As US Struggles, Africa’s COVID-19 Response is Praised

By CARA ANNA

JOHANNESBURG (AP) — At a lecture to peers this month, John Nkengasong showed images that once dogged Africa, with a magazine cover declaring it “The Hopeless Continent.” Then he quoted Ghana’s first president, Kwame Nkrumah: “It is clear that we must find an African solution to our problems, and that this can only be found in African unity.”

The coronavirus pandemic has fractured global relationships. But as director of the Africa Centers for Disease Control and Prevention, Nkengasong has helped to steer Africa’s 54 countries into an alliance praised as responding better than some richer countries, including the United States.

A former U.S. CDC official, he modeled Africa’s version after his ex-employer. Nkengasong is pained to see the U.S. agency struggle. In an interview with The Associated Press, he didn’t name U.S President Donald Trump but cited “factors we all know.”

While the U.S. surpasses 200,000 COVID-19 deaths and the world approaches 1 million, Africa’s surge has been leveling off. Its 1.4 million confirmed cases are far from the horrors predicted. Antibody testing is expected to show many more infections, but most cases are asymptomatic. Just over 34,000 deaths are confirmed on the continent of 1.3 billion people.

“Africa is doing a lot of things right the rest of the world isn’t,” said Gayle Smith, a former administrator with the U.S. Agency for International Development. She’s watched in astonishment as Washington looks inward instead of leading the world. But Africa “is a great story and one that needs to be told.”

Nkengasong, whom the Gates Foundation honors Tuesday with its Global Goalkeeper Award as a “relentless proponent of global collaboration,” is the continent’s most visible narrator. The Cameroon-born virologist insists that Africa can stand up to COVID-19 if given a fighting chance.

Early modeling assumed “a large number of Africans would just die,” Nkengasong said. The Africa CDC decided not to issue projections. “When I looked at the data and the assumptions, I wasn’t convinced,” he said.

Health experts point to Africa’s youthful population as a factor in why COVID-19 hasn’t taken a larger toll, along with swift lockdowns and the later arrival of the virus.

“Be patient,” Nkengasong said. “There’s a lot we still don’t know.”

He warns against complacency, saying a single case can spark a new surge.

As Africa’s top public health official, leading an agency launched only three years ago, he plunged into the race for medical supplies and now a vaccine. At first, it was a shock.

“The collapse of global cooperation and a failure of international solidarity have shoved Africa out of the diagnostics market,” Nkengasong wrote in the journal Nature in April. “If Africa loses, the world loses.”

Supplies slowly improved, and African countries have conducted 13 million tests, enough to cover 1% of the continent’s population. But the ideal is 13 million tests per month, Nkengasong said.

He and other African leaders are haunted by the memories of 12 million Africans dying during the decade it took for affordable HIV drugs to reach the continent. That must not happen again, he said.

This week, more world leaders than ever are gathering online for the biggest global endeavor since COVID-19 appeared, the United Nations General Assembly. If Nkengasong could address them, he would say this: “We should be very careful that history doesn’t record us on the wrong side of it.”

African leaders are expected to say much the same. “The COVID-19 pandemic has shown we have no option but to depend on each other,” Ghana’s president, Nana Akufo-Addo, told the gathering on Monday.

Nkengasong urges African countries not to wait for help and rejects the image of the continent holding a begging bowl. The money is there, he said.

Acting on that idea, Africa’s public and private sectors created an online purchasing platform to focus their negotiating power, launched by the African Union to buy directly from manufacturers. Governments can browse and buy rapid testing kits, N95 masks and ventilators, some now manufactured in Africa in another campaign endorsed by heads of state.

Impressed, Caribbean countries have signed on.

“It’s the only part of the world I’m aware of that actually built a supply chain,” said Smith, the former USAID chief.

When the pandemic began, just two African countries could test for the coronavirus. Now all can. Nkengasong was struck by how much information “doesn’t get translated” to member states, so the Africa CDC holds online training on everything from safely handling bodies to genomic surveillance.

“I look at Africa and I look at the U.S., and I’m more optimistic about Africa, to be honest, because of the leadership there and doing their best despite limited resources,” said Sema Sgaier, director of the Surgo Foundation, which produced a COVID-19 vulnerability index for each region. She spoke even as Africa’s cases were surging weeks ago.

With COVID-19 vaccines the next urgent issue, African countries held a conference to insist on equitable access and explore manufacturing to end their almost complete reliance on the outside world. They began securing the late-stage clinical trials that long have been held outside the continent, aiming to land 10 as soon as possible.

Nkengasong said Africa needs at least 1.5 billion vaccine doses, enough to cover 60% of the population for “herd immunity” with the two likely required doses. That will cost about $10 billion.

The World Health Organization says Africa should receive at least 220 million doses through an international effort to develop and distribute a vaccine known as COVAX.

That’s welcome but not enough, Nkengasong said.

His next hurdle is how to deliver doses throughout the vast continent with the world’s worst infrastructure. Less than half of Africa’s countries have access to modern health care facilities, he said.

COVID-19’s effects are “devastating” for Africa, from education to economies to the fight against other diseases. Nkengasong plans a major conference next year to press countries to significantly increase health spending ahead of the next pandemic.

“If we do not,” he said, “something is terribly wrong with us.”

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Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

13 Former and Present World Leaders Make Urgent Call to Halt Assange's ‘Illegal’ Trial

Morning Star, London

Former Brazilian president Lula da Silva among 165 others urging the British government to free the Wikileaks founder

THIRTEEN former and present world leaders have made an urgent call to the British government to halt Julian Assange’s “illegal” trial on extradition to the US.

Former Brazilian president Lula da Silva is among 165 politicians across 27 countries joining the call to demand the freedom of the Wikileaks founder, currently fighting extradition at the Old Bailey in London.

Endorsing an open letter to PM Boris Johnson, signed by 189 lawyers, Lula said today: “Assange should be perceived as a hero of democracy. He does not deserve to be punished.

“I hope the people of the UK, the people of France, the people of the United States will not allow this atrocity.”

The letter, penned by Lawyers for Assange, claims that the extradition proceedings and request “violate national and international law, breach fair trial rights and other human rights, and threaten press freedom and democracy.”

It alleges that Mr Assange could be at risk of torture in the US, making extradition to the country illegal.

Signatories also include Argentinian President Alberto Angel Fernandez, former Spanish PM Luis Zapatero and Lula’s successor Dilma Rousseff.

The extradition proceedings, which entered their third week on Monday, have been widely criticised for preventing legal observers from entering the court.

Amnesty International today described the judge’s refusal to grant special provision to fair trial monitors as “disturbing.”

“Amnesty International have monitored trials from Guantanamo Bay to Bahrain, Ecuador to Turkey. For our observer to be denied access profoundly undermines open justice,” Amnesty researcher Stefan Simanowitz said.

Mr Assange faces up to 175 years in prison on espionage charges over the release of classified documents in 2010 and 2011, which exposed US atrocities in Iraq and Afghanistan.

Coup President Jeanine Anez Drops Out of Bolivia’s Presidential Race as Polls Show Morales’s Party on Course to Win in First Round

Morning Star, London

BOLIVIA’S coup President Jeanine Anez has dropped out of next month’s presidential elections after polls showed her scraping just over 5 per cent of the vote.

Ms Anez, who was appointed by the army after it forced just re-elected president Evo Morales from power last November, said she was withdrawing “to ensure there is a winner who defends democracy” against Mr Morales’s Movement for Socialism (MAS), which all polls continue to show in first place.

Polls this week showed that MAS candidate Luis Arce would win in the first round with 38.5 per cent of the vote, less than Mr Morales’s 47 per cent first-round win last year, which the opposition refused to accept.

But the showing would avoid a second round run-off because it is more than 10 points ahead of any other candidate, with former president Carlos Mesa in second place on 12.9 per cent.

Fascist paramilitary leader and millionaire Luis Camacho, who organised the violent riots that preceded the army putsch last winter and famously stormed the presidential palace during the coup, tearing down the Pachamama emblem of indigenous Bolivians, is in third place.

Ms Anez did not endorse either, but said the right should unite behind one candidate.

But Mr Morales, who has been banned from standing, said: “Anez and her government are in freefall. On October 18 we will recover democracy and defeat the crisis.”

Bolivia’s ombudsman published a report on Thursday pointing to “crimes against humanity” committed by Ms Anez’s government, which killed scores of mostly indigenous protesters against Mr Morales’s overthrow in its first weeks.

It records that police arrested large numbers simply for demonstrating against the coup, details cases in which individual MAS supporters were tortured or killed and describes an “execution” of 20 people in Sacaba and Senkata on the outskirts of La Paz.

These crimes were “systematically committed against the civilian population under the knowledge of, orders and instructions issued by the transitional government.”

Mr Morales suggested that in the context of the report Ms Anez’s withdrawal from the race could be motivated by her need to “negotiate impunity” for her government’s crimes as well as to unite the right.

