Good evening from a nice hot and humid Cambodia. We
get sporadic rains which cool down the place a bit but overall it’s very hot
and dry and lots of people experience very low water levels where they can get
water from. I was inspired and encouraged by the testimony of another missionary
in Cambodia, who went for the first time during this lockdown to a very remote
place, where they helped people before. The small “”church”” is thriving
through this isolated time. He tells the story of a man that broke 3 ribs in an
accident and his wife prayed for him and he got healed in only 3 days. Another
man’s hands were clutched together due to a spinal injury and when they prayed
for him, his hands open up again. We can see that the church is growing even if
the missionary is not there. Does that mean that our role has changed?? Now we
can discuss that later, would love to hear from you clever people.
I am planning a trip next week into the jungle to go
and see the people and see how we can help them again after these scary times.
Please pray for people to be open and receiving of foreigners in the villages
again. I personally think it's ok as I talk to fellow workers and friends and
they started to work as well. We are still not allowed to have gatherings and
church but when it happens in small numbers they are not so concern. We have 1
more positive case in Cambodia but other than that the virus scare is gone for
now. Let’s pray it to stay that way. They opened up the restrictions of flights
from other countries but just 2 weeks ago they quarantine a whole plane full of
people due to one positive case. That is why one of the requirements to visit
is to have medical insurance of $50 000.
We took the staff of FGC to Baray Lake and had
some fun. It was nice to see young people enjoying themselves in the water.
It was nice and cool with rain in the air. We left just as the rain came in.
Pray for FGC Community Link as they also feel the crunch of this virus.
Donations are not coming in and they need to look at some other options in the
future. Schools will probably start in November again and then they can teach
again. We do not have a pastor at this time for the church but we cannot have
it anyhow. They will start again by doing home visitations this week.
Thank you for praying for us and keeping us covered by
the blood of Jesus. Pray that we will use Common Sense when we go out to the people
we love so much.
Love
Rossouw-clan
The curious case of South Asia's 'low'
coronavirus deaths
Varying demographics and differences in disease
exposure could explain lower mortality rate in South Asian countries.
Islamabad, Pakistan - Scientists and public health
experts are continuing to conduct research into why some South Asian countries
- despite their ramshackle health infrastructure and dense populations - have
witnessed lower coronavirus mortality rates compared with many Western
countries. By early May, the world's richest countries accounted for more than
90 percent of all reported deaths from COVID-19, according to a paper published
in The Lancet medical journal. Adding China, Brazil and Iran to that list takes
the number up to 96 percent.
By contrast, many densely populated developing
countries in South Asia and parts of Africa have fared far better when it comes
to the mortality rate from COVID-19, data from Johns Hopkins University (JHU)
shows.
In Europe, the observed case fatality ratio (CFR, or
the percentage of deaths among confirmed coronavirus patients) has been high,
with France reporting a rate of 15.2 percent, the United Kingdom 14.4 percent,
Italy 14 percent and Spain 11.9 percent, according to JHU data. In the United
States, the CFR is 6 percent, the data shows.
By contrast, in South Asian countries, those rates
have been far lower. India has a CFR of 3.3 percent, Pakistan 2.2 percent,
Bangladesh 1.5 percent and Sri Lanka 1 percent.
"The rest of the world - historically far more
used to being depicted as the reservoir of pestilence and disease that wealthy
countries sought to protect themselves from, and the recipient of generous
amounts of advice and modest amounts of aid from rich governments and
foundations - looks on warily as COVID-19 moves into these regions," write
Richard Cash and Vikram Patel, public health experts at Harvard University, in
The Lancet.
Doctors and scientists say there are a number of
possible explanations for the discrepancy in how COVID-19 is affecting
populations in different parts of the world, whether due to varying
demographics, different levels of exposure to similar viruses or even
incomplete data on mortality in some countries resulting in faulty conclusions.
