Coronavirus highlights role of foreign staff in British hospitals

AFP / Tolga AKMENA mural in central London shows an NHS worker

Joan Pons Laplana is a senior digital charge nurse working on the frontline in an intensive care unit treating coronavirus patients at Sheffield Teaching Hospital in the north of England.

Like many of his colleagues in the state-run National Health Service (NHS), the 45-year-old medic is not British.

The Spanish national works alongside people from Germany, Italy, Portugal, Philippines and India, as well as those from the UK.

"Sometimes the most difficult accents to understand are the British ones," Laplana, who has lived in the UK for 20 years, told AFP.

The international mix of staff at Sheffield is far from untypical in British hospitals.

Parliamentary figures published last July show that some 153,000 workers out of 1.2 million NHS staff are non-British.

"This is 13.1 percent of all staff for whom a nationality is known, or just over one in eight," it reported.

"Between them, these staff hold 200 different non-British nationalities.

Around 65,000 are nationals of other European Union countries -- 5.5 percent of NHS staff in England. Around 52,000 staff are Asian nationals, according tot the parliamentary figures.

Among the most common 16 nationalities of people working for the NHS were Indian (21,207), Nigerians (6,770) and Zimbabweans (4,049).

In addition, the health service think tank the King's Fund, calculates that beyond the NHS, around one in six of the 1.5 million people working in adult social care, in the private sector, are from overseas.

"The NHS depends on the important contribution that they (overseas workers) make," said Alex Baylis, assistant director of policy at King's.

"This has come into sharp focus in recent weeks, as all NHS staff have gone above and beyond the call of duty to look after patients who are ill with coronavirus."

- Foreign staff -

The contribution of the NHS, like health workers globally elsewhere, has been lauded during the coronavirus pandemic.

However, in the UK the role of non-British workers, and particularly those from the European Union, has been brought into sharp focus because of Brexit, where immigration was a key issue.

Britain is reliant on such workers at a time when the future of many of those people to remain in the country is uncertain after the country left the EU in January.

AFP/File / CHRIS J RATCLIFFENHS nurse and Spanish national Joan Pons Laplana says people in Britain 'will go back to blaming migrants for anything' once the coronavirus crisis passes

"Nobody has asked me where I come from in the last few weeks," said Laplana who spoke out publicly against Brexit following the 2016 referendum.

The government said on Wednesday that 69 NHS workers have died during the outbreak, including those from overseas.

They include Alice Sarupinda, a nurse from Zimbabwe, and Jenelyn Carter a healthcare assistant from the Philippines.

Since the 2016 referendum set Britain on a turbulent path to leaving the EU, there have been doubts about how the NHS will cope with any potential exodus of staff as a result.

Freedom of Information figures published in November revealed that in three years since the referendum, more than 11,600 NHS staff from the EU had left the UK, including 4,783 nurses.

Coupled with an election pledge by Boris Johnson's government to spend an extra almost £34 billion (38 billion euros, $42 billion) a year on the NHS, questions have been raised about how workforce gaps could be plugged.

"Regardless of Brexit, the NHS will continue to need staff from overseas," adds Baylis.

"With almost 100,000 vacancies, ethical international recruitment is the only realistic option for addressing the NHS's staffing shortfall for at least the next five years."

- Policy shift -

Already the urgency of coronavirus has seen a shift in government policy.

Last month, the Home Office announced that 2,800 frontline NHS workers, whose visas are due to expire this year, would be extended for 12 months free of charge so they could "focus on fighting coronavirus".

But political opponents say that is not enough.

The Liberal Democrats this week called on ministers "to give all foreign nationals working in the NHS and social care indefinite leave to remain in the UK".

The King's Fund has also called on the government to waive an annual surcharge, set to increase to £625 this year, payable by overseas NHS workers so they can access the healthcare services they help deliver.

Post coronavirus, it is clear that the treatment of international NHS workers will become a major political topic in the UK.

AFP/File / Paul ELLISThe British public has shown warm support for the NHS which employs 153,000 non-UK nationals

In a country where a weekly round of applause is held for NHS and other frontline workers, it would take a brave government to deny healthcare staff improved living and working rights and conditions.

But Laplana is unconvinced.

He said that for his two decades in the UK he did not consider himself a foreigner but "Brexit put an end to that".

"I am a sceptic," he says. "It will last for a while but then we will go back to blaming migrants for anything.

