Peaceful protestors in front of the Brooklyn Public Library in New York City

In the wake of widespread demonstrations in the United States against police brutality, catalyzed by the death of George Floyd while being pinned under an officer’s knee, the World Health Organization has urged protestors to protect themselves against COVID-19.

“We have certainly seen a lot of passion this week, we’ve seen people who’ve felt the need to be out and express their feelings, but we ask them to remember: still protect yourself and others, the coronavirus is all around, protect yourselves and others while expressing yourselves,” said WHO spokesperson Margaret Harris at a briefing in Geneva. “So, all the things we have been saying (still) apply.

“The best precaution is being able to stay one metre away from each other, being able to wash your hands, being able to ensure that you don’t touch your mouth, nose and eyes.”

Meanwhile, in a separate press briefing, WHO also released updated guidance on June 5 for the use of masks to prevent COVID-19 transmission in the general public and healthcare settings.

April Baller, infection prevention & control expert in WHO’s Health Emergencies team, shows how to properly wear a mask – making sure to cover the nose, mouth, and chin.

Governments in areas with widespread COVID-19 transmission should encourage the use of non-medical masks on public transport, in shops and in other locations where physical distancing is difficult, WHO recommends in updated guidance published on Friday.

Additionally, people over 60, or who have underlying health conditions, should wear medical masks in these settings, while all workers in clinical areas of health facilities should also use them – not just those who deal with COVID-19 patients.

For the first time, WHO also released instructions on how to make fabric masks for use by the general public that would provide adequate protection against onwards transmission of the virus, based on scientific research commissioned by the agency.

“What is really new in the guidance, is the research that we requested to be done on looking at which types of materials can actually be used in making these non-medical fabric masks,” said WHO COVID-19 Technical Lead Maria Van Kerkhove.

Masks should consist of an inner layer of absorbent material like cotton, a middle layer of non-woven materials such as polypropylene – a filtering material, and a non-absorbent outer layer made of a polyester or a polyester blend, said Van Kerkhove.

“WHO has developed this guidance through a careful review of all available evidence and extensive consultation with international experts and civil society groups,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I wish to be very clear that the guidance we’re publishing today is an update of what we have been saying for months – that masks should only ever be used as part of a comprehensive strategy. Masks on their own will not protect you from COVID-19.”

WHO Director-General introducing new mask guidelines at the 5 June WHO COVID-19 press briefing

The slow move towards issuing specific guidelines for the broader use of facial coverings comes after an independent Strategic Technical Advisory Group for Infectious Hazards (STAG-IH) released a note supporting the broader use of masks in the community. Earlier in the week, the Lancet had also published a WHO-sponsored meta-analysis that found mask use decreased the risk of infection, although this reduced risk applied only to the use of N95s, surgical masks, and 12-16 layer cloth masks.

Still, WHO experts emphasized that masking will be an important tactic as countries begin to lift stay-at-home orders.

“In many urban areas in India, it’s impossible to maintain physical distancing, and therefore it will be very important that people wear appropriate face coverings when they are out and about, in office settings where physical distancing cannot be maintained, in public transport, and in educational institutions as some states are thinking about opening,” said Soumya Swaminathan, WHO chief scientist. Swaminathan was formerly director-general of the Indian Council of Medical Research.

Masks are mainly used as a form of “source control,” said WHO Health Emergencies Executive Director Mike Ryan. Ryan emphasized that the proper use of masks is mainly recommended to help prevent an asymptomatic or presymptomatic persons from transmitting the virus to others.

WHO Updates Guidance For Surgical Mask Use In Healthcare Settings, But No Changes In N95 Use Recommendations

In areas with widespread transmission, WHO recommended that any person working in a clinical, be it healthcare worker, janitor, or administrative staff, should wear a medical mask at all times, even while working in wards with no COVID-19 patients.

However, the use of N95 masks should still be restricted to use by healthcare workers conducting aerosolizing procedures.

“Evidence shows that there might be a greater reduction in risk by respirators, but this is still limited evidence, with many limitations due to the fact that these are only observational and small studies,” said Benedetta Allegranzi, coordinator of WHO’s infection prevention global unit. “Respirators may also have more side effects than surgical masks, such as skin lesions or difficulty breathing, etc. Also, assessing recommendations for the global level, [we have] to consider many different contexts in different countries where it’s important to assess resource availability… and equitable access.

“All together, these elements led our experts to consider that there is no strong reason for changing our recommendations [for N95 use].”

Benedetta Allegranzi speaking at the June 5 WHO COVID-19 press briefing
How To Mask Properly, According to the WHO

WHO had previously released lukewarm recommendations supporting countries’ public masking policies in areas where physical distancing is not possible.

But the new recommendations are much more specific, including guidance for different age groups, settings; instructions on how to DIY a fabric mask using materials around the house; and instructions on how to properly use and maintain a fabric mask.

“People can potentially infect themselves if they use contaminated hands to adjust a mask or to repeatedly take it off and put it on, without cleaning hands in between,” said Dr Tedros.

A properly worn mask should cover the nose, mouth, and chin. Care to only touch the earloops when removing a mask will help prevent contamination of the hands, and hands should always be washed before putting a mask on and after taking one off, according to a new instructional video featuring WHO expert on infection prevention and control, April Baller.

WHO experts also emphasized that wearing fabric masks is not protective in itself against getting infected. Maintaining physical distancing and frequent handwashing is important to protect oneself against the virus, said larger public health measures such as contact tracing, quarantining and treating cases, and isolating suspected cases must not be abandoned, said Ryan.

“Wearing a mask in a community level is more about protecting others if you happen to be infected rather than protecting yourself. So it’s an altruistic act,” said Ryan. “[We need a] well educated, empowered community, caring for their own personal hygiene and protection, caring for the rest of their community in terms of protection.

“[They need to be] supported by a public health service that’s capable of finding the virus, isolating and quarantining cases, and health system that’s capable of treating people successfully.

“And all of that in the context of good coordination, good governance being implemented. Then [add] the appropriate and targeted use of masks at community level, in order to reduce transmission within the community in areas where physical distance cannot be maintained.”

 

Image Credits: GF Ginsberg/HP-Watch.

Electron microscope image of SARS-CoV-2, the virus that causes COVID-19

In a series of flip-flops on Friday, the United Kingdom suspended the enrollment of new patients into the hydroxychloroquine arm of its massive RECOVERY trial, one of the largest randomised COVID-19 clinical trials in the world, after preliminary data showed “no benefit” for COVID-19 patients receiving the drug.

