U.S. drug overdose deaths rise 30% to record during pandemic

By Julie Steenhuysen and Daniel Trotta

(Reuters) – A record number of Americans died of drug overdoses last year as pandemic lockdowns made getting treatment difficult and dealers laced more drugs with a powerful synthetic opioid, according to data released on Wednesday and health officials.

U.S. deaths from drug overdoses leapt nearly 30% to more than 93,000 in 2020 – the highest ever recorded.

“During the pandemic, a lot of (drug) programs weren’t able to operate. Street-level outreach was very difficult. People were very isolated,” said Dr. Joshua M. Sharfstein, a health policy expert at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Arman Maddela, 24, recognizes he was at risk of being among those who died. A recovering addict, he relapsed during the pandemic and was using fentanyl, a synthetic opioid that is 80-100 times stronger than morphine, and heroin.

“It’s so easy to pass away from using drugs nowadays, just because of the amount of fentanyl out there. A lot of people in the past were able to relapse and come back. But nowadays, that’s not the case,” he said.

He checked himself into rehab a second time in October. “I actually know quite a few people personally that have unfortunately passed away since then from overdose,” said Maddela, who lives in Encinitas, California.

While overdose deaths were already increasing in the months preceding the COVID-19 outbreak, the latest data show a stark acceleration during the pandemic.

Social distancing reduced access to programs that offer needle exchange, opioid substitution therapy or safe injection sites where observers could deploy the overdose antidote Narcan, leaving many addicts to die alone.

Moreover, during stay-at-home orders, addicts were unable to attend support group meetings in person or visit their therapists for live one-on-one sessions.

Pandemic lockdowns and distancing likely contributed to the rise in overdose deaths in less obvious ways, too.

Isolation is known as a factor in anxiety and depression, said Kate Judd, program director at Shoreline Recovery Center, the San Diego rehab facility that treated Maddela. Those feelings can lead to drug abuse.

The drugs themselves became more deadly as well. Drug suppliers more frequently mixed fentanyl with cocaine and methamphetamine to boost their effects, said Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.

“The type of drugs that are now available are much more dangerous,” Volkow said. Closing national borders did not staunch the flow of fentanyl as hoped. Instead, it accelerated.

The deadly combination of events resulted in 93,331 overdose deaths in the 12 months ended in December 2020, compared with an estimated 72,151 deaths in 2019, according to provisional data from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

The data showed opioids were involved in 74.7% of overdose deaths, rising to 69,710 in 2020 from 50,963 in 2019.

“We do know the primary driver of the increase (in deaths) involves synthetic opioids, primarily fentanyl,” Bob Anderson, chief of the Mortality Statistics Branch at the health statistics center, said.

Most U.S. states were swept by the trend, Anderson said, with the highest increases in overdose deaths seen in Vermont, up 57.6%; followed by Kentucky, up 54%; South Carolina, up 52%; West Virginia, up nearly 50%; and California, up 46%.

On a day-to-day basis, Sharfstein estimates that the United States is now seeing more overdose deaths than COVID-19 deaths.

“This is a different kind of crisis, and it’s not going to go away as quickly.”

(Reporting by Julie Steenhuysen in Chicago and Daniel Trotta in Carlsbad, California, additional reporting by Mrinalika Roy in Bengaluru; Editing by Caroline Humer and Cynthia Osterman)

Together again: Elderly New Yorkers rejoice as senior centers reopen

By Maria Caspani

NEW YORK (Reuters) – After more than a year of pandemic-forced separation, 85-year old Justo Fleitas was back at the pool table at his neighborhood’s senior center, finally reunited with a small group of friends and his cue stick.

“It’s beautiful, no words to say how I feel,” said Fleitas, an avid pool player and a regular at the Star Senior Center in Manhattan.

On Monday this week, senior centers in New York City welcomed back the city’s elderly for indoor activities after being closed for more than a year.

Fleitas, who left Cuba for the United States in his 20’s, worked as a barber until he retired more than 20 years ago. After being confined at home with his wife during the coronavirus pandemic that ravaged New York, he said he has been eagerly waiting for the center to reopen.

He was far from alone in that pent up anticipation.

“Before we opened, seniors were already calling, asking for us to reopen,” said Maggie Hernandez, a program coordinator at Star Senior Center. “They were preparing themselves for weeks for this to happen.”

Centers such as the one in the Washington Heights neighborhood of Upper Manhattan are a lifeline for many senior citizens who rely on them for food, companionship and recreation.

When the pandemic shut them down last spring, along with most other activities, some older New Yorkers, at particularly high risk for severe COVID-19, were forced to hunker down at home, often alone.

Staff at Star Senior Center made some 35,000 wellness calls to its seniors who reported suffering from isolation, anxiety and depression, Hernandez said.

