New Coronavirus News from 19 Apr 2022

Correlation Between Mask Compliance and COVID-19 Outcomes in Europe [Cureus, 19 Apr 2022]

by Beny Spira

Abstract
Masking was the single most common non-pharmaceutical intervention in the course of the coronavirus disease 2019 (COVID-19) pandemic. Most countries have implemented recommendations or mandates regarding the use of masks in public spaces. The aim of this short study was to analyse the correlation between mask usage against morbidity and mortality rates in the 2020-2021 winter in Europe. Data from 35 European countries on morbidity, mortality, and mask usage during a six-month period were analysed and crossed. Mask usage was more homogeneous in Eastern Europe than in Western European countries. Spearman's correlation coefficients between mask usage and COVID-19 outcomes were either null or positive, depending on the subgroup of countries and type of outcome (cases or deaths). Positive correlations were stronger in Western than in Eastern European countries. These findings indicate that countries with high levels of mask compliance did not perform better than those with low mask usage.

Introduction
Universal masking has been introduced during the coronavirus disease 2019 (COVID-19) pandemic at an unprecedented global scale as an important tool to curb viral transmission among potential susceptible persons. Face masks still are one of the most significant and controversial symbols in the fight against COVID-19. Two large randomised controlled trials about mask effectiveness performed during the pandemic came out with mixed results [1,2].

Several studies that analysed the effect of masks on the general population (ecological studies) have concluded that masks were associated with a reduction in transmission and cases [3-7]. However, these studies were restricted to the summer and early autumn of 2020. From March 2020 onwards, country after country instituted some form of mask mandate or recommendation. The stringency of these measures varied among the different countries and they, therefore, resulted in different proportions of mask compliance, ranging from 5% to 95% [8]. Such heterogeneity in mask usage among neighbouring countries provided an ideal opportunity to test the effect of this non-pharmaceutical intervention on the progression of a strong COVID-19 outburst.

Materials & Methods
Study design
This analysis aimed to verify whether mask usage was correlated with COVID-19 morbidity and mortality. Daily data on COVID-19 cases and deaths and on mask usage were obtained for all European countries. The rationale behind the choice of European countries for comparison was fourfold: (1) availability and reliability of data; (2) a relative population homogeneity and shared history of epidemics (comparing countries from different continents may bring too many confounding factors); (3) similar age stratification and access to health assistance; and (4) divergent masking policies and different percentages of mask usage among the different populations, despite the fact that the entire continent was undergoing an outburst of COVID-19 at the time period analysed in this study.

Inclusion criterion
Data were collected from the following Eastern and Western European countries: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Hungary, North Macedonia, Poland, Romania, Serbia, Slovakia, Slovenia, Belarus, Estonia, Latvia, Lithuania, Republic of Moldova, Ukraine, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom, and Northern Ireland. The inclusion criterion was a population size higher than one million people.

Data retrieval
Data on morbidity, mortality, and mask usage were retrieved from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington [8]. Data from IHME were downloaded on 14th February 2022. IHME mask data sources are the Delphi Group at Carnegie Mellon University and the University of Maryland COVID-19 Trends and Impact Surveys, in partnership with Facebook, Kaiser Family Foundation, and YouGov COVID-19 Behaviour Tracker Survey (https://www.healthdata.org). Data on vaccination were obtained from Our World in Data (OWID) [9] on 4th April 2022.

Statistical analysis
Data from 35 European countries on morbidity, mortality, and mask usage during a six-month period were collected and analysed. Spearman’s correlation analyses and Shapiro-Wilk normality checks were in JASP (version 0.15; University of Amsterdam, Amsterdam, Netherlands) [10] and linear regressions in Wolfram Mathematica 13.0 (Wolfram Research, Inc., Champaign, Illinois) [11].

