H5N1

Housekeeping note

I've changed the name of the Ebola in DR Congo list to Ebola, and I've added links to the Ugandan Ministry of Health, some relevant Twitter accounts, and a couple of reliable newspapers. I really hope I don't have to add more links.

Ebola: Dr. Mackay makes The Washington Post

The Editorial Board of The Washington Post takes note: Ebola is like a fire. It keeps burning. The full editorial and then a comment:

To understand why the Ebola virus disease is spreading in Congo, think of a fire. The virus burns in a fire pit and periodically leaps out. Health workers scramble to contain the outbreaks, which sometimes strike in locations by surprise. Thus, it is alarming to hear from the World Health Organization that responders are being forced to retreat on some days because of the dangerous security situation created by armed militias.  

So far, Ebola has not leapt over international boundaries, and teams of extremely brave health-care and medical workers are trying to execute the tactic that has worked before: contain the virus inside a ring, interrupting transmission. This requires a skillful choreography: surveillance, case investigation, contact tracing and vaccination. Unlike the 2014-2016 West Africa epidemic that killed more than 11,000 people, today’s responders have a vital tool in an efficacious vaccine. 

But now the WHO has announced that the public-health and medical responders are, in some cases, being forced to suspend work because of the militia attacks. The outbreak is located in two provinces in eastern Congo: North Kivu and Ituri. In two of seven hot spots, Butembo and Katwa, both in North Kivu, the workers have been “reduced to a ‘stop and go’ pattern, where a day or two of activity is followed by a day or two of suspended or limited activity,” the agency said. Imagine a fire in which the firefighters have to retreat for a few days. 

Another serious concern is that 40 percent of the deaths are occurring outside treatment centers. This means people are dying in their communities, where the highly infectious virus is easily transmitted to others, and detection delayed. A report in The Post says the problem of mistrust of doctors in the community, as well as danger to them of violent attack, has led some medical personnel to essentially go undercover to carry out their lifesaving efforts. 

The outbreak has killed 1,073 people out of 1,672 confirmed cases since last summer, the second-worst Ebola outbreak on record. Armed with the vaccine, the WHO has shifted its strategy, lowering the dosage and widening the eligibility to reach more people. But as Australian virologist Ian Mackay points out on his blog, “a revised vaccine strategy . . . can’t succeed unless security is improved, people feel that it’s improved, and community trust is achieved. A vaccine that people don’t want or can’t get, won’t work.” 

Improving security is not a simple matter. Bringing armed forces into the region might further complicate the trust problem in communities. In the West Africa epidemic, authorities realized belatedly that forced quarantines created panic and were counterproductive. Trust cannot be coerced but must be won. New approaches are desperately needed. The armed militias are, by their actions, allowing the Ebola virus to spread. As Mr. Mackay has pointed out, the time it takes for every 200 newly confirmed cases or deaths is growing shorter and shorter. The fire is burning.

I'm delighted to see The Washington Post cite Dr. Mackay—not because that will make him famous, but because it's a recognition that Flublogia, this very loose assortment of experts, journalists, and bystanders like me, is contributing usefully to the global conversation on global health.

I suspected that was true from the outset of this blog 14 years ago, and it seemed to me to be worth pointing out as an unexpected advantage of blogging and social media. But the media on which we rely have been been a bit slow to acknowledge that they rely on us as well.

Housekeeping/historical note

I see I've missed my own 14th anniversary of H5N1: My first post was on March 12, 2005. The blog was a sideline to my real interests at the time, blogging about webwriting and writing fiction. H5N1 was an attempt at self-education, and it's been largely successful—that is, I've learned so much that I have a much greater sense of my own ignorance.

I've also learned that it's not entirely a disaster when a hobby devours your life. I've met and learned from some remarkable people, visited countries I never expected to see, and gained a clearer sense of the awful situation we're in around the world.

Whether you're an old-timer Flublogian or you've just stumbled on this site, thank you for your interest and attention. I hope these posts have been useful for you.

Housekeeping note

I'm negotiating with The Tyee to write a series of articles on dementia—a health issue serious enough to scare a lot of people (including me) into not thinking too much about it.

As usual, I'm starting by trying to teach myself something about the subject, and the way I teach myself is to build a blog and start filling it full of links and posts to articles and reports.

The new blog is called The Politics of Dementia, and it's just a few hours old at this point. As well as being a form of self-teaching, I hope it will be a useful resource for others with an interest in the subject. If you know of any resources I haven't yet linked to on the site, please let me know about them. Comments and critiques of the site itself would also be welcome.

Looking for Brazilian public health resources

Since the end of the yellow fever outbreak, I've lost touch with many of my Brazilian sources of health news. Now, with the impending inauguration of Jair Bolsonaro on January 1, such sources will be increasingly important. 

A quick search for Brazilian health bloggers has turned up very few active blogs, and I doubt the Ministry of Health website and blog will be very helpful. I'm also aware that Brazilian bloggers on political topics sometimes get shot—and I have no desire to see that happen to anyone else.

Still, if you know of any individuals, groups, or agencies that are familiar with Brazil's public health issues, working online in or out of the country, I'd be grateful for the links.

 

Outbreaks, and rumours of outbreaks

Sunday is usually quiet, with most governments and health agencies silent on news. But I'm getting rumours of new outbreaks, and suspicious quiet about others, both of which make me think about the problems of epidemic intelligence—both the professional kind, like CDC and ECDC, and the entirely amateur kind, like this blog.

