THURSDAY, April 15, 2021 — There were more than 87,000 drug overdose deaths in the United States from October 2019 to September 2020, the highest of any one-year period since the nation’s opioid crisis began in the 1990s, preliminary government data shows.
The death toll was 29% higher than in the previous 12-month period and the increase was largely driven by Illicitly manufactured fentanyl and other synthetic opioids, with stimulant drugs such as methamphetamine also playing a role, the U.S. Centers for Disease Control and Prevention reported.
Whites in rural and suburban areas accounted for many of the deaths in the early years of the U.S. opioid epidemic, but the latest data shows Blacks being affected disproportionately.
“The highest increase in mortality from opioids, predominantly driven by fentanyl, is now among Black Americans,” National Institute on Drug Abuse Director Dr. Nora Volkow said at an addiction conference last week, The New York Times reported.
“And when you look at mortality from methamphetamine, it’s chilling to realize that the risk of dying from methamphetamine overdose is 12-fold higher among American Indians and Alaskan Natives than other groups,” she added.
Volkow added that more deaths than ever involved drug combinations, typically of fentanyl or heroin with stimulants.
“Dealers are lacing these non-opioid drugs with cheaper, yet potent, opioids to make a larger profit,” she said. “Someone who’s addicted to a stimulant drug like cocaine or methamphetamine is not tolerant to opioids, which means they are going to be at high risk of overdose if they get a stimulant drug that’s laced with an opioid like fentanyl.”
Overdose deaths fell slightly in 2018 for the first time in decades, but started to climb again the months before the COVID-19 pandemic, and had the highest spike in April and May 2020.
The pandemic likely exacerbated the upward trend of overdose deaths, according to the Times.
In the early months of the pandemic, many addiction treatment centers shut down, at least temporarily, and services were reduced at many drop-in centers that offer support, clean syringes and the overdose-reversal medication naloxone. In many cases, those services have not been fully restored.
Also, the drug overdose crisis has received less attention and resources as the country struggles with the COVID-19 pandemic, the Times said.
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WARNING: Aboriginal and Torres Strait Islander readers are advised that this article contains images and names of people who have died
The protests also mark the 30th anniversary of the Royal Commission into Aboriginal Deaths in Custody, which handed down its final report on April 15, 1991.
The report made 339 recommendations but few have been implemented.
More than 470 Indigenous people have died in custody in the past 30 years, including at least five since the beginning of March this year.
Protests and marches took place in Sydney, Brisbane, Melbourne, Alice Springs and Lismore on Saturday.
In other cities, like Perth and Adelaide, rallies have been organised for Thursday, the exact date of the final report’s 30th anniversary.
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FILE PHOTO: A man waves a Brazilian flag during a protest against new measures implemented to curb the spread of the coronavirus disease (COVID-19) in Rio de Janeiro, Brazil March 26, 2021. REUTERS/Ricardo Moraes/File Photo
April 9, 2021
By Eduardo Simões and Rodrigo Viga Gaier
SAO PAULO (Reuters) – Brazil’s Sao Paulo state and the city of Rio de Janeiro are easing restrictions on hospitality businesses and other activities, authorities said on Friday, even as Latin America’s largest country continues to break its own grim records for daily COVID-19 deaths.
Sao Paulo will allow customers to pick up takeaway food from bars and restaurants starting on Monday, while professional sports games will be permitted without crowds, along with a series of other specific activities, Vice-Governor Rodrigo Garcia told journalists.
In the city of Rio de Janeiro, officials on Friday lifted a broad set of restrictions put in place in late March. Bars, restaurants and malls can resume in-person service, though beaches and parks remain closed and an 11 p.m. to 5 a.m. curfew remains in effect.
Daily deaths remain near historic highs in both Sao Paulo, Brazil’s most populous state, and Rio de Janeiro, the country’s second biggest city. Rio Mayor Eduardo Paes and Sao Paulo’s Garcia both pointed to decreased pressure on local hospital systems when discussing their decisions to ease restrictions.
