H5N1

Primary care for all: Lessons for Canada from peer countries with high primary care attachment

Via CMAJ: Primary care for all: lessons for Canada from peer countries with high primary care attachment. The key points:

• Canada spends less of its total health budget on primary care than the average among Organisation for Economic Cooperation and Development (OECD) countries (5.3% v. 8.1%).  

• Canada can learn lessons to inform policy on primary care from OECD countries like the United Kingdom, Norway, Netherlands and Finland where more than 95% of the population has a regular primary care clinician or place of care.  

• An analysis of these countries shows that those with high rates of primary care attachment have stronger contractual agreements and accountability for family physicians, including where they practise, their scope of practice and who they accept as patients.  

• Countries with high rates of primary care attachment have similar numbers of family physicians, but fewer work in walk-in clinics or specialized areas; family physicians are paid by capitation or salary, work in interprofessional teams and have excellent digital tools and information systems.

Infectivity of exhaled SARS-CoV-2 aerosols is sufficient to transmit covid-19 within minutes

Via Scientific Reports: Infectivity of exhaled SARS-CoV-2 aerosols is sufficient to transmit covid-19 within minutes. The case for continued masking and improved ventilation seems inarguable. The abstract:

Exhaled SARS-CoV-2-containing aerosols contributed significantly to the rapid and vast spread of covid-19. However, quantitative experimental data on the infectivity of such aerosols is missing. Here, we quantified emission rates of infectious viruses in exhaled aerosol from individuals within their first days after symptom onset from covid-19. 

Six aerosol samples from three individuals were culturable, of which five were successfully quantified using TCID50. The source strength of the three individuals was highest during singing, when they exhaled 4, 36, or 127 TCID50/s, respectively. 

Calculations with an indoor air transmission model showed that if an infected individual with this emission rate entered a room, a susceptible person would inhale an infectious dose within 6 to 37 min in a room with normal ventilation. 

Thus, our data show that exhaled aerosols from a single person can transmit covid-19 to others within minutes at normal indoor conditions.

Perceived health inequalities: are the UK and US public aware of occupation-related health inequality?

Via BMC Public Health: Perceived health inequalities: are the UK and US public aware of occupation-related health inequality, and do they wish to see it reduced? The abstract:

Background  

One underexamined factor in the study of lay views of socioeconomic health inequalities is occupation-related health. Examining health by occupational social class has a long history in the UK but has been comparatively overlooked in US public health literatures, where the relationship between health and work has attended more to hazard exposure.  

Methods  

Representative samples of the UK and US indicated the perceived and ideal lifespan of people working in “higher managerial/professional” and “routine” occupations. We examine perceptions of inequality and desires for equality across occupation groups as a function of country and key socio-demographic variables.  

Results  

67.8% of UK and 53.7% of US participants identified that professionals live longer than routine workers. Multivariate models indicated that US participants were markedly less likely to be aware of occupation-related inequalities after controlling for age, gender, and education. Awareness was negatively related to age (in the US) and recent voting behaviours (both samples). Desiring equal life expectancy was less likely in the US sample, and less likely across both samples among older participants and those with lower levels of education.  

Conclusion  

Employing a novel approach to measuring perceived and ideal life expectancy inequality, this is the first study to examine perceptions of lifespan inequality by occupational groups. It reports widespread understanding of the occupation-related gradient in lifespan and a desire that these inequalities be eliminated in the UK, but considerably less awareness and desire for equality in the US. Greater tolerance for social status inequalities in the US than other similar countries appears to also extend to differences in life expectancy.

The 2023 report of the Lancet Countdown on health and climate change: The imperative for a health-centred response in a world facing irreversible harms

Via The Lancet, a major report: The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. An excerpt from the executive summary:

The Lancet Countdown is an international research collaboration that independently monitors the evolving impacts of climate change on health, and the emerging health opportunities of climate action. In its eighth iteration, this 2023 report draws on the expertise of 114 scientists and health practitioners from 52 research institutions and UN agencies worldwide to provide its most comprehensive assessment yet.  

