New Coronavirus News from 11 Mar 2022b

Germany to co-host 2022 Gavi COVAX AMC Summit, pledges additional funding for COVID-19 vaccination in lower-income countries - World [ReliefWeb, 11 Mar 2022]

• Germany will co-host the 2022 AMC Summit to help raise urgent funding to support lower-income countries' dynamic COVID-19 vaccination needs
• In addition, Germany has pledged an additional EUR 350 million to Gavi for the COVAX AMC, as part of a broader US$1.22 billion funding package for the ACT-Accelerator, pending cabinet and parliamentary approval.
• Both the Summit and pledge are in support of Germany's G7 Presidency goal to promote healthy lives worldwide, strengthen efforts to address COVID-19 on a global scale, and prepare for future pandemics and health crises.
• Prof. José Manuel Barroso, Board Chair of Gavi, the Vaccine Alliance: "Germany's support for global vaccination and the fight against COVID-19 has been clear from the beginning. We thank the German government in their G7 Presidency year for their support in helping to break the COVID-19 pandemic by hosting this summit and pledging additional funding to the Gavi COVAX AMC and ACT-Accelerator. We particularly recognize and value that this leadership comes at a time when Berlin along with many other capitals are mobilizing to respond to the terrible civilian suffering created by the conflict in Ukraine."
• Svenja Schulze, German Minister for Economic Cooperation and Development: "To be agile and flexible in our response, we need sufficient resources -- this is one of the key lessons learned in 2021 and essential to pandemic preparedness. We need to respond quickly to in-country needs and invest in strengthening country delivery systems in order to put an end to this pandemic. No one is safe until everyone is safe."

Geneva, 11 March 2022 -- Gavi, the Vaccine Alliance announced today that the Government of Germany will host a leader-level meeting aimed at helping raise at least US$5.2 billion in urgent financial support for COVAX, including US$ 3.8 billion in donor funding for lower-income countries supported by the Gavi COVAX Advance Market Commitment (Gavi COVAX AMC).
The virtual event -- "2022 Gavi COVAX AMC Summit: Break COVID Now" -- will be co-chaired by Svenja Schulze, German Minister for Economic Cooperation and Development and José Manuel Barroso, Gavi Board Chair. It will take place on 8 April 2022.

Almost 1.2 billion funded and donated doses have now been provided through the Gavi COVAX AMC to lower-income countries and territories around the world, and a rapid scale up in deliveries through the end of 2021 has helped narrow the vaccine equity gap while providing countries with critical longer-term visibility on supply -- but significant challenges still remain.
Hundreds of millions of people, mainly in lower-income countries, remain unvaccinated and unprotected, while the virus continues to evolve in uncertain ways: a major variant has been identified every 4 months, on average, since the pandemic was declared.

In 2022, COVAX will be focused on building on the foundation in place to tackle those challenges, serving as an adaptable and flexible mechanism to support lower-income countries' national COVID-19 vaccine objectives, and contributing to the global effort to break COVID.
That will mean providing urgent delivery support to those furthest behind in coverage -- while closely monitoring each country's continually evolving needs and strategies, including the need to prioritise and sequence COVID-19 immunization alongside routine immunization and other essential health systems activities. It will also mean learning from the lessons of the past year and making sure funding is available now to support countries' needs in the face of inevitable future evolutions of the pandemic. To support these goals, COVAX is seeking urgent additional funding of at least US$5.2 billion, of which Gavi is seeking to raise US$3.8 billion from sovereign and private donors.

Catalytic delivery funding will help countries increase rates of administration, now that supply is in place, and there is short and medium-term visibility of supply for the first time in the 12 months that vaccines have been available to AMC participants. In response to the high demand to-date for the $900m COVID-19 Delivery Support package that Gavi and partners have already put in place, urgent additional funding of US$ 1 billion will help lower-income countries rapidly protect more people against COVID-19. Of this amount, Gavi is seeking US$ 600 million to build on its Alliance work and provide direct support to lower-income governments for a range of readiness activities, while UNICEF is seeking US$400 million to support the critical work of its offices in lower-middle income countries and humanitarian contexts. Germany has also committed to work towards this effort with additional funding.

While seeking to build on the progress made, however, it is equally critical that we do not squander the lead we finally have in terms of supply meeting demand. COVAX's current portfolio can meet current demand, but this situation will not remain static. It is essential that we continue to mitigate and guard against future risks: variant-adapted vaccines, new vaccines, changes in booster policies or target populations, shift towards an annual shot model are all potential scenarios that the world must account for. Financing will need to already be in place to respond quickly in each scenario. Failing to do so will result in repeating the past, with lower-income countries once again being at the back of the queue.

To avoid such a situation and manage those risks, Gavi is seeking urgent funding for a "Pandemic Vaccine Pool" -- a flexible financial instrument that blends direct, contingent and innovative financing and will be able to act as a rapid response mechanism to support lower-income countries' needs in the face of these inevitable changes. Alongside US$ 2.7 billion in funding from sovereign and private sector donors, multilateral development banks and lower-income countries can also contribute via cost-sharing, providing another source of rapid funding for vaccines made available through the pandemic vaccine pool to the COVAX AMC.

Gavi is also seeking US$545 million to fund ancillary costs of dose donations, buying syringes and paying for logistics to get doses to countries, helping donations continue to be a sustainable and complementary source of supply alongside funded doses from COVAX agreements.

"To be agile and flexible in our response, we need sufficient resources -- this is one of the key lessons learned in 2021 and essential to pandemic preparedness. We need to respond quickly to in-country needs and invest in strengthening country delivery systems in order to put an end to this pandemic. No one is safe until everyone is safe," said German Minister for Economic Cooperation and Development Svenja Schulze.

