Immunisations photos on Flickr

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Accompagner la mort des autres ne m’a pas immunisée contre l’appréhension de la croiser. Je me méfie de tous ceux qui disent que mourir s’apprend et qu’il existerait une méthode imparable pour se résoudre à l’accepter.

Vivre avec nos morts - Delphine Horvilleur

Flower seller by Ρούνες Λιου

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118 N. Maoming Rd., Shanghai

This photo was taken on 20 November 2022, before the protests broke out, before sporadic lockdowns were in place all over the city under the regular zero-Covid policy, and while urban life maintained a superficial calm. No one could have imagined that half a month later the Chinese government would, unprepared, suddenly drop all restrictions in a malicious manner to artificially encourage mass contagion in an attempt to achieve the goal of immunisation of the population within two or three months - even though it might not actually be achieved.

Lilies in morning sunlight by Mr Joel's Photography

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I photographed the flowers on our North-facing window ledge with my Fujifilm X-T3 camera.

Software used:

Capture One Fujifilm Express for RAR conversion to a Tiff.

Lightroom 5

Photoshop Elements 11 for re-sizing and adding my logo.

I haven't taken many photos so far with this camera, which I bought nearly-new from eBay, shortly before Covid 19 lockdown. I'm looking forward to the time when this nightmare is over, following mass immunisation of everyone. :-)

Dans le secteur des herpestidés @Biotropica by Philippe HELLOIN

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. Les herpestidés constituent une famille de carnivores féliformes et comportent des espèces comme les mangoustes et les suricates(clichés demain)

Les herpestidés ont une face et un corps allongés, des oreilles petites et rondes, des pattes courtes et une queue longue et effilée. La plupart sont tachetées ou grisonnantes ; un petit nombre a une fourrure bien marquée. Leurs griffes ne sont pas rétractiles et elles les utilisent surtout pour creuser la terre.

Moins diversifiées que les viverridés, cette sous-famille regroupe une trentaine d'espèces africaines et asiatiques vivant dans des habitats divers qui vont des forêts ouvertes aux savanes, aux régions semi-arides et aux déserts. Elles sont principalement terrestres, mais quelques-unes sont aquatiques ou semi-arboricoles.

Certaines mangoustes sont immunisées contre les toxines de beaucoup de serpents .......

A la fois prédateur et prédaté, la mangouste naine est une acteur complexe de la chaine alimentaire.

Comme beaucoup de prédateurs, elle peut être dévorée à son tour par des rapaces ou d’autres prédateurs affamés.

Les mangoustes naines et certains calaos entretiennent d’excellentes relations.

Pendant que les mangoustes chassent, les calaos les alertent en cas de danger.

En retour, les calaos se régalent des petites proies débusquées par les mangoustes lors de leurs actives recherches d’insectes;

Poids 300 g taille 30 cm se nourrit de insectes, œufs, petits vertébrés est dépendant(e) de la mère > 2 mois

vit en Afrique où elle est abondante

Je suis incertain quant à l'identification de ce cliché , en comparant avec les mangoustes que j'ai pu cotoyer en Afrique ( elles sont vite familières et très curieuses de tout)qui étaient des mangoustes à rayures.

Je pense d'avantage à un suricate comme le suggère Raymonde...voir ressemblance avec clichés de demain

246. Killing time by In Memoriam: Eiona R

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This should have been Save the Date until I realised that I’d chosen a watch which doesn’t have a date on it. However thanks to the Welsh Govt’s immunisation rollout, I’ll be going for my Covid Autumn Booster Covid Vacc later on…

gov.wales/autumn-booster-invitations-issued-eligible-adul...

TTT #5... 259365 by palo

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Tiny Travel Tip #5

If traveling abroad check to see if you need any vaccinations ... even if you don't like needles ... and take out medical insurance .. making sure you advise the company of any existing health problems otherwise you may not be covered in the event of an illness abroad.

... but Palo what about rabies, malaria, tetanus, cholera, yellow fever, diphtheria ... and there's a million more ...

- well Tiny you don't need to get a needle for all those things just because you are traveling it depends on where we are going ...

... phew

259/365 Toy Project

259/365 One Object 365 Project

Smiles are highly contagious by Steve Taylor

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Remember do not get immunised today

17 May 2021: Ghent finds back its hustle and bustle now that the positive Corona news continues… by RudyMareelPhotography

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17 May 2021: The coronavirus figures continue to fall. During the week from 7 to 13 May an average of 2,267 people in Belgium tested positive for coronavirus each day. This is down 24% on the average for the previous week. There are currently 1,813 patients with COVID-19 being cared for in Belgian hospitals, a fall of 16% on the figures from a week ago. Of those in hospital, 622 are on intensive care wards. The positivity rate is 6% and the reproduction number stands at 0.91. On Friday 14 May 3,851,216 people had already received their first dose of coronavirus vaccine. This is 41.9% of the adult population. Of these 1,277,779 are fully immunised against coronavirus. The Flemish Health Minister announced yesterday that he expects that the vaccination campaign in Flanders will have been completed by mid-August. By then everyone that wishes to be vaccinated will have been given the necessary two vaccine doses (or single dose if the Johnson and Johnson vaccine is used). He added that he also aims to offer all 16- and 17-year-olds in Flanders a coronavirus vaccine by 11 July. Ghent finds back its hustle and bustle now that the positive Corona news continues… - Ghent, Belgium

12 June 2021: We are emerging out of the darkness into the light… by RudyMareelPhotography

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12 June 2021: A recent study carried out by Sciensano, the Belgian public health institute, has found that the coronavirus vaccines are proving highly effective. The study found that no more that 3 out of every 1,000 people that had already been fully immunised became infected with the coronavirus. Moreover, of these 2 out 3 showed no symptoms. There is more good news… From Wednesday, 16 June Belgium, as one of the first European countries, will start issuing the European Digital COVID Certificate. It will be issued to people that have been fully immunised for at least two weeks, have had and recovered from coronavirus within the past 6 months or have had a PCR test and tested negative for coronavirus prior to their departure. The only worrying news is that whilst the British variant is still dominant in Belgium, the more infectious Indian variant (delta variant) is gaining ground. Last week it accounted for 1.3% of all infections, this is 3.9% this week. Meanwhile, the corona figures continue to fall sharply. There are currently 820 COVID-19 patients being cared for in Belgian hospitals; of those hospitalised 302 are on intensive care wards. During the week from 2 to 8 June an average of 1,078 people in Belgium tested positive for the coronavirus. This is 37% down on the figures from the previous week. The positivity rate dropped to 3.3 and the reproductive rate fell to 0.83. Finally, it looks like we are emerging out of the darkness into the light… Tweebruggenstraat, Ghent, Belgium.

6 June 2021: Whilst I’m awaiting my second jab I continue to document Ghent’s streetart… by RudyMareelPhotography

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There have been mixed reactions to yesterday’s announcements by the government of the changes to the coronavirus regulation which consisted generally of a lifting of restrictions. Whilst the hospitality and travel industry welcomed the decisions, healthcare professionals expressed concerns that too many measures are relaxed at the same time and that there is a chance that the relaxations are going too fast compared to the number of vaccinations. Their main concern is a potential surge of the Delta variant, formerly known as the India variant. They are basically okay with the things that are allowed in open air but are finding indoor activities too risky and are hoping that people will remain careful. Otherwise, they are afraid we will see an increase again from the end of June, which is predicted by the statisticians. Meanwhile, the number of people with the virus that are being hospitalised continues to fall. There are currently 1,007 COVID-19 patients being cared for in Belgian hospitals; of those hospitalised 341 are on intensive care wards. During the week from 27 to 2 June an average of 1,578 people in Belgium tested positive for the coronavirus. This is 15% down on the figures for the previous week. The positivity rate remains at 0.44 and the reproductive rate is slightly up to 0.87. On Thursday 3 June (the latest date for which figures are available) 4,882,939 had been given their first dose of coronavirus vaccine. This is 53% of the adult population. Of these 2,351,884 are fully immunised. On display today is another mural from Dok Noord – Ghent, Belgium.

Face of 2020 by Rashmi

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The face of 2020 will haunt us for a long time to come. We were true to these times of fear and courage, despair and hope, helplessness and help. But above all it has been a time when we had nothing to prove but fidelity to the spirit of holding on. Kipling could not have been more proud.

“If you can make one heap of all your winnings

And risk it on one turn of pitch-and-toss,

And lose, and start again at your beginnings

And never breathe a word about your loss;

If you can force your heart and nerve and sinew

To serve your turn long after they are gone,

And so hold on when there is nothing in you

Except the Will which says to them: ‘Hold on!’

As the priority of privileges goes, she and her family may be a long way from getting immunised. But then may be as nature’s priorities go, they may develop herd immunity sooner than science comes to their rescue.

I have seen several such faces, some of them I have shared on Flickr. I am thankful to you for showing support, encouragement and hope.

I have received heart warming responses to my rather scattered gallery of nature and birds and streets.

Fabulous work from Francesc Candel, www.flickr.com/photos/141453264@N07/, Pascal Reiemann, www.flickr.com/photos/95566715@N08/, Nancy Charlton , www.flickr.com/photos/32927502@N07/, has kept me inspired. If it was not for the generosity and kindness of @Leon Van Kemenade, @Jeanne @Paul Gallagher @RavenXXIII @Jean-Marc Depreux Raven, @Laszlo Bacs @James R. Page, @ Eduardo Vales, @robert moushi I would have been but a dull photographer. Your own work is so wonderful, I have learnt many a line and light from you.

With hope in my heart and a little mist in my eyes, my heart-felt thanks to all of you my dear Flickr friends for showing me how to hold on!

A Distraction by Grantmasters

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Something completely different for my photostream.

Acquired immunity - the only way to be sure.

Emilie ... by Hélio Phil

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Emilie ,ma raison de vivre , a strictement respecté le confinement , elle n'est sortie qu'une seule foi pour faire ses courses il y a deux semaines...

Bien sûr , comme tout Français de base (ceux qui ne sont rien...) , elle n'avait ni masque , ni gel ...

Et malgré un maximum de précautions (elle est tout de même prof de microbiologie...) , elle a été contaminée ...

Elle est maintenant en phase descendante de la maladie , et grâce à sa jeunesse , sa vie saine ( ni tabac ni alcool ), aucun surpoids vu qu'elle est une grande sportive , tout s'est passé en confinement , pas d'hôpital...

Elle va donc , en théorie , se trouver en position idéale , puisqu'elle devrait être immunisée contre le Covid 19... (mais il semblerait qu'il mute déjà...)

La cage qui enserrait ma poitrine se desserre progressivement...

Injecting some reality 15/30 by Ralph Rayner

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Off to be Covid-19 immunised today. It took a while as there were a lot of people queueing to go through the cattle sheds. The irony! I feel much better now that the nanobots are working with the 5G signal.

Must D-E-S-T-R-O...... oh no!

Tuberculosis & BCG by ioannis_papachristos

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A composite artistic illustration of three empty beds inside a deserted sanatorium. On one bed there are three doses of « vaccin BCG pour immunisation des nouveau-nés » (BCG vaccine for immunization of newborns); they were produced in 1931 by Institut Pasteur de Paris. Vivien Leigh’s face emerges as an ethereal reminder of the famous star’s death of tuberculosis.

In the past, physicians knew their patients didn’t even want to hear the name of their dreadful diagnosis, so they avoided saying it in full; they used the “TB” abbreviation instead. Tuberculosis (aka Consumption or Phthisis) was uniformly fatal and contagious and a social stigma, all at the same time! Almost half the pages of many medical textbooks were dedicated to this disease, as if Tuberculosis were the leading star amidst all other infections.

Notorious failures ensued from erroneous attempts to treat the disease by compulsory bedrest, being admitted to high-altitude sanatoria, collapse-therapy and the like. Even bloodletting was once advertised for treating tuberculosis!

It was only in the 1950s that effective medication was introduced for treatment (streptomycin discovered in 1944, isoniazid in 1952, rifampicin later etc.).

“Bacille de Calmette-Guérin” (B.C.G.) is the name of the vaccine against tuberculosis; it was introduced in 1921, after being developed over a period of 13 years (1908-1921). BCG is produced from a weakened strain of Mycobacterium bovis. The vaccine can prevent some rare and extremely-rapidly progressing forms of tuberculosis (such as tuberculous meningitis and miliary dissemination via the bloodstream) in newborn babies and infants, if administered 6 weeks after birth rather than at the traditional age of 13 years. The BCG vaccine produces almost lifelong cellular immunity and, consequently, diminishes the diagnostic value of tuberculin tests (e.g. Mantoux) for the rest of the vaccinated persons’ lives.

BCG-vaccinated persons can be affected by Pulmonary Tuberculosis all right (and die of it, if left undiagnosed or untreated) as much as unvaccinated adults can. The introduction of the BCG vaccine in 1921 didn’t impede the spread of tuberculosis in the world; effective antituberculous antibiotics did in the 1950s!

Currently, cases of Multi-Drug Resistant Tuberculosis are very challenging to treat especially in immunocompromised patients. Modern-day physicians are less experienced and less familiarized with diagnosing tuberculosis either in the lab or in the clinical setting.

dans le domaine des mangoustes by Philippe HELLOIN

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. Les herpestidés constituent une famille de carnivores féliformes et comportent des espèces comme les mangoustes et les suricates(clichés demain). Ces deux espèces sont présentes à Biotropica ....

Certaines mangoustes sont immunisées contre les toxines de beaucoup de serpents .......

A la fois prédateur et prédaté, la mangouste naine est une acteur complexe de la chaine alimentaire.

Comme beaucoup de prédateurs, elle peut être dévorée à son tour par des rapaces ou d’autres prédateurs affamés.

Ce cliché remplace (un précédent de Biotropica mal identifié )par un cliché des nombreuses mangoustes qui tentaient de visiter nos tentes en Afrique ( elles sont vite familières et très curieuses de tout)

Merci Raymonde d'avoir attiré mon attention..

Doggie Immunisations coming up by Christine

Daily Dog Challenge: Protection

Kahn & Etta are waiting for the Vet to give them their Kennel Cough Immunisation squirt up the nose. They don't mind because they get a treat along with it :)

Clive's vegetable garden cake ~ stressful for all the wrong reasons! ^**^ by the-icing-on-the-cake. (Jo)

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This cake was for Clive's surprise 60th birthday party! - Here he is in his rather well tended to vegetable garden!

I was getting rather stressed making this cake! - I very nearly decided to deliver a plain white cake and in true 'the Emperor’s clothes style' say it WAS a garden... but it snowed!.

I was stressed - not least because as I prepared to decorate it my husband decided that now was the time to give the cat his worming pill! - Great sense of timing husbands have! - So, me being a nurse!?! was asked to help! - I mean yes, I do give 4 year olds their pre-school booster immunisations, but hey, 4 year olds don't have teeth and claws! (well most don't!).

4 year olds cannot give you the look of sheer horror as they are held tightly with a chunky finger of DH being rammed down their throat either!

I could feel my blood pressure rising and almost steam coming out of my ears by the time we retreaved the pill from the floor for the 3rd time, so I gave up and let the cat go.

I mashed the now very sticky tablet into a paste and hid it in some cooked chicken chunks.

I sat and hand fed some unadulterated chicken to the somewhat terrified cat whilst sat under the dining room table with him. Just as I thought I had lulled him into a false sense of security I made a bid for completion of 'operation worm' by handing him the poison chalice! - yes the piece of chicken laced with no doubt some foul tasting anti-worm medication.

Well, I was spotted - it was unceremoniously spat back at me ... undaunted I offered another piece of chicken, a nice one this time.... and what did I get for my trouble?! - a side swipe from a front paw -and an 'if you think I'm taking poisoned poultry from you, you can think again' look.

Undeterred I offered another piece of chicken - and got side swiped again - bearing in mind I'm still sat under the dining table with the cat!....

... I decide to make a cup of tea and call in reinforcements....

DH comes back in ... I head upstairs to get the secret weapon...

.... My cat (Beaker) has always been fascinated with bags and boxes only marginally big enough to house him ... so I knew he wouldn't resist getting into an empty rucksack.... 3,2,1.... Yep he got in.

