H5N1

Vietnam: How the Khanh Hoa authorities are responding to the human A/H5 case

Health authorities in Khanh Hoa are evidently working hard to find the source of the fatal A/H5 influenza case. Here's another report from Khanh Hoa Online, as translated by Google:

5 samples taken from A/H5 patient's flock test negative

On the afternoon of March 22, according to the leader of the Center for Disease Control of Khanh Hoa province, the results of 5 samples taken from the poultry flock included 2 samples from the chicken flock in the patient's house and 1 sample from the duck flock 50m away from the house, 2 samples Birds in the area where the patient often visited were all negative for the A/H5 virus. Results of daily health monitoring of people in contact with the patient are stable, no suspicious symptoms of the disease have been detected.

Accordingly, the patient with CKD (21 years old, Ninh Hoa town) started the disease on March 11, with symptoms of fever and phlegmy cough. On March 15, the patient went to Ninh Hoa Town Medical Center (facility 2) for examination, was diagnosed with acute pharyngitis - laryngitis, and received outpatient treatment. On March 16, the patient had fever and fatigue so he went to the Emergency Department of Ninh Hoa Regional General Hospital with a diagnosis of intestinal infection, sepsis, and dengue hemorrhagic fever monitoring. 

On the morning of March 17, the disease became severe, the patient was transferred to Khanh Hoa Provincial General Hospital, Department of General Internal Medicine and Neurology for treatment and had samples taken to send to Nha Trang Pasteur Institute for testing. On the afternoon of March 20, Nha Trang Pasteur Institute announced that the sample results were positive for influenza A/H5, with the diagnosis: Severe pneumonia caused by influenza A/H5. The same evening, the patient was transferred to Khanh Hoa Provincial Hospital of Tropical Diseases for treatment.

As soon as they received the information, on March 20, the Provincial Center for Disease Control coordinated with Khanh Hoa Provincial General Hospital to make a list of 14 medical staff at the hospital and 6 medical staff at the Hospital. Tropical to monitor health, perform disinfection of examination and treatment areas, and transport vehicles. Make a list of the patient's family members including 4 people (mother, aunt and sister) to monitor health. 

On March 21, the Center established a working group to coordinate with Nha Trang University where the patient was studying to investigate epidemiology and implement disease prevention measures. Accordingly, at Nha Trang University, the center has compiled a list of 6 roommates and 60 students studying in the same class as the patient to conduct health monitoring. At the same time, 6 samples were taken from people living in the same dormitory room with the patient at Nha Trang University for testing, and the results were negative for influenza A; Conduct disinfection with Chloramin B in the living room and rooms in the dormitory building, recommending the school to strengthen epidemic prevention measures.

Currently, the Provincial Center for Disease Control is continuing to monitor contact and related cases on the above list; coordinate with Ninh Hoa Medical Center, Nha Trang Medical Center, Department of Livestock and Veterinary Medicine to conduct an investigation to find the source of infection. At the same time, conduct monitoring and sampling of patients with severe acute respiratory syndrome caused by viruses; Communicate to people about measures to prevent respiratory diseases and influenza transmitted from animals to humans.

Tanzania confirms first-ever outbreak of Marburg Virus Disease

Via WHO AFRO: Tanzania confirms first-ever outbreak of Marburg Virus Disease.

Brazzaville/Dar es Salaam – Tanzania today confirmed its first-ever cases of Marburg Virus Disease after laboratory tests were carried out following reports of cases and deaths in the country’s north-west Kagera region.  

Tanzania’s National Public Health Laboratory analysed samples to determine the cause of illness after eight people developed symptoms including fever, vomiting, bleeding and renal failure. Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.  

“The efforts by Tanzania’s health authorities to establish the cause of the disease is a clear indication of the determination to effectively respond to the outbreak. We are working with the government to rapidly scale up control measures to halt the spread of the virus and end the outbreak as soon as possible,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa.  

WHO is supporting the Ministry of Health to deploy an emergency team to Kagera to carry out further epidemiological investigations. The emergency team will focus on active case finding in the community and local health care facilities to identify more contacts and provide them with appropriate care.  

While Tanzania has never previously recorded a Marburg case, it has had to respond to other health emergencies including COVID-19, cholera and dengue within the past three years. A strategic risk assessment conducted by WHO in September 2022 showed that the country is at high to very high risk for infectious diseases outbreaks.   

“The lessons learnt, and progress made during other recent outbreaks should stand the country in good stead as it confronts this latest challenge,” said Dr Moeti. “We will continue to work closely with the national health authorities to save lives.”  

