H5N1

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.

Chinese doctors and nurses reportedly told to work while infected as Covid surges

Via The Guardian: Chinese doctors and nurses reportedly told to work while infected as Covid surges. Excerpt:

Chinese doctors and nurses are being told to keep working even when infected with Covid-19, staff and residents reported, as the virus rips through the population in the wake of eased restrictions.  

Some hospitals in Beijing have up to 80% of their staff infected, but many of them are still required to work due to staff shortages, a doctor in a large public hospital in Beijing told Reuters, adding he had spoken to his peers at other big hospitals in the capital.  

All operations and surgeries had been cancelled at his hospital unless the patient was “dying tomorrow”, he said, declining to be named due to the sensitivity of the subject.  

A senior World Health Organization official said on Wednesday that China’s flare-up started “long before” restrictions were lifted, but since the sudden shift in policy major cities in Beijing appear to have experienced a huge surge in cases of Covid-19. Authorities have said it is “impossible” to measure, since most people are not being tested.  

“The explosion of cases in China had started long before any easing of the zero-Covid policy,” WHO emergencies chief Michael Ryan said on Wednesday. “There’s a narrative that, in some way, China lifted the restrictions and all of a sudden, the disease is out of control,” he added at the UN health agency’s headquarters in Geneva.  

“The disease was spreading intensively because the control measures in themselves were not stopping the disease.”  

In Sichuan, a doctor surnamed Li told Reuters that their tertiary hospital was “overwhelmed with patients”.  

“There are 700, 800 people with fever coming every day,” Li said. “We are running out of medicine stocks for fever and cold. A few nurses at the fever clinic were tested positive, there aren’t any special protective measures for hospital staff and I believe many of us will soon get infected.”  

Claims of rampant infections among hospital staff are also spreading across social media. One Chongqing resident said primary care in their city had “imploded”.  

“80% of the newly admitted patients in our small third-level respiratory department in a remote city are positive,” they wrote on Weibo.  

“From December 8, when the first positive patient was allowed to be admitted, to today, December 13, at least half of the medical staff in our department were infected. At the beginning the infected were allowed to go home to rest, but now as long as it is not very serious symptoms, they are not allowed to go home.”

Physical, psychological and cognitive profile of post-COVID condition in healthcare workers, Quebec, Canada

Via medRxiv: Physical, psychological and cognitive profile of post-COVID condition in healthcare workers, Quebec, Canada. This could have serious implications for healthcare systems around the world. The abstract:

Importance Most adults with COVID-19 do not require hospitalization, but the subsequent risk of post-COVID condition, including associated psychological and cognitive dysfunction, remains poorly understood among non-hospitalized versus hospitalized cases.  

Objective To assess the prevalence and duration of post-COVID condition, including physical, psychological and cognitive symptoms.  

Design Case series and case-control study between December 2020 and May 2021  

Setting Healthcare workers in Quebec, Canada  

Participants Eligible cases were symptomatic healthcare workers with PCR-confirmed COVID-19 between July 2020 and May 2021. Among 17,717 contacted cases, 6061 (34%) participated. A random sample of symptomatic healthcare workers with negative PCR result between November 2020 and May 2021 served as controls. Among 11,498 contacted controls, 4390 (38%) participated.  

Exposures In multivariable models, sociodemographic and clinical characteristics, as well as vaccine history, were evaluated as potential risk factors. Prevalence ratios compared self-reported cognitive dysfunctions (difficulty concentrating; difficulty organizing oneself; forgetfulness; loss of necessary items) among cases with post-COVID condition to controls, adjusting for psychological distress and fatigue.  

Outcomes Post-COVID condition was defined by symptoms persisting ≥4 weeks or ≥12 weeks after COVID-19 onset.  

Results Four-week and 12-week post-COVID condition prevalences of 46% (2,746/5,943) and 40% (653/1,746), respectively, were observed among non-hospitalized cases and 76% (90/118) and 68% (27/37), respectively, among hospitalized cases. Hospitalization, female sex and age were associated with higher risk.  

A substantial proportion of non-hospitalized cases with 4-week post-COVID condition often or very often reported cognitive dysfunction, including concentration (33%) or organizing (23%) difficulties, forgetfulness (20%) and loss of necessary items (10%), with no decline at 12 weeks. All four aspects of cognitive dysfunction were 2.2 to 3.0 times more prevalent among cases with post-COVID condition than in controls, but also independently associated with psychological distress and fatigue.  

Conclusions and relevance Post-COVID condition may be a frequent sequela of ambulatory COVID-19 in working-age adults, with important effects on cognition. With so many healthcare workers infected since the beginning of the COVID-19 pandemic, the ongoing implications for quality healthcare delivery could be profound should cognitive dysfunction and other severe post-COVID symptoms persist in a professionally-disabling way over the longer term.  

