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In COVID-hit Syria, people ‘prefer to die than come to hospital’

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The worrying signs were all there: fatigue, high fever, no ability to taste or smell.

Still, Ahmed*, a salesman in a hardware shop in the suburbs of Damascus, never considered getting tested for coronavirus or going to the hospital. The first option was unaffordable, he thought; the second, dangerous.

“I was afraid to get quarantined and not getting proper medical care,” the 20-year-old said, referring to the Syrian government-run facilities where COVID-19 patients are being sent.

Instead, Ahmed confined himself to his room, sought medical advice on Facebook and consulted over the phone with a local doctor. Neither he nor anyone he had been in contact with was tested. “I couldn’t afford it,” he told Al Jazeera by phone, explaining it would have cost him 126,000 Syrian pounds ($246), more than his monthly salary.

Ahmed’s presumed coronavirus infection in late July is believed to be among the thousands of cases going undetected across Syria’s government-held areas. Official data put the number of confirmed COVID-19 infections at 4,366, with 205 related deaths, but several doctors, residents and health experts who spoke to Al Jazeera from inside and outside the war-torn country said these figures do not reflect the true extent of the coronavirus outbreak.

“There is a huge gap between the actual number [of cases and deaths] and the one announced by the government due to its lack of resources and capacity to receive patients, but also because it wants to mitigate any unexpected impact of the pandemic, like social unrest,” Zaki Mehchy, a London-based senior consulting fellow at Chatham House and co-founder of the Syrian Center for Policy Research, told Al Jazeera.

‘People prefer to die’

With a collapsed healthcare system, a battered economy and a severe lack of doctors and nurses due to medical providers fleeing Syria’s brutal war, authorities face an uphill battle to control the spread of COVID-19.

Chronic shortages of medical equipment and supplies – along with poor conditions at quarantine facilities, the need to earn a living and deep distrust towards state institutions after more than nine years of conflict – have all resulted in many suspected patients not reporting symptoms associated with the respiratory disease.

To fill in the gaps, coronavirus-related Facebook groups where doctors offer medical advice have sprung up online – as has happened with businesses renting oxygen tanks to patients for home use.

“People prefer to die rather than coming to the hospital,” Moustafa*, a doctor working in a hospital in Damascus, told Al Jazeera on the phone.

He said he is often contacted by people asking for medical advice but cannot afford any protective gear to visit them in person. A high-quality mask that should be changed daily costs about 5,000 Syrian pounds ($10).

“This is too much for me,” said Moustafa, who earns 96,000 Syrian pounds ($188) per month. “Can you imagine? A doctor that can’t afford to buy a good mask?”

‘Only formalities’

The Syrian economy has been in free fall in recent months, buckling under the weight of the country’s long-running conflict and the impact of a dollar-liquidity crisis next door in Lebanon. The financial turmoil has been compounded by a steep drop in the value of the Syrian pound, which has made life even harder for millions of long-suffering Syrians who survive on daily wages.

With more than 80 percent of the population living below the poverty line, the increase in the price of basic goods prompted sporadic protests over Syria’s summer as a new wave of United States sanctions heaped further pressure on the crippled economy.

“The economic sanctions which are coercive and unfair have been impeding the capacities of many essential services, in particular healthcare services,” Syrian Minister of Health Nizar Yazigi told a virtual meeting of the World Health Organization (WHO) in May, referring to the punitive economic measures imposed by Western countries.

Faced with a deteriorating economic outlook, the government moved too slowly in imposing coronavirus containment measures, critics say – and too quickly in scrapping them. In May, despite an uptick in infections a month after businesses and public markets were allowed to reopen, authorities lifted a two-month night-time curfew and permitted movement between government-held provinces. Mosques also reopened the same month, while students returned to classrooms on September 13.

Students wearing protective face masks sit in a classroom as the school year kicks off amid concerns about the spread of the coronavirus disease, in Damascus, Syria [File: Yamam Al Shaar/Reuters]

“The health ministry is taking only formalities, no [real] measures were adopted [to curb the spread of coronavirus], especially now,” said Jamal*, another doctor at a Damascus clinic, echoing similar calls of concern following a reported spike in the number of coronavirus cases and fatalities in August.

While it is extremely hard to establish exact data over the scale of the outbreak, a group of researchers from Imperial College London last month warned that only an estimated 1.25 percent of COVID-19 deaths were reported in Damascus, with as many as 4,380 fatalities feared undetected as of September 2.

