COVID 19: Beyond the US and China

[kato]

Austria finally entered lockdown to add to the list of euopean countiries. Few countires which have gotten into trouble look like they can avoid a second.

Austria has been fully quarantining localized hotspots for weeks (not just a lockdown, a full Italian-style "close the border to that town").

This provides a real chance of ending the pandemic in the 2021 calendar year.

Eh, not even remotely seeing that happening. By the end of 2021 we may have sufficient production to vaccinate high-risk groups only, and contracts with both Pfizer and Moderna based on their scaled-up production estimats are roughly sufficient to cover that. For industrial western countries only of course.

Spreaders won't be seeing any vaccinations in 2021 other than through underhanded deals to the detriment of the high-risk vaccination strategy.

In addition, given the communication strategy chosen i'm now seeing a really hard third wave around the beginning of Q2/2021.

P.S. Pfizer won't be finishing its clinical trial with the current group until the end of 2022 in order to see if their vaccine provides any long-term protection at all btw.

[tantalus]

Eh, not even remotely seeing that happening. By the end of 2021 we may have sufficient production to vaccinate high-risk groups only, and contracts with both Pfizer and Moderna based on their scaled-up production estimats are roughly sufficient to cover that. For industrial western countries only of course.

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I think pfizer estimated 1.3 billion doses. Iam assuming 2 doses to a person. Will there be potential for the Gates foundation and certain countries to create more production lines by q3 or Q4?

Iam not sure what moderna can manufacture and we should expect other vaccines to come through.

To break transmission (to a very high degree, its a spectrum of return as you roll it out) we can only guess but the number often cited is 60-70%. We should discount those under 16 (for 2021) and we will get help by those who have been infected and are stil retaining some levels of immunity from winter and spring waves. I definitely exaggerated (so am doing some backtracking, clarifying and goal post moving forgive me) when I said end but break the chains of transmission that hospital capacity wont get overun looks possible/on the table by Q4.

Keeping in mind that vaccinating health workers and high risk groups will disproportionately impact hospital capacity favourably and from both ends....low hanging fruit and the law of diminishing returns....

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In addition, given the communication strategy chosen i'm now seeing a really hard third wave around the beginning of Q2/2021.
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Well....that will be one of the big stories when this is all said and done. Communication.

But no matter what I agree first half of 2021 is very tough and tricky to navigate.

P.S. Pfizer won't be finishing its clinical trial with the current group until the end of 2022 in order to see if their vaccine provides any long-term protection at all btw.

Ya I think we just need to assume boosters and second gen vaccines as per my clarification above, not "end", but potentially break the back of the pandemic.

[tantalus]

Initially and in the early phases the hard bit will be avoiding giving more back then we get, as the vaccine rolls out people get so sloppy it outweighs the initial gains but eventually we will break through that,

[kato]

In North Germany police dissolved a burial ceremony for violating Covid restrictions - there were 400 guests present, many without masks. In Bremen, where this happened, burials are limited to 100 people outdoors only with required masks, distancing, desinfection, contact avoidance and documentation of guests; in most other German states it's limited to 10 people. Police intervened and dissolved the crowd, sending them home

There have been some very large burials of members of muslim Lebanese clans in the Ruhr area, which drew relatively large crowds as well. However in these cases - after some problems back in the first two months - the family tended to sit down with the police and municipal government in advance to organize the crowds (of up to 750) to orderly and observing restrictions visit the grave in smaller groups.


It's somewhat unusual that this happened in a North Geman city this time (where people are more standoffish and gruff) - in general, burials in rural South Germany can be relatively elaborate, although it has been going down there in recent years too. Actually talked about the topic with my father back in March when this was also restricted during the first lockdown, who considered it potentially problematic - my grandfather's burial in the 60s (as the family head of the time) apparently also drew nearly 500 guests.

[kato]

The town of Speyer, 20 km from me, currently has the third-highest incidence rate for Covid in Germany (at 363.9/100,000 residents in last rolling 7 days). Both districts higher than it have full lockdowns including stay-at-home orders, i.e. Speyer is the district with the highest incidence rate where people can still move around at will.

