“I slept and dreamt that life was joy. I awoke and saw that life was service. I acted and behold, service was joy”

“Faith is the bird that feels the light when the dawn is still dar”.

“You can’t cross the sea merely by standing and staring at the water”

“Clouds come floating into my life, no longer to carry rain or usher storm, but to add color to my sunset sky.”

“If you cry because the sun has gone out of your life, your tears will prevent you from seeing the stars.”

Rabindranath Tagore

I am concentrating today on the poetry of Rabindranath Tagore. I am grateful to the Times of India who published 10 poems in May this year to mark his birthday 159th birthday. Tagore is a personal favourite of mine and I have been wanting to dedicate one of my post entirely to him.

Rabindranath Tagore (1861-1941)

Rabindranath Tagore was a Bengali poet, writer, composer, mystic and painter. His Impact on Bengali and Indian literature, art and music was immense in the late 19th and early 20th centuries. He was the author of the beautiful and sensitive poem, Gitanjali which led to him becoming in 1913 the first non-European to win the Nobel Prize for Literature. His poetic songs and elegant prose are truly inspiring. He is loved and respected across the Indian Sub-Continent and often referred to as “The Bard of Bengal”. He is one of a few true global literary giants who has an international following but still remains largely unknown to many outside his native lands. He is the author of both the Indian and Bangladesh National Anthems.
Born in Calcutta, he started writing poetry when he was eight and at 16 he published his first collection of poems. This was soon followed by his first short stories and dramas. He denounced the British Raj and was a humanist and internationalist. He modernised Bengali art and literature, moving away from the rigidity of the classical forms. He left a vast collection of poetry, literature, music and paintings as part of his legacy. His ideas, beliefs, philosophies and creativity continue to have a profound impact on the development of India and its neighbouring countries to this day. Even today most children grow up knowing his songs as part of their elementary education.
To me, his poetry is simple but also very sophisticated and mystical at the same time. He loved nature and believed that we interfere with nature at our own peril. He was a true prophet whose message is even more relevant to us all today.

I enclose the 10 poems and hope that you will be inspired in the way that I have been. I have also posted some of his paintings to accompany the poetry.
The poems do not require any complex explanation, they speak for themselves.


The song I came to sing
remains unsung to this day.
I have spent my days in stringing
and in unstringing my instrument.

The time has not come true,
the words have not been rightly set;
only there is the agony
of wishing in my heart…..

I have not seen his face,
nor have I listened to his voice;
only I have heard his gentle footsteps
from the road before my house…..

But the lamp has not been lit
and I cannot ask him into my house;
I live in the hope of meeting with him;
but this meeting is not yet.


Art thou abroad on this stormy night
on thy journey of love, my friend?
The sky groans like one in despair.

I have no sleep tonight.
Ever and again I open my door and look out on
the darkness, my friend!

I can see nothing before me.
I wonder where lies thy path!

By what dim shore of the ink-black river,
by what far edge of the frowning forest,
through what mazy depth of gloom art thou threading
thy course to come to me, my friend?

Thou hast made me endless, such is thy pleasure. This frail vessel thou emptiest again and again, and fillest it ever with fresh life.

This little flute of a reed thou hast carried over hills and dales, and hast breathed through it melodies eternally new.

At the immortal touch of thy hands my little heart loses its limits in joy and gives birth to utterance ineffable.

Thy infinite gifts come to me only on these very small hands of mine. Ages pass, and still thou pourest, and still there is room to fill.

On the nature of love

The night is black and the forest has no end;
a million people thread it in a million ways.
We have trysts to keep in the darkness, but where
or with whom – of that we are unaware.
But we have this faith – that a lifetime’s bliss
will appear any minute, with a smile upon its lips.
Scents, touches, sounds, snatches of songs
brush us, pass us, give us delightful shocks.
Then peradventure there’s a flash of lightning:
whomever I see that instant I fall in love with.
I call that person and cry: `This life is blest!
for your sake such miles have I traversed!’
All those others who came close and moved off
in the darkness – I don’t know if they exist or not.

Paper Boats
Day by day I float my paper boats one by one down the running
In big black letters I write my name on them and the name of
the village where I live.
I hope that someone in some strange land will find them and
know who I am.
I load my little boats with shiuli flower from our garden, and
hope that these blooms of the dawn will be carried safely to land
in the night.
I launch my paper boats and look up into the sky and see the
little clouds setting thee white bulging sails.
I know not what playmate of mine in the sky sends them down
the air to race with my boats!
When night comes I bury my face in my arms and dream that my
paper boats float on and on under the midnight stars.
The fairies of sleep are sailing in them, and the lading ins
their baskets full of dreams.

Where The Mind Is Without Fear
Where the mind is without fear and the head is held high
Where knowledge is free
Where the world has not been broken up into fragments
By narrow domestic walls
Where words come out from the depth of truth
Where tireless striving stretches its arms towards perfection
Where the clear stream of reason has not lost its way
Into the dreary desert sand of dead habit
Where the mind is led forward by thee
Into ever-widening thought and action
Into that heaven of freedom, my Father, let my country awake.

Endless Time
Time is endless in thy hands, my lord.
There is none to count thy minutes.

Days and nights pass and ages bloom and fade like flowers.
Thou knowest how to wait.

Thy centuries follow each other perfecting a small wild flower.

We have no time to lose,
and having no time we must scramble for a chance.
We are too poor to be late.

And thus it is that time goes by
while I give it to every querulous man who claims it,
and thine altar is empty of all offerings to the last.

At the end of the day I hasten in fear lest thy gate be shut;
but I find that yet there is time.

