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Italy’s Response to Coronavirus Outbreak Is Mired in Politics

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MILAN — On the sixth floor of a skyscraper, two dozen epidemiologists and public health experts form the nerve center of the effort to contain a coronavirus outbreak in Italy that has alarmed Europe and put the wealthy Lombardy region at the center of global concern.

They work the phones, pore over digital maps and study computer screens. They update databases with confirmed cases. They track those whom infected people might have had contact with. They coordinate with hospitals and laboratories to verify test results, sometimes for people with no symptoms.

But their efforts have also fueled a political and scientific quarrel that may prove important to how Italy and other countries confront the virus: How much is too much when it comes to containment efforts?

It’s not every day that Italy is accused of being overly efficient, but Lombardy’s response has, unusually, been criticized for its vigor at a time when most governments are worried about being accused of doing too little.

Much of that criticism has come from rival Italian officials at the national level, no doubt concerned about Italy’s blighted image — and their own — as the number of cases in the country has spiked to 650, with 17 deaths.

Cases possibly linked to Lombardy have appeared in Austria, Switzerland, and the Canary Islands of Spain, adding to the impression that the region is the European source in a new stage of global contagion.

“Italy is a safe place,’’ Prime Minister Giuseppe Conte, a rival of Lombardy politicians who has himself faced intense criticism for the government’s handling of the virus, asserted defensively this week, “maybe safer than others.”

There is no doubt that Italy is confronting a significant outbreak. But beneath the political squabbling is a deeper dispute over whether Lombardy’s response has made the problem appear worse than it is.

With coronavirus spreading more widely, political leaders across the world are coming under greater pressure, with many trying to tamp down anxiety that is damaging stock markets, tourism and businesses.

Some leaders are lashing out. On Wednesday, President Trump accused journalists of making the situation “look as bad as possible.”

As a result, the dispute in Lombardy has taken on dimensions in politics, epidemiology and crisis communications that are likely to have consequences in any broader outbreak.

At its heart, the debate centers on testing.

The central government argues that other regions within Italy and other countries have respected global guidelines by focusing tests on people showing symptoms of the virus.

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The Coronavirus Outbreak

  • Answers to your most common questions:

    Updated Feb. 26, 2020

    • What is a coronavirus?
      It is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
    • How do I keep myself and others safe?
      Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.
    • What if I’m traveling?
      The C.D.C. haswarned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China.
    • Where has the virus spread?
      The virus, which originated in Wuhan, China, has sickened more than 80,000 people in at least 33 countries, including Italy, Iran and South Korea.
    • How contagious is the virus?
      According to preliminary research, it seems moderately infectious, similar to SARS, and is probably transmitted through sneezes, coughs and contaminated surfaces. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
    • Who is working to contain the virus?
      World Health Organization officials have been working with officials in China, where growth has slowed. But this week, as confirmed cases spiked on two continents, experts warned that the world was not ready for a major outbreak.

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But according to the Health Ministry, Lombardy has also carried out swab tests on people who are more likely to have come into contact with infected people, even if they have no symptoms themselves.

Experts at the World Health Organization and Italy’s Health Ministry said in interviews that it was possible that Lombardy had created an inflated perception of the threat by including in case totals people who tested positive for the virus but who had not gotten sick. But many scientists say that attempting to track even mild cases of the virus is essential to containing its spread.

On Thursday, after insisting that their comprehensive approach to testing was the right one, Lombardy said it would now conform with national and international guidelines and test only people showing symptoms.

But the numbers tallied in Lombardy’s approach have already made Italy a focus of international concern.

Not everyone who contracts the virus gets sick, a fact that is proving a quandary for scientists and officials trying to formulate a measured response.

Walter Ricciardi, an Italian member of the executive council of the World Health Organization who was recently named councilor of the Italian Health Ministry, said that only a small percentage of people who contracted the virus were infected by people showing no symptoms who did not know they were carriers, he said.

