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‘Utter chaos’: Coronavirus exposes China healthcare weaknesses

Chengdu, China – On January 20, Fubin’s father started coughing and running a fever. As residents of Wuhan, they knew about a deadly new coronavirus that had originated in the central Chinese city weeks ago, but decided to stay home and hope the symptoms would subside. Four days later, when his father’s body temperature soared…

‘Utter chaos’: Coronavirus exposes China healthcare weaknesses

Chengdu, China – On January 20, Fubin’s father started coughing and running a fever. As residents of Wuhan, they knew about a deadly new coronavirus that had originated in the central Chinese city weeks ago, but decided to stay home and hope the symptoms would subside.
Four days later, when his father’s body temperature soared to 40 degrees, Fubin rushed him to hospital.
Together they headed to the Wuhan Union Hospital but, at reception, they were turned away. They were told they had to go to one of seven hospitals the government had designated for fever patients.
The two men went to Wuhan Red Cross Hospital, one of the designated facilities, and found the line of people waiting to get checked was so long they would have to wait outside – potentially for hours – in the cold and rain. They decided to try their luck elsewhere.
The second and third hospital were both packed. It took Fubin two days to get his father admitted to Wuhan No 5 Hospital, and he is one of the lucky ones.

Coronavirus: Life under lockdown in Wuhan

As thousands, if not tens of thousands, of fever patients who fear they might have caught the novel coronavirus that has now killed more than 100 people rush to Wuhan’s hospitals, the outbreak is testing China’s healthcare system on a scale not seen since the country was hit by the Severe Acute Respiratory Syndrome, or SARS, 17 years ago.
“The response from the government has been utter chaos,” said a nurse who works in Wuhan and preferred not to disclose her name. “The current healthcare system was completely unready for a situation like this.”
The nurse works at one of the designated hospitals, treating victims of a virus that has already infected nearly 10,000 people.
“You would think the government and hospitals had learned something from the SARS outbreak and prepared ourselves for another emergency like this,” she said angrily over the phone. “But no – they learned nothing.”

Most Chinese go straight to hospital when they are sick, leading to huge queues for treatment [cnsphoto via Reuters]

First line of defence
There have been urgent appeals for medical supplies not only in Wuhan and the province of Hubei, but beyond. The government has blamed the Lunar New Year holiday, when factories traditionally close, for the shortages of masks, goggles and other crucial supplies, saying it is hard to step up manufacturing during the festive season.
Shortly after the SARS epidemic, the Chinese government established and updated several times a medical materials reserve system that was supposed to ensure sufficient supplies in the event of any public health emergency.
However, reports filed with the Chinese Centre for Disease Control and Prevention suggest reserves at some hospitals have not been maintained.
In a 2019 article detailing Guiyang province’s emergency medical supplies reserve, the provincial CDC said that, of the 11 items needed in the event of a public health emergency, only five items were fully stocked at the local level.
“There are priorities in our expenditure budget and none of us could’ve expected an emergency like this,” an officer from Sichuan’s provincial CDC told Al Jazeera on condition of anonymity. “So I believe sometimes the supplies reserve might not be ideal.”
For ordinary patients like Fubin, it is not just the lack of medical supplies.
In China, a lack of properly trained general practitioners means the first line of defence often does not exist. There is a lack of trust in clinics and GPs, who are often difficult to find, and people prefer to go straight to hospital as soon as they need medical care.
In Wuhan, the capital of Hubei province, that meant a flood of patients in the initial days of the outbreak as people lined up in front of hospitals, hoping to get treatment.

China is building new field hospitals to cope with the surge in patients as a result of the coronavirus. The first 1,000-bed hospital is expected to be completed by 3 February [Yuan Zheng/EPA]

