H5N1

Every Tory MP sent This Is Going to Hurt as reminder of Jeremy Hunt's record

Via The Guardian: Every Tory MP sent This Is Going to Hurt as reminder of Jeremy Hunt's record. Excerpt and then a comment:

Adam Kay is sending a copy of his bestselling memoir about life as a junior doctor, This Is Going to Hurt, to all 330 Conservative MPs ahead of their vote on the new Tory leader, to remind them of how leading contender Jeremy Hunt “left the NHS in tatters” after his stint as health secretary. 

Hunt, who is now foreign secretary, has pitched himself as the “serious leader” the UK needs in the Conservative party leadership race, arguing that he is the best negotiator to deliver Brexit. Kay said he was sending his memoirs to MPs because he “wanted to remind those ‘honourable friends’ with any honour quite what those in the health service actually thought of those ‘negotiation skills’ Mr Hunt has been boasting about’.  

Speaking on Wednesday, Kay said: “If a week is a long time in politics then the 11 months since Jeremy Hunt left the NHS in tatters must be a generation ago. Much as I don’t want to be complicit in a world where we have prime minister Johnson, I can’t sit back and watch Hunt’s record on health go somehow unmentioned.” 

Hunt, who was health secretary between 2012 and 2018, clashed with junior doctors in 2015 and 2016 over a new contract that sought, among other things, to extend doctors’ normal working week hours to include Saturdays and weekday evenings from 7pm until 10pm. The bitter dispute led to strike action across the NHS.

“It was his actions – forcing an unfair and unsafe contract on the junior doctors and then leading a misinformation campaign when they fought against it – that led me to dig out my junior doctor diaries and have them published,” said Kay, lambasting Hunt as “the biggest villain of them all” for “hacking back at NHS funding, driving overworked staff to breaking point, leaving us with over 100,000 vacancies, then watching unflinchingly as his actions saw every imaginable waiting time soar, from ambulance call-outs to oncology appointments.”

Kay's book has been at the top of UK best-seller lists for many months. I reviewed it for The Tyee last October. Highly recommended.

Health crisis in Venezuela: Status of communicable diseases and implications for the EU and EAA, May 2019

Via Eurosurveillance: Health crisis in Venezuela: Status of communicable diseases and implications for the European Union and European Economic Area, May 2019. The discussion and conclusions:

As a consequence of political and economic crisis, Venezuela faces a re-emergence of communicable diseases that were previously eliminated or controlled. Increasing numbers of people are affected by an increased incidence of infectious diseases (and outbreaks) and mortality, which may be underestimated in the absence of proper surveillance and lack of treatment; thus, the magnitude of the outbreaks may be larger than presented. 

In addition, the mass departure of trained medical personnel reported in recent years is having an impact on the proper care of patients. People with chronic health conditions, pregnant and nursing women, children under 5 years, indigenous population, people without a fixed residence and those living with disabilities are among the most vulnerable.  

The migration of people from Venezuela to neighbouring countries and to Europe requires increased awareness that Venezuelans (in particular the aforementioned risk groups) are facing heightened infectious disease risks and that there is a need for appropriate investigation and treatment by healthcare providers in the receiving countries.  

The situation in Venezuela and travel to and from the country increases the possibility for European citizens of being exposed to circulating infectious diseases. Previous outbreaks in neighbouring and European countries have been shown to have originated from Venezuela, such as a Chagas disease outbreak in Colombia in 2017–18 and dengue outbreak in Madeira in 2012. 

The deterioration in public health systems e.g. vaccination programmes in Venezuela also means that migrants to Europe may be at risk from diseases present in Europe, such as measles. Therefore, Venezuelan migrants residing in Europe should be recommended to seek advice from healthcare providers on vaccination requirements in the country of residence. They should also be advised to seek immediate medical advice and mention that they have recently arrived from Venezuela in case of symptoms suggestive of gastrointestinal, respiratory, cutaneous or any other type of infection. 

