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Central African Republic

Central African Republic US Consular Information Sheet
April 01, 2008
COUNTRY DESCRIPTION:
The Central African Republic is one of the world’s least developed nations and has experienced several periods of political instability since inde
endence from France in 1960.
Despite an on-going peace process and the presence of a democratically-elected government in the capital, Bangui, rebels still control large portions of the northern provinces in the country, and highway bandits prey on civilians and travelers in much of western CAR. In the country’s Dzanga-Sangha National Park in the southwest, facilities for tourists are being developed but remain limited. Read the Department of State Background Notes on the CAR at http://www.state.gov/r/pa/ei/bgn/4007.htm for additional information.
ENTRY/EXIT REQUIREMENTS:
A valid passport, visa, and evidence of yellow fever vaccination are required for entry. Travelers should obtain the latest information and details from the Embassy of the Central African Republic, 1618 22nd Street NW, Washington, DC 20008, telephone: (202) 483 – 7800/7801, fax: (202) 332 – 9893. Overseas, inquiries should be made to the nearest Central African Republic Embassy or Consulate. NOTE: In any country where there is no Central African Republic diplomatic mission, the French Embassy has authorization to issue a visa for entry into the Central African Republic.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
See the Department of State’s Travel Warning for the CAR.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Crime remains a significant problem in the capital, Bangui, though it has decreased notably in recent years. Americans should exercise caution while traveling around the city and immediate environs. Petty theft remains a problem in large market areas, particularly in the crowded markets near KM 5 on the outskirts of the city. Armed gangs may operate in outlying residential areas. During previous periods of civil unrest and civil conflict, including most recently in 2002 and 2003, foreign mercenaries and citizens engaged in widespread looting and damaged much of the city’s infrastructure. In the northern and western parts of the country, there are consistent reports of armed robbery and kidnapping by highway bandits (called “coupeurs de routes” or “zaraguinas”), especially during the December to May dry season. When a crime does occur in Bangui, the victim may have to pay to send a vehicle to pick up police officers due to the shortage of police vehicles and fuel.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are extremely limited in the CAR, and the quality of acute care is unreliable. Sanitation levels are low. Many medicines are not available; travelers should carry properly labeled prescription drugs and other medications with them.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning CAR is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In Bangui, road conditions vary, and many roads have large holes and degraded points that prevent the normal flow of traffic. Only a small portion of the roads in the country, including in the capital, are paved, and many of the compacted dirt roads have been degraded. Drivers tend to prefer to drive on the smoothest portion of the road and ignore basic traffic laws, thus slowing the flow of traffic and increasing the risk of collision. The city of Bangui does have a public transportation system consisting of green buses and yellow taxis, though these vehicles are often dangerously overcrowded and very badly maintained.
Due to the risk of armed attacks on motorists in the northern and western regions of the country, overland travel in these areas should be avoided.
Any driving outside the capital should be only during daylight hours.
Most remote areas in the CAR that are frequented by tourists are accessible only by four-wheel drive vehicles, although some roads are not passable at all during the rainy season, from May to October.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in the Central African Republic, the U.S. Federal Aviation Administration (FAA) has not assessed the CAR’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Taking photographs of police or military installations, or any other government buildings, is prohibited. Unauthorized photography may result in the seizure of photographic equipment by CAR authorities. Police or other government authorities can provide information and grant permission for photographing a particular subject or location.
Corruption remains a serious problem among CAR security forces, some members of which have harassed travelers for bribes and small amounts of money. At night, the roads in the capital are often manned with impromptu checkpoints, at which police or other military members ask motorists and travelers for money.
Banking infrastructure remains limited in the CAR, and facilities for monetary exchange exist only in the capital. There are no ATMs in the CAR, and exchange bureaus normally accept dollars and euros but not West African Francs (CFA).

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Central African laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the CAR are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
The U.S. Embassy in Bangui resumed operations in January 2005, following the evacuation of all American staff in 2002 during the civil conflict and looting in Bangui in 2002. The Embassy’s American presence increased in 2006, and a new American Ambassador to the CAR presented his credentials to President Bozize in 2007. Nonetheless, the Embassy continues to operate with limited staffing, and can only provide basic services to American citizens in the CAR.

Americans living or traveling in the CAR are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within the CAR. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located on Avenue David Dacko, B.P. 924, Bangui, tel: 2161-0200; fax: 2161-4494.
*

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This replaces the Country Specific Information for Cameroon dated December 21, 2007, to update sections on Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Fri, 27 Mar 2020 18:17:31 +0100 (MET)

Bangui, Central African Republic, March 27, 2020 (AFP) - The Central African Republic, a poverty-stricken state that the UN has singled out as highly vulnerable to coronavirus, has stepped up measures over fears that the disease is spreading locally.   President Faustin-Archange Touadera, in a statement received by AFP on Friday, said that after four cases of infection ad been detected, all among people coming from abroad, a fifth had now surfaced.

