H5N1

It’s not just bullets and bombs. I have never seen health organisations as worried as they are about disease in Gaza

In The Guardian, Devi Sridhar writes: It’s not just bullets and bombs. I have never seen health organisations as worried as they are about disease in Gaza. Excerpt, with my bolding:

Tragically, the nearly unprecedented death and injury we have seen so far is likely to only be the beginning. From looking at similar conflicts across the world, public health experts know that we are likely to see more children dying from preventable disease than from bullets and bombs. 

While the Israeli government has spoken about safe zones for families to flee to, these aren’t anywhere near what we would consider safe public health zones. They don’t have clean water, functional sanitation and toilets, enough food, or trained medical staff with medicine and equipment. These are the basic needs that any human, especially babies and children, need to stay healthy and alive.

The WHO spokesperson Dr Margaret Harris has said that diarrhoea rates among children in refugee-like camps (sheltered housing) in Gaza were, in early November, already more than 100 times normal levels, and with no treatments available, children can become dehydrated and die quickly. Diarrhoeal diseases are the second leading cause of death in children under five worldwide, and they are caused by contaminated water sources and lack of access to oral rehydration fluids. 

Upper respiratory infections, chickenpox, and painful skin conditions have also increased, and there are fears that the recent floods may result in untreated sewage mixing with fresh water used for drinking and cooking, and cause a cholera outbreak. 

Disease has played a role in battle for centuries. During the American civil war, two-thirds of the estimated deaths of soldiers were caused by pneumonia, typhoid, dysentery and malaria. In 1994, two diseases, cholera and dysentery, linked to unclean water and conflict zones, killed more than 12,000 Rwandan refugees in only three weeks in June 1994.  

An estimated 85% of Gaza’s inhabitant are already displaced according to the UN Relief and Works Agency. Experts analysing previous refugee displacements estimate in the Lancet that crude mortality rates (that is deaths per 1,000 people) were more than 60 times higher than when each conflict began, on average.  

Extrapolating this to the current situation in Gaza, where the crude death rate before the conflict was 3.82 in 2021 (relatively low because of its young demographic), mortality rates could reach 229.2 in 2024 if the conflict and displacement continue at the current level of intensity, and Gazans continue to lack access to sanitation, medical facilities and permanent housing.  

Ultimately, unless something changes, the world faces the prospect of almost a quarter of Gaza’s 2 million population - close to half- a million human beings - dying within a year. These would be largely deaths from preventable health causes and the collapse of the medical system. It’s a crude estimate, but one that is data-driven, using the terrifyingly real numbers of deaths in previous and comparable conflicts. 

International organisations are trying to raise the alarm about this situation, with Harris lamenting: “It seems the world has lost its moral compass.” Unicef has warned: “Lack of water, food, medicine and protection is a bigger threat than bombs to the lives of thousands in Gaza.”  

I have been working in global public health for 20 years, and I have never heard health and aid organisations as forthright and concerned as they are about the level of suffering and deaths in Gaza. It is an unprecedented conflict, breaking the most tragic records, and while experts might debate whether it’s a genocide or not, the truth is we’re witnessing the mass killing of a population, whether by bomb, bullet, starvation or disease.

Surveillance for violent deaths — National Violent Death Reporting System, 48 states, the District of Columbia, and Puerto Rico, 2020

Via MMWR, a long, grim report: Surveillance for Violent Deaths — National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020. Excerpt:

The COVID-19 Pandemic and Homicide

Research using NVDRS data to examine the circumstances of COVID-19 pandemic–related homicides are ongoing, but studies have already underscored the changes in homicide rates. The overall firearm homicide rate in 2020 was higher than it has been in the last 20 years. 

This increase was disproportionately experienced by AI/AN and Black persons. The increased social and economic stressors attributable to the COVID-19 pandemic and associated mitigation measures (e.g., job loss and disruptions in emergency services) might have exacerbated the systemic inequities that have been found to increase risk for experiencing violence. 