‘MISSED HERE SO MUCH’

On the first day of reopening, the center was bustling at lunch hour. Gaggles of seniors gathered around the large tables spread out around the room, filling the place with animated conversations for the first time in more than a year.

Helen Anderson started frequenting the Star Senior Center a few years ago, attracted by its diversity. When the pandemic hit, Anderson said she “tried to survive” by speaking on the phone with the center’s staff.

“Oh my goodness, I missed here so much,” said Anderson, 72, as she tucked a face covering under her glasses to keep it from sliding down.

Anderson, who lives alone, said she started seeing her daughter in person during the Christmas holidays late last year, although she did not allow her inside the apartment for fear of getting sick.

The retired nurse said she religiously watched New York City Mayor Bill de Blasio’s daily news conferences hoping for an announcement about the reopening of senior centers.

On June 1, de Blasio said senior centers could resume outdoor activities and indoor gatherings would resume on June 14.

“Seniors bore the brunt of the COVID crisis, they were the most vulnerable,” the mayor said at the time of the announcement.

New Yorkers 75 and older were hospitalized for COVID-19 at rates four times higher than the rest of the population and died at seven times the rate of the rest of the residents, city health data shows https://www1.nyc.gov/site/doh/covid/covid-19-data-totals.page#summary.

About 128 of the 250 senior centers in the Department for the Aging’s (DFTA) network were reopening as of late Tuesday, according to a spokesperson for the department.

Some centers were still wrestling with the logistics of how to safely resume operations as they are open to both vaccinated and unvaccinated seniors.

“Senior centers are notoriously small places,” said Abbie LeWarn, the assistant director of the Queens Center for Gay Seniors.

Prior to the pandemic, up to 70 seniors would frequent that center daily, said LeWarn. But having a tight space with few windows was one of the hurdles to a safe reopening, despite seniors’ excitement.

On Tuesday, New York Governor Andrew Cuomo lifted most remaining COVID-19 restrictions. But safety measures like face coverings and social distancing will remain in place at senior centers, at least for now, DFTA said, citing unchanged guidance from the New York City Department of Health and Mental Hygiene.

Despite the rain, more than 40 members showed up to Star on Monday. About 150 seniors would frequent the center on a typical day before the pandemic, Hernandez said.

A small but determined group of elderly women stretched with the aid of chairs and moved to the beat of blaring Latin music, taking their cue from an instructor who shouted words of encouragement into a microphone.

“We’re all so thrilled to be back,” Hernandez said.

(Reporting by Maria Caspani, Editing by Bill Berkrot)

COVID-19 far more widespread in Indonesia than official data show – studies

By Tom Allard

JAKARTA (Reuters) – COVID-19 is many times more prevalent in Indonesia than shown by official figures in the world’s fourth most populous country, authors of two new studies told Reuters.

The country of 270 million has recorded 1.83 million positive cases, but epidemiologists have long believed the true scale of the spread has been obscured by a lack of testing and contact tracing.

The results of Indonesia’s first major seroprevalence studies – which test for antibodies – were revealed exclusively to Reuters.

One nationwide study between December and January suggested 15% of Indonesians had already contracted COVID-19 – when official figures at the end of January had recorded infections among only around 0.4% of people.

Even now, Indonesia’s total positive infections are only around 0.7% of the population.

The results of the survey were not unexpected given under reporting, said Pandu Riono, a University of Indonesia epidemiologist who worked on the study carried out with help from the World Health Organization.

Siti Nadia Tarmizi, a senior health ministry official, said it was possible the study was preliminary, but there might be more cases than officially reported because many cases were asymptomatic.

She said Indonesia had low contact tracing and a lack of laboratories to process tests.

Based on blood tests, seroprevalence studies detect antibodies which show up people who likely already contracted the disease. The official figures are largely based on swab tests, which detect the virus itself and only reveal those who have it at the time.

Antibodies develop one to three weeks after someone contracts the virus and stay in the body for months.

WEAK TESTING

Seroprevalence studies in other countries – including India – have also revealed more widespread infections.

“Our official surveillance system cannot detect COVID-19 cases. It is weak,” said the principal investigator for the University of Indonesia study, Tri Yunis Miko Wahyono, who commented on it but was not authorized to confirm the figures.

“Contact tracing and testing in Indonesia is very poor and explains why so few cases are detected.”

Fellow study author Pandu said that although the study showed the wider spread of the virus, Indonesia still appeared to be far from achieving herd immunity – making it a priority to speed up vaccination.

Just 6% of Indonesia’s targeted population of 181 million have been fully vaccinated with two doses so far, while 9.4% have had one shot, according to government data.

