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India didn’t prioritize mental health before Covid-19. Now it’s paying the price


“The worst are the headaches and the pain in my eyes,” said Paul, who lives in Kolkata, West Bengal. “I have had more panic attacks this year than in my entire life combined.”

Research conducted by the Suicide Prevention in India Foundation (SPIF) in May found that nearly 65% of 159 mental health professionals surveyed reported an increase in self-harm among their patients. More than 85% of therapists surveyed said they were experiencing caregiver fatigue, and over 75% said fatigue had impacted their work.

Another survey in April, by the Indian Psychiatric Society, showed that, of 1,685 participants, 40% were suffering from common mental health disorders, such as anxiety and depression, due to the pandemic.

The lockdown may have eased, but the situation isn’t improving. The report’s authors told CNN in August that there’s growing anxiety and uncertainty about when the pandemic will end.

Before Covid-19, India had the highest suicide rate in south-east Asia — now medical experts say the country’s mental health system is being pushed to the limit.

“The system was already creaking and overburdened, now with Covid, we are experiencing the catastrophe of increased demand, woeful supply, and fatigued frontline workers,” said Nelson Moses, founder of SPIF.

No words for mental health

India doesn’t have a long history of discussing mental health.

In 2016, a National Mental Health Survey conducted across 12 states documented a list of over 50 derogatory terms used for people suffering mental illness. “Usually, the public believes that individuals with psychiatric illnesses are incompetent, irrational and untrustworthy consequently, they have low marriage opportunities,” said one of the participants.

“People think that talking about your feelings makes you weak — there are a lot of misconceptions,” said 23-year-old Baldev Singh, a volunteer counselor with the MINDS Foundation, an Indian nonprofit that aims to reduce the stigma around mental health.

Experts say the historical reluctance to address mental health in India could be partly due to a lack of terminology. None of India’s 22 languages have words that mean “mental health” or “depression.”

“People think that talking about your feelings makes you weak — there are a lot of misconceptions.”Baldev Singh, volunteer counselor

While there are terms for sadness (udaasi), grief (shok) or devastation (bejasi) in Urdu and other Indian languages, the specific terminology to address different mental illnesses is lacking. That’s because the practice of psychiatry is largely Western, said Dr S.K. Chaturvedi, Head of department at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore.  “It is easier for people to talk about physical symptoms and illnesses than to express to their families that they are feeling low or depressed,” he said.

Growing up, Paul says her middle-class Indian family didn’t talk about negative feelings.

“Ever since I was a kid it was ingrained that we don’t talk about things that bother us.”

Problems were pushed aside and minimized, she said. “They might just compare it with someone else’s problem and make you feel guilty about it.”

Aritri Paul has spoken about her issues with mental health to encourage others to seek help.

Straining mental health system

The stigma around mental health may prevent some people from recognizing that they need help. For those who do want treatment, facilities are limited.

According to the 2016 National Mental Health Survey, 83% of people suffering mental health problems in India did not have access to adequate mental health treatment.

The same year, India had three psychiatrists for every million people and even fewer psychologists, according to the World Health Organization (WHO). For comparison, the US had 100 psychiatrists and almost 300 psychologists for every million people.

In many cases, access to mental health treatment in India depends on where you live.

“The divide basically comes in the urban versus rural, so if I look at Mumbai, I know that today I can just get up and go to a hospital in my own area,” said Pragya Lodha, the Mumbai Program Director for the MINDS Foundation.

For people in rural India, it’s much harder.

Sub-district hospitals cater to roughly 30,000 people or 15 to 20 villages. However, these hospitals typically don’t have mental health services, according to Amul Joshi, MINDS Foundation’s program director in Gujarat.

Some villagers may have to travel up to 60 kilometers (37 miles) to get treatment, said Joshi. That takes time — and money. “We sometimes pay for their travel to the hospital as an incentive. However, this means that treatment is usually limited to medication as people cannot keep going to the district hospital for therapy,” he said.

People in rural India tend to have other priorities.

“The struggle in rural communities is often about basics so mental health tends to take a backseat,” said Lodha.

The urban-rural divide

India was heading into harvest season when the government announced its nationwide lockdown in March. Farmers were confused about whether they could hire migrant workers amid the ban on cross-border movement, and whether crops could be transported to market, said Singh, the volunteer counselor.

“People have to deal with a lot of stress in villages — farmers have to deal with their produce going bad when they can’t take it to the market or distribute it in time,” said Singh, who lives in Nara Village, a rural farming community of around 2,000 people in Gujarat.

Singh said people in rural India are feeling more isolated than ever.

“In rural India, where people aren’t aware of mental health issues and can’t talk to their friends about their stresses, the situation is only getting worse.”Baldev Singh, volunteer counselor

“In urban India, this may have led to more dialogue among family members. In rural India, where people aren’t aware of mental health issues and can’t talk to their friends about their stresses, the situation is only getting worse,” he said.

Technology has become crucial to mental health intervention in many communities during the pandemic. However, online therapy is not often available to people in villages who don’t have access to smartphones or the internet.

The MIND Foundation trains volunteers — like Singh — to become “community leaders” to raise awareness of mental health and encourage people to seek help when they need it.

Government programs

Changing attitudes in a country of 1.3 billion people is an immense challenge. But in recent months, there have been signs of change.

Chaturvedi, from NIMHANS, is part of a central government initiative to address the mental health of migrants who were disproportionately affected by the lockdown that stretched for 68 days.

“(It’s) definitely proof of the fact that there is a shift in attitudes, and that people understand the importance of mental health,” Chaturvedi said.

