Rabu, 29 Januari 2020

'Utter chaos': Coronavirus exposes China healthcare weaknesses - Al Jazeera English

Chengdu, China - On January 20, Fubin's father started coughing and running a fever. As residents of Wuhan, they knew about a deadly new coronavirus that had originated in the central Chinese city weeks ago, but decided to stay home and hope the symptoms would subside.

Four days later, when his father's body temperature soared to 40 degrees, Fubin rushed him to hospital.

Together they headed to the Wuhan Union Hospital but, at reception, they were turned away. They were told they had to go to one of seven hospitals the government had designated for fever patients.

The two men went to Wuhan Red Cross Hospital, one of the designated facilities, and found the line of people waiting to get checked was so long they would have to wait outside - potentially for hours - in the cold and rain. They decided to try their luck elsewhere.

The second and third hospital were both packed. It took Fubin two days to get his father admitted to Wuhan No 5 Hospital, and he is one of the lucky ones.

Coronavirus: Life under lockdown in Wuhan

As thousands, if not tens of thousands, of fever patients who fear they might have caught the novel coronavirus that has now killed more than 100 people rush to Wuhan's hospitals, the outbreak is testing China's healthcare system on a scale not seen since the country was hit by the Severe Acute Respiratory Syndrome, or SARS, 17 years ago.

"The response from the government has been utter chaos," said a nurse who works in Wuhan and preferred not to disclose her name. "The current healthcare system was completely unready for a situation like this."

The nurse works at one of the designated hospitals, treating victims of a virus that has already infected nearly 10,000 people.

"You would think the government and hospitals had learned something from the SARS outbreak and prepared ourselves for another emergency like this," she said angrily over the phone. "But no - they learned nothing."

China virus

Most Chinese go straight to hospital when they are sick, leading to huge queues for treatment [cnsphoto via Reuters]

First line of defence

There have been urgent appeals for medical supplies not only in Wuhan and the province of Hubei, but beyond. The government has blamed the Lunar New Year holiday, when factories traditionally close, for the shortages of masks, goggles and other crucial supplies, saying it is hard to step up manufacturing during the festive season.

Shortly after the SARS epidemic, the Chinese government established and updated several times a medical materials reserve system that was supposed to ensure sufficient supplies in the event of any public health emergency.

However, reports filed with the Chinese Centre for Disease Control and Prevention suggest reserves at some hospitals have not been maintained.

In a 2019 article detailing Guiyang province's emergency medical supplies reserve, the provincial CDC said that, of the 11 items needed in the event of a public health emergency, only five items were fully stocked at the local level.

"There are priorities in our expenditure budget and none of us could've expected an emergency like this," an officer from Sichuan's provincial CDC told Al Jazeera on condition of anonymity. "So I believe sometimes the supplies reserve might not be ideal."

For ordinary patients like Fubin, it is not just the lack of medical supplies.

In China, a lack of properly trained general practitioners means the first line of defence often does not exist. There is a lack of trust in clinics and GPs, who are often difficult to find, and people prefer to go straight to hospital as soon as they need medical care.

In Wuhan, the capital of Hubei province, that meant a flood of patients in the initial days of the outbreak as people lined up in front of hospitals, hoping to get treatment.

China virus

China is building new field hospitals to cope with the surge in patients as a result of the coronavirus. The first 1,000-bed hospital is expected to be completed by 3 February [Yuan Zheng/EPA]

Health inequality

The majority of people rushed to a limited number of well-known hospitals, also known as a Grade III Level A hospitals, the highest category determined by the Ministry of Health.

Grade III Level A hospitals have attracted the most qualified medical staff and modern equipment, and the well-known concentration of resources has put immense pressure on these hospitals.

"Of course, I'd only go to Grade III Level A hospital," Fubin said. "I doubt other hospitals have doctors good enough to treat diseases properly."

Many experts have said that a sudden rush to these medical facilities might have contributed to the widespread cross-infection.

Authorities are now building two more - temporary - hospitals to accommodate the expected thousands of cases.

"We understand that a lot of patients are choosing top hospitals over others," the Municipal Party Secretary of Wuhan said during a news conference. "But we're trying to change the mentality now so more people could get treated."

But that does not address a larger problem: the unequal distribution of medical resources across China.

