H5N1

Ontario's latest COVID-19 modelling 'catastrophic,' doctor says

Via CBC News: Ontario's latest COVID-19 modelling 'catastrophic,' doctor says. Excerpt:

An "unthinkable" number of deaths could be in store for Ontarians if strict public health measures are not implemented and followed, according to critical care physician Dr. Kali Barrett. 

Her predictions follow new modelling presented by the province's COVID-19 science advisory table on Friday which, in a sobering update, said the pace of vaccinations alone is not enough to contain increasing transmission of the coronavirus and that it could take until the end of June to see case counts drastically drop. 

The latest projections say Ontario could see more than 10,000 new cases per day by late May, and 15,000 by late June.  

"It's catastrophic," Barrett, a member of the science advisory table secretariat, said of the modelling.  

Barrett says keeping Ontarians safe includes public health measures like stay-at-home orders, keeping schools closed while cases are high, masking orders and not forcing people to go to work who don't need to. 

The provincial government on Friday extended its stay-at-home order to a minimum of six weeks, stepped up enforcement powers for police and said it would set up checkpoints along the borders with Manitoba and Quebec, among other measures. 

But, contrary to the repeated recommendation of the science advisory table, Premier Doug Ford stopped short of instituting paid sick days. 

The table also called for doubling down on vaccinations in the highest-risk communities, limiting which businesses are allowed to stay open, and making essential workplaces safer.  

Barrett says the health-care system could face the triage scenario in the coming weeks — physicians having to make choices about how to use their resources based on patients' overall health and probability of survival.  

If two critically ill patients entered a hospital where the ICU could accommodate just one, a group of independent clinicians would assess who would be most likely to benefit from the bed and survive after admission, she said in an interview on CBC's News Network.  

This would be based on factors like the patient's past medical history and how sick they are at the time. 

The other person would be offered full medical care, but not critical care. If their condition worsened, they would be offered palliative care. It has been described as a worst-case scenario by other experts.

Allocating scarce intensive care resources during the COVID-19 pandemic: Practical challenges to theoretical frameworks

Via The Lancet Respiratory Medicine: Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks. The summary:

The COVID-19 pandemic strained health-care systems throughout the world. For some, available medical resources could not meet the increased demand and rationing was ultimately required. Hospitals and governments often sought to establish triage committees to assist with allocation decisions. 

However, for institutions operating under crisis standards of care (during times when standards of care must be substantially lowered in the setting of crisis), relying on these committees for rationing decisions was impractical—circumstances were changing too rapidly, occurring in too many diverse locations within hospitals, and the available information for decision making was notably scarce. 

Furthermore, a utilitarian approach to decision making based on an analysis of outcomes is problematic due to uncertainty regarding outcomes of different therapeutic options. 

We propose that triage committees could be involved in providing policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care. An approach guided by egalitarian principles, integrated with utilitarian principles, can support physicians at the bedside when they must ration scarce resources.

Egypt: MP-elect says Sharqiya hospital COVID-19 deaths due to negligence, lack of oxygen

Thanks to Heather Lander for alerting me to this appalling story. Via Egypt Independent: MP elect says Sharqiya hospital deaths due to negligence, lack of oxygen.

Sharqiya Governorate’s MP elect el-Sayed Rahmo announced that the death of five coronavirus patients at a hospital in Sharqiya on Sunday was due to the hospital’s negligence and a lack of oxygen supplies.  

Rahmo revealed details behind the viral video that shows motionless COVID-19 patients inside Husseiniya Central Hospital who allegedly died due to a lack of oxygen tanks.  

Rahmo stressed in a statement to Al-Masry Al-Youm that the five patients who died, did so as a result of staff negligence at the hospital, namely the mismanagement of the oxygen deficiency crisis. 

He denied the statement of the hospital’s director, refuting his claim that only four people died and there was sufficient oxygen supplies at the time. 

Rahmo said that it was illogical that five patients die at the same time in one place without negligence.  

He added, “I have information that the intensive care doctor informed the hospital director in sufficient time, at least an hour, about the lack of oxygen. But the manager was negligent and the transfer of oxygen cylinders took too long, leading to deaths.” 