The suspension of the trial came just a day after the academic journal The Lancet retracted a widely disseminated  observational hydroxychloroquine study that found an increased risk of mortality and cardiac problems in COVID-19 patients taking the drug, in a highly unusual move. The paper’s withdrawal was requested by three authors who had concerns about the reliability of the underlying data.

“‘We have concluded that there is no beneficial effect of hydroxychloroquine in patients hospitalised with COVID-19. We have therefore decided to stop enrolling participants to the hydroxychloroquine arm of the RECOVERY trial with immediate effect,” Peter Horby and Martin Landray, chief investigators of the RECOVERY Trial, said in a press statement released Friday.

Preliminary results from the trial showed no significant difference in the proportion of deaths in COVID-19 patients taking hydroxychloroquine compared to those who received standard care. Among 1542 patients receiving the drug, 25.7% died after 28 days, compared to 23.5% of the 3132 patients who received standard treatment.

“There was also no evidence of beneficial effects on hospital stay duration or other outcomes,” said the principal investigators. “These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients hospitalised with COVID-19.”

The full results of the trial will be released “as soon as possible,” said the researchers.

Soumya Swaminathan explains reasoning for continuing WHO hydroxychloroquine trial.

Despite the pause on the RECOVERY Trial, the World Health Organization is continuing the hydroxychloroquine arm of its multicountry Solidarity Trial, which WHO temporarily suspended last week to review preliminary mortality data. After finding no increased risk of mortality in COVID-19 patients taking hydroxychloroquine, the WHO Solidarity Trial oversight committee decided to resume the trial without altering the protocol on Wednesday, according to WHO Chief Scientist Soumya Swaminathan.

“We will continue for now,” said Swaminathan, when asked whether the new RECOVERY Trial results affected WHO’s decision.  “We will wait to see the final data analysis, and the publication that’s going to come out of it and certainly our committee will be considering these results as we go on.”

Swaminathan did note, however, that “Solidarity and RECOVERY are two of the larger trials and moreover, they have very very similar study designs.”

Addressing the confusion around whether hydroxychloroquine is harmful, beneficial, or has no effect for COVID-19 patients, WHO Health Emergencies Executive Director Mike Ryan said, “With a story of such huge public interest with 24 hour coverage of those issues, the normal process of science can sometimes appear confusing.

“It is quite normal to have slightly different results coming out from different trials, and that is why the scientific world normally wants more than one trial for any particular drug or vaccine to really confirm that what you’re seeing is actually a true effect,” added WHO COVID-19 Technical Lead Maria Van Kerkhove.

Lancet Withdraws Controversial Hydroxychloroquine Study Finding No Benefit & Increased Risk of Mortality in COVID-19 Patients

After causing an uproar in the two weeks since its release, the Lancet study was retracted at the request of three out of four of the paper’s authors, after concerns arose around the accuracy of the underlying data.

The three authors requested an independent, third-party peer review of the data collected by Surgisphere, the company that supplied the data for the original analysis.

Surgisphere, however, refused to release the full dataset for audit by an independent panel of experts, citing confidentiality and agreements with clients prevented data sharing. This occurred despite the other three authors obtaining the consent of Sapan Desai, second author on the paper and CEO of Surgisphere, for the independent review.

“As a result, we can no longer vouch for the veracity of the primary data sources,” the authors Mandeep Mehra, Frank Ruschitzka, and Amit Patel wrote in a statement published in the Lancet.

The independent review aimed to evaluate the origin of the database elements, to confirm the completeness of the database, and to replicate the analyses presented in the paper.

The WHO Director-General had referred to the study when WHO suspended its hydroxychloroquine arm of the Solidarity trial for review two weeks ago, and France rolled back recommendations for the broader use of the drug to treat severe COVID-19 patients in the wake of the study’s publication.

But soon after Lancet study was published, it drew criticism from other researchers – many of whom were concerned about the design of the analysis and the underlying data sources.

The independent review of the study was meant to address these criticisms, but could not be completed, said the three study authors who retracted the study.

“That is good science, that is doing the right thing,” Ryan said of the paper’s withdrawal at a WHO press briefing Friday. “Occasionally, when a paper is published inadvertently, and subsequently the data that supports that publication is found to be questionable or called in question, then it is the responsible thing to do for the journal to retract their paper.

“I know it sometimes can give the impression that the science community is confused or give mixed messages and for that we all collectively apologize.

“In the vast, vast majority of cases in peer reviewed journals, those papers are not retracted. It’s an incredible success rate.”

Image Credits: National Institute of Allergy and Infectious Diseases, NIH.

United Kingdom Prime Minister Boris Johnson announcing total pledges to Gavi’s 2021-2025 replenishment cycle

Gavi, the Vaccine Alliance raised a whopping US $8.8 billion at the first ever virtual Global Vaccine Summit co-hosted Thursday by the United Kingdom, surpassing the fundraising goal of US $7.4 billion.

“We have secured a fantastic US $8.8. billion for Gavi’s work over the next five years and I’d like to thank everyone very, very much,” said UK Prime Minister Boris Johnson. 

In a rare show of multilateralism, United States President Donald Trump sent a video message of support after Johnson personally reached out – but did not specify the US pledge in his speech. The United States Agency for International Development (USAID) had announced in February a pledge of US $1.16 billion to Gavi for 2020 to 2023.

US President Donald Trump makes rare show of global health solidarity in a video message at the Global Vaccine Summit

”There are no borders, [the virus] doesn’t discriminate, it’s been it’s nasty but we can all take care of it together. It’s great to be partnering with [Gavi]. We will work hard, we will work strong…good luck, let’s get the answer,” said Trump.

Over 25 Heads of State and 50 leaders of agencies, regional associations, and private industry attended the fundraising event for Gavi, a public-private partnership that finances vaccine programs in over 80 low income countries. Germany’s Chancellor Angela Merkel, UN Secretary General Antonio Guterres, the European Commission President Ursula von der Leyen, and World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus were among those who sent messages of support.

“There is an important lesson we need to understand – the vaccine by itself is not enough. Now is the time for global solidarity…to ensure that every person everywhere gets access to the vaccine,” said Antonio Guterres. “In our global village, our individual health depends on our collective health.”

Since COVID-19 struck the world, Gavi’s role has become more important than ever, as 80 million children are at risk of missing out on routine vaccines for TB, pneumonia and diarrhea, said WHO’s Director-General Dr. Tedros.

With the money pledged, Gavi aims to immunise an additional 300 million children in low- and lower-middle income countries, saving an estimated additional 8 million lives between 2020-2025. 

