Posts Tagged ‘Ebola’

WHO delayed Ebola emergency declaration by 2 months – for political expedience

March 20, 2015

In October last year it was revealed that the complacency of the WHO African country heads (mainly political appointees) and who “seem to have been unwilling to even acknowledge that there was a problem on their turfs” had caused avoidable delays.

Now the Associated Press reports (NY Times) that the WHO leadership delayed declaring an emergency by 2 months for reasons of political expediency; to avoid upsetting some African countries, to avoid economic damage and to avoid any interruption to the annual Haj pilgrimage to Mecca. The emergency was declared on August 8th 2014 but from emails obtained by AP, it should have been declared 2 months earlier. That probably means that about 1000 deaths might have been prevented. The death toll from the outbreak is now estimated to have reached over 10,000.

Ebola deaths in West Africa (Data: WHO / Chart CC BY 4.0: JV Chamary / Source: http://onforb.es/1sCVxE1)

The Hindu:

Among the reasons the United Nations agency cited in internal deliberations – worries that declaring such an emergency akin to an international SOS could anger the African countries involved, hurt their economies or interfere with the Muslim pilgrimage to Makkah. ….. 

In public comments, WHO Director-General Margaret Chan has repeatedly said the epidemic caught the world by surprise. ……

But internal documents obtained by AP show that senior directors at the health agency’s headquarters in Geneva were informed of how dire the situation was early on and held off on declaring a global emergency. Such an alert is meant to trigger a surge in outside help, or, as a WHO document put it, “ramps up political pressure in the countries affected” and “mobilizes foreign aid and action”.

When WHO experts discussed the possibility of an emergency declaration in early June, one director viewed it as a “last resort”.

The delay in declaring an emergency was one of many critical problems that hobbled the agency’s ability to contain the epidemic. When aid agency Doctors Without Borders warned Ebola was spiralling out of control, WHO contradicted it, even as WHO’s own scientists called for backup. When WHO did send staffers to Africa, they were of mixed calibre. Fellow responders said many lacked Ebola experience; one WHO consultant who got infected with Ebola broke his own agency’s protocol, putting others at risk and getting WHO kicked out of a hotel, the AP found.

……..  The vacuum of leadership at WHO was so damaging the U.N. created the Mission for Ebola Emergency Response to take over the overall fight against the disease.

….. By the time WHO declared an international emergency, nearly 1,000 people were already dead. Overall, more than 10,000 are thought to have died in the year since the outbreak was announced.

NYT: 5 Key Findings

1. WHO officials privately floated the idea of declaring an international health emergency in early June, more than a month before the agency maintains it got its first sign the outbreak merited one — in late July — and two months before the declaration was finally made on August 8, 2014.

2. WHO blamed its slow response partly on a lack of real-time information and the surprising characteristics of the epidemic. In fact it had accurate field reports — including scientists asking for backup — and it identified the unprecedented features of the outbreak. The agency was also hobbled by a shortage of funds and a lack of clear leadership over its country and regional offices.

3. Politics appear to have clouded WHO’s willingness to declare an international emergency. Internal emails and documents suggest the U.N. health agency was afraid of provoking conflict with the Ebola-stricken countries and wary that a declaration could interfere with the economy and the Muslim pilgrimage to Mecca.

4. An Ebola-infected WHO consultant in Sierra Leone violated WHO health protocols, creating a rift with Doctors Without Borders that was only resolved when WHO was thrown out of a shared hotel.

5. Despite WHO’s pledges to reform, many of the proposed changes are recycled suggestions from previous outbreaks that have never taken hold. Any meaningful reform to the organization would likely require countries to rewrite the constitution, a prospect many find unpalatable.

Advertisements

Sweden gets it wrong in rejecting treatment for Ebola infected UNICEF worker

October 24, 2014

Swedish Social Services received a request yesterday to accept a UNICEF worker smitten with Ebola for treatment. They merely responded with a demand for more information and when they did not get that information they rejected the request.

They got it wrong I think.

I imagine the request was urgent in an effort to find a place willing and capable to treat the unfortunate UNICEF worker. The correct response should have been “Yes, in principle, subject to practical feasibility”. To note the limitations or constraints on what help could be provided would have been perfectly in order. But just a counter-request for more information would have been taken – and rightly so – as prevarication and a fundamental unwillingness to help.

