Category: Covid-19

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Taking Stock of the Covid-19 Recession – Harvard Business Review

August 16, 2020

Executive Summary

Where are we, six months into the coronavirus recession? The authors look back at five common expectations from the early days of the crisis and how they differ from where we are today. The differences in macroeconomic outcomes can largely be explained by countries health care and economic policies. Perhaps surprisingly, the authors found that aggressive economic policy can offset shortcomings in health care policy.

Six months after the start of the coronavirus recession the macroeconomic landscape has become more, not less, confusing. Business leaders have to navigate shattered expectations, widely disparate outcomes, and continued uncertainty. Although we have seen the worst growth decline on record, financial markets are buoyant. Its time to take a step back and reflect on the journey so far.

As the crisis unfolded in February and March of this year, business leaders were forced to rapidly shift their expectations for the future. While expectations varied, we identified five disparities between common assumptions at the time and our current realities.

1. Intensity was underestimated.

Economic forecasts gyrated wildly at the start of the crisis. For example, the median broker forecast for 2Q U.S. growth was still around 0% in mid-March, before collapsing 30 percentage points over the next 20 days. Over the following months the forecast settled around -35% (annualized not to be confused with, but equivalent to, -10% quarter on quarter growth). That figure turned out to be closer to the truth (actual growth was -33% annualized, or -9.5% q/q) but the spread around the median forecast remained extremely large. Regardless of future revisions, a historically bad growth decline is now a fact and the episode highlights the limits of modeling outside of the known empirical range.

2. Systemic stability risks were overstated.

The severe intensity of the crisis fueled fears of systemic meltdown, driven by liquidity and solvency problems cascading through the real and financial economy. Those risks stoked concerns of a new great depression, while the unprecedented policy response also stoked concerns over higher inflation, often portrayed as the trigger for a U.S. debt crisis and the end of dollar hegemony. Though fears remain, they have not been realized so far, as monetary policy has contained stress in the financial system and unprecedented fiscal policy has shored up real economy balance sheets.

3. A false dichotomy was predicted between emerging and developed economies.

A common expectation was that affluent economies would weather the crisis more adroitly than less developed ones, whose ability to respond with policy would be more limited. Yet expectations about a clean correlation between economic heft and crisis outcomes, including health outcomes, have not been realized. The wide distribution of outcomes within the developed and emerging economy clusters (think U.S. vs. Greece, or Brazil vs. China) illustrates the false dichotomy.

4. Recovery shapes were more widely dispersed.

Expectations for the path of the recovery were hotly debated, though a dominant early expectation was for a V-shaped i.e. return to pre-crisis trends recovery. While this today seems hopeful, ultimate recovery shapes are still being written. In fact, V-shapes have emerged at both national level (notably China) and also within the U.S., where, for example, retail sales and housing (new home sales) have bounced back and exceeded pre-crisis levels. As recovery shapes are more about the eventual return to pre-crisis levels and growth rates, and less about speed, it is too early to tell. Perhaps what can be said with some confidence today, is that a full return to pre-crisis trend paths looks ever more challenging as time passes and capital stock growth slows in the crisis.

5. Long-term legacies may be more concentrated than thought.

The extreme intensity of the crisis infected expectations that everything will be different post-Covid. It is too early to say, but first contours have emerged on three dimensions of legacy: a break in the economic structural regime remains unlikely, particularly for the U.S. economy; as mentioned above, the structural damage question remains in flux; however there are many facets of microeconomic and behavioral shifts that look likely to become permanent, creating opportunity in adversity for some sectors and companies.

While all economic downturns have their own idiosyncrasies, the underlying dynamics of this pandemic-induced recession were similar across the world: A health emergency requiring restrictive public health interventions creates a severe economic disruption, which must be bridged by economic policy.

We have observed a degree of substitutability between the two policy dimensions that shape macro outcomes: Successful public health interventions reduce the cost, risk, and complexity of the needed economic policy response. However, where virus control is lacking, aggressive economic policy can offset shortcomings in health care policy.

The U.S. is a case in point. Hopes that rich nations would easily control the virus were quickly dashed as it became clear that a specific mix of institutional capabilities including health policy, government coordination, communication, and support in civil society mattered more than economic heft.

However, despite this public health outcome, the U.S. has fared somewhat better economically in 2Q than Europe where public health outcomes are widely seen to be better. The key driver of this outcome is the speed, depth, and breadth of the U.S. economic policy response that dwarfed European efforts. Economic policy capacity has effectively offset shortcomings on the health side.

While minimizing the health crisis is an important goal in its own right, we think its difficult to link the public health outcomes with expected economic outcomes without considering the idiosyncratic abilities and willingness of nations to bridge the disruption with economic policy.

What can the disparities of the coronavirus crisis so far tell us about the future?

Equity markets are one means to gauge the future, as the asset class purports to reflect the present value of future cash flows. The full recovery to pre-crisis levels of some U.S. markets is widely seen as seriously dissonant with the extreme hardship afflicting the real economy. Yet, apart from some idiosyncrasies (large weight in tech stocks who have won in the pandemic as well as increasingly negative real rates making equities relatively more attractive), we think the markets reflect an embedded view on the substitutability of health policy and economic policy.

