Dear Colleagues
My name is Dr John Wynn-Jones. Some of you may already know me from the time when I was the chair of RuralWonca until last year.
I currently send out a Newscast/Blog twice a week to rural family physicians, other family doctors, nurses, students and academics around the world. I search the internet and social media for Covid-19 infomation and send out up to 50 useful intenational links each time. Some of the posts are rural focused but the majority are general.
To try and bring some humanitity into what is happening, I have also been including some poetry. The poetry come from all over the world.
I currently send it out to Google Groups in South Asia, Europe, the global Rural Young Doctor Group (Rural Seeds), RuDASA, RCGP as well as our own RuralWonca Group
I don’t want to send this to you unless you would find it useful.
I enclose todays post which is on health and happiness
Please feed back your thoughts and if they are positive, I will include AfroPHC
Best wishes
John Wynn-Jones

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
Andrija Štampar, WHO

“To keep the body in good health is a duty… otherwise we shall not be able to keep our mind strong and clear”.

“Let food be thy medicine and medicine be thy food.”

“To be stupid, selfish, and have good health are three requirements for happiness, though if stupidity is lacking, all is los”.
Gustave Flaubert

“Happiness is good health and a bad memory”
Ingrid Bergman

“Money cannot buy health, but I’d settle for a diamond-studded
Dorothy Parker

Health and Wellbeing

How many times have we heard our patients grieve over the loss of good health? It is often only as we get older that we realise that all the wealth in the world is of less value without good health.
As health professionals, health is our job but sadly we spend the great majority of our time dealing with ill-health.
I found it harder than usual to put this short collection pf poems together. There is so much out there about death and disease but health in itself, does not seem to inspire the poets. Perhaps Public Health Departments should employ poets and writers to motivate the population as a whole.
Health is the default that we all wish we had but perhaps don’t invest in as we should. As Maya Angelou in her poem “The Health-Food Diner” suggests, much of the health-related poetry laments the things that don’t give us good health but tempt us by provoking us to feel somewhat guilty and naughty.
Please enjoy! tantalising

Jan Kochanowski (1530-1584)
Jan Kochanowski was a Polish Renaissance humanist poet who dominated the culture of Renaissance Poland. Born into the country nobility, Kochanowski studied at the Jagiellonian University in Kraków and later, between 1552 and 1559, at the University of Padua in Italy. On his return to Poland in 1559, he served as a secretary at the royal court in Kraków. He married about 1575 and retired to his family estate at Czarnolas, in central Poland.
Kochanowski’s first poems, mostly elegies, were written in Latin, but he soon turned to the vernacular. Since Polish was not fully developed at that time as a language of literary expression, he devised his own poetic syntax and patterns of versification, setting high standards for the centuries to come.
He is commonly regarded as the greatest Polish poet before Adam Mickiewicz, and the greatest Slavic poet prior to the 19th century.
I an sure that you will agree with me that the sentiments of “On Health” is just as relevant today 500 years later

On Health

My good and noble health,
Thou matter’st more then wealth.
None know’th thy worth until
Thou fad’st, and we fall ill.

And every man can see,
In stark reality,
And every man will say:
“’Tis health I need today”.

No better thing we know,
No dearer gem we owe,
For all that we possess:
Pearls, stones of great finesse,
High offices and power
– One may enjoy this hour –
And so the gifts of youth,
And beauty are, in truth,
Good things, but only when
Our health is with us then.
For when the body’s weak,
The world around is bleak.
O jewel dear, my home
Awaiteth thee to come;
With thee it shall not perish.
’Tis all for thee to cherish.

Mary Darby Robinson (1757-1800)
Mary Robinson was an English actress, poet, dramatist, novelist, and celebrity figure. She lived in England, in the cities of Bristol and London; she also lived for a time in France and Germany.
She enjoyed poetry from the age of seven and started working, first as a teacher and then as actress, from the age of fourteen. She wrote many plays, poems and novels. She was a celebrity, gossiped about in newspapers, famous for her acting and writing. During her lifetime she was known as “the English Sappho”. She earned her nickname “Perdita” for her role as Perdita (heroine of Shakespeare’s The Winter’s Tale) in 1779. She was the first public mistress of King George IV while he was still Prince of Wales.
In the 18th Century women in the theatre had a dubious reputation. Until then boys had played female roles. Mary Robinson was an extremely talented woman but due to the dictates and values of the time her talents were never fully appreciated, and she sadly died in relative poverty. Please stick with the poem, it takes some reading but it’s well worthwhile.

Ode to Health

Come, bright-eyed maid,
Pure offspring of the tranquil mind,
Haste, my fev’rish temples bind
With olive wreaths of em’rald hue
Steep’d in morn’s ethereal dew,
Where in mild HELVETIA’s shade,
Blushing summer round her flings
Warm gales and sunny show’rs that hang upon her wings.

I’ll seek thee in ITALIA’s bow’rs,
Where supine on beds of flow’rs
Melody’s soul-touching throng
Strike the soft lute or trill the melting song:
Where blithe FANCY, queen of pleasure,
Pours each rich luxuriant treasure.
For thee I’ll climb the breezy hill,
While the balmy dews distill
Odours from the budding thorn,
Drop’d from the lust’rous lids of morn;
Who, starting from her shad’wy bed,
Binds her gold fillet round the mountain’s head.

There I’ll press from herbs and flow’rs
Juices bless’d with opiate pow’rs,
Whose magic potency can heal
The throb of agonizing pain,
And thro’ the purple swelling vein
With subtle influence steal:
Heav’n opes for thee its aromatic store
To bathe each languid gasping pore;
But where, O where, shall cherish’d sorrow find
The lenient balm to soothe the feeling mind.

O, mem’ry! busy barb’rous foe,
At thy fell touch I wake to woe:
Alas! the flatt’ring dream is o’er,
From thee the bright illusions fly,
Thou bidst the glitt’ring phantoms die,
And hope, and youth, and fancy, charm no more.

No more for me the tip-toe SPRING
Drops flowrets from her infant wing;
For me in vain the wild thymes bloom
Thro’ the forest flings perfume;
In vain I climb th’embroider’d hill
To breathe the clear autumnal air;
In vain I quaff the lucid rill
Since jocund HEALTH delights not there
To greet my heart:¬no more I view,
With sparkling eye, the silv’ry dew
Sprinkling May’s tears upon the folded rose,
As low it droops its young and blushing head,
Press’d by grey twilight to its mossy bed:
No more I lave amidst the tide,
Or bound along the tufted grove,
Or o’er enamel’d meadows rove,
Where, on Zephyr’s pinions, glide
Salubrious airs that waft the nymph repose.

Lightly o’er the yellow heath
Steals thy soft and fragrant breath,
Breath inhal’d from musky flow’rs
Newly bath’d in perfum’d show’rs.
See the rosy-finger’d morn
Opes her bright refulgent eye,
Hills and valleys to adorn,
While from her burning glance the scatter’d vapours fly.

Soon, ah soon! the painted scene,
The hill’s blue top, the valley’s green,
Midst clouds of snow, and whirlwinds drear,
Shall cold and comfortless appear:
The howling blast shall strip the plain,
And bid my pensive bosom learn,
Tho’ NATURE’s face shall smile again,
And, on the glowing breast of Spring
Creation all her gems shall fling,
YOUTH’s April morn shall ne’er return.