The travellers visiting Venezuela should be appropriately vaccinated, follow good hygiene practices, practice safe sex and use preventive measures against mosquito bites to prevent vaccine-preventable diseases such as measles, food- and water-borne diseases, sexually transmitted infections such as HIV and mosquito-borne diseases such as dengue or malaria, among others. 

Currently, the overall risk for severe diseases is considered low for European residents and returning travellers from Venezuela if public health advice is followed.

MSF: Mothers and children left to die in Yemen without access to medical care

Via MSF.org: Mothers and children left to die in Yemen without access to medical care. Excerpt:

AMSTERDAM/BARCELONA/SANA’A – Many expectant mothers experiencing complications in childbirth and parents of sick children are unable to reach medical care in Yemen in a safe and timely manner, often with deadly consequences, a report by Médecins Sans Frontières (MSF) has found.

MSF’s new report, Complicated delivery: The Yemeni mothers and children dying without medical care, outlines the impact of the war on pregnant women, new mothers and children under 15 – who are some of the most neglected and vulnerable people in Yemen – as observed by MSF medical teams working in Taiz and Hajjah governorates.

Four years into the conflict, the warring parties in Yemen and their international backers have brought about the effective collapse of the country’s public health system, which cannot meet the needs of Yemen’s 28 million people.

Between 2016 and 2018, 36 mothers and 1,529 children died – 1,018 of whom were new-borns – in MSF’s Taiz Houban hospital, in Taiz governorate, and the MSF-supported Abs hospital, in Hajjah governorate. Of the deaths in Taiz Houban, almost one-third were children and new-borns who were dead on arrival. Many new-borns brought to MSF for care had a low birthweight or were born prematurely, at home or in small private clinics. The most common causes of deaths in neonates were prematurity, birth asphyxia and severe infection (sepsis). 

The high numbers of deaths are linked to a number of factors, with most being from a direct result of the war. These include the lack of functioning health facilities in Yemen, people’s difficulties in reaching them, and their inability to afford alternatives. Many people have to cross frontlines, pass through no-man’s land or negotiate their way through multiple checkpoints in order to reach a hospital that is still functional.

Liberia post Ebola: Ready for another outbreak?

Via The Lancet, an excellent report: Liberia post Ebola: ready for another outbreak? Excerpt:

Comfort Gbainsay is huddled on a bed under a mosquito net at the CB Dunbar Maternity Hospital in Gbarnga, a small city about a 3 hours' drive from Liberia's capital Monrovia. A few days ago, she started feeling weak. She had stomach cramps and was breathing fast. At the hospital, she was diagnosed with stomach ulcers and typhoid fever. The 37-year old is 3 months' pregnant. 

The ward is veiled in darkness. With a torch in one hand and a spoon in the other, Gbainsay is eating her dinner from a plastic container. There are not enough funds to run the hospital generators 24 h a day, so electricity is scheduled. This will be her third child, says Gbainsay. Her large eyes look exhausted, her voice is muted. She gave birth to her other two children at CB Dunbar, but back then, she says, she did not have to pay for any of her medication. 

CB Dunbar is a government hospital and therefore drugs and services should be free. The National Health and Social Welfare Policy 2011–2021 focuses on an essential package of health services, and the country has set itself the goal of reaching universal health coverage. However, the coverage index for essential health services lies at 34, the target value being 100. Gbainsay has already spent more than LRD3000, or around US$18, on medication during her stay, a third of her monthly income as a teacher. 

“The drugs that were here, they gave me; the ones that were not here, they told me to go out and buy”, she says. One of the prescribed medicines is out of stock at all pharmacies in Gbarnga and she had to send her husband to Monrovia to buy it. 

“Everything is becoming very difficult because of, I don't know, the economic condition or because of the new president”, she says. “Over the past year, things that we easily used to do just can't be done easily nowadays. If you don't have money, things don't work for you.” 

