Archive for Nicholas Veliotes

WELLNESS RETREAT AT HOME TO REFRESH, REVIVE, REJUVENATE THE MIND AND BODY


Seek stunning natural surroundings. Think lush foliage, quiet pools, nearby lakes, hills, etc. These natural environments help you relax and unwind.

DISCONNECT FOR INWARD FOCUS to unplug and recharge. When you unplug, you’re able to focus more on the present, whether it’s eating a delicious meal, getting a massage or going on a walk or hike.

ELIMINATE DISTRACTIONSE to allow you to turn your thoughts inwards. Try meditation, yoga or try another mindfulness practice. Sit in a quiet spot and just look at the sky. Having free time lets you really decompress and reconnect to what it is you really want.

“You control your Thoughts, which control your Feelings, determine your Actions, then dictate and control your Events

CLEANSE Try a detoxifying meal plan, packed with nutrient-rich vegetable and fruit juices, raw foods, fresh wheatgrass and essential oils to quickly cleanse the body of unwanted toxins and restore vital nutrients, reclaiming energy and enhanced mental processing.

REVITALIZE You will have time and energy for everything from fitness classes (zoom) to long walks, hikes, massages to swims.

MAKE NEW PATTERNS Include aerobic exercise into your daily routine, learning how to prepare raw foods, or creating a sustainable meal plan that fits your lifestyle.

COVID19 VACCINE

Development usually takes around five years. Once you pick a disease to target, you have to create the vaccine and test it on animals. Then you begin testing for safety and efficacy in humans.

Safety and efficacy are the two most important goals for every vaccine. Safety is exactly what it sounds like: is the vaccine safe to give to people? Some minor side effects (like a mild fever or injection site pain) can be acceptable, but you don’t want to inoculate people with something that makes them sick.

Efficacy measures how well the vaccine protects you from getting sick. Although you’d ideally want a vaccine to have 100 percent efficacy, many don’t. For example, this year’s flu vaccine is around 45 percent effective.

To test for safety and efficacy, every vaccine goes through three phases of trials:

  • Phase one is the safety trial. A small group of healthy volunteers gets the vaccine candidate. You try out different dosages to create the strongest immune response at the lowest effective dose without serious side effects.
  • Once you’ve settled on a formula, you move onto phase two, which tells you how well the vaccine works in the people who are intended to get it. This time, hundreds of people get the vaccine. This cohort should include people of different ages and health statuses.
  • Then, in phase three, you give it to thousands of people. This is usually the longest phase, because it occurs in what’s called “natural disease conditions.” You introduce it to a large group of people who are likely already at the risk of infection by the target pathogen, and then wait and see if the vaccine reduces how many people get sick.

After the vaccine passes all three trial phases, you start building the factories to manufacture it, and it gets submitted to the WHO and various government agencies for approval.

For COVID-19, financing development is not an issue. Governments and other organizations (including our foundation and an amazing alliance called the Coalition for Epidemic Preparedness Innovations) have made it clear they will support whatever it takes to find a vaccine. 

So, scientists are able to save time by doing several of the development steps at once. For example, the private sector, governments, and our foundation are going to start identifying facilities to manufacture different potential vaccines. If some of those facilities end up going unused, that’s okay. It’s a small price to pay for getting ahead on production.

Fortunately, compressing the trial timeline isn’t the only way to take a process that usually takes five years and get it done in 18 months. 

Another way we’re going to do that is by testing lots of different approaches at the same time.

There are dozens of candidates in the pipeline.

As of April 9, there are 115 different COVID-19 vaccine candidates in the development pipeline.

Covid-19 Pandemic

The coronavirus disease (COVID-19) pandemic has created a mass casualty disaster of staggering proportions. By April 2020, the novel coronavirus responsible for COVID-19 had forced many parts of the United States into crisis mode, while others race to prepare for the inevitable. In regions where the case numbers have not yet begun to climb, disaster planning teams have time to prepare for a crisis response and implement lessons learned from those who were impacted earlier. The goal is the greatest good for the greatest number of people, so hospitals and health care systems are turning the focus from individual health to population health in their disaster surge response to save as many lives as possible.    

Mass casualty incidents (MCIs) can be man-made acts of violence, such as mass shootings, bioterrorism, or exploding bridges, or natural disasters in the form of earthquakes, tornados, tsunamis, and pandemics. Tragedies of intentional violence or infrastructure disasters create a sudden surge, demanding a rapid shift in a hospital’s daily routine, and are usually limited geographically—for example, the site of an active shooter or a train derailment. Natural disasters, however, cover much larger regions (i.e., the path of a tornado), whereas, by definition, pandemics know no boundaries.

One key variable in these disasters is time. Time, in most cases, determines our ability to prepare for and maintain a disaster response. In trauma MCIs, there is a window of time when patients arrive to local hospitals, which is often measured in minutes to hours. In the case of bioterrorism or pandemics, timelines are prolonged, measured in days to weeks. Regarding the ongoing COVID-19 pandemic, the window of time is indefinite and unknown. The disruption of a hospital’s daily routine for prolonged periods of time and the need for resources beyond those available, or worse, outstrips the supply chain, placing severe strain on the health care system. Our best tools to manage these challenges are preparation, planning, and practice.  

Preparation and planning take place from the federal and state levels to the community and local health care facility levels. Community planning should be coordinated with local governmental agencies, in accordance with state and federal disaster planning efforts, and integrated with local public health and emergency medical services. With respect to pandemics, community strategies must make every effort to “flatten the curve” in order to break the chain of transmission and slow the spread of infections. At the same time, hospital system strategies “raise the roof” of surge response by increasing health care system capacity (Fig. 1) through predesigned efforts focused on three factors: space, staff, and supplies. The hospital system is the backbone of these three elements.  

