H5N1

Launch of Scenario Hub projecting future COVID-19 health impact

Via ECDC: Launch of Scenario Hub projecting future COVID-19 health impact.

A new online modelling hub launched today, the European COVID-19 Scenario Hub, will present modelling projections on how the COVID-19 pandemic may evolve in terms of cases, hospitalisations and deaths. It will serve as a resource for Member States in their pandemic planning and inform decisions aimed at minimising the expected burden caused by COVID-19 under different scenarios.  

The hub is developed and run by the European Centre for Disease Prevention and Control (ECDC) in co-operation with the Centre for Mathematical Modelling of Infectious Diseases (CMMID) at the London School of Hygiene & Tropical Medicine (LSHTM).  

“The Scenario Hub will help inform public health preparedness and anticipatory action as Europe transitions into new phases of the pandemic,” said Andrea Ammon, ECDC Director. “It will also play a key role in supporting ECDC's risk analysis, assessment of public health advice and strategic planning.”  

Sebastian Funk, Professor of Infectious Disease Dynamics at LSHTM, said: “Exploring plausible scenarios for the future of the COVID-19 pandemic can provide valuable insights for planning purposes. This Scenario Hub will bring together the expertise of different modelling teams to help policymakers come to informed decisions.”  

The Scenario Hub will be updated by collating long-term modelling scenarios for thirty EU/EEA Member States, the UK and Switzerland. Each potential scenario is composed of one or more plausible and policy-relevant variables (which could be, for example, biological parameters such as the rate of waning immunity, or assumed future changes in contact behaviours). Scenarios cover a period of nine to twelve months, including the coming winter period. Instead of just using single projections, the hub combines and compares different modelling projections from different modelling teams across Europe. The hub can thus contribute to increased confidence and robustness of drawn conclusions and insights.   

Scenario modelling combines the best-available epidemiological evidence with realistic assumptions on key uncertainties in order to create future trajectories of relevant indicators. From this, rational policies can be adopted at an early stage. Comparing results contributed by different modelling teams can highlight important parameters, assumptions and sources and the magnitude of their uncertainty, that would otherwise be difficult to capture.  

The Scenario Hub builds on the success of the European COVID-19 Forecasting Hub that was launched in early 2021 and continues to combine short-term forecasts on the number of COVID-19 cases, hospitalisations and deaths. The Scenario hub will complement the Forecasting hub with more long-term projections submitted by modelling teams in academic- and public health institutes across Europe and the USA. 

Visit the European Covid-19 Scenario Hub

Medical associations confront Canada's healthcare crisis

Via Medscape.com: Medical Associations Confront Canada's Healthcare Crisis. Excerpt:

The Canadian healthcare system has reached a breaking point and requires immediate and long-term changes to prevent a total collapse, according to new recommendations from three of the country’s top medical associations.  

The Canadian Medical Association, Canadian Nurses Association, and College of Family Physicians of Canada developed an action plan to rebuild the healthcare workforce, reduce burnout, and retain healthcare workers who have felt strained for more than 2 years.

“We’ve really seen the challenges in the healthcare system brought much more to the forefront during the pandemic. It’s reaching a level of crisis that we’ve not seen before,” Katharine Smart, MD, president of the Canadian Medical Association, told Medscape Medical News.  

“We’re hearing daily from people across the country about how bad things are,” she said. “From primary care to hospitals to specialists, everything is starting to implode.”  

The organizations presented the policy recommendations to the House of Commons’ Standing Committee on Health and the federal/provincial/territorial Committee on Health Workforce in April. The action plan was published on the organizations’ websites on May 16.  

Collaboration and Support  

The Canadian healthcare system was struggling before the COVID-19 pandemic, the authors wrote. For more than 2 years now, healthcare workers have tried to keep the system from buckling under the strain.  

Now healthcare workers are burning out and leaving the industry, which has pushed the system to a tipping point, they wrote. Healthcare professionals are facing massive patient backlogs and cannot provide the care that is needed.  

“We’ve spent the last several months raising awareness of how dire things are,” Smart said. “Canadians have pride about our healthcare, but it idealizes our system and gets in the way of being realistic about what’s happening.”  

The Canadian Medical Association, Canadian Nurses Association, and College of Family Physicians of Canada developed health human resources solutions to address the healthcare workforce in a “proactive and sustainable way,” she said. The plan offers immediate, medium, and long-term policy recommendations for the federal government to adopt and share with provinces and territories.

