H5N1

WHO warns against potential Ebola spread in DR Congo and beyond

Via ReliefWeb, a UN News report: WHO warns against potential Ebola spread in DR Congo and beyond. Excerpt:

Ebola is spreading in a western province in the Democratic Republic of the Congo (DRC), raising fears that the disease could reach neighbouring Republic of Congo and even the capital, Kinshasa, the World Health Organization (WHO) said on Friday.  

The outbreak in Equateur Province emerged in early June and has now spread into another of its 17 health zones, bringing the total number of affected zones to 12. So far, there have been 113 cases and 48 deaths.  

“The most recently affected area, Bomongo, is the second affected health zone that borders the Republic of Congo, which heightens the chances of this outbreak to spread into another country”, said WHO Spokesperson, Fadéla Chaib, underlining the need for cross-border collaboration and coordination.  

The risk of the disease spreading as far as Kinshasa is also a very real concern for the UN agency. One of the affected areas, Mbandaka, is connected to the capital by a busy river route used by thousands every week.  

Logistical challenges, community resistance  

This is the second Ebola outbreak in Equateur Province and the 11th overall in the DRC, which recently defeated the disease in its volatile eastern region after a two-year battle.  

This latest western outbreak first surfaced in the city of Mbandaka, home to more than one million people, and subsequently spread to 11 health zones, with active transmission currently occurring in eight. 

The health zones all border each other and cover a large and remote area often only accessible by helicopter or boat.  

Managing response logistics in Equateur is difficult as communities are very scattered. Many are in deeply forested areas and reaching them requires travelling long distances. In some areas, community resistance is also a challenge, Ms. Chaib added.  

"We learned over years of working on Ebola in DRC how important it is to engage and mobilize communities. WHO is working with UNICEF in engaging religious, youth and community leaders to raise awareness about Ebola," she said. 

Health workers on strike 

The situation has been further complicated by a health worker strike that has affected key response activities for nearly four weeks. 

Locally based Ebola responders have been protesting against low salaries as well as non-payment since the start of the outbreak. 

Although some activities have resumed, many are still on hold, making it difficult to get an accurate picture of how the epidemic is evolving and which areas need the most attention.

MSF responds to new Ebola outbreak in Équateur province DR Congo

Via MSF.org: MSF responds to new Ebola outbreak in Équateur province DRC. Excerpt:

Following the declaration of this eleventh Ebola epidemic in DRC, MSF deployed teams to the health zones of Bolomba, Bikoro, Monieka, Ingende and Lotombe in order to curb the spread of the disease, support community surveillance and provide rapid treatment to patients living in hard-to-reach areas.  

“The epidemic is moving with people by land and river, to remote areas, in a province where infrastructure is scarce and villages far from each other,” said Dr Maria Mashako, MSF medical coordinator. “That’s why MSF is setting up a decentralised response and deploys our teams in the most remote, affected health areas, with small structures easily accessible to the communities.” 

As of 1 September, 2020, MSF teams are supporting nine treatment and isolation centres in five health zones to provide care as close as possible to the active hotspots of the disease.

In Bolomba health zone, in addition to the support provided to the Ebola treatment centre at the general hospital, we set up two small treatment and isolation centres in the remote health areas of Boso Mondomba and Yuli. 

The same decentralised approach has been adopted in the health zones of Monieka and Bikoro, where MSF is supporting four small care and isolation structures in difficult-to-access health areas. 

“We do not limit ourselves to supporting the response to the Ebola epidemic alone,” says Dr Mashako. “We are also supporting health centres in the hotspots and on the major axes of Bolomba and Bikoro, in order to guarantee the continuity of primary health services there, and allow early detection of suspected cases. This is done, for example, by donating drugs, training local medical personnel on Ebola or strengthening infection prevention and control measures.” 

Community engagement is key 

Little information is circulating on Ebola in the province, and the epidemic is affecting some health zones for the first time ever. That’s why our health promotion teams are supporting those of the Ministry of Health to strengthen awareness and community-based surveillance. In Bolomba, Bikoro and Monieka, this is one of the key activities done by MSF.

