South Korea virus cases hit highest level since March

South Korea reported its highest daily number of coronavirus cases since March on Thursday, with a surge of new infections sparking fears of a major third wave.

Officials announced 583 new cases after several weeks of fresh infections ranging between around 100 and 300.

The latest cases have mostly been clusters at offices, schools, gyms and small gatherings in the greater Seoul area, the Korea Disease Control and Prevention Agency said.

New infections also emerged within the military, including dozens of newly enlisted soldiers at a boot camp—prompting the defence ministry to bolster its virus measures.

“We are now in a situation where virus outbreaks can happen at any place,” health minister Park Neung-hoo said.

The government tightened social distancing rules in the capital and the surrounding regions this week as authorities scrambled to contain the spread of the virus.

The measures include closing nightclubs and bars and restricting the number of visitors at weddings and funerals to 100.

Cafes are only allowed to serve takeaways and all restaurants must close by 9pm, with only deliveries permitted afterwards.

Thursday’s figures take the total number of recorded cases in the country to more than 32,000.

South Korea endured one of the worst early COVID-19 outbreaks outside mainland China, but brought it broadly under control with its “trace, test and treat” approach. It never imposed the kind of lockdowns ordered in much of Europe and other parts of the world.

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Covid-19 tests imported from South Korea were ‘flawed’: WPost

Coronavirus tests imported from South Korea by the governor of the US state of Maryland were flawed and ended up not being used, The Washington Post reported on Friday.

The newspaper said Maryland Governor Larry Hogan spent $9.46 million in April to import 500,000 coronavirus tests from South Korea.

But the tests turned out to be flawed and the state “quietly” paid the same South Korean company an additional $2.5 million for 500,000 replacement tests, the Post said.

It said a University of Maryland laboratory abandoned its use of the replacement tests after a spate of suspected false positives but a private lab continues to use them.

Around 370,000 of the replacement tests have been used by the private lab, the Post said.

Hogan, a frequent critic of President Donald Trump, trumpeted the arrival of the South Korea tests in April and praised the assistance of his South Korean-born wife in obtaining them.

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As virus hits Italy’s south, some flee troubled health care

Patients, some wrapped in blankets that look like they came from home, moan in their beds. What appears to be medical tubing and a wad of gauze or paper towels litter the floor of San Giuliano public hospital, which treats coronavirus patients in a bleak town in Italy’s Neapolitan hinterland.

In another surreptitiously filmed scene, 15 kilometers (9 miles) away in Naples, an elderly man suspected of having COVID-19 takes his last, labored breaths in a bathroom at the emergency room of Cardarelli Hospital, his undignified end memorialized on a phone camera by a fellow patient and posted online.

Meanwhile, outside the ER entrance for Cardarelli, the main health care facility for densely populated Naples, those desperate for oxygen for loved ones line up in their cars, waiting for nurses to bring tanks of the life-saving element to ailing passengers anxious to enter the crowded ER.

The pandemic, which has killed more than 46,000 people in Italy, has heightened the urgency of the plight of those seeking medical care in public hospitals in the country’s economically underdeveloped south. But these glimpsed moments of drama, while shocking, are nothing new to people here who depend on such care.

In late September, as coronavirus infections surged in Italy after a summer decline, prosecutors put 17 hospital managers and workers under investigation for an insect infestation at a Naples hospital. Cardarelli, meanwhile, was once accused by the consumer group Codacons of leaving patients crowded in corridors like they were “old boxes.”

Naples prosecutors are investigating the bathroom death at Cardarelli, and the hospital’s director has ordered an internal probe. At San Giuliano, hospital officials declined to speak to an AP reporter who visited Saturday, and there was no immediate answer at the hospital’s administrative office on Tuesday evening.

Many in the Naples area resign themselves to what the La Repubblica newspaper denounced as hellish, “Dantesque” waits to receive treatment for COVID-19. Others bundle up their loved ones and head north, where Italian health care enjoys a better reputation—but many hospitals there are also overwhelmed.

