Friday, 19 July, 2024
HomeA FocusWorld in lockdown as global infections exceed 200,000

World in lockdown as global infections exceed 200,000

Emergencies were declared in SA and Australia while the EU sealed its borders and infections surfaced in every state in the USA, writes MedicalBrief. In the UK, a chilling modelling study forced an abrupt change in government policy, warning that “draconian restrictions” are the only way to suppress a pandemic that will otherwise claim a quarter of a million lives.

The United States and Britain led a global fightback against the economic damage caused by the pandemic, with the Trump administration pressing for a $1trillion package of relief measures, while the UK government is promising £350bn. South Africa has sealed its border for travel to and fro from seriously affected countries, and European Union is effectively shutting for 30 days. 

Internationally, experts predicted in The New Yorker that there would significan disruptions in public services and government internationally, with politicians and administrators falling victim to the virus. 

In the US, five Republican lawmakers and two Democrats self-quarantined because of exposure to people who have tested positive. In Italy, the head of the Democratic Party and a co-partner in the coalition government, announced that he was infected and the medical chief of the Italian province of Varese died of covid-19.

In France, President Emmanuel Macron cut back face-to-face meetings after his Minister of Culture fell ill with the disease, while five French member of parliament have also been diagnosed with the coronavirus. In Spain, the lower house of parliament suspended all activities when the secretary-general of the far-right Vox Party, tested positive. 

Canadian Prime Minister Justin Trudeau opted to self-quarantine — and telework — when his wife tested positive after returning from London. The British junior health minister, Nadine Dorries, tested positive shortly after she met with Prime Minister Boris Johnson.

In Iran, one of the four early hot spots, two vice-presidents, three cabinet officials, 9% of the members of parliament, the director of emergency medical services, the chief of the crisis-management organisation, senior Revolutionary Guard officers, and prominent clerics are on a long list of infected officials. 

At a local level, staff in the Gauteng Department of Human Settlements, the Urban Planning department and the Department of Cooperative Governance and Traditional Affairs have abandoned their posts amid fears of the virus. 

A roundup on COVID-19 from the University of Michigan’s Centre for Infectious Disease Research and Policy (CIDRAP):

As COVID-19 cases continued to surge in Europe, EU leaders approved a plan on Tuesday to close its external borders for the next 30 days. And as disease activity escalated in other parts of the world, the World Health Organisation (WHO) has warned about rapidly evolving outbreaks in its Southeast Asia region, which includes some nations in southern Asia, like India.

The EU ban is similar to the ban the US last week placed on European countries, which followed an earlier ban on travel from China and other virus hot spots. Members of the Schengen countries and the UK are exempt from the ban, which does not apply to the movement of goods. The European Commission also launched a European expert group to strengthen coordination and response to the pandemic.

Italy cases top 31,000

In Europe, where three countries are on lockdown, Italy on Tuesday reported 3,526 new infections, boosting its total to 31,506 cases, according to the health ministry. The country also reported 345 more deaths, raising its fatality count to 2,503. With hospitals overwhelmed with COVID-19 patients in northern Italy and facilities elsewhere in the country feeling pressure from rising activity outside the main hot spots, Italian government officials announced that this year's graduating medical students will skip qualifying tests, allowing them to start working 8 or 9 months earlier than expected.

Of the two other lockdown countries, Spain's total climbed to 11,178 cases with 1,978 new cases and 491 more deaths reported on Tuesday. About 43% of the country's cases are from Madrid. France's number grew to 7,730, with the addition of 1,097 new illnesses reported on Tuesday.

Virus activity is also surging in Germany, which has 1,723 new cases, raising its total to 7,156 cases, 12 of them fatal, according to the Robert Koch Institute. To handle the growing healthcare load, Berlin officials on Tuesday announced a plan enlist the armed forces to build a 1,000-bed hospital in the city to treat serious cases.

