H5N1

NHS England 'on its knees' as performance figures hit new lows

Via The Guardian: NHS England 'on its knees' as performance figures hit new lows.

The NHS was “on its knees” even before winter had begun, health service bosses have said as figures showed it missed key waiting-time targets for A&E care, operations and cancer treatment.  

The performance of the NHS in England in November was yet again its worst ever, prompting concern that it cannot keep up with a relentless rise in the number of people needing care. 

Doctors’ leaders called for Boris Johnson’s government to take urgent action to boost staffing, hospital bed numbers and GP services.  

“These figures show an NHS on its knees and it is no wonder that most leaders predict that this winter will be the worst on record,” said Niall Dickson, the chief executive of the NHS Confederation. “More and more patients are turning up at emergency departments and there is a limit as to how many they can cope with.”  

The latest set of monthly performance figures published by NHS England show:  

• 71% of patients who attended a hospital-based A&E unit in November were seen and discharged, admitted or transferred within four hours – a record low. 

• Hospitals were 95% full, far beyond the 85% that doctors consider safe, even before the surge in demand that winter always brings. 

• The highest number of patients ever were forced to spend at least four hours on a hospital trolley waiting for a bed. 

• Thousands of hospital beds are being lost each week due to norovirus, the winter vomiting bug. 

• Flu is already putting serious strain on the NHS, sparking fears of a major outbreak this winter. 

The number of people waiting for a non-urgent operation has risen to 4.45 million. The numbers of people seeking help at A&E and being admitted as an emergency case were each at record highs last month. And hospitals managed to meet only three of the eight NHS-wide targets for cancer treatment. 

“What we are seeing is a health service that is on a downward spiral as this month we see yet another set of shambolic figures,” said Dr Chaand Nagpaul, the chair of the British Medical Association. 

He blamed the Conservatives for creating the dire situation. “Day one of the new government and another set of stark NHS performance figures. They are not inheriting a problem, they created this problem, and the responsibility ultimately lies with them to fix it.”  

In recent weeks growing numbers of hospitals have had to declare a black alert – an admission that they cannot cope – as they have been overwhelmed by the number of patients seeking care. 

“We’ve seen an early spike in flu, while others have been battling norovirus cases, which are already double the levels we saw last year,” said Miriam Deakin, the director of policy and strategy at NHS Providers, which represents NHS trusts.

Two more deaths from measles in Samoa, toll now 65

Via RNZ News: Two more deaths from measles in Samoa, toll now 65. But see the post just below for the silver lining:

There are now 65 measles related deaths in Samoa following two more fatalities over the past 24 hours.

The government says there is also now at least 4460 measles cases since the outbreak began in October. 

There were 103 new cases recorded in the last 24 hours.  

165 people remain hospitalised including 18 critically ill children and three pregnant women. 

The new figures come after a two-day nationwide shutdown to enable vaccination teams to reach households where people still needed to be immunised. 

Prime Minister Tuilaepa Sailele Malielegaoi said the teams carried out more than 20,000 vaccinations on Thursday and Friday.

Samoa measles: 4,460 cases, 65 deaths—and 89% of population vaccinated

A tweet from the Government of Samoa that packs a hell of a punch in its last sentence. Public health experts around the world will take note, and take heart:

Latest update: 4,460 measles cases have been reported since the outbreak with 103 recorded in the last 24 hours. To date, 65 measles related deaths have been recorded. 

VACCINATION UPDATE: As of 6 Dec, 89% of population have been vaccinated (graphic attached).

Samoa measles: Death toll hits 60

Via Talamua On-line News: MEASLES OUTBREAK: Death toll hits 60. Excerpt:

APIA, SAMOA – WEDNESDAY 4 DECEMBER 2019: Five more people died of measles in the last 24 hours bringing the death toll to 60.  Fifty two (52) of the deaths are children under 4 years old where a total of 2069 measles cases have been recorded since the outbreak.  

The latest update comes as the country prepares for a complete shutdown starting 6.00 tomorrow morning until 6.00 on Friday evening in the push for a complete vaccination of the population. Only essential services will be open and public vehicles are been prohibited. 

The Ministry of Health confirms a total of 4,052 measles cases have been reported to the Disease Surveillance Team, since the outbreak started.  There were 171 recorded in the last 24 hours. 

