H5N1

CHP closely monitors human case of avian influenza A(H5N6) on Mainland

Thanks to FluTrackers for alerting me to this report from the Hong Kong Centre for Health Protection: CHP closely monitors human case of avian influenza A(H5N6) on Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (September 27) closely monitoring a human case of avian influenza A(H5N6) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.        

The case involves a 68-year-old male living in Chongqing, who had exposure to live domestic poultry before the onset of symptoms. He developed symptoms on August 5 and was admitted for treatment on August 10. He passed away on August 20.        

From 2014 to date, 87 human cases of avian influenza A(H5N6) have been reported by Mainland health authorities.        

"All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," a spokesman for the CHP said.        

Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchasing live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry.        

Travellers returning from affected areas should consult a doctor promptly if symptoms develop, and inform the doctor of their travel history for prompt diagnosis and treatment of potential diseases. It is essential to tell the doctor if they have seen any live poultry during travel, which may imply possible exposure to contaminated environments. This will enable the doctor to assess the possibility of avian influenza and arrange necessary investigations and appropriate treatment in a timely manner.

The global community needs to do more to tackle the inequality crisis

Via The BMJ, an opinion piece by Sir Michael Marmot, Monica Geingos, and Joseph E. Stiglitz: The global community needs to do more to tackle the inequality crisis.

Progress on health inequalities is now at risk, argue Michael Marmot and colleagues, the chairs of a new Global Council on Inequality, AIDS, and Pandemics.

The climate emergency and the global rise in inequalities are putting us all at risk. Both will damage health. The global community, with successive climate change conferences (COPs), is taking faltering steps to tackle the climate emergency but is doing little about the inequality crisis. In some countries, political and economic forces are increasing social and economic inequalities, with potentially dire consequences for health inequalities and for people’s vulnerability to pandemics. Unfair distribution of power, money, and resources are driving inequalities in health. 

We’ve been through a good period. Global progress in improving health has been impressive throughout the 20th and early 21st centuries, and health inequalities between countries have diminished. Within countries, too, absolute inequalities in health have lessened, although that picture is more mixed.   

But this progress is now at risk. If the AIDS and covid-19 pandemics did nothing else, they showed how fragile these health improvements are. These pandemics have, to some extent, been driven by social and economic inequalities, and their effects have been to expose and exacerbate health inequalities. The effects of the pandemics have also been disproportionate in some communities and related to socioeconomic circumstances, gender, LGBTQ+ identities, and race and ethnicity.  

To deal with the effects of inequalities on pandemics and of pandemics on health inequalities, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has convened the Global Council on Inequality, AIDS, and Pandemics. We are the co-chairs of this global council. The announcement of the new council was made in Brazil at a meeting hosted by the Brazilian Ministry of Health. Our backgrounds as co-chairs are highly relevant to the council’s mission. We seek to bring the perspectives of international and national economic arrangements, social determinants of health, and human rights to bear on our central questions. The need is great as the following examples show.  

Analyses indicate that countries with greater income inequality have higher rates of HIV infection and of death from AIDS and covid-19. In most, but not all, African cities the urban poor are much more likely to live with HIV than those from higher socioeconomic groups.

HIV and AIDS have also exposed gender inequalities. In the west African countries of Cote d’Ivoire, Ghana, and Liberia, HIV prevalence in people aged 20-24 was five times higher in women than in men.

The unequal effect of the AIDS pandemic on men who have sex with men is a political choice. In Thailand, for example, where identifying as LGBTQ+ is not criminalised, the prevalence of HIV is 12 times higher among men who have sex with men than among other adults. In Malaysia, where identifying as LGBTQ+ is criminalised and subject to arrest, the HIV prevalence rate among men who have sex with men is more than 70 times higher than among other adults.

In Brazil, where racial inequalities were not openly acknowledged for a long time, the evidence of the effects of this on health inequalities is stark. Rates of new HIV infections have been falling among white people, while rising among black people.

The United States provides an important case study of the role of socioeconomic influences and racism on health, including during the covid-19 pandemic. Life expectancy had been falling in the years 2016-18, in part owing to deaths of despair, which show a social gradient—the fewer the years of education, the bigger the effect. The decline stopped, and life expectancy rose slightly in 2019, but then fell sharply in the first two years of the covid-19 pandemic. Covid mortality was higher among socioeconomically disadvantaged communities and black people. In New York City, in the first year of the pandemic, life expectancy fell by three years among white residents, 5.5 years among black residents, and six years among Hispanic residents.

The AIDS and covid-19 pandemics send two clear messages, and hopefully the global community is open to receiving them. The first is that inequalities drive the likelihood and consequences of pandemics, and pandemics amplify health inequalities. This is the problem that this global council is set up to tackle.