I zipped it up.

It wriggled A LOT!. (I wondered if the saying you have to be cruel to be kind was coined for this very occasion…)

I unzipped it slightly until a head popped though the opening.

I zipped it shut again! - so just a head stuck out! - I glanced at my DH - by now we had both seen the funny side of our predicament and casting hilarity aside got on with the job in hand...

Ah-ha - we now had a rucksack, albeit a squirming rucksack, this one has teeth but no claws!.

I took the top jaw, DH took the bottom jaw, and we opened inserted tablet and most of DH's fist! - and hurrah! - tablet was delivered!! ....

... At least we think it was. I will no doubt find it in days to come somewhere in the lounge…

… Never again will I look upon a parent with scorn as they attempt to hold their squirming 4 year old still for me to stick a needle in its arm!.

Beaker is going to the vets for his next worming tablet! … no amount of nursing qualifications will tempt me to try the impossible again!

(anyone noticing the writing style will know I am the biggest fan of Deric Longden!!) LOL!

Return To Innocence II by Ragstatic

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Explored #221. Thank You

Needed some sanity check ! after all the Blending & HDR work, decided to have an immunisation shot :-) . Portraits are not exactly my forte....will soon be heading into "performances/arts photography"

This was shot at Hmong Tribal Village , Chiang Mai, Thailand. She did'nt pose. No Flash. The light was low as she was in a sheltered area.

Hopefully after a couple of single expousres, will be back with some regular programming ;-)

Where's our vaccine??? Wo ist unser Impfstoff??? by Bonzo Din

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Amid discussions about production shortfalls and shortages of vaccine - and possible tricky dealings - Mrs Din and I were mildly surprised on a recent "corona" walk in our neighbourhood to find this building large as life looking down upon us.

The inscription (in majestic majuscules) reads:

"INSTITUTION FOR THE PRODUCTION OF VACCINES."

Well, there you have it!!! And where are the goods??? Who needs Biontech, Moderna, Astra Zeneca and whatever they may call themselves? We, here in little old working-class Ottakring, on the outskirts of Vienna and of the Western World, have our own Royal Imperial vaccine production!!!

Yes, "majestic" is the word! The building dates from the days of the Austro-Hungarian Empire, and the Emperor's Coat of Arms (the double-headed eagle looking east and west) graces the entrance. How long it has been since vaccines were actually produced here, I don't know, but apparently there are older people around and about who can remember being vaccinated here as children. Tuberculosis ("the Viennese Disease") was a major problem in the city well into the twentieth century. This however was fought not only with vaccine, but with Vienna's exemplary community housing projects of the 1920s and the accompanying social services, hygienic measures, medical care, education etc., which resulted from the wise planning of Vienna's Socialist City Council , known as "Das Rote Wien" (Red Vienna).

Currently the building houses the "A.G.E.S." - an institute which oversees the pharmaceutical market in Austria. One of their current responsibilities is to collect data on the spread of Covid-19 and to provide statistics to the government.

Ronyi the Reclined. by Paul Smith

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Our handsome (but extremely naughty) cat Ronyi in our garden at Villa Taman Damai (Ubud, Bali).

Ronyi was taken in as a kitten after being found meowing in trash at the side of the road. He was taken in only a few weeks after our previous cat Boddah was sadly killed by a motorist.

Ronyi has been sterilised and immunised, something that does not occur often enough in Bali and we hope that our neighbours will follow our lead.

Spring on the way by buckaroo kid

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So we've been in lockdown now, with a couple of breaks, for the best part of a year. This morning i was just vaccine -d. Who knows what's next, but at least these daffs remind me that Spring might be on its way at last.

Post-immunisation by Haris Abdul Rahman

cof

Fée visiteuse by Françoise

Vous croyez aux fées?

Avec Maïa nous en avons trouvé plusieurs dans l'appartement. Dont celle-ci qui est venue nous rendre visite.

Si si...les fées sont immunisées contre les virus humains, donc aucun danger.

Celle-ci était venue me porter un message-question d'ami, qu'elle avait récupéré la nuit dernière sur une plume de tourterelle. Et ce message me disait:

A ton avis, qui a suspendu la lune?

Le genre de devinette pas facile du tout...Alors, dans ma grande ignorance, j'ai interrogé le livre Les fées et j'ai découvert, tenez-vous bien, que c'était le tout premier marchand de sable qui s'était chargé de l'opération. L'ancêtre de Gregor, quoi!

Et vous savez pourquoi il l'a suspendue?

Pour permettre à tous et à toutes de l'admirer et de profiter de ses bienfaits. Sinon, il se serait toujours trouvé un humain pour prétendre qu'il en était le seul propriétaire. Malin, le marchand de sable!

J'ai donc glissé ma réponse sur plusieurs plumes et duvets, confié le tout à la fée...J'ose espérer que mon message parviendra sans encombre à destination.

La lune, elle est utile à tous pour les marées, les changements de saison, le jardinage, et même pour couper les arbres.

Si...c'est Joseph qui nous le dit. Et il sait de quoi il cause:

www.youtube.com/watch?v=70vv3SpOEyo

Post-immunisation by Haris Abdul Rahman

Blogged here.

virus by Lars Schleicher

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Coronavirus disease 2019...Passive antibodies... immune systems... antibody-dependent cellular cytotoxicity...Sex differences...Gendered impact of the pandemic and mortality rates are different for men and women. by Hughes Songe

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[8] The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic.[9][10] As of 26 April 2020, more than 2.89 million cases have been reported across 185 countries and territories, resulting in more than 203,000 deaths. More than 822,000 people have recovered.[7]

Common symptoms include fever, cough, fatigue, shortness of breath and loss of smell.[5][11][12] While the majority of cases result in mild symptoms, some progress to viral pneumonia, multi-organ failure, or cytokine storm.[13][9][14] More concerning symptoms include difficulty breathing, persistent chest pain, confusion, difficulty waking, and bluish skin.[5] The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days.[5][15]

The virus is primarily spread between people during close contact,[a] often via small droplets produced by coughing,[b] sneezing, or talking.[6][16][18] The droplets usually fall to the ground or onto surfaces rather than remaining in the air over long distances.[6][19][20] People may also become infected by touching a contaminated surface and then touching their face.[6][16] In experimental settings, the virus may survive on surfaces for up to 72 hours.[21][22][23] It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease.[24] The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.[25] Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using it for routine screening.[26][27]

Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), covering coughs, and keeping unwashed hands away from the face.[28][29] In addition, the use of a face covering is recommended for those who suspect they have the virus and their caregivers.[30][31] Recommendations for face covering use by the general public vary, with some authorities recommending against their use, some recommending their use, and others requiring their use.[32][31][33] Currently, there is not enough evidence for or against the use of masks (medical or other) in healthy individuals in the wider community.[6] Also masks purchased by the public may impact availability for health care providers.

Currently, there is no vaccine or specific antiviral treatment for COVID-19.[6] Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.[34] The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC)[35][36] on 30 January 2020 and a pandemic on 11 March 2020.[10] Local transmission of the disease has occurred in most countries across all six WHO regions.[37]

File:En.Wikipedia-VideoWiki-Coronavirus disease 2019.webm

Video summary (script)

Contents

1Signs and symptoms

2Cause

2.1Transmission

2.2Virology

3Pathophysiology

3.1Immunopathology

4Diagnosis

4.1Pathology

5Prevention

6Management

6.1Medications

6.2Protective equipment

6.3Mechanical ventilation

6.4Acute respiratory distress syndrome

6.5Experimental treatment

6.6Information technology

6.7Psychological support

7Prognosis

7.1Reinfection

8History

9Epidemiology

9.1Infection fatality rate

9.2Sex differences

10Society and culture

10.1Name

10.2Misinformation

10.3Protests

11Other animals

12Research

12.1Vaccine

12.2Medications

12.3Anti-cytokine storm

12.4Passive antibodies

13See also

14Notes

15References

16External links

16.1Health agencies

16.2Directories

16.3Medical journals

Signs and symptoms

Symptom[4]Range

Fever83–99%

Cough59–82%

Loss of Appetite40–84%

Fatigue44–70%

Shortness of breath31–40%

Coughing up sputum28–33%

Loss of smell15[38] to 30%[12][39]

Muscle aches and pains11–35%

Fever is the most common symptom, although some older people and those with other health problems experience fever later in the disease.[4][40] In one study, 44% of people had fever when they presented to the hospital, while 89% went on to develop fever at some point during their hospitalization.[4][41]

Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains.[4][5][42][43] Symptoms such as nausea, vomiting and diarrhoea have been observed in varying percentages.[44][45][46] Less common symptoms include sneezing, runny nose, or sore throat.[47]

More serious symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking, and bluish face or lips. Immediate medical attention is advised if these symptoms are present.[5][48]

In some, the disease may progress to pneumonia, multi-organ failure, and death.[9][14] In those who develop severe symptoms, time from symptom onset to needing mechanical ventilation is typically eight days.[4] Some cases in China initially presented with only chest tightness and palpitations.[49]

Loss of smell was identified as a common symptom of COVID‑19 in March 2020,[12][39] although perhaps not as common as initially reported.[38] A decreased sense of smell and/or disturbances in taste have also been reported.[50] Estimates for loss of smell range from 15%[38] to 30%.[12][39]

As is common with infections, there is a delay between the moment a person is first infected and the time he or she develops symptoms. This is called the incubation period. The incubation period for COVID‑19 is typically five to six days but may range from two to 14 days,[51][52] although 97.5% of people who develop symptoms will do so within 11.5 days of infection.[53]

A minority of cases do not develop noticeable symptoms at any point in time.[54][55] These asymptomatic carriers tend not to get tested, and their role in transmission is not yet fully known.[56][57] However, preliminary evidence suggests they may contribute to the spread of the disease.[58][59] In March 2020, the Korea Centers for Disease Control and Prevention (KCDC) reported that 20% of confirmed cases remained asymptomatic during their hospital stay.[59][60]

A number of neurological symptoms has been reported including seizures, stroke, encephalitis and Guillain-Barre syndrome.[61] Cardiovascular related complications may include heart failure, irregular electrical activity, blood clots, and heart inflammation.[62]

Cause

See also: Severe acute respiratory syndrome coronavirus 2

Transmission

Cough/sneeze droplets visualised in dark background using Tyndall scattering

Respiratory droplets produced when a man is sneezing visualised using Tyndall scattering

File:COVID19 in numbers- R0, the case fatality rate and why we need to flatten the curve.webm

A video discussing the basic reproduction number and case fatality rate in the context of the pandemic

Some details about how the disease is spread are still being determined.[16][18] The WHO and the U.S. Centers for Disease Control and Prevention (CDC) say it is primarily spread during close contact and by small droplets produced when people cough, sneeze or talk;[6][16] with close contact being within approximately 1–2 m (3–7 ft).[6][63] Both sputum and saliva can carry large viral loads.[64] Loud talking releases more droplets than normal talking.[65] A study in Singapore found that an uncovered cough can lead to droplets travelling up to 4.5 metres (15 feet).[66] An article published in March 2020 argued that advice on droplet distance might be based on 1930s research which ignored the effects of warm moist exhaled air surrounding the droplets and that an uncovered cough or sneeze can travel up to 8.2 metres (27 feet).[17]

Respiratory droplets may also be produced while breathing out, including when talking. Though the virus is not generally airborne,[6][67] the National Academy of Sciences has suggested that bioaerosol transmission may be possible.[68] In one study cited, air collectors positioned in the hallway outside of people's rooms yielded samples positive for viral RNA but finding infectious virus has proven elusive.[68] The droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.[16] Some medical procedures such as intubation and cardiopulmonary resuscitation (CPR) may cause respiratory secretions to be aerosolised and thus result in an airborne spread.[67] Initial studies suggested a doubling time of the number of infected persons of 6–7 days and a basic reproduction number (R0 ) of 2.2–2.7, but a study published on April 7, 2020, calculated a much higher median R0 value of 5.7 in Wuhan.[69]

It may also spread when one touches a contaminated surface, known as fomite transmission, and then touches one's eyes, nose or mouth.[6] While there are concerns it may spread via faeces, this risk is believed to be low.[6][16]

The virus is most contagious when people are symptomatic; though spread is may be possible before symptoms emerge and from those who never develop symptoms.[6][70] A portion of individuals with coronavirus lack symptoms.[71] The European Centre for Disease Prevention and Control (ECDC) says while it is not entirely clear how easily the disease spreads, one person generally infects two or three others.[18]

The virus survives for hours to days on surfaces.[6][18] Specifically, the virus was found to be detectable for one day on cardboard, for up to three days on plastic (polypropylene) and stainless steel (AISI 304), and for up to four hours on 99% copper.[21][23] This, however, varies depending on the humidity and temperature.[72][73] Surfaces may be decontaminated with many solutions (with one minute of exposure to the product achieving a 4 or more log reduction (99.99% reduction)), including 78–95% ethanol (alcohol used in spirits), 70–100% 2-propanol (isopropyl alcohol), the combination of 45% 2-propanol with 30% 1-propanol, 0.21% sodium hypochlorite (bleach), 0.5% hydrogen peroxide, or 0.23–7.5% povidone-iodine. Soap and detergent are also effective if correctly used; soap products degrade the virus' fatty protective layer, deactivating it, as well as freeing them from the skin and other surfaces.[74] Other solutions, such as benzalkonium chloride and chlorhexidine gluconate (a surgical disinfectant), are less effective.[75]

In a Hong Kong study, saliva samples were taken a median of two days after the start of hospitalization. In five of six patients, the first sample showed the highest viral load, and the sixth patient showed the highest viral load on the second day tested.[64]

Virology

Main article: Severe acute respiratory syndrome coronavirus 2

Illustration of SARSr-CoV virion

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.[76] All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature.[77] Outside the human body, the virus is killed by household soap, which bursts its protective bubble.[26]

SARS-CoV-2 is closely related to the original SARS-CoV.[78] It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13).[47] In February 2020, Chinese researchers found that there is only one amino acid difference in the binding domain of the S protein between the coronaviruses from pangolins and those from humans; however, whole-genome comparison to date found that at most 92% of genetic material was shared between pangolin coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be the intermediate host.[79]

Pathophysiology

The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell.[80] The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested that decreasing ACE2 activity might be protective,[81][82] though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective and these hypotheses need to be tested.[83] As the alveolar disease progresses, respiratory failure might develop and death may follow.[82]

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium[84] as well as endothelial cells and enterocytes of the small intestine.[85]

ACE2 is present in the brain, and there is growing evidence of neurological manifestations in people with COVID‑19. It is not certain if the virus can directly infect the brain by crossing the barriers that separate the circulation of the brain and the general circulation. Other coronaviruses are able to infect the brain via a synaptic route to the respiratory centre in the medulla, through mechanoreceptors like pulmonary stretch receptors and chemoreceptors (primarily central chemoreceptors) within the lungs.[medical citation needed] It is possible that dysfunction within the respiratory centre further worsens the ARDS seen in COVID‑19 patients. Common neurological presentations include a loss of smell, headaches, nausea, and vomiting. Encephalopathy has been noted to occur in some patients (and confirmed with imaging), with some reports of detection of the virus after cerebrospinal fluid assays although the presence of oligoclonal bands seems to be a common denominator in these patients.[86]

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system.[87] An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China,[88] and is more frequent in severe disease.[89] Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart.[87] ACE2 receptors are highly expressed in the heart and are involved in heart function.[87][90] A high incidence of thrombosis (31%) and venous thromboembolism (25%) have been found in ICU patients with COVID‑19 infections and may be related to poor prognosis.[91][92] Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in patients infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside with the presentation of viral pneumonia.[93]

Another common cause of death is complications related to the kidneys[93]—SARS-CoV-2 directly infects kidney cells, as confirmed in post-mortem studies. Acute kidney injury is a common complication and cause of death; this is more significant in patients with already compromised kidney function, especially in people with pre-existing chronic conditions such as hypertension and diabetes which specifically cause nephropathy in the long run.[94]

