H5N1

WHO update on MERS in South Korea

WHO has published Middle East respiratory syndrome coronavirus (MERS-CoV) – Republic of Korea. Excerpt:

Situation in Korea Between 27 and 30 June 2015, the National IHR Focal Point of the Republic of Korea notified WHO of 1 additional confirmed case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) alongside 2 additional deaths. 

Additional information on the outbreak in Korea 

To date, a total of 182 MERS-CoV cases, including 33 deaths, have been reported. One of the 182 cases is the case that was confirmed in China and also notified by the National IHR Focal Point of China. 

The median age of the cases is 55 years old (ranging from 16 to 87 years old). The majority of cases are men (60%). Twenty-six cases (14%) are health care professionals. To date, all cases (excluding the index case) have been linked to a single chain of transmission and are associated with health care facilities. 

Detailed information concerning MERS-CoV cases in the Republic of Korea can be found in a separate document (see related links). 

Public health response 

The government of the Republic of Korea continues to implement intense case and contact management activities. As of 30 June, 2,638 contacts are being monitored while a total of 13,354 contacts have been released. 

From July 3 to July 14, the city of Gwangju will host the 2015 Summer Universiade (the World University Games). To support the safe and successful hosting of the event, on June 29, the head of the Infectious Disease Management division of the Korean Centers for Disease Control and Prevention established in Gwangju a MERS response & support task force. On the same day, health care workers in the hospitals of the athletes’ village and approximately 200 stadium stewards were trained in the use of fever detectors and educated on how to respond to the occurrence of a suspected MERS-CoV case.

Ebola in Liberia: More on the new case

Via Ebola Deeply ,a June 30 report: Setback for Liberia as Corpse Tests Positive for Ebola.

Health officials on Tuesday confirmed that the dead body of a 17-year-old student from Nedowein, close to Liberia's international airport, has tested positive for Ebola. The news breaks Liberia's good record of zero Ebola cases since early March; the country was declared Ebola-free on May 9, exactly 42 days after the last case. 

"We don't yet know the source of infection," Tolbert Nyenswah, who heads Liberia's Ebola response, told Ebola Deeply. "We are investigating whether the boy had traveled, and we are listing contacts. The boy died at the home of his father, and we are providing the household and community with the support that's needed. It is possible that we will find additional cases, but at this point it is only one case."

About 30 contacts are believed to be under surveillance so far, and the nearest Ebola treatment center, in Margibi County, has been reopened. The boy's parents are believed to be separated, so at least two homes have been quarantined. 

An Ebola Deeply reporter who visited Nedowein on Tuesday afternoon, where the 17-year-old boy died, said the village had not yet been fully cordoned off. Nedowein - far from the borders with Guinea and Sierra Leone - skirts the community of Smell-No-Taste, so called because it once housed a U.S. military community known for cooking pungent dishes. 

Liberia's health minister Bernice Dahn said that officials were alerted when relatives called the Ebola hotline soon after the boy's death. A swab was taken from the boy's body on June 28, and a safe burial was conducted on the same day.  

"This case demonstrates the importance of testing dead bodies before burial," Dahn said. "It also shows that our alert system is working. For us to be successful during the last outbreak, we all worked together; the formal sector and the informal sector. We did it before, so we can do it again." 

Although many of Liberia's Ebola treatment units (ETUs) have been shut down since May 9, Nyenswah said that they have not all been decommissioned. 

"We tested the corpse and we reactivated the ETU. Before, this kind of intervention would have taken a week or two, but we acted within 24 hours this time," he said. "The surveillance system is working. We are disappointed because we wanted to keep our clean sheet of Ebola freedom. [But] we have the energy and the capacity to contain this." 

Many Liberians say they are concerned that the country has kept its borders with Guinea and Sierra Leone open, despite active cases of Ebola there. At least four new cases have been recorded in Sierra Leone since last Thursday, and 32 health workers are currently under quarantine at a Freetown hospital after a woman tested positive after giving birth. 

"Why are the borders still open?" asked Josephine Flomo, from Monrovia, who lost her brother-in-law to Ebola. "There are many unofficial and official crossing points from Liberia to Guinea and Sierra Leone. We are afraid that another case could come by land." 

