As mass testing and contact tracing are rolled out in some nations, others are way ahead.
The push for large-scale coronavirus testing and contact tracing has been at the core of the World Health Organization’s guidance for stopping the coronavirus. And as some nations bring in new track-and-trace systems designed to prevent a second major wave of infections, others’ experiences offer case studies — and cautionary tales.
The latest such effort, in Britain, is being rolled out on Thursday. People with potential Covid-19 symptoms will be tested and, if positive, be asked to list everyone they have recently been in close contact with for at least 15 minutes. Those people will, in turn, be contacted and asked to isolate themselves for 14 days.
The country’s health secretary, Matt Hancock, said this week that the program aimed to replace a nationwide lockdown with individual isolation or smaller localized restrictions if new cases emerge.
The move comes a day after France’s Parliament approved the deployment of a contact tracing app that has set off an intense debate in the country. Critics question how the gathered data will be used and worry about setting a precedent for state-run monitoring. But France’s data privacy watchdog ruled that the app has sufficient safeguards.
In Japan, where the government limited tests to the most severe cases and instead focused on contact tracing, medical experts worried that the approach would allow cases to explode. But Japan continues to have a relatively low Covid-19 death rate.
And in Wuhan, the Chinese city that was once at the center of the pandemic, a large-scale program has tested nearly 6.5 million people in the last two weeks.
Years of neglect had hobbled Mexico’s health care system, leaving it dangerously short of doctors, nurses and equipment to fight a virus that has overwhelmed far richer nations.
Now, the pandemic is making matters even worse, sickening more than 11,300 health workers in the country — one of the highest rates in the world — and further depleting the thin ranks in hospitals. Some hospitals have lost half their workers to illness and absenteeism. Others are running low on basic equipment.
The shortages have had devastating consequences for patients, health workers across Mexico say. Doctors and nurses recounted dozens of preventable deaths in hospitals — the result of neglect or mistakes that never should have happened.
“We have had many of what we call ‘dumb deaths,’” said Pablo Villaseñor, a doctor at the General Hospital in Tijuana, the center of an outbreak. “It’s not the virus that is killing them. It’s the lack of proper care.”
Patients die because they are given the wrong medications or the wrong dose, health workers said. Protective gloves at some hospitals are so old that they crack the moment they’re slipped on, nurses said.
Mexico’s government spends less on health care as a percent of its economy than most countries in the Western Hemisphere, according to the World Bank. President Andrés Manuel López Obrador presided over spending cuts even after acknowledging that his country had 200,000 fewer health care workers than it needed.
“You hear of one patient dying because he didn’t get the proper care — and then another one and another one — and you try not to become paralyzed,” said Dr. Villaseñor, a rheumatologist who said he had to learn how to suit up to treat coronavirus patients by watching a video on YouTube.
Indonesia, the world’s fourth most populous country, offers both a cautionary tale for how dithering leadership can thwart public health and a medical puzzle for why an unprepared nation’s hospitals have so far not been overwhelmed by the coronavirus.
With thousands of islands straddling a section of the Equator wider than the continental United States, Indonesia has counted on its sprawling archipelago and youthful population to slow the contagion. And the government has said that national coronavirus restrictions, already a scattershot effort, must be relaxed to save the economy.
But Indonesia’s caseload is rising quickly — in populated and far-flung areas alike — and experts worry that the country’s health care system will break down if the virus spreads as intensely as it did in Europe and the United States.
In early May, Indonesia had recorded fewer than 12,000 coronavirus cases, with about 865 deaths. By Thursday, the number had increased to 23,851 confirmed cases and 1,473 deaths, and health experts say even this near doubling of cases reflects the limits of testing rather than the true caseload.
In a glimpse of what could be runaway transmission, a sampling of 11,555 people in Surabaya, the country’s second largest city, found last week that 10 percent of those tested had antibodies for the coronavirus. Yet the entire province of East Java, which includes Surabaya, had just 4,142 officially confirmed cases as of Wednesday.
“Massive infection has already happened,” said Dono Widiatmoko, a member of Indonesia’s Public Health Association. “This means it’s too late.”
The fire ravaged a makeshift Covid-19 isolation unit that had been built outside United Hospital in Dhaka, the capital. Hospital officials said that three of the patients were confirmed coronavirus patients,and that the victims’ ages ranged from 45 to 75.
Muneer-ul-Islam, who runs a grocery shop in the neighborhood, said people in other parts of hospital, one of the biggest in Dhaka, started running out of the building after the makeshift compound caught fire.
“People feared the entire building would catch the fire,” he said.
The fire, in Dhaka’s upscale Gulshan area, was brought under control around 10 p.m., officials said. Hospital officials said in a statement that the cause appeared to be an electrical short circuit.
Debashis Bardan, a fire department official, said the government had set up a four-member committee to investigate the cause of the fire.