Morning Star Editorial: We Need a Zero-Covid Strategy – the Government Must Be Made to Change Course

Morning Star, London

A sign advising people to stay two metres apart on a lamppost in the centre of Bradford

GRIM news on rising Covid-19 cases and forecasts of a spike in deaths make the case for a different approach more urgent.

Britain needs to shift to a zero-Covid strategy, as the experts of Independent Sage warned months ago and as recommended by the Socialist Campaign Group of Labour MPs — though as yet the Labour Party leadership is not on board.

The second wave is the government’s fault. It did not impose the original lockdown as early as it should have done, waiting until coronavirus was already well established throughout the population, making it far harder to suppress.

It then relaxed restrictions in line with business priorities without reference to whether the virus was under control.

It has not established a testing regime for those coming into the country, as exists across most of Europe.

It has handed the development of its test-and-trace system to private companies with no relevant experience and poor records of delivering on previous contracts, and renewed their contracts despite their woeful performance so far.

Boris Johnson’s shambolic handling of the pandemic is not merely a failure of competence but an indictment of a government whose political priority has not been containing or suppressing Covid-19, but managing public reactions to a “world-beating” death rate, continuing the privatisation and fragmentation of health service delivery across Britain and rewarding its friends financially.

This is a political question.

England’s chief medical officer Chris Whitty demonstrates as much when he attempts a public health rationale for maintaining business as usual: “If we go too far the other way [in imposing virus control measures] then we can cause damage to the economy which can feed through to unemployment, to poverty, to deprivation — all of which have long-term health effects.”

Indeed they do, but refusing to prevent rising unemployment is a political choice.

The government could launch a youth guarantee of jobs training or employment, as recommended by the Alliance for Full Employment being championed by former prime minister Gordon Brown and national and regional leaders like Welsh First Minister Mark Drakeford, Greater Manchester Mayor Andy Burnham and North of Tyne Mayor Jamie Driscoll.

It could launch a teacher recruitment drive to facilitate smaller classes at school to enable socially distanced learning, as called for by the National Education Union. It could extend the job retention scheme as many other countries such as France and Germany are doing. It could nationalise stricken industries and protect jobs and skills in them while reshaping them to help meet national goals such as reduced emissions.

As for poverty and deprivation, the government should reverse the huge cuts to local authority budgets imposed over the last decade. It should drop talk of abandoning planned rises to the national minimum wage and introduce a mandatory living wage of £15 an hour as demanded by food workers’ union BFAWU.

It should immediately raise statutory sick pay so that workers who fear they may be infected are not driven to continue working, putting others at risk, for fear of destitution. It should move from its inept test-and-trace programme to one of find, test, trace, isolate and support, so that those who need to isolate are given the help they need to do so without starving or losing their homes.

All these measures are possible, and can contribute to a national zero-Covid strategy that would see the virus reduced to minimal levels and allow widespread safe lifting of restrictions, as we have seen in countries that successfully adopted such a strategy, including China and New Zealand.

The government is not going to adopt such measures simply because they work, however. Ministers are happy for Britain to live with Covid-19, unemployment and poverty. Those of us who aren’t must mobilise to force a change of course by exerting pressure at every level of government and on the streets.

Covid Deaths to Reach More Than 200 Per Day as Britain Heads in the ‘Wrong Direction’

Morning Star, London

THE UK could soon face 50,000 new cases and 200 dead per day unless ministers take more action to protect the public, the government’s scientific advisers warned today.

England’s chief medical officer Professor Chris Whitty and the government’s top scientific adviser Sir Patrick Vallance spoke from Downing Street, unaccompanied by ministers for the first time, after infection rates rose to 6,000 people per day.

Prof Whitty said that the country stands at a “critical point,” with the current trend heading in “the wrong direction” as cases approximately double each week.

Mr Vallance said that the recent rise in infections in all age groups was not due to increased testing.

He warned that if current infection rates continue, there may be 50,000 cases per day by the middle of October and 200 or more deaths per day by mid-November.

It came as the government continued to bungle on the NHS app — due to launch four months late on Thursday — as it backtracked on its earlier claim that it would no longer be used for its intended purpose of tracking and tracing the virus.

Unison general secretary Dave Prentis warned that the situation is “spiralling out of control” and that the current measures and “mixed signals” are not enough.

“There’s simply no time for complacency. The government must make public safety a priority,” he said.

“Strict social distancing, fixing the bungled testing system and ensuring low-paid staff don’t take a financial hit for staying off work are crucial.

“Key workers in the NHS, care, schools and other public services must be protected for all our sakes.”

Shadow health secretary Jonathan Ashworth said: “This rapid spike in infections was not inevitable, but a consequence of the government’s incompetence and failure to put in place an adequate testing system.”

He called for an effective testing and tracing system with support for people to self-isolate, and for a Cobra meeting of all regions to be urgently held.

A new poll commissioned by public-ownership campaign We Own It revealed today that three quarters of the British public want the track-and-trace system to be run by public health teams and local health services rather than private companies.

Serco and call-centre company Sitel were initially contracted to run the system up to August 23, but their contracts were extended with a potential value of £528 million for an undisclosed period.

We Own It director Cat Hobbs said: “It’s absolutely staggering that the government is clinging doggedly to its failed, privatised system.

“It’s time for them to face reality. It’s time for them to kick the private companies out of the system and give local public health protection teams the resources to run it instead.”

Areas in north-west England, West Yorkshire and the Midlands face further local restrictions from on Tuesday.

And in Wales, Bridgend, Merthyr Tydfil, Newport and Blaenau Gwent will be placed under a local lockdown from 6pm.

Health Secretary Matt Hancock said today that the final decisions on national restrictions were still being made, but hinted at curbs to households socialising and refused to say whether pubs in England would still be open this weekend.

Social-media users were angry at the government’s silence following the scientists’ announcement and the hashtag #WhereisBorisJohnson was trending on Twitter.

The PM is expected to hold a press conference on Tuesday.

Labour Party Conference 2020 Call for New Post-Covid and Post-Brexit Internationalism to Beat Global Inequality

A health worker collects a nasal swab sample to test for Covid-19 in Hyderabad, India

INEQUALITY and conflict around the world are the “biggest root challenges” that we face, TUC general secretary Frances O’Grady said today in her call for a “new internationalism.”

She was speaking at the Labour Party online conference event The Global Response to Covid, also attended by shadow foreign secretary Lisa Nandy.

Ms O’Grady said that there should be an “international commitment to full employment, rising living standards, fair shares of wealth, trade-union rights and collective bargaining, welfare, maternity rights, recreation, and culture for all.”

She stressed that lasting global peace can “only be established by social justice,” and that that is achievable though international co-operation.

Ms Nandy said that a Labour government would construct a foreign policy “fit for this century rather than the circumstances of the last.”

She said: “In a world spinning out of control, our anchor is our values — the values that the Attlee government used to anchor a world reeling from war: human rights, democracy, freedom of speech and the rule of law.

“But new times require new priorities, so to this list we will add new values of human security, feminism, and environmentalism at the core of our approach.”

Ms Nandy also sought to explain the Labour leadership’s slogan of “putting British people first,” especially in the context of internationalism. The slogan was chosen to appeal to former Labour voters who voted for the Tories en masse because Labour threatened to overturn the EU referendum result.

She said: “When we say we will always put British people first, that is a commitment to internationalism rooted in an understanding that working people’s interests are bound together and a belief that things can and must change,” she waffled.

“We will be rooting foreign policy in the interests of working people here and across the world. If globalisation isn’t working for them, it isn’t working at all.”

Neoliberal Governments Letting Coronavirus 'Run Amok,' Charges Diane Abbott at Labour Fringe

Morning Star, London

Sunday evening’s meeting, titled Fighting the Tories – Transforming the Economy, was hosted by Unite assistant general secretary Steve Turner

NEOLIBERAL governments in Britain, the US, and Brazil have let the coronavirus run amok, Labour MP Diane Abbott said during an online party-conference fringe event.

Sunday evening’s meeting, titled Fighting the Tories – Transforming the Economy, was hosted by Unite assistant general secretary Steve Turner.

Ms Abbott pointed out that the three countries have some of the worst Covid-19 death rates per capita.

She said: “It is a myth that they were trading off lives for the economy. New Zealand put people first and are projected to have one of the mildest recessions.

“We should work to eliminate [the virus], and we demand that jobs and people’s lives are the priority.”

Labour MP Richard Burgon said that it is time for the labour movement to promote policies in Labour’s 2017 and 2019 manifestos and a zero-Covid strategy similar to those of China and Vietnam, where the virus is almost eliminated.

He said: “It’s a precondition to getting the economy started.”

Economist and author Grace Blakeley said that the pandemic has shown that Britain is “run in the interests of a tiny cabal that has a stronghold on every single aspect of our lives.”