Garrett: Trump’s COVID-19 vaccine can’t be trusted

Via Foreign Policy, Laurie Garrett writes: Trump’s Coronavirus Vaccine Can’t Be Trusted. Excerpt:

True to the president’s word—or threat, perhaps—the United States government is preparing to roll out a COVID-19 vaccine on, or before, Nov. 1, even though none of the more than 150 vaccines in the research pipeline worldwide have completed Phase 3 safety and efficacy clinical trials. In its mad sprint to Election Day, the White House has funneled billions of dollars into drug companies and ordered government agencies to execute their public health duties at breakneck speeds that defy credulity. 

Like most experts closely watching these developments, I have no confidence that a safe, effective vaccine will be ready for use by Halloween. Worse, I can no longer recommend that anyone retain faith in any public health pronouncements issued by government agencies.

US: Health officials worry nation’s not ready for COVID-19 vaccine

Thanks to Lauren Weber for sending the link to this report in Kaiser Health News: Health Officials Worry Nation’s Not Ready for COVID-19 Vaccine. Excerpt:

Millions of Americans are counting on a COVID-19 vaccine to curb the global pandemic and return life to normal. 

While one or more options could be available toward the end of this year or early next, the path to delivering vaccines to 330 million people remains unclear for the local health officials expected to carry out the work. 

“We haven’t gotten a lot of information about how this is going to roll out,” said Dr. Umair Shah, executive director of Texas’ Harris County Public Health department, which includes Houston.

In a four-page memo this summer, the federal Centers for Disease Control and Prevention told health departments across the country to draft vaccination plans by Oct. 1 “to coincide with the earliest possible release of COVID-19 vaccine.” 

But health departments that have been underfunded for decades say they currently lack the staff, money and tools to educate people about vaccines and then to distribute, administer and track hundreds of millions of doses. Nor do they know when, or if, they’ll get federal aid to do that. 

Dozens of doctors, nurses and health officials interviewed by KHN and The Associated Press expressed concern about the country’s readiness to conduct mass vaccinations, as well as frustration with months of inconsistent information from the federal government. 

The gaps include figuring out how officials will keep track of who has gotten which doses and how they’ll keep the workers who give the shots safe, with enough protective gear and syringes to do their jobs. 

With only about half of Americans saying they would get vaccinated, according to a poll from AP-NORC Center for Public Affairs Research, it also will be crucial to educate people about the benefits of vaccination, said Molly Howell, who manages the North Dakota Department of Health’s immunization program. 

The unprecedented pace of vaccine development has left many Americans skeptical about the safety of COVID-19 immunizations; others simply don’t trust the federal government.  

“We’re in a very deep-red state,” said Ann Lewis, CEO of CareSouth Carolina, a group of community health centers that serve mostly low-income people in five rural counties in South Carolina. “The message that is coming out is not a message of trust and confidence in medical or scientific evidence.” 

Paying for the Rollout   

The U.S. has committed more than $10 billion to develop new coronavirus vaccines but hasn’t allocated money specifically for distributing and administering vaccines.  

And while states, territories and 154 large cities and counties received billions in congressional emergency funding, that money can be used for a variety of purposes, including testing and overtime pay. 

An ongoing investigation by KHN and the AP has detailed how state and local public health departments across the U.S. have been starved for decades, leaving them underfunded and without adequate resources to confront the coronavirus pandemic. The investigation further found that federal coronavirus funds have been slow to reach public health departments, forcing some communities to cancel non-coronavirus vaccine clinics and other essential services.  

States are allowed to use some of the federal money they’ve already received to prepare for immunizations. But KHN and the AP found that many health departments are so overwhelmed with the current costs of the pandemic — such as testing and contact tracing — that they can’t reserve money for the vaccine work to come. Health departments will need to hire people to administer the vaccines and systems to track them, and pay for supplies such as protective medical masks, gowns and gloves, as well as warehouses and refrigerator space. 

CareSouth Carolina is collaborating with the state health department on testing and the pandemic response. They used federal funding to purchase $140,000 retrofitted vans for mobile testing that they plan to continue to use to keep vaccines cold and deliver them to residents when the time comes, said Lewis. 

But most vaccine costs will be new.