Figure 1

Community efforts to “flatten the curve” of coronavirus infections often intersect with health care system strategies to “raise the roof” for patient capacity (modified from Disaster Med Public Health Prep with permission from the Society for Disaster Medicine and Public Health).

Strategies for increasing health care system capacity will include conservation and substitution during a conventional response, adaptation and recycling during a contingency response, and, finally, reallocation of resources during a crisis response—essentially, withholding resources from one patient population to use them more effectively on another patient population. These “raise the roof” strategies involve nuanced ethical and legal considerations that must be addressed in advance, authorized by hospital leadership, and communicated clearly to frontline health care workers.

System

Ultimately, the hospital system component directs the response that determines the allocation of the three critical resources of space, staff, and stuff, which are based on supply and demand.

A robust hospital incident command system provides broad management for a multitude of issues, including: hospital controls (facility access, ventilation), communication (internal and external), community coordination (health care facilities, state and federal agencies, as well as utilities and supply chains), and continuity of emergency health care operation (vis-à-vis utility or other system failures). The hospital incident command should also determine and communicate which disaster response is being utilized. Disaster response can be described, in escalating intensity, as conventional, contingency, and crisis, dependent on surge severity and resource availability. The more severe the surge, the fewer the resources; the lower the hospital’s capacity to take care of victims, the more quickly the disaster response must shift into a higher mode (Fig. 2). 

Figure 2

As the hospital incident command system escalates the intensity of disaster response—from conventional to contingency to MCI—the minimum acceptable standard of care for patients is diminished (modified from Disaster Med Public Health Prep with permission from the Society for Disaster Medicine and Public Health).

Space

Upon declaration of an MCI, efforts must be made to free up physical space for patients. The size and nature of the disaster will dictate the scope and speed necessary. 

The conventional response is for surges causing a 20% increase in patients beyond normal capacity. In this situation, all staffed beds are made available and filled. Elective procedures are postponed or cancelled, and patient discharge plans are activated to dedicate more space and empty beds to the surge.

A contingency response is used for surges that are twice a hospital’s capacity and demands more aggressive actions. As the numbers of patients greatly exceed the available hospital and critical care beds, hospital spaces designed for other purposes, including step-down units, observation units, and procedure suites, can be repurposed to recruit more space to bed patients. Transferring patients to other available facilities for ongoing, nonemergent care can be initiated.

A crisis situation completely overwhelms a health care facility. Patients fill hallways, and makeshift spaces, such as tents and offices, need to be devised. Erecting tent hospitals with intensive care units in city parks, converting convention centers into field hospitals, and docking of the United States Naval Ship (USNS) Comfort in Manhattan and USNS Mercy in Los Angeles are evidence that our nation is in crisis because of the COVID-19 pandemic.

Staff

As more space becomes available, achieving appropriate staffing and obtaining adequate supplies for the surge of patients is vital. The hospital incident command system should be convened for action as soon as a disaster is declared to urgently alert and mobilize necessary staff. The type of injuries that are expected (e.g., blunt trauma, penetrating trauma, or biological agent) will determine the type of staff best suited to respond. If staffing levels are insufficient, measures to increase staffing may be warranted, including expanding the scope of responsibilities, lengthening shifts, and enlarging patient-to-nurse ratios.  

In a conventional response, trained and credentialed staff are able to care for patients with minor modifications, while maintaining usual standards of care.

The standard of care is challenged in a contingency response, as adequately trained staff must train and supervise off-service staff to safely provide care. Bringing in additional staff should be considered, and outside staff need to be given emergency privileges and credentialing.     

A crisis response demands staff to perform clinical functions outside their usual domain. Aggressive staff recruitment and rapid training are necessary to meet the patient care demands and volume. During crisis mode, triage becomes necessary to ensure that acceptable care is provided for the largest number of people. Over- and under-triage can result in higher mortality rates. 

Supplies (“Stuff”)

Supplies include medications, medical equipment, and personal protective equipment (PPE). Considerations must also be made for laboratory reagents, diagnostic testing, as well as for food, water, and linens.

The hospital system must be aware of onsite and offsite supply storage and availability through supply chains. The ability to adapt, reuse, and reallocate becomes necessary in both contingency and crisis situations.

In the current COVID-19 pandemic, we are witnessing contingency and crisis responses. Hospitals are experiencing severe shortages of ventilators and PPE, meaning patients may be deprived of life-saving care and health care providers are likely to be infected with dire, cascading ramifications.

Radiology Department Response

A departmental incident command team should be in place to implement a disaster management plan and engage in clear and consistent communication. The radiology department must have containment and mitigation strategies that ensure the safety of all staff and patients being imaged. For COVID-19, these measures include ensuring adequate PPE, especially for frontline technicians performing imaging studies, enforcing physical distancing, and limiting in-person interactions. Remote reading should be instituted, where possible. Decontamination protocols must be defined and executed. Nonemergent studies should be halted, including interventional procedures, to preserve PPE and limit exposure.

All real-time changes to address incident-specific issues should be frequently updated and communicated. Implementing these types of measures allows radiology departments to provide safe and appropriate care during surges and helps to ensure sustainable operations.

The lessons we learn from responses nationally and internationally should be incorporated into our hospital and departmental MCI and disaster planning process. Our ability to plan and prepare by focusing on system, space, staff, and stuff will make all the difference in the number of lives saved.

