Fighting erupted anew Sunday between Armenian and Azerbaijani forces over the disputed separatist region of Nagorno-Karabakh and a top territorial official said 16 people were killed and more than 100 wounded, while Azerbaijan’s president said his military has suffered losses.
Armenia also claimed that two Azerbaijani helicopters were shot down and three Azerbaijani tanks were hit by artillery, but Azerbaijan’s defense ministry rejected that claim.
Heavy fighting broke out in the morning in the region that lies within Azerbaijan but has been under the control of ethnic Armenian forces backed by Armenia since 1994 at the end of a separatist war. It was not immediately clear what sparked the fighting, the heaviest since clashes in July killed 16 people from both sides.
Nagorno-Karabakh authorities reported that shelling hit the region’s capital of Stepanakert and the towns of Martakert and Martuni. Armenian Defense Ministry spokesman Artsrun Hovhannisyan also said Azerbaijani shelling hit within Armenian territory near the town of Vardenis.
Artur Sarkisian, deputy head of the Nagorno-Karabakh army, said that 16 people were killed and more than 100 wounded. It wasn’t immediately clear if the figure included both soldiers and civilians. Earlier, the Armenian human rights ombudsman said a woman and child had been killed in the shelling.
Another Armenian Defense Ministry spokeswoman, Shushan Stepanyan, said “the Armenian side” shot down two helicopters and hit three tanks.
Azerbaijani President Ilham Aliyev ordered martial law be imposed in some regions of the country and called for a curfew in major cities.
In a televised address to the nation, Aliyev said that “there are losses among the Azerbaijani forces and the civilian population as a result of the Armenian bombardment,” but didn’t give further details. He also claimed that “many units of the enemy’s military equipment have been destroyed.”
Russian Foreign Minister Sergey Lavrov “is conducting intensive contacts in order to induce the parties to cease fire and start negotiations to stabilize the situation,” Foreign Ministry spokeswoman Maria Zakharova said.
Albanian Prime Minister Edi Rama, chairman of the Organization for Security and Cooperation in Europe, called on the sides to stop fighting. The long-unsuccessful negotiations for resolving the territory’s status has been conducted under OSCE auspices.
Armenian Prime Minister Nikol Pashinian on Sunday said the country could reexamine whether to recognize Nagorno-Karabakh as independent. Such a move would likely obstruct further negotiations.
Foreign Minister Javad Zarif of Iran, which borders both Azerbaijan and Armenia, said “We call for an immediate end to hostilities and urge dialogue to resolve differences. Our neighbors are our priority and we are ready to provide good offices to enable talks.”
Turkey’s ruling party spokesman Omer Celik tweeted: “We vehemently condemn Armenia’s attack on Azerbaijan. Armenia has once again committed a provocation, ignoring law.” He promised Turkey would stand by Azerbaijan and said, “Armenia is playing with fire and endangering regional peace.”
Turkish presidential spokesman Ibrahim Kalin also condemned Armenia.
“Armenia has violated the cease-fire by attacking civilian settlements ... the international community must immediately say stop to this dangerous provocation,” Kalin tweeted.
Mostly mountainous Nagorno-Karabakh — a region around 4,400 square kilometers (1,700 square miles) or about the size of the U.S. state of Delaware — lies 50 kilometers (30 miles) from the Armenian border. Local soldiers backed by Armenia also occupy some Azerbaijani territory outside the region.
The nearly 1 million people around the world who have lost their lives to COVID-19 have left us a gift: Through desperate efforts to save their lives, scientists now better understand how to treat and prevent the disease — and millions of others may survive.
Ming Wang, 71, and his wife were on a cruise from Australia, taking a break after decades of running the family's Chinese restaurant in Papillion, Nebraska, when he was infected. In the 74 days he was hospitalized before his death in June, doctors frantically tried various experimental approaches, including enrolling him in a study of an antiviral drug that ultimately showed promise.
"It was just touch and go. Everything they wanted to try we said yes, do it," said Wang's daughter, Anne Peterson. "We would give anything to have him back, but if what we and he went through would help future patients, that's what we want."
Patients are already benefiting. Though more deaths are expected this fall because of the recent surge in coronavirus infections in the U.S. and elsewhere, there also are signs that death rates are declining and that people who get the virus now are faring better than did those in the early months of the pandemic.
"Some of the reason we're doing better is because of the advances," Dr. Francis Collins, director of the U.S. National Institutes of Health, told The Associated Press. Several drugs have proved useful and doctors know more about how to care for the sickest patients in hospitals, he said.
