H5N1

Mbandaka: ISTM takes measures to secure its students against the new Ebola epidemic

Via Radio Okapi, we learn that the first Ebola case was a medical student: Mbandaka: ISTM takes measures to secure its students against the new Ebola epidemic. The Google translation:

The Higher Institute of Medical Techniques (ISTM) took measures, including vaccination, to secure its students and limit the spread of Ebola, 48 hours after the declaration of the epidemic in Mbandaka by the central government.   

The first confirmed and deceased case was student Yange Bononga, enrolled in the 3rd Nutrition graduate, for the 2021-2022 academic year.   

Thus the management committee meeting on Monday, April 25 asked for the cooperation of the students and the support of the competent services.   

Among these measures taken, there is the awareness of students on the existence of the disease, the respect of barrier gestures and the obligation to present themselves free of charge to the hospital in the event of illness.   

In addition to the installation of washbasins in front of the strategic corners of the institute, the committee also requested the vaccination of the entire ISTM community, particularly the students of the 3rd Nutrition graduate.      

In addition, the ISTM has launched an appeal to public health services and humanitarian organizations to help build its capacity in information and protective equipment. Thus, a conference-debate on the resurgence of the Ebola virus disease in Ecuador is planned this week.   

All these measures are taken, continues the management committee, following the instructions of the minister in charge, to help curb the epidemic.    

Some students unfortunately had contact with the victim during his final moments.   

The management committee clarified, however, that the victim would have contracted the disease during his return trip from the holidays of Boende, where he is from.   

Although he probably arrived on April 10 in Mbandaka, he was directly admitted to health centers without attending the institute. This, until his hospitalization at the Wangata General Reference Hospital, then at the Ebola treatment center, where he passed away. 

WHO: Democratic Republic of Congo declares new Ebola outbreak in northwest province

A news release from WHO AFRO: Democratic Republic of Congo declares new Ebola outbreak in North West Province.

Brazzaville/Kinshasa, April 23, 2022 – Health authorities in the Democratic Republic of the Congo declared an Ebola outbreak today after the confirmation of a case in Mbandaka, capital of Equateur province (north -west). This is the third outbreak in this province since 2018.  

So far, only one case has been confirmed. The patient, a 31-year-old man, began experiencing symptoms on April 5 and after more than a week of home care, he sought treatment at a local health facility. On April 21, the patient was admitted to an Ebola treatment center for intensive care but died later that night. After recognizing the symptoms, health workers immediately took samples for laboratory testing for Ebola virus disease. Investigations to determine the source of the outbreak are ongoing.  

“Time is not on our side,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “The disease has taken a two-week head start and we are now playing catch-up. The good news is that health authorities in the Democratic Republic of the Congo have more experience than anyone else in the world in rapidly controlling Ebola outbreaks."  

The Democratic Republic of Congo is experiencing its fourteenth Ebola outbreak since 1976. The current outbreak is the sixth since 2018 alone, the most frequent event in the country's Ebola history. In Equateur province, previous outbreaks date back to 2020 and 2018, with 130 and 54 cases recorded respectively.  

Efforts to stem the current outbreak are already underway. The deceased patient received a dignified and safe burial, which involves modifying traditional funeral ceremonies in ways that minimize the risk of contagious fluids infecting attendees.   

Anyone who has been in contact with the patient is also identified and their state of health will be monitored. The health facility where the patient received care has been decontaminated.  

WHO experts based in the Democratic Republic of the Congo are supporting national authorities to strengthen key areas of outbreak response, including testing, contact tracing, infection prevention and control, treatment, as well as risk communication and engagement with communities to support public health measures to prevent infections.  

Vaccination should start in the next few days. The country already has stocks of rVSV-ZEBOV Ebola vaccine available in the cities of Goma and Kinshasa. The vaccines will be sent to Mbandaka and administered using the "ring vaccination" strategy - where contacts and contacts of contacts will be vaccinated to curb the spread of the virus and protect lives.  

