“Underestimating deaths in China has impacted pandemic preparedness”

La Croix: In recent weeks, many critics have emerged from the United States, the United Kingdom and, more recently, France vis-à-vis Chinese communication on the epidemic of coronavirus. Is this a feeling shared by the scientific community?

Philippe Ravaud: It seems quite unlikely that the number of coronavirus-related deaths as described by the Chinese is exact. I cannot imagine that there have only been a few thousand deaths in China and that there have been many more in many European countries. There has probably been information that is very insufficient – is deliberately very insufficient, it is always difficult to know – from China on this subject.

→ LIVE. Coronavirus: the latest information in France and worldwide

Exactly, has China been transparent about the evolution of the virus in the international scientific community?

P. R.: It’s complicated to answer because there is a wealth of scientific data. Many data are communicated by the Chinese, whether published or accessible in the form of pre-print, a practice which consists of making the initial version of articles accessible to everyone within 24 to 48 hours, without peer verification and before publication. But, does this data cover all of the important information? I’m not entirely sure.

The difficulty is really linked to the mass of information available which is so important that one cannot really estimate if it is missing 20%, 30%, 50%. Furthermore, it should not be forgotten that in times of major crisis, as was the case in Wuhan, the priority of doctors or scientists is not necessarily to communicate or publish.

Can we speak of a fault on the part of China for having perhaps alerted too late to this epidemic and its risks?

P. R.: For me, this is the original sin of Chinese communication: how could we imagine that there would be hundreds of thousands of dead in Europe when in theory there were only a few thousand in China, a country populated by more than a billion inhabitants? From the start, many experts used the death toll announced in China to reduce the expected impact of COVID-19 in Europe.

The underestimation of the number of deaths observed in China impacted the pandemic preparation of all the other countries. It is not the same thing, in terms of anticipation, when you tell a government that there have been 100,000 or 3,000 dead.

The experience of each country is extremely important for the new countries that are affected and must be reported in a completely transparent manner. This sharing of data on an international scale is crucial because it allows us to observe how the epidemic reacts to each strategy and enriches the reflections for our own deconfinement strategies.

How is the international scientific community organizing to fight together against the epidemic?

P. R.: There’s something completely new with Covid, it’s the habit of sharing information in the form of pre-print. This poses a problem in terms of verifying information but also considerably speeds up its access. Before, it was several months before an article became publicly available.

There are also many collaborations in terms of data sharing, information transmission. In a crisis like this, researchers cannot refuse to share data: this kind of attitude appears non-politically correct in the context of such an intense crisis. We have international registers that allow us to know all the tests that have been done in real time. My team is for example regularly in contact with colleagues in China or Italy to ask them for details on their research.

But what impresses me most is the current acceleration of research. We do things at a speed we couldn’t have imagined before. This is an extremely positive point: there is an emergency and the scientific community is adapting to this emergency.

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the doctor said why there are few coronavirus cases in Samara

The number of patients with coronavirus in the Samara region since the beginning of April has grown by three people. It’s really a bit, but the situation around is more like preparing for combat action. New infectious beds are constantly being prepared in the region, doctors are being trained, hospitals are being re-equipped. Residents perplexed: “More patients? They don’t tell any information? ” In fact, there is no need to look for a dirty trick: citizens are honestly told about how the situation is developing. But what comes next is difficult to predict. Associate Professor of the Department of Infectious Diseases of Samara State Medical University, Chief Specialist of the Ministry of Health of the Samara Region on the Problems of Diagnosis and Treatment of HIV Infection, Infectious Disease Doctor with 30 Years of Experience Elena Strebkova now helps to organize an infectious diseases hospital at the hospital named after Midpoint “There are no patients here, but who knows if they will appear tomorrow.” She told in an exclusive interview to a journalist “KPSamara”, Why the whole branch of medicine is working so hard today, although the numbers of cases and the inhabitants seem low, are Samara residents at risk of picking up a coronavirus and why is COVID-19 more dangerous than“ ordinary flu ”.

