Pakistan- 'Yao Maseed' sit-in participants to boycott polio drive in Waziristan | MENAFN Business.
[3/6/2020 8:19:56 AM]
(MENAFN - Tribal News Network) WANA: The participants of ‘Yao Maseed' (United Mehsuds) sit-in from South Waziristan tribal district have decided to further toughen their stance after no interest shown by the government for resolution of their problems despite 40 days of protest.
The people of South Waziristan are staging a sit-in in Tank against no survey of damaged houses and properties and non-payment of compensation for the last 40 days. The protesters said the tribesmen will continue boycott of polio vaccination campaigns in South Waziristan, other tribal districts, settled districts of Khyber Pakhtunkhwa as well as in Karachi until their demands about the survey of damages and compensation and transfer of the serving deputy commissioner of South Waziristan are not accepted.
The sit-in participants alleged that the district administration, particularly the deputy commissioner, instead of resolving their problems, were further complicating their problems. They said the deputy commissioner has not called a meeting of the steering committee due to which the survey of damages is delayed. The protesters said the people of Mehsud tribe are fully supporting them for their demands and they will also not vaccinate their children till the demands are accepted.
They also made it clear that the next time no talks will be held in any political compound or government office. They said if any government official wants to talk with them then he would have to come to the protest camp. Tribesmen use the threat of polio vaccination boycott from time to time to pursue their political demands. However, this time, a threat has been made about vaccination boycott in the mega city of Karachi. If the threat is implemented, then vaccination efforts in the mega city may suffer a set back and lead to further problems in the country which is already struggling to contain poliovirus.
Apparently taking inspiration from Yao Maseed sit-in, the people of South Waziristan tribal district affected from militancy and military operations have also initiated a sit-in in favor of their demands outside the Frontier Corps (FC) Camp in Wana. A large number of tribal elders and political activists are joining the sit-in titled 'Yao Wazir' which means the Wazir tribesmen are united for their rights.
Original Source Article »
China’s cases of Covid-19 are finally declining. A WHO expert explains why | Vox.
[March 3, 2020 1:58 pm]
A CT scan is preformed on a patient infected by Covid-19 at the Red Cross hospital in Wuhan, China, on February 28, 2020.
Stringer/AFP via Getty Image
Julia Belluz writes:
There’s one country in the world that currently has the most knowledge of and experience with Covid-19: China.
China, and specifically Hubei province, is where the Covid-19 disease emerged; it’s where 83 percent of the 89,000 cases known to date have been recorded; and it’s where doctors and health authorities have been battling an epidemic for two months — while other countries braced themselves for outbreaks — using unprecedented public health measures, including a cordon sanitaire and lockdowns that affected millions.
In recent weeks, though, the number of new infections and deaths reported in China has been declining, which suggests spread of the virus may have peaked there and that transmission is slowing down.
At the same time, cases are rapidly increasing in several other countries, with major outbreaks in South Korea, Italy, and Iran — and a growing case count in the United States.
It’s now critical that the rest of the world learn as much as it can from China’s efforts to respond to and limit the spread of the virus.
That was precisely the intention of a recent World Health Organization (WHO) mission to China, led by the agency’s assistant director general and veteran epidemiologist Bruce Aylward. Its major finding: “China’s bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic.”
On Monday, Vox talked to Aylward about the big takeaways from the mission’s report: the playbook China used to curb Covid-19 spread, why speed in responding to an outbreak is so crucial, whether we can trust China’s data, and why smoking could be exacerbating the impact of the epidemic there. Our conversation has been edited for length and clarity.
What the world can learn from China’s Covid-19 response.
The WHO has been suggesting the world should follow China’s lead, but as you know, there are concerns about the human rights effects from China’s response to the Covid-19 outbreak — most notably, the restrictions on freedom of movement through lockdowns and cordon sanitaires. How do you respond to critics who are concerned about that?
I think people aren’t paying close enough attention. The majority of the response in China, in 30 provinces, was about case finding, contact tracing, and suspension of public gatherings — all common measures used anywhere in the world to manage [the spread of] diseases.
The lockdowns people are referring to — the human rights concerns — usually reflect the situation in places like Wuhan [the city in Hubei province where the virus was first detected]. [The lockdown] was concentrated in Wuhan and two or three other cities that also exploded [with Covid-19 cases]. These are places that got out of control in the beginning [of the outbreak], and China made this decision to protect China and the rest of the world.
