A Chinese company offered Friday to replace thousands of faulty coronavirus test kits after Spanish health authorities – desperate for materials to cope with the world’s second highest COVID-19 death toll – complained they did not work as promised.
China has sold face masks and other medical equipment through a series of personal contacts with Spanish authorities, including discussions between chief executives of Chinese tech giant Alibaba and Spain’s King Felipe.
But the first shipment of 640,000 test kits was found to have “insufficient sensibility” to reliably identify infected patients, according to Health Minister Salvador Illa, who announced Thursday that 58,000 kits had been returned.
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The Chinese company supplying the test kits, Shenzhen Bioeasy Technology, said in a statement quoted by Reuters that the incorrect results may have resulted from a failure to collect samples or use the kits correctly.
The firm said it had not adequately communicated with clients how to use the kits and would resend them “assuring the sensitivity and specificity needed to help Spain fight against COVID-19.”
Spanish medical experts, who have examined the 9,000 kits delivered last week, said they have only a 30 percent probability of detecting the virus.
“They are useless,” said Victor Jimenez Cid, a senior professor in microbiology at Madrid’s Complutense University. For a test to be effective it must have a 70 percent to 80 percent probability of detecting the virus, Cid said.
The failure of Bioeasy’s testing kits is a painful setback for Spanish medical authorities, who are struggling to cope with more than 64,000 cases of COVID-19 and more than 4,900 deaths, second only to Italy.
It is also hugely embarrassing to China, which is seeking to rehabilitate a national image tarnished by its faulty early response to the virus in Wuhan by offering assistance to other hard-hit countries.
“First they send us the virus, then they sell us the medications to stop it and then defraud us. It’s great for China” said a guest in a panel discussion on a broadcast on the Spanish TV channel La Sexta.
The test is performed by dipping a swab with a sample of a patient’s saliva in a protein extraction that gives color indications of the virus’s presence. The speedy method is essential for emergency examinations by hospitals as well as improvised drive-through facilities that Spanish authorities are setting up to isolate and quickly treat cases of contamination.
Until now, Spanish hospitals have relied on slower molecular laboratory testing, which requires specialized personnel and take four hours to produce a result. Tests like those offered by Bioeasy are supposed to produce a diagnosis in 15 minutes.
Mass testing methods proved essential in South Korea’s successful effort against coronavirus and they are recommended by the World Health Organization as an essential way of controlling the pandemic’s spread.
The Chinese embassy in Spain tweeted that Shenzen Bioeasy is not licensed to sell the product and is not included on a list of “recommended suppliers,” which its ministry of commerce offered the Spanish government.
Spain’s health ministry said Bioeasy products have been approved by European Union quality control agencies and that the “specifications of this test, at least of the lot that was received, do not correspond with EU quality certifications.”
Officials said the deal with Bioeasy was made through an unidentified intermediary.
Health ministry emergency coordinator Fernando Simon said Spain is trying to import 6 million testing kits from China and other EU countries. He also said that “intense efforts” are underway with Spanish biotechnology firms to produce them.
United States has now surpassed China in the number of COVID-19 cases around the world, with at least 82,404 people are known to have been infected with the deadly coronavirus, the Johns Hopkins University real-time COVID-19 tracker said on Thursday. It is, however, important to note that the US has been testing people at a much larger scale, when compared with other countries that have been affected by the coronavirus pandemic.
“We now have 370,000 tests that have been done. The majority of those — over 220,000 in the last eight days, which, those of you who have been tracking the South Korea numbers, put us equivalent to what they did in eight weeks that we did in eight days,” Dr Deborah Birx, the White House’s coronavirus response coordinator, told reporters.
Although the US has surpassed China’s 81,782 mark, the COVID-19-related death toll in the country is still lower than China, with 1,178 Americans having died as opposed to the 3,291 Chinese fatalities.
At least 160 million Americans have been ordered to stay home as schools are closed, restaurants and bars have been closed in hope of the curtail spread of the lethal virus, The New York Times reported.
New York City is among the worst-hit cities as the number of confirmed COVID-19 cases in the city has reached 38,000 and 281 have died.
