China rakes up Doklam again, cautions India against more such incidents

Feb 26: China’s massive travel restrictions, house-to-house checks, huge isolation wards and lockdowns of entire cities bought the world valuable time to prepare for the global spread of the new virus.

But with troubling outbreaks now emerging in Italy, South Korea and Iran, and U.S. health officials warning Tuesday it’s inevitable it will spread more widely in America, the question is: Did the world use that time wisely and is it ready for a potential pandemic?

“It’s not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen — and how many people in this country will have severe illness,” said Dr. Nancy Messonnier of the U.S. Centers for Disease Control and Prevention.

Some countries are putting price caps on face masks to combat price gouging, while others are using loudspeakers on trucks to keep residents informed. In the United States and many other nations, public health officials are turning to guidelines written for pandemic flu and discussing the possibility of school closures, telecommuting and canceling events.

Countries could be doing even more: training hundreds of workers to trace the virus’ spread from person to person and planning to commandeer entire hospital wards or even entire hospitals, said Dr. Bruce Aylward, the World Health Organization’s envoy to China, briefing reporters Tuesday about lessons learned by the recently returned team of international scientists he led.

“Time is everything in this disease,” Aylward said. “Days make a difference with a disease like this.”

The U.S. National Institutes of Health’s infectious disease chief, Dr. Anthony Fauci, said the world is “teetering very, very close” to a pandemic. He credits China’s response for giving other nations some breathing room.

China locked down tens of millions of its citizens and other nations imposed travel restrictions, reducing the number of people who needed health checks or quarantines outside the Asian country.

It “gave us time to really brush off our pandemic preparedness plans and get ready for the kinds of things we have to do,” Fauci said. “And we’ve actually been quite successful because the travel-related cases, we’ve been able to identify, to isolate” and to track down those they came in contact with.

With no vaccine or medicine available yet, preparations are focused on what’s called “social distancing” — limiting opportunities for people to gather and spread the virus.

That played out in Italy this week. With cases climbing, authorities cut short the popular Venice Carnival and closed down Milan’s La Scala opera house. In Japan, Prime Minister Shinzo Abe called on companies to allow employees to work from home, while the Tokyo Marathon has been restricted to elite runners and other public events have been canceled.

Is the rest of the world ready?

In Africa, three-quarters of countries have a flu pandemic plan, but most are outdated, according to authors of a modeling study published last week in The Lancet medical journal. The slightly better news is that the African nations most connected to China by air travel — Egypt, Algeria and South Africa — also have the most prepared health systems on the continent.

Elsewhere, Thailand said it would establish special clinics to examine people with flu-like symptoms to detect infections early. Sri Lanka and Laos imposed price ceilings for face masks, while India restricted the export of personal protective equipment.

India’s health ministry has been framing step-by-step instructions to deal with sustained transmissions that will be circulated to the 250,000 village councils that are the most basic unit of the country’s sprawling administration.

Vietnam is using music videos on social media to reach the public. In Malaysia, loudspeakers on trucks blare information through the streets.

In Europe, portable pods set up at United Kingdom hospitals will be used to assess people suspected of infection while keeping them apart from others. France developed a quick test for the virus and has shared it with poorer nations. German authorities are stressing “sneezing etiquette” and Russia is screening people at airports, railway stations and those riding public transportation.

In the U.S., hospitals and emergency workers for years have practiced for a possible deadly, fast-spreading flu. Those drills helped the first hospitals to treat U.S. patients suffering from COVID-19, the disease caused by the virus.

Other hospitals are paying attention. The CDC has been talking to the American Hospital Association, which in turn communicates coronavirus news daily to its nearly 5,000 member hospitals. Hospitals are reviewing infection control measures, considering using telemedicine to keep potentially infectious patients from making unnecessary trips to the hospital and conserving dwindling supplies of masks and gloves.

What’s more, the CDC has held 17 different calls reaching more than 11,000 companies and organizations, including stadiums, universities, faith leaders, retailers and large corporations. U.S. health authorities are talking to city, county and state health departments about being ready to cancel mass gathering events, close schools and take other steps.

The CDC’s Messonnier said Tuesday she had contacted her children’s school district to ask about plans for using internet-based education should schools need to close temporarily, as some did in 2009 during an outbreak of H1N1 flu. She encouraged American parents to do the same, and to ask their employers whether they’ll be able to work from home.

“We want to make sure the American public is prepared,” Messonnier said.

How prepared are U.S. hospitals?