Millions of migrant workers lost their jobs and became stranded in cities when lockdown rules closed workplaces and froze public transport. Some were forced to take shelter under bridges or other public spaces or walk hundreds of miles to get home.

Migrant laborers (were) displaced, forced to go back to their villages, ignored by the state machinery, treated as collateral damage,” Moses said. Sometimes they were unwelcome in their own villages, he added, due to fears they were carrying the virus.

“Thanks to Covid, everyone is in the same boat of despair and despondency.”Nelson Moses, founder of the Suicide Prevention in India Foundation

Under the direction of the Ministry of Health and Family Welfare, NIMHANS set up a helpline that refers prospective patients to mental health professionals. Separately, the government released guidelines on addressing the mental health issues of migrants and health care workers, and advice on identifying patients whose mental health had suffered during the pandemic. And the Health Ministry shared posters stressing the importance of wellness practices, such as yoga to improve mental health.

However, some mental health practitioners say these initiatives are insufficient. “These are helpful but seem to be reductive and appear to pay mere lip service,” said Moses.

Mental health experts say what’s needed is more funding. Of India’s total 2020-2021 budget, just 2% has been set aside for healthcare. And of that figure, less than 1% has been allocated to mental health.

Moses believes now is the time for the Indian government to start prioritizing mental health services.

“Never before have we witnessed more engagement surrounding mental health. Thanks to Covid, everyone is in the same boat of despair and despondency,” said Moses. “It has gone from (being) swept under the carpet to hitting the ceiling.”

Paul chose to speak about her panic attacks to raise awareness of a problem that often is ignored in India. “It is no longer acceptable to label mental health as “taboo,” and move on without addressing the issue,” she said.

“There needs to be a lot more communication … we need to start from ground zero in schools and colleges and rope in parents and make them comfortable with it, so that their children can be comfortable talking to them about their issues.”



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UK coronavirus live: Matt Hancock defends appointment of Dido Harding to lead new health body | UK news


The most obvious next priority is to secure the right and best future for all those other responsibilities of PHE that are not about health protection and I can assure everyone that there will be more on this to follow soon.

It has been the honour and privilege of my career over 41 years to lead PHE and I want to convey my heartfelt thanks to my colleagues for the remarkable contribution each has made to protecting and improving the public’s health over our eight years together.

I have been immensely proud of what we do under intense public and political scrutiny, always with professionalism and dignity and with the values that matter the most: decency, kindness and respect.

I wish Baroness Harding as the chair of this new organisation and the transition every success, and I know everyone will be delighted to hear that Michael Brodie will be returning as the interim chief executive officer to PHE, from tomorrow pending the appointment of a new leadership team.



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Post COVID-19 Pandemic Lets Stop the Next Wave of Medicalisation over Mental Health — Global Issues


The wall at a Community Mental Health Movement in Brazil. Credit: Mario Osava/IPS
  • by Samira Sadeque (united nations)
  • Friday, June 26, 2020
  • Inter Press Service

This is according to Dainius Pūras, the United Nations special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

Pūras recently voiced his concerns about the “historical neglect of dignified mental health care,” that has been even more heightened under the pandemic.

“Before the pandemic, I critically addressed the current status quo of global mental health, and now with this pandemic my position is: even more I would recommend to rethink how we invest in mental health,” Pūras, a medical doctor with notable expertise in mental health and children’s health, told IPS.

He added that there are two principles used when addressing mental health: a human rights and evidence-based approach. Currently, under the pandemic, the latter has come under attack with a massive amount of misinformation and false news spreading, which he says can affect mental health of people and their communities. 

Excerpts of the interview with Pūras follow. Some of the answers have been paraphrased for clarity.

Inter Press Service (IPS): In what ways has the pandemic affected mental health of people?

Dainius Pūras (DP): During a pandemic, there are risks that if a person has a mental health condition, he or she might be hospitalised by force. Also, because of the virus, there might be suspicions that this person may spread the virus, which poses an additional risk factor for discriminating against people with mental health concerns. 

There should be more research done but there are many insights and preliminary observations that this pandemic will probably have a serious impact on the mental health of individuals and societies. 

There are several reasons for this: the spread of the virus and requirements for distancing and isolation, plus economic and social and employment also increase different forms of violence for example domestic violence. All these will fuel mental distress, anxiety, fear, all these feelings of uncertainty about the future 

I should highlight — another serious risk factor is that we witness massive amounts of fake news, disinformation, conspiracy theories around the virus, the origin of the virus and around statistics. This is not good for mental health. 

When children are not going to school, they’re missing out on very important aspects of socialisation. For many children, it’s their only way to get a meal — physical and mental health are interrelated in these ways.  

IPS: What is one of the current challenges of addressing mental health issues, especially under the pandemic? 

DP: I don’t support the narrative that this pandemic fuels mental distress, fear, anxiety, and the narrative that more mental illnesses will come. It’s not about producing more mental illness — it makes people anxious and scared but that’s a part of normal life, I do not want to medicalise that.  

We need to work against pathologisation and medicalisation. Because if we say millions of people are now more anxious than before, does it mean we will go on globally with medicalisation? Does it mean we will suggest  psychological medication to all these people including children and adults? 

I’m not against medication but when I analyse global situations, for sure this has gone too far. Feelings have been medicalised. I am warning that with this pandemic there would be a next wave of medicalisation. That when people are anxious and not happy, there might be an attempt to “medicalise them even more than before”. We have to be creative and to think of some innovative forms of support and cure, not necessarily medicalise. 

IPS: What are the risks involved for those with mental health at this time?

