Yemen faces spread of COVID-19 ‘with no health care system at all’

Yemen faces spread of COVID-19 'with no health care system at all'

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Stephen Snyder

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A health worker takes the temperature of people riding a taxi van, amid concerns of the spread of the coronavirus disease (COVID-19), at the main entrance of Sana’a, Yemen May 9, 2020.

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Khaled Abdullah/File Photo/Reuters

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The United Nations has called the situation in Yemen the worst humanitarian crisis on earth. It’s the product of a five-year war, food shortages, widespread poverty and homelessness. And now, Yemen faces the coronavirus pandemic.  

A virtual pledging conference Tuesday, co-hosted by the United Nations and Saudi Arabia, raised a little over half of its $2.4 billion goal — and half the amount pledged at last year’s conference. Aid group Save The Children called the amount “catastrophic.” 

The annual pledges support programs that bring food and clean water and medical assistance to Yemen. 

“COVID-19 is spreading throughout Yemen, and there are few signs that local authorities can handle the rising number of infections. Health facilities are turning people away because they’re already full or they don’t have what they need to treat people with the virus.”

Mark Lowcock, UN under-secretary-general for humanitarian affairs and emergency relief coordinator

“COVID-19 is spreading throughout Yemen, and there are few signs that local authorities can handle the rising number of infections,” Mark Lowcock, the UN under-secretary-general for humanitarian affairs and emergency relief coordinator, told national representatives who gathered online Tuesday. “Health facilities are turning people away because they’re already full or they don’t have what they need to treat people with the virus.”

Yemeni researchers and activists say the fundraising shortfall follows a pattern in which the war-torn country falls off the global agenda — particularly in light of the pandemic. 

Related: With test kits so scarce, doctors in Yemen are flying blind

“There seems to be a [donor] fatigue over the situation in Yemen,” says Afrah Nasser, a researcher for Human Rights Watch. “Every government is just dealing with their own internal humanitarian situation in light of the COVID-19 crisis. So Yemen is just being forgotten all over again.” 

Nasser, herself a Yemeni working in exile, has watched her country disintegrate since fighting spread throughout the nation in 2015. 

“In the course of the war, we have witnessed systematic targeting of health facilities across the country,” she said. “Hospitals, clinics have been targeted by the different warring parties. And even worse, health workers have been targeted or fled the country. The health care system today, basically, has collapsed. So people today are facing COVID-19 with no health care system at all.”

Yemen reported its first case of the novel coronavirus in April. As of June 4, the World Health Organization was reporting 423 confirmed coronavirus cases, with 96 deaths.

Related: WHO fills gaps to fight COVID-19 in countries with weak systems

The Facebook posts Nasser sees from people inside Yemen provide a more alarming picture. She said she suspects far more people are dying from the virus than official numbers portray.

“I don’t like to exaggerate,” Nasser said. “But I see that there are about 10 or 20 people dying daily. People are expressing the pain and despair through those social media posts … There are funerals happening on a daily basis. There is one graveyard in Sana’a that closed its doors, saying with a big poster on its door that the graveyard is fully occupied.” 

In Aden, Yemen’s southern port city, gravediggers can not keep up with the demand for burials.

Fatima Saleh, a civil society activist living in Sana’a, has also noted the rise in death announcements on Facebook. 

“I’m seeing condolences to our friends, to friends of friends, on a daily basis. It’s crazy. I mean, we’ve been in a war for, like, six years, but we’ve never seen something like this.”

Fatima Saleh, civil society activist living in Sana’a, Yemen

“I’m seeing condolences to our friends, to friends of friends, on a daily basis,” she said. “It’s crazy. I mean, we’ve been in a war for, like, six years, but we’ve never seen something like this.”

Preventative measures observed widely throughout the developed world have not yet been adopted in Saleh’s neighborhood in the Yemeni capital. 

“Yesterday, I went on an errand,” Saleh says. “I was in the shop and many people were not social distancing … And also, many people are not wearing masks or any kind of protection.”

Hisham Al-Omeisy, a Yemeni political analyst living in Cairo with close ties to friends and family in Yemen, says the country is not doing enough to protect its people from the virus.

“All the shops are open. All the roads are open. Even the big areas, where a lot of people crowd, are open,” Al-Omeisy said.