The level of medical care available in an area almost directly correlates with a province's level of development.

In Hubei province, 44 out of 88 Grade III Level A hospitals are located in Wuhan, home to 11 million of the province's more than 50 million people. In China overall, most of the best hospitals are found in the more developed, and wealthier, eastern coastal cities.

Such inequality also extends to the provision of medical staff in different locations.

In Beijing, the capital and home to approximately 20 million people, there are 100,000 registered doctors, whereas in Sichuan, a western province of more than 80 million people, there are 200,000, according to the National Bureau of Statistics.

That means while there are 4.63 doctors per 1,000 people in the capital, there are only 2.46 per 1,000 in Sichuan.

China virus

A medic at the Wuhan Union Hospital in Wuhan. China has deployed nearly 6,000 extra health workers to Wuhan to cope with the demand caused by the coronavirus [Xiao Yijiu/Xinhua via AP Photo]

Hubei province has only 150,000 doctors, the majority of whom are stationed in Wuhan.

To relieve the pressure on the limited number of medics currently fighting on the front line, close to 6,000 doctors and nurses from across China have been parachuted into Wuhan and other surrounding cities, in the hope of containing the outbreak.

'Work harder'

But the lack of doctors is not specific to Wuhan: China simply does not have enough of them, especially those who work in intensive care.

The World Health Organization says that China has 17 doctors for every 10,000 people, well behind the world's best 82 per 10,000 people in Cuba. And, while the country has made progress in improving health indicators over the past decade, few see much incentive to become a doctor.

"The hyper tension and mistrust between the patients and doctors, the low salary of most doctors, and unpredictable hours all contribute to the lack of motive to become a doctor in China," said Zhou, a surgeon at Chengdu's Huaxi Hospital who preferred not to share their full name.

"This outbreak has revealed some of the major problems in our healthcare system that should've been addressed before," Zhou added. "I have confidence that these problems will be fixed soon."

In Wuhan, having had three days of treatment, Fubin's father is on the mend.

His son is relieved.

"I would be lying if I said that I wasn't terrified that my father might not be able to get treatment," he said. "I'm glad that he's getting better, but there are still so many people unable to get treatment, and the government should really work harder to address the problem."

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2020-01-29 11:59:00Z
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US evacuees from China head to California military base as coronavirus outbreak grows - CNN

The flight chartered by the State Department left the Chinese city of Wuhan and touched down late Tuesday night at Ted Stevens Anchorage International Airport in Alaska.
After refueling and passenger screenings in Anchorage, it left for the March Air Reserve Base near Riverside, California.
In Alaska, officials conducted two additional health screenings after prior ones in China. All passengers were approved to continue on to California by the Centers for Disease Control and Prevention, Alaska officials said. In California, they will get more health screenings.
"For many of us directly involved, this has been a moving and uplifting experience," said Dr. Anne Zink, Alaska's chief medical officer. "The whole plane erupted in cheers when the crew said, 'Welcome home to the United States.'"
The fast-moving coronavirus has killed 132 people and infected nearly 6,000 others in China -- most of them in the hardest-hit city of Wuhan. Five cases of the disease have been confirmed in the United States.
Number of Wuhan coronavirus cases inside mainland China overtakes SARS
The flight was originally planned to land at the Ontario International Airport -- a civilian facility about 35 miles from Los Angeles.
It's not immediately clear why the itinerary was changed from the civilian airport to a military base. Curt Hagman, a San Bernardino County commissioner who is on the board of the Ontario airport, said they were informed Tuesday night that the plane would not land there.

Passengers will be screened at various stages

The Alaska Department of Health and Social Services said officials conducted screenings on 201 passengers. Before the flight arrived in Alaska, the Centers for Disease Control and Prevention had said there were about 210 US citizens aboard the flight. It is not clear why the passenger counts from the state and federal agency differ.
The passengers also will go through a series of screenings after they land in California.
"These individuals will be screened before they take off; monitored during the duration of the flight by medical personnel on board; screened again on landing to refuel in Anchorage, Alaska; monitored on the last leg of the flight by medical personnel on board; evaluated upon arrival at March Air Reserve Base ... and then monitored for symptoms post-arrival," the CDC said.
Before the plane's arrival itinerary was changed to a military airport, an official had told CNN the passengers may be forced to stay in isolation between three days and two weeks.
At the time, Hagman said authorities were setting up beds, phone chargers and televisions in an isolated, dormant hangar at Ontario International Airport.
It's unclear whether the same procedure will be followed at the military base, which is in a different county.

