H5N1

Analysis: Could COVID-19 knock out flu in Europe this winter?

Via Reuters: Analysis: Could COVID knock out flu in Europe this winter? Excerpt:

PARIS (Reuters) - As Europeans brace for a grim winter with the threat of rising COVID-19 infections, minimal numbers of flu cases recorded so far point to a possible silver lining.

Data available for Europe since the beginning of October, when flu case numbers usually start to ramp up, mirror shallow figures seen in the Southern Hemisphere earlier this year. 

Some doctors say a combination of lockdowns, mask wearing and handwashing appear to have hampered transmission of the flu, while warning that the data should be treated with caution because the peak of the season is weeks or even months away.  

According to Flu News Europe, a joint monitoring platform of the European Centre for Disease Prevention and Control and the World Health Organization which collects samples in 54 European regions, only one person was diagnosed with flu out of 4,433 sentinel tests during Sept. 28-Nov. 22.  

This sentinel-source data -- case figures collated by national health authorities based on samples taken by a range of community doctors -- translates into a positivity rate of 0.02%, well below a 10% threshold that the WHO considers to be “epidemic” when it comes to flu. 

At the same time last year, this percentage stood at 15%. 

While scientists caution that the coronavirus pandemic has constrained testing for flu, the low sentinel rate so far will provide some relief to governments and health authorities, which had feared a potentially lethal “twindemic” of COVID-19 and flu that could overwhelm hospitals during the winter. 

“In any given typical year, we should be witnessing hundreds of influenza cases at this stage in Europe and beyond,” Bruno Lina, a senior virologist with Hospices Civils de Lyon, which runs 13 hospitals in France’s third-largest city, told Reuters. 

“Steps adopted to prevent transmission of COVID-19 are very efficient against influenza and other respiratory viruses.”

Denmark wants to dig up COVID-19 'zombie mink' that resurfaced from mass graves

Via Reuters: Denmark wants to dig up 'zombie mink' that resurfaced from mass graves.

COPENHAGEN (Reuters) - Denmark’s government said on Friday it wants to dig up mink that were culled to prevent the spread of the coronavirus, after some resurfaced from mass graves. 

Denmark ordered all farmed mink to be culled early this month after finding that 12 people had been infected by a mutated strain of the virus that causes COVID-19, which passed from humans to mink and back to humans. 

The decision led to 17 million animals being destroyed and to the resignation last week of Food and Agriculture Minister Morgens Jensen, after it was determined that the order was illegal. 

Dead mink were tipped into trenches at a military area in western Denmark and covered with two metres of soil. But hundreds have begun resurfacing, pushed out of the ground by what authorities say is gas from their decomposition. Newspapers have referred to them as the “zombie mink”. 

Jensen’s replacement, Rasmus Prehn, said on Friday he supported the idea of digging up the animals and incinerating them. He said he had asked the environmental protection agency look into whether it could be done, and parliament would be briefed on the issue on Monday.  

The macabre burial sites, guarded 24 hours a day to keep people and animals away, have drawn complaints from area residents about possible health risks. 

Authorities say there is no risk of the graves spreading the coronavirus, but locals worry about the risk of contaminating drinking water and a bathing lake less than 200 metres away.

Canada: COVID-19 outbreak declared in neonatal intensive care unit at St. Paul's Hospital in Vancouver

Via CBC News: COVID-19 outbreak declared in neonatal intensive care unit at St. Paul's Hospital in Vancouver.

An outbreak of COVID-19 has been detected in the neonatal intensive care unit (NICU) at St. Paul's Hospital in Vancouver, according to a notice from Vancouver Coastal Health. 

The news was shared in a facility outbreak bulletin from the health authority on Thursday afternoon. Restrictions to prevent transmission of the disease have been put in place.  

Shaf Hussain, spokesperson for Providence Health, which operates the hospital, said the NICU has been shut down and the patients transferred to a temporary satellite unit.  

"We have strict infection control protocols that are immediately followed. We work closely with professionals in public health — they've done an amazing job for B.C.," Hussain told CBC.

St. Paul's NICU provides 24-hour care for premature babies and other newborns with serious health problems who need specialized attention. It is separate from the hospital's maternity unit, which remains open and ready to deliver babies, according to Hussain. 

Hussain couldn't say whether COVID-19 has been detected in a patient or staff members, or how many people have been affected. Outbreaks can be declared in B.C. health-care settings with just one case.  

"We're working with the Vancouver Coastal Health medical health officer in leading the response to this exposure," he said.  

The NICU is now being thoroughly cleaned to prevent further transmission.

COVID-19: Danger looms as Nigerians jettison safety measures

Via the Daily Trust: COVID-19: Danger looms as Nigerians jettison safety measures. Excerpt:

Medical experts have warned that Nigeria could experience dire consequences in the rate of COVID-19 cases and deaths if people continued to violate protective measures against the disease.  

