Category Archives: Corona Virus

Georgias health infrastructure makes Kemps choice particularly dangerous. Girtz worries about the states hospitals. His county has two, but because of rural hospital closures, he says theyre expected to provide services not just for residents of Athens-Clarke County, but for the entire 17-county region around them, home to some 700,000 people. A town like Elberton, 35 miles from us, or Commerce, just 25 miles up the roadthose were places where, a generation ago, you could have a baby, he said. Thats no longer true, and its also true they dont have the ICU beds there.

Few people in Georgia are eager to be a case study in pandemic exceptionalism, but many wont have a choice. Jillian Yeskel, the stylist in Roswell, whose Trump-supporting parents voted for Kemp, said shed had conversations with them in the past week that she couldnt have dreamed of a few months ago. Id assumed theyd support anything Kemp had to say, she told me. I talk to my mom every day, and were both just so upset with him. Theres no polling available on how Georgians feel about social-distancing measures in general, but Yeskels experience with her parents follows national trends: A poll conducted in mid-April by Morning Consult and Politico found that even most respondents who said they view Trump very favorably or voted for Republicans in the 2018 midterm elections wanted to continue social distancing for as long as necessary.

All Georgians can do now is try to protect themselves as best they can. If social distancing decreases because lots of businesses reopen, another deluge of COVID-19 cases could be inevitable. Because of how infections tend to progress, it may be two or three weeks before hospitals see a new wave of people whose lungs look like theyre studded with ground glass in X-rays. By then, theres no telling how many more people could be carrying the disease into nail salons or tattoo parlors, going about their daily lives because they were told they could do so safely.

In the meantime, local leaders whose municipal shutdowns have been overruled by state law are relying on other methods to keep their communities safe: disseminating information about testing, finding funds for food banks, creating grant programs to get a little bit of money to local businesses in need. For some, that includes duties both official and unofficial. On his walk home from city hall last week, Girtz said, he encountered his neighbors, a group of student roommates, enjoying the warm spring day. Hes lived in Athens a long time, and was worried that in a town known for revelry, a few people partying outside could turn into a lot of people partying outside. They were drinking beer on the curb, he recalled. I just had to say, Yall, enjoy your time to the degree that you can, but at least go up on the damn porch.

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Why Georgia Is Reopening Amid the Coronavirus Pandemic - The Atlantic

Pfizer says it will begin testing the experimental vaccine in the United States as early as next week, and says a vaccine could be ready for emergency use in the fall, the Wall Street Journal reported on Tuesday.

Mainz-based BioNTech reported that the first cohort of participants had been given doses of the potential vaccine, BNT162, in a Phase 1/2 clinical study in Germany.

"Twelve study participants have been vaccinated with the vaccine candidate BNT162 in Germany since the start of the study on April 23, 2020," the company said in a statement.

No information on the results is currently available. BioNTech said around 200 healthy volunteers aged 18 to 55 years old would be given doses ranging from 1g (microgram) to 100g to find the optimal dose for further studies.

"In addition, the safety and immunogenicity of the vaccine will be investigated," added the biotech company.

Pfizer and BioNTech plan to initiate trials for BNT162 in the US on regulatory approval, expected shortly, the statement said.

The German Federal Institute for Vaccines and Biomedical Drugs approved the trial -- the country's first clinical trial for a vaccine against Covid 19 -- on April 22.

"The two companies plan to jointly conduct clinical trials for the COVID-19 vaccine candidates initially in Europe and the U.S., across multiple research sites," Pfizer announced in its first quarter report, published online Tuesday.

"The companies estimate that there is potential to supply millions of vaccine doses by the end of 2020, subject to technical success of the development program and approval by regulatory authorities, and the potential to rapidly scale up the capacity to produce hundreds of millions of doses in 2021."

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Potential coronavirus vaccine being tested in Germany could 'supply millions' by end of year - CNN

Covid-19 has forced influencers to swap portraits of themselves in front of waterfalls in Bali with shots taken on the couch in their living room, and quirky coffee shops and upmarket gyms have morphed into homemade latte art and living room workouts.

But beyond the change in content is an even more significant shift. The marketing model that makes up most of an influencers income is falling apart, with brands pulling out of lucrative sponsorship deals and advertising revenue plummeting. As we face a new economic era, it is unclear whether the aspirational lifestyle lauded by influencers can emerge unscathed. Could coronavirus provoke a reconfiguration of the influencer age?

Over the past decade, influencer culture has reshaped how brands reach consumers the influencer marketing industry was worth around $6.5bn in 2019, and almost half of marketers spent more than 20% of their budget on influencer posts. The combination of accessible celebrity and trusted endorsement allowed companies to target their customers in a more tailored way.

Payment for posts reflected this businesses pay influencers with more than a million followers $10,000 or more for a one-off post endorsing their product.

Yet despite creating an innovative new model that defined a digital era, the influencer industry was not without its issues. A saturation of social media marketing recently led to backlash, with many stars being forced to refocus their brand to appear more authentic after fears that they were alienating their fans with heavily posed and paid-for posts. High-profile scandals also rocked the industry, such as the Gabriel Grossman and Marissa Casey Fuchs surprise social-media proposal, which the Atlantic uncovered as having been pitched to brands, heavily staged and sponsored, and the now infamous Fyre festival which saw influencers being paid thousands of dollars to promote an event that had barely been organized and left attendees stranded on a beach in the Bahamas.

2020 should have been the year for influencers to get back to their followers desire for realness. Instead, because of Covid-19, many influencers are being forced to focus on simply surviving 2020s economic downturn rather than taking the chance to grow their businesses.

Due to the disruption in business operations a lot of companies are facing financial challenges, explains Shane Barker, a digital strategist who offers consultancy services for companies using social media to boost their brand, and influencers hoping to reach the right brands and monetize their follower count. In light of that, they are cutting down on all unnecessary expenses. Some are barely able to pay their employees, let alone hire influencers.

One of Shanes clients, Chris Ruden, is a bodybuilder and amputee who uses his platform to share content on overcoming adversity. As one of many influencers who relies on speaking engagements and events to make up some of his income, Ruden has already experienced disruption as a result of coronavirus measures.

