H5N1

Research: 1 in 8 adult Canadians experienced depression for first time during pandemic

Via the Helsinki Times: Research: 1 in 8 adult experienced depression for first time during pandemic. Excerpt:

One in eight older persons in Canada, according to recent large-scale research that included more than 20,000, experienced their first episode of depression during the epidemic.  

The statistics were significantly worse for people who had previously struggled with depression. Nearly half (45 per cent) of this population reported having depression by the fall of 2020.  

The analysis of responses from the Canadian Longitudinal Study on Aging, which gathered information from participants for an average of seven years, was published in the International Journal of Environmental Research and Public Health.  

"The high rate of first-onset depression in 2020 highlights the substantial mental health toll that the pandemic caused in a formerly mentally healthy group of older adults." says first author, Andie MacNeil, a recent Master of Social Work graduate from the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging, University of Toronto.  

Although it is well known that depression among older adults increased during the pandemic, few studies have examined the proportion of people who developed the disorder for the first time or the proportion of people with a history of the condition who had a relapse.  

"The devastation of the pandemic which upended so many aspects of daily life hit those with a history of depression particularly hard," said co-author Sapriya Birk, a researcher formerly based in the Department of Neuroscience, Carleton University, Ottawa who is currently a medical student at McMaster University, Hamilton, Canada, adding, "Health professionals need to be vigilant in screening their patients who had mental health problems at an earlier time in their life."  

The researchers determined that a number of factors, such as low income and savings, loneliness, chronic pain, difficulty accessing healthcare, a history of traumatic childhood experiences, and family conflict, were linked to depression in older adults during the pandemic.

The next pandemic? More likely a polydemic

Last week The Tyee published my article The Next Pandemic? More Likely a Polydemic. After going through a number of unpleasant problems in global health, I concluded:

These are just some of the threats in the present polydemic, which itself is part of the present hot mess of economic decline, rising prices, war, climate change and political polarization that writers like Adam Tooze are calling a polycrisis. And it’s precisely now that Canadian health spending should be rising to support pandemic preparation and prevention, not levelling off.  

From a political point of view, lower spending makes sense. The system is still trying to catch up with all the knee and hip replacements postponed for the last two years. Inflation makes it impossible to raise taxes, and the deficit spending that kept everyone afloat in 2020 and 2021 is now politically unacceptable.  

Besides, governments have learned that they don’t have to take pandemics as seriously as they once did. Provincial governments that let COVID-19 rip have been re-elected. Public health measures like masks and vaccine mandates have triggered a populist backlash that some politicians are exploiting. Health-care workers are exhausted, underpaid and embittered.

So even if a government wanted to take the polydemic seriously, and to build up the system against future pandemics, it would face serious resistance from many voters, not to mention the business sector. Rebuilding health-care staff numbers and infrastructure would take billions, spent over more years than any government is likely to survive. Short-term emergencies would always take priority over long-term needs.  

And when the next pandemic arrived and became a short-term emergency, neither governments nor the governed would implement or accept even proven measures to protect public health. They’d recycle COVID-19 misinformation as precedent: “It was mostly mild, it only killed old people, we got through it.”  

But if it’s a pandemic as lethal as H5N1 or Ebola, which has an average case fatality rate of 50 per cent, the survivors will think otherwise.

Before 2020, the pandemic anticipators I called Flublogia were certainly worried about the impact of a new influenza or other virus. But we still had a naive faith that while it would be bad, we in North America and western Europe and Japan would have the technology and the experts to deal with it.

The response of the western nations, and especially the US, was and is a disgrace and a revelation: just as the fearsome Russian army turned out to be stupid and incompetent, so have the health systems and politicians of the "advanced" nations. If the next virus turns serious, I really doubt whether the public will listen to the advice of the health experts. Nor will healthcare workers be willing to resist another onslaught. And that, of course, will only make matters much, much worse,

Next pandemic may come from melting glaciers, new data shows

Via The Guardian: Next pandemic may come from melting glaciers, new data shows. Excerpt:

The next pandemic may come not from bats or birds but from matter in melting ice, according to new data.  

