Vitamin D supplements

People who tested positive for COVID-19 had lower Vitamin D levels on average than people who tested negative, according to a massive peer-reviewed Israeli study published in the FEBS Journal.

The study found that the average plasma Vitamin D level – or the level of vitamin D in the liquid part of the blood – was 19.00 nanograms per mililitre (ng/mL) in 782 individuals that tested positive for COVID-19, compared to an average of 20.55 ng/mL in 7,025 individuals who tested negative for the virus. The study was conducted on a cohort of patients who were part of Leumit Health Services.

However, some experts urge caution in reading too much into the study’s findings, saying that other factors may explain the relationship observed in the study.

Still, low plasma Vitamin D was associated with a higher risk of COVID-19 infection and hospitalization, even after taking preexisting conditions, socioeconomic status, age, and gender into account, according to the study. In COVID-19 patients who were hospitalized, the average plasma vitamin D level was even lower at 178.38 ng/mL.

Vitamin D could act like a steroid, study author Milana Frenkel-Morgenstern of Bar Ilan University told the Times of Israel. Some steroids, such as dexamethasone, have been shown in clinical studies to improve outcomes for patients facing more serious COVID-19 disease.

Frenkel-Morganstern encouraged the government to maintain adequate outdoor spaces so that people could get sunlight, which is absorbed through the skin and helps the body make Vitamin D. The vitamin has been associated with a wide variety of health benefits, including maintaining bones and regulating calcium levels in the body.

However, others have said that it is too early to tell whether Vitamin D actually reduces the risk of COVID-19 infection. For example, people who get more exercise could have higher Vitamin D levels, and it could ultimately be exercise that is impacting COVID-19 risk, according to Ella Sklan, head of a molecular virology lab at Tel Aviv University.

And proving whether Vitamin D has any benefits as a potential treatment against COVID-19 requires clinical trials. The World Health Organization did not comment on whether Vitamin D would be considered a candidate for its massive Solidarity clinical trials testing potential COVID-19 treatments at the time of publication.

However, maintaining a healthy diet, and supplementing diets with appropriate vitamins is a “positive way to keep oneself healthy,”  and keeping healthy allows the body to help fight infectious diseases, according to a WHO statement.

“In situations where individuals’ vitamin D status is already marginal or where foods rich in vitamin D (including vitamin D-fortified foods) are not consumed, and exposure to sunlight is limited, a vitamin D supplement in doses of the recommended nutrient intakes (200-600 IU, depending on age) or according to national guidelines may be considered,” added the statement.

This story was updated 30 July to include the WHO’s statement

 

Image Credits: Flickr: Filip Patock.

First in a series of stories about how the coronavirus lockdowns and relaxations are playing out in different parts of Africa. 

A middle-aged man sells cloth face masks and face shields along a major highway in Ibadan southwest Nigeria. Photo by Paul Adepoju/Health Policy Watch

Ibadan, Nigeria – While Lagos and Abuja capital city continue to be the epicenter of the COVID-19 pandemic in Nigeria accounting for nearly half of confirmed cases, Oyo State is also generating a buzz. The state, just north of Lagos, has the third highest case count, and infections are steadily rising, even as lockdowns are relaxed more rapidly than elsewhere and students also return to school.  

This has triggered concerns that Oyo could become Nigeria’s Texas or Florida if public health policy measures aren’t followed carefully – right now they are not.  

The World Health Organisation (WHO), globally and regionally, have concluded that the COVID-19 pandemic may not end anytime soon and urged countries and governments across the world to safely reopen their economies without putting citizens, especially the vulnerable age groups to COVID-19. In Nigeria, the Oyo State capital city of Ibadan is emerging as one that is racing towards returning to normal, largely ahead of others.

It is the only state capital where students are already returning to school even as the number of cases continue to rise – about 1,000 cases away from clinging Nigeria’s second highest number of confirmed cases of COVID-19. 

But with a case fatality ratio of just 0.9%, the city’s leadership and a significant proportion of the general public consider the threat of COVID-19 not strong enough to halt students’ education, put families out of work or put the city’s life on hold.

Masks on Neck, Not the Face 

Friends and colleagues, Rabiu and Adeolu, sit on their motorcycles while waiting for passengers to transport to and from the market. When asked about their consciousness about COVID-19, they pointed to the face masks they wore, though improperly. Photo by Paul Adepoju/Health Policy Watch

As early as 6am, activities are already underway at the Agbeni market. Thousands of people roam the tightly packed streets of the market shopping for wares ranging from foodstuffs, building items and musical instruments to clothing and intimate apparel. The only evidence of the existence of the COVID-19 pandemic is an occasional sighting of individuals wearing masks – usually on the neck rather than the face as required by State health authorities – whose enforcement of the rules is even less evident than the masks.

Cases of COVID-19 in Nigeria, 29 July 2020

Although the city was never locked down, a 8pm- 6a.m. curfew was imposed from March 30 to June 20, as COVID-19 spread across west Africa and case counts in Nigeria went from just two confirmed cases on March 9 to 41,804 on July 28. In Ibadan, the first case of COVID-19 in the state was confirmed by the NCDC on March 21 and the case count rose to 2,668 on July 28.

The curfew had devastating impacts on the city’s nightlife and entertainment economy. Moreover, thousands of informal workers associated with this economy had their sole means of livelihood cut off abruptly – without the provision of  commensurate palliatives – unemployment, cash grants or even food aid. 

Just a few meters from the Oyo State Government Secretariat, activities have now been extended to 9pm at the popular Ultima Restaurant following the curfew’s relaxation.

The curfew had devastating impacts on the city’s nightlife and entertainment economy. Moreover, thousands of informal workers associated with this economy had their sole means of livelihood cut off abruptly – without the provision of  commensurate palliatives – unemployment, cash grants or even food aid. 

Just a few meters from the Oyo State Government Secretariat, activities have now been extended to 9pm at the popular Ultima Restaurant following the curfew’s relaxation.

During the curfew, a staff member told Health Policy Watch: “We had to suspend the evening shift which meant fewer workers; we also had to come to terms with the fact that we would have fewer customers. Although luckily for us we had our delivery service which saw increased adoption during the period.” 

Now, activities are returning to normal at the restaurant. Although a sign stating that only 10 people are allowed inside at any time is still at the entrance, customers are no longer asked to wait outside. Furthermore, instead of a handwashing station, the facility has shifted to temperature check and alcohol-based hand sanitizers. It has also been advising its customers to wear face masks – although not many adhere to the rule after gaining entry. 

A customer washes her hands before being allowed to enter a restaurant in Ibadan. Photo by Paul Adepoju/Health Policy Watch

“It will be easy for the city to move on if the people are abiding by guidelines that we are issuing, Ogunniyi Abiodun, public health expert at the Nigeria Center for Disease Control (NCDC), told Health Policy Watch. “Unfortunately, this is not happening as we would have loved it to be, which is why the number of cases continues to rise. But we will continue to appeal to the people and the government to base their decisions on the best available evidence.”

