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    UK at ‘critical’ moment as coronavirus infections double in a week in England

    MPs have been warned that the coronavirus crisis is at a “critical” moment, as figures suggested the number of infections had doubled in a week.Jonathan Van-Tam, the deputy chief medical officer, is understood to have warned that the situation in the UK was now similar to that in early March, before the national lockdown was introduced.      Sadiq Khan, the mayor of London, also predicted further restrictions in the city were inevitable as pubs and restaurants in coronavirus hotspots braced themselves for new restrictions. Boris Johnson is expected to make a statement to MPs on Monday during which he will outline a three-tier local lockdown system designed to slow the spread of the coronavirus. And more details on the possibility of further restrictions emerged last night in a letter written to MPs by Mr Johnson’s chief strategic adviser, Sir Edward Lister. In the letter, written following a meeting with northern leaders, Sir Edward stated that the “rising incidence” of coronavirus in parts of the country meant it was “very likely” that certain areas will face “further restrictions”. The letter also said that the prime minister believed local leaders should “help shape the package of measures in the most concerning areas” and that the government will discuss “difficult choices” with them. In preparation, the chancellor Rishi Sunak unveiled a rescue package for businesses expected to be ordered to shut their doors.  Ministers will cover two-thirds of the wages of all staff in workplaces legally required to close, Mr Sunak announced, in what will be seen as an effective extension of his furlough scheme for some.  
    During a briefing with Matt Hancock and Mr Van-Tam, MPs are understood to have been warned the situation was “critical” and could be compared to early March, just weeks before Boris Johnson ordered an unprecedented nationwide lockdown.The latest infection numbers from the Office for National Statistics revealed cases may be doubling with 224,400 people in England thought to have caught coronavirus between 25 September and 1 October, equating to about one in 240 people. A week earlier, the numbers infected were nearer 116,000.According to the daily data from Public Health England and the NHS 13,864 lab-confirmed cases of coronavirus in the UK were reported on Friday with 87 more people dying within 28 days of a positive test.
    Almost 600 people were admitted to hospital in the last day, with a total of 3,660 now on wards and 436 on ventilators to help them breathe.The latest analysis from the government’s Scientific Advisory Group for Emergencies warned the growth in infections was between 4 and 9 per cent a day with the R rate of transmission at between 1.2 and 1.5.
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    A Year On, the Clean India Mission Falls Short

    Research amidst the COVID-19 pandemic has shown that the virus is transmitted through wastewater. This makes it crucial to revisit the goals of India’s ambitious Swachh Bharat Mission (Clean India Mission, or SBM) that came to a close almost exactly a year ago. While there were substantial improvements made in toilet coverage, a lack of data clarity muddies an understanding of exactly how large these improvements were across the country. According to government estimates, national sanitation coverage was 51% in 2014 when SBM began and reached 78% in 2018, less than a year prior to the end of the program. While this certainly shows progress — the national average was just under 26% in 1999 — no one would think to take these numbers and simply round up to 100%.  

    But at the close of the SBM last fall, this is exactly what Prime Minister Narendra Modi did. Speaking to a crowd, Modi proclaimed that India was now completely open defecation free (ODF), with sanitation coverage reported by the SBM portal as 100% in rural areas and, inexplicably, 105% in urban areas. From the start of the 2014 campaign, the central government maintained that in just five short years, India would be ODF. Despite the gains made, a singular focus on meeting steep targets in a very short amount of time seems to have put Modi in a tight spot by the time October 2019 rolled around. 

    Caste Politics Overshadow Sanitation Issues in India

    READ MORE

    The gaps have been, at times, glaring. News reports from established outlets all over the country reported open defecation in areas that were already recorded as ODF. A 2018 study by the Rice Institute estimated an open defecation rate of 44%, meaning nearly half of the sampled population was still engaging in the practice hardly a year before SBM ended. In urban areas the picture looks a bit better: 95% of urban households access an improved toilet. But this includes community toilets, which may be used by hundreds of other families and are often plagued with maintenance, hygiene and safety issues. Furthermore, one survey from 18 states identified over 48,000 manual scavengers still cleaning “dry” toilets which do not discharge into sewer lines.

