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Tag: respiratory diseases

  • Why is Britain’s health service, a much-loved national treasure, falling apart? | CNN

    Why is Britain’s health service, a much-loved national treasure, falling apart? | CNN


    London
    CNN
     — 

    Most winters, headlines warn that Britain’s National Health Service (NHS) is at “breaking point.” The alarms sound over and over and over again. But the current crisis has set warning bells ringing louder than before.

    “This time feels different,” said Peter Neville, a doctor who has worked in the NHS since 1989. “It’s never been as bad as this.”

    Scenes that would until recently have been unthinkable have now become commonplace. Hospitals are running well over capacity. Many patients don’t get treated in wards, but in the back of ambulances or in corridors, waiting rooms and cupboards – or not at all. “It’s like a war zone,” an NHS worker at a hospital in Liverpool told CNN.

    These stories are borne out by the data. In December, 54,000 people in England had to wait more than 12 hours for an emergency admission. The figure was virtually zero before the pandemic, according to data from NHS England. The average wait time for an ambulance to attend a “category 2” condition – like a stroke or heart attack – exceeded 90 minutes. The target is 18 minutes. There were 1,474 (20%) more excess deaths in the week ending December 30 than the 5-year average.

    Ambulance staff and nurses have staged a series of strikes over pay and working conditions, with the latest walkout by ambulance workers happening Monday. More are planned for the coming weeks. The chief executive of the NHS Confederation, which represents NHS organizations in England, wrote to the government on the eve of an ambulance strike last month to warn of NHS leaders’ concerns that they “cannot guarantee patient safety” that day. In response, a government health minister advised the public to avoid “risky activity.”

    While the NHS has suffered crises before, this winter has brought a new reality: In Britain, people can no longer rely on getting healthcare in an emergency.

    Founded shortly after World War II, the NHS is treated with an almost religious reverence by many. Britons danced for it during the 2012 London Olympics and clapped for it during the pandemic. “Our NHS” is a source of national pride.

    Now, it is coming unstuck. There has long been an implicit contract between British people and the state: Pay taxes and National Insurance contributions in return for a health service that is free at the point of use.

    But, with the tax burden on track to reach its highest sustained level since the NHS was founded, Britons are paying more and more for a service they increasingly cannot access as quickly as they need.

    Some of these strains can be seen elsewhere in Europe. Doctors in both France and Spain have held strikes in recent weeks, as many countries face the same problems of providing care to an increasingly aging population – when inflation is at its highest level in decades.

    Yet there are fears that the NHS is in worse shape than its international peers, and CNN spoke with experts who said they fear they’re witnessing the “collapse” of the service.

    So how did Britain get here?

    When Covid-19 hit, the NHS went into full crisis-fighting mode, diverting staff and resources from across the organization to care for patients with the disease.

    But, for many in the NHS, Covid-19 remains a crisis from which they are yet to emerge.

    During the height of the pandemic, many ordinary practices were put on hold. Millions of operations were canceled. The NHS “backlog” has ballooned. Data from November showed there were more than 7 million people on a hospital waiting list in England.

    This winter, a “twindemic” of Covid and flu continues to put additional strain on capacity.

    Many feel that Covid is a crisis from which the NHS has not yet emerged.

    Explanations for the current crisis “have to start with a consideration of Covid-19,” Ben Zaranko, an economist at the Institute for Fiscal Studies (IFS) whose work focuses on Britain’s health care system, told CNN. “There’s the simple fact that there are beds in hospitals occupied by Covid patients, which means those beds can’t be used for other things.”

    Covid also created a strain on the amount of work the NHS can do. “If you add up all the time that staff spend doing infection control measures, donning protective equipment and separating out wards into people with and without Covid … that might impede the overall productivity of the system,” Zaranko said. Rates of NHS staff sickness are also considerably higher than they were pre-pandemic, according to IFS analysis.

    But, again, Britain was not alone in battling the pandemic, yet it appears to have suffered a worse hit than comparable nations.

    This is despite there being more doctors and nurses in the NHS now than there were before Covid. According to an IFS report, even after adjusting for staff sickness absences, there are 9% more consultants, 15% more junior doctors and 8% more nurses than in 2019.

    Yet the NHS is treating fewer patients than before the pandemic.

    “It seems to be that bits of the system aren’t fitting together anymore,” Zaranko said. “It’s not just about how much staff there are and how much money there is. It’s how it’s being used.”

    Even with the increase in funding since the pandemic, the UK is still playing catchup, after what critics say is more than a decade of underfunding the NHS.

    Neville, a consultant in a hospital, judges 2008 the “best” he has seen the NHS in more than 30 years of working in it. By that time, the NHS had enjoyed nearly a decade of hugely increased investment. Waiting lists fell substantially. Some even complained about getting doctor appointments too quickly.

    “When the Labour government came in in 1997, they injected considerably more money into the NHS. It enabled us to appoint an adequate number of staff and get on top of our waiting lists,” Neville told CNN.

    But this level of investment did not last. In response to the 2007-2008 financial crisis, the Conservatives elected in the coalition government in 2010 embarked on a program of austerity. Budgets were cut and staff salaries frozen. For Neville, the ensuing decade saw a gradual “erosion” of the system: “Slow, subtle, but nonetheless happening.”

    Health Secretary Steve Barclay on a visit to King's College University Hospital in London.

    According to analysis by health charity the Health Foundation, average day-to-day health spending in the UK between 2010 and 2019 was £3,005 ($3,715) per person per year – 18% below the EU14 [countries that joined the EU before 2004] average of £3,655 ($4,518).

    During this period, capital expenditure – the amount spent on buildings and equipment – was especially low, according to the Health Foundation analysis. The UK has far fewer MRI and CT scanners per person than the Organisation for Economic Co-operation and Development (OECD) average, meaning staff often have to wait for equipment to become available.

    Hospital beds are particularly scarce. Over the past 30 years the number of beds in England has more than halved, from around 299,000 in 1987 to 141,000 in 2019, according to analysis by the King’s Fund, an independent think tank.

    Siva Anandiciva, chief analyst at the King’s Fund, told CNN this decrease was partly attributable to the “changing model of care.” As technology and treatments improved, people spent less time in hospital, reducing the need for beds. The last Labour government, in power from 1997 to 2010, also cut bed numbers, despite increasing investment elsewhere.

    “You can keep reducing how long patients stay in hospital,” said Anandaciva, but eventually “you approach a minimum. If you then keep cutting bed numbers … that’s when you start to get into problems like performance.”

    During the austerity years, bed numbers continued to be cut, leaving the UK with fewer beds per capita than almost any developed nation, according to OECD data.

    “For a long time we knew we just didn’t have the bed capacity,” Anandaciva said. But cuts continued in the name of “efficiency,” he added.

    While low bed numbers were seen as a marker of “success” indicating that the NHS was running efficiently, it left the UK woefully underprepared for a shock like Covid-19. The same factors that made the NHS “efficient” in one context made it grossly inefficient when that context changed, in his analysis.

    The bed shortage has been made even more acute by the fact that many of those in hospital no longer need to be there – there is simply nowhere else for them to go.

    “The longest I had a patient that was physically and medically ready to go home, but was sitting around waiting for discharge, was four weeks,” said Angus Livingstone, a doctor working in the John Radcliffe Hospital in Oxford.

    The problem is caused by a crisis in another sector: Social care. Patients that could leave the hospital end up staying there because they cannot access more modest care in a home setting and so cannot be safely discharged.

    Many patients are well enough to leave hospital, but cannot be looked after elsewhere.

    Health and social care are separate sectors in the UK system. Healthcare is provided by the NHS, whereas social care is provided by local councils. Unlike the NHS, social care is not free at the point of use: It is rationed and means-tested.

    There have long been calls to integrate the two systems, since a crisis in one system feeds through into the other.

    “If you allow us to regain the enormous number of beds that are currently occupied by people awaiting social care, then I would be very confident that the immediate snarl-up in A&E and ambulances waiting outside would pretty much disappear overnight,” Neville said.

    “When people ask me, ‘where do you want the money in the NHS?’ My answer is ‘I don’t want it in the NHS. I want it in social care.’”

    With an increasingly aging population – the latest census data show nearly 19% of the population of England and Wales is now 65 or older – demand for social care is increasing. But the sector is struggling to provide it in the face of staffing shortages, rising costs and funding pressures.

    Care work can be grueling and underpaid. Most supermarkets offer a better hourly wage, analysis from the King’s Fund found. So, it is perhaps unsurprising that the sector reported 165,000 vacancies in August.

    The NHS is also reporting an alarming number of vacancies, with about 133,000 open positions as of September.

    This points to a deeper crisis: Morale.

    Jatinder Hayre, a doctor completing the foundation program at a hospital in East London, told CNN that morale is “at an all time low.” Staff are “stressed, fatigued, tired,” he said. “There doesn’t seem to be an end to this.”

    “When you walk into the hospital in the morning, you’re met with this cacophony of grief and dismay and dissatisfaction from patients, who are lined up in the corridor,” Hayre said.

    “You feel awful, but there’s nothing you can do. You’re fighting against a system that’s collapsing.”

    Hayre said that most days there are “around 40 to 50 patients lined up in the corridors” as there is no space left in the wards. “It’s not appropriate. It’s not a safe or dignified environment.”

    Unable to deliver an acceptable standard of care, many staff are demoralized – and considering their options. At Hayre’s hospital, “the day-to-day workplace talk is, ‘are we going to leave?’”

    Britain is braced for another wave of strikes over low pay and working conditions.

    A junior doctor at a hospital in Manchester, who wished to remain anonymous, told CNN that she had made the decision to join the growing number of NHS doctors who are moving abroad. She plans to move abroad in the summer, to work in a country that offers doctors better pay and working conditions.

    Of the eight doctors she lived with at university, six have already left. “They’ve all gone to Australia. They love it,” she said. Only one is planning to stay in the UK.

    Medical students are watching in alarm as their future workplace deteriorates.

    “For everyone I know, it’s almost a given that at some point they’re going to go to Australia or New Zealand,” said Eilidh Garrett, who studies medicine at Newcastle University. She is considering taking exams to work as a doctor in Canada.

    This is a hugely painful decision for many young doctors. “I think about my closest friends. If I go to another country and treat other people’s closest friends, while my friends struggle to see a doctor in the UK – that is really heartbreaking,” Garrett told CNN.

    A growing number of doctors are considering leaving the NHS to work abroad.

    Meanwhile, Britain’s vote to leave the European Union in 2016 has likely not helped the situation. Research by the Nuffield Trust health think tank, published in November, finds that long-standing staff shortages in nursing and social care “have been exacerbated by Brexit.”

    The picture is “more complex” for doctors working in the NHS, the researchers found. While overall “EU numbers have remained relatively stable,” the report says, the data suggest a slowdown in the registration of specialists from the EU and European Free Trade Association countries since Brexit, particularly in certain specialties such as anesthetics.

    The concern is that these issues get worse the longer they go untreated.

    When patients finally get seen, their treatments take more time, forcing those after them to wait even longer as they get sicker.

    “In terms of the system performance, it feels like we’re past the tipping point,” Zaranko said. “The NHS has been gradually deteriorating in its performance for some time. But we’ve gone off a cliff in recent months.”

    It is unclear how the NHS regains its footing. Some compare this crisis to a period in the 1990s when services were rapidly deteriorating. The NHS was in bad shape, but restored its levels of service after a decade of historically high investment while Labour was in power.

    Injections of cash on this scale are unlikely to be replicated. The most recent budget announced by the government in November will see NHS England spending rise by only 2% in real terms on average over the next two years.

