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Coronavirus may be the Disease X WHO cautioned about years ago – Business Standard

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The cautioned years ago that a mysterious “disease X” could spark an contagion. The new coronavirus, with its ability to quickly morph from mild to deadly, is emerging as a contender.

From recent reports about the stealthy ways the so-called Covid-19 virus spreads and maims, a picture is emerging of an enigmatic pathogen whose effects are mainly mild, but which occasionally — and unpredictably — turns deadly in the second week. In less than three months, it’s infected about 77,000 people, mostly in China, and killed more than 2,200.

“Whether it will be contained or not, this outbreak is rapidly becoming the first true pandemic challenge that fits the disease X category,” Marion Koopmans, head of viroscience at Erasmus University Medical Center in Rotterdam, and a member of the WHO’s emergency committee, wrote on Wednesday in the journal Cell.

The disease has now spread to more than two dozen countries and territories. Some of those infected caught the virus in their local community and have no known link to China, the US Center for Disease Control and Prevention said.

ALSO READ: Tokyo 2020 postpones volunteer training due to coronavirus outbreak

“We are not seeing community spread here in the United States yet, but it’s very possible — even likely — that it may eventually happen,” Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters on Friday.

Unlike SARS, its viral cousin, the Covid-19 virus replicates at high concentrations in the nose and throat akin to the common cold, and appears capable of spreading from those show no, or mild, symptoms. That makes it impossible to control using the fever-checking measures that helped stop SARS 17 years ago.

Spreading surreptitiously

A cluster of cases within a family living in the Chinese city of Anyang is presumed to have begun when a 20-year-old woman carried the virus from Wuhan, the outbreak’s epicentre, on January 10 and spread it while experiencing no illness, researchers said Friday in the Journal of the American Medical Association.

ALSO READ: Coronavirus: UP reserves 820 isolation beds for travellers from China

Five relatives subsequently developed fever and respiratory symptoms. Covid-19 is less deadly than SARS, which had a case fatality rate of 9.5 per cent, but appears more contagious. Both viruses attack the respiratory and gastrointestinal tracts, via which they can potentially spread.

While more than 80 per cent of patients are reported to have a mild version of the disease and will recover, about one in seven develops pneumonia, difficulty breathing and other severe symptoms. About 5 per cent of patients have critical illness, including respiratory failure, septic shock and multi-organ failure. “Unlike SARS, Covid-19 infection has a broader spectrum of severity ranging from asymptomatic to mildly symptomatic to severe illness that requires mechanical ventilation,” doctors in Singapore said in a paper in the same medical journal Thursday.

“Clinical progression of the illness appears similar to SARS: patients developed pneumonia around the end of the first week to the beginning of the second week of illness.” Older adults, especially those with chronic conditions, such as hypertension and diabetes, have been found to have a higher risk of severe illness. Still, “the experience to date in Singapore is that patients without significant co-morbid conditions can also develop severe illness,” they said.

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Coronavirus: More new cases outside China than in — WHO – Axios

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19 hours ago – Health
A young tourist wearing a protective facemask and a Carnival mask visits the streets of Venice

A tourist wearing a medical facemask in Venice, Italy. Photo: Andrea Pattaro/AFP via Getty Images

The number of new cases of the novel coronavirus reported outside China has exceeded those inside the country for the first time, the World Health Organization director-general Tedros Adhanom Ghebreyesus told a briefing on Wednesday.

Details: Tedros called the sudden increase in cases in South Korea (1,595), Italy (453) and Iran (141) “deeply concerning.”

The big picture: Some 20 countries have reported their first cases in the past week, many in Europe — including Spain, Greece, Croatia, North Macedonia, Switzerland, Austria, Norway, Denmark, Romania and Estonia.

  • The first cases in the Middle East include Israel, Lebanon, Oman, Afghanistan, Bahrain and Kuwait.
  • Georgia, at the crossroads of Europe and Asia, has also reported its first case, as has Pakistan and Algeria.
  • Brazil became the first place in South America to confirm an infection. The virus spread to Brazil by a 61-year-old man who traveled from Italy, the epicenter of Europe’s outbreak. The country is tracking 20 suspected virus cases.
  • Tedros noted that new cases in Algeria, Austria, Croatia, Germany, Spain and Switzerland were also linked to Italy, while infections in Bahrain, Iraq, Kuwait and Oman had connections with Iran.