Rapid rises in South Asia

Elsewhere, the WHO urged countries in its Southeast Asia region to urgently step up aggressive response measures, as the number of confirmed cases rose to 480, including 8 deaths. Dr Poonam Khetrapal Singh, the regional director, said: "The situation is evolving rapidly." So far of the region's 11 countries, 8 have reported cases, most of them from Thailand (177), Indonesia (134), and India (125). She said more clusters are being confirmed, which is a good surveillance indicator, but also shows the need for strong actions. "We clearly need to do more, and urgently."

Singh also warned that some countries are clearly headed toward community transmission, trends that need to be reversed. In another part of Asia, Malaysia reported 120 more cases, raising its total to 673, and its first 2 deaths. The country is experiencing a resurgence of cases following a mass gathering at a mosque outside of Kuala Lumpur. The country recently announced restrictions on religious activities through the end of the month.

Iran deaths approach 1,000; Brazil reports first fatality

Iran on Tuesday reported 1,178 new cases, along with 135 new deaths, raising its respective totals to 16,169 and 998. In Brazil, the number of confirmed cases has jumped to 291, and the country reported its first death, according to the health ministry. The death involved a 62-year-old man with underlying health conditions who died in Sao Paulo, the country's epicentre. The man had no recent travel history, raising the possibility of community spread, and health officials are investigating four other deaths at the same hospital.

The country's congress cancelled a joint session due to virus concerns. Brazil President Jair Bolsonaro underwent a second round of testing after he had contact with people who tested positive for the virus. He has been criticized for recent appearances with supporters at large crowds, conditions that could fuel the spread of the virus.

In South Africa, the number of confirmed cases of COVID-19 has risen to 116 since Tuesday’s tally of 85, and includes further cases of local transmission, Health Hinister Zweli Mkhize has announced. There are now 14 cases of local transmission, up from the eight announced yesterday, he is quoted in Business Day as saying.

“As part of tracking and tracing, we have collated background information on how these patients were infected. We will provide information to the public, so as to give a sense of how these local transmissions occur. We will, however, not disclose full details as this information is subject to patient confidentiality which we are bound by,” he said.

The information provided by the minister indicates that four of the 12 cases of local transmission are young children.

Mkhize said on Tuesday night that the government would release test results for patients from private labs before validating them with the state laboratory service, and would inform the public if there are cases of false positives that required adjusting the numbers.

In other COVID-19 news…

The South African Medical Association (Sama) said it had been approached by concerned GPs who were unsure of how to protect themselves and their patients. “The average GPs in our networks are extremely concerned because it is difficult to understand which patients can you allow into your rooms,” said Dr Angelique Coetzee, Sama chair in a Saturday Star report. “And we’re trying to come up with a guideline to see how we can advise them. You have to understand that at this stage there is no community detection yet. As the disease is contained and is yet to present itself in the community, the guideline is that patients can come into doctor’s rooms without wearing protective gear or screening.”

This would change as the country started to see its first cases of local transmission. “Then, if you suspect a positive case, you as a GP need to at least wear a N95 face mask with gloves and see that patient in a different room, which can immediately afterwards be disinfected. So, it’s extremely difficult.

“We need to understand that the practices in rural areas or townships or informal settlements have a different behaviour pattern. Patients are walk-ins and that might cause a huge problem. How are we going to screen them and at what stage are you going to screen them? There’s no one with protective gear, so what are you are going to do?”

According to the report, Coetzee said that GPs could not afford to close their practices. “We only have so many GPs – and if I’m in contact with a positive person, there can’t be two rules. I’m saying to the person you are positive, now you and your family need to go into lockdown or self-quarantine for two weeks, but then I’m not adhering to that rule. As GPs, we cannot afford to close our surgeries for two to three weeks.”

Coetzee suggested that patients worried that they had become infected should not go to their doctor’s rooms. “If we can get the message out there to the public, if you have a lower respiratory tract infection, please contact your doctor via Skype, via telephone, via social media. Please do not just come into surgeries unannounced, especially when there’s community involvement.”