    “We recognize the pressures the NHS is facing so announced up to £250 million [$309 million] of additional funding to immediately help reduce hospital bed occupancy, alleviate pressures on A&E and unlock much-needed ambulance handovers,” a spokesperson from the Department of Health and Social Care told CNN in a statement.

    “This is on top of the £500 million [$618 million] Discharge Fund to speed up the safe discharge of patients and rolling out virtual wards to free up hospital beds and cut waiting cuts,” the statement continued.

    Pay negotiations between the government and nursing unions have so far been unsuccessful. British media outlets have reported that Prime Minister Rishi Sunak may be considering offering a one-off hardship payment of £1,000 ($1,236) to attempt to resolve the dispute, but many feel this underestimates the true nature of the crisis.

    “All I hear about is sticking plasters,” Neville said. “It depresses us all.”

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  • Who is Jeff Zients? | CNN Politics

    Who is Jeff Zients? | CNN Politics



    CNN
     — 

    President Joe Biden is expected to tap Jeff Zients, ​​who ran the administration’s Covid-19 response effort and served in high-ranking roles in the Obama administration, to succeed Ron Klain as the next White House chief of staff.

    Biden decided on Zients after an internal search when it became clear that Klain, who is expected to resign in the coming weeks, favored Zients as his successor, a factor that played a big role in the president’s decision. Klain had tapped Zients to lead a talent search for expected staff turnover following the midterm elections, but that didn’t ultimately materialize after Democrats performed better than expected.

    In replacing Klain with Zients, Biden is turning to a consultant with more business experience than political background as he enters the third year of his presidency.

    The decision to pick Zients surprised some internally given that there were differences in Biden’s and Zients’ management styles early on in the administration. But Biden was impressed with his job as the coronavirus response coordinator when Zients inherited what officials described as a “largely dysfunctional” effort by the Trump administration.

    Another factor in the search was how this stretch of Biden’s presidency will focus on implementing the legislation enacted in his first two years, and Zients is seen internally as a “master implementor,” one source said. His operational skills were on display as he handled the coronavirus response and helped with the bungled 2013 launch of HealthCare.gov during the Obama administration.

    Zients, 56, now has a closer relationship with Biden and with his senior advisers and multiple Cabinet members.

    While Zients is not viewed as a political operator, his deep experience inside two administrations and his reputation for technocratic skill would likely serve as assets at a time when both are viewed as critical for what Biden faces in the year ahead.

    Zients (rhymes with “science”) first joined the Biden administration in December 2020 when the then-president-elect appointed him as his White House coronavirus czar. He was tasked at the time with containing the coronavirus pandemic, mass distributing an approved vaccine and rebuilding a battered economy as Biden took office.

    When he left that position over a year later, Biden praised Zients as “a man of service and an expert manager” and touted the progress the US had made in vaccinating Americans and beating back the pandemic under Zients’ watch.

    “I will miss his counsel and I’m grateful for his service,” Biden said.

    Earlier in his career, at the beginning of the Obama administration in 2009, Zients was the country’s first chief performance officer and was tasked with making the government run smarter and less costly. Those duties fell under his other title as deputy director of the Office of Management and Budget. He would later go on to become acting director of that office.

    Zients also served as the director of the National Economic Council and assistant to the president for economic policy under Obama.

    He is credited with reviving the Obamacare enrollment website, Healthcare.gov, which had been plagued with issues and crashed shortly after its launch in 2013. The website, an online marketplace for medical insurance, was a critical centerpiece to Obama’s landmark health care law. Zients was the fix-it man and provided advice to the US Department of Health and Human Services as it worked to resolve the problems.

    Zients has deep ties to the private sector. Before serving in government, he served as the chairman, chief executive officer and chief operating officer of the Advisory Board Company and chairman of the Corporate Executive Board, both Washington-area consulting firms. By the time he was 35, he had already landed a spot on Fortune’s list of the richest Americans under 40, ranking 25th with an estimated worth of $149 million after the Advisory Board went public.

    He also founded Portfolio Logic, an investment firm focused on health care and business services.

    After leaving the Obama administration, he served as the CEO of the holding company Cranemere and served a two-year stint on Facebook’s board of directors. Zients was also an investor in the popular Washington DC deli Call Your Mother and often brought bagels to the office once a week to share with White House staff.

    Zients divested his shares in Facebook and Call Your Mother before gaining coronavirus czar status in the White House. He was worth at least $89.3 million when his financial disclosures were made public in March 2021, the wealthiest member of Biden’s Cabinet appointments.

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  • Jeff Zients to replace Ron Klain as White House chief of staff | CNN Politics

    Jeff Zients to replace Ron Klain as White House chief of staff | CNN Politics



    CNN
     — 

    Jeff Zients, who ran President Joe Biden’s Covid-19 response effort and served in high-ranking roles in the Obama administration, is expected to replace Ron Klain as the next White House chief of staff, according to three people briefed on the matter.

    Klain is expected to step down in the coming weeks.

    The move to replace Klain is particularly important for Biden, who has entered a critical moment in his presidency and his political future. As he continues to weigh whether to seek reelection in 2024, the early stages of a special counsel investigation into his handling of classified documents has rattled Democrats and emboldened congressional Republicans, who now hold the House majority and have pledged their own probes.

    Biden decided on Zients after an internal search when it became clear that Klain favored Zients as his successor, a factor that played a big role in the president’s decision. Klain had tapped Zients to lead a talent search for expected staff turnover following the midterm elections, but that didn’t ultimately materialize after Democrats performed better than expected. Klain is now the most significant departure and is being replaced by the person he picked to help bring in new team members.

    A source said Klain will continue to be involved and remain close to the West Wing. Biden’s core political and legislative team – which includes Steve Ricchetti, Anita Dunn, Mike Donilon, Jen O’Malley Dillon, Bruce Reed and Louisa Terrell – will continue to advise him. Zients’ new role is being compared to when Jack Lew was Obama’s chief of staff and others, like David Plouffe, focused more on his political portfolio.

    Additional political talent is expected to join for the likely re-election campaign, CNN is told.

    In replacing Klain with Zients, Biden is turning to a consultant with more business experience than political background as he enters the third year of his presidency.

    The decision to pick Zients surprised some internally given that there were differences in Biden’s and Zients’ management styles early on in the administration. But Biden was impressed with his job as the coronavirus response coordinator when Zients inherited what officials described as a “largely dysfunctional” effort by the Trump administration.

    Another factor in the search was how this stretch of Biden’s presidency will focus on implementing the legislation enacted in his first two years, and Zients is seen internally as a “master implementor,” one source said. His operational skills were on display as his handled the coronavirus response and helped with the bungled 2013 launch of HealthCare.gov during the Obama administration.

    Zients now has a closer relationship with Biden and with his senior advisers and multiple Cabinet members.

    While Zients is not viewed as a political operator, his deep experience inside two administrations and his reputation for technocratic skill would likely serve as assets at a time when both are viewed as critical for what Biden faces in the year ahead. Still, he will be tasked with replacing an official who was a central force inside the administration – and someone with a rapport developed over decades with Biden himself.

    Klain, who had long planned to depart the White House after Biden’s first two years, has targeted the weeks after the February 7 State of the Union address for the end of his tenure.

    A number of top officials had been viewed as top candidates to succeed Klain, including Cabinet members and close Biden advisers such as Ricchetti, counselor to the president, and Dunn, the senior adviser with a wide-ranging strategy and communications portfolio.

    But while Zients isn’t among the tight-knit circle of long-tenured Biden advisers, he’s been deeply intertwined with the team since the 2020 campaign, when he served as co-chairman of Biden’s transition outfit.

    After the election Biden tapped Zients to lead the administration’s Covid-19 response effort as he entered office with the country facing dueling public health and economic crises. While Zients left that role last spring, he was once again brought into White House operations a few months later when Klain asked him to lead the planning for the expected turnover inside the administration that historically follows a president’s first midterm elections.

    Zients was tasked with conducting a wide and diverse search for prospective candidates outside the administration to fill Cabinet, deputy Cabinet and senior administration roles, officials said, in an effort that would be closely coordinated with White House counterparts.

    But even as wide-scale turnover has remained minimal for an administration that has taken pride in its stability in the first two years, now, the official leading the planning effort may soon shift into one of, if not the, most critical role set to open.

    The White House chief of staff is a grueling and all-consuming post in any administration, and Klain’s deep involvement across nearly every key element of process, policy and politics touching the West Wing only served to elevate that reality.

    A long-time Washington hand with ties Democratic administrations – and Biden – that cross several decades, Klain is departing at a moment that officials inside the West Wing have spent the last several months viewing as a high point.

    Biden entered 2023 on the heel of midterm elections that resulted in an expanded Senate majority for his Democratic Party and the defiance of widespread expectations of massive GOP victories in the House.

    The sweeping and far-reaching cornerstones of Biden’s legislative agenda have largely been signed into law, the result of a series of major bipartisan wins paired with the successful navigation of intraparty disputes to secure critical Democratic priorities.

    Biden has made clear to advisers that the successful implementation of those laws – which is now starting to kick into high gear across the administration – is one of their most critical priorities for the year ahead.

    But Zients will also inherit a West Wing now faced with a new House Republican majority that is girding for partisan warfare – and wide-scale investigations into the administration and Biden’s family.

    This story has been updated with additional information.

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  • Japan considers downgrading Covid-19 to same level as seasonal flu | CNN

    Japan considers downgrading Covid-19 to same level as seasonal flu | CNN


    Tokyo
    CNN
     — 

    Japan will consider downgrading Covid-19 to the same category as seasonal influenza this spring, Prime Minister Fumio Kishida announced Friday.

    Kishida said he had instructed Health Ministry officials to discuss the move and his administration would also review rules on face masks and other pandemic measures.

    “In order to further advance the efforts of ‘living with Corona’ and restore Japan to a state of normalcy, we will transition the various policies and measures to date in phases,” Kishida said.

    While daily Covid-19 cases in Japan have declined in recent weeks, the country still faces around 100,000 new infections a day.

    Covid-19 is categorized as a Class 2 disease, the same status as tuberculosis and avian influenza, according to Japan’s Health Ministry. Officials will now discuss reclassifying it to Class 5 – the lowest rank, which includes seasonal flu.

    Japan fully reopened its borders to overseas visitors last October after more than two years of pandemic restrictions, ending one of the world’s strictest border controls.

    Influenza – or the common flu – and Covid-19 are both contagious respiratory illnesses with simlar symptoms, but they are caused by different viruses and require testing to confirm a diagnosis, the United States’ Centers for Disease Control and Prevention (CDC) says on its website.

    According to the CDC, the risk of death or hospitalization from Covid-19 is greatly reduced for most people due to high levels of vaccination and population immunity from previous infections.

    However, the World Health Organization still lists the coronavirus outbreak as a pandemic, and reiterated in its latest update a recommendation for people to wear masks following recent exposure or close contact with Covid-19, and for “anyone in a crowded, enclosed, or poorly ventilated space” to do the same.

    WHO director-general Tedros Adhanom Ghebreyesus called on governments last week to continue sharing the sequencing data of the coronavirus, as it remained vital to detect and track the emergence and spread of new variants.

    “It’s understandable that countries cannot maintain the same levels of testing and sequencing they had during the Omicron peak. At the same time, the world cannot close its eyes and hope this virus will go away. It won’t,” he said.

    The news came as South Korea announced it will lift its mask mandate for most indoor areas, with exceptions for public transport and health facilities. The changes will take effect on January 30, South Korean Prime Minister Han Duck-soo said Friday.