Preliminary results of a separate seroprevalence study in Bali, done by the University of Udayana, found 17 per cent of those tested in September and November appeared to have been infected, principal investigator Anak Agung Sagung Sawitri told Reuters.

That was 53 times higher than rate of infection based on the cases officially recorded at the time on the tourist island, which is planning to reopen to international visitors next month.

The reopening is opposed by some public health experts, including academic and doctor Ady Wirawan.

“Testing, tracing, isolation and quarantine is very, very weak in Bali,” he said.

(Editing by Matthew Tostevin and Kim Coghill)

U.S. schools turn focus to mental health of students reeling from pandemic

By Maria Caspani and Hannah Beier

OREFIELD, Pa. (Reuters) – As COVID-19 upended education during the past year, Pennsylvania middle school teacher Jennifer Lundberg often began her English lessons gauging the mental wellbeing of her students.

Sometimes, she would turn the lights off and dedicate a few minutes of in-person class to walking the kids through exercises that asked them to identify stressors they were experiencing.

With her own teenage daughter suffering from bouts of depression and anxiety brought on by the pandemic, the veteran teacher saw evidence all around her of the urgent need for mental health support for young people.

“They are struggling in a way that I feel like a lot of times they don’t even have words for,” Lundberg said. “I’ve had students who have left in the middle of the day to go to the ER to get evaluated.”

Lundberg teaches in the Parkland School District in Allentown, where school officials said the coronavirus has been a catalyst for getting better mental health training for staff and care for its more than 9,000 students.

Educators across the country agreed students’ mental wellbeing became a bigger priority after the pandemic forced schools to shut down or operate with a mix of remote and in-person learning. Some students struggled to focus, and isolation, worry and depression took a toll on many.

A Reuters survey earlier this year of U.S. school districts serving more than 2.2 million students found that a majority reported multiple indicators of increased mental health stresses among students.

Those concerns have led to a flood of new funding and initiatives aimed at helping schools navigate the pandemic’s aftermath.

The federal COVID-19 relief package included $122 billion for K-12 schools to implement “strategies to meet the social, emotional, mental health and academic needs” of the hardest-hit students. President Joe Biden’s budget proposal released in April includes another $1 billion to add nurses and mental health services in public schools.

In Utah, a bill signed in March makes mental health a valid excuse for a school absence. Similar legislation has been introduced in other states including Connecticut and Maryland.

Next month, the National Center for School Mental Health will launch ClassroomWISE. The free online course will train U.S. teachers and school staff on how to create a safe and supporting classroom environment, and how to support students with mental health concerns.

Districts nationwide have said the pandemic “has kind of given them a vitamin D shot” in terms of awareness and resources, said Sharon Hoover, co-director of the government-funded center. Sustained focus will be needed for success, she added.

“We’d be kind of kidding ourselves if we think everyone’s going to walk into school doors and things go back to normal,” Hoover said.

FRESH MOMENTUM

Many districts still lack sufficient resources and training, however. And experts say even where there are protocols and initiatives already in place, the severity and novelty of some circumstances amid the pandemic pose challenges.

Amy Molloy, the director of school mental health resources at the non-profit Mental Health Association in New York State, said she thought the state’s schools were well-positioned to attend to students’ mental health thanks to legislation passed in recent years before COVID-19 hit.

But the toll of the pandemic is hard to predict.

“There’s a lot of concern and uncertainty about what kind of trauma experiences, what kind of grief and loss, what kind of enhanced mental health problems… are students bringing back,” Molloy said.

Before the coronavirus, insurance roadblocks had hampered the Parkland School District’s efforts to provide students with one-on-one psychotherapy sessions for their mental health needs, said Brenda DeRenzo, the director of student services.

The pressure created by COVID-19 allowed the Pennsylvania district to finally overcome the financial hurdles through a partnership last fall with a local hospital that linked its middle and high school students with licensed clinicians.

This fall, when students return to full-time in-person learning, the district will implement programs to help them readjust to school and reconnect with their peers.

One initiative will link students to community outreach programs such as a food drive or a nursing home in an effort to rebuild the camaraderie lost to the pandemic, DeRenzo said.

Lundberg, who teaches at Orefield Middle School, said she plans to start hosting morning meetings with parents to facilitate more communication about how their children are coping.

“These kids are good kids, they’re just done; they’re burned out,” she said.

(Reporting by Maria Caspani and Hannah Beier in Orefield, Pennsylvania, Editing by Colleen Jenkins and Cynthia Osterman)

‘Hands of love’: warm latex gloves mimic human touch for COVID-19 patients in Brazil

By Leonardo Benessatto

SAO CARLOS, Brazil (Reuters) – The fight against COVID-19 is a lonely one with patients forced into isolation in intensive care wards, removed from family and friends.