Results
This brief communication reports the correlation between the proportion of mask usage in the population and the number of cases (per million) and deaths (per million) from October 2020 to March 2021 in 35 European countries (Table 1). For this analysis, all European countries, including West and East Europe, with more than one million inhabitants were selected, encompassing a total of 602 million people. All analysed countries underwent a peak of COVID-19 infection during these six months (Figures 1, 2). The average proportion of mask usage in the referred period was 60.9% ± 19.9%, slightly higher in Eastern than in Western Europe (62.1% and 59.6%, respectively). However, the level of mask compliance was considerably more homogeneous in East (SD = 13.4%) than in West European countries (SD = 25.4%).

Surprisingly, weak positive correlations were observed when mask compliance was plotted against morbidity (cases/million) or mortality (deaths/million) in each country (Figure 3).
Neither the number of cases nor the proportion of mask usage followed a Gaussian distribution (Shapiro-Wilk p-values were 0.004 and 0.0536, respectively). A Spearman’s rank test was applied to quantify the correlation between mask usage, cases, and deaths (Table 2).
The positive correlation between mask usage and cases was not statistically significant (rho = 0.136, p = 0.436), while the correlation between mask usage and deaths was positive and significant (rho = 0.351, p = 0.039). The Spearman’s correlation between masks and deaths was considerably higher in the West than in East European countries: 0.627 (p = 0.007) and 0.164 (p = 0.514), respectively. This difference could be associated with the fact that the most populous countries are located in West Europe. However, the correlations did not significantly change when the seven countries with populations > 20 million were excluded from the analysis (cases rho = 0.129 (p = 0.513); deaths rho = 0.375 (p = 0.049)). Analyses of other sub-groups, such as countries with populations smaller or higher than six million, higher than 10 million, or higher than 15 million, were also evaluated. None of these tests provided negative correlations between mask usage and cases/deaths.

Discussion
Mask mandates were implemented in almost all world countries and in most places where masks were not obligatory, their use in public spaces was recommended [12]. Accordingly, the World Health Organization (WHO) as well as other public institutions, such as the IHME, from which the data on mask compliance used in this study were obtained, strongly recommend the use of masks as a tool to curb COVID-19 transmission [8,13]. These mandates and recommendations took place despite the fact that most randomised controlled trials carried out before and during the COVID-19 pandemic concluded that the role of masks in preventing respiratory viral transmission was small, null, or inconclusive [1,2,14,15]. Conversely, ecological studies, performed during the first months of the pandemic, comparing countries, states, and provinces before and after the implementation of mask mandates almost unanimously concluded that masks reduced COVID-19 propagation [3-7,16]. However, mask mandates were normally implemented after the peak of COVID-19 cases in the first wave, which might have given the impression that the drop in the number of cases was caused by the increment in mask usage. For instance, the peak of cases in Germany's first wave occurred in the first week of April 2020, while masks became mandatory in all of Germany's federal states between the 20th and 29th of April [5], at a time when the propagation of COVID-19 was already declining. Furthermore, the mask mandate was still in place in the subsequent autumn-winter wave of 2020-2021, but it did not help preventing the outburst of cases and deaths in Germany that was several-fold more severe than in the first wave (Figure 2).

The findings presented in this short communication suggest that countries with high levels of mask compliance did not perform better than those with low mask usage in the six-month period that encompassed the second European wave of COVID-19. It could be argued that some confounding factors could have influenced these results. One of these factors could have been different vaccination rates among the studied countries. However, this is unlikely given the fact that at the end of the period analysed in this study (31th March 2021), vaccination rollout was still at its beginning, with only three countries displaying vaccination rates higher than 20%: the UK (48%), Serbia (35%), and Hungary (30%), with all doses counted individually [9]. It could also be claimed that the rise in infection levels prompted mask usage resulting in higher levels of masking in countries with already higher transmission rates. While this assertion is certainly true for some countries, several others with high infection rates, such as France, Germany, Italy, Portugal, and Spain had strict mask mandates in place since the first semester of 2020. In addition, during the six-month period covered by this study, all countries underwent a peak in COVID-19 infections (Figures 1, 2), thus all of them endured similar pressures that might have potentially influenced the level of mask usage.