Autopsies of people who died of COVID‑19 have found diffuse alveolar damage (DAD), and lymphocyte-containing inflammatory infiltrates within the lung.[95]

Immunopathology

Although SARS-COV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, patients with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.[96]

Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.[97]

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in COVID‑19 patients.[98] Lymphocytic infiltrates have also been reported at autopsy.[95]

Diagnosis

Main article: COVID-19 testing

Demonstration of a nasopharyngeal swab for COVID-19 testing

CDC rRT-PCR test kit for COVID-19[99]

The WHO has published several testing protocols for the disease.[100] The standard method of testing is real-time reverse transcription polymerase chain reaction (rRT-PCR).[101] The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used.[25][102] Results are generally available within a few hours to two days.[103][104] Blood tests can be used, but these require two blood samples taken two weeks apart, and the results have little immediate value.[105] Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the world could independently develop polymerase chain reaction (PCR) tests to detect infection by the virus.[9][106][107] As of 4 April 2020, antibody tests (which may detect active infections and whether a person had been infected in the past) were in development, but not yet widely used.[108][109][110] The Chinese experience with testing has shown the accuracy is only 60 to 70%.[111] The FDA in the United States approved the first point-of-care test on 21 March 2020 for use at the end of that month.[112]

Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying people who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected people: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count.[113]

A study asked hospitalised COVID‑19 patients to cough into a sterile container, thus producing a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has the potential of being quicker than a swab and involving less risk to health care workers (collection at home or in the car).[64]

Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening.[26][27] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection.[26] Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses.[26][114]

In late 2019, WHO assigned the emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID‑19 without lab-confirmed SARS-CoV-2 infection.[115]

Typical CT imaging findings

CT imaging of rapid progression stage

Pathology

Few data are available about microscopic lesions and the pathophysiology of COVID‑19.[116][117] The main pathological findings at autopsy are:

Macroscopy: pleurisy, pericarditis, lung consolidation and pulmonary oedema

Four types of severity of viral pneumonia can be observed:

minor pneumonia: minor serous exudation, minor fibrin exudation

mild pneumonia: pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

severe pneumonia: diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

healing pneumonia: organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL[118]

Blood: disseminated intravascular coagulation (DIC);[119] leukoerythroblastic reaction[120]

Liver: microvesicular steatosis

Prevention

See also: 2019–20 coronavirus pandemic § Prevention, flatten the curve, and workplace hazard controls for COVID-19

Progressively stronger mitigation efforts to reduce the number of active cases at any given time—known as "flattening the curve"—allows healthcare services to better manage the same volume of patients.[121][122][123] Likewise, progressively greater increases in healthcare capacity—called raising the line—such as by increasing bed count, personnel, and equipment, helps to meet increased demand.[124]

Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of distancing rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation.[122][125]

Preventive measures to reduce the chances of infection include staying at home, avoiding crowded places, keeping distance from others, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.[126][127][128] The CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available.[126] Proper hand hygiene after any cough or sneeze is encouraged.[126] The CDC has recommended the use of cloth face coverings in public settings where other social distancing measures are difficult to maintain, in part to limit transmission by asymptomatic individuals.[129] The U.S. National Institutes of Health guidelines do not recommend any medication for prevention of COVID‑19, before or after exposure to the SARS-CoV-2 virus, outside of the setting of a clinical trial.[130]

Social distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel, and cancelling large public gatherings.[131] Distancing guidelines also include that people stay at least 6 feet (1.8 m) apart.[132] There is no medication known to be effective at preventing COVID‑19.[133] After the implementation of social distancing and stay-at-home orders, many regions have been able to sustain an effective transmission rate ("Rt") of less than one, meaning the disease is in remission in those areas.[134]

As a vaccine is not expected until 2021 at the earliest,[135] a key part of managing COVID‑19 is trying to decrease the epidemic peak, known as "flattening the curve".[122] This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.[122][125]

According to the WHO, the use of masks is recommended only if a person is coughing or sneezing or when one is taking care of someone with a suspected infection.[136] For the European Centre for Disease Prevention and Control (ECDC) face masks "... could be considered especially when visiting busy closed spaces ..." but "... only as a complementary measure ..."[137] Several countries have recommended that healthy individuals wear face masks or cloth face coverings (like scarves or bandanas) at least in certain public settings, including China,[138] Hong Kong,[139] Spain,[140] Italy (Lombardy region),[141] and the United States.[129]

Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.[30][142] The CDC also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose, coughing or sneezing. It further recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available.[126]

For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.[143]

Prevention efforts are multiplicative, with effects far beyond that of a single spread. Each avoided case leads to more avoided cases down the line, which in turn can stop the outbreak in its tracks.

File:COVID19 W ENG.ogv

Handwashing instructions

Management

People are managed with supportive care, which may include fluid therapy, oxygen support, and supporting other affected vital organs.[144][145][146] The CDC recommends that those who suspect they carry the virus wear a simple face mask.[30] Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.[41][147] Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity.[148] Supportive treatments may be useful in those with mild symptoms at the early stage of infection.[149]

The WHO, the Chinese National Health Commission, and the United States' National Institutes of Health have published recommendations for taking care of people who are hospitalised with COVID‑19.[130][150][151] Intensivists and pulmonologists in the U.S. have compiled treatment recommendations from various agencies into a free resource, the IBCC.[152][153]

Medications

See also: Coronavirus disease 2019 § Research

As of April 2020, there is no specific treatment for COVID‑19.[6][133] Research is, however, ongoing. For symptoms, some medical professionals recommend paracetamol (acetaminophen) over ibuprofen for first-line use.[154][155][156] The WHO and NIH do not oppose the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for symptoms,[130][157] and the FDA says currently there is no evidence that NSAIDs worsen COVID‑19 symptoms.[158]

While theoretical concerns have been raised about ACE inhibitors and angiotensin receptor blockers, as of 19 March 2020, these are not sufficient to justify stopping these medications.[130][159][160][161] Steroids, such as methylprednisolone, are not recommended unless the disease is complicated by acute respiratory distress syndrome.[162][163]

Medications to prevent blood clotting have been suggested for treatment,[91] and anticoagulant therapy with low molecular weight heparin appears to be associated with better outcomes in severe COVID‐19 showing signs of coagulopathy (elevated D-dimer).[164]

Protective equipment

See also: § Research

Research into potential treatments started in January 2020,[182] and several antiviral drugs are in clinical trials.[183][184] Remdesivir appears to be the most promising.[133] Although new medications may take until 2021 to develop,[185] several of the medications being tested are already approved for other uses or are already in advanced testing.[186] Antiviral medication may be tried in people with severe disease.[144] The WHO recommended volunteers take part in trials of the effectiveness and safety of potential treatments.[187]

The FDA has granted temporary authorisation to convalescent plasma as an experimental treatment in cases where the person's life is seriously or immediately threatened. It has not undergone the clinical studies needed to show it is safe and effective for the disease.[188][189][190]

Information technology

See also: Contact tracing and Government by algorithm

In February 2020, China launched a mobile app to deal with the disease outbreak.[191] Users are asked to enter their name and ID number. The app can detect 'close contact' using surveillance data and therefore a potential risk of infection. Every user can also check the status of three other users. If a potential risk is detected, the app not only recommends self-quarantine, it also alerts local health officials.[192]

Big data analytics on cellphone data, facial recognition technology, mobile phone tracking, and artificial intelligence are used to track infected people and people whom they contacted in South Korea, Taiwan, and Singapore.[193][194] In March 2020, the Israeli government enabled security agencies to track mobile phone data of people supposed to have coronavirus. The measure was taken to enforce quarantine and protect those who may come into contact with infected citizens.[195] Also in March 2020, Deutsche Telekom shared aggregated phone location data with the German federal government agency, Robert Koch Institute, to research and prevent the spread of the virus.[196] Russia deployed facial recognition technology to detect quarantine breakers.[197] Italian regional health commissioner Giulio Gallera said he has been informed by mobile phone operators that "40% of people are continuing to move around anyway".[198] German government conducted a 48 hours weekend hackathon with more than 42.000 participants.[199][200] Two million people in the UK used an app developed in March 2020 by King's College London and Zoe to track people with COVID‑19 symptoms.[201] Also, the president of Estonia, Kersti Kaljulaid, made a global call for creative solutions against the spread of coronavirus.[202]

Psychological support

See also: Mental health during the 2019–20 coronavirus pandemic

Individuals may experience distress from quarantine, travel restrictions, side effects of treatment, or fear of the infection itself. To address these concerns, the National Health Commission of China published a national guideline for psychological crisis intervention on 27 January 2020.[203][204]

The Lancet published a 14-page call for action focusing on the UK and stated conditions were such that a range of mental health issues was likely to become more common. BBC quoted Rory O'Connor in saying, "Increased social isolation, loneliness, health anxiety, stress and an economic downturn are a perfect storm to harm people's mental health and wellbeing."[205][206]

Prognosis

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The severity of diagnosed cases in China

The severity of diagnosed COVID-19 cases in China[207]

Case fatality rates for COVID-19 by age by country.

Case fatality rates by age group:

China, as of 11 February 2020[208]

South Korea, as of 15 April 2020[209]

Spain, as of 24 April 2020[210]

Italy, as of 23 April 2020[211]

Case fatality rate depending on other health problems

Case fatality rate in China depending on other health problems. Data through 11 February 2020.[208]

Case fatality rate by country and number of cases

The number of deaths vs total cases by country and approximate case fatality rate[212]

The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.[47]

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years, and 4% aged 10-19 years.[22] They are likely to have milder symptoms and a lower chance of severe disease than adults; in those younger than 50 years, the risk of death is less than 0.5%, while in those older than 70 it is more than 8%.[213][214][215] Pregnant women may be at higher risk for severe infection with COVID-19 based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.[216][217] In China, children acquired infections mainly through close contact with their parents or other family members who lived in Wuhan or had traveled there.[213]

In some people, COVID‑19 may affect the lungs causing pneumonia. In those most severely affected, COVID-19 may rapidly progress to acute respiratory distress syndrome (ARDS) causing respiratory failure, septic shock, or multi-organ failure.[218][219] Complications associated with COVID‑19 include sepsis, abnormal clotting, and damage to the heart, kidneys, and liver. Clotting abnormalities, specifically an increase in prothrombin time, have been described in 6% of those admitted to hospital with COVID-19, while abnormal kidney function is seen in 4% of this group.[220] Approximately 20-30% of people who present with COVID‑19 demonstrate elevated liver enzymes (transaminases).[133] Liver injury as shown by blood markers of liver damage is frequently seen in severe cases.[221]

Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful in early screening for severe illness.[222]

Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease.[223] The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available for review, 97.2% of sampled patients had at least one comorbidity with the average patient having 2.7 diseases.[224] According to the same report, the median time between the onset of symptoms and death was ten days, with five being spent hospitalised. However, patients transferred to an ICU had a median time of seven days between hospitalisation and death.[224] In a study of early cases, the median time from exhibiting initial symptoms to death was 14 days, with a full range of six to 41 days.[225] In a study by the National Health Commission (NHC) of China, men had a death rate of 2.8% while women had a death rate of 1.7%.[226] Histopathological examinations of post-mortem lung samples show diffuse alveolar damage with cellular fibromyxoid exudates in both lungs. Viral cytopathic changes were observed in the pneumocytes. The lung picture resembled acute respiratory distress syndrome (ARDS).[47] In 11.8% of the deaths reported by the National Health Commission of China, heart damage was noted by elevated levels of troponin or cardiac arrest.[49] According to March data from the United States, 89% of those hospitalised had preexisting conditions.[227]

The availability of medical resources and the socioeconomics of a region may also affect mortality.[228] Estimates of the mortality from the condition vary because of those regional differences,[229] but also because of methodological difficulties. The under-counting of mild cases can cause the mortality rate to be overestimated.[230] However, the fact that deaths are the result of cases contracted in the past can mean the current mortality rate is underestimated.[231][232] Smokers were 1.4 times more likely to have severe symptoms of COVID‑19 and approximately 2.4 times more likely to require intensive care or die compared to non-smokers.[233]

Concerns have been raised about long-term sequelae of the disease. The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage.[234] This may also lead to post-intensive care syndrome following recovery.[235]

Case fatality rates (%) by age and country

Age0–910–1920–2930–3940–4950–5960–6970–7980-8990+

China as of 11 February[208]0.00.20.20.20.41.33.68.014.8

Denmark as of 25 April[236]0.24.515.524.940.7

Italy as of 23 April[211]0.20.00.10.40.92.610.024.930.826.1

Netherlands as of 17 April[237]0.00.30.10.20.51.57.623.230.029.3

Portugal as of 24 April[238]0.00.00.00.00.30.62.88.516.5

S. Korea as of 15 April[209]0.00.00.00.10.20.72.59.722.2

Spain as of 24 April[210]0.30.40.30.30.61.34.413.220.320.1

Switzerland as of 25 April[239]0.90.00.00.10.00.52.710.124.0

Case fatality rates (%) by age in the United States

Age0–1920–4445–5455–6465–7475–8485+

United States as of 16 March[240]0.00.1–0.20.5–0.81.4–2.62.7–4.94.3–10.510.4–27.3

Note: The lower bound includes all cases. The upper bound excludes cases that were missing data.

Estimate of infection fatality rates and probability of severe disease course (%) by age based on cases from China[241]

0–910–1920–2930–3940–4950–5960–6970–7980+

Severe disease0.0

(0.0–0.0)0.04

(0.02–0.08)1.0

(0.62–2.1)3.4

(2.0–7.0)4.3

(2.5–8.7)8.2

(4.9–17)11

(7.0–24)17

(9.9–34)18

(11–38)

Death0.0016

(0.00016–0.025)0.0070

(0.0015–0.050)0.031

(0.014–0.092)0.084

(0.041–0.19)0.16

(0.076–0.32)0.60

(0.34–1.3)1.9

(1.1–3.9)4.3

(2.5–8.4)7.8

(3.8–13)

Total infection fatality rate is estimated to be 0.66% (0.39–1.3). Infection fatality rate is fatality per all infected individuals, regardless of whether they were diagnosed or had any symptoms. Numbers in parentheses are 95% credible intervals for the estimates.

