H5N1

Covid-19 ravages Navajo Nation as Trump makes election play for area

Via The Guardian: Covid ravages Navajo Nation as Trump makes election play for area. Excerpt:

Last spring, the Covid-19 pandemic struck the Navajo Nation worse than just about anywhere else in the United States or the rest of the world. Infections on the country’s largest American Indian reservation soared, reaching the highest per capita rate in the US in May. 

“Our people out here were hit very hard, and it spread like wildfire in our community,” said Jeff Begay, a business consultant living in the tiny community of Navajo Mountain, Utah. 

Begay, who is Navajo, said federal aid on the reservation has been slow and ineffective. More than 550 people on the reservation have died from Covid-19. Even in remote Navajo Mountain, Begay said there was an outbreak of four cases at a nearby church earlier in the pandemic.  

In mid-May, the Nation’s infection rate was 2,304 cases per 100,000 people – one in every 43 Navajos on the reservation had contracted Covid-19. As help from the federal government lagged, nonprofits like Doctors Without Borders stepped in to fill the void. 

Normally known for providing medical aid in war zones, the organization launched a rare US operation on the Navajo Nation, sending a team of medical professionals to help with infection prevention and offer technical support in health facilities. 

The conditions that are allowing the coronavirus to ravage the Navajo Nation – from poverty to poor healthcare to inadequate water infrastructure – are the result of decades of federal policies that have left the reservation’s living standards behind those of every US state. And under the Trump administration, they have remained the same or gotten worse.  

Unemployment and poverty are rampant. A third of families on the Nation don’t have running water, making hand-washing difficult. Many Navajo households are multigenerational and in hard-to-reach areas, giving the virus an easier path to vulnerable elders living far from health services.

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.

12,000 people per day could die from COVID-19 linked hunger by end of year, potentially more than the disease, warns Oxfam

Via ReliefWeb, a new release from Oxfam: 12,000 people per day could die from Covid-19 linked hunger by end of year, potentially more than the disease, warns Oxfam. Excerpt:

Eight of the biggest food and beverage companies pay out $18 billion to shareholders as new epicentres of hunger emerge across the globe 

As many as 12,000 people could die per day by the end of the year as a result of hunger linked to COVID-19, potentially more than could die from the disease, warned Oxfam in a new briefing published today. The global observed daily mortality rate for COVID-19 reached its highest recorded point in April 2020 at just over 10,000 deaths per day. 

‘The Hunger Virus’ reveals how 122 million more people could be pushed to the brink of starvation this year as a result of the social and economic fallout from the pandemic including through mass unemployment, disruption to food production and supplies, and declining aid. 

Oxfam’s Interim Executive Director Chema Vera said: “COVID-19 is the last straw for millions of people already struggling with the impacts of conflict, climate change, inequality and a broken food system that has impoverished millions of food producers and workers. Meanwhile, those at the top are continuing to make a profit: eight of the biggest food and drink companies paid out over $18 billion to shareholders since January even as the pandemic was spreading across the globe - ten times more than the UN says is needed to stop people going hungry.” 

The briefing reveals the world’s ten worst hunger hotspots, places such as Venezuela and South Sudan where the food crisis is most severe and getting worse as a result of the pandemic. It also highlights emerging epicentres of hunger – middle income countries such as India, South Africa, and Brazil – where millions of people who were barely managing have been tipped over the edge by the pandemic. For example: 

Brazil: Millions of poor workers, with little in the way of savings or benefits to fall back on, lost their incomes as a result of lockdown. Only 10 percent of the financial support promised by the federal government had been distributed by late June with big business favored over workers and smaller more vulnerable companies.  

India: Travel restrictions left farmers without vital migrant labour at the peak of the harvest season, forcing many to leave their crops in the field to rot. Traders have also been unable to reach tribal communities during the peak harvest season for forest products, depriving up to 100 million people of their main source of income for the year. 

Yemen: Remittances dropped by 80 percent – or $253 million - in the first four months of 2020 as a result of mass job losses across the Gulf. Borders and supply route closures have led to food shortages and food price spikes in the country which imports 90 percent of its food.  

Sahel: Restrictions on movement have prevented herders from driving their livestock to greener pastures for feeding, threatening the livelihoods of millions of people. Just 26 percent of the $2.8bn needed to respond to COVID-19 in the region has been pledged. 

