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

As reports of COVID-19 patients presenting with cardiovascular symptoms continue to surface, World Health Organization experts say more research is needed to understand all of the clinical presentations of the new disease. Still, they underlined that the new coronavirus primarily causes respiratory disease.

“It is clear that in a proportion of patients, [COVID-19] is causing a broader inflammatory response, either within the vascular system – that’s the blood carrying system – or in other parts of the body,” said WHO Executive Director of Health Emergencies Mike Ryan. “But when we look at COVID-19, we need to see that obviously as a respiratory disease that’s spread by a respiratory route. It causes a respiratory syndrome.””

Ryan’s comments come just days after The Lancet published a correspondence describing eight young COVID-19 patients who had presented with symptoms similar to Kawasaki’s disease – a pediatric heart condition caused by swelling of the blood vessels. Just a day before, New York City health officials had released an official notice describing 15 similar cases among children 2 to 15 years old, ten of whom were previously exposed to COVID-19. Many of the patients did not present with significant respiratory symptoms. 

WHO COVID-19 Technical Lead Maria Van Kerkhove again attempted to reassure parents that the syndrome was still rare, and added that WHO would be rolling out a new form tailored specifically to collecting information on the ‘Kawasaki-like’ illness. 

But so far, it seems like COVID-19 still primarily causes a respiratory illness. Data from rare reports of the virus attacking other parts of the body must be collected systematically in order to determine how frequently these syndromes occur, or whether they are associated with COVID-19 at all.

“Very often with new emerging diseases, they don’t always have just one target organ. They tend to cause a much more disseminated disease that may affect multiple organs,” explained Ryan. “We’ve also seen reports of encephalitis or swelling or inflammation of the brain. We’ve seen other reports of other effects of the disease.” 

“We’re at the very early stages of understanding how this virus affects the body, and how disease progresses,” added Van Kerkhove. “I have to remind myself that we’re in month five of this pandemic.”

So far, over 10,000 detailed case reports of COVID-19 patients have been collected using a standardized form co-designed by WHO and the International Severe Acute Respiratory Infection Consortium (ISARIC). Individual hospitals are also collecting data on different clinical presentations of COVID-19, which is how the ‘Kawasaki-like’ illness in pediatric COVID-19 patients was first identified. But WHO is “hoping that more and more case records can be obtained so that we could better understand this [disease],” said Van Kerkhove.

Switzerland Will Deploy Official Contact Tracing Application Alongside ‘Old-Fashioned’ Contact Tracing; WHO Emphasizes Finding Active COVID-19 Cases Over Monitoring Virus In Wastewater

Meanwhile, in Switzerland, Swiss Parliament adopted a motion to use a contact tracing application in synergy with classical contact tracing, said Swiss Federal Council Alain Berset at a press conference today. The application will be tested in the next few weeks, before being deployed widely. Switzerland has reported 80 new cases over the pas 24 hours, and 30 207 total cases so far according to the Swiss Federal Office of Public Health.

In Switzerland, the situation is ‘evolving favorably’ and current measures will be further softened on Monday to open schools and libraries, said Berset. Although Switzerland can be “optimistic” right now as the outbreak calms down, Berset urged citizens to  remain ‘prudent’ and ‘pragmatic’ – “The virus is still here,” he warned. Physical distancing measures must be respected and vulnerable populations need to be considered, he said. 

Switzerland’s focus on contact tracing in its reopening strategy aligns with WHO recommendations that countries ramp up capacity to detect, isolate, and treat every case as countries gradually lift lockdown measures. Early detection and isolation of contacts is crucial, as it can prevent people from transmitting the virus before they themselves present with symptoms.

WHO is also exploring other ways of monitoring COVID-19 – including testing for COVID-19 antibodies, or monitoring wastewater for the presence of the virus. Fragments of SARS-CoV-2, the virus that causes COVID-19, have been detected in wastewater, no live or infectious virus has been found in any samples so far.

But while environmental monitoring or antibody testing are important for “understanding the long term trajectory of the pandemic,” countries must not neglect core public health strategies, said Mike Ryan.

“We seem to be avoiding the uncomfortable reality that we need to get back to public health surveillance. We need to go back to where we should have been; finding cases, tracking cases and contacts, testing cases, and isolating people who have tested positive,” said Ryan.

Total cases of COVID-19 as of 7:32PM CET 8 May 2020, with active case distribution globally. Numbers change rapidly.

280 Rohingya Refugees Quarantined Offshore Bangladesh ‘As Precaution’; UN appeals for US$ 6.7 billion To Support Vulnerable Populations

Some 280 Muslim-majority Rohingya refugees were precautionarily quarantined off the coast of Bangladesh on the Bhasan Char island due to fear of coronavirus spread – a move that sparked criticism by Human Rights Watch. Bangladesh is South East Asia’s second fastest growing pandemic hotspot after India, with over 13 000 cases and almost 800 new cases in the past 24 hours.

“Bangladesh faces the tremendous challenge of assisting Rohingya boat people while preventing the spread of Covid-19, but sending them to a dangerously flood-prone island without adequate health care is hardly the solution,” said Brad Adams, Asia director of Human Rights Watch. “Any quarantines need to ensure aid agency access and safety from storms, and a prompt return to their families on the mainland.”

Last weekend, a smaller boat with 29 Rohingya refugees was also taken to Bhasan Char island.

There are approximately 1 million Rohingya refugees in Bangladesh, most of whom are based in the Capital’s Cox Bazar. 

The UN appealed for US$ 6.7 billion to fund an updated plan for responding to the COVID-19 pandemic in 63 of world’s most fragile countries, many of which are hosting refugees, the UNHCR said in a statement released Wednesday. The UNHCR called on countries to support vulnerable populations – with explicit reference to the Rohingya. 

“We call on States in the region to uphold the commitments of the 2016 Bali Declaration as well as ASEAN pledges to protect the most vulnerable and to leave no one behind. Not doing so may jeopardize thousands of lives of smuggled or trafficked persons, including the hundreds of Rohingya currently at sea.”

Despite the UN’s call on South East Asian countries to allow vulnerable populations to land on their coasts, South East Asian nations have not followed.

