H5N1

Syria reports first case of COVID-19

The NGO UOSSM has emailed me a news release: 

Toronto, Canada- This weekend the Syrian Government reported their first case of COVID-19 in Damascus (not including Northern Syria). UOSSM projects a significantly higher number of cases that have gone unreported. Over 80% of the medical infrastructure in Syria is operating at a limited capacity and COVID-19 testing kits are extremely inaccessible.

UOSSM predicts a parabolic jump of cases in North Western Syria in the next two weeks. The medical system definitively does not have the capacity to cope with the influx. The UN reports that there are 4,178,480 people in North Western Syria, living in densely populated conditions with little access to healthcare. In Idlib (pop. 3.5+ million) there are 201 ICU beds and only 95 ventilators. 100% of the ventilators are currently in use and not available to treat COVID-19. In North Western Syria there is currently only one PCR Lab. In the past 12 months alone, 85 medical facilities have been attacked and most are currently not functional. The medical infrastructure cannot handle the existing population needs let alone a wide spread pandemic. Medical staff suffer from a shortage of masks, gloves, gowns, disinfectant, thermal scanners and other medical supplies.

Years of war and malnutrition have left many people’s immune systems compromised and the entire population susceptible to drastically higher mortality rates. It is predicted that the transmission rates will be dramatically higher than global averages due to densely populated IDP camps and multiple families living in the same dwelling.

“The corona virus will spread through refugee camps like wildfire. The large geriatric population and those with chronic conditions (asthma, cancer, diabetes, hepatitis, etc.) are expected to have a very low probability of survival. The international community must make a fair allocation of personal protective equipment and testing kits for Northern Syria.” –Said Dr. Hussam Al Fakir, Chairman of UOSSM International

UOSSM’s response:

· UOSSM’s mobile clinics have made it a top priority to visit communities and educate the population on social distancing, hygiene practices and steps if people are symptomatic.

· UOSSM has nurse/staff in front of medical facilities to screen patients and direct them to the right area.

· UOSSM has asked all health workers to attend the WHO online course “Introduction to Emerging Respiratory Viruses, Including Novel Coronavirus”.

· UOSSM’s technical team has trained all health workers in UOSSM PHC centres on the detection of suspected cases, handling of cases, referral of cases, and reporting.

· UOSSM is working in close collaboration with the Idlib Health Directorate to implement a ‘COVID-19 Response Plan’. A few days ago, the Idlib Health Directorate announced the opening of an epidemic surveillance laboratory to carry out PCR tests to identify Covid-19 (testing kits currently unavailable).

The coronavirus is much worse than you think (because it doesn't seem that bad)

Via Psychology Today, a wise and perceptive analysis by Samuel Veissière: The Coronavirus Is Much Worse Than You Think. His conclusion (but read the whole article):

The abandonment of varied sources of proteins and fibre, as well as the flexible modes of livelihoods and environmental knowledge that sustained hunter-gatherer lifestyles gave rise, in record evolutionary time, to deep physiological changes and damages to the human body. By many accounts, the human species has yet to recover from the shock of the agricultural transition, which, for a while, led to lower statures, tooth decay, and lower bone density from malnutrition; a spike in auto-immune diseases; and increased mortality from new pathogens. 

On another cynical account — judging this time by the bending of human psychology, norms, social roles, moral codes, and patterns of migration and conflict — the new pathogens clearly won the numbers game.    

By this account, COVID-19 is turning out to be a remarkably intelligent evolutionary adversary. By exploiting vulnerabilities in human psychology selectively bred by its pathogen ancestors, it has already shut down many of our schools, crashed our stock market, increased social conflict and xenophobia, reshuffled our migration patterns, and is working to contain us in homogenous spaces where it can keep spreading. We should pause to remark that COVID-19 is extraordinarily successful epidemiologically, precisely because it is not extremely lethal. 

With its mortality rate of 90%, for example, Ebola is a rather stupid virus: It kills its host — and itself — too quickly to spread far enough to reshape other species’ life-ways to cater to its needs.

The bad news for you is that, if you live in a densely populated area, you are very likely to contract the coronavirus — if not this year, next year, or the year after as it undergoes its seasonal global migration pattern with its zoonotic cousins.    

The good news is that you will almost certainly not die from it, and it may not even register that you are slightly more sluggish than usual for a week or two. 

Much more relevant to the terrible threat caused by our Pathogen Overlords, you can prepare to fight the yearly corona invasions to come by resisting your own neuroticism, your own prejudice, and your own irrationality. 

