Human Brain

Cognitive symptoms are being reported by thousands of COVID-19 survivors, even those with mild symptoms and no previous medical conditions. The symptoms often include memory loss, confusion, difficulty focusing, and dizziness. 

A study published just last week covering more than 500 hospitalized patients in Chicago, found that some 82% had experienced neurological symptoms at some point during the course of their disease. The most frequent manifestations were myalgias or muscle pain, (44.8%); headaches (37.7%); encephalopathy, or altered brain function  (31.8%); dizziness (29.7%), dysgeusia, or distorted sense of taste (15.9%); and anosmia, or a loss of small (11.4%). Overall, neurologic pathologies were associated with increased morbidity and mortality, according to the study published in the journal of the American Neurological Association. 

Other studies of post-discharge patients hospitalized with COVID-19, found a wide range of common persistent symptoms, including fatigue, dyspnoea, loss of memory, concentration, and sleep disorders. 55 percent of patients experienced fatigue and 34 percent had loss of memory even 110 days after being discharged.

A report published in the CDC’s Morbidity and Mortality Weekly Report, surveyed 274 symptomatic adults with mild COVID-19 symptoms and found that 35 percent of interviewees had not returned to their usual state of health 2-3 weeks after their initial positive test result. For individuals aged 18-34, 26 percent experienced prolonged illness. 

Some researchers suspect that COVID-19 infections can cause long-lasting changes in the immune system, but further research and long term follow-ups are needed to understand the processes at play. 

WHO – We Are Only Beginning To Understand Long-Term Health Impacts

“We are only beginning to understand the long-term health impacts among people with ‘long-COVID’ so we can advance research and rehabilitation,” said WHO’s Dr Tedros Adhanom Ghebreyesus, speaking at a WHO press conference on Monday, where he warned about the dangers of letting the virus to run free with the hope that the global population might reach some kind of herd immunity.

These persistent symptoms are having serious consequences for patients’ jobs and their ability to return to their daily lives. Speaking to the New York Times, Rick Sullivan, a COVID-19 survivor who has had cognitive symptoms since his recovery in July, said “It is debilitating. I’ve become almost catatonic. It feels as though I am under anesthesia.”

“There’s no question that there are a considerable number of individuals who have a post viral syndrome that really, in many respects, can incapacitate them for weeks and weeks following so-called recovery and clearing of the virus,” said Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, in a review article of the issue published by the JAMA network in late September, entitled “As Their Numbers Grow, COVID-19 ‘Long Haulers’ Stump Experts.”  

Fauci noted that in some individuals, the symptoms are suggestive of myalgic encephalomyelitis/chronic fatigue syndrome, however the causes of persistent COVID-19 cognitive symptoms are currently unknown. 

Mady Hornig, a faculty member of Columbia University Medical Center’s epidemiology department, was quoted in the same review saying, “because of the large number of COVID-19 cases occurring simultaneously, we have a unique scientific window and a huge responsibility to investigate any long term consequences and disabilities that COVID-19 survivors may face.”

Both WHO as well as other experts and researchers have thus underlined the importance of telling the public about the risks of prolonged COVID-19 symptoms and illness. Even if individuals are not considered high risk, precautionary measures need to be taken to avoid infection with SARS-CoV2 and the potential post-viral syndrome after COVID-19, Dr Tedros emphasized in his press conference, using “every tool in the toolbox.”  

-Raisa Santos contributed to this story.

Image Credits: DigitalRalph.

China’s Foreign Ministry Spokesperson Hua Chunying at Friday’s press conference.

China has announced that it will join the WHO co-sponsored COVAX vaccine procurement pool, along with the Republic of Korea.

WHO’s Director General Dr Tedros described it as a major boost to the global effort to manufacture and distribute 2 billion vaccines worldwide equitably by the end of 2021.

“This week, China and the Republic of Korea have now joined the COVAX facility, bringing the total number of countries and economies that are part of the global initiative for vaccine accesses to 171,” said Dr Tedros, speaking at a WHO press conference on Friday.

Tedros said that the facility would enable WHO to “distribute vaccines simultaneously to priority populations, including health care workers, older people and those with underlying conditions.”

Dr Tedros Adhanom Ghebreyesus, WHO Director-General at a press conference on Friday.

In a related move, the WHO Director General said, “We also welcome the announcement by one vaccine developer, Moderna, that it will not enforce its patent rights over its COVID-19 vaccine during the pandemic.”

The company, in an announcement Thursday to shareholders, said it would “not enforce” its COVID-19-related patents against other companies making vaccines to combat the pandemic – and would also be willing to license intellectual property for their COVID-19 vaccines for the post pandemic period.

But Moderna’s chief executives stopped short of saying whether the company would formally offer its vaccines through the COVAX procurement pool that WHO and Gavi, the Vaccine Alliance, are co-sponsoring, or whether it would engage with the ‘COVID-19 Technology Access Pool,’ which aims to reduce IP barriers for low and middle income countries that need to access COVID-19 health products.   

Said Dr Tedros, “We look forward to learning more about what this announcement means in terms of technology transfer. We appreciate this act of solidarity, which is in line with the principles of the COVID-19 Technology Access Pool.”

In announcing the move to join the vaccine facility, a Chinese Foreign Ministry spokesperson said: “We are taking this concrete step to ensure equitable distribution of vaccines, especially to developing countries, and hope more capable countries will also join and support Covax.” 

The moves by China, as well as Korea, mark a major signal of support for the global initiative, particularly after the United States in September said it didn’t want to be “constrained by multilateral organizations influenced by the corrupt World Health Organization and China.” The US go-it-alone approach to COVID-19 vaccine access and distribution, is based on its own sizable pre-purchase agreements with leading pharma developers of front-runner vaccine candidates, including Moderna, Pfizer, and Johnson & Johnson. The European Union has also thrown its support behind the facility, along with non EU  Switzerland and Norway, as well as Japan.

Vaccine Campaigns Need to Be Restarted

In other matters, Dr Tedros called upon the global community to jumpstart stalled immunization campaigns for other diseases, following a meeting on Wednesday of WHO Strategic Advisory Group of Experts (SAGE) on Immunization.

“Millions of children globally are missing out on life saving vaccines. Rapidly restoring immunization clinics, campaigns, and outreach activities is the only way to prevent predictable outbreaks and deaths from diseases like measles and polio,” said Dr Tedros at a press conference on Friday. 

A report by SAGE found that over 80 vaccination campaigns have been either delayed or cancelled by the COVID-19 pandemic in more than 50 countries, leaving millions of children and adolescents unprotected against deadly, but vaccine preventable diseases.

The WHO expert group highlighted the double danger that interrupting vaccine campaigns could pose during the pandemic, saying it could lead to a resurgence of deadly preventable diseases, including measles, polio, diphtheria, and yellow fever. 

Press conference on Friday on the recent biannual meeting of Strategic Advisory Group of Experts on Immunization.

The interruptions have been due both to the extra burden on health systems caused by COVID-19, as well as the decreased demand for vaccination because of national lockdowns and physical distancing requirements, the expert committee said.

Prior to the COVID-19 pandemic, approximately 14 million children under the age of one did not receive any vaccines. According to a recent study, the pandemic and national response policies reduced daily vaccination visits by 52 percent in Karachi, Pakistan and immunization doses given by outreach services dropped by 88 percent. 

