Global & Disaster Medicine

6/17/2019: M 5.8 – 19km S of Changning, China: Left 12 people dead and 135 others injured.

DYFI intensity map

The June 17, 2019, M 5.8 earthquake in the Chinese province of Sichuan occurred as the result of oblique reverse and strike-slip faulting at shallow depths in the crust of the Eurasia plate. Focal mechanism solutions for the event indicate rupture occurred on either a steeply dipping fault striking towards the south, or on a more moderately dipping fault striking towards the northwest. The location, depth and preliminary focal mechanism solution for this earthquake indicate the event occurred as the result of intraplate faulting within the Eurasia plate.

On a continental scale, the seismicity of central and eastern Asia is a result of northward convergence of the India plate against the Eurasia plate at a velocity of about 50 mm/yr. The convergence of the two plates is broadly accommodated by the uplift of the Asian highlands and by the motion of crustal material to the east away from the uplifted Tibetan Plateau.  The June 17 event occurred near the edge of a major uplifted plateau to the south and the Sichuan Basin to the north and may relate to the active tectonics of this juxtaposition.

Seismicity in the region is relatively common, with five earthquakes above M 6.0 within 250 km distance since 1900.  The most recent such event was the August 3, 2014 M 6.2 event near Wenping China, about 200 to the southwest.  Slightly further away, the very large May 12, 2008, M 7.9 Wenchuan earthquake occurred about 330 km northwest of June 17 event.  That event killed more than 69,000 people, with an estimated economic loss of 86 Billion US dollars.


Blackout: All of mainland Argentina and Uruguay lost power early Sunday, affecting tens of millions of people in an unprecedented electrical failure.

NYT

“…..The blackout may have affected a population greater than California’s, across a region four times the size of Texas: Argentina has more than 44 million people, and Uruguay about 3.5 million...….By 10:30 p.m., power had been restored throughout Argentina and in most of Uruguay.….”


Global catastrophic biological risks (GCBRs)

Questioning Estimates of Natural Pandemic Risk
Published Online:
Abstract

Nigeria: CO kills 10 at a wedding and leaves ~30 on life support

Punch

“……Tragedy struck in Imo State on Monday after fumes from a generator left 10 guests who attended a traditional wedding dead…….[N]o fewer than 30 other guests were on life support in different hospitals in the Ikeduru and Mbaitoli Local Government Areas of the state as a result of the fumes they inhaled from the generator…..”

 


6/16/1896: A tsunami originating from an earthquake in the Japan Trench claims up to 27,000 lives

HxC


VAYU

mapimage

PRESS RELEASE-7
Time of issue: 1530 hours IST                                                         Dated: 15-06-2019
Sub: Very Severe Cyclonic Storm ‘VAYU’ over northeast & adjoining eastcentral Arabian Sea

Yesterday’s very severe cyclonic storm “VAYU” over northeast & adjoining eastcentral Arabian Sea (AS) moved nearly westwards during past 24 hours and lay centred at 1430 hrs IST of today, the 15th June, 2019 near latitude 20.7°N and longitude 66.7°E over the same region about 325 km west-southwest of Porbandar (Gujarat), 380 km west-southwest of Veraval (Gujarat) and 435 km nearly west of Diu.
The system is very likely to move nearly westwards during next 24 hours with gradual weakening and recurve northeastwards thereafter and cross north Gujarat coast as a Depression by the evening of 17th June 2019.

Forecast track and intensity are given in the following table: Date/Time(IST) Position (Lat. 0N/ long. 0E) Maximum sustained surface wind speed (Kmph)
Category of cyclonic disturbance
15.06.19/1430 20.7/66.7 120-130 gusting to 145

Very Severe Cyclonic Storm 15.06.19/1730 20.7/66.4 120-130 gusting to 145

Very Severe Cyclonic Storm 15.06.19/2330 20.7/66.0 120-130 gusting to 145

Very Severe Cyclonic Storm 16.06.19/0530 20.9/65.7 100-110 gusting to 125

Severe Cyclonic Storm 16.06.19/1130 21.2/65.9 100-110 gusting to 125

Severe Cyclonic Storm 16.06.19/2330 21.8/66.6 80-90 gusting to 100

Cyclonic Storm 17.06.19/1130 22.5/67.6 55-65 gusting to 75

Deep Depression 17.06.19/2330 23.5/69.0 40-50 gusting to 60 Depression


6/15/1904: More than 1,000 people taking a pleasure trip on New York City’s East River are drowned or burned to death when a fire sweeps through the General Slocum riverboat.