Then come, Oh quickly come, Hygeian Maid!
Each throbbing pulse, each quiv’ring nerve pervade.
Flash thy bright fires across my languid eye,
Tint my pale visage with thy roseate die,
Bid my heart’s current own a temp’rate glow,
And from its crimson source in tepid channels flow.

O HEALTH, celestial Nymph! without thy aid
Creation sickens in oblivions shade:
Along the drear and solitary gloom
We steal on thorny footsteps to the tomb;
Youth, age, wealth, poverty alike agree
To live is anguish, when depriv’d of Thee.
To THEE indulgent Heav’n benignly gave
The touch to heal, the extacy to save.
The balmy incense of thy fost’ring breath
Wafts the wan victim from the fangs of Death,
Robs the grim Tyrant of his trembling prize,
Cheers the faint soul, and lifts it to the skies.

Let not the gentle rose thy bounty drest
To meet the rising son with od’rous breast,
Which glow’d with artless tints at noon-tide hour,
And shed soft tears upon each drooping flower,
With with’ring anguish mourn the parting Day,
Shrink to the Earth, and sorrowing fade away.

Robert Burns (1759-1796)
Robert Burns known familiarly as Rabbie Burns, the National Bard, Bard of Ayrshire and the Ploughman Poet and various other names and epithets, was a Scottish poet and lyricist. He is widely regarded as the national poet of Scotland and is celebrated worldwide. He is the best known of the poets who have written in the Scots language, although much of his writing is in English and a light Scots dialect, accessible to an audience beyond Scotland.
He is regarded as a pioneer of the Romantic movement, and after his death he became a great source of inspiration to the founders of both liberalism and socialism, and a cultural icon in Scotland and among the Scottish diaspora around the world. Celebration of his life and work became almost a national charismatic cult during the 19th and 20th centuries, and his influence has long been strong on Scottish literature. In 2009 he was chosen as the greatest Scot by the Scottish public in a vote run by Scottish television.
So often around the world, toasts wish good health and in this poem, he toasts the of his fair love. Please listen to the poem via the link to hear the Lowland Scots Dialect spoken.

Here’s to thy health
Here’s to thy health, my bonie lass,
Gude nicht and joy be wi’ thee;
I’ll come nae mair to thy bower-door,
To tell thee that I lo’e thee.
O dinna think, my pretty pink,
But I can live without thee:
I vow and swear I dinna care,
How lang ye look about ye.

Thou’rt aye sae free informing me,
Thou hast nae mind to marry;
I’ll be as free informing thee,
Nae time hae I to tarry:
I ken thy frien’s try ilka means
Frae wedlock to delay thee;
Depending on some higher chance,
But fortune may betray thee.

I ken they scorn my low estate,
But that does never grieve me;
For I’m as free as any he;
Sma’ siller will relieve me.
I’ll count my health my greatest wealth,
Sae lang as I’ll enjoy it;
I’ll fear nae scant, I’ll bode nae want,
As lang’s I get employment.

But far off fowls hae feathers fair,
And, aye until ye try them,
Tho’ they seem fair, still have a care;
They may prove waur than I am.
But at twal’ at night, when the moon shines bright,
My dear, I’ll come and see thee;
For the man that loves his mistress weel,
Nae travel makes him weary.
Here’s to my health my Bonnie Lass by Robert Burns

Edward Thomas 1878-1917
Philip Edward Thomas was a British poet, essayist, and novelist. He is commonly considered a war poet, although few of his poems deal directly with his war experiences, and his career in poetry only came after he had already been a successful writer and literary critic.
In 1915, he enlisted in the British Army to fight in the First World War and was killed in action during the Battle of Arras in 1917, soon after he arrived in France.
In his biography of Thomas, Mathew Hollis writes of Thomas’ deep depressive illness “Thomas had been plagued by depression from before his university days at Oxford. There, he fought to shake it out of himself. He tried drink and opium, took up rowing and rowdiness, but could not hold the bleak moods back. When the dark thoughts overran him, he told himself that he valued life too much to take it away or that he was too sedentary to go through with ending it; but in recent years he had become harder to console. In advertising his sorrows, as he put it, he had punished his family, decimated his friends and broken down his self-respect”
Edward Thomas developed a deep friendship with Robert Frost while Frost was living in England. It was Frost who directed him towards poetry.
In this poem, we find him battling with this depression? He dreams of achieving good health but can he still achieve his heart’s desire. “However many hills I climbed over; Peace would still be farther”.


Four miles at a leap, over the dark hollow land,
To the frosted steep of the down and its junipers black,
Travels my eye with equal ease and delight:
And scarce could my body leap four yards.

This is the best and the worst of it –
Never to know,
Yet to imagine gloriously, pure health.

To-day, had I suddenly health,
I could not satisfy the desire of my heart
Unless health abated it,
So beautiful is the air in its softness and clearness, while
Promises all and fails in nothing as yet;
And what blue and what white is I never knew
Before I saw this sky blessing the land.

For had I health I could not ride or run or fly
So far or so rapidly over the land
As I desire: I should reach Wiltshire tired;
I should have changed my mind before I could be in Wales.
I could not love; I could not command love.
beauty would still be far off
However many hills I climbed over;
Peace would still be farther.
Maybe I should not count it anything
To leap these four miles with the eye;
And either I should not be filled almost to bursting with desire,
Or with my power desire would still keep pace.

Yet I am not satisfied
Even with knowing I never could be satisfied.
With health and all the power that lies
In maiden beauty, poet and warrior,
In Caesar, Shakespeare, Alcibiades,
Mazeppa, Leonardo, Michelangelo,
In any maiden whose smile is lovelier
Than sunlight upon dew,
I could not be as the wagtail running up and down
The warm tiles of the roof slope, twittering
Happily and sweetly as if the sun itself
Extracted the song
As the hand makes sparks from the fur of a cat:

I could not be as the sun.
Nor should I be content to be
As little as the bird or as mighty as the sun.
For the bird knows not the sun,
And the sun regards not the bird.
But I am almost proud to love both bird and sun,
Though scarce this Spring could my body leap four yards.

I don’t have a video but this short film tells you something about his life:
In Memoriam – Edward Thomas

Maya Angelou (1928 – 2014)
Maya Angelou was an American poet, memoirist, and civil rights activist. She published seven autobiographies, three books of essays, several books of poetry, and is credited with a list of plays, movies, and television shows spanning over 50 years. She received dozens of awards and more than 50 honorary degrees.
Oh how we crave what is not good for us!

The Health-Food Diner

No sprouted wheat and soya shoots
And Brussels in a cake,
Carrot straw and spinach raw,
(Today, I need a steak).

Not thick brown rice and rice pilaw
Or mushrooms creamed on toast,
Turnips mashed and parsnips hashed,
(I’m dreaming of a roast).

Health-food folks around the world
Are thinned by anxious zeal,
They look for help in seafood kelp
(I count on breaded veal).

No smoking signs, raw mustard greens,
Zucchini by the ton,
Uncooked kale and bodies frail
Are sure to make me run


Loins of pork and chicken thighs
And standing rib, so prime,
Pork chops brown and fresh ground round
(I crave them all the time).

Irish stews and boiled corned beef
and hot dogs by the scores,
or any place that saves a space
For smoking carnivores.