On Wednesday, US Senate leaders and Trump Administration had reached an agreement regarding a USD 2 trillion package to rescue the economy from the coronavirus wrath, paving the way for swift passage of the legislation from both the chambers of Congress.
The G-20 summit which concluded on Thursday pledged to inject over USD 5 trillion into the global economy in a bid to counteract the social, economic, and financial impact of COVID 19 that has impacted people in at least 170 countries and caused over 20,000 deaths.
As of Thursday, 4,62,684 confirmed cases of coronavirus infection were registered in the world, 20,834 of the patients died, WHO data shows.
On March 11, the WHO declared the coronavirus outbreak a pandemic which has now has been detected in 199 countries and territories.
The Armani Group, the leading company in the luxury sector owned by Giorgio Armani, converts all its Italian fashion production into disposable gowns for the individual protection of health workers engaged in dealing with Coronavirus in the Italian hospitals and clinics. In recent weeks, following the initial donation of one million and 250 thousand euros allocated to the Civil Protection and hospitals Luigi Sacco, San Raffaele, the Cancer Institute of Milan and Spallanzani of Rome, Giorgio Armani has now decided to make his contribution also to Bergamo, Piacenza and Versilia hospitals, thus reaching a total donation of 2 million euros.
There are many initiatives launched by entrepreneurs and companies in support of their territories, in particular doctors committed to the front against the pandemic. The Damiani Group, one of the largest jewellery manufacturers in the world, has also launched a program that involves the customers of the Group’s brands so as to be the collector of a fundraiser in favor of entities active in the fight against Covid-19. By purchasing a Damiani or Salvini jewel, a Venini object, either in the specific brand platforms or e-commerce, the company will activate further donations in addition to paying the buyers a discount, which can also be donated to the body chosen by the end customer to support, for example, the hospitals in the most affected regions.
The Group has also decided to pay homage with a jewel to all the doctors and nurses working tirelessly in the Tortona hospital, which as required by the Piemonte Region has been transformed into Covid Hospital, to thank them symbolically for the great work they are carrying out and with the intention of giving them a smile.
As the novel coronavirus rips through a stunned global population, it’s becoming clear that no one can escape the impact it’s having on society. The past few weeks have shown that even the world’s wealthiest and most powerful are as likely to contract the virus as anyone else. However, less attention is being paid to the most vulnerable members of society — those in poverty, people living on the breadline and the homeless.
The problem reached a crunch point in the UK, which has dramatically increased its response to the virus outbreak this week. Food banks that provide a lifeline for some of the estimated 14 million in poverty are running low on volunteers, many of whom have been forced to self-isolate, as well as food itself, which is in short supply following panic-buying. The situation is equally bleak for the UK’s homeless population, estimated to be around 320,000. Unable to follow government advice to self-isolate, they face a double blow as life-saving services close just as they become most needed.
People working on the frontline in homeless shelters told CNN their worst nightmares were already coming true, with at least one facility forced to close after one of its users died from COVID-19. Most of the people in that shelter are now sleeping rough and may have come into contact with virus carriers.
Shelter, a non-profit that provides support for the UK’s homeless population, estimates that the number of people sleeping on the streets has risen 165% since 2010.
That date is important. It’s the year the UK went from having a center-left Labour government to a center-right Conservative-led administration. And in the wake of the 2007-2008 global financial crisis, it embarked on policies that radically cut state spending. “The message was clear… we need to cut back to balance the books,” says Garry Lemon, director of policy at the Trussell Trust, a non-profit that supports food banks in the UK.
“It took a lot of forms, but billions of pounds were taken out of our social security system — and it was done with widespread public support.”
Critics believe that government policies over the past decade have left the social security system severely compromised. “Our research shows that combined impact of those policies amount to average £3,000 a year ($3,560) for the poorest,” says Clare McNeil from the left-of-center IPPR think tank.
Lemon adds that his organization’s research has shown a link between these policies and a rise in “homelessness and food bank usage.”
The subject of food banks is a good place to return to coronavirus, and especially how it affects the vulnerable. “The majority of our volunteers are retired. Some are not in good health because it’s hard to be when you’re over 70,” says Allison, one of seven volunteers at an independent food bank in the UK. (She preferred to withhold her last name in order to be able to speak more freely.
