H5N1

Uttar Pradesh: NCDC in Firozabad to probe ‘viral’ deaths, WHO says ‘dengue haemorrhagic fever’

Via the Times of India: UP: NCDC in Firozabad to probe ‘viral’ deaths, WHO says ‘dengue haemorrhagic fever’. Excerpt:

AGRA/NOIDA: A five-member team of the National Centre for Disease Control (NCDC) sent by the Union health ministry is in Firozabad to investigate deaths of children after prolonged fever, dropping platelets, severe dehydration and bleeding of gums. 

The Firozabad DM and UP DG (health) said dengue haemorrhagic fever could be the cause while the UP medical education principal secretary said these are cases of dengue, leptospirosis and scrub typhus.  

With six more cases, the death toll in Firozabad, the epicentre of the viral disease, touched 71. Of them, 52 were children, local sources said. “The WHO has suggested dengue haemorrhagic fever (DHF) could be causing deaths,” Firozabad DM Chandra Vijay Singh told TOI.  

UP DG (health) Dr Ved Vrat Singh said, “The Centre has asked the NCDC team to investigate deaths due to viral fever and dengue-like symptoms in Firozabad. The team will also study the nature of vector-borne diseases spreading there.” He added, “Local authorities have been alerted about the spread of dengue haemorrhagic fever. It is a severe form of the disease.”

During a visit by UP chief secretary Rajendra Kumar Tiwari to Noida, officials said some samples had been tested. “We can say for sure that there are known causes and there is no mystery. We had sent samples to KGMU (King George’s Medical University), Lucknow that have confirmed dengue in several cases. It was a small outbreak of dengue and leptospirosis,” Alok Kumar, principal secretary of UP medical education, told TOI. Officials said 185 samples had been tested by the Indian Council for Medical Research (ICMR), of which 73 were positive for dengue, 47 for leptospirosis, 28 for scrub typhus and one for Japanese encephalitis.

At a meeting in Lucknow, CM Yogi Adityanath had asked Kumar to position himself in Firozabad and monitor the situation. Senior IAS officer Sudhir M Bobde has been appointed nodal officer for Firozabad district. Sources in Firozabad told TOI that an estimated 5,000 people in the district are bedridden with fever, at home and in hospitals.

Patients share beds as COVID-19 cases overwhelm Mumbai’s hospitals

Via The Guardian: Patients share beds as coronavirus cases overwhelm Mumbai’s hospitals. Excerpt:

In Mumbai’s Sion hospital emergency ward there are two people to a bed. Patients, many with coronavirus symptoms and strapped two to a single oxygen tank, were captured lying almost on top of each other, top-to-toe on shared stretchers or just lying on the floor, in footage shared on social media in India this week. 

Mumbai, a city of more than 20 million people, is weeks into the pandemic, but with new cases showing no sign of slowing down the city’s already weak healthcare system appears to be on the brink of collapse. State hospitals such as Sion, overcrowded in normal times, are overrun. With frontline doctors and nurses falling sick with the virus in their droves, it is also leading to a shortage of medical staff. 

“The volume and density of our population in Mumbai makes it very difficult to see how we will get out of the other side of this peak,” said Manish Shetty, a doctor who works on the Covid-19 ward in Guru Nanak hospital in Mumbai. “Definitely there is a fatigue setting in from all frontline workers, especially because there is a very high chance of healthcare workers getting infected.”  

He added: “There is definitely a shortage of beds for critical care. There is a lot of infrastructure and planning which is happening, but the magnitude of the cases is overwhelming us all.” 

It was at Sion hospital that, in footage that went viral a few weeks ago, Covid-19 patients were seen being treated in a ward alongside dead bodies, wrapped in black plastic bags, after the hospital morgue ran out of room.  

With 52,667 cases, and 1,695 deaths – nearly a quarter of all Covid-19 deaths nationally – the state of Maharashtra, and in particular its biggest city, Mumbai, has emerged as the centre of India’s coronavirus outbreak. According to doctors and officials, the peak began on 6 May, but the curve is showing no signs of flattening, and cases are still doubling every week. 

With state-run hospitals quickly running out of beds and keeping symptomatic patients waiting, the Mumbai municipal corporation has raced to convert a series of stadiums and office complexes into coronavirus wards and quarantine centres. 