Boeing to lay off 10% of workers in civil aviation: sources

AFP/File / Jason RedmondBoeing is set to lay off workers just one day after re-opening its plants in Washington state

Boeing plans to reduce the workforce in its civil aviation unit by 10 percent to cut costs as the coronavirus causes a crisis for airlines, two sources familiar with the matter told AFP.

The layoffs would impact the unit manufacturing the troubled 737 MAX, which has been grounded for more than a year after two deadly crashes, as well as the 787 and 777 long-haul aircraft, the sources said.

The job cuts could affect up to 7,000 workers. Boeing employs more than 160,000 people worldwide, including 70,000 in Washington state, where most of its civilian aircraft are assembled. The plant in South Carolina produces only part of the 787.

The news comes just a day after the company slowly resumed production at its Puget Sound facility in Washington, with new measures to keep workers six-feet apart along with health checks and hand-washing stations.

Chief Executive David Calhoun wants to resolve the downsizing plan before Boeing embarks on complex and sensitive negotiations with the US Treasury to win in federal support for the industrial giant, the sources said.

Boeing has sought $60 billion in public aid for the US aerospace industry in light of the heavy hit to the aviation business from the coronavirus crisis.

Around $17 billion aimed at Boeing was included in the giant federal relief bill approved in late March.

But the government aid is conditional on companies agreeing not to lay off workers once they have received taxpayer dollars.

- 'Voluntary layoffs' -

A spokesman for the Boeing said the company is offering "voluntary layoff" programs, but did not confirm the size of the planned reductions.

Workers who take Boeing's voluntary layoff offer would receive a pay and benefits package as part of the program that "aims to help reduce the size of our workforce through voluntary actions and, importantly, minimize future workforce actions," the spokesman said.

The company, already under strain amid the controversy surrounding the top-selling 737 MAX and uncertainties over when the plane will return to the skies, has suffered a wave of order cancelations from airlines struggling to survive as air travel has ground to a halt amid the pandemic shutdowns.

Aircraft leasing company Avalon canceled an order for 75 of the 737 MAX planes, and the China Development Bank scrapped a request for 29 of the aircraft.

There also is uncertainty about an order from Norwegian Air for 92 MAX planes and five 787 planes after four subsidiaries filed for bankruptcy.

The spokesman said "there is no doubt the aviation industry will look very different as we eventually recover from this pandemic."

Boeing also may replace the executive in charge of the MAX program in announcements that could come when the company releases quarterly results April 29, the sources said.

In Navajo Nation, pandemic exposes water crisis and health disparities

AFP/File / MLADEN ANTONOVA Navajo farm is seen next to a rock formation in Monument Valley Navajo Tribal park, Utah, in 2014

The coronavirus is hitting the United States' largest Native American territory hard, with a spike in cases bringing long-standing disparities to the fore in a land marked by the trauma of past waves of disease.

With its towering sandstone mesas, majestic canyons and ancient ruins, the Navajo Nation is home to about 175,000 people in an area that straddles three southwestern states and is roughly the size of Scotland.

The reservation saw its first COVID-19 case on March 17 and the number has since exploded to 1,206 -- a per capita infection rate just behind the worst-hit states of New York and New Jersey.

Overall deaths remain relatively low right now at 48, but that figure is expected to increase in the coming weeks as the disease takes its toll on those who are seriously ill.

Officials and experts cite a range of factors, from chronic underfunding of the medical system that caters to Native Americans, to poor phone and internet connectivity exacerbating information gaps.

One of the starkest reasons: A lack of access to the running water health authorities have repeatedly stressed is necessary to keep the virus at bay through hand washing.

Up to "30 percent of our citizens do not have access to running water and have to haul water from 20 to 30 miles away for their drinking water and livestock," Navajo Nation President Jonathan Nez told AFP.

"Right here in the middle of the most powerful nation, the United States of America, our citizens don't have the luxury of turning on a faucet to wash your hands with soap and water."

GETTY IMAGES NORTH AMERICA/AFP/File / SPENCER PLATTA man from the Navajo Nation collects water from a public water pump on June 7, 2019 in the town of Gallup, New Mexico; up to 30 percent of Navajo Nation households dont have clean running water

That's because many native lands were passed over when the US expanded its running water and sanitation infrastructure a century ago, according to a recent report by water nonprofit DigDeep.

