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U.S. Confirms First Person-to-Person Spread of Coronavirus | By Erin Mendell, Brianna Abbott and Katie Camero
The first case of human-to-human transmission of the novel coronavirus in the U.S. has been confirmed in Chicago, according to state and federal health officials, as governments and corporations around the world are scrambling to limit the damage from the fast-spreading virus.
The patient, now the sixth confirmed in the U.S., is the husband of the Chicago patient reported last week who had recently traveled to Wuhan. The U.S. Centers for Disease Control and Prevention and state officials emphasized that the overall risk for people in the U.S. and in Illinois remains low.
`` This person-to-person spread was between two very close contacts, a wife and husband, '' said Ngozi Ezike, the director of the Illinois Department of Public Health. `` It is not spreading in the wider community. ''
The new Chicago patient lived with and was in consistent close contact with his wife, who had recently traveled to Wuhan. After returning to the U.S. on Jan. 13, she later developed symptoms and was hospitalized in an isolated setting. Once the husband also started developing symptoms, he was quickly taken to the hospital, health authorities said. The patient, who has underlying health issues, is in a stable condition, health authorities say.
In response to the virus, Russia has tightened its border with China and the U.S. announced plans for a second evacuation of the Chinese city at the center of the epidemic. Companies including Tesla Inc. and IKEA were forced to temporarily halt operations in China.
The moves came as two more countries -- India and the Philippines -- confirmed their first infections, bringing the total number of affected countries to nearly 20, as the total number of confirmed cases approached 8,000.
India said a student from Wuhan University tested positive for the virus while visiting the southern state of Kerala and was in isolation at a local hospital. The Philippines said Thursday it recorded its first confirmed coronavirus case, a 38-year-old Chinese woman who arrived in the country on Jan. 21 from Wuhan.
Moscow, meanwhile, said that it will temporarily restrict passage through 16 road, rail and river checkpoints along its 2,670-mile-long border with China, starting Friday. Though Russia's national carrier Aeroflot hasn't stopped flying to China, smaller Russian airlines have canceled flights into China from the Far Eastern city of Vladivostok.
A number of countries pushed ahead with efforts to extract their citizens from central China.
The State Department on Thursday said it is planning a second evacuation flight from Wuhan, the central Chinese city where the newly identified coronavirus first emerged last month, offering hope for the hundreds of American citizens still believed to be in the city.
White House spokesman Hogan Gidley said the risk coronavirus poses to Americans remains low and that he wasn't aware of government plans to cancel flights to and from China. He said the U.S. is taking `` all the precautions necessary and will continue to do so. ''
Members of a House of Representatives panel briefed by federal medical officials Thursday said that traditional means of stopping infection are still the best guard against the virus's spread.
Members of the subcommittee said federal officials appear to have the situation well in hand and that there isn't any need for a coronavirus `` czar, '' as occurred with the Ebola virus epidemic in West Africa during the Obama administration. Drs. Anthony Fauci of the National Institutes of Health and Robert Redfield of the U.S. Centers for Disease Control and Prevention were among the officials conducting the briefing Thursday morning.
`` You don't need another bureaucrat '' to oversee the government effort, said Rep. Michael Burgess ( R., Texas). Dr. Burgess said traditional techniques such as `` isolation, identification and quarantine of patients '' were `` the magic bullet that took out the virus with SARS, '' and these should continue to work in this case, he said.
Rep. Diana DeGette ( D., Colo.) said Americans need to take even more basic measures such as hand-washing and getting flu shots to stay healthy this winter. Currently in the U.S., she said, the threat from the seasonal flu is greater than that from the coronavirus.
The Indian government is seeking permission from Chinese authorities to operate two flights to repatriate citizens from Hubei province, of which Wuhan is the capital, and will quarantine them for 14 days.
In Japan, controversy erupted Wednesday after two people on a government-chartered evacuation flight from Wuhan to Tokyo refused to be tested for the new coronavirus. Some on social media wondered why the Japanese government didn't quarantine evacuated citizens the way other countries had.
`` This is unforgivable, '' wrote one Twitter user. `` No more charter flights! ''
Prime Minister Shinzo Abe told Parliament Thursday that while the government had pushed for all 206 passengers on the Wednesday flight to be tested, it had no legal power to compel them. Three people on the flight tested positive for the virus, including two without symptoms, according to the health ministry. The two who refused testing didn't show any symptoms and health-ministry staff drove them home in a regular car, health ministry official Takuma Kato said.
A second charter flight to evacuate Japanese citizens from Wuhan arrived in Tokyo on Thursday, and Mr. Kato said all 210 people who returned on that flight had agreed to be screened.
Meanwhile, immigration officials in Hong Kong scoured the city for visitors from Hubei, finding 15 on Wednesday night during searches of 110 hotels, according to Lam Shuk-yee, deputy secretary for security of the Chinese territory on Thursday.
Ms. Lam said 1,600 people from the province had been turned away at the Hong Kong border since the ban.
On the corporate front, big multinational companies moved to temporarily shut down their China operations as workers remained largely in place, with the Lunar New Year holiday extended through the end of the week and transportation links largely curtailed.
Tesla Chief Financial Officer Zach Kirkhorn said Wednesday that the company was halting production at its new Shanghai Gigafactory to comply with a local-government order to extend China's Lunar New Year holiday, which Mr. Kirkhorn said could affect the company's first-quarter performance.
All 30 IKEA outlets in mainland China were closed until further notice, the Swedish furniture giant said Thursday.
Air France -- part of Air France-KLM -- joined the list of airlines cutting service to China. The French carrier said it would suspend all scheduled flights to and from the mainland until Feb. 9 and would operate special flights starting Friday to and from Shanghai and Beijing using volunteer crew members to enable customers and employees to depart safely.
Italian authorities were holding 6,000 passengers and crew aboard a cruise ship docked at the port of Civitavecchia near Rome after a 54-year-old Chinese woman showed flulike symptoms, according to a spokesperson for Costa Crociere, the company operating the ship Costa Smeralda.
The woman and her male traveling companion, who showed no symptoms, were isolated in the ship's hospital, the company said, while Italy's health ministry said it was waiting for the results of tests for coronavirus.
China's national women's soccer team is being held in quarantine in a hotel in the Australian city of Brisbane until Feb. 5, health authorities for the northwestern state of Queensland said Thursday. The 32-member team had traveled to Australia to compete in a qualifying tournament for this summer's Olympics in Tokyo.
The tournament was originally scheduled to be held in Wuhan but was moved to Sydney after the outbreak. The team had departed Wuhan Jan. 22, before the city was locked down, said the Chinese Football Association, which said it also planned to suspend soccer competitions nationwide starting Thursday.
Closer to the outbreak's center, the education department of Wuhan's home province of Hubei encouraged middle and primary schools to move classes online to ensure students keep up with their studies even with the Lunar New Year holidays extended indefinitely.
`` The semester is delayed, but study shouldn't be, '' read a slogan included with the recommendation by the department, which separately encouraged local universities to move academic activities online.
The province also opened a new helpline on Thursday for people struggling with the psychological toll of the outbreak, China's official Xinhua News Agency reported Thursday, citing local officials.
In Chongqing, a southwestern megacity that borders Hubei, pharmacies are now required to report the names of people who buy medication for symptoms like fever and cough, part of an effort to track people who might have coronavirus symptoms, state broadcaster China Central Television reported Thursday. The city of more than 30 million people had 165 confirmed cases of the coronavirus as of midnight Wednesday and is closely connected to Wuhan by road and rail.
In a sign of mounting pressures on medical staff in affected cities, the head of the infectious diseases division at Shanghai's Huashan Hospital declared that all the doctors who had been treating coronavirus patients would be allowed to rest and would be replaced by doctors who were Chinese Communist Party members.
`` We can't bully those who are more obedient, '' Zhang Wenhong said, describing the early responders as heroic. `` So I 've decided to change the shift. It will all be Party members from now on. ''
In words tinged with exhaustion and frustration, Mr. Zhang, who is also the senior party leader of his division, said Communist Party members needed to live up to their vows to serve the people. `` I don't care whether or not you're willing, you're all going to step up, '' he said.
( MORE TO FOLLOW) Dow Jones Newswires
01-30-20 1343ET | business |
Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries | BackgroundWHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus ( HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90–70–90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals ( SDGs) —a one-third reduction in premature mortality from non-communicable diseases by 2030.MethodsThe WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries ( LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10–14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median ( range) of model predictions.FindingsIn 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 ( range 12·9–14·1) per 100 000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% ( 0·1–0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% ( 23·3–37·8), averting 300 000 ( 300 000–400 000) deaths by 2030 ( with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% ( 61·4–66·1), averting 4·8 million ( 4·1–4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% ( 84·0–89·3), averting 13·3 million ( 13·1–13·6) deaths ( with once-lifetime screening), or by 92·3% ( 88·4–93·0), averting 14·6 million ( 14·1–14·6) deaths ( with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% ( 86·6–89·9), averting 45·8 million ( 44·7–46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% ( 95·0–98·0), averting 60·8 million ( 60·2–61·2) deaths ( with once-lifetime screening), or by 98·6% ( 96·5–98·6), averting 62·6 million ( 62·1–62·8) deaths ( with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half ( 48% [ 45–55 ]) of deaths averted would be in sub-Saharan Africa and almost a third ( 32% [ 29–34 ]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths ( age 30–69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% ( 24·4–37·9) by 2030, 96·2% ( 94·3–96·8) by 2070, and 98·6% ( 96·9–98·8) by 2120.InterpretationThese findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives.FundingWHO, UNDP, UN Population Fund, UNICEF–WHO–World Bank Special Program of Research, Development and Research Training in Human Reproduction, Germany Federal Ministry of Health, National Health and Medical Research Council Australia, Centre for Research Excellence in Cervical Cancer Control, Canadian Institute of Health Research, Compute Canada, and Fonds de recherche du Québec–Santé.
WHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus ( HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90–70–90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals ( SDGs) —a one-third reduction in premature mortality from non-communicable diseases by 2030.
The WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries ( LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10–14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median ( range) of model predictions.
In 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 ( range 12·9–14·1) per 100 000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% ( 0·1–0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% ( 23·3–37·8), averting 300 000 ( 300 000–400 000) deaths by 2030 ( with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% ( 61·4–66·1), averting 4·8 million ( 4·1–4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% ( 84·0–89·3), averting 13·3 million ( 13·1–13·6) deaths ( with once-lifetime screening), or by 92·3% ( 88·4–93·0), averting 14·6 million ( 14·1–14·6) deaths ( with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% ( 86·6–89·9), averting 45·8 million ( 44·7–46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% ( 95·0–98·0), averting 60·8 million ( 60·2–61·2) deaths ( with once-lifetime screening), or by 98·6% ( 96·5–98·6), averting 62·6 million ( 62·1–62·8) deaths ( with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half ( 48% [ 45–55 ]) of deaths averted would be in sub-Saharan Africa and almost a third ( 32% [ 29–34 ]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths ( age 30–69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% ( 24·4–37·9) by 2030, 96·2% ( 94·3–96·8) by 2070, and 98·6% ( 96·9–98·8) by 2120.
These findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives.
WHO, UNDP, UN Population Fund, UNICEF–WHO–World Bank Special Program of Research, Development and Research Training in Human Reproduction, Germany Federal Ministry of Health, National Health and Medical Research Council Australia, Centre for Research Excellence in Cervical Cancer Control, Canadian Institute of Health Research, Compute Canada, and Fonds de recherche du Québec–Santé.
In 2018, an estimated 570 000 cases of cervical cancer were diagnosed, and 311 000 women died from the disease.1Ferlay J Ervik M Lam F et al.Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon, France2018https: //gco.iarc.fr/todayDate accessed: October 24, 2019Google Scholar Although cervical cancer has been relatively well controlled for several decades in many high-income countries, mainly because of cervical screening initiatives and effective cancer treatment services, it remains the most common cause of cancer-related death among women in 42 countries, most of which are low-income and lower-middle-income countries ( LMICs).2Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Crossref PubMed Scopus ( 31891) Google Scholar
Prophylactic vaccines against oncogenic human papillomavirus ( HPV) have been available in most high-income countries from 2006 onwards. First-generation vaccines directly protect against oncogenic HPV types 16 and 18 in individuals naive for those types, and these HPV types are responsible for approximately 70% of invasive cervical cancers.3FUTURE II Study GroupQuadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions.N Engl J Med. 2007; 356: 1915-1927Crossref PubMed Scopus ( 1611) Google Scholar, 4Paavonen J Naud P Salmerón J et al.Efficacy of human papillomavirus ( HPV) -16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types ( PATRICIA): final analysis of a double-blind, randomised study in young women.Lancet. 2009; 374: 301-314Summary Full Text Full Text PDF PubMed Scopus ( 1247) Google Scholar More recently, broader-spectrum protection against the types responsible for up to 90% of cervical cancers has been shown either via direct protection against a larger proportion of types ( second-generation 9-valent vaccine) or via cross-protection against non-vaccine included types ( bivalent vaccine).5Joura EA Giuliano AR Iversen OE et al.A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women.N Engl J Med. 2015; 372: 711-723Crossref PubMed Scopus ( 771) Google Scholar, 6Kavanagh K Pollock KG Cuschieri K et al.Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study.Lancet Infect Dis. 2017; 17: 1293-1302Summary Full Text Full Text PDF PubMed Scopus ( 133) Google Scholar However, because vaccines are primarily targeted at pre-adolescents or young adolescents, it is expected to take several decades after deployment in a population before their full benefits in terms of cancer prevention are realised, and a substantial impact of vaccines on cervical cancer incidence or mortality outcomes is yet to be observed. To date, vaccine coverage in LMICs has been low overall, with an estimated 3% of the primary targeted population of young girls in less developed regions vaccinated by 2014.7Bruni L Diaz M Barrionuevo-Rosas L et al.Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis.Lancet Glob Health. 2016; 4: e453-e463Summary Full Text Full Text PDF PubMed Scopus ( 391) Google Scholar By 2016, only 14% of LMICs had established vaccination programmes.8Gallagher KE LaMontagne DS Watson-Jones D Status of HPV vaccine introduction and barriers to country uptake.Vaccine. 2018; 36: 4761-4767Crossref PubMed Scopus ( 75) Google Scholar
Research in contextEvidence before this studyMost low-income and lower-middle-income countries ( LMICs) do not have access to human papillomavirus ( HPV) vaccination, cervical screening programmes are unavailable or poorly implemented, and population-level access to cancer treatment services is variable. WHO, with its partners, is developing a global strategy towards the elimination of cervical cancer as a public health problem. The draft strategy involves triple-intervention targets for scale-up of vaccination, screening, and precancer treatment and invasive cancer treatment and palliative care in all countries; these targets, known as the 90–70–90 WHO triple-intervention strategy, specify 90% coverage of HPV vaccination, 70% coverage of twice-lifetime screening with HPV testing ( or a similarly high sensitivity test), and 90% of women having access to cervical precancer and cancer treatment and palliative care services, by 2030. In the accompanying Article published in The Lancet, the WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC) predicted the impact of various HPV vaccination and screening and precancer treatment strategies on cervical cancer incidence in 78 LMICs. The analysis found that cervical cancer elimination by 2120 at a threshold of four cases per 100 000 women-years was possible in all 78 LMICs if girls-only vaccination was combined with twice-lifetime screening. The results suggested that elimination was consistently achievable, and the number of cervical cancer cases averted maximised, only if vaccination was combined with twice-lifetime cervical screening and with appropriate treatment for women found to have cervical precancer. The CCEMC harnesses three independent, extensively peer-reviewed models: Policy1-Cervix ( Cancer Council NSW, Sydney, NSW Australia), Harvard ( Harvard University, Boston, MA, USA), and HPV-ADVISE ( Laval University, Quebec, QC, Canada). In this analysis, the models projected the reductions in cervical cancer mortality over time by use of standardised scenarios determined via consultations at various WHO technical expert, advisory group, and global stakeholder meetings.Added value of this studyThis analysis of the impact of the WHO triple-intervention cervical cancer elimination strategy on mortality outcomes shows that, in the next 10 years, achieving substantial reductions in mortality will require successful scale-up of cancer diagnostic and treatment services in LMICs, including pathology, surgery, radiotherapy, and chemotherapy; supportive and palliative care services will also need to be scaled up. If this is done, the 2030 UN Sustainable Development Goal of achieving a greater than one-third reduction in premature mortality from non-communicable diseases could be realised for cervical cancer. In the next 50 years, cervical screening and vaccination will both have an important role. The triple-intervention strategy would result in mortality rate reductions of 92% by 2070, increasing to almost 99% over the course of the next century as the full benefits of vaccination of young cohorts are realised over time.Implications of all the available evidenceImplementing the 90–70–90 WHO triple-intervention strategy to achieve cervical cancer elimination will result in more than 74 million cervical cancer cases averted and more than 62 million women's lives saved over the course of the next century. These findings have informed the draft WHO global strategy for cervical cancer elimination, which will be presented to the WHO Executive Board in February, 2020, and thereafter considered at the World Health Assembly in May, 2020.
Most low-income and lower-middle-income countries ( LMICs) do not have access to human papillomavirus ( HPV) vaccination, cervical screening programmes are unavailable or poorly implemented, and population-level access to cancer treatment services is variable. WHO, with its partners, is developing a global strategy towards the elimination of cervical cancer as a public health problem. The draft strategy involves triple-intervention targets for scale-up of vaccination, screening, and precancer treatment and invasive cancer treatment and palliative care in all countries; these targets, known as the 90–70–90 WHO triple-intervention strategy, specify 90% coverage of HPV vaccination, 70% coverage of twice-lifetime screening with HPV testing ( or a similarly high sensitivity test), and 90% of women having access to cervical precancer and cancer treatment and palliative care services, by 2030. In the accompanying Article published in The Lancet, the WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC) predicted the impact of various HPV vaccination and screening and precancer treatment strategies on cervical cancer incidence in 78 LMICs. The analysis found that cervical cancer elimination by 2120 at a threshold of four cases per 100 000 women-years was possible in all 78 LMICs if girls-only vaccination was combined with twice-lifetime screening. The results suggested that elimination was consistently achievable, and the number of cervical cancer cases averted maximised, only if vaccination was combined with twice-lifetime cervical screening and with appropriate treatment for women found to have cervical precancer. The CCEMC harnesses three independent, extensively peer-reviewed models: Policy1-Cervix ( Cancer Council NSW, Sydney, NSW Australia), Harvard ( Harvard University, Boston, MA, USA), and HPV-ADVISE ( Laval University, Quebec, QC, Canada). In this analysis, the models projected the reductions in cervical cancer mortality over time by use of standardised scenarios determined via consultations at various WHO technical expert, advisory group, and global stakeholder meetings.
This analysis of the impact of the WHO triple-intervention cervical cancer elimination strategy on mortality outcomes shows that, in the next 10 years, achieving substantial reductions in mortality will require successful scale-up of cancer diagnostic and treatment services in LMICs, including pathology, surgery, radiotherapy, and chemotherapy; supportive and palliative care services will also need to be scaled up. If this is done, the 2030 UN Sustainable Development Goal of achieving a greater than one-third reduction in premature mortality from non-communicable diseases could be realised for cervical cancer. In the next 50 years, cervical screening and vaccination will both have an important role. The triple-intervention strategy would result in mortality rate reductions of 92% by 2070, increasing to almost 99% over the course of the next century as the full benefits of vaccination of young cohorts are realised over time.
Implementing the 90–70–90 WHO triple-intervention strategy to achieve cervical cancer elimination will result in more than 74 million cervical cancer cases averted and more than 62 million women's lives saved over the course of the next century. These findings have informed the draft WHO global strategy for cervical cancer elimination, which will be presented to the WHO Executive Board in February, 2020, and thereafter considered at the World Health Assembly in May, 2020.
Many high-income countries are transitioning, or considering transitioning, from cervical cytology to primary HPV testing for cervical screening, which is generally a more effective and cost-effective approach to screening.9Ronco G Dillner J Elfström KM et al.Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials.Lancet. 2014; 383: 524-532Summary Full Text Full Text PDF PubMed Scopus ( 891) Google Scholar, 10Lew JB Simms KT Smith MA et al.Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program.Lancet Public Health. 2017; 2: e96-e107Summary Full Text Full Text PDF PubMed Scopus ( 84) Google Scholar, 11Canfell K Caruana M Gebski V et al.Cervical screening with primary HPV testing or cytology in a population of women in which those aged 33 years or younger had previously been offered HPV vaccination: results of the Compass pilot randomised trial.PLoS Med. 2017; 14e1002388Crossref PubMed Scopus ( 45) Google Scholar Initiatives for both HPV vaccination and screening have been introduced in the context of broad access to diagnostic, precancer treatment, cancer treatment, and supportive and palliative care services in high-income countries, and the combination of early detection via screening and effective treatment with surgery, chemotherapy, and radiotherapy has meant that net 5-year survival for cervical cancer is around 60–70% or greater in several high-income countries.12Allemani C Matsuda T Di Carlo V et al.Global surveillance of trends in cancer survival 2000–14 ( CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries.Lancet. 2018; 391: 1023-1075Summary Full Text Full Text PDF PubMed Scopus ( 1214) Google Scholar However, in LMICs, uptake of cervical screening has been low and inconsistent, and population-level access to cancer care is generally poor. As a consequence of these differentials in access to cervical screening and treatment, the majority of deaths ( 91%) from cervical cancer currently occur in LMICs and upper-middle-income countries, and 60% of deaths are in LMICs.1Ferlay J Ervik M Lam F et al.Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon, France2018https: //gco.iarc.fr/todayDate accessed: October 24, 2019Google Scholar Access to supportive and palliative care services for people in LMICs is poor,13Knaul FM Farmer PE Krakauer EL et al.Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report.Lancet. 2018; 391: 1391-1454Summary Full Text Full Text PDF PubMed Scopus ( 315) Google Scholar and thus the majority of women dying from cervical cancer do so with little or no supportive care or pain relief.
In May, 2018, the Director-General of WHO announced a call to action to eliminate cervical cancer as a public health problem, and in January, 2019, the WHO Executive Board requested that a draft global strategy to achieve elimination be developed. The draft global strategy being developed by WHO, with its partners, includes triple-intervention targets for scale-up of vaccination, screening, precancer treatment, and invasive cancer treatment in all countries; these targets specify 90% coverage of HPV vaccination, 70% coverage of twice-lifetime screening, and 90% access to cervical precancer and cancer treatment services and palliative care, by 2030.14WHODraft global strategy towards the elimination of cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cerv-cancer-elimn-strategy-16dec-12pm.pdfDate: Dec 16, 2019Date accessed: January 28, 2020Google Scholar To inform the strategic planning process, the WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC) was formed and has done comparative modelling of potential intervention scenarios in all 78 LMICs. In the accompanying Article published in The Lancet,15Brisson M Kim JJ Canfell K et al.Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30068-4Summary Full Text Full Text PDF PubMed Scopus ( 97) Google Scholar CCEMC predictions of the impact of HPV vaccination, screening, and precancer treatment strategies on cervical cancer incidence and cases averted are presented; the analysis found that elimination by 2120 at a threshold of four cases per 100 000 women was possible in all 78 LMICs if girls-only vaccination was combined with twice-lifetime screening. This strategy was predicted to reduce age-standardised incidence across 78 LMICs by 97% and to avert more than 74 million cervical cancer cases over the next century.15Brisson M Kim JJ Canfell K et al.Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30068-4Summary Full Text Full Text PDF PubMed Scopus ( 97) Google Scholar The analysis concluded that adding screening with high uptake to vaccination will expedite reductions in cervical cancer incidence and the number of cases averted, and will be necessary to eliminate cervical cancer in countries with the highest burden.
The aims of the current analysis were to model cancer treatment scale-up in addition to HPV vaccination and cervical screening and to assess the impact of achieving the 90–70–90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century on the path to elimination. The cervical cancer elimination initiative has been framed within the context of the UN Sustainable Development Goals ( SDGs) to support the realisation of SDG target 3.4—a one-third reduction in premature mortality from non-communicable diseases by 2030.16WHOGoal 3: Ensure healthy lives and promote well-being for all at all ages. Target 3.4: by 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Indicator 3.4.1: mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease.https: //unstats.un.org/sdgs/metadata/files/Metadata-03-04-01.pdfDate: Feb 10, 2017Date accessed: January 24, 2020Google Scholar Therefore, we also assessed the potential for the cervical cancer elimination strategy to deliver a one-third reduction in premature mortality from cervical cancer by 2030.
The 78 LMICs considered were located in six regions according to World Bank definitions: east Asia and Pacific, Europe and central Asia, Latin America and Caribbean, north Africa and the Middle East, South Asia, and sub-Saharan Africa ( see the appendix pp 44–45 for the full list of countries within each region and the grouping of countries by income level).
The WHO CCEMC comprised three modelling groups collaborating with WHO and the International Agency for Research on Cancer ( IARC). The platforms were independent dynamic models, identified by WHO by use of predefined criteria. The modelling methods have been previously described.15Brisson M Kim JJ Canfell K et al.Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30068-4Summary Full Text Full Text PDF PubMed Scopus ( 97) Google Scholar In brief, the selected models for the analysis explicitly considered the dynamic transmission of HPV infection ( and could thus capture the effects of herd immunity); were capable of projecting the impact of HPV vaccination, cervical screening, and precancer treatment and clinical and screen-detected cancer treatment scale-up at a country level for all 78 LMICs considered; and were independently developed and have been extensively validated and peer reviewed. Three models were selected: Policy1-Cervix ( Cancer Council NSW, Sydney, NSW, Australia), Harvard ( Harvard University, Boston, MA, USA), and HPV-ADVISE ( Laval University, Quebec, QC, Canada). The individual CCEMC models have been previously used to inform national policy on cervical screening and HPV vaccination in Australia, Canada, the UK, and the USA, and at the global level.10Lew JB Simms KT Smith MA et al.Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program.Lancet Public Health. 2017; 2: e96-e107Summary Full Text Full Text PDF PubMed Scopus ( 84) Google Scholar, 17Simms KT Steinberg J Caruana M et al.Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study.Lancet Oncol. 2019; 20: 394-407Summary Full Text Full Text PDF PubMed Scopus ( 127) Google Scholar, 18Hall MT Simms KT Lew JB et al.The projected timeframe until cervical cancer elimination in Australia: a modelling study.Lancet Public Health. 2019; 4: e19-e27Summary Full Text Full Text PDF PubMed Scopus ( 140) Google Scholar, 19Kim JJ Burger EA Regan C Sy S Screening for cervical cancer in primary care: a decision analysis for the US Preventive Services Task Force.JAMA. 2018; 320: 706-714Crossref PubMed Scopus ( 51) Google Scholar, 20Burger EA Campos NG Sy S Regan C Kim JJ Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country.Vaccine. 2018; 36: 4823-4829Crossref PubMed Scopus ( 19) Google Scholar, 21Brisson M Laprise JF Drolet M et al.Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study.Vaccine. 2013; 31: 3863-3871Crossref PubMed Scopus ( 43) Google Scholar, 22Jit M Laprise JF Choi YH Brisson M Fewer than three doses of HPV vaccine.Lancet Oncol. 2015; 16: e423-e424Summary Full Text Full Text PDF PubMed Scopus ( 3) Google Scholar The structure of the CCEMC models and the comparative modelling approach were endorsed by the WHO Advisory Committee on Immunization and Vaccines related Implementation Research ( IVIR-AC).23WHOImmunization and Vaccine-related Implementation Research Advisory Committee ( IVIR-AC) recommendations, September 2018.Wkly Epidemiol Rec. 2019; 94: 5-16Google Scholar
HPV transmission and cervical carcinogenesis are modelled for the oncogenic HPV types included in second-generation vaccines ( HPV types 16, 18, 31, 33, 45, 52, and 58) and other oncogenic types, and each model simulates the type-specific natural history of cervical cancer from persistent HPV infection to cervical cancer via high-grade precancerous cervical lesions ( cervical intraepithelial neoplasia grades 2 [ CIN2 ] and 3 [ CIN3 ]). All models can simulate complex cervical screening and treatment algorithms, and for the current analysis these models were adapted to incorporate country-level assumptions about the proportion of women receiving cervical cancer treatment and the consequent survival outcomes. Reporting was done according to a consensus-based framework for modelled evaluations of HPV prevention and cervical cancer control: HPV-FRAME.24Canfell K Kim JJ Kulasingam S et al.HPV-FRAME: a consensus statement and quality framework for modelled evaluations of HPV-related cancer control.Papillomavirus Res. 2019; 8100184Crossref PubMed Scopus ( 15) Google Scholar See the appendix ( pp 50–56, 74–76) for a detailed description of the model platforms and HPV-FRAME reporting.
The comparator ( status quo) S0 scenario assumed no scale-up of vaccination, cervical screening, or cancer treatment. Under the status quo, it was assumed that none of the 78 LMICs had achieved substantial vaccination coverage by 2020, although in practice a few countries, such as Rwanda, have initiated high-coverage vaccination initiatives within the past few years. Thus, our analysis only captures the effect of scaled-up vaccination from 2020 onwards. For cervical screening, modelling groups made different assumptions about whether the impact of limited existing screening coverage was considered in the status quo ( see the appendix pp 50–56 for further details).
Treatment for cervical cancer involves stage-appropriate multimodality therapies with radiotherapy and chemotherapy, with surgery ( partial or total hysterectomy) being an important option for early-stage disease. Cervical cancer clinical staging was based on the International Federation of Gynaecology and Obstetrics ( FIGO) system. Institute for Health Metrics and Evaluation ( IHME) sub-regional-level estimates for the stage distribution of invasive cervical cancer at diagnosis, and data on 5-year and 10-year survival rates were derived from systematic reviews done by WHO based on peer-reviewed publications and national reports including cancer control plans, cross-referenced to data from IARC cancer registries. Radiotherapy access, estimated as machine density per 1000 patients with cancer, was used as a surrogate for multimodal treatment delivery. We used 2018 data for radiotherapy access and availability of external beam radiation therapy and personnel ( radiation oncologists, medical physicists, and radiation therapy technologists) provided by the International Atomic Energy Agency's Directory of Radiotherapy Centres ( DIRAC). Ranges of treatment access rates in each World Bank region encompassed the lowest and the highest treatment access rates of the countries in each region and represented the percentage of the population that could potentially be served with the equipment and workforce available ( table 1). These data were then used to derive initial estimates of country-level current status quo stage distributions, treatment access rates, and survival rates ( appendix pp 63–70). We used these data as an initial ( pre-calibration) input to the models.Table 1Summary of treatment assumptions by region for status quo scenario: FIGO stage distributions, stage-specific survival rates, and treatment access ratesStage distribution at diagnosisOverall 5-year ( and 10-year) survival ratesTreatment access rate ( range) * Treatment access rates were estimated on the basis of radiotherapy access and on the most recent availability of external beam radiation therapy and personnel ( radiation oncologists, medical physicists, and radiation therapy technologists), which were provided by the Directory of Radiotherapy Centres ( DIRAC). Ranges of treatment access rates in each region encompass the lowest and the highest treatment access rates of the countries in each region and represent the percentage of the population that could potentially be serviced on the basis of the equipment and workforce available.Stage 1Stage 2Stage 3–4AStage 4BStage 1Stage 2Stage 3–4AStage 4BEast Asia and Pacific23% 39% 27% 11% 65% ( 15%) 51% ( 13%) 15% ( 10%) 2% ( 2%) 17% ( 0–37) Europe and central Asia34% 19% 28% 19% 74% ( 42%) 62% ( 37%) 34% ( 28%) 6% ( 4%) 48% ( 18–100) Latin America and Caribbean23% 26% 46% 5% 73% ( 39%) 61% ( 34%) 32% ( 26%) 6% ( 4%) 44% ( 0–77) North Africa and Middle East13% 43% 31% 13% 80% ( 59%) 69% ( 52%) 46% ( 39%) 9% ( 6%) 67% ( 0–100) South Asia13% 36% 40% 11% 74% ( 42%) 62% ( 37%) 34% ( 28%) 6% ( 4%) 48% ( 0–55) Sub-Saharan Africa8% 36% 48% 8% 62% ( 6%) 47% ( 5%) 9% ( 4%) 1% ( 1%) 7% ( 0–37) This table provides a regional summary of the data used as an initial ( pre-calibration) input to the models; however, each modelling group also applied a quality factor to further adjust survival in the status quo to fit to Global Cancer Observatory ( GLOBOCAN) 2018 estimates for cervical cancer mortality by 5-year age group appendix pp 3–7, 63–70. Detailed country-specific estimates for status quo treatment access rates are provided in the appendix ( pp 63–70). Staging is according to International Federation of Gynaecology and Obstetrics ( FIGO) staging for carcinoma of cervix ( 2009 version) and TNM, 7th edition. Data based on a systematic review done by WHO, which obtained information from 43 countries, prioritising countries with population-based cancer registries. Results were derived by the Institute for Health Metrics and Evaluation ( IHME) subregions. Regional results shown are weighted on the basis of each country's cancer case burden. * Treatment access rates were estimated on the basis of radiotherapy access and on the most recent availability of external beam radiation therapy and personnel ( radiation oncologists, medical physicists, and radiation therapy technologists), which were provided by the Directory of Radiotherapy Centres ( DIRAC). Ranges of treatment access rates in each region encompass the lowest and the highest treatment access rates of the countries in each region and represent the percentage of the population that could potentially be serviced on the basis of the equipment and workforce available. Open table in a new tab
This table provides a regional summary of the data used as an initial ( pre-calibration) input to the models; however, each modelling group also applied a quality factor to further adjust survival in the status quo to fit to Global Cancer Observatory ( GLOBOCAN) 2018 estimates for cervical cancer mortality by 5-year age group appendix pp 3–7, 63–70. Detailed country-specific estimates for status quo treatment access rates are provided in the appendix ( pp 63–70). Staging is according to International Federation of Gynaecology and Obstetrics ( FIGO) staging for carcinoma of cervix ( 2009 version) and TNM, 7th edition. Data based on a systematic review done by WHO, which obtained information from 43 countries, prioritising countries with population-based cancer registries. Results were derived by the Institute for Health Metrics and Evaluation ( IHME) subregions. Regional results shown are weighted on the basis of each country's cancer case burden.
Global Cancer Observatory ( GLOBOCAN) 2018 estimates are based on IARC-certified cancer registry information where available in a country, or on a series of estimation methods if verified registry data are not available.1Ferlay J Ervik M Lam F et al.Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon, France2018https: //gco.iarc.fr/todayDate accessed: October 24, 2019Google Scholar, 2Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Crossref PubMed Scopus ( 31891) Google Scholar Each group incorporated initial country-level stage-specific 5-year and 10-year survival rates, and models were then calibrated to country-specific and age-specific mortality rates from GLOBOCAN 2018 by incorporating a quality factor into the final estimated country-specific and stage-specific survival assumptions. This approach encompasses limitations in the available data on staging, treatment access, uncertainties in actual delivery of treatment, variations in treatment delivery from established protocols and recommendations, equipment and infrastructure maintenance and logistics, and treatment abandonment. The calibrated results for incidence and mortality are shown for each model in the appendix ( pp 3–7), summarised as the results across all 78 LMICs and at the regional level. Calibration results were comparable for all three models and generally demonstrated good fit with GLOBOCAN 2018.
Models projected age-standardised cervical cancer mortality and deaths over time in 78 LMICs for standardised scenarios. The selection of core scenarios was determined after consultation at several WHO technical expert, advisory group, and global stakeholder meetings in 2018 and was based on a multi-step process, as previously described.15Brisson M Kim JJ Canfell K et al.Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30068-4Summary Full Text Full Text PDF PubMed Scopus ( 97) Google Scholar, 23WHOImmunization and Vaccine-related Implementation Research Advisory Committee ( IVIR-AC) recommendations, September 2018.Wkly Epidemiol Rec. 2019; 94: 5-16Google Scholar The scenarios were aligned with the scale-up targets articulated in the WHO draft global strategy for elimination.14WHODraft global strategy towards the elimination of cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cerv-cancer-elimn-strategy-16dec-12pm.pdfDate: Dec 16, 2019Date accessed: January 28, 2020Google Scholar The final fully articulated core scenarios for the mortality impact analysis were ongoing girls-only vaccination at age 9 years with multi-age cohort catch-up in the first year for ages 10–14 years ( S1); girls-only vaccination, once-lifetime screening at around age 35 years with precancer treatment, and invasive cancer treatment scale-up ( S2); and girls-only vaccination, twice-lifetime screening at around ages 35 years and 45 years with precancer treatment, and invasive cancer treatment scale-up ( S3; the WHO triple-intervention strategy). We also considered two supplementary vaccination scenarios: girls-only vaccination with initial extended multi-age cohort catch-up to age 25 years ( S4), and vaccination of girls and boys at age 9 years with multi-age cohort catch-up at ages 10–14 years ( S5; appendix 57–59).
Vaccination was assumed to scale up to 90% coverage from 2020 with 100% lifetime broad spectrum protection against HPV oncogenic types 16, 18, 31, 33, 45, 52, and 58 in individuals susceptible to the relevant type; the analysis thus applies to a broad-spectrum vaccine that protects against these types either by direct protection ( as per a second-generation 9-valent vaccine) or via cross-protection for non-vaccine-included types. We assumed that full efficacy against vaccine types was achieved with two doses for vaccine recipients aged younger than 15 years, and with three doses for older vaccine recipients ( although dose delivery was not explicitly modelled). Cervical screening was assumed to involve HPV testing once or twice per lifetime at age 35 years, or at ages 35 years and 45 years, with increasing uptake from 45% in 2023, 70% in 2030, to 90% in 2045 onwards. Sensitivity of HPV testing was assumed to be 90% for CIN2 and 94% for CIN3 or worse, independent of age. We assumed that 90% of HPV screen-positive women received visual assessment and appropriate treatment as required for precancer or cancer ( triaging was not explicitly modelled). For successfully delivered precancer treatment, treatment success was assumed to be 100%; CCEMC groups differed in their modelling of post-treatment natural history for whether an elevated risk of recurrence was simulated ( appendix pp 50–56). We assumed that 50% of women with invasive cervical cancers would have access to high quality surgery, radiotherapy, and chemotherapy by 2023, and this would increase to 90% by 2030. Once treatment access was scaled up to 90% in 2030, 10-year survival was assumed to increase to 78% for women diagnosed at FIGO Stage 1, 69% at FIGO Stage 2, 52% at FIGO Stages 3–4A, and 8% at FIGO Stage 4B ( appendix p 71).
For this analysis we considered two types of intervention packages—vaccination alone or vaccination combined with cervical screening and treatment for precancer and screen-detected cancer, delivered in conjunction with scaled-up treatment services for clinically detected cancer. This approach took into account the feasibility and acceptability of whether interventions could be considered in isolation from each other. Although vaccination can be considered in isolation since it is prophylactic, population-wide implementation of cervical screening leads to screening-related detection of precancer and invasive cervical cancer ( with favourable effects on stage-shifting). Referral pathways should be organised so that women with screen-detected invasive cancer are offered prompt and effective treatment ( with treatment capacity scaling up as screening expands), since this approach then leads to improved survival outcomes.
Each single-model analysis was done independently at a country level. The coordinating centre for the analysis ( Cancer Council NSW, Australia) aggregated all results, applied standard populations and population projections, and estimated the median and range of results. Results are presented across all 78 LMICs, regionally, and by country. Rates were age-standardised by applying the age structure of the 2015 World Female Population aged 0–99 years. Premature mortality from cervical cancer was estimated by applying the 2015 World Female Population for ages 30–69 years, and in sensitivity analysis it was based on the probability of death from cervical cancer from age 30 years to 70 years.16WHOGoal 3: Ensure healthy lives and promote well-being for all at all ages. Target 3.4: by 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Indicator 3.4.1: mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease.https: //unstats.un.org/sdgs/metadata/files/Metadata-03-04-01.pdfDate: Feb 10, 2017Date accessed: January 24, 2020Google Scholar For calculation of deaths averted, country-specific and age-specific population projections were based on the UN World Population Prospects: 2017 Revision.25UN Department of Economic and Social AffairsWorld population prospects: the 2017 revision.https: //population.un.org/wpp/Publications/Date: 2017Date accessed: November 13, 2019Google Scholar Relative reductions over time were compared to the status quo. We summarised results for mortality reductions, and deaths averted were calculated from the beginning of 2020 to the end of 2030, 2070, and 2120, with the median ( range) of model predictions for each result. See the appendix ( pp 46–49) for more details.
The analysis was a comparative exercise based on three models with different structural and parameterisation assumptions and a form of sensitivity analysis is built into the reported ranges of results. We reported on key model-specific findings for calibration outcomes and for age-specific mortality rates ( appendix pp 3–7, 11–25). We also ran explanatory ( but counterfactual) scenarios to understand the sensitivity of the model results to underlying aspects of the impact modelling, including an extreme sensitivity analysis on the impact of cancer treatment scale-up. We also assessed the impact of using alternative population structures for age standardisation on the predicted age-standardised rate and the impact of different underlying fertility assumptions for population projections on the cumulative number of cervical cancer deaths averted.
This research was partly funded by WHO, which contributed to study design, data analysis, data interpretation, and writing of the report. Other funders had no role in the design of this analysis or the decision to submit for publication. KC, JJK, and MB had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Predictions from the three models were broadly consistent for all scenarios. Figure 1 shows the summary results across the models for the reduction in age-standardised mortality from 2020 to 2120, table 2 depicts these findings as numerical snapshots of the rates and relative reductions compared to the status quo scenario over time, and the reductions in premature mortality in women aged 30–69 years. Snapshots of the age-specific findings in 2020, 2070, and 2120 for each of the three CCEMC models are shown in the appendix ( pp 11–25).Figure 1Age-standardised cervical cancer mortality over time for all 78 LMICsShow full captionThe solid lines represent the median outcome of the three models; the shading represents the range of model outputs. HPV=human papillomavirus. LMICs=low-income and lower-middle-income countries. S0=status quo ( no scale-up of vaccination, screening or treatment). S1=female-only vaccination at 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.View Large Image Figure ViewerDownload Hi-res image Download ( PPT) Table 2Projected cervical cancer mortality rates over time, across all 78 low-income and lower-middle-income countriesS1: girls-only vaccinationS2: girls-only vaccination, once-lifetime screening, and cancer treatment scale-upS3: girls-only vaccination, twice-lifetime screening, and cancer treatment scale-upSupplementary S4: girls-only vaccination plus multi-age catch-up to age 25 yearsSupplementary S5: vaccination of girls and boysAge-standardised rateReduction vs S0 (%) Age-standardised rateReduction vs S0 (%) Age-standardised rateReduction vs S0 (%) Age-standardised rateReduction vs S0 (%) Age-standardised rateReduction vs S0 (%) Women aged 0–99 years203013·2 ( 12·9 to 14·0) 0·1% ( 0·1 to 0·5) 8·5 ( 8·2 to 11·1) 34·3% ( 21·4 to 37·4) 8·5 ( 8·2 to 10·8) 34·2% ( 23·3 to 37·8) 13·1 ( 12·9 to 13·9) 0·2% ( −0·3 to 1·5) 13·2 ( 13·0 to 14·1) 0·1% ( −0·7 to 0·2) 20705·0 ( 4·5 to 5·4) 61·7% ( 61·4 to 66·1) 1·4 ( 1·4 to 2·2) 88·9% ( 84·0 to 89·3) 1·0 ( 0·9 to 1·6) 92·3% ( 88·4 to 93·0) 3·2 ( 2·7 to 3·8) 77·5% ( 70·8 to 79·7) 4·5 ( 4·5 to 5·0) 65·3% ( 64·3 to 65·6) 21201·3 ( 1·3 to 1·9) 89·5% ( 86·6 to 89·9) 0·3 ( 0·3 to 0·7) 97·9% ( 95·0 to 98·0) 0·2 ( 0·2 to 0·5) 98·6% ( 96·5 to 98·6) 1·3 ( 1·3 to 1·8) 89·7% ( 86·9 to 89·9) 1·3 ( 0·7 to 1·5) 89·9% ( 89·2 to 94·6) Women aged 30–69 years * Note that relative reductions in premature mortality are very similar if using the probability of dying between the ages of 30 and 70 years as a measure ( appendix pp 8–10). ( premature mortality) 203023·7 ( 23·0 to 25·5) 0·2% ( 0·0 to 0·5) 15·2 ( 14·8 to 20·0) 34·2% ( 22·1 to 37·4) 15·2 ( 14·7 to 19·4) 33·9% ( 24·4 to 37·9) 23·6 ( 23·1 to 25·3) 0·1% ( −0·2 to 1·4) 23·7 ( 23·3 to 25·6) 0·0% ( −0·8 to 0·1) 20705·5 ( 5·1 to 6·2) 76·1% ( 75·7 to 78·5) 1·3 ( 1·2 to 2·3) 94·4% ( 91·1 to 94·6) 0·9 ( 0·8 to 1·4) 96·2% ( 94·3 to 96·8) 3·3 ( 3·1 to 3·9) 85·9% ( 84·9 to 86·8) 5·2 ( 4·4 to 5·4) 78·9% ( 77·9 to 81·0) 21202·4 ( 2·1 to 3·4) 89·9% ( 86·6 to 91·1) 0·5 ( 0·4 to 1·2) 98·0% ( 95·5 to 98·3) 0·3 ( 0·3 to 0·8) 98·6% ( 96·9 to 98·8) 2·4 ( 2·0 to 3·4) 89·9% ( 86·8 to 91·2) 2·4 ( 0·9 to 2·8) 89·9% ( 89·2 to 96·2) Results shown represent age-standardised rates per 100 000 women for a given year, and relative reductions are compared to the status quo ( S0) in that year. Results represent the median ( range) of estimates across all three models. Detailed results for each decade are provided in the appendix ( pp 8–10). S0=status quo ( no scale-up of vaccination, screening, or treatment). S1=female-only vaccination. S2=female-only vaccination and once-lifetime HPV testing at age 35 years and treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years and treatment scale-up. Supplementary S4=female-only vaccination with multi-age cohort catch-up to 25 years in 2020. Supplementary S5=vaccination of girls and boys at age 9 years. All vaccination strategies assume the use of a broad-spectrum HPV vaccine with protection against the seven oncogenic types: 16, 18, 31, 33, 45, 52, and 58. Population projections were obtained from the UN and further projected out to 2120 appendix pp 46–49. Model methods incorporate randomness and heterogeneity in estimates, which can occasionally, over shorter term timeframes, lead to relative increases rather than decreases in rates compared to the status quo, shown here as negative values. Randomness and heterogeneity can also lead to slight decreases in the percentage reduction in predicted rates even in the first year modelled ( 2020) and small differences from the expected relative ordering of the impact of different scenarios or the expected relative reductions over time. Caution should be applied in interpreting comparative differences between the values in this table, which represent the median and range across models; any individual median result could represent the findings of any one of the WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC) models. * Note that relative reductions in premature mortality are very similar if using the probability of dying between the ages of 30 and 70 years as a measure ( appendix pp 8–10). Open table in a new tab
The solid lines represent the median outcome of the three models; the shading represents the range of model outputs. HPV=human papillomavirus. LMICs=low-income and lower-middle-income countries. S0=status quo ( no scale-up of vaccination, screening or treatment). S1=female-only vaccination at 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.
Results shown represent age-standardised rates per 100 000 women for a given year, and relative reductions are compared to the status quo ( S0) in that year. Results represent the median ( range) of estimates across all three models. Detailed results for each decade are provided in the appendix ( pp 8–10). S0=status quo ( no scale-up of vaccination, screening, or treatment). S1=female-only vaccination. S2=female-only vaccination and once-lifetime HPV testing at age 35 years and treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years and treatment scale-up. Supplementary S4=female-only vaccination with multi-age cohort catch-up to 25 years in 2020. Supplementary S5=vaccination of girls and boys at age 9 years. All vaccination strategies assume the use of a broad-spectrum HPV vaccine with protection against the seven oncogenic types: 16, 18, 31, 33, 45, 52, and 58. Population projections were obtained from the UN and further projected out to 2120 appendix pp 46–49. Model methods incorporate randomness and heterogeneity in estimates, which can occasionally, over shorter term timeframes, lead to relative increases rather than decreases in rates compared to the status quo, shown here as negative values. Randomness and heterogeneity can also lead to slight decreases in the percentage reduction in predicted rates even in the first year modelled ( 2020) and small differences from the expected relative ordering of the impact of different scenarios or the expected relative reductions over time. Caution should be applied in interpreting comparative differences between the values in this table, which represent the median and range across models; any individual median result could represent the findings of any one of the WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC) models.
Figure 2A depicts annual cervical cancer deaths over time and figure 2B provides information about the cumulative cervical cancer deaths averted. Table 3 summarises these findings for the cumulative deaths and deaths averted over the periods 2020–2030, 2020–2070, and 2020–2120, for all core and supplementary scenarios.Figure 2Projected cervical cancer deaths across all 78 low-income and lower-middle-income countriesShow full caption ( A) Annual cervical cancer deaths. ( B) Cumulative cervical cancer deaths averted. The solid lines in panel A represent the median of the three models and the shading represents the range of the model outputs. In panel B the column height represents the median of the three models and the error bars represent the range of the three models. HPV=human papillomavirus. S0=status quo ( no scale-up of vaccination, screening, or treatment). S1=female-only vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at age 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.View Large Image Figure ViewerDownload Hi-res image Download ( PPT) Table 3Estimated cervical cancer deaths and deaths averted ( in millions) from 2020 to 2030, 2020 to 2070, and 2020 to 2120S0: status quoS1: girls-only vaccinationS2: girls-only vaccination, once-lifetime screening, and cancer treatment scale-upS3: girls-only vaccination, twice-lifetime screening, and cancer treatment scale-upSupplementary S4: girls-only vaccination plus multi-age catch-up to age 25 yearsSupplementary S5: vaccination of girls and boysCumulative deaths by 2030 ( 2020–2030) 2·5 ( 2·5–2·7) 2·5 ( 2·5–2·7) 2·2 ( 2·2–2·4) 2·2 ( 2·2–2·4) 2·5 ( 2·5–2·7) 2·5 ( 2·5–2·7) Deaths averted.. 0·0 ( 0·0–0·0) * Note that table entry is zero due to rounding. Actual median and range of estimates for deaths averted: 620 ( −1100 to 3600) deaths ( model methods incorporate randomness and heterogeneity in estimates, which can occasionally, over shorter-term timeframes, lead to relative increases rather than decreases in rates compared to the status quo, shown here as a negative value).0·3 ( 0·3–0·3) 0·3 ( 0·3–0·4) 0·0 ( 0·0–0·0) 0·0 ( 0·0–0·0) Reduction vs S0 (%).. 0% ( 0–0) * Note that table entry is zero due to rounding. Actual median and range of estimates for deaths averted: 620 ( −1100 to 3600) deaths ( model methods incorporate randomness and heterogeneity in estimates, which can occasionally, over shorter-term timeframes, lead to relative increases rather than decreases in rates compared to the status quo, shown here as a negative value).12% ( 11–12) 12% ( 10–13) 0% ( 0–1) 0% ( 0–0) Cumulative deaths by 2070 ( 2020–2070) 20·7 ( 20·4–22·0) 16·3 ( 15·9–17·1) 7·1 ( 7·1–8·8) 6·4 ( 6·1–7·4) 13·5 ( 13·4–14·8) 16·0 ( 15·9–16·9) Deaths averted.. 4·8 ( 4·1–4·8) 13·3 ( 13·1–13·6) 14·6 ( 14·1–14·6) 7·3 ( 5·6–8·5) 4·8 ( 4·4–5·1) Reduction vs S0 (%).. 22% ( 20–23) 65% ( 60–66) 69% ( 66–71) 35% ( 27–39) 23% ( 22–23) Cumulative deaths by 2120 ( 2020–2120) 70·1 ( 69·7–73·0) 25·1 ( 23·7–27·1) 8·9 ( 8·9–12·8) 7·6 ( 7·3–10·3) 21·5 ( 19·7–22·5) 23·8 ( 22·4–25·5) Deaths averted.. 45·8 ( 44·7–46·4) 60·8 ( 60·2–61·2) 62·6 ( 62·1–62·8) 50·5 ( 47·2–51·4) 47·3 ( 46·3–47·5) Reduction vs S0 (%).. 64% ( 63–66) 87% ( 82–87) 89% ( 86–90) 70% ( 68–72) 66% ( 65–68) Cumulative cervical cancer deaths ( in millions) across all 78 low-income and lower-middle-income countries over three time periods are shown. The values show the median ( range) of three model outputs. All relative reductions are compared to the status quo ( S0) predictions in the same year. HPV=human papillomavirus. S0=status quo ( no scale-up of vaccination, screening, or treatment). S1=female-only vaccination at 9 years with multi-age cohort catch-up to 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years and treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years and treatment scale-up. Supplementary S4=female-only vaccination with multi-age cohort catch-up to 25 years in 2020. Supplementary S5=vaccination of girls and boys at age 9 years, with multi-age catch-up to 14 years in 2020. All vaccination strategies assume the use of a broad-spectrum HPV vaccine with protection against the seven oncogenic types: 16, 18, 31, 33, 45, 52, and 58. Population projections were obtained from the UN and further projected out to 2120 ( appendix pp 48–49). The median for deaths is the median of three possible model outputs for a given time period, and might use results from different models at different periods; similarly, the median for deaths averted and percentage reduction versus S0 is the median model for these metrics independently, and might be different to the median model selected for total deaths metric, and might also be different across the different periods. Caution should be applied in interpreting comparative differences between the values in this table, which represent the median and range across models; any individual median result could represent the findings of any one of the Cervical Cancer Elimination Modelling Consortium models. Note that the sum of averted cases and cases predicted for a given strategy might also not be identical to cases predicted for S0 because of rounding. * Note that table entry is zero due to rounding. Actual median and range of estimates for deaths averted: 620 ( −1100 to 3600) deaths ( model methods incorporate randomness and heterogeneity in estimates, which can occasionally, over shorter-term timeframes, lead to relative increases rather than decreases in rates compared to the status quo, shown here as a negative value). Open table in a new tab
( A) Annual cervical cancer deaths. ( B) Cumulative cervical cancer deaths averted. The solid lines in panel A represent the median of the three models and the shading represents the range of the model outputs. In panel B the column height represents the median of the three models and the error bars represent the range of the three models. HPV=human papillomavirus. S0=status quo ( no scale-up of vaccination, screening, or treatment). S1=female-only vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at age 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.
Cumulative cervical cancer deaths ( in millions) across all 78 low-income and lower-middle-income countries over three time periods are shown. The values show the median ( range) of three model outputs. All relative reductions are compared to the status quo ( S0) predictions in the same year. HPV=human papillomavirus. S0=status quo ( no scale-up of vaccination, screening, or treatment). S1=female-only vaccination at 9 years with multi-age cohort catch-up to 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years and treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years and treatment scale-up. Supplementary S4=female-only vaccination with multi-age cohort catch-up to 25 years in 2020. Supplementary S5=vaccination of girls and boys at age 9 years, with multi-age catch-up to 14 years in 2020. All vaccination strategies assume the use of a broad-spectrum HPV vaccine with protection against the seven oncogenic types: 16, 18, 31, 33, 45, 52, and 58. Population projections were obtained from the UN and further projected out to 2120 ( appendix pp 48–49). The median for deaths is the median of three possible model outputs for a given time period, and might use results from different models at different periods; similarly, the median for deaths averted and percentage reduction versus S0 is the median model for these metrics independently, and might be different to the median model selected for total deaths metric, and might also be different across the different periods. Caution should be applied in interpreting comparative differences between the values in this table, which represent the median and range across models; any individual median result could represent the findings of any one of the Cervical Cancer Elimination Modelling Consortium models. Note that the sum of averted cases and cases predicted for a given strategy might also not be identical to cases predicted for S0 because of rounding.
In 2020, the predicted age-standardised rate for cervical cancer mortality across all 78 LMICs was 13·2 ( range 12·9–14·1) per 100 000 women. By 2030, vaccine-only strategies would have minimal impact on cervical cancer mortality, which would remain at 13·2 ( 12·9–14·0) deaths per 100 000 women, corresponding to a 0·1% ( 0·1–0·5) reduction, averting a median of 620 deaths across all 78 LMICs by 2030 ( rounded to 0·0 million in table 3). However, scaling up twice-lifetime cancer screening and treatment in addition to vaccination would result in a mortality rate of 8·5 ( 8·2–10·8) by 2030, corresponding to a 34·2% ( 23·3–37·8) reduction, averting 300 000 ( 300 000–400 000) deaths, mainly due to the impact of improved access to cancer treatment. In this 10-year timeframe, vaccination plus once-lifetime screening or twice-lifetime screening and treatment scale-up would lead to similar mortality reductions. For further information about the relative contribution of the interventions, see the appendix ( pp 33–40).
By 2070, girls-only vaccination would lead to a mortality rate of 5·0 ( range 4·5–5·4) per 100 000 women, corresponding to a reduction of 61·7% ( 61·4–66·1), averting 4·8 million ( 4·1–4·8) deaths, but scaling up once-lifetime screening and treatment in addition to vaccination would result in a rate of 1·4 ( 1·4–2·2) per 100 000 women, corresponding to a reduction of 88·9% ( 84·0–89·3), averting 13·3 million ( 13·1–13·6) deaths. By 2070, girls-only vaccination, twice-lifetime screening, and treatment would result in a mortality rate of 1·0 ( 0·9–1·6) per 100 000 women, corresponding to a reduction of 92·3% ( 88·4–93·0), averting 14·6 million ( 14·1–14·6) deaths. Compared to girls-only vaccination with catch-up to age 14 years ( S1), extended-multi-age cohort vaccination to 25 years ( S4) would result in increased intermediate-term mortality benefits, bringing forward the benefits of vaccination by about a decade ( figure 1). At the high levels of vaccination coverage for girls assumed in the analysis, additional vaccination of boys at age 9 years ( S5) would have minimal additional impact on cervical cancer mortality in women over the next 50 years and would have similar intermediate-term benefits to girls-only vaccination by 2070 ( figure 1, figure 3, table 2).Figure 3Age-standardised cervical cancer mortality over time for LMICs in each regionShow full captionThe solid lines represent the median outcome of the three models; the shading represents the range of model outputs. HPV=human papillomavirus. LMICs=low-income and lower-middle-income countries. S0=status quo ( no scale-up of vaccination, screening or treatment). S1=female-only vaccination at 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
The solid lines represent the median outcome of the three models; the shading represents the range of model outputs. HPV=human papillomavirus. LMICs=low-income and lower-middle-income countries. S0=status quo ( no scale-up of vaccination, screening or treatment). S1=female-only vaccination at 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.
By 2120, girls-only vaccination would result in a mortality rate of 1·3 ( range 1·3–1·9) per 100 000 women, corresponding to a mortality reduction of 89·5% ( 86·6–89·9), averting 45·8 million ( 44·7–46·4) deaths. By 2120, a mortality rate of 0·2 ( 0·2–0·5) per 100 000 women, corresponding to a reduction of 98·6% ( 96·5–98·6), would be achievable with the WHO triple-intervention strategy, averting 62·6 million ( 62·1–62·8) deaths. If screening were done once per lifetime instead of twice, 60·8 million ( 60·2–61·2) deaths would be averted over the same period. The specific estimate for the incremental benefit of the twice-lifetime versus once-lifetime screening package over this period was 1·6 million ( 1·3–2·5) additional deaths averted, with most of these additional deaths averted before 2070. Compared to girls-only vaccination alone, 16·8 million ( 16·4–17·4) additional deaths would be averted via the triple-intervention strategy by 2120.
In terms of premature mortality outcomes ( deaths at age 30–69 years), the triple-intervention strategy would result in rate reductions of 33·9% ( range 24·4–37·9) by 2030, 96·2% ( 94·3–96·8) by 2070, and 98·6% ( 96·9–98·8) by 2120 ( table 2).
Figure 3 shows the regional results across the models for the reduction in age-standardised mortality from 2020 to 2120. The highest mortality rates in 2020, at approximately 30 per 100 000 women, are in sub-Saharan Africa, followed by Latin America and the Caribbean ( approximately 16 per 100 000 women). These regions are predicted to have the greatest absolute reductions in mortality rates over the next two decades if the triple-intervention strategy can be successfully scaled up; by 2040, cervical cancer mortality in sub-Saharan Africa could be reduced by more than two-thirds to less than ten per 100 000 women, and in Latin America and the Caribbean it could be reduced to approximately six per 100 000 women. Details about the age-specific cervical cancer incidence and mortality rates in 2020, 2070, and 2120 for each region are provided in the appendix ( pp 11–25).
With the WHO triple-intervention strategy, over the next 10 years, about half ( 48% [ range 45–55 ]) of deaths averted would be in sub-Saharan Africa and almost a third ( 32% [ 29–34 ]) would be in South Asia ( including India); over the next century, almost 90% of deaths averted would be in these regions ( appendix p 26).
The appendix ( pp 27–32) provides information at the country level for the predicted impact of the WHO triple-intervention strategy. In all countries, the median estimates of mortality rates by 2120 approach 1 per 100 000 women or lower.
The findings for model-specific, explanatory, and sensitivity analyses are provided in the appendix ( pp 11–25, 33–43). Overall, the findings were concordant between models. The only notable difference was in the level of herd immunity predicted at older ages for unvaccinated individuals, which probably relate to underlying differences in assumptions around assortative sexual mixing among different age groups and different behaviour groups; we consider that the model variation in this area provides a useful reflection of true uncertainty in outcomes. The explanatory results demonstrated that the main benefits by 2030 were via cancer treatment scale-up, and that screening would lead to substantial mortality reductions beyond those conferred by vaccination and cancer treatment scale-up from 2030 to 2070–80. The results of the sensitivity analysis show that the choice of standard population is an important driver for rate estimates and also showed that, for deaths averted, differences between individual model estimates were much smaller than the unavoidable uncertainties in future population projections over the next century.
In this analysis, we have quantified, for the first time, the number of women's lives that could be saved by the successful implementation of the WHO global strategy for cervical cancer elimination. This report complements our parallel analysis on cervical cancer incidence.15Brisson M Kim JJ Canfell K et al.Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30068-4Summary Full Text Full Text PDF PubMed Scopus ( 97) Google Scholar Importantly, by extending the analysis to encompass mortality outcomes, we have quantified the impact of scaling up cancer treatment. Taken together, these two modelling analyses show that successful implementation of the WHO 90–70–90 triple-intervention strategy by 2030 would reduce cervical cancer incidence to 0·7 ( 0·6–1·6) per 100 000 women15Brisson M Kim JJ Canfell K et al.Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30068-4Summary Full Text Full Text PDF PubMed Scopus ( 97) Google Scholar and mortality to 0·2 ( 0·2–0·5) per 100 000 women across all 78 LMICs by 2120. This outcome, which is only achievable through a multi-sectoral and integrated approach across the continuum of cancer care, would represent extraordinary reductions in cervical cancer incidence ( 97% reduction) and mortality ( 99% reduction). Consequently, around 74·1 million cervical cancer cases and 62·6 million deaths would be averted, representing an enormous gain in terms of both quality of life and lives saved.
A major strength of this study is that we used a comparative approach involving well established model platforms that have been previously validated with data from multiple countries and that have jointly informed many national vaccination and cervical screening policy decisions. Predictions from the three models were broadly consistent for all scenarios, even over a century-long projection period. Our results for vaccination-only strategies are generally consistent with a recent analysis of the shorter-term impact on likely radiotherapy demand in LMICs,26Rodin D Burger EA Atun R et al.Scale-up of radiotherapy for cervical cancer in the era of human papillomavirus vaccination in low-income and middle-income countries: a model-based analysis of need and economic impact.Lancet Oncol. 2019; 20: 915-923Summary Full Text Full Text PDF PubMed Scopus ( 15) Google Scholar which estimated that bivalent HPV vaccination of girls aged 12 years would only result in a 3·9% reduction in incident cervical cancer cases from 2015 to 2035. In line with our findings, the analysis found that incremental scale-up of radiotherapy in LMICs in the shorter term ( up to 2035) would yield substantial health gains. Our sensitivity analysis demonstrated that for deaths averted, the variations generated by the differences in models were much smaller than uncertainties due to population size and structure over the next century. The sensitivity analysis also demonstrated that rates are somewhat sensitive to the choice of standard population used; this emphasises the importance of using the 2015 World Female Population for calculating cervical cancer incidence and mortality rates for comparability with our findings and across countries.
There were also some limitations to our analysis. The quality and availability of data about access to cancer treatment services, effective delivery of treatment, stage-distribution at diagnosis, and survival are variable for LMICs. Our modelling of survival was based on the latest data from major WHO reviews and we used updated DIRAC radiotherapy machine density as a surrogate for radiotherapy capacity and treatment access; this approach is reflective of the importance of radiotherapy as a cornerstone of effective treatment for cervical cancer and in line with the approach used by recently published models and the 2015 Lancet Oncology Commission on expanding global access to radiotherapy.26Rodin D Burger EA Atun R et al.Scale-up of radiotherapy for cervical cancer in the era of human papillomavirus vaccination in low-income and middle-income countries: a model-based analysis of need and economic impact.Lancet Oncol. 2019; 20: 915-923Summary Full Text Full Text PDF PubMed Scopus ( 15) Google Scholar, 27Atun R Jaffray DA Barton MB et al.Expanding global access to radiotherapy.Lancet Oncol. 2015; 16: 1153-1186Summary Full Text Full Text PDF PubMed Scopus ( 380) Google Scholar Furthermore, each modelling group independently did country-level model calibration of stage-specific survival to the best available mortality estimates from GLOBOCAN 2018. We incorporated a calibrated quality factor into the final estimated country-specific and stage-specific survival assumptions, which encompasses data limitations in treatment delivery information as well as variations in treatment delivery from established protocols and recommendations, equipment and infrastructure maintenance and logistics, and treatment abandonment due to financial stress or for other reasons. We did not take into account treatment improvements over time, assuming that mortality benefits resulting from cancer treatment scale-up by 2030 will be only due to the delivery of existing, effective treatment modalities, and not to emerging or hypothetical improvements in treatment beyond what is proven to be effective on a large scale in health services in high-income countries today.
Another limitation is that we did not explicitly model HPV infection, precancer and cervical cancer in women living with HIV. Increased progression to precancer and invasive cancer and reduced clearance of HPV is known to occur in women living with HIV, and this group is at increased risk of developing invasive cervical cancer, although this risk might now be partly or largely countered by the beneficial effects of antiretroviral therapy in many settings.28Liu G Sharma M Tan N Barnabas RV HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer.AIDS. 2018; 32: 795-808Crossref PubMed Scopus ( 78) Google Scholar, 29Travassos AG Netto E Xavier-Souza E et al.Predictors of HPV incidence and clearance in a cohort of Brazilian HIV-infected women.PLoS One. 2017; 12e0185423Crossref PubMed Scopus ( 12) Google Scholar A separate collaborative group sponsored and coordinated by WHO is analysing the effects of HIV burden on estimates of cervical cancer elimination timing in selected countries. Current WHO cervical screening recommendations specify more frequent screening in women living with HIV,30WHOComprehensive cervical cancer control: a guide to essential practice.2nd edn. World Health Organization, Geneva2014Google Scholar and thus the mortality benefits we predicted are likely to depend on successful implementation of more intensive strategies for screening in high HIV-burden settings.
We did not include vaccination of boys or adult women in our core scenarios, because neither strategy has been found to be universally cost-effective even in high-income countries, and neither approach is recommended as part of the draft WHO elimination strategy. WHO's Strategic Advisory Group of Experts on Immunisation ( SAGE) has recommended that vaccinating boys or older women should be delayed until current vaccine supply constraints are alleviated.31WHOMeeting of the Strategic Advisory Group of Experts on Immunization, October 2019: conclusions and recommendations.Wkly Epidemiol Rec. 2019; 94: 541-560Google Scholar Priority should be given to vaccination of young girls since this strategy will generate the greatest health benefits overall; boys will derive protection via herd immunity if high-coverage vaccination can be achieved in girls, and older women will be offered protection via scale-up of screening and treatment services. In this analysis, we did not explicitly consider cost-effectiveness, although previous work has shown the cost-effectiveness of combined vaccination and cervical screening approaches in various upper-middle-income countries and LMICs.32Campos NG Sharma M Clark A et al.The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries.Int J Gynaecol Obstet. 2017; 138: 47-56Crossref PubMed Scopus ( 24) Google Scholar, 33Canfell K Shi JF Lew JB et al.Prevention of cervical cancer in rural China: evaluation of HPV vaccination and primary HPV screening strategies.Vaccine. 2011; 29: 2487-2494Crossref PubMed Scopus ( 60) Google Scholar Cost-effectiveness will be required to weigh the trade-offs of the different strategies assessed here, including the incremental costs and benefits of vaccinating boys and doing two cervical screening tests instead of one in a lifetime. We found that the additional benefit of twice-lifetime versus once-lifetime screening was 1·6 million more deaths averted over a century, but the differences in cases averted is much higher.15Brisson M Kim JJ Canfell K et al.Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30068-4Summary Full Text Full Text PDF PubMed Scopus ( 97) Google Scholar Thus, the incremental improvement in quality of life from including a second screen is likely to be substantial. Furthermore, our findings for screening are in the context of rapid and effective scale-up of cancer treatment. If cancer treatment is not as broadly available as we assumed, the incremental benefits of additional cancer prevention via increasing screening to two tests in a lifetime would be larger. Finally, the incremental benefits of a second screen are higher when considered over the next 50 years rather than 100 years, because if vaccination is scaled up successfully then screening will provide the most benefit in the next 50–60 years. In the future, it will be important to assess the potential for future de-intensification of cervical screening, since our findings suggest that this could be considered in some countries after about 2070–80, when the full benefits of vaccination for mortality outcomes are becoming realised. The ongoing work of the CCEMC is focused on more detailed analysis of the incremental benefits of the strategies and on quantifying cost-effectiveness for the 78 LMICs; we are also analysing a larger number of more nuanced alternative scenarios at a country level, including optimal triage policy. In general terms, more detailed country-level analyses, taking into account specific local factors important for the effective delivery of vaccination and screening interventions, will continue to be required, and should be viewed as an important complement to the current large-scale analysis.