A makeshift hospital with 1,000 beds, including intensive care facilities, was built in the city’s business district, the Bandra Kurla Complex. The National Sports Club of India stadium is being converted into a 600-bed quarantine and ICU facility, while the Mumbai planetarium will house 300 beds and the Nehru science centre will be made into a quarantine facility for those living in slums. Private hospitals have also been ordered to give over dozens of their beds for Covid-19 patients. 

A Mumbai municipal corporation spokesperson, Vijay Khabale, denied that coronavirus patients were being denied beds. “There are enough beds but there is a lack of coordination with other agencies, which is why there are these reports. The present situation is that we have more than enough beds and quarantine facilities.” Khabale said that all the new facilities would be completed within the week, but he was optimistic they would not need to be used at full capacity. “We are expecting that within a day or two that the cases will begin to flatten and then begin to decrease,” he insisted, adding: “We have it under control.”  

However, many doctors fear that the worse is still to come. India has been under one of the world’s strictest lockdowns since 24 March, but it has only slowed down the spread of the virus, rather than flattening the curve of cases. India ranks 4th in the world for new cases recorded each day, and with lockdown due to be loosened at the end of this week there are fears it will prompt a spike in infection rates, for which the hospitals are not prepared. India has had 158,000 reported cases. 

To complicate matters further, the beginning of June will bring the monsoon and the outbreaks of dengue fever, malaria and leptospirosis, which already inundate hospitals on an annual basis. Last year India officially reported more than 67,000 cases of dengue, though the real figure is thought to be much higher. 

According to the human rights activist Abraham Mathai, who runs the All India Nurses Association, dozens of patients with non-Covid related diseases are dying because they are being denied access to treatment, with some Mumbai hospitals ordered to only take in Covid-19 patients. Last week, 15-year-old Pawan Maddibona died after six hospitals refused to give him dialysis treatment for his kidneys.

Rainfall and other meteorological factors as drivers of urban transmission of leptospirosis

Via bioRxiv: Rainfall and other meteorological factors as drivers of urban transmission of leptospirosis. The abstract: 

Background 

Leptospirosis is an important public health problem affecting vulnerable urban slum populations in developing country settings. However, the complex interaction of meteorological factors driving the temporal trends of leptospirosis remain incompletely understood. 

Methods and findings 

From 1996 to 2010, we investigated the association between the weekly incidence of leptospirosis and climatic variables in the city of Salvador, Brazil by using a dynamic generalized linear model that accounted for time lags, overall trend and seasonal variation. Our model showed an increase of leptospirosis cases associated with rainfall, lower temperature and higher humidity. 

There was a lag of one-to-two weeks between weekly values for significant meteorological variables and leptospirosis incidence. Independent of the season, a weekly cumulative rainfall of 20 mm increased the risk of the leptospirosis by 10% compared to a week without rain. 

Finally, over the 14 year study period the incidence of leptospirosis decreased significantly by four fold (12.8 versus 3.6 per 100,000 people), independently of variations in climate. 

Conclusions

Strategies to control leptospirosis should focus on avoiding contact with contaminated sources of Leptospira as well as on increasing awareness in the population and health professionals within the short time window after both low-level and extreme rainfall events. Increased leptospirosis incidence was restricted to one-to-two weeks after those events, suggesting that infectious Leptospira survival may be limited to short time intervals.

Kerala battling leptospirosis outbreak after Indian state's worst flooding in century

Via The Independent: Kerala battling 'rat fever' outbreak after Indian state's worst flooding in century. Excerpt:

Kerala, the southern Indian state reeling from its worst flooding in a century, is now battling a “fast, progressive” strain of leptospirosis, or “rat fever”, as it is known locally.  

Some 200 cases of the infection have been confirmed so far, a health ministry spokesman said, and authorities suspect it is the cause of dozens of deaths since mid-August.  

The waterborne bacterial disease can prove fatal and is transmitted by the urine of infected animals, with symptoms including muscle pain and fever.  

The outbreak comes after flooding triggered by torrential rain devastated almost the entire state, destroying thousands of homes, killing hundreds of people and running up a bill for at least £2.81bn in damage. 

The health ministry began distributing preventative medicine last month and warned about the outbreak of leptospirosis and other waterborne diseases such as typhoid and cholera, health minister K K Shailaja told reporters. 

Local media reported three leptospirosis deaths on Monday. 

“The victims had unfortunately not taken preventive medicine,” the minister said. 

