H5N1

Indonesia: Update on the Sulawesi earthquake and tsunami

Via ReliefWeb, a report from the ASEAN Coordinating Centre for Humanitarian Assistance: AHA Centre Situation Update No. 2: M 7.4 Earthquake and Tsunami, Sulawesi, Indonesia - Sunday, 30 September 2018, 17:00 hrs (UTC+7). The highlights:

a. On Friday (28/09) at 13.59 hrs, an earthquake with a strength of 5.9 SR and updated to 6.0 SR Lok: 0.35 LS, 119.82 BT (The epicenter was at land 61 km north of Palu), Depth: 10 km shook the Kab. Donggala, Prov. Central Sulawesi. Earthquake with magnitude 7.7 magnitude strength which is then updated by BMKG to magnitude 7.4 shook the Palu City and Donggala, Central Sulawesi at 17:02 hrs causing more damages. Earthquake epicentre was recorded at 10 km depth, 27 km northeast of Donggala, Central Sulawesi. 

b. Tsunami struck Talise beach in Palu City and beaches in Donggala and some settlements and buildings on the beach. Assessment and data collection on the number of victims are still underway. 

c. According to the population census data of 2010, 1,536,367 are potentially affected by this event across 6 regencies and 85 districts. Initial reports (as at 30 September) have estimated 832 casualties with over 540 injuries and 29 missing across 934 affected villages. There are currently over 16,732 displaced persons being housed with 24 evacuation sites. Note that this figures are still expected to rise. Currently, 264 bodies have been recovered with 87 disaster victims being identified by National Police. 

d. A total of 170 aftershocks has occurred after the Donggala M 7.4 earthquake as at 30/9/2018 at 00:00 (UTC+7). The conditions of Palu and Donggala City are pitch black as electricity is still out and fuel is scarce. According to the population census data of 2010, 1,536,367 are potentially affected by this event across 6 regencies and 85 districts. Initial reports have estimated 384 casualties with over 300 injuries. Rapid assessment is currently underway. 

e. Current immediate needs preliminarily identified are: 

I. Search and Rescue 

II. Food, ready-to-eat meals and public kitchens to support dietary needs 

III. Fuel needs - damaged Fuel terminal facilities have disrupted supply affecting logistics 

IV. Body bags for disaster victims and disaster victim identification 

V. Medical supplies 

VI. Psycho-social support 

f. Based on the ASEAN’s Joint Disaster Response Plan (AJDRP), the potential basic needs identified are: 

I. Food (ready-to-eat meals) which are halal certified 

II. Water, Sanitation and Hygiene (WASH) 

III. Primary healthcare including first aid and psycho-social support 

IV. Nutrition needs 

V. Medicines 

VI. Feminine hygiene kits 

VII. Non-food items

EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu on Sunday, September 30, 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola epidemic in the province of North Kivu on Sunday, September 30, 2018. Some of it makes discouraging reading. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF NORTH KIVU 

Sunday, September 30, 2018   

The epidemiological situation of the Ebola Virus Disease  dated September 29, 2018: 

• A total of 159 cases of haemorrhagic fever were reported in the region, of which 127 confirmed and 32 probable. 

• Of the 127 confirmed, 72 died and  45 are cured. 

• 13 suspected cases are under investigation. 

• 1 new confirmed case in Beni, who died shortly after arriving at the Ebola Treatment Center (ETC) 

• 1 new probable case in Beni, who is a contact of the last confirmed case but who died a day earlier and was buried by his family in an unsecured way.

  

Remarks: 

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The probable case category includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

News of the response     

Press conference in Beni 

• The coordinator of the response, Dr. Ndjoloko Tambwe Bathe, held a press conference this Sunday, September 30, 2018 in Beni. He returned to the impact of the dead city days on the activities of the response:  

º The contact follow-up coverage rate increased from 98% to less than 50% during the dead-city days. 

º There has been a slowdown in active case-finding in health facilities and in the community due to lack of team mobility. 

º There has been a slowdown in monitoring activities at ports of entry and a disruption of water supply at some ports of entry. 