The WHO scale-up targets for elimination can be considered aspirational. Many challenges will need to be overcome, including vaccine and screening test supply and delivery challenges, and the infrastructure challenges associated with scale-up of invasive cancer diagnostics, treatment, and supportive and palliative care services. If scale-up is achieved more slowly than we have assumed, then reductions in mortality will be correspondingly delayed. With respect to HPV vaccination, the assumed scaled up 90% coverage rate is broadly in line with data suggesting that global coverage of other vaccines in LMICs ( including measles, poliomyelitis, hepatitis B and diphtheria-tetanus-pertussis) is 84–90%.34WHOGlobal Health Observatory ( GHO) data.https: //www.who.int/gho/immunization/en/Date accessed: December 19, 2019Google Scholar Our analysis for screening broadly applies to a wide range of clinically validated HPV tests that can achieve benchmark sensitivity and specificity. Testing could be done either at a central laboratory or in a point of care environment, with clinician-collected or self-collected samples; the sensitivity of PCR-based self-collected tests has been shown to be comparable to that of clinician-collected samples.35Arbyn M Smith SB Temin S Sultana F Castle P Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses.BMJ. 2018; 363k4823Crossref PubMed Scopus ( 152) Google Scholar In principle, our findings also apply to any future screening test with similar performance to that of primary HPV testing. For example, machine learning approaches for analysing digitised cervical images hold promise in some settings.36Hu L Bell D Antani S et al.An observational study of deep learning and automated evaluation of cervical images for cancer screening.J Natl Cancer Inst. 2019; 111: 923-932Crossref PubMed Scopus ( 96) Google Scholar Our modelling of screening assumed that the majority ( 90%) of HPV-positive women were treated, with visual assessment for treatment done only to exclude the possibility of a frank cancer or a large precancerous lesion ( which would require referral). Therefore, our findings for the impact of the cervical screening and referral pathway are likely to represent the maximum attainable benefit. In practice, resource-stratified guidelines recommend different approaches in different settings and, where possible, women are triaged to treatment to minimise the potential harms, which include psychosocial impact, potential overtreatment, and a possible impact on obstetric outcomes. WHO is revising its guidelines for cervical screening and has already revised its guidelines for precancer treatment to take into account the latest evidence and the elimination strategy.30WHOComprehensive cervical cancer control: a guide to essential practice.2nd edn. World Health Organization, Geneva2014Google Scholar, 37WHOWHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. World Health Organization, Geneva2019Google Scholar
One of our main findings is that although achieving cervical cancer elimination per se will take many decades, the benefits of scaling up to the WHO elimination coverage targets will start to be realised within a decade. Key to this insight is an understanding of the timing of the effects of each intervention. Over the next 10–20 years, scaling up cancer treatment services will have the greatest impact because thousands of women in LMICs are being diagnosed every year with cervical cancer but have no access to adequate treatment. With appropriate treatment, survival prospects for early-stage and locally advanced cervical cancer are high. As a linked issue, offering appropriate palliative care to women who require it is an ethical and moral imperative. Over the intermediate term ( the next 50–60 years), cervical screening will make an important contribution to outcomes, and over the longer term the full benefits of vaccination will be realised. The realisation of the major benefits of screening and vaccination over the intermediate and longer term will, however, require immediate action to implement these initiatives.
Scaling up to national vaccination, screening, and cancer treatment services in LMICs will be greatly facilitated by the successful realisation of universal health coverage in countries ( SDG target 3.8). The 2019 Political Declaration of the UN high-level meeting on universal health coverage reaffirmed that health is a precondition for, and an outcome and indicator of, all dimensions of sustainable development, and countries strongly recommitted to achieving universal health coverage by 2030.38UNPolitical declaration of the high-level meeting on universal health coverage: “ universal health coverage: moving together to build a healthier world ”.https: //www.un.org/pga/73/wp-content/uploads/sites/53/2019/05/UHC-Political-Declaration-zero-draft.pdfDate: Sept 23, 2019Date accessed: November 15, 2019Google Scholar Building resilient and sustainable health systems could also be facilitated by the cervical cancer elimination initiative.39Union for International Cancer ControlCancer and universal health coverage. World Cancer Leaders ' Summit 2019 report. Nur-Sultan ( Astana), Kazakhstan.https: //www.uicc.org/what-we-do/convening/world-cancer-leaders-summit/2019-world-cancer-leaders-summitDate: Oct 15–17, 2019Date accessed: January 21, 2019Google Scholar For example, cervical screening initiatives might be able to support or build on HIV services, since women receiving antiretroviral therapy return for refills regularly. Opportunities exist to link screening with sexual and reproductive health services, potentially increasing both uptake of screening and of contraception services. The elimination initiative could assist with building cancer literacy and addressing stigma in communities, and scaling up treatment as well as supportive and palliative care services for cervical cancer should have positive implications for various other tumour types. Access to universal health coverage will be a key underlying factor for the achievement of SDG goal 3.4, to reduce premature mortality from non-communicable diseases by a third by 2030. We have shown that, when considered at a level across all 78 LMICs, the cervical cancer elimination initiative will specifically support efforts to achieve this target. More broadly, the elimination agenda will support a reduction in poverty ( SGD1), an increase in gender equality ( SDG5), and reduction in inequalities ( SDG10). Thus, successful implementation of the elimination initiative will have both nearer-term and enduring positive consequences, not only for women but also for their families and broader society.
In conclusion, these findings emphasise the importance of acting now on three fronts to scale up HPV vaccination, screening, and treatment for cervical cancer. In the next 10 years, achieving substantial reductions in cervical cancer mortality will depend on successful scale-up of cancer treatment services in LMICs, and supportive and palliative care will need to be scaled up alongside such services. Implementing the WHO strategy towards cervical cancer elimination will result in large-scale mortality reductions and more than 62 million women's lives saved over the next century in LMICs. These findings have informed the draft WHO global strategy for cervical cancer elimination, which will be presented to the WHO Executive Board in February, 2020, and thereafter considered at the World Health Assembly in May, 2020.
KC, JJK, and MB co-designed the study and co-led overall data interpretation. KC led the Policy1-Cervix analysis, JJK led the Harvard analysis, and MB led the HPV-ADVISE analysis. AK, KTS, MC, EAB, JT, FB, NB, and RH also participated in study design. AI, DT, EF, NB, and RH led the systematic review and analysis of cancer treatment access and survival in LMICs. KC, JJK, MB, MC, AK, DTNN, KTS, EAB, CR, SS, MD, GG, DM, EB, J-FL, AI, DT, EF, and FB participated in data collection. KC, JJK, MB, AK, KTS, MC, EAB, DM, DTNN, EB, SS, CR, MD, GG, J-FL, MAS, EF, DT, AI, and FB participated in data analysis. MC, AK, DTNN, KTS, and KC produced the tables and figures. KC, JJK, and MB drafted the Article and RH coordinated the CCEMC. All authors interpreted the results and critically revised the manuscript for scientific content. All authors approved the final version of the Article.
KC, AK, KTS, MC, DTNN, and MAS report grants from the National Health and Medical Research Council Australia during the conduct of the study. KC and MC are investigators of an investigator-initiated trial of cervical screening in Australia ( Compass; ACTRN12613001207707 and NCT02328872), which is conducted and funded by the VCS Foundation, a government-funded health promotion charity; the VCS Foundation received equipment and a funding contribution from Roche Molecular Systems and Ventana USA but KC and MC ( or their institution on their behalf) do not receive direct funding from industry for this trial or any other project. MAS also reports grants from Cancer Institute NSW during the conduct of the study. JJK, MB, EAB, MD, GG, DM, EB, J-FL, SS, and CR report grants from WHO during the conduct of the study. JT, EF, DT, FB, AI, NB, and RH declare no competing interests.
We acknowledge May Abdel-Wahab and Jose Alfredo Polo Rubio from the Division of Human Health of the International Atomic Energy Agency for providing updated DIRAC data, which have been used to estimate cervical cancer treatment access rates in this study. Where authors are identified as personnel of WHO or the International Agency for Research on Cancer, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of WHO or the International Agency for Research on Cancer.
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Cervical cancer elimination: are targets useful? Cervical cancer is the most common cause of cancer-related deaths in women in 42 low-income and lower-middle-income countries ( LMICs),1 with the highest age-standardised incidence rates ( 40 cases per 100 000 women-years) occurring in 15 countries in sub-Saharan Africa.2 The gross disparity of the burden of this highly preventable disease, whereby 290 000 ( 51%) of the 570 000 new cases estimated to occur annually befall women in LMICs,1 has led many people to call attention to the need for urgent action. Full-Text PDF Department of ErrorHuang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; published online Jan 24. https: //doi.org/10.1016/S0140-6736 ( 20) 30183-5—In this Article, in Procedures, we have corrected the primer sequences for targeting the envelope gene of coronavirus; in the Summary and Data collection, we have corrected the text to reflect that the modified case record form for severe acute respiratory infection clinical characterisation was developed by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium ( ISARIC) together; we have updated the margin link to the ISARIC–WHO case record form; we have updated the Acknowledgments; and in the tables, we updated p values ( three in table 2 and one each in tables 1 and 3) so that they are all given to two significant figures. Full-Text PDF | tech |
' I 'm more useful here ': French doctor stays put in virus-hit Wuhan | Hi, what are you looking for?
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France is preparing to airlift hundreds of its citizens from the Chinese city at the centre of a deadly coronavirus outbreak, but one Frenchman is staying put.
Philippe Klein is head of the International SOS Hospital in Wuhan, the first city to be locked down by Chinese authorities as they battle the spread of the virus.
`` It's not an act of heroism. It's been well thought out, it's my job, '' Klein said of his decision to stay.
`` I think I 'll be much more useful here than in France. ''
The new coronavirus has killed 170 people so far in mainland China, with thousands infected across the country. The virus has been detected in more than a dozen other countries, including as far away as the United States and Canada.
Klein told AFP he wants to help the local French community. Some 500 French nationals are registered with the nation's consulate in Wuhan.
French auto giant PSA and Renault have factories in the city, and the local universities run exchange programmes with institutions in France.
Not all French nationals are leaving -- some for professional or family reasons, and others do not want to spend 14 days in quarantine upon their return to France.
But Klein, a father of four who has been based in China for six years, recommends they do leave.
`` The concern now is that the Chinese hospitals are currently one hundred percent mobilised in controlling this coronavirus epidemic, so there are lots of ways humans could contract other infections or diseases, '' the Metz native said.
`` It would therefore not be appropriate at this time to go to a Chinese hospital under these circumstances. That's why I strongly recommend the French people in Wuhan go back to France. ''
The coronavirus has sparked fear of a wider, global outbreak. In addition to controlling the flow of people from affected areas in China, face masks have also been made mandatory in many areas, including Wuhan.
Many stores in big cities like Beijing have run out of stock in recent days.
But Klein suggests keeping the outbreak in perspective.
He says it's important to remember that the flu `` can kill up to 550,000 people on the planet in one season '' in normal times.
`` I wear the mask regularly when I go out. It's an obligation imposed by the local authorities, so everyone here in Wuhan is wearing a mask, '' he said.
But it is mostly sick people who need to wear the mask, `` so that they don't spread the virus ''.
`` Psychologically, it's an interesting thing, wearing a mask. Of course, it's reassuring and it probably stops you from putting your hands up to your mouth, '' he added.
`` The most important thing is to have good hygiene and wash your hands frequently. ''
For Klein, staying in China is his job, and what he has been trained to do.
`` I am a virus tamer, '' he says, and staying in China, it is `` as if I was with a lion in its cage ''.
France is preparing to airlift hundreds of its citizens from the Chinese city at the centre of a deadly coronavirus outbreak, but one Frenchman is staying put.
Philippe Klein is head of the International SOS Hospital in Wuhan, the first city to be locked down by Chinese authorities as they battle the spread of the virus.
“ It’ s not an act of heroism. It’ s been well thought out, it’ s my job, ” Klein said of his decision to stay.
“ I think I’ ll be much more useful here than in France. ”
The new coronavirus has killed 170 people so far in mainland China, with thousands infected across the country. The virus has been detected in more than a dozen other countries, including as far away as the United States and Canada.
Klein told AFP he wants to help the local French community. Some 500 French nationals are registered with the nation’ s consulate in Wuhan.
French auto giant PSA and Renault have factories in the city, and the local universities run exchange programmes with institutions in France.
Not all French nationals are leaving — some for professional or family reasons, and others do not want to spend 14 days in quarantine upon their return to France.
But Klein, a father of four who has been based in China for six years, recommends they do leave.
“ The concern now is that the Chinese hospitals are currently one hundred percent mobilised in controlling this coronavirus epidemic, so there are lots of ways humans could contract other infections or diseases, ” the Metz native said.
“ It would therefore not be appropriate at this time to go to a Chinese hospital under these circumstances. That’ s why I strongly recommend the French people in Wuhan go back to France. ”
The coronavirus has sparked fear of a wider, global outbreak. In addition to controlling the flow of people from affected areas in China, face masks have also been made mandatory in many areas, including Wuhan.
Many stores in big cities like Beijing have run out of stock in recent days.
But Klein suggests keeping the outbreak in perspective.
He says it’ s important to remember that the flu “ can kill up to 550,000 people on the planet in one season ” in normal times.
“ I wear the mask regularly when I go out. It’ s an obligation imposed by the local authorities, so everyone here in Wuhan is wearing a mask, ” he said.
But it is mostly sick people who need to wear the mask, “ so that they don’ t spread the virus ”.
“ Psychologically, it’ s an interesting thing, wearing a mask. Of course, it’ s reassuring and it probably stops you from putting your hands up to your mouth, ” he added.
“ The most important thing is to have good hygiene and wash your hands frequently. ”
For Klein, staying in China is his job, and what he has been trained to do.
“ I am a virus tamer, ” he says, and staying in China, it is “ as if I was with a lion in its cage ”.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
Online platforms that are precursors of the metaverse vision for the internet's future are already serving as workrooms to develop products.
Russian animal rescuers were fighting for the life of an Amur tiger cub who had been found dying from exhaustion and frostbite.
The Philippine government on Thursday defended a controversial ban on unvaccinated people using public transport.
A federal judge on Wednesday set a September date for the sentencing of fallen biotech star Elizabeth Holmes, who was found guilty.
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Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries | BackgroundThe WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus ( HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries ( LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination.MethodsThe WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years ( with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% ( 2023) to 90% ( 2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median ( range) of model predictions.FindingsGirls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 ( range 19·4–19·8) to 2·1 ( 2·0–2·6) cases per 100 000 women-years over the next century ( 89·4% [ 86·2–90·1 ] reduction), and to avert 61·0 million ( 60·5–63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 ( 0·6–1·6) cases per 100 000 women-years ( 96·7% [ 91·3–96·7 ] reduction) and averted an extra 12·1 million ( 9·5–13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% ( 58–65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% ( 89–100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% ( 37–99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% ( 71–100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11–31 years. Long-term vaccine protection was required for elimination.InterpretationPredictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden.FundingWHO, UNDP, UN Population Fund, UNICEF–WHO–World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec–Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.
The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus ( HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries ( LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination.
The WHO Cervical Cancer Elimination Modelling Consortium ( CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years ( with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% ( 2023) to 90% ( 2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median ( range) of model predictions.
Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 ( range 19·4–19·8) to 2·1 ( 2·0–2·6) cases per 100 000 women-years over the next century ( 89·4% [ 86·2–90·1 ] reduction), and to avert 61·0 million ( 60·5–63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 ( 0·6–1·6) cases per 100 000 women-years ( 96·7% [ 91·3–96·7 ] reduction) and averted an extra 12·1 million ( 9·5–13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% ( 58–65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% ( 89–100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% ( 37–99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% ( 71–100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11–31 years. Long-term vaccine protection was required for elimination.
Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden.
WHO, UNDP, UN Population Fund, UNICEF–WHO–World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec–Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.
Cervical cancer is the second most frequent cancer among women in low-income and lower-middle-income countries ( LMICs).1Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Crossref PubMed Scopus ( 33665) Google Scholar In 2018, 290 000 ( 51%) of the 570 000 new cervical cancer cases worldwide occurred in women living in LMICs ( 500 000 [ 88% ] when including upper-middle-income countries).1Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Crossref PubMed Scopus ( 33665) Google Scholar Without further intervention, these inequalities in the burden of cervical cancer are expected to grow, because recent increases in the uptake of human papillomavirus ( HPV) vaccination and cervical cancer screening have mainly occurred in high-income countries. Less than 30% of LMICs have introduced HPV vaccination compared with more than 85% of high-income countries.2PATHGlobal HPV Vaccine Introduction Overview: projected and current national introductions, demonstration/pilot projects, gender-neutral vaccination programs, and global HPV vaccine introduction maps ( 2006–2022).https: //www.path.org/resources/global-hpv-vaccine-introduction-overview/Date: November, 2019Date accessed: January 9, 2020Google Scholar, 3WHOImmunization, vaccines and biologicals: data, statistics and graphics.https: //www.who.int/immunization/monitoring surveillance/data/en/Date accessed: December 18, 2019Google Scholar Additionally, only about 20% of women in LMICs have ever been screened for cervical cancer compared with more than 60% in high-income countries.4Gakidou E Nordhagen S Obermeyer Z Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities.PLoS Med. 2008; 5: e132Crossref PubMed Scopus ( 328) Google Scholar, 5Riley L Monitoring cervical cancer: screening and treatment coverage. Presentation using the WHO Steps Survey ( cervical cancer screening).https: //apps.who.int/iris/handle/10665/275391Date: 2019Date accessed: December 18, 2019Google Scholar
Research in contextEvidence before this studyIn May, 2018, WHO issued a global call to eliminate cervical cancer as a public health problem. To inform its global strategy to accelerate cervical cancer elimination, WHO created the Cervical Cancer Elimination Modelling Consortium ( CCEMC) to examine the following key questions: what elimination threshold should be used; what prevention strategies can lead to elimination; when could elimination be reached for different countries; and how many cancers could be averted. The current working definition of elimination is an age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years. Alternative definitions, such as an incidence of ten or fewer cases per 100 000 women-years and an 80–90% reduction in incidence, have also been suggested. The only previous multicountry modelling study of cervical cancer elimination suggests that global elimination is possible through girls-only human papillomavirus ( HPV) vaccination at 80–100% coverage with a perfectly effective 9-valent vaccine and twice-lifetime HPV-based screening. Given that models necessarily include simplifying assumptions, the goal of the consortium is to use multiple models, taking into account their respective strengths and limitations, to illustrate the robustness of predictions. A systematic comparative modelling approach was used. To form the CCEMC, WHO selected three models that met the predefined eligibility criteria: HPV-ADVISE, Harvard, and Policy1-Cervix. The models projected reductions in cervical cancer incidence over time based on standardised HPV vaccination and cervical screening scenarios determined after consultations at various WHO technical expert, advisory group, and global stakeholder meetings. Three elimination thresholds were examined ( cervical cancer incidence of four or fewer cases per 100 000 women-years, ten or fewer cases per 100 000 women-years, and ≥85% reduction in incidence).Added value of this studyThis comparative modelling analysis, which includes projections from three independent transmission-dynamic models, provides consistent results suggesting that 90% HPV vaccination coverage of girls can lead to cervical cancer elimination in most low-income and lower-middle-income countries ( LMICs) within the next century. However, countries with the highest cervical cancer incidence ( > 25 cases per 100 000 women-years) might not reach elimination at the threshold of four or fewer cases per 100 000 women-years by vaccination alone, although these countries are predicted to have the greatest absolute reductions. More than 90% of these LMICs are in sub-Saharan Africa. Screening would accelerate elimination by 11–31 years and will be necessary to eliminate cervical cancer in countries with the highest incidence. Profound health benefits are predicted on the path to elimination. Intensive scale-up of girls-only vaccination with twice-lifetime screening is predicted to halve the age-standardised cervical cancer incidence by 2048 ( and by 2061 with vaccination only), and to avert more than 74 million cervical cancer cases ( 61 million with vaccination only) in LMICs over the next century.Implications of all the available evidenceThe results of the CCEMC suggest that cervical cancer elimination as a public health problem is possible by the end of the century. However, to achieve elimination across all LMICs under the most ambitious threshold ( four or fewer cases per 100 000 women-years), both high HPV vaccination coverage and screening uptake will be necessary, which will require considerable international commitment. These results have directly informed WHO's target of 90% HPV vaccination coverage, 70% screening coverage, and 90% of cervical lesions treated by 2030, as well as the WHO global strategy to accelerate cervical cancer elimination, which will be presented at the World Health Assembly in May, 2020.
In May, 2018, WHO issued a global call to eliminate cervical cancer as a public health problem. To inform its global strategy to accelerate cervical cancer elimination, WHO created the Cervical Cancer Elimination Modelling Consortium ( CCEMC) to examine the following key questions: what elimination threshold should be used; what prevention strategies can lead to elimination; when could elimination be reached for different countries; and how many cancers could be averted. The current working definition of elimination is an age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years. Alternative definitions, such as an incidence of ten or fewer cases per 100 000 women-years and an 80–90% reduction in incidence, have also been suggested. The only previous multicountry modelling study of cervical cancer elimination suggests that global elimination is possible through girls-only human papillomavirus ( HPV) vaccination at 80–100% coverage with a perfectly effective 9-valent vaccine and twice-lifetime HPV-based screening. Given that models necessarily include simplifying assumptions, the goal of the consortium is to use multiple models, taking into account their respective strengths and limitations, to illustrate the robustness of predictions. A systematic comparative modelling approach was used. To form the CCEMC, WHO selected three models that met the predefined eligibility criteria: HPV-ADVISE, Harvard, and Policy1-Cervix. The models projected reductions in cervical cancer incidence over time based on standardised HPV vaccination and cervical screening scenarios determined after consultations at various WHO technical expert, advisory group, and global stakeholder meetings. Three elimination thresholds were examined ( cervical cancer incidence of four or fewer cases per 100 000 women-years, ten or fewer cases per 100 000 women-years, and ≥85% reduction in incidence).
This comparative modelling analysis, which includes projections from three independent transmission-dynamic models, provides consistent results suggesting that 90% HPV vaccination coverage of girls can lead to cervical cancer elimination in most low-income and lower-middle-income countries ( LMICs) within the next century. However, countries with the highest cervical cancer incidence ( > 25 cases per 100 000 women-years) might not reach elimination at the threshold of four or fewer cases per 100 000 women-years by vaccination alone, although these countries are predicted to have the greatest absolute reductions. More than 90% of these LMICs are in sub-Saharan Africa. Screening would accelerate elimination by 11–31 years and will be necessary to eliminate cervical cancer in countries with the highest incidence. Profound health benefits are predicted on the path to elimination. Intensive scale-up of girls-only vaccination with twice-lifetime screening is predicted to halve the age-standardised cervical cancer incidence by 2048 ( and by 2061 with vaccination only), and to avert more than 74 million cervical cancer cases ( 61 million with vaccination only) in LMICs over the next century.
The results of the CCEMC suggest that cervical cancer elimination as a public health problem is possible by the end of the century. However, to achieve elimination across all LMICs under the most ambitious threshold ( four or fewer cases per 100 000 women-years), both high HPV vaccination coverage and screening uptake will be necessary, which will require considerable international commitment. These results have directly informed WHO's target of 90% HPV vaccination coverage, 70% screening coverage, and 90% of cervical lesions treated by 2030, as well as the WHO global strategy to accelerate cervical cancer elimination, which will be presented at the World Health Assembly in May, 2020.
Inequalities in HPV vaccination and screening uptake persist, despite the large body of evidence demonstrating that these interventions are highly effective and cost-effective. Large international randomised control clinical trials have shown that HPV vaccines are safe and highly effective against vaccine-type persistent infection and cervical precancerous lesions in women ( with vaccine efficacy ≥93%).6Garland SM Hernandez-Avila M Wheeler CM et al.Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases.N Engl J Med. 2007; 356: 1928-1943Crossref PubMed Scopus ( 1482) Google Scholar, 7Paavonen J Naud P Salmeron J et al.Efficacy of human papillomavirus ( HPV) -16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types ( PATRICIA): final analysis of a double-blind, randomised study in young women.Lancet. 2009; 374: 301-314Summary Full Text Full Text PDF PubMed Scopus ( 1256) Google Scholar, 8Joura EA Giuliano AR Iversen OE et al.A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women.N Engl J Med. 2015; 372: 711-723Crossref PubMed Scopus ( 790) Google Scholar These vaccines target high-risk HPV types that cause about 70% ( bivalent and quadrivalent vaccines: HPV types 16 and 18) and 90% ( 9-valent vaccine: HPV types 16, 18, 31, 33, 45, 52, and 58) of cervical cancers.9de Sanjose S Quint WG Alemany L et al.Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study.Lancet Oncol. 2010; 11: 1048-1056Summary Full Text Full Text PDF PubMed Scopus ( 1609) Google Scholar, 10Serrano B Alemany L Tous S et al.Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease.Infect Agent Cancer. 2012; 7: 38Crossref PubMed Scopus ( 210) Google Scholar Countries that have achieved high vaccination coverage have observed declines of 73–85% in vaccine-type HPV prevalence, and declines of 41–57% in high grade lesions ( cervical intraepithelial neoplasia, grade 2 or worse) among young women, less than 10 years after implementation of HPV vaccination.11Drolet M Benard E Perez N Brisson M HPV Vaccination Impact Study GroupPopulation-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis.Lancet. 2019; 394: 497-509Summary Full Text Full Text PDF PubMed Scopus ( 246) Google Scholar The effectiveness of population-based cervical cancer screening has also been shown, through the sharp declines in age-standardised cervical cancer incidence in high-income countries following the implementation of cytology-based screening.12Bray F Loos AH McCarron P et al.Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening.Cancer Epidemiol Biomarkers Prev. 2005; 14: 677-686Crossref PubMed Scopus ( 247) Google Scholar, 13Franco EL Duarte-Franco E Ferenczy A Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection.CMAJ. 2001; 164: 1017-1025PubMed Google Scholar Randomised controlled trials have shown that HPV-based tests are highly effective at detecting precancerous lesions and are likely to be more effective at preventing cervical cancer than visual inspection with acetic acid or cytology.14Ogilvie GS Krajden M van Niekerk D et al.HPV for cervical cancer screening ( HPV FOCAL): complete round 1 results of a randomized trial comparing HPV-based primary screening to liquid-based cytology for cervical cancer.Int J Cancer. 2017; 140: 440-448Crossref PubMed Scopus ( 52) Google Scholar, 15Sankaranarayanan R Nene BM Shastri SS et al.HPV screening for cervical cancer in rural India.N Engl J Med. 2009; 360: 1385-1394Crossref PubMed Scopus ( 843) Google Scholar, 16Ronco G Dillner J Elfstrom KM et al.Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials.Lancet. 2014; 383: 524-532Summary Full Text Full Text PDF PubMed Scopus ( 904) Google Scholar Finally, mathematical modelling studies have consistently shown that girls-only HPV vaccination and cervical cancer screen-and-treat programmes are cost-effective in LMICs.17Jit M Brisson M Portnoy A Hutubessy R Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study.Lancet Glob Health. 2014; 2: e406-e414Summary Full Text Full Text PDF PubMed Scopus ( 132) Google Scholar, 18Jit M Brisson M Potential lives saved in 73 countries by adopting multi-cohort vaccination of 9–14-year-old girls against human papillomavirus.Int J Cancer. 2018; 143: 317-323Crossref PubMed Scopus ( 8) Google Scholar, 19Fesenfeld M Hutubessy R Jit M Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review.Vaccine. 2013; 31: 3786-3804Crossref PubMed Scopus ( 78) Google Scholar, 20Campos NG Sharma M Clark A et al.The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries.Int J Gynaecol Obstet. 2017; 138: 47-56Crossref PubMed Scopus ( 25) Google Scholar, 21Campos NG Tsu V Jeronimo J Mvundura M Lee K Kim JJ When and how often to screen for cervical cancer in three low- and middle-income countries: a cost-effectiveness analysis.Papillomavirus Res. 2015; 1: 38-58Crossref Scopus ( 30) Google Scholar, 22Canfell K Shi JF Lew JB et al.Prevention of cervical cancer in rural China: evaluation of HPV vaccination and primary HPV screening strategies.Vaccine. 2011; 29: 2487-2494Crossref PubMed Scopus ( 61) Google Scholar
Given the substantial global burden of cervical cancer, the increasing inequalities, and opportunities for effective and cost-effective primary and secondary prevention, the WHO Director-General made a global call in May, 2018, for action towards the elimination of cervical cancer as a public health problem.23WHOWHO Director-General calls for all countries to take action to help end the suffering caused by cervical cancer.https: //www.who.int/reproductivehealth/call-to-action-elimination-cervical-cancer/en/Date: May 19, 2018Date accessed: September 6, 2019Google Scholar To achieve this goal, WHO is developing, with its partners, a global strategy towards the elimination of cervical cancer.24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar Fundamental questions that must be addressed in the global strategy include: what elimination definition and threshold should be used, what prevention strategies can lead to elimination, when could elimination be reached, how many cervical cancers and deaths can be averted on the path to elimination, and what are the most efficient and cost-effective strategies to reach elimination? These important questions can only be addressed through mathematical modelling, which integrates our understanding of HPV transmission, cervical carcinogenesis, vaccine efficacy, and cervical screening and treatment performance to project the long-term health consequences of alternative cancer control policies. Hence, to inform its global strategy to accelerate cervical cancer elimination, WHO assembled the Cervical Cancer Elimination Modelling Consortium ( CCEMC).25WHOAccelerating cervical cancer elimination. Report by the Director-General.http: //apps.who.int/gb/ebwha/pdf files/EB144/B144 28-en.pdfDate: Nov 30, 2018Date accessed: February 5, 2019Google Scholar, 26Brisson M Drolet M Global elimination of cervical cancer as a public health problem.Lancet Oncol. 2019; 20: 319-321Summary Full Text Full Text PDF PubMed Scopus ( 19) Google Scholar
In this Article, we describe the comparative modelling approach used by the CCEMC to inform WHO's global strategy towards the elimination of cervical cancer,24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar and present the CCEMC's predictions of the impact of various HPV vaccination and screening elimination strategies on cervical cancer incidence in 78 LMICs. The specific objectives of this analysis were to identify prevention strategies that lead to elimination, estimate the timing of elimination, and predict the number of cervical cancer cases averted on the path to elimination, for different elimination thresholds and country characteristics. In an accompanying Article,27Canfell K Kim JJ Brisson M et al.Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30157-4Summary Full Text Full Text PDF Scopus ( 91) Google Scholar we present the CCEMC's predictions of the impact of HPV vaccination, screening, and treatment scale-up on cervical cancer mortality.
This comparative modelling analysis adhered to recently published guidelines for multi-model comparisons28den Boon S Jit M Brisson M et al.Guidelines for multi-model comparisons of the impact of infectious disease interventions.BMC Med. 2019; 17: 163Crossref PubMed Scopus ( 17) Google Scholar and for reporting model-based analyses of HPV vaccination and cervical screening29Canfell K Kim JJ Kulasingam S et al.HPV-FRAME: a consensus statement and quality framework for modelled evaluations of HPV-related cancer control.Papillomavirus Res. 2019; 8100184Crossref PubMed Scopus ( 16) Google Scholar ( appendix pp 26–28). A three-step systematic comparative modelling approach was used.
The aim of the first step was to identify and select the mathematical models. To minimise selection bias, WHO selected models that met the following predefined eligibility criteria: the models explicitly included the dynamic transmission of HPV infection, were capable of projecting the impact of HPV vaccination and cervical screening for all 78 LMICs, were independently developed and had been previously peer reviewed and published, and were able to provide predictions in a short timeframe to inform the WHO global strategy.24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar Four independent models were identified: HPV-ADVISE,30Van de Velde N Boily MC Drolet M et al.Population-level impact of the bivalent, quadrivalent, and nonavalent human papillomavirus vaccines: a model-based analysis.J Natl Cancer Inst. 2012; 104: 1712-1723Crossref PubMed Scopus ( 103) Google Scholar, 31Brisson M Laprise JF Drolet M et al.Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study.Vaccine. 2013; 31: 3863-3871Crossref PubMed Scopus ( 43) Google Scholar Harvard,32Burger EA Campos NG Sy S Regan C Kim JJ Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country.Vaccine. 2018; 36: 4823-4829Crossref PubMed Scopus ( 19) Google Scholar, 33Campos NG Burger EA Sy S et al.An updated natural history model of cervical cancer: derivation of model parameters.Am J Epidemiol. 2014; 180: 545-555Crossref PubMed Scopus ( 68) Google Scholar Policy1-Cervix,34Simms KT Steinberg J Caruana M et al.Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study.Lancet Oncol. 2019; 20: 394-407Summary Full Text Full Text PDF PubMed Scopus ( 129) Google Scholar, 35Lew JB Simms KT Smith MA et al.Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program.Lancet Public Health. 2017; 2: e96-e107Summary Full Text Full Text PDF PubMed Scopus ( 87) Google Scholar, 36Smith MA Canfell K Brotherton JM Lew JB Barnabas RV The predicted impact of vaccination on human papillomavirus infections in Australia.Int J Cancer. 2008; 123: 1854-1863Crossref PubMed Scopus ( 48) Google Scholar and Spectrum.37Gopalappa C Guo J Meckoni P et al.A two-step Markov processes approach for parameterization of cancer state-transition models for low- and middle-income countries.Med Decis Making. 2018; 38: 520-530Crossref PubMed Scopus ( 5) Google Scholar, 38Ralaidovy AH Gopalappa C Ilbawi A Pretorius C Lauer JA Cost-effective interventions for breast cancer, cervical cancer, and colorectal cancer: new results from WHO-CHOICE.Cost Eff Resour Alloc. 2018; 16: 38Crossref PubMed Scopus ( 13) Google Scholar
The aim of the second step was to identify HPV vaccination and screening strategies that can lead to cervical cancer elimination and examine between-model variability. The four models were used to predict the change in cervical cancer incidence over time for 40 standardised HPV vaccination and screening scenarios, with a subset of ten LMICs ( appendix pp 14–15). Impact predictions were done without harmonising the basic structure of the models or parameters governing the setting and disease. The results were presented at various WHO technical expert, advisory group, and global stakeholder meetings, and ultimately three HPV vaccination and screening scenarios were identified to proceed in a larger number of countries ( 78 LMICs).39WHOImmunization and Vaccine-related Implementation Research Advisory Committee ( IVIR-AC) recommendations. Sept 2018.Wkly Epidemiol Rec. 2019; 94: 5-16Google Scholar The three final scenarios that were selected for the global analysis ( see scenario descriptions below and in the appendix p 16) were chosen as they showed potential for cervical cancer elimination in LMICs and follow WHO recommendations for HPV vaccination and cervical screening.40WHOEarly diagnosis and screening: cervical cancer.https: //www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/Date accessed: November 6, 2019Google Scholar, 41WHOImmunization, vaccines and biologicals: human papillomavirus ( HPV).https: //www.who.int/immunization/diseases/hpv/en/Date accessed: November 6, 2019Google Scholar
Finally, the aim of the third step was to produce predictions of the population-level impact of the three HPV vaccination and cervical screening scenarios for all 78 LMICs. Three of the four models ( HPV-ADVISE, Harvard, and Policy1-Cervix) were able to provide predictions for all 78 LMICs within the required timelines, and thus form the core models of the CCEMC. The structure of the models and the comparative modelling approach were presented and reviewed by the WHO Advisory Committee on Immunization and Vaccines related Research ( IVIR).39WHOImmunization and Vaccine-related Implementation Research Advisory Committee ( IVIR-AC) recommendations. Sept 2018.Wkly Epidemiol Rec. 2019; 94: 5-16Google Scholar
The three CCEMC models ( HPV-ADVISE, Harvard, and Policy1-Cervix) have been used extensively to inform recommendations on cervical screening and HPV vaccination in Australia, Canada, the UK, the USA, and at a global level.30Van de Velde N Boily MC Drolet M et al.Population-level impact of the bivalent, quadrivalent, and nonavalent human papillomavirus vaccines: a model-based analysis.J Natl Cancer Inst. 2012; 104: 1712-1723Crossref PubMed Scopus ( 103) Google Scholar, 31Brisson M Laprise JF Drolet M et al.Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study.Vaccine. 2013; 31: 3863-3871Crossref PubMed Scopus ( 43) Google Scholar, 32Burger EA Campos NG Sy S Regan C Kim JJ Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country.Vaccine. 2018; 36: 4823-4829Crossref PubMed Scopus ( 19) Google Scholar, 33Campos NG Burger EA Sy S et al.An updated natural history model of cervical cancer: derivation of model parameters.Am J Epidemiol. 2014; 180: 545-555Crossref PubMed Scopus ( 68) Google Scholar, 34Simms KT Steinberg J Caruana M et al.Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study.Lancet Oncol. 2019; 20: 394-407Summary Full Text Full Text PDF PubMed Scopus ( 129) Google Scholar, 35Lew JB Simms KT Smith MA et al.Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program.Lancet Public Health. 2017; 2: e96-e107Summary Full Text Full Text PDF PubMed Scopus ( 87) Google Scholar, 36Smith MA Canfell K Brotherton JM Lew JB Barnabas RV The predicted impact of vaccination on human papillomavirus infections in Australia.Int J Cancer. 2008; 123: 1854-1863Crossref PubMed Scopus ( 48) Google Scholar Although developed independently, the models have common features. First, they are transmission-dynamic models of HPV infection and the natural history of cervical cancer. Second, they include the following components: sexual behaviour and HPV transmission, natural history of cervical cancer, vaccination, and screening, diagnosis, management, and treatment of cervical lesions and cancer. HPV transmission and cervical carcinogenesis are modelled for the HPV types in the 9-valent vaccine ( HPV types 16, 18, 31, 33, 45, 52, 58) and other high-risk types. The models simulate type-specific HPV transmission through sexual activity, based on different risk groups and sexual mixing. The models reproduce the type-specific natural history of cervical cancer, from persistent HPV infection to cervical cancer via precancerous cervical lesions ( cervical intraepithelial neoplasia grade 1 to 3). All models assume that HPV vaccines are prophylactic and capture post-vaccination herd effects. They can also simulate complex cervical screening and treatment algorithms at the individual level, by tracking and simulating each woman's screening history. Finally, all models were calibrated to highly stratified sexual behaviour and epidemiological data, validated to clinical trials or post-vaccination data, or both, and reproduce the age-specific cervical cancer incidence estimates from the Global Cancer Observatory ( GLOBOCAN) 2018 for all 78 LMICs42Ferlay J Ervik M Lam F et al.Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon, France2018https: //gco.iarc.fr/todayDate accessed: October 24, 2019Google Scholar ( see the appendix pp 18–23 for further details of the CCEMC models).
Three standardised base-case HPV vaccination and cervical screening scenarios were examined. The first was vaccination only: routine vaccination of girls aged 9 years ( with a 1-year multi-age cohort catch-up to age 14 years) reaching 90% coverage in the first year ( 2020). The second was vaccination and once-lifetime screening: scenario 1 plus one lifetime screen at age 35 years, assuming screening uptake ramp-up over time ( 45% in 2023, 70% in 2030, and 90% in 2045). The third was vaccination and twice-lifetime screening: scenario 1 plus two lifetime screens at ages 35 years and 45 years, assuming screening uptake ramp-up over time ( 45% in 2023, 70% in 2030, and 90% in 2045).
For the base-case scenarios, HPV vaccination was assumed to provide 100% efficacy against HPV types 16, 18, 31, 33, 45, 52, and 58, and lifelong duration of protection. Cervical screening was assumed to involve primary HPV screen-and-treat testing, with 100% precancer treatment efficacy and 10% of individuals lost to follow-up ( due to treatment non-compliance). To estimate the population-level impact of the base-case scenarios, we also modelled a status quo scenario, which assumes no further scale-up of preventive interventions ( see appendix p 16 for more details). The 40 HPV vaccination and cervical screening scenarios from step 2 of the comparative modelling approach were used to understand the impact of model assumptions on predictions. The sensitivity analysis included varying HPV vaccination coverage, the targeted population ( girls only vs girls and boys), ages at vaccination, screening frequency, the HPV types targeted by the vaccine, and the duration of vaccine protection. Results of the sensitivity analysis are shown for two example countries, representing one low-income country in sub-Saharan Africa ( Uganda) and one lower-middle-income country in east Asia ( Vietnam).
Population-level impact was measured with three main outcomes: age-standardised cervical cancer incidence, relative reductions in age-standardised cervical cancer incidence ( vs status quo), and number of cases averted ( vs status quo). The time horizon of the analysis was from 2020 to 2120. The age-standardised cervical cancer incidence and relative reductions in incidence over time were used to assess the feasibility and timing of cervical cancer elimination at different thresholds. We used the CCEMC models to independently estimate the outcomes for each of the 78 countries. Results were also aggregated by World Bank income level and region ( see appendix p 17 for a description of country characteristics). Outcomes are presented with the median ( range) of the predictions of the three models to represent between-model uncertainty.28den Boon S Jit M Brisson M et al.Guidelines for multi-model comparisons of the impact of infectious disease interventions.BMC Med. 2019; 17: 163Crossref PubMed Scopus ( 17) Google Scholar
The age-standardised cervical cancer incidence over time was estimated for each CCEMC model, vaccination, and screening scenario, and for each country using the predictions of age-specific cervical cancer incidence over time and applying the age structure of the 2015 global female population aged 0–99 years.43UN Department of Economic and Social AffairsWorld population prospects: 2017 revision.https: //population.un.org/wpp/Download/Standard/Population/Date: 2017Date accessed: January 23, 2020Google Scholar Reductions ( absolute and relative) in age-standardised cervical cancer incidence over time were estimated compared to the status quo. Finally, the cumulative number of cases averted over time was estimated with a three-step process. First, for each CCEMC model, vaccination, and screening scenario, and country, we estimated the number of cervical cancers by year and age group by multiplying the predicted age-specific cervical cancer incidence and the age-specific UN population growth projections.43UN Department of Economic and Social AffairsWorld population prospects: 2017 revision.https: //population.un.org/wpp/Download/Standard/Population/Date: 2017Date accessed: January 23, 2020Google Scholar Second, we estimated the number of cervical cancers in each year by summing the cases predicted in each age group. Third, the number of cases averted in each year was estimated by subtracting the number of cases predicted under each vaccination and screening scenario from those predicted under the status quo. The number of cancer cases averted in each World Bank income level or region was estimated by aggregating the country-specific results. The model predictions were done independently by each group and collated by the study's coordinating centre ( Laval University, Québec, QC, Canada). See the appendix ( pp 18–25) for more methodological details.
Our base-case definition of elimination is an age-standardised ( 2015 world standard) cervical cancer incidence of four or fewer cases per 100 000 women-years, which is the current working definition used by WHO and the proposed WHO global strategy towards elimination of cervical cancer.24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar The threshold was determined following multiple WHO technical expert meetings and global stakeholder consultations held between March and September, 2018.24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar Alternative definitions, such as a higher incidence threshold ( ten cases per 100 000 women-years) and a percentage reduction in incidence ( 85–90%), were also discussed.39WHOImmunization and Vaccine-related Implementation Research Advisory Committee ( IVIR-AC) recommendations. Sept 2018.Wkly Epidemiol Rec. 2019; 94: 5-16Google Scholar Thus, as a sensitivity analysis, two alternative definitions were explored: age-standardised cervical cancer incidence of ten or fewer cases per 100 000 women-years and a reduction in age-standardised cervical cancer incidence of ≥85% ( vs status quo). Elimination was predicted to occur the first year in which a country reached the threshold definition. Elimination within a region or income level was predicted to occur the year in which all countries within the region or income level reached elimination.
This study was partly funded by WHO. WHO contributed to study design, data analysis, data interpretation, and writing of the report. The other funding sources had no role in this work. MB, JJK, and KC had full access to all the data in the study and had final responsibility for the decision to submit for publication.
The CCEMC models predicted that girls-only HPV vaccination with 90% coverage will reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 ( range 19·4–19·8) to 2·1 ( 2·0–2·6) cases per 100 000 women-years over the next century, which represents an 89·4% ( 86·2–90·1) reduction in cervical cancer ( vs the status quo; figure 1, table). The addition of screening was predicted to substantially accelerate declines in cervical cancer and to lead to lower cervical cancer incidence at equilibrium. HPV vaccination and once-lifetime screening was predicted to reduce the average age-standardised cervical cancer incidence in LMICs to 1·0 ( 0·9–2·0) cases per 100 000 women-years over the next century ( 95·0% [ 89·0–95·3 ] reduction), whereas HPV vaccination and twice-lifetime screening was predicted to reduce the average age-standardised cervical cancer incidence to 0·7 ( 0·6–1·6) cases per 100 000 women-years at equilibrium ( 96·7% [ 91·3–96·7 ] reduction). Additionally, the models predicted that cervical cancer incidence will be halved in LMICs by 2061 ( 2060–63) with HPV vaccination alone, by 2055 ( 2055–56) when adding once-lifetime screening, and by 2048 ( 2047–49) when adding twice-lifetime screening. Notably, the models predicted that HPV vaccination with or without screening will reduce age-standardised cervical cancer incidence in women of childbearing age ( < 45 years) by more than 85% before 2050 ( appendix p 5).Figure 1Dynamics of cervical cancer incidence after HPV vaccination and cervical screeningShow full captionAverage age-standardised cervical cancer incidence per 100 000 women-years ( A) and relative reduction in incidence ( B) after HPV vaccination and screening ramp-up in low-income and lower-middle-income countries. Median prediction from the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. Equilibrium occurs 90–100 years after the introduction of HPV vaccination only ( and earlier for the screening scenarios). HPV=human papillomavirus.View Large Image Figure ViewerDownload Hi-res image Download ( PPT) TableChange in age-standardised cervical cancer incidence over time, percentage of countries reaching elimination for different thresholds, and year of elimination, by World Bank income level and regionIncidence per 100 000 women-yearsReduction in incidence (%) Base-case elimination threshold: ≤4 cases per 100 000Alternative elimination threshold: ≤10 cases per 100 000Alternative elimination threshold: ≥85% reduction20202045Equilibrium2045EquilibriumCountries (%) Year of eliminationCountries (%) Year of eliminationCountries (%) Year of eliminationAll low-income and lower-middle-income countries ( n=78) Vaccination only19·8 ( 19·4–19·8) 16·9 ( 16·2–17·5) 2·1 ( 2·0–2·6) 12·9 ( 11·6–14·4) 89·4 ( 86·2–90·1) 60·3 ( 57·7–65·4) X ( X–X) 98·7 ( 88·5–100·0) X ( 2096–X) 87·2 ( 37·2–98·7) X ( X–X) Vaccination and one lifetime screen19·8 ( 19·4–19·8) 13·7 ( 13·3–13·8) 1·0 ( 0·9–2·0) 30·3 ( 28·6–30·8) 95·0 ( 89·0–95·3) 96·2 ( 60·3–97·4) X ( X–X) 100·0 ( 94·9–100·0) 2090 ( 2082–X) 100·0 ( 100·0–100·0) 2085 ( 2080–2100) Vaccination and two lifetime screens19·8 ( 19·3–19·9) 11·0 ( 10·7–11·6) 0·7 ( 0·6–1·6) 41·5 ( 40·6–46·1) 96·7 ( 91·3–96·7) 100·0 ( 70·5–100·0) 2098 ( 2097–X) 100·0 ( 98·7–100·0) 2085 ( 2078–X) 100·0 ( 100·0–100·0) 2081 ( 2077–2094) World Bank income levelsLow-income countries ( n=34) Vaccination only32·7 ( 32·7–33·6) 28·6 ( 28·0–31·1) 3·9 ( 3·4–5·7) 13·4 ( 12·7–14·3) 88·1 ( 84·1–89·5) 44·1 ( 41·2–50·0) X ( X–X) 100·0 ( 82·4–100·0) 2093 ( 2090–X) 82·4 ( 14·7–100·0) X ( 2091–X) Vaccination and one lifetime screen32·7 ( 32·7–33·6) 22·6 ( 22·6–25·7) 1·8 ( 1·7–4·6) 31·1 ( 28·4–31·1) 94·7 ( 87·1–94·9) 97·1 ( 44·1–97·1) X ( X–X) 100·0 ( 94·1–100·0) 2082 ( 2079–X) 100·0 ( 100·0–100·0) 2083 ( 2079–2098) Vaccination and two lifetime screens32·8 ( 32·7–33·7) 19·0 ( 17·5–21·8) 1·2 ( 1·2–3·8) 41·9 ( 39·3–46·6) 96·4 ( 89·5–96·5) 100·0 ( 52·9–100·0) 2089 ( 2088–X) 100·0 ( 100·0–100·0) 2076 ( 2074–2099) 100·0 ( 100·0–100·0) 2079 ( 2073–2092) Low-income and lower-middle-income countries ( n=44) Vaccination only17·8 ( 17·2–17·8) 15·3 ( 14·0–15·9) 1·8 ( 1·8–2·1) 12·3 ( 11·0–14·1) 89·7 ( 87·0–90·2) 72·7 ( 70·5–77·3) X ( X–X) 97·7 ( 93·2–100·0) X ( 2096–X) 90·9 ( 54·5–97·7) X ( X–X) Vaccination and one lifetime screen17·8 ( 17·2–17·9) 12·4 ( 11·5–12·5) 0·9 ( 0·8–1·6) 29·8 ( 28·3–30·4) 95·1 ( 89·8–95·4) 95·5 ( 72·7–97·7) X ( X–X) 100·0 ( 95·5–100·0) 2090 ( 2082–X) 100·0 ( 100·0–100·0) 2085 ( 2080–2100) Vaccination and two lifetime screens17·8 ( 17·2–17·9) 9·7 ( 9·5–10·5) 0·6 ( 0·6–1·3) 41·1 ( 40·8–45·7) 96·8 ( 92·0–96·8) 100·0 ( 84·1–100·0) 2098 ( 2097–X) 100·0 ( 97·7–100·0) 2085 ( 2078–X) 100·0 ( 100·0–100·0) 2081 ( 2077–2094) World Bank regionsEast Asia and Pacific ( n=12) Vaccination only19·9 ( 19·3–19·9) 17·0 ( 15·0–17·5) 2·2 ( 2·2–2·5) 13·7 ( 12·0–14·5) 87·3 ( 87·2–89·2) 100·0 ( 91·7–100·0) 2102 ( 2087–X) 100·0 ( 100·0–100·0) 2067 ( 2066–2069) 100·0 ( 91·7–100·0) 2091 ( 2087–X) Vaccination and one lifetime screen19·9 ( 19·2–19·9) 13·4 ( 12·0–13·7) 1·2 ( 0·9–1·7) 31·4 ( 30·8–32·5) 93·8 ( 90·3–95·3) 100·0 ( 100·0–100·0) 2079 ( 2075–2091) 100·0 ( 100·0–100·0) 2061 ( 2060–2061) 100·0 ( 100·0–100·0) 2078 ( 2078–2087) Vaccination and two lifetime screens19·9 ( 19·1–20·1) 10·3 ( 9·6–11·4) 0·8 ( 0·7–1·3) 44·7 ( 42·8–48·5) 96·0 ( 92·4–96·7) 100·0 ( 100·0–100·0) 2071 ( 2069–2085) 100·0 ( 100·0–100·0) 2052 ( 2050–2054) 100·0 ( 100·0–100·0) 2073 ( 2073–2081) Europe and central Asia ( n=6) Vaccination only15·7 ( 15·6–15·7) 11·8 ( 11·6–12·3) 1·4 ( 1·2–1·7) 22·9 ( 21·7–25·0) 90·9 ( 88·5–92·7) 100·0 ( 100·0–100·0) 2080 ( 2078–2080) 100·0 ( 100·0–100·0) 2059 ( 2059–2060) 100·0 ( 100·0–100·0) 2085 ( 2081–2088) Vaccination and one lifetime screen15·7 ( 15·6–15·8) 8·9 ( 8·8–9·0) 0·7 ( 0·7–1·3) 43·2 ( 40·1–44·2) 95·6 ( 91·1–95·8) 100·0 ( 100·0–100·0) 2070 ( 2069–2075) 100·0 ( 100·0–100·0) 2052 ( 2052–2053) 100·0 ( 100·0–100·0) 2073 ( 2078–2079) Vaccination and two lifetime screens15·7 ( 15·5–15·7) 7·6 ( 6·8–7·7) 0·5 ( 0·5–1·1) 51·0 ( 49·6–56·7) 96·7 ( 92·5–96·8) 100·0 ( 100·0–100·0) 2065 ( 2063–2069) 100·0 ( 100·0–100·0) 2048 ( 2046–2049) 100·0 ( 100·0–100·0) 2068 ( 2066–2074) Latin America and Caribbean ( n=5) Vaccination only26·8 ( 25·6–27·0) 21·4 ( 18·9–21·9) 3·0 ( 2·7–3·7) 18·3 ( 18·2–20·3) 88·8 ( 84·1–90·1) 80·0 ( 80·0–80·0) X ( X–X) 100·0 ( 100·0–100·0) 2070 ( 2070–2071) 100·0 ( X-100·0) 2091 ( 2086- X) Vaccination and one lifetime screen26·8 ( 25·8–27·0) 16·5 ( 15·3–16·7) 1·5 ( 1·3–3·0) 37·8 ( 33·7–38·5) 94·5 ( 87·0–95·2) 100·0 ( 80·0–100·0) 2079 ( 2074–X) 100·0 ( 100·0–100·0) 2065 ( 2061–2066) 100·0 ( 100·0–100·0) 2079 ( 2077–2099) Vaccination and two lifetime screens26·8 ( 25·7–26·8) 13·3 ( 13·2–14·3) 1·1 ( 1·0–2·6) 46·6 ( 43·1–50·3) 96·0 ( 88·9–96·4) 100·0 ( 100·0–100·0) 2073 ( 2069–2089) 100·0 ( 100·0–100·0) 2057 ( 2056–2058) 100·0 ( 100·0–100·0) 2076 ( 2072–2094) North Africa and Middle East ( n=7) Vaccination only6·8 ( 6·5–6·8) 6·1 ( 5·2–6·4) 0·8 ( 0·5–0·9) 8·2 ( 6·9–10·5) 88·5 ( 84·9–92·9) 100·0 ( 100·0–100·0) 2081 ( 2076–2081) 100·0 ( 100·0–100·0) 2062 ( 2061–2066) 100·0 ( 71·4–100·0) 2090 ( 2085- X) Vaccination and one lifetime screen6·8 ( 6·5–6·9) 5·2 ( 4·5–5·2) 0·3 ( 0·3–0·7) 23·8 ( 21·3–23·9) 95·0 ( 87·5–95·9) 100·0 ( 100·0–100·0) 2073 ( 2073–2078) 100·0 ( 100·0–100·0) 2058 ( 2057–2058) 100·0 ( 100·0–100·0) 2081 ( 2080–2097) Vaccination and two lifetime screens6·8 ( 6·5–6·9) 4·1 ( 3·8–4·4) 0·2 ( 0·2–0·6) 35·7 ( 34·1–39·6) 96·6 ( 90·1–97·2) 100·0 ( 100·0–100·0) 2068 ( 2068–2074) 100·0 ( 100·0–100·0) 2050 ( 2048–2051) 100·0 ( 100·0–100·0) 2079 ( 2077–2094) South Asia ( n=7) Vaccination only15·5 ( 14·6–15·5) 13·3 ( 11·3–13·8) 1·4 ( 1·1–1·5) 12·3 ( 10·9–14·6) 91·3 ( 88·3–92·8) 100·0 ( 100·0–100·0) 2074 ( 2072–2077) 100·0 ( 100·0–100·0) 2060 ( 2058–2061) 100·0 ( 100·0–100·0) 2087 ( 2082–2092) Vaccination and one lifetime screen15·5 ( 14·6–15·6) 10·8 ( 9·2–11·0) 0·7 ( 0·6–1·2) 28·9 ( 28·3–30·7) 95·8 ( 90·8–96·2) 100·0 ( 100·0–100·0) 2070 ( 2069–2071) 100·0 ( 100·0–100·0) 2053 ( 2053–2054) 100·0 ( 100·0–100·0) 2079 ( 2079–2087) Vaccination and two lifetime screens15·5 ( 14·6–15·6) 8·6 ( 7·6–9·3) 0·4 ( 0·4–0·9) 40·6 ( 40·4–44·6) 97·1 ( 92·9–97·3) 100·0 ( 100·0–100·0) 2063 ( 2063–2065) 100·0 ( 100·0–100·0) 2046 ( 2046–2049) 100·0 ( 100·0–100·0) 2074 ( 2074–2082) Sub-Saharan Africa ( n=41) Vaccination only37·4 ( 37·4–38·7) 33·6 ( 33·0–37·5) 4·9 ( 4·5–6·7) 10·7 ( 10·0–11·7) 87·0 ( 84·1–87·9) 26·8 ( 24·4–36·6) X ( X–X) 97·6 ( 78·0–100·0) X ( 2096–X) 75·6 ( X-97·6) X ( X–X) Vaccination and one lifetime screen37·4 ( 37·4–38·6) 27·2 ( 27·1–31·5) 2·2 ( 2·0–5·5) 27·4 ( 25·0–27·5) 94·1 ( 87·0–94·7) 92·7 ( 26·8–95·1) X ( X–X) 100·0 ( 90·2–100·0) 2090 ( 2082–X) 100·0 ( 100·0–100·0) 2085 ( 2079–2100) Vaccination and two lifetime screens37·5 ( 37·4–38·8) 22·7 ( 21·0–26·7) 1·4 ( 1·4–4·4) 39·4 ( 36·5–43·9) 96·3 ( 89·6–96·4) 100·0 ( 43·9–100·0) 2098 ( 2097–X) 100·0 ( 97·6–100·0) 2085 ( 2078–X) 100·0 ( 100·0–100·0) 2081 ( 2073–2094) Data are median ( range) predictions from three dynamic models. Equilibrium occurs 90–100 years after the introduction of human papillomavirus ( HPV) vaccination only ( and earlier for the screening scenarios). X=elimination not reached in all countries in the income or regional group. Girls-only vaccination refers to vaccination coverage of 90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime cervical screening. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. Open table in a new tab
Average age-standardised cervical cancer incidence per 100 000 women-years ( A) and relative reduction in incidence ( B) after HPV vaccination and screening ramp-up in low-income and lower-middle-income countries. Median prediction from the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. Equilibrium occurs 90–100 years after the introduction of HPV vaccination only ( and earlier for the screening scenarios). HPV=human papillomavirus.
Data are median ( range) predictions from three dynamic models. Equilibrium occurs 90–100 years after the introduction of human papillomavirus ( HPV) vaccination only ( and earlier for the screening scenarios). X=elimination not reached in all countries in the income or regional group. Girls-only vaccination refers to vaccination coverage of 90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime cervical screening. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%.
The predicted dynamics of cervical cancer incidence following HPV vaccination only, and for HPV vaccination with once-lifetime or twice-lifetime screening, were very similar for the three models ( figure 2). Additionally, although the age-standardised cervical cancer incidence in 2020 varied widely by country income level and region ( figure 2; appendix p 5), the models predicted that the post-intervention dynamics and percentage reduction in cervical cancer incidence will be similar ( figure 2, table). For example, the predicted percentage reduction in cervical cancer following HPV vaccination only varied from 87% ( range 84–88) in sub-Saharan Africa to 91% ( 88–93) in South Asia, and percentage reductions following HPV vaccination with twice-lifetime screening varied from 96% ( 90–96) in sub-Saharan Africa to 97% ( 93–97) in South Asia. However, the models predicted that age-standardised cervical cancer incidence following HPV vaccination with or without screening will vary greatly between regions and countries because of the large heterogeneity in the starting incidence ( figure 2, table), which contributed to variability between countries in the potential for and timing of elimination.Figure 2Variability in model predictions of the impact of HPV vaccination and screening strategiesShow full captionThe average age-standardised cervical cancer incidence per 100 000 women-years over time in low-income countries and lower-middle-income countries, by World Bank income level ( A) and region ( B). The solid line represents the median prediction and shaded area represents the minimum and maximum predictions of the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV types 16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. Equilibrium occurs 90–100 years after the introduction of HPV vaccination only ( and earlier for the screening scenarios). HPV=human papillomavirus.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
The average age-standardised cervical cancer incidence per 100 000 women-years over time in low-income countries and lower-middle-income countries, by World Bank income level ( A) and region ( B). The solid line represents the median prediction and shaded area represents the minimum and maximum predictions of the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV types 16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. Equilibrium occurs 90–100 years after the introduction of HPV vaccination only ( and earlier for the screening scenarios). HPV=human papillomavirus.
With the base-case elimination threshold ( four or fewer cases per 100 000 women-years), the CCEMC models predicted that girls-only HPV vaccination could lead to cervical cancer elimination in 60% ( range 58–65) of LMICs, HPV vaccination with once-lifetime screening could lead to elimination in 96% ( 60–97) of LMICs, and HPV vaccination with twice-lifetime screening could lead to elimination in 100% ( 71–100) of LMICs ( figure 3, table). HPV vaccination alone was predicted to result in elimination in all regions in the world, except for sub-Saharan Africa, where 27% ( range 24–37) of countries would reach elimination, and Latin America and Caribbean, where 80% ( 80–80) of countries would reach elimination. The countries that were not predicted to reach elimination through HPV vaccination alone were those with an age-standardised cervical cancer incidence of more than 25 cases per 100 000 women-years in 2020 ( figure 4, appendix p 7). These same countries were predicted to have the greatest absolute reductions in cervical cancer incidence following HPV vaccination ( figure 4). Importantly, for these countries, mainly in sub-Saharan Africa, once-lifetime or twice-lifetime screening was required to achieve elimination. Country-specific and model-specific predictions of elimination and the age-specific cervical cancer incidence at equilibrium are shown in the appendix ( p 7).Figure 3Global map of cervical cancer elimination in 78 low-income and lower-middle-income countriesShow full captionAge-standardised incidence of cervical cancer at equilibrium ( 2100–20), assuming status quo ( A), girls-only vaccination ( B), and girls-only vaccination and two lifetime screens ( C). Median prediction from the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58.Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. See videos 1–3 for the global maps of cervical cancer elimination over time and the appendix ( p 6) for the change in the distribution of the country-specific age-standardised cervical cancer incidence over time. HPV=human papillomavirus.View Large Image Figure ViewerDownload Hi-res image Download ( PPT) Figure 4Impact of current cervical cancer incidence on elimination predictionsShow full captionThe age-standardised incidence of cervical cancer ( A) and relative ( B) and absolute ( C) reduction in incidence at equilibrium ( 2100–20) following vaccination and screening, as a function of initial age-standardised incidence of cervical cancer for each low-income and lower-middle-income country. Median prediction from the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. HPV=human papillomavirus.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
Age-standardised incidence of cervical cancer at equilibrium ( 2100–20), assuming status quo ( A), girls-only vaccination ( B), and girls-only vaccination and two lifetime screens ( C). Median prediction from the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58.Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. See videos 1–3 for the global maps of cervical cancer elimination over time and the appendix ( p 6) for the change in the distribution of the country-specific age-standardised cervical cancer incidence over time. HPV=human papillomavirus.
The age-standardised incidence of cervical cancer ( A) and relative ( B) and absolute ( C) reduction in incidence at equilibrium ( 2100–20) following vaccination and screening, as a function of initial age-standardised incidence of cervical cancer for each low-income and lower-middle-income country. Median prediction from the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. HPV=human papillomavirus.
The models predicted that among the regions that can achieve elimination ( four or fewer cases per 100 000 women-years) with girls-only HPV vaccination alone, elimination will occur between 2074 and 2102 ( table). Adding twice-lifetime screening was predicted to accelerate elimination by 11–31 years. In sub-Saharan Africa, where both HPV vaccination and twice-lifetime screening are required to achieve elimination, elimination is predicted to occur slightly before 2100 ( table). Country-specific and model-specific predictions of the year of elimination are provided in the appendix ( p 8).
The CCEMC models predicted that girls-only HPV vaccination could lead to cervical cancer elimination in 99% ( range 89–100) of LMICs based on a threshold of ten or fewer cases per 100 000 women-years, and in 87% ( 37–99) of LMICs based on a threshold of an 85% or greater reduction ( table; figure 3; figure 4). Adding once or twice-lifetime screening was predicted to result in cervical cancer elimination for 100% of LMICs under both thresholds. Elimination was also predicted to occur faster with these thresholds ( table).
The CCEMC models predicted that 21·3 million ( range 20·7–21·3) cervical cancer cases will occur in LMICs between 2020 and 2060 without further interventions ( status quo). During the same period, including girls-only HPV vaccination with 90% coverage was predicted to avert 3·2 million ( 3·0–3·6) cervical cancer cases; adding once-lifetime screening to vaccination was predicted to avert an extra 2·2 million ( 1·8–2·7) cases, and adding twice-lifetime screening was predicted to avert an extra 4·6 million ( 3·9–4·8) cancer cases ( figure 5; appendix pp 2–4). Hence, in the short to medium term ( < 40 years), adding screening could more than double the number of cervical cancer cases averted in LMICs ( vs HPV vaccination alone). In the longer term, the models predicted that 93·5 million ( 93·5–95·3) cervical cancer cases will occur in LMICs between 2020 and 2120 without further scale-up of HPV vaccination or cervical screening ( ie, the status quo scenario). During this period, including girls-only HPV vaccination with 90% coverage was predicted to avert 61·0 million ( 60·5–63·0) cervical cancer cases; adding once-lifetime screening to vaccination was predicted to avert an extra 6·8 million ( 4·3–9·4) cases and adding twice-lifetime screening was predicted to avert an extra 12·1 million ( 9·5–13·7) cervical cancer cases ( figure 5; appendix pp 2–4). Overall, an estimated 74·1 million ( 70·4–75·1) cases would be averted by 2120 through intensive scale-up of girls-only HPV vaccination with twice-lifetime screening. Predictions of the number of cervical cancer cases averted over time were similar for the three models, at the global and regional levels ( appendix p 9).Figure 5Cervical cancer cases avertedShow full captionCumulative cases averted by girls-only vaccination or girls-only vaccination plus screening, and incremental cases averted by screening in addition to vaccination over time, for lower-middle-income countries ( A), low-income countries ( B), and by region ( C). Median prediction from the three models. Error bars represent the minimum and maximum estimates from the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV types 16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. HPV=human papillomavirus.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
Cumulative cases averted by girls-only vaccination or girls-only vaccination plus screening, and incremental cases averted by screening in addition to vaccination over time, for lower-middle-income countries ( A), low-income countries ( B), and by region ( C). Median prediction from the three models. Error bars represent the minimum and maximum estimates from the three models. Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV types 16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. HPV=human papillomavirus.
Most cervical cancer cases averted through HPV vaccination and screening in LMICs were predicted to be among women living in sub-Saharan Africa ( figure 5; appendix pp 2–4). For example, our models predicted that HPV vaccination and twice-lifetime screening will avert 49·9 million ( range 49·5–50·9) cases in sub-Saharan Africa over the next century, which represents about 70% of all cases averted in LMICs.
The sensitivity analysis suggests that a small reduction in HPV vaccination coverage from 90% to 80% would have little impact on the decline in cervical cancer incidence in the first 30 years following girls-only HPV vaccination ( without screening), but would lead to slightly higher long-term incidence ( appendix pp 10–11). Hence, some LMICs that can eliminate cervical cancer with 90% vaccination coverage ( using the threshold of four or fewer cases per 100 000 women-years) might not with 80% coverage ( eg, countries with current age-standardised cervical cancer incidence of 20–25 cases per 100 000 women-years). In general, if HPV vaccination coverage was high among girls, vaccinating boys was predicted to produce very small incremental gains in cervical cancer prevention ( appendix pp 10–11). For example, the CCEMC models predicted that girls-only HPV vaccination with 90% coverage would produce the same reduction in cervical cancer incidence as vaccinating both girls and boys at 80% coverage. Hence, vaccinating boys in addition to girls would not be sufficient to help countries with the highest age-standardised cervical cancer incidence ( eg, Uganda) reach the elimination threshold of four or fewer cases per 100 000 women-years. Finally, the models predicted that multi-age cohort vaccination up to age 25 years would substantially accelerate the declines in cervical cancer incidence, but would not change cervical cancer incidence at equilibrium ( appendix pp 10–11). Thus, vaccinating older cohorts of girls or women would not ultimately change the potential for elimination.
A sensitivity analysis examining the impact of screening suggests that although twice-lifetime screening without HPV vaccination would substantially reduce cervical cancer incidence, the age-standardised cervical cancer incidence would remain higher than four cases per 100 000 women-years in the countries examined ( appendix pp 10–11). Hence, HPV vaccination is required for most LMICs to reach cervical cancer elimination. In the context of high-coverage girls-only vaccination, adding a third lifetime screen ( to HPV vaccination and twice-lifetime screening) was predicted to provide very small additional gains in cervical cancer prevention, and only slightly accelerated time to elimination.
Finally, our sensitivity analysis showed that the duration of protection and the number of types included in the HPV vaccine can affect whether girls-only HPV vaccination with twice-lifetime screening leads to cervical cancer elimination ( appendix pp 10–11). When assuming 20 years of vaccine protection ( instead of lifelong), the models predicted that the age-standardised cervical cancer incidence would be higher than four cases per 100 000 women-years in the countries examined. Thus, a long-term duration of vaccine protection ( > 20 years) is required to reach elimination in LMICs. The models predicted that cervical cancer elimination might be possible in LMICs with an age-standardised incidence of fewer than 25 cases per 100 000 women-years ( eg, Vietnam) by use of a vaccine that includes only HPV types 16 and 18. However, for LMICs with the highest cervical cancer incidence ( eg, Uganda), broad-spectrum protection against HPV types 16, 18, 31, 33, 45, 52, and 58 was predicted to be required for these countries to reach elimination.
Elimination was generally easier to achieve under the different scenarios examined in the sensitivity analysis with the thresholds of fewer than ten cases per 100 000 women-years and 85% or greater reduction. The models predicted that all vaccination strategies will achieve elimination, except for girls-only vaccination with 80% coverage. Twice-lifetime screening ( without vaccination) could also potentially lead to elimination with these thresholds in LMICs that have an age-standardised cervical cancer incidence of less than 25 cases per 100 000 women-years ( eg, Vietnam).
Our comparative modelling analysis, which includes projections from three independent transmission-dynamic models, provides consistent results predicting that cervical cancer can be eliminated as a public health problem by the end of the century, based on WHO's proposed elimination threshold ( ie, cervical cancer incidence of four or fewer cases per 100 000 women-years). Our modelling study shows that girls-only HPV vaccination would lead to cervical cancer elimination in most LMICs, if high coverage is reached ( > 90% coverage) and the vaccine provides long-term protection. However, countries with the highest cervical cancer incidence at present ( > 25 cases per 100 000 women-years), more than 90% of which are in sub-Saharan Africa, would not reach elimination by vaccination alone. To achieve cervical cancer elimination in all 78 LMICs, our models predict that scale-up of both girls-only HPV vaccination and twice-lifetime screening is necessary, with 90% HPV vaccination coverage, 90% screening uptake, and long-term protection against HPV types 16, 18, 31, 33, 45, 52, and 58. If this global elimination strategy of combined intensive scale-up of HPV vaccination and cervical screening can be achieved, our results suggest that cervical cancer elimination could be achieved in all countries by 2100. In doing so, cervical cancer incidence would be reduced by 97% and more than 74 million cases would be averted over the next century.
In January, 2019, the Executive Board of WHO requested the Director-General to lead the development of a draft global strategy to accelerate cervical cancer elimination, with clear targets for 2030.24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar The draft global strategy will be presented for consideration at the World Health Assembly in May, 2020. The results presented in this study were used to help inform the following key elements of the global strategy: the cervical cancer elimination threshold, the intervention strategies needed to achieve global elimination, and the 2030 targets towards global elimination.
Elimination of cervical cancer requires a clear and commonly agreed upon threshold, under which cervical cancer would no longer be considered a public health problem.24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar Establishment of this threshold thus requires a careful and informed process, as it is more complex than the definition of elimination ( or eradication) of an infectious disease, which is simply reduction to zero incidence. The proposed threshold of four or fewer cases per 100 000 women-years was established on the basis of the definition of a rare cancer,44Rare cancers EuropeAbout rare cancers.https: //www.rarecancerseurope.org/About-Rare-CancersDate accessed: November 6, 2019Google Scholar on the global distribution of cervical cancer incidence showing that this threshold is currently reached in only a few countries ( compared with many countries reaching ten or fewer cases per 100 000),42Ferlay J Ervik M Lam F et al.Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon, France2018https: //gco.iarc.fr/todayDate accessed: October 24, 2019Google Scholar as well as on our modelling results ( and those of Simms and colleagues34Simms KT Steinberg J Caruana M et al.Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study.Lancet Oncol. 2019; 20: 394-407Summary Full Text Full Text PDF PubMed Scopus ( 129) Google Scholar) showing that cervical cancer elimination can be achieved in every country with this threshold. In this study, we examined the consequences of using alternative thresholds ( ten or fewer cases per 100 000 women-years and ≥85% reduction), which were proposed during various WHO meetings and consultations,24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar on the achievability and timing of elimination in LMICs for different prevention strategies and country characteristics. Our results show that intensive scale-up of both HPV vaccination and twice-lifetime screening would eliminate cervical cancer in all LMICs for all thresholds investigated.