Question How common and long-lasting are the physical, psychological and cognitive effects of post-COVID condition in healthcare workers, both hospitalized and non-hospitalized?  

Findings The prevalence of post-COVID condition was 46% at 4 weeks and 40% at 12 weeks among non-hospitalized cases and 76% and 68% among hospitalized cases. One third of non-hospitalized healthcare workers with post-COVID condition reported cognitive impairment, which was independently associated with persistent physical symptoms, but also psychological distress and fatigue.  

Meaning Persistent cognitive and other professionally-disabling sequelae of COVID-19 in essential workers could have critical implications for quality healthcare delivery during and after the pandemic.

US hospitals struggle with staffing shortages and Omicron outbreaks

Via The Guardian: US hospitals struggle with staffing shortages and Omicron outbreaks. Excerpt:

On her fourth day of Covid symptoms, Ruth woke up in the worst pain of her life. It felt like her joints were filled with broken glass; she couldn’t walk, couldn’t move. “It was worse than childbirth,” she said.  

When friends texted to check on her, she couldn’t hold the phone or move her fingers to write back. Her doctor called in medication, and it took Ruth 40 minutes to shuffle to the pharmacy half a block away.  

Ruth – who did not want her full name used – is certain that if she weren’t vaccinated and boosted, she would be in the intensive care unit or worse right now. But while she’s recovering from this “mild” case, she’s unable to work even as cases surge in her region.  

Ruth is an emergency nurse in Washington DC. Her case of breakthrough Covid shows what may happen when the more contagious variant hits health workers all over the country – and the pressures Omicron will put on a US health system already groaning under the weight of the pandemic. In this wave, it’s not a shortage of beds but a shortage of qualified workers to care for people in those beds that is raising alarm bells.  

“What do you do when you have a tidal wave coming at you in a little paddle boat?” Ruth asked. “There’s going to be a huge uptick. Our entire waiting room is going to be all Covid-positive.”  

In Washington DC the infection curve looks like a straight line up. On Saturday, the city nearly tripled its previous record-high number of cases. At least two of Ruth’s colleagues were already out sick with Covid.  

In a matter of weeks, Omicron has become the dominant variant in the United States. It accounts for 73% of sequenced cases, six times higher than last week. As the holidays approach, officials and experts warn of an unmanageable crush of patients and potentially catastrophic staffing shortages.  

“This is a big concern,” said Marcus Plescia, the chief medical officer at the Association of State and Territorial Health Officials. “This is a highly contagious variant, and we really think it could cause significant issues with the workforce.”  

Omicron is spreading like wildfire and slamming into hospitals, and “​​there’s no question that this is going to be on us, really in the next week or so”, Plescia said.  

Others agreed. “There’s no question” that Omicron outbreaks among healthcare workers are “significantly diminishing the workforce”, said Georges Benjamin, executive director of the American Public Health Association. “It has profound implications for our ability to not just take care of people with Covid but [also] the other diseases that are out there.”  

The American Nurses Association is urging US officials to declare the nursing shortage a national crisis, and the American College of Emergency Physicians has expressed concerns the shortage will affect patient care.

Ontario LTC homes call for mandatory COVID-19 vaccines for all health-care workers

Via The Globe and Mail, a report by The Canadian Press: Ontario LTC homes call for mandatory COVID-19 vaccines for all health-care workers.

Ontario long-term care homes are asking the province to mandate COVID-19 vaccination for their staff as well as health-care workers in all settings. 

The Ontario Long-Term Care Association says making vaccines mandatory provincewide would both protect residents and ensure facilities don’t lose their staff to other health-care facilities. 

The province requires staff in long-term care homes to disclose their COVID-19 vaccination status, and those who are unvaccinated for non-medical reasons have to undergo education about the importance of immunization. 

But Premier Doug Ford has refused to mandate vaccines in any setting. 

He has spoken in support of a Toronto hospital network’s policy that unvaccinated staff – and those won’t disclose their vaccination status – have to take a COVID-19 test before coming to work. 

The long-term care association’s call to make vaccines mandatory for health workers echoes recommendations from the Ontario Medical Association and the Registered Nurses’ Association of Ontario.

Delta is worse. This time around, Alabama is facing a two-front war

Via The Washington Post, a powerful and disturbing op-ed by Dr. Michael Saag of the University of Alabama at Birmingham: Delta is worse. This time around, Alabama is facing a two-front war. Excerpt:

As we entered into the July Fourth weekend, many Americans celebrated as if the epidemic had ended: traveling in record numbers and engaging in large gatherings with no masks and no social distancing. All the while, many of those celebrating were unvaccinated and immunologically vulnerable. With the delta variant going from zero cases in March to 60 percent of cases by mid-July, we were approaching a near-perfect storm. 

