H5N1

How Canada’s decentralised covid-19 response affected public health data and decision making

This is a major report that deserves close attention. Via The BMJ: How Canada’s decentralised covid-19 response affected public health data and decision making. Excerpts:

Highs and lows of covid-19 response in Canada  

Highs 

• Public health leadership included women at each level of decision making. 

• Canada became one of the most vaccinated countries with >83% of the population receiving at least one vaccine dose in February 2023. After Health Canada approved Pfizer-BioNTech and the Moderna covid-19 vaccine in December 2020, rollout was prioritised for indigenous populations and those living and working in long term care homes  

• Research collaborations from basic science through to clinical and health services research emerged rapidly to address urgent questions of seroprevalence (eg, covid-19 Immunity Task Force), correlates of infection and immunity, and outbreak mitigation factors and engagement of patients in research conduct such as knowledge synthesis  

Lows  

• Failure to learn from previous reports led to failure to protect older adults and staff in long term care homes and among the highest proportions of deaths in this sector globally  

• Challenges to access and delivery of effective covid-19 medications such as tocilizumab, remdesivir, and ritonavir-nirmatrelvir resulted in provinces and hospitals rationing use  

• An exodus of exhausted and distressed healthcare workers, coupled with inadequate training paths for replacements, produced a critical workforce shortage that is ongoing  

• Canada lacked a coordinated system for evidence generation and use across government jurisdictions  

• Lack of research infrastructure embedded within the healthcare system limited Canada’s ability to participate in or lead clinical trials or other international studies 

• Lack of a clear and standardised approach to case definitions and testing contributed to inability to share use of data and make decisions           

• Absence of data sharing agreements across federal and provincial or territorial jurisdictions slowed or limited data sharing

Key messages

• Canada’s public health system was insufficiently prepared for the covid-19 pandemic

• Public health decisions and outcomes varied across jurisdictions and were hampered by outdated health information systems and lack of integration 

• Decentralisation of public health decision making has benefits such as tailoring interventions to local constituencies, but during a crisis, governance structures need to pivot to enable coordination and systematisation of data collection and analyses 

• Gaps in data and decision structures created a vacuum, filled by science advisory committees with disparate roles, responsibilities, and accountabilities within different jurisdictions 

• A shift to a culture of data access and shared analysis is needed to enhance health system learning and population health benefit, and for future crisis and pandemic preparedness

China is flying blind as pandemic rages

Via Science: China is flying blind as pandemic rages. Excerpt:

Most scientists believe China’s decision to end its zero-COVID policy was long overdue. But now they have a new worry: that the country is collecting and sharing far too little data about the rough transition to a new coexistence with the virus.  

China abruptly dropped virtually all controls a month ago, after protests, a sagging economy, and the extreme transmissibility of the virus’ latest variants made clinging to zero COVID untenable. Now, “SARS-CoV-2 has an open goal in front of it: a population with very low levels of standing immunity,” says evolutionary biologist Edward Holmes of the University of Sydney. But how the epidemic is unfolding is a mystery because the country has practically stopped collecting basic epidemiological data.  

Models that predicted a massive wave of infection and death if China ended zero COVID appear to have been correct. Press reports and social media posts have shown intensive care units stretched beyond capacity, with crowds of patients in wheelchairs and on gurneys in hallways. Doctors and nurses are reportedly working while sick. Crematoriums are overwhelmed. 

But China’s official COVID-19 death toll is widely considered laughably low. And some scientists worry a genomic monitoring plan unveiled last month doesn’t have the power to detect new SARS-CoV-2 variants arising as the virus works its way through one-fifth of the world population.

Earlier in the pandemic China’s daily counts of COVID-19 cases and deaths, based partly on its exhaustive testing programs, were generally believed to be accurate. Now, they are anyone’s guess. Patients with mild symptoms are not encouraged to get tested, let alone those who are asymptomatic. People testing positive at home are not asked to report their results.  