º No vaccination activity for 3 days and poor follow up of people already vaccinated. 

º No samples were collected or analyzed on the 25th of September. 

º Failure to respect the principle that all households and health facilities through which positive cases have been passed must be disinfected within 24 hours. 

º Non-supply of inputs and protective equipment for health care providers and patients in facilities where positive cases have been passed. 

º Difficulty distributing hand washing kits in schools. 

º No awareness activities or psychological support sessions could be organized. 

• The coordinator insisted that the stigmatization of the population in Beni must be stopped. Contrary to what is often repeated in the media, the population of the city has been very cooperative with the teams of the response. This collaboration is to be commended and encouraged. More and more contacts are voluntarily registering with vaccination teams, patients voluntarily present themselves to the CTE when they become ill, and bereaved families call emergency teams to proceed with the dignified and secure burial of their patients. close deceased. The cases of resistance in the city of Beni are actually concentrated around one or two families that caused the spread of the epidemic in Butembo and Tchomia. This is why it is important for the whole community to be involved in stopping the spread of the disease. 

Vaccination 

• Since the beginning of vaccination on August 8, 2018, 12,940  people have been vaccinated , including 4,193 in Mabalako, 3,958 in Beni, 1,632 in Mandima, 1,143 in Katwa, 944 in Butembo, 270 in Masereka, 230 in Tchomia, 220 in Bunia, 164 in Komanda, 121 in Oicha and 65 in Kinshasa (medical staff to deploy).

UK: Laughing, crying, and worrying about the NHS

Via The New Yorker, a must-read article about former doctor Adam Kay and his book This is Going to Hurt, about his time in the National Health Service: Laughing, Crying, and Worrying About the N.H.S. Excerpt:

The success of “This is Going to Hurt” has coincided with a period of deep anxiety about the future of Britain’s health service. The N.H.S. was founded, seventy years ago, in 1948, as part of the new society that emerged after the Second World War. Since then, its fortunes have served as a kind of E.C.G. for the country’s political and economic health. Under Tony Blair’s New Labour government, the N.H.S. received huge increases in funding—between 2000 and 2010, spending rose by ninety-two per cent—and was subjected to an array of reforms. There were missteps but waiting times fell, and health outcomes improved. 

Under the austerity program of Conservative-led governments since 2010, however, the N.H.S. has suffered. Spending has never actually fallen (this year, it will surpass a hundred and twenty-five billion pounds for England alone), but the budget has not kept up with the inexorable needs of an aging population, the rise of chronic conditions such as obesity and diabetes, and the cost of increasingly personalized care. Since 2014, the N.H.S. has been attempting to reform itself for the twenty-first century and save money at the same time—a project that appears impossible.

Last winter, faced with the predictable, seasonal surge in demand for treatment in the nation’s hospitals and emergency rooms, the N.H.S. in England more or less fell over. In January, twenty hospitals declared “black alerts”—discharging patients whose lives were not in danger and cancelling tens of thousands of operations. 

The writer James Meek chronicled the disaster in a twenty-one-thousand-word essay for the London Review of Books: “Between them, the hospitals in Worcester and neighbouring Redditch had to divert emergency patients elsewhere at least 65 times. At Derriford Hospital in Plymouth, staff were stretched so thin they were unable to take breaks. Memos between managers at Southmead Hospital in Bristol in early January, leaked to the local press, warned that beds were ‘104 per cent full.’ ” 

The winter passed, but the sense of an ongoing crisis has not. Doctors, nurses, and administrative staff are all leaving the N.H.S. and not being replaced. Last week, with winter approaching again, workforce figures revealed vacancies for eleven thousand five hundred doctors and forty-two thousand nurses across the system. Nine per cent of N.H.S. posts are currently unfilled. “Widespread and growing nursing shortages now risk becoming a national emergency,” the King’s Fund, the nation’s leading health think tank, reported. 

