Tuesday, May 19, 2020
I’m no “Anti-Vaxxer”, but I’m not one to go running out to get my flu shot either. As a matter of fact, I don’t think I’ve gotten my flu shot since I left the Army in 1994. Maybe I did once at some point as an obligation, or to impress a lady, but I was definitely never a big fan of it. On that same note, I don’t think that people who DO get their flu shot every year are stupid; influenza is a real virus that has killed millions of people. Some people are more susceptible to illnesses and if you think you need it, you should get it. I just never get sick and I’m generally in great health, so I decided to never get the vaccine … until today … against my will. When I woke this morning, I already had a busy schedule planned and adding “getting the flu shot” definitely wasn’t on that list. It wasn’t even on my mind. While having breakfast, Queen Sayira received some very exciting news, “Free Flu shots for kids at Parque Omar, today!”, she read. Brett Jr froze immediately, I could hear his adrenal gland erupt, spilling epinephrine into his bloodstream; his muscles tensed, blood pressure spiked and his heart pounded in a panic. The very utterings of the word “shot” was enough to provoke this involuntary chemical reaction. The best part during this physiological chaos, was Brandon. He was gone, disappeared. I had to review the security cameras just to see the moment when he slid under the table only to disappear like a skulking shadow. And where in the heck did he get those Ninja Smoke Bombs!? It’s normal for kids to hate getting shots. Any kid who likes to get shots, should be analyzed thoroughly and family pets should be monitored for signs of torture. So, you always wondered why little Billy had a CIA waterboard starter kit under his bed? Now you know!
I employed some tracking techniques and quickly locatedBrandon hiding in our cashew tree. I confiscated his nunchakus and throwing stars and sat both of my boys down for “the talk”. No, not THAT talk, I mean the talk about getting vaccinated and the importance it has as preventive medicine. You should have seen them trying to negotiate their way out of it. You would have thought we were negotiating the end of a trade war. Before I knew it, they had agreed to purchase agricultural, industrial and energy products and I was still demanding structural changes with respect to forced technology transfers! I really had them against the ropes. Then Queen Sayira in all her benevolence and wisdom proposed, “You’re getting your vaccination too, right?”. Damn it…. “Whoo whoooo’s ssssside are you on, woman!?”, I stammered loudly. The trade war just took a turn for the worst. I might as well relax my tariffs on steel and aluminum if I’m going to get anywhere with them now. Then my conventionally silent son, Brett spoke up. “Dad, we’ll do it, if you do it.” Brandon´s face clinched as he elbowed his big brother. I leaned back in my chair, our eyes still fixated on one another. “Fine, I’ll do it on one condition”, I told him. “What are your terms, dear father?”, he asked. “I’ll get the shot first, then your mother will take you in right after. Your new bedtime is no later than 10 PM, you’re up for breakfast no later than 7 AM. Together you both cut the grass for the next two months and feed the hummingbirds.”, I suddenly realized that I was trying to negotiate MY way out of getting the same shot they were trying to get out of just a minute ago. “Deal!”, he said. That smug, sly, cold-blooded kid really knows how to make a deal.
So off I embarked on my journey into the city, first to my chiropractor appointment and then on to Parque Omar, in an effort towards keeping my end of the bargain. I told the boys that from what I’d been told, you didn’t even have to get out of the car to get the shot and they gave you ice cream afterward. I pulled up and immediately realized that my Intel was wrong on both accounts. There was a line of about 15 people and even though I was the one that was going to get them ice cream, the parlors are still closed. Foiled again. I almost backed out of it once I realized that I didn’t bring my shot card, but decided to go through the motions anyway. I’ll get to the table and they’ll deny me for not having it, I thought. Nope. They were prepared for wimps like me. Within 10 minutes, I had parked, cleaned my feet on their contraption, had my temperature taken, cleaned my hands with alcohol, gone through the line, gotten a new vaccination card and got stuck in my left arm. Little did I know that the boys had already negotiated eating more vegetables “from now on” to get out of getting their shot today. Oh man, did I get played!!!
TOP NEWS and TIDBITS
PANAMA PIONEERS WITH THE INVESTIGATION OF CONVALESCENT PLASMA
Panama, the country most affected by the coronavirus in Central America, with more than 9,726 cases in a two-month pandemic, is experimenting with the use of convalescent plasma as a therapeutic treatment for people hospitalized for this disease, in a pioneering trial in the region.
The use of convalescent plasma is based on the fact that patients recovered from COVID-19 have more resistant defenses, which can help a faster recovery. This is done through a machine that separates the plasma from the rest of the blood.
In the main building of the Social Security Fund (CSS), located in the center of Panama City, those rehabilitated have donated their blood for weeks. The CSS added that the use of convalescent plasma as a treatment for COVID-19, is a protocol that is under investigation in Panama, as an alternative treatment for patients affected by this virus who are confined in the hospital ward.
The therapy is based on the patient receiving antibodies from someone else who had the virus but has since recovered. Antibodies from a person recovered from the disease caused by the coronavirus are proteins that could help fight infection. There, a group of health specialists injects a needle into each of the donor’s forearms to perform a transfusion. On the one hand, the flow goes out to the machine that divides the plasma from the liquid and on the other the donor receives the rest of the blood properties. In 30 minutes they manage to fill a 600-milliliter plasma bag, which will then be frozen by medical personnel for future use.