What they’re saying: Germany’s health minister said Thursday the country was “at the beginning of an epidemic,” per AP, as cases surged to 27.

  • Australian Prime Minister Scott Morrison said in a news conference his country was preparing for a pandemic, as 23 cases were confirmed.
  • “The risk of a global pandemic is very much upon us,” he said.

Yes, but: The WHO has yet to declare the outbreak a pandemic.

  • “Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems,” Tedros said.
  • “It may also signal that we can no longer contain the virus, which is not true. We are in a fight that can be won if we do the right things.”

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First US coronavirus case of unknown origin marks 'turning point' – Al Jazeera English

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Officials in California expressed frustration on Thursday over access to coronavirus testing kits after the first case of the respiratory disease of unknown origin was diagnosed in the United States, prompting fears of “community spread”. 

On Wednesday, the US Centers for Disease Control and Prevent (CDC) announced that a California patient who contracted COVID-19 did not have relevant travel history or exposure to another individual with the virus.

The case in California’s Solano County brought the total number of COVID-19 cases in the US to 60, including 45 cases among those who were repatriated, the CDC said.

More:

While the US has seen a relatively few number of cases, health experts say the latest development marks a possible turning point, with fears the virus could spread further.

“I expect that we are going to start seeing some community-level transmission, in pockets across the country,” said Peter Jay Hotez, professor and dean at the National School of Tropical Medicine, in Houston, Texas.

“Whether or not it expands beyond that and becomes pervasive across the nation, that’s the unknown,” he told Al Jazeera.

The coronavirus outbreak, which originated in China, has spread to 44 countries around the world, affected markets, suspended flights and shuttered schools in a dozen countries. It has infected more than 82,000 people and killed over 3,000 – mostly in China.

Hotez says faster confirmation of coronavirus infection is crucial to a rapid response by local health authorities and to ensure the safety of both patients and healthcare workers.

“Preparedness is primarily done at the local level, many people think the CDC is in charge of preparedness, but in fact, it is done throughout the various counties and local health departments,” he said.

Testing delayed for four days

Officials say testing was previously done by the CDC in their headquarters in Atlanta, Georgia, which was delaying the diagnosis process by at least a day.

In the recent California case, the patient was brought to UC Davis Medical Center on February 19, but testing was delayed for four days, because the CDC said the patient “did not fit the existing CDC criteria” for the virus, according to a hospital press release.

“We need to start testing in our communities and we need to fix our testing issues, and we need to do this now,” California Representative Ami Bera said during US House of Representatives committee hearing dedicated to addressing coronavirus.

California Governor Gavin Newsom said on Thursday the state currently had about 200 test kits, an “inadequate” number, but that he is in contact with federal agencies who have promised to send more kits in the coming days.

Health and Human Services Secretary Alex Azar told a US House of Representatives committee on Thursday that at least 40 public health labs were now able to test specimens for coronavirus, a number that could double by Friday.

But funding to confront the pandemic has turned into a political issue in the US, which will hold presidential elections in November. Trump, a Republican, asked Congress for $2.5bn, but Democrats said the amount is insufficient and have called for $8.5bn.

Amid a stock market slump over fears of the virus’s spread, Trump on Wednesday sought to quell concerns.

“I don’t think it’s inevitable,” Trump told reporters when asked about the possibility of a larger outbreak in the US.

“It probably will. It possibly will. It could be at a very small level or it could be at a larger level,” he added as he announced that Vice President Mike Pence would oversee the federal government’s effort to contain the virus. “Whatever happens, we’re totally prepared.”

Trump holds a document as he gives a news conference on the coronavirus at the White House [Carlos Barria/Reuters] 

But health officials say that preparing for the possibility of community spread of the virus may prove difficult. 

“We do not have a secret pathway to protect people. Most of the protections that we are using fall into the category of non-pharmaceutical intervention: personal, community and environmental,” Michael Wilkes, Professor of Medicine and Global Health at UC Davis told Al Jazeera.

Personal intervention, Wilkes said, involves individuals taking precautions to protect themselves from contracting the virus, as well as ensuring they do not infect others, by seeking medical attention and isolating themselves if they suspect they have symptoms.

Community measures include cancelling large gatherings of people such as sporting and music events. While environmental involves sanitisation of public spaces.

The virus can cause fever, coughing, wheezing and pneumonia. Health officials say, like the flu, it spreads mainly from droplets when an infected person coughs or sneezes, and affects people in different ways.