I hope that some country with suitable medical services has accepted the unfortunate patient.

From my little experience of emergency situations, the bottom line is that emergency requests for help must be answered YES or NO, and not just generate requests for further information. A YES can – and must – be qualified with the constraints or limitations of what help can be provided. The requests usually originate from the “front line” (whether disease or earthquake or tsunami or typhoon) and it is unreasonable for those receiving requests for help, to burden those at the “front” with more bureaucratic requests for information. Responses must be for the sake of being helpful for those at the “front line” to take a call and make decisions and take actions. A response cannot be – as in this case – something which makes it more difficult for the “front line” to act.

(I would give Fukushima as an example. When the plant engineers and managers at the Fukushima nuclear plant requested permission from Headquarters in Tokyo to use sea water for emergency cooling – which they well knew would permanently disable the plant – TEPCO HQ responded by asking for more information. The “front line” at the plant knew they were no other options but the lack of clear response and unending requests for more information from Tokyo led to many hours (about 6 hours) being lost).

As a response from someone called the “Emergency Management Director” of the National Social Service Board, Sweden’s response left a lot to be desired.

Dagens Nyheter:

On Thursday, Sweden received a request to receive a suspected Ebola infected person who worked for UNICEF in Sierra Leone. But the reflection period was too short and the information was very sketchy and therefore rejected by the National Social Services Board writes expressen.se.

“We had no medical information in general, and requested it, but received no such information. Therefore it was hard to know what to say yes to and what to prepare”, says Johanna Sandwall, emergency management director on the National Social Services Board.

I would suggest that the National Social Services Board has not yet distinguished sufficiently between normal processes and emergency procedures. I take it for granted that Sweden, in fact, does want to assist and is probably among the more capable countries for treating patients.

WHO’s politically appointed country heads in Africa dropped the Ebola ball

October 18, 2014
Dr Louis Sambo

Dr Louis Sambo, WHO Regional Director Africa

Why are the WHO’s Regional Directors (for Africa, Dr. Luis Sambo) not answerable to the head of the WHO in Geneva?

The first indications that the Ebola ourbreak was getting out of control were raised in April by Medecins Sans Frontieres (MSF).

BBC: Medical charity Medecins Sans Frontieres (MSF) warned in April that the outbreak was out of control – something disputed by the WHO at the time.

…… In the worst affected countries – Liberia, Guinea and Sierra Leone – the Ebola virus has now killed 4,546 people with cases of infection numbering 9,191, according to the latest WHO figures.

AP carries a damning story of the complacency of the African WHO representatives who seem to have been unwilling to even acknowledge that there was a problem on their turfs. That the country heads of the WHO are mainly political appointments is not perhaps so surprising, but even all the Regional Directors around the world are apparently not responsible or accountable to the WHO head in Geneva.  That does not seem to be an organisation very conducive to taking actions on medical reasons alone. Presumably the African Regional Director is himself a political appointee (from Angola in this case) and  was elected to his position in 2005. It would seem that the position of Regional Director primarily reflects some political balance rather than just competence for the job to be done.

The outbreak began at least in January and by April had already killed 69 just in Guinea (around 70% fatalities of those infected).

AP:

In a draft document, the World Health Organization has acknowledged that it botched attempts to stop the now-spiraling Ebola outbreak in West Africa, blaming factors including incompetent staff and a lack of information.

In the document obtained by The Associated Press, the agency wrote that experts should have realized that traditional infectious disease containment methods wouldn’t work in a region with porous borders and broken health systems.

“Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall,” WHO said in the document. “A perfect storm was brewing, ready to burst open in full force.”

The U.N. health agency acknowledged that, at times, even its own bureaucracy was a problem. It noted that the heads of WHO country offices in Africa are “politically motivated appointments” made by the WHO regional director for Africa, Dr. Luis Sambo, who does not answer to the agency’s chief in Geneva, Dr. Margaret Chan.

 ….. The document — a timeline on the Ebola outbreak — was not issued publicly but the AP was told the health agency would be releasing it earlier this week. However, WHO officials said in an email Friday that the timeline would now probably not be released publicly. No official at the agency would comment Friday on the draft report.

Dr. Peter Piot, the co-discoverer of the Ebola virus, agreed in an interview Friday that WHO acted far too slowly, largely because of its Africa office.