The Health Food Diner – Maya Angelou

John Thorkild Ellison
I can’t find out much about John Thorkild Ellison. On his Facebook page he wrote “I must be a total freak. I write poetry and I hate Facebook.”
He was born in Melksham, Wiltshire (England) and he lives in Haltwhistle, Northumberland. He clearly wants to remain mysterious and enigmatic but I was captivated by his wonderful poetry
I came across this short description of him from someone else who was trying to find out more about him “I came across the poetry of one John Thorkild Ellison and find myself enchanted. In The Failed Mystic, Ellison expresses his frustration that he cannot “freeze Eternity into one single Moment. He is desperate for transcendence and would like to say that he hears Jesus knocking at his door but says his experience is instead fumbling about in the darkness.”

Poetry Can Damage Your Health

The day my doctor died of smoking
I bought myself a fat cigar –
I realised he must be joking,
His funeral was so bizarre:

A dwarf in multi-coloured clothing
Sang louder than the parish choir
And though my heart was full of loathing
I leapt upon the funeral pyre.

I’d often longed for such a roasting
And knew it was my friend’s desire,
I shouted out ‘We’ll all be toasting
In Hell’s incandescent fire! ‘

Don’t be discouraged by this story,
Smoking cigarettes is fine,
Inhale them on your days of glory
And drink your fill of rich, red wine!!

Mike Dailey
Michael Daley was born in Boston, is a graduate of the University of Massachusetts. In 1976 he was the founding editor of Empty Bowl press in Port Townsend. His first collection of poetry in 1983, The Straits, as described as “Superb, elegant poetically and fresh with the Northwest world.” He has received several awards, but his favourite was a Fulbright teacher exchange that allowed him and his family to spend a year living in Hungary.
I have included this because health doesn’t necessarily mean that you are free of any diseases but one can be living with serious disease and at the same time remaining healthy with a positive mental attitude.

The Truth

It’s true that I have cancer
Not true that it has me
For I choose to live my life
As full as it can be
It’s true they did some cutting
To get the cancer out
But I’m still fighting cancer
And it is quite a bout
It’s true that I’ll do chemo
And chemo makes you sick
While chemo kills the cancer
That’s not what makes me tick
For me, it’s love of family
My daughter and my wife
And I’ll have a brand new grandchild
And that – to me – is life
Each moment that I’m living
My love for them grows strong
And loving equals living
That’s what keeps me going on
So it’s true that I have cancer
Not true that it has me
And like a wise man said once
The truth shall set you free.

A song to watch:

Bee Gees – Stayin’ Alive

Anette Fosse is the Director of Norwegian Centre for Rural Medicine (NCRM), UiT The arctic University of Norway.
She has asked me to post this request for help under the soapbox section. Please read and help her if you can
Her contact details are: Email: Phone: +47 91622312
“During the winter of 2020 the corona pandemic made national authorities around the world to implement various measures to prevent infection. In Norway the spread of the infection was largely related to the big cities. National measures did not take into account the fact that different municipalities and regions were at different stages of the pandemic.
Many rural municipalities therefore adopted local quarantine rules, against the advice of national authorities. The local decisions created a lot of discussion and, in part, conflict between the municipalities and central authorities.
The organization of community medicine and infection control differ between countries. In Norway, each municipality is required by law to have a Public Health Chief Officer. In rural areas, this position is often combined with being a GP. This means that each municipality has access to local infection prevention expertise, which in addition to medical knowledge also has knowledge of local conditions. In Sweden, the regions are the lowest level responsible of infection control. The same applies in Scotland, Ireland, the United Kingdom, New Zealand and others.
The Norwegian Centre for Rural Medicine has started a research project to develop knowledge of how local perspectives can have an impact on the differentiation of national measures by examining various aspects of the process of choosing local infection prevention strategies in rural municipalities in Norway during the corona pandemic. We want to compare Norwegian conditions with local infection prevention strategies in rural areas elsewhere, and hope that similar research projects will be launched in other countries.”
Please look at the attachment which tells of the project in greater detail

European Rural Network:
EURIPA Newsletter Grapevine:
EURIPA: e-Forum:

Today’s Posts

1. India: The Lancet Global Health: COVID-19 care in India: the course to self-reliance
The public health response to COVID-19 in India has been highly centralised, resulting in a homogenous strategy applied across a sixth of the world’s population. India was placed in a nationwide lockdown on March 24, 2020, with restrictions being relaxed in three phases since June. In May 2020, the prime minister called upon the Indian people to be self-reliant. We discuss here opportunities to modify several aspects of the medical response to echo this sentiment.
Until April 27, 2020, national guidelines required that all symptomatic patients and families be transferred to health-care facilities and isolated away from their homes, and entire neighbourhoods be declared containment zones.
1 This strategy overwhelmed the health-care system in India’s most populous cities, including Mumbai and Delhi, and precluded access for non-COVID care.
2 The resultant fear and stigmatisation has resulted in delays in seeking timely care, and violations of privacy.

2. WHO: 2 in 5 schools around the world lacked basic handwashing facilities prior to COVID-19 pandemic — UNICEF, WHO
As schools worldwide struggle with reopening, the latest data from the WHO/UNICEF Joint Monitoring Programme (JMP) reveal that 43 per cent of schools around the world lacked access to basic handwashing with soap and water in 2019 – a key condition for schools to be able to operate safely in the midst of the COVID-19 pandemic.
“Global school closures since the onset of the COVID-19 pandemic have presented an unprecedented challenge to children’s education and wellbeing,” said Henrietta Fore, UNICEF Executive Director. “We must prioritize children’s learning. This means making sure that schools are safe to reopen – including with access to hand hygiene, clean drinking water and safe sanitation.”
According to the report, around 818 million children lack basic handwashing facilities at their schools, which puts them at increased risk of COVID-19 and other transmittable diseases. More than one third of these children (295 million) are from sub-Saharan Africa. In the least developed countries, 7 out of 10 schools lack basic handwashing facilities and half of schools lack basic sanitation and water services.
The report stresses that governments seeking to control the spread of COVID-19 must balance the need for implementation of public health measures versus the associated social and economic impacts of lockdown measures. Evidence of the negative impacts of prolonged school closures on children’s safety, wellbeing and learning are well-documented, the report says.

3. The Lancet Oncology: COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study
Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK.
Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk–benefit discussions to explain COVID-19 risk and enable an evidenced-based approach to national social isolation policies.

4. WHO: INCB, WHO and UNODC statement on access to internationally controlled medicines during COVID-19 pandemic
Scope (COVID-19 and non-COVID-19 patients affected by the pandemic)
The International Narcotics Control Board (INCB), the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) call on governments to ensure that the procurement and supply of controlled medicines in countries meet the needs of patients, both those who have COVID-19 and those who require internationally controlled medicines for other medical conditions.
There is a need to ensure access to controlled medicines such as sedatives and analgesics for intubation protocols for the treatment of patients with COVID-19. Non-COVID patients continue to require controlled medicines for the management of pain and palliative care, surgical care and anaesthesia, mental health and neurological conditions, and for the treatment of drug use disorders.
It is important to remember the needs of existing patients who require controlled medicines for the management of these health conditions. These patients faced barriers to accessing controlled medicines before the COVID-19 pandemic. The COVID-19 pandemic has further resulted in interruptions of the medicines supply chain, and it is critical that access to essential health services and medications not be forgotten or de-prioritised during this pandemic.

5. India: BBC: Coronavirus: The human cost of fake news in India
Fake or misleading news can have a real impact on those who find themselves the targets. This has been a particular problem in India during the coronavirus pandemic, where reliable sources of news are frequently drowned out by unverified information online.
False information has had serious consequences for minority communities as well as some business sectors such as the meat industry.
The Reality Check team has looked at the extent of this misinformation and some of those directly affected.

