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Vietnam

General:
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Viet Nam is becoming a more popular tourist destination with Irish travellers each year. In many cases these will be those who have no defined itinerary and so their travel plans may change at short
otice. Facilities for tourists vary greatly throughout the country and this needs to be borne in mind when considering some of the serious health issues which can occur throughout the country. The climate is cooler in the north and more tropical further south. There is a monsoon season from May to November each year and the Mekong Delta is prone to significant flooding. Transport during this time can be very difficult and there will be a higher incidence of various diseases during and soon after times of flooding.
Further local information on health issues in Viet Nam is available at http://www.doctorkot.com/index.htm
Safety & Security:
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The majority of those visiting Viet Nam will have no particular difficulty though street crime can be a problem in the main cities of Hanoi and Ho Chi Ming. Generally this is in the form of pick-pocketing, or snatch and grab incidents. Take care of your personal belongings at all times and tourists should not flaunt their relative wealth. Be careful while walking along the footpaths as occasionally a motorcyclist may grab at your bag or camera. Use the hotel safe to store belongings. Attacks against ships in the South China Sea are reported and it is sensible to be vigilant at all times.
Local Laws & Customs:
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Drug smuggling offences carry the death penalty. Don’t take photographs of any military or police installation and avoid any large gathering as the mood can suddenly change. Travel to some of the border areas of the country can be very restricted and so should be avoided. Religious freedom in Viet Nam is quite restricted and those attending gatherings may be detained and fined. Police may occasionally raid hotel rooms without notice. Seizure of documents, pornographic material, compact disks and other goods have lead to high fines and detention.
Road Transport:
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Traffic accidents are becoming more common throughout the country and tourists are occasionally involved with serious consequences. Hiring your own means of transport (car, motorbike etc) is generally unwise. International driving licences are not valid and those wishing to drive will need to obtain a Vietnamese licence. The streets are crowded and many road users will stop suddenly to make purchases from roadside vendors. Traffic laws are often unobserved and horns and gesticulations are used to indicate right of way! Outside the cities, buses and trucks often travel at high speed and accidents are a regular occurrence.
Food & Water:
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The level of food and water hygiene varies greatly throughout the country. Many tourists become ill following consumption of food from both street vendors and also from good quality hotels. Care should be taken at all times. Undercooked or reheated food should be avoided and tap water must be checked for the smell of chlorine. Make sure that a sealed bottle of water is brought to your table during meals. Carbonated water is safer. Bivalve shellfish meals are high risk and previously peeled fruit should not be eaten. Typhoid is reported as a particular problem in the Mekong Delta.
Malaria Risks:
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Viet Nam is endemic for malaria and the risk of transmission occurs in many regions of the country. However, the risk is highest during the monsoon season (May to November) and in the southernmost provinces of Ca Mau and Bac Lieu. The urban areas of Hanoi, Ho Chi Minh City, the Red River Delta and the coastal plain north of Nha Trang are regarded as low risk regions throughout the year.
Mosquito Borne Diseases:
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The other two main mosquito borne diseases are Dengue Fever and Japanese B Encephalitis. Both of these viral conditions can cause serious disease and it is essential that all travellers continually take special care to avoid mosquitoes. The mosquitoes which transmit Dengue tend to bite in the main urban areas while the ones that transmit Japanese B (and malaria) are more common out of the large cities.
Sun Exposure:
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The direct sunlight in Viet Nam can be very intense and both burn and dehydration can easily occur. After a long-haul flight this is a particular concern as many travellers will sleep beside the hotel pool to recover from their journey. After just a short while they may have become significantly burnt. Those trekking should increase their fluids and also take more salt in their diet if possible.
Entertainment Problems:
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Viet Nam has a reputation of a location where it is too easy to obtain sexual exposure for those unaware of the risks. This is particularly true following the consumption of alcohol. The risk of AIDS and other serious STD’s is very high and so contact should be avoided at all costs. A number of otherwise healthy male travellers have suddenly died during the past few years following what is thought to have been laced alcoholic drinks.
Rabies Risk:
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Rabies occurs throughout Viet Nam and any contact with warm-blooded animals should be avoided at all times. Dogs, Cats and Monkeys are most commonly involved in transmitting the disease to humans. Treat any exposure very seriously and wash out the wound, apply an antiseptic and seek urgent medical attention immediately.
Vaccinations for Viet Nam:
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There are no essential vaccines for entry to Viet Nam from Western Europe. However, for personal health, it is advised that all travellers consider cover against;
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Poliomyelitis (childhood booster)
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Tetanus (childhood booster)
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Typhoid (food and water borne disease)
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Hepatitis A (food & water borne disease)
For those trekking within the country there are a number of other vaccines which should be considered including Hepatitis B, Rabies, Japanese B and Meningitis.
Summary:
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The biggest risks within Viet Nam tend to be associated with food and water borne diseases, mosquito bites and the traffic. Commonsense and care is needed at all times to ensure a good safe holiday.

Travel News Headlines WORLD NEWS

Date: Mon, 9 Mar 2020 12:15:37 +0100 (MET)

Hanoi, March 9, 2020 (AFP) - Vietnamese authorities vowed Monday to punish anyone concealing sickness after 13 people caught the deadly new coronavirus on a flight to Hanoi, sparking lockdowns and panic-buying in the capital.   The Southeast Asian country had previously reported only 16 cases of the virus despite bordering China -- the epicentre of the global outbreak -- but a cluster of infections was discovered at the weekend among 201 passengers on a Vietnam Airlines flight from Britain.

