Guatemala calls US 'Wuhan of Americas' in battle over deportees

The country’s health minister says deportation flights are driving up coronavirus cases after a flight had 75% test positive


THE GUARDIAN Staff and agencies in Guatemala City Wed 15 Apr 2020 
 

An immigration official in Guatemala oversees the arrival of migrants deported from the US. Photograph: Johan Ordóñez/AFP via Getty Images

US deportation flights to Guatemala are driving up the country’s Covid-19 caseload, according to the country’s health minister, who said that on one flight about 75% of the deportees tested positive for the virus.

Hugo Monroy said that the United States had become the “Wuhan of the Americas” referring to the Chinese province where the pandemic began.

“We must not stigmatize, but I have to speak clearly. The arrival of deportees who have tested positive has really increased the number of [coronavirus] cases,” he said on Tuesday.

US migrant deportations risk spreading coronavirus to Central America

“There are really flights where the deportees arrive … with fever – and they get on the planes that way,” said Monroy on Tuesday. “We automatically evaluate them here and test them and many of them have come back positive.”

Later, the presidential spokesman, Carlos Sandoval, told reporters that Monroy was referring to a March flight on which “between 50% and 75% [of the passengers] during all their time in isolation and quarantine have come back positive”.

Before Tuesday, Guatemala had reported only three positive infections among deportees flown back by the United States.

Joaquín Samayoa, spokesman for the foreign affairs ministry, confirmed a fourth positive case for a migrant who arrived on a flight on Monday. At least three of the migrants who arrived Monday were taken directly to a hospital for Covid-19 testing.

It remained unclear why before Tuesday the government had only reported three deportees who tested positive and how many more would have been among the high percentage who tested positive onboard that March flight.

Guatemala again began receiving deportation flights from the United States on Monday after a one-week pause prompted by three deportees testing positive for Covid-19.

The Guatemalan government had asked the United States to not send more than 25 deportees per flight, to give them health examinations before departure and to certify that they were not infected.

However, the flights resumed on Monday with 76 migrants onboard the first and 106 on the second. Guatemala’s foreign ministry did not immediately clarify why the US had not complied with its requirements, but the flights came on the same day that the US state department announced that aid would continue to Guatemala and the other Northern Triangle countries.

One of Monday’s flights also included 16 unaccompanied minors, according to the Guatemalan Immigration Institute.

Since January, the US has deported nearly 12,000 Guatemalans, including more than 1,200 children.

Trump's decision to cut WHO funding is an act of international vandalism

A lack of international cooperation in the fight against Covid-19 risks repeating the mistakes of the Great Depression

Andrew Gawthorpe 

 is a historian of the United States at Leiden University in The Netherlands

Wed 15 Apr 2020 THE GUARDIAN 

In a parody of self-destructive nationalism, Donald Trump yesterday decided that an unprecedented global health emergency was the perfect time to withdraw American funding from the organization whose job it is to fight global health emergencies. His decision to suspend contributions to the World Health Organization is an extraordinary act of moral abdication and international vandalism at a time when the world desperately needs to find means of working together to combat an unprecedented global threat.

Global problems require global solutions. Covid-19 does not respect borders – even closed ones – and its continued transmission anywhere poses a threat to health everywhere. We are still in phase one of the crisis, in which countries are mostly focused on containing the initial wave of domestic outbreaks. If these efforts are not to be in vain, then intensive international cooperation will be needed to get expertise and resources to where they are needed most – especially as the disease takes root in impoverished countries in the Global South.


The WHO is the only organization in the world with the network and expertise to effectively perform this task. And there is ample precedent of the organization delivering results even amid geopolitical conflict and tension between the world’s leading countries. In the 1960s and 70s, the United States and the Soviet Union worked together to provide the WHO with the resources it needed to eradicate smallpox, a disease which afflicted about 50 million people a year in the early 1950s and no longer threatened humankind at all by 1977.

Smallpox was a very different disease to Covid-19, but the world’s successful eradication of it demonstrates what international organizations can accomplish when governments decide to put geopolitical squabbles and petty politics aside to solve a problem which threatens them all. For the richest country in the world to decide to use its power, wealth and influence to actively undermine rather than lavishly support such efforts today is an act of moral blindness with few parallels in recent American diplomacy.

A lack of international cooperation in the fight against Covid-19 risks repeating the mistakes of the Great Depression, when many countries put up trade barriers in a misguided attempt to protect their own economies. The result was even greater economic devastation for everyone, and a collapse in international trust. By comparison, the international response to the global financial crisis of 2008 was coordinated and effective, lessening the impact of the economic shock. Today the world faces an economic crisis which may rival the Great Depression and a global health crisis unlike anything in the history of modern globalization, and its response looks much more like the 1930s than 2008.

The fact that Trump’s decisions are being driven so transparently by his petty domestic political problems suggests that the world shouldn’t look to Washington to provide responsible leadership any time soon. Trump now blames the WHO for being insufficiently critical of China’s early response to the virus, but he himself praised China’s cooperation with the WHO and separately lauded Beijing as recently as the end of March – before he started taking a battering in polls and needed ways to explain away his own failures. A president who used a daily public health briefing to show a propaganda video praising his own response to the disease is not one thinking in the visionary global terms needed to address this crisis.