Meanwhile, neighboring India’s Asian Infrastructure Investment Bank (AIIB) signed a $500 million “COVID-19 Emergency Response & Health System Preparedness Project” on Friday to help respond to the pandemic and strengthen public health preparedness. India has over 64% of South East Asia’s cases, with almost 54 000 total confirmed cases and 3561 new cases reported over the past 24 hours.

South Africa Releases 20 000 Prisoners From Jails And Facilitates Movement Of Civilians Through New Amendment

To curb the spread of COVID-19 in jails, South Africa released nearly 20,000 prisoners on Friday, announced South African President Cyril Ramaphosa.

Some 45% of Africa’s 35 470 cases are in South Africa, Algeria and Nigeria, and almost 50% of new cases in the past 24 hours were reported in these three countries.

South Africa will also allow individuals and businesses to move premises across the country, including citizens who were not able to do so due to the lockdown, said a statement from the South African government from Thursday. 

Zixuan Yang contributed this story.

Image Credits: NIAID-RML, Johns Hopkins CSSE.

The World Health Assembly in Geneva, Switzerland.

As the 73rd World Health Assembly approaches, the European Union-sponsored draft resolution on the COVID-19 response is gathering steam and storm as it rolls closer to the planned opening of the Assembly on 18 May – with far less clarity about how it might actually hit the shores of the public debate. 

The resolution aims to show unity in the face of a global pandemic – ensuring more equitable access for existing diagnostics and medical equipment as well as potential treatments. But hidden in the layers of diplomatic doublespeak are also multiple nuances, as well as minefields, that could befoul the whole negotiations. 

Strikingly, the resolution also aims to address obvious weaknesses in the international pandemic response frameworks, and address criticism of the World Health Organization’s own response, by calling for an “independent evaluation…to review lessons learnt” about the WHO-coordinated response, as well as the “effectiveness” of mechanisms at its disposal – namely the 2005 International Health Regulations. 

The proposal for independent evaluation apparently has wide support. Although it remains to be seen if such a review can be undertaken in a way that satisfies very different blocs and political agendas – including the United States, which has been bitterly critical of WHO, and European countries that would likely see a stronger international order emerge.

But some observers, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have said that such an investigation should be postponed until after the pandemic wanes.  

“When we emerge from this global crisis, it will be important to look back and build upon the lessons learned from multi-stakeholder collaboration around COVID-19 in order to strengthen future pandemic preparedness and truly enhance global health security,” Thomas Cueni, IFPMA Director-General told Health Policy Watch. “But for now, the most important thing to do is to knuckle down and tackle what is potentially one of the biggest public health, social and economic crisis we have faced in 100 years. 

“Coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency. Multilateral organizations such as the World Health Organization (WHO) have an important role to play in these global efforts and in supporting the most vulnerable populations. International cooperation is critical to maintain global supply chains, to avoid shortages and to ensure effective surveillance mechanisms.”  

In terms of the mechanics of response, the key debate here for medicines access advocates is whether the resolution can really ensure more equitable distribution of COVID-19 treatments. For that to happen, they argue that there needs to be an explicit reference to existing “TRIPS flexibilities” – the legal World Trade Organization framework that allows countries to legally override patent laws when a clear national health interest is at stake. Right now, the text makes only general reference to this: “using fully the provisions of international legal treaties.”  

However, there could be new blocs of allies and opponents forming around the access issue – which traditionally divided roughly along lines of global north and south. 

Recently, for instance, the United States moved to issue an emergency use authorization for remdesivir, the drug produced by Gilead Sciences that has shown some initial efficacy against the SARS-CoV-2 virus that causes COVID-19. That has led to worries in European circles that an “America-first” approach could cut off access to the drug – including in other high-income European countries that have also been at the virus epidemic. As for the ins- and outs of the debate, Health Policy Watch interviewed half a dozen observers of the negotiations; to see what else they had to say. 

Explicit Reference To IP “Flexibilities” In WHA Draft Resolution: A Hot Topic For Debate 

The May 4 draft resolution has called for “equitable access to and fair distribution to all countries” to COVID-19 technologies, “including through using fully the provisions of international treaties…. Required in the response to the COVID-19 pandemic.”

However, these drafts, and even alternative language so far proposed, makes no specific reference to the foundational World Trade Organization treaty and agreements enabling intellectual property barriers to be temporarily lifted under emergency conditions. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) saw IP flexibilities for public health needs further affirmed by the 2001 Doha Declaration on the TRIPS Agreement and Public Health. 

Lack of reference to TRIPS flexibilities is “strange” because “it ignores a great deal of history and the global efforts that were needed to facilitate equitable access to health technologies, products and services” like vaccines or PPE, said Frederick Abbott, Professor of International Law at Florida State University. 

K.M. Gopakumar, Legal Advisor for the Third World Network (TWN).

The draft resolution’s silence is a “double standard” given that some EU members have already taken steps to make use of TRIPS flexibilities, said Legal Advisor for the Third World Network (TWN) K.M Gopakumar.

He referred to recent instances when the European Commission reportedly pressured Roche Pharmaceuticals to disclose the critical recipe for a reagent in a patented diagnostic. Germany has meanwhile amended its patent law to fast-track the issuing of compulsory licenses to override patents on health products, should there be a need. Other countries to have taken similar steps include Israel, Canada, Indonesia, Chile, Colombia and Ecuador.

The silence of the EU-sponsored resolution could nonetheless be explained by the region’s strong pharma industry base, he added. 

Some advocates have pointed their finger squarely at the Member State diplomats engaged in the WHA negotiations as failing to pick up the gauntlet – despite the fact that the international community affirmed the use of such measures through the WTO Doha agreement nearly two decades ago. 

“Member state diplomats who are negotiating at the WHA need to step up to the plate,” said Thiru Balasubramaniam, Knowledge Ecology International’s Geneva representative.

“19 years later after Doha, it is disheartening that WHO delegates tasked with the mandate to protect public health cannot muster the courage to make explicit references [in the draft resolution] to TRIPS public health safeguards amidst a pandemic.”