Genetic analysis of soil and lake sediments from Lake Hazen, the largest high Arctic freshwater lake in the world, suggests the risk of viral spillover – where a virus infects a new host for the first time – may be higher close to melting glaciers.  

The findings imply that as global temperatures rise owing to climate change, it becomes more likely that viruses and bacteria locked up in glaciers and permafrost could reawaken and infect local wildlife, particularly as their range also shifts closer to the poles.  

For instance, in 2016 an outbreak of anthrax in northern Siberia that killed a child and infected at least seven other people was attributed to a heatwave that melted permafrost and exposed an infected reindeer carcass. Before this, the last outbreak in the region had been in 1941.  

To better understand the risk posed by frozen viruses, Stéphane Aris-Brosou and her colleagues at the University of Ottawa in Canada collected soil and sediment samples from Lake Hazen, close to where small, medium and large amounts of meltwater from local glaciers flowed in.  

Next, they sequenced RNA and DNA in these samples to identify signatures closely matching those of known viruses, as well as potential animal, plant or fungal hosts, and ran an algorithm that assessed the chance of these viruses infecting unrelated groups of organisms.  

The research, published in Proceedings of the Royal Society B, suggested that the risk of viruses spilling over to new hosts was higher at locations close to where large amounts of glacial meltwater flowed in – a situation that becomes more likely as the climate warms.  

The team did not quantify how many of the viruses they identified were previously unknown – something they plan to do in the coming months – nor did they assess whether these viruses were capable of triggering an infection.  

However, other recent research has suggested that unknown viruses can, and do, loiter in glacier ice. For instance, last year, researchers at Ohio State University in the US announced they had found genetic material from 33 viruses – 28 of them novel – in ice samples taken from the Tibetan plateau in China. Based on their location, the viruses were estimated to be approximately 15,000 years old.  

In 2014, scientists at France’s National Centre for Scientific Research in Aix-Marseille managed to revive a giant virus they isolated from Siberian permafrost, making it infectious again for the first time in 30,000 years. The study’s author, Jean-Michel Claverie, told the BBC at the time that exposing such ice layers could be “a recipe for disaster”. 

Even so, Aris-Brosou’s team cautioned that predicting a high risk of spillover was not the same as predicting actual spillovers or pandemics. “As long as viruses and their ‘bridge vectors’ are not simultaneously present in the environment, the likelihood of dramatic events probably remains low,” they wrote.  

On the other hand, climate change is predicted to alter the range of existing species, potentially bringing new hosts into contact with ancient viruses or bacteria.  

“The only take-home that we can confidently put forward is that as temperatures are rising, the risk of spillover in this particular environment is increasing,” said Aris-Brosou. “Will this lead to pandemics? We absolutely don’t know.”

World in no better place to fight pandemics than before COVID

Via Reuters: World in no better place to fight pandemics than before COVID - review. Excerpt:

LONDON, May 18 (Reuters) - The world is no better prepared for a new pandemic than it was when coronavirus emerged in 2019 and may actually be in a worse place given the economic toll, according to a panel set up by the World Health Organization (WHO) to evaluate the global response.  

A lack of progress on reforms such as international health regulations means the world is as vulnerable as ever, the Independent Panel for Pandemic Preparedness and Response said in its report.  

The authors, led by former New Zealand prime minister Helen Clark and former president of Liberia Ellen Johnson Sirleaf, acknowledged some progress, including on more robust funding for the WHO, but said the process was going far too slowly.  

"We have right now the very same tools and the same system that existed in December 2019 to respond to a pandemic threat. And those tools just weren't good enough," Clark told reporters.  

"If there were a new pandemic threat this year, next year, or the year after at least, we will be largely in the same place ... maybe worse, given the tight fiscal space of many, if not most, countries right now."  

