at Dadhaleh Institute

Compounding crises undermine ethical, equitable COVID-19 response

Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh The strongest cyclone ever recorded in [ ... ]

The decision by President Trump to “terminate” relations with the WHO over accusations of undue influence by China on the agency was widely condemned, within the U.S. and globally. It remains uncertain if and how this would happen, but experts worry it may exacerbate global health challenges. The President’s suggestion to redirect intended resources (about US$450 million last year, accounting for 15% of the WHO budget) through bilateral development channels could lead to greater incoherence and inefficiency, according to Rebecca Katz (Georgetown University). A Nature article outlines a range of other possible repercussions, from the resurgence of polio and malaria to barriers in the flow of information on COVID-19. As Dr Kelly Lee (Simon Frasier University) warns, the damage to scientific partnerships would also extend to waning U.S. influence in global health initiatives, including ongoing drug and vaccine development and distribution.

A study in Physics of Fluids reporting on the mechanisms of coughing and airborne transmission of viruses. While cough droplets in typical environmental conditions will travel less than the widely mandated 2 meters for social distancing, the authors note that changes in air flow and other environmental properties (e.g. wind, temperature, humidity) can cause that figure to rise quite dramatically. For example, even modest winds (i.e. 4 to 15km/h) could result in saliva droplets dispersing and traveling up to 6 meters. Although the study provides guidelines on the mechanical aspects of droplet transmission, experts suggest the computer simulation may not capture the process of dilution, while the relationship to viral transmission also remains unclear.

A non-peer reviewed pre-print of a study on bioRxiv examining mutations of the novel Coronavirus did not find any variants that had increased transmissibility. While this suggests none of the known mutations are cause for immediate concern, the findings do not rule out the possibility of emerging future variants with different properties. The Director of the Francis Crick Institute has also suggested testing the study conclusions in functional assays of frequently occurring variants in order to examine their proposed mechanisms.

The U.S. Centers for Disease Control and Prevention issued a new guidance with five COVID-19 planning scenarios to public health authorities based on lower and upper bounds across three parameters: virus transmissibility and disease severity, transmission prior to onset of symptoms, and infections that don’t develop symptoms. One of the scenarios, representing the CDC’s “current best estimate about viral transmission and disease severity in the U.S.” (assuming a R0 of 2.5), approximates 35% of COVID-19 infections may be asymptomatic, and that 0.4% of symptomatic positive cases result in mortality. Epidemiologists, however, question the estimates of symptomatic case fatality rate in the scenarios – from 0.2% (least severe) to 1% (most severe) – which is lower than the reported range in the literature.

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Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh

The strongest cyclone ever recorded in the Bay of Bangal (with maximum sustained winds up to 265km/h) is expected to hit India and Bangladesh on Wednesday. Millions of people are being forced to evacuate north-east India, while only 12,000 shelters have been prepared in Bangladesh to house the nearly five million people in the expected path of Cyclone Amphan. The impact is likely to be hardest on those living in low-lying flood prone coastal areas, as the Needs Assessment Working Group of Bangladesh estimates that up to 14.2 million people in coastal districts are likely to be affected, displacing 1.4 million people and damaging up to 600,000 houses.

Vulnerable communities affected by COVID-19 outbreaks and lockdown will also likely be impacted, including the approximately 1.2 million Rohingya refugees that live in over-crowded camps in Cox’s Bazar in Bangladesh. In collaboration with humanitarian partners, including UNICEF and UNHCR, the IOM is constructing a COVID-19 treatment centre in Cox’s Bazar along with cyclone preparedness effort (alerting the community, reinforcing critical infrastructure and prepositioning emergency items before the cyclone makes landfall).

COVID needs in Humanitarian Emergency Settings

The UN High Commissioner for Refugees made an appeal for US$745 million for preparedness and response to outbreaks of COVID-19 among the more than 71 million refugees and forcibly displaced people that remain acutely vulnerable. While no major outbreaks have been reported in large refugee and IDP settlements, UNHCR is rapidly scaling up efforts in 134 refugee-hosting countries that are reporting local transmission. There is also widespread evidence of deep economic impacts on refugees, as 70% of refugees surveyed admitted to skipping meals, and this is most acute among refugee women.