We're in the "stormy adolescence" phase of learning what treatments work — beyond infancy but not "all grown up either," Collins said.
THE AWFUL TOLL
The nearly 1 million deaths attributed to the coronavirus in nine months are far more than the 690,000 from AIDS or the 400,000 from malaria in all of 2019. They're trending just behind the 1.5 million from tuberculosis.
Wealth and power have not shielded rich countries from the awful power of the virus. The United States "has been the worst-hit country in the world" with more than 7 million coronavirus infections and more than 200,000 deaths, reflecting "the lack of success that we have had in containing this outbreak," Dr. Anthony Fauci, the nation's top infectious disease specialist, told a Harvard Medical School audience earlier this month.
More than 40% of U.S. adults are at risk for severe disease from the virus because of high blood pressure and other conditions. It's not just old people in nursing homes who are dying, Fauci stressed.
Dr. Jesse Goodman, a former U.S. Food and Drug Administration chief scientist now at Georgetown University, agreed.
"Nobody should make a mistake about this" and think they're not at risk just because they may not personally know someone who has died or haven't witnessed what the virus can do firsthand, he said.
Although cases are rising, death rates seem to be falling, said Dr. Cyrus Shahpar, a former U.S. Centers for Disease Control and Prevention scientist now at the nonprofit group Resolve to Save Lives.
The virus's true lethality — the infection fatality rate — isn't yet known, because scientists don't know how many people have had it without showing symptoms. What's often reported are case fatality rates — the portion of people who have tested positive and then gone on to die. Comparing these from country to country is problematic because of differences in testing and vulnerable populations. Tracking these within a country over time also carries that risk, but it can suggest some trends.
"The U.S. cumulative case fatality rate in April was around 5%. Now we're around 3%," Shahpar said.
In England, researchers reported that case fatality rates have fallen substantially since peaking in April. The rate in August was around 1.5% versus more than 6% six weeks earlier.
One reason is changing demographics: More cases these days are in younger people who are less likely to die from their infection than older people are.
Increased testing also is playing a role: As more people with mild or no symptoms are detected, it expands the number of known infections and shrinks the proportion that prove fatal, Shahpar said.
It's clear that treatments also are affecting survival, many doctors said. People who have died from COVID-19, especially ones who took part in studies, have helped reveal what drugs do or do not help.
Dexamethasone and similar steroids now are known to improve survival when used in hospitalized patients who need extra oxygen, but might be harmful for less sick patients.
An antiviral drug, remdesivir, can speed recovery for severely ill patients, shaving four days off the average hospital stay. Two anti-inflammatory drugs, one used in combination with remdesivir — the drug Wang helped test — also have been reported to help although results of those studies have not yet been published.
The jury is still out on convalescent plasma, which involves using antibody-rich blood from survivors to treat others. No large, high-quality studies have tested this well enough to know if it works.
The value of rigorous, scientific studies to test treatments has become clear, Goodman said. "We certainly see what happens" when treatments are widely adopted without them as hydroxychloroquine was, he said. "That exposed a lot of people to a potentially toxic drug" and delayed the hunt for effective ones.
Aside from drugs, "the case fatality rate is actually improving over time as physicians get more adept at taking care of these very sick patients," said Dr. Gary Gibbons, director of the U.S. National Heart, Lung and Blood Institute.
In hospitals, doctors know more now about ways to avoid using breathing machines, such as keeping patients on their bellies.
"We've learned about how to position patients, how to use oxygen, how to manage fluids," and hospitals have increased their surge capacity and supplies, Dr. Judith Currier, a University of California, Los Angeles physician said at a recent webinar organized by the American Public Health Association and the U.S. National Academy of Medicine.
The best way to avoid dying from the coronavirus remains to avoid getting it, and experience has shown that the simple measures advocated by public health officials work.
"Prevention is the most important step right now as we're waiting for a vaccine and we're improving treatment," Goodman said.
Wearing a face mask, washing hands, keeping at least 6 feet apart and disinfecting surfaces "clearly are having a positive effect" on curbing spread, Fauci said.
If more people stick with common-sense measures like closing bars, "we should improve our ability to manage this" and prevent more deaths, Shahpar said. "It should take longer to get to the next million if it ever happens."
British Prime Minister Boris Johnson said Saturday that the coronavirus pandemic has frayed the bonds between nations, and urged world leaders to unite against the “common foe” of COVID-19.
Johnson, who made the remarks in a prerecorded speech to the United Nations General Assembly, said that, nine months into the pandemic, “the very notion of the international community looks tattered,” reports AP.