These stressors might also have increased risk for intimate partner violence and child abuse and neglect. Early pandemic reports indicated increased arrests and police calls related to intimate partner violence, and despite fewer visits, a higher proportion of emergency department visits were child abuse and neglect related. 

Additional research on the impact that the COVID-19 pandemic and mitigation measures might have had on increases in homicide rates and potential changes in the contextual factors and characteristics of these fatal incidents is needed.

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."

‘I hope you die’: How the COVID pandemic unleashed attacks on scientists

Via Nature News & Comment: ‘I hope you die’: how the COVID pandemic unleashed attacks on scientists. Excerpt:

Infectious-diseases physician Krutika Kuppalli had been in her new job for barely a week in September 2020, when someone phoned her at home and threatened to kill her.  

Kuppalli, who had just moved from California to the Medical University of South Carolina in Charleston, had been dealing with online abuse for months after she’d given high-profile media interviews on COVID-19, and had recently testified to a US congressional committee on how to hold safe elections during the pandemic. But the phone call was a scary escalation. “It made me very anxious, nervous and upset,” says Kuppalli, who now works at the World Health Organization (WHO) in Geneva, Switzerland.  

She called the police, but didn’t hear that they took any action. The threatening e-mails, calls and online comments continued. The police officer who visited Kuppalli after a second death-threat call suggested she should get herself a gun.  

Kuppalli’s experience during the pandemic is not uncommon. A survey by Nature of more than 300 scientists who have given media interviews about COVID-19 — many of whom had also commented about the pandemic on social media — has found wide experience of harassment or abuse; 15% said they had received death threats.

Some high-profile examples of harassment have been well documented. Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases, was assigned personal security guards after he and his family received death threats; UK chief medical adviser Chris Whitty was grabbed and shoved in the street; and German virologist Christian Drosten received a parcel with a vial of liquid labelled ‘positive’ and a note telling him to drink it. In one extraordinary case, Belgian virologist Marc Van Ranst and his family were placed in a safe house when a military sniper went on the run after leaving a note outlining his intentions to target virologists.  

These examples are extreme. But in Nature’s survey, more than two-thirds of researchers reported negative experiences as a result of their media appearances or their social media comments, and 22% had received threats of physical or sexual violence. Some scientists said that their employer had received complaints about them, or that their home address had been revealed online. Six scientists said they were physically attacked.  

Coordinated social-media campaigns and threatening e-mails or phone calls to scientists are not new: topics such as climate change, vaccination and the effects of gun violence have drawn similar attacks in the past. But even scientists who had a high profile before COVID-19 told Nature that the abuse was a new and unwelcome phenomenon tied to the pandemic. Many wanted the extent of the problem discussed more openly.  

“I believe national governments, funding agencies and scientific societies have not done enough to publicly defend scientists,” one researcher wrote in their survey response.  

Some researchers say that they have learnt to cope with the harassment, accepting it as an unpleasant but expected side effect of getting information to the public. And 85% of survey respondents said that their experiences of engaging with the media were always or mostly positive, even if they were harassed afterwards.  

“I think scientists need training for how to engage with the media and also about what to expect from trolls — it’s just a part of digital communication,” one wrote. Source: Nature analysis But Nature’s survey suggests that even though researchers try to shrug off abuse, it might already have had a chilling effect on scientific communication. Those scientists who reported higher frequencies of trolling or personal attacks were also most likely to say that their experiences had greatly affected their willingness to speak to the media in the future.  

That is concerning during a global pandemic which has been accompanied by a battery of disinformation and misinformation, says Fiona Fox, chief executive of the UK Science Media Centre (SMC) in London — an organization that collates scientific comment and organizes press briefings for journalists. “It’s a great loss if a scientist who was engaging with the media, sharing their expertise, is taken out of a public debate at a time when we’ve never needed them so badly,” she says.  