DP: More and more people are diagnosed. But then because of this diagnosis they’re discriminated against. And also because of that, in many parts of the world, many suffer from institutionalisation: sometimes that can be lifelong. 

Sometimes that’s because of a lack of services in the community and they live in institutions but now we know these institutions are hotspots for the virus. As for many countries, the closed spaces, such as prisons or psychiatric institutions are now making it worse given how dangerous it can be for residents and staff because the virus can spread. IPS: Are there certain communities more vulnerable to facing mental health risks in this pandemic?

DP: Many people who were already left behind will suffer disproportionately… So, in many parts of the world, LGBT people are discriminated against, people with disabilities other than psycho-social ones we discussed, and those with physical disability, indigenous people, migrants and refugees in difficult situations, and also the prison population — these people are at more risk. 

IPS: The issue of mental health appears to have multiple layers of barriers: financial means and social stigma. How do you navigate both financial concern as well as social stigma of this issue?

DP: My approach is that we always have to keep in mind the principles and then we will not be lost when it’s concrete. We should follow non-discrimination, empowerment, accountability and other principles. 

The problem is all these global mental health are based on discriminatory approaches; for example, if a person is diagnosed with a mental health condition or illness they could be discriminated against by mental health law in their country. 

Next week, I will be presenting many arguments to the Office of the High Commissioner of Human Rights (OHCHR) about the need for a shift in paradigm instead of making small changes. A shift is needed. There is too much: the biomedical model is overused; its okay but when it’s overused, it’s harmful. 

 IPS: What’re your hopes going forward? 

DP: With this pandemic what I’m emphasising in my statement; now we should be finally convinced that we need to move ahead with reducing the number of these institutions, with a final goal of abandoning this legacy.  

© Inter Press Service (2020) — All Rights ReservedOriginal source: Inter Press Service

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Instrumentalising the Health Crisis. On Herd Democracy and Human Dignity


In the series of Debates Digital online events, Dubravka Stojanović and Anna Lengyel talk to Debates on Europe’s Carl Henrik Fredriksson about how authoritarian politicians are using the Covid-19 pandemic to limit political freedom and further illiberal democracy.

They add elements of understanding of the situation in their respective countries to their articles we have published on Serbia and on Hungary, and evoke their personal experience.



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Question Time: Fiona Bruce in fiery row with health minister over track and trace ‘loopholes’


Health and Social Care Minister Helen Whately was drawn into a fiery row with Question Time host Fiona Bruce over the ‘loopholes’ in the Government’s new track and trace system.

The low-tech test, track and trace system launched on Thursday and could see healthy Brits forced to self-isolate for two weeks at home if they have been in contact with a confirmed case.

Call handlers will interview those in England who have tested positive and ask for details of anyone they have recently been near.

However, the app is not yet ready and a number of issues surround the scheme including what people will do about work and child care.

This sparked a heated exchange during which Ms Whately began tripping over her words as Ms Bruce said: “Follow the guidance, unless you can’t?” in relation to looking after a child if you have to suddenly self-isolate.

For updates on coronavirus, follow our live blog HERE.

Fiona Bruce brought up a number of inconsistencies in the new guidance

The panelists and the 12 virtual audience members from Glasgow – taking part via video link – had been debating the lack of clarity in the latest proposals and whether Brits will continue to be so compliant in light of the Dominic Cummings scandal.

The test and track system is reliant on people being honest about who they have been in contact with, for example – which some on the show felt the Government can no longer necessarily expect.

While audience member Ginette, a cleaning firm owner, said the new system “could close me down every single week” because her self-employed staff may have to isolate repeatedly or look after children during working hours.

Cleaning firm owner Ginette said track and trace will ruin her business

“Who’s going to pick up the pieces?” she added, with it also being pointed out the Government’s furlough support for the self employed runs out in a matter of days.

Ms Whatley said: “What we’ve seen so far is people consciously following the guidance and in fact the guidance has included recognising some situations will be more difficult, for instance, if you are looking after someone who is particularly vulnerable or a childcare situation.”

Ms Bruce said: “Just to be clear, if you have a childcare situation then, Helen, since you mentioned it – if you have a problem with childcare and you have to be identified as one of the people who has to stay at home for two weeks, you may not necessarily have to stay home?”

Health and Social Care Minister Helen Whately was drawn into a row

The minister responded: “You clearly have to ensure your child is safe as any parent should do so…”

But Ms Bruce cut in: “So if you have to leave home to do that, even if you have been told to self isolate, you can do that?”

Ms Whatley said: “If you are contacted because you are a contact of somebody who’s got symptoms and told to isolate at home, you should be able to do so with your child. Everyone will have their scenarios.”

Ms Bruce said: “But just to be clear, because it’s important, because we’re all going to have to adjust to this now, this new system – if you are told to self-isolate at home for two weeks either because you have symptoms or you’ve been in close contact with someone who has symptoms but you have problems with that – you find that difficult because of child care issues – you can behave otherwise?”

Ms Bruce said the minister must be clear because “it’s important”

Ms Whately responded: “You should follow the guidance – I don’t think anyone is suggesting you should have a child in an unsafe situation…”

“So follow the guidance, unless you can’t?” Ms Bruce cut in.

The minister, who had began tripping over her words, said: “No, that’s not what I’m saying, actually, at all.

“You should absolutely follow the guidance and that’s been the case all the way through.”

“But you’re saying unless…” the host began to say.

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Coronavirus outbreak

But Ms Whately composed herself to add: “The guidance has always said that safety would be a factor, and you should clearly be a responsible parent.

“But I think what’s really important is that people follow the guidance.