I had 28 events scheduled for the year; 95% of them had been postponed, he says. It has made me hit the drawing board to find different ways to give me value that are pandemic proof. Ive resorted to funny content and eased up on motivational content after all, you cant inspire someone and fire them up just to watch Netflix.

While some popular influencers have attracted death threats after sharing images of glamorous trips despite social distancing measures, Barker believes that more sensitive content is crucial in order for influencers to future-proof their brand.

Influencers should create content that resonates with the current situation that people are in, he says. This does not mean that influencers from all industries should just start writing and talking about the pandemic. What I mean is that they should create content relevant to their niche, but keeping in mind what people are going through.

People want to see home content right now as its relatable and we are all in the same boat

Although 69% of brands expect to decrease their advertising spend this year, the amount of time that we are all spending on our devices also means that social media engagement has increased. In a time of crisis, people are also looking online to feel less alone. Lifestyle influencer Em Sheldon recognizes that and has tailored her content accordingly.

Ive always loved sharing workouts and healthy recipes, so for me its been more of an adaption, she says. People want to see home content right now as its relatable and we are all in the same boat. With more eyes now online, people are scrolling more than ever, so actually, as long as its fitting, authentic and tasteful, now is a great time to work with influencers.

Some even believe that this renewed awareness of authentic versus paid posts and the shift away from brand promotion is a good thing.

Biased product reviews were threatening to poison the well as people started to become disenchanted with self-serving influencers who had lost their objectivity, says Michael Solomon, marketing professor and author of Social Media Marketing. Where possible, influencers need to revert to a more altruistic message and find ways to help get through the crisis with constructive suggestions. In times of instability, people look to trusted sources and those that deliver will be remembered after the crisis is over.

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The pandemic and the influencer: will the lifestyle survive coronavirus? - The Guardian

Health Secretary Matt Hancock asserted on Friday that it had met a headline-grabbing aim of conducting 100,000 daily Covid-19 tests by the end of April. The figure was 122,347, he said -- although officials conceded that 40,369 of those were sent to people's homes or to satellite testing centers, and had not necessarily been processed by labs.

The government argued, with some justification, that the huge expansion in testing capacity -- up from 10,000 a day at the beginning of April -- was a huge achievement.

But the fact that the target was needed at all, critics say, only served to illustrate the inadequacies of Britain's testing regime in the first place.

"This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided by the best scientific advice," a government spokesperson told CNN, in response to a request to address the criticisms raised in this article. Ministers and officials have been "working day and night to battle coronavirus, delivering a strategy designed to protect our NHS and save lives," the spokesperson said. "We have provided the NHS with all the support it needs, [and] made sure everyone requiring treatment has received it."

But could more have been done to prevent the scale of loss of life? Should ministers have acted sooner? And could there be more transparency in the overall strategy?

A crucial date

Historians might look back on March 12 as the most significant date in Britain's coronavirus response. This was the day the UK formally abandoned the "contain" phase -- an attempt to stop the virus in its tracks by tracking every outbreak and tracing its origins; and moved to the "delay" phase -- an effort to "flatten the curve" and prevent the health service from being overloaded.

As he spoke, tens of thousands of people gathered at the Cheltenham racecourse for its annual festival, an early fixture in England's social calendar. Was that wise, he was asked? "It is very important that we're guided by the science," Johnson said, using a phrase that was to become a favorite of government ministers. "There is very little epidemiological or medical reason at the moment to ban such events."

Johnson's chief medical officer, Professor Chris Whitty, admitted that even people with "really quite mild symptoms" could be contagious. Despite this, the chief scientific adviser, Patrick Vallance, agreed with Johnson that canceling large events was "not a major way to tackle this epidemic."

Indeed, the next day, Vallance told BBC Radio 4's flagship morning news program, in a now-infamous interview, that a "key" aim would be to "build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission." Government sources have told CNN that herd immunity was never official policy.

Three key questions

Critics are zeroing in on three key areas as they seek to find out what went wrong in the UK.

First, there was the abandonment of mass testing.

At the start of the outbreak in the UK, public health officials tracked and traced every known case. Ministers have never offered a clear reason for why that policy was abandoned. Was it because the testing capacity had been reached? Was it because the system could not cope with the expected upturn in demand? Was it structural, since the public health system in England has, over the years, gradually been centralized?

"Abandoning testing gave the virus the green light to spread uncontrollably," says the Royal Society of Medicine's Gabriel Scally. "If you don't have access to testing, you won't know that you have an outbreak until a lot of people are ill."

Some in the scientific community say an obsession with central control led officials to set up the testing regime initially in just a few labs, rather than allowing local hospitals to do it themselves.

"Sadly, it seems likely to me that once the government models showed how bad the crisis would be, our testing capacity wouldn't be anywhere near able to cope with the coming surge," a leading microbiologist told CNN on condition of anonymity to describe confidential discussions. "God only knows what their thinking was not telling hospitals to get ready. It was a mistake." Downing Street declined to provide an on-the-record explanation to CNN on this issue.

The second crucial question is whether the government failed to order a lockdown early enough.

Even though the government did not know by that March 12 briefing just how many people were infected, Whitty said it was still too early to lock down because "if people go too early, they become very fatigued." If tough restrictions came too early, the theory went, the British public would begin to tire of it just as they were starting to become effective, and demands for them to be lifted would become impossible to resist.

Government sources defended that course of action to CNN, pointing out that some mitigation measures were put in place between March 12 and the full lockdown on March 23, like advising vulnerable groups to stay at home and requiring people with certain symptoms to self-quarantine.

The third big question is the pursuit of so-called "herd immunity."

"It's not possible to stop everybody getting it," said Vallance at the March 12 briefing. However, the experience of countries like South Korea and Germany, where testing and tracking systems have been significantly more rigorous, and in New Zealand, where lockdown measures were taken at a much earlier stage, suggest that it has been possible to stop quite a large number of people from getting it.