COVAX is the vaccines pillar of the Access to COVID-19 Tools Accelerator (ACT-A). To help COVAX meet its goals, Germany has pledged an additional EUR 350 million in funding to the Gavi COVAX AMC, as part of a broader US$ 1.22 billion funding package for ACT-A to support access to COVID-19 treatments, tests, vaccines, and personal protective equipment. This new pledge, which is pending formal approval, builds on existing German pledges of EUR 1.03 billion, bringing the total German contribution to the global COVID-19 vaccination effort to EUR 1.38 billion. Germany has also pledged to donate 175 million doses of vaccines to COVAX, of which 90 million have already been shipped.

"Germany's support for global vaccination and the fight against COVID-19 has been clear from the beginning. We thank the German government in their G7 Presidency year for their support in helping to break the COVID-19 pandemic by hosting this summit and pledging additional funding to the Gavi COVAX AMC and ACT-Accelerator. We particularly recognize and value that this leadership comes at a time when Berlin along with many other capitals are mobilizing to respond to the terrible civilian suffering created by the conflict in Ukraine," stressed Prof. José Manuel Barroso, Board Chair of Gavi, the Vaccine Alliance.

"COVAX will need additional support through 2022 to ensure we can act now to support readiness and delivery to continue to accelerate rollout in countries, and anticipate and address future risks rapidly to meet future country demand. We must hope for the best, and plan for the worst: COVAX cannot again be at the back of the queue," added Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. "We look forward to bringing countries, manufacturers, donors, civil society and the private sector together on April 8th to strengthen the world's collective response to COVID and commitment to future pandemic preparedness -- and thank Germany for helping lead this effort."

About COVAX
COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, is co-led by CEPI, Gavi and WHO -- working in partnership with developed and developing country vaccine manufacturers, UNICEF, PAHO, the World Bank, and others. It is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both high-income and lower-income countries.

Gavi's role in COVAX
Gavi leads on procurement and delivery at scale for COVAX: designing and managing the COVAX Facilityand the Gavi COVAX AMC and working with its traditional Alliance partners UNICEF and WHO, along with governments, on country readiness and delivery.

As part of this role, Gavi hosts the Office of the COVAX Facility to coordinate the operation and governance of the mechanism as a whole, holds financial and legal relationships with 193 Facility participants, and manages the COVAX Facility deals portfolio: negotiating advance purchase agreements with manufacturers of promising vaccine candidates to secure doses on behalf of all COVAX Facility participants. Gavi also coordinates design, operationalisation and fundraising for the Gavi COVAX AMC, the mechanism that provides access to donor-funded doses of vaccine to 92 lower-income economies. As part of this work, Gavi provides funding and oversight for UNICEF procurement and delivery of vaccines to all AMC participants -- operationalising the advance purchase agreements between Gavi and manufacturers -- as well as support for partners' and governments work on readiness and delivery. This includes tailored support to governments, UNICEF, WHO and other partners for cold chain equipment, technical assistance, syringes, vehicles, and other aspects of the vastly complex logistical operation for delivery. Gavi also co-designed, raises funds for and supports the operationalisation of the AMC's no-fault compensation mechanism as well as the COVAX Humanitarian Buffer.

About Gavi, the Vaccine Alliance Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate half the world's children against some of the world's deadliest diseases. Since its inception in 2000, Gavi has helped to immunise a whole generation -- over 888 million children -- and prevented more than 15 million future deaths, helping to halve child mortality in 73 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningitis and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation and reaching zero dose children remaining deprived of even a single vaccine shot still being left behind, employing innovative finance and the latest technology -- from drones to biometrics -- to save millions more lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency. Learn more at www.gavi.org and connect with us on Facebook and Twitter.

Gavi is a co-convener of COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, together with the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO). In its role Gavi is focused on procurement and delivery for COVAX: coordinating the design, implementation and administration of the COVAX Facility and the Gavi COVAX AMC and working with its Alliance partners UNICEF and WHO, along with governments, on country readiness and delivery.

The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners. Post this on LinkedIn

COVID digest: Germany's situation 'critical,' Lauterbach says [DW (English), 11 Mar 2022]

The German health minister has called on the federal states to reevaluate the coronavirus rules before restrictions are lifted. In other news, a Chinese city locks down as COVID cases rise.

German Health Minister Karl Lauterbach said the impact of COVID-19 in the country had reached a "critical" level after the number of infections rose to a record high this week.

"We are in a situation that I would like to describe as critical,'' Lauterbach said at the weekly coronavirus press briefing in Berlin on Friday. "We have strongly rising case figures again. [...] I keep reading that the omicron variant is a milder variant but that's only true to a limited extent."

Despite planning to further relax COVID-19 rules, Germany logged a record high number of coronavirus infections in 24 hours on Thursday, and a figure almost as high, 252,836 cases, on Friday.

"The situation is objectively worse than the public mood," the health minister said.

He said that some people's belief in Germany, including politicians, that the pandemic was now over, was an "error of judgement."

"We can not be satisfied with a situation in which 250 people are dying every day and the prospect is that in a few weeks more people will die,'' he said.

Germany will lift most coronavirus restrictions on March 20 after a period of easing them.

From then on, state governments will be allowed to require measures such as wearing masks, testing and other measures in virus "hot spots" at their own discretion.

Masks will remain mandatory on long-distance trains and flights.

Africa
The government in Kenya announced on Friday that it would scrap wearing of masks in public to ease COVID-19 restrictions that had been in place for two years.

"The mandatory wearing of face masks in open public spaces is now lifted," Health Minister Mutahi Kagwe said in a statement on Friday.

