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Book of the day: The Rules of Contagion by Adam Kucharski review – outbreaks of all kinds | The Guardian.

[Wed 25 Mar 2020 07.30 GMT]

Modellers have a saying: "If you've seen one pandemic, you've seen ... one pandemic." But patterns can be established to do with how things spread.

Nurses care for victims of the Spanish flu outbreak, 1918.

Nurses care for victims of the Spanish flu outbreak, 1918. Photograph: Hulton Archive/Getty Images

Laura Spinney writes:

Did you notice? There was a moment when something shifted, and all topics of conversation besides Covid-19 started to sound trivial. Things will surely shift again, as people realise that the self-confinement could last and escapism becomes our collective goal, but for now Adam Kucharski’s The Rules of Contagion is the book you might want to reach for. Not least – given that the present pandemic is very much in the ascendant – for its subtitle: Why Things Spread – and Why They Stop.

Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine, tells the story of the mathematical modelling of infectious disease, about which we have heard so much lately. The book’s hero is Ronald Ross, the British doctor who in the late 19th century discovered that mosquitoes spread malaria and was rewarded with the 1902 Nobel prize in physiology or medicine.

Ross wasn’t the first to describe an epidemic mathematically, but he was the first to do so armed with a thorough understanding of the biological and social processes that shape it, and this made all the difference. Whereas others had looked backwards, observing how epidemics unfolded over time, he looked forwards, making predictions about the course of an outbreak and how various interventions might affect it. His ideas form the basis of modern disease modelling, and of our governments’ strategies to combat Covid-19. It’s partly thanks to Ross that we have the concept of herd immunity – hopeful because it means that not every mosquito has to be squashed, not every person has to be vaccinated, for a population to be protected against a disease.

A Red Cross worker pours a sanitising gel into a driver’s hand in Dakar, Senegal.

A Red Cross worker pours a sanitising gel into a driver’s hand in Dakar, Senegal. Photograph: Zohra Bensemra/Reuters

Epidemic is a Greek word meaning “on the people”, and until Hippocrates requisitioned it to refer exclusively to the spread of a disease, the Greeks applied it to anything that percolated through a population – from fog to rumour to civil war. What’s striking about Kucharski’s tale is how we’ve circled back to that pre-Hippocratic outlook. Ross and mathematician Hilda Hudson set the ball rolling when they folded their ideas about the spread of disease into a broader “theory of happenings”, but they distinguished between “dependent” happenings, such as a contagious disease, and “independent” happenings, which could not be passed from person to person. In the latter category they placed accidents, divorce and chronic diseases – the kind that kill most of us today.

A century on, ideas have changed. Now the thinking is that many of the things that Hudson and Ross might have considered independent – obesity, smoking, even loneliness – are catching, too. We talk about financial contagion and epidemics of knife crime, and methods borrowed from public health are being applied to try to nip these problems in the bud, or at least slow their spread. Remember when Glasgow had the ignominious reputation of being the murder capital of Europe, known for its signature “Glasgow smile”? Then the Violence Reduction Unit was set up there in 2005, modelled on similar projects in the US, and the city’s homicide rate was cut by two-thirds.

Ross would be surprised, gratified and perhaps also slightly amused. The man who explained that a disease can only get a foothold in a population if new infections outnumber recoveries complained in his lifetime about how long it took for new thinking – his – to catch on. “The world requires at least 10 years to understand a new idea,” he wrote, “however important or simple it may be.” In the 21st century, everyone has got with the programme, including marketers whose goal is to ramp up the transmissibility of an idea or meme as far as they possibly can. Just like the Covid-19 modellers, they build whole strategies around the reproduction number R – the classic measure of the transmissibility of a happening.

The trading floor of the New York Stock Exchange after workers tested positive for Covid-19 on 19 March.