The Trump administration’s nationalism and short-sightedness is particularly concerning as the world moves into the next phase of the Covid-19 epidemic, when many countries are past the initial wave and have the time to consider the situation beyond their own shores. If governments decide to myopically focus purely on their own domestic situations instead – even perhaps hoarding medical supplies to hedge against future waves of the infection – then they risk allowing a tragedy to unfold elsewhere and ultimately return to their own shores.

History teaches us that the sort of collective action needed to address this crisis will not just emerge spontaneously – it must be built painfully, step by step, by countries who trust one another and are able to look beyond their own immediate interests. It often requires a trailblazer who is willing to take the risk of acting first and counting on bringing others along. Previous presidents realized that with America’s great power came great responsibility, and often rose to moments like these – or at least attempted to.

Yet the current occupant of the White House has spent his entire term torching international partnerships, trashing America’s reputation as a responsible and trustworthy actor in world affairs, and making it clear he has no interest in accepting the responsibility which comes from being the leader of the richest and most influential country in the world. He wants to make America “great” but his conception of greatness would be unrecognizable to every other post-war president. If international vandalism is all he has to offer in the face of the greatest global crisis of a generation, then the world we inhabit might soon be, too.

Coronavirus is killing far more US health workers than official data suggests
Challenges in collecting data, a patchwork of state tracking systems and patients who die at home mean the true toll of Covid-19 on US healthcare workers is unknown

Nurses, surgeons, janitors: first US health workers to die from Covid-19

Help us document the US health workers who die fighting coronavirusMore from this serie

We are launching a project to document the lives of every US medical worker who dies helping patients during the pandemic. These are some of the first tragic cases

• Help us document the US healthcare workers who die fighting coronavirus

Sarah Varney, Melissa Bailey, Danielle Renwick and Christina Jewett

Wed 15 Apr 2020 10.00 BSTLast modified on Thu 16 Apr 2020 02.06 BST

Shares

1237

America’s healthcare workers are dying. In some states, medical staff account for as many as 20% of known coronavirus cases. From doctors to hospital cleaners and from nursing home aides to paramedics, those most at risk have already helped save thousands of lives.

Not all these medical professionals survive their encounters with patients. Hospitals are overwhelmed, workers lack protective equipment and some staff suffer from underlying health conditions that make them vulnerable to this pernicious virus.

Health authorities in the US have no consistent way of tallying the deaths of healthcare workers. As of 14 April, the Centers for Disease Control and Prevention reported 27 deaths among health workers – but our reporting shows that is likely a vast undercount.

Lost on the frontline is a collaboration between the Guardian and Kaiser Health News that aims to document the lives of healthcare workers in the US who die from Covid-19, and to understand why so many are falling victim to the pandemic.

These are some of the first tragic cases. We are creating a database and will investigate and record new cases as this project unfolds

Christina Jewett and Liz Szabo | Kaiser Health News Wed 15 Apr 2020 

Staff nurses and administrators wait to welcome and clap in nurses arriving from around the country to help treat coronavirus patients at the Long Island Nursing Institute in New York. Photograph: Al Bello/Getty Image

The number of healthcare workers who have tested positive for the coronavirus is probably far higher than the reported tally of 9,200, and US officials say they have no comprehensive way to count those who lose their lives trying to save others.

The Centers for Disease Control and Prevention released the infection tally on Tuesday and said 27 health worker deaths have been recorded, based on a small number of test-result reports.

Officials stressed that the count was drawn from just 16% of the nation’s Covid-19 cases, so the true numbers of healthcare infections and deaths are certainly far higher.

CDC officials said data provided by states most closely tracking the occupations of people with the virus suggest that healthcare workers account for about 11% of all Covid-19 infections.

“We wanted to spotlight healthcare providers because they are the national heroes now caring for others with this disease at a time of great uncertainty,” said Dr Anne Schuchat, principal deputy director of the CDC. “We know their institutions are trying to provide material to help them work safely, but already thousands have been infected.”

Media reports and Twitter posts have shown case after case of workers saying they do not have adequate protective gear to keep from getting sick. In a recent 60 Minutes report, a frontline nurse from New York City said she was given a Yankees rain poncho in lieu of more official attire.

The data on worker deaths so far has come from “case report” forms that labs send to the CDC, which may be forwarded before a patient’s course of care is completed. Of more than 310,000 forms the CDC analyzed for the report, only about 4,400 included an answer to the questions of whether a healthcare worker was treated and whether the person survived.

Among those reports, 27 were listed as deceased. Schuchat said the CDC is conducting a 14-state hospital study and tapping into other infection surveillance methods and reviewing media reports to document additional deaths. She said challenges remain, such as tallying cases of people in New York City who die at home and relying on overburdened health staff to relay data.

“In some facilities, the person who is supposed to do the reporting is caring for patients and is overwhelmed,” Schuchat said.

The Guardian and Kaiser Health News have launched a project called Lost on the frontline to document the lives of healthcare workers who die during the pandemic. They include hospital janitors, substance abuse counselors, doctors and nurses.

Some states, including Ohio, have reported rates of healthcare worker illness as high as 20% but have not revealed data at the county, city or hospital levels. One health system, Henry Ford in the Detroit area, reported that more than 700 employees tested positive for Covid-19. Yet they have declined to say how many workers died, as in Ohio, to protect patient privacy.

The CDC data released on Tuesday showed that 73% of the health workers falling ill are female and their median age is 42.

