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Public health in China has become a global concern as a consequence of the outbreak and worldwide spread of COVID-19. This article examines the historical place of China in international and global health. Contrary to prevalent narratives in the history of medicine, China and Chinese historical actors played key roles in this field throughout the twentieth century. Several episodes illustrate this argument: the Qing organization of the International Plague Conference in 1911; the role of China in the work of the interwar League of Nations Health Organization and postwar establishment of the World Health Organization; Cold War medical diplomacy; and Chinese models of primary health care during the 1970s. These case studies together show that Chinese physicians and administrators helped shape concepts and practices of “global health” even before that term rose to prominence in the 1990s, and current events are best understood in the context of this history.
The long-term recovery rate of chemosensitive functions in coronavirus disease 2019 patients has not yet been determined.
Method
A multicentre prospective study on 138 coronavirus disease 2019 patients was conducted. Olfactory and gustatory functions were prospectively evaluated for 60 days.
Results
Within the first 4 days of coronavirus disease 2019, 84.8 per cent of patients had chemosensitive dysfunction that gradually improved over the observation period. The most significant increase in chemosensitive scores occurred in the first 10 days for taste and between 10 and 20 days for smell. At the end of the observation period (60 days after symptom onset), 7.2 per cent of the patients still had severe dysfunctions. The risk of developing a long-lasting disorder becomes significant at 10 days for taste (odds ratio = 40.2, 95 per cent confidence interval = 2.204–733.2, p = 0.013) and 20 days for smell (odds ratio = 58.5, 95 per cent confidence interval = 3.278–1043.5, p = 0.005).
Conclusion
Chemosensitive disturbances persisted in 7.2 per cent of patients 60 days after clinical onset. Specific therapies should be initiated in patients with severe olfactory and gustatory disturbances 20 days after disease onset.
The COVID-19 pandemic is nowhere near over. Some things, however, seem relatively clear. So far, the agendas of the world's most powerful actors seem unchanged—or, indeed, accelerated. Partly as a result, disease mortality and economic losses have fallen largely on poorer people, though deaths so far have been concentrated among poorer people in rich countries. Consequently, the pandemic's implications look very different at the local, subnational, and international levels—although at all levels, they thus far reflect accelerations of preexisting trends more than new departures. Many developments reflect remarkable gains in human capacity to cope with disasters—a point highlighted by comparisons to the 1919 flu and other historical events pandemics made by the authors in this forum. Those gains are particularly evident in Asia, though they look more precarious in South Asia and Southeast Asia than in East Asia; this has contributed to a marked shift in rhetoric about global “sickness” and health and seems consistent with prophecies of a coming “Asian century.” However, COVID-19 may not be a singular event like 1919 but may portend a wave of environmental emergencies; in that scenario, no world region has exhibited as much resilience as it would need.
In March 2020, Prime Minister Abe Shinzō, the Tokyo Olympic Organising Committee, and the International Olympic Committee postponed the 2020 Tokyo Olympics for one year. The delay is the most prominent consequence of the COVID-19 crisis in Japan thus far. But the “Corona Calamity” (korona ka) is bigger than the Olympics. The totality of the disaster is impossible to capture. The very thing that makes it a calamity are the myriad rhythms of crisis that intersect at COVID-19. If there is a shared theme to be found in these rhythms, it is the question of recovery. When will it happen? What will it look like? And what, exactly, will we recover? In what follows, I share three rhythms of crisis and recovery: national history, the tourism industry, and the parcel delivery industry.
In response to the COVID-19 pandemic, the Indian government, led by Narendra Modi, imposed a stringent lockdown with only four hours notice. It paid no attention to the millions of migrants who work on a temporary basis in Indian cities. Most lost their livelihoods as a result of the lockdown, and millions sought to return to their native villages. At the same time, the rural economy confronted its own difficulties caused by the lockdown. The relief that the Modi government offered to the large numbers of poor people who had been adversely affected by its response to COVID-19 was limited and poorly delivered. The episode showed the lack of responsiveness of Indian democracy to the needs of working people and the failures of development. Yet Modi's particular brand of authoritarian populism worked so well that a government displaying very little compassion retained strong popular support.