ECDC risk assessment: Monkeypox multi-country outbreak

ECDC has published Risk assessment: Monkeypox multi-country outbreak. Click or tap through to download the full report. The executive summary, with my bolding:

Key messages  

Monkeypox (MPX) does not spread easily between people. Human-to-human transmission occurs through close contact with infectious material from skin lesions of an infected person, through respiratory droplets in prolonged face-to-face contact, and through fomites. The predominance, in the current outbreak, of diagnosed human MPX cases among men having sex with men (MSM), and the nature of the presenting lesions in some cases, suggest transmission occurred during sexual intercourse.  

Based on ECDC’s epidemiological assessment, the likelihood of MPX spreading in persons having multiple sexual partners in the EU/EEA is considered high. Although most cases in current outbreaks have presented with mild disease symptoms, monkeypox virus (MPXV) may cause severe disease in certain population groups (young children, pregnant women, immunosuppressed persons). However, the likelihood of cases with severe morbidity cannot be accurately estimated yet. The overall risk is assessed as moderate for persons having multiple sexual partners (including some groups of MSM) and low for the broader population.  

Treatment is mainly symptomatic and supportive, including prevention and treatment of secondary bacterial infections. Smallpox vaccine can be considered for post-exposure prophylaxis of close contacts at increased risk for severe disease, however careful benefit/risk assessment should be performed for the exposed individual. Important information on the use of currently available smallpox vaccines is missing for groups at increased risk for severe disease. In addition, antivirals are potential treatment options for severe cases.  

EU/EEA countries should focus on prompt identification, management, contact tracing and reporting of new MPX cases. Countries should update their contact tracing mechanisms, their diagnostic capacity for orthopoxviruses and review the availability of smallpox vaccines, antivirals and personal protective equipment (PPE) for health professionals.  

An interim case definition is proposed for case reporting. Guidance for the management of MPX cases and close contacts is also included. Cases should remain isolated until their rash heals completely, avoiding contact with immunosuppressed persons and pets. Abstaining from sexual activity and close physical contact is also advised until the rash heals. Most cases can remain at home with supportive care.  

Close contacts of MPX cases should self-monitor for the development of symptoms up to 21 days from the last exposure to a case.  

Healthcare workers should wear appropriate PPE (gloves, water-resistant gown, FFP2 respirator) when screening suspected cases or caring for a MPX case. Laboratory personnel should also take precautions to avoid occupational exposure.  

Close contacts of a MPX case should be deferred from blood, organ or bone marrow donations for a minimum of 21 days from the last day of exposure.  

Proactive risk communication and multiple community engagement activities should be carried out to increase awareness, provide updates and guidance to those at increased risk and the wider public. Risk communication messages should stress that MPXV is spread through close contact between people, especially in the same household, potentially including the sexual route. A balance should be kept between informing those most at risk but also communicating that the virus does not spread easily between people the risk to the broader population is low.  

There is a potential risk of human-to-animal transmission in Europe, therefore close intersectoral collaboration between human and veterinary public health authorities working from a ‘One Health’ perspective is needed to manage exposed pets and prevent the disease from being transmitted in wildlife. EFSA is not aware to date of any reports on infections in animals (pets or wild animals) in the EU.  

Several unknowns still exist regarding this outbreak and ECDC will continue to monitor developments closely and update the risk assessment as new data and information become available.

WHO: Multi-country monkeypox outbreak in non-endemic countries

WHO has published Multi-country monkeypox outbreak in non-endemic countries. Click or tap through for the full report including tables, a map, and many links. Excerpt:

Outbreak at glance                   

Since 13 May 2022, cases of monkeypox have been reported to WHO from 12 Member States that are not endemic for monkeypox virus, across three WHO regions. Epidemiological investigations are ongoing, however, reported cases thus far have no established travel links to endemic areas. Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics.  

The objective of this Disease Outbreak News is to raise awareness, inform readiness and response efforts, and provide technical guidance for immediate recommended actions.  

The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries. Immediate actions focus on informing those who may be most at risk for monkeypox infection with accurate information, in order to stop further spread. Current available evidence suggests that those who are most at risk are those who have had close physical contact with someone with monkeypox, while they are symptomatic. WHO is also working to provide guidance to protect frontline health care providers and other health workers who may be at risk such as cleaners. WHO will be providing more technical recommendations in the coming days.   

Description of the outbreak  

As of 21 May, 13:00, 92 laboratory confirmed cases, and 28 suspected cases of monkeypox with investigations ongoing, have been reported to WHO from 12 Member States that are not endemic for monkeypox virus, across three WHO regions (Table 1, Figure 1). No associated deaths have been reported to date. 