Overall, nine deaths from the disease have been confirmed, but the number may rise to over 40 pending full medical reports, the ministry spokesman said. 

Leptospirosis rarely spreads from person to person and can be treated with common antibiotics. 

“In the past week, we have seen about 30 deaths in Kozhikode and Wayanad,” said Mohammed Javeed, internal medicine specialist at a private hospital in Kerala, referring to two of the worst flood-affected districts on the state’s southwest coast.  

Mr Javeed said the state has leptospirosis cases every monsoon season as paddy fields fill with water, increasing the chance of infection for farmers, especially through wounds such as cuts. 

Of particular concern, however, is that some of the victims this year did not have usual symptoms such as mild jaundice, blood in urine or bleeding spots on the skin, he said.  

“This time it is a fast, progressive infection,” Mr Javeed. “The recent deaths indicate clearly the threat of an epidemic.”

Puerto Rico’s health care is in dire condition, three weeks after Maria

Via The New York Times, a chronicle of deaths foretold: Puerto Rico’s Health Care Is in Dire Condition, Three Weeks After Maria. My worries about post-Maria leptospirosis have been confirmed. Excerpt and then a comment:

CAGUAS, P.R. — Harry Figueroa, a teacher who went a week without the oxygen that helped him breathe, died here last week at 58. His body went unrefrigerated for so long that the funeral director could not embalm his badly decomposed corpse. 

Miguel Bastardo Beroa’s kidneys are failing. His physicians at the intensive care unit at Doctors Hospital in Carolina are treating him for a bacterial disease that he probably caught in floodwaters contaminated with animal urine. 

José L. Cruz wakes up in the middle of the night three times a week to secure a spot in line for dialysis. His treatment hours have been cut back to save fuel for the generators that power the center. 

“Because of the electricity situation, a lot of people died, and are still dying,” said Mr. Figueroa’s daughter, Lisandra, 30. “You can’t get sick now.”

Nearly three weeks after Hurricane Maria tore through Puerto Rico, many sick people across the island remain in mortal peril. The government’s announcements each morning about the recovery effort are often upbeat, but beyond them are hidden emergencies. 

Seriously ill dialysis patients across Puerto Rico have seen their treatment hours reduced by 25 percent because the centers still lack a steady supply of diesel to run their generators. Less than half of Puerto Rico’s medical employees have reported to work in the weeks since the storm, federal health officials said.

Hospitals are running low on medicine and high on patients, as they take in the infirm from medical centers where generators failed. A hospital in Humacao had to evacuate 29 patients last Wednesday — including seven in the intensive care unit and a few on the operating table — to an American military medical ship off the coast of Puerto Rico when a generator broke down.  

There are urgent attempts to help. The federal government has sent 10 Disaster Medical Assistance Teams of civilian doctors, nurses, paramedics and others to the island. Four mobile hospitals have been set up in hospital parking lots, and the Comfort, a medical treatment ship, is on the scene. A 44-bed hospital will soon open in badly wrecked Humacao, in the southeast.  

But even as the Army Corps of Engineers is installing dozens of generators at medical facilities, and utility crews work to restore power to 36 hospitals, medical workers and patients say that an intense medical crisis persists and that communications and electrical difficulties have obscured the true number of fatalities directly related to the hurricane. The official count rose on Tuesday to 43.  

Matching resources with needs remains a problem. The Puerto Rico Department of Health has sent just 82 patients to the Comfort over the past six days, even though the ship can serve 250. The Comfort’s 800 medical personnel were treating just seven patients on Monday. 

The mayor of Canóvanas, in the northeast part of the island, reported over the weekend that several people in her city had died of leptospirosis, the bacterial disease Mr. Bastardo is believed to have caught from the floodwaters. 

The Puerto Rico Department of Health said Sunday night that several cases were being evaluated, but that lab tests had not yet come back to confirm the diagnosis. At the same time, the agency urged people to drink only bottled water and to wear protective shoes near bodies of water that could be contaminated with animal urine.

According to status.pr, as of October 10 16% of the island has electricity; 70 hospitals are operating, but only 25 have electricity; and 46 dialysis centers are in operating, as of October 6. 

Puerto Rico: María 'has taken us back 20 or 30 years,' says official

Via El Vocero de Puerto Rico: María deja a su paso una grave devastación en Puerto Rico.[Maria leaves in her path grave devastation in Puerto Rico] Excerpt with my translation, and then a comment:

La destrucción que dejó el huracán María a su paso por Puerto Rico retrocedió varias décadas el estado de la isla, incluso cuando las autoridades trabajan para evaluar la magnitud del daño, informó una delegada del territorio.  

