H5N1

Canada: When you know you've been teaching them right

Via The Globe and Mail, a report by Mark Hume: High-flying invention marks B.C. student as top science mind of his age. Excerpt:

Grade 12 is always a busy, exciting time for students but Raymond Wang has had a little more on his schedule than most. 

In addition to preparing for final exams, the St. George’s School student in Vancouver has been doing public speaking engagements, including giving a TED talk and making a presentation at the Society of Experimental Test Pilots annual symposium in the United States. 

In addition, he’s been talking with Boeing Co. and Airbus SAS about how to get aviation regulatory approval for a device he developed for a high school science fair. 

Last spring, the 17-year-old vaulted into the headlines when he won $75,000 (U.S.) and first prize at the Intel International Science and Engineering Fair, which is like the Olympics for young science students. It is the world’s largest high school science fair, and to get top prize all Mr. Wang had to do was beat out 1,700 brilliant students who had been selected from 422 science fairs in more than 75 countries. 

His idea was to make aircraft cabins healthier by improving air quality. 

“Essentially, after doing various computational and visual simulations, I designed a patent-pending device that, for the cost of about $1,000, reduces disease transmission in planes by about 55 times,” Mr. Wang said. 

He didn’t just come up with a smart idea, but he went into a lab and proved it would work. 

“I generated the industry’s first high-fidelity simulations for aircraft cabin air flow,” Mr. Wang said. “A lot of people have studied the outside of airplanes extensively, and understandably so, because the airplane has to fly. But what I’ve been able to do … after 32 different simulations, is come up with a solution [to improve air quality], economically without the need to take the whole cabin apart or spend tens of thousands of man-hours or millions of dollars.” 

Simply put, what Mr. Wang has done is figure out how, by modifying the air-circulation pattern, to isolate passengers in their own cushions of air, isolating them from the germs coughed and sneezed by fellow travellers. 

Now all he has to do, between studying for exams and finding time to hang out with friends, is get regulatory approval for the device.

Nearing triumph over Ebola?

This New York Times editorial has chosen the wrong title: Nearing Triumph Over Ebola. We don't "triumph" over any viral disease; we hold it at bay, and hope it's taught us enough to fend off the next goddam virus as well.

Guinea had every reason to celebrate Tuesday. The country where the West African Ebola epidemic began had been declared free of virus transmission. That in effect meant that the three countries hardest hit by the disease — Guinea, Liberia and Sierra Leone — had broken the chain of infections that took 11,300 lives, jumped borders and spread panic around the world. 

The announcement did not mean that the virus had fully surrendered, and indeed Liberia has twice declared the chain broken only to see the virus mysteriously reappear, and must wait until mid-January for an all-clear. 

Moreover, there is considerable work still to be done to ensure that the global health apparatus — in particular the World Health Organization — will be far better prepared to attack the next epidemic more quickly and effectively. 

For the moment, however, largely ending the transmission of a disease for which there was no vaccine and no effective treatment when the epidemic was detected in March 2014 was a major triumph for the emergency workers and medical teams, many from international organizations like Doctors Without Borders, who risked their lives to battle and finally defeat the Ebola virus. It also provided a moment to recall the suffering of those who lost their lives to the terrible infection and of the millions of their relatives, neighbors and countrymen who endured fear, deprivation and grief as the virus spread through their cities and towns. 

As Liberia’s ordeal suggests, vigilance must continue. There is growing evidence that the virus can survive in recovered Ebola victims, apparently in the eyes or the testes, and then reappear when resistance is lowered. Ebola survivors have also been found to suffer various aftereffects, including hearing loss, lethargy and depression. All this must be watched and studied, and an effective vaccine developed. 

Meanwhile, it is essential that the W.H.O., a United Nations agency, reform its policies for reacting to a disease outbreak. It was five months late in identifying Ebola as a global health emergency, and did so two months after Doctors Without Borders warned that the disease was out of control. 

Two groups of health experts, one independent and one convened by the W.H.O., have recommended various reforms the agency must undertake. Most important among these is that it ensure that it is not influenced by politics, such as pressure from officials to play down an outbreak that may affect tourism or trade, in raising international alarms. Dr. Margaret Chan, the director general of the W.H.O., has already announced some changes and has vowed to carry out other recommendations. 