China is now trying to restart its economy. They can’t do that with millions of people in lockdown in their apartments or with the trains stopped and all their factories suspended. They are getting those things working again, but they have their system primed for rapid detection and rapid response. They never want to be in another situation like a Wuhan — and they haven’t. That’s the first place, and 30 other provinces managed to avoid that, and not just avoid that but reverse the [outbreak].
Okay, so most of the measures used in China to stop the virus were traditional public health moves that are broadly accepted — and the draconian measures were rarer. Is there any sense of what in China’s toolkit was most effective?
I think the key learning from China is speed — it’s all about the speed. The faster you can find the cases, isolate the cases, and track their close contacts, the more successful you’re going to be. Another big takeaway is that even when you have substantial transmission with a lot of clusters — because people are looking at the situation in some countries now and going, “Oh, gosh, what can be done?” — what China demonstrates is if you settle down, roll up your sleeves, and begin that systematic work of case finding and contact tracing, you definitely can change the shape of the outbreak, take the heat out of it, and prevent a lot of people from getting sick and a lot of the most vulnerable from dying.
The question becomes, then, how did they do that, and how much of it is replicable? Since coming back from China, everybody I talk to begins with, “We can’t lock down a city of 15 million people like China.” I say, “Why would you ever want to?” And I ask, “Does your population know x, y, z [about the virus]?” I learn they haven’t started with the basics.
So, No. 1, if you want to get speed of response, your population has to know this disease. You find any population in the West and ask them what are the two presenting signs you have to be alert to. What would you say?
Aren’t the two initial symptoms most commonly fever and dry cough?
Right. [But many still think] it’s a runny nose and cold. Your population is your surveillance system. Everybody has got a smartphone, everybody can get a thermometer. That is your surveillance system. Don’t rely on this hitting your health system, because then it’s going to infect it. You’ve got this great surveillance system out there — make sure the surveillance system is primed. Make sure you’re ready to act on the signals that come in from that surveillance system. You’ve got to be set up to rapidly assess whether or not they really have those symptoms, test those people, and, if necessary, isolate and trace their contacts.
Here, again, is where I’ve seen things starting to break down. What I’ve been told is if you think you’ve been exposed and have a fever, call your [general practitioner]. We’ve got to be better than that. If we are going to use our GPs — do they have an emergency line where you can get through? Do they know what to do?
In China, they have set up a giant network of fever hospitals. In some areas, a team can go to you and swab you and have an answer for you in four to seven hours. But you’ve got to be set up — speed is everything.
So make sure your people know [about the virus]. Make sure you have mechanisms for working with them very quickly through your health system. Then enough public health infrastructure to investigate cases, identify the close contacts, and then make sure they remain under surveillance. That’s 90 percent of the Chinese response.
[Continue reading in source article]
Original Source Article »
The multi-sectorial emergency response to a cholera outbreak in Internally Displaced Persons camps in Borno State, Nigeria, 2017 | BMJ Global Health.
[Open Access] [Received September 16, 2019; Revised January 10, 2020; Accepted January 13, 2020; First published January 28, 2020.; Online issue publication January 28, 2020]
What are the new findings?
Authorities were alerted quickly, but outbreak declaration took 12 days due to a 10-day delay waiting for culture confirmation.
Outbreak investigation revealed several potential transmission channels in the camp, but a leaking latrine around the index cases’ house was not repaired for more than 7 days.
Language, coordination and vaccine hesitancy all changed with IDP camp stratification, activation of emergency operations centre and occurrence of cholera death in community, respectively.
What do the new findings imply?
There is need to strengthen laboratory surveillance in Borno, improve water, sanitation and hygiene conditions in IDPs camps, and conduct formative research as part of risk assessment to inform interventions including use of oral cholera vaccine.
Community engagement should precede community entry to facilitate buy-in to technical and behavioural innervations.
Introduction. In August 2017, a cholera outbreak started in Muna Garage Internally Displaced Persons camp, Borno state, Nigeria and >5000 cases occurred in six local government areas. This qualitative study evaluated perspectives about the emergency response to this outbreak.
Methods. We conducted 39 key informant interviews and focus group discussions, and reviewed 21 documents with participants involved with surveillance, water, sanitation, hygiene, case management, oral cholera vaccine (OCV), communications, logistics and coordination. Qualitative data analysis used thematic techniques comprising key words in context, word repetition and key sector terms.