The China Center for Disease Control and Prevention (China CDC) put the number of confirmed cases the last week of December 2022 at more than 35,000—a fraction of the official number in the United States. But leaked notes from an internal meeting suggest a very different reality: The agency was told that almost 250 million people in China—roughly 18% of the population—may have caught COVID-19 in the first 20 days of December. Some experts said the number is implausibly large, but Yanzhong Huang, a global health specialist at the Council on Foreign Relations, a U.S. think tank, says it’s “not unreasonable,” given credible reports that 80% of Beijing residents have been infected by now.  

As to the death toll, China’s reporting had long been inconsistent, Huang says, with some regions reporting all fatalities in which SARS-CoV-2 was a factor, as most countries do, and others excluding people who died from other conditions, such as heart attacks, even if they had COVID-19. In early December, China’s government decided the narrower definition should be used nationwide.  

Even then, the official count is astonishingly low: just eight deaths for the entire last week of December, which is “not matching media reports and what is being seen on social media,” says Louise Blair, who tracks China’s COVID-19 outbreak for Airfinity, a London-based health analytics firm that estimates about 9000 people were dying of COVID-19–related causes every day in late December.  

Also missing are data on case fatality rates, the average number of new infections stemming from each case, and hospital and intensive care admissions. “These are critical data” that would help health authorities get a handle on the surge and further the world’s understanding of the pandemic, says Xi Chen, a public health scientist at the Yale School of Public Health.

From zero Covid to no plan: Behind China’s pandemic U-turn

Via The New York Times: From Zero Covid to No Plan: Behind China’s Pandemic U-Turn. Excerpt:

The southwestern city of Chongqing was the latest frontline of Xi Jinping’s “zero Covid” war, until it came to epitomize China’s potentially devastating about-face that has cracked the Communist Party’s edifice of absolute control.  

The city last month was enduring one of the biggest outbreaks cropping up across China, when the national leader, Mr. Xi, ordered officials to continue mass testing, lockdowns and quarantines. Chen Min’er, the Chongqing party secretary, devoutly complied, closing off neighborhoods and ordering the instant construction of a quarantine hospital designed to hold up to 21,000 beds.  

“Be resolute in fighting and winning this war of annihilation against the pandemic,” Mr. Chen, a protégé of Mr. Xi, told officials on Nov. 27. “Not a day of delay.”  

But 10 days later, China suddenly abandoned the “zero Covid” strategy on which Mr. Xi had staked his reputation. Now the country faces a surge of infections, and Mr. Xi has left officials scrambling to manage the disarray and uncertainty.

China’s party-run media has cast the shift as a stressful but well-considered exit, opening the way back to good economic times. Warnings about the dangers of the coronavirus have swiftly disappeared, replaced by official claims that the Omicron variant is generally mild. By holding off from easing until now, the government has saved many lives, the People’s Daily said on Thursday in a long article defending Mr. Xi’s pandemic strategy as “totally correct.”  

In reality, an examination of how the shift unfolded in Chongqing and elsewhere reveals a government overtaken by a cascade of Covid outbreaks, confusion over directives, economic woes and then rare political protests.  

Mr. Xi had contrasted his prior pandemic success with the “chaos of the West,” brandishing it as proof of his grand narrative of a rising China: orderly, secure, farsighted. But he had no plan for measured retreat from “zero Covid,” leaving a bewildered populace to improvise after three years of being micromanaged.  

The government is racing to approve vaccines and to obtain Western medicines after shunning them. Officials, long focused on eliminating cases, are struggling to marshal resources to treat an explosion of infections. Even the Chinese Communist Party, a virtuoso at controlling the narrative, is finding it difficult to sell the policy lurch to anxious residents.

China's COVID spike not due to lifting of restrictions - WHO director

Via Reuters: China's COVID spike not due to lifting of restrictions - WHO director. As shown above, the 7-day rolling average keeps falling, but that's because China has stopped counting asymptomatic cases.