In 2022, the Lancet Countdown warned that people's health is at the mercy of fossil fuels and stressed the transformative opportunity of jointly tackling the concurrent climate change, energy, cost-of-living, and health crises for human health and wellbeing. This year's report finds few signs of such progress. At the current 10-year mean heating of 1·14°C above pre-industrial levels, climate change is increasingly impacting the health and survival of people worldwide, and projections show these risks could worsen steeply with further inaction. However, with health matters gaining prominence in climate change negotiations, this report highlights new opportunities to deliver health-promoting climate change action and a safe and thriving future for all.

The rising health toll of a changing climate

In 2023, the world saw the highest global temperatures in over 100 000 years, and heat records were broken in all continents through 2022. Adults older than 65 years and infants younger than 1 year, for whom extreme heat can be particularly life-threatening, are now exposed to twice as many heatwave days as they would have experienced in 1986–2005 (indicator 1.1.2). Harnessing the rapidly advancing science of detection and attribution, new analysis shows that over 60% of the days that reached health-threatening high temperatures in 2020 were made more than twice as likely to occur due to anthropogenic climate change (indicator 1.1.5); and heat-related deaths of people older than 65 years increased by 85% compared with 1990–2000, substantially higher than the 38% increase that would have been expected had temperatures not changed (indicator 1.1.5).

 

Simultaneously, climate change is damaging the natural and human systems on which people rely for good health. The global land area affected by extreme drought increased from 18% in 1951–60 to 47% in 2013–22 (indicator 1.2.2), jeopardising water security, sanitation, and food production. A higher frequency of heatwaves and droughts in 2021 was associated with 127 million more people experiencing moderate or severe food insecurity compared with 1981–2010 (indicator 1.4), putting millions of people at risk of malnutrition and potentially irreversible health effects. The changing climatic conditions are also putting more populations at risk of life-threatening infectious diseases, such as dengue, malaria, vibriosis, and West Nile virus (indicator 1.3).

 

Compounding these direct health impacts, the economic losses associated with global heating increasingly harm livelihoods, limit resilience, and restrict the funds available to tackle climate change. Economic losses from extreme weather events increased by 23% between 2010–14 and 2018–22, amounting to US$264 billion in 2022 alone (indicator 4.1.1), whereas heat exposure led to global potential income losses worth $863 billion (indicators 1.1.4 and 4.1.3). Labour capacity loss resulting from heat exposure affected low and medium Human Development Index (HDI) countries the most, exacerbating global inequities, with potential income losses equivalent to 6·1% and 3·8% of their gross domestic product (GDP), respectively (indicator 4.1.3).

 

The multiple and simultaneously rising risks of climate change are amplifying global health inequities and threatening the very foundations of human health. Health systems are increasingly strained, and 27% of surveyed cities declared concerns over their health systems being overwhelmed by the impacts of climate change (indicator 2.1.3). Often due to scarce financial resources and low technical and human capacity, the countries most vulnerable to climate impacts also face the most challenges in achieving adaptation progress, reflecting the human risks of an unjust transition. Only 44% of low HDI countries and 54% of medium HDI countries reported high implementation of health emergency management capacities in 2022, compared with 85% of very high HDI countries (indicator 2.2.5). Additionally, low and medium HDI countries had the highest proportion of cities not intending to undertake a climate change risk assessment in 2021 (12%; indicator 2.1.3).

 

These inequalities are aggravated by the persistent failure of the wealthiest countries to deliver the promised modest annual sum of $100 billion to support climate action in those countries defined as developing within the UN Framework Convention on Climate Change. Consequently, those countries that have historically contributed the least to climate change are bearing the brunt of its health impacts—both a reflection and a direct consequence of the structural inequities that lie within the root causes of climate change.

The UK's COVID response: "Lies, deceptions and callous conceit"

Via The Lancet, editor Richard Horton studies the UK's dismal government response to COVID-19: Offline: “Laughing at the Italians”.

A former minister for health in England wrote to me that “The COVID-19 inquiry will make us the laughing stock in the eyes of the world.” But it is worse than that. The level of criminal incompetence exposed by recent witnesses to the UK COVID-19 Inquiry, chaired by Baroness Heather Hallett, has proven that many, if not most, of over 230 000 deaths were preventable. Amid the claims of extreme misogyny, profanity, and chaos that litter the evidence is a story of complete government breakdown.  

