Global & Disaster Medicine

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Coronavirus: A pandemic or not?

https://www.vox.com/future-perfect/2020/3/9/21163412/who-coronavirus-covid19-pandemic-world-health-organization

“………….The WHO says that since there’s still uncertainty about the disease’s impact, most countries still have only a few cases, and containment is not yet hopeless, the word “pandemic” isn’t appropriate yet. But many observers have disagreed with the WHO’s decision……… The World Health Organization defines an epidemic as “the occurrence in a community or region of cases of an illness … clearly in excess of normal expectancy.” The CDC defines it as “an increase, often sudden, in the number of cases of a disease above what is normally expected” in a region.……

According to A Dictionary of Epidemiology, the standard reference for epidemiologists, a pandemic is “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.”

A “pandemic” disease sounds much scarier than a mere “outbreak.” But it’s important to remember that “pandemic” refers to how many parts of the world are dealing with an elevated rate of the disease — and, in theory, says nothing about how serious the disease is………”


WHO and COVID-19 Press Conference: 2-28-20

CNBC:  “World Health Organization officials are holding a press conference Friday to update the public on the coronavirus outbreak, which has infected more than 83,700 and killed at least 2,859 across the world so far.

Named COVID-19, the virus has shuttered commerce across much of China and is hitting company earnings, global stock markets and manufacturing across the world. WHO officials declared the virus a global health emergency last month, while urging the public against over-reacting to the virus.

In recent weeks, the virus has spread substantially beyond China and is now circulating in over 44 countries across the world, WHO’s director-general Tedros Adhanom Ghebreyesus said Thursday. Epidemics have emerged in Iran, Italy and South Korea, where the number of cases are rapidly rising every day…..”


World experts and funders set priorities for COVID-19 research

https://www.who.int/news-room/detail/12-02-2020-world-experts-and-funders-set-priorities-for-covid-19-research

12 February 2020

News release
Geneva, Switzerland

Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks.

The 2-day forum was convened in line with the WHO R&D Blueprint – a strategy for developing drugs and vaccines before epidemics, and accelerating research and development while they are occurring.

“This outbreak is a test of solidarity — political, financial and scientific. We need to come together to fight a common enemy that does not respect borders, ensure that we have the resources necessary to bring this outbreak to an end and bring our best science to the forefront to find shared answers to shared problems. Research is an integral part of the outbreak response,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I appreciate the positive response of the research community to join us at short notice and come up with concrete plans and commitment to work together.”

The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including:

  • the natural history of the virus, its transmission and diagnosis;
  • animal and environmental research on the origin of the virus, including management measures at the human-animal interface;
  • epidemiological studies;
  • clinical characterization and management of disease caused by the virus;
  • infection prevention and control, including best ways to protect health care workers;
  • research and development for candidate therapeutics and vaccines;
  • ethical considerations for research;
  • and integration of social sciences into the outbreak response.

“This meeting allowed us to identify the urgent priorities for research. As a group of funders we will continue to mobilize, coordinate and align our funding to enable the research needed to tackle this crisis and stop the outbreak, in partnership with WHO,” said Professor Yazdan Yazdanpanah, chair of GloPID-R. “Equitable access – making sure we share data and reach those most in need,  in particular those in lower and middle-income countries, is fundamental to this work which must be guided by ethical considerations at all times.”

During the meeting, the more than 300 scientists and researchers participating both in person and virtually agreed on a set of global research priorities. They also outlined mechanisms for continuing scientific interactions and collaborations beyond the meeting which will be coordinated and facilitated by WHO. They worked with research funders to determine how necessary resources can be mobilized so that critical research can start immediately.

The deliberations will form the basis of a research and innovation roadmap charting all the research needed and this will be used by researchers and funders to accelerate the research response.

Note to editors

GloPID-R is a global alliance of international research funding organizations investing in preparedness and response to epidemics.


WHO course: Emerging respiratory viruses, including nCoV: methods for detection, prevention, response and control

https://openwho.org/courses/introduction-to-ncov

Course information

Overview: This course provides a general introduction to emerging respiratory viruses, including novel coronaviruses. By the end of this course, you should be able to describe:

  • The nature of emerging respiratory viruses, how to detect and assess an outbreak, strategies for preventing and controlling outbreaks due to novel respiratory viruses;
  • What strategies should be used to communicate risk and engage communities to detect, prevent and respond to the emergence of a novel respiratory virus.

There are resources attached to each module to help you dive further into this topic.