Brett’s Comments: Having donated plasma before, it’s definitely a different experience from just donating blood. I would definitely keep my eye on this procedure as it should give some relief to those suffering from the illness.
GRUPO TOVA: IN PROGRESS DESPITE PARALYSIS
The conglomerate made up of Steven’s, Madison and El Campeón is advancing in a business reconfiguration as required by the new era of local commerce. The confinement meant the Tova Group reinvented its operation. After the complete closure of its 21 branches on March 20, this conglomerate of clothing stores decided to move into the new era of commerce. Jack Esquenazi, CEO of the company, details that for several weeks they have been training employees according to the new health and grooming protocols, they acquire enough sanitary supplies, they fine-tune the online sales platform and they meet in committees to prepare to hoist a sail. Once the Government authorizes the reopening of this type of business.
“We hope that the sanitary protocols of the stores come out as soon as possible. It is very difficult [an opening] when the protocols come out a few days before,” Esquenazi maintains.
To cushion the avalanche of purchases when the date for the reopening of department stores is announced, the Tova Group stocked up on huge quantities of hygiene products. He brought from the East “hundreds of thousands of masks” and enough antiseptic gel and alcohol and other supplies. Retail experts anticipate that shoppers will turn to businesses if they look as clean as an operating room.
Surely they will prefer the establishment capable of inspiring that degree of cleanliness, or they will buy from home, thus losing the opportunity of the unexpected sale, that unforeseen before the emotion of seeing some nice slippers next to the sweater for which the client was to the store.
“Yes, a time of austerity is coming. We are not going to hire more workers, but we are training those we have. We must first support those who have always been with us ”, says Esquenazi.
In accordance with this period of rigorous discipline, the company established committees responsible for guiding its reopening. The health committee – created according to the Government’s stipulation – establishes the guidelines for a public care system in which hygiene measures and purchased supplies protect “clients” so that they feel “safe” and that they at the same time such measures redound “for the benefit of our staff.
The Steven‘s, Madison and El Campeón stores, members of the conglomerate, employ about 3,500 workers. They are people who have been home for two months this week, although they have “the support” of the company since the announcement of the complete closure of its operations.
“On March 20, work was suspended, but contact with collaborators has not been lost. That day we gave each of them a $ 100 voucher to buy a úper super ’before they got home. We have been sending bonds or vouchers to your home, each time something different, in the amount of one hundred dollars. ”
Branches With staff and customers at home and branches closed, multiple inventories are at risk of deterioration or loss in the extreme case. Esquenazi cites the fate that leather goods such as footwear, temperas or cosmetics can suffer, which is why they turn on the air conditioners several times a week. The clothes have the double challenge of preventing their damage due to humidity or falling behind fashion.
“Let’s not forget that the clothes we had bought could not be sold this season. Now you have to see the collateral damage. ”
The Tova Group had arranged for the opening of its online sales for 2020. The presentation of stocks in a digital mega store. Steps that are more than significant if one takes into account the more than seven decades of the company’s existence and “the scant presence on the web of department stores or clothing stores.” Always linked to retail, Esquenazi warns of a major opening of virtual stores in Panama starting in June. Among them, the Tova Group brands.
“For several months we had been working on the installation of a web platform. It will be in some departments, step by step; You can’t do everything at once, because you have to prepare the staff.”
To face this phase, the company has established contacts with transport companies specialized in-home service. They are plans for operational expansion in one of the times of greatest economic harshness and that ends deepening the country’s productive decline in recent years. The company’s effort in its branches for the acquisition of supplies, the training of workers and the adaptation of the online sales platform is being carried out without the certainty of a provision that authorizes the flexibility of contracts. This is an “essential” measure, as well as other government measures taken during the quarantine. Esquenazi recalls actions “fast and on time” in the current period, such as the country’s decision to go to international markets to obtain financing.
“It has been the way to support a system to which we all conform: banks, companies, workers and the official sector.”
It mentions the initial labor decisions of the Government regarding reduction of working hours and suspension of contracts. But beyond the specific measures, “the final idea of all this is to save the sources of work“. Without this purpose, “it will be useless for us to strictly apply labor law in this context, [because] it would give stores a greater option to reduce their payroll.“
Jack Esquenazi considers that “this situation is serious but it will happen”.
It is true: nothing is forever, although the effects of Covid-19 are definitive. This is assumed by the Tova Group.