They said it was worrisome that many people violated wearing of face masks, physical and social distancing, and hygiene measures such as hand washing and use of hand sanitisers among others across the country.

Dr. Ejike Orji, Chairman, Medical Sub-Committee, Federal Capital Territory (FCT) Ministerial Expert Advisory Committee on COVID-19 said that there would be a spike in cases, and that the country would be in serious trouble if the violation continued. 

He said, “It is already happening.  Abuja has been recording an average of 42 cases per day in the last two weeks.  

“The isolation centres at the National Hospital, Abuja, University of Abuja Teaching Hospital, Gwagwalada and Asokoro District Hospitals are filled up. 

“If we continue this way, we are going to be in serious trouble.” 

He said a lot of people in Nigeria were asymptomatic to the disease because its population was largely youthful. 

“70 % of our population is under the age of 30, that is also what is helping us. 

“The disease is serious in people who are older and have co-morbidities like diabetes and hypertension. 

“So young people can have it and feel nothing is wrong with them but be endangering their parents and older people around them.”  

Dr. Omo Izedomwen, a public health expert said the country was already experiencing community transmission of  the COVID-19 pandemic and that the only way to break it currently was to adhere to safety measures and restrictions instituted by the government . 

Izedomwen, who is also the Coordinator of the Abuja Centre of the National Blood Transfusion Service (NBTS) warned that disregarding the public safety measures comes with a cost, which people could regret later, adding “We can make choices but unfortunately cannot decide the consequences of these choices. And the consequences are very dire.”  

He said the United States of America for instance had recorded over 100, 000 deaths already, saying these were people who once laughed and spent time with their loved ones.  

Dr. Audu Onyemocho, an epidemiologist and an associate Professor of Community Medicine said the poor level of compliance by the public does not augur well for curbing the spread of the disease. 

“The public should note that everyone is susceptible to COVID-19. 

“It doesn’t show on the face, so the only way is to protect yourself and people around you,” he said.  

As of yesterday, Nigeria had recorded 15, 682 confirmed cases of COVID-19. 

Of the number, 5, 101 cases have been discharged and 407 deaths recorded.  

Findings by Daily Trust revealed that doubts about the existence of COVID-19 was still widespread among Nigerians in spite of the increasing number of cases. This is happening three months after the country recorded its first case of the disease.

Covid-19 in Latin America: A pandemic meets extreme inequality

Via the World Bank: Covid-19 in Latin America: A pandemic meets extreme inequality. Excerpt:

In late May, the World Health Organization declared that Latin America has become the new epicenter of the Covid-19 Pandemic. It has already been noted that the region’s high levels of inequality have limited the effectiveness of various containment policies, thus contributing to this sad distinction. In this post we look at the reverse direction of causation and ask what effects the pandemic is likely to have on the region’s entrenched inequalities.  

We argue that the impact of the pandemic will itself be highly unequal in Latin America : both in terms of health and economic outcomes, and along income, spatial, gender and racial dimensions. Worse yet, this will be true both in the short-term, during the current “lockdowns”, but also in the medium and longer-term. Nonetheless, the policy responses in some countries suggest that there may be a silver lining: the crisis might provide an opportunity for rethinking the region’s structurally unequal social contract.    

In the short-term, inequalities in how individuals can cope with stay-at-home orders are particularly striking in the region. Living conditions – including access to such basic amenities as piped water and adequate sanitation facilities – are highly unequal.  The homeless and those living in cramped and precarious housing in urban slums, without access to water and sanitation, face huge difficulties in implementing social distancing and maintaining the higher levels of personal hygiene that are now required. ...

Almost one in three Bolivians has no access to piped water at home. Fully half of Brazilians have no access to improved sanitation – a sadly remarkable number. Large numbers of Hondurans and Peruvians are also deprived of access to these basic services.  These deprivations mean that those who were worst-off to begin with are also most vulnerable to the virus.   

This also implies that Covid-19 will not be color- or race-blind in Latin America. Afro-descendants are over-represented among slum dwellers in Brazil, Colombia, and many other countries. Infection and death rates will almost certainly be higher for black Latin Americans than for whites, much as in the United States. Indigenous descendants are also more vulnerable in a number of Andean countries, and in the Brazilian Amazon.   

A second pre-existing inequality that is likely to make the underprivileged more vulnerable to the pandemic is that between formal and informal workers in the region. According to the ILO’s definition, the informal sector accounts for 34% of the GDP in the region, with 53% of total employment being informal: ranging from 23% in Uruguay to above 80% in Bolivia. Perhaps most vulnerable among the informal labor force are self-employed or own-account workers, who typically account for between 20% and 40% of the labor force in Latin America, or even higher in countries such as Bolivia and Colombia. 