“And through doing that, that’s how we manage to keep the infection rate under control and so life can get back to normal or closer to normal – which would be so much better for everybody.”

As part of the new scheme, call handlers will interview those in England who have tested positive and ask for details of anyone they have recently been near.

Recent contacts who do not have symptoms will be called and asked to self-isolate at home for 14 days.

Close contact is defined as being closer than 2metres to someone with symptoms for more than 15 minutes.

Data will be analysed to decide whether workplaces, schools, housing estates or blocks of flats need to be locked down to quell local outbreaks.

As the NHS test and trace app is not ready yet, all tracing will be performed manually.

During Thursday’s Question Time, Ms Bruce also brought up the apparent absurdity in the guidelines surrounding No10 allowing Brits to have BBQs with members of a different household.

Those in attendance must remain two metres apart and outside – leading the host to poke fun at the idea only people with huge gardens could comply – while those in England can have six attendees but Scots can have eight.





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Kim reappears in public, ending absence amid health rumors


SEOUL, South Korea —
North Korean leader Kim Jong Un made his first public appearance in 20 days as he celebrated the completion of a fertilizer factory near Pyongyang, state media said Saturday, ending an absence that had triggered global rumors that he may be seriously ill.

The North’s official Korean Central News Agency reported that Kim attended the ceremony Friday in Sunchon with other senior officials, including his sister Kim Yo Jong, who many analysts predict would take over if her brother is suddenly unable to rule.

State media showed videos and photos of Kim wearing a black Mao suit and constantly smiling, walking around facilities, applauding, cutting a huge red ribbon with a scissor handed by his sister, and smoking inside and outside of buildings while talking with other officials.

Seemingly thousands of workers, many of them masked, stood in lines at the massive complex, roaring in celebration and releasing balloons into the air. A sign installed on a stage where Kim sat with other senior officials read: “Sunchon Phosphatic Fertilizer Factory; Completion Ceremony; May 1, 2020.”

There were no clear signs that Kim was in discomfort. He was shown moving without a walking stick, like the one he used in 2014 when he was recovering from a presumed ankle surgery. However, he was also seen riding a green electric cart, which appeared similar to a vehicle he used in 2014.

It was Kim’s first public appearance since April 11, when he presided over a ruling Workers’ Party meeting to discuss the coronavirus and reappoint his sister as an alternate member of the powerful decision-making Political Bureau of the party’s Central Committee. That move confirmed her substantial role in the government.

Speculation about his health swirled after he missed the April 15 birthday celebration for his late grandfather Kim Il Sung, the country’s most important holiday, for the first time since taking power in 2011.

The possibility of high-level instability raised troubling questions about the future of the secretive, nuclear-armed state that has been steadily building an arsenal meant to threaten the U.S. mainland while diplomacy between Kim and President Donald Trump has stalled.

Some experts say South Korea, as well as its regional neighbors and ally Washington, must begin preparing for the possible chaos that could come if Kim is sidelined by health problems or even dies. Worst-case scenarios include North Korean refugees flooding South Korea or China or military hard-liners letting loose nuclear weapons.

“The world is largely unprepared for instability in North Korea,” said Leif-Eric Easley, a professor at Ewha University in Seoul. “Washington, Seoul and Tokyo need tighter coordination on contingency plans while international organizations need more resources and less controversy over the role of China.”

South Korea’s Unification Ministry, which deals with inter-Korean affairs, confirmed Kim’s visit to the fertilizer factory and said it was part of his efforts to emphasize economic development. The ministry called for discretion on information related to North Korea, saying that the “groundless” rumors of past weeks have caused “unnecessary confusion and cost” for South Korea’s society and financial markets.

South Korea’s government, which has a mixed record of tracking Pyongyang’s ruling elite, repeatedly downplayed speculation that Kim, believed to be 36, was in poor health following surgery.

The office of President Moon Jae-in said it detected no unusual signs in North Korea or any emergency reaction by its ruling party, military and cabinet. Seoul said it believed Kim was still managing state affairs but staying at an unspecified location outside Pyongyang.

The KCNA said workers at the fertilizer factory broke into “thunderous cheers” for Kim, who it said is guiding the nation in a struggle to build a self-reliant economy in the face of “head wind” by “hostile forces.”

The report didn’t mention any direct comment toward Washington or Seoul.

Speaking to reporters at the White House, Trump declined to comment about Kim’s reappearance but said he would “have something to say about it at the appropriate time.”

State media reported Kim was carrying out routine activities outside public view, such as sending greetings to the leaders of Syria, Cuba and South Africa and expressing gratitude to workers building tourist facilities in the coastal town of Wonsan, where some speculated he was staying.

It wasn’t immediately clear what caused Kim’s absence in past weeks. In 2014, Kim vanished from the public eye for nearly six weeks and then reappeared with a cane. South Korea’s spy agency said he had a cyst removed from his ankle.

Analysts say his health could become an increasing factor in years ahead: he’s overweight, smokes and drinks, and has a family history of heart issues.

If he’s suddenly unable to rule, some analysts said his sister would be installed as leader to continue Pyongyang’s heredity dynasty that began after World War II.

But others question whether core members of North Korea’s elite, mostly men in their 60s or 70s, would find it hard to accept a young and untested female leader who lacks military credentials. Some predict a collective leadership or violent power struggles.

Following an unusually provocative run in missile and nuclear tests in 2017, Kim used the Winter Olympics in South Korea to initiate negotiations with Washington and Seoul in 2018. That led to a surprising series of summits, including three between Kim and Trump.