“It depends on caseload and location. I would suspect most hospitals are prepared to handle one to two cases, but if there is ongoing local transmission with many cases, most are likely not prepared just yet for a surge of patients and the ‘worried well,’” Dr. Jennifer Lighter, a pediatric infectious diseases specialist at NYU Langone in New York, said in an email.

In the U.S., a vaccine candidate is inching closer to first-step safety studies in people, as Moderna Inc. has delivered test doses to Fauci’s NIH institute. Some other companies say they have candidates that could begin testing in a few months. Still, even if those first safety studies show no red flags, specialists believe it would take at least a year to have something ready for widespread use. That’s longer than it took in 2009, during the H1N1 flu pandemic — because that time around, scientists only had to adjust regular flu vaccines, not start from scratch.

The head of the World Health Organization, Tedros Adhanom Ghebreyesus, said the U.N. health agency’s team in China found the fatality rate between 2% and 4% in the hard-hit city of Wuhan, the virus’ epicenter, and 0.7% elsewhere.

The world is “simply not ready,” said the WHO’s Aylward. “It can get ready very fast, but the big shift has to be in the mindset.”

Aylward advised other countries to do “really practical things” now to get ready.

Among them: Do you have hundreds of workers lined up and trained to trace the contacts of infected patients, or will you be training them after a cluster pops up?

Can you take over entire hospital wards, or even entire hospitals, to isolate patients?

Are hospitals buying ventilators and checking oxygen supplies?

Countries must improve testing capacity — and instructions so health workers know which travelers should be tested as the number of affected countries rises, said Johns Hopkins University emergency response specialist Lauren Sauer. She pointed to how Canada diagnosed the first traveler from Iran arriving there with COVID-19, before many other countries even considered adding Iran to the at-risk list.

If the disease does spread globally, everyone is likely to feel it, said Nancy Foster, a vice president of the American Hospital Association. Even those who aren’t ill may need to help friends and family in isolation or have their own health appointments delayed.

“There will be a lot of people affected even if they never become ill themselves,” she said.

Mar 3: Just hours after the ending of a week-long “reduction” in violence that was crucial for Donald Trump’s peace deal in Afghanistan, the Taliban struck again: On Monday, they killed three people and injured about a dozen at a football match in Khost province. This resumption of violence will not surprise anyone actually invested in peace for that troubled country. The point of the U.S.-Taliban deal was never peace. It was to try and cover up an ignominious exit for the U.S., driven by an election-bound president who feels no responsibility toward that country or to the broader region.

Seen from South Asia, every point we know about in the agreement is a concession by Trump to the Taliban. Most importantly, it completes a long-term effort by the U.S. to delegitimize the elected government in Kabul — and, by extension, Afghanistan’s constitution. Afghanistan’s president is already balking at releasing 5,000 Taliban prisoners before intra-Afghan talks can begin — a provision that his government did not approve.

One particularly cringe-worthy aspect: The agreement refers to the Taliban throughout  as “the Islamic Emirate of Afghanistan that is not recognized by the United States as a state and is known as the Taliban.” This unwieldy nomenclature validates the Taliban’s claim to be a government equivalent to the one in Kabul, just not the one recognised at the moment by the U.S. When read together with the second part of the agreement, which binds the U.S. to not “intervene in [Afghanistan’s] domestic affairs,” the point is obvious: The Taliban is not interested in peace, but in ensuring that support for its rivals is forbidden, and its path to Kabul is cleared.

All that the U.S. has effectively gotten in return is the Taliban’s assurance that it will not allow the soil of Afghanistan to be used against the “U.S. and its allies.” True, the U.S. under Trump has shown a disturbing willingness to trust solemn assurances from autocrats; but its apparent belief in promises made by a murderous theocratic movement is even more ridiculous. Especially as the Taliban made much the same promise to an Assistant Secretary of State about Osama bin Laden while he was in the country plotting 9/11.

Nobody in the region is pleased with this agreement except for the Taliban and their backers in the Pakistani military. India has consistently held that the legitimate government in Kabul must be the basic anchor of any peace plan. Ordinary Afghans, unsurprisingly, long for peace — but they are, by all accounts, deeply skeptical about how this deal will get them there. The brave activists of the Afghan Women’s Network are worried that intra-Afghan talks will take place without adequate representation of the country’s women — who have, after all, the most to lose from a return to Taliban rule.

But the Pakistani military establishment is not hiding its glee. One retired general tweeted: “Big victory for Afghan Taliban as historic accord signed… Forced Americans to negotiate an accord from the position of parity. Setback for India.” Pakistan’s army, the Taliban’s biggest backer, longs to re-install a friendly Islamist regime in Kabul — and it has correctly estimated that, after being abandoned by Trump, the Afghan government will have sharply reduced bargaining power in any intra-Afghan peace talks. A deal with the Taliban that fails also to include its backers in the Pakistani military is meaningless.