“We’ve given them the option of dropping out and obeying the government guidelines. But it does leave a hole. Now, if a family member coughs, people are gone at the drop of a hat.”
The challenges facing these vulnerable members of society are nothing new. Campaigners hope that this crisis will at least shine a light on the plight of those in poverty and without homes. “This coronavirus exposes the cracks in society — those who have mortgages and regular income could suddenly find themselves facing the same problems as people who are on benefits.
It might be that when all is said and done, previously comfortable people, suddenly forced to stare into the eyes of destitution, will agree with Sahota and be unable to accept that economic prudence is more important than looking after the livelihoods of fellow citizens.
This outbreak will change many things, and it’s not clear how many of those will be undone when it’s all over. Just how the world moves on from this is still anyone’s guess. But, if current projections are right, we in the West are still only in the early stages of this thing.
Do we still know enough about the Sars-Cov-2 virus that has brought world superpowers to their knees? As the question lingered, Spain’s death toll surpassed that of China, where the virus surfaced late last year. Meanwhile, to mitigate a fallout of the pandemic, the US Senate and the White House reached an agreement on a $2 trillion stimulus package for the US economy, and to help the millions of Americans ravaged by the situation.
Britain’s heir to the throne, Prince Charles, has tested positive for the coronavirus, according to a statement from his London household.
* China’s National Health Commission reported 47 new confirmed cases and four more deaths as of March 24. It said all new cases were all imported, meaning they traveled from overseas. * Malaysia has reported another 172 cases of the coronavirus, taking the country’s total confirmed cases to 1,796, Prime Minister Muhyiddin Yassin said in a televised address. * The White House and Senate leaders reached a deal on a massive $2 trillion coronavirus stimulus bill to combat the economic impact of the outbreak.
The Prince of Wales has tested positive for Coronavirus. He has been displaying mild symptoms but otherwise remains in good health and has been working from home throughout the last few days as usual.
The Trump administration struck a deal with Senate Democrats and Republicans on an historic rescue package with more than $2 trillion in spending and tax breaks to bolster the hobbled U.S. economy and fund a nationwide effort to stem the coronavirus.
The Duchess of Cornwall has also been tested but does not have the virus. In accordance with Government and medical advice, the Prince and the Duchess are now self-isolating at home in Scotland. The tests were carried out by the NHS in Aberdeenshire where they met the criteria required for testing.
The spokesman said it was difficult to determine how the prince, aged 71, contracted the virus.
It is not possible to ascertain from whom the Prince caught the virus owing to the high number of engagements he carried out in his public role during recent weeks.
International Olympic Committee (IOC) President Thomas Bach said Wednesday that a surge in coronavirus cases in Africa had prompted the decision to postpone the world’s biggest sporting event.
Bach and Japanese Prime Minister Shinzo Abe announced Tuesday that the Olympic Games, which was due to start in Tokyo on July 24, would be postponed until no later than the summer of 2021 due to the coronavirus pandemic. — Elliot Smith.
The spread of the Coronavirus epidemic (COVID-19) is alarming, as are the measures taken by nations to stop it. States around the world have implemented a wide range of policies in an attempt to safeguard public health and safety, as well as to stem the economic effects of the outbreak. We have collected the data of the main governments, starting from China – the first epicentre of the epidemic – to the most affected countries, from the United States to Africa. It must be said that reactions of the governments adapt according to the “curve” of the contagions. The measures taken by Beijing have been fundamental in reducing the number of new cases. Today China has significantly fewer occupied beds than a two weeks ago. In parallel with the drop in new cases, new antiviral therapies have been adopted, also through the convalescent plasma which now exceed the number of new infections according to the World Health Organization (WHO).