In this light, "there are grounds for fearing local transmission" of coronavirus, he said.   New measures unveiled by the authorities include a two-week ban on people coming in from countries where the virus is being transmitted locally, except for diplomats and NGO workers.

Schools, childcare facilities and universities are being closed, and restrictions have been placed on movement between the capital Bangui and the rest of the country.   The United Nations on Wednesday said the CAR "is one of the least prepared countries to face a COVID-19 outbreak, with 2.2 million people already in need of health assistance and about 70 percent of health services provided by humanitarian organisations."   The country has been ravaged by three civil wars in 20 years and remains prey to violence from armed groups that control two-thirds of the country.
Date: Wed 4 Mar 2020
Source: WHO Disease outbreak news [abridged, edited]

The Central African Republic (CAR) has experienced an upsurge in measles cases as a result of outbreaks since 2019. The 1st case of measles was recorded in week 5 of 2019 (week commencing 28 Jan 2019) and the outbreak has continued through to week 7 of 2020 (week commencing 10 Feb 2020), with 18 health districts affected including 12 newly affected in 2020 (Bimbo, Begoua, Bangui I, Bangui II and Bangui III in the urban area, Bossembele, Bouar, Bozoum, Baboua-Abba, Haute-Kotto, Nangha-Boguila, and Ouango-Gambo in the rural area).

From 1 Jan 2019 through 16 Feb 2020, a total of 7626 suspected cases

including 83 deaths (case fatality rate 1.08%) were reported. A large proportion of cases (72%) were below 5 years old and 18% of cases were between 5 and 10 years old. A total of 1167 samples from suspected cases were tested at the reference laboratory of the Institut Pasteur in Bangui, of which 180 were positive for measles using Immunoglobulin M (IgM).

The low vaccination coverage for routine measles vaccine over the past 5 years (below 60% for the 1st dose at 9 months), the absence of a 2nd measles vaccine dose in the national immunization schedule, and inadequate follow-up campaigns resulted in a high proportion of people susceptible to measles, contributing to the ongoing epidemic. All 35 health districts are at risk of a measles outbreak, and without adequate response, the epidemic could spread through the entire country. The number of districts affected by the measles outbreak is increasing, and as of 1 Mar 2020, 15 health districts have been affected: Alindao, Alindao-Mingala, Baboua-Abba, Bambari, Bangui I, Bangui II, Bangui III, Begoua, Bimbo, Bococaranga-Koui, Bossembele, Bouar, Bozoum, Haute-Kotto, Nangha-Boguila, Ngaoundaye, and Ouango-Gambo.

In December 2019, outbreaks affected 8 health districts, and the country organized local measles vaccination campaigns that targeted children aged 6 -- 59 months in 7 districts (Bambari, Batangafo, Bocaranga-Koui, Grimari-Kouango, Kemo, Ngaoundaye, and Nana-Gribizi). Despite vaccination coverage of more than 95%, as confirmed by the vaccination coverage survey, new cases are being recorded in these districts and neighboring health districts in children aged from 5 -- 15 years old. Based on the age distribution of cases as indicated by epidemiological investigations, the proposed vaccination strategy is to target the risk group from 6 months -- 10 years to help stop transmission.

Public health response
----------------------
Since the official declaration of the outbreak by Ministry of Health on 24 Jan 2020, the following public health actions have been conducted:
- COUSP (Center for Emergency Operations in Public Health) and the Local Crisis Committee have been activated to coordinate the response.
- The Ministry of Health with support from WHO and other partners are developing a comprehensive response plan, which includes the vaccination campaigns.
- Epidemiological surveillance in the affected areas has been strengthened.
- Referral system of severe measles cases to the district health hospital has been set up with free care being offered to measles cases.
- Distribution of drugs and medical supplies to support provision of free medical care is ongoing.
- Isolation units have been established at the district hospital.
- The routine immunization program is being strengthened.
- Health promotion and risk communication activities are ongoing.
- Efforts are underway to mobilize resources to respond to the outbreak.