Conclusions
While no cause-effect conclusions could be inferred from this observational analysis, the lack of negative correlations between mask usage and COVID-19 cases and deaths suggest that the widespread use of masks at a time when an effective intervention was most needed, i.e., during the strong 2020-2021 autumn-winter peak, was not able to reduce COVID-19 transmission. Moreover, the moderate positive correlation between mask usage and deaths in Western Europe also suggests that the universal use of masks may have had harmful unintended consequences.
________________________________________
References
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Hunger and anger in Shanghai's unending lockdown nightmare [CNN, 19 Apr 2022]

by Steven Jiang

(CNN)When my 73-year-old father raised concern about his shrinking food supply late last week, the catastrophe brought by Shanghai's citywide Covid lockdown suddenly hit home.

"Will be running out in a few days if no government handout soon," he messaged me Thursday.

Then, as if anticipating my inevitable worry, he added: "Still have some rice and crackers -- and plenty of coffee."

It was a startling revelation on the grim reality in China's biggest city and financial hub -- from a member of the generation that lived through the Great Famine and the tumultuous Cultural Revolution that killed millions during the first few decades of the People's Republic, founded in 1949 by Communist revolutionary Mao Zedong.

Even during the darkest days in Mao's China, my parents -- Shanghai-born and bred -- used to remind me that, unlike many in the countryside, they were fortunate enough not to fear the prospect of starvation.

Now, with lockdown measures turning increasingly draconian, a once almost-unthinkable topic has struck a chord with residents in the city and beyond, more so than anything else: people going hungry in Shanghai in 2022.

What’s happening in China and what does it mean for the rest of the world?

By the authorities' own acknowledgment, the food shortage has been a largely man-made disaster owing to a lack of planning and coordination.

Despite official pledges, government handouts have been unreliable in many parts of the city, including my father's apartment complex in northeastern Shanghai filled with retirees like him. The elderly crowd had mostly failed to secure supplies through online bulk-purchases,
practically the only way to buy anything in Shanghai at the moment, due to their relatively small demand and lack of tech-savviness.

I set out to help but never had I thought online grocery shopping would be such an emotional rollercoaster.

Armed with a membership for a retail warehouse club -- presumably allowing me to face less stiff competition than those using a general online grocer -- I quickly realized it was impossible to grab one of the coveted delivery slots, which are assigned at 9 p.m. daily, even with food still available on the virtual shelves.

The retailer's app simply crashed each night -- and would only come back online a few hours later with a glaring "no more delivery slots for the day" message.

As frustration and anxiety built up, my hope dwindled along with my father's supply. On Day 2 of my futile attempts, a friend tipped me off about a "boutique" online retailer that was still offering a grocery package with next-day delivery slots. Elated to find out she was right, I immediately ordered for my father.

When I broke the good news in the online family group chat, however, uncles and aunts -- all facing their own food shortage to various degrees -- jumped in to express their shock that I willingly paid 398 yuan ($62) for five kilograms of vegetables and 60 eggs.

"Highway robbery!" cried one uncle, while an aunt stressed the price was more than four times what she would normally pay for the same amount of food in the market.

"But these are boutique eggs," my dad deadpanned.

I was relieved that my father's fridge was replenished in time but, hearing relative's comments, felt a sense of "survivor's guilt": What about the countless residents who can't afford price-gouged groceries?

An indefinite lockdown
Literal survival wasn't a concern for most of Shanghai's 25 million residents before April.

For the past two years, the city had bolstered its status as the most important international gateway to China -- for both people and goods. It had prided itself on its more targeted and lenient approach to Covid containment, despite Beijing's strict zero-Covid policy.

With Shanghai shunning citywide mass testing and adopting less restrictive quarantine rules, it once looked like a potential role model for the whole country as the rest of the world had largely chosen to live with Covid with an emphasis on vaccination.

Then came Omicron, with the highly contagious Covid variant sweeping through the city and infecting more than 390,000 residents since March, according to government statistics.

After repeatedly denying the city would be locked down -- with police even announcing a probe into alleged online rumormongers -- Shanghai authorities abruptly changed course in late March and sealed off the entire metropolis at the beginning of April.