Native Americans are also disproportionately affected by poverty-linked health conditions that lead to more serious forms of the COVID-19 illness, such as heart disease and asthma, said Matthew Heinz, a doctor at Tucson Medical Center who has been treating members of the Apache and Tohono O'odham tribes.

In particular, they have a greater chance of having diabetes than any other US racial group, according to the Centers for Disease Control and Prevention -- a factor that has been linked to an abnormal and often deadly autoimmune response in coronavirus patients.

- Promises broken -

AFP/File / MLADEN ANTONOVRock formations are seen behind the American flag at Gouldings Lodge and Trading Post in Monument Valley Navajo Tribal park, Utah, in 2014

The Navajo Nation was established by a treaty in 1868, after its inhabitants, who also call themselves "Dine," returned to the ancestral land they were forcibly deported from four years earlier.

Like other Native American peoples, they gave up enormous tracts in land in exchange for federally supported free health care and education in perpetuity, said Allison Barlow, director of the Johns Hopkins Center for American Indian Health.

It's a promise that's never been adequately fulfilled.

A case in point: there are only 12 health care facilities across the Nation's 27,000 square miles (70,000 square kilometers).

The Indian Health Service which provides care is also dramatically under-resourced.

"The IHS average per capita spending per user today is $3,333 compared to $12,744 for Medicare (a state program for the elderly) and $9,404 for veterans' medical spending," said Barlow.

Congress has earmarked substantial relief for the tribes hit by the pandemic, with $8 billion to be released soon, "but the challenge now is to be able to spend it on what is needed, given the global shortages in supply of health care equipment and personnel," she added.

- Spotlight -

AFP/File / Eric BARADATThe sun rises over the Monument Valley in April, 2018

Another challenge: the Navajo often live in overcrowded conditions with multiple generations of family members living under one roof.

"Here, we have not just our immediate family, not just our extended family," explained Nez. "We have a clan family."

With the tribe's language endangered, elders are held in sacred esteem adding to psychological stress over fears of losing them.

Native Americans have borne the brunt of past pandemics -- the group's mortality rate during the H1N1 (swine flu) pandemic of 2009 was four times higher than all other racial categories combined, a CDC report found.

Entire communities were likewise decimated by the Spanish flu of 1918.

Since the arrival of the first European conquistadors, "they have experienced waves of decimation from 'novel viruses,' some systematically used by the colonists as germ warfare to wipe out their peoples," said Barlow.

Her organization and other non-profits are stepping in to help fill the resource gap by improving local health facilities and delivering care packages to those in need, as well as vital Personal Protective Equipment.

For Nez, the increased attention during this crisis is long overdue.

"We are the first citizens of this country, but usually we would be ignored," he said, adding that his sovereign nation was open to working with other countries.

"I hope it changes for the better."

SEE  https://plawiuk.blogspot.com/search?q=NAVAJO

'Mission Dharavi': Virus battleground in India's biggest slum

AFP / PUNIT PARANJPEDharavi's narrow alleys, crowded housing and poor sanitation offer the perfect breeding ground for the virus

The 125,000 slum-dwellers living under a lockdown so strict that drones monitor their moves and alert police if they attempt to leave home are at the heart of India's push to contain coronavirus.

But with only a handful of people tested so far in the country's biggest slum, fears are growing that "Mission Dharavi" -- a term coined by officials working there -- may not prevent the virus from raging across the densely packed neighbourhood.

Dharavi is home to an estimated one million people, who eke out a living as factory workers or maids and chauffeurs to the financial capital Mumbai's well-heeled residents. Around an eighth of them live in hotspots where severe containment measures are being enforced.

Its narrow alleys, crowded housing and poor sanitation offer the perfect breeding ground for the virus.

"The biggest challenge is Dharavi itself... 10 to 15 people stay in one room. How is it possible to enforce social distancing?" asked city official Kiran Dighavkar.

He is overseeing an effort involving some 2,500 people, including medical workers, cleaners and volunteers, who are fighting to keep cases -- at nearly 200, with 12 deaths -- from spiralling out of control and overwhelming hospitals.

AFP/File / Indranil MUKHERJEEDharavi's narrow alleys, crowded housing and poor sanitation offer the perfect breeding ground for the virus

The severe lockdown imposed in five virus hotspots in the slum since the first cases were reported in early April is a key part of that undertaking.

"No-one is allowed to go in or out," Dighavkar told AFP, adding that "everything, including grocery shops, is shut".

"Police are using drones to make sure people obey the rules," he said.