“It is much worse now than it was when my book ended,” Kay told me. Nonetheless, his diary conveys the sense of working in a monumental, maddening machine. The N.H.S. is by far Britain’s largest employer, with one and a half million staff members. Employees are bound by outdated hierarchies and quixotic management targets. Its I.T. failures are legion: Kay’s e-mail address, given to him on his first day at work, was [email protected]. (“It’s good to know that no matter what happens today, nobody could accuse me of being the most incompetent person in the hospital.”) 

Every year, on the same day, junior doctors in the N.H.S. move to a new hospital, an administrative nightmare known as Black Wednesday for the accompanying rise in death rates. Doctors are buzzed throughout their shifts by beepers that give no information except an extension number to call, making it difficult to prioritize requests. 

At night, a single junior doctor, fresh out of medical school, is often given responsibility for every patient in the hospital who is not in surgery or in the emergency room. “The fucking lot of them,” Kay writes. “You’re up on the wards, sailing the ship alone. A ship that’s enormous, and on fire, and that no one has really taught you how to sail.”

See also this Guardian review of his book, which I have just bought online as a Kindle book.

DRC - Ebola: National deputy declared 'at-risk contact' (Ministry)

Via Actualite.cd: DRC - Ebola: National deputy declared "at-risk contact" (Ministry). Excerpt from the Google translation:

The Ministry of Health has just declared national deputy Crispin Mbindule, staying in his stronghold, Butembo, in the province of North Kivu, as a "risk contact".  

He was in contact with a woman whose laboratory test proved to be "positive" for the Ebola virus disease while hiding in the Furu district, north of the city, considered by the coordination of the Ebola response as the "last pocket of resistance" in Butembo. 

All members of the Furu pressure group as well as MP Mbindule, who encouraged him not to go to the Ebola Treatment Center (ETC) for treatment, were vaccinated this Saturday, September 29, 2018, announces the Ministry in a statement. 

National deputy Crispin Mbindule was among the politicians who did not believe the existence of Ebola in the region.  

Last August, UNC (Union for the Congolese Nation) MP said in the local media that the Ebola virus disease had been created in laboratories and had been moved from the Equateur province to Beni to "exterminate the population," says the Minister of Health. 

Mbindule, popular in his stronghold, had also advised against his supporters to accept vaccination. The ministry now considers the involvement of the MP and the pressure group as "a major step forward" in the social mobilization and the "lifting of the last pocket of resistance" of Butembo.

CDC estimates 80,000 Americans died of the flu last winter; Canada, 302

Via CBC News, a report by The Associated Press: CDC estimates 80,000 Americans died of the flu last winter. I have no explanation for the disparity between the American and Canadian flu deaths. Excerpt:

An estimated 80,000 Americans died of flu and its complications last winter — the disease's highest death toll in at least four decades. 

The director of the Centers for Disease Control and Prevention, Dr. Robert Redfield, revealed the total in an interview Tuesday night with The Associated Press.  

Flu experts knew it was a very bad season, but at least one found size of the estimate surprising.

"That's huge," said Dr. William Schaffner, a Vanderbilt University vaccine expert. The tally was nearly twice as much as what health officials previously considered a bad year, he said. 

In recent years, flu-related deaths have ranged from about 12,000 to — in the worst year — 56,000, according to the CDC.  

Last fall and winter, the U.S. went through one of the most severe flu seasons in recent memory. It was driven by a kind of flu that tends to put more people in the hospital and cause more deaths, particularly among young children and the elderly. 

The season peaked in early February. It was mostly over by the end of March, although some flu continued to circulate. 

In Canada, there were 302 reported deaths last season due to the flu according to the Public Health Agency of Canada's final FluWatch of the season. In comparison, there were 388 deaths reported during the 2016-17 season.

Indonesia tsunami: Death toll could reach thousands, officials say

Via The Guardian: Indonesia tsunami: death toll could reach thousands, officials say. Excerpt:

The confirmed death toll from the earthquake and tsunami that struck the Indonesian island of Sulawesi has risen to 832, and the vice-president, Jusuf Kalla, has warned it could reach into the thousands. 

