By Countercurrents Collective
World Health Organization (WHO) officials have warned that some countries are not taking the coronavirus crisis seriously enough, as outbreaks surged across Europe and in the U.S. where medical workers sounded warnings over a “disturbing” lack of hospital preparedness.
The epidemic has wreaked havoc on international business, tourism, sports events and schools, with almost 300 million students sent home worldwide.
Religions around the world have also been affected: The Vatican said Pope Francis may have to change his schedule, Bethlehem was placed under lockdown.
Saudi Arabia emptied Islam’s holiest site in Mecca to sterilize it. The kingdom has suspended the year-round Islamic “umrah” pilgrimage, an unprecedented move that raises fresh uncertainty over the annual hajj.
Iraq has cancelled Friday prayers in Karbala, the Shia holy city, over health fears.
Global markets tumbled again over concerns about the impact on the economy and as countries took more drastic steps to prevent contagion of a disease that has killed more than 3,300 people and infected nearly 100,000 in about 85 nations.
Cases soared in Italy, France, Greece and Iran, while a cruise ship was held off the coast of California to test passengers showing symptoms of the disease – echoing a harrowing episode in Japan several weeks ago that saw hundreds infected on a luxury liner.
Political commitment: Lacking
The WHO warned Thursday that a “long list” of countries was not showing “the level of political commitment” needed to “match the level of the threat we all face.”
The WHO chief Tedros Adhanom Ghebreyesus told reporters: “This epidemic is a threat for every country, rich and poor.”
Tedros called on the heads of government in every country to take charge of the response and “coordinate all sectors,” rather than leaving it to health ministries. What is needed, he said, is “aggressive preparedness.”
“This is not a drill. This is not the time for giving up. This is not a time for excuses. This is a time for pulling out all the stops,” he said in Geneva. “Countries have been planning for scenarios like this for decades. Now is the time to act on those plans.”
His comments came as U.S. President Donald Trump was chastised for attempting to play down the threat of the virus by telling Fox News he had “a hunch” the 2 to 3 per cent mortality rate associated with the virus was “a false number” while incorrectly calling the disease a flu.
But President Donald Trump has downplayed the risk, saying the WHO’s conclusion of a 3.4 percent mortality rate was “false.”
The president has previously claimed the virus had been “weaponised” by political opponents due to its damaging effects on US economic growth.
“A lot of people will have this and it’s very mild. They will get better very rapidly. They do not even see a doctor. They don’t even call a doctor,” he said. “You never hear about those people. So you cannot put them down in the category of the overall population in terms of this corona flu and – or virus. So you just can’t do that.”
U.S.: Disturbing results
In California, a state of emergency has been declared.
Mike Pence, the U.S. vice president, warned that the U.S. did not currently have enough testing kits to meet demand.
The largest nursing union in the U.S. said a survey of thousands of nurses at hospitals showed “truly disturbing” results. “They show that a large percentage of our nation’s hospitals are unprepared to safely handle COVID-19,” said Jane Thomason, a hygiene specialist with the union.
Nurses are working without necessary personal protective equipment and lack education and training for handling the disease, said National Nurses United director Bonnie Castillo.
The U.S. Congress passed an emergency $8.3 billion spending bill to combat the coronavirus Thursday as cases surged in the country’s northwest and deaths reached 12. More than 180 people are infected in the U.S.
The U.S. government said it was going to buy 500 million respirators to stockpile for use by healthcare professionals.
Admiral Brett Giroir, the U.S. assistant secretary of health, estimated the death rate at “somewhere between 0.1 percent and one percent” – closer to the seasonal flu – due to a high number of unreported cases.
A National Guard helicopter dropped test kits on the deck of the Grand Princess cruise ship off the coast of San Francisco to determine if any of the nearly 3,500 guests and crew had contracted the new coronavirus.
Health officials sounded the alarm after two passengers who had been on board during a previous voyage later fell ill, and one of them died.
Cases in China falling
Cases in China have gradually fallen as tens of millions of people remain under strict quarantine to contain the virus.
Fresh infections rose for a second consecutive day on Friday, with 143 new cases, and 30 more deaths.
China’s death toll now stands at 3,042 with over 80,500 infections.
Beijing faces a new concern with the number of cases imported from abroad rising to 36.
China has quarantined entire cities, temporarily shut factories and closed schools indefinitely.
South Korea: Second biggest number
South Korea has the second biggest number of cases outside China, with over 6,000 infections and 42 deaths, prompting the country to extend school breaks by three weeks.