The government initially billed it as a four-day "temporary pause" -- claiming they would promptly test the entire population, isolate positive cases and then re-open the city. As a result, many residents never bothered to stock up.

Despite widespread panic buying before the lockdown, my father was among the unfazed. A retired electric engineer who enjoys travel, photography and coffee, he had recently strained his back muscles -- and wasn't going anywhere in any case.

Still, his home confinement turned out to be much longer -- and more precarious -- than he ever envisioned.

With tens of thousands of new infections reported daily, the government has continued to extend the lockdown -- ordering any residential community with a single new positive case to be sealed for an additional 14 days.

My father's apartment complex is currently slated to be locked down until May 2. But even that date remains uncertain, as the authorities continue to retest residents, meaning the lockdown clock could reset at any time.

For once, millions of people in Shanghai -- young and old, rich and poor, liberal and conservative -- seem united by their rising anger.

Despite the censors' ferocious effort to erase all traces of bad news, social media users keep recounting and re-posting heartbreaking stories, increasingly disgusted by highly choreographed state media images showing an orderly and effective lockdown.

Among my friends and family, almost everyone has a personal story to share about the lockdown chaos and misery: from sneaking out in darkness to barter some food with a neighbor, to learning harrowing experiences of a friend dumped into to a hastily built isolation ward with leaking roofs and overflowing toilets, and hearing the wailing of an old woman next door whose children were unable to see their newly deceased father one last time.

Propaganda adds insult to injury
People are also seeing Chinese propaganda czars double down, painting Omicron as a potentially lethal threat while stressing that only zero-Covid can save China from the deaths and havoc caused by the virus in the West.

Officials have made it clear the policy has the personal stamp of approval from the country's strongman leader, Xi Jinping, who has yet to visit Shanghai -- a city he once led -- amid the deepening crisis. Xi is expected to assume an almost unprecedented third term later this year, paving the way for him to rule for life.

Outside Shanghai, that message still seems to resonate with many, though debates have started to emerge and intensify. Inside the eerily quiet metropolis, the lockdown and its ensuing calamity have become a watershed moment for locals and expatriates.

With state media headlines screaming "it's not the flu!" against government statistics showing only about two dozen severe cases among the infected in Shanghai so far, nearly everyone seems to agree on the apparent absurdity of "the solution being worse than the problem" -- particularly as stories surface on social media about deaths relating to those unable to receive medical care for non-Covid causes due to the lockdown.

Some residents have questioned online why the authorities appear more keen to attack critics of zero-Covid than to convince residents aged over 60 in the fast-graying city -- the most vulnerable group with a disappointing vaccination rate of 62% -- to get the shot.

Others reflect on the current tragedy and contemplate their next steps.

"How did Shanghai fall like this?" has been the line I have heard most often lately. It's mostly a rhetorical question -- the real question seems to be "Shall I stay, or shall I go?"

For expats, many have been voting with their feet -- undaunted by the bureaucratic and logistical hoops they must jump through to just exit their residences.

For locals, it involves more soul-searching but, echoing sentiment online, a growing number of Shanghainese -- native or adopted -- have told me they have decided to put their foot down to emigrate.

Entrepreneurs and bankers alike say the brutal lockdown has demonstrated money means nothing in a world where anyone can instantly become collateral damage in plans instigated by a distant and unaccountable leadership.

For most people in Shanghai, especially of the older generations like my father, they will always call the city home. They remain focused on surviving the ongoing nightmare, trying their luck with bulk-purchasing online.

My father said someone in his community recently initiated a coffee group-buy attempt -- but quickly failed due to lack of interest.

"No one seems to be in the mood for coffee right now," he said.