It comes as rates of COVID infection in Kenya had dropped to one percent or less over the past month, the minister explained.

Double vaccinated people will also be allowed into sporting events and all in-person worship services can resume at full capacity so long as the attendees are fully jabbed, he said.

But he also added: "This, however, is not to say that we are already completely out of the woods."

Kagwe encouraged the continued use of masks indoors and social distancing in public places.

Asia China ordered the lockdown the northeastern city of Changchun following a new spike in local COVID-19 cases attributed to the omicron variant.

Mainland China reported over 1,000 new COVID-19 infections, spread across dozens of cities, its highest daily count in about two years, according to the latest daily official count released on Friday.

Residents living in the city of 9 million must stay at home, with one family member allowed to leave the house to buy food and other essentials every two days.

All residents also have to undergo three rounds of mass testing, meanwhile non-essential businesses have been closed and transport links suspended.

In Hong Kong, leader Carrie Lam called for more vaccinations as rising infections raise alarm bells. Lam said on Friday that the city's COVID-19 vaccination program will focus on its elderly and children while authorities battle to curb climbing infections and death rates.

Health authorities reported 29,381 new infections and 196 deaths on Friday. Since early 2020, Hong Kong had recorded almost 650,000 COVID-19 infections and about 3,500 deaths, most of which are from the past two weeks.

A World Health Organization (WHO) official on Friday had urged the Philippines to remain vigilant against Covid-19, warning that another surge was "inevitable."

As cases continue to drop to less than 1,000 per day, authorities in the Philippines had been looking to ease restrictions. Since the start of the month, 40 areas in the country, including the capital, had remained under Level 1 of a five-tier alert system.

This meant businesses have been allowed to operate at full capacity but face masks and social distancing are still required.

Rajendra Prasav Yadav, WHO's acting country representative, said it was "too early to declare victory against the virus."

"When we start lowering our guards and masks, this is a disaster because we're seeing the vaccination pace slow down considerably in the past few days," he said in a television interview.
"We have to be actively careful, stay alert and get ready for the next wave, which I think is inevitable."

Americas
The United States is extending the requirement of wearing masks on planes and public transport for one more month, federal officials said.

It announced the decision while also deliberating on steps that could lead to lifting the rule entirely.

The mandate to wear masks was scheduled to expire March 18, but now has been extended to April 18, Transportation Security Administration (TSA) said.

Opinion | The Covid-19 Pandemic Didn’t Have to Be This Way [The New York Times, 11 Mar 2022]

By Zeynep Tufekci
Opinion Columnist
This article is part of Times Opinion’s reflection on the two-year mark of the Covid pandemic.

We cannot step into the same river twice, the Greek philosopher Heraclitus is said to have observed. We’ve changed, the river has changed.

That’s very true, but it doesn’t mean we can’t learn from seeing what other course the river could have flowed. As the pandemic enters its third year, we must consider those moments when the river branched, and nations made choices that affected thousands, millions, of lives.

What if China had been open and honest in December 2019? What if the world had reacted as quickly and aggressively in January 2020 as Taiwan did? What if the United States had put appropriate protective measures in place in February 2020, as South Korea did?

To examine these questions is to uncover a brutal truth: Much suffering was avoidable, again and again, if different choices that were available and plausible had been made at crucial turning points. By looking at them, and understanding what went wrong, we can hope to avoid similar mistakes in the future.

What happened in the first weeks: China covered up the outbreak.

Our information about what happened when the coronavirus apparently was first detected in Wuhan, China, in December 2019, remains limited. Reporters working for Western media have been kicked out, and even local citizen journalists who shared information during the early days were jailed. But evidence strongly suggests that China knew the danger long before it told the world the truth.

The South China Morning Post, a newspaper owned by a major Chinese company, reported that Chinese officials found cases that date to Nov. 17, 2019. Several Western scientists said colleagues in China had told them of the outbreak by mid-December. Whistleblower doctors reported being silenced from mid-December on. Toward the end of December, hospitals in Wuhan were known to be quarantining sick patients, and medical staff members were falling sick — clear evidence of human-to-human transmission, the first step toward a pandemic.

Finally, on Dec. 31, 2019, as rumors were growing, the Wuhan health officials acknowledged 27 cases of an “unexplained pneumonia” caused by a virus, but claimed there was no evidence of “obvious human to human transmission.” The next day, a Chinese state media outlet announced that authorities had disciplined eight people for spreading rumors about the virus, including Dr. Li Wenliang, who had noted that the mystery pneumonia cases resembled SARS and warned colleagues to wear protective gear, and who would later die of Covid.

Not until Jan. 20, 2020, did Chinese authorities publicly admit that the virus was clearly passing from person to person. Three days later, they shut down the city of Wuhan.

At that point, the virus had had weeks to spread far beyond China’s borders and was beginning to establish outbreaks globally. A pandemic was on its way.

What could have happened: China tells the world the truth and the pandemic is avoided.

China could have notified the World Health Organization sometime in early to mid-December that it had an outbreak of a previously unknown coronavirus similar to the dreaded SARS pathogen, and immediately sequenced the virus and shared the genome, allowing tests to be developed. The rest of the world would have had to act, too. Governments could have made sure tests were immediately developed to find as many cases as possible. Health authorities could have isolated infected people and traced and quarantined their contacts. Travel restrictions and testing could have been put in place to prevent the spread outside China.

It may seem like a fantasy to suggest that the outbreak could have been extinguished before it became a pandemic, but later outbreaks of this virus were contained. This first wave could have been, too, and the pandemic might have been completely avoided, saving millions of lives and much suffering.