“Easing (restrictions) doesn’t have to do with deaths, but rather the most current data regarding urgent and emergency care,” Paes said.
Brazil on Thursday set a daily record of 4,249 COVID-19 deaths, over 1,500 of which were registered in the states of Rio de Janeiro and Sao Paulo, which has emerged as a hotspot in Brazil’s current coronavirus wave.
(Reporting by Eduardo Simoes in Sao Paulo and Rodrigo Viga Gaier in Rio de Janeiro; Writing by Gram Slattery; Editing by Susan Fenton)
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Covid: Brazil has more than 4,000 deaths in 24 hours for first time
Brazil has recorded more than 4,000 Covid-related deaths in 24 hours for the first time, as a more contagious variant fuels a surge in cases.
Hospitals are overcrowded, with people dying as they wait for treatment in some cities, and the health system is on the brink of collapse in many areas.
The country’s total death toll is now almost 337,000, second only to the US.
But President Jair Bolsonaro continues to oppose any lockdown measures to curb the outbreak.
He argues that the damage to the economy would be worse than the effects of the virus itself, and has tried to reverse some of the restrictions imposed by local authorities in the courts.
Speaking to supporters outside the presidential residence on Tuesday, he criticised quarantine measures and suggested without evidence that they were linked to obesity and depression. He did not comment on the 4,195 deaths recorded in the previous 24 hours.
“Brazil now… is a threat to the entire effort of the international community to control the pandemic,” Dr Miguel Nicolelis, who has been closely tracking cases in the country, told the BBC.
“If Brazil is not under control, then the planet is not going to be safe, because we are brewing new variants every week… and they are going to cross borders,” he said.
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He remains unconvinced of any need for lockdowns, which leaves local leaders pursuing a patchwork of measures to prevent the death toll from spiralling further.
It may be too late, with a more contagious variant rampaging across Brazil.
For the first time, new daily cases topped 100,000 on March 25, with many more uncounted.
Miguel Nicolelis, a professor of neurobiology at Duke University who advised several Brazilian governors and mayors on pandemic control, anticipates the total death toll reaching 500,000 by July and exceeding that of the US by year-end.
“We have surpassed levels never imagined for a country with a public health care system, a history of efficient immunisation campaigns and health workers who are second to none in the world,” Mr Nicolelis said.
The system is already buckling, with almost all states’ intensive care units near or at full capacity.
Dr Jose Antonio Curiati, a supervisor at Sao Paulo’s Hospital das Clinicas, the biggest hospital medical in Latin America, said its beds are full, but patients keep arriving.
The city’s oxygen supply is not guaranteed, and stocks of sedatives required for intubation in intensive care units will soon run out.
On March 17 in the northeastern Piaui state, nurse Polyena Silveira wept beside a COVID-19 patient who died on the floor for lack of beds at her public hospital.
“When he was gone, I had two minutes to feel sorry before moving to the next patient,” 33-year-old Ms Silveira said.
‘Coordinated action’ needed
Brazil’s state-run science and technology institute, Fiocruz, has called for a 14-day lockdown to reduce transmission by 40 per cent.
Natalia Pasternak, a microbiologist who presides over the Question of Science Institute, pointed to the city of Araraquara as a success story after seeing its cases and deaths drop after imposing a lockdown.
Ms Pasternak declined to estimate Brazil’s looming daily death toll but said the trend is for continued growth if nothing is done.
“We need coordinated action, and that’s probably not going to happen because the federal government has no real interest in pursuing preventative actions,” Ms Pasternak said.
“[Mayors and governors] are trying to implement preventative measures, but separately and in their own ways. This isn’t the best approach, but it’s better than nothing.”
Minas Gerais, Brazil’s second-most populous state, has closed non-essential shops, while Espirito Santo state will enter lockdown this week.
