Senator Caswell Franklyn Speaks – Government Bungling Response to Coronavirus Crisis

At the outset of the Coronavirus crisis in this country, the Hon. Prime Minister, Mia Mottley, hosted a consultation with members of the Social Partnership and me at the Lloyd Erskine Sandiford Centre, to plan strategy for fighting this threat. I was impressed and congratulated her on the approach. I then went on to say to her that this was not a time for political controversy and that all sides must come together to defeat this scourge.

Rather than busy itself with measures to protect the people of this country, some twelve days after the consultation, Government rushed to Parliament and passed legislation that was already on the books, to manage the ensuing crisis. In essence, that legislation amended the Emergency Management Act by re-enacting certain provisions that already existed at section 28 of the same act; also at sections 2 and 3 of the 1939 Emergency Powers Act; and at section 25 of the Constitution. The amendment also went on to give powers to the Chief Medical Officer that he already had since 1969.

Needless to say, those initial steps did not give me any confidence that Government was capable of handling the situation, however I remained quiet hoping that somehow that they would get it right. I’ve tried to hold my peace but the situation has now reached a stage that I am compelled to speak-up before these bunglers unintentionally kill us all.

The handling of this crisis has been plagued with the bungling that is now characteristic of anything that this administration touches. So far, were are told that there is no evidence of any community spread of the virus. But it would seem that the end result of the Government’s initiatives would lead to what we fear most. What did the Government think would happen when it gave one day’s notice of a 24-hour curfew? As was reasonably foreseeable, people rushed to supermarkets in their thousands, ignoring any suggestion of physical or social distancing. Take some sobering time to imagine what could have happened if there were any carriers of the Coronavirus in those lines?

As if Government fails to learn from its mistakes, post offices were opened for a limited period in order to allow pensioners to cash their National Insurance pension cheques. The foreseeable result happened: hundreds of vulnerable persons throng the post offices thereby creating an incubator for the spread of the Coronavirus.

This virus is deadly and Government must come up with a series of measures that would protect the people of this country. These hit or miss initiatives just will not do.

DeLisle Worrell Speaks to COVID-19

Reproduced with permission, the text of Dr. Delisle Worrell – former Governor of the Central Bank of Barbados – April 2020 newsletter:

The World Health Organisation (WHO) has counselled countries around the world to implement four measures to minimise the risk of an explosive increase in cases of Covid-19. The measures are extensive testing, of persons who are judged to be at risk, whether or not they have fever, respiratory ailments or other symptoms; tracking down everyone who might have had contact with those testing positive for Covid-19; quarantining all those who test positive for Covid-19; and social distancing. Dr Tedros Ghebreyesus, the Director General of the WHO, was at pains to stress that all four of these policies must be implemented in order to contain the spread of the virus.

Dr Ghebreyesus has also advised countries to take advantage of the pause that curfews, lockdowns and the stoppage of air travel afforded them, to prepare for a possible surge in Covid-19 cases. Barbados now has an opportunity to acquire test kits, personal protective gear and medical supplies and equipment, to cope with such an eventuality. Also, the country should ramp up our capacity for testing, the availability of quarantine and the creation of additional treatment facilities for the very ill. All medical personnel in the country should be tested as soon as possible, for their own peace of mind, as well as in the national interest. All workers at the port and airport, and those involved in the recent transfer of cruise ship passengers should also be tested, as soon as practical. Anyone with fever or respiratory symptoms should continue to seek medical advice, so they can be referred by a physician for possible testing.

Read full text @caribbeansignal.comDeLisle Worrell: COVID-19: Saving Lives and Securing Livelihoods

Open Note to Doctors – COVID 19 Notes

The following was posted by Peter Lawrence Thompson to another blog. Given the many unknowns about the COVID 19 virus the blogmaster thought it useful to repost. Obviously the target is the medical community – David, Blogmaster

 


This has a lot of medical jargon, but if you read it carefully it gives a picture of what front line medical staff are faced with. I was written by an Emergency MD in a New Orleans hospital – Peter Lawrence Thompson

“I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won’t make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the “lockdown”, our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn’t appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil’s potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient’s standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn’t often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.”

