H5N1

US: Health care deserves more attention on the campaign trail

An editorial in The New York Times: Health Care Deserves More Attention on the Campaign Trail. Excerpt:

The reaction to opening a medical bill these days is often shock and confusion — for the insured and the uninsured. Prices and deductibles keep rising, policies are drowning in fine print, and doctors are jumping on and off networks. So why hasn’t the growing burden of health care gotten more attention in the presidential campaign? 

One reason may be the sheer complexity of the system. Yet Hillary Clinton, if you look closer at her proposals, has a range of interesting ideas on how to tackle costs and improve care. Donald Trump, meanwhile, rarely ventures beyond his “end Obamacare” slogan. 

With incomes for most Americans stagnant, individuals and families insured under the Affordable Care Act or through employers are bearing more of the cost of medical treatment.

Deductibles for individual coverage increased 63 percent on average, to $1,221 per year, from 2011 to 2016 for people who get health insurance through their employers, according to a report released last week by the Kaiser Family Foundation and the Health Research and Educational Trust. Workers’ contributions to premiums grew more slowly than in previous five-year periods but still jumped 23 percent, to $1,129 a year. 

By contrast, average incomes were up just 11 percent, which means many people are being forced to cut back elsewhere to pay for care. And some people are choosing to forgo or delay going to doctors and hospitals when they are sick.

Florida Health Zika update, September 23: Four new cases

Florida Health has published its daily Department of Health Daily Zika Update for September 23. Excerpt:

There is one new travel related case today in Hillsborough County. Please visit our website to see the full list of travel-related cases. 

There are three new non-travel related cases today in Miami-Dade County, which are all associated with the Miami Beach investigation. 

DOH continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties and mosquito abatement and reduction activities are also taking place around the locations that are being investigated. DOH believes ongoing transmission is only taking place within the identified area in Miami Beach in Miami-Dade County, see map below.

The numbers are 683 travel-related Zika cases, 95 local cases, 90 cases involving pregnant women, 10 nonresident cases, and a total of 878 cases.

Wanted: a fighter for global health to lead WHO

Via Reuters, a must-read: SPECIAL REPORT-Wanted: a fighter for global health to lead the WHO. Excerpt and then a comment:

The view outside the office of the head of the World Health Organization dazzles, stretching across Lake Geneva to Alpine peaks. The view inside is less inspiring: dated furniture and listless pot plants dot the seventh-floor office of Margaret Chan, the WHO's director general.  

Understated decor suits her style. "I am an international civil servant," she told Reuters in an interview. "I am here to facilitate countries to discuss and find solutions."  

Chan's low-key, consensual approach has held sway at the organisation for nearly a decade. A Chinese former teacher and doctor, she says it has brought lasting results - such as progress towards universal health coverage and improved pandemic preparedness.  

"If you want to be successful in global public health ... you need to bring all partners together," she said. Quoting what she said is an African proverb, she added: "If you want to go fast, you go alone. If you want to go far, you go together." 

But as her second five-year spell at the top heads towards a close, numerous public health experts say consensus is no longer enough. In May, 10 influential global health specialists wrote to the British Medical Journal (BMJ), saying of the WHO: "Business as usual cannot continue; transformative leadership is called for." The UN agency requires strategic reform, they said, and needs a bold new director general who can command the world stage. 

Reuters has spoken to eight more specialists who voiced similar views. Jeremy Farrar, director of global health charity the Wellcome Trust, says whoever takes over from Chan has to "inspire a sense that the organisation knows what it's doing, inspire confidence in the member states, and inspire the best people to want to work there." 

In their view, the WHO is losing influence, and at risk of losing more. Despite being a global body, the WHO's spending power is relatively modest: $4.3 billion over two years compared to almost three times that at the U.S. Centres for Disease Prevention and Control. 

Other organisations are attracting big funding from global health philanthropists and making strides in key fields outside the WHO. They include GAVI, the alliance created to improve access to vaccines for children in poor countries, and the Global Fund for AIDS, Tuberculosis and Malaria. 

More recently, the task of tackling antimicrobial resistance - the global spread of superbugs that are not susceptible to antibiotics - is being led not by the WHO but by an independent team headed by Jim O'Neill, a well-connected former Goldman Sachs economist. 