As far as numbers games are concerned, our Pathogen Overlords are much more noble, and much more worthy of our hatred than our fellow human pseudo-enemies in political, religious, and culture wars.

Coronavirus in a war zone: Afghanistan braces for outbreak after first case

Via The Guardian: Coronavirus in a war zone: Afghanistan braces for outbreak after first case. Excerpt:

Preparations for an outbreak of coronavirus were underway in Afghanistan as the country confirmed its first case in the western province of Herat, which borders Iran. 

Seven more suspected cases have been identified in Herat, and three cases in the nearby provinces of Farah and Ghor.  

The affected Herat residents had recently returned from Qom in Iran, where the coronavirus outbreak has already killed at least 16 people and infected dozens of others, according to Iranian officials. 

Afghanistan’s national security council announced on Monday that all air travel to and from Iran had been suspended and borders had been closed. 

However, an estimated 3,000 people cross between Iran and Afghanistan illegally every day.

Oral swabs have been sent from Herat to Kabul’s central public health laboratory for testing. The laboratory in Kabul is the only one in the country of 35 million people able to test for the virus. It has just three machines. 

Alimi Sahib, a project manager at the lab, said more testing equipment was needed. “We need to decentralise to regional level, especially since test results take between four to six hours.

“If there are more cases in the provinces in the future, we cannot continue to send all of them to Kabul,” he said. 

The World Health Organization (WHO) in Afghanistan said work to prepare for an outbreak had been underway since January, but the country needed at least $3.5m (£2.7m) to implement the measures needed.  

“More than 700 surveillance-reporting health facilities have already been allocated in the provinces, but more funding is needed to equip isolated areas, as well as more staff, protective equipment and mechanical ventilation machines,” said Dr Elnoor Muntasir El Hassan from WHO.

At least 78 children died of dengue related illness in Yemen

Via ReliefWeb, a report from Save the Children: At least 78 children died of dengue related illness in Yemen. Excerpt:

Save the Children warns of an epidemic, as 52,000 suspected cases are recorded in the country.  

Seventy-eight children under 16 have already died in the outbreak of Dengue related illness in Yemen[i], with more than 52,000 suspected cases being recorded across the country. Save the Children warned this could signal the start of an epidemic. 

Heavy rainfall, coupled with the ongoing conflict, is disrupting clean water supplies. Because of the disruptions, people use water basins to collect rainwater and these uncovered water sources combined with the rain have contributed to the spread of mosquitoes in the affected areas, resulting in an upsurge in suspected dengue cases. 

If measures are not urgently put in place to strengthen the health care system so that cases can be detected early, the death total which reached 192 people by the end of 2019, could increase sharply. Cases have been recorded in almost all governorates in Yemen with the most affected being Hodeidah and Aden which recorded more than 60% of the deaths in the country.  

Save the Children Hodeidah Field Manager Mariam Aldogani, herself recovering from dengue fever, said: 

“Hodeidah has the second highest death rate in the country with 62 adult and children deaths in 2019. We have never seen anything like this before. More than 40 of our staff including their families have been affected by the fever. We are getting reports of deaths on a daily basis in remote areas of the governorate. Some of our health facilities are working 24 hours a day and last week one of our facilities recorded 30 cases in one day, most of which were children. 

“The economic situation in the country has not made it any better for people. Parents cannot afford to bring their children to the hospital or to buy the medication. Hospitals are full, and some patients are kept in hospitals having to lay on the floor because of a bed shortage. It’s really bad. Children as young as eight months have not been spared by the dengue fever. In some of the hospitals all you can hear are children crying in pain. We are currently supporting 48 health facilities in Hodeidah which recorded more than 6000 dengue fever suspected cases in 2019.”  

Save the Children's health centres have been receiving many cases of children suffering from dengue, and its teams on the ground are diagnosing and treating patients whilst referring the most severe cases.

How Spanish flu sailed between continents

Via Hakai Magazine, an excellent historical report: From Berth to Death. Excerpt:

US Navy soldiers lowered seven army coffins into the cold swell one by one. They said the names of the victims and a few words of solace. But they had other things to fret about as the Leviathan, queen of army transport ships, sped at 21 and a half knots on its way home to New Jersey—slowing down in U-boat territory was not an option.  

The Leviathan was shuttling soldiers from the United States to Europe and had departed for its return voyage from France the previous day. It had left behind dozens more dead soldiers, none casualties of the war. They had died on the voyage over from North America, their war was with a deadlier foe: the greatest pandemic in modern history. 