At this point, expectations for much more than a muddling through in the U.S. health policy are optimistic, however expectations for unparalleled economic policy efforts are more plausible. This will help albeit at likely escalating cost and risk to bridge the economic gaps left by the health care response. Equity markets have taken a view that U.S. economic policy willingness (culture of stimulus) and capacity (reserve currency status, debt capacity, and an anchored inflation regime lend the U.S. unrivaled capacity) more than offset weakness in health policy. U.S. markets strong performance, particularly the strong absolute recovery but also the relative outperformance (Europe), are partly driven by this view.

However, this view of the future harbors two significant risks. The first stems from the markets large bet that the aggressive hunt for a vaccine will shorten traditional development timelines. Any whiff of failure or significant delay would pierce a hole in this view, raising questions about the degree that economic policy can hold economic activity together.

The second risk potentially more damaging is that economic policy could fail to continue bridging the gap in economic activity. As we wrote here before, this failure can generally emerge from either inability (markets reject debt issuance) or unwillingness (political failure to act). While inability is very unlikely for the U.S., unwillingness is not. At the start of an overwhelming crisis political polarization was kept in check at first. But as the crisis drags on and an election season beckons, bipartisanship can turn to intransigence. The economic response to Covid-19 could still turn into a political football.

Six months into this crisis, economic outcomes are no more certain arguably less so. Here are a few things business leaders can do to prepare for the next phase of the coronavirus crisis:

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Taking Stock of the Covid-19 Recession - Harvard Business Review

COVID-19 in Illinois: What residents, businesses need to know this weekend – Peoria Journal Star

August 16, 2020

The U.S. earlier this week recorded the most COVID-19 deaths in a single day since mid-May nearly 1,500.

Meanwhile, coronavirus cases in Illinois surpassed 200,000. In the Tri-County Area, the number of confirmed cases is rising and three deaths were reported this week.

"Our numbers are increasing and we need to do a lot more," Monica Hendrickson, administrator of the Peoria City/County Health Department, said Thursday during her weekly COVID-19 roundup on Facebook. "Overall weve seen an increase from one week of 480 new cases from our Tri-County."

While the Tri-County is seeing an average increase of about 69 new cases each day, hospitals remain well below capacity, with occupancy in non-ICU beds at about 4.3%, and ICU beds at about 11%, Hendrickson said.

New rules and funding for Illinois businesses

Gov. JB Pritzkers emergency rule enforcing mask wearing and social distancing would require businesses, schools and day care facilities to make efforts to ensure that patrons and employees wear face masks and practice social distancing.

Non-compliant businesses will first get a written warning before other punitive measures are instituted, including fines ranging from $75 to $2,500.

"We are working to understand what this means and what the implications are," Hendrickson said.

A number of Peoria-area businesses are getting grants through a program Pritzker touted during a tour of the state this week. The Business Interruption Grants program will distribute $46 million to 2,655 small businesses in 78 counties in Illinois.

The program is designed to help businesses that were overlooked by the federal PPP program. In the Tri-County Area, a number of eateries, salons and gyms received $10,000 or $20,000 grants.

Illness linked to COVID-19 affecting Illinois children

At least 24 children in Illinois have been diagnosed with a severe illness linked to COVID-19. A new federal report placed Illinois among the top seven states in the country for the number of cases, according to a Chicago Tribune article by Lisa Schencker.

Nationwide, 570 cases had been reported to the CDC as of July 29.

Multisystem inflammatory syndrome generally appears two to four weeks after the onset of COVID-19 in a child or adolescent, presenting with rash, fever, red eyes, swollen hands and feet, vomiting and abdominal pain.

According to the Illinois Department of Public Health, no children have died from the illness. It is disproportionately affecting minority populations.

Though children can get very sick and can require intensive care, they typically recover well, said Dr. Frank Belmonte, a physician at Advocate Childrens Hospital in Chicago who has treated about a dozen children with the syndrome.

Back-to-school plans

With teachers in Florida crafting their wills, according to a Florida Times-Union article by Emily Bloch, teachers in Peoria won an important battle this week.

Just before midnight on Monday, the board of Peoria Public Schools reversed an earlier decision to provide a hybrid plan for both in-school and remote learning amid a growing concern for teacher safety.

"It became apparent that the only way the hybrid plan was going to work was with flawless execution," said Board President Doug Shaw. "And human beings being human beings, flawless execution is too much to ask."

Only remote classes will be held in Peoria Public Schools, a decision which prompted administrators to give teachers a few more days to prepare for the start of the school year. School will be starting Aug. 24.

"This adjustment will allow all Peoria Public Schools stakeholders to be ready for Distance Learning to ensure our students will receive the best educational experience this school year," said Peoria Public Schools Superintendent Sharon Desmoulin-Kherat in a message sent to families.

Coronavirus news across the U.S.

A couple good things are happening around the nation.

The number of new COVID-19 cases and hospitalizations are decreasing in California, a state that has been particularly hard hit. And new jobless claims dropped to 963,000, the lowest in months, though that number would have been considered high before the pandemic.

