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Coronavirus Slams Broken, Embattled Yemen Coronavirus Slams Broken, Embattled Yemen
(3 days later)
BEIRUT, Lebanon — In northern Yemen, more and more people are falling ill and dying after having trouble breathing, yet the Iran-backed group that controls the region, the Houthis, has acknowledged only a few coronavirus deaths.BEIRUT, Lebanon — In northern Yemen, more and more people are falling ill and dying after having trouble breathing, yet the Iran-backed group that controls the region, the Houthis, has acknowledged only a few coronavirus deaths.
In southern Yemen, where two groups that previously fought the Houthis together have turned on each other, mortality rates have more than tripled compared with last year.In southern Yemen, where two groups that previously fought the Houthis together have turned on each other, mortality rates have more than tripled compared with last year.
The coronavirus appears to have slammed into Yemen, a country already staggering from five years of war, competing power centers, a health care system in ruins, widespread hunger and outbreaks of cholera and other infectious diseases.The coronavirus appears to have slammed into Yemen, a country already staggering from five years of war, competing power centers, a health care system in ruins, widespread hunger and outbreaks of cholera and other infectious diseases.
But the denial of the outbreak in the Houthi-controlled north, the absence of clear authority in the divided south and the drying-up of aid everywhere have hobbled any hope of limiting the virus’s spread, leaving health care workers and hospitals ill-equipped to cope with it and the public confused and suspicious of efforts to combat it.But the denial of the outbreak in the Houthi-controlled north, the absence of clear authority in the divided south and the drying-up of aid everywhere have hobbled any hope of limiting the virus’s spread, leaving health care workers and hospitals ill-equipped to cope with it and the public confused and suspicious of efforts to combat it.
Yemen was already facing what has been called the world’s worst humanitarian crisis before the virus hit. The war, in which a Saudi-led military coalition is battling the Houthis, has taken 100,000 lives. Saudi-led airstrikes have killed thousands of civilians and destroyed hospitals and schools, while United Nations officials have accused the Houthis of diverting humanitarian aid.Yemen was already facing what has been called the world’s worst humanitarian crisis before the virus hit. The war, in which a Saudi-led military coalition is battling the Houthis, has taken 100,000 lives. Saudi-led airstrikes have killed thousands of civilians and destroyed hospitals and schools, while United Nations officials have accused the Houthis of diverting humanitarian aid.
The pandemic has generated rumors that patients were being euthanized at hospitals, causing many Yemenis to shy away from treatment. Yet when they can no longer avoid the hospital, they are regularly turned away for lack of beds, protective equipment and medical supplies.The pandemic has generated rumors that patients were being euthanized at hospitals, causing many Yemenis to shy away from treatment. Yet when they can no longer avoid the hospital, they are regularly turned away for lack of beds, protective equipment and medical supplies.
The authorities in many places are too weak to prevent large crowds from gathering at prayers, funerals and marketplaces, or residents from traveling within the country.The authorities in many places are too weak to prevent large crowds from gathering at prayers, funerals and marketplaces, or residents from traveling within the country.
The confusion and doubt are compounded by the secrecy surrounding the outbreak — officially, the country has only 282 confirmed cases and 61 deaths.The confusion and doubt are compounded by the secrecy surrounding the outbreak — officially, the country has only 282 confirmed cases and 61 deaths.
“In Yemen, we think there’s no coronavirus because we don’t trust our own health system,” said Salah Mohammed, a school security guard in the southern port city of Aden. “They talk about a curfew to prevent the spread of the disease. Great. But why do they allow people to move freely around the country if there’s a curfew?”“In Yemen, we think there’s no coronavirus because we don’t trust our own health system,” said Salah Mohammed, a school security guard in the southern port city of Aden. “They talk about a curfew to prevent the spread of the disease. Great. But why do they allow people to move freely around the country if there’s a curfew?”
With little testing available and the government and hospitals in disarray, it is difficult to measure the virus’s true spread in Yemen. What numbers are known, however, are grim.With little testing available and the government and hospitals in disarray, it is difficult to measure the virus’s true spread in Yemen. What numbers are known, however, are grim.
As of last week, tests had confirmed more than 500 coronavirus cases just in Sana, the Houthi-controlled capital, said a doctor who advises the Health Ministry there. The deputy health minister is among those infected, and a former president of Sana’s flagship university is among the nearly 80 dead.As of last week, tests had confirmed more than 500 coronavirus cases just in Sana, the Houthi-controlled capital, said a doctor who advises the Health Ministry there. The deputy health minister is among those infected, and a former president of Sana’s flagship university is among the nearly 80 dead.