Richard Pebody, another expert at the World Health Organization, said the organization did not consider asymptomatic transmission a significant factor in the outbreak.

But as the epidemic spreads uncertainty is growing. Other experts have raised concerns that carriers without symptoms could be spreading the virus, and the W.H.O. was under pressure to revise its guidelines, which it was expected to do on Thursday.

The Italian Health Ministry said that counting asymptomatic cases only served to cause alarm.

Of the 650 cases diagnosed in Italy, 403 were in Lombardy, according to regional officials. Of those cases, Lombardy officials said on Thursday, 216 had been treated in a hospital, with 41 requiring intensive care.

That means that 187 of those who tested positive for the virus exhibited only mild symptoms or none at all. In addition, at least 37 of those who did are now healthy and have been discharged.

But other top Italian medical officials warned that while it was possible that asymptomatic people might be less contagious, because, for instance, they cough less, very little is known about the new virus and how it behaves.

“Evidence is lacking,” said Giovanni Rezza, the head of epidemiology at the leading scientific organization of Italy’s National Health Service.

Lombardy officials said they preferred to know who had the virus.

“Either you hide problems under a carpet, or you lift the carpet and you clean the floor,” Attilio Fontana, the region’s president, said in an interview in his office, with views over a foggy and eerily quiet Milan, 29 floors above the virus hunters.

Mr. Fontana is a leading member of the League party, led by the nationalist Matteo Salvini, who has not been shy about leveraging the crisis to pursue his aim of bringing down Mr. Conte’s government. Mr. Salvini has argued in recent days that Mr. Conte had fumbled the response to the crisis and needed to be replaced.

Mr. Fontana said he disagreed with Mr. Conte’s “way of dealing with the crisis.” The region’s tests were necessary, he argued, suggesting that if other places tested as rigorously, they would find more cases, too.

“I don’t exclude that even in your country if they did a serious and attentive epidemiologic analysis they would find more than what the actual infected are,” he said, referring to the United States. Numbers were high in Italy, he added, “because we do a lot of checks.”

In the United States, the Centers for Disease Control is currently limiting testing to those who have symptoms and who have recently traveled to China or had contact with someone who tested positive for the virus.

The uncertainty surrounding the virus has opened fertile ground for political sniping, as politicians engaged in power struggles to shift blame.

Mr. Conte, the prime minister, had questioned Lombardy’s approach in an effort to project a sense of control.

He infuriated regional officials by blaming a Lombardy hospital for the virus’s spread and saying on Tuesday that “exaggerated’’ swab tests ‘‘would end up dramatizing the emergency.”

Lombardy officials had defended their methods.

“We don’t understand what he is talking about,” Mr. Fontana said.

In turn, he criticized Mr. Conte, saying that the prime minister should have listened to a proposal, made in early February, that schoolchildren returning from China stay at home for 14 days.

“They told us it was a racist behavior and they did not want to put in place this little precaution,” Mr. Fontana said.

Experts have speculated that the coronavirus outbreak in Lombardy could be attributed to the region’s close business ties with China or its densely packed population.

In search of Italy’s “patient zero,” Mr. Fontana said officials were pursuing “an Italian citizen with Chinese origins” who visited China around January.

He said that person then came into contact with someone who then “went to Codogno” — one of the Lombardy towns on lockdown. That second person is thought to have had contact with a 38-year-old Italian man, who remains in intensive care.

That man is believed to have spread the virus widely, prompting the lockdown of several towns near Milan.

In Milan’s central train station this week, people were eager to leave the city.

Donatella Monti and her children waited for a train back to Rome, all of them wearing masks bought in a hardware store.

Ms. Monti said that many in Lombardy seemed unfazed by the outbreak, but that her pediatrician back south advised her to keep her young daughter away from school for 10 days. “I’ll go to school with my mask on!” her daughter protested.

In Mr. Fontana’s office, his aides quipped that the masks “didn’t do a thing” to stop the virus and that the Milanese only wore masks during carnival.