The trading floor of the New York Stock Exchange after workers tested positive for Covid-19 on 19 March. Photograph: Lucas Jackson/Reuters

It’s notable, too, that Kucharski’s protagonists flit easily between the very disparate worlds in which these models are now routinely applied. Marine ecologist George Sugihara was wooed away from his study of fish populations to build predictive models for Deutsche Bank. “Basically,” he observed later, “I modelled the fear and greed of mobs that trade.” Epidemiologist Gary Slutkin moved from public health in Africa to crime reduction in Chicago, and Kucharski himself interned at an investment bank in Canary Wharf before turning his attention to the spread of dengue fever and Zika virus disease in the Pacific. And on the theme of crossovers, he includes the pleasing anecdote that bookseller Thomas Guy got out of the South Sea Company just before that particular bubble burst in 1720, and used his profits to found Guy’s Hospital in London. Isaac Newton wasn’t so lucky. “I can calculate the motion of heavenly bodies but not the madness of people,” he allegedly said, after losing the equivalent of £20m in today’s money.

One of the most interesting and topical parts of the book is about the mathematical modelling of fake news. We already knew this was contagious – albeit with its own specific mechanisms of contagion – but as we are seeing yet again, a pandemic of fake news can feed off, and interact with, a pandemic of infectious disease. Happily, the modellers are beginning to get a handle on how fake news spreads, and how to stop it, and their insights are already being translated into practice. In the Democratic Republic of the Congo, which now has Covid-19, polio and measles as well as Ebola, a third of the workforce involved in the Ebola response are social scientists whose job is to build bridges with local people, understand their thinking around the disease, and reinforce sound information while countering rumours.

Memory, too, is contagious – and so is forgetting. We collectively forgot the worst catastrophe of the 20th century, the so-called “Spanish” flu that happened just over a century ago, and now it’s all anyone can talk about. Will that revived memory outlast the new pandemic, or will it sink back into the sediment of our minds as soon as the danger has passed, and the social networks have moved on? It’s too early to say, but one could argue that our long forgetting of that pandemic weakened our incentive for investing in healthcare systems and doing all the other things that public health experts have been urging us to do for decades, to prepare ourselves for the next one. A contagion of forgetting prompted a pandemic which prompted a contagion of remembering.

Modellers have a saying: “If you’ve seen one pandemic, you’ve seen … one pandemic.” Covid-19 doesn’t behave like flu, which doesn’t behave like Ebola. The title of The Rules of Contagion refers to the things that are common to all pandemics – from the ice bucket challenge to bitcoin to infectious diseases – rather than those that are peculiar to each one. Modellers have spent the last century teasing out those rules, and now their conclusions are being put to the mother of all tests. This book explains how they arrived at them, and why they indicate that what each of us does next will make a difference. There may still be a lot of uncertainty around Covid-19, but one thing is clear: for Kucharski and his fellow modellers, it will be one more learning experience.


Laura Spinney's Pale Rider: The Spanish Flu of 1918 and How It Changed the World is published by Vintage. The Rules of Contagion is published by Profile (RRP £16.99). To order a copy go to Free UK p&p over £15.

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Afghanistan: Weekly Humanitarian Update (16 March to 22 March 2020) | ReliefWeb.

[Source: OCHA] [Published: 25 Mar 2020] [Origin: View original]

Northeast: Over 8,000 people received humanitarian assistance.

Fighting between a Non-State Armed Group (NSAG) and Afghan National Security Forces (ANSF) continued in Badakhshan, Baghlan, Kunduz and Takhar provinces.

Between 20 and 21 March, severe flooding and rainfalls caused the destruction of homes in Khowja Ghar, Dashti Qala and Rostaq districts in Takhar province. Inter-agency assessments teams were deployed to assess humanitarian needs.

During the reporting period, 8,736 people affected by conflict received humanitarian assistance in Badakhshan, Baghlan and Kunduz provinces. Moreover, 637 internally displaced persons (IDPs) affected by conflict were assessed and will receive assistance in the coming days in Baghlan province.

East: Almost 8,000 people received humanitarian assistance.

Clashes continued between the ANSF and an NSAG in Sherzad and Mohmand Dara districts in Nangarhar, Ghaziabad district in Kunar, Alishang district in Laghman provinces.

Last week, interagency assessment teams identified 3,843 IDPs to receive humanitarian assistance in the coming days across the eastern part of the country; and 7,978 IDPs and returnees received humanitarian assistance in Nangarhar, Laghman and Kunar provinces. In addition, 6,890 returnees, IDPs and people from host communities were reached with emergency outpatient health services. A total of 5,389 children were vaccinated for polio and measles.