Yet the Houthi authorities have acknowledged only four cases in their territory, leaving public health officials, health care workers and aid groups to sound the alarm about an outbreak whose severity the authorities are playing down.Yet the Houthi authorities have acknowledged only four cases in their territory, leaving public health officials, health care workers and aid groups to sound the alarm about an outbreak whose severity the authorities are playing down.
Some Health Ministry employees have been pleading with senior officials to make the true numbers public so that emergency medical workers and residents understand the gravity of the threat, said the doctor, who asked to remain anonymous because the authorities had threatened colleagues who had tried to go public.Some Health Ministry employees have been pleading with senior officials to make the true numbers public so that emergency medical workers and residents understand the gravity of the threat, said the doctor, who asked to remain anonymous because the authorities had threatened colleagues who had tried to go public.
On Thursday, the Health Ministry in Sana asserted in a statement that other countries’ decisions to publicize their coronavirus case counts had “created a state of fear and anxiety that was more deadly than the disease itself.” The ministry offered no numbers of its own.On Thursday, the Health Ministry in Sana asserted in a statement that other countries’ decisions to publicize their coronavirus case counts had “created a state of fear and anxiety that was more deadly than the disease itself.” The ministry offered no numbers of its own.
“We don’t have to adhere to what the world wants us to,” Yousif al-Hadhiri, a ministry spokesman, said in an interview on Friday. He blamed the World Health Organization and international aid groups for being “lazy” and failing to deal with the outbreak.“We don’t have to adhere to what the world wants us to,” Yousif al-Hadhiri, a ministry spokesman, said in an interview on Friday. He blamed the World Health Organization and international aid groups for being “lazy” and failing to deal with the outbreak.
The reason for the secrecy is unclear. But one result is that the virus is likely to spread further, analysts said.The reason for the secrecy is unclear. But one result is that the virus is likely to spread further, analysts said.
“The Houthis aren’t just shooting themselves in the foot,” said Osamah al-Rawhani, the deputy executive director of the Sana’a Center for Strategic Studies, a think tank focused on Yemen. “They’re shooting people. The people who are in power haven’t recognized or revealed the right information to the public. And secrecy makes people do the wrong things because they’ve gotten the wrong message.”“The Houthis aren’t just shooting themselves in the foot,” said Osamah al-Rawhani, the deputy executive director of the Sana’a Center for Strategic Studies, a think tank focused on Yemen. “They’re shooting people. The people who are in power haven’t recognized or revealed the right information to the public. And secrecy makes people do the wrong things because they’ve gotten the wrong message.”
The coronavirus is ravaging the other side of the front lines as well, where forces opposed to the Houthis are also reporting dubiously low numbers. There, however, the main problem is not denial, but lack of governance and a health care system in meltdown.The coronavirus is ravaging the other side of the front lines as well, where forces opposed to the Houthis are also reporting dubiously low numbers. There, however, the main problem is not denial, but lack of governance and a health care system in meltdown.
In Aden, which served as the interim seat of Yemen’s internationally recognized government until a separatist group seized it last month, burial data showed that 950 people had died in the city in the first 17 days of this month, more than triple the 306 recorded for all of May 2019, according to an analysis by Abdullah Bin Ghouth, an epidemiology professor at Hadramout Universitywho advises the minister of health in Aden.In Aden, which served as the interim seat of Yemen’s internationally recognized government until a separatist group seized it last month, burial data showed that 950 people had died in the city in the first 17 days of this month, more than triple the 306 recorded for all of May 2019, according to an analysis by Abdullah Bin Ghouth, an epidemiology professor at Hadramout Universitywho advises the minister of health in Aden.
The spike in deaths suggests that the official virus death toll is a vast undercount.The spike in deaths suggests that the official virus death toll is a vast undercount.
At a hospital for coronavirus cases that Doctors Without Borders has set up in Aden, the only dedicated Covid-19 facility in southern Yemen, 173 patients have been admitted, more than 68 of whom have died, the group said.At a hospital for coronavirus cases that Doctors Without Borders has set up in Aden, the only dedicated Covid-19 facility in southern Yemen, 173 patients have been admitted, more than 68 of whom have died, the group said.
In other countries, 80 percent of patients did not need hospitalization, suggesting that many more people may be infected than those who went to the hospital.In other countries, 80 percent of patients did not need hospitalization, suggesting that many more people may be infected than those who went to the hospital.
Yemen’s health care system, already overrun with outbreaks of cholera and other serious diseases, is gasping. Most doctors and nurses have not been paid in years, leading many to leave the public health system. Those who stayed are now being asked to treat coronavirus patients without protective gear.Yemen’s health care system, already overrun with outbreaks of cholera and other serious diseases, is gasping. Most doctors and nurses have not been paid in years, leading many to leave the public health system. Those who stayed are now being asked to treat coronavirus patients without protective gear.
