H5N1

BC’s top doctor wrote a book about fighting viruses in 2009

The Tyee has published my article: BC’s Top Doctor Wrote a Book about Fighting Viruses in 2009. Excerpt:

Soap and Water & Common Sense: The Definitive Guide to Viruses, Bacteria, Parasites, and Disease By Dr. Bonnie Henry House of Anansi, 2009. 

Dr. Bonnie Henry’s news conferences have become a part of daily life in B.C. When they attend her briefings, Premier John Horgan, Health Minister Adrian Dix, and Public Safety Minister Mike Farnworth fade into the background, at a safe distance from her and one another. They speak chiefly to endorse what their chief medical officer says. The contrast with Trump’s press conferences is impossible to miss. 

It certainly helps that Dr. Henry can deliver alarming news in a calm tone of voice, without relying on technical jargon; we pay attention, we absorb the news, but we don’t freak out. Treated like adults, we respond like adults.  

Those same communication skills are evident throughout her 2009 book Soap and Water & Common Sense, written years before she became B.C.’s provincial health officer. The book is now available with a new introduction, written in March, and the content itself is still very timely: while our healthcare system is fighting COVID-19, other diseases are going to exploit their opportunity.

COVID-19: Friday afternoon in China

Via Global Times: Real-time update on coronavirus outbreak. Excerpt:

5:59 pm Mar 6 

The Vatican reports its first coronavirus case 

5:31 pm Mar 6 

Second imported COVID19 case found in Shenzhen, Guangdong Province. The 70-year-old woman has traveled to Spain in early January; and during her trip, she changed flights in Abu Dhabi, and then landed in Beijing and flew back to Shenzhen. 

5:28 pm Mar 6 

New discovery: Novel coronavirus affects blood circulation system and causes blood coagulation so severe that critical patients' fingers and toes turn purple. A PUMCH medical team in Wuhan adopted anticoagulation treatment to curb the development of the disease. 

5:18 pm Mar 6 

At 4:30 pm Friday, the last batch of 21 patients was discharged from a Fang Cang makeshift hospital in Wuhan's Guanggu area, becoming the second Fang Cang hospital that closed amid the COVID19 outbreak. 

5:08 pm Mar 6 

827,000 returnees to Beijing are now undergoing 14-day home quarantines, said Beijing authorities. The capital’s battle against the COVID19 spread has hit a crucial point as the city faces risks of imported infections and resultant further domestic spread. 

5:06 pm Mar 6 

Chinese Premier Li Keqiang on Friday afternoon inspected the Beijing International Airport, one of the world's busiest airports. Li examined entry epidemic control and prevention work and coordination based on big data analysis to ensure inflow and outflow safety. 

4:54 pm Mar 6 

More than 3,000 medical staff in Central China's Hubei Province have been infected with COVID19, among them 40% were infected in hospitals and 60% in their communities. They are all non-infectious practitioners in the province. 

More than 40,000 medical staff from other provinces and regions came to support Hubei and none of them got infected with COVID19: Ding Xiangyang, member of the central government's guiding group to Hubei 

3:51 pm Mar 6 

Chloroquine phosphate has become a clinical treatment drug for COVID19, so far no obvious untoward reaction is discovered, said Sun Yanrong, deputy director of the biological center of the Ministry of Science and Technology: reports 

3:42 pm Mar 6 

COVID19 virus mutation has not affected the vaccines and antibodies research and development process, and we are actively pushing forward relevant scientific projects: Zhou Qi, deputy secretary-general of the Chinese Academy of Sciences  

3:24 pm Mar 6 

Chinese central govt's top medical advisor Zhong Nanshan warned in a latest research paper on COVID19 spreading through sewer pollution based on over 1,000 samples collected, showing symptoms like diarrhea and vomiting and indicating new evidence of digestive transmission. 

3:20 pm Mar 6 

East China's Zhejiang will put preventing imported COVID19 cases as a top priority, authorities said on Fri. Zhejiang so far reported 1,215 cases of coronavirus infection as of Friday morning, within which 10 cases were of foreign origin. 

3:09 pm Mar 6 

A South Korean fundraising association returned the 12 billion won ($10.05 million) that the Shincheonji Church, where cluster infection occurred, donated on Thursday to fight the COVID-19 outbreak: media reports. 