WHO risk assessment
-------------------
WHO estimates the overall risk for the CAR from the current measles outbreak to be "high" due to the following reasons:
- The geographic expansion of the epidemic into new health districts.
- The large number of districts with high risk for measles outbreaks, due to low vaccination coverage.
- An increase in the number of cases reported in 2019 compared to 2018.
- The security context of the country which limits access to set up rapid response measures in affected health districts.
- The lack of infrastructure, inputs and resources to ensure free health care.
- The lack of trained staff available for the clinical management of complications of measles.
- Suboptimal measles-containing-vaccine first-dose (MCV1) vaccination coverage of 49% for the past 5 years according to joint WHO / UNICEF estimates, and administrative coverage of 71% in 2019.
- Large population movements between vaccinated and unvaccinated localities.
- Risk at the regional level is assessed as moderate given the large cross border movements of populations to and from neighboring countries including Chad, Democratic Republic of the Congo and Cameroon, both for security reasons and commercial activities.
Date: Tue, 29 Oct 2019 11:56:44 +0100 (MET)

Bangui, Central African Republic, Oct 29, 2019 (AFP) - The worst flooding in two decades in the Central African Republic has left at least 28,000 people homeless, the country's Red Cross said Tuesday, with the government calling the disaster a "huge natural catastrophe".   Torrential rains have pounded the country for several days, causing the Oubangui River and its tributaries to overflow.   "The latest toll is 28,000 people made homeless" across the former French colony, Central African Red Cross president Antoine Mbao-bogo told AFP, adding that entire neighbourhoods are "underwater".

In the capital Bangui, with a population of about one million, mud homes have literally dissolved in the floods.   "Today our country, and not just the city of Bangui, faces a huge natural catastrophe," government spokesman Ange-Maxime Kazagui said in a television address late Monday.   "The Oubangui River has burst its banks, and its tributaries can no longer flow into it, creating a phenomenon of massive overflow."   The country's main river overflows about once a decade, with a 1999 disaster causing major destruction -- but Mbao-bogo said the current flooding is even worse.   "Add to that the deep poverty of our compatriots," he said.

The country of some 4.7 million people, which faces brutal violence from armed groups despite a peace pact signed this year, is one of the world's poorest countries.    With more than two-thirds of the country controlled by militias fighting the government or each other, about a quarter of the population have fled their homes.   Kazagui said Bangui residents living on the banks of the Oubangui had been hit especially hard.   "Drinking water is lacking. There are problems with latrines, mosquitos, cold and the risk of epidemics such as cholera," he said.   "We don't have the infrastructure to shelter people, but we expect that NGOs will provide tents and shelters," Kazagui said.
Date: Sun 1 Sep 2019
Source: WHO Weekly Bulletin on Outbreaks and Other Emergencies, Week 35 [edited]

On 19 Aug 2019, the Institut Pasteur of Bangui (IPB), Central Africa Republic, reported a confirmed case of Rift Valley fever (RVF) in Bossembele health district, Boali sub-prefecture. The case-patient is a 45-year-old male farmer from Bogoin village who initially fell ill on 5 Aug 2019 and presented, on 8 Aug 2019, to the local health facility with fever, chills, headache, nausea, asthenia, myalgia, arthralgia and retro-ocular pain. As part of influenza surveillance, a blood specimen was collected on 9 Aug 2019 and transported to the IPB. Test results released on 19 Aug 2019 confirmed RVF infection by reverse transcriptase-polymerase chain reaction. As of 24 Aug 2019, the case-patient remained in admission in good clinical condition.

Outbreak investigations carried out by the rapid response team identified 7 additional suspected RVF cases from the same health district, 5 through records review in the local health facility and 2 by active case search in the affected community. A total of 12 blood specimens (5 from suspected cases and 7 from healthy control cases) were collected and are being analysed at the IPB; the test results are pending. The suspected cases, with ages ranging from 5 to 45 years, are being followed as outpatients.

Additionally, animal health investigations carried out in the affected community reportedly identified sick domestic animals (mainly cows and sheep), manifesting symptoms such as runny nose, cough and diarrhoea. A total of 21 blood specimens were collected from the sick animals (cows and small ruminants) and taken for laboratory analysis and the test results are pending.

Further epidemiological and entomological investigations are ongoing, and updates will be provided as new information becomes available.

Public health actions
The Ministry of Health is coordinating the response to the RVF outbreak through the emergency operations centre, with support from the health partners.

A multisectoral national rapid response team, comprising of both public and animal health specialists, and entomologists was deployed from 21-24 Aug 2019 to conduct in-depth outbreak investigation.

The epidemiological and laboratory surveillance have been enhanced, and healthcare workers have been oriented on the standard case definition for RVF to facilitate early case detection. Data collection and reporting tools have been distributed to the health facilities.

Case management is ongoing in the affected health district, with some suspected cases being managed as outpatients.

Risk communication activities using various channels are ongoing in the affected communities, however this needs to be enhanced.