As reported by the WHO-China Joint Mission on Coronavirus Disease 2019, a Central Leadership Group for Epidemic Response and the Joint Prevention and Control Mechanism of the State Council were established in China. The prevention and control measures have been implemented rapidly, from the early stages in Wuhan and other key areas of Hubei, to the current overall national epidemic. It has been undertaken protocols for COVID-19 diagnosis and 15 treatment, surveillance, epidemiological investigation, management of close contacts, and laboratory testing were formulated, and relevant surveillance activities and epidemiological investigations conducted. The response mechanism was initiated with multi-sectoral involvement in joint prevention and control measures. Wet markets were closed, and efforts were made to identify the zoonotic source. Measures were also taken to ensure that all cases were treated, and close contacts were isolated and put under medical observation. Other measures implemented included the extension of the Spring Festival holiday, traffic controls, and the control of transportation capacity to reduce the movement of people; mass gathering activities were also cancelled. Information about the epidemic and prevention and control measures was regularly released. Public risk communications and health education were strengthened; allocation of medical supplies was coordinated, new hospitals were built in 10 days, reserve beds were used and relevant premises were repurposed to ensure that all cases could be treated; efforts were made to maintain a stable supply of commodities and their prices to ensure the smooth operation of society.
Italy has found itself managing something completely new, the most difficult crisis since the Second World War. Despite the Chinese experience, the Italian government’s response has been uncertain as to what to do. Giuseppe Conte first closed certain businesses, then reopened them fearing for the national economy. Politicians first appeared on TV saying that the virus was a normal flu, only to later suggest citizens to stay home when the number of infections and deaths rose to alarming levels. In the latest decree, President Conte introduced heavy fines, from 400 to 3000 euros, for those who violate the anti-contagion rules. And the possibility for individual Regions to take harsher measures than national ones if the contagion increases, but in coordination with the government. Not only. Those in quarantine are punished with imprisonment for one to five years because they are positive for Coronavirus and intentionally leaves the house violating the absolute ban on leaving their home. According to Palazzo Chigi, the new decree which tightens sanctions for anti-Coronavirus measures provides for this. The measures so far adopted by Rome include the limitation of the movement of people, also the possibility of moving away domicile or residence, or entering or leaving the national territory except for individual movements, limited in time and space and motivated by work needs, situations of need or urgency, for health reasons or other specific reasons. Quarantine for those who have had close contacts with the infected – absolute ban on leaving the house for the positive, limits or stops at meetings or gatherings in public places; no cultural, recreational, sporting and religious events. In Italy from the beginning of the emergency there have been massive TV information campaigns to educate the public on basic preventative measures like stay home, washing hands, staying away from crowds, maintaining a social distance of 1 meter and not touching your face. With the spread of Coronavirus, French president Emmanuel Macron followed the “Italian” model.
According to ‘Politico’, in the United States many states have limited the operations of dining establishments to prevent the spread of the disease among crowds, requiring bars and restaurants to either shift to takeout-only operations or close down entirely. California, Illinois, Indiana, Michigan, Ohio, Washington, West Virginia and Wisconsin have initiated the most comprehensive policies. They’ve closed all bars and restaurants except for takeout and delivery, banned all gatherings, ordered mandatory state-wide quarantine, closed all nonessential businesses, and closed all schools. California and Washington have also enacted paid sick leave for workers. The American newspaper stress that though the development of a coronavirus vaccine is likely more than a year away, many states have already enacted policies dictating that the vaccine be provided to all residents for free. Lawmakers pushing for this argue the high cost of vaccinating the population for free pales in comparison to the cost of failing to do so and having the virus resurge in the future. Many states have also banned large gatherings to slow the spread of the virus, but there is wide variation on what constitutes a “large gathering.” As the crisis has worsened over the past few weeks, states have brought down the size of allowed gatherings from 1,000 to 250 to 50 to just 10.
