H5N1

WHO steps up efforts to curb Ebola outbreaks in Guinea and the Democratic Republic of the Congo

Via ReliefWeb, a news release from WHO: WHO steps up efforts to curb Ebola outbreaks in Guinea and the Democratic Republic of the Congo. Excerpt:

Brazzaville, 18 February 2021 – With efforts gathering pace to promptly tackle the new Ebola outbreaks in Guinea and the Democratic Republic of the Congo (DRC), the World Health Organization (WHO) is deploying teams of experts to support the national authorities ramp up the response and avert widespread infections. 

Health authorities in Guinea declared an Ebola outbreak on 14 February after three cases detected in Gouécké, a rural community in N’Zerekore prefecture tested positive for the virus. It is the first Ebola outbreak in Guinea since 2016 when a large one was successfully brought under control. 

More than 100 WHO staff, deployed from other countries and from within Guinea, are expected to be part of the Ebola response by the end of February. A team of eight experts from the WHO Regional Office for Africa in Brazzaville is leaving soon. Efforts are ongoing to step up surveillance, contact-tracing, testing and treatment as well as preparing for vaccination. 

“We are hard at work, shifting quickly through the gears to get ahead of the virus. With experts and emergency supplies already getting on the ground, the response is off to a strong start,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Our collective, quick action is crucial to averting an uncontrolled spread of Ebola amid the COVID-19 pandemic which has already pushed health workers and health facilities to the edge.” 

A humanitarian flight arrived on 15 February in N’Zerekore with 700 kg of medical equipment donated by WHO and partners. A consignment of more than 11 000 doses of Ebola vaccine is expected to arrive in Guinea this weekend. In addition, more than 8500 doses will be shipped from the United States of America for a total of 20 000 doses. Vaccination is set to kick off shortly afterwards. A 30-strong vaccination team has already been mobilized locally and is ready to deploy as soon as the vaccines are received. 

Meanwhile, in the DRC, so far there are four confirmed Ebola cases, including two deaths that are epidemiologically linked. WHO has around 20 experts on the ground supporting national and provincial health authorities. About 8000 vaccine doses were still available in the country at the end of the 11th Ebola outbreak. The vaccination of people at high risk was officially launched in Butembo, the outbreak’s epicentre on 15 February. So far nearly 70 people have been vaccinated. The quick rollout of vaccines is a testament to the enormous local capacity built in the previous outbreaks by WHO and partners. 

WHO has released US$ 1.25 million to support the response in Guinea and to reinforce Ebola readiness in neighbouring Cote d’Ivoire, Guinea-Bissau, Liberia, Mali, Senegal and Sierra Leone. Additionally, the United Nations Central Emergency Response Fund has disbursed US$ 15 million to support the response in Guinea and DRC and readiness in the neighbouring countries. 

With the epicentre of the Ebola outbreak in Guinea being a border area, countries in the sub-region are on high alert and increasing public health measures and surveillance in border towns and communities to quickly detect and respond to possible cross-border infections.

Guinea: Vaccination against Ebola begins on Monday February 22

Via guineenews.org: Guinea: vaccination against Ebola begins on Monday February 22 (Ministerial advisor). Excerpt from the Google translation:

The vaccination campaign against Ebola hemorrhagic fever could start as early as next Monday. It is Doctor Mohamed Lamine Yansané, principal advisor to the Minister of Health, who has just announced it during a press videoconference organized by the world health organization, from its regional office in Brazzaville. 

According to Dr Yansané, “the arrival of the vaccine is scheduled for next Sunday. And that the start of vaccination will take place on Monday." Even if, says the representative of the World Health Organization (WHO), Professor Ki-Zerbo, the vaccine arrives in Conakry from where it will be sent to N'Zérékoré where preparations and training have started. 

In addition, the main advice of the Minister of Health reassures that the 7 confirmed remain under control. “The 6 are concentrated there (N'Zérékoré). The one who escaped is taken care of in Conakry. And above all, the 250 contacts are all held,” he explains. 

As for sequencing, in order to determine the variant, it will be done at the Pasteur Institute in Dakar, as part of a collaboration with Senegal.

Guinea: Ebola virus disease outbreak emergency plan of action (EPoA)

Via ReliefWeb, an IFRC news release: Guinea: Ebola Virus Disease Outbreak Emergency Plan of Action (EPoA) DREF Operation n° MDRGN012.

A. Situation analysis 

Description of the disaster 

On 14 February 2021, the Government of Guinea declared a new outbreak of Ebola Virus Disease (EVD) in Gouécké sub-prefecture which is part of N’Zérékoré prefecture in Guinée Forrestière Region. This is the first known resurgence of Ebola in West Africa since the 2013-2016 epidemic that began in Guinea and killed more than 11,300 people across the region. 