The Booming Business of COVID-19

Innovation has been at the heart of the COVID-19 response in the city as individuals and organisations embrace and deploy solutions that best suit their needs and are also within their budgets.

Not too far away from Ultima, a Domino’s Pizza outlet on Osuntokun avenue is co-located with an ice cream franchise. Together they have deployed a custom-built handwashing station that has a tap that users do not even have to touch – thus providing some form of protection against contracting the virus by touching frequently touched surfaces.

The hand washing station at Domino’s Pizza outlet located at Bodija area in Ibadan, southwest Nigeria. Photo by Paul Adepoju/Health Policy Watch

Social Distancing Not an Option

But most small and medium scale entrepreneurs in Ibadan lack the luxury of space enjoyed by franchise chains like Dominos – and therefore cannot effectively implement hygiene or social distancing measures. 

One of the popular landmarks in Ibadan is the Cocoa House at the center of Ibadan’s Dugbe Business District. Completed in 1965 at a height of 105 metres and was once the tallest building in tropical Africa. Opposite the historic building is a line of small shops being used by small business owners. In one of them, Tijani Balogun and four other phone repairmen are attending to customers with damaged mobile devices – a brisk business even in hard times. 

In the small room that is just about one-meter wide, customers watch as their mobile devices are disassembled and damaged parts are replaced. While admitting that the threat posed by COVID-19 to both customers and artisans is imminent, Tijani said it is a risk worth taking considering there is no better option.

“I don’t see any option for us to make daily living and maintain social distancing. Five of us are even struggling to keep up with the annual rent fee. Are we going to say that only one of us should use the shop each day?” he asked.

Presented with the shop serving as a potential petri dish for COVID-19, Tijani said customers without face masks cannot be denied services because of his competitors next door that will gladly welcome them.

“I’m not sure if I will get it (COVID-19) or not but I’m sure that I can die of hunger if I don’t attend to my customers that will pay me and give me money to feed myself and my family,” he said.

Phone repair technicians working together in a small shop in the Dugbe area of Ibadan attend to customers without wearing face masks. Photo by Paul Adepoju/Health Policy Watch

Government Plans Stricter Enforcement of Mask Rules  

Inasmuch as establishments are being compelled to have measures in place to protect workers and visitors, individuals are also expected to prioritise wearing of face masks and are aware that they could be denied entry to public places if they don’t have one on. But a loophole has also emerged – presenting a face mask at the door and removing it after gaining entry.

A cross section of defaulters that spoke to Health Policy Watch in Ibadan metropolis described the wearing of masks as necessary but uncomfortable when they wanted to talk or in need of fresh air.

“Even when I’m the only one in my car, they would not allow me to enter public premises without having a face mask on. So I just have to hang it for them to see and remove it afterwards,” Abiodun Ilori, a civil service worker said.

An overview of COVID-19 response in Ibadan suggests that more enforcement and a clearer attribution of responsibilities would be required to improve the outcomes of current efforts. 

Currently most of the onus for compliance rests on business outlets that can be shut down or receive hefty fines if they contravene government’s guidelines. 

So in general, stores, restaurants and workplaces that can afford to take measures, are attempting to comply with requirements, at least with regards to social distancing and hygiene. But since citizens themselves face no direct repercussions if they fail to wear masks or observe hygiene and distancing rules, abiding with directives has still remained largely optional. 

At a KFC outlet in Ibadan, only one person out of four wore the face mask properly. Photo by Paul Adepoju/Health Policy Watch

Realising this, the state government recently announced that from August 2020, it would start arresting and prosecuting residents caught not wearing masks in public. During the weeks leading up to the commencement of the enforcement measures, the government said it will attempt to “sensitize, persuade and ensure compliance”. 

A similar enforcement approach is being deployed in Lagos which is about 120 kilometers away from Ibadan and is the epicenter of Nigeria’s COVID-19 pandemic. 

Health System Tested by COVID-19

Beyond the enforcement of prevention measures, access to COVID-19 tests is also expanding – although efforts to strengthen the diagnostic capacity have also put health systems to the test.

Even though access to testing is still unequal, community testing is expanding as volunteers are being mobilised from one part of the city to another including open markets. 

More and more health clinics  serving local communities are also opening test collection centres.  And there are ventures to expand testing in non-traditional sites too. For instance, the state government-owned Lekan Salami Stadium at Adamasingba in Ibadan has recently opened a testing center, under a public-private partnership with health tech startup lifebank, Nigeria Institute for Medical Research, Citizen for Citizen (an NGO) and laboratories at University of Ibadan’s College of Medicine.

The state government-owned Lekan Salami Stadium at Adamasingba in Ibadan is also being used as a COVID-19 testing centre. Photo by Paul Adepoju/Health Policy Watch

Prior to COVID-19, the major responsibilities of hospitals under the state’s healthcare system included care of patients living HIV, malaria, maternal health and immunization. With the advent of COVID-19, existing health infrastructures are being converted to aid the response – as has happened in countries elsewhere. 

A newly constructed maternity hospital at Olodo area of Ibadan became the state’s largest COVID-19 isolation centre while the Chest Clinic at Jericho area of the city, which was the hub of tuberculosis diagnosis and treatment prior to the pandemic, was also converted into another isolation center. 

Itunu Adelowo, Director of Operations at the African Development and Empowerment Foundation described the roles being played by the state’s health system as evidence of the need for much bigger investments in, and empowerment of, health systems. 

“When we say invest in ending maternity mortality, COVID-19 has shown that the acquired capacity for fighting maternal mortality could be deployed in tackling health emergencies. As poor as the health system was before COVID-19, it remains a major pillar supporting COVID-19 response. Now imagine what can be achieved when we have a well funded, structured and enabled health infrastructure,” Adelowo told Health Policy Watch. 

“It will be easy for the city to move on if the people are abiding by guidelines that we are issuing, Ogunniyi Abiodun, public health expert at the Nigeria Center for Disease Control (NCDC), told Health Policy Watch. “Unfortunately, this is not happening as we would have loved it to be, which is why the number of cases continues to rise. But we will continue to appeal to the people and the government to base their decisions on the best available evidence.”

Life goes on in a second hand clothes market in Ibadan – Photo by Paul Adepoju/Health Policy Watch

Image Credits: P Adepoju/HP-Watch, Nigeria Centres for Disease Control.

Head of the Italian Medicines Agency Luca Li Bassi at 72nd World Health Assembly, where he led approval of a historic resolution on price transparency in medicines markets.

Italy has become the first nation to require pharmaceutical companies to disclose secret data about any public subsidies it may have received for the development of a new drug, during negotiations over drug pricing and reimbursement with national regulatory authorities, according to a decree published Friday in the nation’s official gazette.

