Coronavirus pandemic: Reports from U.S., India, Pakistan, Afghanistan

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US struggles to fill requests for protective gear

A Salem, Oregon, March 18, 2020 datelined Associated Press report by Andrew Selsky said:

The U.S. government is rushing protective equipment to states, packing dozens of flights and hundreds of trucks with supplies for medical workers who will be on the front lines of the coronavirus fight.

But the pandemic has exposed some of the stockpile’s shortcomings: The cache isn’t designed to be a long-term solution to monumental demand, and some state officials are complaining that the deliveries are falling far short of what’s needed or include expired items.

The Strategic National Stockpile was created in 1999 to respond to bombings and biological, chemical and nuclear attacks. It maintains caches of pharmaceuticals, medical supplies and vaccines in secret locations around the nation.

It has never confronted anything on the scale of the COVID-19 pandemic.

The first real use came in the anthrax-by-mail attacks following the Sept. 11, 2001, attacks, but it was the 2009 H1N1 pandemic that prompted the largest use to date, said Christopher McKnight Nichols, associate professor of history at Oregon State University.

“The SNS as designed and funded cannot and will not be able to fully accommodate the needs of the entirety of the American people,” Nichols said. The system “is designed to help buy time” and prioritize areas of greatest need, he explained.

When the virus first hit the U.S., federal officials did focus on a hot spot: the Seattle area.

The country’s first coronavirus death occurred there on Feb. 29. That same day, Washington Gov. Jay Inslee requested almost one-quarter million N95 respirator masks, which fit tightly to the face, and 200,000 surgical masks. which are less protective than respirators but still deemed acceptable by federal health officials when N95 masks are unavailable. The governor also asked for 5,000 eye protectors, 60,000 disposable gowns and 70,000 pairs of gloves.

Six days later, the shipment came in.

“They met our entire request,” said Mike Faulk, a spokesman for the Democratic governor.

A second order resulted in the delivery of more N95 respirators and other equipment, Faulk said.

But since then, Washington state has received only about 25% of requests, according to Jessica Baggett of the state’s joint information center.

Other states have not gotten what they wanted.

“If anyone in the Trump administration is listening, I want to say this very loudly and clearly: We need a better response from the federal government,” Rhode Island Gov. Gina Raimondo, a Democrat, told a news conference Monday. “We need faster access to our personal protective equipment, masks, goggles, gloves, etc. to protect our frontline healthcare workers. I am out of patience at this point.”

The state requested hundreds of thousands of respirators, surgical masks, gloves and other protective equipment from the stockpile and received a quarter of that request, said Joseph Wendelken, spokesman for the Rhode Island Department of Health.

On March 3, Oregon Gov. Kate Brown asked for 400,000 respirator masks plus gowns, gloves and disposable protective suits, and up to 100 breathing machines in case the outbreak gets out of control. Her office was told Thursday that Oregon would be getting less than one-tenth the requested number of respirator masks, some other gear and no ventilator machines.

“We don’t even know when it’s coming,” Brown told reporters. “The response has been extremely inadequate and absolutely unacceptable. … It’s exposing not only cracks, but I would say canyons, in our federal health care system.”

New Hampshire Gov. Chris Sununu, a Republican, said the state has requested equipment which he expects to arrive this week and has no complaints about the Trump administration’s response to such requests.

One other problem: expired equipment.

The Centers for Disease Control and Prevention said Feb. 28 that some items in the U.S. stockpiles have exceeded their manufacturer-designated shelf life. They are nevertheless being sent to hospitals “due to the potential urgent demand caused by the COVID-19 public health emergency,” the CDC said.

Effective masks are critical because the virus is often absorbed through the mouth or nose from droplets when an infected person coughs or sneezes. But the elastic straps affixing the mask to the face could be degraded and snap, causing the mask to fall and exposing the user to a virus. Or the foam material that touches the nose could be so degraded that it would make the seal around the face ineffective.

Kimberly Clark, a company that makes the mask, told customers two years ago that certain models should be disposed of if beyond their shelf life, the CDC said. Users of masks that have exceeded the shelf life should be notified and told to inspect them and make seal checks, the CDC advised.

As of Monday, the Strategic National Stockpile had roughly 10.5 million respirator masks, down from 12 million two days earlier, said a spokeswoman for the U.S. Department of Health and Human Services, which manages it.

The stockpile has been working as designed but faces being overwhelmed, said Benjamin Brunjes, an assistant professor and public management specialist at the University of Washington in Seattle.

Health experts have previously estimated that demand for masks could reach 300 million per month in a worst-case scenario, he noted.

“Hospitals around the Seattle area are already experiencing mask shortages, and other products are likely not far behind,” Brunjes said.

The Department of Health and Human Services is trying to encourage production, saying it intends to buy 500 million N95 masks.

Ohio Lt. Gov. Jon Husted, a Republican, said it’s important for the federal government to release protective gear to health care workers.

“They are on the front lines of this,” Husted said. “We need to ensure that we are supporting them with the resources that they need.”