WHO declared a Public Health Emergency of International Concern on Jan 30, 2020. The UK Government was confident it could ride out the storm coming from China. Martin Reynolds, who was at the time Prime Minister Boris Johnson's Principal Private Secretary, believed “the system [was] gripping the challenge”. Lee Cain, who was Downing Street's Director of Communications, thought the outbreak was simply a matter for the Department of Health and Social Care. Chris Whitty, the Chief Medical Officer (CMO), briefed Johnson about the risk of a pandemic on Feb 4, 2020. Johnson expressed concern about over-reacting.  

The discussion focused on repatriating UK nationals from China, according to Imran Shafi, then Private Secretary to the Prime Minister for Public Services. Government committees were waking up to the threat. COBR (Cabinet Office Briefing Rooms), a group responsible for managing national crises, concluded that the UK's public health system lacked capacity for dealing with a pandemic.  

But the extent of the danger did not penetrate to the centre of government. The CMO reassured Downing Street that there was no sustained transmission outside Wuhan. Then something very strange took place. Johnson took a 2-week holiday. From Feb 14 to Feb 24, he absented himself from Cabinet and COBR meetings, and received little or no further information about the growing risk of COVID-19. Yet it was clear by mid-February that there was sustained coronavirus transmission in the UK.  

Matt Hancock, then Secretary of State for Health and Social Care, reassured colleagues that a plan was in place. By the time Johnson returned from his vacation, clusters of infection were being reported in Italy's Lombardy region. The “macho culture” of No 10 translated into politicians and their advisers “laughing at the Italians”, according to Helen MacNamara, who was Deputy Cabinet Secretary.  

They remained supremely confident that the UK would be world-beating at conquering COVID-19. A meeting of the Civil Contingencies Secretariat on Feb 28 concluded that a global pandemic was now likely (Shafi). Still Johnson and his closest advisers failed to engage.

Johnson chaired his first COBR meeting on March 2. A COVID-19 Action Plan appeared the next day but, according to Cain, it was nothing more than a “thin overview”. By the time Italy locked down on March 9, Reynolds readily agreed that the UK was “playing catch up”. But there was still no plan, no strategic direction, and no leadership. Instead, a debate raged about mitigation versus suppression. 

 

The evening of March 13 was the moment Downing Street realised that the NHS would be overwhelmed if it continued to pursue a policy of mitigation (herd immunity). Only now did the principals have NHS data showing that hospitalisations were rising faster than models predicted. Dominic Cummings, Johnson's main adviser, drew out the threat on a whiteboard that became the instrument for persuading politicians that lockdown was the only option. Treating coronavirus like influenza had been a monumental mistake—“something had gone horrifyingly wrong” (Cummings). “We were heading for a total disaster” (MacNamara). 

 

Yet Johnson still remained sceptical. In a meeting on March 19 between Johnson and Rishi Sunak, his Chancellor, Johnson said, “We’re killing the patient to tackle the tumour…Why are we destroying the economy for people who will die soon anyway” (Shafi). The UK Government finally locked the nation down on March 23. 

 

Officials who have given evidence looked wearily astonished as they described the country's biggest national crisis since World War 2. After Johnson's landslide election victory in December, 2019, they had expected to serve a two-term government. But as the pandemic spread, they admitted that “we weren’t ready for the crisis” (Reynolds). It was a “historic catastrophe” based on “disastrous groupthink” (Cummings). 

 

The lies, deceptions, and callous conceit that characterised the UK's initial response to COVID-19 must surely bring some kind of reckoning.

 

Vital Signs: Missed opportunities for preventing congenital syphilis — United States, 2022

Via MMWR: Vital Signs: Missed Opportunities for Preventing Congenital Syphilis — United States, 2022. The summary:

What is already known about this topic?  

Since 2012, U.S. congenital syphilis cases increased substantially. Syphilis during pregnancy can lead to stillbirth, miscarriage, infant death, and maternal and infant morbidity, which are preventable through appropriate screening and treatment.  

What is added by this report?  

