Going Viral: Day 77 under COVID-19 lockdown

Like millions of others around the world, Gulf News Foreign Correspondent Mick O’Reilly is currently under COVID-19 lockdown. This is what life is like in social isolation in Ireland, where there are strict rules about who is allowed out, where, and under limited circumstances.

DAY 77

Sunday June 14, 9am

IS THERE ANYBODY OUT THERE?

IT’S SUNDAY – TIME FOR A QUIZ

PUT YOUR THINKING CAPS ON

Right, every two weeks I put together a quiz. There are 50 questions spread over five rounds, each question is worth a point. The answers are at the end of the blog. There are no prizes, just personal satisfaction.

Here you go:

ROUND 1

1. What is the capital city of Switzerland?

2: The Philippines is comprised of how many islands? 6,492, 7,107, or 7,641?

3. TAP is the flag carrier airline of which country?

4. The Daintree Rainforest can be found in which country?

5. If you were to visit the National Diet, you would be visiting the parliament of which country?

6. Machu Picchu is a stunning UNESCO world heritage site found in Peru but what ancient empire built it?

7. Ouzo is the national drink of which country?

8. The Vietnamese flag features what shape?

9. The rand is the official currency of which country?

10. Which beautiful Greek Island is famous for its beautiful whitewashed buildings and black sand beaches?

ROUND 2

11. Belmopan is the capital city of which country?

12. Which Indian state is famous for its house boats?

13. What is the capital of Laos?

14. What microstate is located on the French Riviera?

15. What city is located at the mouth of the River Plate?

16. Edmonton is the capital city for which Canadian province?

17. How many US states are there?

18. What is the currency used in Austria?

19. The movie ‘Braveheart’ tells the story of what character from history?

20. What is 0 degrees Celsius on the Fahrenheit scale?

ROUND 3

21. What year was Nelson Mandela released from Victor Vester prison?

22. What year was President John F Kennedy assassinated?

23. In what year did Neil Armstrong become the first man to walk on the moon?

24: When did the first Apple iPhone go on sale?

25: When were the first Live Aid concerts held?

26. Margaret Thatcher stepped down as UK Prime Minister in what year?

27. What year did the UK vote to leave the EU?

28. What year did the First World War end?

29. What year did the Second World War begin?

30. What year did India gain independence from Britain?

ROUND 4

31. The empire of which modern day African country was founded in the 13th century and was called Abyssinia

32. Which country did the Romans call Helvetia?

33. In which modern country would you find ancient Mesopotamia?

34: The ancient Persian empire was centred in which modern country?

35. Cathay is an anglicised name for which Asian country?

36: Which Pacific island was dubbed The Friendly Island in the 18th century?

37: What’s the modern name for the former colony of British Honduras?

38: In which modern-day European country would you have found Bohemia?

39: The CN Tower is located in which North American city?

40. Huron, Ontario, Superior, Michigan and Erie are known collectively as what?

ROUND 5

41. What part of the body is the Axilla?

42: Who is Gordon Sumner better known as?

43. Who played the first James Bond?

44. How many colonies signed the American Declaration of Independence?

45. Tbilisi is the capital of which country located at the intersection between Europe and Asia?

46. In which year did the USA enter the Second World War?

47. In Scrabble, how many points is the letter K worth?

48. Where would you find the Atacama Desert?

49. Where was the famous explorer Christopher Columbus born?

50. In geometry, what's a ten-sided shape called?

NORWAY SNUBS COVID-19 HOTSPOT SWEDEN IN LIFTING TRAVEL CURBS

A lot of people have looked to Sweden and how it has coped with COVID-19. But the thinking seems to have changed that it’s open policy might not have been so smart.

And maybe that’s why Norway is shunning travel to Sweden now.

The Nordic country will allow travel to and from Finland, Iceland and the Swedish island of Gotland from Monday, but maintain travel restrictions on mainland Sweden due to its higher level of COVID-19 cases, amid concerns of a second wave of infections.

Denmark, Finland and Norway have lifted some of the controls on leisure travel they imposed to slow the coronavirus pandemic, but have kept most of those imposed on Sweden, the richest and most populous of the Nordic countries.

Leaving most of Sweden out of the arrangements breaks with long-standing close cooperation between the Nordic countries, and goes against the wishes of the European Commission, which wants to lift by Monday the internal borders in the Schengen travel zone, which in normal times are open.

Norway is not a member of the EU but belongs to Schengen.

