H5N1

Patient attendance decreases with the new modalities of free healthcare in Butembo

Via Radio Moto Butembo-Beni: Patient attendance decreases with the new modalities of free healthcare in Butembo. The Google translation:

After the new modalities of free healthcare, the attendance of patients has significantly decreased in health facilities. Declaration of Finance KAMASUA administrator health manager in health zone of Katwa. He said it in an interview with RMBB this Saturday 09 February 2019.  

"With regard to the contract amendment since January 16th, the movement of patients has become irregular within the structure, because there are certain diseases that have been discarded, and then there may have been a lot of conditions for care," said the health manager administrator in Katwa Health Zone. 

He took the opportunity to call those who frequent the health facilities calm in case of the presence of the police in these structures. 

"This is true, it's something that may be normal, but I'll ask that the patient be calm and appeased about the situation that happens to him, and when someone is told is suspicious, it is not the end of the world. A suspect is this one now where we will investigate to see if he is really sick of Ebola," he added.  

Recall that since Wednesday, January 16, 2019, we have reduced the package of the service covered by free care in health areas concerned.

Ebola in the Democratic Republic of the Congo: Time to sound a global alert?

Via The Lancet: Ebola in the Democratic Republic of the Congo: time to sound a global alert? Excerpt:

The epidemic of Ebola virus disease in the Democratic Republic of the Congo (DRC) is the second largest in history after the 2014 west African epidemic. A storm of detrimental factors complicates this event: armed conflict, political instability, and mass displacement. WHO, the DRC Government, and non-governmental organisation (NGO) partners have shown remarkable leadership but are badly stretched. The outbreak remains far from controlled, risking a long-term epidemic with regional, perhaps global, impacts. 

Faced with an evolving complex humanitarian crisis, and recent elections complete, WHO Director-General Tedros Adhanom Ghebreyesus should reconvene the Emergency Committee (EC) and consider declaring a Public Health Emergency of International Concern (PHEIC). The first EC report on Oct 17, 2018, called for “intensified” action, fearing “significant deterioration”. 

The EC's fears have been prescient. Cases of Ebola virus disease have more than tripled, with an expanded geographical footprint into 18 health zones. Governments, including the USA, have withdrawn personnel, fearing for their safety. 

Effective mitigation requires case identification. Yet less than 20% of new Ebola cases have been on known contact lists. This situation undercuts vital interventions, such as contact investigations, isolation, and safe burials. WHO might have to shift from ring vaccination to vaccination based on geographical location, but doing so effectively will require far more doses; limited vaccine supplies, therefore, are concerning. 

The risk of cross-border spread of Ebola virus disease to Uganda, Rwanda, and South Sudan is high. Tens of thousands of Congolese cross borders daily to trade, to visit family, or for funerals. Roads to Kigali and Kampala are well travelled and could facilitate Ebola transfer to large population centres. Uganda and Rwanda have fairly strong surveillance systems and are preparing for cross-border spread. Uganda vaccinated essential health workers and is reportedly screening all travellers at Entebbe airport. 

Yet cases could be missed at the border. South Sudan, meanwhile, is among the world's most fragile states. A widening epidemic of Ebola virus disease could destabilise the region and disrupt the tenuous peace in South Sudan, where violence continues and famine is predicted. In the past 6 months, 300 000 DRC refugees have crossed into Uganda, adding to a refugee population of about 1 million. The west African epidemic of Ebola virus disease in 2014–16 reduced regional economies by US$2·8 billion. Similar impact in DRC and neighbouring countries could devastate fragile economies. 

The legal criteria for a PHEIC have been met. The International Health Regulations (2005) (IHR) empower the WHO Director-General to declare a PHEIC. A PHEIC is an extraordinary event with public health risk to other countries that requires a coordinated international response. IHR criteria include public health impact, novelty and scale, and movement of persons. The WHO Director-General must also consider health risks, potential international spread, and EC guidance, among other factors.

Hospitals attacked in Khartoum, Sudan

A letter in The Lancet: Hospitals attacked in Khartoum, Sudan.

The Lancet recently highlighted the humanitarian crisis in Sudan (Jan 19, p 199). In the past weeks, tens of thousands of people across Sudan have been reported to have taken to the streets, calling for an end to President Omar al-Bashir's 30-year rule. According to credible reports received by Amnesty International, security forces had killed 37 protestors by Dec 24, 2018. 

The violent crackdown escalated, with security forces reportedly attacking hospitals in Omdurman on Jan 9, 2019, and Bahri on Jan 13, 2019. Crossing the threshold of hospital grounds is a saddening precedent for a government response that appears to deliberately target health professionals through violence and detention. 