– Elena Alekseevna, why is such mass training, reprofiling of hospitals necessary?

– The measures taken by the government of the country and the region, and now allow us to prevent a surge in incidence. If not for them, we would be faced with a situation that is now happening around the world. Thanks to the measures taken for isolation and sanitation, a large number of cases of infection do not appear. This is done so that all our medical organizations have time to prepare. We see that new cases of infection and new cases appear daily, and we must be prepared to provide highly qualified medical assistance to the residents of the region. Like all my colleagues, we will be happy if we do not have to. But we must be prepared.

– How are hospitals preparing to receive coronavirus patients, what is the peculiarity of interacting with such patients?

– Infectious diseases that we usually deal with in the Samara Region are caused by microorganisms that do not require special preparation from a doctor. And COVID-19 is a particularly dangerous infection. Therefore, all protective measures in hospitals converted to infectious hospitals, for example, in SOKB named after V.D. Seredavina, taken for this class of pathogenicity. For this, doctors put on protective suits, masks, goggles – a person must be fully protected, because even small aerosol drops that remain in the air after coughing or sneezing can get on it and then lead to infection.

– How are doctors trained to resist the coronavirus?

– Doctors at hospitals that are converting to infectious hospitals are currently undergoing training. First of all, they are taught to wear and take off protective clothing correctly. Because the physician must first protect himself from infection, otherwise there will be no one to help people.

In addition, doctors are told how the virus is transmitted and how to protect themselves; they explain all the rules for disinfection. Of course, we study the clinical forms of the disease, how it manifests itself, what supporting signs of coronavirus infection, what indicators you need to pay attention to in order to make a diagnosis and assess the severity of the patient.

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– And as for lung ventilation, for example? Is she taught to do it?

– Naturally, such a huge number of resuscitators, infectious disease specialists, pulmonologists, which may be needed in case of a surge in incidence, is not in the healthcare system. Therefore, if necessary, infectious disease specialists and pulmonologists will work as consultants. One infectious disease specialist and pulmonologist per 100 patients – this will be quite hard work.

Under their guidance, doctors of all other specialties, after training, will be able to work with such patients. But the main burden will fall on resuscitators. Here, one resuscitator with two nurses will work for six people. Although basic training in mechanical ventilation and resuscitation will still pass all the doctors. For example, the staff of Seredavin Hospital is almost completing such training.

– How large, in your opinion, is an infectious disease specialist with 30 years of experience in the likelihood of a scenario when 100 coronavirus patients fall on one pulmonologist?

– We all want to hope that this probability is low, but we should always be prepared for this. It’s impossible to deploy an infectious diseases hospital in a hospital that was not intended for this; deploying such a huge number of resuscitation beds is impossible. The preparations that are currently underway will allow us to avoid the so-called “Italian scenario” – the very help that is needed will be immediately provided to the patients. IN Italy such a difficult situation was due to the large number of patients at the same time. Quarantine was announced late in the country; the healthcare system was not ready for such an arrival of patients who need ventilation support. In our country, the health system managed to prepare.

– Explain why we have so few patients and how relevant is self-isolation in this situation?

– These are the rules for the development of the epidemic. Why in Moscow so many sick? Not only because there are more people. But also because people from different countries flocked there and only then were distributed among the regions. Therefore, a huge number of sources of infection fell precisely in the capital. Naturally, there is the largest percentage of cases. But people from Moscow came here, and now the virus is spreading here. And now it doesn’t have to be contact with a person who came from abroad. This may be contact with a person who has not left the territory of the Samara region, who himself does not suspect that he is a source of infection.

The virus already exists in the urban environment, and it was for this reason that self-isolation measures were taken to protect people from each other. The closer we are to each other, the greater the likelihood of becoming infected, and the biggest danger is that this will happen at the same time, giving a greater burden on the health system.