Lombardy in the north is again the epicenter of Italy’s latest coronavirus outbreak, as it was when the virus first hit Europe. In the regional capital of Milan, coronavirus infections rampaged through the city’s most prestigious home for the elderly early in the pandemic.

In the spring, a severe nationwide lockdown meant that while the north suffered the brunt, the south was largely spared. But now, the virus is hitting several regions hard at once—a phenomenon seen in other European countries.

With the Campania region that surrounds Naples now under strain, at least 116 patients sought treatment this month in neighboring Lazio, at Formia’s Dono Svizzero hospital. Some had tested positive for the virus, while others had other ailments and feared becoming infected with the virus in the area’s chaotic emergency rooms.

“If patients knock on the door, it’s open,” Paolo Nucero, head of the Formia hospital’s emergency room, told Italian state television. “At the moment, we’re holding up. But if we have a super flood, we will start suffering.”

Leaving one’s region to seek better medical treatment elsewhere in Italy is so prevalent that a foundation studying the quality of the nation’s health care publishes what it calls the “flight index.” The GIMBE Foundation found that nearly all those “fleeing” local health care went north.

In Italy’s health care system, each region manages its own spending. In a cruel illustration of the ”rich get richer while the poor get poorer” adage, footing the medical bills of Italians who travel outside their regions still falls to the region where they reside. That means a bonanza of funds for the northern regions providing the care but a drain on the coffers of poorer, southern parts.

Along the Naples waterfront, Luigi Orefice perched his 4-year-old son, Giovanni, on the thick wall lining the promenade. With fog ringing the Vesuvius volcano in the background, the postcard-like panorama would be familiar to tourists. But his job delivering beverages to hospitals lets Orefice see the ugly realities beyond the “O Sole Mio” image of the south.

His deliveries take him inside hospitals in the dead of night, when Orefice says he has witnessed lax protocols, like staff walking barefoot.

“We might have the best hospital department chief of staffs, but at the bottom, hospital workers are poorly managed,” he said.

Outside San Giuliano Hospital in Giugliano in Campania on a recent day, Feliciano Manna, a representative of the UIL labor syndicate for ambulance crews, noted that Campania lost about 15,000 health care workers in recent years to budget cuts. Italy’s Civil Protection force is currently recruiting 450 doctors to help the region care for COVID-19 patients.

Only weeks before the pandemic began did Campania’s public health care system emerge from years of central government control, part of efforts to cut waste and drive down costs.

The person behind the video inside San Giuliano Hospital “took advantage of a moment when he saw some wad of gauze of the floor,” said Manna. “The staff is doing super-human work,” he said. The video “doesn’t discredit that.”

In a parking lot behind the hospital, Giuseppe Sguiglia, 30, and his 26-year-old wife waited in their car, inching forward in a long line of people signed up for COVID-19 tests.

Last year, Sguiglia said, he had to use a local hospital. Judging from that experience, “we understood that Naples would be a disaster” if the pandemic spread south, he said.

Some cite the insidious influence of organized crime on some of Campania’s institutions.

In response to an AP query, the Interior Ministry said Monday that the minister will decide this month whether a sprawling Naples health care district should be put under temporary control of the ministry’s local prefect—depending on if it’s determined that the Camorra infiltrated its administration.

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People in Soweto told us about their fears in the first weeks of South Africa’s lockdown

South Africa’s response to the novel coronavirus outbreak was swift and assertive. The country quickly instituted testing, tracing, and quarantining those affected with COVID-19. But the financial and social effects of quarantine hit people, who were already struggling, especially hard. Racial and economic inequalities were amplified in South Africa, as elsewhere, through the new coronavirus threat.