"Many people in Mbandaka are already vaccinated against Ebola, which should help reduce the impact of the disease," said Dr Moeti. "All those who were vaccinated during the 2020 epidemic will be revaccinated."  

Ebola is a potentially deadly disease, affecting humans and other primates. Case fatality rates have ranged from 25% to 90% in past epidemics. Effective treatment now exists and if patients receive early treatment, as well as supportive care, their chances of survival improve dramatically.

COVID-19 in February 2022

Here is a screenshot from the Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard, taken just a few moments ago:

And here is what I posted from that dashboard on February 1, 28 days ago:

We've seen some dramatic changes: a predicted sharp fall in cases, from 23,183,000 in the week ending January 30, to 10,942,000 in the week ending January 27.  

 

Deaths in the week ending January 30 were 66,304. They peaked on February 6 at 75,455, and fell to 60,232 in the week ending February 27.

 

Vaccinations have been erratic, from a low of 166,866,000 in the week of January 30 to a peak of 257,076,000 in the week ending February 6, and ending the month at 162,473,000.

 

Meanwhile the US with 4,487,000 cases in February has been overtaken in case counts by Germany with almost 5 million cases, and Russia with 4,508,000. Around the world, 60,265,061 persons contracted COVID-19 in February, and 285,999 died of it.

 

All these numbers are of course probably serious undercounts, and the pandemic seems likely to continue indefinitely. It will receive media attention when it afflicts rich or strategically important countries; otherwise the media will go back to stories about sports and entertainment, politics and scandal. We have probably already passed the billionth case, but the official billionth case will trigger lots of headlines. Then COVID-19 will fade out of our awareness until a new strain emerges, or someone in our family falls ill and dies of an old one.

 

I hope I'm still here to post the Johns Hopkins numbers for February 28, 2023.

Africa marks two years of COVID-19 fight

Via WHO AFRO: Africa marks two years of COVID-19 fight.

Brazzaville – Africa today marks two years since the first COVID-19 case was detected in the continent. Countries across the region have made great efforts in combatting the pandemic in which more than 11 million cases and over 242 000 deaths have so far been recorded.     

While the impact of COVID-19 has been widespread and devastating, Africa has drawn from its experience in responding to other outbreaks to tackle the pandemic, and with the support of World Health Organization (WHO) it has bolstered public health measures, learned crucial lessons, improved tactics and grown better at responding to the virus.     

The continent’s capacity to manage COVID-19 cases has improved, with the increased availability of trained health workers, oxygen and other medical supplies. The number of Intensive Care Unit beds has increased across the continent, from 8 per 1 million people in 2020 to 20 today. WHO has also helped increase the number of oxygen production plants in Africa from 68 to 115 – a 60% rise – through supporting the repair, maintenance and procurement of new oxygen plants. Where plants have been set up, the cost of oxygen has decreased by 40%. Despite these improvements, oxygen availability remains a concern, and a large majority of patients who require oxygen as part of their clinical treatment plan are unable to access it.  

“This year we can end the disruption and destruction the virus has left in its path, and gain back control over our lives,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Controlling this pandemic must be a priority, but we understand no two countries have had the same pandemic experience, and each country must, therefore, chart its own way out of this emergency.”     

Although Africa’s pandemic response capacity has improved, the continent must now significantly ramp up COVID-19 vaccination coverage. Only 11% of the population is fully vaccinated so far. Vaccine supplies have increased in recent months and WHO is working with countries facing challenges to overcome the hurdles and widen vaccination reach.

Police move in on Ambassador Bridge blockade after injunction deadline passes

Via CBC News: Police move in on Ambassador Bridge blockade after injunction deadline passes . Excerpt:

Windsor police say their officers and "policing partners" have started enforcement at and near the Ambassador Bridge.  

"We urge all demonstrators to act lawfully and peacefully," police said in a tweet.  

They also advised people to stay away from the area.  

Police could be seen moving in around 8:30 a.m. While some protesters left, others appeared determined to stay put.