Ten days earlier, on September 29, 1918, the Leviathan had slipped its moorings in Hoboken, New Jersey, carrying over 9,000 army personnel bound for the killing fields of France. The most noteworthy passenger, however, was an influenza virus.  

Many of the troops boarded with pounding headaches and sore throats. Some dropped listless on the dock before they reached the vessel. Ship doctors sent a few patients back to shore, but the war was more urgent than a coughing fit or a fever, and the crew set off as planned. 

Within 24 hours of leaving port, the virus had infected 700 troops and the sickbay was overflowing. Within a week, that number climbed to 2,000 as blood, vomit, and sputum coated the decks.

Yemen: MSF hospital partially destroyed in Mocha attack

Via MSF.org: Yemen: MSF hospital partially destroyed in Mocha attack.

Thursday, November 7, 2019 — Sana’a / Paris / London – A hospital run by Médecins Sans Frontières in Mocha, in southwestern Yemen, was partially destroyed on Wednesday evening when an attack hit the surrounding buildings including a military warehouse. 

At the time of the attack, around 30 patients and 35 staff were present in the hospital. Fortunately, no casualties were reported among them. Everyone was rapidly evacuated. The majority of stable patients were able to leave the area on their own, while some critical patients, including two new-born babies, were transferred by MSF teams to another hospital in Mocha.

The MSF hospital was severely damaged by the explosions and the fire which followed the attack which hit a nearby military warehouse. The pharmacy was burnt and the office buildings were destroyed, while damage has still to be assessed on some technical buildings including the one housing the power generator. The windows of the hospital wards were shattered by the force of the blasts. 

Medical activities in the hospital are currently suspended and a part of the medical team will be relocated to Aden. Given the risk of unexploded devices on the site, demining will be needed before any activity can restart.  

The location of the hospital had previously been communicated to all warring parties and authorities and was well known by all warring parties in the area since the hospital opened in 2018.  

MSF once again reminds that all parties to the conflict must proactively take all necessary measures to spare medical facilities.  

“It was only luck that no patients or staff were harmed in this attack; it could have been carnage,” said Caroline Seguin, manager of MSF programmes in Yemen. “As the hospital is currently out of commission, the people in the area are now without much-needed, often lifesaving, care.”  

MSF opened Mocha hospital in August 2018 to provide emergency surgical care for patients suffering from conflict-related injuries, as well as providing treatment of other surgical emergencies, such as caesarean sections for complicated deliveries.  

The 35-bed hospital is the only free-of-charge, civilian hospital providing these services in the Mocha area. 

Since the beginning of the year, a total of 1,787 patients were admitted to hospital, and 2,476 surgical procedures were performed, including 201 caesarean sections.

MSF: Mental health issues emerge amongst people fleeing northeast Syria

MSF has published Mental health issues emerge amongst people fleeing northeast Syria. Excerpt:

Mental health issues are beginning to emerge amongst people arriving in Iraq from northeast Syria. MSF teams recently opened a healthcare centre in Bardarash camp. 

According to Bruno Pradal, the MSF mental health manager: “Roughly 50 per cent of the people we saw during our mental health assessment in the camp were presenting symptoms linked to depression and anxiety, as well as Medically Unexplained Physical Symptoms – or physical symptoms without a medical cause, such as stiffness in the muscles, headache, back pain.”  

Bardarash camp currently hosts 11,000 people from Syria and is already at full capacity as people continue to arrive.

An MSF team is moving tent-by-tent in this camp to meet and talk to people, identify the people most in need of mental health support, and refer them to the new healthcare centre. In certain cases, the teams provided psychological first aid to people in particularly vulnerable conditions.    

“A shell landed near my neighbour, and he was wounded,” said Salih, a construction worker from Qamishli, Syria. “He asked me to take his disabled son with me and look after him. He is with me now amongst my children.”

“There is no safety in Syria anymore,” said Salih. “I don’t sleep and eat properly. I’m scared, I don’t want to go back, I want to be able to sleep without the sound of gunshots and explosions and the fear of a rocket hitting my house.” 

MSF teams providing tips for resilience building 

The mental health workers met people with suicidal thoughts as well as people with the early symptoms of post-traumatic stress disorder. MSF teams are also promoting and strengthening resilience by providing people with tips on how to care for themselves and others, and cope with stress.  

“People were worried about the future and were feeling hopeless, thinking about the things they were forced to leave behind like their homes, jobs, family members, and loved ones,” Pradal said. “Even though it is common to see these symptoms as a result of what these people have been through, that does not mean they are not in need of immediate mental health support.”  