Reinfection

As of March 2020, it was unknown if past infection provides effective and long-term immunity in people who recover from the disease.[242] Immunity is seen as likely, based on the behaviour of other coronaviruses,[243] but cases in which recovery from COVID‑19 have been followed by positive tests for coronavirus at a later date have been reported.[244][245][246][247] These cases are believed to be worsening of a lingering infection rather than re-infection.[247]

History

Main article: Timeline of the 2019–20 coronavirus pandemic

The virus is thought to be natural and has an animal origin,[77] through spillover infection.[248] The actual origin is unknown, but by December 2019 the spread of infection was almost entirely driven by human-to-human transmission.[208][249] A study of the first 41 cases of confirmed COVID‑19, published in January 2020 in The Lancet, revealed the earliest date of onset of symptoms as 1 December 2019.[250][251][252] Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019.[253] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020.[254][255]

Epidemiology

Main article: 2019–20 coronavirus pandemic

Several measures are commonly used to quantify mortality.[256] These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health.[257]

The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 7.0% (203,044/2,899,830) as of 26 April 2020.[7] The number varies by region.[258]

Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time-bound and follow a specific population from infection through case resolution. Many academics have attempted to calculate these numbers for specific populations.[259]

Total confirmed cases over time

Total deaths over time

Total confirmed cases of COVID‑19 per million people, 10 April 2020[260]

Total confirmed deaths due to COVID‑19 per million people, 10 April 2020[261]

Infection fatality rate

Our World in Data states that as of March 25, 2020, the infection fatality rate (IFR) cannot be accurately calculated.[262] In February, the World Health Organization estimated the IFR at 0.94%, with a confidence interval between 0.37 percent to 2.9 percent.[263] The University of Oxford Centre for Evidence-Based Medicine (CEBM) estimated a global CFR of 0.72 percent and IFR of 0.1 percent to 0.36 percent.[264] According to CEBM, random antibody testing in Germany suggested an IFR of 0.37 percent there.[264] Firm lower limits to local infection fatality rates were established, such as in Bergamo province, where 0.57% of the population has died, leading to a minimum IFR of 0.57% in the province. This population fatality rate (PFR) minimum increases as more people get infected and run through their disease.[265][266] Similarly, as of April 22 in the New York City area, there were 15,411 deaths confirmed from COVID-19, and 19,200 excess deaths.[267] Very recently, the first results of antibody testing have come in, but there are no valid scientific reports based on them available yet. A Bloomberg Opinion piece provides a survey.[268][269]

Sex differences

Main article: Gendered impact of the 2019–20 coronavirus pandemic

The impact of the pandemic and its mortality rate are different for men and women.[270] Mortality is higher in men in studies conducted in China and Italy.[271][272][273] The highest risk for men is in their 50s, with the gap between men and women closing only at 90.[273] In China, the death rate was 2.8 percent for men and 1.7 percent for women.[273] The exact reasons for this sex-difference are not known, but genetic and behavioural factors could be a reason.[270] Sex-based immunological differences, a lower prevalence of smoking in women, and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men.[273] In Europe, of those infected with COVID‑19, 57% were men; of those infected with COVID‑19 who also died, 72% were men.[274] As of April 2020, the U.S. government is not tracking sex-related data of COVID‑19 infections.[275] Research has shown that viral illnesses like Ebola, HIV, influenza, and SARS affect men and women differently.[275] A higher percentage of health workers, particularly nurses, are women, and they have a higher chance of being exposed to the virus.[276] School closures, lockdowns, and reduced access to healthcare following the 2019–20 coronavirus pandemic may differentially affect the genders and possibly exaggerate existing gender disparity.[270][277]

Society and culture

Name

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus",[278][279][280] with the disease sometimes called "Wuhan pneumonia".[281][282] In the past, many diseases have been named after geographical locations, such as the Spanish flu,[283] Middle East Respiratory Syndrome, and Zika virus.[284]

In January 2020, the World Health Organisation recommended 2019-nCov[285] and 2019-nCoV acute respiratory disease[286] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species or groups of people in disease and virus names to prevent social stigma.[287][288][289]

The official names COVID‑19 and SARS-CoV-2 were issued by the WHO on 11 February 2020.[290] WHO chief Tedros Adhanom Ghebreyesus explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019).[291] The WHO additionally uses "the COVID‑19 virus" and "the virus responsible for COVID‑19" in public communications.[290] Both the disease and virus are commonly referred to as "coronavirus" in the media and public discourse.

Misinformation

Main article: Misinformation related to the 2019–20 coronavirus pandemic

After the initial outbreak of COVID‑19, conspiracy theories, misinformation, and disinformation emerged regarding the origin, scale, prevention, treatment, and other aspects of the disease and rapidly spread online.[292][293][294][295]

Protests

Beginning April 17, 2020, news media began reporting on a wave of demonstrations protesting against state-mandated quarantine restrictions in in Michigan, Ohio, and Kentucky.[296][297]

Other animals

Humans appear to be capable of spreading the virus to some other animals. A domestic cat in Liège, Belgium, tested positive after it started showing symptoms (diarrhoea, vomiting, shortness of breath) a week later than its owner, who was also positive.[298] Tigers at the Bronx Zoo in New York, United States, tested positive for the virus and showed symptoms of COVID‑19, including a dry cough and loss of appetite.[299]

A study on domesticated animals inoculated with the virus found that cats and ferrets appear to be "highly susceptible" to the disease, while dogs appear to be less susceptible, with lower levels of viral replication. The study failed to find evidence of viral replication in pigs, ducks, and chickens.[300]

Research

Main article: COVID-19 drug development

No medication or vaccine is approved to treat the disease.[186] International research on vaccines and medicines in COVID‑19 is underway by government organisations, academic groups, and industry researchers.[301][302] In March, the World Health Organisation initiated the "SOLIDARITY Trial" to assess the treatment effects of four existing antiviral compounds with the most promise of efficacy.[303]

Vaccine

Main article: COVID-19 vaccine

There is no available vaccine, but various agencies are actively developing vaccine candidates. Previous work on SARS-CoV is being used because both SARS-CoV and SARS-CoV-2 use the ACE2 receptor to enter human cells.[304] Three vaccination strategies are being investigated. First, researchers aim to build a whole virus vaccine. The use of such a virus, be it inactive or dead, aims to elicit a prompt immune response of the human body to a new infection with COVID‑19. A second strategy, subunit vaccines, aims to create a vaccine that sensitises the immune system to certain subunits of the virus. In the case of SARS-CoV-2, such research focuses on the S-spike protein that helps the virus intrude the ACE2 enzyme receptor. A third strategy is that of the nucleic acid vaccines (DNA or RNA vaccines, a novel technique for creating a vaccination). Experimental vaccines from any of these strategies would have to be tested for safety and efficacy.[305]

On 16 March 2020, the first clinical trial of a vaccine started with four volunteers in Seattle, United States. The vaccine contains a harmless genetic code copied from the virus that causes the disease.[306]

Antibody-dependent enhancement has been suggested as a potential challenge for vaccine development for SARS-COV-2, but this is controversial.[307]

Medications

Main article: COVID-19 drug repurposing research

At least 29 phase II–IV efficacy trials in COVID‑19 were concluded in March 2020 or scheduled to provide results in April from hospitals in China.[308][309] There are more than 300 active clinical trials underway as of April 2020.[133] Seven trials were evaluating already approved treatments, including four studies on hydroxychloroquine or chloroquine.[309] Repurposed antiviral drugs make up most of the Chinese research, with nine phase III trials on remdesivir across several countries due to report by the end of April.[308][309] Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.[309]

The COVID‑19 Clinical Research Coalition has goals to 1) facilitate rapid reviews of clinical trial proposals by ethics committees and national regulatory agencies, 2) fast-track approvals for the candidate therapeutic compounds, 3) ensure standardised and rapid analysis of emerging efficacy and safety data and 4) facilitate sharing of clinical trial outcomes before publication.[310][311]

Several existing medications are being evaluated for the treatment of COVID‑19,[186] including remdesivir, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and lopinavir/ritonavir combined with interferon beta.[303][312] There is tentative evidence for efficacy by remdesivir, as of March 2020.[313][314] Clinical improvement was observed in patients treated with compassionate-use remdesivir.[315] Remdesivir inhibits SARS-CoV-2 in vitro.[316] Phase III clinical trials are underway in the U.S., China, and Italy.[186][308][317]

In 2020, a trial found that lopinavir/ritonavir was ineffective in the treatment of severe illness.[318] Nitazoxanide has been recommended for further in vivo study after demonstrating low concentration inhibition of SARS-CoV-2.[316]

There are mixed results as of 3 April 2020 as to the effectiveness of hydroxychloroquine as a treatment for COVID‑19, with some studies showing little or no improvement.[319][320] The studies of chloroquine and hydroxychloroquine with or without azithromycin have major limitations that have prevented the medical community from embracing these therapies without further study.[133]

Oseltamivir does not inhibit SARS-CoV-2 in vitro and has no known role in COVID‑19 treatment.[133]

Anti-cytokine storm

Cytokine release syndrome (CRS) can be a complication in the later stages of severe COVID‑19. There is preliminary evidence that hydroxychloroquine may have anti-cytokine storm properties.[321]

Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed.[322][323] It is undergoing a phase 2 non-randomised trial at the national level in Italy after showing positive results in people with severe disease.[324][325] Combined with a serum ferritin blood test to identify cytokine storms, it is meant to counter such developments, which are thought to be the cause of death in some affected people.[326][327][328] The interleukin-6 receptor antagonist was approved by the FDA to undergo a phase III clinical trial assessing the medication's impact on COVID‑19 based on retrospective case studies for the treatment of steroid-refractory cytokine release syndrome induced by a different cause, CAR T cell therapy, in 2017.[329] To date, there is no randomised, controlled evidence that tocilizumab is an efficacious treatment for CRS. Prophylactic tocilizumab has been shown to increase serum IL-6 levels by saturating the IL-6R, driving IL-6 across the blood-brain barrier, and exacerbating neurotoxicity while having no impact on the incidence of CRS.[330]

Lenzilumab, an anti-GM-CSF monoclonal antibody, is protective in murine models for CAR T cell-induced CRS and neurotoxicity and is a viable therapeutic option due to the observed increase of pathogenic GM-CSF secreting T-cells in hospitalised patients with COVID‑19.[331]

The Feinstein Institute of Northwell Health announced in March a study on "a human antibody that may prevent the activity" of IL-6.[332]

Passive antibodies

Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID‑19 to people who need them is being investigated as a non-vaccine method of passive immunisation.[333] This strategy was tried for SARS with inconclusive results.[333] Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS-CoV-2. Other mechanisms, however, such as antibody-dependent cellular cytotoxicity and/or phagocytosis, may be possible.[333] Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.[333] Production of convalescent serum, which consists of the liquid portion of the blood from recovered patients and contains antibodies specific to this virus, could be increased for quicker deployment.[334]

en.wikipedia.org/wiki/Coronavirus_disease_2019

Union Health Ministry launches India’s 1st indigenous rotavirus vaccine Rotavac by Share GK

The Union Ministry of Health and Family Welfare launched India’s 1st indigenous rotavirus vaccine named Rotavac to combat infant mortality due to diarrhoea. It was launched by the Union Health Minister J.P. Nadda as part country’s ambitious Universal Immunisation Programme (UIP). The vaccine is b... www.sharegk.com/curent-affairs/goverment-current-affairs/...

‪#‎gk‬ ‪‪#‎EntranceExam‬ ‪#‎OnlineTest‬ ‪#‎Aptitude‬‬

Schluckimpfung / Oral vaccination by rudi_valtiner

9 4

Das Weingut Lenikus aus Grinzing, einem Weinbauort in Wien, hatte einen besonders originellen und lustigen Zugang zum Thema Impfung. Offenbar erinnerten sie sich an den "lieben Augustin", der die Pestzeit in Wien selbst in der hochinfektiösen Pestgrube mit all den Pest-Toten angeblich deswegen gesund überstand, weil er durch seine starke Alkoholisierung eine Art Immunisierung erreichte. Aus dieser besonderen Form einer Impfung machte das Weingut zwei verkaufsfördernde Weinbezeichnungen: Schluckimpfung und Wiener Jaukerl (wie der Wiener zu einer gespritzten Impfung sagt). Finde ich lustig ! Gesehen in Wien-Grinzing.

The Lenikus winery from Grinzing, a wine-growing village in Vienna, had a particularly original and funny approach to the subject of vaccination. Apparently they remembered the "dear Augustin", who supposedly survived the plague period in Vienna healthy even in the highly infectious plague pit with all the plague dead because he achieved a kind of immunisation through his strong alcoholisation. The winery made two sales-promoting wine names out of this special form of inoculation: Schluckimpfung and Wiener Jaukerl (Oral vaccination and Viennese Jaukerl, as the Viennese say to an injected vaccination). I find that funny ! Seen in Vienna-Grinzing.

THE WALL by Vincenzo Pisani

15 38

The Israeli West Bank barrier is a separation barrier being constructed by the State of Israel along and within the West Bank. Upon completion, the barrier’s total length will be approximately 760 Km (twice the length of the 1949 Armistice Line (Green Line) between the West Bank and Israel). The barrier is a fence with vehicle-barrier trenches surrounded by an on average 60 meter wide exclusion area (90% of its length), and an 8 meter tall concrete wall (10% of its length). The barrier is built mainly in the West Bank and partly along the 1949 Armistice line, or "Green Line" between Israel and Palestinian West Bank. 12% of the West Bank area is on the Israel side of the barrier.

Supporters argue that the barrier is necessary to protect Israeli civilians from Palestinian terrorism, including the suicide bombing attacks that increased significantly during the Second Intifada. There has been a reduced number of incidents of suicide bombings since the construction of the barrier. Supporters argue that this is indicative of the barrier being effective in preventing such attacks.

Opponents of the barrier object that the route substantially deviates from the Green Line into the occupied territories captured by Israel in the Six-Day War of 1967. They argue that the barrier is an illegal attempt to annex Palestinian land under the guise of security, violates international law, has the effect of pre-empting final status negotiations, and severely restricts Palestinians who live nearby, particularly their ability to travel freely within the West Bank and to access work in Israel.

In a 2004 advisory opinion, the International Court of Justice considered that "Israel cannot rely on a right of self-defence or on a state of necessity in order to preclude the wrongfulness of the construction of the wall". The Court found that "the construction of the wall, and its associated régime, are contrary to international law".

Some Jewish settlers condemn the barrier for appearing to renounce the Jewish claim to the whole of the Land of Israel.

Two similar barriers, the Israeli Gaza Strip barrier and the Israeli-built 7-9 meter (23 – 30 ft) wall separating Gaza from Egypt (temporarily breached on January 23, 2008), which is currently under Egyptian control, are also controversial.

Most of the barrier (over 95% of total length) consists of a "multi-layered fence system". The IDF's preferred design has three fences, with pyramid-shaped stacks of barbed wire for the two outer fences and a lighter-weight fence with intrusion detection equipment in the middle. Patrol roads are provided on both sides of the middle fence, an anti-vehicle ditch is located on the West Bank side of the fence, and a smooth dirt strip on the Israeli side for "intrusion tracking".

In a 2005 report, the United Nations stated that:

“...it is difficult to overstate the humanitarian impact of the Barrier. The route inside the West Bank severs communities, people’s access to services, livelihoods and religious and cultural amenities. In addition, plans for the Barrier’s exact route and crossing points through it are often not fully revealed until days before construction commences. This has led to considerable anxiety amongst Palestinians about how their future lives will be impacted...The land between the Barrier and the Green Line constitutes some of the most fertile in the West Bank. It is currently the home for 49,400 West Bank Palestinians living in 38 villages and towns.”

Médecins du Monde, the Palestinian Red Crescent Society and Physicians for Human Rights-Israel have stated that the barrier "harms West Bank health". Upon completion of the construction, the organizations predict, the barrier would prevent over 130,000 Palestinian children from being immunised, and deny more than 100,000 pregnant women (out of which 17,640 are high risk pregnancies) access to healthcare in Israel. In addition, almost a third of West Bank villages will suffer from lack of access to healthcare. After completion, many residents may lose complete access to emergency care at night. In towns near Jerusalem (Abu Dis and al-Eizariya), for example, average time for an ambulance to travel to the nearest hospital has increased from 10 minutes to over 110 minutes.

A report from Physicians for Human Rights-Israel states that the barrier imposes "almost-total separation" on the hospitals from the population they are supposed to serve. The report also noted that patients from the West Bank visiting Jerusalem's Palestinian clinics declined by half from 2002 to 2003.

The Red Cross has declared the barrier in violation of the Geneva Convention. On February 18, 2004, The International Committee of the Red Cross stated that the Israeli barrier "causes serious humanitarian and legal problems" and goes "far beyond what is permissible for an occupying power".

According to EU foreign policy chief Catherine Ashton, the EU considers the barrier to be illegal to the extent it is built on Palestinian land.

Israeli public opinion has been very strongly in favor of the barrier, partly in the hope that it will improve security and partly in the belief that the barrier marks the eventual border of a Palestinian state. Due to the latter possibility, the settler movement opposes the barrier, although this opposition has waned since it became clear the barrier would be diverted to the east of major Israeli settlements such as Ariel.

According to Haaretz, a survey conducted by the Tami Steinmetz Center for Peace Research, Tel Aviv University, there is an overwhelming support for the barrier among the Jewish population of Israel: 84% in March 2004 and 78% in June 2004.

The Palestinian population and its leadership are essentially unanimous in opposing the barrier. A significant number of Palestinians have been separated from their own farmlands or their places of work or study, and many more will be separated as the barriers near Jerusalem are completed.

Furthermore, because of its planned route as published by the Israeli government, the barrier is perceived as a plan to confine the Palestinian population to specific areas. They state that Palestinian institutions in Abu Dis will be prevented from providing services to residents in the East Jerusalem suburbs, and that a 10-minute walk has become a 3-hour drive in order to reach a gate, to go (if allowed) through a crowded military checkpoint, and drive back to the destination on the other side.

