Global & Disaster Medicine

Archive for October, 2018

Nanoparticles and Snakebites

NYT

Snakes kill or cripple 500,000 people a year

“……Dr. Shea’s lab is creating hydrogel nanoparticles coated with polymers — the building blocks of plastics — small enough to attach to proteins.

While screening them against common venoms, he isolated some nanoparticles that bind with and neutralize two poisons produced by snakes like cobras, kraits, coral snakes, sea snakes and mambas.

José María Gutiérrez, a venom specialist at the University of Costa Rica, injected dozens of mice with the venom of the black-necked spitting cobra. He found that Dr. Shea’s nanoparticles significantly reduced tissue damage in the mice. Importantly, the nanoparticles did not appear to interfere with normal proteins or to trigger dangerous allergic reactions……”


O’Brien J, Lee S-H, Gutiérrez JM, Shea KJ (2018) Engineered nanoparticles bind elapid snake venom toxins and inhibit venom-induced dermonecrosis. PLoS Negl Trop Dis 12(10): e0006736. https://doi.org/10.1371/journal.pntd.0006736

 


Intergovernmental Panel on Climate Change: A world of worsening food shortages and wildfires, and a mass die-off of coral reefs as soon as 2040

NYT

Document:  Global Warming of 1.5 Degrees Centigrade

IPCC PRESS RELEASE

8 October 2018

Summary for Policymakers of IPCC Special Report on Global Warming of 1.5ºC approved by governments

INCHEON, Republic of Korea, 8 Oct – Limiting global warming to 1.5ºC would require rapid, farreaching and unprecedented changes in all aspects of society, the IPCC said in a new assessment. With clear benefits to people and natural ecosystems, limiting global warming to 1.5ºC compared to 2ºC could go hand in hand with ensuring a more sustainable and equitable society, the Intergovernmental Panel on Climate Change (IPCC) said on Monday.

The Special Report on Global Warming of 1.5ºC was approved by the IPCC on Saturday in Incheon, Republic of Korea. It will be a key scientific input into the Katowice Climate Change Conference in Poland in December, when governments review the Paris Agreement to tackle climate change.

“With more than 6,000 scientific references cited and the dedicated contribution of thousands of expert and government reviewers worldwide, this important report testifies to the breadth and policy relevance of the IPCC,” said Hoesung Lee, Chair of the IPCC.

Ninety-one authors and review editors from 40 countries prepared the IPCC report in response to an invitation from the United Nations Framework Convention on Climate Change (UNFCCC) when it adopted the Paris Agreement in 2015.

The report’s full name is Global Warming of 1.5°C, an IPCC special report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty.

“One of the key messages that comes out very strongly from this report is that we are already seeing the consequences of 1°C of global warming through more extreme weather, rising sea levels and diminishing Arctic sea ice, among other changes,” said Panmao Zhai, Co-Chair of IPCC Working Group I.

The report highlights a number of climate change impacts that could be avoided by limiting global warming to 1.5ºC compared to 2ºC, or more. For instance, by 2100, global sea level rise would be 10 cm lower with global warming of 1.5°C compared with 2°C. The likelihood of an Arctic Ocean free of sea ice in summer would be once per century with global warming of 1.5°C, compared with at least once per decade with 2°C. Coral reefs would decline by 70-90 percent with global warming of 1.5°C, whereas virtually all (> 99 percent) would be lost with 2ºC.

“Every extra bit of warming matters, especially since warming of 1.5ºC or higher increases the risk associated with long-lasting or irreversible changes, such as the loss of some ecosystems,” said Hans-Otto Pörtner, Co-Chair of IPCC Working Group II.

Limiting global warming would also give people and ecosystems more room to adapt and remain below relevant risk thresholds, added Pörtner. The report also examines pathways available to limit warming to 1.5ºC, what it would take to achieve them and what the consequences could be.

“The good news is that some of the kinds of actions that would be needed to limit global warming to 1.5ºC are already underway around the world, but they would need to accelerate,” said Valerie Masson-Delmotte, Co-Chair of Working Group I.

The report finds that limiting global warming to 1.5°C would require “rapid and far-reaching” transitions in land, energy, industry, buildings, transport, and cities. Global net human-caused emissions of carbon dioxide (CO2) would need to fall by about 45 percent from 2010 levels by 2030, reaching ‘net zero’ around 2050. This means that any remaining emissions would need to be balanced by removing CO2 from the air.

“Limiting warming to 1.5ºC is possible within the laws of chemistry and physics but doing so would require unprecedented changes,” said Jim Skea, Co-Chair of IPCC Working Group III.

Allowing the global temperature to temporarily exceed or ‘overshoot’ 1.5ºC would mean a greater reliance on techniques that remove CO2 from the air to return global temperature to below 1.5ºC by 2100. The effectiveness of such techniques are unproven at large scale and some may carry significant risks for sustainable development, the report notes.