So far, Russia has managed to contain the coronavirus, but the country is unable to completely block the threat. Vladimir Putin said this when speaking to the nation today, stressing that it is now imperative to respect the indications of the authorities. To contain the epidemic, Putin announced that “one week stop” will be introduced to “non-essential” activities, from March 28 to April 5. “Stay home,” Putin said on television. In Asia, the spotlight remains on South Korea, which has the largest number of patients outside mainland China. More than half of its 5,612 cases are linked to a branch of the Shincheonji religious group in the country’s south. The government has proposed an extra budget of about $9.8 billion in response and recovery, which will be submitted for approval on Thursday. South Korean authorities have aggressively rolled out testing across the country, even setting up drive-through testing stations where people can get tested in minutes, all without leaving their cars. They have also employed creative technologies in this “war,” like a GPS system that sets off an alarm when patients violate quarantine at home. Millions are still working from home across Asia, with both government departments and private companies implementing flexible or remote working arrangements for better social distancing. Events and public gatherings have been cancelled for the same reason — in Japan, the Rugby Sevens invitational tournament was cancelled over coronavirus fears and Olympic Game 2020 have been postponed to 2021 before summer. According to CNN’ reporters, governments in these places have also had to address unexpected issues like panic buying, which saw toilet rolls and face masks sell out across supermarkets in Hong Kong. The same issue is now being seen in Australia, which announced additional cases this week after nearly a month of no new cases — images from cities like Sydney and Brisbane show empty grocery store aisles and crowds jostling for products. In response, governments have urged people not to panic buy, and said that there was no threat to supply. Supermarkets have also imposed limits on how much shoppers can buy of items like toilet roll.
Libya announced yesterday its first positive Covid-19 case, but so far, the conflict still ongoing. Civil organizations and NGOs conducted several campaigns to promote awareness about the virus and sterilization of public places. The Tripoli based government of national accord (GNA) imposed a curfew from 18,00 to 6,00 am, while authorities in the east have previously announced a total curfew with shops open just two hours, then as people were overcrowding the markets, they reduced the time of curfew from 15,00 to 6,00 of morning. UN secretary general, Antonio Guterres, called for a world ceasefire to globally respond to coronavirus emergency. Tunisia also disposed 24h curfew and deployed the army to guarantee the respect of the decision. All shops, restaurant, cafes and mosques remain closed, only excepted groceries and pharmacies. Also India announced yesterday to lockdown with similar measures.
Iran is at the heart of the Middle East outbreak. Bahrain accused the Islamic Republic of “biological aggression” by covering up the spread of the coronavirus and failing to stamp Bahraini travellers’ passports. Gulf Arab states took new steps to contain the virus, with Saudi Arabia’s highest religious authority saying anyone diagnosed with coronavirus was forbidden from attending Friday prayers. Many of the recorded infections throughout the Gulf region are linked to travel to Iran, which hosts several important shrines and pilgrimage sites for Shi’ite Muslims. Iranian Foreign Ministry spokesman Abbas Mousavi has denied that not stamping passports has anything to do with coronavirus and called on Riyadh to avoid politicizing the epidemic. No Gulf Arab state has reported a coronavirus death. The United Arab Emirates (UAE) decided to completely suspend passenger flights for two weeks. Also, the state has stopped issuing visas. The UAE has shown significant effectiveness in taking preventive measures to limit the spread of coronavirus. Since the virus spread itself, the state has been actively implementing stringent procedures at its borders, using thermal scanners, and has also trained qualified medical teams that are available around the clock for residents of the state. The Government supported the epidemiological investigation system, providing strategic reserves of essential medical supplies for the early detection of the virus, quarantine and medical isolation campaigns, and building fully equipped isolation rooms. The authorities also suspended the distribution of paper publications and encouraged e-learning and smart working.
On Monday evening, the White House coordinator for coronavirus task force, Dr. Deborah Birx, told reporters that self-swabbing for corona testing would be available for US citizens by this week.
At the news briefing, making the major announcement over self testing, Dr. Birx said that the new ‘self-swab’ technique would make it much easier for people to collect their own samples to test for the coronavirus. She added that it would speed up the virus detection process in a possibly safer manner. The slow tracing process has posed a major challenge in winning this battle against the new virus.
Besides, self-testing takes the burden off public health institutions and officials as they face dearth of both testing kits and manpower to identify and stamp out outbreaks quickly. The collection of samples also puts the medical personal at risk and with shortage of the protective gear to shield the medical staff against the virus, this comes up as a ‘breakthrough’ solution.
Kelly Wroblewski of the Association of Public Health Laboratories told NPR over an email, “They would be nasal swab, which are different than nasopharyngeal swabs,” That would also help “somewhat with the swab shortage.” She added, “It also keeps people at home instead of going out to get a test with mild symptoms and potentially infecting people.”