The second is that medical and technical responses are crucial but are only part of the story. Inequities in access to care are needless, harmful, and immoral, and should be relatively easy to solve. Could there have been a global rollout of covid vaccines, entailing higher levels of production? Most certainly. Technically, it should be possible in future pandemics to have the capacity to vaccinate the world as needed. The money is certainly there. In the first year of the covid-19 pandemic, the rich world found $18tn to protect the economies of high income countries. Against this amount, $25bn for a global rollout of the vaccine is coffee money. And the technology that would have made it even easier to rollout the vaccine more widely wasn’t shared, even though governments had put up the vast majority of funds for vaccine development. As the old saying has it, this was penny wise but pound foolish because everyone would have benefited from dampening down covid-19 globally.

The effects of transnational economic inequalities are striking. During the covid-19 pandemic, high income countries put trillions into health and social spending to fight the pandemic’s effects, including supporting their economies, but low and middle income countries lacked the fiscal resources to make this choice. In 2021, almost half of all low and middle income countries cut healthcare spending, and about 70% cut spending on education.

The clear lessons from pandemics are that paying attention to the social determinants of health, respecting human rights, and involving communities are critical. Inequalities in health this vast are not inevitable. They are the result of policies—both what we do and what we fail to do. To achieve a world with better health and fewer health inequalities we need knowledge, resources, and political will. One of the tasks of the Global Council on Inequality, AIDS, and Pandemics is to synthesise the knowledge we already have. As the example of the money found by high income countries to protect their economies shows, “we”—the global community—also have the resources. The problem is the skewed distribution of financial and other resources. Political will is the great challenge. The global council will work with partners in governments, agencies, and communities to build the political will and public demand for change. Social justice requires it.

AQLI: Annual Update, August 2023

Via the Air Quality Life Index: August 2023 Annual Update. Click or tap through to download the full report and nation fact sheets. The summary:

Air pollution is the greatest external threat to human life expectancy on the planet. The AQLI’s latest 2021 data reveals that permanently reducing global PM2.5 air pollution to meet the World Health Organization (WHO) guideline would add 2.3 years onto average human life expectancy—or a combined 17.8 billion life years saved. 

The impact of PM2.5 on global life expectancy is comparable to that of smoking, more than 3 times that of alcohol use and unsafe water, more than 5 times that of transport injuries like car crashes, and more than 7 times that of HIV/AIDS.

Lockdowns and face masks ‘unequivocally’ cut spread of Covid, report finds

Via The Guardian: Lockdowns and face masks ‘unequivocally’ cut spread of Covid, report finds. Excerpt:

Measures taken during the Covid pandemic such as social distancing and wearing face masks “unequivocally” reduced the spread of infections, a report has found.  

Experts looked at the effectiveness of non-pharmaceutical interventions (NPIs) – not drugs or vaccines – when applied in packages that combine a number of measures that complement one another.  

The Royal Society report, called Covid-19: examining the effectiveness of non-pharmaceutical interventions, reviewed the evidence gathered during the pandemic for six groups of NPIs and their effectiveness in reducing transmission.  

These included masks and face coverings, social distancing and lockdowns, test, trace and isolate, travel restrictions and controls across international borders, environmental controls, and communications.  

When assessed individually, there was positive – if limited – evidence of transmission reduction from many of the NPIs used in the pandemic, the review found. However, evidence of a positive effect was clear when countries used combinations of NPIs.  

Additionally, evidence showed NPIs were most effective when the intensity of transmission was low, supporting their use early in a pandemic and at first sign of resurgence.  

During the early stages of responding to an emerging infectious disease, NPIs tend to be the only controls available before the development of drug treatments and vaccines.  

However, as was seen during the pandemic, their use can have adverse personal, educational and economic consequences – making assessment of their effectiveness essential.  

Prof Sir Mark Walport, the foreign secretary of the Royal Society and chair of the report’s expert working group, said: “There is sufficient evidence to conclude that early, stringent implementation of packages of complementary NPIs was unequivocally effective in limiting Sars-CoV-2 infections.  

“That does not mean every NPI was effective in every setting, or at all times, but learning the lessons from the wealth of research generated in this pandemic will be key to equipping ourselves for the next one.”  

The review found social distancing and lockdowns were the most effective category of NPIs. Stay-at-home orders, physical distancing and restrictions on gathering size were repeatedly found to be associated with significant reduction in Sars-CoV-2 transmission. The more stringent the measures were the greater the effect they had, the experts found.  

In care homes, measures such as cohorting and visitor restrictions were associated with reduced transmission and reduced outbreaks.  

Additionally, the report found that in school settings, closures and other distancing measures were associated with reduced Covid-19 cases, but the effectiveness varied depending on a range of factors, including adherence and pupils’ ages.