    The measure will be lifted after the Lunar New Year holiday, when a large number of people are expected to travel, the Korea Disease Control and Prevention Agency (KDCA) said.

    New Covid-19 cases, severe cases and related deaths are all declining and the country’s medical response capacity remains stable, KDCA added.

    The agency has strongly recommended people wear masks if they have Covid-19 related symptoms, belong to a high-risk group, have been in contact recently with a positive case, or are in a crowded space.

    Masks will still be required on public transport and in health facilities after South Korea eases its indoor mask mandate on January 30, 2023.

    The prime minister said the easing of the mandate could result in a temporary surge of new cases and urged health authorities to stay vigilant.

    South Korea has scrapped most of its pandemic restrictions and eased its outdoor mask mandate in May 2022. It still requires people who test positive to undergo seven days of home isolation.

    The country has also restricted travel from mainland China and implemented testing requirements for people arriving from China, Hong Kong and Macau following Beijing’s easing of Covid restrictions.

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  • Covid broke supply chains. Now on the mend, can they withstand another shock? | CNN Business

    Covid broke supply chains. Now on the mend, can they withstand another shock? | CNN Business


    Minneapolis
    CNN
     — 

    The pandemic dislodged the global supply chain, hurling once smoothly running businesses, industries and economies into a state of disarray.

    After almost three years of enduring wild swings and extremes, the system is slowly getting up to speed and into better sync: Ocean freight timelines are on a steady decline, ports are less congested, labor strikes have been narrowly averted, product and worker shortages have eased, prices have fallen, warehouses are full (maybe too full), friendshoring, nearshoring and reshoring efforts have accelerated and China has lifted its “zero Covid” policy.

    “We’ve had a fundamental shift that started about six months ago,” said Timothy Fiore, chair of the Institute for Supply Management. “There are certain components, like integrated circuits [and] microcontrollers, that still are impacting manufacturers’ ability to flow material. But, by and large, the pressure has come off.”

    However, plenty of potential roadblocks still loom large.

    Globally, developments in China and Ukraine remain ongoing question marks, especially if the manufacturing megapower suffers another setback or lockdown, or if conditions worsen with Russia’s war in Europe.

    Domestically, exports have weakened and the state of consumer demand remains a wild card, said Phil Levy, chief economist with freight forwarder and consultancy firm Flexport.

    “I would not describe this as a machine that’s humming along at the moment,” he said. “It’s more getting its bearings and trying to figure out what’s next.”

    Among the potential bottlenecks: Warehousing capacity in certain locales, notably Southern California, is pretty near full, he said. Additionally, the inland distribution network — especially rail and areas where transfers are made from one mode to another — has experienced some challenges, he said.

    The system isn’t yet at a steady state where businesses have a good sense of how long it will take for production, shipping and, ultimately, selling.

    “I don’t think we have that,” Levy said. “There’s still a lot of uncertainty about how long it takes to move stuff. When we see the warehouses piled full, is this because demand is too low? Is it because people moved stuff too early? So there’s a lot of stuff that’s still sorting out.”

    Supply chain activity has yet to normalize, but it’s returning to pre-pandemic trajectories, said Zac Rogers, assistant professor of operations and supply chain management at Colorado State University.

    “There’s a sort of reaction-overreaction pattern that always tends to happen anytime there’s a major disruption,” Rogers said. “And Covid is the major-est disruption we’ve had.”

    Early in the pandemic, businesses canceled orders, believing consumer spending would be crushed. However, trillions of dollars were injected into the economy to try to keep consumers and businesses afloat. Americans, stuck at home with fewer outlets for discretionary spending, turned to e-commerce for their shopping.

    The surge in demand for finished goods at a time when supply was severely limited in part due to pandemic-related labor shortages and shutdowns —notably of cities, factories and manufacturing hubs in China — knocked the global logistics system out of whack.

    Ports grew congested, lead times got lengthy, and costs climbed considerably higher as shortages spiked throughout the supply chain.

    “Everyone way over-ordered, and around February and March of [last] year, everything got here — pretty much right in time for the invasion of Ukraine,” Rogers said.

    Gas prices and inflation soared, putting a huge dent in consumer spending.

    “The challenge for the last 10 months in supply chains has been to try to thread the needle between bringing inventories down to a reasonable level, while also not overreacting, yet again, and [landing] back into a shortage situation,” he said. “We’re getting back toward the trend line in a way that we haven’t in the last few years.”

    Helping that along is that supply chains are far more resilient now than they were at the end of 2019, Rogers said.

    “In 2019, we had basically all of our chips in on one hand, which was, things are built in East Asia, come on a boat through the ports in Southern California, they get on trains that go to Chicago and then on other trains or trucks to distribute to the East Coast,” he said.

    And while it’s nearly impossible to divorce from China, companies are embracing different paths for the supply chain, whether it be in Vietnam, Bangladesh, Central America or domestically, Rogers said.

    “Because of that, supply chains are not as brittle as they were three years ago,” he said. “And so if there is another shock — particularly if there’s a China-centric shock — I think we’ll be able to absorb it a little better than we had. … But you can’t price in something like the invasion of Ukraine or a viral outbreak that shuts down the world — no systems are built to handle that smoothly.”

    Rogers is also a researcher and co-author of the Logistics Managers’ Index, a monthly survey of supply chain executives conducted by a team of university researchers and the Council of Supply Chain Management Professionals.

    The index’s December reading — which measures inventory levels and costs; warehousing capacity; utilization and prices; and transportation capacity, utilization and prices — came in at 54.6, a 1-point increase following eight months of declines.

    The majority of the LMI metrics were in the range of 40s, 50s and 60s, Rogers said, noting it’s the first time since the onset of the pandemic that the indices haven’t been in the 70s or 80s.

    The container ship Ever Libra (TW) is moored at the Port of Los Angeles on Monday, Nov. 21, 2022. The supply backlogs of the past two years -- and the delays, shortages and outrageous prices they brought with them -- have improved dramatically since summer.

    “If you’re in 40, that’s contraction, but 50s are normal, healthy rates of growth,” he said. “There could be another huge black swan event in a month that throws everything upside down; but for right now, it seems like respondents are predicting steadiness in the supply chain.”

    If anything, the pandemic’s shock to the supply chain should be a wake-up call, said Jack Buffington, director of supply chain and sustainability at First Key Consulting and assistant professor of supply chain management at the University of Denver.

    “I would categorize it as ‘efficiently broken,’” said Buffington, whose own book about supply chains, “Reinventing the Supply Chain: A 21st Century Covenant with America,” had its release delayed due to supply chain issues.

    “All supply chains really are is supply and demand, and there’s been so much disruption in materials and consumer demand related to labor and inflation and geopolitics,” he said. “Inherently, the foundation of the model is broken in comparison to what the demands are for today. The complexities related to a globalized supply chain, human systems aren’t capable of handling it.”

    He added: “Covid wasn’t the cause of the problems with the supply chain, it was a trigger to show how bad it was,” he said.

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  • Parents are not OK after three years of Covid and a brutal winter of children’s respiratory illness | CNN

    Parents are not OK after three years of Covid and a brutal winter of children’s respiratory illness | CNN



    CNN
     — 

    With children back in school and daycare after the holidays, weary parents fear what illness awaits them next during this brutal respiratory virus season.

    Since October, RSV, a respiratory virus which often is most severe in young children and older adults, hit early and cases started rising quickly. Cases of influenza started rising soon after, all while Covid-19 continued to spread, with new variants surfacing.

    The CDC estimates:

    • At least 24 million illnesses and 16,000 deaths have occurred due to the flu this season;
    • About 15% of the US population lives in a county with a “high” community level of Covid-19;
    • There were about 14 RSV hospitalizations for every 100,000 children under 5 in the latest week of complete data – about eight times higher than the overall hospitalization rate.

    CNN spoke to parents across the country about the challenges this flu season. They described canceling Christmas, missing trips home to see family and pulling their children out of daycare to keep them safe from illness.

    Here are some of their stories, as told in their own words. Their responses have been edited for length and clarity.

    Michaela Riley from Issaquah, Washington

    I am a single mom living in the suburbs of Seattle. I work for one of the major corporations here. On the outside, I look successful. I have senior in my title, I consistently get promotions and recognition. On the inside, I am breaking from stress related to illness, never getting a real vacation and now the inability to pay for my basic needs.

    I had to work through the holidays, and I had my kids. My parents were going to watch them. Then they got norovirus, which also canceled Christmas. Then my daughter’s father got some horrible flu, so my backup plan for Christmas got canceled. We still hadn’t celebrated Christmas until January 7 because everyone was healing.

    I have 4-year-old and 11-year-old daughters. Basically, all November one of us was sick. My kids got RSV and were so sick for 14 days. After that, I got it. I had no vacation time, so I had to work from home with them. It was a very long, trying time.

    As a single parent, I’ve always been focused on keeping all the balls in the air. But now it is so much harder that what I’m actually doing is making decisions on which ball to drop, just to keep myself going.

    I have used every single vacation day on either my children being sick, me being sick or me having to take one mental health day because I was totally overwhelmed since the beginning of quarantine. I was supposed to go camping last year with the family. I got Covid for the fourth time and had to cancel. I’m going a little bonkers.

    The group I work with has been so supportive of me and understanding of my situation. They honestly helped me during the worst times.

    I have this hashtag for 2023: #BeFree23. Instead of focusing on the struggle, I focus on what’s working in my life. I feel better about 2023. I don’t think anything’s going to change, but changing my mindset is the one thing I have control over.

    Jason Hecht holds his baby, Leon, at a hospital just hours before he was intubated.

    Jason Hecht from Ann Arbor, Michigan

    I am a doctor who works in critical care with a wife who works in primary care. Not only are we struggling on the health care worker side with the massive demands of this season but also struggling far more at home.

    The last month or two have probably been the most mentally and emotionally taxing I’ve ever had in my life. We have a 2-year-old and a 3-month-old. It was our youngest who was sick about a month ago and ended up in the ICU on the ventilator with RSV.

    At the time, we had a healthy, thriving 2-month-old without an issue in the world. To see him so quickly knocked down and be to the point of almost dying in the intensive care unit was very sobering for my wife and I. Seeing your baby that sick – that part alone has been very emotionally draining.

    I was all too aware of how severe his illness was. It was difficult to play the role of father, husband and caretaker because the pull was so strong to go into health care provider mode.

    We had to completely upend our life, pull both kids out of daycare. We’re still struggling to find a reliable source of child care that’s going to be safe for both of them, including our now vulnerable son. We’re still paying for both kids’ daycare spots, even though they aren’t going, because daycare waitlists are so long. As parents and health care workers, we are not coping well.

    We’ve used six or seven weeks of PTO total so far since this happened in November. This was difficult, too, with my wife coming off maternity leave. Her maternity leave has been mostly unpaid, so that was already three months we were going without her paycheck. I don’t have any paternity leave.

    I am very passionate about what I do, and I love being able to help people when they’re at their worst in the ICU. It’s been difficult to have to put all that aside to prioritize only being a parent right now.

    Adriana from Warwick, Rhode Island (She asked that her last name not be used)

    The only reason I waited only two hours in the ER is because my son stopped breathing. Everyone rushed to take care of him. His oxygen levels were at 73. My youngest caught RSV at 7 weeks old.

    My soul left my body when I was in the hospital. I saw there was a respiratory therapist, a pediatrician and two nurses, that they lay down my baby and they started suctioning all the mucus because he was so stuffy, he couldn’t breathe. They put him on oxygen.

    I couldn’t believe how lucky we were that he responded to the treatment as fast as he did.