What happened after China covered up: The world failed to heed warnings and take action.

On Dec. 30, 2019, ProMED, a service that tracks infectious disease outbreaks globally, warned of “unexplained pneumonia” cases in Wuhan. The veteran infectious disease reporter Helen Branswell shared the news alert on Twitter the next day and said it was giving her “#SARS flashbacks.” That same day, Taiwan’s Centers for Disease Control — with its close contacts on the ground in China — fired off an email to the W.H.O. with its concerns that patients were being isolated in Wuhan — a clear sign of an outbreak with person-to-person spread.

On Jan. 11, 2020, a Chinese scientist bravely allowed an Australian colleague to upload the virus’s genome to a gene bank, without official authorization. This meant that the whole world could now see this was a novel coronavirus, closely related to SARS. The next day, the scientist’s lab was shut down.

Doubts over whether the virus was capable of spreading from person to person should have been swept away in mid-January 2020 by reports that a woman in Thailand and a man in Japan had tested positive without having been to the Wuhan seafood market that Chinese authorities had said was the center of the spread. Meanwhile, despite such clear evidence of the virus’s transmissibility, the number of cases that China reported remained at 44. (We’d later learn that medical professionals weren’t even allowed to report cases that weren’t connected to the seafood market.) Yet the W.H.O. kept repeating China’s line that there was no evidence of human-to-human transmission.

It wasn’t until China shut down Wuhan on Jan. 23, 2020, that the rest of the world could see how serious the threat was — even then, the global response remained feeble.

What could have happened: The world sees through China’s deception and takes action.
How could nations have gotten around China’s smokescreen? They could have done what Taiwan did.

On Dec. 31, 2019, the same day Taiwan officials sent that email to the W.H.O., they started boarding every plane that flew there directly from Wuhan, screening arriving passengers for symptoms like fever.

“We were not able to get satisfactory answers either from the W.H.O. or from the Chinese C.D.C., and we got nervous and we started doing our preparation,” foreign minister Joseph Wu told Time magazine.

Masks were rationed, to ensure there were enough for the entire population, and were distributed to schools. Soldiers were put on production lines at mask factories to increase supply. The country quickly allocated money to businesses that lost customers and revenue.

For most of 2020, Covid was rare in Taiwan. On 253 consecutive days that year there were no locally transmitted cases there, even though there had been extensive travel to China, including Wuhan, before January 2020. With extensive testing and tracing, they squashed two major outbreaks — one that started in March 2020, and more impressively, a major outbreak of the more transmissible Alpha variant in summer 2021 — bringing local cases back to zero. That shows what was possible with an early and robust response.

Taiwan has suffered 853 deaths. If the United States had suffered a similar death rate, we would have lost about 12,000 people, instead of nearly a million.

Taiwan shows that even in early January, there was enough information to be concerned about the virus, and the potential to suppress any outbreak.

What happened after the outbreak went global: The real contagious threat was ignored.
On the precipice of a pandemic, too many important officials failed to understand how the virus was spreading, despite emerging evidence, keeping them from effectively limiting its spread and costing thousands of lives.

On Feb. 3, 2020, the cruise ship Diamond Princess was ordered to stay in Yokohama harbor, in Japan, two days after a passenger who had disembarked in Hong Kong tested positive for Covid. After 10 other people on the ship were found to be infected, the ship was quarantined. Eventually there would be 712 cases, about 19 percent of those on board, with 14 deaths.

Nine public health workers attending to the ship were infected. It seemed quite unlikely, the Japanese virology professor Hitoshi Oshitani noted, that all these professionals with expertise in infection control had failed to take the recommended precautions.

At that point the guidelines from the W.H.O. and the Centers for Disease Control and Prevention were based on the assumption that this virus was spread by large droplets from the nose and mouth that quickly fell to the ground or to surfaces, because of their size. People were advised to keep enough distance from others to stay out of the range of these droplets, and to wash their hands in case they picked them up from surfaces.

If the workers became infected despite those precautions, and if passengers were infected even when they were quarantined, Oshitani suspected that the virus was probably spread by airborne transmission of tiny particles — aerosols — that could spread more widely, float around and concentrate, especially indoors.

This case for aerosol spread strengthened after 61 people attended a choir practice in Skagit, Wash., on March 10, 2020. The church followed droplet-based guidance by propping the door open so nobody would touch the door knob and avoiding handshakes or hugs. No one was six feet in front of the person suspected to have been the single initial source. Nevertheless, 52 people — 85 percent of those present — became infected.

Many Western experts, including in the United States and Europe and at the W.H.O., discounted these and other evidence of airborne transmission. Countries like the United States did not require masks to limit airborne spread but worried instead about germs spreading on people’s mail and groceries.

After more evidence, and organized attempts by hundreds of aerosol scientists, minor course corrections started later in 2020, but they were halting, incomplete and underpublicized. For example, it wasn’t until December 2020 that the W.H.O. started recommending that masks be worn indoors regardless of distance, and even then only if the space was poorly ventilated, and it wasn’t until December 2021 — two years after it all began — that it recommended highly protective masks for health care workers.

It was also assumed that only people with symptoms — like fever — would be infectious, even though evidence to the contrary had emerged early.

On Jan. 26, 2020, the Chinese minister of health gave a news conference warning that people without symptoms could transmit the virus. The same week an article in The Lancet had documented a case in which infection was visible in the lungs of a patient who had shown no symptoms. An article published in the New England Journal of Medicine, also the same week, noted cases presenting only mild symptoms, with the authors stressing that this would make it easy to miss them. Multiple reports from German scientists soon disclosed similar conclusions based on cases there.