More broadly, Palestinian spokespersons, supported by many in the Israeli left wing and other organizations, claim that the hardships imposed by the barrier will breed further discontent amongst the affected population and add to the security problem rather than solving it.

Guide to the West Bank Barrier (BBC News): news.bbc.co.uk/2/shared/spl/hi/guides/456900/456944/html/...

LOAD6 20141026 Frozen Party_3600 by Melissa Shanhun

5 11

When you were invited to Elizabeth and Annie’s Princess dress up party there was no doubt who you wanted to be. You had borrowed an Ariel costume for the last party so I decided to splurge on a new costume, hair clips and a necklace When I arrived home from Lucy’s immunisations with this dress you were so excited, you thanked me right away. You couldn’t wait for the accessories to arrive in the mail.

We watched the movie together a while before the party.

A night at Sally Bowles in Berlin by Genderfluid Ashleigh

Fully immunised, and with some proper precautions I can go out again last week.

It has been so frustrating having bought all these wonderful shoes, skirts, clothes and pantyhose and nit being able to show them off.

One of my favourite cocktail lounges in Berlin, is Sally Bowles, which is themed around the Cabaret era and named after its female lead.

The skirt, which suited the theme of Sally Bowles is from my favourite Australian designer, Alannah Hill, during her heyday. Sadly that label has deteriorated since she was forced out of the business.

The glitzy evening heels are by Aldo, the pantyhose are black Wolford Neon 40 and the lace gloves are from Kitten D’Amour in Brisbane.

Unfortunately I didn’t quite capture the sexy blac lace top from Wolford..

Flint after his immunisations by sezohanim

8 23

He is lethargic and most unlike his usual self. We really wonder if it was necessary.

HE IS NOW BACK TO HIS NORMAL ENERGETIC AND PLAYFUL SELF! ;-))

Doctor immunising a child, 1941 by State Library of Queensland

6 2

Creator: Unidentified.

Location: Brisbane, Queensland.

Description: Dr. Weaver immunising a child while a nurse looks on, Brisbane, 1941. Sunday Sun Collection. 25 June 1941.

View the original image at the State Library of Queensland: hdl.handle.net/10462/deriv/96937

Information about State Library of Queensland’s collection: www.slq.qld.gov.au/resources/picture-queensland

You are free to use this image without permission. Please attribute State Library of Queensland.

Bracing for a short, sharp jab by DFID - UK Department for International Development

Nine month old Emabet is about to receive her measles vaccination, in Ethiopia's Merawi province.

One in ten children across Ethiopia do not live to see their fifth birthday, with many dying of preventable diseases, like measles, pneumonia, malaria and diarrhoea.

But British aid has helped to double immunisation rates across Ethiopia in the past five years, by funding medicines, equipment and training for doctors and nurses.

Additional funding from the UK and other countries will help GAVI roll out new, life-saving vaccines in other countries around the world.

To find out more, please see the full story at: www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-m...

Picture: Pete Lewis / DFID

Terms of use

This image is posted under a Creative Commons - Attribution Licence, in accordance with the Open Government Licence. You are free to embed, download or otherwise re-use it, as long as you credit the source as 'Pete Lewis / Department for International Development'.

Preparing a measles vaccine in Ethiopia by DFID - UK Department for International Development

16 3

A nurse at Merawi health centre in northern Ethiopia prepares a measles vaccine for delivery.

Ethiopia is one of more than 70 developing countries benefitting from the support of the GAVI Alliance.

Three years ago, there were fewer than 750 health centres across Ethiopia. Now, thanks in part to support from British aid, there are more than 2100 health centres providing vaccinations and other life-saving care.

To find out more, about how UK aid is working in Ethiopia, please visit: www.gov.uk/government/priority/supporting-development-in-...

Picture: Pete Lewis / DFID

Terms of use

Sky Tree by XPAT-Polska

Forgive me if I don't comment much, but my back problem has got worse and is now serious. I have to do physio every 90 minutes until the pain in my legs (which stops me from walking) eases - otherwise there is a danger I may have permanent nerve damage and end up on wheels. I am not allowed to bend in any way which makes life difficult.

To make matters worse I have been diagnosed as being bitten by a Tick.

Today I had a bood test to determine if I have an infection - I have a growing ring of angry red on my thigh which is spreading and which was wrongly diagnosed as a fungal infection. The good news is I am immunised against 'Lymes Disease ' which affectes the brain and is incurable. Apparently this bite must have happened 2 months ago and only showed up when I was on holiday in Italy a month ago.

I am OK, but not in the best of mental health. I am taking antobiotics and other medications.

Comments have been disabled here until I'm feeling better, but I will continue to post.

Not fair of me to expect comments if I am unable to make them myself.

Update - comments box reinstated Sept 2013

Immunised by badger_beard

5 3

A year to the day since the first English lockdown started I got my Covid-19 vaccination at The Grafton, Cambridge

ASHA by Social Geographic

8 5

Portrait of a community health activist ASHA shot at Betul, Madhya Pradesh.

------------------------------------------------------------------------------------------

One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist ASHA or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Following are the key components of ASHA :

• ASHA must primarily be a woman resident of the village married/ widowed/ divorced, preferably in the age group of 25 to 45 years.

• She should be a literate woman with due preference in selection to those who are qualified up to 10 standard wherever they are interested and available in good numbers. This may be relaxed only if no suitable person with this qualification is available.

• ASHA will be chosen through a rigorous process of selection involving various community groups, self-help groups, Anganwadi Institutions, the Block Nodal officer, District Nodal officer, the village Health Committee and the Gram Sabha.

• Capacity building of ASHA is being seen as a continuous process. ASHA will have to undergo series of training episodes to acquire the necessary knowledge, skills and confidence for performing her spelled out roles.

• The ASHAs will receive performance-based incentives for promoting universal immunization, referral and escort services for Reproductive & Child Health (RCH) and other healthcare programmes, and construction of household toilets.

• Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every ASHA is expected to be a fountainhead of community participation in public health programmes in her village.

• ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.

• ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services.

• She would be a promoter of good health practices and will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals.

• ASHA will provide information to the community on determinants of health such as nutrition, basic sanitation & hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilisation of health & family welfare services.

• She will counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract Infection/Sexually Transmitted Infections (RTIs/STIs) and care of the young child.

• ASHA will mobilise the community and facilitate them in accessing health and health related services available at the Anganwadi/sub-centre/primary health centers, such as immunisation, Ante Natal Check-up (ANC), Post Natal Check-up supplementary nutrition, sanitation and other services being provided by the government.

• She will act as a depot older for essential provisions being made available to all habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA), chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.

• At the village level it is recognised that ASHA cannot function without adequate institutional support. Women's committees (like self-help groups or women's health committees), village Health & Sanitation Committee of the Gram Panchayat, peripheral health workers especially ANMs and Anganwadi workers, and the trainers of ASHA and in-service periodic training would be a major source of support to ASHA.

Photograph by Firoz Ahmad

------------------------------------

Mothers comfort their children after immunisations by DFID - UK Department for International Development

9 1

Babies are comforted after being vaccinated at the Jembe Community Health Centre in Bo District, southern Sierra Leone.

Their mothers know the seconds of pain their children have had to endure will give them the best chance of surviving diseases like diarrhoea and pneumonia, which account for over 40% of child deaths in Sierra Leone.

To find out more, please see the full story at: www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-m...

Covid Vaccination Centre - Sheffield Arena, UK by Tim Dennell

5 1

Coronavirus album:

www.flickr.com/photos/shefftim/albums/72157713538756686

You know you're in Japan when this drives down the road. by The 10 Thousand Things

10 5

Minolta srT-101

MC W.Rokkor 28mm f/2.8

Kodak Gold 200

...I've lived here a long time, so generally I am pretty well immunised against "WTF Japan" moments... but this one got me.

Providing hope for a better future by DFID - UK Department for International Development

Mariatu Kamara lost a son to pneumonia a year ago in Sierra Leone. He was just one year old.

“I did manage to get him to hospital,” she says, “but there was nothing they could do and he died during the night.”

Mariatu, who is now four months pregnant with another child, found out about the new pneumococcal vaccine during an antenatal check-up.

“I was so happy to hear about the new vaccine that will help to stop babies like mine from dying of pneumonia,” she says. “And, of course, when my new baby is born I will take him or her to the clinic to be vaccinated.”

Every year, two million children like Mariatu's son die of diseases that can be prevented by immunisation. That's one child every 20 seconds.

Vaccinations offer a simple, cost-effective solution to this problem. For the price of a cup of coffee a child can be vaccinated against five of the major childhood killers, including Hepatitis B, diphtheria and tetanus.

To find out more about UK aid is helping prevent millions of preventable deaths, please see the full story at: www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-m...

Bahraini Merchants by Muharraq Forever

From right to left: Yusuf Bin Ahmed Kanoo (1861-1945), Salman Bin Hussain Matar (1837-1944), Jacques-Théodule Alfred Cartier (1884-1941), Mugbil Bin Abdulrahman Al-Thukair (1844-1923), and Abdulrahman Bin Abdulaziz Al-Ibrahim (1875-1960) circa March 1912.

(Contrary to earlier conflicting accounts about the location of this famous photograph, local historians now believe it was taken during Jacques Cartier's introductory visit to Salman Bin Hussain Matar, the undisputed doyen of the Bahraini pearl industry for more than five decades, in his townhouse on the island of Muharraq, by one of Cartier's assistants, while seated outside on the columned portico (Iwan) of the main reception hall in the inner courtyard of the house, since the densely populated once-walled old Muharraq town, with its maze of narrow winding streets, was not only the largest urban centre on the small island, but also the capital of Bahrain and the seat of power for its Al Khalifa ruling dynasty from 1810 to 1923, in addition to being the then ultimate capital of pearling in the Arabian Gulf)

(The date of birth of Yusuf Kanoo of 1861 in the caption above is arguably the most accurate of all his purported birth dates, in particular when compared to the other two widely circulated unsubstantiated discretionary dates of 1874 and 1868, the first of which is found in the British national archives (India Office Records), vaguely based on Yusuf Kanoo's own account, casting doubt on the questionable veracity of some of the information-gathering methods of the British archival records, while the second is a more recent date, first appearing as the official birth date of Kanoo in the late 1990s, it is important to note that, with few exceptions here and there, prior to the gradual establishment of the modern bureaucratic centralised state system in Bahrain in the 1920s and the following decades, virtually every birth date in Bahrain and the rest of the basic protection social contract of Arab Gulf polities where the livelihoods and worldly possessions of the people were under the protection of a specific ruler in a loosely designated geographical area was usually determined by word-of-mouth discretionary supposition, collective consensus, and, in some rare cases, chronicled by momentous or calamitous events occurring at random during any given time in a certain year, such as warfare, lethal epidemics, or destructive natural disasters, typically identifying the year by a distinctive feature or characteristic attributed to the calamity itself by describing the person born in the year in question, irrespective of gender, routinely referred to as "being born in the year of so and so," and at best by adding the season of birth according to the seasonally unaligned Islamic Hijri Calendar, which would become over the course of time part of the collective and cultural orally transmitted from one generation to another folk memory of the Bahraini people and the Gulf region in general, at a time when a sizable portion of the indigenous local population was both illiterate and semiliterate before the spread of government-sponsored formal education in the early 1920s and 1930s in the newly formed Saudi Arabia and the rest of the Gulf, for example when the devastating Spanish flu pandemic reached Arabia as a whole in the autumn of 1919, including Bahrain, resulting in the death of more than fifteen hundred inhabitants in Bahrain alone, the year of the outbreak was called "The Year of Mercy" due to the frequency of funerary prayers and supplications for mercy for the souls of so many victims who succumbed to the disease one after another, an Islamic religious nomenclature once commonly used in the Arabian Peninsula in relation to the catastrophic reoccurrences of virulent diseases that ravaged the Peninsula, as people in Arabia sauntered through a never-ending cycle of rampant epidemics, with very high mortality rates as one would expect under such conditions, not dissimilar to those in mediaeval Europe or even to those of their contemporaries relatively more advanced standards of the neighbouring fertile crescent, constantly girding themselves for the worst, in view of the practically complete lack of modern medical care facilities, preventive healthcare, quarantine measures, including immunisation, and public sanitation with the significantly effective though insufficient three modern healthcare facilities exceptions in the Gulf, operating in chronological order with the opening of each of them, starting with the commercial, for-profit enterprise medical services of the American Mission Hospital in 1903 in Manama, Bahrain, followed three years later by the semi-gratuitous medical services of the chronically underfunded Victoria Memorial Hospital, together with its small quarantine facility in 1906, located near the sea, directly across from the British political agency (now the British Embassy), further down the same long, meandering street as the American hospital, both facilities catered not only to the local Bahraini population but also to those from the eastern and central regions of present-day Saudi Arabia, and finally, the American Mission Hospital of Kuwait in 1914 served Kuwait and its urban and desert sedentary environs communities where there was practically a yearly infestation of at least one epidemic, most notably bubonic plague, cholera, malaria, and smallpox, causing numerous fatalities in a short space of time, particularly along the Arab polities of the western coast of the low-density populated and extensively penurious Arabian Gulf region and throughout the Arabian Peninsula in the first third of the twentieth century, before the life-changing discovery of oil in the 1930s and 1940s, and the subsequent development of an efficient free-of-charge governmental medical system funded by oil revenues, however, one of the most noteworthy calamities to leave an indelible mark on the collective consciousness of the people of the Gulf was an odd hurricane of cataclysmic proportions on the 1st of October 1925, dubbed "The Year of the Sinkage," inflicting variable damage to buildings and the surrounding environment, especially vulnerable mud huts with palm-frond thatched roofs (known as Barastis) in coastal aquicultural and fishing villages belonging to indigent toiling fishermen and indentured farmers, these huts were torn apart, interspersing their roofs across far-flung distances, and, needless to say, the pearl fishing industry during the final weeks of the four-month-long summer pearling season in anticipation of the onset of the dormant winter months for the industry and its ancillary essential sectors in the Gulf, the cornerstone of the regional fragile monocultural economy, which was hit hard, with thousands of boats sunk and, tragically, over five thousand lives, predominantly sailors, lost in a single thunderous foreboding night in the otherwise almost always placid waters of the Gulf; the calamity wrought havoc in its wake, leaving a path of devastation across a vast region, primarily in the central part of the Arabian Gulf, centring on the Bahrain archipelago and the eastern coastline of the Qatar peninsula, coupled with a number of islands and the sparsely populated coastal towns and villages along the present-day eastern coast of Saudi Arabia, including Dammam (now a metropolis) and Tarout Island, well-known back then for its small fishing and pearl diving communities, namely the famous pearl diving town of Darin, and also the nearby agricultural town of Qatif, where one hundred and fifty people died from falling date palm trees on their homes, in addition to Ras Tanura, and to a lesser extent Jubail in the north, thus the perfectly apt appellation, as these rudimentary speculative and dubious methods were the order of the day, rather than any accurate, bureaucratic official government or religious documentation specifying the exact date and year of birth, with the first large-scale issuance of birth registration certificates in Bahrain beginning in earnest in the 1950s, given the discovery of an officially notarised endowment trust fund transfer deed dated Thursday the 15th of Rabi' al-Thani 1295 in the Hijri Calendar, corresponding to the 18th of April 1878 in the Gregorian Calendar, undermining decidedly the credibility of the two earlier mentioned alleged dates of birth of Yusuf Kanoo, where respected foodstuff merchant Ahmed Mohamed Kanoo and his eldest son Yusuf were among the nine legally required consenting adults, competent witnesses to validate the strict transfer of wealth procedure, since both of the previously stated birth dates of Yusuf Kanoo pertinent to the timeline of the binding legal solemnity of such a document are incompatible with the required legal age of the witnesses, whereas Yusuf Kanoo was illogically either an undiscerning child of four or a child of ten, indicating that he was a minor under the legal age of majority of full legal responsibility in both instances to be allowed to appear before an Islamic Sharia Judge or any other judge of any civil or religious denomination for that matter, it should be clarified that, with the exception of Iran (historically known as Persia), which is still reliant on its own highly precise unique Solar Hijri Calendar designed by the renowned Muslim polymath, Omar Khayyam (1048-1131), time and age measurements, and the foundation for standard civic purposes of all aspects of mundane life, not just religious holidays, worshipping activities, and festivities, were calculated in the Arabian Gulf and much of the Islamic world then, per the purely lunar Islamic Hijri Calendar's dynamic but orderly unaligned seasons of the monthly cycles of the phases of the Moon, in contrast to the seasonally aligned, more dependable Gregorian, and less complex Solar Calendar, and all currently in use others, in a number of Asian nations, such as China, India, Vietnam, Korea, and Japan, are regulated by their indigenous hybrid Lunisolar Calendar's overlapping intercalations of both the positions of the Moon and the Sun, in compatibility with the Western globalised economic requirements and realities of modern life, in conclusion, as expounded earlier in the text, in the absence of a centralised efficient bureaucratic state system in the late modern period, from roughly the early nineteenth to the mid-twentieth century in Bahrain and the rest of the Gulf, it was a challenging task to determine the precise birth dates of the vast majority of the population, including those of the ruling and mercantile elites, with a few rare anomalous exceptions, mostly among the clergy, demonstrating beyond a shadow of a doubt that Yusuf Kanoo, as one of the signatories of the said revealing document, was of the irrefutable legal adult majority discerning age of eighteen lunar years, marking the adulthood threshold where individuals were recognised as legally responsible for their actions, according to the prevailing consensus since the late mediaeval period of the four principal Islamic Sunni orthodoxy schools of jurisprudence at the time, before the partial implementation of more secular western-influenced administrative reforms and legislations by the British colonial local authorities in the Gulf in the first third of the twentieth century, slowly but surely replacing the lunar Hijri Calendar in daily civic use by the Gregorian solar Calendar, among other modernising measures, as part of the British worldwide imperial colonial grafting process policy similar to that of the French, but in a less brutal, culturally imperialist, and bloodstained manner, by paternalistically integrating Britain more vigorously to its racially inferior and inherently less civilised colonies in varying degrees, while taking into account the distinct circumstances of each of the occupied territories according to British evaluation that constituted the British Empire through the self-designated various British classification of each territory (such as Colonies, Crown Colonies, Charter Colonies, Protectorates, Mandates, etc) via the subtle influence of cultural assimilation, thus securing the long-term economic interests of Britain whether through primarily peaceful persuasion or, when necessary, forceful means, as demonstrated in the implementation of the aforementioned administrative reforms starting in the field experiment of Bahrain in post-World War one, the smallest yet the most advanced Arab state on the western coast of the Gulf in all fields prior to the discovery of oil, namely the establishment of a modern, centralised, bureaucratic, Western-style state system, where both approaches of grafting were aggressively adopted, derived from the ancient and still in use horticultural technique of grafting, whereby different strains of plant tissues are united to create a strong, inseparable bond, ensuring the optimal growth of desirable traits, this practice mirrors some of the nuanced strategies of European colonial powers to secure future dominance over their colonies through the soft power of cultural hegemony)