Public use of surgical masks to slow COVID-19




In laboratory experiments, the masks significantly reduced the amounts of various airborne viruses coming from infected patients, measured using the breath-capturing “Gesundheit II machine” developed by Dr Don Milton, a professor of applied environmental health at the University of Maryland and a senior author of the study. Milton has already conferred with federal and White House health officials on the findings, which closely follow statements from the head of the US Centres for Disease Control and Prevention saying the agency was reconsidering oft-stated advice that surgical masks aren’t a useful precaution outside of medical settings. (The debate takes place at a time when clinicians themselves face dangerously inadequate supplies of masks – a shortfall other UMD researchers are scrambling to help solve.)

The question of masks has roiled society as well, with some retailers refusing to let employees wear them for fear of sending negative signals to customers, and cases of slurs and even physical attacks in the US and elsewhere against Asians or Asian Americans who were wearing masks, a measure some consider a necessity during a disease outbreak.

The study, conducted prior to the current pandemic with a student of Milton’s colleagues on the faculty of medicine at the University of Hong Kong, does not address the question of whether surgical masks protect wearers from infection. It does suggest that masks may limit how much the infected – who in the case of the novel coronavirus often don’t have symptoms – spread diseases including influenza, rhinoviruses and coronaviruses. Milton, who runs the Public Health Aerobiology, Virology, and Exhaled Biomarker Laboratory in the School of Public Health, demonstrated in a 2013 study that surgical masks could help limit flu transmission. However, he cautions that the effect may not be as great outside of controlled settings.

Nevertheless, he said, the chance they could help justifies taking a new look at whether all people should be encouraged to wear them when they venture out of their houses to stores or other populated locations during the current COVID-19 lockdown.

“In normal times we’d say that if it wasn’t shown statistically significant or the effective in real-world studies, we don’t recommend it,” he said. “But in the middle of a pandemic, we’re desperate. The thinking is that even if it cuts down transmission a little bit, it’s worth trying.”

Previous studies have shown that coronavirus and other respiratory infections are mostly spread during close contact, which has been interpreted by some infectious disease specialists to mean that the disease could spread only through contact and large droplets, such as from a cough or sneeze – a message that has often been shared with the public.

“What they don’t understand is that is merely a hypothesis,” Milton said. The current study (along with earlier ones) shows, by contrast, that tiny, aerosolized droplets can indeed diffuse through the air. That means it may be possible to contract COVID-19 not only by being coughed on, but by simply inhaling the breath of someone nearby who has it, whether they have symptoms or not. Surgical masks, however, catch a lot of the aerosolized virus as it’s exhaled, he said.

The study was conducted at the University of Hong Kong as part of the dissertation research of the lead author, Dr Nancy Leung, who, under the supervision of the co-senior authors Drs Cowling and Milton, recruited 246 people with suspected respiratory viral infections. Milton’s Gesundheit machine compared how much virus they exhaled with and without a surgical mask.

“In 111 people infected by either coronavirus, influenza virus or rhinovirus, masks reduced detectable virus in respiratory droplets and aerosols for seasonal coronaviruses, and in respiratory droplets for influenza virus,” Leung said. “In contrast, masks did not reduce the emission of rhinoviruses.”

Although the experiment took place before the current pandemic, COVID-19 and seasonal coronaviruses are closely related and may be of similar particle size. The report’s other senior author, Professor Benjamin Cowling, division head of epidemiology and biostatistics, School of Public Health, HKUMed, and co-director of the World Health Organisation Collaborating Centre for Infectious Disease Epidemiology and Control, said, “The ability of surgical masks to reduce seasonal coronavirus in respiratory droplets and aerosols implies that such masks can contribute to slowing the spread of (COVID-19) when worn by infected people.”

Milton pointed to other measures his research has found is even more effective than masks, such as improving ventilation in public places like grocery stores, or installing UV-C lights near the ceiling that works in conjunction with ceiling fans to pull air upwards and destroy viruses and bacteria.

“Personal protective equipment like N95 masks are not our first line of defence,” Milton said. “They are our last desperate thing that we do.” Hong Kong University contributed to this report.

Coronaviruses and Acute Respiratory Syndromes (COVID-19, MERS, and SARS)


Coronaviruses are enveloped RNA viruses that cause respiratory illnesses of varying severity from the common cold to fatal pneumonia. 

Numerous coronaviruses, first discovered in domestic poultry in the 1930s, cause respiratory, gastrointestinal, liver, and neurologic diseases in animals. Only 7 coronaviruses are known to cause disease in humans. 

Four of the 7 coronaviruses most frequently cause symptoms of the common cold

Coronaviruses 229E and OC43 cause the common cold; the serotypes NL63 and HUK1 have also been associated with the common cold. 

Rarely, severe lower respiratory tract infections, including pneumonia, can occur, primarily in infants, older people, and the immunocompromised.

Three of the 7 coronaviruses cause much more severe, and sometimes fatal, respiratory infections in humans than other coronaviruses and have caused major outbreaks of deadly pneumonia in the 21st century:


  • SARS-CoV2 is a novel coronavirus identified as the cause of coronavirus disease 2019 (COVID-19) that began in Wuhan, China in late 2019 and spread worldwide.

  • MERS-CoV was identified in 2012 as the cause of Middle East respiratory syndrome (MERS).

  • SARS-CoV was identified in 2002 as the cause of an outbreak of severe acute respiratory syndrome (SARS).

These coronaviruses that cause severe respiratory infections are zoonotic pathogens, which begin in infected animals and are transmitted from animals to people.

COVID-19 is an acute, sometimes severe, respiratory illness caused by a novel coronavirus SARS-CoV2.

COVID-19 was first reported in late 2019 in Wuhan, China and has since spread extensively in China and worldwide. 

Transmission of COVID-19

Early COVID-19 cases were linked to a live animal market in Wuhan, China, suggesting that the virus was initially transmitted from animals to humans. 

Person-to-person spread occurs through contact with infected secretions, mainly via contact with large respiratory droplets, but it could also occur via contact with a surface contaminated by respiratory droplets. 