However, many health authorities ignored, denied and even belittled evidence of spread without symptoms. It took until well into March for officials in the United States, for example, to accept that people without symptoms could be infectious.

The failure to acknowledge this type of transmission meant that the urgency for mass testing wasn’t realized and the virus spread silently, without critical precautions being taken, until explosive growth occurred in places like New York City. The need to identify and quarantine people who had come in contact with those who were infected was considered unnecessary and alarmist in the United States. The C.D.C. and the W.H.O. initially recommended masks only for the sick.

Another crucial misstep was the failure to recognize the virus’s dominant pattern of spread, in large bursts.

That February, Oshitani and his colleagues concluded that a vast majority of infected people didn’t transmit at all, while a small number of individuals were superspreading, in closed indoor settings like restaurants, night clubs, karaoke bars, gyms and such — especially if the ventilation was poor. They developed new approaches to trace infections to their origin, to find cluster transmission and thus look for other cases.

What could have happened: Officials put in place effective and early mitigation strategies.

The rest of the world could have understood the virus as Japanese officials did. Based on their understanding, which was arrived at in February 2020, that Covid was airborne, spread without symptoms and driven by clusters, by early March they were recommending mask-wearing, emphasizing the need for ventilation and advising the public to avoid the three Cs: closed spaces, crowded places and close-contact settings.

Americans, on the other hand, were disinfecting their groceries, and the W.H.O. kept emphasizing hand-washing and social distancing, or remaining six feet apart. Japan has had about 25,000 Covid deaths, which would be the equivalent of just under 66,000 in a country the size of the United States.

Mass testing could have detected people who were infectious before they even knew they were sick and sometimes those who never had symptoms at all. Ventilation and air filtration could have kept indoor spaces safer.

Instead of closing parks, activities could have been moved outside weather permitting, since natural ventilation more effectively dissipates the virus. The key role of masks would have been understood earlier, along with the benefits of higher quality masks. Rather than wasting money on plexiglass barriers — which can’t fully block aerosols and can even create dead zones for ventilation, increasing infection risk — schools would have begun updating their ventilation and HVAC systems, and installing HEPA air filters, which can filter viruses. Japan’s cluster-busting strategy could have been adopted.

Also, even though epidemics are easier to suppress with early action, it’s silent spread and superspreading that make a timely response even more important, as shown by South Korea’s early response.

South Korea experienced major superspreading events in February 2020, including one in a secretive church that accounted for more than 5,000 infections, with a single person suspected as the source. The country had the highest number of cases outside of China at that point.

South Korean officials sprang into action, rolling out a mass testing program — they had been readying their testing capacity since January — with drive-through options and vigorous contact tracing.

South Korea beat back that potentially catastrophic outbreak, and continued to greatly limit its cases. They had fewer than 1,000 deaths in all of 2020. In the United States, that would translate to fewer than 7,000 deaths from Covid in 2020. Instead, estimates place the number of deaths at more than 375,000.

What happened: When vaccines were developed, rich countries hoarded them.

The greatest scientific achievement of the pandemic may have been the speedy development of safe, effective vaccines.

In January 2020, the C.E.O. of BioNTech, Ugur Sahin, started designing vaccines as soon as he read The Lancet study noting the case without symptoms, which convinced him that a pandemic was likely. He then persuaded Pfizer, his initially skeptical investor, to back him.
On May 15, 2020, the United States began Operation Warp Speed, which financed the development of six vaccine candidates. Five of them quickly proved to be highly effective — not at all a given. The first to deliver spectacular results was that produced by Pfizer and BioNTech. Moderna’s quickly followed.

Supply was an immediate problem. Pfizer initially estimated it could make as many as 1.35 billion doses in 2021 — enough for about only 8.5 percent of the world’s people to get two doses. Moderna, a much smaller company, wasn’t expected to exceed that. AstraZeneca’s vaccine, too, would not cover the gap quickly enough.

There also was too little commitment to how vaccines could be distributed fairly around the world.

Instead, wealthy countries that had preordered or financed research got most of the initial doses.

Vaccine production grew, but too slowly. There was no consortium or sharing of resources to ramp up supply. Technology wasn’t transferred to lower- and middle-income countries. Patents were left in place. The W.H.O. initiative to get vaccines to poorer countries, known as Covax, was not able to buy enough doses, and what donations were made were insufficient and haphazard.

Then, in a largely unanticipated plot twist, dangerous variants of the coronavirus started emerging in late 2020 — Alpha, Delta and then Omicron.

Widespread earlier vaccination could have helped limit the possibility for these variants emerging. Plus, many variants may have arisen through persistent infections in immunocompromised people — like those who have untreated H.I.V., another terrible legacy of global health inequity.

What could have happened: Vaccine supply ramps up, with sensible distribution.

Political leaders in wealthy countries should have brought together vaccine manufacturers to arrange conditions and deals that can likely be struck only with government prodding: sharing manufacturing facilities, training experts, sharing intellectual property. Technology transfer to poorer countries could have achieved the ultimate goal: a world with many countries that can produce effective vaccines. Existing vaccine manufacturers could still profit handsomely — especially considering they, too, benefit from publicly funded research.

Countries may want to first vaccinate their own citizens, even those at much less risk. But to save the most lives, priorities should have been set globally. Health care workers, the elderly and those at high risk throughout the world should have gotten the first vaccinations.

Trials could have been immediately started to assess whether delaying second doses might work well while allowing doses to be spread more widely geographically. Early results on the protective effect of first doses were encouraging.

A few countries like Canada and Britain did lengthen the interval between doses as a strategy to protect more of their citizens — to great results. More of their vulnerable population got protected quickly. Plus, longer intervals, as some immunologists had predicted earlier, still left people protected — the unusually short three- and four-week period between the two initial shots had been put in place partly to speed up the trials. In the United States, though, such adaptive strategies could not be studied or rolled out.