Médecins Sans Frontières has outlined five key priorities for the international community in order to protect migrants and vulnerable populations in humanitarian response locations. These include:

Ensuring COVID-19 is not used as an excuse to enforce restrictive migration control policies and evade international obligations towards refugees, asylum seekers and migrants;
Governments must not use COVID-19 emergency measures to target refugees, asylum seekers and migrants, and measures should be proportionate and limited in duration, respect human dignity, and based on scientific evidence and not applied arbitrarily;
Lockdowns and mass quarantining cannot be cut-and-pasted or discriminatorily applied;
Direct humanitarian evacuation corridors for displaced people at risk (including people above 60 years and those with respiratory conditions, diabetes, or other health complications); and
Safeguarding access to healthcare for all (ensuring border closures do not prevent the mobility of people, essential supplies and aid workers, particularly in humanitarian response locations).

EU is Creating Humanitarian Air Bridges to enable the COVID-19 Response

The European Commission has allocated 10 million Euro to support a humanitarian air bridge amid travel shutdowns. In the absence of commercial air travel, the air bridge will allow humanitarian staff and supplies to be delivered across 30 routes deemed important for the COVID-19 response, with the first flight launched last week from France to the Central African Republic with 60 humanitarian workers and 13 metric tons of humanitarian cargo.

Build Back Better After COVID-19

The International Recovery Platform developed a toolkit of existing guidelines and tools to support countries and communities when they are ready to recover from the COVID-19 pandemic crisis. It supports recovering communities to “build back better” towards more resilient health systems, economies, and more just societies. The Compendium of Tools and Guidelines are organized according to four categories: Health Sector Recovery; Private Sector and Livelihood Recovery; Inclusive Recovery; and Disaster Recovery Governance. The IRP is a joint initiative of UN, international finance institutions, national and local governments, and NGOs engaged in disaster recovery and sustainable development.

A paper commissioned by the Swedish International Development Cooperation Agency provides analysis and guidance on to inform the design, implementation and adaptation of conflict sensitive humanitarian and development responses to COVID-19.

Lancet Papers Decry the lack of Ethical global leadership on health inequities around COVID-19

A paper in the Lancet calls for greater ethical global leadership on health inequities during the COVID-19 pandemic. The authors reference widespread reports of the disproportionate impact of the pandemic on vulnerable communities around the world, while pointing to “unconscionable stockpiling by wealthy countries” and even attempts to extract profits from the crisis through economic speculation.

Another paper in the same issue highlights how social inequalities in health profoundly, and unevenly, impacting COVID-19 morbidity and mortality. Among the social determinants of health, the authors identify emerging findings on the correlation of the pandemic with poverty (including homelessness), physical environment, and race or ethnicity. The paper also notes how physical distancing measures are significantly more difficult for vulnerable and marginalized populations, while school closures have increased food insecurity for children living in poverty, exacerbating physical and mental health. The authors urge policymakers to emphasize the mitigation of social determinants, including improving housing and reducing overcrowding as well as improving access to health services and income support. The paper also calls on social determinants of health to be an essential part of pandemic research priorities, public health goals, and policy implementation.

