Archive for March, 2018
14 people, including four children, were hospitalized after a mass botulism food poisoning outbreak in southern Kyrgyzstan.
Thursday, March 15th, 2018
WHO renews its call for the protection of health workers and for immediate access to besieged populations.
Thursday, March 15th, 2018Seven years of Syria’s health tragedy
14 March 2018 | Geneva – After seven years of conflict in Syria, WHO has renewed its call for the protection of health workers and for immediate access to besieged populations.
Attacks on the health sector have continued at an alarming level in the past year. The 67 verified attacks on health facilities, workers, and infrastructure recorded during the first two months of 2018 amount to more than 50% of verified attacks in all of 2017.
“This health tragedy must come to an end,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Every attack shatters communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.”
Health systems are being attacked in the very places where they are needed most. An estimated 2.9 million Syrians live in UN-declared hard-to-reach and besieged locations. WHO is providing health assistance to many of these areas but lacks consistent access.
In East Ghouta, nearly 400,000 people have lived under siege for half a decade. Basic health supplies have all but run out, and there are now more than 1,000 people in need of immediate medical evacuation.
“It is unacceptable that children, women, and men are dying from injuries and illnesses that are easily treatable and preventable,” said Dr Tedros.
Critical medical supplies are also routinely removed from inter-agency convoys to hard-to-reach and besieged locations. Earlier this month, more than 70% of the health supplies intended to reach East Ghouta were removed by authorities and sent back to the WHO warehouse. The items removed are desperately needed to save lives and reduce suffering.
Seven years of conflict have devastated Syria’s healthcare system. More than half of the country’s public hospitals and healthcare centres are closed or only partially functioning and more than 11.3 million people need health assistance, including 3 million living with injuries and disabilities.
WHO is committed to ensuring that people across Syria have access to essential, life-saving healthcare. Last year, WHO delivered over 14 million treatments across the country, including through cross-border and cross-line services.
“The suffering of the people of Syria must stop. We urge all parties to the conflict to end attacks on health, to provide access to all those in Syria who need health assistance, and, above all, to end this devastating conflict,” said Dr Tedros.
It works! Sending community health workers door-to-door to look for sick kids in Mali
Thursday, March 15th, 2018“…..When the study began in 2008, one in seven children in the Bamako region died before the age of five. By 2015, that had fallen to one in 142, which is comparable to the rate in the United States. This level would meet the UN’s goal of reducing deaths among children under five to no more than 25 deaths per 1,000 live births by 2030…..
The intervention sent health workers to people’s homes to ask about children’s well-being, provided care at the doorstep and triaged the sickest patients to health care facilities. The community health care workers provided counseling, diagnosed malaria for people of all ages, as well as pneumonia, diarrheal disease and malnutrition for children under five. They treated the uncomplicated cases, and referred patients with danger signs or conditions that were outside their scope of practice to primary health centers.
Over the course of the study, the percentage of young children who had fevers was cut in half and the number of patient visits in the home and the clinic increased by ten times.
The workers offered antimalarial treatment, and the number of children with fevers who received antimalarial treatment within 24 hours of the onset of their symptoms more than doubled, from about 15 percent to just over 35 percent.
The intervention also strengthened government primary care facilities with more infrastructure, training, and staff. And workers were on call, in case someone needed their services. They also made follow-up visits to help patients adhere to their therapy, particularly in the case of diarrheal disease, and searched for sick newborns, pregnant women and those who had just given birth and needed care, to evacuate them to primary care facilities for treatment.
The approach, which the researchers called Proactive Community Case Management, cost between $6 and $13 dollars per person, per year, over what the government was already spending on health care.