Kadidia Diallo, a female milk producer in Burkina Faso, told Oxfam: “COVID-19 is causing us a lot of harm. Giving my children something to eat in the morning has become difficult. We are totally dependent on the sale of milk, and with the closure of the market we can’t sell the milk anymore. If we don’t sell milk, we don't eat.”

Dr. Joanne Liu: 100 days of solitude during COVID-19

An excerpt from today's Globe and Mail: Opinion: 100 Days of Solitude: 18 experiences of isolation during the pandemic.

Joanne Liu is a pediatric emergency specialist at Montreal’s Sainte-Justine Hospital and the former international director of Médecins sans frontières. 

In March, the invisible enemy was at everyone’s door – including mine, at the monastic lakeside writers’ retreat I was attending just outside of Geneva.

I had been fortunate enough to get a year-long sabbatical to write a book, but when I saw people were dying in the thousands from COVID-19, I knew had to help. I had already seen too many people die alone in places such as Yemen, Liberia and Sierra Leone, as we worked to staunch cholera and Ebola. 

From that version of isolation, I returned to Montreal and I self-isolated for 14 days. That was tough in its own way: While I was used to contributing concretely in health crises abroad, I was suddenly powerless in my own country, just waiting to get my hospital privileges reactivated. 

Eventually, I was lucky to find a way to contribute. I offered advice to governments in Ottawa, Quebec and New Brunswick, and did shifts in the ER and in our devastated senior-care homes. I always thought this was the best way to own a crisis – taking calls and going out into the field. 

 But one memory kept racing through my mind during this pandemic, just as it did during the Ebola crisis: seeing a child in Liberia, bawling in his bed as his nose bled, surrounded not by loved ones, but by medical staff rushing around in triage mode. Human beings are not meant to die alone. Full stop.  

The doctors who joined me then vowed to never feel so powerless again – to never be caught without diagnostic tests, treatments and vaccines. Yet here I was, in my own G7 country in 2020, where we were realizing too late that epidemics have no mercy – that if there are vulnerabilities in the chain, diseases will break them. 

Hopefully, no one will ever judge any country overwhelmed by an epidemic again. It’s been a hard 100 days, but in the days still to come, we need to understand that we are only as strong as our weakest link. We’re not over COVID-19 until all of us are over COVID-19.

DR Congo: Government to support Equateur in the fight against COVID-19 and Ebola

Via 7sur7.cd: DRC: Government to support Equateur in the fight against covid-19 and Ebola (Eteni Longondo). The Google translation:

The Minister of Health of the Democratic Republic of Congo, Doctor Eteni Longondo, arrived on Friday 05 June 2020 in Mbandaka, chief town of the province of Equateur.  

The latter used his stay in this part of the country to announce to the provincial authorities that the government will support them in the fight against the Ebola epidemic and the coronavirus pandemic. 

"We have thought about the eradication of these two diseases that are here. It is Ebola and covid-19 because we have a first case of covid-19 here in the province of Equateur. And I told the province that the government will support it technically and financially in the eradication of these two diseases,'' said the Minister of Health.  

He also presented to the provincial executive of Equateur the partners who made the trip with him as part of this mission. These include the delegation from OXFAM, UNICEF and the World Health Organization.  

It should be noted that the province of Ecuador has registered to date 11 cases of Ebola including 10 in Mbandaka and 1 in Bikoro, among which there are 6 deaths. However, 1 case of covid-19 is confirmed in Mbandaka, in the town of Wangata by the National Biomedical Research Institute. 

MSF opens coronavirus COVID-19 centre in Venezuela

Via MSF.org: MSF opens coronavirus COVID-19 centre in Venezuela.

More than 100 professionals from different disciplines have set up a specialist COVID-19 centre in a wing of the Ana Francisca Pérez de León II hospital in Petare, northeast Caracas, Venezuela. 

The plan to rehabilitate the hospital’s infrastructure and create an inpatient unit, including intensive care beds, where COVID-19 patients can receive medical and psychological care, is being carried out by Médecins Sans Frontières (MSF) in collaboration with Venezuelan authorities and the hospital's management team. Hospital staff have also received personal protective equipment (PPE) and training.    