The MP stated that until he is sworn in on January 10, he is not able to officially follow up with government agencies on this incident. However, he assured that the negligent would be held accountable. 

He concluded: “Denying any lack of oxygen is a disaster. We have to confront and acknowledge the crisis, not deny it, so that this tragedy will not be repeated.” 

The governor of Sharqiya, Mamdouh Ghorab, downplayed the incident, stating that the four deaths at the hospital were a result of preexisting chronic health conditions and not the hospital’s failing. 

Egypt’s Minister of Health Hala Zayed also assured that sufficient stocks of medical oxygen are available in all hospitals receiving coronavirus patients across the country, adding that the state spares no effort in preserving the health of citizens.  

But families of the victims believe otherwise. One man, whose 44 year-old father passed away at the hospital on Saturday, came forward stating that his father had no preexisting medical conditions and was in good health.  

Egypt’s second wave of the virus continues, with 1,309 new cases and 64 deaths reported on Sunday. 

Health officials have stated that the country’s actual figures are roughly ten times higher than what is reported, due to testing accessibility and the exclusion of private hospitals in the daily count. 

COVID-19: The US has passed the hospital breaking point

Early in the life of this blog, I asked my very few readers: What happens to the ordinary patients in a pandemic, when the hospitals are jammed with urgent cases of some new disease? Now we know. 

Via The Atlantic, Robinson Meyer and Alexis C. Madrigal write: The U.S. Has Passed the Hospital Breaking Point. Excerpt (but you'd better read the whole article):

At the springtime peak, even as Northeast hospitals faced a deluge, 60,000 people were hospitalized nationwide. When the Sun Belt frothed with cases this summer, hospitalizations again reached the 60,000 mark before they started to fall.  

A month ago, in early November, hospitalizations passed 60,000—and kept climbing, quickly. On Wednesday, the country tore past a nauseating virus record. For the first time since the pandemic began, more than 100,000 people were hospitalized with COVID-19 in the United States, nearly double the record highs seen during the spring and summer surges. 

The pandemic nightmare scenario—the buckling of hospital and health-care systems nationwide—has arrived. Several lines of evidence are now sending us the same message: Hospitals are becoming overwhelmed, causing them to restrict whom they admit and leading more Americans to needlessly die. 

The current rise in hospitalizations began in late September, and for weeks now hospitals have faced unprecedented demand for medical care. The number of hospitalized patients has increased nearly every day: Since November 1, the number of people hospitalized with COVID-19 has doubled; since October 1, it has tripled. 

Throughout that time, health-care workers have worried that hospitals would soon be overwhelmed. “The health-care system in Iowa is going to collapse, no question,” an infectious-disease doctor told our colleague Ed Yong early last month. The following week, a critical-care doctor in Nebraska warned, “The assumption we will always have a hospital bed for [you] is a false one.” 

These catastrophes seem to be coming to pass—not just in Iowa and Nebraska, but all across the country. A national breakdown in hospital care is now starkly apparent in the coronavirus data.

Why emergency COVID-19 vaccine approvals pose a dilemma for scientists

Via Nature.com: Why emergency COVID-vaccine approvals pose a dilemma for scientists. Excerpt:

After a flurry of positive results from clinical trials of COVID-19 vaccines, developers are now seeking ‘emergency use’ approvals, which could see these immunizations deployed in potentially tens of millions of people. But scientists are concerned that this kind of early deployment could compromise the ongoing clinical trials that seek to show conclusively how well the vaccines work.  

Following the release of early data from phase III trials on 9 November, vaccine makers Pfizer and BioNTech have sought regulatory permission to deploy their vaccine under emergency-use rules. The developer of another leading vaccine, Moderna, is expected to do the same within weeks.  

Once a vaccine is granted emergency approval, there is pressure on developers to offer the immunization to trial participants who received a placebo. But if too many people cross over to the vaccine group, the companies might not have enough data to establish long-term outcomes, such as safety, how long vaccine protection lasts and whether the jab prevents infection or just the disease.  