Even so, negotiations are still ongoing – and a reference to TRIPS may yet appear in later drafts, said Jaume Vidal, Senior Policy Advisor of Health Action International. 

Intellectual Property Rights May Not Be The Issue – Compulsory Licences Could Be Innovation Barrier

Thomas Cueni, director general of the IFPMA

There are also concerns, however, that opening the floodgates to a practice of very widespread compulsory licensing could upend the status quo of patent-driven R&D, at a critical moment when private investment in research is needed now, more than ever – alongside the public sector grants and donations.

In an interview with Health Policy Watch, Francis Gurry, Director General of The World Intellectual Property Organization (WIPO) pointedly noted that patent rights is not the main barrier accessing treatments right now; in fact the main barrier is the lack of treatments, for which private sector investment is important.   

Those sentiments are echoed by IFPMA’s Cueni, who has been highly supportive of recent UN and global moves to expand public funding for drug development and ensure broad access; “IP is not a hindrance to developing COVID-19 treatments or vaccines, indeed quite the opposite,” Cueni said. “The main policy challenge is to encourage the innovation that may lead to COVID-19 vaccines, treatments and cures, as well as innovation that assists in managing the coronavirus crisis.”  

Added Cueni, “There is no evidence that IP has been or will be an impediment to the research, development and testing of potential COVID-19 treatments and vaccines or to the many research partnerships underway between companies and institutions around the world.

“We can only overcome this through a coordinated, inclusive, and multi-stakeholder response,” he added.  Referring to a recent UN General Assembly resolution on COVID-19 response, which received broad industry blessing, he said, “We hope WHO member states will be able to build on this momentum and approve a truly inclusive text that recognizes that the expertise of the private sector is central in fighting this pandemic.”

Managing Director of Vital Transformation, Duane Schulthess

Lifting intellectual property protections could have long-term repercussions on innovation, warns Duane Schulthess, a health consultant and Managing Director of the Belgium-based consultancy firm, Vital Transformation.

Compulsory licenses will make it “hugely expensive and risky to produce at scale for any commercial enterprise,” said Shutlthess, who works with both public and private sectors in Europe.  

“As an investor and consultant to many international biotech firms and biopharma supporting governments, I think that a compulsory license is a REALLY bad idea in this case.” 

Issuing compulsory licenses for new therapies that are typically more costly to development, such as vaccines or monoclonal antibody treatments “may seem like a good idea in the short-term”, but would become “a huge barrier against anyone taking on risk for vaccine or monoclonal antibody development.” 

Given the high safety standards required for vaccines, as well as debate over the actual fatality rate for COVID-19, any company willing to invest “multiples of billions of Euros” to develop and manufacture a vaccine or monoclonal antidote at scale will be “extremely concerned.”

“The up-front costs of development will be astronomical due to the need to simultaneously invest in manufacturing capacity”, as well as the need for high safety standards, he said. 

Voluntary Patent Pools Offer A Third Way – But Some Not So Sure It will Work 

There has been widespread support by countries, as well as by WHO, for a voluntary “patent pool” – whereby industry would offer licenses to other countries to manufacture their products. 

This would build upon the successful model of the Medicines Patents Pool, which has succeeded in bringing affordable treatments for HIV/AIDS and Hepatitis C to billions in Africa and elsewhere. 

Indeed, the most recent drafts of the EU resolution call for member states to “work collaboratively at all levels, including through existing mechanisms, for voluntary pooling of patents, and licensing of medicines and vaccines to facilitate equitable and affordable access (OP 7.2).”  

But not everyone is convinced such schemes will really work for the challenges posed by COVID-19. 

Michelle Childs, Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDI)

“We need to hope for the best and prepare for the worst,” said Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDi) Michelle Childs. 

“Everyone would prefer if there were no intellectual property barriers and for innovators to waive their rights through a voluntary patent pool, but we need to have all tools in our toolbox just in case that doesn’t happen. Countries should have all options available to them, such as compulsory licensing.” 

Said Vidal, “the patent pool is a unique mechanism to operationalise voluntary licensing. Within its constraints, it is an effective instrument to improve access conditions. It is not, and was not, designed to be a remedy for the anticompetitive practices of patent holders, nor can it compensate the excesses of monopolies worldwide. Support for the Medicines Patent Pool does not invalidate the need to promote a widespread and intensive use of Compulsory Licensing, beyond COVID-19.” 

Already during the COVID-19 pandemic, the world has observed some countries halting export of certain drugs or personal protective equipment (PPE) so as to insure domestic supplies, other observers note. 

The irony is that while past outbreaks or pandemics have seen northern countries pitted against the south, here the fault lines may shape up around the Atlantic – between the United States and European countries nervous that they might not get access to new therapies such as remdesivir, developed or manufactured elsewhere, other observers note.  

“We need to deal with equitable access issues in advance – when push comes to shove, people end up panicking, and we’ve seen countries hoard things like PPE,” said one source. 

Prioritizing Access – Will Health Workers, Older People & Those With Pre-existing Conditions Really Come First? 

Iranian healthcare workers in personal protective equipment

Presuming that some international mechanism is created, voluntary or compulsory, to ensure widespread access to new treatments or vaccines – agreement on what groups might be prioritized will be another minefield in any process. Most experts would agree that in the case of COVID-19, healthcare workers, older people and those with pre-existing conditions are those most in need of any forthcoming treatments and vaccines. 

But while the preamble (PP11) of the draft resolution emphasizes the need to protect key populations like ‘people with pre-existing conditions…older persons and healthcare professionals,” there is no explicit reference to those groups as priorities for being the first to receive new drugs or interventions in the operative sections of the draft. 

Rather, there is a general call for governments to: “Put in place…measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization.”

Even that language may somehow become tied up in traditional disputes over a) sanctions, such as those currently applied by the US against Iran and b) language that refers to sexual and reproductive rights in the healthcare context – something that has been hotly opposed by the US administration in recent years due to fears that it could be somehow interpreted as legitimizing abortion.  