“How can the virus spread if we all sit at home?”

– Let’s really look at things. You are not sitting at home. Anyway, you go to the store, to the pharmacy, where to whatever. The main distribution path is through door handles, through the buttons of elevators, in contact with trolleys in stores. These are transmission routes that no one has canceled. And with close contact at a distance of less than two meters, infection from person to person is also possible.

– They say that coronavirus is less dangerous than ordinary flu, it has less mortality, there is no reason for panic?

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– Mortality from influenza was also quite high until the moment of mass vaccination. Now vaccination saves us from a large number of deaths with the flu. And we expect the appearance of a coronavirus vaccine only by the end of the year. Therefore, people are not protected. And since the virus is new, it first appeared this year, we have no immunity. And since no one has immunity, there is no layer that would restrain the explosive nature of the epidemic. Explosive is when several thousand cases appear at one moment. According to some experts, the main surge in the incidence may occur next week. The medical system must be prepared for this.

– In social networks, KP-Samara asked readers why, in their opinion, in the Samara region such a low incidence of coronavirus. It turned out that most are sure: we just have little testing for coronavirus. How do you rate coronavirus testing in the region? Are they enough?

– We test as much as necessary, except Rospotrebnadzor A laboratory has been deployed at the AIDS Center. They test those who came from abroad and are in quarantine, all patients with pneumonia, with severe forms of acute respiratory infections, pregnant women – volumes are large.

“And the main question that worries everyone is when will it all end?”

– So far, the measures taken are designed for the next three months. But we will all be happy if everything ends earlier.

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Nursing homes face unique challenges with Coronavirus – NBC Los Angeles

From Miami to Seattle, nursing homes and other facilities for the elderly host stocks of masks and thermometers, preparing staff shortages and checking visitors to protect a particularly vulnerable population from the coronavirus.

In China, where the epidemic started, the disease was basically deadly for the elderly. In Italy, the epicenter of the virus epidemic in Europe, the more than 100 people who died were elderly, suffering from other complications or both.

Of the 19 deaths in the United States since Saturday, at least 14 had been linked to a nursing home in the Seattle area, along with many other infections among residents, staff and family members. The Seattle Times reported that a second nursing home and a retired community in the area had reported a virus case.

This has alerted other structures in the United States, especially in states with large populations of older residents, such as Florida and California. About 2.5 million people live in long-term care facilities in the United States.

“For people over the age of 80 … the death rate could reach 15%,” said Mark Parkinson, president of the American Health Care Association nursing homes group.

The federal government is now focusing all inspections of nursing homes on infection control, identifying facilities in the city with confirmed cases and those previously mentioned for not following the protocol.

Federal regulations already require homes to have a specialist in preventing infections in staff, and many have already taken measures to deal with seasonal flow and other ailments that pose a greater risk to the elderly.

Even so, the response of structures to coronavirus has varied across the country.

In Florida, where some 160,000 seniors live in nursing homes and assisted living facilities, mandatory screening for visitors is not expected “because we are not at that point,” said Florida Health Care Association spokeswoman Kristen Knapp.

But aged care centers are posting signs that urge visitors to stay away if they have symptoms and are looking for alternative ways to connect to families, such as through video chats, Knapp said.

Concierges in the 14 Florida nursing homes managed by Palm Gardens Corporation are now offering all visitors a short questionnaire asking for information on symptoms, recent trips and contacts with others, said company vice president Luke Neumann.

Neumann said that nursing homes have also purchased additional thermometers in case they have to check visitors’ temperatures and accumulate preventive supplies, including medical masks, protective goggles and clothing. In laundries they make sure to use enough bleach and heat to kill any persistent viral germs, he said.

In the South Shore Rehabilitation and Skilled Care Center south of Boston, patient Leo Marchand holds a container of disinfectant wipes on a shelf near the bed that he uses several times a day. The 71-year-old Vietnam veteran and retired truck driver has chronic obstructive pulmonary disease which makes it difficult to breathe. The possibility of contracting the coronavirus scares him.