Priority was given to US citizens at risk

The passengers include US diplomats and their families. The State Department had said American citizens could also board on a reimbursable basis if space was available.
While there are about 1,000 Americans living in Wuhan, priority was given to US citizens who are "most at risk for contracting coronavirus" if they stay in the city, the State Department said.
It said it was unable to accommodate everyone due to space limitations, but it's working to identify alternative routes for US citizens to depart Wuhan by land.
The State Department issued a Level 4 advisory for Wuhan, meaning Americans should not travel to the city while the virus has an impact, Vice President Mike Pence said. It also ordered personnel working at the US Consulate in Wuhan to depart for the United States.
Other countries including South Korea and Japan are also sending charters to evacuate citizens from the epicenter of the outbreak. The European Commission said it was sending two aircraft to evacuate European Union citizens out of Wuhan.
Meanwhile, in the most drastic action yet by a major airline as the deadly coronavirus spreads, British Airways has suspended flights between the United Kingdom and China.
The UK's Foreign Office warned people against traveling to mainland China in all but essential cases.

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2020-01-29 11:36:00Z
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British Airways suspends flights to China as coronavirus spreads - CNN

"We have suspended all flights to and from mainland China with immediate effect following advice from the Foreign Office against all but essential travel," the company said in a statement Wednesday.
The UK's Foreign Office warned people against traveling to mainland China in all but essential cases on Tuesday.
It's the most drastic action yet by a major airline as the deadly coronavirus continues to spread. The virus has killed 132 people and infected nearly 6,000 people in China so far, with dozens more cases confirmed in places such as the United States, Japan, Germany and France.
US airlines offer to change China flights for free for another month as coronavirus spreads
British Airways operates direct flights from London Heathrow to Beijing (PKX) and Shanghai (PVG), according to the company's website. Those flights were unavailable to book online through February 29. Passengers can still book BA flights to mainland China via connections in cities such as Hong Kong.
The carrier's move comes a day after United Airlines (UAL) temporarily reduced its schedule between the United States and three cities in China.
The US airline said in a statement Tuesday that "significant decline in demand" had forced it to suspend flights from February 1 though February 8 between its US hubs and Beijing, Hong Kong and Shanghai.
In total, 24 round trips are affected. They are between Hong Kong to San Francisco and Newark; Beijing (PEK) to Washington Dulles, Chicago O'Hare and Newark; and Shanghai (PVG) to San Francisco, Newark and Chicago O'Hare.
American Airlines (AAL), Delta Air Lines (DAL) and United all extended change fee waivers through the end of February.
Cathay Pacific (CPCAY), Hong Kong's flagship airline, has said it will reduce the capacity of flights to and from mainland China by half or more until the end of March.
Finland's Finnair is canceling three weekly flights between Helsinki and Beijing (PKX) between February 5 and March 29, and two weekly flights between Helsinki and Nanjing (NKG) between February 8 and March 29, because of the suspension of group travel by Chinese authorities. It will continue to operate flights to Beijing (PEK), Shanghai (PVG), Hong Kong (HKG) and Guangzhou (CAN).
— Jordan Valinsky and Stephanie Halasz contributed to this report.

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2020-01-29 10:45:00Z
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First Middle East cases of coronavirus confirmed in the UAE - CNBC

Virologist Sandro Halbe observes cell culture dishes in a research laboratory of the Institute of Virology at the Philipps University of Marburg. The novel coronavirus, which has made hundreds of people sick in China, also employs scientists from Hessen.

Arne Dedert | Getty Images

DUBAI, United Arab Emirates — The first cases of the deadly coronavirus in the Middle East have been confirmed in the United Arab Emirates, the country's Ministry of Health and Community Protection said in a statement Wednesday.

The infected patients are members of a family that had traveled from Wuhan, China, a city of 11 million and the epicenter of the new virus that has killed 132 people and infected more than 6,000. The vast majority of deaths and infections are in mainland China.