During the seven years of the study, the childhood mortality rate in Mali was falling, although not by much, and in 2015, it was still among the highest in the world at 114 deaths per 1,000 live births. By contrast, that same year, the area of the intervention had a child mortality rate of 7 deaths per 1,000 live births. The researchers are currently at work on a large-scale randomized trial that will follow 100,000 people at 137 different sites to see if door-to-door home visits by community health workers lowers childhood mortality……”
Monsoon season: The world’s largest refugee camp, a temporary home to more than half a million Rohingyas that sprawls precariously across barren hills in southeastern Bangladesh may soon face landslides, flash floods, & inundation.
Thursday, March 15th, 2018Antismoking Activists Face Threats and Violence in Certain Parts of the World
Wednesday, March 14th, 2018“……They were first quietly warned that they were upsetting cigarette companies, tobacco farmers or government officials connected to the industry. If the activists persisted, threats or violence escalated suddenly and unpredictably……”
A United States-FAO partnership working to strengthen the capacity of developing countries to manage outbreaks of diseases in farm animals has in just 12 months succeeded in training over 4,700 veterinary health professionals in 25 countries in Africa, Asia and the Middle East.
Wednesday, March 14th, 2018March 2018, Rome – A United States-FAO partnership working to strengthen the capacity of developing countries to manage outbreaks of diseases in farm animals has in just 12 months succeeded in training over 4,700 veterinary health professionals in 25 countries in Africa, Asia and the Middle East.
The FAO-provided technical trainings covered a gamut of key competencies, including disease surveillance and forecasting, laboratory operations, biosafety and biosecurity, prevention and control methods and outbreak response strategies.
All told, 3,266 vets in Asia, 619 in West Africa, 459 in East Africa, and 363 in the Middle East benefitted. They are on the front line of the effort to stop new diseases at their source. (Full list below)
“Over the course of this relationship we’ve learned that there are many mutually beneficial areas of interest between the food and agricultural community and the human health community,” said Dennis Carroll, Director of USAID’s Global Health Security and Development Unit.
“A partnership with FAO not only enables us to protect human populations from future viral threats, but also to protect animal populations from viruses that could decimate food supplies. It’s not just a global health, infectious disease issue, but also a food security, food safety, and economic growth issue,” Carroll added.
“Some 75 percent of new infectious diseases that have emerged in recent decades originated in animals before jumping to us Homo sapiens, a terrestrial mammal. This is why improving adequately discovering and tackling animal disease threats at source represents a strategic high-ground in pre-empting future pandemics,” said Juan Lubroth, FAO Chief Veterinary Officer
“A proactive approach is absolutely critical, and for that, the world needs well-trained, up-to-speed professionals — biologists, ecologists, microbiologists, modellers, physicians and veterinarians — which is why the United States’ consistent support for building up that kind of capacity has been invaluable,” Lubroth said.
Viral risks
Population growth, agricultural expansion and environmental encroachment, and the rise of inter-continental food supply chains in recent decades have dramatically altered how diseases emerge, jump species boundaries, and spread, FAO studies have shown.
A new study just published by USAID’s Dennis Carroll and experts from several institutions including FAO suggests that just 0.01 percent of the viruses behind zoonotic disease outbreaks are known to science. The authors have proposed an international partnership, The Global Virome Project, aimed at characterizing the most risky of these. Doing so would allow more proactive responses to disease threats, with benefits not only for public health but also for the livelihoods of poor, livestock-depending farming communities.
Partnering for global health security
The close FAO-USAID partnership on animal health goes back over a decade.
Experts from the two organizations are meeting in Rome this week to review progress achieved in the past year and how to respond to threats like species-jumping zoonotic illnesses and the growing trends of antimicrobial resistance and options for intervention measures in food production and protection of public health.
In addition to trainings, via the USAID- Emerging Pandemic Threats (EPT) programme, FAO conducts research and advises on policy in order to help countries increase their resilience to disease emergence and protect animal and human health.
And to enable rapid responses by governments to disease events FAO has leveraged USAID support to work with the United Nations Humanitarian Response Depots to establish a series of emergency equipment and gear stockpiles in 15 countries that facilitate rapid and adequate responses to outbreaks.
