H5N1

Uganda: Family denies exhuming body of Ebola casualty

Via The Monitor, which has done an excellent job of covering the outbreak: Family denies exhuming body of Ebola casualty. Excerpt:

The family of an Ebola Virus Disease (EVD) victim, whose body was allegedly exhumed by unknown people, have asked the Ministry of Health and the security agencies to investigate the incident.  

The incident took place in Kitongo Village, Kalwana Sub-county Kassanda District about a month ago, according to district health officials.  

While meeting the Kassanda District Ebola taskforce, Health Minister Jane Ruth Aceng, and other officials at Kassanda District headquarters on Wednesday, a family representative, Mr Mubarak Muwade Kawuki, denied claims that they exhumed the body to perform Muslim burial rituals on it.  

He added that they are now being stigmatised, “causing a lot of distress to our family”.   

“Our own investigation reveals that nobody tampered with the grave,” he said.  

Mr Kawuki insisted that the rituals and the preparation of the grave were performed prior to their loved one being buried.  

He added that the interment was done by the burial team from the government.     

“There was no single reason as family members to have the body of a person presumed to have died of Ebola exhumed in the name of performing a religious burial,” he said.   

He added: “It is also interesting that when we asked the police to investigate the incident, they have failed to give us a report.”  

The family has asked the government to institute a special investigation to examine the grave and possibly exhume the body to find out if it was tampered with.  

But in an earlier interview with this paper, the Kassanda Resident District Commissioner, Ms Phoebe Namulindwa, revealed that the health officials have recovered some evidence but did not give any more details on the matter.  

She added that some people had also confessed to exhuming the body.  

“I only request the community to stop stigmatising the family because we are all focused on fighting the Ebola Virus Disease in Kassanda District,” she said.  

Meanwhile Dr Aceng urged the family to join the fight against Ebola and forget the past.  

“I will call the team and interact with them to find out what really happened. We have had some challenges in Kassanda District as we fight the Ebola pandemic. We should work as a team to stop the spread of Ebola,” she said.  

It was revealed at the meeting that the cumulative confirmed Ebola cases is now 50, while the cumulative death cases are now 18 in Kassanda District.

Cracks in the foundation: How COVID-19 showed our failures

Via The Lancet, a review by Mary T. Bassett: Cracks in the foundation: how COVID-19 showed our failures.

In 1963, James Baldwin, one of the USA's greatest essayists, published The Fire Next Time. The book's title comes from a slave song—”God gave Noah the rainbow sign/No more water but the fire next time”. Baldwin's words sounded a warning that the USA needed to confront its racial hierarchy by embracing racial equality or doom its future.  

Sandro Galea's book, The Contagion Next Time, is titled in a homage to Baldwin and it also sounds a warning. Galea's central argument is that vulnerability to COVID-19 lies with a societal failure to recognise that the foundation of health rests on a healthy everyday life and not simply in the provision of health care. He ponders why this key lesson is not at the centre of pandemic discourse, which instead focuses on vaccination and treatment. In often lyrical prose, Galea roams across history, culture, literature, moral values, economics, politics, and personal pandemic experience. Although situated in a global context, the book's focus is the USA. Galea considers especially the enduring impacts of racism on health and the centrality of structural racism to understanding the USA.  

Globally, there were more than 6 million COVID-19 deaths by early April, 2022. Amid this carnage, few have asked why, if this novel virus was the spark, there was so much dry grass. The Contagion Next Time is suffused with Galea's anguish that failure to grapple with this question will cost more lives. Worse, the world may fare even more poorly when the next contagion arrives.

After the omicron (B.1.1.529) surge, which occurred after this book was written, the USA is now approaching a staggering 1 million COVID-19 deaths. An analysis in 2021 by the Lancet Commission on public policy and health in the Trump era, to which both Galea and I contributed, found that about 40% of US COVID-19 deaths “could have been averted had the US death rate mirrored the weighted average of the other G7 nations”. In February, 2022, the per capita cumulative COVID-19 death rate in the USA exceeded that of other wealthy nations and during omicron placed the USA in a league all its own. Just what is going on?  