MSF staff working with hospital staff across disciplines 

A team, made up of MSF and hospital staff and including doctors, nurses, epidemiologists, psychologists, technicians and transport and maintenance staff, has already begun caring for patients with COVID-19 symptoms. 

“It has been hard work and not without its challenges, due to the urgency of the situation and the need to adapt the hospital structure to the biosecurity measures, without compromising the rest of its emergency activities,” says Isaac Alcalde, coordinating MSF's emergency responses in Caracas and Miranda. “This has been possible thanks to the willingness of MSF staff and the hospital’s management team to find the best solutions for patients. It's a new situation for everyone.” 

Challenges in providing protective equipment 

So far, one of the biggest challenges for MSF in our global response to COVID-19 has been the shortage of PPE for our medical teams.

“We know that, in many countries, health workers have been exposed to risk, and there have been many infections due to the lack of PPE,” says Alcalde. “We will do our best to ensure that this does not happen here.”  

“But even with sufficient protection, the medical teams will face very difficult situations, both personally and professionally,” continues Alcalde. “We will make sure to provide them with all the support they need, including psychological support, to minimise the impact of this extraordinary situation.”   

MSF providing contact tracing, psychological care 

People arriving at the Ana Francisca Pérez de León II hospital with suspected COVID-19 are received by a medical team and questioned about their symptoms before being tested, either with a rapid test or with a polymerase chain reaction (PCR) test. Those who test positive are taken to the isolation area to be stabilised and to receive medical and psychological care. 

An MSF team visits patients’ families to provide health information and psychological support, while actively tracing the patient’s contacts and searching for other people with symptoms within their community. 

The COVID-19 centre has 22 beds, including 16 inpatient beds and 6 intensive care beds. We are also operating three ambulances, and have rehabilitated a further five public ambulances, for transporting patients between hospitals and between local diagnosis centres and hospitals. These are available not only for coronavirus patients but for patients suffering from other medical emergencies.

MSF opens a COVID-19 treatment centre in Haiti

Via MSF.org, a May 18 report: MSF opens a coronavirus COVID-19 treatment centre in Haiti. Excerpt and then a comment:

Médecins Sans Frontières (MSF) continues to respond to the global COVID-19 pandemic by opening a treatment centre in Port-Au-Prince, Haiti’s capital city, to help provide a coordinated response to the new coronavirus outbreak and strengthen the capacity of the Haitian healthcare system. 

MSF has re-purposed the Grands Brûlés hospital in Drouillard, a neighbourhood of the capital, to support patients who have tested positive for COVID-19 and have been referred by the Ministry of Public Health and Population, with hospitalisation and oxygen. The COVID-19 Centre is launching its activities with a 20-bed capacity, but can accommodate up to 45 beds, as the outbreak evolves.  

Our COVID-19 global response is focused on three main priorities: supporting health authorities to provide care for patients with COVID-19; protecting people who are vulnerable and at risk; and keeping essential medical services running.  

Protective equipment is scarce 

However, the COVID-19 pandemic is posing numerous challenges for health systems worldwide. In Haiti, there is a scarcity of personal protective equipment (PPE), including crucial items such as masks and aprons, and medical tools such as COVID-19 tests. 

“These challenges, including a shortage of medical staff due to travel restrictions, have forced us to reorient our activities at the Grands Brûlés hospital, and rely on our existing staff, who are working tirelessly to respond to this emergency,” said Hassan Issa, MSF Head of Mission in Haiti. 

"We have made preparations to prevent the spread of COVID-19 at our medical facilities by strengthening infection prevention and control, and working to ensure proper PPE is in stock. Triage and isolation spaces have been set up in the health structures we manage, and in those we support across the country.  Currently, we are supporting health institutions in Martissant, Port-à-Piment, Port Salut, Les Cayes, Croix-des-Bouquets, and Gonaïves."

The Haitian Ministry of Public Health and Population reports 812 confirmed COVID-19 cases and 25 deaths as of May 21.

MSF: New Ebola cases confirmed in DR Congo

Thanks to Mary Marshall for sending the link to this MSF report: New Ebola cases confirmed in DRC. Excerpt:

On 10 April 2020, a new case of Ebola was confirmed in the city of Beni, North-Kivu, northeastern Democratic Republic of Congo. The news came after a long interval without new confirmed cases: 52 days had passed since the notification of the previous confirmed case and 40 days had elapsed since the last patient was declared free of Ebola.  