Backsliding could prompt renewed outbreaks 

Alejandro Cravioto, Chair of SAGE, underscored the importance of learning from the Ebola epidemic in the Democratic Republic of Congo, where an outbreak of measles was occurring simultaneously in 2019. The measles outbreak had higher rates of deaths and confirmed cases than Ebola, with the worst impact on children. 

“Our immunization services are really compromised when we have another problem we’re handling,” said Cravioto at a WHO press conference earlier on Friday. “I think what is important is to make sure that we see all of these as a single entity, as the single problem that we have.

We might be vaccinating the elderly against COVID. And we have to make sure that we’re vaccinating the younger ones against all the other diseases for which we have a vaccine. But this has to be an integrated approach.”

Guidelines produced by SAGE in March provide countries with a roadmap to the provision of immunization services during the COVID-19 pandemic. While individual countries are advised to make domestic risk assessments, SAGE informs decision makers of the necessity to continue immunization services – prioritizing catch-up immunization on vaccine preventable diseases – and strengthen health system capacities and provision of essential health services. 

“We have to stand back up the immunization program, which is the bedrock for primary health care services in so many countries, and will be the bedrock for the delivery of COVID vaccines,” said Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals at WHO.

WHO Addresses the Toll of COVID-19 on Mental Health

In his Friday briefing, Dr Tedros also highlighted the need for increased attention to and investment in mental health, a deeply neglected issue. Close to one billion people globally are living with a mental health disorder and one person dies every 40 seconds by suicide, according to WHO. 

The lack of access to quality mental health services is especially prevalent in low and middle income countries – with over 75 percent of people with mental, neurological and substance abuse disorders receiving no treatment. And on average only two percent of countries’ health budgets are spent on mental health. 

The COVID-19 pandemic has exacerbated existing mental health issues and has triggered new ones. A recent WHO survey found that over 90 percent of the world’s countries reported disruptions of critical mental health services as a result of COVID-19.

“It’s time to increase investment in mental health services on a massive scale so that access to quality mental health services becomes a reality for everyone,” said Dr Tedros. 

On Saturday, World Mental Health Day, the WHO is hosting an online global advocacy event, The Big Event for Mental Health on its @WHO Twitter and Facebook channels. The event, including musicians, film, artists and speakers, co-designed with United for Global Mental Health and the World Federation of Mental Health, to focus attention on mental health and increase funding for mental health services.

Image Credits: Ministry of Foreign Affairs of the People's Republic of China, WHO.

Refugees in Uganda receive their monthly emergency ration from the World Food Program.

The United Nations World Food Program (WFP) has been awarded the 2020 Nobel Peace Prize for its efforts in fighting hunger in a year when food supplies for millions of people have been disrupted by COVID-19, destroyed by flooding and devoured by unprecedented locust swarms spreading across Africa and beyond.

In Friday’s announcement, the Oslo-based Nobel Committee, said it had awarded the prize to WFP “for its efforts to combat hunger, for its contribution to bettering conditions for peace in conflict-affected areas and for acting as a driving force in efforts to prevent the use of hunger as a weapon of war and conflict.”

“Until the day we have a medical vaccine, food is the best vaccine against chaos,” said Berit Reiss-Andersen, Nobel committee chair, in announcing the award. She called upon the international community to boost funding for WFP at a critical moment when the COVID-19 pandemic is wreaking havoc with the global economy.

WFP replied, saying, “WFP is deeply humbled… “This is in recognition of the work of WFP staff who put their lives on the line every day to bring food and assistance to more than 100 million hungry children, women and men across the world.”

World has Faced Special Challenges in Food Security This Year

In its award announcement the Nobel Prize Committee noted that: “The World Food Programme is the world’s largest humanitarian organisation addressing hunger and promoting food security. In 2019, the WFP provided assistance to close to 100 million people in 88 countries who are victims of acute food insecurity and hunger.

“The coronavirus pandemic has contributed to a strong upsurge in the number of victims of hunger in the world,” Reiss-Anderson said. “In recent years, the situation has taken a negative turn. In 2019, 135 million people suffered from acute hunger, the highest number in many years. Most of the increase was caused by war and armed conflict.

“In countries such as Yemen, the Democratic Republic of Congo, Nigeria, South Sudan and Burkina Faso, the combination of violent conflict and the pandemic has led to a dramatic rise in the number of people living on the brink of starvation. In the face of the pandemic, the World Food Programme has demonstrated an impressive ability to intensify its efforts.

The award commitee stressed that the fight against world hunger has special meaning in the pandemic year.

“According to the most recent reports, the COVID-19 pandemic could tip over 130 million more people into chronic hunger by the end of 2020, due to the economic disruptions that have occurred worldwide, often hitting hardest at the poorest countries and economies.”

In the WHO African region alone, an additional 22 million people were undernourished as a result of the economic fallout from COVID-19 lockdowns – on top of the 200 million Africans that are already undernourished, said World Food Programme officials predicted earlier this year. 

The UN State of World Food Security and Nutrition published in July, estimates that almost 690 million people went hungry in 2019 – up by 10 million from 2018. High costs and low affordability also mean billions cannot eat healthily or nutritiously. The hungry are most numerous in Asia, but expanding fastest in Africa.

The majority of Africa’s population lives hand-to-mouth, and lack of income opportunities under the lockdowns have left many people unable to afford food. The cost of basic foodstuffs increased, and deliveries of essential food supplies were also delayed due to trade and travel restrictions imposed earlier in the year.

Over the course of 2020, East Africa and the Horn of Africa have also faced a series of unprecedented, overlapping natural disasters, including a record season of flooding and locusts, according to a recent report by the International Federation of the Red Cross (IFRC).

The widespread flooding in Ethiopia, Kenya, Somalia, South Sudan, Tanzania, Rwanda and Uganda during the spring displaced around 500,000 people. The flooding also set back key interventions against the worst locust crisis the area has faced in decades.

Announcement ends Speculation of WHO and Greta Thunberg as contenders

The announcement ended speculation about a range of other contenders for the prize, from the World Health Organization to climate activist Greta Thunberg, who was also passed over in 2019.

“Are there really people who seriously believe that I will win. It’s not serious. Of course not, I won’t win. Why would I win?”  the climate activist, Thunberg told reporters while appearing at a Fridays for Futures climate protest in Stockholm Sweden.

Speaking at a press conference later Friday, WHO Director General Dr Tedros Adhanom Ghebreyesus, said “I would like to congratulate the World Food programme upon being awarded the Nobel Peace prize today. Every day WFP does tremedous work in countries. We are delighted for WFP and for the whole UN family.”

Added the WHO head of health emergencies, Mike Ryan, who worked with the agency in West Africa, “WFP rocks. Well done WFP.”

World Food Programme lauded for its Work Addressing Upsurge of Needs

Created in 1961, the World Food Programme today provides food for over 90 million people a year. It has stepped up its operations significantly in recent months as the impact of the Covid-19 pandemic has expanded.

WFP has faced a drop in financial contributions in recent years as countries reduce funding for global organisations – and it was clear that the Nobel Committee’s award aimed to send a message to donors.

“This is also a call to the international community not to underfund the World Food Programme,” Reiss-Andersen said. “This is an obligation, in our mind, of all states of the world to ensure that people are not starving.”

