H5N1

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.