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In recent days, masks have become mandatory in all public spaces — indoors or outdoors — in Madrid, Greece, Portugal’s Madeira Islands and Hong Kong.

Those moves seemingly contradict the long-held understanding that Covid-19 is more dangerous indoors. The British government, among others, used its first steps out of lockdown to encourage people to meet outdoors; parks, beaches and nature spots around the world have been inundated by guests throughout the pandemic.

But the reasoning behind the decisions is simpler than that: after months of mixed messaging from health authorities on face coverings, governments are opting for blanket rules to help make mask-wearing a cultural norm.

“There’s been a lot of confusion about where people should wear masks, and where there’s confusion, people just disengage and don’t wear them,” Melinda Mills, director of Oxford University’s Leverhulme Centre for Demographic Science, told CNN. “That’s why (some countries) are moving to a broad, blanket policy.

“I’m for clarity in public messaging, and in many countries, I think it’s been a mess,” she added.

What we know now about masks

The science behind airborne transmission of Covid-19 is growing, but experts still agree the risk is usually higher indoors.

Earlier this month a group of 239 scientists wrote an open letter to the World Health Organization, appealing for better recognition of the potential airborne transmission of coronavirus. “A lot of people crowded close together indoors where it is poorly ventilated — that is what drives the pandemic,” a co-organizer of the letter and a professor of environmental health, told CNN at the time.

But the outdoors is not Covid-free, and universal mandates on mask-wearing are likely to reduce the spread in many kinds of settings.

Researchers reported Monday that communities that mandated the use of face masks in public saw an ongoing decline in the spread of the coronavirus, but it takes some time.

Once mandates had been in place for about three weeks, the daily growth rate slowed by about 2% on average, researchers reported in the journal Health Affairs.

Their estimates suggest that these percentage decreases could add up. They calculate that between 230,000 and 450,000 Covid-19 cases could have been averted by May 22 by mask mandates.

Other scientists agree that there can be a significant risk of outdoor transmission.

“There is open air, so generally the risk is slightly lower, but it’s spreading outdoors too,” said Abrar Chughtai, an epidemiologist at the University of New South Wales. “Whenever you’re unable to maintain social distancing, you should wear a mask.”

“It’s very low risk in a setting like a park, or a big open space where there aren’t many people,” added Richard Stutt of the University of Cambridge in England, who modeled the impact of mask-wearing in curbing Covid-19 transmission.

“But if you’re walking down a busy high street, there’s quite a large potential for spread there — and defining exactly what constitutes a high-risk outdoors space versus a low-risk outdoors space would be very difficult to do.

“There’s additionally the complication that if people are constantly taking their mask off and putting it back on, then they run the risk of contaminating their hands and passing it on to other people,” he noted.

New WHO report says airborne coronavirus transmission 'cannot be ruled out' in outbreaks in some indoor settings

That scientific knowledge is one factor driving stricter mask mandates, which are beginning to appear in countries like the UK too.

But there’s a sociological element at play as well, and it’s a simple one: mask rules are working, and so governments are going further than they may have expected to.

“There were a few countries holding out, thinking the public would revolt (to mask orders), but the public just doesn’t want to be in quarantine anymore,” said Mills. “Governments will be emboldened a little bit in expanding their policies if they think these things are effective.”

Many researchers are surprised at just how effective they’ve been. In April, an alarmingly low proportion of British people were wearing masks — just 19%, according to a Kings College study published on Thursday. But 70% of Brits now say they have worn one in the last few weeks, the same study found.

“People have very quickly become convinced that they do help,” Bobby Duffy, the director of King’s Policy Institute and the leader of the study, told CNN. “There’s very, very high level of belief in their efficacy, which in itself is quite remarkable given how quickly the advice has shifted.”

That shift is particularly noticeable in a country where the government’s attempts to ease restrictions have been criticized as vague and muddled. A study by University College London last week found that just 45% of British people feel they understand the government’s current rules.

The same has been true elsewhere in Europe; hard-hit places like Italy and Spain saw mask use become a cultural norm almost immediately, and studies indicate that even in the United States — where a culture war has erupted over the use of face coverings — adherence is generally very high.

