H5N1

Chile: Health ministry reports first human case of H5N1, in north of country

I believe this is the first case of human H5N1 contracted in the Americas. Via La Nación: Minsal informa primer caso humano de gripe aviar en el norte del país.[Health ministry report first human case of avian flu in the north of the country] The full report, with my translation:

El Ministerio de Salud (Minsal) informó la tarde de este miércoles el primer caso en Chile de gripe aviar en humanos, reportado en el norte del país. 

The Ministry of health reported Tuesday afternoon on the first case in Chile of avian flu in a human, reported in the north of the country.

La persona enferma corresponde a un hombre de 53 años afectado por un cuadro de influenza grave. El paciente se encuentra estable dentro de su gravedad. 

The person is a 53-year-old man with a case of severe influenza. The patient is in serious but stable condtion.

Se indicó que se activaron los protocolos sanitarios establecidos para el manejo de esta enfermedad y se tomaron los exámenes correspondientes para su análisis por el Instituto de Salud Pública (ISP), que confirmó que se trata de influenza aviar. 

The ministry said it had activated health protocols established for control of the disease; tests were analyzed by the Institute of Public Health, which confirmed the disease was avian flu.

Se investiga la fuente de contacto y si existen antecedentes de otros afectados en el entorno del paciente. 

The source of the infection in being investigated, as well as the possibility of others' infection among the patient's contacts.

El virus H5N1 o gripe aviar es un virus que se puede transmitir desde aves o mamíferos marinos al ser humano, pero no se conocen casos de contagios de humano a humano. 

The H5N1 virus, or avian flu, can be transmitted from birds or infected marine mammals to humans, but human-to-human cases are unknown.

El Ministerio de Salud hace un llamado a la ciudadanía a no manipular aves o mamíferos enfermos o muertos e insta a los trabajadores avícolas a seguir los protocolos de seguridad correspondientes y a vacunarse contra la influenza estacional.

The Ministry of Health asked the public not to handle or touch birds of marine mammals, whether sick or dead, and asked workers in the poultry industry to follow the appropriate safety protocols and to obtaain a vaccination against seasonly influenza.

Kirundo-Muyinga: A mysterious disease with symptoms resembling those of the Ebola virus appears

Via SOS Médias Burundi, a March 27 report: Kirundo-Muyinga: a mysterious disease with symptoms resembling those of the Ebola virus appears. The Google translation:

An as yet unidentified disease killed three people in three days in the commune of Gitobe in the province of Kirundo and in the commune of Butihinda in the province of Muyinga (north-eastern Burundi). 

Symptoms developed by patients suffering from this disease resemble those of Ebola hemorrhagic virus or Marburg virus disease. In the case of Kirundo, the governor and the provincial doctor are waiting for the results of samples taken by specialists from the INSP (National Institute of Public Health) to decide.  

The ministry in charge of health has already confirmed for that of Muyinga that it is neither the Marburg virus disease nor Ebola. (SOS Media Burundi) This disease, not yet identified but having signs similar to those of Ebola, has just claimed the lives of two people in the commune of Gitobe. Both people died within 24 hours of showing the signs. All the patients come from the same Migwa hill, in the Baziro area.  

According to witnesses on the spot, "the symptoms include abdominal pain, nasal bleeding which increases after death, acute headaches, high fever, vomiting and dizziness". This disease kills very quickly, noted a nurse interviewed by SOS Media Burundi.  

“It's a disease that kills quickly. Within 24 hours, the infected person dies. It's terrible, we are all waiting for death," said a panicked nurse from the Migwa health center in the Gashoho health district in Muyinga province where patients were sent, including two women who died there.

When the population of Baziro wanted to bring the third person there, the population of Migwa blocked the entrances, fearing the spread of the disease. For the moment no one can leave the area of ​​Baziro which, it seems, has been confined. 

Samples were taken by the INSP to identify which disease it is.  

But until now the disease is not yet detected, according to doctors.  

In the morning of Friday, the governor of Kirundo, Albert Hatungimana, accompanied by the provincial doctor, carried out a raid in the commune of Gitobe, but they made no forecast.  

"We are awaiting the results of the swabs," a member of the governor's cabinet said.  

The population is worried because, she says, "So far no real prevention strategy against this disease has been communicated".  

“Apart from washing your hands and avoiding greeting each other, there are no strict measures, which can promote contamination,” residents insisted.  

Note that at Kirundo hospital, the first case was also admitted on Friday evening. In the commune of Ntega (same province), people with the same symptoms were reported on the same Friday evening.  

The population of the urban center of Kirundo lives in panic fear. She asks the government to declare the epidemic so that there is a rapid intervention.  

Another case was recorded in Giteranyi commune, Muyinga province (neighboring Kirundo). A student from Kobero Basic School not far from the border with Tanzania, died of this disease last Thursday.  