Preventing a COVID-19 Related Global Food Crisis

The Food and Agriculture Organization made an appeal for US$350 million to scale up efforts to address hunger and livelihood-boosting efforts in contexts vulnerable to food crisis. As part of the broader UN Global Humanitarian COVID-19 Plan, the appeal will include supporting farmers’ access to fields, seeds and other inputs to plant or buy feed for their animals in order to avoid the cascading impacts of missing planting seasons such as drops in output. The FAO also advocates proactive efforts for stronger emergency livelihoods interventions to avoid famines.
The WEF also reports how the pandemic has amplified the risk of worldwide food-price spikes, urging greater coordination across governments to avert disruptions to food supply chains, including through food protectionism. While lockdowns have led to a collapse in demand for discretionary goods and services, the opposite is true of food as panic buying and food hoarding has proliferated. On the supply side, global grain stockpiles could be quickly depleted as the virus disrupts production and distribution, compounded by the worst locust outbreak in 70 years that have left countries in East Africa acutely vulnerable. In Kenya, for example, the price of staple foods has risen by 60% since last year.
ICRISAT published a new report that outlines four key strategies to protect the lives and livelihoods of farming communities in Eastern and Southern Africa. These include:
1. Diversification of farming systems for improved resilience and profitability (including technologies suitable for sustainable intensification);
2. Enhancing access to seed at scale of grain legumes and dryland cereals (through community seed banks that also supports grain aggregation);
3. Building capacity of partners to promote technologies in a participatory manner (including governments, community organizations, local leaders and women); and
4. Gender integration and empowerment to engage actively in agribusinesses (including livelihood-strengthening activities like climate-smart agriculture)

CommunityFirst COVID-19 Roadmap

This week, SeeChange Initiative and Ilisaqsivik Society, in partnership with the Association of Médicos Sin Fronteras in Latin America, and the Dahdaleh Institute, launched the CommunityFirst COVID-19 Roadmap, a planning tool to empower communities in developing local strategies to organize, prepare and respond to COVID-19. The Roadmap is available in English, Spanish and Inuktitut, and also includes an Emergency Readiness Checklist. Last month, the Executive Director of SeeChange and a Steering Committee member of the CommunityFirst Roadmap published an article in the Lancet on local efforts among Inuit communities to address COVID-19 and TB. The role of community-based responses to the pandemic was also highlighted in STAT.

Webinar Resources

COVID-19 in Humanitarian Setting: Magnifying Gender Inequalities? (JHU)
- Wednesday, May 20, 2020 (8-9am EST)
Digital Solutions to Covid-19 and Urban Challenges in Sub-Saharan Africa (CSIS)
- Thursday, May 21, 2020 (9-10am EST)
Humanitarian Operations During Covid-19: A Conversation with UNHCR (CSIS)
- Monday, June 8, 2020 (9:30-10:15am EST)

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The growing pandemic funding gap

The gap between donor commitments and the funding needed to respond to the pandemic continues to grow. As the UN Office for the Coordination of Humanitarian Affairs tripled its appeal last week to US$6.7 billion, they admit to only receiving US$1 billion towards its initial request for US$2 billion. That includes a mere $65 million contribution from the U.S. that a senator described as “unconscionable,” while the Washington Post reports the US$3 trillion COVID-19 bill introduced by Democrats this past week contains no funding for international assistance. Germany and France likewise agreed to support a 500 billion Euro aid package to support E.U. countries with recovery from the pandemic.

NGOs such as the International Rescue Committee argue that much of the aid is stuck within multilateral channels, as humanitarian funding to front-line NGOs accounts for only 2% of commitments under the UN Global Humanitarian Response Plan.

The global economy is shrinking, and 130 million people may be pushed into extreme poverty

Global economic output is expected to drop by 3.5% in 2020, and by US$8.5 trillion over the next two years as a result of the pandemic. The UN World Economic Situation and Prospects report warns that an additional 34 million people could fall below the extreme poverty line by the end of this year. The UN Department of Economic and Social Affairs did “not anticipate (the global economy) would dive as quickly as it did” amidst the sharpest economic contraction since the Great Depression. The report projects that by 2030, an estimated 130 million will be pushed into extreme poverty. Africa is expected to absorb 56% of the rise in poverty, in part due to limited economic and social protection measures as well as debt burdens.

In the World Economic Forum’s weforum.org, the Dean of the Wharton Business School projects that COVID-19 would also reverse trends in globalization and urbanization. The resulting compression of the global economy, he predicts, will be further impacted by reduction in international cooperation and increased likelihood of international conflict.