More than 150 aftershocks followed the 7.4-magnitude earthquake and subsequent tsunami that hit Sulawesi on Friday, causing thousands of homes, hotels, shopping malls and several mosques to collapse.  

Of the fatalities, 821 were in the city of Palu, with 11 casualties so far recorded in Donggala, the worst-hit area, which is home to 300,000 people. Hundreds of bodies have been found on beaches and authorities fear many may have been washed out to sea. 

Speaking at a press conference, Sutopo Purwo Nugroho, the spokesman for the BNBP disaster agency, said the area affected was much bigger than originally thought.  

“The deaths are believed to be still increasing since many bodies were still under the wreckage while many have not able to be reached,” said Sutopo, emphasising that access to Donggala, as well as the towns of Sigi and Boutong, was very limited so the final death toll was impossible to predict.  

The city of Palu has been completely devastated by the earthquake and tsunami waves, which reached as high as six metres in some areas. In the city, partially covered bodies lay near the shore and survivors sifted through a tangled mess of corrugated steel roofing, timber, rubble and flotsam. One man was seen carrying the muddy corpse of a small child.  

“Many corpses are scattered on the beach and floating on the surface of the sea,” one local resident, Nining, told local media. The identified bodies are being buried in mass graves, Sutopo said. 

Sutopo confirmed there was no electricity in Palu and Donggala, while drinking water and fuel were running out. There was limited access to heavy equipment needed to help rescue efforts, so the search for people trapped in the rubble was mostly being carried out by hand.

Rescue efforts are continuing for dozens of people still trapped in the collapsed ruins of the eight-storey Roa Roa hotel in Palu, with voices heard screaming from the wreckage. “There are 50 people under the rubble of the building. Heavy equipment is needed for evacuation,” said Sutopo.  

There were concerns about the whereabouts of hundreds of people preparing for a beach festival that had been due to start on Friday, a spokesman for the BNBP said.

At least 540 people had been badly injured, the agency said, as hospitals struggled to cope with the influx of casualties, setting up open-air clinics to treat the injured. 

Dwi Haris, who suffered a broken back and shoulder, rested outside Palu’s army hospital, where patients were being treated outdoors due to the continuing strong aftershocks. Tears filled his eyes as he recounted feeling the violent earthquake shake the fifth-floor hotel room he shared with his wife and daughter. 

“There was no time to save ourselves. I was squeezed into the ruins of the wall, I think,” said Haris, adding that his family was in town for a wedding. “I heard my wife cry for help, but then silence. I don’t know what happened to her and my child. I hope they are safe.”

Powerful typhoon bears down on flood-battered Japan

Via Thomson Reuters: Powerful typhoon bears down on flood-battered Japan. Excerpt:

A powerful typhoon headed towards Japan's main island on Sunday forcing the cancellation or suspension of airline and train services and causing power outages and evacuations from areas still recovering from a typhoon last month.

Kansai International Airport in Osaka, western Japan, which was heavily flooded by a typhoon last month, said it had closed its runways from 11 a.m. (0200 GMT) on Sunday until 6 a.m. on Monday. The airport only fully reopened on Sept. 21. 

Airlines cancelled more than 1,100 flights, public broadcaster NHK said. And most of local trains and bullet trains in central and western areas suspended operations on Sunday, operators West Japan Railway and Central Japan Railway said. 

East Japan Railway said it will halt all train services in the Tokyo metropolitan area from 8 p.m. (1100 GMT) on Sunday and operations of some bullet trains were also suspended. 

Tokyo Metro announced it will suspend operation of some subway trains from 9 p.m.  

Japan issued evacuation orders and warnings to about 700,000 households in southern and western Japan and more than 300,000 households have suffered power outages in southern Okinawa and Kagoshima prefectures, said NHK, adding about 60 people had been injured in Okinawa and Kagoshima. 

A woman in her 60s went missing in Miyazaki prefecture, southern Japan, after she was washed away in a paddy irrigation channel, according to NHK. 

Japan Meteorological Agency issued warning of landslides and flooding from possible storm surges. 

