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China Created a Fail-Safe System to Track Contagions. It Failed. | The New York Times.

[Published March 29, 2020; Updated March 30, 2020, 8:46 a.m. ET]

After SARS, Chinese health officials built an infectious disease reporting system to evade political meddling. But when the coronavirus emerged, so did fears of upsetting Beijing.

Medical staff checking on a coronavirus patient at the Red Cross hospital in Wuhan, China, in early March.

Medical staff checking on a coronavirus patient at the Red Cross hospital in Wuhan, China, in early March.Credit...Agence France-Presse — Getty Images

Steven Lee Myers writes:

The alarm system was ready. Scarred by the SARS epidemic that erupted in 2002, China had created an infectious disease reporting system that officials said was world-class: fast, thorough and, just as important, immune from meddling.

Hospitals could input patients’ details into a computer and instantly notify government health authorities in Beijing, where officers are trained to spot and smother contagious outbreaks before they spread.

It didn’t work.

After doctors in Wuhan began treating clusters of patients stricken with a mysterious pneumonia in December, the reporting was supposed to have been automatic. Instead, hospitals deferred to local health officials who, over a political aversion to sharing bad news, withheld information about cases from the national reporting system — keeping Beijing in the dark and delaying the response.

The central health authorities first learned about the outbreak not from the reporting system but after unknown whistle-blowers leaked two internal documents online.

Even after Beijing got involved, local officials set narrow criteria for confirming cases, leaving out information that could have provided clues that the virus was spreading among humans.

Hospitals were ordered to count only patients with a known connection to the source of the outbreak, the seafood market. Doctors also had to have their cases confirmed by bureaucrats before they were reported to higher-ups.

As the United States, Europe and the rest of the world struggle to contain the coronavirus pandemic, China has cast itself as a model, bringing down a raging outbreak to the point where the country has begun to lift the kinds of onerous restrictions on life that are now imposed around the world.

This triumphant narrative obscures the early failures in reporting cases, squandered time that could have been used to slow infections in China before they exploded into a pandemic.

“According to the rules, this of course should have been reported,” Yang Gonghuan, a retired health care official involved in establishing the direct reporting system, said in an interview. “Of course they should have seized on it, found it, gone to understand it.”

Aggressive action just a week earlier in mid-January could have cut the number of infections by two-thirds, according to a recent study whose authors include an expert from Wuhan’s municipal Center for Disease Control and Prevention. Another study found that if China had moved to control the outbreak three weeks earlier, it might have prevented 95 percent of the country’s cases.

“I regret that back then I didn’t keep screaming out at the top of my voice,” Ai Fen, one of the doctors at Wuhan Central Hospital who spotted cases in December, said in an interview with a Chinese magazine. “I’ve often thought to myself what would have happened if I could wind back time.”

China’s leader, Xi Jinping, has sought to move quickly past the early failings and shift attention to the country’s drive to end the outbreak. The Chinese government has been widely castigated for its initial mistakes, which have become a top talking point of President Trump.

The central leadership has focused blame on local bureaucrats, including for censuring doctors who warned others about the infections. It promptly dismissed two health officials and, later, the party secretaries for Hubei Province and its capital, Wuhan.

Now, interviews with doctors, health experts and officials, leaked government documents, and investigations by the Chinese media reveal the depth of the government’s failings: how a system built to protect medical expertise and infection reports from political tampering succumbed to tampering.

Others tried to fill the void of information when the early warning system failed. The medical community found other, informal ways to alert others, disclosing government directives and hospital reports on the internet. During a rare burst of relative transparency early in the epidemic, Chinese journalists did much to expose the problems, but censors closed that window.

The government has vowed to fix flaws exposed in the disease surveillance system, but similar promises were made after SARS. Fresh efforts to repair the system now could also falter under a political hierarchy that leaves experts — doctors, even public health officials — unwilling to take on local leaders. In China, politics often ends up overriding the very safeguards created to prevent interference in the flow of information.

The failures in the first weeks “greatly reduced the vigilance and self-protection of the public and even medical workers, making it harder to contain the epidemic,” said a study of the epidemic by 12 medical experts from Shanghai Jiao Tong University. “Only precautions in ordinary times can prevent great disasters from arising.”

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Covid-19 and people with neuromuscular disorders: World Muscle Society position and advice | The World Muscle Society.

The category of neuromuscular disease (NMD) covers a wide range of different diagnoses with widely varying levels of disability even in people with the same diagnosis. It is difficult, therefore to make specific recommendations that apply generally. The following are recommendations that apply to numerous neuromuscular disorders. These recommendations are designed primarily for patients, carers, general neurologists and non-specialist medical providers. They are also intended to inform neuromuscular specialists particularly regarding frequently asked questions and basic service requirements. In-depth reference links are provided.

Note: Covid-19 is a rapidly evolving field. The advice in this document is subject to revision every 3 days. Please ensure that you are using the most up to date version of the document.


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New analytic approaches for analyzing and presenting polio surveillance data to supplement standard performance indicators | Vaccine: X

[Open Access] [Received 12 September 2019, Revised 7 March 2020, Accepted 9 March 2020, Available online 21 March 2020]

Abstract.

Background.

Sensitive surveillance for acute flaccid paralysis (AFP) allows for rapid detection of polio outbreaks and provides essential evidence to support certification of the eradication of polio. However, accurately assessing the sensitivity of surveillance systems can be difficult due to limitations in the reliability of available performance indicators, including the rate of detection of non-polio AFP and the proportion of adequate stool sample collection. Recent field reviews have found evidence of surveillance gaps despite indicators meeting expected targets.

Methods.