COVID-19 Vaccine Advanced Market Commitment Fund Created to Secure Supply For Low-Income Countries

Gavi also announced an anticipated COVID-19 Advanced Market Commitment (Covax AMC), which will be used to make volume guarantees to sellers of effective COVID-19 vaccines, and make sure a portion of the global supply will be set aside for low-income countries. 

“Donors commit funds upfront to guarantee the price of vaccines once they’ve been developed. This provides vaccine manufacturers with the incentive to invest in vaccine R&D, and to scale up manufacturing capacity,” explained Gavi CEO Seth Berkley. “GAVI’s role is to address [vaccine] market failures when market forces don’t deliver the best outcome for the public.”

GAVI’s CEO Seth Berkley explains how advanced market commitments function

AstraZeneca became the first pharma manufacturer to sign up for the Covax AMC, guaranteeing a supply of at least 300 million doses once their vaccine candidate, developed in conjunction with Oxford University, receives regulatory approval. AstraZeneca had announced the intention to sell any COVID-19 vaccines ‘not-for-profit.’

However, the price-per-vaccine has not yet been disclosed. Médecins Sans Frontières (MSF) released a call ahead of the launch for the vaccine to be sold ‘at-cost,’ and for a price to be set as soon as possible.

“We won’t know whether a vaccine is indeed sold at “not-for-profit” prices if large manufacturers don’t make their investments and cost of goods as well as the final prices publicly available,” Manuel Martin, innovation & access advisor at MSF Access Campaign told Health Policy Watch.

The Gavi Covax AMC has an initial goal of raising US$ 2 billion; enough for Gavi-supported countries to immunise health care workers and high-risk individuals, as well as create a flexible buffer of doses to be deployed where needed most. 

The AMC model had been previously used to provide volume guarantees for the pneumococcal vaccine, giving producers incentive to scale up production and sell to low-income countries. Some US $177.5 million from the PCV advanced market commitment will be rolled over into COVAX.

The initiative is part of a broader COVID-19 Global Vaccine Access Facility (Covax Facility) that will be available for all countries to access.

Donors & Pharma Show Strong Support For Gavi

The top three historical donors, The United Kingdom, the United States, and Norway, each upped their contributions to Gavi in this funding round. 

Johnson kicked off the replenishment event with a £1.6. billion pledge from the UK. The United States pledge stands at US $1.16 billion, and Norway followed closely with a $1 billion commitment. 

“We know from our own experience that investing in vaccines is one of the best public health investments we can make, ” said Norway Prime Minister Erna Solberg. “Norway was one of the founders of Gavi 20 years ago. We believed, and still believe in innovation and the mission to improve the world one vaccine at a time. We must continue to make sure no one is left behind.”

Norway Prime Minister Erna Solberg

Among other major pledges, Germany committed €600 million; Canada committed CAD $600 million, Australia, and Japan pledged US $300 million, and Italy upped it’s pledge to €287.5 million.

China, meanwhile, contributed US $20 million, in stark comparison to its massive contribution at the World Health Assembly of US$2 billion towards the COVID-19 effort and to accelerate the completion of Africa’s CDC headquarters.

Leaders and executives from the pharmaceutical sector also voiced strong support for GAVI, and announced increased supply commitments for the human papillomavirus (HPV) vaccine.

Merck Sharpe&Dohme, Glaxosmithkline, Innovax, The Serum Institute of India, and Chinese vaccine manufacturer Walvax have pledged to ramp up HPV vaccine production to supply Gavi-supported countries with enough doses to vaccinate 84 million girls, an increase from a original commitment to vaccinate 50 million girls.

Pharma is working at “unprecedented levels of collaboration and speed”, said Director General of the International Federation of Pharmaceutical Manufacturers (IFPMA) Thomas Cueni. “Thankfully, what is not unprecedented is the notion that collaborative efforts and partnerships can deliver and can transform lives. We will succeed by working openly.”

GSK CEO Emma Walmsley emphasized that “global, fair access to COVIDー19 vaccines is an absolute priority.” GSK leadership, along with executives from AstraZeneca and Johnson&Johnson announced their companies’ intentions to sell vaccines at a “no-profit” price last week.

“We do it not-for-profit for the pandemic period, as we want to [ensure] equitable access over the world…and especially to get vaccines to make sure we get a stop to the pandemic,” said CSO of Johnson & Johnson Paul Stoffels last week.

Photo Credit: Gavi/Karel Prinsloo

A day ahead of a major pledging event, Gavi-the Vaccine Alliance has received some US $70 million in pledges from a broad range of corporations, foundations, initiatives and individual philanthropists to modernise, streamline and strengthen its delivery of vaccines to children in the world’s poorest countries over the next 15 years.

Meanwhile, Médecins sans Frontières (MSF) issued a call on Tuesday for governments to ensure that COVID-19 vaccines are sold at the cost of production, particularly so that low-income countries supported by Gavi can access any successful products.

Both developments come on the eve of the UK Government-hosted Global Vaccine Summit, which will aim to culminate in pledges of at least US$ 7.4 billion for Gavi’s efforts between 2021 and 2025 to immunise a further 300 million children.

“Gavi is the consummate example of how public-private partnerships play a substantial role in saving lives and putting whole societies on trajectories of progress and prosperity,” said Seth Berkley, CEO of Gavi. “We understand the innovation that exists and can be unlocked when we work with the private sector. As a result, we’re extraordinarily proud of and grateful to our many private sector partners, with whom we have been able to pioneer some transformational changes in immunisation systems.”

Ireland, Italy, Spain, Greece, New Zealand, and Canada have also announced commitments prior to the official event, following a massive US $1 billion pledge by Norway to the Vaccine Alliance.

Vaccine manufacturers Merck Sharpe&Dohme, Glaxosmithkline, Innovax, Serum Institute of India Pvt. Ltd. (SII) and Walvax have also committed to providing enough human papillomavirus vaccine to protect 84 million girls against cervical cancer.

MSF Calls For ‘At-Cost’ Pricing Ahead of Gavi’s COVID-19 Vaccine Funding Facility Launch

Photo Credit: NIAID

A new ‘COVAX’ funding facility will also be launched by Gavi on the same day in order to generate funding for advance commitments to buy highly anticipated COVID-19 vaccines for low-income countries.

Specifically, the MSF statement specifically calls for the vaccine to be sold  at-cost, and for the price point to be negotiated at the outset.

“Governments must ensure any future COVID-19 vaccines are sold at cost and universally accessible to all across the world,” said Kate Elder, senior vaccines policy advisor at MSF’s Access Campaign in a press statement.

Elder’s statement echoed those of several heads of state, including France’s Emmanuel Macron, Germany’s Angela Merkel, South Africa’s Cyril Ramaphosa, and China’s Xi Jinping, who have called for COVID-19 vaccines to be treated as “global public goods.”