The way forward is democratising the economy by giving workers more control over institutions, she said.

Des Moines Says No to Governor’s Demand for Classroom Return

By SCOTT McFETRIDGE

September 20, 2020

FILE - In this Sept. 7, 2020, file photo, Des Moines Public School students and supporters march from Roosevelt High School to the Governor's Mansion at Terrace Hill to protest the cancellation of fall and winter extracurriculars, in Des Moines, Iowa. All in-person activities were suspended this month as the district's classroom instruction remains virtual. (Olivia Sun/The Des Moines Register via AP, File)

DES MOINES, Iowa (AP) — Students in Iowa’s largest school system are facing the possibility that this most unusual school year could stretch into next summer, and the district could be hit with crippling bills because of a dispute with the governor over the safety of returning to classrooms during the coronavirus pandemic.

Des Moines school officials have repeatedly refused to abide by Republican Gov. Kim Reynolds’ order requiring the state’s 327 school districts to hold at least half their classes in-person rather than online. For Des Moines, it’s a question of trying to keep its more than 33,000 students and 5,000 staffers from contracting the disease. But after the school board last week again voted to violate Reynolds’ order, the governor called the action “unacceptable” and began the process for punishing the district.

Reynolds has dismissed Des Moines’ officials’ concerns, noting that nearly all other Iowa districts have reopened their classrooms despite some virus outbreaks and the occasional need to quarantine students, saying, “Where there’s a will, there’s a way.”

School districts across the country have struggled with the decision of whether to return to classrooms despite the risk of coronavirus infections or shift to online learning, and the choice is especially stark for Iowa’s capital city. Des Moines has had one of the nation’s highest rates of people testing positive for COVID-19, and school board members ask how it would be possible to enforce social distancing rules in their crowded classrooms and packed school buses.

The school board delayed the start of school by a week as the district sought a court injunction to block the governor’s order, arguing that she had overstepped her authority. A judge initially sided with the governor, but the district proceeded with its plan to distribute thousands of laptops to students and launched a completely online course offering on Sept. 8.

District officials have said they’re deeply troubled to be out of compliance with state standards, but they believe the governor has put them in a no-win situation by ordering students to spend at least half their time in classroom. Reynolds’ order does allow waivers allowing online-only instruction, but only for districts where more than 15% of people test positive for the virus, which is triple the 5% positivity rate that the Centers for Disease Control and Prevention and other health experts say would be appropriate for resuming in-person classes.

The district notes that 31% of its staff members have health concerns that put them at higher risk from COVID-19 and 10% are older than 60. If forced to resume classes, officials contend that many teachers and bus drivers would quit rather than risk being infected by the virus.

The positivity rate in Polk County, where most of Des Moines is located, reached 12% earlier in September but recently dropped to about 7%.

“Except for our state Department of Public Health, every other health expert we talk to doesn’t understand why we’re even having to have this fight because they recognize it isn’t safe for us to reopen our schools,” said Des Moines Superintendent Tom Ahart. “It feels like operating in an alternate reality.”

If they find the district is out of compliance, state officials could take a variety of actions, including requiring the district to keep students in classes until the end of June — nearly a month later than usual. A district official said each additional day would cost about $1.5 million, draining the district’s reserves within days.

District officials have assured students that they will get credit for the online classes they’re taking, but parent Jason Hahn told school board members at a recent online meeting that he was worried they could be wrong, since the district lost the first round in its lawsuit. The longer the district continues with only online learning, the deeper the financial risk, he said.

“The end result of continuing to operate without an approved plan will likely be a district that loses accreditation and that is bankrupt,” Hahn said. “This scenario would be catastrophic for the community, the district and the students.”

Reynolds is the only Midwest governor to issue a statewide order requiring in-person instruction, with all other states in the region leaving decisions to local school districts. Reynolds, a strong supporter of President Donald Trump who has demanded on Twitter that “SCHOOLS MUST OPEN IN THE FALL,” also has refused to issue a statewide mask requirement and told at least 10 cities that they can’t enforce local mandates because they would exceed her actions.

Although Des Moines’ lawsuit hasn’t been resolved, a judge ruled that the state has power over school districts, even if its rationale is based on flawed coronavirus benchmarks. In a separate lawsuit, another judge sided with the state and against Iowa City schools and a teachers union, saying the governor has broad emergency powers that local school boards don’t have.

The union, the Iowa State Education Association, opposed the governor’s action, but a teacher walkout is unlikely because state law prohibits public employees from striking.

The state first issued its requirements to school districts in July, and at a news conference Wednesday, the governor expressed exasperation at what she called Des Moines’ “slow walk to compliance.”

Asked how the state would respond, Education Department Director Ann Lebo wouldn’t be specific but said the agency would begin a process to punish the district for not complying.

“We were very hopeful to work with the district to find a solution,” Lebo said. “At this point it seems they are well into a plan that is out of compliance and will continue to do so, so we will have to initiate that process on our end.”

The school board will discuss the issue again Monday night and will consider a plan still being developed that would include a part-time return to classrooms.

Middle school Spanish teacher Trisha Peckosh, who has children in the district, said it’s hard to see how the district and state will resolve the dispute. It’s true that students would learn better if they were in classroom, but Des Moines is right to worry about the safety of students and staff, she said.

“Everybody is in such a hard position,” she said. “Every time you come up with a solution that could work, there’s a roadblock.”

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Follow Scott McFetridge on Twitter: https://twitter.com/smcfetridge

COVID ‘Long Haulers’ Suffer Symptoms Weeks, Months, Later

By CLAIRE CLEVELAND

September 20, 2020

Malea Anderson, who has suffered headaches, fatigue and other symptoms she suspects are related to the coronavirus, is shown at her home in Erie, Colo., Thursday, Aug. 27, 2020. In Colorado, Anderson and dozens of people report a wide range of lingering COVID-19 symptoms that last for weeks, even months, but little is known about the reasons why. (Hart Van Denburg/Colorado Public Radio via AP)

DENVER (AP) — In the early hours of an April morning, at her home in Erie, Malea Anderson woke up with what felt like an explosion of ice water up her spine and into her head. She had a massive headache and tried to get out of bed to go to the bathroom, but her limbs wouldn’t cooperate. She feared she was having a stroke.

Her partner, Randy, took her to the emergency room. The doctor suspected she had COVID-19, but she couldn’t get a test. At the hospital, the 53-year-old had a brain scan that came back normal — no stroke. She was sent home from the hospital, again.

It was her second visit to the emergency room in a matter of weeks and third since March. She’d had countless telehealth appointments with various primary care physicians, seen specialists and started taking supplements like vitamin D and zinc to help with her long list of symptoms: fatigue, brain fog, exhaustion, headaches, vertigo, shortness of breath, chest pain, muscle aches.

Some days she feels like she might be getting better. Then she crashes again.

“I got to where I could walk and function and maybe go make dinner. So I would get up, I would make coffee. And that would determine how the day went,” Anderson told Colorado Public Radio. “Most days I would come back to bed. If I could plan meals for my family, that would be a good day. And then outside of that, I was in bed.”

Anderson isn’t alone. A Facebook group called Survivor Corps for those who describe themselves as “long haulers” has just over 102,000 members. While the World Health Organization estimates that 80 percent of COVID-19 infections “are mild or asymptomatic,” and patients recover after two weeks, those who are still suffering question the notion of a “mild” case.

In Colorado, dozens of people report a wide range of lingering symptoms including shortness of breath, elevated heart rate, fatigue and malaise, headaches, gastrointestinal issues, body aches, brain fog and more.

“I call it the trifecta. I have fatigue, insomnia and exhaustion,” said Cindy Maetzold, who lives in Snowmass. “But when I say fatigue, I’ll go for a walk, and I’ll come back and I just sit down, do nothing. It’s not that I’m lazy. It’s that I don’t have the energy to do anything.”

It’s not clear how many people have had lingering symptoms, and how many moving forward will. In a multistate phone survey of adults who tested positive for the virus, 35 percent had not returned to their pre-Covid-19 health 2 to 3 weeks after their test, according to the Centers for Disease Control and Prevention.

A small study out of Italy that surveyed 179 patients, found that 87 percent of patients who were hospitalized still had symptoms 60 days after they started feeling sick. A small study in Germany found that 78 percent of COVID-19 patients had lingering heart problems two to three months out.

In Colorado Springs, Dr. Robert Lam and his medical students started surveying patients with COVID-19 after they left the hospital. The survey asks about mental, physical and financial health. Initially, the mental implications of isolation and loneliness stood out, until they started to notice some patients just weren’t recovering.

“Our initial results showed that up to a fourth of patients were still having lingering symptoms of COVID. And so that was something that we didn’t expect,” Lam said. “We are starting to see hints and concerns that there is probably some potential long term lung damage as we’re not seeing patients recover completely.”