The decree, following on from last year’s milestone World Health Assembly resolution on transparency of markets for health products, represents a “very important” step towards enabling government authorities to negotiate more effectively with the private sector over new drug prices, Luca Li Bassi, former Director-General of the Italian Medicines Agency (AIFA), told Health Policy Watch.

“The Decree is a very good step forward that addresses the asymmetry of information at the negotiating table with the private sector”, said Li Bassi, who was also the leading architect, on behalf of the Italian Government, of the WHA transparency resolution from 2019. “Having information is vital when you’re negotiating, otherwise you’re negotiating blindly.”

Luca Li Bassi holds his transparency award

The decree was actually approved by Italy’s Ministers of Health and Finance in August 2019.  But after a government reshuffle in the fall, it languished in limbo due to a technicality – as it had not been published in the official Italian government gazette.  Last Friday, it finally surfaced, observers say at an opportune moment as Italy’s badly hit health system recovers from the first wave of the pandemic. COVID-19 has also churned up further debate over issues of drug access, pricing and transparency  – as pharma companies and countries scramble to research and acquire technologies that could better treat the viral disease.

“For a COVID-19 pandemic response to be effective and legitimate, it is critical to ensure that transparency is upheld, particularly when it comes to clinical trials, pricing and supply schemes,” said Jaume Vidal, Senior Policy Advisor of Health Action International, to Health Policy Watch. “The decree clearly shows that the need for greater transparency on medicine prices and R&D costs is still in the agenda more than a year after the historic Italy-led WHA resolution was approved.”

According to Li Bassi, the decree will strengthen AIFA’s negotiating position with pharmaceutical companies as they seek reimbursement for their innovations. It will provide public health authorities not only with data about contributions public sources may have made to the R&D of a new drug, but also about sales revenue, marketing costs and the status of relevant patents. The new regulations also require pharmaceutical companies to submit information to AIFA about reimbursement prices in other countries. That would provide Italian government authorities with a means to compare reimbursements, and thus prices, for the same health products across countries. 

“Most importantly, this decree enables AIFA to make a far better informed analysis of the reimbursements demands made by suppliers, resulting in a significantly transformed negotiation process across the table”.

The decree is also a “very important step” that could encourage other countries to follow in the same direction, and for more collaboration to spearhead the transparency agenda in the future, said Li Bassi: 

“Anything that can be done to enhance transparency in the biopharmaceutical sector is definitely going to be useful.”

Image Credits: Twitter/@Italy_UNGeneva, l'Observatoire Médicaments Transparences.

Vaccination can effectively prevent mother-to-child transmission of hepatitis B

In a landmark achievement, incidence of chronic hepatitis B has successfully dropped below 1% in children under five, reaching the 2020 goal set at the 2016 World Health Assembly, said World Health Organization Director-General Dr. Tedros Adhanon Ghebreyesus on Monday.

The target reduction in hepatitis B virus (HBV) incidence in children was met in 2019, a rare case where global health goals were achieved within the intended timeline. The achievement, announced just ahead of World Hepatitis Day, provides a much-needed boost of morale for the embattled global health community in the wake of this year’s pandemic and its knock-on effects on other disease areas. 

“HBV has been a scourge in many countries for so many decades”, said WHO’s Head of Health Emergencies Mike Ryan. “To see incidence [of hepatitis B] less than 1% in children is just incredible”

“I know it doesn’t sound like it, but we should take these successes because they’re true victories for global health.”

The reductions in HBV incidence in children were largely thanks to the wide deployment of a childhood vaccine against the virus. 

Still, Dr Tedros warned that countries must stay on guard.

Disruption of essential services, like vaccination against Hepatitis B, could result in five million additional chronic hepatitis B (HBV) infections in children born between 2020 and 2030, as well as one million additional HBV-related deaths among those children later on, according to a study by Imperial College London and WHO which has not been published yet. 

Additionally, the hepatitis death toll could skyrocket because of coronavirus-related disruptions, warned Dr. Tedros. Hepatitis infections can cause liver damage and liver cancer, and currently claim 1.3 million lives a year. 

Globally, about 325 million people live with hepatitis B and C, the most deadly of the five types of hepatitis disease.

Hepatitis B Vaccine Coverage Threatened During Coronavirus Pandemic
A healthcare worker in Lao PDR provides the first dose of the hepatitis B vaccine, given within 24 hours of birth.

As a result of the pandemic, disruption of essential hepatitis services, like HBV vaccination of infants, threatens to claim thousands of additional lives, added panelists at the WHO briefing.

“Even in the midst of the COVID-19 pandemic, we must ensure that mothers and their babies have access to life-saving services including hepatitis B vaccinations. Preventing transmission of hepatitis B from mother-to-child and in early childhood is the most important strategy for controlling the disease and saving lives”, said Dr. Tedros.

Mother-to-child transmission is responsible for the brunt of new HBV infections, and the virus claims nearly 900,000 lives each year. Boosting vaccine coverage is particularly important in WHO’s African Region, where HBV vaccine coverage at birth is ten times lower than the global average of 42%.

“For regions such as sub-Saharan Africa with low access to the vaccine, increasing coverage of a timely birth dose is the priority,” emphasized Doherty.

Some countries have successfully maintained essential services for other infectious diseases like measles despite the pandemic, suggesting the same could be done for HBV. Ethiopia, for instance, has successfully vaccinated almost 15 million children against measles during the pandemic, according to a report from WHO’s African region on Monday.

The HBV vaccine can protect against the virus in more than 95% of cases, and has been proven to be safe after nearly four decades of use.

WHO Issues New Hepatitis Guidelines To Prevent Mother-to-Newborn Transmission

On Monday, Dr. Tedros also called on countries to implement two new recommendations to prevent onward transmission of HBV from pregnant women to their newborns.

As part of the new guidance, pregnant women that are HBV-positive and present a high viral load can protect their newborns through preventive antiviral therapy from the 28th week of pregnancy until birth.

The antiviral of choice, tenofovir, only costs $3 per month in many regions of the world.

However, in settings where viral load testing is unavailable, women are encouraged to use the low-cost “HBeAg” antigen test to assess their infection status, recommends the WHO.

Battle Against Hepatitis C Continues Amidst High Medicines Costs and Barriers To Diagnosis
Meg Doherty, WHO’s Director of Global HIV, Hepatitis and STI Programmes

In recent years, so-called “direct acting antivirals” have also prevented thousands of deaths from hepatitis C (HCV) for as little as $60 in some regions, Meg Doherty, WHO’s Director of Global HIV, Hepatitis and STI Programmes, said on Monday. A typical treatment course on these drugs is twelve weeks.