But two nurses in the small city of Sao Carlos, in Sao Paulo state, have discovered a way to help with a millimeter of latex and some warm water that mimics a human touch.

Semei Araújo Cunha and Vanessa Formenton improvised the technique they call “little hands of love” while working in the Santa Felicia Emergency Care Unit.

They fill latex medical gloves with warm water in a hospital shower, tying them off like water balloons.

Cunha demonstrated how she puts the gloves on an unconscious man fighting for his life against COVID-19, placing one glove on each side of the hand.

“The patient feels comforted as if someone were holding hands with them,” Formenton said.

The man is one of several patients sharing a small hospital room, each person hooked to an array of machines tracking their vitals with a cacophony of beeps and alarms.

The two nurses developed the method about a month ago, as the current brutal surge in COVID-19 was gaining speed. Brazil is now leading the world in daily average COVID-19 deaths and is second only to the United States in total death toll.

Warming patients hands has several benefits beyond the emotional support it can provide, they say, including increased blood flow.

Cold hands can result in incorrect readings of patients’ blood oxygen levels, falsely showing that oxygen levels are low. The gloves ensure that doesn’t happen.

Hospitals around the city are now using the technique, with staff praising the “hands of love” for delivering immediate results.

“It’s unbelievable that you can see how fast the change in the patient is, it’s magnificent,” Cunha said.

(Reporting by Leonardo Benassatto; Writing by Jake Spring; Editing by Andrea Ricci)

Coronavirus tag: How the pandemic can affect young minds

By Kate Kelland

LONDON (Reuters) – It’s a bit like tag, except that you get tagged when someone coughs on you and that means you have the virus and have to go into isolation. If you come out and get tagged again, you die.

Child psychotherapists say playground games in the time of COVID-19 are becoming infused with words that many of the children playing them had never heard before: pandemic, isolation, lockdown.

So while the disease caused by the new coronavirus appears to produce relatively mild symptoms in many children, doctors and psychologists warn the impact of the outbreak and its anxiety-inducing spread may be far more traumatic.

“I’m worried we could develop a generation of children with health anxiety,” said Nikhil Chopra, a family doctor and father of two girls, aged 2 and 4, living in southern England.

His 4-year-old, normally playful and worry-free, he said, was coming home from school last week saying: “If we don’t wash our hands we could die.”

A psychotherapist who works with children in London said the games and playground talk among young children sharply reflect the new world.

Describing the coronavirus tag game, where “if you’re tagged you have to stand at one end of the playground in isolation, and if you come out and get tagged again, you die”, the therapist said fear and confusion were leading some kids to lash out.

“There’s quite a lot of ethnic diversity in the school I work in, and the Chinese children are being victimized and bullied – they are being told they’re “unclean” and “revolting” because “they eat dogs and snakes”. It’s so sad. The children are not bad, but their fear is so great that the only thing they can do is project it onto others to gain a sense of control.”

NERVOUS AND BRAVE

Across the Atlantic, 4-year-old Asher Henkoff says he’s fine when asked how the pandemic is affecting him: “I have my stuffed animals to keep me company, and I get to watch TV,” the Houston, Texas boy said, adding he feels “nerv-brave” – a mix of nervous and brave.

His mother, Alexandra Wax, says Asher has become uncharacteristically clingy, is asking non-stop questions about the new virus and has begun having accidents during the night – something he hasn’t done in years.

While some young minds will be resilient and enable those children to bounce back after the crisis, the risk for others, psychotherapists say, is that the anxiety they see around them now will impact their mental growth and future lives.

“Adults panicking is going to mean children panicking because they will be feeling very unsafe,” said Lucy Russell, a clinical psychologist in southern England and author of an online child mental health blog called “They are the Future”.

“I’m most worried not because of the distress I’m seeing in children right at this moment, but because of the distress I’m seeing in adults and how that will be transmitted to children.”

Russell and other mental health specialists such as Mary Calabrese, a Cambridge, Massachusetts-based child psychologist, say traumas like the global coronavirus pandemic can affect children particularly strongly.

Because their brains are still forming, trauma can cause the amygdala – the emotional part of the brain linked to fear and anxiety – to over-react at a time when its link to the frontal cortex – the thinking and more rational part of the brain – is not fully developed.

“The connections aren’t strong,” Russell said. “So young children tend to react emotionally to things – and the thinking, rational part of the brain can’t calm them down.”

Calming becomes a job for adults – parents, neighbors, teachers and friends – said Russell and Calabrese.

Acknowledging how hard this can be for parents and carers whose own lives are filled with anxiety and uncertainty, the specialists advise creating as much structure and predictability as possible to help children feel secure and safe.

And because children’s minds are geared toward problem-solving, they might also respond well to reassurance that focuses on what can be done to control the spread of the virus – like washing hands and staying inside.

