H5N1

Covid-19 in Latin America: A pandemic meets extreme inequality

Via the World Bank: Covid-19 in Latin America: A pandemic meets extreme inequality. Excerpt:

In late May, the World Health Organization declared that Latin America has become the new epicenter of the Covid-19 Pandemic. It has already been noted that the region’s high levels of inequality have limited the effectiveness of various containment policies, thus contributing to this sad distinction. In this post we look at the reverse direction of causation and ask what effects the pandemic is likely to have on the region’s entrenched inequalities.  

We argue that the impact of the pandemic will itself be highly unequal in Latin America : both in terms of health and economic outcomes, and along income, spatial, gender and racial dimensions. Worse yet, this will be true both in the short-term, during the current “lockdowns”, but also in the medium and longer-term. Nonetheless, the policy responses in some countries suggest that there may be a silver lining: the crisis might provide an opportunity for rethinking the region’s structurally unequal social contract.    

In the short-term, inequalities in how individuals can cope with stay-at-home orders are particularly striking in the region. Living conditions – including access to such basic amenities as piped water and adequate sanitation facilities – are highly unequal.  The homeless and those living in cramped and precarious housing in urban slums, without access to water and sanitation, face huge difficulties in implementing social distancing and maintaining the higher levels of personal hygiene that are now required. ...

Almost one in three Bolivians has no access to piped water at home. Fully half of Brazilians have no access to improved sanitation – a sadly remarkable number. Large numbers of Hondurans and Peruvians are also deprived of access to these basic services.  These deprivations mean that those who were worst-off to begin with are also most vulnerable to the virus.   

This also implies that Covid-19 will not be color- or race-blind in Latin America. Afro-descendants are over-represented among slum dwellers in Brazil, Colombia, and many other countries. Infection and death rates will almost certainly be higher for black Latin Americans than for whites, much as in the United States. Indigenous descendants are also more vulnerable in a number of Andean countries, and in the Brazilian Amazon.   

A second pre-existing inequality that is likely to make the underprivileged more vulnerable to the pandemic is that between formal and informal workers in the region. According to the ILO’s definition, the informal sector accounts for 34% of the GDP in the region, with 53% of total employment being informal: ranging from 23% in Uruguay to above 80% in Bolivia. Perhaps most vulnerable among the informal labor force are self-employed or own-account workers, who typically account for between 20% and 40% of the labor force in Latin America, or even higher in countries such as Bolivia and Colombia. 

Brazil: Amid collapse, the interior of the Amazon struggles over lockdown and chloroquine

Via Deutsche Welle Brazil: Amid collapse, the interior of the Amazon struggles over lockdown and chloroquine. Excerpt from the Google translation:

The meeting of the murky waters of the Amazon River with the clarity of Tapajós produces one of the postcards of Santarém, in western Pará. The natural beauty of the city surrounded by water as far as the eye can see attracts tourists from all over the world, especially to the village of Alter from the ground. For those who live in the region, the reality is quite different. Only half of the population has access to clean water in Santarém, one of the 100 largest municipalities in Brazil. Basic sanitation, in turn, is a privilege of 4.2%.  

"The Amazon receives the pandemic in the worst possible conditions," says Caetano Scannavino, coordinator of the Saúde & Alegria Project, an NGO that has been operating in the region for more than three decades. "The main cause of infant mortality here is diarrhea from contaminated river water. Imagine working on the importance of hygiene with the population that does not have a tap at home."  

The advancement of the new coronavirus in the region caused the health system in Santarém to collapse, as had already occurred in Belém and Manaus, the main capitals of the region. The 31 available ICU beds are full, and the city is a service reference for a population of more than 1 million people, distributed in 22 municipalities in the interior of the Amazon.  

Some of these municipalities are larger than European countries. Itaituba, with just over one hundred thousand inhabitants, is twice the size of Belgium. The displacement of patients who need assistance in Santarém depends on transport by helicopter that the state government has made available.  

Of the 7.8 million Brazilians who are more than four hours from a breathing apparatus, more than half live in the Amazon. The state of Pará alone accounts for almost a third of this population. 

While at the beginning of the pandemic, the city of São Paulo had one respirator per 2,400 inhabitants, the rate was one per 20,000 in Santarém. This Tuesday (May 26), the city of Pará reached 1,016 confirmed cases and 65 deaths due to covid-19, the disease caused by the new coronavirus.  