    Now, I always carry a little oximeter with me. If he gets stuffy or anything like that, I put that on his finger. That’s part of my diaper bag.

    Between my son being hospitalized for one night and the two kids’ deductibles and co-payments, we are $3,000 in debt, just from September until today. He was given just two doses of Tylenol at the hospital and that was almost $300.

    Every time I call the pediatrician’s office, they pretty much triage us over the phone to see if the child is sick enough to grant a visit because of how slammed they are. I have been constantly redialing for several minutes just to get through. When you go into the office, you can see they’re all very tired.

    I think that anything that has to do with kids lately in the country is being overlooked. There’s still the formula shortage. A lot of parents like me, we’re still struggling to find the right formula. I drive all around Rhode Island to find it, and I’m lucky if I can get two cans. My baby is allergic to cow milk protein, so it’s not like I can just get him any formula.

    We usually fly back home for the holidays – I’m from Puerto Rico. But this year we just stayed home. It was a bummer for my oldest because he’s used to spending the holidays with the grandparents.

    Rahman's wife, Tazima Nur, holds their son, Aarish, while he was sick in the ER.

    Mahbubur Rahman from Bonney Lake, Washington

    In the last three months, we got five colds, four ear infections, visited urgent care 10 times and the emergency room four times, once while my kid was sick with RSV. In the last two years, my child had a cold only once.

    This is our first child. He’s a Covid child – he’s not exposed to anywhere because we stayed at home for the last two years. When we started sending him to preschool then this started happening, all things are coming together: face the fear of Covid, viruses like the flu and then, RSV.

    My child had a febrile seizure. His temperature cannot go past 102 and we need to continuously use Tylenol and ibuprofen just to control it. This is happening like every other week. We prepared our car with emergency things for if we need to stay at the hospital. We always pack our bag and put it in our car – like it still is there.

    I am working from home and my wife is not working. Still, we feel like we are exhausted. In the last two months, I think I did like 50% of the work that I usually do. When my son and wife had RSV, my manager actually just told me to manage time whenever I can work, and it does not need to be 9 to 5.

    For the holidays, we had a plan to go back our country, Bangladesh, but we had to cancel the trip. We did not visit our home the last three years. I did in 2019 before Covid and never went back because my wife was pregnant and then my child was born.

    I hope that this will go away, and everything will be better this year. But the fear and the emotions, I think will not go away pretty soon.

    Stephanie Archinas-Murphin and her daughter, Margot, wait in the ER for the third time. This time, Margot was hospitalized.

    Stephanie Archinas-Murphin from Lakewood, California

    My 3-year-old daughter started preschool in September and sure enough she got three viruses – RSV, rhinovirus and pneumonia – all at the same time. She spent four days at the hospital, and it was hell watching her going through it.

    It’s very heartbreaking to just have her come out and experience the world. And now all these things are happening with her getting sick. We want to have a different experience for her.

    We pretty much got everything. My older daughter got the flu, so did my husband and myself. We’ve been on this never-ending journey since October.

    When my youngest was ill, she had to be out for three weeks. My husband was out for two weeks just to be able to take care of her. But when we got hit by the flu after Thanksgiving, my husband didn’t have any time off left. I have a private practice and don’t get PTO, but I had to take the brunt and cancel my clients. That was a dent in our income because I didn’t have any pay. Thankfully, I have some savings, so that helped a lot.

    When I was low on Motrin and my daughter Morgan had the flu, I happened to post it on Instagram. My relative asked if I want some and even dropped off Motrin for me and drove from almost 40 miles away. It was so heartwarming to know that there are people out there who are looking out for me.

    I’m all about taking it one day at a time. I don’t want to overwhelm myself. I’m not going to stop planning or going out, but I’m being mindful that things may change.

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  • China says 60,000 people have died of Covid since early December | CNN

    China says 60,000 people have died of Covid since early December | CNN



    CNN
     — 

    Close to 60,000 people have died of Covid in China since the country abruptly abandoned its tight “zero-Covid” policy in early December, a medical official from the National Health Commission (NHC) told a press conference in Beijing on Saturday.

    Jiao Yahui, head of the NHC’s medical affairs department, said China recorded 59,938 Covid-related death between December 8 and January 12. Of those deaths 5,503 came from respiratory failure caused by Covid infections, and 54,435 were people infected with Covid as well as underlying diseases, such as cancer and cardiovascular diseases.

    China has previously listed only those Covid patients who succumbed with respiratory failure as having died of Covid. In the month after December 8, China reported only 37 deaths from local Covid cases, according to figures released on the Chinese Center for Disease Control and Prevention (CDC) website – even as the outbreak has overwhelmed hospitals and crematoriums amid apparent Covid surges in multiple cities.

    The World Health Organization and the United States have accused China of “under-representing” the severity of its current outbreak, while top global health officials have also urged Beijing to share more data about the explosive spread of Covid in China, where reports have emerged of overwhelmed hospitals and funeral homes.

    On Saturday, WHO director-general Dr Tedros Adhanom Ghebreyesus spoke to Chinese Health Minister Ma Xiaowei about the surge.

    Chinese officials shared information including the latest numbers on outpatient clinics, hospitalizations, patients requiring emergency treatment and critical care, and hospital deaths, the WHO said in a statement.

    “WHO is analyzing this information, which covers early December 2022 to January 12, 2023, and allows for a better understanding of the epidemiological situation and the impact of this wave in China,” it said.

    The health organization also requested a more detailed breakdown of data by province over time and asked the Chinese government to continue to share further sequences of the coronavirus with open access databases.

    Jiao, the medical official, said fever clinical visits and Covid hospitalizations in China have already peaked.

    According to the NHC, fever clinic visits – both in cities and rural areas – have been declining since the peak when more than 2.86 million people visited them on December 23, 2022.

    On January 12, 477,000 people visited fever clinics across China, Jiao said Saturday.

    The NHC said hospitalizations of Covid-19 patients also peaked on January 5, 2023, when 1.63 million people was hospitalized, and 1.27 million Covid patients were still in hospital as of January 12, Jiao added.

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  • White House Covid-19 Response Team’s chief science officer to retire | CNN Politics

    White House Covid-19 Response Team’s chief science officer to retire | CNN Politics



    CNN
     — 

    Dr. David Kessler, chief science officer for the White House Covid-19 Response Team, is retiring, according to a statement from the US Department of Health and Human Services.

    “For decades, Dr. Kessler has worked tirelessly to address our nation’s most challenging public health issues, and his work during the COVID-19 pandemic has been no different,” HHS Secretary Xavier Becerra said in the statement Friday.

    “Whether he was leading our effort to develop and distribute safe and effective COVID-19 vaccines and treatments, or sharing his perspective during daily strategy sessions and data deliberations, Dr. Kessler’s contributions to our COVID-19 response have helped save lives. I am grateful for the wisdom he has shared with us and wish him the best in his future endeavors,” Becerra continued.

    Kessler’s government career began when President George H.W. Bush appointed him to lead the US Food and Drug Administration in 1990; he oversaw the rollout of the agency’s iconic Nutrition Facts label on packaged foods and helped streamline its drug approval process. After stepping down from the FDA in 1997, he became dean of the Yale School of Medicine and then joined the University of California, San Francisco.

    President Joe Biden chose Kessler for the Covid-19 response team in 2021. He was also co-chair of the Biden transition’s coronavirus task force and that administration’s head of Operation Warp Speed, the group formed under President Donald Trump to speed vaccine development and distribution.

    “Every day for two years, David has been laser focused on ensuring we had enough vaccines and treatments for the American people,” Dr. Ashish Jha, the response team coordinator, said Friday on Twitter. “An extraordinary public servant. We will miss him.”

    Ron Klain, the White House chief of staff, tweeted, “There has been no more valued and trusted wise advisor to the @POTUS on scientific and medical matters than Dr. Kessler. He will be GREATLY missed.”

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  • ‘This is the last thing we need:’ Millions of businesses hammered by the pandemic need to start paying back Covid loans | CNN Business

    ‘This is the last thing we need:’ Millions of businesses hammered by the pandemic need to start paying back Covid loans | CNN Business



    CNN
     — 

    At Teddy & The Bully Bar restaurant near downtown Washington, DC, business has never been the same since the pandemic hit.

    “It’s very challenging,” owner Alan Popovsky said. “I’m still going to be climbing the hill for quite some time. Probably for the rest of my life.”

    The pandemic closed two of Popovsky’s four restaurants in the area. He said government loans saved the other two. But with city centers struggling to bring back commuters and foot traffic, he said revenue is still down more than 45%, and they’re fighting to stay open.

    To make matters worse, it’s time to start paying back those loans.

    “We just got over paying back the landlord,” Popovsky said. “It’s really a feeling that you’re just a hamster spinning on a wheel.”

    At the start of the pandemic, as business stalled, nearly 3.8 million small business owners took out Economic Injury Disaster Loans (known as EIDL loans) from the federal government, averaging roughly $100,000 per loan, according to the Small Business Administration. Unlike some other pandemic programs, these 30-year loans, carrying an interest rate of 3.75% for businesses, were intended to be paid back.

    After more than two years of deferrals, the first EIDL loan monthly payments have started to come due. Around 2.6 million businesses across the country will owe money by the end of January.

    Popovsky said he owes the federal government roughly $780,000, and started receiving monthly bills for more than $3,700 in October.

    “We can’t afford anything, but what we’re doing is paying the interest only right now,” he said. “We have not made a dent on the principal.”

    A new survey from the National Federation of Independent Business found only 36% of their small business members have reached their pre-pandemic sales levels, while 31% of businesses are still below 75% of their pre-crisis sales.

    Coming out of the pandemic, small businesses have faced difficult hurdles, like staffing shortages, supply chain issues and inflation.

    Now add a possible looming recession, just as these EIDL loans come due.

    “The challenges are immense for many of them and they’re having to navigate a lot of those headwinds,” said Holly Wade, executive director of the NFIB Research Center. “It is one more cost that they’re going to have to deal with, and some small business owners, unfortunately, are going to struggle with meeting those obligations.”

    Lisa Klein, who owns a physical therapy practice in the Washington, DC, area, said Covid-19 is still keeping some patients away.

    Lisa Klein, who owns and operates an outpatient physical therapy practice with offices in Virginia and in Washington, DC, said her practice is still trying to claw its way back after Covid-19, which is keeping some patients away or forcing costly last-minute cancellations.

    “The costs of everything have gone up,” Klein said. “The whole business is still suffering, and this is just kind of adding insult to injury.”

    Klein took out a $200,000 EIDL loan at the start of the pandemic but returned half of it after a year as the interest began piling up. The SBA estimates that businesses have accrued between $32 billion and $34 billion in interest over the 30-month deferment period.

    She’s now paying nearly $1,000 a month, with a total balance of just under $80,000.

    “It’s like you’re swimming and trying to catch up and get your head above water, and you just keep getting hit by something else,” Klein said. “But we have no choice, because if we don’t keep paying it, it’s going to accrue more interest.”

    Struggling businesses can declare hardship and make partial payments of 10% of the regular monthly payment with a minimum of $25 for six months, according to the SBA. But interest will keep accruing, forcing owners like Klein to weigh short-term protection against a big bill further down the line.

    Borrowers are still responsible for repaying loans even if their business closes, unless the debt has been discharged in bankruptcy, according to the SBA. For EIDL loans over $200,000, a personal guaranty was required for individuals with 20% or more ownership in the business.

    Popovsky said he has considered shutting down Teddy & The Bully Bear but has felt inspired to keep fighting by the memory of his father as well as his co-founder, Melvyn, who passed away in 2014, just one year after the restaurant opened.