-Pip Cook/Geneva Solutions contributed to this story

 

Image Credits: Flickr – USAID, Flickr – USAID.

Mother practices breast feeding her baby in the hospital maternity room in Ethiopia.

One stillbirth occurs every 16 seconds worldwide with approximately 2 million stillborn babies a year, says the first UN-wide report to document the global scale of the issue.

And COVID-19 related interruptions in maternal and child care services, particularly emergency obstetric care, could lead to an additional 60,000 to 200,000 stillbirths over the next 12 months, warns the report that was jointly produced by UNICEF, the World Health Organization, the World Bank and the Population Division of the United Nations Department of Economic and Social Affairs.  

“COVID will have an increase, reversing the gains that we have made,” said Anshu Banerjee, Director of the Department of Maternal, New born, Child and Adolescent Health and Ageing at the WHO, speaking at a press briefing on the report, which was released today. “However, we have seen that it is possible to make progress,” by strengthening health systems, improving the quality of care, and increasing the skills of birth attendants.” 

The WHO defines a stillbirth as babies born with no signs of life at 28 weeks of pregnancy. Approximately 2 million babies are stillborn every year. Often, these are deaths that lead to long-lasting psychological and financial consequences for women and their families.

In the majority of cases, stillbirths could have been avoided with high-quality care antenatally and during birth. The global issue of stillbirths is largely neglected in terms of research, data collection, and funding for interventions – although there is increasing recognition of the issue as a critical global health problem. 

“Losing a child at birth or during pregnancy is a devastating tragedy for a family, one that is often endured quietly, yet all too frequently, around the world,” said Executive Director of UNICEF Henrietta Fore. 

The report finds several reasons for these preventable deaths, including: absence of or poor quality of care during pregnancy and birth, lack of investment in preventable interventions, absence of global and national leadership on the issue, and few established global targets. 

Access to Emergency Obstetric Care Could Reduce Scale Of Problem

With over 40 percent of stillbirths occurring during labour, access to emergency obstetric care and improved monitoring could reduce their scale, the report finds.  

“The tragedy of stillbirth shows how vital it is to reinforce and maintain essential health services, and how critical it is to increase investment in nurses and midwives,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. 

84 percent of stillbirths occur in low- and middle-income countries, with 3 in 4 stillbirths taking place in sub-Saharan Africa or Southern Asia, according to the report. In sub-Saharan Africa, 1 in 46 babies are stillborn, compared to the global average of 1 in 72 or the European and Northern American average of 1 in 321. 

Stillbirth rates globally per 1,000 births in 2019.

There are substantial disparities in stillbirths between income groups. And strikingly, one-half of all stillbirths occur across six countries – India, Pakistan, Nigeria, Democratic Republic of the Congo, China, and Ethiopia. The risk of a stillbirth is 23 times higher in the worst affected countries compared to countries with the lowest stillbirth rates. 

Access to health care, maternal education, socioeconomic status, and ethnicity are other factors that contribute to the variations in stillbirth rates. Notably, higher rates are observed in rural areas, among women without post-secondary education, in groups on the lower end of the socioeconomic spectrum, and among ethnic minorities. 

Over the past two decades there has been slow progress on preventing stillbirths. Although the global stillbirth rate declined by 35 percent since 2000, progress has lagged in comparison to achievements in reducing maternal and under-five mortality rates. 

The Every Newborn Action Plan (ENAP) was launched in 2014 to provide evidence-based solutions to prevent newborn deaths and stillbirths. It established a target rate of 12 stillbirths per 1,000 total births to be achieved by 2030 and issued guidelines for national steps to achieve this goal, which includes investing in quality antenatal and delivery care. 

Projected number of stillbirths by different scenarios from 2020 to 2030.

Currently, 56 countries are at risk of missing the ENAP target by 2030, 34 countries are at risk of missing it by 2050, and eight countries will not meet the target by the end of the century, according to the report. 

Projections for the next decade estimate that 20 million babies will be stillborn by 2030, of which 2.9 million could be prevented. In order to curtail the current trend, the new report calls for increased political will, smart policies, and targeted investment in antenatal and delivery care to accelerate progress towards the ENAP aims and Sustainable Development Goals. 

COVID-19 Exacerbates Existing Stillbirth Trends

The COVID-19 pandemic has disrupted health systems and services globally, including antenatal and labor care. The report projects that these disruptions could lead to 60,000 to 200,000 additional stillbirths over 12 months, increasing the global number of stillbirths by 3.2 to 11 percent. The impact is expected to be greatest in Armenia, the Dominican Republic, Jamaica, Egypt, Iraq, Pakistan, and South Africa, among others. 

“COVID-19 has triggered a devastating secondary health crisis for women, children and adolescents due to disruptions in life-saving health services,” said Muhammad Ali Pate, Global Health Director for Health, Nutrition and Population at the World Bank. 

The collective action plan provided by the report emphasizes the importance of reducing stigma, supporting bereaved families, strengthening health systems, nationalizing and localizing stillbirth targets, prioritizing equity through investment, and improving the measurement of stillbirth data. 

 

Image Credits: Flickr – UNICEF Ethiopia, UNICEF.

Moderna’s mRNA research and innovation centre

Moderna, Inc., developer of one of the four front-running COVID-19 vaccine candidates, announced on Thursday that the the company would “not enforce” its COVID-19-related patents against other companies making vaccines to combat the pandemic – and would also be willing to license intellectual property for their COVID-19 vaccines for the post pandemic period. 

“We feel a special obligation under the current circumstances to use our resources to bring this pandemic to an end as quickly as possible.” said the company’s statement, which raises the bar on corporate policies around patents as the world fights a pandemic. “Accordingly, while the pandemic continues, Moderna will not enforce our COVID-19 related patents against those making vaccines intended to combat the pandemic. 

“Further, to eliminate any perceived IP barriers to vaccine development during the pandemic period, upon request we are also willing to license our intellectual property for COVID-19 vaccines to others for the post-pandemic period. Moderna is proud that its mRNA technology is poised to be used to help end the current pandemic.”

Speaking at a webcast of the company’s 8 October update where the announcement was made public,  Stephen Hoge, president of Moderna told investors, “It is our responsibility to be upfront and transparent, but we’re not going to be using those patents and try to enforce them.”    

Added Tal Zaks, Moderna Chief Medical Officer at the presentation:  “It is the right thing to do, to protect the population.”  

Leading Medicine Access Advocate Applauds Moderna Announcement – Others Demand More 

The announcement was greeted with applause by one leading medicines access advocate, Jamie Love of Knowledge Ecology International, who said that the new Moderna policy offers a model that other pharma companies should follow: 

Statement by Moderna on Intellectual Property during COVID-19 Pandemic

“Moderna is the only company manufacturing a drug or vaccine that has made a pledge to openly share its COVID-19 patents,” Love, generally an outspoken critic of pharma positions, told Health Policy Watch.  “And the statement includes both the period during the pandemic, and an offer to license in the post-pandemic,”

Love added that the commitment, “should be matched by every manufacturer of a therapeutic, vaccine or diagnostic test…”  

Love contrasted the Moderna pledge with the fact that Oxford University had granted the pharma company AstraZeneca exclusive rights to the IP associated with the adenovirus vector vaccine technology that they are co-developing, with backing from the Bill and Melinda Gates Foundation.  