Only two days remained before the expected declaration of the end of the outbreak (i.e. 42 days after the clearance of the last confirmed case) and the new confirmed diagnosis erased any expectation of such declaration.  

Unclear transmission of new case 

It is still unclear how the patient confirmed positive on 10 April contracted the virus:  he was diagnosed after his death, had no known contacts with previous Ebola patients and was not a former survivor of the virus who might have relapsed. Since the notification of this new case, five more Ebola cases have been confirmed in Beni, reaching a total of six new confirmed cases since 10 April. 

These new cases generated frustration and a certain level of suspicion within the community, and protests were held in the city of Beni, highlighting the need for strong communication efforts and community engagement.  

Flare-ups of disease still possible 

Although the end of the outbreak was in sight, flare-ups are likely according to World Health Organization, which highlights four main reasons why cases could resurge in DRC: Ebola transmission might have gone undetected due to gaps in the surveillance system or in areas where access for humanitarian organisations is limited due to the complex security environment.  

• The Ebola virus can persist in used needles, syringes or vials for several weeks. 

• The Ebola virus can persist in the body fluids of survivors for many months, and can be transmitted for a long time after a patient’s recovery (for example via sexual transmission or breastmilk), or in rare cases, a convalescent patient can relapse - as observed already during this outbreak. 

• The Ebola virus may be present in an animal reservoir in the region, and there is always a risk of a new introduction to humans.

COVID-19 turns the clock back on the war in Ukraine, as needs grow

Via The New Humanitarian: COVID-19 turns the clock back on the war in Ukraine, as needs grow. Excerpt:

In the six years Nataliia Kyrkach has been providing assistance in conflict-affected eastern Ukraine, she has seen aid programmes move from urgent crisis response to resilience and development, as people living amidst this ongoing war have slowly begun to rebuild their lives. 

2020 had brought some hopes for peace, after Russian President Vladimir Putin met his Ukrainian counterpart Volodymyr Zelensky for talks in Paris in December. But over the last month, as COVID-19 has swept the world, Krykach says the region is tumbling back to the dark days of 2014-15, at the beginning of the conflict. 

“The situation is going backwards by 100 percent,” Kyrkach told The New Humanitarian by phone from the town of Sviatohirsk in the eastern Donetsk region where the NGO she heads, Slavic Heart, is based.  

In the second half of March, Slavic Heart – which provides a range of humanitarian aid from psychosocial services to food, hygiene items, and medicines – saw a more than 200 percent increase in pleas for assistance on its hotline. This was after Ukraine introduced strict quarantine measures, closing its borders, shuttering schools and all non-essential business, and halting public transport.  

Ukraine has yet to see COVID-19 infection figures comparable to the worst-hit countries in Europe – as of 20 April, there were 5,710 registered cases in a population of 42 million, and 151 deaths. However, with a chaotic and underfunded national health system, and as the country’s politics and economy has been weakened by this low-intensity but still deadly war, its fallout is likely to hit hard. And nowhere more so than in the war-torn east, where sporadic clashes continue between government forces and two breakaway regions backed by Russia: Donetsk, and neighbouring Luhansk. 

Even before the epidemic, the UN estimated that 3.4 million Ukrainians were in need of humanitarian assistance in 2020. Most live in the so-called “grey zone” – a sliver of territory along both sides of the “contact line” that divides Ukrainian government-controlled land from separatist-run areas.  

Adapting aid to the new normal 

Sixty percent of Slavic Heart’s clients – mostly women – have lost most or all of their income since quarantine measures were imposed, said Kyrkach.  

With already limited public transport in frontline areas now completely stopped, many people are unable to access healthcare or get food and hygiene supplies, and most are rapidly running out of funds. 

Already high levels of domestic violence are reportedly soaring. Social workers, reliant on public transport and lacking basic protective equipment, are unable to visit their vulnerable clients.  

The contact line – which used to see up to a million crossings each month by people claiming social and pension payments or travelling for work, health, and family reasons – is now closed.

