H5N1

Singapore: Updates on novel coronavirus

Via the Singapore Ministry of Health: Updates on Novel Coronavirus. Excerpt:

25 Jan 2020:  MOH is aware of rumours circulating online that an individual has died of the novel coronavirus infection at a shopping mall in Singapore.  We would like to clarify that there had been no deaths among suspect or confirmed cases.  We advise members of the public not to speculate and/or help spread unfounded rumours.  Please visit this page (www.moh.gov.sg) for updates on the novel coronavirus situation. 

25 Jan 2020:  The Immigration and Checkpoints Authority (ICA) is aware of rumours circulating online that more than 100 arriving travellers from Wuhan were denied entry into Singapore.  ICA would like to clarify that this is untrue and the alleged incident did not take place. ICA advises members of the public not to speculate or help spread unfounded rumours.  They can also visit MOH’s website for updates on the novel coronavirus (Wuhan virus) situation.

Coronavirus fears fuelled by misinformation on social media

Via CBC News Second Opinion: Coronavirus fears fuelled by misinformation on social media. Excerpt:

People collapsing in the streets of Wuhan, coverups of unreported deaths and travellers "escaping" quarantine in China at risk of spreading the coronavirus.  

If you've been following the outbreak on social media, you may have seen some, or more, of these types of claims.  

But the truth is, they're completely unverified – and in most cases, flat out untrue.  

Social media has completely changed the way in which information about a disease outbreak travels around the world and experts say it's not for the better.  

"When there's a lack of information and there's fear, rumours come in to fill that gap," said Alfred Hermida, professor and director of the journalism program at the University of British Columbia. 

"The reason people are sharing this is because they're trying to make sense of what is a really complicated situation and also something that is potentially worrying. The danger is that it spins out of control, because fear then takes over."  

Hermida began tracking the rate at which information about the coronavirus has been shared on Twitter since coverage of the outbreak began late last month.  

What he found was that there was little traffic around hashtags related to the coronavirus until Tuesday, the day the first U.S. case was reported, when the volume of tweets spiked.  

Hermida's data showed about 25,000 tweets on Monday in the U.S., followed by over 80,000 Tuesday, close to 200,000 Wednesday, more than 350,000 Thursday and almost half a million on Friday alone. 

"Fear is a very powerful motivator here," he said. "It's very easy to weaponize and for most people, it's very hard to figure out if something you see on social media is true or not. 

"It plays to our worst fears."

Another good nCoV2019 real-time resource

Wuhan Coronavirus Global Cases is an excellent new resource, tracking the outbreak in real time. As of 2:30 p.m. January 22, it reports 555 confirmed cases and 17 deaths (updated 5 minutes ago). It's on the Novel Coronavirus Links list.

The last couple of days have almost made me nostalgic for the early days of H1N1 and H7N9: we thought we were being swamped with online information, but this is far more intense. Whatever they name this virus, it's got an alarming side effect: Coronavirus Information Shock.

Links to nCoV2019 resources

Well, we have a situation here, with coronavirus news coming in faster than we can handle but still not fast enough. I've created a new list of Novel Coronavirus Links, over in the far right column: a mishmash of health agencies, media, and Twitter links, very likely to expand. Its purpose is mostly to save myself some time in finding news stories, but its yours as well. And if you find other reliable sources of coronavirus news, let me know and I'll add them to the list.

China coronavirus: Beijing breaks its silence, but only to ‘deny rumours’

Via the South China Morning Post: China coronavirus: Beijing breaks its silence, but only to ‘deny rumours’. Excerpt:

China’s central government has broken its silence on the Wuhan pneumonia outbreak with an online post aimed at “defying the rumours” surrounding the spread of the new coronavirus but without providing any new facts or figures. 

In an information poster reproduced on social media and its own website on Saturday night, the Chinese Centre for Disease Control and Prevention said the new virus was not Sars (severe acute respiratory syndrome),which killed more than 700 people around the world in 2003. 