“This makes the deal that Oxford and Gates struck with AstraZeneca look absurd,” Love said, adding that no matter how rights are used during the pandemic, the framework of the latter also leaves AstraZeneca to “tighten the screws” when the pandemic is over while, “Moderna will provide licenses that extend post-pandemic.”    

A KEI statement, however, added that Moderna should still go further and “engage with the WHO COVID-19 Technology Access Pool (C-TAP) and the Medicines Patent Pool” – which are serving as vehicles for more systematic pooling of vaccines and their patents. “Every manufacturer of a vaccine, drug or diagnostic should follow suit and publish the patents relevant to the technology, waive or license rights in those patents, and  provide constructive transfer of manufacturing know-how and access to cell lines and data when necessary”.

Other advocates expressed skepticism about the reasons behind the moves, saying that the announcement was motivated by pending legal challenges to Moderna IP claims, as well as rising consumer and political pressures:  Moderna “should not be lionized for taking baby steps on access when we are in a race for our lives,” stated an op-ed by Asia Russell, Brook Baker and Jessica Bassett, published by HealthGap Global Access Project:

“It is no accident that Moderna’s announcement comes less than a week after South Africa and India filed a petition to the World Trade Organization calling for waiver or suspension on the granting or enforcement of any intellectual property protections on COVID-19-related medical technologies for the duration of the pandemic.

“But Moderna knows that this non-enforcement-of-patents concession is meaningless without a commitment to share not only the patents, but also all the information, know-how, data, and biologic resources needed for other qualified vaccine manufacturers to produce the vaccine economically and at scale to meet global need. Moderna should fully commit to sharing all necessary rights and knowledge through the WHO COVID-19 Technology Access Pool (C-TAP), with no artificial time limitation based on the severity of the pandemic.”

Moderna To Submit Vaccine Candidate to FDA 25 November for Approval

The Moderna announcement comes just days after Moderna’s chief executive officer Stéphane Bancel said that the company aims to submit the candidate vaccine to the FDA for emergency use authorization by 25 November 2020. The company then intends to submit the vaccine as a candidate for the general population by late January. If approved, the vaccine would be available for widespread distribution by spring 2021. 

Stéphane Bancel, CEO of Moderna

Based in Cambridge, Massachusetts, Moderna is a biotechnology company pioneering the development of messenger RNA (mRNA) vaccine and therapeutics. The mRNA-1273 technology contains the “coding” for a stabilized form of the Spike (S) protein that is characteristic of the SARS-CoV2 virus that, which was co-developed by Moderna and investigators from NIAIDS’s Vaccine Research Center.

Moderna’s vaccine candidate uses novel mRNA technology to prime and boost the immune response in regards to antibody neutralization across all age groups. Effectively, the vaccine  “teaches” human cells to induce an immune response that could build the body’s own defense against COVID-19. 

The company’s Phase 3 study of RNA-1273, the vaccine candidate against COVID-19 began in July, and is close to its target enrollment of around 30,000 US participants.

AstraZeneca and Pfizer are also in late-stage Phase 3 testing; however, AstraZeneca’s timeline has been stalled after reports of severe side effects from several trial participants administered its vaccine candidate, which is based on a different technology. Participants from both Moderna and Pfizer’s Phase 3 studies have reported symptoms of high fever, body aches, headache, and exhaustion after receiving the respective candidate vaccines. The two companies have recognized that there is potential for the recipients of their vaccines to induce “mild” side effects similar to mild COVID-19 symptoms.

Tal Zaks, chief medical officer at Moderna
Other Pharma Companies Received Billions in Public Subsidies – But Holding Patents Close

Only recently, KEI sharply criticized Moderna for failing to disclose public funding from BARDA [US Biomedical Advanced Research and Development Authority]as well DARPA, (Defense Advance Research Projects Agency), in its patent applications, and the two agencies are currently examining the alleged omissions.

But even if the company made the announcement under burgeoning consumer and government pressure, its new policy still contrasts sharply with other firms that have benefited from similar public subsidies for urgent COVID-19 research, but are retaining their patent rights close to their chest.  

Among those, BioNTechSE, partner of Pfizer Inc., have been adamant about their about complete ownership of their vaccine patents – even when they, too, benefitted from large US government subsidies. 

 “Contrasts should be drawn between Moderna and other companies, including in particularly those that have benefited from massive subsidies from governments and foundations, that are not even making patent landscapes transparent, let alone making the inventions widely available,” said Love in the KEI statement..

“Moderna is also making it clear that government agencies like the NIH [National Institutes of Health] and BARDA have been too willing to grant or enable exclusive rights when subsidizing COVID-19 research.”

 

Image Credits: Moderna, Moderna, Moderna, Moderna TX.

Punjab, India – Crop burning reduces crop yield and worsens air pollution.

With fires from crop stubble burning spreading across northern India heralding the beginning of Delhi’s winter air pollution season, Delhi’s Chief Minister Arvind Kejriwal has pledged to take pre-emptive action – announcing a ‘war on pollution,’ led from a ‘war room’ that he will personally command. His arsenal includes a seven-point action plan that will include:  tracking the city’s hotspots; launching a ‘green Delhi’ mobile app to address open air burning complaints; and repairing the city’s potholed roads to control dust.  But his most powerful weapon for now could be a cheap and simple rapid compost brew, Pusa Decomposer that he hopes will inspire farmers in surrounding rural states to turn their crop waste into valuable fertilizer rather than burning it.

If Kerjiwal’s initiative succeeds, that could mark a turning point in decades of inaction contributing to northern India’s bleak air pollution situation – as well as climate change.

If not, Delhi and neighboring areas are headed for what Indians are now calling an ‘Airpocalypse’, or toxic pollutant-laced air that is poised to exacerbate COVID-19 respiratory disease in a country that has the second highest coronavirus case toll in the world.

In particular, cases are surging in the very regions facing potential air pollution emergencies. While Punjab is about to cross one 100,000 positive cases, Haryana has reported 118,000 cases so far. Delhi, one of the worst affected states of the country, has 260,000 infections so far. And the evidence that air pollution puts people at an increased risk of COVID-19 is strong.

But the war on air pollution has only been declared. And time for Delhi is quickly running out, as the seasonal crop burning in neighbouring rural regions of Punjab, Haryana and Uttar Pradesh, which fuel Delhi’s air pollution, has aleady begun, while the city’s Air Quality Index already crossed the 200 mark yesterday after months of double digit levels. 

In addition, it’s so far unclear how much backing Kerjriwal will receive for his war from Prime Minister Narendra Modi – a political rival who has remained largely indifferent to the criticism heaped upon him nationally and globally over his failure to take action on practical matters like stubble burning – as well as the bigger picture of expanded dirty coal power production. His ruling Bharatiya Janata Party is already grappling with farmers already agitating against the passage of three agriculture bills in Parliament last month.

New Delhi, India – Toxic smog blocks out the sun.

Crop waste fires contribute to nearly half of Delhi’s Pollution in Peak Season

Due to an unfortunate convergence of weather and geography, the impact of rural crop burning on Delhi and other parts of northern India’s plains is huge. Particularly in the autumn months, preveailing winds bring the smoke emitted by crop burning into the city. Low wind speeds, dry weather, and temperature inversions combine to keep pollutants trapped in and around the metropolis and the wider region. The Himalayas form an additional barrier to the north, preventing toxic pollutants from dissipating. Past year’s have seen record air pollution events, with levels reaching hundred of times higher than the WHO’s recommended limits, and urban average are among the highest in the world. 

