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orbemnews · 4 years ago

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Vaccines Won’t Protect Millions of Patients With Crippled Immune Systems For more than a year, Dr. Howard Wollowitz has mostly been cloistered inside his home in Mamaroneck, N.Y. As chief of emergency medicine at Montefiore Medical Center in the Bronx, Dr. Wollowitz, 63, was eager to help treat patients when the coronavirus began raging through the city last spring. But a cancer treatment in 2019 had obliterated his immune cells, leaving him defenseless against the virus, so he instead arranged to manage his staff via Zoom. A year later, people in Dr. Wollowitz’s life are returning to some semblance of normalcy. His wife, a dancer and choreographer, is preparing to travel for work at Austria’s National Ballet Company. His vaccinated friends are getting together, but he sees them only when the weather is nice enough to sit in his backyard. “I spend very little time in public areas,” he said. Like his friends, Dr. Wollowitz was vaccinated in January. But he did not produce any antibodies in response — nor did he expect to. He is one of millions of Americans who are immunocompromised, whose bodies cannot learn to deploy immune fighters against the virus. Some immunocompromised people were born with absent or faulty immune systems, while others, like Dr. Wollowitz, have diseases or have received therapies that wiped out their immune defenses. Many of them produce few to no antibodies in response to a vaccine or an infection, leaving them susceptible to the virus. When they do become infected, they may suffer prolonged illness, with death rates as high as 55 percent. Most people who have lived with immune deficiencies for a long time are likely to be aware of their vulnerability. But others have no idea that medications may have put them at risk. “They’ll be walking around outside thinking they’re protected — but maybe they’re not,” said Dr. Lee Greenberger, chief scientific officer of the Leukemia and Lymphoma Society, which funds research on blood cancers. The only recourse for these patients — apart from sheltering in place until the virus has retreated — may be to receive regular infusions of monoclonal antibodies, which are mass-produced copies of antibodies obtained from people who have recovered from Covid-19. The Food and Drug Administration has authorized several monoclonal antibody treatments for Covid-19, but now some are also being tested to prevent infections. Convalescent plasma or gamma globulin — antibodies distilled from the blood of healthy donors — may also help immunocompromised people, although a version of the latter that includes antibodies to the coronavirus is still months from availability. “It’s a clear area of unmet need,” said Hala Mirza, a spokeswoman for Regeneron, which has provided its monoclonal antibody cocktail to a handful of immunocompromised patients through a compassionate use program. (Regeneron released trial results this week showing that the cocktail reduces symptomatic infections by 81 percent in people with normal immune systems.) It’s unclear how many immunocompromised people don’t respond to coronavirus vaccines. But the list seems at least to include survivors of blood cancers, organ transplant recipients, and anyone who takes the widely used drug Rituxan, or the cancer drugs Gazyva or Imbruvica — all of which kill or block B cells, the immune cells that churn out antibodies — or Remicade, a popular drug for treating irritable bowel disease. It may also include some people over age 80 whose immune responses have faltered with age. “We’re extremely concerned and interested in trying to see how we might be able to help those particular patients,” said Dr. Elad Sharon, an immunotherapy expert at the National Cancer Institute. As the pandemic spread, doctors who specialize in treating blood cancers or who care for immunocompromised people expected at least some of their patients to encounter difficulties. Dr. Charlotte Cunningham-Rundles, an immunologist at Icahn School of Medicine at Mount Sinai in New York, has about 600 patients who are almost entirely dependent on getting regular doses of gamma globulin to stay safe from pathogens. Even so, 44 of her patients became infected with the coronavirus; four died, and another four or five had long-term illnesses. (Chronic infections may offer opportunities for the virus to evolve into dangerous variants.) Steven Lotito, 56, one of Dr. Cunningham-Rundles’ patients, was diagnosed with a condition called common variable immune deficiency when he was 13. Before the pandemic, he had an active lifestyle, exercised and ate well. “I’ve always known to take sort of special care of my body,” he said. That included infusions of gamma globulin every three weeks. Despite taking careful precautions, Mr. Lotito caught the virus from his daughter in mid-October. He had a fever for nearly a month, and spent a week in the hospital. Convalescent plasma and remdesivir, an anti-viral drug, provided relief for a couple of weeks, but his fever returned. He finally felt better after one more infusion of gamma globulin, during which he sweated through four shirts. Updated April 15, 2021, 2:02 p.m. ET Still, after nearly seven weeks of illness, Mr. Lotito had no antibodies to show for it. “I still have to take the same precautions that I was taking, you know, a year ago,” he said. “It’s a little disheartening.” People like Mr. Lotito depend on those around them choosing to be vaccinated to keep the virus at bay, Dr. Cunningham-Rundles said. “You’re hoping that your entire family members and all your close colleagues are going to go out and get some shot, and they’re going to be protecting you with herd immunity,” she said. “That’s what you have to start with.” Dr. Cunningham-Rundles has tested her patients for antibodies and signed a few up for Regeneron’s monoclonal antibody cocktail. But many other people with such conditions are not aware of their risks or their options for treatment. The Leukemia and Lymphoma Society has set up a registry to provide information and antibody tests to people with blood cancers. And several studies are assessing the response to coronavirus vaccines in people with cancer, autoimmune conditions like lupus or rheumatoid arthritis, or who take drugs that mute the immune response. What You Need to Know About the Johnson & Johnson Vaccine Pause in the U.S. On April 13, 2021, U.S. health agencies called for an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination. All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use of the vaccine. The U.S. military, federally run vaccination sites and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix, also paused the injections. Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher. The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy. Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses. In one such study, British researchers followed nearly 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals in the country. They found that less than half of patients who took Remicade mounted an immune response following coronavirus infection. In a follow-up, the scientists found that 34 percent of people taking the drug were protected after a single dose of the Pfizer vaccine and only 27 percent after a single dose of the AstraZeneca vaccine. (In Britain, the current practice is to delay second doses to stretch vaccine availability.) Likewise, another study published last month indicated that fewer than 15 percent of patients with cancers of blood or the immune system, and fewer than 40 percent of those with solid tumors, produced antibodies after receiving a single dose of the Pfizer-BioNTech vaccine. And a study published last month in the journal JAMA reported that only 17 percent of 436 transplant recipients who got one dose of the Pfizer-BioNTech or Moderna vaccine had detectable antibodies three weeks later. Despite the low odds, immunocompromised people should still get the vaccines because they may produce some immune cells that are protective, even antibodies in a subset of patients. “These patients should probably be prioritized for optimally timed two doses,” said Dr. Tariq Ahmad, a gastroenterologist at the Royal Devon and Exeter NHS Foundation Trust who was involved in the infliximab studies. He suggested that clinicians routinely measure antibody responses in immunocompromised people even after two vaccine doses, so as to identify those who also may need monoclonal antibodies to prevent infection or a third dose of the vaccines. Wendy Halperin, 54, was diagnosed at age 28 with a condition called common variable immunodeficiency. She was hospitalized with Covid-19 in January and remained there for 15 days. But the coronavirus induced unusual symptoms. “I was having trouble walking,” she recalled. “I just lost control of my limbs, like I couldn’t walk down the street.” Because she was treated for Covid-19 with convalescent plasma, Ms. Halperin has had to wait three months to be immunized and has made an appointment for April 26. But despite her condition, her body did manage to produce some antibodies to the initial infection. “The take home message is that everybody should try and get the vaccine,” said Dr. Amit Verma, an oncologist at Montefiore Medical Center. The gamble did not pay off in Dr. Wollowitz’s case. Without antibodies in his system to protect him, he is still working from home — a privilege he is grateful for. He was an avid mountain biker and advanced skier, both of which carry risk of injury, but with the coronavirus, he is playing it safe. In anticipation of returning to his normal lifestyle, Dr. Wollowitz is tuning his bicycles. But he said he foresaw himself living this way till enough other people are vaccinated and the number of infections in the city drops. “I’m not exactly sure what that date is,” he said. “I’m really waiting to get back out.” Source link Orbem News #Crippled #immune #Millions #patients #protect #systems #Vaccines #Wont

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jwesulm · 5 years ago

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Social distancing for COVID-19: Buying time to reinforce the front

Hi everyone, just an update as a lot of you across several social media have been in touch with me about coronavirus Q&A’s and the possibility of posting up a weekly, detailed FAQ here on your questions; as some of you have heard, I’ve had to put that aside for now since, alongside primary duties, I’m working on applying a bioinformatic system I developed years ago in a bid to help more rapidly identify promising COVID-19 drug candidates. It’s a bit of ad hoc improvisation at best on a pre-developed resource, and even under the most optimistic scenarios there’s not going to be a cure with this, only some extra tools in the therapeutic arsenal to reduce COVID-19 severity and expedite recovery. But for that very reason, I wanted to don my public health hat one more time before going on quasi-social media hiatus, since even the most promising new SARS-CoV-2 treatment prospects won’t amount to much if the (already imminent) torrent of new COVID-19 cases rises even more steeply than it already is to swarm US hospitals: Please, please diligently follow all the social distancing measures being outlined by public health authorities to the letter, especially avoiding mass gatherings and taking pains to wash hands thoroughly after touching surfaces with high contact (such as doorknobs and handles).