Lam’s patient population spent time in the hospital, so their long-term impacts will likely be different from those of people like Anderson who were never admitted, never on a ventilator and never treated for COVID-19.

To complicate matters even more, many patients like Anderson weren’t able to get a PCR test while they were sick because of a lack of tests in the early months of the pandemic. It further distorts the picture of how many people have contracted the virus, and of those, how many still have symptoms.

On Jan. 15, Ty Godwin, 58, was in South Africa on a work trip. He works in sales and travels internationally a dozen times a year. That night he woke up to his sheets wet from sweat. Like most people in the U.S., he hadn’t heard of COVID-19 yet, but he had been traveling internationally for work. It was one of the dozen trips he takes a year. What he thought was a normal cold or flu hung on for weeks.

“I’ve had three CT scans. I’ve had two echocardiograms. I had a $25,000 PET scan of my entire body,” Godwin said. “And I’ve been tested for everything from Lyme disease to HIV, to anything and everything you could imagine.”

None of those tests resulted in a diagnosis. As he learned more, he started to suspect he might have had the coronavirus. It took time and many tests, but his doctor now thinks the culprit is COVID-19. Early on, he had all the common symptoms, although he got an antibody test that came back negative.

He’s been to the doctor at least 40 times since January, and he’s registered a fever at some point in the day, every day since.

“I think people have figured out to not ask me, are you feeling better today? There are no good days. There are good hours in the day. Typically mornings are pretty decent, but you know, yesterday I had a fever at 10:30 in the morning,” Godwin said. “There’s a time when, I call it the witching hour, where more debilitating fatigue would kick in at the end of my business day, and sometimes that creeps in during the day.”

After months of research on the SARS-CoV-2 virus and COVID-19, the disease it causes, much still remains unclear. There’s no approved treatment nor vaccine, yet, and so doctors are left to use trial treatments and focus on treating symptoms.

“When you’ve done your traditional testing and you’ve looked at CAT scans and functional tests, and looked at the data and everything is normal, it’s also frustrating for docs out there because they don’t know what to do,” said Dr. Nir Goldstein, a pulmonologist at National Jewish Health. “It doesn’t look like there’s anything to fix and you don’t know how to fix it. We can at least offer these patients some guidance and at least make them feel like they’re not alone and they’re not crazy.”

Some patients have struggled with their doctors not believing them, a phenomenon that’s been documented more often in female patients. Anderson met with a new primary care provider looking for more answers. She was telling him about her shortness of breath when he suggested that perhaps she had anxiety.

“I was like, I do not have anxiety,” she said. “And he’s still only sort of taking me seriously, but I did get a referral to a neurologist. And, um, she listened, but they don’t know. They just don’t know what’s going on. You know, they prescribed me the low half of a low dose of anxiety medicine. And it has not really helped.”

And not everyone has found their community to be more supportive.

“When I talk to people who knew I had COVID back in May, and I talk to them now, they find out I’m still recovering, they tend to be really surprised,” said Paul Nielsen, a 60-year-old data architect who lives in Colorado Springs. “I think people don’t understand how much damage it does to your body.”

Nielsen turned to the internet to find community in online forums like Survivor Corps that helped him to navigate the disease process. He also found a community of people who understood what he was going through. But, there are also people in other Facebook groups who don’t understand.

“I find it very frustrating when people say the pandemic as a hoax, or it’s just being politicized or they don’t feel like they need to wear a mask. Or there’s an easy cure with hydroxychloroquine, plus a z-pack plus zinc,” he said. “I know from my experience, that the COVID disease is much more complex than any one simple, you know, here you go, it’s cured.”

Right now, the only thing doctors can do is treat the symptoms

The lives of people with lingering symptoms have been flattened, and in many cases, reduced to long bouts of fatigue, racing heart rate and brain fog.

“I like to say I’m relatively intelligent and sort of articulate, and now I feel like I’m completely inarticulate and incapable of putting a story together in any sort of logical way,” said Tara Schumacher, who got sick in mid-March. “If I don’t write things down, if I don’t make a list before I go to the store, I’m not bringing back the things that I meant to.”

Schumacher, 47, is a landscape photographer and runs an Airbnb out of her home in Fort Collins. The worst of her symptoms lasted through May. Now, she’s left with lingering brain fog. This week, nearly five months after her first symptoms, she was diagnosed with post-COVID pneumonia.

Until there’s more research on long haulers, all doctors can do is treat the symptoms.

“And so it’s mainly supportive therapy, and we don’t even really know what the best ones are. We are going to try them and we’re going to see how people do. And we’re going to read the literature and develop and change as more information becomes available,” Goldstein said. “And hopefully we’ll publish our own experience, but it’s really a lot of learning on the job with these patients. There are no established guidelines or trials that can guide you.”

In the meantime, patients are left to wait and hope they get better soon.

‘I Miss Mommy’: Families Shattered by COVID Forge New Paths

By MATT SEDENSKY, KELLI KENNEDY and DAVID CRARY

Siblings, from left, Katherine, Jennifer, Jazzmyn and Zavion look at their mother Lunisol Guzman's wedding album, Thursday, Sept. 17, 2020, in Newark, N.J. Four-year-old Zavion and 2-year-old Jazzmyn have been taken in by the oldest of Lunisol Guzman's other three children, Katherine and Jennifer, after she died from symptoms of coronavirus. Lunisol Guzman had adopted them when she was in her 40s. (AP Photo/Mary Altaffer)

Just four months had passed since Ramon Ramirez buried his wife and now, here he was, hospitalized himself with COVID-19. The prognosis was dire, and the fate of his younger children consumed him. Before ending his final video call with his oldest, a 29-year-old single mother of two, he had one final request: “Take care of your brothers.”

Before long, he was added to the rolls of the pandemic’s dead, and his daughter, Marlene Torres, was handed the crushing task of making good on her promise. Overnight, her home ballooned, with her four siblings, ages 11 to 19, joining her own two children, 2 and 8.

The emotional and financial demands are so overwhelming that Torres finds herself pleading to the heavens. “Please help me,” she begs her parents. “Guide me.”

As the U.S. approaches the milestone of 200,000 pandemic deaths, the pain repeats: An Ohio boy, too young for words of his own, who plants a kiss on a photo of his dead mother. A New Jersey toddler, months ago the center of a joyous, balloon-filled birthday, now in therapy over the loss of her father. Three siblings who lost both mom and dad, thrusting the oldest child, a 21 year old, into the role of parent to his sisters.

With eight in 10 American virus victims age 65 and older, it’s easy to view the young as having been spared its wrath. But among the dead are an untold number of parents who’ve left behind children that constitute another kind of victim.

Micah Terry, 11, of Clinton Township, Michigan, misses seeing his dad at his karate classes, stopping by his father’s workplace, and sneaking in chicken nuggets with him at the movies. At his saddest points, he talks about him all day. But his brother, 16-year-old Joshua, grows quiet when the grief hits, channeling his feelings through the piano, which he learned to play from his father.

“My dad was my best friend,” Joshua says about Marshall Terry III, who died in April. “My goal is to make him proud while he watches from heaven.”

In Waldwick, New Jersey, Pamela Addison’s 10-month-old son Graeme is bubbly and doesn’t seem to notice his father is missing, but it’s different for her daughter, Elsie. Addison sees the tot’s last truly happy day as her birthday in March, when Papa bought balloons and the virus seemed a distant threat.

Martin Addison was dead a month later at 44; today, Elsie, at the tender age of 2, is in grief counseling to handle it all.

“She’s having a difficult time adjusting to the fact he’s not coming home,” Addison says.

Four-year-old Zavion and 2-year-old Jazzmyn have been taken in by siblings after the death of their mother, 50-year-old Lunisol Guzman of Newark, New Jersey, who had adopted them when she was in her 40s. The oldest of her other three children, Katherine and Jennifer Guzman, swiftly decided to seek guardianship.

“These kids are our family,” Katherine said. “For us, it was a no-brainer.”

She says that Zavion and Jazzmyn are mostly resilient, but occasionally utter the same simple, heartbreaking sentence: “I miss mommy.”

No authoritative count of parents of minors lost to the coronavirus has been tallied, but it appears certain to run into the thousands in the U.S. Some children are now landing in the homes of grandparents like Anadelia Diaz, whose 29-year-old daughter, a single mother of three, died of COVID-19.

“I don’t call it a burden,” says Diaz, of Lake Worth, Florida. “It’s unconditional love.

Her 15-year-old grandson has long lived with her, but Diaz feels like a new mother again, aching from racing after two little ones – one 18 months old, another a year older – in a yard now dotted with a swing set and a kiddie pool.

She and her husband once dreamed of a vacation in Alaska; now she’s had to stop working as a housekeeper and even a trip to the grocery store is an ordeal. The toddlers were used to sharing one room with their mother and, striving not to disrupt their routine even more, Diaz now sleeps in her den with them, where they wake each morning to a big picture of their mother on the wall.