The Democratic Nursing Organisation of SA (Denosa), South Africa’s largest nursing union, has welcomed Ramaphosa’s announcement declaring COVID-19 a national disaster and the travel ban on high-risk countries. Business Day reports that Denosa communications manager Sibongiseni Delihlazo also called on the government to provide clean water to all communities and health facilities, noting that some clinics in the North West and KZN do not have running water. This poses a serious threat to the management and control of the coronavirus “because at the core of its management is cleanliness”, he said.

Denosa also called on the government to provide sufficient protective equipment. Delihlazo said ahead of the expected rapid rise in the number of patients: “Denosa reiterates its call that staff numbers must be beefed up to ensure that health workers are able to handle the large number of patients.”

Kenyan nurses at a coronavirus isolation ward have started a go-slow to protest against working conditions. The Kenya National Union of Nurses secretary general Seth Panyako told the BBC that the nurses will only report back to work once they have received training on how to handle patients and been given protective gear.

“Nurses are the most exposed workers in hospitals,” Panyako said. Mbagathi Hospital in Nairobi is one of the facilities with isolation wards for treatment of patients infected with the virus. It is monitoring 22 people who came into contact with the country’s first confirmed case.

In the UK, retired or not fully qualified nurses and other medical staff could be called in to help tackle the coronavirus pandemic, and given protection against any negligence claims, among a sweeping range of measures planned under emergency legislation.

The Guardian reports that another possible power would allow police or immigration officers to detain a person for a limited but unspecified period if they might be infectious “and to take them to a suitable place to enable screening and assessment”.

The laws will also give ministers the power to ban gatherings or events and temporarily close schools and colleges in the effort to curb the spread the virus.

The role and expertise of occupational health professionals is going to become “ever-more prominent” as the UK, and UK employers, wrestle with responding to COVID-19. Personnel Today reports that this is according to Dr Bola Akinwale, head of strategic research and analysis at the government’s Joint Work and Health Unit, who said the outbreak of the virus had highlighted the importance of examining how access to quality occupational health advice could be improved in the future.

Explaining some of the government’s priorities around improving workplace health and the various pilots underway, Akinwale said: “One of the things that government can do, I think, is set the right conditions for all of us to do the right thing in relation to health and work.”

The consultation had been focused on examining ways to reduce ill health-related job loss and role of employers in that, she highlighted. Strengthening the role of Statutory Sick Pay, and especially whether the current lower earnings limit should be removed, had been another key topic within this.

The UK Chancellor Rishi Sunak has announced a lifeline to businesses in the form of a £330bn bail out to protect the British economy from coronavirus shockwaves. Describing the coronavirus as an “economic emergency” unlike any other seen in peace time, the chancellor pledged guaranteed loans to support businesses as well as a three-month mortgage holiday.

The pledge came as Britons were advised against non-essential travel to anywhere in the world and experts admitted the UK could already have up to 55,000 cases of the disease.

South Africa’s Social Development Minister Lindiwe Zulu has activated the National Disaster Relief Fund and set aside R96m to provide immediate assistance to individuals and families affected by the coronavirus.

But, in adhering to President Cyril Ramaphosa's call prohibiting more than 100 people gathering in a single place, Zulu has ordered that there will be a staggering of pay dates.

Travel restrictions and school closures too effect on Wednesday 18 March. Speaking at a briefing late Tuesday, Transport Minister Fikile Mbalula noted the "high-risk" nature of aviation, stressing that high-risk countries would be no-go areas, as would the travel visa for those from said countries seeking to enter South Africa.

Zimbabwe has set up a state-of-the-art isolation and quarantine centre in case coronavirus reaches its streets, reports eNCA. That may be surprising given the collapsing health system in the country.

The Zimbabwe health sector is compromised and in recent months doctors and nurses have gone on strike and protested in the streets. There are shortages of medicines and some health institutions have closed departments but the government has managed to set up a coronavirus isolation centre, at the Wilkins Infectious Diseases Hospital in Harare.

“We are happy that it has delayed coming to Zimbabwe, but as it is, we do have an isolation facility,” said Harare Health director Prosper Chonzi. “We have members of staff who are trained and prepared to work on it. We have the doctors, nurses, the general hands that are trained. We have the protective equipment. We have been doing drills throughout to make sure health workers are safe".