Now we are in it. Cases are exploding. Here in Alabama, the state with the lowest vaccination rate (less than 35 percent), rates of infection have risen from less than three cases per 100,000 people four weeks ago to more than 54 cases per 100,000 this week. 

Suzanne Judd at the University of Alabama at Birmingham School of Public Health generated models that show, by Labor Day, cases will skyrocket to two to three times the peak we experienced in January. At our 1,157-bed hospital in Birmingham, Alabama’s largest, we have risen from three cases in-house in mid-June to more than 67 cases on Wednesday. Statewide, the rise exceeds 500 percent since July 4. 

These trends are terrifying and, as a virologist who had covid-19 last spring, I can say they induce a kind of pre-traumatic stress in our health-care workers. We know what’s coming. We’ve experienced this trauma before. We don’t want to do this again, but the die is already cast. My fellow health-care workers are being thrown back into the fire, like servicemen and women going back for a third tour of duty in a war zone. 

This week alone, one infectious-disease colleague and four ER physicians, all fully vaccinated, have become ill with the variant. This is very different from what we experienced before. Delta is different. 

With the current spike of cases, 99 percent of deaths are occurring in unvaccinated people. Almost all of these are preventable. That is particularly troublesome to health-care workers who struggle valiantly to save the lives of those who now present to the hospital, the vast majority of whom chose not to be vaccinated. 

Making it worse is the hate we experience from a small, but very real, group of people who seek to undermine our efforts through the steady release of misinformation in social media and elsewhere. I received an inquiry this week from a person who claimed to be a CNN reporter, initially asking me for information about delta and then demanding “proof” that delta is here. Despite my best effort to explain, I was berated with accusations that I was making this up. (He later posted most of the exchange on Facebook.) 

I am not alone in suffering these types of attacks. It is this sort of behavior that has led to poor vaccine uptake among many people and resulted in this new spike of cases. 

Despite the static and misinformation, we will get it done. It will be helpful, however, if this time around we pull together as a country, ignore those who spew hate and sow mistrust of those trying to serve the public. The virus is a formidable enemy and terrifying enough. We can’t afford to be fighting a two-front war.

Doctors, nurses and other health groups call for mandatory vaccinations for all health workers

Via The Washington Post: Doctors, nurses and other health groups call for mandatory vaccinations for all health workers. Excerpt:

Medical groups representing millions of doctors, nurses, pharmacists and other health workers on Monday called for mandatory vaccinations of all U.S. health personnel against the coronavirus, framing the move as a moral imperative as new infections mount sharply. 

“We call for all health care and long-term care employers to require their employees to be vaccinated against covid-19,” the American Medical Association, the American Nurses Association and 55 other groups wrote in a joint statement shared with The Washington Post. “The health and safety of U.S. workers, families, communities, and the nation depends on it.” 

The statement — issued by many groups calling for a mandate for the first time — represents an increasingly tough stance by the medical and public health establishment amid the sluggish pace of national vaccinations. It comes as new cases rip through the nation, driven by the hyper-transmissible delta variant. Confirmed coronavirus infections have nearly quadrupled during July, from about 13,000 cases per day at the start of the month to more than 50,000 now, according to The Post’s tracking. Hospital leaders in states such as Alabama, Florida and Missouri have implored holdouts to get vaccinated, citing data that the shots prevent hospitalizations and even death. 

But many workers in the health field remain unvaccinated, despite having priority access to coronavirus vaccines, which first became available in December. More than 38 percent of nursing home staff were not fully vaccinated as of July 11, despite caring for patients at elevated risk from the coronavirus, according to data collected by the Centers for Medicare and Medicaid Services and analyzed by LeadingAge, which represents nonprofit nursing homes and other providers of elder care. 

An analysis by WebMD and Medscape Medical News estimated that about 25 percent of hospital workers who had contact with patients had not been vaccinated by the end of May.

Indonesia reports record number of doctor deaths from COVID-19 in July

Via Reuters: Indonesia reports record number of doctor deaths from COVID-19 in July. Excerpt:

JAKARTA, July 18 (Reuters) - Deaths of doctors from COVID-19 in Indonesia rose sharply in the first half of July, according to the profession's association, as the Delta variant of the coronavirus fuelled a surge in infections across the country. 

A total of 114 doctors died during July 1-17, the highest number reported for any period of similar length and more than 20% of the 545 total doctor deaths from COVID-19 since the beginning of the pandemic, officials from Indonesia's doctors association (IDI) said during a virtual news conference. 

Mahesa Paranadipa, a senior IDI official, said the association was concerned that the medical system may not be able to cope, according to a recording of the event. 