Tracking harassment  

In June, the Australian SMC in Adelaide asked researchers on its COVID-19 media lists about their experiences. The centre had been alerted to online bullying and hate campaigns directed at scientists, and wanted to know whether it was a broader problem, says Lyndal Byford, the centre’s director of news and partnerships.  

Byford shared the results with Nature. Fifty researchers answered the SMC’s informal survey. Nearly one-third reported experiencing emotional or psychological distress after talking about COVID-19; 6 people (12%) reported receiving death threats, and 6 said they had received threats of physical or sexual violence. “I think any organization involved in helping scientists communicate would find that quite disturbing,” Byford says.  

To get a broader sense of the scale of harassment, Nature adapted the Australian SMC’s survey, and asked science media centres in the United Kingdom, Canada, Taiwan, New Zealand and Germany to send it to scientists on their COVID-19 media lists. Nature also e-mailed researchers in the United States and Brazil who had been prominently quoted in the media.

The results are not a random sample of researchers who have given media interviews on COVID-19, because they represent only the experiences of the 321 scientists who chose to respond (predominantly in the United Kingdom, Germany and the United States). But the numbers reveal that researchers in many countries are facing abuse related to the pandemic, and the proportions reported were higher than in the Australian survey. More than one-quarter of respondents to the Nature survey said they always or usually received comments from trolls or were personally attacked after speaking in the media about COVID-19. And more than 40% reported experiencing emotional or psychological distress after making media or social media comments.

Politicized science
To some extent, this harassment of scientists reflects their rising status as public figures. “The more prominent you are, the more abuse you’re going to get,” says historian Heidi Tworek at the University of British Columbia in Vancouver, Canada, who is studying online abuse of health communicators in the pandemic. Most US public-health departments have also received harassment directed at staff and officials, adds Beth Resnick, a public-health researcher at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, who has surveyed 580 departments in a study that is not yet published.

And such attacks might have little to do with the science itself and more to do with who’s talking. “If you’re a woman, or a person of colour from a marginalized group, that abuse will probably include abuse of your personal characteristics,” says Tworek. For instance, Canada’s chief public-health officer Theresa Tam is Asian Canadian, and abuse levelled against her included a layer of racism, Tworek says. Kuppalli, a female scientist of colour, says she also experienced this. Abusers told her she “needs to go back where she came from”.

The police as public health crisis

Via The Lancet: Fatal police violence by race and state in the USA, 1980–2019: a network meta-regression. The summary and then a comment:

Background  

The burden of fatal police violence is an urgent public health crisis in the USA. Mounting evidence shows that deaths at the hands of the police disproportionately impact people of certain races and ethnicities, pointing to systemic racism in policing. Recent high-profile killings by police in the USA have prompted calls for more extensive and public data reporting on police violence. 

This study examines the presence and extent of under-reporting of police violence in US Government-run vital registration data, offers a method for correcting under-reporting in these datasets, and presents revised estimates of deaths due to police violence in the USA.  

Methods  

We compared data from the USA National Vital Statistics System (NVSS) to three non-governmental, open-source databases on police violence: Fatal Encounters, Mapping Police Violence, and The Counted. We extracted and standardised the age, sex, US state of death registration, year of death, and race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic of other races, and Hispanic of any race) of each decedent for all data sources and used a network meta-regression to quantify the rate of under-reporting within the NVSS. Using these rates to inform correction factors, we provide adjusted estimates of deaths due to police violence for all states, ages, sexes, and racial and ethnic groups from 1980 to 2019 across the USA.  