In Hildburghausen, the district at the top (at 629.8 today) a crowd of 400 anti-lockdown protesters was dispersed with pepper spray by police on the night from wednesday to thursday. The chief administrator of the rural district criticized the protesters in the press the next morning. He's now under police protection after receiving death threats.

[kato]

In Hildburghausen, the district at the top (at 629.8 today) a crowd of 400 anti-lockdown protesters was dispersed with pepper spray by police on the night from wednesday to thursday. The chief administrator of the rural district criticized the protesters in the press the next morning. He's now under police protection after receiving death threats.

Hildburghausen district, becoming effective in about 4 hours, has outlawed all public and private events, festivities or assemblies. This includes all religious activity except for last rites and funerals, as well as all political assemblies whether in public or in private estates. All municipalities within the district are to suspend all political meetings of their administration (e.g. city councils).

Since there's a constitutional right to (political) assembly i'm giving it about 48 hours for a court to strike it down.

[JRT]

(succinct caption to a video at this link)

The Covid-19 pandemic is driving a spike in suicides in Japan

27 November 2020

In October 2020, more people died by suicide in Japan than were killed by the novel coronavirus in 10 months. Experts say this alarming spike is being partially driven by women, who often work in industries most affected by the pandemic. CNN's Selina Wang speaks to a Japanese woman who attempted suicide when she was struggling to make ends meet.

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In Japan, more people died from suicide last month than from Covid in all of 2020. And women have been impacted most

by Selina Wang, Rebecca Wright, Yoko Wakatsuki

Posted 28 November 2020
Updated 29 November 2020

Tokyo(CNN)Eriko Kobayashi has tried to kill herself four times.

The first time, she was just 22 years old with a full-time job in publishing that didn't pay enough to cover her rent and grocery bills in Tokyo. "I was really poor," said Kobayashi, who spent three days unconscious in hospital after the incident.

Now 43, Kobayashi has written books on her mental health struggles and has a steady job at an NGO. But the coronavirus is bringing back the stress she used to feel.

"My salary was cut, and I cannot see the light at the end of the tunnel," she said. "I constantly feel a sense of crisis that I might fall back into poverty."

Experts have warned that the pandemic could lead to a mental health crisis. Mass unemployment, social isolation, and anxiety are taking their toll on people globally.

In Japan, government statistics show suicide claimed more lives in October than Covid-19 has over the entire year to date. The monthly number of Japanese suicides rose to 2,153 in October, according to Japan's National Police Agency. As of Friday, Japan's total Covid-19 toll was 2,087, the health ministry said.

Japan is one of the few major economies to disclose timely suicide data -- the most recent national data for the US, for example, is from 2018. The Japanese data could give other countries insights into the impact of pandemic measures on mental health, and which groups are the most vulnerable.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," said Michiko Ueda, an associate professor at Waseda University in Tokyo, and an expert on suicides.

"That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."

Covid's toll on women
Japan has long struggled with one of the highest suicide rates in the world, according to the World Health Organization. In 2016, Japan had a suicide mortality rate of 18.5 per 100,000 people, second only to South Korea in the Western Pacific region and almost triple the annual global average of 10.6 per 100,000 people.

While the reasons for Japan's high suicide rate are complex, long working hours, school pressure, social isolation and a cultural stigma around mental health issues have all been cited as contributing factors.

But for the 10 years leading up to 2019, the number of suicides had been decreasing in Japan, falling to about 20,000 last year, according to the health ministry -- the lowest number since the country's health authorities started keeping records in 1978.

The pandemic appears to have reversed that trend, and the rise in suicides has disproportionately affected women. Although they represent a smaller proportion of total suicides than men, the number of women taking their own lives is increasing. In October, suicides among women in Japan increased almost 83% compared to the same month the previous year. For comparison, male suicides rose almost 22% over the same time period.