But she noted that “it doesn’t help and could exacerbate other supply chain issues, if there are many more specimens coming in for testing.”
To conduct the self-swab testing, individuals still need to follow the FDA guidelines i.e. they would have to deposit their samples to the government authorised clinical or drive-through testing sites, and would have to meet the Centers for Disease Control and Prevention (CDC)’s screening requirements in order to obtain the test results in the first place.
“It has been around for a long time – said the US president – so we know that if things do not go as planned it will not kill anyone”. Trump added that it is a common drug and that it will soon be available on “prescription”, calling it a “turning point”. He also announced the reduction of “bureaucracy to develop vaccines and therapies as quickly as possible”. Rio Giardinieri, a Florida man 52 years old resulted positive to COVID-19 tests, confirms today he was saved from certain death by the anti-malarial drug touted as a possible treatment by President Trump. After attended a conference in New York, where he was probably infected, he said had started showing typical symptoms of the new coronavirus, such as back pain, headaches, cough and fatigue for five days. When the doctors at the Joe DiMaggio Children’s Hospital in South Florida get the positive result to COVID-19 test, with a severe form of pneumonia, have put him on oxygen in the ICU.
After more than a week, doctors told him there was nothing more they could do and, on Friday evening, Giardinieri said goodbye to his wife and three children. The Florida man told to local media he was at the point where he was “barely able to speak and breathing was very challenging,” adding that he thought that his end was there”. But the situation completely changed when a friend sent him an article about hydroxychloroquine, the prescription drug that’s been used to treat malaria for decades and auto-immune diseases like lupus. Although doctors had doubts about the effectiveness of the treatment, given his so critical condition and the few possibilities to survive, they decided to give him Benadryl and some other drugs. “When I woke up around 4:45 a.m., it was like nothing ever happened”. Giardinieri claims, adding that fever and pain were disappeared and that he was able to breathe normally again.
The Florida man, so far, would not be the only case. Also, the Actor Daniel Dae Kim affirms that a medication commonly used to treat malaria was “crucial” in his recovery from coronavirus. Kim, 51 years-old, described the malaria drug hydroxychloroquine as the “secret weapon” in his hospitalization in a new video on Instagram. The “Lost” actor stressed that he’s not a doctor or lawyer, and that his comments should not be taken as though he’s a medical professional, but he wanted to share his own personal experience with his fans and followers. Also, in his case, the Hydroxychloroquine was one of several medications, included Tamiflu and the antibiotic widely known as Zpack, in addition to using an inhaler to help with breathing and inflammation, that made up a “drug cocktail” of treatment to win against the new COVID-19. If those stories confirm what Trump said about malaria medication that could be a “game changer” in the fight against coronavirus, Dr. Antony Fauci, a leading infectious disease expert in the USA, said a definitive statement cannot be made about it in terms of treating COVID-19.
The number of deaths and infections from the global coronavirus pandemic, COVID-19, is now higher outside than in China, where the outbreak began, across the country. In Italy yesterday the deaths toll (3405) exceeded that in China. Also, Iran and South Korea were among the countries most affected by the novel virus. According to the World Health Organization (WHO), Japan has recorded 814 cases since March 17. Even taking into account the 712 cases of the cruise ship Diamond Princess, which has been moored in the port of Yokohama for over three weeks as a virus spread among passengers and crew, the cases in Japan are just over 900 and only 32 deaths. Many have wondered why the rate of infection in Japan is so relatively low despite its proximity to China, and above all, if weaker strains of Covid-19 exist which would explain why even in Italy only some regions have been more affected than others, or because Italy has recorded more deaths than China.
According to Hiroaki Richard Watanabe of the University of Sheffield, the main answer seems to be that Japan has not conducted extensive tests on the coronavirus, especially compared to countries like South Korea and Italy, which have done many tests. Watanabe explains that this may have to do with Japan’s policy-making system. The Japanese prime minister and Cabinet Office increased their power to make policy as a result of administrative reforms since the 1990s, while the power of bureaucrats and MPs declined to some extent. Japan’s policy towards the coronavirus seems to be centred on discussions at expert meetings under the jurisdiction of the Ministry of Health, Labour and Welfare (MHLW). Although the office of Prime Minister Shinzo Abe played a role in making decisions to prevent the spread of the coronavirus by convening several meetings, those decisions were based on the MHLW’s expert policy recommendations.