Related: As it braces for coronavirus, Yemen offers lessons of survival

“I just feel scared when I go outside because I know that people are not being careful and cautious regarding COVID,” Saleh said. “And some of the people treat it as just the flu.” She sees ominous signs in Sana’a’s busy streets and marketplaces. “Countries in the first world closed all facilities. But we didn’t take lessons learned from this … And we don’t know if we are at the peak or not. Nobody is telling us any death toll or any numbers.”

“The situation back home is hell,” Omeisy said. “People are literally dropping like flies.” 

Omeisy says Yemeni officials seem to be deliberately opaque about the spread of the virus: “On one hand, they tell the UN and other bodies it’s serious, on another, they downplay it locally.”

“The Houthis even had the audacity to announce they are preparing 19 cures for the ‘US-made virus,’” said Omeisy, who was imprisoned and tortured by the Houthis before he escaped to Cairo. He says lack of a clear public health response by authorities imperils the Yemeni way of life. “We’re completely helpless against a virus that cares nothing about our goodness or community values. It even seems that the virus is capitalizing on [our] closely-knit society to ravage through our communities.”

Chile’s ‘COVID-19 card’ sparks controversy over ‘uncertainty of evidence’ about immunity

Chile’s ‘COVID-19 card’ sparks controversy over ‘uncertainty of evidence’ about immunity

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The World staff

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Amulya Shankar

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A man wearing a protective face mask as a precaution against the spread of the coronavirus disease (COVID-19) rests in a public square in Valparaiso, Chile, April 27, 2020. 

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Rodrigo Garrido/Reuters 

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Chile is one of several countries trying to plan ahead for a return to normalcy amid the COVID-19 pandemic.

Its health ministry has pushed for the use of so-called “immunity passports” — an all-clear card of sorts issued to people who have already had the illness — so that parts of the population can return to work. 

Related: Countries herald lifting of coronavirus lockdowns, but UK says not yet

But scientists, doctors and researchers still lack much information about the coronavirus and how it works. Experts with the World Health Organization worry about moving too quickly and have advised against the use of such passport documentation to indicate immunity from COVID-19. 

Paula Daza, sub-secretary of Chile’s health ministry, told reporters on Sunday that while many uncertainties remain about the coronavirus pandemic, evidence points to a reduced risk after the first bout of the coronavirus.

“One of the things we know is that a person who has…lived through the disease is less likely to become ill again,” Daza said. She said certifying this status was the “goal of the COVID-19 card that is being prepared will soon be delivered” to patients.

WHO said that issuing certificates could inspire false confidence and increase the risk of spreading the virus. People who have recovered may ignore advice about taking precautions against the virus, the WHO said.

“There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection,” said WHO. 

Daza clarified on Sunday that the certificates Chile planned to issue did not certify immunity.

“It is very important, and I want to reiterate, that we have not talked about an immunity card,” she said.

But Chile’s top health official, Jaime Manalich, said early in April that those who have recovered from the coronavirus represented a population that was immune to it and incapable of transmitting it.

He said those with the medical discharge certificate would be “freed from all types of quarantine or restriction, specifically because they can help their communities enormously since they pose no risk.”

Daza did not specifically address the contradiction when asked by a reporter Sunday.

Chile has confirmed 14,885 cases of coronavirus since the outbreak began in the South American nation in early March, as well as 216 deaths.

Related: Kids in Spain venture outside for first time in weeks

Dr. Cristóbal Cuadrado is a professor of public health at the University of Chile who joined host Marco Werman from Santiago to discuss the idea behind the immunity passport concept — and why it sparked so much controversy. 

Marco Werman: Dr. Cuadrado, can you tell us what Chile has decided with regard to the immunity passports?

Dr. Cristóbal Cuadrado: There has been a lot of controversy regarding this issue in the last weeks. At the beginning, the Ministry of Health wanted to give this kind of immunity passport to any person that had acquired the disease in the last two weeks. So, any person that has been diagnosed and cleared from the disease was suspected to be immune, and therefore, given this kind of passport. Additionally, there was a discussion into if antibody testing should be added to the definition.

But the problem, as World Health Organization has mentioned, is that we don’t know if this rapid testing available now in the market really is able to detect effective antibodies on how long this potential immunity could last. So, I think there is a lot of controversy at this point in Chile, and also in other countries that are looking forward to move on these kinds of measures.

Right, and depending on how you feel about this idea, I suspect you may or may not agree with even whether to call it an “immunity passport.” The WHO has recommended against them because there is no evidence currently supporting immunity. The idea that if you’ve been infected once that you can’t be reinfected — we just don’t know. So, has the Chilean government addressed these concerns in any way?