Brazil’s two biggest cities, Rio De Janeiro and Sao Paulo, have imposed extensive restrictions on non-essential activities.
Their state authorities brought forward holidays to create a 10-day period of repose, which started on Friday.
President undermines health guidelines
Restrictive measures, however, are only as strong as citizens’ compliance.
And Mr Bolsonaro continues to undermine their willingness by painting even partial shutdown as an assault on one’s right to earn an honest day’s wages.
“We need to open our eyes and understand this is no joke,” said Rio’s Mayor Eduardo Paes, stressing that no mayor wants to cause unemployment.
“No one knows this disease’s limit. No one knows how many variants could emerge.”
Hundreds of protesters marched along Rio’s Copacabana beach over the weekend, with many sporting the green-and-yellow shirts that are a hallmark of pro-Bolsonaro rallies, while declining to wear masks.
They chanted “We want to work!” and directed vitriol at Mr Paes.
The World Health Organization’s director, Tedros Adhanom Ghebreyesus, has called for everyone in Brazil to muster a serious response “whether it’s the government or the people”.
“It’s a concerted effort of all actors that will really reverse this upward trend,” he said.
“Especially we’re worried about the [weekly] death rate, which doubled in just one month from 7,000 to 15,000.”
Variants add to challenges
The spread of the virus has been turbocharged by more contagious variants which have become cause for concern beyond Brazil’s borders, not just in South America.
Dr Anthony Fauci, the top US infectious disease expert, said his team would be meeting with Brazilian authorities and are “quite concerned” about the situation in Brazil.
The US has seen its death toll plunge since January, amid a massive vaccine rollout, with its seven-day average dipping below 1,000.
By contrast, Brazil’s vaccine rollout has been strained, at best.
The government bet big on a single vaccine provider, AstraZeneca, while for months rejecting offers to purchase others.
Only after delivery delays from AstraZeneca jeopardised the rollout did Brazil’s health ministry begin buying vaccines — but too late for most deliveries to arrive in the first half of this year.
The nation has fully vaccinated fewer than 2 per cent of its citizens, which experts widely consider an embarrassment for a country long regarded as a global model for vaccination programs.
More than 500 of the nation’s most influential economists and executives wrote an open letter last week calling for mass vaccination, while decrying the situation.
They said that controversy regarding the economic impacts of social distancing is a false dilemma and all levels of government should be prepared to implement emergency lockdown.
While Brazil’s economy did not contract as much as regional peers last year, the worsening health crisis casts a shadow over 2021, according to William Jackson, chief emerging markets economist at Capital Economics.
GDP will return to pre-crisis levels late this year, at the earliest, marking a weak recovery relative to other emerging markets.
Monica de Bolle, a Brazilian senior fellow at the Peterson Institute for International Economics in Washington, was more pessimistic, and expects another recession in 2021.
“All in all, it’s a huge disaster,” said Ms de Bolle, who has done postgraduate studies in immunology and genetics.
“Could have been avoided… wasn’t. Very difficult to fix now.
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A top World Health Organization coronavirus expert says the weekly global count of deaths is rising again, a “worrying sign” after about six weeks of declines.
Maria Van Kerkhove, technical lead on COVID-19 at the UN health agency, said on Monday the growth followed a fifth straight week of confirmed cases increasing worldwide.
She said the number of reported cases went up in four of the WHO’s six regions, though there were significant variations within each.
“In the last week, cases have increased 8 per cent percent,” Van Kerkhove told reporters.
“In Europe, that is 12 per cent – and that’s driven by several countries.”
The increase is due in part to the spread of a variant that first emerged in Britain and is now circulating in many other places, including eastern Europe, she said.
Southeast Asia registered a 49 per cent week-to-week jump in confirmed cases, while WHO’s Western Pacific region reported a 29 per cent rise largely fuelled by the Philippines, Van Kerkhove said.
The eastern Mediterranean saw cases rise 8 per cent percent, while the number of cases reported in the Americas and Africa declined.