Tanzania declared a Marburg virus epidemic on March 21. A cousin of Ebola, this “filovirus” causes high fevers accompanied by virulent haemorrhages. So far, there is no vaccine or antiviral treatment for this disease, which can also attack primates. It is suspected that it is the Marburg virus which has spread in the Burundian provinces bordering Tanzania, the epidemic having been detected in the Kagera region in the north-west of Tanzania not far from Burundi and Rwanda .

Unravelling the commercial determinants of health

Via The Lancet, an editorial: Unravelling the commercial determinants of health. Excerpt:

In early March, in the wake of the COVID-19 pandemic, nearly 200 people—including former UN Secretary-General Ban Ki-moon—signed a letter strongly criticising pharmaceutical companies for putting a desire to make extraordinary profits before the needs of humanity. Selling publicly funded vaccines, treatments, and tests to the highest bidder resulted in inequities that cost more than a million lives, while private companies made billions of dollars. The signatories called on world leaders to ensure that such an injustice is never repeated.  

The conflict between profits and health equity is not new. The global health community fought for decades to provide access to antiretrovirals for patients with HIV/AIDS in less-resourced settings. Many commercial actors attempt to negatively influence national and international policies, undermine science, or to directly attack individuals calling out their actions. The recent Lancet Series on breastfeeding showed how an extensive network of lobbying by formula milk companies has derailed progress on breastfeeding education. 

This history speaks to the central importance to health equity of the commercial determinants of health, the subject of a Series published in this issue of The Lancet, led by Rob Moodie of the University of Melbourne, along with authors spanning 15 countries and six continents, with the support of the Victorian Health Promotion Foundation of Australia.  

The headline findings are startling: four industries (tobacco, unhealthy food, fossil fuel, and alcohol) are responsible for at least a third of global deaths per year. Yet much of the work to understand the harmful (or beneficial) impact of commercial actors has to date been done in health research silos. Each field faces many of the same tactical battles and strategies without a unified agenda to protect health. There is a lack of consensus across fields of health to define and understand the commercial determinants of health.  

The Lancet Series seeks to remedy this long-standing and complex situation with a consensus definition of the commercial determinants of health (“systems, practices, and pathways through which commercial actors drive health and equity”), a framing to understand commercial entities' impact on health, and a commitment to address its challenges in a holistic way.  

The Series authors set out a bold vision in which governments, commercial actors, and civil society contribute first and foremost to improving health and societal wellbeing. Such a vision is needed urgently. As the second paper in the Series outlines, commercial actors are diverse and many play a vital role in society, but the products and practices of many are having increasingly negative impacts on human and planetary health and equity.  

The Series provides a comprehensive agenda for action, recognising the need for regenerative business models and accountable transparent policies (including an end to commercial actors opposition to health regulation and policies).  

Moodie emphasises that the Series is not anti-business; it is pro-health. There are some notable good models of pro-health-acting businesses. For example, nearly 200 leading financial institutions (which together manage more than US$16 trillion) have signed a pledge to support tobacco-free policies across lending, investment, and insurance. However, although Environmental, Social and Governance frameworks are increasingly used to guide more responsible investment, they still lack specific health indicators.  

Health needs to become a crucial consideration of investor frameworks and global capital markets. Doing so will require the adoption of different economic models, new legislative and regulatory measures, civil society advocacy and accountability, and better corporate social responsibility. Governments must be empowered to encourage businesses to prioritise positive health impacts.  

As Tedros Adhanom Ghebreyesus, WHO Director-General, writes in an accompanying Comment, public health cannot progress without action on the commercial determinants of health. The Lancet welcomes the upcoming WHO Congress and first Annual Report on the commercial determinants of health, especially in helping to address non-communicable diseases. Given their huge unresolved impacts, the commercial determinants of health must be recognised—and funded—as a crucial field of research.

Tanzania confirms first-ever outbreak of Marburg Virus Disease

Via WHO AFRO: Tanzania confirms first-ever outbreak of Marburg Virus Disease.

Brazzaville/Dar es Salaam – Tanzania today confirmed its first-ever cases of Marburg Virus Disease after laboratory tests were carried out following reports of cases and deaths in the country’s north-west Kagera region.  

Tanzania’s National Public Health Laboratory analysed samples to determine the cause of illness after eight people developed symptoms including fever, vomiting, bleeding and renal failure. Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.  

“The efforts by Tanzania’s health authorities to establish the cause of the disease is a clear indication of the determination to effectively respond to the outbreak. We are working with the government to rapidly scale up control measures to halt the spread of the virus and end the outbreak as soon as possible,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa.  

WHO is supporting the Ministry of Health to deploy an emergency team to Kagera to carry out further epidemiological investigations. The emergency team will focus on active case finding in the community and local health care facilities to identify more contacts and provide them with appropriate care.  