That so many are getting sick is alarming to Christopher Friese, a nurse who continues to see patients and is director of the University of Michigan’s center for improving patient and population health. He said it was also concerning that the names of those who die are so hard to come by.

“It’s an insult that we can’t even honor or respect these colleagues in a respectful way,” he said. “We have nurses in Manhattan in garbage bags and goggles, and we have no way to track our fallen clinicians. We cannot even grieve properly: We can’t even honor them because we may not even know who we’ve lost.”

Health experts condemn Trump's halting of funding to WHO

Gates Foundation and Wellcome heads among those dismayed by ‘dangerous and short-sighted’ action amid coronavirus pandemic

Sarah Boseley Health editor Thu 16 Apr 2020 
 

President Trump accused the WHO of covering up the Covid-19 threat, even though it declared a public health emergency on 30 January. Photograph: Fabrice Coffrini/AFP via Getty Images

Global health leaders have rounded on Donald Trump, warning that his decision to suspend funding to the World Health Organization is recklessly endangering the chances of ending the pandemic as fast as possible.

Experts said they were dismayed and appalled at the US president’s announcement, which will not only deprive the WHO of the resources it needs to lead the fight, but potentially undermine international collaboration between scientists.

“Halting funding to the WHO is a dangerous, short-sighted and politically motivated decision, with potential public health consequences for all countries in the world, whether they are rich or poor,” said Peter Piot, director of the London School of Hygiene and Tropical Medicine and formerly head of UNAIDS.

“The Covid-19 pandemic is the greatest global health challenge facing our societies and economies for more than 100 years.

“We need the World Health Organization now more than ever. Its technical expertise, guidance and leadership is supporting countries to implement optimum science-based strategies to prevent and control Covid-19, and will catalyse global action against future health emergencies.”

Trump announced late on Tuesday that US funding would be put on hold for 60 to 90 days pending a review of the WHO’s warnings about the coronavirus and China. He accused the global body of “severely mismanaging and covering up” the threat, even though it declared a public health emergency on 30 January.

On 26 February, during a coronavirus task force press briefing at the White House, Trump said: “I want you to understand something that shocked me when I saw it that – and I spoke with Dr Fauci on this, and I was really amazed, and I think most people are amazed to hear it: the flu, in our country, kills from 25,000 people to 69,000 people a year. That was shocking to me.

“And, so far, if you look at what we have with the 15 people and their recovery, one is – one is pretty sick but hopefully will recover, but the others are in great shape. But think of that: 25,000 to 69,000.”


WHO warned of transmission risk in January, despite Trump claimsMark Suzman, chief executive of the Gates Foundation – the second largest funder of the WHO after the US – said he would “strongly oppose” any cuts to the funding of the WHO which was critical to the Covid-19 crisis. He also announced a further $150m donation towards the hunt for a vaccine, for which the foundation plans to build factories and therapeutics.

The UK government’s response was lukewarm. Asked about Trump’s decision, Boris Johnson’s spokesman said: “Our position is that the UK has no plans to stop funding the WHO, which has an important role to play in leading the global health response. Coronavirus is a global challenge and it’s essential that countries work together to tackle this shared threat.”

Asked if this meant No 10 was disappointed by the president’s move, the spokesman said: “I can only set out the UK’s position and that is we have no plans to stop funding the WHO.”

At his daily press briefing in Geneva, the director general of the WHO expressed regret at the US move and warned that the coronavirus would exploit divisions among those trying to fight it.

When the pandemic was over, WHO’s performance against Covid-19 would be scrutinised, said Dr Tedros Adhanom Ghebreyesus, but now was not the time. “Covid-19 does not discriminate between rich nations and poor, large nations and small. It does not discriminate between nationalities, ethnicities or ideologies,” he said.

“This is a time for all of us to be united in our common struggle against a common threat. When we are divided, the coronavirus exploits the cracks between.”

The US had been a long-standing and generous friend to WHO and they hoped it would continue to be so, said Tedros. “We regret the decision of the president of the United States to order a halt in funding to WHO.”

He and his colleagues mounted a robust defence of their actions. WHO had not hesitated to warn of the possibility of human-to-human transmission, they said. As early as 11 January, it issued guidance on the dangers of droplets spreading from one person to another, which could transmit the infection to frontline health workers, as happened in Sars, said Dr Maria Van Kerkhove, an American infectious diseases epidemiologist working at WHO.

Experts fear that the work of the WHO in fighting disease and improving health and healthcare systems around the world could be jeopardised. At issue is not just the response to the current pandemic, and major programmes such as polio eradication which receives substantial funds from the US, but the collaboration between scientists and doctors at institutions around the world, who will hesitate to pool their knowledge and expertise if they think there may be political consequences.

“The WHO is a place where anxieties and concerns can be discussed without the sense that you are going to be somehow called out,” said David Nabarro, professor of global health at Imperial College London who worked at the highest levels of WHO for many years.

“The challenge for the director general of WHO is always to maintain the core values of public health even when this goes against some of the political priorities of elected leaders. It is not unusual for there to be some form of conflict. The challenge is to try to create an environment where the opportunity for people to share is maintained and they are not having to look over their shoulder in fear that they are going to fall foul of the political priorities of leaders.”

David Heymann, professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, also emphasised WHO’s role as a forum for the world’s scientists and health experts.