HxC


Vayu

 


WHO Director-General: Though the spread of Ebola to Uganda is a new development, it doesn’t signal a shift in outbreak dynamics.

WHO

14 June 2019

Thank you, Dr Aavitsland,

Good evening from DRC.

I would like to thank Dr Aavitsland for his leadership of the Emergency Committee, and all the members of the committee, as well as the advisors and those who made presentations.

As you have heard, the Emergency Committee has recommended for a third time, and I have agreed, that the current Ebola outbreak in DRC does not constitute a public health emergency of international concern.

Although the outbreak does not at this time pose a global health threat, I want to emphasise that for the affected families and communities, this outbreak is very much an emergency.

Today I have been in Kinshasa to discuss the current Ebola outbreak with the Prime Minister of DRC, the Minister of Health, opposition leaders, donors and others.

Tomorrow I will travel to Goma and Butembo, to meet with our incredible staff and partners who are on the frontline of this outbreak.

I will also be traveling to Uganda to assess the situation.

Since the outbreak started last August, there have been 2108 cases of Ebola, and 1411 deaths. This is tragic.

Although the spread of Ebola to Uganda is tragic, it is not a surprise. We have said since the beginning of the outbreak that the risk of cross-border spread was very high, and it remains very high.

The fact that it has taken this long is a testament to the incredible work of all partners on both sides of the border.

I particularly want to commend the Government of Uganda for the way it has responded. So far, the investments they have made and the plans they have put in place to prepare for Ebola are paying off.

The spread of Ebola to Uganda is a new development, but the fundamental dynamics of the outbreak haven’t changed.

We have the people, the tools, the knowledge, and the determination to end this outbreak.

We need the sustained political commitment of all parties, so we can safely access and work with communities.

We also need the international community to step up its financial commitment to ending the outbreak.

WHO’s current funding needs for the period from February to July are 98 million U.S. dollars, of which 43.6 million dollars has been received, leaving a gap of 54 million dollars. We call on all our partners to fill this gap as soon as possible.

I will not hesitate to convene it again if needed.

Thank you.

DRC:

Total cases: 2108
– Confirmed cases: 2014
– Probable cases: 94

Deaths: 1411
– Confirmed: 1317
– Probable: 94


Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo

WHO

14 June 2019

The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding Ebola virus disease in the Democratic Republic of the Congo (DRC) took place on Friday, 14 June 2019, from 12:00 to 17:00 Geneva time (CEST).

Context and Discussion

The Committee expressed its deep concern about the ongoing outbreak, which, despite some positive epidemiological trends, especially in the epicentres of Butembo and Katwa, shows that the extension and/or reinfection of disease in other areas like Mabalako, presents, once again, challenges around community acceptance and security. In addition, the response continues to be hampered by a lack of adequate funding and strained human resources.

The cluster of cases in Uganda is not unexpected; the rapid response and initial containment is a testament to the importance of preparedness in neighbouring countries. The Committee commends the communication and collaboration between DRC and Uganda.

At the same time, the exportation of cases into Uganda is a reminder that, as long as this outbreak continues in DRC, there is a risk of spread to neighbouring countries, although the risk of spread to countries outside the region remains low.

The Committee wishes to commend the heroic work of all responders, who continue to work under extremely challenging and stressful conditions.

The Committee extensively debated the impact of a PHEIC declaration on the response, possible unintended consequences, and how these might be managed. Differing views were expressed, as the Committee acknowledged that recent cases in Uganda constitute international spread of disease.

Conclusions and Advice

It was the view of the Committee that the outbreak is a health emergency in DRC and the region but does not meet all the three criteria for a PHEIC under the IHR. While the outbreak is an extraordinary event, with risk of international spread, the ongoing response would not be enhanced by formal Temporary Recommendations under the IHR (2005).

The Committee provided the following public health advice, which it strongly urges countries and responding partners to heed:

  • At-risk countries should improve their preparedness for detecting and managing exported cases, as Uganda has done.
  • Cross-border screening in DRC should continue and its quality improved and sustained.
  • Continue to map population movements and sociological patterns that can predict risk of disease spread.
  • All priority countries should put in place approvals for investigational medicines and vaccines as an immediate priority for preparedness.
  • Optimal vaccine strategies that have maximum impact on curtailing the outbreak, as recommended by WHO’s Strategic Advisory Group of Experts (SAGE), should be implemented rapidly.
    • The Committee is deeply disappointed that WHO and the affected countries have not received the funding and resources needed for this outbreak. The international community must step up funding and support strengthening of preparedness and response in DRC and neighbouring countries.
    • Continue to strengthen community awareness, engagement, and participation. There has been a great deal of progress in community engagement activities. However, in border communities, where mobility is especially likely, community engagement needs to be more sharply targeted to identify the populations most at risk.
    • The implementation by the UN and partners of more coordinated measures to reduce security threats, mitigate security risks, and create an enabling environment for public health operations is welcomed and encouraged by the Committee as an essential platform for accelerating disease-control efforts.
    • The Committee strongly emphasizes its previous advice against the application of any international travel or trade restrictions.
    • The Committee does not consider entry screening at airports or other ports of entry to be necessary.
  • The Committee advised the WHO Director-General to continue to monitor the situation closely and reconvene the Emergency Committee as needed.