GENEVA, Dec 14 (Reuters) - The recent explosion of COVID-19 infections in China is not due to the sudden easing by the government of its strict policy, a World Health Organization director said on Wednesday as he warned of low vaccination levels in the world's No. 2 economy.  

The WHO's emergencies director Mike Ryan said in a briefing with media that the virus was spreading "intensively" in the nation long before the lifting of restrictions.

He said "control measures" were not stopping the disease.  

The challenge for China in getting the virus under control is getting an adequate number of people vaccinated, he said.

China might be back to pre-Covid normal by mid-2023, health expert Zhong Nanshan forecasts

Credit: Xinhua

Via the South China Morning Post: China might be back to pre-Covid normal by mid-2023, health expert Zhong Nanshan forecasts. Zhong Nanshan is the patriarch of China's healthcare system, and he's been a major factor in the country's responses to infectious diseases since at least the early H5N1 cases. He seems surprisingly optimistic about the impending resurgence of COVID-19. Excerpt:

China should ramp up vaccination to avoid an epidemic of Covid-19 infections over the Lunar New Year, but could return to some normality by the middle of next year, according to a leading infectious disease expert.  

“It is highly unlikely that people will be restricted from travelling home for Lunar New Year celebrations in 2023, but it is still important to step up preparations,” state news agency Xinhua quoted Zhong Nanshan as saying in an interview in the southern city of Guangzhou on Friday.  

“I suggest that people who are ready to travel back home should get booster vaccinations so that they won’t develop serious symptoms even if they catch Covid.  

“A booster shot usually takes effect in two weeks. It will help to prevent mass transmission during the Lunar New Year migration when people gather in crowds.”  

Under the zero-Covid policy of the past three years, Chinese authorities have urged the public to stay put and avoid travel during holidays, including Lunar New Year, a time when people catch up with their family.  

But the policy dealt a heavy blow to the economy and authorities have been abandoning the toughest restrictions in the past few weeks.  

In the latest relaxation on Wednesday, authorities allowed home quarantine for people with mild and asymptomatic infections. Mass PCR testing was also dismantled and the country resumed its vaccination drive.  

Infections have surged in big cities like Beijing and Guangzhou as social and economic activity has picked up slowly. Analysts said the economic recovery would be bumpy as the mass infections would continue to disrupt the economy, with normal life only expected to return later next year.

China ramps up livelihood, economic support amid COVID-19 control

Something is going on in China. The country seems fed up with lockdown measures, and the government is trying to calm things down. Via People's Daily, a Xinhua report: China ramps up livelihood, economic support amid COVID-19 control. Excerpt:

BEIJING, Nov. 26 (Xinhua) -- Local governments across China are rolling out policies to support businesses and residents amid the ongoing COVID-19 control, allowing virus-hit supermarkets to reopen sooner and reducing operating costs for struggling companies.  

The Chinese capital Beijing promised to expedite the reopening of shopping malls and supermarkets that sell livelihood-related products, as the latest effort to ensure the smooth operation of the city and the market while striving to corral the outbreak.  

Speaking at a media conference on Thursday, Beijing municipal government spokesperson Xu Hejian said that such business outlets, if affected by the COVID-19 cases, are allowed to reopen after one day of required closure and disinfection, and will not be closed for more than three days.  

Responding to public concerns, the Beijing government will rev up support for residents who have to leave their closed-off compounds to seek medical services, Xu said. Garbage from high-risk areas will be taken care of, the official added.  

Municipal officials also said they had directed major e-commerce companies to stock up with three to five times the usual level of supplies so as to stabilize prices.  

On Friday, Beijing reported 586 locally transmitted confirmed cases of COVID-19 and 2,009 locally transmitted asymptomatic cases. The latest outbreak has seen many restaurants and shops closed and residents advised to reduce unnecessary outings.  

In southwest China's Chongqing Municipality, which has registered more than 60,000 infections since Nov. 1, authorities organized retail companies to set up temporary stands outside the residential complexes that were under closed-off management.  

