Air-France KLM warned Tuesday the coronavirus outbreak will hit its business harder in coming months after February passenger numbers fell 0.5 percent overall as flights to China were cut.
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China exports plunge on coronavirus epidemic
China’s exports plummeted in the first two months of this year on the back of a coronavirus epidemic that forced businesses to suspend operations, disrupting the world’s supply chains.
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End in sight, but flare-ups likely in the Ebola outbreak in the Democratic Republic of the Congo
Remarks by Dr Ibrahima Socé Fall, World Health Organization Assistant Director-General, Emergency Response
Good afternoon.
I hope that your busy week was interrupted, like mine, with a moment of joy on Tuesday.
That moment was the celebration of a woman being discharged from an Ebola treatment centre in Beni. Her name is Masiko.
She was the last person in the Democratic Republic of the Congo confirmed to have Ebola.
Health workers and other responders sacrificed a lot to get to this point.
Since the outbreak was declared in August 2018 there have been 420 attacks on health facilities in DRC, resulting in 11 deaths and 86 injuries among health care workers and patients.
It’s been a huge amount of work. At the peak of the outbreak, more than 120 cases were being reported each week. 28 health zones were affected, with cases appearing 1200 kilometres apart. In response:
- 11 labs have been set up to test around 3500 samples each week
- 11 Ebola treatment centres were set up to care for people with Ebola
- 300 000 people have been vaccinated
- 250 000 contacts have been registered
- 26 000 safe and dignified burials have been conducted
- More than 3000 health facilities were identified for infection prevention and control support
- More than 1000 metric tonnes of supplies have been delivered
- An Ebola vaccine has been licensed, and two treatments found to be highly effective
- Almost 160 000 million people have been screened for Ebola symptoms at borders or other points of control
This work is continuing. The outbreak isn’t over. WHO recommends waiting two full incubation periods – that’s 42 days – after the last person tests negative a second time before declaring the end of the outbreak.
We must stay in active response mode to get us over that finish line.
We have to be prepared for other cases emerging. It’s is a very real risk.
Remember that during the Ebola outbreak in West Africa flare-ups of new cases occurred after the end of the outbreak.
There are four reasons why new cases may emerge during this 42-day period, or even after the end of the outbreak.
- First, because of the complex security environment, Ebola transmission outside of groups under monitoring is possible.
- Second, Ebola virus can persist in used needles, syringes or vials for several weeks.
- Third, Ebola virus can persist in the body fluids of survivors for many months, and can be transmitted well after recovery, or in rare cases can result in relapse – as we’ve already seen during this outbreak.
- Finally, Ebola virus is present in an animal reservoir in the region, and there is always a risk of a new spillover to humans.
This is why it’s critical to maintain surveillance and rapid response capacities.
And that’s what we are doing. We’re still in full response mode.
In addition to the activities I already mentioned, I have to underline how critical it is to continue supporting the Survivor Programme, which provides follow-up care for almost all of the 1169 survivors in 26 health areas in North Kivu and Ituri. The programme also helps reduce the risks of re-introduction events.
We need to continue this work until the end of the outbreak, to keep the capacity in place to rapidly respond to flare-ups, to keep supporting survivors after the outbreak, and to transition the capacities built in this response toward building a stronger health system.
But to be very frank, right now the world risks dropping the baton at the finish line. WHO faces an immediate US $20 million funding gap. If no new resources are received, we will run out of money before the end of the outbreak.
We appreciate the generosity of donors who have supported the response since August 2018. Now we need to get over the finish line. WHO is calling on the international community to help us end this outbreak, and keep our promises to communities to build a stronger health system.
If we are forced to scale back operations because of a lack of funds, and then a new case emerges, we might not have the people and resources on the ground that we need to shut down transmission quickly. Just a single case could re-ignite the epidemic.
That would be a tragedy. An avoidable tragedy.
It is important that the global community doesn’t only focus efforts when there is an immediate threat, then walk away when the threat subsides.
The health system has to be strong to stop much more than Ebola. It has to stop malaria, measles, cholera, and now COVID-19.
There is a lot more work to do.
Thank you.
