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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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Development of a new oral poliovirus vaccine for the eradication end game using codon deoptimization | npj Vaccines.

[Open Access] [Received 05 September 2019; Accepted 14 February 2020; Published 20 March 2020]

Abstract.

Enormous progress has been made in global efforts to eradicate poliovirus, using live-attenuated Sabin oral poliovirus vaccine (OPV). However, as the incidence of disease due to wild poliovirus has declined, vaccine-derived poliovirus (VDPV) has emerged in areas of low-vaccine coverage. Coordinated global cessation of routine, type 2 Sabin OPV (OPV2) use has not resulted in fewer VDPV outbreaks, and continued OPV use in outbreak-response campaigns has seeded new emergences in low-coverage areas. The limitations of existing vaccines and current eradication challenges warranted development of more genetically stable OPV strains, most urgently for OPV2. Here, we report using codon deoptimization to further attenuate Sabin OPV2 by changing preferred codons across the capsid to non-preferred, synonymous codons. Additional modifications to the 5′ untranslated region stabilized known virulence determinants. Testing of this codon-deoptimized new OPV2 candidate (nOPV2-CD) in cell and animal models demonstrated that nOPV2-CD is highly attenuated, grows sufficiently for vaccine manufacture, is antigenically indistinguishable from Sabin OPV2, induces neutralizing antibodies as effectively as Sabin OPV2, and unlike Sabin OPV2 is genetically stable and maintains an attenuation phenotype. In-human clinical trials of nOPV2-CD are ongoing, with potential for nOPV strains to serve as critical vaccine tools for achieving and maintaining polio eradication.


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Without Mass Testing, the Coronavirus Pandemic Will Keep Spreading | Foreign Policy.

[MARCH 23, 2020, 2:50 PM]

Countries such as South Korea that test thousands of people per day have slowed the outbreak. Other nations must adopt Seoul's model before it's too late.

Devi Sridhar is a Professor and Chair of Global Public Health at the University of Edinburgh. Twitter: @devisridhar. She writes:

When a patient arrived at a Chinese hospital with acute respiratory distress in mid-December 2019, there was uncertainty about what was causing these symptoms. Known pathogens were quickly ruled out: It was not SARS, MERS, or influenza—and, quickly, a novel coronavirus was detected. When doctors tried to raise the alarm, police threatened them, and health officials initially said they had no clear evidence of human-to-human transmission.

When China finally informed the World Health Organization of the outbreak through its China office on Dec. 31, 2019, it was clear the government was privately worried that it was not going to be easy to contain or manage.

By Jan. 23, China had 571 cases and a death toll of 17. Infectious disease specialists who create predictive models of epidemics immediately sounded the alarm about the new coronavirus disease—known as COVID-19—noting that China could experience 100,000 new infections per day with hundreds of millions of people becoming infected. By the following day, the central government of China had imposed a lockdown in Wuhan and other cities in Hubei province affecting 56 million people.

But even before these measures were implemented, the virus had already started spreading to Hong Kong and other countries such as Singapore, South Korea, and beyond. South Korea reported more than 2,000 total confirmed cases on Feb. 28. Then, in early March, something unexpected occurred: The exponential increase of cases in these countries stared to flatten. China has managed to keep its confirmed cases under 90,000, with daily new cases coming down. Italy, which recorded its first cases of COVID-19 on Jan. 30, has now lost more of its citizens (more than 6,000 as of March 23) to the disease than China has.

The severe Chinese response bought other countries time, but not all leaders took advantage of it. Before the outbreak reached their shores, heads of state across the world each decided to plan—or not plan—for this outbreak in their own way. Some, such as U.S. President Donald Trump, downplayed the dangers on national television, while others, such as South Korean President Moon Jae-in, acted early and decisively.

Indeed, South Korea stands out as an exemplar. After one of the world’s largest initial outbreaks outside China, it has managed to bring daily new cases into relative decline without imposing draconian nationwide lockdown measures. Comparing Italy to South Korea shows how dramatic the differences can be. On March 1, Italy had only 1,701 cases and 41 deaths, while South Korea had 3,736 cases and 21 deaths. Three weeks later, on March 22, Italy’s caseload had exploded to 59,138, with 5,476 deaths, while South Korea’s total caseload had merely doubled to 8,897, with 104 deaths.