6. Haiti: World Bank: Sowing Seeds for COVID-19 Resilience in Haiti
• COVID-19 increases the risk of food insecurity in Haiti, due to external factors such as financial markets, decreased remittances, and border closures.
• The local agriculture sector is essential to avoid further food insecurity, but Haitian farmers face a number of challenges to sustaining or increasing their production.
• The World Bank has quickly mobilized support for farmers in Haiti’s southern regions to sustain the next two cropping seasons. A total of 17,600 farmers will receive subsidies.

7. Philippines: Rappler Talk: Video: Health workers on how the Philippines can recover from COVID-19

S ED Video

8. USA: Washington Post: U.S. coronavirus death toll approaches 180,000
Coronavirus-related deaths in the United States were nearing 180,000 on Sunday, according to tracking by The Washington Post, as states hit hard by a surge of infections earlier in the summer continued to record numbers of daily fatalities.
The total number of cases reported in the United States was also approaching a worrying new milestone, on track to exceed 6 million in the next few days, according to The Post’s data.
The most concerning trend, Gottlieb said, was an uptick in cases in rural parts of the country, where outbreaks could quickly overwhelm local health-care systems. “They don’t have the same kinds of hospitals and the same kinds of resources to deal with an epidemic like this,” he said.

9. International: The Pew Research Centre: Most Approve of National Response to COVID-19 in 14 Advanced Economies
But many also say their country is more divided due to the outbreak
Countries’ approaches to combat the spread of the coronavirus have varied throughout Europe, North America, Australia, Japan and South Korea, but most publics in these regions believe their own country has done a good job of dealing with the outbreak, according to a new Pew Research Center survey of 14 advanced economies. Overall, a median of 73% across the nations say their country has done a good job of handling novel coronavirus, which has reached nearly every corner of the globe, infected more than 20 million people worldwide and resulted in the deaths of several hundred thousand.
But the pandemic has had a divisive effect on a sense of national unity in many of the countries surveyed: A median of 46% feel more national unity now than before the coronavirus outbreak, while 48% think divisions have grown. This includes 77% of Americans who say they are further divided than prior to the pandemic, while just 18% believe the country to be more united.

10. USA: Washington Post: Six feet may not be enough to protect against coronavirus, experts warn
Factors such as crowd density, ventilation, face masks and whether people are silent, speaking, shouting or singing should all be considered in assessing distance.
Public health experts are reevaluating guidelines for safe social distancing amid growing evidence that the novel coronavirus can travel farther than six feet under certain conditions.
A team of infectious-disease experts argues in a new analysis, published this week in the BMJ, that six-feet protocols are too rigid and are based on outmoded science and observations of different viruses. Other researchers say six feet is a start — but only a start, warning that more space is almost always better, especially in poorly ventilated areas indoors.
Factors such as air circulation, ventilation, exposure time, crowd density, whether people are wearing face masks and whether they are silent, speaking, shouting or singing should all be part of assessing whether six feet is sufficient, experts say.

11. China: The Lancet Planetary Health: Floods in China, COVID-19, and climate change
China has made substantial progress regarding COVID-19 control, as the local transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has almost been stopped. However, a serious natural disaster, flooding, unfortunately threatened the lives and homes of people in 27 provinces across central and southern China in July, 2020. Starting on June 2, 2020, authorities in China issued alerts for heavy rainfall for 41 consecutive days. The average precipitation in areas along the Yangtze River has reached the highest level since 1961. As of August 13, at least 219 people had been killed, 0·82 million people needed emergency assistance, 4·01 million people were evacuated, and 63·46 million people were affected by the flooding. Flooding has destroyed nearly 0·4 million homes and damaged 5 million hectares of farmland. According to the Ministry of Emergency Management of China, it is estimated that direct economic losses exceed US$25 billion.
Floods are among the most frequent natural disasters in China.
1 It has been estimated that flooding in China between 1950 and 2018 killed more than 282 737 people and damaged 6 billion hectares of land, and that flooding directly cost approximately $6000 billion between 1990 and 2018. However, the indirect effect of floods was not considered in this estimation of costs. The area of land damaged by flooding each year since 1950 shows an increasing trend, which suggests that the potential impact of floods is also increasing, although mortality directly associated with flooding has been decreasing

12. UK: BMA: COVID-19 guidance for doctors on the impact of coronavirus on your work, training, education, and wellbeing as a medical professional.

13. UK: BMA: COVID-19: refusing to treat where PPE is inadequate
This guidance sets out the process for doctors to follow to identify whether your PPE is adequate and what you can do if it is not.
A lack of PPE puts both doctors and patients at risk of contracting a potentially fatal infection. It also presents doctors with challenging decisions about whether to provide treatment in the absence of effective PPE.
The BMA has raised serious concerns regarding the further amendment to PHE guidelines undertaken on 17 April. We continue to press the government to resolve this dire situation.
This guidance sets out the process to follow to identify whether your PPE is adequate and the steps you can take if it is not.

14. USA: Washington Post: New Trump pandemic adviser pushes controversial ‘herd immunity’ strategy, worrying public health officials
One of President Trump’s top medical advisers is urging the White House to embrace a controversial “herd immunity” strategy to combat the pandemic, which would entail allowing the coronavirus to spread through most of the population to quickly build resistance to the virus, while taking steps to protect those in nursing homes and other vulnerable populations, according to five people familiar with the discussions.
The administration has already begun to implement some policies along these lines, according to current and former officials as well as experts, particularly with regard to testing.
The approach’s chief proponent is Scott Atlas, a neuroradiologist and fellow at Stanford’s conservative Hoover Institution, who joined the White House in August as a pandemic adviser. He has advocated that the United States adopt the model Sweden has used to respond to the virus outbreak, according to these officials, which relies on lifting restrictions so healthy people can build immunity to the disease rather than limiting social and business interactions to prevent the virus from spreading.

15. USA + UK: Washington Post: Wealthy nations applaud their leaders’ covid-19 responses. The U.S. and U.K. are the exceptions.
A poll of 14 developed nations found majorities in most countries were pleased with how their governments had handled the coronavirus pandemic. More than 9 out of 10 respondents in Australia and Denmark said their countries have done a good job.
But there were two countries where a majority thought otherwise: the United States and Britain.
In the United States, 52 percent said they thought their government had done poorly, and 54 percent in Britain said the same.

16. UK: HSJ: Embracing the seismic shift in digitisation
As the NHS continues to resume routine services, and deals with the huge backlogs of care the pandemic has created, it’s essential that technology is used in a way that best supports and enhances care for both staff and patients, writes Rachel Hutchings.
In his speech on the future of healthcare a few weeks ago, the Secretary of State applauded the acceleration in digital technology that happened in the NHS at the peak of the coronavirus pandemic. “Because so many things went right, we’ve got to bottle the best”, he announced. But now that a few months have passed, what enabled this to occur? Can it simply be bottled, and will it lead to lasting change?
There can be absolutely no argument that the pandemic saw an explosion in digital technology and remote working – and that provided a clear solution to the problems facing the NHS in March. Our briefing today lays out the breadth of what happened.
There has been a seismic shift away from face to face appointments in primary and secondary care, as well as increased use of the NHS app, NHS login and e-prescription services. Prior to the pandemic, around 80 per cent of GP appointments took place face to face. As of June 2020, this had fallen to just under half, with around the same amount taking place over the telephone.