In Pakistan, home to 220 million people and rickety
health infrastructure that offers just six hospital beds per 10,000 people, the
first case of the coronavirus was reported on February 26, a returning
traveller from neighbouring Iran. Since then, the virus has spread rapidly,
with at least 42,125 cases reported countrywide as of May 18, making Pakistan
the 20th in the world in terms of the total number of cases. It has reported
903 deaths, making it 26th worldwide on that list, with a CFR one-third that of
the US, and up to 13 percent lower than some European countries.
Is the data accurate?
The first question researchers have asked when
examining the data is whether the number of deaths being reported in Pakistan
and other countries is, in fact, accurate.
South Asia coronavirus cases
India Cases - 96,169
Deaths - 3,029
Pakistan Cases - 42,125 Deaths – 903
Bangladesh Cases - 23,870 Deaths – 349
Sri Lanka Cases – 981 Deaths – 9
Nepal Cases – 304 Deaths – 2
Maldives Cases - 1,090 Deaths – 4
Bhutan Cases – 21 Deaths – 0
In neighbouring India, for example, some have
questioned whether deaths are being accurately documented, with as many as 78
percent of deaths not being medically certified under normal circumstances. In
Pakistan, too, this is a possibility - although medical experts working with
the government in its fight against the pandemic suggest the error rate would
be far lower.
"There is such a stigma around the whole business
of COVID, that people do not want to bring their patients to the
hospitals," said Dr Seemin Jamali, head of the largest government hospital
in Karachi, the country's most populated city. The bodies of those confirmed to
have been infected with COVID-19 at the time of death are dealt with through
strict measures at government hospitals, with officials in full protective kits
bathing the body as part of traditional Islamic burial. "The district
[officials] come to receive the dead body, and we pack it in a body bag. There
needs to be a better mechanism for transporting the dead, because this is
something that people don't want to [happen]," says Jamali. "Bathing
[the dead body] is a very important ritual for Muslims in Pakistan, so it is
not possible that you to completely sideline people and say you will bury
[their family members] yourselves."
Nevertheless, Jamali and other experts agreed that
this appeared to result in only a modest decrease in the reporting of deaths -
whether COVID-19-related or not. Dr Faisal Sultan, Pakistani Prime Minister
Imran Khan's focal person on the coronavirus crisis, says the government has
put systems in place to ensure that all deaths are being accounted for,
including direct coordination with provincial health authorities and community
outreach using Pakistan's extensive network for polio vaccination.
"The health system is so sensitised right now to
COVID that in the present situation, the possibility of [large numbers of]
underreported deaths is unlikely," he told Al Jazeera. Dr Faisal Mahmood,
head of infectious diseases at Karachi's Aga Khan University Hospital, the
largest research hospital in the country, concurred, saying results from a
preliminary survey at the city's graveyards had not suggested a rise in deaths
as opposed to the previous year.
Al Jazeera also interviewed doctors and officials at
major government hospitals in Karachi, the eastern city of Lahore, the capital
Islamabad and the southwestern city of Quetta - where a number of coronavirus
cases have been reported. None noted any marked increase in patients who were
dead on arrival, whether from the coronavirus or other causes.
However, Dr Mahmood cautioned: "It may be that
our death rate is not low, but that our epidemic is slow or that we are earlier
in our epidemic, and that eventually, we will have the same death rate."
Younger populations
If the data on the number of deaths is relatively
accurate, that leaves several other possible explanations for why Pakistan is
seeing so few deaths compared with other countries. The US, for example, at the
same stage in its outbreak (66 days since 100 cases were confirmed) had
reported more than 65,000 deaths. Pakistan's 903 is two orders of magnitude
below that number.
Dr Adnan Khan, a public health researcher and
infectious disease specialist, says much of the exploration of correlations
with coronavirus mortality rates is "conjecture" at this point
without the backing of hard facts and comprehensive study, but that the demographics
of South Asia's population, and South Asians' physiology, may have the answer.
"The younger population hypothesis is more
credible [than other theories]," he says, citing Pakistan's relatively
younger demographics as compared with countries where COVID-19 has claimed more
lives. "Many of the deaths in developed countries have reportedly happened
in elderly people living in nursing homes."