While Tanzania has never previously recorded a Marburg case, it has had to respond to other health emergencies including COVID-19, cholera and dengue within the past three years. A strategic risk assessment conducted by WHO in September 2022 showed that the country is at high to very high risk for infectious diseases outbreaks.   

“The lessons learnt, and progress made during other recent outbreaks should stand the country in good stead as it confronts this latest challenge,” said Dr Moeti. “We will continue to work closely with the national health authorities to save lives.”  

Marburg virus disease is highly virulent and causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Many patients develop severe haemorrhagic symptoms within seven days. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.  

There are no vaccines or antiviral treatments approved to treat the virus. However, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves likelihood of survival.

Tanzania on high alert after strange disease kills five

Via The Citizen: Tanzania on high alert after strange disease kills five.

Tanzania’s ministry of health has issued a public notice about an unknown disease that has so far killed 5 people in Bukoba, Kagera Region.  

The notice comes after 7 people were reported to have fallen ill, showing symptoms of fever, vomiting, bleeding, and kidney failure.  

The ministry has called on the general public to remain alert and advised that anyone who shows signs of nausea, weakness, bleeding, diarrhea, or fever to report to the nearest health centre. 

“Anyone who sees someone with the aforementioned symptoms should alert authorities by calling a toll-free number (199).”  

It is believed that the disease is infectious and samples from the dead bodies have been taken to determine what type of disease it is.  

The ministry also said that a rapid response team has been dispatched to the affected areas.

8 dead skunks found in Vancouver and Richmond test positive for H5N1 avian flu

Via CBC News, a story that's getting close to home: 8 dead skunks found in Vancouver and Richmond test positive for avian flu. Excerpt:

Eight skunks found dead last month in Vancouver and nearby Richmond, B.C., have tested positive for avian flu. 

The B.C. government says it is the same strain of avian influenza associated with the outbreak that began in April 2022.  

The skunks were found in residential areas in both cities and were taken to B.C.'s Animal Health Centre over concerns they may have been deliberately poisoned.  

British Columbia's Ministry of Agriculture says the skunks were infected with the same H5N1 strain that has caused the deaths of millions of domestic poultry since the outbreak began in April last year.  

The ministry says in a statement the skunks may have contracted H5N1 by scavenging on infected wild birds.  

The statement says while avian flu in skunks is considered to be a low risk to human health, there are always risks when people or pets come into contact with sick or dead wild animals.

Avian influenza overview December 2022 – March 2023

ECDC has published Avian influenza overview December 2022 – March 2023. The abstract:

Between 3 December 2022 and 1 March 2023 highly pathogenic avian influenza (HPAI) A(H5N1) virus, clade 2.3.4.4b, was reported in Europe in domestic (522) and wild (1,138) birds over 24 countries. An unexpected number of HPAI virus detections in sea birds were observed, mainly in gull species and particularly in black-headed gulls (large mortality events were observed in France, Belgium, the Netherlands, and Italy). The close genetic relationship among viruses collected from black-headed gulls suggests a southward spread of the virus. Moreover, the genetic analyses indicate that the virus persisted in Europe in residential wild birds during and after the summer months. 

Although the virus retained a preferential binding for avian-like receptors, several mutations associated to increased zoonotic potential were detected. The risk of HPAI virus infection for poultry due to the virus circulating in black-headed gulls and other gull species might increase during the coming months, as breeding bird colonies move inland with possible overlap with poultry production areas. 

Worldwide, HPAI A(H5N1) virus continued to spread southward in the Americas, from Mexico to southern Chile. The Peruvian pelican was the most frequently reported infected species with thousands of deaths being reported. The reporting of HPAI A(H5N1) in mammals also continued probably linked to feeding on infected wild birds. 

In Peru, a mass mortality event of sea lions was observed in January and February 2023. Since October 2022, six A(H5N1) detections in humans were reported from Cambodia (a family cluster with 2 people, clade 2.3.2.1c), China (2, clade 2.3.4.4b), Ecuador (1, clade 2.3.4.4b), and Vietnam (1, clade 2.3.4.4b), as well as two A(H5N6) human infections from China. 

The risk of infection with currently circulating avian H5 influenza viruses of clade 2.3.4.4b in Europe is assessed as low for the general population in the EU/EEA, and low to moderate for occupationally or otherwise exposed people.

Bangladesh: One dies of Nipah virus in Rajshahi

Thanks to ProMED-mail for linking to this report in the Dhaka Tribune: One dies of Nipah virus in Rajshahi.

One woman died of Nipah virus in Rajshahi Medical College Hospital (RMCH) Wednesday afternoon.  

The deceased, Farida Yasmeen, 25, was admitted to the neuro medicine ward of RMCH with common symptoms like fever and seizures.   

Complications escalated after she was diagnosed with Nipah virus on Wednesday morning and was eventually referred to Nipah ICU. She died around 5pm while undergoing treatment.  