17. China: BBC: Coronavirus: Vaccine front-runner China already inoculating workers
Earlier this month, the head of a well-known, privately-owned Chinese conglomerate told his staff that a vaccine for Covid-19 was expected to come to market by November.
The boss, whose firm has a healthcare division, said that he saw it as a portent of economic recovery; a chance for his firms to sell more, according to a person privy to the comments. Within a few weeks the Chinese government was forced to go public with its apparent progress.
The novel coronavirus that causes Covid-19 originated in humans in China, before it spread ceaselessly across the world. Now China is using its global footprint in a relentless effort to win the race to develop and deploy an effective vaccine.
Last week one of the developmental vaccines was pictured in state-run media; a small branded box was shown, held up by a smiling woman in a lab. Sinopharm said it hopes to have it ready to go on sale by December. It even named a price, equivalent to about $140 (£106).

18. New Zealand: COVID-19 media update: Video: The Prime Minister and the Director of Public Health Dr Caroline McElnay l provide an update on COVID-19
N Video

19. USA: CDC: CDC Study Finds Sudden, Serious Cardiac Events Common in Adults Hospitalized with Flu
A CDC study published today that looked at more than 80,000 U.S. adults hospitalized with flu over eight flu seasons (2010-11 through 2017-18) found that sudden, serious heart complications were common and occurred in one out of every eight patients (~12% of patients).
The study looked at a range of sudden heart complications called “acute cardiac events” that resulted in the following:
• damage to the heart muscle,
• inflammation of the heart muscle,
• fluid or inflammation of the sac surrounding the heart, or
• weakening of the pumping function of the heart.

20. China: China Daily: Guideline cites incubation period of virus
It can take up to 14 days before COVID-19 carriers see symptoms, document says
The incubation period for COVID-19, the time between exposure to the virus and the onset of symptoms, is about three to seven days for most people and can be up to 14 days, during which these pre-symptomatic patients can be contagious, according to China’s latest national guideline on diagnosis and treatment of COVID-19 published on Wednesday.
The five days after symptoms occur is when the disease becomes highly transmissible, the guideline said. Respiratory droplets and close contact with infected patients and contaminated objects are the primary methods of transmission, it added.
“Since the global pandemic is still ongoing and the situation may persist for quite some time, the risk of COVID-19 spreading in our country will still exist,” the guideline said. Therefore, early diagnosis, quarantine and treatment are crucial for improving cure rates and reducing mortality, it added.

21. International: Washington Post: At least 463 million students around the world have no access to digital or broadcast lessons, UNICEF report says
At least 463 million students around the world have no access to remote lessons provided by digital or broadcast means because families don’t have the ability to receive them or governments are not providing them, a new UNICEF report released Wednesday says.
The report — titled “Covid-19: Are children able to continue learning during school closures?” — looked at data from 100 countries about the potential reach of remote-learning policies and found, not surprisingly, that digital and broadcast remote learning is more available in wealthier countries and/or urban areas and ranges from zero percent to 100 percent in low- and middle-income countries.
The study was undertaken after most of the schools around the world closed this spring when the novel coronavirus began to spread and turned into a pandemic. Almost all of the world’s 1.5 billion pre-K-12 students were affected as governments rushed to provide remote learning with digital tools, television- and radio-based teaching, and paper packages taken home by students.

22. USA: Washington Post: The CDC’s new testing guidance is nonsensical
Without explanation, and in contravention of common sense, federal officials have issued new guidance against testing asymptomatic individuals — specifically, those who have been exposed to someone diagnosed with covid-19. The recommendations, issued without fanfare on Monday by the Centers for Disease Control and Prevention, pose a danger to public health, and contradict what we know about how to stem the spread of the pandemic.
The numbers tell the story. The CDC itself estimates that 40 percent of people with covid-19 don’t have symptoms. They are capable of spreading the disease, even if not quite as effectively as those with symptoms; again, according to the CDC, the chance that an asymptomatic individual will infect another person is 75 percent of that of someone with symptoms. Due largely to insufficient testing of asymptomatic individuals, CDC Director Robert Redfield has estimated that the number of people with covid-19 is as many as 10 times higher than the official count.
In other words, we should be testing more people without symptoms, not fewer.

23. Bangladesh: Care: Rohingya Refugees Remain at a Crossroads Three Years After Mass Exodus From Myanmar
Nearly 1 million people are still waiting for justice, their rights back, and to return home. Ram Das is the Deputy Country Director, Humanitarian Response, for CARE Bangladesh. In 2017, hundreds of thousands of Rohingyas fled Myanmar to settle in the Cox’s Bazar region of Bangladesh. Three years later, nearly 1 million Rohingya are still waiting for justice, their rights back, and to return home. Most of them settled in the world’s most overcrowded refugee camps amid a complex humanitarian situation. Now the COVID-19 pandemic has added another layer of complexity to their lives. At the height of the pandemic, they are also dealing with the monsoon-cyclone season. As I write these lines, heavy downpour in Cox’s Bazar has inundated large areas in the camps.

24. USA: CDC: Seroprevalence of SARS-CoV-2 Among Frontline Health Care Personnel in a Multistate Hospital Network — 13 Academic Medical Centers, April–June 2020
What is already known about this topic?: Little is known about the prevalence and features of SARS-CoV-2 infection among frontline U.S. health care personnel.
What is added by this report?: Among 3,248 personnel observed, 6% had antibody evidence of previous SARS-CoV-2 infection; 29% of personnel with SARS-CoV-2 antibodies were asymptomatic in the preceding months, and 69% had not previously received a diagnosis of SARS-CoV-2 infection. Prevalence of SARS-CoV-2 antibodies was lower among personnel who reported always wearing a face covering while caring for patients (6%), compared with those who did not (9%).
What are the implications for public health practice?: A high proportion of SARS-CoV-2 infections among health care personnel appear to go undetected. Universal use of face coverings and lowering clinical thresholds for testing could be important strategies for reducing hospital transmission.

25. Spain: The Canaries: Tiempo de Canaries: 120 médicos afirman que Atención Primaria “está agotada, física, anímica y moralmente”
Una plataforma compuesta por facultativos denuncia “un caos organizativo” y exige cambios para afrontar la pandemia
120 doctors affirm that Primary Care “is exhausted, physically, emotionally and morally”
A platform made up of doctors denounces “an organizational chaos” and demands changes to face the pandemic
Al menos 120 médicos y médicas de Atención Primaria de Canarias se han unido para exigir cambios a la Consejería de Sanidad y poder enfrentarse a la pandemia con garantías. “Atención Primaria está agotada, física, anímica y moralmente”, según un comunicado colgado en Facebook. Una portavoz resume: Atención Primaria está “desbordada”.
Ponen el acento en Gran Canaria, donde la situación es peor que en las otras islas, piden cambios en la organización de los centros, más rastreadores, descentralización de la toma de muestras para los análisis PCR, menos carga burocrática y una apuesta clara por las consultas telefónicas.
Atención Primaria siempre ha estado sobrecargada, pero ahora la pandemia supone “angustia y sobreesfuerzo”, señala el comunicado. Denuncian, además, un “caos organizativo” y “falta de directrices claras”, según el escrito colgado en la red social.