And…. Even if a Resolution is Passed – Enforcement Will Be A Challenge  

A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo with PPE and diagnostics supplies

Even if widespread access to treatment by the groups most in need was enshrined in the final WHA resolution – enforcing such provisions would be another matter altogether. 

International agreements are critical, but they are insufficient if they are not enforced, sources underlined to Health Policy Watch.

“It’s not just about intellectual property… we need international agreements about how drugs and other technologies will be used,” said the source.

“We’ve seen very good statements about what countries want to achieve but they need to follow that…They’re trying to outsource some of [access] questions to initiatives like WHO’s Access to COVID-19 Tools (ACT) Accelerator (ACT). There are no easy answers…

“We cannot leave this to the [international] agencies. Countries have to do this work themselves and follow what they have publicly committed to do.” 

Equitable access will also depend on a range of other factors, as well, including scaling up manufacturing capabilities and securing supply mechanisms within health systems, said Vidal.

An Investigation of The WHO’s Handling of COVID-19 Is Important –  But Not Right Now

Frederick Abbott, Professor of International Law at Florida State University.

Regarding the independent examination of investigation of COVID-19 management, there appears to be agreement across the classic fault lines of industry, academia and civil society that the timing is not right for this now. 

Says Abbott: “Conducting a review as soon as possible is likely to be a drain on internal WHO resources that are vitally needed to coordinate the global response. There are external political pressures underlying the demand for immediate initiation of a review, and this exacerbates the risks of politicizing the endeavor.” 

It will also be vital to assure the objective integrity of the review process and not to succumb to external politics that have pressured the review to be undertaken as soon as possible, said Abott.

A review of the WHO’s efforts will be important after we emerge from this global crisis, underlines Cueni, which has also publicly backed the WHO co-sponsored Access to Covid-19 Tools Accelerator that just raised nearly US$ 7.4 billion this week for drug research, manufacture and distribution. However, the “most important thing to do” right know is is to “knuckle down and tackle” the crisis.

While accountability is good for transparency and governance within international organisations, the WHO ‘cannot be a chip in a power game’ between certain Member States, says Vidal. And he adds, suggestively, that WHO is not the only entity that should be examined:  

“When we scrutinise WHO handling of the pandemic we should also look into the actions (or indeed inaction) of some Member States, experts and political figures.”

Senior Policy Advisor of Health Action International Jaume Vidal

Image Credits: WHO, K.M Gopakumar, IFPMA , Duane Schulthess, Michelle Childs, Twitter: @WHOEMRO, Matshidiso Moeti, Health Policy International.

Matshidiso Moeti, WHO Regional Director for Africa at regular press conference

Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study  by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday.

The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support.

African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people.

Africa – The Continent With The Lowest Hospital Bed Capacity In The World

Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: 

“While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.”

“Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.”

The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables.

In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries.

 

Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records .

icipe scientists study malaria in Kenya

A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. 

This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. 

“Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.”

Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito.

Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite.

Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected.

The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease.

The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. 

Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities.

There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. 

Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow.

A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. 

The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. 

Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication.

“The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote.

Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. 

World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access

Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations.

The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. 

The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests.

Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response.

The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies.

WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced

WHO has been monitoring reports of the  ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. 

“To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. 

But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past.

Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases.

Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. 

Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms.

US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb

As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. 

Trump is briefed on COVID-19 at the White House

US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. 

This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening.

““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said.

He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. 

The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. 

“The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.”

The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April.

Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly.

Rising Cases In Africa and Southeast Asia Raise Alarm

But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon.

However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday.

And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.”

“It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove.

Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic.

Total number of cases in each WHO Region as of Tuesday night.

Gauri Saxena contributed to this story

Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO.

Peru – Mobile truck screens for Tuberculosis in one of the poorest districts of Lima, Carabayllo.

A 3-month long lockdown could lead to an additional 1.4 million TB deaths and an additional 6.3 million cases over the next five years – if existing tuberculosis services are put on a prolonged hold, reports a new study by the Stop TB Partnership, which estimated the global impact of COVID-19 lockdowns on TB. The study has important implications for policymakers as they struggle to balance the length of lockdowns with other impacts, including on health systems. 

However, if TB services are rapidly restored, the long-lasting impacts of the COVID-19 lockdown on TB could be minimized, concludes the study, released on Wednesday. In the best case scenario of a 2-month lockdown and an ‘enhanced’ 2-month long recovery period, there would be a 4% increase in TB deaths (342,500) and 3% increase in TB cases (1,826,400) over the next 5 years, predicted the researchers.

Existing TB services thus need to be restored as quickly as possible; otherwise COVID-imposed lockdowns could set back the fight against tuberculosis by 5-8 years, warned the Stop TB Partnership’s Executive Director, Lucica Ditiu, in an interview with Health Policy Watch:

“In the agitation of COVID, it appears people forgot that there are other diseases…all existing financial efforts and tools have been disrupted or diverted, and all the efforts you have made for the past 5-8 years may be gone.

“By disrupting existing services, we will pay this price later and it will cost us much more,” said Ditiu.

TB is the biggest infectious disease killer worldwide, leading to 1.5 million deaths and 10 million cases every year.  The mortality rate from TB is about 3% – equal or even greater to that of COVID-19, depending on the estimates. It is estimated that about a quarter of the world’s population has at some time in their lives been infected by TB – although many infections also remain latent and are eventually overcome by the body’s own defenses. 

TB incidence and mortality dynamics following COVID-19 lockdown

The USAID-supported study, carried out by Imperial College, Avenir Health, and Johns Hopkins University examined two scenarios for how the pandemic might impact TB prevention, treatment and control.  

In the study, a number of scenarios were modelled, including 2-3 month lockdowns and 3-10 month recovery periods. The study finds that on average, for every month of lockdown, there would be an excess of 130 000 deaths and 600 000 cases of TB per month. 

In the worst case scenario,  a 3-month long lockdown and a slow 10-month long recovery period could lead to an additional 1,367,300 deaths in the next five years, increasing total TB deaths by 16%. In this scenario, TB cases would increase by 10% to 6,331,100 cases over the next 5 years. 

The “worst-case scenario” reported by the study is probably an underestimate, said Ditiu.