New Coronavirus News from 20 Apr 2022

Ever-increasing ever-increasing corona cases increased concern, 65% cases increased again in 24 hours [News Track English, 20 Apr 2022]

By Shruti Wilson

New Delhi: Corona cases are increasing rapidly across the country. In the last 24 hours, 2067 cases of corona infection have been reported. Earlier on Monday, 1247 cases were found.
Meaning, in 24 hours, about 65 percent cases have increased in the country. In the last 24 hours, 40 people have died due to corona in the country. However, due to this 1,547 people have become healthy. So far, a total of 4,30,47,594 cases of corona have been reported in the country. At the same time, active cases have increased to 12,340. So far 4,25,13,248 people have recovered from corona. So far 5,22,006 people have died due to corona in the country.

The situation in the national capital Delhi is very worrying. Here in the last 24 hours, 26 percent corona cases have increased. On Tuesday, 632 new cases of corona were reported in Delhi.
Earlier on Monday, 501 cases were reported. Active cases have increased to 1,274. However, on Tuesday, 414 people have recovered. However, no one has died from Corona in the last 24 hours. The positivity rate has gone up to 4.42 percent.

Apart from Delhi, there is a huge increase in the cases of corona in Uttar Pradesh too. 163 cases have been registered in the last 24 hours. Active cases have increased to 798 cases. 55 people have been cured in the last 24 hours. In the same Maharashtra, the cases of corona have increased very rapidly on Tuesday. In the last 24 hours, 137 new cases have been reported here. Whereas a day earlier, on Monday, 59 cases were reported.

Corona cases rise again globally [Uttarakhand News Network, 20 Apr 2022]

The uncontrollable pace of Corona continues in Germany, France and Italy. In Germany, about 2 lakh cases have been reported in a day. In China’s financial center Shanghai, the government has decided to extend the lockdown as the situation in the city regarding Corona has not eased. Meanwhile, India has registered a 66 percent increase in corona cases in 24 hours. A record 1009 cases of corona have been reported in the capital Delhi.

Corona’s new sub-variant XE has created panic all over the world. This variant is a sub-variant of Omicron. As per reports, this variant is more infectious and dangerous than all the variants of corona so far. The new sub-variant of Corona has once again stalled the powerful countries of the world. The pace of corona has become uncontrollable in western countries. Corona cases in Germany, France and Italy are scary. Whereas, cases of corona are increasing continuously in South Asian countries as well. Corona cases are increasing in China and India.
On Tuesday, 1.98 lakh new cases of corona were reported in Germany. After which the corona cases have increased to 23,658,211. The news agency Reuters also reported 348 new deaths, citing data from the Robert Koch Institute. At the same time, France has reported 181 new deaths from Corona on Tuesday. While 25,465 new infection cases have been reported. France is currently battling with the once again escalation of the Corona epidemic.

On the other hand, 27,214 cases were reported in Italy on Tuesday. Italy’s health ministry said deaths had risen to 127, up from 79 the previous day. The Health Ministry said that 174,098 COVID tests were conducted on Tuesday as compared to the previous 105,739.

95 percent corona cases reported from Shanghai
On Wednesday, 19927 new cases of corona were reported in China. Whereas in Shanghai city alone, 18902 cases were reported with 95 percent cases. While 2495 of these people had symptoms of corona. Strict curfew is currently in force in Shanghai regarding Corona. Earlier this week, the government allowed 40 lakh people to step out of the house, easing the lockdown slightly. This permission was only for buying essential items.

2000 new cases of corona in India, scary situation in Delh
On Wednesday, 2000 new cases of corona were reported in India. Whereas, in the evening, 1009 new cases of corona were reported in the capital of the country. With these cases, the risk of corona in Delhi has increased again. In such a situation, the government has again made it mandatory to wear masks in public places. Failure to comply with the order will attract a fine of Rs 500.

Nearly 2 Lakh Covid cases in Germany, Shanghai eases more curbs: Global updates [Hindustan Times, 20 Apr 2022]

By Ishika Yadav

1.98 lakh cases in Germany, Shanghai eases curbs: Global Covid updates in 8 points

Confirmed Covid cases in Germany went up by 1.98 lakh. Italy witnessed a single-day spike of 27,214 cases on Tuesday. In Shanghai, the Chinese government has decided to lift the lockdown further. Here are the top global Covid-19 updates.

