Coronavirus Lockdown May Spur Surge in Mental Illness, U.N. Warns

The coronavirus is wreaking havoc on people’s health in ways that at first glance would seem to have little connection to the virus’s devastating primary effects.

The United Nations is warning of new risks to children and a subsequent plague of mental illness. And national governments are noting the unintended consequences of lockdowns and other restrictions, including a rise in domestic violence. In Mexico, a decision to ban alcohol sales was followed by scores of deaths after people drank tainted homemade alcohol.

Millions of children are at risk of dying, the United Nations said on Wednesday, not of Covid-19, but of preventable causes. Unable to get care at hospitals that are straining to fight the virus, more than a million children aged 5 or younger will die every six months, UNICEF said in a report.

And the World Health Organization, the health body that has been working to coordinate global efforts to combat the disease, warned on Thursday of a looming mental illness crisis, the result of “the isolation, the fear, the uncertainty, the economic turmoil,” brought on by the pandemic.

Devora Kestel, the head of the W.H.O.’s mental health department, who presented the report, said the world could expect to see a surge in the severity of mental illness, notably in children and health care workers.

“The mental health and well-being of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently,” she said.

A typhoon packing winds of nearly 100 miles per hour made landfall in the eastern Philippines on Thursday after gathering strength across the Pacific Ocean, prompting evacuations and raising concerns that the nation’s most populous area may still lie in its path.

Typhoon Vongfong was traveling westward at about 10 m.p.h. when it hit Samar Island in the eastern Philippines at 12:15 p.m., according to the Philippine Atmospheric Geophysical and Astronomical Services Administration.

Thousands were evacuated on Samar Island amid widespread power outages, officials said. There were no immediate reports of deaths.

Forecasters predicted that the storm could dump torrential rains across a wide area of the Philippines, perhaps including Luzon, the country’s largest island. It has a population of 60 million and includes the capital, Manila.

Much of Luzon remains on lockdown because of the coronavirus epidemic. That could complicate emergency efforts should the storm strike the island with particular force.

“Definitely this is going to add to our emergency situation,” said Harry Roque, a spokesman for President Rodrigo Duterte. “While the areas expected to be hit by the typhoon are not heavily ravaged by Covid-19, we have set some guidelines.”

He said families taken to evacuation areas would have to observe strict social-distancing rules. But judging from evacuations during previous typhoons, he conceded, “enforcing that would be a challenge.”

Russia is hailing its medical workers as heroes, their photographs plastered on billboards and their stories glamorized on state TV. But as the country becomes one of the global hot spots of the pandemic, those workers are suffering astonishing levels of infection and death in their ranks.

Thousands have been infected, and more than 180 doctors, nurses, paramedics and other medical workers have died.

Like their colleagues in much of the rest of the world, many of those doctors and nurses are suffering from a shortage of protective gear and equipment. But Russian health workers are also at the mercy of a convoluted, unforgiving bureaucracy that increasingly appears outmatched by the pandemic.

An internal federal government document obtained by The New York Times illuminated Russia’s lack of preparedness. In late March, regional Russian officials were sounding alarm bells about a drastic undersupply of protective equipment and pervasive confusion about how they were supposed to tackle the virus.

Those problems still have not been fully resolved. Now, six weeks later, even doctors at Moscow’s top hospitals are reporting nearly overwhelming levels of infection among their colleagues.

“I think that, as of today, I know a handful of people who have not been sick,” said Dr. Evgeny Zeltyn, a cardiologist at a Moscow hospital.

Dr. Zeltyn said he had been lucky: He was at work when he collapsed with a fever of 102 degrees. He received treatment right away, spent the night in his hospital as a patient and was back at work within five days.

“People are fighting,” he said. “People are incredibly tired.”

One of the two who tested positive is a refugee while the other is a member of the host population, according to the United Nations refugee agency. A community leader in the camps said that up to 1,900 people who had contact with the pair have been identified and may undergo some form of quarantine.

In Bangladesh, the tented Rohingya encampments spread across landslide-prone hills are already susceptible to disaster and disease. Diphtheria, all but eradicated in most of the world, has raced through them. Marauding elephants have trampled children to death. A fire recently destroyed hundreds of shelters.

A mobile internet ban imposed by the Bangladeshi authorities has made dispersing accurate information difficult. In the Rohingya camps, there is not a single intensive care bed, and fewer than 110 refugees have been tested for the virus, according to the United Nations refugee agency.