Medical experts both inside and outside the government's circle of trusted advisers have admitted to CNN that they believe the government waited too long to enter lockdown. "Many of the decisions the government has made ignore basic public health science," says Dr. Bharat Pankhania, senior clinical lecturer at University of Exeter. "From abandoning track and trace, to the timing of the lockdown, to providing the correct protective equipment, ignoring basic public health science may have led to more deaths than necessary."

Pankhania believes that despite government claims it has been guided by science at every step, the decision to delay lockdown was likely "governed by economic consideration, rather than public health science."

This conflict between the government's claim that it has followed the science from day one, and some in the scientific community's skepticism as to how good that evidence is, has become a key battlefield between those inside and outside the UK government.

Following the science

This secrecy has led to speculation from prominent members of the public health community about the quality and breadth of evidence that is reaching the top levels of government. "The government's decisions show no characteristics of public health input. I wouldn't be surprised if the public health voice was marginalized both within SAGE and in government," says Scally, of the Royal Society of Medicine.

It's "driving the public health guys mad," said another scientist who has contributed to the UK's National Risk Register, an overview of the potential threats facing the UK.

Another criticism of the process has been that the government has at times even sidestepped the normal groups of scientific advisers. "Things are moving so fast that they're rather going direct to the modelers," said Openshaw. "The epidemiological modelers have got a very direct line into government."

However trivial it might seem, disagreements between public health experts and scientific modelers are a significant part of the story. "We're seeing a struggle that has been going on for about 20 years between modelers and epidemiologists," a scientist who advises SAGE told CNN on the condition of anonymity to discuss confidential government business.

It's no secret that Dominic Cummings, Johnson's top adviser, has a personal interest in scientific modeling. So it's little surprise that public health experts were enraged when the government was forced to admit last week that Cummings had attended SAGE meetings, which are supposed to be independent advisory forums. The government said he attended in order to understand the scientific debate around the virus and its behavior.

Multiple members of SAGE and groups that advise it defended their impartiality to CNN. "The debate is robust, and everyone sets out their case clearly and articulately," said one member, requesting anonymity to discuss sensitive matters. "There are lots of people criticizing from the sidelines, but I think it's possible those people are angry they have been left on the sidelines."

A source who advises SAGE said: "Frankly, I find it hard to see that the presence of Cummings makes much difference. We're not talking about shrinking violets."

However, the source went on to express concern at how scientific evidence is being presented. "Science is not homogenous... The best SAGE can do is present imperfect material. The government has been able to take advantage of the public view of science as a voice of certainty, and present some of its decisions as being taken with more concrete certainty than they have."

This has prompted fears that at some time in the future, the government might try hiding behind the science for decisions they've taken -- or worse, throw members of SAGE under a convenient bus. "It certainly does seem to be an anxiety of some of my colleagues, but I am less worried. Many politicians are not exceptional thinkers. Should a public inquiry come, I would be surprised if it's the scientists who do a bad job of making their case," said a member of SAGE.

That public inquiry seems inevitable, once the worst of the crisis is over.

And when it comes, the government will stick to its line that the decision to prioritize the protection of the NHS was the right course of action, and that it succeeded. While it's true the NHS didn't fall over during what look like the worst weeks of the crisis, a cynic might claim that focusing on hospitals ignored what was happening in the wider community.

"People might well reply that it protected the NHS at the expense of shifting deaths elsewhere. Not to mention the physical and mental suffering experienced across the country," said one of the scientists advising SAGE.

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Where did it go wrong for the UK on coronavirus? - CNN

Tripoli, Lebanon (CNN) -- A large bag of the thistly gundelia plant arrives at Um Ahmad's door as it does nearly every day. Wearing a double layered headscarf, she settles into a blue armchair. She has until the afternoon to trim the spines off the wild plant for her customers to cook.

"We work on the akoub (gundelia) so that we can live," says Um Ahmad, using a pseudonym.

When visitors walk into her dark, cavernous room to meet her, she doesn't even look up. A drama series blasts from an old TV.

"The akoub doesn't even come every day," says Um Ahmad, never meeting her guests' eyes.

Um Ahmad lives beneath a centuries-old souk (or marketplace) in Lebanon's northern city of Tripoli.

Outside, the city roils with violent demonstrations, known as the "hunger protest." These started just as Lebanon was loosening its coronavirus lockdown, and beginning to contend with poor living conditions exacerbated by the near shutdown of the economy.

Nightly confrontations between demonstrators and the Lebanese army have rocked Tripoli over the last week, turning it into the epicenter of the country's renewed uprising against its political elite.

Tripoli is the poorest city in Lebanon, despite being home to some of its most high-profile billionaires. A slum stretches across the banks of the city's Abu Ali river, just minutes from pockets of extravagant wealth. The income disparity was always stark, but these days, Tripoli's locals say it is unbearable.

"No one has trust in the banks. No one has trust in the state. There's injustice, there's shame and there's oppression," says Ahmad Aich, who runs a shoe stand.

Aich's voice rises to a crescendo. As with many Tripoli natives, the conversation begins with the soft tones of a city folk known for their kindness to strangers, but quickly turns into a tirade about living conditions.

"The solution is for the army chief to round up all the politicians who robbed this country and to put them in jail," says Aich. "They pillaged the country and killed it and killed its people."

Calls for the army to deliver justice echo across Tripoli even as demonstrators hurl stones, fireworks and Molotov cocktails at the armed forces. The military has responded with brute force. It has fired tear gas and rubber bullets, and, in some instances, live fire, at protesters, killing one on Monday and wounding dozens over the last week.

"The army are our brothers. What we want is for them to join us, take the politicians from their houses, and throw them in the garbage dump," says protester Ghassan, a 24-year-old handyman and a father-to-be who asked not to disclose his full name for security reasons.

"If your child is hungry, you will eat your rulers to feed your children," he adds.

Rising poverty

It is a dramatic drop in living standards for a country which in 2018 had the highest GDP per capita among the Arab world's non-oil producing nations.

In recent weeks, the Lebanese lira lost over half its value, hurting both merchants and consumers. Small shop owners are struggling to secure supplies, and the country's growing legions of poor people can't afford to buy them.

In Tripoli, many people say that most staple goods have at least doubled in price, making the working class increasingly reliant on aid from charities.