The onset of the COVID-19 pandemic has produced two different narratives in India. One, here described as “historical,” looks back to the pandemics of the colonial past—bubonic plague from 1896, influenza in 1918–19—as a source of comparisons, lessons, and dire warnings for the present. This narrative envisages the reenactment of past scenes, including flight from the cities, victimization of the poor, and the questioning of state authority. The other narrative, here called “insurgent,” questions the value of historical analogies, doubts that history ever substantially repeats itself, and stresses the specificity of postcolonial Indian politics and health. While recognizing the validity of both narratives, the author urges caution in employing colonial history to critique contemporary events and, while recognizing the 1890s plague as a watershed moment, questions whether even the most devastating pandemics (such as 1918's influenza) necessarily result in profound social, political, and health care changes.
To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient.
Methods
Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed.
Results
The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8–26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001).
Conclusion
Performing a tracheostomy in coronavirus disease 2019 positive patients at 8–14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.
To evaluate the prevalence of severe acute respiratory syndrome coronavirus-2 infection in patients presenting with epistaxis to a tertiary otolaryngology unit.
Methods
A prospective study was conducted of 40 consecutive patients presenting with epistaxis referred to our tertiary otolaryngology unit. A group of 40 age-matched controls were also included. All patients underwent real-time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus-2. Symptoms of fever, cough and anosmia were noted in the study group.
Results
The mean age was 66.5 ± 22.4 years in the study group. There were 22 males (55 per cent) and 18 females (45 per cent). The mean age in the control group was 66.3 ± 22.4 years (p = 0.935). There were six positive cases for severe acute respiratory syndrome coronavirus-2 (15 per cent) in the epistaxis group and one case (2.5 per cent) in the control group. The difference was statistically significant (p = 0.05).
Conclusion
Epistaxis may represent a presenting symptom of severe acute respiratory syndrome coronavirus-2 infection. This may serve as a useful additional criterion for screening patients.
The coronavirus disease 2019 pandemic has necessitated almost exclusive National Health Service focus on emergency work and cancer care. There are concerns that increased hospital and community pressures will lead to decreased referrals and worse outcomes for head and neck cancer patients.
Method
This is a retrospective review of all cases referred for suspected head and neck cancer to our institution in January and April 2020.
Results
There was a 55 per cent decrease in referrals but diagnostic yield rose from 2.9 per cent in January to 8.06 per cent in April. In both months, 100 per cent of patients met the 31- and 62-day targets, with similar 14-day wait time success (97.83 per cent for January vs 98.33 per cent for April). Referrals for laryngopharyngeal reflux rose from 27.5 per cent to 41.9 per cent. Referrals for those aged over 60 years fell from 42 per cent to 26 per cent.
Conclusion
It is suggested that further research be conducted into the reasons why fewer patients were referred, particularly elderly patients, and why laryngopharyngeal reflux is so prevalent in fast-track referrals.
A study was carried out to evaluate the relationship between anosmia and hospital admission in coronavirus disease 2019 patients.
Methods
The clinical data of 1534 patients with confirmed coronavirus disease 2019 virus were analysed. The study was conducted with medical records of 1197 patients (78 per cent). The basic characteristics of patients and symptoms related to otolaryngology practice were examined. The patients were divided into two groups according to their follow up: an out-patient group and an in-patient group.
Results
The majority of patients presented with anosmia (44.2 per cent), dysgeusia (43.9 per cent) and fever (38.7 per cent). Anosmia was observed in 462 patients (47 per cent) in the out-patient group, and in only 67 patients (31.2 per cent) in the in-patient group. Younger age (odds ratio = 1.05, 95 per cent confidence interval = 1.03–1.06) and the presence of anosmia (odds ratio = 2.04, 95 per cent confidence interval = 1.39–3) were significantly related to out-patient treatment.
Conclusion
Anosmia could be a symptom in the clinical presentation of the coronavirus disease 2019 infection.