But difficulties still remain. A bipartisan deal for a new coronavirus stimulus package has stalled, and the director of the Center for Disease Control and Prevention issued a warning about the next few months. Americans should continue to wear masks, socially distance and wash their hands to prevent an avalanche of illness, said Robert Redfield, director of the CDC.

"I'm not asking some of America to do it. We all have to do it," Redfield told WebMD. "Or this could be the worst fall from a public health perspective that we have ever had."

Information from USA TODAY, The Washington Post, The Chicago Tribune, the Florida Times-Union and WebMD was used to compile this report.

Leslie Renken can be reached at 270-8503 or lrenken@pjstar.com. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.

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COVID-19 in Illinois: What residents, businesses need to know this weekend - Peoria Journal Star

Martinsville-region COVID-19/coronavirus daily update from state, nation and world: Aug. 15 – Martinsville Bulletin

August 16, 2020

There is a new death from COVID-19 in Patrick County. This fact was included in the morning's update from the Virginia Department of Health. No details have been released by the West Piedmont Health District. That's five deaths now in the county, one of the last in Virginia to have a positive test for the coronavirus. The county has had 176 cases now. Blue Ridge Therapy Connection, a senior-care facility at Stuart, had the recent large outbreak that sparked the rise of cases in the county. Across the district Saturday there were 19 new cases and one new hospitalization -- that also in Patrick County. Twelve of those new cases were in Henry County. U.S. Rep. Morgan Griffith spoke to leaders in Martinsville on Friday, and he talked about the idea of the U.S. Postal Service and how it might be used in the 2020 election because so many want to avoid polling places because of the pandemic. He said President Trump's comments made him cringe. Meanwhile, health experts say in new guidance from the CDC for pediatricians that children make up more than 7% of all coronavirus cases in the U.S., and the rate of child cases has been "steadily increasing" since March. Back-to-school discussions continue in many states, most recently in Michigan.The Virginia Department of Health reportsthis morning there have been 105,750 cases and 2,381 deaths statewide -- an increase of 11. Some 8,701 people have been hospitalized. Henry County has had 672 cases, with 73 hospitalizations and 9 deaths. Martinsville has had 240 cases, with 38 hospitalizations and 3 deaths. Patrick County has had 176 cases including 36 hospitalizations and 5 deaths. Franklin County has had 182 cases, 8 hospitalizations and 1 death. Danville has reported 451 cases, and Pittsylvania County has had 560.Johns Hopkins University's real-time mapshowed 21,250,743 cases worldwide and 766,648 deaths. In the U.S. there are 5,314,814. There have been168,462 deaths in the U.S. because of COVID-19.

(176) updates to this series since Updated 9 hrs ago

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Martinsville-region COVID-19/coronavirus daily update from state, nation and world: Aug. 15 - Martinsville Bulletin

No deaths, 123 new cases of COVID-19 in ND for August 14; active cases statewide are 1,162 – KX NEWS

August 16, 2020

The North Dakota Department of Health Saturday morning has confirmed 123 new cases of COVID-19 in the state during testing August 14, bringing the total positives since testing began to 8,444.

The number of currently active COVID-19 cases in the state stands at 1,162 as of August 14.

Of the new cases, 18 were in Burleigh County and 5 were in Morton County. Both counties accounted for 18 percent of the new cases.

Williams County had 2, Stark County had 2 and Ward County had 9.

A total of 121 people have died so far in North Dakota as a result of COVID-19.

Of those, 101 are directly attributable to COVID-19 according to official death records. Another 6 deaths are where COVID-19 is not the primary cause of death. Eight death records are pending.

The health department reports 7,161 people are considered recovered from the 8,444 positive cases, an increase of 95 people from August 13.

This means there are actually 1,162 active COVID-19 cases in the state as of August 14.

Burleigh County has 271 active cases as of August 14, the most in the state and more than double the number of active cases in Cass County (90). Morton County has 114 active cases.

Burleigh and Morton counties together account for 33 percent of all active COVID-19 cases as of August 13.

Stark County has 128, Ward County has 52 and Williams County has 48 active cases.

According to state health department numbers (which have been revised several times for specific dates), the statewide active cases first peaked on May 21 at 672 active cases, then began falling until they hit a low of 213 on June 22.

After that, the statewide active cases have once again been trending upward.

According to the numbers, 84 percent of those who have tested positive for COVID-19 in North Dakota to date have recovered from the virus.

The number of people reported recovered from COVID-19 on August 14 (95) is lower than the number of new COVID-19 cases reported that day (123).

65 people are currently hospitalized due to COVID-19 as of August 14, a decrease of 10 from August 13. A total of 457 hospitalizations have been reported since data tracking began.

COVID-19 cases have been reported in all 53 of North Dakotas counties.

Cass County (3,117 cases) and Grand Forks County (775 cases) account for 46 percent of all positive North Dakota COVID-19 cases to date. Cass County alone accounts for 38 percent of all positive cases.

Burleigh County (1,344 cases) and Morton County (440 cases) together account for 21 percent of all positive COVID-19 cases to date.

Stark County is fifth with 375 cases.

Williams County has 301, Ward County has 263, Mountrail County has 151 and Stutsman County has 130 cases.

Other county numbers are availablehere.