I know how stir-crazy things are getting right now especially with all the mounting anxiety (and desire to assuage it with public get-togethers to greet springtime’s arrival), but having lately been in touch with medical colleagues in US epicenters like Seattle, NYC, San Francisco -- even unexpected hotspots like Kansas City, Phoenix, and Orlando -- I can’t emphasize this point enough: the nightmare scenarios we’ve been witnessing recently in parts of Italy, Spain, Britain and the Middle East aren’t worrisome hypotheticals anymore, they’ve already arrived in many regions of the United States. American hospitals are being inundated, we’re critically low on PPE (personal protective equipment) and test kits for complex reasons I don’t want to get into here, and healthcare workers are themselves suffering casualties from infection even with full-body protective gear -- the bottom line is we’re on a war footing in the US, in the most concrete sense imaginable. And we need assistance from all corners to relieve pressure on the front: the medical centers being overwhelmed with a rapid surge in COVID-19 cases. As abstract and intangible as it can often seem at times, social distancing and contagion control, practiced at an individual + small group level X millions of Americans, is absolutely crucial to flatten the curve and buy the time we need to get reinforcements in the form of additional ventilators and supplies, vaccines, and treatments to improve survival and recuperation.

While all of us are liable to slip up from time to time amid the strictures of the lockdowns and shelter-at-home orders, there are still far too many cases of heedless, gratuitous mass assemblages like the Spring Break parties down in Florida or the multitudes thronging in Bondi Beach, Australia. For all practical purposes, those crowds right now are mass Petri dishes for SARS-CoV-2 to multiply like mad and launch new chain reactions to infect millions more people. I realize this sounds grisly but regrettably, that’s how aggressive this microbial foe is. In the lingo of viral epidemiology, this betacoronavirus -- the taxonomic subgroup to which SARS-CoV-2 belongs -- has a significantly higher R0 (R naught) than the flu, a metric of its contagious capacity; is now known to linger in the air for potentially hours; and is transmissible on many fomites (surfaces with frequent human contact) for days. It has a long incubation period (now thought to be around five days) during which it can be disseminated before a victim is symptomatic, and is thus uniquely capable of exponential spread. The US was also relatively slow to ramp up testing compared to South Korea and Italy (with the Koreans testing 20,000 a day, until recently more than America in a month), which means that undetected community spread has been rampant in the USA for weeks. Brisk strolls in the park and exercise al fresco are fine to break the cabin fever, but especially at this point, large gatherings are a formula to mass-disseminate SARS-CoV-2 still further and utterly deluge America’s already limited supply of hospital beds, ICU rooms, ventilators, and hospital staff to provide treatment. Keep in mind that COVID-19 is slamming us on top of a ruthless flu season and an increase in other medical issues to boot, all of which are being pushed aside to triage for the novel coronavirus avalanche. And then you have another accelerant to the vicious cycle with the attrition from nurses and doctors falling ill (which is exactly what happened to me as a doctor in a previous epidemic from pertussis, requiring years to recover).

Not trying to sound dismal here, but to provide a critical reality check on how basic behavioral modification by communities across the USA, on a mass scale, is pivotal to prevent an overwhelming and potential collapse of the US healthcare apparatus if the caseload surges still further; as dark as things are right now, there is real prospect for hope on the horizon if we can make it through the gauntlet we’re facing in the next few months. We’ve been here before, after all, with horrific pandemics like the 1918 Spanish flu (a misnomer as it may have originated right here in Kansas in a WWI army barrack) and numerous smallpox, typhus, cholera, polio, yellow fever, and even plague epidemics ravaging the US before the era of mass immunization or antibiotics for bacterial contagions. Early vaccine research is promising, though it can’t be rushed much beyond the (likely minimum) 18 month lag time due to vaccines’ administration to healthy people, and the technical difficulty of ascertaining the most immunogenic cocktail to prime the immune system. And there are dozens of resourceful research and clinical groups across the world right now seeking to develop new COVID-19 drugs or redirect old ones, to which I’m contributing. Many countries have successfully beaten this thing and protected their populations with aggressive public health measures, particularly Taiwan, Vietnam, South Korea, Singapore, China (with rigorous control after the initial blunders and half-measures in Hubei), Hong Kong, and some countries in Europe and South America. COVID-19 takes a level of mobilization and mustering of public resources beyond any we’ve had to marshal in recent decades, far more than the H1N1 swine flu pandemic in 2009 or Ebola in 2014, but it can be and has been managed successfully. So we don’t have to despair, because new tools are on the way to help us prevail.

Yet this makes it all the more important to buy time for such relief and reinforcements to be produced and arrive at the front. And just to be clear, such public health measures are imperative for all demographics, including younger ones. Contrary to conventional wisdom at the outset, more recent findings are showing that COVID-19 is quite dangerous to children and young adults, much more so than initially thought. The early complacency about this may simply have resulted from the sheer scale of China’s all-out effort to contain the contagion once Wuhan’s and Hubei’s authorities woke up to it, and the similar success of Taiwan and South Korea with mass testing, tracking, and selectively targeted isolation. This nipped SARS-CoV-2’s spread in the bud in East Asia, not only forestalling further infection but also probably reducing viral load and severity of the infectious course among those who did catch it, particularly children. Unfortunately, the comparative lack of early testing, screening, tracking, and isolation in the US and many other Western countries translates into greater sick contact density and a potentially higher viral load for infections here, which raises the danger level for everyone, including kids and college students at beach parties. (For the technically-minded among you out there, the paper in Amer J Respir Crit Care Med, 2010, by DeVincenzo et al., has a good summary of how initial viral load can greatly exacerbate pediatric infection severity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001267/ ) We likewise know that there at least two major strains of this deadly coronavirus -- S-type and L-type -- and now possibly more given its high mutation rate.

Moreover, not only is COVID-19’s lethality at least an order of magnitude higher than the flu, but it also has an alarmingly high rate of serious illness in acute cases, and we know precious little about medium or longer-term sequelae; not to mention that SARS-CoV-2 is hardly confined to the lungs but has been shown to affect the liver and GI tract, kidneys, and even central nervous system in many patients. And it’s not yet clear why, but immunity to COVID-19 seems to wane precipitously in many patients infected by SARS-CoV-2, leaving them vulnerable to deadly re-infections -- a likely reason that initial attempts to achieve “herd immunity” through clustered infection (as opposed to immunization) in some countries, as trial-ballooned in e.g. the UK and Australia, have had catastrophic results and been abandoned. There’s not going to be a magic bullet or straightforward victory here. This is going to be a months-long grind as the infectious curve is flattened and new options emerge to mitigate contagious spread and facilitate recovery in those already afflicted. Meanwhile, communities across the country need to do everything possible to buy time for the aforementioned reinforcements to arrive, and this means rigorous adherence to social distancing and other measures announced by authorities to break the chain of contagion. We will get through this; please keep safe everyone. -- J. Wes Ulm, MD, PhD

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brajeshupadhyay · 4 years ago