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Twitter CEO Dorsey to ‘reconsider’ Africa plans
Twitter chief executive Jack Dorsey said Thursday he is rethinking plans to spend as long as six months in Africa, partly due to concerns over the new-coronavirus epidemic.
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Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12 February 2020
The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) to review the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) took place on Wednesday, 12 February 2020, from 14:00 to 16:45 Geneva time (CEST).
Proceedings of the meeting
Members and advisors of the Emergency Committee were convened by teleconference.
The Secretariat welcomed the Committee and thanked them for their support. The meeting was turned over to the Chair, Dr Robert Steffen.
Dr Steffen also welcomed the Committee and gave the floor back to the Secretariat.
Representatives of WHO’s legal department and the department of compliance, risk management, and ethics briefed the Committee members on their roles and responsibilities.
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 who was present was surveyed and no conflicts of interest were judged to be relevant to the meeting.
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 (DRC), the WHO Secretariat, and the UN Ebola Emergency Response Coordinator.
The current situation in the DRC was reviewed. As of 10 February 2020, there were a total of 3431 cases, of which 3308 were confirmed and 123 were probable. 2253 persons have died (66%). Between 3 and 9 February 2020, three new confirmed cases were reported in Beni Health Zone, North Kivu. These three cases were already registered as contacts and two were under surveillance at the time of detection. More than 2000 contacts are being followed. There has been an increase in the number of security incidents in recent months.
Challenges that remain include: strengthening of community acceptance for full commitment to response measures; protection of personnel at strategic health checkpoints; improvement of infection prevention and control practices in health facilities; strengthening of the local health system; and comprehensive treatment and support for patients in recovery.
The WHO Secretariat gave an overview of the epidemiological situation, which shows an overall encouraging trend in case incidence and geographic spread. It was noted that sustaining this progress depends on the security situation and control of the well-known drivers of transmission, particularly in traditional health facilities, and on continued trust and communication with the community.
A risk communication and community engagement programme has been developed, as has an EVD survivors programme. It is critical to ensure the long-term sustainability of these two initiatives.
The situation in countries neighbouring DRC was reviewed, as was preparedness in nonaffected areas of DRC. An EVD operational readiness standardized approach has been implemented in 9 priority countries. More than 2400 alerts have been investigated, and more than 14,600 health workers have been vaccinated.
The UN Ebola Emergency Response Coordinator gave a brief report on operational support, focused on security challenges and preparations for any resurgence of disease.
Context and Discussion
The Committee noted a great deal of progress in the situation since its last meeting and commended the response, under the leadership of the DRC Ministry of Health and the multisectoral coordination commission established in July 2019. Support provided by WHO, UN agencies, nongovernmental organizations and other partners has also contributed to limiting the spread and impact of this virus in a difficult context. An increase in the number of alerts was attributed to strong and proactive community surveillance.
Conclusions and Advice
It was the unanimous view of the Committee that this event still constitutes a public health emergency of international concern (PHEIC) under the IHR (2005).
The Committee acknowledged the revised risk assessment, which puts the risk now as high at national and regional levels, and low at the global level.
The Committee was concerned that withdrawing the PHEIC now might have adverse consequences for the response efforts through diminishing focus. Additionally, although the primary concern of the Committee is EVD, there are serious ongoing outbreaks of other diseases, including measles and cholera, in DRC. The country continues to need support to combat infectious diseases as well as to strengthen its health system. Further, there remains an urgent need to maintain international solidarity for the response.
The Committee noted the ongoing discussions about the interpretation in the text of the IHR (2005) of the terms international and regional spread, and about creating an intermediate level of response between the binary possibilities of PHEIC or no PHEIC, in a way that does not require reopening negotiations on the Regulations. The Committee supports these discussions, as an intermediate level would be as useful for gradually ending a PHEIC and for signaling the potential for one to be declared.
The Committee provided the following advice to the Director-General for his issuance as revised Temporary Recommendations under the IHR (2005).
For DRC:
- Sustain the political commitment and multisectoral coordination approach to the response.
- Continue to engage and build trust with associations of survivors to facilitate rapid detection of any cases arising from exposure to infected bodily fluids of survivors.