However, the choice of threshold can produce disparities in the effort required by countries to achieve elimination. For example, based on the threshold or ten or fewer cases per 100 000 women-years, only 1% of LMICs were unable to achieve elimination through HPV vaccination alone. By contrast, based on the proposed threshold of four or fewer cases per 100 000 women-years, 40% of LMICs were unable to achieve elimination through vaccination alone. These countries have the highest burden of cervical cancer ( incidence > 25 per 100 000 women-years) and are mostly in sub-Saharan Africa. For these countries, up to 90% uptake of twice-lifetime screening is required, in addition to vaccination, to reach the proposed elimination threshold. More generally, our results indicate that elimination will be hardest to achieve in countries with the highest burden of cervical cancer and lowest income level. Considerable financial and political international commitment is needed so that HPV vaccination and cervical screening resources can be prioritised for these countries, not only to achieve global elimination but also to reduce the enormous disparities in the worldwide cervical cancer burden. This is particularly important since current HPV vaccination and cervical screening uptake is very low in most low-income and sub-Saharan African countries.2PATHGlobal HPV Vaccine Introduction Overview: projected and current national introductions, demonstration/pilot projects, gender-neutral vaccination programs, and global HPV vaccine introduction maps ( 2006–2022).https: //www.path.org/resources/global-hpv-vaccine-introduction-overview/Date: November, 2019Date accessed: January 9, 2020Google Scholar, 3WHOImmunization, vaccines and biologicals: data, statistics and graphics.https: //www.who.int/immunization/monitoring surveillance/data/en/Date accessed: December 18, 2019Google Scholar, 4Gakidou E Nordhagen S Obermeyer Z Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities.PLoS Med. 2008; 5: e132Crossref PubMed Scopus ( 328) Google Scholar, 5Riley L Monitoring cervical cancer: screening and treatment coverage. Presentation using the WHO Steps Survey ( cervical cancer screening).https: //apps.who.int/iris/handle/10665/275391Date: 2019Date accessed: December 18, 2019Google Scholar
Partly based on the CCEMC projections presented here and the considerations described above, WHO has proposed the following triple-intervention global cervical cancer elimination strategy: intensive scale-up of girls-only HPV vaccination, twice-lifetime screening, and treatment of cancer and precancers.24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar The 2030 targets for this strategy are for 90% of girls to be fully vaccinated, for 70% of women to be screened at 35 years and 45 years of age, and for 90% of women diagnosed with cervical precancer or cancer to receive treatment or care. Our findings suggest that to achieve global elimination by the end of the century, these targets need to be met in the countries with the highest burden of cervical cancer, and these countries also need to be supported to scale up twice-lifetime screening from 70% to 90% by 2045. Although we show that many LMICs could achieve elimination with HPV vaccination alone, the triple-intervention strategy was chosen as the global elimination strategy as it would accelerate elimination by 11–31 years and prevent an additional 12 million cervical cancer cases over the next century ( compared with vaccination alone). Furthermore, combining cervical screening with HPV vaccination has been predicted to be cost-effective across several LMICs.20Campos NG Sharma M Clark A et al.The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries.Int J Gynaecol Obstet. 2017; 138: 47-56Crossref PubMed Scopus ( 25) Google Scholar, 21Campos NG Tsu V Jeronimo J Mvundura M Lee K Kim JJ When and how often to screen for cervical cancer in three low- and middle-income countries: a cost-effectiveness analysis.Papillomavirus Res. 2015; 1: 38-58Crossref Scopus ( 30) Google Scholar, 22Canfell K Shi JF Lew JB et al.Prevention of cervical cancer in rural China: evaluation of HPV vaccination and primary HPV screening strategies.Vaccine. 2011; 29: 2487-2494Crossref PubMed Scopus ( 61) Google Scholar The CCEMC is currently examining the incremental cost-effectiveness of the triple-intervention cervical cancer elimination strategy at the global level. Importantly, the proposed global cervical cancer elimination strategy provides general direction about the country-specific strategies that should be used, which should be customised to country-specific epidemiological, economic, and social contexts. For example, countries might want to scale up vaccination and screening at different ages than those modelled, because of logistical issues or to maximise uptake.
The base-case vaccination-only strategy examined in the comparative-model analysis was routine girls-only HPV vaccination at age 9 years with a 1-year multi-age cohort catch-up for girls aged 10–14 years. This strategy was chosen as it is the recommended strategy by the WHO Strategic Advisory Group of Experts on Immunization ( SAGE) 41WHOImmunization, vaccines and biologicals: human papillomavirus ( HPV).https: //www.who.int/immunization/diseases/hpv/en/Date accessed: November 6, 2019Google Scholar and a large body of evidence shows that it is highly cost-effective in LMICs and high-income countries.17Jit M Brisson M Portnoy A Hutubessy R Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study.Lancet Glob Health. 2014; 2: e406-e414Summary Full Text Full Text PDF PubMed Scopus ( 132) Google Scholar, 19Fesenfeld M Hutubessy R Jit M Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review.Vaccine. 2013; 31: 3786-3804Crossref PubMed Scopus ( 78) Google Scholar, 31Brisson M Laprise JF Drolet M et al.Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study.Vaccine. 2013; 31: 3863-3871Crossref PubMed Scopus ( 43) Google Scholar, 32Burger EA Campos NG Sy S Regan C Kim JJ Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country.Vaccine. 2018; 36: 4823-4829Crossref PubMed Scopus ( 19) Google Scholar However, given the recent worldwide shortage of vaccine supply, SAGE recommended in October, 2019, that multi-age cohort catch-up vaccination for girls aged 10–14 years should be postponed to alleviate the demand for vaccine doses in the coming years. The recommended WHO alternative strategies are variants of our base-case vaccination-only strategy: routine vaccination of girls aged 14 years, with a later switch to routine vaccination at an earlier age ( eg, 9 years); and routine vaccination at age 9 years, with an extended interval of 3–5 years between doses.45WHOMeeting of the Strategic Advisory Group of Experts on Immunization, October 2019: conclusions and recommendations.Wkly Epidemiol Rec. 2019; 94: 541-560Google Scholar The recommendations were partly based on results from HPV-ADVISE showing that these strategies would produce similar benefits to girls-only vaccination at age 9 years with a 1-year catch-up for girls aged 10–14 years.46Brisson M Jit M Bénard É et al.Optimal HPV immunization strategies in the context of limited resources & vaccine supply. WHO-SAGE meeting.https: //www.who.int/immunization/sage/meetings/2019/october/brisson hpv sage october 2019.pdfDate: Oct 9, 2019Date accessed: January 22, 2020Google Scholar Implementation of these alternative strategies would alleviate vaccine supply to allow sufficient doses for all LMICs to reach 90% coverage within the next few years.45WHOMeeting of the Strategic Advisory Group of Experts on Immunization, October 2019: conclusions and recommendations.Wkly Epidemiol Rec. 2019; 94: 541-560Google Scholar Hence, assuming countries follow SAGE recommendations, the HPV vaccine shortage should have little long-term impact on our projections of time to elimination provided supply constraints are relieved over the next decade. In our sensitivity analysis, we examined the impact of gender-neutral and multi-age cohort vaccination up to 25 years of age on cervical cancer incidence over time. Because our models predict that 90% girls-only vaccination can almost eliminate HPV vaccine types, the incremental benefits of vaccinating boys on cervical cancer incidence were predicted to be small. Multi-age cohort vaccination up to 25 years of age was predicted to substantially accelerate elimination and avert additional cervical cancer cases but would have no effect on whether a country reaches elimination, which is only determined by long-term routine vaccination coverage. Given their low incremental impact in relation to the number of doses required, WHO recommended that countries should temporarily postpone the implementation of gender-neutral and multi-age cohort HPV vaccination strategies, to maximise the number of countries that can introduce vaccination.45WHOMeeting of the Strategic Advisory Group of Experts on Immunization, October 2019: conclusions and recommendations.Wkly Epidemiol Rec. 2019; 94: 541-560Google Scholar
The two base-case screening strategies examined, primary HPV screen-and-treat testing with once-lifetime and twice-lifetime screening, were chosen as they are the recommended strategies by WHO.40WHOEarly diagnosis and screening: cervical cancer.https: //www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/Date accessed: November 6, 2019Google Scholar These screening scenarios were meant to represent a wide range of validated HPV tests and future screening tests, given their high sensitivity and specificity ( see Canfell, Kim, Brisson and colleagues27Canfell K Kim JJ Brisson M et al.Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries.Lancet. 2020; ( published online Jan 30.) https: //doi.org/10.1016/S0140-6736 ( 20) 30157-4Summary Full Text Full Text PDF Scopus ( 91) Google Scholar for an in-depth discussion of the screening strategies). Our results suggest that including screening in addition to HPV vaccination would substantially increase the number of cervical cancer cases averted and would accelerate elimination, mainly by preventing cases in older, unvaccinated women. Additionally, cervical cancer elimination can be achieved in all but three LMICs ( in sub-Saharan Africa) with once-lifetime screening and in all LMICs with twice-lifetime screening. This is because even if HPV vaccination were to eradicate HPV types 16, 18, 31, 33, 45, 52, and 58, a proportion of LMICs ( mainly in sub-Saharan Africa) would still have cervical cancer incidence greater than the threshold of four cases per 100 000 women-years; about 10% of cervical cancers are due to HPV types that are not in the currently available HPV vaccines10Serrano B Alemany L Tous S et al.Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease.Infect Agent Cancer. 2012; 7: 38Crossref PubMed Scopus ( 210) Google Scholar and many countries have cervical cancer incidence higher than 40 cases per 100 000 women-years.1Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Crossref PubMed Scopus ( 33665) Google Scholar For these countries, high cervical screening uptake will have to be sustained for elimination to be maintained ( or additional types would have to be included in future HPV vaccines). Finally, in the sensitivity analysis, we predicted relatively small additional gains in cervical cancer prevention by including a third lifetime screen.
Our study has two major strengths. First, we used a comparative modelling approach including three models that have been extensively peer reviewed and validated with post-vaccination surveillance data.30Van de Velde N Boily MC Drolet M et al.Population-level impact of the bivalent, quadrivalent, and nonavalent human papillomavirus vaccines: a model-based analysis.J Natl Cancer Inst. 2012; 104: 1712-1723Crossref PubMed Scopus ( 103) Google Scholar, 31Brisson M Laprise JF Drolet M et al.Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study.Vaccine. 2013; 31: 3863-3871Crossref PubMed Scopus ( 43) Google Scholar, 32Burger EA Campos NG Sy S Regan C Kim JJ Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country.Vaccine. 2018; 36: 4823-4829Crossref PubMed Scopus ( 19) Google Scholar, 33Campos NG Burger EA Sy S et al.An updated natural history model of cervical cancer: derivation of model parameters.Am J Epidemiol. 2014; 180: 545-555Crossref PubMed Scopus ( 68) Google Scholar, 34Simms KT Steinberg J Caruana M et al.Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study.Lancet Oncol. 2019; 20: 394-407Summary Full Text Full Text PDF PubMed Scopus ( 129) Google Scholar, 35Lew JB Simms KT Smith MA et al.Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program.Lancet Public Health. 2017; 2: e96-e107Summary Full Text Full Text PDF PubMed Scopus ( 87) Google Scholar, 36Smith MA Canfell K Brotherton JM Lew JB Barnabas RV The predicted impact of vaccination on human papillomavirus infections in Australia.Int J Cancer. 2008; 123: 1854-1863Crossref PubMed Scopus ( 48) Google Scholar Without harmonising the model structure or parameters, the three models produced very similar results in terms of absolute and relative reductions in cervical cancer incidence and cancer cases averted over time following HPV vaccination and cervical screening by country, income level, and region. Our results are consistent in part because the key drivers of our predictions ( eg, achievability and timing of elimination) are country-specific baseline cervical cancer incidence and percentage of cancers due to the HPV vaccine types, which were based on the same data sources.1Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Crossref PubMed Scopus ( 33665) Google Scholar, 10Serrano B Alemany L Tous S et al.Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease.Infect Agent Cancer. 2012; 7: 38Crossref PubMed Scopus ( 210) Google Scholar However, the results were not sensitive to the main differences between our models, which were the sexual behaviour components. At high HPV vaccination coverage and vaccine efficacy, our models predicted similar dynamics and herd effects across the different LMICs, even though sexual behaviour varies substantially. Although we could not directly compare our results to other HPV transmission-dynamic models in LMICs because of the scarcity of such models and their incompatibility in intervention scenarios, a previous systematic comparison of 16 HPV models in high-income countries ( including the three CCEMC models) showed consistent predictions of the population-level impact of HPV vaccination when coverage is high.47Brisson M Bénard E Drolet M et al.Population-level impact, herd immunity and elimination after HPV vaccination: a systematic review and meta-analysis of predictions of transmission-dynamic models.Lancet Public Health. 2016; 1: e8-e17Summary Full Text Full Text PDF PubMed Scopus ( 135) Google Scholar Second, key knowledge users from WHO were involved in all aspects of the study, from its design to interpretations of findings. Additionally, the modelling results were presented and discussed at multiple WHO advisory group and global stakeholder meetings.24WHODraft: global strategy towards eliminating cervical cancer as a public health problem.https: //www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf? sfvrsn=8a083c4e 0Date: Dec 16, 2019Date accessed: December 19, 2019Google Scholar, 39WHOImmunization and Vaccine-related Implementation Research Advisory Committee ( IVIR-AC) recommendations. Sept 2018.Wkly Epidemiol Rec. 2019; 94: 5-16Google Scholar, 48WHOStrategic Advisory Group of Experts on Immunization. Working Group on human papillomavirus ( HPV) immunization—conclusions and recommendations.https: //www.who.int/immunization/sage/meetings/2018/october/3 SAGE2018 WG recommendation FINAL.pdf? ua=1Date: Sept 27–28, 2018Date accessed: September 9, 2019Google Scholar This process has ensured that the study was responsive to the needs of global policy decisions and, importantly, that those using the findings are aware of both its strengths and limitations.
Our study has four main limitations. First, our projections are for more than 100 years, a period over which substantial demographic and behavioural changes and technological development are anticipated that can have an impact on cervical cancer incidence.43UN Department of Economic and Social AffairsWorld population prospects: 2017 revision.https: //population.un.org/wpp/Download/Standard/Population/Date: 2017Date accessed: January 23, 2020Google Scholar, 49Baussano I Lazzarato F Brisson M Franceschi S Human papillomavirus vaccination at a time of changing sexual behavior.Emerg Infect Dis. 2016; 22: 18-23Crossref PubMed Scopus ( 15) Google Scholar Population growth and changes in life expectancy can have an important impact on our predictions of cervical cancer cases averted. When producing projections with low population predictions from the UN,43UN Department of Economic and Social AffairsWorld population prospects: 2017 revision.https: //population.un.org/wpp/Download/Standard/Population/Date: 2017Date accessed: January 23, 2020Google Scholar we estimated that 62 million cervical cancer cases would be averted with the triple-intervention global elimination strategy, and that 88 million cases would be averted with the UN's high population predictions, versus 74 million cases with base-case projections ( appendix p 12). However, given that the definition of elimination is based on age-standardised cervical cancer incidence, demographic changes are expected to have minimal impact on our predictions of the achievability and timing of elimination. Sexual behaviour has been changing in many LMICs, from a more traditional pattern of sexual behaviour, with a lower reported number of lifetime partners and wider age gaps between partners, to a more sex-similar pattern of behaviour, where both sexes have a similar and higher number of partners and narrow age gaps. In these countries ( mainly in Asia), age-adjusted HPV infection and cervical cancer rates might be increasing,49Baussano I Lazzarato F Brisson M Franceschi S Human papillomavirus vaccination at a time of changing sexual behavior.Emerg Infect Dis. 2016; 22: 18-23Crossref PubMed Scopus ( 15) Google Scholar and thus time to elimination might be slightly longer than predicted. Technological developments should not have major implications for our predictions, as we assumed 100% vaccine efficacy, high screening test sensitivity and specificity, and 100% treatment efficacy. Second, we assumed intensive scale-up and 90% uptake of HPV vaccination and cervical screening. These assumptions are based on data suggesting that worldwide coverage of measles, poliomyelitis, hepatitis B, and diphtheria-tetanus-pertussis vaccines have reached 84–90% ( ≥90% in many LMICs) 50WHOGlobal Health Observatory ( GHO) data.https: //www.who.int/gho/immunization/enDate accessed: December 19, 2019Google Scholar and that more than 90% of women in high-income countries are screened for cervical cancer at least once in their lifetime.4Gakidou E Nordhagen S Obermeyer Z Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities.PLoS Med. 2008; 5: e132Crossref PubMed Scopus ( 328) Google Scholar If scale-up is slower than modelled, this would delay the predicted timing of elimination and reduce the number of cancer cases averted, but it would not affect whether or not elimination can be achieved. Thirdly, our models do not include plausible biological interactions between HIV and HPV ( eg, HPV acquisition and disease progression might be increased among people living with HIV).51Looker KJ Ronn MM Brock PM et al.Evidence of synergistic relationships between HIV and Human Papillomavirus ( HPV): systematic reviews and meta-analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status.J Int AIDS Soc. 2018; 21e25110Crossref PubMed Scopus ( 35) Google Scholar By not capturing such interactions, our models might overestimate the impact of HPV vaccination in high HIV prevalence settings ( five of 78 LMICs have HIV prevalence ≥10% 52WHOGlobal Health Observatory data repository. Number of people ( all ages) living with HIV, estimates by country.http: //apps.who.int/gho/data/view.main.22100? lang=enDate accessed: December 19, 2019Google Scholar). Specific prevention strategies might be required for people living with HIV to accelerate cervical cancer elimination in high HIV prevalence settings. Modelling work is ongoing as part of the CCEMC to examine these issues. Finally, our country-specific cervical cancer incidence data are based on GLOBOCAN estimates,42Ferlay J Ervik M Lam F et al.Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon, France2018https: //gco.iarc.fr/todayDate accessed: October 24, 2019Google Scholar, 53Ferlay J Colombet M Soerjomataram I et al.Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods.Int J Cancer. 2019; 144: 1941-1953Crossref PubMed Scopus ( 2456) Google Scholar which, where possible, are derived from extrapolation of recent trends in incidence obtained from national or subnational population-based cancer registries. If cervical cancer incidence is underestimated because of underreporting in these countries, elimination might take longer than predicted. There is an overwhelming need to strengthen population-based cancer surveillance in many LMICs to improve the accuracy of GLOBOCAN estimates, to inform local cancer control strategies, and to monitor whether elimination targets are being met.
In conclusion, our comparative modelling analysis suggests that cervical cancer elimination as a public health problem is possible by the end of the century, resulting in a 97% reduction in cervical cancer incidence in LMICs. To achieve elimination across all LMICs under the proposed threshold ( four or fewer cases per 100 000 women-years), both high HPV vaccination coverage and screening uptake will be necessary, particularly in countries with the highest burden. Considerable international commitment will be required to achieve WHO's triple-intervention targets, particularly in countries with the highest burden of cervical cancer, where scale-up of vaccination and screening resources are most urgently needed. Our results are being used by WHO to inform its global strategy to accelerate cervical cancer elimination, which will be presented at the World Health Assembly in May, 2020.
MB, JJK, and KC co-designed the study and co-led overall data interpretation. MB led the HPV-ADVISE analysis, JJK led the Harvard analysis, and KC led the Policy1-Cervix analysis. NB and RH also participated in study design. MD, EAB, EB, CR, KTS, and AK did the literature searches. MB, MD, GG, KTS, EB, CR, AK, M-CB, MA, FB, EF, PJNB, NB, RH, and DTNN participated in data collection and MB, JJK, KC, GG, KTS, AK, EAB, EB, DM, SS, CR, J-FL, MC, RH, FB, and NB participated in data analysis. MB, GG, MD, and EB produced the tables and figures. MB, JJK, and KC drafted the Article and RH coordinated the CCEMC. All authors interpreted the results and critically revised the manuscript for scientific content. All authors approved the final version of the Article.
MB, MD, GG, DM, EB, J-FL, JJK, EAB, SS, CR, and DTNN report grants from WHO during the conduct of the study. KC, AK, KTS, MC, and MAS report grants from the National Health and Medical Research Council Australia during the conduct of the study. KC and MC are investigators of an investigator-initiated trial of cervical screening in Australia ( Compass; ACTRN12613001207707 and NCT02328872), which is conducted and funded by the VCS Foundation, a government-funded health promotion charity; the VCS Foundation received equipment and a funding contribution from Roche Molecular Systems and Ventana USA but KC and MC ( or their institution on their behalf) do not receive direct funding from industry for this trial or any other project. MAS also reports grants from Cancer Institute NSW during the conduct of the study. M-CB, MJ, MA, FB, EF, FE, PJNB, NB, and RH declare no competing interests.
Where authors are identified as personnel of the International Agency for Research on Cancer or WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer or WHO. M-CB acknowledges Centre funding from the MRC Centre for Global Infectious Disease Analysis ( MRC-GIDA). This award is jointly funded by the UK Medical Research Council ( MRC) and the UK Department for International Development ( DFID) under the MRC/DFID Concordat agreement and is also part of the European and Developing Countries Clinical Trials Partnership ( EDCTP2) programme supported by the European Union ( MR/R015600/1).
Download.pdf ( 10.38 MB) Help with pdf files Supplementary appendix
eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJhOTEyMzg2ZjIzZGU1ZjMzNzZiY2UyZjNlNGZjZmRiZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjMzODIzMzE4fQ.Ee Ln9PEZNL7dZ Q7N 0wmfRkfj5A75RdAw986XzdJMXVeZm0kGdbsLHYqNwB8jBcUARozkZbRzHGY13fAnUZ-ynyZqaNMtV73JnApk uiCiOqkovhARS5Uyw0vGTQ3LrmNSNX12YExMwaNLHceDJ3bv9UIKNuwMdGGnzDMIFK0wSjK1Y2uwtRrghqDnfYrGbEbNcBiEH4AhyPAI-6tZaXFhRgmSDsY9SDCo1FyZhSKajO1p6Yn CB9vVy3manGM1VcLQEPhwb0YC-KUflZwd08SdwEQU5YLCOvxB5o94Z3mdUsSd2eDYAbTLrAVTgoI0kMGGCReu2rFIuX4sQQiPQ Download.mp4 ( 0.77 MB) Help with.mp4 files Supplementary Video 1Global map of cervical cancer elimination over time - Girls-only HPV vaccinationVideo shows the predicted change in the age-standardised incidence of cervical cancer over time in 78 low-income and lower-middle-income countries following the introduction of girls-only HPV vaccination. On the left hand side ( left legend), we present the change, over time, in the distribution of cervical cancer incidence by World Bank income level and region, percentage of countries reaching elimination, and year of elimination using the ≤4 per 100 000 women-years ( dark blue) and ≤10 per 100 000 women-years ( light blue) elimination thresholds. Results are the median prediction from the three Cervical Cancer Elimination Modelling Consortium ( CCEMC) models ( HPV-ADVISE, Harvard, and Policy1-Cervix). Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. HPV=human papillomavirus.Youtube url: https: //youtu.be/-KnLYrvNJAY
eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiZDAzYWI2YzkyMTkxNzhhODdhNTE1NmNjMDdhMWYyYyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjMzODIzMzE4fQ.bFuRcfAdWsK9NrY-VZB9irWl9vVW5IoptVI zAsid7arBo8VQqAbd6JS4zNxISpl-5qvPamvuEjJGEcP4v8Tit6Ir7LuIlLD9ZJxhIOgmF8GGaKldg6SU5u-g3pcdj0RNA6QYcbxvRxnTx he-jYtmMyJnydp2PutvHUL6NvvFwcdZlYqsCzdOepQdSpZ5YtjXkgcX66apYH9xFJVAeEZoMstjPWdLwpIicN6gjKz 6njW-RAaarXADL2YwwbuccxzAowME-ewubB29xyydYQz3QGbaGC7NIYMntPawCbdyf8YMpdIW9Qhh6kUyw5ais puGwyIGacDngC5 gDH0fw Download.mp4 ( 0.8 MB) Help with.mp4 files Supplementary Video 2Global map of cervical cancer elimination over time - Girls-only HPV vaccination & one lifetime screenVideo shows the predicted change in the age-standardised incidence of cervical cancer over time in 78 low-income and lower-middle-income countries following the introduction of girls-only HPV vaccination and scale-up of once lifetime screening. On the left hand side ( left legend), we present the change, over time, in the distribution of cervical cancer incidence by World Bank income level and region, percentage of countries reaching elimination, and year of elimination using the ≤4 per 100 000 women-years ( dark blue) and ≤10 per 100 000 women-years ( light blue) elimination thresholds. Results are the median prediction from the three Cervical Cancer Elimination Modelling Consortium ( CCEMC) models ( HPV-ADVISE, Harvard, and Policy1-Cervix). Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening at age 35 years. Screening=HPV testing. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. HPV=human papillomavirus.Youtube url: https: //youtu.be/rfHFEfGCDFk
eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIxZjQxNTU5M2Q0YTE0MWM2ZjIwZDM0OTc2OWYxYzQzNyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjMzODIzMzE4fQ.PmFp9r7fGwToybMQ9yrpQfUKAYSArdNDeLYr3zlNq8bh0Bssrz9KWgoSRafKwYroleUQoVirYTOPnz4-Ppbqwo39sHxU9u8QvAkEBrysY26sQV3NBjG1hYky92a05LLzrZ9M-Xosod8ND1b5CIc Ht LGjXKsw7FDvq Jq-sKVZ2t12KsgE8IuRocmwx9qb7wkOzRZgLxxumun6wPTXTIwOnn-ApfLMKmrgLRgIWSoqDRG0zmCfiyxCAE Ve2rUajFu TIbfxVbEdiXOvMDsDNK8r0PHBWzXjZWADYVG539my9MzfV8VQ3eJ9Dly4vHpi1HWB5MCV9WkePXvo5VLog Download.mp4 ( 0.79 MB) Help with.mp4 files Supplementary Video 3Global map of cervical cancer elimination over time - Girls-only HPV vaccination & two lifetime screensVideo shows the predicted change in the age-standardised incidence of cervical cancer over time in 78 low-income and lower-middle-income countries following the introduction of girls-only HPV vaccination and scale-up of twice lifetime screening. On the left hand side ( left legend), we present the change, over time, in the distribution of cervical cancer incidence by World Bank income level and region, percentage of countries reaching elimination, and year of elimination using the ≤4 per 100 000 women-years ( dark blue) and ≤10 per 100 000 women-years ( light blue) elimination thresholds. Results are the median prediction from the three Cervical Cancer Elimination Modelling Consortium ( CCEMC) models ( HPV-ADVISE, Harvard, and Policy1-Cervix). Vaccination coverage=90% at age 9 years ( and at ages 10–14 years in 2020). Vaccine efficacy=100% against HPV16, 18, 31, 33, 45, 52, and 58. Vaccine duration=lifetime. Screening at ages 35 years and 45 years. Screening uptake=45% ( 2023–29), 70% ( 2030–44), and 90% ( 2045 onwards). Screen and treat efficacy=100%. Loss to follow-up=10%. HPV=human papillomavirus.Youtube url: https: //youtu.be/FpiOn9Tp8Ss
Cervical cancer elimination: are targets useful? Cervical cancer is the most common cause of cancer-related deaths in women in 42 low-income and lower-middle-income countries ( LMICs),1 with the highest age-standardised incidence rates ( 40 cases per 100 000 women-years) occurring in 15 countries in sub-Saharan Africa.2 The gross disparity of the burden of this highly preventable disease, whereby 290 000 ( 51%) of the 570 000 new cases estimated to occur annually befall women in LMICs,1 has led many people to call attention to the need for urgent action. Full-Text PDF Department of ErrorHuang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; published online Jan 24. https: //doi.org/10.1016/S0140-6736 ( 20) 30183-5—In this Article, in Procedures, we have corrected the primer sequences for targeting the envelope gene of coronavirus; in the Summary and Data collection, we have corrected the text to reflect that the modified case record form for severe acute respiratory infection clinical characterisation was developed by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium ( ISARIC) together; we have updated the margin link to the ISARIC–WHO case record form; we have updated the Acknowledgments; and in the tables, we updated p values ( three in table 2 and one each in tables 1 and 3) so that they are all given to two significant figures. Full-Text PDF | tech |
Overwatch League cancels February and March games in China following coronavirus outbreak | The Overwatch League’ s plans for a truly global e-sports league have taken a major hit. Today, Blizzard announced that the China-based games taking place in February and March planned for the 2020 season have been canceled following the outbreak of the coronavirus. In a statement posted this evening to Twitter, the league explained that the decision was made to “ protect the health and safety of our players, fans, and staff. ”
“ We hope fans have a safe and happy Lunar New Year, and we remain incredibly excited to play Overwatch League matches in China later this season, ” the statement reads. “ We’ ll share more information about when and where the matches will take place at a later date. ”
pic.twitter.com/nLEPHrJZXS
The 2020 season of OWL was set to be the first in league history where each of the 20 teams hosted matches out of their home cities. The league features teams based in Asia, Europe, and North America, and there are currently four Chinese clubs — Shanghai, Chengdu, Hangzhou, and Guangzhou — each of which was expected to host at least two events. The first was slated for the second week of the season, starting February 15th in Shanghai.
Prior to today’ s news, most of the teams released their own statements outlining their plans for dealing with the outbreak. Both the Guangzhou Charge and Shanghai Dragons, for instance, moved their preseason operations to South Korea for safety reasons. The Overwatch League regular season is slated to kick off February 8th with games in both Dallas and New York.
OWL isn’ t the only e-sports league dealing with the fallout from the coronavirus. The League of Legends Pro League — arguably the biggest professional gaming circuit in the world — recently announced that it would postpone the competition “ until we can ensure the safety and health of our players and fans. ”
Related | tech |
Tesla says China has ordered its Shanghai factory shut down over coronavirus fears | The Chinese government has ordered the shutdown of Tesla’ s new factory in Shanghai over coronavirus fears, which will delay the company’ s production of the Model 3 there, executives announced in a call with investors. The ramp of the Model 3 production will be delayed by a week and a half and the shutdown may “ slightly ” impact the company’ s profitability in the first quarter of 2020, Tesla finance chief Zach Kirkhorn said.
“ At this point we’ re expecting a one to one-and-a-half week delay in the ramp of Shanghai-built Model 3s due to a government required factory shutdown, ” he said on the call. Tesla is one of several companies affected by the Chinese government’ s order, which requires facilities to remain shut down until February 9th.
Tesla began delivering the first cars produced at its Shanghai factory at the end of 2019. The deliveries marked an important milestone for Tesla, which hopes to use its Shanghai factory to gain a foothold in China, the world’ s largest market for electric vehicles. Having a local factory speeds up deliveries and may insulate the company from the ongoing trade war between US and China. The Shanghai Gigafactory is the first wholly foreign-owned car plant in China.
But the new coronavirus could throw a wrench in those plans. The new virus appeared in Wuhan at the start of December, and has already infected hundreds of people in nearly a dozen countries. The World Health Organization said that it’ s too early to declare a public health emergency globally, although the outbreak is a major emergency in China. The government has said all companies in the city are not allowed to resume operations until next week.
The company doesn’ t expect too big of a financial hit, though, as the Shanghai-produced Model 3 only represents a tiny fraction of the company’ s quarterly profits, Kirkhorn said.
Tesla isn’ t the only company to be disrupted by the viral outbreak. Google said today it was temporarily shutting down all of its China offices due to the coronavirus. Apple and Facebook both restricted employee travel this week.
| tech |
WHO Declares Coronavirus Outbreak a Global Public Health Emergency -- Update | By Brianna Abbott, Katie Camero and Erin Mendell
The World Health Organization declared the coronavirus outbreak in China a public health emergency of international concern, pointing to a significant increase in the number of cases and the disease's spread to other countries.
The designation, issued Thursday, came as the first person-to-person transmission of the virus was reported in the U.S.
The WHO designation indicates that international public-health authorities now consider the respiratory virus a significant threat beyond, China where it originated last month. The move could further heighten the global response to the outbreak.
The agency made the declaration after the second meeting of its emergency committee, which previously declined to do so after meeting twice last week.
Since then, China, other governments and multinational businesses have taken emergency steps to limit the virus's spread, including halting some travel to China.
In the U.S., a sixth person tested positive for the infection in the first case of human-to-human transmission. The patient is the husband of a Chicago woman infected with the virus whose case was reported last week. She had recently traveled to Wuhan, the central Chinese city where the coronavirus first emerged last month.
The U.S. Centers for Disease Control and Prevention and state officials emphasized that the overall risk for people in the U.S. and in Illinois remains low.
`` This person-to-person spread was between two very close contacts, a wife and husband, '' said Ngozi Ezike, the director of the Illinois Department of Public Health. `` It is not spreading in the wider community. ''
A public health emergency of international concern is a situation that is serious, unusual or unexpected with international implications that potentially requires a coordinated, international response, according to the WHO.
Public-health authorities say the designation helps mobilize resources to contain the virus's spread. The WHO's director-general can make recommendations to the international community, though they aren't legally binding.
WHO Director-General Tedros Ghebreyesus said he was confident in China's capacity to control the outbreak, which has sickened more than 7,800 people and killed 170, mostly in the Hubei province in China surrounding Wuhan.
`` Let me be clear. This declaration is not a vote of no confidence in China, '' said Dr. Tedros. `` I have never in my life seen this kind of mobilization. ''
Since it got the power, in 2005, to declare an international emergency, WHO had applied the designation to just five prior situations. The first was in 2009 in response to the H1N1 swine flu, followed by polio in 2014 and the Ebola and Zika virus outbreaks in 2016.
At least 15 other countries or territories have also reported a small number of cases, with Finland, India and the Philippines now reporting cases in people who have traveled to Wuhan, according to WHO.
In response to the virus, Russia has tightened its border with China and the U.S. announced plans for a second evacuation of Americans from Wuhan. Companies including Tesla Inc. and IKEA temporarily halted operations in China.
The CDC has investigated 165 people for the virus, according to the numbers released Wednesday, and 68 have tested negative and been cleared. Over 90 cases are pending, and health authorities said that they expect additional cases.
The new Chicago patient lived with and was in consistent close contact with his wife. After returning to the U.S. on Jan. 13, she developed symptoms and was hospitalized in an isolated setting. Once her husband also started developing symptoms he was quickly taken to the hospital. The patient, who has underlying health issues, is in a stable condition, health authorities said.
`` It is clear that this virus is highly transmittable, and this assumption is based on the rapid rate of spread of this infection in China, '' said Eyal Leshem, director of the Institute for Travel and Tropical medicine at Sheba Medical Center in Israel.
`` When there is a public health uncertainty, you always want to slightly overreact to make sure that you don't miss a critical issue, '' said Dr. Leshem. `` Once you learn a little bit more about the risk and the effective steps, then you can scale back. ''
Health authorities believe the virus was spread while the first patient was symptomatic, rather than before.
Officials said the man, who is in his 60s, didn't attend any mass gatherings. There are currently 21 people under investigation in Illinois, Dr. Ezike said, and local and federal health authorities are working to monitor close contacts of the second Chicago patient.
`` This is a very serious public health situation, '' said Nancy Messonnier, the director for the National Center for Immunization and Respiratory Diseases at the CDC. `` We're trying to spark a balance in our response right now. ''
The CDC says that people who had recently traveled should be vigilant for symptoms and signs of the virus, which include fever, cough and shortness of breath.
White House spokesman Hogan Gidley said the risk coronavirus poses to Americans remains low and that he wasn't aware of government plans to cancel flights to and from China. He said the U.S. is taking `` all the precautions necessary and will continue to do so. ''
Members of a House of Representatives panel briefed by federal medical officials Thursday said that traditional means of stopping infection are still the best guard against the virus's spread.
Members of the subcommittee said federal officials appear to have the situation in hand and that there isn't any need for a coronavirus `` czar, `` as occurred with the Ebola virus epidemic in West Africa during the Obama administration.
Authorities in Russia, meanwhile, said they would temporarily restrict passage through 16 road, rail and river checkpoints along its 2,670-mile border with China. Though Russia's national carrier Aeroflot hasn't stopped flying to China smaller Russian airlines have canceled flights.
A number of countries have pushed ahead with efforts to extract their citizens from central China.
The State Department on Thursday said it is planning a second evacuation flight from Wuhan for the hundreds of American citizens still believed to be in the city.
The Indian government is seeking permission from Chinese authorities to operate two flights to repatriate citizens from Hubei province, and will quarantine them for 14 days.
In Japan, controversy erupted Wednesday after two people on a government-chartered evacuation flight from Wuhan to Tokyo refused to be tested for the new virus.
Prime Minister Shinzo Abe told Parliament on Thursday that while the government had pushed for all 206 passengers on the flight to be tested, it had no legal power to compel them. Three people on the flight tested positive for the virus, including two without symptoms, according to the health ministry. The two who refused testing didn't show symptoms, health ministry official Takuma Kato said.
A second charter flight to evacuate Japanese citizens from Wuhan arrived in Tokyo on Thursday, and Mr. Kato said all 210 people aboard agreed to be screened.
Meanwhile, immigration officials in Hong Kong scoured the city for visitors from Hubei, finding 15 on Wednesday night during searches of 110 hotels, according to Lam Shuk-Yee, deputy secretary for security of the Chinese territory on Thursday. Ms. Lam said 1,600 people from the province had been turned away at the Hong Kong border since the ban.
On the corporate front, big multinational companies moved to temporarily shut down China operations as workers remained largely in place, with the Lunar New Year holiday extended through the end of the week and transportation links largely curtailed.
Tesla Chief Financial Officer Zach Kirkhorn said Wednesday that the company was halting production at its new Shanghai Gigafactory to comply with a local-government order to extend the Lunar New Year holiday, which Mr. Kirkhorn said could affect the company's first-quarter performance.
All 30 IKEA outlets in mainland China were closed until further notice, the Swedish furniture giant said Thursday.
Air France joined the list of airlines cutting service to China. The carrier said it would suspend all scheduled flights to and from the mainland until Feb. 9 and operate special flights starting Friday to and from Shanghai and Beijing using volunteer crew members to enable customers and employees to depart safely.
Italian authorities were holding 6,000 passengers and crew aboard a cruise ship at the port of Civitavecchia near Rome after a 54-year-old Chinese woman showed flulike symptoms, according to a spokesperson for Costa Crociere, the company operating the ship Costa Smeralda.
The woman and her male traveling companion, who showed no symptoms, were isolated in the ship's hospital, the company said, while Italy's health ministry said it was waiting for the results of tests for coronavirus.
China's national women's soccer team is being held in quarantine in a hotel in the Australian city of Brisbane until Feb. 5, health authorities for the northwestern state of Queensland said Thursday. The 32-member team had traveled to Australia to compete in a qualifying tournament for this summer's Olympics in Tokyo.
The tournament was originally scheduled to be held in Wuhan but was moved to Sydney after the outbreak. The team had departed Wuhan Jan. 22, before the city was locked down, said the Chinese Football Association, which said it also planned to suspend soccer competitions nationwide starting Thursday.
( MORE TO FOLLOW) Dow Jones Newswires
01-30-20 1644ET | business |
Latest results show revenue rise for Mondelēz, but gum and confection side remains sluggish in US | Related tags: Mondelez International, financial report function sanitize gpt value2 ( gptValue) { var vOut= '' ''; var aTags = gptValue.split ( ', '); var reg = new RegExp ( '\\W+ ', `` g ''); for ( var i=0; i < aTags.length; i++) { vOut += aTags [ i ].trim ().replace ( reg, '- ').substring ( 0,40); if ( i! = ( aTags.length-1)) vOut += ', '; } vOut = vOut.toLowerCase (); return vOut; } $ ( document).ready ( function () { dataLayerNews = { }; dataLayerNews.related tags = sanitize gpt value2 ( `` Mondelez International, financial report ''); dataLayer.push ( dataLayerNews); });
Shares in Mondelēz International Inc went up 3% immediately after the company reported quarterly revenue that beat estimates helped by a 4.5% rise in sales from the Asia, Middle East and its Africa business. Looking ahead, the Illinois-based company said it expects organic sales growth of +3% and high single-digit EPS growth.
Mondelēz has been pushing hard on investments and can still be in more stores, chairman and CEO Dirk Van de Put said. He singled out growth in the company's biscuit businesses in India and China, as well as strong chocolate and gum sales in each country, respectively.
Net earnings attributable to the company fell to $ 726m, or 50 cents per share, in the quarter ended December 31. Excluding items, Mondelēz earned 61 cents per share, a cent above analysts estimates.
Net revenue rose 2.1% to $ 6.91bn, beating analysts ' expectations of $ 6.84 bn.
`` 2019 was a major step forward for the company: Execution of our strategy, including investments in global and local brands, enabled us to deliver strong top-line performance and to meet or exceed all of our financial targets. We are increasingly confident that our incremental investments in brands and capabilities, emphasis on volume leverage and profit dollar growth will create a virtuous cycle that consistently delivers attractive top- and bottom- line growth and sustained free cash flow generation, '' said Van de Put.
Nigel Frith, a senior market analyst at asktraders.com, told ConfectioneryNews: “ Sales at Mondelēz smashed expectations thanks to investment in its biggest brands. The strategy of getting more shelf space for its most well recognised names such as Cadbury’ s and Milka chocolate whilst complimenting these with regional brands that appeal to local tastes is hitting the sweet spot. Comparable sales jumped 4.1% more than doubling expectations helping the share price jump 3% immediately in after the hours trading. ”
In a conference call to analysts, Van de Put said Mondelēz has added approximately 140,000 new stores tin China and are planning to continue expanding into the 2020.
“ So, it does help our revenue clearly, I mean we’ ve seen a well above category growth in China and we are seeing very strong double-digit growth in India. And we are counting that our distribution expansion is helping us. And at the same time in the developed markets, we want to continue that shift into more seasonals and more alternative growth channels, which also will help our revenue growth, ” he said.
China accounts for nearly 4.5% of the company's sales, and Van de Put told analysts and investors the coronavirus is expected to have only a short-term impact. “ We have four factories in China, and the government has asked to keep two of our factories closed for another 10 days, in order to not have too much of a risk with the infection. We now have to see in the coming weeks what has happened with the sell-out during Chinese New Year. ''
Frith said that one point of concern is Mondelēz expansion into China, a market where it faces tough competition from local brands. “ The Lunar New Year is typically a key and lucrative time for snack makers. However, the coronavirus outbreak could dampen sales significantly. ”
On the sluggish gum and confection side, Van de Put said, “ It is clearly not the strongest category in those markets, but it is positive growth for the category and positive share for us in emerging markets. We continue to be challenged in developed markets. Largely in the US, Europe is in a better situation, but it’ s the US that continues to be very difficult for us.
`` The category is displaying now low growth, but it’ s growing, but we are still losing some share. And we have some fundamental category challenges and we have some brand challenges.
`` On gum, what has changed, or not changed, is the fact that we are doing very well in emerging markets, where we are gaining shares in our gum business. We have year-to-date very good revenue growth, we gained shares particularly in China, which is our second biggest gum market in the world and in Brazil, where we are also gaining share.
`` The reason why candy was not as vibrant this year was largely due to the US market where we had capacity issue. That capacity issue is now solved and we expect a much better 2020 for our candy business in the US. I would say that, as we look at the future plans for gum, it’ s a difficult situation for us, because gum is very profitable and gives a scale in key markets.
`` So it’ s not something that we can just sort of shift to the side. We are working on a number of initiatives to address that share decline. ``
Van de Put also said Brexit is a `` risk '' to the company, but he does not expect to see an impact this year. `` If there is no deal near the end of the year, that would possibly be a disruptor, '' he said.
Rounding off the call with investors and analysts, Van de Put said: “ There’ s certainly more work to do, and a long way of opportunities is ahead of us, but we believe that the early success combines with the attractive category dynamics, and further targeted investment provides us greater confidence that we can deliver sustained long-term growth and attractive total returns. ” | general |
Unilever to Review Global Tea Business -- Earnings Review | By Matteo Castia
Unilever PLC ( ULVR.LN) said Thursday that it was reviewing options for its global tea business as it reported 2019 earnings. Here's what you need to know:
SALES: Sales for the year were 51.98 billion euros ( $ 57.21 billion), below the expected EUR52.85 billion estimated by a panel of 11 analysts taken from FactSet.
NET PROFIT: Net profit attributable to shareholders fell to EUR5.63 billion in 2019, as last year it was boosted by the sale of its spreads business. Consensus forecast was EUR5.84 billion, taken from FactSet and based on seven analysts ' projections. Including minority interests, net profit was EUR6.03 billion.
WHAT WE WATCHED:
-CORONAVIRUS: The company said that the impact of coronavirus on Unilever's key Asian market is still unknown at this time.
-SALES GUIDANCE: Unilever reported underlying sales growth of 2.9%. It had warned last December that underlying sales in 2019 were likely to be below guidance but still in the lower half of its 3% to 5% multi-year growth target. For this year, the company reiterated its expectations to miss the target for the first half and reach its bottom end for the whole year.
-NEW CHAIRMAN COMMENTS: Unilever's earnings didn't include any statement from Chairman Nils Andersen, who was appointed to the role last November. However, the company's new strategy to favor disposal of slow-growth assets over bolt-on acquisitions may be a reflection of Mr. Andersen's vision for the group, analysts at Citi said.
-SHARE REACTION: Shares rose following the report and traded up 1.8% in late morning trading in London.
Write to Matteo Castia at matteo.castia @ dowjones.com
| business |
Stephen Colbert breaks down Alan Dershowitz's 'crazy, corrupt argument ' | On The Late Show, Stephen Colbert unpacked what many think could be the final days of Donald Trump’ s impeachment trial, as “ the Republicans are trying to wrap it all up in time to not learn anything. ”
On Wednesday, senators submitted handwritten questions to the arguing teams. One asked Trump’ s defense team why a quid pro quo mattered, eliciting a shocking response from Trump lawyer Alan Dershowitz. “ Dershowitz previously gave us the crazy theory quid pro quo isn’ t impeachable, ” said Colbert, and “ today he rolled out his sequel: it might be good. ”
Dershowitz argued that politicians believe it is in the public interest for them to be elected, and “ if a president does something which he believes will help him get elected in the public interest, that can not be the kind of quid pro quo that results in impeachment. ”
“ Let me get this straight, ” Colbert said. “ He’ s saying that if a politician believes their re-election is in the public interest – and he just said all politicians believe that – it naturally follows that anything they do to get re-elected is fine. That seems like a crazy corrupt argument. ”
Colbert continued: “ Searching through the logical turd Dershowitz just pinched out in the Senate well there, it’ s hard to find the largest corn kernel of logical fallacy. But I would argue it’ s this: his justification why any quid pro quo with a foreign government to manipulate our elections would be fine ” is, to quote Dershowitz, “ your election is in the public interest. ”
“ No it’ s not! ” Colbert retorted. “ Only the public gets to decide what’ s in the public interest, not the politician. It’ s we the people, not you the douchebag. ”
First, it was “ there’ s no quid pro quo. ” Then, it was “ maybe there was, but Trump did it to help the country. ” Now, Trump’ s defense is “ Donald’ s gon na do what Donald’ s gon na do. ” pic.twitter.com/RjNzDV243O
On the Daily Show, Trevor Noah also unpacked a day of “ questioning ” in the Senate, which was basically senators just asking “ questions to their own side that gave them another chance to repeat their talking points ”, he said. “ Democrats asked: Donald Trump is guilty, isn’ t he? And Republicans asked: what is it that makes Donald Trump so innocent and handsome?
“ But there was one moment from the trial that caught everyone’ s attention, ” said Noah. That would be Alan Dershowitz’ s assertion that anything the president does is in the public interest, and therefore fine.
“ Ladies and gentlemen, we have finally arrived, ” said Noah. “ First it was: there was no quid pro quo. Then it was: maybe there was a quid pro quo but it was to help the country, not Donald Trump. And now it’ s: Amen, the Donald gon na do what the Donald gon na do, you little bitch asses need to shut the hell up.
“ Just to be clear: the Trump team’ s argument is now that anything Trump does to get himself re-elected is fine because his re-election in his mind is good for the country and then it’ s not impeachable, ” Noah said. “ Anything. Yeah, so Trump can collude, Trump can obstruct, and it’ s all good. ”
Noah then took a handwritten question, Senate-style, addressed to Dershowitz. “ It says, uh … get the fuck outta here! ”
“ If you’ re tired of all the sad, scary impeachment news, now there’ s another story we can be sadder and scared-er about, ” said Samantha Bee on Full Frontal. That would be the coronavirus, which is rapidly spreading in China as thousands are infected and millions quarantined. “ The only way China could be locking down cities any harder would be if the coronavirus were protesting for Hong Kong’ s independence, ” Bee joked.
The real focus should be on the people facing the direct impact of the virus, Bee said, “ but since America is basically the drunk single sister at the wedding who has to make everything about herself, fine, let’ s make it about us ”. The Centers for Disease Control has been monitoring over 100 people in the US for coronavirus, and maintains the threat is minimal. “ The good news is, the CDC is working hard to contain and study the coronavirus, ” said Bee. “ The bad news is that same CDC has lost a dangerous amount of its funding. ”
In recent years, the CDC has scaled back work in dozens of countries based on budget cuts; it cut efforts to prevent outbreaks in foreign countries by 80% in 2018. “ Despite the obvious benefits to funding an agency that prevents a zombie apocalypse, the Trump administration’ s budget proposal actually recommended another 10% cut to the CDC’ s funding, ” said Bee. “ How does a notorious germaphobe cut the budget of an agency that fights infectious diseases? Just tell Trump the CDC needs the money to keep him from catching whatever necrosis is making Rudy decompose. ”
The Trump administration plans to cut another $ 30m this year, said Bee, “ and as with every issue in America, the ones who will be hit hardest are the poor and people of color, who often don’ t have hospitals in their area or access to healthcare at all. ”
Ultimately, “ we don’ t know if this coronavirus will be the next big pandemic, but we do know that another pandemic is inevitable, ” Bee concluded. Thus, “ we need to get our shit together and better fund the CDC so that all of us can survive … until the partisan civil war that will immediately follow the 2020 election. ” | general |
Huawei overtakes Apple in annual race to Samsung’ s smartphone crown | Huawei overtook Apple to become the world’ s second best selling smartphone manufacturer in 2019, according to reports from Strategy Analytics, Counterpoint Research, and Canalys. Over the course of the year, the Chinese manufacturer reportedly shipped around 240 million phones, compared to just under 200 million for Apple. Samsung retained its comfortable lead in first place, shipping just shy of 300 million devices. Xiaomi and Oppo rounded out the list of the top five manufacturers.
The jump is especially surprising given Huawei’ s continued presence on the USA’ s entity list, which prevents the company from installing Google’ s apps and services on its new devices, limiting their appeal outside of China. As a result, Huawei’ s main strength was in its home country. Counterpoint Research says China accounted for 60 percent of its sales, allowing its shipments worldwide to increase by 17 percent between 2018 and 2019 — though not in Q4 specifically.
However, tensions with the US still had an effect. Canalys notes that 2019 could have been the year that Huawei challenged Samsung for the number one smartphone spot, but ultimately this challenge never materialized. It’ s unclear when the situation could change in the future.
Huawei has been nipping at Apple’ s heels for a while. Back in 2017 Huawei initially overtook Apple to sell more smartphones in the months of June and July, and the following year IDC reported that it had sold more phones than Apple in the second quarter of the year. But in 2019, the company overtook Apple to sell more phones throughout the entire year.
Although it lost out on the number two spot for 2019 as a whole, Apple had a very strong fourth quarter as is typical for the company. All three market analyst firms agreed that it managed to outsell Samsung in the last quarter, with sales being driven by the iPhone 11’ s lower pricing in particular. Analysts said that Apple’ s phone sales were up by between 7 and 11 percent in Q4 2019 compared to the same quarter in 2018.
Samsung is expected to rebound this quarter with the launch of its flagship Galaxy S20 series next month. Apple is also likely to receive a boost from the launch of its long-rumored successor to the more affordable iPhone SE, which could be popular in price-sensitive markets like India.
Despite individual gains, all three reports agree that the industry sold fewer phones in 2019 than it did in 2018. Counterpoint Research notes that this is the first time the smartphone market has ever declined for two years in a row. With the US’ s trade wars still ongoing, and China’ s coronavirus scare having potential implications for supply chains, 2020 could be another challenging year. | tech |
Japan prosecutors issue warrants over Ghosn escape | Hi, what are you looking for?
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Published
Japanese prosecutors on Thursday issued arrest warrants for a former US special forces operative and two other people accused of helping former Nissan chief Carlos Ghosn jump bail and flee the country.
The prosecutors also issued a warrant for Ghosn for leaving the country illegally, after he escaped to Lebanon via Turkey last month.
Warrants were issued for Michael Taylor, 59, reportedly a former US special forces operative-turned-security consultant, 26-year-old Peter Taylor, who local media identified as his son, and George Zayek, 60.
They are suspected of taking Ghosn to a hotel in Osaka, western Japan, and hiding him inside a case before taking him to Kansai airport where they allegedly helped him evade a security inspection.
The warrants are the first official confirmation of the reported details about how Ghosn slipped past security and jumped bail shortly after Christmas.
Ghosn has refused to confirm or deny the various reports on how he gave Japanese authorities the slip.
The escape of perhaps the most high-profile suspect on bail in Japan left officials red-faced and they have demanded Ghosn returns to face trial.
Lebanondoes not have an extradition treaty with Japan.
Ghosn was arrested in November 2018 and faced four charges of financial misconduct, which he denies.
He has said he did not believe he would get a fair trial, and accused Nissan executives opposed to his plans to integrate the firm further with its French partner Renault of effectively cooking up the charges against him.
Japanese prosecutors on Thursday issued arrest warrants for a former US special forces operative and two other people accused of helping former Nissan chief Carlos Ghosn jump bail and flee the country.
The prosecutors also issued a warrant for Ghosn for leaving the country illegally, after he escaped to Lebanon via Turkey last month.
Warrants were issued for Michael Taylor, 59, reportedly a former US special forces operative-turned-security consultant, 26-year-old Peter Taylor, who local media identified as his son, and George Zayek, 60.
They are suspected of taking Ghosn to a hotel in Osaka, western Japan, and hiding him inside a case before taking him to Kansai airport where they allegedly helped him evade a security inspection.
The warrants are the first official confirmation of the reported details about how Ghosn slipped past security and jumped bail shortly after Christmas.
Ghosn has refused to confirm or deny the various reports on how he gave Japanese authorities the slip.
The escape of perhaps the most high-profile suspect on bail in Japan left officials red-faced and they have demanded Ghosn returns to face trial.
Lebanondoes not have an extradition treaty with Japan.
Ghosn was arrested in November 2018 and faced four charges of financial misconduct, which he denies.
He has said he did not believe he would get a fair trial, and accused Nissan executives opposed to his plans to integrate the firm further with its French partner Renault of effectively cooking up the charges against him.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
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Fight for survival: Photographer Claudia Andujar defends Brazil's Yanomami | Hi, what are you looking for?
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Swiss-born photographer Claudia Andujar has spent five decades fighting to protect the rights of Brazil's Yanomami tribe. But the feisty octogenarian says her battle is not over.
Andujar began documenting the Yanomami in 1971 after visiting members of the group deep inside the Amazon rainforest in the northwestern state of Roraima, near the Venezuelan border.
She hopes a major retrospective of her work opening in Paris on January 30 will call attention to the renewed threats they face under President Jair Bolsonaro, who is pushing to legalize mining and farming in protected native territory.
`` The Yanomami are my relatives, they are part of my family and I want to defend my family, '' Andujar, 88, tells AFP at her Sao Paulo apartment.
Spending weeks at a time with the Yanomami, whose territory in Brazil covers some 37,000 square miles -- an area bigger than Portugal -- Andujar battled stifling heat and malaria to capture fragments of their daily life, such as hunting trips or shamanistic rituals.
`` I tried to follow their way of living... I just tried to make them understand that I 'm looking for friendship, '' Andujar says of her first few weeks with the tribe.
`` They had never been photographed so they didn't understand what I was doing and I didn't want to invade them. ''
By experimenting with infrared film, flashes and even vaseline smeared on the camera lens, Andujar created distorted images that offer an interpretation of the Yanomami's complex spiritual world.
`` She tried to convey and to represent things that were invisible to Western eyes, '' says Thyago Nogueira from the Moreira Salles Institute in Brazil and curator of the exhibition for the Fondation Cartier pour l'art contemporain in the French capital.
Featuring some 300 mostly black and white photos taken largely in the 1970s and 1980s, `` The Yanomami Struggle '' marks Andujar's biggest temporary exhibition.
A smaller version was on display for much of 2019 in Sao Paulo and then Rio de Janeiro, catching the eye of the Fondation Cartier.
`` She was not just a journalist trying to narrate a story or an anthropologist documenting a society, '' Nogueira tells AFP.
`` She completely immersed herself in the subject and she felt free to experiment. ''
- Growing threats -
The exhibition charts Andujar's transition from photographer to activist as the Yanomami -- whose population in Brazil is around 26,000 -- faced increasing threats to their survival. Some 11,000 Yanomami live in Venezuela.
Brazil's military rulers began constructing highways across the Amazon in the 1970s to open up the rainforest to development.
The Yanomami and other tribes were devastated by diseases introduced by non-indigenous Brazilians settling in the remote region.
They also confronted deadly invasions by gold miners seeking to exploit reserves of the precious metal on their land.
Andujar was expelled from the region in 1977 after becoming a thorn in the side of authorities.
She then joined Yanomami shaman and spokesman Davi Kopenawa in a campaign for the legal demarcation of the tribe's territory, which was granted in 1992.
Using her camera as a political weapon, Andujar `` avoided a genocide, '' says Nogueira.
But the hard-won rights remain under threat, says Andujar.
`` The government, if they decide they want to go and extract gold or other minerals, they will go and try to do it, '' she says.
These fears have intensified under Bolsonaro, who took power in January 2019 promising to open up more of the mineral-rich Amazon to development.
The far-right leader presided over an 85 percent surge in deforestation last year, official figures show.
He also has dismantled environmental protections that activists say have made tribes increasingly vulnerable to invasions by illegal miners and loggers.
His government is expected to send a bill to Congress soon that would legalize mining on indigenous land.
In recent months, three indigenous people have been killed in two separate incidents in the northeastern state of Maranhao.
One of them died after being ambushed by loggers. The others were killed in a drive-by shooting.
`` Bolsonaro has no experience at all with indigenous people, '' Andujar says derisively.
`` I always worry about their future. ''
- 'Right to live ' -
After fleeing Europe during World War II, Andujar lived in New York before joining her Swiss mother in Brazil in 1955.
The loss of her Hungarian Jewish father and his relatives in Nazi death camps in Germany and Poland has fuelled Andujar's determination to protect the Yanomami.
`` It's something that in the Second World War I was not able to do, '' Andujar explains.
Even now, as she struggles to walk and spends much of her time at home, Andujar continues to devote herself to their survival.
She last visited the Yanomami two years ago and does not know if she will return.
`` I 'm getting older, '' she says chuckling.
Andujar plans to attend the opening of her exhibition in Paris where she hopes to meet with political leaders, including French President Emmanuel Macron, and raise her concerns.
`` These people have the right to live, '' she says of the Yanomami.
`` They have to decide what they want and not the government. ''
Swiss-born photographer Claudia Andujar has spent five decades fighting to protect the rights of Brazil’ s Yanomami tribe. But the feisty octogenarian says her battle is not over.
Andujar began documenting the Yanomami in 1971 after visiting members of the group deep inside the Amazon rainforest in the northwestern state of Roraima, near the Venezuelan border.
She hopes a major retrospective of her work opening in Paris on January 30 will call attention to the renewed threats they face under President Jair Bolsonaro, who is pushing to legalize mining and farming in protected native territory.
“ The Yanomami are my relatives, they are part of my family and I want to defend my family, ” Andujar, 88, tells AFP at her Sao Paulo apartment.
Spending weeks at a time with the Yanomami, whose territory in Brazil covers some 37,000 square miles — an area bigger than Portugal — Andujar battled stifling heat and malaria to capture fragments of their daily life, such as hunting trips or shamanistic rituals.
“ I tried to follow their way of living … I just tried to make them understand that I’ m looking for friendship, ” Andujar says of her first few weeks with the tribe.
“ They had never been photographed so they didn’ t understand what I was doing and I didn’ t want to invade them. ”
By experimenting with infrared film, flashes and even vaseline smeared on the camera lens, Andujar created distorted images that offer an interpretation of the Yanomami’ s complex spiritual world.
“ She tried to convey and to represent things that were invisible to Western eyes, ” says Thyago Nogueira from the Moreira Salles Institute in Brazil and curator of the exhibition for the Fondation Cartier pour l’ art contemporain in the French capital.
Featuring some 300 mostly black and white photos taken largely in the 1970s and 1980s, “ The Yanomami Struggle ” marks Andujar’ s biggest temporary exhibition.
A smaller version was on display for much of 2019 in Sao Paulo and then Rio de Janeiro, catching the eye of the Fondation Cartier.
“ She was not just a journalist trying to narrate a story or an anthropologist documenting a society, ” Nogueira tells AFP.
“ She completely immersed herself in the subject and she felt free to experiment. ”
– Growing threats –
The exhibition charts Andujar’ s transition from photographer to activist as the Yanomami — whose population in Brazil is around 26,000 — faced increasing threats to their survival. Some 11,000 Yanomami live in Venezuela.
Brazil’ s military rulers began constructing highways across the Amazon in the 1970s to open up the rainforest to development.
The Yanomami and other tribes were devastated by diseases introduced by non-indigenous Brazilians settling in the remote region.
They also confronted deadly invasions by gold miners seeking to exploit reserves of the precious metal on their land.
Andujar was expelled from the region in 1977 after becoming a thorn in the side of authorities.
She then joined Yanomami shaman and spokesman Davi Kopenawa in a campaign for the legal demarcation of the tribe’ s territory, which was granted in 1992.
Using her camera as a political weapon, Andujar “ avoided a genocide, ” says Nogueira.
But the hard-won rights remain under threat, says Andujar.
“ The government, if they decide they want to go and extract gold or other minerals, they will go and try to do it, ” she says.
These fears have intensified under Bolsonaro, who took power in January 2019 promising to open up more of the mineral-rich Amazon to development.
The far-right leader presided over an 85 percent surge in deforestation last year, official figures show.
He also has dismantled environmental protections that activists say have made tribes increasingly vulnerable to invasions by illegal miners and loggers.
His government is expected to send a bill to Congress soon that would legalize mining on indigenous land.
In recent months, three indigenous people have been killed in two separate incidents in the northeastern state of Maranhao.
One of them died after being ambushed by loggers. The others were killed in a drive-by shooting.
“ Bolsonaro has no experience at all with indigenous people, ” Andujar says derisively.
“ I always worry about their future. ”
– ‘ Right to live’ –
After fleeing Europe during World War II, Andujar lived in New York before joining her Swiss mother in Brazil in 1955.
The loss of her Hungarian Jewish father and his relatives in Nazi death camps in Germany and Poland has fuelled Andujar’ s determination to protect the Yanomami.
“ It’ s something that in the Second World War I was not able to do, ” Andujar explains.
Even now, as she struggles to walk and spends much of her time at home, Andujar continues to devote herself to their survival.
She last visited the Yanomami two years ago and does not know if she will return.
“ I’ m getting older, ” she says chuckling.
Andujar plans to attend the opening of her exhibition in Paris where she hopes to meet with political leaders, including French President Emmanuel Macron, and raise her concerns.
“ These people have the right to live, ” she says of the Yanomami.
“ They have to decide what they want and not the government. ”
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
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Pilots just sued American Airlines to force a halt to China flights | American Airlines had already canceled some flights to China due to the coronavirus outbreak — which was officially designated a global health emergency by the WHO earlier today, having sickened thousands around the world — but the airline’ s independent union, Allied Pilots Association, is now suing for a temporary restraining order on all American Airlines flights between the US and China, effective immediately.
In the meanwhile, it’ s telling American Airlines pilots that they should refuse to fly to China if they’ re asked to do so.
That’ s because while American Airlines has canceled some flights, the airline is still flying to China right now — the lawsuit points out that the suspensions don’ t begin until February 9th and are only for flights out of Los Angeles, with American Airlines reportedly refusing to suspend flights out of Dallas. By February 9th, pilots will have had to fly from Dallas to China 26 more times, and they’ ll be required by law to spend 32 hours on the ground to rest each time, according to the APA. The implication is that pilots might get sick during that time, and the union points out that other major airlines, including British Airways, have completely suspended their flights already.
United Airlines and Delta have also reduced flights because of less demand.
“ Due to the known and unknown risks associated with traveling to China right now, concurrent with the filing of our lawsuit, we are directing all American Airlines pilots assigned to flights between the United States and China, other than those on return trips to the United States, to decline the assignment, ” reads part of a statement from APA President Capt. Eric Ferguson.
American Airlines tells The Verge that it’ s “ aware of the filing, ” and that the company is actively monitoring the coronavirus situation. “ We are in close contact with the Centers for Disease Control and Prevention ( CDC) and global public health officials to make sure we are taking all necessary precautions for our customers and team members, ” wrote a representative.
It’ s worth noting that there may be other motives for the union to push American Airlines right now. It’ s currently fighting to negotiate a new contract with American Airlines, and it was just yesterday that hundreds of pilots held a public demonstration at DFW International Airport to express their frustration, the Dallas Morning News reported.
We’ re tracking all the updates about the coronavirus outbreak, including which tech companies have been affected, in our StoryStream linked here and below.
Update, 7:01 AM ET: Added American Airlines’ statement. | tech |
After meager 2019, Samsung's modest chip recovery outlook falls flat | But in a guarded outlook, the world's biggest memory chip and smartphone maker said on Thursday it couldn't rule out the possibility that demand growth may be curbed amid lingering tensions on U.S.-China trade and looming fears of the economic impact of the new coronavirus outbreak in China and beyond.
The conservative forecast failed to satisfy investors hoping for a brighter outlook, and the company's shares ended down 3.2%, having fallen as much as 3.9% at one point, while the Seoul market benchmark was off 1.7%.
Samsung, which counts smartphone rivals Apple Inc and Huawei Technologies Co as customers for its chips and displays, said fourth-quarter operating profit slumped to 7.16 trillion won ( $ 6.13 billion) on weaker chip demand, down 34% from the same period a year earlier.
That was in line with its own estimate, though net profit for the quarter skidded 38% to 5.2 trillion won, meaning Samsung missed analysts ' estimate of 5.6 trillion won.
The October-December quarter marks the end of a year marred by bloated stockpiles of chips that squeezed prices, and the U.S.-China trade war that roiled global supply chains and prospects for consumer demand. For the year, the South Korean conglomerate posted operating profit of 27.8 trillion won, its lowest since 2015.
Samsung said it also expected January-March earnings to fall from the preceding quarter, reflecting low seasonal demand for chips and displays.
Speaking during a conference call, a Samsung chip executive flagged uncertainties in chip demand.
`` The macroeconomic and geopolitical concerns are showing signs of easing recently, but we can't rule out the possibility that the situation would deteriorate, '' said Han Jin-man, senior vice president at Samsung's semiconductor business unit. He didn't identify specific issues that could affect the company.
VIRUS OUTBREAK
In contrast with Samsung's modest forecast, chip peers like Intel Corp and TSMC earlier offered positive outlooks, fuelling hopes of a rebound in chip prices after a slide that started in late 2018.
`` Samsung offered a conservative outlook for the memory market, and there is a disconnect between market views and the company views when it comes to strength of the recovery, '' said Park Sung-soon, an analyst at Cape Investment & Securities.
Meanwhile, after posting strong results, Apple earlier this week flagged uncertainty created by the coronavirus outbreak in China which economists fear could hurt the global economy.
On Thursday Samsung Electronics, which has chip, display and home appliance plants in China, declined to comment on the impact of the outbreak on demand. In a statement to Reuters, it said it had extended a holiday closure for some factories in line with Chinese government guidance.
But supplier Samsung SDI, which makes phone batteries and materials for chips and displays, said it expects current-quarter earnings to be adversely affected by the virus outbreak.
Fourth-quarter operating profit more than halved to 3.45 trillion won in Samsung's mainstay chip division, while its mobile division profit surged by two-thirds to 2.52 trillion won, thanks to strong sales of flagship models and a revamp of its mid- and lower-end A series line-up.
Samsung said the actual pace of 5G network expansion and its effects on memory demand remains to be seen, although the company sees demand picking up around mass-market 5G models.
It said it aims to expand its presence in the 5G network equipment market in the United States, while continuing to look at the possibility of entering the European market.
This week Britain granted Huawei a limited role in developing the country's 5G mobile network, frustrating a global attempt by the United States to exclude the Chinese telecoms giant from the West's next-generation communications.
By Hyunjoo Jin and Heekyong Yang | business |
Levi's shuts half its China stores on coronavirus outbreak, expects financial hit | This comes a few months after Levi's opened its largest store in China in the city of Wuhan, the epicenter of the coronavirus epidemic which has killed about 170 people, marring its plans to tap into the city's 11-million strong population.
`` It will put a dampener on our growth objectives in the near term, '' Singh told Reuters in an interview about the store closures in China, which contributes about 3% to the company's revenue.
The flu-like virus has set-off alarm bells across the globe, with companies such as Starbucks Corp and Tesla Inc warning of a financial hit from slowing business in the world's most populous country. Earlier this week, Starbucks also said it closed about half its stores in China.
Levi's has also stopped all employee travel in and out of China.
Singh said the coronavirus impact was not baked into the company's full year forecast, but will be quantified when it reports first quarter results in April.
Levi's forecast 2020 earnings above estimates, boosted by demand for women's apparel in its own stores and online, sending shares up 3% for the company which returned to public markets last year.
Singh pointed to the strong start to 2020 fiscal year, saying Levi's had `` hit the ground running '' during the crucial holiday shopping season.
The company missed fourth quarter revenue estimates, hurt by plunging sales at department stores and protests in Hong Kong which dented demand in the Asian shopping hub.
Fourth quarter net revenue fell 1.4% to $ 1.57 billion, compared with analysts ' estimates of $ 1.58 billion, according to IBES data from Refinitiv.
Adjusted net income fell 9% to $ 108 million, or 26 cents per share, in the quarter ended Nov. 24, beating expectations of 21 cents per share.
The company forecast adjusted 2020 profit of $ 1.18 per share to $ 1.22 per share above Wall Street estimates of $ 1.17.
By Uday Sampath Kumar and Aditi Sebastian | business |
Weak earnings hit Europe amid virus fears; FTSE slides as BoE stands pat | A day ahead of Britain's exit from the European Union, the BoE left rates unchanged in Governor Mark Carney's final policy meeting, saying it saw signs of a post-election pick-up in growth. Market participants had been almost evenly split on what the BoE's would do.
`` We continue to expect the BoE to remain dovish - but on hold - in the near-term, before turning more hawkish in mid-2020 as economic activity and inflation rebounds, '' said Kallum Pickering, a senior economist at Berenberg.
The pound rallied, while London's blue chip index extended losses to close down 1.4% and mid-caps lost 0.8%. [.L ] [ GBP/ ]
The pan-European STOXX 600 ended 1% lower to take losses so far this week to 2% - its worst weekly performance in nearly four months.
Global equities and some commodities markets have experienced a sharp sell-off this week as the number of reported cases of people infected with the flu-like coronavirus jumped. It has so far claimed 170 lives in China and spread to more than 16 countries, disrupting global travel and company operations. [ MKTS/GLOB ]
London-listed shares of Royal Dutch Shell were the biggest drag on the benchmark index, shedding 4.4% after the company's quarterly profit halved. The wider energy subsector fell 2.6%, also pressured by lower oil prices. [ O/R ]
Shares of watchmaker Swatch Group slipped 3.9% as it reported a marked drop in annual sales and forecast continuing challenges in its key Hong Kong market this year.