“I do want to mention that it had been about six weeks where we were seeing decreases in deaths,” said Van Kerkhove.
“And in the last week, we’ve started to see a slight increase in deaths across the world, and this is to be expected if we are to see increasing cases. But this is also a worrying sign.”
WHO emergencies chief Dr Michael Ryan acknowledged an urge among the public in many places to emerge from pandemic restrictions.
Ryan insisted any easing should coincide with measures such as strict case surveillance and high levels of vaccination but said vaccines alone would not be enough.
“I’m afraid we’re all trying to grasp at straws. We’re trying to find the golden solution: ‘So we just get enough vaccine and we push enough vaccine to people and that’s going to take care of it,”‘ he said. “I’m sorry, it’s not.”
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Coronavirus hospital deaths keep falling as 41 more people in England and Wales died of the disease – a significant fall on a week ago.
The death toll is down a third from last Sunday, when 61 people died after contracting the virus.
A further 35 people died in England, bringing the total number of reported deaths in hospitals in the nation to 85,765.
A 37-year-old with no underlying conditions was among the victims, NHS England confirmed.
Public Health Wales reported six further deaths, taking the total in the country since the start of the pandemic to 5,488.
Data for Northern Ireland and Scotland, usually lower on Sundays because of a reporting lag, will be released later.
Yesterday, the UK’s coronavirus hospital death toll rose by 85 in the lowest Saturday figure in five months.
The figure included 71 in England, six in Wales, eight in Scotland, and no new deaths in Northern Ireland.
Britain hit a major vaccinations milestone yesterday as Matt Hancock revealed half of all UK adults have now received a first dose.
The Health Secretary announced the milestone in a Twitter video and wrote: “Yesterday we vaccinated more people than any day yet. I’m delighted to be able to say that we’ve now vaccinated HALF of all adults in the UK.
“The vaccine is a national success story & our way out of this pandemic. When you get the call, get the jab.”
The UK has rolled out the Pfizer/BioNTech and Oxford/AstraZeneca vaccines at pace, as Boris Johnson stakes his roadmap out of lockdown in part on the success of the vaccine rollout.
A record number of people received their Covid-19 vaccine on Friday, with 711,156 doses given to the UK public.
The Department of Health and Social Care said it remains “on track” to offer the vaccine to all over-50s by April 15.
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The Northern Territory Government has removed ceiling fans from all cells in Darwin’s prison, after the NT coroner first raised concerns about them in 2017.
Ceiling fans have been removed from all cells at Darwin Correctional Centre
Independent environmental modelling shows “acceptable comfort” levels for prisoners
Lawyers have called for improvements in prisoner conditions
In a statement, the NT Department of Correctional Services said desk fans had been placed in sleeping areas and independent environmental modelling showed “acceptable comfort levels” for prisoners.
But lawyers representing prisoners in the Territory’s jails say they receive frequent complaints about oppressive conditions that fail to meet international health guidelines for prisoners.
Marty Aust, president of the Criminal Lawyers Association of the NT, said consecutive NT governments and their agencies have failed to follow through on recommendations to improve conditions in the Territory’s prisons.
NT Coroner Greg Cavanagh raised concerns about ceiling fans after the 2017 and 2018 inquests into the deaths of low-security prisoners Roy Melbourne, 81, and Vernon Bonson, 34, at Darwin Correctional Centre.
Mr Cavanagh found the prisoners used “classic hanging points” to take their own lives in their cells and questioned why one of Australia’s newest prisons had installed ceiling fans.
Former Corrections Commissioner Ken Middlebrook told Mr Cavanagh the fans were installed as a cost-cutting measure when the prison was built in 2014 and that no testing took place to determine whether the fans would collapse under a person’s body weight.
The Northern Territory Government was required to answer questions and provide evidence about the fans.
In its response, the government said a load sensing device, which would make the ceiling fans suicide-proof, had been developed and was in the final stages of testing and approval.