The data, however, have a large lag. As there is no structure for conducting clinical examinations in Santarém, the samples are sent by plane to Belém, the state capital, and take up to two weeks to be processed. There is also a limitation of rapid tests, mainly used to monitor already detected cases. 

"Given the number of hospitalizations, I estimate that there are between 20,000 and 40,000 infected in western Pará," says João Guilherme Assy, an infectious disease physician in the municipality, who monitors local health units. The growth of the queue for an ICU bed forces doctors to improvise. 

Often, patients have to take respirators to ensure more people have access to oxygen. There is also a shortage of medical professionals, as those on the front line become ill from contact with the virus. 

Lockdown raises tension 

The situation is aggravated by the population's low adherence to social isolation. To respond to this situation, the city government decreed a lockdown, that is, drastic measures of confinement, for six days, until last Sunday. The social isolation rate rose from 39% to an average of 49.9% on the days the measure was in force. Despite the improvement, the indicator was below the 70% recommended by the World Health Organization (WHO).

Covidly.com on Wednesday night reports 414,661 Brazilian cases—19,995 in the past 24 hours. Deaths total 25,697; 1,092 have died in the past 24 hours.

Leveraging Africa's preparedness towards the next phase of the COVID-19 pandemic

Via The Lancet Global Health: Leveraging Africa's preparedness towards the next phase of the COVID-19 pandemic. Excerpt:

The coronavirus disease 2019 (COVID-19) response in many African countries has been swift, progressive, and adaptable, despite resource limitations. As the novel coronavirus infection spread through Wuhan (China) in January, 2020, African countries rapidly acquired de novo severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing capacity so that by March, most could confirm COVID-19. Airport screening began early and efforts to mitigate the spread of COVID-19 have typically emphasised case identification, contact tracing and isolation, handwashing and hand hygiene, and several social distancing and stay-at-home measures with, in some cases, lockdowns of exceedingly high risk areas (appendix). 

These strategies are likely to remain integral to disease mitigation until an effective vaccine is deployed or population immunity is sufficient to slow transmission. However, the application of COVID-19 mitigation strategies in sub-Saharan Africa needs careful and continued deliberation because of the unique socioeconomic dynamics in this region. In this Comment, we discuss some of these challenges and suggest potential, non-resource-intensive solutions. 

Rapid urbanisation has led to an informal sector surge and consequent increase in people living in informal settlements and slums within African cities. These communities are particularly susceptible to economic shock resulting from stay-at-home orders and lockdowns, which need to be tempered with food and basic necessity provisions. Water tanks can be set up for handwashing and sanitation in these susceptible communities, as well as public toilets which could potentially serve as sentinel COVID-19 surveillance sites through periodic faecal matter sampling and testing. 

An added layer of complexity is the multigenerational structure and large size of typical African households. Household transmission is a substantial driver of SARS-CoV-2 spread in the community and multigenerational households might be prone to higher fatality. Interrupting COVID-19 transmission is challenging because a substantial proportion of transmission occurs in the presymptomatic stage.  

Effective contact tracing, testing in the community, and targeted door-to-door surveillance in high-risk areas can help to identify preclinical COVID-19 patients early and isolate them to prevent onward transmission. Mandatory involuntary quarantine could be deemed an impingement of civil liberties. However, voluntary isolation at financially compensated (ie, pre-paid for by government) designated facilities for those who cannot self-isolate at home, and for frontline health-care workers who risk exposing their families to COVID-19, could be instrumental to curbing transmission. 

Sustained containment of COVID-19 will ideally prevent uncontrolled spread in the community and overwhelming of health-care capacity. Most African countries have a narrow margin for error because of weak health systems operating at near capacity outside of a pandemic and the need to maintain control of other infectious diseases. Staggered periods of relaxed social distancing could avoid a large resurgence of cases while providing respite for economic activity. 

However, monitoring the effectiveness of non-pharmaceutical interventions and exercising flexibility in their implementation needs to be guided by continued surveillance through community testing. To meet this demand, testing capacity and implementation need to be scaled up substantially. 

Pooling of samples for quantitative PCR (qPCR) detection will be the most cost-effective approach, with one study showing that a SARS-CoV-2-positive sample could be detected by qPCR in a pool of up to 31 samples. Scientists from Harvard (MA, USA) and the Broad Institute (MA, USA) are developing a low-technology framework to guide sample pooling strategies on the basis of the number of samples collected and testing capacity. 