Some states appear to have adequate supply of protective equipment, for now.

California state officials said they had a stockpile of 20 million masks for health care workers.

The masks are expired, but the CDC gave them permission to use them anyway.

Flooded toilets, dirty sheets

A New Delhi, March 18, 2020 Reuters report by Devjyot Ghoshal and Alasdair Pal said:

When Mrinal Sabharwal and his wife landed in New Delhi with hundreds of other passengers from Barcelona on Monday, they expected clean coronavirus quarantine facilities.

Instead, after hours of waiting at the airport and on a bus, they were taken to a converted police training centre.

There, the travelers found stained beds seven or eight to a room, dirty floors and mouldy vegetable peelings left in a cupboard. Eighty people on each floor were expected to share a few clogged toilets during their two weeks in quarantine.

As the number of coronavirus cases in South Asia ramps up – doubling to more than 500 in the last few days – experts fear unsanitary testing and quarantine centers could present a problem in the densely populated region.

Some patients have even broken out of quarantine, putting healthy people at risk.

Sabharwal and four others who have been held in two testing centers in India told Reuters of unsanitary conditions there – a pattern repeated in Pakistan and Afghanistan.

“We did not want 5-star facilities,” said Sabharwal, a 33-year-old businessman. “We just wanted clean rooms and sanitized bathrooms.”

Public health experts say poor facilities in the region could speed up the spread of the virus, and authorities should encourage people who test positive to quarantine themselves at home.

“Due to the high volume of people requiring quarantine and lack of hygienic facilities, it is more efficient to encourage quarantine at the homes of the travelers,” said Giridhara R Babu, an epidemiologist at the Public Health Foundation of India.

Sabarwal’s account of the conditions was corroborated by two other people at the facility, along with photographs and video. He was released to be isolated at home early on Tuesday after being tested, but before results were available. As of Wednesday afternoon, he had still not received the results.

Officials at Delhi’s south-western district, which oversees the quarantine facility, did not respond to requests for comment.

Authorities in South Asia have struggled to get travelers to self-isolate or stay quarantined in medical facilities that many view as poor and unhygienic.

In Navi Mumbai, a suburb of Mumbai, local media reported on Monday that police were forced to launch a manhunt after 11 people, who had been isolated after returning from Dubai, failed to appear at a hospital for quarantine.

Pakistan and Afghanistan, which share long land borders with Iran – one of the countries worst affected by the virus – have reported similar problems at crossing points.

In Pakistan, some politicians branded quarantine facilities “a joke” after footage emerged on social media showing ostensibly quarantined people lodged four or five to a single tent at Taftan, one of the main border crossings with Iran.

And about 38 Afghans, who were in isolation after recently returning from Iran, escaped from a facility in western Afghanistan on Monday after breaking windows and attacking staff. At least one of the fugitives was confirmed to have the coronavirus.

Two people at the camp said doctors lacked basic equipment like masks and gloves.

“They put eight to 10 patients in a small room with a very unhygienic bathroom,” said Freba, a 48-year-old woman who goes by one name, and said she fled the centre in Herat before being sent back to the camp.

“A suspect can easily get infected with the virus if he or she gets stuck in such a place.”

Pakistan can’t afford to shutter cities to prevent virus: PM Imran Khan

A March 18, 2020 datelined AFP report said:

Pakistan cannot afford to implement the type of large-scale urban lockdowns the West is undertaking as it tries to slow the spread of coronavirus, Prime Minister Imran Khan said Tuesday.

The United States and many other nations have either mandated or recommended the closure of restaurants and other businesses as a way of stopping people from passing the virus on.

In Pakistan, home to megacities such as Karachi with millions of people living in close proximity, Khan said such a move was considered early on but officials feared it would devastate the country’s fragile economy.

“The Pakistan situation is not the same as that of the US or Europe… 25 percent of our population is living in grave poverty”, Khan said in a televised address to the nation.

“If we shutdown the cities — people are already facing difficult circumstances — we will save them from corona at one end, but they will die from hunger on other side.”

Pakistan has however closed cricket stadiums, schools, colleges and universities, Khan noted.

The South Asian nation is considered vulnerable to the impacts of the novel coronavirus pandemic.

Its porous borders, creaking hospitals, culture of hand shaking and hugging, and large illiterate populations in crowded urban centers mean containing the crisis could be a huge challenge.

Additionally, Pakistan has a large fiscal deficit and has needed multiple International Monetary Fund loans.

Khan said Pakistan’s economy had made gains last year but now faced pressures from the coronavirus crisis and suggested the IMF should consider relief on the country’s loan repayments.

“We will speak to the IMF because … we have to give relief to our industries and exporters”, he said.

The cricketer-turned-politician also warned “very strict action” would be taken against food hoarders.

As of Tuesday, Pakistani health authorities had only tested 1,571 suspected cases, with over 200 of them positive.

There have been no official deaths so far, but observers fear the true number of cases is higher than is reflected by statistics.



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