WHO: Pulse survey on continuity of essential health services during the COVID-19 pandemic

A news release from WHO about its Pulse survey on continuity of essential health services during the COVID-19 pandemic: interim report, 27 August 2020. 

The World Health Organization (WHO) today published a first indicative survey on the impact of COVID-19 on health systems based on 105 countries’ reports. Data collected from five regions over the period from March to June 2020 illustrate that almost every country (90%) experienced disruption to its health services, with low- and middle-income countries reporting the greatest difficulties. Most countries reported that many routine and elective services have been suspended, while critical care - such as cancer screening and treatment and HIV therapy – has seen high-risk interruptions in low-income countries.

"The survey shines a light on the cracks in our health systems, but it also serves to inform new strategies to improve healthcare provision during the pandemic and beyond,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "COVID-19 should be a lesson to all countries that health is not an ‘either-or’ equation. We must better prepare for emergencies but also keep investing in health systems that fully respond to people’s needs throughout the life course."

Services hit across the board: Based on reports from key informants, countries on average experienced disruptions in 50% of a set of 25 tracer services. The most frequently disrupted areas reported included routine immunization – outreach services (70%) and facility-based services (61%), non-communicable diseases diagnosis and treatment (69%), family planning and contraception (68%), treatment for mental health disorders (61%), cancer diagnosis and treatment (55%).

Countries also reported disruptions in malaria diagnosis and treatment (46%), tuberculosis case detection and treatment (42%) and antiretroviral treatment (32%). While some areas of health care, such as dental care and rehabilitation, may have been deliberately suspended in line with government protocols, the disruption of many of the other services is expected to have harmful effects on population health in the short- medium- and long-term.

Potentially life-saving emergency services were disrupted in almost a quarter of responding countries. Disruptions to 24-hour emergency room services for example were affected in 22% of countries, urgent blood transfusions were disrupted in 23% of countries, emergency surgery was affected in 19% of the countries.

Disruption due to a mix of supply and demand side factors. 76% of countries reported reductions in outpatient care attendance due to lower demand and other factors such as lockdowns and financial difficulties. The most commonly reported factor on the supply side was cancellation of elective services (66%). Other factors reported by countries included staff redeployment to provide COVID-19 relief, unavailability of services due to closings, and interruptions in the supply of medical equipment and health products.

Adapting service delivery strategies. Many countries have started to implement some of the WHO recommended strategies to mitigate service disruptions, such as triaging to identify priorities, shifting to on-line patient consultations, changes to prescribing practices and supply chain and public health information strategies. However, only 14% of countries reported removal of user fees, which WHO recommends to offset potential financial difficulties for patients.

The pulse survey also provides an indication of countries’ experiences in adapting strategies to mitigate the impact on service provision. Despite the limitations of such a survey, it highlights the need to improve real-time monitoring of changes in service delivery and utilization as the outbreak is likely to wax and wane over the next months, and to adapt solutions accordingly.

To that end, WHO will continue to work with countries and to provide supportive tools to address the fallout from COVID-19. Given countries’ urgent demand for assistance during the pandemic response, WHO is developing the COVID19: Health Services Learning Hub, a web-based platform that will allow sharing of experiences and learning from innovative country practices that can inform the collective global response. WHO is also devising additional surveys at the sub-national level and in health facilities to gauge the longer-term impact of disruptions and help countries weigh the benefits and risks of pursuing different mitigation strategies.

Morocco’s king warns of potential new lockdown as Covid-19 cases spike

Via France24, an AFP report: Morocco’s king warns of potential new lockdown as Covid-19 cases spike. Excerpt:

Morocco could return to a complete coronavirus lockdown as cases continue to spike, Moroccan King Mohammed VI said on Thursday, warning of severe economic repercussions. 

The warning came as a jump in infections in the once bustling tourist hub of Marrakech strained health services and led to protests by medical staff in recent days.  

New cases nationally have surged to more than 1,000 a day since Morocco lifted a strict three-month long lockdown in late June and hit a record high of 1,766 on Aug. 15. 

“If figures continue to increase, the Covid-19 Scientific Committee may recommend another lockdown, perhaps with even tighter restrictions,” the King said in a speech. The deterioration of the health situation “does not leave much room for optimism”, he said. 