Home care is supposed to help. In a COVID-19 pandemic it may hurt

Via The Tyee, my colleague Andrew MacLeod writes: Home Care Is Supposed to Help. In a Pandemic It May Hurt. Excerpt:

The patchy state of B.C.’s home-care sector is creating a huge potential for the spread of COVD-19 among vulnerable seniors. 

That’s the assessment of Matthew Lowe, who has 14 years’ experience in the sector and is the founder of Community Plus Home Health Care & Nursing in Greater Victoria. 

“To have all these people running around out there, with no supplies, possibly no training, providing services to our seniors in the middle of a pandemic when we don’t know where this is spreading right now, it’s insane,” Lowe said.  

Lowe is not alone. A June report by B.C.’s Office of the Seniors Advocate raised concerns about the performance of the sector long before the pandemic hit. 

 Some 40,000 people receive home support each year. It’s delivered through the province’s health authorities by nearly 10,000 community health workers, according to that report. 

The workers help people, many of them seniors or vulnerable, with daily tasks that require close personal contact — like getting out of bed, taking medicine, bathing, dressing, eating, grooming and using the toilet. Workers visit several homes a day. 

Public services are delivered by a mix of health authority staff and contract agencies. Companies that provide similar services to people who pay privately are also used by the health authorities when demand rises. 

Lowe said his company pays a living wage and has nurses and caregivers on staff. 

But he said some companies doing overflow work for Island Health manage their workers as subcontractors and download responsibility for following requirements like having protective equipment, such as gloves, to them. 

“Some of them would take gloves from other providers, some of them would actually buy their own, but a lot of them would just go out there with nothing,” Lowe said.  

Some companies in the sector have a long history of cutting corners and hiring with little screening as they’ve been desperate to fill positions, he said. “A lot of them, as uncertified unregistered caregivers, may have never had a hand hygiene education in their life and that should be really scary to a lot of people, especially when you have these people basically hopping across homes across Victoria,” he said.  

“What greater opportunity is there to spread an illness like this to our most vulnerable seniors besides a home-support worker? There aren’t a lot of other individuals out there who are going in, providing a highly personal service at close proximity, and doing it across a large region.”

WHO: Pneumonia of unknown cause – China

WHO has published Pneumonia of unknown cause – China. Excerpt:

On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan City, Hubei Province of China. As of 3 January 2020, a total of 44 patients with pneumonia of unknown etiology have been reported to WHO by the national authorities in China. Of the 44 cases reported, 11 are severely ill, while the remaining 33 patients are in stable condition. According to media reports, the concerned market in Wuhan was closed on 1 January 2020 for environmental sanitation and disinfection.  

The causal agent has not yet been identified or confirmed. On 1 January 2020, WHO requested further information from national authorities to assess the risk. 

National authorities report that all patients are isolated and receiving treatment in Wuhan medical institutions. The clinical signs and symptoms are mainly fever, with a few patients having difficulty in breathing, and chest radiographs showing invasive lesions of both lungs. 

According to the authorities, some patients were operating dealers or vendors in the Huanan Seafood market. Based on the preliminary information from the Chinese investigation team, no evidence of significant human-to-human transmission and no health care worker infections have been reported.  

Public Health Response 

National authorities have reported the following response measures: 

• One hundred and twenty-one close contacts have been identified and are under medical observation; 

• The follow-up of close contacts is ongoing; 

• Pathogen identification and the tracing of the cause are underway; 

• Wuhan Municipal Health Commission carried out active case finding, and retrospective investigations have been completed; 

• Environmental sanitation and further hygiene investigations are under way. 

WHO is closely monitoring the situation and is in close contact with national authorities in China.  

WHO risk assessment 

There is limited information to determine the overall risk of this reported cluster of pneumonia of unknown etiology. The reported link to a wholesale fish and live animal market could indicate an exposure link to animals. The symptoms reported among the patients are common to several respiratory diseases, and pneumonia is common in the winter season; however, the occurrence of 44 cases of pneumonia requiring hospitalization clustered in space and time should be handled prudently.  

Wuhan city, with a population of 19 million, is the capital city of Hubei province, with a population of 58 million people. WHO has requested further information on the laboratory tests performed and the differential diagnoses considered.

