfaced in Malaysia.

The incubation period for the disease is up to 14 days and people may be able to infect others before symptoms appear.

The firm said it immediately adopted “extensive measures” to contain the virus and protect employees and the wider community. Those included self-isolation for all 109 attendees, of whom 94 were from overseas and had left Singapore.

But the virus kept spreading.

Two South Korean delegates fell sick after sharing a buffet meal with the Malaysian, who also passed the infection to his sister and mother-in-law. Three of the firm’s Singapore attendees also tested positive.

Then cases started appearing in Europe.

An infected British delegate had headed from the conference to a French ski resort, where another five people fell ill. Another linked case then emerged in Spain, and when the Briton returned to his home town in the south of England the virus spread further.

“It feels really scary that one minute it’s a story in China… and then the next minute it is literally on our doorstep,” said Natalie Brown, whose children went to the same school as the British carrier. The school said in a letter that two people at the school had been isolated.

“It’s scary and sobering how quickly it seems to have spread,” said Brown.

TIME RUNNING OUT

Back in Singapore, authorities were battling to keep track of new cases of local transmissions, many unlinked to previous cases.

Management at the hotel – the Grand Hyatt Singapore – said they had cleaned extensively and were monitoring staff and guests for infection but did not know “how, where or when” conference attendees were infected. The lion dancers, who posted photos of the event on Facebook, said they were virus free.

“Everyone assumes it was a delegate but it could have been a cleaner, it could have been a waiter,” said Paul Tambyah, an infectious diseases expert at National University Singapore. He added it was “very important” to find “patient zero” to establish other possible “chains of transmission”.

But time may be running out.

Singapore health ministry’s Kenneth Mak said the government will continue to try and identify the initial carrier until the outbreak ends, but as days pass it will get harder.

“We might never be able to tell who that first patient is,” Mak said.

Meanwhile, the fallout from the conference continues to sow trepidation weeks after the event and thousands of miles away.

Reuters visited Servomex’s offices in the suburbs of South Korea’s capital, Seoul. It was closed and dark inside, and a building guard told Reuters employees were working from home.

A notice posted by building management stated a coronavirus patient had entered the complex, while several young women could be overheard in a nearby elevator discussing whether it had been used by the infected person.

“Do you think the patient would have gotten on this elevator or the other one?” one said.

(Reporting by John Geddie, Joe Brock and Keith Zhai in Singapore, Sangmi Cha and Josh Smith in Seoul, Kate Holton in London, and Joseph Sipalan in Kuala Lumpur; Editing by Raju Gopalakrishnan)

Cold, disease threaten more than half a million Syrians fleeing Idlib fighting

By Khalil Ashawi

AZAZ, Syria (Reuters) – Cold weather, disease and a lack of shelter and medicine threaten hundreds of thousands of civilians as they flee fighting in Idlib province, in one of the biggest upheavals of Syria’s nine-year civil war, aid groups and doctors said.

The migrants, their numbers swelling by the day, are trapped between advancing Syrian government forces, keen to crush the last significant opposition stronghold, and Turkey’s closed border.

Some are having to flee by foot, while many others are having to sleep in their cars, as Syrian and Russian warplanes bombard the highways leading north toward Turkey.

A U.N. official appealed for emergency financial assistance to help an estimated 800,000 people in northwest Syria to survive the coming months.

“People are facing a tragedy. For the last two weeks it’s been very, very cold. There is rain and mud, and influenza is spreading,” said Wassim Zakaria, a doctor who works in a clinic in Idlib city that closed on Monday due to heavy bombardment.

The numbers on the move have increased in recent days as the forces of Syrian President Bashar al-Assad advanced to within 8 km (5 miles) of Idlib city, said Selim Tosun, the Turkish Humanitarian Relief Foundation’s (IHH) media adviser in Syria.

“If the cold weather continues…there is a risk of epidemics as a large migrant flow is coming,” he said.

Since November, 692,000 people have abandoned towns south of Idlib city, Tosun said. The number “is rising every hour” and could reach 1 million, he added.

Zakaria said people had also started to flee from Idlib city but their options for shelter were limited, with people forced to sleep in cars or tents, many near the walled-off border which prevents Syrians taking refuge in Turkey.

“It’s like people are imprisoned here. Last week women and children demonstrated at the border, asking to be allowed across,” he said.

Turkey’s IHH is distributing urgent aid and blankets to those traveling on the highway from Idlib city and has set up 2,000 tents, with plans to put up another 1,500, Tosun said.

Some 700 breeze-block dwellings have also been built out of a total 10,000 which Turkey is planning to erect in the region south of its border, he said.

He added that many people were now seeking shelter beyond Idlib province, already home to waves of civilians displaced earlier in Syria’s civil war, and were heading toward Afrin and Azaz, areas just to the northeast under the control of Turkish-led Syrian rebel forces.