Amer El-Deek, 30, used to own a shoe stand and made ends meet with a daily income of $10. Now, he says, all he can do is beg and rely on food packages from an Islamic charity.

"We don't know how we're even alive," says Deek, the father of a six-year-old. "I now go to sleep and think: God, I hope I don't wake up. I hope I die tomorrow."

'Hunger protests'

When the "hunger protests" kicked off last week, few were surprised. "I see that a revolution of the hungry is coming," Hezbollah-backed MP and former intelligence chief Jamil El-Sayyed tweeted in December.

The uprising's largely peaceful protests turned violent after a nearly two-month respite due to coronavirus. In Tripoli, protesters staged large demonstrations outside politicians' homes vowing to avenge their alleged corruption. Nearly every bank branch in the city has been damaged by the protests, with demonstrators voicing their fury at the banking sector's discretionary capital controls.

On any given work day, long queues of people begging to withdraw their cash can be seen outside bank branches. Lebanese authorities have resisted calls to formalize capital controls, raising suspicions that the economic elite in Lebanon have been exercising their influence to remove their funds from the country, while small depositors are largely denied access to their life savings.

Young and old head to Tripoli's protest sites after Ramadan's Taraweeh prayers, which are performed after the fast is broken during the holy month.

They arrive on mopeds, gather in crowds and yell protest chants. Most do not wear face masks, and no one is observing government-mandated social distancing rules. That's because most of the people on Tripoli's streets believe that coronavirus doesn't exist here.

The lockdown has stoked resentment, fueled rumors of a government conspiracy to further impoverish the poor and ultimately ignited the protests.

"We don't have coronavirus here in Tripoli. Coronavirus is a heresy. (The politicians) made it up," says one city native, Marwan el-Zahed.

"What do I care about coronavirus," says another Tripolitan, Ahmad Abou Abdallah. "(The politicians) are worse than coronavirus. They are dirtier than coronavirus. They are making people hungry. Doesn't that make them worse than the virus?"

Fourteen cases of the coronavirus have been reported so far in Tripoli. In total, Lebanon has had 740 confirmed cases of the virus and 24 deaths. It has received some credit for a largely successful bid to contain the virus.

Underground, Um Ahmad is too busy working on her gundelia to talk politics. She has also lapsed into disillusionment.

"My situation is just as you see it," she says, gesturing to her home's conditions. "Sometimes I empty the pulp of zucchini for people. But also that doesn't come every day."

Originally posted here:

'If your child is hungry, you will eat your rulers to feed your children' - CNN

She was just 12 when she dropped out of school and began clocking in for endless shifts at one of the garment factories springing up in Bangladesh, hoping to pull her family out of poverty.

Her fingers ached from stitching pants and shirts destined for sale in the United States and Europe, but the $30 the young woman made each month meant that for the first time, her family had regular meals, even luxuries like chicken and milk.

A decade later, she was providing a better life for her own child than she had ever imagined.

Then the world locked down, and Shahida Khatun, like millions of low-wage workers around the world, found herself back in the poverty she thought she had left behind.

In a matter of mere months, the coronavirus has wiped out global gains that took two decades to achieve, leaving an estimated two billion people at risk of abject poverty. However indiscriminate the virus may be in its spread, it has repeatedly proven itself anything but that when it comes to its effect on the world's most vulnerable communities.

The garment factory helped me and my family to get out of poverty, said Ms. Khatun, 22, who was laid off in March. But the coronavirus has pushed me back in.

For the first time since 1998, the World Bank says, global poverty rates are forecast to rise. By the end of the year, half a billion people may be pushed into destitution, largely because of the pandemic, the United Nations estimates.

Ms. Khatun was among thousands of women across South Asia who took factory jobs and, as they entered the work force, helped the world made inroads against poverty.

Now those gains are at grave risk.

These stories, of women entering the workplace and bringing their families out of poverty, of programs lifting the trajectories of families, those stories will be easy to destroy, said Abhijit Banerjee, a professor at the Massachusetts Institute of Technology and a winner of the 2019 Nobel Prize for economics.

While everyone will suffer, the developing world will be hardest hit. The World Bank estimates that sub-Saharan Africa will see its first recession in 25 years, with nearly half of all jobs lost across the continent. South Asia will most likely experience its worst economic performance in 40 years.

Most at risk are people working in the informal sector, which employs two billion people who have no access to benefits like unemployment assistance or health care. In Bangladesh, one million garment workers like Ms. Khatun 7 percent of the countrys work force, and many of them informally employed lost their jobs because of the global lockdowns.

For Ms. Khatun, whose husband was also laid off, that means that the familiar pangs of hunger are once again filling her days, and she runs into debt with a local grocer to manage even one scant meal of roti and mashed potato a day.

The financial shock waves could linger even after the virus is gone, experts warn. Countries like Bangladesh, which spent heavily on programs to improve education and provide health care, may no longer be able to fund them.

There will be groups of people who climbed up the ladder and will now fall back, Mr. Banerjee, the M.I.T. professor, said. There were so many fragile existences, families barely stitching together an existence. They will fall into poverty, and they may not come out of it.

The gains now at risk are a stark reminder of global inequality and how much more there is to be done. In 1990, 36 percent of the worlds population, or 1.9 billion people, lived on less than $1.90 a day. By 2016, that number had dropped to 734 million people, or 10 percent of the worlds population, largely because of progress in South Asia and China.

Since 2000, Bangladesh brought 33 million people 20 percent of its population out of poverty while funding programs that provided education to girls, increased life expectancy and improved literacy.

Famines that once plagued South Asia are now vanishingly rare, and the population less susceptible to disease and starvation.

But that progress may be reversed, experts worry, and funding for anti-poverty programs may be cut as governments struggle with stagnant growth rates or economic contractions as the world heads for a recession.

The tragedy is, its cyclical, said Natalia Linos, executive director of Harvard Universitys Franois-Xavier Bagnoud Center for Health and Human Rights. Poverty is a huge driver of disease, and illness is one of the big shocks that drive families into poverty and keep them there.