In 2022, lack of timely testing and adequate treatment contributed to almost 90% of congenital syphilis cases in the United States, including substantial proportions of congenital syphilis cases in all U.S. Census Bureau regions and among all racial and ethnic groups.  

What are the implications for public health practice?  

Implementing tailored strategies addressing missed opportunities at the local and national levels could improve timeliness of testing and appropriateness of treatment for syphilis during pregnancy and thereby reduce the incidence of congenital syphilis and complications of syphilis during pregnancy.

Delhi air pollution spikes to 100 times WHO health limit

India Today

Via The Guardian: Delhi air pollution spikes to 100 times WHO health limit. Excerpt:

Air quality in Delhi hit severe levels on Friday and a thick toxic smog cloaked the city, marking the beginning of a pollution season that has become an annual catastrophe for India’s capital.  

Schools were shut and non-essential construction was banned around Delhi as the air quality index in the city almost hit 500 – the highest the measurement will go and 100 times the limit deemed to be healthy by the World Health Organization. 

Air quality in the city had deteriorated over the past week, attributed to a sharp rise in farmers in the neighbouring states of Haryana and Punjab burning their fields during the crop planting season, compounded by winds that carried the pollutants into Delhi and a drop in temperatures trapping the particles.  

On Sunday, the state of Punjab saw a 740% increase in farm fires, with more than a thousand recorded in a single day. Other causes of pollution in the city are car emissions, construction and the burning of rubbish at waste plants.  

Delhi, home to about 33 million people, is regularly ranked the most polluted city in the world. According to this year’s air quality life index, compiled by the University of Chicago’s energy policy institute, the people of Delhi could have their lives shortened by 11.9 years due to the poor air they breathe.  

Doctors in Delhi said they had begun to see the damaging impacts of pollution on the city’s residents. “The number of patients with breathing problems has increased, with more people having coughs, colds, watery and irritated eyes, and breathing problems. People of all ages are affected by this. It is time for us to wear masks and go out only when needed,” said Nikhil Modi, a doctor at Apollo hospital in Delhi.

The impact of the COVID-19 pandemic on cognitive decline

Via The Lancet Healthy Longevity, a disturbing comment: The impact of the COVID-19 pandemic on cognitive decline.

The effect of the COVID-19 pandemic on the general population has been catastrophic. Despite substantial progress in understanding the virology, transmission, and pathogenesis of SARS-CoV-2, many of the long-term consequences of COVID-19 or the restriction measures implemented around the world remain unknown. Evidence for the associated adverse effects of isolation, loneliness, post-traumatic stress, depression, fear, anger, and confusion is overwhelming. However, changes in cognitive and physical functioning due to the COVID-19 pandemic have been less well documented.  

Anne Corbett and colleagues used longitudinal data from the PROTECT study to evaluate the effect of the pandemic on cognition in older adults in the UK, exploring various factors associated with changes in cognitive functioning. The use of computerised neuropsychological data collected before the pandemic and during its first and second years enabled repeated measures to be obtained for the same individuals across the pandemic.  

Declines in executive function and working memory were observed across the whole cohort in the first year of the pandemic, including in subgroups of individuals with mild cognitive impairment or a history of COVID-19, and the decline in working memory continued into the second year of the pandemic.  

Although initially thought to cause acute respiratory symptoms, the effects of SARS-CoV-2 on other systems—including the central and peripheral nervous system—is becoming increasingly clear. The new findings from the PROTECT study indicate domain-specific cognitive changes for individuals with a history of COVID-19 that mirrored similar trajectories for those with mild cognitive impairment but with a slightly lower rate of decline.  

This study also highlights reduced exercise, alcohol use, depression, and loneliness as key risk factors that affected the rates of cognitive decline in the older population during the COVID-19 pandemic. The study was observational in nature and therefore causality cannot be inferred, but it would be of interest to elucidate some of the potential biological mechanisms involved in these associations.  

Alcohol intake and lack of exercise could have direct effects on psychological wellbeing and cognitive function; for example, alcohol can inhibit the communication between nerve cells and suppress the activity of excitatory nerve pathways. Unhealthy lifestyles are linked to oxidative stress, which is recognised as a contributing factor in ageing and in the development of neurodegenerative diseases, including Alzheimer's disease.  