Results. Authorities were alerted quickly, but outbreak declaration took 12 days due to a 10-day delay waiting for culture confirmation. Outbreak investigation revealed several potential transmission channels, but a leaking latrine around the index cases’ house was not repaired for more than 7 days. Chlorine was initially not accepted by the community due to rumours that it would sterilise women. Key messages were in Hausa, although Kanuri was the primary local language; later this was corrected. Planning would have benefited using exercise drills to identify weaknesses, and inventory sharing to avoid stock outs. The response by the Rural Water Supply and Sanitation Agency was perceived to be slow and an increased risk from a religious festival was not recognised. Case management was provided at treatment centres, but some partners were concerned that their work was not recognised asking, ‘Who gets the glory and the data?’ Nearly one million people received OCV and its distribution benefited from a robust infrastructure for polio vaccination. There was initial anxiety, rumour and reluctance about OCV, attributed by many to lack of formative research prior to vaccine implementation. Coordination was slow initially, but improved with activation of an emergency operations centre (EOC) that enabled implementation of incident management system to coordinate multisectoral activities and meetings held at 16:00 hours daily. The synergy between partners and government improved when each recognised the government’s leadership role.
Original Source Article »
Conclusion. Despite a timely alert of the outbreak, delayed laboratory confirmation slowed initial response. Initial responses to the outbreak were not well coordinated but improved with the EOC. Understanding behaviours and community norms through rapid formative research should improve the effectiveness of the emergency response to a cholera outbreak. OCV distribution was efficient and benefited from the polio vaccine infrastructure.
Utah Woman May Be Longest Living Polio Survivor | KSL TV.
[MARCH 5, 2020 AT 7:39 PM]
[View video report in source article]
Heather Simonsen writes:
PANGUITCH, Utah - A Utah woman could be the longest living survivor in the U.S. of a renowned pandemic.
At its peak in the middle of the 20th century, polio killed half a million people every year. Longevity despite hardship came down to one thing: extraordinary strength.
In Butch Cassidy Country, you have to be strong to survive. It's where you'll find 97-year-old Loraine Allen - in a nursing home inside a wing of Garfield Memorial Hospital in Panguitch.
Although hard of hearing, Allen is surrounded by sounds. The sounds she loves most, though are the voices of her family, and memories of a time of struggle.
"I was three years old," said Loraine Allen. ''They thought I had pneumonia. I couldn't walk."
It was polio - a condition that crippled the nation.
For Loraine, that meant numerous surgeries and many doctors. Long before there was such a thing as accessibility, she walked with a severe limp. The teasing at school was relentless.
"Heavens, yes," Loraine said.
She learned to survive by smiling through the pain. The tough times didn't stop her from doing pretty much everything the other kids did.
"I started tap dancing soon as I found out what tap dancing was and I danced clear through college," she said.
Then she met Sam.
"He asked me to dance and we went right on dancing. He was a little jewel," Loraine said.
They married in 1942 and moved to Panguitch.
"A new bride, and I limped. All 500 residents asked me why," she said. "(I would) smile and tell them I had polio."
Two sons came. As decades passed, grandchildren, great-grandchildren, and a great-great-grandchild.
Loraine has a mix of tenderness and toughness in her soul.
"She is the definition of strength," said Kenzie Allen, Loraine's great-granddaughter. "I think she just never had the choice not to be. She's just always been a rock to everybody, and everybody just leans on her. I have never seen my grandmother cry."
For Loraine, the tears came.
"You can hold up pretty good when you're out in the public but when you get home? Wow. I bawled... hard. I bawl a lot. They just don't know it" she said.
Loraine learned tenderness from her father.
Loraine Allen, 97, Is the beloved matriarch of her family. She also may be the longest living polio survivors in the US. She contracted the disease when she was only 3 years old.
“When he’d find me howling because somebody had asked me about limping, he gathered me up and we would go have a little treat,” she said.
Her mom gave her resilience in a tube of red lipstick.
“I was the color of a paper plate after being sick so much,” she said. “When you get feeling really white, put a little color on your lips.'”
Loraine has worn red lipstick every day since.
“I want them to look at my face, not my legs,” she said.
She’s outlived her husband and both sons.
“I’m gonna make it to 100,” Loraine said.
She has survived with endurance honed on the ranch, and courage from those she holds dear.