Other luxury brands - LVMH, Hermes, Gucci owner Kering, Moncler, Burberry - also slipped between 0.4% and 2.1%.
British cybersecurity company Avast was the worst performer on the pan-regional index after it announced the closure of the scandal-hit Jumpshot analytics business, which will see it take a charge of $ 15- $ 25 million in 2020 in wind-down costs.
Fashion retailer H & M, consumer goods giant Unilever and truck maker Volvo were the biggest boosts to the STOXX 600 after reporting upbeat results.
As the global growth outlook worsens, Germany's inflation came in below the European Central Bank's target for a ninth month in a row, strengthening the case for the bank's easing bias. Germany's DAX slipped 1.5%.
By Susan Mathew and Medha Singh | business |
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The Options Clearing Corporation ( OCC) is set to change its rule book in order to make it easier for buy-side firms to participate in default auctions.
The equity derivatives clearing giant is working with the US Securities and Exchange Commission ( SEC) on changes that would significantly simplify a lengthy document that clearing firms have to sign to allow their clients to make bids during default auctions.
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VIR BIOTECHNOLOGY, INC.: Other Events ( form 8-K) | Item 8.01 Other Events.
On January 29, 2020, Dr. George Scangos, President and Chief Executive Officer of Vir Biotechnology, Inc. ( the `` Company ''), provided interviews with several news media outlets to discuss the Company's efforts to develop a therapy for 2019-nCoV, also known as `` Wuhan coronavirus ''. In the interviews, Dr. Scangos discussed the timing of potentially developing a therapy and stated that the Company believes that it will know whether any of its current antibodies are effective against the Wuhan coronavirus in the next weeks to months. Dr. Scangos also disclosed that manufacturing would take an additional number of months, and that the expected process could total approximately 10 months, although actual timelines are difficult to predict. In addition, the Company is in discussions with manufacturers and regulators regarding expediting the manufacture and regulatory pathway for any potential therapy.
Forward-Looking Statements
This Current Report on Form 8-K contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as '' may, '' `` will, '' `` expect, '' `` plan, '' `` anticipate, '' `` estimate, '' `` intend, '' `` potential '' and similar expressions ( as well as other words or expressions referencing future events, conditions or circumstances) are intended to identify forward-looking statements. These forward-looking statements are based on the Company's expectations and assumptions as of the date of this Current Report. Each of these forward-looking statements involves risks and uncertainties. Actual results may differ materially from these forward-looking statements. Forward-looking statements contained in this Current Report include statements regarding the timing of development, manufacture and regulatory approval of a potential therapy to address the Wuhan coronavirus. Many factors may cause differences between current expectations and actual results including unexpected safety or efficacy data observed during preclinical or clinical studies, clinical site activation rates or clinical trial enrollment rates that are lower than expected, changes in expected or existing competition, difficulties identifying or entering into contracts with manufacturers, unexpected problems with the manufacturing process, regulatory delays and unexpected litigation or other disputes. Other factors that may cause actual results to differ from those expressed or implied in the forward-looking statements in this Current Report are discussed in the Company's filings with the Securities and Exchange Commission, including the section titled `` Risk Factors '' contained therein. Except as required by law, the Company assumes no obligation to update any forward-looking statements contained herein to reflect any change in expectations, even as new information becomes available.
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© Edgar Online, source Glimpses | business |
Tesla Tops Estimates, Vows To Lift Sales by Over a Third -- WSJ | By Tim Higgins
Tesla Inc. vowed to increase its vehicle sales by more than a third this year while posting upbeat fourth-quarter results, giving investors more reason to believe the electric-car maker has put past problems behind it.
The Silicon Valley auto maker on Wednesday said it was well on its way to producing its next car -- the Model Y compact sport-utility vehicle -- at its assembly plant in Fremont, Calif. First deliveries of the model are due before April, the company said. It previously said production would begin by this summer.
Tesla, which is working on transforming itself from niche manufacturer into mass-market electric-vehicle maker, told investors its business should be profitable going forward.
Chief Executive Officer Elon Musk made a similar statement a year ago. But two quarters of steep losses followed, leaving the company with a full-year $ 862 million loss despite a profitable second half. Tesla has never been profitable on an annual basis.
The company's adjusted earnings per share of $ 2.14 for the fourth quarter topped the $ 1.77 a share that analysts surveyed by FactSet had predicted. Net income fell to $ 105 million from $ 140 million a year earlier.
Tesla shares rose more than 11% in aftermarket trading following Wednesday's earnings report.
Daniel Ives, an analyst for Wedbush Securities, called the results potentially `` game changing '' and signaling `` what could be a new era for Musk and Fremont. ''
Tesla said its commitment to continuing profitability was subject to `` temporary exceptions, particularly around the launch and ramp of new products. ''
The 16-year-old company has traditionally struggled when introducing new vehicles. The Model 3 compact car, which began production in 2017, was plagued with months of delays that strained the company into the following year.
Mr. Musk worked through the issues and the Model 3 went on to defy skeptics. The compact car drove a 50% rise in global deliveries last year, enabling Mr. Musk to meet his goal of selling between 360,000 and 400,000 vehicles in 2019 after a rocky start that included challenges related to taking the Model 3 overseas for the first time.
The company aims to pick up the pace in 2020, announcing plans Wednesday to deliver more than 500,000 vehicles globally, up from 367,000 last year. That goal relies heavily on churning out more vehicles from Tesla's newly opened China assembly plant.
Tesla cautioned that its vehicle production would likely outpace sales this year as its Chinese operations hit stride and the Model Y comes online.
Chief Financial Officer Zach Kirkhorn, during an earnings call with analysts and investors, said the company could face challenges in the first quarter, a period traditionally tough for sales during the winter months. Additionally, Tesla is bracing for potential fallout from the spread of the coronavirus that could hamper efforts to increase production in Shanghai and slightly dent first-quarter earnings, he said. The car maker also is on alert for potential supply-chain disruptions as companies grapple with the effects of the illness.
The fourth-quarter results also underscore the challenges Mr. Musk faces in trying to increase sales volume with high-price vehicles in Tesla's lineup.
Deliveries soared 23% from the year-earlier quarter with the help of the Model 3, while revenue rose just 2%, to $ 7.38 billion. Tesla handed 112,000 new electric vehicles to customers during the final three months of the year, but deliveries of its more-expensive car models declined.
The company attributed the modest revenue growth, in part, to the introduction of a cheaper version of the Model 3 and to adjustments in pricing. `` We do not expect [ average selling price ] to change significantly in the near term, which means volume growth and revenue growth should correlate more closely this year, '' the company said.
Analysts estimated the average selling price of the Model 3 fell to $ 47,700 in the fourth quarter, from $ 57,000 in 2018. Combined deliveries of the Model S large sedan and Model X sport-utility vehicle fell 33% to around 67,000 last year. Those vehicles traditionally had sold for about $ 100,000 or more.
The company's automotive gross margin, a closely watched measure of cost efficiencies compared to sales, fell to 22.5% in the latest quarter from 24.3% a year earlier.
Tesla has encountered challenges in some markets recently. Last year in the U.S., it sought to lower the price of its vehicles to counter the phaseout of a tax credit that effectively made the company's cars and SUVs thousands of dollars more expensive. Tesla doesn't break out deliveries by region, though it will give details on U.S. revenue figures in coming weeks through a quarterly regulatory filing. Third-quarter results showed a 39% decline in U.S. revenue while the company's overseas business was growing.
Tesla deliveries in the U.S. rose an estimated 11% in the U.S. last year, according to Edmunds, an online website that tracks auto sales. The Model 3 outsold traditional gas-powered competitors in the compact, luxury- car segment.
The record f ourth-quarter global deliveries, which the company reported earlier this month, helped propel Tesla's share price to new heights and a total market value that exceeds all auto-making rivals but Toyota Motor Corp. The electric-car maker sells a fraction of the vehicles that giants such as General Motors Co. and Volkswagen AG do.
David Whiston, an analyst for Morningstar Research Services, said the latest results had `` lots of positives and not much negative right now. '' But, he cautioned, `` the stock seems priced for perpetual perfection and that tends to eventually not end well. ''
Tesla should get another boost beyond the Model Y. The company on Wednesday reiterated that production should begin this year of the Semi, an all-electric semitrailer truck revealed in 2017. Tesla also said Model Y production would begin in China in 2021 and deliveries of vehicles from a new plant near Berlin should start the same year.
Write to Tim Higgins at Tim.Higgins @ WSJ.com
| business |
Air France joins China flight suspensions as virus unnerves cabin crew | Cabin crew unions demanded an immediate halt to Air France's Beijing and Shanghai flights ahead of a works council meeting, staff representatives said.
`` Air France's top priority is the health and safety of its customers and employees, '' the airline said, adding that flights to mainland China had been suspended until Feb. 9 `` after careful consideration of the developing situation ''.
The airline joins others including British Airways and Germany's Lufthansa that have dropped mainland Chinese destinations besides Wuhan, the outbreak's centre, which is closed to commercial air traffic.
Virgin Atlantic also said on Thursday it would suspend its daily operations to Shanghai from Sunday for two weeks because of the safety of customers and staff and a declining demand for tickets.
`` Flights to Hong Kong continue to operate as scheduled, '' it said.
Other major carriers have kept flying to China, but protective masks and shorter layovers designed to reduce exposure have done little to reassure crews.
Thai Airways is hosing its cabins with disinfectant spray between China flights and allowing crew to wear masks and gloves.
`` I don't think it's safe at all even with gloves and masks, because you catch it so many ways, like your eyes, '' said one flight attendant, who spoke on condition of anonymity.
`` My friends also feel unsafe and don't want to fly, '' she said. `` When we fly, we don't sleep a lot. ''
Delta Air Lines is operating fewer China flights and shorter layovers, with food deliveries so crew can stay in their hotels.
Korean Air Lines Co Ltd and Singapore Airlines are sending additional crew to fly each plane straight back, avoiding overnight stays.
The South Korean carrier also said on Thursday it was loading hazmat suits for flight attendants who might need to take care of suspected coronavirus cases in the air.
The outbreak poses the biggest epidemic threat to the airline industry since the 2003 SARS crisis, which led to a 45% plunge in passenger demand in Asia at its peak in April of that year, analysts said.
Air France, which maintained China flights throughout the SARS epidemic, faced growing pressure to suspend its flights.
`` When the staff see that other airlines have stopped flying there, their reaction is 'Why are we still going? ', '' said Flore Arrighi, president of UNAC, one of the airline's four main flight attendants ' unions.
The airline still plans to fly special services to China with volunteer crews to help repatriate French nationals stranded by the health crisis.
Its Dutch stablemate, KLM, said services linking Amsterdam with Beijing and Shanghai will be suspended early next week, giving customers currently in China an opportunity to return.
The spectrum of measures taken by airlines underlines how little is known about coronavirus transmission.
Cathay Pacific has cut hot towels, blankets and magazines from its China flights, while British Airways crews still flying to Hong Kong are wearing gloves to hand out towels, according to one pilot who returned recently from the city.
`` The crew weren't really using their masks, although they were given three each for the flight, '' he said.
( Reporting by Laurence Frost, Aradhana Aravindan and Chayut Setboonsarng; Additional reporting by Caroline Pailliez in Paris, Josephine Mason in London, John Geddie in Singapore, Panu Wongcha-um in Bangkok, Tracy Rucinski in Chicago, Jamie Freed in Sydney and Joyce Lee in Seoul; Writing by Jamie Freed; Editing by Sudip Kar-Gupta/ Timothy Heritage/Susan Fenton/Alexander Smith)
By Laurence Frost, Aradhana Aravindan and Chayut Setboonsarng | business |
Exclusive: In break from past, Louis Dreyfus boss is open to selling stake | Margarita Louis-Dreyfus, who assumed control of the company in 2009, stressed she was in no rush and that an investor would have to strengthen the business.
Last year, the billionaire businesswoman completed consolidating Louis Dreyfus Company Holdings B.V. ( LDHBV) - the structure that holds the family's shares in LDC - via her Akira family trust which now controls over 96% of the holding firm.
She has spent a decade negotiating costly and acrimonious buyouts of minority family shareholders, while profits at LDC declined in increasingly tough agricultural markets.
`` It is the first time in our almost 170-year history that we are prepared to open our capital to an external shareholder, '' the 57-year-old said in an interview.
`` But we are not under pressure. We want to keep majority control. Everything else depends on the quality of offers. ''
The group has previously indicated it could bring `` regional players '' into the business to help strengthen its positions in areas where it seeks expansion, such as China.
Akira's consolidation of LDC's ownership has come at a cost: it borrowed $ 1 billion from Credit Suisse last year to buy out the minority shareholders, pledging its shares in LDC as collateral, its filing showed.
Credit Suisse declined to comment.
This comes at a time when LDC, like its rivals, faces a challenging business environment - with swine fever in China, which could hit economic growth and protein demand in the world's largest consumer of pork, as well as the coronavirus outbreak.
'NOW COMPANY IS FREE '
LDC, also known as Dreyfus, is the `` D '' of the `` ABCD '' quartet of global agri-traders that also includes Archer Daniels Midland, Bunge and Cargill.
Like its peers, LDC has restructured operations, exiting activities including dairy and metals trading while focusing more on food processing, notably in Asia.
The company's top priority was to develop its business, said Louis-Dreyfus, a Russian-born Swiss citizen.
`` Until 2018 we were in a process of consolidating the company's shareholder structure. Now the company is free of that issue and can fully focus on the business. ''
A new investor should bring value to strengthen the company, she said.
`` It is not only about size. It is also about quality. ''
Speculation about consolidation has been rife in the industry since takeover approaches for U.S.-based Bunge.
Commodity group Glencore made an approach for Bunge two years ago and has said the sector needs consolidating. China's COFCO International has also been seen as a potential bidder for other trading firms as it expands overseas.
'ADAPTING TO NEW REALITY '
In October 2019, Dreyfus reported a first-half net profit from continuing operations of $ 73 million, down from $ 91 million a year earlier, and said international trade tensions and the swine disease epidemic would weigh on its annual profit.
Full-year 2019 results will be published later this year. Louis-Dreyfus said it would show a `` resilient '' bottom line despite a challenging backdrop of swine fever and trade tensions, which depressed U.S. soybean imports into China.
`` We are adapting to a new reality of higher volatility and political unpredictability, '' Louis-Dreyfus said, adding that a recovery of crush margins -- the profits made from processing soybeans -- and cost savings should help 2020 results.
A cost-cutting programme announced internally in November is being led by new Chief Operating Officer Michael Gelchie, whose appointment was part of a recent management reshuffle, the latest in a series of changes.
`` We are cautiously optimistic that we shall see a rebound in 2020, '' she said.
Over the past decade, Louis-Dreyfus has bought the shares of minority family members wishing to sell under a long-term arrangement established by her late husband, Robert. Akira increased its ownership in LDHBV to over 96% from 50.1%.
`` In fact, all we have been doing these years is following Robert's guidance to develop the company's strategy, '' she said.
( Additional reporting by Gus Trompiz in Paris. Editing by Pravin Char and Carmel Crimmins)
By Dmitry Zhdannikov | business |
Kenya Airways: Kenyan Citizens Will Not Be Evacuated From China Amid Coronavirus Scare | Kenya's citizen will not be evacuated from China, even as the coronavirus effect continues to bite parts of the Asian country.
Speaking to a local news outlet, Kenya's Ambassador to China Sarah Serem, has noted that China has already put measures to control the outbreak.
`` I prefer the Chinese government to handle the coronavirus since they are in a better position to deal with it. I don't think Kenya is ready to deal with the virus. By bringing Kenyans back, it will only expose the rest to the danger of infection, '' Ms Serem told Citizen TV in an interview.
Meanwhile Kenya's National Carrier, Kenya Airways has said that it will not cancel its flights to Guangzhou.
The national carrier has said that it is closely 'monitoring ' the situation before it takes the next step. Ambassador Sarah Serem had however called upon the carrier to suspend its flights to the country until the virus is contained. This comes after a student from Guangzhou on Tuesday was quarantined at the Kenyatta National Hospital in Nairobi over the suspected deadly virus.
The Kenyan government has however issued a travel advisory against travel to China. There are currently over one million Chinese nationals living in Africa, according to data from Annual Report on Overseas Chinese.
African countries continue to operate flights to China despite the threat. Several African countries have direct flights to the Asian country including Ethiopian Airlines, Egyptair, which announced its flights to the country last year.
By the 22nd, Chinese authorities had presented new epidemiological information that revealed an increase in the number of cases, of suspected cases, of affected provinces, and the proportion of deaths in currently reported cases of 4% ( 17 of 557). They reported fourth-generation cases in Wuhan and second-generation cases outside Wuhan, as well as some clusters outside Hubei province.
According to Chinese health authorities, by 27th January 2020, 2,858 confirmed cases of pneumonia caused by the novel coronavirus ( 2019-nCoV) have been reported. The pneumonia situation has resulted in a total of 82 deaths, while 57 people have recovered.
CNN has reported that hundreds of Americans returning from the epicenter of the deadly coronavirus outbreak arrive in California and now face an uncertain period of quarantine and monitoring.
The Chinese Embassy in Kenya however said it is closely monitoring with the Chinese Community the entry of Chinese into Kenya.
`` The Chinese side always puts the life and health of the Chinese citizens and foreigners including Kenyans in China above everything else, and will continue to take effective and timely measures to address their legitimate concerns, '' the statement from Chinese embassy in Kenya reads.
To further contain the coronavirus epidemic, China says it has taken all-around strict measures including transport restrictions, extending the Spring Festival holiday, postponing school openings, cancellations of gatherings, temporary closures of public venues, personnel tracking and management, temperature detection at subway and railway stations, airports, etc. Passengers with abnormal body temperatures will be sent to the hospital.
Meanwhile, African governments have been grappling with disease outbreak scares even as the Ebola crisis continues to bite in Guinea and in the Democratic Republic of the Congo ( DRC).
In October last year, the World Health Organization ( WHO) called out Tanzania for failing to provide information about possible Ebola virus infections. According to a report by BBC, WHO said it had learned of one suspected fatal case in Dar es Salaam and two others but, despite repeated requests, was given no information.
The latest outbreak has killed more than 2,000 in eastern DR Congo, with Uganda battling to stop any spread.
Copyright The Exchange. Distributed by AllAfrica Global Media ( allAfrica.com)., source News Service English | business |
WHO Declares Coronavirus Outbreak a Global Public Health Emergency -- 3rd Update | By Brianna Abbott, Katie Camero and Erin Mendell
The World Health Organization declared the coronavirus outbreak a public-health emergency of international concern Thursday as the first person-to-person transmission of the virus was reported in the U.S.
The WHO designation, pointing to an increase in the number of cases, indicates that international public-health authorities now consider the respiratory virus a significant threat beyond China, where it originated last month. The move could further heighten the global response to the outbreak.
The agency made the declaration after a meeting of its emergency committee, which declined to do so last week. Since then, China, other governments and multinational businesses have taken emergency steps to limit the virus's spread, including halting some travel to China.
In the U.S., a sixth person tested positive for the infection in the first case of human-to-human transmission. The patient is the husband of a Chicago woman infected with the virus whose case was reported last week. She had recently traveled to Wuhan, the central Chinese city where the coronavirus first emerged last month.
The U.S. Centers for Disease Control and Prevention and state officials emphasized that the overall risk for people in the U.S. and in Illinois remains low. `` This person-to-person spread was between two very close contacts, a wife and husband, '' said Ngozi Ezike, the director of the Illinois Department of Public Health. `` It is not spreading in the wider community. ''
Public-health authorities said the WHO designation helps mobilize resources to contain the virus's spread. The WHO's director-general can make recommendations to the international community, though they aren't legally binding.
WHO Director-General Tedros Adhanom Ghebreyesus said he was confident in China's capacity to control the outbreak, which has sickened more than 7,800 people and killed 170, mostly in the Hubei province in China surrounding Wuhan.
`` Let me be clear. This declaration is not a vote of no confidence in China, '' Dr. Tedros said. `` I have never in my life seen this kind of mobilization. ''
Since it gained the power, in 2005, to declare an international emergency, WHO had applied the designation to just five prior situations. The first was in 2009 in response to the H1N1 swine flu, followed by polio in 2014 and the Ebola and Zika virus outbreaks in 2016. It declared a public emergency for another Ebola outbreak in 2019 and faced criticism for delaying that decision.
At least 18 other countries or territories have also reported a small number of coronavirus cases, with Finland, India and the Philippines now reporting cases in people who have traveled to Wuhan, according to WHO.
In response to the virus, Russia has tightened its border with China and the U.S. announced plans for a second evacuation of Americans from Wuhan. Companies including Tesla Inc. and IKEA temporarily halted operations in China.
The CDC has investigated 165 people in the U.S. for the virus, according to the numbers released Wednesday, and 68 have tested negative and been cleared. Over 90 cases are pending, and health authorities said that they expect additional cases.
The new Chicago patient lived with and was in consistent close contact with his wife. After returning to the U.S. on Jan. 13, she developed symptoms and was hospitalized in an isolated setting. Once her husband also started developing symptoms he was quickly taken to the hospital. The patient, who has underlying health issues, is in a stable condition, health authorities said.
`` It is clear that this virus is highly transmittable, and this assumption is based on the rapid rate of spread of this infection in China, '' said Eyal Leshem, director of the Institute for Travel and Tropical medicine at Sheba Medical Center in Israel.
`` When there is a public-health uncertainty, you always want to slightly overreact to make sure that you don't miss a critical issue, '' Dr. Leshem said. `` Once you learn a little bit more about the risk and the effective steps, then you can scale back. ''
Health authorities believe the virus spread while the first patient in Chicago was symptomatic, rather than before.
Officials said the man, who is in his 60s, didn't attend any mass gatherings. There are 21 people under investigation in Illinois for possible infection, Dr. Ezike said, and local and federal health authorities are working to monitor close contacts of the second Chicago patient.
Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC, called the coronavirus `` a very serious public-health situation. '' She added: `` We're trying to spark a balance in our response right now. ''
The CDC said that people who had recently traveled should be vigilant for symptoms and signs of the virus, which include fever, cough and shortness of breath.
President Trump during a speech in Michigan said the administration is working closely with China and sought to minimize fears about the virus in the U.S.
`` We think we have it very well under control. We have very little problem in this country at this moment, '' Mr. Trump said, adding that the handful of victims are recuperating. `` We think it's going to have a very good ending for us. That I can assure you. ''
On Wednesday, Mr. Trump announced a task force to address the coronavirus, which he said had been meeting daily since Monday. The group is led by Health and Human Services Secretary Alex Azar.
Members of a House of Representatives panel briefed by federal medical officials Thursday said that traditional means of stopping infection are still the best guard against the virus's spread.
Members of the subcommittee said federal officials appear to have the situation in hand and that there isn't any need for a coronavirus `` czar, `` as occurred with the Ebola virus epidemic in West Africa during the Obama administration.
Authorities in Russia, meanwhile, said they would temporarily restrict passage through 16 road, rail and river checkpoints along its 2,670-mile border with China. Though Russia's national carrier Aeroflot hasn't stopped flying to China smaller Russian airlines have canceled flights.
A number of countries have pushed ahead with efforts to extract their citizens from central China.
The State Department on Thursday said it is planning a second evacuation flight from Wuhan for the hundreds of American citizens still believed to be in the city.
The Indian government is seeking permission from Chinese authorities to operate two flights to repatriate citizens from Hubei province, and will quarantine them for 14 days.
In Japan, controversy erupted Wednesday after two people on a government-chartered evacuation flight from Wuhan to Tokyo refused to be tested for the new virus.
Prime Minister Shinzo Abe told Parliament on Thursday that while the government had pushed for all 206 passengers on the flight to be tested, it had no legal power to compel them. Three people on the flight tested positive for the virus, including two without symptoms, according to the health ministry. The two who refused testing didn't show symptoms, health ministry official Takuma Kato said.
A second charter flight to evacuate Japanese citizens from Wuhan arrived in Tokyo on Thursday, and Mr. Kato said all 210 people aboard agreed to be screened.
Meanwhile, immigration officials in Hong Kong scoured the city for visitors from Hubei, finding 15 on Wednesday night during searches of 110 hotels, according to Lam Shuk-Yee, deputy secretary for security of the Chinese territory on Thursday. Ms. Lam said 1,600 people from the province had been turned away at the Hong Kong border since the ban.
On the corporate front, big multinational companies moved to temporarily shut down China operations as workers remained largely in place, with the Lunar New Year holiday extended through the end of the week and transportation links largely curtailed.
Tesla Chief Financial Officer Zach Kirkhorn said Wednesday that the company was halting production at its new Shanghai Gigafactory to comply with a local-government order to extend the Lunar New Year holiday, which Mr. Kirkhorn said could affect the company's first-quarter performance.
All 30 IKEA outlets in mainland China were closed until further notice, the Swedish furniture giant said Thursday.
Air France joined the list of airlines cutting service to China. The carrier said it would suspend all scheduled flights to and from the mainland until Feb. 9 and operate special flights starting Friday using volunteer crew to enable customers and employees to depart safely.
Italian authorities held 6,000 passengers and crew aboard a cruise ship at the port of Civitavecchia near Rome after a 54-year-old Chinese woman showed flulike symptoms. Health authorities late Thursday ruled out she was affected by coronavirus and passengers were allowed to disembark, according to a statement by Costa Crociere, the company operating the ship.
China's national women's soccer team is being held in quarantine in a hotel in the Australian city of Brisbane until Feb. 5, health authorities for the northwestern state of Queensland said Thursday. The 32-member team had traveled to Australia to compete in a qualifying tournament for this summer's Olympics in Tokyo.
The tournament was originally scheduled to be held in Wuhan but was moved to Sydney after the outbreak. The team had departed Wuhan Jan. 22, before the city was locked down, said the Chinese Football Association, which said it also planned to suspend soccer competitions nationwide starting Thursday.
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01-30-20 1942ET | business |
Kenya Airways: KQ - No Decision Yet to Suspend China Flights, Safety Measures in Place on Coronavirus | Kenya's national carrier Kenya Airways said Thursday it was not planning to suspend flights to and from China in the wake of coronavirus that has killed over 130 and infected over 6000 others.
The airline issued the statement, a day after flying in a Kenyan student who had travelled from Wuhan city, the epicentre of the deadly viral disease.
The student was later taken to Kenyatta National Hospital where he was quarantined and samples taken from him for further tests at the Influence Centre. Results were due later Wednesday, according to Health Cabinet Secretary Sicily Kariuki.
`` The airline remains in consultation with the Ministry of Health and would like to assure our customers that we are evaluating all options and we will communicate the next steps of action at the appropriate time, '' KQ said in a statement.
It also assured on `` additional precautionary measures to ensure that our staff and customers are safe. ''
Some of the measures KQ is taking include screening all passengers at Guangzhou Airport.
`` Passengers from Wuhan and sorrounding districts will only be accepted on our flights after clearance by the Guangzhou Airport health authorities, '' it said.
On Wednesday, Kenya's envoy to China Sarah Serem said the country will not evacuate its citizens from China yet with the primary focus being on containing the viral coronavirus outbreak.
Serem, Kenya's High Commissioner to China, announced the decision while indicating that she had cancelled her leave to jet back to Beijing from where embassy staff are monitoring the epidemic that broke out in the city of Wuhan, Hubei province.
`` The best measure that has been taken by the Chinese government is to ensure that those within the area are not further exposed, so the option of evacuation shouldn't be an immediate concern for now I think the best way is to contain and when the 14 days of quarantine are over, and everybody is safe then it's easy to move and access, '' Serem told Citizen TV in Eldoret.
`` I have had to cancel my leave to be on the ground, the unfortunate bit is that I can't be in Wuhan because the place is on lock-down but the Kenyan embassy in Beijing is open 24 hours and we have been in contact with the Kenyan community in China giving them updates and assuring them that things are under control, '' she stated.
The envioy said Kenyans in every province in China had been issued with emergency contacts to report any case that may arise and that it's much safer to have the virus contained from within.
However, some countries such as the US, France and Japan have evacuated their citizens from Wuhan.
Others like Australia, France, India and South Korea are also preparing evacuation plans for hundreds of their citizens in the city.
While pointing out that she has cancelled her leave to fly to China on Wednesday evening, Serem stated that the embassy is in contact with Kenyans to help.
This is contrary to reports by some of the Kenyans in Wuhan that there has been no communication from the Kenyan Embassy in Beijing.
China locked down Hubei in an unprecedented operation affecting tens of millions of people and intended to slow transmission of the respiratory virus.
A statement released by the Ministry of Foreign Affairs on Monday stated that the Kenyan embassy is aware of 85 Kenyans who are in Wuhan, the epicenter of the virus, the embassy in China urging unregistered Kenyans to contact the embassy.
Ministry of Foreign Affairs also cautioned Kenyans against non-essential travel to China'sWuhan City.
Copyright Capital FM. Distributed by AllAfrica Global Media ( allAfrica.com)., source News Service English | business |
As Apple reports strong Q1 earnings, where does the firm go next? ( Includes interview) | Hi, what are you looking for?
By
Published
Apple has declared a set of very positive financial results, as the result of a balanced mix of national and international sales. As well as ‘ developed markets’ the company saw double-digit growth in several emerging markets as well. As well as the latest iPhone models, growth was boosted by strong sales with products like Watch, AirPods, and Beats.
Overall, iPhone sales ( $ 55.9 billion) and Apple’ s services ( $ 12.7 billion) were among the most prominent contributors to the company’ s growth. This led to shares in Apple climbing two percent in after-hours trading.
According to Tim Cook, Apple’ s CEO: “ We’ re thrilled to report Apple’ s biggest quarter ever, which set new all-time records in both revenue and earnings. We generated revenue of $ 91.8 billion, which is above the high end of our guidance range, with revenue growth accelerating for the third consecutive quarter. ”
However, growth for the next quarter could be lower. Cook indicates that the coronavirus outbreak, which has made headlines during January 2020, has affected the company’ s China manufacturing and retail operations.
Commenting on the news, Haris Anwar, senior analyst at financial markets platform Investing.com, tells Digital Journal: “ It’ s a very strong earnings report that exceeds analysts’ expectations in many ways. The biggest driver is Apple’ s revival in iPhone growth, which surpassed expectations by a large margin. ”
There are other issues as well that account for the growth, as Anwar reports: “ The other factor driving these robust earnings was the company’ s wearables division, which had a particularly strong quarter thanks to rising demand for Apple Watch and AirPods. The 37 percent revenue growth for those products confirms that Apple is ramping up its focus on products besides its flagship iPhone that diversifies the company in a powerful way. ”
Anwar summarizes: “ This potent mixture of strength in the core product and rising diversification is what has been driving Apple stock to record highs almost every other day. ”
Dr. Tim Sandle is Digital Journal's Editor-at-Large for science news. Tim specializes in science, technology, environmental, and health journalism. He is additionally a practising microbiologist; and an author. He is also interested in history, politics and current affairs.
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Pandora: Jeweller Pandora closes 53 shops in China due to coronavirus | The Danish company followed recommendations from Chinese authorities, a spokesman said.
( Reporting by Jacob Gronholt-Pedersen; Editing by Elaine Hardcastle) | business |
Disabled teenager in China dies at home alone after relatives quarantined | A 17-year-old boy with cerebral palsy from a rural village in China’ s Hubei province has died because his relatives were unable to care for him after being quarantined as a result of the coronavirus outbreak, the state-run Beijing Youth Daily newspaper has reported.
Government officials from Hong’ an County, 60 miles north of the provincial capital, Wuhan, where the outbreak first started, have launched an investigation into the death, said the report, which was picked up by other local media.
The boy, Yan Cheng, was found dead in his bed on Wednesday, six days after his father and his 11-year-old brother were taken from their home and quarantined at a facility 15 miles to the south. Both had developed a fever and were suspected of having the virus. Yan Cheng was left alone at home.
It is caused by a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. The World Health Organization ( WHO) has declared it a pandemic.
According to the WHO, the most common symptoms of Covid-19 are fever, tiredness and a dry cough. Some patients may also have a runny nose, sore throat, nasal congestion and aches and pains or diarrhoea. Some people report losing their sense of taste and/or smell. About 80% of people who get Covid-19 experience a mild case – about as serious as a regular cold – and recover without needing any special treatment.
About one in six people, the WHO says, become seriously ill. The elderly and people with underlying medical problems like high blood pressure, heart problems or diabetes, or chronic respiratory conditions, are at a greater risk of serious illness from Covid-19.
In the UK, the National health Service ( NHS) has identified the specific symptoms to look for as experiencing either:
As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work, and there is currently no vaccine. Recovery depends on the strength of the immune system.
Medical advice varies around the world - with many countries imposing travel bans and lockdowns to try and prevent the spread of the virus. In many place people are being told to stay at home rather than visit a doctor of hospital in person. Check with your local authorities.
In the UK, NHS advice is that anyone with symptoms should stay at home for at least 7 days. If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.
China’ s national health commission confirmed human-to-human transmission in January. As of 6 April, more than 1.25m people have been infected in more than 180 countries, according to the Johns Hopkins University Center for Systems Science and Engineering.
There have been over 69,500 deaths globally. Just over 3,200 of those deaths have occurred in mainland China. Italy has been worst affected, with over 15,800 fatalities, and there have been over 12,600 deaths in Spain. The US now has more confirmed cases than any other country - more than 335,000. Many of those who have died had underlying health conditions, which the coronavirus complicated.
More than 264,000 people are recorded as having recovered from the coronavirus.
Unable to get out of quarantine, his father posted messages asking for help on the social media platform Weibo. Village officials reportedly visited Yan but fed him only twice over the six-day period.
A group called Rice and Millet, founded by a former state-media journalist and focused on children with cerebral palsy and other illnesses, posted photos of the boy in a wheelchair and in bed on Wechat.
The group posted a statement on Wednesday saying that Yan’ s aunt visited him after his other relatives were taken away but was not able to visit during his final three days because of her own ill health.
Cerebral palsy is a motor disability that can affect movement, posture, muscle tone and speech. The severity of symptoms can vary significantly. Some people only have minor problems, while in extreme cases people may be severely disabled and require round-the-clock care. Yan is reported to have been mostly immobile and had difficulty speaking.
Calls by the Guardian to the Hong’ an County government were referred to Huahe town. Phones at the government office there rang unanswered on Thursday.
The new virus has now infected more people in China than were made ill there during the 2002-03 outbreak of Sars, another type of coronavirus. | general |
Amazon holiday sales jump as one-day shipping pays dividends, stock up 13% | Shares soared as much as 13% in after-hours trade, putting the online retailer back in the $ 1 trillion market capitalization club. If the share gain holds on Friday, it will be the biggest daily jump for Amazon since October 2017.
Amazon also forecast operating income of up to $ 4.2 billion in the current quarter, down from $ 4.4 billion the year prior. Still, that appeared to assuage investor concerns about Amazon's continued spending on fast delivery, which could have erased windfalls from e-commerce, advertising and cloud computing sales.
`` We’ re past the worst in terms of the margin pressure from the one-day shipping initiative, '' said Atlantic Equities analyst James Cordwell. That and the `` massively overstated '' concerns about cloud competition rebutted some of the biggest arguments against buying the stock, he said.
Amazon Chief Financial Officer Brian Olsavsky told reporters that additional investment in one-day shipping came slightly under the $ 1.5 billion the company had forecast for the fourth quarter, despite more customer orders. Extra costs in the current period will be about $ 1 billion for the delivery effort, he said.
Olsavsky added that spending on video would rise going forward, but the company was still determining its overall level of investment for 2020.
Jeff Bezos, Amazon's chief executive, said in a statement that the world's biggest online retailer now has more than 150 million paid members in its loyalty club Prime, a 50% increase from its last disclosure in April 2018.
Subscribers keep returning to Amazon to benefit from perks like fast delivery, television and music streaming. Its suite of voice-controlled Echo speakers has prompted still more engagement from customers, and grocery orders more than doubled in the holiday quarter in a vote of confidence for Amazon's 2017 bet to buy Whole Foods Market.
This formula has helped make Bezos the richest person in the world.
Amazon is hoping that cutting delivery times to one day for Prime members will let it outmaneuver rivals such as Walmart Inc that have marketed two-day shipping without subscription fees. The company made progress in the holiday season, reporting that it quadrupled one-day and same-day deliveries over the year-ago quarter.
Revenue from subscription fees grew 32% to $ 5.2 billion for the quarter ended Dec. 31, Amazon said, as more shoppers signed up for Prime than in any period prior.
WATCHING CORONAVIRUS
Net sales rose 21% to $ 87.4 billion while net income rose 8% to $ 3.3 billion - each over $ 1 billion more than analysts had expected, according to IBES data from Refinitiv.
The profit rise reflects the evolving nature of Amazon's business. The company has been moving away from low-margin retail toward a marketplace model where it takes lucrative fees for shipping and advertising the products of other merchants on its platform.
This has helped weather massive spending at Amazon, a company that has long passed up short-term results in favor of bets that could reap it future profit.
For instance, faster delivery has meant a surge in hiring and related costs. The company said its full-time and part-time headcount rose 23% to 798,000 in the quarter, as it expanded both fulfillment and corporate software roles.
Expenses similarly grew as the company moved inventory closer to customers and built out its last-mile delivery network, which now handles the biggest share of Amazon-ordered packages in the United States. Amazon said worldwide shipping costs rose 43% to $ 12.9 billion.
Amazon Web Services ( AWS) also has seen infrastructure and marketing costs rise. The unit responsible for selling data storage and computing power in the cloud lost out to Microsoft Corp in a high-profile deal last quarter to sell technology to the U.S. Department of Defense, in what could have netted the company $ 10 billion over a decade. Amazon is contesting the contract decision.
Microsoft on Wednesday reported a 62% quarterly rise in sales for its Azure cloud computing service. Yet Amazon posted better results than feared, growing revenue 34% to $ 9.95 billion, similar to its third-quarter increase.
`` This is important because it ends six quarters of measurable decline in AWS growth, reassuring investors that the segment has signs of stability, '' Gene Munster, managing partner at Loup Ventures, said in a research note.
Amazon's international business also narrowed losses to $ 617 million in the fourth quarter. The company has less exposure to China than Apple Inc and other technology industry peers, which may help it weather economic uncertainty surrounding the outbreak of the coronavirus.
Olsavsky said Amazon is watching the situation very carefully and is starting to put China travel restrictions on employees. The company considers China to be a far less strategic market than India, which CEO Bezos visited earlier this month partly to announce a new $ 1 billion investment in the country.
( Graphic: Amazon shipping costs, https: //fingfx.thomsonreuters.com/gfx/mkt/13/1612/1587/Amazon% 20shipping% 20costs.jpg)
By Jeffrey Dastin and Akanksha Rana | business |
Court clears French cardinal who failed to report suspected paedophile priest | Hi, what are you looking for?
By
Published
A French appeals court Thursday overturned a cardinal's conviction for shielding an alleged child-molesting priest in a case that fuelled accusations of a Catholic Church coverup of sex abuse by clerics.
Cardinal Philippe Barbarin, archbishop of Lyon, was given a six-month suspended jail sentence last March for not reporting a priest in his diocese who had allegedly abused dozens of boy scouts in the 1980s and 1990s.
The appeals court in Lyon said that Barbarin should have reported priest Bernard Preynat to the authorities but ruled it did not hold him criminally liable for his lack of action.
Barbarin, 69, had been twice convicted of failing to report Preynat to the police: first in 2010 when the priest admitted a history of abuse to the cardinal, and again in 2014 when Alexandre Hezez -- an alleged victim -- told Barbarin what had happened to him.
`` Cardinal Barbarin is innocent, '' Jean-Felix Luciani, a lawyer for the cleric said after Thursday's judgment.
`` The court has recognised that the cardinal was telling the truth. He made mistakes. He admitted that. The Church certainly has made mistakes, but he is not the Church. ''
Hours after the verdict, Barbarin announced he would offer his resignation to the Pope, who would take time to consider it.
`` Once again, I will place my office as Archbishop of Lyon in the hands of Pope Francis, '' he told journalists.
The Pope had refused Barbarin's resignation after his conviction last year, pending the outcome of the appeal.
`` My thoughts go today, always, to the victims, '' said the cardinal, adding his exoneration should allow the Church of Lyon `` to turn the page and open a new chapter. ''
- 'Horrible facts ' -
The Bishops ' Conference of France assured Barbarin, who was not at court for the verdict, of its `` fraternal communion ''.
The pope, meanwhile, `` will make his decision known in due course, '' said Matteo Bruni, the head of the Vatican's press centre.
Plaintiffs in the case said they would take the decision on appeal to a higher court.
Barbarin is the most senior French priest to be caught up in a global clerical paedophilia scandal which has seen clergy hauled before courts from Argentina to Australia.
He consistently denied the charges against him but stepped back from his duties after last year's conviction.
The priest he is accused of protecting, Preynat, has been defrocked and is awaiting a ruling on March 16 in his trial on sex abuse charges.
Preynat confessed during his trial this month to `` caresses '' he knew were forbidden, and admitted he got sexual pleasure from his acts with boy scouts at camps he supervised.
Barbarin, a staunch conservative who became archbishop of Lyon in 2002, has long been accused by victims ' groups of turning a blind eye to decades of child abuse in his diocese which blighted many lives.
Investigators initially dropped the case against him in 2016 after concluding the allegations were either impossible to prove or had happened too long ago to be brought to court.
But a group of victims succeeded in having the probe reopened, which led to Barbarin being put on trial.
He insisted he had `` never tried to hide, let alone cover up, these horrible facts ''.
But the trial court ruled that he had chosen not to tell authorities of the abuse allegations `` in order to preserve the institution to which he belongs ''.
The appeals judges agreed Thursday that Barbarin should have reported Preynat after his 2010 confession. But his failure do so happened too long ago, under the statute of limitations, to be punishable now, they ruled.
- 'Disappointment ' -
They also found that he could not be held criminally liable for anything that flowed from his discussion with victim Hezez in 2014.
Hezez was by then an adult and nothing prevented him from filing a complaint against Preynat on his own account, the judges said -- upholding an argument of the defence.
`` It is not up to the cardinal to report an offence in the place of a man who is not incapable of doing so himself, '' said Luciani.
The court also found it `` seriously objectionable from a moral point of view '' that Preynat had been allowed to remain in contact with children for five years after he confessed the abuse to Barbarin.
Jean Boudot, a lawyer for victims, said there was a `` strong feeling of disappointment '' with the verdict.
A French appeals court Thursday overturned a cardinal’ s conviction for shielding an alleged child-molesting priest in a case that fuelled accusations of a Catholic Church coverup of sex abuse by clerics.
Cardinal Philippe Barbarin, archbishop of Lyon, was given a six-month suspended jail sentence last March for not reporting a priest in his diocese who had allegedly abused dozens of boy scouts in the 1980s and 1990s.
The appeals court in Lyon said that Barbarin should have reported priest Bernard Preynat to the authorities but ruled it did not hold him criminally liable for his lack of action.
Barbarin, 69, had been twice convicted of failing to report Preynat to the police: first in 2010 when the priest admitted a history of abuse to the cardinal, and again in 2014 when Alexandre Hezez — an alleged victim — told Barbarin what had happened to him.
“ Cardinal Barbarin is innocent, ” Jean-Felix Luciani, a lawyer for the cleric said after Thursday’ s judgment.
“ The court has recognised that the cardinal was telling the truth. He made mistakes. He admitted that. The Church certainly has made mistakes, but he is not the Church. ”
Hours after the verdict, Barbarin announced he would offer his resignation to the Pope, who would take time to consider it.
“ Once again, I will place my office as Archbishop of Lyon in the hands of Pope Francis, ” he told journalists.
The Pope had refused Barbarin’ s resignation after his conviction last year, pending the outcome of the appeal.
“ My thoughts go today, always, to the victims, ” said the cardinal, adding his exoneration should allow the Church of Lyon “ to turn the page and open a new chapter. ”
– ‘ Horrible facts’ –
The Bishops’ Conference of France assured Barbarin, who was not at court for the verdict, of its “ fraternal communion ”.
The pope, meanwhile, “ will make his decision known in due course, ” said Matteo Bruni, the head of the Vatican’ s press centre.
Plaintiffs in the case said they would take the decision on appeal to a higher court.
Barbarin is the most senior French priest to be caught up in a global clerical paedophilia scandal which has seen clergy hauled before courts from Argentina to Australia.
He consistently denied the charges against him but stepped back from his duties after last year’ s conviction.
The priest he is accused of protecting, Preynat, has been defrocked and is awaiting a ruling on March 16 in his trial on sex abuse charges.
Preynat confessed during his trial this month to “ caresses ” he knew were forbidden, and admitted he got sexual pleasure from his acts with boy scouts at camps he supervised.
Barbarin, a staunch conservative who became archbishop of Lyon in 2002, has long been accused by victims’ groups of turning a blind eye to decades of child abuse in his diocese which blighted many lives.
Investigators initially dropped the case against him in 2016 after concluding the allegations were either impossible to prove or had happened too long ago to be brought to court.
But a group of victims succeeded in having the probe reopened, which led to Barbarin being put on trial.
He insisted he had “ never tried to hide, let alone cover up, these horrible facts ”.
But the trial court ruled that he had chosen not to tell authorities of the abuse allegations “ in order to preserve the institution to which he belongs ”.
The appeals judges agreed Thursday that Barbarin should have reported Preynat after his 2010 confession. But his failure do so happened too long ago, under the statute of limitations, to be punishable now, they ruled.
– ‘ Disappointment’ –
They also found that he could not be held criminally liable for anything that flowed from his discussion with victim Hezez in 2014.
Hezez was by then an adult and nothing prevented him from filing a complaint against Preynat on his own account, the judges said — upholding an argument of the defence.
“ It is not up to the cardinal to report an offence in the place of a man who is not incapable of doing so himself, ” said Luciani.
The court also found it “ seriously objectionable from a moral point of view ” that Preynat had been allowed to remain in contact with children for five years after he confessed the abuse to Barbarin.
Jean Boudot, a lawyer for victims, said there was a “ strong feeling of disappointment ” with the verdict.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
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Hong Kong university students paid solemn tribute to two campus statues marking Beijing's 1989 suppression of Tiananmen Square protesters.
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Euronav announces fourth quarter 2019 results | HIGHLIGHTS
ANTWERP, Belgium, 30 January 2020 – Euronav NV ( NYSE: EURN & Euronext: EURN) ( “ Euronav ” or the “ Company ”) today reported its non-audited financial results for the fourth quarter of 2019 ended 31 December 2019.
Hugo De Stoop, CEO of Euronav said: “ Tanker sector fundamentals improved further during Q4 to drive large tanker markets to their highest level since 2008. Specific catalysts have continued to influence short term freight rates - reflecting the current balance in market dynamics. Our fuel procurement strategy has delivered operational security over the key implementation period of IMO 2020. With continued limited contracting of new vessels, an order book at 25 year low and fleet expansion capital being rationed, the prospects for a sustainable cyclical upturn remain in place. The updated guidance on dividend policy provides a clear mechanism for future returns to shareholders ”.
For the fourth quarter of 2019, the Company had a net gain of USD 160.8 million or USD 0.75 per share ( fourth quarter 2018: a net gain of USD 0.3 million or USD 0.00 per share). Proportionate EBITDA ( a non-IFRS measure) for the same period was USD 273.3 million ( fourth quarter 2018: USD 105.9 million).
The average daily time charter equivalent rates ( TCE, a non IFRS-measure) can be summarized as follows:
* Euronav owned ships in TI Pool ( excluding technical offhire days) * * Including profit share where applicable * * * Including profit share where applicable ( excluding technical offhire days)
EURONAV TANKER FLEET
On 19 November 2019 Euronav entered into a joint venture together with affiliates of Ridgebury Tankers and clients of Tufton Oceanic to acquire two Suezmaxes for USD 40.6 million with delivery later that same month. Each 50% -50% joint venture company has acquired one Suezmax vessel. Euronav provided financing for the joint ventures. Both vessels will be commercially managed by Euronav’ s chartering desk.
On 30 December 2019 Euronav delivered three VLCC vessels to Taiping & Sinopec Financial Leasing Ltd Co as part of a sale and leaseback transaction. The three VLCCs are the Nautica ( 2008 – 307,284), Nectar ( 2008 – 307,284) and Noble ( 2008 – 307,284). The vessels were sold for a net en-bloc purchase price of USD 126 million.
The transaction produced a capital gain of about USD 23.0 million. Following IFRS 16 only USD 9.3 million which corresponds to the gain related to the rights transferred to the buyer and, as a result, has impacted the financial statements as per 31 December 2019 positively. After repayment of the existing debt, the transaction generated USD 66.6 million free cash.
Euronav has leased back the three vessels under a 54-months bareboat contract at an average rate of USD 20,681 per day per vessel. At the end of the bareboat contract, the vessels will be redelivered to their new owners.
UPDATED RETURNS TO SHAREHOLDERS GUIDANCE
In practical terms, the 2019 final dividend proposal from the board to the shareholders will be confirmed with the announcement of the final year results for 2019 on 31st March 2020. This dividend, as with previous years, will then have to be approved by shareholders at the AGM in May with payment thereafter.
The first application of the new Belgian company code allowing quarterly dividends will be with the Q1 2020 results due to be announced in early May 2020. The ex-date and payment profile will follow within a month of the announcement. Going forward the company will announce results on a quarterly basis with dividends following the same pattern of ex-date and payment date.
GUIDANCE ON HOW CURRENT POLICY WILL BE APPLIED
The following guidance on the current policy will be applicable as of the first quarter 2020 results:
In line with the current policy, the calculation will not include capital gains ( reserved for fleet renewal) but will include capital losses and the policy will at all times be subject to freight market outlook, company balance sheet and cyclicality along with other factors and regulatory requirements.
Euronav believes this approach has the flexibility to manage the Company through the cycle, retaining sufficient capital for fleet renewal whilst simultaneously rewarding our shareholders.
FINAL 2019 DIVIDEND PROPOSED
Management is therefore pleased to announce that it intends to recommend to the Board of Directors, subject to final audited results being identical to the preliminary ones presented herewith and absent of material adverse circumstances that the Board proposes for approval of the AGM a final full year dividend of USD 0.35 per share.
Taking into account the interim dividend distributed in 2019 in the amount of USD 0.06 per share, the expected dividend payable after the AGM should be USD 0.29 per share.
The total final USD 0.35 dividend per share is in line with the target return guidance when compared to underlying earnings for the full year 2019 of USD 0.44 per share ( after stripping out capital gains).
Therefore, taking into account the share buybacks executed over the course of 2019, the total return of capital to shareholders related to the full year 2019 is USD 105 million or USD 0.49 per share.
CLIMATE AND ESG COMMITTEE
In December 2019 Euronav held its first meeting with a new committee – the ESG and Climate Committee. This committee will meet on a regular basis and consists of members of the executive management team and non-executive directors from the board.
This initiative reflects the commitment by Euronav to fully engage on climate and ESG matters and ensure the secure transportation of crude oil is a core part of the energy transition to a cleaner future with lower emissions. Euronav is also committed to gaining a rating from CDP ( Climate Disclosure Program) during 2020 from which it intends to develop challenging emission reduction targets. Euronav has already been providing full scope carbon emissions data since 2017.
Euronav was a key party of the drafting of the Poseidon Principles formally launched in June 2019. Euronav is a founding partner of the Global Maritime Forum from which many sustainable initiatives were, and are expected, to be created. One of which is the Getting to Zero coalition which aims to develop zero emissions vessels by 2030 and to which Euronav is one of the signatories.
INCLUSION IN BLOOMBERG GENDER EQUALITY INDEX FOR 2020
Euronav remains committed to applying the highest corporate governance standards possible. This was reflected during 2019 with gender equality being a key orientation, which is visible in all layers of the Company, including Board and Management level.
In addition Euronav has been included in the Bloomberg Gender-Equality Index 2020 ( “ GEI ”). This is the third year Euronav has been included in this index. The 2020 Index is a reference index which measures gender representation across internal company statistics, employee policies, external community support and engagement, and gender-conscious product offerings. The 2020 GEI expands globally to represent 42 countries and a combined market capitalization of USD 12 trillion.
FUEL PROCUREMENT PROJECT AND IMPLEMENTATION OF IMO 2020
During 2019 Euronav purchased sufficient fuel to cover more than half of its compliant fuel requirements for calendar 2020. The key driver behind this strategy was to provide security of fuel supply and ensure a smooth transition into IMO 2020. The compliant fuel has been deployed since end of Q4. The inventory, which has been fully tested, was purchased at a very competitive price well below the current spot price for compliant fuel.
Following implementation of IMO 2020 a dynamic fuel oil market will provide numerous and sustained challenges for shipowners. Euronav has a dedicated fuel procurement team coupled with a strong balance sheet and operational capability to meet these challenges. The fuel procurement strategy implemented so far has provided Euronav adequate protection against higher fuel prices and a high degree of optionality going forward regarding fuel strategies. This includes the potential to install scrubber technology. Management will continue to closely monitor fuel market dynamics and update stakeholders when necessary.
For more details on our IMO strategy: https: //www.euronav.com/investors/company-news-reports/presentations/2019/euronav-imo-2020-webinar/
TANKER MARKET
Demand and ton-mile
Demand for crude oil recovered strongly during Q4 ( IEA estimate 1.9 bpd for Q4 2019) on factors other than seasonality with a prolonged period of refinery maintenance reversing ahead of IMO 2020 coupled with GDP growth from improving trade conditions.
The OPEC production cuts were extended in early December into 2020 but the impact on the tanker market has been negligible as longer ton mile trading routes principally from the Atlantic ( US Gulf, Brazil and the new Johan Sverdrup field from Norway) shipping crude to the Far East. The US crude export phenomenon continues to deliver with a new high of 4.4 million bpd recorded in December ( source EIA).
Periodic geo-political tensions, primarily in the Middle East, also contributed to a stronger freight environment during the quarter and into Q1. Other potential disruptions from vessels leaving the fleet to install scrubbers were far less intrusive than anticipated during Q4 as half the planned 98 installations were deferred into 2020. On an annualized basis consensus estimates that a further 96 VLCCs plan to retrofit scrubbers during 2020 reducing the fleet capacity by 1.9% - thus providing a further positive driver to already robust fundamentals.
Supply
Contracting of new vessels has continued to remain benign with the order book ( new orders as% of existing fleet) static at 25 year lows and the run rate of new tanker orders over the past 12 months below the level of new VLCCs required per year from IEA demand projections.
Two key factors are driving such reluctance to order; ( 1) increasingly restricted access to capital from traditional shipping banks as regulatory pressures build ( e.g. Basel IV) and historical asset price volatility drives some policy decisions ( source: Petrofin) ( 2) owners reluctance to invest capital in current technology whilst the sector is targeting substantial reductions in carbon emissions by the end of the new decade which is likely to require new propulsion technologies and/or fuels.
The world large tanker fleet will also come back as of this year to a more regular fleet age profile across all vintages. This means, that should the freight markets show weakness, there will be a healthy number of vessels old enough to be recycled and therefore reduce the supply of ships available for crude oil transportation.
Recent market activity
The fundamentals that underpinned a robust freight rate market through most of Q4 2019 were augmented by IMO related disruption to fleet supply and increased geopolitical risk as the calendar year closed. Combined with seasonal strength during the winter period this pushed freight rates temporarily to elevated levels between mid-December and mid-January. As expected seasonal trading patterns have reduced earnings and activity since then to more normalized levels. Concerns over the potential impact of the Coronavirus, a serious respiratory virus, on freight rates and capital market activity are at a very early stage but will require monitoring.
OUTLOOK
Q1 2020 has begun very strongly with some short term factors driving freight rates to highly elevated if temporary levels. Robust underlying fundamentals of vessel supply and demand are supportive to a stronger freight market of some duration. The effects of IMO 2020 should be a positive overlay during the current and subsequent quarters but are also likely to provide some short term disruption to the global shipping network. The recent trade deal ( first phase trade agreement) between US and China requires over USD 50 billion of Chinese purchasing of energy product including crude oil.
Whilst the fundamentals remain very good, management acknowledge that it is premature to assess the impact of the outbreak of the Coronavirus in China.
So far in the first quarter of 2020, the Euronav VLCC fleet operated in the Tankers International Pool has earned about USD 89,200 per day and 60% of the available days have been fixed. Euronav’ s Suezmax fleet trading on the spot market has earned about USD 57,500 per day on average with 51% of the available days fixed.
CONFERENCE CALL
Euronav will host a conference call today at 8.00 a.m. EST / 2.0 p.m. CET today to discuss the results for the fourth quarter 2019.
The call will be a webcast with an accompanying slideshow. You can find details of this conference call below and on the “ Investor Relations ” page of the Euronav website at http: //investors.euronav.com.
Telephone participants may avoid any delays by pre-registering for the call using the following link to receive a special dial-in number and PIN conference call registration link: http: //dpregister.com/10138467. Pre-registration fields of information to be gathered: name, company, email.
Telephone participants located in the U.S. who are unable to pre-register may dial in to +1-877-328-5501 on the day of the call. Others may use the international dial-in number +1-412-317-5471.
A replay of the call will be available until 6th of February 2020, beginning at 9 a.m. EST / 3 p.m. CET on 30 January 2020. Telephone participants located in the U.S. can dial +1-877- 344-7529. Others can dial +1-412-317-0088. Please reference the conference number 10138467.
Forward-Looking Statements
Matters discussed in this press release may constitute forward-looking statements. The Private Securities Litigation Reform Act of 1995 provides safe harbor protections for forward-looking statements in order to encourage companies to provide prospective information about their business. Forward-looking statements include statements concerning plans, objectives, goals, strategies, future events or performance, and underlying assumptions and other statements, which are other than statements of historical facts. The Company desires to take advantage of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 and is including this cautionary statement in connection with this safe harbor legislation. The words `` believe '', `` anticipate '', `` intends '', `` estimate '', `` forecast '', `` project '', `` plan '', `` potential '', `` may '', `` should '', `` expect '', `` pending '' and similar expressions identify forward-looking statements.
The forward-looking statements in this press release are based upon various assumptions, many of which are based, in turn, upon further assumptions, including without limitation, our management's examination of historical operating trends, data contained in our records and other data available from third parties. Although we believe that these assumptions were reasonable when made, because these assumptions are inherently subject to significant uncertainties and contingencies which are difficult or impossible to predict and are beyond our control, we can not assure you that we will achieve or accomplish these expectations, beliefs or projections.
In addition to these important factors, other important factors that, in our view, could cause actual results to differ materially from those discussed in the forward-looking statements include the failure of counterparties to fully perform their contracts with us, the strength of world economies and currencies, general market conditions, including fluctuations in charter rates and vessel values, changes in demand for tanker vessel capacity, changes in our operating expenses, including bunker prices, dry-docking and insurance costs, the market for our vessels, availability of financing and refinancing, charter counterparty performance, ability to obtain financing and comply with covenants in such financing arrangements, changes in governmental rules and regulations or actions taken by regulatory authorities, potential liability from pending or future litigation, general domestic and international political conditions, potential disruption of shipping routes due to accidents or political events, vessels breakdowns and instances of off-hires and other factors. Please see our filings with the United States Securities and Exchange Commission for a more complete discussion of these and other risks and uncertainties.
* * *
Contact: Brian Gallagher – Head of IR, Research and Communications & Executive Committee member Tel: +44 20 78 70 04 36 Email: IR @ euronav.com
Announcement of 2019 Full Year Results: 31st March 2020
About EuronavEuronav is an independent tanker company engaged in the ocean transportation and storage of crude oil. The Company is headquartered in Antwerp, Belgium, and has offices throughout Europe and Asia. Euronav is listed on Euronext Brussels and on the NYSE under the symbol EURN. Euronav employs its fleet both on the spot and period market. VLCCs on the spot market are traded in the Tankers International pool of which Euronav is one of the major partners. Euronav’ s owned and operated fleet consists of 2 V-Plus vessels, 42 VLCCs, 27 Suezmaxes ( two of which are in a joint venture) and 2 FSO vessels ( both owned in 50% -50% joint venture).
Regulated information within the meaning of the Royal Decree of 14 November 2007
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Charting a corrective bounce, S & P 500 balks at first resistance | U.S. stocks are lower early Thursday, pressured as the coronavirus overhang continues to crowd out generally strong earnings reports.
Against this backdrop, the S & P 500 has thus far balked at near-term resistance ( 3,280) matching the 20-day moving average, currently 3,279. An overdue consolidation phase seems to be taking hold to conclude January.
Before detailing the U.S. markets’ wider view, the S & P 500’ s
SPX,
-1.03%
hourly chart highlights the past two weeks.
As illustrated, the S & P has registered a lackluster week-to-date recovery attempt.
The index remains capped by an inflection point matching the former range bottom ( 3,280) and the 20-day moving average, currently, 3,279. Its
near-term
bias remains bearish pending a close atop this area.
Meanwhile, the Dow industrials’
DJIA,
-1.48%
backdrop remains incrementally weaker.
In its case, the index has stalled near its former breakout point ( 28,872) preserving a bearish near-term bias.
A retest of the 2019 close ( 28,538) is underway early Thursday.
Against this backdrop, the Nasdaq Composite
COMP,
-0.07%
remains the strongest major benchmark.
To reiterate, the index has maintained its breakout point ( technically 9,093), an area better illustrated on the daily chart below.
More immediately, a retest of near-term support ( 9,185) is underway early Thursday. The early session low ( 9,185) has matched the inflection point.
Widening the view to six months adds perspective.
On this wider view, the Nasdaq has thus far weathered the late-January downdraft. Recall that the week-to-date low ( 9,088) has effectively matched the breakout point ( 9,093) punctuating a successful retest.
More broadly, important support matches the 2020 low ( 8,943.5) and the ascending 50-day moving average, currently 8,926. The Nasdaq’ s intermediate-term bias remains bullish barring a violation.
Looking elsewhere, the Dow Jones Industrial Average has pulled in more aggressively.
Recall that the index has violated its breakout point ( 28,872) — unlike the other benchmarks — and subsequently failed the initial retest from underneath. ( Also see the hourly chart.)
On further weakness, the 50-day moving average ( 28,425) closely matches the January low ( 28,418) and is followed by gap support ( 28,381). An eventual violation of these areas would raise an intermediate-term caution flag.
Meanwhile, the S & P 500’ s reversal has stalled at near-term resistance.
The specific area matches the former range bottom ( 3,280) and the 20-day moving average, currently 3,279. ( Also see the hourly chart.)
The bigger picture
As detailed above, a late-January market divergence remains in play. The major benchmarks are doing slightly different things.
For instance, the Dow Jones Industrial Average has asserted a posture under its breakout point ( 28,872) while the Nasdaq Composite has maintained its corresponding breakout point ( 9,093).
Amid the cross currents, a near-term consolidation phase remains underway, though each benchmark’ s intermediate-term bias remains bullish.
Moving to the small-caps, the iShares Russell 2000 ETF
IWM,
+0.92%
continues to press next support.
The specific area spans from 163.54 to 163.99 —
detailed previously
— levels matching the early-January low and the 50-day moving average.
The IWM has ventured under this area early Thursday, though as always, it’ s the session close that matters.
Similarly, the SPDR S & P MidCap 400 ETF
MDY,
-0.20%
is challenging next support.
Its corresponding floor spans from 370.63 to 371.95, levels matching the early-January low and the 50-day moving average.
More broadly, consider that the early-week downdraft was fueled by increased volume, and punctuated by a flattish lighter-volume rally attempt. Bearish price action.
Looking elsewhere, the SPDR Trust S & P 500
SPY,
-1.06%
continues to test its trendline, a level closely tracking the 20-day moving average, currently 327.10.
Delving deeper, the SPY’ s breakout point — the 324.90-to-325.20 area — remains a notable floor.
And here again, the mid-week rally attempt has been flattish, fueled by decreased volume.
Against this backdrop, the S & P 500 has asserted a bearish near-term bias.
Recall that near-term inflection points match the former range bottom — the 3,280-to-3,283 area — and the 20-
day
moving average, currently 3,279.
The failed initial retest from underneath signals waning bullish momentum. An overdue consolidation phase seems to be underway.
More broadly, the S & P 500’ s intermediate-term bias remains bullish.
As detailed repeatedly, notable support rests at 3,215, a level matching the December gap ( 3,216), the January low ( 3,214.6) and the S & P’ s former projected target ( 3,215).
The 50-day moving average, currently 3,209, is rising toward support.
To reiterate, an eventual violation of the 3,210-to-3,215 area would mark a material “ lower low ” — combined with a violation of the 50-day moving average — raising an
intermediate-term
caution flag.
Beyond technical levels, the early-week downdraft registered as aggressive — marking the strongest selling pressure since October — while the mid-week rally attempt has been comparably lackluster. The weekly close, also a monthly close, will likely add color.
Thursday’ s Watch List
The charts below detail names that are technically well positioned. These are radar screen names — sectors or stocks poised to move in the near term. For the original comments on the stocks below, see
The Technical Indicator Library.
Drilling down further, the United States Oil Fund
USO,
-2.10%
has started 2020 with a nearly straightline first-month downdraft. The fund tracks the price of West Texas Intermediate ( WTI) light, sweet crude oil.
The latest leg lower punctuates a failed test of trendline resistance, from underneath, and subsequent violation of the 200-day moving average.
More immediately, the week-to-date rally attempt has registered as flat. Bearish price action.
Tactically, initial resistance ( 11.50) is followed by the 200-day moving average, currently 11.97, an area closely matching the breakdown point. The pending retest of these areas should be a useful bull-bear gauge.
Moving to U.S. sectors, the Energy Select Sector SPDR
XLE,
-2.04%
has broken down technically,
Specifically, the group has plunged to 52-week lows, violating well-defined support amid increased volume.
The subsequent “ rally attempt ” has been flat, fueled by decreased volume, and capped by the breakdown point ( 55.90). The group’ s prevailing backdrop supports a bearish view pending repairs, though an eventual close atop this area would mark a step toward stabilization. ( Also note the downward sloping 50- and 200-day moving averages.)
More broadly, the group is vulnerable on the
five-year chart,
likely positioned to register its worst monthly close since 2010.
Moving to specific names, PepsiCo, Inc.
PEP,
-2.05%
is a well positioned large-cap name. ( Yield = 2.7%.)
Earlier this month, the shares knifed to all-time highs, rising from a four-month base.
The subsequent pullback has been orderly — fueled by decreased volume — placing the shares at an attractive entry near the breakout point, and 1.7% under the January peak.
Abbott Laboratories
ABT,
+0.75%
is a well positioned large-cap name.
As illustrated, the shares have recently rallied to record territory, rising amid increased volume after the company’ s fourth-quarter results
The subsequent pullback places the shares at an attractive entry near the breakout point and 3.7% under the January peak.
More broadly, the shares are also well positioned on the
five-year chart.
Finally, United Therapeutics Corp.
UTHR,
+0.10%
is a mid-cap biotech name coming to life.
Technically, the shares have knifed to the range top, edging to eight-month highs amid a down market.
More broadly, the January price action has been punctuated by tandem strong-volume rallies, laying the groundwork for a potentially more decisive breakout. A near-term target projects to just under the 100 mark on follow-through.
Still well positioned
The table below includes names recently profiled in The Technical Indicator that remain well positioned. For the original comments, see
The Technical Indicator Library.
Company
Symbol
Date Profiled
Morgan Stanley
MS
Jan. 29
Halozyme Therapeutics, Inc.
HALO
Jan. 29
Akamai Technologies, Inc.
AKAM
Jan. 24
StoneCo Ltd.
STNE
Jan. 24
Spirit Airlines, Inc.
SAVE
Jan. 23
Himax Technologies, Inc.
HIMX
Jan. 23
International Business Machines
IBM
Jan. 22
Yeti Holdings, Inc.
YETI
Jan. 22
Home Depot, Inc.
HD
Jan. 21
IntercontinentalExchange, Inc.
ICE
Jan. 16
PulteGroup, Inc.
PHM
Jan. 16
Square, Inc.
SQ
Jan. 16
Lattice Semiconductor Corp.
LSCC
Jan. 15
SailPoint Technologies Holdings, Inc.
SAIL
Jan. 15
Dunkin Brands Group, Inc.
DNKN
Jan. 15
SPDR S & P Homebuilders ETF
XHB
Jan. 14
Netflix, Inc.
NFLX
Jan. 14
Newmont Corp.
NEM
Jan. 13
SBA Communications Corp.
SBAC
Jan. 13
Guess, Inc.
GES
Jan. 13
CME Group, Inc.
CME
Jan. 10
Motorola Solutions, Inc.
MSI
Jan. 10
fMcDonald’ s Corp.
MCD
Jan. 9
TE Connectivity Ltd.
TEL
Jan. 9
Big Lots, Inc.
BIG
Jan. 9
Micron Technology, Inc.
MU
Jan. 8
Zendesk, Inc.
ZEN
Jan. 8
Fortinet, Inc.
FTNT
Jan. 7
Atlassian Corp.
TEAM
Jan. 7
Twilio, Inc.
TWLO
Jan. 7
Coupa Software, Inc.
COUP
Jan. 6
Progressive Corp.
PGR
Jan. 6
SPDR Gold Shares ETF
GLD
Jan. 2
Amazon.com, Inc.
AMZN
Jan. 2
iShares Transportation Average ETF
IYT
Dec. 23
Union Pacific Corp.
UNP
Dec. 23
Activision Blizzard, Inc.
ATVI
Dec. 20
Cree, Inc.
CREE
Dec. 19
Ciena Corp.
CIEN
Dec. 18
Air Products and Chemicals, Inc.
APD
Dec. 18
PTC Therapeutics, Inc.
PTCT
Dec. 18
Autodesk, Inc.
ADSK
Dec. 17
iRobot Corp.
IRBT
Dec. 17
American Express Co.
AXP
Dec. 16
Paycom Software, Inc.
PAYC
Dec. 16
FormFactor, Inc.
FORM
Dec. 16
NXP Semiconductors N.V.
NXPI
Dec. 11
Bristol-Myers Squibb Co.
BMY
Dec. 10
Splunk, Inc.
SPLK
Dec. 9
Macom Technology Solutions Holding, Inc.
MTSI
Dec. 6
Best Buy Co., Inc.
BBY
Dec. 6
Yamana Gold. Inc.
AUY
Dec. 5
VanEck Vectors Gold Miners ETF
GDX
Dec. 3
Pan American Silver Corp.
PAAS
Dec. 3
Nuance Communications, Inc.
NUAN
Dec. 3
Shopify, Inc.
SHOP
Nov. 27
Lowe’ s Companies, Inc.
LOW
Nov. 27
MKS Instruments, Inc.
MKSI
Nov. 26
Stanley Black & Decker, Inc.
SWK
Nov. 25
Baidu, Inc.
BIDU
Nov. 22
Medtronic plc
MDT
Nov. 21
Wheaton Precious Metals Corp.
WPM
Nov. 20
Nevro Corp.
NVRO
Nov. 19
Agios Pharmaceuticals, Inc.
AGIO
Nov. 18
Allstate Corp.
ALL
Nov. 14
Adobe, Inc.
ADBE
Nov. 14
Zebra Technologies Corp.
ZBRA
Nov. 13
AstraZenaca, plc
AZN
Nov. 12
Health Care Select Sector SPDR
XLV
Nov. 11
Advanced Micro Devices, Inc.
AMD
Nov. 7
Alibaba Holdings Group, Ltd.
BABA
Nov. 5
Alphabet, Inc.
GOOGL
Nov. 4
Teledoc Health, Inc.