Galea, who is Dean of the Boston University School of Public Health, USA, seeks the answers with erudition and passion. He begins with reflections of an array of relevant data. But most of the book reads as a journey towards understanding why the USA has fared so poorly. The answers have little to do with the scientific breakthroughs that brought us COVID-19 vaccines in such record time.  

Galea points to the US obsession with individualism, making achievement of health a personal project, rather than a collective one, and an attachment to technology that has given priority to medical care over public health. He also posits widespread lack of compassion, which erodes solidarity. Galea does not shrink from naming an aversion to complexity in some quarters that made policy making difficult in the pandemic. COVID-19 demanded high-impact decisions that rested on imperfect, incomplete information. A lack of humility may also have contributed to at times contradictory public pronouncements. And there is a failure to confront racism (embedded in the founding of the USA), marginalisation, and socioeconomic inequality.  Galea ends by observing that choosing health will mean “reorienting our social, economic and political priorities” to support our collective wellbeing.  

But there are questions that go unasked and unanswered. Just why would a belief that medical care creates health persist, faced with decades of public health thinking that has shown the minor share of population health attributable to clinical care? The WHO Commission on Social Determinants of Health began its 2008 final report, “Social justice is a matter of life and death.” It would seem time to ask, who benefits from these unhealthy arrangements?  

And there are answers. At their root lies an unfettered pursuit of profit that is not good for health. The US departure from the health performance of its peer nations began in around 1980 as market-oriented policies triumphed. Nicholas Freudenberg in his book At What Cost: Modern Capitalism and the Future of Health confronts directly how with present predatory capitalism in the USA there is widespread damage to the public's health. Haven’t we seen this also with COVID-19? Millions lost their jobs while the stock market flourished. Income inequality increased as life expectancy plunged precipitously among racially marginalised groups in the USA. Meanwhile, equitable access to COVID-19 treatments and vaccines is not a reality for many people in low-income and middle-income countries. Debates continue over patent protections.  

The impact of anti-communism in the USA has limited interrogation of capitalism. But the USA is a capitalist country. Nearly 60 years ago, Baldwin sounded the alarm for the enduring harm of racism to the future of the USA, a lesson which Galea has amplified. Perhaps a more courageous book that contemplates the next contagion would go a step further in sounding the alarm for the health effects of modern capitalism.

Our long night of the virus

The Tyee has published my long review of four important new books about the pandemic: Our Long Night of the Virus. Excerpt:

The pandemic and climate change, combined, have triggered what [Adam] Tooze calls a “great acceleration,” when events outrun earlier predictions and solutions. We will therefore have to improvise new solutions — or, like the populists, stick to a very old non-solution of anti-science white supremacy in the hope of returning to the “before times.” 

The imperial infection  

Rupa Marya, an American physician of Indian descent, and Raj Patel, a British academic, journalist and author, offer a solution from the before times in their book Inflamed: Deep Medicine and the Anatomy of Injustice. They argue that this pandemic, like countless disease outbreaks before it, is a consequence not just of a virus but of an imperialist world order that triggered disease and then built a medical system to serve the rulers, not the victims.  

This is not some radical Marxist spin, but established medical history. In the early 19th century, British development turned wetlands into farmlands in what is now Bangladesh, and brought a marine bacterium called Vibrio cholera into human guts. Cholera rapidly migrated on trade routes to London and beyond.  

In London, Dr. John Snow founded modern epidemiology by spotting the precise well that was infecting the neighbourhood. His medical colleagues dismissed his idea, but eventually Britain rebuilt its water supply system and greatly improved its workers’ health. Travellers from India were screened at Suez to try to stop further outbreaks from reaching Europe. But like Omicron, cholera was all over the planet by the time it was recognized.  

Meanwhile, cholera was left to ravage India itself, and we are now in the seventh cholera pandemic, which began in Indonesia in 1961 and most recently exploded in Haiti in 2010.  

Marya and Patel are by far the most radical analysts of this pandemic. They have no interest in blaming Donald Trump or the CDC; they are just the agents of a system created to serve the interests of 19th century empires, and which now protects the white heirs of those empires while ignoring the “essential” workers who serve those heirs.  