Bangladesh has reported fewer than 20,000 cases of the coronavirus, but health experts believe the true number is much higher.

“This pandemic could set Bangladesh back by decades,” said Athena Rayburn, who manages the group Save the Children’s efforts to aid the Rohingya.

Save the Children, the global charity, reported Thursday that at least 385 people had died over the past week with Covid 19-like symptoms in the city of Aden, where the first cluster — five cases — surfaced at the end of April.

Several hospitals in Aden have closed, and some medical workers have refused to work because of a lack of protective equipment, Save the Children said. The two main public hospitals are providing only emergency services, and are not admitting patients, it reported.

Earlier Thursday, U.N. officialsalso sounded the alarm. “Humanitarian agencies have every reason to believe that community transmission is taking place across the country,” said Ramesh Rajasingham, the acting deputy emergency relief coordinator.

The five-year war in Yemen and the nine-year one in Syria have combined with the pandemic to create especially dire challenges for vulnerable civilian populations, who are often displaced and have limited or no access to food and medical care.

The World Food Program, the anti-hunger agency of the United Nations, said on Twitter on Thursday that a record 9.3 million people in Syria are “food insecure” — meaning they regularly don’t have enough to eat. Spiraling prices and the coronavirus have “pushed families beyond their limits,” the agency said.

Even in hard-hit countries, small fractions of the population have caught the coronavirus so far, new studies in England, Spain and France show — sobering evidence that the world remains far from defeating the contagion.

Public health officials warn that relaxing social distancing rules risks causing new waves of the pandemic, in part because the vast majority of people may still be susceptible to infection.

Scientists say it is likely, though not certain, that people who have had the virus gain some immunity to it. The new findings support experts’ warnings that populations are still far from achieving “herd immunity,” when enough people are resistant to slow its spread.

A Spanish study, announced by the government on Wednesday, was different in that it tested for antibodies, not the virus itself, so it measured how many people had been infected at some point, including those who had recovered. It found that about 5 percent of the nation’s population had caught the coronavirus.

In all three countries, the great majority of those who have been tested for the virus had symptoms, and they were primarily people in hospitals or nursing homes. The tests are imperfect — infected people often test negative — but in all three countries, significantly less than 1 percent of the population has tested positive.

Britain has had more than 33,000 confirmed Covid-19 deaths, the second-most after the United States. France and Spain have each had more than 27,000.

Neurologists around the United States have reported a flurry of unexplained strokes among Covid-19 patients, including among young and otherwise healthy people.

One of those patients was Ravi Sharma, a 27-year-old emergency medical technician in New York City who spent weeks ferrying sick, elderly patients from nursing homes to hospitals.

He self-quarantined in mid-March when he developed a dry cough, knowing he was probably infected even though he wasn’t able to get a test. Then he had a sudden stroke that left him unable to speak or move the right side of his body.

He was rushed to the hospital, where he was sedated and placed on a ventilator. His family wasn’t sure if he would make it.

He is now recovering at a rehab facility, where he has learned to walk again. He’s trying to gain back some of the 50 pounds he lost during his illness.

“I’m 27, and if this could happen to me, it could happen to anyone,” Mr. Sharma said. “This is real and it’s scary. I want people to go out there and be cautious.”

The strokes appear to be related to a broader phenomenon that has emerged in critically ill Covid-19 patients: excessive blood clotting.

A government official in France said on Thursday that it would be unacceptable for the French drug giant Sanofi to give the United States early access to any Covid-19 vaccine it develops, after comments by the company’s chief executive suggested that America would be first in line because it helped finance the research.

Sanofi has received $30 million from an office of the U.S. Department of Health and Human Services, Mr. Hudson said.

“I’ve been campaigning in Europe to say the U.S. will get vaccines first,” he said. “That’s how it will be, because they’ve invested to try and protect their population, to restart their economy.”

Sanofi later said in a statement that it was “committed in these unprecedented circumstances to make our vaccine accessible to everyone,” and noted that it has manufacturing plants around the world.

The issue is a delicate one for President Emmanuel Macron of France, who has said repeatedly that Europe needs to develop its “economic sovereignty” to depend less on the United States and China for strategic technological and medical goods.

On Thursday, Prime Minister Édouard Philippe said on Twitter that“equal access to the vaccine for all is nonnegotiable.”