A problem I share with the professionals is that poor countries have more health problems, and also tend to have repressive or plain incompetent governments. (Some are competent only in repression.) So when rumours began popping up about a viral hemorrhagic fever in Sudan, the only source of information was Radio Dabanga—which operates outside Sudan. The rumours seemed to involve a chikungunya outbreak in Kassala state, but chikungunya is not hemorrhagic. Severe dengue can be, but it's relatively rare; the two diseases are both mosquito-borne and have similar symptoms. So maybe Sudan's really dealing with a dengue outbreak involving a strain that's new to the local population: if you've recovered from one strain of dengue, you may be at risk of severe dengue if you contract another.

In fairness, Sudan's Federal Ministry of Health does have a news item on it its website about "joint medical experts" conducting a study of chikungunya in Kassala. But when I try to access it I get warnings about how hazardous visiting that page may be. So I don't know what it says or even the date of the news item. 

This in turn raises another issue: poor countries with serious outbreaks have terrible official websites for their health ministries, or no websites at all. During the West African Ebola outbreak, Guinea had no site, and Liberia and Sierra Leone started with terrible sites that only slowly improved. Presumably those governments figured their own citizens weren't online that much so a website would be pointless. The idea that the rest of the world might be interested didn't concern them.

I've also heard of something going on in Eritrea, but good luck getting beyond rumour: Eritrea is a thoroughgoing dictatorship, and we tend to learn about health issues there only when refugees turn up in Europe or the Middle East suffering from relapsing fever or MDR-TB. I can't find an Eritrean ministry of health website; even Wikipedia falls back on the CIA Factbook and other outside sources. WHO AFRO's Eritrea page has very little information, and much of it is dated.

More prosperous countries can pose problems too. Saudi Arabia is a case in point, still offering minimal information about MERS. And now, with Brazil haing elected Jair Bolsonaro as president, we can expect the Brazilian ministry of health to become much less transparent than it was, for example, during the yellow fever outbreak.

If Bolsonaro is elected, and carries out his stated policies such as opening the Amazon and selling off Indigenous peoples' land to the highest bidder, major outbreaks are inevitable: dengue, yellow fever and measles are likely to become more entrenched, and Zika could return, while the ministry will surely lack the funds to address them.

Or if it has the funds, it won't have the personnel—the Cubans in the "Mais Medicos" program will go home, and many Brazilian healthcare workers will leave the country in search of a safer place to work. So a public health disaster could affect a country of 209 million—but we will learn of it only through social media and political refugees.

Yes, it's depressing. But that's all the more reason to push ahead with more epidemic intelligence efforts—especially professional, but with the amateurs lending what help we can.

Housekeeping note

Some of the stories I cover here eventually turn into articles for The Tyee, the Vancouver online magazine I've been happily writing for since 2003. Way down at the bottom of the right-hand column you'll find links to my health-related articles, going back to 2004—when I was just a few weeks away from starting this blog as a way to teach myself about H5N1 avian flu. I've finally got round to including the 2018 articles so far. You may find some of these items of interest.

A new blog: Hothouse Earth

I started this site back in 2004 as an effort in self-education about H5N1 avian flu. It scope is now a little broader than I ever expected, and I know a little more than I expected to learn as well.

Now I've started another blog, Hothouse Earth, focusing on some of the major changes going on around us due to climate change. It's still very preliminary, with just a few links and posts about recent scientific studies. If you're also interested in climate change, I hope you'll find it of some value.

The impact of news exposure on collective attention in the United States during the 2016 Zika epidemic

Via bioRxiv: The impact of news exposure on collective attention in the United States during the 2016 Zika epidemic. The abstract:

In recent years, many studies have drawn attention to the important role of collective awareness and human behaviour during epidemic outbreaks. A number of modelling efforts have investigated the interaction between the disease transmission dynamics and human behaviour change mediated by news coverage and by information spreading in the population. Yet, given the scarcity of data on public awareness during an epidemic, few studies have relied on empirical data. 

Here, we use fine-grained, geo-referenced data from three online sources - Wikipedia, the GDELT Project and the Internet Archive - to quantify population-scale information seeking about the 2016 Zika virus epidemic in the U.S., explicitly linking such behavioural signal to epidemiological data. 

Geo-localized Wikipedia pageview data reveal that visiting patterns of Zika-related pages in Wikipedia were highly synchronized across the United States and largely explained by exposure to national television broadcast. Contrary to the assumption of some theoretical models, news volume and Wikipedia visiting patterns were not significantly correlated with the magnitude or the extent of the epidemic. 

Attention to Zika, in terms of Zika-related Wikipedia pageviews, was high at the beginning of the outbreak, when public health agencies raised an international alert and triggered media coverage, but subsequently exhibited an activity profile that suggests nonlinear dependencies and memory effects in the relation between information seeking, media pressure, and disease dynamics. 

This calls for a new and more general modelling framework to describe the interaction between media exposure, public awareness and disease dynamics during epidemic outbreaks.

Housekeeping note

I've changed one of my lists; Ebola & Lassa Resources is now Ebola in the DR Congo, and it's now near the top of far-right column. Some of the old Ebola links are still there, but most are new and deal with this new outbreak. Many are in French, but Google Translate works pretty well on them.

A word of caution: The newspapers I've found in the DR Congo are mostly obsessed with politics and football, and pay little attention to Ebola and other health stories. The Ministry of Public Health is back online but seems slow to update.

If you're aware of other websites that should be on this list, please let me know.