Marburg virus disease is highly virulent and causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Many patients develop severe haemorrhagic symptoms within seven days. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.  

There are no vaccines or antiviral treatments approved to treat the virus. However, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves likelihood of survival.

COVID-19 in South Korea, March 2022

Here's a screenshot of the Johns Hopkins dashboard taken on February 28:

South Korea then ranked 8th in case counts, with 3.273 million cases and 1,303 deaths.  But 2.228 million cases had been recorded in the preceding 28 days. Something was already going wrong in a country that had done a pretty good job through 2020 and 2021.

And here's a screenshot taken this evening, after the March 31 case counts had been posted by the KDCA:

South Korea now ranks first in the world with 13,375,518 cases, of which 16,505 resulted in death. So an advanced, prosperous nation of 52 million has seen 10,102,069 of its citizens fall ill in 31 days. As well, 15,202 of them died in the same 31 days.

And this was the result of deliberate policy, as pointed out in a devastating article in The Korea Herald today. An excerpt: 

The rationale for the omicron plan is that the intensive social distancing of the delta days is “no longer viable nor cost-efficient,” according to the Health Ministry spokesperson on March 2. And as omicron is milder, doing so would pose little threat to the population.

Similarly, Jeong Eun-kyeong, commissioner of the Korea Disease Control and Prevention Agency, said at a March 21 briefing that “as there already has been substantial exposure in the community due to omicron’s high transmissibility, controlling the outbreak with social distancing alone will have significant limits.”

But the focus on social distancing eclipses what health officials should do without having to ask people to stay home and relive the intense isolation of the early pandemic days, according to public health professor Dr. Oh Ju-hwan of Seoul National University.

By using social distancing as a “blanket term” for pandemic control measures, health officials sold people on the idea that we no longer had to sacrifice freedoms to contain the virus, he said. “The narrative that social distancing is the only approach is misleading, and it’s been used as an excuse for authorities to do less of what they ought to be doing.”

With omicron’s rise, first to be abandoned were measures that exact the most administrative burdens, like extensive contact tracing and testing that Korea had prided itself on, he said. While quick to remove the no-cost testing-for-all policy and contact tracing, health officials kept social distancing restrictions, though eased, for the public. The cap on the size of personal gatherings and nighttime curfews for stores are still in effect, though they are anticipated to be removed soon.

Google mobility trends shows movements have been on a decline in Korea after omicron took over as the dominant virus in late January. Visits to retail and recreation facilities especially have fallen considerably compared to when the delta variant was raging across the country in the fall of 2021.

“When cases soar and hospitals fill up, people exercise caution voluntarily,” Oh said. “The mobility trends data demonstrates that the surge we’re seeing now is not in fact attributable to the lack of social distancing, as some officials and experts suggest.”

Although health officials like to emphasize the pains of social distancing, and how they are no longer sustainable, what was glaringly absent were efforts to test and trace cases and grasp the true scale of the outbreak, he said.

Active tracing was also crucial to “monitor variants, as letting the virus run amok in the community gives it more opportunities to evolve,” he said.

This policy seems to be what most governments are adopting now, including the US and Canada. I think we are going to see case counts on a Korean scale well before summer—and like South Korea, the true numbers will be even higher, because we won't be testing or contact tracing either.

Nor will we consider that 10 to 20 percent of these COVID-19 cases will evolve into long COVID, with consequences for millions of people who are now celebrating the end of "restrictions" like mask mandates.

New Zealand records another 41 Covid cases as it braces for biggest outbreak of pandemic

Via The Guardian: New Zealand records another 41 Covid cases as it braces for biggest outbreak of pandemic. Excerpt:

New Zealand is bracing for its biggest coronavirus outbreak yet as cases rise, the locations of interest balloon to more than 400 sites, and the number of close contacts swells to more than 15,700 people. 

On Tuesday, the country recorded 41 new positive cases, bringing the total number in its outbreak to 148 – the majority of whom are Samoan, and linked to a sub-cluster who assembled at the Assembly of God church in Mangere, Auckland before the lockdown. 

A nationwide, level 4 lockdown – the highest setting – has been extended until at least the end of the week, as the country battles to contain the outbreak of the Delta variant. 

Auckland – the country’s largest city, where the majority of cases have been detected – will remain in lockdown until the end of the month. 

Of the 41 new cases, 38 are in Auckland, and 3 are in Wellington. Of the total 148 cases, 89 are epidemiologically linked to the Auckland cluster, with the remaining still under investigation, but likely to be linked because they are either household contacts or have been at a location of interest. 