Wednesday's report comes ahead of next week's World Health Assembly in Geneva, the WHO's annual decision-making forum, which is expected to address some of the issues raised.

Global Health Security Index: We haven't learned a damn thing

The Global Health Security Index came in for some deserved ridicule in 2020 when it declared the US health system as the best-prepared for a pandemic. But its latest report heaps scorn back on almost everyone, especially wealthy nations. As we stumble into the third year of this pandemic, such failure to prepare is inexcusable. An excerpt from its latest Report & Data:

Overall Finding

Although many countries were able to quickly develop capacities to address COVID-19, all countries remain dangerously unprepared for meeting future epidemic and pandemic threats. A great opportunity exists, however, to make new capacities more durable to further long-term gains in preparedness.

Additional Findings

Most countries, including high-income nations, have not made dedicated financial investments in strengthening epidemic or pandemic preparedness. 

• The overall average score for national-level financing is 35.2 out of 100.  

• 90 countries have not fulfilled their full commitment to contribute to the WHO; of those, 14 are high-income countries.  

• 66 countries have not identified special emergency public financing mechanisms and funds that the country can access in the face of a public health emergency; of those, 32 are high-income countries.  

• 155 countries have not allocated nonemergency national funds within the past three years to improve their capacity to address epidemic threats; among those, only two low-income countries have evidence of allocated funds.  

• The average score for national financing for epidemic preparedness is 21 out of 100; low-income countries have an average score of 7 out of 100.  

• Financing for emergency response has a global average score of 66.  

• High-income countries have the lowest average score of 46; low-income countries have the highest average, with 93.  

• Only four countries (Eritrea, Indonesia, Liberia, and Timor-Leste) have a JEE or NAPHS that describes specific funding from the national budget to address previously identified gaps.  

• High-income and upper-middle-income countries receive the lowest scores for financing when reviewed under the JEE and OIE Performance of Veterinary Services (PVS) Pathway assessments and related to financing for emergency response.  

• The average score for financing under the JEE and PVS report is 1 out of 100; this score reflects the provisions for funding IHR implementation through the national budget or other mechanisms.

Our long night of the virus

The Tyee has published my long review of four important new books about the pandemic: Our Long Night of the Virus. Excerpt:

The pandemic and climate change, combined, have triggered what [Adam] Tooze calls a “great acceleration,” when events outrun earlier predictions and solutions. We will therefore have to improvise new solutions — or, like the populists, stick to a very old non-solution of anti-science white supremacy in the hope of returning to the “before times.” 

The imperial infection  

Rupa Marya, an American physician of Indian descent, and Raj Patel, a British academic, journalist and author, offer a solution from the before times in their book Inflamed: Deep Medicine and the Anatomy of Injustice. They argue that this pandemic, like countless disease outbreaks before it, is a consequence not just of a virus but of an imperialist world order that triggered disease and then built a medical system to serve the rulers, not the victims.  

This is not some radical Marxist spin, but established medical history. In the early 19th century, British development turned wetlands into farmlands in what is now Bangladesh, and brought a marine bacterium called Vibrio cholera into human guts. Cholera rapidly migrated on trade routes to London and beyond.  

In London, Dr. John Snow founded modern epidemiology by spotting the precise well that was infecting the neighbourhood. His medical colleagues dismissed his idea, but eventually Britain rebuilt its water supply system and greatly improved its workers’ health. Travellers from India were screened at Suez to try to stop further outbreaks from reaching Europe. But like Omicron, cholera was all over the planet by the time it was recognized.  

Meanwhile, cholera was left to ravage India itself, and we are now in the seventh cholera pandemic, which began in Indonesia in 1961 and most recently exploded in Haiti in 2010.  