The government is also negotiating with e-commerce platforms to increase supplies while helping retailers resume business online after the closure of their physical shops, said Zhang Yongwu, head of the Chongqing municipal commission of commerce.  

The Ministry of Commerce has pledged greater efforts to ensure the supply of daily necessities, especially for residents in areas hit hard by the COVID-19 resurgence.

US CDC begins agency-wide changes after pandemic failures

Via The Lancet: US CDC begins agency-wide changes after pandemic failures. Excerpt:

The US Centers for Disease Control and Prevention (CDC) is on a mission to reorganise and modernise itself, so that its mistakes during the pandemic will not happen again. The aim is to make the nation's leading disease detective more nimble and accountable, and fortify its role as public health protector. But although some changes have been made, progress will be limited without support from the US Congress. 

The CDC's Director, Rochelle Walensky, an infectious disease physician and research scientist appointed by President Joe Biden in January, 2021, commissioned an independent review of the CDC's pandemic record in April, conducted by James McCrae, Associate Administrator for Primary Health Care in the Department of Health and Human Services’ Health Resources and Services Administration. “To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications”, Walensky told her roughly 11 000 staff when she unveiled a summary of the review's findings in August (panel).  

Panel  

Key findings and recommendations from the CDC review  

It takes too long for the CDC to publish its data and science for decision making  

• Create an online mechanism for pre-publication delivery of science  

• Expedite the review or approval process for scientific publications and data (including laboratory data) to match the needs of the emergency  

The agency's turnover of staff during the COVID-19 response created gaps and other challenges for partners   

• Increase the number of CDC leaders trained and ready to deploy to a response  

• Require a minimum of 6-month rotation for leadership positions on the response; build a redundancy model of emergency staffing (ie, backup or co-lead staff in all key positions) to prevent response burnout and assure continuity in operations  

The agency's guidance documents are confusing and overwhelming, and the website is not easy to navigate  

• Produce plain-language, easy-to-understand implementation guidance documents that apply over multiple settings; reduce the number and length of guidance documents; include a brief scientific rationale or background in the implementation guidance with a referenced or accompanying Morbidity and Mortality Weekly Report, Science Brief, as necessary  

• Restructure the agency web site and digital communication platforms to eliminate unnecessary content and focus on key target audiences with a primary emphasis on the public  

COVID-19 uncovered the need for flexibilities that do not exist today at the CDC  

• Establish new authorities that will allow the CDC to be more nimble and work faster, such as public health and regulatory authorities mandating data collection from local jurisdictions, and human resource authorities with authority to hire faster, and ensure competitive salaries to recruit and retain for hard-to-fill positions like data scientists

Vietnam: MoH proposes to strengthen the prevention and control of avian influenza in Phu Tho province

Via the Ministry of Health: The Ministry of Health proposes to strengthen the prevention and control of avian influenza in Phu Tho province - Information on management direction. The Google translation:

Through the infectious disease surveillance system, on October 17, 2022, the Central Institute of Hygiene and Epidemiology - Ministry of Health recorded 1 patient who tested positive for influenza A(H5), currently living. in Thanh Ba district, Phu Tho province. This is the latest human case of influenza A(H5) in Vietnam since February 2014.  

According to information from the Department of Animal Health - Ministry of Agriculture and Rural Development, avian influenza is still recorded in poultry flocks in many localities across the country. Next time is the Lunar New Year and festival season, so the total poultry flock and poultry transport and trade may increase. Besides, the weather is currently in the period of changing seasons and abnormal changes favorable for avian influenza virus to develop. Therefore, there is always a potential risk of transmission of avian influenza to humans.  