A total of 178,145 unique individual tests have been conducted to date, with 169,701 coming back negative for COVID-19, or roughly a 4 percent cumulative positive rate.

While COVID-19 is seen as a virus that mostly impacts older people, in North Dakota, 58 percent of those testing positive for the virus are under 40.

Those in the 20 to 29 year age range have the most positive cases among those tested to date.

The health department is releasing test results daily around 11:00 a.m. The results cover all testing performed the previous day.

You can read more on the daily statistics as well as other COVID-19 information and resources at the North Dakota Department of Health websitehere.

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No deaths, 123 new cases of COVID-19 in ND for August 14; active cases statewide are 1,162 - KX NEWS

He Is 16 and His Mother Died of Covid-19. What Happens To Him Now? – The New York Times

August 14, 2020

For the Fryson brothers, the year had begun on a hopeful note. They had finally reunited with their mother, Beatrice McMillian, after years of being in foster care.

Ms. McMillian had secured rental assistance for an apartment so she could move out of a homeless shelter. The older brother, Kasaun, was embarking on adulthood, working at Whole Foods and attending community college.

The younger brother, EJ, was living with his mother and doing well in high school. Then, in April, Ms. McMillian died of Covid-19. Her death shattered everything the family had gained. Mr. Fryson, 22, headed to court to try to become his 16-year-old brothers guardian and keep him from returning to foster care. He needs someone, and Im going to be that person, said Mr. Fryson.

When the coronavirus pandemic killed thousands of people in New York City, it made orphans of an unknown number of children. At least eight children have been placed in foster care because their parents died from the virus, according to the city Administration for Childrens Services.

The total number is likely higher. Children in families with more money or wider support systems usually handle guardianship issues privately.

The sudden loss has thrust some young adults like Mr. Fryson into the unexpected role of surrogate parent, fighting to keep what is left of their families together.

Your physical home is gone, your emotional home is gone. Then, youre going to be put with someone youve never known in your life, said Karen J. Freedman, the founder and executive director of Lawyers for Children, which represents children in foster care, including some whose parents died in the pandemic. That is a terrifying process for any child.

Jessica Barrera, 16, faced the prospect of losing her home this spring. Her father died of tuberculosis in March, just as the virus was erupting in New York. Jessicas mother, Maria Arizaga, who worked in a bakery, was worried about how to care for Jessica and her older brother, Luis.

Her parents had emigrated from Ecuador, and did not have close family in Brooklyn, where they lived.

At the funeral, Ms. Arizaga turned to a family friend, Cesar Cevillo, and remarked that her children would now belong to him. It was the kind of brief, emotional remark that a grieving person might whisper in the moment, and Mr. Cevillo politely nodded.

Only weeks later, Ms. Arizaga died of Covid-19. Her son, Luis, began desperately looking for an adult to be a guardian to Jessica so that she would not be placed in foster care. At 19, he was about two years too young to be considered for the role.

The last time I spoke to my mom on the phone, she said, If anything happens to me, just take care of your sister, OK? Mr. Barrera said. I had to be the responsible one for my sister.

He turned to Mr. Cevillo, who had just recovered from the coronavirus himself. Mr. Cevillo then asked his sister, Laura, to help.

Ms. Cevillo, who has her own teenage daughter, said she had to establish remote learning for Jessica, take her to the doctor and make sure she was eating tasks that Luis, who worked at a supermarket and attended college, could not handle on his own. He also had to plan a trip to Ecuador, where he and his sister took their parents ashes in July.

Ms. Cevillo said it had not been easy trying to comfort and care for teenagers who have lost two parents within weeks of each other, but she said she did not want to give up. I was sad because these children were alone, she said.

A judge granted temporary guardianship, which will likely be extended at a hearing on Friday. But the judge will have to ultimately decide who will be Jessicas permanent guardian.

David Villar, 17, feared he was headed to foster care after his father died of Covid-19 in March, just two years after his mother died of a heart attack at home, where he had tried to save her with cardiopulmonary resuscitation.

But he is now with his sister, Giannie Done, who has been given guardianship. Ms. Done, 21, said she felt obligated to care for her brother. He didnt have anybody. I wanted him to know Im his sister, and Im here for him, she said.

Ms. Done, who works as a sales representative at AT&T, said she is learning how to be a guardian, but knows she is not a mother to David. Hes not a child; hes my little brother, she said. I just want him to respect me.

David had been adopted out of foster care and briefly returned when his father went through another illness. He assumed he was going back again. I didnt know where I would go to, he said, adding that he was grateful to his sister.

Updated August 12, 2020

Now, its official, he said, laughing about the paperwork that awarded Ms. Done guardianship.

Like Ms. Done, Mr. Fryson was determined to prevent his brother, EJ, from having to return to foster care.

The brothers went into the care of the state in 2013, after their father died of prostate cancer. Their mother, Ms. McMillian, was in prison, serving a sentence for manslaughter.

But Ms. McMillian, who killed her boyfriend in a domestic dispute in 2009, was a fierce protector from prison, Mr. Fryson said. She monitored the welfare of her sons in phone calls to foster parents and agencies. She pushed to get her sons moved into a more suitable home when they told her they were having problems with one foster mother, Mr. Fryson said.