Besides, her mother-in-law Rahima Begum is admitted in the Nipah Suspect Ward with the same symptoms. Farida's father-in-law Abdul Haque had died at home with the same symptoms two weeks ago.  

Although the family thinks it was a natural death, however, doctors believe that her father-in-law was also infected with Nipah virus. Besides, it has been reported that their entire family eats date juice without boiling it, a common cause of the spread of this disease.  

Dr Azizul Haque, medicine specialist at Rajshahi Medical College Hospital, said: “Relatives of deceased patients are at higher risk of infection. So, they need to be extra careful. We are working in coordination with IEDCR.”  

He urged to be careful while drinking date juice.  

However, Rajshahi Civil Surgeon Dr Abu Yusuf Mohammad Farooq said that there is no need for regular care of the patient's relatives. The IECCR has collected and tested the samples of everyone who came in contact with the infected patient. However, everyone should be careful while drinking date juice.   

A total of five people have died in Rajshahi Medical College Hospital (RMCH) so far. All of them have a history of drinking date palm juice. Besides, everyone was admitted to the general ward of the hospital with common symptoms like jaundice. Then suddenly the physical condition started to deteriorate. Death occurred on admission to the ICU. Nipah in one of the deceased was identified after death.

China reports new H5N1 avian flu case

Thanks to FluTrackers for alerting me to this CIDRAP report by Lisa Schnirring: China reports new H5N1 avian flu case. Excerpt:

China has reported a new human H5N1 avian flu case, marking the second case in recent months, an official with the World Health Organization (WHO) confirmed today.  

Daniel Epstein, with the WHO's news media team, said China informed the WHO about the case on Feb 24. The patient is a 53-year-old woman from Jiangsu province who has a history of contact with poultry. The woman's symptoms began on Jan 31, and she was hospitalized on Feb 4.       

Genetic sequencing suggests that she was infected with the 2.3.4.4b H5N1 clade, which is currently circulating widely in birds, Epstein said. "Since 2020, an increased number of avian influenza outbreaks have been reported in wild birds and poultry globally, and we can expect additional sporadic human cases."  

The new case from China was first reported yesterday by BNO News.  

China's last H5N1 case involved a woman from Guangxi province who was sick in November and died from her infection. In a late December risk assessment, the WHO said the virus from that Chinese patient, as well as a recent case in Vietnam, also involved the 2.3.4.4b H5N1 clade.  

CDC weighs in on Cambodian H5N1 clade  

In related news, the US Centers for Disease Control and Prevention (CDC) yesterday detailed its genetic analysis of the full H5N1 avian flu virus sequence, shared by Cambodia's health ministry, from a girl who recently died from her infection.  

The CDC said that the virus belongs to the 2.3.2.1c clade and is different from the 2.3.4.4b clade that is currently circulating in US wild birds and poultry and in domestic and wild birds across the globe. It added that the clade found in the Cambodian patient is similar to 2.3.2.1c clade H5N1 viruses that have been circulating in Southeast Asia in recent years.  

Sequencing by the CDC also suggests that an existing clade 2.3.2.1c candidate vaccine virus would offer protection against the virus. Also, the CDC found no genetic changes known to be linked to enhanced ability to spread to people or reduced susceptibility to antiviral medications.

Hospitalizations for COVID-19 among Canada’s youngest surged by more than 600% in the second year of the pandemic

Via the Canadian Institute for Health Information: Hospitalizations for COVID-19 among Canada’s youngest surged by more than 600% in the second year of the pandemic. Excerpt:

The second year of the pandemic saw a surge of hospitalizations for COVID-19 and other infections among Canadian children age 0 to 4. Data from the Canadian Institute for Health Information (CIHI) shows that COVID-19 was the sixth most common reason kids in this age group were hospitalized in 2021–2022. This represents an increase of more than 600%, with a total of 2,315 COVID-19 hospitalizations among this cohort in 2021–2022 compared with 325 hospitalizations in 2020–2021. See Inpatient Hospitalization, Surgery and Newborn Statistics, 2021–2022 (XLSX).  

CIHI’s report shows that in addition to an increase in hospitalizations for COVID-19, respiratory infections (including pneumonia) and other viral infections returned as top 10 diagnoses that required hospitalization for Canadians age 0 to 4 in 2021–2022. The increase in hospitalizations for virus-related illnesses coincided with the easing of public health measures across the country.  

“This uptick in hospitalizations for COVID-19, respiratory infections and other viral illnesses seen among the youngest Canadians in the second year of the pandemic is concerning both for the health of our youngest and most vulnerable, and for the additional strain placed on health systems and health care workers that were already stretched thin,” said Juliana Wu, Director, Acute and Ambulatory Care Information Services, CIHI. “We are continuing to monitor hospital activity in this third year of the pandemic to understand the ongoing impacts of COVID-19 on Canadians.”  