However, these lifesaving drugs are still out of reach for many patients in high- and middle-income countries, where a twelve-week treatment course can even climb to $3000 given the absence of special licenses with generic companies to produce the drugs at a cheaper price, Doherty told Health Policy Watch.

“Not all countries will have access to the [cheaper] generics, though more and more countries have access now [over 105 countries] to some of the direct acting antivirals.”

She also added that without access to testing, “the medicines will remain out of reach”, as she referred to the fact that only 19% of HCV patients (13.1 million) are diagnosed with HCV, and only 7% of people with HCV (5 million) are treated for the disease, according to WHO data from 2017.

People waiting to receive free hepatitis C
testing during World Hepatitis Day 2016, Rwanda

Image Credits: WHO, Flickr: CDC Global, WHO, WHO.

Moderna, a frontrunner in the COVID-19 vaccine development race, today entered the final phase of testing required before pursuing regulatory approval, beginning the Phase III trial for their vaccine candidate mRNA-1273.

The trial, titled COVE (Coronavirus Efficacy), will measure how well a 100 microgram dose of the vaccine can protect people against developing symptomatic COVID-19 disease. It will enroll over 30,000 volunteers in the United States, and also measure how well the vaccine can prevent severe disease, and infection with SARS-CoV-2, the virus that causes COVID-19.

Moderna’s Phase III trial launch comes days after the biotech firm lost a key patent dispute last Thursday against Arbutus, a small Canadian company that holds rights to technology that delivers medical treatments via mRNA. The US Patent and Trademark Office ruled against Moderna’s claims that Arbutus’ patents were invalid. Moderna’s vaccine uses an mRNA vector to deliver the vaccine component.

So far, the dispute settlement seemed to have no effect in slowing down Moderna’s vaccine development. However, Arbutus could file for an injunction, which could block Moderna from selling the vaccine, or force the company to negotiate a license agreement that would require a portion of profits to go to Arbutus, according to STAT News.

But some patent experts think that governments are unlikely to let patent disputes hold up the vaccine’s market debut if trials are successful – particularly given the urgency of the coronavirus pandemic.

“If patent thickets present real delays in manufacturing, governments should, and I expect will, issue compulsory licenses and/or refuse injunctions,” James Love, director of patent watchdog Knowledge Ecology International, told Health Policy Watch. Compulsory licenses allow companies to override patent protections in select cases to scale up production of a medical product, or reduce competition to encourage lower prices.

Moderna claimed in a statement that the company “is not aware of any significant intellectual property impediments for any products we intend to commercialize, including mRNA-1273.”

Developed in collaboration by the United States National Institute of Allergies and Infectious Diseases (NIAID) and now supported in clinical trials by the United States Biomedical Advanced Research and Development Authority (BARDA), an arm of the US Department of Health and Human Services, Moderna’s vaccine candidate seems to have the solid backing of the US government.

Moderna Gets US $472 Million from BARDA For Late Stage Clinical Trials

Vaccine candidates use different mechanisms, shown above, to prompt the body to produce an immune response against SARS-CoV-2.

Moderna on Sunday announced a US $472 million infusion in funding from US BARDA for the mRNA1273 Phase III trial, bringing the total amount of funding Moderna has received from the US agency to US $955 million.

The biotech firm’s vaccine candidate is one of five to enter into final phase clinical trials, after being the first to publish early phase trial results in a peer-reviewed journal just two weeks ago. It is one of 25 vaccine candidates currently being tested in humans.

The COVID-19 vaccine rat race has been moving at record speed. Anthony Fauci, director of the US NIAID and America’s foremost trusted COVID-19 expert, described the rapid pace of vaccine development as “unprecedented” in a webinar hosted by the TB Alliance last week.

“We started a Phase I 62 days following the beginning of vaccine development. And many candidates, at least a handful more, will be going into phase three trials in the next several months, one of which will start at the end of this month,”  Fauci said at the webinar, referring to the Moderna trial. “That is unprecedented.”

Massive final Phase III trials will be critical in determining whether the vaccine candidate can actually protect against developing COVID-19 symptoms or infection by the novel coronavirus. While Phase I and Phase II results from many vaccine candidates have shown that the vaccines can induce an immune response in healthy volunteers and is safe to use, they are not large or robust enough to prove whether the vaccine can actually prevent infection.

Image Credits: Flickr: Marco Verch, US Government Accountability Office.

Elyne Kaingu, a 33-year old mother and her 2 -year old son Abdul. Elyne benefitted from IPTp treatment during her second pregnancy.

Kilifi County, Kenya – Elyne Kaingu, a 33-year old mother from the beautiful Mnarani area of Kilifi County, overlooking the Indian Ocean, was extremely wary during her first pregnancy about the silent killer in her midst – malaria.  She knew some other first time mothers had fallen ill with the disease, and had even lost their babies or had premature births.

“I had to be very careful, given the pain caused by the disease to first time mothers, which I had witnessed,” recounts the homemaker, who was born and raised in Kilifi.  

For example, she was aware of the complications that might arise from maternal aneamia attributable to malaria.

Kaingu therefore took extra precautions by seeking medical advice from the village antenatal care (ANC) clinic, “where I was given iron and folic acid tablets, that prevented anemia while helping the development of the baby,” she says.

She was one of the lucky first-time mothers who had a successful and safe birth.

When she became pregnant for a second time in 2018, she discovered something that allowed her to feel even more reassured.  

During a prenatal check at the Mafumbini Dispensary she heard about the fact that Intermittent preventive treatment of malaria in pregnancy (IPTp) could help protect mothers and their babies from malaria, and she decided to take the treatment. 

“For every [ANC] clinic visit, I was given the malaria medicine which had to be taken at the dispensary before leaving for home,” Kaingu said, recalling the trips she made from the second trimester onward. 

There are good reasons for requiring the treatment be done at the clinic, she says, explaining that since the medicine sometimes causes nausea, some women might not take it within the confines of their homes.  

Even so, she made sure to arrive at the clinic with a good meal in her stomach. “It was not advisable to take the medicine on an empty stomach, according to the advice of the clinicians,” she says, explaining this helped ward off possible nausea.

Intermittent preventive treatment in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in preventing maternal death and reducing maternal malaria episodes.

A minimum of three doses of sulfadoxine-pyrimethamine (SP) from the second trimester onwards has been shown to help prevent maternal malaria episodes, maternal and foetal anaemia, and related adverse outcomes like low birth weight and premature birth, according to the Geneva-based Medicines for Malaria Venture.  MMV is working with the World Health Organization, Roll Back Malaria and other partners to help ramp up IPTp treatment worldwide in the malaria-endemic zones at highest risk.  

About 31% of pregnant women that need IPTp treatment in Sub-Saharan Africa get at least two doses of the preventive medicine, according to WHO’s 2019 World Malaria Report. That is a big leap since 2010 when only about 2% of women received treatment, but still a long way to go in terms of ensuring full coverage.    