On Missing a Dear One
let me not forget

Freedom from fear is the freedom
I claim for you my motherland!
Freedom from the burden of the ages, bending your head,
breaking your back, blinding your eyes to the beckoning
call of the future;
Freedom from the shackles of slumber wherewith
you fasten yourself in night’s stillness,
mistrusting the star that speaks of truth’s adventurous paths;
freedom from the anarchy of destiny
whole sails are weakly yielded to the blind uncertain winds,
and the helm to a hand ever rigid and cold as death.
Freedom from the insult of dwelling in a puppet’s world,
where movements are started through brainless wires,
repeated through mindless habits,
where figures wait with patience and obedience for the
master of show,
to be stirred into a mimicry of life.

Free Love
By all means they try to hold me secure who love me in this world.
But it is otherwise with thy love which is greater than theirs,
and thou keepest me free.

Lest I forget them they never venture to leave me alone.
But day passes by after day and thou art not seen.

If I call not thee in my prayers, if I keep not thee in my heart,
thy love for me still waits for my love.

The Boat

I must launch out my boat.
The languid hours pass by on the
shore—Alas for me!

The spring has done its flowering and taken leave.
And now with the burden of faded futile flowers I wait and linger.

The waves have become clamorous, and upon the bank in the shady lane
the yellow leaves flutter and fall.

What emptiness do you gaze upon!
Do you not feel a thrill passing through the air
with the notes of the far-away song
floating from the other shore?

See Videos:
Finding Tagore – The Tagore Festival 2011

Rabindranath Tagore, 1913 Nobel Prize in Literature

Rabindranath Tagore Biography and Life History | Author, Nobel Prize Winner

Finding Tagore – The Tagore Festival 2011

Today’s Post

New articles published in Rural and Remote Health:
5787 – Australasia – A severe diarrhoeal outbreak in a remote Pacific island community, Anuta Island, Solomon Islands, April–June 2019
In May 2019, there was a severe diarrhoea outbreak in a very remote and isolated community on Anuta Island, halfway between the Solomon Islands archipelago and Tuvalu. This Short Communication reports on the investigation and response to the outbreak, highlights the system challenges faced in mounting the response and provides suggestions that may help overcome these challenges.
5791 – North America – Exploring children’s perceptions of barriers and facilitators to physical activity in rural Northwestern Ontario, Canada
This article reports on a study examining barriers and facilitators to physical activity for children living in a rural and isolated region in Canada. Findings suggest a need to understand contextual barriers specific to rural environments, and specific to particular rural regions.
1. China: South China Morning Post: Telemedicine is the big health care game changer to emerge from the coronavirus pandemic, say experts
The concept, in which patients interact with a doctor by phone or video, must be used sensibly, in tandem with traditional offline health care, say panellists on a webinar
Digital health can play a role in providing the care patients need while minimising the transmission risk of infectious diseases like Covid-19
Telemedicine, in which a doctor’s appointment happens over phone or video, could be the health care game changer to emerge from the
Covid-19 pandemic
. But a perfect marriage with offline services is needed to make the system work efficiently, say experts in the health care industry.
“Due to Covid-19, people have noticed that a lot of things could be done online. But health care is unique. There is still a large portion of services needed to be done offline,” said Jeff Chen, chief innovation officer of Fullerton Healthcare Corporation.

2. Nature: How the pandemic might play out in 2021 and beyond
This coronavirus is here for the long haul — here’s what scientists predict for the next months and years.
June 2021. The world has been in pandemic mode for a year and a half. The virus continues to spread at a slow burn; intermittent lockdowns are the new normal. An approved vaccine offers six months of protection, but international deal-making has slowed its distribution. An estimated 250 million people have been infected worldwide, and 1.75 million are dead.
Scenarios such as this one imagine how the COVID-19 pandemic might play out1. Around the world, epidemiologists are constructing short- and long-term projections as a way to prepare for, and potentially mitigate, the spread and impact of SARS-CoV-2, the virus that causes COVID-19. Although their forecasts and timelines vary, modellers agree on two things: COVID-19 is here to stay, and the future depends on a lot of unknowns, including whether people develop lasting immunity to the virus, whether seasonality affects its spread, and — perhaps most importantly — the choices made by governments and individuals. “A lot of places are unlocking, and a lot of places aren’t. We don’t really yet know what’s going to happen,” says Rosalind Eggo, an infectious-disease modeller at the London School of Hygiene & Tropical Medicine (LSHTM).
“The future will very much depend on how much social mixing resumes, and what kind of prevention we do,” says Joseph Wu, a disease modeller at the University of Hong Kong. Recent models and evidence from successful lockdowns suggest that behavioural changes can reduce the spread of COVID-19 if most, but not necessarily all, people comply.

3. USA: Journal of American Informatics Association: Telehealth in Response to the Covid-19 Pandemic: Implications for Rural Health Disparities
Telehealth programs have long held promise for addressing rural health disparities perpetuated by inadequate healthcare access. The COVID-19 pandemic and accompanying social distancing measures have hastened the implementation of telehealth programs in hospital systems around the globe. Here, we provide specific examples of telehealth efforts that have been implemented in a large rural healthcare system in response to the pandemic, and further describe how the massive shift to telehealth and reliance on virtual connections in these times of social isolation may impact rural health disparities for those without access to necessary broadband to deploy digital technologies. Finally, we provide recommendations for researchers and policy makers to ensure that telehealth initiatives do not amplify existing health disparities experienced by those living in rural communities.