When Chris Mayville heard that an injunction had been granted to clear out the protesters taking part in a blockade at the Ambassador Bridge in Windsor, he immediately struck an angry and defiant tone.  

"Bring it," Mayville said. "Do you think I care? Do you think I care about a fine? I'm going to pay a fine? No. You think I care about their mandates? No. This needs to end.  

"I'm going to stay until the arrests."  

It was a sentiment shared by others blocking the bridge, where protests against COVID-19 public health restrictions have been snarling cross-border traffic since Monday. Some said they were determined to dig in and continue the blockade, whether or not they were confronted by law enforcement.  

The protesters were bracing for police to enforce the injunction when it came into effect at 7 p.m. ET. But as the deadline passed and no police action was initiated, the crowd appeared to grow in size, jubilance and defiance. And by early Saturday morning, around 100 protesters remained.   

Windsor Mayor Drew Dilkens told CBC News that the goal is to have the protesters leave voluntarily, "but if they refuse to leave, steps will have to be taken to remove them."

COVID-19 on February 1

Here is a screenshot of the Johns Hopkins dashboard, taken this evening:

It's grim enough that the US continues to report cases and deaths that would have been unthinkable two years ago: over 75 million cases, a quarter of them in the last 28 days, and almost 900,000 deaths, with 57,000 of them in the same 28 days. Yet it's as if the Americans scarcely notice.

Pay attention to the charts on the right. The omicron spike seems to be coming down, from 23.277 million in epi-week 3 to 23.07 million in epi-week 4. If cases fall as sharply as they rose, by the end of February we'll have seen roughly 160 million cases in the first two months alone of 2022. 

Meanwhile, deaths have risen despite omicron's famous mildness: a rapid climb from 45,000 in epi-week 1 to 65,000 in epi-week 4, for a total of about 338,000 deaths in 4 weeks.

As for vaccinations, the numbers are huge but dropping: epi-week 1 saw 242 million, but they're down to a bit below 167 million in epi-week 4.

It's nice to think case counts and deaths will continue to fall indefinitely, while vaccinations soar again. But other variants will follow omicron, and some of them could be even nastier. If you think you're tired now, imagine was February 1, 2023 could be like.

China’s zero-Covid policy is a pandemic waiting to happen

An op-ed in The New York Times: China’s Zero-Covid Policy Is a Pandemic Waiting to Happen. Much as I respect Drs. Emanuel and Osterholm, I'm nervous about their use of terms like "have to live with it" and "endemic." They sound at this point like acceptance of high mortality and morbidity rates, which will be endured much more by working-class people and people of colour. Excerpt:

As the Winter Olympics approach and some 3,000 athletes, their retinues and the media converge in and around Beijing, the Chinese government has gone to extraordinary lengths to prevent the 24th version of the games from becoming a Covid super spreading event. 

Though athletes and coaches will be required to be vaccinated, they will face severe restrictions. Those who receive a medical exemption from vaccination are being required to quarantine for 21 days after entering the country. Even the vaccinated will have to present two negative tests. Olympic participants must submit to daily Covid tests and will be restricted to an Olympic bubble where they will be confined to prevent spread to the local population.  

These extreme measures are in line with China’s zero-Covid policy. President Xi Jinping and his government seem to believe that the country can be sealed off until the virus is eradicated around the world.  

But that goal is unattainable with the highly transmissible Omicron variant and has set the nation up for disaster. The coronavirus is not going to disappear — the world will have to live with it. Making matters worse, China’s vaccines are much less effective against Omicron. And the Chinese health care system simply is not equipped to care for millions of people sickened by the virus.  

Yes, China has weathered the pandemic well so far. Even with about four times the population of the United States, China has had fewer than 140,000 confirmed Covid cases and fewer than 6,000 deaths since January 2020, according to the World Health Organization. A vast majority of factories continued to operate. Early in the pandemic, China added thousands of hospital beds to its health care system in days.  

All of this seems like an enormous success when compared with the messy and often chaotic response to the virus in the United States, where more than 860,000 people have died and some 2,000 more die each day. Many hospitals are under siege. The economy has been disrupted.  

