H5N1

Cambodia: Factory collapse kills at least two

Via The Cambodia Daily, a report that echoes the disaster in Dhaka just weeks ago: Factory Collapse Kills At Least 2, Injures 6. Excerpt:

A ceiling collapse at a shoe factory in Kompong Speu province killed at least two workers and left six seriously injured early Thursday morning, while an unknown number of people still remain trapped in the wreckage, a local official said. 

The workers were killed as they entered the building to start their shift at the Taiwanese-owned factory. 

“Two died, a male and a female worker, and six are in critical condition,” said Kong Pisei district governor Ma Savath. “My authorities are still trying to save the victims trapped inside.” 

According to Mr. Savath, the factory collapse occurred at around 7:20 a.m. at the Wing Star Shoes Co. Ltd., a Taiwanese-owned factory located in Maha Russei commune. He said that more than 2,000 workers are employed in the factory complex, which consists of several buildings.

Bangladesh: You can't lose them all

Credit: The Daily Star

Via The New York Times: Woman Rescued in Bangladesh Rubble 17 Days After Collapse. Excerpt:

Day after day, the grim drudgery of digging for bodies had progressed at Rana Plaza. Talk of rescuing survivors had faded. This was the recovery phase, and what was being recovered were corpses, the numbers spinning remorselessly forward: 700 dead became 800, then 900, with no end in sight. 

By Friday morning, the number had pushed above 1,000. And then, late in the afternoon, a soldier from the Bangladeshi Army, standing atop the rubble of the wrecked building, noticed an iron rod that seemed to be moving. There was a noise, a voice. Rescuers hurriedly carved a hole through a concrete pillar. Television stations in Bangladesh cut to the scene: a woman, gasping, was alive in the wreckage, nearly 17 full days after Rana Plaza had collapsed. 

A new number was announced: One. A female garment worker named Reshma. A survivor. A miracle.

And here is the story in The Daily Star, a Bangladeshi newspaper whose website is now nothing but Reshma.

Bangladesh: 1,027 dead so far in Rana Plaza collapse

Via bdnews24.com: Savar toll crosses 1000. I have been trying to avoid this story as too grim to contemplate, but here is the complete report as of 9:15 a.m. May 9, local time:

The death toll of Savar's Rana Plaza collapse crossed 1000 on Friday morning and more bodies were being recovered after over two weeks of the nine-storied building collapse.      

The control room set up at the site said the death toll now stood at 1027 at 9:15am in the morning. This is easily the world's worst incident of collapse of an industrial-commercial structure by itself. 

The 9/11 Twin Towers tragedy led to more loss of lives but it was the result of an unprecedented terror strike and not a case of structural failure as the Rana Plaza collapse.

H7N9: Taiwan poultry firm owners suffering from flu to notify hospital of profession

Via The China Post: Poultry firm owners suffering from flu to notify hospital of profession. Excerpt:

The Council of Agriculture (COA) yesterday demanded poultry business owners who are suffering from flu symptoms to seek medical treatment immediately and notify the hospital of their profession so that the relevant authorities can conduct H7N9 influenza inspections more easily. 

Huang Guo-ching (黃國青), the deputy director of the COA, said that the council will also double the number of random inspections on migratory birds and fowl from 12,000 to 24,000 annually. 

“H7N9 does not produce any symptoms in fowl, so the COA is taking more precautions to prevent a potential influenza outbreak,” Huang said. 

“The COA would also like to ask poultry business owners to go to a doctor immediately when they start to show flu symptoms, instead of waiting until the condition worsens,” the deputy director added. 

“It is important to let medical personnel know that the patient is in the poultry business so that they can run a test to verify if the patient is suffering from H7N9,” Huang said. 

The COA can also track the source and make sure if the location in which the patient keeps poultry or fowl contains the H7N9 influenza virus, according to Huang. 

Poultry-related businesses, Huang added, include people who keep, transport, cook, or sell fowl and poultry.