4. USA: Washington Post: I travel the country as a nurse. This pandemic is like a wildfire.
My weeks at a New York hospital felt like the hardest of my career. But the hardest weeks keep happening. In mid-February, I took a 13-week contract to work as a nurse at Westchester Medical Center, outside New York City. I’m a travel nurse, meaning that I work short-term contracts in health-care facilities in different parts of the country. I thought it’d be a chance to check out Broadway, to see some museums. By mid-March, the novel coronavirus hit its peak in the state.
In my nearly 30 years as a nurse, I’d never seen anything like this disease. The hospital converted nearly all its units to treat virus patients, even opening up a wing that hadn’t been used in years just to get eight extra beds. I saw patient after patient who, no matter how much I upped their oxygen levels, kept gasping for breath. After transfer to the intensive care unit, they rarely returned.
By the time the job ended in May, I associated New York so strongly with all of the suffering and death I’d seen — all those people, of all races and ages, struggling for air — that I didn’t want to stay a day longer than I had to. I flew back to Phoenix thinking I’d left all of that trauma behind. I told myself that the worst of the pandemic was over.

5. East Africa: Rural Elites Mentorship Initiative East Africa: At the Front Lines
At The frontlines of COVID-19 is a storytelling activity under our The Health Equity Voice project and part of our COVID-19 response.
This pivot was guided by the observed effect the COVID-19 pandemic has had on much better-resourced systems and the projected grave impact on weaker health systems in Low and Middle-Income countries, including Uganda.
In these times, it is going to be hard to understand what can work in very resource-constrained settings without severe loss of life. That is why our major storytelling focus will shift to call for stories reflecting the best practices and challenges the rural health workers are facing in responding to this Pandemic and how they are adapting.
Frontline Stories: Here are the stories from the Health workers at the Frontline of the COVID-19 pandemic in Uganda

6. USA: New York Times: How to Think Like an Epidemiologist: Don’t worry, a little Bayesian analysis won’t hurt you.
There is a statistician’s rejoinder — sometimes offered as wry criticism, sometimes as honest advice — that could hardly be a better motto for our times: “Update your priors!” In stats lingo, “priors” are your prior knowledge and beliefs, inevitably fuzzy and uncertain, before seeing evidence. Evidence prompts an updating; and then more evidence prompts further updating, so forth and so on. This iterative process hones greater certainty and generates a coherent accumulation of knowledge.
In the early pandemic era, for instance, airborne transmission of Covid-19 was not considered likely, but in early July the World Health Organization, with mounting scientific evidence, conceded that it is a factor, especially indoors. The W.H.O. updated its priors, and changed its advice.
This is the heart of Bayesian analysis, named after Thomas Bayes, an 18th-century Presbyterian minister who did math on the side. It captures uncertainty in terms of probability: Bayes’s theorem, or rule, is a device for rationally updating your prior beliefs and uncertainties based on observed evidence.
S ED Humanities

India: Down to Earth: How to stall COVID’s march in rural India
7. As cases of COVID-19 emerge in India’s rural areas, the time is ripe in strengthening implementation of National Rural Health Mission and decentralised governance
The country-wide lockdown imposed by Prime Minister Narendra Modi from March 25, 2020, impaired the lives of many urban migrants who lost their jobs overnight.
With all modes of public transport being suspended, urban migrants had no choice but to walk on foot to their native places. P Sainath, veteran development journalist, called it a “gigantic movement in Indian history.”
After many cities lurched under its calamitous impact, the novel coronavirus has unearthed a new hunting ground in rural areas. With several migrants returning to their native places, there has been a trend reversal.
The rural areas of many districts are now reporting an upsurge in the number of confirmed cases of novel coronavirus disease (COVID-19). The World Health Organization’s chief scientist, Soumya Swaminathan, has also expressed her concern, stating that rural India is the next coronavirus hotbed.
Uttar Pradesh, West Bengal, Madhya Pradesh, Bihar, Assam, Odisha and Jharkhand, that are now witnessing a heavy spike in the number of cases, are the states that have received the highest influx of migrants.
The rural areas of Rajasthan and Karnataka have also started to record an escalation in the number of cases.
Nearly 6.7 million migrants returned to 116 districts in six states from urban centres, according to preliminary data compiled by the Union Ministry of Skill Development and Entrepreneurship.
Of them, about 4.4 million or two-thirds returned to 53 districts. Bihar topped the six states, with 2.36 million migrants returning to 32 districts, followed by Uttar Pradesh, with 1.748 million returning to 31 districts.

8. International: International Renewable Energy Agency: Around a billion people today rely on health facilities without electricity supply.
While most large hospitals may have round-the-clock access to power, electrification rates drop significantly for rural clinics. In the absence of reliable power, many of the basic life-saving interventions cannot be undertaken safely or at all.
A recent study analysing more than 121,000 health facilities, in 46 low and middle-income countries, found that almost 60% of them lacked access to reliable electricity. Even facilities with electricity access can often suffer from an unreliable supply – negatively impacting the ability of medical professionals in rural communities to deliver modern health services.
Renewable energy is at the forefront of solving this issue. Off-grid (stand-alone and mini-grid) renewable energy solutions represent a cost-effective, rapidly deployable and reliable option to electrify healthcare centres, transforming lives whilst bolstering global efforts to achieve Sustainable Development Goal 3 – good health and wellbeing.