But this may very well be the future China is facing. Its pursuit of zero Covid will prove to be a huge mistake. The policy has left it wholly unprepared for what will become endemic Covid.

Do vaccines protect from long COVID?

Via The Lancet Respiratory Medicine: Do vaccines protect from long COVID?

On Jan 6, 2022, the UK Government's Office of National Statistics (ONS) published their latest report on the prevalence of long COVID in the UK from a representative survey. As of Dec 6, 2021, around 1·266 million people living in the UK had self-reported long COVID (95% CI 1·228–1·304; 2% of the total population), defined as symptoms persisting for more than 4 weeks after the first confirmed or suspected COVID-19 infection. Of these individuals, 892 000 (70%) had confirmed or suspected COVID-19 at least 12 weeks previously. Fatigue was the most common symptom reported, followed by loss of smell, shortness of breath, and difficulty concentrating.  

The numbers in the ONS report are high enough to give pause for concern, particularly as long COVID was reported in all sub-populations, including around 77 000 children aged 2–16 years and 134 000 people aged 17–25 years. Yet there is still uncertainty about the true prevalence of long COVID in adults and children following infection. A previous ONS article suggested that, of individuals who tested positive for COVID-19 infection in the UK between April, 2020, and August, 2021, between 3% and 12% had new or ongoing symptoms 12 weeks after the initial infection, including people who were not symptomatic during the acute phase.

Part of the problem with assessing the prevalence of long COVID is an absence of consistent information on terminology, definitions, and diagnosis of the condition. For example, a guideline from the UK National Institute for Clinical Excellence (NICE) defines long COVID as signs and symptoms that continue or develop after acute COVID‑19 from 4 weeks onwards, whereas WHO uses the term post COVID-19 condition, defined as occurring in individuals 3 months from the onset of SARS-CoV-2 infection.  

Additionally, a substantial proportion of patients might have persistent symptoms for a year or more after infection; more than half a million individuals (40%) from the January 2022 ONS report who described having long COVID had been infected at least 1 year ago. However, the general consensus is that long COVID is the failure to return to normal, pre-COVID levels of health, and is surprisingly common.  

More research is needed to gauge the full spectrum of symptoms of long COVID to facilitate diagnosis of the condition; as well as fatigue and shortness of breath, the NICE guideline lists many other commonly reported symptoms including palpitations, neurological symptoms such as dizziness, and gastrointestinal symptoms including nausea and weight loss.  

As Annelise Wilder-Smith (London School of Hygiene & Tropical Medicine, London, UK) commented “Long COVID is so much more than just chronic fatigue, and ranges from reduced stamina for athletes to erectile dysfunction in young men.”  

Research is also needed to understand why after acute COVID-19 infection, the impact of the disease varies from patient to patient, from full recovery to severe persistent symptoms affecting multiple organs and mental health. Anthony De Soyza (National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle University, Newcastle, UK) commented “Long COVID can arise in people who had mild acute COVID [and] so can affect anyone. Long COVID affects people differently and might well be a number of distinct subtype[s], each requiring better understanding of what causes the particular symptoms and how best to treat—this requires ongoing research.”  

Wilder-Smith added “Long COVID may be due to persistence of the virus, an autoimmune response, or damage triggered by the acute illness, but we need more data to answer this question.”

The data on long COVID are worrying, particularly during the current increase in global cases of COVID-19 infection. There are, however, encouraging emerging data that individuals who are vaccinated against COVID-19 are less likely to report long COVID symptoms. For example, a case-control study of 1·2 million users of a COVID symptom tracker app in the UK showed that there were lower odds of symptoms lasting 28 days or more in individuals who had received two vaccine doses (odds ratio 0·51 [95% CI 0·32–0·82]; p=0·0060)—ie, the risk of developing long COVID was reduced by around 50% in those who were double vaccinated.