Still, MSF Access Campaign director Sidney Wong is concerned that “nationalist interests could lead to a scramble for who can buy [vaccines] first.”

Sanofi, a French pharma company, had previously walked back on a statement saying they would sell any successful vaccines first to the United States, following widespread backlash from health advocates and Macron himself. A Pfizer executive last week said that no premarket agreements had been signed.

Pharma Leaders Say They’ll Sell “No-Profit” Vaccine

Johnson & Johnson CSO, Jonathan Stoffels speaking at a 28 May press briefing

Some pharma industry leaders last week announced intentions to provide any successful COVID-19 vaccines under “not-for-profit” pricing. The International Association of Pharmaceutical Manufacturers and Associations (IFPMA) later released a softened statement regarding the industry commitment to ensuring an accessible vaccine.

“Johnson & Johnson made a commitment to the pandemic period where we will supply [a successful vaccine] all over the world, at a at a ‘not-for-profit’ price,” said Johnson & Johnson Chief Science Officer Jonathan Stoffels, in a Thursday press briefing on vaccine development, organized by IFPMA.

Glaxosmithkline CEO Emma Walmsley and AstraZeneca CEO Pascal Soriot echoed that successful vaccines developed with their companies’ support would likewise be sold at a ‘no-profit’ price. Pfizer CEO Albert Bourla was also present at the briefing, although he did not make any specific references to selling a vaccine “not-for-profit.”

“It’s encouraging to see that pharma companies are claiming that they won’t conduct business as usual during this devastating pandemic, and say that they’ll charge a ‘not for profit’ price for future COVID-19 vaccines,” Elder said to Health Policy Watch.

“Of course, the devil is in the details: how will pharmaceutical corporations substantiate that? Are they planning to open their books so the public can scrutinize their costs and see if indeed the price they set is truly not-for-profit?” questioned Elder, adding a call for companies to be transparent around the cost of production.

IFPMA later released a statement with softened language, affirming the industry’s commitment “to deliver safe, quality, effective, and affordable COVID-19 vaccines to all” without specific reference to selling at a ‘no-profit’ price.

The industry group did however, affirm its commitment to continue supporting Gavi, joining other private industry sectors to support the public-private partnership. Several foundations, including the UPS Foundation, the ELMA Vaccines & Immunization Foundation, Laerdel Global Health Fund and the Rockerfeller Foundation committed funds to Gavi support supply chain strengthening and frontline healthcare workers.

Airtel and Mastercard committed services and funding for digitising immunization data, and social media brand TikTok and Unilever have committed donations to help generate demand for vaccines. United Bank of Africa (UBA) Foundation, Gamers Without Borders (GWB), and Netflix founder Reed Hastings have also made commitments to Gavi ahead of Thursday’s pledging conference.

Image Credits: Gavi/Karel Prinsloo 2017, NIAID.

(Left-right): Mike Ryan, Dr Tedros Adhanom Ghebreyesus, Maria Van Kerkhove, and Soumya Swaminathan at WHO press briefing Wednesday

The World Health Organization finally appears poised to recommend wider public use of masks as an additional measure to prevent transmission of COVID-19 – after months of hesitation while countries took unilateral action mandating face coverings, particularly for busy shops, transport systems and public settings.

The WHO move, announced at a Wednesday press briefing, follows new recommendations by its Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH),  supporting ” mask use by the general public in the community to decrease the risk of infection.”

In another statement at Wednesday’s briefing, WHO’s Chief Scientist Soumya Swaminathan, said that enrollment would resume in WHO co-sponsored clinical trials of the anti-malarial and lupus drug hydroxychloroquine – after a review of the evidence so far found no significant rise in mortality among people using the treatment.

“The advisory committee of both Solidarity and Recovery have recommended that the trials can continue,” said Swaminathan, referring to the consortiums that are guiding the research with WHO. “We hope that the ongoing trials will continue until we have definite answers. That is what the world needs.” 

WHO suspended the trial last week, in the wake of a Lancet study that seemed to find a higher mortality rates among people taking the drug – although the observational study was later criticized for not adequately taking into account the baseline condition of the patients considered in its analysis of death rates.

Said Swaminathan: “The only way to get definite answers is to do well conducted randomized trials, to see which [treatments] will reduce illness and infection rates in the communities, we should be guided by the science and the evidence.”

STAG Report and Lancet Study Tip the Balance on Mask Recommendations

The STAG advisory group recommendations were released shortly before a WHO-sponsored meta-analysis published by The Lancet, concluded that public use of masks could be an effective infection control measure – although there remains a dearth of robust studies on the topic. 

“Face mask use could result in a large reduction in risk of infection…., with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable
12–16-layer cotton masks,” the Lancet study concluded.

The STAG advisory group particularly recommended the use of masks in settings where there is “active and widespread community transmission occurring with high attack rates in the population… [for] activities in closed environments without efficient air exchanges, such as commuting on public transportation and over-the-counter consultations in pharmacies.” 

Commuters wear masks to protect against transmission of COVID-19 on a train in Singapore

Public use of facial coverings can also be useful “as part of a transitional package from a ‘confinement’ or ‘stay-at-home’ order to demonstrate solidarity, community empowerment, understanding of the seriousness of the situation,” according to the STAG note.

WHO’s COVID-19 Technical lead Maria Van Kerkove said that updated guidance would be forthcoming in light of the STAG Committee’s recommendations. 

“We are planning to update and release new guidance on use of masks in the coming days,” said Van Kerkhove, in response to a query from Health Policy Watch at a Wednesday press briefing. 

Masks  – As Part of A Continuum of Management

However, Health Emergencies Executive Director Mike Ryan stressed, “We see masks as part of a continuum of risk management, not as an alternative to public health interventions, physical distancing, or surveillance.

“As we move back to work and back to school, everyone is concerned [about] how I can reduce risk. How I can manage the risk to me or my family?

“With regard to the use of masks at the community level, they would mainly be used for the purposes of source control. In other words, [they are recommended] for people who may be infectious, reducing the chances that they will infect someone else,” said Ryan. But mounting evidence of asymptomatic transmission makes it impossible for some people to know if they are indeed infectious or not, and thus the move to wider public mask use may be justified, he acknowledged. 

Wearing masks to protect from COVID-19 in Nigeria Credit: @CRSPHCDA1

The STAG recommendations also underline that the use of masks helps prevent transmission of the virus by asymptomatic or presymptomatic individuals – those who may be infected but not yet showing symptoms. 