9. UK: HSJ: The NHS needs to protect the GPs at high risk from Covid-19
Dr Rebecca Fisher gives the lowdown on why maintaining general practice as a ‘front door’ to the NHS that is safe for both GPs and patients is not easy
It’s fair to say that Matt Hancock’s pronouncement that henceforth all consultations should be “teleconsultations unless there’s a compelling reason not to”, has not been universally welcomed in general practice. In my surgery, practicing in a pandemic has seen us change our ways of working beyond imagination.
In March, like many other practices, we shifted overnight to a “telephone first” approach. And whilst at peak-pandemic we kept face-to-face consultations to a minimum, we’re now seeing more and more patients in person again.
Although many consultations can be safely done over the phone, we’re very clear that there are some patients – and some conditions and circumstances – where a patient needs a face-to-face appointment with a GP. NHS England have also been clear that all practices must offer face-to-face consultations if clinically appropriate.

10. Nature: SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19
Immune cells found in unexposed people. T cells that are prepared to attack SARS-CoV-2 exist in some people who have never been exposed to the virus. Researchers surveyed blood samples from around 100 people for T cells that react to the SARS-CoV-2 spike protein. Reactive cells were found in 83% of people with COVID-19, as well as 35% of healthy blood donors. These cells might have been primed by past infections with related coronaviruses. We still don’t know whether these cells offer real-world protection against SARS-CoV-2.

11. Sierra Leone: Thompson Reuters Foundation: Powerless in a pandemic: Solar energy prescribed for off-grid healthcare
As Sierra Leone emerged from an Ebola epidemic in 2015, it was clear that health facilities lacking a reliable energy supply had been a big obstacle to treating patients.
But putting solar panels on the roof of every clinic wasn’t the right answer either as often such projects fall into disrepair within a year, said Nick Gardner, the Sierra Leone manager for the U.N. Office for Project Services (UNOPS).
Instead, the government and UNOPS decided to bring electric power to 94 communities – starting with their health centres – by using nearly $50 million in aid funding to build solar mini-grid systems, seen as more sustainable.
Fifty have now been switched on and handed over to companies, which are investing $14 million of their own money and running them as businesses, charging customers fair tariffs.
“We wanted these to be commercially viable standalone mini-grids that do not need ongoing subsidisation from the government or donors,” Gardner told an online event this week.
Most community health centres still struggle to pay for electricity, he said – but that problem was solved by getting the facilities to donate public land to site the grids in exchange for free power.

12. USA: NEJM: Letter from South Dakota
The CMO of a large rural health care system reflects on Covid-19’s impact in her region, including delayed preventive care and lost hospital revenues, and the urgency of finding sensible solutions to living with a long-lasting pandemic.
Many rural communities in the Midwest have not experienced the surge of Covid-19 cases that devastated large U.S. cities, beyond distressing outbreaks at some of our food-processing plants and large nursing homes. But we will surely bear the long-term consequences of unemployment, delayed health care, and hospital financial losses from the pandemic. At Sanford Health in South Dakota, we are prepared for a future surge should it happen. We must all now focus on how our communities live with Covid-19, through testing, tracing, and ongoing safety measures, until an effective vaccine is available.

13. USA: NRHA: Rural Health Voices: Rural child social workers offer pandemic perspective
The allure of being a child social worker in a rural area is strong. Social workers who decide to work in smaller communities may forgo an abundance of resources to support families, but they gain slower-paced, socially supportive neighborhoods with strong connections to the natural environment. So what happens during a first-in-our-lifetime pandemic in communities already lacking in resources? It gets complicated.
“We need kids to be in school,” says one anonymous child welfare social worker in rural Maryland. “We aren’t getting reports nearly at the rate we used to, but I know abuse is still occurring. I am concerned we are keeping kids safe from the coronavirus but putting them at a high level of risk for abuse. Parents are at the end of their ropes. We need PPE for staff. We need to be doing lots of things to set the office up with social distancing in mind so we can bring kids in to interview them. Staff don’t have suitable laptops. I wish we had been better trained in new technology before this happened.”

14. Nigeria: Akaninyene Obot Blog: Via ProfMoosa: Strengthening primary healthcare and leaving no one behind: A case study of Ukana West 2 community-based health initiative (CBHI)
In Nigeria there are over 30, 000 Primary Health Centres (PHCs) with only about 20% working (Adewole, 2016) and in Akwa Ibom State, there are over 400 PHCs. Presently, most of the PHC facilities in Nigeria lack the capacity to provide essential health-care services, in addition to having issues such as poor staffing, inadequate equipment, poor distribution of health workers, poor quality of health-care services, lack of trust between the health service providers and community, poor condition of infrastructure, high fee for services and lack of essential drugs supply (Chinawa, 2015). The above has led to poor healthcare service delivery by the health workers in the PHCs and low service uptake by the communities thereby leaving most of the health facilities dysfunctional in the rural area. Primary Health Care (PHC) still remains the minimum package of healthcare that should be provided to every individual and community across Nigeria Health System. The aim is to improve relatively the health status of the nation ensuring provision of healthcare services to people in the rural area (Oluwasogo & Ibrahim, 2020).

15. USA: Nature: Two decades of pandemic war games failed to account for Donald Trump
The scenarios foresaw leaky travel bans, a scramble for vaccines and disputes between state and federal leaders, but none could anticipate the current levels of dysfunction in the United States. Like all pandemics, it started out small. A novel coronavirus emerged in Brazil, jumping from bats to pigs to farmers before making its way to a big city with an international airport. From there, infected travellers carried it to the United States, Portugal and China. Within 18 months, the coronavirus had spread around the world, 65 million people were dead and the global economy was in free fall. This fictitious scenario, dubbed Event 201, played out in a New York City conference centre before a panel of academics, government officials and business leaders last October. Those in attendance were shaken — which is what Ryan Morhard wanted. A biosecurity specialist at the World Economic Forum in Geneva, Switzerland, Morhard worried that world leaders weren’t taking the threat of a pandemic seriously enough. He wanted to force them to confront the potentially immense human and economic toll of a global outbreak. “We called it Event 201 because we’re seeing up to 200 epidemic events per year, and we knew that, eventually, one would cause a pandemic,” Morhard says.