Marya and Patel are by far the most radical analysts of this pandemic. They have no interest in blaming Donald Trump or the CDC; they are just the agents of a system created to serve the interests of 19th century empires, and which now protects the white heirs of those empires while ignoring the “essential” workers who serve those heirs.  

The authors have strong confirmation from others like Alex de Waal, whose recent book shows how Louis Pasteur’s germ theory defeated the German scientist-politician Rudolf Virchow, who had long argued for social and economic inequality as the root of disease outbreaks. Pasteur had blamed individual microbes, which could be isolated, fought and defeated like rebellious tribesmen in some remote colony. We still fall back on war metaphors to describe our response to the pandemic.

A new study ties lifespans to wealth gaps in Greater Vancouver

The Tyee has published my latest article: A New Study Ties Lifespans to Wealth Gaps in Greater Vancouver. Excerpt:

We like to think of Greater Vancouver as one of the best places to live in Canada, if not in the world. Yes, it is — especially for those of us living in the most affluent neighbourhoods. Those in the poorest neighbourhoods, however, are dying younger than their rich neighbours, sometimes by many years. And the gap between them was getting wider even before the opioid-overdose crisis and the COVID-19 pandemic became twin health emergencies. 

That’s an easy conclusion to draw from a recent study published in the journal Health & Place. Of course it’s more complicated than that, but it still seems paradoxical that a region as prosperous as Greater Vancouver should see some people die years younger than others living just a few kilometres away.  

The study involved UBC researchers working with the Institute for Health Metrics and Evaluation at the University of Washington and with Imperial College, London. Its ambitious goal was to track life expectancy and major causes of deaths in Greater Vancouver over a quarter-century, from 1990 to 2016. Moreover, they broke the numbers down to the census-tract-level — in effect, neighbourhood by neighbourhood. Overall, the study offers an invaluable portrait of our collective health before the pandemic.  

In some ways, it’s a very flattering portrait. Even the poorest males, in the tenth percentile, had a median life expectancy in 2016 of 77.6; that is, half died before that age and half later. For tenth-percentile females, median life expectancy was 82.5.  

But in the 95th percentile, the richest five per cent of our population, median male life expectancy was 87.1. For females in the 90th percentile, it was 90.8. The poor were paying with almost a decade of their lives for the privilege of living here. 

 The study makes a striking observation: “Between 1991 and 2016, there was a downward trend in the LE [life expectancy] gap, whereby the lowest gap was observed in 2001 (6.9 years for females and 7.9 for males), but this reversed and increased by 1.4-1.6 years between 2001 and 2016.” By a wild coincidence, 2001 was the year the BC Liberals won a huge majority over the NDP and ran the province under Gordon Campbell and then Christy Clark until 2017.  

British researchers noticed a very similar effect during Margaret Thatcher’s years in power: Around 1980, British and Japanese life expectancy were about the same, but then, as the U.K. income gap widened, British lives grew shorter. In Japan, with a much narrower income gap, life expectancy rose to among the highest on the planet.  

What we’re dying of  

And what have Greater Vancouver residents been dying of? Between 1990 and 2016, deaths from cardiovascular diseases, neoplasms (cancers) and unintentional injuries dropped sharply. Clearly, we’ve been exercising more, smoking less, and taking care of ourselves, at least up to a point.  

But we’ve also seen a 10 per cent increase in neurological disorders, a catch-all term that can include everything from Alzheimer’s to eating disorders to meningitis. Other noncommunicable diseases like diabetes mellitus and kidney disease rose by almost four per cent.  

And while the richest of us had little to fear from infectious diseases in 1991, the poorest were already contending with (and dying from) HIV-AIDS and sexually transmitted infections at 12 times the rate as the richest. The poorest faced seven times the rate of maternal and neonatal disorders. They died of neoplasms at over four times the rate of the richest.