In its statement, the health ministry reported the family as being in a stable condition under medical observation. Health authorities in the U.S. say the fatality rate for the respiratory disease is currently between 2% and 3%.

The exact number of cases is unclear and the ministry did not specify where in the UAE the cases had appeared.

The UAE said last week it would screen all passengers arriving at its airports from China. Dubai International Airport (DXB) is a popular transit hub for Asia and is the world's busiest airport in terms of passenger traffic.

Airlines suspending flights to China

U.K. carrier British Airways on Wednesday announced it will halt all flights to and from mainland China, while other airlines including United and Air Canada have canceled select flights. The U.S. has issued a travel advisory warning for China and the Trump administration is considering suspending all China-U.S. flights. The U.S. and other countries have begun evacuating its citizens out of China.

The Centers for Disease Control and Prevention (CDC) is telling Americans to avoid all nonessential travel to China, expanding its travel warning from the city of Wuhan to the entire country as the coronavirus outbreak worsens.

Hong Kong has halted transport links to mainland China and extended school closures after declaring a virus emergency for the city over the weekend.

Chinese authorities have restricted travel for at least 17 cities in its central Hubei province, where Wuhan is located. It is an area encompassing more than 50 million people. The virus is believed to have first appeared in a Wuhan seafood market also selling wildlife including snakes and marmots. Hubei on Sunday shut down inter-city and inter-province buses in an effort to curb the outbreak.

The World Health Organization is sending a delegation of researchers and other health experts to China to help combat the coronavirus outbreak. WHO Director-General Tedros Adhanom Ghebreyesus met with Chinese President Xi Jinping in Beijing earlier Tuesday.

While the majority of confirmed coronavirus cases and deaths are in mainland China, the virus has also been identified in Japan, South Korea, Taiwan, Thailand, Vietnam, Singapore, Nepal, France, Germany, Australia, the UAE and the U.S.

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2020-01-29 08:17:00Z
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Coronavirus cases in China overtake SARS — and the economic impact could be 'more severe' - CNBC

Amid concerns about the Coronavirus causing illness and deaths in China, many parade goers during New York City, New York's annual Lunar New Year parade wore surgical masks, January 25, 2020.

EuropaNewswire | Gado | Getty Images

The number of coronavirus cases in China has already surpassed that of SARS, and the economic impact of the new virus from Wuhan could be more severe than the 2002-2003 epidemic, or at least similar, according to economists.

It took more than 6 months for the number of SARS cases to surpass 5,000 in mainland China. China had 5,327 SARS cases between Nov. 1 2002 and July 31 2003, according to the World Health Organization.

On the other hand, it's taken about a month for the number of new coronavirus cases to climb past 5,000 on Tuesday. The new virus was first officially reported in the Chinese city of Wuhan on Dec. 31.

According to China's National Health Commission, the number of cases in mainland China stood at 5,974 at the end of Tuesday, up from 4,515 the prior day.

Initial figures from the government indicate a death rate of between 2% and 3% in China for the new virus, compared to a mortality rate of about 7% for SARS.

The Wuhan coronavirus, which could lead to a type of pneumonia, has sparked alarm as it comes from the same family of viruses as SARS which killed some 800 people. The latest outbreak has killed 132 in China as of Wednesday's update.

"There are reasons to worry about this time around compared to SARS because first of all, the connectivity in terms of transportation and economy is much greater nowadays (as compared) to the SARS episode," Tommy Wu, senior economist at Oxford Economics, told CNBC on Wednesday.

We believe the economic impact of the coronavirus could be bigger in comparison to SARS in 2003.

The disease has spread beyond Wuhan to Beijing, Shanghai and other highly populated cities in the country. Cases in other parts of Asia such as Thailand, Japan, Singapore and South Korea, have also been reported. In Europe, cases have been reported in France and Germany, and the United States currently has 5 confirmed cases.

Economic impact

"We believe the economic impact of the coronavirus could be bigger in comparison to SARS in 2003," wrote analysts from Nomura in a Wednesday report.

China's real GDP growth plunged by 2 percentage points (pp) from the first quarter to the second quarter of 2003 due to the SARS outbreak, Nomura analysts noted. "Based on our assumptions, real GDP growth in Q1 2020 could materially drop from the 6.0% pace achieved in Q4 2019, on a scale perhaps bigger then 2pp registered during the SARS outbreak in 2003."