Pakistan: Polio teams in Swat refuse security

Via The Express Tribune, a new definition of courage: Self-protection: Polio teams in Swat refuse security.

Following attacks on polio teams in Khyber-Pakhtunkhwa earlier this year, vaccination drives are now being conducted amidst tight security. But female workers in Swat have refused to take security personnel with them during the campaigns. 

“The district administration has decided to administer polio vaccines amidst security but we do not want police by our side because it makes us more visible and susceptible to attacks. It is better to do our work in a way that makes us less noticeable,” Zareena, a schoolteacher, told The Express Tribune. 

Many lady health workers (LHW) too have refused to accept security. “We always administer polio drops at our own villages, so we have no threat. Before starting this campaign we decided to take no visible security,” said Zaibunisa, an LHV in Amankot. 

Regardless, security forces in Upper Swat closely monitor the anti-polio campaign by appearing in civilian clothes.

Branswell: Experts say 'superspreaders' could turn new coronavirus into SARS-like event

Via CTV News, a fascinating report by Helen Branswell of The Canadian Press: 'Superspreaders' could turn new coronavirus into SARS-like event: experts. Excerpt from a long, informative article:

People who think the new coronavirus couldn't take off and cause a SARS-like crisis may have forgotten a phenomenon that was a game-changer during SARS -- patients called superspreaders. 

At present, this new coronavirus doesn't seem to spread easily from person to person, a fact which some people use to argue it will not become the next SARS. Some limited human transmission has occurred, but confirmed cases are few and sporadically seen. 

However, several experts suggest that superspreaders, which turned SARS into a global outbreak, could do the same with this new virus. That term refers to people who buck the transmission trend with a given bacteria or virus, infecting many more people than is the norm. 

Dutch virologist Ron Fouchier gives a succinct answer when asked if a superspreader could be profoundly alter the pattern of spread with this emerging virus: "Yes." 

If the virus infected someone who turned out to be a superspreader, and that person sought care in a hospital that wasn't taking precautions against novel coronavirus infections, this new disease could rapidly begin to resemble SARS. 

"I think we would be in big trouble," says Fouchier, who is with Erasmus Medical Centre in Rotterdam. "There were really only very few cases that caused the trouble during the SARS outbreak." 

So far there have been 16 confirmed infections with the new virus, 10 of which have been fatal. Cases have emerged from Saudi Arabia, Qatar and Jordan. 

After the dust settled from the whirlwind 2003 event and infectious diseases teams traded their emergency response vests for their research coats, it became apparent that the SARS coronavirus hadn't spread very well. 

In fact, most people who contracted the virus either didn't infect anyone else, or passed it on to a single person. With that kind of inefficient transmission, an outbreak would normally stall, lacking the momentum to keep itself going. 

But during SARS, a select few people inexplicably ended up infecting a dozen, two dozen or more people, turning a disease that might otherwise never have been spotted into a four-month worldwide panic. 

SARS went global thanks to a superspreader -- a Chinese doctor who infected more than a dozen people at a Hong Kong hotel in late February. One of those people brought the virus to Canada. 

In Singapore, one SARS patient infected 62 people. In Toronto, which had several superspreaders, one early case infected 44 others. 

In fact, an elderly couple who contracted the virus on the night SARS made its first appearance in a Toronto hospital were both superspreaders. 

The woman, who had taken her husband to hospital for a heart problem, brought him back a few days later when he began to suffer from the symptoms that would come to be recognized as SARS. Later, people who traced the spread of the virus through Toronto hospitals would see that she infected three admission clerks, a security guard, five visitors, three nurses and one housekeeper -- all within a 2 1/2 hour span. 

"She wasn't that sick, actually. I don't even know if she had a fever," says Dr. Donald Low, the Toronto microbiologist who helped lead the city's SARS response. 

"But clearly she was excreting a lot of virus ... which then ping-ponged into a massive number of cases throughout the city."

