Iranian deal offers no relief to India on oil imports

Geneva, Jun 24: The global cumulative count of confirmed coronavirus cases is approaching nine million, with 133,326 cases recorded over the past day, the World Health Organisation (WHO) said in its daily situation report on Tuesday.

Over the past 24 hours, 3,847 people died from COVID-19 worldwide, taking the cumulative death toll to 469,587 fatalities, according to the report.

The global case total has now reached 8,993,659.

The Americas still account for the majority of cases and deaths -- 4.4 million and 224,207, respectively.

The United States remains the country with the highest count of cases and fatalities -- 2.3 million and 119,761, respectively.

Washington, Mar 29: The number of known coronavirus US cases soared well past 115,000, with more than 1,900 dead, as President Donald Trump said on Saturday he was considering imposing a quarantine on the hard hit New York region.

American healthcare workers in the trenches of the pandemic are appealing for more protective gear and equipment to treat a surge in patients that is already pushing hospitals to their limits in virus hot spots such as New York City, New Orleans and Detroit.

Trump told reporters he could order a quarantine on three states, New York, New Jersey and Connecticut, which between them have recorded at least 64,000 infections and 895 deaths.

He also appeared to soften his previous comments calling for the US economy to be swiftly reopened. Asked whether he thought the United States would restart by Easter Sunday, April 12, Trump replied, "We'll see, what happens."

New York Governor Andrew Cuomo said he had no details on any possible quarantine order for his state, telling a briefing: "I don't even know what that means. I don't know how that would be legally enforceable, and from a medical point of view I don't know what you would be accomplishing."

He said New York was postponing its presidential primary election to June 23, from April 28.

As the crisis deepened, nurses at Jacobi Medical Center in New York's borough of the Bronx protested outside the hospital on Saturday, saying supervisors asked them to reuse personal protective equipment, including masks. Some held signs with slogans including "Protect our lives so we can save yours."

"The masks are supposed to be one-time use," one nurse said, according to videos posted online. "Now, all of a sudden the CDC (Centers for Disease Control and Prevention) is saying that it's fine for us to reuse them. These choices are being made not based on science. They're being made based on need."

One resident at New York Presbyterian Hospital said they were issued with just one mask.

"This is your mask forever. You can bring it home with you. Here's how you can clean your mask," said the resident, who asked not to be named because he was not authorized to speak to the media. "It's not the people who are making these decisions that go into the patients' rooms."

Doctors are also especially concerned about a shortage of ventilators, machines that help patients breathe and are widely needed for those suffering from COVID-19, the pneumonia-like respiratory ailment caused by the highly contagious novel coronavirus.

Hospitals have also sounded the alarm about scarcities of drugs, oxygen tanks and trained staff.

By Saturday afternoon, the US number of cases stood at 115,842 with at least 1,929 deaths, according to a Reuters tally. The United States has had the most recorded cases of any country since its count of infections eclipsed those of China and Italy on Thursday.

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As shortages of key medical supplies abounded, desperate physicians and nurses were forced to take matters into their own hands.

New York-area doctors say they have had to recycle some protective gear, or even resort to bootleg suppliers.

Dr. Alexander Salerno of Salerno Medical Associates in northern New Jersey described going through a "broker" to pay $17,000 for masks and other protective equipment that should have cost about $2,500, and picking them up at an abandoned warehouse.

"You don't get any names. You get just phone numbers to text," Salerno said. "And so you agree to a term. You wire the money to a bank account. They give you a time and an address to come to."

Nurses at Mount Sinai Hospital in New York said they were locking away or hiding N95 respirator masks, surgical masks and other supplies that are prone to pilfering if left unattended.

"Masks disappear," nurse Diana Torres said. "We hide it all in drawers in front of the nurses' station."

One nurse at Westchester Medical Center, in the suburbs of the city, said colleagues have begun absconding with scarce supplies without asking, prompting better-stocked teams to lock masks, gloves and gowns in drawers and closets.

An emergency room doctor in Michigan, an emerging epicenter of the pandemic, said he was wearing one paper face mask for an entire shift due to a shortage and that hospitals in the Detroit area would soon run out of ventilators.

"We have hospital systems here in the Detroit area in Michigan who are getting to the end of their supply of ventilators and have to start telling families that they can't save their loved ones because they don't have enough equipment," the physician, Dr. Rob Davidson, said in a video posted on Twitter.

Sophia Thomas, a nurse practitioner at DePaul Community Health Center in New Orleans, where Mardi Gras celebrations late last month fueled an outbreak in Louisiana's largest city, said the numbers of coronavirus patients "have been staggering."

In the nation's second-largest city, Los Angeles Mayor Eric Garcetti said spiking cases were putting Southern California on track to match New York City's infection figures in the next week.

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.