A state-run school, a sports complex and a formerly defunct hospital are being used to house patients and as quarantine facilities.

Around 40,000 people have undergone thermal screening over the past week at so-called fever camps.

And Dharavi's 225 public toilets -- a lifeline for its residents -- are disinfected daily, he said.

- 'In a panic' -

Mumbai is even considering handing out hydroxychloroquine -- an anti-malarial drug touted by US President Donald Trump -- "as a preventive measure" to Dharavi residents in quarantine facilities, said Daksha Shah, a senior health official with the city authority.

"Right now the community is in a panic... so we have to be a bit careful," she told AFP, adding that they were awaiting approval from New Delhi.

AFP/File / INDRANIL MUKHERJEEOnly a handful of people have been tested so far in India's biggest slum

Officials have partnered with non-profits to distribute food and medicine in the area, also home to thousands of migrant workers left jobless by a weeks-long nationwide lockdown.

Although the restrictions ordered across India are less severe than those imposed in Dharavi's hotspots, they have had a lethal impact on the poor.

The Roti Bank Foundation's operations manager Jayandrath Tambe told AFP the non-profit organised 4,500 meals daily for Dharavi's confined residents and was feeding 32,000 people across Mumbai with the help of local hotels.

Social worker Imran Idris Khan turned to YouTube to upload videos explaining relief efforts in Dharavi and used WhatsApp to inform residents about where to find food.

"Many families are still sitting at home or people are stuck in factories without any idea about food-packet distribution drives and therefore going hungry," he told AFP.

"This should not be happening."

- 'I feel helpless' -

The capital of Maharashtra state, which has the highest number of COVID-19 cases in India, Mumbai has recorded over 3,000 infections among its 18-million-strong population.

The central government has reported more than 20,000 cases so far in the nation of 1.3 billion people.

Maharashtra's chief minister Uddhav Thackeray on Sunday tweeted that around 70-75 percent of coronavirus cases in the state "have very mild symptoms or are asymptomatic".

AFP / INDRANIL MUKHERJEEMaharashtra's chief minister said around 70-75 percent of coronavirus cases in the state 'have very mild symptoms or are asymptomatic'

Officials in Dharavi tried to ramp up testing by including residents without symptoms, but Mumbai city authority spokesman Vijay Khabale-Patil told AFP New Delhi rejected the move.

Under the central government's guidelines, asymptomatic people are tested only if they are high-risk or have come into direct contact with an infected person.

Just 657 people have been tested in the slum, raising fears that hospitals -- reportedly already at full capacity -- might struggle to cope if there's an unexpected spike in severe cases.

One Dharavi resident receiving treatment for coronavirus said he had no symptoms for three weeks spent almost entirely indoors, before developing a sore throat and fever which refused to subside.

He has now been in hospital for nine days.

"I feel helpless at times and worry about my family and neighbourhood," the 24-year-old told AFP on condition of anonymity as he fears being stigmatised for being sick.

"Looking at so many people losing lives due to infections makes me feel terrible. Will we ever recover from this?"

WHO warns 'long way to go' in coronavirus crisis

AFP / VLADIMIR SIMICEKA worker wearing protective clothes disinfects a street in Bratislava, Slovakia

The global coronavirus crisis will not end any time soon, with many countries still in the early stages of the fight, health experts have warned as researchers revealed the first US deaths from the disease came weeks before the alarm was raised there.

The COVID-19 pandemic has killed more than 180,000 people and infected 2.6 million, and nations are struggling to check its spread with social distancing measures and lockdowns, while trying to repair their virus-ravaged economies.

 

AFP / Yuri KADOBNOVMedical workers get ready for a shift treating coronavirus patients at the Spasokukotsky clinical hospital in Moscow

Some have started to slowly ease restrictions as pressure mounts on governments to find ways to reopen their societies after tens of millions of jobs were wiped out.

But World Health Organization chief Tedros Adhanom Ghebreyesus on Wednesday cautioned that the struggle is far from over.

"Make no mistake: we have a long way to go. This virus will be with us for a long time," he said.

AFP / Ulises RUIZThe Civil Protection and Fire Department of Zapopan teaches "Pre-hospital management of patients with COVID-19 and Biosafety" to its officers in Mexico

"Most countries are still in the early stages of their epidemics. And some that were affected early in the pandemic are now starting to see a resurgence in cases."

The comments came after the director of the US Centers for Disease Control asked Americans to prepare for a second, possibly more devastating, wave of coronavirus infections.