“It’s a real vaccine development dilemma,” says Klaus Stöhr, who formerly headed vaccine design at the pharmaceutical company Novartis in Cambridge, Massachusetts, and is now retired. Still, Stöhr thinks that the vaccine should be granted emergency use authorization because its effectiveness has been established and there is a dire need.

As COVID-19 soars, hospitals hope to avoid an agonizing choice: Who gets care and who goes home

Via The Washington Post: As coronavirus soars, hospitals hope to avoid an agonizing choice: Who gets care and who goes home. Excerpt:

The coronavirus pandemic is rolling across America like a great crimson wave.  

In Illinois, the rate of new infections is so high that a group of doctors sent an urgent letter to the governor. “We’re having to almost decide who gets treatment and who doesn’t,” said one of its leaders.

In Ohio, the rapid spread of the virus has pushed the state health-care system to the brink. Expressing deep concern, Gov. Mike DeWine (R) vowed to enforce his statewide mask mandate and issued new restrictions on social gatherings. “We can’t surrender to this virus. We can’t let it run wild,” he said. 

And in Iowa, where a record number of new infections in a day coincided with a record number of deaths, the White House coronavirus task force issued a dire warning about “the unyielding covid spread” throughout the state. 

The number of new daily coronavirus cases in the United States jumped from 104,000 a week earlier to more than 145,000 on Wednesday, an all-time high. Nearly every metric is trending in the wrong direction, prompting states to add new restrictions and hospitals to prepare for a potentially dark future.  

“We’re at a fairly critical juncture," said Dave Dillon, a spokesman for the Missouri Hospital Association. The day will soon come when hospital staffing will fall below standards that are normally required, he said. 

“While we have beds, those beds are only as good as the staff that you can place around them. There are hospitals at this point that have, at a given time, been unable to do admits,” Dillon said.

Johnson & Johnson temporarily pauses all dosing in our Janssen COVID-19 vaccine candidate clinical trials

An October 12 news release: Johnson & Johnson Temporarily Pauses All Dosing in Our Janssen COVID-19 Vaccine Candidate Clinical Trials.

At Johnson & Johnson, there is no greater priority than the safety and well being of the people we serve every day around the world. We are committed to providing transparent updates throughout the clinical development process of our vaccine candidate, in compliance with regulatory standards and our own high ethical and scientific principles. 

We have temporarily paused further dosing in all our COVID-19 vaccine candidate clinical trials, including the Phase 3 ENSEMBLE trial, due to an unexplained illness in a study participant. Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians. 

Adverse events – illnesses, accidents, etc. - even those that are serious, are an expected part of any clinical study, especially large studies. Based on our strong commitment to safety, all clinical studies conducted by the Janssen Pharmaceutical Companies of Johnson & Johnson have prespecified guidelines. These ensure our studies may be paused if an unexpected serious adverse event (SAE) that might be related to a vaccine or study drug is reported, so there can be a careful review of all of the medical information before deciding whether to restart the study.  

We must respect this participant’s privacy. We’re also learning more about this participant’s illness, and it’s important to have all the facts before we share additional information. SAEs are not uncommon in clinical trials, and the number of SAEs can reasonably be expected to increase in trials involving large numbers of participants. Further, as many trials are placebo-controlled, it is not always immediately apparent whether a participant received a study treatment or a placebo.  

“Study Pause” vs. “Regulatory Hold:” What’s the Difference?  

While these terms are sometimes used interchangeably, there is a significant distinction between a study pause and a regulatory hold of a clinical trial.  

• A study pause, in which recruitment or dosing is paused by the study sponsor, is a standard component of a clinical trial protocol. As noted in the ENSEMBLE study protocol, Johnson & Johnson has robust mechanisms in place to protect the safety of participants in its clinical trials. While the Company informs all study investigators, we typically do not communicate study pauses publicly. 

• A regulatory hold of a clinical trial is a requirement by a regulatory health authority, such as the U.S. Food and Drug Administration (FDA). As outlined in our transparency commitments, we proactively disclose any regulatory hold of a pivotal clinical trial.

