H5N1

Belluz: What the dip in US life expectancy is really about: Inequality

In Vox.com, Julia Belluz has a must-read report: What the dip in US life expectancy is really about: inequality. Click or tap through for the full article with excellent links, tables, and graphs. Excerpt:

Living in the US increasingly looks like a health risk. Average life expectancy in the country dropped for the third year in a row, according to recent data from the Centers for Disease Control and Prevention. That’s the longest downturn since the Spanish flu wiped out more than 50 million people a century ago. 

The grim trend stems from a toxic mixture of more drug- and alcohol-related deaths and more suicide in many parts of the country. And it puts Americans at a higher risk of early death compared to their counterparts in other wealthy countries. 

But what’s often lost in the conversation about the uptick in mortality in the US is that this trend isn’t affecting all Americans. In fact, there’s one group in the US that’s actually doing better than ever: the rich. While poor and middle-class Americans are dying earlier, the wealthiest among us are enjoying unprecedented longevity. 

So when we talk about life expectancy slipping, what we should also talk about is the growing problem of health inequality in America. And it’s an increasingly urgent discussion, health researchers are warning, because of policy changes on the horizon that are poised to make the mortality gap even wider. 

Some of these policies will hamper access to medical care (such as rescinding funding for CHIP, the health insurance program for low-income children) but others that aren’t even directly related to health care, like tax cuts, may have even more insidious effects on the American mortality gap. 

America’s alarming life expectancy gap 

The rich have long enjoyed more longevity than the poor, but the gap in life expectancy has been widening in the US over the past few decades, along with other types of social and income inequality.  

The CDC’s Division of Vital Statistics, which tracks mortality in the US, uses death certificates as the data source and doesn’t collect family income data. But we do have good data on the mortality gap and income from a study published in JAMA in 2016. 

A group of researchers, led by Stanford University economist Raj Chetty, analyzed income data for the US population from 1.4 billion tax records between 1999 and 2014. They then compared it with mortality data from Social Security Administration death records. They found that, from 2001 to 2014, the richest Americans gained about five years of longevity, while life expectancy for the poor didn’t budge.

7.0 magnitude earthquake rocks Southcentral Alaska

Via KTVA in Anchorage: 7.0 magnitude earthquake rocks Southcentral. Excerpt:

A 7.0 magnitude earthquake hit Southcentral at 8:29 a.m. Friday. It was 25 miles deep. Aftershocks of 5.7 magnitude and 4.1 magnitude followed, along with more smaller quakes.   

The State Of Alaska Division of Homeland Security and Emergency Management are advising that an aftershock larger than the original earthquake could happen this afternoon.

Alaska Gov. Bill Walker has issued a declaration of disaster and says he is in direct contact with the White House, according to a post on his official Facebook page.       

Anchorage's Mayor Ethan Berkowitz declared a local state of emergency Friday morning, following Gov. Bill Walker's disaster declaration at the state level. 

Service members at Anchorage’s Joint Base Elmendorf-Richardson were accounting for personnel and assessing any damage on base, according to a statement. They were also “preparing to provide emergency support to the base populace and the community as needed.”  

Preliminary reports gauged the quake at 6.6 magnitude centered 10 miles outside of Anchorage. 

See also these reports in The Guardian and The New York Times.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri at Friday, November 30, 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri at Friday, November 30, 2018. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday, November 30, 2018   

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

• Since the beginning of the epidemic, the cumulative number of cases is 428, including 380 confirmed and 48 probable. In total, there were 248 deaths (200 confirmed and 48 probable) and 131 people cured. 

• 66 suspected cases under investigation. 

• 1 new probable case (historical death) identified in Katwa. 

º This is the index case of the cluster of confirmed cases in a family in the health zone of Katwa, reported on 20/11/2018. 

• 1 new case confirmed in Beni. 

• 2 new deaths in Beni. 

• 5 new healed people, including 4 exits from the CTE of Beni and 1 from the CTE of Butembo. 

• 1 new person healed out of Butembo CTE.

  

 /! \  The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas. 