The authors have strong confirmation from others like Alex de Waal, whose recent book shows how Louis Pasteur’s germ theory defeated the German scientist-politician Rudolf Virchow, who had long argued for social and economic inequality as the root of disease outbreaks. Pasteur had blamed individual microbes, which could be isolated, fought and defeated like rebellious tribesmen in some remote colony. We still fall back on war metaphors to describe our response to the pandemic.

Scientists mystified, wary, as Africa avoids COVID disaster

Via The Associated Press: Scientists mystified, wary, as Africa avoids COVID disaster. Excerpt:

HARARE, Zimbabwe (AP) — At a busy market in a poor township outside Harare this week, Nyasha Ndou kept his mask in his pocket, as hundreds of other people, mostly unmasked, jostled to buy and sell fruit and vegetables displayed on wooden tables and plastic sheets. As in much of Zimbabwe, here the coronavirus is quickly being relegated to the past, as political rallies, concerts and home gatherings have returned.  

“COVID-19 is gone, when did you last hear of anyone who has died of COVID-19?” Ndou said. “The mask is to protect my pocket,” he said. “The police demand bribes so I lose money if I don’t move around with a mask.” Earlier this week, Zimbabwe recorded just 33 new COVID-19 cases and zero deaths, in line with a recent fall in the disease across the continent, where World Health Organization data show that infections have been dropping since July.  

When the coronavirus first emerged last year, health officials feared the pandemic would sweep across Africa, killing millions. Although it’s still unclear what COVID-19’s ultimate toll will be, that catastrophic scenario has yet to materialize in Zimbabwe or much of the continent.  

Scientists emphasize that obtaining accurate COVID-19 data, particularly in African countries with patchy surveillance, is extremely difficult, and warn that declining coronavirus trends could easily be reversed.  

But there is something “mysterious” going on in Africa that is puzzling scientists, said Wafaa El-Sadr, chair of global health at Columbia University. “Africa doesn’t have the vaccines and the resources to fight COVID-19 that they have in Europe and the U.S., but somehow they seem to be doing better,” she said.  

Fewer than 6% of people in Africa are vaccinated. For months, the WHO has described Africa as “one of the least affected regions in the world” in its weekly pandemic reports.  

Some researchers say the continent’s younger population -- the average age is 20 versus about 43 in Western Europe — in addition to their lower rates of urbanization and tendency to spend time outdoors, may have spared it the more lethal effects of the virus so far. Several studies are probing whether there might be other explanations, including genetic reasons or exposure to other diseases.  

Christian Happi, director of the African Center of Excellence for Genomics of Infectious Diseases at Redeemer’s University in Nigeria, said authorities are used to curbing outbreaks even without vaccines and credited the extensive networks of community health workers.  

“It’s not always about how much money you have or how sophisticated your hospitals are,” he said.  

Devi Sridhar, chair of global public health at the University of Edinburgh, said African leaders haven’t gotten the credit they deserve for acting quickly, citing Mali’s decision to close its borders before COVID-19 even arrived.  

“I think there’s a different cultural approach in Africa, where these countries have approached COVID with a sense of humility because they’ve experienced things like Ebola, polio and malaria,” Sridhar said.

Reading about COVID-19

Early next year, I'll be teaching "Perspectives on Pandemics," a course for Eldercollege here on the North Shore—going back to the Athenian and Justinianic plagues and the Black Death, but focusing on COVID-19. I'm pulling together a suggested reading list for my students, and it occurred to me that others might want to explore some of these titles as well. So here they are. Some include links to my Tyee reviews; others will be mentioned in a long article I'm working on. I'll update this list from time to time.

Peter Baldwin, Fighting the First Wave: Why the Coronavirus Was Tackled So Differently Across the Globe. Cambridge University Press, 2021. My review: https://thetyee.ca/Analysis/2021/03/30/Best-Book-Written-About-COVID-Pandemic/

Alex De Waal, New Pandemics, Old Politics: Two Hundred Years of War on Disease and Its Alternatives. Polity Press, 2021. My review: https://thetyee.ca/Culture/2021/07/09/All-Plagues-Are-Political/

Elaine Dewar, On the Origin of the Deadliest Pandemic in 100 Years: An Investigation. Biblioasis, 2021.