    Proceedings of the meeting

    Members and advisors of the Emergency Committee were convened by teleconference.

    Because the Chair, Dr Robert Steffen, was unable to attend the meeting in person, Dr Preben Aavitsland chaired the proceedings.

    The Director-General welcomed the Committee by phone from the Democratic Republic of the Congo.

    Representatives of WHO’s legal department and the department of compliance, risk management, and ethics briefed the Committee members on their roles and responsibilities, as well as the requirements of the IHR and the criteria that define a PHEIC: an extraordinary event that poses a public health risk to other countries through international spread and that requires a coordinated international response. The Committee’s role is to give advice to the Director-General, who makes the final decision on the determination of a PHEIC. The Committee also provides advice or temporary recommendations as appropriate.

    Committee members were reminded of their duty of confidentiality and their responsibility to disclose personal, financial, or professional connections that might be seen to constitute a conflict of interest. Each member was surveyed and no conflicts of interest were identified.

    The Chair then reviewed the agenda for the meeting and introduced the presenters. Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo and of the National Communicable Disease Control Commission of Uganda.

    The situation in the Democratic Republic of the Congo was reviewed, including the current epidemiological situation and response strategies, including changes instituted to improve community engagement. Sustained, serious security incidents, which have resulted in injuries and deaths among responses have seriously impeded the response. There have been four waves of the outbreak since August 2018, but during the last month there has been a reduction in numbers of cases. Active case-finding for missing contacts is ongoing. Factors contributing to the ongoing outbreak include population movement, health-seeking behavior directed to traditional healers, poor infection prevention and control measures in health facilities, security challenges, and lack of involvement by political leaders.

    Representatives of the National Communicable Disease Control Commission in Uganda reviewed recent cases, contacts, and contact tracing. They updated the Committee on their response actions, including notification to WHO and political involvement, and preparedness activities that have been taking place since August 2018. A national coordination task force has been activated and a rapid response team deployed. Clinical management is available in an Ebola Treatment Unit in Bwera. Screening is taking place at official points of entry. Ring vaccination will begin on 15 June.

    A representative of the WHO Regional Office for Africa presented the status of regional preparedness activities, particularly in Burundi, Rwanda, South Sudan, and Uganda. Ongoing challenges were noted, especially at district/subnational levels, as well as inadequate crossborder collaboration and a lack of funding to sustain preparedness activities.

    A representative of the International Organization for Migration updated the Committee on prevention, detection, and control measures at points of entry, for cross-border preparedness.

    The UN Ebola Emergency Response Coordinator gave an update on the security situation and efforts to create a dynamic, nimble enabling environment to support outbreak response. There have been frequent disruptions to the response, which has had implications for increased numbers of cases. UN-wide support is needed to strengthen the public health response and coordinate international assistance. Access and community acceptance are increasing, with decreases in cases in some areas. Increases in attacks in some areas are being addressed.

    The WHO Secretariat gave an update on the current situation and provided details on the response to the current Ebola outbreak and preparedness activities in neighbouring countries. The risk assessment for DRC remains very high at national and regional levels but low at global level. Risk in Uganda remains moderate at the national level and low and regional and global levels. However, the high risks of the Uganda event have been mitigated by rapid communication and coordination among authorities across jurisdictions; detection at points of entry and subsequent response activities; and operational preparedness and readiness in Uganda. A high level of cooperation and transparency between DRC and Uganda was noted with appreciation.

    There has been an overall decline in case incidence in the last 5 weeks, but substantial rates of transmission continue, especially in a few hotspots. IPC measures, safe burials, and population mobility were reviewed, along with details of contact tracing. Operational scale-up was reviewed and a serious need for funding, both for the response and for preparedness, was underscored. Less than one-third of the resources needed are available; presently there is a funding shortfall of USD $54 million against $98 million needed for the response through July 2019.

    Based on the above advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment that the Ebola outbreak in the Democratic Republic of the Congo does not constitute a Public Health Emergency of International Concern. In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.


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