The coroner was told approval was “expected to be finalised in a matter of days.”
In 2017, then NT corrections minister Natasha Fyles told Mr Cavanagh the government had pursued development of the load sensing device with Charles Darwin University but that testing was only able to obtain a 93 per cent success rate.
Kishan Kariippanon, a lecturer and research fellow at the University of Wollongong, said an appropriate prototype model could be available in 12 months if funding was available for research.
The government removed ceiling fans from single-occupancy cells at the prison and replaced them with less powerful desk fans in 2017.
Ceiling fans from double bedrooms and sleep-out areas were removed in late 2020, after delays in doing the work because of COVID-19 restrictions.
Mr Aust from the Criminal Lawyers Association said the government should address concerns about conditions for prisoners.
“It’s falling short … we hear time and time again that NT prisoners have to lay down on the floor to try and get some peace and comfort to sleep, but we keep hearing from Corrections that that’s what they want to do,” he said.
The United Nations’ Standard Minimum Rules for the Treatment of Prisoners and the Standard Guidelines for Prison Facilities specifies the importance of air, heating and ventilation, ensuring buildings “meet all requirements of health.”
Minimum standard rules set by the United Nations High Commissioner for Refugees (UNHCR) include all prisoner sleeping accommodation give “due regard” to climatic conditions.
The Royal Commission into Aboriginal Deaths in Custody in the 1990s recommended that Police and Corrective Services should carefully scrutinise equipment and facilities provided in prisons “with a view to eliminating and/or reducing the potential for harm.”
NT Correctional Services regulations do not include requirements to ensure prisoners are living in a room within defined temperatures, only that the clothing provided be suitable for the climate.
Complaints from prisoners
Beth Wild from the North Australian Aboriginal Justice Agency said that “certainly, over the warmer months, over the wet season and the build-up we get frequent complaints from clients about the conditions within the prison.”
“Anyone in the NT would know what it’s like to be inside a building made out of besser-block, without a ceiling fan and no aircon,” she said.
“In the build-up those conditions would be distressing to anybody.”
Ben Pascoe, the uncle of Vernon Bonson who died in the prison in 2016, said his family from the remote community of Maningrida was still asking for answers about the death.
“They didn’t fix the fans. Why?”
In his statement provided to the ABC before his current period of leave, NT Correctional Services Commissioner Scott McNairn said the top priority for the department was the safety and wellbeing of all prisoners, staff and the wider community.
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“WE’VE KILLED it,“ drawls a grand client at a fancy hairdresser in Delhi. “Covid came to India but we were so grubby and diseased it just bounced off, rolled over and died.” The hyperbole elicits a round of chuckles, as it was meant to.
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Such glibness might seem tasteless, considering an official national death toll of nearly 160,000, as well as ominous signs that India is on the cusp of a second wave that its vaccination drive may be too slow to suppress. Yet as a share of its nearly 1.4bn people, the tally is minuscule, despite a huge outbreak. A national survey of blood samples suggests that by December some 22% of Indians had been exposed to covid-19, 30 times the official tally of around 11m cases to date. If that estimate is right and if India’s fatality rate had been as high as, say, Britain’s, there would have been some 10m deaths.
Arun Madhavan, a doctor in Palakkad, a town in the southern state of Kerala, was pretty sure one patient would not survive covid-19. Thin and frail, the farm labourer was over 80. More to the point, she had lost a lung to tuberculosis 40 years earlier. Yet to Dr Madhavan’s amazement she suffered only sniffles, aches and a fever.
Across the country, tales of such resilience abound. Politicians have been quick to grab credit, ascribing the low numbers to their wisdom in decreeing strict lockdowns or boosting hospital capacity. Health experts are sceptical. India has certainly made big efforts, but its lockdown and subsequent easing may have actually spread the disease, as migrants were first cooped up in covid-racked cities and then allowed to return to their villages. Neither convincing data nor medical evidence have yet been produced to explain why the disease’s impact has been relatively light.