 

AFP / PRAKASH MATHEMAHindu holy women (sadhvis) sit at the front door of a house as a sadhu looks down from a window during a government-imposed lockdown in Kathmandu, Nepal

The United States is the hardest-hit country on the planet, with more than 46,500 coronavirus deaths and nearly 840,000 infections.

Researchers have now revealed that the first COVID-19 fatalities in the country happened weeks earlier than previously thought -- meaning the current US tally is likely far short of reality.

 

AFP / Behrouz MEHRIA face mask-clad shrine worker sweeps the ground before a Shinto ritual during the annual spring festival at the Yasukuni shrine in Tokyo

The newly confirmed COVID-19 deaths on February 6 and February 17 were in California's Santa Clara county, where Stanford University researchers found that the true number cases was at least 50 times higher than the confirmed official figure.

But pressure is growing on authorities to ease restrictions to boost the economy, which is reeling from the pandemic.

President Donald Trump, who is keen to restart the US economy, issued rare criticism of a Republican state governor on Wednesday, after Georgia allowed small businesses to reopen.

"It's too soon," the president said.

The explosion of coronavirus cases across the United States has overwhelmed healthcare facilities, from the most developed parts like New York City to the Native American territory of the Navajo Nation in the southwest, where a lack of running water and poor infrastructure has made the situation worse.

AFP / RIJASOLOMalagasy army soldiers distribute masks and samples of a local herbal tea, touted by President Andry Rajoelina as a powerful remedy against the COVID-19 coronavirus, in Antananarivo

"Right here in the middle of the most powerful nation, the United States of America, our citizens don't have the luxury of turning on a faucet to wash your hands with soap and water," Navajo Nation President Jonathan Nez told AFP.

- Vaccine trials -

The WHO and other health experts have warned that strict containment measures like lockdowns should remain until there is a viable treatment or vaccine for the coronavirus.

AFP / VALERY HACHEAn elderly woman carries her shopping down a street in Nice on the 37th day of a strict lockdown in France

There was a ray of hope on that front in Europe, where Germany announced Wednesday that human trials for a vaccine will start by next week.

It is only the fifth such effort to have been authorised worldwide, and is a significant step in making a vaccine "available as soon as possible", Germany's regulatory body said.

But even at the current, rapid pace of development, an effective prophylactic could be several months away.

AFP / Jonathan NACKSTRANDPeople have lunch at a restaurant in Stockholm during the coronavirus COVID-19 pandemic.

In Europe -- where the death toll climbed past 110,000 -- some countries have slightly eased coronavirus measures, but bans on large gatherings have been extended.

Finland said it would maintain a ban on gatherings of more than 500 people until the end of July, while hard-hit Spain said it did not expect to lift its strict lockdown until mid-May.

"We must be incredibly careful in this phase," said Spanish Prime Minister Pedro Sanchez.

Vietnamese authorities eased social distancing measures as cases in the country plateaued, with experts saying the apparent success was down to aggressive containment measures and contact tracing.

Vietnam's Communist government has reported just 268 coronavirus cases and no deaths, despite its long and porous border with China -- where the virus first emerged late last year.

- 'I feel helpless' -

The pressure on governments everywhere to ease the economic pain is growing by the day, with tens of millions unemployed and several countries at risk of famine.

AFP / Johan ORDONEZVolunteers wait to deliver food to people economically affected by the COVID-19 coronavirus outbreak, at the Rayuela Bar in Guatemala City

With movement and travel severely restricted, sectors from small business to tourism and aviation have been hammered.

Providing more evidence of the scale of devastation, the UN's International Civil Aviation Organization said Wednesday the pandemic could mean 1.2 billion fewer passengers worldwide, with hundreds of billions of dollars slashed off airline revenues.

The economic suffering is intense for the people of Dharavi, the largest slum in India, who have been unable to leave home to eke out a living as factory workers or maids and chauffeurs to the well-heeled residents of Mumbai.

AFP / Gal ROMAThe 3 Ts of COVID-19: testing, tracking, tracing

Home to an estimated one million people, the massive slum has been under a strict lockdown, with police drones patrolling to make sure no one goes outside.

"I feel helpless at times and worry about my family and neighbourhood," one Dharavi resident, in hospital for COVID-19 treatment, told AFP.

"Looking at so many people losing lives due to infections makes me feel terrible. Will we ever recover from this?"