IPTp Offered in an Integrated Package of Services 

Integrating IPTp treatment with other services important to pregnant women has been one of the scale-up strategies stressed by MMV and others. 

In Kaingu’s case, the integrated approach was evident from the start – giving her extra motivation to return for more ANC care – and IPTp treatments. 

During her visits, for instance, she was provided with an insecticide-treated mosquito net: “Up until that time, I was using an ordinary, untreated mosquito net in my home.” 

Other benefits included being tested for breast cancer; advice on breastfeeding and on saving money specifically to meet the needs of the newborn baby.  Finally, there was the assurance that she could remain safe from malaria. 

“The treatment and the clinic visits have been beneficial to me and my baby, because I have never been attacked by malaria,” says Kaingu.

IPTp reduced malaria in pregnancy – even while Kilifi saw an overall rise in malaria cases
Malaria is still a concern in seaside Kilifi County, nestled by the Indian Ocean in southeast Kenya.

IPTp is one of the most widely used preventive interventions in this coastal region of Kenya as well as in Kenya’s Lake Victoria area – where malaria is endemic and incidence has even risen in recent years.

Expanding access to IPTp is the first objective of the six-phase Kenya Malaria Strategy adopted in 2019, which aims to help everyone in at-risk areas adopt appropriate measures to prevent malaria from the outset – as compared to only taking a curative approach.

Whereas some parts of Kenya have seen gradual declines in malaria incidence, heavy rains seen in the coastal area have led to a rising disease rate in some counties, such as Kilifi, where Kaingu lives. 

In 2018, there were an estimated 20-50 confirmed malaria cases, per 1,000 people, in Kilifi County, according to county malaria records. By 2019, that rate had doubled.  

Even so, malaria incidence among pregnant women in the rural area where Kaingu lives, actually declined over that same period, according to the records of the Kadzinuni Kendrick Dispensary, which serves her area. And the IPTp rollout has had a lot to do with that, in the opinion of Daniel Karisa, the clinical officer in charge of the Dispensary, which covers the northern rural part of Kilifi County. 

Daniel Karisa, a clinician at Kendrick Dispensary Kadzinuni in Kilifi, attending to a patient and his parent.

“There is a significant reduction of malaria cases among pregnant women even though there is an upsurge of malaria cases in the general population, during the rainy season,” Karisa said in an interview with Health Policy Watch. 

Some 200 pregnant women visited the dispensary for ANC treatment last year Karisa said in the interview, in which he constantly referred to the carefully kept dispensary records. Of those, only nine developed malaria in their second trimester and thereafter  – or 4.5% of pregnant women. The rate was 9% per cent on average before IPTp treatment was started.

Karisa believes that the integrated approach taken by the clinic to providing the treatment, in combination with bednets, advice about breastfeeding and breast cancer prevention, has   yielded other benefits. Out of their exposure to such issues, many women have developed better health-seeking behaviors. 

“IPTp is a big part of this change,” Karisa says.

Less Maternal Anaemia, Low-Weight Babies and Involuntary Abortions
Kendrick Dispensary Kadzinuni in Kilifi County on the Kenyan coast, where mothers receive IPTp treatment and other pregnancy-related care.

Karisa cites a long list of other benefits that he has observed, in terms of pregnancy outcomes: 

“There was reduced hospitalization resulting from severe maternal anaemia,” he asserts, referring again to the records. He notes that out of 100 mothers receiving IPTp, and reviewed during their ANC visits, only one was found to be severe anaemic. IPTp treatment helps prevent maternal anaemia by killing malaria parasites in the placenta. 

None of the babies born at the dispensary over the past year were low-birth weight (less than 1.5 kilograms).  Says Karisa: “Following the introduction of IPTp in the community, it is now rare to have low birth weight deliveries.”  

Finally, there has also been a reduced incidence of premature labour as well as a decline in involuntary abortions, he says, noting that the facility used to record an average of 4 cases of involuntary abortion per month for expectant mothers, before IPTp treatment was introduced. 

This year, between January and June, there was only a single case of miscarriage. This occurred among a total of 10 pregnant women who were found to be infected with malaria in their first trimester – when current forms of IPTp cannot be safely administered.  

“This is caused by the malaria parasites lodging inside the womb,” Karisa explains.

COVID-19 Slowed but Didn’t Stop IPTp Services  

In Kenya’s priority areas, IPTp coverage appears to already be slightly higher than it is Africa-wide. According to the Kenya Malaria Indicator Survey (KMIS) some 38 percent of pregnant women in the priority areas of Kilifi and Lake Victoria received IPTp treatment in 2015, the last year for which national data is available.

Based on observations at clinics such as Kadzinuni, the proportion of women being reached also seems to have increased further over the past five years. However, it will be some time before new national data is forthcoming, since the updated malaria survey that had been due to take place in 2020 has been pushed back to 2021, in light of the  COVID-19 pandemic. 

Indeed, coronavirus has been another new challenge that local health facilities have had to address – along with the unusually heavy rains, Karisa says. 

“The fear was that the new disease could severely handicap our ability to dispense malaria treatment to patients,” he explains.  “Fortunately this has not come to pass.”

Initially, in April and May, the number of mothers seeking ANC services dropped by about half, as COVID-19 cases started to spike nationwide.

While the clinic used to receive 100 individuals on average per day, the number dropped to between 50 and 60 in that period. As there was no lockdown in Kilifi, this was largely due to women’s fears of getting infected with the new disease.

“This however, is not to say that the services were interrupted per se; they were delayed,” Karisa says, noting that in June, numbers of women visiting the clinic rebounded  – even though COVID-19 cases began to climb sharply around the country.

Fortunately so far, COVID-19 case counts in Kilifi have also remained relatively low. On 19 July, for instance, six new COVID cases were recorded in the county, out of 603 cases nationally. 

Healthcare workers, like Daniel Karisa, are providing essential malaria care against the background of the COVID-19 pandemic and unusually heavy rains.

Against the uncertain landscape of the pandemic, the determination of health workers like Karisa to maintain routine health services, such as treatment for malaria in pregnancy, is good news to David Reddy, CEO of MMV.  

“As responding to COVID-19 will be a marathon, not a sprint, it is critical that prevention and treatment of leading killers such as malaria not be left behind,” Reddy told Health Policy Watch. “This is particularly the case in sub-Saharan Africa where the malaria disease burden remains so very high particularly among children and pregnant women. In that context, preservation and scale up of essential services such as those that prevent malaria in pregnancy remains critical.”

Malaria Remains a Major Burden to Communities
Elyne Kaingu, a 33-year old mother in Kilifi and her 2 -year old son Abdul.

And despite the progress seen recently on reducing malaria in pregnancy, the parasitic disease  remains a big burden, socially and economically, to communities in Kilifi County, Karisa underlines. 