Altogether, it is estimated that crop burning in the States of Punjab and Haryana last winter accounted for up to 44% of Delhi’s air pollution during peak burning periods in autumn 2019, Central Pollution Control Board Member Secretary Prashant Gargava stated.  The burning of crop stubble by farmers in Punjab and Haryana cause fires so large that they can be seen from outer space.

This year, again, Nasa satellite data tracking PM2.5, the most health-harmful particulate pollutants, has already begun showing small spikes caused by farm fires, although the worst is yet to come. Fires usually peak to around 4,000 per day by late October and smoke from these add to the existing urban pollution load of vehicles, construction, road dust and other sources. So any measures to deal with crop stubble, if successful, would be significant.

True colour image and aerosol optical thickness (AOT) showing smoke depth from open agricultural burning in India in fall 2016 spreading across the northern plains, NPP VIIRS satellite data, NOAA View

At the same time, to really turn the corner on air pollution year round, the Delhi leader also needs to update plans on existing solutions like increasing electric buses for public transport; enacing stricter waste management measures; stricter enforcement and penalties for emissions from coal power plants; and better controls on upcoming government construction projects that could have a large pollution footprint. 

On the plus side, critics see it as a good sign that the Delhi Chief Minister’s initiative addresses multiple sources of pollution – instead of only focusing on the politically-charged crop residue burning by farmers from neighboring states. He has, in fact, reiterated his commitment to strengthen the newly-announced electric vehicle policy and denounced coal power plants that aren’t meeting their emission norms, while also announcing a renewed focus on transplanting mature trees rather than saplings to replace those sacrificed to new construction.

Serious implementation of a mix of these initiatives, including the composting technology, will be key to any significant reduction in air pollution, especially as the economy gears up to recover from the Covid-induced lockdown.

India had the world’s highest outdoor air pollution rate in 2017

Composting crop waste to save Delhi’s air 

In the states of Haryana, Punjab, Rajasthan and Uttar Pradesh, farmers produce almost 50 million tons of straw a year, four fifths of which are burnt, concluded a joint industry-government report in Bloomberg. CIMMYT’s more conservative estimates say farmers in northern India burn an estimated 23 million tons of straw from their rice harvests. That enormous mass of straw, if packed into 20-kilogram 38-centimeter-high bales and piled on top of each other, would reach a height of over 430,000 kilometers — about 1.1 times the distance to the moon.

Burning of crop residue not only releases toxic gases into the air, it also burns precious nutrients away from soil, reduces crop yields, and promotes excessive use of fertilizers, according to the International Wheat and Maize Improvement Center. Use of fertilizers is not only more expensive for governments, which provides massive fertilizer subsidies, it also increases costs for farmers.

In mid-September, a task force led by PK Mishra, principal secretary to Prime Minister Narendra Modi met with the states of Punjab, Haryana and Uttar Pradesh to brainstorm how farmers can limit stubble burning and reduce pollution.

Of all the measures that are being discussed, the Pusa Decomposer seems to be the most promising.  The technology includes four ‘bio-decomposer’ capsules that can be dissolved into a liquid formulation, sprayed on shredded paddy straw, turning it into manure, said Dr YV Singh, principal scientist at the Indian Agricultural Research Institute. 

“The four capsules in a pouch can be used to make 25 litre solution which can then be used on one hectare or 2.5 acres of field,” he told India Today last week. “This capsule will help in curbing the practice of crop burning. This can be used in all forms and on any farm.”

Whereas rice paddy straw from the summer’s harvest normally takes 45 days to compose even if it is shredded, the Pusa Decomposer speeds up the process to  25 days, according to Singh. Shortening the process would give farmers time needed to prepare fields for their winter wheat crop – without harming having to burn their fields.  

Delhi officials are now trying to promote the idea amore widely: ‘This will end stubble burning and pollution to a huge extent,” said Delhi State’s Environment minister Gopal Rai. “We are planning to provide all sorts of help to farmers so that Delhi is safe from stubble burning,” he added. 

Growing the wrong crop at wrong time in wrong state

Wheat field in Punjab, Pakistan – sown after the rice harvest is finished.

Crop-stubble burning isn’t new. But it has become much more common in the past decade, after a government order in 2009 compelled farmers to begin sowing their rice seeds in June at the beginning of the monsoon season, rather than in April, when the weather is still hot and dry. The new policy was intended to ensure that the first monsoon rains recharge groundwater reservoirs before the rice planting began, but it backfired.

As a result of delaying the time of the harvest to early autumn, farmers have struggled to clear their fields in time for the next planting season, leaving them no other choice but to burn their fields – the quickest option they had.

Winds also change direction by October, so if paddy fields are on fire due to the later harvest, toxic smoke from the north blows directly towards urban areas with dense populations such as Delhi, as well as satellite towns known as the National Capital Region –  choking roughly 46 million residents in the area.

More fundamentally, rice is one of the most water-hungry crops in the world, and Punjab isn’t the ideal location to grow rice at all, as its groundwater levels are chronically low; rice also requires standing water in its early stages of growth.  Traditionally the area grew wheat and other nutrient-rich legumes and grains, which were more in tune with local conditions – and also healthier diets. 

However, over the past few decades, government rice subsidies encouraged farmers to grow so much rice that India has now become one of its largest exporters, at 12 million tonnes a year. Even the government’s own stocks are now more than twice the required level. By growing so much rice, environmentalists, the country is effectively exporting its most precious resource – water – out of the country. Some have theorized that Punjab’s shifts in crop sowing and production patterns have also been encouraged by the government and industry promotion of genetically modified Bt rice seeds.  The agrochemical conglomerate Monsanto has been promoting the seeds, which include genetic material from the Bacillus thuringiensis to ward off pests across Asia, although so far China has resisted, India was more accomodating. 

Monsanto seeds are less nutritious than traditional varieties, and result in high levels of silica in soil

An analysis by the NGO Ecologise Network explains that the government subsidies, along with the industry promotion of GM seed varieties has, over time, undercut production of  more nutritious, traditional varieties of legumes, grains and seeds. These were not only less water-hungry but also easier to manage after harvests because they did not require widespread burning. Some of the new varieties of rice also leave high silica levels in paddy stalks, making them unusable for use as animal fodder.   

The network also charges that other Monsanto GMO maize and wheat products are contributing to the destruction of bee colonies that pollinate 90% of the world’s food supply, including plants vital to Indian food production, also replacing human food stocks with ones destined for animals.  

“Monsanto’s GMO maize is also not fit for human consumption and is primarily used as chicken feed. Likewise, most of Monsanto’s wheat is used to feed animals because it is unfit for human consumption,” charges the NGO.  

Getting more with less: the power of ancient grains  

Merely by shifting its subsidy policies and food support, the government could easily persuade farmers – and consumers – to switch back to traditional Indian coarse grains that are more nutritious, use less water, and don’t need to be burned at  the end of the season, critics say. These include pearl millet (bajra), finger millet (ragi), sorghum (jowar), barley, rye and maize – all of which are traditionally grown in India. These grains have a high iron content and are perfect for a country that harbors one quarter of the world’s cases of anaemia. 