250 million Africans could be infected, with up to 190,000 dead by years’ end

Modelling by the WHO predicts that nearly a quarter of a billion people across 47 African countries will be infected with the Coronavirus, with as many as 190,000 projected mortalities by year’s end, according to a study to be published in BMJ Global Health. While African countries may experience fewer severe cases and deaths per capita due to younger populations and lower obesity rates, health system capacity gaps and disruptions in maternal and child health could result in additional deaths.=

ODI calls for increased solidarity to support developing countries

The Overseas Development Institute estimates that the economic impacts of the pandemic to sub-Saharan Africa remain uncertain but will likely exceed $100 billion. While many countries have imposed stringent measures to contain the spread of the virus, there are immediate and long-term concerns about the lag in economic and social protection measures as governments face major liquidity and fiscal constraints. Since much of the global economic dislocation stems from decisions to protect citizens in wealthier countries, the ODI calls for increased international solidarity to support developing countries. That can include special drawing rights to address capital outflows, moratoria on debt service repayments, development finance to provide liquidity to protect employment, as well as non-concessional lending and economic resource packages as aid.

Rising Inequity Gap

The IMF warns that COVID-19 could widen the inequality gap between rich and poor across and within countries, urging policymakers to put in place risk-sharing and social assistance mechanisms to protect the most vulnerable from economic impacts. Using past pandemics as a guide, the analysis shows net increases in Gini coefficient (a measure of inequity within a country) after five years as well as long-term impacts due to job loss and other shocks to income (e.g. lower remittances). To minimize long-term damage (or “scarring”) to the livelihoods of vulnerable communities – and improve resilience to future shocks (including the effects of climate change), the IMF urges countries to consider a range of measures including:

Access to sick leave, unemployment benefits, and health benefits;
A “New Deal,” particularly in countries where the employment sector is largely informal and where social protection systems are limited; and
Expanding social assistance systems, introducing new transfers, boosting public work programs, and progressive tax measures.

“Nothing lays bare inequality and discrimination like a disaster”

In a forceful address on the human rights dimensions of the COVID-19 pandemic, the UN Special Representative for Disaster Risk Reduction highlighted the disproportionate impact on marginalized and vulnerable populations, amplifying social inequities, forced displacement as well as gender- based violence. The central message was that the international community “must do more.” This includes treating persons at risk as people with human rights and not just as beneficiaries of humanitarian actions, who are consulted in decision-making relevant to their lives, and to foster greater resilience by focusing on the drivers of disaster risk, including poverty, lack of international solidarity and pandemic preparedness, and increasing frequency and magnitude of extreme weather events.

‘Donor states can and must do more’

According to a Devex survey of development professionals, two thirds say donors are not doing enough to respond to the Coronavirus. The UN estimates that US$500 billion will be needed to address the pandemic in developing countries, as Oxfam urged 30 donors of the OECD Development Assistance Committee to contribute $300 billion. In addition to more funding, development experts point to three other steps donors should take:

Simplified funding mechanisms for a faster response;
Clarity and transparency on decisions; and
Looking beyond the immediate needs, including longer-term impacts of COVID-19 and what preparation is needed now to respond to those.

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“Impartial, independent, and comprehensive evaluation”

For the first time in the WHO’s history, its annual World Health Assembly (WHA) was entirely virtual. With a focus almost entirely on the Coronavirus pandemic, the condensed two-day meeting was preceded by three weeks of intense negotiations.

The most significant outcome this year was the adoption of a COVID-19 resolution that was proposed by the European Union and supported by 120 countries that contained three major elements (A73/CONF/1), including an “impartial, independent, and comprehensive evaluation (of the) international health response to COVID-19.” In the closing remarks, the WHO Director General affirmed that the review would take place “as soon as possible.”

Rising geopolitical tensions shape emergent Global Health institutions and practices

The WHA opened with a failed motion to grant Taiwan Observer status, underscoring growing tensions in part arising from accusations by the U.S. (and shared by other Western and Pacific Asian countries) that China was not transparent in the early days of the pandemic.

In a letter, the U.S. President threatened to permanently eliminate the funding that was temporarily withdrawn from the WHO, suggesting the U.S. would pursue bilateral aid channels including US$500 million to 40 ‘at risk’ countries. The President of China addressed the Assembly directly pledging US$2 billion over the next two years to support COVID-19 response efforts in developing countries, and an ambition to establish China as a “global humanitarian response capital and hub.” Focusing on African countries in particular, President Xi referenced debt suspension initiatives, building “green corridors” to accelerate delivery of essential goods as well as partnering with 30 major hospitals in Africa to build a China Centres for Disease Control headquarters on the continent.

