H5N1

Health officials expect more coronavirus cases, but say risk of outbreak in Canada remains low

Via CBC News: Health officials expect more coronavirus cases, but say risk of outbreak in Canada remains low. Excerpt and then a comment:

Federal health officials expect more cases of the coronavirus, but say the risk of an outbreak in Canada remains low.  

Health Minister Patty Hajdu said officials at all levels of government are working with hospitals and international partners to prevent and respond to potential infections.   

"We're working actively to limit the spread of the virus," Hajdu said at a news conference in Ottawa Sunday morning after the first "presumptive" case of coronavirus was reported in Toronto. 

Hospitals have an "incredibly strong" system to prevent and control infections, she said.

Hajdu said much has been learned from the SARS virus in 2003. Since the first cases of this novel coronavirus were reported in China in December, the federal government has been in close contact with the provincial health authorities and international players to share information in a "collaborative, responsive" approach.

Hajdu said there is considerable misinformation being spread about the virus which "belies the reality" that the risk to Canadians remains extremely low. C

BC News has reported that misinformation and unverified claims about the virus have been circulating on social media.  

While the government does not expect a chartered plane is necessary to evacuate Canadians from the Wuhan region where the outbreak began, Hajdu said Global Affairs Canada stands ready to provide support services for any Canadian trying to leave China. 

CBC News has learned that one Canadian will be on board a flight chartered by Washington to fly diplomats and Americans out of Wuhan. A government official said 67 Canadians are registered as being in the affected region, but because registration is voluntary, the figure does not give a complete picture of Canadians in Hubei or in China. 

Canada's Chief Public Health Officer Theresa Tam said despite the fact the number of cases in China is increasing, the export to other countries remains low and the risk remains low in Canada.  

Tam said the reported case Saturday was "not unexpected."

I completely agree that Canadian hospitals and the healthcare system in general will handle this well. SARS sandbagged us in 2003 because the Chinese had been too secretive about it; this time we've had a month to prepare a system already primed for such an event.

Meanwhile, I'm increasingly anxious about the political and economic consequences of the outbreak, which the world's media have so far ignored.

 

Quite about from the collateral damage to routine healthcare in China, which will likely cause more illness and death than coronavirus itself, I worry about a Chinese economy that's hemorrhaging money due to lost production, shuttered tourism, and a crippled transportation system.

 

I also worry about the political and social unrest that is already simmering below the surface: distrust of the healthcare system leading to resentment of a repressive government and all its other institutions. President Xi Jinping has already sent his own Beijing people to Wuhan to run the response, which shows how seriously he's taking the outbreak.

 

I tried to outline these concerns in a recent Tyee article, and the last two days have only worsened my anxiety. If China staggers, the whole world will shudder.

China coronavirus: Death toll rises to 41; more than 1,000 cases of infection confirmed in mainland

Years ago I spoke with a European healthcare worker who talked about "the pandemic" (H1N1 in 2009) the way combat veterans talk about "the war." He even had the thousand-yard stare I'd seen in Vietnam veterans. 

 

Today's healthcare workers are likely to talk about "coronavirus" the same way, and with the same faraway stare. Via the South China Morning Post: China coronavirus: Death toll rises to 41; more than 1,000 cases of infection confirmed in mainland. Conditions in Wuhan presage conditions in healthcare systems around the world: 

A medical doctor suspected to have coronavirus died on Saturday in Hubei – marking the first death of a medical professional since the outbreak of the virus – as the number of confirmed cases in mainland China exceeded 1,000. 

Liang Wudong, a surgeon at Xinhua Hospital in Hubei province, died at 7am at the age of 62, Shanghai-based news portal thepaper.cn reported. 

Liang was suspected of being infected last week, before he was transferred to Wuhan’s Jinyintan Hospital for treatment.

Some 29 provinces in China have reported 1,287 cases of the deadly pneumonia-like virus, with 729 in Hubei, the epicentre of the outbreak, according to data released by local governments on Saturday. 

Hubei’s death toll was 39, with the other two fatalities in the provinces of Hebei and Heilongjiang. 