Finland: Bird flu monitoring for all fur farms starts from minks

Via the Finnish Food Agency: Bird flu monitoring for all fur farms starts from minks. The Google translation:

At the beginning of September, the Finnish Food Agency will start bird flu monitoring for all fur farms. In the first phase of monitoring, the occurrence of the bird flu virus in minks from fur farms is investigated, because bird flu infections in minks pose a greater health risk to humans than bird flu infections in foxes and raccoons. Samples are taken from each of Finland's approximately 130 mink farms.  

Mink is a particularly problematic animal species when it comes to avian influenza virus infections. In the mink's upper respiratory tract, there are receptors that bind both bird and human influenza viruses, which is why mink are susceptible to infections caused by both types of influenza. The simultaneous infection of these viruses in mink can cause the emergence of a new type of virus variant, which may be more susceptible to infecting humans.  

The first phase of the monitoring is to be completed by the end of October, after which we will move on to the monitoring and sampling of the fox and raccoon kennels. Blood samples are taken from fur farms for antibody tests, and animals that have died or are euthanized by themselves are taken to detect the virus. Samples are taken by municipal veterinarians and samplers authorized by the Food Agency. The samples are examined in the Food Agency's laboratory. The samples are also examined for the presence of the coronavirus (SARS-CoV-2) at the same time.  

The infection was found in 25 fur farms  

The bird flu epidemic started in fur farms in Ostrobothnia in mid-July. The first infected fur farm was found in the Food Agency's laboratory tests on July 13, and since then bird flu infections have been confirmed at a total of 25 fur farms.  

For these shelters, shelter-specific reports on the infection situation have been made and a total of approximately 120,000 animals have been ordered to be euthanized. Termination orders have been issued to 13 shelters so far, and terminations are still ongoing in one shelter. In total, there are approximately 400 fur farms in Finland, which are estimated to have 1.3 million fur animals. After the autumn skinning, there are about 300,000 animals left in the shelters.  

In controlling animal disease epidemics, the most important thing is to identify animal farms where there are animals affected by the disease. In the monitoring of animal diseases, diseases are best found by examining sick or recently dead animals, because in them the infection is most likely to be active and the probability of finding the cause of the disease is also the highest. By killing infected and exposed animals, the infection pressure can be reduced in the most effective way.  

Monitoring of various animal diseases is carried out continuously at the Food Agency, and the need to expand the monitoring program is evaluated as necessary. Regarding bird flu, it has been decided to investigate all fur farms.

WHO: Weekly epidemiological update on COVID-19 - 3 August 2023

WHO has published Weekly epidemiological update on COVID-19 - 3 August 2023. Click or tap through to download the complete report. The overview:

Globally, over one million new COVID-19 cases and over 3100 deaths were reported in the last 28 days (3 to 30 July 2023). While five WHO regions have reported decreases in the number of both cases and deaths, the Western Pacific Region has reported an increase in the number of cases and a decrease in the number of deaths. 

As of 30 July 2023, over 768 million confirmed cases and over 6.9 million deaths have been reported globally. Currently, reported cases do not accurately represent infection rates due to the reduction in testing and reporting globally. 

During this 28-day period, 46% (107 of 234) of countries and territories reported at least one case to WHO – a proportion that has been declining since mid-2022. 

In this edition, we include:  

• The COVID-19 epidemiological update at the global and the regional levels  

• An update on hospitalizations and ICU admissions  

• An update on the SARS-CoV-2 variants of interest (VOI) and variants under monitoring (VUM)  

• An update on the vaccine effectiveness of primary series and booster vaccination against the Omicron and its descendant lineages

Communication of COVID-19 misinformation on social media by physicians in the US

Via JAMA Network: Communication of COVID-19 Misinformation on Social Media by Physicians in the US. The key points and abstract:

Key Points  

Question  What types of COVID-19 misinformation have been propagated online by US physicians and through what channels?  

Findings  In this mixed-methods study of high-use social media platforms, physicians from across the US and representing a range of medical specialties were found to propagate COVID-19 misinformation about vaccines, treatments, and masks on large social media and other online platforms and that many had a wide reach based on number of followers.  

Meaning  This study’s findings suggest a need for rigorous evaluation of harm that may be caused by physicians, who hold a uniquely trusted position in society, propagating misinformation; ethical and legal guidelines for propagation of misinformation are needed.  

Abstract  

Importance  Approximately one-third of the more than 1 100 000 confirmed COVID-19–related deaths as of January 18, 2023, were considered preventable if public health recommendations had been followed. Physicians’ propagation of misinformation about COVID-19 on social media and other internet-based platforms has raised professional, public health, and ethical concerns.  

Objective  To characterize (1) the types of COVID-19 misinformation propagated by US physicians after vaccines became available, (2) the online platforms used, and (3) the characteristics of the physicians spreading misinformation.  