Health inequality
The majority of people rushed to a limited number of well-known hospitals, also known as a Grade III Level A hospitals, the highest category determined by the Ministry of Health.
Grade III Level A hospitals have attracted the most qualified medical staff and modern equipment, and the well-known concentration of resources has put immense pressure on these hospitals.
“Of course, I’d only go to Grade III Level A hospital,” Fubin said. “I doubt other hospitals have doctors good enough to treat diseases properly.”
Many experts have said that a sudden rush to these medical facilities might have contributed to the widespread cross-infection.
Authorities are now building two more – temporary – hospitals to accommodate the expected thousands of cases.
“We understand that a lot of patients are choosing top hospitals over others,” the Municipal Party Secretary of Wuhan said during a news conference. “But we’re trying to change the mentality now so more people could get treated.”
But that does not address a larger problem: the unequal distribution of medical resources across China.
The level of medical care available in an area almost directly correlates with a province’s level of development.
In Hubei province, 44 out of 88 Grade III Level A hospitals are located in Wuhan, home to 11 million of the province’s more than 50 million people. In China overall, most of the best hospitals are found in the more developed, and wealthier, eastern coastal cities.
Such inequality also extends to the provision of medical staff in different locations.
In Beijing, the capital and home to approximately 20 million people, there are 100,000 registered doctors, whereas in Sichuan, a western province of more than 80 million people, there are 200,000, according to the National Bureau of Statistics.
That means while there are 4.63 doctors per 1,000 people in the capital, there are only 2.46 per 1,000 in Sichuan.

A medic at the Wuhan Union Hospital in Wuhan. China has deployed nearly 6,000 extra health workers to Wuhan to cope with the demand caused by the coronavirus [Xiao Yijiu/Xinhua via AP Photo]

Hubei province has only 150,000 doctors, the majority of whom are stationed in Wuhan.
To relieve the pressure on the limited number of medics currently fighting on the front line, close to 6,000 doctors and nurses from across China have been parachuted into Wuhan and other surrounding cities, in the hope of containing the outbreak.
‘Work harder’
But the lack of doctors is not specific to Wuhan: China simply does not have enough of them, especially those who work in intensive care.
The World Health Organization says that China has 17 doctors for every 10,000 people, well behind the world’s best 82 per 10,000 people in Cuba. And, while the country has made progress in improving health indicators over the past decade, few see much incentive to become a doctor.
“The hyper tension and mistrust between the patients and doctors, the low salary of most doctors, and unpredictable hours all contribute to the lack of motive to become a doctor in China,” said Zhou, a surgeon at Chengdu’s Huaxi Hospital who preferred not to share their full name.
“This outbreak has revealed some of the major problems in our healthcare system that should’ve been addressed before,” Zhou added. “I have confidence that these problems will be fixed soon.”
In Wuhan, having had three days of treatment, Fubin’s father is on the mend.
His son is relieved.
“I would be lying if I said that I wasn’t terrified that my father might not be able to get treatment,” he said. “I’m glad that he’s getting better, but there are still so many people unable to get treatment, and the government should really work harder to address the problem.”
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Chaos and hunger amid India coronavirus lockdown

New Delhi, India – As countries globally began enforcing strict lockdowns to prevent the spread of the coronavirus, India, the world’s second most populous country, followed suit. Prime Minister Narendra Modi on Tuesday announced a 21-day lockdown to contain the virus spread that has now killed 17 Indians and infected more than 700 others.  More: Coronavirus:…

Chaos and hunger amid India coronavirus lockdown

New Delhi, India – As countries globally began enforcing strict lockdowns to prevent the spread of the coronavirus, India, the world’s second most populous country, followed suit.
Prime Minister Narendra Modi on Tuesday announced a 21-day lockdown to contain the virus spread that has now killed 17 Indians and infected more than 700 others. 
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The South Asian nation reported its first coronavirus case on January 30 but in recent weeks the number of infections has climbed rapidly, worrying public health experts who say the government should have acted sooner.

“The police will beat me. I’m afraid they’ll beat me.” Police across India are using force against violators of the country’s 21-day nationwide coronavirus lockdown. pic.twitter.com/cviSrdSs54
— Al Jazeera English (@AJEnglish) March 26, 2020

India’s main opposition Congress party has also criticised the government over a delayed response.
Government defends lockdown
But the ruling Bharatiya Janata Party (BJP) leader Sundhanshu Mittal said India was one of few countries to have acted swiftly and decisively to contain the outbreak.

“You can’t have knee-jerk reactions to such catastrophes without evaluating and anticipating the scale of the problem and looking at the international domain knowledge and consensus. A lot of administrative decisions were made,” he said.
India’s Health and Family Welfare Ministry claims the rate of increase in infections has stabilised. “While the numbers of COVID-19 cases are increasing, the rate at which they are increasing appears to be relatively stabilising. However, this is only the initial trend,” a spokesperson said.
According to the latest report by the country’s top medical research body, the Indian Council of Medical Research (ICMR), 27,688 coronavirus tests had been carried out by 9am on Friday.
“A total of 691 individuals have been confirmed positive among suspected cases and contacts of known positive cases,” read the ICMR update. On Thursday, India witnessed the highest daily increase in COVID-19 cases of 88 people.
While the numbers do not paint a grim picture compared to other countries that are finding it difficult to contain the virus, concern is growing among healthcare experts who believe that the number of infections could be far higher than what is being reported.
Academics from three American universities and the Delhi School of Economics in a report based on current trends and demographics have claimed that India could experience as many as 1.3 million coronavirus infections by mid-May.
Scaling up testing facilities
Experts also say India’s capacity to test is poor and more robust testing would reveal the true extent of the pandemic.