The key to South Korea’s success has been speed and an early push toward mass testing, rigorous contact tracing, and mandatory quarantine for anyone near a carrier of the virus.The country, with a population of 51 million, tests more than 20,000 people a day at more than 600 testing sites nationwide, while integrating apps that not only track individuals if they have tested positive, but also warn them if they might have been exposed to a known case.

Yet in the United States and the United Kingdom, there is a public and internal government debate over whether testing matters—particularly for those who are only having minor symptoms. As of March 20, South Korea’s rate of testing was 6,148 per million people, while the United Kingdom was testing only 960 people per million and the United States just 314. Why waste resources and time trying to identify who has the disease, these officials ask.

In fact, the U.K. government even took a strategic decision on March 12 to stop testing those who have mild symptoms, those coming into hospitals but not admitted, or even the country’s health workforce. This was a dangerous and shortsighted decision, as Prime Minister Boris Johnson’s U-turn less than a week later, when he committed to a goal of 25,000 tests per day, reveals.

There are five key reasons why testing matters.

First, people generally seem much more likely to isolate themselves if they are confirmed as a virus carrier. Government advice has been for individuals to isolate themselves for 7 or 14 days (depending on the country) in order not to spread the virus beyond their household. However, this is unrealistic for those who can only earn a living by showing up at work and depend on daily income, as well as those who wonder if they really have COVID-19 or are just having another of the seasonal viruses that circulate during the winter and early spring. As with HIV, knowing one’s status can ensure that people understand the ramifications of their actions and how they need to act responsibly to prevent further spread.

Second, to break chains of transmission, public health officials need to know where the virus is and who has been exposed to it. Given that some studies estimate that presymptomatic transmission accounts for approximately 50 percent of cases, testing is required to ensure that carriers of the coronavirus are not unknowingly passing it on to others. In addition, close contacts of virus carriers must be informed so that they isolate themselves, meaning colleagues at work, people in the same apartment building, or those who have been in the same cafes, shops, trains, or planes. This is a classic public-health technique and one of the only ways to build a robust picture of who could have possibly been exposed to the virus and be carrying it.

Third, as local authorities scramble to allocate hospitals the right amount of personal protective equipment for staff, appropriate equipment such as ventilators and oxygen and beds, and even personnel, they need to predict how many people will be arriving in intensive care units in the coming days. By testing who has COVID-19 at an early stage, and by having existing data on what percentage of these people will require further care in hospitals, officials can make these decisions based on more precise and accurate data so that resources can flow appropriately.

Fourth, as China and South Korea have shown, certain parts of a country can become hot spots with a high number of cases. This is already happening in London, given the number of people arriving in hospital who are seriously ill with COVID-19. But rather than gauging this by looking at the number of people currently requiring hospital admission—which is actually a glimpse of past community transmission—by actively testing, public health authorities could see where new hot spots are emerging , and inside those hot spots, the role of superspreading events where numerous people become infected in one place, such as during church services or eating at restaurants.

Finally, the World Health Organization is producing daily reports noting the number of confirmed cases per country in order to track the evolution of the outbreak, but the accuracy of these numbers is reliant on actually doing tests. Without widespread testing of all cases including those with mild symptoms or those who are asymptomatic virus carriers, no one knows how large the problem is. It makes a huge difference if a country has 50 cases, 500 cases, or 50,000 cases, and without accurate numbers, governments and doctors are trying to fight a fire without knowing how large the blaze is, or where unseen embers are burning.

Every outbreak starts and ends with a diagnostic test. The director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, has made it clear that the “backbone” of every country’s public health response to this outbreak is testing, isolation, and contact tracing—and South Korea is showing how this model ultimately pays off in reducing spread, taking pressure off health services, and keeping its death rate one of the lowest in the world.

Rather than thinking they know best, the U.S. and U.K. governments should be listening and learning from other countries and the World Health Organization, and realizing that East Asian nations are now leading the way.


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DIY Iron Lung (Jan, 1952) | Modern Mechanix.

Should you ever need one, here are detailed instructions on how to make your own iron wooden lung.

Amazingly, in a later issue they have a little notice saying that due to the huge response the magazine got about this article they were offering a large set of blue prints and templates. I guess a lot of people actually built these.