“The primary role of masks (of any kind) in the community is to reduce exposure risk for others from infected persons in the pre-symptomatic period,” the STAG-IH group writes. “Infections from such persons are not considered a major driver of the pandemic, but there are concerns that viral loads are highest during the early phase of the disease.”

The WHO move towards wider use of masks has been slow. In the early days of the pandemic, Ryan, Kerkhove and others repeatedly stressed that masks should be limited to health clinics or caring for a sick person at home.  Widespread public use of masks in Asia was described by Ryan as a “cultural” habit – although that habit also clearly originated in the Asian experience with previous pandemics such as the 2003 SARS.

Masked protest in Minneapolis against the death of George Floyd

The WHO message evolved slowly, as  the evidence grew about potential virus transmisison by people with no symptoms, and through simple actions like speaking or singing. The number of countries recommending or requiring facial coverings in public also grew well beyond Asia to Africa, where public health leaders stressed that social distancing is almost impossible, as well as more affluent countries such as Hungary, the Czech Republic, Israel, and some US states.

 

Mask use has become even more significant as countries begin to lift stay-at-home orders. Israel, for instance, which had one of the lowest per capita mortality rates in the height of the pandemic, has seen a rapid rise in cases after lifting its lockdown, and has since strengthened its enforcement of requirements to don masks in schools, stores and other public places. In the US, protestors have been circulating advice via social media to wear masks while attending the massive rallies protesting the death of a Minnesota black man, George Floyd, while in police custody. The mass gatherings have put millions of people into much closer contact with each other in the world’s pandemic epicentre, albeit in outdoors environments. 

 

Image Credits: Jade Lee , Cross River State Primary Health Care, Nigeria , Jenny Salita.

The six dogs being trained in the UK to detect COVID-19

Dogs could be trained to discern COVID-19 in humans, reported researchers from The London School of Hygiene and Tropical Medicine (LSHTM), Medical Detection Dogs and Durham University in a podcast last Wednesday. The study has received £500,000 from the UK government and hopes to be able to train dogs for rapid virus detection in airports and other ports of entry. 

The work builds on previous malaria research, which successfully trained dogs to detect malaria in people based on its characteristic odour.

Over 10 years ago, anecdotal evidence suggested that dogs could detect cancer in urine samples, leading to formal studies that confirmed the theory. Ever since, dogs have been used to detect a wide range of conditions – including bladder cancer, but also rapid changes in blood sugar levels in advanced diabetics.

Dogs are an ideal candidate to detect subtle smells because their sense of smell is highly developed. They have over 350 million olfactory receptors, allowing them to sniff out a teaspoon of sugar in the volume of water held in two Olympic-sized swimming pools, said researchers at the podcast. Another advantage of using dogs is that they are used to working alongside humans and are ‘highly trainable’- their use is already widespread in security programs and agriculture, among other uses.

Dogs could also screen up to 250 people an hour, said researchers. But if dogs were used in the future to detect COVID-19, they would not replace swab tests or antibody tests; rather, they would augment the testing capacity in specific locations. The team is looking to scale up the venture and apply it to other countries, if it proves to be successful. 

The study on malaria detection — which used foot odours from socks worn by Gambian children, that dogs could detect at a high accuracy — provides a template for the COVID-19 study and could help “prevent a second wave by identifying people from high-risk countries at ports of entry”. 

In the case of COVID-19, dogs will be given samples from face masks or the feet of people with COVID-19, as well as placebos, and researchers will evaluate whether the dogs can recognise COVID-19 odours, which they will communicate to researchers through physical gestures. The samples collected will also be analysed in laboratories to identify whether there are volatile biomarkers associated with COVID-19 infection. 

If there are odours associated with COVID-19, dogs could take about eight weeks to train, before practicing in more realistic scenarios.

Currently, six dogs (cocker spaniels, retrievers and mixes) are being trained to identify the odours of COVID-19. These dogs are experienced bio-detection dogs as well as assistance dogs that monitor the health of people with life-threatening diseases. 

 

Image Credits: MDD/BexArts/Nigel Harper.

Antimicrobials are becoming less effective at treating infections

As the COVID-19 pandemic spawns increased antibiotic use all over the world, more drug-resistant microbes are bound to bite us back , said Dr. Tedros at a WHO press conference on Monday. The repercussions on disease treatment and deaths will be severe, given that the world is running out of effective ways to treat antimicrobial resistance (AMR).

“COVID-19 has led to an increased use of antibiotics, which ultimately will lead to higher bacterial resistance rates that will impact the burden of disease and deaths during the pandemic and beyond,” Dr Tedros said.  He was referring to the fact that patients seriously ill with the SARS-COV-2 virus are often receiving antibiotics to prevent secondary bacterial lung and other infections.

“As we gather more evidence, it’s clear that the world is losing its ability to use critically important antimicrobial medicines, all over the world…In some countries, there is an overuse of antibiotics and antimicrobial agents in both humans and animals,” Dr Tedros said.

That is the picture painted by the latest data updates of WHO’s Global Antimicrobial Resistance (AMR) and Use Surveillance System (GLASS).  The trends reflect ‘”disturbing” rates of increases in antimicrobial resistance, WHO says. On the positive side, participation in the surveillance has grown exponentially since the system was created in 2018.

Microbe Resistance to Some Common Drugs – Running as High as 93%

Among the worrisome indicators, the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% in 33 reporting countries, the WHO data found.

The WHO data comes a year after the major UN interagency report “No Time to Wait” predicted that mortality from drug resistant infections could increase more than ten-fold, causing up to 10 million deaths a year by 2050, in business-as-usual scenarios.

And as antimicrobial resistance increases, the R&D pipeline to bring effective antimicrobials to the market is drying up.

“There has been very little market incentive to develop new antibiotics and antimicrobial agents, which has led to multiple market failures of very promising tools in the past few years,” Dr Tedros also said.  

Antibiotics are ubiquitous in modern medicine – They are used in most surgical procedures like joint replacement, but also in patients with conditions like cancer, cystic fibrosis or diabetes. When antimicrobials like antibiotics are used excessively, microorganisms can mutate to become drug-resistant.

R&D for antibiotics has declined for over three decades
Record Number Of Countries Are Participating In WHO’s Surveillance System For AMR

Despite the looming threat of antimicrobial resistance, a record number of countries are now monitoring and reporting antibiotic resistance through WHO’s GLASS system – marking a major step forward in the global fight against drug resistance. 

“This step is extremely important so we can look into the magnitude of the problem within different countries. And we hope that more will engage,” said WHO’s Assistant Director-General for Antimicrobial Resistance Hanan Balkhy, at Monday’s press conference.