People continue to flee northeast Syria 

Most people say they are coming from Ras Al-Ayn or Qamishli – 220 and 110 kilometres, respectively, from the Iraq/Syria border. A few have started to mention they’ve come from Al-Hasaka. Some of the people our teams talked to fled to at least one other location inside northeast Syria before making the decision to cross the border into Iraq.

Many said other people were left behind, either because they had a sick member of the family or because they couldn't find the right time to leave, among other constraints. 

“Two of my daughters are still in Syria. They told me to go and they would follow soon after with their families,” said Salih. “It’s been 10 days and I haven’t had contact with them, and I don’t know whether they’ve come out or not, or what happened to them.”

The US has stopped Ebola before. But it may never repeat that success

A disturbing must-read from The Washington Post: The U.S. has stopped Ebola before. But it may never repeat that success. The conclusion (but you'd better read it all):

The future of disease eradication won’t be in friendly territory. “If you look at Yemen, you look at Somalia, you look at Syria, you look at what’s going on in Myanmar, they are countries under siege or failed states,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “This is what we need to expect.” 

Or as Michael Ryan, executive director of the World Health Organization’s Health Emergencies Program, said about Congo, “We’re trying to deal with the most dangerous virus in the world in the most dangerous place in the world.”  

Public health is about using civic institutions to wage campaigns against those diseases. But in many of the sickest nations, those civic institutions are collapsing, and the international and nongovernmental organizations dedicated to propping up health systems are stretched to a breaking point. 

“Whenever you have disruption of the social order, that’s when you have outbreaks,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “The malaria in Venezuela is [happening because] the health-care system is essentially in disarray right now, the economic situation is in disarray.”  

The Ebola outbreak in Congo is an example of what happens when a populace does not trust institutions. When the virus began circulating last August, the health responders who descended on the city of Beni, and later Butembo and Katwa, found a population that deeply distrusted outsiders. Their government in far-off Kinshasa had never shown an interest in bettering their lives, so why would it now? Up to half the new Ebola cases in Congo are occurring in people who do not appear on lists of those who have come into contact with a patient, an indication that many victims are avoiding health-care workers trying to track the virus’s spread.  

In Congo, Afghanistan and beyond, public health officials worry that the breakdown of institutional authority and the accompanying isolationist turn against national or international institutions will have profound effects that aren’t yet clear. 

“A lot of the basic premises of an open, globalist, diplomatically oriented world are just no longer the operating principles, and we don’t know what the new operating principles are,” says Prabhjot Singh, former director of the Arnhold Institute for Global Health at the Icahn School of Medicine.

But one thing is clear: The spread of preventable diseases — Ebola, polio, malaria, measles — is not something the United States will always be able or welcome to fight.

Latest refugee influx to Iraq passes 10,000 mark as humanitarian needs mount in Syria

What an upheaval a single phone conversation can start! Via ReliefWeb, UNHCR has published Latest refugee influx to Iraq passes 10,000 mark as humanitarian needs mount in Syria. Excerpt:

This is a summary of what was said by UNHCR spokesperson Andrej Mahecic – to whom quoted text may be attributed – at today's press briefing at the Palais des Nations in Geneva. 

Teams from UNHCR, the UN Refugee Agency, in northern Iraq report that last night more than 900 Syrian refugees arrived at the Bardarash camp on 45 buses, bringing the camp population to nearly 9,700.  

So far more than 10,100 Syrian refugees have crossed into Iraq seeking safety. Nearly 75% of all registered refugees are women and children. More than a quarter of refugee families are female-headed households. Arrivals also include unaccompanied children. 

UNHCR and partners continue to provide life-saving assistance to them. Our technical teams, protection and registration staff as well as our partners are in the camp every single day, assessing and meeting the needs as early as possible. They also ensure that all services in the camp are running and that new arrivals are immediately attended to and provided with the necessary aid and services.  

UNHCR stresses the importance of freedom of movement for fleeing civilians and that the borders remain open so that refugees can seek safety and protection. UNHCR and other humanitarian partners are working with authorities of the Kurdistan Region of Iraq (KRI) and are committed to supporting their response to the latest refugee influx. 

Bardarash camp, in Dohuk governorate, is ready to receive up to 11,000 people. Other nearby sites have been identified to shelter more refugees. We are grateful for the response of the local authorities, especially those of Dohuk Governorate, for receiving and assisting the newly arrived Syrian refugees, in addition to more than 230,000 already there.  