Tears have flowed freely this month at a nursing home in Wassenaar, a coastal community in the Netherlands. And — a rarity in the midst of a pandemic — they have been tears of joy.

The cabin, divided by a glass wall, has two entrances. On one side, a nursing home resident walks in with a staff member’s help. On the other side, up to two family members can enter the cabin after disinfecting their hands. An intercom allows the family to communicate.

“The first visit in the cabin was very special,” Mr. Holleman said. “Two daughters came to see their mother for the first time after three weeks. All three of them sobbed.”

Mr. Holleman said he was amazed by how the idea had taken off and spread throughout the Netherlands to other nursing homes. For now, the facility allows four half-hour visits per day. All of the slots have been booked up through the end of this month.

“Of course we all prefer to hug each other and walk outside while holding hands,” Mr. Holleman said. “This is second best.”

Mumbai is India’s most densely populated city. A scraggly peninsula framed by the Arabian Sea and other waterways. A city of outsize dreams and desperate poverty. It is where Asia’s richest man, Mukesh Ambani, built a 27-story single-family home, and where “Slumdog Millionaire” was filmed and set.

Indians call it Maximum City.

And as the coronavirus gnaws its way across India, Mumbai has suffered the country’s worst outbreak. The city of 20 million is now responsible for 20 percent of India’s coronavirus infections and nearly 25 percent of the deaths. Hospitals are overflowing. Police officers are exhausted enforcing a stay-at-home curfew.

Doctors say the biggest enemy is Mumbai’s density, particularly in the city’s vast slum districts, where social distancing is impossible. People often live eight to a room across miles and miles of informal settlements made of concrete blocks and topped with sheets of rusted iron. As temperatures climb toward 100 degrees Fahrenheit, many can’t help but to spill into the streets.

But India’s testing is also relatively low, so many experts fear that the real number of infections is far higher. Many people still don’t have masks.

For the past eight weeks, Atul Loke, a second-generation newspaper photographer, has been tracking the spread of the coronavirus across Mumbai. His photographs, which can be viewed at the link below, reveal a city under siege.

The United Nations intended to celebrate its 75th birthday during the annual General Assembly this September. But the meeting — the world’s biggest diplomatic gathering — may instead be held by videoconference because of the coronavirus pandemic.

Diplomats have been saying privately that they do not see how it would be possible to convene such a meeting if New York, the host city, is still grappling with basic health and safety issues, which seems likely.

Dozens of world leaders and thousands of diplomats and other officials would normally descend on the city, with hotels, restaurants and meeting venues booked well in advance for guests, receptions, side-meetings and related events.

Secretary-General António Guterres, who ordered the 193-member organization’s headquarters to be largely vacated two months ago and asked employees to work from home, has suggested that he is looking at different options for this year’s General Assembly, including a drastically scaled-down version augmented by internet videoconferences.

But aides to Mr. Guterres and to the General Assembly’s current president, Tijjani Muhammad-Bande of Nigeria, said they have not ruled out a physical gathering.

Stéphane Dujarric, the spokesman for Mr. Guterres, said Thursday that Paris Match magazine, which had quoted Mr. Guterres as saying that a meeting of thousands of representatives was “unlikely,” had taken the comment out of context.

“He did not say that it would not happen,” Mr. Dujarric said at a daily news briefing, which like other U.N. events is now held via videoconference.

Reem Abaza, a spokeswoman for Mr. Muhammad-Bande, speaking in the same videoconference, also said no decisions had been made. “It’s still too early to know for sure what will happen in September,” she told reporters.

The General Assembly has been held every year since the organization’s founding in 1945. The meeting is scheduled to start Sept. 15, and the speeches by world leaders are set to begin Sept. 22.

Workers at Amazon’s six French warehouses won some concessions from the company in late March: After hundreds of employees threatened to walk out unless the company better protected them from the coronavirus, the internet giant strengthened social distancing measures, provided masks and hand sanitizer and took employee temperatures.

But that was not enough for workers like Jean-François Bérot, who a few weeks later felt like his colleagues were still too close for comfort, putting themselves at risk to fulfill orders for items as trivial as nail polish.

“People kept coming to work feeling worried about being exposed to a mortal danger,” said Mr. Bérot, 50, who works at a warehouse south of Paris.

The case, now headed to the French Supreme Court, will test Amazon’s ability to sidestep the demands of workers who are fulfilling a sudden surge in orders amid the pandemic.