BORDER CLOSURE WILL CAUSE DEPRIVATION IN CENTRAL AMERICA
The Federation of Chambers and Associations of Exporters of Central America and the Caribbean (Fecaexca) warned of an early shortage of food, medicines and hygiene products due to the border restrictions imposed by Costa Rica to avoid the increase in contagion due to coronavirus. The “unilateral” sanitary measure imposed by the neighboring country prevents the passage of 1,659 vans that are stranded in Costa Rica and perishable products are about to be lost, Fecaexca members alerted on the morning of this Tuesday, May 19 at a press conference virtual. Roberto Tribaldos, president of the Panamanian Association of Exporters (APEX), representing Panama, stated that the sanitary alternatives proposed by Costa Rica are not viable because they are paralyzing the borders of the region, which will trigger a shortage of food and medicines. Panama imports from the region, medicines, animal feed, flour, breads, fertilizers, packaging, supplies for the preparation of sauces, condiments and food, Tribaldos explained. He said that the Panamanian company Open Blue, dedicated to cobia farming, retains 126 metric tons of fish food on the border with Costa Rica. Javier Visuetti, manager of Regulatory and Community Affairs of Open Blue, said that if the border measure continues, the farming of 500,000 fish would be at risk. This company imports 350 metric tons of palletized food from the neighboring country per month. Panama maintains more than 135 containers stranded in Costa Rica, without counting the paralysis of the Paso Canoas border crossing, Tribaldo explained at the virtual press conference. Fecaexca members also allege that these provisions are causing neighboring countries such as Panama, Honduras and Nicaragua to proceed to implement reciprocity measures that will affect the regional integration scheme and limit intra-regional trade. In this sense, they request that Costa Rica suspend the restrictions and propose that together with the Presidents, Ministers of Economy and Ministers of Health of the region, the best procedures and mechanisms be identified that guarantee the flow of goods and the facilitation of trade, through solutions viable for the transport sector. For his part, Ramón Martínez, Minister of Commerce and Industries (MICI), “demanded” his Costa Rican counterparts to resolve the border situation immediately.
According to the official, these measures “affect the value chain, which of course worsens the condition of the economic sectors involved.” Clearly, “the decrees adopted by Costa Rica violate the agreement on the application of sanitary and phytosanitary measures of the World Trade Organization, which also support the regional integration process,” emphasized Martínez.
https://www.prensa.com/economia/cierre-fronterizo-provocara-desabastecimiento-en-centroamerica/
CONTAGIOUS PEOPLE WITHOUT SYMPTOMS PROMOTE VIRUS TRANSMISSION
In the midst of the global pandemic due to Covid-19 disease, which transmits the SARS-CoV-2 virus, there is one aspect of which there is little information: people who have the virus and do not have symptoms, the so-called asymptomatic. There are asymptomatic in all types of infectious diseases, but very little is known about those without Covid-19 symptoms. However, there are studies that show that asymptomatic people influence the spread of the virus. In Panama, the Ministry of Health has already reported that four resident surgical doctors at the Santo Tomás Hospital became infected with Covid-19 after having contact with patients who had no symptoms of the virus. Minsa reported that the fact was verified when the doctors had contact with patients who presented surgical emergencies and it was not known that they were positive for Covid-19 (they were asymptomatic).
It was estimated that four to five patients had the virus without symptoms and transmitted it. Jorge Luis Prosperi, a doctor specializing in Public Health and former representative of the World Health Organization in the region, stated that there is no doubt that knowing the number and location of the automatic machines would be, “if possible,” the ideal situation for track and examine all contacts and isolate them, among other measures.
However, he added that “although there is evidence with sufficient specificity and sensitivity, probably no country has the financial or human resources to examine the entire population.”
“Also, what is the use of testing a random sample of the population, and obtaining a percentage, say 14%, as a result. It only serves to know the presence of the virus and to track that percentage. And the rest? ”, He argued.
Jean Paul Carrera, virologist and epidemiologist at the Gorgas Memorial Institute for Health Studies, explained that a recent study by Imperial College London, conducted in a community in Italy, showed that 43% of SARS-CoV-2 infections were infections asymptomatic. He stressed that the study found no evidence that viral load (the amount of virus in a person) was statistically different between people with symptoms and those without symptoms. Given this scenario, he said, the tracking of contacts after the total quarantine in this city, showed that infections in this region occurred before closure or from asymptomatic relatives living in the same house. Carrera concluded that this study demonstrated that contact tracing of positive cases and asymptomatic infections are important in halting the new number of cases.
THE MINSA ALERTS ON HOME TESTS TO DETERMINE COVID-19
The Ministry of Health (Minsa) reported that the distribution and sale of rapid tests “IgM / lGG COVID-19” have been detected, which are not authorized. Dr. Juan Miguel Pascale, director of the Gorgas Commemorative Institute, highlighted that what some clinics are offering recently are rapid tests that detect antibodies and that the problem with these tests is that people think they can determine if they have an acute infection and they do not work.
He added that “the tests would not work because the individual will not have antibodies for at least one week after having the COVID-19 infection.”
“If the person is tested on the second day of symptoms, it is very likely that the test will come back negative, but they are infected and do not take the necessary measures such as staying home and could develop symptoms thinking it is a common cold,” explains the scientist.
Minsa, as the governing body of health in Panama, recalled that the only official entity for conducting tests is the Gorgas Commemorative Institute and does them throughout the country. The tests are part of the tools used by health teams in this emergency period and in no way can they be considered on their own as a diagnosis to rule out COVID-19 infection and their use should be limited to medical institutions and laboratories.