Eight people are in hospital with the virus, but no one is in intensive care. 

Genome sequencing has linked the cluster to a returnee from Australia. It is not yet known how the virus was transmitted from the traveller, who was in quarantine, to the community, but a walkway and an atrium in the facility is being investigated. 

On Tuesday afternoon, the director general of health, Dr Ashley Bloomfield, said dealing with the Delta variant was like dealing with a whole new virus. 

“It is, as we know, highly infectious and transmissible, and as we have seen spreads rapidly.” 

Bloomfield said this reinforced “just how critical it is” that people follow the level 4 lockdown rules.

Growing New Zealand Covid cluster linked to Sydney Delta outbreak

Via The Guardian: Growing New Zealand Covid cluster linked to Sydney Delta outbreak. Excerpt:

New Zealand’s coronavirus cluster has grown to 10, with genomic sequencing linking it to the Delta outbreak that began in Sydney, as the country woke up to day one of a snap lockdown stemming from just one case. 

The prime minister’s office confirmed three new cases on Wednesday evening. 

The Covid-19 response minister, Chris Hipkins, told broadcaster RNZ “we’re seeing more cases coming through, I don’t have details of those cases. But yes, I can confirm that we have further positive test results since the press conference today.” 

He expected more cases to emerge overnight. 

The country went into a snap level four lockdown – the highest level of restrictions – on Tuesday night, after detecting one case with no obvious links to the border. New Zealand has not had a level four lockdown in more than a year, and the case is the country’s first instance of Delta transmission in the community. 

The prime minister, Jacinda Ardern, warned on Wednesday that there would be more cases given the activity of those infected and that a link to the border had yet to be established, adding “there is more to be done to help piece together this puzzle”. 

“Our ability to narrow down that this is a case that is linked to New South Wales outbreak, gives us a lot of leads to chase down as quickly as we can,” she said. 

The seven community cases are all linked to the 58-year-old man who tested positive on Tuesday. One person is a fully vaccinated nurse at Auckland city hospital and another is a teacher at an Auckland high school. 

The director general of health, Ashley Bloomfield, said most of the cases identified were in their 20s. 

“They’ve been out and about a lot, and I’m flagging that there will be large numbers of locations of interest. It is very important that everybody keeps an eye on these,” he said. 

That includes the Sky City casino on Saturday night and a central Auckland church on Sunday. 

The 58-year old man is believed to have been infectious since 12 August. Since then he has travelled from Auckland to Coromandel and back, stopping at a number of locations along the way. 

Ardern said the public should expect to see the number of cases rise, given how active the people have been, how quickly Delta spreads and that the man spent time in a region that is a popular destination for travellers from other parts of the country. 

“I know that given Delta has not been in our community before, that will be news that people will find deeply concerning – but just I want to reassure people the best place we can be right now for that news and information is level four, and following all the level four rules,” she said. “These measures have worked before and they will work again.”

Ebola in Côte d'Ivoire: WHO reports one new suspected case and nine contact cases

Via Africa Radio, an AFP report: Ebola in Côte d'Ivoire: WHO reports one new suspected case and nine contact cases. If I understand this report, the young woman may have been healthy when she left Labé and was infected somewhere along the 1,600-km road to Abidjan. The Google translation:

The World Health Organization (WHO) said on Tuesday that in addition to the confirmed case of Ebola contamination detected in Côte d'Ivoire, one suspected case and nine contact cases had been identified and were being followed up. 

"We are continuing the investigations to identify the contacts," explained to AFP the prefectural director of health (DPS) of Labé, Dr. Mamadou Hady Diallo. 

"We do not know where the contamination took place. If it is here in Labé, if it is outside Labé, in particular during the journey which took her to Ivory Coast via Forest Guinea," to N'Zérékoré, he said. 

"It was precisely in Forest Guinea that the 2021 epidemic was triggered, but also the one that struck West Africa between the end of 2013 and 2016 and which killed more than 11,300 people, mainly in Guinea (2,500 dead), Liberia and Sierra Leone, three of the poorest countries in the world. An undervalued assessment by the WHO itself. - Zaire strain - WHO has ruled."

Nanjing airport coronavirus cluster ‘spreads to 15 other Chinese cities’

Via the South China Morning Post: Nanjing airport coronavirus cluster ‘spreads to 15 other Chinese cities’. Excerpt:

China’s Covid-19 control measures are under intense pressure after an airport cluster in Jiangsu province’s Nanjing is believed to have led to infections in 15 cities across the country in just over a week. 