There are several potential reasons for this. Women make up a larger percentage of part-time workers in the hotel, food service and retail industries -- where layoffs have been deep. Kobayashi said many of her friends have been laid off. "Japan has been ignoring women," she said. "This is a society where the weakest people are cut off first when something bad happens."

In a global study of more than 10,000 people, conducted by non-profit international aid organization CARE, 27% of women reported increased challenges with mental health during the pandemic, compared to 10% of men.

Compounding those worries about income, women have been dealing with skyrocketing unpaid care burdens, according to the study. For those who keep their jobs, when children are sent home from school or childcare centers, it often falls to mothers to take on those responsibilities, as well as their normal work duties.

Increased anxiety about the health and well-being of children has also put an extra burden on mothers during the pandemic.

Akari, a 35-year-old who did not want to use her real name, said she sought professional help this year when her premature son was hospitalized for six weeks. "I was pretty much worried 24 hours," Akari said. "I didn't have any mental illness history before, but I could see myself really, really anxious all the time."

Her feelings got worse as the pandemic intensified, and she worried her son would get Covid-19.

"I felt there was no hope, I felt like I always thought about the worst-case scenario," she said.

"A Place for You"
In March, Koki Ozora, a 21-year-old university student, started a 24-hour mental health hotline called Anata no Ibasho (A Place for You). He said the hotline, a nonprofit funded by private donations, receives an average of over 200 calls a day, and that the vast majority of callers are women.

"They lost their jobs, and they need to raise their kids, but they didn't have any money," Ozora said. "So, they attempted suicide."

Most of the calls come through the night -- from 10 p.m. to 4 a.m. The nonprofit's 600 volunteers live around the world in different timezones and are awake to answer them. But there aren't enough volunteers to keep up with the volume of messages, Ozora said.


University student Koki Ozora started a 24-hour mental health hotline staffed by volunteers in March. They now get more than 200 calls a day.

They prioritize the texts that are most urgent -- looking for keywords such as suicide or sexual abuse. He said they respond to 60% of texts within five minutes, and volunteers spend an average of 40 minutes with each person.

Anonymously, over online messaging, people share their deepest struggles. Unlike most mental health hotlines in Japan, which take requests over the phone, Ozora says many people -- especially the younger generation -- are more comfortable asking for help via text.

In April, he said the most common messages were from mothers who were feeling stressed about raising their kids, with some confessing to thoughts of killing their own children. These days, he says messages from women about job losses and financial difficulties are common -- as well as domestic violence.

"I've been accepting messages, like 'I'm being raped by my father' or 'My husband tried to kill me,'" Ozora said. "Women send these kinds of texts almost every day. And it's increasing." He added that the spike in messages is because of the pandemic. Before, there were more places to "escape," like schools, offices or friend's homes.

Pressure on children
Japan is the only G-7 country where suicide is the leading manner of death for young people aged 15 to 39. And suicides among those under 20 had been increasing even before the pandemic, according to health ministry.

As pandemic restrictions take children out of school and social situations, they're dealing with abuse, stressful home lives, and pressures from falling behind on homework, Ozora said. Some children as young as five years old had messaged the hotline, he added.

School closures during the pandemic in the spring have contributed to homework piling up; kids also have less freedom to see friends, which is also contributing to stress, according to Naho Morisaki, of the National Center for Child Health and Development. The center recently conducted an internet survey of more than 8,700 parents and children and found that 75% of Japanese schoolchildren showed signs of stress due to the pandemic.

Morisaki says he thinks there's a big correlation between the anxiety of children and their parents. "The children who are self-injuring themselves have the stress, and then they can't speak out to their family because probably they see that their moms or dads are not able to listen to them."

Stigma of solving the problem
In Japan, there is still a stigma against admitting loneliness and struggle. Ozora said it's common for women and parents to start the conversation with his service with the phrase: "I know it's bad to ask for help, but can I talk?"

Ueda says the "shame" of talking about depression often holds people back.

"It's not something that you talk about in public, you don't talk about it with friends or anything," she said. "(It) could lead to a delay in seeking help, so that's one potential cultural factor that we have in here."