“The strength of WHO is that it is able to bring together public health experts from around the world to exchange information, review scientific evidence, and make evidence based consensus recommendations on disease prevention and control,” he said.


Public health and infectious diseases experts said the WHO needed more funds, not less, to lead the fight against the pandemic and help low and middle-income countries, where it plays a crucial role.

“We are facing the greatest challenge of our lifetime and the WHO is doing an extraordinary job ensuring every country can tackle this virus, protect citizens and save lives,” said Dr Jeremy Farrar, director of research charity the Wellcome Trust. “No other organisation can do what they do and we owe them all our respect, thanks and gratitude. This is a time for solidarity not division.”

What does the WHO do, and why has Trump stopped supporting it?
Trump has suspended funding to the World Health Organization over its coronavirus response

Peter Beaumont and Sarah Boseley Wed 15 Apr 2020 
 

Photograph: Fabrice Coffrini/AFP via Getty Images

What is the World Health Organization’s remit?

The World Health Organization (WHO) was founded as the UN global health body in 1948 in the aftermath of the second world war with a mandate to promote global health, protect against infectious disease and to serve the vulnerable. It was inspired by the international sanitary conferences of the 19th century set up to combat communicable diseases such as cholera, yellow fever and plague.

Its current programme envisages expanding universal healthcare to a billion more people, protecting another billion from health emergencies and providing a further billion people with better health and wellbeing.

What does that involve?

In practical terms, the badly underfunded WHO acts as a clearing house for investigation, data and technical recommendations on emerging disease threats such as the coronavirus and Ebola. It also supports eradication of existing diseases such as malaria and polio and promotes global public health.

While its role on emerging diseases is most familiar in the developed world with its more resilient healthcare systems, its practical involvement is far more marked in the global south, where it has been working to expand basic healthcare, support vaccination and sustain weak and often stressed health systems through its emergencies programmes. Its 2018-9 budget was $4.8bn, which became $5.7bn when emergencies were included.

Why is the WHO under fire from Trump?

Trump has presented the freezing of US funding to the WHO as a direct response to what he claims was its slow reaction in raising the alarm over the global threat from the coronavirus and being too “China-centric” in its response. But the organisation’s funding was already in his sights on 7 February, when his administration was suggesting cutting the US contribution, about $400m annually, by half as part of $3bn cuts to US global health funding across the board.

The WHO, to whom the US theoretically contributes roughly 10-15% of its budget as its largest contributor, has been appealing for an extra $1bn to help fight the coronavirus.

The allegation by Trump and his supporters that the WHO was slow to warn of the risk of human-to-human transmission, and that it failed to cross-examine Chinese transparency early on, is largely not borne out by the evidence. WHO technical guidance issued in early January was warning of the risk of human-to-human transmission and the organisation declared coronavirus a public health emergency of international concern a day before Trump announced his partial ban on flights from China.

Instead, it appears Trump is following a familiar playbook: finding others to blame amid his own handling of the coronavirus outbreak, which has included calling it the “Chinese virus”, blaming the previous Obama administration and taking aim at state governors.

How does the WHO’s performance in the coronavirus crisis compare with the 2014-15 Ebola outbreak?The WHO, under the then-director general, Margaret Chan, was savaged from all sides for responding so slowly to an Ebola outbreak that began in a remote forested part of Guinea where the borders with Sierra Leone and Liberia were virtually non-existent. By the time the WHO acted, six months late, it had reached the dense cities.

The fallout for the WHO was serious and undermined its credibility. US critics suggested scrapping it and setting up a new global public health body, although the idea did not take off and President Obama did not support it. An independent report commissioned by Chan said the WHO’s funding was inadequate and governments had not increased their contributions in years. Dr Tedros Adhanom Ghebreyesus, the current director general, and all other candidates for the role after Chan stood down pledged to reform its governance and funding.

Most health experts agree the organisation under Tedros has performed much better over the coronavirus.

How big an impact will the US funding cuts have?

While the suspension of funding by the US for 60-90 days is relatively small – not least because the US is so far in arrears in its annual payments – the potential for a general US withdrawal from global health funding under the cover of this announcement would be very serious and felt most profoundly in places that need the most support.

Even before the Trump announcement, the organisation was looking at potential cuts to already underfunded programming. Such impacts could be felt in programmes already complicated by the coronavirus, such as vaccination for communicable diseases and in building up early warning systems and resilience to deal with diseases such as Ebola in African countries.

Devi Sridhar, the chair of global public health at the University of Edinburgh, called Trump’s decision extremely problematic, noting that the WHO was leading efforts to help developing countries fight the spread of Covid-19. “This is the agency that’s looking out for other countries and leading efforts to stop the pandemic. This is exactly the time when they need more funding, not less,” she said.
What other impacts will there be?

Trump’s assault on the reliability of WHO data and early warning systems, in pursuit of his own agenda against China, threatens its leadership role. While global health diplomacy is a balancing act when dealing with countries like China, which have a poor record on freedom of speech, transparency and human rights, the information provided to health officials by the WHO is designed to be scientifically and clinically useful in the control of the spread of disease.

Canada's bid to beat back coronavirus exposes stark gaps between the provinces

Quebec and Ontario have been hit hardest, but as the virus spreads concern for Canada’s remote Indigenous communities is growing

Leyland Cecco in Toronto THE GUARDIAN Wed 15 Apr 2020

Canadian forces members in Toronto fan out across the

 country to help fight the coronavirus pandemic.