But late Wednesday, Mr. Fontana posted a video on Facebook in which he explained that one of his aides had tested positive for the virus.

The governor said that he himself had tested negative, but that he would nonetheless “live in a sort of auto isolation” for the next two weeks, avoiding public events and news conferences and wearing a mask in the office.

“So when you see me in the coming days, I will be like this,” he said, pulling a green mask over his face. “Don’t be scared. It’s always me.”

Emma Bubola contributed reporting from Milan, and Elisabetta Povoledo from Rome.

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Virginia Democrats advance efforts to protect abortion, voting rights, marriage equality

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RICHMOND, Va. (AP) — Democrats who control both chambers of the Virginia legislature are hoping to make good on promises made on the campaign trail, including becoming the first Southern state to expand constitutional protections for abortion access.

The House Privileges and Elections Committee advanced three proposed constitutional amendments Wednesday, including a measure to protect reproductive rights. Its members also discussed measures to repeal a now-defunct state constitutional ban on same-sex marriage and ways to revise Virginia’s process to restore voting rights for people who served time for felony crimes.

“This meeting was an important next step considering the moment in history we find ourselves in,” Democratic Del. Cia Price, the committee chair, said during a news conference. “We have urgent threats to our freedoms that could impact constituents in all of the districts we serve.”

The at-times raucous meeting will pave the way for the House and Senate to take up the resolutions early next year after lawmakers tabled the measures last January. Democrats previously said the move was standard practice, given that amendments are typically introduced in odd-numbered years. But Republican Minority Leader Todd Gilbert said Wednesday the committee should not have delved into the amendments before next year’s legislative session. He said the resolutions, particularly the abortion amendment, need further vetting.

“No one who is still serving remembers it being done in this way ever,” Gilbert said after the meeting. “Certainly not for something this important. This is as big and weighty an issue as it gets.”

The Democrats’ legislative lineup comes after Republican Governor Glenn Youngkin, to the dismay of voting-rights advocates, rolled back a process to restore people’s civil rights after they completed sentences for felonies. Virginia is the only state that permanently bans anyone convicted of a felony from voting unless a governor restores their rights.

“This amendment creates a process that is bounded by transparent rules and criteria that will apply to everybody — it’s not left to the discretion of a single individual,” Del. Elizabeth Bennett-Parker, the patron of the voting rights resolution, which passed along party lines, said at the news conference.

Though Democrats have sparred with the governor over their legislative agenda, constitutional amendments put forth by lawmakers do not require his signature, allowing the Democrat-led House and Senate to bypass Youngkin’s blessing.

Instead, the General Assembly must pass proposed amendments twice in at least two years, with a legislative election sandwiched between each statehouse session. After that, the public can vote by referendum on the issues. The cumbersome process will likely hinge upon the success of all three amendments on Democrats’ ability to preserve their edge in the House and Senate, where they hold razor-thin majorities.

It’s not the first time lawmakers have attempted to champion the three amendments. Republicans in a House subcommittee killed a constitutional amendment to restore voting rights in 2022, a year after the measure passed in a Democrat-led House. The same subcommittee also struck down legislation supporting a constitutional amendment to repeal an amendment from 2006 banning marriage equality.

On Wednesday, a bipartisan group of lawmakers voted 16-5 in favor of legislation protecting same-sex marriage, with four Republicans supporting the resolution.

“To say the least, voters enacted this (amendment) in 2006, and we have had 100,000 voters a year become of voting age since then,” said Del. Mark Sickles, who sponsored the amendment as one of the first openly gay men serving in the General Assembly. “Many people have changed their opinions of this as the years have passed.”

A constitutional amendment protecting abortion previously passed the Senate in 2023 but died in a Republican-led House. On Wednesday, the amendment passed on party lines.