Reading about COVID-19

Early next year, I'll be teaching "Perspectives on Pandemics," a course for Eldercollege here on the North Shore—going back to the Athenian and Justinianic plagues and the Black Death, but focusing on COVID-19. I'm pulling together a suggested reading list for my students, and it occurred to me that others might want to explore some of these titles as well. So here they are. Some include links to my Tyee reviews; others will be mentioned in a long article I'm working on. I'll update this list from time to time.

Peter Baldwin, Fighting the First Wave: Why the Coronavirus Was Tackled So Differently Across the Globe. Cambridge University Press, 2021. My review: https://thetyee.ca/Analysis/2021/03/30/Best-Book-Written-About-COVID-Pandemic/

Alex De Waal, New Pandemics, Old Politics: Two Hundred Years of War on Disease and Its Alternatives. Polity Press, 2021. My review: https://thetyee.ca/Culture/2021/07/09/All-Plagues-Are-Political/

Elaine Dewar, On the Origin of the Deadliest Pandemic in 100 Years: An Investigation. Biblioasis, 2021.

Fang Fang, Wuhan Diary: Dispatches from a Quarantined City, translated by Michael Berry. HarperCollins, 2020. My review: https://thetyee.ca/Culture/2020/05/27/Wuhan-Diary-Book/

Richard Horton, The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again. Polity Press, 2020. My review: https://thetyee.ca/Culture/2020/06/22/Only-Newly-Vigilant-Society-Can-Stop-Next-Pandemic/

Colin Kahl & Thomas Wright, Aftershocks: Pandemic Politics and the End of the Old International Order. St. Martin’s Press, 2021.

Michael Lewis, The Premonition. W.W. Norton, 2021. My review: https://thetyee.ca/Culture/2021/05/18/Hot-Pandemic-Book-Poses-Danger/

Rupa Marya & Raj Patel, Inflamed: Deep Medicine and the Anatomy of Injustice. Farrar, Straus & Giroux, 2021.

Jon Sternfeld, Unprepared: America in the Time of Coronavirus. Bloomsbury, 2021. My review: https://thetyee.ca/Culture/2020/12/22/Unprepared-America-Time-Coronavirus-Book/

Steven Taylor: The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. Cambridge Scholars Publishing, 2019. My review: https://thetyee.ca/Culture/2020/07/10/Mental-Toll-Covid-Doctors-Saw-Coming/

Adam Tooze, Shutdown: How Covid Shook the World’s Economy. Viking 2021.

Lawrence Wright, The Plague Year: America in the Time of COVID. Alfred A. Knopf, 2021.

The EU will create an agency to guide its response to future pandemics

Via The New York Times: The E.U. will create an agency to guide its response to future pandemics.

The European Union announced on Wednesday the creation of a new biomedical authority designed to better respond to future pandemics, as it seeks to avoid repeating the mistakes that plagued its early response to the coronavirus. 

Ursula von der Leyen, the president of the European Commission, the bloc’s executive arm, also pledged to donate 200 million extra coronavirus vaccine doses to middle- and low-income countries by mid-2022, in addition to 250 million already promised by the end of the year.  

In her annual speech on the state of the union, Ms. von der Leyen described vaccination discrepancies as one of the greatest geopolitical issues facing nations.  

“The scale of injustice and the level of urgency are obvious,” Ms. von der Leyen said in front of lawmakers at the European Parliament in Strasbourg, in eastern France. E.U. member countries had only donated 18 million doses as of early September, a fraction of the 200 million promised.  

While most developing countries have yet to administer a single dose of a coronavirus vaccine, including in the European Union’s immediate neighborhood, more than 70 percent of adults across the bloc have been fully vaccinated. Ms. von der Leyen said that puts the bloc among the world’s leaders in vaccinations.  

“We delivered,” she said, although she conceded that the bloc faced wide discrepancies domestically, as several Eastern European countries have been lagging behind.  

Ms. von der Leyen’s confident tone on Wednesday came in great contrast with her speech last year, when new Covid-19 cases were picking up across the bloc and coronavirus vaccines were months away.  