“Could Yogi not have arranged even a bus for us, Is it because we’re? Poor?”-Rajneesh, is walking 247Km on foot to Bareilly. “Poverty will kill us before the virus”- If we airlift Indians how can we abandon millions of our poor. If states wont, let the Army. My #Mojo report pic.twitter.com/mZhRPO5bQf
— barkha dutt (@BDUTT) March 26, 2020

“We have to test anyone who is showing any symptoms, we can’t be restricted to hospitalised cases or those with travel history,” said Dr T Sundaraman, the national convener of the People’s Health Movement.
“We don’t know much because the rate of testing is still modest and very limited. If the testing expands we may find the real numbers which we don’t have,” he told Al Jazeera.

People walk in a crowded Mandi (market place) in New Delhi, as the nationwide lockdown continues [Yawar Nazir/Getty Images]

Facing its biggest health emergency since the country gained independence from Britain in 1947, the Indian government announced a series of steps starting with a 14-hour public curfew on Sunday. 
The government has also scaled up testing facilities and engaged private contractors to help it conduct tests.
From 72 testing centres initially, India now has 104, with a capacity to test 8,000 samples daily. Another two rapid testing laboratories that can conduct more than 1,400 tests per day are also expected to be operating soon.
Leena Meghaney, a legal expert on public healthcare, claimed that a global shortage of chemicals used in the tests and the validation of testing kits being produced domestically were hindering India’s testing capacity.
“This shortage was not specific to India but a global phenomenon. It happened in the USA and France, and India must have faced a similar shortage. The government had to scale it up and procure testing kits from companies which had to be first validated [which] also took some time,” Meghaney told Al Jazeera.
Shortage of PPE and ventilators
Not only is India’s testing capability low, as COVID-19 cases continue to rise, the country is also facing a shortage of equipment needed to support medical staff.
Some say shortages of N-95 masks and other personal protective equipment (PPE) used by healthcare workers have been caused by a last-minute rush by the government, despite the World Health Organization (WHO) warning governments in February to scale up production.
India has 0.7 hospital beds for every 100,000 people, far fewer than countries like South Korea (six per 100,000) that have been able to successfully contain the virus.
Ventilators are also in short supply. India has nearly 100,000 ventilators but most are owned by private hospitals and are already being used by existing patients with critical illnesses.

A man walks past parked supply trucks at a yard during the lockdown in Kolkata [Rupak De Chowdhuri/Reuters]

Some reports suggest that India needs another 70,000 ventilators, which it usually imports, but on Friday, the government announced that it had ordered only 10,000. 
“Ventilators are a costly and critical piece of equipment which are going to go under production by [the state-run] Defence Research and Development Organisation,” said Dr Preeti Kumar of the Public Health Foundation of India, a public-private organisation.
“And then we have items like caps, masks, gowns and gloves. These are high-volume and low-cost consumables that will definitely be produced. It is not the state that is going to produce, it will only order. A lot will depend on how geared up our production companies are to come up to speed and start producing.” 
Migrants workers stranded
Meanwhile, Sundaraman from the People’s Health Movement highlighted how the stress of lockdown appeared to be overtaking the stress of the disease. Sundaraman said his biggest concern was the thousands of migrants who found themselves stranded across India as Modi announced the lockdown with just four hours’ notice.
“What is really worrying is the huge migration that has started across the country. You just can’t stop public transport like that. The lockdown should have been done in a phased way. People shouldn’t be stranded without income, without work. Even in an authoritarian state, they would know that this is something the state has to do,” said Sundaraman.

