India is bracing for a potential explosion of coronavirus cases as authorities rush to trace, test and quarantine contacts of 31 people confirmed to have the disease.
It is screening international travelers at 30 airports and has already tested more than 3,500 samples. The Indian army is preparing at least five large-scale quarantine centers.
For weeks, India watched as cases of COVID-19, the disease caused by the virus, multiplied in neighboring China and other countries as its own caseload remained static — three students evacuated from Wuhan, the disease epicenter, who were quarantined and returned to health in the southern state of Kerala.
Prime Minister Narendra Modi's government said last week that community transmission is now taking place. India has shut schools, stopped exporting key pharmaceutical ingredients and urged state governments to cancel public festivities for Holi, the Hindu springtime holiday in which people douse each other with colored water and paint.
Modi canceled travel plans to Brussels for an India-EU summit amid a rising caseload in Belgium, and tweeted that he would not attend any Holi festivities.
Experts fear these precautions won't be enough for India's beleaguered, under-funded and under-staffed health system to stave off an epidemic. Here are their foremost concerns:
TOO FEW LABS, NOT ENOUGH HOSPITALS
As the virus spread globally, India began bolstering its ability to test and detect the virus. While the National Institute of Virology at Pune remains the main testing facility, the government has identified 35 additional labs for testing.
But concerns remain over India's overstretched health infrastructure — a single state-run hospital for every 55,591 people on average and a single hospital bed for every 1,844 people. India needs about 10 times more doctors to meet the norms prescribed by the World Health Organization, a shortfall of at least 500,000 doctors.
Experts fear that an epidemic would cause other routine health care functions to suffer.
"Everything will become about COVID-19. And other routine services like immunization or taking care of maternal mortality would be affected," said Anant Bhan, a global health and policy expert.
HEALTH CARE INEQUALITY
India's health performance, an index that includes access to primary care, maternal mortality rates and child health, runs the spectrum, with some states outperforming others by almost 2.5 times, according to the government-run think tank NITI Aayog.
The best performer was Kerala, the small state that found and treated India's first three cases. The worst was Uttar Pradesh, a state with roughly the population of Brazil that has detected at least six cases. Kerala has a doctor for approximately every 6,000 people, while Uttar Pradesh has one for every 18,000 people. The inequalities are further pronounced between urban and rural areas, with the bulk of the available beds concentrated in India's cities.
India spent an average of $62.72 per person on health care in 2016, according to WHO, compared to China's $398.33.
Inequalities could make prevention even harder. In places with limited access to clean water, washing hands to prevent the spread of the virus is difficult, said Dr. Gagandeep Kang, a microbiologist who heads India's Translational Health Science and Technology Institute.
Retired virologist and pediatrician Dr T. Jacob John said these inequalities aren't just a reflection of not spending enough on health care, but also of not knowing where to spend.
"The last time a needs-based survey was done for India's health care was in 1946," he said, adding that the country's "health management system is very inadequate for India's existing problems, let alone new ones."
India's health minister told Parliament that the "need of the hour" is to contain viral clusters, to prevent and break chains of transmission. But in India, with a population of 1.4 billion, that is far from easy.
Take the city of Agra, famous for the Taj Mahal, where six Italian tourists tested positive for the virus. Apart from the 40,000 tourists who visit the monument each day, the city has a population of more than 4 million, with nearly 3,000 people crammed into every square mile. Following WHO advice, the Indian government has told people keep a distance of at least six feet from others.
But "anywhere you've a dense population, all the issues of social distancing become challenging," Kang said.
SHORT ON MEDICINES
With the virus lockdown in China resulting in shortages in India, the government halted the export of 13 key drug ingredients and the medicines made from them on Tuesday.
Although India is the world's primary supplier of generic drugs, it relies on China for nearly 70% of the active pharmaceutical ingredients it uses for making medicines.
India has said it has enough stocks, but the government's minister for chemicals and fertilizers told Parliament that there remains "an apprehension" that supplies of ingredients from China would be disrupted if the epidemic continues.
On Thursday, Health Minister Harsh Vardhan met the management of India's top private hospitals to ask them to work with the government in dealing with the outbreak, and urged them to "prepare a pool of beds."
Kang said India's current approach, which is focused on travelers, might restrict some cases. But eventually, it will have to expand testing to limit the spread of the disease within the country, Kang said. The question, she said, is whether authorities want to do that now, or at the height of an epidemic.
The Great Barrier Reef is facing a critical period of heat stress over the coming weeks following the most widespread coral bleaching the natural wonder has ever endured, scientists said Friday.