Her sons visited her at Bedford Hills Correctional Facility, and went to a nearby sleep-away camp during the summer so they could spend more time with her.

When Mr. Fryson learned his mother had coronavirus and would be hospitalized, he immediately went to the homeless shelter where his family was staying in Kips Bay and got his brother. Doctors ordered them to quarantine for two weeks in his apartment on the Lower East Side, so they were unable to visit their mother before she died in the hospital.

The funeral was a blur, Mr. Fryson said. It wasnt really much of a funeral. You cant see the person. They wont let you see the body. You just stand at the box for 10 minutes, he said.

He reached out to Lawyers for Children, which had represented them in the past. The group referred him to a private lawyer, Philip Katz, who said a judge recently awarded Mr. Fryson custody, although there are still complications.

Mr. Fryson cannot have overnight visitors for long stays at the supportive housing building where he lives, so EJ sometimes has to bunk with relatives. Mr. Fryson has applied to move into a larger apartment in the building so the brothers can live together full time.

Mr. Fryson said his mother would have wanted them to stay together. She was a good mom, he said.

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He Is 16 and His Mother Died of Covid-19. What Happens To Him Now? - The New York Times

COVID-19 Daily Update 8-13-2020 – West Virginia Department of Health and Human Resources

August 14, 2020

The West Virginia Department of Health andHuman Resources (DHHR) reportsas of 10:00 a.m., on August 13, 2020, there have been 339,349 total confirmatory laboratory results receivedfor COVID-19, with 8,151 total cases and 153 deaths.

CASESPER COUNTY: Barbour (29), Berkeley (720), Boone (112),Braxton (8), Brooke (70), Cabell (431), Calhoun (6), Clay (18), Doddridge (6),Fayette (160), Gilmer (17), Grant (131), Greenbrier (92), Hampshire (84),Hancock (112), Hardy (62), Harrison (238), Jackson (165), Jefferson (302),Kanawha (1,020), Lewis (28), Lincoln (96), Logan (276), Marion (195), Marshall(130), Mason (67), McDowell (62), Mercer (216), Mineral (125), Mingo (195),Monongalia (962), Monroe (20), Morgan (31), Nicholas (39), Ohio (271),Pendleton (42), Pleasants (14), Pocahontas (42), Preston (125), Putnam (204),Raleigh (276), Randolph (212), Ritchie (3), Roane (19), Summers (16), Taylor(60), Tucker (11), Tyler (15), Upshur (38), Wayne (214), Webster (4), Wetzel(44), Wirt (7), Wood (266), Wyoming (43).

As case surveillance continues at thelocal health department level, it may reveal that those tested in a certaincounty may not be a resident of that county,or even the state as an individual in question may have crossed the stateborder to be tested. Such is the case of Jackson,Mineral, Nicholas and Ohio counties in this report.

Please note that delays may be experiencedwith the reporting of information from the local health department to DHHR.

On August 12, 2020, DHHR announced thatboth confirmed and probable deaths will be reported on the dashboard, per CDCguidelines. Probable deaths are defined as decedents who had no knownpositive laboratory test for COVID-19 but whose death certificate listsCOVID-19 as a cause of death or contributing factor, or decedents who weresymptomatic and had a known exposure to COVID-19.

Confirmed and probable cases have beenreported in this report since April but will now be combined for the purpose ofthis report. Data is published daily at 10 a.m. on thedashboard located at http://www.coronavirus.wv.gov.

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COVID-19 Daily Update 8-13-2020 - West Virginia Department of Health and Human Resources

This physician has battled epidemics, quakes, and poverty in Haiti. Now, she’s taking on COVID-19 – Science Magazine

August 14, 2020

Every time you make progress you are pushed back by either a natural or political catastrophe, says Marie Marcelle Deschamps.

By Robert BazellAug. 13, 2020 , 2:30 PM

Science's COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.

Marie Marcelle Deschamps remembers the first patient with COVID-19 to visit a clinic she runs in Portau-Prince, Haiti. It was late March. His blood oxygen saturation, normally above 90%, was 35%. The 45-year-old man died within 1 hour. Oh my God, she recalls telling her colleagues. Its here.

As the director of a major health care organization in Haiti, Deschamps was already stretched thin by the struggles of providing medical help in one of the poorest nations on Earth. Her clinic was soon seeing thousands of COVID-19 cases per week, and her days became consumed with treating patients, supervising the other doctors, and dispatching teams to provide care and counseling to people in Haitis urban slums and countryside.

Those who have met Deschamps (including this reporter) know her as amazingly warm, bright, and charming. Clinic staff, patients, and even strangers greet her fondly as she rushes past. The need for women to take an increasing role in Haitis health care has long been identified as a key to economic development, and after 4 decades of practicing medicine in her native country, Deschamps is seen by many as an icon and a role model. She is inspiring, says Sandra Lamarque, head of mission in Haiti for Doctors Without Borders.

Jean William Pape, founding director of GHESKIO, the private nonprofit health organization Deschamps now heads, credits her for introducing multiple programs that have improved womens health and wellbeing, including ones that care for victims of sexual assault, guide poor women in obtaining microcredit loans to start businesses, or help them get their children into schools. When she sets out to solve a problem, it gets solved, says Pape, who now co-directs Haitis response to COVID-19.