In March, the government introduced extreme lockdown restrictions barring South Africans from leaving their homes except to buy essential goods and seek medical care. We conducted a study to capture how people were coping during lockdown in Soweto, a large conglomerated urban area southwest of Johannesburg. Psychological assessments were done between April 2019 and March 2020; and again in the first six weeks of the lockdown.

We called 957 adults living in Soweto who had been enrolled in existing studies on the epidemiology of syndemics, or synergistic epidemics. We spoke to them about how they perceived and experienced lockdown and COVID-19. A large majority of our sample were female, middle aged (average age was 43 years old), and shared a room at home. Nearly 91% of adults in our sample reported having at least one underlying health condition or more—a potential risk factor for COVID-19 infection.

We already had some information about them, such as early childhood trauma and current mental and physical health as they are already participants in research we are currently undertaking. We also conducted a brief mental health questionnaire on the phone during lockdown.

Our results show that people who viewed their risk of COVID-19 infection to be higher than others in their community exhibited greater depressive symptoms. Furthermore, people who reported histories of childhood trauma had worse depressive symptoms as a result of their perceived risk of getting COVID-19. These findings confirm existing research that shows that people who face more adversity during childhood may be more vulnerable to the effects of stress and trauma in the future—such as the stressors of the pandemic.

We found a strong relationship between COVID-19 risk perceptions and depressive symptoms. But an overwhelming majority (74%) of respondents didn’t think that their life under lockdown and wider pandemic conditions affected their mental health. This discrepancy potentially highlights the ever-present stigma and lack of awareness around mental health in Soweto and the country at large. Our study reemphasises the importance of prioritizing and providing accessible mental health services for resource-limited communities in Soweto and across South Africa.

Public perceptions

Many people called it a “virus that kills” and suggested they feared the virus in some way. This most likely inspired people to say that they frequently used preventative measures, such as “I wash my hands and stay home” or “wear a mask” or “keep my distance from people.” Many described feeling some anxiety because they are “always thinking about it.” Most worried about those with preexisting conditions, like HIV, diabetes, or heart disease. They considered these community members most at risk.

Social challenges were common. Many had already lost their jobs and worried about putting food on the table. Others worried because “since lockdown, movement is very difficult.”

Residents were scared to leave the house. One participant was scared because a neighbor’s house was bulldozed and his family had nowhere to go.

Few cases of COVID-19 were detected in Soweto during the first month of lockdown, although many people still perceived their risk to be high. Many described deep anxiety and fear over personal well being, and caring for those they love.

We found people perceived their own risk for COVID-19 infection differently relative to others in their community. About 58% of adults thought they were at lower risk of COVID-19 than others, while 29% reported having the same risk, and 14% having more risk. This risk perception was unaffected by personal characteristics such as age, finances, education, or household density. Greater knowledge of how to prevent coronavirus transmission and to keep their families safe was associated with lower perception that they were at risk of infection.

One in three people in South Africa is expected to experience a common mental disorder like anxiety or depression in their lifetimes. During lockdown, most did not think that COVID-19 had affected or could hurt their mental health. Nevertheless, we found a variety of stressors that caused deep worry, anxiety, and rumination (“thinking too much”) in approximately 20% of adults.

We found that those who perceived their risk for COVID-19 to be higher had more depressive symptoms and more severe histories of childhood trauma. This was true regardless of people’s mental health before lockdown, what they knew about COVID-19, how they coped, and their family and financial backgrounds.

But these measures were collected simultaneously. So we don’t know if these adults were depressed because they felt at risk, or whether they felt at risk because they were depressed. Because we controlled for recent psychiatric status in the first wave of our study before COVID-19, we can be more sure that COVID-19 risk and depression are tightly linked regardless of people’s mental health going into the pandemic.

Finally, we found preliminary evidence that the depressive effects of COVID-19 risk were worse among adults with histories of childhood trauma. In other words, those with greater childhood adversity exhibited worse psychological outcomes during the first six weeks of the lockdown compared to those with fewer accounts of childhood trauma.