What needs to happen
When the pandemic is over, the temptation will be to move on and reclaim what had been normal life. For individuals that will be fine. But the cracks revealed in our governments and public health institutions by two years of inertia, mistakes and resistance to evidence make it crucial that a broad, tough dissection of what happened take place if we are to choose the correct course in future challenges.

National and international commissions need to help us see where we went wrong, without scapegoating, and how to respond to future outbreaks, without defensively excusing what public health authorities and national leaders did this time, even if well-meaning. In some countries, it would be easy to focus only on political leaders like President Donald Trump, who severely damaged America’s response. But top public health officials, high-level scientists and state governors made many missteps along the way. At a time of growing international distrust we need to work to increase trust and mutual cooperation. We need to better understand how to rapidly incorporate evidence into scientific policy and to better understand human response to such major, complicated events.

If we can do that, to save lives and ease suffering in the future, it will not make up for all the loss and hardship we have endured in the last two years. But we can at least say we did our best to learn from it, and let that be the one positive legacy of all this.

New Coronavirus News from 11 Mar 2022

Opinion | The Covid-19 Pandemic Didn’t Have to Be This Way [The New York Times, 11 Mar 2022]

By Zeynep Tufekci
Opinion Columnist
This article is part of Times Opinion’s reflection on the two-year mark of the Covid pandemic.

We cannot step into the same river twice, the Greek philosopher Heraclitus is said to have observed. We’ve changed, the river has changed.

That’s very true, but it doesn’t mean we can’t learn from seeing what other course the river could have flowed. As the pandemic enters its third year, we must consider those moments when the river branched, and nations made choices that affected thousands, millions, of lives.

What if China had been open and honest in December 2019? What if the world had reacted as quickly and aggressively in January 2020 as Taiwan did? What if the United States had put appropriate protective measures in place in February 2020, as South Korea did?

To examine these questions is to uncover a brutal truth: Much suffering was avoidable, again and again, if different choices that were available and plausible had been made at crucial turning points. By looking at them, and understanding what went wrong, we can hope to avoid similar mistakes in the future.

What happened in the first weeks: China covered up the outbreak.

Our information about what happened when the coronavirus apparently was first detected in Wuhan, China, in December 2019, remains limited. Reporters working for Western media have been kicked out, and even local citizen journalists who shared information during the early days were jailed. But evidence strongly suggests that China knew the danger long before it told the world the truth.

The South China Morning Post, a newspaper owned by a major Chinese company, reported that Chinese officials found cases that date to Nov. 17, 2019. Several Western scientists said colleagues in China had told them of the outbreak by mid-December. Whistleblower doctors reported being silenced from mid-December on. Toward the end of December, hospitals in Wuhan were known to be quarantining sick patients, and medical staff members were falling sick — clear evidence of human-to-human transmission, the first step toward a pandemic.

Finally, on Dec. 31, 2019, as rumors were growing, the Wuhan health officials acknowledged 27 cases of an “unexplained pneumonia” caused by a virus, but claimed there was no evidence of “obvious human to human transmission.” The next day, a Chinese state media outlet announced that authorities had disciplined eight people for spreading rumors about the virus, including Dr. Li Wenliang, who had noted that the mystery pneumonia cases resembled SARS and warned colleagues to wear protective gear, and who would later die of Covid.

Not until Jan. 20, 2020, did Chinese authorities publicly admit that the virus was clearly passing from person to person. Three days later, they shut down the city of Wuhan.

At that point, the virus had had weeks to spread far beyond China’s borders and was beginning to establish outbreaks globally. A pandemic was on its way.

What could have happened: China tells the world the truth and the pandemic is avoided.

China could have notified the World Health Organization sometime in early to mid-December that it had an outbreak of a previously unknown coronavirus similar to the dreaded SARS pathogen, and immediately sequenced the virus and shared the genome, allowing tests to be developed. The rest of the world would have had to act, too. Governments could have made sure tests were immediately developed to find as many cases as possible. Health authorities could have isolated infected people and traced and quarantined their contacts. Travel restrictions and testing could have been put in place to prevent the spread outside China.

It may seem like a fantasy to suggest that the outbreak could have been extinguished before it became a pandemic, but later outbreaks of this virus were contained. This first wave could have been, too, and the pandemic might have been completely avoided, saving millions of lives and much suffering.

What happened after China covered up: The world failed to heed warnings and take action.

On Dec. 30, 2019, ProMED, a service that tracks infectious disease outbreaks globally, warned of “unexplained pneumonia” cases in Wuhan. The veteran infectious disease reporter Helen Branswell shared the news alert on Twitter the next day and said it was giving her “#SARS flashbacks.” That same day, Taiwan’s Centers for Disease Control — with its close contacts on the ground in China — fired off an email to the W.H.O. with its concerns that patients were being isolated in Wuhan — a clear sign of an outbreak with person-to-person spread.

On Jan. 11, 2020, a Chinese scientist bravely allowed an Australian colleague to upload the virus’s genome to a gene bank, without official authorization. This meant that the whole world could now see this was a novel coronavirus, closely related to SARS. The next day, the scientist’s lab was shut down.

Doubts over whether the virus was capable of spreading from person to person should have been swept away in mid-January 2020 by reports that a woman in Thailand and a man in Japan had tested positive without having been to the Wuhan seafood market that Chinese authorities had said was the center of the spread. Meanwhile, despite such clear evidence of the virus’s transmissibility, the number of cases that China reported remained at 44. (We’d later learn that medical professionals weren’t even allowed to report cases that weren’t connected to the seafood market.) Yet the W.H.O. kept repeating China’s line that there was no evidence of human-to-human transmission.