FAO is also key player and advisor to the Global Health Security Agenda (GHSA), a growing partnership of over 60 countries, NGOs and international organizations working to improve early detection of and responses to infectious disease threats. USAID support under the GHSA umbrella is helping FAO engage with 17 countries in Africa and Asia to strengthen capabilities to detect and respond to zoonotic diseases.
Thanks to USAID support for the EPT and GSHA, FAO is actively tackling disease issues and building national capacities in over 30 countries
Economic impacts as well as health consequences
Beyond the risks posed to human health, animal diseases can cost billions of dollars and hamstringing economic growth.
The most damaging outbreaks of high impact disease in recent decades all had an animal source, including H5N1 highly pathogenic avian influenza, H1N1 pandemic influenza, Ebola, severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
For example, the H5N1 outbreak of the mid-2000s caused an estimated $30 billion in economic losses, globally; a few years later, H1N1 racked up as much as $55 billion in damages.
Not to mention that for millions of the world’s poorest people, animals are their primary capital assets — “equity on four legs”. Losing them can push these families out of self-reliance and into destitution.
Note to editors. The countries where the trainings took place were: Bangladesh, Burkina Faso, Cambodia, Cameroon, China, Democratic Republic of the Congo, Egypt, Ghana, Guinea, Indonesia, Jordan, Kenya, Laos People’s Democratic Republic , Liberia, Mali, Myanmar, Nepal, Senegal, Sierra Leone, United Republic of Tanzania, Uganda and Viet Nam.
The nerve agent Novichok is believed to be orders of magnitude more lethal than sarin or VX.
Wednesday, March 14th, 2018“…..Novichok nerve agent, a weapon invented for use against NATO troops, was released in the quiet town of Salisbury, its target a former Russian spy named Sergei V. Skripal. Mr. Skripal and his daughter, Yulia, collapsed onto a bench in a catatonic state on March 4, and remain hospitalized, in critical condition.……”
A plane carrying 71 passengers and crew has crashed on landing at Nepal’s Kathmandu airport, killing 49
Tuesday, March 13th, 2018Pandemic planning: Ethical epidemic response
Monday, March 12th, 2018Flu season and pandemic planning: Ethical epidemic response
Triage and ethical considerations in prioritizing care for healthcare professionals and the public in an influenza pandemic
Feb 28, 2018
By Jeffery A. King, faculty, American Military University
The Centers for Disease Control and Prevention recently signaled that the 2017-2018 flu season is expected to meet the criteria for a “high severity” epidemic. At the end of January, there were more than 83,000 reported cases of flu with heightened mortality. This year’s viruses are beginning to overwhelm healthcare providers around the country. The challenge of caring for so many is only compounded by shortages of rapid influenza diagnostic tests, Tamiflu, IV bags, and even bed space in many hospitals.
Trials like this can force public health officials and healthcare providers into the unenviable position of making impulsive and impactful decisions during unprecedented situations. As with so many other public safety initiatives, these decisions can test American ethics by pitting individual liberties and other shared values against approaches that are hard to swallow but often necessary to achieve a greater good. Here are a few ethical challenges to consider for current and future pandemic planning.
Ethical challenges: how to prioritize care?
One of the more difficult challenges that can arise for public health and healthcare decision-makers is the task of prioritizing care among otherwise equally affected patients. It is worth pointing out that during an epidemic, patients cannot always be directed to other facilities, and medicine and equipment cannot always be borrowed or redistributed because multiple regions are suffering from similar shortages.
Determining how patients are prioritized and how treatment is managed when there simply are not enough personnel, beds, equipment or medicine is a morally unpleasant choice. Providers can either treat patients on a first-come, first-served basis, which could leave scores without appropriate healthcare, or they can triage patients based on factors like the relative acuteness of their illness, overall health, age and other characteristics.