“Validate their fears without making it worse,” Calabrese said. “You might want to say: ‘Let’s find out together what this means’. Pull it away from them personally, and say: ‘This is why we all owe it to each other to socially distance’.”

(Reporting and writing by Kate Kelland in London. Additional reporting by Nick Brown in New York; Editing by Janet Lawrence)

Man held after Dutch family found locked away in secret farmhouse room

Man held after Dutch family found locked away in secret farmhouse room
By Hilde Verweij

RUINERWOLD, Netherlands (Reuters) – A man who paid the rent on a Dutch farmhouse where six members of a family were found locked away in a secret room will appear in court on Thursday on charges of unlawful detention and harming others’ health, prosecutors said.

Five siblings, estimated to be aged between 18 and 25, and a man they identified as their ailing father were found at the farm near Ruinerwold, a village in the province of Drenthe where they had apparently lived in isolation for years.

The 58-year-old suspect, who lived nearby and whose name has not yet been released by authorities, was to be brought before a judge on Thursday, prosecutors said in a statement.

“The man is suspected at this stage of the investigation of involvement in unlawful detention and injuring the health of others,” the statement said.

The mayor of Ruinerwold, Roger de Groot, said the suspect was not the father of the family.

“The man is still in custody and is being questioned,” said Drenthe police spokeswoman Grietje Hartstra. “A lot is still unclear and we are investigating exactly what happened there.”

The family was discovered after one relative, a 25-year-old man and the eldest of the siblings according to local media, sought help at a nearby cafe.

In a statement, police said they found the family in a “small space in the house which could be locked” and that it was unclear whether they were being held against their will.

Investigators have not commented on published reports that the family may have held apocalyptic “end of days” beliefs.

“There is a lot of speculation in the media about what happened, but as police we deal with facts. We still have a lot of unanswered questions,” Hartstra said.

The mother of the children was believed to have died before the family moved to the Dutch farm in 2010, De Groot told reporters. None of the family members was registered as a resident with the municipality, the police statement said.

REMOTE SPOT

The farm is located on a secluded plot of land on the outskirts of the village. Residents were surprised that anyone could have been hidden away for so long in their tiny community without being noticed.

“It’s possible here … (it) is such a remote spot, in the middle of fields,” said neighbor Roelie van Dijk. “You see it can happen anywhere. Not only in a big city but also in the countryside. And perhaps even more in the countryside, where you can hide completely.”

Van Dijk said she and her husband had seen a man driving in and out of the property for years and doing construction work. He always kept the gates closed and never socialized, she said.

Her husband Sjon said he once asked to see how the renovations were coming along, but the man yelled “no” and sped off.

“We tried to make contact, my husband just last week, with the man in the car…(But) he drove on. He went through the gates and locked them again.”

The siblings had apparently lived in makeshift rooms inside the farm and survived partly on vegetables and animals from a secluded garden on the property, local TV RTV Drenthe reported.

(Reporting by Anthony Deutsch and Stephanie van den Berg Writing by Anthony Deutsch; Editing by Mark Heinrich)

With Venezuela in collapse, towns slip into primitive isolation

A man weighs coffee beans, given as a means of payment, in a hardware store in Guarico, Venezuela April 24, 2019. Picture taken April 24, 2019. REUTERS/Manaure Quintero NO RESALES. NO ARCHIVES.

By Corina Pons

PATANEMO, Venezuela (Reuters) – At the once-busy beach resort of Patanemo, tourism has evaporated over the last two years as Venezuela’s economic collapse has deepened and deteriorating cellphone service left visitors too afraid of robbery to brave the isolated roads.

Gone are the vendors who once walked the sands of the crescent-shaped beach hawking bathing suits and empanadas – a traditional savory pastry.

These days, its Caribbean shoreline flanked by forested hills receives a different type of visitor: people who walk 10 minutes from a nearby town carrying rice, plantains or bananas in hopes of exchanging them for the fishermen’s latest catch.

With bank notes made useless by hyperinflation, and no easy access to the debit card terminals widely used to conduct transactions in urban areas, residents of Patanemo rely mainly on barter.

It is just one of a growing number of rural towns slipping into isolation as Venezuela’s economy implodes amid a long-running political crisis.

From the peaks of the Andes to Venezuela’s sweltering southern savannahs, the collapse of basic services including power, telephone and internet has left many towns struggling to survive.

The subsistence economy stands in stark contrast to the oil boom years when abundance seeped into the most remote reaches of what was once Latin America’s richest nation.

“The fish that we catch is to exchange or give away,” said Yofran Arias, one of 15 fishermen who have grown accustomed to a rustic existence even though they live a 15-minute drive from Venezuela’s main port of Puerto Cabello.