    “I feel them saying keep pushing on, Alan, keep pushing on,” he said. “I feel like they’re the wind beneath my wings.”

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  • How much should people worry about Covid’s newly-dominant XBB.1.5 variant? Our medical analyst explains | CNN

    How much should people worry about Covid’s newly-dominant XBB.1.5 variant? Our medical analyst explains | CNN



    CNN
     — 

    A new Covid-19 variant, XBB.1.5, is spreading rapidly throughout the United States. In December 2022, the proportion of new Covid-19 infections due to this Omicron offshoot have increased from 4% to 18%, according to a January 6 release from the US Centers for Disease Control and Prevention, and is projected to rise further still. In some parts of the country, it constitutes more than half of all new infections. According to the World Health Organization, XBB.1.5 is the most transmissible form of Omicron yet.

    What should people know about XBB.1.5? Do vaccines and treatments work against it? Can tests pick it up? Will hospitals become overwhelmed again? Should kids wear masks to school again? And could there be even more worrisome variants that emerge in the future?

    To guide us through these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

    CNN: What should people know about the latest Covid-19 variant, XBB.1.5?

    Dr. Leana Wen: People should not be surprised that there is a new variant. The more viruses replicate, the more they mutate. Most mutations do not confer evolutionary advantage and won’t spread further, but some do.

    There are three key questions to ask about new variants. First, is it more contagious? Second, does it cause more serious disease? And third, is it more immune-evasive, meaning it undercuts the protection of existing vaccines and treatments?

    The mutations XBB.1.5 has acquired have made it more contagious. A more transmissible strain has the evolutionary advantage that it will spread faster than others, and therefore could displace other strains. This is a trend seen throughout the coronavirus pandemic — new, even more transmissible strains replacing their predecessors and becoming dominant.

    The good news is that, thus far, this strain does not appear to cause more severe disease. Like other Omicron descendants, it probably causes milder illness compared with the Delta variants that predated Omicron.

    There are some studies that suggest XBB.1.5 is more immune-evasive compared with previously dominant Omicron strains. Further research is underway to identify the degree of immune protection afforded by existing vaccines; the White House’s Covid-19 response coordinator Dr. Ashish Jha said that “data suggests that if you’ve been vaccinated, if you’ve gotten that updated bivalent booster, you’re still going to have a good amount of protection,” during an interview Friday with CNN’s Kate Bolduan.

    But even if it turns out these vaccines don’t hold up as well against infection with XBB.1.5, they will probably protect well against severe illness — which underscores the need for people to receive the updated booster if they are eligible.

    CNN: Can tests pick up this new variant?

    Wen: PCR tests definitely can, and there’s no reason to think that this variant won’t be picked up by rapid home antigen tests. If you have symptoms or are exposed to someone with the coronavirus, you should certainly get tested. The tests won’t show you which strain you picked up, but they should detect circulating variants.

    CNN: Do existing treatments work against XBB.1.5?

    Wen: Antiviral treatments like Paxlovid should work against XBB.1.5. Unfortunately, monoclonal antibody treatments probably don’t. In November, the US. Food and Drug Administration withdrew their authorization of the last remaining monoclonal antibody because of its lack of efficacy against new variants. And on January 6, the agency issued a statement that the preventive antibody Evusheld may be ineffective against XBB.1.5.

    On a policy level, it’s critical there are urgent investments into better treatments. There are many people vulnerable to severe outcomes due to Covid-19, and we need to have a wider range of effective treatments available for them.

    CNN: Could hospitals become overwhelmed again?

    Wen: Covid-19 infections could rise in the coming weeks due to a combination of this new variant and the fact that many people will have traveled and gathered over the holidays. I don’t think the surge will be nearly as bad as the initial Omicron wave in early 2022, though, because of the large proportion of Americans who have by this point already contracted Covid-19 and have some baseline immunity to it.

    If you have symptoms or are exposed to someone with the coronavirus, you should certainly get tested, says Dr. Leana Wen.

    Increasing booster rates, particularly among the elderly, will help blunt the rise in hospitalizations. It’s a major problem that only about a third of Americans ages 65 and older have received the updated bivalent booster, which has been shown in a recent study to reduce hospitalization by 73% in this age group.

    CNN: How much should people worry about XBB.1.5?

    Wen: It depends on the individual. There are many people who are not concerned about contracting Covid-19. They may be young and healthy and unlikely to become severely ill due to the coronavirus. Maybe they have just recovered from a previous infection and are protected against serious illness for several months. Or maybe the downside of continuing precautions is significant to them. I don’t think it’s wrong for people to proceed with their pre-pandemic routines, considering that XBB.1.5 is not likely to be the last variant of concern we see — and that it doesn’t appear to cause more severe disease.

    On the other hand, there are many people who are worried about becoming severely ill from Covid-19. People who are elderly or who have underlying health conditions should speak with their physician about their risk of severe illness due to Covid-19. If they are at high risk even after getting the bivalent booster, they should consider additional precautions to avoid infection while this highly transmissible variant is circulating. That includes asking others to take a rapid test prior to socializing and wearing a high-quality N95 or equivalent mask while in crowded indoor places.

    CNN: Some school districts are bringing back mask mandates. Should kids wear masks to schools again?

    Wen: This will depend on the family. If everyone is generally healthy, the parents or caregivers are going to work without a mask and all members are socializing freely with others outside of school, then it wouldn’t add much more protection to mask in the classroom.

    On the other hand, families that are still taking many precautions because of, for example, a severely immunocompromised household member might decide to all mask while in in crowded indoor spaces.

    My children have not been masking in school since the beginning of this school year, and I don’t currently plan for this to change. We would reconsider if a new variant emerges that causes much more severe disease, but that does not appear to be the case with XBB.1.5.

    CNN: Could there be even more worrisome variants that emerge in the future?

    Wen: Yes. This is the reason why genomic surveillance is so important. We need to identify and study new variants as they emerge. This is part of our “new normal”— there will be new variants that, from time to time, lead to surges of infections. The key is to make sure people are still protected against severe disease and to keep hospitals from becoming overwhelmed. And we must make sure everyone makes use of the tools we have available, including vaccines.

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  • Satellite images capture crowding at China’s crematoriums and funeral homes as Covid surge continues | CNN

    Satellite images capture crowding at China’s crematoriums and funeral homes as Covid surge continues | CNN



    CNN
     — 

    Satellite images taken over a number of Chinese cities have captured crowding at crematoriums and funeral homes, as the country continues its battle with an unprecedented wave of Covid-19 infections following its dismantling of severe pandemic restrictions.

    The images – taken by Maxar in late December and early January and reviewed by CNN – show a funeral home on the outskirts of Beijing, which appears to have constructed a brand-new parking area, as well as lines of vehicles waiting outside of funeral homes in Kunming, Nanjing, Chengdu, Tangshan and Huzhou.

    The scene at the same home last week, showing more cars parked along streets near the entrance.

    China recently moved away from its strict zero-Covid approach to the virus, which had sparked mass unrest after more than two years of tight controls on citizens’ personal lives.

    China’s strict policy shielded its population from the kind of mass deaths seen in Western nations – a contrast repeatedly driven home by the Communist Party to illustrate the supposed superiority of its restrictions.

    Since those rules were lifted, people have regained freedom to travel around their country

    The satellite pictures are consistent with CNN’s reporting and witness accounts shared to social media concerning overcrowding in funeral homes and crematoriums.

    CNN has reported first-hand in Beijing on the makeshift facilities being used to store the deceased, as overworked staff try to keep up with the volume of crates containing yellow body bags, and families report waiting for days to bury or cremate their loved ones.

    A Tangshan City funeral home in January 2020, before the pandemic swept the country.

    The same home last week, where many more vehicles are parked.

    Meanwhile, China’s official Covid-19 death toll since it eased restrictions remains strikingly low – with only 37 deaths recorded since December 7.

    As reports of overwhelmed hospitals and funeral homes roll in, China is facing accusations from the World Health Organization (WHO) and US that it is under-representing the severity of its current outbreak, as top global health officials urge Beijing to share more data about the explosive spread.

    “We continue to ask China for more rapid, regular, reliable data on hospitalizations and deaths, as well as more comprehensive, real-time viral sequencing,” WHO director-general Tedros Adhanom Ghebreyesus said at a news briefing in Geneva Wednesday.

    “WHO is concerned about the risk to life in China and has reiterated the importance of vaccination, including booster doses, to protect against hospitalization, severe disease, and death,” he said.

    Speaking in more detail, WHO executive director for health emergencies Mike Ryan said the numbers released by China “under-represent the true impact of the disease” in terms of hospital and ICU admissions, as well as deaths.

    He acknowledged that many countries have seen lags in reporting hospital data, but pointed to China’s “narrow” definition of a Covid death as part of the issue.

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  • What the return of Chinese tourists means for the global economy | CNN Business

    What the return of Chinese tourists means for the global economy | CNN Business


    Hong Kong
    CNN
     — 

    In the years before Covid, China was the world’s most important source of international travelers. Its 155 million tourists spent more than a quarter of a trillion dollars beyond its borders in 2019.

    That largesse fell precipitously over the past three years as the country essentially closed its borders. But, as China prepares to reopen on Sunday, millions of tourists are poised to return to the world stage, raising hopes of a rebound for the global hospitality industry.

    Although international travel may not return immediately to pre-pandemic levels, companies, industries and countries that rely on Chinese tourists will get a boost in 2023, according to analysts.

    China averaged about 12 million outbound air passengers per month in 2019, but those numbers fell 95% during the Covid years, according to Steve Saxon, a partner in McKinsey’s Shenzhen office. He predicts that figure will recover to about 6 million per month by the summer, driven by the pent-up wanderlust of young, wealthy Chinese like Emmy Lu, who works for an advertising company in Beijing.

    “I’m so happy [about the reopening]! ” Lu told CNN. “Because of the pandemic, I could only wander around the country for the past years. It was difficult.”

    “It’s just that I’ve been stuck inside the country for a little too long. I’m really looking forward to the lifting of the restrictions, so that I can go somewhere for fun! ” the 30-year-old said, adding that she wanted to visit Japan and Europe the most.

    As China announced last month it would no longer subject inbound travelers to quarantine starting January 8, including residents returning from trips abroad, searches for international flights and accommodations immediately hit a three-year high on Trip.com

    (TCOM)    .

    Bookings for overseas travel during the upcoming Lunar New Year holiday, which falls between January 21 and January 27 this year, have soared by 540% from a year ago, according to data from the Chinese travel site. Average spending per booking jumped 32%.

    The top destinations are in the Asia Pacific region, including Australia, Thailand, Japan and Hong Kong. The United States and the United Kingdom also ranked among the top 10.

    “The rapid buildup in … [bank] deposits over the past year suggests that households in China have accumulated significant cash holdings,” said Alex Loo, a macro strategist for TD Securities, adding that frequent lockdowns have likely led to restraints on household spending.

    There could be “revenge spending” by Chinese consumers, mirroring what happened in many developed markets when they reopened early last year, he said.

    That’s good news for many economies battered by the pandemic.

    “We estimate that Hong Kong, Thailand, Vietnam and Singapore would benefit the most if China’s travel service imports were to return to 2019 levels,” said Goldman Sachs analysts。

    Hong Kong — the world’s most visited city with just under 56 million arrivals in 2019, most of them from mainland China — could see an estimated 7.6% boost to its GDP as exports and tourism income increase, they said. Thailand’s GDP may be boosted by 2.9%, while Singapore would get a lift of 1.2%.