- Continue to strengthen capacity, implementation, and coordination for community awareness and engagement, including a focus on hotspots, preventing resurgence where cases have declined, and to support survivors in their communities.
- Further enhance the acceptance of response measures and address access and security issues by engaging influencers and decision makers for all interventions.
- Strengthen measures to prevent and manage nosocomial infections, including systematic mapping of health facilities, targeting of IPC interventions and sustain support to those facilities through monitoring and supervision, including in private-sector and traditional health facilities.
- Continue cross-border screening and step up monitoring at checkpoints around hotspots and at main roads.
- Continue to implement and share real-time full-genome genetic sequencing of all new confirmed cases.
- Strengthen measures to prevent and manage nosocomial infections, including systematic mapping of health facilities, targeting of IPC interventions and sustain support to those facilities through monitoring and supervision.
- Strengthen preparedness in non-affected provinces of DRC, and more generally strengthen the health system across the country to respond to concurrent health emergencies.
- Continue to implement optimal vaccine strategies that have proven maximum impact on curtailing the outbreak, as recommended by WHO’s Strategic Advisory Group of Experts (SAGE).
For countries at risk:
- At-risk countries should maintain their work with partners to improve their preparedness for detecting and managing imported or locally acquired cases, including the transparent sharing of detailed information on suspect cases, as required by the International Health Regulations (2005), and sharing laboratory samples of suspect cases for confirmatory testing in accordance with WHO norms and guidance.
- Countries should continue to map population movements and sociological patterns that can predict risk of disease spread.
- Risk communications and community engagement, especially at points of entry, should be maintained.
For all countries:
- As recommended previously, no country should close its borders or place any restrictions on travel and trade.
- The Committee does not consider entry screening at airports or other ports of entry outside the region to be necessary.
The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of these recommendations.
Based on this advice, the reports made by the affected State Party, and the currently available information, the Director-General accepted the Committee’s assessment and on 12 February 2020 maintained the Ebola outbreak in the Democratic Republic of the Congo as a Public Health Emergency of International Concern (PHEIC).
The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005) to reduce the international spread of Ebola, effective 12 February 2020. The Director-General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within two months or earlier if the situation requires.
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Pregnancy and breastfeeding during an Ebola virus outbreak
Women who are pregnant or breastfeeding in an Ebola outbreak face similar challenges as other population groups, but they have specific health needs which must be met.
As the second largest Ebola outbreak in history continues in the Democratic Republic of Congo, WHO has released new clinical guidelines for healthcare providers supporting pregnant or breastfeeding women in the context of Ebola virus disease.
Improving clinical care and reducing mortality
Clear and coherent guidance is needed to meet the combined needs of women requiring Ebola treatment, pregnancy care and management of complications.Information on how to protect breastfeeding children and other members in the community from transmission of the disease is also critical.
Limited scientific evidence on how to best manage these needs has previously been a challenge for affected countries. In addition, misconceptions that pregnant women have a higher mortality rate than other populations with Ebola may in some contexts have put pregnant women at risk of not receiving standard care.
WHO’s Guideline on the management of pregnant and breastfeeding women in the context of Ebola virus reviews existing evidence and provides a single set of recommendations on the care continuum for women exposed to, diagnosed with, or recovered from Ebola.
This will enable healthcare providers, emergency response teams and health policy-makers to improve prevention and treatment measures in an Ebola outbreak.
Obstetric care at an Ebola Treatment Centre
Optimal supportive care should be offered to all pregnant women with Ebola. Likewise, they should be offered experimental treatment and vaccination under the same conditions as non-pregnant populations.
Ebola virus disease does increase the risk of miscarriage and early labour, requiring close clinical management at Ebola treatment centres. It is important to engage both obstetric providers and those trained in Ebola response.
This dual expertise is also important because early Ebola and pregnancy-related symptoms can overlap. Pregnant women should be prioritised for testing to confirm an Ebola infection.
Ebola virus can persist in pregnancy related fluids as well as breastmilk. If healthcare providers are not clear on how to manage Ebola infection risk, they may be less willing to provide care. This stigma can be life-threatening for women who experience complications during delivery.