Photograph: Carlos Osorio/Reuters

Every day for nearly a month, Justin Trudeau has emerged from his residence – rain, shine or snow – with a message that the only way for his country to beat back the coronavirus is with a herculean “Team Canada” effort.

His deputy, Chrystia Freeland, has likened fighting the pandemic to a national wartime effort. Even the conservative premier of Ontario, Doug Ford – once a rival to Trudeau’s Liberals – has called for unity.

Trudeau warns Canada's coronavirus shutdown likely to remain for weeks

All of Canada’s provinces have declared states of emergency and called on residents to practice physical distancing, often using the length of a hockey stick as a model. But as the virus moves across the country, vast disparities have emerged as provinces anticipate starkly different caseloads and fatalities.

Quebec has seen 13,500 documented cases of the coronavirus. But in two of the country’s sparsely populated northern territories – the Yukon, Northwest Territories – only 13 confirmed cases have been logged. Not a single case has been reported in the sprawling territory of Nunavut.

Meanwhile, British Columbia appears to have started “flattening” the curve of its outbreak.

These vast regional differences – a function of geography, policy and luck – have only been magnified in recent weeks as Canada reported 26,897 cases and nearly 900 deaths from the coronavirus on Tuesday.

Compared with its southern neighbour, Canada’s response has been largely coordinated and swift: in the United States, critical weeks lagged between the application of lockdowns in different states, but it took only a few days before schools across Canada were shut down and residents were being asked to stay at home.

Nonetheless, tens of thousands of Quebec residents left for Europe and the United States in early March for the province’s spring break – one of the earliest in the country. That accident of timing meant that Quebec went on to become the centre of the country’s outbreak.

On the other side of the country, British Columbia’s spring break wasn’t until mid-March, leaving officials with enough to time to request residents refrain from travelling, order schools shut down and plead for residents to physically distance themselves.

That call, from the province’s top doctor, Bonnie Henry, has taken on a prescient quality: the province’s case numbers remain disproportionally low. “Some parts of it are luck, and some parts of it are being prepared,” she said recently.

In Ontario, where cases continue to increase, Ford also initially encouraged families to enjoy their vacation. “Go away, have a good time, enjoy yourself,” he said – before tempering his message a few days later.

Canada nursing home reels from death of almost half its residents

With the second-highest number of cases in the country, Ontario has previously said its supply of personal protective equipment was run critically low – a challenge exacerbated after American officials temporarily halted a new shipment of respirators.

“We’ve been asked to be more parsimonious with our safety equipment, to not change our masks unless we think that we’ve been exposed or somehow compromised,” said James Maskalyk, an emergency room doctor in downtown Toronto.

“But we have enough for today. And at this point, that’s what matters. We’re mindful that everyone on the planet is in the same situation that we are.”

Resources in Ontario have not yet been fully strained – as they have in hospitals in New York or northern Italy. But Kulvinder Gill, head of Concerned Ontario Doctors, cautioned that celebration would be premature.

“On the frontlines we are essentially blind to the true reality of Covid-19 in our province,” she said. “We have the lowest per capita testing in Canada, so we are only capturing a very tiny fraction of known cases.”

 Justin Trudeau has emphasized his country’s ‘Team Canada’ 

approach to fighting the virus. 

Photograph: Dave Chan/AFP via Getty Images

With current measures remaining in place, Ontario has suggested as many as 15,000 people could die over the course of the pandemic, which officials say could last as long as two years. But experts say the province’s testing is inadequate and fails to capture the spread of the virus.

“Modelling is only as good as the data that you have. And we have such terrible data that it’s impossible to come up with any sort of accurate modelling from it,” said Gill.

In the western Prairie provinces, doctors have watched with a cautious optimism after surveying the battles outside their borders.

“A lot of us feel like it’s the calm before the storm,” said Brittany Ellis, an emergency room physician involved in pandemic response planning in the city of Saskatoon. “But Saskatchewan is more sparsely populated than other regions – and we also have the benefit of time. Many contagious diseases tend to start in places that have extensive international travel. We really don’t have a lot of that.

RIGHT TO LIFE GOVT DOES NOT CARE ABOUT LIFE, JUST OIL
In neighbouring Alberta, which has long tied its fortunes to the price of oil, the provincial government has been forced to manage both an unfolding pandemic and an energy crisis. Last week, the price of Canadian oil dipped below $4 a barrel.

“The shutdown in much of our economy is having a devastating impact,” said the premier, Jason Kenney, who suggested as much as a quarter of the province’s workforce could be out of a job. An unemployment rate of 25% would be worse than anything experienced in the rest of the country. At the same time, the province has forecast as many as 3,100 deaths and hundreds of thousands of Covid-19 infections.

Experts fear that the worst of the pandemic is likely to be felt in remote Indigenous communities, where many residents already suffer from underlying health issues.

“You’ve got populations that are malnourished, living in overcrowded conditions with higher levels of co-morbidities – chronic obstructive lung disease, cardiovascular disease and obesity – that are now going to get a virus,” said Anna Banerji, director of global and indigenous health at the University of Toronto’s faculty of medicine. “Especially with the overcrowding, I’m sure this virus will spread quickly.”