    Social Pressure-Cooker

    What explains these inconsistencies? The use of shame-based tactics to stop open defecation, alongside a rush to meet ODF goals, have built up a pressure-cooker environment. The SBM has continued prior national efforts that deemphasized technical solutions and focused heavily on strategies to encourage behavior change at the local level. One such strategy is Community-Led Total Sanitation (CLTS), which hinges on “triggering” disgust and extreme emotions among community members to spur the abandonment of open defecation. Despite some concerns about shame-based approaches, the SBM continued with the CLTS Foundation and others as implementation partners.

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    But open defecation is an issue that needs more than short-term emotional reactions. The longstanding practice is mired in cultural tradition, casteist taboos and environmental factors, among others. Some reasons people give for it is that they do not wish to empty a pit themselves, that it is considered more hygienic to defecate further away from the home — certainly reasonable considering how few poor Indian homes have running water — or that community toilets are dirty and unsafe, so squatting in a quiet area nearby is actually preferable.

    In the SBM environment, people who have not built a toilet, for whatever reason, are highly likely to experience retaliation for continuing to defecate in the open. Because Indian culture is quite collective — the actions of one person are seen to have radiating effects on the family and community — sometimes social pressure can play a role in nudging behavior change. However, this is a slippery slope. In India’s highly unequal society, characterized by stark gender and caste-based hierarchies amidst a wide array of languages and ethnicities, such strategies have the potential to be misused, with large social costs.

    There is ample evidence to show this. In June 2017, Zafar Hussein, a local community leader agitating against the eviction of his settlement in Rajasthan, was allegedly beaten to death by local officials for trying to stop officials from taking photographs of women defecating in the open. His death was reported by multiple outlets. In other areas of Maharashtra, people have been followed by a loud band, jailed or fined for defecating in the open.

    Walls of shame have been instituted by local village councils onto which the names and photographs of people defecating openly are be pasted. These individuals were often removed from eligibility for local government programs. The previously mentioned Rice Institute study also recorded coercion and threats of the loss of government rations as a way to bring down open defecation rates. Notably, the study found that Dalits and Adivasis were the most likely to face such behaviors. India’s Health Ministry has publicly denounced the results of the Rice survey. But in September last year, weeks before Modi’s ODF declaration, two young Dalit children were beaten to death in their village in Madhya Pradesh for defecating in the open.

    Numbers, Strategies and Health Equity

    These debates over sanitation data are not merely academic exercises. They have real, material impacts on people. In some ways, the above tragedies are not surprising. If a hasty approach is taken toward declaring areas ODF, it follows that any activity hinting that this claim is not matched by reality will be quashed. Despite this, the Bill and Melinda Gates Foundation bestowed the Global Goalkeeper Award upon Modi last year. It is surprising that one of the largest, most influential health organizations in the world, committed to facts and data, accepted without question the Indian prime minister’s claims, failing to consider all the evidence to the contrary.

    So what is the solution? Certainly, the answer is not to give up on sanitation programming as the need remains great. There are several organizations on the ground that have successfully integrated mobilization with communities, technical expertise and a sustained presence through which people are not merely pressured to stop a practice but meaningfully guided toward an alternative and given the facts and tools to integrate that alternative into their lives.

    However, this takes a more long-term presence, a less single-minded focus on quick targets, a commitment toward waste management infrastructure besides just toilets, and a willingness to meet people where they are. Further, the same people who have fallen through the gaps in the SBM are those with a lot to lose during the current pandemic: the rural poor, slum-dwellers, sanitation workers, manual laborers and migrants. Brutal crackdowns against those who kept working amidst India’s COVID-19 lockdown illustrate that retaliation cannot continue to be a solution when reality does not match the official word. Amidst the pandemic, sanitation infrastructure and the transparency of data surrounding it are necessities that cannot afford to wait.