Researchers are still learning how readily this virus spreads from person to person or how sustainable infection will be in a population, although it appears more transmissible than SARS and spread is probably more similar to that of influenza.

Super-spreaders played an extraordinary role in driving the 2003 SARS outbreak and may also play a significant role in the current COVID-19 outbreak. 

A super-spreader is an individual who transmits an infection to a significantly greater number of other people than the average infected person. 

Quarantine and isolation measures are being applied in an attempt to limit the local, regional, and global spread of this outbreak.

Symptoms and Signs

People with COVID-19 may have few to no symptoms, although some become severely ill and die. Symptoms can include fever, cough, and shortness of breath. 

Those with more severe disease may have lymphopenia and chest imaging findings consistent with pneumonia. 

The exact incubation time is not certain; estimates range from 1 to 14 days. The risk of serious disease and death in COVID-19 cases increases with age.

Symptoms and signs reference


1. Centers for Disease Control and Prevention: Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 69:343-346, 2020. doi: 10.15585/mmwr.mm6912e2external icon.

Diagnosis


Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing of upper and lower respiratory secretions.

Diagnostic testing for COVID-19 is being made available to select laboratories authorized by the Federal Drug Administration under an Emergency Use Authorization (EUA). 

Clinicians can also access laboratory testing through public health laboratories in their jurisdictions.

For initial diagnostic testing for COVID-19, the CDC recommends collecting and testing a single upper respiratory nasopharyngeal swab. 

Collection of only oropharyngeal swabs is acceptable if other swabs are not available. 

The CDC also recommends testing lower respiratory tract specimens, if available. 

For patients for whom it is clinically indicated (eg, those receiving invasive mechanical ventilation), a lower respiratory tract aspirate or bronchoalveolar lavage sample should be collected and tested as a lower respiratory tract specimen. 

Collection of oropharyngeal swabs is a lower priority and if collected should be combined in the same tube as the nasopharyngeal swab. 

Collection of sputum should be done only for those patients with productive coughs. Induction of sputum is not recommended. 

Specimens should be collected as soon as possible, regardless of the time of symptom onset. 

Maintain proper infection control when collecting specimens. 

For biosafety reasons, the CDC recommends local institutions do not attempt to isolate the virus in cell culture or do initial characterization of viral agents in patients suspected of having COVID-19 infection.

Because of the increasing availability of test kits in the US, previous restrictions on patient selection for testing are being relaxed, and testing is expanded to a wider group of symptomatic patients. 

Clinicians should use their judgment as to whether a patient’s symptoms and signs are compatible with COVID-19 and whether they should be tested. 

Decision to test should also take into account the local epidemiology of COVID-19, the course of illness, and the patient’s epidemiologic factors such as close contact with a confirmed COVID-19 case within 14 days of symptom onset or history of travel to an affected geographic area within 14 days of symptom onset. 

Clinicians are also strongly encouraged to test for other causes of similar respiratory illness (eg, influenza). 

Areas of sustained transmission will vary as the outbreak proceeds. For areas inside the US, clinicians should consult state or local health departments. 

For countries outside the US, affected areas as of March 5, 2020 include China, Iran, Italy, Japan, and South Korea.

If any of these criteria are present, infection control personnel at the healthcare facility and the local or state health department should be notified immediately.

Treatment


Supportive Treatment of COVID-19 is supportive. No vaccine, antiviral drug, or other specific treatment is available.

To help prevent spread from suspected cases, health care practitioners should use standard, contact, and airborne precautions with eye protection.

Why Greece Succeeded as Italy, Spain Failed to Tackle Coronavirus

When the covid-19 pandemic broke out in Europe, no government had any experience of how to face it and each tried to weather the storm in its own ways. Some governments fared better, some less so.

By and large, there are three major factors that have determined, and still do, how governments cope with the virus.

These are, first, the resoluteness and efficiency of their leadership; second, the capacity of states and public health systems in particular to deal with such an extraordinary health crisis situation; and, third, the cooperation of national publics in following emergency rules.

At a more specific level, as shown by an even cursory comparison of the Spanish and Greek experiences with the pandemic, it seems that a well-integrated and liberal government performs significantly better than one which is disunited and, moreover, diluted with populists. Let’s have a closer look at the two cases.

At the time of this writing (5 April 2020), Spain has close to 130,000 confirmed cases of coronavirus victims and about 12,000 deaths. At the same time, Greece has about 1,700 confirmed cases and 68 deaths.

So, the question is: Why these two Mediterranean countries, whose people are equally sun-loving, bar-hopping, and intensely social, and which should have drawn the same lessons from Italy’s preceding experience, have had such different fates during the early phase of the coronavirus crisis? The answer is simple, almost mundane: Different governments!

The little comparison table below shows the reaction of Italy, Spain, and Greece to the coronavirus outbreak. It reveals three things.

First of all, Italy, the first country in Europe to be hit by the virus with catastrophic results, offered valuable lessons that shouldn’t be missed by other governments.

Secondly, Spain’s government failed to learn and, in fact, performed even worse than Italy.

And, finally, among these countries, Greece is by far the best performer in confronting the pandemic, at least so far.

It certainly helped, of course, that Greece has a centralized state administration system which, unlike in Spain or Italy, facilitates the fast implementation at regional and local levels of decisions taken at top state level. But this explains only part of the different reactions to the pandemic in Spain and Greece. Let’s have a closer look beginning with the case of Italy, which served as a backdrop against which the Spanish and Greek governments made their decisions.

table_pappas.jpg

Italy, indeed, offered early valuable lessons to any government that was willing to learn. Coronavirus was confirmed there on 31 January, when a traveling Chinese couple, originally from Wuhan, China, tested positive in Rome. In the next three weeks, more cases of infection were confirmed in the northern regions of Lombardy and Veneto and, on 22 February, the first death from the coronavirus was reported.