When it comes to a pandemic like the coronavirus outbreak, Ms. Linos said, the poor are even more outmatched than people with means. They cannot afford to stock up on food, which means they must go more frequently to stores, increasing their exposure. And even if they have jobs, they are unlikely to able to work from home.

A resolution that committed the United Nations to eliminating poverty and hunger and providing access to education for all by 2030 may now be a pipe dream.

More than 90 countries have asked the International Monetary Fund for assistance. But with all countries hurting, well-to-do nations may be too strapped to provide the aid the developing world needs or offer debt forgiveness, which some countries and aid organizations are calling for.

To avoid having large chunks of their population slipping into devastation, countries need to spend more, Mr. Banerjee said. In times of crises, like after World War II, economies rebounded because governments stepped in with big spending packages like the Marshall Plan.

But so far, economic stimulus packages and support for those newly out of work have been weak or nonexistent in much of the developing world.

While the United States has committed nearly $3 trillion in economic stimulus packages to help the poor and small businesses, India plans to spend just $22.5 billion on its population of 1.3 billion four times the size of Americas. Pakistan, the worlds fifth-largest country, has committed about $7.5 billion, far less than Japans $990 billion stimulus package.

In Bangladesh this week, several hundred garment factories decided to reopen a move almost certain to worsen the countrys coronavirus caseload.

Ms. Khatuns employer, however, remains shuttered.

The owner told employees that even after the pandemic, he may no longer have work for them. The demand for clothing in Western countries may drop if people have less to spend, he said.

Ms. Khatun worries she and her family will be evicted from the small room they rent, with a bathroom and kitchen they share with neighbors.

If they are thrown out, she said, they will return to the village she left a decade ago as a child determined to to improve her lot in life.

My only dream was to ensure a proper education for my son, she said. I wanted people to say, Look, although his mother worked for a garment factory, her son is well educated and has a good job.

That dream is now going to disappear.

Julfikar Ali Manik contributed reporting from Dhaka, Bangladesh.

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Millions Had Risen Out of Poverty. Coronavirus Is Pulling Them Back. - The New York Times

We log in every day at 7.45am. One by one, we join an array of faces on our screens. We doctors arent used to video-conferencing like this, and still greet each other with excited waving hands. Since the coronavirus crisis began, these daily virtual meetings have proved an invaluable way to keep up to speed on clinical guidelines, in-house protocols and staff wellbeing all of which are changing every day.

But these meetings also bring us news that we take more personally: how many of our patients have symptoms? How many have tested positive? How many have died? These are important questions, for sure, but my public health training reminds me to think globally. The coming year will see developments that will allow us to bring the virus under control in the west, but what about in other countries? I cannot help but think of my relatives in India, and what this pandemic will mean for them not just now, but in the future. The really important question is not who will die of coronavirus tomorrow, but in 200 years time.

For coronavirus is not the only pandemic the world faces. There is another one raging right now. Since cholera first spread across the globe, two centuries ago, it has killed about 50 million people. In the time it takes you to read this article, another five people will have died from it. It is now mostly ignored in the west, but in other parts of the world, it has never gone away.

While I will surely be able to offer my patients in England a coronavirus vaccine in a year or two, and while western health systems will be reinforced to be more ready for a potential future outbreak, I worry that we may repeat the mistakes of cholera: conquering coronavirus everywhere except for the poorest parts of the world.

To reach my grandparents house in Bihar, in north-east India, you have to take a car from Patna airport across one of the longest river bridges in the world, the Mahatma Gandhi Setu. This bridge takes you north over the river Ganges, past Hajipur, a city famous for its fragrant bananas, and up to Darbhanga, near the border with Nepal. When I was a child, the road was so damaged by the regions regular floods and monsoons that the journey, which would take just two hours in the UK, took seven hours, bumping over gut-lurching potholes. Today, the road is smooth and elevated, giving a spectacular view of the areas lush flood plains. They provide the perfect conditions for cultivating the fruits mangoes, lychees and guava that still flavour my memories of visits to my grandparents.

The wet, semi-tropical conditions in the Ganges delta also make it a hotspot for water-borne diseases. And it is in northern India that cholera is thought to have originated several millennia ago, owing to the abundance of still water pools and Hindu ceremonies involving worshippers washing themselves in rivers. A 2,000-year-old inscription at a temple in Gujarat vividly describes the clinical picture of patients afflicted by severe cholera: The lips blue, the face haggard, the eyes hollow, the stomach sunk in, the limbs contracted and crumpled as if by fire.

In the 19th century, the scientist Max von Pettenkofer believed, incorrectly, that cholera required certain soils and environmental factors unique to India, and so thought that it could not be contagious or endemic in Europe. But the persistence of cholera in this area has less to do with climate and more to do with political choices.

Cholera is an infectious disease that turns on all the taps in your gut, so that water and salts pour out of your system, giving you copious watery diarrhoea that looks starchy, like rice water. This diarrhoea helps the infection spread between people, leaving a trail of victims so severely dehydrated that, if they dont receive treatment, they shrivel up like prunes within hours.

For centuries, cholera only caused localised epidemics in north-east India. That was until 1817, when one of these outbreaks, originating in Bengal, spread across the world, starting the first of seven cholera pandemics. But just as Wuhan cannot be blamed for the current Covid-19 pandemic, we cannot hold this region responsible for choleras spread, any more than North America should be blamed for the 2009 H1N1 swine flu pandemic, which originated in industrially farmed pigs. What the spread of these diseases has in common is international trade, and the movement of animals and people that comes with it.

Empire shaped the history of cholera, and it was the economic concerns of imperial powers that brought cholera to heel in the west. But if imperialism was crucial to providing the impetus to end cholera, it also produced a logic that divided the world and only eliminated the disease from one half.

In his book Plagues and Peoples, the historian William Hardy McNeill describes how the British army carried cholera overland into Nepal and Afghanistan, while British navy and merchant ships carried it beyond the Indian Ocean. That is how the first pandemic spread from the Bay of Bengal to south-east Asia, the Middle East, east Africa, and then to Europe by the early 1820s.