“You can bring in these rules and people will follow them,” Duffy said. “It’s incredible how quickly people get used to things. You can see that in the lockdown measures, too; there was incredible support for going into lockdown, even when a couple of weeks (prior) that would have seemed unthinkable.”

Are lessons finally being learned?

The benefits of expanded mandates are myriad, but the most significant is that it allows governments to firm up their messaging by setting a strict but simple rule: if you’re in public, you have to wear a mask.

“A blanket rule is much easier to adhere to, and also to enforce,” Stutt said.

But many experts are vexed that it’s taken so long to get here — and are imploring other countries to follow suit and make their mask laws black and white.

Two women wear face masks in Seoul. Countries in which covering one's face is a social norm have generally fared better during the pandemic.

Mills said she was “really surprised and shocked” by the conflicting guidance of the World Health Organization and many governments, which said early in the pandemic that mask use wasn’t necessary in curbing spread.

WHO Director-General Tedros Adhanom Ghebreyesus said last month that the organization switched gears and encouraged mask use after several weeks because evidence had evolved. “Our updated guidance contains new information on the composition of fabric masks, based on academic research requested by WHO,” Tedros said last month.

“It was indeed very frustrating as a scientist, (because) there have been a lot of material studies that show these good, high quality masks can really stop filtration,” Mills said.

By contrast, a number of Asian countries — many of which experienced the worst of the SARS epidemic — quickly encouraged citizens to wear masks.

“Think about Japan: they were really effective and clear, they had the Three Cs,” Mills said, referring to a government slogan ordering masks in closed spaces, crowded places, and close-contact settings.

“They just keep repeating it and repeating it, and they’ve had about 1,000 deaths in a population of 126 million,” she added, noting that Japan’s relative success depended on several other factors.

Refusing to wear face masks should be as taboo as drunk driving, science chief says

“It’s not quite as simple as this, but those places that did wear masks from the start have had vastly lower death rates,” added Stutt.

The stop-start uptake in much of the West stood in stark contrast to those countries. But now that governments are feeling confident enough to set stricter rules, experts can envisage mask-wearing to become normal in every public place soon.

“A strong message from governments and organizations like the WHO does have a significant effect on people, and makes it much more socially acceptable to wear a mask and increase adoption rates,” said Stutt.

“That mandatory use of masks is not going to result in huge rebellion from the majority of the population,” added Duffy, citing his research that showed a rapid uptake in the UK.

“There will be fractions who do object really strongly to it — that will get a bit larger and more vociferous, and our attention will be drawn to those people,” he said. “But the reality will be that the majority of the population will adapt and accept it.”

CNN Health’s Naomi Thomas contributed to this report.

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Coronavirus: Health chief hails Africa’s fight against Covid-19

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  • Coronavirus pandemic

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image captionMost African states urged people to wear masks from the beginning of the outbreak

The head of the Africa Centres for Disease Control has praised African states for managing to curb the spread of coronavirus.

Africa has seen about 1.4 million cases, and 34,000 deaths since March.

These figures are far lower than those in Europe, Asia or the Americas, with reported cases continuing to decline.

Early interventions played a crucial role in curbing the virus’ spread, John Nkengasong told the BBC’s Newsday programme.

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He described as “false” suggestions that cases and deaths in Africa were significantly under-reported.

“We may not have been picking up all the cases, just like in other parts of the world… but we are not seeing people around the continent falling dead on the streets or mass burials going on,” Dr Nkengasong said.

All African states introduced a series of measures to tackle the virus as soon as the first cases were reported in March. Many, including South Africa, introduced nationwide lockdowns, but others such as Ethiopia opted for less strict measures.

Dr Nkengasong, however, attributed the low number to a “joint continental effort”, which focused on “scaling up testing and following up contact tracing and very importantly masking”, or the wearing of face masks.

“In many countries, including Ethiopia where I live, if you go to the streets of Addis Ababa you will see there is almost 100% masking,” he added.

What other reasons did he give?

Africa’s relatively young population also contributed to the low number of cases, Dr Nkengasong said.