“From my family,” she said. “Just being there.”
Love that’s never-ending.
Thanks to what’s considered the most successful vaccination campaign of all time, polio was eradicated in the United States in 1979.
For 20 years, Loraine was a healthcare worker who made sure children in rural Utah received their vaccinations.
According to Post-polio International, there’s no way to know for sure if Loraine is the oldest living polio survivor in the US. No organization tracks it, but their experts didn’t know of any survivor older than her.
They said it’s also remarkable that she has lived with the disease for 94 years, since she contracted it at the age of 3.
Original Source Article »
Pakistan Polio Snapshot – January 2020 | GPEI.
Update on polio eradication efforts in Pakistan for January 2020.
[Image is for preview only; please download PDF]
Original Source Article »
Polio this week as of 04 March 2020 | GPEI via ReliefWeb.
[Source: GPEI] [Published: 4 Mar 2020] [Origin: View original]
- It is the run up to International Women’s Day and we are excited to be highlighting some of the tremendous work that women have contributed in the fight against polio. Take a look at Dr Faten Kamel’s journey working against polio in different countries.
- In May 2019, Iran reported an isolation of a wild poliovirus type1 in a sewage sample from Sistan & Balochistan province. The virus was confirmed to be genetically linked to the wild poliovirus from Karachi, Pakistan. This development, per existing global polio programmeguidelines, triggered opening of an ‘Event’. After months of consultations and a high level of poliovirus surveillance sensitivity, the event has now been declared closed therefore eliminating Iran from the list of outbreak countries.
- Summary of new viruses this week (AFP cases and environmental samples):
- Afghanistan: two WPV1 cases
- Pakistan: four WPV1 cases, 16 WPV1 positive environmental samples and six cVDPV2 cases
- Somalia: one cVDPV2 positive environmental sample
- Angola: one cVDPV2 case and two cVDPV2 positive environmental samples
- Chad: four cVDPV2 cases
- Côte d’Ivoire: one cVDPV2 positive environmental sample
- Democratic Republic of the Congo: two cVDPV2 cases
- Ethiopia: one cVDPV2 case
- Malaysia: three cVDPV1 positive environmental samples
Original Source Article »
Download report (PDF | 811.07 KB)
We’re learning a lot about the coronavirus. It will help us assess risk | STAT.
[MARCH 6, 2020]
The coronavirus that causes Covid-19.COURTESY NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES-ROCKY MOUNTAIN LABORATORIES, NIH
Helen Branswell, Senior Writer, Infectious Disease, writes:
It has been two months since China announced a previously unknown virus had been identified as the cause of a new outbreak in the city of Wuhan. In the weeks since then, the coronavirus — now called SARS-CoV2 — has raced around the globe, igniting major outbreaks in Iran, South Korea, Italy, Japan and now, it seems, Seattle.
There are still many, many questions about this virus and the disease it causes, Covid-19. But in a matter of mere weeks, a number of features of the disease have come into focus, through extraordinarily rapid sharing of research.
“Eight weeks into Covid-19, there’s quite a lot that we are learning,” Maria Van Kerkhove, who heads the World Health Organization’s emerging diseases and zoonoses unit, said in a recent interview. (Zoonoses are diseases that jump to people from animals.)
Kerkhove spoke to STAT after returning to the agency’s headquarters in Geneva after two weeks in China, where she was part of an international mission to learn about China’s response to its outbreak.
You can read the mission’s report on the WHO’s site. But interviews with Kerkhove and others help illuminate some of the most interesting findings. Of note: For now, they pertain to the outbreak in China. Some may change as the virus spreads to locations that use different approaches to try to limit its spread.
People are infectious really early in the course of their disease.
When the world saw a SARS outbreak in 2002-2003, one of the reasons it could be contained was because people were most infectious about seven days after they started to be sick — by which point they were generally already in isolation and their contacts were in quarantine. The same has been true in the case of some other related viruses. But Van Kerkhove said early studies on Covid-19 suggest people who have contracted the coronavirus are emitting, or “shedding,” infectious viruses very early on — in fact sometimes even before they develop symptoms.
“We do know from shedding studies that people can shed in the pre-symptomatic phase,” Van Kerkhove said, adding that while the data are still preliminary “it seems that people shed more in the early phases rather than the late phases of disease.”