Reported cases thus far have no established travel links to an endemic area. Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics.  

To date, all cases whose samples were confirmed by PCR have been identified as being infected with the West African clade. Genome sequence from a swab sample from a confirmed case in Portugal, indicated a close match of the monkeypox virus causing the current outbreak, to exported cases from Nigeria to the United Kingdom, Israel and Singapore in 2018 and 2019.  

The identification of confirmed and suspected cases of monkeypox with no direct travel links to an endemic area represents a highly unusual event. Surveillance to date in non-endemic areas has been limited, but is now expanding.  WHO expects that more cases in non-endemic areas will be reported. Available information suggests that human-to-human transmission is occurring among people in close physical contact with cases who are symptomatic.

Ebola in Mbandaka: Death of a 4th confirmed case

Via Radio Okapi: Ebola in Mbandaka: death of a 4th confirmed case. The Google translation, with my bolding:

The fourth confirmed case of the Ebola virus disease died on Friday May 20 in Mbandaka. This is the fourth recorded since the outbreak of the epidemic on April 21. He was discovered on Thursday in the Maman Balako health area, Wangata health zone and commune.  

Only 24 hours after his discovery, the patient died, after having dragged around the community for a long time without proper care.  

Medical sources claim that the victim was a 12-year-old child in the Maman Balako health area. Since May 14, he had been developing symptoms of Ebola, including fever, fatigue, blackish vomit.  

For five days, he was cared for at home, until Thursday, May 19; date on which he was taken to a medical center in the Mbandaka II district. The results of the analysis of the samples taken on the same day from the child were found to be positive for the Ebola virus disease.  

But the family resisted and brought the child home on Thursday evening, where he passed away on Friday morning.  

Sources add that another 9-year-old child died with the same symptoms, in the same neighborhood, on May 6 and buried, without post-mortem collection or a dignified and secure burial. This raises fears of a multiplication of cases.  

The response teams are preparing for the decontamination of different places, through which the deceased child passed. They seek the cooperation of the populations around the case and in the health area concerned.  

They also invite the inhabitants to appropriate all the preventive measures recently enacted by the provincial authority, in order to avoid a large-scale spread of the disease. Among these measures, there is a compulsory post-mortem sample before any burial of bodies in the city.

World in no better place to fight pandemics than before COVID

Via Reuters: World in no better place to fight pandemics than before COVID - review. Excerpt:

LONDON, May 18 (Reuters) - The world is no better prepared for a new pandemic than it was when coronavirus emerged in 2019 and may actually be in a worse place given the economic toll, according to a panel set up by the World Health Organization (WHO) to evaluate the global response.  

A lack of progress on reforms such as international health regulations means the world is as vulnerable as ever, the Independent Panel for Pandemic Preparedness and Response said in its report.  

The authors, led by former New Zealand prime minister Helen Clark and former president of Liberia Ellen Johnson Sirleaf, acknowledged some progress, including on more robust funding for the WHO, but said the process was going far too slowly.  

"We have right now the very same tools and the same system that existed in December 2019 to respond to a pandemic threat. And those tools just weren't good enough," Clark told reporters.  

"If there were a new pandemic threat this year, next year, or the year after at least, we will be largely in the same place ... maybe worse, given the tight fiscal space of many, if not most, countries right now."  

Wednesday's report comes ahead of next week's World Health Assembly in Geneva, the WHO's annual decision-making forum, which is expected to address some of the issues raised.

Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study

Via The Lancet Regional Health - Americas: Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study. The summary:

Background  

Before widespread vaccination, the United States was disproportionately affected by COVID-19 with a mortality rate several times that of other affluent societies. Comparing regions with different rates of health insurance, we assess how much of this excess mortality may be due to the relatively large population without health insurance.  

Methods  

We use daily surveillance data from the US Centers for Disease Control and Prevention (CDC) stratified by region, age group, gender, and race in regression analysis of daily COVID-19 cases, hospitalization, and mortality. COVID-19 data have been matched with structural characteristics of the region including average proportion with health insurance. As checks, we have estimated regressions for different time periods, different groups of states, and by comparing adjacent counties between states with and without Medicaid expansion.  

Findings  

Groups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization. Early in the pandemic, they were also less likely to be tested for COVID-19. Applying our regression estimates, we estimate that had there been full health insurance coverage of the population, there would have been 60,000 fewer deaths, 26% of the total death toll in the period of this analysis.  