As of Thursday, Morocco had recorded a total 47,638 cases, including 775 deaths and 32,806 recoveries.  

Pictures posted on social media platforms showed Covid-19 patients in Marrakech lying on the floor of crowded hospitals. 

Medics have staged protests in recent days to highlight the congestion and lack of anti-coronavirus equipment and oxygen.

The health ministry said on Wednesday it will boost capacity at the city’s hospitals.

Ebola outbreak in western Democratic Republic of the Congo reaches 100 cases

Via ReliefWeb, a WHO news release: Ebola outbreak in western Democratic Republic of the Congo reaches 100 cases. Excerpt:

Brazzaville, 21 August 2020 – The number of cases in the ongoing Ebola outbreak in western Democratic Republic of the Congo (DRC) has reached 100, a near two-fold increase in a little over five weeks. 

This latest outbreak, DRC’s 11th, was declared on 1 June 2020 in Equateur Province. A cluster of cases was initially detected in Mbandaka, the provincial capital. The outbreak has since spread to 11 of the province’s 17 health zones. Of the 100 cases reported so far, 96 are confirmed and four are probable. Forty-three people have lost their lives.  

The outbreak presents significant logistical challenges, with affected communities spanning large distances in remote and densely-forested areas of the province, which straddles the Equator. At its widest points, the outbreak is spread across approximately 300 km both from east to west and from north to south. It can take days to reach affected populations, with responders and supplies often having to traverse areas without roads, necessitating long periods of river boat travel.  

An Ebola outbreak occurred in the same province in May 2018 and was contained in less than three months with 54 cases and 33 deaths recorded. 

“With 100 Ebola cases in less than 100 days, the outbreak in Equateur Province is evolving in a concerning way,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “The virus is spreading across a wide and rugged terrain which requires costly interventions and with COVID-19 draining resources and attention, it is hard to scale-up operations.” 

The current response is underfunded, adding challenges to the existing logistical barriers. WHO initially provided US$ 1.7 million and subsequently supplemented this with another US$ 600 000 from its contingency fund for emergencies. The DRC Ministry of Health has presented an integrated plan to donors and partners for about US$ 40 million and has committed US$ 4 million. There is a critical need for additional support.  

“Without extra support the teams on the ground will find it harder to get ahead of the virus,” said Dr Moeti. “COVID-19 is not the only emergency needing robust support. As we know from our recent history we ignore Ebola at our peril.”

Population-wide testing of SARS-CoV-2: Country experiences and potential approaches in the EU/EEA and the United Kingdom

ECDC has published Population-wide testing of SARS-CoV-2: country experiences and potential approaches in the EU/EEA and the United Kingdom. The executive summary: 

• Different population-wide testing approaches have already been used in various countries, including household testing, individual testing and the testing of incoming travellers, irrespective of whether or not they are displaying symptoms. 

• Factors that need to be considered prior to implementation of any population-wide testing strategy which is to include all individuals are the epidemiological situation, costs, logistics, technical feasibility, resource availability, contact tracing capabilities, barriers to testing, potential false positivity and timely notification. 

• Population-wide testing strategies can complement other public health measures and are more effective when paired with case isolation and contact tracing.

New report: An Interim Framework for COVID-19 Vaccine Allocation and Distribution in the US

A news release from Johns Hopkins Bloomberg School of Public Health: New Report: An Interim Framework for COVID-19 Vaccine Allocation and Distribution in the U.S.

Today (Wednesday, August 19, 2020), the Center for Health Security at Johns Hopkins Bloomberg School of Public Health released a new report providing an ethical framework for making decisions about allocation and distribution of a COVID-19 vaccine during the initial period when such a vaccine has first been authorized for use and is still in limited supply.   

The report, Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States, proposes specific tiers of high-priority candidates for receiving a first vaccine based on this framework, including recognizing the contributions of essential workers who have been overlooked in previous allocation schemes:  

Tier 1 includes those: 

• Most essential in sustaining the ongoing COVID-19 response. 

• At greatest risk of severe illness and death, and their caregivers. 

• Most essential to maintaining core societal functions. 

Tier 2 includes those: 

• Involved in broader health provision. 

• Facing greater barriers to access care if they become seriously ill. 