Cases have also been reported in Hong Kong, Macau, Taiwan and eight other countries.

Tens of millions of people in Hubei are effectively on lockdown as a travel ban has been imposed on most of the province. 

Flights, trains, buses and ferries connecting Wuhan to other cities in Hubei have been suspended. Wuhan is the hub for several major high-speed rail lines. 

Eighteen Chinese provinces have activated a top-level public health emergency response to the outbreak, meaning public events, businesses and schools can be suspended and the migrant population quarantined in these areas. 

In Wuhan, video footage of people desperately seeking help was widespread on social media. Some nurses and doctors were reported to be suffering emotional breakdowns in hospital consulting rooms while outpatients crowd corridors with some pictured lying on the floor. 

More than 20 hospitals in Wuhan have posted statements pleading for aid from various sectors as there has been a shortage of masks, latex gloves, protective goggles and surgical gowns.

Hubei has also tightened restrictions on private vehicles from Wuhan. A notice posted by a petrol station in Chibi, next to Wuhan, said all fuelling stations in the city were now off-limits to vehicles with Wuhan licence plates, on orders of the Chibi municipal government. 

On Friday, China Development Bank granted a 2 billion yuan (US$288.3 million) emergency loan to Wuhan for virus prevention and treatment. On Thursday, China’s finance ministry announced an allocation of 1 billion yuan to be used by Hubei authorities to halt the contagion’s spread.

DRC Congo: Who's minding the Ministry of Health?

While trying to learn more about the undiagnosed outbreak in Mai-Ndombe this morning, I checked the DRC Ministry of Health website for the first time in months. It was a discouraging experience.

The site seems abandoned. Major stories are a year old, or older. Dr. Oly Ilunga Kalenga is still listed as minister of health in a May 2018 post about the start of the Equateur Ebola outbreak, but the post is just one sentence long.

Meanwhile the ministry's Twitter account hasn't been updated since last September.

This seems to be the unwelcome result of the ouster of the former health minister, Dr. Oly Ilunga Kalunga. He objected to the government's decision to go ahead with a second Ebola vaccine, and the result was a whole new Ebola agency, CMRE, led by Dr. Jean-Jacques Mutembe Tamfum. Ilunga soon found himself being interrogated by the police over charges of misusing Ebola response funds, but I haven't seen anything about him in months. He too has vanished from Twitter.

The new minister of health, whose name I can't recall, does turn up in occasional news reports about Ebola, always as second fiddle to Dr. Mutembe. Meanwhile, the DRC has also been battling the worst measles outbreak in the world, cholera, and a host of other ills. Not a word of these outbreaks on the ministry website.

The MoH hasn't disappeared; it's certainly engaged on the measles response and other health campaigns. But it's alarming when the ministry of health of a very large country effectively vanishes from online communication with the rest of the world.

Bushfires expose weaknesses in Australia's health system

Via The Lancet: Bushfires expose weaknesses in Australia's health system. Excerpt:

Australia is in the grip of unprecedented bushfires that have affected every state across the country. The threat to lives, homes, and wildlife has already resulted in more than 20 deaths and 2000 homes lost, millions of acres burned, and up to 1 billion animals dead. 

While Australia has one of the world's most robust health-care systems, the crisis has not only left doctors unprepared to deal with the health impacts of climate change, but it has also revealed that the health system was not fully equipped to handle the massive humanitarian impact such a crisis would have on communities. 

At the time of writing, dozens of fires continued to burn out of control across large swaths of the country, exposing people to toxic smoke and putting firefighters and rescue workers in grave danger of serious injury and death. For weeks on end, smoke haze has blanketed parts of the country, including Sydney and Canberra, where millions of people live. Air quality in Canberra—which made headlines around the world—reached more than 22 times the hazardous level set by WHO. In Sydney, some suburbs have experienced air quality more than ten times the hazardous limit. 

Arnagretta Hunter, a cardiologist in Canberra, told The Lancet she had seen an increase in patients, particularly those with respiratory problems and people with underlying lung and heart problems. She said there had also been an increase in infections including urinary tract infections and skin infections, likely to be attributed to fine particulate matter exposure. 