Much will depend on the WHO's next leader. Richard Horton, editor of the influential medical journal The Lancet, said: "The WHO needs a director general who can speak truth to power." He said he is "very optimistic" about what could be done at the WHO by the right sort of personality at the top. 

"If you have the right person, it's a fantastic opportunity," he said. "If you have the wrong person, then it's paralysis and failure."

While most North Americans are obsessing about the US presidential election, the election of the next WHO Director General will probably affect the lives of far more people.

Singapore mulls monitoring program for babies born to women with Zika

Via the South China Morning Post: Singapore mulls monitoring programme for babies born to women with Zika. Excerpt:

Singapore is exploring plans to establish a national surveillance programme to monitor the development of babies born to pregnant women infected with the Zika virus, the state-owned Channel NewsAsia (CNA) said on Friday. 

Sixteen pregnant women have been confirmed to have the virus in Singapore, CNA said, quoting the Ministry of Health - a doubling of the eight cases reported on September 11.   

CNA said the ministry was keeping close tabs on the women. 

While most people experience mild symptoms, Zika infections in pregnant women have been shown to cause microcephaly, a severe birth defect in which the head and brain are undersized. In adults, it can cause a rare neurological syndrome called Guillain-Barre. 

Island city-state Singapore reported its first locally infected Zika patient on August 27, and since then the number of reported infections has risen to 387 as of Friday.

Iraq: The coming crisis in Mosul

Via The New Yorker: The Coming Crisis in Mosul. Excerpt:

A humanitarian catastrophe is looming over northern Iraq. As many as a million people are expected to stream out of Mosul when Iraqi government forces, backed by the United States, move to retake the city from isis, which took control two years ago. The much anticipated military operation could begin as early as next month, but aid workers here say they do not have anywhere near the resources, money, or manpower to deal with the expected human tide. 

“It’s a nightmare—a disaster heading our way,’’ Alex Milutinovic, the director of the International Rescue Committee in Erbil, told me. “The Iraqi government is determined to destroy isis, but it is impossible to accommodate the number of refugees the military operation is going to produce.”  

The Iraqi and American governments have been planning to retake Mosul since isis invaded the country and captured the city, in 2014. The reasons for doing so are obvious and urgent: the people of Mosul are being held hostage by violent fanatics; last month, according to the Iraq Oil Report, which has correspondents inside the city, isis agents arrested ninety people on charges of spying for the Iraqi government and executed sixty of them.

Once the military operation begins, it’s possible that isis fighters will block civilians from fleeing and use them as human shields. But, ultimately, much of Mosul is likely to be destroyed. Without proper preparation, the invasion could resemble the ends of the first Gulf War or the Rwandan civil war, both in the nineteen-nineties, both of which produced hundreds of thousands of refugees, and immense suffering. 

Aid workers have communicated their alarm to Iraqi and American commanders, but preparations for the offensive continue apace. In a joint appearance at the United Nations with President Obama this week, Iraqi Prime Minister Haider al-Abadi said he expected military operations to begin as soon as late October. Abadi and other Iraqi officials have either brushed off concerns about refugees and civilian deaths or given blithe assurances that everything will be fine. 

“The capture of Mosul will be finished in record-breaking time,” General Yahya Rasool, the spokesman for the Iraqi Army, told the Financial Times recently.  

At the Debaga refugee camp outside of Erbil, you can glimpse a future that may be in the works. The camp is one of many spread across Iraqi Kurdistan, where a million and a half refugees from other parts of Iraq and from Syria are gathered in tents, schools, and mosques. Aid workers say that half of them are children. 

The Debaga complex, spread across a rolling field of pasture and sand, was designed to accommodate twenty-eight thousand people. Today, it has nearly forty thousand, with desperate families who have fled the fighting turning up every day.

India: 63 test positive for chikungunya in a day in Jaipur

Via The Times of India: 63 test positive for chikungunya in a day.

JAIPUR: Chikungunya, which has wreaked havoc in Delhi, has become a nightmare for health authorities in Jaipur too. On Friday, 63 persons tested positive for the vector-borne disease in the city. 