The group were in quarantine Monday and recovering, Vietnam's health ministry said, with the hospital they were held in placed on lockdown along with several houses and hotels in Hanoi where they had stayed.   Vietnam Prime Minister Nguyen Xuan Phuc vowed Monday to "duly punish" those who fail to disclose a coronavirus diagnosis, according to state media.   He told a meeting of officials in Hanoi that "we need strong, adequate and immediate measures to effectively stop the source of infection".   Authorities have launched an online tool asking all citizens to declare their health status.   "Declaring false information... may be subject to criminal handling," stated an official notice.

A 29-year-old woman on the flight from London was found to be suffering from the disease after returning to Hanoi from a tour of France, Italy and Britain.   She is believed to have infected her aunt and driver, forcing authorities to isolate several houses near her home and a private hospital where she first sought treatment.   The other patients included Vietnamese, British, Irish and Mexican nationals.   A minister on the same flight tested negative for the virus but was also quarantined for 14 days with the group.   The health ministry said there may be "more cases to be discovered as a result of close contact" with the first patient.   People in the capital were seen panic-buying staple items as the lockdown of the hospital began.

The infections bring the country's total to 30, including a man who returned from South Korea, but more than 18,600 people have been monitored for illness or placed in isolation since early February. No-one has died from the virus.   Vietnam has granted limited access to visitors from China and South Korea -- another major coronavirus hotspot -- since the outbreak began at the start of the year, imposing a 14-day quarantine at government-controlled centres.   Several sports and cultural events have been cancelled across the nation, but Vietnam's inaugural Formula One race is still set to go ahead on April 5 in Hanoi.
Date: Thu, 13 Feb 2020 06:24:23 +0100 (MET)

Vinh Phuc, Vietnam, Feb 13, 2020 (AFP) - Vietnam announced Thursday that a commune of 10,000 people will be placed under quarantine due to fears over the spread of the new coronavirus.    "As of February 13, 2020, we will urgently implement the task of isolation and quarantine of the epidemic area in Son Loi commune," said a health ministry statement.    "The timeline... is for 20 days".    There are 15 confirmed cases of the COVID-19 virus in Vietnam, five of them in Son Loi commune.
Date: Sat, 1 Feb 2020 13:33:09 +0100 (MET)

Hanoi, Feb 1, 2020 (AFP) - Vietnam has suspended all China flights as part of "strengthening measures" against the coronavirus outbreak, its civil aviation authority said in a statement on Saturday.   The step applies to all airlines "which have routes between Vietnam and China" and also includes Hong Kong and Macau, the directive posted on its website said.  An earlier version included Taiwan but references to the island had been removed late Saturday.

Vietnam is the latest country to impose extraordinary travel barriers after the virus spread to two dozen nations and killed 259 people in China where it originated in the city of Wuhan.   The United States temporarily barred entry to foreigners who had been in China within the past two weeks and Australia said it was barring entry to non-citizens arriving from China.   Italy, Singapore and Mongolia have also taken similar sweeping precautions.   The World Health Organization declared the coronavirus outbreak a global health emergency on Thursday but did not advise international trade of travel restrictions.

Vietnam's announcement came after the country confirmed its sixth case of the coronavirus.   A 25-year-old hotel receptionist working in Nha Trang contracted the SARS-like pathogen after coming into contact with Chinese tourists who were later diagnosed with coronavirus.   She was also the first domestic infection for a Vietnamese national with no known history of travel to China.

Three of the country's six cases were Vietnamese nationals who had travelled to Wuhan.   The receptionist's health is "stable, no fever or cough", a hospital staffer told AFP on condition of anonymity, adding she had "no history of travel to China recently".   Vietnam has joined Thailand, China, Germany, Japan, South Korea, France and the United States as the only countries with confirmed domestic coronavirus infections.
Date: Thu, 10 Oct 2019 13:13:57 +0200 (METDST)

Hanoi, Oct 10, 2019 (AFP) - Selfie-snapping tourists railed against the closure of Hanoi's 'train street' on Thursday after police blocked off the Instragram-famous tracks for safety reasons.   The narrow railway corridor in central Hanoi has become a hotspot among visitors seeking the perfect holiday snap on the tracks -- often dodging trains that rumble through daily.    But Hanoi authorities said this week they would block people from the tracks to avoid accidents, and police on Thursday erected barricades to keep out disappointed visitors.    "I'm very frustrated because today I can't go in and take a picture," Malaysian tourist Mustaza bin Mustapha told AFP, vowing to come back later.

Dozens of other tourists were turned away, though some managed to get onto still-open sections of the railway, moving out of the way as an afternoon train chugged past.    Built by former colonial rulers, the railway once shipped goods and people across France's former Indochina colony and remains in use today by communist Vietnam's state-run railway company.    The stretch of the tracks was once known as a rough part of town, occupied by drug users and squatters until their recent discovery by camera-wielding holidaymakers who have splashed images of the area across social media.