Akari, the mother of the premature baby, agrees. She had previously lived in the US, where she says it seems easier to seek help. "When I lived in America, I knew people who went through therapy, and it's a more common thing to do, but in Japan it's very difficult," she said.

Following the financial crisis in the 1990s, Japan's suicide rate surged to a record high in 2003, when roughly 34,000 people took their own lives. Experts say the shame and anxiety from layoffs, of mostly men at the time, contributed to depression and increased suicide rates. In the early 2000s, the Japanese government accelerated investment and efforts around suicide prevention and survivor support, including passing the Basic Act for Suicide Prevention in 2006 to provide support to those affected by the issue.

But both Ozora and Kobayashi say it has not been nearly enough: reducing the suicide rate requires Japanese society to change.

"It's shameful for others to know your weakness, so you hide everything, hold it in yourself, and endure," Kobayashi said. "We need to create the culture where it's OK to show your weakness and misery."

Celebrity suicides
A succession of Japanese celebrities have taken their lives in recent months. While the Japanese media rarely details the specifics of such deaths -- deliberately not dwelling on method or motive -- the mere reporting on these cases often causes an increase in suicide in the general public, according to experts such as Ueda.

Hana Kimura, a 22-year-old professional wrestler and star of the reality show "Terrace House," died by suicide over the summer, after social media users bombarded her with hateful messages. Hana's mother, Kyoko Kimura, says she was conscious that media reports on her daughter's death may have affected others who were feeling suicidal.

Kyoko Kimura says coronavirus restrictions prevented her daughter, Hana, from wrestling. Hana became overwhelmed by negative comments on social media and subsequently took her own life.
"When Hana died, I asked the police repeatedly not to disclose any concrete situation of her death, but still, I see the reporting of information only the police knew," Kimura said. "It's a chain reaction of grief."

Kimura said the pandemic led her daughter to spend more time reading toxic social media messages, as she was unable to wrestle because of coronavirus restrictions. Kimura is now setting up an NGO called "Remember Hana" to raise awareness about cyberbullying.

"She found her reason to live by fighting as a professional wrestler. It was a big part of her. She was in a really tough situation as she could not wrestle," Kimura said. "The coronavirus pandemic made society more suffocating."

Professional wrestler Hana Kimura took her own life over the summer.
The third wave
In recent weeks, Japan has reported record-high daily Covid-19 cases, as doctors warn of a third wave that could intensify in the winter months. Experts worry that the high suicide rate will get worse as the economic fallout continues.

"We haven't even experienced the full economic consequences of the pandemic," Ueda said. "The pandemic itself can get worse, then maybe there's a semi-lockdown again; if that happens, then the impact can be huge."

Compared with some other nations, Japan's coronavirus restrictions have been relatively relaxed. The country declared a state of emergency but has never imposed a strict lockdown, for example, and its quarantine restrictions for international arrivals have not been as unbending as those in China.

But as cases rise, some worry harsher restrictions will be needed -- and are concerned about how that could affect mental health.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," Ueda said. "That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."

Despite having to deal with a salary cut and constant financial insecurity, Kobayashi says she is now much better at managing her anxiety. She hopes that by speaking publicly about her fears, more people will do the same and realize they are not alone, before it's too late.

"I come out to the public and say that I have been mentally ill and suffered from depression in the hope that others might be encouraged to speak out," Kobayashi said. "I am 43 now and life starts to get more fun in the middle of my life. So, I feel it's good that I am still alive."

How to get help: In the US, call the National Suicide Prevention Lifeline at 1-800-273-8255. The International Association for Suicide Prevention and Befrienders Worldwide also provide contact information for crisis centers around the world.

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...

[tbm3fan]

Japan has always had a high suicide rate compared to others. Yet when it comes to toeing the line on anti-virus protocols they have to be one of the best in the world consequently their low death rate. That is no surprise to me based on my experiences flying JAL. Almost all passengers are Japanese, many are wearing masks on the flights and this was in the 90s, they are polite, they are quiet, they stay in their seats, they are orderly upon embarking and disembarking. Flying to Tokyo for 10 hours was extremely peaceful compared to some chaos on Chinese airlines ( Singapore to Taiwan to China in that ordr) and total chaos on Philippine airlines.