Losing a daughter felt like losing part of herself. Her daughter’s memory is what keeps Diaz going. She turned 56 the day she buried Samantha, and she prayed she could survive to see the children through to adulthood.

“All I ask God is for our health and for strength, nothing else,” she says.

Stepping in for those who’ve died can be uncertain terrain.

After Ramath Mzpeh Warith and Sierra Warith married and had their first child, Ramath Jr., they settled on a division of labor: Mom would focus on classes to become an ophthalmologic assistant and handle most childcare responsibilities. Dad would work late as a Cleveland bus driver to support them.

As they awaited their second baby, though, both parents tested positive for the coronavirus and, while Ramath was mostly asymptomatic, Sierra grew sicker. After she was hospitalized, a baby boy named Zephiniah was born by C-section on May 14.

Sierra never would be well enough to hold him. She died a day before she would have turned 24.

Suddenly, he was mourning the love of his life and learning to take on all the things he relied on her to do. He took parenting classes at the hospital and his mother moved in upstairs so she could help. His 20-month-old, Junior, plants kisses on a picture of his mother and cries that he’s no longer nursed to sleep or cuddling beside her in bed.

Warith, 38, knows he will one day have to sit his boys down and tell them about their mother. But for now, he’s taking it day by day, trying to be the best father he can be in a forever-altered life.

“They still need a parent,” he says. “They still need to be hugged and kissed and loved.”

It’s impossible not to think of how things were before the losses the pandemic wrought.

For Nashwan Ayram of Sterling Heights, Michigan, it was a life of staying up late and sleeping until noon, and afternoons enjoying his mother’s cakes. He was used to being spoiled by his parents, used to carefree plans like a summer backpacking trip in Europe, used to a life with few responsibilities.

“I used to wake up having a full tank of gas in my Camaro,” he says, “worrying about nothing.”

Now, both of the 21-year-old’s parents are dead of the virus, and he’s left watching over two sisters he never felt particularly close to before. He’s teaching 18-year-old Nadeen to drive and helping 13-year-old Nanssy with school, all while attending to daily chores like grocery shopping and weeding through a mountain of paperwork to handle his parents’ affairs and become a legal guardian.

He feels anger at his parents for dying and robbing him of his carefree life. He also calls them heroes for being so brave to leave their native Iraq and build a new life in the U.S. In a weird way, he says, losing them both at once may have been easier than only losing one: Now, he knows, life can never get worse.

Ayram wishes he could return to a carefree life of partying and freedom, but knows what he must do to make his parents proud.

“It’s the only thing I can do,” he says. “Honestly, it’s just me living for my sisters.”

Sedensky can be reached at msedensky@ap.org and https://twitter.com/sedensky.

 ZANU PF Indaba to Observe Covid-19 Rules

22 SEP, 2020 - 00:09 

Zimbabwe Herald

ZANU PF acting spokesperson Cde Patrick Chinamasa (centre) addresses the media flanked by secretary for External Affairs Cde Simbarashe Mumbengegwi (right) and Secretary for Indigenisation and Economic Empowerment Dr Mike Bimha in Harare yesterday. — Picture Memory Mangombe

Herald Reporter

AHEAD of its annual conference to be held in Bindura, Mashonaland Central, the ruling Zanu PF party has hinted that it is likely to reduce the number of delegates in line with the Covid-19 regulations.

The 19th Zanu PF Annual People’s Conference will be held in December and yesterday the party’s acting spokesperson Cde Patrick Chinamasa told journalists that preparations for the annual party indaba were going on well.

“As we go forward, we are looking forward to holding our 19th Annual People’s Conference whose venue is Bindura and this will take place in December, but the format will take into account Covid-19 regulations and when we get nearer to that date party cadres in all provinces and structures will be informed as to the numbers that will be allowed to attend and the format it will take in order to take into consideration the Covid 19 regulations,” he said.

However, as Zimbabwe begins to flatten the curve of the pandemic, the Government is gradually opening the economy, all the while observing the WHO set regulations.

Apart from discussing the easing of the lockdown, which has resulted in the reopening of school examination classes, extension of operating hours for business and re-introduction of inter-city bus operations, the Central Committee was also briefed on the ongoing DCC elections by the party political commissar Cde Victor Matemadanda.

“The emphasis by the political commissar was that there would be no imposition of candidates, there would be no vote buying and that no other nefarious activities will be tolerated. As of now the process of submission of CVs has been completed and they are now in the process of being transmitted to the Political Commissar,” Cde Chinamasa.

He said the Commissariat and the Security Departments would carry out the vetting of candidates and warned that those fomenting factionalism and other forms of indiscipline would be punished. The Central Committee was briefed on the Pfumvudza Concept by Lands, Agriculture, Water and Rural Resettlement Deputy Minister Vangelis Haritatos.

Over three million people have been trained under the programme and will benefit from the Presidential Input Scheme.

Zanu PF Secretary for External Affairs Cde Simbarashe Mumbengegwi appraised the Central Committee of the recent bilateral meeting between Zanu PF and the South Africa’s ANC.

He said the meeting dispelled notions of a crisis in Zimbabwe adding the relations between the two liberation movements remained strong. Cde Mumbengegwi said Zimbabwe like any other country was facing its challenges which were, however, surmountable.

“As sister parties and former liberation movements it is our responsibility in the process of resolving these challenges which are not of our making but of various situations which have arisen,” he said. “We also agreed that an attack on Zanu PF by our usual detractors is an attack on the ANC and other liberation movements. An attack on one is an attack on all of us and therefore we must all work in solidarity in order to defeat the agents of regime change,” Cde Mumbengegwi said.

Cde Mike Bimha who is the Zanu PF Secretary for Indigenisation and Empowerment also briefed the Central Committee on the review of the indigenisation and empowerment policy.

Zambia Sees Reduction in COVID-19 Cases

By Natasha Sakala

20th September 2020

Health Minister Chitalu Chilufya gives a COVID-19 update

MINISTER of Health Dr Chitalu Chilufya says the country has seen a reduction in the number of COVID-19 cases after recording a low of 61 new cases from 1,521 tests done in the last 24 hours.

And Dr Chilufya data following the reduction in cases, the daily update will now be done twice a week with statistics released on a daily basis.

Meanwhile, director of clinical services Professor Lloyd Mulenga says schools should ensure that they have safe places where children and learners can go and breath after having a mask for a long while.

Speaking during the daily update, Sunday, Dr Chilufya noted that the country had seen a reduction in the number of patients in the isolation centres which was a good indicator for the country.

“Today, we continue to see a reduction in the number of patients in the hospitals, in the COVID-19 facilities, which is a good indicator. We see a critical mass of citizens in various parts of the country wearing masks, it’s a good thing. It is the reason why we have seen a reduced transmission, we have seen reduced transmission from the tests that we do. This must be encouraged…In the last few weeks, you noted we had high numbers of people in our hospitals who were very sick, we needed to mop,” Dr Chilufya said. “Kudos to the clinical teams, they kept the mortality low and treated a lot of our patients who have been discharged. The reduced numbers that we see in our clinical facilities gives us yet another window to push back the interventions in the community where we must ensure transmission is disrupted and we close the leaking tap in the community and we continue to see less and less numbers in our hospitals until we have zero number of cases in our hospitals.”

He said more of the new cases were from communities and truck drivers.

“61 cases have been recorded in the last 24 hours out of 1,521 tests done and these have been recorded in Lusaka, Nakonde, Kabwe, Serenje. Therefore, our cumulative number of cases now stands at 14,131. The distribution, again you see truck drivers, you see members of the community during routine screening,” Dr Chilufya said. “When we look at the number of deaths, the total number of deaths stands at 330 and these are classified as 111 due to COVID-19, 216 due to COVID-19 related deaths and 3 others are being reviewed. As we speak today, we have seen a reduced number of cases in our COVID-19 facilities, a good indicator but that also summons us to shift the fight into the community. So 34 patients in our various facilities with 15 on oxygen.”

He said the reduced community transmission was attributable to the improved use of masks in the country.

“So the understanding of the situation today with the reduced numbers in the hospitals is that cases which are coming in are going lower, the community transmission is reduced and this is attributable to the improved use of masks. Going around the country, I have seen a critical mass of Zambians wearing masks, therefore the sensitization has been working. This can be sustained only if we upscale these same measures we have been talking about, the five golden rules,” Dr Chilufya said.

And the Minister announced that the mode of updates would change, with live briefings only being done on Mondays and Fridays white an updatable dashboard of statistics would be released on a daily basis.