    Elsewhere in the world, Cambodia, Mauritius, Malaysia, Taiwan, Myanmar, Sri Lanka, South Korea and Philippines are also likely to benefit from the return of Chinese tourists, according to research by Capital Economics.

    Hong Kong has suffered particularly acutely from the closure of its border with mainland China. The city’s pillar industries of tourism and real estate have been hit hard. The financial hub expects GDP to have contracted by 3.2% in 2022.

    The city government announced Thursday that up to 60,000 people would be allowed to cross the border daily each way, starting Sunday.

    Several other Southeast Asian countries reliant on tourism have kept entry rules relatively relaxed for Chinese tourists, despite the record Covid-19 outbreak that has swept through China in recent weeks. They include Thailand, Indonesia, Singapore and the Philippines.

    “This is one of the opportunities that we can accelerate economic recovery,” Thailand’s health minister said this week.

    New Zealand has also waived testing requirements for Chinese visitors, who were the second largest source of tourist revenue for the country before the pandemic.

    But other governments are more cautious. So far, nearly a dozen countries, including the United States, Germany, France, Canada, Japan, Australia and South Korea, have mandated testing.

    The European Union on Wednesday “strongly encouraged” its members states to require a negative Covid test for visitors from China before arrival.

    There is clearly “conflict” between the tourism authorities and the political and health officials in some countries, said Saxon, who leads McKinsey’s travel practice in Asia.

    Airlines and airports have already blasted the EU’s recommendations for testing requirements.

    The International Air Transport Association, the airline industry’s global lobby group, together with airports represented by ACI Europe as well as Airlines for Europe, issued a joint statement on Thursday, calling the EU move “regrettable” and “a knee-jerk reaction.”

    But they welcomed the additional recommendation to test wastewater as a way of identifying new variants of the disease, saying it should be an alternative to testing passengers.

    Besides restrictions, it will take time for international travel to fully rebound because many Chinese must renew their passports and apply for visas again, according to analysts.

    Lu from Beijing said she was still considering her travel plans, taking into consideration the various testing requirements and the high price of flying.

    “The restrictions are normal, because everyone wants to protect people in their own country,” she said. “I’ll wait and see if some policies will be eased.”

    Liu Chaonan, a 24-year-old in Shenzhen, said she had initially wanted to go to the Philippines to celebrate the Chinese New Year, but didn’t have time to apply for the visa. So she switched to Thailand, which offers quick and easy electronic permits.

    “Time is short and I need to leave in about 10 days. People may choose some visa-friendly places and countries to travel to,” she said, adding that she plans to learn scuba diving and wants to buy cosmetics. Her total budget for the trip could exceed 10,000 yuan ($1,460).

    Saxon said he expected China’s outbound international travel to fully recover by the year end.

    “Generally, individuals are pragmatic and countries will welcome Chinese tourists due to their spending power,” he said, adding that countries may remove restrictions quickly when the Covid situation improves in China.

    “It will take time for international tourism to get going, but it will come rushing back, when it happens.”

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  • World’s largest iPhone factory bounces back from Covid disruption that hurt Apple | CNN Business

    World’s largest iPhone factory bounces back from Covid disruption that hurt Apple | CNN Business


    Hong Kong
    CNN
     — 

    Production at the world’s biggest iPhone factory, disrupted since October by China’s Covid-19 restrictions and worker protests, is now running at nearly full capacity, according to a Chinese state media report.

    The sprawling campus in central China, owned by Apple

    (AAPL)     supplier Foxconn, was running at 90% of planned production capacity at the end of December, the Henan Daily newspaper reported Tuesday. It cited an interview with Wang Xue, deputy general manager of the facility, which is also known as iPhone city.

    “At the moment, the order books look good, and the orders will peak from now until a few months after Chinese New Year,” he was quoted as saying. The Lunar New Year will begin on January 22.

    Foxconn hasn’t yet responded to CNN’s request for comment about the report.

    The company said last month it was working on restoring production, which had been badly affected by supply disruptions caused by Covid restrictions. Wedbush Securities analyst Daniel Ives estimated in November that the disruptions in Zhengzhou had been costing Apple roughly $1 billion a week in lost iPhone sales.

    According to a UBS report in November, the wait time for the latest 14 Pro and 14 Pro Max in the United States touched 34 days just before the Christmas holidays because of supply chain constraints in China. The UBS analyst called the wait time “extreme.”

    The Henan Daily separately quoted an executive responsible for Foxconn’s logistics as saying that, in the first two days of January, the volume of inbound and outbound shipments had reached the highest level in a year.

    The report of a nearly full resumption of production comes one month after China abruptly ended three years of pandemic controls, setting off a huge wave of Covid infections.

    According to a report in the Wall Street Journal, a letter from Foxconn founder Terry Gou played a major role in persuading Chinese leaders to accelerate plans to dismantle the country’s Covid-19 policies. Gou was quoted as warning that strict Covid controls would threaten China’s central position in global supply chains.

    Gou’s office told CNN that it “denies the report and its contents.”

    Wang was quoted by the Henan Daily as saying iPhone City currently had about 200,000 workers on site. The employees were each eligible for a maximum of 13,000 yuan ($1,883) per month in bonuses, he said, without specifying their base salaries.

    The troubles for Foxconn started in October when workers left the campus, located in the central Chinese province of Henan, because of concerns about Covid-related working conditions and shortages of food. Short on staff, bonuses were offered to workers to return.

    But violent protests broke out in November when the newly-hired staff said management reneged on their promises. Workers clashed with security officers, before the company eventually offered them cash to quit and leave the site.

    Analysts said the production woes at iPhone City would speed up the pace of Apple’s supply chain diversification away from China.

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  • Xi Jinping estimates China’s 2022 GDP grew at least 4.4%. But Covid misery looms | CNN Business

    Xi Jinping estimates China’s 2022 GDP grew at least 4.4%. But Covid misery looms | CNN Business


    Hong Kong
    CNN
     — 

    China’s economy grew at least 4.4% in 2022, according to leader Xi Jinping, a figure much stronger than many economists had expected. But the current Covid wave may hobble growth in the months ahead.

    China’s annual GDP is expected to have exceeded 120 trillion yuan ($17.4 trillion) last year, Xi said in a televised New Year’s Eve speech on Saturday. That implies growth of more than 4.4%, which is a surprisingly robust figure.

    Economists had generally expected growth to slump to a rate between 2.7% and 3.3% for 2022. The government had maintained a much higher annual growth target of around 5.5%.

    “China’s economy is resilient and has good potential and vitality. Its long-term fundamentals remain unchanged,” Xi said. “As long as we are confident and seek progress steadily, we will be able to achieve our goals.”

    In his remarks, Xi made a rare admission of the “tough challenges” experienced by many during three years of pandemic controls. Many online commentators noted that his tone appeared softer and less self congratulatory than his New Year’s addresses over the past two years.

    In 2020, Xi devoted much time to praising China’s economic achievements, highlighting that it was the first major global economy to achieve positive growth. Last year, he emphasized the country had developed rapidly and that he had won praise from his counterparts for China’s fight against Covid.

    However, in 2022, China’s economy was hit by widespread Covid lockdowns and a historic property downturn. Its growth is likely to be at or below global growth for the first time in 40 years, according to Kristalina Georgieva, managing director of the International Monetary Fund.

    Chinese policymakers have vowed to seek a turnaround in 2023. They’re betting that the end of zero-Covid and a series of property support measures will revive domestic consumption and bolster growth.

    But an explosion of Covid infections, triggered by the abrupt easing of pandemic restrictions in early December, is clouding the outlook. The country is battling its biggest-ever Covid outbreak.

    Last week, Beijing announced it will end quarantine requirements for international arrivals from January 8, marking a major step toward reopening its borders.

    The sudden end to the restrictions caught many in the country off guard and put enormous strain on the healthcare system.

    The rapid spread of infections has kept many people indoors and emptied shops and restaurants. Factories have been forced to shut down or cut production because workers were getting sick.

    Key data released Saturday showed factory activity in the country contracted in December by the fastest pace in nearly three years. The official manufacturing purchasing managers’ index (PMI) slumped to 47 last month from 48 in November, according to the National Bureau of Statistics.

    It was the biggest drop since February 2020 and also marked the third straight month of contraction for the index. A reading below 50 indicates that activity is shrinking.

    The non-manufacturing PMI, which measures activity in the services sector, plunged to 41.6 last month from 46.7 in November. It also marked the lowest level in nearly three years.

    “For the next couple of months, it would be tough for China, and the impact on Chinese growth would be negative,” said Georgieva in an interview aired by CBS News on Sunday. “The impact on the region would be negative. The impact on global growth would be negative.”

    Analysts are also expecting the economy to face a bumpy start in 2023 — with a likely contraction in the first quarter, as surging Covid infections dampen consumer spending and disrupt factory activity.

    However, some forecast the economy will rebound after March, as people learn to live with Covid. Many investment banks now forecast China’s 2023 growth to top 5%.

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  • Opinion: A New Year’s resolution we all need to embrace | CNN

    Opinion: A New Year’s resolution we all need to embrace | CNN

    Editor’s Note: Sophia A. Nelson is a journalist and author of the book “Be the One You Need: 21 Life Lessons I Learned Taking Care of Everyone but Me.” The views expressed in this commentary are her own. View more opinion on CNN.



    CNN
     — 

    It’s the start of another year, and we are still working our way through a once-in-a-generation, life-changing pandemic almost three years after it began. We’ve all been affected by Covid-19’s scourge of sickness, hospitalization, death, loneliness, isolation, work dislocation and family disruption. Perhaps, like me, you even got sick with the coronavirus and are living with its long-term effects.

    When Covid-19 hit, workers in teaching, nursing, hospitality and retail — occupations where women predominate — bore a fair part of the burden associated with the disease. And no group felt this more acutely than Black and brown women.

    Women struggle to balance self-care against filling the needs of their families. But for Black women, juggling those competing needs often comes against a backdrop of intergenerational trauma and suppression of their emotions.

    In the Black community, women have perfected obsessive selflessness to an art form. We end up exhausted, emotionally drained — and in many cases, unhealthy — because we are conditioned to serve the needs of others and display superhuman strength — to our own detriment. I have lost friends, sorority sisters and mentors to hypertension-induced strokes, heart attacks, diabetes complications and plain old exhaustion from a lack of meaningful self-care.

    The effects of environmental stress on Black women are severe. One study found that by the time a Black woman reaches her 50s, the toll of stress on her body has resulted in an additional seven years of biological aging compared with White women. Black women are more likely to die from breast cancer, heart disease and diabetes, too.

    Northwestern University clinical psychologist Inger Burnett-Zeigler addressed the downside of viewing the strong Black woman as a “cultural icon” in her book, “Nobody Knows the Trouble I’ve Seen: The Emotional Lives of Black Women.”

    “Some Black women do not have the necessary tools to cope with their feelings in a healthy way and, as a result, may engage in unhealthy coping strategies such as eating unhealthy foods, drinking alcohol, using illicit drugs, being sedentary or a workaholic. While these behaviors may offer a Band-aid to the problem, they are not a long-term solution,” she said in an interview discussing the work that was published last year.

    In short, for Black and brown women, focusing on self-care is a matter of survival. But some of us needed the additional wake-up call that came from confronting the pandemic.

    My own Covid-19 journey started in February 2020 when I came down with an early case before we had testing or vaccines. I contracted the disease while speaking at a conference in Louisiana. I was sick for a week with a high fever, respiratory distress and other complications.

    I got a second, milder case in August 2021 after being vaccinated and boosted. I was lucky enough not to have to be hospitalized during either episode, but I still suffer the effects of long Covid-19, including some heart valve damage and residual issues with my right lung. Living with these infirmities means prioritizing the vital self-care I might otherwise have ignored.