The centre also dismissed suggestions that hospitals outside Wuhan had been secretly treating people infected with the virus, saying that all known cases were being dealt with in the central China city. 

Despite its efforts to counter the so-called rumours, the notice left many people on social media with more questions than answers. 

“How infectious the virus is, how serious it is and if it can spread from human to human – the poster just keeps people guessing,” said a person on Weibo, China’s Twitter-like platform. 

Another suggested that “all the information we see has been filtered … the real situation could be worse”.

“Just for sake of protecting yourself, please wear masks, wash your hands often and avoid crowded places,” the person said. 

As of Sunday afternoon, the centre’s post had generated more than 5,300 comments, many of them asking the same question: how can there not have been cases in other Chinese cities if two Chinese visitors to Thailand and a Chinese man working in Japan have been confirmed as being infected? 

Later on Sunday China’s National Health Commission said that the outbreak was “preventable and controllable”. However, it added that the source of virus has yet to be found and its path has yet to be fully mapped. 

“It still requires close monitoring for any possible mutations,” the commission’s statement said.

The municipal health commission in Wuhan has been the sole source of official information about the new coronavirus, interest in which has been growing both within China and around the world. The commission reported 17 new cases on Friday, taking the total in the city to 62, but no other mainland cities have reported any confirmed or suspected cases. 

However, the South China Morning Post reported on Saturday that at least two suspected cases had been recorded in Shenzhen and a third in Shanghai. Authorities in the two cities declined to comment on the suggestions and the central government has made no mention of them. 

There was little coverage of the pneumonia outbreak in Shanghai’s media on Sunday, and no obvious signs on the city’s streets that more people than normal were wearing face masks.

But a doctor at a leading hospital there said medical staff were being prepared for a possible outbreak. 

“I heard there was a suspected case in Shanghai today [Sunday] and our hospital is holding a training session on virus prevention and treatment,” he said. 

“The hospital is rushing to buy more masks, caps and hand sanitiser for us,” he said on condition of anonymity as he is not authorised to speak to the media. 

“To be honest, I feel frightened. It is a virus with a lot of aspects still unclear.”

DRC Congo: Who's minding the Ministry of Health?

While trying to learn more about the undiagnosed outbreak in Mai-Ndombe this morning, I checked the DRC Ministry of Health website for the first time in months. It was a discouraging experience.

The site seems abandoned. Major stories are a year old, or older. Dr. Oly Ilunga Kalenga is still listed as minister of health in a May 2018 post about the start of the Equateur Ebola outbreak, but the post is just one sentence long.

Meanwhile the ministry's Twitter account hasn't been updated since last September.

This seems to be the unwelcome result of the ouster of the former health minister, Dr. Oly Ilunga Kalunga. He objected to the government's decision to go ahead with a second Ebola vaccine, and the result was a whole new Ebola agency, CMRE, led by Dr. Jean-Jacques Mutembe Tamfum. Ilunga soon found himself being interrogated by the police over charges of misusing Ebola response funds, but I haven't seen anything about him in months. He too has vanished from Twitter.

The new minister of health, whose name I can't recall, does turn up in occasional news reports about Ebola, always as second fiddle to Dr. Mutembe. Meanwhile, the DRC has also been battling the worst measles outbreak in the world, cholera, and a host of other ills. Not a word of these outbreaks on the ministry website.

The MoH hasn't disappeared; it's certainly engaged on the measles response and other health campaigns. But it's alarming when the ministry of health of a very large country effectively vanishes from online communication with the rest of the world.

WHO: China virus outbreak shows Asia needs to step up infection preparation

A statement from WHO's Western Pacific Regional Office: China virus outbreak shows Asia needs to step up infection preparation.

In early January, the World Health Organization was notified by China that 41 people in Wuhan, the country’s seventh most populous city, had been hospitalized with what appeared to be a mystery strain of pneumonia. Many were reported to be workers in or visitors to a live animal market.  