“Given that Damascus is likely to have the most robust surveillance in Syria, these findings suggest that other regions of the country could have experienced similar or worse mortality rates due to COVID-19,” the researchers said.

In the city of Aleppo, the impoverished family of a man in his 60s who in August fell ill with coronavirus hesitantly decided to take him to Aleppo University Hospital. “No one trusts hospitals in Aleppo; everybody knows that if a coronavirus patient gets in, he or she won’t make it,” Khalil*, the man’s nephew, said.

Once at the overcrowded facility, Khalil said a paramedic told his cousin: “You have to wait if one of the [other] patients dies, only in this case your father would be admitted.” Two days later, the man died at home.

‘Like a prison’

Meanwhile, under-resourced medical professionals say they have to perform their duties under the watchful eye of the powerful security services roaming state-run healthcare facilities.

This, some say, acts as a further deterrent for patients already reluctant to seek treatment in a country where fear of the state apparatus runs high and any critical discussions about the handling of the pandemic could be seen as a threat to a government determined to convey a message of control.

“The hospital is like a prison: you can see people from the intelligence, they check everything you do and say,” Moustafa said. “We have to hide everything, not to talk about anything [related to COVID-19].”

Jamal said, “Patients arrive at the hospital on their last breath”.

“Those cases need equipment that hospitals don’t have, and people know it,” he added over the phone, noting that the government does not have the resources to implement preventive measures and can neither treat nor test patients.

‘A million other reasons to die’

In a bid to help address the crisis in the government-controlled areas, the WHO has set up five testing facilities – in the capital, rural Damascus, Aleppo, Homs and Latakia – carrying out up to 1,000 coronavirus tests per day.

But that is not enough, according to Akjemal Magtymova, the WHO’s Syria representative.

“Even if I could detect tens of thousands of more cases, what do I do if we don’t have the resources to cure them?” Magtymova asked, her voice imbued with a tone of exasperation.

According to the global health agency, only half of the country’s 113 public hospitals were fully operational by the end of June. There are fewer than three beds available for every 10,000 people – three times less than international standards.

But what is even more alarming for Magtymova is the shortage of medical professionals. According to a United Nations report published in March, a staggering 70 percent of them have left the country since the start of the war in 2011.

“One of my biggest concerns is that we are working with a very limited number of healthcare workers, which are at a high risk of infection,” she told Al Jazeera.

“We are expecting a new wave – we have to check those children going back [from school] to their extended family,” said Magtymova, stressing that while the rate of transmission is not as high as in August, the situation remains “very fragile” amid the deepening economic woes.

“People are starving; 9.3 million are food insecure and depend on a daily wage,” Magtymova said. “Why would they declare to be sick and put themselves in isolation?”

Mustafa concurred: “This is not just about COVID-19, that is the least fear we have. Here, you can die for a million other reasons before COVID-19.”

  • Interviewees asked that their real names be changed for security reasons.

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The real death toll from the pandemic in America may already be 300,000

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The official Covid-19 mortality figures might be dramatically underestimating the real death toll of the pandemic in the US, according to a new report from the Centers for Disease Control and Prevention.

From late January to early October, nearly 300,000 “excess deaths” occurred in America, the report authors estimate. That’s about a third more than the 216,025 coronavirus deaths the US reported in the same period.

Excess mortality is a figure that simply calculates how many more people died in a given period and place, of any cause, than what would be typically expected based on past years. It’s important to track during a pandemic because official death counts may not capture undiagnosed fatal infections, or those who died of causes indirectly related to the virus, such as interruptions in health care. (We know of a few such interruptions, such as people experiencing heart attacks have been forgoing emergency room visits, and a drop in new cancer diagnoses.)

To come to these estimates, the CDC authors looked at weekly death rates by age group and ethnicity this year, and compared those to historical averages for 2015 through 2019.

According to the report, 66 percent of the estimated 299,028 excess deaths could be attributed to Covid-19, while the remaining third were linked to other causes — such as misclassified Covid-19 deaths, or deaths from “disruptions in health care access or utilization.”

Young people experienced the greatest relative increase in excess deaths

The most attention-grabbing finding relates to the pandemic’s toll on young people: For 25- to 44-year-olds, the excess death rate is up 27 percent. That’s the largest percentage increase of any age group.

“Historically, increases in death rates like this are rare among young people,” said Sam Harper, a population health researcher at McGill University, “especially across all population groups simultaneously.”

But while the number is certainly worrisome, it also needs to be put in context, Harper added. The report authors were using relative increases in deaths to describe the changes. Since younger people have a much lower death rate at baseline than older groups — 2,500 deaths per week among 25- to 44-year-olds compared to 10,000 per week among 45- to 64-year-olds — “even a few more additional deaths in 2020 will have a much greater impact using this metric,” Harper said.