But Nyenswah said Liberian authorities plan to keep borders open in order to allow trade and free movement. Temperature checks are enforced at major crossing points. 

"Border closure is not an option," he said. "We have not established whether or not this case came from across the border."

Liberia: Was new Ebola case contracted from dog meat?

Via FrontPageAfrica: Ebola Mystery: Dog Meat Story Eclipses Border Lapse Theory. Excerpt:

The source of Liberia’s new confirmed case of the deadly Ebola virus remains unknown with the professed strong surveillance network of the Ministry of Health unable to identify any clue since the death of patient zero on June 27, nearly a week ago. Liberia was officially declared Ebola free on May 9 by the World Health organization with assurances from officials of the Ministry of Health that the right system has now been put in place to quickly detect any new emergence of the killer virus. 

More than 11,000 people have died of the disease since December 2013, the vast majority of them in Liberia, Guinea and Sierra Leone. But it has all turned out to be a hectic task for the country as the source of the virus which was confirmed positive in the specimen of a 17 year old boy who died before his status was known remains unknown. 

According to Assistant Minister of Health for Curative and Preventive Services, Deputy Minister Designate of the Ministry of Health for Surveillance and Disease Control they are conducting investigation as there is no trace of the deceased travel outside Liberia prior to his death. “We know the community where the case came from but what we don’t know is the epic link or chain of transmission and we don’t also know the source of transmission. This is what we are investigating”, said Neynswah. 

Dog meat eating 

While the Ministry of Health is still sweating over finding out the source of the new Ebola case, in the village of Nedowein in Margibi County, some 30 miles from the capital, Monrovia, villagers are confused same as health officials, as a team of health workers from the Ministry of Health, the African Union Ebola mission (ASEOWA) all gathered on the main motor road in front of the village. 

A team of FrontPageAfrica reporters visiting the area of the latest casualty noticed several jeeps and officials from the U.S. Center for Disease Control and the African Union monitors in chatters with residents as they sought to get to the bottom of how Ebola clawed its way back to Liberia. 

In the village, what appears to be the inability of the government to provide essential information on the source of the virus has now led to speculations with news that the deceased and others ate a rotten dog meat. According to sources in the village the 17-year old boy along with others exhumed the body of dead dog that had been buried and used it for meal. 

Although animals to human transmission is one major source of the deadly virus but domestic animals such as dog are yet to be established as one of the modes of transmission of Ebola. In its effort to trace the source of the virus the Ministry of Health looks to be heavily relying on the dog eating news from villagers. Accordingly a friend to the deceased also a teenager has fallen sick after eating the dog meat along with his late friend and others. A pregnant woman who is believed to have cooked the dog is also said to be sick. 

Fear grips C. H. Rennie Hospital 

In Kakata, Margibi County at the C.H. Rennie Hospital, the only referral in the county, specimen from a suspected patient was transferred to the Bong County Ebola laboratory for testing, a senior nurse at the hospital confirmed to FrontPageAfrica Tuesday morning. On Tuesday, fear gripped workers at the hospital with Ebola preventive measures reintroduced especially thorough screening of people entering and leaving the hospital with nurses were suited in their Personal Protective Equipment. 

Angeline Kollie, a 23 year-old practicing nurse expressed fear over the suspected case observed at the hospital and said she hopes it proves negative. 

“I pray to God for it to be negative because we know what Ebola did to this country, we don’t want it to come back”, she said. The practicing nurse said although they are aware of the preventive measures, but Ebola is normally very difficult to put under control.

South Korea reports no additional cases of MERS for fourth straight day

Via Yonhap News: S. Korea reports no additional cases of MERS for fourth straight day. The full report and then a comment:

No additional cases of Middle East Respiratory Syndrome (MERS) have been found in South Korea over the past four days, the health ministry said Wednesday, indicating the outbreak may be nearing its end. 

The number of people diagnosed with the disease here has remained unchanged since Saturday at 182, according to the Ministry of Health and Welfare. 

Also, no additional MERS-related deaths were filed over night, with the death toll standing at 33, unchanged from the previous day. 