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CAIRO — For months, one enduring mystery of the coronavirus was why some of the world’s most populous countries, with rickety health systems and crowded slums, had managed to avoid the brunt of an outbreak that was burning through relatively affluent societies in Europe and the United States. Now some of those countries are tumbling into the maw of the pandemic, and they are grappling with the likelihood that their troubles are only beginning. Globally, known cases of the virus are growing faster than ever with more than 100,000 new ones a day. The surge is concentrated in densely populated, low- and middle-income countries across the Middle East, Latin America, Africa and South Asia. Not only has it filled hospitals and cemeteries there, it has frustrated the hopes of leaders who thought they were doing everything right, or who believed they might somehow escape the pandemic’s worst ravages. “We haven’t seen any evidence that certain populations will be spared,” said Natalie Dean, an assistant professor of biostatistics at the University of Florida. For those not yet affected, she said, “it’s a matter of when, not if.” Several of the newly hit countries are led by strongmen and populists now facing a foe that cannot be neutralized with arrests or swaggering speeches. In Egypt, where the rate of new confirmed infections doubled last week, the pandemic has created friction between President Abdel Fattah el-Sisi and doctors who have revolted over a lack of protective equipment and training. In Brazil, the total death toll surpassed 32,000 on Thursday, with 1,349 deaths in a single day, dealing a further blow to the populist president, Jair Bolsonaro, who has continued to minimize the threat. “We are sorry for all the dead, but that’s everyone’s destiny,” he said Tuesday. In Bangladesh, natural disaster helped spread the disease. Cyclone Amphan, a deadly storm that tore through communities under lockdown there last month, helped drive cases up to 55,000. This week Bangladeshi authorities reported the first death from Covid-19 in a refugee camp, a 71-year-old Rohingya man from Myanmar — an ominous sign for wider worries about the plight of vulnerable people huddled in hundreds of such camps in the world’s most fragile countries. The upswing marks a new stage in the trajectory of the virus, away from Western countries that have settled into a grinding battle against an increasingly familiar adversary, toward corners of the globe where many hoped that hot weather, youthful populations or some unknown epidemiological factor might shield them from a scourge that has infected 6.5 million people and killed almost 400,000, over a quarter of them in the United States. Some countries now being overrun by the virus seemed to be doing the right thing. In Peru, where President Martín Vizcarra ordered one of the first national lockdowns in South America, over 170,000 cases have been confirmed and 14,000 more deaths than average were recorded in May, suggesting there were many more virus fatalities than the official count of about 5,000. South Africa, Africa’s economic powerhouse, banned sales of tobacco and alcohol as part of a strict lockdown in March, yet now has 35,000 confirmed infections, the highest on the continent. Even so, President Cyril Ramaphosa eased the restrictions last week, citing economic concerns. The pandemic’s new direction is bad news for the strongmen and populist leaders in some of those countries who, in its early stage, reaped political points by vaunting low infection rates as evidence of the virtues of iron-fisted rule. President Vladimir V. Putin of Russia, whose delivery of a planeload of medical aid to the United States in March was seen as a cocky snub, is grappling with the world’s third-largest outbreak, with 440,000 cases that have enraged the public and depressed his approval ratings to their lowest in two decades. For Mr. el-Sisi of Egypt, the outbreak has posed a rare challenge to his preferred narrative of absolute control. Although Egypt’s 30,000 cases are far fewer than those of several other Arab countries — Saudi Arabia has three times as many — it has by far the highest death toll in the region and its infection rate is soaring. Last Sunday the government recorded 1,500 new cases, up from about 700 just six days earlier. The next day the minister for higher education and scientific research warned that Egypt’s true number of cases could be over 117,000. Some hospitals are overflowing and doctors are up in arms over shortages of protective equipment that, they say, has resulted in the deaths of at least 30 doctors. Outrage crystallized last week around the death of Dr. Walid Yehia, 32, who had been denied emergency treatment at the overwhelmed Monira general hospital where he worked. Fellow doctors at the hospital went on strike for a week to protest his death. The main doctors union issued a statement accusing the government of “criminal misconduct” and warning that Egypt was veering toward “catastrophe” — strong words in a country where Mr. el-Sisi has jailed tens of thousands of opponents. Last week, Mr. el-Sisi railed on Twitter against unspecified “enemies of the state” who attacked government efforts to combat the virus. Earlier, Egypt’s public prosecutor warned that anyone spreading “false news” about the coronavirus faced up to five years imprisonment. Doctors at several hospitals said they had been threatened by Mr. el-Sisi’s feared security apparatus for daring to complain. The doctors interviewed for this article spoke on condition of anonymity out of fear of reprisal or arrest. When doctors at the Mansheyat el Bakry hospital threatened to strike last month to protest the lack of training and protective equipment, they received a warning from a hospital senior manager: Anyone who failed to turn up for work the following day would be reported to the National Security Agency, which human rights groups have accused of torture and other abuses. Reached by phone, the manager, Dr. Hanan el-Banna said the message was part of “normal disciplinary measures.” Then she denied that she had sent it. A spokesman for Egypt’s Health Ministry did not respond to questions about the message, or other complaints from doctors. The power of the virus was brought home to Mr. el-Sisi in the early stages of the pandemic, when two senior generals died from Covid-19. Yet his government has frequently seemed determined to put a Panglossian spin on how well it is being handled. Updated June 2, 2020 Will protests set off a second viral wave of coronavirus? Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. How do we start exercising again without hurting ourselves after months of lockdown? Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. My state is reopening. Is it safe to go out? States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. What’s the risk of catching coronavirus from a surface? Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. What are the symptoms of coronavirus? Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. How can I protect myself while flying? If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) How many people have lost their jobs due to coronavirus in the U.S.? More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said. Should I wear a mask? The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. What should I do if I feel sick? If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. Last week the Health Ministry published a promotional video that showed coronavirus patients in a hospital praising their care and hailing Mr. el-Sisi. “I can’t believe this, President Abdel Fattah el-Sisi,” says one masked patient. “I can’t believe what he’s doing for our sake.” A very different picture emerges on Facebook, where desperate patients or their relatives have posted videos pleading for help. In one widely circulated recording, a weeping woman says that her ailing father was refused treatment at several hospitals. In another, a man with coronavirus symptoms remonstrates with hospital security guards who turn him away. “Take your complaint to the police,” they tell him. Even if Egypt’s doctors were not muzzled by their government, Western-style social distancing would be nearly impossible in a chaotic, densely populated city of 20 million people like Cairo where many families survive on day jobs. Mosques, churches and airports remained closed, but the decision to relax a night curfew during the holy month of Ramadan — ostensibly to allow people to break their daily fast together — may have accelerated the spread of the virus, experts say. Many low- and middle-income countries, now grappling with surging cases, are also struggling to balance public health against the realities of poverty-stricken societies, said Ashish Jha, professor of global health at the Harvard T.H. Chan School of Public Health. “At some point the lockdown becomes intolerable,” he said. “The human cost to day laborers, many of whom are already barely surviving, is enormous.” The hopes of some countries that they could somehow avoid the pandemic are likely to be dashed, he added. “In the early days, people were seeing patterns that were not really there,” he said. “They were saying that Africa would be spared. But this is a highly idiosyncratic virus, and over time the idiosyncrasy goes away. There is no natural immunity. We are all, humanity-wise, equally susceptible to the virus.” Experts say that Mr. el-Sisi’s obsession with showing that he is beating the pandemic may have encouraged some Egyptians to drop their guard — a phenomenon similar to that in the United States, where some Americans have taken comfort in President Trump’s breezy reassurances. Unfortunately, such heedlessness can have dire consequences. In March, Mohammed Nady, 30, an employee at the Sheraton hotel in central Cairo, posted a video to Facebook dismissing the virus as an American-engineered conspiracy to humiliate China. A few weeks later, he posted a second video from the hospital announcing that he had contracted the coronavirus. A third clip showed him in bed, struggling to breath. “I am dying,” he said. “I am dying.” He died in April, three days before his father also died from the disease. Reporting was contributed by Nada Rashwan in Cairo, Michael Cooper in New York, Manuela Andreoni in Rio de Janeiro, and Mitra Taj in Lima, Peru. The post Coronavirus Rips Into Regions Previously Spared appeared first on Sansaar Times.

http://sansaartimes.blogspot.com/2020/06/coronavirus-rips-into-regions.html

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ladystylestores · 5 years ago

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Coronavirus in Africa: Contained or unrecorded?

Medical staff at the Chandaria Health Centre try on face shields in Nairobi, Kenya – 14 May 2020

The World Health Organization (WHO) has warned that nearly a quarter of a billion Africans could contract coronavirus in the first year of the pandemic, with between 150,000 and 190,000 of them dying.

Africa has had less than 100,000 cases so far, but WHO experts believe the continent will have a prolonged outbreak over a few years – and the huge focus on containing the virus has led to other health issues being neglected.

Here, five BBC reporters give a snapshot of what is happening in their countries:

Short presentational grey line

Congolese ‘probably had virus without knowing it’

By Emery Makumeno, Kinshasa

DR Congo is grappling with coronavirus and Ebola

The Democratic Republic of Congo confirmed its first case of Covid-19 in early March, but a doctor in the capital, Kinshasa, believes the disease arrived earlier.

“During December and January, I can’t remember how many patients came for medical treatment, coughing and with fever and headaches,” he said, referring to Covid-19 symptoms listed by the WHO.

“I am convinced that we, the medical staff, have been exposed to coronavirus already, without knowing it, and we have built a sort of immunity,” he added.

But DR Congo has carried out few tests to check the Covid-19 status of people, because of a lack of medical equipment.

Countries with successful testing strategies, such as South Korea and Germany, have rapidly reached at least 1% of their population, UK medical journal The Lancet points out.

If equipment is available, many African states could ramp up tests – they did more HIV tests between 1 October and 31 December than the 1% target for Covid-19 testing, The Lancet says.

Number of Covid-19 tests done in DR Congo by 18 May: 4,493

Tests required to make up 1% of population: 895,614

HIV tests done from 1 October to 31 December 2019: 203,859

Sources: Africa CDC; The Lancet

So far, DR Congo has recorded more than 1,600 cases of the virus – the ninth-highest number in Africa, according to WHO.