These traditional crops would also give farmers a longer window of time to clear their fields so they don’t have to slash and burn so hurriedly. Furthermore, with India’s ethanol policy 2018, any ethanol produced as a by-product can help farmers augment their income. For the country as a whole, investing in ethanol would also help create new employment opportunities and to save on oil imports.  

Until recently, the government’s main alternative to crop burning involved the promotion of tractors such as the ”Happy Seeder”, that mechanically cut stubble and sow seeds, and which have become popular in Punjab. However, critics say that the diesel-run machines are not only polluting but expensive to operate.  And they have not gained widespread acceptance either. Farmers in the neighboring state of Uttar Pradesh, for instance, have instead opted for more traditional farming techniques, as well as seed varieties that produce less stubble and silica than their counterparts in Punjab.

India could halt subsidies for the Happy Seeder – a dirty diesel-run machine to cut stubble and sow seeds

Improving Appetite For Stubble – IKEA Leads Way

At the same time, whether or not stalk waste is  processed by big tractors or more traditional methods, farmers will stop burning crop stubble if they can cut it and sell it. So solutions that reuse farm waste, and preferably monetize it, also  incentivize farmers not to burn it. Some advocates have proposed that the government directly pay farmers to deposit crop waste at collection centres or link it to their support price payments. 

Still other solutions would involve subsidies to entrepreneurs that create solutions to tackle crop stubble burning, such as green refrigeration systems powered by farm waste or ecologically-based crockery or textiles, which also reduces plastic use.

The Swedish home furnishings company IKEA, for instance, recently launched its Forandring collection of home accessories like baskets and mats, textiles,  made  in collaboration with local industries, and which are using rice stubble pulp.  The collection is part of IKEA’s  Better Air Now initiative which is collaborating with the UN Environment Programme’s  Climate and Clean Air Coalition.

“No-till” farming can improve soil quality and crop yields

There is yet another way to reduce the air pollution and greenhouse gas emissions from crop burning by almost 80%  – and it can also maximize profits for farmers, according to a 2019 study published in Science.

No-till practices that leave straw on top of the soil as mulch can preserve soil moisture and improve soil quality and crop yields in the long-run, said Principal Scientist of the International Maize and Wheat Improvement Center M.L Jat, who co-authored the Science study.

Image Credits: Neil Palmer, Sumitmpsd , Our World In Data, AishaSaleemkhan100, Karen Eliott, Science Direct, Maggilautaro .

Pfizer is one of the front-runners in development of a COVID-19 vaccine.

Acting on the advice of experts, the United States Food and Drug Administration on Tuesday issued new safety-focused guidelines for approval of new COVID-19 vaccines, that would almost certainly delay their emergency approval until after the November Presidential elections.

Just hours after the rules were issued, United States President Donald Trump accused the FDA of carrying out a “political hit job” against him by releasing new standards that could delay authorization of a coronavirus vaccine until after the November election.

“But in a subsequent video issued Wednesday evening, Washington DC time,  Trump said he’d go along with the FDA vaccine timeline, and was switching his focus to accelerating rapid FDA emergency use approval of the new antibody-rich cocktail, Regeneron, that he himself had used as a treatment, while hospitalized for COVID-19 over the past week.

In his video-taped message, issued on his personal Twitter account, the president described rapid approval of the antibody treatments as “much more important than a vaccine” since it could bring immediate relief to people who are already ill with the virus, in the way that it did for him.

“We have Regeneron, we have a very similar drug from Eli Lilly and we are trying to get them on an emergency basis,” Trump said in the video. “We have to get them to the hospital where people are feeling badly, that is much more important than the vaccine….I want to get you what I got. I want to make it free,” he also said.

“On the vaccines, we have many companies that are in final stages, Johnson & Johnson, Moderna, Pfizer… and we are going to have a great vaccine very very shortly.  I think we should have it before the election. But frankly the politics gets involved, and that’s ok. They want to play their games, it’s going to be right after the election.

“The FDA has acted as quickly as ever they acted in history, and no president has pushed them like I did. And so the FDA is approving things in a matter of weeks, that used to take them years,” Trump added in a 5-minute message that also lambasted the virus as “China’s fault.”

The new FDA guidance on vaccine aprovals, posted on the Agency’s website, would require vaccine manufacturers to follow trial participants for at least two months after they completed their vaccine course, to ensure that major adverse effects did not emerge – at least immediately.

Since the two leading vaccines in the most advanced stages of clinical trials, by Moderna and Pfizer, both require two doses, it appeared increasingly unlikely that either firm would have sufficient trial candidates having cleared that two-month milestone before November.

COVID-19 vaccine research

According to news reports, the White House had earlier tried to block the FDA’s plans to formally publish the new safety guidelines including the two-month data requirement, arguing there was “no clinical or medical reason” for it. President also had openly opposed any delays when he talked about the potential offered by forthcoming COVID vaccines in the Presidential debate with former Vice President Joe Biden, the Democratic Party candidate, last week.

But on Tuesday, the FDA posted the guidance on the agency’s website anyway, pushing back against the president’s pressures.  The requirements include a review by a panel of experts and two months of safety data. The guidelines are intended to reassure the American public any vaccine is safe and effective, amid fears that the President has been trying to accelerate approvals ahead of the elections – no matter what the data shows.

FDA Commissioner Stephen Hahn said in a statement posted on the FDA’s website: “We are committed to expediting the development of COVID-19 vaccines, but not at the expense of sound science and decision making. We will not jeopardize the public’s trust in our science-based, independent review of these or any vaccines. There’s too much at stake.” Pharma companies have generally taken a prudent stand.

Pfizer’s CEO Albert Bourla even spoke out publicly last week out about his concerns over the politicization of the vaccine approval timetable, saying that it was caught in the “crucible” of the presidential elections.

Albert Bourla, CEO of Pfizer

In an FDA press release introducing the new guidance, Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research added:

“Being open and clear about the circumstances under which the issuance of an emergency use authorization for a COVID-19 vaccine would be appropriate is critical to building public confidence and ensuring the use of COVID-19 vaccines once available. The FDA’s new guidance on emergency use authorization of COVID-19 vaccines underscores that commitment by further outlining the process and recommended scientific data and information that would support an emergency use authorization decision. In addition to outlining our expectations for vaccine sponsors, we also hope the agency’s guidance on COVID-19 vaccines helps the public understand our science-based decision-making process that assures vaccine quality, safety and efficacy for any vaccine that is authorized or approved.”

The FDA said it will now convene on October 22 an open session of its Vaccines and Related Biological Products Advisory Commitee to discuss any upcoming emergency use authorization requests and processes for handling them:

“The FDA plans to convene an open session of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) prior to issuance of any EUA for a COVID-19 vaccine to discuss the EUA request and whether the available safety and effectiveness data support the authorization. The VRBPAC is currently scheduled to meet on Oct. 22 to discuss the general development, authorization and/or licensure of COVID-19 vaccines,” said the press release. “While this meeting is not intended to discuss any particular vaccine candidate, the agency is prepared to rapidly schedule additional future meetings of this committee after submission of any BLA or request for EUA to further ensure transparency.”

Trump, who is still recovering himself from a coronavirus infection, has been tweeting aggressively on a range of matters since returning from Walter Reed medical facility, where he was undergoing medical treatment, back to the White House earlier in the week.