The destruction left in Puerto Rico in the path of Hurricane María has pushed the condition of the island back several decades, including when the authorities work to assess the magnitude of the damage, a delegate of the territory has said.

“La devastación de Puerto Rico nos ha llevado casi 20-30 años para atrás... No te puedo negar que es un Puerto Rico distinto al que vimos hace una semana atrás”, dijo Jenniffer González, Comisionada Residente de Puerto Rico. “La devastación de propiedades, de estructuras en el piso, de familias sin casa, de escombros por doquier. El verdor de la isla ya no está”, agregó. 

"The devastation of Puerto Rico has put us back about 20-30 years. ... I can't deny that this is a different Puerto Rico from what we saw a week ago," said Jenniffer González, Resident Commissioner of Puerto Rico. "The devastation of property, the collapsed buildings, homeless families, ruins everywhere. The greenery of the island is gone," she added.

Ingenieros planeaban el domingo inspeccionar la represa de Guajataca, de 90 años de antigüedad, la cual tiene una reserva que cubre alrededor de 5 kilómetros cuadrados (2 millas cuadradas) en el noreste de Puerto Rico. El gobierno informó que la presa tiene una enorme grieta luego de que María depositó casi 15 pulgadas de lluvia en las montañas aledañas y puntualizó que “colapsará en cualquier minuto”. Residentes del área fueron evacuados, pero comenzaron a regresar a sus casas el domingo luego de que un aliviadero aminoró la presión en la presa.

Engineers were planning on Sunday to inspect the 90-year-old Guajataca dam, whose reservoir covers 5 square kilometers (2 squar miles) in the northwest of Puerto Rico. The government has report the dam has an enormous crack since María dumped almost 15 inches of rain in the surrounding mountains. They pointed out that "it can collapse at any moment." Residents of the area were evacuated, but began to return to their homes on Sunday after a spillway was opened to relieve pressure on the dam.

Long after the mainland media have lost interest in the disaster, some of the worst consequences will emerge, and many of them will be in the public-health sector.

We can expect a spate of waterborne diseases: leptospirosis, skin infections, diarrhea, hepatitis A and E, typhoid, and maybe even cholera. Add to that untold swarms of mosquitoes, some carrying malaria, dengue, Zika, and chikungunya. As well, mental health issues will slow Puerto Rico's recovery as thousands struggle with PTSD, depression, and anxiety.

 

The healthcare system will struggle just to deal with such problems, never mind control or eliminate them. 

 

So far, the US government has shown much more concern about uppity black millionaire athletes than about the fate of 3.5 million people living (barely) on American soil. 

ECDC on Hurricane Irma: Risk of communicable diseases in the affected countries

ECDC has published Rapid Risk Assessment: Hurricane Irma: risk of communicable diseases in the affected countries. The abstract:

In the aftermath of Hurricane Irma, the most immediate risks in the affected areas of the Caribbean are increased transmission of diarrhoeal diseases related to lack of access to safe drinking water and acute respiratory infection in children accommodated in overcrowded shelters. The risk of an upsurge in cholera cases in areas with previous transmission and flood-specific risks (e.g. tetanus and leptospirosis) should be given priority when adopting mitigating measures. Mosquito-borne diseases represent a delayed risk that should be taken into account in this context.

Colombia landslide leaves more than 250 dead

Via The Guardian, a Reuters report: Colombia landslide leaves more than 250 dead. Excerpt and then a comment:

Flooding and mudslides in the Colombian city of Mocoa sent torrents of water and debris crashing onto houses in the early hours of Saturday morning, killing 254 people, injuring hundreds and sending terrified residents, some in their pyjamas, scrambling to evacuate. 

Heavy rains caused several rivers to overflow, pushing sediment and rocks on to buildings and roads in the capital of southwestern Putumayo province and immobilising cars in several feet of mud. 

“It was a torrential rainstorm, it got really strong between 11pm and 1am,” said local resident Mario Usale, 42, who was looking for his father-in-law in the debris. “My mother-in-law was also missing, but we found her alive two kilometers away. She has head injuries, but she was conscious.”  