The first Covid-19 case was detected in La Gombe, the main business district in Kinshasa. The government moved swiftly to introduce a lockdown, but the virus has since spread to seven of the country’s 26 provinces – including the mining hub of Lubumbashi.

Story continues

The outbreak comes at a time when DR Congo – which has poor health services, and has been hit by decades of conflict in the east – is also grappling with an Ebola outbreak. It has killed more than 2,000 people since 2018.

The UN children’s agency, Unicef, has also raised concern about a reduction in vaccination rates, saying gains made from immunisation over the past two years could be erased.

Hundreds of thousands of children have not been vaccinated

Unicef said vaccinations were already declining at the beginning of this year, and that the effects of coronavirus will make it worse.

Hundreds of thousands of children had not received polio, measles, yellow fever and other vaccines.

DR Congo might lose its polio-free status and there could be a resurgence of other deadly diseases.

Health workers lacked equipment to protect themselves or the children from Covid-19, and parents were afraid to bring them to vaccination centres.

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Kenya hospital has ‘fewer patients but more corpses’

By Mercy Juma, Nairobi

To cover your face become the norm in Kenya

A major public hospital in Kenya’s capital, Nairobi, saw an almost 40% increase in respiratory illnesses such as tuberculosis, pneumonia and asthma between December and early March, a doctor who works there told the BBC.

However, the hospital had a sharp decline in such cases since mid-March, said the doctor, who spoke to the BBC on condition of anonymity as he was not authorised to speak to the media, added.

One reason was that the government had imposed a nationwide dusk-to-dawn curfew to contain the spread of coronavirus.

This has resulted in a drop in night-time admissions, but an increase in the number of dead people being brought to the hospital’s mortuary, the doctor said.

Some people have been desperate to get out of quarantine

People also seemed to be avoiding hospital for fear of being diagnosed with Covid-19 and being sent to quarantine centres, he said.

This is because quarantining has been controversial in Kenya, with the government forcing suspected Covid-19 patients to pay for their own confinement.

The price ranges from $20 (£16) to $100 a night, depending on the centre, though the government has now promised to cover costs at public quarantine centres.

Number of Covid-19 tests done in Kenya by 18 May: 44,851

Tests required to for 1% of population: 537,713

HIV tests done from 1 October to 31 December 2019: 2, 177,170

Sources: Africa CDC; The Lancet

Hostels at schools and universities as well as private hotels have been used as quarantine centres.

A video clip went viral last month, showing several people scaling a wall to flee a centre in Nairobi.

Those quarantined have complained that some centres are not much better than prisons, with poor hygiene and overcrowding making it impossible to practise social distancing.

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‘More patients and more corpses’ in northern Nigeria

By Ishaq Khalid, Abuja

Very little testing for Covid-19 has been done in Nigeria

There have been reports of more people falling ill and dying in Nigeria’s most populous state, Kano, since the outbreak of coronavirus nearly three months ago.

So, it is not surprising that President Muhammadu Buhari has extended the lockdown in the northern state to the end of the month.

A grave digger at the Abattoir Graveyard in the main city, also known as Kano, told the BBC: “We have never seen this, since the major cholera outbreak that our parents tell us about. That was about 60 years ago.”

Prof Musa Baba-Shani – the head of department of medicines at Aminu Kano Teaching Hospital, the main hospital in the state – told the BBC that they have been treating more patients with illnesses such as asthma, pneumonia, and tuberculosis, as well as chest pains and sore throats.

The professor, who works with the respiratory diseases unit of the hospital, said there had been an increase of between 40% and 45% in the number of respiratory cases in about the last months.

He attributed the rise to the closure of many hospitals in the state, especially private clinics, because of a lack of protective gear for medics. This has forced more patients to seek treatment at the Aminu Kano Teaching Hospital.

Prof Baba-Shani said some of those with respiratory illnesses were diagnosed with coronavirus, and referred to the treatment centres set up for Covid-19 patients.

He decried the slow testing for coronavirus in Africa’s most-populous country, which has a population of around 200 million. It would be better for both patients and hospitals if testing was speeded up, he said.

Number of Covid-19 tests done in Nigeria by 18 May: 33,970

Tests required to for 1% of population: 2,061,396

HIV tests done from 1 October to 31 December 2019: 1,160,920

Sources: Africa CDC; The Lancet

Another doctor at the hospital, who asked not to be named because he was not authorised to speak to the media, said some people were avoiding seeking treatment because they feared contracting Covid-19 in hospitals.

In north-eastern Yobe state, an unusually high number of people – 471 people – have died in the past five weeks.

It is unclear whether the deaths are linked to coronavirus, but the state’s health commissioner, Dr Muhammad Lawan Gana told the BBC that a preliminary investigation had found that most of the dead were elderly people with pre-existing health conditions such as hypertension and diabetes.

Nigeria has more than 6,000 confirmed cases of coronavirus, the third-highest in Africa.

The commercial capital, Lagos, is at the epicentre of the outbreak, but a lockdown imposed at the end of March has been partially eased, raising fears that the virus could spread.

“It’s tough decision, but I think it was the wrong call,” said Dr Andrew Iroemeh, who works at a Covid-19 isolation centre in the city,

“It’s recommended [that] for a lockdown to be relaxed we should have a consistent reduction in the rate of infection for at least 14 days. We haven’t seen that,” he added.

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‘Few signs of virus’ in Ethiopia

By Kalkidan Yibelta, Addis Ababa

Ethiopia has banned gatherings of more than four

Respiratory infections are common in Ethiopia, Africa’s second most-populous state, with a population of more than 100 million. Research shows they are the third major cause of death each year, after neonatal disorders and diarrheal diseases.

The coronavirus outbreak does not seem to have led to more patients with respiratory infections being admitted to hospitals over the past few weeks.

A doctor in the capital, Addis Ababa, told the BBC that he was looking for signs of unreported Covid-19 cases but he did not detect anything unusual.

Number of Covid-19 tests done in Ethiopia by 18 May: 59,029

Tests required for 1% of population: 1,149,636

HIV tests done from 1 October to 31 December 2019: 136,307

Sources: Africa CDC; The Lancet

There was no increase, for example, in the number of patients with pneumonia, a severe complication caused by the virus.

Similar reports were given by a doctor and a nurse the BBC spoke to in eastern and southern Ethiopia respectively.

In recent days, the number of cases detected daily has risen from single to double digits. This has raised some concern, but the overall number is still low – less than 400.

This is despite the fact that Ethiopia, unlike many other states, has not introduced a lockdown, taking limited measures, such as a ban on sporting events and gatherings of more than four people, to curb the spread of the virus.

The doctor in Addis Ababa said Ethiopians might have been spared the worst of the virus because of less foreign travel, or there may be other unknown factors at play.

He said people should take precautions to prevent the spread of the virus as the possibility of a surge could not be ruled out.

Short presentational grey line

Uganda to focus on ‘verbal autopsies’

By Catherine Byaruhanga, Kampala

Traders have been ordered to sleep in markets to reduce the risk of them taking the virus to their homes

Uganda has imposed one of the strictest lockdowns in East Africa and so far it has one of the lowest number of Covid-19 cases in the region – around 260 – and no deaths.

Most of the testing in Uganda has been on truck drivers who arrive from neighbouring states. Last week, Health Minister Ruth Aceng said that of the 139 confirmed cases at the time, 79 were truck drivers.

The President of the Uganda Medical Association, Dr Richard Idro, said that doctors around the country had not reported seeing more patients with respiratory illnesses, though the lockdown – which includes a ban on travel – could have prevented them from going to hospital.

People with mild symptoms of coronavirus might have also stayed at home, resulting in some cases going unrecorded.

Number of Covid-19 tests done in Uganda by 18 May: 87,832

Tests required to constitute 1% of population: 457,410

HIV tests done from 1 October to 31 December 2019: 2,098,734

Sources: Ugandan government; The Lancet

In a recent address, Uganda’s President Museveni said the government planned to carry out “verbal autopsies”https://ift.tt/2HfCbR7; in communities to find out whether people might have died from Covid-19.

The government has promised to distribute free masks to all citizens above six years old over the next two few weeks before easing lockdown measures.

Ugandans on social media have generally been sceptical about the plans, pointing to the delays in giving food to 1.5 million people in and around the capital, Kampala, after they lost their income because of Covid-19 restrictions.

If the mask distribution is successful, Mr Museveni has promised that shops will be allowed to open, public transport will be back on the road but carrying half the number of passengers and food market vendors – who have been sleeping at their stalls under the president’s orders – will be allowed to go home at the end of each day.

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asfeedin · 5 years ago

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How does the new coronavirus compare with the flu?

Editor’s note: This article was revised on April 30 with the latest information on COVID-19.

Since the new coronavirus was first discovered in January, many people have compared it with a more well-known disease: The flu.