There are currently 177 measles cases who are in-patients at all health facilities.  Of this, 142 are at the Tupua Tamasese Meaole Hospital (TTMH), 4 at Poutasi District Hospital, 1 at Lalomanu DH, 22 at the Leulumoega Rural District Hospital, 6 at the Malietoa Tanumafili II Hospital (MTIIH) 1 at Foailalo DH and 1 at Safotu District Hospital.  Admissions include 20 critically ill children in ICU/HDU and 3 pregnant women and 2 postnatal at TTMH.  

The total number of measles cases admitted to all hospitals recorded for the outbreak to date is 1,246.  Of that, 1,009 (81%) patients have been discharged. Recovery rate has remained constant since the last update.  

To date, 60 measles related deaths have been recorded, with 5 fatalities in the last 24 hours.

Samoa Airways flies in medical support, pledges donation to measles relief

Via Talamua On-line News: Samoa Airways flies in medical support, pledges donation to Measles relief. This is such a wise and obvious move that I wonder why it isn't standard operating practice in any country getting international aid for a disease outbreak. In West Africa, several airlines stopped flying to the Ebola countries. Excerpt:

APIA, SAMOA – 28 NOVEMBER 2019: Samoa Airways is supporting international agencies by providing free freight services and flights for life saving medical equipment and medical personnel coming to the aid of Samoa’s measles state of emergency. 

CEO for Samoa Airways, Tupuivao Seiuli Alvin Tuala says the airline is doing their part to contribute toward the health crisis relief effort. 

“Out of this emergency, we have seen many examples of the generosity of spirit in our people who are working tirelessly to help save lives and provide support to families and health care workers in great need,” said Tupuivao. 

“Samoa Airways will continue to deliver this message of hope and re-affirm our commitment to lifting up our communities especially when disaster strikes.” 

A collaborative effort by Pacific Trade Invest Australia and Bella Vista Group Australia/New Zealand with Samoa Airways enabled the delivery of 3 critical care ventilators and supporting medical supplies to health care workers at the front line.  

The National Emergency Operations Centre (NEOC) is also currently coordinating with Samoa Airways to bring over 15 volunteer nurses provided through the Bella Vista Group Australia/New Zealand, who are expected to arrive this week along with more ventilators. 

“Samoa Airways is assisting to transporting all medical personnel and medical supplies at this time at no cost,” said Tupuivao. “We must all step up and do whatever we can at this time to help our people and our country.” 

Donation to Measles Relief Response 

In addition to freight and flight services support by the airline, a monetary contribution from all airfare sales made through all of November will be donated to the measles epidemic relief response through NEOC who is responsible for the co-ordination of all assistance and donations.  

The orders of the State of Emergency in Samoa do not include an international travel ban and Samoa Airways’ long haul services will continue to operate within the parameters of the 30 day health emergency proclamation by Samoa and American Samoa until further notice.

Measles claims more than twice as many lives than Ebola in DR Congo

Via UN News: Measles claims more than twice as many lives than Ebola in DR Congo. Excerpt:

Since the beginning of 2019, measles has taken more than 5,000 lives in the Democratic Republic of the Congo (DRC), a top UN Children’s Fund (UNICEF) official said on Wednesday, pointing out that over 90 per cent of the deaths were children under-five.  

“While the Ebola outbreak, which has claimed more than 2,000 lives in the Eastern DRC, has commanded sustained international attention, measles, which has claimed more than twice as many lives, continues to be underreported”, said Edouard Beigbeder, UNICEF Representative in the country. 

Violence and insecurity, lack of access to healthcare and vaccine and medical kit shortages in the worst-affected areas, have rendered thousands of children unprotected and hindered efforts to stop the deadly disease from spreading.   

“Cultural beliefs and traditional healthcare practices also often get in the way of vaccinating children against measles and treating those with symptoms”, he explained. 

The World Health Organization (WHO) said that measles, which has gripped all provinces in the country, is the world's largest and fastest-moving epidemic.  

While a safe, effective and affordable vaccine can prevent the disease, Mr. Beigbeder stressed that “the key is to reach every single child, no matter where they are”.   

WHO maintains that responding to measles requires a range of approaches to ensure that all children get their vaccines on time. This requires effective communication and engagement on their critical importance as well as the dangers of the disease.  