India, meanwhile, will not see this deal as a positive for regional peace or its relationship with the U.S. It comes barely a week after Trump’s India visit, which made it painfully clear that shared strategic concerns are the only thing keeping the countries together. New Delhi remembers that India is not, on paper, a U.S. “ally.” In that respect, an intensification of terrorism targeting India, as happened the last time the U.S. withdrew from the region, would not even be a violation of Trump’s agreement. One possible outcome: Over time the government in New Delhi, which has resolutely sought to keep its ties with Kabul primarily political, may have to step up security cooperation. Nobody knows where that would lead.

The irresponsible concessions made by the U.S. in this agreement will likely disrupt South Asia for years to come, and endanger its own relationship with India going forward. But worst of all, this deal abandons those in Afghanistan who, under the shadow of war, tried to develop, for the first time, institutions that work for all Afghans. No amount of sanctimony about “ending America’s longest war” should obscure the danger and immorality of this sort of exit.

Washington, May 30: The United States will end its relationship with the World Health Organization over the body’s handling of the coronavirus pandemic, U.S. President Donald Trump said on Friday, accusing the U.N. agency of becoming a puppet of China.

The move to quit the Geneva-based body, which the United States formally joined in 1948, comes amid growing tensions between Washington and Beijing over the coronavirus outbreak. The virus first emerged in China’s Wuhan city late last year.

Speaking in the White House Rose Garden, Trump said Chinese officials “ignored their reporting obligations” to the WHO about the virus - that has killed hundreds of thousands of people globally - and pressured the agency to “mislead the world.”

“China has total control over the World Health Organization despite only paying $40 million per year compared to what the United States has been paying which is approximately $450 million a year,” he said.

Trump’s decision follows a pledge last week by Chinese President Xi Jinping to give $2 billion to the WHO over the next two years to help combat the coronavirus. The amount almost matches the WHO’s entire annual program budget for last year.

Trump last month halted funding for the 194-member organization, then in a May 18 letter gave the WHO 30 days to commit to reforms.

“Because they have failed to make the requested and greatly needed reforms, we will be today terminating our relationship with the World Health Organization and redirecting those funds to other worldwide and deserving urgent global public health needs,” Trump said on Friday.

It was not immediately clear when his decision would come into effect. A 1948 joint resolution of Congress on U.S. membership of the WHO said the country “reserves its right to withdraw from the organization on a one-year notice.”

The World Health Organization did not immediately respond to a request for comment on Trump’s announcement. It has previously denied Trump’s assertions that it promoted Chinese “disinformation” about the virus.

“It’s important to remember that the WHO is a platform for cooperation among countries,” said Donna McKay, executive director of Physicians for Human Rights. “Walking away from this critical institution in the midst of an historic pandemic will hurt people both in the United States and around the world.”

‘ABSOLUTELY CRITICAL’

The United States currently owes the WHO more than $200 million in assessed contributions, according to the WHO website. Washington also gives several hundred million dollars annually in voluntary funding tied to specific WHO programs such as polio eradication, HIV, hepatitis and tuberculosis.

Amesh A. Adalja, a senior scholar at Johns Hopkins Center for Health Security, said that in practice Trump’s decision was unlikely to change the operations of the WHO.

“From a symbolic or moral standpoint it’s the wrong type of action to be taking in the middle of a pandemic and seems to deflect responsibility for what we in the U.S. failed to do and blame the WHO,” said Adalja.

When Trump halted funding to the WHO last month, two Western diplomats said the U.S. suspension was more harmful politically to the WHO than to the agency’s current programs, which are funded for now.

The WHO is an independent international body that works with the United Nations. U.N. Secretary-General Antonio Guterres said last month that the WHO is “absolutely critical to the world’s efforts to win the war against COVID-19.”

When asked about Trump’s decision, a U.N. spokesman said: “We have consistently called for all states to support WHO.”

Trump has long scorned multilateralism as he focuses on an “America First” agenda. Since taking office, he has quit the U.N. Human Rights Council, the U.N. cultural agency, a global accord to tackle climate change and the Iran nuclear deal. He has also cut funding for the U.N. population fund and the U.N. agency that aids Palestinian refugees.

“The WHO is the world’s early warning system for infectious diseases,” said U.S. Representative Nita Lowey, a Democrat who chairs the House Committee on Appropriations. “Now, during a global pandemic that has cost over 100,000 American lives, is not the time to put the country further at risk.”