COVID-19 continued to present challenges for Canadians of all ages and was the second most common reason for hospitalization in Canada in 2021–2022, jumping from seventh in 2020–2021. This represents an increase of more than 60%, with a total of 77,344 hospitalizations in 2021–2022 compared with 47,715 hospitalizations in 2020–2021.

Long Covid in the United States

Via NBER: Long Covid in the United States. Click through to download the full report as a PDF. The abstract:

Although yet to be clearly identified as a clinical condition, there is immense concern at the health and wellbeing consequences of long COVID. Using data collected from nearly half a million Americans in the period June 2022-December 2022 in the US Census Bureau’s Household Pulse Survey (HPS), we find 14 percent reported suffering long COVID at some point, half of whom reported it at the time of the survey.  

It peaks in midlife in the same way as negative affect. Ever having had long COVID is strongly associated with negative affect (anxiety, depression, worry and a lack of interest in things). The effect is larger among those who currently report long COVID, especially if they report severe symptoms.  In contrast, those who report having had short COVID report higher wellbeing than those who report never having had COVID.  

Long COVID is also strongly associated with physical mobility problems, and with problems dressing and bathing. It is also associated with mental problems as indicated by recall and understanding difficulties. Again, the associations are strongest among those who currently report long COVID, while those who said they had had short COVID have fewer physical and mental problems than those who report never having had COVID.  

Vaccination is associated with lower negative affect, including among those who reported having had long COVID.

BC: The epicenter of an ‘unusual’ avian flu outbreak

Via the Fraser Valley Current: The epicenter of an ‘unusual’ avian flu outbreak. Excerpt:

An avian influenza outbreak that has plagued the Fraser Valley’s poultry farms since the spring has seemingly diminished for now. But it’s expected to return.  

Although every province except for Prince Edward Island has identified cases of the highly pathogenic avian influenza (HPAI), the Fraser Valley is the epicenter of the “unprecedented outbreak,” with millions of birds killed locally.  

The first case of HPAI in BC was detected last April. It wasn’t discovered in the Fraser Valley for another month. Since then, the virus has killed more than 3.6 million birds across the province at 103 different locations, 81 of which are in the Fraser Valley.   

The virus doesn’t usually survive the summer heat, but in this case it did, making this strain particularly unusual, said Amanda Brittain, BC Egg’s director of communications.  

The strain is particularly virulent, Brittain said, and has infected many more birds than previous outbreaks. There were 51 previously infected sites in BC that have been declared influenza-free and released from the CFIA’s watch. But another 52 locations are still considered infected and will need to meet certain criteria before they are deemed safe.  

There is some hope: it's been more than 30 days since a case was last detected in BC. The last case was on Jan. 22 at a commercial poultry farm in Chilliwack. Since then no new cases have been reported.  

But it doesn’t mean the worst is over.  

“Avian influenza follows the migratory bird season,” Brittain said. “That’s why we had a spring and then a fall outbreak… and we are anticipating more infections with the spring migration.”  

Farmers, even in uninfected areas, have been forced to take extra precautions. In the fall, farmers were ordered to keep all commercial birds indoors to keep them away from wild birds, which are one of the main transmitters of the virus.  

“Farmers are under a great deal of stress,” Brittain said. “Even if you’re not on an infected farm, there’s all kinds of rules about movements.”

Second case of H5N1 bird flu in Cambodia confirmed

Via the Khmer Times: 2nd case of H5N1 bird flu in Cambodia confirmed. Excerpt:

The Ministry of Health has just issued a statement confirming the discovery of a second case of Highly Pathogenic Avian Influenza A(H5N1) in Prey Veng province – the father of an 11 year old girl who died from the virus on Wednesday  

The outbreak is centred around Roleang village, Romlech commune, Sithor Kandal district, Prey Veng province.  

The Ministry says that after the girl’s death, the emergency research work team of the Ministry of Health in collaboration with local authorities and Prey Veng Provincial Health Department, together with health partners, arrived at the village immediately on February 23, 2023.  

The emergency response team collected samples from 12 people.  One of the 12 samples – taken from a 49-year-old man living in Roleang village – has been confirmed as positive.   

The Ministry of Health states that the virus was not previously found in humans for the past 9 years in the Kingdom of Cambodia.   

The emergency response team has been investigating the outbreak of the H5N1 virus and is responding to national procedures, and has been working with the emergency response team, human and veterinary vets, to find the source of the infection.  

Animals and humans will continue to be tested for suspected cases to prevent transmission to others in the community in the village where the incident occurred.  

Public health expert Dr Quach Mengly said the disease has symptoms similar to a cold, cough, and fever and is highly life-threatening without treatment.  

“To prevent the infection, please avoid touching and eating sick and dead animals,” he said. “Bury the dead animals properly, and wash your hands properly after that.”

