By Noemie Olive
PARIS (Reuters) – Doctor Alexandre Avenel has four COVID-19 patients in his intensive care ward, all with depleted blood oxygenation levels but none under intubation. That might not have been the case six months ago.
As a second wave of coronavirus sweeps across France, and the number of seriously ill patients climbs, intensive care medics say the lessons learned from early in the pandemic are leading to changes in how they treat the sick.
Avenel and his colleagues are delaying mechanical ventilation, a procedure which involves running a tube down a person’s windpipe, increasingly placing non-sedated patients on their fronts and reducing the doses used in cortico-therapy.
“Little by little, we learned that we didn’t have to intubate all the time, and so now we try to put this off,” Avenel told Reuters during his shift at a public hospital in Aulnay-sous-Bois, on the northern edge of Paris.
“We needed the experience of the first wave in March and April to realise these people could resist it and that we could hold off (intubating) while they fought it.”
Ventilators are vitally important and have helped save lives. But doctors have highlighted the risks of using invasive, mechanical ventilators too early or too frequently.
Avenel said at the outset of the crisis his team would intubate once a patient’s blood oxygen saturation fell to 75-80%, based on experience from other acute respiratory diseases.
Now they understood that the condition of some seriously ill patients would plateau, allowing for other ventilation techniques and therapeutic strategies, including corticosteroids, to be used. These, Avenel said, did not carry the same risk of secondary lung lesions and heart complications as intubation.
“We’ve had good results,” Avenel said of placing conscious patients with non-invasive ventilation on their fronts.
The refined approach reflects a broader shift on the frontlines of the COVID-19 pandemic in Europe and beyond, as doctors have rethought their use of mechanical ventilators to treat severe sufferers.
In France, the number of COVID-19 sufferers in intensive care has more than doubled to 752 over the past month. In Marseille, epicentre of the second wave, doctors warn their units are close to saturation.
Avenel’s hospital in Seine-Saint-Denis has 18 intensive care beds. Six are dedicated to COVID patients, four are occupied.
Seine-Saint-Denis’ blue-collar, racially diverse demographics meant it was one of the hardest hit parts of France during the first wave. The summer lull in cases brought brief respite to Avenel’s ward, and with it the danger of complacency.
The ward saw just one staff member test positive during the height of the epidemic in the spring. Last week alone, six tested positive.
Asked about the physical and mental wellbeing of his staff as admissions rise again, Avenel’s ward leader Francesco Santoli said: “We’re tired, and a little fatalistic.”
(Reporting by Noemie Olive; Writing by Richard Lough; Editing by Janet Lawrence)
Trump bars Americans from staying at 400+ Cuban hotels believed to be under government control
Americans visiting Cuba are going to be prohibited from staying at 433 hotels that are believed to be owned or controlled by the government or “certain well-connected insiders,” the State Department announced Wednesday.
The order was taken as part of a broader effort announced by President Donald Trump to tighten restrictions on the Cuban government, a sharp reversal from the more open policies toward the island nation under President Barack Obama.
“Today we reaffirm our ironclad solidarity with the Cuban people and our eternal conviction that freedom will prevail over the sinister forces of communism and evil in many different forms,” Trump said in remarks meant to honor veterans of the ill-fated Bay of Pigs invasion in 1961, in which Cuban exiles attempted to launch an invasion of their homeland. “Today we declare America’s unwavering commitment to a free Cuba.”
The sanctions come amid a tight race for the presidency ahead of the Nov. 3 election in the critical swing state of Florida where Cuban-Americans are an important voting bloc.
In announcing the list of hotels, the State Department said the profits from them “disproportionately benefit the Cuban government, all at the expense of the Cuban people, who continue to face repression at the hands of the regime.”
Instead, the department urged travelers to stay at casas particulares, private accommodations owned by “legitimately independent entrepreneurs.”
The order will likely encourage more Cubans to rent rooms or residences through services like Airbnb, said John Kavulich, president of the U.S.-Cuba Trade and Economic Council in New York.