We propose two simple new approaches for AFP surveillance performance indicator analysis to supplement standard indicator analysis approaches commonly used by the Global Polio Eradication Initiative (GPEI): (1) using alternative groupings of low population districts in the country (spatial binning) and (2) flagging unusual patterns in surveillance data (surveillance flags analysis). Using GPEI data, we systematically compare AFP surveillance performance using standard indicator analysis and these new approaches.

Results.

Applying spatial binning highlights areas meeting surveillance indicator targets that do not when analyzing performance of low population districts. Applying the surveillance flags we find several countries with unusual data patterns, in particular age groups which are not well-covered by the surveillance system, and countries with implausible rates of adequate stool specimen collection.

Conclusions.

Analyzing alternate groupings of administrative units is a simple method to find areas where traditional AFP surveillance indicator targets are not reliably met. For areas where AFP surveillance indicator targets are met, systematic assessment of unusual patterns (‘flags’) can be a useful prompt for further investigation and field review.


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Immune modulatory capacity of probiotic lactic acid bacteria and applications in vaccine development | Beneficial Microbes.

[Pay to View Full Text] [Published Online: March 27, 2020]

Abstract.

Vaccination is one of the most important prevention tools providing protection against infectious diseases especially in children below the age of five. According to estimates, more than 5 million lives are saved annually by the implementation of six standard vaccines, including diphtheria, hepatitis B, Haemophilus influenza type b, polio, tetanus and yellow fever. Despite these efforts, we are faced with challenges in developing countries where increasing population and increasing disease burden and difficulties in vaccine coverage and delivery cause significant morbidity and mortality. Additionally, the high cost of these vaccines is also one of the causes for inappropriate and inadequate vaccinations in these regions. Thus, developing cost-effective vaccine strategies that could provide a stronger immune response with reduced vaccination schedules and maximum coverage is of critical importance. In last decade, different approaches have been investigated; among which live bacterial vaccines have been the focus of attention. In this regard, probiotic lactic acid bacteria have been extensively studied as safe and effective vaccine candidates. These microorganisms represent the largest group of probiotic bacteria in the intestine and are generally recognised as safe (GRAS) bacteria. They have also attracted attention due to their immunomodulatory actions and their effective role as novel vaccine adjuvants. A significant property of these bacteria is their ability to mimic natural infections, while intrinsically possessing mucosal adjuvant properties. Additionally, as live bacterial vaccines are administered orally or nasally, they have higher acceptance and better safety, but also avoid the risk of contamination due to needles and syringes. In this review, we emphasise the role of probiotic Lactobacillus strains as putative oral vaccine carriers and novel vaccine adjuvants.


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Pakistan: Three more polio cases found in KP | DAWN.

[March 30, 2020]

ISLAMABAD: Three boys have been paralysed in Khyber Paktunkhwa by the crippling polio disease, taking up the current year’s tally to 36.

According to an official of the National Institute of Health, a nine-month-old boy infected with polio virus is a resident of District and Tehsil Lakki Marwat, Union Council (UC) Abdul Khel and his right upper limb was paralysed.

“A six-month-old boy, a resident of District Karak, Tehsil Takhti-i-Nasrat, UC S.G. Khel, is also infected with polio and his both lower limbs are paralysed. The third child is 19-month-old boy, a resident of District Tank, Tehsil Jandola, UC Khesarai, and his both lower limbs are paralysed,” he said.

Polio is a highly infectious disease caused by poliovirus and it mainly affects children under the age of five. The polio virus invades the nervous system and can cause paralysis and even death of a child. While there is no cure for polio, vaccination is the most effective way to protect children from this crippling disease.

Each time a child under five is vaccinated, his/her protection against the virus is increased.

Repeated immunisations have protected millions of children from polio, making almost the entire world polio free, except Pakistan and Afghanistan where polio cases are still being reported.

Pakistan is still under a polio-linked travel restriction imposed by the World Health Organisation in 2014 and since then every person travelling abroad has to carry a polio vaccination certificate.


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Pakistan: Polio in a pandemic | Editorial | The News International.

[March 30, 2020]

We are already struggling badly to deal with the Covid-19 pandemic which has now claimed 13 lives in our country. But even while we continue life under lockdown and watch the terrifying scenes from the country’s hospitals where badly equipped medical staff battle to treat the growing number of patients, we must not forget that the terrible shadow of polio continues to lurk over us and threatens to turn into an epidemic – once again. Pakistan is already one of only two countries in the world endemic for polio, the other being Afghanistan. Last year, it recorded 146 cases of a disease that had been on the brink of being wiped out in 2017, when eight cases were recorded and 2018, when the total for the year was 12.

The current chaos in the country means a new epidemic of the virus could hit us at any time. We must attempt to prevent this by continuing with our anti-polio drive. The first phase of this was carried out in February, before the coronavirus threat paralysed our lives. The fact that we are now forced due to the coronavirus to observe social distancing and limit travel would make any drive against polio harder. But mechanisms must be found to deliver the vital vaccine to children under five who risk being crippled for life by an illness that can be easily prevented simply by swallowing a few amber drops at regular intervals. How this would be managed in the situation Covid-19 has placed us in must be thought out. We will need to be innovative.

Experts will no doubt be able to offer other suggestions. The situation certainly makes the delivery of drops more difficult. But this difficulty must not tempt us to abandon the effort and allow hundreds of children to be affected or even killed by the disease. Already, 33 cases have been reported this year; 15 of them are from Khyber Pakhtunkhwa, the province which was also worse affected in 2019. Two new cases were uncovered in Sindh during the last few days. Nationwide action is needed. It must be planned and enacted swiftly to avoid yet another health disaster with a long-term impact. Polio has been wiped out by almost the entire world. Pakistan must not lag behind.


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