“Money doesn’t buy anything so it’s better for people to bring food so we can give them fish,” he said, while cleaning bonefish, known for abundant bones and limited commercial value.

In visits to three villages across Venezuela, Reuters reporters saw residents exchanging fish, coffee beans and hand-picked fruit for essentials to make ends meet in an economy that shrank 48% during the first five years of President Nicolas Maduro’s government, according to recent central bank figures.

Venezuela’s crisis has taken a heavy toll on rural areas, where the number of households in poverty reached 74% in 2017 compared with 34% in the capital of Caracas, according to an annual survey called Encovi carried out by private Venezuelan universities.

Residents rarely travel to nearby cities, due to a lack of public transportation, growing fuel shortages and the prohibitive cost of consumer goods.

In some regions, travel requires negotiating roads barricaded by residents looking to steal from travelers. At one such roadblock in eastern Venezuela, a Reuters witness saw a driver fire gunshots in the air to disperse a crowd

“I haven’t been to the city center in almost two years. What would I do there? I don’t have enough (money) to buy a shirt or a pair of shorts,” said a fisherman in Patanemo who identified himself only as Luis.

“I’m better off here swapping things to survive.”

COFFEE FOR FUEL

Venezuela is suffering one of the worst economic collapses in modern history. Inflation has topped 1 million percent, according to figures released by the opposition-run congress. The United Nations says 4 million citizens have fled Venezuela, 3.3 million of them since 2015.

A fisherman carries a plastic bag full of fish that can be used as a means of payment at a fishermen's camp in Patanemo, Venezuela May 17, 2019. REUTERS/Manaure Quintero

A fisherman carries a plastic bag full of fish that can be used as a means of payment at a fishermen’s camp in Patanemo, Venezuela May 17, 2019. REUTERS/Manaure Quintero

Maduro blames the situation on an “economic war” waged by his political adversaries as well as U.S. sanctions that have hobbled the oil industry and prevented his government from borrowing abroad.

The central bank in April released economic indicators for the first time in the nearly four years, showing a less severe cataclysm than figures published by Congress. But the bank’s data underscored a dramatic contraction and spiraling consumer prices, nonetheless.

The bolivar has lost 99% of its value since Maduro took office in 2013.

In the mountains of the central state of Lara, residents of the town of Guarico this year found a different way of paying bills – coffee beans.

Residents of the coffee-growing region now exchange roasted beans for anything from haircuts to spare parts for agricultural machinery.

“Based on the cost of the product, we agree with the customer on the kilos or number of bags of coffee that they have to pay,” said hardware store manager Haideliz Linares.

The transactions are based on a reference price for how much coffee fetches on the local market, Linares said. In April, one kilo (2.2 pounds) of beans was worth the equivalent of $3.00.

In El Tocuyo, another town in Lara state, three 100 kilo sacks of coffee buy 200 liters (53 gallons) of gasoline, which is in increasingly short supply in the OPEC nation due to chronic operational problems at state oil company PDVSA.

Keila Ovalles works in her garden to harvest vegetables and fruit, which she uses to for bartering, in Borburata, Venezuela May 17, 2019. REUTERS/Manaure Quintero

Keila Ovalles works in her garden to harvest vegetables and fruit, which she uses to for bartering, in Borburata, Venezuela May 17, 2019. REUTERS/Manaure Quintero

In Borburata, another town a few miles from Patanemo, Keila Ovalles harvests eggplant, tomato and passion fruit in the backyard of her modest home. She said it was similar to the way her family lived in the early 20th century.

She stopped drinking coffee after being unable to pay for it, and now makes tea out of lemongrass instead.

“I tell the guys that I’m swapping passion fruit for something else, they spread the word and someone always comes,” said the 55-year-old woman.

(Reporting by Corina Pons; additional reporting by Keren Torres in Guarico, Tibisay Romero in Valencia and Angus Berwick in Cumana; Editing by Daniel Flynn and Tom Brown)

The digital drug: Internet addiction spawns U.S. treatment programs

Danny Reagan,a former residential patient of the Lindner Center of Hope, which admits only children who suffer from compulsion or obsession with their use of technology, sits in a common room at the center in Mason, Ohio, U.S., January 23, 2019. REUTERS/Maddie McGarvey

By Gabriella Borter

CINCINNATI (Reuters) – When Danny Reagan was 13, he began exhibiting signs of what doctors usually associate with drug addiction. He became agitated, secretive and withdrew from friends. He had quit baseball and Boy Scouts, and he stopped doing homework and showering.

But he was not using drugs. He was hooked on YouTube and video games, to the point where he could do nothing else. As doctors would confirm, he was addicted to his electronics.