However, such lifestyle factors could also mediate direct associations between depression, loneliness, and cognitive decline—for example, depression and social isolation could lead to an increase in alcohol consumption and sedentary behaviour, consequently influencing the rate of cognitive decline through systemic inflammation or reduced mental and social engagement. Longer periods of follow-up—in addition to the availability of key data from before, during, and after the pandemic—are necessary. The wealth of longitudinal cohort studies of ageing in the UK could help to provide some of the necessary answers.  

Looking back, COVID-19 has revealed the astonishing vulnerability of our societies, but also the lack of strategy and organisation from so many governments worldwide, and our shared fragility when confronted with infections. Older people (aged ≥50 years) with cardiovascular disease and complex comorbidities have almost double the risk of being infected with SARS-CoV-2 compared with those without chronic conditions.  

Let us remind ourselves that COVID-19 is not a thing of the past, but a reality for which we must continue to adapt and prepare.

How covid-19 spreads: Narratives, counter narratives, and social dramas

Via The BMJ: How covid-19 spreads: narratives, counter narratives, and social dramas. The key points:

• A flawed narrative that SARS-CoV-2 was transmitted by droplets rather than being airborne became entrenched early in the pandemic 

• Measures aimed at an assumed droplet pathogen (handwashing, surface cleansing, physical distancing) were over-emphasised 

• Measures to reduce airborne transmission (improving indoor air quality, reducing indoor crowding and time spent indoors, and high-grade respiratory protection) were under-emphasised 

• UK policy makers seemed to favour narratives from a narrow group of scientific advisers 

• Consequences included care home deaths, mission critical delays in public masking, and avoidable infections of healthcare workers

The impact of the global COVID-19 vaccination campaign on all-cause mortality

Via NBER: The Impact of the Global COVID-19 Vaccination Campaign on All-Cause Mortality. The abstract:

The global COVID-19 vaccination campaign is the largest public health campaign in history, with over 2 billion people fully vaccinated within the first 8 months. Nevertheless, the impact of this campaign on all-cause mortality is not well understood. 

Leveraging the staggered rollout of vaccines, we find that the vaccination campaign across 141 countries averted 2.4 million excess deaths, valued at $6.5 trillion. We also find that an equitable counterfactual distribution of vaccines, with vaccination in each country proportional to its population, would have saved roughly 670,000 more lives. 

However, this distribution approach would have reduced the total value of averted deaths by $1.8 trillion due to redistribution of vaccines from high-income to low-income countries.

Cambodian man dies from H5N1 avian flu

Thanks to FluTrackers for alerting me to this story. Via Barrons, an AFP report: Cambodian Man Dies From Bird Flu.

A 50-year-old man has died from bird flu in Cambodia, the health ministry said on Sunday, the second death from the virus recorded in the country this year.  

The World Health Organization has called for vigilance after bird flu was detected in mammals, but has stressed that the risk to humans is low.  

The ministry said that tests had confirmed the man -- who has not been named, but is from eastern Svay Rieng province bordering Vietnam -- was positive for bird flu virus H5N1 from October 7.  

Officials did not specify the man's time of death, but said health authorities are "investigating and researching this bird flu case".  

The disease typically spreads from birds to humans through direct contact.  

Officials said they were looking into the source of the infection, and were examining any suspected cases or people who may have been in contact with the victim.  

The ministry said around 50 poultry, some belonging to the man and some owned by his neighbours, had died recently.  

"The dead chickens were shared among villagers to eat," the health ministry statement said.  

The ministry urged villagers to be vigilant about H5N1, which is "still a threat to the health of people, especially children".  

The case is the 58th recorded instance of bird flu since the virus hit Cambodia two decades ago. In February an eleven-year-old girl died from the virus.  

Since late 2021, Europe has been gripped by its worst-ever outbreak of bird flu, with North and South America also experiencing severe outbreaks.  

This has led to the culling of tens of millions of domestic poultry worldwide, many with the H5N1 strain. The global outbreak is also responsible for the deaths of tens of thousands of wild birds.  