COVID-19 and NCDs

Submitted by Caleb Pilgrim

Personally, I would rather deal with systemic issues, despite obvious limitations of time and space. In this vein, you may wish to have Dr. Doughlin and/or others opine on the substance of the PAHO/WHO 2018-2024 report attached.

https://apps.who.int/iris/bitstream/handle/10665/272851/ccs-brb-2018-2024-

The Coronavirus is no doubt a game changer.  Policy wise, the question remains what exactly is to be done?  Or, in sum, despite bluffing, are we, in the Caribbean, in a situation analogous to the man who puts on a condom well after he has been severely infected?

Arguably, the risks increase drastically if “43%” of the QEH patients suffer from diabetes or diabetic complications.  Ditto other Caribbean islands.

Similarly, data coming out of China/Wuhan indicates that 50% of the fatalities there are for patients suffering from high blood pressure.  Ditto Barbados and the other Caribbean islands. Ditto, heart disease patient(s).  Ditto various cancers as well, not uncommon in Barbados.  In fact, all of the foregoing diseases are already commonplace in B’dos.

Finally, if we must – re the debate on the “social gospel”, perhaps, it was not by accident that we used to meet in John Moore’s Bar/“Rum shop”, where Dr. Doughlin (an Adventist) addressed us before we all drifted off in different directions.

I believe that, based on our reading of the Canon, a reasonable interpretation is that Jesus’s radical gospel absolutely frightened the Establishment of his day.   Thus, his 26 or more healing miracles would have frightened the crap out of the doctors (see for instance Mark’s treatment of the woman with the “issue of blood”, versus Dr. Luke’s treatment of the same issue.   Per Luke, the poor woman had spent all that she had …).

Similarly, the merchants who lost their income, when he fed the thousands, including turning water into wine.  Imagine if you owned a Package Store or an Off License.  The merchants become apoplectic.

Similarly, when he taught a totally contrarian doctrine in the synagogues, the Scribes (the lawyers), Pharisees and Sadducees would have feared losing respect and money, (or vice versa).

I don’t know that we can never escape the relevance of the “social gospel”, so long as the poor, the sick, the infirm and those who suffer remain with us.

Recharge – COVID-19 @Stage 2 and 3

grenville-phillips

Submitted by Grenville Phillips II,

Well, I have finally gotten the message – the threats are now too personal to ignore. To balance the safety of my family, and my duty to Barbados, these will be my final recommendations on COVID-19. They are to cover Stages 2 and 3.

The accusations are, of course, baseless. Asking basic questions is not breaking rank. Questioning is normal when the four steps to develop national plans are not followed.

Step 1 is to develop a draft plan. Step 2 is to present that plan for rigorous public scrutiny (since the public are stakeholders). Step 3 is to analyse the feedback and finalise the plan. Step 4 is to implement the plan.

Both administrations typically only do Steps 1 and 4. There is rarely critical review. This results in either stubbornly staying with a failing plan, or making band-aids under pressure to a weak plan.

The media should be asking pertinent questions, but they seem to have gotten the message a long time ago. They make press conferences as meaningless as a soap-opera. How about asking some of these questions.

The Government claimed that they will be spend $30M to build quarantine sites and respond to this virus. How is the Government procuring the $30M in goods and services?

No-bid contracts normally cost the public two to five times what the contract is actually worth. Is the Government using the same corrupting no-bid contracts for contractors, consultants and supplies? What qualifications are needed to share in the $30M to be disbursed?

The Government promised to appoint a contractor general to put an end to these corrupting no-bid contracts. How is that progressing? Why not start prequalifying Barbadian business right now, instead of automatically disqualifying most of them with the sorry excuse of urgency?

The hurricane season is approaching. We should not be constructing sub-standard buildings in Barbados, especially after turning the six-storey NIS building into rubble. So, to what category of hurricane are the buildings being built? Also, to what magnitude of earthquake? How durable are they?

I dare our established media to ask just one of these questions. Once they realise that the sky has not fallen, perhaps they will be less terrified – and ask another.

RECOMMENDATIONS

In preparation for Stage 2, we should assume that at least one person in our household will get the virus, and plan accordingly.

1. Supplement Diet

If I got the virus, then I would strengthen my body so that it can fight for me – as it has always successfully done. I would add to my daily diet: 1,000 mg of Vitamin C, at least one table-spoon of Blackstrap molasses, and at least five table-spoons of Apple Cider Vinegar.

You can purchase one gallon of blackstrap molasses from the sugar bond area of the port for $2, but carry a clean wide-mouth container. You only need a quarter of that, so distribute the remainder to others.