• Contributing to maintenance of core societal functions. 

• Whose living or working conditions give them elevated risk of infection, even if they have lesser or unknown risk of severe illness and death. 

The framework is guided by the following ethical principles, which the report authors believe should guide COVID-19 vaccine allocation and help identify more specific policy goals and objectives around vaccine policies: 

• Promotion of the common good, by promoting public health while enabling social and economic activity. 

• The importance of treating individuals fairly and promoting social equity, for example by addressing racial and ethnic disparities in COVID-19 mortality, and by recognizing the contributions of essential workers who have been overlooked in previous allocation schemes.  

• The promotion of legitimacy, trust and a sense of community ownership over vaccine policy, while respecting the diversity of values and beliefs in our pluralist society.

Klain on COVID-19: US healthcare workers are dying at a shameful rate

Via The Guardian, Ronald A. Klain writes: I was Obama’s Ebola tsar. US healthcare workers are dying at a shameful rate. Excerpt:

Healthcare workers usually bear the brunt of an epidemic. Doctors, nurses and other medical personnel are in constant contact with people who may be infected. The cruel math of such potential exposures, multiplied over and over, inevitably takes a toll.  

Covid-19 is no exception. Lost on the Frontline, a new database from the Guardian and Kaiser Health News, shows that more than 900 American healthcare workers have already paid the ultimate price in the battle against coronavirus. 

What makes the deaths of these men and women especially painful is that many of them could have been prevented. Although America has applauded health workers, banged pots in their honor and offered grateful video tributes, we have consistently failed them where it mattered most.  

This failure starts with a lack of adequate protective gear – essentials like masks, gloves, gowns and protective shields. Countless healthcare workers have had to reuse masks day after day. In some cases nurses were forced to wear garbage bags in lieu of actual protective equipment.  

President Trump abandoned state governments and hospitals to meet critical gaps in protection for healthcare workers with little help from Washington. He also refused to use his power under the Defense Production Act – a power he used to equip border patrol units – to meet the needs of healthcare workers. When their pleas for help became public, Trump actually stood in the Rose Garden and claimed that healthcare workers lacked protective gear because they were pilfering it and selling it on the black market.

But that is not the only way in which we let our healthcare workers down. 

The social media images of healthcare workers holding signs saying “Please Stay Home to Protect Those of Us Who Can’t” should haunt us all. 

During the second world war, our parents and grandparents made countless, burdensome sacrifices in their daily lives to provide vital resources to the troops on the frontlines. In the life-or-death struggle over Covid-19 – a struggle that has had an average monthly death toll since March comparable to that of the second world war – the sacrifices most of us were asked to make were relatively modest by comparison. 

One fewer trip to a beauty parlor or a bar or a barbershop or a restaurant might have spared a doctor or a nurse. In too many cases, too many of us failed to do our part to reduce the risk to our healthcare workers. 

Finally, the stubborn refusal of many Americans to wear masks around others – and the refusal of some public officials to use their power to mandate mask-wearing or even model it (including the president, until recently) – also raises risk for these frontline disease fighters. This failing is the most ironic, because claiming it is too uncomfortable or unsightly to wear a mask for 15 minutes during a trip to a grocery or hardware store has put at risk doctors and nurses who “mask up” for hours each day, without complaint, to save others.

Covid has affected all Americans, but it hasn’t affected all of us equally. Lost on the Frontline tells that story. As with Covid victims as a whole, the list of healthcare workers who have died disproportionately includes people of color. And while we still do not have complete data, it is likely that nursing will be the profession that has lost more people to Covid than any other occupation in our country.  

Of the many hard days I spent coordinating the US fight against Ebola in 2014-15, none was more painful than 29 November 2014, when I spoke at the funeral of Martin Salia, a doctor who left Maryland to return to his native Sierra Leone to help cope with the devastating death toll among healthcare workers during that epidemic. Dr Salia contracted Ebola while performing surgery; by the time he was airlifted back to the US for treatment, he was too ill to be saved. 

At his funeral, I noted that while history is filled with all sorts of accidental heroes and unwilling heroes, “the greatest heroes are people who choose to face danger, who voluntarily put themselves at risk to help others.”