So, for example, an extra 1,000 deaths would cause a 40 percent mortality increase among 25- to 44-year-olds. But to get to a 40 percent mortality increase among 45- to 64-year-olds, an additional 4,000 people would need to die, Harper explained. And that’s why, in absolute terms, it’s still the older age groups who have borne the brunt of deaths in the pandemic.

Look at this breakdown of excess deaths by age group here and you can see the scale of the problem in younger versus older cohorts more clearly:

CDC

Still, even though the coronavirus is less deadly in younger people compared to older groups, it’s certainly not benign. “The long-term health consequences of the virus have barely been studied,” Vox’s Brian Resnick recently pointed out. “When we expose younger, healthier people to the virus … we don’t know what the consequences of that will be down the road.”

And already, some Covid-19 patients with no symptoms have been found to experience heart and lung damage, while others go on to experience “long Covid,” or months of debilitating symptoms including fevers, brain fog, pain, and fatigue.

Deaths were already on the rise in America, even among young people

Again, the CDC report doesn’t tell us which deaths in each age group are caused by Covid-19 versus other things. And even before the pandemic, the mortality rate in younger people had already been rising, said Steven Woolf, a family medicine and population health professor at Virginia Commonwealth University.

Drug overdoses and suicides were major contributors to the trend — and the arrival of the coronavirus may be exacerbating these factors.

“If young adults were already dying at higher rates from drug overdoses and suicide before the pandemic, the additional stresses brought on by the pandemic could not have helped matters,” said Woolf.

So even a small uptick in absolute terms is worth paying attention to, Harper said. “[It’s] clear that young people’s mortality is being adversely affected by the pandemic, which should drive home the message that we can’t ignore the experiences of any part of the population.”

Woolf expects that in the years ahead, we’ll find there was a lot more devastation than is currently visible. Future analyses could reveal, for example, a surge in deaths from chronic conditions — like diabetes, congestive heart failure, and HIV — as a result of Covid-19 disruptions in health care or job losses that lead to insurance losses.

“Decades from now, researchers may be talking about the ‘pandemic generation,’” Woolf said, “and some of the health effects they tolerated because they grew up in the midst of this.”


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The Trump Administration Is Getting Sued Over COVID Exploding in Prisons

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America’s prison system has become a hotbed for COVID-19. More than 16,500 federal inmates have tested positive for the virus, and at least 127 have died, according to the most recent government data.

On Wednesday, the American Civil Liberties Union filed a Freedom of Information Act lawsuit against the Trump administration to figure out what went wrong.

The civil rights group, which has gone head-to-head with the Trump administration hundreds of times since the president took office, is demanding that the Federal Bureau of Prisons, the U.S. Department of Justice, and the U.S. Department of Health and Human Services fulfill months-old records requests that could shed light on how COVID-19 spread so aggressively among incarcerated individuals and prison workers alike. 

The ACLU first sought records relating to COVID-19 from the Bureau of Prisons in April and requested further records from the DOJ and U.S. Centers for Disease Control and Prevention in July, according to the lawsuit. While the agencies acknowledged the requests, they have yet to provide the civil rights organization with documents that could detail how the government reacted—or didn’t react— to repeated outbreaks at detention facilities, according to Somil Trivedi, one of the lead attorneys in the ACLU’s lawsuit.

Prisoners are increasingly elderly and susceptible to chronic illness and don’t always have the ability to properly socially distance from others. The ACLU has separately fought to get some of those at-risk people released.

“The Trump administration, in typical Trump administration fashion, has sort of compounded their incompetence with COVID in jails and prisons with lying,” Trivedi said. “They have said, publicly, ‘We’re doing a great job. The virus is almost gone in federal facilities.’ Through our other litigation, we have sworn documents that say that, and they’re very happy to say that to the press.”

The Bureau of Prisons’ director, Michael Carvajal, and its top doctor, Jeffrey Allen, defended the agency’s “sound pandemic plan” and “well-established history of managing and responding to communicable disease” in comments to the Senate Judiciary Committee in June. 

“In response to the COVID-19 pandemic, the bureau has taken, and will continue to take,

aggressive steps to protect the safety and security of all staff and inmates, as well as members of the public,” the officials said in a joint statement to the committee.  