(In light of the fact that Bahrain was the centre of the pearl trade in the Arabian Gulf, renowned worldwide for producing some of the finest natural pearls since antiquity, the small seafaring nation became the haunt for anyone seeking business success in the lucrative highly sought-after market for natural pearls in the second half of the nineteenth and early twentieth centuries, igniting what might have been an unprecedented pearl mania in recorded history to satisfy the ever-increasing international demand for pearl jewellery, especially among the upper echelons of Indian society, dominated by the British Raj vassal potentates of Hindu Maharajas and Muslim Nawab princes, feudal successors of the then defunct once-mighty Mughal Empire, the waning old European royalty, supremely represented by the doomed absolutist and fabulously extravagant Russian imperial house of Romanov, the vigorous burgeoning capitalist upwardly mobile Western bourgeoisie, and the extraordinarily wealthy urban-dwelling ostentatious nouveau riche American tycoons, primarily of New York, amidst the sweeping American Industrial Revolution, epitomising the opulence and excess of the era known as the "Gilded Age," as in the case of the young French jeweller Jacques-Théodule Alfred Cartier (1884-1941), who opted to bypass the exorbitant prices of the Parisian coterie of pearl dealers by sourcing pearls directly from local suppliers in the Arabian Gulf, depicting an example of the final connections between the international Western jewellery industry, where natural pearls were marketed as luxury finished products in the high-end jewellery shops of major Western capitals and cities such as London, Paris, and New York, and the intricate hierarchical network of interwoven business relationships within the once steeped in tradition centuries-old rich history of the Arabian Gulf pearl trade, personified by the four transnational Arab merchants, each of whom was associated with Bahrain to a varying degree due to its advantageous economic standing in comparison to its Arab Gulf neighbours in this iconic picture taken by one of Jacques Cartier's assistants and meticulously stored in the photo albums of the Cartier company archives in Paris, along with hundreds of other photographs taken during his several trips to the Gulf and India, as Cartier was keen on photographically documenting as much as he could of all the major events he had participated in during these trips, particularly those from his second extended visit to Bahrain in 1912, and also his handwritten, pedantically detailed travel journal containing vital information about the places he visited and the key people he met in his trips to the Orient and other parts of the world, but let us be clear, this picture for the most part is about the three noted pearl merchants he conducted business with: Al-Thukair, Bin Matar, and Al-Ibrahim, who more or less share similar backgrounds since they all hail directly from the Najd region of central Arabia, taking into account that Bahrain meant a different thing for each of them; for Mugbil Bin Abdulrahman Al-Thukair (1844-1923), it was a second home away from home after his beloved birthplace of Unaizah in Najd however, for the magnanimous and highly esteemed longest reigning doyen of the Bahraini business community for over half a century, the honourable staid and reticent Salman Bin Hussain Matar (1837-1944), it was his native birthplace, as his grandfather and namesake moved to Bahrain from Najd in 1825, making it his permanent home, and finally, for Abdurrahman Bin Abdulaziz Al-Ibrahim (1875-1960), Bahrain was a worthwhile frequent business destination halfway between his country of origin, Kuwait, on the northern tip of the Arabian Gulf, where his family moved in from Najd in the early 1700s, soon after the country was established as an independent sovereign political entity by the Al-Sabah dynasty of the Bani Utbah tribal confederation of Najd, and the bustling British-founded Indian entrepôt city of Bombay, now known as Mumbai, the financial capital and most populous city in India, and the abode of choice of Al-Ibrahim until the end of his life, apart from being his final resting place, the vibrant commercial hub on the Arabian Sea and the main gathering place for Arab traders and their families in the Indian subcontinent for nearly a century, and in many instances, the real head start for a slew of industrious young Arab merchants from the inhospitable, population-repelling, and, on the whole, economically deprived pre-oil Arabian Peninsula as for the apparent role of the fourth Arab in the picture as an Arabic-Hindi and English interpreter in this historically significant photograph, the shrewd and influential merchant Yusuf Bin Ahmed Kanoo (1861-1945), whose ancestors originated from Najd, north of the present-day Saudi capital, Riyadh, emigrated more than a hundred years before his birth to the broadly Arab eastern coast of the Arabian Gulf; then after one or two generations in the early nineteenth century, the descendants of those ancestors decided once again to relocate to the pearl-rich island state of Bahrain off the western coast of Arabia near their ancestral homeland in the Najd plateau, central Arabia, following a temporary sojourn on what is now erroneously called the Persian coast, as scores of Arabs from the hinterlands of Arabia did in the past for one reason or another before the creation of nowadays artificial political borders when the Gulf was an Arabian lake for many centuries, needless to say, Kanoo's role was not just confined to language interpretation; therefore, it is first and foremost necessary to shed light on his business interests and activities prior to his fortuitous entry into the shipping agency business in 1911, when he was appointed as the Bahraini shipping agent for the ill-fated short-lived pioneering first fully Arab-owned shipping and passenger company "The Arab Steamers, Limited" by the majority of the principal shareholders of the budding company, most of whom were his friends, where he embraced wholeheartedly this unexpected business opportunity which came knocking at his door, as it would also play a pivotal role in shaping his future business career making him synonymous with the shipping liner and oil tanker industries in the last three decades of his life and posthumously, the eponymous company he founded up to the present, notwithstanding his involvement in significant business activities other than shipping, including the acquisition in 1913 of the highly profitable agency for the Anglo-Persian Oil Company (now British Petroleum "BP"), in particular, before the discovery of oil in Bahrain in 1932 and the introduction of locally oil-refined byproducts with the completion and opening of the Bahrain refinery in 1936, the paramount byproduct of these in the Bahraini market in the first third of the twentieth century was Kerosene, also known as paraffin, when monthly shipments of thousands of barrels of the essential commodity imported from the Anglo-Persian Oil Company's refinery in Abadan in the northern Gulf used to arrive in Bahrain for local consumption, to be transported by dhow boats from a steamship anchored in deep water in the middle of the sea to the port of Manama (the current site of Bahrain Financial Harbour), a small shallow-water port incapable of receiving deep-draught large ships, then uploaded onto donkey-pulled carts to the warehouses of the nearby seaside landmark building belonging to Yusuf Kanoo in Manama, but after the building was sold, in 1934, the Kerosene shipments were stored in the warehouses of the Kanoo main office building inside the old Manama souk (the future office building of the Y.B.A. Kanoo group until 2016), for distribution to the local Kanoo subagents, as Kerosene oil was indispensable for domestic use as the primary fuel source for lighting lamps, portable lanterns and, to a smaller scale, cooking stoves, as the majority of Bahrainis used wood for cooking, while some low-income households used dried cow dung as an affordable, easy substitute for the more expensive wood prior to the gradual establishment of an electrical power grid in the 1930s and subsequent decades, other oil derivatives, especially petrol and diesel fuel, were insignificant products since the country only had two hundred motor vehicles by 1930, Yusuf Kanoo was also the first local merchant to import diesel-electric engines, ice making machines, and mechanical water pumps into Bahrain in post-World War One, in addition to becoming the refuelling and ground handling agent for Imperial Airways' long flights from London, landing in Bahrain en route to Karachi and Delhi in British India, and the Orient Express-like exorbitantly expensive luxurious nine-day flight to Sydney, Australia in 1929, the predecessor for "British Airways", for he was the only Bahraini supplier of petroleum products for almost twenty years, laying the groundwork for the highly lucrative Kanoo regional aviation ground handling business in the coming decades, specifically in Bahrain and across Saudi Arabia, his efficiency in managing plane refuelling resulted in his appointment as the travel agent for Imperial Airways in 1937, thus he become the owner of the first airline travel agency in Bahrain, which ten years later would become the first agency in the Gulf to be accredited by IATA (International Air Transport Association) in 1947, among the myriads of products and services he launched in Bahrain and the Gulf as a whole, inadvertently leading to the development of arguably the first genuinely local Western-style management-based modern business firm in the Arabian Gulf, with the contemporary state-of-the-art Y.B.A. Kanoo regional conglomerate still maintaining substantially a similar scope of the then nascent businesses of its forward-thinking founder Yusuf Kanoo in the early twentieth century, most significantly shipping, travel, machinery, and oil & gas, where the company has steadily risen to become a market leader in these sectors across all of its operational markets, achieving this in less than two decades after its founder passed away in 1945, this growth has been evident particularly since the impactful first oil boom in the mid-1970s in its three main regional markets by business size: Saudi Arabia, the United Arab Emirates, and Bahrain, as these new businesses and technologies were briefly touched upon above in the course of Yusuf Kanoo's fifty-five-year business career, in which he weathered numerous trials and tribulations through an almost unbroken chain of three major global crises: the First World War, the Great Depression, and the Second World War, as Yusuf was chiefly a banker and general trader during the first twenty years of his long business career, and as a British-influenced maverick cosmopolitan entrepreneur with a global perspective, branching out from the foodstuff business of his father, Ahmed Muhammad Kanoo (1835-1905), one of the major wholesale foodstuff merchants in Bahrain in the late nineteenth and early years of the twentieth century, and the owner of two large mixed-use elongated buildings in Manama built in the traditional Gulf architectural style, primely located close to each other, separated by the existing narrow Al Khalifa Avenue, flanked from the right side of the main building by an equally detached building of similar length but slightly broader width, formerly belonging to the brothers Abdullah & Salman Kamal, constituted the current smaller attached row of buildings consisting of shops, representing a miscellaneous collection of businesses and trades, mostly in the retail sector, owned by several different proprietors, are on the left side of the now covered pedestrian no-car strip of Souq Bab Al Bahrain Avenue, across from what were once customs bonded warehouses, the present-day site of Bab Al Bahrain shopping mall, whereas the left side of the Kanoo building is flanked by another building of the same length belonging to Sheikh Hamad, the 33-year-old crown prince of Bahrain and future ruler, and which remains in the possession of his descendants from the Bahraini royal family, as the main building is a nearly five-hundred-foot-long three-story building and fifty-five-foot width, one of the largest detached commercial buildings in Manama in the late nineteenth and early twentieth centuries, while the smaller opposite one, the once seaside building is a two-story over two hundred feet long and also detached as its much larger sister, yet of identical width, with the first floor of the smaller building serving as a private residence for the only surviving male offspring of Ahmed Kanoo, Yusuf, whom he and his two nephews and soul heirs then sold several decades later in 1934 to the ruler of Bahrain Sheikh Hamad (1932-1942), coupled with other properties sold to others, the most important being Yusuf Kanoo's own constructed impressively huge two-story building on a plot of land reclaimed from the sea at the turn of the twentieth century, the largest mixed-use commercial and residential building in Bahrain and the whole Gulf back then, the present site of several prime location properties owned by the Bahraini royal family, consisting of the Unitag Group building and its car park, the Regency Intercontinental Hotel's auxiliary Plaza Spa and wellness building at the back, and the adjacent large building alongside it where a number of mostly financial firms and banks operate, covering the total three-hundred-foot right wing width of the old building, and at one point facing the old customs house, part of the one hundred and twenty thousand square feet plot of land encompassing the entire incomplete rectangular-shaped semi-bottom square bracket building, including the three-hundred-foot built-up two wings width across the two-hundred-foot length of the semi-courtyard partially unbuilt hollow-shaped space opposite the sea at the back of the property, serving as a docking area for the building, where in the mid-1970s, the Regency Intercontinental Hotel was erected on sea-reclaimed land in front of the docking area, which Yusuf Kanoo sold to prominent Kuwaiti pearl merchant Helal Bin Fajhan Al-Mutairi (1855-1938) in late 1934 for a quarter of a million British Raj rupees, the official currency used across the Gulf as the polities of the Gulf were under the jurisdiction of the British Indian Raj, in a desperate sale transaction to alleviate some of his massive debt incurred as a result of the global crisis of the Great Depression, as with a multitude of merchants across the Arabian Gulf, nevertheless, the present site of the smaller building is the Bab AL Bahrain Hotel, and all of the rented spaces on the four corners of the ground floor of the detached property, as the previous property is also owned by the royal family of Bahrain, located in close proximity to the Bab Al Bahrain archway (Gateway of Bahrain) historical landmark in Manama separated by just a thin aisle pedestrian passage between the two buildings, the upcoming exposition, is partly based on an amalgamation of varied documented materials spanning both local and foreign, including archival sources, notarised official documents, diaries, biographies, and so on, but above all based on the detailed descriptive notarised "deed of gift" of Ahmed Muhammad Kanoo, the father of Yusuf Kanoo, outlining in detail how he gifted specific holdings of his fixed and movable assets during his lifetime to his four adult heirs, these were his four adult offspring, his two sons Yusuf and Muhammed, and his two daughters Latifa and Hussa, where the aforementioned properties and their boundaries were clearly stated, among other heirlooms, leaving no room for ambiguity or obfuscation, dated 5th of Jumada al-Awwal 1323, in Hijri Islamic Calendar, corresponding to Saturday 8th of July 1905, in Gregorian Christian Calendar, penned shortly prior to the passing of Ahmed, stating that the two neighbouring buildings belonging to him in Manama were gifted to his sons Yusuf and Muhammed equally, whereas the large rear building served as the future headquarters offices of the titular firm of the eldest son of Ahmed, Yusuf, the posthumous Y.B.A. Kanoo regional conglomerate owned by the nephews and heirs of Yusuf, the sons of his deceased younger brother Muhammed, Jassim and Ali Kanoo, and their immediate eight male offspring and their legal heirs of both sexes' descendants, given that Muhammed died soon after his father Ahmed in 1905 of the plague during one of the requiring outbreaks of the deadly infectious disease at the turn of the twentieth century in Bahrain, since Yusuf did not have children of his own despite his three successive marriages, the building described above became symbiotically attached to the Y.B.A. Kanoo family business in the minds of many ordinary Bahrainis, especially dwellers of old Manama, for several generations from the death of Ahmad in 1905 to the death of his son Yusuf forty years later on the 21st of December 1945, and then operating continuously from the same premises for the next seven decades, albeit the old traditionally built structure was rebuilt in a Semi-Mediterranean commercial style using modern building materials in the late 1950s, until finally in 2016, when the company moved to a new steel and glass high-rise headquarters after more than a century in the same location, however, with respect to the smaller building, it became solely owned by Yusuf Kanoo, explaining why it was sold by him as thoroughly discussed earlier; in the meantime, the two said daughters of Ahmed received gold jewellery, in contrast to the commonly held inaccurately long perpetuated conception that Yusuf Kanoo started from humble origins and died practically bankrupt in 1945, as will be explained further in the text, it should be noted that when Yusuf established the first local bank in Bahrain and the entire Gulf, including Persia (Iran) in 1890, he was venturing into the risky uncharted territory of banking business in the Arabian Gulf at a time when banking was associated, at least in this deeply conservative puritanical region of the Arab world in the local Muslim collective consciousness, with unethical exploitative usury, as the Bank of Yusuf Kanoo remained the only bank in Bahrain for thirty years until the opening of the British-owned Oriental Bank in 1920 (The Chartered Bank of India, Australia, and China), the present-day Standard Chartered Bank, having been inspired by the successful banking firms of the British Raj in India, the Kanoo Bank was significantly different from regular commercial banks as it leaned more towards private banking, targeting Bahraini wealthy pearl merchants with sizeable monetary surpluses, some of whom were occasionally in need of significant cash flows for the thousands of indentured workers on their payroll throughout the four-month-long summer pearl diving season in a non-banking-based economic environment, particularly those of the island of Muharraq and its towns where Yusuf Kanoo was constantly courting their goodwill, as they were the real drivers of the fragile local monocultural economy, as with the rest of the region, Muharraq was the most active pearling town in the Arabian Gulf, thanks in large part to having the richest pearl oyster beds in the Gulf in its northern waters, and, as a matter of course, home to the highest number of pearl divers and the largest fleet of pearling vessels in the region, the former political capital of Bahrain and the seat of power of its Al Khalifa ruling dynasty for over a century, and the beating heart of the pearling industry of the tiny archipelago, the most salient of those Muharraq's merchants was the closest, steadfast, and trusted friend of Yusuf Kanoo and chief creditor, referred to earlier in the preface, one who cannot be commended highly enough or quantify his innumerable virtuous deeds, the celebrated, unassuming, and bonhomous legendary philanthropist Salman Bin Matar, who was widely recognised for donating large amounts of rice and dates to the poor in Bahrain during the dire economic conditions of the First and Second World Wars to alleviate the sudden shortages of imported foodstuffs, principally rice, the staple food for the vast majority of Bahraini people regardless of class, stemming from disruptions in international supply chains caused by military operations, and to make matters worse, the economic strife of the First World War was compounded by a virulent epidemic, as in the situation in Bahrain, where five thousand people died from an outbreak of plague in December 1914, as referred to by the British political agent in Bahrain, Captain Keyes, in his correspondence to his superior, Deputy Political Resident Major Trevor of the British Residency in Bushehr, Persia (Iran) on the 5th of December 1914 in the following excerpted letter passage: (Divers and coolies continued to leave Bahrain till the outbreak of plague in December when hundreds of Persians also left. Plague further reduced the population by some 5000. There was then a slight revival of trade and the profits in coffee and tea were so good that several merchants took advantage of the cheapness of the labour market to collect stones and build, thus, giving work to numbers of the most indigent. There was also a market for household articles, old clothes etc, and it was not till February that any people were entirely without resources. Two or three merchants, notably Salman Bin Matar, then made large donations of rice and dates, and work was found for some men by the Agency), in conjunction with his bountiful donations in times of economic crises, there was the daily sight of long queues of the less fortunate at his doorstep all year long, both at his winter and summer residences awaiting alms of the generous distribution of cooked meals made of lamb and rice, Salman Bin Matar, the wealthiest merchant in Bahrain, aside from being its most consequential pearl merchant for nearly fifty years from the 1890s until his greatly lamented death on the 10th of February 1944, the subsequent concise bracketed excerpt below originates from a declassified comprehensive report compiled by two British political agents, Captain N. N. E. Bray (1885-1962) and Major H. R. P. Dickson (1881-1959), who served consecutively though briefly in Bahrain, whereas the latter would significantly influence the modern history of Bahrain's northern neighbour Kuwait as a future political agent, this report offers a glimpse into the mindset of these colonial officers and the prevailing racist climate in the West, as reflected in this extremely subjective observational case study of the people of Bahrain from a British colonial perspective, verifying the typical racist European tropes and stereotypes of how none white people were widely viewed back then, including two opposing lists of influential Bahrainis who played central roles in shaping the socioeconomic and political landscape of the small state, either by aligning with Britain or opposing it, with Salman Bin Matar prominently placed at the top of the Whitelist, this list evidently refers to a group of the wealthiest and most powerful high-ranking Bahrainis considered allies of the British, conversely, the Blacklist represents a diverse group of individuals from all segments of Bahraini society, belonging to various social backgrounds, faiths, affiliations, and origins, unified by the suspicion and hostility they faced from the British colonial authorities in Bahrain, for reasons that were not exclusively political, Bin Matar was described in this special 1920 report by the British political agency in Bahrain as follows: quote (1. Salman Bin Matar. A wealthy pearl merchant, very friendly.) a simple yet emblematic description of a man who maintained a modest demeanour all his life despite his immense wealth, dedicating much of his long life to assisting the downtrodden and improving the quality of life of the Bahraini people in general in every way possible irrespective of their race, ethnicity, creed, or colour, in particular, through the introduction of modern formal government education, as he was one of the founders of the first formal school in Muharraq, the