TDOC
Nov. 1
Salesforce.com, Inc.
CRM
Oct. 31
Qualcomm, Inc.
QCOM
Oct. 31
Citrix Systems, Inc.
CTXS
Oct. 31
Industrial Select Sector SPDR
XLI
Oct. 31
Invesco QQQ Trust
QQQ
Oct. 30
Centene Corp.
CNC
Oct. 30
Generac Holdings, Inc.
GNRC
Oct. 25
RingCentral, Inc.
RNG
Oct. 24
United Technologies Corp.
UTX
Oct. 23
Nvidia Corp.
NVDA
Oct. 22
Tesla, Inc.
TSLA
Oct. 21
Garmin, Ltd.
GRMN
Oct. 18
Facebook, Inc.
FB
Oct. 16
Qorvo, Inc.
QRVO
Oct. 16
Skyworks Solutions, Inc.
SWKS
Oct. 15
Jabil Inc.
JBL
Oct. 15
TJX Companies, Inc.
TJX
Oct. 8
Comtech Telecommunications Corp.
CMTL
Oct. 4
Taiwan Semiconductor Manufacturing Co.
TSM
Sept. 27
RH
RH
Sept. 27
Sony Corp.
SNE
Sept. 26
Nike, Inc.
NKE
Sept. 26
Toll Brothers, Inc.
TOL
Sept.25
Synaptics, Inc.
SYNA
Sept.25
Intel Corp.
INTC
Sept. 18
VanEck Vectors Semiconductor ETF
SMH
Sept. 11
Kansas City Southern
KSU
Sept. 10
Lam Research Corp.
LRCX
Sept. 3
iShares U.S. Home Construction ETF
ITB
Aug. 27
Apple, Inc.
AAPL
Aug. 21
XPO Logistics, Inc.
XPO
Aug. 20
Itron, Inc.
ITRI
Aug. 19
Cirrus Logic
CRUS
Aug. 16
Builders FirstSource, Inc.
BLDR
Aug. 16
D.R. Horton, Inc.
DHI
July 31
Teradyne, Inc.
TER
July 30
Franco-Nevada Corp.
FNV
July 18
Inphi Corp.
IPHI
July 8
Lululemon Athletica, Inc.
LULU
June 19
Ross Stores, Inc.
ROST
June 14
Consumer Staples Select Sector SPDR
XLP
Mar. 28
iShares U.S. Real Estate ETF
IYR
Mar. 13
Costco Wholesale Corp.
COST
Mar. 6
Microsoft Corp.
MSFT
Feb. 22
Procter & Gamble Co.
PG
Feb. 8
Applied Materials, Inc.
AMAT
Jan. 25
Utilities Select Sector SPDR
XLU
Oct. 25 | business |
Toyota second in 2019 global car sales, overtaking Nissan-Renault | Toyota Motor Corp. group climbed to second place in the 2019 global auto sales rankings on its robust North America demand, overtaking the Nissan Motor Co., Renault SA and Mitsubishi Motors Corp. alliance, data showed Thursday.
Toyota sold a record 10.74 million units globally in 2019, up 1.4 percent from a year earlier, to finish behind only Volkswagen AG of Germany. Robust sales of Lexus-brand cars and the company’ s RAV4 sport-utility vehicle were behind the result.
Daihatsu Motor Co. minivehicles and trucks sold by Hino Motors Ltd. are included in Toyota’ s figure.
Volkswagen took the top spot for the fourth consecutive year with a record-high 10.97 million units sold, up 1.3 percent from the previous year, while the French-Japanese alliance posted sales of 10.16 million units, down 5.6 percent.
The alliance has suffered sluggish sales in the U.S. market since November 2018, around the time of the arrest of the group’ s former boss Carlos Ghosn.
RELATED STORIES Toyota stops production in China until Feb. 9 amid coronavirus outbreak Toyota union to demand ¥10,100 monthly rise and bonus of 6.5 months ' pay Nissan takes an ax to the house that Ghosn built with new cost-cutting measures Panel upholds decision not to indict ex-Nissan chief Hiroto Saikawa | tech |
Policymakers fret over risk to global growth from China virus outbreak | In a sign of alarm over the possible damage, Bank of Japan Deputy Governor Masayoshi Amamiya said on Thursday that China's huge presence in the world economy must be taken into account in gauging the impact the outbreak could have on global growth.
Stocks around the world tumbled on Thursday as the death toll from the spread of the coronavirus reached 170, forcing airlines to cut flights and some stores to close.
The potential impact on the world economy from the outbreak took centre stage in U.S. Federal Reserve Chair Jerome Powell's news conference on Wednesday.
`` China's economy is very important in the global economy now, and when China's economy slows down we do feel that - not as much though as countries that are near China, or that trade more actively with China, like some of the Western European countries, '' Powell said.
Japanese Prime Minister Shinzo Abe also voiced concern on Thursday, saying he was closely watching the impact on Japan's economy, including declining tourism from abroad.
Zhang Ming, an economist at the Chinese Academy of Social Sciences, a top government think tank, projected the outbreak would cut China's first-quarter growth by one percentage point to 5% or lower. Economists at Citibank and elsewhere have forecast a similar slowdown.
China has imposed travel restrictions and shut businesses to contain the outbreak, but that has not quelled rising concern among companies and governments across the world.
`` Apart from the risk to human lives, it is likely to hit travel and consumption activities. In a scenario of widespread infection, it could materially weaken economic growth and fiscal positions of governments in Asia, '' S & P said in a note to clients on Thursday.
The International Monetary Fund was more cautious, saying that it was too soon to quantify the potential economic effects of the virus, noting that the direct impact on consumer and business demand had been most severe in Hubei Province, the outbreak's epicentre.
IMF Managing Director Kristalina Georgieva said the negative impact on economic activity could be recouped within a year if the virus is quickly contained, as happened during the Severe Acute Respiratory Syndrome ( SARS) outbreak in 2002 and 2003. But the number of cases of the new coronavirus now exceeds the total number of SARS cases.
`` The immediate impact is obvious. We have travel, tourism, manufacturing in China and a little bit beyond China in Asia being impacted, '' Georgieva said at the Centre for Global Development in Washington.
`` So let's say for this quarter, very likely there would be some negative impact. What would happen beyond this quarter, we have to just observe and assess, '' she said.
BIGGER DAMAGE THAN SARS?
Analysts are comparing the current coronavirus outbreak to the 2002-2003 SARS epidemic, which led to about 800 deaths and slowed Asia's economic growth.
Many say the impact on global growth could be bigger this time as China now accounts for a larger share of the world economy, a view echoed by BOJ's Amamiya.
The number of Chinese tourists visiting Japan has increased by more than 20 times since then, Amamiya said. `` The outbreak also spread during China's Lunar ( New Year) holiday, when consumption tends to peak, '' he added.
`` We're looking very carefully at developments, including how much the impact could spread, '' Amamiya said in a seminar in Tokyo hosted by Jiji news agency.
The fallout from the epidemic casts a shadow over the Bank of Japan's projection that global growth will pick up around midyear and help Japan's economy sustain a moderate recovery.
China is Japan's second-largest export destination. The Chinese make up 30% of all tourists visiting Japan and nearly 40% of the total sum foreign tourists spent last year, an industry survey showed.
By Lindsay Dunsmuir and Leika Kihara | business |
When old films go viral: how coronavirus gave Contagion an unexpected afterlife | Conventional wisdom has it that audiences flock to escapism in troubled times, but an unexpected new entry on the UK iTunes movie rental chart suggests otherwise. Nestling among the current hits is a film made nine years ago that paints a more terrifying picture of humanity than Joker and Downton Abbey combined. As the coronavirus scythes outwards from China, there have been enough rentals of Steven Soderbergh’ s 2011 thriller Contagion to propel the movie into the Top 10. ( At the time of writing, it’ s at No 13.) The picture, which stars Gwyneth Paltrow and concerns a deadly virus with the potential to decimate the global population, has, in a very real sense, gone viral.
Twitter users have been posting variations on the theme of: “ Is it just me or did Contagion predict the coronavirus? ” I missed Soderbergh’ s film when it was released, and I happen also to be frightened of dying from viral pneumonia, so I killed two birds with one download and watched the movie this week. It’ s true that the similarities are striking enough to suggest a case of life imitating … well, if not art exactly, then a top-of-the-line B-movie. In both fictional and real-life cases, the outbreak originates in China and in each instance bats are implicated. As a doctor ( played by Jennifer Ehle) at the Centers for Disease Control explains: “ Somewhere in the world, the wrong pig met up with the wrong bat. ” Worst Tinder date ever.
One Twitter user, mariow08, identified another possible culprit: “ As with many things, ” he tweeted, “ it’ s probably Gwyneth Paltrow’ s fault. ” This is not an allusion to the fact that the first reports of the coronavirus reached the World Health Organization less than a month before Paltrow’ s healing-and-wellness documentary series The Goop Lab came to Netflix. In the case of the virus in Contagion, it really does seem to have been Paltrow’ s fault – sort of. The virus goes from bat to pig to a chef who touches her without washing his hands. She hops on a plane home to her husband, played by Matt Damon, after cheating on him with an old flame, so in conventional movie morality terms she deserves what she gets when she expires shortly after; the monogamous Damon, on the other hand, miraculously survives. Fidelity to one’ s partner is in many cases to be recommended, though viewers should not infer from Contagion that this will provide immunity to coronavirus.
There is no word yet on how the growing audience for Contagion is divided among countries or continents, but it must be the case that viewers have been watching it as a sort of “ how to ” guide in the event of a catastrophe in their vicinity. Or at least a “ what to ” – what to expect when you’ re expecting an epidemic.
With streaming being a recent phenomenon, it is hard to say whether there was a direct precedent for the spike in rentals of old movies during similarly unforeseen events. Perhaps in the 90s, there would have been a stampede down to Blockbuster to fight over the five VHS copies of Outbreak, a schlocky but efficient example of the genre in which Dustin Hoffman and Kevin Spacey battle a killer virus. Strange to think that in the midst of the # MeToo era, many people consider Hoffman and Spacey to be at least as disagreeable a prospect as any deadly epidemic.
The closest analogy to the Contagion effect would be the death of a celebrity, which always reignites interest in their back catalogue. Rarer are those instances when movies make an accidental prediction or inadvertently nurture some conspiracy theory of the future. The villains in The Long Kiss Goodnight, one of the best films of the 90s, turn out to be US defence officials who plan to stage a terrorist incident and to “ blame the Muslims ” in an attempt to win a budget increase. ( They even mention the 1993 World Trade Center bombing.) And Edward Zwick’ s 1998 terrorism thriller, The Siege, felt so close to home after 9/11 that the Pentagon held a three-day conference with Hollywood screenwriters and producers in which they brainstormed potential worst-case scenarios to get the jump on future atrocities.
It is more often the case that cinema capitalises on a pre-existing fear or neurosis. The nuclear meltdown depicted in the 1978 thriller The China Syndrome, starring Jane Fonda and Michael Douglas, drew on flaws in operations at the Dresden generating station in Illinois in the early 70s, but also had the good fortune to be released in cinemas just days before the Three Mile Island nuclear accident. Money can’ t buy that kind of PR.
Perhaps that’ s the only silver lining here. A worldwide epidemic is bad news for humanity, but a kind of good news for anyone who worked on The Cassandra Crossing or The Andromeda Strain, Carriers or Contracted, and whose agent had the foresight to negotiate residuals. | general |
Bat soup, dodgy cures and 'diseasology ': the spread of coronavirus misinformation | Fake news and conspiracy theories about the origin of the coronavirus have swiftly followed the outbreak around the world.
The quick spread of the virus from its origins in China’ s Hubei province, and the lack of early detail about where it comes from or how to treat it, has provided ample room for speculation. One week after the city of Wuhan was placed under effective lockdown, the tide of misinformation is so high that Twitter, Facebook, and Google are struggling to cope.
On Friday, after the WHO declared the outbreak a global health emergency, Facebook said it would “ remove content with false claims or conspiracy theories that have been flagged by leading global health organisations and local health authorities that could cause harm to people who believe them ”.
On Thursday, Twitter announced it would “ adjust search prompt in key countries across the globe to feature authoritative health sources when you search for terms related to novel # coronavirus. ”
Here are some of the examples of misinformation spreading around the world.
The biggest piece of misinformation about the cause of the virus is the widely circulated video of a woman eating a bat. It has been spread by the Daily Mail, RT and far-right YouTuber Paul Joseph Watson among others.
The Chinese celebrity Wang Mengyun said she has received death threats since the video went viral this month.
The origins of the coronavirus are believed to have been from illegally sold wildlife at a seafood market in Wuhan, and bats could potentially have been the source, but the video was not filmed in a Wuhan restaurant as some had claimed, but in Palau, Micronesia, for a travel video in 2016.
Proponents of the QAnon conspiracy theory, such as Jordan Sather, have been spreading the idea that the outbreak of the coronavirus was timed to coincide with the start of Donald Trump’ s impeachment trial.
Sather claimed in a thread posted to his 100,000 followers that the disease was planned and manufactured. He pointed to a coronavirus patent granted to a firm with ties to the Bill & Melinda Gates foundation. The firm, Pirbright, had to issue a statement correcting misinformation. The firm said it researches infectious bronchitis virus, a coronavirus that infects poultry and pigs – not humans.
The Washington Times claimed in a story that the coronavirus outbreak could be linked to the Wuhan Institute of Virology, quoting a former Israeli military intelligence officer who claimed a bioweapon was one possible option.
Other conspiracy theories have suggested the virus was smuggled out of Canada into China.
The Washington Post, however, spoke to a number of experts who said based on the virus genome there is no indication it was engineered. The MIT professor Vipin Narang said in a tweet that there is no evidence it is a bioweapon, and if it were, it would be a bad one, because a good bioweapon should be more deadly but not as easily spread.
These days 5G is blamed for everything, from cancer to bushfires, so it is not surprising that conspiracy theories that 5G caused, or helped spread coronavirus have been shared into the anti-5G groups on Facebook.
One post debunked on Facebook claimed Wuhan was where 5G was first rolled out, and 5G “ wrecked immune systems and thereby boosted the virulency of the normal cold ”.
Wuhan was one of a few places where 5G was rolled out in China in 2020, along with other parts of the world. There is no evidence that 5G weakens immune systems or is harmful to humans.
Prominent anti-vaxxers and natural medicine groups have been sharing posts suggesting oregano oil, vitamin C, and salt water are either good ways to prevent coronavirus or cure it. They will not.
One of the more dangerous remedies again comes from prominent QAnon conspiracy followers, with Daily Beast reporting the pro-Trump conspiracy theorists have told people to buy their “ miracle mineral solution ” that is supposed to cure everything, including autism or HIV/AIDS.
The Food and Drug Administration has said the solution is “ a dangerous bleach ”.
There have been various viral posts on social media all trying to appear to be an official health-related update about what people should do to try to prevent them from getting in contact with the coronavirus.
One of the most prominent spread in Australia, via childcare centres, is an apparent “ urgent notice ” from the “ Department of Diseasology Parramatta ”.
and these child care centres in Wentworthville and Wiley Park pic.twitter.com/dJNdjj1Hw2
This non-existent department warned of food that could be contaminated including wuxhang rice, fortune cookies, migoreng noodles, Yakult, and Chinese Red Bull.
The New South Wales health department was forced to issue a statement stating there was no such entity as the Department of Diseasology Parramatta. “ NSW Health would like to assure the community that the locations mentioned in this post pose no risk to visitors, and there have been no ‘ positive readings’ at train stations. ”
Another warning spread on social media claims to come from Queensland Health and warns people to stay away from certain suburbs in Brisbane and any populated areas that have a certain proportion of Chinese residents.
The Brisbane MP Duncan Pegg tweeted that the warning was fake and designed to malign the community. | general |
Coronavirus Anger Boils Over in China and Doctors Plead for Supplies | WUHAN, China — One week into a lockdown, anger and anxiety deepened in China on Thursday as the central province at the center of the coronavirus outbreak endured shortages of hospital beds, medical supplies and doctors.
In a sign of growing frustration, a relative of a patient infected with the virus beat up a doctor at a hospital in Wuhan, the capital of Hubei Province, the state broadcaster CCTV reported on Thursday, citing the police. The man was accused of pulling and damaging the doctor’ s mask and protective clothing — potentially exposing him to the virus — after his father-in-law died in the hospital. The man was later detained.
[ Read: China says 1,700 health workers have contracted coronavirus. ]
At the same time, hospitals in the region renewed pleas to the public for help to replenish their supplies, which were fast disappearing. The shortages have become especially severe in Huanggang, a city of seven million not far from Wuhan, where some medical staff members were wearing raincoats and garbage bags as shoe covers to protect against infection, according to Yicai, a financial news site.
Amid growing unease, the World Health Organization declared a global health emergency, which acknowledges that the disease now represents a risk beyond China. Nations can then decide whether to shut their borders, cancel flights or screen people arriving at ports of entry. Late Thursday, the State Department urged Americans not to travel to China, issuing a Level 4 advisory, which represents the highest safety risk.
Also Thursday, Chinese government agencies announced plans to issue subsidies of up to $ 43 per day to front-line medical workers and to reopen factories to boost production of medical supplies and protective gear.
“ We absolutely can not let Huanggang become a second Wuhan, ” Wang Xiaodong, the governor of Hubei Province, said at a news briefing on Wednesday.
On Thursday evening, provincial leaders said at a news briefing that the director of Huanggang’ s health committee had been fired.
For many Chinese, such decisive government announcements are too little, too late. Concerns have grown as the death toll from the coronavirus has quickly ticked upward, rising by 43 to hit 213 on Friday. All but one of those recent deaths have occurred in Hubei Province; the other died in the southwestern province of Sichuan.
Fueling the anger on Thursday was the publication this week of a new paper about the coronavirus in The New England Journal of Medicine by a team of researchers affiliated with, among other places, the Chinese Centers for Disease Control and Prevention and the Hubei Provincial Centers for Disease Control and Prevention.
Drawing on data from the first 425 confirmed cases in Wuhan, the paper states that “ there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. ”
Chinese people online were incensed, asking why the government had waited until Jan. 20 to inform the public that the virus was capable of being transmitted from human to human. By Thursday evening, many had seized on the paper as evidence that the authors had purposely withheld valuable information out of academic self-interest.
“ I’ m about to explode, I need an explanation from the authors!!!! ” Wang Liming, a professor at Zhejiang University, wrote in a widely shared social media post that was quickly deleted. “ As a researcher with firsthand information, you knew that the virus could be transmitted between humans three weeks before the public did. Did you do what you were supposed to do? ”
As China raced to contain the outbreak, countries grappled with how to evacuate their citizens from Wuhan and how to stop the virus from spreading.
Australia announced a plan to evacuate its citizens in Wuhan to Christmas Island, which has played an important but checkered role in the country’ s contentious use of faraway sites to house refugees and other migrants. The announcement drew immediate questions over the implications of using the island as a quarantine site.
Moving people to Christmas Island is not an “ appropriate solution, ” Dr. Tony Bartone, the president of the Australian Medical Association, said in a television news interview. He said the government had other, more suitable facilities, such as military sites.
In Japan, a furor erupted over the refusal of some evacuees who had returned to submit to medical testing.
Two of the Japanese citizens who have been evacuated from Wuhan refused to be tested for the coronavirus, leading the prime minister to explain that citizens could not be forced to submit to a medical examination.
Japanese social media users said the travelers, who arrived in Tokyo on Wednesday, were putting the country at risk. Some called them terrorists.
“ We tried to persuade the two returnees from Wuhan for many hours ” to be tested, Prime Minister Shinzo Abe said in Parliament on Thursday, when asked about the government’ s treatment of repatriated citizens. “ But there is no legally binding force, and that’ s a great regret. ” Mr. Abe said.
Russia ordered 16 of its approximately 25 crossing points on its 2,600-mile border Chinese border to be closed as of midnight local time as fears about the coronavirus outbreak mounted in Moscow.
“ We have to do everything to protect our people, ” Prime Minister Mikhail Mishustin said on Thursday in televised remarks at a cabinet meeting.
Italy blocked thousands of people from leaving a cruise ship that docked there on Thursday over concerns that someone aboard might have the virus. Although a Chinese national with a fever later tested negative for the coronavirus and the Italian authorities said passengers were allowed to disembark, for much of the day the country was gripped by fears that the coronavirus had arrived on its shores.
Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’ t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’ s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “ very rare, ” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’ s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’ s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’ t being told to stay at home, it’ s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. ( Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’ s temperature to look for signs of fever is not as easy as it sounds, as “ normal ” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’ t have a thermometer ( they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’ t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’ t replace hand washing and social distancing.
If you’ ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’ re sick and you think you’ ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’ s a chance — because of a lack of testing kits or because you’ re asymptomatic, for instance — you won’ t be able to get tested.
That concern proved warranted later Thursday, when the government reported the country’ s first two confirmed cases, neither of which were related to the ship.
Prime Minister Giuseppe Conte also announced that Italy had halted all flights to and from China.
The virus has infected more than 8 million people and has been detected in nearly every country.
In the United States, health officials on Thursday reported the first case of person-to-person transmission of the coronavirus in the United States. The patient is the husband of a woman who was the first reported case in Chicago, officials said at a news briefing. The woman, who is in her 60s, had returned from Wuhan.
The American commerce secretary, Wilbur Ross, said the United States could see a positive byproduct from China’ s woes because the outbreak could prompt employers to move jobs to its shores.
“ I don’ t want to talk about a victory lap over a very unfortunate, very malignant disease, ” Mr. Ross said in an interview on Fox Business. “ I think it will help to accelerate the return of jobs to North America. Some to the U.S., probably some to Mexico as well. ”
His remarks may be seen as insensitive to a country in crisis, and he has faced such criticism in the past. During the government shutdown in early 2019, Mr. Ross suggested that furloughed workers should take out loans while they went without pay for more than a month.
With the evacuations and lockdown, Wuhan, a typically bustling metropolis, has been transformed into a ghost town. Since the city was effectively sealed off last week, most shops have shut down. The city government has put restrictions on traffic. The lack of transportation options has made it difficult for medical workers and sick residents to get to hospitals.
But most residents of Wuhan are not leaving their homes because they are too scared of catching the virus.
“ Local Wuhan residents who aren’ t worried about being sick aren’ t even going on the streets, ” Chen Qiushi, a Beijing-based lawyer who has been in Wuhan since the lockdown began, said in a video blog posted on Thursday. “ The locals are all very scared. ”
When Wuhan residents step outside, it’ s mostly to go to the supermarkets, food stores and pharmacies that stay open as part of a government effort to sustain the city. Senior officials have promised that residents need not worry about vegetables, fruit or other staples.
While Wuhan residents have been able to buy food, some complained about price increases or expressed fear that a prolonged shutdown might choke off food supplies. And if the shutdown lasts weeks longer, with the rest of China also scrambling to secure food supplies, it could make things more serious, several residents said.
“ If we can’ t bring in produce, it will become more expensive, or we might even have to close up, ” said Zuo Qichao, who was selling piles of cucumbers, turnips and tomatoes. As he spoke, a woman accused him of unfairly raising the turnips’ price.
“ Every county, every village around here is now putting up barriers, worried about that disease, ” Mr. Zuo said. “ Even if the government says it wants food guaranteed, it won’ t be easy — all those road checks. ”
Amy Qin reported from Beijing, and Christopher Buckley from Wuhan, China. Reporting was contributed by Elaine Yu, Tiffany May, Russell Goldman, Austin Ramzy, Alexandra Stevenson, Motoko Rich, Anton Troianovski, Isabella Kwai, Chris Horton, Makiko Inoue, Daisuke Wakabayashi, Karen Weise, Iliana Magra, Christopher Cameron and Mike Isaac. Research was contributed by Elsie Chen, Zoe Mou, Albee Zhang, Amber Wang, Yiwei Wang and Claire Fu. | business |
Is the coronavirus outbreak as bad as SARS? | By Maciej F. Boni 30 January 2020
As the new coronavirus continues to cross international borders, the two key questions on public health officials ' minds are: 'How deadly is it? ' and 'Can it be contained? '.
The two outbreaks in recent memory that give the most insight into these questions are the 2002-2003 SARS outbreak, which spread from China to 26 other countries but was contained after eight months, and the 2009 H1N1 influenza pandemic, which originated in Mexico and spread globally despite all containment efforts.
The severity and mortality of a novel emerging virus, which we scientists in this case are calling 2019-nCoV, are very difficult to judge when new data are coming in on a daily basis. During the 2009 influenza pandemic, the earliest reports listed 59 deaths from approximately 850 suspected cases, which suggested an extremely high case fatality of 7%.
Related: Coronavirus Death Toll Up To 170: Live updates on 2019-nCoV
However, the initially reported information of 850 cases was a gross underestimate. This was simply due to a much larger number of mild cases that did not report to any health system and were not counted. After several months — when pandemic data had been collected from many countries experiencing an epidemic wave — the 2009 influenza turned out to be much milder than was thought in the initial weeks. Its case fatality was lower than 0.1% and in line with other known human influenza viruses.
The case fatality for SARS, during its eight months of circulation, was just under 10%.
Is the current epidemic more similar in severity and transmissibility to the SARS outbreak or the 2009 flu pandemic? I am a professor of biology who studies the evolution and epidemiology of infectious disease, and in my view, in late January 2020, we do not yet have enough solid evidence to answer this question. I am optimistic that the scientific community's sharing ethos and rapid data analytics that we have seen over the past two weeks will soon generate the needed data.
As with the 2009 pandemic, initial reports from Wuhan described small numbers of both deaths and cases. On January 20, there were six deaths out of 282 confirmed cases. By January 28, there were 106 deaths from about 4,500 confirmed cases.
These numbers taken alone suggest a case fatality rate of around 2%, very high for a respiratory virus. But the true number of infected individuals circulating in the population is not known and is likely to be much higher than 4,500. There may be 50,000 or 100,000 additional cases in Wuhan that have gone undetected, and, if this is the case, it would put the case fatality of 2019-nCoV infections in the range of 0.1% to 0.2%.
During these early stages of the outbreak investigation, it is difficult to estimate the lethality, or deadliness, of this new virus.
So, with all of this uncertainty, how much effort should public health officials put into containment, quarantine and isolation activities? Should all airports be implementing temperature screening for incoming passengers? There are no easy answers to these questions, as there are only a few historical examples to look back on. And, none of them is guaranteed to be a template for this year's 2019-nCoV epidemic.
Fortunately for human beings, a pathogen like 2019-nCoV can not have its cake and eat it too. The virus can not be both deadly and undetectable. To illustrate, we can consider the hypothetical examples of a severe and a non-severe respiratory virus.
With a more severe symptoms profile, a respiratory infection will have more sudden onset, earlier symptoms, a higher chance of severity and death, and it will probably cause patients to report to hospitals at an earlier stage of infection. An outbreak of a respiratory virus like this will typically be deadly but containable.
With a less severe symptoms profile, patients may stay in an asymptomatic or mildly symptomatic state for a long time, symptoms appearance may be more gradual than sudden, and progression to hospitalization and death would be rare. An infection like this is difficult to detect and thus difficult to control, but fortunately it is much less lethal.
A key characteristic to examine in these two disease profiles is whether symptoms appear before transmissibility — i.e. at a point when patients are not yet able to infect others — or the other way around. For SARS, symptoms usually appeared before transmissibility. This feature made SARS containable.
For the 2009 H1N1 pandemic, transmissibility appeared about one day before symptoms. This meant that even the best control measures missed 20% of transmitting patients, simply because they showed no symptoms.
For the 2019-nCoV epidemic, it appears that individuals can transmit the virus before being symptomatic. However, at this early stage, this is far from certain.
Can a pathogen like this have its international spread controlled? Will airport screening and isolation of febrile cases be effective at slowing down the initial outbreak or perhaps containing it entirely?
To answer this question, we can look at data from containment efforts during the 2009 pandemic. In 2009 I was working at the Hospital for Tropical Diseases in Ho Chi Minh City, where containment efforts relied on a live synthesis of airline passenger data, symptoms data, isolation data, and diagnostics data that were coming in on a daily basis.
Data were assembled in Ho Chi Minh City for the first three months of the pandemic, covering a total of 760,000 airline passengers arriving from abroad. About 1,000 incoming travelers were suspected of being influenza-positive. That's about one passenger for every three incoming flights. The majority of these virus-positive individuals were isolated at the Hospital for Tropical Diseases and treated.
During the early stages of the pandemic, about 80% of these patients ' `` infectious days '' were spent in isolation, effectively cutting the virus's transmission rate by a factor of five.
On the one hand, a containment effort like this can be viewed as a success. The virus's entry into the city was slowed down, and an epidemic that seemed imminent in mid-June was held off until late July.
On the other hand, with about 200 influenza-positive cases coming in during the three-month containment effort, there were likely dozens of cases that came in undetected in their `` pre-symptomatic '' stage. The influenza pandemic was not destined to be locally containable.
At this moment, 2019-nCoV looks to me like its severity and transmission profile is somewhere between SARS and the 2009 H1N1 influenza.
If this is accurate, airport screening, case isolation, contact tracing and social distancing efforts may be enough in some cities to delay or fend off the arriving stream of new cases. In the next month or two, we will see how easily newly introduced seed cases are able to establish local epidemics outside the Chinese mainland.
With a little luck some cities may be able to control their outbreaks. With open scientific collaboration we may learn which containment strategies work best, in preparation for our next pandemic later this decade.
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This article was originally published at The Conversation. The publication contributed the article to Live Science's Expert Voices: Op-Ed & Insights. | general |
How far could the new coronavirus spread? | By Nicoletta Lanese 30 January 2020
The transmissibility of the virus depends on many factors, some of which remain unknown.
With every passing moment, another breaking report about the newfound coronavirus, 2019-nCoV, hits your news feed. So far, more than 7,700 cases of the virus have been confirmed, including more than 100 cases beyond China.
But one vital question is on many people's minds: How far will the virus spread?
It can be maddeningly difficult to pin the answer down to a question like this, because the epidemic's extent will depend on a number of factors, including when infected individuals become contagious, how long they remain contagious and how long the virus can survive outside a human host.
However, one estimate predicts that the total number of infections in five major Chinese cities — Beijing, Shanghai, Guangzhou, Shenzhen and Chongqing — will peak between late April and early May, according to a model developed by researchers at The University of Hong Kong. During this period, as many as 150,000 new cases may be reported in Chongqing each day due to the city's large population and the volume of travel from Wuhan to Chongqing, the team reported. The same model predicts that the number of people showing symptoms in Wuhan will spike to more than 50,000 by this upcoming weekend. Of course, things are changing rapidly, and the model’ s estimates rely on many unknowns.
Some disease transmission has already taken place beyond Chinese borders, specifically in Germany. As the illness has been reported in 22 countries so far, additional international transmission may be inevitable, but whether the outbreak will reach epidemic levels remains to be seen. To answer that question, scientists are working to determine how quickly the virus can spread between people and at what stage the disease is most transmissible.
A pathogen's ability to spread depends on its transmissibility, meaning how easily the bug can hop from one host to the next. Scientists estimate how efficiently a bug spreads between people by calculating a number known as R0, pronounced R-nought.
Also known as the `` basic reproduction number, '' R0 predicts the number of people who can catch a given bug from a single infected person. For example, diseases such as polio, smallpox and rubella have R0 values in the 5 to 7 range; such values mean that, on average, one sick person would be likely to infect five to seven people who were not resistant to the virus, according to the Centers for Disease Control and Prevention ( CDC). The measles virus ranks among the most highly transmissible diseases on the planet, with an estimated R0 value of 12 to 18.
As Chinese health officials confirmed more and more cases of 2019-nCoV, scientists around the world rushed to estimate R0 for the new virus. Last week, several reports placed the figure between 2 and 3, while the World Health Organization reported that the virus's R0 falls slightly lower, at between 1.4 and 2.5. Other estimates have surpassed this range, hovering above 3.5. But what do all these numbers really mean?
For context, know that diseases with an R0 below 1 typically disappear from a population before becoming widespread, as infected people recover faster than the bug can be transmitted to new hosts. `` In general, you want an R0 below 1; that's how you know the disease is under control, '' Dr. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said in a news briefing held Monday ( Jan. 27). An R0 above 1 suggests that a given disease will continue to spread, but the number doesn't reveal how quickly transmission will take place.
Related: Going viral: 6 new findings about viruses
Remember that R0 represents the average number of people that could be infected by a single contagious person; that seemingly straightforward number can reflect a variety of scenarios. An infection might ripple through a population in even waves, with each diseased person infecting a similar number of people. Alternatively, transmission might occur in sudden spurts, with a few so-called superspreaders passing on the infection to many people at once while other infected individuals recover before infecting anyone at all.
In the early days of an outbreak, scientists can not map these transmission patterns in detail, because they have too few data points. Such is the case with 2019-nCoV. `` The cases that have been identified skew to the severe … How does this skew our understanding of the virus? '' Alex Azar, U.S. secretary of Health and Human Services, said during a news briefing on Tuesday ( Jan. 28).
What's more, R0 estimates vary from location to location, as disease transmission depends on how often people in the affected area come into contact with each other and how prevalent infection is in a given population. The current estimates for 2019-nCoV are specific to the Chinese city of Wuhan, the epicenter of the ongoing outbreak.
R0 values also depend on characteristics of the infection itself, including how long infected people remain contagious, whether asymptomatic people can pass on the disease and how long the bug can survive outside the body, according to a study published in the January 2019 issue of the journal Emerging Infectious Diseases.
Chinese health officials reported isolated cases of disease transmission from asymptomatic people, but the CDC has not yet reviewed this data or verified the conclusion, CDC Director Robert Redfield said during the news briefing on Jan. 28. But even if asymptomatic transmission can occur, `` an epidemic is not driven by asymptomatic carriers, '' added Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Historically, symptomatic carriers `` shed '' far more of the virus than asymptomatic people during outbreaks of respiratory infection, he said.
Scientists will continue to refine the R0 estimate for 2019-nCoV as more data rolls in from around the world. Regardless of the final calculation, however, the new virus has already hopped aboard several international flights and spread far beyond Chinese borders.
To prevent 2019-nCoV from spreading further, countries such as the U.S., Australia and the U.K. are screening travelers coming from China and quarantining those with potential infections. This week, the CDC announced that its screening efforts will be expanded to cover 20 airports. In addition, health officials will monitor both infected people and their close contacts in order to identify more cases and better understand how the disease progresses over time.
For those traveling home from China, passengers seated next to the window may be the least likely to pick up the virus from an infected person onboard, as people in the window seat move about the cabin less often and come into contact with fewer people passing in the aisles, according to National Geographic. People seated in the same row as an infected person, however, stand the highest risk of infection.Imported goods from China should not carry infectious strains of the virus, especially given that most coronaviruses can survive on surfaces for only a matter of hours, Messonnier said on Monday ( Jan. 27). `` There's no evidence to support the transmission of this virus through imported goods, '' she said.
Related: The 9 deadliest viruses on Earth
`` While the vast majority of Americans will not have exposure, some will, '' Messonnier added during the Jan. 28 news briefing. Health care workers stand the greatest risk of being exposed to the virus, but with only five confirmed cases nationwide, the threat of infection remains low for most Americans, she said.
Since the start of the outbreak, the new virus has claimed 170 lives in China and infected more than 7,700 people worldwide. The true lethality and transmissibility of the virus will become clear in time, and meanwhile, health officials will continue developing diagnostics, therapeutics and preventative countermeasures to fight the disease. The average person can lower their risk of infection by washing their hands, covering their mouth when coughing or sneezing, and staying home when ill.
In the words of the CDC's Redfield, `` Everyone has a role to play to help contain the spread of this virus. ''
Originally published on Live Science.
| general |
As Coronavirus Explodes in China, Countries Struggle to Control Its Spread | Australians flown home from Wuhan, China, will be quarantined on an island for two weeks. Americans, also evacuated from Wuhan, will be “ temporarily housed ” on an air base in California. And in South Korea, the police have been empowered to detain people who refuse to be quarantined.
For countries outside China, the time to prevent an epidemic is now, when cases are few and can be isolated. They are trying to seize the moment to protect themselves against the coronavirus outbreak, which has reached every province in China, sickening more than 7,700 people and killing 170.
More than a dozen nations with a handful of cases — including the United States — are isolating patients and monitoring their contacts, as well as screening travelers from China and urging people to postpone trips there.
But whether this virus can be contained depends on factors still unknown, like just how contagious it is and when in the course of the infection the virus starts to spread.
China, with nearly 1.4 billion people, is the most populous nation on Earth, and it has taken extreme measures to try to stop the disease, first reported in December in Wuhan, a city of 11 million. The government has stopped travel in and out of that city and surrounding ones, effectively locking down tens of millions of people.
“ The fact that to date we have only seen 68 cases outside China and no deaths is due in no small part to the extraordinary steps the government has taken to prevent the export of cases, ” Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, said at a news briefing on Wednesday.
But the disease has spread far and wide inside China and, with extensive worldwide travel by its citizens, especially during the celebration of the Lunar New Year, countries everywhere are bracing for the arrival of more new cases.
Person-to-person transmission is occurring, and cases have turned up in several countries with people who have not visited China. Mentioning those cases, Dr. Tedros said the potential for further global spread was one of the reasons he had called on the W.H.O.’ s emergency committee to meet again on Thursday to decide whether to declare the epidemic a public health emergency of international concern. The committee met twice last week but was split about whether to declare an emergency, saying it did not have enough information to decide.
“ I think things are going to get worse before they get better, ” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the United States, said in a podcast posted on Tuesday by the medical journal JAMA.
transcript
From The New York Times, I’ m Michael Barbaro. This is “ The Daily. ”
Today: China says it has made lifesaving reforms since the last time it was the source of a public health crisis 17 years ago. So why is the deadly coronavirus spreading so rapidly across the country? My colleague, Javier Hernández, reports from the center of the outbreak.
It’ s Thursday, January 30.
Javier, how did you first hear about this outbreak?
Well, we started hearing reports in early January that there was this mysterious virus that was affecting Wuhan, which is a city in central China.
Staff at Wuhan Hospital are working around the clock to identify a mystery virus.
People were falling ill to this kind of pneumonia-like virus, which scientists were calling a coronavirus.
Experts believe this is a new kind of coronavirus, which typically causes symptoms of the common cold, but in some rare cases, can lead to pneumonia.
It’ s a very frightening virus that spreads from animals to humans. It was believed to be behind some very serious respiratory illnesses, so it sounded pretty scary. But the official narrative was that this strain couldn’ t pass from human to human. It would only go from animals to humans.
The potentially deadly coronavirus is thought to have spread from animals into humans at a live produce market in Wuhan.
And at that point, they were saying that it was all originating at a single meat market in central China. This meat market sold wild animals, things like bamboo rats, badgers, wolves even. And the assumption was that people had come into contact with these animals and picked up this virus.
And it sounds like because it was one meat market, and because this virus could only pass from animals to humans, that this is a pretty small problem.
At this point, the reports were that only about 130 people had been infected and that, of those, only about four had died.
Chinese officials say the outbreak is under control.
And so the prognosis was that the outbreak was controllable, that it was treatable and that things would be O.K.
And Javier, what are you thinking when you hear the Chinese government talking this way, saying that everything is going to be O.K.?
We were a bit skeptical. We knew that the Chinese government had a history of downplaying outbreaks like this. And as we saw more and more reports in the international media of this virus spreading, we began to question whether the officials were being totally upfront about what was happening.
And what do you mean when you say a history of downplaying situations like this?
Well before this virus, there was the outbreak of SARS 17 years ago. And it turned into this global health crisis that infected more than 8,000 people. It killed more than 800 people. And a big part of the reason that it spread so violently was because the Chinese government didn’ t tell the world. And there was this period of months and months when it was spreading very rapidly in China, and the world just didn’ t know about it. And for a lot of Chinese today, that experience with SARS makes them very skeptical of anything that the government says when it comes to public health.
And I imagine a reporter like you would be similarly skeptical.
Right. We really wanted to make sure that we got this one right.
We wanted to double check that this was, in fact, a small scale outbreak as the government was portraying it. And we wanted to talk to people who were getting sick with this virus to get a sense of what it was like for them — how severe it was, whether they were getting the care they needed.
And so what do you do?
So I live in Beijing. So I rushed to our bureau here and grabbed masks, enough to last me a couple days, and then headed to the airport and boarded a flight to Wuhan. And I just remember everyone on board, almost everyone, was wearing a mask. I was just struck by that. You never see people wear masks on this scale. And so it felt like there was this sense of anxiety already in the air even before we landed.
Once I got there, I rushed off to meet an ambulance doctor who had been posting on social media about this outbreak. And we had contacted him because he was challenging the official narrative about what was happening. He was saying he didn’ t believe the official numbers. He thought that this could be another SARS-like outbreak.
And what was happening to his posts once they went online?
They lasted for a while, and then they would be taken down, just disappeared. It was clear that the government was cleaning and trying to scrub the internet of any critical questions about official data. And so we wanted to talk to him about what he was seeing on the ground.
And what did he tell you?
He told me that he felt like people weren’ t taking enough precautions, that the government wasn’ t being urgent enough. And he worked in a hospital and had a lot of interaction with doctors and other medical workers. So he felt like his job could be at stake if he were to come forward publicly.
So the numbers the Chinese government is providing are relatively small. This ambulance doctor you’ re meeting with is saying the problem is bigger. So what do you do to try to reconcile those two pieces of information?
We wanted to find the people whose relatives had fallen ill to this virus. And so we were looking online for people who were reporting symptoms of fever, cough, basically anything that was associated with this kind of virus. And we stumbled on a guy from Shanghai. He was a 40-year-old architect, and he told me that his stepmother had died just a couple of days earlier from a mysterious pneumonia-like illness. And so I found him, sent him a message, and we agreed to meet at a cafe. [ CHATTER ]
And what is the story of what happened to his stepmom?
He tells me that she was a very healthy, normal 65-year-old woman who, a couple of weeks earlier, had started to feel like she was having a flu. So she had some coughing. She had kind of a sore throat, but it didn’ t seem like anything that bad. But it suddenly began to worsen. She was having a fever. She needed a respirator to breathe. And all very suddenly she was sent to a contagious disease ward, and the family was told that she would likely die.
And what did she or her stepson understand about what was behind her illness?
They didn’ t really understand much. For days and days, according to Mr. Wei, the family had tried to get her tested for this coronavirus, this mysterious virus that was spreading across Wuhan. And the doctors and other medical workers refused.
He pulled out his phone and showed me her death certificate, and all it said was that she died of severe pneumonia.
But why wouldn’ t they test her, and what does it tell you that they wouldn’ t test her?
It became clear to me in that moment that there seemed to be something going on here. Were these hospitals just not prepared? Did they not have enough testing kits? Were they running out of tests? Had they tested so many people that they didn’ t have any tests left? Were they just not counting people anymore because they weren’ t even diagnosing them? And if she wasn’ t diagnosed with this illness, then maybe she wasn’ t even included in the official count. And one other thing really stuck with me from my interview with Mr. Wei. And that was that the hospital, according to him, told them that his mother’ s body had to be burned immediately, had to be cremated immediately. [ CHATTER ]
And what does that tell you? What does that mean to you that they’ re burning these bodies?
It began to put in my head the sense that the hospital workers were beginning to think that this illness was contagious. And the fact that they wanted that body burned immediately began to suggest that perhaps they thought it posed a threat to other people.
Her death got us thinking about whether there were other people like her. And when you went online and search social media, you could quickly find others who were reporting similar experiences — people saying that they went to hospitals, they brought their sick relatives and were simply turned away. We began to kind of add things up, and it seemed like the numbers weren’ t right.
So at this point, it sounds like your skepticism is growing, and it’ s sounding pretty warranted. So what do you do next?
So I head back to my hotel and start to try to make sense of all of this. And as I’ m sitting there in my room, I begin to see these reports emerging on social media —
For the first time since the mysterious pneumonia-like illness broke out in China, the country’ s health authorities admitted the disease could be contagious.
— that one of China’ s top health experts has acknowledged that this virus is now spreading from person to person, which had never been the case before.
[ SPEAKING CHINESE ]
We considered risks of this before, but now evidence has confirmed that it is contagious among humans.
And he’ s an 83-year-old guy that they dug out of retirement essentially. He was a renowned expert during the SARS crisis. And suddenly, he’ s all over social media, telling people that this crisis is much worse than had been previously known.
So this doctor is very much validating what you have been hearing.
Yes. He’ s saying that there was even a case where one patient was able to infect 14 medical workers.
Wow.
And I begin to see the panic kind of spread across social media.
Say I have coronavirus. Could I give it to you right now?
It’ s possible, if you’ re coughing and sneezing. If you have a fever, it can be transmitted.
But the spread of Corona virus is accelerating.
This is the moment when the world begins to wake up.
Meanwhile, new cases are being confirmed outside of China as well.
Thailand has reported the first case of the Wuhan coronavirus found outside of China.
— because now they’ re talking Thailand, Singapore, possibly Scotland. The U.K. is bracing for it to go in there. We have airports here in the United States very concerned about it —
That are doing surveillance.
— here in New York, Chicago and L.A. Every day it seems growing exponentially.
It is. It’ s growing.
The numbers after that point just keep spiraling and spiraling.
The number of people who have died —
The death toll climbing once again overnight.
The death toll from a deadly viral outbreak of the new coronavirus —
26 deaths so far from the —
— has now passed 40.
[ SPEAKING CHINESE ]
It’ s not just Chinese people who are worried. Everyone is worried. They’ re all afraid of dying.
You just hear people wondering whether the virus is ever going to be contained.
We’ ll be right back.
And Javier, what are you thinking and feeling at this moment? Because you’ re in this city. You’ re interacting with people who are taking care of those who are sickened and infected by this illness.
Yeah.
Are you anxious?
Well I’ m beginning to feel like this is much worse than I thought. And I think a sense of paranoia can easily settle in sometimes in these situations. I had masks. I was washing my hands all the time. But I couldn’ t help but think about every button in the elevator that I touched, every surface and every cough or sniffle that I saw around me. The virus could be anywhere, so I had to be careful.
I mean, understandably.
So I finished up my reporting, and I grabbed a flight back to Beijing.
Just one day before China’ s massive Lunar New Year holiday, as hundreds of millions crisscross the country to celebrate with families, an unprecedented act.
And then the very next day, I hear —
Today, the entire city of Wuhan, population 11 million, is on lockdown.
The Chinese government has placed this entire city under lockdown.
Wow.
Trains, flights, buses, and ferries have been canceled. Even public transport within Wuhan has ground to a halt.
So the city you have just left has basically told everybody else who remains that they’ re not going anywhere.
Right. This city is being closed off in a way that China has never done before — or even any other major modern city, really, hasn’ t done it in recent times.
Across China tonight, an expanding lockdown to contain an epidemic.
And it was quickly becoming clear to the government that this wasn’ t just a local problem.
Travel bans in over a dozen cities affecting 35 million people.
They quickly expanded it to not just Wuhan, but to other cities, so that there were tens of millions of people who were essentially forced to stay at home and not allowed to go out. They’ ve just put in place the biggest lockdown that we’ ve ever seen and what experts are saying is the biggest experiment in public health that they’ ve ever seen.
Despite their efforts, authorities say the virus has not been stopped.
Much depends on whether the measures set in place by the Chinese government will prove effective.
It’ s hard to imagine most any other country being able to mount that kind of a response. I mean, I’ m just trying to fathom an American city somehow being locked down.
So this is what it looks like when China’ s authoritarian system is in full force. There’ s no choice for people to leave. Many people are stuck there. They are going to hospitals that are overcrowded, but they can’ t get the health care they need. Doctors are complaining about a lack of medical supplies and critical items like masks and goggles. And you get the sense that people are kind of stuck with what they have, and that’ s the bargain they’ ve made by living in this system. They have no choice but to follow the government’ s orders. They can’ t push back. They can’ t swim against the current here. Everyone’ s essentially forced to comply with this mass lockdown.
You know, from everything we’ ve learned about China and its authoritarian government, it seems like it controls every aspect of its citizens’ lives and it surveils every aspect of citizens’ lives. And you’ ve just walked us through how they were able to essentially suddenly drop a wall around Wuhan. So knowing all that, shouldn’ t China’ s government have been able to identify and control this outbreak before it got out of hand?
You would think that, because the government is so well known for being able to pull off these massive displays of citizen mobilization — it’ s been known to be able to pull off these technological feats. But at the same time, there’ s a flip side of this coin, which is that China’ s authoritarian culture, in many ways, set the stage for this crisis.
What do you mean?
Well for decades, China has built this system, this ruthless system in which if you are an official in the Communist Party, you are expected to be almost perfect. If anything goes bad, you are the one who is going to take responsibility. You are the one who is going to fall. And this has created an incentive system where local officials fear saying anything about bad news. They worry that if they are found to have done something wrong, that they will lose their power. So in a situation like this, the incentive is to cover up. It’ s to conceal. It’ s to delay. It’ s to try to get a handle on these problems on your own, hoping that perhaps nobody will ever hear about it.
So by the time something like, say, a medical crisis gets really big, it may be too late for the local officials who have been trying to contain it themselves and keep it from Beijing.
Exactly. These kinds of dynamics played a huge role in the scale of the SARS outbreak. It was clear in this case that local officials knew exactly what was going on. They knew that people were dying of this illness. But for months and months, they didn’ t want to report it up the chain. Instead, they tried to cover it up. They tried to see if they could perhaps deal with it secretly, and maybe nobody would ever find out about it. They hoped that Beijing would know about it. But eventually it broke.
So did China learn from that experience with SARS, that dynamic that led to that breakdown, that cover-up?
China said it would make a lot of changes to its system after the SARS crisis. It said that it would expand its disease reporting system so that these kinds of reports from the local provinces would come to the central government in a more timely fashion. They promised to be more transparent in the release of data and other things. But what they didn’ t change was this authoritarian culture, where people fear bringing bad news. And so that has actually gotten worse under President Xi.
Why?
He has made himself out to be the most powerful leader since Mao. He is somebody who’ s always speaking about this great ascendant moment for China in which China is going to be this superpower. And anything that goes against Xi’ s vision of this harmonious, resurgent China is going to be seen as a problem. And the people who are creating that problem will pay the consequences. And when I was there in Wuhan, I could sense the fear just rippling across all parts of the society. There were people like the ambulance doctor, who was afraid of challenging the official statistics. There were hospitals that seemed to be paralyzed, that didn’ t want to test patients for fear of knowing the results. They didn’ t want to be seen as speaking out or telling the truth or bringing this unsavory story into public view.
So that had trickled down all the way to the frontline health care workers, who are supposed to be treating this and sounding the alarm.
Right. They’ re fearful of being seen as responsible for this crisis. They don’ t want to stand out. And when you think about where this virus might be headed next — to other provinces, to other cities — you have to wonder if these same dynamics would be playing out again. If people will stay silent, if they will not report official cases, because they fear for their jobs and they fear for their livelihoods.
So it seems like whatever reforms the Chinese government made after the failures of SARS, that in the end, none of them really matter, because it hasn’ t changed the problem that’ s at the root of this.
At the root of all this is a sense of fear that is both the Communist Party’ s strength, but it’ s also a huge weakness. They can mobilize entire cities to be on lockdown. They can convince people to stay indoors. They can scrub social media of information that counters their narrative. That’ s all very effective when you’ re trying to get the public behind your policies. But at the end of the day, the fear is also a huge vulnerability. It creates this system where people are unwilling to speak out, unwilling to bring problems that are really important and that affect people’ s lives.
Right. I mean, for the Chinese leadership, that works until it doesn’ t, right? Until you very much need for people to stop being afraid and to speak out about something like a public health crisis.
Exactly.
And so when you look at the culture, you wonder whether China can actually contain these viruses, whether we will continue to live in a world where the internal politics of the party are going to put lives around the world in danger.
Javier, thank you.
Thanks, Michael.
On Wednesday, the total number of people infected by the coronavirus in mainland China surpassed those infected with the SARS virus during that epidemic. As of Wednesday evening, the virus had infected more than 6,000 people in mainland China. Later today, the World Health Organization will convene its emergency committee to determine whether the outbreak amounts to a public health emergency of international concern, its most severe classification.
We’ ll be right back.
Here’ s what else you need to know today. The Times reports that the White House has sent former national security adviser, John Bolton, a letter, warning him not to publish a book in which he recounts speaking to President Trump about the quid pro quo with Ukraine at the heart of the impeachment trial. In the letter, the White House claims that the book contains significant amounts of classified information that could harm U.S. national security. The letter was sent before The Times published a story describing the book’ s contents, a story that has further fueled calls for Bolton to testify in the Senate trial. Senators are expected to vote on whether to call witnesses like Bolton later today.
That’ s it for “ The Daily. ” I’ m Michael Barbaro. See you tomorrow.
If China can somehow contain its outbreak, and if other countries with cases can prevent sustained transmission, Dr. Fauci said that it might be possible to end the outbreak, just as the coronavirus that caused the SARS epidemic in 2003 was stamped out.
“ But it’ s going to be a real kind of tightrope walk, because if it gets so expansive then it’ s not going to just disappear the way SARS did, ” he said. “ I think the next four to five weeks are going to be critical. It’ s either going to start peaking and go into a downturn, or it’ s going to explode into a global outbreak. ”
Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention, said in an interview that he thought it would become clear in a few days whether the outbreak could be contained.
“ If we’ re seeing widespread transmission, thousands or tens of thousands of infections in the community, I don’ t see how this gets controlled, ” Dr. Frieden said. “ On the other hand, if we see a SARS-like situation, where with incredible effort they were able to isolate people, tamp down the spread, then we’ re in a containment situation. ”
A particular concern is the possibility that the virus could wreak havoc in Africa, where possible cases are being investigated.
“ We are very concerned about Africa because some of the least prepared countries for outbreaks are in Africa, ” Dr. Frieden said, adding, “ We know the systems there to find it and stop it are weaker there than elsewhere. ”
If efforts to contain an outbreak fail, public health authorities will focus on “ mitigation ” — dealing with the disease and trying to minimize the harm it does to people and communities.
“ It’ s a worrisome situation in China, ” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said in an interview on Wednesday. “ It seems like more of a mitigation strategy than a control strategy that China has moved to. ”
The United States still has a chance to avoid China’ s fate, she said.
“ We still only have five cases, and we can really do aggressive measures around those cases, ” Dr. Messonnier said. “ We’ re trying to contain the disease, and by being aggressive we’ re hoping to learn more about what it takes to contain it. ”
The five patients have hundreds of contacts. Some are being tested for the virus, and the results may help researchers understand how the disease is transmitted. The C.D.C. is also monitoring more than 100 “ patients under investigation ” — some with cough or fever who have been to Wuhan, or have had contact with a patient.
But if the case count were to increase exponentially, Dr. Messonnier said, it would be hard to continue the concerted containment efforts. The C.D.C. is already gearing up should the approach need to evolve to mitigation strategies like closing schools, preventing public gatherings and helping hospitals prepare for a surge of cases.
One troubling question is whether infected people can start spreading the virus before they themselves get sick. Chinese health officials have said they believe such transmission has taken place. If it happened often, it could make stopping an outbreak much harder.
The reason is that the first step in halting outbreaks has traditionally been to identify people who are ill and then stop them from infecting others, usually by isolating them. But that approach will not work as well if people without any symptoms are already transmitting the disease.
Health officials in the United States said they had not seen data from China to support that claim, nor any evidence that people without symptoms had spread the disease in the United States. The five patients in the United States had all visited Wuhan, and so far none of their contacts have become ill or tested positive for the virus.
Updated June 16, 2020
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’ t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’ s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “ very rare, ” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’ s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’ s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’ t being told to stay at home, it’ s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. ( Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’ s temperature to look for signs of fever is not as easy as it sounds, as “ normal ” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’ t have a thermometer ( they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’ t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’ t replace hand washing and social distancing.
If you’ ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’ re sick and you think you’ ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’ s a chance — because of a lack of testing kits or because you’ re asymptomatic, for instance — you won’ t be able to get tested.
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Dr. Fauci said that epidemics are fueled by people with symptoms — like sneezing and coughing, which help spray the virus around — and not by those without symptoms, even if some of them can spread the virus. Dr. Frieden said if asymptomatic people do transmit some virus, sick patients are likely to spread a lot more.
People with colds or flu can spread viruses for a day or two before they become ill, but how big a role that plays in outbreaks is not known, researchers say.
In any case, flu spreads worldwide every year, infecting tens of millions of people.
And the spread of the new coronavirus is starting to resemble that of seasonal flu, said Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“ I think we have to revisit which model we’ re really using, and I think we really over the past week and a half have come closer to the influenza model, ” Dr. Osterholm said. “ Trying to stop influenza in a community without vaccine is like trying to stop the wind. I don’ t know how we’ re going to stop this. ”
He added, “ The only thing operating in our favor is at least it doesn’ t appear to be as severe as SARS or as MERS. ”
Among patients with the Wuhan coronavirus, about 20 percent have become seriously ill, and the rest have a mild illness, the W.H.O. said at a news briefing on Wednesday. So far, the death rate appears to be about 2 percent, but that is not certain yet. Those who die tend to be older people with underlying ailments. The median age of the first 425 patients in China was 59, and a little more than half were male, according to a report published in The New England Journal of Medicine on Wednesday.
Diseases caused by related coronaviruses are deadlier: SARS killed 10 percent, and MERS about 35 percent.
But if the new virus were to spread even more widely and a 2 percent mortality rate continued, the death toll could be considerable. Seasonal flu, with a much lower overall death rate of 0.1 percent, kills more than half a million people worldwide every year. At least 8,200 people in the United States have died during this flu season, according to estimates from the C.D.C.
Roni Caryn Rabin contributed reporting for this article. | business |
Wilbur Ross Says Coronavirus Could Bring Jobs Back to the U.S. | WASHINGTON — Commerce Secretary Wilbur Ross predicted Thursday morning that a deadly virus originating in China would cause companies to reconsider their global supply chains and ultimately “ help to accelerate ” the return of jobs to the United States.
In an interview on Fox Business, Mr. Ross said diseases like the Wuhan coronavirus, which has killed more than a hundred people and sickened thousands, were “ another risk factor that people need to take into account ” when considering where to locate operations.
“ Every American’ s heart has to go out to the victims of the coronavirus, so I don’ t want to talk about a victory lap over a very unfortunate, very malignant disease, ” Mr. Ross said. “ But the fact is, it does give businesses yet another thing to consider when they go through their review of their supply chain. ”
He cited the deadly SARS outbreak that paralyzed China 17 years ago, as well as the African swine fever that has decimated China’ s pig farms.
“ So I think it will help to accelerate the return of jobs to North America, ” Mr. Ross said of the coronavirus. “ Some to U.S., probably some to Mexico as well. ” | business |
A Virus’ s Journey Across China | Listen and subscribe to our podcast from your mobile device: Via Apple Podcasts | Via Spotify | Via Stitcher
Nearly two decades ago, China was at the heart of a public health crisis over a deadly new virus. It said it had made lifesaving reforms since. So why is the Wuhan coronavirus now spreading so rapidly across the world? Our correspondent went to the center of the outbreak to find out.
On today’ s episode:
Javier C. Hernández, a New York Times correspondent based in Beijing.
Background reading:
What is the coronavirus? And why is China struggling to control its spread around the world?
Unless you are at high risk for catching the disease, it may be a good idea to avoid buying a face mask. There is now a shortage of masks, leaving health care workers unprotected and expediting the spread of the disease.
The virus has infected more than 7 million people and has been detected in nearly every country.
Tune in, and tell us what you think. Email us at thedaily @ nytimes.com. Follow Michael Barbaro on Twitter: @ mikiebarb. And if you’ re interested in advertising with “ The Daily, ” write to us at thedaily-ads @ nytimes.com.
Javier C. Hernández contributed reporting.
“ The Daily ” is made by Theo Balcomb, Andy Mills, Lisa Tobin, Rachel Quester, Lynsea Garrison, Annie Brown, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Larissa Anderson, Wendy Dorr, Chris Wood, Jessica Cheung, Alexandra Leigh Young, Jonathan Wolfe, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, Adizah Eghan, Kelly Prime, Julia Longoria, Sindhu Gnanasambandan, Jazmín Aguilera, M.J. Davis Lin, Austin Mitchell, Sayre Quevedo, Monika Evstatieva, Neena Pathak, Dan Powell, Dave Shaw, Sydney Harper and Daniel Guillemette. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Mikayla Bouchard, Stella Tan, Julia Simon, Lauren Jackson and Nora Keller. | business |
Cruise Passengers Are Held at Italian Port in False Alarm Over Coronavirus | CIVITAVECCHIA, Italy — Thousands of passengers stuck on a towering cruise ship. Doctors racing to the scene. Confusion and fear spreading.
For more than 12 hours on Thursday, the travelers aboard a ship docked north of Rome were ensnared in what was an ultimately false alarm after a Chinese national came down with a fever.
The episode prompted by a single sick passenger illustrates the fear that is spreading around the world along with the outbreak of the coronavirus, which has sickened nearly 9,800 people globally, the vast majority of them in mainland China. All 213 deaths have been reported in China.
For much of the day, Italy was gripped by fears that the coronavirus had arrived in the country. At least 68 cases have been reported outside mainland China, but there had not yet been any confirmed cases in Italy — though that changed later Thursday, when the government announced the first two cases, which were unrelated to the ship.
Giuseppe Ippolito, scientific director of the Spallanzani Hospital, which specializes in infectious diseases, said late Thursday that the two confirmed coronavirus cases, two Chinese tourists visiting Rome, were being held in isolation at the hospital.
“ They were put in isolation as soon as the diagnosis was verified, ” he said at a late night news conference with Prime Minister Giuseppe Conte and Health Minister Roberto Speranza.
The officials offered reassurances that they would investigate the movements of the two Chinese tourists and attempt to identify those they may have been in contact with, “ to absolutely avoid any further risks, ” the prime minister said.
Mr. Conte said that Italy had blocked all flights to and from China. “ As far as I know we are the first country in Europe to adopt such a precautionary measure, ” he said.
The scare on the cruise ship began Thursday morning after Italian health officials stopped passengers from leaving the ship, the Costa Smeralda, when it landed in the port town of Civitavecchia on the western Italian coast.
The ship, carrying 5,023 passengers and 1,628 crew, was part of the way through a seven-day cruise, with stops in Italy, France and Spain. It left the Spanish port of Palma de Majorca and arrived at 8 a.m. Thursday in Civitavecchia. More than 1,143 guests had planned to end their cruise on Thursday, but were prevented from disembarking.
Later Thursday, a health ministry task force that Italy instituted to counter the spreading virus announced that tests on the passengers for the coronavirus were negative. Italian maritime health authorities said that passengers were allowed to disembark.
Costa Cruises said in a statement Thursday night that passengers who wished to disembark from the ship could, while passengers who wished to remain onboard would be accommodated and could begin their return home Friday. The ship will remain docked in Civitavecchia until Friday evening, skipping the port of La Spezia.
The company apologized for the inconvenience but said they had acted to “ ensure maximum safety for all our guests, crew and the community as a whole. ”
Onboard the Costa Smeralda, reactions swung wildly.
Maria Cartagena, a passenger on the ship, said that the situation on board “ was tranquil. ”
“ They are doing checks on 2 Chinese passengers and for now ( logical) they don’ t tell us anything else, ” she wrote on Twitter. “ Kind of stressful. ”
Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “ comes with issues of potential breathing restriction and discomfort ” and requires “ balancing benefits versus possible adverse events. ” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “ In my personal experience, ” he says, “ heart rates are higher at the same relative intensity when you wear a mask. ” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’ t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’ s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “ very rare, ” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’ s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’ s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’ t being told to stay at home, it’ s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. ( Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’ re sick and you think you’ ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’ s a chance — because of a lack of testing kits or because you’ re asymptomatic, for instance — you won’ t be able to get tested.
Other passengers took to social media to vent concerns and frustrations and share photographs from onboard the ship.
The all-clear came after controls were carried out by experts from the Spallanzani hospital. It is part of a coronavirus task force, which includes health, transportation and civil protection agency officials, which the health ministry set up earlier this month for just such an event.
In Civitavecchia, some passengers waiting to board the Costa Smeralda were scared about what awaited them.
Graziana Iuso, 39, from the southern Italian town of Torremaggiore, said she was nervous.
“ I don’ t want to get on that boat, ” she said as she waited to board. “ A couple of hours is not enough to do checkups. ”
Another woman who was set to board the ship for a vacation, Antonella Libardo, the owner of a pizzeria in Puglia, said she trusted the company and would board without hesitation if the authorities gave passengers the green light.
“ This virus thing is becoming a psychosis, ” she said.
Emma Bubola reported from Civitavecchia and Elisabetta Povoledo and Jason Horowitz from Rome. Megan Specia contributed reporting from London. | business |
Deaths Surpass 200, and State Department Urges Against Travel to China | Read the latest developments in the coronavirus outbreak here.
The State Department on Thursday night issued a travel advisory telling Americans not to travel to China because of the public health threat posed by the coronavirus. Secretary of State Mike Pompeo confirmed the travel advisory on Twitter.
The department set the new advisory at Level 4, or Red, its highest caution, which is reserved for the most dangerous situations.
The World Health Organization declared on Thursday that the new coronavirus outbreak was a global health emergency, acknowledging that the disease represents a risk outside of China, where it emerged last month.
The declaration — officially called a Public Health Emergency of International Concern — serves notice to all United Nations member states that the world’ s top health advisory body rates the situation as serious.
Countries can then decide whether to close their borders, cancel flights, screen people arriving at airports or take other measures.
The decision came as cases have begun to appear in people who had not traveled to China during the outbreak.
Prime Minister Giuseppe Conte announced in a Thursday night news conference that Italy had blocked all flights to and from China as the country confirmed its first cases of the coronavirus.
The government announced the country’ s first two confirmed cases during the news conference. Officials said they would investigate the movements of the two people, Chinese tourists, and try to identify those they may have been in contact with.
The news capped a tense day in Italy, after thousands of passengers had been blocked from leaving a cruise ship that docked at an Italian port for more than 12 hours over concerns that someone aboard might have had the virus. That episode was ultimately a false alarm.
A Chinese national with a fever later tested negative for the coronavirus and the Italian authorities said that passengers were allowed to disembark.
The American Airlines pilots’ union said on Thursday that it was suing the airline in an attempt to halt all service between the United States and China, citing “ a threat to the safety of passengers and flight crew. ”
In a statement, the union, the Allied Pilots Association, said it was instructing its members to turn down requests to fly to China.
The airline had previously announced that, because of declining demand, it would suspend flights from Los Angeles to Beijing and Shanghai starting on Feb. 9. Service from Dallas to those cities is expected to continue.
In another development, United Airlines on Thursday announced a new wave of cancellations affecting hundreds of flights through the end of March. The cutback, a response to declining demand, will reduce the number of daily flights from 12 to four from its United States hubs to Beijing, Hong Kong and Shanghai.
In all, the reduction includes 332 round trip cancellations between Feb. 9 and March 28.
Health officials on Thursday reported the first case of person-to-person transmission of the new coronavirus in the United States.
The patient is the husband of a woman who was the first reported case in Chicago, officials said at a news briefing. The woman, who is in her 60s, had returned from Wuhan, China, the epicenter of the virus. She was hospitalized but appears to be doing well, said Dr. Jennifer Layden, an epidemiologist at the Illinois Department of Public Health.
Her husband, who had not traveled to China, recently began showing symptoms and was immediately isolated in the hospital. Lab tests have now confirmed that he was infected with the coronavirus, Dr. Layden said.
Health officials are tracking the places visited by both patients and identifying all close contacts to monitor them. The public is at low risk, officials said.
Person-to-person transmission may occur if someone who is sick breathes, talks, coughs or sneezes in the vicinity of others. Respiratory droplets carrying the virus may then travel from the sick person to other people or surfaces.
Based on the transmission patterns seen in China and other countries, experts have expected to see some person-to-person spread in the United States, said Dr. Robert Redfield, director of the Centers for Disease Control and Prevention. “ We understand that this may be concerning, ” Dr. Redfield said. “ But our assessment remains that the immediate risk to the American public is low. ”
The disease is not spreading widely in the U.S. and people who have not had close contact with someone who recently traveled to China are unlikely to get infected.
◆ Forty-three more deaths in China were announced early Friday, bringing the toll to 213.
◆ Nearly 2,000 new cases were recorded in China in the past 24 hours, raising the worldwide total to nearly 9,800, according to Chinese and World Health Organization data. The vast majority of the cases are inside China; 98 cases have been confirmed in 18 other countries.
◆ Tibet has reported its first confirmed case. This means that all of China’ s provinces and territories have now been touched by the outbreak.
◆ Thailand has reported 14 cases of infection; Japan has 11; Hong Kong and Singapore have 10; Taiwan has eight; Australia, Malaysia and Macau each have seven; France and the United States have six; South Korea, Germany and the United Arab Emirates each have 4; Canada has three; Vietnam and Italy each have two; and India, the Philippines, Nepal, Cambodia, Sri Lanka and Finland each have one.
◆ Confirming India’ s first case, the government said the patient, in the southern state of Kerala, was a student at Wuhan University. It said arriving passengers with a history of travel to China were being screened at 20 airports, up from seven earlier in the week.
◆ Cases recorded in Taiwan, Germany, Vietnam, Japan and France involved patients who had not been to China. There have been no reported deaths outside China.
The rapid spread of the coronavirus has unleashed a wave of panic and, in some cases, outright anti-Chinese sentiment across the globe.
In Japan, the hashtag # ChineseDon’ tComeToJapan has been trending on Twitter.
In Singapore, tens of thousands of residents have signed a petition calling for the government to ban Chinese nationals from entering the country.
In Hong Kong, South Korea and Vietnam, businesses have posted signs saying that mainland Chinese customers are not welcome.
And in France, a front-page headline in a regional newspaper warned of a “ Yellow Alert. ”
At a time when China’ s rise as a global economic and military power has unsettled its neighbors in Asia as well as its rivals in the West, the coronavirus is feeding into latent bigotry against the people of mainland China.
“ Some of the xenophobia is likely undergirded by broader political and economic tensions and anxieties related to China, which are interacting with more recent fears of contagion, ” said Kristi Govella, an assistant professor of Asian studies at the University of Hawaii, Manoa.
With China’ s emergence as a major cultural market in recent years, the effects of the coronavirus outbreak quickly rippled through the arts world.
The Boston Symphony Orchestra announced Thursday morning that it was canceling a tour of Asia that had been scheduled to begin next week. The Hong Kong Philharmonic called off a pair of Beethoven concerts this weekend under the baton of its music director, Jaap van Zweden, who holds the same post at the New York Philharmonic, after its venue was closed. Film shoots were shut down; movie premieres postponed; a dozen concerts by the Cantopop star Andy Lau were canceled; and some prominent galleries were calling for Art Basel Hong Kong, the prestigious international art fair scheduled for March, to be canceled.
The Boston Symphony called off its tour, which was to have featured the pianist Yefim Bronfman, after learning that one of the halls it planned to play at, the Shanghai Oriental Art Center, had canceled its performances, and amid rising concerns about the spread of the virus.
Tours are hugely expensive undertakings for large symphony orchestras, and the Boston Symphony, which does not carry insurance for tour concert interruptions, will now begin discussions about costs with various vendors — including for its flights, cargo, and hotels — as well as with the concert presenters.
The National Symphony Orchestra, of Washington, is scheduled to perform in Beijing and Shanghai with its music director, Gianandrea Noseda, after several dates in Japan.
Gary Ginstling, the orchestra’ s executive director, said that the orchestra had been conferring with government officials, presenters and medical experts as it monitors the situation.
Commerce Secretary Wilbur Ross said on Thursday that China’ s loss might be America’ s gain, because the coronavirus outbreak could prompt employers to move jobs to the United States.