But negotiations have faltered in past months over disagreements in exchanging sanctions relief and disarmament steps, which raised doubts about whether Kim would ever fully deal away an arsenal he likely sees as his strongest guarantee of survival.

Kim entered 2020 vowing to build up his nuclear stockpile and defeat sanctions through economic “self-reliance.” Some experts say the North’s self-imposed lockdown amid the coronavirus crisis could potentially hamper his ability to mobilize people for labor.



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COVID-19: Praise for pandemic health pros prompts patio dance party


Article content

Each night at 7 p.m., Vancouverites collectively stand on their balconies, patios and yards to bang pots, pans and other cookware, as a way of applauding essential workers across the city who continue to step up in the face of COVID-19.

A few minutes after that is when the party gets started – that is, the Mount Pleasant patio dance party.

Harry Curtin, 28, is a teacher and has been working remotely from his condo near Main and 7th since health officials ordered schools and workplaces closed to curb the spread of the virus.

He and two roommates had been regularly participating in the nightly 7 p.m. cheer when, on a sunny Tuesday in early April, the trio decided to play some music over a speaker when the clanging and banging subsided.

“It just seemed like – we could all clearly see each other but we just kind of walked back into our apartment,” Curtin said of his neighbourhood, which consists of condominiums clustered around a Main Street intersection.



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Person under 18 dies of coronavirus in Los Angeles, health experts report



Los Angeles County on Tuesday confirmed four more deaths linked to the coronavirus, including the first of a person under the age of 18.

The number of deaths in the county from the virus is now 11. Tuesday’s update also included a previously reported death in Long Beach. The young person who died was from Lancaster. No further details were immediately available.

“This is a devastating reminder that COVID-19 affects people of all ages,” L.A. County Public Health Department director Barbara Ferrer said.

Two of the people who died were between the ages of 50 and 70. One had underlying health issues and resided in the West Adams neighborhood, health officials said.

Officials also confirmed an additional 128 cases of coronavirus infections, bringing the county’s total to 662. Of those positive cases, 42% occurred in individuals between the ages of 18 and 40, and 39% were in people ages 41 to 65.

At least 119 residents, or 18% of all positive cases in the county, have been hospitalized for the virus.

In Orange County, officials announced 27 new coronavirus cases, bringing the total to 152. There have not been any deaths linked to COVID-19.

San Mateo County saw a jump of 19 new cases and its second fatality, pushing the county’s overall total to 161 positive tests. The number of cases increased by more than 10% in one day, according to Preston Merchant, a public information officer working in the county’s joint information center.

The county’s second death occurred Monday at the Atria Senior Living facility in Burlingame. The facility received news of confirmed COVID-19 cases in their community on March 15. A number of residents tested positive for the virus, and Monday’s fatality was the senior facility’s first coronavirus-related death at its Burlingame location.

“Our thoughts are with their family during this difficult time,” Atria said in a statement. “We remain in close communication with all our residents and their families and continue to provide our support as we navigate this unprecedented situation together.”

Atria said it is working closely with the San Mateo County Health Department, and officials have been on site to confirm proper health and safety measures are in place.

The number of coronavirus cases in California surged to nearly 2,500 Tuesday afternoon and the death toll climbed to 50 as officials issued urgent warnings about the need for more hospital beds and equipment as medical facilities begin to fill up.

Gov. Gavin Newsom says he believes California will need 50,000 hospital beds for patients suffering from the illness caused by the coronavirus. That marks a significant increase from the 20,000 beds his administration forecast last week. The Democratic governor said the state’s 416 hospitals were doubling their “surge plans,” a move that will result in 30,000 new beds across the system.

San Francisco officials warned that a surge in coronavirus infections was expected to come within a week or two, and voiced dismay over images of the public crowding beaches and parks across California.

“The worst is yet to come,” said Dr. Grant Colfax, San Francisco’s director of public health, at a news conference Monday.

San Francisco has already taken steps to decompress the healthcare system — banning almost all visitors to hospitals and long-term-care facilities, canceling elective surgeries and routine medical visits, ordering that appointments be done by phone or video if possible, and opening up tents to care for patients who have mild symptoms in order to keep hospital beds free for those more seriously ill.

A steep rise in people being hospitalized with COVID-19 in Los Angeles County likely signals the approach of a wave of extremely sick patients that could overwhelm hospitals in the coming weeks, experts say.

As of March 6, five people in the county had been hospitalized at some point with COVID-19. Two weeks later, on Friday, that figure had jumped to 48. By Monday, the total had climbed to 90.

Though the raw numbers remain relatively low, the rate of increase has set many doctors and nurses on edge after watching the disease’s alarming trajectory in China, Italy and, most recently, New York City.

Two Cal State Long Beach students tested positive for the virus and were in self-isolation off campus, the university announced in an email to students Tuesday morning.

One student had not been on campus for two weeks, the university said. In the second case, public health officials determined there was no opportunity for on-campus exposure. Students who might have come into close contact with the patients were being notified by health officials, according to the email.

As the number of cases continues to rise, officials throughout the state kept up their call for an increase in testing capacity and reporting.

Frustrated public health directors in six Bay Area counties have ordered an assortment of commercial, university and pop-up testing sites that are screening residents for COVID-19 to begin reporting not just the positive cases, but the negative results too.

Dr. Sara Cody said testing remains woefully inadequate as Santa Clara County wrestles with mounting deaths. As of Tuesday, 16 people had died in the county, more than half of the virus fatalities in California.

Santa Clara County’s Sheriff’s Office confirmed four cases among staff, including a deputy who is self-isolating at home.