Findings  

Across all races and states in the USA, we estimate 30 800 deaths (95% uncertainty interval [UI] 30 300–31 300) from police violence between 1980 and 2018; this represents 17 100 more deaths (16 600–17 600) than reported by the NVSS. Over this time period, the age-standardised mortality rate due to police violence was highest in non-Hispanic Black people (0·69 [95% UI 0·67–0·71] per 100 000), followed by Hispanic people of any race (0·35 [0·34–0·36]), non-Hispanic White people (0·20 [0·19–0·20]), and non-Hispanic people of other races (0·15 [0·14– 0·16]). This variation is further affected by the decedent's sex and shows large discrepancies between states. Between 1980 and 2018, the NVSS did not report 55·5% (54·8–56·2) of all deaths attributable to police violence. When aggregating all races, the age-standardised mortality rate due to police violence was 0·25 (0·24–0·26) per 100 000 in the 1980s and 0·34 (0·34–0·35) per 100 000 in the 2010s, an increase of 38·4% (32·4–45·1) over the period of study.  

Interpretation  

We found that more than half of all deaths due to police violence that we estimated in the USA from 1980 to 2018 were unreported in the NVSS. Compounding this, we found substantial differences in the age-standardised mortality rate due to police violence over time and by racial and ethnic groups within the USA. Proven public health intervention strategies are needed to address these systematic biases. State-level estimates allow for appropriate targeting of these strategies to address police violence and improve its reporting.

Canada is not much different. We have used our police, including the well-marketed Royal Canadian Mounted Police, to suppress Indigenous and other minority peoples, with increasingly poor results. I suggested a solution back in 2007: Disband the RCMP. 

New findings on pandemic kids. And what they really tell us

The Tyee has published my article: New Findings on Pandemic Kids. And What They Really Tell Us. Excerpt:

A new report by Children First Canada takes a long and detailed look at the state of our kids in this second year of pandemic. Even if you don’t have children, but hope for a decent and dignified old age, you’d better take note the findings of Raising Canada 2021 — and take appropriate action in this and future elections. 

The report finds that COVID-19 has aggravated ten major threats to our children. Those threats have been still more aggravated by “cross-cutting themes”: access to education and child care, access to health care and social services, inequity and inequality, and climate change. 

The report points to a host of threats to children that are also threats to us all. And those threats are unlikely to be blunted short of the kind of social transformation we usually call a revolution. 

Let’s look at the threats first. Some are simply intensified forms of the pre-pandemic status quo. Kids are coming into emergency departments with opioid and other poisonings, and cannabis ingestions. Their parents’ attempts to cope with stress don’t work with the kids either. 

Pre-pandemic Canada was stressful enough, but the report finds that “the effects of school closures have accelerated this threat,” leading to more eating disorders, substance misuse and suicide attempts among adolescents.

Systemic racism and discrimination stress racialized families, and the pandemic has only stressed them more. So it should be no surprise that “status First Nations, Métis, Inuit and Black children are disproportionately overrepresented in the child welfare system.” 

So stressed parents with no support are taking it out on their kids: “In some jurisdictions, clinicians have seen twice as many infants for maltreatment-related concerns, specifically fractures and head trauma.” 

More work for the health-care system 

Meanwhile, even less-stressed parents have skipped routine childhood vaccinations, ensuring more work for our health-care system when kids start coming down with measles and other preventable diseases. While many Canadian and U.S. states try to vaccinate their kids from age 12 and up, the report says, for those under 12 “vaccines may not be available until 2022.” Cuba is already testing its homegrown vaccines on kids as young as three. 

The pandemic has worsened childhood poverty, notably in a third of female lone-parent families, and “households with children are more likely to face food insecurity compared to households without children.” In other words, kids aren’t getting enough to eat. We are “ranked 37th out of 41 countries when it comes to providing healthy food for children.” Failing to nourish our children today will have consequences for the rest of the century. 

Well, not for those who die in infancy. The report says, “Canada’s infant mortality rate has increased. It is now the second highest among 17 OECD countries, at approximately 4.4 infant deaths per 1,000 live births. This is a marked change from 1960, when Canada ranked fifth lowest.”