“ I don’ t want to talk about a victory lap over a very unfortunate, very malignant disease, ” Mr. Ross said in an interview on Fox Business. “ I think it will help to accelerate the return of jobs to North America. Some to the U.S., probably some to Mexico as well. ”
Mr. Ross cited previous disease outbreaks in China, suggesting that a prevalence of diseases there would become a factor in businesses leaving the country and relocating to North America.
“ You had SARS, you have the African swine virus there, now you have this, ” Mr. Ross said.
His remarks may be seen as insensitive to a country in crisis, and he has faced such criticism in the past. During the government shutdown in early 2019, Mr. Ross suggested that furloughed workers should take out loans while they went without pay for more than a month.
Russia prepared for a partial closure of its 2,600-mile border with China as fears about the coronavirus outbreak mounted in Moscow.
Prime Minister Mikhail Mishustin on Thursday ordered 16 of the approximately 25 crossing points that Russia operates on the Chinese border to be closed as of midnight local time. He said the closures would be part of a new raft of measures to stop the infection from spreading to the country from Russia’ s southeastern neighbor.
Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’ s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “ very rare, ” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’ s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “ start at no more than 50 percent of the exercise you were doing before Covid, ” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “ When you haven’ t been exercising, you lose muscle mass. ” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’ t being told to stay at home, it’ s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. ( Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’ s temperature to look for signs of fever is not as easy as it sounds, as “ normal ” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’ t have a thermometer ( they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’ t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’ t replace hand washing and social distancing.
If you’ ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’ re sick and you think you’ ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’ s a chance — because of a lack of testing kits or because you’ re asymptomatic, for instance — you won’ t be able to get tested.
Russia’ s Foreign Ministry urged Russians to postpone all travel to China and suspended the issuance of electronic visas for Chinese citizens.
Russian officials say that no cases of coronavirus infection have been confirmed in Russia.
“ We have to do everything to protect our people, ” Mr. Mishustin said in televised remarks at a cabinet meeting. “ We will inform everyone about the relevant actions being taken to close the border in the Far Eastern region and other measures being taken by the government. ”
Anger and frustration have escalated in Wuhan, the center of the outbreak, as the city’ s overwhelmed hospitals pleaded for urgent help to replenish diminishing supplies.
A relative of a coronavirus patient assaulted a doctor at a hospital in Wuhan, pulling and damaging the doctor’ s mask and protective clothing, the state broadcaster CCTV reported on Thursday, citing the local police. The Beijing Youth Daily, a state-owned newspaper, reported that two doctors had been attacked at the hospital, including one who was threatened and had his protective gown torn off.
In the face of rising public anger, the central government has sought to present itself as intervening to hold accountable local officials in areas that have been hit hard by the epidemic.
CCTV aired footage on Thursday showing a central government inspection team grilling officials in Huanggang, a city about 50 miles from Wuhan, about the number of beds they had set aside for coronavirus patients. As the two local health officials fumbled their responses to seemingly basic questions, the visiting inspectors’ questions took on a more impatient tone.
Unusual in its blunt portrayal of inadequate government response, the report was quickly shared on Chinese social media sites with the hashtag “ one question, three don’ t knows. ”
Officials say medical supplies are running dangerously low in central China, despite gear being delivered in bulk from around the world. The Huazhong University of Science and Technology in Wuhan wrote on Weibo, a social media platform, that the city had received 240,000 masks, 25,000 protective gowns and 4,000 pairs of medical goggles from its alumni group in Germany. The Chinese community in Singapore sent 75,000 medical masks.
Photographs posted online showed hospital workers, many still in protective gear, slumped over their desks and on the floors in exhaustion.
From Chris Buckley, our chief China correspondent, on the ground in Wuhan:
Since the central Chinese city of Wuhan went under official lockdown last week, most shops have shut, few cars venture onto the roads and fear has kept most people in their homes.
When Wuhan residents do step outside, it’ s mostly to the supermarkets, food stores and pharmacies that have stayed open as part of a government effort to sustain the city. Senior officials have promised that residents need not worry about supplies of vegetables, fruit or other staples, even as large swaths of the province, Hubei, are also locked down to curtail the outbreak.
Yet Wuhan residents complained about price hikes, and expressed fear that a prolonged shutdown might choke off food supplies. Poorer people, both in urban Wuhan and in the countryside, would suffer more acutely from tightening supplies.
“ If we can’ t bring in produce, it will become more expensive, or we might even have to close up, ” said Zuo Qichao, who was selling piles of cucumbers, turnips and tomatoes. As he spoke, a woman accused him of unfairly raising the turnips’ price.
“ Every county, every village around here is now putting up barriers, worried about that disease, ” Mr. Zuo said. “ Even if the government says it wants food guaranteed, it won’ t be easy — all those road checks. ”
In Taiwan, anger has been growing over China’ s refusal this week to let Taiwan evacuate about 300 of its people from Wuhan, even as it has given the United States, Japan and other countries permission to do so.
China’ s ruling Communist Party considers Taiwan, a democratically governed island, to be part of China, and the two sides have no formal ties. Referring to the rebuffed evacuation request on Tuesday, Ma Xiaoguang, a spokesman for China’ s Taiwan Affairs Office, said in a statement that Taiwanese people in Hubei Province, which includes Wuhan, were receiving “ appropriate care. ”
Kolas Yotaka, a spokeswoman for Taiwan’ s government, said China was prioritizing politics over lives. Many of the Taiwanese seeking evacuation from Wuhan were tourists or on business trips, while others were residents of the city who suffered from chronic diseases, Ms. Kolas said.
“ We call on the Chinese government to demonstrate basic humanity and agree to our request as soon as possible, ” she said.
As part of its campaign to isolate Taiwan diplomatically, China has blocked it from participating in international bodies like the World Health Organization — a fact that has also angered Taiwanese people this week, as they try to prepare along with the rest of the world for the possibility of a worsening epidemic.
Fears that a fast-moving virus in China could impact the global economy drove investors in Asia to dump stocks on Thursday.
Money fled riskier assets like stocks and oil and flowed instead into investments that are considered safe havens, like gold, as growing numbers of policymakers, economists and corporate executives sounded alarms. Major benchmarks across the region fell by more than 1 percent. China’ s markets remain closed for an extended holiday until Feb. 3.
Brent crude oil, the international benchmark, hit its lowest price this year before paring some of its losses. It was trading at about $ 59 a barrel.
European markets finished higher, and the S & P 500 closed up 0.3 percent.
A growing number of companies have warned they will have to close or shift operations and could take a financial hit from widespread business disruptions in China.
Reporting was contributed by Russell Goldman, Austin Ramzy, Tiffany May, Elaine Yu, Alexandra Stevenson, Motoko Rich, Christopher Buckley, Anton Troianovski, Isabella Kwai, Chris Horton, Megan Specia, Christopher Cameron, Makiko Inoue, Daisuke Wakabayashi, Karen Weise, Iliana Magra, Elisabetta Povoledo, Mike Isaac, Knvul Sheikh, Roni Caryn Rabin, Donald G. McNeil Jr., Karen Zraick and Neil Vigdor. Elsie Chen, Zoe Mou, Albee Zhang, Amber Wang, Yiwei Wang and Claire Fu contributed research. | business |
As Coronavirus Spreads, So Does Anti-Chinese Sentiment | In Japan, the hashtag # ChineseDon’ tComeToJapan has been trending on Twitter. In Singapore, tens of thousands of residents have signed a petition calling for the government to ban Chinese nationals from entering the country.
In Hong Kong, South Korea and Vietnam, businesses have posted signs saying that mainland Chinese customers are not welcome. In France, a front-page headline in a regional newspaper warned of a “ Yellow Alert. ” And in a suburb of Toronto, parents demanded that a school district keep children of a family that had recently returned from China out of classes for 17 days.
The rapid spread of the coronavirus that has sickened about 9,800 people — the overwhelming majority in China, with all of the 213 deaths there — has unleashed a wave of panic and, in some cases, outright anti-Chinese sentiment across the globe.
While officials scramble to contain the crisis — the World Health Organization declared a global health emergency and the State Department issued a “ do not travel ” to China advisory — fears over the dangerous outbreak have fueled xenophobia. And the wave of spreading panic has, at times, far outstripped practical concerns.
At a time when China’ s rise as a global economic and military power has unsettled its neighbors in Asia as well as its rivals in the West, the coronavirus is feeding into latent bigotry against the people of mainland China.
“ Some of the xenophobia is likely undergirded by broader political and economic tensions and anxieties related to China, which are interacting with more recent fears of contagion, ” said Kristi Govella, an assistant professor of Asian studies at the University of Hawaii, Manoa.
[ Read: Coronavirus is forcing foreign students in China to choose: stay or go. ]
Some of the response to the outbreak can be seen as a rational calculation based on the risk of infection: Airlines are canceling flights to Wuhan, the center of the epidemic, and other Chinese cities, and conference organizers are asking Chinese delegations not to attend.
Late Thursday, Italy’ s prime minister said that his country had blocked all flights to and from China. And countries like Malaysia, the Philippines, Russia and Vietnam have temporarily stopped issuing certain classes of visas to travelers from Hubei Province, where Wuhan is situated, or China altogether.
“ I think it is time to put a temporary ‘ do not enter’ sign on our doorstep for visitors from China, ” said Ralph Recto, a lawmaker in the Philippines.
Bangkok residents are avoiding malls that are particularly popular with Chinese tourists. A plastic surgery office in the wealthy Gangnam neighborhood of Seoul has instructed employees that they can see Chinese customers only if they can prove that they have been in South Korea for 14 days or more, the potential period that the virus can lie dormant.
At a sushi restaurant in the neighborhood that once housed the Tsukiji fish market in Tokyo, where about 90 percent of the customers are Chinese, Yaeko Suenaga, 70, a server, said she understood why some stores might want to reject visitors from China.
“ I don’ t think this fear comes from discrimination, ” Ms. Suenaga said, “ but from the true fear that humans have of getting infected with a virus that may lead to death. ” Ms. Suenaga said that her restaurant would continue to welcome all customers, but that workers would wear masks.
It is not always easy to discern the boundary between understandable fear and unmistakable discrimination. But some protective measures have effectively amounted to racial or ethnic profiling.
At Bread Box, a banh mi restaurant in central Hoi An, a popular tourist outpost in Vietnam, the owners posted a makeshift sign outside their storefront this month reading, “ We can’ t service for Chinese, SORRY! ” Up the coast, the Danang Riverside Hotel announced on Saturday that it would not accept any Chinese guests because of the virus.
Kwong Wing Catering, a small restaurant chain in Hong Kong, announced in a Facebook post on Wednesday that it would serve only patrons speaking English or Cantonese, the city’ s native language — a tongue distinct from the Mandarin spoken on the mainland. The business has been a vocal supporter of the Hong Kong democracy movement that has risen up in defiance of Beijing.
Public health experts said they understood some of the impulses. “ In a sense, it’ s a natural reaction to try to distance yourself from a potential cause of illness, particularly when there’ s no known cure, ” said Karen Eggleston, director of the Asia health policy program at the Shorenstein Asia-Pacific Research Center at Stanford University.
But examples in both mass and social media have clearly crossed a line. In Australia, The Herald Sun, a Murdoch-owned newspaper, published the words “ China Virus Panda-monium ” over an image of a red mask. More than 46,000 people from the resident Chinese community in Australia signed a petition that called the headline “ unacceptable race discrimination. ”
Le Courrier Picard, a regional newspaper in northern France, caused outrage with its “ Yellow Alert ” headline this month. The newspaper later apologized.
On Twitter in Japan, where there has long been unease about the conduct of Chinese tourists, commenters have labeled them “ dirty ” and “ insensitive ” and have called them “ bioterrorists. ”
Disinformation is also running high. A much-viewed YouTube video in South Korea claims that a biochemical weapons facility in China leaked the coronavirus, a theory that has gained currency in other corners of the globe. In Australia, a fake post circulating on Instagram warned that shops in Sydney containing items like fortune cookies, rice and “ Chinese Red Bull ” were contaminated.
The episodes of racism have swept up other people of Asian descent. In France, one Vietnamese woman told the newspaper Le Monde that she had been insulted by a car driver who shouted “ Keep your virus, dirty Chinese! ” and “ You are not welcome in France ” as he sped away through a puddle, splashing her.
In Australia, Andy Miao, 24, an ethnic Chinese Australian who returned this month from a trip to China, said that passengers on public transport gave him odd looks if he was not wearing a face mask.
Updated May 20, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $ 40,000 or less lost work, compared with 13 percent in those making more than $ 100,000, a Fed official said.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. ( Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.
Yes, but make sure you keep six feet of distance between you and people who don’ t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’ s temperature to look for signs of fever is not as easy as it sounds, as “ normal ” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’ t have a thermometer ( they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’ t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’ t replace hand washing and social distancing.
If you’ ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’ re sick and you think you’ ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’ s a chance — because of a lack of testing kits or because you’ re asymptomatic, for instance — you won’ t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
“ It makes people like me who are very, very Australian feel like outsiders, ” Mr. Miao said. “ It’ s definitely invoking a lot of past racial stereotypes. ”
The Chinese — and Asians in general — were subjected to similar xenophobic reactions during the SARS epidemic of 2003. But now far more Chinese are traveling abroad: According to the Ministry of Culture and Tourism, Chinese travelers made about 150 million overseas trips in 2018, up more than 14 percent from the previous year.
China’ s lockdown of tens of millions of people, intended to curb the spread of the virus, may be spurring other governments to overreact, said Koichi Nakano, a political scientist at Sophia University in Tokyo.
“ The fact that the Chinese government itself is treating people like that would in some ways enable or encourage some of the other people or governments to take equally draconian measures, ” Mr. Nakano said.
Some governments are trying to ease the panic. In Toronto, politicians, a school board and some community groups have issued public appeals to avoid a repetition of the racism that swept the city in 2003, when SARS killed 44 people there.
“ While the virus can be traced to a province in China, we have to be cautious that this not be seen as a Chinese virus, ” the school board in the York Region, a suburb with many Asian residents, said in a statement issued on Monday. “ At times such as this, we must come together as Canadians and avoid any hint of xenophobia, which in this case can victimize our East Asian Chinese community. ”
Although Indonesia has suspended flights from Wuhan, the governor of West Sumatra, Irwan Prayitno, ignored a plea from a citizens group to reject all Chinese tourists. On Sunday, he went to the airport to welcome 174 Chinese visitors from the southwestern city of Kunming.
In the Ginza shopping district of Tokyo, which is often thronged with Chinese tourists, Michiko Kubota, who runs a clothing boutique, said she hoped the Japanese government might do more to help China, such as by sending masks or other medical supplies.
“ Japan and China may be critical of each other sometimes, but the kindness is mutual, ” Ms. Kubota said. “ I hope we could do more to help eradicate fear in China as well. ”
Reporting was contributed by Ian Austen, Hannah Beech, Aurelien Breeden, Jason Gutierrez, Makiko Inoue, Isabella Kwai, Su-Hyun Lee, Tiffany May, Seth Mydans, Katrina Northrop, Jin Wu, Eimi Yamamitsu and Li Yuan. | business |
Tea Giant Unilever Weighs Giving Up on Tea -- Update | By Saabira Chaudhuri
The world's largest tea maker is considering giving up on tea.
Unilever PLC is exploring the sale of its tea business after years of sluggish sales growth, in a sign of how changing tastes are roiling some of the world's best-known food and drink brands.
The owner of Lipton, Brooke Bond and PG Tips has struggled to drive growth in black tea, which makes up the bulk of its portfolio. The company says consumption has declined in developed markets like the U.S. and Europe as consumers increasingly reach for other drinks. When they do drink tea, it is increasingly herbal or fruit-infused.
`` Insanity is carrying on doing the same thing expecting different outcomes, '' Chief Executive Alan Jope said Thursday. `` For 10 years we 've been trying to ignite growth into our tea business unsuccessfully. ''
The review of the tea business, which generates annual sales of about EUR3 billion ( $ 3.3 billion), could lead to an outright sale, part ownership or a different structure.
Unilever executives said the tea business was a similar size, and had comparable geographic reach, to the spreads division it sold for about $ 8 billion in 2018. The company hopes the tea business will draw interest from other tea makers looking to cut costs in what is a highly fragmented market.
The news came as Unilever, which also owns Hellmann's mayonnaise and Dove soap, reported anemic sales growth for the fourth quarter and said it was continuing to evaluate its broader portfolio. Underlying sales growth for the last three months of 2019 came in at 1.5%, down from 2.9% in the prior-year period.
Unilever has tried to pivot away from black tea in the developed world, buying Pukka Herbs, a British organic herbal tea maker, and Tazo Tea from Starbucks Corp. It also bought premium Australian tea company T2, which sells pricey loose leaf in flavors like beetroot and broccoli and red chocolate mint. It has since rolled the brand out internationally.
Despite those efforts, the company's greater presence in black tea has weighed on the business.
For 2019, Unilever's tea volumes dropped, even as prices helped buoy sales overall.
Unilever became a tea giant in 1971 when it acquired Lipton, a business founded by a young Scottish entrepreneur. In 1984, it bought Brooke Bond, the world's largest tea company, giving it the leading position in Britain, a nation of avid tea drinkers.
The Anglo-Dutch company has come up with new products for decades in an attempt to forestall any slowdown, including pyramid-shaped tea bags in the 1990s, which it claimed improved taste.
Thursday's announcement is the latest sign of how packaged food makers are being forced to make big changes to respond to fast-changing shopper tastes.
`` Younger consumers are looking for novel experiences, '' Mr. Jope said. `` The black tea drinkers are getting older and consuming less and will start to fall over and that is actually the fundamental problem. ''
Apart from shifting demographics, Mr. Jope also blamed the low price of a cup of tea as thwarting the company's premiumization efforts. Others in the industry, like Associated British Foods PLC-owned Twinings, have been more successful at premiumizing tea, but prices in general have remained low, he said.
Unilever's recent financial performance has piled pressure on Mr. Jope -- who became CEO last year -- to jump-start growth.
In December, Unilever disappointed investors, warning that sales growth on an underlying basis -- which strips out currency and acquisition impacts -- would be below its guidance of 3% to 5% in 2019.
The company said it still expects growth this year to be at the lower end of that target, but that it was yet to account for the impact of the coronavirus outbreak in China.
Unilever's full-year revenue rose 2% to EUR51.98 billion. Net profit dropped 40% to EUR5.63 billion compared with the previous year, which was boosted by a gain from the sale of the spreads business.
Aside from tea, Unilever is contending with changing tastes and rising competition in the U.S. haircare market, where it is battling longtime rival Procter & Gamble Co. and a host of smaller shampoo brands. It is also grappling with an economic slowdown in India -- its largest market by volume.
Write to Saabira Chaudhuri at saabira.chaudhuri @ wsj.com
| business |
Unilever profit falls as sales miss growth target | Unilever PLC reported Thursday a fall in net profit for 2019 as sales missed its growth target, and said it would consider options for the future of its global tea business.
The multi-sector retailer
ULVR,
-0.37%
UL,
+0.21%
which owns consumer brands such as Ben & Jerry’ s ice cream and Dove soap, reported a 38% fall in net profit to 6.03 billion euros ( $ 6.64 billion). The consensus forecast was EUR5.84 billion, taken from FactSet and based on seven analysts’ projections.
Turnover was up 2% to EUR51.98 billion, driven by a solid Asian market, which remained the company’ s largest by region. Unilever said that the impact of the coronavirus outbreak in China is unknown at this time.
Turnover forecast was EUR52.85 billion, taken from FactSet and based on 11 analysts’ estimates. On an underlying basis sales rose 2.9% compared with recent guidance for the lower half of its 3% to 5% multi-year target. Unilever blamed missing this range on a weak fourth quarter.
For the year ahead the company reiterated that it will miss the same underlying sales target in the first half of 2020. However it expects sales to be second-half weighted and to be at the bottom end of the range for the year.
Chief Executive Alan Joppe said that the company is beginning a strategic review of its global tea business, which includes brands such as Lipton and PG Tips. The company said it will consider all options and conclude the review by the middle of 2020.
The board has declared a dividend of 41.04 European cents for the fourth quarter, up from 38.72 cents for the same period in 2018. | business |
Amazon Revenue Jumps on Holiday Sales as Profit Rises -- 3rd Update | By Dana Mattioli
Amazon.com Inc.'s fourth-quarter sales blew past a previous record as robust holiday sales and profit from cloud and advertising businesses helped offset growing shipping costs for its one-day Prime program.
The Seattle company's shares jumped more than 10% in after-hours trading, adding about $ 100 billion to the company's market value. Should the stock keep the gains Friday, Amazon would be the fourth U.S. company to finish with a market cap above $ 1 trillion.
Profit rose 8% to $ 3.3 billion during the all-important holiday quarter, after sliding more than 25% from July to September due to its costly one-day shipping effort for Prime members. The company beat its quarterly profit estimate of between $ 1.2 billion and $ 2.9 billion. Earnings per share were $ 6.47, compared with analyst estimates of $ 4.04 a share, according to a survey by FactSet.
Amazon's fourth-quarter revenue rose 21% to $ 87.4 billion from a year earlier.
`` There was investor concern that one-day shipping would be a drag to margins, so the fact that they have been able to offer one-day shipping and also at the same time drive some efficiency has to please investors, `` Raymond James analyst Aaron Kessler said.
The company's shipping costs rose to $ 12.88 billion, a 43% increase from a year earlier. Amazon's costs to build out one-day shipping capabilities have continued to surge as Amazon moves inventory closer to customers. One-day spending reached more than $ 800 million from April to June and was expected to nearly double in the fourth quarter to $ 1.5 billion.
Last month, Amazon said that it had its best holiday shopping season ever, with billions of orders received globally. The National Retail Federation reported that U.S. holiday sales grew by 4.1% in 2019, with online sales growing 15%.
Amazon said it has more than 150 million Prime members world-wide.
Members pay $ 119 a year to access free and fast shipping options, Amazon's streaming service, discounts at Whole Foods Market and other benefits.
The last time Amazon disclosed the number of Prime members was in April 2018, when the company said it had more than 100 million members.
Amazon's holiday results outperformed competitors, who reported weak results for the quarter. Target Corp.'s holiday sales missed its forecasts partly due to a slump in sales in the toy and electronics categories. Macy's Inc., J.C. Penney Co., Kohl's Corp. and Victoria's Secret parent L Brands Inc. all reported lower sales for November and December.
In the quarter, Amazon spent a little less than the $ 1.5 billion it projected for the quarter to fuel its one-day Prime shipping program, Brian Olsavsky, Amazon's chief financial officer, said during a call with media.
`` We are getting more efficient, '' he said.
The company expects an additional $ 1 billion in costs related to the program next quarter. As the company fulfills more one-day orders, it has added warehouse and delivery employees.
Amazon's head count grew by 23% to 798,000 from a year earlier.
Amazon Web Services, the company's cloud-computing operation and its main profit center, continued to show signs of slowing growth.
The unit delivered $ 10 billion in sales, rising 34% from a year earlier. The division had historically grown by more than 40% each quarter.
Operating income for AWS rose 19% to $ 2.6 billion. During the quarter, Amazon's cloud-computing business suffered a blow when the Pentagon chose competitor Microsoft Corp. as its vendor for a $ 10 billion government contract. Amazon is protesting the result.
By contrast, Microsoft posted record sales Wednesday buoyed by its cloud-computing business. The company's cloud-computing sales increased 62% in its fiscal second quarter from a year ago.
Amazon's advertising business posted $ 4.8 billion in sales, a 41% increase from the year-earlier period. The unit, which sells advertising space in the form of sponsored products in search and display ads, has become another cash cow for the company.
Amazon's international business posted another operating loss for the quarter, and profit declined 15.6% in its North American unit, which includes the bulk of its e-commerce operations.
The physical stores segment, which includes Whole Foods, had $ 4.4 billion in sales for the period, down 1% from a year ago.
Amazon said it expects first-quarter sales of between $ 69 billion and $ 73 billion.
It projected its operating income to fall to between $ 3 billion and $ 4.2 billion, compared with $ 4.4 billion in first quarter 2019.
`` We're watching it very carefully, '' Mr. Olsavsky said in response to a question on whether the coronavirus outbreak in China would affect business operations. Amazon doesn't have direct operations in Wuhan, China, but a large number of its third-party sellers are from China.
-- Sebastian Herrera contributed to this article.
Write to Dana Mattioli at dana.mattioli @ wsj.com
| business |
Amazon Revenue Jumps on Holiday Sales as Profit Rises -- 2nd Update | By Dana Mattioli
Amazon.com Inc.'s fourth-quarter sales blew past a previous record as robust holiday sales and profits from cloud and advertising businesses helped offset growing shipping costs for its one-day Prime program.
The Seattle company's shares jumped 12% to $ 2,088 in after-hours trading, adding more than $ 100 billion to the company's market value. Should the stock close at these levels Friday, Amazon would be the fourth U.S. company to finish with a market cap above $ 1 trillion.
Profit rose 8% to $ 3.3 billion during the all-important holiday quarter, after sliding more than 25% from July to September due to its costly one-day shipping effort for Prime members. The company beat its quarterly profit estimate of between $ 1.2 billion and $ 2.9 billion. Earnings per share were $ 6.47, compared with analyst estimates of $ 4.04 a share, according to a survey by FactSet.
Amazon's fourth-quarter revenue rose 21% to $ 87.4 billion compared with a year earlier.
`` There was investor concern that one-day shipping would be a drag to margins, so the fact that they have been able to offer one-day shipping and also at the same time drive some efficiency has to please investors, `` Raymond James analyst Aaron Kessler said.
The company's shipping costs rose sharply to $ 12.88 billion, a 43% increase from the same period a year ago. Amazon's costs to build out one-day shipping capabilities have continued to surge as Amazon moves inventory closer to customers. One-day spending reached more than $ 800 million from April to June and was expected to nearly double in the fourth quarter to $ 1.5 billion.
Last month, Amazon said that it had its best holiday shopping season in its history, with billions of orders received globally. The National Retail Federation reported that holiday sales grew 4.1% in 2019, with online sales growing 14.6%.
Amazon said it now has more than 150 million Prime members world-wide. Members pay $ 119 a year to access free and fast shipping options, Amazon's streaming service, discounts at Whole Foods Market and other benefits. The last time Amazon disclosed the number of Prime members was in April 2018, when the company said it had more than 100 million members.
Amazon's holiday results outperformed competitors, who reported weak results for the quarter. Target Corp.'s holiday sales missed its forecasts partly due to a slump in sales in the toy and electronics categories. Macy's Inc., J.C. Penney Co., Kohl's Corp. and Victoria's Secret parent L Brands Inc. all reported lower sales for November and December.
In the quarter, Amazon spent a little less than the $ 1.5 billion it projected for the quarter to fuel its one-day Prime shipping program, Brian Olsavsky, Amazon's chief financial officer, said during a call with media.
`` We are getting more efficient, '' he said. The company is expecting another $ 1 billion in costs related to the program next quarter. As the company fulfills more one-day orders, it has added warehouse and delivery employees. Amazon's head count grew 23% to 798,000 from a year earlier.
Amazon Web Services, the company's cloud-computing operation and its main profit center, continued to show signs of slowing growth. The unit delivered $ 10 billion in sales, rising 34% from a year earlier. The division had historically grown by more than 40% each quarter.
Operating income for AWS rose 19.2% to $ 2.6 billion. During the quarter, Amazon's cloud-computing business suffered a blow when the Pentagon chose competitor Microsoft Corp. as its vendor for a $ 10 billion government contract. Amazon is protesting the result.
By contrast, Microsoft posted record sales Wednesday buoyed by its cloud-computing business. The company's cloud-computing sales increased 62% in its fiscal second quarter from a year ago.
Amazon's advertising business posted $ 4.8 billion in sales, a 41% increase from the year-earlier period. The unit, which sells advertising space in the form of sponsored products in search and display ads, has become another cash cow for the company.
Amazon's international business posted another operating loss for the quarter, and profit declined 15.6% in its North American unit, which includes the bulk of its e-commerce operations.
The physical stores segment, which includes Whole Foods, had $ 4.4 billion in sales for the period, down 1% from a year ago.
Amazon said it expects first-quarter sales of between $ 69 billion and $ 73 billion.
It projected its operating income to fall to between $ 3 billion and $ 4.2 billion, compared with $ 4.4 billion in first quarter 2019.
`` We're watching it very carefully, '' Mr. Olsavsky said in response to a question on whether the coronavirus outbreak in China would affect business operations. Amazon doesn't have direct operations in Wuhan, China, but a large number of its third-party sellers are from China.
-- Sebastian Herrera contributed to this article.
Write to Dana Mattioli at dana.mattioli @ wsj.com
| business |
OUE Commercial Real Estate Investment Trust: C-REIT Achieves 12.0% Increase In 4Q 2019 DPU To 0.84 Cents On Distribution Of S $ 45.1 Million | PRESS RELEASE
For Immediate Release
OUE C-REIT Achieves 12.0% Increase in 4Q 2019 DPU
to 0.84 Cents on Distribution of S $ 45.1 million
30 January 2020 - OUE Commercial REIT Management Pte. Ltd., in its capacity as manager ( the `` Manager '') of OUE Commercial Real Estate Investment Trust ( `` OUE C-REIT ''), wishes to announce a distribution ( after retention for working capital purposes) of S $ 45.1 million for the financial period 1 October 2019 to 31 December 2019 ( `` 4Q 2019 ''), translating to a DPU of 0.84 cents. The result included the first full quarter's contribution from the Merger ( effective from 4 September 2019) and contribution from OUE Downtown Office ( acquired on 1 November
2018).
For the financial year ended 31 December 2019 ( `` FY2019 ''), amount to be distributed ( after retention for working capital purposes) was S $ 123.2 million, 72.8% increase from FY2018. FY2019 DPU was 3.31 cents, translating to a distribution yield of 5.9% based on OUE C-REIT's unit closing price of S $ 0.565 as at 31 December 2019.
Summary of OUE C-REIT's Group Results
( S $ '000)
4Q 2019
4Q 2018
Change
FY2019
FY2018
Change
(%)
(%)
Revenue
86,794
48,036
80.7
257,329
176,396
45.9
Net Property Income
70,576
36,635
92.6
204,951
138,187
48.3
Amount Available
46,629
21,500
116.9
124,714
71,290
74.9
For Distribution
Amount to be
45,129
21,500
109.9
123,214
71,290
72.8
Distributed ( 1)
DPU ( 1) ( Cents)
0.84 ( 2)
0.75 ( 3)
12.0
3.31 ( 2)
3.48 ( 3)
( 4.9)
Notes:
Net property income in 4Q 2019 was S $ 70.6 million, an increase of 92.6% YoY due primarily to a full quarter's contribution of the Merger, augmented by contribution from OUE Downtown Office which was acquired on 1 November 2018.
Amount available for distribution for 4Q 2019 more than doubled YoY to S $ 46.6 million, mainly attributable to higher net property income and the drawdown of income support at OUE Downtown Office, partially offset by higher interest expense as a result of higher borrowings. Amount distributed after retention for working capital purposes is S $ 45.1 million, translating to DPU of 0.84 cents.
OUE C-REIT has a semi-annual distribution policy. 3Q 2019 DPU was 0.79 cents, of which a clean-up distribution of 0.53 cents per Unit for the period from 1 July 2019 to 3 September 2019 was paid on 5 December 2019 pursuant to the completion of the Merger on 4 September 2019. The balance DPU of 0.26 cents for the period 4 September 2019 to 30 September 2019 will be paid together with the 4Q 2019 DPU of 0.84 cents. Hence, the total DPU for the period 4 September 2019 to 31 December 2019 is 1.10 cents, which will be paid on Friday, 6 March 2020.
2
As at 31 December 2019, the value of OUE C-REIT's investment properties was S $ 6,770.2 million, translating to a net asset value per Unit of S $ 0.62. The significant increase in OUE C-REIT's portfolio from S $ 4,494.5 million a year ago was mainly due to the consolidation of OUE Hospitality Trust's portfolio post- Merger.
Mr Lee Yi Shyan, Chairman of the Board of the Manager, said, `` With the successful merger of OUE Hospitality Trust, 2019 turned out to be a year of transformation for OUE C-REIT. As we enter the new financial year, we do so in great confidence in and anticipation of operational excellence, continued growth and value creation for our Unitholders. ''
Ms Tan Shu Lin, Chief Executive Officer of the Manager, said, `` The merger with OUE Hospitality Trust has placed us in a position of strength from which to execute our strategies to optimise portfolio performance for the benefit of Unitholders. Not only has OUE C-REIT's resilience strengthened with a larger portfolio of properties, the broadened investment mandate and enlarged capital base also allow for enhanced flexibility for OUE C-REIT to pursue future growth opportunities. ''
`` While the pace of growth of Singapore CBD Grade A office rents has moderated, the Manager expects continued positive operational performance for OUE C-REIT's Singapore office portfolio as expiring rents in 2020 are below current market rents, having been committed at a time when rents were lower. We are also pleased to announce that Crowne Plaza Changi Airport has turned in an exceptional set of results in 2019, surpassing its minimum rent based on full year performance. We believe it will continue to benefit from the expansion of facilities at Changi Airport in the longer-term. Further, the hospitality segment, which is expected to experience a gradual recovery on continued investments in tourism against the backdrop of a benign supply outlook, will also see a boost from the resumption of biennial MICE events this year, '' added Ms Tan.
3
Commercial Portfolio - Continued Organic Growth
The commercial ( office and retail) portfolio reported revenue and net property income of S $ 62.0 million and S $ 47.8 million, respectively, for 4Q 2019. For FY2019, revenue and net property income were S $ 225.0 million, and S $ 175.3 million, respectively. Net property income growth in the commercial portfolio was primarily driven by contribution from Mandarin Gallery as a result of the Merger.
As at 31 December 2019, OUE C-REIT's commercial portfolio committed occupancy was stable at 95.2%, whilst the Singapore office properties recorded an occupancy of 95.7%. In addition, all office properties in Singapore reported positive rental reversions during the quarter of between 9.4% and 26.5% as rents for renewed leases were higher than expiring rents in 4Q 2019. Average passing rents for the Singapore office portfolio as of December 2019 were higher YoY as a consequence of consecutive quarters of positive rental reversions.
Lippo Plaza's committed office occupancy edged down 0.9 percentage points ( `` ppt '') quarter-on-quarter ( `` QoQ '') to 89.9% as at 31 December 2019, due to intense leasing competition amidst a supply increase. Nevertheless, this was ahead of overall Shanghai Grade A office occupancy of 87.6% for 4Q 2019. The range of committed rents for new and renewed office leases was RMB7.50 per sq m ( `` psm '') per day to RMB11.50 psm per day during the quarter, against an average passing rent of RM9.65 psm per day for the quarter.
Within the prime Orchard Road location in Singapore, Mandarin Gallery maintained high committed occupancy of 98.3% as at 31 December 2019, while the average passing rent remained stable at S $ 21.95 per sq ft ( `` psf '') per month for December 2019.
Approximately 20.2% of the gross rental income for the commercial portfolio is due for renewal for the balance of 2020, with a further 28.3% of gross rental income due in 2021.
4
Hospitality Portfolio - Positive Operational Performance
The hospitality portfolio reported 4Q 2019 revenue of S $ 24.8 million and net property income of S $ 22.8 million. For FY2019, revenue and net property income were S $ 32.3 million and S $ 29.6 million, respectively.
For 4Q 2019, the hospitality portfolio RevPAR increased by 1.9% YoY to S $ 216 on the back of higher demand, as the segment was supported by increased tourist arrivals and strong line-up of major events during the quarter. The increase was largely driven by higher room rates and increased demand at Crowne Plaza Changi Airport which registered a 9.9% YoY increase in RevPAR to S $ 198 for the quarter, while Mandarin Orchard Singapore maintained a relatively stable performance.
For FY2019, with the absence of certain large-scale biennial events primarily in the first half of the year, the hospitality portfolio RevPAR registered a slight decline of 0.4% YoY in RevPAR to S $ 209, mitigated by a stronger performance from Crowne Plaza Changi Airport. Crowne Plaza Changi Airport delivered an exceptional performance and surpassed its minimum rent of S $ 22.5 million per annum for FY2019. The hotel also achieved a 9.0% YoY increase in RevPAR of S $ 196, on the back of improved operating performance driven by increased demand from corporate and wholesale segments, while Mandarin Orchard Singapore recorded a decline of 4.3% YoY in RevPAR to S $ 216 as it continued to face downward pressure in the trading environment.
The hospitality market remains poised to benefit from increased strategic partnerships to drive increase visitor arrivals, boosted by long-term investments in city-wide tourism infrastructure by the Singapore government, while supported by limited new hotel supply over the new few years.
Prudent Capital Management
OUE C-REIT's aggregate leverage as at 31 December 2019 was 40.3%. The weighted average cost of debt remained stable at 3.4% per annum, while the average term of debt was 2.2 years. The proportion of fixed rate debt remained
5
stable at 75.0% as at 31 December 2019, mitigating interest rate volatility, in line with the Manager's prudent and disciplined approach to capital management.
Following the Merger, OUE C-REIT's larger capital base and funding capacity enhances its ability to undertake larger transactions as well as asset enhancement initiatives. This will provide flexibility for OUE C-REIT to react with greater speed to capture potential accretive investments which will drive growth and benefit Unitholders in the long-term.
For 4Q 2019, the Manager has elected to receive 20% of its base management fees in cash with the balance in Units, in alignment with its objective of delivering sustainable and stable DPU to Unitholders.
Outlook
According to CBRE, core CBD Grade A occupancy in Singapore remained stable at 96.1% in 4Q 2019, while core CBD Grade A office rents edged up 0.9% QoQ to S $ 11.55 psf per mth, marking the tenth consecutive quarter of growth since the trough in 2Q 2017 and a cumulative increase of 29.1%. Demand was driven mainly by flexible workspace operators and the technology sector. Islandwide net absorption in 4Q 2019 was 358,434 sq ft, resulting in 2019 net absorption of 1.08 million sq ft, below the 10-year average of 1.63 million sq ft. With limited new Grade A office supply in the medium-term, CBD Grade A office rents are expected to remain stable. OUE C-REIT's portfolio of high-quality and strategically located office properties are expected to continue to achieve committed rents which are in line with or above market rents. As expiring rents of OUE C-REIT's Singapore office portfolio are below current market rents, rental reversions are expected to be positive.
For the first 11 months of 2019, international visitor arrivals to Singapore grew 2.9% to 17.4 million compared to same period a year ago driven by significant gains from top source markets of China, Indonesia, and Australia. For the month of November 2019, international visitor arrivals increased 8.9% YoY, while the number of visitor
6
days increased by 8.4% for the same period, averaging 3.1 days. Singapore continues to invest and strengthen its tourism infrastructure across the city, while increasing flight connectivity to key source markets and the expansion of its aviation facilities including a four-year upgrading project for Changi Airport Terminal 2 which will commence end-January 2020. Further, the Singapore Tourism Board continues to drive visitor arrivals through strategic partnerships which position Singapore as a prime fly-cruise and convention destination. OUE C-REIT's strategically located hospitality assets in the prime Orchard Road belt and in Changi Airport are prime beneficiaries from these favourable medium-term developments.
Whilst the resumption of large-scale biennial events in 2020 and limited future hotel supply over the next few years is supportive of a recovery in the Singapore hospitality sector, the outbreak of the Wuhan coronavirus and measures put in place to prevent its spread may adversely impact tourism demand in the near-term.
According to Colliers International, Shanghai CBD Grade A office demand rebounded in 4Q 2019. However upside in rents was capped by the existing high level of vacancy in the market. Consequently, Shanghai CBD Grade A occupancy edged up 0.1 ppt QoQ to 87.6% as at 4Q 2019, while rents moderated 1.2% QoQ to RMB10.10 psm per day. In Puxi, Grade A office occupancy rose 0.2 ppt QoQ to 90.4% as at 4Q 2019, while rents softened 1.0% QoQ to RMB 9.46 psm per day. Leasing demand is expected to continue to intensify with the peaking of office supply expected in 2021. Compounded by competition from decentralised markets, rental outlook is expected to be subdued in the near-term. As supply eases after 2021, stable demand is expected to underpin steady rental growth.
- End -
For further information and enquiries, please contact:
Elaine Cheong
Vice President, Investor Relations
Tel: +65 6809 8704
Email: elaine.cheong @ ouect.com
7 | business |
Jet fuel demand takes a hit as coronavirus leads to travel restrictions | Oil prices have dropped this month on expectations that the deadly coronavirus will lead to a slowdown in demand from China and beyond, but jet fuel consumption in the Asian nation already has taken a measurable hit on the back of travel restrictions aimed at curbing the infection rate.
Flight cancellations have reached about 30% in some parts of China, said Claudio Galimberti, head of demand, refining and agriculture at S & P Global Platts. The cancellations can result in about 200,000 barrels a day in reduction of jet fuel use globally, or 3% of global jet demand, he said.
Last week, the Chinese government placed a travel lockdown on the city of Wuhan, the center of the outbreak, as well as other cities in the nation’ s Hubei province. The nation extended the Lunar New Year holiday by three days to Feb. 2 in an effort to contain the virus, which has
infected more than 7,700
people and is responsible for at least 170 deaths, as of Thursday. Many countries have advised against non-essential travel China. Many airlines have suspended, or plan to suspend, flights to China.
Global flight cancellations averaged nearly 1,785 a day over the past four days, strategists at RBC Capital Markets wrote in a note dated Thursday. Data show that flight activity plunged 12% over the Lunar New Year weekend at five of China’ s busiest airports, “ and continues to track lower, down over 24% from normal, ” they said.
“
‘ We are early into the current coronavirus outbreak, but the risk to global air travel and the aerospace sector is substantial.’
”
— Ken Herber, Canaccord Genuity
Wuhan International is central China’ s busiest airport, handling an estimated 25 million passengers in 2019, and it is roughly the 15th most active in terms of China’ s passenger traffic, according to a research note from Ken Herber, analyst at Canaccord Genuity, released earlier this week.
“ We are early into the current coronavirus outbreak, but the risk to global air travel and the aerospace sector is substantial, ” said Herbert.
Read:
WHO declares coronavirus a public health emergency of international concern
Analysts said that jet fuel represents a large share of China’ s overall growth in oil demand.
Jet fuel demand has “ accounted for some 15% of Chinese [ oil ] demand growth over the past five years, ” according to strategists at RBC Capital Markets. An average annualized domestic growth rate of 11% makes jet fuel the “ firmest portion of the demand story in China relative to other major refined products. ”
The fuel market, however, hasn’ t likely seen the full impact of coronavirus.
There’ s a complicated relationship between crude oil and the oil product prices, with jet fuel related to diesel prices, which are in turn linked to crude prices—so the end users aren’ t likely to see an immediate reaction to the recent declines in oil prices, said Galimberti of S & P Global Platts.
On Thursday
, U.S. benchmark West Texas Intermediate crude saw its March futures contract
US: CLH20
settle at $ 52.14 a barrel, the lowest finish for a front-month contract since August. It’ s on track for a monthly loss of 14.6%. Global benchmark Brent saw its March contract
UK: BRNH20
end the session at $ 58.29, the lowest since October, with prices headed for a monthly loss of 11.7%. Both benchmarks are poised to suffer their largest January percentage losses since 1991, according to Dow Jones Market Data.
Read:
Oil on brink of bear market as coronavirus fuels 'demand destruction’ fears
The travel lockdown in China has affected approximately 100,000 to 150,000 barrels per day in road transport demand for gasoline and diesel in the Hubei province of China so far, out of the usual consumption of roughly 300,000 barrels per day, Galimberti said.
So road transport fuel demand in February may be “ impacted severely, ” with a large but “ gradually ” decreasing impact in March and April, with that fast approaching zero after June, as previous epidemic have shown, he said.
Retail gasoline prices fell below $ 2.50 a gallon on Wednesday for the first time since March, according to
data from fuel-price tracker GasBuddy
, which pegged the average price for regular gasoline at the pump late Thursday afternoon at $ 2.489.
Meanwhile, the U.S. Gulf Coast refined jet fuel spot price was at $ 1.5993 a gallon on Wednesday, according to data from the Oil Price Information Service, which says the number represents spot bulk purchases, generally by airlines and refiners, in the U.S. Gulf Coast. Prices started the year at $ 1.9366.
“ The coronavirus is currently contained as a Chinese jet fuel demand story for now and not yet a global oil demand story, ” said strategists at RBC Capital Markets. “ Despite headlines of restricting travel from various countries or airports to China…we have yet to see a meaningful drop off in traffic among the biggest Asian airports excluding China. ”
The strategists noted that several U.S. airlines have announced curtailment to flights to major Chinese cities, but that is not set to take place until early to mid-February.
Read more about how airlines are responding to coronavirus
“ Timely and unprecedented measures taken by the Chinese government to restrict travel means that jet fuel demand will likely weaken further before it improves, but such action can help to prevent a longer, more protracted period of oil demand weakness, ” said the RBC Capital Markets strategists. | business |
Coronavirus: officials confirm first US case of person-to-person transmission | The first US case of person-to-person transmission of the coronavirus has been confirmed by health officials.
The individual is married to the Chicago woman who was diagnosed with the virus after she returned from a trip to Wuhan, China, the epicenter of the coronavirus outbreak. There have been cases reported of the infectious virus spreading to others in a household or workplace in China and elsewhere.
The new case is the sixth reported in the United States. The other five were travellers who developed the illness after returning to the US from China. The latest patient had not been in China.
The virus can cause fever, coughing, wheezing and pneumonia. It is a member of the coronavirus family that’ s a close cousin to the Sars and Mers viruses that have caused outbreaks in the past. The new virus has sickened thousands, mostly in China, and killed about 170.
The Chicago woman, who is in her 60s, returned from central China on 13 January then last week went to a hospital with symptoms and was diagnosed with the viral illness. She and her husband are hospitalized.
Experts have said they expected additional cases, and that at least some limited spread of the disease in the United States was likely. Health officials think the new virus spreads mainly from droplets when an infected person coughs or sneezes, similar to how the flu spreads.
The Centers for Disease Control and Prevention and Illinois health officials announced the case on Thursday.
At a press briefing last Friday, the CDC’ s Dr Nancy Messonnier said: “ We are likely going to see some cases among close contacts of travellers and human-to-human transmission. ”
An international outbreak caused by the virus first emerged last month in China. Doctors there began seeing the new virus in people who got sick after spending time at a wholesale food market in Wuhan. Officials said the virus probably initially spread from animals to people, as did Sars and Mers. | general |
A look at the Coronavirus and your global supply chain | You’ ve probably heard the news…about 100 deaths from Coronavirus so far, and the death toll is climbing. The city of Wuhan, China, with a population of 11 million, has been sealed off and locked down – no in-or-out transportation.
All public gathering places and factories are closed. All Chinese New Year public celebrations have been cancelled. Supply chains in and out of the area have come to a screeching halt. Many countries, including the U.S., are evacuating their citizens from Wuhan and other cities.
Wuhan, one of China’ s industrial hubs is home to its steel industry. An inland city, about 500 miles from Shanghai, Wuhan is a manufacturing center for automotive companies including Nissan, Honda, and GM, and other corporate hubs including IBM, HABC, Honeywell, Siemens, and Walmart. Wuhan’ s manufacturing significance has grown over the past 15 years because as an inland city, it can draw labor from the surrounding area at lower cost than migrants traveling to other manufacturing areas of China. The overall cost of living and operational costs are also lower than China’ s eastern seaboard factories. These economics have drawn large corporations and whole industries to develop manufacturing sites in Wuhan. Airports, railways, trucking, and logistics services are also excellent.
Parts of your supply chain may originate or pass through Wuhan for manufacturing, assembly or finishing. If so, you can expect wide-spread shortages or delays for materials sourced or manufactured there. The length of the lock-down in Wuhan is unknown and your global supply chain for raw materials, parts, or finished goods may be at risk.
If you haven’ t already started working on an alternate sourcing and manufacturing strategy that excludes China, you should start immediately. Propelled by the Trump Administration Trade Wars, many companies have already left China for other Asian manufacturing locations. But - there are no guarantees that the virus won’ t spread to these new locations.
The Coronavirus should be a serious wake-up call for supply chain professionals to develop several alternate sourcing and manufacturing plans in different regions of the world, in response to all kinds of world events. While natural disasters and events such as the Coronavirus can not be predicted, you can develop alternate plans in case they do happen. Start now. Have a Plan B and a Plan C – just in case.
Rosemary Coates Ms. Coates is the Executive Director of the Reshoring Institute and the President of Blue Silk Consulting, a Global Supply Chain consulting firm. She is a best-selling author of: 42 Rules for Sourcing and Manufacturing in China and Legal Blacksmith - How to Avoid and Defend Supply Chain Disputes. Ms. Coates lives in Silicon Valley and has worked with over 80 clients worldwide. She is also an Expert Witness for legal cases involving global supply chain matters. She is passionate about Reshoring. | general |
Oil Teetering On The Brink Of Bear Market On Coronavirus Fears | After a brief reprieve earlier this week, oil prices tumbled again on Thursday, approaching a bear market, as fears spread that the coronavirus outbreak in China would depress oil demand, at least in the short term. & nbsp; At 1052 a.m. EDT on Thursday, WTI Crude was down 2.38 percent at $ 52.06 and Brent Crude was trading down 2.39 percent at $ 57.52, both flirting with bear market territory. Since the outbreak of the coronavirus in China, oil prices have lost more than 10 percent, and are now at their lowest levels since early October 2019. Even with Libya & rsquo; s oil production plummeting by nearly 1 million barrels per day bpd due to the port blockade by forces loyal to General Khalifa Haftar, oil prices have seen downward pressure over the past week and a half as fears of oil demand destruction currently outweigh supply outages. Yesterday & rsquo; s EIA inventory report was also not supportive for oil prices, after the Energy Information Administration reported a build in oil inventories of 3.5 million barrels for the week to January 24. Analysts had expected a draw of 460,000 bpd, after last week the EIA reported a draw of 400,000 bpd for the seven days to January 17. According to oil market analysts, until the impact of the Wuhan virus on the Chinese economy and oil demand becomes clearer, market participants will continue to be spooked by the specter of waning oil demand at a time when demand is weakest in the year. Related Why The Coronavirus Is A Real Threat To Oil Markets & ldquo; The Wuhan virus outbreak and its economic fall-out on Asia, the engine room of the world, remains the most crucial issue facing oil markets, with any rally likely to have short half-lives, & rdquo; Jeffrey Halley, senior market analyst at OANDA, told Reuters. & ldquo; There is the risk that sentiment gets hit further in the near term, & rdquo; ING strategists said on Thursday, noting that & ldquo; A number of international flights to China have been cancelled and if this trend continues in the coming days and weeks it will likely only deepen demand concerns. & rdquo; Yet, if losses in Libya & rsquo; s oil supply to the market persist for longer, they would be enough to tip the oil market into deficit this quarter, ING strategists Warren Patterson and Wenyu Yao said. By Tsvetana Paraskova for Oilprice.com | business |
Coca-Cola posts solid sales growth, helped by low-sugar soda | The information you requested is not available at this time, please check back again soon.
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Coca-Cola Co. rose after reporting better-than-expected revenue growth for the fourth quarter, citing rising demand overseas and higher demand for its low-sugar offerings in the U.S.
The Atlanta-based beverage giant said unit case volume gained three per cent. Organic revenue, which strips out some items like currency effects, increased seven per cent — above analysts’ average estimate of 4.9 per cent growth, according to Bloomberg Consensus. Quarterly earnings matched the average of analysts’ predictions.
• Diversifying its product lineup beyond sugary soda is paying off. Coca-Cola Zero Sugar had another year of double digit volume growth, the company said. Abroad, one of its juice and smoothie brand, Innocent, will expand further in 2020. The recently acquired dairy business, Fairlife, also has contributed to sales growth.
• Coca-Cola sees a gain of about five per cent in organic revenue in 2020. The company sees earnings of about US $ 2.25 a share for the year, seven per cent higher than the 2019 result.
• Executives said in a call with analysts that it is too early to tell what the short-term impact would be from the coronavirus outbreak in China that has killed more than 100 and disrupted daily life for millions. For now, the company is prioritizing employee safety and supporting efforts to contain the virus. Coke officials said that the SARS outbreak of almost two decades ago ended up not being particularly noticeable from a business standpoint.
Coke shares rose as much as 2.9 per cent, the most in three months, on Thursday. | general |
Coronavirus Is a ‘ Global Health Emergency.’ Stocks Rose Anyway. | The World Health Organization declared the coronavirus a “ global health emergency. ” That sounds like negative news for markets, but stocks gained ground, closing solidly in positive territory, after officials commended the Chinese government for its swift response to the outbreak.
The Dow Jones Industrial Average ended the day with a 0.4% gain, and the S & P 500 and the Nasdaq Composite both moved up 0.3%, a rebound that came after the WHO’ s press conference concluded. Stocks had been down as much as 0.9% after the Centers for Disease Control identified the first case of human-to-human contact in the U.S. earlier in the day.
While the WHO called the coronavirus an “ unprecedented outbreak ” it stressed that it would have been much worse were it not for China setting “ a new standard for outbreak response. ”
“ The Chinese government is to be congratulated, ” said Dr. Tedros Adhanom, the organization’ s director general.
Despite Beijing’ s efforts, the WHO said, the virus could still spread to areas with weaker health systems and less infrastructure to combat the disease.
There have been 7,834 confirmed cases of the coronavirus and 170 people have died, the WHO said. To date, there have been no deaths outside of China. There have only been eight instances of the disease spreading through human-to-human contact.
WHO officials stressed that there was no need to take measures that would unnecessarily interfere with international business and trade. | business |
HopTea craft brews non-alcoholic tea like a beer | Or wait...
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30-Jan-2020 - Last updated on 30-Jan-2020 at 11:06 GMT
Related tags: Tea, non-alcoholic, non-alcoholic drinks, craft beverages, Hops, Fancy Food Show function sanitize gpt value2 ( gptValue) { var vOut= '' ''; var aTags = gptValue.split ( ', '); var reg = new RegExp ( '\\W+ ', `` g ''); for ( var i=0; i < aTags.length; i++) { vOut += aTags [ i ].trim ().replace ( reg, '- ').substring ( 0,40); if ( i! = ( aTags.length-1)) vOut += ', '; } vOut = vOut.toLowerCase (); return vOut; } $ ( document).ready ( function () { dataLayerNews = { }; dataLayerNews.related tags = sanitize gpt value2 ( `` Tea, non-alcoholic, non-alcoholic drinks, craft beverages, Hops, Fancy Food Show ''); dataLayer.push ( dataLayerNews); });
The tea drinks are infused with hops, and made without sugars, additives or fermentation. The lack of fermentation differs them from kombucha, resulting in a 0.0% ABV drink. HopTea has six core SKUs.
Co-founders Dean Eberhardt and Andrew Markley launched HopTea in May 2018 with the intent of producing a unique alcohol alternative, separate from seltzers, sodas and juices. They use whole leaf tea and flowers for their base and organic flavorings.
At the Winter Fancy Food Show in San Francisco this month, HopTea sampled its latest flavor. The Hoplemousse One is made from a white tea base with grapefruit, and is similar to a citrus radler beer. It joins The Green Tea One, The Calm One, The Lemony One, The White Tea One and The Really Hoppy One.
Black tea, white tea, green tea and chamomile are all used as foundations to the beverages. HopTea is based in Boulder, Colorado and the core six are sold in retail, cafes and bars in the local Denver area.
HopTea told BeverageDaily that the black tea drinks are the most ‘ hoppy,’ the green tea resembles a pale ale and the Lemony flavor is compared most to an authentic beer taste. The brand operates a taproom in Boulder that also rotates limited edition flavors.
Though the teas are positioned as a non-alcoholic beer alternative, HopTea said they have not experienced much competition in their category. Consumers like them as a standalone drink or a palate cleanser, and they mostly compete with kombucha and cold brew drinks.
“ No one is directly aligned with what we’ re doing, ” HopTea said.
After the launch in 2018, HopTea sold at Colorado farmer’ s markets before opening the taproom in summer 2019. The teas are packaged in 16oz BPA-free cans. Hoplemousse and Lemony contain 30 calories each and 6g of sugar, and Green Tea, White Tea, Calm and Really Hoppy have no calories and 0g of sugar.
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Related topics: Ingredients, Tea and Coffee, Retail & Shopper Insights, Markets, Soft Drinks & Water, Beer, Wine, Spirits, Cider, Beer, Health and Wellness, Natural and Organic, Emerging Markets, Future Flavors, Functional Beverages, Beverage Entrepreneurs, Craft
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The Coronavirus Is Now Officially a Global Emergency | The World Health Organization declared the China outbreak an international threat, raising questions about many countries ' health infrastructure. | tech |
Stan Wong's Top Picks: Jan. 30, 2020 | The information you requested is not available at this time, please check back again soon.
One market anxiety has given way to another as U.S-China trade relations improve and fears around the coronavirus outbreak grow. The disease evokes memories of the SARS epidemic and also the more recent Ebola, Zika and MERS outbreaks. It’ s important to note that none of these past epidemics wielded a lasting negative impact on the economy or financial markets.
Earlier this month, North American equity markets yet again reached new all-time highs as investors become less worried about an impending economic recession. Fourth-quarter corporate earnings have also been solid thus far, with 75 per cent of the companies that have already reported beating analyst estimates. Equity valuations are somewhat extended though, with price-to-earnings ratios at the upper range of the past 10 years. This combined with the strong move in stock prices in 2019 and fears over the coronavirus outbreak will likely set the stage for volatility over the near-term.
In Stan Wong Managed Portfolios, we’ re taking a cautious approach towards equities. Yet, we believe that good buying opportunities will present themselves as they always do during times of unsettled markets. We continue to overweight U.S. equities, with our largest sector weightings in communications, healthcare, financials and consumer discretionary. Overall, we prefer companies with high-quality attributes and strong balance sheets ( high return on equity, low financial leverage and steady earnings growth). We like defensive growth, low volatility and high-dividend strategies as the global macroeconomic backdrop matures.
Stan Wong of Scotia Wealth shares his top picks: Booking Holdings, Merck and Starbucks.
BOOKING HOLDINGS ( BKNG NASD) Last bought in January 2020 at around $ 1,870.
With over US $ 16 billion in expected revenues for 2020, Booking Holdings is the world’ s largest online travel agency by revenue, offering booking services for hotel and vacation rooms, airline tickets, rental cars, restaurant reservations, cruises and other vacation packages. The company operates a number of brands including Priceline.com, Booking.com, Agoda, OpenTable and Kayak.
Booking shares are attractively valued, trading at 17-times forecast earnings with a long-term estimated earnings growth rate of about 15 per cent. This gives the shares an estimated price-earnings to growth ( PEG) ratio of just 1.1 times. The stock is in oversold territory, down over 10 per cent from its highs earlier this month, representing an attractive buying opportunity. Booking reports its next quarterly results on Feb. 26.
MERCK ( MRK NYSE) Last bought in January 2020 at around $ 85.
With nearly US $ 50 billion in expected revenues for 2020 and its products being marketed in over 140 countries, Merck is one of the world’ s largest health care companies. It has operations in pharmaceutical, animal health and consumer care. Merck’ s core products include treatments for cancer, diabetes and HPV. The company’ s wide lineup of high-margin drugs and robust pipeline of new drugs should ensure strong revenue and earnings growth over the long term. Indeed, Merck has reported 23 consecutive quarters of positive earnings surprises.
Merck shares offer investors a defensive growth name with an attractive valuation. The company trades at 16 times forecast earnings, with a long-term estimated earnings growth rate of 10 to 12 per cent. The shares also yield a healthy 2.8 per cent dividend. Merck reports its next quarterly results on Feb. 5.
STARBUCKS ( SBUX NASD) Last bought in January 2020 at around $ 85.
With over US $ 28 billion in expected revenues for 2020 and over 30,000 stores across 80 countries, Starbucks provides investors with an iconic consumer growth story.
This week, the company reported strong first-quarter earnings results that surpassed analyst estimates. However, the stock has declined nearly 10 per cent from highs earlier this month due to the coronavirus outbreak and its effects on the company’ s operations in China. While China is highly important to Starbucks’ future, today only 10 per cent of its overall revenue comes from that country. Hence, its vulnerability to the outbreak may not be as severe as some investors think.
Despite its size in North America, Starbucks still has meaningful domestic growth potential, with continued beverage innovation, enhanced mobile and reward initiatives and improved store formats. The stock trades at 27 times forecast earnings, with a long-term estimated earnings growth rate of 12 to 15 per cent. The shares also yield a modest 1.9-per-cent dividend.
Stan Wong of Scotia Wealth reviews his past picks: Dollar General, UnitedHealth and Waste Management.
TWITTER: @ StanWongWealth WEBSITE: stanwong.com
The Federal Reserve signaled it will start raising interest rates “ soon ” and shrink its bond holdings after liftoff has begun, moving toward ending ultra-easy pandemic support to fight the hottest inflation in a generation.
The Bank of Canada surprised markets Wednesday by keeping its key lending rate at 0.25 per cent, while putting Canadians on notice that interest rates will eventually rise.
Canadians are able to get a fuller picture of the reasons why the Bank of Canada opted to hold its benchmark rate on Wednesday, with the release of its Monetary Policy Report ( MPR).
Homeowners who have opted for a variable rate mortgage over a fixed-rate one are likely cheering the Bank of Canada’ s decision on Wednesday to hold steady on its key lending rate.
Dr. Donna Ferguson, clinical psychologist at CAMH, talks about how employers can support their workers’ mental health as we approach the second anniversary of the COVID-19 pandemic. She says leaders need to be trained on mental health, check-in with their workers more frequently and expand accessibility to resources as many individuals are still working from home. Ferguson added that workers need to be careful about setting boundaries around their job since it’ s easy to lose that work-life balance while being remote.
Advocates in Ontario's live music industry say upcoming shows big and small hang in the balance as they face provincial restrictions that are tougher on concert and live theatre venues than other entertainment spaces.
When Jenny Dickson goes grocery shopping, they only buy off-brand foods or items on sale for fear of overestimating how much money they have available in their bank account.
Snowpack in the U.S. West has decreased by about 20 per cent in the last century, making man-made snow more vital each year to opening ski resorts and fueling ski town economies as they head into an uncertain future | general |
Tesla Ploughs Through $ 600 After Earnings ( TSLA) | The stock had a tough start to 2019 and for many, it must have looked like the writing was on the wall. But the tables flipped in the second half of last year. Having already rallied 150% since October and 35% since the start of this month, investors would have been forgiven for thinking that shares were already starting to look overcooked and there was more risk than reward on the table going into these earnings. However, they went into yesterday’ s close up 2.5% and following the release surged a full 11% more. Thursday’ s session looks likely to be a wild one as Wall Street digests the numbers and bears reevaluate their positions. And there’ s plenty of numbers on the table.
Despite beating expectations, these numbers weren’ t absolute knockouts. Revenue was up 2% year on year, net income was down 5% and EPS were down almost 30% year on year. These paint a picture of a company in or at least close to fundamentally negative growth, at least for the moment.
But Tesla has always been about future earnings and potential and that’ s what investors seem to be focusing on in the wake of Wednesday’ s release. Even talk about the coronavirus outbreak delaying Model 3 production in China did nothing to temper trader’ s enthusiasm in the after-hours session. Wedbush was out with a note after the release and talked about the rapidly approaching inflection point for electric vehicles and how Tesla are well-positioned to capture and boom in demand.
document.write ( ' < a style= '' text-decoration: none; font-weight: normal; color: # 696969; '' target= '' blank '' rel= '' nofollow '' href= '' https: //www.ame ' + 'ricanconsumernews.net/scripts/click.aspx? NativeDisplayAdID=588 & ImpressionID=0 & UserID=0 & Placement=PlaceOnArticlePage '' > '); Wall Street legend who picked Apple in 2003 — and Bitcoin in 2016 — shares his # 1 pick for 2020s.
2019 was also the first year that the company hit its annual deliveries forecast without any mid-year revisions needed. If Musk is going to start delivering on all his promises like this, then the famous Tesla bears are in real trouble.
For example, the company plans to sell more than 500,000 vehicles in the coming year which was “ mind-blowing ” according to Bill Selesky from Argus Research. Forward guidance like this seems to have easily offset any concerns about the slow or negative growth seen in the headline numbers.
They’ re also promising a quick ramp for the new Model Y and are expecting to finally be cash flow positive in 2020 with some “ possible temporary exceptions ”. This would mean they’ re on the verge of being self-sufficient; a major milestone and validation of their business model.
Short interest has been declining in recent weeks in the midst of this latest rally as bears start to throw in the towel. It will be interesting to see what effect the $ 600 level being broken has on the remainder. Earlier this month the company surpassed the high water mark that Ford ( NYSE: F) set in 1999 with a $ 100 billion market cap. This is a significant notch on Tesla’ s belt as they continue to position themselves as the Ford of the 21st century.
For investors looking to get involved at these levels, it’ s a tough buy out the gate given RSI is close to 90. Any pullback should be considered a buying opportunity until Musk tells us otherwise. And that’ s the main risk to be cognizant of. If there are fresh production delays or a hint of lower than expected demand, then these prices will not be justified. Until that happens though, this is a company that appears to be on the verge of taking off for decades to come.
5 Travel Company Stocks Likely to Suffer From the Coronavirus
How important is the global travel and tourism industry? It’ s a sector that accounts for about 10% of the world’ s adult workforce. That’ s 350 million people. The industry also accounts for at least 4% of the global gross domestic product ( GDP). In short, it’ s an industry that accounts for trillions of dollars for the economy. And it relies on the most visible workers like pilots and cruise ship captains to the kitchen and housecleaning staff and servers. The travel industry is in many ways a service industry. But when there’ s nobody to service, these businesses take a tumble. And tumble it has. The world is going through a period of enforced social distancing. Many countries are taking even more extreme measures to lock down parts, or all, of their countries in an effort to contain the spread of the coronavirus and to flatten the curve to prevent healthcare workers and hospitals from being overwhelmed. But that means fewer people are flying. Planned vacations are being canceled. And all of this is bad news for a sector that relies on the mobility of global travelers. To be fair, the best of these companies should recover just fine. However, some of these companies had fundamental concerns that will be magnified by the loss of revenue.
View the `` 5 Travel Company Stocks Likely to Suffer From the Coronavirus ''.
Complete the form below to receive the latest headlines and analysts ' recommendations for your stocks with our free daily email newsletter: | business |
Sonic Automotive Is On The Move Ahead Of Earnings | With earnings season in full swing, it’ s no surprise to find stocks on the move. Usually, you find stocks moving after the release, less often before the release, but in either case, it can be an indication of future investment results. In this case, Sonic Automotive ( SAH) is moving higher before the release and the why is very important. Sonic Automotive is a dividend-growth stock with expansion in progress and a distribution increase on tap.
Expansion Is In Progress
At first glance, you might think Sonic’ s share price is rising because the company is expected to post solid earnings growth and that is true. Sonic has been executing on a two-pronged strategy that has been driving results in all three segments of business; franchised new-car sales, used cars and certified pre-owned.
The gem of the strategy is Echo Park. Echo Park is a certified pre-owned auto dealership and it is growing fast. Over the first three quarters of the year, the Echo Park franchise exceeded management’ s own wildest expectation. Each quarter, management increased its forecast for the next and that is expected again this quarter.
The company has only 9 locations in operation now but is expected to open at least four more by the end of the calendar year. If results are typical, the new stores could drive a 44.5% increase in segment revenue not counting the impact of comp-store growth. That 44.5% is equal to 5% of total revenue.
The Used Car Market Is Hot
While sales of new cars continue to stagnate there is a robust outlook for used and pre-owned car sales in 2020. Sales of used and pre-owned cars rose mid-single digits in 2019 and are expected to accelerate in 2020.
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The only negative in the outlook is that prices are expected to moderate as more inventory comes on the market. Because the margins for used cars are far greater than for new cars, about $ 950 per car versus $ 140, declining prices are not a major worry provided demand improves as expected.
Jessica Caldwell, Edmunds executive director of industry analysis, said this in a recent market analysis …
“ Used vehicles will likely grow in popularity as new-car substitutes if incentives continue to stagnate and interest rates creep up. A large quantity of near-new used vehicles are expected to come into the market that will undoubtedly offer a compelling value message that resonates with discerning new-car shoppers. ”
A Dividend Increase Is Expected
After digging a little deeper you will find Sonic is a dividend payer and a dividend grower. Better yet, it is expected to deliver another distribution increase this earnings cycle and it could be a big one. The company has been incrementally increasing the dividend since the 2008 Financial Crisis ( when they had to cut it) and has stepped up those efforts over the last two years.
Sonic Automotive increased its distribution regularly for the last two years and by substantial margins. The company still has a very low payout ratio, near 16%, which means the company could double the payout and not hurt its cash-flow situation.
Sonic has very little in the way of debt but it is funding the Echo Park expansion internally, so I don’ t expect the increase to be quite that large. Even so, the five-year CAGR of the distribution is 32% suggests a solid double-digit increase. The downside is the yield is low, about 1.20%, and easy to beat with other investments. The upshot is capital appreciation and total returns could easily reach the 20% to 30% range over the next 12 months.
The Technical Outlook Is Bullish
Shares of Sonic Automotive have been ratcheting higher since the first quarter of 2019. This move coincides with the proof-of-concept of Echo Park’ s first locations and the ramp of its expansion. The stock recently broke to a 13-year high and is now in consolidation above a key support target. Price action just confirmed support at the short-term moving average and the previous high pointing to a continuation of the rally.
The indicators are bullish and convergent with the move higher. This combiation points to a retest of the recent highs at least and the possibility of retesting the all-time highs. A move up to the $ 35 level, inclusive of dividends, would be a +10% gain over the next 12 months. A move up to the all-time high at $ 40 would be a gain of 20%.
5 Travel Company Stocks Likely to Suffer From the Coronavirus
How important is the global travel and tourism industry? It’ s a sector that accounts for about 10% of the world’ s adult workforce. That’ s 350 million people. The industry also accounts for at least 4% of the global gross domestic product ( GDP). In short, it’ s an industry that accounts for trillions of dollars for the economy. And it relies on the most visible workers like pilots and cruise ship captains to the kitchen and housecleaning staff and servers. The travel industry is in many ways a service industry. But when there’ s nobody to service, these businesses take a tumble. And tumble it has. The world is going through a period of enforced social distancing. Many countries are taking even more extreme measures to lock down parts, or all, of their countries in an effort to contain the spread of the coronavirus and to flatten the curve to prevent healthcare workers and hospitals from being overwhelmed. But that means fewer people are flying. Planned vacations are being canceled. And all of this is bad news for a sector that relies on the mobility of global travelers. To be fair, the best of these companies should recover just fine. However, some of these companies had fundamental concerns that will be magnified by the loss of revenue.
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Western Digital ( WDC) Earnings Report Trading Blueprint | Macro Context and Influences
The S & P 500 ETF ( NYSEARCA: SPY) is our macro market indicator. WDC earnings come the day after the FOMC rate decision, which can set the macro market narrative moving forward for risk-on or risk-off stance. Concerns over balance sheet expansion ( quantitative easing) under the guise of short-term repo purchases being the true driver of the market rally lingers. The daily SPY stochastic has crossed down and needs to regain a close above 329 blunt the downdraft. Falling back under 325.90 can further flame bearish headwinds towards the 320.28 and 318.80 Fibonacci ( fib) reversion levels and daily lower Bollinger Bands ( BBs), respectively. Negative macro market sentiment can trigger further selling on WDC and blunt upside momentum.