“The restoration period is likely to be more than 10 months because it looks like lockdowns are going to continue. I think that we will see a much bigger mortality than the modelling study suggests.”

The study’s authors contend that these are probably underestimates of true TB infection and death trends, mainly because they did not include underlying comorbidities like direct interactions between the Tuberculosis bacterium and the SARS-CoV-2 virus. There is already some evidence that people with TB history or existing TB are more vulnerable to the SARS-CoV-2 virus, just like any other patient with an underlying illness, said Deputy Executive Director of the Stop TB Partnership Suvanand Sahu, in a webinar Tuesday launching the report.

Increased poverty due to COVID-19 lockdowns can further increase TB burden over the next few months because TB disproportionately affects people living in poverty. Poverty was not included in the study’s model, however.

However, COVID-19 will increase poverty for the first time in 22 years, according to a recent report by the World Bank, which predicts that over 8% of the world’s population will sink below the poverty line as a result of COVID-19.

Carabayllo, one of the poorest districts at the edge of Peru’s Capital, Lima

Rapidly Restoring Existing Tuberculosis Services Can Minimize Negative Impact Of COVID-19 Lockdowns

The lockdown has already led to a worrying drop in TB diagnosis in the two countries with the highest TB burden in the world – Indonesia and India. Identification of cases has dropped by 80% in India and by 70% in Indonesia, said Ditiu.

Lockdowns can have a profound effect on TB burden because people are often unable to visit health clinics for more routine care, and this leads to missed opportunities to diagnose and treat undetected TB cases.

“Rapid restoration of TB services is critical for minimising these adverse impacts [of COVID-19 lockdowns]…Long term outcomes can be strongly influenced by the pace of short-term recovery,” said the study.

As the pandemic drags on, a range of supplementary measures and resources can be used to recover pre-pandemic TB detection rates, the study highlights:

“Such measures may include ramped-up active case-finding, alongside intensive community engagement and contact tracing…[as well as ensuring an]…uninterrupted supply of quality assured treatment and care for every single person with TB.” 

It’s Not Rocket Science To Address Both COVID-19 & TB; Romania’s Timis County Tests and Treats Both Simultaneously

Executive Director of the Stop TB Partnership Lucica Ditiu spoke at the Stop TB Webinar on Tuesday

It is not difficult to address both COVID-19 and existing diseases, and it is not necessary to disrupt existing services. “The solution is not rocket science”, said Ditiu, in an interview with Health Policy Watch.

“There is no need to disrupt existing services for which treatments are available such as immunization programs or malaria, especially for diseases that cause millions of deaths. 

“Furthermore, we can address TB and COVID-19 simultaneously because we already have the infrastructure to do both in parallel,” said Ditiu.  The Geneva-based, UN-hosted organization, includes   more than 2,000 partners worldwide.

‘There are many intersection points between TB and COVID-19, that’s absolutely clear. Firstly, healthcare staff working for TB programs know a lot about diagnosis, treatment and infection control measures for COVID-19. Secondly, we can also use the GeneXpert machines [to diagnose both TB and COVID-19] as well as other putting other measures that are already in place like contact tracing [to work].”

In March, Cepheid, the manufacturers of GeneXpert, a widely-used TB diagnostic, received emergency US Food and Drug Administration approval for a COVID-19 test on the platform.

In Western Romania’s Timis County, the TB situation is “very good” because it is protocol to maintain existing TB services during the emergency period, said Adriana Socaci, TB Coordinator for the Timis County, in an interview with Health Policy Watch. 

Timis County has thus maintained ambulatory TB diagnosis and treatment services in the region, administering some 400 tests in the past two months. So far, ambulatory TB services have identified 2 patients with both TB and COVID-19, said Socaci. However, TB hospital visits are being spaced further apart snce the lockdown to respect COVID-19 social distance guidelines, and that has led to an overall reduction in the number of patients that can be seen. 

During routine COVID-19 testing in Timis County, healthcare workers also collect sputum samples to test patients for TB when lung X-rays are suggestive of the bacterial disease. 

Sputum samples, which are analyzed for TB using a combination of already-existing smear testing and the higher-throughput GeneXpert tests, were used to identify 8 patients with TB that did not have COVID-19, said Socaci. In the past two months, almost 125 suspected COVID-19 cases have also been tested for TB.

Romania – Healthcare worker prepares for routine Tuberculosis screening in Victor Babes Hospital, Timis County

National Policies Must Adjust To Regional And Local Conditions; Funding Must Triple

As countries try to address COVID-19 and TB, Ditiu warns that policies need to adjust based on each country’s conditions and the location of available services.

“There is no one solution that can be generalized across countries, as every country is different. Policies need to adjust based on the country’s conditions and the location of available services.We will have to be mindful of whether these services are centralized or not.”

Funding will also be a big question, said Ditiu. We will need to triple current spending to get back to where we were with respect to TB. 

We will also need to find ways to ensure that money currently earmarked and available for TB gets used, he stressed.

“While Africa’s funding for TB has not been suspended, Africa’s capacity to spend the money for TB right now is 0.”

Tuberculosis – a disease of the poor

 

Image Credits: Socios en Salud, Svĕt Lustig Vijay, PLOS Medicine.

Geneva Health Forum 2018 (Photo Credit: Louis Brisset/HUG)

From a small and modest gathering of booths and stands in 2006, the ​Geneva Health Forum​ has grown into an international event with a strong array of scientific sessions. ​Although the GHF was forced to postpone its eighth annual conference, from March to 16-18 November due to the COVID-19 pandemic, that has not prevented the Forum’s leadership, including GHF Director, Dr Eric Comte, from responding to the unprecedented challenge created by the crisis.

A medical doctor and epidemiologist by training, who worked for Médecins Du Monde (MDM) and Médecins sans Frontières, Comte also witnessed the spread of Ebola in West Africa. Geneva Solutions interviewed Comte to hear about the role GHF is playing in the present emergency, and his views gleaned from years in epidemic management.

Geneva Solutions (GS): What role is the Geneva Health Forum trying to play in this crisis?