Hunter said she had been giving advice such as to stay inside and avoid physical activity, but that “I don't think we have any real idea” of the health impacts of such exposure. 

“In Australia, we are used to having clean air; air pollution is not an issue. Our health brains do not work like this”, she said. “We have a robust health system and we are good at providing high-level health to our population [but] the planning for the health impacts of climate change has been almost non-existent. Our system was not prepared for this. Hospitals are working in disaster mode. I think we will be able to measure the impact of this crisis in life expectancy in the next 12 months.” 

Her concern follows the Australian Medical Association (AMA) warning that prolonged exposure to toxic smoke could affect the health of many Australians. “The length and density of smoke exposure is a new and possibly fatal health risk”, AMA President Tony Bartone said in a statement. “With denser smoke haze and longer periods that people endure smoke inhalation, there is a much higher risk that previously healthy people will face developing serious illness.” 

Meanwhile, Ewen McPhee, immediate past president of the Australian College of Rural and Remote Medicine and a general practitioner (GP) based in central Queensland, said a lack of preparation for the health impact of the bushfires was leaving rural communities vulnerable. “There was no preparation for impaired air quality, with the federal government only now releasing funds to source P2 masks in the millions for rural people”, he said.

WHO: Deaths from DR Congo measles outbreak top 6000

WHO AFRO has published Deaths from Democratic Republic of the Congo measles outbreak top 6000.

Kinshasa, 7 January 2020 – With the death toll from the world’s worst measles epidemic in the Democratic Republic of the Congo (DRC) surpassing 6000, the World Health Organization (WHO) is calling for more funding to stop the outbreak.  

Under the leadership of the DRC Ministry of Health, WHO, Gavi, the Vaccine Alliance, and other partner aid agencies vaccinated more than 18 million children under five across the country in 2019. However, in some areas, routine vaccination coverage remains low and 25% of the reported measles cases are in children over the age of five, who are the most vulnerable. 

“We are doing our utmost to bring this epidemic under control. Yet to be truly successful we must ensure that no child faces the unnecessary risk of death from a disease that is easily preventable by a vaccine. We urge our donor partners to urgently step up their assistance,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

Since the start of 2019, around 310 000 suspected measles cases have been reported. The epidemic has been aggravated by low vaccination coverage among vulnerable communities, malnutrition, weak public health systems, outbreaks of other epidemic-prone diseases, difficult access by vulnerable populations to health care and insecurity that has hampered response in some areas.  

Lack of funding remains a huge impediment to successfully curbing the outbreak. So far, US$ 27.6 million have been mobilized. However, a further US$ 40 million are required for a six-month plan to extend the vaccination to children between six and 14 years and to reinforce elements of the outbreak response beyond vaccination, including improving treatment, health education, community engagement, health system strengthening, epidemiological surveillance and response coordination.  

“We recognize the Government’s engagement in the efforts to end the outbreak and we are grateful for the generosity of our donors. But we still need to do more,” said Dr Amédée Prosper Djiguimdé, Officer in charge of WHO office in the DRC. “Thousands of Congolese families need our help to lift the burden of this prolonged epidemic from their backs. We cannot achieve this without adequate finances.” 

The European Civil Protection and Humanitarian Aid Operations, Gavi, the Vaccine Alliance, Médecins du Monde, Médecins Sans Frontières, United Nations Children’s Fund, WHO and other partners have been supporting the Government to bring the long-running epidemic under control. In December 2019, WHO trained 60 health professionals from the Ministry of Health to conduct a range of services, including community engagement, health education and surveillance. These health professionals are being deployed this week as part of the response.

Hong Kong: Government launches Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance

Via the Centre for Health Protection: Government launches Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance. The full statement and then a comment:

The Government today (January 4) launched the Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance (The Plan). In parallel, the Serious Response Level was activated with immediate effect.        

The Plan sets out the Government's preparedness and response plan in case of an outbreak of Novel Infectious Disease of Public Health Significance. A three-tier response level is adopted in the plan. Three response levels, namely Alert, Serious and Emergency, will be activated based on the risk assessment of the Novel Infectious Disease of Public Health Significance that may affect Hong Kong and its health impact on the community.        

Upon the risk assessment of the cluster of cases of viral pneumonia with unknown cause in Wuhan reported by the National Health Commission, the Serious Response Level was activated. Under the Serious Response Level, the immediate health impact caused by Novel Infectious Disease of Public Health Significance on local population is moderate.        

"'Novel Infectious Disease of Public Health Significance' refers to any infectious disease caused by a pathogen unknown to cause human disease before, but may have changed its property to cause human infection with or without the ability of efficient human-to-human transmission. The disease has the potential to lead to international spread and public health emergency. The current cluster of viral pneumonia cases in Wuhan can be regarded as a Novel Infectious Disease of Public Health Significance," a spokesman for the Centre for Health Protection (CHP) of the Department of Health said.        

"The Government will assess the risk from time to time in view of the latest scientific evidence and situation, activate or deactivate the response level and implement corresponding measures," the spokesman said.        

For more information, please refer to the Plan which has been uploaded to the CHP's website (www.chp.gov.hk/files/pdf/govt_preparedness_and_response_plan_for_novel_infectious_disease_of_public_health_significance_eng.pdf).

Hong Kong's CHP was established after the shock of the 1997 H5N1 outbreak, and ever since it's been an exemplar of a public health agency. If sniffles break out in a kindergarten, or someone comes home from Dubai a bit feverish, CHP will be on the scene and prepared to tell the world what's infected the kids and whether the traveller has MERS (so far, not a single person).

H5N1 may have fizzled out, but the Hong Kong Centre for Health Protection has not.

Climate change, crime and political chaos: A deadly mix in Honduras dengue epidemic

Via The New York Times: Climate Change, Crime and Political Chaos: A Deadly Mix in Honduras Dengue Epidemic. Excerpt:

CHOLOMA, Honduras — More than 400 people died this year as one of the worst dengue epidemics on record swept through Central America — a type of outbreak that some scientists and public health officials are warning is likely to become more frequent and more widespread because of climate change.  

But while climate change is threatening to increase the spread of dengue worldwide by expanding the range of the mosquitoes that carry the virus, the disease has already found an especially fertile breeding ground in Honduras, for reasons that go beyond the environment.  

In Honduras, which accounted for more than 40 percent of the dengue deaths in Central America this year, according to the Pan American Health Organization, the effects of climate change have been compounded by government dysfunction, political tumult and public apathy. 

Dengue has hit the country hard. This year, it had more than 107,000 cases of the viral disease — more than 13 times the number recorded last year — and at least 175 deaths. In 2018, only three people in Honduras died from the disease, according to the Pan American Health Organization.

Honduras’s notorious criminality has worsened matters, too, as public health teams, already stretched thin by budget cuts and a lack of trained personnel, have been blocked by gangs from entering some of the most severely afflicted neighborhoods to educate residents and fumigate against mosquito infestations.  

Dengue is transmitted to humans by a type of mosquito called Aedes, which thrives in urban areas of the world’s tropical and subtropical regions. Tens of millions of cases occur each year in more than 100 countries, and symptoms may include fever, internal bleeding and shock. Inadequately treated, the illness can quickly kill. 

In Honduras, health officials trace the start of the current epidemic to the fall of 2018. The number of incidents then rose sharply during the first half of 2019, hitting a peak this summer before falling off as the year ended. A nationwide health emergency declared in July by the administration of President Juan Orlando Hernández remains in effect.  

The outbreak struck during a time of political turbulence in Honduras, with violent street protests against Mr. Hernández and calls for his ouster. Some of the protests have been driven by fears the government planned to privatize the health and education sectors. 

The nation also suffers from high murder rates and widespread poverty, which have combined to drive tens of thousands of Hondurans in recent years to emigrate, with many trying to make it to the United States.  

The dengue outbreak has met little resistance from a public health system gutted by budget cuts and pervasive corruption, analysts and officials said.  

“It’s a collapsed system, an inefficient system,” said Ismael Zepeda, an economist with Fosdeh, a research group in Tegucigalpa, the capital.

MSF: DRC Ebola outbreak crisis update, December 2019

MSF.org has published DRC Ebola outbreak crisis update. The summary: 

Democratic Republic of Congo (DRC) declared their tenth outbreak of Ebola in 40 years on 1 August 2018. The outbreak is centred in the northeast of the country, in North Kivu and Ituri provinces, with cases also now appearing in South Kivu. With the number of cases having surpassed 3,000, it is now by far the country's largest-ever Ebola outbreak. It is also the second-biggest Ebola epidemic ever recorded, behind the West Africa outbreak of 2014-2016.  

During the first eight months of the epidemic, until March 2019, more than 1,000 cases of Ebola were reported in the affected region. However, between April and June 2019, this number doubled, with a further 1,000 new cases reported in just those three months. Between early June and the beginning of August, the number of new cases notified per week was high, and averaged between 75 and 100 each week; since August, this rate has been slowly declining, with just 70 cases identified throughout all of October.

While there are positive signs that the number of cases is slowly reducing, the outbreak remains a serious public health concern, and it is unclear when it may end. 

Although the proportion of new Ebola cases previously identified and monitored as contacts has increased in the last three months, the rate is still hovering at around one-third. However, 40 per cent of new Ebola cases were never registered as contacts, showing that identifying and following up contacts of people diagnosed with Ebola remains difficult. Reasons include the movement of people (such as in the case of motorbike taxi drivers), to downright fear in some communities which hinders engagement. 

New Ebola patients are confirmed and isolated with an average delay of five days after showing symptoms, during which time they are both infectious to others and miss the benefit of receiving early treatments with a higher chance of survival.  

On 11 June 2019, Uganda announced that three people had been positively diagnosed with Ebola, the first cross-border cases since the outbreak began. After several weeks with no recorded cases, the Ugandan government announced a new case on 29 August; the patient, a young girl, sadly died. 

On 14 July 2019, the first case of Ebola was confirmed in Goma, the capital of North Kivu, and a city of one million people. The patient, who had travelled from Butembo to Goma, was admitted to the MSF-supported Ebola Treatment Centre in Goma. After confirmation of lab results, the Ministry of Health decided to transfer the patient to Butembo on 15 July, where the patient died the following day. On 30 July, a second person in Goma was diagnosed with Ebola; they died the next day and two more cases were announced.  

No new cases have since been recorded in either Uganda or in Goma.  

In reaction to the first case found in Goma, on 17 July 2019, the World Health Organization (WHO) announced that the current Ebola outbreak in DR Congo represents a public health emergency of international concern (PHEIC).  

In mid-August, the epidemic spread to neighbouring South Kivu province - becoming the third province in DRC to record cases in this outbreak - when a number of people became sick in Mwenga, 100 kilometres from Bukavu, the capital of the province. 

Given the ongoing challenges in responding to the outbreak, MSF believes that Ebola-related activities should be integrated into the existing healthcare system, in order to improve proximity of the services to the community and ensure that it remains functional during the outbreak.

Is it Ebola, or just a drill? How to test a public health crisis response

Via The Conversation Africa: Is it Ebola, or just a drill? How to test a public health crisis response.

There wasn’t an Ebola outbreak in Lesotho – but for a few hours in November 2019, you may have heard that there was. 

On November 14, Lesotho public health authorities conducted a simulation exercise involving a woman who was rushed to hospital and tested positive for Ebola after crossing the border from South Africa. Media picked up on this event and reported it as if it were true. But a few hours later it was revealed that there had been no Ebola case in Lesotho, and this event was only a drill. 

The Lesotho government was conducting a public health simulation exercise. When done properly, a simulation exercise is a useful tool for evaluating preparedness for a public health emergency. When done poorly, a simulation exercise can cause unnecessary panic in local or international communities. Here, we’ve drawn on our experience in Liberia to outline how to properly plan and execute a simulation exercise.  

What is a simulation exercise? 

A public health simulation exercise is a test of an emergency response system. Simulation exercises are used to develop emergency response protocols, train staff, and monitor and evaluate the capability of the public health system to respond to emergencies. Regular exercises make it possible to identify areas for improvement and ensure that a health system will be able to respond appropriately to a true crisis. 

The World Health Organisation (WHO) lays out guidelines for planning various types of simulation exercises. Simulation exercises can range from tabletop discussions to partial tests to full-scale field exercises. 

The simulation in Lesotho was a full-scale exercise. This is the most complex type, intended to mirror real-life emergency situations as closely as possible. It tests many components of an emergency plan and may involve many organisations and multiple countries. Full-scale exercises are immensely valuable for testing emergency management plans under close-to-real conditions. But they are difficult to plan and can cause alarm in the wider community if not executed thoughtfully and deliberately.  

Planning a simulation 

Planning a simulation exercise should involve discussions with key stakeholders about the purpose, scope and objectives of the exercise. An exercise management team should be created to develop and conduct the exercise. This will typically include a project management plan, identification of participants and logistics management. 

The people being tested – such as local health workers – should not be told that they are undergoing a simulation exercise. After all, the purpose is to assess what would occur in a true emergency. That said, key stakeholders who are not being tested should be made aware that a simulation exercise is under way. Otherwise they may respond as if there were a real crisis, leading to unnecessary mobilisation.  

Key stakeholders may include the leaders of ministries such as health, information and internal affairs; members of the media; and leaders of partner organisations who may be involved in a public health response. If the simulation involves multiple countries, stakeholders in each country should be informed.  

Stakeholders should be informed in advance and updated while the simulation exercise is under way. It is very important that the word “simulation” or “exercise” is displayed prominently in all communication.  

Media organisations should be informed ahead of time. If news media outlets hear about the event but are unaware that it is a simulation, they may report it as if it were true. This can cause unnecessary panic.

NHS England 'on its knees' as performance figures hit new lows

Via The Guardian: NHS England 'on its knees' as performance figures hit new lows.

The NHS was “on its knees” even before winter had begun, health service bosses have said as figures showed it missed key waiting-time targets for A&E care, operations and cancer treatment.  

The performance of the NHS in England in November was yet again its worst ever, prompting concern that it cannot keep up with a relentless rise in the number of people needing care. 

Doctors’ leaders called for Boris Johnson’s government to take urgent action to boost staffing, hospital bed numbers and GP services.  

“These figures show an NHS on its knees and it is no wonder that most leaders predict that this winter will be the worst on record,” said Niall Dickson, the chief executive of the NHS Confederation. “More and more patients are turning up at emergency departments and there is a limit as to how many they can cope with.”  

The latest set of monthly performance figures published by NHS England show:  

• 71% of patients who attended a hospital-based A&E unit in November were seen and discharged, admitted or transferred within four hours – a record low. 

• Hospitals were 95% full, far beyond the 85% that doctors consider safe, even before the surge in demand that winter always brings. 

• The highest number of patients ever were forced to spend at least four hours on a hospital trolley waiting for a bed. 

• Thousands of hospital beds are being lost each week due to norovirus, the winter vomiting bug. 

• Flu is already putting serious strain on the NHS, sparking fears of a major outbreak this winter. 

The number of people waiting for a non-urgent operation has risen to 4.45 million. The numbers of people seeking help at A&E and being admitted as an emergency case were each at record highs last month. And hospitals managed to meet only three of the eight NHS-wide targets for cancer treatment. 

“What we are seeing is a health service that is on a downward spiral as this month we see yet another set of shambolic figures,” said Dr Chaand Nagpaul, the chair of the British Medical Association. 

He blamed the Conservatives for creating the dire situation. “Day one of the new government and another set of stark NHS performance figures. They are not inheriting a problem, they created this problem, and the responsibility ultimately lies with them to fix it.”  

In recent weeks growing numbers of hospitals have had to declare a black alert – an admission that they cannot cope – as they have been overwhelmed by the number of patients seeking care. 

“We’ve seen an early spike in flu, while others have been battling norovirus cases, which are already double the levels we saw last year,” said Miriam Deakin, the director of policy and strategy at NHS Providers, which represents NHS trusts.