Fang Fang, Wuhan Diary: Dispatches from a Quarantined City, translated by Michael Berry. HarperCollins, 2020. My review: https://thetyee.ca/Culture/2020/05/27/Wuhan-Diary-Book/

Richard Horton, The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again. Polity Press, 2020. My review: https://thetyee.ca/Culture/2020/06/22/Only-Newly-Vigilant-Society-Can-Stop-Next-Pandemic/

Colin Kahl & Thomas Wright, Aftershocks: Pandemic Politics and the End of the Old International Order. St. Martin’s Press, 2021.

Michael Lewis, The Premonition. W.W. Norton, 2021. My review: https://thetyee.ca/Culture/2021/05/18/Hot-Pandemic-Book-Poses-Danger/

Rupa Marya & Raj Patel, Inflamed: Deep Medicine and the Anatomy of Injustice. Farrar, Straus & Giroux, 2021.

Jon Sternfeld, Unprepared: America in the Time of Coronavirus. Bloomsbury, 2021. My review: https://thetyee.ca/Culture/2020/12/22/Unprepared-America-Time-Coronavirus-Book/

Steven Taylor: The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. Cambridge Scholars Publishing, 2019. My review: https://thetyee.ca/Culture/2020/07/10/Mental-Toll-Covid-Doctors-Saw-Coming/

Adam Tooze, Shutdown: How Covid Shook the World’s Economy. Viking 2021.

Lawrence Wright, The Plague Year: America in the Time of COVID. Alfred A. Knopf, 2021.

Covid is killing rural Americans at twice the rate of people in urban areas

Via NBC News, a report by Lauren Weber of Kaiser Health News: Covid Is killing rural Americans at twice the rate of people in urban areas. Excerpt:

Rural Americans are dying of Covid at more than twice the rate of their urban counterparts — a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer and less vaccinated.  

While the initial surge of Covid-19 deaths skipped over much of rural America, where roughly 15 percent of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute.  

Since the pandemic began, about 1 in 434 rural Americans have died from Covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall Covid death rates since the winter peak, rural mortality rates are now more than double that of urban ones — and accelerating quickly.  

In rural northeastern Texas, Titus Regional Medical Center CEO Terry Scoggin is grappling with a 39 percent vaccination rate in his community. Eleven patients died of Covid in the first half of September at his hospital in Mount Pleasant, population 16,000. Typically, three or four nonhospice patients die there in a whole month.  

“We don’t see death like that,” Scoggin said. “You usually don’t see your friends and neighbors die.”

Part of the problem is that Covid incidence rates in September were roughly 54 percent higher in rural areas than elsewhere, said Fred Ullrich, a University of Iowa College of Public Health research analyst who co-wrote the institute’s report. He said the analysis compared the rates between nonmetropolitan, or rural, areas and metropolitan, or urban, areas. In 39 states, he added, rural counties had higher rates of Covid than their urban counterparts.  

“There is a national disconnect between perception and reality when it comes to Covid in rural America,” said Alan Morgan, head of the National Rural Health Association. “We’ve turned many rural communities into kill boxes. And there's no movement towards addressing what we're seeing in many of these communities, either among the public, or among governing officials.”  

Still, the high incidence of cases and low vaccination rates don’t fully capture why mortality rates are so much higher in rural areas than elsewhere. Academics and officials alike describe rural Americans’ greater rates of poor health and their limited options for medical care as a deadly combination. The pressures of the pandemic have compounded the problem by deepening staffing shortages at hospitals, creating a cycle of worsening access to care.  

It's the latest example of the deadly coronavirus wreaking more havoc in some communities than others. Covid has also killed Native American, Black or Hispanic people at disproportionately high rates.  

Vaccinations are the most effective way to prevent Covid infections from turning deadly. Roughly 41 percent of rural America was vaccinated as of Sept. 23, compared with about 53 percent of urban America, according to an analysis by The Daily Yonder, a newsroom covering rural America. Limited supplies and low access made shots hard to get in the far-flung regions at first, but officials and academics now blame vaccine hesitancy, misinformation and politics for the low vaccination rates.