Design, Setting, and Participants  Using US Centers for Disease Control and Prevention guidelines for the prevention and treatment of COVID-19 infection during the study window to define misinformation, structured searches of high-use social media platforms (Twitter, Facebook, Instagram, Parler, and YouTube) and news sources (The New York Times, National Public Radio) were conducted to identify COVID-19 misinformation communicated by US-based physicians between January 2021 and December 2022. Physicians’ state of licensure and medical specialty were identified. The number of followers for each physician on 4 major platforms was extracted to estimate reach and qualitative content analysis of the messages was performed.  

Main Outcomes and Measures  Outcome measures included categories of COVID-19 misinformation propagated, the number and traits of physicians engaged in misinformation propagation, and the type of online media channels used to propagate misinformation and potential reach.  

Results  The propagation of COVID-19 misinformation was attributed to 52 physicians in 28 different specialties across all regions of the country. General misinformation categories included vaccines, medication, masks, and other (ie, conspiracy theories). Forty-two physicians (80.8%) posted vaccine misinformation, 40 (76.9%) propagated information in more than 1 category, and 20 (38.5%) posted misinformation on 5 or more platforms. Major themes identified included (1) disputing vaccine safety and effectiveness, (2) promoting medical treatments lacking scientific evidence and/or US Food and Drug Administration approval, (3) disputing mask-wearing effectiveness, and (4) other (unsubstantiated claims, eg, virus origin, government lies, and other conspiracy theories).  

Conclusions and Relevance  In this mixed-methods study of US physician propagation of COVID-19 misinformation on social media, results suggest widespread, inaccurate, and potentially harmful assertions made by physicians across the country who represented a range of subspecialties. Further research is needed to assess the extent of the potential harms associated with physician propagation of misinformation, the motivations for these behaviors, and potential legal and professional recourse to improve accountability for misinformation propagation.

The evolution of SARS-CoV-2 seroprevalence in Canada: A time-series study, 2020–2023

Via CMAJ: The evolution of SARS-CoV-2 seroprevalence in Canada: a time-series study, 2020–2023. The abstract:

Background: During the first year of the COVID-19 pandemic, the proportion of reported cases of COVID-19 among Canadians was under 6%. Although high vaccine coverage was achieved in Canada by fall 2021, the Omicron variant caused unprecedented numbers of infections, overwhelming testing capacity and making it difficult to quantify the trajectory of population immunity.  

Methods: Using a time-series approach and data from more than 900 000 samples collected by 7 research studies collaborating with the COVID-19 Immunity Task Force (CITF), we estimated trends in SARS-CoV-2 seroprevalence owing to infection and vaccination for the Canadian population over 3 intervals: prevaccination (March to November 2020), vaccine roll-out (December 2020 to November 2021), and the arrival of the Omicron variant (December 2021 to March 2023). We also estimated seroprevalence by geographical region and age.  

Results: By November 2021, 9.0% (95% credible interval [CrI] 7.3%–11%) of people in Canada had humoral immunity to SARS-CoV-2 from an infection. Seroprevalence increased rapidly after the arrival of the Omicron variant — by Mar. 15, 2023, 76% (95% CrI 74%–79%) of the population had detectable antibodies from infections. The rapid rise in infection-induced antibodies occurred across Canada and was most pronounced in younger age groups and in the Western provinces: Manitoba, Saskatchewan, Alberta and British Columbia.  

Interpretation: Data up to March 2023 indicate that most people in Canada had acquired antibodies against SARS-CoV-2 through natural infection and vaccination. However, given variations in population seropositivity by age and geography, the potential for waning antibody levels, and new variants that may escape immunity, public health policy and clinical decisions should be tailored to local patterns of population immunity.

WHO: Influenza A(H1N2)v-United States of America

A WHO DON: Influenza A(H1N2)v-United States of America. Excerpt:

Situation at a glance:  

On 4 August 2023, the United States International Health Regulations (IHR) National Focal Point informed PAHO/WHO of a human infection with a novel influenza A(H1N2) variant virus identified in the State of Michigan. This was confirmed by Reverse Transcription Polymerase Chain Reaction at the United States (US) Centers for Disease Control and Prevention (CDC) on August 2.  

The case was not hospitalized and is recovering from the illness. Investigations by local public health officials identified swine exposure by the patient at an agricultural fair.  

Additional public health response efforts including enhanced surveillance for cases is undergoing. Given the potential impact on public health, human infections with these viruses need to be monitored closely. In this event, there was no reported evidence of sustained human-to-human transmission, the illness was mild and no further influenza variant virus transmission in the community has been identified.  

Description of the case:  

On 4 August 2023, the United States IHR National Focal Point informed PAHO/WHO of a human infection with a novel influenza A(H1N2) variant virus identified in the State of Michigan and confirmed by the US CDC.   