North: First COVID-19 death confirmed in Balkh.

Fighting between an NSAG and ANSF continued in Balkh and Faryab provinces.

According to the Ministry of Public Health, one person died of COVID-19 on 22 March in Balkh province which was the first death from the virus in Afghanistan.

1,099 IDPs affected by conflict received humanitarian assistance in Sar-e-Pul and Jawzjan provinces. Also, interagency assessment teams identified 1,652 people displaced by conflict in Balkh, Faryab, Sar-e-Pul and Jawzjan provinces to receive humanitarian assistance in the coming days.

South: Ongoing fighting displaced people in Zabul and Hilmand.

Fighting continued between an NSAG and the ANSF in Hilmand, Kandahar and Zabul provinces. According to initial reports, ongoing fighting displaced 50 families (approximately 350 people) in Arghandab district in Zabul province. Also, ongoing clashes in Nahr-e-Saraj district in Hilmand province reportedly displaced some families and resulted in the injury of three civilian including a child according to initial reports.

199 IDPs affected by conflict received humanitarian assistance in Zabul province. Inter-agency assessment teams identified 2,297 people who were displaced by conflict to receive humanitarian assistance in the coming days in Hilmand and Nimroz provinces. Needs assessments for IDPs affected by conflict are ongoing for 2,640 people in Kandahar and Hilmand provinces.

Centre: Over 1,000 people received humanitarian aid.

406 IDPs affected by natural disasters received humanitarian assistance in Daykundi and Paktya provinces. In addition, 777 IDPs affected by conflict received cash and water, sanitation and hygiene (WASH) assistance in Paktya province.

West: Restricted movement announced in Hirat.

Fighting continued between an NSAG and the ANSF in Shindand district in Hirat, Balamurghab district in Badghis provinces. Jawand district in Badghis province remained under the control of an NSAG which interrupted the delivery of food assistance to people in need in the Badghis district administrative centre and its surrounding villages.

A total of 767 IDPs were assessed and assisted in the western part of the country. Needs assessments are ongoing in Badghis, Ghor and Hirat provinces.

The Hirat Provincial Governor announced in a public statement a restriction on movement due to COVID-19 starting 25 March along with plans to disinfect Hirat city. Further details on accessing essential services will be shared shortly. The implications of these measures on humanitarian operations are being assessed.

Contact tracing for the people confirmed with COVID-19 is ongoing with confirmed cases in Hirat, Samangan, Balkh, Daikundi, Farah, Kapisa, Badghis, Logar, Zabul, Kandahar, Ghazni and Kabul provinces. Most people with the virus have a travel history outside Afghanistan. To date, testing has been small scale which may account for the relatively low number of confirmed cases given the high number of border crossings with Iran where there are thousands of cases.

Funding Update.

A $1.5 million Afghanistan Humanitarian Fund (AHF) Reserve Allocation for the COVID-19 response was disbursed to the WHO last week. The AHF is completing the first Standard Allocation totalling $20 million for multi-cluster response for approval by the Humanitarian Coordinator next week. To support COVID-19 response, the Humanitarian Coordinator is planning to disburse remaining AHF funds (approximately $10 million) through reserve allocations, including to keep the vital UN Humanitarian Air Service operational.

UN Office for the Coordination of Humanitarian Affairs :
To learn more about OCHA's activities, please visit

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The deadly polio epidemic and why it matters for coronavirus | The Conversation.

[March 25, 2020 12.27pm GMT] Carl Kurlander writes:

The fear and uncertainty surrounding the coronavirus pandemic may feel new to many of us. But it is strangely familiar to those who lived through the polio epidemic of the last century.

Like a horror movie, throughout the first half of the 20th century, the polio virus arrived each summer, striking without warning. No one knew how polio was transmitted or what caused it. There were wild theories that the virus spread from imported bananas or stray cats. There was no known cure or vaccine.

For the next four decades, swimming pools and movie theaters closed during polio season for fear of this invisible enemy. Parents stopped sending their children to playgrounds or birthday parties for fear they would “catch polio.”