She and colleagues have started a petition demanding the federal government allocate more resources to Indigenous communities, many of which are only accessible by air.

On Tuesday, the federal government announced plans to increase funding for communities in the north. An aid package of C$130m ($94m) allocates funds to help the territories prepare their health and social services and subsidize the cost of food and hygiene products. The new funding is separate from the C$305m previously announced with the aim of helping Indigenous communities prepare for the virus.

But territorial leaders worry the funding, which they have requested for weeks, has come too late.

“Nunavut is chronically underfunded, and we cannot be expected to deal with this new global reality from behind the starting line,” said Nunavut premier Joe Savikataaq.

And while regions like Nunavut have so far been spared an outbreak, Banerji believes it is only a matter of time before the virus arrives.

“If a whole bunch of people become sick in the Canadian Arctic or in these remote communities, and these people are getting sick from the coronavirus, then what happens?” she said. “People will die.”

Will coronavirus shock the global economy into long-term thinking?

The state has had to pump in money to prop up a system in which too many people were hanging on by their fingertips

When the market breaks down it returns to Keynesianism 
Larry Elliott Wed 15 Apr 2020 

Larry Elliott is the Guardian’s economics editor
 

‘It would be an act of supreme folly to write off 2020 as an aberration and assume that everything can return to normal.’ Closed shops and businesses in Cardiff, March 2020. Photograph: Matthew Horwood/Getty Images

The financial markets think the worst is over. Share prices have largely been rising for the past week (although on Tuesday they went down) on the basis that some countries are starting to lift the lockdown restrictions imposed to limit the Covid-19 pandemic. Amid sighs of relief all round on Wall Street, the hope is that it will soon be business as usual.

In one sense, it’s not an unreasonable thought because the virulence of this particular strain of the coronavirus could not have been predicted. It was what economists call an exogenous shock: something that has a big impact, but comes from outside the system itself.

So, the argument goes, when the International Monetary Fund says that the global economy is going to suffer its worst year since the Great Depression or the UK’s Office for Budget Responsibility pencils in a slump unmatched for three centuries, that has absolutely nothing to do with the way the world economy is organised or run. Covid-19 does not mean the end of globalisation: it is a freak of nature, that’s all.

The view that nothing fundamental will change as a result of the twin health and economic emergencies may be right. There was, after all, much talk of how global capitalism was going to be fundamentally reformed after the banking crisis of 2008, but that’s all it turned out to be: talk.

In retrospect, the big lesson to be learned from 2008 was that the global economic system was operating on terrifyingly thin margins. Banks were taking ever-bigger bets on products they didn’t really understand but had very little capital in reserve to cover any losses. There was virtually no slack in the system and this almost proved fatal when the bets went spectacularly wrong.

The same applies now, only on a much bigger scale. The financial system may perhaps be more resilient than it was in 2008 but the global economy as a whole operates with the scantiest of safety buffers and with no margin for error. And that’s true from top to bottom: from the ultra-low interest rates that have been keeping the global economy afloat for the past decade to the scramble to find intensive-care beds in the NHS. When politicians say that the fundamentals of the economy are sound, they could not be more wrong.


Here’s the real picture. The past 30 years have seen global markets – especially global financial markets – increase in both size and scope. Long and complicated supply chains have been constructed: goods moving backwards and forwards across borders in the pursuit of efficiency gains; hot money flowing into emerging markets looking for high returns and flowing out again just as quickly at the first sign of trouble.

The development of stronger global institutions might have acted to constrain some of the excesses of transnational capital but not since the 1930s has multilateral cooperation been so lacking. The only effective form of international coordination comes from central banks, which ensure that money is cheap and plentiful. Any attempt to raise interest rates to what would once have been considered more normal levels is met by stock market panic and is quickly reversed.

But this is not just a big-picture story. The reason the UK government has been pumping so much money into the health service, into wage subsidies, into support for the self-employed and for small businesses is that they were all only just managing before the crisis broke.

The weakest decade for real-wage growth since the 19th century meant that millions of workers are only one payday away from penury. For most, self-employment is a daily struggle to make enough to live on. Small businesses, such as family-run restaurants, operate on wafer-thin margins. For them, the cost of taking out an emergency government-backed loan (assuming they could get one) would wipe out their profits for the next two years.

What this amounts to is a world clinging on by its fingertips, even in what passes for the “good times”. Anybody who seriously believes that there are no lessons to be learned from what has happened globally since China warned the World Health Organization on New Year’s Eve that it might have a problem on its hands is living in a bubble. It would be an act of supreme folly to write off 2020 as an aberration and assume that everything can return to normal.

Some changes look inevitable. Companies will shorten their supply chains as a result of the disruption caused by the pandemic. Extra money will have to be found for health systems so that they can operate with more spare capacity. Covid-19 has exposed the risks of a country such as Britain running down its domestic manufacturing base and relying so heavily on financial services. Investment bankers are surplus to requirements when the country is short of testing kits and PPE.

Other reforms look tougher. There is a need for a stronger international system to both manage the fight against the pandemic and minimise the economic damage it has caused. No country can operate a go-it-alone approach to Covid-19, despite what Donald Trump might think.