Bangladesh has a poor record on fire safety. Most buildings rely on cheap and often compromised designs, and risks are often compounded by poor enforcement and unscrupulous management.
Bangladesh has reported 544 coronavirus deaths and more than 38,000 cases, but some health experts say the actual number of cases could be far higher because testing is scant. Many hospitals have been overwhelmed with patients.
The first confirmed coronavirus infections in Europe and the United States, discovered in January, did not ignite the epidemics that followed, according to a close analysis of hundreds of viral genomes.
Those outbreaks began weeks later, the study concluded. The revised timeline may clarify nagging ambiguities about the arrival of the pandemic, The Times writer Carl Zimmer reports.
Although President Trump has frequently claimed that a ban on travelers from China prevented the outbreak from becoming much worse, the new data suggest that the virus that started Washington State’s epidemic arrived about two weeks after the ban was imposed on Feb. 2.
And the authors say that the outbreak’s relatively late emergence means that more lives could have been saved by early action, such as testing and contact tracing.
The new analysis is not the last word. Scientific understanding of the virus is evolving almost daily, and this type of research yields a range of possible results, not complete certainty.
Many infections in Washington State appear to have occurred earlier in February, and other models suggested that the epidemic there began before the middle of the month. But a number of virus experts said the new report convincingly ruled out a connection between the first confirmed cases and the later outbreaks.
“This paper clearly shows this didn’t happen,” said Kristian Andersen, a computational biologist at the Scripps Research Institute in San Diego who was not involved in the research.
Forecasters expect the weekly U.S. Labor Department report on unemployment claims released on Thursday morning to show an additional 2.1 million filings last week, according to MarketWatch. That would push the total past 40 million since the pandemic began devastating the country’s economy in March.
The latest claims may not only be a result of fresh layoffs, but also evidence that states are working their way through a backlog. And overcounting in some places and undercounting in others makes it difficult to measure the layoffs precisely.
Under the Pandemic Unemployment Assistance program, Congress approved an expanded palette of jobless benefits for people including freelancers, self-employed, gig workers and others who would not usually qualify under state rules. But many states, flooded with applicants, were slow to put the program into effect, and those eligible may not yet be fully reflected.
“When we think about what to do when benefits expire, it would be helpful to know how many people are actually getting them,” said Elizabeth Pancotti, a research assistant at the National Bureau of Economic Research. The Labor Department reports may be the best source of information, she said, but they offer an “incomplete picture.”
Myanmar’s government is abusing regulations aimed at limiting the spread of the coronavirus by routinely sentencing people to prison for violating curfew, quarantine and social distancing requirements, human rights activists say.
In the last two months, at least 500 people have received prison sentences ranging from two weeks to a year over violations of the public health measures, according to Human Rights Watch and the Myanmar-based rights group Athan.
Some found guilty of breaking the virus rules have been fined up to $35 and then jailed because they couldn’t afford to pay. Myanmar’s prisons are notoriously overcrowded and unsanitary.
“Throwing hundreds behind bars in crowded, unhygienic prisons defeats the purpose of containing the spread of Covid-19,” said Phil Robertson, deputy Asia director at Human Rights Watch.
Myanmar, one of the poorest nations in Southeast Asia, has reported only 206 coronavirus cases and six deaths. But it has conducted fewer than 22,000 tests for a nation of 54 million people, and health experts believe that many cases have gone undetected.
To encourage the public to take precautions, Myanmar’s civilian leader, Daw Aung San Suu Kyi, has posted videos of herself washing her hands and sewing a face mask.
In addition to those sentenced to prison for violating the public health rules, at least 500 others face charges, including many who are in jail awaiting trial, said Athan’s co-founder and research manager, Ko Ye Wai Phyo Aung.
He said the rules were often applied unevenly. In one case, he said, a violator was fined the equivalent of 4 cents while another was sentenced to a month in jail for a similar offense. Meanwhile, he said, officials who break the rules are not charged at all.
China’s leader, Xi Jinping, has big dreams for his country’s soccer future. “My biggest hope for Chinese soccer is that its teams become among the world’s best,” he said in 2015.
This won’t be the year for that. Even before professional play has had a chance to begin in 2020, China’s top leagues have lost more than a fifth of their teams, the result of longstanding financial woes compounded by the coronavirus shutdown.
The Chinese Football Association said on Saturday that 11 clubs had been disqualified because they owed wages to players, coaches and staff members. Five other teams — including Tianjin Tianhai, from the top-division Chinese Super League — withdrew on their own. Tianjin Tianhai said its financial situation had reached “desperate straits.”
The Super League will have 16 teams this year, the association said, with Shenzhen Football Club replacing Tianjin Tianhai in the league’s ranks. A start date to its season has not been announced.
Some of the Chinese clubs that are out this year began folding months ago, before the epidemic led to the suspension of professional play and ticket sales.