Emergency Wooden Respirator Page 1 of 6

Emergency Wooden Respirator Page 1 of 6

Page 2 | Page 3 | Page 4 | Page 5 | Page 6.

Emergency Wooden Respirator

Could a life have been saved in your community if a mechanical respirator had been at hand for immediate use? Often just a matter of minutes means the difference between life or death for a little child stricken with polio, or a victim of drowning or a paralyzing accident. Here’s a chance for every community to be ready at little expense for such emergencies. Members of clubs and civic organizations can do a great service by making one of these respirators and placing it in competent hands. Save a life - maybe your own.

INTENDED only for emergency use until a commercial respirator could be obtained, this “wooden lung” was designed by engineers and built by a volunteer group under the supervision of Dr. Gerald M. Cline, Dr. Homer O. Dolley, and Sister Celine of the medical staff of St. Joseph’s Hospital, Bloomington, Illinois. On completion, the unit was put into immediate use in emergency treatment of eight-year-old Rudy Landheer, a victim of polio in the epidemic of 1949. The original unit did emergency service for 12 hours until a conventional iron lung could be obtained.

The unit, detailed on the following pages, has been approved only for emergency use under the direct supervision f a doctor or registered nurse. The motor-driven mechanism can be changed to hand operation in a few seconds, if necessary. As detailed, drive ratios have been arranged to give the proper diaphragm action, and a variable-speed pulley on the motor can be adjusted to give a respiratory frequency within the required range of 12 to 20 cycles per minute. The large sprocket on the final drive shaft has 26 teeth.

The cabinet and frame, Fig. 2, are of the simplest construction, all joints in the cabinet assembly being glued and screw-fastened. Note that the bed, Fig. 1, and the end panel and headrest are joined to form one unit which rolls on swivel casters. When the bed is in position in the cabinet, luggage clamps placed at the four corners hold the head panel, Fig. 4, and draw it tightly against the gasket. Note that all openings into the cabinet, Fig. 3, are fitted with gaskets and that the access doors are fitted with ordinary sash locks, which exert sufficient pressure on the gaskets to assure an airtight seal when the doors are closed and locked. The top openings into the cabinet are closed with clear-plastic panels screwed over sponge-rubber gaskets. Note that the clamp which holds the sponge-rubber head gasket in place is drilled to slip over two bolts in the head panel and is locked with wing nuts. Although the photo on page 262 shows two hanger bolts located above the wing nuts, two additional bolts should be added below the wing nuts, to permit anchoring four straps to alleviate tension of the gasket on the patient’s neck.

The base for the motor mount, Fig. 2, is screw-fastened to the frame stretchers and is reinforced with two crossmembers placed underneath with the ends joined to the stretchers. The motor mount, Fig. 5, is made entirely of metal and is provided with an adjusting screw so that the motor can be positioned and the belt properly ten-sioned in accordance with the setting of the variable-speed pulley. The slotted slides are bolted to the mounting base and care must be taken to position them properly so that the parts do not bind. The exact position of the motor mount on the base is determined by the location of the reduction drive unit, shown in working position in the two photos below Fig. 6. The reduction drive is connected to the drive lever, or rocker arm, by means of a link cam, Figs. 7 and 9, and a drive link, Fig. 7. The drive lever is pivoted in the manner detailed, one end being attached to the diaphragm yoke and the other pinned to the drive link by means of a removable T-pin, Fig. 8. Removal of the pin disconnects the power unit and permits hand operation of the diaphragm by the emergency handle.

Fig. 10 shows the construction and method of mounting the diaphragm chamber. The diaphragm is made from a section of tractor-tire inner tube, as specified, and is clamped onto the diaphragm chamber by means of a circular clamp. Note in the lower detail that a gasket is placed between the bottom of the cabinet and the top of the diaphragm chamber. The final fittings on the cabinet are the centimeter gauge, the inlet and discharge valves and the valve-adjustment guides, Fig. 6. The valves are located on the back panel of the cabinet.

[See source article for additional comments]


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A Piece From Our Past: 'Wooden' lung ingenious contraption for polio epidemic | Mclean County Museum Of History | The Pantagraph.

[Source article may not be viewable in EU except via a suitable VPN]

Pfop

Ingenuity helped Bloomingtonians solve problems during the shortage of iron lungs in 1949.

