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Puzzled scientists seek reasons behind Africa’s low fatality rates from pandemic
29 September 2020, 5:20 AM

Africa’s overburdened public health systems, dearth of testing facilities and overcrowded slums had experts predicting a disaster when COVID-19 hit the continent in February.

The new coronavirus was already wreaking havoc in wealthy Asian and European nations, and a United Nations agency said in April that, even with social-distancing measures, the virus could kill 300 000 Africans this year.

In May the World Health Organisation (WHO) warned that 190 000 people on the continent could die if containment measures failed. Yet as the world marks 1 million COVID-19 deaths, Africa is doing much better than expected, with a lower percentage of deaths than other continents.

The continent’s case fatality count stands at 2.4%, with roughly 35 000 deaths among the more than 1.4 million people reported infected with COVID-19, according to Reuters data as at late Monday.

In North America, it is 2.9% and in Europe 4.5%

Hard-hit countries such as Italy and Britain have recorded fatality counts of 11.6% and 9.0% respectively, compared to 1.6%for Ethiopia, 1.9% for Nigeria and 2.4% for South Africa, the continent’s worst affected country.

Hospitals in many African countries say COVID-19 admission rates are falling.

“Based on what we have seen so far it is unlikely that we are going to see anything at the scale that we are seeing in Europe – both in terms of infections and mortality,” said Rashida Ferrand, a London School of Hygiene and Tropical Medicine professor working at the Parirenyatwa Group of Hospitals in the Zimbabwean capital Harare.

Experts say that some COVID-19 deaths in Africa probably are being missed.

Testing rates in the continent of about 1.3 billion people are among the lowest in the world, and many deaths of all types go unrecorded.

South Africa saw some 17 000 extra deaths from natural causes between early May and mid-July, 59% more than would normally be expected, according to a July report from the South African Medical Research Council.

That suggests the death toll from COVID-19 could be significantly higher than the official figure, currently over 16 000, researchers say.Even so, there is wide agreement that COVID-19 fatality rates have not so far been as bad as predicted.

Why? Scientists and public health experts cite a number of possible factors, including the continent’s youthful population and lessons learned from previous disease outbreaks.

African governments also had precious time to prepare due to the relative isolation of many of their citizens from airports and other places where they could come into contact with global travellers.

Some scientists are also exploring the possibility that a tuberculosis vaccine routinely given to children in many African countries might be helping reduce deaths from COVID-19.

Another theory being considered is whether prior exposure to other coronaviruses including those that cause the common cold has provided a degree of resistance in some of the very communities once thought to be most vulnerable.

“There is a lot of circumstantial evidence,” Salim Abdool Karim, a South African infectious disease specialist who has advised the government on COVID-19, told Reuters, “but there is no smoking gun.”

The virus hit Africa later than other continents, giving medical personnel time to set up field hospitals, source oxygen and ventilators, and learn from improvements in treatment elsewhere.

“We got the gift of time,” said Thumbi Mwangi, senior research fellow at the University of Nairobi’s Institute of Tropical and Infectious Diseases. “We had an amount of preparation that others did not.”

One reason could be that international travel is limited in many African countries, and travelling domestically can be more difficult than on other continents, Matshidiso Moeti, WHO regional director for Africa, told a news conference on Thursday.

The continent’s governments have also battled deadly infectious diseases such as Ebola, which killed more than 11 000 people in West Africa in 2013-16. So officials took notice when the new coronavirus started spreading around the globe rapidly early this year.

Many African countries were quick to introduce screening at airports, suspend flights from heavily affected nations and enforce social distancing measures and mask wearing.

Within a week of Kenya reporting its first case, schools were shut, incoming travellers had to undergo a mandatory quarantine and large gatherings were banned.

Nigeria, Africa’s most populous nation, imposed a ban on interstate travel and a curfew. Many of its land borders had already been closed since August 2019 to cut down on smuggling, which helped fight the pandemic too.

South Africa introduced one of the world’s toughest lockdowns in late March, when the country had confirmed just 400 cases.

“Africa brought down the hammer earlier in terms of coronavirus lockdowns,” said Tim Bromfield, regional director for East and Southern Africa at the Tony Blair Institute for Global Change, a UK-based think tank.

Experts also point to the continent’s demographics.

Research has found that the risk of developing severe COVID-19 increases with age.

A 2019 United Nations report said 62% of sub-Saharan Africa’s population was under 25 and just 3% 65 or over.

In the UN’s Europe and North America region, 28% were under 25 while 18% were age 65 and up.

Chikwe Ihekweazu, director general of the Nigeria Centre for Disease Control, attributed his country’s relatively low case mortality rate in part to the fact that the majority of patients were between the ages of 31 and 40.

Scientists in several countries including South Africa are testing whether the century-old Bacille Calmette-Guérin (BCG) vaccine, widely used on the continent against tuberculosis, provides a degree of cross-protection.

BCG vaccines have been shown to protect against other viral respiratory illnesses, and a study published in the scientific journal Proceedings of the National Academy of Sciences in July found that countries with higher vaccination rates for tuberculosis had lower peak mortality rates from COVID-19.