“Limiting global warming to 1.5°C compared with 2°C would reduce challenging impacts on ecosystems, human health and well-being, making it easier to achieve the United Nations Sustainable Development Goals,” said Priyardarshi Shukla, Co-Chair of IPCC Working Group III.

The decisions we make today are critical in ensuring a safe and sustainable world for everyone, both now and in the future, said Debra Roberts, Co-Chair of IPCC Working Group II.

“This report gives policymakers and practitioners the information they need to make decisions that tackle climate change while considering local context and people’s needs. The next few years are probably the most important in our history,” she said.

The IPCC is the leading world body for assessing the science related to climate change, its impacts and potential future risks, and possible response options.

The report was prepared under the scientific leadership of all three IPCC working groups. Working Group I assesses the physical science basis of climate change; Working Group II addresses impacts, adaptation and vulnerability; and Working Group III deals with the mitigation of climate change.

The Paris Agreement adopted by 195 nations at the 21st Conference of the Parties to the UNFCCC in December 2015 included the aim of strengthening the global response to the threat of climate change by “holding the increase in the global average temperature to well below 2°C above preindustrial levels and pursuing efforts to limit the temperature increase to 1.5°C above pre-industrial levels.”

As part of the decision to adopt the Paris Agreement, the IPCC was invited to produce, in 2018, a Special Report on global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways. The IPCC accepted the invitation, adding that the Special Report would look at these issues in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty.

Global Warming of 1.5ºC is the first in a series of Special Reports to be produced in the IPCC’s Sixth Assessment Cycle. Next year the IPCC will release the Special Report on the Ocean and Cryosphere in a Changing Climate, and Climate Change and Land, which looks at how climate change affects land use.
– 3 –
The Summary for Policymakers (SPM) presents the key findings of the Special Report, based on the assessment of the available scientific, technical and socio-economic literature relevant to global warming of 1.5°C.

The Summary for Policymakers of the Special Report on Global Warming of 1.5ºC (SR15) is available at http://www.ipcc.ch/report/sr15/ or www.ipcc.ch.

Key statistics of the Special Report on Global Warming of 1.5ºC

91 authors from 44 citizenships and 40 countries of residence – 14 Coordinating Lead Authors (CLAs) – 60 Lead authors (LAs) – 17 Review Editors (REs) 133 Contributing authors (CAs) Over 6,000 cited references A total of 42,001 expert and government review comments (First Order Draft 12,895; Second Order Draft 25,476; Final Government Draft: 3,630)

For more information, contact: IPCC Press Office, Email: ipcc-media@wmo.int Werani Zabula +41 79 108 3157 or Nina Peeva +41 79 516 7068


FEMA Sit Rep: Health and Medical issues after Michael as of October 14

GA: 2 (-5) hospitals on generator power, 1 (+1) no power; 1 nursing home no power, 9 (-13) on generator power; 10 (-11) sheltering-in-place •

FL: 3 hospitals closed; 8 dialysis centers closed; Nursing Homes/ Assisted Living Facilities: 18 sheltering in place, 2 with no power, 17 (-1) on generator power, 1(-1) closed/evacuating, and 7 (-1) closed/evacuated •

HHS DMATS: FL: 6; AL 1 (and 1 DMORT); 1 cache staged in Atlanta, GA


Local, state, and Federal responses continue after Michael

AL EOC at Partial Activation:

o Governor declared a statewide State of Emergency

o Emergency Declaration FEMA-3407-EM approved on October 12th

• FL EOC at Full Activation:

o Governor declared a State of Emergency for 35 counties

o Emergency Declaration FEMA-3405-EM-FL approved October 9th

o Major Disaster Declaration FEMA-4399-DR-FL approved October 11th

GA EOC at Full Activation:

o Governor declared State of Emergency for 108 counties

o Emergency Declaration FEMA-3406-EM-GA approved on October 10th

o Governor requested an Major Disaster Declaration on October 12th

NC EOC at Monitoring; Governor declared a State of Emergency

SC EOC at Normal Operations; Governor declared a State of Emergency

TN EOC at Monitoring (EMAC support)

• VA EOC at Monitoring; Governor declared a State of Emergency

 

FEMA Region IV

• RRCC at Level I (24/7), all ESFs, DCO/DCE and DHS NPPD

• LNOs deployed to FL and GA

• IMAT-2 deployed to FL EOC

 

FEMA HQ/Federal Response

• NRCC at Level II with select ESFs

• National IMAT East deployed to FL EOC

• Region II IMAT deployed to AL EOC

• Region V IMAT deployed to GA EOC

• ISB Team deployed to Montgomery, AL

• Staging areas: Montgomery, AL (Maxwell AFB); Fayetteville, NC (Ft Bragg); North AF AUX, SC


The Condition of Healthcare after Michael

FEMA Daily Operations Briefing for October 13, 2018

Health and Medical

• GA: 7 hospitals & 20 nursing homes/assisted living facilities on generator power, 6 dialysis centers closed

• FL: 4 hospitals closed; 8 dialysis centers closed; 23 nursing homes/assisted living facilities closed, 20 on generator power, 2 without power

• HHS DMATS: FL: 6; AL 1 (and 1 DMORT); 1 cache staged in Atlanta, GA


Hurricane Leslie swept into the centre and north of Portugal leaving 15 000 homes without power.