2. Sunshine

Ultra-violet sunlight is an effective disinfectant. Therefore, everyday, I would open every window curtain and let the sun shine in. I would also open the windows (with insect screens) to ventilate the house. Therefore, maintain some insect mesh and duct tape to keep out flies and mosquitoes.

If I got the virus, I would spend my days near a window where I can get natural light, and breathe clean air.

3. Flush Closed Toilets

COVID-19 RNA has been confirmed in blood and stool samples of some infected persons. Droplets from the toilet have been found on bathroom ceilings after flushing. Therefore, droplets can reach the bathroom’s sink (and any exposed toothbrushes) and towel rack. I would insist that everyone in my household close the lid when flushing the toilet.

Many infected persons have had diarrhea. You are likely to go through toilet paper more rapidly in that condition. Therefore, I would try to maintain 12 rolls of toilet paper for each member of my household.

4. Disinfect Shoes

Not everyone will stop their habitual spitting. The COVID-19 can exist for hours in the air and days on surfaces. You may step on someone’s spit, especially after it rains. Therefore, spray disinfectant on the bottom of your shoes before entering your house, and on your car mats when you get home.

5. Clean Pet Trays

If you feed pets outside, then clean their trays. Uneaten food attracts birds. Birds can step in the same spit and bring the virus to you, so do not attract them.

6. Invest in Yourself

If you are quarantined, then do not squander this opportunity. Take maximum advantage of our double taxation agreements with various countries, especially the US, and grow your Internet based business.

Between managing your business and your household, learn something new. There are many free on-line courses that Universities offer. Take one that can improve your productivity and increase your earnings, then take another.

Please do not waste this time with only entertainment (watching movies and reading fiction). Instead, recharge.

Accept that you may likely get infected, and perhaps more than once. Therefore, maintain your household supplies, and use this opportunity to cultivate a closer relationship with your Creator.

Parting Comments

I have been asked how I know so much. I have worked in disaster areas over the past 2 decades, where the economy came to a halt. In those situations, there is normally no economic activity, nothing to purchase, and no reliable government services.

I have had over 12 deployments to Haiti, when cholera had infected about 800,000 people and killed about 10,000. One member of my team actually had cholera while I was there.

I am also doing doctoral research, and the doctoral research community is rich in cutting edge knowledge. I critically review others’ research and they critically review mine. Why? Because we want to do research that will benefit humanity. Critical review is the most effective method of achieving that aim.

Adrian Loveridge Column – Coronavirus Uncertainty

Adrian Loveridge

Adrian Loveridge

Perhaps the single biggest challenge to our ‘local’ tourism industry is the uncertainty that the Coronavirus brings with it. Many airlines that service Barbados have sensibly implemented a no-change fee, subject to various conditions, some more generous than others, which allows those booking in a restricted time window to change flight dates without financial penalties.

Likewise, an increasing number of tour operators have adopted a similar policy.

At this time, it has to be the most responsible policy to adopt. There is absolutely no mileage into forcing people who have already booked and made a substantial economic commitment, to travel at a time they feel threatened, whether that perception is realistic or not. This is especially concerning to our more mature visitors, who understandably feel substantially more at risk. It’s already a difficult time for the airlines with the ongoing Boeing B737 MAX problems, not looking even remotely likely to re-enter service until very late this year.

Perhaps, at least partially mitigating this situation is the dramatic fall in oil prices, reaching the lowest per barrel prices for nearly 30 years and reflected in the one third lower cost of aviation fuel over the last year (source: IATA).

The next ‘moral conundrum’ stance that these airlines will be forced to make is for all those passengers who have booked and paid for tickets outside the newly revised Coronavirus conditions and whether people already holding confirmed flights will actually ‘risk’ travelling. In my case, I am due to travel across the Atlantic within the next two weeks.  Do we simply ‘write-off’ the cost of the tickets if the involved airline refuses to transfer to a later date, or does the carrier gain our valuable onward brand loyalty by allowing changes? Under current rules air carriers are allowed to cancel and exempt from paying compensation up to 14 days prior to travel.

For our policymakers, this scenario is close to a nightmare.

Damned if you do, or damned if you don’t, while I honestly believe they are doing all that they reasonably can, given the fact, that frankly, none of us know how the ultimate sequence of events are going to develop. Likewise for our hotels and other accommodation providers, do they adopt a carry-forward stance without forfeiture, where confirmed guests having paid deposits are allowed to re-book for a later date?