If successful, the resolution proposed by House Majority Leader Charniele Herring would be part of a growing trend of reproductive rights-related ballot questions given to voters. Since 2022, 18 questions have gone before voters across the U.S., and they have sided with abortion rights advocates 14 times.

The voters have approved constitutional amendments ensuring the right to abortion until fetal viability in nine states: Arizona, California, Colorado, Maryland, Michigan, Missouri, Montana, Ohio and Vermont. Voters also passed a right-to-abortion measure in Nevada in 2024, but it must be passed again in 2026 to be added to the state constitution.

As lawmakers debated the measure, roughly 18 members spoke. Mercedes Perkins, at 38 weeks pregnant, described the importance of women making decisions about their own bodies. Rhea Simon, another Virginia resident, anecdotally described how reproductive health care shaped her life.

Then all at once, more than 50 people lined up to speak against the abortion amendment.

“Let’s do the compassionate thing and care for mothers and all unborn children,” resident Sheila Furey said.

The audience gave a collective “Amen,” followed by a round of applause.

___

Associated Press writer Geoff Mulvihill in Cherry Hill, New Jersey, contributed to this report.

___

Olivia Diaz is a corps member for The Associated Press/Report for America Statehouse News Initiative.

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Trump chooses anti-vaccine activist Robert F. Kennedy Jr. as health secretary

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NEW YORK (AP) — President-elect Donald Trump says he will nominate anti-vaccine activist Robert F. Kennedy Jr. to lead the Department of Health and Human Services, putting him in charge of a massive agency that oversees everything from drug, vaccine and food safety to medical research and the social safety net programs Medicare and Medicaid.

“For too long, Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health,” Trump said in a post on his Truth Social site announcing the appointment. Kennedy, he said, would “Make America Great and Healthy Again!”

Kennedy, a former Democrat who ran as an independent in this year’s presidential race, abandoned his bid after striking a deal to give Trump his endorsement with a promise to have a role in health policy in the administration.

He and Trump have since become good friends, with Kennedy frequently receiving loud applause at Trump’s rallies.

The expected appointment was first reported by Politico Thursday.

A longtime vaccine skeptic, Kennedy is an attorney who has built a loyal following over several decades of people who admire his lawsuits against major pesticide and pharmaceutical companies. He has pushed for tighter regulations around the ingredients in foods.

With the Trump campaign, he worked to shore up support among young mothers in particular, with his message of making food healthier in the U.S., promising to model regulations imposed in Europe. In a nod to Trump’s original campaign slogan, he named the effort “Make America Healthy Again.”

It remains unclear how that will square with Trump’s history of deregulation of big industries, including food. Trump pushed for fewer inspections of the meat industry, for example.

Kennedy’s stance on vaccines has also made him a controversial figure among Democrats and some Republicans, raising question about his ability to get confirmed, even in a GOP-controlled Senate. Kennedy has espoused misinformation around the safety of vaccines, including pushing a totally discredited theory that childhood vaccines cause autism.

He also has said he would recommend removing fluoride from drinking water. The addition of the material has been cited as leading to improved dental health.

HHS has more than 80,000 employees across the country. It houses the Food and Drug Administration, the Centers for Disease Control and Prevention, the Medicare and Medicaid programs and the National Institutes of Health.

Kennedy’s anti-vaccine nonprofit group, Children’s Health Defense, currently has a lawsuit pending against a number of news organizations, among them The Associated Press, accusing them of violating antitrust laws by taking action to identify misinformation, including about COVID-19 and COVID-19 vaccines. Kennedy took leave from the group when he announced his run for president but is listed as one of its attorneys in the lawsuit.

__ Seitz reported from Washington.

The Canadian Press. All rights reserved.

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In Cyprus, Ukrainians learn how to dispose of landmines that kill and maim hundreds

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NICOSIA, Cyprus (AP) — In a Cypriot National Guard camp, Ukrainians are being trained on how to identify, locate and dispose of landmines and other unexploded munitions that litter huge swaths of their country, killing and maiming hundreds of people, including children.