A Texas hospital is so overwhelmed with COVID-19 cases that a man shot six times has waited a week for surgery

Via Business Insider Australia, a Fox 26 Houston report: A Texas hospital is so overwhelmed with COVID-19 cases that a man shot six times has waited a week for surgery. Excerpt:

A Texas man who was shot six times one week ago is anxiously awaiting surgery at a Houston hospital, where doctors are struggling to respond to COVID-19 cases. Joel Valdez, a local business owner from Houston, Texas, told Fox 26 Houston that he’s been waiting for surgery since last Saturday, August 7. 

“Everybody is really surprised I’m still in this bed a week later,” he told Fox 26 from his hospital room at Ben Taub. Valdez had been leaving a grocery store last Saturday morning when a stranger shot him six times in the neck and shoulder. 

Three of those shots left one of his shoulders broken, the body part on which he’s waiting to get surgery. 

“Having broken bones and bullets in me for over a week now, it’s a little frustrating,” Valdez said. 

Ben Taub’s ICU is at 98% capacity, a spokesperson told Fox 26. About a third of those ICU patients are being treated for the coronavirus, the spokesperson said. 

When reached for comment, the Harris Health System, which operates Ben Taub Hospital, told Insider the doctors at Ben Taub prioritize cases each day because of spiking COVID-19 numbers driven by the Delta variant. 

“In response to the increase in COVID-19 cases overwhelming the hospitals of Harris Health System, our medical experts review all surgical cases throughout the day to determine the acuity level and patient’s overall condition,” said Amanda Callaway, spokesperson with the Harris Health System. 

“Due to strained resources, surgical patients are being prioritized based on several factors, which unfortunately may result in a delay of non-emergent surgical procedures. Harris Health and its medical partners are working diligently to provide the best possible care during these difficult times,” Callaway continued. 

Valdez’s case comes as the Delta variant surges in Texas. More than 10,000 Texans have been hospitalized as of August 10, according to data from the Texas Department of State Health Services. Compared to the past week, that figure reflects an increase of nearly 3,000 patients.

MSF in Haiti: Violence puts patients, staff, and medical activities at risk

A news release from MSF: Haiti: Violence puts patients, staff, and medical activities at risk.

Port-au-Prince, June 11, 2021—A spike in violence in Haiti's capital is putting medical activities in jeopardy, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, warning that medical care cannot be sustained while armed clashes and robberies affect patients, staff, health facilities, and vehicles. 

In the first week of June, clashes in the neighborhood of Martissant and other districts of Port-au-Prince caused many injuries and displaced more than 1,000 people, including MSF patients and staff. From June 2 to 4, MSF's emergency center in Martissant received 42 patients with gunshot wounds, many of whom were transferred to MSF's trauma hospital in the Tabarre neighborhood, which increased its capacity for trauma patients from 50 to 68 beds. 

"We are witnessing an extremely worrying deterioration in the security situation," said Alessandra Giudiceandrea, MSF head of mission. "Some armed clashes took place near MSF's emergency center and offices in Martissant, where staff had to take cover from stray bullets. Armed individuals robbed two MSF ambulance drivers among other vehicles traveling from Martissant. To protect our staff, we had to reduce our community activities, but we are still treating emergencies based on our initial admission criteria." 

Clashes also took place in the city's Cité Soleil and Bel Air neighborhoods from May 15 to 31, and MSF's Tabarre hospital reached the limits of its capacity after receiving 41 patients, including 32 with wounds from violence. In another incident, a staff member of the Tabarre hospital was shot and killed on May 25 while returning home from work. 

The increased level of chronic violence is taking place amid a broader political and economic crisis in Haiti that affects people in many ways. Health systems are strained not only by insecurity but by a current increase in COVID-19 cases, economic challenges, and a high level of medical needs. 

"At a time when we should be scaling up because of COVID-19 and other needs, we are struggling to keep our existing facilities open due to insecurity," Giudiceandrea said. "We ask everyone to respect the need for medical activities to continue." 