16. UK: Kings College London: Post-menopausal women at higher risk of developing severe COVID-19, study finds
Post-menopausal women with lower levels of the female sex hormone estrogen appear to be at higher risk of developing serious complications of COVID-19, a study has found.
Research published recently in medRxiv, led by King’s College London, has found that high levels of estrogen may have a protective effect against the novel coronavirus. Using the COVID Symptom Study App, researchers examined the rate of predicted COVID-19 among post-menopausal women, premenopausal women using the combined oral contraceptive pill (COCP) and post-menopausal women taking hormone replacement therapy (HRT), from more than 500,000 women in the UK, between 7 May and 15 June 2020. The sex hormone estrogen, which declines in women post-menopause, interacts with the immune system in various ways, including influencing how many immune cells are produced and how they respond to infection.
Researchers hypothesised that estrogen could serve as a protectant against COVID-19. Previous studies on SARS-CoV and MERS suggest this might explain why men of all ages are at a higher risk of severe infection, including COVID-19.
The pre-print study, which has not been peer-reviewed, found post-menopausal women had a higher rate of predicted COVID-19 than other studied women. Women in the 45-50 age group were most likely to be at risk, and reported symptoms of anosmia, fever and a persistent cough, and the need for oxygen treatment in hospital were significant in this group.

17. USA: New York Times: “Like a Horror Movie”: A Small Border Hospital Battles Coronavirus
The hospital in Starr County, Texas, had no ICU, and only one doctor on duty each shift. Then the coronavirus began surging through the Rio Grande Valley.
A tense rescue scene has been unfolding for weeks outside a small rural hospital on the Mexican border that has been the first line of defense against one of the most voracious coronavirus outbreaks in the country.
Nearly every day, a crew at Starr County Memorial Hospital prepares a patient whom its doctors are unable to help, loads the gurney into a helicopter and stands back as the aircraft roars into the country sky.
“Very, very unfortunately, of all of the patients we have transferred, none have come back alive,” said Dr. Jose Vazquez, the health authority in Starr County, a remote section of the Rio Grande Valley in Texas that before the coronavirus outbreak did not have a single I.C.U. bed.
There was a time not long ago when the pace was a lot less frantic at Starr County Memorial, whose 45 beds were once sufficient for the roughly 65,000 people spread out along the border near Tamaulipas, Mexico. The county is dotted with tiny villages, long stretches of open road, cattle ranches and the occasional small town.

18. Spain: Catalunya Radio: El Clínic redueix un 50% la mortalitat per la Covid-19 amb intel·ligència artificial
En temps real s’han creuat fins a 3 trilions de dades de 2.000 pacients per trobar patrons d’evolució de la malaltia i el millor tractament per cada un
The Clinic reduces 50% the mortality for the Covid-19 with artificial intelligence.
In temps real s’han creuat fins to 3 trilions of dades of 2,000 patients per trobar patrons d’evolució de la malaltia i el millor tractament por un un
Un estudi pioner de l’Hospital Clínic de Barcelona i l’Institut d’Investigacions Biomèdiques (IDIBAPS), basat en estratègies d’intel·ligència artificial, ha permès preveure complicacions en pacients amb Covid-19 de manera automàtica i en temps real, i administrar-los tractaments personalitzats de manera precoç. S’ha aconseguit predir l’evolució dels pacients amb una eficàcia del 90% i reduir la mortalitat a la meitat.
A finals de març, el 80% dels pacients ingressats a l’Hospital Clínic de Barcelona tenien la mateixa malaltia: la Covid-19. Per atendre’ls es van dedicar tots els esforços humans: metges en malalties infeccioses i respiratòries, però també traumatòlegs, ginecòlegs i oftalmòlegs; és a dir, especialistes de tota mena.

19. Nature: One scientist’s six-point recovery plan to tackle COVID-19 anxiety
Fernando T. Maestre was diagnosed with anxiety during Spain’s coronavirus lockdown. A change in approach to work, life and parenting helped to restore his health. One week after giving a webinar (in Spanish) about the need to address poor mental health in academia, I was in the medical centre following several sleepless nights and chest pains that I had never experienced before. As an advocate for a healthier research environment, I’ve always tried to prioritize the health and personal lives of the people working with me. But it is one thing to deal with someone else’s issues, and another to hear your doctor say: “You have anxiety.”
The coronavirus pandemic has been difficult for me professionally. Too many Zoom and Skype meetings caused my day-to-day work to pile up, alongside the stress of home-schooling 2 kids, 11 and 3 years old, with my wife — while trying to fulfill family and household obligations. While attempting to catch up on work, I got into bad habits that I had abandoned long ago, such as replying to e-mails during the night and working at every spare moment.
S ED Mental

20. USA: CDC: Caregiving among rural adults: 2015-2018 behavioural risk factor surveillance system (BRFSS) data from rural adults in 41 states and the District of Columbia