Situation interpretation
Health authorities in Central African Republic have reported a new outbreak of RVF, the 1st time such an event has been formally reported in the country. Information on the circulation of RVF virus (RVFV) in Central African Republic is limited, partly due to gaps in the surveillance system, and specifically due to limited surveillance for RVF disease. Literature indicates that RVFV was 1st isolated in Central African Republic in 1969 from a pool of _Mansonia africana_ mosquitoes. However, a recent study in Central African Republic detected RVFV-specific antibodies in humans, and 15 strains [isolates] of RVFV were isolated from humans and sylvatic mosquitoes.

The current confirmation of RVF in the country should alert health authorities to strengthen surveillance for the disease and other zoonoses. Additionally, in-depth epidemiological and entomological investigations should be undertaken to properly understand the epidemiology of the disease and identify all potential vectors species in the country. The ongoing rainy season, running from May to October 2019, may result in increased [mosquito] vector density, constituting another risk factor for escalation of RVF.
======================
[It is interesting that this year (2019) it was a human case that signaled the presence of Rift Valley fever virus RVFV) in the country. The results of the subsequent field studies by the multidisciplinary rapid response team found additional human cases and evidence that the virus is being transmitted to livestock.

Finding evidence of RVF virus in the Central African Republic (CAR) is not surprising. Last year (2018), human and animal cases occurred in neighboring South Sudan (see Valley fever - South Sudan (09): (EL) human, animal, WHO http://promedmail.org/post/20180410.5735975). If focal geographic areas of transmission are identified in this CAR situation, increased surveillance of people and livestock should be initiated and livestock vaccination considered. RVF-infected livestock can pose a significant risk to humans in contact with them, often livestock owners and veterinarians. Abortions in livestock with a loss in productivity present an economic problem for many ethnic groups that depend on them for livelihoods. Apparently, this RVF outbreak did not result in an abortion storm that could have had serious economic, social and public health consequences. It is likely that RVF virus will persist in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Central African Republic: <http://healthmap.org/promed/p/66>]
Date: Fri 1 Feb 2019
Source WHO Weekly Bulletin on Outbreaks and Other Emergencies [edited]

During the period 2 Mar 2018 - 27 Jan 2019, 34 cases of monkeypox, of which 25 are confirmed, have been reported to the WHO. There have been 2 deaths.

Since 2 Oct 2018, clusters of cases have been identified across 3 health districts, namely; Mbai-ki district with 9 cases including 8 confirmed, Bangassou district with 5 cases including 3 confirmed, and Bossembele district with 4 cases including 3 confirmed. One death was reported in Bossem-bele. Previous clusters have occurred in 3 districts: Bangassou (weeks 9-11, 9 cases including 6 confirmed), Bambari (weeks 13-16, 15 cases including 3 confirmed) and Mbaiki (weeks 26-27, 5 cases including 2 confirmed).
====================
[ProMED-mail has been reporting sporadic cases of monkeypox (MPX), which are not new to the Central African Republic (CAR). Since 2013, CAR has been experiencing at least one MPX outbreak every year, especially in its eastern region. The case fatality rate continues to be very low.

Prevention of MPX virus infections will not be possible without knowing the source of infection. The question remains about the source of these recent infections within Nigeria, Cameroon, Liberia, and more recently in CAR. Monkeys are not the reservoirs of the virus, despite the name that the virus has received.

One wonders whether there is an MPX virus epizootic going on in rodent hosts across a relatively wide geographic area in CAR and the other affected countries. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or in previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected.

The MPX virus clade involved in this outbreak and previous ones is not mentioned. As noted in previous ProMED-mail posts, the monkeypox virus clade in the Congo Basin causes more severe disease in humans -- with a case fatality rate of 11-17 percent -- than the clade in Ghana, which causes few fatalities. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Central African Republic: <http://healthmap.org/promed/p/66>]
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World Travel News Headlines

Date: Tue, 7 Apr 2020 13:16:35 +0200 (METDST)

Madrid, Spain, April 7, 2020 (AFP) - Spain's daily coronavirus death toll shot up to 743 on Tuesday after falling for four straight days, lifting the total to 13,798, the health ministry said.   However, it emphasised that the rise was due to weekend deaths being tallied and that the overall "downward trend" is continuing.   The new figure represents a 5.7 percent increase over the 637 deaths recorded on Monday, the lowest number of fatalities since March 24 in the world's second hardest-hit country after Italy in terms of deaths.

The number of new infections also grew at a faster pace, rising 4.1 percent to 140,510, the health ministry said. The number of new cases had risen by 3.3 percent on Monday.   The "slight" rise was due largely to the fact that many deaths and new infections which occur over the weekend are only now being tallied, said Maria Jose Sierra of the health ministry's emergencies coordination unit.   "In reality the downward trend is what we continue to observe in the reports we have received in recent days," she told a daily news conference to discuss the figures.   The number of people in hospital intensive care units continues to fall, she added.   Spain had seen the number of new infections and death drop each day since it recorded a record 950 fatalities on Thursday.   But the percentage increase in the number of new deaths is far lower than the 32.63 percent leap recorded as recently as March 21.