The new president Gbainsay is referring to is ex-footballer George Weah, who was sworn in as head of state in January, 2018. Voters had high expectations and hoped he would rein in corruption, kick-start the economy, alleviate poverty, and rebuild the health system after the Ebola outbreak of 2014–15, which killed 4810 people in Liberia, including almost 180 health workers. When the haemorrhagic fever struck, the health sector was on a slow path to recovery after years of brutal civil war that had ended in 2003. 

However the new president has other priorities, as he highlighted in his second annual message in January, of this year. “…I have set my eyes on roads as my administration's path to delivering a better living condition for the Liberian people”, he said and added that good road connectivity will, among other things, “reduce travel times to schools and hospitals”. Health care was otherwise barely touched upon.

The scary shortage of infectious-disease doctors

Via The New York Times, an op-ed: The Scary Shortage of Infectious-Disease Doctors. Is this also true of countries with reasonable health-insurance systems? Excerpt:

Many have heard of the rise of drug-resistant infections. But few know about an issue that’s making this threat even scarier in the United States: the shortage of specialists capable of diagnosing and treating those infections. 

Infectious diseases is one of just two medicine subspecialties that routinely do not fill all of their training spots every year in the National Resident Matching Program (the other is nephrology). Between 2009 and 2017, the number of programs filling all of their adult-infectious-disease training positions dropped by more than 40 percent. 

This could not be happening at a worse time. Antibiotic-resistant microbes, known as superbugs, are pinballing around the world, killing hundreds of thousands of people every year. The Times recently reported on Candida auris, a deadly new fungus that has infected hospital patients in Illinois, New Jersey and New York. 

Everyone who works in health care agrees that we need more infectious-disease doctors, yet very few actually want the job. What’s going on?  

The problem is that infectious-disease specialists care for some of the most complicated patients in the health care system, yet they are among the lowest paid. It is one of the only specialties in medicine that sometimes pays worse than being a general practitioner. At many medical centers, a board-certified internist accepts a pay cut of 30 percent to 40 percent to become an infectious-disease specialist. 

 This has to do with the way our insurance system reimburses doctors. Medicare assigns relative value units to the thousands of services that doctors provide, and these units largely determine how much physicians are paid. The formula prioritizes invasive procedures over intellectual expertise.

The problem is that infectious-disease doctors don’t really do procedures. It is a cognitive specialty, providing expert consultation, and insurance doesn’t pay much for that. 

For example, I recently diagnosed a case of fungal pneumonia. To arrive at this diagnosis took hours: first, speaking with the patient’s primary care doctor and pulmonologist, followed by a long stretch reviewing chest X-rays and other imaging studies with a radiologist, before examining the cells in the patient’s lung tissue under a microscope to confirm the diagnosis and report back to the anxious patient and family. Most of this work was done free. 

A generation ago, most well-rounded doctors knew what to do when a patient developed a fever. Not anymore. New threats like Candida auris pop up all the time, and to identify a deadly pathogen, we often have to use a sophisticated technique called matrix-assisted laser desorption ionization time-of-flight mass spectrometry. As the name suggests, it requires a bit of expertise.

Back in the day, there were only a handful of reliable antibiotics to choose from. But as more bugs have emerged, and more have become resistant to standard treatments, we’ve had to develop new drugs to fight them. The good news is that in 2018, the Food and Drug Administration approved a cadre of new antibiotics to confront the rising threat of superbugs, including eravacycline, plazomicin and omadacycline, and we can expect even more this year. But very few physicians know how to use these powerful new drugs. Many don’t even know how to pronounce them.  

Infectious-disease specialists are often the only health care providers in a hospital — or an entire town — who know when to use all of the new antibiotics (and when to withhold them). These experts serve as an indispensable cog in the health care machine, but if trends continue, we won’t have enough of them to go around. 