It wasn’t until China shut down Wuhan on Jan. 23, 2020, that the rest of the world could see how serious the threat was — even then, the global response remained feeble.

What could have happened: The world sees through China’s deception and takes action.
How could nations have gotten around China’s smokescreen? They could have done what Taiwan did.

On Dec. 31, 2019, the same day Taiwan officials sent that email to the W.H.O., they started boarding every plane that flew there directly from Wuhan, screening arriving passengers for symptoms like fever.

“We were not able to get satisfactory answers either from the W.H.O. or from the Chinese C.D.C., and we got nervous and we started doing our preparation,” foreign minister Joseph Wu told Time magazine.

Masks were rationed, to ensure there were enough for the entire population, and were distributed to schools. Soldiers were put on production lines at mask factories to increase supply. The country quickly allocated money to businesses that lost customers and revenue.

For most of 2020, Covid was rare in Taiwan. On 253 consecutive days that year there were no locally transmitted cases there, even though there had been extensive travel to China, including Wuhan, before January 2020. With extensive testing and tracing, they squashed two major outbreaks — one that started in March 2020, and more impressively, a major outbreak of the more transmissible Alpha variant in summer 2021 — bringing local cases back to zero. That shows what was possible with an early and robust response.

Taiwan has suffered 853 deaths. If the United States had suffered a similar death rate, we would have lost about 12,000 people, instead of nearly a million.

Taiwan shows that even in early January, there was enough information to be concerned about the virus, and the potential to suppress any outbreak.

What happened after the outbreak went global: The real contagious threat was ignored.
On the precipice of a pandemic, too many important officials failed to understand how the virus was spreading, despite emerging evidence, keeping them from effectively limiting its spread and costing thousands of lives.

On Feb. 3, 2020, the cruise ship Diamond Princess was ordered to stay in Yokohama harbor, in Japan, two days after a passenger who had disembarked in Hong Kong tested positive for Covid. After 10 other people on the ship were found to be infected, the ship was quarantined. Eventually there would be 712 cases, about 19 percent of those on board, with 14 deaths.

Nine public health workers attending to the ship were infected. It seemed quite unlikely, the Japanese virology professor Hitoshi Oshitani noted, that all these professionals with expertise in infection control had failed to take the recommended precautions.

At that point the guidelines from the W.H.O. and the Centers for Disease Control and Prevention were based on the assumption that this virus was spread by large droplets from the nose and mouth that quickly fell to the ground or to surfaces, because of their size. People were advised to keep enough distance from others to stay out of the range of these droplets, and to wash their hands in case they picked them up from surfaces.

If the workers became infected despite those precautions, and if passengers were infected even when they were quarantined, Oshitani suspected that the virus was probably spread by airborne transmission of tiny particles — aerosols — that could spread more widely, float around and concentrate, especially indoors.

This case for aerosol spread strengthened after 61 people attended a choir practice in Skagit, Wash., on March 10, 2020. The church followed droplet-based guidance by propping the door open so nobody would touch the door knob and avoiding handshakes or hugs. No one was six feet in front of the person suspected to have been the single initial source. Nevertheless, 52 people — 85 percent of those present — became infected.

Many Western experts, including in the United States and Europe and at the W.H.O., discounted these and other evidence of airborne transmission. Countries like the United States did not require masks to limit airborne spread but worried instead about germs spreading on people’s mail and groceries.

After more evidence, and organized attempts by hundreds of aerosol scientists, minor course corrections started later in 2020, but they were halting, incomplete and underpublicized. For example, it wasn’t until December 2020 that the W.H.O. started recommending that masks be worn indoors regardless of distance, and even then only if the space was poorly ventilated, and it wasn’t until December 2021 — two years after it all began — that it recommended highly protective masks for health care workers.

It was also assumed that only people with symptoms — like fever — would be infectious, even though evidence to the contrary had emerged early.

On Jan. 26, 2020, the Chinese minister of health gave a news conference warning that people without symptoms could transmit the virus. The same week an article in The Lancet had documented a case in which infection was visible in the lungs of a patient who had shown no symptoms. An article published in the New England Journal of Medicine, also the same week, noted cases presenting only mild symptoms, with the authors stressing that this would make it easy to miss them. Multiple reports from German scientists soon disclosed similar conclusions based on cases there.

However, many health authorities ignored, denied and even belittled evidence of spread without symptoms. It took until well into March for officials in the United States, for example, to accept that people without symptoms could be infectious.

The failure to acknowledge this type of transmission meant that the urgency for mass testing wasn’t realized and the virus spread silently, without critical precautions being taken, until explosive growth occurred in places like New York City. The need to identify and quarantine people who had come in contact with those who were infected was considered unnecessary and alarmist in the United States. The C.D.C. and the W.H.O. initially recommended masks only for the sick.

Another crucial misstep was the failure to recognize the virus’s dominant pattern of spread, in large bursts.

That February, Oshitani and his colleagues concluded that a vast majority of infected people didn’t transmit at all, while a small number of individuals were superspreading, in closed indoor settings like restaurants, night clubs, karaoke bars, gyms and such — especially if the ventilation was poor. They developed new approaches to trace infections to their origin, to find cluster transmission and thus look for other cases.

What could have happened: Officials put in place effective and early mitigation strategies.

The rest of the world could have understood the virus as Japanese officials did. Based on their understanding, which was arrived at in February 2020, that Covid was airborne, spread without symptoms and driven by clusters, by early March they were recommending mask-wearing, emphasizing the need for ventilation and advising the public to avoid the three Cs: closed spaces, crowded places and close-contact settings.