News of the response

 Awareness raising for people living with a disability 

• This Friday, November 30, 2018, an awareness session on the Ebola virus disease was organized for people living with a disability in Beni. Around 50 representatives of people with disabilities, including the blind, deaf-mute and the physically challenged, took part in this activity. The sensitization focused on the prevention, the modes of contamination, the vaccination, the dignified and safe burial, and the removal of the reluctances within the community. A second session will be organized for about fifty other representatives living outside the city of Beni.   

Vaccination 

• Since vaccination began on 8 August 2018, 38,018  people have been vaccinated , including 17,808 in Beni, 5,348 in Katwa, 4,544 in Mabalako, 3,130 in Butembo, 1,828 in Kalunguta, 1,663 in Mandima, 732 in Masereka, 521 in Oicha, 475 in Vuhovi, 434 in Bunia, 431 in Mutwanga, 355 in Tchomia, 241 in Kyondo, 240 in Komanda, 234 in Musienene, and 34 in Alimbongo.

Finland: About 100 exposed to measles from one case

Via Yle Uutiset: Friday's papers: Measles case, Tallinn rail tunnel and sauna benefits.

A pre-school aged child in Ostrobothnia has contracted measles and has thereby exposed about a hundred other people to the highly contagious disease, reports daily Helsingin Sanomat. 

Based on information from the National Institute of Health and Welfare (THL), people exposed in the municipality of Luoto include the child’s family and relatives. In addition, the unvaccinated pre-schooler had spent time in daycare, the emergency unit of the Kokkola hospital and a religious gathering, HS writes.  

According to Mia Kontio from the THL, it is difficult to estimate the exact number of people exposed because the size of the religious event, for example, is not known.  

"However, new infections are possible, because the child has been in the same space with other unvaccinated people,” Kontio said.  

The child had recently traveled abroad and likely contracted the disease occurred there, HS speculates.  

Annika Saarikko, Minister of Family Affairs and Social Services, urged mothers and fathers to trust medical experts and Finland’s vaccination programme. 

“Parents refusing to immunise their children make a choice not only for their child, but also for those who cannot get the vaccine due to health reasons, for example," Saarikko said. 

She said she considers the case in Luoto particularly serious, because the region suffers from a lower-than-average vaccination coverage.

“To minimise the risk of a disease spreading, the vaccination coverage needs to be at about 95 percent. This area does not benefit from that.”  

The THL said it will continue to map out those persons possibly exposed to measles in the Luoto area, HS writes.

MSF: Gazans’ injuries risk permanently shattering lives

Via MSF.org: Gazans’ injuries risk permanently shattering lives. Excerpt:

A slow-motion healthcare emergency is unfolding in Gaza as the cumulative needs of patients shot by the Israeli army and seriously injured during protests mount.  

The vast majority of the 3,117 patients treated by MSF between 30 March and 31 October – out of the total 5,866 the Ministry of Health says have been injured by live fire – had been shot in the leg. Around half suffered open fractures, with severe soft tissue damage to many of the rest.   

These are complex and serious injuries that do not quickly heal. Their severity and the lack of appropriate treatment in Gaza’s crippled health system means that infection is a high risk, especially for patients with open fractures. 

Gaza currently lacks the ability to properly diagnose bone infections, but from experience MSF expects that at least 25 per cent of patients with fractures are infected. Out of roughly 3,000 open fractures, this means it is likely that more than 1,000 patients are infected. 

Based on a preliminary analysis of MSF’s patients in Gaza, we estimate that at least 60 per cent of the total number of injured patients treated by all health providers – a massive 3,520 people – will need further surgery, physiotherapy and rehabilitation.  

A significant proportion of those patients will require some form of reconstructive surgery to properly heal, but untreated infections will prevent that from happening.  

This burden is too much to bear for the health system in Gaza in its current form, weakened as it is by more than a decade of blockade. 

Such a large number of injuries affects not just the injured; it also puts a strain on the provision of regular healthcare in Gaza.  

The consequences of these wounds – especially if untreated – will be lifelong disability for many, and if infections are not tackled then the results could be amputation or even death.

Although MSF and other organisations are working hard to provide treatment for these patients, the scale of the needs is quickly becoming overwhelming, challenging our continued ability to respond. 

The situation is also worsening as more people are shot, wounded flesh and bone dies, and the risk of infection increases. 