As many as 40% of people visiting health facilities may receive a malaria diagnosis – at least in the rainy season.  And some people are discouraged from seeking treatment, because they have to travel such long distances to get to a clinic. 

Just like many mothers in her community, Kaingu also has been more wary of visiting the clinic for routine care for fear of COVID-19. “Honestly, I stopped going to the clinic, unless my child fell ill,” she says. 

However, she remains keenly aware of how important IPTp treatment is to pregnant women, even in the coronavirus period, and is actively encouraging other women to seek it. 

She now volunteers to mobilize women in her community whenever there is a health-related drive in her village.

She notes that malaria remains a huge concern, “especially at this time, when we are experiencing a lot of rains.” Mothers like her are particularly vigilant as spikes in early childhood mortality from malaria have been observed.  

In speaking out about the issues, Kaingu is also a model to other women – some of whom may still be fearful about getting treatment, but also fearful about speaking out about the risks.  Indeed, malaria in pregnancy remains a traumatic issue to talk about among women in Kilifi – as there are more than a few women who have suffered the tragic consequences. 

Kaingu says more action is still needed:

“Even though a lot of effort has been made in encouraging expectant women to visit health facilities and seek ANC services, I think more still need to be done to sensitize this population group in the community, on the importance of guarding against malaria in pregnancy.”

A view of the Indian Ocean in Kilifi County, Kenya.

Image Credits: HP-Watch/G Kamadi, Karel Prinsloo/Jhpiego.

COVID-19 responders receive training on how to don and doff protective equipment

Ibadan, Nigeria – As the number of health care worker infections continues to rise in Africa, Health Ministers are calling attention to increasing pressure on Africa’s health system – and the people running it.

Lack of personal protective equipment, adequate infection prevention protocols, and burnout have led to widespread dissatisfaction among doctors in recent weeks, culminating in health worker strikes in some countries.

Over 10,000 health workers across 40 countries in Africa have tested positive for COVID-19, representing about 2% of the continent’s total number of coronavirus cases, according to African Health Ministers and experts present at a World Health Organization press briefing on Thursday.

While globally, some 10% of all cases are among health workers, the large shortage of healthcare workers in Africa predating the pandemic has many experts and Health Ministers concerned. On average, most African countries have less than 1 physician per 1000 people, and less than 2 nurses or midwives per 1000 people, according to World Bank data.

And in four Sub-Saharan countries, health workers make up more than 10% of all infections.

In Gambia, 22% of individuals that tested positive for COVID-19 are health workers, according to the WHO African region’s 21st COVID-19 situation report published July 22. This is followed by Niger Republic, where health workers account for 16.6% of COVID-19 cases in the country. 

In Africa, WHO noted that there is limited information on health worker infections, but health workers make up more than 5% of cases in 14 countries in sub-Saharan Africa.

WHO described the increasing number of health workers infected with COVID-19 as a sign of the challenges that medical staff on the frontlines of the outbreak face. It added that some countries are approaching a critical number of infections that can place stress on health systems as the pandemic continues to wax stronger across the continent further exposing health workers to the virus.

“The growth we are seeing in COVID-19 cases in Africa is placing an ever-greater strain on health services across the continent,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This has very real consequences for the individuals who work in them, and there is no more sobering example of this than the rising number of health worker infections.”

Regional Director for WHO Africa Matshidiso Moeti

Aside from personal exposure to COVID-19, Moeti added that health workers are also afraid of taking the virus home, potentially exposing their family members to the pandemic. 

And the availability of personal protective equipment, and infection prevention and control measures were often inadequate and weak in many countries in Africa.

The agency added that health workers can also be exposed to patients who do not show signs of the disease and are in the health facilities for a range of other services. 

“Risks may also arise when health personnel are repurposed for COVID-19 response without adequate briefing, or because of heavy workloads which result in fatigue, burnout and possibly not fully applying the standard operating procedures,” WHO stated.

It is therefore not surprising that health workers in several African countries have expressed their dissatisfaction with a number of industrial actions, including strikes.

African Governments’ Limited Options – Sierra Leone’s Case

In Sierra Leone, three doctors, two community health workers and one nurse have died of COVID-19.

In all, about 10% of the country’s COVID-19 cases are among health workers. Moreover, a row between doctors and the country’s government over what doctors described as misuse of funds for the coronavirus response in the country and a lack of protection and compensation for health workers escalated into strike action early July. Even doctors treating patients with COVID-19 refused to continue working.

The country’s Medical and Dental Association said the government bought about 30 4×4 vehicles for managers from money intended for the fight against the virus rather than drugs and equipment.

But the country’s Minister of Health and Population, Dr Alpha Wurie acknowledged that healthcare workers in Sierra Leone were the first to be affected by COVID-19 while participating in a WHO press conference on Thursday.

Sierra Leone’s Minister of Health and Population Alpha Wurie

“It so happens that while COVID-19 treatment centers were in readiness and had enough PPEs, this was not so in the other hospitals,” Wurie said.

He also described how a doctor and several nurses at one of the country’s designated COVID-19 treatment centres, tested positive, resulting in the closure of the facility.

While admitting that the country has not become fully confident in the ways it is striving to prevent the spread of COVID-19, he countered that the case fatality management for COVID-19 has been satisfactory – compared with the outcomes of the country’s cycles of Ebola outbreak.

“The recovery rate for COVID-19 has been very good and the case fatality rate has been very low at 3.8%,” Wurie said.

Nurses Can’t Social Distance in Ghana

Dr. Jemima Dennis-Antwi, an Accra-based international maternal health and midwifery specialist, decried the paucity of published information on the true magnitude of health professionals’ infectivity which she described as an information that is highly guarded by countries.

Ghana has reported 2,035 cases of health workers infected with COVID-19. Some 91% fully recovered and there have been nine deaths which included four doctors, one nurse and three laboratory workers.

In addition to the use of PPEs, maintaining social distancing is another major COVID-19 prevention measure. But for several health workers, especially nurses, this is unrealistic.

“Nurses and midwives have the majority of infectivity – over 410 nurses and midwives have been affected in Ghana in the line of duty. This is because we are designated to serve our patients 24/7,” Antwi said.

Jemima Dennis-Antwi, an Accra-based international maternal health and midwifery specialist

Increasing exposure of health workers to COVID-19 without adequate provision of PPEs has led to health workers refusing to attend to patients, causing psychological stress to self and families, and constant threat of legal action. She noted that the implication of the development has impacts on a wide array of health issues other COVID-19 and other infectious diseases.

“This has serious implications for quality care, especially reproductive, maternal, newborn, child and adolescent care,” she said.

While calling for urgent action to keep Africa’s health professionals alive to provide the care they are trained to give, Antwi added that health workers on their part also needs to be more proactive and take actions that would boost their immune systems and will also clear respiratory pathways which is the major route of entry for COVID-19.