Deschamps decided on a career in medicine after witnessing her father die a slow death from kidney failure. I had such a desire to become a good doctor, she says. The beginning of her career coincided with the huge outbreak in Haiti of the disease that came to be called HIV/AIDS, before there were meaningful treatments. She recalls telling her husband, I am signing so many death certificates I hope that one day people wont judge me for being a bad doctor.

In the early days of the HIV/AIDS crisis, a group of senior Haitian and U.S. doctors chose Deschamps to study in the United States, where she did fellowships in Anthony Faucis lab at the National Institute of Allergy and Infectious Diseases, Walter Reed military hospital, and the Centers for Disease Control and Prevention. On her return to Haiti, she and Pape expanded GHESKIO. It grew from humble origins in a tiny building across the street from an enormous slum known as City of God into a health organization that now treats more Haitians with HIV/AIDS and tuberculosis than any other group in Haiti, as well as caring for people with myriad other maladies.

Deschamps sees COVID-19 as just the latest chapter in the Haitian saga. Every time you make progress, finding the solutions, you are pushed back by either a natural or political catastrophe, she says. You are always in a situation of crisis where you have to act rapidly. After the devastating 2010 earthquake, Deschampss clinic allowed hundreds of slum dwellers whose shacks had collapsed to camp on its property. She and her colleagues circulated among the injured treating horrible fractures and other injuries.

Soon after the earthquake, U.N. troops from Nepal unknowingly brought a cholera epidemic to Haiti that sickened more than 800,000 and killed more than 10,000 over several years, putting enormous additional stress on all of Haitis health facilities, including Deschampss clinics. The country has been very vulnerable, Deschamps says, citing threats as diverse as political destabilization, impacts of deforestation on farmland and drinking water sources, hurricanes, and a never-ending procession of infectious diseases. Now COVID, she says with a laugh. So, I said to my myself, what is it we have not seen finally.

Until Deschamps saw her first COVID-19 patient in late March, Haitis poverty and isolation had kept it relatively safe from the pandemic. The government had taken precautions, closing the international airport and shutting down businesses. Two infected travelers, one from the United States and one from Europe, had been discovered and quickly isolated.

But the patient in her clinicand others who quickly followedhad been working at hotels in the Dominican Republic, which shares a porous border with Haiti on the island of Hispaniola. Because it is a popular winter tourist destination for people from the northeastern United States and Europe, the Dominican Republic got hit hard and early with COVID-19. More than 30,000 Haitians lost their jobs there and were either forced out or fled homesome bringing the virus with them. Another 300,000 had commuted back and forth for occasional work.

For several weeks, Haiti saw large numbers of COVID-19 cases, often overwhelming the relatively few available hospital beds. Because many Haitians lack shelter, food, and medical care, the United Nations Economic and Social Council warned that COVID-19 could trigger a humanitarian catastrophe, a theme echoed in a letter co-authored by Deschamps and published on 16 June inThe New England Journal of Medicinetitled Facing the Monster in Haiti.

The letter warned that stigmatizationonce directed against those with HIVwas now impeding care for those with COVID-19. Health care workers have endured threats and had stones thrown at them. Some patients have been driven from their homes and shunned by relatives, forcing them to live on the streets. Deschamps has directed community health workers to try to combat stigma and educate people about safety measures, but she acknowledges it isnt easy. How can you ask someone to adopt proper distancing measures when five people are living in one room?

So far, however, the worst predictions havent come to pass. Although testing and surveillance is limited, the official number of confirmed cases declined from almost 300 per day in mid-June to about 100 in mid-July. As of 9 August, Haiti had reported only 183 COVID-19 deaths in its population of 11.2 million. Deschamps says that even at current levels COVID-19 represents a huge burden, but she is hopeful and skeptical at the same time about the future.

Some other resource-poor countries have reported similar declines in cases. Global health experts have speculated that those countries may benefit from relatively younger populations, shanties that though crowded are well-ventilated, or a more effective early immune response to COVID-19 because of the many other infections people face. We just dont know the reasons for this but it is a very intriguing question, says immunologist Barry Bloom, former dean of the Harvard T.H. Chan School of Public Health.

Although she could live and practice medicine anywhere, Deschamps insists shell never leave Haiti. This is my place, she says. Haitians are resilient, she says, in spite of all theyve endured. Its not that we forget [but] we are always looking for the light.

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This physician has battled epidemics, quakes, and poverty in Haiti. Now, she's taking on COVID-19 - Science Magazine

Faculty inform WHO’s COVID-19 and breastfeeding guidelines – Cornell Chronicle

August 14, 2020

Cornell researchers are leading a living systematic review on the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through breast milk intake and breastfeeding.

Findings will inform the World Health Organizations (WHO) international guidelines on breastfeeding during the COVID-19 pandemic.

Dr. Saurabh Mehta and Julia Finkelstein, both associate professors in Cornells Division of Nutritional Sciences, are leading the ongoing effort. Mehta is a physician and infectious disease epidemiologist and leads an acute febrile illness surveillance program in Ecuador. Finkelstein specializes in maternal and child health and leads a community-based surveillance program among reproductive-age women in Southern India.