Eric Comte (EC): Geneva benefits from a special position due to the presence of the World Health Organization and many organizations which revolve around it. We are fortunate to have this extremely rich environment and the advantages of a small city which greatly facilitates contacts.

We generally have two objectives: On the one hand, to facilitate discussions between the various health stakeholders who are willing to work together but who are caught up in their fields of activity and their schedules. Getting people to work together is not so natural. On the other hand, promote links between actors based here and those from countries with more limited resources. The objective is to see what the innovative practices are to improve access to health, in Europe as well as in developing countries.

Since the start of the crisis, our interlocutors have been contacting us to tell us about their initiatives and to collect information that we may have, thanks to our network. We are exploring how we might better organize these initiatives. We also are called upon by those who are active in global health, including medical practitioners, policymakers, and academics, including various actors working in Africa who need guidance about how to respond. In this context, we are also trying to bring together various strategic documents produced by WHO, the African Center for Diseases Control, as well as MSF operational documents, that provide guidance in the establishment of emergency response healthcare structures, adapted to the conditions of resource-limited countries. Our role is to share them. We are not the only ones doing it, but this an example of the type of work we are trying to do.

GS: ‘Coordination’ seems to be the key word in this crisis?

EC: Yes, but there is also information sharing and anticipation. I would like to point out that WHO has been widely criticized on Ebola, but as a result has set up an emergency department which activates a Task Force during crises. In this pandemic, in their coordination function, they were very proactive and produced a lot of useful guidance with clear messages, which comes back to the mantra: test the cases as soon as possible and trace the affected patients to isolate them.

GS: Have we not totally missed the point despite the warnings of the WHO? Many countries have failed to follow their recommendations.

EC: The only thing I can say is: we have to follow these measures. Often in epidemics, there are recommendations that should be followed but there are limitations in the field. You will always find problems with implementation in the field. A month ago, [for example] tests were not available. There are two possible ways to react. The first is to do everything to make them available. The second, is to cope with the scarcity, which many countries did. We are late, yes.

GS: The second key word you mentioned is ‘sharing information’, is that happening?

EC: I think there is a lot of sharing going on. The big difficulty is that many documents are in English and much less available in other languages like French or Spanish. This is a major obstacle for areas like West Africa, it creates an important barrier. But it is also true that we are also sharing much more than a decade ago thanks to the electronic network. This effort must be continuous.

GS: But there is no withholding of information as there is sometimes in the medical field due to issues of ego, commercial strategies, etc.?

EC: There are certainly economic interests. This is not a big open generous market, but there is a desire for openness and sharing – without being naive.

GS: What about the third key word, ‘anticipation’?

EC: As the experience with the lack of tests in Europe shows – governments are just starting to acquire tests – the ideal would have been to have them a month ago. The mobilization should ideally have been done earlier. Now there has been a surge of cases in Africa, but the mobilization of African actors is still quite weak. There the epidemic will definitely reach a critical point within 10 days to two weeks and in an epidemic that is a lot. In such a rapid epidemic like COVID-19, you must be early and proactive. Mobilization for and in Africa is certainly insufficient.

GS: What is the big challenge for Africa?

EC: Clear strategy guidelines are needed so that each country does not act alone. We must learn from other countries that have gone through the crisis. Additionally, resource shortages can make it difficult to treat severe cases, so the decisive impact that can be made would be in case detection. It is important to test, identify positive cases and isolate them at home. So, the challenge is to set up massive testing very quickly. But test availability is not the only problem. Once you obtain tests you have to have a clear strategy for where to test and who to test. Like the new drive-in test initiatives, we have seen elsewhere, Africa needs decentralized testing locations, outside of the regular hospital quarters, so as to speed up results and avoid infecting other patients and health workers. It’s not that difficult but it’s a race against the clock to make sure the strategies are in place when the tests arrive.

GS: People are very afraid for their future. What scares you the most in this crisis?

EC: When you work in Africa on cholera epidemics, you have all the ingredients that we are facing here today. Local players are confronted with overloaded hospitals, racing against the clock to detect positive cases, containing the epidemic, and treating serious cases. What’s going on here isn’t so exceptional. What is exceptional is that it has happened in Europe where we were no longer used to this, and obviously did not have the necessary structures in place. This is exceptional by the geographic scale and the number of patients, but it is a classic epidemic pattern. We had this with Ebola in West Africa. It was the same scenarios. The trauma in Sierra Leone and Guinea were the same: destruction of health systems, exceptionally large number of deaths among health workers, fear within the population, destruction of local economies.

GS: Based on your experience, what would you say?

EC: We need to keep calm, mobilize communities, which is being done. The reactions are not bad. We are always late in a crisis. The lockdown measures of “confinement” are being respected; the tests came late but they are on the way. If we compare with Ebola, in this crisis we are much responding much faster, only five years later.

GS: What are your hopes?

EC: With what is in place, we will succeed in limiting the cases. One must not feel afraid. Fear in an epidemic is not a good reflex. We must try to implement the WHO guidelines and normally we should have an influence on bending the curve.

________________________________________________________

Republished from Geneva Solutions. Health Policy Watch is partnering with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. In the midst of the Coronavirus pandemic, a special news stream is published at heidi.news/geneva-solutions, providing insights into how the institutions and people in Geneva are responding to this crisis. The full Geneva Solutions platform and its daily newsletter will launch in August 2020. Follow @genevasolutions on Twitter for the latest news updates.

Image Credits: Louis Brisset/HUG, Geneva Health Forum.

WHO Kenya’s Community Health Coordinator educates communities on hand-washing – a crucial personal protective measure against COVID-19

A new report published Wednesday provides guidance to African governments on how to use data to chart a way out of COVID-19 lockdowns. Concerns that the economic impact of stringent stay-at-home orders may become too tough to bear for families has some African countries considering adapting or easing public health restrictions.

Some 69% of people in 28 African cities surveyed for the Responding to COVID-19 in Africa: Using Data to Find a Balance report said that getting adequate food and water would be a problem if they were required to remain home for more than 14 days, and 51% said they would run out of money. In Western and Central Africa, 83% of those surveyed worried about running out of food and water if required to stay home for 14 days. The surveys covered 20 countries. 