In 1831, cholera reached the north-east of England, the region where I grew up. One of the first victims, in Sunderland, was a 12-year-old girl called Isabella Hazard. Her illness was characteristically swift: she was entirely well one evening and dead the next afternoon. She was an early victim of the first of a series of waves of the disease that caused pandemonium in 19th-century Europe. Port cities, crucial to trade, were affected particularly badly.

It is hard to imagine the panic created by the Blue Death, as cholera was nicknamed, because at the time its cause was a total mystery. The most common theory that the disease was associated with bad airs (or miasmas) inspired desperate experiments to control it. In Kingston, Jamaica, for instance, British colonial officers tried to banish the disease by firing cannons through the streets to destroy the morbific power that lurked in the dark alleys.

So cholera went on, unabated, in wave after wave of pandemics throughout the 19th century, causing millions of deaths, mainly in poor neighbourhoods. The working classes rioted across Europe, suspecting the disease was a conspiracy by the ruling elite, who they thought were poisoning them. In the 1830s, the revolutionary Mario Adorno accused the Bourbon royal family of concocting a devilish plot bent on poisoning the people of Sicily with cholera, as part of his attempt to topple them.

But disasters like pandemics are never just destructive they also induce change, and often spark scientific developments and social reforms. The European imperial powers eventually started pouring resources into discovering the true cause of the disease, primarily to prevent the catastrophic economic downturns that accompanied every fresh outbreak. This investment led to three major developments that helped end cholera in the western world: reforms that improved public health, to stop populations getting the disease in the first place; the discovery of new medicines, to prevent and treat the disease; and international cooperation, to unite against a common enemy.

In 1813, Frances Snow gave birth to her first child, John, in York. She and her husband, William, who worked at the local coal yard, raised John in one of the poorest parts of the city. Like Bihar in India, the area John grew up in was regularly affected by flooding, when the River Ouse broke its banks.

When John became a doctor, he grew sceptical of the idea that cholera was caused by miasmas. Instead, he suspected it had something to do with water. He famously proved his theory in 1854, during an outbreak in Soho which killed 616 people. He created a dot map of all the cholera cases in the area and spoke to the families to understand their daily habits, meticulously doing what we would today call contact tracing. He discovered that nearly everyone who had been afflicted used the same water pump on Broad Street. Snow had the handle of the pump removed, making it unusable, which led to a sharp decline in cholera cases in Soho. It was later found that this particular well was shallow and had been contaminated by a nearby cesspit. In one elegant experiment, Snow had unveiled the spectre of cholera, which had haunted him since his childhood: the cause was just plain old dirty water.

This was a problem for colonial powers, because their cities and colonies were unsanitary places. Rapid industrialisation had impoverished both English and Indian rural workers, triggering mass migrations to cities for work. Provided with no public amenities, these new migrants built makeshift homes in unhygienic and polluted slums. Snows revelations led to the creation of Improvement Trusts and a Commission for Public Health in major cities across India, and these did improve the sanitary conditions, but largely only for British expats and colonial officers. By the end of British rule, clean water was available to nearly all British citizens in India, but only 1% of Indians outside the colonial walls.

Today, more than half of Indian households have no access to any kind of formal sanitation, meaning that they must defecate in the open, and 70% of sewage is untreated when it re-enters rivers and streams. As a result, up to 30,000 people in India die from cholera every year. Those who can afford it resort to digging their own water wells, deep into the ground. Given the trouble and expense my grandparents went to do this, I know the fact that their well-water still gives me an upset stomach, forcing me to drink bottled water when I visit, brings them great shame. But it isnt their fault; there is only so much individuals can do when their government refuses to invest enough to ensure clean water for all its people.

John Snows discovery was the first step towards halting cholera. But as the pandemic continued to ravage Europe, effective medicines were needed to prevent and treat the disease. And those could only be developed once scientists understood how dirty water made us sick.

In Florence, a contemporary of Snows spent his days with his eye pressed up against the cold brass ring of a microscope that he himself had designed. Filippo Pacini was a professor of pathology and a pioneer in the kingdom of the tiny; he had a gift for the new art of microscopy and was naming previously undiscovered parts of the human body when he was only 19. He was convinced that the cause of many medical mysteries, like the ones that afflicted his sisters for most of their lives, could be found through careful observation with this powerful new tool.

Pacini studied the organs of four patients who had died of cholera. He pored over their intestines with his microscope, and noticed the same thing was wrong in each. The lining of their gut was highly abnormal: not pink and rubbery as it should be, but pale and coming off in floppy sheets, like soggy newspaper. When he teased apart this lining with a tiny probe, he noticed that multitudes of tadpole-like dots emerged from the tissue.

Pacini recognised that these dots which he called vibrios (commas), because of their shape must be the cause of cholera. He was the first person to observe for certain what had been speculated for centuries: that diseases could be caused by things too small to see by the naked eye. However, the scientific community failed to appreciate the value of his research, and his findings languished, largely ignored, for another three decades.

Pacini had discovered the germ, but it was not until the German physician Robert Koch himself discovered the comma bacillus in Egypt in 1883 that germ theory became popularised. During the following century, further research led to two crucial targeted therapies, based on breakthroughs by scientists from the Indian subcontinent shortly after it gained independence. In 1953, Hemanda Nath Chatterjee developed a simple mix of salt and sugar that could be added to water to safely replace the copious fluids lost as diarrhoea. The basic recipe is still used today.

Six years later, Sambhu Nath De discovered that cholera released a poisonous toxin, which deserved just as much attention as the bacterium itself. Using modest equipment in a laboratory in Kolkata, he showed that the bacteria were not needed to make people sick. If they were stewed in a soupy culture, then removed like whole spices even just the remaining broth was enough to cause life-threatening intestinal damage and give all the symptoms of the disease.

These discoveries transformed our understanding of cholera, and how it could be treated. They provided the basis of two new medicines: oral rehydration therapy, to replace lost salts; and a cholera vaccine, to induce an immune response against the bacteria and its toxin.