“Never again must we wage 193 separate campaigns against the same enemy,” he said.
Johnson set out a plan for preventing another global pandemic, including a network of zoonotic research labs around the world to identify dangerous pathogens before they leap from animals to humans.
Johnson — who contracted COVID-19 in the spring and spent three nights in intensive care — also called for countries to share data to create a global early-warning system for disease outbreaks, and urged countries to stop slapping export controls on essential goods, as many have done during the pandemic.
Johnson also committed 500 million pounds ($636 million) through the global COVAX vaccine-procurement pool to help 92 of the world’s poorest countries obtain a coronavirus vaccine, should one become available.
He announced that the U.K. is boosting its funding for the World Health Organization by 30%, to 340 million pounds ($432 million) over the next four years, and urged world leaders to acknowledge “that alarm bells were ringing before this calamity struck’ and to learn from the experience.
“With nearly a million people dead, with colossal economic suffering already inflicted and more to come, there is a moral imperative for humanity to be honest and to reach a joint understanding of how the pandemic began, and how it was able to spread — not because I want to blame any country or government, or to score points,″ Johnson said. “I simply believe – as a former COVID patient – that we all have a right to know, so that we can collectively do our best to prevent a recurrence.″
Johnson is seeking to counter the impression that Britain is retreating from the world stage or becoming more protectionist in the wake of its departure from the European Union. The U.K. left the bloc’s political institutions in January and will make an economic break when a transition period ends on Dec. 31.
As an example of British leadership and generosity, he noted Oxford University researchers had immediately shared a discovery that a cheap medicine called dexamethasone reduces the risk of death by over a third for patients on ventilators . He also referred to efforts in Britain by Oxford and drugmaker AstraZeneca to develop and manufacture a vaccine.
“It would be futile to treat the quest for a vaccine as a contest for narrow national advantage and immoral to seek a head start through obtaining research by underhand means,″ he said. “The health of every country depends on the whole world having access to a safe and effective vaccine, wherever a breakthrough might occur; and, the UK, we will do everything in our power to bring this about.″
He has also struck a more measured tone than in last year’s speech to the U.N. gathering, a rambling address about the perils and promise of technology that mentioned “terrifying limbless chickens,” “pink-eyed Terminators from the future” and fridges that beep for more cheese.
After the first shot, he had no reaction. But Kan Chai felt woozy following the second dose of a COVID-19 vaccine approved for emergency use in China.
"When I was driving on the road, I suddenly felt a bit dizzy, as if I was driving drunk," the popular writer and columnist recounted in a webinar earlier this month. "So I specially found a place to stop the car, rest a bit and then I felt better."
His is a rare account from the hundreds of thousands of people who have been given Chinese vaccines, before final regulatory approval for general use. It's an unusual move that raises ethical and safety questions, as companies and governments worldwide race to develop a vaccine that will stop the spread of the coronavirus.
Chinese companies earlier drew attention for giving the vaccine to their top executives and leading researchers before human trials to test their safety and efficacy had even begun. In recent months, they have injected a far larger number under an emergency use designation approved in June, and that number appears poised to rise.
A Chinese health official said Friday that China, which has largely eradicated the disease, needs to take steps to prevent it from coming back. But one outside expert questioned the need for emergency use when the virus is no longer spreading in the country where it was first detected.
It's unclear exactly who and how many people have been injected so far, but Chinese vaccine makers have offered some clues. State-owned Sinopharm subsidiary CNBG has given the vaccine to 350,000 people outside its clinical trials, which have about 40,000 people enrolled, a top CNBG executive said recently.
Another company, Sinovac Biotech Ltd., has injected 90% of its employees and family members, or about 3,000 people, most under the emergency-use provision, CEO Yin Weidong said. It has also provided tens of thousands of rounds of its CoronaVac to the Beijing city government.
Separately, the Chinese military has approved the use of a vaccine it developed with CanSino Biologics Inc., a biopharmaceutical company, in military personnel.
"The first people to have priority in emergency use are the vaccine researchers and the vaccine manufacturers because when the pandemic comes, if these people are infected then there's no way to produce the vaccine," Yin said.
Now, large Chinese firms including telecom giant Huawei and broadcaster Phoenix TV have announced they're working with Sinopharm to get the vaccine for their employees.
Several people who say they work in "front-line" organizations have said on social media that their workplaces have offered vaccinations for about 1,000 yuan ($150). They declined to comment, saying they would need permission from their organizations.
In an established but limited practice, experimental medications have been approved historically for use when they are still in the third and last phase of human trials. Chinese companies have four vaccines in phase 3 — two from Sinopharm, and one each from Sinovac and CanSino.