DR Congo: MSF urges humanitarian organisations to return to southern North Kivu

Via MSF.org, a sobering account of the other problems North Kivu is dealing with: DR Congo: MSF urges humanitarian organisations to return to southern North Kivu. Excerpt:

KINSHASA – For years, the territories of Masisi, Walikale and Rutshuru, in the southern part of North Kivu, Democratic Republic of Congo, have been plagued with armed violence and banditry. In the past months, these armed clashes have intensified, further aggravating the dire humanitarian situation, leading to significant numbers of displaced people and worrying signs of malnutrition, sexual violence and gunshot wounds among them. 

“Since the start of the year, the number of victims of sexual violence treated by MSF in Masisi has doubled compared to last year, and we have seen an increase in malnutrition cases”, says Ewald Stals, MSF field coordinator in Masisi health zone. “The escalation of armed clashes has also led to more people being treated for bullet wounds, and to a surge of displaced families arriving in already overcrowded camps where access to water and sanitation is scarce. Unsurprisingly, cholera cases have been reported and we’ve had to rapidly set up a cholera treatment centre.” 

“Where are the humanitarians?” 

From January to September 2019, MSF teams working in the territories of Masisi, Rutshuru and Walikale treated more than 11,220 malnourished children, 2,310 victims of sexual violence and 1,980 people with weapons injuries. Despite this critical situation, these territories – often referred to as the ‘Little North’ of North Kivu in the aid sector – suffer from a glaring lack of assistance from humanitarian organisations.   

“In recent years, several NGOs have left the ‘Little North’ because of insecurity, difficulties in movement around the region, and a lack of funding,” says Karel Janssens, MSF Head of Mission in DRC. “Given this reduction in the number of organisations, we have been responding to an increasing number of medical, but also non-medical, needs, especially in camps. Now we’re running at maximum capacity, and other emergency organisations must urgently come back and help respond to the massive humanitarian needs on the ground.” 

According to recent estimates, more than 687,000 people are living in camps for internally displaced people or are being hosted by local families in the territories of Masisi, Rutshuru and Walikale. For months, MSF has been advocating for the on-the-ground return of other humanitarian organisations. These efforts resulted in the arrival of a handful of organisations with temporary funding from the DRC Humanitarian Fund in mid-November.  

“This support is temporary and far from enough to meet the needs,” says Janssens. “Given the scale of the crisis, a much larger humanitarian response is needed in southern North Kivu, with organisations being present on the ground and benefitting from longer-term funding. The Humanitarian Response Plan 2020 for DRC must clearly take this into account in its upcoming revision.”

DRC: 16 new cholera cases, including 2 deaths, recorded in week 45 in Mbuji-Mayi (Kasai Oriental)

Via provinces26rdc.net: DRC: 16 new cholera cases, including 2 deaths, recorded at the 45th week of the year in Mbuji-Mayi (Kasai Oriental). The Google translation:

The statistical data of the 45th week of the year are not satisfactory. Several rural and urban health areas experienced a slight increase in cholera, while almost all areas affected by the disease had not reported any more cases in recent weeks.  

Dr. Jean-Pierre Sumba, Epidemiologist Epidemiologist of the Provincial Health Division in Kasaï Oriental is concerned about this situation affecting his sector.  

"We had around 16 cases of cholera for week 45, including 2 deaths with 6 cases from the health zone side of Tshishimbi with Tshilundu [...]. At the level of the city of Mbuji-Mayi, it is also the same because we had for the week just ended 7 cases in the health zones of Muya, Lukelenge and Dibindi, "confirmed Dr. Jean-Pierre Sumba.  

The epidemic is under control because all areas are provided with inputs necessary for the proper management of diseases. 

"The care there, we have enough inputs that we bring to all levels where there are problems. Not long ago, we sent inputs to the Tshishimbi health zone, but at the Muya health zone, there are plenty of inputs, there is no problem," added the epidemiologist doctor of the Provincial Health Division in Kasai Oriental, Dr. Sumba. 

After nearly two years of response, Kasai Oriental is still struggling to end cholera, a situation that exposes the precarious hygienic conditions in this part of the DRC.

North Kivu: At least 830,000 people expected to be vaccinated against cholera

Via Radio Okapi: North Kivu: at least 830,000 people expected to be vaccinated against cholera. Excerpt from the Google translation:

Approximately eight hundred and thirty thousand people will be vaccinated in seven health zones in North Kivu against cholera. The campaign was launched Wednesday (October 30th) by the Congolese Minister of Public Health, Eteni Longondo, and will last five days. It concerns all people aged at least one year.  