Breastfeeding is the cornerstone for ensuring that children get a healthy start in life, Mehta said, but it also may be the source of transmission of some infections from mother to child.

The ongoing pandemic is expected to lead to major global increases in childhood malnutrition due to multiple factors, including the reduction in food quality and access, and an interruption in feeding programs, Mehta said.

One of the World Health Organizations critical functions is to develop guidelines for what should be done in these times, Mehta said. With the anticipated risk to child health and nutrition due to the pandemic, its important to determine the role of breast milk and breastfeeding in transmission of the virus, if any.

When COVID-19 first appeared in January, the review team examined hundreds of papers and reports to inform WHOs emergency guidelines for breastfeeding and COVID-19.

As of July 7, the team had screened 19,414 scientific articles and found 309 studies that reported on breastfeeding among women with suspected or confirmed COVID-19 and their infants. Among these, 38 studies included a molecular-based assessment of breast milk samples for SARS-CoV-2, the virus that causes COVID-19.

In a WHO scientific brief posted online June 23, the organization recommended that mothers with suspected or confirmed COVID-19 cases should be encouraged to initiate or continue to breastfeed. The paper, Transmission of Novel Coronavirus (COVID-19) Through Breast Milk and Breastfeeding: A Living Systematic Review, which informs the WHOs recommendation, has been accepted and will be published in a forthcoming issue of the Annals of the New York Academy of Sciences.

This highlights the need for additional studies that not only report on the presence of viral particles within breast milk, but to understand if these particles are infectious, Finkelstein said. As new evidence emerges, our team will continue to synthesize and report on relevant data to help inform infant feeding guidelines in the context of COVID-19.

The Cornell review team members also include:

The WHO collaborators include: Dr. Juan Pablo Pea-Rosas, head of Cross-cutting Global Initiatives in the Department of Nutrition and Food Safety; Dr. Pura Rayco-Solon, a scientist in the Department of Maternal, Newborn, Child and Adolescent Health and Aging; Maria Nieves Garcia-Casal, nutrition scientist; and Lisa Rogers, technical officer in the Department of Nutrition and Food Safety.

Funding for this ongoing research is provided by the WHO.

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Faculty inform WHO's COVID-19 and breastfeeding guidelines - Cornell Chronicle

More than half of Mumbai’s slum residents might have had Covid-19. Here’s why herd immunity could still be a long way off – CNN

August 14, 2020

While some were alarmed by the results of the study conducted by the Mumbai authorities and the Tata Institute of Fundamental Research, others were optimistic. Mumbai's slums, where social distancing is nearly impossible, might now have some of the highest levels of immunity in the world -- only 23.5% of samples taken by India's National Center for Disease Control tested positive for antibodies in Delhi and 14% tested positive in New York, in a study sponsored by the New York State Department of Health.

Scientists believe it's likely that recovering from coronavirus leaves a person with some immunity, but it's not clear how strong it is or how long it lasts. Herd immunity is the idea that a disease will stop spreading once enough of a population becomes immune -- and is appealing because, in theory, it might provide some protection for those who haven't been ill.

If more than half of people in Mumbai's slums had contracted coronavirus, could they be approaching herd immunity -- without a vaccine?

One expert thought so.

"Mumbai's slums may have reached herd immunity," Jayaprakash Muliyil, chairman of the Scientific Advisory Committee of India's National Institute of Epidemiology, said, according to a Bloomberg report. "If people in Mumbai want a safe place to avoid infection, they should probably go there."

But others have been more cautious. David Dowdy, an associate professor in epidemiology at Johns Hopkins Bloomberg School of Public Health, said it was possible that the researchers had used a test that created false positives.

And Om Shrivastav, an infectious diseases expert in Mumbai, cautioned that, less than eight months into the virus' existence in society, it was too early to make any "decisive, conclusive statements."

The risk of a high death toll is exactly why India's health authorities say the country is not aiming for herd immunity. "Herd immunity can be achieved through immunization -- but that is in future," health official Rajesh Bhushan told reporters last month.

What is herd immunity?

Herd immunity works like this: Assume that each infected person infects three more people. If two of those three people are immune, then the virus is only able to make one person sick. This mean that fewer people are infected by the illness -- and over time, even people who aren't immune end up being protected as they are less likely to be exposed to the virus.

The level of immunity needed in a population depends on the disease. Scientists don't yet know what proportion of a population needs to be immune to achieve herd immunity for the novel coronavirus.

Building up the level of immunity in a population can happen in two ways. People can become immune by being vaccinated, or they catch the virus and develop natural immunity by recovering from it.

And that's where things get controversial.

Most other countries -- including India -- have taken a different approach. "Herd immunity in a country with the size of population of India cannot be a strategic choice, it can only be an outcome and that, too, at a very high cost," said the health official, Bhushan.

As Dowdy puts it: "We could very rapidly develop a population immunity to the coronavirus simply by exposing every single person in the population to the disease ... it's just that millions and millions of people are going to die in the process."

Can we build natural immunity?