In addition to the country seeing no additional fatalities and infection cases, two more people previously diagnosed with MERS have been discharged following complete recoveries, the ministry said. 

Out of the 182 diagnosed with the disease, 97 have fully recovered while 52 still remain hospitalized. 

South Korea confirmed its first outbreak of the viral respiratory disease on May 20. 

Ministry officials said no additional cases over the past four days may indicate that the spread of the disease is now on the wane. 

However, they noted the country was still far away from being able to declare an end to the outbreak as the country still has over 2,000 suspected cases. 

As of Wednesday, 2,451 people were in isolation, mostly at their own homes, for possible infection after coming in close contact with MERS patients. The number dropped from 2,638 on the previous day. 

There currently is no vaccine or treatment for the disease that is still fairly new to humans. The disease carried a high fatality rate of over 40 percent until the outbreak here. 

In South Korea, the fatality rate of the disease remains at 18.1 percent.

When this outbreak is indeed over, the South Koreans may want to have a quiet word with the Saudis and Gulf Arabs. MERS has been a distressing, embarrassing, and very expensive episode for South Korea, entirely the result of a disease the Arabs have largely ignored when they might have studied it, learned how to suppress it, and thereby spared their trade partners (and their own people) a lot of grief.

No doubt South Korea and other Asian nations rely on Saudi oil to some extent, but at some point even cheap oil becomes too expensive. Quiet words from South Korea, Thailand, Malaysia, India, Bangladesh, Pakistan, China, and the Philippines might just achieve what medical advice has so far failed to do: Get the Saudis and Gulf Arabs to take responsibility for a disease that should have been stamped out long before now.

Cholera eradication in Haiti will take ‘some years,’ says outgoing UN coordinator

Via ReliefWeb, a report from UN News Service: Cholera eradication in Haiti will take ‘some years,’ says outgoing UN coordinator. Excerpt and then a comment:

While some 16,000 new cases of cholera have been reported in Haiti so far this year, the disease is now under control but it will not be eradicated unless improving water and sanitation conditions are given a higher priority by both the Government and donors, says the outgoing United Nations official tasked with leading the response to the outbreak. 

“And in today’s world, in the 21st century, it’s not acceptable to have this huge number of cases of cholera,” Pedro Medrano Rojas said in an interview with the UN News Service, as he wrapped up his assignment as UN Senior Coordinator for the Response to Cholera in Haiti. 

Any country with this number of new cases of cholera would declare it an “emergency,” added Mr. Medrano, who served in the post for two years. 

“This is what we are trying to convey to donors and to the international community” so that they will contribute more towards the eradication of the largest epidemic in the Western Hemisphere. Currently, only about 20 per cent of the $2.2 billion needed for the 10-year national plan to eliminate cholera is available. 

Mr. Medrano, who has been responsible for strengthening overall coordination among UN entities and mobilizing a coherent and effective response by the international community, recalled that in the 1990s there had been an outbreak of cholera in the Latin American region that started in Peru. It had taken almost 10 years to eliminate cholera at that time. 

Comparing the water and sanitation infrastructure in the 20 countries in the region that were affected back then, where over 80 per cent of people had access to water and adequate sanitation, Mr. Medrano noted that “Haiti has a third of that.” 

“So we need to do a robust investment in water, sanitation and health, and this takes time,” he said. 

“So we have to be able to treat the cases, the emergency response, and we can control it and save lives. But what is really important is to have the infrastructure – in water and sanitation in particular – which has not been the priority of the international community for many decades.”

Note that clean water and sanitation are said not to have been "the priority of the international community for many decades"—because for many decades, the priority of the Haitians has been irrelevant to those making decisions about Haiti.

Ever since Haiti's slaves liberated themselves, the white nations of Europe and North America have treated with a mix of contempt and fear. The French had the chutzpah to charge the Haitians for kicking them out of the country, as the price of resuming even marginal trade.

 

Then the Americans took charge, treating Haiti to periodic occupations by the Marines until that became politically inconvenient and homegrown stooges like Duvalier pere et fils would no longer serve.