BBC


Mexico Beach reduced to rubble in the aftermath of Michael

NYT

“……..Mr. Foster, 60, and his 99-year-old mother had no car, no electricity. The food had spoiled in his refrigerator. The storm had ripped off large sections of his roof. He had no working plumbing to flush with. No water to drink. And as of Friday afternoon, he had seen no sign of government help……This was the problem that government officials were racing to solve on Friday, as desperation grew in and around Panama City under a burning sun. Long lines formed for gas and food, and across the battered coastline, those who were poor, trapped and isolated sent out pleas for help……”


With 11 new Ebola cases confirmed yesterday and today, the Democratic Republic of Congo’s Ebola outbreak total climbed to 205 cases

WHO

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news
11 October 2018

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni. These incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. WHO continues to distinguish between the incidents of conflict between rebel and government forces, and pockets of community push-back on the response. A recent increase in the incidence of new cases (Figure 1) is the result of the multitude of challenges faced by response teams. This also reflects improved active surveillance and reporting from the community.

Since the last Disease Outbreak News (data as of 2 October), 29 new confirmed EVD cases were reported: 23 from Beni, four from Butembo, one from Mabalako, and one from Masereka Health Zones in North Kivu Province. Fifteen of these confirmed cases have been linked to known cases or were linked retrospectively through case to transmission chains within the respective communities, while fourteen recently reported cases remain under investigation.

As of 9 October 2018, a total of 194 EVD cases (159 confirmed and 35 probable), including 122 deaths (87 confirmed and 35 probable)1, have been reported in seven health zones in North Kivu Province (Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene and Oicha), and three health zones in Ituri Province (Mandima, Komanda and Tchomia) (Figure 1). An overall increasing trend in weekly case incidence is seen (Figure 2); however, these rising trends are likely underestimated given expected delays in case reporting, the ongoing detection of sporadic cases, and security concerns which limit contact tracing and investigation of alerts. Of the 194 confirmed and probable cases for whom age and sex information is known, the majority (64%) are within 15-44 years age range. Females (55%) accounted for a greater proportion of cases (Figure 3). Since the last Disease Outbreak News update, one new health care worker infection was reported, bringing the cumulative case count to 20 (19 confirmed and one probable), of whom three have died.

The MoH, WHO and partners continue to closely monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. As of 9 October, 25 suspected cases in the Democratic Republic of the Congo are awaiting laboratory testing. Since 4 October, alerts have been investigated in several provinces of the Democratic Republic of the Congo, as well as in neighbouring countries. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries.

Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 9 October 2018 (n=194)

Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 9 October 2018 (n=190)*

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. Date of illness onset unknown for n=7 cases. Edited on 12 October 2018.

Figure 3: Confirmed and probable Ebola virus disease cases by age and sex, data as 9 October 2018 (n=159)*

Figure 3: Confirmed and probable Ebola virus disease cases by age and sex, data as 9 October 2018 (n=159)*

*Age and/or sex unknown for n=35 cases.

Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC) measures, clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance and preparedness activities in neighbouring provinces and countries.