According to the report, the case is under 18 years old, with no comorbidities, resident in the State of Michigan, who developed respiratory illness on 29 July 2023. The case presented with fever, cough, sore throat, muscle aches, headache, shortness of breath, diarrhea, nausea, dizziness, and lethargy. On 29 July, the case sought medical care at an emergency department, and an upper respiratory tract specimen was collected on 30 July. The specimen tested positive for influenza A virus on the same day. On 1 August, the patient received influenza antiviral treatment (Oseltamivir).  

On 31 July, the specimen was tested at the Michigan Department of Health and Human Services (MDHHS), and RT-PCR results were positive for influenza A virus but lacked reactivity with diagnostic tests for contemporary human influenza viruses representing either (H1) pdm09 or (H3) subtypes. The specimen was then sent to the US CDC for further testing and received on 2 August. On the same day, RT-PCR analysis of the specimen indicated an influenza A(H1N2) variant (v) virus. The virus was isolated and subsequent analysis including genetic sequencing is underway.  

The case was not hospitalized. Investigation by local public health officials identified swine exposure by the patient at an agricultural fair, that took place between 23 and 29 July, within 10 days prior to illness onset. Additional investigation did not identify respiratory illness in any of the patient’s close contacts or household contacts. No additional cases were identified related to this agriculture fair. No person-to-person transmission of influenza A(H1N2)v virus associated with this case has been identified. No additional cases of human infection with A(H1N2)v virus have been identified as of 10 August 2023.  

This is the first influenza A(H1N2)v virus infection identified in the United States this year. Since 2005, there have been 512 influenza A variant virus infections (all subtypes), including 37 (human infections with influenza A (H1N2)v viruses reported in the United States.

WHO: Weekly epidemiological update on COVID-19 - 3 August 2023

WHO has published Weekly epidemiological update on COVID-19 - 3 August 2023. Click or tap through to download the full report. The overview:

Globally, over one million new COVID-19 cases and over 3100 deaths were reported in the last 28 days (3 to 30 July 2023). While five WHO regions have reported decreases in the number of both cases and deaths, the Western Pacific Region has reported an increase in the number of cases and a decrease in the number of deaths. 

As of 30 July 2023, over 768 million confirmed cases and over 6.9 million deaths have been reported globally. Currently, reported cases do not accurately represent infection rates due to the reduction in testing and reporting globally. 

During this 28-day period, 46% (107 of 234) of countries and territories reported at least one case to WHO – a proportion that has been declining since mid-2022. 

In this edition, we include:  

• The COVID-19 epidemiological update at the global and the regional levels  

• An update on hospitalizations and ICU admissions  

• An update on the SARS-CoV-2 variants of interest (VOI) and variants under monitoring (VUM)   

• An update on the vaccine effectiveness of primary series and booster vaccination against the Omicron and its descendant lineages

How we used machine learning to look where Ebola may strike

Via ProPublica: How We Used Machine Learning to Look Where Ebola May Strike. Excerpt:

ProPublica spent months teaching a computer to analyze past Ebola outbreaks linked to deforestation. What we found reveals a weakness in the way that governments and public health experts are preparing for future pandemics. 

The bright spots on the map struck us like a lightning bolt. 

We had spent months teaching a computer about the Ebola virus –– feeding it information about the landscapes and populations in places where the disease had previously emerged, showing it how to analyze those outbreaks for patterns, and then instructing it to flag other areas that looked similarly perilous.   

Some of the highlighted spots were predictable; the virus had repeatedly ravaged one of those countries.  

But we didn’t expect our model to light up Nigeria, the most populous country in Africa. The West African nation and international travel hub has never seeded an Ebola outbreak, but just a year ago, it served as the springboard for another virus to travel into Europe and the Americas and spread across the globe. However that virus, mpox, originally known as monkeypox, is rarely fatal.  

What if it had been Ebola, which kills about half of the people it infects?  

We asked Nigerian public health officials whether they were concerned.  

“Ebola is not part of our top concerns any more,” said Oyeladun Okunromade, the director of surveillance and epidemiology at the Nigeria Centre for Disease Control.  

In the aftermath of the 2014 West African Ebola epidemic, the worst on record, Nigerian officials were on high alert. But last year, they took the virus off the list of the top infectious diseases the country needed to prepare for, downgrading Ebola in relation to threats like mpox, which Nigeria was actively fighting.  

The disjoint between how our model sees Nigeria’s risk and how the nation’s health officials view it reveals a weakness in the way that governments and public health experts are preparing for future pandemics. The methods many countries use to rank threats focus mainly on factors that occur after an outbreak has already begun, such as the potential economic impact of an epidemic. Or they rely on past cases, looking at where a pathogen has previously struck.  

Neither approach considers the root causes.  