Since 2018, GLASS has grown ‘exponentially’, she said, with over 64,000 surveillance sites, across 66 countries, as compared to only 729 sites across 22 countries when the system was founded. That led to some two million patient reports in 2020. 

AMR Is A Global Health Priority That Disproportionately Affects Low And Middle Income Countries 
Distribution of antimicrobial resistance around the world

Many low and middle-income countries already have high AMR rates – And AMR was projected to grow faster in these contexts than in high-income countries, according to a 2018 report by the Organisation for Economic Co-operation and Development (OECD).

In Brazil, Indonesia and the Russian Federation, for example, about half of infections are caused by drug resistant microorganisms – and resistance in these countries is predicted to rise 4–7 times faster than in other OECD countries.

With increasing globalization, tackling AMR is a “global health priority” because microorganisms know no borders, said Assistant Professor at Warwick University Marco Haenssgen, at a webinar on Tuesday hosted by the London School of Tropical Hygiene and Medicine.

In the late 1950’s and early 1960’s, South East Asia was one of the first regions to report about the development of drug-resistant strains of malaria (plasmodium) parasites. Since then, drug-resistant malaria has even spread to high-income countries like the UK, said Haessgen. 

Rationalizing Antibiotics Use in Humans and Animals Requires ‘Multi-Sectoral’ and ‘Customized’ Solutions
WHO Assistant Director-General Hanan Balkhy

Resolving AMR is ‘very complex’, said Balkhy, as it is ‘extremely difficult to identify’. Another issue is that the drivers of resistance are “very different” in each country.

In some contexts, AMR may be caused by over-prescription of antibiotics in human patients. In OECD countries, about half of antibiotics were inappropriately prescribed by general practitioners, which either prescribed the wrong antibiotic, or prescribed unecessarily. reported a 2018 OECD study. The same OECD study projected that AMR could cost up to $3.5 billion per year. 

In other settings and countries, AMR may be largely due to excessive use of antibiotics in agriculture. Antibiotic consumption in livestock was projected to increase by almost 70% in the most populated countries of the world by 2030, according to a 2014 study published in the Proceedings of the National Academy of Sciences. And livestock consumption of antimicrobials will be 99% higher in Brazil, Russia, India, China, and South Africa (BRICS) compared to other countries, the study estimated. 

Whether antimicrobials are used in livestock or humans, they are not a panacea for ‘good hygiene’, said Balkhy. “It is important that we do not replace good hygiene in either context by the excessive use of antimicrobials.”

WHO’s Interim Guidance on mitigating antimicrobial resistance during COVID-19

Given the complexity of the problem, the WHO has “taken a big step” to address AMR in a “customized, multi-sectoral fashion” by working directly with countries and regularly updating technical advice.

In the WHO’s latest interim guidance for clinical management of COVID-19 from late last month, it has outlined how antibiotic therapy can be used to treat patients in a way that mitigates antimicrobial resistance.

But to accelerate the development of viable candidates, new R&D models and public-private partnerships will be needed to incentivize “sustainable innovation” of newer, and more effective antimicrobials, said Dr. Tedros.

“We must bolster global cooperation and partnerships including between the public and private sectors to provide financial and non-financial incentives for the development of new and innovative antimicrobials”, added Balkhy.

Image Credits: WHO / Sergey Volkov, OECD, WHO, FAO and OIE, PNAS, WHO.

Dr Tedros speaking at a WHO COVID-19 press briefing.

China stalled for ‘at least’ two weeks in providing the World Health Organization with detailed data on COVID-19 cases, frustrating WHO’s top echelons –  even as they tried to put on a positive public face, according to an investigative report by the Associated Press of exchanges that occured in January.

China also withheld the genome sequence of the COVID-19 virus for over a week, releasing it only on  11 January – though three separate government labs in China had already sequenced the SARS-CoV-2 virus as of 3 January, states the AP report. . 

As the World Health Organization publicly praised Beijing for ‘immediately’ sharing the genetic sequence of the SARS-CoV-2 virus in January, internal WHO meetings record the “considerable frustration” of  WHO officials with the “significant delays” in China’s timely release of the gene sequence and other critical information,  according to the AP report, which it said was based on dozens of confidential interviews as well as written and audio recordings of internal WHO conversations in early January. 

“We have informally and formally been requesting more epidemiological information,” WHO’s top China official, Gauden Galea, was quoted as saying in one critical meeting. “But when asked for specifics, we could get nothing.

“We’re currently at the stage where yes, they’re giving [the necessary information] to us 15 minutes before it appears on CCTV,” Galea added, referring to the state-owned China Central Television.

Mike Ryan, Executive Director of WHO Health Emergencies Programme

In the second week of January, WHO’s chief of emergencies, Dr. Michael Ryan, reportedly told other WHO colleagues it was time to “shift gears” and apply more pressure on China, saying that he feared China’s lack of transparency would lead to a repeat of circumstances similar to those that fueled the spread of Severe Acute Respiratory Syndrome 2002, which began in China but led to the deaths of nearly 800 people worldwide.

“This is exactly the same scenario, endlessly trying to get updates from China about what was going on,” he is quoted as saying. With reference to SARS, he added:  “WHO barely got out of that one with its neck intact given the issues that arose around transparency in southern China.”

In fact, the WHO management of SARS under former director general Gro Harlem Brundtland, who publicly called out Beijing for its lack of transparency, and then issued an unprecedented  advisory against travel to the country, has been heralded, even by US President Donald Trump, as exemplary.

Wedged between Two Superpowers

The AP report comes as WHO has faced a hail of criticism from the United States, culminating in Friday’s decision by Trump to withdraw the United States membership in the UN agency and terminate its funding.

The AP report provides a fresh narrative of the China-WHO dealings, one which ultimately left the global health organization trapped in a bitter United States-China rivalry – even though its own collaboration with China was laced with internal frustrations, which officials were loathe to express publicly at the risk of information flow further drying up.

Already on 6 January, the WHO had privately complained about being kept in the dark as China gave it insufficient information despite the legal provisions of the International Health Regulations: “We’re going on very minimal information,” said WHO’s technical lead for COVID-19, Maria van Kerkhove, at another internal meeting, cited by AP. “It’s clearly not enough for you to do proper planning.”

China’s Xi Jinping in 18 May address before the World Health Assembly

Given the WHO’s position, public praise  of China was probably the only strategy at its disposal to secure access to crucial epidemiological data, public health experts familiar with the organization noted.    