[Albany Rifles]

Kato,

Apropos of nothing....I forgot you are near Speyer.

Spent quite a bit of time in Germersheim.

[kato]

Spent quite a bit of time in Germersheim.

Actually was over there a few months ago to have a look at the small mall they turned a former Bundeswehr depot in one of the 18th century fortress casemates into.
I think the last time before that that i was in Germersheim was when the Air Force guys wanted to show off their fancy new shooting simulator to us groundhogs.


Situation in Speyer seems to be slowly relaxing - although they just announced that they'll switch schools to a two-shift system on wednesday (pupils one day in school, one day distance learning).

Baden-Württemberg state over on this side of the Rhine is by rumours currently preparing legislation for full lockdowns with stay-at-home orders for all hotspot districts above 200 cases/100,000 residents in last 7 days.

[Albany Rifles]

I did some work 1998-2002 at the depot there at Germersheim. I also spent a lot of tie all over Baden-Wurttemburg, Bayern, Swabia, & Rhineland-Pfalz...as recently as 2018.

Basically if there is an American flag there I was there on business. Also spent a bit of time at Waldorf at SAP HQ. When HQ USAREUR & Vth Corps was in Heidelberg we used to stay in Leimen all the time.

[snapper]

UK first to approve a vaccine... why? Possibly because it is likely that tarrifs may apply from next month.

[tantalus]

I hear merkel is floating a december 27th lockdown as they are unhappy with how lockdown lite has gone. Whats the dynamic on this kato? Hard to see how they would settle on a december start date....

[kato]

I hear merkel is floating a december 27th lockdown as they are unhappy with how lockdown lite has gone. Whats the dynamic on this kato? Hard to see how they would settle on a december start date....

Merkel doesn't decide anything in this regard - any sort of lockdown is up to the states. The federal government tries to coordinate this somewhat in regular meetings between Merkel and the minister-presidents of the states. Usually this results in some sort of "intended package" announced in the media which the states then tend to water down significantly in their territories.
These meetings go for a couple hours of negotiations over video conference, until some form of consensus is found - and the state governments tend to transfer their adaption into law pretty quickly, typically within 1-2 days. They also discuss other things, but Corona tends to be the focus in recent months.

There are several states who have been calling for another meeting before Christmas with the intention of trying to coordinate more stringent lockdown rules compared to the last "package" announced. The regular next meeting would be on Jan 4th. The main actors in this are Minister-President Winfried Kretschmann, Greens of Baden-Württemberg state (where hotspots above 200 incidence rate already have lockdowns/curfews) and Minister-President Markus Söder, Christian Socialists of Bavaria state (which just declared a state of emergency again, in the form of a state-wide lockdown).

One idea that has been floated in German media for this next meeing is fully locking down between Dec 27th and either Jan 3rd or Jan 10th - including closing all shops etc (like in Spring) and possibly extending christmas vacations in schools for that period. The idea is being pushed by Karl Lauterbach, Social Democrat member of the Federal Parliament and a Harvard graduate in epidemiology. Given that this comes from the federal level and i haven't seen any support for it from any states i'm giving it a zero percent chance of being passed. The states don't really go along with these kind of fed shenanigans.

[kato]

Given that this comes from the federal level and i haven't seen any support for it from any states i'm giving it a zero percent chance of being passed.

Except today Kretschmann has publicly stated that he agrees with Lauterbach and wants a full lockdown.

Baden-Württemberg state will also introduce a further restricted Phase 5 restriction set for hotspots above an incidence rate of 300. Currently only one city is above that.
Oh, and selling alcohol "to-go" will be banned in our state. This is due to crowds forming around stands selling mulled wine - there have been a couple incidents the last couple days in which police had to dissolve such crowds (sometimes with pepperspray) and hand out dozens to hundreds of fines.