Wilkes says not everyone who gets coronavirus will suffer from severe illness and evidence shows that four out of five people infected suffer from relatively minor illness. He adds that although the spread of the virus poses a serious risk to public health, he also worries about the effect it may have on society.

“We are following the evidence and we are doing what needs to get done medically, but the biggest battle we have is fear,” Wilkes said.

Gavin Newsom

California Governor Gavin Newsom speaking to journalists at a news conference in Sacramento, California [Randall Benton/AP Photo] 

As for the Solano County, California, case, officials say they are attempting to locate anyone who may have come into contact with the patient. The county also declared a state of emergency.

California Governor Newsom, who expressed frustration over access to testing kits, declined to declare a statewide emergency, and said: “People should go about their day-to-day lives with common sense. I don’t want to instil any sense of new anxiety.”

With additional reporting by William Roberts in Washington, DC.

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How Can the US Confront Coronavirus With 28 Million People Uninsured? – Truthout

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As the coronavirus continues to spread around the world, we don’t yet know either the full scale of the unfolding global health disaster or the cumulative impact economically. But over the past week, as virus hotspots have emerged in South Korea, in Iran, in Italy and elsewhere, and as more and more countries find cases of the disease, we’re beginning to get a sense of the magnitude of what is unfolding.

China has spent two months trying to contain an outbreak. As an authoritarian country it hasn’t shied away from locking down megacities, even cocooning entire residential communities — allowing only one household member out every couple of days to go looking for food. Tens of millions of people are now living a dystopian existence essentially barricaded within their own apartment walls. Yet even with these emergency responses, large numbers have fallen sick and thousands have died. Meanwhile, consumer spending in the world’s second largest economy has all but ground to a halt. Month-on-month car purchases in the country are down by a staggering 92 percent.

South Korea has imposed extraordinary controls in Daegu, a city of roughly 3 million people. Italy has quarantined tens of thousands of people, deploying police and military to stop them from leaving the region that is at the center of that country’s outbreak. In Turkey, on Tuesday, a plane from Iran with a person on board suspected of carrying the virus was met at the airport by health officials and all the passengers were promptly quarantined for two weeks.

Until this week’s stock market swoon, the inevitable economic toll had gotten lost in the panicked coverage of the virus’s spread. When countries shut down rail and air and road routes in and out of regions, when schools are closed, when public gatherings are discouraged or banned, when curfews are imposed, and when nonessential businesses are shuttered, the economic cost is immense.

The intricately interconnected parts of the global trade and supply chain systems are unraveling at warp speed as the disease spreads, and, assuming these lockdowns last, the consequences will likely be economically devastating. If the stock market continues to sink, if factories remain shuttered, and if consumers pull back from spending, over the coming months there could be massive, and unexpected, spikes in unemployment and poverty, even in places not directly experiencing the mass transmission of the virus within their populations.

Trump’s Pollyannaish statements on coronavirus in the U.S. notwithstanding, this country will not, of course, remain inured to the epidemic’s consequences. That belated realization among investors was what triggered this week’s panicked stock market sell-off. Between Friday of last week and the close of business on Tuesday, the Dow Jones shed roughly eight percent of its value. On both Monday and Tuesday, the market dived on a scale reminiscent of the chaotic days during the summer and early autumn of 2008, as the housing crisis morphed into a broader financial crisis.

If the bad news about the virus’s spread continues, that market retraction will also continue over the trading days and weeks ahead, making what happened in the first days of this week only a prelude to a larger and longer crisis. Public health experts at the CDC and in the universities increasingly think it’s only a matter of time before the United States, too, experiences serious outbreaks. Indeed, the announcement late Wednesday afternoon that a Californian who had neither traveled to a hot zone nor been in close contact with someone who had has the virus signifies it is likely already starting to circulate within the U.S. If it is, the impacts will be huge, not just on the country’s overstretched health systems, but on the political and economic infrastructure. It’s not a stretch to imagine global stock market collapses over the coming weeks and a stark contraction of consumer spending and of employment in their wake.

Even if this dislocation doesn’t grow to the cataclysmic scale of the 1918-19 Spanish Flu, the coming months will surely force the U.S. to confront some glaring policy shortcomings — and to do so at speed.