SOME 21 UNITS OF THE NATIONAL AERONAVAL SERVICE WIN THE BATTLE TO COVID-19
Until mid-April, the Ministry of Security (Minseg) reported more than 228 law enforcement units infected with the new coronavirus, while more than 450 were quarantined for possible contagion or contact. The entity thanked the medical personnel and all those who provided support to the uniformed personnel affected by the deadly virus. quarantine for possible contagion or contact. On March 27 the National Police confirmed the loss of its first unit as a result of the virus. It was Deputy Commissioner Juan De la Cruz, who had 26 years of service at the institution and worked in the Infrastructure Branch. On April 3, the deadly virus brought mourning and pain to the family of the National Border Service (Senafront) after the death of the first post-mortem corporal, Abel Ábrego, after being detained in the Intensive Care Unit of a private medical center.
Likewise, on April 11, the death by COVID-19 of the post mortem captain of the National Police, Edwin Magallón, who served the institution for 20 years and three months, where he held various positions, was reported. The National Aeronaval Service (Senan) indicated that of the 42 aeromedical evacuations to different hospital centers carried out between March to date, 24 of the 54 patients were COVID-19 positive.
SIXTH LIST OF PERSONS DEPRIVED OF FREEDOM CANDIDATES FOR REDUCING PENALTIES IS PUBLISHED
The Ministry of Government (Mingob), through the Penitentiary System published the sixth list consisting of 47 people deprived of liberty, candidates to be benefited with the reduction of sentence. This measure as a follow-up to the National Government’s humanitarian aid policy, to reduce overcrowding in penitentiary centers in the midst of the health crisis caused by COVID-19. It is published for three days, starting today. According to the Mingob, victims may exercise their right of opposition for the next 48 hours, after the last day of publication of the list, before the General Directorate of the Penitentiary System or at the following email address: sistemapenitenciario@mingob.gob.pa
https://www.tvn-2.com/nacionales/Publican-listado-privados-libertad-candidatos_0_5582441731.html
MINSA REITERATES THAT COMPANIES MUST ADAPT AND COMPLY WITH SPECIFIC PROTOCOLS
Companies that begin the process of returning to their activities as part of the so-called new normality, must comply with five points to be developed in the specific protocols by economic sector, this was reiterated on Tuesday by the Ministry of Health (Minsa). Among the aspects that must be implemented are the organization of a special health and hygiene committee for the prevention and care of COVID-19 in each public or private institution, business and economic sector. This committee must be made up of 2 to 6 workers. , depending on the size of the company, which is established by Resolution No. DM-137-2020. The establishment of controls for workers, as well as special hours and restriction of the number of people, and other modalities such as teleworking, for face-to-face roles to avoid personnel from vulnerable groups (over 60 years, pregnant women, etc.).
“Prevention measures and general controls must be established for workers, employers, clients, suppliers, and visitors: Handwashing with soap and water, use of gel alcohol, use of masks, physical distance of at least 2 meters between people, equipment personal protection according to the activity of the job and inherent risks; constant cleaning and disinfection of work areas and common areas, proper waste management ”, details the Minsa.
Disinfection is recommended to be carried out with chlorinated compounds, sodium hypochlorite (chlorine), 5.25% or 3.5% in a dilution of 0.05 %%, 70% alcohol, hydrogen peroxide or quaternary ammonium compounds. Likewise, a monitoring of symptoms is due to the collaborators and clients, temperature taking at the entrance and exit of the establishment and if any person has the temperature is above 38 ° C or more, it must be communicated to the authorities.
“The area managers must inform the Human Resources Office in case of identifying any collaborator with symptoms, managing work stress with active breaks during the day in order to carry out stretching exercises, breathing, going to the bathroom,” he points out.
The entity in a statement. To reduce the risk, it is recommended to establish special hours where there is no interlinking of shifts, and in case of needing the temporary modification of the working day, it should be done based on article 159 of the Labor Code and Executive Decree No. 71. In addition, companies will be responsible for maintaining the continued provision of basic hand hygiene services such as water, liquid soap, paper towels, toilet paper, and 60-95% alcohol gel.
https://www.telemetro.com/nacionales/2020/05/19/minsa-reitera-empresas-deben-adecuarse/2874589.html
FILED LAWSUIT AGAINST SUSPENSION OF EVICTIONS, WILL BE SERVED BY MAGISTRATE RUSSO
Ángela Russo, magistrate of the First Civil Chamber of the Supreme Court of Justice (CSJ), will have to process an unconstitutionality claim presented by Rony Batista acting in her own name against article N ° 5 of Executive Decree N ° 145 of May 1, 2020, which suspends evictions and freezes leasing fees for up to two months after the health emergency declared by the COVID-19 pandemic. This, according to judicial distribution No. 273 of this Monday, May 18. In its article No. 5, the decree of the Ministry of Housing and Territorial Planning (Miviot) dictates that while the state of national emergency lasts and until 2 months after the lifting of this measure, the freezing of the rental fees is ordered, the clauses of increases and penalties for unilateral termination of the contract and the relative interest for late payment. This being the case, Judge Russo is concerned with examining and analyzing the complaint and, if she considers it, presenting a project before the Plenary Session of the CSJ, so that it is in this scenario that she decides on the case. The document, which is signed by the President of the Republic, Laurentino Cortizo Cohen and Inés Samudio, head of the Miviot, has 12 articles and includes measures on leases, launch and eviction processes, suspends all the launch and eviction processes of real estate destined for residential use, commercial establishments, professional use, industrial and educational activities, without distinction of the lease fee, while the State of National Emergency lasts. Likewise, up to two months after the national emergency is lifted, the lease fees, the clauses of increases and / or the penalty for unilateral termination of the contract and those related to interest for late payment are also ordered.