Following an alert by the director of the regional hospital of N’Zérékoré of cases of vomiting, bloody diarrhoea, and total haematuria, bleeding at the injection sites of five (05) patients from the same family hospitalized in the intensive care unit and followed by a transfer to Conakry (CHU Donka). The surveillance team from the regional health authorities (DRS) and prefectural health authorities (DPS) went to the hospital and the subprefecture of Gouécké respectively for an investigation. 

Based on known information, seven (07) people have been infected to date including three deaths, three patients hospitalized in N’Zérékoré and one hospitalized in Conakry. Although the first case was confirmed in February, it is unclear when the outbreak started, which means the virus might have spread beyond the current known cases and there have been at least two unsecure burials of community deaths. The origins of the outbreak are unknown for the moment and all known cases so far are within the same family (Gouécké and N'Zérékoré) and in people aged over 25 years. 

As of 16 February, a joint mission of the Ministry of Health has already deployed to support Gouecké team for the field assessment. Several actions have been launched to prevent transmission and identify new infections: case isolation, investigations & data collecting for tracing potential new cases, mobilization of vaccines and diagnostic kits, opening of a treatment centre, and safe and dignified burials to prevent post-mortem transmission. A national level coordination mechanism has also been launched to mobilize partners, while neighbouring countries including Côte d’Ivoire, Liberia and Sierra Leone are on high alert. 

As investigations and contact tracing are ongoing to determine the scale of the outbreak and the geography of the risk, all humanitarian partners are expected to meet on 19 February to strategize on intervention. 

The probable impact areas are the prefectures of N’Zérékoré, Guékédou, Macenta, Lola, Yomou and Beyla. The number of people at risk in these areas is estimated at 1,042,251 inhabitants. The expected effect is a considerable increase in cases and the spread of the disease due to the displacement of infected people. 

To note, N'zérékoré region is the third most populated region in Guinea, covering 18% of the national territory. It is at the same time the furthest from Conakry (870 km away), the most landlocked and the least urbanized. Socio-cultural conflicts (ethnic, religious or socio-economic) have led to unprecedented violence in Guinea Forest region since 2010. The region's rugged terrain makes access difficult, which highlights the isolation of several villages in the region. 

The response to the Covid-19 epidemic has set a positive dynamic in terms of epidemic control and increased hygiene measures amongst the population to curb the spread of the disease. However, this should not be considered sufficient to prevent a 2014 scenario with the EVD outbreak spreading in the region. In that remote area, isolation of population and behaviours guided by fear of stigma and social impacts of the last Ebola outbreak remain an issue and community burials are both standard practice and a high risk for rapid transmission of the virus. 

In this context, the next few weeks will be crucial and must be spent building robust protection and control actions to avoid the spread of the outbreak.

'It's just exhausting': Rural Louisiana hospital workers tell of Covid-19 burnout

Lauren Weber of Kaiser Health News has a report in The Guardian: 'It's just exhausting': rural Louisiana hospital workers tell of Covid burnout. Excerpt:

The “heroes work here” sign in front of St James parish hospital is long gone, along with open intensive care unit beds in the state of Louisiana. 

Staffers at the rural hospital spent hours each day in January calling larger hospitals in search of the elusive beds for Covid-19 patients. They leveraged personal connections and begged nurses elsewhere to take patients they know are beyond their hospital’s care level. 

But as patients have waited to be transferred out of the hospital, which is about 45 minutes outside New Orleans, doctors such as Landon Roussel are forced to make unthinkable choices. As recently as 29 January, he had to decide between two patients: which one should get the sole available BiPAP machine to push oxygen into their lungs? 

That’s like a “war situation, which is not a situation that I want to be in – in the United States”, he said. 

As the nation’s attention shifts to the vaccine rollout, rural hospitals such as St James parish hospital have struggled to handle their communities’ sick following the holiday surge of Covid patients. 

“We knew it was coming. We saw it coming,” Mary Ellen Pratt, the hospital’s chief executive, said by phone. “It really has to happen to their family for them to really go, ‘OK, wow.’” 

And even though the vaccines have arrived and caseloads continue to improve after the holiday surge, only about 30% of staffers have opted to get their shots. Disparities in the broader community persist: in the initial rollout, only 9% of those vaccinated were Black in a parish – the Louisiana equivalent of a county – that is nearly 49% Black. 

Staff members are burned out from months of handling never-ending Covid crises. 

“They had been giving 150%, and they’re just getting really tired,” Pratt said. “It’s just exhausting.” 

‘Sometimes, your best isn’t enough’ 

In mid-January, the closest intensive care bed the staff could find was 600 miles away in Brownsville, Texas – so far that a plane would have been necessary to transport a patient. After three days, a closer bed was found at a Veterans Affairs hospital about 45 miles away. 