California requires labs and hospitals to report known cases of COVID-19, but not the number of negative tests. Cody said that information is critical to tracking the spread of the virus. She warned that Santa Clara County’s current critical situation is a window into what will be seen in San Francisco and other Bay Area communities in the next one to two weeks.

Contra Costa County is one of the six counties that ordered new requirements. On Friday, health officer Chris Farnitano said the county would issue an order for negative tests to be reported as well.

Meanwhile, California remains largely shut down under state and local orders. L.A. County officials have cracked down on nonessential businesses, which Sheriff Alex Villanueva declared Tuesday includes gun stores. If gun sellers don’t close their doors, he said, they will be cited and face penalty, including the loss of their business licenses.

Officials previously closed beach parking lots, parks and hiking trials amid concerns some people were not staying at least six feet apart while in public. Laguna Beach took the restrictions a step further and closed its beaches entirely on Monday.

On Tuesday, Los Angeles City Councilman David Ryu called for the closure of Runyon Canyon Park and Lake Hollywood Park on weekends.

“Making this request pains me greatly. I grew up in a two-bedroom apartment off the 101 Freeway, and our city’s parks were my only access to outdoor space,” Ryu said of his recommendation to Michael Shull, the general manager of the city’s Department of Recreation and Parks. “I don’t make this recommendation easily, but closing Runyon Canyon Park on weekends, when we have seen the highest volume of visitors, should follow to keep everyone safe.”

In Sonoma County, all parks and open spaces were closed indefinitely, public health officials announced this week.

The closure includes city, county, state and federal parklands and recreational lands operated by private groups and nonprofits, according to a news release.

“Closing parks is a difficult decision, but it is the right decision at this time,” Sundari Mase, the county’s interim health officer, said in a statement. “Allowing crowded conditions in parks is not in our best interest during this health crisis. The best action we can take is to stay close to home and limit our outdoor time to our yards and neighborhoods.”

Mase announced the closure Monday after too many visitors flocked to outdoor spaces over the weekend.

Criminal and civil trials were discontinued in California for at least two months after a sweeping order was issued late Monday by the state’s chief justice that aimed to sharply reduce public traffic in state courthouses.

Chief Justice Tani G. Cantil-Sakauye said in her order that court facilities were “ill-equipped to effectively allow the social distancing and other public health requirements” that had been imposed across California to prevent the spread of the novel coronavirus.

“Even if court facilities could allow for sufficient social distancing, the closure of schools means that many court employees, litigants, witnesses, and potential jurors cannot leave their homes to attend court proceedings because they must stay home to supervise their children,” Cantil-Sakauye said in the order.

The 60-day delay — which puts the courts in California’s 58 counties on a uniform trial delay schedule — came the same day that the presiding judge of Los Angeles County Superior Court, Kevin C. Brazile, blocked public access to county courthouses except for attorneys, staff, defendants and “authorized persons,” a vague category that includes news reporters. The clerk’s office will still be available to accept filings and assist people by phone or electronically.

The California National Guard on Monday provided details about how personnel would be deployed across the state to assist in coronavirus aid. Officials said the guard was being used purely for humanitarian purposes, such as distributing food and medical supplies as well as helping at food banks and working with officials on the Grand Princess cruise ship, which docked in California after an outbreak of the virus on board.

With the coronavirus pandemic further stifling the efforts of California and other states to issue Real ID licenses, President Trump on Monday said he would extend the Oct. 1 deadline for people to apply for the identification cards to board domestic flights in the United States.

Times staff writers Priscella Vega, Paige St. John and Luke Money contributed to this report.





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900,000 Public Health Workers Going Door To Door Without Masks Or Hand Sanitizer



Dibyangshu Sarkar / Getty Images

Local residents make homemade facemasks in Kolkata, March 20.

The journalists at BuzzFeed News are proud to bring you trustworthy and relevant reporting about the coronavirus. To help keep this news free, become a member and sign up for our newsletter, Outbreak Today.


NEW DELHI — Every morning for the past week N.K., a 35-year-old community health activist, has received a WhatsApp message from her supervisor with the names of the latest group of travelers returning to India from countries affected by the coronavirus. Once she has the list of names, N.K. tracks down their addresses. By noon, she’s at someone’s doorstep, armed with a list of do’s and don’ts for people suspected of carrying the virus.

Over the phone, she reeled off the list of instructions she gave people: “Wash your hands, clean your living spaces. Avoid: crowds, religious gatherings, weddings, elderly people and eating food from outside. If you have a cough, cough into a mask. If you have fever or any other symptoms, call me. Even if you don’t, I’ll be here.”


Sam Panthaky / Getty Images

A volunteer distributes masks in Ahmedabad, March 20.

Women like N.K. are known as ASHAs — an acronym for Accredited Social Health Activists, which also spells the Hindi word for “hope” — and have been deployed as India’s first line of defense to track down “imported cases” of the coronavirus. These are Indian travelers who might be bringing the virus home from China, Europe or the Gulf countries, where a large section of Indians work as migrant labour. According to the latest Indian health ministry advisory, India currently only has “imported cases” of the novel coronavirus and no recorded cases of community transmission — which makes the ASHAs’ work of monitoring travelers and their families even more crucial.

India has so far appears to have escaped the worst of the coronavirus pandemic, with 194 cases and four deaths, and has been praised by the World Health Organization for its response so far. But while the government has launched an aggressive airport screening program, it is not carrying out widespread testing, and Indians returning from Europe have raised concerns about the quarantine centers they were held in.