However, article 6 establishes: “After the effects of the declaration of the State of National Emergency have ceased, the lessee who unjustifiably refuses to pay the lessor the fees not paid during said period, will be sanctioned” according to Law 93 of 1973, which governs leases.
It was established that the lessor and the lessee may settle by mutual agreement the conflicts originated on the lease fees not paid during the measures and provisions established in the Executive Decree, which will last up to two years from their registration before the General Directorate of Miviot Leases and will remain in force as long as the lessee does not breach the agreement. The rule, which already governs, specifies that the lessor who by means of methods or actions in fact suspends the supply of gas, water, electricity and other services, as a pressure measure to the lessee to evict the property or violate the established provisions, will be penalized according to Law 93 of 1973. Likewise, the lessee who has not been economically affected in his income by the sanitary crisis and does not comply with the payments will be sanctioned with Law 93. The General Directorate of Leases of the Miviot will know, process and decide on the complaints between lessor and lessee, derived from the present norm, also for sanctions, there is an appeal for reconsideration before that office, and an appeal in second instance (the latter before the Miviot minister). The head of the Housing portfolio urged the justices of the peace to ensure compliance with this decree, so that their powers and functions are respected. From July 2019 to March 2020, the Miviot had registered 2,234 lease contracts and extensions, both residential, commercial, industrial and professional, and a number of complaints and queries regarding the subject in the middle of COVID-19.
GOVERNMENT PREPARES TO DEFINE BLOCK 2 DATE
The Minister of Health, Rosario Turner, reported yesterday that they are preparing a new measurement of epidemiological parameters to set the date for the reopening of economic activities in Block 2.
The information, without further details, was disclosed through a statement in which it was also said that the minister issued instructions to start the tender process for rapid tests to detect cases of Covid-19. Turner said that in the next few days ministry personnel will visit several companies to “supervise the level” of compliance with the adjustments established in the protocols for entering the “new normal”.
https://www.prensa.com/impresa/panorama/gobierno-se-prepara-para-definir-fecha-del-bloque-2/
PUGA: WORKERS MUST BE REINTEGRATED WITH THE SAME CONDITIONS THAT THEY HAD BEFORE THE PANDEMIC
Given the uncertainty that a part of the labor sector maintains in the face of the suspension of contracts measure adopted by the Ministry of Labor and Labor Development (Mitradel) in the face of the coronavirus pandemic (COVID-19), the general secretary of the Central de Trabajadores de The Republic of Panama, Guillermo Puga, indicated that companies must comply with the commitment that they reinstate workers with the same conditions that they previously had.
“Those contracts are still on hold, it is not known when they will return, most must return in the second block when the economic activities of industry and construction are opened, so there is a commitment and there is a duty of each company in Particularly to reintegrate these workers again with the same conditions that they had before the pandemic, that for us is essential,” Puga explained on RPC Radio.
He added that the crisis caused by COVID-19 cannot be used by companies as an excuse to terminate collaborators.
“You cannot take advantage of the pandemic issue to fire workers, not to call workers, to dismiss them, especially those who are over 60 years old, that is, there is no legal argument for that,” he emphasized.
He explained that the law and the Labor Code establish clear rules regarding which are the circumstances by which any cause of dismissal can be applied to a worker.
He also stated that in the face of the crisis caused by the pandemic, the fundamental guarantees established by the International Labor Organization (ILO) regarding labor law must be respected, as well as the provisions of the Panamanian Labor Code.
“It is essential that once the companies reopen, they can then reintegrate the workers whose contracts were suspended due to the pandemic issue,” he stressed.
PREPARED DOCUMENT FOR A STAGED OPENING OF THE UNIVERSITY OF PANAMA
Since last March, the University of Panama formed a tripartite commission to deal with COVID-19, which continues to prepare a draft document with recommendations for the partial and phased opening of its faculties. Said opening, even without a stipulated date, would begin with the cleaning and sanitation of the institution’s headquarters, nationwide.
“The programming of the staggered opening will be done following the guidelines of the Ministry of Health,” cited a statement from the entity.
The tripartite commission is made up of professors, students and administrative staff and is chaired by the dean of the Nursing Faculty.
https://www.tvn-2.com/nacionales/Preparan-documento-escalonada-Universidad-Panama_0_5582441772.html
80% OF CONTACTS IN VERAGUAS ARE DUE TO COMMUNITY CONTACT, ACCORDING TO HEALTH OFFICIALS
80% of infections in Veraguas are occurring between relatives and neighbors, this is due to both positive and suspicious people; They are not respecting the appropriate isolation measures that the health authorities reiterate daily, to prevent the progress of this virus. While the remaining 20% is due to labor and commercial issues. Epidemiologist Heidi Núñez indicated that there are well-defined areas where the risk of contagion is at the community level. So far, 384 have been reported, with the district of Santiago reporting the most infections, in the Rodrigo Luque district.
https://www.tvn-2.com/nacionales/contagios-Veraguas-comunitario-funcionarios-Salud_0_5582441744.html
WHAT WE DID RIGHT: ISRAELI DOCTORS EXPLAIN HOW THEY BEAT THE CORONAVIRUS
Brett’s Comments: A friend sent this to me recently. You’ll immediately note that it isn’t a report on Panama, but it does show us where I wish we were with this virus. Israel is defeating this virus where many others are not. Their numbers are dropping and have been for several days now. The secret to their success is right here in this (very long) article. Prepare yourselves, this will take a while. Cathy and Larry, now would be a good time for a refill.