2:48 pm Mar 6 

Shanghai reported three new cases of COVID-19 infection as of Friday noon, all from Tehran, Iran: Shanghai health authority  

The three people, two from NW China's Ningxia and one from Gansu, studied in Iran and arrived at Shanghai Pudong International Airport on Monday and Tuesday, respectively. Upon arrival, they were sent to designated places for quarantine and diagnosed on Friday. 

12:52 pm Mar 6  

Central China's Hubei Province where the first COVID-19 outbreak occurred has fully banned the consumption of wild animals, effective Thursday. 

12:50 pm Mar 6  

Wuhan has reported 126 new confirmed cases of COVID-19 in the last 24 hours. For the first time, all other cities in Hubei reported zero confirmed cases over 24 hours.

Progress against COVID-19 in China as new cases wane in epidemic hot zone

Via the South China Morning Post, a little good news: Progress against coronavirus in China as new cases wane in epidemic hot zone.

Signs of progress against the coronavirus epidemic emerged in China on Friday with epicentre Hubei province reporting no new cases of infection outside the provincial capital and scientists pointing to advances in the development of vaccines and drugs. 

In Beijing, Zheng Zhongwei, director of the National Health Commission’s Science and Technology Development Centre, said China was moving full steam ahead to develop vaccines for the coronavirus, which has sickened more than 90,000 people and killed over 3,000 worldwide. 

“Our different approaches [to vaccines] are steadily advancing and [we are] following national laws and regulations [in our development],” Zheng said. “According to our estimates, we are hopeful that in April some of the vaccines [that are being developed] will enter clinical research or they would be of use in emergency situations.” 

Under national regulations, vaccines developed for major public health emergencies can be deployed for urgent use under specified conditions, if the National Medical Products Administration considers that the benefits of the treatment outweigh the risks.

A sense of optimism was evident among Chinese officials as they outlined plans to ease draconian lockdowns imposed to stop the spread of the disease, which has been reported in more than 80 countries around the world since it erupted in Wuhan, the provincial capital, in December. 

In Wuhan, Ding Xiangyang, deputy secretary general of the State Council, said he was confident that the control measures would end soon but he stopped short of giving a specific date. 

“When I left home this morning, I saw that the cherry trees outside were blooming,” said Ding, a member of a special task force sent by Beijing to Hubei to oversee the containment of the disease. “This tells us that winter is over and spring is here. 

“I am confident the day that everyone is waiting for will not be too far away.”

DR Congo: 19 months of Ebola

On August 1, 2018, the Democratic Republic of the Congo declared the tenth Ebola outbreak, even as the ninth was winding down. Nineteen months later, CMRE has published Situation épidémiologique du 01 Mars 2020. The outbreak seems finally to be approaching its end. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI ON FEBRUARY 29, 2020 

Sunday, March 01, 2020   

• Since the start of the epidemic, the cumulative number of cases has been 3,444, of which 3,310 have been confirmed and 134 are probable. In total, there were 2,264 deaths (2,130 confirmed and 134 probable) and 1,168 winners (healed persons, or survivors); 

• 404 suspected cases under investigation; 

• No new confirmed cases for the 12th consecutive day ; 

• No new deaths among the confirmed cases, of which: 

o No community death was recorded; 

o No deaths among the confirmed cases; 

• No healed person has left the CTE;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 167 (approximately 5% of all confirmed / probable cases), including 41 deaths; 

The data presented in this table are likely to change later, after in-depth investigations and after redistribution of cases and deaths in their respective health zones. 

NEWS  

NOTHING TO REPORT 

VACCINATION  

• 19,654 people were vaccinated, on February 28, 2020, with the 2nd vaccine Ad26.ZEBOV / MVA-BN-Filo (Johnson & Johnson) in the two health areas from Karisimbi to Goma; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 298,914  people have been vaccinated; 

• Approved on October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and on October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

• This new vaccine complements the first, rVSV-ZEBOV, a vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval by the Ethics Committee on May 20, 2018. It was recently pre-qualified for certification. 

SURVEILLANCE AT ENTRY POINTS  

• Since the start of the epidemic, the total number of travelers checked (temperature measurement ) at health checkpoints is 157,200,341 ;  

• To date, a total of 109 entry points (PoE) and health control points (PoC) have been established in the provinces of North Kivu and Ituri in order to protect the country's major cities and avoid the spread of the epidemic in neighboring countries.