In the outbreak of 1916, health workers in New York City would physically remove children from their homes or playgrounds if they suspected they might be infected. Kids, who seemed to be targeted by the disease, were taken from their families and isolated in sanitariums.

In 1952, the number of polio cases in the U.S. peaked at 57,879, resulting in 3,145 deaths. Those who survived this highly infectious disease could end up with some form of paralysis, forcing them to use crutches, wheelchairs or to be put into an iron lung, a large tank respirator that would pull air in and out of the lungs, allowing them to breathe.

Ultimately, poliomyelitis was conquered in 1955 by a vaccine developed by Jonas Salk and his team at the University of Pittsburgh.

In conjunction with the 50th anniversary celebration of the polio vaccine, I produced a documentary, “The Shot Felt ‘Round the World,” that told the stories of the many people who worked alongside Salk in the lab and participated in vaccine trials. As a filmmaker and senior lecturer at the University of Pittsburgh, I believe these stories provide hope in the fight to combat another unseen enemy, coronavirus.

Pulling together as a nation.

Before a vaccine was available, polio caused more than 15,000 cases of paralysis a year in the U.S. It was the most feared disease of the 20th century. With the success of the polio vaccine, Jonas Salk, 39, became one of the most celebrated scientists in the world.

He refused a patent for his work, saying the vaccine belonged to the people and that to patent it would be like “patenting the Sun.” Leading drug manufacturers made the vaccine available, and more than 400 million doses were distributed between 1955 and 1962, reducing the cases of polio by 90%. By the end of the century, the polio scare had become a faint memory.

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Two Drops of Life: India’s Path to End Polio | JSTOR Daily.

[March 24, 2020]

On the eve of its 6th polio-free anniversary, India immunizes over 170 million children, despite a lack of roads, reinfection threats, and a periodic mistrust of vaccines.


Lina Zeldovich

Lina Zeldovich writes:

Wrapped in a colorful yellow scarf, polio immunizer Rajbala stands among a vibrant crowd of parents and children, holding her records folder to her chest. Around her swirls a colorful chaos of mothers carrying their youngsters to get vaccinated against poliomyelitis—a viral disease that can attack the spinal cord, causing paralyses. Another immunizer, named Alka, holds a small bottle containing the oral polio vaccine over each child’s mouth and squeezes it slightly, making sure the two requisite drops make it right in. As one young mother walks off, an elderly woman with a baby takes her place. “This is my granddaughter,” she says proudly, squeezing the infant’s cheeks to get her mouth opened.

Rajbala, Alka and hundreds of their colleagues are administering these oral vaccines as part of India’s National Immunization Day (NID), a multi-day annual occurrence that usually takes place in January. Just this year alone, the country aimed to immunize over 174 million children under five years old against polio. Alka has been doing it for ten years, and Rajbala for 28. She still remembers how polio crippled people, leaving some unable to walk and only to crawl. Others couldn’t feed themselves or do any work, because their hands wouldn’t obey them. You can still find some adults who got paralyzed by polio in childhood, but today you rarely see kids afflicted by it—thanks to the country’s persistent vaccination efforts. That’s exactly why Rajbala and Alka stand at their immunization booth in Chandmari Jhuqq, an urban slum of Ghaziabad, a city in India’s state of Uttar Pradesh.

Rajbala and Alka. Photo by Lina Zeldovich

Rajbala remembers that when the vaccinations first started, people were afraid of them. They used to throw stones at the vaccinators. They pretended they weren’t home. They hid the children. Today, this doesn’t happen, but occasionally some residents do resist campaigns. This time around, some locals wouldn’t let the immunizers put their booth here, so the team had to ask the police for help. But the police didn’t apply force, Rajbala adds. They just reasoned with the people, and eventually the team was able to set up camp. In two days, they were able to vaccinate 163 children out of the 165 that Rajbala has on her list. If the remaining two don’t show up, the team will stop by their houses. They will go door to door, checking all the remaining households, making sure to vaccinate those kids whose parents didn’t make it to the booth—it’s crucial that there’s not a single child left.

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