The terrifying part is that most patients won’t even know about the deficit. Your doctor won’t ask a specialist for help because in some parts of the country, the service simply won’t be available. She’ll just have to wing it.

Venezuela: UN should lead full-scale emergency response

A news release from Human Rights Watch: Venezuela: UN Should Lead Full-Scale Emergency Response. Excerpt:

The combination of severe medicine and food shortages within Venezuela, together with the spread of disease across the country’s borders, amounts to a complex humanitarian emergency that requires a full-scale response by the United Nations secretary-general, researchers from Johns Hopkins Bloomberg School of Public Health and Human Rights Watch said in a report released today. The Venezuelan authorities during the presidency of Nicolás Maduro have proven unable to stem the crisis, and have in fact exacerbated it through their efforts to suppress information about the scale and urgency of the problems.

The 71-page report, “Venezuela’s Humanitarian Emergency: Large-Scale UN Response Needed to Address Health and Food Crises,” documents increased numbers of maternal and infant deaths; the unchecked spread of vaccine-preventable diseases, such as measles and diphtheria; and sharp increases in the transmission of infectious diseases such as malaria and tuberculosis in Venezuela. Available data shows high levels of food insecurity and child malnutrition, as well as of hospital admissions of malnourished children.  

“No matter how hard they try, Venezuelan authorities cannot hide the reality on the ground,” said Shannon Doocy, Ph.D., associate professor of International Health at Johns Hopkins Bloomberg School of Public Health, who conducted research at Venezuela’s border. 

“Venezuela’s health system is in utter collapse, which, combined with widespread food shortages, is piling suffering upon suffering and putting even more Venezuelans at risk. We need UN leadership to help end this severe crisis and save lives.”

Uneven access to health services drives life expectancy gaps: WHO

A WHO news release: Uneven access to health services drives life expectancy gaps. Excerpt:

• Where women can access health services, maternal deaths decrease, lengthening women’s life expectancy.  

• In many circumstances, men access health care less than women. 

• Men are much more likely to die from preventable and treatable noncommunicable diseases and road traffic accidents. 

• 18.1-year gap in life expectancy between poorest and richest countries. 

Women outlive men everywhere in the world – particularly in wealthy countries. The World Health Statistics 2019 – disaggregated by sex for the first time – explains why.  

“Breaking down data by age, sex and income group is vital for understanding who is being left behind and why,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“Behind every number in the World Health Statistics is a person, a family, a community or a nation. Our task is to use these data to make evidence-based policy decisions that move us closer to a healthier, safer, fairer world for everyone.”  

The gap between men’s and women’s life expectancy is narrowest where women lack access to health services. In low-income countries, where services are scarcer, 1 in 41 women dies from a maternal cause, compared with 1 in 3300 in high-income countries. In more than 90 per cent of low-income countries, there are fewer than 4 nursing and midwifery personnel per 1000 people.  

Attitudes to healthcare differ. Where men and women face the same disease, men often seek health care less than women.  In countries with generalized HIV epidemics, for example, men are less likely than women to take an HIV test, less likely to access antiretroviral therapy and more likely to die of AIDS-related illnesses than women. Similarly, male TB patients appear to be less likely to seek care than female TB patients.  

The report also highlights the difference in causes of death between men and women – some biological, some influenced by environmental and societal factors, and some impacted by availability of and uptake of health services.  

Of the 40 leading causes of death, 33 causes contribute more to reduced life expectancy in men than in women. In 2016, the probability of a 30-year-old dying from a noncommunicable disease before 70 years of age was 44% higher in men than women. 

Global suicide mortality rates were 75% higher in men than in women in 2016. Death rates from road injury are more than twice as high in men than in women from age 15, and mortality rates due to homicide are 4 times higher in men than in women. 

Published to coincide with World Health Day on 7 April, which this year focuses on primary health care as the foundation of universal health coverage, the new WHO statistics highlight the need to improve access to primary health care worldwide and to increase uptake. 