UNICEF and its partners are not only conducting measles vaccination campaigns in the worst-affected areas, but also supplying clinics with medicine to treat the disease.  

So far, they have distributed 1,317 medical measles kits – containing antibiotics, rehydration salts, Vitamin A and other medicines – to affected health zones to treat children with complications.  

“Yet these measures can only ever be a short-term solution, as significant investment in strengthening DRC’s national vaccination programme and wider health care systems is crucial to guarantee the health and wellbeing of the country’s children”, the UNICEF representative underscored.

Children bear the brunt as the world's biggest measles epidemic sweeps DR Congo

Via The Guardian: Children bear the brunt as the world's biggest measles epidemic sweeps Congo. Excerpt:

More than 5,000 people, mostly children, have been killed in the Democratic Republic of the Congo, in what is currently the world’s biggest measles epidemic.  

Measles, which is preventable through vaccination, has spread to all 26 provinces of the country, which is also battling a 15-month-long Ebola epidemic. 

About a quarter of a million people in DRC are thought to have been infected by measles this year alone, more than three times the number infected in 2018. Three-quarters of cases, and around nine in 10 deaths, involve children younger than five years old.

“The situation is very critical and very alarming,” said Xavier Crespin, Unicef’s chief of health in DRC. “All the international community are focusing on Ebola but we are seeing the number of measles cases in DRC are far more,” he added.  

Since August 2018, authorities have struggled to contain the spread of Ebola, which has claimed 2,196 lives in the eastern North Kivu and Ituri provinces. The country’s weak health infrastructure, combined with political instability and widespread suspicion of health workers, have severely hampered efforts to tackle the disease. Officials have described the outbreak as the most complex public health emergency in history. 

On Friday, the World Health Organization warned of escalating violence, which has is preventing health staff from reaching communities. The WHO has documented more than 300 attacks on health care facilities in the country this year, including six deaths of workers and patients. 

Health workers say the same problems, combined with a shortage of vaccines caused by funding delays, are also undermining attempts to stop measles.  

“We don’t have a lot of vaccines to cover all of the country. We are doing the immunisation campaign step by step: we begin with hotspot areas and then move to other group of provinces because we cannot do all of them at the same time,” said Crespin.  

In some cases, families who live far from clinics make expensive and lengthy journeys to health facilities, only to find there are no jabs available. “When they come sometimes there is a stock out of vaccines, they go back [home] and they cannot come back,” said Crespin. 

A lack of trust in health teams, which has also severely disrupted the Ebola response, is leading some to refuse vaccines. “In some remote areas it can take two, three or four days just for the team to do 100km, it takes a lot of time to reach the population, and when you come there people are not sensitised and some refuse the vaccine,” Crespin added.  

Children require two jabs to be protected against measles, which means health teams face the additional challenge of reaching families, and convincing parents, a second time.

DRC Ebola: CMRE update, November 14

CMRE has published Situation épidémiologique du 14 novembre 2019. Excerpt from the Google translation: 

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AT NOVEMBER 13, 2019 

Thursday, November 14, 2019 • Since the beginning of the epidemic, the cumulative number of cases is 3,292, of which 3,174 are confirmed and 118 are probable. In total, there were 2,193 deaths (2075 confirmed and 118 probable) and 1067 people cured. 

• 527 suspected cases under investigation; 

• 1 new case confirmed in North Kivu in Mabalako; 

• No new deaths of confirmed cases have been recorded; 

• No cured person has emerged from ETCs;  • No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 163 (5% of all confirmed / probable cases), including 41 deaths;

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS

Ebola Virus Disease Comprehensive Response Coordination Announces Three Road Traffic Accident in Bunia, Ituri

• Overall Coordination of Epidemic Response to Ebola Virus Disease in North, South Kivu and Ituri was informed this Thursday, November 13, 2019 of the tragic accident of road traffic between two motorcycles, one of which carried three agents of the response;

• These three officers, who work for the Epidemiological Surveillance Commission at the Point of Entry and Control, were returning from Bunia to Mambasa, where they are respectively delivering;

• This accident occurred around Marabo in Bunia on the evening of Wednesday 13 November 2019;

• The balance sheet reports an officer who died at the scene and two others who were seriously injured, including one in a coma. The two wounded were taken to the Nyakunde Reference General Hospital in Ituri for appropriate care;

• The overall coordination of the response sends its deepest condolences to the grieving family and expresses all its compassion and solidarity to the injured officers, while wishing them a quick recovery.