Till September 12, only 15 persons had tested positive in Jaipur. However, over the next 11 days, the number of affected persons rose to 329. 

Hospitals are flooded with patients as vector-borne diseases and viral fever took its toll on people's health. From September 10 to September 20, more than 15,000 people were found suffering from various seasonal diseases in 35 dispensaries of the city. 

For the corresponding period last year, the number of chikungunya cases was less. Official figures show that only 55 cases of chikungunya were reported till September last year. But, the disease is giving sleepless nights to health authorities this year. They blamed Delhi, where chikungunya outbreak was first reported, for the spread of the disease in Jaipur. 

Chikungunya spreads through the bite of infected Aedes aegypti mosquito. It is the same mosquito which transmits dengue. "If Aedes aegypti mosquito bites a person suffering from chikungunya, it becomes infected with chikungunya virus. When the same mosquito bites a healthy person, it transmits the virus to him who then becomes infected," chief medical health officer (Jaipur I) Dr Narottam Sharma said. 

He advised citizens to take precautions to keep seasonal diseases away by keeping the environment clean and not letting water accumulate to prevent the breeding of mosquitoes. 

Besides, the health department on Friday started conducting fogging with its new vehicle-mounted high capacity machines. Up till now, the department had only used portable fogging machines.

Branswell: It takes two chemicals to knock out mosquitoes that carry Zika

Via STAT, Helen Branswell writes: It takes two chemicals to knock out mosquitoes that carry Zika. Excerpt:

Aerial spraying of the insecticide naled, followed by a product that targets mosquitoes when they are in the larval stage, may be responsible for a sharp drop in Aedes aegypti mosquitoes in a part of Miami where local transmission of the Zika virus was first found, the Centers for Disease Control and Prevention reported Friday. 

CDC Director Dr. Tom Frieden said the apparent success of the combination in the Miami neighborhood of Wynwood may represent a new standard for control of Aedes aegypti mosquitoes. 

“It appears that the aerial application of this one-two punch has the ability to rapidly interrupt transmission,” Frieden said during a media conference Friday.  

“The findings are quite striking,” he added. “Those who’ve worked in the field of arbovirology and control of diseases spread by Aedes aegypti and have looked carefully at this data are struck that we haven’t seen similar control in other diseases spread by this particular mosquito species.”

Singapore: 16 pregnant women confirmed to have Zika

Via Channel NewsAsia: 16 pregnant women in Singapore confirmed to have Zika. Excerpt:

A total of 16 pregnant women have been confirmed to have the Zika virus in Singapore, the Ministry of Health said on Friday (Sep 23), nearly a month since the first locally transmitted Zika case was identified by authorities. 

The doctors of the pregnant women are following up closely with them to provide counselling and support.  

As of Friday, there are 387 confirmed Zika cases in Singapore, according to data on the National Environment Agency's website. 

Responding to queries by Channel NewsAsia, the Health Ministry confirmed that 658 Zika tests were conducted between Sep 7 and Sep 17. Of these, 197 were for pregnant and or symptomatic individuals who required the test.  

The Ministry also added that it is exploring plans to set up a national surveillance programme to monitor the development of babies born to pregnant women with Zika. It added that it is keeping close tabs on the pregnant women who have been notified to have the Zika virus infection.

Singapore Zika update, September 23: Two new cases

The National Environment Agency has published its Zika Clusters update for September 23. It reports two new confirmed cases. That makes a total of 387 cases since the outbreak began on August 27.

According to Channel NewsAsia, these new cases are not related to any existing clusters.

South-east Asian Zika virus strain linked to cluster of cases in Singapore

A rapid communication this week's Eurosurveillance: South-east Asian Zika virus strain linked to cluster of cases in Singapore, August 2016. The abstract:

Zika virus (ZIKV) is an ongoing global public health emergency with 70 countries and territories reporting evidence of ZIKV transmission since 2015. On 27 August 2016, Singapore reported its first case of local ZIKV transmission and identified an ongoing cluster. Here, we report the genome sequences of ZIKV strains from two cases and find through phylogenetic analysis that these strains form an earlier branch distinct from the recent large outbreak in the Americas.