David Wachenfeld, chief scientist at the Great Barrier Reef Marine Park Authority, the government agency that manages the coral expanse off northeast Australia, said ocean temperatures over the next month will be crucial to how the reef recovers from heat-induced bleaching.
"The forecasts ... indicate that we can expect ongoing levels of thermal stress for at least the next two weeks and maybe three or four weeks," Wachenfeld said in a weekly update on the reef's health on Thursday.
"So this still is a critical time for the reef and it is the weather conditions over the next two to four weeks that will determine the final outcome," he said.
Ocean temperatures across most of the reef were 0.5 to 1.5 degrees Celsius (0.9 to 2.7 degrees Fahrenheit) above the March average.
In parts of the marine park in the south close to shore which avoided the ravages of previous bleachings, ocean temperatures were 2 to 3 degrees Celsius (3.6 to 5.4 degrees Fahrenheit) above average.
The authority has received 250 reports of sightings of bleached coral due to elevated ocean temperatures during an unusually hot February.
The 345,400-square kilometer (133,360-square mile) World Heritage-listed colorful coral network has been devastated by four coral bleaching events since 1998. The most deadly were the most recent, in consecutive summers in 2016 and 2017.
Scientists fear the latest coral death rate could match those events.
"At the moment, it's definitely the most extensive bleaching event we've ever had," U.S. National Oceanographic and Atmospheric Administration Coral Reef Watch scientist William Skirving said Friday.
"It's certainly an end-to-end bleaching event with severe bits at each end and it's not looking good for the southern end, but it really depends on the weather in the next two weeks," he said.
Ove Hoegh-Guldberg, a scientist from the Australian Research Council Center for Excellence in Coral Reef Studies, said how much of the bleached coral would recover and how much would die would not be known for weeks.
"I'm very worried about the situation given how warm the temperatures are on the Great Barrier Reef and what the projections are," Hoegh-Guldberg said.
"If it cools down a bit, they'll recover or, if not, we may head off into something not too different from 2016 and 2017. We're right at the fork in the road," he added.
The Great Barrier Reef Marine Park Authority last year downgraded its outlook for the corals' condition from "poor" to "very poor" due to warming oceans.
Its latest report, which is updated every five years, found the greatest threat to the reef remained climate change. The other threats are associated with coastal development, land-based water runoff and human activity such as illegal fishing.
President Donald Trump is expected to sign an $8.3 billion measure to help tackle the coronavirus outbreak. The legislation would provide federal public health agencies money for vaccines, tests and potential treatments, and help state and local governments prepare for and respond to the threat.
The Senate passed the measure Thursday to help tackle the outbreak in hopes of reassuring a fearful public and accelerating the government's response to the virus. Its rapid spread is threatening to upend everyday life in the U.S. and across the globe.
The money would pay for a multifaceted attack on a virus that is spreading more widely every day, sending financial markets spiraling again Thursday, disrupting travel and potentially threatening the U.S. economy's decade-long expansion.
Thursday's sweeping 96-1 vote sends the bill to the White House for President Donald Trump's signature. Sen. Rand Paul, R-Ky., cast the sole "no" vote. The House passed the bill Wednesday by a 415-2 vote.
The plan would more than triple the $2.5 billion amount outlined by the White House 10 days ago. The Trump proposal was immediately discarded by members of Congress from both parties. Instead, the bipartisan leadership of the House and Senate Appropriations committees negotiated the increased figure and other provisions of the legislation in a burst of bipartisan cooperation that's common on the panel but increasingly rare elsewhere in Washington.
"In situations like this, I believe no expense should be spared to protect the American people, and in crafting this package none was," said Appropriations Committee Chairman Richard Shelby, R-Ala. "It's an aggressive plan, a vigorous plan that has received an overwhelming positive reaction."
Trump was sure to sign the measure, which has almost universal support. It is intended to project confidence and calm as anxiety builds over the impact of the virus, which has claimed 12 lives in the U.S.
"The American people are looking for leadership and want assurance that their government is up to the task of protecting their health and safety," said Sen. Patrick Leahy, D-Vt.
The impact of the outbreak continues to mount. The British government is considering suspending Parliament for five months in hope of limiting the spread of the virus in the United Kingdom.
The legislation would provide federal public health agencies money for vaccines, tests and potential treatments, including $300 million to deliver such drugs to those who need it. More than $2 billion would go to help federal, state and local governments prepare for and respond to the coronavirus threat. An additional $1.3 billion would be used to help fight the virus overseas. There's also funding to subsidize $7 billion in small business loans.
Other dollars would be directed to help local officials prepare for the potential worsening of the outbreak and subsidize treatment by community health centers. Medicare rules would be loosened to enable remote "telehealth" consultations whereby sick people could to get treatment without visiting a doctor.