21. UK: HSJ: Improving mental health with digital CBT: bridging the treatment gap for insomnia
In its efforts to address insomnia and improve mental health, the NHS is grappling with long-standing challenges that leave millions every year without access to therapy. Sleepio’s digital CBT for insomnia offers an intervention that is safe, effective, and scalable – and now proven to offer multimillion pound cost reductions in primary care for NHS commissioners. By Professor Colin Espie
Insomnia is the UK’s most common mental health complaint, with 8-12 per cent of adults suffering from chronic insomnia and 30-50 per cent experiencing insomnia symptoms. Left untreated, it is associated with increased risk of mental health disorders such as anxiety and depression, and chronic conditions including diabetes, obesity, and cardiovascular disease.
National Institute for Health and Care Excellence clinical guidelines recommend Cognitive Behavioural Therapy (CBT) as the first-line treatment for chronic insomnia. However, millions of people are unable to access the treatment they need – with harmful consequences for patients and the NHS.
S ED Mental

22. USA: Journalists Resource: Covering rural health care amid COVID-19: 4 tips from Carrie Henning-Smith
As COVID-19 cases continue to emerge in rural areas of the U.S., rural health care systems will need to respond to the crisis with fewer resources than urban-based hospitals, and for a population that is generally older and sicker than urban populations. Journalists will need to tell their stories.
While working on our research roundup on rural health care and COVID-19, Journalist’s Resource spoke with Carrie Henning-Smith, an assistant professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health, and deputy director of the University of Minnesota Rural Health Research Center.
Henning-Smith served as a panelist on a May 4 online SciLine media briefing titled COVID-19: Health Disparities and Vulnerable Populations. “Nearly 80% of rural areas are designated as medically underserved,” she said in the briefing. “Rural residents live farther, on average, from emergency rooms. And rural counties are also less likely to have ICU beds or ventilators available. When they do have them, they might just have one or two instead of enough to serve the population. Rural areas are also less likely to have access to reliable broadband internet and cellular connectivity. That’s really relevant in this current context. It makes it difficult to access health care and other services remotely.”

23. Canada: Gateway Rural Health: Gateway survey reveals COVID-19 related stress experienced by Huron health care workers
Gateway Centre of Excellence in Rural Health (CERH), surveyed essential healthcare workers in Huron County, who continued to work during the COVID-19 pandemic, to report on how the pandemic has affected their health and well-being. The survey was intended to be a snapshot during the peak period of COVID activity in our rural area. Data for this initiative was collected through an online questionnaire, which resulted in 160 participants.
Gateway CERH secured funding from Perth-Huron United Way for this project. As Nancy Simpson, Project Lead, said: “… collectively and in partnership, we are making a difference in our community.” The results from the survey provided insight into the emerging needs of our local rural healthcare workers, the types of support systems currently available, as well as identifying supports needed to serve healthcare workers in our local communities.
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24. Philippines: Rappler: Only 4 out of 600 localities in PH have contact tracing capability – Magalong
Only around 8 out of 37 close contacts of every positive COVID-19 case is being traced, says tracing czar Benjamin Magalong The country’s own “tracing czar,” Baguio City Mayor Benjamin Magalong, said only 0.68% – or 4 – of 614 local government units who answered a survey he sent out had a good COVID-19 contact tracing system in place. “Nakakalungkot lang po na banggitin ko rito na talagang napakababa po ang ating contact tracing efficiency. Only 0.68% of the 600 plus na nagresponde po ay talagang mayroon silang established na contact tracing capability,” he said on Thursday, July 30, during a virtual press briefing. (It’s sad for me to mention here that our contact tracing efficiency is really low. Only 0.68% of the 600 plus who responded have an established contact tracing capability.)
Magalong said he asked 1,800 local governments to answer a “diagnostic questionnaire” to give him a better understanding of their contact tracing capability. Of these, only 614 responded.

25. USA: Washington Post: Fearing coronavirus and missed classes, many parents prefer mixing online and in-person school, poll finds
Most American parents think it is unsafe to send their children back to school given the risks of the novel coronavirus, and more than 80 percent favor holding school at least partly online, according to a Washington Post-Schar School survey conducted by Ipsos.
But parents also express serious concerns with online schooling and many are drawn to systems that mix the two.
The mixed feelings reflect deep and widespread anxiety among parents as they approach the end of a summer break that has produced no national consensus on how to balance the risks of the virus against the academic, social and economic impacts of keeping schools closed.
Given three options for the fall, a plurality of parents — 44 percent — want their schools to offer a mix of online and in-person classes, an idea that has been considered by many school districts and adopted by some. In a close second place is all-virtual education, favored by 39 percent of parents.

26. Australia: Sydney Morning Herald: Seizures and battered heart: how COVID-19 scarred a healthy Sydney doctor
A fit and healthy Sydney GP has described his harrowing brush with COVID-19 that triggered epileptic seizures and permanently scarred his heart.
Dr Warren Lee, an avid cyclist, can no longer drive nor exercise after testing positive for the novel coronavirus (SAR-CoV-2) in April.
On April 1, Dr Lee was seeing patients with flu symptoms at the clinic, wearing a face mask and a full-sleeve gown when he noticed he had a mild sore throat.Add to shortlist
“It didn’t feel like anything, just a scratchy throat,” Dr Lee said in a video posted on Facebook by the NSW Jewish Board of Deputies.
But he immediately stopped working in line with NSW Health guidelines.
“It’s a very unusual experience going up to the waiting room and telling everyone, ‘You have to go home’,” he said.

27. International: The guardian: Cost of preventing next pandemic ‘equal to just 2% of Covid-19 economic damage’
World must act now to protect wildlife in order to stop future virus crises, say scientists
The cost of preventing further pandemics over the next decade by protecting wildlife and forests would equate to just 2% of the estimated financial damage caused by Covid-19, according to a new analysis.
Two new viruses a year had spilled from their wildlife hosts into humans over the last century, the researchers said, with the growing destruction of nature meaning the risk today is higher than ever.
It was vital to crack down on the international wildlife trade and the razing of forests, they said. Both bring wildlife into contact with people and their livestock. But such efforts are currently severely underfunded, according to the experts.