Typhoon Trami, rated category 2 by Tropical Storm Risk, with category 5 the highest, is currently heading towards Japan's northeast. It will cross the islands of Kyushu and the main island of Honshu between Sunday and Monday, a path similar to that taken Typhoon Jebi early in September.

Central Sulawesi earthquake and tsunami death victims increase to 832

Via Makassar Today in Sulawesi: Central Sulawesi Earthquake and Tsunami Death Victims Increase to 832 People. Excerpt from the Google translation:

Terkini.id, Palu - National Disaster Management Agency (BNPB) on Sunday, September 30, 2018, recorded that the death toll from the earthquake and tsunami in Central Sulawesi increased to 832 people. 

The latest information was conveyed by the Head of Data and Public Relations Center at the National Disaster Management Agency (BNPB), Sutopo Purwo Nugroho.  

"Update on the impact of the disaster on the number of casualties until this afternoon at 1:00 p.m., a total of 832 people died in 821 people in Palu City and 11 people in Donggala," Sutopo said, quoted from Kompas, Sunday, September 30, 2018. 

The number of victims, said Sutopo, is likely to continue to increase because searches and evacuations continue.  

The search and evacuation process for victims today focuses on the collapsed Hotel Roa Roa, Ramayana, Talise Beach, and Balaroa housing.  

"There are an estimated 50 victims at the Roa Roa Hotel," he said. 

Sutopo said, SAR operations were not easy because of constrained power outages, lack of heavy equipment facilities, until access to the location was cut off. 

Previously, the Head of BNPB, Willem Rampangilei, said there were around 10,000 refugees scattered in 50 points in Palu City.

"They will be given assistance in shelter, food and medicine for the sick," Willem said.

Uganda: Two suspected Ebola patients isolated in Bundibugyo

Google Maps

Thanks to Mary Marshall for sending the link to this Daily Monitor report: Two suspected Ebola patients isolated in Bundibugyo. As the map shows, Bundibugyo is a short drive from Beni.

Two people who presented what looked like signs and symptoms of Ebola have been transferred to an Isolation Unit at Bundibugyo Heath Centre IV. 

“Blood samples have been taken to Kampala awaiting results,” Bundibugyo District Health Officer, Mr Majidu Bagonza told the District Ebola Preparedness Team during a meeting at the district headquarters on Friday.  

Mr Bagonza said they are still looking for two Congolese who are said to have attended the burial of an Ebola patient who died at Kasenyi on the shores of Lake Albert in the Democratic Republic of Congo, and are said to have crossed to Ngamba Sub-county in Bundibugyo District. 

“We received information from our colleagues in Ntoroko District on Wednesday that two Congolese have entered Bundibugyo. We are still following up on them such that they don’t infect our people,” Mr Bagonza said. 

Bundibugyo District being at the Uganda-DR Congo border, is among the districts on high alert following the outbreak of the disease in the neighbouring country because of its porous borders.  

The District Health Inspector, Mr Ismail Mbakania said the district Ebola Preparedness Team is mobilising and sensitising the community on the preventive measures of the deadly disease.  

The district authorities have resolved to establish a toll free line at the district headquarters and an emergency line at the district’s main hospital. 

The district authorities have also set up hand-washing facilities at the screening centres along the border points of Busunga and Butogo. 

Recent outbreak  

In 2007, Ebola outbreak struck Bundibugyo District affecting over 176 people, killing 36 people including five health workers.

Sudan: Security agencies prevent the arrival of blood donations to Kassala

Via Al-Raquba: Security agencies prevent the arrival of blood donors to Kassala. The Google translation:

The security services in the state of Al-Jazeera on Friday morning blocked the crossing of three ambulances loaded with blood donated by the people of the island in favor of Kassala without giving reasons. 

Activists in voluntary work initiatives for Dabanga radio said the amounts of blood from Khartoum and the various states to Kassala patients were running out. 

A number of families have appealed for blood donations because the Kassala Blood Bank does not accept blood donation from the city's population because of the outbreak.