Learning objective: Describe the fundamental principles of emerging respiratory viruses and how to effectively respond to an outbreak.

Course duration: Approximately 1 hour.

Certificates: No certificate available at this time.

Attention:

  • WHO teams are working on additional modules which will be uploaded in the coming days.
  • You will be notified when new modules and videos are uploaded. Currently, the materials are offered as slide decks.
  • The course will offer a certificate in the future, after all of the modules have been published and a quiz has been added to each module.

Course contents

  • Emerging respiratory viruses, including nCoV: Introduction:

    This brief introduction provides an overview of emerging respiratory viruses, including nCoV.

  • Module A: Introduction to Emerging respiratory viruses, including nCoV:

    Overall learning objective: To be able to explain why an emerging respiratory virus, including nCoV are a global threat to human health

  • Module B: Detecting Emerging respiratory viruses, including nCoV: Surveillance and Laboratory investigation:

    Overall learning objective: To describe how to detect and assess an emerging respiratory virus outbreak

  • Module C: Risk Communication and Community Engagement:

    Overall learning objective: To describe what strategies should be used to communicate risk and engage communities to detect, prevent and respond to nCoV


WHO and its consultants

VOX

“…..But Tedros appears to have embraced change, of a sort. Halfway through his five-year term, his reform — known as “the transformation” — is still in progress. And while he has offered WHO staff opportunities to engage in the process, the agency is also crawling with outside consultants, current and former WHO staffers told Vox.

“The one thing that WHO staff didn’t want,” a senior official who was involved in the reform process, “is a McKinsey type of reform,” using the well-known firm as a shorthand for what they’ve seen consultants bring to WHO and other health agencies over the years: “musical chairs,” “cost cutting,” and “debunked management fads.”

In addition to McKinsey, WHO confirmed they’ve worked with five other consultancies during the transformation: BCG, Deloitte, Preva Group, Seek Development, and most recently, Deliver Associates, which has a multi-year contract worth $3.85 million. The total value of the consultant contracts is about $12 million, at least a quarter of which has been paid for directly by the Bill and Melinda Gates Foundation, one of the most powerful players in global health…..”

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Microplastics: Another cause for concern in this troubled world?

WHO Microplastics Document 2019

“……..Background
Over the past few years, several studies have reported the presence of microplastics in treated tap and bottled water, raising questions and concerns about the impact that microplastics in drinking-water might have on human health. This report, which contains a summary of the evidence, key findings, recommendations and research needs, is the World  Health Organization’s (WHO) first effort to examine the potential human health risks associated with exposure to microplastics in the environment. The focus of this report is on the potential human health impacts of exposure to microplastics through drinking-water. However, brief information on other routes of human exposure is included for context.
This report was informed by literature reviews undertaken on the occurrence of microplastics in the water cycle, the potential health impacts from microplastic exposure and the removal of microplastics during wastewater and drinking-water treatment. Throughout the report, WHO experts examined the quality and relevance of the studies they found. The report was also informed by reviews conducted by several major entities; these are referenced throughout the report.
As a category, microplastics encompass a wide range of materials with different chemical compositions, shapes, colours, sizes and densities. There is no scientifically-agreed definition of microplastics, although most definitions focus on composition and size.
………

 

“……Recommendations
Routine monitoring of microplastics in drinking-water is not recommended at this time, as there is no evidence to indicate a human health concern. Concerns over microplastics in drinking-water should not divert resources of water suppliers and regulators from removing microbial pathogens, which remains the most significant risk to human health from drinking-water along with other chemical priorities. As part of water safety planning, water suppliers should ensure that control measures are effective and should optimize water treatment processes for particle removal and microbial safety, which will incidentally improve the removal of microplastic particles.
However, for researchers, it would be appropriate to undertake targeted, welldesigned and quality-controlled investigative studies to better understand the sources and occurrence of microplastics in fresh water and drinking-water, the efficacy of different treatment processes and combinations of processes, and the significance
Executive summary xiii
of the potential return of microplastics to the environment from treatment waste streams including the application of sludge biosolids to agricultural land.
Measures should also be taken to better manage plastics and reduce the use of plastics where possible, to minimize plastic and microplastic pollution despite the low human health risk posed by exposure to microplastics in drinking-water, as such actions can confer other benefits to the environment and human well-being. 