28. India: New York Times: Indian Billionaires Bet Big on Head Start in Coronavirus Vaccine Race
The world’s largest vaccine producer, the Serum Institute, announced a plan to make hundreds of millions of doses of an unproven inoculation. It’s a gamble with a huge upside. And huge risks.
In early May, an extremely well-sealed steel box arrived at the cold room of the Serum Institute of India, the world’s largest vaccine maker.
Inside, packed in dry ice, sat a tiny 1-milliliter vial from Oxford, England, containing the cellular material for one of the world’s most promising coronavirus vaccines.
Scientists in white lab coats brought the vial to Building 14, carefully poured the contents into a flask, added a medium of vitamins and sugar and began growing billions of cells. Thus began one of the biggest gambles yet in the quest to find the vaccine that will bring the world’s Covid-19 nightmare to an end.
The Serum Institute, which is exclusively controlled by a small and fabulously rich Indian family and started out years ago as a horse farm, is doing what a few other companies in the race for a vaccine are doing: mass-producing hundreds of millions of doses of a vaccine candidate that is still in trials and might not even work.

29. USA: The Nation: It’s Time to Tell a New Story About Coronavirus—Our Lives Depend on It
The way we talk about contagion matters. It shapes how societies respond—and whether many of us will survive.
In the summer of 1832, a mysterious scourge that had come all the way from Asia loomed over the city of New York, having ravaged London, Paris, and Montreal. Medical officials collected data showing that the disease—cholera—was spreading along the newly opened Erie Canal and the Hudson River, heading straight to New York City. But New York’s leaders did not attempt to regulate traffic coming down the waterways.
The demands of commerce were part of the reason; officials knew that shutting down the routes would have disrupted powerful commercial interests. But no less powerful was the belief that they didn’t need to. According to the reigning paradigm, contagions like cholera spread through clouds of smelly gas called miasmas. Cholera, one expert said at the time, was “an atmosphere disease…carried on the wings of the wind.” To protect themselves from these deadly gases, people burned barrels of tar and strung up large pieces of meat on poles, which they hoped would soak up the cholera vapors. In London they attempted to rid their homes of stinky miasmas by dumping human waste into the river, which also served as the city’s drinking water supply.
Paradigms—the obscure, unspoken conceptual frameworks that shape our ideas—are powerful. They bring order and understanding to our observations about the messy, changing world around us. Without them, the philosopher Thomas Kuhn said, scientific inquiry is impossible: We would not know which questions to ask or what facts to collect. But paradigms blind us, too, as during the cholera pandemics of the 19th century, elevating certain narratives and serving particular interests, often to our peril.

30. International: One Health: An interview with Dr Rajiv J. Shah President of the Rockefellar Foundation
As you look to the future, does there need to be a holistic approach that takes into account global health issues, climate change, migration, poverty, racism and other factors when preparing for future crises? Do you feel that these factors are interrelated?
Absolutely. In public health this is called “one health,” and it’s the concept that the health of humans is intricately connected with the health of the environment and the health of animals. Let me give you an example. In the forest region of Guinea in late 2013, a village had moved into land that was previously purely forest. As the village used more land, animals were pushed further into the forest. A bat that had been living in a tree defecated in the dead tree. A child from the village was playing in the tree and came into contact with the bat excrement. The bat had been carrying the virus that causes Ebola, and the child became infected. The disease then spread from person to person – starting in that village and traveling with the people as they sought help – until more than 11,000 people were dead across three West African countries………………. What we do to the environment affects us, whether it’s through climate change, overpopulation, migration, or any other reason that can bring animals and humans together in detrimental ways and allow diseases to jump between animals and humans. We really need to understand this concept and take all these aspects into consideration as we work to protect the health of people, animals, and the environment.

31. JAMA: Cognitive Bias and Public Health Policy During the COVID-19 Pandemic
As the coronavirus disease 2019 (COVID-19) pandemic abates in many countries worldwide, and a new normal phase arrives, critically assessing policy responses to this public health crisis may promote better preparedness for the next wave or the next pandemic. A key lesson is revealed by one of the earliest and most sizeable US federal responses to the pandemic: the investment of $3 billion to build more ventilators. These extra ventilators, even had they been needed, would likely have done little to improve population survival because of the high mortality among patients with COVID-19 who require mechanical ventilation and diversion of clinicians away from more health-promoting endeavors.1 Yet most US residents supported this response because the belief that enough ventilators would be available averted their having to contemplate potentially preventable deaths due to insufficient supply of these devices.

32. International: Bloomberg Prognosis:When It Comes to Covid Shots, Rich Nations Are First in Line
Wealthy countries have already locked up more than a billion doses of coronavirus vaccines, raising worries that the rest of the world will be at the back of the queue in the global effort to defeat the pathogen.
Moves by the U.S. and U.K. to secure supplies from Sanofi and partner GlaxoSmithKline Plc, and another pact between Japan and Pfizer Inc., are the latest in a string of agreements. The European Union has also been aggressive in obtaining shots, well before anyone knows whether they will work.
Although international groups and a number of nations are promising to make vaccines affordable and accessible to all, doses will likely struggle to keep up with demand in a world of roughly 7.8 billion people. The possibility wealthier countries will monopolize supply, a scenario that played out in the 2009 swine flu pandemic, has fueled concerns among poor nations and health advocates.