11-year-old Cambodian girl dies of H5N1 bird flu

Google Maps

Via Vietnam+: 11-year-old Cambodian girl dies of H5N1 bird flu. I couldn't find anything about the case in the Cambodian media, but FluTrackers are all over the story from multiple sources.

Phnom Penh (VNA) - An 11-year-old girl from southeast Cambodia's Prey Veng province had died of H5N1 human avian influenza, the country's Ministry of Health's Communicable Disease Control Department reported on February 22. 

The girl fell ill on February 16, with the symptoms of a high temperature of 39 degrees Celsius, cough and sore throat, the department said, adding that she first sought local health service, but her condition saw no improvements, so she was then transferred to the National Pediatric Hospital in Phnom Penh. 

On February 21, the doctor took her samples for diagnosis at the National Institute of Public Health and the results came out one day later, confirming that she was positive for H5N1 bird flu, and the girl died later.  

The department called on people not to touch ill or dead poultry and if suspected of having been infected with the virus.

Want to fix public health? Stop thinking like a doctor

Via The Nation, Eric Reinhart writes: Want to Fix Public Health? Stop Thinking Like a Doctor. Excerpt:

A changing of the guard in US public health is impending—and, with it, a chance to rejuvenate a flailing field. Anthony Fauci has retired in the shadow of one of the worst preventable disasters in history, and President Biden is moving to make new appointments while establishing a permanent White House Office for Pandemic Preparedness and Response Policy. 

In doing so, Biden and his advisers must confront the fact that the rot in public health is structural: It cannot be cured by simply rotating the figureheads who preside over it. Building effective national health infrastructure will require confronting pervasive distortions of public health and remaking the leadership appointment systems that have left US public health agencies captive to partisan interests. 

 Part of what has made public health vulnerable and a plaything of partisan politicking is the field’s gradual medicalization. Consider, for example, the history of the nation’s most important public health agency. Since 1953, every director of the Centers for Disease Control and Prevention (CDC) has had a doctor of medicine, or MD, degree as their primary credential, with secondary degrees serving mostly as résumé decor. 

Given that medical interventions constitute only 10–20 percent of modifiable factors affecting health, the backgrounds reflected in CDC leadership—and, likewise, at most state and local public health agencies—are notable for their consistent prioritization of narrow biomedical expertise at the expense of other fields that represent the remaining 80–90 percent of pertinent knowledge for making public health policy.  

Physician and public health scholar Milton Roemer once observed that for the work of public health, “most of medical education is irrelevant.” But neither doctors’ irrelevant medical knowledge nor relative ignorance of essential fields—labor history, social anthropology, political economy, epidemiology, environmental sciences—is the most troubling aspect of physician control of public health. Rather, it’s the lack of epistemic humility, conferring an inability to recognize the limits and hazards of clinical reasoning, with which medical training often imbues them. Clinical reasoning is not only not the population-level logic of public health; it is frequently antithetical to it.

When we treat patients, doctors are appropriately oriented around taking care of the individual in front of us. We recognize that we typically cannot change their life circumstances—such as economic and housing conditions, employers’ demands, student and medical debt, neighborhood violence, or social isolation—and so we focus our clinical attention on helping them live as well as possible within existing constraints.

Public health, by contrast, is about treating populations. As with medicine, the goal of public health is to enable individuals to be free of health limitations that curtail their ability to live as they please. But public health pursues this by very different means. The task is not to help individuals accommodate to oppressive social or labor contexts. It is instead to use the power of government to change conditions that are constraining people’s freedom. The core tools of public health, then, are not just vaccines or lab tests but also policies pertaining to corporate regulation and consumer safety standards; labor protections; public jobs and housing programs; investments in community health workers, decriminalization, and decarceration; and civil rights lawsuits.

How deadly was China’s Covid wave?

Via The New York Times: How Deadly Was China’s Covid Wave? Excerpt:

After China relaxed the world’s most stringent Covid-19 restrictions in December, the virus exploded. Hints of the surge were everywhere: Hospitals turned away patients. Crematories were overwhelmed with bodies. A wave of top scholars died.  

But China’s official Covid death toll for the entire pandemic remains strikingly low: 83,150 people as of Feb. 9. That number is a vast undercount, researchers believe, in part because it only includes infected people who died in hospitals, excluding anyone who died at home.  

While a precise accounting is impossible, epidemiologists have been working to piece together the mystery of the outbreak that accelerated in December. Four separate academic teams have converged on broadly similar estimates: China’s Covid wave may have killed between a million and 1.5 million people.  

All of the researchers consulted by The New York Times cautioned that without reliable data from China, the estimates should be understood as informed guesses, with significant uncertainty — although the estimates fit the evidence far better than the official figures do.  