 

When a serious, democratically elected president took power in Haiti, the US arranged his ouster and then bullied the UN into doing the Marines' dirty work by sending in a "peacekeeping" force—as if Haiti's internal quarrels were like those of Greeks and Turks over Cyprus. Well, it was doubtless cheaper to import Uruguayans and Brazilians than to plunk still more Marines in the country.

 

But bringing in the Nepalis also brought in Nepal's cholera, with which Haiti is now saddled indefinitely. The UN has of course denied all responsibility, adding deliberate insult to accidental injury. It severely compromised its own health agency, WHO, as complicit in a politically motivated public-health disaster. 

 

When you think about it, WHO got off lightly for its cowardly silence about Haiti. But Haiti helped create the internal culture at WHO that was slow to react to Ebola in West Africa. And that slowness was disastrous for WHO's reputation.

 

Health catastrophes like cholera and Ebola tend to happen in poor countries. Poor countries tend to be black countries. Funding for such catastrophes comes from rich white countries—which really don't like black countries very much, but sometimes enjoy playing Lady Bountiful by tossing pennies to the beggars.

 

If WHO really represented the vast nonwhite majority of the UN's member states, it would have blown the whistle on the UN and the Americans over Haiti's cholera. It would have blown the whistle on the West African Ebola nations, instead of waiting for MSF to kick ass and take names.

 

But just as West African burial culture promotes the spread of Ebola, WHO's political culture promotes recurrent outbreaks of disease with no solution but to whine while thrusting a beggar's bowl into the face of Lady Bountiful.

 

Haitians will go on drinking shit in their water for generations before Lady Bountiful either pays for sanitation or allows the Haitians to do it themselves.

South Korea: Emergency room culture is blamed for MERS spread

Via JoongAng Daily, a July 1 report: Emergency room culture is blamed for MERS spread. Excerpt:

Security personnel stood guard at Seoul National University Hospital’s emergency ward on Thursday, checking visitors’ body temperature and medical histories before they entered. 

The emergency room had fewer patients than before the outbreak of Middle East respiratory syndrome (MERS), but it was still hard to find people in urgent need of medical treatment. Most of the patients on Thursday were getting intravenous injections or appeared to have slight coughs. 

“My left thigh was swollen when I woke up,” said Kang Su-cheol, 81. “It didn’t hurt much but I came here because I don’t need any sort of complicated treatment.” 

Kang was not even ushered into a doctor’s office, but instead given an IV with antibiotics in the waiting room. 

“I came here because I was sick and felt nauseous this morning,” said Kim Gyeong-sun, 61, who visited the emergency room with her husband. 

She talked to a doctor for just three minutes before being given a prescription. 

Doctors there acknowledged that most of the patients in the emergency room were not urgent cases. 

“Some are fine enough to drive to the hospital,” said a professor in the emergency medicine department. “Others are even here for the morning-after pill.” 

According to Seoul National University Hospital, 18,957 people visited its emergency room from January to May this year, and about 80 percent were not urgent cases. 

And many experts believe that the main reason why MERS was able to spread so quickly here is directly related to emergency room culture in the country. 

“People across Korea just go to emergency rooms at large hospitals in Seoul if they need treatment,” said Choi Jae-wook, an official from the Korean Medical Association. “And they crowd the emergency room while waiting their turns.” 

In an analysis by the Ministry of Health and Welfare, 24 percent of some five million patients at 141 emergency rooms nationwide in 2013 were not in need of urgent medical treatment. 

This trend was even more prominent at Korea’s top five hospitals, with many patients going to the emergency room for treatment without first seeking out assistance at smaller hospitals or clinics. 

The ratio of the number of patients to emergency room beds stood at 175.2 percent at Seoul National University Hospital; 144 percent at Samsung Medical Center; 110.8 percent at Seoul St. Mary’s Hospital; 105.5 percent at Severance Hospital and 103.8 percent at Asan Medical Center. 

Those numbers mean that even those in serious condition must wait longer to receive treatment. 

Among Korea’s 20 most crowded hospitals, average waiting time for those in need of urgent care was about 14.5 hours. 