Slum dwellers in Ahmedabad receive free food packets during a 21-day nationwide lockdown [Amit Dave/Reuters]

Photographs of migrant workers walking hundreds of kilometres or crammed in trucks and empty railway crates show how the government ignored their plight.
Police have also resorted to heavy-handedness against migrants, street vendors and meat sellers. One person died in the state of West Bengal after being beaten up by police for venturing out to buy milk during the lockdown.
In a video shared on Twitter, police appeared to use batons on Muslim worshippers leaving a mosque during a ban on religious gatherings. Al Jazeera has not verified whether the video is authentic.
Meanwhile, in an apparent violation of the lockdown rules, Chief Minister Yogi Adityanath of India’s most populous state, Uttar Pradesh, was seen organising a religious function in Ayodhya town.
‘Totally unplanned’
Reetika Khera, associate professor at the Indian Institute of Management, Ahmedabad and a right to food activist, claimed that the prime minister’s speeches created panic among migrants and then police mishandled the lockdown.
“Now the police are the biggest problem. They are violating government rules. Essential services are to remain open and the biggest violator is the police. I am not sure about the government’s communication strategy, they are supposed to be sharp at that but clearly that is not the case if we can’t communicate clearly to the police,” she said.
The lockdown has also led to the shutdown of routine healthcare services, with Megahney claiming that people with other illnesses have now been stranded without healthcare.
“I know a number of people with HIV who have been stranded. Similarly, a lot of cancer patients are finding it hard to access basic healthcare services. This must be addressed urgently because one of the fallouts of COVID-19 could be that people with other diseases could end up paying the price,” said Meghaney.
Mittal, the BJP leader said the lockdown was announced swiftly so the government could contain the spread of infection.
“If there are migrants who are stranded, government is making provisions to make them reach their houses.”
Meanwhile, the Indian government on Thursday announced a $23bn fiscal stimulus package to help the poor address financial hardships during the three-week lockdown. India’s finance minister claimed that no one would go hungry during this period. 
“One unequivocally good announcement is the doubling of entitlement for existing Public Distribution System card holders,” Khera told Al Jazeera.
India has an existing welfare programme for the poor and the government appears to be using that to provide direct cash transfers and food grains.
However, nearly 85 percent of India’s population works in the informal sector and migrants, in particular, do not have access to these resources.

India under complete lockdown due to COVID-19 [Javed Sultan/Anadolu]

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Iowa caucus chaos due to ‘coding error’: Officials

A new mobile app was supposed to help United States Democratic officials quickly gather information from some 1,700 caucus sites throughout Iowa. Instead, a “coding issue” within the app is being blamed for delays that left the results unknown the morning after the first-in-the nation presidential nominating contest and caused chaos Monday night. Glitches with a…

Iowa caucus chaos due to ‘coding error’: Officials

A new mobile app was supposed to help United States Democratic officials quickly gather information from some 1,700 caucus sites throughout Iowa. Instead, a “coding issue” within the app is being blamed for delays that left the results unknown the morning after the first-in-the nation presidential nominating contest and caused chaos Monday night.
Glitches with a new mobile app Monday caused confusion, and some caucus organisers were forced to call in results for the state party to record manually, introducing delays and the possibility of human error. Iowa Democratic Party Chairman Troy Price said the delays were not the result of a breach and party systems were secure.
“While the app was recording data accurately, it was reporting out only partial data. We have determined that this was due to a coding issue in the reporting system,” Price said in a statement on Tuesday, adding the issue has since been fixed. “The application’s reporting issue did not impact the ability of precinct chairs to report data accurately.”
More:

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US election 2020: What are presidential primaries and caucuses?

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The Iowa Democratic Party told presidential campaigns it will release more than half of Monday’s delayed caucus results at 4pm local time (22:00 GMT) on Tuesday.
“We have always said that we have a paper trail in this process,” Price told campaigns on a briefing call. “We’ve always had to chase down results.”
Price said that the results would be released as they are finalised.
US Department of Homeland Security Acting Secretary Chad Wolf told Fox News on Tuesday that there was no indication of “any malicious cyberactivity”. He added that Iowa Democrats declined his department’s offer to test the reporting app. That’s not unusual, as outside security firms do similar testing. The state party had said previously that it had worked closely with security experts to test the app.
‘A mess’ 
Des Moines County Democratic Chair Tom Courtney said he heard that in precincts across his county, including his own, the mobile app was “a mess”. When precinct leaders called Democratic Party headquarters, “they weren’t answering the phones”, Courtney said.
The problems were an embarrassment for a state that has long sought to protect its prized status as the first contest in presidential primaries and the nation’s first vetter of candidates. The delay was certain to become fodder for critics who argued that the caucuses – party meetings that can be chaotic, crowded and messy – are antiquated and exclusionary.