Stopping the Ebola virus, despite the late start and the huge challenge of working in countries with woefully poor health systems, was an example of what the world can do once it acknowledges an emergency and provides the resources needed to save lives. The entire experience is also a clear warning of the need for significantly better preparations and procedures next time.

To which I might add this: dangerous outbreaks tend to occur in poor countries precisely because they're poor. They lack the people, the resources, the funding, the surveillance and the communication systems to smother an outbreak in the first week or two.

The rich countries, therefore, would be well advised to invest heavily in building up the healthcare systems of poor countries. If need be, do as the Cubans do and train those countries' health workers at no cost, and then ship them back to fight diseases on the front lines. If West Africa already had such health workers, it might have stopped Ebola early in 2014 and it would already be a forgotten scare.

 

But as long as we enjoy feeling superior to the poor countries, the reservoirs of disease in those countries will remain as deadly to us as smallpox was to the upper classes in Charles Dickens's Bleak House. That novel was first published in the early 1850s. 

 

The old maestro understood the social determinants of health over a century and a half ago, but we remain as obtuse about them as the ignorant, arrogant Victorians.

Brazil: Yellow fever scare is over in Rio Grande do Norte

Via the Brazilian MOH: Clarification of suspected cases in NB. Edited excerpt from the Google translation:

The Ministry of Health was notified by the State Secretariat of Rio Grande do Norte Health of a suspected case of yellow fever in the capital Natal, near the Parque das Dunas. The ministry shared the research and provided support to the health departments of the state and the municipality in conducting the case. 

The Ministry of Health classifies the case as a suspect until the conclusion of the investigation, but points out that there is no epidemiological evidence to suggest the transmission of yellow fever virus in the city. In the past six months, there have been no new reports of the disease . 

On the case under investigation, the patient had onset of symptoms (not compatible with yellow fever) on 28 June this year. She progressed to death on July 6. It is noteworthy that the patient had no travel history to an endemic area of ​​the disease. The results of laboratory tests carried out by the Instituto Evandro Chagas (IEC), in Belém do Pará, and confirmed by the Adolfo Lutz Institute (IAL), in São Paulo, suggest infection with yellow fever. The Ministry of Health was informed of the results on 22 December. However, it is still necessary to complement the investigation. 

Importantly, there have been, so far, other suspected cases in humans or non-human primates (NHP) confirmed in the state of Rio Grande do Norte and no evidence of yellow fever virus transmission in humans in Natal (RN) since 1930. 

How software developers helped end the Ebola epidemic in Sierra Leone

Via The Guardian: How software developers helped end the Ebola epidemic in Sierra Leone. Excerpt:

Little known to the rest of the world, a team of open source software developers played a small but integral part in helping to stop the spread of Ebola in Sierra Leone, solving a payroll crisis that was hindering the fight against the disease. 

Emerson Tan from NetHope, a consortium of NGOs working in IT and development, told the tale at the Chaos Communications Congress in Hamburg, Germany. 

“These guys basically saved their country from complete collapse. I can’t overestimate how many lives they saved,” he said about his co-presenters, Salton Arthur Massally, Harold Valentine Mac-Saidu and Francis Banguara, who appeared over video link. 

Tan was dispatched to Sierra Leone in October 2014 with a vague mandate: “Go there and improve things.” 

The problem that most urgently needed solving was distributing wages to healthcare workers on the frontline fighting the epidemic. 

“In the old system, nobody gets paid, for months,” Tan said, which caused multiple problems. Doctors and nurses were forced to take money from patients, he said, undermining people’s confidence in the health system at a vital time. And when healthcare workers went on strike, Ebola patients in hospital quarantines broke out in search of food, exacerbating the spread of the disease. 

When millions of dollars began pouring in from international sources, it wasn’t clear how to distribute it to the 30,000 healthcare workers needed to tackle the epidemic because until that point, payroll had been handled in cash. Tan said he was sometimes handling “kilograms of money”. 

“Sometimes I would just weigh it, because it’s easier to weigh a stack of money than to count it.” The country’s central bank at one point informed him they were going to run out of bank notes. On top of those problems, there were only eight ATMs in the entire country. 

Time was a pressing concern. A UN official told Tan: “We have a couple of months, or we’re going to lose the region.” 