Mari Angels Rodriguez, a nurse at the Hospital Josep Trueta hospital in Girona in northeastern Spain, said the volume of work in the intensive care unit had fallen "a lot".   "The collapse in the first few days was brutal, everyone was coming to emergency services, all the usual causes as well as all the possible cases of COVID-19," she told AFP.   "What wears me out the most is seeing young and middle aged people, without chronic conditions, who arrive in moderate shape and quickly end up in the intensive care unit (ICU)."   "The other day a 17-year-old girl was admitted to hospital and the next day she was in the ICU. It is full of young people. Psychologically you are not ready for this," she added.   "It hits you the speed with which a patient gets seriously ill. When they start to get bad, it is like they are drowning, in half an hour they are intubated or are dead."
Date: Tue, 7 Apr 2020 12:57:35 +0200 (METDST)

Seoul, April 7, 2020 (AFP) - Two elderly South Korean coronavirus patients recovered from severe pneumonia after being treated with plasma from survivors, researchers said Tuesday, offering hope in the face of the global pandemic.   Scientists have pointed to the potential benefits of plasma -- a blood fluid -- from recovered individuals who have developed antibodies to the virus enabling the body's defences to attack it.   Since emerging in China in December, the coronavirus has killed almost 75,000 people as drugmakers worldwide race to develop a vaccine and treatments for the disease.

Plasma therapy could become "an alternative treatment for patients in critical condition who do not respond to antiviral drugs," said Choi Jun-yong, a doctor and researcher at Severance Hospital in Seoul, where both patients were treated.   But large-scale clinical trials were needed to prove its effectiveness, he added.   One of the two patients was a 71-year-old man with no underlying conditions who only improved when treated with plasma from a recovered patient in his 20s, along with steroids.   He was initially given malaria drugs and a respirator for severe pneumonia.   The other patient, a 67-year-old female, also did not respond to initial treatments including malaria, HIV drugs, and oxygen therapy. She began to recover after receiving plasma therapy and steroids at the same time, researchers said.

Their findings were published in the peer-reviewed Journal of Korean Medicine.   Kwon Jun-wook, an official at Seoul's Central Disease Control Headquarters, said plasma therapy was "important" when there was "currently no vaccine or treatment available" for the virus.    He called on experts to examine the two cases urgently.   Research on plasma and other therapies "will proceed quickly", Kwon added.   Small studies on plasma have demonstrated its effectiveness in treating infectious diseases, including Ebola and SARS.

Trials started in France on Tuesday involving 60 patients in Paris hospitals, half of whom will receive plasma from recovered patients.   The US Food and Drug Administration authorised physicians to experiment with the strategy to fight the coronavirus, and tests are also being carried out in China.   South Korea endured one of the worst early outbreaks of the virus, but appears to have brought it under control thanks to its extensive "trace, test and treat" programme.
Date: Tue, 7 Apr 2020 12:55:32 +0200 (METDST)

Athens, April 7, 2020 (AFP) - Hundreds of Greek healthcare workers demonstrated on Tuesday to protest at working conditions and lack of manpower and equipment in public hospitals during the coronavirus pandemic.   The demonstrations were staged to coincide with World Health Day, according to the federation of hospital personnel.   "You only saw us when we covered our faces," proclaimed a poster printed by hospital trade unions, bearing a picture of doctors wearing anti-coronavirus masks.    Demonstrators at the large Evangelismos hospital in central Athens held up signs demanding job hiring, virus testing and hospital equipment.

Police tried to enter the hospital courtyard where the rally was taking place before being forced back by demonstrators, an AFP photographer said.   A similar protest was held at the main hospital in Larissa in central Greece, according to images from public television ERT.    Despina Tossonidou, president of the doctors' union at Voula hospital in southern Athens, said that in addition to the hiring of medical staff, intensive care units in private clinics should be requisitioned "to overcome the shortcomings of the public sector" during the virus crisis.   Health care in Greece was drastically affected by the country's 2010-2018 financial crisis and tough austerity required by creditors in exchange for bailouts.