26. The Lancet Infectious Diseases: Air travel in the time of COVID-19
The COVID-19 pandemic is changing the way we think about travelling. Most countries in the world have adopted some measure of lockdown or restriction to movement to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and ease the burden of admissions in struggling health systems. These measures have raised questions about the safety of travelling for work and leisure, and current recommendations discourage unnecessary travel. Although the risk of contracting an infectious disease when travelling has always existed, the COVID-19 pandemic has made travellers more aware of this possibility.
However, with the relaxing of lockdown measures in some countries in light of reductions in the number of COVID-19 cases and the holiday season in the northern hemisphere, many people are facing the dilemma of choosing to travel after months of restrictions or to remain at home for fear of being confined in an aeroplane for hours with other people. Considerations include where it is safe to go, what is the risk of travelling, and what new measures are in place to reduce the risk of COVID-19 for those who decide to travel.

27. Bangladesh: The Lancet: Global Health: Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series
Stay-at-home orders (lockdowns) have been deployed globally to control COVID-19 transmission, and might impair economic conditions and mental health, and exacerbate risk of food insecurity and intimate partner violence. The effect of lockdowns in low-income and middle-income countries must be understood to ensure safe deployment of these interventions in less affluent settings. We aimed to determine the immediate impact of COVID-19 lockdown orders on women and their families in rural Bangladesh.
COVID-19 lockdowns present significant economic, psychosocial, and physical risks to the wellbeing of women and their families across economic strata in rural Bangladesh. Beyond supporting only the most socioeconomically deprived, support is needed for all affected families.

28. USA: WBR: COVID-19 Leaves Millions Hungry Around The World, With Women Disproportionately Affected
The number of people undernourished or chronically hungry worldwide could rise from 690 million to 820 million because of the COVID-19 pandemic, according to a new report from the humanitarian group CARE.
Data collected by the U.S. Census Bureau in late July reveals that 29 million adults say their household sometimes or often didn’t have enough to eat in the proceeding seven days. The burden of hunger, CARE says, falls disproportionately on girls and women. “It’s become both a result of losing income and not being able to afford food — but also not being able to access food as people have not been able to get out to markets on a regular basis to purchase the food that they need,” says Tonya Rawe, CARE’s director of global food and nutrition security advocacy.
Food insecurity is a global challenge, Rawe says. In West and Central Africa, the number of people facing starvation has more than doubled, according to the report, with food shortages having gone up 90% in South Africa.
In the U.S., 6 million Americans became eligible for food stamps since the early months of the pandemic, according to the Washington Post. Stretching food safety nets to meet the increased need poses a challenge for countries because of how fast the numbers are rising, she says.

29. The Lancet: Psychiatry: The NIMH global mental health research community and COVID-19
The world faced substantial challenges in meeting the demands for mental health care, even before the emergence of coronavirus disease (COVID-19). With the havoc caused by the pandemic and the impending impact on economies, social structures, and health systems, a global mental health crisis is arising. The Director-General of the UN forecast this situation in a policy brief on May 13, 2020, stating, “The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently.”
1 Three critical actions were recommended: apply a whole-of-society approach to promote, protect, and care for mental health; ensure widespread availability of emergency mental health and psychosocial support; and support recovery from COVID-19 by developing mental health services for the future.
In a field that is chronically underfunded and ignored by most policy makers, especially in low-income and middle-income countries (LMICs), taking action is not easy. Upwards of 90% of people with mental health conditions receive no treatment in LMICs. As the COVID-19 pandemic unfolds, and given the likelihood of even fewer resources dedicated to mental health services, questions arise about whether it will be feasible to implement the UN’s recommendations in the coming years.

30. USA: STAT: Four scenarios on how we might develop immunity to Covid-19
As the world wearies of trying to suppress the SARS-CoV-2 virus, many of us are wondering what the future will look like as we try to learn to live with it.
Will it always have the capacity to make us so sick? Will our immune systems learn — and remember — how to cope with the new threat? Will vaccines be protective and long-lasting?
These pressing questions gained even greater urgency Monday with the news that scientists in Hong Kong have confirmed a 33-year-old man was reinfected with Covid-19; his second infection as diagnosed — by airport screening — came 4.5 months after his first infection in March.

31. The Lancet Digital Health: Transparency during global health emergencies
Medical research and publishing communities have been admonished for the lack of transparency in the reporting of COVID-19 data, exemplified by two recent retractions of COVID-19 papers published in The Lancet and The New England Journal of Medicine. These studies reported proprietary data from electronic health records allegedly obtained from hundreds of hospitals around the world by the company, Surgisphere. Post-publication analysis of these papers revealed multiple inconsistencies in the data and questions about the provenance of the data sources. When these concerns were put to the authors of the papers, it was revealed that the data could not be shared with the public nor an independent auditor, and so the veracity of these data could not be guaranteed.
The Surgisphere misconduct case resulted in the loss of precious resources and time during a critical global emergency. The case also brought into sharp focus the desperate need to accelerate efforts for greater data oversight and transparency in medical research. Disclosure of raw data can protect against potential misconduct. More importantly, as Cosgriff and colleagues highlight, data sharing will enhance global collaboration and will promote real-time analysis for improved control of future outbreaks like COVID-19. So why is COVID-19 data not being shared with medical researchers?

32. USA: Washington Post: First presumed U.S. case of coronavirus reinfection reported in Nevada
A 25-year-old Reno man is the first reported coronavirus patient to be reinfected in the United States, scientists say. Unlike the world’s first presumed case of reinfection in Hong Kong, this patient developed more severe symptoms when he got sick in late May after a mild case in April, according to the newly released study, which has not yet been peer-reviewed. Scientists with the medical school at the University of Nevada at Reno and the Nevada State Public Health Laboratory used advanced testing that sequenced the genetic strains, finding they were distinct between the infections.

33. The Lancet Neurology: COVID-19 related stroke in young individuals
Evidence is mounting on the diverse neurological presentations associated with COVID-19. In a Rapid Review in The Lancet Neurology, Mark Ellul and colleagues nicely cover these findings, but we would like to emphasise the risk of associated stroke. As described in this Rapid Review, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be more likely to cause thrombotic vascular events, including stroke, than other coronavirus and seasonal infectious diseases. In fact, a 7·6-fold increase in the odds of stroke with COVID-19 compared with influenza was recently reported. The reported incidence of cerebrovascular disease in patients testing positive for SARS-CoV-2 ranges from 1% to 6%, potentially equating to large numbers of individuals as the pandemic progresses in some countries. The proposed mechanisms for these cerebrovascular events include a hypercoagulable state from systemic inflammation and cytokine storm;
postinfectious immune-mediated responses; and direct viral-induced endotheliitis or endotheliopathy, potentially leading to angiopathic thrombosis, with viral particles having been isolated from the endothelium of various tissue, including brain tissue.
Multiple regions with high COVID-19 prevalence have reported stable or increased incidence of large vessel stroke and increased incidence of cryptogenic stroke (patients with no found typical cause of stroke), despite observing a decrease in mild stroke that is possibly secondary to quarantine and self-isolation.
This quarantine effect is supported by a nationwide analysis in the USA of automated stroke imaging processing software showing decreased imaging evaluation for stroke during the pandemic.Our group observed that five patients younger than 50 years who tested positive for SARS-CoV-2, some with no vascular risk factors, were admitted with large vessel stroke to our hospitals during a 2-week period (March 23 to April 7, 2020) during the height of the pandemic in New York City (NY, USA). This was a 7-fold increase in the rate of large vessel stroke in young people compared with the previous year, and the patients had laboratory findings that suggested a hypercoagulable state, leading to the postulation that stroke was probably related to the presence of SARS-CoV-2 in these young patients.