To solve the problem, Massally and his team drew on existing open source software solutions for payroll management, biometrics, logistics and accounting. 

“None of this would be possible without open source software and frameworks,” Tan told the audience at the technology conference. “You could not possibly develop systems this quickly for such low amounts of money without the existence of this huge open source ecosystem.” 

The team cannibalized Sierra Leone’s existing voter registration machines to create a payroll enrollment scheme. They couldn’t use fingerprint biometrics because it would have created a cross-contaminating risk, so they used open source facial recognition software called OpenBR to enroll healthcare workers. 

Then, they developed a mobile money system, that substituted cellphone-minutes for cash, and created an automated payment system. 

They completed the core system in two weeks, going without sleep for days at a time, knowing that millions of lives depended on their work. 

"People were paid on time, 100% of the time," Tan said, "for the first time in Sierra Leone's history." As a result, people's faith in the healthcare system was restored, he said, drawing a direct link between that and the end of the Ebola epidemic.

CIDRAP: Saudi Arabia reports MERS case near recent cluster

Via CIDRAP, Jim Wappes writes: Saudi Arabia reports MERS case near recent cluster. Excerpt:

Saudi Arabia's Ministry of Health (MOH) today reported a new MERS-CoV illness in Unaizah, near a city that saw two potentially related cases in recent weeks, while a report yesterday detailed a fatal case in a pregnant woman. 

Saudi patient in critical condition 

The Unaizah case involves a 59-year-old Saudi man who is hospitalized in critical condition. He is not a healthcare worker and does not appear to have contracted the disease from another MERS-CoV (Middle East respiratory syndrome coronavirus) patient, the MOH said. 

Unaizah is located in north-central Saudi Arabia, about 200 miles northwest of Riyadh in Al-Qassim region. It lies just south of Buraidah, where officials confirmed a MERS infection in a healthcare worker on Dec 16 that was likely linked to a previous case from late November. 

The new case brings the country's MERS-CoV totals since 2012 to 1,283 cases, including 551 deaths, the MOH noted. 

After reporting 126 cases in August, 66 in September, and 24 in October, the agency confirmed only 4 cases in November and 5 so far this month. 

Pregnant woman, husband, son infected 

The case report, which appeared yesterday in Emerging Infectious Diseases, described the clinical deterioration of a 32-year-old pregnant Jordanian woman in the United Arab Emirates who sought medical care after 4 days of fever and back pain. 

She declined hospital admission at that point but returned to the emergency department 3 days later—on Nov 22, 2013—with worsening fever, cough, and shortness of breath. She said she had not travelled recently or had contact with sick people or with animals. She was admitted to the hospital with suspected pneumonia and began receiving ceftriaxone and azithromycin. 

The woman was transferred to the intensive care unit the next day after her condition worsened. She developed acute respiratory distress on Nov 24, which required mechanical respiratory and circulatory support. Oseltamivir (Tamiflu) and vancomycin were added to her regimen. 

Because of the woman's persistent state of low oxygen, her healthy baby was delivered later that day via cesarean section. The next day, real-time polymerase chain reaction testing revealed that she had MERS. 

Despite intensive therapy, the woman's condition continued to deteriorate, and she developed septic shock on Nov 27 and died on Dec 2.

It's discouraging to think that it took two years for the report on this case to see print.

Canada: Vancouver earthquake upgrades needed in hospitals, fire halls, schools and condos, says expert

Via CBC News: Vancouver earthquake upgrades needed in hospitals, fire halls, schools and condos, says expert. Excerpt:

Many Vancouver-area hospitals, fire stations, schools and apartment blocks have not been sufficiently upgraded to withstand a big earthquake, says an expert who is urging the city to upgrade a range of public buildings. 

While the province and city have poured billions into upgrading public infrastructure, including roads, bridges, tunnels, and schools, there are still big gaps, said Prof. Carlos Ventura, director of the Earthquake Engineering Research Facility at the University of British Columbia. 

"In general, we have made a lot of progress towards preparing for an earthquake," Prof. Ventura said. "But many things have yet to be done," he said.

Ventura singled out Vancouver-area hospitals and fire stations as those institutions most in need of upgrades. 