If the WHO pushed too hard on Beijing, WHO officials might even have been expelled from the country, Adam Kamradt-Scott, global health professor at the University of Sydney told AP. In mid-March, China kicked out American journalists from the New York Times, The Wall Street Journal and The Washington Post – most of whom aggressively reported on the evolving COVID-19 epidemic in its earliest days as the Chinese government tried to play down its severity.

WHO – Lack of Enforcement Power

In Friday’s announcement over the severing of ties, Trump charged that WHO had given into Chinese pressures to coverup its mistakes in the coronavirus response, “China has total control over the World Health Organization.”

But the fundamental weakness by the AP report uncovered is not any active collusion, but rather WHO’s lack of enforcement power in health emergencies. This means that WHO must rely entirely on voluntary cooperation from countries. It does not have the power to compel nations to do what it says, nor to independently investigate outbreaks in countries. 

Even so, WHO Director General Dr Tedros Adhanom Ghebreyesus’ efforts to coax China into cooperation while avoiding any public criticism of Beijing for its handling of the pandemic has come at a high price.

“It’s definitely damaged WHO’s credibility,” said Kamradt-Scott told AP. “Did he go too far? I think the evidence on that is clear….it has led to so many questions about the relationship between China and WHO. It is perhaps a cautionary tale.”

AP notes that WHO officials named in its story declined to answer questions posed about the internal meetings, without direct access to audio or written transcripts of the recorded meetings, “which the AP was unable to supply to protect its sources.”

For more details on the unfolding of COVID-19 in its early stages and the politics of China;s response that cost many lives, see AP’s full report here.

Image Credits: WHO/Pierre Virot, WHO.

Police handcuff and arrest protestors in Brooklyn, New York. Even in peaceful protests, social distancing crumbles.

“I can’t breathe” could have been a slogan for those suffering the worst effects of COVID-19. But now it has become the battle cry of Americans angered over the police killing by strangulation of a Minneapolis man, George Floyd, last week. 

While this is the latest in a years-long series of violent events involving African American men and women who were abruptly shot, choked or otherwise killed by police for either minor offenses or no offense at all, it has heightened significance in the wake of the widespread economic and social disparities created by Covid-19 pandemic.   

What the New York Times called the “parallel plagues” of COVID-19 and police brutality have both taken an outsize toll on American’s minorities—sparking outrage and grief across a nation already polarized by racial, ethnic and economic divisions that have been heightened by Covid-19. 

And indeed, civil violence is also a public health threat, both recognized by the World Health Organization as well as tracked by countless experts.

“The same broad-sweeping structural racism that enables police brutality against black Americans is also responsible for higher mortality among black Americans with Covid-19,” Maimuna Majumder, a Harvard epidemiologist also working on the Covid-19 response, told Vox.

African-American Deaths from COVID-19: 2-3 Times More than Expected
Protesters with hands up, symbolic of the Black Lives Matter movement, at a peaceful Minneapolis protest over the death of George Floyd

For Americans, Minneapolis has long had a reputation as a progressive and tolerant city and state, graced with higher than average incomes and educational levels and a strong social welfare net, compared to many other parts of the US. However, the protests that began in Minneapolis quickly spread over the weekend to some 140 other urban centers, which face even sharper racial and economic divides. The circle of violence quickly choked Washington DC, Los Angeles, Atlanta, and New York City – where poor and working class minority communities often live in close proximity to the national power centers of government, business and culture.

The brutal scenes of police pushback against the protestors captured on Twitter and Instagram, fueled a feedback loop of yet more outrage and waves of demonstrations. 

https://twitter.com/i/status/1267306908983218176

“Last night was an ugly night in the state and the country,” remarked New York Governor Andrew Cuomo in a press conference on Sunday.

A national analysis of data from the COVID Racial Tracker, finds that African-American deaths from COVID-19 are nearly two times greater than would be expected based on their share of the population, National Public Radio reported. In four states, the rate is three or more times greater.  In some 42 states plus Washington D.C., Hispanics/Latinos also make up a greater share of confirmed cases than their share of the population. White deaths from COVID-19 are lower than their share of the population in 37 states and the District of Columbia, the analysis also found.  

Other studies have found that low socio-economic status is closely associated with crowded living conditions and a higher rate of other chronic health conditions, all of which raise the risks of serious illness from COVID-19.

African-Americans make up 35 percent of coronavirus cases in Minneapolis, though they are less than 20 percent of the city’s population.” “By one estimate, black people accounted for at least 29 percent of known Covid-19 cases in Minnesota, despite making up about 6 percent of the state’s population, reported VOX.”

Critics have also compared the very hard line taken by US President Donald Trump against the current wave of protests to his much softer line vis a vis the gun-bearing demonstrators that marched around business centers and state capitals, such as Lansing Michigan, only a few weeks ago, demanding that COVID-19 lockdown measures be ended.

Tweet compares President Trump’s reaction to protests against lockdown in early May and police brutality last week.

The United States is not the only COVID-19 epicentre now facing major social upheaval. In Sao Paolo, Brazilians were met by a hail of police rubber bullet fire when they came out into the streets to protest President Jair Bolsonaro’s laissez faire handling of the crisis over the weekend.

Meanwhile, in Brazilia, Bolsonaro joined protestors in Brasilia demanding the total reopening of the country, as well as the shutdown of Congress and the Supreme Court – which is set to hear an investigation over the president’s allegedly illegal interference with Federal Police. The protests rocked major cities as the country marked 500,000 COVID-19 infections, with the fourth highest number of deaths worldwide – outpaced only by the US, the United Kingdom and Italy.  

In a parallel development, the US sent two million doses of hydroxychloroquine to Brazil, reported the White House on Sunday. The anti-malarial drug will be used to treat Brazilians infected with COVID-19, the White House said. This was despite the fact that a growing body of evidence indicates that hydroxychloroquine can increase mortality and lead to heart complications in people with Covid-19.

United States Continues Business Reopenings

While some US cities were put under tough curfews due to the wave of unrest and violence, the reopening of businesses following the COVID-19 lockdown has continued apace. 

In New York, Governor Cuomo announced Sunday that dentists could reopen their offices statewide on Monday. He said that overall cases in the state continued their sharp decline – although there were still 1,110 new infections reported overnight Saturday-Sunday.  New York State has seen a total of some 370,000 virus cases, and more people have died in New York State alone than in any other country, except for Italy and the United Kingdom. 

On the far end of the continent, however, Alaska saw an uptick in cases in the past few days, reporting some 30 new cases  on Sunday, the largest increase seen since April 1-2 when cases peaked at 187. Alaska was one of the first states to open restaurants and rollback business restrictions in mid-April. On May 22, Alaskan Governor Mike said “it will all be open just like it was prior to the virus,” at a press conference.