Obviously, there is a real net cost to our tourism partners here, as you cannot sell an empty room twice, to compensate for the loss, but there is a much better chance of retaining that guest with good faith for a future stay. That certainly was the approach that worked for our small hotel in previous occasions, where there was no tangible element to apportion blame and liability.

Whatever the end game, it is inevitable that there will be negative fiscal consequences for the country and I am sure that our planners at the highest level are currently implementing mitigating measures, to possibly minimize this level of potential damage.

Government might even consider speeding up the essential revision of taxes and levies on tourism, which will help make our offerings more affordable to a domestic market, that are now also faced with dwindling overseas travel options.

Coronavirus Back Story – Why Barbados is NOT Banning Travel from Affected Areas

The Editor

Barbados Underground

Barbados, W.I

Dear Sir/Madam

There was an article in your newspaper of 3 .February 2020 entitled: “Barbados not rushing to ban travellers from China.” The same message was also aired on radio. Mention was made about the statistical likelihood of an outbreak locally being under two percent. There was even mention of the fact that since 1967 there was no real impact on Barbados of the outbreak of contagious diseases. According to the aired news the local authorities were following the World Health Organization (WHO) guidelines. As the holder of a doctorate in microbiology and some one who has done post doctoral studies in the discipline, I have a few questions, which I want answered in the public interest.

According to the Center for Disease control and Prevention (CDC). the virus has an incubation period of two weeks. Infected person maybe asymptomatic during the two-week period. It was for this reason the USA instituted a ban on persons who had been exposed for less than two weeks entering its domain. The reason given for doing so was the logistics involved in screening for potential carriers. Let me explain.

Let us assume there is an asymptomatic carrier who has entered the Barbadian domain and is interacting with the locals. After realizing that there is an active carrier in Barbados, it is incumbent on the authorities to track down and screen all persons who have interacted with the carrier. If the carrier has interacted with one hundred persons, each person has to be screened. This only allows for interaction of the carrier with one hundred persons. Allowance also has to be made for the interaction of each member of the one-hundred with other people. As can be envisaged, the number of persons required to screen, dramatically increases to such an extent, that the screening process breaks down. It is for this reason that countries have introduced a ban on persons who come from infected areas. In the case illustrated above where would Barbados get the required trained persons to actively carry out screening?

There has been mention of the fact that Barbados is following the WHO guidelines. Is this the same WHO that was shown to be totally incompetent its handling of Ebola? What about the Haitian cholera outbreak? The latter was under the aegis of the United Nation of which WHO is a part. The best scientists in the field do not work for WHO; they are found in research institutions. The WHO like all other United Nations bodies are constrained by political realities of member states who push political objectives ahead of what the correct scientific should be. As far as I can make out, there seems to be a pecuniary method behind Barbados’s stance on this matter: namely an effort not to affect the tourist industry.

 

Sincerely

 

Robert D. Lucas, PH.D.

Coronavirus Declared Global Emergency

Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)

30 January 2020

Geneva, Switzerland

The second meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the outbreak of novel coronavirus 2019-nCoV in the People’s Republic of China, with exportations to other countries, took place on Thursday, 30 January 2020, from 13:30 to 18:35 Geneva time (CEST). The Committee’s role is to give advice to the Director-General, who makes the final decision on the determination of a Public Health Emergency of International Concern (PHEIC). The Committee also provides public health advice or suggests formal Temporary Recommendations as appropriate.

Proceedings of the meeting

Members and advisors of the Emergency Committee were convened by teleconference.

The Director-General welcomed the Committee and thanked them for their support. He turned the meeting over to the Chair, Professor Didier Houssin.

Professor Houssin also welcomed the Committee and gave the floor to the Secretariat.

A representative of the department of Compliance, Risk management, and Ethics briefed the Committee members on their roles and responsibilities.

Committee members were reminded of their duty of confidentiality and their responsibility to disclose personal, financial, or professional connections that might be seen to constitute a conflict of interest. Each member who was present was surveyed and no conflicts of interest were judged to be relevant to the meeting. There were no changes since the previous meeting.

The Chair then reviewed the agenda for the meeting and introduced the presenters.

Representatives of the Ministry of Health of the People’s Republic of China reported on the current situation and the public health measures being taken. There are now 7711 confirmed and 12167 suspected cases throughout the country. Of the confirmed cases, 1370 are severe and 170 people have died. 124 people have recovered and been discharged from hospital.