Cafe owners complained that business would be hurt thanks to the new regulations, and that tourists always moved out of the way for oncoming trains.   "There has never been any regretful accidents here," said Le Tuan Anh, who runs a cafe from his home along the tracks.   "Compared to traffic density elsewhere in the city, this is much safer," he said, referring to Hanoi's chaotic, motorbike-clogged streets.   New signs were installed in the area Thursday, warning passersby not to take photos or videos in the "dangerous area", much to the chagrin of British tourist Harriet Hayes.   "People come from all over the world to Hanoi just to see the train go past," she told AFP.   "It's such a shame that we come and have been told that we have to leave."
Date: Wed 11 Sep 2019
Source: Saigon Giai Phong [edited]

The Hanoi-based Bach Mai Hospital yesterday [Tue 10 Sep 2019] warned of a high possibility of death from rare Whitmore's disease [melioidosis], as the disease re-occurred and killed 4 people in August [2019].

Moreover, the fatal disease infected 12 patients including a woman suffering from a severe abscess on her nose. The case was very rare, and the hospital treated such cases for the 1st time, said Director of the hospitals' Tropical Disease Center Dr. Do Duy Cuong. The patient was misdiagnosed as having sepsis caused by a staphylococcal infection at a local hospital. However, tests from her wound carried out at the center were positive for the Whitmore bacterium, _Burkholderia pseudomallei_.

The doctors had to change the treatment regimen; otherwise the patient could have died, as Dr. Cuong said. After 2 weeks of treatment, her wound had improved. However, she will still be undergoing treatment for at least 3 months under the close watch of doctors to avoid disease recurrence.

Dr. Cuong added that there have been around 20 cases of melioidosis in the past 5 to 10 years, but since the beginning of the year [2019], the center has admitted 20 cases, mostly from the northern and central provinces.

Melioidosis is an infectious disease caused by the bacterium _Burkholderia pseudomallei_. that can affect humans or animals. It is predominately a disease of tropical climates, especially in Southeast Asia and northern Australia where it is widespread.

The bacteria causing melioidosis are found in contaminated water and soil. It is spread to humans and animals through direct contact with the contaminated source. Patients developing the disease may die without proper treatment.  [Byline: Minh Khang - Translated by Uyen Phuong]
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[Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption (kava is an herbal member of the pepper family that can be associated with chronic liver disease).

Melioidosis may present at any age but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, and chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, lung, liver, and spleen, and a very high mortality rate of 80-95%. With prompt optimal therapy, the case fatality rate can be decreased to 40-50%.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials, and in fact bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy; and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the Weaponization of Infectious Diseases. Totowa NJ: Humana Press, 2008 pp 145-58. - ProMED Mod.LL]

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World Travel News Headlines

Date: Tue, 31 Mar 2020 10:27:16 +0200 (METDST)

Nairobi, March 31, 2020 (AFP) - Six of Africa's 54 nations are among the last in the world yet to report cases of the new coronavirus. The global pandemic has been confirmed in almost every country, but for a handful of far-flung tiny island states, war-torn Yemen and isolated North Korea.  In Africa authorities claim they are spared by god, or simply saved by low air traffic to their countries, however some fear it is lack of testing that is hiding the true impact.

- South Sudan -
The east African nation is barely emerging from six years of civil war and with high levels of hunger, illness and little infrastructure, observers fear the virus could wreak havoc.   Doctor Angok Gordon Kuol, one of those charged with overseeing the fight against the virus, said the country had only carried out 12 tests, none of which were positive.   He said the reason the virus has yet to reach South Sudan could be explained by the low volume of air traffic and travel to the country.   "Very few airlines come to South Sudan and most of the countries affected today they are affected by... people coming from abroad."   He said the main concern was foreigners working for the large NGO and humanitarian community, or people crossing land borders from neighbouring countries.   South Sudan has shut schools, banned gatherings such as weddings, funerals and sporting events and blocked flights from worst-affected countries. Non-essential businesses have been shuttered and movement restricted.   The country can currently test around 500 people and has one isolation centre with 24 beds.

- Burundi -
In Burundi, which is gearing up for general elections in May, authorities thank divine intervention for the lack of cases.   "The government thanks all-powerful God who has protected Burundi," government spokesman Prosper Ntahorwamiye said on national television last week.   At the same time he criticised those "spreading rumours" that Burundi is not capable of testing for the virus, or that it is spreading unnoticed.   Some measures have been taken, such as the suspension of international flights and placing handwashing stations at the entrances to banks and restaurants in Bujumbura.   However several doctors have expressed their concerns.   "There are zero cases in Burundi because there have been zero tests," a Burundian doctor said on condition of anonymity.

- Sao Tome and Principe -
Sao Tome and Principe -- a tiny nation of small islands covered in lush rainforest -- has reported zero cases because it is unable to test, according to World Health Organisation representative Anne Ancia.   However "we are continuing preparations," with around 100 people in quarantine after returning from highly-affected countries, and the WHO keeping an eye on cases of pneumonia.   With only four ICU beds for a population of 200,000 people, the country is desperate to not let the virus take hold and has already shut its borders despite the importance of tourism to the local economy.

- Malawi -
Malawi's health ministry spokesman Joshua Malango brushed aside fears that Malawi might not have registered any Covid-19 cases due to a lack of testing kits: "We have the testing kits in Malawi and we are testing."   Dr Bridget Malewezi from the Society of Medical Doctors told AFP that while "we may not be 100 percent ready", government was gearing up for the arrival of the virus.   She suggested it may only be a matter of time before the pandemic hits Malawi.    "It's only been in the past few weeks that it has been rampantly spreading across Africa so most people feel it will get here at some point...," she said.   Malawi has asked people coming from hard-hit countries to self-quarantine, which Malawezi said had helped "safeguard the country from any possible spread of the virus".