Later that month, it was revealed that, among the federal inmates who had been screened for the virus so far, more than 1 out of 3 had tested positive for COVID-19. VICE News and the Marshall Project also reported in June that Bureau of Prisons staff were ignoring or minimizing COVID-19 risks, leading some prisoners to fear for their lives. 

By August, new COVID-19 cases among people incarcerated in state and federal prisons reached a pandemic high, thanks in part to outbreaks at federal facilities and detention centers in Florida and California, according to the Marshall Project and the Associated Press. At that point, ABC News reported that testing wasn’t still available for staff at a federal prison in Illinois and that employees were required to find independent testing sites on their own. That was difficult to do, since many were working “double 16-hour shifts almost on a daily basis,” the institution’s union president said. 

There have been at least 147,100 COVID-19 cases reported among prisoners in state and federal facilities overall, and 1,246 deaths, according to data compiled by the Marshall Project and the Associated Press, Meanwhile, of the 16,500-plus federal prisoners who were positive with COVID-19 this year, nearly 14,900 have since recovered, according to Bureau of Prisons data

“People are still getting sick and dying in jails and prisons across the country and the federal government has not only done next-to-nothing about it, but their mismanagement has made it worse,” Trivedi said.

There are more than 155,000 federal inmates nationwide, either in the Bureau of Prisons’ care, the care of privately managed facilities, or “other types of facilities,” according to the agency’s website.

But the Bureau of Prisons does not oversee the nation’s local jails and state prisons—which have also been slammed with outbreaks in the past several months. Inmates in those facilities are also of concern to the ACLU, and the organization has requested records from the CDC, since the health agency issued what Trivedi called “weak tea” guidance to detention facilities nationwide. Those records would encompass a far broader subset of people, Trivedi said. 

The Bureau of Prisons, Department of Justice, Department of Health and Human Services, and U.S. Centers for Disease Control and Prevention did not immediately respond to requests for comment about the ACLU’s lawsuit Wednesday.

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Malicious Campaigns Are Trying to Stop Black and Latinx People From Voting

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Women wearing face masks fill out vote-by-mail ballots at the Orange County Supervisor of Elections office on October 15, 2020 in Orlando, Florida. (Photo by Paul Hennessy/NurPhoto via AP)​

Women wearing face masks fill out vote-by-mail ballots at the Orange County Supervisor of Elections office on October 15, 2020 in Orlando, Florida. (Photo by Paul Hennessy/NurPhoto via AP)

Logo_Disinfo Dispatch Padding

Unraveling viral disinformation and explaining where it came from, the harm it’s causing, and what we should do about it.

Back in 2016, “no single group of Americans was targeted by [the Kremlin’s] disinformation operatives than African-Americans,” the Senate Intelligence Committee report into Russia’s election interference concluded.

In 2020, the situation is even worse.

“I would say that we’re seeing more disinformation,” Rai Lanier, an organizer at Michigan Liberation, an activist group and super-PAC focused on criminal justice reform in the greater Detroit area, told reporters during a conference call on Tuesday.

“It’s obviously evolved and more sophisticated since we all know it went down in 2016. As for whether it’s foreign or domestic, I would have to say it’s a mix,” Lanier said.

Activists in Black and Latinx communities across the U.S. say they’re facing an unprecedented surge of disinformation designed to persuade voters not to cast their ballots in November’s election — using social media, telephone calls, messaging apps, and even billboards to suppress the vote.

“We’re seeing Black and Brown voters being heavily targeted with [disinformation] that says vote-by-mail is fraudulent, or voters being told that they would be added to a national watch list because they’re registering to vote — really using some of these old school tactics, but in new school ways with the weaponization of digital media,” Ashley Bryant, of Win Black/Pa’lante, a network of activist groups that are coordinating to counter disinformation against these communities.

While Donald Trump’s campaign actively tried to depress the Black vote in 2016 using social media disinformation, in 2020 those conducting the campaigns are using new tactics, including playing on voters’ concerns about the pandemic.

“There’s been an extraordinary amount of disinformation, particularly targeted at Black Georgians, or Black Twitter and Instagram users, around COVID,” Nse Ufot, CEO of the New Georgia Project, said during the call.

Some disinformation campaigns target vulnerable members of the community by telling them they could catch the virus if they vote in person, while other campaigns said that if voters cast their ballots they are automatically given the coronavirus vaccine — even though one doesn’t exist yet.

These campaigns are especially effective in Georgia, given the fact that communities of color are disproportionately impacted by the coronavirus. “80% of the people who’ve been hospitalized in Georgia, due to COVID are Black and Brown, while 50% of the people who’ve died due to COVID-19 are Black or Brown,” Ufot said. 