As part of its measures to deal with the pandemic, the government has offered clinics 30 million euros ($32.6 million) and announced the hiring on short-term contracts of 2,000 doctors and 2,000 nursing staff.    "These measures are just a drop in the ocean," said Tossonidou, a radiologist.    "The hospital system needs 30,000 additional permanent doctors," she said, also citing the lack of protective equipment and COVID-19 testing in hospitals.    "The majority of tests are currently carried out in private hospitals at costs ranging from 150 to 300 euros ($163-326)," said Tossonidou.    Greece, a country of around 10.7 million people, has suffered relatively less than other European nations in the pandemic, recording 81 deaths out of 1,755 cases.
Date: Tue, 7 Apr 2020 11:28:32 +0200 (METDST)

Tokyo, April 7, 2020 (AFP) - Japan on Tuesday declared a state of emergency over a spike in coronavirus cases, ramping up efforts to contain infections but stopping short of the strict lockdowns seen in other parts of the world.  The government has come under mounting pressure to tackle an outbreak that remains small by global standards but has raised concerns among Japanese medical experts, with warnings that local healthcare systems are already overstretched.   "As I decided that a situation feared to gravely affect people's lives and the economy has occurred... I am declaring a state of emergency," Abe said.   The move allows governors in seven affected regions including Tokyo to ask people to stay indoors and request businesses close.

But many supermarkets and other shops will stay open, transport will continue to run and there are neither enforcement mechanisms nor penalties laid out for those who fail to comply with government requests.   "Although a state of emergency is declared, it won't mean a city lockdown as seen overseas," Abe said.   "We will prevent the spread of infection while maintaining economic and social services such as public transport as much as possible."   Pressure to declare an emergency had increased after Tokyo reported several days of record infections, with 143 new cases logged on Sunday.

Tokyo Governor Yuriko Koike has already asked residents of the capital to avoid unnecessary outings and work from home, but had pushed for an emergency declaration to give her requests legal strength.   Seven regions are covered by the month-long declaration: Tokyo, neighbouring Chiba, Kanagawa and Saitama, the western hub of Osaka and neighbouring Hyogo, and the southwestern region of Fukuoka.   The measure will last through to the end of the Golden Week holiday period, when much of the country travels in a rare break.

- 'Lives at stake' -
"It may cause inconvenience in daily life, but I call for everyone's cooperation because lives are at stake," Koike told reporters earlier.   The measure also allows governors to commandeer property for medical purposes and close public facilities like schools, many of which have already shut down.   The economic impacts of the measure and the broader global pandemic have raised concern of a recession in Japan, and Abe on Monday unveiled plans for a stimulus package worth around $1 trillion, or 20 percent of gross domestic product.

Japan has so far been spared the sort of virus outbreak seen in parts of Europe and the United States, with close to 4,000 confirmed infections and 80 deaths.   But medical experts have repeatedly sounded the alarm in recent weeks, citing the rapid increase of infections in parts of the country.    And on Monday, doctors in Tokyo said the situation in the capital was already in "critical condition".

- Public backing -
In a bid to ease the pressure, rules requiring people infected with the virus to stay in hospital even if their symptoms are mild have been relaxed, with Koike saying hotels would be designated as quarantine facilities for those in non-serious condition.   The government has also pledged to step up testing capacity and the number of beds and ventilators available to treat those in serious condition.

The state of emergency is a relatively relaxed approach to lockdown compared to other parts of the world, a function of Japan's legal system, which restricts the government's ability to limit the movement of citizens.   "Japan is still haunted by the negative legacy of the war and the oppression of its citizens," said Yoshinobu Yamamoto, an emeritus professor of international politics at the University of Tokyo.   But he warned that there could be calls for stronger measures if the outbreak continues to spread.

Japan saw its first case of the virus in mid-January, and came under heavy criticism for its handling of the coronavirus-wracked Diamond Princess, where an on-board quarantine ended with over 700 people contracting the virus and 11 deaths.   In the capital, people expressed support for the state of emergency, with some saying they felt it should have been declared sooner.   "When you see on TV what's going on in New York with the cases doubling within three, four days, it really sends chills down my spine," 76-year-old Mitsuo Oshiyama told AFP.   "I don't understand why the government waited so long."
Date: Tue, 7 Apr 2020 10:17:01 +0200 (METDST)

Helsinki, April 7, 2020 (AFP) - Finland announced tougher controls on Tuesday to further reduce arrivals from its neighbours including Sweden, where measures to tackle the coronavirus have been less severe and infection rates  higher.   The two countries' land border in Lapland is usually crossed by thousands of workers and families every day, although traffic across the Swedish and Norwegian borders has fallen by 95 percent since the government banned all but essential traffic on March 14, Finland's Interior Minister Maria Ohisalo told a press conference.   "In addition to extending the measures (for a month until May 13), quarantine requirements for arrivals will be tightened," Ohisalo said.