Women are excluded from global COVID-19 coverage, experts say

This baffles me, because I rely so heavily on women who are health experts. Via The Washington Post: Women are excluded from global coronavirus coverage, experts say. Excerpt:

On a Canadian Broadcasting Corporation program earlier this month, a debate between two physicians over coronavirus-related restrictions turned into a brief clash over the role of gender in mainstream discourse. “

You’re just shouting; you’re not actually speaking,” infectious-disease expert Neil Rau told his female colleague, interrupting.  

“Do not be sexist,” family doctor and medical anthropologist Nili Kaplan-Myrth responded, not missing a beat. “I’m speaking in an assertive voice.”  

“NEVER tell a woman (professional or otherwise) that she cannot speak with authority,” she wrote later on Twitter. “NEVER tell us we aren’t educated enough, experts enough, or good enough. We have every bit as much authority to speak.”  

The exchange underscored a broader concern over the lack of female voices in media coverage of and policy debates on the coronavirus pandemic. 

In coverage of the coronavirus, female scientists and doctors are cited far less frequently than their male counterparts, according to multiple multicountry studies. And when women are vocal, as with other policy debates and key areas of coverage, they often face online harassment and second-guessing of their expertise, several female scientists told The Washington Post. 

The consequences are far-reaching. The marginalization of female experience and expertise colors the information available to policymakers forming coronavirus responses — which means interests and issues important to women may get underprioritized. This dynamic has, according to a recent study commissioned by the Bill and Melinda Gates Foundation, perpetuated a “war framing” around the virus, reinforcing the gendered stereotype that men are more reliable in emergencies and as decision-makers.  

Marginalized voices 

Since reports of the novel coronavirus began circulating in January, the world has been inundated with news and perspectives. Male scientists and physicians have played an outsize role in global efforts to make sense of the virus. 

“The pandemic exacerbated the lack of women’s voices,” said Muge Cevik, who works on infectious diseases and medical virology at the University of St. Andrews in Scotland. “It just reinforced the prevailing gender norm in which men continue to be allocated to leadership roles, speaking to media.” 

Last month’s Gates Foundation report, written by audience researcher Luba Kassova, analyzed coronavirus coverage published in mainstream publications online in the United Kingdom, the United States, Kenya, South Africa, Nigeria and India. The study focused on articles identified by Google’s news search engine as highly ranked between March 1 and April 15. It found that women are “worryingly marginalized.” On average, every female voice in a coronavirus story was “drowned out” by at least three male interviewees, the study concluded. 

“Women were four times less likely to feature as experts and commentators” in stories on the coronavirus, the study found. When cited, “women are more likely to be used as sources sharing subjective views than experts sharing authoritative expertise,” according to the report. Women constituted 19 percent of experts quoted overall and were less likely to feature as protagonists in coronavirus stories.  

The trend has been documented elsewhere. A report published last month by the French Ministry of Culture and the ministry responsible for gender equality found that during the country’s coronavirus lockdown this spring, “newspapers devote[d] a predominant place to male personalities in their content.” More than 83 percent of the people pictured on the front page of major newspapers during this period were men, who also wrote a majority of opinion pieces. 

A recent University of Zurich study calculated that women made up two of the 30 scientists most frequently cited by the Swiss media in coronavirus coverage during the first half of the year. 

The experiences of female scientists and medical experts echo across sectors. Statistically, few women are part of national-level decision-making processes on the coronavirus, although 69 percent of health professionals around the globe are women. For working mothers and women from minority and marginalized communities, many disparities are growing even deeper amid school and economic disruptions.  

“There are lots of women who are working really hard [on coronaviruses-related research] and they don’t make it into the media or policy advisories,” said Emma Hodcroft, one of the two female scientists among the group most widely cited in Switzerland, who studies and tracks viruses at the University of Basel.

Sweden's COVID-19 gamble

A long feature article in Science: Sweden's gamble. It's a fascinating glimpse of the battles going on inside a very good health system. Excerpt:

Swedish authorities actively discouraged people from wearing face masks, which they said would spread panic, are often worn the wrong way, and can provide a false sense of safety. Some doctors who insisted on wearing a mask at work have been reprimanded or even fired. 