The science around immunity to Covid-19 is still developing.

The fact that antibody levels decline over time doesn't necessarily mean that immunity doesn't last, Dowdy says. In other viruses, antibody levels decline over time, too, but the immune response is still able to ramp up again if a person is re-exposed to the virus.

According to Dowdy, our immunity to other coronaviruses tends to last a few years, rather than being life-long. "If those are a guide, then that's what we might expect from this new coronavirus," he said. "But it's hard to say. We don't have any data on this particular virus."

But for now, Tanoto says we don't know how much -- if at all -- these T cells are helping fight off Covid.

In reality, once there is herd immunity -- whether naturally or through vaccines -- it probably won't be the impenetrable shield some people might imagine.

Tanoto's co-author Nina Le Bert, a senior research fellow at Duke-NUS Medical School in Singapore, points out that it's rare to have complete immunity from infection. Instead, immunity often means that a person's body is able to respond fast enough to the virus so that it doesn't gain a foothold -- and doesn't develop enough to infect other people.

"That will be good enough, but that doesn't mean you don't get infected," Le Bert said.

Even if certain areas do achieve herd immunity, it might not last.

The virus could mutate, meaning people who previously had immunity are no longer immune to the new version of the virus, or a person's immunity to the virus might not last long, according to Kleczkowski, from the University of Strathclyde.

"Even if we reach herd immunity at some point in time, we might lose it again," he said. "I don't think it's a silver bullet."

Dowdy says that herd immunity "isn't a magic number" to solve coronavirus.

"It doesn't mean that the disease is going to go away. It means that if you gave it 1,000 years, it would go away."

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More than half of Mumbai's slum residents might have had Covid-19. Here's why herd immunity could still be a long way off - CNN

2 in 5 schools around the world lacked basic handwashing facilities prior to COVID-19 pandemic UNICEF, WHO – World Health Organization

August 14, 2020

As schools worldwide struggle with reopening, the latest data from the WHO/UNICEF Joint Monitoring Programme (JMP) reveal that 43 per cent of schools around the world lacked access to basic handwashing with soap and water in 2019 a key condition for schools to be able to operate safely in the midst of the COVID-19 pandemic.

Global school closures since the onset of the COVID-19 pandemic have presented an unprecedented challenge to childrens education and wellbeing, said Henrietta Fore, UNICEF Executive Director. We must prioritize childrens learning. This means making sure that schools are safe to reopen including with access to hand hygiene, clean drinking water and safe sanitation.

According to the report, around 818 million children lack basic handwashing facilities at their schools, which puts them at increased risk of COVID-19 and other transmittable diseases. More than one third of these children (295 million) are from sub-Saharan Africa. In the least developed countries, 7 out of 10 schools lack basic handwashing facilities and half of schools lack basic sanitation and water services.

The report stresses that governments seeking to control the spread of COVID-19 must balance the need for implementation of public health measures versus the associated social and economic impacts of lockdown measures. Evidence of the negative impacts of prolonged school closures on childrens safety, wellbeing and learning are well-documented, the report says.

Access to water, sanitation and hygiene services is essential for effective infection prevention and control in all settings, including schools," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "It must bea major focus of government strategies for the safe reopening and operation of schools during the ongoing COVID-19 global pandemic.

Other key findings from the report include:

The report identifies several resources necessary for COVID-19 prevention and control in schools, including 10 immediate actions and safety checklists. It builds on guidelines on the safe reopening of schools issued by UNESCO, UNICEF, WFP and the World Bank with practical advice for national and local authorities on how to prepare for safe school reopening and keep children safe when they return to school. The guidelines include several WASH-related protocols on hygiene measures, use of personal protective equipment, cleaning and disinfection, as well as providing access to clean water, handwashing stations with soap, and safe toilets.

UNICEF and WHO are committed to achieving equitable access to adequate WASH services worldwide. The agencies recently launched a joint initiative, Hand Hygiene for All, to support the most vulnerable communities with the means to protect their health and environment. It brings together international partners, national governments, public and private sectors, and civil society to ensure affordable products and services are available, especially in disadvantaged areas.

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For further information, please contact:

Sara Alhattab, UNICEF Headquarters (working out of Jordan), Tel: +962 7 80180363, salhattab@unicef.orgWHO Media Enquiries: Tel: +41 22 791 2222, mediainquiries@who.int

About UNICEF

UNICEF works in some of the worlds toughest places, to reach the worlds most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.

Follow UNICEF onTwitterandFacebook

About WHO

The World Health Organization directs and coordinates international health within the United Nations system. Working with its 194 Member States, WHOs mission is to promote health, keep the world safe and serve the vulnerable.

For more information about WHO, visit http://www.who.int.

FollowWHOonTwitterandFacebook

About the Joint Monitoring Programme

The WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply, Sanitation and Hygiene is responsible for monitoring global progress towards the Sustainable Development Goal (SDG) targets and indicators relating drinking water, sanitation and hygiene (WASH). The JMP produces national, regional and global estimates of progress on WASH in households, schools and health care facilities.

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2 in 5 schools around the world lacked basic handwashing facilities prior to COVID-19 pandemic UNICEF, WHO - World Health Organization

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