Germany, France and Italy continue to fight a rise in daily infections and Covid-linked deaths, with Germany reporting nearly 2 lakh cases in a day. In China’s financial hub Shanghai, the government has decided to lift the lockdown further as it intensifies Covid-19 testing in the city. Meanwhile in India, a 66 per cent rise in cases was recorded in 24 hours as daily cases crossed the 2,000-mark for the second time this week to break a downward trend.

Here are the top global Covid-19 updates:
1. Confirmed Covid cases in Germany went up by 1.98 lakh to reach 23,658,211 on Tuesday. 348 new deaths were also reported by Reuters citing Robert Koch Institute data.

2. France reported 181 new deaths - a sharp increase from recent daily figures - and 25,465 new infections on Tuesday. France is currently struggling with a surge in the number of Covid-19 patients needing intensive care.

3. Italy witnessed a single-day spike of 27,214 cases on Tuesday, the health ministry said, while deaths rose to 127 as against 79 the previous day. 174,098 Covid tests were carried out on Tuesday, compared with a previous 105,739, the health ministry said.

4. Shanghai allowed an additional four million more people out of their homes Wednesday as curfew rules eased. A total of almost 12 million people in the city of 25 million are allowed to go outdoors following the first round of easing of restrictions last week, health officials said as per news agency AP.

5. On Wednesday, China's mainland witnessed 19,927 new cases. Shanghai accounted for 95% of the total, or 18,902 cases, of which only 2,495 had symptoms.

6. US President Joe Biden said on Tuesday that "it's up to them" when asked whether people should keep wearing masks on aeroplanes. Cab service providers Uber and Lyft have also scrapped face mask mandates for their riders and drivers in the United States.

7. The BA.2 sub-variant of Omicron and its sublineage BA.2.12.1 is estimated to make up more than 90% of the coronavirus cases in the US as of last week, the US' Centers for Disease Control has said.

8. British prime minister Boris Johnson on Tuesday apologised to parliament after he was fined by police for breaking lockdown rules, saying he did not know a birthday gathering at the height of the pandemic was in breach of the rules he had set.

COVID-19: Germany, South Korea, Australia report highest cases globally; check full list here [Free Press Journal, 20 Apr 2022]

The US continues to be the worst-hit country with the world's highest number of cases and deaths at 80,732,919 and 989,328 respectively, according to the CSSE.

The global coronavirus caseload has topped 505.8 million, while the deaths have surged to more than 6.20 million and vaccinations to over 11.19 billion, according to Johns Hopkins University.

In its latest update on Wednesday morning, the University's Center for Systems Science and Engineering (CSSE) revealed that the current global caseload and the death toll stood at 505,893,847 and 6,202,920 respectively, while the total number of vaccine doses administered increased to 11,191,789,391.

Meanwhile, according to COVID-19 tracker Worldometer, there are several countries that are still reporting a huge amount of cases. South Korea, Japan, Australia have reported the maximum cases on Monday, April 18.

Check out the list below:
Germany - 130,759
South Korea - 118,445
Australia - 38,608
USA - 33,193
Japan - 28,282

Check the full list here.
The US continues to be the worst-hit country with the world's highest number of cases and deaths at 80,732,919 and 989,328 respectively, according to the CSSE.

India accounts for the second highest caseload at 43,045,527.

The other countries with over 10 million cases are Brazil (30,275,272) France (28,010,387), Germany (23,658,211), the UK (22,033,383), Russia (17,829,009), South Korea (16,583,220), Italy (15,758,002), Turkey (15,003,696), Spain (11,627,487) and Vietnam (10,489,319).

The nations with a death toll of over 100,000 are Brazil (662,396), India (521,966), Russia (366,436), Mexico (323,949), Peru (212,654), the UK (172,498), Italy (161,893), Indonesia (155,937), France (145,425), Iran (140,877), Colombia (139,754), Germany (133,308), Argentina (128,344), Poland (115,838), Spain (103,104) and South Africa (100,195).