From there on, the number of deaths in Italy went into an upward spiral. By 5 March, as the number of the deceased had reached one hundred, the government shut down all schools and universities nationwide.

On 8 March, with confirmed cases approaching 6,000, Prime Minister Giuseppe Conte extended the quarantine lockout to all of Lombardy and other northern provinces, which, at the time, was the most radical measure to combat the virus taken anywhere outside China. On 10 March, the government expanded the quarantine to all of Italy and ordered Italians to stay at home.

From the first confirmed case, it took the Italian government 38 days (and 16 days since the first death) before it imposed a first nationwide lockdown. It was, unfortunately, too late. A few days later, on 19 March, Italy became the country with the highest number of confirmed deaths in the world.

Clearly, then, the chief lesson from Italy was that governments elsewhere would need to react early and take most aggressive measures in order to check the pandemic. But the reactions of the governments in Spain and Greece couldn’t differ more than they actually did. And that had very different consequences in each of these two countries.

Spain, first, was reluctant to learn from Italy. “We are going to have only a handful of cases,” asserted on 9 February Dr. Fernando Simón, an epidemiologist serving as the head of medical emergencies in Madrid. Even as the number of confirmed cases of coronavirus continued to increase, the Spanish government still resisted to take mitigating steps so as to combat the virus spread; in fact, it initially defended the decision to let mass gatherings go on.

On 8 March, about 120,000 people were allowed to march through the center of Madrid to celebrate the international Women’s Day and some 60,000 soccer fans filled one of the city’s stadiums. During that same weekend, 9,000 supporters of Vox, an upcoming right-wing party, gathered inside a former bullring.

By Friday, 13 March , Spain already had the second highest number of coronavirus infections of any European country after Italy, now facing the fastest spreading contagion on the continent and an already overwhelmed health care system. Two ministers of Sánchez’s cabinet, including Irene Montero, the partner of Deputy Premier Pablo Iglesias and one who had participated in the women’s march, tested positive. Another prominent victim of the virus was Santiago Abascal, the leader of Vox.

It was only then, on 13 March, one full month after the first death from the virus was reported (13 February) and with the tally of deaths at 189, that the government decided to close all schools and declare a state of emergency across the country. Why all this was let to happen?

For one thing, it didn’t help that Prime Minister Pedro Sánchez leads a leftist minority government that only formed with difficulty after the inconclusive elections in November 2019.

In the aftermath of that contest, Sánchez, leader of the center-left PSOE, and Pablo Iglesias, leader of left populist Unidas Podemos, formed an alliance which subsequently produced Spain’s first coalition government since its transition to democracy. The new government, consisting of the prime minister, four deputy prime ministers and 22 ministers, formed on 13 January 2020.

Nor did it help that Podemos as a populist party has thrived on political polarization, often militated against the legality of Spain’s institutions for allegedly failing to serve the people’s interests, and typically opposes technocracy and the expert knowledge stemming from it. All that played at the level of micro-politics with disastrous consequences.

Friday, 13 March, was a critical moment. Sánchez announced his intention to enact emergency measures and decree a state of alarm across all the country on the following day. But things went awfully wrong.

The coalition government’s Council of Ministers, which was meant to include only ministers considered essential for responding to the crisis, was marred by intense infighting . Pablo Iglesias, who was supposed to be in quarantine after his partner had tested positive for the virus, appeared unexpectedly to the Council objecting the concentration of powers under the ministries of interior, defense, transport, and health, all headed by PSOE politicians, and demanding that his party be given prominent roles in the national emergency situation.

He also insisted that the government takes social measures for helping poor families, such as paying rents and mortgages. According to El País , the minister of finance rejected the proposal for the high cost it involved amid a developing economic crisis.

The Council of Ministers meeting lasted eight hours and ended with acrimony on both sides with dire consequences for the country. It first of all delayed the implementation of lockdown and other emergency measures, and also led to cancelling a teleconference planned for the same day between Sánchez and the leaders of Spain’s regional governments.

Even worse, since all that happened on a sunny Saturday, several people from Madrid and other big cities left for the regions, bringing the virus with them. One such case was José María Aznar, Spain’s former conservative prime minister, who moved to his holiday villa in the rich resort of Marbella, fueling public anger against him and the government alike.

Meantime, as the death toll keeps rising, Spain’s fissured coalition government utterly failed to rally the opposition parties on its side for creating a unified front against the pandemic. Pablo Casado, the leader of the center-right People’s Party, accused prime minister Sánchez for spreading lies and misinformation, while ultra-right Vox called for Sánchez’s resignation and replacement by a government of national unity.

To make things even worse, most of the regional governments, especially in separatist Catalonia, miss no chance to show their displeasure with the incompetence of, and health crisis mismanagement by, the central state administration.

How different from Spain was the reaction to the coronavirus pandemic in the other Mediterranean country, Greece!

For starters, the effect of the virus in Greece was a particularly big setback since the country was just coming out of years of recession and recent projections for its economic future were quite optimistic.

But Greece’s government was quick to learn from Italy and Spain, and act decisively and swiftly, despite having to simultaneously face additional difficulties.

In February, Turkey ignited a refugee crisis by opening its border with Greece to Europe and aiding thousands of displaced persons to cross it. Greece responded by strengthening the border with soldiers and armed police, soliciting the support of her EU partners, and by refusing to accept asylum applications for a period of one month. The situation at the border remained tense during most of March, which diverted part of the Greek government’s attention to that crucial front.