“When I stood here in front of you a year ago, I didn’t know when and if we could have a safe and effective vaccine against the pandemic,” she said.  

The European Commission, which negotiated for vaccines on behalf of member countries, was heavily criticized for the sluggish beginning of its vaccination program. The commission signed its first deal on behalf of member nations months after the United States, hampering vaccine deliveries and, later, inoculation campaigns.  

Yet the rollout gained speed in recent months, and many E.U. countries have now overtaken other rich nations like the Britain, Israel and the United States, and have started administering booster shots to millions of older and vulnerable residents.  

On Wednesday, Ms. von der Leyen said the new agency, known as the Health Emergency Preparedness and Response Authority, or HERA, would aim to “make sure that no virus will ever turn a local epidemic again into a global pandemic.”  

The new authority is set to become the European equivalent of the United States’ Biomedical Advanced Research and Development Authority, or BARDA, the federal health agency that focuses on vaccine development and pandemic preparedness.  

It is set to receive 50 billion euros (about $59 billion) in funding by 2027 and will function alongside the E.U.’s existing health agencies, the European Center for Disease Control and the European Medicines Agency.

WHO opens pandemic intelligence hub to look out for future crises

You always need surveillance long before you think you need surveillance. Via The Guardian: WHO opens pandemic intelligence hub to look out for future crises.

A World Health Organization “pandemic intelligence hub” launched by the UN agency’s director general, Tedros Adhanom Ghebreyesus, and Germany’s Angela Merkel in Berlin on Wednesday will try to help governments identify future pandemics at an earlier stage and improve monitoring of new variant strains of Covid-19. 

The hub, which will host scientists and policymakers from around the globe on a project-by-project basis, is designed to make it easier for governments to compare notes on emerging infectious diseases and pull in additional relevant information on travel patterns, trade routes or human-animal interactions in agriculture. 

The WHO, which connects the UN’s 194 member states on health policy, sounded its highest level of alarm about the Covid-19 pandemic on 30 January 2020, but studies have since suggested the coronavirus may have circulated globally at least a month beforehand.

"Covid-19 has highlighted a problem,” said Oliver Morgan, the director of the WHO’s health emergency information and risk assessment department. “There is a lot of data and public information out there at the moment that we are struggling to make sense of.” 

Every month the WHO processes on average 9m pieces of information relating to pandemic or epidemic developments, and investigates about 300 events in more detail. 

The WHO says part of the problem is that while governments and NGOs are collecting more and more information relevant to public health, databases are rarely streamlined to allow easy international comparisons. 

Analytical tools are often developed in isolation or on an ad hoc basis, and analyses are hampered by data formatting issues. Morgan said the problem was becoming particularly apparent in the monitoring of new variants of Covid-19. 

“One problem we have is that clinical samples are currently often de-linked from epidemiological information such as incidence rates or hospitalisations. So even if we do identify a variant, we don’t know if it will be a gamechanger,” he said. 

Epidemic surveillance through genome sequencing – which involves deciphering the order of the nucleotide molecules that spell out a particular virus’s genetic code – has proved valuable in monitoring polio and strains of influenza. 

But while countries such as the UK and South Africa have scaled up their genomic sequencing capacities over the last decade, the worldwide coverage remains patchy. “We currently don’t have a consistent view of how Covid-19 variants are developing across the globe, and no single database that allows us to easily share information,” Morgan said. “We only really have small windows into the overall picture via some countries with advanced labs.” 

A focus on improving the global tracking of Covid-19 variants via genome sequencing was likely to be the new hub’s initial priority, he said. 

The hub will be part-funded by the German government with $100m for the first three years, and will initially operate from a space on Luisenstrasse in central Berlin, leased from the Charité university hospital. 

It will later move to a permanent campus on Moritzplatz in Kreuzberg district. The hub will have space for up to 120 people, most of whom will not be WHO staff but visiting scientists or policymakers.