In the UK, more than 37 percent of the country's
33,614 coronavirus-related deaths have occurred in elder care homes, according
to the UK's Office of National Statistics. In the US, that number is also about
one-third of all coronavirus deaths, according to a report in the New York
Times.
By contrast, Pakistan - and South Asia in general -
has a far younger population than those countries, with a median age of 22.5. "This
may be one of the reasons, because if you look at the population pyramid, we
have fewer elderly people as compared with the US and Europe, and we know those
are the folks who are dying more frequently," said Dr Mahmood.
Varying immune responses
Another factor that has been suggested is differences
in the population's immune characteristics.
"Is it the environment around us? Different
environmental factors that have changed our immune system in some way? We have
chronic infections like tuberculosis and others [in this part of the world], or
it may be because of vaccinations," says Mahmood. "We don't know the
answer to that particular one."
Adnan Khan, the public health researcher, believes
there could be higher immunity due to exposure to other infections, but that
any correlation with vaccine use would have to be borne out by further study.
S Asia - India
Pakistani children receive expanded immunization, with
vaccinations against nine different diseases being administered in several
rounds before the age of 18 months. Dr Sultan agrees that this could be a
factor, but cautioned against jumping to conclusions - as many have hastily
concluded that use of the BCG tuberculosis vaccine gives greater resistance to
COVID-19.
"People talk about how our exposure to various
pathogens or patterns of immunisation change how our immune system is," he
says. "All of these things are possible, but no one has been able to
categorically prove it."
Another possible factor could be the environment in
South Asian countries, he said, indicating that regions with higher average
temperatures and levels of sunlight and its associated ultraviolet radiation
have shown relatively lower death rates so far.
Researchers have, based on the data available so far,
downplayed the possibility that the strains of the virus affecting South Asia
are different in any meaningful way from those hitting European and other
countries where death rates are higher.
"Biologically we know that the coronaviruses do
not mutate that much - whenever a virus replicates, there is a bit of mutation
built in, but the coronaviruses have error-proofing enzymes, so they tend to
mutate less," said Dr Mahmood. "And these mutations don't always
affect how virulent the virus is […] they are more useful in terms of
identifying the strain than affecting its [lethality]."
Whatever the reason, all researchers that Al Jazeera
spoke to said it was far too early to say categorically why certain countries
were seeing lower levels of deaths from the coronavirus. "I want to be
clear: we don't know exactly what is going on right now [with the lower
deaths]," said Dr Sultan.
Wide prevalence, lower deaths
On the other end of the spectrum from examining
deaths, Dr Wajiha Javed, the head of public health and research at Getz
Pharmaceuticals in Karachi, has been examining the prevalence of the virus
among Pakistanis. Her findings tend to bolster the conclusion that something is
causing people in Pakistan - and the region generally - to react differently to
the virus.
Pakistan, like many developing countries, is
performing limited numbers of tests per day, which are almost exclusively
Polymerase Chain Reaction (PCR) swab tests. The country has conducted 387,335
tests since the outbreak began, according to government data. Those tests are
being conducted largely only on those who have exhibited symptoms.
Javed, however, found that the prevalence of
asymptomatic carriers of the virus in her surveys has been far higher than
expected. In results from 4,000 tests carried out on factory and office
workers, her data shows that between 7 and 8 percent were testing positive.
"This was in 'normal' people, not people who are
going to the hospital, who are even sick or have any symptoms whatsoever,"
she said. Out of her sample, roughly 90 percent had not exhibited any symptoms
at all, she said.
"Our disease is different. We have people who are
exhibiting mild symptoms or no symptoms at all. That might show that we have
some sort of innate immunity that is protecting us from going into severe or
moderate disease," she added, stressing that those who do experience
severe forms of the disease have the same risk of death. "That doesn't
mean we are not infected, and that we are not infecting others." https://www.aljazeera.com/news/2020/05/curious-case-south-asia-coronavirus-deaths-200518090320358.html?fbclid=IwAR1nlhRlxogG_3bkoG3VQbKYTZv-qqjO0pWeClLw0sSP9kOmK3JJ-ItUIug
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