DRC Ebola: February 27 update

CMRE has published Situation épidémiologique du 27 Février 2020. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI ON FEBRUARY 26, 2020 

Thursday, February 27, 2020   

• Since the start of the epidemic, the cumulative number of cases has been 3,444, of which 3,310 have been confirmed and 134 are probable. In total, there were 2,264 deaths (2,130 confirmed and 134 probable) and 1,168 winners (healed persons, or survivors); 

• 446 suspected cases under investigation; • No new confirmed cases; 

• No new deaths among the confirmed cases, of which: 

o No community death has been recorded; 

o No deaths among the confirmed cases; 

• 1 healed person leaving the CTE in North Kivu in Beni;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 167 (approximately 5% of all confirmed / probable cases), including 41 deaths.

 

The data presented in this table are likely to change later, after in-depth investigations and after redistribution of cases and deaths in their respective health zones. 

NEWS  

End of mission of 156 health personnel engaged in the fight against Ebola 

• The Technical Secretariat of the Multi-Sectoral Committee on the Ebola Virus Disease Response (ST / CMRE), the Ministry of Health and the overall coordination of the response to the Ebola Virus Disease with the World Health Organization (WHO) proceeded this Thursday, February 27, 2020 in Goma, capital of the province of North Kivu to the ceremony of thanks and end of mission of 156 health providers; 

• A total of 156 health personnel, 102 of whom are national and 44 international, are on assignment; 

• These heroes and valiant doctors from different health fields who worked for the response to the Ebola virus disease epidemic each received a certificate of thanks for the work done during their performances during this epidemic which has been going on for more than a year in the eastern part of the DRC; 

• These teams, in turn, thanked the local communities for their commitment in the fight against this epidemic which concerns not only the Congolese nation, but which has become a health emergency problem of international scope; 

• The general coordinator of the response to the Ebola virus disease epidemic, Prof. Steve Ahuka Mundeke, also congratulated the population for their collaboration during this tenth Ebola epidemic in the DRC, before stressing that with the determination of the community in the East, this epidemic will soon be combined with the past; 

• " For the first time, the country has done more than a week without new cases thanks to the determination of these health providers supported by the community," said Prof. Ahuka;  

• Healthcare providers at the front for several months reported their experience and said they left with a feeling of satisfaction. They say they are happy to have participated in the struggle which aimed to save human lives; 

• On behalf of the WHO, Abdoulaye Salam, incident manager for the WHO response to Ebola, said that this day is symbolic because it is about celebrating the courage of these providers; 

• This ceremony was closed with the sharing of a drink between the providers in the spotlight and various stakeholders in the response to Ebola. 

VACCINATION  

• 17,613 people were vaccinated, on February 26, 2020, with the 2nd vaccine Ad26.ZEBOV / MVA-BN-Filo (Johnson & Johnson) in the two health areas from Karisimbi to Goma; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine   298,209  people have been vaccinated; 

• Approved on October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and on October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

• This new vaccine complements the first, rVSV-ZEBOV, a vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval by the Ethics Committee on May 20, 2018. It was recently pre-qualified for certification. 

SURVEILLANCE AT ENTRY POINTS  

• Night health control activities resumed at the MAKEKE control point after several days of inactivity; 

• Since the start of the epidemic, the total number of travelers checked (temperature measurement ) at health checkpoints is 155,976,329 ;  

• To date, a total of 109 entry points (PoE) and health control points (PoC) have been established in the provinces of North Kivu and Ituri in order to protect the country's major cities and avoid the spread of the epidemic in neighboring countries.

COVID-19: Tuesday morning in China

Via the Global Times: Real-time update on coronavirus outbreak. Excerpt:

10:50 am Feb 25  

Starting from Monday, Qingdao has arranged designated vehicles to shuttle all foreign visitors arriving in the city, to their homes, except those requiring quarantine or observation. Designated hotels will be arranged for visitors on short-term trips or business travels  

10:37 am Feb 25  

Hunchun, a city bordering China and North Korea in northeast China’s Jilin, imposes 14-day mandatory quarantine for all foreign returnees to the city amid COVID-19 outbreak. Designated quarantine zones will be arranged for those without a permanent residence. 