“One of WHO’s triple billion goals is for 1 billion more people to have universal health coverage by 2023,” said Dr. Tedros. “This means improving access to services, especially at community level, and making sure those services are accessible, affordable, and effective for everyone – regardless of their gender.”

WHO scales up health response to Cyclone Idai in Mozambique

WHO AFRO has published WHO scales up health response to Cyclone Idai in Mozambique. Excerpt:

Beira, 1 April 2019 – Today the World Health Organization (WHO) Regional Director for Africa, Dr Matshidiso Moeti, took a first-hand look at response efforts to save lives and protect health for the people in Beira, the city hardest hit by Cyclone Idai in Mozambique. 

“The next few weeks are crucial and speed is of the essence if we are to save lives and limit suffering,” said Dr Moeti after visiting devastated communities and witnessing the damage to health centres caused by the cyclone. 

To expand the emergency response, WHO has deployed experts, including epidemiologists, logisticians and disease-prevention experts, to build a 40-strong team.  

Restoring regular health services is equally imperative as mitigating the spread of cholera and other diseases, Dr Moeti stressed. “I saw the paediatric ward of Pontagera Health Centre had been completely destroyed, the roof had been torn off and the equipment and supplies ruined by water. We must do everything we can to protect the people of Mozambique from a disease outbreak or other health problems caused by lack of access to essential services,” she said. 

WHO is helping to restore primary care services so that facilities can deliver essential services, including immunization, basic treatment for common illnesses, acute malnutrition and maternal care while ensuring the ongoing supply of medications for people living with HIV, tuberculosis or diabetes.   

Also of concern, Dr Moeti emphasized, are the health workers whose own families and homes have been affected. WHO is working to support them in their health care roles as well as rehabilitating the health facilities where they work.  

On her visit to Beira, Dr Moeti visited the Central Hospital, a general health centre, a cholera treatment centre and two field hospitals set up by emergency medical teams from Italy and Portugal. She also visited a health clinic in a settlement camp where more than 1000 people are living temporarily.  

Planning for cholera has been one of the Organization’s top priorities in its support to the Ministry of Health for this emergency. WHO has deployed cholera specialists and supported the deployment of supplies, including life-saving intravenous fluids, diagnostic tests, oral rehydration solution and other medical supplies to support cholera treatment centres.   

As of this week, 500 beds are now open in seven cholera treatment centres across the affected area, with plans to boost the capacity significantly to cope with an expected increase in cases. WHO is training 30 health workers on case management for cholera and on setting and monitoring standards and protocols in those centres.

Venezuela: PAHO reports ten deaths and over 160 cases of diphtheria in 2019 alone

Via Efecto Cocuyo, a March 19 report: Diez muertes y más de 160 casos de difteria registra OPS en Venezuela solo en 2019. [PAHO reports ten deaths and over 160 cases of diphtheria in Venezuela in 2019 alone] Excerpt, with my translation, and then a comment:

La epidemia de difteria continúa activa. El brote que inició en el estado Bolívar a mediados de 2016 todavía persiste tres años después y sigue cobrando vidas. En su última actualización epidemiológica, con fecha de este lunes, 18 de marzo, la Organización Panamericana de la Salud (OPS) confirmó 10 muertes por esta enfermedad en Venezuela hasta la semana epidemiológica 8, es decir, hasta el 24 de febrero. 

The diphtheria epidemic continues active. The outbreak that began in Bolívar state in mid-2016 persists three years later and keeps taking lives. In its latest epidemiological bulletin, date Monday, March 18, the Pan American Health Organization (PAHO) confirmed ten deaths from this cause in Venezuela as of epidemiological week 8, February 24.

El organismo regional detalló que entre enero y febrero de este año se han contabilizado un total de 164 infecciones. Hasta la fecha, solo Venezuela y Haití han reportado casos de esta enfermedad.  