Furthermore, the emphasis on community-driven initiatives, and experience in contact-tracing from fighting diseases like Ebola, had helped countries to tackle the virus, he said.

“This virus is in the community, and without a strong community response and strong community engagement there is no chance we can fight it,” Dr Nkengasong added.

Warning over second wave

Analysis by Anne Soy, BBC News, Nairobi

The drop in the number of Covid-19 cases on the continent is mainly driven by South Africa, which accounts for nearly half of Africa’s cases but also a big proportion of tests.

As of Tuesday, South Africa had conducted more than four million tests. In comparison, the entire continent of more than 50 countries crossed the 10 million tests mark a month ago.

image copyrightReuters
image captionVery few hospitals in South Africa were overwhelmed by Covid-19 patients

By international standards, this is a relatively low number, and it is blamed on global shortages of testing equipment and a lack of manufacturing in Africa. It continues to undermine the Africa “success” story.

While there may be cases that have gone undetected, experts such as Dr Nkengasong say there is no indication of a large number of unexplained deaths in most countries.

But there are warnings there could be second wave of infections as more and more countries relax restrictions.

media captionThe coronavirus diagnostics kit made in South Africa

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Israel is winning on the world stage, but losing the plot at home

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“Let us pause for a moment to appreciate this remarkable day. Let us rise above any political divide. Let us put all cynicism aside. Let us feel on this day the pulse of history,” he said last Tuesday. “For long after the pandemic is gone, the peace we make today will endure.”

The normalization deals were the latest feathers in the cap of a leader who’s been on a diplomatic winning streak lately. From the outside, Israel projects the image of a small but mighty country punching far above its weight on the global stage, an innovative “start-up nation” whose thousands of tech firms attract billions in foreign investment each year.

At home it’s a different story, however. The second wave of coronavirus infections in Israel long ago eclipsed the first, forcing the country into a second general lockdown that has shuttered schools, restaurants, entertainment venues and more. And while the coronavirus may be the most pressing challenge facing Netanyahu right now, it’s far from the only one. The 70-year-old leader is being attacked from both left and the right, not only for his handling of the public health crisis, but also for mismanagement of the economy, his response to his criminal trials, and more.

“We have a dysfunctional government, good at producing ceremonies in the White House, bad at running a country,” said opposition leader Yair Lapid. “This is the worst failure Netanyahu ever experienced and we are experiencing it with him … or because of him.”

At home, weekly protests have swelled outside the Prime Minister’s residence in Jerusalem, where thousands of people have come out and called on Israel’s longest-serving leader to resign. The angry crowd, undeterred by a steady barrage of attacks from Netanyahu’s political allies, hold signs that read “Crime Minister” and “Bibi Go Home.” This past weekend, in the first protest since Israel reimposed a general lockdown, eleven protesters were arrested, police said.

Unemployment remains near 19%, according to the Israel Unemployment Service, and an already fragile economy will suffer another blow during the current lockdown. (The Central Bureau of Statistics, which uses a different set of criteria for determining unemployment, says the current rate is between 10.4% and 11.8%.)

Restaurant owners, frustrated as they face a closure that threatens their livelihoods, smashed plates on the floor in protest. Some are more defiant, saying they plan to keep their businesses open.

“No one is caring for us, we have to​ care for ourselves,” restaurateur Yoni Salomon told Israel’s Kann News. “We won’t let anyone take our most basic rights — there is no sense in this closure and I’ll deal with the fine.”

It’s not just restaurateurs defying government lockdown orders. Israeli police handed out almost seven thousand fines​ for violating the restrictions over the holiday of Rosh Hashanah, according to police spokesman Micky Rosenfeld.

Exemplary leadership from the top has also been noticeably lacking. Despite Netanyahu stressing the importance of wearing masks and social distancing, some of his ministers have been photographed without face coverings during cabinet meetings, and two of Netanyahu’s aides have ​been accused of violating quarantine regulations ​within the last week.