10:35 am Feb 25  

About 60% of Chinese firms face operational difficulties due to the novel coronavirus. 6% of them face bankruptcy and 20% see a temporary suspension. Just 5% see no obvious impact from COVID-19: survey 

10:10 am Feb 25  

Chinese stocks sink following global market nosedive! The benchmark Shanghai market was down 1.62%  and Shenzhen had fallen 1.99 % at opening, after global markets saw some of the sharpest overnight falls in years, reportedly due to the spreading of coronavirus 

10:01 am Feb 25  

"He was overwrought for preparing for the election," Consul general of Slovakia in Shanghai refutes reports that claimed Slovak Prime Minister Peter Pellegrini is infected with the COVID-19: reports. 

9:58 am Feb 25  

The local COVID-19 prevention and control authority of Jiang'an District in Wuhan said  the rumor that “120 elderly were infected in a nursing home” is untrue. It said in fact 8 people had tested positive and have been sent to hospital for treatment. 

9:50 am Feb 25  

Tianjin University has successfully developed an oral vaccine to protect against COVID-19. Huang Jinhai, the professor who led the project, has taken four doses without any side effects. The team is now looking for partners to promote clinical trials 

9:43 am Feb 25  

The National Development and Reform Commission will ensure supplies of daily necessities in Hubei, guarantee daily supplies for 30 days are stored in the province. Another 10,000 tons of pork from China’s National reserves will be sent to Hubei.

My parents were against vaccines. Getting immunized as an adult shouldn’t have been so hard

I am happy to interrupt the relentless COVID-19 coverage to link to this excellent long article in The Globe and Mail: Opinion: My parents were against vaccines. Getting immunized as an adult shouldn’t have been so hard. Take some time away from the outbreak to read it. Excerpt:

On a grey morning in January, 2019, I walked into my doctor’s office for what I hoped would be a quick, straightforward visit. I sat in the examination room, clenching and unclenching my fists as I waited. My palms were sweating, my heart was racing. I was nervous and my body knew it.  

After what felt like hours, the nurse practitioner finally came in. “Well, hello,” she said, a warm smile spreading across her face. “What can I do for you today?” 

I shrugged my shoulders, took a deep breath and tried to gather my courage. “I’m 27 and I haven’t been vaccinated since I was three,” I blurted out. “Can you help?”  

I watched her smile slowly slip away. “Oh my God,” she said. “Hold on, let me go talk to my supervisor.”

Interim estimates of 2019/20 vaccine effectiveness during early-season co-circulation of influenza A and B viruses, Canada, February 2020

Via Eurosurveillance: Interim estimates of 2019/20 vaccine effectiveness during early-season co-circulation of influenza A and B viruses, Canada, February 2020. The abstract:

Interim results from Canada's Sentinel Practitioner Surveillance Network show that during a season characterised by early co-circulation of influenza A and B viruses, the 2019/20 influenza vaccine has provided substantial protection against medically-attended influenza illness. 

Adjusted VE overall was 58% (95% confidence interval (CI): 47 to 66): 44% (95% CI: 26 to 58) for A(H1N1)pdm09, 62% (95% CI: 37 to 77) for A(H3N2) and 69% (95% CI: 57 to 77) for influenza B viruses, predominantly B/Victoria lineage.

The new COVID-19 coronavirus and preparing for the next viral pandemic

An excellent perspective from Michael Specter in The New Yorker: The New Coronavirus and Preparing for the Next Viral Pandemic. Excerpt:

These viruses all pose special threats because they are new, which means that humans have no antibodies to defend against them. The 2009 H1N1 epidemic infected at least 1.4 billion people, most of them before vaccines or treatments for the virus were available. And that was in a year when, by most accounts, the W.H.O. moved as expeditiously as it ever has. That strain of influenza killed as many as two hundred thousand people in the world—but it could have been many times worse. 

In 1957, for example, the Asian flu pandemic killed more than a million people. In 1968, the Hong Kong flu pandemic killed between one and four million. Maybe we will also be lucky this year. (It ought to be remembered that, even now, the seasonal flu poses a much greater threat to the health of the average American.) Unless covid-19 proves to be uniquely virulent, it will likely subside within a few months, and the danger it poses will be substantially forgotten, like that of sars, mers, avian influenza, and other zoonotic diseases. But it is too soon to know for certain. 