The WHO Secretariat provided an overview of the situation in other countries. There are now 82 cases in 18 countries. Of these, only 7 had no history of travel in China. There has been human-to-human transmission in 3 countries outside China. One of these cases is severe and there have been no deaths.

At its first meeting, the Committee expressed divergent views on whether this event constitutes a PHEIC or not. At that time, the advice was that the event did not constitute a PHEIC, but the Committee members agreed on the urgency of the situation and suggested that the Committee should continue its meeting on the next day, when it reached the same conclusion.

This second meeting takes place in view of significant increases in numbers of cases and additional countries reporting confirmed cases.

Conclusions and advice

The Committee welcomed the leadership and political commitment of the very highest levels of Chinese government authorities, their commitment to transparency, and the efforts made to investigate and contain the current outbreak. China quickly identified the virus and shared its sequence, so that other countries could diagnose it quickly and protect themselves, which has resulted in the rapid development of diagnostic tools.

The very strong measures the country has taken include daily contact with WHO and comprehensive multi-sectoral approaches to prevent further spread. It has also taken public health measures in other cities and provinces; is conducting studies on the severity and transmissibility of the virus and sharing data and biological material. The country has also agreed to work with other countries who need their support. The measures China has taken are good not only for that country but also for the rest of the world.

The Committee acknowledged the leading role of WHO and its partners.

The Committee also acknowledged that there are still many unknowns, cases have now been reported in five WHO regions in one month, and human-to-human transmission has occurred outside Wuhan and outside China.

The Committee believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. It is important to note that as the situation continues to evolve, so will the strategic goals and measures to prevent and reduce spread of the infection. The Committee agreed that the outbreak now meets the criteria for a Public Health Emergency of International Concern and proposed the following advice to be issued as Temporary Recommendations.

The Committee emphasized that the declaration of a PHEIC should be seen in the spirit of support and appreciation for China, its people, and the actions China has taken on the frontlines of this outbreak, with transparency, and, it is to be hoped, with success. In line with the need for global solidarity, the committee felt that a global coordinated effort is needed to enhance preparedness in other regions of the world that may need additional support for that.

Advice to WHO

The Committee welcomed a forthcoming WHO multidisciplinary technical mission to China, including national experts. The mission should review and support efforts to investigate the animal source of the outbreak, the clinical spectrum of the disease and its severity, the extent of human-to-human transmission in the community and in healthcare facilities, and efforts to control the outbreak. This mission will provide information to the international community to aid in understanding the situation and its impact and enable sharing of experience and successful measures.

The Committee wished to re-emphasize the importance of studying the possible source, to rule out ongoing hidden transmission.

The Committee also emphasized the need for enhanced surveillance in regions outside Hubei, including pathogen genomic sequencing, to understand whether local cycles of transmission are occurring.

The Committee would welcome strong leadership to engage in the discussion about proportionality in control measures, particularly with regard to potentially damaging travel and trade restrictions.

WHO should continue to use its networks of technical experts to assess how best this outbreak can be contained globally.

WHO should provide intensified support for preparation and response, especially in vulnerable countries and regions.

Measures to ensure rapid development and access to potential vaccines, diagnostics, antiviral medicines and other therapeutics for low- and middle-income countries should be developed.

WHO should continue to provide all necessary technical and operational support to respond to this outbreak, including with its extensive networks of partners and collaborating institutions, to implement a comprehensive risk communication strategy, and to allow for the advancement of research and scientific developments in relation to this novel coronavirus.

WHO should continue to explore the advisability of creating an intermediate level of alert between the binary possibilities of PHEIC or no PHEIC, in a way that does not require reopening negotiations on the text of the IHR (2005).

The Director-General declared that the outbreak of 2019-nCoV constitutes a PHEIC, accepted the Committee’s advice and issued this advice as Temporary Recommendations under the IHR (2005).

To the People’s Republic of China

Continue to:

  • Implement a comprehensive risk communication strategy to regularly inform the population on the evolution of the outbreak, the prevention and protection measures for the population, and the response measures taken for its containment.
  • Enhance rational public health measures for containment of the current outbreak.
  • Ensure the resilience of the health system and protect the health workforce.
  • Enhance surveillance and active case finding across China.
  • Collaborate with WHO and partners to conduct investigations to understand the epidemiology and the evolution of this outbreak and measures to contain it.
  • Share full data on all human cases.
  • Strengthen the efforts to identify a zoonotic source of the outbreak, and particularly the potential for ongoing circulation with WHO as soon as it becomes available.
  • Conduct exit screening at international airports and ports, with the aim of early detection of symptomatic travelers for further evaluation and treatment, while minimizing interference with international traffic.