Approximately one third of the respondents also said they did not get enough information about the coronavirus, including how it spreads and how to protect themselves. Almost two thirds believed that the pandemic would have a major impact on their countries, but only 44% believed that the virus would be a personal threat. 

“This report highlights the large information gaps on COVID-19 which exist in Africa and threaten response efforts,” said Dr Matshidiso Moeti, World Health Organization Regional Director for Africa. 

“The findings of this report, along with COVID-19 trend data, will help countries make strategic decisions on relaxing their lockdowns. What we’ve learnt from Ebola and other outbreaks is that countries need to decentralize the response to the community level and increase their capacity to identify and diagnose cases.”

The report recommends that governments closely monitor data on how public health measures meet local needs; build capacity to test, isolate and treat while case numbers are low; and engage communities to adapt any public health measures, such as business closures, to the local context.

A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo, with PPE and diagnostics supplies

‘Finding the Balance’ – Special Considerations for Africa

The recommendations are specifically tailored to Africa, where many nations have rapidly responded to early cases by stepping up contact tracing and enacting some of the earliest stay-at-home orders, which have appeared to slow the spread of the virus. However, pre-existing weak social welfare have led to widespread fears that food insecurity and poverty may threaten just as many, if not more people during lockdowns.

Many countries are considering relaxing or adapting lockdown measures as they consider the threat to livelihoods against the threat from COVID-19.

“There are three factors that will be particularly important to weigh in this concept of finding the balance in Africa,” said Tom Frieden, chief executive officer of Resolve to Save Lives and former head of the United States Centers for Disease Control.

“The first is the age structure of population – with fewer elders, there is less risk of widespread illness and death among the elderly population. But still, there is the risk in vulnerable populations and a lack of information by who is most in need,” he added. 

The report found that there was rampant misinformation across the continent. For example, more than 58% of survey respondents believed that taking vitamin C could ward off the virus, and 53% believed that hotter climates could prevent the spread of the virus. While there has been scientific speculation around both of those claims, neither has been proven in peer-reviewed studies. 

“Second,” adds Frieden, “There are limited safety nets. As the report shows, the ability for communities and individuals to thrive and flourish during a lockdown is even less than in many other parts of the world.”

The report found that the lowest-income households expected to run out of food and money in less than a week. Some 42% of non-violent COVID-19 related security incidents, such as peaceful protects, were organized around seeking additional government support during the crisis. Many African nations have had stay-at-home orders in place for more than three weeks now. 

“And finally, there is a critical scarcity of healthcare workers, even before COVID-19, and therefore it’s crucially important that every step is taken to protect those who protect the rest of us, and ensure that healthcare workers and other essential workers are protected,” said Frieden. The global shortage of protective equipment has hit the continent especially hard, with approximately a third of all peaceful protests across the continent organized around demanding protections for healthcare workers, according to the report.

But despite the limitations, communities in cities have largely supported public health and social measures enacted to protect them against the coronavirus.

Over 90% of respondents across all surveyed regions supported halting sporting matches and concerts; and closing schools, restaurants and nightclubs. Around 70% of those surveyed supported halting prayer gatherings, and closing churches and mosques. However, more people opposed transportation shutdowns, closing workplaces, and shutting down markets – activities deemed by many citizens to be essential for their livelihoods.

Gathering such data points is crucial to understanding how public health measures are impacting the general public – and how likely they are to follow guidance. 

“As we prepare for a long term response, there’s too much to be learned about the virus and the impact you have on people, and systems on the continent,” said John Nkengasong, Director of the Africa CDC. “Therefore, we must use evidence to drive decision making, and apply lessons from the past so we can implement the most effective and responsible policies, while protecting lives and livelihoods.”

Along with the public survey conducted in 28 cities across 20 African Union Member States, other indicators of disease transmission, population movement and unrest, were used to inform the report. The final document was produced by the Partnership for Evidence Based Response to COVID-19 (PERC), which consists of the Africa Centres for Disease Control and Prevention; Resolve to Save Lives, an initiative of Vital Strategies; the World Health Organization; the UK Public Health Rapid Support Team; and the World Economic Forum. Private market research and data analytics firms Ipsos and Novetta Mission Analytics also supported the partnership.

Gauri Saxena contributed to this story

Image Credits: WHO African Region, Matshidiso Moeti.

Rows of artemisia annua in West Virginia

Research into traditional medicines for COVID-19 should be welcomed, so long as it is held to the same standards as research into other drug candidates, the World Health Organization Africa Regional Office expressed in a statement issued Monday.

The diplomatically-framed WHO statement came after widespread media coverage of Madagascar’s president and other African leaders over the weekend, who suggested that the medicinal plant artemisia annua (sweet wormwood) was effective against the coronavirus.

“WHO recognizes that traditional, complementary and alternative medicine has many benefits, and Africa has a long history of traditional medicine,” said the WHO statement. 

Several decades ago, the same plant was found to be effective against malaria parasites, leading to the development of modern artemisinin-based combination therapies (ACTs), which are now a worldwide standard for malaria. 

While no such studies of the plant’s effect in COVID-19 patients have been published, initially promising results from cell studies conducted by Chinese researchers in 2005 showed that artemisia annua extract may have activity against the SARS-CoV virus – a cousin to the SARS-CoV-2 virus that causes COVID-19. The Max Planck institute in Germany recently announced a collaboration with researchers in the United States and Denmark to investigate the plant’s efficacy against SARS-CoV-2.

According to WHO COVID-19 Technical Lead, Maria Van Kerkhove, there are “hundreds” of ongoing clinical trials exploring the use of traditional remedies for the coronavirus. “The idea of traditional medicines, particularly for COVID-19, is something that is is well under investigation,” she told reporters Monday.

However, WHO warned that, “caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies.

“Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.””

The statement comes as hydroxychloroquine, an anti-malarial drug is making headlines as a potentially dangerous COVID-19 therapeutic. While hope is still being pinned on the drug, recent studies showed that it could cause heart arrhythmias at high doses, underlining the importance of conducting proper clinical trials before approving a drug for use. The naturally-occurring source of hydroxychloroquine is the chinchona tree, a national symbol of Peru.