“Families are entirely alone,” said Kyrkach. Her NGO is using its three mobile support brigades for victims of domestic and gender-based violence to deliver food and hygiene parcels, and has moved its support groups online. But many settlements in the grey zone lack internet access.  

International aid groups like the UN’s refugee agency, UNHCR, and the International Committee of the Red Cross, which had previously scaled back direct assistance to focus on income generation and infrastructure projects, are also reinstating food and hygiene deliveries – all the while rushing to put their own anti-epidemic measures in place to protect both staff and beneficiaries in a war zone.

COVID-19 in Canada: Quebec snubs doctor who helped lead fight against Ebola

Via CBC News, a little more on a Canadian scandal: Quebec snubs doctor who helped lead fight against Ebola. Excerpt and then a comment:

Dr. Joanne Liu, the former president of Doctors Without Borders who steered the organization through its Ebola response and has 25 years of experience in pandemic preparedness, says the Quebec government refused her offer to help with its planning.  

Liu says she has been part of a team of volunteer doctors advising the federal government in its fight against the spread of COVID-19, but that her proposals to assist the provincial one have gone unheeded.   

Liu says she also put her name in the hat of doctors the government requested to step in at the province's beleaguered long-term care homes.   

Finally, Friday evening, Health Minister Danielle McCann tweeted that her department would reach out to Liu so that she could help in the CHSLDs.  

But McCann ignored Liu's offer to help in planning. The doctor is already slated to help at Montreal's Geriatric Institute, which has been hard-hit by a COVID-19 outbreak that has infected at least 132 people and killed 33 between its two wings.  

Liu is a pediatric emergency specialist at Montreal's Sainte-Justine Hospital. She has more than 25 years of experience in pandemic response, and was featured in TIME Magazine's 100 Most Influential People in 2015.  

Under her leadership, Doctors Without Borders called for global action in response to the spread of Ebola, demanding stronger action.  

In an interview on CBC Montreal's Daybreak Friday morning, Liu recounted how she and others had been in touch with Quebec officials suggesting she help out with the province's COVID-19 response. 

Liu says she was told her services were not needed.  

"It feels like being in a hockey game and being on the penalty bench, and waiting to jump in the ice, but your time is not up yet," Liu said.  

"I think I have something to offer and I think that me, and many other people, do. But right now, we have a government that's really, really overwhelmed by the situation and isn't able to take up the offer that everybody is giving." 

François Audet, the director of the Université du Québec à Montréal's international studies school, in another tweet, compared the situation to sidelining a world-renowned general in times of war.  

"When you have the best general in the world, you don't send them to the infantry," Audet said of Liu working in a CHSLD instead of providing expertise. 

Quebec's response more 'reactive than anticipatory' 

The Quebec government has been criticized for not acting swiftly enough when the virus began to spread in the province's seniors' and long-term care homes.

Liu says she sees a number of missed opportunities in how the government attempted to prevent spread of the coronavirus inside the institutions, noting the strategy appeared more "reactive than anticipatory." 

Stopping visitors from coming in was a good first step, Liu says, calling it "radical shielding," but it should have been accompanied by other measures.  

"[They] never inquired: was there enough people to care for them? Did they have enough infection and prevention control in place? Did they have the right [personal protection equipment] and did they know how to use them? We just put them apart," she said.   

"You need to do radical shielding but you need to be able as well to support the system in making sure there's enough care and there's enough protection."  

Not having those things in place allowed the virus to enter the facilities unnoticed at first, and spread among the residents and staff, Liu explained.

She added she had sympathy for decision-makers because the pandemic is "unprecedented." 

In their daily briefings to the media, Legault and McCann repeatedly said there was a shortfall of thousands of staff in the homes — which had been beset by shortages before the pandemic and are now missing even more people after hundreds had to go into isolation.

Unlike health agencies like WHO and CDC, MSF is independently funded (I'm proud to have been a donor since 2004). This gives it freedom of action and speech, and it can be sharply critical of governments. Dr. Liu was blunt in her criticism of the international response to Ebola in West Africa, and embarrassed governments have long memories.

So I can well believe that when Dr. Liu returned to Quebec she was considered more dangerous than useful to the provincial government's COVID-19 response.

 

Still, the response would have done far better to have welcomed her with open arms, and then enjoyed the bragging rights of having such a heavy hitter in the vanguard of the fight against COVID-19.