"They are essential to the community," Ventura said adding that their level of preparedness on a scale of one to 10 is less than five. 

"Many hospitals are very in need of a serious retrofit." 

Poorly constructed condos at risk 

Ventura also noted that many Vancouver apartment buildings that were constructed in the 1980s and 1990s are at risk of serious damage in a large quake. 

Many of those buildings weren't built to high standards and have already needed repairs for water leaks. 

"We have a good inventory of wood frame construction (buildings) that were very poorly built," Ventura said. "The construction practices were poor." 

Vancouver school officials, meanwhile concede that about 50 of the city's 116 schools have been identified as high risk in the event of a quake. Many may collapse.  

"We can't have our kids in unsafe schools," school board chair Mike Lombardi said. Upgrades have been done at 22 schools. And there are plans in place to retrofit another 29, Lombardi said. 

However, the Vancouver school board and province have been at an impasse over the pace and funding of school upgrades. 

The school board has complained that the province has withheld grants to pay for retrofits. The province says it's waiting for the board to complete long term upgrade plans before it will release the money.

$17 billion in seismic upgrades 

According to a provincial background paper on earthquake preparedness, B.C. has committed, or has already invested, more than $17 billion in seismic infrastructure upgrades, including more than $4 billion in new bridge and highway upgrades. 

However, not all of the money earmarked has been spent. 

For example, the Ministry of Health has committed about $3 billion over the next three years for upgrades to health centres across the province. 

St. Paul's Hospital in downtown Vancouver is slated to close down and a new facility will have up-to-date seismic design. 

Only 6 fire halls meet code 

Jonathan Gormick, a spokesperson for Vancouver Fire and Rescue Services said the city has been working to upgrade the city's 20 fire halls. Right now, just six fire halls meet the national building codes. And another two fire stations are undergoing retrofits.

Saudi Arabia: Management and long-term survival of severe MERS cases

Thanks to Greg Folkers for sending the link to this report in Respiratory Care via PubMed.gov: Acute Management and Long-Term Survival Among Subjects With Severe Middle East Respiratory Syndrome Coronavirus Pneumonia and ARDS. The abstract and then a comment:

BACKGROUND: Data on the management, clinical course, and outcome of critical patients with Middle East respiratory syndrome coronavirus are scarce. We report here our experience and long-term outcome of such patients. 

METHODS: Subjects intubated for management of ARDS from Middle East respiratory syndrome coronavirus pneumonia and ARDS during the April-May 2014 outbreak were included. Their characteristics, ICU course, management, and outcome were evaluated. 

RESULTS: Fourteen subjects, including 3 health-care workers, met study criteria. Besides 2 health-care workers, all subjects had comorbidities. Predominant symptoms were fever, cough, and dyspnea. The worst median PaO2 /FIO2 ratio of 118 post-intubation was seen on the third day, and median APACHE II score was 27. All subjects received lung-protective ventilation and 1 mg/kg/d methylprednisolone infusion for ARDS. Eleven subjects received ribavirin and peginterferon α-2a. 

Subjects had a critical ICU course and required neuromuscular blockade (n = 11; 79%), required rescue therapy for respiratory failure (n = 8; 57%), developed shock (n = 10; 71%), and required renal replacement therapy (n = 8; 57%). Declining C-reactive protein levels correlated with clinical improvement despite continued positive real-time polymerase chain reaction results. Nine subjects died in ICU. Five subjects, including 3 health-care workers, were discharged from hospital and were alive after 1 y. 

CONCLUSIONS: Middle East respiratory syndrome coronavirus pneumonia with ARDS has high mortality in subjects with comorbidities. The mainstay of treatment is meticulous ARDS management. Those who survived the acute infection and its complications remained well after 1 y in our study. The role of ribavirin and interferon warrants urgent further evaluation.

Just five survivors out of 14 cases sounds alarming, and the treatments required indicate that a critical MERS patient really is desperately ill. This is one of the few Saudi-authored MERS reports I've seen in the last three years, and I hope we see many more.