In the lull following the first infection wave, physicians tell Haaretz how they adjusted on the fly – and helped push Israel’s number of new cases per day into the low double-digits
It has been two and a half months since the discovery of the first coronavirus patient in Israel on February 27. During this period the focus has been on counting the sick, the tests and the ventilators, along with the mathematical models, the scenarios and the directives.
Meanwhile, the medical teams have faced the sharp edge: patients afflicted by a pneumonia that sometimes leads to multiple organ failure – and in about half the worst cases to death. These teams had to learn on the job. They scanned scientific studies and drew insights from the medical community both at home and abroad.
Still, the gaps in the information about COVID-19 left a lot of room for interpretation and each hospital became a research and experimentation center in treating patients. At least 15 different treatment protocols, coming from various places around the world, were adopted and replaced at the hospitals.
The crisis is still far from the summation stage, even as the number of new cases per day in Israel has fallen into the low double-digits. However, in the lull following the first infection wave, the doctors have time to look back.
Time
Above all, every pandemic is a race against time, whether in stopping the spread of the disease or treating individual patients. Many doctors admit that COVID-19 surprised them and that it doesn’t resemble anything they ever encountered.
“At first we thought it was a kind of flu because you see that as with the flu, most people infected get well and recover without complications,” says Dr. Khetam Hussein, head of the Infection Control Service and the coronavirus unit at the Rambam Health Care Campus in Haifa.
“The clinical picture of the seriously ill also looked similar, or at least we thought so at first. But as you’re treating people, you discover that it has a characteristic very different from the flu.
“At a certain moment the progress of the illness becomes very violent. Within a single day the patient deteriorates and enters a situation of multiple organ failure, which damages the lungs, liver, kidneys and heart.”
Dr. Shaul Lev heads the intensive care unit at Hasharon Hospital of the Rabin Medical Center in Petah Tikva. Hasharon was converted into a facility treating coronavirus patients only. In recent weeks, Lev and his colleagues noticed a pattern of deterioration among the gravely ill, about 3 percent of COVID-19 patients.
“In them, on the eighth or ninth day of the illness, the disease begins a process of lung damage in which there are two elements,” Lev says. “At this point the patients experience an overreaction by their immune system that causes severe bilateral pneumonia.”
Research and science
The urgent need to know as much as possible about the coronavirus and COVID-19 has led doctors to a place they dwell in normal times: the scientific literature. Still, the physicians quickly discovered that it’s hard to rely on the wealth of information that was published quickly.
“One thing that has characterized the coronavirus crisis is the huge amount of scientific garbage that has been disseminated,” Lev says.
For example, many articles that influenced the treatment of the illness were later criticized, in part because of dubious research methods, the absence of suitable control groups and the publication of far-reaching conclusions based on very small groups of patients.
“In the time of the coronavirus, articles have been published that wouldn’t have been published in other times, because of the pressure,” Hussein says. “In normal times researchers have to sweat blood for their articles to be accepted.”
But she believes that the trend will change, with the publication of more in-depth research papers.
Tests
Swab tests – polymerase chain reaction tests, or PCR tests – are the main tool for diagnosing COVID-19. But this method suffers two crucial limitations.
First, a PCR test provides a picture of the situation the moment the test is done. Thus a negative result on the day of the test won’t necessarily be valid the following day. The second problem is that reliability is estimated at only around 70 percent.
This triggers dilemmas; for example, when deciding whether to hospitalize a patient with coronavirus symptoms at a coronavirus unit or a general unit.
“We encountered patients with a classical coronavirus clinical picture, sometimes also people who arrived from abroad who came out negative in the swab tests,” says Prof. Dror Mevorach, head of the coronavirus unit and the Rheumatology Research Center at Hadassah Medical Center in Ein Karem, Jerusalem.
As the crisis progressed, the doctors had to find solutions to the unclear science of diagnosing COVID-19. They started doing additional tests, among them antibody (serological) tests as well as bronchoscopy tests, which involves the taking of fluid samples from the lungs.
In addition, at some hospitals such as Hadassah Ein Karemand Sheba Medical Center at Tel Hashomer, units were opened for patients suspected of having COVID-19. They were isolated from both coronavirus patients and other patients.
Respiratory support
From the start of the coronavirus outbreak, it was clear that the main manifestation was damage to the respiratory system. In some cases respiratory support has been needed for two weeks or more. In the most severe cases, some patients need so-called extracorporeal membrane oxygenation – ECMO – which buoys the heart and lungs.
“At the start of the outbreak the prevailing method, which came from China and Italy, was that the severely ill patients should be ventilated as quickly as possible,” says Dr. Yonathan Shapira, head of the coronavirus department at Shamir Medical Center.
“Today we realize that this isn’t necessarily right. We’ve also learned that you don’t have to rush into employing invasive ventilation methods. Eventually we began to use less invasive methods, and we had success.”