Sen. Maria Cantwell, D-Wash., whose state is at the center of the crisis, praised the bill because it "will increase access for public lab testing, help pay for isolation and quarantine, help pay for sanitizing in public areas, better track the virus and those who might come into contact with it, help labs who are trying to identify hot spots, and limit exposure."
The legislation contains a hard-won compromise that aims to protect against potential price gouging by drug manufacturers for vaccines and other medicines developed with taxpayer funds. Health and Human Services Secretary Alex Azar would have the power to make sure commercial prices are reasonable. Azar is a former drug industry lobbyist.
Democrats said other steps may be needed if the outbreak continues to worsen.
"This may be a first step because we have issues that relate to unemployment insurance for people who are put out of work." Pelosi said as she signed the bill to send it to Trump.
"We have only about 27% of people in this country who have paid sick days. So if they have to go home what is going to happen to them and their families?" said Rep. Rosa DeLauro, D-Conn.
DeLauro said Pence responded that he would raise the issue with the president.
The bill seeks to restore $136 million that the Department of Health and Human Services cut from other accounts such as heating subsidies for the poor to battle the virus.
The legislation comes as carping over the administration's response to the outbreak is quieting down. Lawmakers in both parties had faulted a shortage of tests for the virus and contrasting messages from Trump and his subordinates. In an interview with Sean Hannity of Fox News on Wednesday, Trump downplayed the lethality of the virus, saying the World Health Organization's updated estimate of a 3.4% death rate in coronavirus cases is "a false number."
"Now you're starting to see rapid deployment of tests, which makes me feel better, quite honestly," said Rep. Raul Ruiz, D-Calif., a doctor. "I think their communications are a little better. As long as the president doesn't contradict the experts and the scientists who know what they're doing, things will get better."
Gunmen killed at least 27 people and wounded at least 55 others in Afghanistan's capital on Friday at a remembrance ceremony for a minority Shiite leader, officials said.
Heath Ministry spokesman Wahidullah Mayar said the injured had been taken to hospitals in Kabul. All of the casualties were civilians, said Interior Ministry spokesman Nasrat Rahimi.
Several prominent political leaders escaped the ceremony unhurt, including Abdullah Abdullah, the country's chief executive and a top contender in last year's presidential election.
Afghan security forces were still trying to flush the gunmen out of a half-finished apartment building, Rahimi said. Dozens of Afghan security forces had cordoned off area.
The Taliban have denied they were behind the attack, and while no one has claimed responsibility for carrying it out, Afghanistan's upstart Islamic State affiliate has declared war on the country's minority Shiites. Most of the people attending the memorial service were Shiite.
The attack came just days after the United States and the Taliban signed an ambitious peace deal that lays out a conditions-based path to the withdrawal of American forces from Afghanistan. Any U.S. troop pullout would be tied in part to promises by the Taliban to fight terrorism and IS.
Friday's ceremony was held in the mostly Shiite Dasht-e-Barchi neighborhood of the capital, Kabul.
The memorial marked 25 years since the death of Abdul Ali Mazari, the leader of Afghanistan's minority ethnic Hazaras, who are mostly Shiite Muslims. He was killed in 1995 by the Taliban as they moved to take control of Kabul, which had been destroyed by a brutal civil war among mujahedeen groups, including Mazari's.
Pope Francis on Friday accepted the resignation of a French cardinal who was convicted and then acquitted of covering up for a pedophile priest in a case that fueled a reckoning over clergy sexual abuse in France.
Lyon Cardinal Philippe Barbarin, 69, had offered to resign when the Lyon court in March 2019 first convicted him and gave him a six-month suspended sentence for failing to report the predator priest to police.
Francis declined to accept it then, saying he wanted to wait for the outcome of the appeal. He allowed Barbarin to step aside and turn the day-to-day running of the archdiocese over to his deputy.
In January, after an appeals court acquitted Barbarin, the cardinal said he would again ask Francis to accept his resignation. He said he hoped his departure would allow for the church in Lyon to "open a new chapter" with new leadership.
Francis didn't name a replacement archbishop on Friday. A brief Vatican statement merely said he had accepted the resignation. At 69, Barbarin is six years shy of the normal retirement age for bishops.
Barbarin had been accused of failing to report the Rev. Bernard Preynat to civil authorities when he learned of his abuse. Preynat has confessed to abusing Boy Scouts in the 1970s and 1980s. His victims accuse Barbarin and other church authorities of covering up for him for years.
Barbarin told the appeal hearing that he followed Vatican instructions in his handling of the case.