How the US vaccine effort derailed and why we shouldn’t be surprised

Via The Guardian: How the US vaccine effort derailed and why we shouldn’t be surprise. Excerpt:

There are very specific, well-documented reasons that Americans are hesitant to take vaccines. They vary from the troubling way the medical system treats people of color, to vaccine misinformation campaigns overwhelmingly popular in conservative circles, to logistical challenges.  

But population health researchers, whose work considers how society as a whole is fairing, said low vaccine uptake may be looked at another way: as the predictable outcome of a campaign subject to entrenched social forces that have diminished American health and life expectancy since the 1980s.  

“When I look at this I do see a very familiar pattern,” said Dr Steven Woolf, a prominent population health researcher at Virginia Commonwealth University. “When Operation Warp Speed came out I thought I was just seeing a modern example of this old problem where the scientific community developed the vaccine at ‘warp speed,’ but the implementation system for getting it out into the community was inadequate”.  

Woolf calls this “breakthrough without follow-through”. In that light, the plodding vaccination campaign could be seen as one more aspect of the American “health disadvantage”.  

The phrase describes a paradox: the US houses among the most advanced medical and research centers in the world, but performs poorly in basic health metrics such as maternal mortality and infant mortality; accidental injury, death and disability; and chronic and infectious disease.

"So much of the whole issue of social determinants of health and the US ‘health disadvantage’ is rooted in a lack of trust and a lack of trustworthiness in many parts of our society,” said Laudan Y Aron, a senior fellow at the Urban Institute’s health policy center. 

A key piece of research in this area is a 2013 report by a panel chaired by Woolf, directed by Aron, and funded by the National Institutes of Health. Called US Health in International Perspective: Shorter Lives, Poorer Health, the report describes how Americans spend more than double per person on healthcare compared to 17 peer nations, but rank near the bottom in health outcomes.  

The phenomenon is described as “pervasive”, impacting all age groups up to 75, with life expectancy declining especially for women. In just a few examples, Americans have the highest infant mortality, children are less likely to live to age five, and the US has the worst rates of Aids among peer nations.  

The US also has the highest or among the highest rates of cardiovascular disease, obesity, chronic lung disease and disability. Together, these risk factors culminate in Americans having the worst or second worst probability of living to age 50.  

Americans know intuitively that their healthcare is expensive, frustrating and often unfair. Remarkably, even amid the pandemic, roughly 30 million Americans went without health insurance, exposing them to potentially ruinous medical debt.  

“It’s also really interesting how often the messaging is: talk to your doctor, talk to someone you trust,” said Aron. “Yet, we don’t really acknowledge how many people don’t have a doctor, or a doctor they have a trust-based relationship with them”.

To comply or not comply? A latent profile analysis of behaviours and attitudes during the COVID-19 pandemic

Via PLOS One: To comply or not comply? A latent profile analysis of behaviours and attitudes during the COVID-19 pandemic. The abstract:

How and why do people comply with protective behaviours during COVID-19? The emerging literature employs a variable-centered approach, typically using a narrow selection of constructs within a study. This study is the first to adopt a person-centred approach to identify complex patterns of compliance, and holistically examine underlying psychological differences, integrating multiple psychology paradigms and epidemiology. 

1575 participants from Australia, US, UK, and Canada indicated their behaviours, attitudes, personality, cognitive/decision-making ability, resilience, adaptability, coping, political and cultural factors, and information consumption during the pandemic’s first wave. Using Latent Profile Analysis, two broad groups were identified. 

The compliant group (90%) reported greater worries, and perceived protective measures as effective, whilst the non-compliant group (about 10%) perceived them as problematic. The non-compliant group were lower on agreeableness and cultural tightness-looseness, but more extraverted, and reactant. They utilised more maladaptive coping strategies, checked/trusted the news less, and used official sources less. Females showed greater compliance than males. 

By promoting greater appreciation of the complexity of behaviour during COVID-19, this research provides a critical platform to inform future studies, public health policy, and targeted behaviour change interventions during pandemics. The results also challenge age-related stereotypes and assumptions.

The surreal lives of Arkansas nurses fighting Covid-19 inside the hospital and denial on the outside

Via CNN, a discouraging report: The surreal lives of Arkansas nurses fighting Covid-19 inside the hospital and denial on the outside. Excerpt:

(CNN)Sunny worked as a nurse on a Covid-19 floor of a hospital at the height of the pandemic. The work was hard, but what made it surreal was doing it while living in small town Arkansas, where many people, even some in her own family, said the virus was overblown -- "just the flu." 