“It’s a concern,” said Marchand. “Really.”

Many facilities across the country have said they have trouble getting masks and medical clothes because of the shortage.

The more intense screening of visitors, meanwhile, isn’t going well with some.

“Some of the visitors have been quite reluctant to comply, and this has been stressful,” said Janet Snipes, executive director of Denver’s Holly Heights nursing center.

Under federal regulations, nursing homes are considered to be a patient’s residence and facilities want to keep them in contact with the family, especially when they are almost dead.

“I don’t think you can completely prevent visitors,” said Dr. David A. Nace, director of long-term care and flu programs at the University of Pittsburgh Department of Medicine. Supervise 300 facilities in Pennsylvania.

For now, facilities in most states are underlining basic precautions, including hand washing and the cough tag.

Centers across the country are also trying to prepare staff for the worst.

An adult daycare center in the Little Havana neighborhood of Miami purchased long-lasting ready meals in preparation for possible shortages. The Hebrew Home in Riverdale, New York is running nursing staff through exercises to see how they will handle situations in the 750-bed facility if the virus progresses. Their IT department is building an infrastructure to allow staff to work remotely if they get sick.

“If one of our sites has an outbreak, we will quickly run out of staff in that position,” said Randy Bury, CEO of The Good Samaritan Society, one of the largest nonprofit senior care providers in the country, with 19,000 employees in 24 states.

Some families are considering withdrawing loved ones from the facilities.

Kathleen Churchyard said her family decided to move her 80-year-old mother out of her retirement community near Jacksonville, Florida, and to her sister’s home nearby if the virus is confirmed in the area.

Churchyard, who lives in Concord, North Carolina, fears that her mother won’t take her seriously, and is particularly concerned about her dining room.

“I tried to get her to buy things to prepare … She said, ‘No. If (the virus) catches me, it takes it,'” said Churchyard.

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Associate associate writer Philip Marcelo in Rockland, Massachusetts contributed to this report.

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The Associated Press receives support for health and scientific coverage from the Howard Hughes Medical Institute’s Department of Education. The AP is solely responsible for all content.

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Governor Charlie Baker, Boston Mayor Marty Walsh to provide preparation and planning update – NBC Boston

As the number of cases continues to rise here and across the country, Massachusetts government Charlie Baker and Boston Mayor Marty Walsh are slated to provide an update on local preparation and planning on Friday.

Baker, Walsh, Marylou Sudders, secretary for health and human services, commissioner for public health Monica Bharel and other city and state health officials are expected to hold a press conference at 12:30. at Boston City Hall.

On Thursday, the Massachusetts Public Health Department confirmed a third possible coronavirus case in the state. A woman in Middlesex county in her sixties who recently traveled to northern Italy has a presumptive case of COVID-19.

Health officials say a Tennessee man who tested positive for coronavirus traveled through Boston airport.

Earlier Thursday, hospital officials said they confirmed that a patient who had entered Norwell’s South Shore Medical Center had an alleged positive coronavirus case. It was not immediately clear whether this was the same case. Norwell is located in the county of Plymouth.

Previously, public health officials recognized a confirmed case in a UMass Boston student who had traveled to Wuhan, China, and an alleged positive case involving a 20-year-old woman living in Norfolk County who had recently returned. from Italy with a school group.

Rhode Island and New Hampshire also had two suspected positive cases each.

Several local restaurants claim to be struggling with the uncertainty caused by the coronavirus epidemic.

Biogen announced on Thursday that three people who attended a corporate meeting in Boston last week have tested positive for the virus.

And Tennessee health officials announced that a 44-year-old man diagnosed with that state’s first coronavirus case had recently flown to Boston Logan International Airport on a round-trip flight from Nashville International Airport. They said it was asymptomatic during the trip.

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