An adequate response will cost tens of millions of euros – money that urgently needs to be found. 

“MSF has already tripled its capacity in Gaza but the required volume of surgery, carefully managed antibiotics, intensive nursing care, and long-term physiotherapy and rehabilitation is staggering,” said Marie-Elisabeth Ingres, MSF’s head of mission in Palestine.  

“This many patients would overstretch the best healthcare systems in the world. In Gaza, it is a crushing blow."

Excess winter deaths in England and Wales highest since 1976

Via The Guardian: Excess winter deaths in England and Wales highest since 1976. Excerpt:

There were 50,100 excess deaths in England and Wales last winter, when there was a prolonged spell of extreme cold, making it the highest number since 1976, figures have shown.  

The Office for National Statistics said flu and the ineffectiveness of the flu vaccine were key reasons for the rise of excess winter deaths in 2017-18.  

The deaths occurred during the NHS’s most serious “winter crisis” for many years. A lack of staff and beds meant all types of health services, particularly hospitals, were unable to cope with both the number of patients needing treatment and the severity of many of their conditions.  

Women and people aged over 85 were among those most likely to die last winter, although the rate of winter deaths among males aged up to 64 doubled in just a year, the ONS found. A third of the deaths were due to serious breathing difficulties, including flu, asthma and bronchitis.  

The 50,100 excess deaths were about 15,000 (45.1%) more than those that occurred in 2016-17 and double the total in 2015-16. 

Nick Stripe, a specialist in health analysis and life events at the ONS, said: “It is likely that last winter’s increase was due to the predominant strain of flu, the effectiveness of the influenza vaccine and below-average winter temperatures.”  

Doctors and groups representing older people said too little was being done to keep older people warm and safe, and to give the NHS the resources it needs. 

Caroline Abrahams, Age UK’s charity director, said: “A toxic cocktail of poor housing, high energy prices and ill-health can make winter a dangerous time for many older people, and tragically it is the oldest and those who are the most vulnerable who particularly suffer the consequences. 

“Last winter, there were nearly 46,000 excess winter deaths among people aged 65 and over – a shocking 92% of all excess deaths – equating to 379 older people a day. These distressing figures are now the highest we’ve seen in over 40 years.”

BUTEMBO: About 30 media facilitators on good communication skills to eradicate Ebola

Via Radio Moto Butembo-Beni: BUTEMBO: About 30 media facilitators on good communication skills to eradicate Ebola. The edited Google translation:

A meeting was held in this regard on Thursday, November 29, 2018. The International Committee of the Red Cross, IARC, the Butembo Red Cross in collaboration with WHO have maintained journalists, animators and producers of programs on the disease. The subject was Ebola virus and communication in crisis. One of the meeting rooms at the Joli Rêve Welcome Center served as the setting for the meeting.  

Frank from the ICRC sensitized participants on "Community Engagement and Rescue". He showed that the involvement of each member of society in the communication of preventive measures of a certain crisis situation is a duty for the well being of all. 

He acknowledges, however, that the community is slowly becoming aware of the existence of the epidemic.  

"There are fake messages circulating in the community. Some communities are already engaged. Today the community is slowly understanding. It is, itself, defining what is true and what is false. Which obviously allows them to engage. Because we had areas where we did not have access, and where we could not even set foot. Today we have access to these areas thanks to the commitment of these communities," he said.  

WHO's Barry Rodrigue reinforced this message by outlining ways the media should follow to promote health. He recommended the self-information of the media presenters on a crisis occurring elsewhere in his community as a means of prevention.  

Rodrigue warned against the spread of rumors and false information especially during the period of response to a crisis. After the crisis, society and its leaders should ultimately develop recovery strategies for members of society, at least those who have lost theirs. It was from this angle that the speaker asked everyone to console the victims and not to give them speeches that remind them of the misfortunes they have experienced.

As Ebola outbreak worsens, health experts urge Trump administration action

Via PBS.org: As Ebola outbreak worsens, health experts urge Trump administration action. Excerpt:

“It is in U.S. national interests to control outbreaks before they escalate into a crisis,” one group of global health experts wrote in a commentary in the Journal of the American Medical Association. A separate one in the New England Journal of Medicine said: “Given the worsening of the outbreak, we believe it’s essential that these security concerns be addressed and that CDC staff return to the field.” 