Brazil: Amid collapse, the interior of the Amazon struggles over lockdown and chloroquine

Via Deutsche Welle Brazil: Amid collapse, the interior of the Amazon struggles over lockdown and chloroquine. Excerpt from the Google translation:

The meeting of the murky waters of the Amazon River with the clarity of Tapajós produces one of the postcards of Santarém, in western Pará. The natural beauty of the city surrounded by water as far as the eye can see attracts tourists from all over the world, especially to the village of Alter from the ground. For those who live in the region, the reality is quite different. Only half of the population has access to clean water in Santarém, one of the 100 largest municipalities in Brazil. Basic sanitation, in turn, is a privilege of 4.2%.  

"The Amazon receives the pandemic in the worst possible conditions," says Caetano Scannavino, coordinator of the Saúde & Alegria Project, an NGO that has been operating in the region for more than three decades. "The main cause of infant mortality here is diarrhea from contaminated river water. Imagine working on the importance of hygiene with the population that does not have a tap at home."  

The advancement of the new coronavirus in the region caused the health system in Santarém to collapse, as had already occurred in Belém and Manaus, the main capitals of the region. The 31 available ICU beds are full, and the city is a service reference for a population of more than 1 million people, distributed in 22 municipalities in the interior of the Amazon.  

Some of these municipalities are larger than European countries. Itaituba, with just over one hundred thousand inhabitants, is twice the size of Belgium. The displacement of patients who need assistance in Santarém depends on transport by helicopter that the state government has made available.  

Of the 7.8 million Brazilians who are more than four hours from a breathing apparatus, more than half live in the Amazon. The state of Pará alone accounts for almost a third of this population. 

While at the beginning of the pandemic, the city of São Paulo had one respirator per 2,400 inhabitants, the rate was one per 20,000 in Santarém. This Tuesday (May 26), the city of Pará reached 1,016 confirmed cases and 65 deaths due to covid-19, the disease caused by the new coronavirus.  

The data, however, have a large lag. As there is no structure for conducting clinical examinations in Santarém, the samples are sent by plane to Belém, the state capital, and take up to two weeks to be processed. There is also a limitation of rapid tests, mainly used to monitor already detected cases. 

"Given the number of hospitalizations, I estimate that there are between 20,000 and 40,000 infected in western Pará," says João Guilherme Assy, an infectious disease physician in the municipality, who monitors local health units. The growth of the queue for an ICU bed forces doctors to improvise. 

Often, patients have to take respirators to ensure more people have access to oxygen. There is also a shortage of medical professionals, as those on the front line become ill from contact with the virus. 

Lockdown raises tension 

The situation is aggravated by the population's low adherence to social isolation. To respond to this situation, the city government decreed a lockdown, that is, drastic measures of confinement, for six days, until last Sunday. The social isolation rate rose from 39% to an average of 49.9% on the days the measure was in force. Despite the improvement, the indicator was below the 70% recommended by the World Health Organization (WHO).

Covidly.com on Wednesday night reports 414,661 Brazilian cases—19,995 in the past 24 hours. Deaths total 25,697; 1,092 have died in the past 24 hours.

COVID-19: 2 meters may not be enough

Via Physics of Fluids: On coughing and airborne droplet transmission to humans. The abstract:

Our understanding of the mechanisms of airborne transmission of viruses is incomplete. This paper employs computational multiphase fluid dynamics and heat transfer to investigate transport, dispersion, and evaporation of saliva particles arising from a human cough. 

An ejection process of saliva droplets in air was applied to mimic the real event of a human cough. We employ an advanced three-dimensional model based on fully coupled Eulerian–Lagrangian techniques that take into account the relative humidity, turbulent dispersion forces, droplet phase-change, evaporation, and breakup in addition to the droplet–droplet and droplet–air interactions. We computationally investigate the effect of wind speed on social distancing. 

For a mild human cough in air at 20 °C and 50% relative humidity, we found that human saliva-disease-carrier droplets may travel up to unexpected considerable distances depending on the wind speed. When the wind speed was approximately zero, the saliva droplets did not travel 2 m, which is within the social distancing recommendations. However, at wind speeds varying from 4 km/h to 15 km/h, we found that the saliva droplets can travel up to 6 m with a decrease in the concentration and liquid droplet size in the wind direction. 

Our findings imply that considering the environmental conditions, the 2 m social distance may not be sufficient. Further research is required to quantify the influence of parameters such as the environment’s relative humidity and temperature among others.

This article in South China Morning Post discusses the study.

As COVID-19 overruns Russia, doctors are dying on the front lines

Via The New York Times: As Coronavirus Overruns Russia, Doctors Are Dying on the Front Lines. Excerpt

MOSCOW — Dr. Rimma Kamalova says her hospital’s leadership ignored her warnings about an unexplained pneumonia outbreak back in March. She kept working. 