Scientists are moving with great speed to stop this pandemic. They sequenced the virus in less than two weeks—an essential step in creating diagnostics, drugs, and vaccines, and one that only a few years ago would have taken months. But, even with expedited trials and drug development, it could take a year to create a vaccine. If this virus were to swerve out of control before then, the death rate could soar. 

In addition to the human toll, the economic damage to China—and, eventually, to the rest of the world—would be enormous. Industrial supply chains throughout the world have already been badly disrupted. Travel to and from China has all but stopped, and xenophobic attacks against Asians are rising. Although New York City has not reported a single confirmed case of covid-19, business in Chinatown has reportedly fallen by more than fifty per cent since the epidemic began.  

Not all of this has to happen; we can do a much better job of preparing for these epidemics, just as we no longer wait to have heart attacks before we use our knowledge to limit their risk. Prevention works, and it can work with viral epidemics. For now we can be much more vigilant about improving sanitary conditions and regulating livestock in the kinds of markets where outbreaks are likely to occur. Sufficient and reliable tests for people who may have been exposed must be made readily available. There are scores of similar viruses found in host reservoirs—most notably, bats. Many of those viruses have genetic similarity to this coronavirus, and also to sars and mers. 

The time has come to use the modern tools of molecular and synthetic biology to make drugs and vaccines to protect us from them. We can make DNA vaccines in laboratories and store them as spare parts, just as we do with parts for a phone or a laptop. Why not work on making vaccines that would protect broadly against this entire class of virus, rather than waiting for each one to attack us, and then try to fight back? Today, with the annual flu, we grow most of our vaccines in eggs, just as we have for decades. It’s time to move on. 

At some point, not many years from now, we will have the capacity to instantly sequence viruses and to make and operate diagnostic tests anywhere, not just in a lab. Biology is becoming digital information, and it needn’t be stored only in Cambridge, or Palo Alto, or Paris. It is already possible to transmit and print a DNA sequence using the molecular equivalent of 3-D printers—a process that could enable scientists almost anywhere to construct vaccines. Making this technique readily available should be a national and, in fact, an international priority. 

There are other possible solutions, such as editing the genes of pigs (and bats) to repulse the viruses that can transfer to humans. This kind of ecological intervention would be scientifically difficult, and ethically questionable. But it will inevitably be discussed, so let’s do it rationally. 

Even if this pandemic passes quickly, there will be another one, possibly far more catastrophic, next year, or in ten years’ time, or twenty. All we can know for sure is that if we have any hope of containing it, the time to prepare is now.

World experts and funders set priorities for COVID-19 research

A WHO news release: World experts and funders set priorities for COVID-19 research.

Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks. 

The 2-day forum was convened in line with the WHO R&D Blueprint – a strategy for developing drugs and vaccines before epidemics, and accelerating research and development while they are occurring. 

“This outbreak is a test of solidarity -- political, financial and scientific. We need to come together to fight a common enemy that does not respect borders, ensure that we have the resources necessary to bring this outbreak to an end and bring our best science to the forefront to find shared answers to shared problems. Research is an integral part of the outbreak response,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I appreciate the positive response of the research community to join us at short notice and come up with concrete plans and commitment to work together.” 

The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including: 

• the natural history of the virus, its transmission and diagnosis; 

• animal and environmental research on the origin of the virus, including management measures at the human-animal interface; 

• epidemiological studies; 

• clinical characterization and management of disease caused by the virus; 

• infection prevention and control, including best ways to protect health care workers; 

• research and development for candidate therapeutics and vaccines; 

• ethical considerations for research; 

• and integration of social sciences into the outbreak response. 

“This meeting allowed us to identify the urgent priorities for research. As a group of funders we will continue to mobilize, coordinate and align our funding to enable the research needed to tackle this crisis and stop the outbreak, in partnership with WHO,” said Professor Yazdan Yazdanpanah, chair of GloPID-R. “Equitable access – making sure we share data and reach those most in need,  in particular those in lower and middle-income countries, is fundamental to this work which must be guided by ethical considerations at all times.”    

During the meeting, the more than 300 scientists and researchers participating both in person and virtually agreed on a set of global research priorities. They also outlined mechanisms for continuing scientific interactions and collaborations beyond the meeting which will be coordinated and facilitated by WHO. They worked with research funders to determine how necessary resources can be mobilized so that critical research can start immediately.  

The deliberations will form the basis of a research and innovation roadmap charting all the research needed and this will be used by researchers and funders to accelerate the research response.