The recent detection of the disease in a number of mammals, including foxes, otters, minks, sea lions and even grizzly bears, has sparked concern that humans could be more at risk.

Cambodian man dies from H5N1 avian flu

Thanks to FluTrackers for alerting me to this story. Via Barrons, an AFP report: Cambodian Man Dies From Bird Flu.

A 50-year-old man has died from bird flu in Cambodia, the health ministry said on Sunday, the second death from the virus recorded in the country this year.  

The World Health Organization has called for vigilance after bird flu was detected in mammals, but has stressed that the risk to humans is low.  

The ministry said that tests had confirmed the man -- who has not been named, but is from eastern Svay Rieng province bordering Vietnam -- was positive for bird flu virus H5N1 from October 7.  

Officials did not specify the man's time of death, but said health authorities are "investigating and researching this bird flu case".  

The disease typically spreads from birds to humans through direct contact.  

Officials said they were looking into the source of the infection, and were examining any suspected cases or people who may have been in contact with the victim.  

The ministry said around 50 poultry, some belonging to the man and some owned by his neighbours, had died recently.  

"The dead chickens were shared among villagers to eat," the health ministry statement said.  

The ministry urged villagers to be vigilant about H5N1, which is "still a threat to the health of people, especially children".  

The case is the 58th recorded instance of bird flu since the virus hit Cambodia two decades ago. In February an eleven-year-old girl died from the virus.  

Since late 2021, Europe has been gripped by its worst-ever outbreak of bird flu, with North and South America also experiencing severe outbreaks.  

This has led to the culling of tens of millions of domestic poultry worldwide, many with the H5N1 strain. The global outbreak is also responsible for the deaths of tens of thousands of wild birds.  

The recent detection of the disease in a number of mammals, including foxes, otters, minks, sea lions and even grizzly bears, has sparked concern that humans could be more at risk.

Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada

Via CMAJ: Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada. The abstract:

Background: Increased rates of pediatric eating disorders have been observed during the COVID-19 pandemic, but little is known about trends among adults. We aimed to evaluate rates of emergency department visits and hospital admissions for eating disorders among adolescents and adults during the pandemic.  

Methods: We conducted a population-based, repeated cross-sectional study using linked health administrative data for Ontario residents aged 10–105 years during the prepandemic (Jan. 1, 2017, to Feb. 29, 2020) and pandemic (Mar. 1, 2020, to Aug. 31, 2022) periods. We evaluated monthly rates of emergency department visits and hospital admissions for eating disorders, stratified by age.  

Results: Compared with expected rates derived from the prepandemic period, emergency department visits for eating disorders increased during the pandemic among adolescents aged 10–17 years (7.38 v. 3.33 per 100 000; incidence rate ratio [IRR] 2.21, 95% confidence interval [CI] 2.17–2.26), young adults aged 18–26 years (2.79 v. 2.46 per 100 000; IRR 1.13, 95% CI 1.10–1.16) and older adults aged 41–105 years (0.14 v. 0.11 per 100 000; IRR 1.15, 95% CI 1.07–1.24). Hospital admissions for eating disorders increased during the pandemic for adolescents (8.82 v. 5.74 per 100 000; IRR 1.54, 95% CI 1.54–1.54) but decreased for all adult age groups, especially older adults aged 41–105 years (0.21 v. 0.30 per 100 000; IRR 0.72, 95% CI 0.64–0.80).  

Interpretation: Emergency department visits for eating disorders increased among adolescents, young adults and older adults during the pandemic, but hospital admissions increased only for adolescents and decreased for all adult groups. Differential rates of acute care use for eating disorders by age have important implications for allocation of inpatient mental health resources.

COVID-19 Epidemiological Update - 29 September 2023

WHO has published COVID-19 Epidemiological Update - 29 September 2023. Click or tap through to download the full report. The overview:

Globally, the number of new cases decreased by 55% during the 28-day period of 28 August to 24 September 2023 as compared to the previous 28-day period, with over 685 000 new cases reported. The number of new deaths decreased by 34% as compared to the previous 28-day period, with over 1900 new fatalities reported. As of 24 September 2023, over 770 million confirmed cases and over 6 million deaths have been reported globally. 

 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).

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