The lockdown restrictions themselves are a study in bureaucratic legalese, often adjusted and tweaked at the last second so as not to anger Netanyahu’s ultra-Orthodox coalition partners, or any other group with its own interests and goals that the Prime Minister decides he cannot afford to offend.

The current Israeli government is the largest in the country’s 72-year history, a so-called unity government bringing together — at least in theory — the two main political parties: Netanyahu’s Likud party and alternate Prime Minister Benny Gantz’s Blue and White party. The bloated political Frankenstein, with 34 ministers and 8 deputy ministers, was fabricated with bits and pieces broken off from existing ministries to create additional jobs for politicians to fill, such as the position of alternate Prime Minister and the Ministry of Higher Education and Water Resources.

And yet despite the government’s size, it remains almost exclusively a one-man show. Netanyahu didn’t even notify his Foreign Minister or Defense Minister​– who happens to be Benny Gantz — about the agreement with the United Arab Emirates until it was announced publicly, claiming he was concerned they would leak the news.

This government, specifically designed to handle the coronavirus crisis, was officially sworn in on May 17. ​On that day, Israel recorded just 11 new cases of Covid-19, according to Ministry of Health data. There were 44 patients on ventilators and 3,403 active cases across the country, out of a total of 16,617 cases.

READ: Full text of the Abraham Accords and agreements between Israel and the United Arab Emirates/Bahrain

At the time, critics quipped that the government could put a government minister next to each patient on a ventilator.

Four months later, Israel’s unity government has abjectly failed in its self-declared primary mission. As of Wednesday morning, there were 54,322 active cases in Israel out of a total of 200,041 cases since the beginning of the pandemic.

The Ministry of Health recorded 6,861 new cases Tuesday, with 171 patients on ventilators. Across the country’s beleaguered hospital system, 634 patients were in serious condition.

“Israelis are extremely pessimistic as a result of the corona crisis, and the perceived mismanagement of the economic and health aspects of the crisis,” said Yohanan Plesner, President of the Israel Democracy Institute (IDI). A former politician, Plesner said he’s never seen anything like the problems within this current government.

A recent survey from the IDI showed that Israelis overwhelmingly support the normalization agreement with the United Arab Emirates, but that hasn’t translated into a sense of trust in government or confidence about the future of the country. Approximately two-thirds of Israelis believe the national mood is either moderately pessimistic or very pessimistic, according to the survey results, conducted by the Midgam Institute and prepared by the Guttman Center for Public Opinion and Policy Research. ​

“Supposedly, this should have been a national unity government that is steering us out of the crisis, creating the necessary reforms to prepare us for the post-corona era; instead it’s a government that is in total paralysis,” Plesner said.

And yet Netanyahu displayed his brash brand of confidence last Thursday, when he tried to assure Israeli citizens that they’re in good hands. “The main thing I am telling you is that health and the economy are in our hands. This is the time for responsibility — personal responsibility and mutual guarantee. We will defeat the coronavirus but only together will we do so,” Netanyahu said.

Israel is going into a second nationwide lockdown over Covid-19

Netanyahu boasted about making peace with two Arab nations in 29 days, from August 13th to September 11th. During that same time period, approximately 62,000 thousand Israelis were diagnosed with Covid-19, while 446 citizens died of the disease. But when Netanyahu was asked last week who should shoulder the blame for the failure to contain the virus, he responded, “There are no failures, only achievements.”

The comment marked a strikingly different tone from that of President Reuven Rivlin just a few days later, when Israel’s head of state offered a forthright apology to the nation for the failure of the country’s leadership to lead.

“I know that we have not done enough as a leadership to be worthy of your attention. You trusted us and we let you down,” said Rivlin. “You, the citizens of Israel, deserve a safety net that the country gives you. Decision-makers, government ministries, policy implementers must work for you and only for you — to save lives, to reduce infection, to rescue the economy. I understand the feeling that none of these were done satisfactorily.”

If Israel’s public health policy is under fire, its economic policy-making is even more sclerotic. The last national budget was passed in 2018, and Netanyahu and Gantz were unable to reach agreement on a new one last month, so they decided instead to simply postpone for a few months in the interests of keeping their government afloat. The head of the budget division in the Ministry of Finance quit his job, joining his counterpart at the Ministry of Health’s public health division, who walked out a few months earlier. Both wrote fiery resignation letters critical of the country’s leadership or lack thereof.