COURTESY, MCLEAN COUNTY MUSEUM OF HISTORY

In the summer of 1949, at a time when Central Illinois communities were hit particularly hard by the deadly disease polio, St. Joseph’s Hospital and Eureka Williams Corp. decided to fight back.

Officials with St. Joseph (then located on Bloomington’s west side) feared their two iron lungs might not be enough at any one time, a shortage that might endanger the life of someone who needed but could not get one. As a result, engineers and machinists from Bloomington manufacturer Eureka Williams volunteered to design and build one from scratch using everyday household materials.

As a fully functioning negative pressure ventilator, this “wooden” lung (so-called because its frame was built of plywood) did the same job as the polished, commercially manufactured “iron” ones. It was an ingenious mechanical feat that drew national attention.

Poliomyelitis (polio’s scientific name, though it’s often known as infantile paralysis) is a virus that spreads person to person. The disease, for which there is no known cure, can lead to atrophied muscles and paralyzed, misshapen limbs, and at its most dangerous, death from suffocation. Many who grew up during the polio epidemics after World War II recall all too well friends, neighbors or family members subjected to confinement in iron lungs, leg braces, corrective footwear and painful physical therapy.

Polio patients sometimes lost the ability to control the muscles involved in breathing. An iron lung was a cylindrical, bed-like machine in which patients were treated with rhythmic fluctuations in air pressure, forcing oxygen in — and carbon dioxide out — of the lungs. An iron lung was usually needed for several days or weeks until the virus ran its course, though a small number of patients ended up spending the greater part of their lives tied to such machines.

On Friday, August 5, 1949, members of the Eureka Williams engineering staff and a handful of volunteers were at the Bell Street plant to start the ambitious project. Fifteen men worked all day Saturday and through to midnight Sunday to finish the job.

Over the same weekend, polio killed two at St. Joseph’s: John Lynch, age 2, of Gibson City; and Mary Guyon, age 11, of Streator. These deaths and the hospital’s growing caseload likely weighed heavily on the minds of those working at Eureka Williams.

The six-foot-long wooden lung was built from materials “you’d find in any hardware store or lumber shop in any one-horse town,” noted Ralph C. Osborn, Eureka Williams vice president of engineering. “Our idea was to make a lung that any carpenter can build anyplace it’s needed.” The “Bloomington lung” was put together using, among other items, household electrical switches; a washing machine motor and gear box; an inner tube from a tractor tire; a wash tub; an alarm clock; and the aforementioned plywood.

On August 10, the machine was put to an unexpected life-and-death test. That night, 8-year-old Rudy Landherr of the Whiteside County community of Morrison arrived at St. Joseph’s to find both iron lungs occupied. With paint still drying on the plywood, hospital staff realized they had no other choice than to use the wooden lung. Landherr remained inside the cobbled-together machine through the night, unable to breathe without it. The next morning he was moved to an iron lung when one became available.

The Bloomington lung saved the boy’s life, announced Sister M. Celine Friske, St. Joseph’s chief administrator. “I didn’t have to breathe,” Landherr told a Pantagraph reporter several weeks later. “It breathed for me.” He ended up living to the age of 65, passing away in the summer of 2006 in his hometown of Morrison.

Back in 1949, news of the wooden lung, which eventually earned the American Medical Association’s seal of approval, spread fast across the nation. Both Associated Press and United Press International ran the story on their national wire, and local officials found themselves inundated with requests for blueprints. Eureka Williams eventually published a 12-page how-to booklet, and by late 1951 had sent copies to more than 1,000 groups around the country. Popular Mechanics magazine even featured Bloomington’s “emergency wooden respirator” in its January 1952 issue.

Jonas Salk was the first to cross the finish line of the “Great Race,” developing a polio vaccine in 1952 (though its announcement wasn’t made until 1955). Albert Sabin followed shortly thereafter with an oral vaccine, famously administered with sugar cubes. Since then, polio has been eradicated in the United States and the rest of the Americas, but is still endemic in several countries, including Afghanistan.

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[The Pantagraph] Editor's note: This story originally was published Nov. 21, 2009. Pieces From Our Past is a weekly column produced by the McLean County Museum of History.

 


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