Chinese authorities have now made a preliminary determination of a new, previously undetected coronavirus as the cause of the respiratory illness, and over the weekend shared the virus’s genetic sequencing to enable other countries to quickly diagnose potential new cases.  

Any outbreak of an undetermined disease prompts concern across Asia and beyond, and memories remain strong of the 2003 outbreaks of severe acute respiratory syndrome, or SARS, and bird flu, which infected thousands, killed hundreds and sparked massive disruption to global travel and trade.  

In the past two decades, China has rapidly strengthened its capacity to prepare for and respond to public health threats and, in the face of the latest challenge, moved swiftly to investigate the cause, isolate patients and trace their close contacts. Authorities also closed the implicated market and are conducting environmental assessments. 

WHO immediately activated all three of its levels -- China country office, regional office and headquarters -- and stands ready to launch a broader response, if needed.  

This New Year's wake-up call reminds us to be vigilant against SARS, bird flu and the causes of more recent outbreaks in the region, including dengue, measles, polio, influenza, Middle East respiratory syndrome, Zika and a range of other emerging diseases. In fact, two of the last four influenza pandemics began in the Western Pacific Region -- home to 1.9 billion people and a hot spot for outbreaks of emerging infectious diseases and natural disasters. These were threats that put people's health and safety and economic development at risk.  

At a time like this, it is fair to ask: are we safer from health security threats than we were a decade ago, following the H1N1 influenza pandemic? Or than we were when SARS emerged 17 years ago?  

In many respects, we are safer, having learned important lessons from dozens of other outbreaks and emergencies. 

The 37 countries and areas that make up the Western Pacific Region, from Mongolia to New Zealand, have made considerable progress in strengthening systems for preparedness and response, guided by WHO. Most now have emergency operations centers and rapid response teams, and have introduced field epidemiology training programs and event-based surveillance systems for early identification and monitoring. China’s rapid identification of a new coronavirus last week, and its quick action to share the virus sequence with other countries, is testament to the strength of this approach. 

As a result, many countries can respond quickly to disease outbreaks, and some have the capacity to support their neighbors. All of this has made the region -- and the world -- safer. 

But we are not completely safe.  

Our surveillance teams identify, on average, two disease outbreak events every week, and the context in which these events occur is far more complex than before, due to rapid urbanization and dramatic increases in the movement of people and goods. In addition, climate change has increased the frequency and impact of natural disasters and expanded the geographic reach of epidemic-prone diseases. As a result, the region is being impacted by diseases, such as MERS and yellow fever, that seemed unlikely just a few years ago. 

And social media are spreading rumors faster than viruses spread disease -- often passing along incorrect information that can make situations worse. 

But there is good news: we have the power to strengthen systems for handling health security threats for decades to come. Specifically, we urge our member states and partners to focus on five key points to reinforce health security.

First, we need to extend and modernize disease surveillance systems at the local level, so that health services detect and report emerging infectious diseases quickly and at the source.

Second, we need to strengthen decision-making systems to ensure rapid responses. The earlier we detect an event, the more complex and challenging the decision-making becomes, because it often takes place in the context of more uncertainty. Responding in this environment requires conducting systematic assessments that draw upon multiple sources of information and intelligence.

Third, we have to communicate more effectively so that we engage all relevant sectors and communities, to be better prepared for responding to health emergencies and outbreaks.

Fourth, in a region that is a recognized hot spot for diseases from animals, we must continue to strengthen collaboration between the animal and human health sectors, including to address the growing threat of antimicrobial resistance, or drug-resistant infections.

Finally, we need to continue to strengthen collaboration and coordination between countries for so-called global public health goods -- those things that universally benefit all of us, such as clean air and water and protection from infectious diseases.

No one can undertake this journey alone -- not a single country, nor a single organization. We must work together, reaching across sectors, to prepare for the next pandemic. We must test and update response plans time and again. We must continue to strengthen the systems required to implement responses. And we must keep up momentum to continue improving health security.

These simple steps -- by WHO, member states and our partners -- can further strengthen the initiatives and programs we already have in place to ensure health systems are ready for and capable of responding to disease outbreaks, keeping people safe.

Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study

Via The Lancet: Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study. The summary:

Background 

Hong Kong has been embroiled in increasingly violent social unrest since June, 2019. We examined the associated population mental health burden, risk factors, and health-care needs. 

Methods 

In a population-based prospective cohort, adult participants aged 18 years or older were assessed at nine timepoints from 2009. Probable depression was measured using the Patient Health Questionnaire-9 (score ≥10) and suspected post-traumatic stress disorder (PTSD) by the PTSD Checklist—Civilian Version (score ≥14), plus direct exposure to traumatic events related to the ongoing social unrest. We used multivariable logistic regression to identify factors associated with both outcomes, adjusting for doctor-diagnosed depression or anxiety disorders before the unrest. On the basis of routine service statistics and respondents' intention to seek professional care, we projected the number of additional ambulatory specialist psychiatric visits required. 

Findings 

After the two baseline surveys, we followed up random subsets of 1213–1736 adults at each timepoint. Probable depression was reported by 11·2% (95% CI 9·8–12·7) of participants in 2019, compared with 1·9% (1·6–2·1) during 2009–14 and 6·5% (5·3–7·6) in 2017 after the Occupy Central Movement and before the current unrest. Prevalence of suspected PTSD in 2019 was estimated to be 12·8% (11·2–14·4). Age, sex, educational attainment, or household income were not associated with either outcome, whereas heavy social media use (≥2 h per day) was associated with both. Political attitude or protest participation was not associated with probable depression, but neutrality towards the extradition bill approximately halved the risk of suspected PTSD. Family support mitigated against probable depression. We estimated that the mental health burden identified would translate into roughly an excess 12% service requirement to the public sector queue or equivalent. 

Interpretation 

We have identified a major mental health burden during the social unrest in Hong Kong, which will require substantial increases in service surge capacity. Health-care and social care professionals should be vigilant in recognising possible mental health sequelae. In a world of increasing unrest, our findings might have implications for service planning to better protect population mental health globally.

See also this comment in The Lancet on the Hong Kong study.

China: 8 people spread false information about pneumonia and were processed

Via Chutian Dushi Bao, a Wuhan newspaper: 8 people spread false information about pneumonia and were processed. The Google translation:

According to a Xinhua News Agency report from the Wuhan Public Security Bureau on the 1st, some false information about "Wuhan Viral Pneumonia" has been circulating on the Internet recently, and the public security department investigated it. Currently, eight people have been dealt with by the police in accordance with the law due to the distribution of false information. 

According to the Wuhan police report, recently, some medical institutions in Wuhan have found and received multiple cases of pneumonia. Wuhan Municipal Health Commission issued a briefing on this. However, some netizens publish and forward false information on the Internet without verification, causing adverse social impact. After investigation and verification by the public security organs, eight illegal personnel have been summoned and handled according to law. 

Wuhan police reminded that laws and regulations should be followed when posting information and remarks on the Internet. The police will investigate and deal with illegal acts of fabricating, spreading, spreading rumors and disrupting social order, and will not tolerate them. The police urged netizens not to create rumors, believe rumors, or spread rumors, and to build a harmonious and clear cyberspace.  

According to a report by the Wuhan Municipal Health Commission on December 31, 2019, some medical institutions recently discovered and received multiple cases of pneumonia that were associated with the local South China Seafood Wholesale Market. The diagnosis of viral pneumonia was conducted by experts. As of the notification day, no human-to-human transmission was found in the investigation, and no medical staff infection was found.

Housekeeping note: New measles list

I've (finally) added a list of measles links; you'll find it in the right-hand column, just below the Ebola list. If you're aware of any reliable, frequently updates measles resources, please let me know and I'll add them.

The infographic just below got me going on this. I was disappointed but somehow not surprised to find that the health ministries of Madagascar and Ukraine have essentially to say about the outbreaks they're contending with. But I'll keep looking on their sites, and if some obscure page turns up on either site, I'll link to it on the list.