A total of thirty-four health areas, considered high-risk, are targeted in the seven health zones selected for this second cholera vaccination campaign in the provinces.  

While cholera is endemic in the four eastern provinces of the DRC (North and South Kivu, Tanganyika and Upper Lomami), the province of North Kivu alone has recorded almost one-quarter of all the cases enumerated since the beginning of the year in the country.  

This situation justifies the need and urgency of this reactive vaccination, says Goma WHO official in Goma Kwam. "The province of North Kivu has registered almost a quarter of the total number of cases registered in the country, or 4836 with 46 deaths," he says. 

MSF: Remain in Mexico policy leaves more than 1,500 asylum seekers stranded in border camp

Via Doctors Without Borders USA: Remain in Mexico policy leaves more than 1,500 asylum seekers stranded in border camp.

The Remain in Mexico policy, officially known as the US Migrant Protection Protocols (MPP), has left more than 1,500 vulnerable asylum seekers waiting in an informal camp at the international bridge between the violent border city of Matamoros, in Mexico’s Tamaulipas state, and Brownsville, Texas. 

Though latrines and showers have been installed in the camp, Doctors Without Borders/Médecins Sans Frontières (MSF) teams have witnessed the unsanitary conditions in which people are being held and are increasing medical humanitarian activities accordingly. The MPP, initially implemented in January 2019, requires people applying for asylum in the US to wait out their legal proceedings in Mexico. 

“We have a team with a doctor, psychologists and social workers who treat issues such as anxiety and post-traumatic stress disorder—consequences of the hopelessness produced by the uncertainty of not knowing what is going to happen with their future or their family,” said Anneli Droste, project coordinator for MSF Mexico's northern border project. 

In the last three weeks, MSF has also conducted 178 medical consultations for ailments including diarrhea, hypertension, diabetes, psychiatric conditions, and asthma. Most of the patients exhibited respiratory and skin and soft tissue conditions related to the overcrowded and unsanitary living conditions in the camp. Of these consultations, 48 percent were for women and 52 percent were for men. More than half were under 15 years old (58 percent).  

Droste said that she recently spoke with a 15-year-old boy living in the camp with his family while waiting for a decision on their asylum claim. “He told me that they don’t want to be separated from the asylum seekers’ group, because they fear assault or kidnapping,” Droste said. “Staying together is one of the measures they have taken to feel, in some way, protected.” 

MSF remains gravely concerned about the humanitarian needs of asylum seekers along Mexico’s northern border and demands, once again, that the Mexican and US governments protect their lives and well-being.

DRC: 11 NGOs warn of 'catastrophic' situation of hundreds of thousands of displaced people in Ituri

Via Actualite.cd: DRC: 11 NGOs warn of "catastrophic" situation of hundreds of thousands of displaced people in Ituri. The Google translation:

Humanitarian Action Against Hunger, AVSI, Danish Refugee Council, Intersos, Mercy Corps, Norwegian Refugee Council, Oxfam, Solidarity International, Tearfund, Trócaire and Welthungerhilfe have issued an alert on the need for funding to meet the needs of many hundreds of thousands of people affected by the resurgence of violence in the Djugu and Mahagi territories in Ituri province.

These 11 organizations report that most people who have fled the violence live in appalling conditions lacking clean water, medicines and sanitation.   

Others spend the night cramped in public places, such as churches and schools, or try to survive in overcrowded makeshift camps exposed to heavy rains and life-threatening diseases.  

In some cases, 500 people have to share a single toilet.   

These living conditions also increase the risk of sexual violence against women and girls.    

"The situation is catastrophic. Many children are malnourished. Most people lost everything and witnessed the worst atrocities. Now they are facing a terrible dilemma: finding themselves with nothing to eat or risking their lives by returning to their fields," confirms Corinne N'Daw, country director Oxfam in the DRC.    

According to Benjamin Vienot, Country Director of Action Against Hunger in the DRC, humanitarian organizations have not had sufficient funding to cover needs and they still face insecurity in this part of the country.   

"Humanitarian organizations have not been able to reach all those who needed help during the last crisis in 2018 due to lack of funding and insecurity, which made access to the people extremely difficult. We are now faced with an equally dark picture," he added.   

Ten months after the beginning of 2019, DR Congo received only 35% of the necessary funds, in a country where 15.6 million people are affected by severe food insecurity.   

Other parts of the country are also beset by the humanitarian crisis. These are the provinces of South Kivu, Tanganyika and Kasai.