    By self-care, I don’t mean going to the beach or taking a vacation. That is respite.

    The kind of self-care I want to see Black women practice is the kind that liberates the soul. The kind that allows us to be our authentic selves. The kind that frees us to wear our hair how we want, to speak our truths, to seek healthier romantic partners and build better friends. And it’s the kind of self-care that lasts a lifetime.

    The good news is that despite the heaviness of our times, we see examples of prominent Black women saying enough is enough — it’s time to put our wellness first. Women such as Olympic gymnast Simone Biles, tennis star Naomi Osaka and actress Taraji P. Henson have spoken openly about the importance of their mental health to their overall well-being.

    As a Black woman now in her 50s, it took me years to learn that although my family and friends matter, I matter most of all. I’ve learned that I have a right to joy, to peace and to self-care, too. I wrote about those hard-knock lessons in my fourth book, “Be the One You Need.”

    My hope was that by sharing just a few of my own life experiences, I can help educate and inspire a new generation of Black girls and women to embrace lives filled with self-care, hope, joy, physical and emotional wellness.

    But even if you’re neither Black nor a woman, these lessons can benefit you as well. Start by asking yourself three important questions: What do I want? What do I need? How am I really feeling? Your inner voice will provide the answers. Trust that you will find the courage to follow through on the wisdom you already possess.

    Here are three more things to bear in mind as you focus on your emotional wellness this new year:

    1. Self-care is a life strategy for success. It’s about setting healthy boundaries and ensuring that those boundaries are respected by others. It requires that you change you first and that you accept you can never change others.

    2. Prioritize your mental and emotional health above all else. You’re no good to anyone if you’re not good to yourself. Your mental and emotional well-being is one of the many “health verticals” you must tend to, just as you might regularly monitor your weight, heart health or blood pressure.

    3. “No” is a complete sentence. This one has really saved me a lot of heartache, unspoken resentment and time. I no longer do the things I do not want to do, to please others. I reserve my energy for only those things and people that are worth my energy.

    Women in general, and Black women specifically, often find it hard to say no. But it’s what you sometimes must do, even when your kids have endless requests, your boss has demands, and friends who have supported you in the past are in a crisis. And the reason for centering your own needs is implied in the subtitle of my book “Life Lessons I Learned Taking Care of Everyone but Me.” It’s simply not sustainable.

    Generations of Black women have watched our mothers, grandmothers and aunts do, give, run, lift, build up, sacrifice, protect and offer up themselves to anyone and everyone in need. This new year, we all have an opportunity to do better for ourselves.

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  • Novak Djokovic back in Australia following high-profile visa ban | CNN

    Novak Djokovic back in Australia following high-profile visa ban | CNN



    CNN
     — 

    Novak Djokovic is back in Australia, according to a spokesperson with Tennis Australia, nearly a year after his high-profile visa ban from the country over his stance on the Covid-19 vaccination.

    The 21-time grand slam champion is slated to open his 2023 tennis season next week in Adelaide for the Adelaide International 1. It comes more than a month after Australian officials said that Djokovic’s three-year ban from entering the country would be overturned.

    The Serbian was deported from Australia in January after former immigration minister Alex Hawke found the tennis star posed a risk to public health and order because, as a celebrity sportsman who had previously expressed opposition to people being compelled to get the Covid-19 vaccine, he could be seen as an “icon” for anti-vaxxers.

    The minister’s decision to deport the former world No. 1 men’s player meant he was initially banned from reentry for three years.

    On Monday, Tennis Australia CEO Craig Tiley said, “We will welcome him back to Australia.”

    As for the reception Djokovic should expect to receive from Aussies, Tiley said, “I have a great deal of confidence in the Australian public. I think we have a very well-educated sporting public particularly those that come for tennis. They love their tennis. They love seeing greatness. They love seeing great athleticism, great matches.

    “I have a lot of confidence that the fans will react like we hope they would react and have respect for that,” he added.

    CNN has reached out to the tennis star for comment.

    Djokovic has won nine men’s singles titles at the Australian Open, more than anyone else in history. He is entered to play in the 2023 edition next month.

    Djokovic’s high-profile visa saga overshadowed the Australian Open earlier this year, pitting one of tennis’ biggest stars against the Australian government and dividing opinion in the country, which had enacted tough pandemic border restrictions.

    The government revoked the Serbian’s visa shortly after his arrival in Melbourne on January 5 because he was not vaccinated against Covid-19.

    Djokovic said he was under the impression he could enter the country because two independent panels associated with Tennis Australia and the Victorian state government had granted him an exemption on the grounds he had been infected with the virus a few weeks prior to his arrival.

    But the federal government argued that was not a valid reason for an exemption under its rules.

    A judge later ruled that border officers had been “unreasonable” when they canceled Djokovic’s visa and ordered his release from an immigration detention center.

    But his visa was then revoked for a second time and after losing his bid to challenge the decision, the tennis star left Australia.

    Despite his return to action in selected tournaments following the ordeal, the player’s Covid-19 vaccination stance restricted his participation in others.

    In July, Djokovic won his 21st grand slam title, beating Nick Kyrgios in the final at Wimbledon.

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  • Beijing to distribute Pfizer antiviral drug as Covid wave strains health system | CNN

    Beijing to distribute Pfizer antiviral drug as Covid wave strains health system | CNN


    Beijing
    CNN
     — 

    Beijing will begin distributing Pfizer’s Covid-19 drug Paxlovid to the city’s community health centers in the coming days, state media reported Monday.

    The report comes as the city grapples with an unprecedented wave of infections that has severely strained its hospitals and emptied pharmacy shelves.

    The state-run China News Service reported Monday that after receiving training, community doctors will administer the medicine to Covid-19 patients and give instructions on how to use them.

    “We have received the notice from officials, but it is not clear when the drugs will arrive,” it cited a worker at a local community health center in Beijing’s Xicheng district as saying.

    Paxlovid remains the only foreign medicine to treat Covid that has been approved by China’s regulator for nationwide use, but access is extremely difficult to come by. When a Chinese healthcare platform offered the antiviral drug earlier this month, it sold out within hours.

    Azvudine, an oral medicine developed by China’s Genuine Biotech, has also been approved.

    After nearly three years of lockdowns, quarantines and mass testing, China abruptly abandoned its zero-Covid policy this month following nationwide protests over its heavy economic and social toll.

    The sudden lifting of restrictions sparked panic buying of fever and cold medicines, leading to widespread shortages, both at pharmacies and on online shopping platforms. Long lines have become routine outside fever clinics and hospital wards overflowing with patients in the capital Beijing and elsewhere in the country.

    An emergency room doctor in Beijing told the state-run People’s Daily on Thursday that four doctors on his shift did not have time to eat or drink. “We have been seeing patients nonstop,” he said.

    Another emergency room doctor told the newspaper he had been working despite having developed fever symptoms. “The number of patients is high, and with fewer medical staff, the pressure is multiplied,” said the doctor.

    In a sign of the strain on Beijing’s medical system, hundreds of health professionals from across China have traveled to the city to assist medical centers.

    As the capital, Beijing has some of the best medical resources in the country. However, the abrupt zero-Covid u-turn has left people and health facilities ill-prepared to deal with a surge in infections.

    China’s official Covid case count has become meaningless after it rolled back mass testing and allowed residents to use antigen tests and isolate at home. It has stopped reporting asymptomatic cases, conceding it was no longer possible to track the actual number of infections.

    According to an internal estimate from the National Health Commission, almost 250 million people in China have caught Covid in the first 20 days of December – accounting for roughly 18% of the country’s population.

    Experts have warned that as people in big cities return to their hometowns for the Lunar New Year next month, the virus could sweep through China’s vast rural areas, where vaccination rates are lower and medical resources are severely lacking.

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  • Biden signs vital $858 billion defense bill into law, nixing military’s Covid-19 vaccine mandate | CNN Politics

    Biden signs vital $858 billion defense bill into law, nixing military’s Covid-19 vaccine mandate | CNN Politics



    CNN
     — 

    President Joe Biden on Friday signed the National Defense Authorization Act into law, a massive defense spending bill with provisions that will give service members a pay raise, fund support for Ukraine and Taiwan and rescind the US military’s Covid-19 vaccine mandate.

    In a statement following the signing of the NDAA, Biden said the act “provides vital benefits and enhances access to justice for military personnel and their families, and includes critical authorities to support our country’s national defense, foreign affairs, and homeland security.”

    The Senate voted last week to pass the massive NDAA with bipartisan support. It follows the House’s bipartisan approval of the legislation the week prior.

    The defense bill outlines the policy agenda for the Department of Defense and the US military and authorizes spending in line with the Pentagon’s priorities. But it does not appropriate the funding itself. The legislation, which authorizes $817 billion specifically for the Department of Defense, will provide $45 billion more than Biden’s budget request earlier this year.

    The increase for fiscal year 2023 is intended to address the effects of inflation and accelerate the implementation of the national defense strategy, according to the Senate Armed Services Committee. It authorizes $12.6 billion for the inflation impact on purchases, $3.8 billion for the impact on military construction projects and $2.5 billion for the impact on fuel purchases, according to a bill summary from the committee.

    The NDAA includes provisions to strengthen air power and land warfare defense capabilities, as well as cybersecurity. And it shows Congress’ continued support for helping Ukraine repel Russia’s invasion, even though several Republican lawmakers have raised questions about the ongoing US aid. Additionally, the NDAA establishes a specific defense modernization program for Taiwan to deter aggression by China.

    Among a series of provisions to support service members and their families, the funding will provide a 4.6% increase in military basic pay for service members – the largest in 20 years. The Department of Defense’s civilian workforce will get the same raise. It also bumps up service members’ housing allowance.

    In addressing service member suicides, the act requires the Secretary of Defense to compile a report on suicide rates within the ranks.

    The act also ends the requirement that troops receive the Covid-19 vaccine. However, it will not reinstate members of the military who were discharged for refusing to get vaccinated.

    White House press secretary Karine Jean-Pierre previously said the White House had viewed the removal of the vaccine mandate as “a mistake,” but she declined to say whether Biden would sign a bill that ends the requirement, noting that the president would “judge the bill in its entirety.”

    Biden said in his statement on Friday that while he’s pleased the funding bill supports several critical objectives, “certain provisions of the Act raise concerns.”

    He repeated past concerns about barring funds to transfer Guantanamo Bay detainees into the custody of certain foreign nations and several “constitutional concerns or questions of construction” over other provisions – including concerns about the transmission of highly sensitive information to Congress.

    Biden also called a portion of the NDAA requiring that documents, including presidential communications, be shared unconstitutional.

    “I will commit to complying with its disclosure requirements only in such cases where a committee has a need for such Presidential communications that outweighs the potential harm to the confidentiality interests underlying the Presidential communications privilege,” the president’s statement said.

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  • Leaked notes from Chinese health officials estimate 250 million Covid-19 infections in December: reports | CNN

    Leaked notes from Chinese health officials estimate 250 million Covid-19 infections in December: reports | CNN


    Hong Kong
    CNN
     — 

    Almost 250 million people in China may have caught Covid-19 in the first 20 days of December, according to an internal estimate from the nation’s top health officials, Bloomberg News and the Financial Times reported Friday.

    If correct, the estimate – which CNN cannot independently confirm – would account for roughly 18% of China’s 1.4 billion people and represent the largest Covid-19 outbreak to date globally.