No one in Zimbabwe has tested positive for COVID-19 but over 3m Zimbabweans are believed to be living in South Africa and there are fears that those expats might bring the virus home.

The pharmaceutical company Aspen is ramping up production of its over–the-counter pain, respiratory and colds and flu medicines after panic buying since the end of last week, says a Fin24 report. Orders for respiratory products, anti-inflammatory pain medications like Mybulen and Ibumol, as well as the cold and flu treatment Flusin have spiked.

These medicines may be stockpiled to alleviated potential coronavirus symptoms, but other Aspen medicines like the antispasmodic treatment Hyospasmol have also been in massive demand. Aspen will now redirect resources to increase production of some of these medicines – as a signal to the market to stop the panic buying.

Aspen Group CEO Stephen Saad is quoted in the report as saying that the orders for some medicines in a single day were the equivalent to 20% of a monthly order.

International Relations Minister Naledi Pandor started the government’s COVID-19 press conference on Monday by implementing one of President Cyril Ramaphosa’s instructions. There were over 100 people at the event and she instructed anyone who did not need to attend to leave.

Daily Maverick reports that addressing the media in a lengthy briefing at the International Relations and Cooperation Department in Pretoria, almost 20 ministers explained how efforts to reduce the spread of COVID-19 would be implemented.

Health Minister Zweli Mkhizi said South Africa had 61 confirmed cases of COVID-19 as of Sunday and another four cases awaited verification from the National Health Laboratory Service (NHLS). “It appears that there may be already some who are internal transmissions. Those cases of internal transmission will only be announced once we have all the information,” said Mkhize, emphasising that the NHLS still needed to verify reported cases of local transmission. “We need to intervene at an early, early stage,” he added, a point ministers returned to throughout the briefing.

Using a military analogy, Mkhize is quoted in the report as saying the government had been preparing to battle the virus and had conducted reconnaissance. As confirmed cases of COVID-19 were doubling daily, now was the time for all sectors of society to fight. “That for us is not just exponential. We think it’s an explosive rise in the cases that are positive,” he said of the rise in confirmed cases.

Mkhize raised the possibility of implementing a state of emergency to tighten enforcement measures if the current interventions fail. According to the report, Justice Minister Ronald Lamola said the restrictions of rights allowed under the current state of disaster were, for now, sufficient.

Transport Minister Fikile Mbalula said screening facilities will be established at all taxi ranks across the country. He said trains and taxis will be expected to be sanitised and an awareness programme will be launched in the public transport sector.

Home Affairs Minister Aaron Motsoaledi said there will be heightened vigilance at airports – including the provision of masks and gloves to staff dealing with travellers, interjected Mbalula – but no airports are being closed.

Trade and Industry Minister Ebrahim Patel said the business sector must look at how to uphold guidelines on social distancing and improve hygiene in the workplace in line with World Health Organisation guidelines, but the question of whether workplaces constituted a gathering of more than 100 people would only be answered after consultations.

Sports, Arts and Culture Minister Nathi Mthethwa said the limit on gatherings affected all residents in South Africa but was “not carte blanche”.

Defence Minister Nosiviwe Mapisa-Nqakula said all armed forces hospitals should establish isolation areas for COVID-19 patients and should be ready to take patients from the public if directed from the Health Department.

South Africa has shut its borders to travellers from high-risk countries and will close all schools from Wednesday as part of the package of measures announced by President Cyril Ramaphosa on Sunday night to limit the spread of COVID-19. The Mail & Guardian reports that announcing the number of people infected with the virus, Ramaphosa said it was “concerning” that internal transmission of the virus had now started. Ramaphosa said that previously all of those people infected had returned from travelling to high-risk countries, including Italy, but that the virus was now spreading among the broader population.

Social distancing and the restriction of movement were now necessary, as was tracking and screening of all those people who had come into contact with the initial carriers of the virus.

The report says Ramaphosa made the announcements after a lengthy Cabinet meeting and several hours of consultations with stakeholders, which delayed his scheduled briefing by more than three hours.