To all countries

It is expected that further international exportation of cases may appear in any country. Thus, all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO. Technical advice is available on the WHO website.

Countries are reminded that they are legally required to share information with WHO under the IHR (2005).

Countries should place particular emphasis on reducing human infection, prevention of secondary transmission and international spread, and contributing to the international response though multi-sectoral communication and collaboration and active participation in increasing knowledge on the virus and the disease, as well as advancing research.

The Committee acknowledged that, in general, evidence has shown that restricting the movement of people and goods during public health emergencies may be ineffective and may divert resources from other interventions. Further, restrictions may interrupt needed aid and technical support, may disrupt businesses, and may have negative effects on the economies of countries affected by the emergencies.

However, in certain specific circumstances, measures that restrict the movement of people may prove temporarily useful, such as in settings with limited response capacities and capabilities, or where there is high intensity of transmission among vulnerable populations.

In such situations, countries should perform risk and cost-benefit analyses before implementing such restrictions to assess whether the benefits would outweigh the drawbacks. Countries must inform WHO about any travel measures taken, as required by the IHR. Countries are cautioned against actions that promote stigma or discrimination, in line with the principles of Article 3 of the IHR.

The Committee asked the Director-General to provide further advice on these matters and, if necessary, to make new case-by-case recommendations, in view of this rapidly evolving situation.

To the global community

As this is a new coronavirus, and it has been previously shown that similar coronaviruses required substantial efforts to enable regular information sharing and research, the global community should continue to demonstrate solidarity and cooperation, in compliance with Article 44 of the IHR (2005), in supporting each other on the identification of the source of this new virus, its full potential for human-to-human transmission, preparedness for potential importation of cases, and research for developing necessary treatment.

Provide support to low- and middle-income countries to enable their response to this event, as well as to facilitate access to diagnostics, potential vaccines and therapeutics.

Under Article 43 of the IHR, States Parties implementing additional health measures that significantly interfere with international traffic (refusal of entry or departure of international travellers, baggage, cargo, containers, conveyances, goods, and the like, or their delay, for more than 24 hours) are obliged to send to WHO the public health rationale and justification within 48 hours of their implementation. WHO will review the justification and may request countries to reconsider their measures. WHO is required to share with other States Parties the information about measures and the justification received.

The Emergency Committee will be reconvened within three months or earlier, at the discretion of the Director-General.

The Director-General thanked the Committee for its work.

 

Coronavirus Outbreak – Is Barbados Becoming a Satellite of China?

This submission is timely with the Coronavirus in China. Nine million Chines in one region have been asked to evacuate. How worried should Barbados be about the virus? The blogmaster exercised license by inserting ‘Coronavirus’ in the title.
David, blogmaster

Submitted from and email addressee ‘is time to wake up’.

Today I listen to BBC and its report on the horrific conditions of Muslims in China who in large numbers are kidnapped , tortured and having their human rights violated.  I did an online investigation and talked to the few Chinese I know, to see if it is true. All reports independent of the oppressive government indicate that the government run Nazi type totalitarian concentration camps are true.  The Chinese in Barbados refuse to talk publically for fear of retribution but some outside of Barbados are talking up.  The current government of China does not want a society that is inclusive and have independent thought. Caribbean governments and people who benefit financially from the Chinese government turn a blind eye to the violation of human rights.

China’s Communist party is intensifying religious persecution as Christianity’s popularity grows. A new state translation of the Bible will establish a ‘correct understanding’ of the text. While China hasn’t established concentration camps for Christians as it has done for Muslims, it has harassed Christian congregations, closed and destroyed churches.

A previous Guyanese Ambassador to China secretly held Christian services in his embassy in Beijing. Do your own investigation in Guyana!  The Barbados previous ambassador to China in Beijing, had issue with the lack of rights to worship in the Christian faith as well as the smog in Beijing but he strongly coerced (ordered) by the Chinese to be the Barbadian Ambassador.  He did not want to be there.  Is Barbados a “Satellite of none” as Right Honorable Errol Barrow said  or  just willing to turn the blind eye to atrocities and doing anything for handouts. Do your own investigation in Barbados!