Another problem was the cramped living conditions in refugee camps in both Greece’s islands and the mainland. And yet, the government’s response to the coronavirus outbreak was nearly outstanding as it determined to reduce the spread of the virus within the country and flatten the curve as early as possible in the hope that the long-term effects on both the society and the economy could be minimized. Here’s what happened in Greece, in brief.

The first case in Greece of a person to test positive – a woman who had recently traveled to Milan – was reported on 26 February and, on the following day, two more cases were confirmed.

That same day, Greece’s minister of health cancelled all planned carnival events throughout the country and the government banned all educational trips abroad.

Only thirteen days later, on 10 March, with the number of confirmed cases totaling 89 and no deaths, the government closed all daycare centers, schools, and universities nationwide.

On 11 March, Prime Minister Kyriakos Mitsotakis, in a nationally televised address, urged the public to follow the instructions of doctors and other experts, and admonished the Church to refrain from delivering the “holy communion” and instead cooperate with the state authorities in enforcing the public health regulations.

On 12 March, the first death from coronavirus was reported in Greece. In the few days to follow, the government shut down theaters, cinemas, restaurants, bars, shopping centers, playgrounds, museums, courthouses, parks, recreational areas, marinas, organized beaches and ski resorts; it only excluded supermarkets, pharmacies and food outlets.

Eventually, the government suspended all religious services, including the Sunday masses of the Greek Orthodox church, and also announced the closure of most hotels in the country and subjected all Greek citizens returning from abroad to mandatory 14-day quarantine.

During March, the Geek prime minister gave five nationally televised addresses (on 11, 17, 19, 22 and 25 March), every time explaining to the Greek people the development of the situation and asking them to comply to the new rules.

The government’s infectious disease spokesman, epidemiologist Sotiris Tsiodras, goes on TV every afternoon to both brief journalists and offer advise to the citizens. As of Greece’s significant opposition parties, they all showed an admirable sense of social responsibility, political moderation, and even readiness to support the government in its difficult decisions during crisis.

The major moral from the different stories of pandemic prevention in Spain and Greece is that governments matter a lot.

More specifically, they need to set aside their political compulsion and listen to experts and other technocrats; they must act early and swiftly; and they should be efficient in making working trade-offs with the society at large, various economic interest groups, and, perhaps more importantly, the political opposition.

So far, Spain’s government has unfortunately failed in all these areas with enormous cost for the Spanish society. And the Greek government gets all credit due for its success in preventing the wild spread of the virus and minimizing the suffering Greek society would otherwise have to endure.

Coronavirus Test For World Leaders

We often learn the most about leadership by observing our leaders in times of crisis. As world leaders attempt to contain the rapid spread of COVID-19, they must simultaneously perform two opposing and difficult tasks—prepare their countries for significant risk and avoid inciting panic.

What we’re seeing as a result is multiple test cases in crisis leadership, as several different countries face similar versions of the same problem and react with noticeably different approaches and results. 

Focusing on the COVID-19 response in three continents—specifically examining China, Italy and the United States—there are clear takeaways and learnings on different aspects of the response to and management of the outbreak. These lessons are not only helpful to other countries as they manage their COVID-19 responses, but they also provide valuable examples for leaders in any field.

China shows limits of command and control and benefits of decisive action 

Even before the COVID-19 outbreak, the Chinese government has been widely reported to have significant capacity for control, using vast state authority and a significant surveillance program. As the origin point of COVID-19, the Chinese government’s effort to control the virus has been watched by the entire world.

China responded with what the World Health Organization called “perhaps the most ambitious, agile and aggressive disease containment effort in history,” including closing down manufacturing sectors, sharing information widely, executing mass testing and quarantining millions of people. The Chinese government made the decision to absorb a significant short-term economic cost to contain COVID-19 rather than potentially lose control. It seems to be working as the number of new cases has steadily decreased in recent weeks and people are getting back to work and factories are ramping up.

This is an example of the benefit of command and control leadership and decisive action to immediately consolidate efforts into an aggressive response.

However, it’s worth considering the erosion of trust this type of system creates. The Atlantic documented the ways in which local Chinese officials underreported the spread of COVID-19 to the federal government, as the Wuhan province failed to report the outbreak until weeks after it began and downplayed the likelihood of human transmission until whistleblowers stepped forward—and were subsequently punished. This delay cost China valuable time in containing the initial outbreak.

When people are afraid to come forward to tell the truth and are discouraged from speaking up, critical information often does not reach leadership until the problem has intensified. While it cannot be known for sure, the COVID-19 outbreak may have been contained earlier had early warnings been escalated.

Italy demonstrates peril of slow response and lack of coordination 

The epicenter of COVID-19 in Europe has been Italy, which saw a rapid increase of cases over the past two weeks—the number of cases even jumped by 50 percent in a single day on March 1.

In part because the outbreak in Italy intensified so quickly, there was a lack of consistency in the Italian government’s response. CNN reported that Italian Prime Minister Giuseppe Conte acknowledged a “not entirely proper,” management of a North Italy hospital helped contribute to the outbreak. Even as the virus spread, the Italian government and tourism heads tried to convey that everything was under control and that it was business as usual, encouraging tourists not to cancel their visits.

Just two days later, Italy drastically scaled up their response, shutting down schools, sporting events and tourism sites, following China’s example. Then, this week, Italy took quarantine measures nationally, effectively placing the entire country in lockdown. These rapidly different and changing messages coming from the Italian government have created confusion and frustration for both citizens and tourists.

The lesson is clear—in a crisis, leaders can create panic and distrust when they rapidly change their messaging. It seems the country’s officials underestimated the potential spread of the virus and various groups and stakeholders were not acting in coordination. When significant problems arise, leaders must be careful to avoid saying something they will end up contradicting later.