‘No monopolies on access’ to COVID treatments and vaccines in a pandemic

The negotiations on access to treatments and future vaccines were far more divisive. Led by Costa Rica, developing countries and civil society organizations expressed particular concern about ensuring equitable access, including to COVID-related knowledge, lessons learned, experience, and best practices. The WHO Secretariat will have until May 29 to develop a framework for a voluntary COIVD-19 Intellectual Property Pool for patents and clinical trial data, while the EU-led resolution also references WTO TRIPS flexibilities allowing countries to override patents to ensure access.

COVID is a ‘wake-up call to our global fragility’

In his address to the World Health Assembly, the UN Secretary General called for greater unity and solidarity along three dimensions: a coordinated and comprehensive health response guided by the WHO and focusing on developing countries; policies to address the social and economic dimensions of the COVID crisis; and a response and recovery plan based on equity, inclusion and sustainability centred on human rights. Given the unprecedented nature of the pandemic, some civil society organizations such as South Centre expressed disappointment in the lack of ambition of the COVID-19 resolution. Knowledge Ecology International (KEI) likewise referred to the “typical watered down, lawyered ambiguity” of the final draft that fails to limit legal monopolies that could affect access (they noted that other proposals like Canada’s would have called for “universal and non-exclusive and open-licensing” that referenced data sharing and more expansive mandate beyond existing mechanisms).

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A new WHO study projects that up to 190,000 people in Africa could die and an additional 29-44 million could get infected by the Coronavirus in the first year if containment measures fail.
Harvard Professor Joseph Nye – one of the world’s leading scholars on global governance- examines the “abysmal failure of leadership” from the U.S. and China, urging that more global solidarity and recognition of mutual interest is essential to address the pandemic
In collaboration with DIGHR, the Ilisaqsivik Society, and Médecins Sans Frontières (Latin), SeeChange Initiative is launching a Community Roadmap planning tool today to support communities organize, prepare and respond to COVID-19. See:
- CommunityFirst COVID-19 Emergency Readiness Checklist
- What the Covid-19 pandemic is teaching us about community (STAT)
In a commentary, Nobel Peace Prize laureate, Kailash Satyarthi, highlights the compassionate work of community and civil-society groups working with vulnerable populations, urging G20 to increase international aid and coordination through UN agencies like WHO, UNICEF and UNOCHA.
A study in Lancet Global Health projects an additional 0.25-1.2 million children under 5 could die indirectly in the next six months as a result of the pandemic though disruption of health systems and decreased access to food. This would be the first increase in global child mortality since World War II. The researchers from Johns Hopkins also estimate that indirect maternal deaths could rise from 8% to 38%.
An analysis by the New York Times reveals spikes in fatalities across Latin America (including Brazil, Ecuador and Peru) that exceed the worst pandemic trajectories in Europe and the U.S. The Brazilian president, when asked about the death toll, replied “So what? What do you want me to do?”.
Amazon indigenous leaders warn of the potentially devastating effects of COVID-19 (New Humanitarian), where “no specific attention has been given to indigenous communities”.In Brazil, the potential effects highlight the lack of government support with food and health services. The former health minister of Ecuador, meanwhile, warns that “everyone is at risk” if marginalized communities are not able to afford basic health services, while officials in Mexico suggest that thousands of deaths are not being reported, obscuring the true toll of the COVID-19 epidemic.
China, South Korea and Japan are experiencing a resurgence in COVID cases, as the WHO and public health experts warn against lifting containment measures too early (CNBC)
- Authorities in Wuhan plan to test all 11 million residents over the next ten days after discovering new infections for the first time since its lockdown was lifted, prioritizing vulnerable groups and high-density areas (BBC)
Exceptionally heavy seasonal rains across East Africa since late April have resulted in widespread floods that caused a heavy loss of life and property, compounding the risks to human health and food security from the COVID-19 pandemic and the most serious desert locust invasion in decades. (WMO)
COVID19 epitomises why a “One Health” approach – which recognises the fundamental interconnectedness of humans, animals, and their shared environment- is key to ensuring the healthy and sustainable future of the planet. coChairs of the Lancet One Health Commission are calling for a COVID-19 One Health Research Coalition (Lancet)