Under the new measures, workers must now carry a permission slip from their employer stating that the border crossing is essential and must remain under quarantine for 14 days on arrival in Finland.    The measures come after a senior Finnish infection specialist called for an end to work-related travel over the Lapland border, where 2,000 border crossings a day were still being made.    "It is a significant risk when so many people are coming through the border every day," Dr Markku Broas of Lapland Central Hospital told Finnish public broadcaster Yle on 29 March.

As of Monday, Sweden had recorded 477 deaths from coronavirus, compared with just 27 in Finland.   But while Finland has imposed emergency laws closing schools, blockading its capital region and forcing restaurants to close, Sweden has taken a notably softer approach with far fewer restrictions than elsewhere in Europe.

On Tuesday, Finland also announced that passenger ferries linking Finland with Germany, Estonia and Sweden would also stop selling tickets from Friday, as all existing restrictions on movement were extended for a further month until May 13.   Ohisalo told the press conference that the measures so far had succeeded in slowing the spread of the virus in Finland and that the government would begin "an exit conversation" in the coming days about when to roll back the restrictions.
Date: Tue, 7 Apr 2020 07:07:55 +0200 (METDST)
By Philippe Carillo

Port Vila, Vanuatu, April 7, 2020 (AFP) - A deadly cyclone destroyed much of Vanuatu's second-largest town but early warnings appeared to have prevented mass casualties in the Pacific nation, with some residents sheltered in caves to stay safe, aid workers said Tuesday.   Tropical Cyclone Harold, which claimed 27 lives when it swept through the Solomon Islands last week, lashed Vanuatu's northern provinces overnight as a scale-topping category five superstorm.   The town of Luganville, population 16,500, took a direct hit as winds of 235 kilometres per hour (145 miles per hour) brought down buildings and caused flash flooding.

World Vision's Vanuatu director Kendra Gates Derousseau said the charity's local manager told her the damage was comparable to the last category five monster to hit the country, Cyclone Pam in 2015.   "I managed to speak to her on a satellite phone and she estimated about 50 percent of dwellings have been significantly damaged, the World Vision office has lost its roof," she told AFP.   "She mentioned that she has heard no reports of casualties or any significant injuries at this time," the Port Vila-based aid worker added.

Communications remain down across much of the country and Gates Derousseau said the scale of the disaster would remain unclear until remote island communities, such as southern Pentecost, had been contacted.   "They were directly in the eye (of the cyclone) and they have very few concrete buildings, they shelter in traditional thatch dwellings or caves," she said.   Red Cross Vanuatu secretary general Jacqueline de Gaillande said the communications issues meant that the most recent updates she received were social media posts from the charity's local staffers on Monday evening.   "They showed a lot of damage but we have no numbers of casualties yet," she told AFP.

- COVID-19 complications -
A massive international aid effort was launched after Cyclone Pam in 2015 flattened Port Vila, killed 11 people and wiped out almost two-thirds of the country's economic capacity.   Gates Derousseau said a similar operation was unlikely in Harold's wake because Vanuatu was determined to remain one of the world's few places with no confirmed COVID-19 cases.   She said allowing an influx of international aid workers risked inadvertently importing the virus, so Vanuatu's international borders would remain closed to new arrivals.

"It (the aid effort) has to be locally led, locally driven, working with humanitarian partners who are currently in-country.   "There are already large stockpiles of supplies in place, which is a lesson we learned from Pam, so we can get to work fairly quickly."   She said replacement supplies could be brought in from overseas once the stockpiles ran out, but they would be disinfected to ensure they were virus-free.   Vanuatu lacks the health infrastructure to deal with even a mild coronavirus outbreak, with local media reporting last month that the nation of 300,000 has only two respiratory ventilators.

Cyclone Harold has already caused widespread damage in the Solomon Islands, where an inter-island ferry ignored weather warnings and 27 people died after being washed off its decks.   Modelling early Tuesday showed it continuing to track southeast, passing south of Fiji as a category four Wednesday and weakening to category two as it brushes Tonga a day later.   However, the storm system has already proved unpredictable, with forecasters initially expecting it to only reach category three before petering out.   Fiji on Tuesday pre-emptively issued cyclone alerts for its southern islands, warning of high seas and damaging gale-force winds.
Date: Tue, 7 Apr 2020 04:07:12 +0200 (METDST)

Copenhagen, April 7, 2020 (AFP) - Denmark is to gradually lift restrictions put in place to fight the new coronavirus, starting with the reopening of day-care nurseries, kindergartens and primary schools from April 15.   Prime Minister Mette Frederiksen said that according to health authorities "it is appropriate and justified to start a slow opening. But on condition that everyone keeps their distance and washes their hands."