Peter Aldhous / BuzzFeed News

Total cases and deaths by country

Several Indian state governments, such as in Punjab, Karnataka, Andhra Pradesh, Kerala, and Maharashtra, have deployed community health workers to do the work N.K. is doing — track down returnees, monitor them and their families for 14 days to check whether they develop any symptoms of the coronavirus, and go door to door teaching people how to practice social isolation, and to protect themselves.

It’s crucial but dangerous work. In Italy, where coronavirus has killed more people than in any other country in the world, one in 12 people infected by the virus so far have been health workers. In the US, the CDC recommends that public health professionals who do the work that the ASHAs are doing in India, conduct interviews over the phone or on video chat. In the event that they are checking for symptoms in person, health workers should wear full personal protective equipment (PPE) before entering homes of possible patients. Recommended PPE includes a gown, gloves, face shield, goggles and a respirator mask like the N-95.

Do you have questions you want answered? You can always get in touch. And if you’re someone who is seeing the impact of this firsthand, we’d also love to hear from you (you can reach out to us via one of our tip line channels).

But BuzzFeed News spoke to ASHAs in four different states — Punjab, Haryana, Karnataka, and Andhra Pradesh — who said they had not even been given masks or hand sanitizer while conducting house calls to potential coronavirus carriers. Several had spent their own money to buy masks and sanitizers, others were making them at home. None of them were able to follow the WHO or Indian health ministry’s guidelines on masks: to wear a new one every six hours, and get rid of used masks by burning or deep burial. An ASHA from Haryana told BuzzFeed News that her state government had organized a training program to teach community health workers about precautions to take while conducting surveys of coronavirus patients, but the training was canceled due to fears of the organizers contracting COVID-19, the disease caused by the coronavirus.

Most women refused to speak on the record fearing professional retaliation from their supervisors, N.K. agreed on the condition that she was identified only by her initials.


Nishita Jha

ASHAs from Uttar Pradesh pictured in 2016.

On Thursday evening, Indian Prime Minister Narendra Modi finally addressed the nation about the growing threat the coronavirus posed. He urged citizens to dismiss the idea that the virus could not affect them and to follow guidelines on social distancing. While he did not go into the details of how the government was responding to the coronavirus, he encouraged people to stand at their doorways or balconies at 5 p.m. on Sunday to clap, ring bells, or clank cooking utensils, so everyone could express their gratitude and appreciation for public health workers.

It’s unclear however how the sound of cooking pans being whacked with metal spoons will help the ASHAs, who form the backbone of India’s public health care system.

State governments have routinely failed to take the safety of ASHA workers into account. Even before the pandemic, ASHAs across the country have gone on strike for being severely underpaid (approximately $80 per month), having no worker rights (they are considered “honorary volunteers” instead of government employees), and frequently finding themselves on the frontlines of both disease and violence and burdened with extra hours of labor each time state governments want a survey carried out.


Uma Shankar Mishra / Getty Images

A man wearing a face mask watches Prime Minister Narendra Modi’s address to the nation, March 19.

There is almost no clear state-wise data on the number of COVID-19 cases in India, only aggregated press releases sent out twice a day. The health ministry is slow to update information received about positive cases, and there is a complete information vacuum on several people who have no travel history to foreign countries but have still contracted the virus — the Indian government is still not testing for community transmission. In this environment, ASHAs are in danger of contracting the disease and spreading it further.

Susana Barria, who works for the global union federation, Public Services International, said that community health workers across the world, who are almost always women, are told that the work they do qualifies as “care or volunteer work,” not a proper job. This is why they rarely get the benefits of employment, like protection against disease, maternity leave, paid sick leave, all of which will be especially crucial now.

“It’s never been clearer that public healthcare needs community health workers,” Barria said. “The skills and the capacity these women have, the way in which they are familiar with each community’s members — the sick, the elderly, the children — the ASHAs are the most likely to know when someone is displaying symptoms of coronavirus, has been traveling abroad or is missing from the home. Without them, doctors will be operating blind,” Barria said.


Getty Images

A woman wearing a protective mask walks in a market in New Delhi, March 19.

But there are other systemic challenges to ASHA workers that the unions and governments must resolve together — it’s not as easy as just handing out an endless supply of masks

“A big concern is that if ASHA workers show up at people’s homes wearing masks, it might create panic in the community,” Barria said. “On the other hand, if they contract the disease and fall ill, there is no guarantee from state governments that they will receive paid leave, whether they will be tested and treated free of cost, if they will be quarantined, whether they will still be able to work, if the governments will help their older family members who might get the virus from them,” (ASHAs are usually between 25-45.)

What it all comes down to, said Barria, is whether the government will finally recognize community health workers as actual workers and not “honorary volunteers.”

“The state governments love to describe the ASHAs as ‘volunteers’ and encourage them to get other paying jobs — but who can work another job with a 12-hour shift of going door to door, monitoring people’s health? It’s hard, back-breaking work which has only increased with their new coronavirus-related duties,” she said.

Repeated calls and emails from BuzzFeed News to ASHA supervisors in Punjab, Karnataka, and Andhra Pradesh to inquire about the status and safety of community health workers went unanswered. One supervisor in Punjab hung up after saying: “Is your story about the women’s rights or coronavirus? It can’t be about both.”


Stringer / Getty Images

A man uses hand sanitizer after leaving a metro station in New Delhi, March 16.

Punjab is one of several Indian states that is afraid of coronavirus casualties growing as migrant laborers return home, particularly from the Gulf countries, where thousands of Indians go to earn a living and send money back home. Despite this, Punjab has tested only 110 people for the coronavirus so far, while at least another 335 people who returned home after traveling abroad are still untraceable.