Roughly 28 million Americans lack health insurance. That number has gone up every year of the Trump presidency and will continue to go up so long as current policies are in place that drive immigrants ever further outside the safety net, that encourage states to limit Medicaid access, and that make it harder for individuals to access health care exchanges set up under the Affordable Care Act. It’s pretty much impossible to rein in a pandemic, especially of a disease that is communicable before a sufferer becomes sick enough to visit the ER, with so many people entirely excluded from primary care coverage. Millions more, who do have insurance, are so under-insured and have such high deductibles that, in practice, they too do not visit primary care doctors nearly as often as they should.

So far, the Democratic candidates running for the presidency haven’t linked the virus outbreak to their calls for expanded and more affordable health care coverage. It’s past time for them to do so. With this outbreak, not only does the moral imperative for universal health care grow, but so does the pragmatic rationale: Germs don’t obey class and ethnic and national boundaries. If poor, uninsured people don’t get treated for viral pneumonia in proper facilities, they will spread that disease throughout the community. It will be impossible to bring regional outbreaks under control if huge swathes of the population cannot access doctors either because they are afraid they will be bankrupted by medical bills, or because they are terrified they will render themselves vulnerable to deportation by putting themselves onto medical system and government radars. And the more people remain untreated, the more the virus will spread, creating a cascading effect of health and economic consequences. Economically, it would likely prove to be far less expensive to expand health coverage to everyone now, rather than try to clean up the mess of an epidemic made worse by massive numbers of people being uninsured.

This isn’t an issue that can wait for a long policy debate post-election. In an emergency, policies have to meet new needs at speed. And right now, there’s an unprecedented need to expand the health care umbrella to everyone who lives in the United States.

But that alone is only one part of a much larger puzzle. Forty percent of Americans are only one missed paycheck away from poverty — they have no, or only minimal, savings to fall back on, and no cushion for paying monthly bills such as rent or mortgage, utilities, and car payments in the event of an unexpected economic jolt. If a region in the U.S. were to be locked down in the way that cities have been in China, South Korea, Italy and Iran, a vast number of that region’s residents would be quickly bankrupted, and a large proportion of small businesses that rely on a constant flow of customers would go under. Of course, this isn’t just about individuals; it’s also about the cascading economic impact on entire communities. Prolonged quarantines and lock-downs could devastate already financially on-edge neighborhoods as surely as de-industrialization devastated the Rust Belt and the 2008 housing crisis devastated everywhere from California Central Valley cities such as Stockton to urban regions of Nevada.

Unlike most of our peer nations, in the U.S. there is no legal right to paid sick leave, although the Family and Medical Leave Act does allow for up to 12 weeks of unpaid leave. In practice, the country’s sick leave rules are so ludicrously weak that they provide a strong disincentive for people, even in food processing and restaurants and other industries where germs spread particularly fast, to stay off work when sick. That’s as backward an approach as possible during a pandemic when health officials are urging the precautionary principle be adopted, and asking people to self-quarantine if they think they may have been in contact with a sick person. Again, while candidates such as Bernie Sanders have pushed for paid sick leave, they haven’t, as yet, linked it to the issue of quarantine.

During World War II, Winston Churchill’s government set up an insurance system, under the War Damages Act, in the U.K. to ensure that victims of the blitz who lost homes or businesses to the aerial bombardment wouldn’t be left to sink on their own. The insurance system was paid for out of tax receipts, and was designed so that that the state would cover these losses and large numbers of individuals, and communities heavily hit by the bombing, wouldn’t be left destitute. Surely, in an age of pandemic, of mass quarantines, and of sudden lockdowns, such an insurance system is similarly imperative in the U.S.

Yet, nothing in the Trump administration’s approach suggests it is thinking big-picture. Instead, it has asked Congress to appropriate a relatively paltry $2.5 billion to fight the virus’s spread — and half of that money will come from raiding other existing public health funds. That’s barely one-third of the amount that it is demanding from the Pentagon over the coming months to work on Trump’s border wall. While there seems to be no shortage of funds for the military and for crackdowns on asylum seekers and destitute migrants, the pool of resources isn’t there for a massive effort to buffer the impacts of coronavirus. Nothing suggests the administration would, for example, roll back tax cuts on the wealthy and on corporations to fund a mutual insurance program for its economic victims.

We are on the edge of the unknown, facing the possibility of a pandemic — and accompanying economic dislocation — on a scale not seen for generations. In the face of this, big and bold policy responses will likely be required, and required fast. Unfortunately, the Trump administration doesn’t inspire any confidence that it’s up to this enormous task.

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