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Hong Kong political crisis deepens despite protest lull during virus

AFP / Anthony WALLACEActivists have accused Chief Executive Carrie Lam's government of taking advantage of the world being distracted by the coronavirus pandemic

A roundup of Hong Kong pro-democracy activists and a row over the powers of Beijing's office in the city have deepened the political crisis engulfing the financial hub even as a coronavirus lockdown prevents large-scale protests.

The mass demonstrations that convulsed the semi-autonomous Chinese city for seven straight months last year have dissipated during the COVID-19 crisis as cautious residents stick to social distancing.

But over the past week, political tensions have soared once more, threatening to upend the calm in a city still ruptured by ideological divides and where many fear China's strengthening grip is eroding their freedoms.

There is a "new, gritty nastiness emerging", risk management consultants Steve Vickers Associates warned in a note this week, and with neither Beijing nor the democracy camp willing to make compromises, future unrest was near inevitable.

On Saturday, police arrested 15 prominent activists on charges linked to last year's demonstrations.

Those detained were not masked protesters who often violently clashed with police, but rather some of the city's best-known moderates -- including former lawmakers, academics and a media tycoon.

Among them was 81-year-old barrister Martin Lee, who in the 1980s helped draft the "Basic Law" -- the city's mini-constitution that grants liberties and a high degree of autonomy unseen on the Chinese mainland.

The police swoop came during a row over whether Beijing was reinterpreting a key part of that document.

- Constitutional row -

The spat began when the Liaison Office -- which represents China's central government -- issued a statement condemning pro-democracy lawmakers for filibustering in the legislature.

The office suggested the politicians had breached their oath of office and could be prosecuted.

That sparked accusations that Beijing had crossed a line.

While China's control over Hong Kong's foreign policy and defence is undisputed, Article 22 of the Basic Law forbids Beijing departments from "interfering" in areas where the city governs itself -- such as its legislature and separate judicial system.

AFP/File / Anthony WALLACEExpectations are now rising that the current lull is temporary and last year's unrest will return

As criticism mounted, the Liaison Office made a landmark announcement: it was not governed by the provision -- even though documents previously submitted to Hong Kong's legislature stated it was.

Instead, it argued it had a "distinctive" role and could exercise a "supervisory power" over the city.

Hong Kong's government deepened the confusion when it issued a statement initially saying the Liaison Office was governed by Article 22, only to retract it hours later and issue two more corrected versions.

The cabinet member whose office provided the advice for the initial statement was moved to a new position in a reshuffle on Wednesday, although city leader Carrie Lam denied it was linked to the furore.

Critics seized on the move as the latest attempt by Beijing to increase control over Hong Kong's politics.

The Progressive Lawyers Group called it "brazen in its intention to tighten Beijing's grip on the city by unconstitutionally expanding the powers of the Liaison Office".

And the Bar Association published a legal analysis concluding there was "no question" Beijing's offices in the city were bound by the non-interference clause.

- 'No choice' -

Prominent activist Joshua Wong told AFP he believed China's leaders were taking advantage of the world being distracted by the pandemic.

"Beijing in the upcoming future will just strengthen and enhance interference in Hong Kong local affairs," he said.

Others disputed the idea that the Liaison Office crossed a legal rubicon.

AFP/File / NICOLAS ASFOURIPolice fire water cannon outside government headquarters in Hong Kong in September 2019

"Merely commenting and expressing one's view on a matter of public interest would not count as intervention," Simon Young, a law professor at the University of Hong Kong, told AFP.

Jasper Tsang, a former president of Hong Kong's legislature and a pro-Beijing heavyweight, said the Liaison Office felt it had "no choice" but to wade into the paralysis in the legislature, which had left a dozen bills languishing for months.

Opponents are filibustering to delay a bill outlawing insults to the Chinese national anthem -- a serious provocation to Beijing.

Tsang said the Liaison Office would likely be more confrontational in future.

"How can you stop it?" he said.

Expectations are now rising that last year's unrest will return, especially with legislative elections due in September, when the pro-democracy camp is hoping to score large gains.

Beijing has also made it clear it wants Hong Kong to have a new national security law -- a proposal that sparked huge protests in 2003.

Now, some dissidents have started calling for a protest on July 1 even if social distancing measures against the virus are still in place.

"Businesses should prepare for further civil unrest, as the threat from the virus recedes and friction rises," said Steve Vickers Associates.