The United States tries to control the narrative

The United States’ exposure to COVID-19 has been comparatively limited, but the threat is increasing by the day and the country is on high alert and preparing for the worst. The Center for Disease Control (CDC) has been cautioning Americans to prepare for a potential outbreak since February 25, and Vice President Mike Pence has been tasked with leading the government’s coordinated response.

Even President Donald Trump’s allies would likely admit that this challenge is out of step with his leadership tendencies. President Trump likes to control the narrative surrounding his administration and tries to avoid unfavorable press coverage. This causes him to downplay issues to win the PR battle, as he did in late February in response to a sudden stock market downturn.

Trump has shown a tendency during difficult situations to rely heavily on his inner circle, including his son in law, rather than subject matter experts and to state opinions as facts. This has created several situations where he has contradicted experts on his own task force attempting to educate the public, most notably by consistently overstating the scientifically acknowledged timeline to create a vaccine.

Trump has also questioned the reported fatality rate of the virus, saying in an interview “I think the 3.4 percent [number] is really a false number,” without providing a factual basis for his own assessment or “hunch”. This does not inspire trust and confidence with the masses.

In business, attempting to control the narrative is a common way to respond to public adversity, and it can work when there is not a large divergence from the underlying facts. Just as a leader of a struggling startup might do, the American government has attempted to alleviate concerns and assure Americans COVID-19 has already been contained, when it’s becoming clearer by the day that is not the case. 

However, the virus does not respond to public perception. While the future of COVID-19 in America is unclear, if the virus follows the same pattern of escalation as in China and Italy, there will likely be a lot of criticism of the President’s initial response.

Crisis management is perhaps the most difficult test for leaders. This is especially true for a case like COVID-19, which does not have a comparable historical precedent or solution and where the threat is evolving constantly.

Leaders in all fields can learn from countries’ responses: problems are best preempted in environments of trust and transparency, challenges are best faced with cohesive, decisive and consistent action. They should also realize that winning the short-term news cycle isn’t a long-term solution. Only time will tell exactly how effective the world’s leaders have been and which strategies produced the best outcome.

Coronavirus Vaccine Is Ready


For Human Testing, And It Will Help Save Lives

With each passing day, the Wuhan Coronavirus continues to spread like wildfire not just in China, but also several parts of the globe. Today it has infected over 78,000 people and has killed over 2700.

The fear for contracting the COVID-19 has resulted in major global events like the Mobile World Congress to get cancelled with various participants hesitant to step out of the country. And this fear also surrounds the upcoming 2020 Tokyo Olympics.

Need for a vaccine to stop this novel coronavirus is needed today more than ever. And it looks like we might not have to wait for long after all.

Scientists since the news of the outbreak have been working on a vaccine to combat and prevent people from the novel coronavirus and now a company called Moderna has announced that it has finally developed a coronavirus vaccine that will soon be ready for human testing.

Coronavirus Death Toll Reaches 2,835 In China With Close To 80,000 People Infected

First reported by the Wall Street Journal, the vaccine has already been provided to the US governments at the National Institute of Allergy and Infectious Diseases in Bethesda. It reveals that there are two doses to the vaccine, and the twin doses are designed for an adult to save him/her against infection.

Looking at the pace in which the research is moving a final product for human trial could be ready as early as July this year. While it sure feels like a lot of time, you need to understand that the rate at which the research for the vaccine is moving at, is unprecedented, to say the least.

Researchers need to make sure a number of things before they decide to inject the vaccine into a human. Not only should it work as we intend it to, but it should also protect the person from contracting the virus for a considerable amount of time. 

Moreover, it shouldn’t come with any adverse side effects or cause severe harm to a person’s body. Researchers will also have to look at how it pairs with existing common medication that people consume.

Coronaviruses



Clinical Presentation

Coronaviruses cause acute, mild upper respiratory infection (common cold).

Structure

Spherical or pleomorphic enveloped particles containing single-stranded (positive-sense) RNA associated with a nucleoprotein within a capsid comprised of matrix protein. The envelope bears club-shaped glycoprotein projections.

Classification

Coronaviruses (and toroviruses) are classified together on the basis of the crown or halo-like appearance of the envelope glycoproteins, and on characteristic features of chemistry and replication. Most human coronaviruses fall into one of two serotypes: OC43-like and 229E-like.

Multiplication

The virus enters the host cell, and the uncoated genome is transcribed and translated. The mRNAs form a unique “nested set” sharing a common 3′ end. New virions form by budding from host cell membranes.

Pathogenesis

Transmission is usually via airborne droplets to the nasal mucosa. Virus replicates locally in cells of the ciliated epithelium, causing cell damage and inflammation.

Host Defenses

The appearance of antibody in serum and nasal secretions is followed by resolution of the infection. Immunity wanes within a year or two.

Epidemiology

Incidence peaks in the winter, taking the form of local epidemics lasting a few weeks or months. The same serotype may return to an area after several years.

Diagnosis

Colds caused by coronaviruses cannot be distinguished clinically from other colds in any one individual. Laboratory diagnosis may be made on the basis of antibody titers in paired sera. The virus is difficult to isolate. Nucleic acid hybridization tests (including PCR) are now being introduced.

Control

Treatment of common colds is symptomatic; no vaccines or specific drugs are available. Hygiene measures reduce the rate of transmission.

Introduction

Coronaviruses are found in avian and mammalian species. They resemble each other in morphology and chemical structure: for example, the coronaviruses of humans and cattle are antigenically related. There is no evidence, however, that human coronaviruses can be transmitted by animals. In animals, various coronaviruses invade many different tissues and cause a variety of diseases, but in humans they are only proved to cause mild upper respiratory infections, i.e. common colds. On rare occasions, gastrointestinal coronavirus infection has been associated with outbreaks of diarrhoea in children, but these enteric viruses are not well characterized and are not discussed in this chapter.