Today, its easy for westerners to get their hands on the most effective vaccine, Dukoral. Using it simply involves adding a vial of the liquid vaccine to water, together with a sachet of a granulated buffer that protects the vaccine from stomach acid. Its no harder than adding milk and sugar to tea. Two doses will induce an antibody response that will protect you for about five years. But Dukoral cannot be used in the areas where cholera is most prevalent, because they dont have access to clean water, so taking the medicine could actually put people at risk. Besides, it is unaffordable in those places; to earn enough to pay for two doses, the average Briton would have to work for less than an hour, while the average Indian farmer would have to work for three whole days.

There are other, cheaper cholera vaccines, such as Shanchol, which is manufactured by Shantha Biotechnics in India. This has the advantage of not needing any extra water, as it is poured directly into the mouth. But it is not as effective as Dukoral, as it does not protect you against the toxin, just the bacteria. Plus, it still requires two doses given two weeks apart. Thats hardly feasible for healthcare workers trying to cover vast areas of rural India.

There are many other obstacles to cholera vaccination programmes. To be effective, they must reach enough of the population to achieve herd immunity. This requires accurate surveillance, which is impossible without a strong and centralised public health system. Like the other countries where cholera is still endemic, India lacks this infrastructure, largely owing to the long shadow of colonial extraction, post-colonial debt, and loans granted by the IMF and the World Bank in the 1990s on the condition that the government reduce its spending, which led to cuts to public health and education programmes the very things that a society needs to haul itself out of the conditions that stoke cholera.

So although the World Health Organization (WHO) recommends the use of the cholera vaccine in areas where cholera is endemic, and despite the existence of an easy-to-use vaccine which is manufactured in their own country, my relatives in their remote village in Bihar have not had it. But if I, as a westerner, want to visit them for a week, I can easily get it in the UK.

Oral rehydration therapy and the cholera vaccine have greatly reduced choleras reach in subsequent decades, but it has not gone away completely. Two years after Sambu Nath Des seminal research, a new pandemic the seventh sprung up in Indonesia and took hold in Asia and north Africa. This pandemic is still ongoing. More than a billion people live in countries at risk of the disease which, by no coincidence, are some of the poorest countries on earth.

In the two decades after cholera first reached Europe, individual European nations, acting in isolation, tried in vain to prevent and contain it. But there was no point cleaning up port cities at great expense when you could not vouch for the sailors and cargo flowing through it. They eventually realised that a problem caused by globalisation required an international solution.

This led to the first example of global cooperation in order to combat a disease. In 1851, the first International Sanitary Conference, convening the major European imperial powers, was held in Paris. Still, it took time for all those gathered to reach a consensus, and the first International Sanitary Conventions were not adopted until 1892.

According to Anne-Emanuelle Birn, a professor at the University of Toronto School of Public Health, trade was the driving motive of these meetings, and public health just a necessary means. They proved successful: transnational interventions, such as quarantine and disease surveillance by international health bureaux, did bring down cholera deaths. These International Sanitary Conferences proved the power of international cooperation to improve health and boost the economy, and provided the blueprint for the Health Organization of the League of Nations, and later the WHO.

Perhaps the greatest achievement of this cooperation came in 1979, when smallpox was eradicated globally. But unlike smallpox, cholera has not been eradicated not because of some insurmountable biological hurdle, but because we have thrown our weight behind schemes that focus solely on cholera, rather than trying to end the poverty that makes such diseases likely. There are still about 3 million cases and 100,000 deaths from cholera every year, all entirely preventable. Based on recent estimates, from 1 January to 25 March of this year, cholera claimed more lives than the coronavirus. But we are saying so much about coronavirus and so little about cholera because coronavirus has broken the unwritten rule that dangerous infections should not befall those in the west.

A map of the places still struggling with cholera shows 47 countries in Central America, sub-Saharan Africa and southern Asia. This might seem to confirm that tropical countries are bound to nurture this bacteria, because of their warm climates and high population density. But the experience of the Marshall Islands, a remote Pacific archipelago that suffered a cholera outbreak at the end of 2000 and start of 2001, shows that there is nothing inevitable about where the disease takes its toll. As the University of Hawaii researchers Seiji Yamada and Wesley Palmer have shown, two neighbouring islands there experienced very different fates despite having similar climates and being just four miles apart.

The US maintains a military base on Kwajalein Island, where the menial labour is carried out by low-paid workers who live on another nearby island, Ebeye. Many of them are descended from refugees from other islands in the archipelago who were displaced by US weapons testing in the 40s and 50s. The housing and infrastructure provided to them on Ebeye by the military is not much better than a slum. The average household is home to nine people, so infections spread rapidly. The sewers pour their contents into lagoons where people swim and fish, and when it rains they overflow into the streets.

At the time of the outbreak, there was no running water on Ebeye. Furthermore, since the land there was not fit for agriculture, traditional Marshallese ingredients were unavailable, and nearly all food was imported, unhealthy and expensive, leaving many malnourished. It was a ship bringing food to the island that is thought to have started the outbreak of 2000-2001.

On Kwajalein Island, meanwhile, the residents are almost exclusively American expats who work for private military contractors. They live in detached villas with amenities like those of a beach resort, and the population density is 20 times less than that on Ebeye. Once the outbreak had begun, workers were only allowed to commute from Ebeye to Kwajalein if they could prove that they had received vaccination or prophylactic antibiotics. During the cholera outbreak, there were 400 cases and six deaths on Ebeye. However, on Kwajalein there was not a single case.

What made contracting cholera so likely on Ebeye and so unlikely on Kwajalein has nothing to do with climate or geography. There is no biological or environmental reason why cholera cannot be eradicated for good in Ebeye, and Bihar, and right across the world. It is not the knowhow that is lacking, but rather the political will to extend these benefits to all people.

It is now 200 years since the cholera pandemics began, more than 150 years since the bacteria was identified, and 60 years since an inexpensive treatment and vaccination regime was developed. And yet still this contagion is plaguing some countries as if none of that progress had ever happened. That is the real lesson of cholera.

There are fears that coronavirus is now distributed so widely that, like cholera, it may be here for the long haul. It is not yet known whether this current coronavirus, Sars-CoV-2, will eventually mutate to cause milder, cold-like symptoms, like the four endemic coronaviruses; or instead go the way of the first Sars coronavirus and remain as a deadly, but contained, infection. In either scenario, Sars-CoV-2 or a similar future virus could, like cholera, be eliminated only from the richer parts of the world, and left to circulate, with deadly consequences, in the worlds poorest regions.