The spread is being fuelled by the highly infectious Delta variant that has now swept across 132 countries, according to the World Health Organization this week. 

China’s zero-tolerance approach to the virus has put tremendous political pressure on the city and governing Jiangsu province, with senior officials admitting to the need to “deeply reflect” on lessons learned and improve their political judgment and understanding of epidemic control. 

The Nanjing outbreak has already infected more than 200 people including at least 30 people in 15 other cities, with Beijing and Sichuan province’s Chengdu among them, according to various city statements. 

The Nanjing cluster broke out last week with several cleaners at the city’s Lukou International Airport initially affected. 

Public health experts believe the latest outbreak is still in the early stages. It is already larger than a May outbreak that mostly affected Guangdong and was the first community spread of the Delta variant in China, with 167 cases reported. 

The health experts said more surveillance was needed to find out if there were more cases linked to the airport and if tougher control measures were needed.

Ineffective management has been blamed for the outbreak, thought to be connected to an international cargo flight more than two weeks ago.

Nine airport cleaners tested positive on July 20 during routine testing but by then had already infected colleagues and other service staff. At least 173 people in Nanjing have been infected including more than 60 cleaners, according to the city’s health authorities. 

“The airport faced problems such as poor supervision and unprofessional management, and prevention and control measures were not implemented effectively,” said the Commission for Discipline Inspection, China’s top anti-corruption body, in a website statement on Wednesday. 

The airport did not separate cleaning staff responsible for international flights from domestic ones, exposing a serious lack of day-to-day supervision, the statement said. International and domestic flight operations were mixed together, meaning the virus was imported and has spread in China, it added.

China: A superspreader event in Zhangjiajie?

Google Maps

Thanks to @ironorehopper for alerting me to this China Youth Network report: 6 people in Chengdu infected 5 people have been to Zhangjiajie! Emergency tracing in many provinces! Excerpt from the Google translation: 

On July 28, the Chengdu Municipal Information Office held a press conference on epidemic prevention and control. At the meeting, He Xiao, deputy director of the Chengdu Municipal Health Commission, introduced that from the 27th to 18:00 on the 28th, 5 new local confirmed cases and 1 local asymptomatic infection were added in Chengdu. Among them, 5 were from Zhangjiajie City, Hunan Province who came (returned) to Chengdu, and 1 was an associated case. 

According to the National Government Service Mini Program, at 17:00 on July 28, Chengdu and Chengdu were upgraded to medium-risk areas, namely: Xi'an, Youpin Road, Guanghua Street, Qingyang District, and Yasongju, Capital City, Shiyang Street, High-tech Zone. At present, there are 5 high-risk regions and 49 medium-risk regions in the country. 

Multiple cases are related to Zhangjiajie 

Recently, many provinces have reported local new coronavirus cases or asymptomatic infections, especially the Nanjing, Jiangsu epidemic has spread to 6 provinces and 11 cities. Among them, the cases reported in Liaoning, Sichuan and Hunan are related to the activities of the spilled cases from Nanjing in Zhangjiajie. 　　

• From 0:00 to 20:00 on July 27, one new confirmed case was added in Dalian, Liaoning Province, who had been infected with Nanjing and watched the same large-scale performance in Zhangjiajie on July 22 (approximately 18:00 to 19:30) . Attendance at the performance are all seats A in the center, adjacent to the front and back (rows 8 and 9). 　　

•  According to the Hunan Daily News on the 27th, the Hunan Provincial Center for Disease Control and Prevention issued a notice on the investigation and health management of three asymptomatic cases of new coronary pneumonia in Dalian. According to the announcement, three cases in Dalian traveled asymptomatically in Zhangjiajie for a week and were transited at Nanjing Lukou Airport.　　

Watch this performer, report quickly! 

Hunan Zhangjiajie Epidemic Prevention and Control Headquarters Office issued a notice on the 28th, due to the diagnosis of 3 cases of asymptomatic infection in Dalian City, Liaoning Province on July 26, and 1 case of asymptomatic infection in Dalian City on July 27. There is a trajectory intersection in space, which points to the charming Xiangxi Theater in Zhangjiajie on the night of July 22. According to evaluation, all the audiences in the first show (18:00-19:00) of the charming Xiangxi on the evening of July 22 are high-risk groups. The personnel of this department are requested to report to the local community (village) or disease control agency immediately.