Meanwhile over a dozen of his staff are reported to be ill with COVID-19, while unconfirmed reports put the number closer to 30.

 

Image Credits: Pfizer, Pfizer, Pfizer .

Dr Tedros Adhanom Ghebreyesus, Tuesday 6 October at Special WHO EB session.

The United States on Tuesday gave conditional praise for the “progress made” by an independent oversight committee examining the response of the WHO’s Health Emergencies Programme to the COVID-19 pandemic – asking for more updates in November and early 2021.

The report by the Independent Oversight and Advisory Committee (IOAC) to WHO’s Health Emergencies operations is was one of three reports heard by the EB at Tuesday’s meeting on various aspects of the WHO organizational and global pandemic response.

One of the key findings of the IOAC interim report, however, was that the “politicization of the pandemic response is a material impediment to defeating the virus.”

And indeed it seemed as though the member states were already taking that piece of advice to heart.

While the last Executive Board meeting in May saw significant geopolitical tensions emerge between the United States and China over who was most at fault for the expansion of the pandemic, this meeting remained sober and substantive – with both sides dialing down their remarks.

And after months of blithering White House criticism of the WHO, the conditional endorsement of the inpendent review, still underway, seemed to indicate that Washington was well along the path to remaining within the Organization, despite US President Donald Trump’s announcement in July that the US was withdrawing.

“We appreciate the progress made,” said US Deputy Secretary of Health and Human Services Brett Giroir, asking that EB members be briefed again in November and early 2021 “so we can engage in substantive discussions about how best to address the challenges and issues identified.”

Key Report Findings

Key findings of the report were that despite WHO’s declaration of a global public health emergency (PHEIC), response among member states was inconsistent and delayed.  Key gaps also emerged in national preparedness strategies, further hampering rapid mobilization. And the overall level of COVID-19 data reporting, “needs furhter improvement in terms of speed, consistency, and completeness.

Interim report of the Independent Oversight Advisory Committee (IOAC)

 

EU Bloc; Strengthen WHO’s ‘Perogative’ in Access to Information

While the committee also found that WHO acted within the legal frameworks that is currently has available, key WHO EB members suggested that those need to be strengthened.

Significantly, Germany speaking on behalf of the European Union bloc said member states need to consider “strengthening WHO’s perogative in terms of access to information” and urged the three panels that are now exploring the pandemic response from various angles: “do not to be afraid to tell uncomfortable truths.

Roles and responsibilities of the three independent committees and panels examining various aspects of the response by WHO and countries to the COVID-19 pandemic

“In your recommendations, do not be afraid to challenge all as member states to question current modes of operation and to show boldness and vision. You can count on the full support of the EU and its member states states,” said Björn Kümmel, Germany’s EB representative, to review panel members.

That EU statement, coming after months of heavy US criticism of Beijing, for allegedly withholding vital information on the emergence of a mysterious virus in Wuhan, China in late 2019, is highly significant – as it represents the diplomatic backing Washington may receive for rules changes that require  greater transparency among member states, when it comes to reporting on emerging infection threats.  Along with EU member states, Japan and Australia as well as the United Kingdom have also voiced criticism of Beijing’s handling of the pandemic in the past.

Germany also suggested that the addition of an “intermediate level” of alert that would be short of a full-fledged global public health emergency.

“We support considering the long standing idea of creating an intermediate level of alert. But we need the expertise of the Secretariat and of the evaluation groups regarding its definition, the consequences that will be attached to its activation, and the possible process for its implementation,”  Kümmel, added, also speaking on behalf of the European Union bloc.

“We look forward to discussing ideas such as increased accountability of member states on preparedness, for example, through the establishment of a periodic review mechanism, as proposed by the African Union, and all strengthening WHO’s prerogatives in terms of access to information.

“Emphasis must also be placed on development of proper and unified health data collection at all levels,” Kümmel added.  

The United Kingdom, meanwhile, said that the team leading a second review, The Independent Panel (IPPR), which is examining both national and WHO response, should add a scientific advisory panel to structure.

“Given the potentially unlimited amount of quantitative and qualitative information available to the panel, we believe a scientific advisory group will be a beneficial addition to your structure,” said the UK’s representative Chris Whitty. “It would ensure that the advice given to the Co-chairs and the panel is fully independent and impartial, capturing the best evidence available.

“It would streamline and speed up the collection and analysis of evidence enabling the development of a comprehensive pace to inform your reviews output, and it will provide the co-chairs and panel with consistent advice over the entire course of review, covering the range of necessary technical expertise, including for example, as mentioned by others, human health, animal health, behavioural science, organisational change and modelling and forecasting.”

Russia Criticizes Makeup of Review Committee – China remarks remain muted

The meeting was not without its flashpoints, however couched they were in diplomatic language.

Russia complained about geographic imbalance in the makeup of a second review committee, the Independent Panel, which was mandated by the last World Health Assembly in May to take a broad look at both the WHO and national response to the pandemic.  The 13 member Panel chaired by former New Zealand Prime Minister Helen Clark and former Liberian Prime Minister Helen Johnson Sirleaf,  includes members from all WHO regions.

However,  Minister of Health Mikhail Albertovič Murashko, Russia’s EB representative, maintained nonetheless that the reprsentation on the panel was lopsided.  “As we see it, it’s important to take a balanced approach, and sadly, within the IPPR at present we do not see a balanced situation because there is one whole geographical region that is not represented at all, and if you consider the fact that this region represents a very significant proportion of the world’s population, that is a serious imbalance.”

Yet a third review committee is examining the functioning of the International Health Regulations, which form the legally binding framework under which countries report about health emergencies and WHO’s shapes its guidance and response.

China reacted in a muted way to the reports. It said it hoped the reviews would enhance the ability of WHO and the international community to “take more targeted measures to further support countries with weak health systems.”

China’s EB representative, Zhang Yang, also called upon the review panels to “inform members states of their work in a timely manner and use their platforms to enhance direction with member states.”

WHO Provides Extensive Review of COVID-19 Pandemic Response To Date

The debate over WHO’s performance followed an extensive review by WHO of the state of the pandemic and its response to date – including everything from the direct distribution of emergency supplies to the massive WHO “Solidarity Trial” for new tests, drugs and other health products involving research in dozens of countries; laboratory capacity-building; and the creation of the COVAX vaccine pool,  which 168 countries have joined so far.

The review illustrated the volatile nature of the pandemic in terms of its geographic impacts – but also included somebright spots including strikingly lower case and death counts in the African region, and the beginnings of decline in South-East Asia.  This, as cases in WHO’s European region were seeing a significant rise.

 

At the same time, one sobering note was the striking disruptions of key health services in countries across the world. Among the services hardest hit, according to a recent WHO survey: some 77% of countries have reported pandemic-related  interruptions of dental services, 66 % of countries reported interruptions in routine immunization services; 65% NCD diagnosis, 64% in family planning and contraception, and 55% of countries reported interruptions in treatment for mental health disorders.

-Pippa Cook contributed reporting to this story

President Donald Trump, still ill with coronavirus, waves to his supporters in a drive-by outside of Walter Reed National Military Medical Center on Oct. 4.

A hail of criticism has followed US President Donald Trump’s drive-by to wave at supporters outside of the Walter Reed National Military Medical Center, including by a doctor at Walter Reed who said the president put the Secret Service at great risk.