    The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy. More

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    Coronavirus: 'Worrying' questions remain after technical error blamed by PHE for 15,000 missing cases, expert says

    Following the revelation that some 15,000 overlooked coronavirus test results had been added to the weekend’s totals, experts have warned the seemingly “fundamental” IT error raises “worrying” questions over the government’s past and future handling of data.The explanation prompted concern that additional cases may remain overlooked, with one expert comparing the system apparently used to collate testing data to “a similar architecture you used to see in banks 30 years ago”.And as officials grappled with drastically altered local infection rates, a data scientist warned the blunder’s possible “knock-on effects” on the already strained contact-tracing system could have a “substantial influence on the generation of new cases”.After the government’s Covid-19 Dashboard showed record daily caseloads of 12,872 and 22,961 on Saturday and Sunday respectively, officials said the stark rise was due to an IT glitch discovered on Friday evening.As a result, 15,841 cases were included that had previously been left out of the totals announced between 25 September and 2 October.Watch moreWhile the revelation prompted furious and still unanswered questions over how many possibly infected people had been missed by contact tracers as a result of the glitch, Public Health England (PHE) sought to clarify the cause of the error.The “technical issue” was that some digital “files containing positive test results exceeded the maximum file size” accepted by the government’s central computer systems, officials said.A “rapid mitigation” had been put in place to split large files, while “a full end-to-end review of all systems” had been ordered “to mitigate the risk of this happening again”, PHE said, adding that there are already a number of automated and manual checks within the system.But a computer science expert said the explanation raised a “whole series of unanswered questions, some of which are quite worrying”.The statement suggests that the mistake was only picked up as officials audited or reconciled previous counts of results, and that computer systems did not issue basic alerts that some results had been rejected by the central server.“It’s quite an oddity because it only seems to have been found out by happenstance. It’s not that the system was warning them,” Alan Woodward, visiting professor at the University of Surrey’s Department of Computer Science, told The Independent. This appeared to raise the possibility that test results had been slipping through the gaps for weeks, and thus omitted from official counts in the past.“It is a possibility, and that’s one of the really worrying things about this, are they going back to look?” Prof Woodward said. “I mean, how big are these files?”He added: “If this [explanation] is plausible, what’s also plausible is the fact that it may have been happening before, so were the numbers higher all along?“But then presumably somebody would have caught it earlier and, if they didn’t catch it, does that mean they weren’t reconciling things to make sure all the tests were actually counted?”Asked whether smaller quantities of test results could have been slipping under the radar for weeks, a PHE spokesperson told The Independent: “Smaller numbers wouldn’t have triggered this problem. It’s not that the individual files are too big, it’s that when they’re all grouped together and large numbers are reported simultaneously, that can become too big. “I’m not sure how big the individual files are, but I’m reassured that the problem is with bundling them together rather than the actual file size. “It’s also important to note that this isn’t the only place where there’s a record of [the results] — the individual trusts who perform the tests keep a record which can be … cross-referenced.”Despite the multiple records available for cross-referencing, the spokesperson was unable to explain the week-long delay in officials realising thousands of results had not been counted.Meanwhile, the admission that the government’s computer systems send test results over in batches rather than in real-time raised eyebrows.“That’s a very old fashioned way of doing it,” Prof Woodward said. “In this day and age, especially with continuous connectivity, there should be no reason why … once [a test result] gets confirmed and validated inside the lab, it goes up, so as real-time as possible could be done.”He added that the structure by which results appear to be collated from individual laboratories is “a similar architecture you used to see in banks 30 years ago”.Coronavirus test chief Baroness Harding denies system is failing as pressure mounts“Being naive, I thought it would have been just literally the test centres would have had a … piece of software they would be putting their results into and that would then get stored on the central database,” Prof Woodward said. “But it looks like what’s happening is that all the testing centres have got their own systems and then at some point a batch of those get sent to the centre, which is a bit odd for this day and age.”He continued: “It’s not a huge surprise on a big system that you get teething problems, but at the same time — and I should show some of my frustration here — building a completely new system as we have done rather than continue with the existing NHS track and trace and just utilising that all seems odd to me. The very time you do not need to be ironing out the bugs in a new system is in the middle of a pandemic.”Meanwhile, Test and Trace chiefs insisted that all those who tested positive received their results “in the normal way” and were told to self-isolate.And despite daily positive tests caseloads in the week from 25 September being between 744 and 4,786 infections higher than shown in government figures, the government insisted decisions on localised restrictions affecting millions of people had not been affected.But in Liverpool, where new restrictions were imposed on Thursday, the revised total meant the city’s infection rate soared from 287 to 456 cases per 100,000 residents, while Manchester emerged as the worst-hit part of the UK, with some 496 infections per 100,000 people.“The big problem with this latest data issue from PHE is that we were misled as to the underlying trend during that period,” said independent statistician Nigel Marriott. “Up to Friday it looked like the recent surge in cases had paused and there was hope of a turnaround in some places.  But with the revisions, it is clear that there is still a strong upward trend and more measures may be needed to reverse the trend.  “At present, the ‘50,000 cases by mid-October scenario’ postulated by [England’s chief medical officer Chris Whitty] last month can’t be ruled out, although I suspect the number will be closer to 25,000. “What hasn’t changed is the sensitivity of the national trend to what is happening in the North.  The sooner the North slows down and reverses, the less likely we are to fulfil the CMO’s scenario”.And as cabinet minister Therese Coffey was unable to give an estimate for how many people had been missed by contact-tracers as a result of the blunder, one expert warned there would be a knock-on effect upon future contact-tracing efforts.“While it appears [contacts] are now being contacted as a matter of priority, this additional strain on a system already stretched to its limit implies that further delays are likely to occur for other cases where contact tracing is needed,” said Rowland Kao, a professor of veterinary epidemiology and data science at the University of Edinburgh.“These knock-on effects may have a substantial influence on the generation of new cases, over a period even longer than that.” More

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    Coronavirus: ‘Extraordinary’ flaw leaves NHS app unable to process tens of thousands of test results

    The long-delayed NHS Covid-19 app has hit fresh trouble after it emerged it could not process tens of thousands of test results in England.Ministers were under pressure to explain the “extraordinary” failure, affecting tests at NHS hospitals and Public Health England laboratories, which provoked more criticism of the technology.To add to the embarrassment, the Welsh government said it had avoided the same problem – which came just two days after the app was finally launched, four months later than promised.The Department for Health and Social Care (DHSC) on Saturday night that developers had fixed the flaw after “working urgently” to tackle the issue, which left people in England whose tests were carried out at the privately run “lighthouse labs” able to input results but not those in NHS settings.The results are meant to be used to enable the app to carry out contact tracing, the key purpose of the technology to help curb the spread of coronavirus infectionsWatch moreProfessor Stephen Reicher, a government adviser, said the “extraordinary” weakness pointed to “centralised privatised cronyism” which was undermining the test and trace system.“It exemplifies precisely why test and trace continues to fail: the divorce between the new privatised testing system and NHS/Public Health structures,” he tweeted.“So, fix the app. But that won’t be enough. We need a rapid reset of testing more generally. No more centralised privatised cronyism. Rebuild the system based on trusted local NHS and Public Health.” Jonathan Ashworth, Labour’s health spokesman, asked: “Have they really launched an app that doesn’t actually link to tests carried out by NHS hospital labs & PHE labs instead only including tests carried out via the outsourced lighthouse lab network??”On Friday, more than 61,000 processed tests in England were handled by PHE and the NHS, underlining the potential scale of the problem.It emerged when one concerned user warned, on Twitter, that he could not submit his test results to the app on its launch day, because he did not have a code.The app’s own account replied, saying: “If your test took place in a Public Health England lab or NHS hospital, or as part of national surveillance testing conducted by the Office for National Statistics, test results cannot currently be linked with the app whether they’re positive or negative.”While DHSC said the issue had been fixed on Saturday for those who receive a positive test result, it acknowledged there was still no way for people in England to log a negative result.The Welsh government was quick to point out it had no such problems, saying: “We took the decision to link our all-Wales laboratory testing systems with the NHS Covid-19 app.“Here you’ll get a code in your test result notifications to enter into the app, whether your result is positive or negative.”Since Thursday’s launch, some people have complained of being unable to download the app, and that only positive results could be inputted if tests were booked outside the app.Read moreThe technology uses the Bluetooth signal in both Apple and Android mobile phones to detect close and sustained contact between users.But there are also fears it will have little impact unless installed by most of the public. Experts once warned an 80 per cent take-up was needed – but even the most successful apps in other countries have not topped 40 per cent.It also allows users to check and report symptoms, to book a test, to find out if the result was positive, to check the local risk level and to provide contact details to premises.A DHSC spokesperson said: “Everyone who receives a positive test result can log their result on the app. “A minority of people, such as hospital patients, who were unable to log their positive result can now request a code when contacted by NHS Test and Trace to input on their app.” The ability to log a negative result is being looked at after users said they wanted to be able to do so,  DHSC added. More

