In today's edition:

  • India’s crisis is a global problem
  • FDA moves to ban menthols
  • Should masks be worn outdoors?
'This Time It Was Like a Rocket'
How COVID-19 Ripped Through India
In a Facebook Live session on Thursday, Randeep Guleria, director of the India Institute of Medical Service in New Delhi; Gagandeep Kang, professor of microbiology at Christian Medical College in Vellore; and Amita Gupta, chair of the Johns Hopkins India Institute, talked with Josh Sharfstein about the unprecedented public health disaster in India. 
The grim situation is the result of multiple converging factors, said Guleria: successful containment of initial waves that led to a sense of complacency, large gatherings that resumed just as new variants entered the country, plus a slow rollout of COVID-19 vaccines.
“If [the curve of infections] was like a mountain last time, this time it was almost like a went up straight,” said Guleria.
The crisis began in the west of India but the surge is spreading eastward. Kang, speaking from the southern city of Vellore, said that they are “still waiting” for the surge to hit the area. That particular region has two benefits that much of the rest of the country doesn’t have: a strong public health department and infrastructure, and the fact that 95% of medical personnel are already vaccinated. Also, public health restrictions have been put in place, including fines for not wearing a mask and closure of big shopping centers. 
Still, a major complication for the entire country is a critical shortfall of vaccines: The supply to date is only about 70 million of the 120 million doses that were promised by the end of December 2020, Kang said. This is where other countries need to step in to provide not only authorized COVID-19 vaccines, but the raw supplies needed for India to ramp up its own manufacturing capabilities, Galeria said. 
And this is, indeed, a global problem: “What happens in India matters to the entire world,” said Gupta. “We care from a humanitarian perspective, a public health perspective, and a health security perspective.” Already, neighboring countries like Nepal, Pakistan, and Bangladesh are showing an uptick in COVID-19 cases. Plus, anywhere the virus is circulating has the potential to spin out more variants of concern. 
There is much for the rest of the world to learn from India’s crisis. “Countries with the best resources in the world did not manage very well, and preparedness where you link surveillance and the ability to respond with your medical care systems is going to be critical,” Kang said. “We need to focus on remembering what we’ve been through to make sure it doesn’t happen again.”
To stop further deterioration of India’s health care infrastructure, the country urgently needs a nationwide shelter-at-home directive–but a humane one, write Sunil Solomon and Shruti Mehta. 

Johns Hopkins is working urgently with partners on the ground to offer support and expertise to India, with efforts organized and led by the newly created Johns Hopkins India Institute, chaired by Amita Gupta. Read more about what’s being done here.
ICYMI: Amita Gupta talked with Josh Sharfstein about India’s crisis yesterday on Public Health On Call. You can listen here
FDA Moves on Menthols
The FDA took a big step toward banning menthol cigarettes and flavored cigars yesterday—taking aim at products disproportionately targeted at communities of color. 
The goal is to implement the ban within a year—but first, the proposed rule must go through a public comment period.
Big Tobacco will fight to topple the move—and for such a rule to have the intended impact, the final version must account for loopholes, says the Bloomberg School’s Joanna Cohen.
For example: Last year the FDA banned flavored cartridges except tobacco and menthol flavors—and that simply pushed vapers toward devices with pre-loaded flavors, Cohen told NPR.
“If you squeeze in one area, the balloon—the tobacco industry—is just going to expand into some other area,” she cautions. “So you have to really be thoughtful and comprehensive whenever you do one of these things, because if you're not careful, it moves the problem.” 
Chile: COVID May Be Surging, But So Is Civil Society
News of Chile’s first COVID-19 case last spring hit on the heels of massive economic and political protests—led by a newly empowered civil society sector.
The same forces proved to be valuable advocates for sound public health interventions against the pandemic, says Bloomberg School alum Javier de la Maza, a pediatric emergency physician and assistant professor of Health Communication at Pontificia Universidad Católica de Chile.
De la Maza details more of what went well for Chile, and what could have gone better, in this latest installment of GHN’s COVID country dispatches.
Mark your calendars: President Bill Clinton is convening leaders from across the faith and public health communities for a discussion on how to take action on the overdose crisis—which is still spiraling amid the pandemic.
  • President Bill Clinton
  • Ellen J. MacKenzie, Bloomberg School Dean
  • Sanjay Gupta, CNN Chief Medical Correspondent 
  • David Satcher, 16th US Surgeon General 
  • Bishop Vashti McKenzie, African Methodist Episcopal Church
The Outdoor Masking Debate
Should masks be worn outdoors?
Public health heavy hitters debated the issue in a BMJ article this week. 
In the ‘Yes’ camp: Babak Javid, Dirk Bassler, and Manuel B Bryant argued that face coverings outside should be normalized because it may reduce COVID-19 transmission—and may encourage mask wearing indoors. 
Coming down on the ‘No’ side: The Bloomberg School’s Stefan Baral, along with Muge Cevik and Zeynep Tufekci, argued that outdoor transmission contributes very little to overall infection rates and that efforts should focus on reducing indoor transmission.
"We need to protect those who are at highest risk," explains Johns Hopkins Center for Health Equity director Lisa Cooper in an animated video produced by our social team.
"There are a lot of things that you can do to help create more equity in the vaccine rollout."
As of this week, more than 234,000,000 doses of the COVID-19 vaccines have been administered in the U.S.—that means 54.5% of adults over 18 have received at least one dose, according to the CDC.

But our work isn't finished.

Encourage your friends and family to get vaccinated when they're able to do so. It keeps them safe, and it protects everyone else, too!
Share this Instagram post to spread the word.
An Update on COVID-19 in Canada
Canada is experiencing a serious wave of COVID infections with the majority from variants of concern like B.1.1.7. British Columbia currently has one of the highest rates of P.1 outside of Brazil itself where the variant was first discovered. Brian Goldman, the host of two CBC podcasts and a clinician at Sinai Health System in Toronto, returns to the podcast to talk with Josh Sharfstein about the factors that contributed to Canada’s COVID crisis, including logistical issues with distributing vaccines. 
Help! If There’s a Chance That I Could Endanger Others, Should I Still Travel? (The New York Times)
Our Tripped Up columnist helps weigh the public health and ethical elements of traveling amid rising infection rates. Amber D'Souza weighs in. 

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