Staffers have tried Mississippi and Alabama with mixed luck. One patient they tried to transfer four hours away couldn’t go because the ambulance didn’t have enough oxygen to make it that far. A hospital in Florida even called them looking for ICU beds at St James parish hospital, which has never had any. 

More than half of US counties are like St James Parish and have no intensive care beds, full or empty. Rural hospitals in those communities are designed for step-down care: they often serve as a stopping point to stabilize people before they can be sent to larger hospitals with more specialized staff and equipment. 

Across the country, rural residents’ mortality rate from Covid has been consistently higher than that of urban residents since August, according to the Rural Policy Research Institute Center for Rural Health Policy Analysis. That has occurred even though Covid incidence has been lower among rural populations than urban ones since the middle of December, said Fred Ullrich, who runs the health policy department at the University of Iowa’s College of Public Health and co-authored the study.

Ebola in Guinea: A note on geography

As the article below says, the new Ebola outbreak is centered on the town of Gouécké in southern Guinea. Thanks to Google Maps, we can see that it's about 40 km north of Nzerekere, about a 45-minute drive on the N2.

Nzerekere itself is a substantial city of about 200,000, the country's second largest. One case, we've learned, was taken to the capital, Conakry, which is a considerable distance away: 783 km by road, and that's taking a shortcut through Sierra Leone—which could well close its borders. Presumably the patient in this case was flown to Conakry to get special care. 

The land route through Guinea goes through some communities with painful memories of 2014-16, like Macenta and Guéckedou, where the residents may not be happy to see ambulances carrying Ebola patients again.

It seems likely that supplies and responders will have to be flown in to Nzerekare, making the response more expensive while all involved are also fighting COVID-19.

Priorities for the COVID-19 pandemic at the start of 2021: Statement of the Lancet COVID-19 Commission

Via The Lancet: Priorities for the COVID-19 pandemic at the start of 2021: statement of the Lancet COVID-19 Commission. Excerpt:

The Lancet COVID-19 Commission calls for three urgent actions in the COVID-19 response (our broader overview is available on our website). 

First, all regions with high rates of new COVID-19 cases, including the USA and the European Union (EU), should intensify measures to minimise community transmission alongside rapid deployment of COVID-19 vaccines. 

Second, governments should urgently and fully fund WHO and the Access to COVID-19 Tools (ACT) Accelerator, including COVAX. 

Third, the G20 countries should empower the International Monetary Fund (IMF) and multilateral development banks to increase the scale of financing and debt relief. 

Success on all three priorities—containment of transmission, rapid vaccination, and emergency finance—will require improved global cooperation. The high rates of community transmission (>100 new COVID-19 cases per million per day) in the USA, Europe, South Africa, and other countries show the emergence of new variants of SARS-CoV-2, such as lineage B.1.1.7 in the UK, 501Y.V2 in South Africa, and additional variants emerging in California, USA, and in Brazil. 

New lineages are increasing transmission of infection and raising risks in regions that have been less affected by COVID-19, including in sub-Saharan Africa. Additionally, acquired immunity from earlier COVID-19 infections might be less protective against reinfection with some of the new SARS-CoV-2 variants. Mutant lineages might also reduce the efficacy of COVID-19 vaccines and require adapted vaccines or boosters. 

The numbers of new COVID-19 cases in east Asia and the Pacific (<10 new cases per million per day in most countries) have been consistently below those of Northern America and Europe. The lower numbers of COVID-19 cases in these countries result from the successful implementation of comprehensive containment measures: border restrictions and other limits on movement; behavioural changes including widespread use of face masks and physical distancing; active surveillance by public health systems, including mass testing, backward tracing (to identify the sources of outbreaks), and forward tracing (to identify the contacts of new cases); and the quarantine of all suspected cases and the use of facility-based isolation of confirmed cases of COVID-19. 

The USA and the EU failed to implement such comprehensive measures, and there was generally excessive decentralisation of containment efforts across the 50 US states and 27 EU members in 2020. Lack of centralised coordination undermined control of COVID-19, not least because of interstate travel in the USA and intercountry travel in the EU. Both the USA and EU need to step up more top–down coordination in 2021. 

Stronger health systems that incorporate universal health coverage and community-based health workers are vital in the response to COVID-19. At least half of the world's population lacks access to essential health services. Strengthening community-based and gender-responsive health systems will be essential to implement inclusive and comprehensive COVID-19 immunisation campaigns. 

The global roll-out of COVID-19 vaccines to date is neither inclusive nor adequately planned. COVAX has targeted immunisation coverage of at least 20% of the population in each participating country by the end of 2021, and has contracted for 2 billion doses of COVID-19 vaccines. Yet the timely supply of vaccines to COVAX is in question, as high-income countries (HICs) step to the front of the queue for limited supplies of COVID-19 vaccines. 