“After I got my console, I kind of fell in love with it,” Danny, now 16 and a junior in a Cincinnati high school, said. “I liked being able to kind of shut everything out and just relax.”

Danny was different from typical plugged-in American teenagers. Psychiatrists say internet addiction, characterized by a loss of control over internet use and disregard for the consequences of it, affects up to 8 percent of Americans and is becoming more common around the world.

“We’re all mildly addicted. I think that’s obvious to see in our behavior,” said psychiatrist Kimberly Young, who has led the field of research since founding the Center for Internet Addiction in 1995. “It becomes a public health concern obviously as health is influenced by the behavior.”

Psychiatrists such as Young who have studied compulsive internet behavior for decades are now seeing more cases, prompting a wave of new treatment programs to open across the United States. Mental health centers in Florida, New Hampshire, Pennsylvania and other states are adding inpatient internet addiction treatment to their line of services.

Some skeptics view internet addiction as a false condition, contrived by teenagers who refuse to put away their smartphones, and the Reagans say they have had trouble explaining it to extended family.

Anthony Bean, a psychologist and author of a clinician’s guide to video game therapy, said that excessive gaming and internet use might indicate other mental illnesses but should not be labeled independent disorders.

“It’s kind of like pathologizing a behavior without actually understanding what’s going on,” he said.

A room at the Lindner Center of Hope's "Reboot" program in Mason, Ohio, U.S., January 23, 2019. REUTERS/Maddie McGarvey

A room at the Lindner Center of Hope’s “Reboot” program in Mason, Ohio, U.S., January 23, 2019. REUTERS/Maddie McGarvey

‘REBOOT’

At first, Danny’s parents took him to doctors and made him sign contracts pledging to limit his internet use. Nothing worked, until they discovered a pioneering residential therapy center in Mason, Ohio, about 22 miles (35 km) north of Cincinnati.

The “Reboot” program at the Lindner Center for Hope offers inpatient treatment for 11 to 17-year-olds who, like Danny, have addictions including online gaming, gambling, social media, pornography and sexting, often to escape from symptoms of mental illnesses such as depression and anxiety.

Danny was diagnosed with Attention Deficit Hyperactivity Disorder at age 5 and Anxiety Disorder at 6, and doctors said he developed an internet addiction to cope with those disorders.

“Reboot” patients spend 28 days at a suburban facility equipped with 16 bedrooms, classrooms, a gym and a dining hall. They undergo diagnostic tests, psychotherapy, and learn to moderate their internet use.

Chris Tuell, clinical director of addiction services, started the program in December after seeing several cases, including Danny’s, where young people were using the internet to “self-medicate” instead of drugs and alcohol.

The internet, while not officially recognized as an addictive substance, similarly hijacks the brain’s reward system by triggering the release of pleasure-inducing chemicals and is accessible from an early age, Tuell said.

“The brain really doesn’t care what it is, whether I pour it down my throat or put it in my nose or see it with my eyes or do it with my hands,” Tuell said. “A lot of the same neurochemicals in the brain are occurring.”

Even so, recovering from internet addiction is different from other addictions because it is not about “getting sober,” Tuell said. The internet has become inevitable and essential in schools, at home and in the workplace.

“It’s always there,” Danny said, pulling out his smartphone. “I feel it in my pocket. But I’m better at ignoring it.”

IS IT A REAL DISORDER?

Medical experts have begun taking internet addiction more seriously.

Neither the World Health Organization (WHO) nor the American Psychiatric Association recognize internet addiction as a disorder. Last year, however, the WHO recognized the more specific Gaming Disorder following years of research in China, South Korea and Taiwan, where doctors have called it a public health crisis.

Some online games and console manufacturers have advised gamers against playing to excess. YouTube has created a time monitoring tool to nudge viewers to take breaks from their screens as part of its parent company Google’s “digital wellbeing” initiative.

WHO spokesman Tarik Jasarevic said internet addiction is the subject of “intensive research” and consideration for future classification. The American Psychiatric Association has labeled gaming disorder a “condition for further study.”

“Whether it’s classified or not, people are presenting with these problems,” Tuell said.

Tuell recalled one person whose addiction was so severe that the patient would defecate on himself rather than leave his electronics to use the bathroom.

Research on internet addiction may soon produce empirical results to meet medical classification standards, Tuell said, as psychologists have found evidence of a brain adaptation in teens who compulsively play games and use the internet.

“It’s not a choice, it’s an actual disorder and a disease,” said Danny. “People who joke about it not being serious enough to be super official, it hurts me personally.”