Technical Analysis
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Utilizing the rifle charts, WDC has a bullish monthly mini pup pattern with 5-period MA support overlapping with the 58.24 fib. The weekly stochastic is stalled at the 90-band with the 5-period MA overlapping the 67.73 fib line in the sand. This means if WDC closes under 67.73 this week, then the weekly stochastic would cross down. The daily stochastic has crossed down forming a bearish mini inverse pup with the 5-period MA resistance overlapping the 68.63 fib. Making the near-term momentum bearish with downside targets at the 64 “ gatekeeper ” fib and 62.53 fib overlapping daily lower BBs.
Sympathy Stocks:
The direct sympathy stock for WDC is competitor storage device maker Seagate Technologies ( NYSE: STX) and memory chip supplier Micron Technologies ( NYSE: MU). AMD tends to move with MU, which can move with WDC most of the time. If WDC is too volatile, then consider trading MU as the sympathy peer stock since there’ s more liquidity from the thicker float.
Trading Game Plan:
WDC has traded between 72 and 65.32 in the past week. The bearish daily mini inverse pup coupled with AMD earnings dumper sets the negative sentiment heading into earnings. However, focus on the reaction, not the reason. The bearish daily mini inverse pup makes the 5-period MA and fib at 68.63 a viable resistance to contend and the 62.63 daily lower BBs a rational downside target upon completion. The 64-price level is a super fib composed of multiple 0.618 and 0.382 overlapping fibs make it a prime bounce area on first tests and as well as 62.53 fib. These are viable downside targets if the third gapper reaction downtrend forms on the 60-minute and 15-minute rifle charts. If WDC manages to gap up, then consider the 69.60, 70.59 and 72.12 for initial short-sell reversion scalps back to the 5-minute 5-period MAs first, then gauge whether the 68.53 fib holds pullbacks to base for the third reaction uptrend. If WDC gaps down, then watch for initial reversions off the 65.40, 64.40, 63.90 and 62.40 ranges for reversion scalps. WDC can be very fast and volatile off the open as scalps can range from 0.25 to 0.75 before spreads tighten with time. MU can be swapped out for WDC for more liquidity and slower pace reactions. Add STX with MU to gauge when negative correlation forms with WDC. For example, if WDC is a dumper and coils off a key fib area, then look to play a long scalp on MU or STX. Make sure you pace yourself and limit trading volume to the most liquid periods of the day which is the morning session and stay out of deadzone.
10 Great Cheap Stocks to Buy Now for Under $ 10
As the P/E ratios of most S & P 500 companies look very expensive and the stock market continues to regularly hit new all-time highs, it's very difficult for investors to find cheap stocks to buy now. This goes for both share price, since most stocks are trading higher on a per-share basis, and valuation relative to earnings. Right now, the typical S & P 500 company is trading at about 25 times forward-looking earnings. Historically, S & P 500 companies have traded at about 15 times earnings in more normal markets. While the S & P 500 as a whole is expensive, there are still a handful undervalued stocks that are trading at less than $ 10.00 per share. Value investing opportunities for value exist if you know where to look. Putting together a list of cheap stocks to buy now requires looking into some smaller, riskier, unloved or undiscovered parts of the market. These low-priced stocks might not look especially attractive today, but long-term investors stand to profit if they are willing to be patient and hold onto shares of these companies through multiple market cycles. Some of these companies are great investing ideas because they're too small and too risky to attract the interest of most mutual funds and Wall Street money managers. Others have been beaten up by the market after a period of slowing earnings and profits, but are now trying to turn around and bounce back. In this list, you might find marijuana stocks, dividend-paying stocks, large-cap stocks, growth stocks, small-cap stocks, and even some bitcoin stocks. While these low-priced stocks have a lot of differences, these 10 stock picks all share a common characteristic, a super-low share price of $ 10.00 or less.
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W.H.O. Declares Global Emergency as Wuhan Coronavirus Spreads | The World Health Organization declared a global health emergency on Thursday as the coronavirus outbreak spread well beyond China, where it emerged last month.
The move reversed the organization’ s decision just a week ago to hold off such a declaration. Since then, there have been thousands of new cases in China and clear evidence of human-to-human transmission in several other countries, including the United States.
All of which warranted a reconsideration by the W.H.O.’ s emergency committee, officials said.
The declaration “ is not a vote of no confidence in China, ” said Tedros Adhanom Ghebreyesus, the W.H.O.’ s director-general. “ On the contrary, the W.H.O. continues to have confidence in China’ s capacity to control the outbreak. ”
The declaration comes now, he said, because of fears that the coronavirus may reach countries with weak health care systems, where it could run amok, potentially infecting millions of people and killing thousands.
Following the declaration, the State Department on Thursday night warned travelers to avoid China altogether.
China’ s Foreign Ministry spokeswoman, Hua Chunying, said that the country “ is fully confident and capable of winning the battle against this epidemic. ”
In a statement on the ministry’ s website, she added that China was willing to continue to work with the W.H.O. and other countries to safeguard public health.
The W.H.O.’ s declaration — officially called a “ public health emergency of international concern ” — does not have the force of law.
The agency is governed by an annual convocation of the health ministers of all U.N. countries, and its role is only to offer advice. Governments then make their own decisions about how they protect themselves.
States of emergency are “ merely guidance, ” said Dr. David L. Heymann, a former W.H.O. assistant director-general who now analyzes the work of the agency’ s emergency committee. Governments and even private companies “ may or may not follow it. ”
Nonetheless, emergency declarations signal that the world’ s top health advisory body thinks the situation is grave. Many scientific experts welcomed the decision.
The public health emergency “ allows them to further lean into the role of global leadership for governments and the private sector, ” said Dr. Thomas R. Frieden, the former director of the Centers for Disease Control and Prevention and a veteran of several global health emergencies.
The first goal, he said, should be to understand more about how the virus is spreading — whether mostly in hospitals and clinics, what ages and sexes or professions are most affected, how sick they become and what risk factors are dangerous.
But Amir Attaran, a professor of law and epidemiology at the University of Ottawa and a frequent W.H.O. critic, called the declaration “ inexcusably late. ” The committee’ s reasoning that it lacked enough scientific evidence to declare an emergency last week was “ balderdash, ” he added.
“ W.H.O. is paralyzed for the same political reasons that ruined its scientific judgment in SARS, Ebola and Zika, ” he said. “ Borders are closed, aircraft grounded and ships anchored as W.H.O. mutely dithers over whether or not to declare an emergency. ”
“ Events have comprehensively overtaken them, proving their uselessness yet again, ” he added.
Declaring emergencies is always a hard decision, Dr. Tedros said on Wednesday. Border closings and flight cancellations may cause hardships for millions of healthy people near the epicenter, and enormous economic disruption.
In the worst cases, supplies of food and medicine can run short and panic can spread, threatening to do more damage than the disease.
Experts at the W.H.O. have lavishly and repeatedly praised China’ s response as remarkably aggressive.
The country is building two hospitals, in just two weeks, to house coronavirus patients. Chinese scientists deposited the genetic signature of the coronavirus in public databases, greatly speeding the development of diagnostic tests and, potentially, vaccines.
Chinese authorities cordoned off the major cities at the outbreak’ s epicenter, Hubei Province, stranding more than 50 million people at the height of the Lunar New Year holidays — a measure that few other countries could have undertaken.
Whether that massive cordon will prove effective remains to be seen. Five million people were able to leave Wuhan, the city where the outbreak began, before its train and bus stations and airports were closed, the mayor said. There were soon outbreaks across the country.
Dr. Tedros praised the Chinese government, saying it “ is setting a new standard for outbreak response. ” Other countries should be grateful that only 98 of the nearly 10,000 cases confirmed so far have occurred outside China’ s borders, he said.
Despite the emergency declaration, and despite the State Department’ s urging Americans to stay away from China, the W.H.O. opposes restrictions on travel to China or on trade with it.
Measures the agency considers unwarranted include border closures, visa restrictions and the quarantining of apparently healthy visitors from the affected regions, said the chairman of the agency’ s emergency committee, Dr. Didier Houssin, an adviser to France’ s national health security agency.
Many such measures have already been taken against China by other countries, and Dr. Houssin said the W.H.O. would question the scientific rationales behind them.
Neither he nor Dr. Tedros questioned the decision by the United States and other countries to evacuate their citizens from China, and they said the cancellation of flights by airlines was justified if the real reason was that they had no passengers.
Dr. Tedros, who met with President Xi Jinping in Beijing on Tuesday, said he was struck by how much Mr. Xi knew about the outbreak and by the fact that Ma Xiaowei, director of China’ s National Health Commission, was on the ground in Wuhan leading the response.
Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’ s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “ very rare, ” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’ s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “ start at no more than 50 percent of the exercise you were doing before Covid, ” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “ When you haven’ t been exercising, you lose muscle mass. ” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’ t being told to stay at home, it’ s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. ( Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’ s temperature to look for signs of fever is not as easy as it sounds, as “ normal ” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’ t have a thermometer ( they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’ t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’ t replace hand washing and social distancing.
If you’ ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’ re sick and you think you’ ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’ s a chance — because of a lack of testing kits or because you’ re asymptomatic, for instance — you won’ t be able to get tested.
That is not say there haven’ t been missteps. The W.H.O. last week described its risk assessment for the outbreak as “ moderate, ” when it should have said “ high. ” The error was corrected in a footnote to the agency’ s report; Dr. Tedros described it on Twitter as a “ human error. ”
Experts in the United States have complained of spotty epidemiological information from China.
Also, the W.H.O. can not share information with Taiwan, which now has eight coronavirus patients, because Taiwan is not a member of the United Nations.
The agency “ doesn’ t want to upset its major stakeholders, ” said Charles Clift, a senior consulting fellow at the Chatham House, an international affairs research group in London. “ China carries the political clout that other countries don’ t. ”
And the outbreak seems to accelerating, along with its consequences. China said on Friday that another 43 people had died from the disease, bringing the total to 213. No deaths have yet occurred outside China.
On Thursday, Russia closed much of its 2,600-mile border with China and stopped all train service between the countries, except for a regular train between Moscow and Beijing. Some airlines, including British Airways, have stopped flying there; others are greatly reducing their service.
Within China, some medical experts have questioned their country’ s response, arguing that local officials should have imposed stricter travel restrictions before the virus spilled out of Wuhan. The country has now confirmed cases in every province and region.
Residents have complained that local authorities kept mum about the outbreak’ s severity — initially insisting that there was no evidence of person-to-person transmission outside Wuhan — but admitted the truth after press reports in Hong Kong.
As the dimensions of the outbreak became clear, the mayor of Wuhan on Monday offered to resign.
A W.H.O. delegation was allowed to visit Wuhan for just one day. Dr. Gauden Galea, the organization’ s representative in Beijing, said the visit was not intended “ to pass judgment. ”
“ Everything is being done with a sense of intensity, and to our assessment, good practice, ” he added. “ I don’ t want to be an apologist. You have to understand the large scale and the comprehensiveness of the operation. ”
Following the trip, China agreed to permit international experts coordinated by the W.H.O. into the country to work with Chinese scientists on containing the epidemic. The C.D.C. is assembling a team to join them.
The W.H.O. has made just five emergency declarations since its power to do so was established in 2005: for the pandemic influenza in 2009; a polio resurgence in 2014; the Ebola epidemic in West Africa that year; the Zika virus outbreak in 2016; and an Ebola outbreak in the Democratic Republic of Congo last year.
Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine and one of the discoverers of the Ebola virus and the presence of AIDS in Africa, agreed with the W.H.O.’ s emergency declaration but felt the process was flawed.
“ It is time for the W.H.O. to change its all-or-nothing, binary approach ” to declaring an emergency, Dr. Piot said. “ In every emergency, there is a spectrum of alert levels. ”
Dr. Tedros expressed the same frustration at a news conference on Wednesday, suggesting that the agency might need to switch to a graduated “ green-yellow-red '' system.
Austin Ramzy contributed reporting from Hong Kong, and Chris Horton from Taipei. Elsie Chen contributed research.
| business |
The Coronavirus Is Now Infecting People Who Haven't Traveled to China | Public health experts worry the outbreak is entering a dangerous new phase as cases of local transmission in other countries accumulate. | tech |
Coronavirus Halts Flow Of Latin American Oil To China | The flow of oil traveling from Latin America to China has stopped in the wake of the deadly outbreak of the coronavirus that has sunk oil prices to three-month lows, with no oil making its way from Brazil or Colombia to China since last week, according to Bloomberg. & nbsp; Chinese refineries are responsible for taking one-third of all oil from Brazil, Colombia, and other Latin American countries. The demand for jet fuel and gasoline stemming from travel restrictions that have been put in place in an effort to stop the virus from spreading is expected to fall sharply, which will inevitably catch up to the refineries who are expected to cut back production at some point. & nbsp; Brazil is the main Latin American supplier of crude oil to China -- particularly to the independent refiners known as teapots, who are most exposed to the effects of reduced demand. According to Bloomberg, the death toll from the virus has climbed to 170, with more than 8,000 infected with the coronavirus in China. So much so is the fear surrounding the effect on oil demand and prices that OPEC announced yesterday that it is considering moving up its March meeting as the effects of the deadly coronavirus continues to exert strong downward pressure on oil prices. The cartel was said to already be discussing an extension of the current production cut agreement, and that all options were on the table. Even with Libya & rsquo; s oil production plummeting by nearly 1 million barrels per day bpd due to the port blockade by forces loyal to General Khalifa Haftar, oil prices have seen downward pressure over the past week and a half as fears of oil demand destruction currently outweigh supply outages. Earlier in the week, Petrobras said it had suspended all employee travel to China due to the virus, but was quick to add that shipments of oil to China would continue. By Julianne Geiger for Oilprice.com | business |
Virus outbreak pushes China's stretched health care workers to breaking point | She flew back from the United Kingdom, where she lives and works, to spend the festive season in her hometown, Wuhan, a sprawling metropolis in central China. For 24 hours a day, Shi -- who is in her mid-30s -- sat by her mother's bedside in hospital, taking care of her.
Around her, more and more people were getting sick from a newly identified coronavirus. But Shi wasn't too worried.
After all, Chinese authorities were saying that the outbreak was `` preventable and controllable. ''
Now, three weeks after Shi arrived in China, it's clear the outbreak is not under control. The virus has spread to every Chinese province and region, across Asia and as far away as Europe and the United States. It has infected more than 9,800 people and killed over 200. Wuhan has been placed on an effective lockdown, almost entirely sealed off from the outside world.
On Monday, preliminary results showed Shi could also be infected with the virus.
But she is more worried for her family -- for her 67-year-old father who also appears to have the virus, and for her mother who has been uprooted to what she describes as an older, inferior hospital building, to make way for the rush of coronavirus patients.
Shi, and others like her, have become victims of a public health care crisis. Over the past few days, CNN has spoken to patients, medical staff and experts who have told of delays in testing for the virus, in telling the public the true nature of the virus ' spread, and of an already overburdened health system creaking under the enormous weight of a rapidly expanding outbreak.
The start of an outbreak
When Shi arrived in China on January 10, the coronavirus outbreak was already well underway.
By then, a few dozen people in Wuhan had presented with a mysterious virus that seemed similar to severe acute respiratory syndrome ( SARS), a coronavirus that originated in southern China in November 2002, infecting more than 8,000 people and killing 774 worldwide.
On January 7, Chinese scientists identified the pathogen as a novel coronavirus. Two days later, the first death occurred.
But it wasn't until over a week later, Shi says, that a doctor pulled her aside. The situation wasn't good, the doctor said, and everyone needed to wear a face mask.
`` I saw this doctor going to patients ' families one by one, privately, '' Shi said. `` It was only then when we realized how serious this was getting. ''
On January 17, there were 41 confirmed cases in Wuhan. By January 20, the total number of confirmed cases jumped to 201 across China, with three dead.
While the virus was discussed widely online over that period, it didn't make the front page of official state newspaper, the People's Daily, until January 21.
Chinese authorities traced the virus back to a now-shuttered market in Wuhan that sold a number of wild animals. On January 3, the city's health authorities said there was no obvious sign of human-to-human transmission, and no medical staff had been infected.
Less than three weeks later, it was a different story.
On January 20, Chinese-appointed expert Zhong Nanshan said there was evidence of the virus being transmitted between humans. Wuhan's mayor Zhou Xianwang later acknowledged that information on the virus wasn't communicated well.
Under Chinese law, local governments need to report an epidemic outbreak with unknown causes to the national health department and get approval from the State Council before they can make an announcement.
But Mary Gallagher, the director of the Center for Chinese studies at the University of Michigan and an expert in Chinese politics, believes that the numbers of infections was likely under-reported by Wuhan authorities in December and the start of January.
`` It's not even necessarily an insidious command from the central government -- it's almost like an implicit norm, that bad news is to be covered up as much as possible, '' she said.
Chinese President Xi Jinping said Tuesday that the government was releasing information in a `` transparent and responsible manner. ''
`` The Chinese people are engaging in a serious battle against the outbreak of the new coronavirus pneumonia. People's lives and health are always the first priority for the Chinese government, and the prevention and control of the epidemic is the most important task at present, so I have been directing and deploying the works myself. ''
Around the same time as the jump in cases, two men in full hazmat suits barged into Shi's mother's ward, demanding they move to another floor within 30 minutes. `` They gave no reasoning, just the order, '' Shi said. `` It was only when I asked the hospital staff, and they told me that all patients on this floor -- like my mum, they are all cancer patients -- must be evacuated to make space for handling novel coronavirus. ''
A few days later, the whole city went into an almost total lockdown.
But by that point, it was likely already too late to contain the virus, Guan Yi, a leading virologist, told Caixin. According to Wuhan authorities, 5 million people left the city due to Lunar New Year and the outbreak. As of January 27, there were still more than 4,000 Wuhan residents overseas.
Slow testing
The truth about the virus also came too late for other patients in Wuhan's hospitals.
By January 26, Shi began to have a fever -- one of the symptoms of the novel coronavirus. She went to the hospital's fever clinic where she found over 20 patients, all waiting to be tested by one doctor.
She says she was given three tests -- a nasal swipe to rule out the flu, a CT scan to compare her lungs against those of infected patients, and a blood test. After nine hours of tests and waiting for results she says the doctor told her that she had coronavirus, but because he could not give her the fourth and most definitive test, she could only be considered a suspected patient. Her 67-year-old father is in the same situation.
Shi called hospitals all over Wuhan, trying in vain to find one with the confirmation test -- a reagent test which chemically tests for the virus.
For now, Shi and her father are not counted in the official statistics of people infected.
John Nicholls, a professor in pathology at the University of Hong Kong ( HKU), said it was no surprise that Shi could have caught the virus in hospital. He points out viruses can easily spread within a hospital if doctors don't take proper precautions.
Others, like Shi, have experienced delays in tests or have struggled to get tested at all.
One Wuhan resident who asked to be referred to as Leya as she fears government reprisals for speaking out said she and her young son have spent days waiting to hear if they have coronavirus. They have had a CT scan and a nucleic acid test -- a laboratory examination to identify a virus. They still haven't got confirmation of coronavirus -- and until they do, they can not be admitted to hospital. Her husband, his parents and her parents are already in hospital with the virus, and she is convinced that she and her son are likely to have the virus, too.
`` I think I might have been infected, '' Leya said fearfully. `` I don't know, everyday I 'm getting pains around my heart. ''
Dora Jiang's 72-year-old uncle -- who is based in Wuhan -- is in a similar position. He went to a dedicated coronavirus hospital, but he says they delayed testing him for days and would not admit him until he receives a formal diagnosis, said Jiang, who spoke with CNN from her home in Germany.
These reports of test delays come amid assurances from Chinese manufacturer Shanghai ZJ Bio-Tech that it can produce enough testing kits to meet nationwide demand. According to state media reports on Monday, the company said it can produce 8,000 boxes per day and has enough raw materials in stock to make testing kits for 2 million people.
On Tuesday evening, Wuhan's Communist Party chief Ma Guoqiang acknowledged that before mid-January, samples had to be sent to the Chinese Center for Disease Control and Prevention ( China CDC) in Beijing. From mid-January, Wuhan was able to test about 300 cases a day, he said. China CDC says it is using a test known as fluorescent RT-PCR to detect the virus, which can be done via a nasal swab, blood, urine, or a serum specimen.
HKU's Nicholls said that the PCR rapid test could be done in a couple of hours. He said the nasal swab was worthwhile to exclude ordinary flu, but he thought both a chest X-ray and blood tests to check for an increase in inflammatory cells would be a waste of resources.
The delays in testing can mean patients miss out on treatment but may also mean the scale of the problem is worse than we know.
As Gallagher from the University of Michigan puts it: `` I don't think the numbers that are coming out now are inaccurate because of deliberate under-reporting, I think they may be under-reported because of a lack of capacity to test. ''
' I feel so powerless '
It's not just testing kits that places like Wuhan are short of. Authorities there have asked for more supplies, and announced they would build two new hospitals in a week to increase the city's capacity to fight the outbreak.
According to a nurse in Wuhan who asked not to be identified for fear of professional repercussions, staff are overwhelmed, resources are running low, and there are no beds. There are so few hazmat suits that staff disinfect them at the end of their shift to wear again the next day, she said. Around 30 of the 500 medical staff at her hospital are now sick and admitted to hospital, and others -- including her -- have self-quarantined at home.
`` There really are a lot of people who can't get admitted, but there's no point in blaming the nurses. There are no beds, no resources. Are we supposed to just fight this battle bare-handed? '' she said. `` Right now, loads of medical staff are at breaking point... I see my sisters charging toward the front line and I feel so powerless. ''
Similar things are happening in other Wuhan hospitals. On Sunday, a nurse from Wuhan Central Hospital told CNN that at least a dozen medical staff had been infected with coronavirus. One doctor at one of Wuhan's maternity hospitals, who spoke with CNN on condition of anonymity, said hospital staff are encouraging those with minor symptoms to stay at home and self-quarantine.
`` If you have a fever, don't come to the hospital, '' she posted on WeChat, a Chinese social media platform. Unless someone is suffering from serious conditions, she believes they should stay away from hospitals as they risk infecting others and causing unnecessary strain on the health system.
System under pressure
Even before the Wuhan coronavirus outbreak, China's health care system was under pressure, says Chen Xi, an assistant professor at Yale School of Public Health.
After the SARS outbreak in 2003, the Chinese government poured huge amounts of money into building hospitals, he said. When the government started trying to develop its primary health care sector -- the equivalent of general practitioners -- it was too late: there was already a growing population and a culture of going to hospital for any health issue, including minor ailments, as people thought the hospitals were more trustworthy.
There is still a large divide between the care provided at urban hospitals in the most developed cities -- like Wuhan -- and the care in rural hospitals, Chen said.
People in rural areas often travel huge distances to access better care, leading to even more overcrowding at urban hospitals. Particularly at this time of year, hospitals in places like Wuhan would already be extremely busy because it's flu season, Chen added.
According to University of Michigan's Gallagher, there is also a lack of health care professionals, in part because of a fear that becoming a doctor or nurse puts them at risk of violence. Last month, a Beijing doctor was fatally stabbed by a patient's relative. The problem is so widespread that China has passed a new law -- which comes into effect later this year -- to protect medical workers.
Wuhan may be struggling, but as a major city, its hospitals are relatively good compared to others in China, said Gallagher.
It's plausible that the situation could be even worse in smaller centers where there is lower quality of care. Around 46 million people live in the 14 cities other than Wuhan under travel restrictions in Hubei province, and all those places have less developed health services than the provincial capital.
Many of those people might have otherwise traveled to Wuhan for care -- but now, they will have to stay put. In WeChat groups seen by CNN, there are already discussions over regional hospitals lacking supplies.
Health care inequality could also be a problem for China's migrant workers, who have returned home over the Lunar New Year period, Gallagher said. They may be unable to afford health care in the urban center where they work, but health care services could be inadequate in the rural area they are from.
For now, there is little people like Shi can do.
Shi and her father self-quarantined themselves at home this week, and were too afraid to visit Shi's mother lest they infect others.
`` My dad really wants to go and visit mum, but we both seem to have got the virus. We can't go. Our hearts are extremely conflicted, '' she said. `` I am less worried about myself -- I 'm more worried for my father, because it seems that the elderly are more vulnerable to this disease. I just hope that a hospital can take him in first. ''
Shi's father was admitted to hospital Thursday, but Shi is still at home. Earlier this week, a hospital worker told Shi that they don't have space for her and her father. When Shi asked what kind of patient would be admitted, she says the staff member responded: `` We will admit ( them) if they're dying. '' | business |
Why 2020 Could Be A Record Year For Oil Trading Giants | Retail investors with long positions in crude oil markets had little to cheer about in 2019 as the market failed to maintain the early-year rally as pipeline outages, geopolitical tensions and dramatic changes in ship fuel regulations shook up the global oil market leading to high volatility. It was an annus mirabilis, though, for large oil traders, who took full advantage of the choppy markets and a spike in volatility to make a killing through oil trades. Bloomberg has reported that dozens of large oil traders made billions of dollars in profits in the year, with many posting record earnings thanks to a rocky oil market. According to Marco Dunand, CEO of Mercuria Energy Group Ltd., one of the five largest independent oil traders in the world, 2019 was among the best years ever for the energy trading industry. The good news for oil traders the trading bonanza could be set for a repeat in 2020. The current oil market could be headed for an encore as many of the catalysts that shaped last year & rsquo; s market remain in force. Rich pickingsIndependent traders were among the biggest winners, with the likes of Vitol Group and Trafigura posting record profits. Trafigura, one of the largest commodity trading companies on the globe, was the first to provide an early glimpse into the rich pickings at its fiscal year ending report in September. The company revealed that its oil unit delivered a record gross profit of $ 1.7 billion for the full year. Vitol, the world & rsquo; s largest independent oil trader, is expected to report earnings near $ 2 billion, one of its best ever, while Mercuria's CEO revealed that it also enjoyed a & ldquo; very good year & rdquo;. & nbsp; But it & rsquo; s not just independent traders that enjoyed last year & rsquo; s bonanza. & nbsp; In-house trading units of oil giants such as Royal Dutch Shell Plc, BP Plc and Total Plc also pocketed billions of dollars in profits in the volatile market. These oil giants probably made the biggest bucks considering their oil trading divisions dwarf those by independent players. For instance, Shell trades the equivalent of 13 million barrels of oil per day, nearly double the 7.5Mb/d by Vitol. & nbsp; According to a person knowledgeable in the matter cited by Bloomberg, Shell and BP made several billions of dollars apiece from oil trades last year. A series of catalysts conspired to create the kind of volatility that these oil traders thrive on. First off, & nbsp; scores of supply outages boosted the premiums that oil refiners pay over the benchmark price. & nbsp; In 2019, Washington imposed fresh sanctions on Venezuela, disrupting flows. & nbsp; Related Can Seawater Batteries Replace Lithium Then in April, several countries halted Russian shipments into Europe via the key Druzhba pipeline amid concerns of contamination with pollutants. & nbsp; The biggest supply disruption, however, came after Saudi exports were cut off following a major terrorist attack on the country & rsquo; s key petroleum facilities in September. Then there was the IMO2020 rules that force the shipping industry to use fuel with a lower sulfur content. The rules, which came into force in January, have resulted in increased volatility in the price of fuel-oil and marine diesel. & nbsp; Shell is rumored to have made at least $ 1 billion in trades linked to the IMO2020 changes. There were other factors at play, too. & nbsp; Gunvor CEO Torbjorn Tornqvist said that 2019 was & ldquo; up there among the best years ever & rdquo; for the trading house, thanks to the company & rsquo; s expansion into LNG, super-cooled natural gas that can be transported by vessel.Most of the world & rsquo; s LNG is transported by LNG carriers in onboard, super-cooled cryogenic tanks. The bumper trading profits for publicly traded companies is expected to soften some of the blow by low energy prices and asset write-downs that have overtaken the industry. Shell is expected to report 4th quarter and fiscal 2019 earnings on 30th January before market open while BP is expected to do the same on 2nd February. More of the sameSo far, the current year is displaying the same kind of uncertainty that created turbulent oil markets last year. The China coronavirus outbreak and continued inventory builds in the US market have been depressing prices. & nbsp; Only a few weeks ago, nobody foresaw the epidemic risk factor with the first case reported in December. Second, crude stocks gained 3.5 million barrels in the week to Jan. 24 -- more than 7x market expectations with gasoline stocks rising to a record high for the 12th consecutive week to 261.1 million barrels pointing again at weak demand. Meanwhile, tensions in the Middle East have somewhat dissipated but remain high. There are rumours that ISIS is taking advantage of the US-Iran crisis to make a comeback, though the United States has been downplaying the threat. The unlikely coalition between the US and Iran was responsible for pushing ISIS back, and expulsion of US troops from Iraq could give the jihadist group an upperhand and could lead to a another flare up in tensions in the region. The signing of the Phase One Trade Deal between Washington and Beijing also partly removed a major risk overhang from the oil market. The ongoing events seem to support a rather bullish thesis by a leading industry prognosticator. Two weeks ago, the US Energy Administration EIA published its latest short-term oil outlook where it predicted that inventory builds in 2020 and draws in 2021 would lead to Brent prices averaging $ 65/b in 2020 and $ 68/b in 2021. That & rsquo; s considerably higher than the current Brent price of $ 57.44/barrel. The EIA says it expects, & lsquo; & lsquo;... global oil prices to be affected by both the downward price pressures of relatively weak oil market balances and by the upward price pressures of geopolitical risk. & rsquo; & rsquo; But that & rsquo; s just part of the story. Related U.S. To Become Net Oil Exporter This Year EIA This forecast assumes that Brent crude oil prices will decline in early 2020 through May 2020 as risk premiums slowly fade then climb from mid-2020 and into 2021 due to tightening market fundamentals. However, the EIA failed to account for a key supply disruption Libya. As ING recently cautioned, outages in Libya -- where production has been steadily declining amid a blockade -- should not be discounted and could swing the market into a deficit as early as in the first quarter despite continuing lackluster demand. It & rsquo; s this sort of rocky backdrop that created excessive volatility in the markets in 2019 and led to record profits by oil punters. Source Investng.com Crude Oil Volatility Index, or Oil VIX OVX is a popular volatility indicator for oil traders. OVX tends to spike near market bottoms while lulls are more commonly seen near short-term market tops. After falling steadily in December, volatility in the oil market is once again spiking suggesting a bottom might not be far off. Source Investing.com Hedgers and professional traders tend to dominate the energy futures market, with hedge funds speculating on long- and short-term direction while industry players are taking positions to offset physical exposure. Retail investors tend to exert less influence in oil futures markets than in more emotional markets, like high beta growth stocks and precious metals. That said, retail & rsquo; s influence can rise considerably when crude oil trends sharply by attracting small players who are drawn into energy markets by table-pounding talking heads and & nbsp; front-page headlines. & nbsp; Waves of greed and fear can intensify underlying momentum, thus contributing to epic climaxes and collapses while printing exceptionally high volume. Tight convergence between positive catalysts can generate powerful uptrends while the opposite rings true for negative elements. With the oil futures market being extremely liquid and low margin costs offered by many brokers, retail traders with their fingers on the pulse, a keen eye on the charts and plenty of gumption can also partake in some of the oil profits the majors have been enjoying. By Alex Kimani for Oilprice.com | business |
Tough quarantine measures have spread across China | WEIJI VILLAGE is a bleak spot in winter, even without the disease-control roadblock just up the road complete with medical staff in blue protective suits, using pistol-shaped electronic thermometers to check the foreheads of drivers and passengers for signs of fever. The village’ s colour palette ranges from the grey of the sky to flat green fields of winter wheat and the brown of mud-filled potholes so deep that ordinary cars can not pass. China is full of rural scenes like this one, in a forgotten corner of Henan province. Weiji’ s only distinction is that it is a border village, a short walk from Hubei, an inland province of nearly 60m people ( roughly the population of Italy) that has been all but sealed off from the outside world to slow the spread of a dangerous new coronavirus.
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Chinese cities brim with migrant workers from villages like Weiji, hauling bricks on building sites or delivering fast food on electric mopeds. During China’ s rapid growth of the past 40 years, such people have helped spread wealth to the countryside. They send money back to home villages with taps on a smartphone app—for China is way ahead of the West when it comes to mobile payments—and return in person for the lunar new year, laden with gifts of city-bought clothes and fancy foods. Not this year, however.
About 200 migrants from Weiji work in Hubei’ s capital, Wuhan, the city where the virus was discovered ( pictured, under lockdown). Because some returned to the village for the new year, which began on January 25th, Weiji was dragged into a vast quarantine operation that has trapped tens of millions of Chinese in their homes, grounded some international flights, halted long-distance bus services and closed the country’ s largest tourist sites. The virus-control campaign explains a splash of colour on Weiji’ s almost-empty main street, a red banner urging locals to be tested. It reads: “ Find It Early! Treat It Early! Medical Fees All Free! ”
That encouraging, cajoling sign is buttressed by a dose of coercion. The village’ s fresh-faced Communist Party chief, who wears a smart black windbreaker, describes instructions from higher-ups. Cars with Hubei number plates are to be turned away, and migrants returning from that province sent back. Those who made it home to Weiji before controls were imposed on January 20th must submit to temperature checks twice a day and remain indoors in their family homes, with no visitors allowed. Foreign experts may debate the medical efficacy of mass quarantines, but locals describe a sense of comfort from doing something to fight what President Xi Jinping calls a “ devil ” virus.
A farmer and grandfather of two points to government notices fluttering on shuttered shop fronts. Officials have said that staying at home is “ the biggest contribution one can make ”, he explains. Unbidden, another local offers a patriotic commentary to the foreign reporter in his village. When the government tells the Chinese people to make sacrifices for the country, they listen, he booms. “ It’ s different from your Western countries. ”
Many villages have shut themselves off from outsiders using barricades made of freshly-dug earth, lumps of concrete or, in one case, a parked tractor ( an example outside the village of Wangyoufang, southern Henan, is pictured). At one such roadblock, old men in disposable face-masks sit at a wooden office desk, a pot of thermometers in front of them. The campaign is an odd mix of high and low technology. Henan police questioning this reporter were able to summon up his photograph and details by tapping his Chinese telephone number into a mobile device. But electronic thermometers gave very different readings in the space of a few seconds—an alarming flaw when even a hint of fever at a checkpoint can result in 14 days of quarantine.
The virus’ s spread is straining a public health system that lags other Chinese infrastructure ( under-staffed, ill-equipped hospitals sit next to gleaming high-speed railway stations). It is also a giant test for an authoritarian, one-party political system designed in a simpler China, when most workers toiled for the state or rural collectives, rarely moved around and relied on state and party news outlets to learn what was going on.
Today bullet trains criss-cross the country. Affluent urbanites use lunar new year to take foreign holidays. Even villagers in Weiji admit to reading criticisms of the government’ s crisis response on such social-media platforms as Weibo or WeChat, though censors still race to delete any posts chiding Mr Xi and other national leaders. Posts rebuking lower-level authorities are being allowed more often than usual. When Hubei Daily, a party newspaper, warned readers to refrain from rumour-mongering, it triggered a sardonic backlash. “ I can only trust the punctuation marks in Hubei Daily, ” grumbled a commentator on Weibo. Police have punished actual rumour-spreaders, such as a man detained in south-eastern China for three days for ( falsely) messaging friends about an infected stranger roaming his village. In contrast, eight “ rumour-mongers ” punished by Wuhan police, in a case announced on January 1st and covered prominently by state media, were in fact doctors sharing early tidings of a strange new virus in a medical WeChat group. In a rare intervention, the Supreme People’ s Court posted an online article on January 28th lamenting the silencing of those doctors.
Schooled in the idea that they live in an all-knowing surveillance state, Chinese netizens have reacted with surprise as the virus campaign reveals the authorities’ blind spots. The websites of big state newspapers have published lists of more than 100 flights and trains taken by infected people, urging fellow-passengers to seek medical tests. How come the authorities can not find passengers in a split second, asked a Weibo user, adding: “ Aren’ t we all 2020-big-data-high-tech now? ”
China’ s response to the virus has been unmistakably authoritarian, involving the locking down of Hubei’ s cities, and mandatory orders to stay indoors for a fortnight for those who leave Hubei and head to such centres as Shanghai. But it is not totalitarian. Unlike in the Mao era, when blind loyalty was demanded from citizens, the party has at times responded to public anger with a hint of understanding. In a much-discussed state television interview, Wuhan’ s mayor, Zhou Xianwang, offered to resign if the public wished. Still, his mea culpa contained an unsubtle jab at his masters in Beijing. Acknowledging that the city had held back information about the outbreak, Mr Zhou noted that he needed superiors’ permission to disclose news of an infectious disease.
The principle of quarantine is rarely challenged, even in Wuhan. Residents reached by telephone describe a mix of community spirit, such as bakeries offering free food to medics, a mass singing of the national anthem out of apartment windows as well as some grumbling about confusing and draconian local decisions. In a city of 9m people ( the mayor says another 5m left, just before the quarantine was imposed, because of the holiday and the virus) taxis are now the only public transport. They can no longer be hailed on the streets, however, or summoned through an app. They have been commandeered by the city. Duties include “ emergency runs ” such as ferrying the sick to hospitals, says Wang Jie, a retired taxi driver. Rides are free. The city pays drivers 600 yuan ( $ 86) a day, more than double what they make in normal times. Still, many fear being infected, says Ms Wang. Most have to buy their own protective masks, goggles and gloves.
Hundreds of expatriates left Wuhan on chartered airliners this week. Philippe Klein, a French doctor serving the city’ s expatriate community ( Wuhan is home to big French car factories), is staying put. Dr Klein, whose clinic is attached to the Union Hospital, describes exhausted local doctors being relieved by military medics, and by volunteer doctors from other provinces. The number of new patients seeking testing had been growing each day but has now stabilised, he says. Hospital bosses hope that the epidemic will peak in Wuhan around February 8th. If disease prevention began slowly, one reason was the cost of being tested, which put some locals off. Now the state will pay. It has built field hospitals to house those who test positive. “ Overall, I am optimistic, ” says Dr Klein.
Lu Xiaoyu, an academic who works in Australia but who flew back to Wuhan for the lunar new year, says morale is rising. Fine weather on January 28th brought residents out of their homes. Neighbourhood food shops have reopened, sparing people from stressful trips to large supermarkets. A lingering concern involves discrimination against Wuhan folk both inside and outside China. “ We have turned into refugees, ” he worries. Such concerns are well-founded. On January 27th several dozen people from Shanghai refused to board a plane in Japan when they realised that a small contingent from Wuhan was aboard. ( Their accent gave them away.) The incident went viral on China’ s social media. Many netizens backed the Shanghainese.
The virus has given new energy to localist sentiment within the protest movement in Hong Kong, where anti-mainland prejudice lurks alongside a yearning for greater political freedom. Bowing to public pressure, Hong Kong’ s government is denying entry to Hubei residents and those recently in the province. That did not stop someone posting online bomb threats and demands to seal the mainland border, shortly after police found three small, home-made explosive devices.
Chinese leaders insist that one-party rule is vital for stability and progress. The world will judge, in due course, whether their brand of bossy, secretive authoritarianism helped to stop a pandemic, or let the coronavirus spread out of control. Already, the crisis is revealing a country which talks a lot about unity and is capable of great feats of national mobilisation, but which is easily divided and painfully low on trust. That is an ailment for which party bosses seem to have no cure. ■
Published since September 1843 to take part in “ a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress. ”
Copyright © The Economist Newspaper Limited 2021. All rights reserved. | business |
Shell’ s Slide Is A Major Red Flag For Oil Markets | Royal Dutch Shell reported a steep drop in earnings in the fourth quarter, and the financial squeeze may slow the pace of share buybacks and force more asset sales. Shell & rsquo; s earnings of $ 2.9 billion were down by half from a year earlier, leading to a 3 percent drop in its share price on Thursday morning. After the takeover of BG Group several years ago, the Anglo-Dutch company is now just as much a natural gas major as it is an oil major, so the global gas glut is hitting the company hard. Shell is one of the largest LNG exporters in the world. LNG prices in Asia are at a 10-year low and showing very little signs of life. Meanwhile, chemical and refining margins have also narrowed. The oil majors are overbuilding chemical capacity, and are now reeling from the deterioration in that segment. & ldquo; Chemicals are really at the floor, & rdquo; Shell & rsquo; s CEO Ben Van Beurden said. Shell said that it will slow the pace of its $ 25 billion share buyback program as both crude oil and natural gas prices have fallen sharply. & ldquo; All macroeconomic indicators are working against us, & rdquo; van Beurden said after reporting earnings on Thursday. & ldquo; It is essential to have a resilient balance sheet to manage the kind of volatility we are seeing at the moment, & rdquo; he said, according to the FT. Shell had previously announced plans to sell off $ 10 billion in assets between 2019 and 2020, but van Beurden said the total could climb to $ 13 billion. & ldquo; How that pans out depends a little bit on the pace at which we can close deals, and we will be driven by an economic rationale, rather than a desire to have early cash, & rdquo; he said. Meanwhile, Shell & rsquo; s debt has also increased. Its gearing ratio & ndash; the ratio of debt to total capital & ndash; rose to over 29 percent in the fourth quarter, up from 28 percent in the third quarter. Related Can Seawater Batteries Replace Lithium Shell also wrote down $ 2.24 billion due to low natural gas prices, an impairment that was revealed in December. The company had previously said that it needed Brent prices to trade above $ 65 per barrel in 2019 and $ 66 per barrel in 2020 in order for it to keep its debt levels in check. Shell & rsquo; s share price is trading at its lowest point in two years, and it has vastly underperformed the S & amp; P 500 in recent years. In short, the results are not great. But, it could be worse & ndash; ExxonMobil & rsquo; s share price is at a 10-year low. The near-term is not promising for the oil majors. Crude prices are at multi-month lows and demand forecasts for the year could be revised down due to the unknown hit to consumption from the coronavirus in China.Related U.S. To Become Net Oil Exporter This Year EIA Analysts still differ on the significance of the outbreak. The number of cases of the coronavirus are larger, so we will & ldquo; doubtlessly see a dent in oil demand growth despite the virus & rsquo; lower lethality, & rdquo; JBC Energy said in a note. & ldquo; Each day the virus spreads weakens Chinese economic growth, following an already pressured last year. & rdquo; But Beijing could turn to more stimulus, which could lead to a rebound, JBC said. For its part, Raymond James wondered about why the market was so focused on China when the supply impact in Libya is vastly more substantial. At the moment, the LNA in Libya has disrupted around 1 million barrels per day mb/d of exports. & ldquo; [ E ] veryone seems to be fixating on demand-related headlines while ignoring the supply side of the equation. Thus, fears about Chinese oil demand are totally overshadowing the fact that Libya & rsquo; s oil exports are essentially shut down, as well as an apparent Houthi attack against Saudi, & rdquo; Raymond James wrote in a note. Justified or not, the oil market has soured and OPEC is facing questions about what it is going to do in response to Brent falling back below $ 60 per barrel. For the oil majors reporting bad fourth quarter numbers, the start of 2020 is not offering any relief. By Nick Cunningham of Oilprice.com | business |
Singapore, Malaysia clamp down on online falsehoods about coronavirus | Singapore evokes online falsehoods law while Malaysia makes arrests in their attempt to stem the spread of inaccurate reports concerning the coronavirus.
Eileen Yu began covering the IT industry when Asynchronous Transfer Mode was still hip and e-commerce was the new buzzword. Currently an independent business technology journalist and content specialist based in Singapore, she has over 20 years of industry experience with various publications including ZDNet, IDG, and Singapore Press Holdings.
Both Singapore and Malaysia have moved to clamp down on inaccurate online reports about the coronavirus, with the latter making several arrests of individuals for posting and sharing such content. Singapore also vows to take `` swift action '' against the spread of such reports.
The Malaysian Communications and Multimedia Commission ( MCMC) on Wednesday said it, alongside the Royal Malaysia Police, had conducted four separate raids that resulted in the arrest of four individuals suspected of posting and distributing false reports about the outbreak, which had affected several nations in the region.
Three of the detainees allegedly uploaded inaccurate information on Facebook, while the fourth had shared such content on Twitter.
Country's government is missing the point with its use of correction directives, when it should be looking more closely at how the legislation can be used to address bigger security threats as it prepares for its first elections since the emergence of technology, such as deepfake, and increased online interference.
MCMC added that smartphones, SIM cards, and memory cards believed to have been used to upload the content were confiscated during the raids.
Detained under Malaysia's Communications and Multimedia Act, Section 233, for sharing offensive and menacing content, the four individuals -- if found guilty -- would face fines of up to RM50,000 ( $ 12,247) or imprisonment of up to a year, or both. They also would be fined an additional RM1,000 ( $ 245) for each day the alleged falsehood remained online after their conviction.
The arrests had followed another on Tuesday when an individual in Selangor was detained for allegedly posting falsehoods about the virus on Facebook.
The MCMC said it would continue to step up enforcement efforts, alongside the police, to `` control the spreading of false news ''.
Meanwhile, Malaysia's southern neighbour evoked its Protection from Online Falsehoods and Manipulation Act ( POFMA) twice this week over false statements made about the coronavirus.
Singapore's Minister for Health on Monday instructed the POFMA Office to issue a General Correction Direction to SPH Magazines, which operates the HardwareZone forum, over a post on the forum that falsely claimed a man had died in Singapore from the virus.
A General Correction Direction can be issued to internet intermediaries, telecom and broadcast licensees, and permit holders of the country's Newspaper Printing Presses Act, requiring them to publish, broadcast, or transmit a correction notice to their users in Singapore.
Under the directive, HardwareZone will be required to carry a correction notice to anyone in Singapore who accessed its online forum.
A day later on Tuesday, the Minister for Transport instructed the POFMA Office to issue a Targeted Correction Direction to Facebook over falsehoods made by two users of the social media site, who falsely stated Woodlands MRT station was closed for disinfection due to a suspected case of the coronavirus. Such directives can be issued to internet intermediaries whose services are used to communicate falsehoods that affected public interest. They require these sites to communicate correction notices, by means of its service, to all users in Singapore who accessed the falsehood through its service.
In this instance, Facebook had to carry a correction notice on the two posts that contained the falsehood, according to the POFMA Office.
Commenting on the POFMA directive involving HardwareZone, Singapore's Minister for Communications and Information S. Iswaran noted that more than 4,600 unique visitors had read the false report before it was taken down. `` We must take swift action against such falsehoods [ or ] there is a grave risk they will spread and cause panic among our citizens, '' Iswaran said.
`` And that is why we have POFMA and we will not hesitate to use the powers under the law to take action against any party that spreads such falsehoods. ''
He added that the objective was to ensure Singaporeans are provided with the facts to enable them to safely browse online platforms and distinguish truth from falsehoods.
The Singapore government last week ordered for local access to a website, operated by Malaysia-based Lawyers for Liberty, to be blocked for failing to comply with a correction directive issued under the POFMA. In response, the human rights group did not comply with the correction notice order and, instead, filed a motion in Kuala Lumpur's High Court against Singapore's Home Affairs Minister K. Shanmugam. The lawsuit claimed the Singapore government was attempting to `` encroach upon '' freedom of speech in Malaysia.
Under the POFMA, offenders could face up to three or five years ' imprisonment, a SG $ 30,000 or SG $ 50,000 fine, or both. If bots or inauthentic accounts were used to amplify falsehoods, the potential penalties that could be applied would be doubled. Offending internet intermediaries, meanwhile, could face up to SG $ 1 million in fines, and also would receive a daily SG $ 100,000 fine for each day they continued to breach the Act after conviction.
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US-China Oil Deal Dictated By A Market That Hates It | The & lsquo; big beautiful monster & rsquo; Phase One trade deal between the United States and China may end up being truly beautiful for U.S. exports on paper only & mdash; at least as far as energy is concerned. Analysts have largely concurred that the Chinese promise to buy additional US $ 52.4 billion worth of U.S. energy products in 2020 and 2021 on top of the 2017 levels of Chinese energy imports is most likely unachievable, even if China intends to fulfill all its pledges in the deal. Just read the fine print in the phase-one deal, which could undermine the promise of a U.S. energy export boom to China. & ldquo; The Parties acknowledge that purchases will be made at market prices based on commercial considerations and that market conditions, particularly in the case of agricultural goods, may dictate the timing of purchases within any given year, & rdquo; the trade deal reads. At the signing of the deal, Chinese Vice Premier Liu He also explicitly said that China & rsquo; s purchases will be & ldquo; based on the market demand in China, in line with market terms. & rdquo; In other words, China says its purchases will be driven by market conditions. If this turns out to be the case, China will not rush into buying huge volumes of crude oil and liquefied natural gas LNG, due to both governmental and market circumstances in energy trade, at least right now. Chinese tariffs on some U.S. energy products are still in place, market demand this year is becoming increasingly difficult to quantify with the coronavirus outbreak, and even the ongoing refinery capacity expansion in China is not geared toward processing America & rsquo; s light U.S. oil. China & rsquo; s Tariffs on U.S. Energy Weigh on Market The problem with the market-driven imports of U.S. energy products is that China & mdash; despite signing the phase one trade deal & mdash; has not yet removed its tariffs on U.S. energy imports. Nor has it hinted after the signing of the deal that removal of those tariffs is imminent. & nbsp; & nbsp; China still has a 5-percent import tariff on U.S. crude oil, and another, much steeper, 25-percent tariff on imports of LNG. And the Chinese have not signaled yet they would consider removing those tariffs, which essentially make oil and natural gas imports in China uneconomical for many companies. Related Tesla Shares Race, But How Long Will The Rally Last While state-owned major oil corporations could be directed by the Chinese government to buy U.S. crude and swallow weak refining margins due to the higher price of imports with the tariff, China & rsquo; s independent refiners & mdash; the so-called teapots & mdash; are likely to continue to shun U.S. oil, according to Alan Gelder, vice president, refining, at Wood Mackenzie. The 5-percent tariff, if it & rsquo; s not removed, would weigh on refining margins at a time when China promises to buy so much more U.S. oil, Gelder said last week. & ldquo; This would discourage the country & rsquo; s independent refiners from processing large volumes of US crude, & rdquo; he noted. The national oil companies NOCs in China, on the other hand, have more wiggle room to stomach weaker refining margins from importing U.S. oil plus the 5-percent tariff in their large and complex operations, according to Gelder. & nbsp; Growing Chinese Refining Capacity Not Geared to Process US Light Oil Another market-driven consideration in China & rsquo; s promise to significantly boost its imports of U.S. crude oil is the fact that although China continues to expand its refining capacity, most new refineries that have come online over the past two years are configured to process medium high-sulfur crude grades, typically imported from the Middle East, rather than light low-sulfur crudes from the United States. & ldquo; Baseloads for the new refineries are mainly Middle Eastern grades so U.S. flows will likely push out West African or North Sea oil [ of similar quality ], & rdquo; Michal Meidan, director of the China energy programme at the Oxford Institute of Energy Studies OIES, told Reuters, commenting on China & rsquo; s new refinery additions and oil trade flows in the U.S.-China trade deal. & ldquo; Now, political fiat will have to defy market fundamentals & mdash; as China has yet to lift tariffs on US energy goods or grant exemptions to buyers & mdash; to ensure enough crude, LNG, LPG, ethanol and coal flow from the US to China, & rdquo; Meidan wrote in OIES & rsquo; s & lsquo; China Key themes for 2020 & rsquo; report earlier this month. Still, total U.S. energy flows to China are set to increase from the current very low levels, Meidan and other analysts concur & mdash; they just don & rsquo; t see China meeting its ambitious pledges in the phase-one trade deal. Sliding Oil Prices and Coronavirus Outbreak & ldquo; At current WTI prices, to meet targets, China would need to buy about 1.1 million b/d of US crude per year in 2020 and 2021, equal to an additional $ 24 billion per annum, & rdquo; Gavin Thompson, Vice Chairman, Energy & ndash; Asia Pacific at Wood Mackenzie, wrote in an opinion post last week. To compare, the record for U.S. oil exports to China was set in March 2018, when the U.S. shipped 469,000 bpd of oil to China. Related U.S. To Become Net Oil Exporter This Year EIA Moreover, at the time when WoodMac & rsquo; s Thompson quantified ten days ago the volumes necessary for China to reach its target, the & lsquo; current WTI Crude & rsquo; prices were still comfortably trading at around $ 58 a barrel. After the coronavirus outbreak & mdash; which threw the markets in panic over expected weakening of already weak oil demand growth & mdash; WTI Crude traded at around $ 52 a barrel early on Thursday. & nbsp; & nbsp; The low oil prices may lead to demand creation in nations heavily dependent on imports, especially the world & rsquo; s largest oil importer, China. But the lower the price of oil, the more volumes China needs to buy to reach the target in the deal, which is set in US dollars, not in barrels per day. Sure, China could significantly boost imports of U.S. LNG to meet the US dollar target of energy purchases, but the current 25-percent tariff is utterly prohibitive for importers, especially at a time when LNG spot prices are at a decade low. & nbsp; & nbsp; Until China removes tariffs on its energy imports from the United States, there is little room for a U.S. oil and gas export boom on the Chinese market. & nbsp; & nbsp; By Tsvetana Paraskova for Oilprice.com | business |
Stocks, oil tumble on fears virus to hurt China's economy | Gold gained along with the safe-haven Japanese yen and Swiss franc, as the number of people infected by the virus in a fast-spreading health crisis surpassed 8,100 people globally, more than the total from the 2002-2003 SARS epidemic.
The World Health Organization declared a global emergency as people infected by the virus spread to 18 countries.
Tedros Adhanom Ghebreyesus, WHO director-general, said the organization's greatest worry is the potential for the outbreak to spread to countries with weaker health systems.
The International Monetary Fund said it was too soon to quantify the potential economic impact of the virus, which has halted tourism and commerce throughout China.
Damage to China's economy is still hard to assess, but Wall Street economists see slower growth. Fitch Solutions said it maintains its real GDP growth forecast for China at 5.9% for 2020, but the impact of the virus could reduce that to 5.4%.
Major equity indexes slid across the globe, with the declines sharper in Asia and Europe than on Wall Street, where late in the session stocks turned positive.
Fading risk appetite sent yields on U.S. Treasuries down to their lowest in more than three months. A closely watched part of the yield curve briefly inverted.
Investors, who are confused about the strength of the U.S. economy, are buying on the dip as alternatives to owning stocks does not seem attractive, said Rick Meckler, a partner at Cherry Lane Investments in New Vernon, New Jersey.
`` This is a market where people are very nervous, '' he said. `` There's fear about committing new capital to this market given how far it's come, but there's even a greater fear on missing out on the gains. ''
MSCI's broadest index of Asia-Pacific shares outside Japan <.MIAPJ0000PUS > closed 2.29% lower, while emerging market stocks lost 2.20%.
Latin American assets have been hit hard by expected demand disruptions in China, one of the region's largest export destinations.
The pan-European STOXX 600 index lost 1.01% while MSCI's gauge of stocks across the globe but also cut losses late in the session to <.MIWD00000PUS > shed 0.33%. More than half of the world index is weighted to U.S. stocks.
Shares in London fell 1.36%, extending losses as the pound climbed against the dollar after the Bank of England kept interest rates unchanged.
Disappointing earnings in Europe weighed on blue-chips, adding to the gloom. Royal Dutch Shell fell 4.4% after fourth-quarter profit halved to its lowest in more than three years.
The Dow Jones Industrial Average rose 124.99 points, or 0.43%, to 28,859.44. The S & P 500 gained 10.26 points, or 0.31%, to 3,283.66 and the Nasdaq Composite added 23.77 points, or 0.26%, to 9,298.93.
The benchmark 10-year Treasury note rose 3/32 in price to yield 1.5856%. The yield curve between three-month bills and 10-year notes inverted for the second time this week, a bearish economic signal.
Yields on top-rated, tax-exempt U.S. municipal bonds hit record lows of 1.15% for 10-year debt and 1.80% on 30-year debt, according to Municipal Market Data.
German government bond yields fell sharply, with 10-year German bund yields dropping to a three-month low of -0.445%.
The dollar fell on news the U.S. economy posted its slowest annual growth in three years in 2019 and personal consumption weakened dramatically. The dollar index fell 0.13% after it had gained 0.65% in the last two weeks as investors sold off risk assets.
Still, coronavirus fears persisted, boosting the Japanese yen and Swiss franc.
The euro was up 0.21% to $ 1.1032. The yen strengthened 0.05% at 108.96 per dollar.
Gold prices rose, with U.S. gold futures settling up 0.8% at $ 1,583.50 an ounce.
Oil prices fell more than 2% to the lowest in three months on virus-related worries, while traders also considered the possibility of an early meeting or the Organization of the Petroleum Exporting Countries.
Brent crude lost $ 1.52 to settle at $ 58.29 a barrel, while U.S. crude fell $ 1.19 to settle at $ 52.14 a barrel.
By Herbert Lash | business |
CORRECTED-SE Asia Stocks-Markets fall as coronavirus death toll rises, Vietnam down over 3% | ( Corrects paragraph 12 to show Malaysian stocks recorded their eighth straight session of losses, not lost for record eight sessions) * Vietnam sees worst day in over a year * Vietnam Airlines hits record low * Malaysia closes lower for eighth straight session By Arpit Nayak Jan 30 ( Reuters) - Southeast Asian stocks fell across the board on Thursday as the death toll from the coronavirus in China rose sharply, with Vietnamese shares losing more than 3%. Vietnam markets opening after the Lunar New Year holidays saw their worst session in over a year, as investors priced in the economic impact of the virus outbreak. Adding to woes, the World Health Organization ( WHO) on Wednesday expressed concern over the person-to-person spread of the virus in three countries, including Vietnam. Flag carrier Vietnam Airlines was among the biggest losers as it shed 6.9% to close at a record low. Meanwhile, WHO said it would reconvene later on Thursday to deliberate whether the rapid spread of the virus could now be labelled a global emergency. The new virus has claimed 170 lives in China so far, with the number of infected patients growing to 7,711 in the country. Infections have been reported in at least 15 other countries, prompting investors to worry about the fiscal health of the world's second-largest economy which recently started showing signs of recovery. So far, confirmed cases of infection have been reported in Singapore, Malaysia, Philippines, Vietnam and Thailand. Indonesian shares shed 0.9% after the finance minister on Wednesday said the tourism sector would be hit as Chinese tourists, who make up a bulk of tourist footfalls in the country, cancel travel plans due to the outbreak. Financials and automakers were the biggest drags on the index, with Bank Mandiri and automotive firm Astra International losing 1.9% and 2.9%, respectively. The Singaporean index also slid, as lender DBS Group Holdings dropped 0.5% and transport services provider SATS Ltd fell 1.7%. The Malaysian stock index fell for an eighth straight session, as resources and utility stocks weighed. Philippine shares also fell, closing at their lowest since Dec. 10, 2018. For Asian Companies click; SOUTHEAST ASIAN STOCK MARKETS Change on the day Market Current Previous close Pct Move Singapore 3170.68 3182.57 -0.37 Bangkok 1523.99 1524.59 -0.04 Manila 7392.68 7462.31 -0.93 Jakarta 6057.596 6113.045 -0.91 Kuala Lumpur 1545.59 1550.47 -0.31 Ho Chi Minh 959.58 991.46 -3.22 Change so far in 2020 Market Current End 2019 Pct Move Singapore 3170.68 3222.83 -1.62 Bangkok 1523.99 1579.84 -3.54 Manila 7392.68 7,815.26 -5.41 Jakarta 6057.596 6,299.54 -3.84 Kuala Lumpur 1545.59 1588.76 -2.72 Ho Chi Minh 959.58 960.99 -0.15 ( Reporting by Arpit Nayak in Bengaluru; Editing by Shounak Dasgupta) | business |
Bangkok Airways PCL: announces precaution and prevention plan for the Novel Coronavirus 2019 Pneumonia | Bangkok Airways Public Company Limited announces its precaution and transmission prevention plans for the airline and its three airports regarding the Novel Coronavirus 2019 Pneumonia, for the reassurance of passenger health and safety.
Mr. Puttipong Prasarttong-Osoth, President of Bangkok Airways commented that, 'The airline has ordered all of its stations and airports to strictly follow advice and prevention procedures of the local authorities and to inform the Emergency Response Planning Division regularly in order to take appropriate measures. The company's precaution and prevention plans are in accordance with the standards and guidance of national authorities such as Department of Disease Control, Ministry of Public Health, The Civil Aviation Authority of Thailand as well as international organizations such as International Air Transport Association ( IATA), World Health Organization ( WHO). '
The precaution and prevention plans for Bangkok Airways ( airline) are as follows:
All stations, both in Thailand and overseas, are to strictly follow advice and prevention procedures of the local authorities and airports.
To perform primary screening by observing any obvious general health conditions of the passengers, whether at the ticketing office, check-in counters, or in the cabin once aboard. If any passenger is found with signs or symptoms of acute respiratory infection ( as defined by the Department of Disease Control and World Health Organization), the staff shall notify public health officers at such port immediately.
To intensify hygienic measures aboard the aircraft including disinfecting and cleaning the aircraft flying to and from China immediately before operating any and all flights.
In the event that a suspected Coronavirus-infected passenger is found on any Bangkok Airways flight, the airline will have the aircraft cleaned and sterilized immediately.
An assistance center has been set up to assist staff who may require emergency assistance such as flight crew or ground service personnel.
In-flight announcements regarding additional instructions have been implemented on flights that operate in and out of China.
Protective face masks are provided to crew members and ground service staff to wear when on duty. Especially, staff at Chongqing and Chengdu station in China as they are required to wear protective face masks and protective glasses at work at all times.
The precaution and prevention plans for airports are as follows:
Samui Airport
Set up various notification boards around the airport to provide necessary information about the Coronavirus for passengers as well as provide trainings for airport staff and operations on relevant topics.
Thermal surveillance equipment such as thermo-scanners and infrared thermometers have been installed at inbound gates to screen passengers who are arriving at Samui airport from China.
Passengers on direct flights from China to Samui will undergo health screening, including having their temperature taken by a Department of Disease Control officer. If any passenger has body temperature above 38 degrees Celsius and is from the risk-area, the Department of Disease Control will set up the Emergency Operations Center ( EOC) and have the medical staff take the passenger to the designated hospital.
Samui Airport has been in contact with the Samui Tourism Association to notify all the hotels on Koh Samui, especially those hotels with Chinese guests, to help observe if there are any guests showing respiratory symptoms, and if so, to have the hotel contact the designated hospital immediately.
Samui Airport has prepared adequate amounts of Cleansing hand gels for passengers throughout the airport and also increased the frequency of general cleaning in high-traffic areas such as at check-in counters, passenger lounges, and restrooms.
Sukhothai Airport and Trat Airport
Closely monitor the situation and strictly follow guidance from local authorities.
Set up various notification boards around the airport to provide necessary information about the Coronavirus for passengers as well as provide trainings for airport staff and operations on relevant topics.
Provide additional areas for cleansing hand gels
Have protective face masks ready for passengers and staff
Increase the frequency of general cleaning in high-traffic areas such as check-in counters, passenger lounges, and restrooms.
Bangkok Airways Public Company Limited takes the Novel Coronavirus 2019 Pneumonia outbreak seriously and puts the health and safety of its passengers and staff at the highest priority. The company is working closely with the local authorities in monitoring the situation. Passengers who may require further information about the Novel Coronavirus 2019 Pneumonia may contact the Department of Disease Control at Call Center tel. 1422 ( 24hrs.)
( C) 2020 Electronic News Publishing, source ENP Newswire | business |
Virus Outbreak Leaves Asia Grappling With Tourism Fallout — and Growing Xenophobia | Get exclusive stories and unlimited access to Skift.com news
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Xinyi Liang-Pholsena, Skift
January 30th, 2020 at 6:20 AM EST
The coronavirus threat has given rise to a cloud of anti-Chinese discrimination. A virus outbreak is not an occasion for xenophobia or prejudice but a time for the tourism sector to work in solidarity to overcome the crisis. After all, viruses respect no borders or nationalities.
Xinyi Liang-Pholsena
As the outbreak of the new coronavirus spreads to more than 15 countries worldwide, China’ s ability to contain the epidemic is coming under increasing scrutiny. But growing in tandem with the virus spread are louder calls to impose greater travel restrictions on Chinese nationals in order to curb the spread of coronavirus, and that has come to the attention of travel industry leaders in the region.
Such reactions in Asia are not surprising though, said Mario Hardy, CEO of Pacific Asia Travel Association. “ I think people are generally concerned and worried, especially those who have experienced SARS, ” he explained.
The SARS ( severe acute respiratory syndrome) epidemic, which swept across Asia in 2003, still lingers fresh for many people. The virus killed 774 people worldwide in 17 countries, causing widespread fear and severely curtailing travel in Asia.
For now, China has taken the unprecedented move of sealing Wuhan, the epicenter of the new coronavirus outbreak, while halting group tours and urging its citizens to put off overseas travel for the time being. Such drastic measures have already taken a toll on inbound tourism in Asian destinations, for which China is a dominant visitor source market.
Major airports worldwide are screening for coronavirus to prevent the entry of the virus, while airlines are either suspending or cutting down on services in and out of China. Many countries in Asia are temporarily restricting the entry of Chinese nationals from Wuhan and the surrounding areas in China’ s Hubei province.
But as the contagion continues spreading to new shores and the death toll climbs above 100, worries are mounting among Asia’ s populace, spurring a spate of online petitions, from Singapore to Malaysia to Korea, to urge governments to close country borders to Chinese travelers. That tourism dollars are being prioritized over public health was the rallying cry for the petitioners.
Medical practitioners and travel industry players, however, have expressed their doubts over the effectiveness of blanket travel bans in curbing the spread of the Wuhan virus, given how interconnected the world is now.
“ A ban is totally not realistic, it’ s a bit like Trump building the wall, ” Bill Barnett, founder and managing director of Phuket-based C9 Hotelworks, said. “ The Chinese have banned overseas tour groups and airline services to from Wuhan are contained. The Philippines is the only one I am aware of who has banned Chinese but it’ s only a matter of time before the virus shows up there. ”
While the fear of contracting the virus is a valid concern, Barnett stressed the importance of “ prevention and monitoring ” as “ life goes on ” during a pandemic.
Uzaidi Udanis, president of the Malaysia Inbound Tour Association, believes that a blanket ban is “ unnecessary ”, as the screening measures that the Malaysian authorities have implemented at the country’ s airports and borders are suffice for now. Visas have been suspended for Chinese nationals from Wuhan, while tour guides have also been trained to spot signs of travelers with coronavirus and refer them to the hospitals, added the association chief.
Hardy agreed, “ A complete ban [ of Chinese travelers ] might be too extreme at this stage. Taking proper precautions, like wearing face masks and use of sanitizers, are a more reasonable approach on how travelers can limit the virus spread. ”
Furthermore, Asia’ s travel industry members are also concerned that a blanket ban on Chinese travelers, if put into place, would fuel pandemic panic and stoke stronger anti-Chinese sentiments on the ground.
Hardy, who in recent days has witnessed episodes of public castigations of Chinese tourists amid the coronavirus scare, is urging “ decency and respect ” among Asia’ s traveling public. He also cautioned industry stakeholders against relying on social media or unreliable sources for updates, and instead seek information from reputable sources such as the World Health Organization to measure an appropriate response.
Putra Mosque, a popular attraction in Malaysia’ s Putrajaya, had closed its doors to China tourists, a move that has earned a strong rebuke from Malaysia Inbound Tour Association, according to Uzaidi. “ We don’ t discriminate against Chinese tourists. If they have been screened and proven healthy, there’ s no need to stop them from traveling in Malaysia, ” he stressed. “ Likewise, there’ s no need for attractions and product operators to press the panic button. ”
For now, tackling any outward signs of discrimination by Malaysian attractions and operators against Chinese travelers is among his most urgent tasks, said Uzaidi. The association chief also revealed that he is currently in talks with the Malaysian Ministry of Tourism, Arts and Culture to set up a tourism recovery action committee to minimize negative fallouts on the tourism sector, including lending a helping hand to tour operators — a majority of which are small- and medium-sized enterprises — as well as Chinese tourists currently stranded in Malaysia.
“ Sooner or later the crisis will be over, ” said Uzaidi. “ But right now we want to make sure that Chinese tourists visiting Malaysia are comfortable and can go around the country without prejudice or discrimination.
“ We don’ t abandon China during crisis, and go to them only when we want their tourists, ” Uzaidi remarked. “ The people-to-people economy is very important to us. In times like this, we’ re with them [ China ]. ”
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Updated Dec. 17, 2021
Xinyi Liang-Pholsena, Skift | general |
Event Planners Move Toward Green Ways: Eventbrite Report | Get exclusive stories and unlimited access to Skift.com news
Access every online Skift event live or on demand
Access exclusive travel research, data insights, and surveys
Free stories left to read
Subscribe to Skift Pro to get unlimited access to stories like these ( $ 25/month)
Andrew Sheivachman, Skift
January 30th, 2020 at 12:30 AM EST
Small things can make a big difference when it comes to event sustainability. The structural problems with wasteful venues and food sourcing, though, still need to be dealt with.
Andrew Sheivachman, Skift
Improving sustainability has become a major challenge across the travel industry, and planners are taking more steps to ensure their events are creating less waste.
New research from Eventbrite shows a surge in awareness on sustainability issues from event planners, along with the specific steps they are taking to deal with them. Check out the story below.
We also have a look at how hotels are dealing with guests smoking weed and the latest on the impact of the coronavirus outbreak on travel in Asia.
If you have any feedback about the newsletter or news tips, feel free to reach out via email at as @ skift.com or tweet @ sheivach.
— Andrew Sheivachman, Senior Enterprise Editor
How Event Planners Are Finally Embracing Green Practices: New Report: Planners are taking simple steps to address sustainability at their events, with a specific focus on reducing waste. How effective they can be in transforming their events, though, is another question altogether.
Hotels Are Confused by Rise of Legal Marijuana: Opportunity or Liability? The legalization of marijuana by states is getting murkier in the eyes of the federal government, which has still not legalized pot. Some hotels are embracing certain forms of cannabis. Others don’ t want the potential liability.
Asian Destinations Reel From China’ s Outbound Travel Ban: For a string of Asian destinations, China is by far the number one market, so the outbound travel ban that became effective Monday there has shaken tourism businesses even though they know it is for the good.
Most Big Hotel Chains Are Now Committed on Plastics: Here’ s the Problem With Promises: We’ re drowning in press releases about global hotel companies promising to reduce their reliance on single-use plastics. Most of these items require alternatives though, so what are they?
Accor Taps Sabre for Pilot of Major Hotel Tech Project: Accor recently rebranded its loyalty program under the phrase “ Live Limitless. ” The company needs to replace its limited technology structure to meet that ambition, and this deal represents a huge commercial win for Sabre.
Opening Closed Doors: Can Hotels Do More to Fight Human Trafficking? Human trafficking touches every corner of the travel industry — especially hotels. And while the accommodations sector didn’ t create the problem, it does have an elevated responsibility to put an end to it. The question is: How effective have the industry’ s efforts been so far?
The Best of EventMB is our newest section, giving you a look into key content from EventMB, whether it be reports, articles, or resources for planners. EventMB joined the Skift family in September and is the largest online media resource for trends, technology, innovation, and education in the events industry.
Event Industry’ s Outcry as Evian Partners With Fyre Festival Planner: Andy King, an event producer of the infamous Fyre Festival, recently partnered with Evian to create limited-edition water bottles. Despite all the talk of planners taking on more strategic, senior roles in our industry, King is being rewarded for going the extra mile — in the worst possible direction.
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Senior Enterprise Editor Andrew Sheivachman [ as @ skift.com ] curates the Skift Meetings Innovation Report. Skift emails the newsletter every Wednesday.