Americans, on the other hand, were disinfecting their groceries, and the W.H.O. kept emphasizing hand-washing and social distancing, or remaining six feet apart. Japan has had about 25,000 Covid deaths, which would be the equivalent of just under 66,000 in a country the size of the United States.

Mass testing could have detected people who were infectious before they even knew they were sick and sometimes those who never had symptoms at all. Ventilation and air filtration could have kept indoor spaces safer.

Instead of closing parks, activities could have been moved outside weather permitting, since natural ventilation more effectively dissipates the virus. The key role of masks would have been understood earlier, along with the benefits of higher quality masks. Rather than wasting money on plexiglass barriers — which can’t fully block aerosols and can even create dead zones for ventilation, increasing infection risk — schools would have begun updating their ventilation and HVAC systems, and installing HEPA air filters, which can filter viruses. Japan’s cluster-busting strategy could have been adopted.

Also, even though epidemics are easier to suppress with early action, it’s silent spread and superspreading that make a timely response even more important, as shown by South Korea’s early response.

South Korea experienced major superspreading events in February 2020, including one in a secretive church that accounted for more than 5,000 infections, with a single person suspected as the source. The country had the highest number of cases outside of China at that point.

South Korean officials sprang into action, rolling out a mass testing program — they had been readying their testing capacity since January — with drive-through options and vigorous contact tracing.

South Korea beat back that potentially catastrophic outbreak, and continued to greatly limit its cases. They had fewer than 1,000 deaths in all of 2020. In the United States, that would translate to fewer than 7,000 deaths from Covid in 2020. Instead, estimates place the number of deaths at more than 375,000.

What happened: When vaccines were developed, rich countries hoarded them.

The greatest scientific achievement of the pandemic may have been the speedy development of safe, effective vaccines.

In January 2020, the C.E.O. of BioNTech, Ugur Sahin, started designing vaccines as soon as he read The Lancet study noting the case without symptoms, which convinced him that a pandemic was likely. He then persuaded Pfizer, his initially skeptical investor, to back him.
On May 15, 2020, the United States began Operation Warp Speed, which financed the development of six vaccine candidates. Five of them quickly proved to be highly effective — not at all a given. The first to deliver spectacular results was that produced by Pfizer and BioNTech. Moderna’s quickly followed.

Supply was an immediate problem. Pfizer initially estimated it could make as many as 1.35 billion doses in 2021 — enough for about only 8.5 percent of the world’s people to get two doses. Moderna, a much smaller company, wasn’t expected to exceed that. AstraZeneca’s vaccine, too, would not cover the gap quickly enough.

There also was too little commitment to how vaccines could be distributed fairly around the world.

Instead, wealthy countries that had preordered or financed research got most of the initial doses.

Vaccine production grew, but too slowly. There was no consortium or sharing of resources to ramp up supply. Technology wasn’t transferred to lower- and middle-income countries. Patents were left in place. The W.H.O. initiative to get vaccines to poorer countries, known as Covax, was not able to buy enough doses, and what donations were made were insufficient and haphazard.

Then, in a largely unanticipated plot twist, dangerous variants of the coronavirus started emerging in late 2020 — Alpha, Delta and then Omicron.

Widespread earlier vaccination could have helped limit the possibility for these variants emerging. Plus, many variants may have arisen through persistent infections in immunocompromised people — like those who have untreated H.I.V., another terrible legacy of global health inequity.

What could have happened: Vaccine supply ramps up, with sensible distribution.

Political leaders in wealthy countries should have brought together vaccine manufacturers to arrange conditions and deals that can likely be struck only with government prodding: sharing manufacturing facilities, training experts, sharing intellectual property. Technology transfer to poorer countries could have achieved the ultimate goal: a world with many countries that can produce effective vaccines. Existing vaccine manufacturers could still profit handsomely — especially considering they, too, benefit from publicly funded research.

Countries may want to first vaccinate their own citizens, even those at much less risk. But to save the most lives, priorities should have been set globally. Health care workers, the elderly and those at high risk throughout the world should have gotten the first vaccinations.

Trials could have been immediately started to assess whether delaying second doses might work well while allowing doses to be spread more widely geographically. Early results on the protective effect of first doses were encouraging.

A few countries like Canada and Britain did lengthen the interval between doses as a strategy to protect more of their citizens — to great results. More of their vulnerable population got protected quickly. Plus, longer intervals, as some immunologists had predicted earlier, still left people protected — the unusually short three- and four-week period between the two initial shots had been put in place partly to speed up the trials. In the United States, though, such adaptive strategies could not be studied or rolled out.

What needs to happen
When the pandemic is over, the temptation will be to move on and reclaim what had been normal life. For individuals that will be fine. But the cracks revealed in our governments and public health institutions by two years of inertia, mistakes and resistance to evidence make it crucial that a broad, tough dissection of what happened take place if we are to choose the correct course in future challenges.

National and international commissions need to help us see where we went wrong, without scapegoating, and how to respond to future outbreaks, without defensively excusing what public health authorities and national leaders did this time, even if well-meaning. In some countries, it would be easy to focus only on political leaders like President Donald Trump, who severely damaged America’s response. But top public health officials, high-level scientists and state governors made many missteps along the way. At a time of growing international distrust we need to work to increase trust and mutual cooperation. We need to better understand how to rapidly incorporate evidence into scientific policy and to better understand human response to such major, complicated events.

If we can do that, to save lives and ease suffering in the future, it will not make up for all the loss and hardship we have endured in the last two years. But we can at least say we did our best to learn from it, and let that be the one positive legacy of all this.