We’ve spent more than a year digging into the question of what causes outbreaks and what the world can do to prevent them. And we’ve learned that while science has advanced so we’re starting to understand the complex factors that trigger an outbreak, the world is not doing nearly enough to try to head off the next big one.

UK almost ‘flying blind’ on Covid this autumn, experts say

Via The Guardian: UK almost ‘flying blind’ on Covid this autumn, experts say. Excerpt:

The UK is nearly “flying blind” when it comes to Covid this autumn, experts have said, amid an increase in cases.  

While the UK Health Security Agency (UKHSA) continues to track some metrics of Covid, including hospitalisation numbers, many of the community surveillance studies tracking infection levels have finished.  

Now experts have said the situation is leaving the country in the dark about how Covid may play out in the months ahead.  

Christina Pagel, a professor of operational research at University College London, said a new wave of Covid appeared to be under way – possibly driven by waning immunity, new variants of Omicron, and factors including poor weather keeping people inside.  

With the autumn coming on and people returning to school and work, Covid pressures may increase, Pagel added.  

“We might see the wave continue to grow, and grow faster, in September,” she said.  

As well as public health measures including reintroducing high-quality masks within healthcare settings, Pagel said she would support bringing back the nationwide infection survey published by the Office for National Statistics for autumn and winter, as well as expanding it to cover flu and RSV.  

Failing that, she said, wastewater monitoring should be reinstated across the UK as a cheaper alternative that is used in many countries to track Covid prevalence and variants. Such schemes have recently been cut in England and Wales.  

“What worries me most is if we get a repeat of the last winter NHS crisis this winter again, with Covid, flu and RSV all hitting around the same time,” said Pagel. “We are definitely flying near blind.”  

Prof Rowland Kao, an epidemiologist at the University of Edinburgh, also highlighted the decline in surveillance.  

“With seasonal flu, we have of course a certain amount of predictability with the many years of data. However, with Covid, now that we don’t have those multiple data streams to rely on, it’s harder to say what is happening [in the general population],” he said.  

Kao added that the variant emergence patterns for Covid were largely unknown and Covid was not simply following seasonal patterns.

WHO: Weekly epidemiological update on COVID-19 - 3 August 2023

Via WHO: Weekly epidemiological update on COVID-19 - 3 August 2023. Click or tap through to download the full report. The overview:

Globally, over one million new COVID-19 cases and over 3100 deaths were reported in the last 28 days (3 to 30 July 2023). While five WHO regions have reported decreases in the number of both cases and deaths, the Western Pacific Region has reported an increase in the number of cases and a decrease in the number of deaths. 

As of 30 July 2023, over 768 million confirmed cases and over 6.9 million deaths have been reported globally. Currently, reported cases do not accurately represent infection rates due to the reduction in testing and reporting globally. During this 28-day period, 46% (107 of 234) of countries and territories reported at least one case to WHO – a proportion that has been declining since mid-2022.

Eurosurveillance: Highly pathogenic avian influenza A(H5N1) virus infection on multiple fur farms in the South and Central Ostrobothnia regions of Finland, July 2023

Via Eurosurveillance, a report on the explosive spread of H5N1 in Finland: Highly pathogenic avian influenza A(H5N1) virus infection on multiple fur farms in the South and Central Ostrobothnia regions of Finland, July 2023. The introduction:

Highly pathogenic avian influenza (HPAI) A(H5N1) virus belonging to clade 2.3.4.4b has since the end of April 2023 caused widespread outbreaks in wild and domestic birds in 25 countries in Europe. In wild birds, black-headed gulls have been heavily affected, with mass deaths observed in many places, including in Finland. 

First reported on 14 July, an outbreak of avian influenza among farmed foxes, minks and raccoon dogs occurred in the regions of South and Central Ostrobothnia and is still ongoing. Up to 27 July, animals on 20 farms have been affected. Here, we provide an initial description of the outbreak and control measures taken, and discuss the source, potential reasons for and consequences of the outbreak.

CIHI releases inaugural report exploring priority health care topics in Canada

A news release from the Canadian Institute for Health Information: CIHI releases inaugural report exploring priority health care topics in Canada. Excerpt:

August 2, 2023 —  The Canadian Institute for Health Information (CIHI) has released its inaugural report on priority health care topics, Taking the pulse: A snapshot of Canadian health care, 2023. This report is the first of what will be an annual series — the result of a formal commitment made in early 2023 by the Government of Canada and the provincial and territorial governments to improve health care in Canada in shared priority areas.   

As part of that commitment, governments agreed to work with CIHI to collect, share and learn from health information, with CIHI reporting to Canadians on the priority areas each year. Quebec is not participating in the joint reporting exercise.     