Effective start of Johnson & Johnson vaccination in two Goma health areas

• Ebola vaccination with the Ad26.ZEBOV / MVA-BN-Filo vaccine, produced by Janssen Pharmaceuticals for Johnson & Johnson, started on Thursday 14 November 2019 in two Karisimbi health areas in the city of Goma, North Kivu province;

• The Epidemic Response Coordinator for Ebola Virus Disease in North, South Kivu and Ituri, Prof. For this purpose, Steve Ahuka Mundeke visited the vaccination sites to inquire about the evolution of activities in the field. He was satisfied with the work of the teams;

• He took the opportunity to invite the population of the targeted areas to be vaccinated in order to protect themselves from the resurgence of the Ebola virus;

• Several people were present in Majengo and Kahembe health areas to get vaccinated. The first person to be vaccinated is a Kahembe community leader who has been protected against the Ebola virus today and also in case of a possible new outbreak of Ebola. This community leader has appealed to all residents of his community and sites targeted to come take this second vaccine. "This is an opportunity not to be missed, because it is said that prevention is better than cure, " he said;

• The logistics of this vaccination are provided by the international non-governmental organization Médecins Sans Frontières of France (MSF / France).

• Approved October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and October 23, 2019 by the National Ethics Committee, this second vaccine, called Ad26.ZEBOV / MVA-BN -Filo , is produced by Janssen Pharmaceuticals for Johnson & Johnson;

• This new vaccine complements the first, the rVSV-ZEBOV, the vaccine used until then in this epidemic. Manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee on May 20, 2018, it was recently approved.

Closing of the training workshop for media professionals in Beni on the role and responsibility of journalists during public health crises

• The Deputy Mayor of the city of Beni, Muhindo Bakwanamaha Modeste, closed this Thursday, November 14, 2019 in Beni in the province of North Kivu the training of media professionals on the role and responsibility during public health crises;

• The coordinator of the Beni Ebola Ebola response, Dr Pierre Adikey, on behalf of the Coordinator of the Response, Prof. Steve Ahuka, wished to see these kinds of trainings be organized, not only in other sub-Coordination of the response, but also throughout the Democratic Republic of Congo so that journalists from all over the country are ready to face any possible epidemic crisis;

• This training, he said, is part of the zero-case Ebola strategy and strengthening the health system of tomorrow;

• The focal point of Beni's journalists, Moustapha MULONDA, reaffirmed the commitment of journalists to combat Ebola Virus Disease through various programs and publications disseminated and published by their respective media thanks to the new tools acquired during this period. training;

• This training was organized by the Ministry of Health in collaboration with the World Health Organization and benefited from the facilitation of the overall coordination of the response, UNICEF, CDC Africa and MSF.

VACCINATION

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 251,637 people have been vaccinated;

• Vaccination with the second Ad26.ZEBOV / MVA-BN-Filo vaccine, produced by Janssen Pharmaceuticals for Johnson & Johnson, began on Thursday November 14, 2019 in Goma. This vaccine was approved on 22 October 2019 by the decisions of the Ethics Committee of the School of Public Health of the University of Kinshasa and 23 October 2019 of the National Ethics Committee;

• Until then, only one vaccine was used in this outbreak. This is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee in its decision of 20 May 2018 and which has recently been approved.

MONITORING AT ENTRY POINTS

• A 27-year-old woman from Butembo for Goma, an escaped suspect from Makasi Hospital in Butembo, North Kivu, was intercepted at the Kanyabayonga checkpoint in Kayna. When she was intercepted, she experienced signs such as fever at 38.4°C, severe asthenia, abdominal pain and vaginal bleeding. She was sent to the KAYNA Transit Center.