34. Australia: ACRRM and RDAA: Media Release: “Howdy Pardner”: rural doctors urge tourists to work with them as travel resumes
As travel restrictions are eased across much of Australia, rural doctors are urging visitors to their towns to work with them to ensure the local doctor workforce can continue to provide sustainable health services after what has been a horror year.
The Rural Doctors Association of Australia (RDAA) and Australian College of Rural and Remote Medicine (ACRRM) say public education is crucial in informing visitors that hospital care in rural areas relies on local GPs being called out of their homes after-hours – not in-house doctors who are at the hospital all the time. “Many of our colleagues have been ‘through the ringer’ multiple times this year – first with the bushfires, then with COVID-19…and some even with a flood crisis in between!” Dr Adam Coltzau, Clinical Lead for RDAA “After what has been an incredibly challenging year for rural doctors and other rural health professionals, many are understandably feeling the onset of fatigue and desperately need some downtime. “They are also still concerned about COVID-19 coming to their towns, and are doing everything they can to ensure the testing of possible cases is undertaken in the safest possible way, to minimise the risk of infection. “Those living in rural communities tend to have a really good understanding of the concept of partnering with their local doctor in their healthcare.—partner-in-care-27-8-20.pdf?sfvrsn=3d2bb6f2_2&utm_source=country%20watch&utm_medium=email&utm_campaign=27%20Aug%2020

35. Africa: Global Cause: The fight against malaria must continue amidst the COVID-19 pandemic
The scale down of malaria control activities due to the COVID-19 outbreak risks to derail the gains achieved and might set us back to similar levels of malaria death as 20 years ago, a recent modelling by WHO and partners warns.
Building a strong partnership for malaria control: World Malaria Day serves as an opportune moment for everyone to reflect on how we can best contribute to sustaining the gains achieved against a disease that continues to devastate humankind, with women and children being disproportionately affected on the African continent.
The Pan-African Mosquito Control Association (PAMCA) is working to build a platform for advancing expert knowledge exchange and support for malaria endemic countries in Africa. On this World Malaria Day, we urge all PAMCA members, malaria control experts, civil society, NGOs and the private sector to come together, to support national malaria control programmes (NMCP), to defeat the disease and save lives. We must continue to promote cross-country dialogue about the challenges facing malaria control efforts as we work to defeat the COVID-19 pandemic.
Through strong networks, we must share good practice and innovations that promote the continuation of much needed vector control initiatives across our chapters and collaborators in Africa.

36. Australia: Australian College of Rural and Remote Health: Covid-19 Support
ACRRM is committed to supporting and providing up-to-date information for members regarding COVID-19. We are monitoring the situation closely and believe the most effective contribution the College can make is to facilitate communication. This includes directing members to the most appropriate updates and working with various national, state and local stakeholders to inform members via email and social media.

37. The Lancet Respiratory Medicine: Apples and oranges: international comparisons of COVID-19 observational studies in ICUs
Multiple observational cohorts describing the outcome of patients with COVID-19 from across the world have been published. Typically, these studies have reported regional or national cohorts and no two countries have had the same experience. The reasons for these differences are complex and difficult to quantify. Nonetheless, to be able to draw meaningful inferences from these data we must tackle the issues associated with international comparison. Initial reports of outcomes in COVID-19, which emerged from China early in the pandemic, reported a range of mortality rates from intensive care units (ICUs) (0–78%).
Case series from North America and Europe have been equally variable (with ICU mortality ranging 0–85%). A major issue has been the large number of patients in these series who had incomplete outcomes at the time of reporting, a factor that has commonly resulted in mortality being overestimated or underestimated. For example, in UK Intensive Care National Audit and Research Centre (ICNARC) data, early reports from March, 2020, estimated ICU mortality for COVID-19 to be 79 (48%) of 165 patients admitted, when 610 (79%) of 775 patients had an incomplete outcome (ie, were still in the ICU). In the latest report, from July 31, 2020, ICU mortality had decreased to 40% in 10 341 patients with complete outcomes.
In the appendix, we have summarised European data on COVID-19 mortality, as of Aug 8, 2020, highlighting the range of outcome measures reported. Another key difference is the status of the health systems in which these patients have been managed, in particular the degree of so-called stress that those systems were under.
This factor is more difficult to adjust for. Variations in clinical decision making between health-care systems, reflected in the characteristics of patients admitted to ICUs and in the methods of ventilation used, also confound direct comparison. This confounding is potentially evident when comparing ICU admissions between the UK and Germany, where the median age of patients receiving invasive mechanical ventilation was 72 years in a large German series versus 60 years in the latest ICNARC report. However, ICU mortality was similar, emphasising the role of admission criteria. Regardless, the wide variation observed suggests the possibility that some factors are modifiable. Therefore, making comparisons between countries and systems is important.

38. USA: Washington Post: Fed up with anti-maskers, mask advocates are demanding mandates, fines — and common courtesy.
In a country stumbling to control a rampant and deadly virus, masks are effective and popular weapons. Three-quarters of Americans favor requiring people to wear face coverings in public to stop the spread of the novel coronavirus, including 89 percent of Democrats and 58 percent of Republicans, according to an Associated Press-NORC Center for Public Affairs Research poll in July.

39. UK: Scotland: The Guardian: Scottish secondary school pupils set to wear face masks in corridors
Nicola Sturgeon consults councils and teaching bodies as fears grow over overcrowding
Secondary school pupils in Scotland are expected to be told soon that they must wear face coverings in school corridors and communal areas after health fears escalated following a series of overcrowding incidents.
Nicola Sturgeon, the Scottish first minister, said her deputy, John Swinney, was consulting councils and teaching organisations about the measure after they were recommended for secondary schools by the World Health Organization at the weekend.
WHO said face coverings were useful where physical distancing between adults and pupils aged 12 and over was impossible, or in areas of high transmission.

40. USA: Washington Post: Young people urged to take virus more seriously as pandemic worsens in U.S.
Health officials are imploring young people to wear masks and practice social distancing as coronavirus transmission among younger Americans continues to drive record outbreaks in several states. The pleas come as governors in Texas and Florida instituted new limits on bars and alcohol consumption to stop the spread of the novel coronavirus, citing the skyrocketing number of young people who are contracting it. At the White House on Friday, Vice President Pence and other members of the Trump administration’s coronavirus task force, in its first briefing in weeks, urged young people to take the virus more seriously.
“Younger Americans have a particular responsibility to make sure that they’re not carrying the coronavirus into settings where they would expose the most vulnerable,” Pence said.

41. Middle East: Washington Post: New coronavirus cases signal wider outbreak in Gaza
The Gaza Strip has been under degrees of lockdown since 2007, when Israel and Egypt imposed blockades after the militant group Hamas took control of the impoverished Palestinian territory. The same conditions that make life a daily struggle there, and that have obstructed even the most basic preparations for the looming threat of a coronavirus outbreak, have perhaps made it harder for the virus to find a toehold. That could be about to change.
The few points of entry to the coastal enclave of nearly 2 million people largely closed in March. But on Tuesday, authorities imposed a 48-hour lockdown after reporting the first four confirmed cases of the virus in the general population. By Wednesday, nine more cases had been discovered in two different areas. The territory also reported the first death related to covid-19 contracted through community spread.
For months, aid agencies have warned that the silent transmission of the virus through the conflict-weary strip could be calamitous. Gaza has one of the densest populations on Earth, a collapsed health-care system, and small supplies of electricity and clean water. Health-care workers are bracing for further signs of a wider outbreak among already vulnerable communities.