Ultimately, the shock from the banking crisis was not big enough to effect real change. This one might be different, and not simply because people are losing their lives in such numbers. Avowedly free-market governments like the UK’s have not gone a long way to nationalising their labour markets because they have had a Damascene conversion to socialism: they have done so because of the inherently fragile nature of their economies. The best argument those pressing for capital controls, wealth taxes and – like me – a green new deal, is that they will make the world more resilient in the next time of crisis. Because, as things stand, there will be a next time.
Some changes look inevitable. Companies will shorten their supply chains as a result of the disruption caused by the pandemic. Extra money will have to be found for health systems so that they can operate with more spare capacity. Covid-19 has exposed the risks of a country such as Britain running down its domestic manufacturing base and relying so heavily on financial services. Investment bankers are surplus to requirements when the country is short of testing kits and PPE.

Other reforms look tougher. There is a need for a stronger international system to both manage the fight against the pandemic and minimise the economic damage it has caused. No country can operate a go-it-alone approach to Covid-19, despite what Donald Trump might think.

Ultimately, the shock from the banking crisis was not big enough to effect real change. This one might be different, and not simply because people are losing their lives in such numbers. Avowedly free-market governments like the UK’s have not gone a long way to nationalising their labour markets because they have had a Damascene conversion to socialism: they have done so because of the inherently fragile nature of their economies. The best argument those pressing for capital controls, wealth taxes and – like me – a green new deal, is that they will make the world more resilient in the next time of crisis. Because, as things stand, there will be a next time.

Rita Wilson tells of 'extreme side effects' of experimental Covid-19 drug chloroquine
The singer, who was admitted to an Australian hospital with husband Tom Hanks, says she was given chloroquine after developing a fever of 38.9C

Naaman Zhou@naamanzhou Wed 15 Apr 2020 
 

Tom Hanks and Rita Wilson tested positive for coronavirus in March in Australia. The singer says she suffered ‘extreme side effects’ from chloroquine. Photograph: Monica Almeida/Reuters

The singer Rita Wilson has claimed to have suffered “extreme side effects” after being treated with the experimental Covid-19 drug chloroquine in an Australian hospital.

Wilson, who was touring Australia, and her husband, Tom Hanks, who was filming a Baz Luhrmann film about Elvis Presley, both tested positive for Covid-19 on 12 March while in Australia.

The drugs chloroquine and hydroxychloroquine are used to treat malaria, but their ability to treat Covid-19 is still disputed by experts, despite being touted by the US president, Donald Trump, as a “gamechanger”.


Wilson and Hanks were admitted to Gold Coast University hospital in Queensland for treatment, where Wilson said she was given chloroquine after she developed a fever of 38.9C.

“They gave me chloroquine,” she told American TV channel CBS. “I know people have been talking about this drug. But I can only tell you that – I don’t know if the drug worked or if it was just time for the fever to break.

“My fever did break but the chloroquine had such extreme side effects, I was completely nauseous, I had vertigo and my muscles felt very weak … I think people have to be very considerate about that drug.”

A spokeswoman for Gold Coast University hospital would not confirm whether Hanks and Wilson were given chloroquine, but said that “selected patients” did receive the drug.

“Gold Coast Health has used a variety of medication in patients with more severe Covid-19,” a spokeswoman said. “Chloroquine, hydroxychloroquine and lopinavir-ritonavir have been used on selected patients.”

Trump proclaimed the chemical’s effectiveness in March, but the US’s top infectious diseases adviser, Dr Anthony Fauci, has warned that there is not enough medical evidence to prove that it is useful.


2:59 Trump grilled over continued promotion of hydroxychloroquine to treat coronavirus – video


Australian researchers have also said it could cause potentially life-threatening side-effects, such as heart damage.

In March, a man in Arizona died after taking chloroquine phosphate – a chemical used to clean fish tanks – after Trump’s advice. “Trump kept saying it was basically pretty much a cure,” his wife told NBC.

Last week, the Australian Health Protection Principal Committee – the expert panel on health emergencies – recommended against using the drugs in hospitals, contradicting the federal health department.

The department has told hospitals they can prescribe the drug “in a controlled environment in the treatment of severely ill patients in hospital”, after the government waived therapeutic goods registration requirements to fast-track their import into Australia.

Wilson and Hanks have both recovered from the illness, and said their blood had been taken for a study to determine the level of antibodies they developed.
CBS This Morning(@CBSThisMorning)

WATCH: In her first interview since her COVID-19 diagnosis, @RitaWilson says she's feeling great — and giving back.

Wilson told @GayleKing about the story behind her #HipHopHooray remix benefiting @MusiCares, her journey to recovery, and her symptoms when she first got sick. pic.twitter.com/yF3IZrFjCSApril 14, 2020

Q&A

What is hydroxychloroquine

Hydroxychloroquine, also known by its brand name, Plaquenil, is a drug used to treat malaria. It is a less toxic version of chloroquine, another malaria drug, which itself is related to quinine, an ingredient in tonic water.

A widely publicized study in France where 40 coronavirus patients were given hydroxychloroquine, with more than half experiencing the clearing of their airways within three to six days has led to it being touted in some quarters as a potential cure for Covid-19. This apparent improvement is important as it would curtail the timeframe in which infected people could spread Covid-19 to others.

However, experts have warned that the study is small and lacks sufficient rigour to be classed as evidence of a potential treatment. The French study followed work by Chinese researchers which suggested that hydroxychloroquine can slow infections by blocking the virus behind Covid-19 from entering cells in the body. But more recent, albeit small-scale, research from China has shown that patients who were treated with the drugs fought off coronavirus no more quickly than those who didn’t get it. Indeed, one patient given hydroxychloroquine severely worsened in condition while four patients on the medicine developed signs of liver damage and experienced diarrhoea.