The regional agency noted that between January and February this year, 164 cases have been recorded. To date,only Venezuela and Haiti have reported cases of this disease.

Desde el inicio de la epidemia, la OPS señala en su reporte que Venezuela ha notificado más de 2.700 casos sospechosos, con 2018 como el año en el que se registró mayor número de contagios, un total de 1.198 casos.  

From the start of the epidemic, PAHO says in its report, Venezuela has reported over 2,700 suspected cases, with 2018 as the year with the largest number—a total of 1,198 cases.

Del total de notificaciones, 1.612 casos han sido confirmados hasta la fecha: 128 por análisis de laboratorio y 1.084 por criterio clínico o nexo epidemiológico.  

Of the reports, 1,612 have so far been confirmed: 128 by laboratory tests and 1,084 by clinical or epidemiological criteria.

De 2016 a 2019, la enfermedad ha cobrado la vida de 280 personas. El año pasado también fue el período en el que se registró mayor número de defunciones, con 150 muertes. Le siguieron 2017 (con 103) y 2016 (17).  

From 2016 to 2019, the disease has taken 280 lives. Last year was also the period in which most deaths were reported, 150. The year 2017 was second, with 103, and 2016 saw 17.

La OPS alerta que la tasa de letalidad de los casos confirmados aumentó, pasando de 20% en 2018 a 26% para este 2019.

PAHO warns that the case fatality rate of confirmed cases has risen, from 20% in 2018 to 26% in 2019.

Venezuela's health department stopped publishing regular bulletins sometime in 2016 or thereabouts. Since then, various professional groups have tried to estimate just how many Venezuelans have been falling ill with various diseases, of which diphtheria is only one. 

So I guess it's nice that the Maduro government is at least talking to PAHO. To the best of my knowledge, Venezuela never reported reliable numbers during the Zika outbreak, whether of Zika itself or Zika-related microcephaly and other neurological disorders. We will be a long time repairing the grievous lapses in South American public health caused by purely political decisions in Caracas.

Ebola simulation in three counties gives Liberia’s health system a failing grade

Via The Bush Chicken: Ebola Simulation in Three Counties Gives Liberia’s Health System a Failing Grade. Excerpt:

SUAKOKO, Bong – The chief medical officer of Liberia, Dr. Francis Kateh, said Liberia scored an ‘F’ in a recent simulation of the country’s resilience and preparedness to handle another Ebola epidemic. 

The simulation was simultaneously done by the National Public Health Institute of Liberia in three counties: Bong, Lofa, and Nimba, with cases of the Ebola virus disease reported at separate health facilities. 

“Couple of days ago, we had a simulation exercise portraying EVD entering the country. And so what we were doing was basically testing our system to see how strong the system is if we were to have anything like Ebola or other virus hemorrhagic fever,” Kateh said. 

He clarified that there is no case of Ebola in Liberia; rather, the National Public Health Institute of Liberia and partners were testing the country’s resilience and preparedness to fight Ebola in case of a reemergence of the disease. 

The simulation created panic amongst citizens and health workers in the three counties, with fears that the disease that killed almost 5,000 people in Liberia between 2014/2015 was once again in the country. 

Kateh spoke with reporters on Friday at the Phebe Hospital in Suakoko, Bong following a debriefing meeting to discuss the simulation exercises across the three counties.  

The gathering was attended by health workers as well as local and national partners working in Liberia’s health sector. 

Kateh said he graded the overall result of the simulation with a failing grade because there were a lot of lapses on the part of health workers who handled the Ebola cases during the simulation.

“There were lots of things that we anticipated to have happened with the resources that have been placed into the health sector. There were lots of missteps at various areas,” he said. 

Lofa was the best performing county in the simulation, followed by Bong. Kateh said Nimba performed the worst.  

Considering the overall result of the exercise, Kateh said the Ministry of Health and partners will conduct refresher training on how to respond to Ebola and other diseases for health workers across the country.