"We are worried about the potential of a functional collapse," Paranadipa. "This is the reported data, not yet data that may not have been reported to us."

Doctors deaths have increased in Indonesia, the world's fourth most-populous nation, despite a 95% vaccination rate among health workers. This has prompted the government to use a batch of Moderna vaccines as booster shots to China's Sinovac for healthcare workers. 

Fuelled by the spread of the more virulent Delta variant, Indonesia has reported more new coronavirus cases than any country in the world in recent days, data from the latest seven-day average from a Reuters tracker showed. It was second only to Brazil in terms of the number of deaths. 

Health experts are calling the country the new epicentre of the pandemic. Indonesia reported 44,721 cases and 1,093 new deaths from the virus on Sunday.

Hundreds of vaccinated medical workers in Indonesia hospitalized

Via Medscape.com: Hundreds of Vaccinated Medical Workers in Indonesia Hospitalized. This could have serious implications for populations vaccinated with Sinovac.

More than 350 doctors and medical workers in Indonesia who received a Chinese-made COVID vaccine have tested positive for the virus, Reuters reported. 

Most are asymptomatic but dozens have been hospitalized with a high fever and other symptoms, Badai Ismoyo, head of the health office in the district of Kudus in central Java, told Reuters. 

Health care workers in Indonesia were among the first to be vaccinated. Almost all of them were given the vaccine developed by Chinese biopharmaceutical company Sinovac, the Indonesian Medical Association (IDI) told Reuters. 

The number of infected medical workers raises questions about how well that vaccine works against the Delta variant, which is thought to be causing the recent surge in cases in Indonesia. 

"The data shows they have the Delta variant (in Kudus) so it is no surprise that the breakthrough infection is higher than before, because, as we know, the majority of healthcare workers in Indonesia got Sinovac, and we still don't know yet how effective it is in the real world against the Delta variant," Dicky Budiman, an epidemiologist at Australia's Griffith University, told Reuters. 

The World Health Organization said the Sinovac vaccine prevented symptomatic disease in 51% of recipients and prevented severe COVID-19 and hospital stays, Reuters said. 

Last month, the WHO gave emergency authorization for the Sinovac vaccine, meaning it could be used in COVAX, the global vaccination program for low-income nations, Reuters said. 

The pandemic has hit Indonesia hard. The WHO says the nation of about 270 million people recorded more than 1.9 million infections and 53,000 deaths. Reuters said around 950 doctors and nurses have died in the pandemic. 

Reuters, citing health ministry data, reported that Indonesia recorded 12,624 new COVID infections on Thursday, the most since Jan. 30.

COVID-19 creates conditions for emergence of 'superfungus' in Brazil

Via medicalexpress.com, a FAPESP report: COVID-19 creates conditions for emergence of 'superfungus' in Brazil. Excerpt:

Fully occupied intensive care units (ICUs). Physically and mentally exhausted health workers. Chaotically overcrowded hospitals. These and similar problems posed by the COVID-19 pandemic in Brazil have created ideal conditions for the emergence of Candida auris, a microorganism some are calling a "superfungus" because of the speed with which it has developed drug resistance. 

The first two cases were confirmed in December 2020 at a hospital in Salvador (state of Bahia, Northeast Brazil), and are described in the Journal of Fungi by a group of researchers led by Arnaldo Colombo, head of the Special Mycology Laboratory at the Federal University of São Paulo (UNIFESP). The study was supported by São Paulo Research Foundation—FAPESP. 

"Nine other C. auris patients have since been diagnosed at the same hospital, some colonized [with the fungus in their organism but not doing harm] and others infected," Colombo told. "No other cases have been reported in Brazil, but there are grounds for concern. We're monitoring the evolutionary characteristics of C. auris isolates from patients at the hospital in Salvador, and we've already found samples with reduced sensitivity to fluconazole and echinocandins. The latter belong to the main class of drugs used to treat invasive candidiasis." 

Except for C. auris, fungi of the genus Candida are part of the human gut microbiota and cause problems only when there are imbalances in the organism, Colombo explained. These include infections such as vaginal yeast infection and thrush (oral candidiasis), often caused by C. albicans. 

In some cases, however, the fungus enters the bloodstream and causes a systemic infection known as candidemia, the most common form of invasive candidiasis, similar to bacterial sepsis. Invasion of the bloodstream and the immune system's exacerbated response to the pathogen can cause damage to several organs and even lead to death. According to scientific evidence, mortality among candidemia patients infected by C. auris can reach 60%. 

"The species quickly becomes resistant to multiple drugs and isn't very sensitive to the disinfectants used by hospitals and clinics," Colombo said. "As a result, it's able to persist in hospitals, where it colonizes health workers and ends up infecting patients with severe COVID-19 and other long-stay critical patients."