And yet from the lofty position of Israel’s Prime Minister, ​none of the above counts as the number one problem. Netanyahu’s biggest issue is the fact he has been charged with bribery and fraud and breach of trust. He continues to maintain his innocence, attacking the attorney general, investigators, and the judicial system, accusing them of an attempted coup driven by the left-wing and the media.

His trial begins in earnest in January, when a panel of judges will begin hearing from witnesses. It is hard to imagine a White House ceremony big enough to draw attention away from those criminal proceedings.​​​

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Pelosi wrestles with House factions ahead of Supreme Court confirmation fight

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Both factions see their priorities as key to delivering Democrats sweeping power in the House, Senate and White House next year. Whether Pelosi can keep her sprawling caucus from splintering in the month before the election will be critical.

“Leadership has to try to tend to the many different voices in a big very tent. And I understand that,” said Rep. Gerry Connolly (D-Va.), a senior member of the House Oversight Committee.

“But I think this goes beyond an issue of politics,” Connolly added. “It’s about the future of the country. And that’s why I favor robust action that would have been considered really out there — bold — a few years ago.”

Since the death of the liberal icon on Friday, Pelosi has carefully sought to temper progressive expectations about the Supreme Court fight without dampening their enthusiasm — and risk depressing voter turnout on the left over the issue.

Liberal Democrats, both in Congress and leading grassroots groups across the country, have been incensed as they watched Senate Majority Leader Mitch McConnell (R-Ky.) lock down support for a vote before the election or during a lame duck that could give the court a conservative majority for decades.

Cash is flooding in, and protests have lined the streets of Washington. Activists and even some elected Democrats have begun to talk seriously about packing the courts or an end to the Senate filibuster — historic institutional changes that establishment Democrats have long rejected.

Some chatter even emerged on the left of pursuing the impeachment of a Trump appointee like Attorney General William Barr in a last-ditch attempt to slow the process, though progressives in Washington have been far more restrained in their messaging. Senior Democrats have also repeatedly privately dismissed the idea, saying it wouldn’t work anyway.

“We’ve got to talk about what’s at stake now, what’s at stake in the lives of millions and millions of people,” said Sen. Elizabeth Warren (D-Mass.) when asked about liberal calls for court-packing or ending the filibuster. “Health care is on the ticket once again. … This fight touches the lives of every single person in this country.”

The most progressive voices in the party, including Rep. Alexandria Ocasio-Cortez (D-N.Y.), have clearly articulated their support for Senate Democrats to ultimately strike back, such as eliminating the legislative filibuster and adding justices to the court.

“Frankly, I think if Vice President Biden wants to accomplish anything significant in his term, that is what is going to be necessary,” the liberal Democrat told POLITICO. “If I’m Joe Biden and I completely shut down the possibility of expanding the court, I would seriously question what you can even accomplish as president.”

But Ocasio-Cortez has also made a concerted effort to stay on message with the Democratic party leadership in the crucial final run-up to the November election.

Over the weekend, Ocasio-Cortez appeared alongside Senate Minority Leader Chuck Schumer (D-N.Y.) in a New York City press conference, where both insisted that Democrats would keep their options open. And Ocasio-Cortez also said even though Biden hasn’t embraced far-left ideas like court-packing, he is at least “open” to different ideas and she thinks he is “calculating correctly.”

The demands of the far left could hardly look more different than the centrist wing of the Democratic Party, which is more worried about holding onto their seats in November. They say the party’s only response should be talking more about the threats to Americans’ health care — repeating the playbook that helped propel the party back to power in the House in 2018.

And most centrist Democrats have little interest in heeding demands of outside liberal groups and even some members, which they fear will cause lasting damage to the institution and may only backfire the next time the Republican party seizes power.

“We have to focus on right now and protecting health care today,” said Rep. David Cicilline (D-R.I.), who leads the caucus’ messaging arm. “If we’re privileged enough to win the House, the Senate and the White House, we’ll have lots of opportunities to talk about solutions. But right now, we need to call out the president for what he is attempting to do.”