The question of how many people died has enormous political relevance for the ruling Communist Party. Early in the pandemic, China’s harsh lockdowns largely kept the coronavirus at bay. Xi Jinping, the top leader, has portrayed that earlier success as evidence of China’s superiority over the West, a claim that would be hard to maintain with a high death toll.  

The differences between China’s figures and researchers’ estimates are dramatic. The official numbers would give China the lowest death rate per capita of any major country over the entirety of the pandemic. But at the estimated levels of mortality, China would already have surpassed official rates of death in many Asian countries that never clamped down as long or as aggressively. 

At the same time, China would rank below Germany, Italy, the United States and other countries where outbreaks accelerated before vaccines became available.  

Two of the estimates were in papers published in academic journals or posted for peer review, while two other analyses were shared by epidemiologists in response to queries from The Times.  

Researchers used a variety of approaches to gauge how many people may have been infected and — a crucial question — how effective China’s homegrown vaccines were at preventing death. Some drew on how the virus behaved in past outbreaks in Hong Kong and Shanghai, where data was more reliable, and a few used detailed computer models to simulate the epidemic.  

Still others turned to official sampling data, based on China’s systematic testing of hundreds of thousands of people, to develop a model that estimated deaths to be far beyond the government's tally.  

“If the data say what we think they say, this was an explosive wave,” said Lauren Ancel Meyers, a professor of biology and statistics at the University of Texas at Austin.

Bird flu spreads to new countries, threatens non-stop "war" on poultry

Via Reuters: Bird flu spreads to new countries, threatens non-stop "war" on poultry. Excerpt:

CHICAGO, Feb 15 (Reuters) - Avian flu has reached new corners of the globe and become endemic for the first time in some wild birds that transmit the virus to poultry, according to veterinarians and disease experts, who warn it is now a year-round problem.  

Reuters spoke to more than 20 experts and farmers on four continents who said the prevalence of the virus in the wild signals that record outbreaks will not abate soon on poultry farms, ramping up threats to the world's food supply. They warned that farmers must view the disease as a serious risk all year, instead of focusing prevention efforts during spring migration seasons for wild birds.

Outbreaks of the virus have continued in North and South America, Europe, Asia and Africa, undefeated by summer heat or winter cold snaps, since a strain arrived in the United States in early 2022 that was genetically similar to cases in Europe and Asia.

Egg prices set records after the disease wiped out tens of millions of hens last year, putting a staple source of cheap protein out of reach to some of the world's poorest at a time the global economy is reeling from high inflation.   

Wild birds are primarily responsible for spreading the virus, according to experts. Waterfowl like ducks can carry the disease without dying and introduce it to poultry through contaminated feces, saliva and other means.  

Farmers' best efforts to protect flocks are falling short.  

In the United States, Rose Acre Farms, the country's second-largest egg producer, lost about 1.5 million hens at a Guthrie County, Iowa, production site last year, even though anyone who entered barns was required to shower first to remove any trace of the virus, Chief Executive Marcus Rust said.

A company farm in Weld County, Colorado, was infected twice within about six months, killing more than 3 million chickens, Rust said. He thinks wind blew the virus in from nearby fields where geese defecated.  

"We got nailed," Rust said. "You just pull your hair out."  

The United States, Britain, France and Japan are among countries that have suffered record losses of poultry over the past year, leaving some farmers feeling helpless.  

"Avian flu is occurring even in a new poultry farm with modern equipment and no windows, so all we could do now is ask God to avoid an outbreak," said Shigeo Inaba, who raises chickens for meat in Ibaraki prefecture near Tokyo.

Goodbye, Johns Hopkins covid tracker

Via The Washington Post: Goodbye, Johns Hopkins covid tracker. Excerpt:

When the pandemic hit, the federal government struggled to publish snapshots of the virus’ spread.  

So, academics and journalists quickly filled the void, creating new tools with near real-time estimates of the unfolding pandemic. Since January 2020, Johns Hopkins University has operated one of the most prominent resources for tracking covid-19 case counts and deaths across the world.   

After more than three years, the university will stop updating its tracker on March 10 as the country has moved into a different stage of the pandemic with a different data flow. But the story of the online dashboard — a $13 million project that’s been viewed over 2.5 billion times — is more than just about a tool to track the pandemic. It underscores the country’s fragmented public health systems and its decentralized and underfunded reporting system, which hobbled the U.S. pandemic response.    

“The thing that became the biggest surprise was the importance and reliance on it by everyone: by the general public and decision-makers and everyone in between,” said Lauren Gardner, the director of the Johns Hopkins Center for Systems Science and Engineering who started the global tracker with one of her PhD students.  

“Hopkins filled a gap that nobody else was able to do,” Ali Mokdad, a professor of health metrics sciences at University of Washington’s IHME. “So all of us, reporters, us in academia, we went to Hopkins to get the data.”  

Why now?  