If people can infect others before they know they themselves are ill, it makes it much more difficult to break the chains of transmission.
“If you are feeling a little bit unwell and you’re in your early stage of disease, you’re not necessarily in hospital. It takes a few days for you to develop more severe disease and you wouldn’t necessarily seek health care. So it does make sense in terms of what we’re seeing with the epidemiology” of the outbreak, Van Kerkhove said.
People can shed virus for weeks after they have recovered. But that doesn’t mean they are infectious.
There have been a number of studies that suggest Covid-19 patients may shed virus in stool or from their throats for some time after they’ve recovered. That naturally raises concerns about whether they are still infectious.
It’s too soon to draw that conclusion.
Testing for these viruses is based on what’s known as PCR — polymerase chain reaction. It’s a process that looks for tiny snippets of the genetic code of the virus in sputum from a throat or nasal swab, or in stool.
Finding that recovered patients are emitting virus fragments does not mean they are shedding whole viruses capable of infecting others. To determine if they are, scientists need to try to grow viruses from the sputum or stool of recovered Covid-19 patients, Van Kerkhove said.
The report from the WHO mission that traveled to China concluded that viable — i.e. potentially infectious — virus has been isolated from stool in some cases, but it questions whether that means much for spread of a virus that attacks the respiratory tract. Those mainly spread by coughs and sneezes.
Van Kerkhove said researchers should follow recovered patients over time to map out whether and how long they remain infectious, testing them at intervals of seven days, 14 days, and 21 days to see if they can grow virus from their sputum.
Truly asymptomatic Covid-19 infections are probably rare.
An early report on a cluster of cases in Germany caused a huge stir when the authors claimed a woman from China who was asymptomatic had infected several colleagues in Germany when she visited her company’s headquarters there.
It was later revealed the woman had had some symptoms while she was in Germany, but sloughed them off as jet lag. Despite that, the authors continue to describe her as having infected others before she became ill.
People infected with Covid-19 who are truly asymptomatic are rare, Van Kerkhove said. Studies in China estimate that about 1.2% of confirmed cases are asymptomatic. But Van Kerkhove said when the scientists on the WHO mission to China pressed for more detail, it became clear that most of the people who were first described as asymptomatic actually were pre-symptomatic — they’d been detected through contact tracing before their symptoms manifested.
“So, very, very few,” she said. “And [asymptomatic cases are] definitely not a major driver of transmission.”
People probably aren’t being re-infected after recovery.
There has been concern on social media about reports of people getting infected, recovering, and then later developing symptoms again. Some scientists from China have suggested the virus is able to re-infect people after a very short time.
Van Kerkhove said this probably is not what is happening. In fact, it would be unusual if an immune system that had just fought off a viral invader would forget how to recognize it and fend it off within a period of days or a few weeks.
What more likely, Van Kerkhove said is this: In order for hospitalized Covid-19 patients to be released after an infection they have to test negative for the virus twice, in tests conducted 24 hours apart. In some cases, people have had the two negative tests — but then tested positive again later.
Van Kerkhove said those results likely reflect more about the way the tests were conducted than about the status of the patient — how a throat swab was taken, for instance. “I don’t think that they’re actually truly negative and then they get re-infected again. It’s likely that they’re still positive for some time.”
Transmission in China happened among family members and close contacts. True “community spread” was less common.
“This virus is not circulating in the community, even in the highest incidence areas across China,” Van Kerkhove insisted.
What’s the difference between spread among close contacts and community spread, you might wonder? Van Kerkhove said the data the mission saw in China pointed to the virus finding its way into households and transmitting there. One family member gets infected and infects others. The “secondary attack rate” — the percentage of people in a household who got infected after someone brought the virus into the home — was between 3% and 10%.
Van Kerkhove said true community spread involves transmission where people get infected in a movie theater, on the subway, or walking down the street. There’s no way to trace back the source of infection because there’s no connection between the infected person and the person he or she infects. That’s not what the Chinese data show, she said.
Marc Lipsitch, an infectious diseases epidemiologist at the Harvard School of Public Health, found this claim puzzling. “I have reached out to the World Health Organization to understand the basis of some of those statements. My perception is that there is significant community transmission, especially when you aren’t aware that someone is sick, because there’s not enough testing,” he said.
China’s Covid-19 outbreak isn’t driven by spread in hospitals.