Tracking & Adjusting to Realities in Burkina Faso

Moeti also admitted that more needs to be done to reveal the true status of the pandemic among the continent’s health workers and to guide the enactment of appropriate policies.

“We are looking at improving the collection of data on health workers so that we can determine the extent of infection at work, and to inform the health workers on how to limit transmission at home,” she said.

In Burkina Faso for example, 8.5% of confirmed cases of COVID-19 are from health workers. While admitting that health professionals in the country are exposed to the pandemic, Dr Léonie Claudine Lougue, Minister of Health of Burkina Faso said the country has introduced a surveillance measure to screen its health workforce for COVID-19.

Léonie Claudine Lougue, Minister of Health of Burkina Faso

But a bigger problem still exists, persisting even as African countries continue to deal with COVID-19 – it is the limited capacity of the continent’s health institutions. 

WHO stated that in many African countries, infection prevention and control measures aimed at preventing infections in health facilities are still not fully implemented. 

“When WHO assessed clinics and hospitals across the continent for these measures, only 16% of the nearly 30 000 facilities surveyed had assessment scores above 75%. Many health centres were found to lack the infrastructure necessary to implement key infection prevention measures, or to prevent overcrowding. Only 7.8% (2213) had isolation capacities and just a third had the capacity to triage patients,” WHO stated.

Wurie however expressed optimism noting that in spite of the weak health systems across the continent, health workers will still be able to handle the pressure and threats from COVID-19 considering the case fatality ratio is rapidly reducing as the number of confirmed cases continues to rise.

“For people that may be infected, most of them are asymptomatic. The confidence of each country in being to manage the pandemic is getting better and the more we provide psychosocial support services for our health workers, the more their confidence also develops,” Wurie said.

 

Image Credits: WHO AFRO, HP-Watch/P Adepoju.


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Mangroves under threat in India

Three of India’s leading environmental websites, including Fridays For Future – India, part of the climate youth movement founded by Sweden’s Greta Thunberg, were blocked this week by Delhi police – after they protested a pending revision in the country’s environmental rules that would pave the way for polluting industries to mount projects without public hearings or appeals.

Late Thursday evening, the Indian police withdrew some of their initial allegations that the Fridays for Future group violated anti-terror laws, eventually allowing it and a second site, LetIndiaBreathe, to resume operations.  But a third Indian environmental site, There Is No Earth B, remained in a blackout Friday evening, even though it had never received any police warning. Meanwhile, environmental advocates expressed worries about the wider implications of the media censorship.

“Government muzzles young environmental voices in India,” said Greta Thunberg Thursday in a retweeted post by India’s Fridays For Future (FFF), protesting the crackdown. “Youth environmental movement @FFFIndia slapped with bizarre allegations by authorities &silenced by digital censorship for facilitating ‘too many emails’ to the MOEFCC.”

The saga began in early July, when Fridays For Future’s internet service provider was sent notices by New Delhi’s Cyber Crime division after the environmental activist group had posted stories and launched email campaigns protesting the hotly debated revisions in the country’s Environmental Impact Assessment (EIA), which would limit or even cancel opportunities for the public to review and object to new industrial projects potentially harmful to health and the environment.  On the other hand, There Is No Earth B, never received a notice in the first place, organizers told Health Policy Watch.

India’s Revisions In EIA Follow Plans For Massive Coal Mining Expansion

The proposed loosening of EIA rules comes as India faces mounting criticism for fueling its post-pandemic recovery with dirty energy by auctioning off 41 Indian coal mines to private investors for the first time ever, in moves announced last month.

Observers called it a significant repression of media freedoms in one of the world’s largest democracies. They said it has been orchestrated by the powerful Minister of Industry, Prakash Javadekar, who is also Minister of Environment as well as the Minister of Public Information and Broadcasting.

They said the new rules would open the way for mining and industrial projects to pour even more pollution into India’s chronically dirty skies and rivers in a country where air pollution killed some 1.2 million people a year in 2017, according to a study in The Lancet, and reduces life expectancy by an average 2.6 years, according to India’s Center for Science and Environment.  

“The draft of the new EIA dilutes several environmental norms which allow for faster environmental clearances bypassing existing safeguards”, Jyoti Pande Lavakare, an environmental journalist and founder of the Delhi-based NGO Care for Air, told Health Policy Watch. She also added that it eases environmental clearance and expands the list of projects exempted from publications or clearances altogether.

Jyoti Pande Lavakare, New Delhi based independent journalist and co-founder of Indian non-profit Care for Air

Industry, Environment and Media Portfolios Concentrated in Hands of One Minister

She attributed the media crackdown to the concentration of industry, environment and media portfolio into the hands of just one minister. 

“The Environment minister is the same as the heavy industries minister, who is the same as the information and broadcasting minister – one man – Prakash Javadekar,” said Pande Lavakare. “So there is a direct conflict here. As industry minister, he wants faster approvals for projects especially now when India is staring at a recession. As information and broadcasting minister, media is afraid to call him out on the environmental front.”

“Unlawful Activities” & “Terrorist Acts” 

In early July, New Delhi’s Deputy Commissioner of Police Anyesh Roy urged FFF’s internet service provider – Endurance Domains Technology LLP – to block the website for its “unlawful activities’:

“The above website [FFF] depicts objectionable contents and unlawful activities or terrorist acts, which are dangerous for the peace, tranquility and sovereignty of India.”

“It is requested that you may take necessary action [block FFF’s website] in this regard and send us a report immediately.”

Said India’s FFF branch in response to the crackdown: “Our movement is based on peaceful protests…It’s a shock to know that our dissent has been reduced to ‘being illegal’ with our site being censored.”

Others added that civil society is “simply carrying out its duty” to compensate for the government’s failure to protect its citizens.

“The Indian Constitution’s Article 51-A (g), says that ‘It shall be duty of every citizen of India to protect and improve the natural environment’ including forests, lakes, rivers & wild life & to have compassion for living creatures.”

“The authorities have repeatedly failed and it’s imperative now that we hold them accountable and demand action”, said There Is No Earth B.

This story was modified on July 24 as two of the websites were partiallly restored, though it is stll unclear whether the website of ThereIsNoEarthB is back online, according to Indian reporting agency Newslaundry.

Image Credits: There Is No Earth B / Sanjay Vann, Twitter: @FFFIndia, Jyoti Pande Lavakare, Fridays For Future.

Dr Tedros responds to US Secretary of State allegations that WHO made a deal with China.

In the strongest and most direct rebuttal yet to United States’ allegations of misconduct by the World Health Organization, WHO Director-General Dr Tedros Adhanom Ghebreyesus emphatically told reporters on Thursday that claims that he was ‘bought off’ by China are “untrue, without any foundation, and unacceptable.”