Many of these comparisons pointed to the perhaps underappreciated toll of the flu, which causes millions of illnesses and tens of thousands of deaths every year in the U.S. alone. (During the current flu season, the Centers for Disease Control and Prevention (CDC) estimates that there have been 39 million to 56 million flu illnesses and 24,000 to 62,000 flu deaths in the U.S., although that number is an estimate based on hospitalizations with flu symptoms, not based on actually counting up every person who has died of flu.)

The new coronavirus disease, COVID-19, has caused more than 1 million illnesses and 60,000 deaths in the U.S. as of April 29, according to data from Johns Hopkins University.

Related: Is 6 feet enough space for social distancing?

Both COVID-19 and the flu are respiratory illnesses. But COVID-19 is not the flu. Research so far indicates that COVID-19 spreads more easily and has a higher death rate than the flu.

Scientists are racing to find out more about COVID-19, and our understanding may change as new information becomes available. Based on what we know so far, here’s how it compares with the flu.

Symptoms and severity

Both seasonal flu viruses (which include influenza A and influenza B viruses) and COVID-19 are contagious viruses that cause respiratory illness.

Typical flu symptoms include fever, cough, sore throat, muscle aches, headaches, runny or stuffy nose, fatigue and, sometimes, vomiting and diarrhea, according to the CDC. Flu symptoms often come on suddenly. Most people who get the flu will recover in less than two weeks. But in some people, the flu causes complications, including pneumonia. The overall hospitalization rate in the U.S. for flu this season is about 68 hospitalizations per 100,000 people, according to the CDC.

With COVID-19, doctors are still trying to understand the full picture of disease symptoms and severity. Reported symptoms in patients have varied from mild to severe, and can include fever, cough and shortness of breath, according to the CDC. Other symptoms may include fever, chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell. COVID-19 symptoms appear to come on more gradually than those of flu, according to Healthline.

Older adults and people with underlying medical conditions, including heart disease, lung disease or diabetes, appear to be at higher risk for more serious complications from COVID-19, compared with people in younger age groups and those without underlying conditions.

The overall hospitalization rate for COVID-19 in the U.S. is about 29 hospitalizations per 100,000 people as of April 18, although the hospitalization rate for adults ages 65 and older is higher, at 95 hospitalizations per 100,000 people, according to the CDC. However, because fewer people have likely gotten COVID-19 in the U.S. than have gotten the flu, the odds of becoming hospitalized if you have a confirmed case of COVID-19 are thought to be higher than the odds of being hospitalized with influenza.

Children are a high risk group for complications from flu, but this doesn’t seem to be the case for COVID-19 — few children have been hospitalized with the new coronavirus. A study of COVID-19 cases in the United States published March 18 found that, among 4,226 reported cases, at least 508 people (12%) were hospitalized, and of these, less than 1% were younger than 20 years old. In addition, no fatalities among children were reported.

It’s important to note that, because respiratory viruses cause similar symptoms, it can be difficult to distinguish different respiratory viruses based on symptoms alone, according to the World Health Organization.

Related: Can homemade masks protect you from COVID-19?

Coronavirus science and news

Death rate

The death rate from seasonal flu is typically around 0.1% in the U.S., according to news reports.

Though the death rate for COVID-19 is unclear, almost all credible research suggests it is much higher than that of the seasonal flu.

It’s important to note that there is no one death rate for COVID-19; the rate can vary by location, age of person infected and the presence of underlying health conditions, Live Science previously reported.

Among reported COVID-19 cases in the U.S., nearly 6% have died. This is what’s known as the case fatality rate, which is determined by dividing the number of deaths by the total number of confirmed cases. But the case fatality rate is limited for a few reasons. First, not everyone with COVID-19 is being diagnosed with the disease — this is in part due to testing limitations in the U.S. and the fact that people who experience mild or moderate symptoms may not be eligible for or seek out testing. As the number of confirmed cases goes up, the fatality rate may decrease.

Researchers from Columbia University recently estimated that only 1 in 12 cases of COVID-19 in the U.S. are documented, which they said would translate to an infection fatality rate of about 0.6%, according to The Washington Post. But even this lower estimate is still at least six times higher than that of the flu. (The case fatality rate in people who become sick with flu may be 0.1%, but when you account for people who become infected with flu but never show symptoms, the death rate will be half or even a quarter of that, the Post reported.)

What’s more, unlike the flu, for which there is a vaccine, everyone in the population is theoretically susceptible to COVID-19. So while the flu affects 8% of the U.S. population every year, according to the CDC, between 50% and 80% of the population could be infected with COVID-19, according to a study published March 30 in the journal The Lancet. In the U.S., that would translate to 1 million deaths from COVID-19 if half the population becomes infected and there are no social distancing measures or therapeutics, the Post reported.

Another limitation with the case fatality rate is that some people who are counted as confirmed cases may eventually die from the disease, which would lead to an increase in the death rate. For example, South Korea initially reported a case fatality rate of 0.6% in early March, but it later rose to 1.7% by the beginning of April, according to New Scientist.

Related: Why are more men dying from COVID-19?

It’s also important to note that estimates of flu illnesses and deaths from the CDC are just that — estimates (which make certain assumptions) rather than raw numbers. (The CDC does not know the exact number of people who become sick with or die from the flu each year in the U.S. Rather, this number is estimated based on data collected on flu hospitalizations through surveillance in 13 states.) . A recent study posted on the preprint database medRxiv emphasized this point when it found that the number of confirmed and probable COVID-19 deaths in New York City was 21 times higher than the number of reported flu deaths over the same period, from Feb. 1 to April 18.

Virus transmission

The measure scientists use to determine how easily a virus spreads is known as the “basic reproduction number,” or R0 (pronounced R-nought). This is an estimate of the average number of people who catch the virus from a single infected person, Live science previously reported. The flu has an R0 value of about 1.3, according to The New York Times.

Researchers are still working to determine the R0 for COVID-19. Preliminary studies estimated an R0 value for the new coronavirus to be between 2 and 3, according to a review study published Feb. 28 in the journal JAMA. This means each infected person has spread the virus to an average of 2 to 3 people.

Some studies suggest COVID-19 has an even higher R0 value. For example, a study published April 7 in the journal Emerging Infectious Disease used mathematical modeling to calculate an R0 of nearly 6 in China.

It’s important to note that R0 is not a constant number. Estimates can vary by location, depending on such factors as how often people come into contact with each other and the efforts taken to reduce viral spread, Live Science previously reported.

Pandemics

Seasonal flu, which causes outbreaks every year, should not be confused with pandemic flu, or a global outbreak of a new flu virus that is very different from the strains that typically circulate. This happened in 2009 with the swine flu pandemic, which is estimated to have infected up to 1.4 billion people and killed between 151,000 and 575,000 people worldwide, according to the CDC. There is no flu pandemic happening currently.

On March 11, the WHO officially declared the outbreak of COVID-19 a pandemic. This is the first time the WHO has declared a pandemic for a coronavirus.

Related: When will a COVID-19 vaccine be ready?

Prevention

Unlike seasonal flu, for which there is a vaccine to protect against infection, there is no vaccine for COVID-19. But researchers in the U.S. and around the world are working to develop one.

In addition, the flu has several treatments approved by the Food and Drug Administration (FDA), including antiviral drugs such as amantadine and rimantadine (Flumadine), and inhibitors of influenza, such as oseltamivir (Tamiflu) and zanamivir (Relenza). In contrast, the FDA has yet to approve any treatments for COVID-19, although approval for remdesivir, an antiviral initially developed to treat Ebola, is pending.

In general, the CDC recommends the following to prevent the spread of respiratory viruses, which include both coronaviruses and flu viruses: Wash your hands often with soap and water for at least 20 seconds; avoid touching your eyes, nose and mouth with unwashed hands; avoid close contact with people who are sick; stay home when you are sick; and clean and disinfect frequently touched objects and surfaces.

Wearing cloth face coverings in public and practicing social distancing — or staying at least 6 feet (1.8 meters) away from other people — is also recommended to prevent the spread of COVID-19.

Originally published on Live Science.

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antti-nannimus · 5 years ago

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Wash Your Hands Rupert Beale 2230 words

I first heard about coronaviruses in 1999. Their special cunning is in the huge length and complexity of their RNA genome. RNA is much less stable than DNA, so RNA viruses tend to be short. We measure them approximately in kilobases (kb) of information. Polio is a mere 7 kb, influenza stacks up at 14, and Ebola weighs in at 19. Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-CoV-2), the causative agent of Covid-19, is 30 kb. That’s quite normal for a coronavirus, but close to the chemical limits of information storage for RNA – about as long as a strand of RNA can be without collapsing. The viruses therefore need some clever tricks to survive. I remember being fascinated by the RNA ‘pseudoknot’ and ‘slippery sequence’, which allow the viral genome to be read in two different ways simultaneously; the virus can regulate expression of different genes according to the way they are read.

Virologists need more than clever tricks: we also need cash. Twenty years ago, funding wasn’t available to study coronaviruses. In 1999, avian infectious bronchitis virus was the one known truly nasty coronavirus pathogen. Only poultry farmers really cared about it, as it kills chickens but doesn’t infect people. In humans there are a number of fairly innocuous coronaviruses, such as OC43 and HKU1, which cause the ‘common cold’. Doctors don’t usually bother testing for them – you have a runny nose, so what?

When Sars broke out in 2002 we had no effective vaccine for any coronavirus, no antiviral drugs, minimal clues about how it caused disease and very little idea about the dynamics of transmission. It killed a reported 774 people, about 10 per cent of everyone it infected. In retrospect we were lucky that the Sars outbreak of 2002-3 was so nasty: it was easy to spot when someone had it, isolate them and treat them as best we could. There was a brief, intense flurry of funding, which rapidly subsided along with the virus. In 2012 a new, seriously pathogenic coronavirus emerged, Middle East respiratory syndrome related coronavirus (Mers). Like Sars it came to us from bats, but unlike Sars it arrived via dromedary camels – the intermediate host. It’s even nastier than Sars, killing about 30 per cent of people it infects (858 in total), but it doesn’t transmit well between humans. Covid-19 is especially difficult to deal with as most cases are mild. You have a cough, a sore throat, maybe a fever, maybe no symptoms at all – so what?

As the US health secretary Michael Leavitt put it in 2006, ‘anything we say in advance of a pandemic happening is alarmist; anything we say afterwards is inadequate.’ The Chinese government, for all its undoubted faults, instituted rational measures to contain the spread of the virus from its origin in Wuhan. Public transport, schools, large gatherings of any kind – all shut down. Known cases isolated, contacts traced and strict quarantine enforced. Enormous new hospitals built in less than a fortnight. Oxygen and ventilatory support supplied no matter the cost. Medics deployed from across the country, working extraordinary hours. Failure to comply not an option.

The current ‘multi-focal epidemic’, or ‘pandemic’ as virologists would usually describe it, has at the time of writing caused 3408 deaths. If governments move rapidly to contain and delay the spread, and effectively provide optimal medical care, we can expect a case fatality rate just under 1 per cent – though there is still a lot of uncertainty about this. South Korea is showing what a medium-sized country with a democratic government should do. They quickly ramped up their testing capacity, educated the public about self-isolation, shut down large gatherings, restricted travel, increased hospital capacity. They have allocated 30 trillion won (£19 billion) to the response. They have confirmed 6593 cases, but only 42 deaths so far – though only 41 people have been declared to have recovered. The main effort has been in rapid and efficient testing. Detecting and isolating mild cases delays the spread of the disease and reduces the proportion of the population that will be infected. ‘Social distancing’ – reducing human contact – can be achieved by shutting schools, universities, public transport etc, and can mitigate the undetected spread of untested mild cases. The approximately 20 per cent of severe cases requiring hospital treatment, and the roughly 5 per cent of critical cases requiring intensive care, thus do not all arrive in a short time-frame. Resources are not overwhelmed, and lives can be saved.

In countries where rapid testing and isolation do not happen, the disease will at its peak rapidly overwhelm the ability of hospitals to cope, and the case fatality rate will be much higher. The global case fatality rate is above 3 per cent at the moment, and if – reasonable worst case scenario – 30-70 per cent of the 7.8 billion people on earth are infected, that means between 70 and 165 million deaths. It would be the worst disaster in human history in terms of total lives lost. Nobody expects this, because everyone expects that people will comply with efficient public health measures put in place by responsible governments.

Things do not look good in Iran. There was a cluster of cases in Qom. No containment measures were put in place until a number of people had died. The disease spread across Iran and to neighbouring countries, destroying any lingering hope for global containment – though that was always going to be a long shot given the number of cases emerging from China in the early phase of the pandemic. Tehran’s official figure of 4747 cases is likely to be between ten and a hundred times lower than the true number. The World Health Organisation is now involved and the reality may become apparent in the next few weeks. The initial lack of testing and lack of isolation of cases – denialism by the regime – is likely to lead to healthcare services being overwhelmed and tens or hundreds of thousands of deaths.

Most democratic governments will follow South Korea rather than Iran. The UK’s record on testing and isolation of cases has so far been pretty good, though we need to increase testing capability. The announcement on 5 March that containment was no longer realistic and that we are moving towards a policy of delay is exactly right. Politicians will have to make some brave and possibly unpopular decisions on the advice of public health officials.

In the US the response so far has been slow. The situation isn’t helped by a president who keeps suggesting that the virus isn’t that bad, it’s a bit like flu, we will have a vaccine soon: stopping flights from China was enough. Tony Fauci, the director of the National Institute of Allergy and Infectious Disease, deftly cut across Trump at a White House press briefing. No, it isn’t only as bad as flu, it’s far more dangerous. Yes, public health measures will have to be put in place and maintained for many months. No, a vaccine isn’t just around the corner, it will take at least 18 months. Fauci was then ordered to clear all his press briefings on Covid-19 with Mike Pence in advance: the vice president’s office is leading the US response to the virus. ‘You don’t want to go to war with a president,’ Fauci remarked.

The Centres for Disease Control and Prevention (CDC) are in charge of testing for and responding to the outbreak in the US. Astonishingly, their website reports that ‘CDC is no longer reporting the number of persons under investigation (PUIs) that have been tested, as well as PUIs that have tested negative. Now that states are testing and reporting their own results, CDC’s numbers are not representative all of [sic] testing being done nationwide,’ and: ‘As of 4 March 2020, 1524 patients had been tested at CDC. This does not include testing being done at state and local public health laboratories, which began this week.’ As a result, the US has reported only 233 cases. But by piecing together analysis of the genomes of viruses isolated from patients, virologists have shown that Sars-CoV-2 must be circulating undetected in the US. There was a very worrying case in California, where a patient was immediately suspected by his doctors to have Covid-19, but wasn’t tested because he didn’t meet the narrow CDC criteria. Five days later, he tested positive.

The US response will be complicated by its lack of socialised healthcare. Most cases in healthy young people will be mild. Your chance of death as a fit thirtysomething is probably much lower than 0.1 per cent. If you smoke, have diabetes, heart disease or a pre-existing lung condition, or are immunosuppressed, your chance of death is much higher. If you are in your eighties, it’s approaching 15 per cent. People often don’t go to the doctor in the US because they are understandably fearful of the huge costs they may incur. New York City and Washington State have already mandated that testing should be free; we must hope this becomes universal soon. Part of the public health response will have to be self-isolation of possible mild cases. You must not go to work. Will it be possible to convince the US public that they will have to endure some economic hardship to protect their vulnerable compatriots?

The US as a whole is immensely wealthy, and doesn’t have an excuse not to put in place stringent testing and isolation procedures. What about poorer countries? A few cases have been reported in sub-Saharan Africa. There is infrastructure in place to monitor influenza pandemics, which can be repurposed to test for Sars-CoV-2. But to ramp it up to the scale that South Korea has achieved is probably not realistic for a country like Malawi. The test at the moment is expensive, and requires a complicated machine as well as trained staff. There are efforts beginning in the UK, and no doubt elsewhere, to develop a simple ‘point-of-care’ test that could be self-administered. But even a prototype is several months away. Low and middle-income countries will have to put in place measures to increase ‘social distancing’, which could cause significant hardship.

For all its huge genome and clever tricks, Sars-CoV-2 has significant vulnerabilities. It has a fairly feeble fatty envelope, which it needs to sneak into cells. That’s destroyed by soap, and by alcohol – so washing your hands carefully or smearing them in alcohol hand gel will kill the virus. Most transmission is either by very close contact – someone coughs or sneezes in your face – or because a droplet containing the virus touches your hands, and then you touch your face; the virus gets into the body especially easily through the membranes in the eyes, nose and mouth. Expect to be bored to tears over the coming months by pious injunctions to wash your hands. It doesn’t seem like much, but it’s going to reduce the risk at least somewhat.

The second great vulnerability of the virus is that it has to take great pains copying its genome. All RNA viruses (influenza, for example) have a special enzyme that copies RNA into RNA. These RNA-dependent RNA polymerases are usually very sloppy copyists. They do not bother with proofreading, and make huge numbers of errors. This high mutation rate enables them to evolve very rapidly; that’s one reason we need a new flu vaccine every year. Coronaviruses have to be much more careful, or else their huge genome will accumulate too many errors. Their mutation rate is therefore lower, so we may be able to develop a fairly effective vaccine – though it will take a year or two, assuming it’s possible at all.