The SARS outbreak mainly occurred in hospitals. Sick people who weren’t recognized as cases infected other patients nearby or the health workers looking after them. Large hospital outbreaks have also been a feature of MERS infections.
With this new disease, more than 2,000 health workers have become ill. But Van Kerkhove said it seems like most of them were infected at home — something she acknowledged came as a surprise.
“Given our experience with SARS and MERS, I was expecting that there would be large hospital outbreaks,” she said. “But even among the health care worker infections that have been reported to date, when they went back and did interviews with them and then looked at exposures, it’s likely that most of those exposures were in the community rather than in health care facilities.”
That pattern may not hold. With global supplies stretched thin of of N-95 respirators and other equipment needed to protect health workers, there is a real risk of shortages that could put the front line workers at risk, the WHO has warned.
China’s Covid-19 outbreak isn’t driven by spread in schools.
Children and teens make up a smaller proportion of China’s cases than adults do, accounting for just 2.1% of nearly 45,000 cases reported in a study from the China CDC. The WHO report said that in China, about 2.5% of children and teens who became infected developed severe disease and 0.2% developed critical disease. None of the infected children 9 and younger died; only one teenager succumbed to infection.
South Korea, which is grappling with an explosive outbreak, has likewise seen small numbers of infections in children and teens and no deaths in those age groups. Of 6,284 cases, only 0.7% were under the age of nine; 4.6% were ages 10 to 19. A bigger chunk of the total cases, 29.9%, were ages 20 to 29. Even in that age group, South Korea reported no deaths.
“Even when we looked at households, we did not find a single example of a child bringing the infection into the household and transmitting to the parents. It was the other way around,” Van Kerkhove said. “And the children tending to have mild disease.”
If that pattern holds true elsewhere, it would question the value of closing schools to slow spread. But that could happen regardless, if teachers fall ill or families are worried about letting their children attend school.
The big unknown: How deadly is this outbreak?
In order to calculate a case fatality ratio — CFR in epidemiology speak — you need to know how many people have been infected and how many have died. The assumption before the WHO-led team went to China was that there were probably mild cases that hadn’t come to light.
In the report, the team indicated it couldn’t find much evidence of undetected cases. But the only way the world will know for sure is when researchers start testing the blood of people who were not confirmed cases in places where the virus has circulated.
If they find antibodies to the virus in the blood of people who never made the case list, that will change the math. This week the WHO said the case fatality ratio currently looks like 3.4% — which is not a reassuring number.
Researchers have been working feverishly to develop the tests needed to do this kind of research. China has recently licensed a couple of serology tests and Singaporean researchers have developed one as well. More will come on board soon.
Any country or location that has cases should be conducting this type of research, Van Kerkhove said.
“These types of studies should be conducted now,” she said. “This is one of the major things that needs to be done now. And everywhere. Not just in China. In the U.S., in Italy, in Iran — that would give us a better understanding of where this virus is and if we’re truly missing a large number of cases,” she said.
“Until we have population based sero-surveys, we really don’t truly know.”
Original Source Article »
Susan Desmond-Hellmann: The coronavirus is alarming. Here’s why you should not panic | STAT.
[MARCH 6, 2020]
JAMIE MCCARTHY/GETTY IMAGES FOR BILL & MELINDA GATES FOUNDATION
Matthew Herper writes:
Susan Desmond-Hellmann has a unique set of experiences. Until February, she was the CEO of the Bill & Melinda Gates Foundation, where part of her job was thinking up new ways to battle infectious disease. Before that, she was the chancellor of the University of California, San Francisco. In the 2000s, she was one of the most prominent people in the pharmaceutical industry, running drug development at Genentech during its time as one of the most closely watched biotechnology companies.
That made her a perfect person to speak to about the risks posed by the novel coronavirus that causes Covid-19. STAT caught up with her earlier this week. The transcript below has been lightly edited for length and clarity.
My first question about Covid-19 is simple: How worried are you?
I’m very worried. I’m very worried for a couple of reasons. With pandemic preparedness, a respiratory-borne illness was always the big worry. And here we are. The efficiency of spread of Covid-19 has me worried. The fact that individuals who are infected may be mildly symptomatic or asymptomatic and yet transmit the virus makes normal procedures, like telling people to stay home if you’re ill, or taking someone’s temperature as they walk through the airport, ineffective. That puts testing and, really, labor-intensive public health at a premium.
Can we still control community spread at this point?