- Lesotho -
Tiny Lesotho, a kingdom encircled by South Africa with only two million inhabitants, went into national lockdown on Monday despite registering zero cases.   Until last week the country had no tests or testing centres, and received its first kits thanks to a donation by Chinese billionaire Jack Ma.   Authorities had reported eight suspected cases which they had not been able to test and the first results are expected soon.

- Comoros -
The Indian Ocean island nation of the Comoros, situated between Madagascar and Mozambique, has yet to detect a single case of the virus, according to the health ministry.   One doctor in the capital Moroni, Dr Abdou Ada, wonders if it may not be because of the wide use of the drug Artemisinin to treat malaria.   "I believe that the mass anti-malarial treatment explains the fact that the Comoros are, at least for now, spared from Covid-19. it is a personal belief that needs to be confirmed scientifically."
Date: Tue, 31 Mar 2020 09:50:04 +0200 (METDST)
By Sophie DEVILLER with Dene-Hern CHEN

Bangkok, March 31, 2020 (AFP) - Underfed and chained up for endless hours, many elephants working in Thailand's tourism sector may starve, be sold to zoos or be shifted into the illegal logging trade, campaigners warn, as the coronavirus decimates visitor numbers. Before the virus, life for the kingdom's estimated 2,000 elephants working in tourism was already stressful, with abusive methods often used to 'break them' into giving rides and performing tricks at money-spinning animal shows.   With global travel paralysed the animals are unable to pay their way, including the 300 kilograms (660 pounds) of food a day a captive elephant needs to survive.

Elephant camps and conservationists warn hunger and the threat of renewed exploitation lie ahead, without an urgent bailout. "My boss is doing what he can but we have no money," Kosin, a mahout -- or elephant handler -- says of the Chiang Mai camp where his elephant Ekkasit is living on a restricted diet.   Chiang Mai is Thailand's northern tourist hub, an area of rolling hills dotted by elephant camps and sanctuaries ranging from the exploitative to the humane.   Footage sent to AFP from another camp in the area shows lines of elephants tethered by a foot to wooden poles, some visibly distressed, rocking their heads back and forth.

Around 2,000 elephants are currently "unemployed" as the virus eviscerates Thailand's tourist industry, says Theerapat Trungprakan, president of the Thai Elephant Alliance Association. The lack of cash is limiting the fibrous food available to the elephants "which will have a physical effect", he added.  Wages for the mahouts who look after them have dropped by 70 percent.   Theerapat fears the creatures could soon be used in illegal logging activities along the Thai-Myanmar border -- in breach of a 30-year-old law banning the use of elephants to transport wood.  Others "could be forced (to beg) on the streets," he said. It is yet another twist in the saga of the exploitation of elephants, which animal rights campaigners have long been fighting to protect from the abusive tourism industry.

- 'Crisis point' -
For those hawking a once-in-a-lifetime experience with the giant creatures -- whether from afar or up close -- the slump began in late January.   Chinese visitors, who make up the majority of Thailand's 40 million tourists, plunged by more than 80 percent in February as China locked down cities hard-hit by the virus and banned external travel. By March, the travel restrictions into Thailand -- which has 1,388 confirmed cases of the virus -- had extended to Western countries.

With elephants increasingly malnourished due to the loss of income, the situation is "at a crisis point," says Saengduean Chailert, owner of Elephant Nature Park.   Her sanctuary for around 80 rescued pachyderms only allows visitors to observe the creatures, a philosophy at odds with venues that have them performing tricks and offering rides.   She has organised a fund to feed elephants and help mahouts in almost 50 camps nationwide, fearing the only options will soon be limited to zoos, starvation or logging work.  For those restrained by short chains all day, the stress could lead to fights breaking out, says Saengduean, of camps that can no longer afford medical treatment for the creatures.

Calls are mounting for the government to fund stricken camps to ensure the welfare of elephants. "We need 1,000 baht a day (about $30) for each elephant," says Apichet Duangdee, who runs the Elephant Rescue Park. Freeing his eight mammals rescued from circuses and loggers into the forests is out of the question as they would likely be killed in territorial fights with wild elephants. He is planning to take out a two million baht ($61,000) loan soon to keep his elephants fed.   "I will not abandon them," he added.
Date: Tue, 31 Mar 2020 07:10:34 +0200 (METDST)
By Bernadette Carreon

Koror, Palau, March 31, 2020 (AFP) - A coronavirus-free tropical island nestled in the northern Pacific may seem the perfect place to ride out a pandemic -- but residents on Palau say life right now is far from idyllic.   The microstate of 18,000 people is among a dwindling number of places on Earth that still report zero cases of COVID-19 as figures mount daily elsewhere.   The disparate group also includes Samoa, Turkmenistan, North Korea and bases on the frozen continent of Antarctica.

A dot in the ocean hundreds of kilometres from its nearest neighbours, Palau is surrounded by the vast Pacific, which has acted as a buffer against the virus.   Along with strict travel restrictions, this seems to have kept infections at bay for a number of nations including Tonga, the Solomons Islands, the Marshall Islands and Micronesia.   But remoteness is not certain to stop the relentless march of the new disease. The Northern Mariana Islands confirmed its first cases over the weekend, followed by a suspected death on Monday.