Vietnam: All eyes on Ho Chi Minh City

Via Vietnam Weekly: All Eyes on Ho Chi Minh City. By the terms of the rest of the world, this is a minor flurry. In Vietnam, which has done everything right, it's a disaster. Excerpt:

Ho Chi Minh City’s Luck Runs Out 

Let’s get some raw numbers out of the way first: on Monday morning, this ongoing outbreak had accounted for 2,164 cases - a figure that is now 3,295, along with 11 deaths. This brings Vietnam’s case total for the pandemic to 6,356 (3,453 are active), and 46 deaths. 

Tuesday alone saw 444 cases announced, obliterating the country’s previous single-day case record, which had already been set and broken several times during this wave. 

The big news is the emergence of a new cluster in HCMC yesterday, ending the city’s frankly miraculous general avoidance of this surge (though it’s now clear the virus has been present for some time without detection). 

On Wednesday, three members of a local evangelical sect visited a hospital in Binh Thanh District with respiratory conditions. They were isolated and tested, and were positive for COVID-19. 

Contact tracing and testing found 33 more cases through Thursday night, all linked to the sect (29 members, seven close contacts), with positive cases spread across 16 districts, including a chef at the Sheraton Hotel downtown. 53% of these people have shown COVID-19 symptoms - which is high. 

The group in question is the Revival Ekklesia Mission, with an address in Go Vap District. According to their Facebook page, the mission is “a Christian charismatic congregation in fervent prayers for Revival and Salvation in Jesus Christ’s name for everyone.” It was founded “in the 1990s” by two missionaries named Phuong Van Tan and Vo Xuan Loan. 

Numerous locations around town, including the Sheraton, have been isolated, and more of this can be expected as contact tracing expands. 

The initial source of this cluster is not currently known, while health officials have said it’s possible that the virus has been present for some time, given the number of positive F1 cases. 

 This morning, the Mekong Delta province of Long An reported its first case as part of this wave - another employee in the kitchen of the Sheraton. 

HCMC’s government has responded by increasing restrictions, with gatherings of more than 10 people banned (previously 20), the shuttering of religious establishments, beauty salons and barbershops shut down, and all restaurants and cafes having to switch to take-away or delivery only. (Previously this had only applied to street-side eateries.) Repatriation flights and charter flights bringing in foreign experts have also been suspended from landing in the city. 

This is complicated, to say the least, and case numbers in the city are sure to increase (a bakery and an apartment tower in Thao Dien were blockaded yesterday afternoon in relation to a case, and that’s just in my neighborhood). 

Sadly, this is also not surprising: people have been complacent here in HCMC, even with huge numbers being reported from northern provinces, and over 100 restaurants in one district alone have been fined in the last 10 days for breaching COVID-19 restrictions.

Vietnam: The outbreak grows

Via Mike Tatarski's excellent Vietnam Weekly: The Outbreak Grows. Excerpt:

Before Friday’s infection updates, the Ministry of Health had logged 120 local COVID-19 cases since this new wave began on April 29. That has now grown to 411 cases of community infection: 120 in Hanoi, 85 in Bac Ninh, 52 in Vinh Phuc and 37 in Bac Giang. Those neighboring provinces make up the bulk of cases, though Da Nang has turned into a hotspot of its own with 48 infections. 

Overall, cases have been found in 26 provinces and cities, while almost 60,000 people nationwide are in some form of quarantine due to exposure to known cases. 

Here in Ho Chi Minh City, the situation is still in good shape, though this week will be different since schools are now closed. 

One concerning aspect of this latest outbreak is its spread into medical facilities: at least 10 hospitals in Hanoi (including a public cancer hospital) and elsewhere are currently locked down. Hospital clusters are what made the Da Nang outbreak last fall so dangerous. In fact, all 35 of Vietnam’s COVID-19 deaths came from that. 

It’s been hard to keep track of exactly where all these cases came from, though we know that many are linked to foreign experts who tested positive after completing quarantine. A karaoke bar in Vinh Phuc has also been linked to a number of cases. 

Nationwide contact tracing is ongoing, and hundreds of direct and indirect contacts have been found for a known patient who went to Da Lat over the Reunification Day holiday - that city was absolutely packed at the time. 

Minister of Health Nguyen Thanh Long has warned of the dangers of this outbreak given the presence of different strains and also multiple initial infection points (the index patient hasn’t been found in some areas). 

In vaccine news, 851,513 Oxford/AstraZeneca doses have been injected, meaning the health ministry has used almost all of the 917,600 doses it has received thus far. There is no word on when more deliveries may arrive. Last Friday, Vietnam reported its first death related to the vaccine, a 35 year-old medical worker in An Giang Province. She died of anaphylaxis.