In Martissant, insecurity and displacement may be hindering patients' ability to reach health care services. While MSF's emergency center reported an influx of trauma patients following the largest incidents of violence last week, patient numbers have now dropped below the center's normal average. 

MSF also provides care to survivors of sexual and gender-based violence through clinics in Port-au-Prince and Gonaïves, but staff are now seeing fewer patients, as people may fear leaving their homes to seek medical attention. MSF is concerned that the general increase in violence in the country is affecting the ability of sexual violence survivors to seek much-needed care. 

MSF has provided life-saving medical care to communities in Haiti for 30 years, but to continue providing such services in any community, MSF must be able to ensure the safety of patients and staff en route to and inside health care facilities. MSF demands that all groups and individuals involved in incidents of violence in Haiti respect the safety of health care workers, patients, medical supplies and facilities and that health care vehicles are granted safe passage without risk of attack.

Amid political and civil unrest in Myanmar, health services are inaccessible

A letter in The Lancet: Amid political and civil unrest in Myanmar, health services are inaccessible.

Myanmar is a democratic country in political crisis, and a suspension of health services is placing millions of patients with chronic illnesses in increasingly difficult situations. On Feb 1, 2021, the military initiated a coup and committed aggressive repression. In response, Myanmar's citizens engaged in massive protests and a civil disobedience movement in an attempt to end the coup and restore democracy. 

Our colleagues and friends in Myanmar, who ask for anonymity to protect themselves and their families from military reprisals, have relayed to us how political turmoil turned violent and continues to escalate. Numerous service sectors, including transportation and health care, have been disrupted. Public spaces have become unsafe due to increased violence, streets have been closed as a result of confrontations, and health services have either been suspended or operate on reduced hours because of a decrease in workforce and military police raids. 

We are particularly concerned for those patients with chronic illnesses who have multiple unmet needs. For example, essential HIV services (including HIV testing), delivery of antiretroviral therapy, viral load testing, and adherence counselling have been reduced or suspended because of closed facilities and the disappearance of providers in many towns throughout Myanmar. Within the health-care system, many medical facilities have closed or relocated to avoid military or police targeting. Health-care workers' security is under threat from state violence, resulting in additional barriers to accessing care. Most public hospitals with inpatient services have stopped providing services, leaving patients no choice but to use expensive private institutions. 

Moreover, because public transportation is unavailable and personal safety is increasingly threatened by violence on the streets, patients are reluctant to travel to refill life-sustaining medications. Given the far-reaching impacts of political instability on the health-care infrastructure, people with various illnesses in Myanmar are likely to experience serious service interruptions. 

Considering these dire conditions, we urgently call for humanitarian interventions from the international health-care community to ensure patients in Myanmar with chronic illnesses have access to necessary medical care for basic health maintenance and survival. Financial aid, human resources, and technical support are needed to create one-stop, wrap-around services for these patients, from screening to treatment. A continuous flow of medical supplies must be secured. Safe transportation is crucial for access to health care. 

Finally, research is needed to investigate how patients with chronic illnesses in Myanmar use health services because their physical and psychological health is negatively influenced by traumatic geopolitics. This research would allow the development of evidence-based interventions and serve populations who need support during these unstable political conditions.

Unknown men kill 5 polio vaccinators in eastern Afghanistan

Via Radio Killid: Unknown Men Kill 5 Vaccinators in E. Afghanistan.

Unknown gunmen on Tuesday morning gunned down five vaccination campaign workers in the provincial capital of Nangahar province, a security source told TKG. 

The polio vaccination workers were killed in separate attacks in the fourth and seventh districts of Jalalabad city, the provincial capital, the source spoke to TKG on condition of anonymity.  

The source put the toll of the dead to four women and a man who were polio vaccination workers.  Provincial officials confirmed the attack without disclosing details of casualties. 

There was no immediate claim of responsibility.