Analysts say Ukraine is among the countries that are the most affected by landmines and discarded explosives, as a result of Russia’s ongoing war.

According to U.N. figures, some 399 people have been killed and 915 wounded from landmines and other munitions since Russia’s full-scale invasion of Ukraine on Feb. 24, 2022, equal to the number of casualties reported from 2014-2021. More than 1 in 10 of those casualties have been children.

The economic impact is costing billions to the Ukrainian economy. Landmines and other munitions are preventing the sowing of 5 million hectares, or 10%, of the country’s agricultural land.

Cyprus stepped up to offer its facilities as part of the European Union’s Military Assistance Mission to Ukraine. So far, almost 100 Ukrainian armed forces personnel have taken part in three training cycles over the last two years, said Cyprus Foreign Ministry spokesperson Theodoros Gotsis.

“We are committed to continuing this support for as long as it takes,” Gotsis told the Associated Press, adding that the Cyprus government has covered the 250,000 euro ($262,600) training cost.

Cyprus opted to offer such training owing to its own landmine issues dating back five decades when the island nation was ethnically divided when Turkey invaded following a coup that sought union with Greece. The United Nations has removed some 27,000 landmines from a buffer zone that cuts across the island, but minefields remain on either side. The Cypriot government says it has disposed of all anti-personnel mines in line with its obligations under an international treaty that bans the use of such munitions.

In Cyprus, Ukrainians undergo rigorous theoretical and practical training over a five-week Basic Demining and Clearance course that includes instruction on distinguishing and safely handling landmines and other explosive munitions, such as rockets, 155 mm artillery shells, rocket-propelled grenades and mortar shells.

Theoretical training uses inert munitions identical to the actual explosives.

Most of the course is comprised of hands-on training focusing on the on-site destruction of unexploded munitions using explosives, the chief training officer told the Associated Press. The officer spoke on condition of anonymity because he’s not authorized to disclose his identity for security reasons.

“They’re trained on ordnance disposal using real explosives,” the officer said. “That will be the trainees’ primary task when they return.”

Cypriot officials said the Ukrainian trainees did not want to be either interviewed or photographed.

Defusing discarded munitions or landmines in areas where explosive charges can’t be used — for instance, near a hospital — is not part of this course because that’s the task of highly trained teams of disposal experts whose training can last as long as eight months, the officer said.

Trainees, divided into groups of eight, are taught how to operate metal detectors and other tools for detecting munitions like prodders — long, thin rods which are used to gently probe beneath the ground’s surface in search of landmines and other explosive ordnance.

Another tool is a feeler, a rod that’s used to detect booby-trapped munitions. There are many ways to booby-trap such munitions, unlike landmines which require direct pressure to detonate.

“Booby-trapped munitions are a widespread phenomenon in Ukraine,” the chief training officer explained.

Training, primarily conducted by experts from other European Union countries, takes place both in forested and urban areas at different army camps and follows strict safety protocols.

The short, intense training period keeps the Ukrainians focused.

“You see the interest they show during instruction: they ask questions, they want to know what mistakes they’ve made and the correct way of doing it,” the officer said.

Humanitarian data and analysis group ACAPS said in a Jan. 2024 report that 174,000 sq. kilometers (67,182 sq. miles) or nearly 29% of Ukraine’s territory needs to be surveyed for landmines and other explosive ordnance.

More than 10 million people are said to live in areas where demining action is needed.

Since 2022, Russian forces have used at least 13 types of anti-personnel mines, which target people. Russia never signed the 1997 Ottawa Convention banning the use of anti-personnel mines, but the use of such mines is nonetheless considered a violation of its obligations under international law.

Russia also uses 13 types of anti-tank mines.

The International Campaign to Ban Landmines said in its 2023 Landmine Monitor report that Ukrainian government forces may have also used antipersonnel landmines in contravention of the Mine Ban Treaty in and around the city of Izium during 2022, when the city was under Russian control.

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