Ramaphosa said the country was facing a “grave emergency” but that swift, common action could limit the spread of the deadly virus. He said the Cabinet had identified measures that had to be taken to offset the severe effects on the economy and on the productivity and viability of businesses, job retention and job creation. “The package will consist of various fiscal and other measures and will be concluded in consultation with business, labour and others,” he said.

Ramaphosa said that co-operation among all sectors of society was necessary if South African were to limit the effects of the outbreak in the longer term. “This epidemic will pass, but it is up to us to determine how long it will last, how damaging it will be, and how long it will take our economy and our country to recover,” he said.

Ramaphosa said the pandemic required “extraordinary responses”, which included declaring a national state of disaster in terms of the Disaster Management Act. This allows the government to set up and co-ordinate disaster systems around the country, including setting up quarantine centres and taking steps to limit the movement of people.

Excerpt from President Ramaphosa’s speech:
Following an extensive analysis of the progression of the disease worldwide and in South Africa , the cabinet has decided on the following measures:

First, to limit contact between persons who may be infected and South African citizens, we are imposing a travel ban on foreign nationals from high-risk countries such as Italy, Iran, South Korea, Spain, Germany, the US, the UK and China from 18 March 2020. We have cancelled visas to visitors from those countries from today and previously granted visas are hereby revoked.

South African citizens are advised to refrain from all forms of travel to or through the EU, US, UK and other identified high-risk countries such as China, Iran and South Korea. This is effective immediately.

The government will continue to regularly issue travel alerts referring to specific cities, countries or regions as the situation evolves based on the risk level.

Any foreign national who has visited high-risk countries in the past 20 days will be denied a visa. South African citizens returning from high-risk countries will be subjected to testing and self-isolation or quarantine on return to South Africa.

Travellers from medium-risk countries – such as Portugal, Hong Kong and Singapore – will be required to undergo high-intensity screening.

All travellers who have entered South Africa from high-risk countries since mid-February will be required to present themselves for testing.

We will strengthen surveillance, screening and testing measures at OR Tambo, Cape Town and King Shaka International airports.

South Africa has 72 ports of entry in the country, which are land, sea- and airports. Of the 53 land ports, 35 will be shut down with effect from Monday 16 March. Two of the eight seaports will be closed for passengers and crew changes.

Effective immediately, all non-essential travel for all spheres of government outside the republic is prohibited.

We further discourage all non-essential domestic travel, particularly by air, rail, taxis and bus.

Drastic steps will have to be taken to ensure the well-being of the poor in informal settlements during the coronavirus outbreak, KwaZulu-Natal Health MEC Nomagugu Simelane-Zulu is quoted in Polity as saying. "Once a positive case is identified in an informal settlement, you will be forced to remove everyone that is suspected in that area. You can't identify who has been in touch with who.

"We are working on a plan on what should happen if there is a positive case in (these areas). We need to be prepared for a worst-case scenario so that should it happen, we know what to do. Currently we are looking at different areas of quarantining." She said Ramaphosa gave government the authority to remove anyone "who is at a site that is affected, and who will be unable to self-quarantine".

The report says she also called for the protection of health workers. "It is important to take care and protect health workers in the process of them taking care of us… Our health care workers will be protected and taken care of."

Also speaking at the inter-ministerial briefing Transport Minister Fikile Mbalula says random screening will be conducted at train stations and taxi ranks. He is quoted in a Polity report as saying his department had implemented further preventative measures to stem the spread of the virus.

Mbalula said the Passenger Rail Agency of SA (Prasa) and trains would undergo sanitisation processes and that public transport users would be urged to practice social distancing. "Random screening will be applied in all taxi ranks and in trains," he said. The Civil Aviation Authority would also conduct inspections and identify high-risk airlines, he said.

These restrictions would also impact the South African Maritime Safety Authority (SAMSA), which is to implement an operation plan guided by the World Health Organisation. Mbalula added that cargo would be allowed to enter and exit, but not people.