The world will eventually recover a semblance of normality by adopting the same three techniques we used against cholera: prevention of transmission, targeted treatments and global cooperation between nations. But as we saw with cholera, all three strategies can exacerbate global divides, if they are applied selectively to protect only the richer half of the world.

There are signs that this is happening already: from richer countries buying up so much extra personal protective equipment that poor countries will be unable to obtain or afford enough to protect their health workers; to the outsourcing of coronavirus clinical trials to poor countries, like India, that will be less able to afford the vaccine once it is developed; to poor countries becoming blind spots in the worlds gaze on coronavirus, because they lack the digital infrastructure necessary to collect comprehensive data about their outbreaks.

It is hardly news that we live in an unequal world. In the 90s, global health experts began to refer to the so-called 10/90 gap, based on the fact that only 10% of health research funding was addressing the health problems that affected 90% of the worlds population. At the time, diarrhoeal diseases accounted for 7.2% of global disease burden, but attracted only 0.06% of health research investment. The 10/90 gap has remained largely unchanged. But with this new pandemic, we have an opportunity to put that right.

Just as cholera gave birth to global health, coronavirus should trigger its latest reboot. Richard Smith, the former editor of the BMJ, has compared the stages of global health since the first cholera pandemics to the updates of an operating system. I welcome what he calls Global Health 4.0: namely, research and policy led by researchers and activists from poor countries. And while the WHO has not always lived up to its lofty goals, nor managed to achieve eradication of cholera as it did for smallpox, the solution is not to weaken it, as per Donald Trumps removal of funding, but the opposite: it needs much more funding, and more independence from corporate donors, if it is to help tackle the socio-economic conditions that make us sick.

Besides the basic moral argument for a system of public health and international cooperation that benefits all people, it is also in everyones interests, because as long as infections blight poor countries, they will continue to pose a threat to the west, too. The Nigerian global health scholar Obijiofor Aginam has written that enormous sacrifices must then be made by the developed world to confront mutual vulnerability. Coronavirus has reminded us, once again, of this mutual vulnerability.

To prevent further pandemics, Aginam calls for a communitarian globalism: a bottom-up approach, based on ideals of fairness, justice, and equitable distribution of scarce but moderate global resources. We have already seen glimpses of this kind of solidarity in the current crisis: from the communist government in Kerala giving food and shelter to migrant workers; to the Somalian doctors offering their help in crisis zones such as Italy; to Cuba allowing an infected British cruise ship to dock to receive timely medical care by its doctors.

There are, of course, important differences between coronavirus and cholera. The fact that coronavirus has a higher transmission rate than cholera, for instance, will make curbing its spread particularly challenging. But the lesson from cholera holds nonetheless. If we allow global health to be funded and governed by the old colonial logic that is embedded in its current structures, then the story will play out as it did for cholera.

For now, I will continue to worry about my patients and colleagues in England, and how many of them will succumb to this virus. But while there are certainly better and worse ways to respond to the crisis here in the short term, history will judge us not just on who dies from coronavirus today, but in the centuries to come.

For when my patients die during a pandemic in one of the richest countries in the world, it is of course a tragedy, but I can take comfort in the fact that it is an exceptional one, and that every effort is being made to prevent further such deaths. A much bigger moral failing would be if there are still people in the poorest parts of the earth dying of coronavirus in 2200. In 50 years time, when I take the road north through Bihar to my ancestral home, I hope I will be able to buy a bunch of bananas in Hajipur without wearing a mask, and fill my nostrils with their sweetness.

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Cholera and coronavirus: why we must not repeat the same mistakes - The Guardian

More than 70% of patients with coronavirus admitted to critical care are men, according to new data.

The figures come from the UKs Intensive Care National Audit and Research Centre (ICNARC) and were based on a sample of 7,542 critically-ill patients confirmed as having Covid-19. Researchers found that 5,389 of these patients were men and 2,149 were women.

The report, published on Friday, also found that men were more likely to die in intensive care, with 51% dying compared to about 43% of the women who were admitted.

The report analysed data on patients with confirmed Covid-19 from 286 NHS critical care units in England, Wales and Northern Ireland taking part in the ICNARC programme up to 4pm on Thursday.

The new data echoes comments of a leading expert who said that Covid-19 was just as deadly as Ebola for people admitted to hospital in the UK.

Prof Calum Semple from the University of Liverpool, a consultant respiratory paediatrician at Alder Hey childrens hospital and chief investigator on a study published on Wednesday, said the data highlighted the danger of coronavirus.

Research by Semple and his team found that of the total number of coronavirus patients admitted to hospital, 17% required admission to high dependency or intensive care units and of these, 31% were discharged alive, 45% died and 24% continued to be treated in hospital.

Semple explained: Some people persist in believing that Covid-19 is no worse than a bad dose of flu.

They are gravely mistaken. Despite the best supportive care that we can provide, the crude case fatality rate for people who are admitted to hospital that is, the proportion of people ill enough to need hospital treatment who then die with severe Covid-19 is 35 to 40%, which is similar to that for people admitted to hospital with Ebola. Its a really nasty disease.

The new ICNARC data also showed that around 56% of 60 to 69-year-olds, 67% of 70 to 79-year-olds, and 65% of people aged 80 and over admitted to critical care died there, compared to about 24% of people aged under 50.

It also found that about 26% of patients in critical care with Covid-19 were black or Asian, compared to 66% who were of white ethnicity.

A separate Institute for Fiscal Studies report found that per capita deaths among the black Caribbean population in English hospitals are three times those of white British people.

This follows a report from the Office for National Statistics which found people living in the most deprived areas of England have experienced coronavirus mortality rates more than double those living in the least deprived areas.

The ICNARC report also said that 25% of critical care coronavirus patients were from the most deprived quintile (fifth of the population), compared to 14.5% who were in the least deprived one.

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Coronavirus: over 70% of critical care patients in UK are men - The Guardian