And at least one senior expert said it was unnecessary to test every resident in Wuhan, given the low number of cases in the city.

The testing drive, which is likely to require the mobilization of thousands of medical and other workers, shows the ruling Communist Party’s resolve to prevent a second wave of infections as it tries to restart China’s economy. The plan was announced this week after Wuhan reported six coronavirus cases, breaking a streak of more than a month without any new confirmed infections.

The city’s goal of testing every resident is unrivaled in scale and in the speed at which Wuhan apparently plans to carry it out.

Mr. Abe said he would review the state of emergency for the remaining prefectures next week to determine whether it could be lifted before the end of the month.

He declared the emergency last month, through May 7, and later extended it until the end of this month.

Japan has reported a total of 16,079 infections and 687 deaths from the coronavirus. On Thursday, the health ministry reported 57 new cases for the nation and 19 deaths.

Mr. Abe urged residents not to let their guard down after the emergency declaration is lifted. He asked that people continue to wash hands, abide by social distancing guidelines and wear masks when going out. He also asked residents to avoid crowds in enclosed, poorly ventilated places and refrain from visiting places like nightclubs, karaoke parlors and live music halls.

“We will have to create a new model in daily life from now on, and today is the start of that,” he said. He added that if infections begin to rise significantly again, “unfortunately we might have to resort to a second declaration of a state of emergency.”

Warning of “the darkest winter in modern times,” a whistle-blower, ousted as head of a federal agency working on a coronavirus vaccine, told Congress on Thursday that the pandemic could “get worse and be prolonged.”

The country needs a national strategy for widespread testing, and for production and distribution of a vaccine on a scale beyond the ability of any one company, he said. He added that his superiors were indifferent to his warnings early this year of inadequate supplies.

Dr. Bright was removed last month as head of the Biomedical Advanced Research and Development Authority, and moved to a narrower position at the National Institutes of Health. He had clashed with Trump administration officials over a malaria drug that the president has promoted, despite a lack of evidence, as a Covid-19 treatment.

Mr. Trump said on Twitter Thursday that Dr. Bright “should no longer be working for our government,” and later described him as “nothing more than a really unhappy disgruntled person.”

Burundi has expelled four top World Health Organization officials days before a crucial general election, amid criticism that the country has not done enough to curb the coronavirus pandemic.

The county’s foreign ministry declared four W.H.O. officials — including Dr. Walter Kazadi Mulombo, the U.N. agency’s top representative in the country — “persona non grata.” The authorities did not give a reason for expelling the experts, but said that they had to leave Burundi by Friday.

Burundi — which will go to the polls on Wednesday to choose a president, lawmakers and local officials — has reported just 27 cases and one death from Covid-19. Health experts have called those numbers suspiciously low, especially as cases spike in neighboring Tanzania, which has also been accused of not reporting the virus’s true toll.

“I jumped at the chance,” she said in a phone interview from Zurich. “Doing this online breaks a lot of boundaries that felt insurmountable.”

The authors found that over the five years before the coronavirus pandemic, 19 children with Kawasaki disease were treated at the Papa Giovanni XXIII Hospital, which has an advanced pediatric department, in the country’s Bergamo Province.

But this year, from February 18 to April 20 alone, the hospital — which is at the epicenter of Italy’s coronavirus outbreak — treated 10 children with similar hyper-inflammatory symptoms.

That suggests a cluster driven by the coronavirus pandemic, the authors said, especially since overall hospital admissions during this time were much lower than usual.

Reporting and research were contributed by Mike Baker, David Yaffe-Bellany, Liz Alderman, Hannah Beech, Pam Belluck, Aurelien Breeden, Lauretta Charlton, Niraj Chokshi, Lynsey Chutel, Abdi Latif Dahir, Jeffrey Gettleman, Rick Gladstone, Russell Goldman, Jason Gutierrez, Yonette Joseph, Raphael Minder, Alex Marshall, Claire Moses, Elian Peltier, Richard Pérez-Peña, Motoko Rich, Siobhan Roberts, Adam Satariano, Kirk Semple, Megan Specia, Anton Troianovski, Shalini Venugopa, Vivian Wang, Sui-Lee Wee, Ceylan Yeginsu, Wang Yiwei, Karen Zraick, Knvul Sheikh and Roni Caryn Rabin.

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