Prof. Mevorach of Hadassah, too, notes the change in the approach to timing ventilation.
“At first we had the impression that it was best to ventilate patients quickly, but now it appears preferable to postpone it as much as possible,” he says, noting that “intubation is violent for the lungs, which could worsen some of the phenomena.”
Mevorach adds that as the crisis proceeded, doctors realized that not all patients were alike.
“Today we know that there are at least two subgroups of patients who represent a somewhat different pattern of the illness and need different treatments,” he says.
In the group of severe cases, some have symptoms similar to those suffered by mountain climbers.
“The difference is very significant,” he says, noting that in “mountain climber” coronavirus patients ventilation must be done a different way. “Incorrect treatment could worsen the patient’s situation.”
Lev of Hasharon Hospital adds:
“We’ve learned that you can manage the ventilated patients, but it’s difficult. This requires many resources and a lot of skill on the part of the team, so the smart thing is to identify the patients who are going to deteriorate and create treatments that will prevent the inflammatory deterioration.”
Medication
So far, a number of medications have been used at hospitals for COVID-19, some of them experimental. In fact, sometimes the knowledge and experience has been meager and the doctors have been gambling. Eventually, some drugs have been eagerly adopted and then discarded; treatment changed on the fly.
“The problem is that there wasn’t sufficient data on the efficacy of the medications,” says Prof. Shlomo L. Maayan, an infection control specialist at Barzilai Medical Center in Ashkelon.
“Each medical center had to draw up its own treatment protocol that determines what you do with a patient in medium to grave condition. Right from the very start there were unfounded protocols based on studies that weren’t controlled.
“This is a mistake because without control groups it’s very hard to know whether it was the treatment that helped the patient or the natural progression of the illness in which many patients recover spontaneously. So a doctor gives a medication, the patient recovers and the doctor is convinced that the treatment worked. But this is a bad mistake when it comes to a new disease that there isn’t enough information on.”
Maayan says the difference between the treatments at the various hospitals depends to a large degree on who’s making the decision.
“An expert on infectious diseases or intensive care or an internist – each will have a different point of view,” he says.
Thus, for example, many Israeli hospitals began to treat parents with chloroquine – or the more advanced version, hydroxychloroquine – an antiviral intended for malaria whose efficacy hasn’t been proved. Sometimes it was combined with the antibiotic azithromycin, but soon enough it turned out that the combination could cause life-threatening changes to patients’ heartbeats.
“We don’t have a magical treatment for the viral element of the illness,” says Lev of Hasharon Hospital. “Remdesivir looks very promising at the moment in ventilated patients, but we don’t yet know the extent to which it’s successful, and it’s also less available.”
Shapira of Shamir Medical Center adds:
“We’ve used hydroxychloroquine and plasma from patients who have recovered, and remdesivir hasn’t reached us.”
Mevorach of Hadassah says:
“The American Food and Drug Administration approved remdesivir in a situation of distress. It’s not certain that in an ordinary situation it would have been approved. This is a drug that was originally developed for Ebola. But if I have the drug, I’ll definitely want to give it to a patient.”
To treat the inflammatory element of the illness, many doctors are using the drug Actemra (tocilizumab).
“And in extreme cases steroids are also given as a treatment, which is controversial,” Shapira says.
Also noticed in severe cases is excessive clotting, thus blood thinners are usually included. Mevorach says the anticoagulant Clexane (enoxaparin sodium) has become standard treatment for COVID-19.
Children
Children were believed to enjoy a safe haven during most of the crisis; the data showed a low infection rate, or at least asymptomatic infection or very mild symptoms. Some of the evidence supported the hypothesis that children get infected and infect others less than adults do.
But during the past month reports have come in on an illness similar to Kawasaki disease, which was first described in Japan in the 1960s.
“This is an inflammation of the blood vessels that usually appears in children under 5 and is characterized by a rash and involvement of the coronary arteries,” Mevorach says.
“Usually people recover with treatment with aspirin and immunoglobulins and sometimes steroids, but there’s a danger of expansion of the coronary arteries and even death. A number of children with COVID-19 in other countries have died because of those phenomena.”
Last month in various countries, nearly 100 cases were reported of children with the coronavirus who came down with an illness similar to Kawasaki disease; three cases ended in death. In Israel thus far six cases have been reported of children with this illness and COVID-19.
Doctors don’t yet know what causes the disease in children. Mevorach is researching the issue with scientists at Mount Sinai Hospital in New York.
”We’re hoping that there will be findings in the coming months,” he says.
STATUS UPDATE:
PANAMA REGISTERS A TOTAL OF 9,867 CASES AND 281 DEATHS DUE TO COVID-19.
- 9,867 positive cases
- 141 new cases
- 281 deaths
- 3,055 home isolation (682 hospital hotels)
- 337 are hospitalized (267 in ward / 70 intensive care)
- 6,194 clinically recovered
The epidemiological surveillance system reports 51,815 tests carried out to diagnose COVID-19, of which 40,142 have been negative.
Coronavirus statistics from Day 1:
- Mon, March 9: 1 case – Panama’s first detected case.