“It’s the regional office in Africa that’s the front line,” he said at his office in London. “And they didn’t do anything. That office is really not competent.” 

WHO’s other regional directors — the Americas, Southeast Asia, Europe, Eastern Mediterranean and the Western Pacific — are also not accountable to Geneva and are all elected by their regions.

Piot, director of the London School of Hygiene and Tropical Medicine, also questioned why it took WHO five months and 1,000 deaths before the agency declared Ebola an international health emergency in August.

“I called for a state of emergency to be declared in July and for military operations to be deployed,” Piot said. But he said WHO might have been scarred by its experience during the 2009 swine flu pandemic, when it was slammed for hyping the situation.

In late April, during a teleconference on Ebola among infectious disease experts that included WHO officials, Doctors Without Borders and the U.S. Centers for Disease Control and Prevention, questions were raised about the performance of WHO experts, as not all of them bothered to send Ebola reports to WHO headquarters, according to the draft document.

In the timeline, WHO said it was “particularly alarming” that the head of its Guinea office refused to help get visas for an expert Ebola team to come in and that $500,000 in aid was being blocked by administrative hurdles. ….

In fact the outbreak dates back at least to the beginning of this year. In Guinea, 69 people had already died between January and April 21st of Ebola:

MedicalDaily: Apr 21, 2014

Sixty-nine people have died since January of Ebola in the West African country of Guinea with 109 cases now confirmed by the World Health Organization (WHO). … WHO’s Dr. Rene Zitsamele-Coddy said in a press release. “As soon as the outbreak was confirmed on March 21, we started to work with [Guinea officials] and other partners to implement necessary measures,” she said. ”It is the first time the country is facing an Ebola outbreak, so WHO expertise in the area is valuable.”

 

Juxtaposition: Call for health care strikes in Liberia and in the UK

October 13, 2014

There was a time when societies accepted that certain professions and essential activities and vocations were considered to transcend the right to strike. But even today there are strikes and there are strikes.

There are many heroes in West Africa who in spite of low pay, delayed salaries and a shortage of protective equipment continue to treat the many Ebola patients around them. Ninety-five health workers have so far died from the virus in Liberia.

I am sure that the calls to strike in both Liberia and the UK have their own justifications. It is just that they both come today and it is the juxtaposition of the two strike calls which I find interesting.

Liberia

BBCNurses and medical assistants fighting the Ebola outbreak in Liberia have largely ignored a call to strike over danger money and conditions. Most health workers were working as normal on Monday, the BBC’s Jonathan Paye-Layleh in Monrovia said. A union official said the government had coerced workers to ignore the strike – but the government said it had simply asked them to be reasonable.

Liberia is the country hit hardest by the deadliest ever Ebola outbreak. Health workers are among those most at risk of catching the disease. Ninety-five have died from the virus in Liberia.

The latest outbreak has killed more than 4,000 people in Liberia, Sierra Leone, Guinea and Nigeria since it was identified in March. …….. Liberia’s National Health Workers Association, a union, had called the strike to demand an increase in the monthly risk fee paid to those treating Ebola cases.

It wants workers to be paid a risk fee of $700 (£434) a month. The fee is currently less than $500 a month, on top of basic salaries of between $200 and $300. The association also wants more protective equipment and insurance for workers, and has accused the government of not providing enough protection from the virus.

UK

The GuardianNHS staff are to take further industrial action next month unless ministers agree to give them a 1% pay rise.

Unions whose members are taking part in the first walkout by NHS staff over pay since 1982 will undertake further action in November if the health secretary, Jeremy Hunt, does not meet them for talks and offer more money.

“We are already planning, and will definitely be taking, further industrial action if the government doesn’t put more money on the table and doesn’t talk to us,” said Rachael Maskell, head of health at the Unite union. “There will definitely be more industrial action by NHS staff if Jeremy Hunt doesn’t sit down and talk and make more money available. It’s clear that the government are going to have to find money [to settle] this [dispute].”

The seven unions taking part in Monday’s action were discussing three options for the next stage of their attempts to force the coalition to pay all NHS staff the 1% rise recommended last year by the NHS Pay Review Body but rejected by Hunt.