Taking the pulse: A snapshot of Canadian health care, 2023 offers Canadians an initial overview of where we are today in the 4 priority areas:  

• Expanding family health services and improving access to primary health care  

• Increasing the supply of health workers and decreasing backlogs in care to support resilient health systems  Improving access to mental health and substance use services   

• Modernizing health care’s information systems and digital tools for the secure sharing of electronic health information  

The indicator results (none of which include data from Quebec) are based on publicly available data stemming from a partnership between Canada Health Infoway, integrated youth services networks, Statistics Canada and CIHI.  

Selected indicator highlights include the following:  

• 88% of Canadians age 12 and older reported having a regular health care provider.  

• There were about 743,000 fewer surgeries performed in Canada during the first 2.5 years of the pandemic, a drop of about 13% compared with before the pandemic.  

• Half of Canadians who required community mental health counselling received a first appointment in less than a month, while 1 in 10 waited about 4 months (data is not available for Prince Edward Island, Quebec, Ontario and Nunavut).  

• Fewer than 40% of Canadians have accessed their personal health information online.

Outcomes and characteristics of patients hospitalized for COVID-19 in British Columbia, Ontario and Quebec during the Omicron wave

Thanks to FluTrackers for alerting me to this report in CMAJ Open: Outcomes and characteristics of patients hospitalized for COVID-19 in British Columbia, Ontario and Quebec during the Omicron wave. The abstract:

Background: Omicron is the current predominant variant of concern of SARS-CoV-2. We hypothesized that vaccination alters outcomes of patients hospitalized with COVID-19 during the Omicron wave and that these patients have different characteristics and outcomes than in previous waves. 

Methods: This is a substudy of the Host Response Mediators in Coronavirus (COVID-19) Infection (ARBs CORONA I) trial, which included adults admitted to hospital with acute COVID-19 up to July 2022 from 9 hospitals in British Columbia, Ontario and Quebec. We excluded emergency department visits without hospital admission, readmissions and admissions for another reason. Using adjusted regression analysis, we compared mortality and organ dysfunction between vaccinated (≥ 2 doses) and unvaccinated patients during the Omicron wave, as well as between all patients in the Omicron and first 3 waves of the COVID-19 pandemic.  

Results: During the Omicron wave, 28-day mortality was significantly lower in vaccinated (n = 19/237) than unvaccinated hospitalized patients (n = 12/127) (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.15–0.89); vaccinated patients had lower risk of admission to the intensive care unit, invasive ventilation and acute respiratory distress syndrome and shorter hospital length of stay. Patients hospitalized during the Omicron wave had more comorbidities than in previous waves, and lower 28-day mortality than in waves 1 and 2 (adjusted OR 0.38, 95% CI 0.24–0.59; and 0.42, 95% CI 0.26–0.65) but not wave 3 (adjusted OR 0.81, 95% CI 0.43–1.51) and had less organ dysfunction than in the first 2 waves.  

Interpretation: Patients who were at least double vaccinated had lower mortality than unvaccinated patients hospitalized during the Omicron wave. Patients hospitalized during the Omicron wave had more chronic disease and lower mortality than in the first 2 waves, but not wave 3. Changes in vaccination, treatments and predominant SARS-CoV-2 variant may have decreased mortality in patients hospitalized during the Omicron wave.

The Finnish Food Authority is ordering all minks to be put down at fur farms with diagnosed avian influenza infections

Via the Finnish Food Authority: The Finnish Food Authority is ordering all minks to be put down at fur farms with diagnosed avian influenza infections.

The Finnish Food Authority has specified the euthanasia criteria for fur animals infected with avian influenza. The decision states that all minks will be put down at fur farms with diagnosed avian influenza infections. This policy decision on minks by the Finnish Food Authority also takes into account the view of the Finnish Institute for Health and Welfare (THL). The decisions to put down foxes and raccoon dogs will still be made on a case-by-case basis.  

Mink is an especially problematic species when it comes to avian influenza infections. This is due to the fact that minks’ upper respiratory tracts contain receptors that can bind to both avian and human influenza viruses, which makes minks sensitive to infections caused by both types of influenza. Minks can therefore be more effective than other mammals as an intermediate host for avian influenza, enabling the virus to mutate more effectively into a form that will infect humans. To prevent such variants of the virus, it is important to put down all minks at infected fur farms. 

With regard to decisions on putting down foxes and raccoon dogs, the Finnish Food Authority may order all or some of the foxes and raccoon dogs at a fur farm to be put down. This decision is impacted by the extent and intensity of the symptoms of avian influenza at the farm. It is also possible that no immediate euthanasia order will be issued for the animals at a farm if symptoms and increased mortality have stopped at the farm. 

However, the restrictions on fur farms imposed by the Regional State Administrative Agency and the measures to prevent the spread of the disease will remain in force at all the farms where avian influenza has been detected. If some animals at an infected farm have not been ordered to be put down, additional samples will be taken repeatedly from the animals at those farms to monitor the infection situation. Euthanasia decisions may be extended later on the basis of the results.  