Clinical Manifestations

Coronaviruses invade the respiratory tract via the nose. After an incubation period of about 3 days, they cause the symptoms of a common cold, including nasal obstruction, sneezing, runny nose, and occasionally cough (Figs. 60-1 and 60-2). The disease resolves in a few days, during which virus is shed in nasal secretions. There is some evidence that the respiratory coronaviruses can cause disease of the lower airways but it is unlikely that this is due to direct invasion. Other manifestations of disease such as multiple sclerosis have been attributed to these viruses but the evidence is not clear-cut.

Figure 60-1. Clinical manifestations and pathogenesis of coronavirus infections.

Figure 60-1

Clinical manifestations and pathogenesis of coronavirus infections. 

Figure 60-2. Immunopathogenesis of coronavirus infections.

Figure 60-2

Immunopathogenesis of coronavirus infections. 

Structure

Coronavirus virions are spherical to pleomorphic enveloped particles (Fig. 60-3). The envelope is studded with projecting glycoproteins, and surrounds a core consisting of matrix protein enclosed within which is a single strand of positive-sense RNA (Mr 6 × 106) associated with nucleoprotein. The envelope glycoproteins are responsible for attachment to the host cell and also carry the main antigenic epitopes, particularly the epitopes recognized by neutralizing antibodies. OC43 also possesses a haemagglutin.

Figure 60-3. Electron micrograph showing human coronavirus 229E.

Figure 60-3

Electron micrograph showing human coronavirus 229E. Bar, 100 mn (Courtesy S.Sikotra, Leicester Royal Infirmary, Leicester, England.) 

Classification and Antigenic Types

The coronaviruses were originally grouped into the family Coronaviridae on the basis of the crown or halo-like appearance given by the glycoprotein-studded envelope on electron microscopy. This classification has since been confirmed by unique features of the chemistry and replication of these viruses. Most human coronaviruses fall into one of two groups: 229E-like and OC43-like. These differ in both antigenic determinants and culturing requirements: 229E-like coronaviruses can usually be isolated in human embryonic fibroblast cultures; OC43-like viruses can be isolated, or adapted to growth, in suckling mouse brain. There is little antigenic cross-reaction between these two types. They cause independent epidemics of indistinguishable disease.

Multiplication

It is thought that human coronaviruses enter cells, predominantly, by specific receptors. Aminopeptidase-N and a sialic acid-containing receptor have been identified to act in such a role for 229E and OC43 respectively. After the virus enters the host cell and uncoats, the genome is transcribed and then translated. A unique feature of replication is that all the mRNAs form a “nested set” with common 3′ ends; only the unique portions of the 5′ ends are translated. There are 7 mRNAs produced. The shortest mRNA codes for the nucleoprotein, and the others each direct the synthesis of a further segment of the genome. The proteins are assembled at the cell membrane and genomic RNA is incorporated as the mature particle forms by budding from internal cell membranes.

Pathogenesis

Studies in both organ cultures and human volunteers show that coronaviruses are extremely fastidious and grow only in differentiated respiratory epithelial cells. Infected cells become vacuolated, show damaged cilia, and may form syncytia. Cell damage triggers the production of inflammatory mediators, which increase nasal secretion and cause local inflammation and swelling. These responses in turn stimulate sneezing, obstruct the airway, and raise the temperature of the mucosa.

Host Defenses

Although mucociliary activity is designed to clear the airways of particulate material, coronaviruses can successfully infect the superficial cells of the ciliated epithelium. Only about one-third to one-half of infected individuals develop symptoms, however. Interferon can protect against infection, but its importance is not known. Because coronavirus infections are common, many individuals have specific antibodies in their nasal secretions, and these antibodies can protect against infection. Most of these antibodies are directed against the surface projections and neutralize the infectivity of the virus. Cell-mediated immunity and allergy have been little studied, but may play a role.

Figure 60-4. Seasonal incidence of coronavirus infections.

Figure 60-4

Seasonal incidence of coronavirus infections.

Epidemiology

The epidemiology of coronavirus colds has been little studied. Waves of infection pass through communities during the winter months, and often cause small outbreaks in families, schools, etc. (Fig. 60-2). Immunity does not persist, and subjects may be re-infected, sometimes within a year. The pattern thus differs from that of rhinovirus infections, which peak in the fall and spring and generally elicit long-lasting immunity. About one in five colds is due to coronaviruses.

The rate of transmission of coronavirus infections has not been studied in detail. The virus is usually transmitted via inhalation of contaminated droplets, but it may also be transmitted by the hands to the mucosa of the nose or eyes.

Diagnosis

There is no reliable clinical method to distinguish coronavirus colds from colds caused by rhinoviruses or less common agents. For research purposes, virus can be cultured from nasal swabs or washings by inoculating organ cultures of human fetal or nasal tracheal epithelium. The virus in these cultures is detected by electron microscopy or other methods. The most useful method for laboratory diagnosis is to collect paired sera (from the acute and convalescent phases of the disease) and to test by ELISA for a rise in antibodies against OC43 and 229E. Complement fixation tests are insensitive; other tests are inconvenient and can be used only for one serotype. Direct hybridization and polymerase chain reaction tests for viral nucleic acid have been developed and, particularly with the latter, are the most sensitive assays currently available for detecting virus .

Control

Although antiviral therapy has been attempted, the treatment of coronavirus colds remains symptomatic. The likelihood of transmission can be reduced by practising hygienic measures. Vaccines are not currently available.

Coronavirus


Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV)A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.  

Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. 

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. 


Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

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