The Chinese government referenced the World Health Organization's emergency-use principles to create its own through a strict process, National Health Commission official Zheng Zhongwei said at a news conference Friday.
He said there have been no serious side effects in the clinical trials.
"We've made it very clear that the COVID-19 vaccine we put into emergency use are safe," Zheng said. "Their safety can be ensured but their efficacy is yet to be determined."
Under the emergency rule, high-risk personnel such as medical and customs workers and those who have to work overseas are given priority access, he said. He declined to provide exact numbers.
"In China's case, the pressure in preventing imported infections and domestic resurgence is still huge," Zheng said.
But Diego Silva, a lecturer in bioethics at the University of Sydney, said that giving vaccines to hundreds of thousands outside of clinical trials doesn't have "scientific merit" in China, where there are currently very few locally transmitted cases, and incoming arrivals are quarantined centrally.
"If it's in the U.S. where the virus is still raging that's a bit different, but in a country like China it doesn't seem to make sense to me," he said. "Because there's not enough of the virus in China locally to deduce anything, you're introducing a whole host of others factors" by injecting people outside of trials.
Zheng said that all those injected under emergency use are being closely tracked for any adverse health effects.
Kan Chai, the columnist, wrote in an article posted online in September that despite initial hesitation, he decided to sign up after he heard a state-owned company was looking for volunteers.
He didn't say whether his was an emergency-use case, but the timing of his vaccination suggests it was. He took the first dose in late July, when the emergency inoculations were getting started and the trials were all but over.
"I'm willing to be a little white mouse, and the biggest reason is because I have trust in our country's vaccination technology," he said.
His real name is Li Yong, but his 1.65 million followers on the Twitter-like social platform Weibo know him better by his pen name, which means "10 years of chopping wood." He declined an interview request.
He described taking the vaccine in a public webinar hosted by 8am HealthInsight, a popular health media outlet. It's unclear why he qualified to receive it.
Scant information is publicly available about the program's scope, size, and scientific merit. CNBG and parent Sinopharm declined to comment. Zheng, the National Health Commission official, did not know about the Kan Chai case.
While emergency use may be the right path, Chinese companies are not being transparent about issues such as informed consent, said Joy Zhang, a professor who researches the ethical governance of emerging science at University of Kent in Britain.
Zhang said that she could not find any relevant information on the Sinopharm website, and aside from reports published in international medical journals, there is little else made public.
She said relatively more information is publicly available about other trials such as one run by Oxford University and AstraZeneca. The trial was halted after a participant developed severe neurological side effects, and only resumed after clinical data was submitted to an independent review board.
China has a troubled past with vaccines, with various scandals over the past two decades.
The most recent case was in 2018, when Changsheng Biotechnology Co. came under investigation for falsifying records and making ineffective rabies vaccines for children.
In 2017, Wuhan Institute of Biological Products Co., a CNBG subsidiary behind one of the vaccines in phase 3 trials, was found to have made defective diphtheria vaccines that were ineffective.
Public anger over the case prompted an overhaul of a vaccine punishment law in 2019. The country tightened supervision over the vaccine development and distribution process, and increased penalties for fabricating data.
Those concerns seem to be of the past. Guizhen Wu, the chief biosafety expert for China's Center for Disease Control, said a vaccine could be ready for the general public in China as early as November. She said she took an experimental vaccine back in April.
An overseas employee at a Chinese state-owned company, who spoke on condition of anonymity because she wasn't authorized to speak with the media, said she decided to sign up last week.
She said she isn't worried because a vaccine is a government priority, so authorities will keep a close watch on the process.
Prime Minister of India Narendra Modi on Saturday announced a $15 million grant for the promotion of Buddhist ties with its neighbor Sri Lanka.
He made the offer during a virtual summit with his Sri Lankan counterpart Mahinda Rajapaksa, reports AP.
Buddhism is practiced by more than 70% of Sri Lanka's population, while most of India's people are Hindu.
India's External Affairs Ministry said the promotion will be through construction and renovation of Buddhist monasteries, capacity development, cultural exchanges, archaeological cooperation and reciprocal exposition of Gautam Buddha's relics.
India recently upgraded its airport in Kushinagar, an important Buddhist pilgrimage site in the northern Indian state of Uttar Pradesh, to receive international flights.
India also plans to fly a Buddhist delegation from Sri Lanka on the inaugural flight soon.
The Buddhists believe that Buddha attained a transcendent state after his death in Kushinagar.