Moderate Democrats were privately furious that some of their more liberal counterparts, like Judiciary Chair Jerry Nadler (D-N.Y.), would float the idea of expanding the court in retaliation for Republicans ramming through a new Supreme Court justice this year.

And even publicly, some congressional Democrats argue that the vocal calls for scorched-earth tactics right now could have unintended consequences for the party.

“Why provide anybody any ammunition at all to attack us for something that is speculative?” said Rep. Jamie Raskin (D-Md.), a member of the Judiciary Committee. “The Republicans would love nothing more than to shift this into an academic discussion about the number of times that the Supreme Court’s size has changed.”

Pelosi refused to rule out extreme dilatory tactics like impeachment during an interview on ABC on Sunday, saying the House will use “every arrow in our quiver” to stop Republicans from confirming President Donald Trump’s third high court nominee. But Democrats privately shut down the idea of pursuing impeachment. And Pelosi has repeatedly tried to shift the focus to what the Supreme Court fight means for preserving or destroying Obamacare.

Pelosi and Schumer circulated talking points encouraging Democrats to frame the Supreme Court fight in those terms. And Pelosi has repeatedly emphasized the success of Democrats’ almost singular health care message in 2018.

Pelosi speculated that Republicans and Trump were rushing to fill the high court vacancy to strike down the Affordable Care Act, a move she predicted would backfire on the GOP like the party’s effort to dismantle the law in 2018. The Supreme Court is slated to hear arguments in the Trump administration’s challenge to Obamacare the week after the election.

“You overturn the Affordable Care Act, you overturn preexisting conditions, 2018 will be a way of life for Republicans,” Pelosi told Democrats on a private call Tuesday, according to sources on the call.

Many moderate Democrats have already made health care a top issue in their reelection campaigns this fall.

But they’ve also begun to feel the intense pressure on another issue: economic relief for tens of millions of Americans who’ve been left struggling as the U.S. economy sputtered over the last six months due to the pandemic.

“People in my district are worried about their pocketbooks and their kids,” Rep. Elissa Slotkin (D-Mich.), a frontliner, said in an interview Tuesday. “And while they feel very strongly about the importance of a lifetime appointment … they want to know when the next Covid emergency relief bill is gonna be here, they want to know how they can get masks and supplies to keep their businesses open, they want to know what’s happening with unemployment.”

Democrats in the most competitive races have begun vocally pressing Pelosi and her leadership team for more dramatic steps on a coronavirus relief package. More than 20 Democrats, including Slotkin, signed a bipartisan letter to Pelosi and House Minority Leader Kevin McCarthy (R-Calif.) on Tuesday urging them to keep lawmakers in Washington until a relief bill can be passed — even if it means less time to campaign before November.

“This should be our number one priority in the coming days,” lawmakers wrote in the letter, which was first reported by the New York Times and obtained by POLITICO.

At least a dozen Democrats are also privately discussing joining a GOP discharge petition that would force a vote on additional aid for small business grants, known as the Paycheck Protection Program. That includes Rep. Abigail Spanberger (D-Va.), Anthony Brindisi (D-N.Y.) and Jared Golden (D-Maine) — all facing tough reelection battles this fall.

In one sign of hope, Pelosi told her members in a private call on Tuesday that she’s still pushing to secure a pandemic aid package with GOP leaders — regardless of the intense discussions over the court across the Capitol — with hopes of delivering relief before the election.

House Majority Leader Steny Hoyer (D-Md.) told members on Tuesday they should be expected to remain in town next week and he is keeping the schedule open for a potential vote.

“Getting into these beltway arguments, in this bubble, when people are hurting, small businesses are going out of business every day for good. … What are we quibbling about here?” said Rep. Kathleen Rice (D-N.Y.), referring to the debate over court-packing and nuking the filibuster.

“There’s still an alarming rate of Covid positive tests in this country. I just think it’s a little premature to talk about what Democrats are gonna do in the Senate in January.”



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