Klamiokl Tulop, a 28-year-old artist and single mum, is hopeful Palau can avoid the fate of Wuhan, New York or Madrid -- where better-resourced health services were overrun.   But she describes a growing sense of dread, a fear that the virus is coming or could already be on the island undetected.   "You can feel a rising tension and anxiety just shopping," she told AFP. "Stores are crowded even more during non-payday weeks."   There have been several scares on Palau, including a potential case that saw one person placed into quarantine this week as authorities await test results.

- Antarctic seclusion -
Inside Australia's four remote Antarctic research bases, around 90 people have found themselves ensconced on the only virus-free continent as they watch their old home transform beyond recognition.   There is no need for social distancing in the tundra.   "They're probably the only Australians at the moment that can have a large dinner together or have the bar still open or the gym still open," Antarctic Division Operations manager Robb Clifton told AFP.   The bases are now isolated until November, so the group is safe, but Clifton admits "the main thing that's on the mind of expeditioners is how their loved ones are going back home."

In some places, reporting no cases does not always mean there are no cases to report.   North Korea has portrayed emergency measures as an unqualified success in keeping COVID-19 out, despite sustained epidemics in neighbouring China and South Korea.   But state media also appears to have doctored images to give ordinary North Koreans face masks -- handing sceptics reason to believe the world's most secretive government may not be telling the whole truth.

- 'Waiting for the inevitable?' -
While Palau has no confirmed cases, it has still been gripped by the society-altering fears and economic paralysis that have affected the rest of the world.   Supermarket aisles in the country's largest town Koror have seen panic buying and there are shortages of hand sanitisers, masks and alcohol.   The islands depend heavily on goods being shipped or flown in, meaning supplies can quickly run low.

United Airlines used to fly six times a week from nearby Guam -- which has seen more than 50 cases -- but now there is just one flight a week.   "Look at how bad we coped when shipments were late before this pandemic happened," Tulop said. "Everyone was practically in uproar."   Residents have been practising social distancing. Doctors are waiting for test kits to arrive from Taiwan. The government is building five isolation rooms that will be able to hold up to 14 patients.   It all feels like waiting for the inevitable.   "I would like to be optimistic we won't get the virus," Tulop said. "But Palau would most definitely get it. We rely heavily on tourism and most of us even need to travel for work."

Rondy Ronny's job is to host big tourist events, but work has already dried up, and he admits to being "very anxious".   "I have loans and bills and payments due," he said. "This will definitely put me back, I hope the government will do something about our economy too, to help it recover."   Palau's biggest test may yet come with the first positive case.   But even in the most remote corners of the world, the impact of this truly global pandemic is already being felt.   Nowhere, it seems, is truly virus-free.
Date: Tue, 31 Mar 2020 04:46:26 +0200 (METDST)

Panama City, March 31, 2020 (AFP) - The government of Panama on Monday announced strict quarantine measures that separate citizens by gender in an effort to slow the spread of the novel coronavirus.   From Wednesday, men and women will only be able to leave their homes for two hours at a time, and on different days.   Until now, quarantine regulations were not based on gender.

Men will be able to go to the supermarket or the pharmacy on Tuesdays, Thursdays and Saturdays, and women will be allowed out on Mondays, Wednesdays and Fridays.   No one will be allowed to go out on Sundays.

The new measures will last for 15 days.   "This absolute quarantine is for nothing more than to save your life," security minister Juan Pino said at a press conference.   According to Pino, more than 2,000 people were detained last week for not abiding by the quarantine.   Since the first case was reported on March 10, Panama has confirmed 1,075 cases of the coronavirus, 43 of which are in intensive care, and 27 deaths.
Date: Tue, 31 Mar 2020 00:54:08 +0200 (METDST)
By Celia Lebur with AFP Africa Bureaux

Lagos, March 30, 2020 (AFP) - More than 20 million Nigerians on Monday went into lockdown in sub-Saharan Africa's biggest city Lagos and the capital Abuja, as the continent struggles to curb the spread of coronavirus.   President Muhammadu Buhari ordered a two-week "cessation of all movements" in key cities to ward off an explosion of cases in Africa's most populous country.

Businesses are being closed, non-food shops shut and people required to stay at home as officials look to track down possible carriers of the disease after reporting 131 confirmed cases and two deaths so far.   Enforcing the restrictions in sprawling Lagos will be a mammoth challenge as millions live crammed into slums and rely on daily earnings to survive.

In the ramshackle outdoor markets of Lagos Island, anxious locals complained they did not have the money to stock up, while at higher-end supermarkets better-off residents queued to buy supplies.    "Two weeks is too long. I don't know how we will cope," said student Abdul Rahim, 25, as he helped his sister sell foodstuffs from a stall in Jankarra market.    "People are hungry and they won't be able to stock food."

City officials have pledged to provide basic provisions to 200,000 households but the central government in Africa's largest oil producing nation is already facing financial strain as the price of crude  has collapsed.    The streets of Ghana's capital Accra were also empty as most people in two regions appeared to be following a presidential order to stay indoors after it went into force.

- Zimbabwe locks down -
Dozens of African nations have imposed restrictions ranging from night-time curfews to total shutdowns.    Zimbabwe, which is already suffering a recession, began enforcing a three-week lockdown after the disease left one person dead and infected six others.   Police mounted checkpoints on routes leading to Harare's central business district, stopping cars and turning away pedestrians who had no authorisation to be in the area.   "We don't want to see people here on the streets. We don't want to see people who have no business in town just loitering," a policewoman said through a loud hailer. "Everyone to their homes."