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The doubling rate of confirmed COVID-19 cases dropped to once every 21 days from a high of once every 7 days on April 1. As some countries experience stabilizing or declining national death tolls, it has prompted attempts to loosen lockdown measures. This includes France, Italy and Spain, three of the world’s hardest hit countries (accounting for 20% of cases and a third of all COVID-related deaths worldwide). Germany is begun to relax lockdown measures, as face masks have become mandatory in public. The National Health Service of the United Kingdom set out a six-week plan to ‘return to normal’ following projections that the U.K. has ‘likely survived the first wave’ of the pandemic and will get close to testing targets. Despite a record daily increase in confirmed cases,South Africa restarted some mining operations, as India has also begun to ease lockdown measures following a drop in reported

As some Asian-Pacific countries such as Singapore experience major outbreaks in the second wave of transmission, hospitals across Europe have raised concerns. The WHO noted that many states also do not have adequate testing capacity needed to support a safe reopening strategy that can detect, trace and isolate new COVID transmission. China has meanwhile provided a guide on how countries can prevent a second wave, including compulsory masks in public, fines for failure to exercise public hygiene practices, as well as public markings for social distancing lanes.

The LSHTM is gathering data on hundreds of intervention measures from around the world to determine factors contributing to disease outbreak as well as relative effectiveness of control strategies. For example, to date, Hong Kong’s swift surveillance, quarantine and social-distancing measures – such as the use of face masks and school closures – helped to cut Coronavirus transmission with only 4 deaths in a (urban) population of 7.5 million. The LSHTM platform is being developed to support the WHO’s technical support to member states, and includes more than 1,100 volunteers, multiple universities, public health organizations and non-profits, including ACAPS which analyses humanitarian crises.

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A paper in Nature this week reports that Chinese scientists discovered RNA of the virus in tiny droplets in Wuhan hospitals, raising the possibility of airborne transmission. The range of clinical manifestations in patients that test positive for COVID-19 remains a public health challenge, with some remaining asymptomatic while others die quickly. Despite the more than 1,000 papers that are published every week, a Science articles concludes that a “clear picture is elusive, as the virus acts like no pathogen humanity has ever seen.”

The CDC this week added six new symptoms that may be linked with COVID-19. These include chills, repeated shaking with chills, muscle pain, headache, sore throat and a loss of taste or smell – in addition to previously listed symptoms (fever, cough and shortness of breath or difficulty breathing).

The number of cases in Russia has surged past 100,000 following a record daily increase that included its Prime Minister testing positive. The Prime Minister of Japan has also suggested the country is likely to extend the state of emergency past May 4. Yesterday, Chile announced that it will back away from plans to distribute immunity cards following warnings by the WHO of the lack of evidence of ‘sufficient immunity’ to COVID-19 that would prevent reinfection. In its daily briefing, the WHO also has urged countries to be vigilant and to avoid prematurely lifting control measures as early evidence of sero-epidemiological data suggests a significant proportion of infected people may have been missed by surveillance measures.

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Earlier today, China increased the number of COVID-related deaths in Wuhan by 50%, raising the country’s toll by 1,300 to 4,632. While the government claims this reflects updated hospital counts as well as those who died at home, the revision in the reported figures partially validates accusations of under-reporting, including by intelligence agencies. The broader challenge is that most models of the pandemic are based on prior figures from China and may need to be revised to reflect these significant adjustments.

In China, a cluster of cases linked to the Nigerian community in Guangzhou has also sparked alleged discrimination towards Africans by locals and virus prevention officials.

Asian-Pacific countries are beginning to experience second waves of infections, including Singapore which is reporting the highest case rate in the region (500 cases per million people). Despite these spikes, the “suppress and lift” strategy of aggressive testing, isolation, and contact tracing by countries such as Singapore and Hong Kong remains a model response and has helped prevent exponential spread.