• Since the beginning of the epidemic, the total number of travelers checked (temperature rise) at the sanitary control points is 116,622,388 ;

• To date, a total of 112 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

WHO scales up cholera vigilance in Khartoum, Sudan

WHO EMRO has published WHO scales up cholera vigilance in Khartoum, Sudan. Excerpt:

5 November 2019, Khartoum, Sudan -- To prevent a potential spread of the current cholera outbreak to Khartoum State – including to the country’s capital Khartoum City – and at the request of the Federal Minister of Health Dr Akram Eltom, WHO is working closely with health partners, nongovernmental organizations, and at-risk communities to ensure that suspected cases are quickly identified and responded to, and that people can effectively protect themselves from infection.   

“The risk of cholera spreading is very real. If not properly managed, this could have potentially serious consequences. More than 8 million people live in Khartoum State, where the public health system is impacted by the economic crisis, recent flooding, and ongoing outbreaks of infectious diseases,” said Dr Naeema Al Gasseer, WHO Representative in Sudan.  

As of 3 November, Sudan’s Ministry of Health reported 332 suspected cases of cholera, concentrated in Blue Nile and Sennar States. Two cases were confirmed in Khartoum State on 19 October.  

Together with the Ministry of Health, WHO has conducted initial risk mapping in Khartoum State to identify which areas are more likely to be at increased risk of an outbreak. This will allow for more informed planning to ensure high-risk areas, including Sharq Elnil and Ombada localities, are better prepared to respond as needed. 

Scaling up health capacities to detect and respond to cholera 

To ensure that health facilities and cholera treatment centres in Khartoum State are equipped to diagnose and treat suspected patients, WHO has delivered cholera medicines and supplies sufficient for 400 severely dehydrated patients, and 500 rapid diagnostic tests used for immediate detection and screening of cholera patients in health facilities.  

WHO is also supporting the establishing of 2 cholera treatment centres in Ombada and Bahri localities by providing additional cholera medicines, medical supplies, and rapid diagnostic tests.   

To strengthen disease surveillance in Khartoum State, WHO, with the support of MSF, is providing refresher training for 271 health staff and paramedics from all 7 localities on cholera detection and management. An additional 35 health staff are being trained to form rapid response teams who will be the first to respond to suspected cases at locality level.

US: Public health consequences of wildfire-induced blackouts

Via the Fort Bragg Advocate-News in northern California, an October 31 report: PSPS roils coast; community steps up. Excerpt:

Steve Orsi and Dave Latoof, fire chiefs from Fort Bragg and Mendocino, both reported an increase in calls for practical concerns and information (does the fire department deliver water to your house? – no, it does not). But both reported people getting along, generally not setting things on fire and being reasonably well-prepared. 

That was not the case across the board. The Mendocino Coast District Hospital Emergency Room was deluged by people with a variety of needs, according to Will Lee, medical staff services director (also mayor of Fort Bragg).  

City government’s email system and internet service, provided by Comcast, went out and remained out Wednesday morning. This reduced City Manager Tabatha Miller to sending updates on the situation by text, and severely limited communication for all city employees during a crisis event. 

City council member Lindy Peters was at City Hall Monday, and said he (and council member Bernie Norvell) had spent part of Sunday at the police station, where a steady stream of people, many of them refugees from Sonoma County, came in with all manner of questions and problems.  

Medical needs 

Oxygen bottles were a major issue, Lee said. State law requires everyone needing oxygen to have six- to eight-bottle backup supply, Lee said. It turned out quite a few people didn’t have that backup, couldn’t get more or fill bottles without electricity, and came to the ER for help.  

Lee said one of the companies that supplies oxygen bottles was responsive to the crisis. The other was not, he said, and that is a situation that needs to be corrected. 

Lack of a generator to adequately power the North Coast Family Health Center’s Urgent Care Center also put an extra load on the emergency room Monday, but a generator supplied Tuesday eased the load. 

Another strain on local medical services were refugees from the Kincade Fire in Sonoma County, which has driven well over 100,000 people from their homes. With air quality bad and motel rooms scarce farther south, many fire refugees came to the Mendocino Coast even without power and very limited shelter. 

A number, Lee said, had respiratory issues from having to deal with intense smoke. Others had anxiety-related complaints, others had full-on medical emergencies. While the hospital ran on backup generators (which, contrary to rumor, Lee said, have all functioned fine throughout), the medical staff dealt with a significant increase in traffic.  

Lee said the blackout itself triggered some anxiety-related issues among local people, from chest pains to mental health crises, and they all ended at the Emergency Room.