Many new arrivals need psycho-social support, children and adults alike. Last week at Bardarash camp, our psycho-social support team came across Dilwar, a three-year-old boy. He was in tears as he got lost from his mother upon arrival to the camp. Even after being reunited with his mum, Dilwar continued crying. She explained that Dilwar experienced loud explosions as they were fleeing their home. This made him agitated and sad and he could not stop crying. Our team attended to Dilwar, worked with him and their efforts were ultimately rewarded with a smile. UNHCR is coordinating with partners and other actors to ensure a blanket coverage of psychosocial first aid to all the new arrivals.  

Meanwhile in Syria, some 180,000 people have been displaced across the country’s north-east according to the latest UN estimates. The majority of the displaced are women and children.  

As part of inter-agency response inside Syria, UNHCR is providing emergency aid and protection services to thousands of people to ensure as much safety and dignity as possible for displaced families. 

Those who fled their homes are seeking safety in collective shelters and with family and friends. To date, more than 75,000 newly displaced people in host communities, collective shelters and camps have received relief items through the network of UNHCR partners on the ground. This includes winter jackets, high thermal blankets and sleeping bags to ensure that families are protected from the cold.

Northeast Syria: MSF forced to evacuate staff due to extreme volatility in the region

Via MSF.org: Northeast Syria: MSF forced to evacuate staff due to extreme volatility in the region. 

AMSTERDAM/NORTHEAST SYRIA - Following the launch of Turkish military operations and the extremely volatile situation in northeast Syria, Médecins Sans Frontières (MSF) has taken the difficult decision to suspend the majority of our activities and evacuate all our international staff from northeast Syria. 

Since Wednesday 9 October, the extreme volatile situation in northeast Syria has forced MSF international staff to evacuate from our projects in Ain Issa, Al Hol, Tal Abyad, Tal Tamer, Tal Kocher/ Yaroubiyah, Kobane/ Ain Al Arab and Raqqa city. These have been extremely difficult decisions, as MSF is very aware of the needs of fleeing and vulnerable people in the region. 

However, the highly unpredictable and fast-changing situation at present has made it impossible for MSF to negotiate safe access to deliver healthcare and provide humanitarian assistance to people in distress. Given the numerous groups fighting on different sides of the conflict, we can no longer guarantee the safety of our Syrian and international staff.   

“The people in northeast Syria have already endured years of conflict and uncertainty. The latest developments have only increased the need for humanitarian assistance, yet it is impossible to deliver it with the current insecurity,” says Robert Onus, MSF emergency manager for Syria.  

“It is with a heavy heart that MSF has taken the difficult decision to suspend the majority of its activities and evacuate its international staff out of northeast Syria. We cannot operate at scale until we can gain the assurances and acceptance of all parties to the conflict that we can operate safely.  

“We are extremely worried about the safety of our Syrian colleagues and their families who remain in northeast Syria in these troubled times. We will continue to support our Syrian colleagues remotely and explore all possible options to deliver assistance to the people in northeast Syria, despite the constraint,” says Onus. 

The decision to suspend the majority of MSF’s activities comes as the humanitarian situation spirals further out of control and needs are likely to increase. 

In Tal Tamar town, MSF teams were providing blankets, emergency food rations, bottles of water, and soap to the thousands of displaced people who were arriving in the town daily after having fled from their homes with little more than the clothes on their backs.  

Until October 13, MSF was supplying water to several villages in the area to overome water shortages after an airstrike reportedly damaged the water pumping station, cutting off the water supply to whole towns.  

Airstrikes, shelling, and armed clashes have had a grave impacts on the civilian population and on the ability of humanitarian organisations to deliver aid safely.  

On 13 October, dozens of people wounded by an airstrike were brought into Tal Tamer hospital. In Ain Issa town, MSF teams witnessed the population fleeing their homes on foot and seeking safety away from the ongoing conflict. Health workers were evacuated and relocated from the Ain Issa hospital, which had been one of the main hospitals treating wounded people over the past five days.    

Today, as MSF teams depart, we have heard from our staff that the people in Ain Issa camp are severely lacking food, water and medical assistance. Just last week, MSF teams were providing healthcare and, supplying water and mental health support to people living in the camp. Now they are left in a very precarious situation and we are extremely worried for their wellbeing. 

MSF calls on all parties to the conflict to ensure the protection of civilians. We further call on them to provide humanitarian organisations with safe and unhindered access to the civilian population so they can deliver assistance, at a time when it is urgently needed. 

Note: MSF remains present in northwest Syria, providing health care in various facilities and via mobile clinics, as well as supporting health structures in the area.