(Reporting by Gabriella Borter; editing by Grant McCool)

Squeezing North Korea: old friends take steps to isolate regime

Friendship bridge between China and North Korea

By Ju-min Park and Tony Munroe

SEOUL (Reuters) – From kicking out North Korean workers and ending visa-free travel for its citizens, to stripping flags of convenience from its ships, Cold War-era allies from Poland to Mongolia are taking measures to squeeze the isolated country.

More such moves, with prodding from South Korea and the United States, are expected after North Korea recently defied U.N. resolutions to conduct its fifth nuclear test.

North Korea’s limited global links leave most countries with few targets for penalizing the regime on their own.

Mounting sanctions over the years have made Pyongyang more adept at evasion and finding alternative sources for procurement, a recent paper by experts at Harvard University and the Massachusetts Institute of Technology found.

Nonetheless, South Korea has been especially active in pushing the North’s allies for unilateral action in hopes of reining in Pyongyang’s arms program.

“If long-standing friends of North Korea continue to publicly curb their ties with the country, Pyongyang will have fewer places overseas where its illicit networks can operate unhindered or with political cover from the host capital,” said Andrea Berger, deputy director of the proliferation and nuclear policy program at the Royal United Services Institute (RUSI).

South Korean officials have declined to say whether they have made inducements to countries to punish North Korea.

“Presumably in the course of that diplomatic interaction it is also being made clear to Pyongyang’s partners that deeper trade ties with economies like South Korea will not be fully realizable” without taking steps against North Korea, Berger said.

Angola, for one, has suspended all commercial trade with Pyongyang, banning North Korean companies from operating there since the U.N. toughened sanctions in March, a South Korean foreign ministry official told Reuters recently.

Angola was suspected of buying military equipment in 2011 from North Korea’s Green Pine Associated Corp, which is under U.N. sanction, according to a 2016 U.N. report. North Korea had also cooperated with Angola in health care, IT and construction, South Korea’s embassy there said in December.

Angolan officials did not respond to requests for comment, but the country told the U.N. in July it had not imported any light weapons from North Korea in recent years.

North Korea’s export of cheap labor has also been targeted.

Earlier this year, Washington urged countries to curb the use of North Korean workers, who number roughly 50,000 and generate between $1.2 billion and $2.3 billion annually for Pyongyang, according to a 2015 U.N. report.

Poland, which hosted as many as 800 North Korean workers, according to some estimates, this year stopped renewing visas, as did Malta.

Travel restrictions have also increased, with Ukraine recently revoking a Soviet-era deal that allowed visa-free visits for North Koreans.

Singapore, which has been a hub for North Korea-linked trade, will require visitors from the country to apply for visas starting next month, its immigration authority said in July.

DE-FLAGGED

The vast majority of North Korea’s trade is with China, and experts warn sanctions will have limited impact without Beijing’s backing. China condemns Pyongyang’s nuclear program but is also its chief ally and is unwilling to pressure leader Kim Jong Un’s regime too far, fearing a collapse that would destabilize the entire region. That means agreeing significantly tightened U.N. sanctions could be difficult.

Some of the most tangible results of recent efforts to isolate North Korea have seen countries ban its ships from their registries. North Korean-owned vessels are suspected of using other flags to camouflage the movement of illicit cargo.

Landlocked Mongolia, which is among Pyongyang’s steadiest allies but also has close ties with Seoul, canceled the registrations of all 14 North Korean vessels flying its flag, according to a report it submitted to the U.N. in July, even though sanctions compelled it to act on just one of them.

Cambodia, once the most popular flag of convenience for North Korea, ended its registry scheme for all foreign ships in August, although it did not single out North Korea.

The flags of 69 North Korean ships, none of them on a U.N. blacklist, have been de-registered since the U.N. tightened sanctions in March, South Korea’s foreign minister said last month. The North’s merchant fleet is estimated by the U.N. at roughly 240 vessels.

Still, one-off measures by various countries mean Pyongyang can simply shift its business elsewhere – a shortcoming of unilateral actions in general.

China and Russia employ the bulk of North Korean workers and have publicly shown no inclination to halt the practice.

Last week, North Korean state media announced the Sept 19 “inauguration” of its embassy in the Belarusian capital Minsk. However, on Monday, the Belarus foreign ministry said there was no North Korean embassy there, although it did not immediately give further information.

Pyongyang has been known to use diplomatic personnel, several whom have been caught with large amounts of gold or cash, to procure banned equipment or fund illegal activities.

China, experts say, remains the key.

“Rather than being efficient, unilateral actions put psychological pressure on the North,” said Chang Yong-seok, a senior researcher at the Institute for Peace and Unification Studies at Seoul National University. “But like criminal gangs, North Korea won’t cringe much under psychological pressure.”

(Additional reporting by Andrei Makhovsky in Minsk, Herculano Coroado in Luanda and Prak Chan Thul in Phnom Penh; Editing by Lincoln Feast)