“The compliance levels countrywide to health measures, generally, has improved. Positivity has gone down, today we report the lowest positivity of four percent. This is commendable and we must commend the public for adhering to the golden rules of masking up in addition to other rules. This is informing the cautious relaxation of restrictions. Going forward, as the number of cases of COVID-19 is abetting and the community is responding very well in engaging with us, the updates are going to be equally restructured. We are now going to be issuing updates twice in a week on Monday we will be reviewing the weekend and on Friday, we will be reviewing what has happened during the week but on a daily basis, there will be press releases or an updatable dashboard which will show you the new cases on a daily basis,” said Dr Chilufya.

Meanwhile, Prof Mulenga said the confidence to stop children from masking up is derived from the data showing 0.05 positivity in that age group.

“We look at the age group of two years and also looked at the age group below five years and for us, we looked at the data which we have had in Zambia; those less than five years, less than 0.05 percent have been infected. So when we looked at that data, we found that the risk of acquisition is low, which can give us confidence that we can recommend no masking for those below five. However, even as we do so, we need to protect these little ones, which is why we need to have safe places in the school places so that even those who are masking up can have time to breath,” said Prof Mulenga.

“The recommendation for Zambia is those who are five years and above should mask up, then those who are below five years, they should not but we are advising that they should have a loose cloth around the face. Now that cloth when it’s put on the face, it’s largely trying to protect the individuals who they infect, it’s not protecting them. It’s protecting the one who is next to them, if they have COVID-19.”

Angola: Covid-19 - Health Ministry Reiterates Strict Measures in Churches

21 SEPTEMBER 2020

Angola Press Agency (Luanda)

Luanda — Ministry of Health (MINSA) has recommended strict preventive measures against Covid-19 during the church services.

Churches resumed their activity on Saturday (September 19) in Luanda.

Church services and worships, with large gatherings, had been banned from March this year, in the light of the State of Emergency, as part of measure to contain the spread of virus.

The return of the activities comes in compliance of the last Presidential Decree on the Public Calamity Situation, in force since 09 September.

The decree imposes stricter biosafety measures inside the temples.

Measures include creation of biosafety conditions to meet the health authorities' demand.

Churches are also required to provide hygiene equipments to ensure the hand washing, use of face masks, inside and outside the temple.

The Health Authorities also recommends measurement of body temperature and 50% capacity of the place when held indoors.

"The disease is not very friendly with the people. People should observe social distancing, defined capacity and biosafety measures", said Franco Mufinda, Secretary of State for Public Health.

Angola Negotiates $6.2 Billion Debt Relief From Creditors: IMF

Sept. 21, 2020, at 11:15 a.m.

BY KARIN STROHECKER AND Joe Bavier

LONDON/JOHANNESBURG (Reuters) - Angola will receive $6.2 billion in debt relief over the next three years thanks to agreements lined up with three of its major creditors, the International Monetary Fund (IMF) said in a report released on Monday.

On Friday, Angola said it was close to striking debt agreements with a number of Chinese banks and government agencies.

The African oil exporter has buckled under a rising debt burden following a sharp decline in crude prices and amid the economic fallout from the coronavirus pandemic.

"Although debt is sustainable, significant vulnerabilities remain," the IMF said in its report. "Debt dynamics are highly sensitive to further oil-price volatility."

In a letter included in the report, the Angolan government, which has already sought relief from official bilateral creditors under an initiative backed by the Group of 20 (G20) wealthy economies, acknowledged its precarious position.

"To the extent that unforeseen risks to achieving the medium-term debt target materialise, we will act to mitigate those risks, including by seeking additional debt relief from a wider group of creditors," it said.

Private sector participation in debt relief has become a hotly debated issue ahead of a decision by the G20 on whether to extend debt payment holidays beyond 2020.

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While the World Bank has pushed for private creditors to shoulder some of the burden of debt relief, investors as well as some governments have argued this would endanger their access to international capital markets.

Asked about the prospect of compulsory private creditor involvement on Friday, Angola's Secretary of State for Budget and Investment Aia-Eza Silva told Reuters: "Our main focus now is to deal with the main creditors, our big (bilateral) creditors, and this is where we are putting our emphasis now." Meanwhile a 5% plunge in oil prices has added to the pressure on Angola's dollar bonds , which dropped more than 4 cents in the dollar to trade at just over 86 cents, their lowest level since mid-July according to Tradeweb data.

CHINESE DEBT

Angola owes more than $20 billion to a number of Chinese entities, including $14.5 billion to the China Development Bank (CDB) [CHDB.UL], and nearly $5 billion to the Export-Import Bank of China (EximBank) <2544.HK>. It has also borrowed from China's largest lender, ICBC.

While the IMF declined to name the creditors involved in the debt reprofiling deals, two private analysts following the negotiations said two of them were the CDB and EximBank.

Luanda struck a deal with one of its largest creditors, identified by the analysts as the CDB, in June, the IMF said. That agreement grants a three-year deferral of principal payments on three loans, with the largest one to be repaid over seven years thereafter.

An agreement with a second large creditor, identified by the analysts as EximBank, is being worked out with a similar reprofiling of principal payments, the IMF said in the report.

"The authorities have secured concrete and credible financing assurances from these creditors," it said.

Meanwhile, discussions with a third creditor were ongoing, according to the report.

The Fund estimated that Angola's debt-to-GDP ratio would steadily decline from just over 120% predicted for the end of the year to 37.8% by the end of 2030.

(Reporting by Karin Strohecker in London and Joe Bavier in Johannesburg; Editing by Tommy Wilkes and Hugh Lawson)

Total CEO Meets Mozambique’s President Over Growing Security Concerns

9/21/2020

MAPUTO, MOZAMBIQUE (Bloomberg) - Total CEO Patrick Pouyanné and Mozambican president Filipe Nyusi met to discuss an intensifying Islamic State-linked insurgency in the country’s north, where the French oil giant is building a massive natural-gas project.

For more than a month, militants have occupied a town about 60 kilometers (37 miles) south of where Total is spending $20 billion to extract natural gas from below the ocean and export it to European and Asian customers. The violence is now creeping toward Total’s Mozambique LNG project in the far northeast.

Recent videos that appear to show abuses, including torture and executions of civilians, by Mozambique’s army suggest the Cabo Delgado province has become increasingly lawless. Total last month said it signed an agreement with the government for a joint task force to provide security to the project. Hundreds of Mozambican soldiers had already been guarding the site.

“The security situation in Cabo Delgado was at the core of the discussion between President Nyusi and Patrick Pouyanné,” a Total spokesperson said of the Sept. 12 meeting in Maputo, the capital. “The government of Mozambique recently reiterated its commitment to respect international humanitarian law.”

Two days after the meeting, a widely shared video of men in military uniform gunning down a naked woman caused a public outcry in the country. Amnesty International said it has verified the men as government soldiers and that the incident occurred near a town less than 100 kilometers from the LNG project.

Woman Executed

A statement from the presidency about the meeting didn’t mention security. The Mozambican government has consistently tried to downplay the insurgency since it began nearly three years ago. The state has also rejected accusations by rights groups that its military is committing abuses and has blamed the insurgents for fabricating the videos.

The execution of the woman was carried out by the same forces who protect the natural-gas projects, according to the Center for Democracy and Development, a local non-governmental organization.

“There is no way to dissociate the LNG companies from this situation, as the army is in Cabo Delgado to protect above all the LNG projects,” Adriano Nuvunga, who heads the center, said in an interview.

Local Communities

“Total unequivocally denounces and condemns all forms of violence,” the company said. “The Group is concerned by the violence in Cabo Delgado, which affects local communities first and foremost.”

The memorandum of understanding the company signed with the government includes specific clauses to report, investigate and address any grievance closely or remotely related to the joint task force protecting the project, Total said. The agreement “includes very strict provisions on the respect of human rights,” it said in an emailed response to questions.

The violence has cost more than 1,900 lives and displaced at least 250,000 people in one of the poorest regions of the world. The European Union’s parliament this week declared “grave concern” and urged the authorities “to take effective and decisive action in countering the Islamist insurgence and to protect all citizens of Cabo Delgado.”

If not stopped, the insurgency could grow and spill over into neighboring countries, threatening regional stability, the EU said in an emailed statement.

Illicit Gold Trade Thriving in DR Congo: Report

Traders, exporters legally registered in DRC, Rwanda, Uganda 'operating without apparent fear of sanction'

Rodrigue Forku   |18.09.2020

YAOUNDE, Cameroon 

Illicit gold trade in the Democratic Republic of Congo (DRC) continues to thrive, despite efforts to clean up the sector, a report said Thursday.

The report by IMPACT, a global independent natural resources watchdog, said some traders and exporters legally registered in the DRC, Rwanda and Uganda are operating “without apparent fear of sanction,” even after being publicly pointed out by the United Nations for contributing to the illicit trade of artisanal DRC gold.

Some traders and exporters in the DRC are “pocketing massive profits” from gold smuggling, said the report, which noted it is time to bring these intermediaries out of the shadows they operate in.

“Much effort has been made to strengthen responsible artisanal gold trade in the DRC, but as long as these shady intermediaries between the miners and the market operate with impunity, all such efforts are futile,” said Joanne Lebert, IMPACT’s executive director.