Euthanasia order issued for three fur farms  

So far, the Finnish Food Authority has issued euthanasia orders for the animals of three fur farms. Preparations for new euthanasia orders are continuing this week. The Finnish Food Authority is not publishing information on the fur farms that have been issued euthanasia orders.  

Animal owners have the right to claim compensation from state funds for animals put down by an order issued by the Finnish Food Authority. The amount of compensation is still undetermined.  

Avian influenza had been diagnosed at twenty fur farms by the end of July. Samples from four farms are currently being analysed.

Covid-19: Leaked cremation data hint at true scale of China’s death rate

Via The BMJ: Covid-19: Leaked cremation data hint at true scale of China’s death rate. Excerpt:

Cremation figures released and then quickly withdrawn by authorities in China’s Zhejiang province appear to confirm widespread doubts about the government’s official pandemic death count, and lend support to international forecasts which predicted roughly 1.5 million deaths from covid in the weeks after China abandoned its zero covid policy last December.  

In the relatively wealthy and developed eastern province, where more than 99% of all deaths end in cremation, the number of cremations in the first quarter of 2023 was just under 171 000, compared with 99 000 in the first quarter of 2022 and 90 000 in the first quarter of 2021.  

Extrapolated across China, this 72% rise in mortality would translate to about 1.5 million excess deaths in the first quarter of 2023, closely matching predictions of several models developed by epidemiologists.

WHO: Weekly epidemiological update on COVID-19 - 27 July 2023

WHO has published Weekly epidemiological update on COVID-19 - 27 July 2023. The overview:

Globally, over 868 000 new COVID-19 cases and over 3700 deaths were reported in the last 28 days (26 June to 23 July 2023). While five WHO regions have reported decreases in the number of both cases and deaths, the Western Pacific Region has reported an increase in the number of both cases and deaths.  

As of 23 July 2023, over 768 million confirmed cases and over 6.9 million deaths have been reported globally. Currently, reported cases do not accurately represent infection rates due to the reduction in testing and reporting globally. During this 28-day period, 52% (122 of 234) of countries and territories reported at least one case – a proportion that has been declining since mid-2022.    

In this edition, we include:  

• The COVID-19 epidemiological update at the global and the regional levels  

• An update on hospitalizations and ICU admissions  

• An update on the SARS-CoV-2 variants of interest (VOI) and variants under monitoring (VUM)

How Canada’s decentralised covid-19 response affected public health data and decision making

This is a major report that deserves close attention. Via The BMJ: How Canada’s decentralised covid-19 response affected public health data and decision making. Excerpts:

Highs and lows of covid-19 response in Canada  

Highs 

• Public health leadership included women at each level of decision making. 

• Canada became one of the most vaccinated countries with >83% of the population receiving at least one vaccine dose in February 2023. After Health Canada approved Pfizer-BioNTech and the Moderna covid-19 vaccine in December 2020, rollout was prioritised for indigenous populations and those living and working in long term care homes  

• Research collaborations from basic science through to clinical and health services research emerged rapidly to address urgent questions of seroprevalence (eg, covid-19 Immunity Task Force), correlates of infection and immunity, and outbreak mitigation factors and engagement of patients in research conduct such as knowledge synthesis  

Lows  

• Failure to learn from previous reports led to failure to protect older adults and staff in long term care homes and among the highest proportions of deaths in this sector globally  

• Challenges to access and delivery of effective covid-19 medications such as tocilizumab, remdesivir, and ritonavir-nirmatrelvir resulted in provinces and hospitals rationing use  

• An exodus of exhausted and distressed healthcare workers, coupled with inadequate training paths for replacements, produced a critical workforce shortage that is ongoing  

• Canada lacked a coordinated system for evidence generation and use across government jurisdictions  

• Lack of research infrastructure embedded within the healthcare system limited Canada’s ability to participate in or lead clinical trials or other international studies 

• Lack of a clear and standardised approach to case definitions and testing contributed to inability to share use of data and make decisions           

• Absence of data sharing agreements across federal and provincial or territorial jurisdictions slowed or limited data sharing

Key messages

• Canada’s public health system was insufficiently prepared for the covid-19 pandemic

• Public health decisions and outcomes varied across jurisdictions and were hampered by outdated health information systems and lack of integration 

• Decentralisation of public health decision making has benefits such as tailoring interventions to local constituencies, but during a crisis, governance structures need to pivot to enable coordination and systematisation of data collection and analyses 

• Gaps in data and decision structures created a vacuum, filled by science advisory committees with disparate roles, responsibilities, and accountabilities within different jurisdictions 

• A shift to a culture of data access and shared analysis is needed to enhance health system learning and population health benefit, and for future crisis and pandemic preparedness