Democratic 2020 US presidential candidate and US Senator Elizabeth Warren speaks at a caucus night rally in Des Moines, Iowa [Rick Wilking/Reuters] 

The Iowa Democratic Party pressed forward with the new reporting system amid warnings about the possibility of hacking and glitches. Party officials said they took numerous security precautions and maintained that any errors would be easily correctable because of backups and a paper trail.
But organisers running precincts in Iowa didn’t get to test the app beforehand. Iowa party officials had said they would not be sending the new mobile app to precinct chairs for downloading until just before the caucuses to narrow the window for any interference.
Some precinct chairs said they had trouble downloading or logging into the app and didn’t use it.
The apps were barely working Monday night, according to a person involved in processing the data who requested anonymity to discuss the party’s internal system. That forced party aides to record results from the precincts via phone and enter them manually into a database. Officials were left using photos of results to validate outcomes and ensure accuracy.

Democratic US presidential candidate Senator Amy Klobuchar speaks at her rally following the Iowa caucus in Des Moines, Iowa [Brenna Norman/Reuters] 

Jonathan Green, who chaired a precinct in Lone Tree, Iowa, said that when he tried to put the results into the reporting app, he kept getting a confusing error message: “Unknown protocol. The address specifies a protocol [e.g., “wxyz:??”.] the browser does not recognise, so the browser cannot properly connect to the site.”
He said he ultimately gave up and tried to call in the results to the party. Like others, he was put on hold for an extended period of time. In the end, it took hours to report results from his small site, he said.
Risky
The slowdown was exacerbated by the fact that the party was for the first time attempting to report three different sets of data – an initial headcount of each candidates’ support, a count after supporters had realigned, and the state delegate winners.
“We found inconsistencies in the reporting of three sets of results,” the party said in a statement. “This is simply a reporting issue, the app did not go down and this is not a hack or an intrusion. The underlying data and paper trail is sound and will simply take time to further report the results.”
President Donald Trump’s campaign quickly seized on the issue to sow doubt about the validity of the results.
“Quality control = rigged?” Trump campaign manager Brad Parscale tweeted Monday evening, adding an emoji with furrowed brows.
Richard L Hasen, an election expert and professor of law and political science at University of California, Irvine School of Law, cautioned against jumping to conclusions about the integrity of the election.
“Most of the time when there is a problem with an election it turns out to be the result of administrative incompetence rather than someone cheating or some outside interference,” Hasen said.

Democratic presidential candidate former Vice President Joe Biden and wife Jill Biden at a caucus night campaign rally in Des Moines, Iowa [John Locher/AP Photo]

Deploying new technology this close to an election is always a risky proposition, said Lawrence Norden, an elections expert with The Brennan Center for Justice at NYU School of Law. Norden said it’s akin to a major retailer using new cash registers for the first time on Black Friday.
“To roll out a new technology without really testing it and making it available as early as possible and giving folks the opportunity to challenge it and work out all the bugs is a high-stakes decision which I think is proving to be problematic today,” Norden said.
Norden said party officials were wise to slow down the reporting to ensure accurate results, given concerns of another round of election interference by Russia or other hostile governments seeking to undermine US democracy.
“People aren’t going to remember in two weeks that these results were late, but you can bet if the results changed dramatically they would,” Norden said. “Those of us who work in the election space support accuracy over speed.”
Ruth Thompson, who chaired a precinct at Lincoln High School in Des Moines, said she did not use the app to report results because organisers had problems trying to download and test it.

Democratic presidential candidate Senator Bernie Sanders speaking to supporters at his rally in Des Moines, Iowa, US [Carlo Allegri/Reuters] 

“We just came to a consensus that nobody was happy with the app,” she said. She also did not try to report her site’s results over the phone after hearing reports of long delays in answering the line at state headquarters, she said.
Instead, veteran caucusgoers at her site used calculators to compute the delegate allocation and then texted a photo of the results to Polk County Democratic Party officials, who drove it to state party headquarters.
Thompson said the delays in results were unfortunate because the process went “remarkably smoothly” in other ways.

Democratic presidential candidate and former South Bend, Indiana Mayor Pete Buttigieg stands with his husband Chasten while addressing supporters at his rally at Drake University in Des Moines, Iowa, US [Jonathan Ernst/Reuters] 

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