Some people were trying to head for villages.   "We would rather spend the 21 days at our rural home, where we don't have to buy everything. I can't afford to feed my family here when I am not working," said Most Jawure.   "We have been waiting here for more than two hours but there are no buses," Jawure told AFP while standing with his wife and daughter beside a bulging suitcase.

For many of Zimbabwe's 16 million people, the lockdown means serious hardship.   With the unemployment rate estimated at around 90 percent, most Zimbabweans have informal jobs to eke out a living and few have substantial savings.   As a similar scenario played out in other poor nations, the UN on Monday called for a $2.5-trillion aid package to help developing countries weather the pandemic, including debt cancellation and a health recovery "Marshall Plan".

- 'A matter of time' -
Experts warn that Africa is highly vulnerable to COVID-19 given the weak state of health systems across the continent.    The number of infections lags far behind Europe but testing has been limited and the figures are growing rapidly.    Angola and Ivory Coast on Sunday became the latest countries to record their first deaths, bringing the number of African fatalities to around 150 of nearly 4,800 recorded cases.

In Democratic Republic of Congo, two new cases were reported in the volatile South Kivu region and an adviser to the nation's president announced he had tested positive.

Ugandan President Yoweri Museveni ordered a 14-day lockdown in a bid to halt the spread of the disease after reporting 33 infections.    Police in South Sudan, one of a few nations in Africa yet to confirm a case, enforced strict new rules, shutting shops selling non-essential items and limiting passengers in public transport.   Mauritius, which has 128 cases -- the highest in East Africa -- has extended its lockdown to April 15.

South Africa's defence minister Nosiviwe Mapisa-Nqakula on Monday denounced alleged intimidation by security forces after videos emerged showing some forcing civilians to squat or roll on the ground for allegedly violating restrictions.   In an interview with local Newzroom Afrika television channel, she said she was aware of two videos "which have circulated where clearly there (is) some abuse".   "I'm saying I condemn that, we will not allow that to continue," she said.
Date: Mon, 30 Mar 2020 21:41:43 +0200 (METDST)

Kampala, March 30, 2020 (AFP) - Ugandan President Yoweri Museveni on Monday ordered an immediate 14-day nationwide lockdown in a bid to halt the spread of the coronavirus which has so far infected 33 people in the country.   Uganda last week banned public transport and sealed its borders and urged the population to stay home, but stopped short of a full shutdown.

Museveni said that from 10:00pm Monday private vehicles would also be banned, seeking to avoid give a more advanced warning that would see people flee the city, as has happened across the continent where many poor residents see better chances of survival in the countryside.   "I would have given the public time to adjust but... a longer time would give people time to go to the villages and in so doing they would transfer the very sickness we're trying to prevent. This freezing of movement will last for 14 days," he said in a televised address.

Museveni also ordered a 14-day nationwide curfew from 7:00pm.   Shopping malls and businesses selling non-food items were ordered to close.   Food market vendors who continue to trade are forbidden to return to their homes for the duration of the 14-day lockdown, while factories could stay open if remain on the premises for the duration of the shutdown.

People are still allowed to move around on foot but not gather in groups of more than five at a time.    In recent days, opposition leaders Kizza Besigye and Bobi Wine had undertaken small-scale food deliveries to people who had ost their incomes due to earlier restrictions but Museveni criticised such actions as "cheap politics".   "I direct the police to arrest the opportunistic and irresponsible politicians who tried to distribute food," he said.   "Anybody arrested in that effort will be charged with attempted murder."   Museveni said the government would begin distributing food to those who needed it, without providing details.

A weary looking Museveni, 75, pleaded with the population to change their behaviour in the face of the threat from the virus.   "This virus would not do much damage if it was not for the carelessness of people. Don't go into a group of people if you have a cold. Stay at home," he pleaded.   Last week police and Local Defence Units (LDUs) -- a uniformed militia under the control of the military - violently cleared streets in central Kampala.   Following a public outcry, army chief General David Muhoozi on Monday apologised for those actions, describing them as "high-handed, unjustified and regrettable" and said the culprits would be "dealt with".
Date: Sun 29 Mar 2020
Source: Spanish government COVID-19 update 58 [in Spanish, trans. ProMed Mod.MPP, edited]

COVID-19 update 59 [data as of 28 Mar 2020 21:00 CET]
-----------------------------------------------------
Situation in Spain
------------------
In Spain, to date [28 Mar 2020], 78 797 cases have been reported, of which 6528 have died and 14,709 recovered (table 1 and figure 1 -- at source URL above). The Autonomous Communities with the greater cumulative incidence in the last 14 days are La Rioja 419.5 per 100,000 population), Madrid 287.1 per 100,000 population), Navarre (279.4 per 100,000 population), and Castile-La Mancha (238.3 per 100,000 population) (figures 2, 3). The distribution by age groups of hospitalized patients, those admitted to the ICU, and deaths is found in table 2.