Fewer tests, fewer cases, fewer deaths recorded for Covid-19. The same policy has also been applied by other countries, such as Tunisia, where the number of people in quarantine are over 5600, but just over 600 tests conducted. Of these, only 39 were political, with an incidence of 6.38%. Even in the case of Tunisia only one death has been ascertained for Coronavirus, but there could be other deaths of people who had not been subjected to the storm, or unaware of having been infected by the new virus. Compared to the number of tests conducted in South Korea, more than 248,000 so far, the number in Japan has been just over 10,000. The small number of tests was due to the slow administrative answer, which was also seen in the poor crisis management of the Diamond Princess case.
Other factors, Watanabe says, may have contributed to the relatively low rate of coronavirus infection in Japan, such as the government’s recommendation to close schools until early spring break and cancellation of sporting events and concerts. However, these measures have also been adopted by other governments around the world and their impact is difficult to measure. And Abe’s decision to close schools without consulting his own party, opposition parties, governors and education committees of Japan’s prefectures has been severely criticized.
By the way, the reasons for choosing to reduce the number of tests for COVID-19 on the population many including avoiding the spread of panic between citizens, the lack of means and sufficient tests to manage the emergency. For Watanabe, the suspicion was that the Japanese government had conducted only a small number of tests in Japan to hide the scope and severity of the infection, partly due to the Abe administration’s determination to hold the 2020 Olympics in Tokyo. We should not forget that the Japanese government has already learned a lot about crisis management since the Fukushima nuclear disaster in 2011 even if there is still the problem of insufficient coordination between government ministries and between the government and the identified private sector which led to the collapse of stock prices and had a catastrophic impact on the Japanese economy and society. In light of all this, it seems that we can rule out the possibility of a weaker virus in Japan than in other countries, but that the differences in COVID-19 data between one nation and another depend on the number of tests conducted, as well as the management of the emergency by each Government.
The first affiliated hospital of Zhejiang University School of Medicine released a useful ‘Handbook of COVID-19 prevention and treatment” compiled according to clinical experience. Prof. Tingbo Liang, Editor-in-Chief of the Handbook and Chairman of the First Affiliated Hospital of Zhejiang University, explains that Faced with an unknown virus, sharing and collaboration are the best remedy. As French president Emmanuel Macron said in a televised speech, “we are at war” and the invisible enemy for all is the novel Coronavirus. Many of the new cases in Italy, the second country after China, are doctors and medical workers engaged in first battlefield, the hospitals. Professor Liang affirms that to win this war, we must first make sure that our medical staff is guaranteed sufficient resources, including experience and technologies. Also, we need to make sure that the hospital is the battleground where we eliminate the virus, not where the virus defeats us. Therefore, the Jack Ma Foundation and Alibaba Foundation have convened a group of medical experts who have just returned from the frontlines of fighting the pandemic. With the support of the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU), they quickly published a guidebook on the clinical experience of how to treat this new coronavirus. The treatment guide offers advice and reference against the pandemic for medical staff around the world who are about to join the war.
Founded in 1947, The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU), is the earliest affiliated hospital of Zhejiang University. With six campuses, it has now evolved into a medical center integrating health care, medical education, scientific research and preventative care. In terms of overall strength, FAHZU is ranked 14th in China. As a large-size general hospital, it currently has over 6,500 employees, including academicians of the Chinese Academy of Engineering, National Distinguished Young Scholars and other outstanding talents. There is a total of 4,000 beds available to patients in FAHZU. Its main campus handled 5 million emergency and outpatient visits in 2019.
The handbook opens describing in details how to prevent the spread of COVID-19 in the hospitals, isolating the area management. Healthcare facilities shall set up a relatively independent fever clinic including an exclusive one-way passage at the entrance of the hospital with a visible sign; according to the clinical experience the doctors stress that the movement of people shall follow the principle of “three zones and two passages” : a contaminated zone, a potentially contaminated zone and a clean zone provided and clearly demarcated, and two buffer zones between the contaminated zone and the potentially contaminated zone. Then the handbook suggests to medical workers the screening Criteria for Suspected COVID-19 Cases. The manual also shows how to donning and removing personal protective equipment to manage COVID-19 patients and the disinfection procedures of isolating area and medical equipment.