Colombian President Juan Manuel Santos flew to Mocoa, population 345,000, to oversee rescue efforts on the city outskirts and speak with affected families. “We will do everything possible to help them,” Santos said after confirming the death toll. “It breaks my heart.” 

The army said in a statement that 254 people were killed, 400 people had been injured and 200 were missing. More than 1,100 soldiers and police officers were called in to help dig people out in 17 affected neighborhoods. 

Even in a country where heavy rains, a mountainous landscape and informal construction of homes combine to make mud and landslides a common occurrence, the scale of the Mocoa disaster was daunting compared to recent tragedies, such as a 2015 landslide that killed nearly 80 people in Salgar, Antioquia.  

Colombia’s deadliest landslide, the 1985 Armero disaster, left more than 20,000 dead. “It’s a big area,” Mocoa mayor José Antonio Castro, who lost his house, told Caracol radio on Saturday. “A big portion of the many houses were just taken by the avalanche.” 

He said people were warned ahead of time and many were able to get out, but several streets and two bridges had been destroyed. 

Weather authorities said light rains were expected in the area on Saturday night and Sunday. 

Photos posted on Twitter by the air force showed streets filled with mud and damaged houses, while videos on social media showed residents searching for survivors in the debris and struggling to move through waist-high water during the night.

Recovery will likely be complicated by diseases like diarrhea and leptospirosis, not to mention mosquito-borne dengue, Zika, and chikungunya.

Peru seeks more international aid to cope with extreme floods

Via Thomson Reuters: Peru seeks more international aid to cope with extreme floods. Excerpt:

Peru needs more international aid to help hundreds of thousands of people cope with continuing floods and mudslides that have killed more than 100 people and torn apart much of the country's infrastructure, the transportation minister said Friday.  

Minister Martin Vizcarra told Reuters that the government will likely award reconstruction contracts in August or September, once heavy rains and the current crisis have subsided. 

Peruvians displaced by raging rivers and landslides still need bottled water, canned food, tents, toilet paper, medicine and other basics to survive coming months, Vizcarra said. 

Peru has distributed 4,000 tonnes of aid so far, most of it donated by Peruvian families and companies and institutions, but another 4,000 tonnes will likely be needed in coming months, Vizcarra said. 

Local donations were tapering off as raging rivers and mudslides continue to slam parts of Peru.

"Every family, company has a limit to what it can give," Vizcarra told Reuters in an interview. "But people are going to be in need for a long time. There are families that have nothing." 

He noted that Peru prefers goods that could be distributed immediately to cash donations. 

A railway used to transport zinc and copper concentrates from mines in central Peru to port will likely take another two weeks to become operative, Vizcarra said.  

The government will likely hold public tenders for "packets" of projects - such as bridges needed in a region - to ensure a swift recovery.

The website of the Peruvian Ministry of Health has many stories on the consequences of the flood, from fighting leptospirosis and dengue to providing mental health services to the homeless.

Leptospirosis: Rare disease strikes a Bronx area all too familiar with rats

Via The New York Times: Rare Disease Strikes a Bronx Area All Too Familiar With Rats. Excerpt:

The rare disease goes by many names. Mud fever, sewerman’s flu, swamp fever — those are just a few of the monikers for the illness caused by the bacterium Leptospira. 

As the names indicate, the disease is associated with filth, and in the developed world, it is exceedingly rare. But in the Grand Concourse neighborhood of the Bronx, where the conditions in some of the buildings have long been called unlivable by residents, the disease found its way into the vast rat population and has now been linked to a cluster of infections that have left one resident dead and two others severely ill.  

The authorities ordered people living in eight illegal apartments in a subcellar at 750 Grand Concourse, one of the buildings where the infections occurred, to vacate the premises, and they have stepped up efforts to combat the rat population through extermination and better garbage management. 

“I want to make clear that this is a very rare infection,” Dr. Mary Bassett, the commissioner of the New York City Department of Health and Mental Hygiene, said on Wednesday, calling the flare-up of leptospirosis cases a “cluster” on this one Bronx block, rather than an outbreak or an epidemic. “Since 2006, we’ve seen some 26 cases in New York City. The last data we have for the country as a whole suggests in 2015 there were fewer than 30 cases diagnosed across the whole country.” 

The disease is caused by exposure to an infected animal’s urine, Dr. Bassett explained, not through bites or by touch or by watching a rat scurry across subway tracks. She urged anyone in the area with flulike symptoms to seek medical help. The disease can be treated with antibiotics.