Autonomous Community:
Total / last 24 hours / Incidence per 100,000 population in past 14 days

  • Madrid: 22,677 / 1157 / 287.14
  • Catalonia: 15,026 / 763 / 186.46
  • Basque Country: 5740 / 604 / 231.45
  • Castile and Leon: 5414 / 623 / 213.46
  • Castile-La Mancha: 5246 / 734 / 238.33
  • Valencia: 4784 / 750 / 87.43
  • Andalusia: 4682 / 405 / 50.45
  • Galicia: 3139 / 367 / 109.06
  • Navarre: 2011 / 182 / 279.42
  • Aragon: 1858 / 266 / 129.69
  • La Rioja: 1629 / 193 / 419.51
  • Extremadura : 1456 / 62 / 127.47
  • Canary Islands: 1125 / 100 / 47.18
  • Asturias: 1088 / 84 / 92.98
  • Cantabria: 1023 / 86 / 167.28
  • Balearic Islands: 958 / 96 / 79.69
  • Murcia: 872 / 70 / 53.62
  • Melilla: 48 / 3 / 46.25
  • Ceuta: 21 / 4 / 23.59
********
Total: 78,797 / 6549 / 151.04
======================
[Spain has been rapidly accelerating in terms of transmission of the SARS-CoV-2. As of today (29 Mar 2020), there have been a total of 78 797 cases and 6528 deaths reported, an increase from 72 248 cases with and 5690 deaths confirmed in the preceding 24 hours. The countrywide 2-week incidence per 100 000 population is 151. It is now 2nd in Europe, behind Italy, and 4th globally behind the USA, Italy, and China, in terms of absolute numbers of cases.

Of the 78,797 cases, 43 397 (55.1%) were hospitalized, 4907 (6.2%) were admitted to the ICU. The crude reported death rate was 8.3% with more deaths occurring than reported ICU admissions.

A map of Spain showing provinces (autonomous communities) can be seen at
and a HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/43>.

La Rioja, Navarre, and Basque Country are located together in the north of the country. Madrid is in the northern part of central Spain and Castilla de la Mancha is just to the south of Madrid, with Toledo as its capital. - ProMed Mod.MPP]
Date: Sun 29 Mar 2020
Source: Worldometer [accessed 10:30 PM EDT]

USA cases by state
State: Total cases / New cases

  • New York: 59,648 / 6193
  • New Jersey: 13,386 / 2262
  • California: 6312 / 653
  • Michigan: 5486 / 836
  • Massachusetts: 4955 / 698
  • Florida: 4950 / 912
  • Washington: 4483 / 173
  • Illinois: 4596 / 1105
  • Louisiana: 3540 / 225
  • Pennsylvania: 3419 / 668
  • Texas: 2808 / 479
  • Georgia: 2683 / 237
  • Colorado / 2307 / 246
  • Connecticut: 1993 / 469
  • Tennessee: 1720 / 208
  • Ohio: 1653 / 247
  • Indiana: 1514 / 282
  • Maryland: 1239 / 247
  • North Carolina: 1167 / 145
  • Wisconsin: 1154 / 165
  • Nevada: 920 / 299
  • Arizona: 919 / 146
  • Missouri / 903 / 65
  • Virginia: 890 / 151
  • Alabama: 827 / 125
  • South Carolina: 774 / 114
  • Mississippi: 758 / 179
  • Utah: 719 / 117
  • Oregon: 548 / 69
  • Minnesota: 503 / 62
  • Arkansas: 449 / 40
  • Kentucky: 439 / 45
  • Oklahoma: 429 / 52
  • District of Columbia: 401 / 59
  • Iowa: 336 / 38
  • Kansas: 319 / 58
  • Idaho: 310 / 49
  • Rhode Island: 294 / 55
  • New Hampshire: 258 / 44
  • Maine: 253 / 42
  • New Mexico: 237 / 29
  • Vermont: 235 / 24
  • Delaware: 232 / 18
  • Hawaii: 175 / 24
  • Montana: 161 / 32
  • West Virginia: 124 / 11
  • Nebraska: 120 / 24
  • Alaska: 102 / 17
  • North Dakota: 98 / 15
  • South Dakota: 90 / 22
  • Wyoming: 87 / 3
  • Guam / 56 / 5
  • Northern Mariana Islands: 2
  • Puerto Rico: 127 / 27
  • US Virgin Islands: 21 / 0
  • Wuhan repatriated: 3 / 0
  • Diamond Princess Cruise: 46 / 0
**************
Total: 142 321 / 38 179
Total reported deaths: 2484
====================
[The above are the latest breakdowns of confirmed cases of SARS-CoV-2 infection in the USA, as per Worldometer data. The total number of confirmed cases in the USA and territories is now 142 321 including 2484 deaths. New York state, with 59 648 (41.9%) cumulative cases reports and 6193 (33.3%) newly confirmed cases over the past 24 hours, is clearly the epicenter of the outbreak in the USA, although case reporting elsewhere is showing increases. Daily reported case counts are accelerating in New Jersey, Michigan, Florida, Louisiana, Massachusetts, and Illinois.

The Centers for Disease Control and Prevention website (<https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html>) has 2 epidemic curves. One focuses on date of confirmation of disease, the other on date of onset of illness. The curve of interest, by date of onset of disease, is based on 14.6% of the number of cases plotted on the epidemic curve using date of confirmation of disease.

A map of the United States can be seen at
<http://www.mapsofworld.com/usa/> and a HealthMap/ProMED-mail map at
Date: Sun 29 Mar 2020 11:46 AM GST
Source: Reuters [abridged, edited]

Iran's coronavirus death toll has risen to 2640, a health ministry official said on Sunday [29 Mar 2020], as the Middle East's worst-hit country grapples with the fast-spreading outbreak. "In the past 24 hours we had 123 deaths and 2901 people have been infected, bringing the total number of infected people to 38 309," Alireza Vahabzadeh, an adviser to the health minister, said in a tweet. "12,391 people infected from the virus have recovered." Health ministry spokesman Kianush Jahanpur told state TV that 3467 of those infected were in "critical condition".  "I am happy to announce that also 12,391 people who had been infected across the country have recovered," Jahanpur said. "The average age of those who have died of the disease is 69."