IMPACT investigates and develops approaches for natural resources to improve security, development and equality.

Despite efforts by the DRC government and international actors to introduce traceability and due diligence for artisanal gold supply chains in the Central African country, the illicit trade appears to be booming.

“Only a fraction of gold production is exported legally, meaning declared to authorities with all duties and taxes paid,” according to the report.

‘’Gold smuggled out of the DRC and flowing onto the legal international gold market –into consumer products—is potentially tied to criminality, money laundering, armed groups and human rights abuses,” it said.

It added that neighboring Rwanda is the main transit hub of the golf traffic. The DRC’s South Kivu gold “is being smuggled across the border to Rwanda, then laundered into the legitimate international supply chain through its export to Dubai as supposedly Rwandan gold.”

The DRC has been rocked by violence for several decades.

The illicit exploitation of natural resources continues to be a root cause and driver of conflict in the east of the country, according to the UN.

Most of the militia groups have set aside their political demands and are involved in mineral trafficking.

At least 50 artisanal miners were killed when a gold mine collapsed in the eastern part of the DRC last weekend.

Global Copper Market Flips to Deficit by June After Q1 Surplus: ICSG

Author: Nick Lazzaro 

Editor: Keiron Greenhalgh 

HIGHLIGHTS

Deficit in June hits 235,000 mt after 130,000 mt surplus in Q1

Refined copper demand supported by China as usage slides elsewhere

Pittsburgh — The global refined copper balance through June plunged to an apparent deficit of 235,000 mt after reaching a 130,000 mt surplus at the end of the first quarter, according to data released Sept. 21 by the International Copper Study Group.

Register Now Estimated data from the ICSG indicated that monthly world refined copper usage rose to 2.25 million mt in June from 2.09 million mt in May, but production remained mostly unchanged at 2.06 million mt.

Global apparent refined copper usage in the first half of 2020 stayed flat year over year at 12.1 million mt as markets slowly recovered from coronavirus pandemic-related lockdowns that negatively impacted the world economy and copper end-use sectors, according to the trade association.

ICSG said the stability in copper demand was mostly supported by China, where net refined copper imports and apparent usage increased by 31% and 9%, respectively, in the first half of 2020.

Conversely, apparent refined copper usage slid 9% year over year ex-China during the first six months. On a regional basis, usage declined by 12% in Japan, 10% in the EU, 4.5% in the US and 8% in Asia ex-China.

The global refined copper balance from January to June adjusted for changes in Chinese bonded stocks indicated a market surplus of about 278,000 mt, the ICSG added.

Copper mine production slips through June

World copper mine production during the first half of the year slipped only 1% compared with the year-ago period to 9.8 million mt, as mine production recovered in June after temporary shutdowns caused by the pandemic in April and May, the ICSG said.

Mines in Peru were impacted most by the pandemic in April and May when mine suspensions, operational issues and adverse weather led to a 38% year-on-year fall in output during the two-month period. Mining production in June then declined by only 9% year over year as the country's industry came back online.

Chile, the world's biggest copper mining country, saw a 2.6% increase in output.

Copper-mine production in the Democratic Republic of Congo rose 5% in the period as mining ramp-ups offset the temporary closure of the Mutanda mine in 2019.

In Indonesia, the ICSG said copper production in the first half of the year grew by 18% as output levels improved following the transition of the country's two major copper mines to different ore zones.

ICSG analysts said year-to-date copper mine output through June declined in Australia, Canada, Mexico, Mongolia and the US.

Through June, global copper concentrate production fell 1.2% and solvent extraction-electrowinning output slipped by 0.4%.

Refined copper production rises slightly

ICSG data showed a 1% increase in world refined copper production to 11.9 million mt during the first six months of 2020, compared with the first half of 2019, with primary production from electrolytic and electrowinning operations increasing by 2.3% and secondary production from scrap falling 5.2%.

Total refined copper production in Chile through June climbed 12.5% year over year, mainly supported by a 51% surge in electrolytic refined output.

The ICSG said Chinese refined production growth was negatively impacted by temporary shutdowns related to the pandemic, limited scrap supply, disrupted copper concentrate imports and oversupply in the sulfuric acid market.

In Africa, refined production in the DRC increased 4%, but production in Zambia slid 16% due to operational issues and temporary shutdowns.

Output in India is estimated to have declined by 25% year over year through June due to the suspension of Birla Copper's operations at the end of March following a nationwide lockdown, ICSG analysts said.

ICSG said refined production in Japan rose by 4%, mainly representing a recovery from a number of maintenance shutdowns in the same period of 2019.

US refined copper production dropped 12% due to maintenance shutdowns and the ongoing labor strike at Asarco's US operations that began in October.

11 Die in DR Congo’s ‘Death Triangle’

BENI, DR Congo: Ten civilians and a soldier were killed overnight in eastern DR Congo in an attack blamed on rebels of the Allied Democratic Forces (ADF), a local official said on Monday. The attack occurred in an area of North Kivu province near neighbouring Uganda dubbed the “Triangle of Death” where the ADF has killed 570 civilians since the army launched a crackdown against them in November last year, according to experts. The militia, which originated in the 1990s as a Ugandan Muslim rebel group, is one of more than 100 armed groups that trouble the eastern provinces of the vast Democratic Republic of Congo.

The attacks are apparently reprisals for the army operation or designed to warn locals against collaborating with the army.

Beni administrator Donat Kibwana told AFP that the assailants had reached within 400 metres (yards) of a government office in the town of Mbau when they launched the attack. “The enemy are the ADF,” he said, adding that another three people were wounded and several more went missing. Mbau civil society leader Omar Kalikia said eight of those killed were women, adding that it was a provisional toll. He told AFP that the attack began around 8:30 pm and lasted two and a half hours, with three homes torched and “all the property taken away” including goats.

Ebola, COVID‐19 and Africa: What We Expected and What We Got

Shibu Sasidharan  

Harpreet Singh Dhillon

20 September 2020 https://doi.org/10.1111/dewb.12292

Abstract

Democratic Republic of the Congo’s fight with Ebola was just settling when WHO declared COVID‐19 to be a global pandemic on March 12, 2020. This has caused concomitant setbacks in the treatment and control of major health issues like HIV, tuberculosis, measles, and malaria in the country. This, coupled with civil unrest and risk to the safety of the health workers, is a 'perfect storm' waiting to unfold. Military contingents as peacekeepers are having the most difficult time, handling the situation, in the wake of risks involved.

1 BACKGROUND

Democratic Republic of the Congo’s fight with Ebola was just settling when it sustained another big blow in the form of COVID‐19 pandemic. This has made it impossible to control other major health issues like HIV, tuberculosis, measles, and malaria in the country. All this in the background of existing violent armed clashes and inter‐communal conflict, and risk to the life of health care workers, it is the ‘perfect recipe’ for disaster. The United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (DRC) or MONUSCO, is a United Nations peacekeeping force in the Democratic Republic of the Congo. Under the aegis of MONUSCO, the Level III Indian Field Hospital in Goma is a modern state of the art facility that is maintained by the Indian military contingent deputed to the Democratic Republic of the Congo. It is also the regional centre in Africa for all cases of COVID‐19, and in the forefront of the race in the containment of the contagion.

2 DISCUSSION

The Ebola Virus Disease (EVD) raged through Africa between 2014‐2016, and went on to be the biggest International Public Health Concern of International Concern (PHEIC) of the decade. The virus was first discovered in 1976 in an 18‐month‐old boy from a village in Guinea, who was believed to have been infected by bats as the index case in December 2013. It spread quickly enveloping the neighbouring countries and wreaking havoc owing to fragile surveillance systems and weak public health infrastructure. The WHO lifted the PHEIC status on Africa’s Ebola situation on March 29, 2016, but the impact this epidemic had on the world, and principally West Africa, was momentous. A total of 28,616 cases of EVD and 11,310 deaths were reported, and the maximum cases were in DRC, Guinea, Liberia, and Sierra Leone. There were an extra 36 cases and 15 deaths that occurred outside of these three countries. Sierra Leone’s first case of EVD surfaced in January 2016 but was declared Ebola‐free on March 17, 2016. In Guinea, the first outbreak ended in December 2015, with additional cases seen in March and April 2016. Guinea was finally declared Ebola‐free in June 2016.

The latest outbreak of EVD was declared by WHO on June 1, 2020 in the Equateur Province which started with a cluster of cases in Mbandaka and has gradually spread to 11 of the province’s 17 health zones. This is DRC’s eleventh outbreak which has claimed 43 lives till now and the cases are spread over approx. 300 sq. km, mainly comprising densely forested remote and inaccessible areas. With around 100 Ebola cases in less than 100 days and COVID‐19 already draining resources and attention, WHO has expressed profound concern in containing this particular outbreak compared to previous ones.1 In view of the same, WHO has scaled up screening procedures, advocated ring vaccination of the high risk groups and has urged for additional funding and logistic support.