Research has shown that adversity during childhood can increase risk for major depression later in life. More childhood trauma also may influence the severity of adult depression and increase how people respond emotionally to future stressors like the coronavirus.

Urgent need for services

Childhood trauma is well-known to influence how severely and for how long people experience depression.

This study shows how those who have experienced social adversity growing up may be struggling more than others in this current moment.

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Identifying clusters central to South Korea’s COVID-19 response

South Korean interventions controlled the transmission of COVID-19 quickly, resulting in a smaller epidemic made up of “clusters” of cases.

A new report from the Imperial College London COVID-19 Response Team says that caution is needed in attempting to duplicate the South Korean “test, trace, isolate” response in countries with larger and more generalized epidemics. 

Despite a rapid growth of cases early in the global pandemic, South Korea brought the transmission of COVID-19 under control with less stringent nation-wide social distancing policies than countries such as Italy, France, and the UK. This has led to substantial interest in their early “test, trace, isolate” strategy as other nations begin to ease lockdown measures. 

Ms Amy Dighe, one of the authors of the paper, said: “Caution should be exercised if applying South Korea’s “test, trace isolate” strategy in settings where transmission is geographically widespread and case numbers are much higher, like the US or many countries in Europe.” 

Professor Steven Riley, Professor of Infectious Disease Dynamics, said: “As we exit lockdown in the UK, we need to learn as much from other countries as we can. The South Korean example shows us the importance of clusters.  Although we certainly need to trace the contacts of individuals as quickly and as efficiently as we can, we also need to jump ahead of the virus by identifying clusters and rapidly quarantining, testing and isolating.” 

The research is published in Report 25 from Imperial College London’s WHO Collaborating Centre for Infectious Disease Modelling within the MRC Centre for Global Infectious Disease Analysis, Jameel Institute (J-IDEA) and Imperial’s Department of Mathematics. 

Test, trace, isolate 

South Korea controlled transmission of COVID-19 rapidly, resulting in a relatively small epidemic made up of large linked clusters, the Imperial College London COVID-19 Response Team has found. This was in spite of South Korea experiencing a sharp growth in cases early in the global pandemic. 

As of May 28th, a total of 11,344 cases have been reported in South Korea. While South Korea experienced a sharp growth in COVID-19 cases early in the global pandemic, it has since rapidly reduced rates of infection and now maintains low numbers of daily new cases. 

This review of South Korea’s interventions in response to the COVID-19 epidemic draw insights into the different components of the response. Suspected and confirmed cases were isolated quickly even during the rapid expansion of the epidemic and identification of a cluster of cases among members the Shincheonji group. A localized lockdown was implemented which reduced movement in Daegu decreased by 80% during this period as compared to the same time in 2019.

Isolation of cases and self-quarantine of contacts has been a consistent feature of the South Korean response. Suspected and confirmed cases were isolated quickly even during the rapid expansion of the epidemic and identification of the Shincheonji cluster. South Korea swiftly scaled up testing capacity and was able to maintain case-based interventions throughout the epidemic. 

Alongside this, South Korea asked people to leave their houses only for daily necessities, healthcare and commuting to work, and many community spaces were asked to close. This led to a 38% national decrease in movement which occurred voluntarily between February 24th – March 1st. 

Cluster investigations 

Imperial researchers find that contact tracing for infected individuals, rather than associated with a specific cluster, was a relatively minor aspect of the control program. Contacts traced through one individual currently account for only 11% of total cases. Cluster investigations account for a far higher proportion of cases, with 48% of all cases in the Shincheonji cluster and 20% in other clusters.  

The high volume of testing and low number of deaths suggests that South Korea experienced a small epidemic of infections relative to other countries. The authors say that caution is needed when attempting to duplicate the South Korean response in settings with larger more generalized epidemics as finding, testing and isolating cases that are linked to clusters may be more difficult in such settings. 

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