The use of this documentation is not clear any longer because the initial idea of the government was to produce this documentation so people could move freely and not be forced to stay at home, for example, when quarantines were in place in some cities. But just recently, a few days ago, they needed to step back on this and they stopped calling this an immunity passport. So, this is still something that is ongoing and probably we will hear from the Chilean government in the next week, how they are going to or plan to use this documentation if it’s not aiming to warrant immunity to the persons that are holding it.

So in a matter of a few weeks, the Chilean government contradicted itself on this. What kind of reaction has there been to the plan so far?

In the media, it has been very clear that there were profound differences with the ministry of health. For example, the Chilean Society of Immunology or the Chilean Society of Infectology were both calling for prudence on the implementation of these measures in the context of uncertainty of the evidence. And I think the message from the World Health Organization during the last week was also very, very influential for the decision of the government to step back on this decision.

Will it give people false confidence when we just don’t have full details on immunity to COVID-19?

Yeah, absolutely. I think that one of the main criticisms of this idea of the immunity passport is not to be transparent in the uncertainties behind the idea. So, I think you can implement something like this, but you need to be very, very transparent to the public. What we do know and what we don’t know. I think that is, of course, a point of contention, because the economy needs to start working again. But we need to do it in a way that we protect the population’s health as well.

This interview has been edited and condensed for clarity. Reuters contributed to this report. 

‘No fast track’ to normal when it comes to reopening economies

'No fast track' to normal when it comes to reopening economies

By
Elana Gordon

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A customer pays in the book store “Buchhandlung Lerchenfeld” after the Austrian government loosened its lockdown restrictions during the coronavirus disease (COVID-19) outbreak in Vienna, Austria, April 14, 2020. 

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Leonhard Foeger/Reuters

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Strict physical distancing measures in response to the novel coronavirus have disrupted economies and lives in massive ways. But as shutdown measures stretch into weeks and months, many communities across the globe are now wrestling with when and how to relax those policies. 

The United Kingdom has announced it would continue its lockdown for at least three more weeks. Meanwhile, on Thursday evening, US President Donald Trump is slated to lay out his plan and guidelines for when places in the US can get back to work. Though Trump falsely claimed he had “absolute authority” as president to make that call, the power to reopen is largely vested in the states. 

There’s no simple transition for countries looking to ease restrictions, said Dr. Hans Henri Kluge, director of the World Health Organization’s regional office in Europe, during a press briefing Thursday.  

“Ultimately, the behavior of each of us will determine the behavior of the virus. This will take perseverance and patience. There is no fast track back to normal.”

Dr. Hans Henri Kluge, WHO

“Ultimately, the behavior of each of us will determine the behavior of the virus,” he said. “This will take perseverance and patience. There is no fast track back to normal.”

Health researchers such as Caroline Buckee, associate director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health, are wrestling with how to understand the best way to ease restrictions to limit the future spread of COVID-19 and prevent even more harm down the road. For her, critical pieces of this puzzle are still missing. 

“In many areas we don’t really know where we are with the epidemic because of the lack of testing,” Buckee told The World during a Facebook Live discussion co-produced with the Forum at Harvard’s Chan School. “So I’d say it’s very variable, geographically, and in terms of timing.”

Related: COVID-19: The latest from The World

Understanding this variability is important, Buckee said, because the pandemic is playing out differently across the globe, depending on where you live and how well those health systems are able to care for patients who are sick with COVID-19. 

More than 2 million cases of the disease have been documented. Some parts of the world are just at the beginning of their outbreak, while places like China and Singapore are on the other side of their major peak. The situation is even more unclear in communities that lack necessary testing. 
 
Buckee said in the United States, another important aspect of the pandemic that needs to be understood is how many people have already been infected, and how people who are asymptomatic spread the virus. 

To know whether someone has had the new coronavirus requires a specific kind of antibody test that has yet to be fully rolled out in the US. It is also unclear if and how long a person who has had COVID-19 is immune to the disease in the future.

“It gives a clearer picture of how far along a community is in the epidemic, when it’s sensible to restart economies and go back to work,” Buckee said. 

Robust contact tracing is also key in preventing future spikes, as communities seek to scale back social distancing. Transition policies, said Buckee, must also take into account how to limit coronavirus exposure to those who may be most likely to experience complications, such as the elderly and those with chronic health conditions.