In Florida, much of the disinformation targets the large Latinx population, which poses problems for social networks on which it is spread. 

“We’re seeing a ton of Spanish speaking disinformation, which presents a challenge because a lot of the platforms have really only been focused on flagging or trying to remove English language content, and really has been lacking on the Spanish language content,” Bryant said.

But it’s not just social media platforms. Fake WhatsApp messages that appear to come from grassroots community groups are, in fact, targeted disinformation campaigns.

Bryant said a number of these disinformation campaigns focus on religion and faith, using audio, video, and images to push “this narrative of not being able to be a democrat and a Catholic, or you can’t be a good Christian and a Democrat.”

And now, the disinformation and voter suppression campaigns have moved offline and are operating IRL.

Santra Denis, Interim Executive Director of Miami Workers Center, highlighted that one of the biggest concerns among minority communities is a “heightened police presence at polling sites.” 

An example of this was seen Tuesday, when an armed police officer was pictured at a polling station wearing a Trump 2020 mask. The Miami Police Department condemned his behavior and have promised to address the situation.

The threat of police intimidation is particularly of concern in Florida, Denis said, among voters who are new to the country and to voting.

“We are specifically dealing with a community that is very diverse in terms of not only race, but ethnicity, and there are new arrivals to the country who may have maybe their first time voting.”

In Texas, organizers have been facing a billboard campaign that targets Latinx voters. “They have been seeing a lot of billboarding, and signage about vote-by-mail, saying that vote-by-mail is either illegal or saying people shouldn’t participate in vote-by-mail, they shouldn’t use the postal service to return their ballots because that’s not a safe way to do it,” Andre Banks of Win Black/Pa’lante said.

For the moment, it remains unclear who is behind the campaigns.

“It’s very, very hard in real-time to understand where these threats are coming from,” Banks said. “Even people who have every research tool at their disposal, can’t tell on the day whether an attack is coming from a bot, from a paid troll, from a campaign, or from a foreign agent, it’s almost impossible.”

And waiting to find out who is targeting these communities is simply not an option this time around.

“If we wait to learn where the threat is coming from, in order to act, we have completely missed the ability to get our folks educated. Make sure that people have the information they need, and they’re getting out and we’re pushing back,” Banks added.

Here’s what else is happening in the world of election disinformation.

Two websites with Nigerian administrators are churning out U.S. election disinformation

The Election Integrity Project, a network of researchers working to mitigate the impact of attempted voter misinformation and election delegitimization, discovered a pair of connected websites churning out voter disinformation that is being picked up by pro-Trump Facebook groups.

One site billed itself as “a civil rights NGO” and the other posed as a news site that “stands for the truth all the time.” Both published articles with inaccurate claims about voting in the American presidential election. 

While the sites don’t appear to be connected, both of them have Facebook pages with Nigerian administrators, and their social media accounts boost each others’ stories. While Facebook has removed ads with false claims about voting, one of the ads is still visible in several pro-Trump Facebook groups, and posts using the same text as the ads are also still up. 

Here’s how the QAnon grift works

As support for the QAnon conspiracy theory grows among Republicans, many of those who are peddling the theory are now trying to cash in. More than a dozen QAnon influencers who have been kicked off Facebook or YouTube are turning to Patreon to fund their efforts.

An investigation by Media Matters for America has found that at least 14 QAnon grifters are monetizing their popularity among followers, with some making as much as $7,000 a month from divining the cryptic messages coming from Q. And of course, because Patreon takes a cut of all subscriptions, it’s also benefiting from the QAnon grift.

The latest twists and turns in the Hunter Biden laptop story

The FBI commented on the controversy surrounding the laptop that allegedly belongs to Hunter Biden, saying that it had “nothing to add” to the comments made by the Director of National Intelligence John Ratcliffe on Sunday.

Ratcliffe told Fox News that the emails from the laptop, which were leaked to the New York Post by Rudy Giuliani, were not part of a disinformation campaign. Democrats hit out at those comments, criticizing Ratcliffe for politicizing the ongoing FBI investigation.

So on Tuesday, in response to a demand for more information from Congress, Assistant Director of the FBI, Jill Tyson, issued this carefully worded response:

“Regarding the subject of your letter, we have nothing to add at this time to the October 19th public statement by the Director of National Intelligence about the available actionable intelligence. If actionable intelligence is developed, the FBI in consultation with the Intelligence Community will evaluate the need to provide defensive briefings to you and the Committee pursuant to the established notification framework.”

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