- Tues 10: 8 cases (+7)
- Wed 11: 14 cases (+6)
- Thu 12: 27 cases (+13)
- Fri 13: 36 cases (+9)
- Sat 14:43 cases (+7)
- Sun 15: 55 cases (+12)
- Mon 16: 69 cases (+14)
- Tues 17: 86 cases (+17)
- Wed 18: 109 cases (+23)
- Thu 19: 137 cases (+28)
- Fri 20: 200 cases (+63)
- Sat 21: 245 cases (+45)
- Sun 22: 313 cases (+68)
- Mon 23: 345 cases (+32)
- Tues 24: 443 cases (+98)
- Wed 25: 558 cases (+115)
- Thu 26: 674 cases (+116)
- Fri 27: 786 cases (+112)
- Sat 28: 901 cases (+115)
- Sun 29: 989 cases (+88)
- Mon 30: 1075 cases (+86)
- Tues 31: 1181 cases (+106)
- Wed April 1:1317 cases (+136)
- Thu 2: 1475 cases (+158)
- Fri 3: 1673 cases (+198)
- Sat 4: 1801 cases (+128)
- Sun 5: 1988 cases (+187)
- Mon 6: 2100 cases (+112)
- Tues 7: 2249 cases (+149)
- Wed 8: 2528 cases (+279)
- Thu 9: 2752 cases (+224)
- Fri 10: 2974 cases (+222)
- Sat 11: 3234 cases (+260)
- Sun 12: 3400 cases (+166)
- Mon 13: 3472 cases (+72)
- Tues 14: 3574 cases (+102)
- Wed 15: 3751 cases (+177)
- Thu 16: 4016 cases (+265)
- Fri 17: 4210 cases (+194)
- Sat 18: 4273 cases (+63)
- Sun 19: 4467 cases (+194)
- Mon 20: 4658 cases (+191)
- Tues 21: 4820 cases (+162)
- Wed 22: 4992 cases (+171)
- Thu 23: 5166 cases (+174)
- Fri 24: 5338 cases (+172)
- Sat 25: 5538 cases (+200)
- Sun 26: 5779 cases (+241)
- Mon 27: 6021 cases (+242)
- Tues 28: 6200 cases (+179)
- Wed 29: 6378 cases (+178)
- Thu, 30: 6532 cases (+154)
- Fri, May 1: 6720 cases (+188)
- Sat, May 2: 7090 cases (+370)
- Sun, May 3: 7197 cases (+107)
- Mon, May 4: 7387 cases (+190)
- Tue, May 5: 7523 cases (+136)
- Wed, May 6: 7731 cases (+208)
- Thu, May 7: 7868 cases (+137)
- Fri, May 8: 8070 cases (+202)
- Sat, May 9: 8282 cases (+212)
- Sun, May 10: 8448 cases (+166)
- Mon, May 11: 8616 cases (+168)
- Tue, May 12: 8783 cases (+167)
- Wed, May 13: 8944 cases (+161)
- Thu, May 14: 9118 cases (+174)
- Fri, May 15: 9268 cases (+150)
- Sat, May 16: 9449 cases (+181)
- Sun, May 17: 9606 cases (+157)
- Mon, May 18: 9726 cases (+120)
- Tue, May 19: 9867 cases (+141)
ENDNOTES
I’ve already mentioned that I love music. I’m, almost always listing to something. Right now I’m typing this while listening to Santana… …dude. Anyways, I have an open-door policy and my immediate circle can enter at any time with anything of grave importance. They also know that there is a 3-step process to entering.
- STEP 1 – Enter, physically enter. I don’t mean, start talking to me while you’re on your way to my office, but instead, wait until your entire body is completely 100% in my office, and then prepare to speak.
- STEP 2 – Observe. Do I have my earbuds in or am I on the phone? If the answer to both is “no”, now would be a good time to speak. If I’m on the phone, hold your horses. If my earbuds are in, wave me down like you´re running from Murder Hornets and you’re trying to warn the people ahead of you.
- STEP 3 – Presentation of offerings. Nah, just kidding. Ok, NOW you may speak once the earbuds are out.
Strangers from distant lands, friends of old and new. Tonight, as I scribed my thoughts, I hearkened to my own conditions as I passively peruse my playlist. Are not the very minutes of my life utterly spent mundanely towards false inspiration? There are those who would not deem it so. Still here I rest, apprehensive yet eager to gain an understanding of my own originality. Through the product of which songs hath such audacious articulation been conjured? Feast now upon that which I offer unto thee:
(Take a look at the songs that motivated me tonight, look them up and listen to something old or something new…)
| Artist | Song |
|---|---|
| Journey | Lights |
| George Harrison | My Sweet Lord |
| Van Halen | Dance the Night Away |
| Traffic | Dear Mr Fantasy |
| Maná | Corazon Espinado |
| Boston | Peace of Mind |
| The White Stripes | Seven Nation Army |
| Fleetwood Mac | The Chain |
| Cat Stevens | Father & Son< |
| Ricky Martin | Vuelve |
| Eagles | Take It Easy |
| ZZ Top | Rough Boy |
| Sublime | Santeria |
| Evanescence | My Immortal |
| Led Zeppelin | Kashmir |
Stay safe… Stay healthy… And by all means STAY HOME!!…