The Johns Hopkins researchers point out that they don’t believe the pandemic has ended — and the move to stop updating the tracker shouldn’t be conflated as such. Instead, the decision comes amid a different phase of the pandemic and was made for two main reasons.   

The first: The Centers for Disease Control and Prevention and the World Health Organization have built up their capacity to share covid data with the general public, which Gardner called the “appropriate” entities to be providing this information long term.   

The second: The quality of the tracker depends on the quality of publicly available data. At the beginning of the pandemic, states, counties and even cities were providing daily covid updates, which scrapers for the tracker could collect data from. But that’s not the case anymore, and that has a direct impact on what the dashboard can do.   

Looking forward  

The country has made some improvements on its data collection efforts, but there’s still a ways to go, according to several experts.   

Beth Blauer, an associate vice provost at Johns Hopkins University who helped run the Coronavirus Resource Center, said that many states closed up their covid reporting with little information on any next steps.  

“Our big question is whether or not they’re making long-term investments in critical public health data infrastructure to navigate lots of challenges that they face,” Blauer said, citing the opioid epidemic and economic mobility. 

Fixing the crisis in public health

The Tyee has published my article Fixing the Crisis in Public Health. Excerpt:

After three years of pandemic and the turmoil it’s generated, Canada is looking a little the worse for wear. We may want to think it’s over, but 50,344 Canadians have died of COVID — 18,920 of them in 2022. As well, the winter of 2022-23 has put a brutal strain on health-care workers and their patients.

Meanwhile, Ottawa and the provinces have been growling at one another about health-care funding. Given the mess in the health-care system, they seem likely to come up with some kind of cost-sharing formula on Feb. 7, which may improve the situation.  

Dr. Theresa Tam, Canada’s chief public health officer, has made some excellent suggestions for improving the health-care system in her annual reports for 2021 and 2022. But I expect the politicians will ignore her.  

Health spending has been enormous since the pandemic began in 2020. According to the Canadian Institute for Health Information, total health spending in 2022 was expected to reach $331 billion, or $8,563 per capita. Hospitals got 24.6 per cent, physicians received 13.6 per cent, and 13.6 per cent of all health spending was for drugs.  

Strikingly, only 5.3 per cent of that was for public health.

‘It was all for nothing’: Chinese count cost of Xi’s snap decision to let Covid rip

Via The Guardian: ‘It was all for nothing’: Chinese count cost of Xi’s snap decision to let Covid rip | Coronavirus. Excerpt:

When Sunny[not her name] thinks back to March last year, she laughs ruefully at the ordeal. The 19-year-old Shanghai student spent that month locked in her dormitory, unable to shop for essentials or wash clothes, even banned from showering for two weeks over Covid fears. In April, the entire city locked down.  

It was the beginning of the chaos of 2022, as local Chinese authorities desperately tried to follow President Xi Jinping’s zero-Covid decree while facing the most virulent strain of the virus yet: Omicron. “Everyone was panicking, no one was ready,” she tells the Observer.  

By the end of the year, zero-Covid was gone. Sunny says she felt instantly “relieved” that lockdowns were over but her feelings soon turned to anger as it became clear China’s government had opened up the country, knowing it wasn’t ready. “I felt it was all for nothing,” Sunny says.  

Over the last two months, the virus has rapidly spread through the country. Up to 10,000 critical cases were registered in hospitals every day. Morgues were overwhelmed, pharmacies reported shortages of basic medications, and supply of antiviral drugs was held up by protracted negotiations with foreign suppliers. Online and in the streets, people spoke of almost everyone they knew having caught Covid, and of elderly relatives dying.  

Sunny’s grandfather was among those who died in that wave. “It was the morning, and my mum walked into my room and said: your grandpa is in the emergency room,” she recalls. “A few hours later, he passed away. My grandmother was in tears, saying he had left her behind.”  

Xi’s extraordinary backflip left analysts alarmed and confused. China was not the only country to choose a zero-Covid strategy, and certainly not the only one to “let it rip” once it dropped it. But it was the last, and global health experts say there were plenty of lessons it could have heeded – primarily, making sure vaccinations and health resources were high before the tsunami of cases hit.  

“All governments had to decide to open up at some stage or risk the consequences of lockdowns far outweighing the problems of Covid,” says Professor Emma McBryde, an epidemiologist at James Cook University, Townsville, Queensland, Australia. 

 “Most models suggest that it would be better for the health system to open up slowly. Although there would be little change in how many people get infected, it could mean some lives are saved if the health system can function well.”  

But Xi threw the gates open. Right up until the day of repeal, local governments were still developing and enforcing zero-Covid measures and infrastructure. The city of Chongqing was building a 21,000-bed quarantine centre.  

Experts on health and Chinese politics have told the Observer they believe the local authorities were hamstrung. Any preparations for ending zero-Covid would be seen as a vote of no confidence in both the policy and Xi – an act of political suicide.