33. Australia: Rural Doctors of Australia: Press Release: Worse than Pinocchio… COVID lies cost lives
Doctors are urging people to save rural communities from COVID by being honest about their travel movements.
Dr John Hall, President of the Rural Doctors Association of Australia (RDAA) said that the whole of Australia has now seen where lying on your declaration can get you.
“If you think it might be bad getting coronavirus, imagine just how much worse you’ll feel with coronavirus and a case of criminal charges on top,” Dr Hall said.

34. UK: The Guardian: Coronavirus: UK virologists criticise handling of Covid testing contracts: Experts say decisions apparently being made on ideological grounds
A group of Britain’s leading virus experts say mistakes are being made in the handling of the Covid pandemic, with testing contracts awarded on apparently ideological grounds to private sector companies rather than based on expertise.
In a letter to England’s chief medical officer and the chief scientific adviser, nearly 70 clinical virologists say they have been sidelined by the government and excluded from discussions on how to respond to the pandemic.
New 90-minute tests announced with fanfare by ministers on Monday were the latest example of how virologists were being bypassed, they say. They have been using rapid tests such as these already – but say they have no knowledge of or information on the DnaNudge or LamPORE tests that the government is contracting to buy.

35. Nature: ‘It’s like we’re going back 30 years’: how the coronavirus is gutting diversity in science
The pandemic is sabotaging the careers of researchers from under-represented groups, but institutions can help to staunch the outflow.
Years of slow improvement in diversity and inclusion in science could come undone because of the COVID-19 crisis. In a June letter to Nature Ecology and Evolution1, 19 researchers from around the world warned that job losses during the pandemic might pose “disproportionate existential threats” to researchers from under-represented groups, including women, people from minority ethnic backgrounds and those who are financially disadvantaged.

36. USA: Snops: Misinformation on Coronavirus is Proving Highly Contagious
As the world races to find a vaccine and a treatment for COVID-19, there is seemingly no antidote in sight for the burgeoning outbreak of coronavirus conspiracy theories, hoaxes, anti-mask myths and sham cures.
The phenomenon, unfolding largely on social media, escalated this week when President Donald Trump retweeted a false video about an anti-malaria drug being a cure for the virus and it was revealed that Russian intelligence is spreading disinformation about the crisis through English-language websites.
Experts worry the torrent of bad information is dangerously undermining efforts to slow the virus, whose death toll in the U.S. hit 150,000 Wednesday, by far the highest in the world, according to the tally kept by Johns Hopkins University. Over a half-million people have died in the rest of the world.

37. Africa: Daily Maverick: More than 10,000 healthcare workers in Africa infected with coronavirus
The Covid-19 outbreak continues to evolve in the Africa region since it was first detected in Algeria on 25 February. As of 24 July, the World Health Organisation (WHO) reports 638,903 cumulative cases in 47 African countries,10,000 of which are healthcare workers.
In a virtual press conference on 23 July, WHO regional director for Africa Dr Matshidiso Moeti spoke about health worker infections in Africa. Moeti was joined by Dr Léonie Claudine Lougue (minister of health of Burkina Faso), Dr Alpha T Wurie (minister of health and population of Sierra Leone), and Dr Jemima A Dennis-Antwi (international maternal health and midwifery specialist based in Ghana).
So far, about 10% of all cases globally are among healthcare workers. However, this varies widely between individual countries. In Africa, information on health worker infections is still limited.

38. United Nations: Covid-19 Response (+Video): “The future of education is here”:
Education is the key to personal development and the future of societies.
It unlocks opportunities and narrows inequalities. It is the bedrock of informed, tolerant societies, and a primary driver of sustainable development.
The COVID-19 pandemic has led to the largest disruption of education ever.
In mid-July, schools were closed in more than 160 countries, affecting over 1 billion students. At least 40 million children worldwide have missed out on education in their critical pre-school year.
And parents, especially women, have been forced to assume heavy care burdens in the home. Despite the delivery of lessons by radio, television and online, and the best efforts of teachers and parents, many students remain out of reach.
Learners with disabilities, those in minority or disadvantaged communities, displaced and refugee students and those in remote areas are at highest risk of being left behind.
And even for those who can access distance learning, success depends on their living conditions, including the fair distribution of domestic duties.
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39. Australia: RACGP: Inquiry finds GPs side-lined during pandemic
Major shortfalls in Victoria’s COVID-19 response were highlighted just one day before the state announced its worst ever 24-hour case total.
A further 725 cases and 15 deaths were announced by Victorian Premier Daniel Andrews on 5 August, taking the state’s number of active cases to 7227 – and deaths to 162.
The record-breaking 24-hour period follows the release of a Public Accounts and Estimates Committee interim report into Victoria’s coronavirus response, which made 23 recommendations after identifying numerous problems, including issues related to poor contact tracing and communication with frontline GPs.

40. UK: The Health Foundation: Responding to COVID-19: How the Health Foundation is supporting the UK’s health and care system to deal with current challenges and building the evidence needed to understand longer-term implications on the nation’s health
The coronavirus (COVID-19) pandemic represents an unprecedented challenge to health and care services, bringing intense pressure and radical change to systems, organisations and to all of us as individuals.
As a foundation with a mission to improve health and health care, we are supporting individuals and organisations across the health and social care system to deal with current challenges, but also building the evidence needed to understand longer term implications on the nation’s health.

Thoughts as before are with you all as always, especially those of you working on the front line.
Please feel free to feedback and ask for help

Best wishes

John Wynn-Jones