The new WHO guidelines advise healthcare workers on how to protect themselves while caring for pregnant women with Ebola virus disease. This includes induced labour or surgical procedures, which carry greater risk of transmission in cases of acute infection. Any invasive treatments should be carried out in full personal protective equipment.
Breastfeeding recommendations in an Ebola outbreak
WHO recommends that women with suspected or confirmed Ebola immediately stop breastfeeding and are prioritised for diagnostic testing. Any child exposed to Ebola through breast milk should be placed into safe care, closely monitored for symptoms over a 21-day period and fed with an appropriate breast milk substitute.
The guidelines strongly recommend that breastfeeding is only restarted following two consecutive negative tests of breast milk, separated by 24 hours.
A breast milk substitute should be used even if infection is confirmed for both the mother and her child. Exceptions can be made for infants under 6 months of age who are already infected, if breast milk substitutes are not feasible, affordable, sustainable or safe and separation cannot be implemented safely.
Women’s health and rights in a disease outbreak
A disease outbreak does not change women’s and adolescent girls’ fundamental human right to sexual and reproductive healthcare, including evidence-based care during pregnancy and childbirth.
Women need support to make informed reproductive health care choices for themselves and their children. Women living in an Ebola outbreak should have access to all relevant reproductive options, regardless of economic, cultural, racial or religious status, including contraception and safe abortion to the full extent of the law.
Pregnant and breastfeeding women across affected communities need equitable and respectful care that considers the risks they face and supports the choices they make.
Accessing the guidelines and further research
These guidelines are now available online and may be freely downloaded. The executive summary will be available in French.
WHO will closely monitor new data as it emerges, as there is still a pressing need to prioritise ongoing research related to Ebola virus transmission.
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US$675 million needed for new coronavirus preparedness and response global plan
To fight further spread of the new coronavirus (2019-nCoV) outbreak in China and globally, and protect states with weaker health systems, the international community has launched a US$675 million preparedness and response plan covering the months of February through to April 2020.
“My biggest worry is that there are countries today who do not have the systems in place to detect people who have contracted with the virus, even if it were to emerge,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Urgent support is needed to bolster weak health systems to detect, diagnose and care for people with the virus, to prevent further human to human transmission and protect health workers.”
The Strategic Preparedness and Response Plan (SPRP) for the new coronavirus lays out activities and resources needed by international health organizations globally, including WHO, to implement priority public health measures in support of countries to prepare and respond to nCoV-2019 for a period February-April 2020. The objectives of the plan are to limit human-to-human transmission of the virus, particularly in countries most vulnerable if they were to face an outbreak; identify, isolate and care for patients early; communicate critical risk and event information; minimize social and economic impact; reduce virus spread from animal sources; and address crucial unknowns.
The plan focuses on:
- Rapidly establishing international coordination and operational support;
- Scaling up country readiness and response operations;
- Accelerating priority research and innovation.
“The effectiveness of outbreak response depends on the preparedness measures put in place before outbreaks strike,” said Dr Mike Ryan, head of WHO’s Health Emergencies Programme. “That is why we are seeking resources to safeguard the most vulnerable countries to protect people from the new coronavirus before it arrives on the doorstep.”
As noted in the SPRP, WHO assesses that the outbreak poses a very high risk in China, and high risk regionally and globally. The risk assessment was based on factors including the likelihood of further spread, the potential impact on human health, and the varying levels of effectiveness in national preparedness and response measures. Accelerated action, as called for in the plan, can address these risks and areas requiring support.
As of 10 a.m. Central European Time on 5 February, 25 countries have reported confirmed cases of the new coronavirus, including China, where 24,363 people had contracted the virus, or over 99% of all cases. In all other countries, 191 cases have contracted the virus.
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Global study shows diabetes and heart disease can be a deadly combination
The combination of type 2 diabetes and coronary artery disease can be deadly.
New research from a global study led by a physician from UConn Health has found that patients with Type 2 diabetes admitted into the hospital for congestive heart failure face a one in four chance of dying over the next 18 months.
The results were presented on June 11 at the American Diabetes Association’s (ADA) annual meeting in New Orleans and published online in the ADA journal Diabetes Care. The findings paint a much grimmer picture of the outcome for diabetes patients with severe heart disease than was previously known.
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