Azzubair, an emergency room doctor at a hospital in Dhamar Province, south of Sana, said he and his colleagues had been given only cheap, flimsy masks and gowns despite treating an average of six suspected Covid patients a day.Azzubair, an emergency room doctor at a hospital in Dhamar Province, south of Sana, said he and his colleagues had been given only cheap, flimsy masks and gowns despite treating an average of six suspected Covid patients a day.
Updated June 5, 2020 Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“We can’t help but deal with possible Covid-19 cases on a daily basis,” said Azzubair, who asked to be identified only by his first name to avoid reprisals. “It’s like being in the monster’s jaws. By the time you realize you’re dealing with a suspected coronavirus case, it’s too late. You don’t really understand why they’re handling this issue in such secrecy.”“We can’t help but deal with possible Covid-19 cases on a daily basis,” said Azzubair, who asked to be identified only by his first name to avoid reprisals. “It’s like being in the monster’s jaws. By the time you realize you’re dealing with a suspected coronavirus case, it’s too late. You don’t really understand why they’re handling this issue in such secrecy.”
In the south, only a few hospitals are accepting coronavirus cases, with other facilities refusing patients or closing down altogether because they lack protective equipment or staff are abandoning their posts. Doctors Without Borders, which operates Covid-19 centers with a total of 25 intensive-care beds across the country, does not have enough masks, gowns or medical staff to open more, said Claire Ha-Duong, the head of the group’s mission in Yemen, and turns away patients every day.In the south, only a few hospitals are accepting coronavirus cases, with other facilities refusing patients or closing down altogether because they lack protective equipment or staff are abandoning their posts. Doctors Without Borders, which operates Covid-19 centers with a total of 25 intensive-care beds across the country, does not have enough masks, gowns or medical staff to open more, said Claire Ha-Duong, the head of the group’s mission in Yemen, and turns away patients every day.
Funding has fallen far short of the need. International donors suspended or cut much of their funding before the pandemic over concerns that the Houthis were keeping aid from going where it was needed. Lise Grande, the top United Nations official in the country, said the Houthis had since agreed to concessions that she hoped would reopen the spigot.Funding has fallen far short of the need. International donors suspended or cut much of their funding before the pandemic over concerns that the Houthis were keeping aid from going where it was needed. Lise Grande, the top United Nations official in the country, said the Houthis had since agreed to concessions that she hoped would reopen the spigot.
For any public health response to stick, however, Yemenis need to accept the need for it at a time when trust in the powers that be is at a low ebb.For any public health response to stick, however, Yemenis need to accept the need for it at a time when trust in the powers that be is at a low ebb.
One persistent rumor darting around Yemen is that people who go to the hospital receive lethal injections to put them out of their misery. In Houthi territory, armed personnel have fired into the air to keep people away as medical teams take people suspected of being infected into quarantine, residents said.One persistent rumor darting around Yemen is that people who go to the hospital receive lethal injections to put them out of their misery. In Houthi territory, armed personnel have fired into the air to keep people away as medical teams take people suspected of being infected into quarantine, residents said.
In Aden, a city of half a million, the recent power transfer has left no authority capable of mounting an organized public-health campaign. There are no quarantine centers and no restrictions on movement or gathering, and residents have protested against attempts to impose them.In Aden, a city of half a million, the recent power transfer has left no authority capable of mounting an organized public-health campaign. There are no quarantine centers and no restrictions on movement or gathering, and residents have protested against attempts to impose them.
Yahya, 36, a Sana resident who asked to be identified only by his first name to avoid running afoul of the Houthis, buried three relatives who died with coronavirus-like symptoms. He partly blamed those in charge: If officials had been transparent about the size of the outbreak, he said, people would have taken the virus more seriously.Yahya, 36, a Sana resident who asked to be identified only by his first name to avoid running afoul of the Houthis, buried three relatives who died with coronavirus-like symptoms. He partly blamed those in charge: If officials had been transparent about the size of the outbreak, he said, people would have taken the virus more seriously.
He, too, had begun to show symptoms, but said he had refused to go to a hospital or a quarantine center.He, too, had begun to show symptoms, but said he had refused to go to a hospital or a quarantine center.
“I wouldn’t go anywhere, even if it’s a Movenpick,” he said, referring to the five-star Sana hotel that shut down during the war and has now been converted into a quarantine facility. “There’s no trust anymore.”“I wouldn’t go anywhere, even if it’s a Movenpick,” he said, referring to the five-star Sana hotel that shut down during the war and has now been converted into a quarantine facility. “There’s no trust anymore.”
Saeed al-Batati contributed reporting from Al Mukalla, Yemen, and Shuaib Almosawa from Sana.Saeed al-Batati contributed reporting from Al Mukalla, Yemen, and Shuaib Almosawa from Sana.