Italy: Biggest number in Europe
Italy, which has the biggest outbreak in Europe, has ordered schools and universities shut until March 15, and on Thursday reported a sharp rise in deaths, bringing the total to 148.
Italy, the worst afflicted region on the continent, announced an almost 800 cases in a 24-hour period. In response the government, which had already temporarily closed all schools, has implemented restrictions on visiting relatives in nursing homes.
Japan: Quarantine on arrival
Japan imposed quarantine on arrivals from South Korea and China, angering Seoul, which summoned the Japanese ambassador to protest the “irrational” move.
France: The number jumps
France also reported a steep jump in cases, bringing its total to 423 with seven deaths, as President Emmanuel Macron warned the country was heading towards an “inevitable” epidemic.
Iran: Travel limit
In Iran, the government began to limit travel between cities in a response similar to that conducted by China during the early stages of the epidemic.
Officials set up checkpoints and urged citizens to consider limiting their use of paper money, the latest in a string of more drastic measures deployed by Tehran, which has included releasing low-level prisoners and the mass closure of schools.
The virus has particularly affected the nation’s ageing legislature. Of the 107 deaths recorded by the state, which has been accused of covering up the severity of the virus within its borders, two have been senior government officials.
On Wednesday, an adviser to the foreign minister died after contracting Covid-19, following on from a senior adviser to the Supreme Leader Ayatollah Khamenei. About eight per cent of Iran’s political class is reported to be infected with the virus.
The nation has become the epicenter of the disease in the Middle East, where the spread has led to stringent measures being applied across the region.
In Bethlehem in the West Bank, the Church of the Nativity was closed and disinfected for a second time.
UK Switzerland Ireland
The virus has also continued to spread across Europe, with the UK and Switzerland announcing their first deaths linked to it and Ireland announcing seven new cases including one patient with no travel link to an infected area.
The number of confirmed virus cases in Greece surged after 21 travelers recently returned from a bus trip to Israel and Egypt tested positive for the virus.
Bosnia and S Africa
Bosnia and South Africa confirmed their first cases.
In Australia, authorities announced the country’s first school closure after a 16-year-old pupil tested positive for coronavirus. The nation has reported 60 cases so far, while two elderly people have died.
300 millions out of school
Almost 300 million students worldwide faced weeks at home with Italy and India the latest to shut schools. Schools have also shut in Iran. In Japan, nearly all schools are closed until early April.
Several countries have implemented extraordinary measures, with UNESCO saying on Wednesday that school closures in more than a dozen countries have affected 290.5 million children.
India later announced it was closing all primary schools in the capital New Delhi until the end of March to prevent the virus from spreading.
While temporary school closures during crises are not new, UNESCO chief Audrey Azoulay said, “The global scale and speed of the current educational disruption is unparalleled and, if prolonged, could threaten the right to education”.
India-EU summit postponed
The orders came as an India-EU summit scheduled for March 13 has also been postponed.
The airline industry could lose up to $113 billion (101 billion euros) in revenue this year due to the impact of the new coronavirus, the International Air Transport Association (IATA) warned, as governments issue travel restrictions or ban visitors from virus hotspots.
Israel this week barred entry to almost all non-resident arrivals from five European nations, prompting Lufthansa to cancel all its flights to the country on Thursday.
Fear grips global economy
The outbreak’s rapid spread has prompted fears of a global economic downturn and rumbled global stock markets, with Europe’s major exchanges sinking again Thursday.
The IMF said earlier it was making $50 billion in aid available for low-income and emerging-market countries to fight the epidemic, which it sees as a “serious threat” that it said would slow global growth to below last year’s 2.9 percent.
“At a time of uncertainty… it is better to do more than to do not enough,” IMF chief Kristalina Georgieva said.
Italy on Thursday unveiled a 7.5-billion-euro ($8.4-billion) economic rescue plan to deal with the impact of the virus, and in the United States, lawmakers reached a deal to provide more than $8 billion to fight the outbreak.
Stock markets in Asia: Lower
Fears about the economic fallout caused stock markets in Asia to open lower on Friday, with Tokyo losing more than 3.0 percent by the break.
New measures in Italy, where 50,000 are under quarantine in several northern towns include a month-long nationwide ban on fan attendance at sports events, and advising people to avoid greetings like kissing on the cheek or shaking hands.