As of Feb 9, 2021, 148·08 million COVID-19 vaccine doses had been delivered, of which 115·67 million were delivered in the USA (43·21 million), China (40·52 million), the EU (18·36 million), and the UK (13·58). Other countries in Africa, Latin America and the Caribbean, and Asia (not including China) have received very few vaccine doses or none at all. 

This unequal access to COVID-19 vaccines is partly due to the difficulty of managing the ultracold supply chain needed for the two mRNA vaccines, but it is also due to the vaccine supply deals negotiated by HICs directly with the vaccine producers, rather than through COVAX.

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Old people use a lot of primary care, and my wife and I have seen what a difference the pandemic has made in the quantity and quality of that care. Via CMAJ: Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada. The abstract:

BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada. 

METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. 

RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). 

INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.

ECDC: Stress test on logistical aspects of COVID-19 vaccination deployment plans

A technical report from ECDC: Stress test on logistical aspects of COVID-19 vaccination deployment plans: final report. The executive summary:

Member States were asked to describe the deployment plans in place for delivering a vaccine with strict cold chain requirements to their target priority groups. All participating Member States were able to describe the process, albeit in varying levels of detail, reflecting that they were at different points in their planning. Most described bespoke cross-government governance arrangements where a task force had been convened to oversee the deployment. Electronic systems for logistics management and vaccination registries were described, some newly developed and others that had been used in previous vaccination programmes. Plans were also in place, or in development, to promote the vaccination campaign including using and monitoring social media to support the roll-out. 

One of the most important aspects of the stress test, however, was to provide an opportunity for those involved in developing their vaccine deployment plan to test it against a realistic scenario, to work through all the elements of deployment and provide reassurance that the plan was robust and that any issues identified could be addressed. Feedback from those who took part in the stress test indicated that this was achieved. The stress test was completed when participants came together in a webinar to hear an overview of the results and share their experiences of vaccine roll-out to date.

COVID-19: PAHO donates oxygen cylinders and supplies to Manaus, Brazil

A news release: PAHO donates oxygen cylinders and supplies to Manaus, Brazil. Except:

Brasília, Brazil, February 1, 2021 (PAHO) – The Pan American Health Organization (PAHO) donated 4,600 oximeters last week to the Amazonas State Health Department and to the Manaus Municipal Health Department. These devices help monitor the health conditions of patients with COVID-19.   

PAHO has also sent 45 oxygen cylinders to supply health facilities in the state and 1,500 thermometers to take patients’ temperatures.   

In addition, the international organization has guaranteed the delivery of 60,000 rapid antigen tests to support COVID-19 diagnosis. PAHO has donated these supplies to several countries in the Americas in order to facilitate the identification of people infected with the disease, even in hard-to-reach communities.   

Rapid antigen tests are more accurate in determining if someone is currently infected. In contrast, rapid antibody tests can show when someone has had COVID-19 but usually provide a negative result during the early stages of infection.

Oxygen thefts mount as Mexico reports record COVID-19 deaths

Via The Associated Press: Oxygen thefts mount as Mexico reports record COVID-19 deaths. Excerpt:

MEXICO CITY (AP) — Thefts of oxygen mounted as Mexico reported its highest daily death toll since the coronavirus pandemic began, with 1,584 deaths confirmed Tuesday. There was also a near-record one-day rise in new virus cases of 18,894. The Mexican Social Security Institute reported that an armed man burst into a government hospital in northern Sonora state around noon Tuesday and stole seven oxygen tanks.  

The institute said the man pointed a gun at a hospital employee, demanded to know where the oxygen was kept, and took four empty cannisters and three full ones. Authorities in the city of Navajoa are looking for the man and and another suspect who drove off in a car carrying the tanks.  

Also on Tuesday, police in the town of Tultepec, just north of Mexico City, chased down a small freight truck carrying 44 oxygen tanks, after the truck was reported stolen. Two suspects were detained at the scene.  

The thefts came as authorities launched a campaign urging people to return rented oxygen tanks they no longer need, saying enormous demand amid the pandemic has created a shortage of the cylinders. 

The consumer affairs agency launched an online campaign under the slogan “Return Your Tank, For The Love of Life.” 

With hospitals in Mexico City and other states overwhelmed by a wave of COVID-19 cases, many families have turned to treating their relatives at home with supplementary oxygen, creating spot shortages of tanks and oxygen for refills. 

But once patients recover, the agency said, many people simply keep the cannisters just in case someone else falls ill. 

“By doing this they are depriving other patients of something they need at a given moment, and cannot get,” the agency said.  

Even those who have their own tanks must often wait in long lines and wait hours to get oxygen tanks filled. 

Mexico has seen almost 1.67 million confirmed coronavirus infections and almost 143,000 test-confirmed deaths related to COVID-19. With the country’s extremely low testing rate, official estimates suggest the real death toll is closer to 195,000.