  • Surveillance: Over 8000 contacts have been registered, of which 2732 remain under surveillance as of 9 October2. Beni Health Zone has the greatest number of contacts (n=1834) and the greatest challenges in contact tracing due to a combination of factors, including: community reluctance and refusal for contact tracing; contacts lost to follow-up; and a deteriorating security situation.
  • Vaccination: As of 10 October, 90 vaccination rings have been defined, in addition to 31 rings of health and frontline workers. To date, 15 828 eligible and consented people have been vaccinated, including 6327 health and frontline workers and 3439 children. Vaccination preparedness progress is being made in neighbouring Uganda, South Sudan, Rwanda, and Burundi. The Ebola Treatment Centre (ETC) managed by the Alliance for International Medical Action (ALIMA) in Beni has increased its capacity to 25 beds.
  • IPC activities are ongoing and are supported by several partners in the field. In Butembo Health Zone, fine-tuning of IPC infrastructure at Matanda Hospital is ongoing alongside follow-up and supervision of pre-triage; IPC construction is estimated to be at least 80% complete at Sainte Famille Hospital. Training on triage and pre-triage took place at Sainte Famille Hospital on 5 October, and three additional structures have been identified for pre-triage support in Butembo.
  • Risk communication, community engagement, and social mobilization has been integrated with surveillance, contact tracing, and vaccination work as part of a revised strategy to address community concerns about the response. Under this approach, young persons under civil society leaders’ supervision are notified of community alerts, arrive first on-site to engage in dialogue with families, and remain with family members and the response teams to address any concerns or issues. This strategy has been implemented in 12 Beni neighbourhoods and is under consideration for scaling across health zones. Community engagement activities have also been extended to essential groups like women’s groups, taxi drivers, youth groups, and students. Refresher training with community relays and leaders to improve the quality of engagement and community-based surveillance is underway in Beni and Tchomia, with sessions planned in Oicha and Butembo next week.
  • Red Cross safe and dignified burial (SDB) teams are operational in Mangina, Beni, Oicha and Tchomia; trained teams are on stand-by in Mambasa and Goma. The recent escalation of violence, including an incident resulting in injury to three Red Cross volunteers on 2 October, has resulted in the cessation of Red Cross SDB activities in Butembo until further notice. Civil Protection teams are currently responding to SDB alerts in Butembo. As of 10 October, a total of 236 SDB alerts were received, of which 190 were responded to successfully. Thirty-two responses were unsuccessful due to community refusals or burials conducted prior to the arrival of SDB teams. Seven SDB alerts have not been responded to due to security concerns. Capacity for Beni SDB is being strengthened due to an anticipated increase in alerts, and the mayor of Beni has announced that all deaths must be accompanied by a death certificate. Rapid diagnostic tests are being considered as part of validating hospital and community deaths.
  • Point of Entry (PoE): A cross-border coordination meeting was held from 2-4 October in Uganda to discuss preparedness and response to the current Ebola outbreak, with representatives from Democratic Republic of the Congo, Uganda, South Sudan, Rwanda, Burundi, Tanzania and Kenya in attendance. As of 9 October, health screening has been established at 57 Points of Entry (PoEs) and over 7.7 million travellers have been screened. IOM and PNHF have set a community-based cross-border coordination meeting in Tchomia. Staff from the United States Centers for Disease Control and Prevention (CDC) have deployed to support health screening at 11 operational PoEs in South Sudan.

To support the MoH, WHO is working intensively with a wide range of multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries. Among the partners are a number of UN agencies and international organizations including: European Civil Protection and Humanitarian Aid Operation (ECHO; International Organization for Migration (IOM); the United Nations Children’s Fund (UNICEF); UN High Commission for Refugees (UNHCR); World Food Programme (WFP); United Nations Office for the Coordination of Humanitarian Affairs (OCHA); Inter-Agency Standing Committee (IASC); UK Public Health Rapid Support Team; United States Agency for International Development (USAID); Centers for Disease Control and Prevention (CDC); multiple Clusters, peacekeeping operations and the UN mission; UN Department of Safety and Security (UNDSS); World Bank and regional development banks; African Union, Africa Centres for Disease Control and Prevention and regional agencies; Health Cluster partners and NGOs including ALIMA, ADECO, AFNAC, CARITAS DRC, CEPROSSAN, CARE International, COOPI, CORDAID/PAP-DRC, ICRC, IFRC, Red Cross of the Democratic Republic of the Congo, INTERSOS, IRC, MEDAIR, MSF, PNHF, Samaritan’s Purse, and SCI; Global Outbreak Alert and Response Network (GOARN), Steering Committee, EDPLN, ECCARN, technical networks and operational partners, and the Emergency Medical Team (EMT) Initiative. GOARN partners continue to support the response through deployment for response and readiness activities in non-affected provinces and in neighbouring countries and to different levels of WHO.

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the country, which borders Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. On 28 September 2018, based on the worsening security situation, WHO revised its risk assessment for the outbreak, elevating the risk at national and regional levels from high to very high. The risk remains low globally. WHO continues to advise against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international travel to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

For more information, see:


1The number of cases is subject to change due to ongoing reclassification, retrospective investigation, and the availability of laboratory results.

2The total number of contacts under surveillance is highly dynamic with new cases being registered daily, and those who complete 21 days of post-exposure follow up, without developing symptoms, are released from surveillance.


10/12/2002: 3 bombings shatter the peace in Kuta, Bali leaving 202 dead and more than 200 others injured

History Channel


10/12/2000: A motorized rubber dinghy loaded with explosives blows a 40-by-40-foot hole in the port side of the USS Cole, a U.S. Navy destroyer that was refueling at Aden, Yemen.

History Channel

  • Seventeen sailors were killed
  • 38 wounded

 


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