“I think we need to be honest and say that in the Nordics this is something of a difficult issue at the moment,” Norwegian Prime Minister Erna Solberg told a news conference.

“At the same time we have a good conversation about how we’re doing it, and the fact that we’re applying objective criteria has been met with understanding.”

MORE SWEDISH POSITIVES A RESULT OF MORE TESTING

Swedish Home Affairs Minister Mikael Damberg said his government would continue to work on opening up the whole of the Nordic region. He said a rise in coronavirus cases reported in Sweden in recent days was the result of increased testing.

“That means we are going to see an increase in the number of cases with mild symptoms, but it does not mean that there is a greater rate of infection,” he said in a written comment to Reuters.

Norway’s arrangements add to the patchwork of bilateral travel arrangements various European countries have made as they emerge from lockdowns.

Norway will assess the public health situation of each region in the Nordics separately and will review its travel advice every fortnight, starting June 15, Solberg said.

Gotland, a Baltic island with close to 60,000 inhabitants, is the only Swedish region Norway will allow Norwegians to travel to without having to undergo a 10-day quarantine on their return. Swedish travellers from Gotland will be allowed to travel to Norway without undergoing quarantine.

Sweden adopted fewer restrictions during the pandemic and by June 10, Sweden’s COVID-19 deaths were 4,717 – four times that in the other Nordic countries combined.

ITALIAN PROSECUTORS QUESTION PM CONTE FOR THREE HOURS OVER CORONAVIRUS RESPONSE

Here in Ireland, public health officials trace the initial spread of COVID-19 to a number of tourists who returned from Northern Italy and Austria in mid-January. Italy was hard hit by the coronavirus, so it’s no wonder then that

Italian Prime Minister Giuseppe Conte was questioned by prosecutors on Friday about the country’s response to its coronavirus outbreak. More than 34,000 people there from COVID-19..

The prosecutors from Bergamo, one of the northern cities hit hardest by the pandemic, are looking into why badly affected small towns around the city were not locked down earlier in the outbreak, when infections were rising fast.

Conte, who was questioned as a witness for three hours in his office in Rome and is not under criminal investigation, later told reporters via his spokesman: “I wanted to explain every stage to the smallest detail.” Prosecutors also questioned Interior Minister Luciana Lamorgese and Health Minister Roberto Speranza.

In interviews with several Italian newspapers on Friday, Conte said he would tell prosecutors everything he knew and was not worried by the possibility he could be personally investigated.

If that did happen, it would be likely to weaken an already fractious coalition government and add fuel to already frequent speculation that Conte may be pushed out despite his high personal approval ratings in opinion polls.

HALF OF ITALY’S DEATHS CENTRED ON BERGAMO

Prosecutor Maria Cristina Rota said the meeting had taken place “in an atmosphere of great calm and institutional collaboration”. The region of Lombardy, which includes Bergamo, was the original epicentre of Italy’s virus outbreak and has remained by far the worst hit of its 20 regions, accounting for about half of its total deaths and most new infections.

The decision not to isolate Bergamo and the surrounding towns has been one of the most contentious episodes, with the central government and Lombardy’s regional authorities each saying the other was responsible. In Lombardy, which is led by the right-wing opposition League party, the Bergamo prosecutors have already interrogated the regional president and health chief.

League leader Matteo Salvini was quick to seek political capital from Conte’s interrogation, tweeting that it was Rome’s decision not to set up a so-called “red zone” to seal off Bergamo and enforce it with the army and police.

“Now we expect that Conte will at least apologise to the relatives and the friends of too many Bergamo citizens who have died,” he tweeted. COVID-19 death rates and infections have subsided in Italy in recent weeks, but anger is still running high among residents of the towns and cities at the centre of the epidemic. A group representing relatives of those who died in

MEME OF THE DAY

I came across this on Facebook and thought it was chuckle-worthy.

CANADA TO MANDATE TEMPERATURE CHECKS FOR AIRLINE PASSENGERS, TRUDEAU SAYS

I spent 20 years living in Canada and love its people and places. I generally visit there once a year. I find it interesting now that Canada will take airline passengers’ temperatures before they fly and anyone with a fever will not be allowed to travel.

“Temperature checks will not be detecting people with COVID-19,” Prime Minister Justin Trudeau said on Friday. “It’s an extra layer of safety to encourage people who might feel sick to stay home and not put others at risk.”

The screening will be phased in, with those arriving in Canada being screened by the end of June, and then for those leaving the country as well as for domestic travelers at the country’s four biggest airports by the end of July.

If a traveller is found to have a fever after two separate measurements 10 minutes apart, they will be asked to rebook after 14 days have passed, the transport minister said.

Canada and the US are set to extend a ban on non-essential travel to late July as both countries seek to control the spread of the coronavirus, three sources familiar with the matter told Reuters earlier this week.

Canada last week said it would require most airport workers and flight crews to wear non-medical masks.

The spread of the coronavirus has slowed in Canada in recent weeks, and all the provinces have begun to ease restrictions and open up for business again. As of Thursday, Canada had recorded 97,530 total cases and 7,994 deaths, up from 7,960 deaths a day earlier, official data show.

More than 80 per cent of the deaths have been in long-term care facilities and nursing homes, prompting Ottawa to send the military to help out.

Also on Friday, Trudeau extended the military presence in long-term care homes in both Ontario and Quebec until June 26. When the military pulls out, the Canadian Red Cross will be moving in to help, Trudeau said.

TAKING STOCK

HOW I’M PRETENDING TO GROW £10,000 IN PLAY MONEY

A reminder that this is all pretend, I started out in lockdown with £10,000 – about Dh45,000 to invest on the London Stock Exchange, I don’t pay for trades and I can only buy or sell when the market is closed. There’s no minimum on the amount of stocks I can buy, just as long as I can afford them.

I will decide before markers open on Monday how to shake it up, but I am cashing in my Ocado and Diageo shares that, together with £233.88 cash in hand, gives me £4971.88 to reinvest after a week that saw my pretend portfolio lose more than £1,000 in value

This is how things stand:

Net worth £12,985.88

PowerHouse, 1200 shares: £4080.00

Ryanair, 350 shares: £3934.00

Cash in hand: £4971.88

£ loss on last trading day: £60.

% gain overall: 29.8 per cent

£ Gain overall: £2985.88

CONFESSIONS FROM LOCKDOWN

I came across and interesting element on NBC where those under lockdown posted their one line confessions from lockdown. What they thought, what they did, their fears and other worries or concerns. The comments show that we’re pretty much the same the world over. You can always share yours to Readers@gulfnews.com and mark it for the Going Viral blog.

Here are 10 more confessions:

1: I am a childcare essential worker and I feel we do not get any credit For all our hard work during this pandemic.

2: Feels horrible to realise that we all knew before the lockdowns about so many people we would not see ever again.

3: I’m working from home and my partner is retired. Too much togetherness.

4: My biggest fear is that after all of this is over we'll discard the lessons learned and repeat everything that got us here.

5: Pending a layoff notice for my husband and suspect I'll get let go within a month as well. I have no idea what we'll do.

6: I'm a healthcare provider. Encouraging infection prevention has somehow become "political". Scary and heartbreaking.

7: I was unemployed before the crisis. Good luck finding work now. And I don’t qualify for any handouts.

8: I publish an alt-weekly in a small town. I'm sick of having to cover ignorant protestors and their childish tantrums.

9: Hubby was psych inpatient from the stress. Received nothing. COVID-19 has other effects too, take care of each other.

10: I'm secretly so happy I don't have to see a bunch of old patients. I'm an audiologist and I was so sick of them.

WHAT ICU DOCTORS HAVE LEARNED ABOUT COVID-19 — AND HOW THEY'RE PREPARED FOR A SECOND WAVE

The World Health Organisation had just declared COVID-19 a pandemic when intensive care units in the US started to see an influx of severely ill patients. It was mid-March, and though coronavirus cases had been mounting in countries including China, South Korea and Italy, in the US there was still a dearth of knowledge about how the virus spread, how it affected patients, and what type of threat it posed to the doctors treating them.

Within three months, critical care physicians across the country received a crash course on a disease that didn't exist in the US before this year, and are more prepared in the event of a second wave of the illness. Now, in June, doctors have a better sense of which medicines and interventions to use or avoid, how the virus affects the body, and how to face their own COVID-19 fears.

In the beginning, “everyone had the concern of getting infected,” Dr. Francis Castiller, medical director of critical care at UNC REX Hospital in Raleigh, North Carolina, said. The new disease was spreading rapidly, before many ICUs were able to prepare for the surge or protect their staff appropriately.

Dr. Josh Denson, a pulmonary medicine and critical care physician in New Orleans, said he diagnosed the first critically ill COVID-19 patient in Louisiana. But the hospital did not yet have strict protocols for quarantining patients.

“They hadn’t isolated this patient appropriately, so my team members and I were exposed,” said Denson, who works at Tulane Medical Centre but was at a different hospital when he was exposed to the virus. “We had real concerns about whether we were going to get this or not.”

He never got sick, and has since tested negative for COVID-19 antibodies.

But it was those fears, in part, that affected how critically ill patients were cared for in the beginning of the outbreak in the US

VENTILLATORS

COVID-19 notoriously wreaks havoc on the lungs, leaving severely ill patients struggling to breathe. As cases started emerging in the US, doctors looked to their colleagues in Italy, who were already in the middle of a huge influx of extremely sick patients.

For patients with severe breathing problems, the Italian doctors were using a type of therapy called high flow nasal oxygen, a much less invasive approach than putting a patient on a mechanical ventilator. Patients can get 100 per cent oxygen through the nose without having to have a breathing tube put in place.

But an unusually high number of health care personnel in Italy — 20 per cent, according to an editorial in The Lancet medical journal — were becoming infected with the coronavirus. They blamed the high flow nasal oxygen, figuring the treatment was aerosolizing the virus, spreading it to doctors and nurses.

As a result, many doctors in the US were initially wary of using high flow oxygen for COVID-19 patients.

"We were very concerned, so we didn't use it," Dr. Hugh Cassiere, director of critical care medicine at Northwell Health's North Shore University Hospital on Long Island, New York, told NBC

Instead, patients were intubated and put on ventilators, often right away. “Reports from other places was that you should put people on the ventilator early, because the disease was so rapidly progressive,” Dr. Todd Rice, an associate professor of medicine at Vanderbilt University Medical Centre, said.

But putting patients on ventilators comes with risks, too, including infection and unintentional damage to the lungs. Very often, patients require heavy sedatives to paralyse them so doctors can get the breathing tube into the patients' windpipe. That procedure, called intubation, also carries the risk of infection and lung complications, and can expose health care workers to virus-filled respiratory droplets.

That's a big deal. If you can prevent someone from being intubated, that could change their whole course.

What's more, the longer a person remains on a ventilator, the greater the chances for blood clots, gastrointestinal bleeding, pneumonia and death.

The first few months were a learning experience. Now, doctors are trying to avoid ventilators if possible. Both Rice and Cassiere said more current data show high flow oxygen does not put health care workers at increased risk. And experience has shown them that not all patients require a ventilator. When possible, doctors see if patients improve with the high flow oxygen first.

“That's a big deal,” Cassiere said. “If you can prevent someone from being intubated, that could change their whole course.”

TARGETING THE KIDNEYS

Despite attempts to move away from ventilators, some COVID-19 patients still need them. As the pandemic has progressed, it's become apparent that coronavirus patients on ventilators need special care.

When patients are put on a ventilator, they're often given diuretics to get rid of extra fluid in the body. Lungs that need help need to be "dry" to function properly. When they're wet, "they can't move oxygen as well," Denson said.

But the coronavirus has since proved it's not a simple respiratory illness. It can affect the lungs, the brain, the blood and, critically for patients on ventilators, the kidneys.

Unlike lungs, kidneys prefer to be hydrated. The longer patients are kept dehydrated, their chances of kidney failure increase. Denson said he's changed his treatments for COVID-19 patients to give additional hydration if they're showing damage to the kidneys.

"I'm targeting the kidneys a little bit more," he said. "I'm less aggressive up front getting people dry, and I'm more willing to use fluids if needed."

It's a balancing act that requires extreme attention on the part of ICU doctors and their staff. Too much hydration hurts the lungs. Too little hurts the kidneys. "It's a constant battle," Denson told NBC.

MEDICATIONS

When doctors faced the first surge of severely ill COVID-19 patients, no drugs had been shown to work against the virus, making treatment more challenging. As a result, doctors were willing to try certain medications based on limited evidence.

Early on in the pandemic, the drug hydroxychloroquine emerged as a potential treatment, following two studies that suggested it might be beneficial. As a result, many patients were given the drug, which is already approved for malaria and rheumatoid arthritis. But doctors soon found the drug was not useful in treating COVID-19, and subsequent research has shown it does not appear to help.

Now, doctors in ICUs are turning to the drug remdesivir. It's not a cure, but it's the only treatment that's been shown in a clinical trial to have an effect on the illness so far.

Some physicians are also finding success with other pharmaceutical approaches, though evidence remains anecdotal.

Cassiere has given ventilated patients steroids to reduce inflammation in the lungs.

"I was gun-shy up front about doing that, because I was concerned I could be doing more harm," Cassiere said, citing research from the 2003 SARS outbreak that suggested steroids cause coronaviruses to linger longer in patients. He found that combining the steroids with convalescent plasma, an antibody-rich blood product of recovered COVID-19 patients, appeared to cancel out that risk.

Cassiere also said he's changed his methods of sedating patients who need to be put on a ventilator, opting for fewer narcotics like fentanyl in favour of other drugs such as benzodiazepines or ketamine.

"My experience has been that the narcotics hang around longer, and may have something to do with the prolonged awakening some of these patients have," Cassiere said, referring to those who take an unusually long time to wake up from a coma after being removed from a ventilator.

MAINTAINING CONNECTION THROUGH A LENGTHY ILNESS

That COVID-19 patients tend to be sick for a long time, spending weeks in the intensive care unit in some cases, is another factor physicians are getting used to in dealing with COVID-19.

"Taking care of patients requires a lot of patience," Dr. Steve Stigler, director of the medical intensive care unit at the University of Alabama at Birmingham, said. He coaches his physicians to stay the course with treatment and supportive care.

Patients "improve up to a point, and then it can be several weeks before we would see them continue to improve," Stigler said.

Castiller, of UNC REX Hospital in Raleigh, also said it's critical for ICU physicians to communicate that to families of COVID-19 patients.

One of the biggest lessons we've learned is the importance of human contact.

"Families need to prepare for that, as well as peaks and valleys" seen so often in the sickest patients, Castiller told NBC News. To offer support, Castiller said his staff calls patients' families daily with updates.

Rice's team at Vanderbilt does the same. "Every day, we call families and say, 'Here's the update on your loved one.' It's gone really, really well, and it's something we're proud of," he said. The staff also uses videoconference technology, like Zoom, so the family can visit with patients.

"One of the biggest lessons we've learned is the importance of human contact," Castiller said. Hospital restrictions that prohibit visiting COVID-19 patients have been major stressors for families, as well as those in the hospital. "We make sure to address that by using technology to maintain some level of communication."

‘I’M A COVID-19 WARRIOR NOW’

Early fears that critical care physicians had about becoming infected with the coronavirus have eased significantly. Cassiere, who said he was terrified at the beginning of bringing the virus home to his family, has tested negative for antibodies. He credits appropriate use of personal protective equipment, such as masks, gloves and gowns.

"All my protection I've had has helped. I'm confident that I'm not bringing it home. I'm confident that if I'm protected, I'm not going to get infected," Cassiere told NBC. "And now, I'm armed with the knowledge and different approaches I have for battling COVID-19."

Experience matters. "Being a good critical care doctor is a lot of experience," Rice added. "Now we've seen this, and we've done this, and it will result in us providing even better care for our patients."

"We know we don't know everything about it, but we know the spectrum of disease and what it does to the body," Cassiere said. "I didn't know that back in March. I have all that knowledge behind me. I'm a COVID-19 warrior now. We're totally prepared for it."

QUIZ ANSWERS

ROUND 1

1. Bern; 2. 7,641; 3. Portugal; 4. Australia; 5. Japan; 6. Inca empire; 7. Greece; 8. Star; 9. South Africa; 10. Santorini.

ROUND 2

11. Belize; 12. Kerala; 13. Vientiane; 14. Monaco; 15. Buenos Aires; 16. Alberta; 17. 50; 18. Euro; 19. William Wallace; 20 32

ROUND 3

21. 1990; 22. 1963; 23. 1969; 24. 2007; 25. 1985; 26. 1990; 27. 2016; 28. 1918; 29. 1939; 30. 1947

ROUND 4

31. Ethiopia; 32. Switzerland; 33. Iraq; 34. Iran; 35. China; 36. Tonga; 37. Belize; 38. Czech Republic; 39. Toronto; 40. The Great Lakes.

ROUND 5

41. Armpit; 42. Sting; 43. Sean Connery; 44. 13; 45. Georgia; 46. 1941; 47. 5; 48. Chile; 49. Italy; 50. Decagon.

QUESTIONS AND ANSWERS

I’m not an expert, but I might be able to help you make a bit of sense of this. And we can all get through it together. Isn’t this what this is all about.

Send your questions for me to Readers@gulfnews.com.

That’s it for now. Let’s check in with each other tomorrow. I have used files from Reuters, AP, DW, Sky News, Twitter and other European and North American media outlets in today’s blog. And remember to stay safe.

Mick O’Reilly is the Gulf News Foreign Correspondent based in Europe