Healthcare workers (HCWs) caring for EVD patients are at the highest risk for contracting the disease. During the last epidemic, Liberia lost 8% of its doctors, nurses, and midwives in its battle to EVD.2 Compounding the overwhelming effects EVD had on the HCWs in DRC, Guinea, Liberia, and Sierra Leone, there were concomitant setbacks in the treatment and control of major health issues like HIV, tuberculosis, measles, and malaria in these countries.3

Measles is another health problem in the DRC. Since 2019, 369,520 cases and 6779 deaths have been reported.4 This has been named as the world's worst measles epidemic outbreak by the WHO. The DRC had established the Expanded Program on Immunization (EPI) in 1978 and the medical humanitarian organization Médecins Sans Frontières (MSF), operating in DRC since 1981, has been a vital companion of the Ministry of Health (MoH) in responding to measles epidemics in the past decade. But the ongoing Congo EVD outbreak and civil unrest has had a negative and disastrous impact on routine child immunization in the DRC.

DRC’s fight with EVD and measles was just settling when WHO declared COVID‐19 to be a PHEIC on March 12, 2020. DRC announced its first COVID‐19 case on March 10, 2020, almost one month after Algeria had reported the first COVID‐19 case in Africa from Egypt on February 14, 2020 and Nigeria reported the first case in Sub‐Saharan Africa as an Italian citizen who worked in Nigeria and flew into the commercial city of Lagos from Milan on February 25, 2020. The evolution of the COVID‐19 outbreak in DRC is not yet clear. The first case was a Congolese man who had travelled from France and transited through Kinshasa. The Ministry of Health and Social Affairs communiqués5 reported 3763 cases (81 deaths, 512 recoveries, 7 cases transferred outside the country, 143 fresh cases in a day) and 2016 persons under observation as of June 6, 2020 with a transmission classification status as per WHO being Community Transmission.6 COVID‐19 continues to spread faster there than in the neighbouring countries like Senegal, which, together with Mali and Nigeria, were the 4 countries which successfully tackled the 2014 Ebola outbreak in Africa. Government authorities in DRC have placed various measures like systematic body temperature screening with screening at almost every gate and public gathering and suspension of all flights and banning all air traffic since March 19, 2020. Borders were closed and a state of emergency was declared on March 24, 2020. But despite these measures, the virus’s continued progression throughout the country suggests that these measures were inadequate.7 Measures to ban mass gatherings and curfews, were some proactive steps taken to complement DRC’s response. WHO has provided testing kits to the National Institute for Biomedical Research (INRB), Kinshasa and thirty‐nine laboratories in the WHO African region now test for COVID‐19. WHO has dispatched essential supplies for screening and handling suspect cases at airports and other points of entry.

North Kivu is the epicentre of the Kivu Conflict where armed conflict between the military of the DRC (FARDC) and the Hutu power group has resulted in violent armed clashes and inter‐communal conflict.8 With a 21,000 member force, MONUSCO constitutes the largest peacekeeping force currently in operation. This area has about one million uprooted people and shares its borders with Uganda and Rwanda, with cross border movement for trade. The humanitarian crisis and deterioration of the security situation is expected to affect any response to the outbreak.9

WHO described this combination of violence and disease outbreaks as a ‘perfect storm’, in their statement – ‘“A perfect storm of active conflict, limiting our ability to access civilians, distress by segments of the community, already traumatized by decades of conflict and of murder.”10 That in addition to misinformation by the political parties and the attack on UN health workers makes humanitarian and medical help difficult to deliver.

Compounding this threat is the added lack of security to HCWs in the background of political unrest. It indeed is the ‘perfect storm’. The United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (DRC) or MONUSCO, is a United Nations peacekeeping force in the Democratic Republic of the Congo. The MONUSCO Level III Indian Field Hospital in Goma is a modern state of the art facility that is maintained by the Indian contingent, and treats MONUSCO/UN staff and casualties, assists medical NGOs and treats the local population. Presently, the facility is also geared up as a regional COVID‐19 referral centre for all the staff and dependents of MONUSCO to cater to the requirements of the Force during this pandemic.

3 IMPLICATIONS

Before suggesting any health related recommendations for low income countries of Africa, it is important to fully appreciate the concomitant complexities and challenges of each, wherein might lie the key to improvement measures. We will talk about DRC as the model country, since by virtue of being located here, we have the most creditable on ground understanding.

3.1 Poverty

While its poverty rate has fallen to some extent over the past 20 years, particularly in the rural areas, the DRC nevertheless remains one of the poorest countries in the world.11 DRC is one of the countries with the highest maternal and child mortality ratios in the world. Here, women have an average of 6.6 children; and 42 percent of women in the age group 15‐19 years are mothers or pregnant with their first child. For every 1,000 children born, 58 die before the age of 1, and 104 die within the first five years of life. Chronic malnutrition affects 43 percent of children under five.

3.2 Education

The DRC ranks 135/157 in terms of human capital. With a human capital index score of 0.37%, which is below the average in Sub‐Saharan Africa (0.40). This translates into the fact that a child born today will be 37% less productive in adulthood than a child who received a complete education and proper health care in other parts of the world. Congolese children on an average spend only 9.2 years in school and more than 43% of children are malnourished.12 There are eight medical schools in DRC.

3.3 High demand for healthcare

Long before COVID‐19, infectious diseases have swept throughout this country. Hepatitis A, Ebola, measles, malaria, lower respiratory infections, tuberculosis, diarrheal diseases, and HIV/AIDS are some of the major causes of death. Neonatal disorders, ischemic heart disease, stroke, congenital defects and road injuries being the remaining major contributors. Mental health and the consequences of violence are major public health challenges. With significant cases under each category, along with malnutrition and other diseases, the demand for healthcare is immense.

3.4 Insufficient resources

Health financing in the DRC is almost totally dependent on external aid which is essentially based on humanitarian assistance. COVID‐19 has frozen many external supply of funds, due to allocation of those funds into their own health systems. With no public funding and fragmented national leadership, regulation of the health sector is essentially broken. Developing a strategy for medical education with such scarcity of funds is unthinkable.

3.5 Dysfunctional Healthcare System

The lack of a strategy for developing organised human resources for healthcare, combined with stopping recruitment in the public health service for more than 20 years, has led to dwindling of HCW densities in the DRC. With 0.28 physicians, and 1.91 nurses and midwives per 10,000 population, DRC has one of the least number of skilled healthcare professionals and medical educators in the world. The existing health sector workforce is also aging and the quality of work has compromised considerably.

Above all these, chronic political instability, social unrest and armed conflict have made it difficult for DRC to increase domestic spending on healthcare and education. But COVID‐19 has spelled uncertain, uncharted territories, and we are all grappling to find alternatives for a new norm.

4 RECOMMENDATIONS

4.1 Utilizing existing infrastructure

The existing WHO collaborating centres13 (eg. The Institut National de Recherche Biomédicale (INRB) in Kinshasa which was primarily tasked for research on human African trypanosomiasis) can be transformed to provide medical education. This will yield a dual advantage ‐ continuing medical education and augmentation of health care workers at the same time.

4.2 Harnessing funds and logistic supports

The active assistance and participation of WHO can help harness the potential of international organisations such as TUFH, which can provide necessary financial and human resources required to continue medical education and enhance community health services.14

5 CONCLUSION

On analysis of the spatial events leading to rapid spread and increased severity of EVD in West Africa, with consequent high fatality rates, and extrapolating it with the pattern of the current pandemic of COVID‐19, it translates into one of the biggest threat facing any treating doctor in the world. There is a need to intellectualise understanding of outbreaks with valuable recommendations crucial to preventing or curtailing any future outbreak of the disease. For this, a meticulous data collection, compilation of line‐lists and analysis of outbreak investigations are recommended to define the epidemiology of the epidemic, to guide quick and operative reactive campaigns. Population‐based coverage surveys should be implemented to determine the susceptibility profile and to recognize spaces of low coverage to better prioritize and resourcefully use capitals in order to target the most vulnerable groups. There is also a desideratum to garner international attention and take steps to increase public awareness.

Biographies

Shibu Sasidharan, MD, DNB, is Head of Department, Department of Anaesthesia and Critical Care & Trauma, Level III IFH Hospital, Goma, DRC. He is an Assistant Professor and Lieutenant Colonel in the Indian Armed Forces Medical Services serving with the United Nations peacekeeping force MONUSCO in the Democratic Republic of the Congo.

Harpreet Singh Dhillon, MD, is a Psychiatrist and Reader at the Department of Psychiatry, Level III IFH Hospital, Goma, DRC. He is a Major in the Indian Armed Forces Medical Services serving with the United Nations peacekeeping force MONUSCO in the Democratic Republic of the Congo