In addition, it could entice the Cuban government to sell hotels to some of the foreign companies that currently have management contracts to run them, taking them off the list and thus making them able to book U.S. visitors again, Kavulich said.
But with the list limited the number of accommodations for Americans in Cuba, it may force airlines to cut their flight schedules there as well, he added.
The order also prohibits Americans from bringing home Cuban rum or cigars.
The Trump administration has taken several steps to isolate Cuba. In June 2019, it stopped cruise ships from visiting the island, which had been allowed since 2016 following the re-establishment of diplomatic relations between the two countries two years earlier. That October, it banned flights to all Cuban cities but the capital, Havana. Earlier this summer, it ordered Marriott to close its Four Points Sheraton hotel in Havana.
Legally, U.S. travelers can still visit Cuba under specific conditions:
Official U.S. government business
Professional research and meetings
Educational activities (like those from U.S. academic institutions and secondary schools)
Support for the Cuban people
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Contributing: Jayme Deerwester and David Oliver, USA TODAY; The Associated Press
This article originally appeared on USA TODAY: Cuba: Trump bars American travelers from more than 400 hotels
China running 380 detention centres in Xinjiang: researchers
China’s network of detention centres in the northwest Xinjiang region is much bigger than previously thought and has been expanded in recent years, according to research presented by an Australian think tank Thursday.
The Australian Strategic Policy Institute said it had identified more than 380 “suspected detention facilities” in the region — where China is believed to have detained more than one million Uighurs and other mostly Muslim Turkic-speaking residents.
The number of facilities is around 40 percent greater than previous estimates and, according to Australian researchers, has been growing despite China’s claims that many Uighurs have been released.
Using satellite imagery, eyewitness accounts, media reports and official construction tender documents, the institute said “at least 61 detention sites have seen new construction and expansion work between July 2019 and July 2020.”
Fourteen more facilities were under construction in 2020 and around 70 have had fencing or perimeter walls removed, indicating their use has changed or they have been closed.
US lawmakers recently voted to ban imports from Xinjiang, citing the alleged use of systematic forced labour.
Beijing recently published a white paper defending its policies in Xinjiang, where it says training programmes, work schemes and better education mean life has improved.
It has defended the so-called training centres as necessary to stamp out extremism.
Following the publication of the latest report, Chinese government-controlled nationalist tabloid the Global Times cited “sources” saying Australian Strategic Policy Institute contributors Clive Hamilton and Alex Joske were banned from entering China.
GOP’s Biden report littered with debunked claims and “Russian disinformation”
Chuck Grassley and Ron Johnson Photo illustration by Salon/Getty Images
Senate Republicans on Wednesday released an interim report of their investigation into Democratic nominee Joe Biden and son Hunter Biden that largely recycles old claims to back up allegations which have already been debunked.
Sens. Ron Johnson, R-Wis., the chairman of the Senate Homeland Security and Governmental Affairs Committee, and Chuck Grassley, R-Iowa, the chairman of the Senate Finance Committee, released an interim report titled “Hunter Biden, Burisma and Corruption” less than six weeks ahead of the election.
Johnson previously teased that he had found evidence which would “certainly help Donald Trump win re-election.” But the report largely relies on witnesses who already testified on the matter in the House impeachment inquiry and presents little evidence to support allegations which have been refuted.
“Hunter Biden’s position on Burisma’s board was problematic and did interfere in the efficient execution of policy with respect to Ukraine,” the report said, though it provided no evidence of any policies which were affected.
The report went on to acknowledge as much, undermining its own conclusion by noting that “the extent to which Hunter Biden’s role on Burisma’s board affected U.S. policy toward Ukraine is not clear.”
Sen. Ron Wyden, D-Ore., the top Democrat on the Senate Finance Committee, said the report was the culmination of a “sham investigation.” He described the probe as “an attempted political hit job facilitated by the State Department and rooted in the disinformation pushed” by Russian operatives.