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Andrew Sheivachman, Skift
January 30th, 2020 at 12:30 AM EST
Tags: eventbrite, meetings, meetingsiq, sustainability
Photo credit: The registration desk at an event for the League of Women Voters. League of Women Voters / Flickr
Subscribe to Skift Pro to get unlimited access to stories like these ( $ 25/month) | general |
Coronavirus ' Effect on the Travel Industry Deepens as Global Emergency Is Declared | Get exclusive stories and unlimited access to Skift.com news
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Rosie Spinks, Skift
January 30th, 2020 at 2:52 PM EST
While the World Health Organization has stopped short of calling for a shutdown of global travel and trade, many travel companies are limiting their operations to reduce the impact of the coronavirus outbreak on their financials while helping to safeguard public health.
Andrew Sheivachman
The World Health Organization convened an emergency committee on Thursday to decide whether to upgrade the status of the coronavirus outbreak spreading across the world to a global emergency.
While the group declared a public health emergency, the travel industry needs no such confirmation. In a matter of days, the virus’ effect on the industry has gone from speculative to one that’ s reflected in earnings, schedules, and share prices of multiple sectors in the industry. From airlines to border crossings and cruise ships, the virus’ spread across the globe is, like it or not, facilitated by the travel industry’ s core operations.
Hedge funds have shorted their positions against airlines who operate a high volume of flights to China, with European carriers including British Airways, Lufthansa, Air France-KLM particularly exposed. All three have halted flights to and from China completely, while others have cut down on schedules. Share prices of both Air France KLM and Lufthansa have fallen 13 percent this month, according to the Financial Times. Similarly, after cancelling some itineraries to China, Royal Caribbean said its 2020 earnings reporting next week would be hurt by as much as $ 0.20 per share.
Aviation analyst firm ForwardKeys released their latest figures Thursday, describing “ a substantial setback in flight bookings ” for the Lunar New Year period, which lasts until Feb. 6. While the impact has been most pronounced in the Asia Pacific region, bookings are slowing the world over.
“ As of 19th January, [ Asia Pacific ] bookings were 1.3 percent behind where they were at the equivalent moment in 2019; a week later, they were 15.1 percent behind, ” said a statement from Olivier Ponti, ForwardKeys’ vice president of insights. “ The deterioration seen for other global regions has been similar, but a little less severe. As of 19th January, bookings to the Americas were 14.3 percent behind, to Africa and the Middle East were 0.7 percent behind and to Europe were 10.5 percent ahead. A week later, bookings to the Americas were 22.5 percent behind, to Africa and the Middle East were 9.9 percent behind and to Europe were 0.5 percent ahead. ”
That said, some airlines could potentially see an upside because oil prices have decreased in response to the crisis. Jay Shabat, senior analyst at Skift’ s Airline Weekly, said “ for most airlines outside of Asia, the sharp drop in oil prices could wind up outweighing any loss of China traffic. We’ ll see if the pandemic spreads. It’ s already clear though that for Chinese airlines, this has been extremely painful financially. ”
Many are drawing comparisons to the SARS crisis of 2003 to 2004, a period which Lufthansa’ s former chief executive called aviation’ s “ worst ever crisis ” in terms of revenue. But for the travel and tourism industry, the situation could turn out to be even worse this time around, at least in economic terms. ( While coronavirus appears to be less deadly than SARS, which killed 774 people, it has already surpassed it in terms of the number of cases.)
“ If you look back at SARS, I think we had eight cases in the U.S. and we didn’ t have one death, but SARS dropped travel from Asia by 30 percent, ” said Roger Dow, president and CEO of the U.S. Travel Association, in a Thursday interview with Skift. “ We’ ve got to watch it every minute, but I do think sometimes there is an overreaction. We as an industry, and as an economy, never call an all-clear. When something happens, we’ re slow to say: it’ s back. ”
The SARS epidemic happened at a much different time of development for the global travel industry. China has become a much more important source market for the world’ s travel industry in the intervening years.
Figures released earlier this week from GlobalData illustrates that growth: “ China has grown from the fourth largest source market in the world, with 47.7 million outbound tourists in 2009, to become the largest, with a staggering 159 million outbound tourists in 2019. This accounted for 12.2 percent of all outbound travelers globally. Furthermore, the Chinese outbound market was the second highest spending in 2019, with expenditure of $ 275bn. ”
It added that amongst all the other headwinds the industry is facing — Brexit, geopolitics, extreme weather events — the quick rise of coronavirus “ could mean a tough year lies ahead for the international tourism industry. ”
Now, instead of welcoming tourists from their largest source markets, many destinations are doing the opposite. Russia has closed its entire border with China, and others are implementing visa restrictions. While those moves have been preventative, increasing calls across Asia to shut borders to Chinese citizens also have a disturbing ring of xenophobia.
Just days ago, the UN World Tourism Organization expressed prudent optimism for the year ahead for tourism arrivals. Depending on how the crisis plays out in the coming weeks, that forecast could drastically change.
— Skift Senior Enterprise Editor Andrew Sheivachman contributed to this report.
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Rosie Spinks, Skift | general |
5 Takeaways From the Year's Largest Hotel Industry Conference | Get exclusive stories and unlimited access to Skift.com news
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Nancy Trejos, Skift
January 30th, 2020 at 2:30 AM EST
The hotel industry is expected to have a slowdown in profits this year, yet companies keep starting new brands and expanding existing ones. Where is this optimism coming from?
Nancy Trejos
Every January, about 3,000 hotel executives, owners, developers, and management companies gather in Los Angeles to make pronouncements about the health of the industry and their goals for the year.
While hotel companies always say that they are optimistic about the future—they’ re making more deals, creating new brands, expanding existing brands—the numbers tell a murkier story.
Industry research firm STR and Tourism Economics released its first forecast of 2020 this week at the Americas Lodging Investment Summit ( ALIS).
For the first time since 2009, the U.S. hotel industry is likely to have flat growth in revenue per available room, or RevPAR, a key metric.
STR revised its predictions from its previous forecast in November, when it predicted increases in RevPar of 0.5 percent in 2020 and 0.7 percent in 2021. Now, it is saying there will be no growth this year and 0.5 percent growth in 2021.
STR president Amanda Hite said 2019 was the worst year since the recession in terms of RevPar growth, coming in at 0.9 percent after nine years of increases of 3 percent or higher.
The good news, she said, is that demand is still high so hotels are selling rooms. Looking at the situation relatively, RevPar growth may be slowing but that’ s on top of increases over the last few years that were at record high levels.
Despite the tepid outlook for 2020, hotel executives and developers said this week that they will continue to forge ahead with plans to start new brands and expand existing ones.
Here are five takeaways from the 2020 ALIS conference.
Hilton stole the thunder from some of its competitors by announcing its new lifestyle brand Tempo by Hilton at a splashy affair in New York City on Jan. 16. Hilton, as usual, was present in full force at ALIS this year showing off Tempo. But its competitors were not to be outdone.
Choice Hotels International introduced Everhome Suites, an all-new construction midscale extended stay brand with customizable, apartment-style accommodations.
The company on Tuesday broke ground on the first Everhome Suites in Corona, California. It has agreements for 13 hotels in Austin and Los Angeles. The first Everhome Suites will open in 2021.
CEO Patrick Pacious said Choice has figured out the extended stay business. It has more than 400 hotels across its existing WoodSpring Suites, MainStay Suites and Suburban Extended Stay.
Pacious insists there is demand for another extended stay brand, saying that 20 percent of hotel stays last year were for seven days or more but that only about 9 percent of existing supply was in extended stay.
“ The customer at this segment we believe has been under-served, ” Pacious said. “ This brand is targeted at the heart of midscale, so we’ re looking at the value-conscious customer who is really looking at apartment-style accommodations … so that when they get into the space they can adapt it to the way they want to live their life and the way they want to work on the road. The idea is for them to continue their routines while on the road. ”
It’ s a familiar refrain sounded by Hilton CEO Chris Nassetta when introducing Tempo, which is not an extended stay brand but is designed to help customers maintain their wellness on the road.
The Choice team said they are offering a more rounded experience.
Everhome Suites will have studios and one-bedroom apartment-style layouts. All rooms will have defined spaces.
“ You don’ t want to work and play in the same space when you are there for that amount of time, ” said Anna Scozzafava, vice president of operations for brand strategy and operation for extended stay for Choice.
There will be a rolling variable heights workstation, a full-size closet, bathrooms with ample counter space, and fully-equipped kitchens. Public spaces will have multi-purpose lobbies. There will be fitness centers, business centers, libraries, laundry facilities, and in many cases, a swimming pool.
The average daily rate will likely be about $ 85.
“ It is probably the first brand to be launched in the heart of midscale extended stay in probably over a decade, ” Chief Development Officer David Pepper said. “ Most of the hotels in this segment probably average about 15 years old of the age of the property. What we’ re trying to do is bring new life and breathe new life into this very attractive segment. ”
Other new brands will likely pop up this year, but some executives said they think there will be a slowdown. Nassetta told Skift on Jan. 16 that Hilton is done with introducing new brands for a while, a proclamation that his deputies reiterated this week.
Soft brands are a way for independent hotels to take advantage of a large hotel companies’ marketing, reservations and distribution systems, technology, and loyalty programs.
Many companies have multiple soft brands. Hilton, for instance, has Curio, Tapestry and LXR Hotels and Resorts, a luxury collection.
Best Western Hotels and Resorts already has a few soft brands, including BW Signature Collection.
BWH Hotel Group, parent company of Best Western, announced a new collection of hotels as part of its acquisition last year of WorldHotels, an upper upscale and luxury hotel collection.
WorldHotels Crafted Collection is a collection within a collection. Each hotel will have a TripAdvisor rating of 4.5 or above. Each will have its own design and services that reflect its location.
“ A lot of independents want to have a platform but don’ t want to lose their essence, ” WorldHotels CEO Kristin Intress said.
Hotels will have to go through a rigorous inspection process to get into and stay in the collection, she said. So far there are 25 hotels included.
Expect more soft brands and collections to be created in the future as it becomes more and more difficult to compete with what large companies like Marriott International have to offer, particularly their loyalty programs.
Despite the not so shiny outlook for the year, hotel companies are continuing to expand their brands.
Canopy by Hilton, a lifestyle brand, will open 20 hotels this year, more than doubling its size. It now has 12 properties around the world. The new hotels will open in Brazil, France, Mexico, the United Arab Emirates, and the United Kingdom. A property is still scheduled for China in Hangzhou-West Lake, despite the coronavirus outbreak in Wuhan.
The U.S. will get Canopy hotels in cities such as Austin, Baltimore and Dallas.
Gary Steffen, Hilton’ s global head of Canopy, said that he doesn’ t see a slowdown in the number of developers wanting to build hotels.
“ Owners want to develop these newer brands, ” Steffen said. “ I still think there’ s a sentiment of positivity out there. It may not be that robust nature we felt three or four years ago, but just talking to owners, I’ ve had at least 10 good conversations. ”
The luxury segment is also moving forward with rigor. Luxury hotel company Loews Hotels & Company, for instance, is set to open three hotels within the next 70 days. They are located in St. Louis, Orlando, and Kansas City. The three openings will bring the number of Loews Hotels to 29.
The company also got approval in December for a $ 550 million hotel in Arlington, Texas, with 888 rooms, more than twice the size of the Live! by Loews hotel that opened there last year. It will have a 150,000 square foot convention center.
The hotel is part of the Texas Live! complex nestled between AT & T Stadium and Globe Life Park.
“ We think Arlington, Texas, can be one of the next great meetings and events destinations in the U.S., ” Loews Chief Commercial and Development Officer Alex Tisch said. “ It’ s 15 minutes from DFW ( airport), which is closer than both Dallas and Fort Worth, it’ s got a great year-round climate, lots of available labor, and with the demand generation of the two ball parks plus the medal of honor museum just announced, we think there is a really great opportunity there. ”
Loews has also signed a deal for a 242-room property with 15,000 square feet of meeting space in Coral Gables, Florida, which Tisch said is in need of luxury properties.
STR and Tourism Economics said that the luxury hotel market is expected to have the highest average daily rate growth of all segments this year at 1.3 percent.
Hotel companies are always going to keep trying to grow but they will face some challenges this year.
“ The overall economy has started to slow down, ” STR’ s Hite said. “ We’ ve seen the GDP growth in the last half of 2019 start to slow down. ”
The other issue: There are so many new hotels out there. “ We have supply growth outpacing demand but demand growth is still positive and that’ s the number of rooms sold, ” Hite said.
Hoteliers have not been able to raise room rates as a result, and that will affect their profit margins.
The one area that seems to be looking bright is group meetings. Hoteliers aren’ t raising room rates but they are seeing an uptick in food and beverage revenue, Hite said.
The coronavirus outbreak in China, however, is wreaking havoc for hotel companies, mostly in Asia. Hotels have closed down in the Wuhan area. Major hotel companies such as Marriott, Hyatt and Hilton are waiving change fees in China or for anyone scheduled to travel from China to other countries.
Airlines are canceling flights. United Airlines, for instance, suspended flights to China from Feb. 1 to Feb. 8.
“ The impact to the U.S., certainly a drop in GDP in China, would affect our overall economy, ” Hite said.
Hotels that have benefited from the number of Chinese travelers who have spent a lot of money in the U.S. will probably be affected by the cancellation of flights to gateways cities such as New York and San Francisco.
“ What will that do to the rates and occupancies? ” Hite said. “ Coronavirus was not something we knew of three weeks ago when we sat down to do our forecast. It wasn’ t anything that people were talking about. ”
As usual, the topic of Airbnb and short-term rentals could not be avoided.
A new twist this year is how the traditional and short-term rental industries have gotten so intertwined that short-term rental companies Domio and Sonder were among the sponsors of the conference.
Traditional hotel companies such as Marriott have even gotten into the homesharing business by launching Homes & Villas by Marriott International. Since April, it has reached about 5,000 listings. The company has 7,000 hotels worldwide.
The American Hotel and Lodging Association continues to lobby for such companies to follow the same rules that traditional hotels do, paying the same taxes and abiding by the same safety regulations.
In years past, there was more negativity towards homesharing businesses at the ALIS conference. This year, hoteliers seemed a bit more resigned.
“ We believe this is a different kind of customer looking for a different kind of stay, ” Hilton’ s Steffen said. “ We don’ t think it’ s bad for the industry. It’ s bringing in people who want to travel. ”
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Nancy Trejos, Skift | general |
Coronavirus Triggers Damage Control From Governments, Companies -- Update | By Erin Mendell
HONG KONG -- Government officials and corporate executives around the world are scrambling to limit the damage from the fast-spreading coronavirus as Russia tightened its border with China and the U.S. announced plans for a second evacuation of the Chinese city at the center of the epidemic.
In response to the virus, companies including Tesla Inc. and IKEA were forced to temporarily halt operations in China.
The moves came as two more countries -- India and the Philippines -- confirmed their first infections, bringing the total number of affected countries to nearly 20, as the total number of confirmed cases approached 8,000.
India said a student from Wuhan University tested positive for the virus while visiting the southern state of Kerala and was in isolation at a local hospital. The Philippines said Thursday it recorded its first confirmed coronavirus case, a 38-year-old Chinese woman who arrived in the country on Jan. 21 from Wuhan.
Moscow, meanwhile, said that it will temporarily restrict passage through 16 road, rail and river checkpoints along its 2,670-mile-long border with China, starting Friday. Though Russia's national carrier Aeroflot hasn't stopped flying to China, smaller Russian airlines have canceled flights into China from the Far Eastern city of Vladivostok.
A number of countries pushed ahead with efforts to extract their citizens from central China.
The State Department on Thursday said it is planning a second evacuation flight from Wuhan, the central Chinese city where the newly identified coronavirus first emerged last month, offering hope for the hundreds of American citizens still believed to be in the city.
White House spokesman Hogan Gidley said the risk coronavirus poses to Americans remains low and that he wasn't aware of government plans to cancel flights to and from China. He said the U.S. is taking `` all the precautions necessary and will continue to do so. ''
In a briefing on the administration's efforts to combat the opioid epidemic, Assistant Secretary of Public Health Brett Giroir said it was under control in the U.S., noting there had been no person-to-person transmission of coronavirus in the country. `` This is no cause for urgent panic, '' he said.
The Indian government is seeking permission from Chinese authorities to operate two flights to repatriate citizens from Hubei province, of which Wuhan is the capital, and will quarantine them for 14 days.
In Japan, controversy erupted Wednesday after two people on a government-chartered evacuation flight from Wuhan to Tokyo refused to be tested for the new coronavirus. Some on social media wondered why the Japanese government didn't quarantine evacuated citizens the way other countries had.
`` This is unforgivable, '' wrote one Twitter user. `` No more charter flights! ''
Prime Minister Shinzo Abe told Parliament Thursday that while the government had pushed for all 206 passengers on the Wednesday flight to be tested, it had no legal power to compel them. Three people on the flight tested positive for the virus, including two without symptoms, according to the health ministry. The two who refused testing didn't show any symptoms and health-ministry staff drove them home in a regular car, health ministry official Takuma Kato said.
A second charter flight to evacuate Japanese citizens from Wuhan arrived in Tokyo on Thursday, and Mr. Kato said all 210 people who returned on that flight had agreed to be screened.
Meanwhile, immigration officials in Hong Kong scoured the city for visitors from Hubei, finding 15 on Wednesday night during searches of 110 hotels, according to Lam Shuk-yee, deputy secretary for security of the Chinese territory on Thursday.
Ms. Lam said 1,600 people from the province had been turned away at the Hong Kong border since the ban.
On the corporate front, big multinational companies moved to temporarily shut down their China operations as workers remained largely in place, with the Lunar New Year holiday extended through the end of the week and transportation links largely curtailed.
Tesla Chief Financial Officer Zach Kirkhorn said Wednesday that the company was halting production at its new Shanghai Gigafactory to comply with a local-government order to extend China's Lunar New Year holiday, which Mr. Kirkhorn said could affect the company's first-quarter performance.
All 30 IKEA outlets in mainland China were closed until further notice, the Swedish furniture giant said Thursday.
Air France -- part of Air France-KLM -- joined the list of airlines cutting service to China. The French carrier said it would suspend all scheduled flights to and from the mainland until Feb. 9 and would operate special flights starting Friday to and from Shanghai and Beijing using volunteer crew members to enable customers and employees to depart safely.
Italian authorities were holding 6,000 passengers and crew aboard a cruise ship docked at the port of Civitavecchia near Rome after a 54-year-old Chinese woman showed flulike symptoms, according to a spokesperson for Costa Crociere, the company operating the ship Costa Smeralda.
The woman and her male traveling companion, who showed no symptoms, were isolated in the ship's hospital, the company said, while Italy's health ministry said it was waiting for the results of tests for coronavirus.
China's national women's soccer team is being held in quarantine in a hotel in the Australian city of Brisbane until Feb. 5, health authorities for the northwestern state of Queensland said Thursday. The 32-member team had traveled to Australia to compete in a qualifying tournament for this summer's Olympics in Tokyo.
The tournament was originally scheduled to be held in Wuhan but was moved to Sydney after the outbreak. The team had departed Wuhan Jan. 22, before the city was locked down, said the Chinese Football Association, which said it also planned to suspend soccer competitions nationwide starting Thursday.
Closer to the outbreak's center, the education department of Wuhan's home province of Hubei encouraged middle and primary schools to move classes online to ensure students keep up with their studies even with the Lunar New Year holidays extended indefinitely.
`` The semester is delayed, but study shouldn't be, '' read a slogan included with the recommendation by the department, which separately encouraged local universities to move academic activities online.
The province also opened a new helpline on Thursday for people struggling with the psychological toll of the outbreak, China's official Xinhua News Agency reported Thursday, citing local officials.
In Chongqing, a southwestern megacity that borders Hubei, pharmacies are now required to report the names of people who buy medication for symptoms like fever and cough, part of an effort to track people who might have coronavirus symptoms, state broadcaster China Central Television reported Thursday. The city of more than 30 million people had 165 confirmed cases of the coronavirus as of midnight Wednesday and is closely connected to Wuhan by road and rail.
In a sign of mounting pressures on medical staff in affected cities, the head of the infectious diseases division at Shanghai's Huashan Hospital declared that all the doctors who had been treating coronavirus patients would be allowed to rest and would be replaced by doctors who were Chinese Communist Party members.
`` We can't bully those who are more obedient, '' Zhang Wenhong said, describing the early responders as heroic. `` So I 've decided to change the shift. It will all be Party members from now on. ''
In words tinged with exhaustion and frustration, Mr. Zhang, who is also the senior party leader of his division, said Communist Party members needed to live up to their vows to serve the people. `` I don't care whether or not you're willing, you're all going to step up, '' he said.
-- Miho Inada, Yijun Yin, Ann Simmons, Lekai Liu, Eva Dou, Kersten Zhang, Wenxin Fan, Raffaele Huang, Reddy Zhao, Rajesh Roy, Giovanni Legorano and Rebecca Ballhaus contributed to this article.
Write to Erin Mendell at erin.mendell @ wsj.com
| business |
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Canada's Magna bans China travel as coronavirus spreads | It has 55 manufacturing and assembly units in China, where it employs around 11% of its total workforce. The company has over 166,000 employees, according to its website.
Earlier this week, China's cabinet had announced it would extend the Lunar New Year holidays to Feb. 2 to strengthen the prevention and control of the new coronavirus. The holidays had been due to end on Jan. 30.
The outbreak of the virus could also hit profits at luxury car brands Jaguar and Land Rover, parent Tata Motors said on Thursday.
General Motors Co, the No.1 U.S. automaker, too said it has placed a temporary restriction on travel to Wuhan, where the company has a manufacturing base as part of a joint venture with China's SAIC Motor.
Several companies including Tesla Inc, Apple and Starbucks have warned of a possible impact from the outbreak.
Airlines have been suspending flights to China in the wake of the outbreak, which as of Thursday had killed 170 people and infected almost 8,000.
( Reporting by Ankit Ajmera and Arunima Kumar in Bengaluru; Editing by Shinjini Ganguli) | business |
Dow rises more than 100 points in late comeback, erases a 244-point drop | Stocks closed higher on Thursday after a sharp comeback late in the session erased earlier losses stemming from concerns around the coronavirus.
The Dow Jones Industrial Average gained 124 points, or 0.4%. At its low of the day, the Dow was down 244 points. The S & P 500 ended the day up 0.3%. The Nasdaq Composite also gained 0.3%.
The major averages started paring losses with roughly one hour to go after the World Health Organization declared a global health emergency, but at the same time, did not recommend travel to China be restricted and said the country had the situation under control.
Airline stocks also rebounded, with American and United each closing more than 3% higher. Las Vegas Sands and Wynn Resorts, two coronavirus proxies for their gaming exposure in Macao, ended the day up more than 2% each.
Stocks were down for most of the session as the death toll in China from the coronavirus hit 171, with confirmed cases of the virus surpassing 8,000. The Centers for Disease Control and Prevention later confirmed the first human-to-human transmission of the virus in the U.S., pushing the major indexes back towards their session lows.
`` The spread of the Wuhan virus isn't accelerating, but markets becoming more concerned about future earnings and economic growth as companies implement work stoppages to reduce the chance of the disease spreading, '' said Tom Essaye, founder of The Sevens Report.
Microsoft led the Dow higher with a 2.8% gain after the tech giant reported better-than-expected quarterly results. That rise pushed the S & P 500 into record territory, advancing 0.9%.
Still, concerns over the coronavirus and how it will impact remain. Investors increased their exposure to bonds, briefly pushing the 10-year Treasury yield below its 3-month counterpart, triggering a so-called inversion. Traders worry when the yield curve inverts because, in the past, this event has preceded recessionary periods.
`` This tells us that investors are reconsidering, at least in the near term, how they feel about the growth prospects of this country. And not just that, but global GDP, '' said Yousef Abbasi, director of U.S. institutional equities at INTL FCStone. `` So with that in mind, the question becomes, how can you justify paying a multiple of 18.5 times earnings, when the bond market is kind of telling you that growth prospects are starting to diminish or potentially be impacted in a negative way? ''
Stocks have been mired all week by fears over the coronavirus and its toll on the global economy. The S & P 500 and Dow are both down about 0.4% for the week while the Nasdaq has lost 0.2%. The Dow and S & P 500 were on pace for their first back-to-back weekly declines since a three-week slide that ended in early October. The Nasdaq has not logged in consecutive weekly declines since late September.
in corporate news, Facebook reported quarterly results that showed a sharp rise in expenses and narrowing margins. Facebook shares fell more than 6%.Tesla enjoyed a second consecutive quarterly profit on record vehicle deliveries and vowed to produce over 500,000 units this year, sending the stock surging by 10.3%.
About 200 S & P 500 companies have reported quarterly earnings thus far, with 70% of them posting better-than-expected profits, FactSet data shows.
—CNBC's Elliot Smith contributed to this report. | business |
Travel Businesses Face Huge Coronavirus Costs as Insurance Coverage in Question | Get exclusive stories and unlimited access to Skift.com news
Access exclusive travel research, data insights, and surveys
Carolyn Cohn, Sumeet Chatterjee and Noor Zainab Hussain, Reuters
January 30th, 2020 at 6:00 AM EST
With epidemics usually excluded from insurance coverage, the spectre of a huge coronavirus bill looms for hotels, airlines, and event companies.
Raini Hamdi
Many global companies from hotels and airlines to industrial houses are expected to have to foot the bill for disruptions caused by a new coronavirus in China, with epidemics usually excluded from insurance cover, experts said.
With 132 deaths in China and new cases being reported around the world, companies are set to face billions of dollars in losses linked to events and travel cancellations and closure of businesses, they said.
The virus originated in the city of Wuhan, forcing airlines to cancel flights and companies including Facebook and HSBC to suspend travel to China.
“ For insurers, the bulk of the claims from this outbreak will come from businesses, mainly travel, hospitality and event firms, followed by mortality and healthcare costs, ” said a Hong Kong-based insurance sector lawyer with a global law firm.
Risk modeling firm RMS said it was too early to estimate insured losses.
While some large global firms buy coverage for communicable diseases, most “ standard insurance policies ” exclude such outbreaks to keep costs low, said the lawyer, declining to be identified as he was not authorised to speak to the media.
Global insurers typically cover risks such as earthquakes and plane crashes, but have been paring back exposure to certain risks to avoid huge losses.
Previous viruses, such as SARS ( Severe Acute Respiratory Syndrome), Ebola and Zika, have also led insurers to be more cautious about exposure, with specific virus exclusions added to most basic coverage policies, industry insiders said.
The SARS pandemic which spread to 37 countries in 2003 caused $ 4 billion worth of economic losses in Hong Kong, $ 3- $ 6 billion in Canada, and $ 5 billion in Singapore, according to insurance broker Marsh.
Insurance experts also told Reuters that most event cancellation policies would not cover the new virus.
“ A lot of these airlines and hotels are offering refunds to their customers, ” said Richard Coyle, London-based head of risk financing and non-standard solutions at Miller Insurance. “ Without adequate insurance in place, the airlines and hotels are absorbing the financial losses themselves. ”
A standard event cancellation policy issued by firms in the 99-member Lloyd’ s of London insurance market and elsewhere has a “ communicable disease ” exclusion, two underwriters said.
Companies buy business interruption policies with their property insurance to cover loss of revenue if they are forced to close temporarily, but those policies are also likely to exclude communicable diseases, an underwriter in London and insurance executives said.
“ The Asian hospitality industry is an obvious example of an industry already affected. For many lines of business … it is common market practice to have epidemic outbreak risk excluded, ” a Munich Re spokesman said.
While some firms including Munich Re have developed specific insurance products and policies for infectious diseases, not many firms have bought them, insurers said.
The impact on tourism and transport is also likely to hit supply chains in Asia, Narges Dorratoltaj, senior scientist at catastrophe risk modeling firm AIR, said.
While most travel insurers are likely to reimburse costs associated with trip cancellations and medical expenses for policies bought before the spread of the virus, some are excluding the coverage for select destinations now, industry officials said.
Insurers Aviva, Allianz and AXA said individual policyholders would be covered if they are impacted by the virus, provided they follow travel advisories from governments.
This article was written by Carolyn Cohn, Sumeet Chatterjee and Noor Zainab Hussain from Reuters and was legally licensed through the NewsCred publisher network. Please direct all licensing questions to [ email protected ].
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The Coronavirus cruise ship problem: 'Every lost voyage ' could cost $ 4 million in revenue | The exponential spread of the coronavirus is upending the travel industry with cruise operators being hit particularly hard.
On Thursday, cruise stocks fell following the news that roughly 6,000 passengers were being held on a Costa Smeralda cruise ship amid fears that a person onboard potentially had the virus that originated in Wuhan, China.
“ By our math, every lost voyage is $ 3 to $ 4 million of revenue, and about $ 0.02 of earnings, ” James Hardiman, the managing director of equity research for Wedbush Securities, told Yahoo Finance’ s On The Move on Tuesday.
Royal Caribbean International ( RCL), the world’ s largest cruise operator, canceled cruises from Shanghai while Carnival ( CCL) canceled several of its scheduled trips in the region. Royal Caribbean stock was down 3.8% as of 1:30 p.m. EST on Thursday, while Carnival was down over 4.6%.
The cancellations will have a negative impact on earnings, according to Hardiman.
“ I think with every passing day it is becoming a — it's creating a materially negative impact on the earnings at some of these cruise companies, ” he said.
Hardiman, who focuses on travel companies, said hope rests with stabilization of the virus. But, he adds, “ In the absence of that, I think they're going to have to be extra conservative in terms of how they guide 2020. ”
Nobody in the travel business is spared as people around the world curtail their travel, Hardiman noted. United Airlines ( UAL), British Airways, and Finnair have suspended some flights to China, and other airlines are offering refunds for those who have booked travel.
It’ s difficult to assess the extent of harm caused by coronavirus, but analysts often cite the severe acute respiratory syndrome ( SARS) outbreak of 2002-2003 as they try to make sense of how coronavirus will affect the markets.
SARS cost the global economy more than $ 40 billion, but Hardiman cautions that it’ s not an accurate comparison, in part because companies today have far greater exposure to China.
“ The only challenge with SARS from a stock perspective is the idea that back then, you know, early 2000s, most of these companies, whether it's the cruise names or the online travel names that we follow, neither of them had anywhere near the exposure that they have today with respect to China and broader Asia, ” he said.
However, it may still be too early to determine the outcome of the virus. “ I think that the impact is going to be widespread, ” Hardiman said. “ You know, a year from now, we're going to look back upon this and at some point there's going to be a buying opportunity. But as we sit here in the midst of it, it's hard to say when and where that is exactly. ”
Editor’ s note: This article was originally published on Wednesday, Jan. 29. It was updated on Jan. 30 with news of stranded passengers on the Costa Smeralda and falling cruise stocks.
Yvette Killian is a producer for Yahoo Finance’ s On The Move.
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Tesla 4Q earnings top expectations, company sees 500K+ deliveries in 2020 | Tesla’ s ( TSLA) stock surged after the company posted fourth-quarter results that handily topped consensus expectations, which came in the wake of a faster-than-expected launch of local production in China and record deliveries at the end of last year.
Here were the main metrics from the Tesla’ s fourth-quarter 2019 report, compared to consensus expectations compiled by Bloomberg:
The stock, up more than 10% in after-hours trading Wednesday, held onto most of these gains into market open Thursday. Tesla’ s shares hit a fresh record high Thursday, soaring 10% to $ 639 per share shortly after market open.
Tesla also guided toward an increase in deliveries over last year and said vehicle deliveries “ should comfortably exceed 500,000 units ” in 2020. Tesla handed over about 367,500 units in 2019, or a level consistent with the company’ s prior guidance range. Fourth-quarter deliveries totaled around 112,000.
“ Due to ramp of Model 3 in Shanghai and Model Y in Fremont, production will likely outpace deliveries this year, ” the company said in a statement Wednesday. “ Both solar and storage deployments should grow at least 50% in 2020. ”
First-quarter results could be temporarily impacted by the coronavirus outbreak, Tesla CFO Zachary Kirkhorn told investors during an earnings call Wednesday. Tesla anticipates a one to one-and-a-half week delay to its ramp of Shanghai-built Model 3 units due to a government required factory shutdown in the region, he said. Kirkhorn said the company is also monitoring for supply chain interruptions for cars built in Fremont, but so far is “ not aware of anything material. ”
In its earnings release, Tesla said it expected production for its Model Y vehicle would begin at its newly opened Shanghai Gigafactory in 2021. Tesla’ s Fremont factory has already begun ramping production for the Model Y this month, or ahead of schedule, the company said, and Model Y deliveries will begin by the end of the current quarter.
Tesla said installed production capacity for the Model 3 and Model Y combined is now 400,000 units per year, and that it is adding machinery across its factories to boost that level to 500,000 units per year.
The company’ s cash position also improved during the fourth quarter, further assuaging cash balance concerns that had once been a point of scrutiny. Cash and cash equivalents improved by $ 930 million to a record $ 6.3 billion during the quarter, which Tesla said was driven “ through persistent cost control across the business. ”
Automotive gross margin, a closely watched measure for Tesla, narrowed to 22.5% in the fourth quarter from 22.8% last quarter and 24.3% in the same period last year. Tesla attributed this to a higher proportion of lower-margin Model 3 vehicles being sold, as well as various reductions to vehicle prices.
“ We do not expect ASP ( average selling price) to change significantly in the near term, which means volume growth and revenue growth should correlate more closely this year, ” Tesla said. The company also said it expects positive GAAP net income going forward, except in certain cases including around the launch and ramp of new products.
“ Continuous volume growth, capacity expansion and cash generation remain the main focus, ” it said.
Tesla’ s latest earnings report comes on the heels of a soaring performance for its stock. The stock has more than doubled since its third-quarter earnings results in October, surging well above the $ 420 per-share level CEO Elon Musk once considered in a dropped plan to take the company private. That’ s brought the company’ s market capitalization to more than $ 100 billion, or more than that of General Motors and Ford combined.
The stock closed at a then-record of $ 580.99 per share on Wednesday, and jumped above the $ 650 per-share level after market close.
Those share gains coincided with a surprise third-quarter profit, record-breaking delivery results in the last three months of the year and a faster-than-expected completion of the company’ s Shanghai Gigafactory.
Tesla delivered its first cars built at its Shanghai Gigafactory to local Chinese customers earlier this month, having ramped up production to 1,000 cars per week in China less than a year after breaking ground on the facility.
Updates with opening share prices Thursday, Jan. 30.
—
Emily McCormick is a reporter for Yahoo Finance. Follow her on Twitter: @ emily mcck
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Confirmed Coronavirus Cases Climb to 7818 Globally – 170 Deaths in China | Coronavirus Map: Distribution of 2019-nCoV case as of January 30, 2020. Credit: WHO
Note: There is now a newer Novel Coronavirus ( 2019-nCoV) Situation Report 11.
During previous outbreaks due to other coronaviruses ( Middle-East Respiratory Syndrome ( MERS) and Severe Acute Respiratory Syndrome ( SARS), human-to-human transmission occurred through droplets, contact, and fomites, suggesting that the transmission mode of the 2019-nCoV can be similar. The basic principles to reduce the general risk of transmission of acute respiratory infections include the following:
WHO does not recommend any specific health measures for travelers. In case of symptoms suggestive of respiratory illness either during or after travel, travelers are encouraged to seek medical attention and share their travel history with their healthcare provider. | tech |
8 February circled as possible end-date for China’ s coronavirus lockdown measures |
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Seafood companies doing business in China are looking to 8 February as a potential date for China to lift the travel and trade restrictions it has put in place as a result of the rapid spread of the deadly coronavirus... | general |
8 February circled as possible end-date for China’ s coronavirus lockdown measures |
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Seafood companies doing business in China are looking to 8 February as a potential date for China to lift the travel and trade restrictions it has put in place as a result of the rapid spread of the deadly coronavirus... | general |
European Stocks Are Falling Because Coronavirus Worries Are On the Rise Again | European stocks were tracking losses in Asian markets on Thursday, as the coronavirus death toll and number of infected climbed and concerns grew over how the fallout could dent the Chinese economy.
Virus worries overshadowed a scattering of positive earnings news and a corporate reshuffle that sent shares of Hennes & Mauritz climbing.
The Stoxx Europe 600 index fell 0.6% to 416.96, but off session lows after gaining 0.4% on Wednesday. The French CAC 40 and German DAX 30 index were lower while the FTSE 100 index’ s drop was less severe as investors await a knife-edge Bank of England interest rate decision on Thursday.
Chinese authorities on Thursday raised the death toll to 170 and said more than 7,700 people were infected. A World Health Organization emergency panel will meet on Thursday to reassess the global threat of the coronavirus.
Asia led the way lower, as Taiwan stocks reopened after the Lunar New Year holiday to a nearly 6% loss. U.S. stock futures were also lower.
Federal Reserve Chairman Jerome Powell said on Wednesday the central bank is closely monitoring the severity of the deadly coronavirus and potential disruption to the global economy. The central bank left a key interest rate unchanged.
Topping the Stoxx 600 gainer’ s list, shares of H & M climbed nearly 9% after the Swedish retailer’ s chief executive officer stepped down in a board reshuffle that took markets by surprise. The retailer posted a forecast-beating rise in net profit.
Shares of Deutsche Bank rose. The German lender reported its third-straight quarterly loss and a revenue drop, and swung to a €5.3 billion ( $ 5.8 billion) loss in 2019, but saw a rise in revenue for its fixed-income business.
Roche Holding shares rose after the Swiss pharmaceutical giant reported higher profit and sales and said it sees further growth this year. | business |
Trump Signs USMCA into Law Amid Record Natural Gas Exports | Sign in to get the best natural gas news and data. Follow the topics you want and receive the daily emails.
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Amid surging exports of pipeline natural gas from the United States to Mexico, and tension between the oil and gas industry and Mexico’ s government, President Trump on Wednesday signed the United States-Mexico-Canada Agreement ( USMCA) into law.
The deal, which still must be ratified by Canada, is a revamped version of the North American Free Trade Agreement ( NAFTA) and seen as vital to the energy sectors and economies of all three signatory countries.
In the wake of Mexico’ s 2013-2014 constitutional energy reform signed under then-president Enrique Peña Nieto, international oil companies now hold exploration and production rights in both onshore and offshore blocks in Mexico. By contrast, when NAFTA took effect in 1994, state oil company Petróleos Mexicanos ( Pemex) was the only operator allowed in Mexico’ s upstream segment.
Peña Nieto’ s successor, Andrés Manuel López Obrador, has criticized the reform and put a halt to new bid rounds, but his Morena coalition, which controls both houses of congress, has left the legislation intact.
The USMCA, meanwhile, “ locks in for U.S. investors, service suppliers, and other companies the benefits of Mexico’ s historic 2013 energy reforms, ” according to a fact sheet on the deal published by the office of United States Trade Representative ( USTR) Robert Lighthizer.
The agreement also ensures no tariffs on the flow of energy products across North America, more flexible rules of origin requirements for oil and gas moving between the three countries, and a streamlined regulatory process for U.S. liquefied natural gas ( LNG) exports to Mexico and Canada, according to the USTR.
Crucially for U.S. oil companies operating in Mexico, the USMCA also preserves for select industries, among them oil and gas, the investor dispute settlement mechanism ( ISDS) from Chapter 11 of NAFTA.
This means that “ U.S. and Canadian firms who have invested in Mexico over the past years in the aftermath of the energy reform will continue to receive protections under the wording of the USMCA, ” the Woodrow Wilson Center’ s Duncan Wood told NGI’ s Mexico GPI, “ and that helps those companies, but it also helps Mexico to attract investment. ” Wood directs the center’ s Mexico Institute.
American Petroleum Institute ( API) CEO Mike Sommers on Wednesday called the new agreement “ a win-win for American workers and energy consumers, ” adding, “ North American energy markets are deeply integrated and interconnected, and the free flow of energy products and investments in natural gas and oil across our borders is critical to sustaining American energy leadership and economic growth. ”
Pipeline natural gas exports from the United States to Mexico averaged 5.5 Bcf/d in October 2019, up from 4.9 Bcf/d in October 2018, according to the latest available data from the Energy Information Administration.
Sommers also highlighted that Mexico is the No. 1 destination for U.S. exports of gasoline, fuel oil and total refined products, while Canada is the leading market for U.S. produced crude oil and fuel blending components.
“ These exports represent viable markets for U.S. products, ” Sommers said, “ spurring more production and economic benefits here at home. ”
Sommers hailed the bipartisan efforts of U.S. legislators to hammer out the agreement, saying the cooperation across the aisle “ sends an important signal to our trading partners and provides certainty for American supply chains that support millions of U.S. jobs. ”
Independent Petroleum Association of America ( IPAA) CEO Barry Russell welcomed the news, saying Wednesday, “ The terms of the USMCA signed today by President Trump are good news for U.S. independent oil and natural gas producers. Free trade helps not only our industry, but the U.S. economy as a whole. ”
Russell continued, “ At a time when oil and natural gas production is increasing, we have the best high growth outlets we could ask for in our neighbors Mexico and Canada. ” He cited that the two countries combined to account for 75% of U.S. natural gas exports and about 30% of petroleum exports in 2018.
“ We appreciate the bipartisan action on this agreement that will enhance our country’ s status as an energy leader and benefit U.S. workers and consumers, ” Russell added.
API is one of more than 200 companies and associations from the agriculture, manufacturing, labor, energy and small business sectors that comprise the USMCA Coalition, which lobbied for the agreement’ s approval by the United States Congress.
In related news, API, Mexico oil and gas trade association Amexhi and the International Association of Oil and Gas Producers ( IOGP) signed on Wednesday a memorandum of understanding ( MOU) “ to strengthen their working relationship and joint efforts to help advance operational performance across North America operations. ”
“ For Amexhi, this MOU represents the opportunity to implement in Mexico the best international practices in the operations of the oil and gas industry, ” said Amexhi’ s Merlin Cochran, general director.
IOGP’ s Wafik Beydoun, Americas director, said the partnership “ will help boost the operational performance of the oil and gas industry in Central and North America, including more consistent operational practices in the Gulf of Mexico. ”
The three groups pledged to “ work jointly on specific projects to promote advancement in areas such as health and safety performance, environmental protection in the Gulf of Mexico, legal frameworks and even cybersecurity. ”
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Natural gas futures nosedived on Monday on forecasts for benign weather into December and worries about the possible effects of a new coronavirus variant on energy demand. The January Nymex contract, on its opening day as the prompt month, dropped 62.3 cents day/day and settled at $ 4.854/MMBtu. February fell 59.6 cents to $ 4.768. NGI’ s Spot…
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Pemex Claims Ownership of Lion's Share of Zama Field | Sign in to get the best natural gas news and data. Follow the topics you want and receive the daily emails.
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Adding further friction to the frayed relationship between the government in Mexico and the private sector, the chief of Mexico’ s Petróleos Mexicanos ( Pemex), Octavio Romero Oropeza, said on Wednesday he believed the state oil company held the majority of the resources in the massive offshore Zama field.
“ It’ s a shared basin, ” he said, referring to the Zama shallow water reservoir that straddles one block operated by Talos Energy Inc. and another operated by Pemex. “ In the Talos interpretation, they have the biggest part of the field. At Pemex, we feel we have the biggest share. But independent of this, Pemex is going to drill exploratory wells to determine this…
“ Both Pemex and Talos want to be operator of this basin, ” he said, “ because it’ s an important well. So we need to reach an agreement of who is operator. ”
Oropeza said Pemex was in discussions with the Energy Ministry and with Talos and the issue would be determined through “ technical means. ” Zama is considered to be the largest find in Mexico by a private sector company and the dispute is being seen as part of the larger narrative of Mexico wanting to give greater power to state firms.
Talos CEO Tim Duncan reportedly told Reuters that it was concerning to the Houston-based company “ that the development of our world-class discovery, which also entails up to $ 28 billion in fiscal revenue for the Mexican government and a significant boost in production for Pemex, could end up being delayed by other non-Zama exploratory plans from Pemex. It’ s clear that our plan also offers the fastest, most realistic path to first oil. ”
Earlier this month, Talos announced that Netherland, Sewell & Associates, Inc. ( NSAI) had concluded its contingent resource estimate for Zama. NSAI’ s best estimate of Zama’ s 2C, or contingent gross recoverable resource, is about 670 million boe, in line with Talos’ s previously guided range of 400-800 million boe.
Talos holds a 35% operating interest in the consortium that operates offshore Block 7, which was awarded through the Round 1.1 bidding process conducted in 2015 by upstream regulator Comisión Nacional de Hidrocarburos ( CNH). The remaining stakes are held by Sierra Oil & Gas, a Wintershall DEA Co. ( 40%), and Premier Oil plc ( 25%), which is seeking to sell its stake in Zama.
“ NSAI estimates 60% of the total resources of Zama are located on Block 7 in the 2C case, ” Talos said. “ As previously disclosed, the Zama reservoir extends into the adjacent block to the east, owned by Pemex and, therefore, is subject to unitization between the consortium and Pemex. ”
The news of additional strain between the public and private sectors comes at an inconvenient time for Mexico’ s economy, which is undergoing a sharp downturn. Gross domestic product shrunk 0.1% in 2019, according to preliminary data released Thursday. President Andrés Manuel López Obrador had promised annual growth of 4% during his 2018-2024 six-year term.
Still, López Obrador, speaking in the same press conference, was adamant the government would not return to private sector auctions in the upstream segment, calling the energy reform of the previous administration a fraud.
“ We are respecting the contracts that were given out during the so-called energy reform, ” Lopez Obrador said. “ The old government fooled us, not the companies, when they said that the energy reform would lead to foreign investment and lots of oil. They said we would be at 3 million bbl/d of oil by now. It was a big trick.
“ We can’ t think of new rounds, contracts, if we don’ t have results. This is clear. ”
“ The president reiterated however that private sector participation in Mexico’ s oil industry would continue to take place in the upstream services area, where “ there is good work being done by the private sector services companies. ”
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Natural gas futures faltered again Tuesday despite a huge day/day decline in production. The losses reflected changes in the latest weather outlook, which had been colder over the weekend but then warmed in the last couple of runs. The January Nymex gas futures contract fell 4.7 cents to $ 3.747/MMBtu. Spot gas prices, meanwhile, came crashing…
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The beleaguered PennEast Pipeline got a lift on Thursday from FERC, which granted a petition for declaratory order by finding the project may condemn state-owned land as a certificate holder with the power of eminent domain.
PennEast, which filed the petition in October, called the order “ encouraging news. ” The decision would better position the project to petition the U.S. Supreme Court for review of an adverse ruling from the U.S. Court of Appeals for the Third Circuit that stopped it from seizing land in New Jersey, said PennEast spokesperson Patricia Kornick.
The Federal Energy Regulatory Commission found that eminent domain authority under the Natural Gas Act ( NGA) applies to state land. FERC also ruled that Congress delegated such authority to certificate holders and not the Commission itself.
PennEast obtained FERC approval and received a certificate of public convenience and necessity in 2018. However, New Jersey has prevented the pipeline’ s sponsors from seizing 42 parcels of state-owned land that it claims are preserved for recreational, conservation and agricultural uses. The project’ s backers sued to condemn the land.
The Third Circuit concluded that the Eleventh Amendment of the U.S. Constitution bars a certificate holder from bringing an action in federal court under the NGA to seize property in which a state or its agencies hold an interest. The court ruled that New Jersey’ s sovereign immunity wasn’ t revoked by the project’ s certificate and also found that the federal government’ s exemption from sovereign immunity was not delegated to PennEast.
While FERC did not address the broader Constitutional issue of sovereign immunity, ClearView Energy Partners LLC said the order is at least likely to expedite the Supreme Court’ s review if it chooses to hear the case.
PennEast requested an extension last week to file its Supreme Court petition pending FERC’ s order.
“ In agreeing with PennEast, the Commission reiterated that vital infrastructure should not be disrupted by parochial interests after having been found by expert federal regulators to be in the broad public interest and environmentally safe, ” Kornick said on Thursday.
PennEast has been in the works for about five years, but it has yet to receive a water quality certificate and other permits in New Jersey, which along with environmental groups has largely opposed the project. New Jersey Sierra Club director Jeff Tittel called FERC’ s decision “ an outrageous interference in the legal process. ”
The project would move more than 1 Bcf/d of Appalachian gas to markets in Pennsylvania and New Jersey. About one-third of the pipeline would be in New Jersey’ s Hunterdon and Mercer counties.
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Natural gas futures faltered again Tuesday despite a huge day/day decline in production. The losses reflected changes in the latest weather outlook, which had been colder over the weekend but then warmed in the last couple of runs. The January Nymex gas futures contract fell 4.7 cents to $ 3.747/MMBtu. Spot gas prices, meanwhile, came crashing…
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Shell reins in share buybacks after profit halves | The Anglo-Dutch energy company warned again that a slowing global economy could affect its buyback programme, which is the world's largest, and Chief Executive Ben van Beurden said the coronavirus epidemic was dominating the negative backdrop.
Shell is set to buy back about $ 1 billion of its shares in the first quarter of 2020, down from $ 2.75 billion a quarter since July 2018, which means it will probably miss its target of completing the programme by the end of 2020, analysts said.
Van Beurden said Shell still planned to complete the programme but did not provide a new time frame. `` All economic indicators are working against us, '' he told reporters.
Shell's shares traded in London slumped more than 4% and were 2.8% lower at 1045 GMT, underperforming the overall FTSE 100 index, which was down 0.7% mainly on fears about the fallout from the coronavirus.
Shell shares hit a low of 2,037 pence, matching their lowest on April 21, 2017.
Shares of the world's biggest oil and gas companies have struggled in recent years, caught between an unsteady recovery in oil prices and growing investor concerns about the future of the sector as the world tries to shift away from fossil fuels.
Shell had already warned in October that the buyback programme could miss its target because slowing global growth due to the Sino-U.S. trade war had hit demand for oil, natural gas and chemicals.
`` With $ 15 billion done to date it now looks extremely challenging to complete the programme by year end, '' Redburn analysts said.
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A rise in Shell's debt ratio, or gearing, to 29.3% in its fourth quarter from 27.9% in the previous quarter, added to the pressure on the oil company and van Beurden said it was likely to remain above its of 25% target this year.
Shell, which pays about $ 15 billion in dividends every year, is aiming to increase payouts to investors through dividends and share buybacks to $ 125 billion between 2021 and 2025.
While rising tensions in the Middle East and a Phase 1 trade deal between Washington and Beijing sent oil prices above $ 70 a barrel in early January, they dropped below $ 60 this week as the coronavirus exacerbated concerns about global growth. [ O/R ]
Shell's fourth-quarter headline profit fell 48% to $ 2.9 billion from $ 5.7 bln in the same period of 2018, its lowest in more than three years, as weaker oil and gas prices pushed the company to take a $ 1.65 billion charge on its U.S. gas fields.
Shell's cash generation, a key metric for its operations that have undergone deep cost cuts in recent years, also fell sharply to $ 10.3 billion from $ 22 billion a year earlier.
Van Beurden said if the current global economic conditions continued to weigh, Shell's cash flow could fall by more than $ 7 billion in 2020 compared with last year.
Shell's fourth-quarter charge was mainly related to its shale natural gas fields in North America. Rivals including Chevron and BP have also booked a number of significant provisions in recent months.
The drop in net income attributable to shareholders, based on a current cost of supplies ( CCS) and excluding identified items to $ 2.9 billion was below a forecast of $ 3.2 billion in a survey of analysts provided by Shell.
For 2019 as a whole, Shell's profit came in at $ 16.5 billion, down 23% from 2018.
Free cash flow, a measure of the amount of money Shell has to pay for dividends and share buybacks, plummeted to $ 5.4 billion in the quarter from $ 16.7 billion a year earlier.
By Ron Bousso and Shadia Nasralla | business |
Coca-Cola Posts Higher Quarterly Sales -- 2nd Update | By Dave Sebastian
Coca-Cola Co. reported higher sales in the latest quarter as demand for its namesake drinks grew, beating analysts ' estimates, and said it would reopen some factories in China that have been closed this month amid the spread of the pneumonia-like coronavirus.
Fourth-quarter sales rose 16% to $ 9.07 billion from a year earlier, ahead of the $ 8.88 billion analysts polled by FactSet had expected.
The beverage giant on Thursday said organic revenue, which excludes currency swings, acquisitions and divestitures, grew 7%. Global unit case volume increased 3% for the quarter, led by growth in emerging markets.
The company is reopening some manufacturing facilities in China that have been closed since the Lunar New Year holiday began `` under the auspices of the Chinese government '' to distribute its product in a way that wouldn't contribute to the pathogen's spread, Chairman and Chief Executive James Quincey said on a call with analysts. The country accounts for about 10% of the company's global sales volume, he said.
`` It's way too early to tell what the impact in the short term is, '' Mr. Quincey said, adding that Coke's offices and some factories remain closed.
A company spokesman said the Chinese government has extended the Lunar New Year holiday through Feb. 9 and asked businesses to remain closed.
`` While our business is closed for the extended holiday, we are able to continue some operations, where needed, with permission from local authorities, '' the spokesman said in an email.
Shares rose 2.9% Thursday afternoon.
Sales of its sparkling soft drinks, which include its namesake soda drink, Diet Coke, Fanta and Sprite, grew 3% for the quarter, led by growth in China, Brazil and Southeast Asia.
Sales of water, enhanced water and sports drinks were up 2%, and tea and coffee volume grew 4%.
Coke has pushed to roll out new flavors and diversify its offerings in recent years. The company late last year launched a new flavored seltzer brand, Aha, with caffeinated options. It was a late entrant to the category that includes market-leading bubbly water LaCroix, which has lost share as new drinks crowd store shelves. PepsiCo Inc. in 2018 l aunched a competitor called Bubly.
Unit case volume, or the number of 24 8-ounce servings of finished beverage sold, in North America was flat for the quarter, though the metric for its water, enhanced water and sports drinks grew 3%. The Coca-Cola Zero Sugar beverage grew by a double-digit percentage, the company said.
In Europe, the Middle East and Africa, unit case volume grew 4%, driven by growth in Nigeria, North Africa, Turkey and central and Eastern Europe. But quarterly operating income in the region fell 14%, or 5% on an adjusted basis, due to reduced bottler-inventory levels as European bottlers stocked up last year in advance of Brexit -- due to take place Friday, Coke said.
In Asia Pacific, unit case volume grew 2%, though sales in China softened as growth in sparkling-soft-drink sales was offset by the downsizing of certain water and juice products.
The Atlanta-based company recorded earnings of $ 2.04 billion, or 47 cents a share, compared with $ 870 million, or 20 cents a share, in the same period last year.
Adjusted earnings were 44 cents a share, meeting analysts ' expectations.
For 2020, the company expects organic sales to grow about 5%. It sees adjusted earnings of about $ 2.25 a share for the year.
The first quarter will include the effect of the operational pause in China amid the outbreak and U.S. sales of Coca-Cola Energy, which became available in the U.S. this month after the company cleared a legal hurdle with Monster Beverage Corp. last year. The beverage is available in about 45 markets, a spokesman said.
Finance Chief John Murphy said the company sees more growth in the second half of the year, as it has one less day in the first quarter and two additional days in the fourth quarter.
The outbreak of the severe acute respiratory syndrome, or SARS, nearly two decades ago didn't affect Coke that much `` from a business point of view, '' Mr. Quincey said, adding that China's economy has since grown.
RBC Capital Markets analyst Nik Modi said Coke's management has been taking calculated risks and making quick decisions since Mr. Quincey became CEO in 2017, especially in making new products. The company grew sales in categories `` no one thought could grow, '' Mr. Modi told The Wall Street Journal.
But the energy-drink market could be a tough market for Coke, said Mr. Modi. `` It could be a nice niche, but I don't think this is going to be a really big part of the Coke franchise, '' he said.
Mr. Modi said he doesn't expect the coronavirus outbreak to weigh on the company's earnings this quarter.
Write to Dave Sebastian at dave.sebastian @ wsj.com
| business |
Southeast Asia stocks: Extend losses as coronavirus fears deepen, Philippines falls most | The death toll from the virus crossed the 200-mark in China with confirmed cases of infection reported in at least 22 other countries and regions.
The WHO director-general on Thursday said the greatest concern was the virus ' potential spread to countries with weaker healthcare systems, compounded by cases of person-to-person transfer of the virus outside China.
Economists have signalled the impact of the new virus could be worse than that of the Severe Respiratory Syndrome ( SARS) epidemic in 2002-2003, which took 800 lives and cost the global economy an estimated $ 33 billion.
All south-east Asian markets were headed for weekly losses as the virus continued to dampen risk appetite in the region.
Providing some relief, China's manufacturing activity in January was in line with expectations, dodging a contraction.
`` China markets ' return in the coming week will be assessed for impact and could add to the noise as selling gets underway, '' IG Market Strategist Jingyi Pan said in note.
With the growing reassessment of the growth trajectory for China this year by brokers following the virus outbreak, the sentiment may be overtly bearish at present, the note added.
Indonesian shares slumped as much as 1.7% and were on course to slip 4.2% for the week, with financial and consumer stocks being the biggest drags on the index.
An index of Indonesia's 45 most liquid stocks <.JKLQ45 > fell over 2%.
Bank Rakyat Indonesia shed 2.6% and household goods maker Unilever Indonesia dipped 2.7%.
Philippine stocks lost 1.8%, on course for a fifth consecutive session of losses and were set to be down 4.8% for the week.
Financials and consumer stocks took the biggest hit, with BDO Unibank and conglomerate SM Investments dropping 2.9% and 2.2%, respectively.
Singapore shares dipped 0.3% and headed for a loss of about 1.8% for the month, with conglomerate DBS Group Holdings losing 1.4% and Mapletree Logistics Trust down 1.1%.
Vietnamese stocks fell nearly 1% after losing over 3% in the previous session.
The Malaysian index inched lower 0.1%, following eight consecutive sessions of losses.
The Thai bourse inched 0.3% lower, ahead of trade data for December expected later on Thursday.
By Arpit Nayak | business |
WHO Declares Coronavirus Outbreak a Global Public -2- | In Chongqing, a southwestern China city of more than 30 million people that borders Hubei, pharmacies are now required to report the names of people who buy medication for symptoms such as fever and cough, part of an effort to track people who might have coronavirus symptoms, state broadcaster China Central Television reported Thursday. The city had 165 confirmed cases of the virus as of midnight Wednesday.
Write to Brianna Abbott at brianna.abbott @ wsj.com and Erin Mendell at erin.mendell @ wsj.com
| business |
Coronovirus Fears Sunk Carnival and Royal Caribbean Stock | The impact of the coronavirus outbreak in China sent shares of Carnival and Royal Caribbean Cruises falling again on Thursday.
Thousands of guests on board a ship operated by Carnival ( ticker: CCL) subsidiary Costa Cruises were kept on board at an Italian port due to a possible case of the virus. Costa Cruises said in a statement that one guest, a 54 year-old-woman of Chinese nationality, was put on isolation in the on-board hospital Wednesday night. Hours later, Carnival said officials gave the entire ship permission to disembark, adding that the passenger was diagnosed with the common flu.
“ As soon as the suspected case was detected, the medical team on board immediately activated all the relevant health procedures to promptly isolate and manage the clinical condition, ” the company’ s statement read. “ The Health Authority has been immediately notified and is now on board to conduct all the pertinent measures. It is our utmost priority to ensure the health and safety of passengers and crew. ”
European economic struggles have dragged on Carnival’ s local brands. Carnival stock has fallen 23% in the past year. Shares are down 12% so far this month, as investors grapple with the impact of the coronavirus outbreak in China.
Carnival said in a regulatory filing earlier this week that it would suspend cruise operations from Chinese ports between Jan. 25 and Feb. 4. The company said the virus could cause an earnings-per-share hit between 3 cents and 4 cents. If such cancellations continue through the end of February, it expects an additional EPS hit of 5 cents and 6 cents.
Nomura Instinet analyst Harry Curtis wrote in a note on Tuesday that there were five Carnival-owned ships impacted, adding that lower Chinese demand for foreign-based ships could also be in play. Curtis expects first-quarter EPS of 35 cents, well below the consensus estimate of 49 cents cited by the analyst.
“ We expect the Street to reduce estimates to include the impact of the coronavirus and higher fuel prices over the coming days, ” Curtis wrote.
Royal Caribbean ( RCL) also canceled three sailings through Feb. 8 of its Spectrum of the Seas ship. The ship’ s home port is in China, where two more ships are set to join it in May and July, respectively. China represents 6% of the company’ s 2020 capacity.
Since the virus’ impact came amid the Lunar New Year holiday, Royal Caribbean expects an impact on 2020 EPS of about 10 cents—but the impact could reach 20 cents if travel restrictions in China continue through the end of February. Royal Caribbean is set to report fourth-quarter earnings on Tuesday.
Carnival stock fell nearly 4% to $ 44.75 Thursday, while Royal Caribbean stock fell 1.6% to $ 119.70. The S & P 500 index fell 0.3%. | business |
WHO Declares Coronavirus Outbreak a Global Public Health Emergency -- 3rd Update | By Brianna Abbott, Katie Camero and Erin Mendell
The World Health Organization declared the coronavirus outbreak a public-health emergency of international concern Thursday as the first person-to-person transmission of the virus was reported in the U.S.
The WHO designation, pointing to an increase in the number of cases, indicates that international public-health authorities now consider the respiratory virus a significant threat beyond China, where it originated last month. The move could further heighten the global response to the outbreak.
The agency made the declaration after a meeting of its emergency committee, which declined to do so last week. Since then, China, other governments and multinational businesses have taken emergency steps to limit the virus's spread, including halting some travel to China.
In the U.S., a sixth person tested positive for the infection in the first case of human-to-human transmission. The patient is the husband of a Chicago woman infected with the virus whose case was reported last week. She had recently traveled to Wuhan, the central Chinese city where the coronavirus first emerged last month.
The U.S. Centers for Disease Control and Prevention and state officials emphasized that the overall risk for people in the U.S. and in Illinois remains low. `` This person-to-person spread was between two very close contacts, a wife and husband, '' said Ngozi Ezike, the director of the Illinois Department of Public Health. `` It is not spreading in the wider community. ''
Public-health authorities said the WHO designation helps mobilize resources to contain the virus's spread. The WHO's director-general can make recommendations to the international community, though they aren't legally binding.
WHO Director-General Tedros Adhanom Ghebreyesus said he was confident in China's capacity to control the outbreak, which has sickened more than 7,800 people and killed 170, mostly in the Hubei province in China surrounding Wuhan.
`` Let me be clear. This declaration is not a vote of no confidence in China, '' said Dr. Tedros. `` I have never in my life seen this kind of mobilization. ''
Since it gained the power, in 2005, to declare an international emergency, WHO had applied the designation to just five prior situations. The first was in 2009 in response to the H1N1 swine flu, followed by polio in 2014 and the Ebola and Zika virus outbreaks in 2016. It declared a public emergency for another Ebola outbreak in 2019 and faced criticism for delaying that decision.
At least 18 other countries or territories have also reported a small number of coronavirus cases, with Finland, India and the Philippines now reporting cases in people who have traveled to Wuhan, according to WHO.
In response to the virus, Russia has tightened its border with China and the U.S. announced plans for a second evacuation of Americans from Wuhan. Companies including Tesla Inc. and IKEA temporarily halted operations in China.
The CDC has investigated 165 people in the U.S. for the virus, according to the numbers released Wednesday, and 68 have tested negative and been cleared. Over 90 cases are pending, and health authorities said that they expect additional cases.
The new Chicago patient lived with and was in consistent close contact with his wife. After returning to the U.S. on Jan. 13, she developed symptoms and was hospitalized in an isolated setting. Once her husband also started developing symptoms he was quickly taken to the hospital. The patient, who has underlying health issues, is in a stable condition, health authorities said.
`` It is clear that this virus is highly transmittable, and this assumption is based on the rapid rate of spread of this infection in China, '' said Eyal Leshem, director of the Institute for Travel and Tropical medicine at Sheba Medical Center in Israel.
`` When there is a public-health uncertainty, you always want to slightly overreact to make sure that you don't miss a critical issue, '' said Dr. Leshem. `` Once you learn a little bit more about the risk and the effective steps, then you can scale back. ''
Health authorities believe the virus spread while the first patient in Chicago was symptomatic, rather than before.
Officials said the man, who is in his 60s, didn't attend any mass gatherings. There are 21 people under investigation in Illinois for possible infection, Dr. Ezike said, and local and federal health authorities are working to monitor close contacts of the second Chicago patient.
Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC, called the coronavirus `` a very serious public-health situation. '' She added: `` We're trying to spark a balance in our response right now. ''
The CDC said that people who had recently traveled should be vigilant for symptoms and signs of the virus, which include fever, cough and shortness of breath.
President Trump during a speech in Michigan said the administration is working closely with China and sought to minimize fears about the virus in the U.S.
`` We think we have it very well under control. We have very little problem in this country at this moment, '' Mr. Trump said, adding that the handful of victims are recuperating. `` We think it's going to have a very good ending for us. That I can assure you. ''
Members of a House of Representatives panel briefed by federal medical officials Thursday said that traditional means of stopping infection are still the best guard against the virus's spread.
Members of the subcommittee said federal officials appear to have the situation in hand and that there isn't any need for a coronavirus `` czar, `` as occurred with the Ebola virus epidemic in West Africa during the Obama administration.
Authorities in Russia, meanwhile, said they would temporarily restrict passage through 16 road, rail and river checkpoints along its 2,670-mile border with China. Though Russia's national carrier Aeroflot hasn't stopped flying to China smaller Russian airlines have canceled flights.
A number of countries have pushed ahead with efforts to extract their citizens from central China.
The State Department on Thursday said it is planning a second evacuation flight from Wuhan for the hundreds of American citizens still believed to be in the city.
The Indian government is seeking permission from Chinese authorities to operate two flights to repatriate citizens from Hubei province, and will quarantine them for 14 days.
In Japan, controversy erupted Wednesday after two people on a government-chartered evacuation flight from Wuhan to Tokyo refused to be tested for the new virus.
Prime Minister Shinzo Abe told Parliament on Thursday that while the government had pushed for all 206 passengers on the flight to be tested, it had no legal power to compel them. Three people on the flight tested positive for the virus, including two without symptoms, according to the health ministry. The two who refused testing didn't show symptoms, health ministry official Takuma Kato said.
A second charter flight to evacuate Japanese citizens from Wuhan arrived in Tokyo on Thursday, and Mr. Kato said all 210 people aboard agreed to be screened.
Meanwhile, immigration officials in Hong Kong scoured the city for visitors from Hubei, finding 15 on Wednesday night during searches of 110 hotels, according to Lam Shuk-Yee, deputy secretary for security of the Chinese territory on Thursday. Ms. Lam said 1,600 people from the province had been turned away at the Hong Kong border since the ban.
On the corporate front, big multinational companies moved to temporarily shut down China operations as workers remained largely in place, with the Lunar New Year holiday extended through the end of the week and transportation links largely curtailed.
Tesla Chief Financial Officer Zach Kirkhorn said Wednesday that the company was halting production at its new Shanghai Gigafactory to comply with a local-government order to extend the Lunar New Year holiday, which Mr. Kirkhorn said could affect the company's first-quarter performance.
All 30 IKEA outlets in mainland China were closed until further notice, the Swedish furniture giant said Thursday.
Air France joined the list of airlines cutting service to China. The carrier said it would suspend all scheduled flights to and from the mainland until Feb. 9 and operate special flights starting Friday using volunteer crew to enable customers and employees to depart safely.
Italian authorities held 6,000 passengers and crew aboard a cruise ship at the port of Civitavecchia near Rome after a 54-year-old Chinese woman showed flulike symptoms. Health authorities late Thursday ruled out she was affected by coronavirus and passengers were allowed to disembark, according to a statement by Costa Crociere, the company operating the ship.
China's national women's soccer team is being held in quarantine in a hotel in the Australian city of Brisbane until Feb. 5, health authorities for the northwestern state of Queensland said Thursday. The 32-member team had traveled to Australia to compete in a qualifying tournament for this summer's Olympics in Tokyo.
The tournament was originally scheduled to be held in Wuhan but was moved to Sydney after the outbreak. The team had departed Wuhan Jan. 22, before the city was locked down, said the Chinese Football Association, which said it also planned to suspend soccer competitions nationwide starting Thursday.
In Chongqing, a southwestern China city of more than 30 million people that borders Hubei, pharmacies are now required to report the names of people who buy medication for symptoms such as fever and cough, part of an effort to track people who might have coronavirus symptoms, state broadcaster China Central Television reported Thursday. The city had 165 confirmed cases of the virus as of midnight Wednesday.
Write to Brianna Abbott at brianna.abbott @ wsj.com and Erin Mendell at erin.mendell @ wsj.com
| business |
Gold holds gains on worries of coronavirus impact on world economy | Gold held onto gains on Thursday, supported by concerns over the potential impact on global economic growth of a fast-spreading coronavirus outbreak in China which has killed 170 people.
Spot gold was up 0.35% to $ 1,582.615 per ounce after rising 0.7% on Wednesday, while U.S. gold futures were 0.7% higher at $ 1,587.3 per ounce.
`` The whole run into gold and government debts ( bonds), away from equities, is due to worries regarding the scale of the outbreak of the virus, '' said SP Angel analyst Sergey Raevskiy.
`` Copper prices are falling off a cliff, which is an indication of how the markets perceive the risks of the virus to the economic growth. '' Copper is often regarded as a leading indicator of the health of the global economy.
Global equity markets fell, while Germany's benchmark 10-year Bund yield dropped to a near three-month low and U.S. 10-year Treasury yields hit their lowest since Oct. 10.
A Chinese government economist on Wednesday said China's economic growth may drop to 5% or even lower due to the outbreak, which has spread to more than 10 countries.
Federal Reserve chair Jerome Powell acknowledged the risks of a short-term slowdown in China, including to the U.S. economy, following the central bank's widely expected decision to keep interest rates unchanged.
Bullion is often seen as a safe store of value during times of political and economic uncertainty.
The World Health Organisation ( WHO) will reconvene on Thursday to decide whether the coronavirus outbreak constitutes a global emergency.
`` Technically, if the ( gold) price can surpass the high reached three days ago at ( around) $ 1,585, we will have another signal of strength, '' ActivTrades chief analyst Carlo Alberto De Casa said in a note.
Gold is being supported by markets ' struggle to understand the `` real '' impact of the virus on the global economy, he added.
Elsewhere, palladium lost 0.2% to $ 2,283.85 per ounce, having hit a record high of $ 2,582.19 on Jan. 20 on supply worries.
Russia's Norilsk Nickel said on Wednesday its Global Palladium Fund would deliver three tonnes of palladium ingots to the market from its current stock to provide short-term relief to tight supplies.
Silver gained 1.1% to $ 17.74, while platinum fell 0.4%, to $ 970.23. | business |
Read the January/February 2020 edition of Pharmafocus online now! | It’ s a path paved with uncertainty, but it does provide clarity for business and industry which have been previously unable to plan ahead in such a divided climate. But the challenges ahead will be great, and are embodied in the news that NHS waiting times have now hit the worst level ever recorded.
But if you can’ t get enough of the continuing drama of Brexit, you don’ t need to wait long until the next seismic political event; the US Presidential Election is looming in November, and the Democratic Party will name its nominee for the presidency in July, a decision that will set the stage for a showdown with sitting President Donald Trump on key issues like drug pricing and the opioid crisis.
These issues will be of the utmost importance to voters in a climate where the tightening grip of conspiracy theories and anti-vaccine disinformation has caused measles rates to rocket to its highest rate in 27 years. In a special feature, Pharmafocus looks at each of the presidential candidates and their plans to tackle the opioid epidemic.
Elsewhere in the issue, we document the first chapters of the ongoing Wuhan coronavirus outbreak, cover the latest wave of drug price hikes from Big Pharma in the US, and examine why the WHO is warning that efforts against antimicrobial resistance are under threat. | tech |
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