Triage during a resource-constrained epidemic might exclude many of those who are too sick or who would require overly intensive care, thus allowing concentrated effort on those most likely to recover. Beyond the deathly ill, what other factors might the public consider justifiable toward accomplishing the greater good? Is it only acceptable under epidemic conditions to deny treatment to complex cases, such as those with other acute or chronic health conditions, the disabled or the elderly? If the elderly are to be denied treatment, at what age would the limit be set? What about an elderly physician or nurse who may be able to assist in the response if she can recover?
All of these decisions require consequentialist thinking – an attempt to justify decisions by their expected outcomes. The difficulty with a consequentialist approach is that decisions can easily slide into the arbitrary depending on context, variables, and the decision-maker’s subjective appraisal of the outcomes. Decision-makers are rarely able to foresee the full consequences and the law of unintended consequences will almost certainly introduce suspicion into any well-intended triage and treatment plan. In order to achieve agreement on the just and equitable provision of healthcare during an epidemic, the process and procedures for decision-making should be publicly and openly debated well before an epidemic ever occurs.
Prioritizing healthcare workers
In a 2014 case study on ethical decision-making during catastrophic pandemics, Dr. Linda Kiltz advocates strongly for the prioritization and protection of healthcare providers. Influenza and other viruses are not discriminatory in their transmission; like water, viruses follow a path of least resistance. As the most seriously affected patients make their way to healthcare facilities, the employees at those facilities are in the direct path of the virus.
Medical professionals who are obligated or willing to expose themselves directly to a viral epidemic should receive prioritized care if they contract the virus. They are accepting risk to their own health, and communities owe them a certain respect and reciprocity for that sacrifice. In short, where healthcare workers have a duty to care for the community, the community has a reciprocal duty to support them.
Communities must, for example, ensure that healthcare workers have access to the appropriate training and personal protective equipment to perform their jobs competently and safely. Communities must also ensure that healthcare workers’ personal and family needs, like child and elder care, meals, and even mental and spiritual care, are supported.
Beyond reciprocity, protecting and supporting healthcare providers during an epidemic serves a distinctly utilitarian purpose. It is easily agreed that healthcare providers are one of the most valuable resources during an epidemic. These professionals represent a valuable, limited human resource, so protecting their health and supporting their personal needs can help to ensure their continued availability for response.
Protecting the public
Protecting the public by controlling the spread of viruses is another priority during epidemics. Quarantine and isolation are common public health tools used to prevent or mitigate the effects of an epidemic. While these practices have long been authorized by law, officials still must appreciate the sensitivities and impacts, and plan for supporting those affected. Nowhere else is the struggle to balance public health priorities against individual liberties more palpable than it is with implementing preventative actions.
Restrictions on freedom of movement are, practically speaking, the most disruptive burdens for citizens placed in isolation or quarantine. Restricting a person’s movement means impairing their ability to support themselves and their families. It precludes and jeopardizes employment, prohibits attendance at school and church, and cuts families off from all manner of goods and services.
Beyond due process and mere fairness, citizens placed in isolation and quarantine also require support from the government and their communities. If citizens know that their needs will continue to be supported, and their employment and other opportunities protected, then restrictions on their liberty will be far less distressing and disagreeable.
Engagement and collaboration
An influenza epidemic like the one the U.S. is currently experiencing can present a significant threat to public health and overall domestic safety and security. Seeing the ethical challenges in decisions being made during a frenzied response should encourage communities to address the issues early. The more time a community has to fully discuss, negotiate, and agree on policies and plans that will guide action during response, the less distrust those actions will incur.
If the decision-making during an epidemic response appears arbitrary and unequitable, it can break down a community’s trust and motivation for compliance. In the end, collaboration between the government, the healthcare sector, and the broader community is necessary to create consensus on these ethically challenging matters.
About the Author
Jeff King is a retired Coast Guard judge advocate and a faculty member in the School of Security & Global Studies at American Military University, where he primarily teaches undergraduate and graduate courses in law and ethics. To contact him, email IPSauthor@apus.edu.