The health consequences of war: The case of Iraq

If you're not already registered with the The Lancet, click through and register at once. It's free and gives you access to some important reports. This week, the March 16-22 issue deals with Iraq and the health consequences of the war—not only on the Iraqis, but on the soldiers who invaded.

Canada: More on the HCW flu vaccination controversy

This weekend, The Tyee published Why Your Nurse Didn't Have to Take a Flu Shot. It's based on British Columbia government documents, obtained through Freedom of Information, about the problems of getting healthcare workers to accept flu shots. Excerpt:

[BC Medical Officer of Health Dr. Perry] Kendall claimed studies in The Lancet, British Medical Journal, Canadian Medical Association Journal and Society for Healthcare Epidemiology supported mandatory immunization of health-care workers, but Dr. Tom Jefferson of the Cochrane Collaboration said reviews found several recent studies to be at a high risk of bias.

I've heard of Jefferson before, and I've done a brief web search on him and Cochrane. Clearly he's a contrarian on the vaccination issue, and he's attracted some unsavoury allies among the anti-vaccination people. 

But I don't know how seriously to take him. We've had a recent report on the inefficacy of the current H3N2 flu vaccine. If any healthcare professionals want to offer opinions on this issue in general, and Jefferson in particular, I'd be grateful to hear them.

Nigeria: Special security ordered for health workers

Nigeria's media are understandably agog today about their soccer team winning the Africa Cup of Nations, but almost no one has published any follow-up to the horrendous attacks on polio vaccinators and the North Korean doctors. However,The Punch does have this story: IG orders special security for health officers. Excerpt:

The Inspector-General of Police, Mohammed Abubakar, has ordered special security for all health officers involved in immunisation and other special medical tasks in the country. 

Abubakar directed all Commissioners of Police and zonal Assistant Inspectors-General of Police, especially those in northern states, to devise “customised” security strategies to ensure that there was no further attack on health workers in the country. 

The directive came following the killing of nine health workers in Kano State last Friday. 

A statement by the Deputy Force Public Relations, Frank Mba, in Abuja on Sunday, assured Nigerian and expatriate medical personnel in the country that the police would ensure their safety. 

Mba said the police had begun an investigation into the attack on the workers and assured the citizens that the perpetrators would be brought to book soon. 

He said, “Command CPs and Zonal AIGs, especially those covering the northern states have been directed to devise customised and tailor-to-suite security strategies to ensure that no further attack on innocent health workers occur.”

North Korean doctors killed in northeast Nigeria

Via Reuters: North Korean doctors killed in northeast Nigeria. Excerpt:

The unknown attackers ransacked the apartment in Potiskum, Yobe state, after killing the doctors in the early hours. 

It was unclear who carried out the killings. Potiskum has been frequently targeted by Islamist sect Boko Haram, a group that killed hundreds last year in its effort to carve out an Islamic state in Nigeria's mostly Muslim north. 

However, there could also be a criminal motive as foreign workers are associated with wealth in Nigeria. Western embassies have designated northeastern states "red zones" and advise their nationals not to travel there. 

Boko Haram's insurgency has contributed to a breakdown in order across the north of Africa's most populous nation and security sources believe criminal gangs carry out deadly armed robberies hoping the militants will be blamed. 

"The three North Koreans were slaughtered at about 1 a.m.. They worked at the General Hospital," Yobe Police Commissioner Sanusi Rufai told Reuters by telephone. 

The commissioner said in 2009 the reclusive state had struck an agreement with Yobe to send 18 doctors to different parts of the state.

This story has taught me something: When I saw the first report I automatically assumed that it was inspired by terrorism, that healthcare workers were the new target. I also assumed that the doctors must be South Korean, because...well, because who ever heard of North Koreans in Nigeria?

Even when I linked to the KBS World story that clearly said they were North Koreans, I didn't read closely enough to notice that fact right in the headline.

I was trying to fit surprising new information into an existing story—a story about Boko Haram, like their Pakistani counterparts, threatening health workers. So I started jumping to conclusions instead of waiting for more information. I'll try to do better.