Analysts say that type of culture at emergency rooms was what allowed MERS to spread to more than 80 patients at Samsung Medical Center. 

“Patient No. 14 stayed in the emergency ward for three days before being hospitalized at Samsung Medical Center,” said Professor Eom Joong-sik, an infectious disease specialist at Hallym University Medical Center and a member of the government’s MERS countermeasure headquarters’ immediate response team. 

“Hospitals are now more vulnerable to infectious diseases because emergency rooms have become like waiting rooms for those who are hoping to be hospitalized.”

Branswell: Canadian military medical staff end Ebola mission

Via The London Free Press, Helen Branswell of The Canadian Press writes: Canadian military medical staff end Ebola mission. Excerpt:

A six-month mission that sent Canadian Armed Forces medical personnel to West Africa to help with the Ebola response has wound up, the federal government announced Tuesday. 

The Canadian military doctors, nurses, medics and support staff have been working at a British-run Ebola treatment unit at Kerry Town, in Sierra Leone. With a marked drop in new cases, the British government informed Canada it no longer needs additional assistance to run the unit. 

"I would like to thank the Canadian Armed Forces personnel for their efforts to help contain the Ebola virus in Sierra Leone," Defence Minister Jason Kenney said in a statement announcing the end of Operation Sirona. 

"The military component of Canada's response to this epidemic has been instrumental in our whole-of-government approach to alleviate the human suffering the Ebola virus has caused in West Africa." 

The unprecedented outbreak, centred in the West African countries of Guinea, Sierra Leone and Liberia, is believed to have started in late December 2013. Since then there have been over 27,500 cases -- which is more than 10 times the number of all known Ebola cases recorded before this outbreak. 

The outbreak has claimed more than 11,000 lives. 

Health-care workers -- whose contact with Ebola patients always places them at high risk during outbreaks -- have been particularly hard it. The most recent figures from the World Health Organization suggest at least 872 health-care workers have been infected in this outbreak and 507 have died. 

It was to address the needs of that specific population that the Kerry Town treatment unit was opened. The facility, located about 30 kilometres south of Sierra Leone's capital, Freetown, was established to provide high quality care for health-care workers -- local and international -- who contracted Ebola. 

Most foreign countries, however, have chosen to fly their citizens home for care if they became infected while working in the Ebola hospitals of West Africa. 

The first contingent of Canadians -- drawn from the Canadian Forces Health Services Group -- arrived in Sierra Leone on Dec. 30, 2014, after spending several weeks in Britain learning how to safely care for Ebola patients. Three waves of personnel were sent on the mission, deploying for roughly 60 days each time. 

A total of 79 medical and support personnel from the Canadian Armed Forces took part in Operation Sirona.

Belluz: Why Greece's financial crisis is a health crisis too

Julia Belluz at Vox.com has an important article: Why Greece's financial crisis is a health crisis too. Excerpt (but read the whole thing):

Greece's crisis isn't only an economic one; it's a health crisis, too. 

Athina Tatsioni sees it every day at the University Hospital of Ioannina, where she is an emergency-room doctor. When she started in 2009, there was a maximum of 280 patients per day. Now, she and her colleagues are overwhelmed by more than 600 patients a day. Many have lost their health insurance with their jobs and can't afford to pay for care. They show up with late-stage disease, leaving serious conditions like diabetes untreated until they can't live another day without seeing a doctor. 

"There are days when we see several patients in a row, and they all come for similar complaints — chest tightness, headaches. We run all the tests, and we find nothing," she told Vox. "And then they start talking about their personal life: how they lost their job, their financial difficulties." 

To meet their needs, Dr. Tatsioni now works double shifts — 16 hours as opposed to eight — every other day. And she wonders how she'll keep it up. Not only is the pace exhausting, but there are drug and medical supply shortages that have made it increasingly difficult to deliver the kind of care her patients need. She says she now has to worry about whether she'll have the basics to help her patients: saline, antibiotics, painkillers. 

No other country in Europe has felt a greater shock from the global economic crisis than Greece. That shock has also impacted Greek health. Over the last five years, cuts in public spending have had a devastating impact on the medical system — with lasting effects on public health. 