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    UK to become WHO's largest state donor with 30% funding increase

    Boris Johnson will announce a 30% increase in the UK’s funding of the World Health Organization, making the UK the single largest national donor after the US leaves.In an announcement at the UN General Assembly, he will urge it to heal “the ugly rifts” that are damaging the international fight against coronavirus.While Trump has denounced the WHO as corrupt and under China’s influence, Johnson will announce £340m in UK funding over the next four years, a 30% increase. He will also suggest the body be given greater powers to demand reports on how countries are handling a pandemic.The proposals will form part of a British vision, drawn up in conjunction with the Gates Foundation, of how future health pandemics could be better controlled, including “zoonotic labs” capable of identifying potentially dangerous pathogens in animals before they transmit to humans.Johnson’s pre-recorded video, on the final main day of the UN General Assembly and four days after most world leaders have spoken, comes at the end of a week in which China and the US have argued over responsibility for the virus. Both have refused to join the WHO effort to find a global coronavirus vaccine, preferring a national approach.Johnson will say: “After nine months of fighting Covid, the very notion of the international community looks tattered. We know that we cannot continue in this way. Unless we unite and turn our fire against our common foe, we know that everyone will lose.“Now is the time therefore – here at what I devoutly hope will be the first and last ever Zoom UNGA – for humanity to reach across borders and repair these ugly rifts. Here in the UK, the birthplace of Edward Jenner who pioneered the world’s first vaccine, we are determined to do everything in our power to work with our friends across the UN to heal those divisions and to heal the world.”Earlier at the UN this week, he said that the coronavirus “came out of left field, humanity was caught napping, let’s face it, we were woefully underprepared”.The extra UK cash comes ahead of WHO board meeting next week at which a joint Franco-German paper is to be discussed calling for more reliable, larger and less conditional funding of the WHO.The UK contribution will be set at £340m over the next four years, making it the most generous nation state contributor, Downing Street said. While the US is currently the largest funder, if Trump is re-elected president, it will pull out by next summer, taking with it as much as $900m in voluntary and compulsory contributions over two years.Apart from funding increases designed to help multilateral bodies and ensure equitable distribution of a coronavirus vaccine, once it is discovered, Johnson will also call for new pandemic early-warning systems, new global protocols for health crises and the removal of trade barriers.The WHO has set up an internal inquiry into its handling of the pandemic, including China’s role in informing the WHO that the virus was on the loose in the country.Johnson will also use his address to announce significant new investment in Covax, the international coronavirus vaccines procurement pool announced in April. The UK will contribute an initial £71m to secure purchase rights for up to 27m vaccine doses for the UK. He will also announce £500m in aid funding for the Covax advance market commitment, a facility to help 92 of the world’s poorest countries access any coronavirus vaccine at the earliest opportunity. The commitment is also designed to guarantee to private manufacturers that they will have a market for their vaccines, ensuring the necessary research and development takes place. Neither China nor the US have agreed to join Covax, preferring to keep their vaccine research under their own control.Johnson will use his UN speech to call for “a vast expansion of our ability to collect and analyse samples and distribute the findings, using health data-sharing agreements covering every country”.His speech contains no direct criticism of China’s sharing of data at the beginning of the crisis, Downing Street said. More