Dr Tedros called the allegations a “distraction,” saying politicization of the pandemic would hinder the response.

“Our sole focus is on saving lives. WHO will not be distracted by these comments, and we don’t want the entire international community to also be distracted,” Dr Tedros emphasized. “One of the greatest threats we face continues to be the politicization of the pandemic. COVID-19 does not respect borders, ideologies, or political parties.

“I have said it many times – COVID politics should be quarantined. Politics and partisanship have made things worse.”

Other members of WHO’s core COVID-19 response team, including COVID-19 Technical Lead Maria Van Kerkhove, who is an American citizen, echoed Dr Tedros’ response.

“I feel the need to say something as an American and as a proud WHO employee,”  said Van Kerkhove. “I see firsthand, every day, the work that Dr Tedros, Mike and our teams do all over the world. We are firmly focused on saving lives, we will not be distracted.”

WHO Health Emergencies Executive Director Mike Ryan said that it was important to maintain morale of “front-line workers” at the WHO and around the world. He added that while the the agency had room for growth, Dr Tedros’ leadership had been essential in catalyzing a “transformation in the organization.”

“Many of us have worked 20 hours a day, seven days a week for the past seven months,” said Ryan. “We have for years, sent our people in harm’s way every day. Many of us have spent months and years on the front line, risking our lives, worrying our families.

“None of us are perfect. But we all serve to save lives… We have benefited from [Dr Tedros’] leadership and from a transformation in the organization [that I thought would never come], and I can say this as someone who has spent a quarter of a century associated with this organization.”

WHO Team Growing Weary Of Repeated US Attacks

The WHO team was responding to reports of US Secretary of State Mike Pompeo’s claim that China had ‘bought-off’ Dr Tedros, helping him secure the 2017 election as WHO’s Director-General. The alleged deal led to WHO missteps in handling the pandemic, contributing to “dead Britons,” Pompeo was quoted as saying in The Telegraph while in London on Tuesday. The US Secretary of State reportedly made his remarks in a closed door meeting with British Members of Parliament on Tuesday, according to unnamed sources.

The strong response from the WHO reflected the agency’s growing weariness with US claims attacking WHO’s handling of the coronavirus crisis.

In March, the Trump administration threatened to withhold funding from the WHO, claiming that the Organization had yielded to pressure from China to downplay the virus’ seriousness. The ensuing back and forth led to Trump notifying the United Nations and Congress in early July that he was beginning the process to officially withdraw the US from the agency by July 2021.

Dr Tedros’ comments calling the US’ allegations “distracting” echoed comments from critics who have accused the Trump administration of using WHO as a scapegoat for the US’ own botched coronavirus response.

With nearly 4 million cumulative cases and more than 140,000 deaths, the United States has the highest coronavirus burden in the world, and the number of new cases reported daily is rapidly rising. Still, the administration has been pushing for states to reopen, resisted passing a national masking mandate, and encouraged schools to resume in-person learning in the fall, countering advice from their own public health experts.

Cumulative cases of COVID-19 around the world and COVID-19 deaths in the United States (top left) as of 8:00PM CET 23 July 2020, Numbers change rapidly.

 

Image Credits: Johns Hopkins CSSE.

COVID-19 is on it’s way to becoming the deadliest infectious disease in the world this year, and could cause more deaths worldwide than the current deadliest infectious disease killer tuberculosis.

Currently tuberculosis, one of humankind’s oldest known infectious diseases, takes the lives of some 1.8 million people per year.

Global Deaths Due to Various Causes & COVID-19 – by Tony Nickonchuk. Tuberculosis deaths are not included.

However, Wednesday marked a gain in the fight against TB. Pretomanid, only the third antibiotic to be approved for treating the disease in nearly half a century, was on Wednesday approved for use in India, which has the highest TB burden in the world. The oral drug has a 90% cure rate when used correctly to treat multi-drug resistant TB, according to peer-reviewed studies published by the TB Alliance, who developed pretomanid.

Meanwhile, COVID-19 has killed over 600,000 people since the beginning of the pandemic, already surpassing the number of deaths caused by HIV/AIDS, suicide, and malaria. But experts at a virtual event hosted by the TB Alliance on Wednesday warned that steadily growing outbreaks in hotspots like the United States, Latin America, South Asia, and Africa could lead to a death count higher than that of tuberculosis.

“Tragically COVID-19, which didn’t exist a year ago, may be in a position to match or surpass tuberculosis as the infectious killer this year,” warned Ariel Pablos-Mendez, a founding board member of the TB Alliance. 

“I don’t mean to be melodramatic about it, but it is really, as an infectious diseases person, a public health person, almost your worst nightmare. It’s almost the perfect storm,”  said Anthony Fauci, director of the US National Institute of Allergies and Infectious Diseases. Fauci has become a household name in recent months, emerging as the preeminent expert voice on COVID-19 in the United States, many times countering messages put out by the Trump administration downplaying the seriousness of the virus.

COVID-19 is the “Perfect Storm” – And It’s Not Going Away Anytime Soon
Subway workers in New York City hand out masks to commuters. Even those who don’t show symptoms of COVID-19 can spread the disease if they were infected.

The novel coronavirus has a number of characteristics that make it “particularly formidable,” said Fauci. It causes a wide range of disease severity, and is easily spread between humans.

SARS-CoV-2, the virus that causes COVID-19, has the ability to jump from animals to humans, and is easily spread from one person to the next as a respiratory-borne virus.

Some 20-45% of infected people may never show symptoms. But people without symptoms are still able to pass the disease onwards, although it’s unclear how much of COVID-19’s spread can be contributed to asymptomatic transmission.

“It is spectacularly efficient in spreading from human to human,”  said Fauci. “I don’t see this disappearing the way that SARS1, [the virus that sickened over 8000 in a 2002-2003 epidemic], did. I don’t really see us eradicating it.”

Additionally, the virus causes anywhere from non-existent to critical disease, hitting large swathes of the population like older people and those with common preexisting conditions particularly hard.

“I have never seen an infection in which you have such a broad range of [disease severity],”  said Fauci. “[You have] literally nothing – no symptoms at all – in a substantial proportion of the [infected] population, to some who get ill with minor symptoms, to some who get ill enough to be in bed for week and have post-viral syndromes, to others who get hospitalized, require oxygen intensive care, ventilation, and face death.”

Still, Fauci remained cautiously hopeful.

“I think with the combination of good public health measures, a degree of global herd immunity, and a good vaccine, which I do feel cautiously optimistic we will get, we will get very good control of this,” he said. “Whether it’s this year, or next year I’m not certain. But I think ultimately… we will bring it down to such a low level that we will not be in the position that we’re in right now for an extended period of time.”

Image Credits: Marc A. Hermann / MTA New York City Transit.