Death rate higher than previously thought, says WHO
The coronavirus has killed 3.4% of patients globally, according to the WHO. This is higher than previous estimates, which predicted around 2%.
Experts have been quick to say the new figure is likely an “overestimate,” with milder cases that do not require treatment potentially going unreported. Some said a 1% death rate seems more “reasonable”.
Incidences appear to be plateauing in China, making some optimistic the outbreak may have “peaked” in its epicenter.
While the figures may sound alarming, four out of five cases are thought to be mild, while more than 50,000 patients have “recovered.”
Of the countries with confirmed cases, 21 have just one patient, while 122 nations are yet to report any.
Speaking at a media briefing on Tuesday, WHO’s director-general Dr Tedros Adhanom Ghebreyesus said: “Globally, about 3.4% of reported Covid-19 cases have died.”
Calculating the death rate in the midst of a new outbreak is far from straightforward.
Death rates are generally defined as the percentage of fatalities among the number of cases.
This is different from the death toll, which gives the number of fatalities.
On 29 January, the WHO cited a likely death rate of 2%.
Just a few days later, the Chinese National Health Commission reported it appeared to be 2.1%, based on 425 deaths among 20,438 confirmed cases.
On 20 February, a WHO-China joint statement put the death rate at 3.8% based on 2,114 deaths among 55,924 cases.
With Covid-19 virtually unheard of at the beginning of the year, its death rate was initially estimated according to hospital data.
Patients who require hospital treatment are severe by definition.
Milder cases – who may experience fever, cough and breathlessness – could have gone unreported.
“We do not report all the cases,” said Professor John Edmunds from the London School of Hygiene and Tropical Medicine.
“In fact, we only usually report a small proportion of them.
“If there are many more cases in reality, then the case-fatality ratio will be lower.
“Estimating what fraction of the cases might be reported is very tricky.
“This long-winded explanation goes to show how difficult it is to get an estimate of the death rate.”
Dr Toni Ho – from the University of Glasgow – agreed, adding some countries have “limited testing” when it comes to diagnosing mild or asymptomatic patients.
“This [3.4%] is likely an overestimate as a number of countries have had limited testing,” he said.
“Hence few of the mild cases have been picked up and [the cases] we are observing is the tip of the iceberg.
“Furthermore, determining mortality using confirmed deaths over total cases does not account for the fact that outcome is still unknown for many confirmed cases, as they are still hospitalized.
“Lastly, since subclinical [an infection not severe enough to cause “observable” symptoms] and asymptomatic infections have been reported, [the] true case-fatality ratio cannot be estimated until population surveys can be undertaken to estimate the proportion of individuals that were infected but did not manifest symptoms.”
“Population surveys” refers to testing the public for an antibody protein produced by the immune system in response to the infection.
Taking into account those with mild or no symptoms, Dr Christl Donnelly – from Imperial College London – estimated a 1% fatality rate appears more likely.
“In an unfolding epidemic it can be misleading to look at the naïve estimate of deaths so far divided by cases so far,” she said.
“The infection-fatality ratio is the proportion of infections (including those with no symptoms or mild symptoms) that die of the disease.
“Our estimate for this is 1%.”
Dr Tom Wingfield, from the Liverpool School of Tropical Medicine, also pointed out that the definition of a Covid-19 case is not always clear-cut.
This was shown when China changed its definition to “definitely infected” if a patient presented with symptoms, alongside a CT scan showing a chest infection.
Beforehand, patients were confirmed via a nucleic acid test. Nucleic acids are substances in living cells, making up the “NA” of DNA.
As a result, cases appeared to spike overnight in mid-February, despite one expert stressing it was “solely an administrative issue.”
Death rates can also change over the course of an outbreak.
This may be due to mutations within the virus making it more or less “potent,” as well as humans potentially developing immunity or becoming less exposed to the infection due to quarantines and other interventions.
A lack of awareness at the start of the outbreak may also have meant patients only sought treatment when their symptoms became severe.
Death rates may reduce as patients start “self-identifying” their symptoms earlier on.
“The best estimates of case-fatality rates would have to occur once an epidemic was over,” said Dr Wingfield.
“Estimating in real time during the epidemic is fraught with difficulties.”
Dr Paul Hunter of the University of East Anglia agreed, adding: “In my view, 1%-to-2% is a reasonable estimate.”
This is not the first time Covid-19’s suspected case-fatality rate has sparked a debate, with experts questioning how many could become infected and the number that will go on to die.