We can also target the virus with drugs. Remdesivir was developed to target the Ebola polymerase, and may also work against Sars-CoV-2. It certainly works in a Petri dish, and there are ongoing clinical trials in China and the US to see if it works in humans. Sars-CoV-2 produces many of its genes in long, multi-functional proteins that need to be chopped up – by its own ‘protease’ enzymes – into the right chunks. Such proteases have been successfully targeted by antiviral drugs in viruses like Hepatitis C. In my lab we are trying to work out which human proteins Sars-CoV-2 needs to replicate, and the interactions between virus and host may also be good drug targets. But we are a long way off, so in the meantime, what should we do?

I received an email from a colleague in infectious diseases. His message was in no way reassuring. He made three main points:

1. This is NOT business as usual. This will be different from what anyone living has ever experienced. The closest comparator is 1918 influenza.

2. EARLY social distancing is the best weapon we have to combat Covid-19.

3. Humanity will get through this fine, but be prepared for major changes in how we function and behave as a society until either we’re through the pandemic or we have mass immunisation available.

I am writing in haste. This is a fast-moving situation, and the numbers are constantly changing – certainly the ones I have given here will be out of date by the time you read this. What’s very clear is that we must comply immediately with whatever measures competent public health authorities urge us to take, even if they seem disproportionate. It’s time to increase ‘social distance’ in all sorts of ways. And wash your hands.

6 March

Rupert Beale Rupert Beale is a Clinician Scientist Group Leader at the Francis Crick Institute.

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jobsearchtips02 · 5 years ago

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Coronavirus Kills Third Person, Spreads to South Korea and More Chinese Cities

BEIJING—A newly identified virus originating in central China has spread quickly around the country and across Asia, infecting 156 new patients in Beijing, Shanghai, Shenzhen and other densely populated cities, and reaching South Korea for the first time—a major escalation in the pneumonia-like disease’s transmission.

The number of confirmed cases of the new coronavirus—part of a class of pathogens that can cause illnesses ranging from the common cold to the deadly severe acute respiratory syndrome, or SARS—has more than tripled to 218 cases, according to Chinese state media and health authorities.

Zhong Nanshan, one of China’s best known epidemiology experts who leads an expert committee on the outbreak for China’s cabinet-level National Health Commission, said in an interview on state broadcaster China Central Television Monday that there was a human-to-human transmission of the virus, which has now claimed three lives.

President

Xi Jinping

on Monday urged authorities to make efforts to prevent and control the spreading infection, according to the state-run Xinhua News Agency. Officials should “release outbreak information in a timely manner and deepen international cooperation,” he said.

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How worried are you about the new virus spreading from central China? Join the conversation below.

Beijing, Shanghai and the southern metropolis of Shenzhen—three of the country’s biggest and most prosperous cities—confirmed a total of 14 patients infected with the pneumonia-causing virus, all of them on Monday, according to state media and local authorities.

South Korean authorities, meantime, said Monday that a 35-year-old Chinese woman who had flown into the country from the central Chinese city of Wuhan, where the outbreak first occurred, had contracted the coronavirus.

The sudden spread of the disease raises fresh concerns as tens of millions of Chinese citizens travel this week for the annual Lunar New Year, many of them to their hometowns. It is also likely to spark questions over the transparency of disclosures by Chinese health authorities.

China is working with other countries to prevent and control the outbreak, Chinese Foreign Ministry spokesman Geng Shuang said at a regular media briefing in Beijing on Monday. “We’ve formulated prevention and control plans, treated patients, monitored their close contacts, conducted epidemiological research and released information in a timely matter,” he said.

A cyclist rides near a large seafood and livestock wholesale market in Wuhan where the disease is believed to have first broken out. Photo: str/Shutterstock

Health authorities in Wuhan, a densely populated city of 19 million people, said Monday that the number of patients infected with the new coronavirus has jumped to 198, from 62 on Sunday. The statement said 35 of those cases were severe, while nine were critical.

The death of a third infected patient occurred over the weekend, Wuhan authorities said Monday, without offering any specifics. In the case of the two earlier fatalities, authorities had previously said the men suffered from existing illnesses.

A number of Chinese provinces—including Shandong on the east coast, Sichuan in the interior and southwestern Yunnan and Guangxi on the border with Vietnam—are all monitoring suspected coronavirus cases of their own, China Central Television said Monday. Separately, five suspected cases were reported by health authorities in coastal Zhejiang province, just south of Shanghai on the country’s east coast.

While the newly discovered coronavirus is believed to be less serious than SARS, which killed hundreds of people after its outbreak in southern China in late 2002 and early 2003, the pneumonia-like virus is in the same class of pathogens and appears to be spreading quickly.

Going Viral

Since it first appeared in the central Chinese city of Wuhan last month, a newly identified coronavirus has spread across China and into neighboring countries.

New coronavirus cases

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Chinese health authorities haven’t reached any conclusions about the new coronavirus’s origins and its spread. A number of patients were exposed to a large seafood and livestock wholesale market in Wuhan where the disease is believed to have first broken out, but others have said they didn’t visit the market and only came into contact with people in Wuhan.

The Wuhan market is close to the city’s main railway station, an important travel hub in the center of the country.

The World Health Organization said earlier Monday that the spread of the disease was likely the product of “some limited human-to-human transmission occurring between close contacts.”

Wuhan authorities have been recommending that people wear a face mask and pay attention to fever and coughing symptoms.

In numerous instances, infected patients had traveled to Wuhan and showed symptoms of fever and fatigue.

The Chinese patient in South Korea had flown into Incheon International Airport from Wuhan and was quarantined by airport authorities before being transferred to a medical center for treatment, according to South Korea’s Centers for Disease Control and Prevention.

Likewise, the previous three patients that have been identified outside China—two Chinese tourists in Thailand and a man from Japan—had all traveled from the Wuhan area.

South Korean authorities are in the process of identifying crew members and other passengers who were in close contact with the Chinese patient during her flight. They received reports of seven people with coronavirus-like symptoms and have released four of them. Authorities are separately monitoring 14 patients, according to Jung Eun-kyeong, director of KCDC.

In Shanghai, the one confirmed case was a 56-year-old female who had traveled from Wuhan, according to the city’s health authorities.

Beijing has five confirmed cases, according to state media; a district authority has said that two patients had returned from Wuhan.

One of the confirmed cases in southern Guangdong province is 10 years old, according to local authorities. Most of the other infected patients who have been identified by authorities have been elderly.

China’s national health commission said it has issued a new detection kit and is asking regional authorities to step up testing, which could uncover more previously unknown cases.

The sharp uptick since the weekend has sparked questions over whether authorities are underreporting cases or failing to disclose information in a timely fashion. At a hospital affiliated with Tsinghua University in the northern Beijing district of Changping, doctors believed that they had a coronavirus case, but they were instructed not to disclose the information as of early Monday, according to a person familiar with the matter. A spokeswoman said Monday that the hospital would disclose information based on the city government’s instructions.

A separate independent estimate by scholars at Imperial College London said that more than 1,700 people in Wuhan are likely to have symptoms of the virus and could be infected with it, based on modeling of cases of the virus discovered in Thailand and Japan and estimates of the number of people passing through Wuhan’s international airport.

In the U.S., where no cases have so far been detected, the Centers for Disease Control and Prevention and Department of Homeland Security’s Customs and Border Protection have begun screening people traveling from Wuhan for fevers, coughs or difficulty breathing.

—Xiao Xiao and Eun-Young Jeong contributed to this article.

Write to Chao Deng at [email protected]

from Job Search Tips https://jobsearchtips.net/coronavirus-kills-third-person-spreads-to-south-korea-and-more-chinese-cities/

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biofunmy · 5 years ago

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Local authorities: Mysterious illness in China is not SARS

Local authorities say the mysterious illness that has infected dozens of people in a central Chinese city is not SARS

YANAN WANG Associated Press

January 5, 2020, 3:33 PM

2 min read

BEIJING — The mysterious respiratory illness that has infected dozens of people in a central Chinese city is not SARS, local authorities said Sunday.

The 2002-2003 SARS epidemic started in southern China and killed more than 700 people in mainland China, Hong Kong and elsewhere. Fears of a SARS recurrence arose this month after a slate of patients were hospitalized with an unexplained viral pneumonia in Wuhan, the capital of Hubei province.

As of Sunday, 59 people were diagnosed with the condition and have been isolated while they receive treatment, according to the Wuhan Municipal Health Commission. Seven were in critical condition, while the rest were stable.

The commission said in a statement that initial investigations have ruled out SARS — severe acute respiratory syndrome — as well as Middle East respiratory syndrome, influenza, bird flu and adenovirus.

The commission previously said the condition’s most common symptom was fever, with shortness of breath and lung infections appearing in a “small number” of cases. There were no clear indications of human-to-human transmission.

Several patients were working at the South China Seafood City food market in sprawling Wuhan’s suburbs. The commission said the market would be suspended and investigated.

Hong Kong’s Hospital Authority said Sunday that a total of 15 patients in Hong Kong were being treated for symptoms including fever and respiratory infection after recent visits to Wuhan.