"It's extremely difficult to watch so many people die, and then have people tell you on Facebook or in Walmart that you're a liar," Sunny said. Sometimes that would come from the loved ones of the patients she was taking care of. 

"We had people accuse us of giving their loved one something else so that they would die and we could report it as Covid. We heard it more than once that we were fudging the numbers, or we were killing people on purpose to make Covid look like it was worse than it was, or to make it look real when it wasn't," she said. 

Sunny asked CNN not to use her real name, because some dedicated Covid-19 deniers have harassed health care workers, or tried to get outspoken ones fired.

The politicization that led people to believe Covid-19 was some kind of scam is now affecting how many get vaccinated. 

Just 36% of Arkansans are fully vaccinated, the third-lowest rate in the country. This week, Arkansas had its biggest spike in cases since February, and it has the worst case rate in the country. The state government is offering incentives to get vaccinated, like free lottery tickets. It hasn't convinced many; Gov. Asa Hutchinson has said it's not working. 

Sunny fears that could mean the Delta variant will make many people in her community sick, and push some nurses to quit. 

"A lot of nurses have compassion fatigue. And I am really scared of how that's gonna play out, because a lot of the cases that we're seeing are in non-vaccinated individuals." 

"Nurses were really the symbol for this pandemic and all of the hate was centered around us -- the hate, the fear, the respect, all of it," Sunny said. A lot of nurses have PTSD from 2020, she said, "And now we're having people come in and look us in the face and be like, 'No I didn't get the vaccine, and now I'm sick."

Mucormycosis (Black Fungus) in COVID-19 patients—India—19 May 2021

EpiCore is a very interesting group of public-health professionals working as a a volunteer epidemic-intelligence group. It recently responded to a request for information on black fungus, and issued this report: Mucormycosis (Black Fungus) in COVID-19 patients—India—19 May 2021.

Media quoting clinicians in India have been reporting that mucormycosis, a rare fungal infection, has been recently identified in several COVID-19 patients in the country. The disease has been increasingly documented in these patients in different areas including Pimpri-Chinchwad (YCMH) and Mumbai (Sion Hospital). One of the hypotheses is that some drugs used for COVID-19 treatment could play a role by reducing immunity and push up blood sugar levels in diabetics and non-diabetic patients and represent a risk factor for mucormycosis. 

An RFI has been sent to EpiCore members to collect details that could support the assessment of the risk for this condition in COVID-19 patients. 

The EpiCore network has confirmed the occurrence of these cases in India, informing about similar cases documented in other cities, as New Delhi. The network has provided additional details, professional opinions and sources for further information. 

It has been commented that the general feeling is that in India steroids may be often misused for the treatment of COVID-19 as prescribers tend using them virtually in all patients even though recovery trials have showed benefits in only a small subset of them: it is thought that the increase in mucormycosis cases could be related to the drop in immunity in these patients following extensive use of steroids. 

EpiCore network has also informed that there is a report available online that includes contributions, professional comments and updates in terms of new cases from several clinicians from all around the country, in addition to valid and updated useful details for diagnosis, treatment and prognosis purposes. These experts noted that cases have not been noted during the first wave (when steroids were not used as much as today) and that there are other possible risk factors that should be considered. 

For more details, please refer to the source below (see link) that include comments from clinicians from several cities (Bengaluru, Bhagalpur, Chennai, Delhi, Goa, Hyderabad, Indore, Lucknow, Maharashtra, Raipur, Ranchi and Vadodara). 

It should be also mentioned that media are reporting that a link between the fungal infection and cow dung use is currently being explored. 

The RFI has been supported with information available online and related to comments from local clinicians about this event. 

More information: 

Post-COVID Tsunami of Mucormycosis (May 10, 2021) 

https://cmeindia.in/post-covid-tsunami-of-black-fungus-mucormycosis/ 

Example of media reporting a possible link to cow dung (May 17, 2021) 

https://www.india.com/health/cow-dung-increases-chances-of-black-fungus-in-diabetic-and-covid-patients-say-doctors-4669763/