Interpretation  

Our study demonstrates that a significant share of COVID-19 mortality in the United States, and much of the excess mortality in the United States compared with other countries, is due to our reliance on a system of market-driven healthcare. Providing universal insurance coverage should be part of our campaign to reduce COVID-19 mortality. It also suggests that these concerns should not be restricted to COVID-19 but apply across all diseases, contributing to many unnecessary deaths in the United States each year even apart from the COVID-19 pandemic.

Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study

Via The Lancet Regional Health - Americas: Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study. The summary:

Background  

Before widespread vaccination, the United States was disproportionately affected by COVID-19 with a mortality rate several times that of other affluent societies. Comparing regions with different rates of health insurance, we assess how much of this excess mortality may be due to the relatively large population without health insurance.  

Methods  

We use daily surveillance data from the US Centers for Disease Control and Prevention (CDC) stratified by region, age group, gender, and race in regression analysis of daily COVID-19 cases, hospitalization, and mortality. COVID-19 data have been matched with structural characteristics of the region including average proportion with health insurance. As checks, we have estimated regressions for different time periods, different groups of states, and by comparing adjacent counties between states with and without Medicaid expansion.  

Findings  

Groups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization. Early in the pandemic, they were also less likely to be tested for COVID-19. Applying our regression estimates, we estimate that had there been full health insurance coverage of the population, there would have been 60,000 fewer deaths, 26% of the total death toll in the period of this analysis.  

Interpretation  

Our study demonstrates that a significant share of COVID-19 mortality in the United States, and much of the excess mortality in the United States compared with other countries, is due to our reliance on a system of market-driven healthcare. Providing universal insurance coverage should be part of our campaign to reduce COVID-19 mortality. It also suggests that these concerns should not be restricted to COVID-19 but apply across all diseases, contributing to many unnecessary deaths in the United States each year even apart from the COVID-19 pandemic.

COVID-19 in North Korea: Workers' Party of Korea Central Committee Politburo Conference held

Via the Korea Central News Agency: Workers' Party of Korea Central Committee Politburo Conference held. Excerpt:

The Politburo of the Central Committee of the Workers' Party of Korea convened a meeting on May 14 at the headquarters of the Central Committee of the Workers' Party of Korea to check the operation status of the maximum emergency quarantine system and to reinforce practical political measures.  

Comrade Kim Jong -un, who is the general secretary of the Workers' Party of Korea , led the council. Members of the Standing Committee of the Politburo of the Central Committee of the Workers' Party of Korea and members of the Politburo of the Party Central Committee and candidate members participated in the meeting.  

Officials from the national emergency quarantine department and senior officials from the Ministry of Health attended.  

The Politburo first listened to the report of the National Emergency Response Command on the spread of the epidemic as of May 13.  

On May 13, 174,440 new cases of fever were reported nationwide, 81,430 recovered, and 21 died.  

From the end of April to May 13, the total number of sick people nationwide was 524,440, of which 234,630 were fully recovered, 288,810 were receiving treatment, and the number of deaths so far is 27.  

In the report, data on the spread of infectious diseases by region and unit and disease course characteristics were mentioned, and in most cases, it was notified that human casualties were caused due to negligence, including drug overdose, because scientific treatment methods were not well known.  

The Politburo discussed practical political measures to quickly suppress and manage the spread of infectious diseases across the country and secure strategic initiative.

The truth about decolonising global health worth spreading

A letter in The Lancet: The truth about decolonising global health worth spreading.

With any myth about decolonising global health (as Richard Horton describes it), always question intent, dissent, lament, and discontent. Then, remember the wise words of Frederick Douglass, “power concedes nothing without a demand, it never has and it never will”.  

In the words of Chinua Achebe, we are living in a time when the “lions have their own historians”, and they have finally arrived to take the stage to tell the story of the hunt and the stories of their struggle, their own way, as history has glorified the hunter for too long. Those who stand in the way of this moral conscience are part of the problem, not the solution.  

Decolonising global health is an unconventional movement, told from the point of view of everyday people, and soaked in the struggles of their daily living, the bravery even, of the lions. The process is also so much more than a destination—it is a journey. 

I state this knowing that this movement still has struggles ahead. There is a lot of work to do before anyone or any group can claim to decolonise something as rugged and dynamic or complex as global health. This movement might not bear fruit even in one's lifetime, but at least generations will know that with global health, there was a struggle. We might fail, but at least we struggled to tell our stories, our way. This is the truth about decolonising global health worth spreading.