Union sources said one option could be a repeat of the four-hour walkout by midwives, paramedics, porters and other non-medical staff. Another option would be to escalate that into a full-day stoppage. Or they may opt for different groups of workers taking action at different times over the course of a day.

Safety protocols for Ebola treatment are not fool-proof

October 12, 2014

A hospital worker in Texas who helped treat Thomas Duncan, the Liberian Ebola patient who died last Wednesday, has now tested positive (to be confirmed) for the disease. He had used a full protective suit and all the safety protocols of the Center for Disease Control and Prevention (CDC) were apparently followed. If confirmed, it would be the first known case of the disease being contracted or transmitted in the U.S. The infected health worker apparently has a pet which is now being tested. A Spanish nurse in Madrid who treated a priest who had contracted Ebola was the first person infected outside West Africa. Her dog Excalibur was put down as a precaution.

One other person is in isolation at the hospital,  the Texas Health Presbyterian Hospital, which is no longer accepting emergency patients.

There is some serious speculation that the Ebola virus could become air-borne and the disease would not only be subject to transmission by contact with body fluids. Even if the case in Texas was due to some breach of safety protocols, these procedures are clearly not fool-proof. And they would be obsolete and quite ineffective if the virus is already mutating on its way to going air-borne.

It also brings into sharp focus the risks being run by health workers treating Ebola patients in West Africa.

Washington Post:

…. The worker is in isolation and in stable condition, the hospital system said.

Daniel Varga, chief clinical officer for Texas Health Resources, which operates Texas Health Presbyterian Hospital Dallas, said the worker had been under self-monitoring in recent days, which includes taking a temperature twice daily. When the health worker showed signs of a fever, the person notified the hospital, went directly there and immediately was admitted to an isolation room. Varga said the entire sequence of events took less than 90 minutes. 

The CDC did not consider person to be “high risk,” Varga said. The person treated Duncan, the Ebola patient, after his second visit to the ER, on Sept. 28. The health worker was “following full CDC precautions,” including wearing a gown, gloves, a mask and a protective face shield.

“We’re very concerned,” Varga said, though he added that the hospital is “confident that the precautions that we have in place are protecting our health-care workers.”

The hospital has put its emergency room on “diversion,” which means that ambulances are not currently bringing patients to the ER, though patients already in the hospital are still being cared for.

“The system of monitoring, quarantine and isolation was established to protect those who cared for Mr. Duncan as well as the community at large by identifying any potential Ebola cases as early as possible and getting those individuals into treatment immediately,” Varga said.

Dallas officials deployed hazmat teams to decontaminate the entrance and common areas of an apartment complex in the 3700 block of Marquita Avenue where the health worker presumptively lives and the vehicle that the person used to travel to the hospital.

This Ebola epidemic has now claimed over 4,000 lives in West Africa predominantly in Liberia, Sierra Leone and Guinea. If the disease does become air-borne it would probably happen first where the virus is present in abundance and that would probably be in West Africa.

Global warming (what else?) caused ISIS, spread Ebola and will change male-female ratio!

October 3, 2014

Global warming – which has now been absent for 18 years – has been blamed for many things. In fact projects – in any field – which have managed to claim a possible link with global warming have had a much greater probability of being funded. Now global warming is blamed for the rise of ISIS, the spread of Ebola and even for altering the male-female ratio among humans.

clip_image002

 

In just the last few days these articles have appeared and pass for serious commentary in supposedly serious media!

  1. Charles B. Strozier and Kelly A. Berkell, How Climate Change Helped ISIS
  2. Elijah Wolfson, Ebola and Climate Change: Are Humans Responsible for the Severity of the Current Outbreak?

  3. Rachael Rettner, Climate Change Could Alter the Human Male-Female Ratio

Not only are global temperatures not increasing (and maybe decreasing), but there is no linkage between observed “extreme” weather and global warming.

Climate Depot:

Hurricanes: 3,264 Days Without a Major (Cat 3 +) Hurricane Strike – ‘Nearly 9 years…the last being Wilma in October, 2005′

Tornadoes:U.S. Tornado Count Plummeting to Record Low Levels Three Consecutive Years

Droughts:New Research Confirms Human CO2 Not Causing A Global Drought Increase – ‘Droughts in the U.S. are more frequent and more intense during COLDER periods’


%d bloggers like this: