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Coronavirus Disease 2019 (COVID-19)

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  • Added guidance for mold awareness, monitoring, and remediation during and after prolonged building shutdowns
  • Updated Legionella guidance for people with weakened immune systems and the use of respiratory protection when flushing water systems
  • Updated title to reflect content

The temporary shutdown or reduced operation of a building and reductions in normal water use can create hazards for returning occupants. Two potential microbial hazards that should be considered prior to reopening after a period of building inactivity are mold and Legionella (the cause of Legionnaires’ disease). For mold, a “prolonged period” may be days, weeks, or months depending upon building-specific factors, season, and weather variables.1 For Legionella, a “prolonged period” may be weeks or months depending on plumbing-specific factors, disinfectant residuals, water heater temperature set points, water usage patterns, and preexisting Legionella colonization.2 Note that additional hazards, outside of those discussed in this document, may exist for returning occupants. These can include other microbial hazards, such as non-tuberculous mycobacteria, changes in water chemistry that lead to corrosion, leaching of metals (such as lead) into stagnant water, disinfection by-products, and sewer gases that enter buildings through dry sanitary sewer drain traps.

Mold

Mold will grow on building materials where there is moisture, produced from leaks or condensation from roofs, windows, or pipes, or from  a flood. Mold can grow on a variety of surfaces, such as ceiling tiles, wallpaper, insulation, drywall, carpet, and fabric. People with asthma and other respiratory conditions and those with mold allergy or weakened immune systems should avoid buildings suspected or confirmed to have mold contamination. Ensure that your building does not have mold after a prolonged shutdown to maintain a safe working environment for returning occupants.

5 steps to minimize mold risk during and after a prolonged shutdown

  1. Maintain indoor humidity as low as possible, not exceeding 50%, as measured with a humidity meter. Building managers may consider continuous monitoring of indoor humidity using a digital hygrometer, ideally more than once daily, to minimize the need to access the building.
  2. After a prolonged shutdown and before occupants return, buildings should be assessed for mold and excess moisture.
    1. Building inspections by trained industrial hygienists can recognize dampness or mold by sight or odor, without the need for sampling and laboratory analysis. NIOSH offers tools and instructions to assess dampness and mold in schools and general buildings. These tools can be used by building maintenance staff as well as industrial hygienists.
    2. If dampness or mold is detected, address the source of water entry first. Clean-up and remediation should then be conducted before the building is reoccupied. Plan the remediation before beginning work. Resources for remediation of buildings and homes with mold are provided by NIOSH, the New York City Department of Health and Mental Hygienepdf icon, the Environmental Protection Agencyexternal icon (EPA), and CDC .
  3. After an assessment has confirmed that mold and moisture are not detected (Step 2a), OR after remediation has been completed (Step 2b), a building HVAC system that has not been active during a prolonged shutdown should be operated for at least 48 to 72 hours (known as a “flush out” period) before occupants return.
    1. During this period, open outdoor air dampers to the maximum setting that still allows desired indoor air temperatures.
    2. If an odor is detected that suggests mold growth (such as a musty smell) after the “flush out” period, look for mold that may not have been identified earlier. If mold is found, conduct remediation as described in Step 2b.
    3. Continue the “flush out” process until no odors are apparent.
    4. The condition of HVAC filters used during the “flush out” period should be carefully assessed prior to building occupancy and replaced with new or clean filters as necessary.
  4. After a building is reopened and occupied, routine (e.g., weekly) checks of the HVAC system are recommended to ensure operating efficiency.
    1. During HVAC checks, inspect and replace filters as indicated or needed.
    2. The frequency of HVAC system checks can be gradually reduced (e.g., monthly, quarterly), depending on the operational and maintenance specifications for the HVAC system.
    3. Maintain indoor temperature and relative humidity within ranges recommended in ASHRAE Standard 55-2017, Thermal Environmental Conditions for Human Occupancyexternal icon.
  5. If no routine HVAC operation and maintenance program is in place for the building, one should be developed and implemented. At a minimum, consider including the following:
    1. Inspection and maintenance of HVAC components
    2. Calibration of HVAC system controls
    3. HVAC testing and balancing

Content adapted from the National Institute for Occupational Safety and Health [NIOSH] Heating, Ventilation, and Air Conditioning [HVAC] Cleaning and Remediation guidance.

Additional information and CDC guidance on controlling dampness issues that result in indoor mold growth, as well as on renovation and remediation if indoor mold has become an issue is available from NIOSH.

Legionella and Legionnaires’ disease

Stagnant or standing water in a plumbing system can increase the risk for growth and spread of Legionella and other biofilm-associated bacteria. When water is stagnant, hot water temperatures can decrease to the Legionella growth range (77–108°F, 25–42°C). Stagnant water can also lead to low or undetectable levels of disinfectant, such as chlorine. Ensure that your water system is safe to use after a prolonged shutdown to minimize the risk of Legionnaires’ disease and other diseases associated with water.

People at increased risk of developing Legionnaires’ disease, such as those with weakened immune systems, should consult with a medical provider regarding participation in flushing, cooling tower cleaning, or other activities that may generate aerosols. Wearing a half-face air-purifying respirator equipped with an N95 filter, or an N95 filtering facepiece, may be appropriate in enclosed spaces where aerosol generation is likely. Respirators must be used in accordance with a comprehensive respiratory protection program, which includes fit testing, training, and medical clearance ahead of their use (see OSHA standard 29 CFR 1910.134external icon and OSHA Legionellosis websiteexternal icon). For more information about N95 respirators, visit the NIOSH National Personal Protective Technology Laboratory (NPPTL) website.

8 steps to minimize Legionella risk before your business or building reopens

  1. Develop a comprehensive water management program (WMP) for your water system and all devices that use water. Guidance to help with this process is available from CDC and others.
    1. Water Management Program Toolkit:
      This toolkit is designed to help people understand which buildings and devices need a Legionella water management program to reduce the risk of Legionnaires’ disease, what makes a good program, and how to develop it.
      https://www.cdc.gov/legionella/wmp/toolkit/index.html
    2. Preventing Legionnaires’ Disease: A Training on Legionella Water Management Programs (PreventLD Training):
      Take this training from CDC and partners on creating a water management program to reduce risk of Legionnaires’ disease. PreventLD Training aligns with industry standards on managing risk of Legionella bacteria.
      https://www.cdc.gov/nceh/ehs/elearn/prevent-LD-training.html
    3. Hotel Guidance:
      Considerations for Hotel Owners and Managers: How to Prevent Legionnaires’ Disease
      https://www.cdc.gov/legionella/wmp/hotel-owners-managers.html
    4. Operating Public Hot Tubs/Spas for pool staff and owners:
      https://www.cdc.gov/healthywater/swimming/aquatics-professionals/operating-public-hot-tubs.html
    5. Reduce Risk from Water: Plumbing to Patients:
      Water management programs in healthcare facilities are an important way to help protect vulnerable patient populations as well as staff and visitors.
      https://www.cdc.gov/hai/prevent/environment/water.html
    6. Preventing Occupational Exposure to Legionella:
      https://www.cdc.gov/niosh/docs/wp-solutions/2019-131/default.html
  2. Ensure your water heater is properly maintained and the temperature is correctly set.
    1. Determine if your manufacturer recommends draining the water heater after a prolonged period of disuse. Ensure that all maintenance activities are carried out according to the manufacturer’s instructions or by professionals.
    2. Make sure that your water heater is set to at least 120°F.
    3. Higher temperatures can further reduce the risk of Legionella growth, but ensure that you take measures to prevent scalding if your water heater is set to >130°F.
  3. Flush your water system
    1. Flush hot and cold water through all points of use (e.g., showers, sink faucets)
      1. Flushing may need to occur in segments (e.g., floors, individual rooms) due to facility size and water pressure. The purpose of building flushing is to replace all water inside building piping with fresh water.
    2. Flush until the hot water reaches its maximum temperature.
    3. Care should be taken to minimize splashing and aerosol generation during flushing.
    4. Other water-using devices, such as ice machines, may require additional cleaning steps in addition to flushing, such as discarding old ice. Follow water-using device manufacturers’ instructions.
  4. Clean all decorative water features, such as fountains
    1. Be sure to follow any recommended manufacturer guidelines for cleaning.
    2. Ensure that decorative water features are free of visible slime or biofilm.
    3. After the water feature has been re-filled, measure disinfectant levels to ensure that the water is safe for use.
  5. Ensure hot tubs/spas are safe for use
    1. Check for existing guidelines from your local or state regulatory agency before use
    2. Ensure that hot tubs/spas are free of visible slime or biofilm before filling with water
    3. Perform a hot tub/spa disinfection procedure before use
      1. CDC Hot Tub Disinfection Guidance (follow Steps 4–9 and 12–13). https://www.cdc.gov/legionella/downloads/hot-tub-disinfection.pdfpdf icon
      2. Facilities may decide to test the hot tub/spa for Legionella before returning to service if previous device maintenance logs, bacterial testing results, or associated cases of Legionnaires’ disease indicate an elevated level of risk to occupants. All Legionella testing decisions should be made in consultation with facility water management program staff along with relevant public health authorities.
  1. Ensure cooling towers are clean and well-maintained
    1. Ensure that cooling towers are maintained (including start-up and shut-down procedures) per manufacturer’s guidelines and industry best practices.
      1. Guidance on start-up and shut-down procedures from the Cooling Technology Institute (CT 159): https://cti.org/pub/cticode.phpexternal icon
    2. Ensure that the tower and basin are free of visible slime, debris, and biofilm before use.
      1. If the tower appears well-maintained, perform an online disinfection procedure.
  2. Ensure safety equipment including fire sprinkler systems, eye wash stations, and safety showers are clean and well-maintained
    1. Regularly flush, clean, and disinfect these systems according to manufacturers’ specifications.
  3. Maintain your water system
    1. Consider contacting your local water utility to learn about any recent disruptions in the water supply. This could include working with the local water utility to ensure that standard checkpoints near the building or at the meter to the building have recently been checked or request that disinfectant residual entering the building meets expected standards.
    2. After your water system has returned to normal, ensure that the risk of Legionella growth is minimized by regularly checking water quality parameters such as temperature, pH, and disinfectant levels.
    3. Follow your water management program, document activities, and promptly intervene when unplanned program deviations arise.

1 For example, a building that is damp and has poor ventilation in a humid region might develop mold growth in a few days that will proliferate unless these conditions change. In contrast, a building that is dry and well-ventilated in a arid climate might not develop significant mold growth for weeks, months, or at all.

2 For example, a building potable water system with extensive dead-legs, low disinfectant residuals, tepid hot water temperatures, minimal water flow, and an established Legionella biofilm might promote substantial Legionella growth and dissemination in weeks or months. In contrast, a building with an efficiently designed potable water system that maintains high disinfectant residuals, elevated hot water temperatures, regular water flow, and has no preexisting Legionella population may not support Legionella colonization at all.



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Ebola virus disease – Democratic Republic of the Congo

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Ebola virus disease – Democratic Republic of the Congo


There have been no new cases of Ebola virus disease (EVD) reported in the ongoing outbreak in the Democratic Republic of the Congo since 17 February 2020. However, because there is still a risk of re-emergence of EVD, it is critical to maintain surveillance and response operations until and after the end of outbreak declaration – as outlined in the WHO recommended criteria for declaring the end of the EVD outbreak.

Unfortunately, the response faces increasing limitations that could result in delayed detection and control of flare-ups. These limitations include a funding shortfall, ongoing insecurity and lack of access to some areas, and limited staffing and resources amidst other local and global emergencies.

No funding for the Ebola response has been received by WHO since December 2019. An urgent injection of USD 20 million is required to ensure that response teams have the capacity to maintain the appropriate level of operations through to the beginning of May 2020. If no new resources are received, WHO risks running out of funds for the Ebola response before the end of the outbreak. For more information, please see this statement.

Ongoing response activities include investigating and validating new alert cases, supporting appropriate care and rapid diagnosis of suspected cases (which continue to be detected), supporting survivors through a multi-disciplinary programme, and strategically transitioning activities. From 9 to 15 March, over 32 000 alerts were reported and investigated. Of these, 2550 alerts were validated as suspected cases, requiring specialized care and laboratory testing to rule-out EVD. During this same period, 2760 samples were tested, including 1565 blood samples from alive suspected cases, 405 swabs from community deaths, and 790 samples from re-tested patients.

As of 17 March 2020, a total of 3444 EVD cases were reported from 29 health zones (Table 1), including 3310 confirmed and 134 probable cases, of which 2264 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 56% (n=1931) were female, 28% (n=975) were children aged less than 18 years, and 5% (n=171) were health care workers.

Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 17 March 2020*


*Excludes n=148 cases for whom onset dates not reported. Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. ‘Non-active zones’ indicate health zones that have not reported new cases in the last 42 days.

Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu Province, Democratic Republic of the Congo, data as of 17 March 2020**


**Total cases and areas affected during the last 21 days are based on the initial date of case alert and may differ from date of confirmation and daily reporting by the Ministry of Health.

Public health response

For further information about public health response actions by the Ministry of Health, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:


WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment concluded that the national and regional risk levels remain high, while global risk levels remain low.

WHO advice

WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. Any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for travellers to/from the affected countries. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practise good hygiene. Further information is available in the WHO recommendations for international traffic related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo.

For more information, please see:



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The cost of inaction: COVID-19-related service disruptions could cause hundreds of thousands of extra deaths from HIV

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The cost of inaction: COVID-19-related service disruptions could cause hundreds of thousands of extra deaths from HIV


A modelling group convened by the World Health Organization and UNAIDS has estimated that if efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500 000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021. In 2018, an estimated 470 000 people died of AIDS-related deaths in the region.

There are many different reasons that could cause services to be interrupted—this modelling exercise makes it clear that communities and partners need to take action now as the impact of a six-month disruption of antiretroviral therapy could effectively set the clock on AIDS-related deaths back to 2008, when more than 950 000 AIDS-related deaths were observed in the region. And people would continue to die from the disruption in large numbers for at least another five years, with an annual average excess in deaths of 40% over the next half a decade. In addition, HIV service disruptions could also have some impact on HIV incidence in the next year.

“The terrible prospect of half a million more people in Africa dying of AIDS-related illnesses is like stepping back into history,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

“We must read this as a wake-up call to countries to identify ways to sustain all vital health services. For HIV, some countries are already taking important steps, for example ensuring that people can collect bulk packs of treatment, and other essential commodities, including self-testing kits, from drop-off points, which relieves pressure on health services and the health workforce. We must also ensure that global supplies of tests and treatments continue to flow to the countries that need them,” added Dr Tedros.

In sub-Saharan Africa, an estimated 25.7 million people were living with HIV and 16.4 million (64%) were taking antiretroviral therapy in 2018. Those people now risk having their treatment interrupted because HIV services are closed or are unable to supply antiretroviral therapy because of disruptions to the supply chain or because services simply become overwhelmed due to competing needs to support the COVID-19 response.

“The COVID-19 pandemic must not be an excuse to divert investment from HIV,” said Winnie Byanyima, Executive Director of UNAIDS. “There is a risk that the hard-earned gains of the AIDS response will be sacrificed to the fight against COVID-19, but the right to health means that no one disease should be fought at the expense of the other.”

When treatment is adhered to, a person’s HIV viral load drops to an undetectable level, keeping that person healthy and preventing onward transmission of the virus. When a person is unable to take antiretroviral therapy regularly, the viral load increases, impacting the person’s health, which can ultimately lead to death. Even relatively short-term interruptions to treatment can have a significant negative impact on a person’s health and potential to transmit HIV.

This research brought together five teams of modellers using different mathematical models to analyse the effects of various possible disruptions to HIV testing, prevention and treatment services caused by COVID-19.

Each model looked at the potential impact of treatment disruptions of three months or six months on AIDS mortality and HIV incidence in sub-Saharan Africa. In the six-month disruption scenario, estimates of excess AIDS-related deaths in one year ranged from 471 000 to 673 000, making it inevitable that the world will miss the global 2020 target of fewer than 500 000 AIDS-related deaths worldwide.

Shorter disruptions of three months would see a reduced but still significant impact on HIV deaths. More sporadic interruptions of antiretroviral therapy supply would lead to sporadic adherence to treatment, leading to the spread of HIV drug resistance, with long-term consequences for future treatment success in the region.

Disrupted services could also reverse gains made in preventing mother-to-child transmission of HIV. Since 2010, new HIV infections among children in sub-Saharan Africa have declined by 43%, from 250 000 in 2010 to 140 000 in 2018, owing to the high coverage of HIV services for mothers and their children in the region. Curtailment of these services by COVID-19 for six months could see new child HIV infections rise drastically, by as much as 37% in Mozambique, 78% in Malawi, 78% in Zimbabwe and 104% in Uganda.

Other significant effects of the COVID-19 pandemic on the AIDS response in sub-Saharan Africa that could lead to additional mortality include reduced quality clinical care owing to health facilities becoming overstretched and a suspension of viral load testing, reduced adherence counselling and drug regimen switches. Each model also considered the extent to which a disruption to prevention services, including suspension of voluntary medical male circumcision, interruption of condom availability and suspension of HIV testing, would impact HIV incidence in the region.

The research highlights the need for urgent efforts to ensure the continuity of HIV prevention and treatment services in order to avert excess HIV-related deaths and to prevent increases in HIV incidence during the COVID-19 pandemic. It will be important for countries to prioritize shoring up supply chains and ensuring that people already on treatment are able to stay on treatment, including by adopting or reinforcing policies such as multimonth dispensing of antiretroviral therapy in order to reduce requirements to access health-care facilities for routine maintenance, reducing the burden on overwhelmed health-care systems.

“Every death is a tragedy,” added Ms Byanyima. “We cannot sit by and allow hundreds of thousands of people, many of them young, to die needless deaths. I urge governments to ensure that every man, women and child living with HIV gets regular supplies of antiretroviral therapy—something that’s literally a life-saver.”

 

Sources:

Jewell B, Mudimu E, Stover J, et al for the HIV Modelling consortium, Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple models. Pre-print, https://doi.org/10.6084/m9.figshare.12279914.v1, https://doi.org/10.6084/m9.figshare.12279932.v1.

 

Alexandra B. Hogan, Britta Jewell, Ellie Sherrard-Smith et al. The potential impact of the COVID-19 epidemic on HIV, TB and malaria in low- and middle-income countries. Imperial College London (01-05-2020). doi: https://doi.org/10.25561/78670.

 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

 

WHO

The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.

 





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Preserving Macao’s bamboo tradition through sculptural works

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Preserving Macao's bamboo tradition through sculptural works


Written by Stella Ko, CNNMacao

Many of Asia’s biggest cities owe their skylines to long bamboo poles that allow construction workers to climb to great heights.

This type of scaffolding has been used for centuries in places like Macao, where two architects are now trying to change local perceptions by transforming the poles into works of art.

Rita Machado and João Ó, founders of the design studio Impromptu Projects, have teamed up with local bamboo masters, who are known as “spiders” for their deft and dangerous work on the web-like structures.

“We formed a kind of friendship where the masters share their knowledge and we show their work,” Machado says.

Early uses of bamboo

Bamboo has long been used for construction in parts of Asia where it grows plentifully and rivals steel in strength and durability. It grows incredibly quickly — and up to 8 meters (26 feet) high — making it a sustainable building material that has endured for centuries.

The poles were once used to build huts and small-scale projects, though bamboo grids stretching hundreds of meters into the air alongside modern high-rises are now a common sight.

The merging of old and new is a central theme in Ó and Machado’s bamboo projects. And Macao, with its blend of Portuguese and Chinese history, offers a rich palate for them to work with.

Preserving Macao’s bamboo tradition through sculptural works

The first Portuguese settlers arrived in Macao in the 1500s and it soon became an important hub along Portugal’s Asian trading route. Portuguese influences can be seen in the European architecture and the distinctive blue and white tiles that the merchants imported on their ships. Chinese influences are also apparent, especially in the A-Ma Temple, built in 1488, one of the city’s oldest buildings.

In 2005, the city’s historical center was added to the World Heritage List as a place of outstanding universal value — an accolade it owes, in part, to bamboo.

Every year, residents build a bamboo-shed theater outside the A-Ma Temple to pray for the safety of fishermen at sea. It’s a tradition that has endured in this port city for more than 100 years — one that captured the attention of the two architects, who live next door.

Bamboo has long been used for construction in China. Credit: Dan Tham/CNN

“This kind of annual renewal of ancestral technology is amazing,” says Machado. “We re-adapted this knowledge that already existed in the city and created a new form of expressing ourselves.”

Beyond simply expressing themselves, the designers want to draw attention to a skill that is in danger of dying out.

Macao’s ‘spiders’

Macao’s humid summers and tightly-packed buildings produce challenging conditions for the territory’s remaining bamboo scaffolders.

Chio Seng Wai has been in the industry for nearly 50 years. In that time he has erected hundreds of skeleton frames with his bare hands, instinctively judging the correct length of the bamboo poles and how they should be assembled. Over the years, he’s worked on commemorative arches, swimming sheds and buildings that stretch up dozens of stories.

His knowledge can only be passed down through intensive physical training, but in recent years there have been few candidates willing to learn.

“Young people are not interested in this field because it is dangerous, working in high elevation above the ground, and it is hard labor under the strong sun,” says Chio. “We are old and have to retire, but we want to take our industry global to spread our culture and crafts.”

There are fewer than 50 bamboo experts left in Macao, Chio says. This statistic alarmed the Impromptu Projects team, which has closely observed the scaffolders as they work.

Chio says there have been too few candidates who are willing to learn the technique of bamboo scaffolding.

Chio says there have been too few candidates who are willing to learn the technique of bamboo scaffolding. Credit: Macao Cultural Affairs Bureau

“The width of the grid in the scaffolding is the length of their arm and the height is their legs, so they can interlock it and use their hands freely,” explains Ó.

“Their way of interlocking and grabbing the bamboo poles and breathing follow certain forces in their environment,” he continues. “We came to understand that their positions on the bamboo structure were very close to tai chi movements.”

Reviving a dying profession

The bamboo designs may take shape in the architects’ studio, but the real work happens outside. Using 3D models, the bamboo artisans set about recreating their vision, lifting and tying each pole by hand.

Workers climb onto slender poles woven into web-like walls and platforms to construct the city's buildings.

Workers climb onto slender poles woven into web-like walls and platforms to construct the city’s buildings. Credit: Impromptu Projects

“Bamboo used in our structure is always the second, third, or the fourth life of the scaffolding used previously, and the material again returns back to other construction sites,” Machado explains.

The architects say it is important to show their work to the local community, so residents appreciate bamboo scaffolding as art, not just a tool.

Ó and Machado believe that having scaffolding workers engage in the art scene will help keep the tradition — and an endangered profession — alive.

“We see the craftsmen as artisans, not just the low-ranking construction industry workers,” says Ó. “This idea of renewal of the technology and ancestral knowledge passed verbally or visually — it’s a continuation of the local identity.

“We feel responsible to extend this knowledge to the next generation.”



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China hits back at so-called coronavirus ‘lies’ by US politicians as war of words escalates

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China hits back at so-called coronavirus 'lies' by US politicians as war of words escalates


An 11,000-word article posted on the Chinese Foreign Ministry’s website on Saturday gave a point-by-point rebuttal of the 24 “preposterous allegations and lies” that it said were fabricated by US politicians and media outlets to “shift the blame to China for their inadequate response to Covid-19.”
The article was also carried Sunday by Xinhua, China’s government-run news agency, and shared by its official account on Twitter.

The lengthy refutation is the latest attempt by Beijing to defend its handling of the outbreak, as it comes under international scrutiny over its handling of the virus and faces mounting calls for an independent inquiry.

In recent weeks, the US has doubled down on blaming China for the spread of the virus, accusing it of withholding important information — especially in the critical early stages of the outbreak — and questioning its death toll. US President Donald Trump and Secretary of State Mike Pompeo have also claimed, without providing evidence, that the virus originated from a lab in the Chinese city of Wuhan, where the outbreak was first reported last December.
Beijing has pushed back at the claims, accusing the Trump administration of deflecting blame for its own failure to contain the virus within the US and smearing China to bolster Trump’s reelection chances.

The article released over the weekend began with a prologue that invoked Abraham Lincoln, the 16th President of the United States.

“As Lincoln said, you can fool some of the people all the time and fool all the people some of the time, but you cannot fool all the people all the time,” it said.

It then gave a breakdown of each claim, and cited a variety of media reports, scientific studies and World Health Organization statements to support its counterarguments.

The article lashed out at claims tying the origin of the virus to China. “Being the first to report the virus does not mean that Wuhan is its origin. In fact, the origin is still not identified,” it said, echoing a point that has been repeatedly stressed by Chinese officials and government-controlled media.

It also refuted theories that the virus was created by a lab at the Wuhan Institute of Virology or was leaked from the lab in an accident.

As the virus spreads across the world, Beijing has come under mounting international criticism for allegedly suppressing vital early information about the outbreak and downplaying its severity.

The article attempted to deny accusations of China’s initial cover-up and delayed release of information about the virus, offering a timeline to show the Chinese government’s apparent “open, transparent and responsible” manner in providing “timely information” to the world.

But the article did not mention the admission by the Wuhan mayor that his government did not disclose information on the coronavirus “in a timely fashion” during an interview with CCTV on January 27.

The mayor, Zhou Xianwang, said at the time that under Chinese law on infectious diseases, the local government first needed to report the outbreak to national health authorities, and then get approval from the State Council before making an announcement.

The article also rejected Western criticism against Beijing over the case of Li Wenliang, a Wuhan doctor who tried to sound the alarm on the outbreak in late December but was reprimanded and silenced by police for “spreading rumors.” He died of the coronavirus in early February after contracting it from a patient, sparking a nationwide outpouring of grief and anger.

The article said Li was not a “whistleblower,” as he was widely referred to in Western media. Instead, it highlighted the fact that Li was a member of the Chinese Communist Party, and had received posthumous honors as a “national model healthcare worker in fighting Covid-19” and a “martyr.”

“Labeling Dr. Li Wenliang as an ‘anti-establishment hero’ or ‘awakener’ is very disrespectful to Dr. Li and his family. It is purely political manipulation with no sense of decency,” the article said.

To pacify public outrage following Li’s death, the Chinese government has sought to paint Li as a model party member and doctor who dedicated his life to the fight of the coronavirus. It launched a weeks-long investigation into Li’s case, which withdrew the reprimand against Li and blamed a local police officer for mishandling his case — a result that drew criticism on Chinese social media.

The article also hit back at criticism that Beijing has been spreading disinformation about Covid-19, saying China is “a victim of disinformation” from “US politicians, scholars and media outlets that are hostile to China.”

It did not mention Chinese Foreign Ministry spokesman Zhao Lijian had publicly promoted an unfounded conspiracy theory in March that the virus might have been brought to China by the US military.





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Chinese and Indian soldiers engage in ‘aggressive’ cross-border skirmish

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Chinese and Indian soldiers engage in 'aggressive' cross-border skirmish


The incident, which occurred at a remote, mountainous crossing close to Tibet, is the latest in a long line of border flare-ups between the two neighboring powers.

“Aggressive behavior by the two sides resulted in minor injuries to troops,” said the spokesman.

“The two sides disengaged after dialogue and interaction at a local level. Troops resolve such issues mutually as per established protocols,” the spokesman added.

Eleven soldiers, four Indian and seven Chinese, were reported to have been injured in the incident, which took place during a patrol in Nuka La, North Sikkim, according to CNN affiliate News18.

The Indian ministry spokesman said “temporary and short” face-offs between troops from both countries are a regular occurrence due to the fact that “boundaries are not resolved.”

CNN has requested comment from the Chinese foreign ministry.

India and China share one of the world’s longest land borders. In 1962, the two countries engaged in a bloody Himalayan border war and skirmishes have continued to break out sporadically in the decades since.

In 2017, the two sides engaged in a months-long territorial standoff on the disputed Doklam plateau, on the unmarked border between China and Bhutan.

Though not a part of Indian territory, the area is close to the “chicken’s neck,” a strategic corridor that serves as a vital artery between Delhi and its far northeastern states.

After months of rising tensions and live-fire drills, the two governments eventually agreed to back down in August 2017. Prime Minister Narendra Modi and President Xi Jinping agreed to work together to avoid further border disputes in 2018.
But despite the agreement, tensions continue. As recently as September 2019, Indian and Chinese troops became involved in a “scuffle” on the border near Pangong Lake in the Himalayas, according to News18.



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Communities, Schools, Workplaces, & Events

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Communities, Schools, Workplaces, & Events



Shared and Congregate Housing



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Ebola virus disease – Democratic Republic of the Congo

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Ebola virus disease – Democratic Republic of the Congo


No new cases have been reported in the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo since 17 February 2020 (Figure 1). However, due to challenges related to continued insecurity and population displacement in previous hotspots, limited access to some affected communities, and potential shortages of resources amidst other local and global emergencies, there remains a high risk of re-emergence of the virus. Therefore, it is critical to maintain surveillance and response operations in the period leading up to the declaration of the end of the outbreak, as well as after the declaration – as outlined in the WHO recommended criteria for declaring the end of the EVD outbreak.

Active outbreak response activities continue, which include investigating and validating new alert cases, supporting appropriate care and rapid diagnosis of suspected cases (which continue to be detected), supporting survivors through a multi-disciplinary programme, and strategically transitioning activities. From 18 to 24 March, an average of 4619 alerts were reported and investigated daily. Of these alerts, 358 were validated as suspected cases, requiring specialized care and laboratory testing to rule-out EVD. From 16 to 22 March, 2747 samples were tested including: 1479 blood samples from alive, suspected cases; 374 swabs from community deaths; and 894 samples from re-tested patients. Overall, laboratory activity was conducted at similar levels as compared to the prior week.

Last week, nine historical probable cases were validated, whose dates of symptom onset were between October 2018 and July 2019, bringing the cumulative number of probable cases to 143. Further historical probable cases are expected to be validated as investigations into past cases continue.

As of 24 March 2020, a total of 3453 EVD cases were reported from 29 health zones (Table 1), including 3310 confirmed and 143 probable cases, of which 2273 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 57% (n=1935) were female, 29% (n=979) were children aged less than 18 years, and 5% (n=171) were health care workers.

WHO has not received funding for the Ebola response since December 2019. An urgent injection of US $20 million is required to ensure that response teams have the capacity to maintain the appropriate level of operations through to the beginning of May 2020. If no new resources are received, WHO risks running out of funds for the Ebola response before the end of the outbreak. For more information, please see this statement.

Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 24 March 2020*


*Excludes n=149 cases for whom onset dates not reported. Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. ‘Non-active zones’ indicate health zones that have not reported new cases in the last 42 days.

Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu Province, Democratic Republic of the Congo, data as of 24 March 2020**


**Total cases and areas affected during the last 21 days are based on the initial date of case alert and may differ from date of confirmation and daily reporting by the Ministry of Health.

Public health response

For further information about public health response actions by the Ministry of Health, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:


WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment concluded that the national and regional risk levels remain high, while global risk levels remain low.

WHO advice

WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. Any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for travellers to/from the affected countries. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practise good hygiene. Further information is available in the WHO recommendations for international traffic related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo.

For more information, please see:



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New FAQs address healthcare workers questions on breastfeeding and COVID-19

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New FAQs address healthcare workers questions on breastfeeding and COVID-19


Mothers and healthcare workers who support them have many questions and concerns about whether it is safe for mothers with confirmed or suspected COVID-19 to be close to and breastfeed their babies during the pandemic.

To address their questions, WHO has released a list of Frequently asked questions: Breastfeeding and COVID-19. The FAQ complements the WHO interim guidance: Clinical management of severe acute respiratory infection when COVID-19 is suspected and draws upon other WHO recommendations on infant and young child feeding.

The FAQs aim to provide information to healthcare workers supporting mothers and families in maternity services and community settings, and communicate how the interim guidance should be implemented. Additionally, the FAQs provide information about the protective effects of breastfeeding and skin-to-skin contact, and the harmful effects of inappropriate use of infant formula milk.

Accompanying the FAQs is a decision tree which provides step-by-step guidance to health workers on how to support mothers with confirmed or suspected COVID-19 to breastfeed. It provides advice on what to do if mothers are not well enough to breastfeed, as well as appropriate hygiene measures for mothers, including wearing a medical mask if available, to reduce the possibility of the COVID-19 virus being spread to her infant.

Benefits of breastfeeding outweigh potential risks

The COVID-19 virus has not been detected in the breastmilk of any mother with confirmed and suspected COVID-19 and there is no evidence so far that the virus is transmitted through breastfeeding. Researchers continue to test breastmilk from mothers with the infection.

WHO recommends that all mothers with confirmed or suspected COVID-19 continue to have skin-to-skin contact and to breastfeed. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also reduces the risk of breast and ovarian cancer for the mother. Skin-to-skin contact, including kangaroo mother care, reduces neonatal mortality, especially for low birth weight newborns.

While infants and children can contract COVID-19, they are at low risk of infection. The few confirmed cases of COVID-19 in young children to date have experienced only mild or asymptomatic illness.

WHO’s recommendations on the care and feeding of infants whose mothers have confirmed or suspected COVID-19 aim to improve the immediate and lifelong survival, health and development of their newborns and infants. These recommendations consider the likelihood and potential risks of COVID-19 in infants and also the risks of serious illness and death when infants are not breastfed or when infant formula milk are used inappropriately.

WHO’s Q&A on breastfeeding and COVID-19 also provides additional infection prevention advice to mothers with confirmed or suspected COVID-19.



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‘Like the tart, I never change’: The secret behind Macao’s most famous dessert

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'Like the tart, I never change': The secret behind Macao's most famous dessert


Macao (CNN) — You can smell it before you see it. The sweet smell of sugar, egg and custard, baking til it’s cooked just right. Flaky pastry on the outside, soft custard on the inside, and crispy, burnt, sugar on top.

It’s the signature smell of Margaret’s Café e Nata — one of the most popular places to eat in Macao, a former Portuguese colony.

The cafe is especially famous for one thing: the Macanese egg tart. It’s a sweet pastry inspired by its Portuguese and Chinese counterparts, made fresh daily by owner Margaret Wong.

If visitors aren’t there for a treat from the bakery, chances are they’re there to see Wong.

After three decades in the food business, she’s a colorful personality who still spends every day working hard at the cafe. She can be spotted working the cash register or bustling about in the kitchen.

A family affair

Margaret’s Café e Nata’s famous Macanese egg tarts.

Maggie Hiufu Wong/CNN

Few people know Macanese egg tarts better than Wong, who began making the dish 30 years ago with her late ex-husband Andrew Stow.

The couple founded their first bakery business, Lord Stow’s, in 1989. Today, Lord Stow’s is run by their daughter Audrey and Andrew’s sister Eileen.

Margaret’s Café e Nata, which she subsequently founded in 1992, is entirely run by Wong herself.

Some online reports suggest that Wong founded her cafe to compete with Lord Stow’s — which netizens claim was born as a result of a domestic feud following the couple’s divorce.

She wouldn’t comment on the rumors, though she spoke openly about the early days of their romance.

“We were married three times — once in Hong Kong, once in England and once in a church,” she says.

According to Wong, the couple met in a local church, where she played the organ.

“One day my foster mother was visiting from America, and we bumped into Andrew, who gave me a hug and a kiss and I went all red. He was friends with everybody so I didn’t think I was anything special … but my mother said ‘Margaret, I think this is the right one for you.'”

The two were married in 1988.

Up to 10,000 tarts a day

Macao visitors lineup outside Margaret's  Café e Nata.

Macao visitors lineup outside Margaret’s Café e Nata.

CNN

Together, the couple created their signature egg tart dish, which is now an iconic Macao dish. Purists argue this egg tart tastes nothing like its Portuguese or Chinese counterparts.

According to Wong, that’s the point.

“When we started our bakery, someone asked Andrew to make a pasteis de nata, because they were very popular in Portugal. The first tray came out burnt and wrong, and Andrew wanted to throw them away. I said, hold on, they’re edible, so let people just try them. They tried one, and then two, and by the third I said, ‘I have to charge you because clearly, it’s good!’ ”

It’s this same recipe, three decades later, that continues to be sold across Macao.

Today, hundreds of tourists and locals alike line up at her cafe for a bite of this now famous pastry.

Wong’s cafe alone can make up to 10,000 tarts a day — all of which are bound to sell out.

“Sometimes people walk in and say — can I have just one egg tart — and I say, not even one bite.”

‘Like the tart, I never change’

Visitors to Margaret's  Café e Nata will usually find her in the kitchen or behind the till.

Visitors to Margaret’s Café e Nata will usually find her in the kitchen or behind the till.

CNN

Every single dish sold by the bakery is graced with Wong’s magic touch. In addition to egg tarts, other items on the menu include brownies, cakes and croissants. There’s also a salad and sandwich bar.

Despite long working hours, and the physically demanding nature of her work, she still spends almost every day bouncing back and forth between the kitchen and the shop.

“Some of my staff have been working with me for 15 years, they know everything, but still sometimes I have to make sure everything is good — I’m the boss!” she says.

She’s the boss, but she’s also a local celebrity. During our interview Wong is regularly interrupted by friends and fans dropping by to wish her well.

“I open the shop at 8:30 a.m., and I’m here until we close at 4:30 p.m., and I have an hour for lunch. My friend’s say I’m crazy… and I’m exhausted,” she says with a laugh. “I say I’m getting old, that’s why.”

Clearly young at heart, Wong abruptly cuts our interview short, informing us she needs to head to a rock ‘n’ roll dance class — but leaves us with a taste of wisdom.

“These days, teenagers, they always want to change their jobs. But for us, we never change. Like the tart, I never change my recipe, I don’t want to.”

Margaret’s Café e Nata, 17B R. do Cmte. Mata e Oliveira, Macao; +853 2871 0032



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