In order to proactively prevent avian influenza from infecting humans, on October 20, 2022, the Department of Preventive Medicine - Ministry of Health sent Official Letter 1164/DP-DT requesting Comrade Director of Phu Tho Department of Health to only Directing to strengthen the prevention and control of avian influenza in the province with a number of key contents as follows:  

1. Organize the investigation and thoroughly handle the outbreak; strengthen surveillance to detect new outbreaks in humans; hospitals are ready to collect, isolate and treat according to regulations of the Ministry of Health and promptly notify the provincial Center for Disease Control for timely epidemic prevention and control measures.  

2. Work closely with veterinary authorities and local authorities in monitoring and detecting influenza outbreaks in poultry, promptly sharing information and thoroughly handling outbreaks.  

3. Strengthen communication of measures to prevent avian influenza from spreading to humans in areas with sick and dead poultry and high-risk areas.  

4. Prepare drugs, supplies, chemicals and means of timely support for the locality to implement measures to handle the outbreak.  

5. To coordinate in the prevention and control of diseases transmitted from animals to humans in accordance with the provisions of the Joint Circular No. 16/2013/TTLT-BYT-BNN&PTNT dated May 27, 2013 of the Ministry of Health and Ministry of Agriculture and Rural Development; Report on infectious diseases according to the Circular No. 54/2015/TT-BYT dated December 28, 2015 of the Minister of Health on the Department of Preventive Medicine.

Uganda: MSF responds to Ebola outbreak

Via Doctors Without Borders USA: Uganda: MSF responds to Ebola outbreak.

NEW YORK, SEPTEMBER 23, 2022—Following the September 20 declaration of an Ebola outbreak in Uganda in the country’s central Mubende district, the ministry of health has asked the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) to support its efforts in the fight against the spread of the disease.  

On September 21, an MSF team of six people—including doctors and logisticians—traveled to the town of Mubende to carry out an assessment of the situation and the needs at the regional referral hospital, where the first case was detected. The virus has been confirmed to be the rarer Sudan strain of Ebola for which there is no approved vaccine or treatment, unlike the Zaire strain that caused the last several outbreaks in the Democratic Republic of Congo.  

Since carrying out this assessment, MSF has begun setting up an Ebola isolation and treatment center in the Mubende hospital to help improve patient care. Teams are also exploring the possibility of setting up a second center in the town of Madudu, which is approximately 25 kilometers [15 miles] north of where the first person who died from Ebola originated and where several suspicious cases are reported.  

MSF is currently putting together a team of health workers, epidemiologists, and logisticians with experience in hemorrhagic fevers to start work next week.  

The last Ebola outbreak in the country occurred in 2019. MSF intervened at that time to support the Ugandan health authorities in the management of people who had been in contact with these confirmed cases, the establishment of an Ebola treatment unit, and the improvement of infection prevention and control measures in health facilities.

The Ugandan Ministry of Health has tweeted an update:

Oxfam: Response to Lancet Commission on lessons from COVID-19 for future pandemics

Via Oxfam International: Response to Lancet Commission on lessons from COVID-19 for future pandemics.

Responding to The Lancet COVID-19 Commission’s report on lessons for future pandemics, Anna Marriott, Health Policy Manager at Oxfam and Policy Co-Lead for the People’s Vaccine Alliance, said: 

“The Lancet Commission details the utter failure of rich country leaders and pharmaceutical companies to ensure the tools needed to end this pandemic were accessible to everyone, everywhere. The findings of this commission should shame the international community. Nationalism, racism, profiteering, and an overreaching intellectual property system all prevented lower-income countries from accessing or producing vaccines.  

“It is vital that we learn the lessons of this report, end pharma’s deadly monopolies, and build more capacity for the development and manufacturing of vaccines, tests, and treatments in low and middle-income countries. Governments need to act immediately to extend an agreement made earlier this year on overriding COVID-19 vaccine patents to cover lifesaving treatments and tests. And they must safeguard World Health Organisation backed efforts to produce mRNA vaccine manufacturing on every continent from the threat of litigation from companies like Moderna.  

"The pandemic treaty currently under discussion needs to make clear that saving lives must come before profits and decisions about who lives and who dies are never again outsourced to the CEOs of big pharma.”