Regardless of these findings, any drug being used for a certain purpose before full clinical trials are completed is, by definition, untested and unproven. It’s too early to say if hydroxychloroquine can have a major benefit or not. The European Medicines Agency, an agency of the EU, has said hydroxychloroquine should not be taken by coronavirus patients except for clinical trials or emergency use programs.

Oliver Milman

We scientists said lock down. But UK politicians refused to listen   

For 11 fateful days in March, the government ignored the best coronavirus advice. It must learn from that mistake

Helen Ward is professor of public health at Imperial College London
Wed 15 Apr 2020

‘On 12 March, the government alarmed public health experts by abandoning containment, community case-finding and contact-tracing would stop.’ Boris Johnson arrives at a news conference on 12 March. Photograph: Simon Dawson/PA

In mid-February a colleague mentioned that for the first time in his life he was more concerned than his mother, who had been relatively blase about the risks of Covid-19. It felt odd for him to be telling her to take care. We are both professors in a department of infectious disease epidemiology, and we were worried.

Two months on, that anxiety has not gone, although it’s also been joined by a sense of sadness. It’s now clear that so many people have died, and so many more are desperately ill, simply because our politicians refused to listen to and act on advice. Scientists like us said lock down earlier; we said test, trace, isolate. But they decided they knew better.

Am I being unfair? The government assures us that its decisions and timing are based on science, as if it is a neutral, value-free process resulting in a specific set of instructions. In reality, the science around coronavirus is in its infancy and developing daily, with researchers across the world trying to understand how the virus spreads, how the body responds – and how to treat it and control it. The speed at which our knowledge has increased is impressive, from the sequencing of the virus in January through to having candidate vaccines in early February.

Mathematical models are being refined to predict the extent and speed of spread and estimate the impact of control methods. My own group is studying the response of communities, showing how the epidemic is amplifying existing social inequalities. People with the lowest household income are far less likely, but no less willing, to be able to work from home or to self-isolate.

But while scientists carry out observations and experiments, testing, iterating and discovering new knowledge, it is the role of policymakers to act on the best available evidence. In the context of a rapidly growing threat, that means listening to experts with experience of responding to previous epidemics.

When I say that politicians “refused to listen”, I am referring to the advice and recommendations coming from the World Health Organization, from China and from Italy. The WHO advice, based on decades of experience and widely accepted by public health leaders and scientists around the world was clear – use every possible tool to suppress transmission. That meant testing and isolating cases, tracing and quarantining contacts, and ramping up hygiene efforts.

The UK did well in the early phase, but then, on 12 March, the government alarmed many public health experts by abruptly abandoning containment and announcing that community case-finding and contact-tracing would stop. The aim was no longer to stop people getting it, but to slow it down while protecting the vulnerable.

The evidence underpinning the government’s decision appears in a report from 9 March summarising the potential impact of behavioural and social interventions. The report did not consider the impact of case-finding and contact-tracing, but it did suggest that the biggest impact on cases and deaths would come from social distancing and the protection of vulnerable groups.

And yet social distancing was not recommended then. That day, 12 March, after hearing with disbelief the government announcement that didn’t include widespread social distancing, I recommended to my team at Imperial that they should work from home for the foreseeable future. Indeed, I have not been to my office since.

Neither the advice nor the science were followed that week. My colleagues, led by Neil Ferguson, published a report on 16 March estimating that without strong suppression, 250,000 people could die in the UK. The government responded that day with a recommendation for social distancing, avoiding pubs and working from home if possible. But there was still no enforcement, and it was left up to individuals and employers to decide what to do. Many people were willing but unable to comply as we showed in a report on 20 March. It was only on 23 March that a more stringent lockdown and economic support was announced.

Between 12 and 23 March, tens, if not hundreds of thousands, of people will have been infected. Boris Johnson himself may well have been infected that week, and his stay in the intensive care unit may have been avoided if the government had shifted to remote working on 12 March. The current best estimate is that around 1% of those infected will die.

So where to now? Once again, public health experience, including modelling, leads to some very clear recommendations. First, find cases in the community as well as hospitals and care homes; isolate them, and trace their contacts using a combination of local public health teams and digital tools.

Second, know your epidemic. Track the epidemic nationally and locally using NHS, public health and digital surveillance to see where cases are continuing to spread. This will be essential so that we can start to lift the lockdown while shielding the population from hotspots of transmission. Build community resilience by providing local support for vulnerable people affected by the virus and the negative impact of the control measures.

Third, ensure transmission is suppressed in hospitals, care homes and workplaces through the right protective equipment, testing, distancing and hygiene. Investigate the differential effects on black and minority ethnic groups, and provide appropriate protection.

Fourth, ensure that the most vulnerable, socially and medically, are fully protected through simple access to a basic income, rights for migrants, and safety for those affected by domestic violence.

Many, including the Labour leader, Keir Starmer, say that now is not the time for blame. I am not looking to blame – but for scrutiny so that lessons can be learned to guide our response. We need to avoid further mistakes, and ensure that the government is hearing, and acting on, the best advice.

How coronavirus changed the world in three months – video