42. New Zealand: Nature: ‘We felt we had beaten it’: New Zealand’s race to eliminate the coronavirus again
Genomics could reveal details about the source of the country’s first outbreak in more than 100 days, says epidemiologist Amanda Kvalsvig.
A week ago, New Zealand was an exemplar for how swift and decisive action can stifle the spread of the coronavirus. No locally acquired cases of COVID-19 had been reported since the start of May. But the emergence this week of a cluster of cases — currently numbering 30 — has caught the nation by surprise and is a blow to the government’s strategy to eliminate the virus. Amanda Kvalsvig, an epidemiologist at the University of Otago in Wellington, has been assisting with the country’s COVID-19 response. She spoke to Natureabout the rapid response to the new cases, and whether an elimination strategy is still possible.

43. The Lancet: Haematology: Bringing hospital care closer to patients amidst COVID-19
On March 14, 2020, Spain declared a state of alarm and lockdown measures due to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). From that day, COVID-19 changed the practice of oncological care across the country, affecting our comprehensive cancer centre in Madrid, one of the hardest hit cities by the pandemic to date. During those days, when it became clear what was coming, we felt fear and uncertainty. Would we be able to take care of our patients? Would they suffer from COVID-19 more severely than non-cancer patients? There were too many questions with no answers.
I have attended Mr A, a gentleman aged 76 years with chronic lymphocytic leukemia (CLL), for many years. He needed to start therapy with ibrutinib, an oral BTK inhibitor, and had an appointment scheduled at our clinic 1 week after the state of alarm was declared. He was reluctant to attend the visit because of the fear of contagion. The confinement rules limited his transport options. What could we offer Mr A so that he could continue his treatment plan? Would it be safe to delay the start of therapy? These questions came to our mind for every patient.

44. USA: Washington Post: Controversial change in guidelines about coronavirus testing directed by the White House coronavirus task force
An abrupt shift this week in government testing guidelines for Americans exposed to the novel coronavirus was directed by the White House’s coronavirus task force, alarming outside public health experts who warn the change could hasten the disease’s spread.
The new guidance — introduced this week, without any announcement, on the Centers for Disease Control and Prevention website — replaces advice that everyone who has been in close contact with an infected person should get tested to find out whether they had contracted the virus. Instead, the guidance says those without symptoms “do not necessarily need a test.”
Several leading infectious-disease experts predicted that, after months of public health exhortations encouraging people to get tested, the turnaround could heighten public confusion, impede contact tracing and lead to more cases. The CDC estimates that 40 percent of those who test positive for the coronavirus have no symptoms but may be highly infectious and spread it to other people.

45. USA: Washington Post: Trump is right that with lower testing, we record fewer cases. That’s already happening.
Both the CDC and an outside analysis say we’re missing most coronavirus infections
The United States recorded its 4 millionth confirmed coronavirus caseThursday, a spread that would have been hard to fathom five months ago. Fully a quarter of those cases were recorded in the past 16 days.
To hear President Trump tell it, this is an artificial milestone. The reason we’ve recorded so many cases, he argues, is that we’ve done so many tests. It’s an effort to spin bad news — worst outbreak in the world — into good, highlighting the increase in testing over the past few months. But it’s also thoroughly disingenuous.
“Every time you test, you find a case and it gets reported in the news: We found more cases,” he complained during an interview that aired on Fox News on Wednesday night. “If instead of 50 [million], we did 25, we’d have half the number of cases.”
“So I personally think it’s overrated,” he continued, “but I am totally willing to keep doing it. You know we have so many more tests than any other country by far.”

46. USA: Washington Post: Six months ago, Trump said that coronavirus cases would soon go to zero. They … didn’t.
But with new constraints on testing, Trump may get his wish eventually.
It was exactly six months ago Wednesday when the spread of the coronavirus in the United States had become too significant for President Trump to wave away. He and several members of the team planning the administration’s response held a news briefing designed to inform the public about the virus and, more important, to allay concerns.
This was the briefing in which Trump made one of his most wildly incorrect assertions about what the country could expect.
“The level that we’ve had in our country is very low,” Trump said, referring to new confirmed infections, “and those people are getting better, or we think that in almost all cases they’re better, or getting. We have a total of 15. We took in some from Japan — you heard about that — because they’re American citizens, and they’re in quarantine.”

47. USA: Washington Post: Covid-19 surges back into nursing homes in coronavirus hot spots
The novel coronavirus is surging back into U.S. nursing homes, where it killed tens of thousands at the start of the pandemic and now once again threatens some of the people most vulnerable to covid-19, the disease caused by the virus.
The development is a discouraging result of widespread community transmission of the virus in many parts of the country and in hot spots where it is even less controlled. With staff — and in some cases patients and visitors — entering and leaving facilities, the community-acquired infection almost inevitably finds its way inside.
“The strongest predictor of whether or not we’ll see cases in [a particular setting] is community spread,” said David C. Grabowski, a professor of health care policy at Harvard Medical School, who studies long-term care. “We saw that in the Northeast and now, unfortunately, we’re seeing it in the Sun Belt states.”

48. UK: The Guardian: The UK’s gathering Covid-19 autumn storm: Boris Johnson faces turmoil as Britain returns to work amid fears of a second wave of coronavirus and economic chaos
During the contest to select a new Tory leader last summer, many local Conservatives decided to vote for Boris Johnson over Jeremy Hunt – not because they saw him as more competent but because they thought he would be more fun.
On the hustings trail around the country, Hunt, the former health secretary, impressed with his grasp of detail and air of managerial competence. But Johnson’s more jokey, broad-brush “let’s have a go” approach lifted activists’ spirits after the cheerless Theresa May premiership. They knew Johnson was a risk. But it was one a majority were prepared to take.
A little over a year on, as millions of working people, parents and schoolchildren prepare for a hugely difficult autumn return to schools and workplaces with cases of Covid-19 rising again, and with the government in turmoil over the exams crisis, there are signs that plenty of Tories are now beginning to wonder how big a mistake they might have made. In a YouGov poll last week, the Tory lead over Labour had been cut to just 2%, having stood at over 25% in many surveys in March.

49. UK: BBC: Coronavirus: How will the world vaccinate seven billion?
Teams across the world are working to develop a vaccine that will be effective against Covid-19. Prime Minister Boris Johnson has called it “the most urgent shared endeavour of our lifetimes”. But away from the high-tech science of finding a winning formula, what about the logistics of rolling out a vaccine to seven billion people worldwide? In the UK, the heart of that effort is at the Harwell Science Campus, on an ex-RAF airbase in Oxfordshire. It is going to be the UK’s Vaccines Manufacturing and Innovation Centre (VMIC), plans for which have been brought forward by Covid-19. “We’ve really compressed the timeline into almost half. So whereas we were expecting to have it ready at the end of 2022, we’re now hoping to have it online in 2021,” explains Matthew Duchars, chief executive of VMIC.
“To use an analogy – it’s like baking a cake at home. You can spend hours preparing the perfect cake and now you’ve got to go out and bake 70 million of them and they all have to be perfect, so it’s quite a challenge.”

Best Wishes and Stay Safe
John Wynn-Jones