However, the analysts pointed out that "the coronavirus may prove to be only a temporary shock (both on the demand and supply sides) and may not necessarily leave a long-lasting impact."

Still, "the scale of the current slowdown and timing of the recovery are mainly determined by the unfolding coronavirus, which remains uncertain," Nomura said.

Oxford's Wu also flagged the timing of the outbreak, which took place just before the Lunar New Year holiday, when hundreds of millions of Chinese traveled domestically and internationally to be with their families during the festivities.

"The timing is also important because this time around is during Chinese New Year, where there are mass movements of citizens around the country going back home for family reunion. And during the next couple weeks, there'll be a massive flow coming back from home to the cities they work," Wu said. "That's why it's possible that this time around the impact could be more severe than during the SARS episode."

"Even if the coronavirus outbreak is brought under control quicker than SARS was in 2003, the economic impact now looks likely to be of at least a similar scale," wrote Mark Williams, chief Asia economist at Capital Economics in a note on Monday.

According to an estimate by Capital Economics, SARS lowered China's growth by three percentage points in its worst-affected quarter. Overall, growth slowed from 8% year-on-year to 5% during that outbreak.

"The very limited data available so far suggest that the current impact is not yet that severe but it could end up being similar," Williams said. "But it is now certain that the outbreak will have a significant impact on China's GDP this quarter."

Travel restrictions and services halted

He cited the slowdown in activity within China. Beyond the Lunar New Year holiday, Shanghai has told businesses to remain shut for an additional week, while travel restrictions are in place in around 20 cities. Many long-distance bus and high-speed rail services have also been halted.

"On top of these ... steps, many businesses such as restaurants have chosen to close and people are avoiding crowded places," Williams said.

He flagged that rail passenger numbers on Saturday — the first day of the Lunar New Year — was 42% lower compared to the equivalent 2019 period, while road passenger traffic decreased by 25%.

In May 2003 — the peak month of the SARS outbreak — year-on-year declines were 57% for rail passenger traffic and 45% for road passenger traffic, Williams said.

"While the more open and proactive official response this time may prove more effective in containing the virus, it could also make the initial economic disruption larger," he pointed out.

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2020-01-29 07:56:00Z
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Trump releases long-awaited Middle-East peace plan - BBC News - BBC News

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2020-01-29 07:31:19Z
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Selasa, 28 Januari 2020

CDC tells travelers to avoid China in expanded travel warning as coronavirus spreads - CNBC

Passengers wear protective masks to protect against the spread of the Coronavirus as they arrive at the Los Angeles International Airport, California, on January 22, 2020.

Mark Ralston | Getty Images

The Centers for Disease Control and Prevention is telling Americans to avoid all non-essential travel to China, expanding its travel warning from the city of Wuhan to the entire country as the coronavirus outbreak worsens, the agency said Tuesday.

Last week, the CDC advised against all nonessential travel to Wuhan, the epicenter of the disease's outbreak and where the majority of cases have been reported.

The U.S. Department of State on Monday also raised its travel advisory for China from Level 2 to Level 3 asking Americans to "reconsider travel to China due to the novel coronavirus." They added that some areas have "added risk."

Chinese health authorities said Tuesday that the virus, which was first diagnosed less than a month ago, has now killed 106 people and infected 4,515.

Former Food and Drug Administration Commissioner Scott Gottlieb said he's worried that coronavirus cases in China are actually much higher than the official numbers show.

"I think we are dramatically underestimating" cases in China by "tens of thousands," Gottlieb told CNBC's "Squawk Box."

Chinese authorities have quarantined several major cities in China and canceled Lunar New Year's festivities in Beijing and other areas.

Multiple cases of the virus have been confirmed in Hong Kong, Macao, Taipei, Thailand, Vietnam, South Korea, Singapore, Malaysia, Japan, Australia, France and the United States. There have been no confirmed deaths caused by the illness outside of China.

The CDC confirmed five cases of coronavirus in the U.S. and said Monday that U.S. health officials are currently monitoring 110 people across 26 states for the coronavirus.

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2020-01-28 15:12:00Z
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