That Sudan had repeated outbreaks of yellow fever, cholera, and Chikungunya, reported as recently as October, 2018, suggests a vulnerability of Sudan's neglected health system. This is in a country whose ruler was alleged in 2010 to have stashed billions of dollars in UK bank accounts. 

As Sudan's health professionals use their voices and bodies to peacefully demand a better health system, the international community should amplify these calls and hold the government to account when they shamefully defy norms by attacking hospitals, patients, and clinicians.

Butembo: Free healthcare has become partial

Via Radio Moto Butembo-Beni: BUTEMBO: Free healthcare has become partial. The Google translation is a bit confusing, but it's clear that healthcare—made free of charge in the hot zone for the duration of the Ebola outbreak—isn't entirely free any more.

This bias follows the failure to take care of certain diseases since the renewal of free on January 16, 2019. The announcement was made this Thursday, January 24, 2019 by the administrator managing the health institution, AGIS assigned to the KATWA Reference General Hospital. 

Confiding in the RMBB, this AGIS cited some diseases that are no longer treated free of charge in health facilities from January 16, 2019 to April 15, 2019. He cited in particular gynecology, surgery, any disease of internal medicine having a chronic character, known hypertension, diabetes and ambulatory care not referred. 

"According to the contract, it is until April 15, 2019. In this free, bias indexed the entire surgery: major or minor. There it is the patient who has to pay the bill of his care. The second is gynecological pathologies," he said. 

Nothing is yet known about the reasons for reducing the package of diseases supported by free care.

Ebola and war in the Democratic Republic of Congo: Avoiding failure and thinking ahead

Via JAMA: Ebola and War in the Democratic Republic of Congo: Avoiding Failure and Thinking Ahead. This article was published online last October, but its recommendations are still timely:

An expert consultation—with public health, humanitarian, security, anthropology, and human rights expertise—made the following recommendations to deepen US and global engagement, while recognizing key security details are not public.  

First, through the UNSC, the United States and allies should mobilize high-level political attention and resources for the Ebola response. Many lives are at risk if the epidemic is not rapidly contained. The Security Council should engage all parties, including the DRC and African Union, to achieve mitigation of armed attacks by the ADF and other militia; improved security for health workers; a comprehensive aid package to communities; stronger preparedness in neighboring states; and a contingency plan to sustain the response if security worsens. US ambassadors in the region should use all diplomatic tools available to ensure the viability of the response. 

Second, the US, along with allies and the UN, should develop a plan to deploy public health personnel to North Kivu. It is in US national interests to control outbreaks before they escalate into a crisis. The cost of addressing this epidemic now is far less than if mass mobilization were required due to international spread of the virus. The WHO and DRC have requested support from experienced personnel supported by US agencies. CDC and USAID experts could, for example, be embedded in the WHO or other UN agencies. The plan should include US security and diplomatic resources, coordinating with the UN, to assess and improve health worker security. Lessons can be drawn from humanitarian operations in unstable settings, including northern Nigeria and South Sudan. 

Third, US engagement should be closely coordinated with the WHO and the national government. The WHO is the lead health agency for containing potential PHEICs. When deploying US and other countries’ resources in a conflict zone, an uncoordinated response could be counterproductive. Strategic and operational engagement, therefore, should be part of a unified response with clear coordinating authority, starting with the DRC and WHO.  

Fourth, the United States should increase funding to the DRC to enhance local response capabilities. Congolese health leaders have much experience in containing Ebola outbreaks, but lack resources to detect, assess, and respond. Many health workers are not reliably compensated. African universities also have anthropology, communications, and health research capacities that could be resourced to deploy. Engaging the Congolese diaspora and using mobile communications for innovations in field epidemiology also may be valuable.  

Fifth, with the epidemic likely to continue for many months, the US and WHO should immediately collaborate to expand the response workforce. Building on the CDC’s Field Epidemiology Training Program, the US and WHO should rapidly train and equip more health workers to sustain a prolonged Ebola response. 

Sixth, longer term, the United States should craft a transparent framework for responding to epidemics in conflict zones. Risk aversion can impede early, effective intervention that prevents outbreaks from becoming crises. This is especially true when US agencies represent a significant part of global disease response capacity. The US, working proactively with partners, should develop a transparent framework for assessing and mitigating risk, balanced against the global public good of preventing PHEICs.  

Seventh, the US and international partners should ensure sustainable funding for national action plans for health security. The US helped launch the Global Health Security Agenda in 2014 to expand capacities in key countries and recently recommitted at the Global Health Security Agenda Ministerial in Indonesia. Investing in preparedness is much less costly than crisis response and enables burden sharing, “smart” diplomacy, local leadership, and public trust. 