Hospitals and doctors have been directed to report cases of fever in anyone who has traveled to Wuhan in the past 14 days, Hong Kong’s health chief, Sophia Chan, said Sunday.

The hospital authority said it has activated a “serious response” level to curb spread of the infection. Chan warned Hong Kong residents against visiting wet markets and eating wild game in mainland China.

The World Health Organization said it was closely monitoring the situation and maintaining contact with Chinese authorities. No travel or trade restrictions are necessary at this time, the WHO said.

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drdeepikasclinic · 1 year ago

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drdeepikasclinic · 2 years ago

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drdeepikasclinic · 2 years ago

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drdeepikasclinic · 2 years ago

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brajeshupadhyay · 4 years ago

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Coronavirus Rips Into Regions Previously Spared

Now some of those countries are tumbling into the maw of the pandemic, and they are grappling with the likelihood that their troubles are only beginning.

Globally, known cases of the virus are growing faster than ever with more than 100,000 new ones a day. The surge is concentrated in densely populated, low- and middle-income countries across the Middle East, Latin America, Africa and South Asia.

Not only has it filled hospitals and cemeteries there, it has frustrated the hopes of leaders who thought they were doing everything right, or who believed they might somehow escape the pandemic’s worst ravages.

“We haven’t seen any evidence that certain populations will be spared,” said Natalie Dean, an assistant professor of biostatistics at the University of Florida. For those not yet affected, she said, “it’s a matter of when, not if.”

Several of the newly hit countries are led by strongmen and populists now facing a foe that cannot be neutralized with arrests or swaggering speeches. In Egypt, where the rate of new confirmed infections doubled last week, the pandemic has created friction between President Abdel Fattah el-Sisi and doctors who have revolted over a lack of protective equipment and training.

In Brazil, the total death toll surpassed 32,000 on Thursday, with 1,349 deaths in a single day, dealing a further blow to the populist president, Jair Bolsonaro, who has continued to minimize the threat.

“We are sorry for all the dead, but that’s everyone’s destiny,” he said Tuesday.

In Bangladesh, natural disaster helped spread the disease. Cyclone Amphan, a deadly storm that tore through communities under lockdown there last month, helped drive cases up to 55,000.

This week Bangladeshi authorities reported the first death from Covid-19 in a refugee camp, a 71-year-old Rohingya man from Myanmar — an ominous sign for wider worries about the plight of vulnerable people huddled in hundreds of such camps in the world’s most fragile countries.

The upswing marks a new stage in the trajectory of the virus, away from Western countries that have settled into a grinding battle against an increasingly familiar adversary, toward corners of the globe where many hoped that hot weather, youthful populations or some unknown epidemiological factor might shield them from a scourge that has infected 6.5 million people and killed almost 400,000, over a quarter of them in the United States.

Some countries now being overrun by the virus seemed to be doing the right thing. In Peru, where President Martín Vizcarra ordered one of the first national lockdowns in South America, over 170,000 cases have been confirmed and 14,000 more deaths than average were recorded in May, suggesting there were many more virus fatalities than the official count of about 5,000.

South Africa, Africa’s economic powerhouse, banned sales of tobacco and alcohol as part of a strict lockdown in March, yet now has 35,000 confirmed infections, the highest on the continent. Even so, President Cyril Ramaphosa eased the restrictions last week, citing economic concerns.

The pandemic’s new direction is bad news for the strongmen and populist leaders in some of those countries who, in its early stage, reaped political points by vaunting low infection rates as evidence of the virtues of iron-fisted rule.

President Vladimir V. Putin of Russia, whose delivery of a planeload of medical aid to the United States in March was seen as a cocky snub, is grappling with the world’s third-largest outbreak, with 440,000 cases that have enraged the public and depressed his approval ratings to their lowest in two decades.

For Mr. el-Sisi of Egypt, the outbreak has posed a rare challenge to his preferred narrative of absolute control.

Although Egypt’s 30,000 cases are far fewer than those of several other Arab countries — Saudi Arabia has three times as many — it has by far the highest death toll in the region and its infection rate is soaring.

Last Sunday the government recorded 1,500 new cases, up from about 700 just six days earlier. The next day the minister for higher education and scientific research warned that Egypt’s true number of cases could be over 117,000.

Some hospitals are overflowing and doctors are up in arms over shortages of protective equipment that, they say, has resulted in the deaths of at least 30 doctors. Outrage crystallized last week around the death of Dr. Walid Yehia, 32, who had been denied emergency treatment at the overwhelmed Monira general hospital where he worked.

Fellow doctors at the hospital went on strike for a week to protest his death. The main doctors union issued a statement accusing the government of “criminal misconduct” and warning that Egypt was veering toward “catastrophe” — strong words in a country where Mr. el-Sisi has jailed tens of thousands of opponents.

Last week, Mr. el-Sisi railed on Twitter against unspecified “enemies of the state” who attacked government efforts to combat the virus. Earlier, Egypt’s public prosecutor warned that anyone spreading “false news” about the coronavirus faced up to five years imprisonment.

Doctors at several hospitals said they had been threatened by Mr. el-Sisi’s feared security apparatus for daring to complain. The doctors interviewed for this article spoke on condition of anonymity out of fear of reprisal or arrest.

When doctors at the Mansheyat el Bakry hospital threatened to strike last month to protest the lack of training and protective equipment, they received a warning from a hospital senior manager: Anyone who failed to turn up for work the following day would be reported to the National Security Agency, which human rights groups have accused of torture and other abuses.

Reached by phone, the manager, Dr. Hanan el-Banna said the message was part of “normal disciplinary measures.” Then she denied that she had sent it.

A spokesman for Egypt’s Health Ministry did not respond to questions about the message, or other complaints from doctors.

The power of the virus was brought home to Mr. el-Sisi in the early stages of the pandemic, when two senior generals died from Covid-19. Yet his government has frequently seemed determined to put a Panglossian spin on how well it is being handled.

Updated June 2, 2020

Will protests set off a second viral wave of coronavirus?

Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

How do we start exercising again without hurting ourselves after months of lockdown?

Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

My state is reopening. Is it safe to go out?

States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

What’s the risk of catching coronavirus from a surface?

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

What are the symptoms of coronavirus?

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

How can I protect myself while flying?

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

How many people have lost their jobs due to coronavirus in the U.S.?

More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

Should I wear a mask?

The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

What should I do if I feel sick?

If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Last week the Health Ministry published a promotional video that showed coronavirus patients in a hospital praising their care and hailing Mr. el-Sisi. “I can’t believe this, President Abdel Fattah el-Sisi,” says one masked patient. “I can’t believe what he’s doing for our sake.”

A very different picture emerges on Facebook, where desperate patients or their relatives have posted videos pleading for help.

In one widely circulated recording, a weeping woman says that her ailing father was refused treatment at several hospitals. In another, a man with coronavirus symptoms remonstrates with hospital security guards who turn him away. “Take your complaint to the police,” they tell him.

Even if Egypt’s doctors were not muzzled by their government, Western-style social distancing would be nearly impossible in a chaotic, densely populated city of 20 million people like Cairo where many families survive on day jobs. Mosques, churches and airports remained closed, but the decision to relax a night curfew during the holy month of Ramadan — ostensibly to allow people to break their daily fast together — may have accelerated the spread of the virus, experts say.

Many low- and middle-income countries, now grappling with surging cases, are also struggling to balance public health against the realities of poverty-stricken societies, said Ashish Jha, professor of global health at the Harvard T.H. Chan School of Public Health.

“At some point the lockdown becomes intolerable,” he said. “The human cost to day laborers, many of whom are already barely surviving, is enormous.”

The hopes of some countries that they could somehow avoid the pandemic are likely to be dashed, he added.

“In the early days, people were seeing patterns that were not really there,” he said. “They were saying that Africa would be spared. But this is a highly idiosyncratic virus, and over time the idiosyncrasy goes away. There is no natural immunity. We are all, humanity-wise, equally susceptible to the virus.”

Experts say that Mr. el-Sisi’s obsession with showing that he is beating the pandemic may have encouraged some Egyptians to drop their guard — a phenomenon similar to that in the United States, where some Americans have taken comfort in President Trump’s breezy reassurances.

Unfortunately, such heedlessness can have dire consequences.

In March, Mohammed Nady, 30, an employee at the Sheraton hotel in central Cairo, posted a video to Facebook dismissing the virus as an American-engineered conspiracy to humiliate China.

A few weeks later, he posted a second video from the hospital announcing that he had contracted the coronavirus.

A third clip showed him in bed, struggling to breath. “I am dying,” he said. “I am dying.”

He died in April, three days before his father also died from the disease.

Reporting was contributed by Nada Rashwan in Cairo, Michael Cooper in New York, Manuela Andreoni in Rio de Janeiro, and Mitra Taj in Lima, Peru.

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