President Trump was hospitalized on Friday, after testing positive for SARS-CoV2 hours earlier. Trump was moved to Walter Reed after the White House reported that he was experiencing “mild symptoms”, including a low-grade fever, nasal congestion and a cough. 

On Sunday, the White House physician Sean P. Conley corrected previous reports, announcing that Trump had a high fever on Friday and his blood oxygen levels dropped below 95 percent on two occasions, on Friday and again on Sunday. 

The president received an antibody cocktail from Regeneron, a biotech company that has developed a treatment to lower the level of the virus. Later on Friday Trump began taking the experimental drug Remdesivir, developed by Gilead. And the following day, he was given dexamethasone, a drug reserved for use in “severe and critical COVID-19” cases, according to WHO guidelines. He was also reportedly given oxygen on a couple of occasions. 

The White House has been widely criticized for the incomplete and sometimes contradictory information regarding Trump’s health. Infectious disease experts have begun questioning if Trump’s condition is more serious than implied by his doctors due to the combination of drugs he has been given. 

Trump has attempted to quell concerns by posting a video on Twitter, praising his doctors at Walter Reed and saying, “I learned a lot about COVID…I get it and I understand it.” Moments after releasing the video, Trump left the hospital in a vehicle with his Secret Service detail to wave to his supporters – who he referred to as “the great patriots” – gathered outside. Trump was wearing a mask and the Secret Service agents were wearing respirators and eye protection.

Trump’s actions have been harshly criticized by doctors and experts for putting the Secret Service agents at risk. James Phillips, an attending physician at Walter Reed, said Trump’s drive-by was “political theater” and “insanity.” 

“The risk of COVID-19 transmission inside [the vehicle] is as high as it gets outside of medical procedures. The irresponsibility is astounding,” said Phillips. 

According to the White House spokesperson, Judd Deere, the drive was “cleared by the medical team as safe.” However, Secret Service agents told the Washington Post that Trump’s behavior was reckless. 

“By taking a joy ride outside Walter Reed the president is placing his Secret Service detail at grave risk,” said Jonathan Reiner, professor of medicine and surgery at George Washington School of medicine and health services. 

Trump’s Medical Team Report That He Will Be Discharged
White House Physician, Sean Conley, and President Trump’s medical team hold press conference on Oct. 4.

Meanwhile, Conley announced on Monday that the president will be discharged from the hospital and return to the White House on Monday evening. Trump has received a third dose of remdesivir and continues to take dexamethasone, according to his doctors at Walter Reed. 

Trump affirmed that his health has drastically improved, saying on Twitter, “I feel better than I did 20 years ago!” These feelings, however, could be attributed to the dexamethasone that the president has been taking. The steroid dampens the body’s immune response and can cause some patients to develop “insomnia, mania, agitation and grandiosity,” said Céline Gounder, a clinical assistant professor of medicine and infectious diseases at the NYU Grossman School of Medicine. 

Several medical experts have raised concerns about the decision to discharge Trump. “I think it would be disastrous to be in a situation where he gets really sick at the White House, and you’re having to emergency transfer him,” said Gounder. 

However, in the absence of more detailed, and transparent, reports about the President’s health by his doctors, the speculation remained just that.  

As the US COVID-19 deaths reached 210,000 on Monday, President Trump tweeted ,defiantly, “Don’t be afraid of COVID. Don’t let it dominate your life.”

Image Credits: Flickr – White House, Flickr – White House.

The COVID-19 pandemic has disrupted mental health services in 93% of countries at a time when they are most needed, concludes a new WHO survey, released Monday. The survey is based on data from 130 WHO countries gathered between June and August 2020.

Despite rising awareness of the enormous strain that the pandemic has placed on the mental health of people in rich and poor countries alike – as well as mounting research evidence that the SARS-CoV-2 virus can also cause or exacerbate neurological conditions – most of the world’s countries are facing massive shortfalls in funding for mental, neurological and substance use services.

WHO’s director of the Mental Health and Substance Use department Dévora Kestel

And these are exactly the kinds of services that are most needed now – as people face huge economic losses, disruption in school and social plans, and increased isolation as a result of the measures taken to contain the virus spread.  

“We want to make sure that people in need of attention receive the care they deserve and need,” aid WHO’s director of the Mental Health and Substance Use, Dévora Kestel, at a WHO press briefing. “And so we want to make sure that there is better, [and] more investment on essential services for mental, neurological, and substance use [disorders].” 

While nine out of 10 countries surveyed have included mental health and psychosocial support within their national COVID-19 response plans, less than one-fifth have allocated enough funding to implement those plans, according to the report, published just days before World Mental Health is observed on 10 October, including WHO’s Big Event for Mental Health.

“The problem is that only 17% of countries have the funding for the implementation of [mental health and psychosocial] plans,” added Kestel.

Even though evidence-based interventions in mental health are highly cost-effective, mental health funding has stagnated at less than 2% of national health budgets, according to WHO.

The data were collected by WHO through a web-based survey completed by mental health focal points at ministries of health between June and August 2020. 

Children And Adolescents Most Affected By Mental Health Service Disruption

Children and adolescents are the most severely affected by mental health service disruptions

Children, adolescents and older people were the most severely affected groups, said the report. Disruptions in services for these groups were reported by 70% of countries, especially mental health promotion and prevention services in schools. 

Almost two-thirds of mental health services in schools or workplaces were wholly or partially disrupted, warned the report. Only 30% of mental health services for children and adolescents or for older adults were fully available without disruption.

Community-based and outpatient mental health services were also deeply affected, including the closure of, or restrictions on residential, home and day-care services.

Disruptions in mental health services are often a result of travel restrictions that have prevented patients from reaching clinics, especially in low-income countries, which have had trouble responding to COVID-19 through digital healthcare services like telemedicine, teletherapy or hotlines. 

While over 80% of high-income countries said they used digital healthcare to replace in-person consultations, only 50% of low-income countries have been able to do so, revealed the report.

Lower-income countries have found it harder to adopt digital health solutions during the pandemic

Countries Must Ramp Up Mental Health Surveillance And Research

Countries must ramp up mental health surveillance and research, especially as the coronavirus exacerbates existing mental, neurological and substance use issues and triggers new ones – including delirium, strokes or psychoses, said Kestel.  She added that only half of  130 surveyed countries have collected data on mental, neurological and substance use disorders – and fewer than one-tenth are researching how the COVID-19 virus attacks the brain.

People with pre-existing mental, neurological and substance use disorders are also more vulnerable to COVID-19 disease, according to the latest research.

In one cohort study of almost 1,700 patients with COVID-19, those with psychiatric disorders were about 1.5 times more likely to die from COVID-19, even after adjusting for differences in age, underlying conditions or hospital locations, reported researchers from Yale University’s School of Public Health less than a week ago.

Even if people with mental health disorders are safe from the coronavirus, inadequate access to services can be life-threatening. Together, suicides, alcohol and drug overdoses kill over 4 million people a year – or four times more than the coronavirus has killed thus far.

“The impact of the pandemic on people’s mental health is already extremely concerning,” said Director-General of the World Health Organization Dr Tedros Adhanom Ghebreyesus in mid-May. “Social isolation, fear of contagion, and loss of family members is compounded by the distress caused by loss of income and often employment.”

Image Credits: WHO/NOOR/Sebastian Liste, WHO, WHO.