Eighth, the UNSC should create a plan to safeguard public health action in conflict zones. In 2016, the UN secretary-general submitted specific recommendations to protect health workers under UNSC resolution 2286, but the council has not acted. It is certain that the UN will be called on to provide security in future health crises. It must prepare and maintain readiness for that eventuality.

Non-urgent patients wait up to 8 hours at Hong Kong’s public hospitals amid flu surge

Via the South China Morning Post: Non-urgent patients wait up to 8 hours at Hong Kong’s public hospitals amid flu surge – and things unlikely to get better before Lunar New Year. Excerpt:

Overcrowded public hospital wards are bracing for an even heavier winter flu load ahead of the Lunar New Year holiday next month, with non-urgent patients having to wait up to eight hours to see a doctor. 

The health authority last week announced the city had entered the winter peak season for influenza and warned virus activity could further increase in coming weeks. So far the surge has claimed eight lives. 

The Department of Health said the peak flu season normally lasted for at least a month, meaning the problem of packed wards could worsen ahead of the holiday, during which many doctors usually took a break. 

As of Friday, one child and seven adults had died of flu. Another 18 adults had severe cases of flu, while a six-year-old girl was critically ill with severe paediatric influenza. 

The overall occupancy rate at public hospitals was 109 per cent on Saturday, which meant temporary beds had to be laid along corridors or in between fixed ones. Tseung Kwan O Hospital had the highest occupancy, at 128 per cent, followed by Queen Elizabeth Hospital in Yau Ma Tei with 121 per cent. 

There were waiting times of up to eight hours at all accident and emergency units, according to Hospital Authority data. 

That came as a survey of 356 residents by the Business and Professionals Alliance found that more than a third were unsatisfied about perennially long waiting times at public hospitals and over half had waited at least two hours at casualty units. 

“The authority should seriously review the health care system, and assess whether they can cope with the shortage in resources and manpower. This is the root of the problem,” alliance community organiser Li Sze-man said. 

Also, 66 per cent reported having to wait an extra 30 minutes to pick up medication from the pharmacy while 20 per cent waited two hours or more for prescriptions.

Doctors’ strike in Sudan enters second week

While we watch political turmoil in the DRC and worry about its effect on the Ebola response, Sudan's healthcare sector is taking an active part in what begins to look like an overdue revolution. Via Radio Dabanga: Doctors’ strike in Sudan enters second week.

The strike called for by the Sudanese Central Doctors’ Committee has entered its second week. By last week,  the strike action had spread to at least 38 hospitals in Sudan, with increased government pressure on medics to return to work. 

Sudanese doctors have not only been treating those caught up in the violence, but also leading some protests. The UK Channel 4 TV station anonymously interviewed a doctor in Sudan who claimed that the security service deliberately arrested medics in Khartoum. “Wounded protesters end up in hospital. If you take out the doctors, you cripple the protests,” the doctor claimed. 

Doctor strikes 

Doctors started striking in several Sudanese states last week. Together with medical students of the Faculty of Medicine in El Gedaref they held a protest in front of El Gedaref Teaching Hospital in solidarity with the march organised by the Sudan Professionals Association in Khartoum on December 26. Witnesses from El Gedaref said that security forces and policemen forced the doctors to enter the hospital again before blocking traffic to the main road to the hospital. 

Vigils 

Doctors in Kassala Hospital notified authorities on December 25 that they will only deal with emergencies. The same day, doctors and lawyers in Port Sudan, capital of Red Sea state, organised two separate protest vigils. The vigils were dispersed by police using tear gas. 

On December 31, the security service in Sennar used tear gas to break up a peaceful march called by lawyers to hand over a memorandum. Witnesses told Radio Dabanga from Sennar that the march was joined by dozens of doctors, to hand over a memorandum to the judiciary demanding the regime to step down. 

The Sudanese Central Pharmacists Committee, in cooperation with the Community Pharmacists Committee and the Department of Pharmacy Owners announced a general strike and closure of all pharmacies in Khartoum state last week, in solidarity with the doctors and mass protests.

DR Congo: Free healthcare is doing well in different health facilities in Butembo

We often forget that even when a disease outbreak occurs, most people don't contract it—but they may well contract other diseases. If the healthcare system can't help them, the mortality rate from those diseases may well exceed that of the pandemic du jour.

The DRC Ministry of Health wisely declared that all healthcare in the Ebola hot zone would be free—creating an incentive for people to go on seeking healthcare rather than avoiding hospitals and clinics as Ebola death traps.