I’m not confident that we know the answer to that yet. I think the next several weeks will be very important. But I think it is very reasonable to be concerned that in fact we won’t be able to control community spread. We don’t enforce the kind of control measures that we’ve seen enforced in China.
How much do you trust the data coming from other countries on things like transmissibility and mortality?
I think the numbers should all be treated as estimates. It isn’t that I have a trust issue because of anything nefarious. But [data] have to be amended with the expectation that there are many, many mild or asymptomatic cases. And, so even when the number 2% mortality was widely discussed in my mind, I amended it to likely 1% or less.
I still have a big question about young people. Are kids somehow more immune or are they just not at all getting sick? Are they transmitting the infection? But with regard to the high mortality rate in folks with underlying medical conditions, or who are over 60: Those numbers, I think, we need to believe.
What should people do now? We’ve had a really dramatic change in how people are reacting. What is prudent, and what is panic?
I think very simple public health measures are the best thing for the general public to do. The Centers for Disease Control and Prevention website offers steps that are very good: avoiding nonessential travel, especially to high-risk areas; hand-washing, serious hand washing, 20-second hand-washing. Or use those hand sanitizers, but I think people over-rely on hand sanitizers. Really good hand washing is very effective, you just don’t always have access to soap and water. Avoiding touching your face is very important.
If you are sick, call your health care provider. Don’t show up unless you’re very sick. Many workplaces are now banning non-essential travel, which I see as very reasonable. There’s a push to work from home. I also agree with the tenet that schools need to start to talk to parents about what they would do if they had to teach kids at home.
I’ll tell you personally, I’m not stocking up on groceries. And I’m not buying masks. I agree with the surgeon general that we should have masks available for health care providers.
At the Gates Foundation, you were involved in trying to set up a system for developing therapeutics in a pandemic. Where do you think we are with regard to therapeutics and vaccines?
I’m so glad that we invested in CEPI [the Coalition for Epidemic Preparedness Innovations], which is funding aggressive efforts in vaccines. I’m really grateful once again for multinational pharmaceutical companies who are racing to look at vaccines, antibodies, and therapeutics.
But there are two other things I would emphasize. We need to put more emphasis on diagnostics. Diagnostics are under-invested, they’re under-reimbursed and right now, the diagnostics are a bottleneck in public health measures. The second thing is we need to have funding for our local public health departments. This is classic basic shoe-leather epidemiology. And having an effective staffed funded public health department is essential.
The timelines for therapeutics and vaccines are very fast – therapeutics within a year, vaccines within two. Does that sound realistic?
I think it’s reasonable. There needs to be human testing, especially for safety because many, many people won’t have a high mortality or even morbidity, which is why it’s not faster. And everyone wants it even faster. Look at Ebola. With Ebola, there was a very effective vaccine. It wasn’t ready the first time, but it was ready in the recent epidemic and, and made a big difference. In the meantime, therapeutics are also very important.
The high levels of mortality — as high as 15% — being seen in patients who are older than 60 is surprising.
Yes, I’m surprised how high it is. But as we get more cases, I think we’ll see whether or not that’s the truth. But there’s no doubt about it that that over 60 — in some of the cases recently reported out of Washington state, people were in their fifties, but had additional medical conditions — have a very high spike in mortality rates.
There was recently a study of the genetics of the viruses in Washington state that indicated there could be hundreds of cases that went undetected there. How does that change your mental model of what’s happening?
That’s the kind of thing that the Gates Foundation has been doing with partners and collaborators for polio. It’s extremely helpful for disease tracking and understanding an epidemic. You have to make sure you remember that it’s modeling, not truth. But I found it incredibly compelling. What my mental model is moving to is when you have someone very, very sick who goes on a ventilator, that’s probably your evidence that you do have community spread, and there are many, many more cases than you’d think on the surface. Many more. Like hundreds of cases.
Do you have any closing thoughts?
It’s frightening for people to have an unknown virus. And it feels very scary. It is true that most people will be able to protect themselves and their families, and they’re not going to have something that makes them very, very sick. But really think about how sad it is for those people who did get sick and die, and their families. To think that you were in a nursing home, or somebody who was traveling and got sick. … This is really sad. So I do hope we can ramp up the testing and get this thing under control. It’s always good to remember that there are people behind all this.
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Senior Writer, Medicine
Matthew covers medical innovation — both its promise and its perils.