WHO Ebola sitrep, December 30: No new confirmed cases

WHO has published Ebola Situation Report - 30 December 2015, bringing a bad two years to a close with a worldwide case tally unchanged at 28,637, with 11,315 deaths. The summary:

• No confirmed cases of Ebola virus disease (EVD) were reported in the week to 27 December. On 29 December, WHO declared that human-to-human transmission of Ebola virus has ended in Guinea, after the completion of 42 days with zero cases since the last person confirmed to have EVD received a second consecutive negative blood test for Ebola virus RNA. Guinea has now entered a 90-day period of heightened surveillance. 

• Human-to-human transmission linked to the most recent cluster of cases in Liberia will be declared to have ended on 14 January 2016, 42 days after the 2 most-recent cases received a second consecutive negative test for Ebola virus, if no further cases are reported. In Sierra Leone, human-to-human transmission linked to the primary outbreak was declared to have ended on 7 November 2015. The country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016. 

• The 8th meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) regarding the EVD outbreak in West Africa took place by teleconference on 15 December 2015. Based on the advice of the Committee, the Director-General declared that the 2014–15 Ebola outbreak continues to constitute a Public Health Emergency of International Concern.  

• The most recent cluster of cases in Liberia was the result of the re-emergence of Ebola virus that had persisted in a previously infected individual. Although the probability of such re-emergence events is low, the risk of further transmission following a re-emergence underscores the importance of implementing a comprehensive package of services for survivors that includes the testing of appropriate bodily fluids for the presence of Ebola virus RNA. The governments of Liberia and Sierra Leone, with support from partners including WHO and US CDC, have implemented voluntary semen screening and counselling programmes for male survivors in order to help affected individuals understand their risk and take necessary precautions to protect close contacts. 405 male survivors had accessed semen screening services up to 27 December in Liberia and Sierra Leone. A network of clinical services for survivors is also being expanded in Liberia and Sierra Leone, with plans for comprehensive national policies for the care of EVD survivors due to be completed in January 2016. 

• In order to effectively manage and respond to the consequences of residual Ebola risks, Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD to the relevant authorities. In the week to 27 December, 933 community death alerts were reported in Guinea from all of the country’s 34 prefectures. Over the same period 9 operational laboratories in Guinea tested a total of 541 new and repeat samples (6 samples from live patients and 535 from community deaths) from only 14 of the country’s 34 prefectures. In Liberia, 611 alerts were received from all 15 of the country’s counties. The country’s 5 operational laboratories tested 469 new and repeat samples (281 from live patients and 188 from community deaths) for Ebola virus over the same period. In Sierra Leone 1226 alerts were reported in the week to 20 December (the most recent week for which data are available). 734 new and repeat samples (10 from live patients and 724 from community deaths) were tested for Ebola virus by the country’s 8 operational laboratories in the week ending 27 December. 

• The deployment of rapid-response teams following the detection of a new confirmed case continues to be a cornerstone of the national response strategy in Guinea, Liberia, and Sierra Leone. Each country has at least 1 national rapid-response team, with strengthening of national and subnational rapid-response capacity and validation of incident-response plans continuing through December and January.

Branswell: 18 must-follow Twitter accounts about health and medicine

Via STAT, Helen Branswell brings a very welcome holiday present: 18 must-follow Twitter accounts about health and medicine. Excerpt:

At this time of year, “best of” lists abound: the top-selling books; the highest-impact papers; the 10 biotech stocks that most exceeded expectations.

This is not one of those lists.

Here at STAT, we’ve compiled a list of Twitter feeds to follow for insights into the worlds of health, medicine, and science. These aren’t necessarily the biggest names in social media. Or even the most important voices. They are simply people whose tweets we value. (We’ve put all these names into a Twitter list you can follow. Please note, you must be logged into Twitter to see this list.)

Canada: Manitoba Workers Compensation Board to start recognizing PTSD in new year

Via the Winnipeg Free Press, a Canadian Press report: Manitoba Workers Compensation Board to start recognizing PTSD in new year.

Manitoba's Workers Compensation Board will soon recognize post-traumatic stress disorder as a work-related disease. 

Starting Jan. 1, anyone diagnosed by a medical professional after a traumatic event on the job will be eligible for treatment and compensation. 

Kevin Rebeck, president of the Manitoba Federation of Labour, says while it’s not a very common disease, getting people help is critical. 

Rebeck says the new legislation will hasten the process to allow people to access treatment. 

Premier Greg Selinger calls it compassionate but smart legislation.