AID APPEAL

David Swanson, U.N. regional spokesperson for the Syria crisis, said $336 million was urgently needed to help those being displaced, with shelter a critical problem.

“This crisis continues to deteriorate by the minute. This is easily one of the largest waves of displacements since the (Syrian civil war) began in March 2011,” Swanson said.

“Hundreds of thousands of people are in now in urgent need of critical, life-saving assistance,” he said.

The United Nations has put the number of displaced from the Idlib fighting since Dec. 1 at 520,000, with a further 280,000 seen at “imminent risk of displacement”.

Many of the displaced are staying with host communities who themselves are struggling to cope, while others have sought shelter in schools or mosques, or are sleeping in their vehicles or in the open air, said Swanson.

“The humanitarian situation in Syria is more catastrophic than ever before. Who would have imagined that entire cities would be displaced in a single month?” said Atef Nanou, manager of Molham Volunteering Team, a relief group in northern Syria.

He said he had encountered families unable to get away from the bombing because they couldn’t afford fuel for their car or transportation costs.

“So they either stayed despite the bombing or went out on foot on the international road that the Syrian regime and Russian warplanes are bombing around the clock,” Nanou added.

(Additional reporting by Dominic Evans and Daren Butler in Istanbul and Eric Knecht in Beirut; Writing by Daren Butler; Editing by Gareth Jones)

Wider Image: The Indian children who need to take a train to get to water

By Rajendra Jadhav

MUKUNDWADI, India (Reuters) – As their classmates set off to play after school each day, nine-year-old Sakshi Garud and her neighbor Siddharth Dhage, 10, are among a small group of children who take a 14-km (9-mile) return train journey from their village in India to fetch water.

Their families are some of the poorest in the hamlet of Mukundwadi, in the western state of Maharashtra, a village that has suffered back-to-back droughts.

India’s monsoons have brought abundant rain and even floods in many parts of the country, but rainfall in the region around Mukundwadi has been 14% below average this year and aquifers and borewells are dry.

“I don’t like to spend time bringing water, but I don’t have a choice,” Dhage said.

“This is my daily routine,” said Garud. Their cramped shanty homes are just 200 meters (220 yards) from the train station. “After coming from school, I don’t get time to play. I need to get water first.”

They are not alone. Millions of Indians do not have secure water supplies, according to the UK-based charity, WaterAid. It says 12% of Indians, or about 163 million people, do not have access to clean water near their homes – the biggest proportion of any country.

For an interactive graphic on India’s depleting water resources, please click https://tmsnrt.rs/2mgof1L

Recognizing the issue, Indian Prime Minister Narendra Modi has promised to spend more than 3.5 trillion rupees ($49 billion) to bring piped water to every Indian household by 2024.

More than 100 families in Garud and Dhage’s neighborhood do not have access to piped water and many depend on private water suppliers, who charge up to 3,000 rupees ($42) for a 5,000-litre tanker during summer months.

But private water supply is something Garud and Dhage’s parents say they can not afford.

“Nowadays, I don’t get enough money to buy groceries. I can’t buy water from private suppliers,” said Dhage’s father, Rahul, a construction worker. “I am not getting work every day.”

PIPE DREAM

The children take the train daily to fetch water from the nearby city of Aurangabad.

The train is often overcrowded, so a group of small children jostling to get on board with pitchers to fill with water is not always welcome.

“Some people help me, sometimes they complain to railway officials for putting pitchers near the door. If we don’t put them near the door, we can not take them out quickly when the train stops,” Dhage said.

Garud’s grandmother Sitabai Kamble and an elderly neighbor help occasionally by pushing them on board in the face of irritable passengers.

“Sometimes they kick the pitchers away, they grumble,” Kamble said.

When the train pulls into Aurangabad thirty minutes later, they scramble to fill the pitchers at nearby water pipes. Garud can’t reach the tap, so she relies on her taller sister, Aaysha, 14, and grandmother.

Others, like Anjali Gaikwad, 14, and her sisters, also board the train every few days to collect water and wash clothes.

Their neighbor Prakash Nagre often tags along with soap and shampoo. “There’s no water to bathe at home,” he says.

When the train returns them to Mukundwadi, they have just under a minute to disembark. At times, Dhage’s mother, Jyoti, is waiting at the station to help.

“I’m careful, but sometimes pitchers fall off the door in the melee and our work is wasted,” she said, holding her infant in one arm and a pitcher in the other. “I can’t leave my daughter at home alone so I have to take her along.”

(Reporting by Rajendra Jadhav; Additional reporting by Francis Mascarenhas; Writing by Sankalp Phartiyal; Editing by Euan Rocha and Neil Fullick)