1) Suicides are on the rise 

Historically, Greece had one of the lowest suicide rates in the world. But it's not unusual for suicides to spike when an economy dips, and Greece has experienced what is the most extreme fallout from the global financial crisis compared with any European country. 

Sadly, Greece is now recording the concomitant suicide trend. "The passage of new austerity measures in June 2011 marked the beginning of significant, abrupt and sustained increases in total suicides and male suicides," a 2015 BMJ Open study on the question reads. 

In 2012, Greece recorded its highest months of suicide in 30 years. Overall, since 2011, suicides increased by 36 percent. Other population surveys have tracked increases in the prevalence of major depression. 

"As future austerity measures are considered," the BMJ authors warned, "greater weight should be given to the unintended mental health consequences of these measures." 

2) Health-care budgets have been slashed 

Since 2008, federal spending on hospitals dropped from 6.3 percent to 3.9 percent of GDP. Hospitals have had to slash their budgets by as much as 50 percent, firing staff, cutting back on testing and supplies, and abstaining from hiring new doctors to replace those who have retired. According to the Financial Post, "This has far outpaced the rate of economic contraction, where output has shrunk by a Depression-era 25 per cent." 

One UK doctor, who was recently working in Greece, said the conditions in Greek hospitals rivaled those of developing countries: 

The moment the hospital doors open on ‘emergency’ days, people flood in. The collapse in official primary and community health care services means everyone who needs healthcare comes to A+E — whether for a major accident, medication for a long term condition or to get their child immunized. Staff told me that serious trauma cases often have to wait hours for X-rays and treatment due to understaffing and that, if too many cases come in at the same time, people die before they can be treated. 

Recent studies have found that doctors are routinely experiencing shortages of medical supplies they need to do their job, and doctors are also experiencing burnout. 

Cost cutting has also eroded health coverage. Because health care in Greece is linked to social security plans or employment status, government cuts and rising unemployment levels have increased the number of people without health insurance.

It goes on, and it gets worse.

ECDC: 18th rapid risk assessment on MERS

ECDC has published Rapid risk assessment: Severe respiratory disease associated with Middle East respiratory coronavirus (MERS-CoV), 18th update. Click through to download the PDF. The abstract:

​This update was prompted by the epidemic of confirmed MERS cases reported from South Korea in light of an upcoming international sports event (Universiade), as well as the identification of a travel-related MERS case in Thailand.

Liberia quarantines area where new Ebola case appeared

Via The New York Times, an Associated Press report: Liberia Quarantines Area of Where New Ebola Case Appeared. Excerpt and then a comment:

Liberian authorities on Tuesday quarantined the Nedowein area where the corpse of a 17-year-old boy was found with Ebola, sparking fears this West African country could face another outbreak of the disease nearly two months after being declared Ebola-free. 

"Liberia has got a re-infection of Ebola," Tolbert Nyenswah, deputy health minister and head of Liberia's Ebola response team, told The Associated Press. 

The boy died at his home and was buried safely to avoid spread of the disease, said Nyenswah. Nedowein is close to the country's international airport, about 30 miles (48 kilometers) south of the capital, Monrovia. 

Teams are investigating how the boy became infected, Nyenswah said. The area is not near Liberia's borders with Sierra Leone and Guinea, neighboring countries that still have Ebola cases. 

The World Health Organization declared Liberia Ebola-free on May 9, after it went 42 days without a new case. Liberia had been hardest hit before by the outbreak with a death toll of more than 4,800 people. 

This is the only known case in Liberia now, said Nyenswah. 

The boy died on June 28 and was buried that day, said Nyenswah, correcting his earlier statement that he died on June 24. 

Figures for the number quarantined would be available later, and food is being sent to those homes, he said.

This case appears to have caught everyone off guard. Helen Branswell and Kai Kupferschmidt have engaged in a Twitter conversation that's more informative than either the Liberian ministry of health or WHO. (WHO has just posted an update on Ebola numbers, but still has Liberia at May 9.) Margibi County is just a few kilometers southeast of Monrovia, and far from the famously porous borders with Sierra Leone and Guinea.