FAHZU is a designated hospital for COVID-19 patients, especially severe and critically ill individuals whose condition changes rapidly, often with multiple organs infected and requiring the support from the multidisciplinary team (MDT). Since the outbreak, FAHZU established an expert team composed of doctors from the Departments of Infectious Diseases, Respiratory Medicine, ICU, Laboratory Medicine, Radiology, Ultrasound, Pharmacy, Traditional Chinese Medicine, Psychology, Respiratory Therapy, Rehabilitation, Nutrition, Nursing, etc. A comprehensive multidisciplinary diagnosis and treatment mechanism has been established in which doctors both inside and outside the isolation wards can discuss patients’ conditions every day via video conference. This allows for them to determine scientific, integrated and customized treatment strategies for every severe and critically ill patient. The doctors affirm that thoracic imaging is of great value in the diagnosis of C0VID-19, monitoring of therapeutic efficacy, and patient discharge assessment. A high-resolution CT is highly preferable. Portable chest X-rays are helpful for critically ill patients who are immobile. CT for baseline evaluation of patients with C0VID-19 is usually performed on the day of admission, or if ideal therapeutic efficacy is not reached, it can be re-performed after 2 to 3 days. If symptoms are stable or improved after treatment, the chest CT scan can be reviewed after 5 to 7 days. Daily routine portable chest X-rays are recommended for critically ill patients.
The expert team noted that C0VID-19 at the early stage often presents with multifocal patchy shadows or ground glass opacities located in the lung periphery, subpleural area, and both lower lobes on chest CT scans. The long axis of the lesion is mostly parallel to the pleura. Interlobular septa I thickening and intralobular interstitial thickening, displaying as subpleural reticulation namely a “crazy paving” pattern, is observed in some ground glass opacities. A small number of cases may show solitary, local lesions, or nodular/ patchy lesion distributed consistent with bronchus with peripheral ground glass opacities changes. Disease progression mostly occurs in the course of 7-10 days, with enlarged and increased density of the lesions compared with previous images, and consolidated lesions with air bronchogram sign. Critical cases may show further expanded consolidation, with the whole lung density showing increased opacity, sometimes known as a “white lung”.
Before the treatments the handbook classify the COVID-19 cases in 4 big groups: mild cases with mild clinical symptoms no pneumonia manifestations can be found in imaging; moderate cases with symptoms such as fever and respiratory tract symptoms; severe cases with one of the following critieria: the respiratory rate is 30 breaths/min, oxygen saturations 93% at a rest state; arterial partial pressure of oxygen (PaO,)/oxygen concentration (FiO,) s; 300 mm Hg, > 50% lesions progression within 24 to 48 hours in lung imaging and critical cases with occurrence of respiratory failure requiring mechanical ventilation; presence of shock; other organ failure that requires monitoring and treatment in the ICU. Critical cases are further divided into early, middle and late stages according to the oxygenation index and compliance of respiratory system. The doctors of Zhejiang recorded that early antiviral treatment can reduce the incidence of severe and critical cases, although there is no clinical evidence for effective antiviral drugs.
The clinical experience shows that COVID-19 is a disease of viral infection, therefore antibiotics are not recommended to prevent bacterial infection in mild or ordinary patients, but it should be used carefully in severe patients based on their conditions. The handbook affirms that antibiotics can be used with discretion in patients who have the extensive lung lesions, excess bronchial secretions, chronic airway diseases with a history of pathogen colonization in the lower respiratory tract, taking glucocorticoids with a dosage less to 20 mg for 7 days. The options of antibiotics include quinolones, the second or third generation cephalothins, as lactamase inhibitor compounds.
Due to the spread of the COVID-19 epidemic, the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU) and Alibaba jointly established the International Medical Expert Communication Platform of FAHZU with an aim to improve the quality of care and treatment and promote the sharing of global information resource. The platform allows medical experts all over the world to connect and share their invaluable experience in the fight against COVID-19.
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