Studies have also started in South Africa and Zimbabwe to assess the impact of past exposure to other coronaviruses.

More than half of Africa’s urban population is concentrated in slums, where access to water for hand washing is scarce, and physical distancing is near-impossible.

Diseases spread rapidly under such conditions, but some scientists wonder whether that may have been an unexpected boon in this case. There is some evidence that T cells developed by the body’s immune system after exposure to other common cold coronaviruses could help fight off COVID-19.

“I would say that is at least a plausible explanation as to why there are different levels of resistance to the virus in different populations,” said Thomas Scriba, an immunologist and deputy director of the South African Tuberculosis Vaccine Initiative.

Others are more sceptical.

“All other regions have been exposed to coronaviruses, have poor people and slums and have received BCG vaccination,” said Humphrey Karamagi, team leader for data and analytics at the WHO’s Africa office. “We are most probably looking at a mix of multiple factors working together – and not a single magic bullet.”

For Sam Agatre Okuonzi, from the Arua Regional Referral Hospital in Uganda, the doomsday predictions were informed by entrenched prejudices, including that the continent is prone to disease.

“COVID-19 has shattered a lot of biases about disease in general but also about Africa,” he told Thursday’s briefing. “The severity of the pandemic has not played out in line with the outrageous predictions.”

Global coronavirus deaths surpass 1 million – Reuters tally
29 September 2020, 4:52 AM

More than 1 million people have died of COVID-19 around the world as of Tuesday, according to a Reuters tally, with the pace of fatalities picking up as infections again surge in several countries.

Deaths from coronavirus-related illnesses have doubled from half a million in just three months, led by fatalities in the United States, Brazil and India.

More than 5 400 people are dying around the world every 24 hours, according to Reuters calculations based on average deaths so far in September.

That equates to around 226 people per hour, or one person every 16 seconds. In the time it takes to watch a 90-minute soccer match, 340 people die on average.

The United States, Brazil and India account for nearly 45%of all COVID-19 deaths globally, with the Latin American regional one responsible for more than a third of them.

India is the latest epicentre of the pandemic globally,recording the highest daily growth in infections in the world in recent weeks, with an average of about 87 500 new cases each day since the start of September.

On current trends, India will overtake the United States as the country with the most confirmed COVID-19 cases by the end of the year, even as Prime Minister Narendra Modi’s government pushes ahead with easing lockdown measures in a bid to jump start the struggling economy.

Despite the surge in cases, India’s death toll of around 95 500 and pace of growth of fatalities remains below those of the United States, Britain and Brazil.

Health experts stress that official data for both deaths and cases globally since the first reported case in China in early January is almost certainly being under-reported, especially in countries with limited testing capacity.

The reported global death rate has picked up from three months ago when an average of around 4 700 people were dying COVID-19 linked illness every 24 hours, or one person every 18 seconds.

Infection numbers are rising again in the United States and setting new records in Europe, which accounts for nearly 25% of deaths. The World Health Organisation (WHO) has warned of a worrying spread in western Europe just weeks away from the winter influenza season.

The WHO has also warned the pandemic still needs major control interventions amid rising case numbers in Latin America,where many countries have started to resume normal social and public life.

Much of Asia is experiencing a relative lull after emerging from a second wave.

In Australia, officials have lifted some reimposed internal travel curbs.

The high number of deaths has led to changes in traditional and religious burial rites around the world, with morgues and funeral businesses overwhelmed and loved ones often barred from bidding farewell in person.

In Israel, the custom of washing the bodies of Muslim deceased is not permitted, and instead of being shrouded in cloth, they must be wrapped in a plastic body bag. The Jewish tradition of Shiva where people go to the home of mourning relatives for seven days has also been disrupted.

In Italy, Catholics have been buried without funerals or a blessing from a priest, while in Iraq former militiamen dropped their guns to dig graves at a specially-created cemetery and learned how to conduct both Christian and Muslim burials.

In some parts of Indonesia, bereaved families have barged into hospitals to claim bodies of COVID-19 victims, fearing their relatives might not be given a burial in line with religious beliefs.

An indigenous group in the Ecuadorean Amazon took two police officers and a state official hostage, successfully demanding authorities return the body of a community leader for a traditional burial.

The United States, Indonesia, Bolivia, South Africa and Yemen have all had to work overtime to dig new graves and locate new burial sites as cemeteries fill up.

Australia’s coronavirus infection trend falls in hotspot state
29 September 2020, 4:36 AM

Australia’s coronavirus hotspot state of Victoria on Tuesday reported 10 new infections in the past 24 hours, turning around a second contagion wave that only last month was infecting over 700 people every day.

The country’s second most populous state has paid a high price to contain the spread of the virus, placing nearly 5 million residents of its capital Melbourne under one of the world’s most stringent lockdowns since early August.

The state, which accounts for the bulk of the country’s over 27 000 infections, and 882 deaths, on Sunday lifted some of the restrictions, including nightly curfews.