Until last month, Sweden's official policy stated people without obvious symptoms are very unlikely to spread the virus. So instead of being quarantined or asked to stay home, family members, colleagues, and classmates of confirmed cases had to attend school and show up for work, unless they had symptoms themselves. Testing in Sweden still lags behind many other countries, and in many districts infected people are expected to notify their own contacts—in contrast to, say, Germany and Norway, where small armies of contact tracers help track down people who may have been exposed.  

The Swedish approach has its fans. Protesters against coronavirus-related restrictions in Berlin in late August waved Swedish flags. In the United States, a prominent member of President Donald Trump's coronavirus task force, neuroradiologist Scott Atlas, has cited Sweden as a model to follow. The policies also have widespread public support in Sweden, where consensus is prized and criticism of the government is rare. 

But within Sweden's scientific and medical community, a debate about the strategy has simmered and frequently boiled over—in the opinion pages of newspapers, within university departments, and among hospital staff. A group of scientists known as “the 22” has called for tougher measures since April, when it published a blistering critique of the country's public health authority, the Folkhälsomyndigheten (FoHM). The group, which has grown to include 50 scientists and another 150 supporting members, now calls itself the Vetenskapsforum COVID-19 (Science Forum COVID-19).  

It says the price for Sweden's laissez-faire approach has been too high. The country's cumulative death rate since the beginning of the pandemic rivals that of the United States, with its shambolic response. 

And the virus took a shocking toll on the most vulnerable. It had free rein in nursing homes, where nearly 1000 people died in a matter of weeks. Stockholm's nursing homes ended up losing 7% of their 14,000 residents to the virus. The vast majority were not taken to hospitals. Although infections waned over the summer, scientists worry a new wave will hit in the fall. Cases are rising rapidly in the greater Stockholm area, where almost one-quarter of the Swedish population lives.  

The group's criticism has not been welcomed—indeed, some of the critics say they have been pilloried or reprimanded. “It has been so, so surreal,” says Nele Brusselaers, a member of the Vetenskapsforum and a clinical epidemiologist at the prestigious Karolinska Institute (KI). It is strange, she says, to face backlash “even though we are saying just what researchers internationally are saying. It's like it's a different universe.”

WHO to probe 'sexual exploitation' by Ebola aid workers in DR Congo

This is bad. Via BBC News: WHO to probe 'sexual exploitation' by aid workers in DR Congo. Excerpt:

The World Health Organization (WHO) has pledged to investigate allegations that aid workers tackling the Ebola outbreak in the Democratic Republic of Congo sexually abused and exploited women. 

WHO and other aid agency staff were accused by 50 women in a joint investigation by two news agencies. 

Local women were allegedly plied with drinks, "ambushed" in hospitals, forced to have sex, and two became pregnant. 

The allegations cover the period between 2018 and March this year. 

The New Humanitarian news agency and the Thomson Reuters Foundation have carried out an almost year-long investigation. 

The WHO said the allegations would be "robustly investigated". 

"Anyone identified as being involved will be held to account and face serious consequences, including immediate dismissal," it said in a statement. 

"The betrayal of people in the communities we serve is reprehensible." 

More than 2,000 people died in the Ebola outbreak in DR Congo. 

The WHO, which spearheaded global efforts to curb the spread of the outbreak, declared it over in June this year. 

The UN and aid agencies have previously promised zero tolerance of sexual abuse following similar allegations against some of their staff in other countries. 

A spokesperson for the UK's Foreign, Commonwealth and Development Office said it would scrutinise the WHO findings closely, adding: "Sexual exploitation and abuse are completely abhorrent. We regularly assess all of our partners against the highest safeguarding standards." 

Who does the investigation implicate the most? 

Most of the allegations of sexual abuse and exploitation were against men, including doctors, said to be from the WHO. At least 30 women made allegations against them, the news agencies reported. 

The next highest number of allegations - made by eight women - were against men said to be from DR Congo's health ministry. 

Two other UN agencies, and four international charities, were also named in the report.

Some of the accused men came from Belgium, Burkina Faso, Canada, France, Guinea-Conakry and Ivory Coast. 

Many men refused to wear condoms, and at least two women said they became pregnant as a result of the abuse, the news agencies reported.