China has no shortage of passionate soccer fans. Emboldened by Mr. Xi’s support for the game, investors have piled into Chinese clubs, helping them spend on expensive foreign talent, including the Brazilian forward known as Hulk. But the three leagues’ popularity has fallen short of owners’ lofty dreams, particularly for lower-division clubs.
For some clubs that have not been kicked out of their leagues, there is another problem. A third of foreign players and coaches are trapped outside of China because of the country’s tight pandemic-related entry restrictions, the soccer association’s president told a state-run broadcaster this month.
One mask depicts a middle finger, stuck defiantly upward, silk-screened in black ink on a blue background. Others feature sunflower seeds, a surveillance camera or creatures from ancient Chinese mythology.
An assortment of Mr. Ai’s masks, made of nonsurgical cloth, will be sold on eBay for Charity, from Thursday until June 27, to raise money for humanitarian and emergency relief efforts around the coronavirus pandemic.
Mr. Ai — who has been working across time zones, with a team in Wuhan, on a documentary about Covid-19 — said that the idea for the masks had come to him late one night. While making carvings with his son, he printed a middle finger on a mask and posted it to Instagram. (He has used this image before, including in a “Study of Perspective” series that had backdrops of different monuments.)
People wanted to know where they could get one. “I wanted to do something,” he said. “I didn’t want to just be sitting there and waiting for the time to pass.”
Just over four months after the government confirmed the first known case, more than 100,000 people who had the coronavirus have died in the United States, according to a New York Times tally.
The death toll — far higher than that of any other nation — is on track to be the country’s deadliest public health disaster since the 1918 flu pandemic in which about 675,000 Americans died.
President Trump and the presumptive Democratic nominee, Joseph R. Biden Jr., have outlined two very different strategies for moving forward. Mr. Biden, who laid out his plan in a Medium post, said he would set up testing through the federal government, with a public-private board to oversee test manufacturing and distribution, federal safety regulators enforcing testing at work and at least 100,000 contact tracers tracking down people exposed to the virus.
The Trump administration released its new testing strategy over the weekend, as it was required to do under the Paycheck Protection Program and Heath Care Enhancement Act. The plan, detailed in an 81-page document, would hold states responsible for carrying out all coronavirus testing, although the federal government would provide some supplies.
More than 1.6 million people in the country have been infected, and while hard-hit northeastern states have reported decreases in new cases in recent days and the pace of deaths nationwide has fallen, health experts warn of a possible resurgence as lockdowns are lifted.
And most statisticians and public health experts, including Dr. Anthony S. Fauci, the nation’s top infectious disease expert, say the death toll is probably far higher than official counts indicate.
Three big men lock arms. Three from the other team do the same. At the referee’s signal, they lunge toward each other, their faces inches apart.
Often there is a rule violation of some kind, and they have to get up and do it again. And maybe again.
Scrums would not be barred outright, but World Rugby is advising that they not be reset repeatedly by the referee. Tacklers will have to come in low, not upright, another situation with the potential for close face-to-face contact.
The group also recommended barring huddles and spitting. And it is advising that at halftime the ball be washed and players don new uniforms.
The World Health Organization says that risks of transmission are greatest when people are close to each other for 15 minutes or more. The rugby players who are most often in scrums are in close contact with the opposition for about 13 and a half total minutes per game, World Rugby said.
Remembering those we’ve lost.
José María Galante relentlessly gathered evidence of torture and other abuses committed during the Franco dictatorship in Spain. He did so for decades, despite an amnesty law passed two years after Franco’s death in 1975 that was designed to help smooth Spain’s return to democracy.
Mr. Galante died on March 29 in a Madrid hospital. He was 71. His partner, Justa Montero, said the cause was Covid-19.
Here are some of the others we’ve lost to Covid-19 complications:
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Yu Lihua, 90, whose nuanced portraits of overseas Chinese students and intellectuals in America captured the cultural displacement and identity crisis felt by many in the Chinese diaspora.
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Tendol Gyalzur, who fled Tibet during the 1959 uprising and returned after more than three decades to start the region’s first private orphanages. She was believed to be 69.
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John Houghton, 88, a Welsh climate scientist and influential figure in the U.N. panel that brought the threat of climate change to the world’s attention.
Reporting was contributed by Ian Austen, Hannah Beech, Aurelien Breeden, Stephen Castle, Choe Sang-Hun, Ben Dooley, Jack Ewing, Sophie Haigney, Mike Ives, Natalie Kitroeff, Stephen Kurczy, Mark Landler, Victor Mather, Raphael Minder, Saw Nang, Richard C. Paddock, Amy Qin, John Schwartz, Megan Specia, Muktita Suhartono, Paulina Villegas, Sameer Yasir, Raymond Zhong and Carl Zimmer.