The reopening of schools will take place gradually, with kindergartens and primary schools opening from April 15 and middle and high schools waiting until May 10, she told a press conference on Monday.   Bars, restaurants, nightclubs, shopping centres, hairdressers and massage parlours will remain closed, and gatherings of more than 10 people are still prohibited.   "Daily life is not going to return as before for the moment. We will live with many restrictions for many more months," the prime minister warned.   Border closures remain in place and travel abroad is not recommended.

Large gatherings are prohibited until August.   Frederiksen called on Danes to keep observing health rules and social distancing.   "A little slip in our individual behaviour can have a big impact on our well-being as a society," she said.    Denmark closed its borders to foreigners on March 14, the same day it recorded its first coronavirus fatality, and days later closed bars and restaurants and most shops.

The Nordic nation has recorded 4,875 infections and 187 deaths related to COVID-19.    It is the second European country after Austria to unveil its plans for a gradual easing of restrictions.
Date: Tue, 7 Apr 2020 00:04:15 +0200 (METDST)

Rabat, April 6, 2020 (AFP) - Wearing face masks in public will be obligatory in Morocco from Tuesday in a bid to stem the spread of coronavirus, according to an official decree.   The decision was announced late Monday after a government meeting on how to control the epidemic.   Morocco imposed a public health state of emergency on March 19, confining everyone to their homes except those with a permit to be out and about for their work.

Police, security agents and soldiers in armoured cars have been deployed around the country, erecting road barriers and control points.   The official number of COVID-19 cases in Morocco has doubled in a week to 1,120, including 80 fatalities.   The real numbers are likely to be significantly higher as there is a lack of testing gear in the country.
Date: Mon, 6 Apr 2020 22:58:13 +0200 (METDST)

Sao Paulo, April 6, 2020 (AFP) - The epicentre of the coronavirus outbreak in Latin America, Brazil's Sao Paulo state, said Monday it expects 111,000 deaths in the next six months, and extended its stay-at-home measures another two weeks.   The forecast -- an official projection, the state government said -- would appear to put Brazil on track to become one of the worst-hit countries in the world.   The global death toll from the virus currently stands at 70,000, according to a tally compiled by AFP.

Sao Paulo, the teeming industrial hub where the new coronavirus first appeared in Latin America, has confirmed 4,620 cases and 275 deaths so far.   Governor Joao Doria, who closed non-essential businesses on March 24 and advised people to stay home, said containment measures would be needed for at least two more weeks or the situation would get far worse.   "If we continue seeing people in the streets and gathering unnecessarily, we will go to more restrictive measures," he told a news conference.   Police are already authorized to break up crowds by force if necessary, he said.

Without containment measures, Sao Paulo -- whose capital is the mega-city of the same name -- would register 270,000 deaths in the next six months, said the head of the state's public health research institute, Dimas Covas.   Brazil has been the Latin American country hit hardest by the new coronavirus, with 553 deaths and more than 12,000 confirmed cases so far.   Health experts warn under-testing means the real number is likely much higher.

Sao Paulo, a state whose population of 46 million makes it about the size as Spain, has seen more infections and deaths than any other.   The state is probably facing another 1,300 deaths this week, Covas said.   The governor has openly clashed over containment measures with far-right President Jair Bolsonaro, who claims they are needlessly wrecking the economy over a disease he has compared to a "little flu."
Date: Mon, 6 Apr 2020 22:54:10 +0200 (METDST)

Jerusalem, April 6, 2020 (AFP) - Israel will ban inter-city travel from Tuesday to Friday this week in order to forestall the spread of coronavirus during the Passover holidays, Prime Minister Benjamin Netanyahu said.    "There will be a lockdown between Tuesday from 4:00 pm (1300 GMT) until Friday at 7:00 am -- you must stay in your cities and villages," he said late Monday on television.

He also said that on Wednesday evening, when the traditional Seder meal for Passover is to be held, only people living under the same roof will be permitted to interact.     "Every family must stay at home and nobody can leave their homes between 6:00 pm on Wednesday and 7:00 am on Thursday," the prime minister added.     "The coming days will be decisive for the state of Israel," he said.    Coronavirus has so far killed 57 people in the Jewish state and infected more than 8,900, according to official figures.    Cases in Israel are concentrated heavily in the ultra-Orthodox community where health restrictions have been slow to take root, with some refusing to accept the limitations.

Netanyahu on Friday gave the green light for soldiers to be deployed in the mostly ultra-Orthodox city of Bnei Brak, which is considered the centre of Israel's novel coronavirus outbreak.   In his address on Monday, the premier pointed to "positive signs of progress" in the fight against coronavirus.   "We can envisage starting to come out of quarantine progressively after Passover, but it will depend on you," he told citizens.   Israelis are currently restricted from venturing out more than 100 metres (330 feet) from their homes, except to go to the supermarket, pharmacy or hospital.