Wilder-Smith said “Even if COVID-19 did not cause deaths, the high morbidity as a result of this viral infection would justify vaccinating all. The reasons for vaccination beyond the most pressing need to avert severe disease and deaths are manifold, but foremost it is to prevent long COVID.” De Soyza added “Ideally preventing both acute severe COVID through vaccination and also reducing the chances of long COVID represents an additional driver to support people to get vaccinated.”

New Zealand not prepared for Omicron outbreak expected in ‘matter of weeks’, experts warn

Via The Guardian: New Zealand not prepared for Omicron outbreak expected in ‘matter of weeks’, experts warn. Excerpt:

Two of New Zealand’s most prominent Covid-19 experts have warned that the country is unprepared to prevent the health system from being overloaded by an Omicron outbreak, with likely fatal consequences.  

Otago University’s Dr Nick Wilson and Dr Michael Baker also said it was only a “matter of weeks” before the highly transmissible variant seeped into the community due to border failures.  

Wilson said that despite New Zealand’s high vaccination rates, the number of adults who had received a booster dose of the vaccine – essential for minimising the effects of Omicron – remains dangerously low, and noted that the vaccine rollout for children between five and 11 still had not begun.

New Zealand received its first shipment of Pfizer’s paediatric vaccine only at the weekend, and intends to begin child vaccinations from 17 January, despite some comparable countries beginning their child vaccine rollout late last year.  

Omicron’s short incubation period also means New Zealand’s system for identifying and containing new community cases would be much less effective.  

Wilson panned the country’s traffic light system – which replaced the more stringent alert-level system last year – as “not fit for purpose” with Omicron due to its tolerance for relatively significant social interaction for vaccinated people when Covid is in the community.  

Baker agreed, calling for the government to rapidly reinstate an amended version of the alert level system. “The traffic light system won’t help us very much because it was never designed to dampen down transmission, it was only designed to nudge people towards vaccination,” Baker said.  

Until these weaknesses were fixed, he said, “we need to hugely turn down the tap of people arriving in New Zealand”. Wilson agreed: “The priority is to have a tighter border so that we don’t have to vaccinate kids and conduct a booster program during an outbreak.”  

The pair called for a “significant tightening” of the number of New Zealanders entering the country.  

Over the weekend, 64 positive Covid cases were recorded within New Zealand’s oversubscribed managed isolation facilities (MIQ) for incoming travellers, many of which were expected to be Omicron.  

Wilson said he was “perplexed” that poor ventilation and shared spaces within MIQ had not been fixed and that the resulting “high risk” of an Omicron outbreak was “unacceptable”.

To relieve the pressure on MIQ, Wilson said, the government ought to require rapid antigen testing for travellers immediately prior to allowing them on flights, and cap the number of travellers coming from high-risk countries such as the UK, where Omicron rates have skyrocketed.

COVID-19 on December 27: Are we just going through the motions now?

This morning's Johns Hopkins dashboard has more information than it seems to. We might settle for the big numbers at the top and click away to some other site.

Yes, we have a nice round 280 million cases, and 300 million will likely be the total in a few weeks. Deaths are at 5.4 million; we will hear a lot of comparisons to the Holocaust when the virus has killed 6 million.

But look at the US: over 4 million cases in the past 28 days, and over 1,000 deaths per day in that period. Perhaps the first year of the Trump response ensured that the Biden response would fail, but this badly? Many of these cases and deaths must be due to the active resistance to Biden's policies of many state governments and their Trumpist supporters.

Over on the right, the weekly case count is now at 5.2 million, sharply higher than the previous 4.55 million. Forty-five thousand people worldwide have died, a slight drop from the previous week. Vaccinations have dropped also. It's not much more reassuring when you click on "28-day" and see the graphs for the last 4 weeks: cases and deaths were far worse a few days ago, but vaccinations have fallen sharply.

All of these numbers are likely severe undercounts, and all of them will be higher 28 days from now, when Omicron has made itself dominant around the world. Maybe I'm just tired after two years, but they suggest to me that most governments, from municipalities to nations, are just going through the motions.