“Throughout this effort, I have been deeply disturbed by Senate Republicans’ willingness to disregard national security concerns and push Russian disinformation,” Wyden said. “The Senate must never again be abused in this way.”
The probe was launched after Trump was impeached by the House of Representatives for pressuring Ukrainian President Volodymyr Zelensky to investigate unsubstantiated allegations of wrongdoing by Hunter Biden while he worked for the energy firm Burisma, even though Ukrainian prosecutors said there was no evidence of any wrongdoing by Biden.
Trump has falsely claimed that Biden pressured Ukraine to fire a prosecutor who had investigated Burisma to protect his son, even though a coalition of western nations had pushed for the prosecutor’s removal over corruption allegations. Multiple State Department officials repeatedly refuted that claim during the impeachment inquiry.
Democrats expressed concerns during the investigation that Johnson’s probe relied on Russian misinformation aimed at hurting Biden. The GOP report devoted 10 of its 87 pages to countering allegations that their probe had fueled a Russian disinformation effort.
Democrats said the Republicans advanced a narrative pushed by sanctioned pro-Russia Ukrainian lawmaker Andrii Derkach, who provided information to the committee. The report claimed that Johnson and Grassley “did not receive” and were “unaware of” the information sent by the lawmaker, arguing that “it is impossible that Derkach’s efforts could have shaped the committees’ investigation in any way.”
But Politico noted that Johnson’s allegations “mirror those pushed by Derkach.” The Ukrainian lawmaker also met with Trump attorney Rudy GIuliani, who led the off-book investigation in Ukraine which ultimately led to Trump’s impeachment.
Johnson also had contact with former Ukrainian diplomat Andriy Telizhenko, who worked for Blue Star Strategies, a lobbying firm that represented Burisma, and advanced the debunked conspiracy theory that Ukraine interfered in the 2016 election to help Trump’s Democratic rival Hillary Clinton.
The report cited “confidential sources” nearly 100 times, whose identities remain unclear. Republicans also did not immediately release transcripts from witness interviews, instead only releasing selective quotes from the interviews.
Democrats slammed Republicans for withholding the transcripts. Sen. Gary Peters, D-Mich., the top Democrat on the Senate Homeland Security Committee, said releasing the report without simultaneously releasing the transcripts was a “direct violation” of rules that weakened “the committee’s ability to effectively carry out its responsibilities on behalf of the public in the future.”
The report largely relies on the testimony of top State Department official George Kent, who testified during the impeachment proceedings. Echoing his comments to the House last year, Kent told Republican investigators that Hunter Biden’s role on the company was “very awkward” for U.S. officials pushing anti-corruption policies in the country.
The report also cites a New Yorker article published last year, which details a discussion between Joe Biden and an aide about his son’s role at the company. However, the article did not include Biden’s side of the conversation.
The report said Kent and another official had raised concerns about a potential conflict of interest and Hunter Biden’s role at Burisma casting “a shadow” on U.S. policy in Ukraine. But it did not provide any evidence that it affected U.S. policy.
Johnson cast the release of the report as damaging to Biden’s electoral chances.
“People need to take a look at this report very carefully and understand what the ramifications are for electing Joe Biden as president,” he said in a radio interview the day before the report’s release.
Johnson’s repeated insistence that the report would hurt Biden prompted criticism from within his own party.
“It is not the legitimate role of government, for Congress or for taxpayer expense, to be used in an effort to damage political opponents,” Sen. Mitt Romney, R-Utah, said last week, calling the investigation a “political exercise.”
Sen. Richard Burr, R-N.C., the former chairman of the Senate Intelligence Committee, also confronted Johnson over concerns that his probe would fuel Russia’s disinformation effort, according to Politico.
Biden campaign spokesman Andrew Bates told the outlet on Wednesday that Johnson had “wasted months” on the investigation while seeking to “subsidize a foreign attack against the sovereignty of our elections with taxpayer dollars — an attack founded on a long-disproven, hardcore rightwing conspiracy theory.”
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