It is not clear how many Centers for Disease Control and Prevention workers are now trying to tackle the outbreak from Congo’s capital, Kinshasa, which is nearly 1,000 miles (1,600 kilometers) away.

A State Department official said that CDC experts — and those with the U.S. Agency for International Development, who are also affected by the order — are still working closely with international partners to stop the outbreak. 

There was no immediate comment from the CDC to the commentaries.

The security concerns are real, Ebola responders say. Teams with the WHO and Congo’s health ministry venture out on virus containment missions accompanied by U.N. peacekeepers or other armed security in areas where gunfire echoes daily.  

Given the complications, this Ebola outbreak will last at least another six months before it can be contained, WHO emergencies chief Dr. Peter Salama has predicted.  

Despite the challenges, Ebola health workers have made breakthroughs that have given new hope in the fight against one of the world’s most notorious diseases. More than 37,000 people have received Ebola vaccinations and Congo has begun the first-ever trial to test the effectiveness and safety of four experimental Ebola drugs. 

Speaking to The Associated Press on Friday from the outbreak zone, the Ebola response program director for the International Rescue Committee, Dr. Stacey Mearns, said the absence of the CDC’s experts can be felt acutely. Her colleague, Dr. Mesfin Teklu Tessema, the IRC’s senior health director, was among the more than two dozen people who signed the statement published in JAMA on Thursday. 

“If the (U.S.) ban were not in place, the CDC would have a big and growing presence here,” said Mearns, who worked closely with the CDC in West Africa’s Ebola outbreak. The U.S. sent thousands of responders to West Africa from the CDC and other government agencies, including the military. 

The CDC’s experts have rich experience in surveillance, treatment and lab testing, Mearns said, adding that some of that work is now being done from afar. 

“We haven’t seen the height of this outbreak,” she warned as Ebola moves into new areas in Congo that are worrying close to a heavily traveled border with Uganda. “If want to see the end of this, we do need all critical actors on the ground.”

ECDC: CDTR, week 48

ECDC has published Communicable disease threats report, 25 November-1 December 2018, Week 48. The abstract:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 25 November-1 December 2018 and includes updates on West Nile virus, Ebola virus disease, influenza, cholera and influenza A(H5N6).

DRC: Ebola outbreak becomes second most dangerous in the world

Via Actualite.cd: DRC: Ebola outbreak becomes second most dangerous in the world. Excerpt from the Google translation:

The current Ebola outbreak in the provinces of North Kivu and Ituri, where 245 people died in the 426 cases, has become the second largest Ebola outbreak in the world. 

This Friday, November 30, the Minister of Health, Oly Ilunga said, "The epidemic in North Kivu has become the second largest Ebola epidemic in the world, after that of West Africa."  

The deadliest epidemic to date was in West Africa in December 2013, and lasted more than two years, killing more than 11,300 people out of 29,000 reported cases. 

The second largest epidemic, the current epidemic is the "first epidemic in history in which so many preventive and curative treatments are available to protect the population against Ebola.These treatments have allowed us to avoid having already thousands of cases and deaths," added the minister. 

This epidemic, which is raging in an area facing armed conflict, also exceeds that which struck Uganda for the first time in September 2000. In five months, 425 people contracted the virus, which killed 224 people.  

"This shows that Ebola is above all a disease with a social dimension, and beyond the medical response, it is up to the community to decide to stop the spread of this scourge by committing itself and respecting prevention," notes the health authority of the DRC. 

Declared since 1 August 2018, the current epidemic remains dangerous and unpredictable, according to the authorities, 87 suspected cases under investigation. A massive malaria campaign was launched in Beni, the epicenter of the Ebola outbreak.

For four days, the campaign aims to "distribute free insecticide-treated mosquito nets" and anti-malaria drugs, one of the world's leading causes of death. Up to 50% of people who arrive at the Ebola Treatment Center (ETC), who are "considered to be suspected cases, actually suffer from malaria, whose initial symptoms are similar to those of the virus disease Ebola," according to the health audience.