“I’m doing the same thing I always do — spending my own money and time for this,” N.K. told BuzzFeed News, adding that she has followed similar protocols going door-to-door in the past, including when she made visits to check on tuberculosis and SARS patients. “I buy a fresh mask whenever the chemist gets a supply, otherwise I use my dupatta,” she said, referring to a type of scarf. “I have a bath as soon as I get back and wash my hands as often as I can.”

Even as the pandemic panic began and Modi endorsed appeals to work from home, N.K. has continued to work her 12-hour shifts, which now include making daily house calls to eight different homes where she said people have returned from coronavirus-affected countries. She said she has been instructed by her supervisors to visit their homes every day for two weeks, in order to monitor their symptoms.

In addition to visiting potential coronavirus carriers, N.K. and other ASHA workers are also performing their usual duties: assisting in deliveries, teaching young mothers how to care for newborns, helping the elderly and administering basic first aid. Usually, an ASHA looks after 1,000 to 2,500 families in a district.

“Most people believe that the coronavirus will go away if they drink warm fluids and get enough rest,” N.K. said. “Others believe they have stronger immunity than people in the West. The big fear is that they will be locked up if they show symptoms — I’ve seen family members hide sons who used to work as laborers abroad until last month. They are afraid that once their sons are locked away for a sneeze or a cough, there will be no one left to earn for the family.”●



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Anxious about the coronavirus? Here are 5 tips from mental health experts


TORONTO —
Between the worrisome headlines and the drastic measures meant to limit the spread of COVID-19, the virus can be an added stressor for anyone.

Mark Henick, a mental health advocate and public speaker, said major public health events can be especially troublesome for someone with mental illnesses such as anxiety, depression or obsessive compulsive disorder.

“The problem when you have a mental illness like anxiety is that it interferes with their life, that you overcompensate in many ways, so they might be self-isolating, which is not good for your mental health at all,” he said in a recent phone interview with CTVNews.ca.

There have been 153 cases of COVID-19 in Canada, primarily in Ontario and British Columbia. One person has died thus far.

Keith Dobson, a researcher with the Mental Health Commission of Canada and a professor at the University of Calgary, said the COVID-19 outbreak has shown itself to be particularly anxiety inducing because of its unpredictability, uncontrollability and salience.

“This condition is a triple threat from a psychological perspective,” he said. “It’s not surprising there’s a lot of anxiety and lots of perceived threat.”

There are, however, several strategies that can be effective to help cope with the stresses associated with an outbreak, regardless of whether you have a mental illness.

UNDERSTAND THIS WILL PASS

While the situation might seem increasingly dire, Henick said it’s important to understand the outbreak will inevitably pass and there are some already simple ways to mitigate your risk, such as washing your hands and avoiding close contact.

“If people are dwelling on this, if it’s making them extremely anxious and that anxiety is impacting their health, I think it’s an important reminder that they’re probably going to be fine,” he said.

“Like all challenging public health events, we will get through this and we’ll learn from it.”

UNDERTAND EVERYONE’S BEING AFFECTED

With so much flux, someone with a mental illness might find it hard to deal with changes to their routine, but Mark Ferdinand, co-chair of the Canadian Alliance on Mental Illness and Mental Health, suggests it’s important for the people to understand that everyone is dealing with these same challenges.

“It’s important for people to know that this unprecedented situation that we’re experiencing right now with regards to how COVID-19 is affecting everyone in terms of what their daily lives are looking like,” he said.

When it comes to anxiety, Dobson argued those with an anxiety disorder might even be better off than the general public.

“Putting this on top of other issues in some ways might even be less severe than people with lower levels of anxiety, because the relative difference isn’t so much,” he said. “I actually think that for people with anxiety, it may not be too bad.”

AVOID SELF-ISOLATING IF NOT SICK

Henick suggests the biggest issue people with a mental illness might face during a pandemic is they might self-isolate out of fear, which can be particularly troublesome.

“It’s important to maintain contact with people in whatever way makes sense to do that, whether it’s online, by phone or by other means,” Henick said.

Henick added that mass cancellations of social gatherings such as concerts, sporting events and religious gatherings can only add to this feeling of isolation among people with mental health issues.

“While those are smart preventative measures from a public health perspective, it limits the opportunity for people who are already isolated to reach out and connect with others,” he said.

Family and friends of someone with a mental illness also play a part in making sure they don’t feel alone. Henick said something as simple as phone call can go a long way toward helping someone.

“One of the great parts of living in such a highly connected world now is that we have many ways of connecting with people and I think that we need to make the effort to do that,” he said.

FOLLOW THE NEWS IN MODERATION

As COVID-19 dominates the international headlines, the concerning news can lead to increased anxiety among some people, while others might fixate on the latest developments.

“Something that people do when they’re anxious, especially in times like this, is to overconsume media about it,” Henick said. “That’s just the way our brain works. We’re looking for answers, we’re looking for reassurance.”

Henick suggests it’s important for people to keep abreast about what’s going on in the world, but to do so responsibly.

Dobson agreed that it might be a good idea to stay away from the headlines, though it might not be entirely possible.

“This is a public health concern,” he said. “It’s appropriate, I think, that everybody has some degree of appropriate anxiety here about the issues.”

FIND A ‘COPING STRATEGY’

Ferdinand suggests “coping strategies” can be effective when it comes to keeping someone’s mind off a stressful and potentially problematic situation.

These activities can include anything that makes the person happy, such as reading, listening to music, chatting with a friend or playing an instrument.

“I think the idea is to find the coping strategy that either works for you, that makes you happy or to keep the connection alive with someone that you like talking to,” he said.



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