In Iran, the number of reported cases and deaths approach 80,000 and 5,000, respectively. Fearing a protracted economic crisis, some “low-risk” businesses were allowed to open, prompting concerns of a second wave of infections. The government has asked for economic support and sanction relief from the IMF, which the U.S. has thus far blocked despite international pressure to sideline geopolitical tensions to allow countries to respond to the pandemic.

With 13,835 confirmed cases, India has become the third Asian country to surpass the 10,000 mark. Like in Pakistan (7,025) and Bangladesh (1,838), the true outbreak size is expected to be significantly higher in India due to varying testing and counting strategies. In India, the government has extended the nation-wide lockdown until May 3, while food shortages and a mass exodus from major urban areas has raised concern about local transmission in rural parts of the country. There are positive reports that some states like Kerala have managed to bend the curve by adopting “aggressive testing, contact tracing, and cooked meals.”

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Several countries have made adjustments to their official figures over the last couple days, including China adding over 1,300 uncounted deaths from Wuhan. The broader challenge is that most models of the pandemic are based on prior figures from China and may need to be revised to reflect these significant adjustments.

The U.S. CDC revising its case and death counts to reflect both confirmed and probable cases and deaths. With more than 675,000 total cases, the U.S. has more cases than the next four highest reporting countries combined, while accounting for almost 20% of all reported COVID-related deaths globally.

Revelations of significantly higher rates of transmission and deaths in elderly care facilities contributed to Canada becoming the 15^th country to report at least 1,000 deaths, as total cases spiked by 30% this week to over 30,000. While the Canadian government announced that control and border measures will remain for months to come, the U.S. President yesterday outlined a Federal Plan to open up the country to widespread criticism by public health experts and government officials across the country.

Total confirmed cases worldwide increased to 2.2 million, as the number of COVID-19 related deaths approach 150,000 as of Friday morning.

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On Monday, the Center for Health Security published a National Plan for Contact Tracing in the U.S. that estimates an“army” of 100,000 additional workers would be required. Meanwhile, healthcare workers have been disproportionately affected by the Coronavirus, and in multiple hospitals have been asked to work while possibly infected. There are also reports that the U.S. government is exploring surveillance measures adopted by some countries (including China and Israel) that may violate civil liberties, while troops are also reportedly being readied to assist with COVID public health measures.

Meanwhile, the U.S. CDC and Public Health Agency of Canada shifted its messaging by recommending face coverings in public where other social distancing steps are hard to maintain.

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Amy Maxmen, Nature News, 1 April 2020

https://www.nature.com/articles/d41586-020-00983-9

The threat of a COVID-19 explosion across developing countries continues to grow. While the first dozen cases in Africa were detected in March, the virus likely arrived weeks or months before. Despite the rising incidence of test positive cases, limited testing and contact tracing capacity, political leadership and resource mobilization from donor nations has been lacking, despite calls from the WHO and the UN Secretary General. Many countries face underfunded healthcare systems, unreliable stocks of essential medicines, precarious access to health facilities, and frequent power outages. The Ebola outbreaks also showed that when health systems are overwhelmed by one infectious disease, many often die from a lack of care for malaria, pneumonia and other preventable diseases, as well as care during pregnancy and childbirth. At the same time, case reports from the peak of the epidemic in Wuhan, China suggest that an estimated 2.6 ICU beds were required per 10,000 adults. Italy has less than half that capacity and is overwhelmed. Many low-income countries, including those in sub-Saharan Africa, have less than one ICU bed per million people. Given the lack of well-funded health systems, countries in Africa are focusing on mitigation strategies to prevent COVID-19 from spreading as soon as they confirm their first cases. This includes shutting down most activities with the threat of arrest, rolling out tests to detect genetic sequences from the virus and a willingness to deploy rapid, easy-to-use tests(even if they are not as accurate as PCR tests that require lab capacity), and sequencing the genome of SARS-Cov-2 sampled from Nigeria.

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