Research needs
To better assess human health risks and inform management actions, a number of research gaps need to be filled. With respect to exposure, there is a need to better understand microplastics occurrence throughout the water supply chain, using quality assured methods to determine the numbers, shapes, sizes, composition and sources of microplastics and to better characterize the effectiveness of water treatment. Research is also needed to better understand the significance of treatment-related waste streams as contributors of microplastics to the environment.
With respect to potential health effects, quality-assured toxicological data are needed on the most common forms of plastic particles relevant for human health risk assessment. Further, a better understanding on the uptake and fate of microplastics and nanoplastics following ingestion is needed.
Finally, given that humans can be exposed to microplastics through a variety of environmental media, including food and air, a better understanding of overall exposure to microplastics from the broader environment is needed.


WHO reviews the current state of MERS-CoV

WHO MERS Global Summary and Assessment of Risk

“…..Between 2012 and 30 June 2019, 2449 laboratory confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection were reported to WHO, of which 84.0% were reported by the Kingdom of Saudi Arabia.

In total, cases have been reported from 27 countries in the Middle East, North Africa, Europe, the United States of America, and Asia.  Males above the age of 60 with an underlying medical conditions, such as diabetes, hypertension and renal failure, are at a higher risk of severe disease, including death.  To date, 845 individuals have died (crude CFR 34.5%).

Since the last global update published on 30 June 2018, 219 laboratory-confirmed cases of MERS-CoV from four countries were reported to WHO (204 from Saudi Arabia, 13 from Oman, 1 from the Republic of Korea, and 1 from the United Kingdom), of whom 53 (24.2%) have died.  Among these cases, 79.0% were male and the median age was 52 years old (IQR 39-65; range 16-94 years old).  The median age is similar to the median age of all cases reported to WHO since 2012 (52 years old, IQR 37-65).

At the time of writing, 49 of the 219 (22.4%) patients were reported as asymptomatic or having mild disease. At least one underlying condition was reported in 145 cases (66.2%) since the last update, including chronic renal failure, heart disease, diabetes mellitus, and hypertension…….”


WHO’s director-general, Tedros Adhanom Ghebreyesus, PhD, declared that the Democratic Republic of the Congo’s Ebola outbreak is a public health emergency of international concern (PHEIC).

WHO

17 July 2019

News release
Geneva

WHO Director-General Dr. Tedros Adhanom Ghebreyesus today declared the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) a Public Health Emergency of International Concern (PHEIC).

“It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,” said Dr. Tedros. “Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders — coming from not just WHO but also government, partners and communities — to shoulder more of the burden.”

The declaration followed a meeting of the International Health Regulations Emergency Committee for EVD in the DRC. The Committee cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world.

This was the fourth meeting of the Emergency Committee since the outbreak was declared on 1 August 2018.

The Committee expressed disappointment about delays in funding which have constrained the response. They also reinforced the need to protect livelihoods of the people most affected by the outbreak by keeping transport routes and borders open. It is essential to avoid the punitive economic consequences of travel and trade restrictions on affected communities.

“It is important that the world follows these recommendations. It is also crucial that states do not use the PHEIC as an excuse to impose trade or travel restrictions, which would have a negative impact on the response and on the lives and livelihoods of people in the region,” said Professor Robert Steffen, chair of the Emergency Committee.

Since it was declared almost a year ago the outbreak has been classified as a level 3 emergency – the most serious – by WHO, triggering the highest level of mobilization from WHO. The UN has also recognized the seriousness of the emergency by activating the Humanitarian System-wide Scale-Up to support the Ebola response.

In recommending a PHEIC the committee made specific recommendations related to this outbreak.

“This is about mothers, fathers and children – too often entire families are stricken. At the heart of this are communities and individual tragedies,” said Dr. Tedros. “The PHEIC should not be used to stigmatize or penalize the very people who are most in need of our help.”


Finally, the year-old Ebola epidemic in the Democratic Republic of Congo is now considered a global health emergency

NYT

‘……“This is still a regional emergency and by no way a global threat,” said Robert Steffen of the University of Zurich, chairman of the W.H.O. emergency committee that recommended the declaration.

But the panel was persuaded by several factors that have made combating the epidemic more urgent in recent weeks: The disease reached Goma, a city of nearly two million people; the outbreak has raged for a year; the virus has flared again in spots where it had once been contained; and the epidemic hot zone has geographically expanded in northeastern Congo near Rwanda and into Uganda……’

“…..The W.H.O. said it had received $49 million from international donors from February to July, only half the money it needs. Officials who have visited the region say supplies are running short, including the protective gear that health workers need to avoid becoming infected. At a United Nations meeting about the outbreak on Monday, one official said he had seen syringes and gloves being reused because equipment was becoming scarce.….”