President Hassan Rouhani urged Iranians to adapt to their new way of life, which was likely to continue for some time. "We must prepare to live with the virus until a treatment is discovered ... The new measures that have been imposed are for everyone's benefit ... Our main priority is the safety and the health of our people," Rouhani said during a televised meeting.

The government has banned inter-city travel after warning of a potential surge in coronavirus cases because many Iranians defied calls to cancel travel plans for the Persian New Year holidays that began on [20 Mar 2020]. The authorities told Iranians to stay at home, while schools, universities, cultural, religious, and sports centres have been temporarily closed.

To stem the spread of the virus in crowded jails, Iran's judiciary on Sunday [29 Mar 2020] extended furloughs for 100,000 prisoners. On [17 Mar 2020], Iran said it had freed about 85,000 people from jail temporarily, including political prisoners. "The 2nd wave of (the) temporary release of prisoners had already started and their (100,000 prisoners) furloughs have been extended until [19 Apr 2020]," judiciary spokesman Gholamhossein Esmaili was reported as saying by state television. Iran said it had 189,500 people in prison, according to a report submitted by the UN special rapporteur on human rights in Iran to the Human Rights Council in January [2020].  [byline: Parisa Hafezi]
===================
[In the 24 hours from 28 to 29 Mar 2020, the number of cases of COVID-19 confirmed in Iran grew from 35 408 to, 38 309, an increase of 2901 newly confirmed cases. The number of deaths has also increased from 2517 to 2640 an increase of 123 deaths in the 24-hour period. In terms of total numbers of confirmed cases, Iran ranks 7th globally behind USA, Italy, China, Spain, Germany and France. In early March 2020, Iran and Italy were on the same trajectory with respect to daily growth in cumulative newly confirmed cases, but starting 8 Mar 2020, Italy's daily reported newly confirmed cases accelerated at an alarming speed. By 14 Mar 2020, Italy was reporting almost twice as many cases as Iran on a daily basis.

A map of Iran showing provinces can be seen at
HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/128>. - ProMed Mod.MPP]
Date: Sun 29 Mar 2020
Source: Italian Government Health Ministry [in Italian, machine trans., edited]

Cases in Italy as of 6:00 pm 29 Mar 2020
----------------------------------------
Regarding health monitoring related to the spread of the new coronavirus [SARS-CoV-2] on the national territory, there are a total of 97,689 cases. At the moment 73,880 people are positive for the virus; 13,030 people have recovered. There are 27,386 patients hospitalized with symptoms, 3906 are in intensive care, and 42,588 are in home isolation.

There have been 10,779 reported deaths, however, this number can only be confirmed after the Istituto Superiore di Sanita has established the actual cause of the death.

Case distribution by province:
number of cases (number of new cases in past 24 hours)

  • Lombardy: 41 007 (1592)
  • Emilia-Romagna: 13 119 (736)
  • Veneto: 8358 (428)
  • Marche: 3558 (185)
  • Piedmont: 8206 (535)
  • Tuscany: 4122 (305)
  • Campania: 1759 (167)
  • Lazio: 2706 (201)
  • Liguria: 3076 (254)
  • Friuli Venezia Giulia: 1480 (44)
  • Sicily: 1460 (101)
  • Apulia: 1549 (91)
  • Umbria: 1023 (54)
  • Abruzzo: 1293 (160)
  • Molise: 127 (4)
  • Trento: 1594 (89)
  • Bolzano: 1214 (105)
  • Sardinia: 638 (14)
  • Basilicata: 202 (20)
  • Aosta Valley: 584 (73)
  • Calabria: 614 (59)
*********
Total: 97,689 (5217)
======================
[The tally of confirmed cases of COVID-19 in Italy is now 97,689 cases, including 10,779 deaths, up from 92,472 cases and 10,023 deaths reported on 28 Mar 2020. The 24-hour change between 28 and 29 Mar 2020 was 5217 newly confirmed cases, compared with 5974 newly confirmed cases between 27 and 28 Mar 2020. Cases continue to be concentrated in Lombardy (41 007), the epicenter of the outbreak, Emilia-Romagna (13 119), and Veneto (8358), all in the northern part of the country. Those 3 provinces combined account for 52.8% of newly confirmed cases in the past 24 hours, representing a drop from the previous 24 hours when they represented 56.% of nationally reported cases. Another active province is Piemonte with a total of 8206 cases and represents 10.3% of newly reported cases. In the past 24 hours Tuscany has reported 5.9% of newly reported cases, a slight drop from the preceding day when it was reporting 6.1% of newly confirmed cases. There is an excellent interactive map at <http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1> to visualize the caseloads per region in near real time.

On 9 Mar 2020, Italy announced a lockdown for the northern provinces where the outbreak was concentrated. On 10 Mar 2020, this was expanded to be countrywide. On 11 Mar 2020, Italy announced the closure of non-essential businesses. It is now 19 days since the start of the lockdown in the north and 18 days since the countrywide lockdown.

A map of Italy showing regions can be seen at
HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/75>. - ProMed Mod.MPP]