[link url="https://www.newyorker.com/news/our-columnists/how-much-is-the-coronavirus-infecting-world-leaders-and-disrupting-governments?"]Full New Yorker article[/link]

[link url="http://www.cidrap.umn.edu/news-perspective/2020/03/eu-closes-borders-slow-covid-19-activity-escalates-south-asia"]Centre for Infectious Disease Research and Polity (CIDRAP) material[/link]

[link url="https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6"]Johns Hopkins online tracker[/link]

[link url="https://www.businesslive.co.za/bd/national/health/2020-03-18-covid-19-cases-soar-to-116-with-more-local-transmission/?utm_source=&utm_medium=email&utm_campaign=Breaking+News%3A+Covid-19+cases+soar+to+116%2C+with+more+local+transmission&utm_term=http%3A%2F%2Fwww.businesslive.co.za%2Fbd%2Fnational%2Fhealth%2F2020-03-18-covid-19-cases-soar-to-116-with-more-local-transmission%2F"]Full Business Day report[/link]

[link url="https://www.iol.co.za/saturday-star/news/coronavirus-doctors-fear-for-their-own-health-says-medical-association-44867018"]Full Saturday Star report[/link]

[link url="https://www.businesslive.co.za/bd/national/labour/2020-03-16-denosa-calls-for-more-health-workers-as-covid-19-spread-threatens/"]Full Business Day report[/link]

[link url="https://www.bbc.com/news/live/world-africa-47639452?ns_mchannel=social&ns_source=twitter&ns_campaign=bbc_live&ns_linkname=5e6f2660c429ed066b5926dc%26Kenyan%20nurses%20at%20coronavirus%20ward%20begin%20go-slow%262020-03-16T07%3A53%3A41.053Z&ns_fee=0&pinned_post_locator=urn:asset:e0ca6d1f-4375-43cf-abd8-839b321aaccb&pinned_post_asset_id=5e6f2660c429ed066b5926dc&pinned_post_type=share"]Full BBC News report[/link]

[link url="https://www.theguardian.com/world/2020/mar/17/retired-and-student-medics-may-be-called-in-to-tackle-covid-19-in-uk"]Full report in The Guardian[/link]

[link url="https://www.gov.uk/government/publications/coronavirus-bill-what-it-will-do/what-the-coronavirus-bill-will-do"]Outline of planned laws[/link]

[link url="https://www.personneltoday.com/hr/occupational-health-set-to-have-prominent-role-in-fight-against-coronavirus/"]Full Personnel Today report[/link]

[link url="https://www.enca.com/news/zimbabwe-sets-isolation-facility-coronavirus"]Full eNCA report[/link]

[link url="https://m.fin24.com/Companies/Health/amid-panic-buying-of-medicines-in-south-africa-aspen-is-ramping-up-production-20200317"]Full Fin24 report[/link]

[link url="https://www.dailymaverick.co.za/article/2020-03-16-national-disaster-explained-we-need-to-act-to-avoid-the-risk-of-overwhelming-the-health-services-zweli-mkhize/"]Full Daily Maverick report[/link]

[link url="https://mg.co.za/article/2020-03-15-national-disaster-declaration-follows-confirmation-of-internal-transmission-of-covid-19/"]Full Mail & Guardian report[/link]

[link url="https://www.businesslive.co.za/bd/national/2020-03-15-full-statement-president-announces-measures-to-combat-coronavirus-pandemic/?utm_source=&utm_medium=email&utm_campaign=Breaking+News%3A+Government+could+declare+state+of+emergency+if+Covid-19+spread+escalates&utm_term=http%3A%2F%2Fwww.businesslive.co.za%2Fbd%2Fnational%2F2020-03-15-full-statement-president-announces-measures-to-combat-coronavirus-pandemic%2F"]Full speech on the Business Day site[/link]

[link url="https://www.polity.org.za/article/drastic-steps-must-be-taken-to-protect-the-poor-from-coronavirus-kzn-health-mec-2020-03-16"]Full Polity report[/link]

[link url="https://www.polity.org.za/article/coronavirus-mbalula-announces-random-screening-at-taxi-ranks-train-stations-2020-03-16"]Full Polity report[/link]

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