On Sunday, some 600 Americans died from COVID-19 – in a week that saw mortality nearly double, and then decline again. 

WHO Warns Against Infection Spread From Mass Gatherings  

Protests seen in the US may also increase risks of refueling the US centres of the outbreak, politicians and some public experts have also worried.

Los Angelos Mayor Eric Garcetti warned that the protests could become “super-spreader events” – although other public health experts said that the outdoor settings may mitigate infection spread.

“The outdoor air dilutes the virus and reduces the infectious dose that might be out there, and if there are breezes blowing, that further dilutes the virus in the air,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University, told the New York Times. “There was literally a lot of running around, which means they’re exhaling more profoundly, but also passing each other very quickly.”

However Howard Markel, a medical historian, countred that “Public gatherings are public gatherings — it doesn’t matter what you’re protesting or cheering,” he told The Times. Screaming and shouting slogans during a protest also can accelerate the virus spread, Markel said, while tear gas and pepper spray used to disperse crowds, also cause people to tear up and cough, and further increasing respiratory secretions and the possibility of transmission. Police barricades, arrests and efforts to move in and around crowds also results in more contact in tight spaces.

And while some of the US protestors have been donning masks and attempting to keep a distance, many precautions are thrown to the wind during the kinds of spontaneous protests now being seen in the United States, he added.

The risks of virus spread in uncontrolled mass gatherings were echoed by WHO Director General Dr Tedros Adhanom Ghebreyesus and senior WHO scientists at in a press briefing on Monday.

“Mass gatherings have the potential to act as super spreading events,” Dr Tedros said, even though he made no mention of the wave of US protests.  He announced that WHO was releasing updated guidance to help organizations determine how and when mass gatherings can safely resume.

“The close contact between people can pose a risk,”said WHO’s Technical Lead for COVID-19 Maria van Kerkhove, adding that such events need “rigorous planning” to ensure that physical distancing is not forgotten.

“And we need to ensure that in locations that are considering these…mass gathering events, that you have a system in place to prevent and detect and respond to any such cases.” she added. 

After a tough, public rebuke of protestors that rioted in the city’s streets over the weekend, saying that they had dishonored the memory of the slain George Floyd, Atlanta’s mayor, Keisha Lance Bottoms, had a simple piece of advice. She told them to: “go get a COVID test this week.”

 

Image Credits: G. Ginsberg/HPW, Jenny Salita.

A new survey by WHO has found that the COVID-19 pandemic has ‘severely’ disrupted the delivery of services to prevent and treat non-communicable diseases (NCDs) in almost 80% of countries surveyed – or 122 out of 150 countries.

This is of “significant concern” WHO said on Monday in a statement, because people with NCDs also are more vulnerable to COVID-19 infection and death. And even prior to the pandemic, some three quarters of all deaths worldwide were due to NCDs.

“It is not an understatement to say that the emerging evidence is dramatic,” said CEO of NCD Alliance Katie Dain on Monday, in response to the WHO’s findings. “People exposed to…unhealthy diets, smoking, alcohol use, lack of physical activity, and air pollution are far more vulnerable to COVID-19 infection, far more vulnerable to developing severe complications, and far more vulnerable to death from the virus.” 

In Italy, for instance, 98% of people that died from COVID-19 had pre-existing NCD conditions, including cardiovascular issues (67%) and diabetes (31%). According to the WHO’s estimates, diabetics are twice as likely to die from COVID-19 compared to people without diabetes.

A main reason for the neglect of NCD treatment has been the partial or full reassignment of healthcare staff to COVID-19 prevention and response – Which was reported in 94% of the 155 health ministries surveyed.

In the WHO’s rapid assessment, rehabilitation services were the most commonly disrupted NCD service – with a partial or total standstill in two-thirds of surveyed countries. Rehabilitation services often include physiotherapy, as well as other programmes supporting recovery from heart attack, stroke, surgery, amputations and COVID-19.

Said WHO in the statement, although rehabilitation is “key to a healthy recovery following severe illness from COVID-19”, it “continues [to be] wrongly perceived as a non-essential health service for all patients when for many patients it is essential.” 

COVID-19 has also upended other services like hypertension, diabetes, cancer treatment and cardiovascular emergency services – with over half of countries reporting disruptions in hypertension management services, and about half of countries with disruptions in diabetes services. 

When outbreaks were more severe, NCD services were more likely to be disrupted – an  ‘unsurprising correlation’, said the WHO statement.

For instance, only 35% of countries reported disruptions in diabetes services when transmission was sporadic. However, this number almost doubled when outbreaks were transmitted at the community level. 

And the standstill in chronic disease services is likely to disproportionately affect low-income countries as they struggle to incorporate these essential services into national COVID-19 plans.

New Ebola Outbreak in Northwestern Democratic Republic of Congo

Wangata hospital in the Democratic Republic of Congo

On Monday, a new outbreak of Ebola virus disease was detected in Northwestern Democratic Republic of the Congo (DRC), said WHO Director General Dr. Tedros Adhanom Ghebreyesus. So far, six Ebola cases were identified in the Wangata region, of which four have died and two are alive and under care, said the WHO in a statement. 

The announcement follows a “complex Ebola” outbreak in Eastern DRC, which “seems to be in its final phase”. On 14 May 2020, DRC’s Ministry of Health began the 42-day countdown to declare the end of the Ebola outbreak in Eastern DRC.

“This is a reminder that COVID-19 is not the only health threat people face,” said Dr Tedros.

To reinforce local leadership, the WHO will deploy a team “to support scaling up the response”, said WHO Regional Director for Africa Matshidiso Moeti. “Given the proximity of this new outbreak to busy transport routes and vulnerable neighbouring countries, we must act quickly.”

Total cases of COVID-19 as of 1 June 2020, with active case distribution globally. Numbers change rapidly.

Meanwhile in South America, cases “have not reached peak yet”, said WHO Emergencies head Mike Ryan. In the past week, South America has emerged as the epicentre of the COVID-19 pandemic- And in the past day, five of the ten countries reporting the highest number of COVID-19 cases were in the Americas, including Brazil, the USA, Peru, Chile and Mexico.  

While deaths in Brazil were almost on-par with the USA in the past day, Brazil’s new cases (33 274) in the past 24 hours were double that of the US (17,962), according to the latest WHO situational report.

As of Monday, a cumulative toal of 6.2 million cases of COVID-19 were reported across the world. More than 373,000 people have lost their lives as a result, said Dr. Tedros.

Tsering Lhamo contributed to this story.

Image Credits: WHO, Johns Hopkins CSSE.