The hospital admitted more than 50 people for planned procedures the day that the staff learned a deceased patient had tested positive for the coronavirus, records show. She kept working.  

The hospital was ordered quarantined, with Dr. Kamalova and more than 1,200 other staff members and patients trapped inside. Days later, she grew feverish, but she kept working, relying on her own intravenous line for relief.  

“Give yourself a drip, get up, treat, lie down, give yourself another drip, get up, treat,” Dr. Kamalova, head of the rheumatology department at Kuvatova Republican Clinical Hospital in the south-central Russian city of Ufa, said in a telephone interview. “You had no choice.”  

Russia is hailing its medical workers as heroes, their photographs plastered on billboards and their stories glamorized on state TV. But as the country develops into one of the global epicenters of the disease, those workers are suffering astonishing levels of infection and death in their ranks. 

And as the number of reported coronavirus cases in Russia grows, many fear the worst is yet to come. 

A website memorializing health care workers who have died during the pandemic lists more than 180 doctors, nurses, paramedics and others. 

At one top Moscow hospital, a department head said that 75 percent of the department’s staff was sick. In St. Petersburg, 1,465 health care workers have caught the virus, the governor said on Wednesday, accounting for more than one in six of the city’s total cases. 

Russia’s health minister, Mikhail Murashko, said on Wednesday that 400 Russian hospitals had suffered outbreaks of the coronavirus. Image Ambulances in Saint Petersburg last month. 

Like their colleagues in much of the rest of the world, many of those doctors and nurses are suffering from a shortage of protective gear and equipment. But Russian health workers are also at the mercy of a convoluted, depersonalized and unforgiving bureaucracy that increasingly appears outmatched by the pandemic.  

An internal federal government document obtained by The New York Times illuminated Russia’s lack of preparedness. In late March, regional Russian officials were sounding alarm bells about a drastic undersupply of protective equipment and pervasive confusion about how they were supposed to tackle the virus.

ECDC: Infection prevention and control and preparedness for COVID-19 in healthcare settings - third update

ECDC has published Infection prevention and control and preparedness for COVID-19 in healthcare settings - third update. The summary:

This document aims to provide guidance to EU/EEA healthcare facilities and healthcare providers on infection prevention and control (IPC) measures for the management of suspected and confirmed cases of COVID-19 infection in healthcare settings, including long-term care facilities. It also offers guidance on the management of specimens at laboratories in the EU/EEA. This is an update of the ECDC guidance dated 31 March 2020 ‘Infection prevention and control for COVID-19 in healthcare settings'.

Johns Hopkins: National Action Plan for Expanding and Adapting the Healthcare System for the Duration of the COVID-19 Pandemic

Via Johns Hopkins: National Action Plan for Expanding and Adapting the Healthcare System for the Duration of the COVID Pandemic. The introduction:

The COVID-19 (COVID) pandemic has led to unprecedented action and innovation in the US healthcare system; at the same time, it has presented extraordinary challenges and risks. Through dramatic augmentation of surge capacity, deferral of other services, and implementation of crisis standards of care, hospitals in many locations have been able to absorb the blow of the first peak of COVID cases and continue to provide lifesaving care to both COVID patients and others with life-threatening emergencies. 

But many communities are just beginning to experience the full force of the pandemic, and in every location, the healthcare response to COVID has come at a very dear price. Healthcare facilities have sustained huge financial losses, and healthcare workers’ health and well-being have been put at high risk. New standard operating procedures and work processes have been improvised, and many old lessons have had to be relearned. 

There is an urgent near-term need to address key challenges faced now by healthcare facilities and healthcare workers in the pandemic, and this current crisis also has made painfully apparent the many vulnerabilities of our healthcare system and the longer-term structural reforms that are necessary to sustain it. This report offers answers and recommendations related to the following problems, for which there are tractable solutions:  

• How can we improve infection prevention in hospitals and maintain a robust supply chain for personal protective equipment (PPE)? 

• What approach should we take to restarting deferred healthcare services? 

• What financial support is needed for hospitals and healthcare providers? 

• How should the healthcare workforce be sustained and augmented? 

• How can we provide mental health support for healthcare workers in this crisis? 

• How can we provide medical care and sick leave for all people in the United States? 

• How can we make telemedicine a new normal? How can we reduce the number of undiagnosed infectious diseases in our hospitals? 

• How can we better protect emergency medical services (EMS) personnel from infectious diseases? 

• How can we better coordinate the healthcare response to COVID and the next pandemic? 

This is not an exhaustive compilation of all the challenges the health sector faces, but these are among the most important. We have organized these topics and recommendations roughly in order of the urgency with which they must be addressed. There is much to be done now.