One place that provides clues is Kerala, a state with much better record-keeping than most of India. It claims to register 100% of births and deaths, compared to less than 50% in many other states. K.K. Shailaja, the state’s health minister, notes that, despite the state’s strong public-health system, its 35m people should have been more susceptible to covid-19 than the rest of the country: “We have double the population density as the rest of India, but also a higher proportion of old people and also more lifestyle diseases, like diabetes.”
Yet in January, when the state released its vital statistics for 2020, the number for deaths from all causes revealed a surprise. They showed that Kerala saw nearly 30,000 fewer deaths during the epidemic year than in 2019, and fewer deaths than in any year since 2012. Whereas overall mortality rose by 15% in America last year, and in almost covid-free New Zealand dropped by 5%, in Kerala it seemed to have plummeted by an astonishing 11%.
Alas, this news proved too good to be true. Since the initial tally was published, the addition of unreported deaths has narrowed the gap to a still impressive 8%. It may shrink further. “I would have waited before tom-tomming those numbers,” cautions Rajeev Sadanandan, a former top health official in the state. “Civil registration data always come with a delay, which may now be worse because of covid, so we will only know for sure by June or so.”
Even with the downward estimate, Kerala appears to have weathered the pandemic remarkably well (see chart). A group of students returning from Wuhan, China in January 2020 brought the state’s (and India’s) first cases. But a fierce government-led campaign, mobilising more than 300,000 volunteers to trace and look after patients, nearly eradicated the virus. The subsequent lifting of India’s national lockdown and the return of some 500,000 expatriate workers from the Gulf fed a surge in cases that was harder to control. But the state’s stronger curbs seem to have delayed the peak of its first wave, which came in October, a month after the rest of India’s. The most recent national survey of blood samples showed Kerala’s rate of exposure to the virus was half the national average, a sign of success in containing its spread. Official figures also suggest that Kerala’s fatality rate has been substantially lower, at just 0.4% of confirmed cases, than the rate of 1.4% for India as a whole.
These figures, too, are far from accurate. Dr Madhavan has carefully compared local newspaper obituaries with official death records. For political reasons, he believes, the state has been underreporting covid-19 fatalities by 30-40%. Other doctors concur, saying they are encouraged to cite comorbidities as the cause of death when covid-19 was the main factor.
Even if Kerala has suffered far more than the official 4,300 fatalities from the disease, however, its overall death rate remains strikingly low. Critics such as Mr Madhavan concede that the communist-led state government, which faces an election in April, has done a creditable job of caring for people, including the very poor. Health experts cite a range of other reasons for the low death rate, such as reduced traffic accidents, less stress-related illness and an almost total absence of other infectious diseases. One doctor jokes that colleagues complained of having so few cases in Kerala’s post-monsoon “fever season” last summer that they feared going out of business.
The limited data available suggest that in other parts of India, too, covid-19 has been less lethal than in much of Europe or the Americas. One group of researchers compared data on deaths with the infection rate (based on surveys of blood samples) in the state of Karnataka and the city of Mumbai. In those locations, too, they found that Indians, and especially the elderly, had an unusually high chance of survival. The number of covid-19 deaths in Karnataka would need to have been underreported by a factor of five to match the typical global fatality rate.
Mr Sadanandan says plenty of research disproves the theory that India may have lucked out with a weaker strain of the disease. Dr Madhavan agrees. “The fact is that Indians have been exposed to a lot of pathogens, so there is probably some cross-immunity at play here.” Perhaps the talk in Delhi’s hair salons is not all bluster. ■
All our stories relating to the pandemic and the vaccines can be found on our coronavirus hub. You can also listen to The Jab, our new podcast on the race between injections and infections, and find trackers showing the global roll-out of vaccines, excess deaths by country and the virus’s spread across Europe and America.
This article appeared in the Asia section of the print edition under the headline “Getting off lightly”
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