The COVID-19 pandemic has gendered implications for women's time and resources. The use of informal institutions that pose obstacles to women's electoral viability may also be particularly consequential at a time of rapid change, when election dates and procedures are being amended because of health concerns. Together, these dynamics suggest that the COVID-19 pandemic may impact women's electoral participation, support, and viability in meaningful ways. The November 2020 Brazilian municipal elections provide an opportunity to explore this. Employing data from an original survey of eligible individuals and aspirant candidates, we find that the main obstacle to women's representation is not personal political ambition or efforts but women's perceptions of their access to support for their candidacies. In the face of greater challenges, resilient aspirants are choosing to work harder to compensate for potential losses in campaign support and funds.
We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.
Setting:
A 635-bed, tertiary-care hospital in Daegu, South Korea.
Methods:
To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.
Results:
From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).
Conclusions:
Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
As governments tackle the ongoing COVID-19 pandemic, both the role of women in governments and the specific effect of the pandemic on women have come under scrutiny. This research note examines the descriptive representation of women in the U.K. government's response to the coronavirus. It finds that 43% of the government's daily press briefings featured an all-male lineup with no female politician or expert present. In particular, female politicians are missing, with only one female cabinet member ever leading the briefing. Women's (in)visibility raises concerns about the legitimacy of democratic decisions and likely has policy consequences: women's absence may exacerbate gendered inequalities resulting from the crisis.
The connection between women leaders and superior pandemic performance is likely spurious. This narrative overlooks that women currently govern precisely the kinds of countries that should mount effective pandemic responses: wealthy democracies with high state capacity. This article maps where women currently serve as presidents and prime ministers. The article then uses data from the Varieties of Democracy Project and the Organisation for Economic Co-operation and Development to show that many women-led countries score high on state capacity and that high-capacity states have low coronavirus mortality regardless of whether they are led by women or by men. Arguments emphasizing women chief executives’ superior pandemic performance, while offered in good faith, are misleading.
The prevalence of dementia is rising in low-resource countries, where specialist memory services are almost non-existent. The COVID-19 pandemic has created opportunities for innovative remote healthcare. Research shows a lack of dementia literacy and help-seeking behaviour for memory-related problems among older adults in South Asian countries. This paper proposes a remote memory service model and virtual dementia training in South Asian countries, called Memory First Aid (MFA). MFA offers help to a person experiencing memory difficulties until appropriate professional help is received. The MFA course is a 12-h webinar-based package consisting of four weekly modules. It covers dementia awareness and clinical features. The aim is to develop a non-medical workforce able to screen and assess older people with suspected dementia.
Media outlets have reported that women leaders around the globe are managing the COVID-19 crisis better than their male counterparts, responding faster and communicating better about pandemic policies. In this article, we examine empirical data on the timing of policy responses from the Coronavirus Government Response Tracker to determine whether and how countries led by women reacted differently to the pandemic. Exploring the relationship between the gender of leaders and legislators and the timing of stay-at-home orders, school closures, and coordinated public information campaigns, we find no statistical evidence supporting popular claims in the media. However, we find some evidence that the level of gender equality in legislatures is related to school closures, a policy with clear gendered consequences. These conclusions are an important first step in understanding the potentially gendered nature of the crisis response and identifying new avenues for research.
COVID-19 pandemic in Argentina has affected the care of older adults with dementia deeply. Our objective was to study how the obligatory social isolation affected stress caregiver and burden of care of family members of subjects living with dementia in the community after the initial 4 weeks of quarantine in our setting. We did a questionnaire survey among 80 family caregivers of persons with Alzheimer’s disease (AD) or related dementia collected on April 2020. We designed a visual analog scale to test the level of the burden of care. Characteristics of people with dementia and their caregivers were analyzed with descriptive (mean, standard deviation, frequency and percent) and inferential statistics (chi-square test). The sample included older adults (mean age: 80.51 ± 7.65) with different stages of dementia. Family was the primary provider of care in 65%. Overall, COVID-19 confinement increased stress caregiver independently of the dementia stage, but those caring for severe cases had more stress compared to milder forms of the disease. Other findings were that half of the subjects with dementia experienced increased anxiety and that most family members discontinued all sort of cognitive and physical therapies. Family members’ main concerns were for severe dementia cases, fear of absence of the paid caregiver during the epidemic, and for mild cases fear of spreading the disease while assisting patients with instrumental activities. A partnership between departments of public health, care workers and families must be planned to guarantee continuity of care during these unique COVID-19 times.