former capital of Bahrain in 1919, he was also a vital member of all the governmental councils and committees of the newly formed bureaucratically centralised, and chronically underfunded Bahraini state, where he unfailingly provided generous financial funding to these fledgling government bodies, both before and after the discovery of oil in 1932, and continued to do so until his death, as evidenced by a short though thoughtful obituary in the declassified British colonial annual archival report of 1944 on Bahrain, the following is the slightly edited bracketed obituary: (The death occurred during the year of Haj Salman Bin Matar, one of the leading pearl merchants of Muharraq, who was well known for his philanthropic deeds. For several years he provided food for large numbers of poor people who were daily fed at his doors. He sat on various councils and committees and was a valuable member of the community), he was also well-known for his significant contributions as the biggest and longest-standing depositor of the Kanoo Bank until its bankruptcy and permanent closure at the height of the Great Depression in the early 1930s; furthermore, he was accredited for waiving all of his large outstanding debts to his local and regional debtors during the decade-long debilitating depression crisis, followed by the conflagration of the Second World War, including, as expected, the debt of Yusuf Kanoo, his lifelong friend and confidant amounting to more than half a million Indian British Raj silver rupees without legal recourse, a considerable fortune in the pre-oil Arabian Gulf, in spite of the constant insistence of Yusuf Kanoo on offering his most prized possession, his mixed-use monumental building, which he then sold to Kuwaiti pearl merchant Helal Al-Mutairi, as previously mentioned, and additional properties comprising the building gifted to him and his late brother by their father, who he sold as above indicated to the ruler of Bahrain, Sheikh Hamad, and a medium-sized date palm orchard within the vicinity of Al Khamis village near Manama, to cover the stupendous debt of Salman Bin Matar, after all the last-ditch attempts of Kanoo, a trustworthy man of impeccable integrity in all of his business dealings, to offer the building among other assets to Bin Matar in exchange for the defaulted debt had failed, thus, upon the arrival of Al-Mutairi at dusk, a good friend of both eminent Bahraini merchants from Kuwait, to seal the critical sale deal of the building on an unspecified day in a cold late December evening of 1934, Yusuf Kanoo, accompanied by his prospective Kuwaiti buyer, walking in the unlit dark narrow alleys of Muharraq, aided by oil lanterns carried by assistants, went to the winter residence townhouse of Salman Bin Matar in the heart of the old town of Muharraq in a poignant final gesture of sincere goodwill to persuade him to accept the building as the least credible rightful legal settlement for the substantial outstanding debt; however, he resolutely declined, a clear attestation to the incomparable altruism and nobility of this exceptional gentleman, demonstrated by being deservedly afforded the appellation 'Father of Orphans and Protector of Widows' by the Bahraini people many a decade before these affairs, an honorific that remained synonymous with him throughout much of his long adult life and posthumously until the present, due in no small part to the cherished memories he represents for a lot of Bahrainis from all walks of life passed down through the generations, as he is unanimously recognised as the preeminent philanthropist Bahrain has produced in modern times, and also as its foremost pearl merchant of the golden age of the pearl trade, interestingly, the preceding debt case incident represents a compelling true moral story seldom seen in our fast-paced, materialistically driven, and consumer-oriented globalised village society in a world increasingly characterised by cynicism, moral apathy, and venal propensity, where meaningless vapid and insipid hypocritical rhetoric about human rights is routinely harangued tediously on the world media, serving as irrefutable proof of the remarkable mutual fidelity and devotion these two friends held for each other throughout their long friendship of over fifty years, lasting from the mid-1890s to their close deaths separated by just well over a year, prompting Yusuf Kanoo, a few months after this defining incident in 1935, to take the necessary precautions to ensure the continuity of his business enterprise for posterity by transferring ownership of his company and all of his remaining properties into the safe and capable hands of his nephews, Jassim and Ali, ten years before his passing in 1945, except for the dear to him 'Anglo-Persian Oil Company' (APOC) agency, now the multinational oil giant British Petroleum (BP), which remained under his ownership until his death, stipulating that the company will continue to bear his name after his death, thereby eliminating any future claims by creditors, and to limit the inheritance to the two brothers as the sole heirs of Yusuf Kanoo and their male progeny, ensuring the smooth transition of the family business in a traditional patriarchal society as a logical consequence, Yusuf died with virtually no inheritance left behind, debunking the notion that his heirs rebuilt his company from scratch, bearing in mind that the previously mentioned nephews at the time of Yusuf's death were middle-aged, well-established businessmen in their own right, owning business interests independently from the firm of their illustrious uncle, and married with grown-up children and even grandchildren, whose pioneering sons, Ahmed, the eldest son of Ali, and Muhammed, the eldest son of Jassim, and their diligent younger brothers, following steadily in the footsteps of their great uncle Yusuf Kanoo in the late 1940s, ably taking on the heavy mantle of his, expanding the resilient eponymous company he built almost sixty years prior across the Arabian Gulf, transforming it into the multinational regional conglomerate it is today, the following bracketed excerpt from the declassified 1945 colonial annual report of the British political agency in Bahrain on internal and external affairs of the country and the Arabian Gulf is an edited obituary of Yusuf Kanoo, explicitly confirming his high status both locally and regionally, as the unfounded and nebulous age of Kanoo, stated to have been born in 1874 in the said archival obituary, has been refuted conclusively in the comprehensive and detailed missive above on the different hypotheses about his age, delving concisely into the chaotic rudimentary birthdate documentation methods in Bahrain and the rest of the Arabian Peninsula before the establishment of modern centralised bureaucratic state systems in the region, which commenced in earnest after the end of World War One, (On the 21st December Haji Yusuf Ahmed Kanoo died at the age of 71, (most likely between 84 and 85). His association with His Majesty's Government started in 1898 in the time of the Agent Haji Ahmed bin Abdul Rasool (Al Safar). He continued to serve as Assistant until the arrival of Mr. Gaskin in 1902, and was associated with Major Prideaux and Captain Mackenzie until 1909. He received the Kaisar-i-Hind Medal II. Class in 1911, the title of KHAN SAHIB in 1917 and the M.B.E. in 1919. In 1924, a C.I.E. was bestowed upon him. In 1913, the Anglo-Iranian Oil Company appointed him their agent in Bahrain. He received honours from the late King Hussain of the Hedjaz and, also, from His Highness the Amir (Abdullah) of Transjordan (now kingdom of Jordan), who granted him the title Pasha. The death of this well-known old Arab was marked in Bahrain by the closing of the bazaars for one day. The political Agent sent a message of condolence to the bereaved family.), at any rate, the collapse of the only Bahraini indigenous-owned bank during the Great Depression reflects the far-reaching cataclysmic effects of the first economic crisis of the modern economic realities of the ever-increasingly interconnected world of the twentieth century, turning it into a global phenomenon where plenty of financial institutions and businesses irrespective of size were falling prey to insolvency, engendering widespread economic hardship and turmoil; the momentous collapse of Kanoo Bank had a significant impact on the establishment of another indigenous bank in Bahrain, delaying the whole process for a quarter of a century until the establishment of the first commercial Bahraini-owned bank in the country, the National Bank of Bahrain (NBB) in 1957, in view of the modest oil revenues of the slowly gaining momentum new Bahraini oil economy in comparison to the exponentially oil-rich Arab Gulf neighbours of Bahrain, namely Saudi Arabia, Kuwait, and to a lesser extent Qatar in the 1950s and early 1960s, before the arrival of the last two crucial newcomers on the oil-producing scene in the Arabian Gulf, the Emirate of Abu Dhabi and the Sultanate of Oman, where the former would later become the dominant Emirate of the newest robust country in the Arabian Gulf, and its newly rebuilt capital city, Abu Dhabi, would be proclaimed the federal capital of the seven dynastic Emirates of the federal state of the UAE after independence from Britain in 1971, due to its geographical size and enormous hydrocarbon wealth, not to mention the British loosening of their monopolising grip on the Bahraini local banking sector in the aftermath of the brief but consequential Anglo-French debacle of the 1956 Suez crisis, which was up until then under complete control of the British, symbolised by only two British banks, the formerly alluded to Standard Chartered Bank and the British Bank of the Middle East (BBME), what is now the HSBC Bank Middle East, the second biggest Kanoo Bank depositor was leading pearl merchant Muhammad Bin Rashid Bin Hindi Al Mannai (1850-1934), also from the historic previously walled eponymous town of Muharraq, as Salman Bin Matar, the largest and most densely populated on the island, with an architectural landscape signalised by the few extant buildings of the once-forest of wind towers and sun-gleaming white facades of traditional ornate residential and commercial buildings constructed largely of coral stone and covered in white lime mortar, forming the UNESCO World Heritage Site of the Pearling Path, standing as testament to the prosperous and storied past of the island, when Muharraq was the pearl capital of the entire Gulf, along with the respected merchants and cousins Sayyid Khalifa Bin Abdulghafoor Al Sadah (1839-1912) and Sayyid Abdullah Bin Ibrahim Al Sadah (1853-1932) of the historically seafaring sand spit town of Al Hidd on the southeastern extremity of the island, these key pearl merchants and other business leaders were the primary economic drivers of the local economy and the largest employers prior to the turning point discovery of oil and the following gradual formation of the modern centralised state bureaucratic apparatus system in the Arabian Gulf region; yet, it is a little-known fact that Yusuf Kanoo was also a sagacious and trusted pearl broker, both locally and regionally, acting as a sort of decorous middleman interpreter and poised interlocutor between visiting international pearl dealers and their local and regional counterparts as the socially savvy, energetic, and knowledgeable multilingual comprador Yusuf Kanoo would turn his hand to anything commercially favourable, oddly enough, the majority of those international pearl dealers were French Jews, such as Léonard Rosenthal (1874-1955), Jacques Bienenfeld (1875-1933), and Solomon Pack (Date of birth unknown), who forged not only strong business relations with their Arab counterparts, but also strong enduring friendships in the Gulf and throughout Arabia; two prime examples of these friendships stand out: the first is between Abdulrahman Bin Hassan Algosaibi (1880-1976), the famed transnational well-travelled pearl merchant based in Bahrain from the Najd region of central Arabia, and Albert Habib, the affable, fluent in Arabic Paris-based pearl merchant and nephew of Léonard Rosenthal, who, like many others during the 1930s, struggled with bankruptcy owing to the Great Depression, and for whom Algosaibi generously paid his medical bills following a post-crisis malaise brought about by the abrupt price plunge of natural pearls, causing him to lose most of his sizable fortune, demonstrating the loyalty and support of Algosaibi during hardship and adversity, the other notable friendship was between the international pearl dealer, the benevolent Muhammed-Ali Zainal Alireza (1884-1969) of Jeddah and David Bienenfeld (1893-19?), the younger brother of the Jacques mentioned above; Alireza earned the title "The King of Pearls" in the Arabian Gulf during the 1920s and later became known as "The King of Diamonds" in post-World War Two India, when the farsighted Alireza eschewed his pearl trade business altogether after the worldwide collapse of the pearl market in the mid-1930s, as a direct outcome of the Great Depression, impelling him to move aggressively into the diamond trade in India, where diamonds were first discovered thousands of years ago; this opportune move came after his permanent relocation from Paris to Bombay with his small family, just before the German blitzkrieg invasion of France in 1940; Bombay became his second home after his birthplace of Jeddah, where he lived until his death in 1969 and was laid to rest, it should be pointed out that in the interwar period, Alireza moderately dealt in cut diamonds and diamond jewellery alongside his main pearl business; this involvement gave him some familiarity with the more stable diamond trade, especially in comparison to the at times volatile and unpredictable pearl market, unlike some of his pearl merchant peers who emerged from the Depression unscathed or with minimal losses and opted for comfortable retirement, he chose not to rest on his past laurels in the pearl trade, but instead, in less than a decade of his highly successful business transition, he became the principal diamond merchant in India and one of the foremost in the world in the 1950s, as for Alireza's preceding friendship with David Bienenfeld, who was forsaken and shunned by most of his friends, particularly those from the bourgeoisie French elite, after he lost almost all of his wealth and that of his family due to the Great Depression of 1929, except for his noble Muslim Arab religiously conscientious business partner and close friend Alireza, who stood by him and his immediate family steadfastly until the end, Alireza was renowned in the Arabian Gulf for the earlier pearl-related sobriquet, for he was perceived as a bearer of good fortune by local pearling communities, as he, together with his other collaborative distinguished pearl merchants of French Jewish friends, typically the 'Rosenthal Freres' (Rosenthal brothers) operating from offices in the same building on Rue La Fayette in Paris, was responsible for purchasing nearly half of the per annum pearl produce of the entire Gulf spanning from Kuwait to Dubai in the 1920s, while the remainder was either bought by Indian merchants from the Banyan community, who frequently visited the Gulf many decades before their Western counterparts, or sold directly by Gulf merchants in Bombay, dispelling the recently propagated and deliberately Western media-manufactured myth of imagined animosity between the followers of the two Abrahamic faiths, aiming to give credence to the ongoing destructive colonial legacy of the Sykes-Picot agreement in the modern Middle East, and also in some fringe, largely unrecognised polemical academic Western circles of the intractable ancient discord between predominantly Arab Muslim majority in Muslim-governed polities on one side, and particularly followers of other monotheistic religions on the other, these are Jews and Christians, as Jews, Muslim Arabs, Arab Christians, non-Arab Muslims, non-Arab Christians, and, in some cases, Mandaeans and Zoroastrians, with a special dispensation for Hindus and Buddhists, coexisted peacefully under the collective term of "Dhimmīs" (protected people) status Islamic jurisdiction, derived from the singular dhimmi (Arabic: ذمي) meaning "protected person" this jurisdiction was initially intended according to the Qur'anic text for the people of the covenant or the monotheistic people of the book, specifically Jews, Christians, and Mandaeans, even though these scriptures are Islamically deemed interpolated or corrupted sacred texts before including other religious groups in the aftermath of the century-long Arab Islamic conquests following the death of prophet Muhammad in 632 AD, considering this jurisdiction pervaded throughout the mediaeval Islamic world's golden age, in the 8, 9, and 10th centuries, and subsequent centuries, and even during the two tumultuous bloody centuries of the Crusades, stretching from Muslim Iberia all the way to Central Asia and later centuries in the Ottoman Empire, where tens of thousands of Spanish Jews fled the torturous persecution of the dreadful inquisition court under Catholic Spain after the fall of the only remaining Muslim stronghold of Granada in 1492, the last bastion of tolerance, culture, learning, and diversity in the Iberian Peninsula to the safety of the Ottoman Turkish Empire, as for the so-called friction between Muslims and Jews, it is a newfound phenomenon that began to rear its ugly head when British imperial designs for the Near Eastern legacy of the Ottoman Empire converged with Zionism, a late nineteenth-century Jewish nationalist ideology strongly influenced by emerging nationalist movements in Europe in the second half of the nineteenth century, and concurrent European settler colonial experiences involving mass displacement and extermination of native populations in the Americas, Africa, and Australia, leading to the ominous Balfour Declaration of 1917 and culminating in the genocidal bloodstained establishment of the state of Israel thirty years later, in the years 1947 and 1948, forcibly displacing and ethnically cleansing the majority of the Palestinian Arab indigenous population and their rich deeply rooted and nuanced cultural heritage in its wake (known in the Arab world as "The Nakba," the catastrophe or calamity), with unwavering and unequivocal Anglo-French support at all levels and from the bulk of the Western bloc until the mid-1960s, when the steering helm of the Middle East was taken over by the new mighty American-led Western alliance thenceforth, creating an unduly artificial and ephemeral schism in the primordial cradle of civilisation and monotheism in the fertile crescent and Arabia amongst adherents of two of the three major Semitic monotheistic closely related Abrahamic religions of Judaism, Christianity, and Islam ever since, other than the significant foreign international pearl dealers previously described, there was one notable indigenous exception from the Arabian Peninsula and the only Arab of the lot during the heyday of pearls, embodied in the interwar period by the earlier mentioned, the venerable Hijazi (from the Hijaz region of western Arabia), cosmopolitan, and multilingual, intermittently residing in Paris with his second English wife Ruby Elsie Jackson (1919-1973?), the mother of his three daughters Aminah, Hafsa, and Mariam, pearl dealer Muhammad-Ali Zainal Alireza, a member of the prominent transnational Persianized Arab trading family Alireza of Jeddah, widely regarded for his extraordinary largesse and numerous philanthropic charitable works throughout the Arabian Peninsula and beyond, most notably, his invaluable progressive contributions to the eradication of pervasive illiteracy and ignorance in Arabia and other regions of the Muslim world through the proliferation of formal modern education for both genders, encompassing the entire twelve-year curriculum, constitute his most enduring legacy, where he established the first formal, comprehensive charitable school in Jeddah named "Alfalah" (Success) at the tender age of twenty-one in 1905, followed by a similar institution in the holy city of Mecca in 1911 and complemented by a network of akin charitable schools for both sexes by the same name in Bombay, India, Dubai, and Bahrain in the first three decades of the twentieth century, with the schools in existence now being the ones in Jeddah and Mecca, while the others were closed down in the 1950s after being superseded by government-funded formal school education, Alireza was also the only merchant from Arabia to own both a flat on the world-famous Avenue des Champs-Élysées in Paris and a house in the chic Cleveland Square in London in the 1920s, in addition to the aforementioned periodic visits of the Paris-based pearl tycoons, Bahrain was regularly visited by well-known international jewellers, such as the acclaimed French jewellers of the house of Cartier and their representatives, as well as representatives of other prestigious Western jewellery houses, including the American Tiffany & Co, who frequented the Gulf on pearl purchasing expeditions, with a special focus on Bahrain, the regional pearl trade centre, with its exceptionally well-stocked pearl oyster beds, the source of its unparalleled rare-hued coveted pearls, attributed by environmental experts to the unique undersea freshwater springs found in the shallow waters of Bahrain, a phenomenon exclusive to this archipelago on the western shores of the Arabian Gulf, giving it its then Gulf advanced economic position and international fame; however, it is worth noting that in the early twentieth century, natural pearls were priced internationally in French francs, as Paris was the undisputed international pearl trade centre during the golden age of pearls, when pearls were valued more than fourfold the price of diamonds in world markets owing to their rarity and natural shape, especially after the discovery of the South African diamond mines until the 1929 Wall Street stock exchange crash, precipitating a catastrophic, slow, remorseless onslaught of a global decade-long economic depression, coinciding with the introduction of the much cheaper Mikimoto Japanese cultured pearls and the discovery of oil in the Gulf, beginning with Bahrain in 1932, the Arabian Gulf centre of the pearl fishing industry, and followed in the next few years by Saudi Arabia, Qatar, and Kuwait, supplanting the quasi-feudal industry of pearl fishing's gruelling, low-paying vicious circle of servitude indentured labour, and the time-consuming, with prolonged health risks such as blindness and deafness, particularly for pearl divers, who often had lower life expectancy than the rest of the crew members due to their primitive, sparsely clad protective diving gear, suggesting it gave little protection from the months-long detrimental exposure to the sea salinity and hazardous predatory marine creatures, followed immediately by the Second World War, delivering the final death blow to the already severely weakened reeling pearl industry by the protracted Great Depression, as if the timing of these calamitous events had conspired in a preordained twist of fate, resulting in a disastrous collapse in pearl prices from which it would not recover for several decades, effectively bringing an end to the seasonally highly organised and regimented centuries-old pearl fishing industry with its ancient rich cultural traditions of the in-part husbandry industry of dhow boat shipbuilding and its various supplementary traditional crafts and folklore, featuring boat crew folk dances and the soulful, melancholic sea shanty bard songs transmitted orally from one generation to another, performed by deep-voiced, highly skilled, mostly illiterate singers in the Gulf, this once colossal industry, employing at its zenith in the 1920s around a third to half of the able-bodied male workforce across the Arabian Gulf, has since the late 1990s transformed into an occasional immensely financially rewarding experience resembling a solitary treasure-hunting pastime, on top of being an equally rewarding tourist attraction for some fortunate scuba diving tourists)