WHO updates global guidance on medicines and diagnostic tests to address health challenges, prioritize highly effective therapeutics, and improve affordable access

WHO

New essential medicines and diagnostics lists published today

9 July 2019

News release
Geneva

WHO’s Essential Medicines List and List of Essential Diagnostics are core guidance documents that help countries prioritize critical health products that should be widely available and affordable throughout health systems.

Published today, the two lists focus on cancer and other global health challenges, with an emphasis on effective solutions, smart prioritization, and optimal access for patients.

“Around the world, more than 150 countries use WHO’s Essential Medicines List to guide decisions about which medicines represent the best value for money, based on evidence and health impact,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The inclusion in this list of some of the newest and most advanced cancer drugs is a strong statement that everyone deserves access to these life-saving medicines, not just those who can afford them.”

The Essential Medicines List (2019)

Cancer treatments: While several new cancer treatments have been marketed in recent years, only a few deliver sufficient therapeutic benefits to be considered essential. The five cancer therapies WHO added to the new Medicines List are regarded as the best in terms of survival rates to treat melanoma, lung, blood and prostate cancers.

For example, two recently developed immunotherapies (nivolumab and pembrolizumab) have delivered up to 50% survival rates for advanced melanoma, a cancer that until recently was incurable.

Antibiotics: The Essential Medicines Committee strengthened advice on antibiotic use by updating the AWARE categories, which indicate which antibiotics to use for the most common and serious infections to achieve better treatment outcomes and reduce the risk of antimicrobial resistance.  The committee recommended that three new antibiotics for the treatment of multi-drug resistant infections be added as essential.

Other updates to the medicines list include:

  • New oral anticoagulants to prevent stroke as an alternative to warfarin for atrial fibrillation and treatment of deep vein thrombosis. These are particularly advantageous for low-income countries as, unlike warfarin, they do not require regular monitoring;
  • Biologics and their respective biosimilars for chronic inflammatory conditions such as rheumatoid arthritis and inflammatory bowel diseases;
  • Heat-stable carbetocin for the prevention of postpartum haemorrhage. This new formulation has similar effects to oxytocin, the current standard therapy, but offers advantages for tropical countries as it does not require refrigeration;

Not all submissions to the EML Committee are included in the list. For example, medicines for multiple sclerosis submitted for inclusion were not listed. The Committee noted that some relevant therapeutic options currently marketed in many countries were not included in the submissions; it will welcome a revised application with all relevant available options. The EML Committee also did not recommend including methylphenidate, a medicine for attention deficit hyperactivity disorder (ADHD), as the committee found uncertainties in the estimates of benefit.

The List of Essential (in vitro) Diagnostics

The first List of Essential Diagnostics was published in 2018, concentrating on a limited number of priority diseases – HIV, malaria, tuberculosis, and hepatitis. This year’s list has expanded to include more noncommunicable and communicable diseases.

Cancers: Given how critical it is to secure an early cancer diagnosis (70% of cancer deaths occur in low- and middle-income countries largely because most patients are diagnosed too late), WHO added 12 tests to the Diagnostics List to detect a wide range of solid tumours such as colorectal, liver, cervical, prostate, breast and germ cell cancers, as well as leukemia and lymphomas. To support appropriate cancer diagnosis, a new section covering anatomical pathology testing was added; this service must be made available in specialized laboratories.

Infectious diseases: The list focuses on additional infectious diseases prevalent in low- and middle-income countries such as cholera, and neglected diseases like leishmaniasis, schistosomiasis, dengue, and zika.

In addition, a new section for influenza testing was added for community health settings where no laboratories are available.

General test: The list was also expanded to include additional general tests which address a range of different diseases and conditions, such as iron tests (for anemia), and tests to diagnose thyroid malfunction and sickle cell (an inherited form of anemia very widely present in Sub-Saharan Africa).

Another notable update is a new section specific to tests intended for screening of blood donations.  This is part of a WHO-wide strategy to make blood transfusions safer.

“The List of Essential Diagnostics was introduced in 2018 to guide the supply of tests and improve treatment outcomes,” said Mariângela Simão, WHO Assistant Director-General for Medicines and Health Products. “As countries move towards universal health coverage and medicines become more available, it will be crucial to have the right diagnostic tools to ensure appropriate treatment.”

 

 


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