A key indicator, the rolling 14-day average, fell to 18.2, tracking ahead of state government expectations, officials said.

“That continuous improvement will serve us well as we continue to open up,” premier Daniel Andrews told reporters on Tuesday. “This strategy is working (and) is delivering us those lower numbers.”

Meanwhile, the state of Western Australia reported 8 new coronavirus infections, following a small outbreak on a cargo ship that arrived from the Philippines earlier this month.

The state had zero or low single digit daily virus infections for weeks before reporting on Sunday infections among workers on the bulk carrier moored off the iron ore export hub of Port Hedland.

A total of 17 crew members of the Patricia Oldendorff have tested positive for the virus, and are quarantining on the vessel or onshore, the company said in a statement.

Australia’s most populous state, New South Wales, reported two new infections on Tuesday, both returned travelers who were already quarantining in hotels. The state has not had any locally acquired cases in four days, officials said.

Netherlands tightens coronavirus rules amid second wave
29 September 2020, 3:31 AM

The Dutch government on Monday announced a raft of new restrictions to slow a second wave of coronavirus infections, including earlier closing times for bars and restaurants and limited travel between major cities.

The measures, which also include wider use of cloth masks for the public in Amsterdam and other big cities, came as daily new infection rates have passed their earlier peak in April.

Dutch Prime Minister Mark Rutte said the steps were unavoidable due to the speed of the virus’s spread.

“Naturally these measures will have negative economic consequences,” he said in a televised press conference. “But allowing the virus to flare up would have even bigger consequences, including damage to the economy.”

Businesses were instructed to have employees work from home except when strictly necessary. Bars and restaurants must shut by 10 p.m.

People were told to avoid non-essential travel between hot spots Amsterdam, Rotterdam and The Hague. Retail stores in those cities will be allowed to refuse customers who do not wear masks.

Sporting events will be closed to the public and gatherings limited to 40 people. Social gatherings at home must be limited to three guests.

Rutte had said on Friday he was considering regional measures to slow the outbreak, but by Monday the situation had worsened, prompting the nationwide measures.

The National Institute for Health (RIVM) on Monday reported 2 914 new cases, just shy of Sunday’s all-time record of 2 995.

Hospitalisations and deaths are below April’s levels, but the head of the country’s intensive care units warned that non-essential procedures will be delayed to make way for COVID-19 patients again starting this weekend.

Health Minister Hugo de Jonge said the number of infections was projected to increase to 5 000 per day from a current 3 000 before the measures kick in.

Trump, pressured over pandemic, says states will receive 150 million tests
29 September 2020, 2:09 AM

President Donald Trump, under fire over his handling of the coronavirus epidemic, announced on Monday the federal government would ship 150 million rapid tests to US states and warned an increase in positive cases is likely in the days ahead.

Trump, at a Rose Garden event, said the tests would largely be used for opening schools and ensuring safety at centers for senior citizens. He has been pressuring state governors to do more to open schools for in-person learning.

Trump, Vice President Mike Pence and virus adviser Scott Atlas warned more positive cases may result from stepped up testing.

“With cases and positivity rising in 10 states in the Midwest and the near-West, and with this historic advance in testing that’s being distributed … the American people should anticipate that cases will rise in the days ahead,” Pence said.

The President has repeatedly suggested that more testing leads to more cases, when in fact testing uncovers cases that already exist. Other metrics like increased hospitalisations and deaths have no link to more testing.

The United States has the world’s highest number of confirmed COVID-19 cases at more than 7 million and the most coronavirus-related deaths, approaching 205 000.

Coronavirus task force members Dr. Anthony Fauci, Dr. Deborah Birx and Centers for Disease Control and Prevention (CDC) Director Robert Redfield were not at the event.

Two weeks ago Trump was irked when Redfield said in congressional testimony that wearing a mask may be just as important as a vaccine.

Trump said 50 million tests will go to the “most vulnerable communities” including nursing homes, assisted living facilities, home health and hospice care. Nearly 1 million will be sent to historically Black colleges and universities and tribal nation colleges.

He said 100 million tests would be given to states and territories to “support efforts to reopen their economies and schools immediately and (as) fast as they can.”

“The support my administration is providing would allow every state on a very regular basis test every teacher who needs it,” Trump said.

He said 6.5 million tests will go out this week and the rest in coming weeks.

Trump is trying to show progress in the battle against the pandemic as he campaigns for re-election on November 3 against Democrat Joe Biden. The first presidential debate will be held on Tuesday night in Cleveland, Ohio.

The rapid tests announced by Trump were purchased from Abbott Laboratories in August.

Abbott has said it would scale production capacity to 50 million tests per month by October, and that it could currently produce “tens of millions” of the tests, indicating it will take at least a few months for the tests to be fully distributed to states and territories.

Admiral Brett Giroir, who heads testing efforts for Trump’s coronavirus task force, demonstrated at the event how to conduct the Abbott rapid test, swabbing his nasal passages and dipping the swab into a solution. Results are produced in about 15 minutes.



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