The two excerpts below are from two different sources; the first is slightly edited, from an archival file of the British colonial Arabian Gulf Residency in Bushehr, Persia (Iran), covering the period from the 1st to the 31st of March 1912, pertaining to the timeline of the visit of Jacques Cartier to Bahrain, a tiny section of the stupendous detailed, file consisting of miscellaneous news reports received by the Gulf Residency (the 'Political Diary' of the Residency) relating to various areas of Persia (Iran) and the Arabian Gulf, for each month from November 1911 to December 1920. The reports were compiled by the Political Resident in the Arabian Gulf (Lieutenant-Colonel Percy Zachariah Cox) or, in his absence, by the Officiating Political Resident, the Deputy Political Resident, or the First Assistant Resident. (There are discrepancies between the diary of Jacques Cartier and the said report in terms of the exact dates of Cartier's arrival and departure and the unveiling of his unrealised intended final destination on his second extended Arabian Gulf trip) while the second excerpt is a citation from the book "Cartier: Jewellers Extraordinary", by Hans Nadelhoffer, which is part of the author's description of the Oriental trips of Jacques Cartier particularly those to the Arabian Gulf and his adoption of some of the local business customs and practices during those trips.

The following two brief paragraphs provide a first-hand British archival summary of Jacques Cartier and his travel companions' trip to the Arabian Gulf in March 1912.

A young Frenchman, Monsieur Jacques Cartier, arrived with two companions, Monsieur Maurice Richard, also a Frenchman, and Mr. J. S. Sethna, a Parsi Indian by the Arab Steamer "Tynesider" on March 13th. They came to the Agency to get an order of exemption for the quarantine at Kuwait. When they learned that this was impossible, they determined to stay in Bahrain until the "Tynesider" returned from Basra. They were put up by Haji Mugbil Al-Thukair to whom they brought recommendations from Bombay Arabs. They left for Bombay on the return of the ship on 1st April.

Monsieur Cartier represents the firm of Cartier of Paris and London (175 New Bond Street) and his visit was professional. He cultivated the acquaintance of the local Arab merchants and is said to have brought pearls to the value of Rs. 25,000. He informed the Political Agent that he might return to Bahrain for the pearl season of 1913. Others say that his companion, Mr. Sethna previously dealt in pearls on his own account and will be sent to work for the firm here.

The edited citation below is from the book "Cartier: Jewellers Extraordinary" by Hans Nadelhoffer.

Jacques Cartier was the firm's special expert on pearls, and it was he who accompanied the sales assistant Maurice Richard on various journeys to the Arabian Gulf and to India. In accordance with Oriental custom, he would sit cross-legged in his negotiations with local traders, and he learned the customs, languages, and habits of the various nations that he visited. Two of his journeys were recorded in the form of a diary and various other reports.

www.google.com.bh/books/edition/Cartier/xnKpjh1g&

National Cancer Institute of Colombia by Pan American Health Organization PAHO

Women are immunized against cervical cancer and pap smears are conducted in the HPV Immunisation room. Bogota, Colombia.

Lay-By Love by Mario Bekes

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It is Love on Sale?! Maybe Love is on Special after 14th Feb...? Maybe I dont know what love is...?

Or maybe I wasn't immunised against love...?

A night at Sally Bowles in Berlin by Genderfluid Ashleigh

Fully immunised, and with some proper precautions I can go out again last week.

It has been so frustrating having bought all these wonderful shoes, skirts, clothes and pantyhose and nit being able to show them off.

One of my favourite cocktail lounges in Berlin, is Sally Bowles, which is themed around the Cabaret era and named after its female lead.

The glitzy evening heels are by Aldo, the pantyhose are black Wolford Neon 40 and the lace gloves are from Kitten D’Amour in Brisbane.

Unfortunately I didn’t quite capture the sexy blac lace top from Wolford..

Anticipation by Kristen Elsby

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A young girl living in a government relief camp in Dadu cries in anticipation of the immunization injection she is about to receive for measles and polio from a lady health worker. Since the devastating monsoon floods struck seven months ago, more than 12.7 million children have received polio immunizations and more than 11.3 million children have received measles immunizations through UNICEF. Campaigns have also started among displaced children in Mohmand Agency in FATA.

Dadu, Sindh Province, Pakistan, 2011

A night at Sally Bowles in Berlin by Genderfluid Ashleigh

Fully immunised, and with some proper precautions I can go out again last week.

It has been so frustrating having bought all these wonderful shoes, skirts, clothes and pantyhose and nit being able to show them off.

One of my favourite cocktail lounges in Berlin, is Sally Bowles, which is themed around the Cabaret era and named after its female lead.

The glitzy evening heels are by Aldo, the pantyhose are black Wolford Neon 40 and the lace gloves are from Kitten D’Amour in Brisbane.

Unfortunately I didn’t quite capture the sexy blac lace top from Wolford..

Saving lives like Abdul's - prevention is better than cure by DFID - UK Department for International Development

Sierra Leone, May 2011. Aged just two years old, Abdul Kamara’s life was threatened by severe diarrhoea, but he's just received rehydration treatment, and is begining to recover.

The leading cause of severe infant diarrhoea is a common virus – rotavirus. Nearly every child in the world will have at least one rotavirus infection before reaching the age of three.

Death from rotavirus is extremely rare in developed countries. More than 85% of child diarrhoeal deaths occur in Africa and Asia, where access to clean drinking water is limited and immune systems are weakened by malnourishment, or diseases such as malaria.

Sierra Leone is one of the poorest countries in the world. Although real progress has been made since the civil war ended ten years ago, poverty is high and healthcare is basic. These factors come together with deadly results for young children.

Rotavirus vaccines were introduced in Sierra Leone at the start of 2011 with the support of the GAVI Alliance and UK aid.

To find out more, please see the full story at: www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-m...

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