    The figures cited were presented during an internal meeting of China’s National Health Commission (NHC) on Wednesday, according to both outlets – which cited sources familiar with the matter or involved in the discussions. The NHC summary of Wednesday’s meeting said it delved into the treatment of patients affected by the new outbreak.

    On Friday, a copy of what was purportedly the NHC meeting notes was circulated on Chinese social media and seen by CNN; the authenticity of the document has not been verified and the NHC did not immediately respond to a request for comment.

    Both the Financial Times and Bloomberg laid out in great detail the discussions by authorities over how to handle the outbreak.

    Among the estimates cited in both reports, was the revelation that on Tuesday alone, 37 million people were newly infected with Covid-19 across China. That stood in dramatic contrast to the official number of 3,049 new infections reported that day.

    The Financial Times said it was Sun Yang – a deputy director of the Chinese Center for Disease Control and Prevention – who presented the figures to officials during the closed-door briefing, citing two people familiar with the matter.

    Sun explained that the rate of Covid’s spread in China was still rising and estimated that more than half of the population in Beijing and Sichuan were already infected, according to the Financial Times.

    The estimates follow China’s decision at the start of December to abruptly dismantle its strict zero-Covid policy which had been in place for almost three years.

    The figures are in stark contrast to the public data of the NHC, which reported just 62,592 symptomatic Covid cases in the first twenty days of December.

    How the NHC came up with the estimates cited by Bloomberg and the Financial Times is unclear, as China is no longer officially tallying its total number of infections, after authorities shut down their nationwide network of PCR testing booths and said they would stop gathering data on asymptomatic cases.

    People in China are also now using rapid antigen tests to detect infections and are under no obligation to report positive results.

    Officially, China has reported only eight Covid deaths this month – a strikingly low figure given the rapid spread of the virus and the relatively low vaccine booster rates among the elderly.

    Only 42.3% of those aged 80 and over in China have received a third dose of vaccine, according to a CNN calculation of new figures released by the NHC on December 14.

    Facing growing skepticism that it is downplaying Covid deaths, the Chinese government defended the accuracy of its official tally by revealing it had updated its method of counting fatalities caused by the virus.

    According to the latest NHC guidelines, only deaths caused by pneumonia and respiratory failure after contracting the virus are classified as Covid deaths, Wang Guiqiang, a top infectious disease doctor, told a news conference Tuesday.

    The minutes of the Wednesday closed-door NHC meeting made no reference to discussions concerning how many people may have died in China, according to both reports and the document CNN viewed.

    “The numbers look plausible, but I have no other sources of data to compare [them] with. If the estimated infection numbers mentioned here are accurate, it means the nationwide peak will occur within the next week,” Ben Cowling, a professor of epidemiology at the University of Hong Kong told CNN in an emailed statement, when asked about the purported NHC estimates.

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  • Democracy has its flaws, but it has emerged from the pandemic in much ruder health than the alternative | CNN

    Democracy has its flaws, but it has emerged from the pandemic in much ruder health than the alternative | CNN



    CNN
     — 

    For nearly half a decade, you could be forgiven for thinking just about everything in Western democracy seemed a bit broken. The social-media yelling in 140 characters. The wild populism, and dog-whistle racism. The clumsy coronavirus lockdowns and their attendant conspiracy theories. The tolerance of absolute, constant falsehoods. The questioning and beleaguering of the electoral process.

    Some began to behave as if it were smoother on the other side of the fence, in autocracies where things are just ordered to happen, and criticism is swallowed whole.

    Yet, as we stagger past the third anniversary of Covid-19’s emergence, the fallacy that autocracies are a superior social contract is crumbling. At the end of 2022, the world is a place where consent matters, and debate might actually save your hide.

    The Trump era created a safe space for autocracies to flex on the global stage, while American tried to put itself First, and its commander-in-chief was happy to receive “lovely” letters from North Korea, or get very close to the Kremlin. But it took the pandemic to expose the utter mess one man in charge can create.

    The most glaring and unimaginably stark example is Russia. President Vladimir Putin bumbled his way through the pandemic with snap lockdowns, a poorly performing vaccine, and a general disregard for how useful accurate data can be in defeating a complex foe like Nature. But it was his personal choices that led to a disconnect which has proved fatal to tens of thousands of innocent Ukrainians, and perhaps even more Russian soldiers.

    The persistent warnings from Western intelligence in January that an invasion of Ukraine was imminent seemed far-fetched to many analysts, including me. Those analysts overlooked the enormity of the task, and the assumption the Kremlin remained a rational actor. Those calming caveats were swiftly whisked away when – in the days leading up to the war – Putin summoned his security henchmen and dressed them down, at a safe distance of well over 20 feet, and then delivered a 57-minute televised speech showing he had spent the pandemic reading all the wrong parts of the internet.

    His spoken dissertation even reminded Russians how mean Bill Clinton had been 20 years ago, shunning Putin’s stated desire to join NATO. Putin’s isolation had compounded not just his historical grievances. There were now fewer subordinates in contact with him, and fewer opinions voiced to counter the absurd assumption Russia’s invasion would be welcomed by Ukrainians and last about three days.

    A RUSI report recently noted that seized Russian orders showed units expected to be “cleaning up” within 10 days, and that no effective “red team” assessment of the plan – challenging its assumptions – had happened.

    And so, the largest land war in Europe for 75 years began, and with it a likely military defeat for Russia that may rewrite the established norms of European security and see Moscow’s place as a global superpower evaporate. Putin’s insecurities over NATO and the practical task of connecting the occupied Crimean Peninsula to the Russian mainland fueled his catastrophic decision. But the Kremlin head’s isolation – along with his echo chamber of paranoid nonsense – cemented it.

    But even now, in this late stage in the Russian military demise, when its readiest form of resupply is forced conscripts to the frontline, Moscow must be mindful of consent. The “partial mobilization” announced in September has sent 77,000 Russian men to Ukraine, Putin recently said. But it has also unleashed a wave of protests perhaps not seen in Russia since the 1990s.

    Tightening the screws on dissent is a sign opposition is growing, not ebbing. The nastier Russia gets, the more acutely aware the Kremlin is of its unpopularity. Invading Ukraine was the worst decision a Russian leader has made since the Soviets invaded Afghanistan. We know how that misadventure ended.

    Police officers detain demonstrators in St. Petersburg on September 21, 2022, following calls to protest against partial military mobilisation announced by President Vladimir Putin.

    The pandemic caused economic and emotional stress in every society, leaving citizens less tolerant of poor managers and outdated dogma. Even the United Kingdom swiftly ejected two prime ministers over issues of conduct and incompetence, not long after their ruling Conservative Party had won a landslide victory at the last election.

    The economic fallout from the pandemic is also the backdrop for another dazzling failure of autocracy, in Iran. But the focal point of recent protests has been the brutal treatment of teenagers for protesting mandatory headscarves. Killing a young woman for not wanting to dress more conservatively than her grandmother perhaps did (Iran was – as recently as the 1970s – secular) is grotesque in any society.

    Iranians protest the death of 22-year-old Mahsa Amini after she was detained by the morality police, in Tehran, Iran, on October 1, 2022.

    But it lit the touch paper in communities ravaged by years of sanctions, the pandemic, and persistent inflation of perhaps as much as 50%. Permit salaries and savings to diminish that much annually, and any elected government could expect to be ousted fast. In Iran’s cities, the violence around this dogma did not distract from the economic fury, but amplify it.

    Well over half of Iran’s population was born in the 1990s, when the Islamic Revolution was already a decade old. A system born in the era of the landline is telling youth born into the world of fax machines how to behave in the era of quantum computing.

    The pandemic hit Iran hard, and I witnessed in 2020 how poorly resourced Tehran’s hospitals were. When your parent is dying and you can’t get a ventilator for them, you don’t have time for a lengthy discourse blaming US sanctions imposed because of Iran’s confrontation of the American hegemony in the region. An emergency like Covid can damage what remains of the contract between ruling conservatives and citizens: If you cannot protect us from a disease at our time of need, then what is the purpose of the corruption, repression and rules on women’s dress?

    Medical workers transport a patient with Covid-19 at Rasoul Akram Hospital in Tehran on October 20, 2020.

    The recent public confusion over whether the country’s morality police would be disbanded – a statement made by the prosecutor general which was later mauled – is a sign of government reform perhaps, but also an indication of how state power is not a tidy behemoth in Iran. There is debate, too, and here it clearly, with hundreds of corpses already underfoot, considered bending to popular will.

    This stark and deadly repression does not at this time herald the demise of the Iranian regime. But it is perhaps a moment of irreversible acceptance that the people cannot just be Ctrl-Alt-Deleted when they don’t suit the state program. It is a recognition that even the best-resourced, most controlling and efficient of repressive regimes – China – has had to deal with.

    Iranians protest the death of 22-year-old Mahsa Amini after she was detained by the morality police, in Tehran on October 27, 2022.

    The pandemic led Beijing to resort to mass control on a whole new level. Its solution to the disease ravaging the planet was to be the harshest of all – in limiting movement. The authorities’ favored tool – used to its limits – was the one almost every other society realized would not work indefinitely.

    Until recently, Chinese citizens were still being welded into their homes in quarantine, and even burning to death in one tragic instance when they perhaps could have been rescued from a domestic fire. It’s perhaps the most damning indictment of China’s one-person rule this century.

    Workers in protective clothes walk past barriers placed to close off streets in areas locked down after the detection of cases of Covid-19 in Shanghai on March 15, 2022.

    The world has been on a steep learning curve, where social distancing, economic subsidies, vaccines, agonizing deaths and limited global travel have led most societies to now accept the Covid-esque persistent cough as part of what happens in winter. Yet China’s initial decision – stifle the disease – has barely evolved. Its vaccine program has faltered, yet its original tool of mass surveillance has not.

    What is more remarkable is not protests breaking out under such an authoritarian yoke, but that President Xi Jinping did not presume they would.

    Beijing appeared to have been taken by surprise, but also believed it could repress its way out of the unrest. The recent removal of significant parts of the quarantine and testing systems does not solve China’s Covid problems. It was simply their authorities’ only choice. And it is a badly timed one. China is not adequately vaccinated to cope with a massive rise in cases, particularly its elderly population, many experts argue. Even if 1% catch it badly, that is 14 million people in need of medical care – roughly the population of Zimbabwe.

    A demonstrator holds a blank sign and chants slogans during a protest in Beijing, China, on Monday, November 28, 2022.

    Huge challenges require decision-makers of enormous ability. Xi has unparalleled power, evidenced when he sat by as his predecessor Hu Jintao was inexplicably led out during the highly choreographed closing moments of the recent National Congress. But it is pretty clear that Xi got the big decisions around Covid wrong. And that the country where SARS-Cov-2 first emerged is enduring the longest impact of the virus because of poor decisions by its leaders.

    It is a problem for Xi. The singular selling point of autocratic power is that it is absolute: that you can get things done without the delay of debate and compromise that democratic systems endure.

    The point is to be strong, implement decisions fast, and consider dissent the cost of tough, good decisions; not to appear strong, implement fast, and then change your mind publicly after months pursuing a bad idea. For Xi, it is also dangerous for a population to learn they can only truly communicate with their government through disobedience and protest.

    It’s important to feel discomfort when extolling the virtues of modern democracy. It doesn’t really work. It is slow and encourages ego and half-measures. It keeps changing its mind and wasting endless resources while stumbling for the solution.

    But it provides space for dissent and, more importantly, other, competing ideas. And, if you are forcing taxi drivers to fight in a war of choice you are losing, or shooting teenagers for taking off headscarves, or imprisoning people in their apartments to suppress a virus the rest of the world is living calmly with, alternative ideas are important.

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