Via Radio Moto Butembo-Beni: Free healthcare is doing well in different health facilities in Butembo. The Google translation:

Statement made by Radio Moto Butembo-Beni this Thursday, January 3, 2019. At the Kitatumba Reference General Hospital, your reporter met the managing director of this health institution. In Matanda, Dr. NZANZU KALIMA indicated that the stock of drugs is always sufficient for the patients who frequent the structure. The sick continue to salute this act in these different structures. 

At the reference general hospital in Kitatumba we met the managing director of this health institution. Justin KWAMIRE confirms this free of charge. "The duration was estimated at 3 months. We are still in the free period. Maybe at the end of this month, the authorities will have to evaluate the work. It is now up to them to decide if the free will continue or stop as planned, " he said.  

At MATANDA General Hospital, this free treatment operation is also doing well. To the question of whether the stock of drugs is enough for the patients who attend the structure, Dr NZANZU KALIMA attending doctor at the Matanda hospital responded positively. At MIHAKE health center this free continues also. During this tour of RMBB in different health facilities in Butembo this Thursday, some patients continue to rejoice in this measure. 

"It's really free. In any case free. It is true we can do 3 days without being treated because of an exceptional craze in the hospital. We are happy, however, that in the end we will be treated," said a patient. 

Recall that the free care in some health institutions in Butembo health zones, Katwa, and Kalunguta Masereka began on 1st   November 2018 and will end January 31, 2019. During this time it is from the August 20 that this measure is in force in health zones of Beni, Mabalako and Oisha.

Sweden: Suspected case of Ebola in Uppsala

Thanks to Mary Marshall for alerting me to this story. Via Uppsala Nya Tidning: Suspected case of Ebola in Uppsala. Excerpt from the edited Google translation, and then a comment:

At 12:45 on Friday afternoon, Region Uppsala writes in a press release that a patient suspected of Ebola infection has entered the hospital in Enköping.  

"The patient came in to the hospital this morning. He then hadbloody vomiting, which can be a symptom of Ebola infection," says Mikael Köhler, chief medical officer at Region Uppsala and continues: 

"The patient came home from a trip to Burundi, in central Africa, three weeks ago, but should, as far as we know, not have visited areas where there is active Ebola infection. The patient has been moved to the Academic Hospital in Uppsala and is currently being cared for at the hospital's infection clinic. The patient is currently isolated. 

"The staff who care for the patient have special training for it. They also have special equipment in the form of protective clothing," says Mikael Köhler. 

Köhler says that the Ebola virus is not airborne, but very infectious via body fluids. It is mainly blood, but also sweat or saliva that can carry the infection.  

That the patient would be infected with Ebola is a suspicion, and is thus not confirmed. In the press release, Region Uppsala writes that test answers will probably come Friday night. 

"Until we know what this is about, we handle the case as if it were Ebola. The emergency room in Enköping will be closed until the test answers have arrived. The staff and the patients who were there when the suspected Ebola patient came, must remain there until then. The samples have been sent to the Public Health Authority."  

Mikael Köhler, chief medical officer at Region Uppsala, tells TT that the sick person is a younger man. Even the man's relatives are in the hospital. 

 "They are cared for and kept isolated," says Mikael Köhler.

This is almost certainly just a scare, but it's helpful to see how a well-equipped healthcare system responds to a potential threat.

UK hospitals expecting 'mayhem' when cold snap hits, top doctor says

Via The Guardian: UK hospitals expecting 'mayhem' when cold snap hits, top doctor says. Excerpt:

Hospitals will be hit by “mayhem” this weekend because of the coming cold snap, a growing number of people with flu and the NHS’s staffing problems, a leading doctor has warned.  

Dr Nick Scriven, president of the Society for Acute Medicine, said hospitals will face “severe difficulties” this weekend as lower temperatures lead to a surge in patients needing care. 

“Influenza is here and is already impacting the NHS and, with colder weather starting to set in, this will further stress already stretched services.  

“I and many colleagues across the country are anticipating mayhem this weekend as temperatures drop, but it will come as no surprise to us,” Scriven said. 

Some A&E units and intensive care units are already full, especially with people who have serious breathing problems, he disclosed. 

“Within the last week I have had colleagues warning of emergency departments and intensive care units being full, and that will only worsen in the coming weeks,” added Scriven. 

“Skeleton staffing” of social care services over the festive period has meant patients who were medically fit to leave had not been able to get home from hospital, he added. “The capacity problems this will cause will be profound,” he added. 

Hospitals’ ability to withstand a sudden increase in winter-related illness will also be compromised by the NHS being “horrendously understaffed”, Scriven said. Official figures show that the NHS in England has 103,000 vacancies, including for 42,000 nurses and 10,000 doctors. 

Scriven’s comments came as NHS England revealed that almost 40,000 people so far this winter have had to spend at least 30 minutes with an ambulance crew because A&E units were too busy to accept them.