Global Trends

Number of cases by WHO region

Of the 27 000 new cases recorded Sunday in Europe, almost a third of cases, some 10 000 new cases, were in the Russian Federation, and 20% of new cases were in the UK, according to the latest WHO situational report. So far, Europe hosts about half of COVID-19 cases and 60% of deaths worldwide.

As countries like Italy, Portugal and Austria relaxed their lockdowns on Monday, and Spain recorded its lowest numbers since a peak in March, COVID-19 is still not over in Europe, nor in any other region of the world. 

This week, the UK will announce a comprehensive roadmap to lift its month-and-a half- long lockdown despite the meagre reductions in cases since mid-April, with 5000 new cases reported over the past day.

On Sunday morning, the third flight from China delivered 2.1 million face masks and 32,000 surgical gowns to Ireland’s capital, Dublin. The three flights were organized and funded by Dublin-based aircraft leasing company Avolon, which has raised a total of €350,000 in a crowdfunding campaign. Rock band U2 contributed € 10 million to the cause.

In the Americas, meanwhile, the USA, Brazil and Peru accounted for over 80% of new cases reported in the continent in the past day, according to the latest WHO situational report. As of Monday, 26 000 new cases were confirmed in the USA and 6000 new cases were reported in Latin America’s epicentre Brazil, with a total of 102,717 cases and 7,025 deaths. 

The Amazonian city of Manaus emerged as the new hotspot of the virus, experiencing widespread chaos in morgues and coffin shortages after recording most of the country’s new cases. On Monday, Brazilian Health Minister Nelson Teich arrived in the Manaus to expand testing and to ensure that the region received reinforcements of some 270 health professionals.

In the Western Pacific, two countries have experienced an uptick in cases in recent days – Singapore and Japan. Singapore’s outbreak declined in mid-April, but it has reported the most new cases in the Western Pacific in the past day, with 650 cases on Monday and 932 new cases on Friday.

The majority of Singapore’s cases in past days have been traced to dormitories of foreign construction workers and common worksites, said Lawrence Wong, Minister For National Development, in a statement on Monday. To curb the outbreak, Singapore has halted the movement of workers in and out of all dormitories, and put the construction workers living outside the dormitories on a stay-home requirement. Like Singapore, Japan’s cases have also risen since last week, mostly in Hokkaido and the capital, Tokyo, with 300 new cases reported in the past 24 hours.

In the Eastern Mediterranean region, cases are growing in Afghanistan and Saudi Arabia.

In the past day, Saudi Arabia became the Eastern Mediterranean region’s hotspot. Over 70% of civilians in the holy city of Mecca could be infected with the virus, according to senior Saudi medical sources, reported Middle East Eye late last week.Like in Mecca, up to a third of people in the capital Kabul could have COVID-19 according to a random test of 500 Afghanis, reported AP on Sunday.

Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly.

-Updated on 6 May 

Image Credits: Jorge Ferreira, WHO, Johns Hopkins CSSE.

Ursula von Der Leyen, president of the European Commission, announced the EU pledge at the Coronavirus Global Response Pledging Event on 4 May

Countries from around the world committed 7.36 billion Euro for the global coronavirus pandemic response Monday, nearly reaching the ambitious 7.5 billion Euro initial goal that had been set out only a week ago in a press conference with heads of state from Europe, Africa, Asia, Latin America and the World Health Organization. 

The United States, the world’s biggest global health donor and country with the most COVID-19 cases and deaths, was noticeably absent in this show of multilateralism, at the pledging event hosted by the European Commission. 

Leaders from most of the other G20 group of the world’s most industrialized countries made pledges, including China, whose permanent ambassador to the European Union announced a commitment of over USD $20 million to the global coronavirus response.

The European Commission kicked off the event with a 1 billion Euro pledge.

“Today, the world is coming together. Governments from every continent will join hands and team up with global health organizations, and other experienced partners. The pandemic is affecting every single country in the world. The goal is one; to defeat this virus,” said Ursula Von der Leyen, European Commission president.

But funding committed at the initial pledging event, which aimed to raise 7.5  billion Euros, is just the first “downpayment” for accelerating the development of new tools, said United Nations Secretary General Antonio Guterres. 

“To reach everyone everywhere, we likely need five times that amount, and we call on partners to join in this effort… to sustain our momentum,” he added.

Many country leaders explicitly designated that funding pledged would also go to the World Health Organization, which is facing a significant budget shortfall after US President Donald Trump announced a temporary suspension of its nearly US $ 500 million annually in funding, pending an investigation into the agency’s handling of the coronavirus crisis.

Erna Solberg announces Norway’s pledge, leading with renewed funding for the WHO

Norway, one of the co-hosts of the event, led the movement with an additional 50 million krone infusion into WHO’s coffers. 

“Norway supports the leadership of the World Health Organization. Without the WHO, an effective and coordinated response to the pandemic will not be possible,” Norwegian Prime Minister Erna Solberg said. “Cooperation is more important than ever.” 

The pledging event was co-led by the leaders of France, Germany, Japan, Norway, Canada, Italy, Spain, the United Kingdom, and Saudi Arabia. The package of new grants, loans, and repurposed global health funding from bilateral donors, philanthropic foundations, and the European Investment Bank will be directed towards accelerating the development of COVID-19 tools, and support countries most vulnerable to the pandemic.

Accelerating Development of & Ensuring Access to COVID-19 Diagnostics, Drugs, & Vaccines

A majority of funding announced at the pledging event will fund various efforts to speed up the development of COVID-19 diagnostics, therapeutics and vaccines. As of now, there are no approved drugs or vaccines for the virus.

“This is now a human endemic infection,” said Jeremy Farrar, director of the Wellcome Trust, which together with the Gates Foundation and Mastercard, is supporting the new COVID-19 Therapeutics Accelerator, another funnel for funding pledged. “We will need all three; diagnostics, therapeutics, and a vaccine.”

In one of his first international appearances since recovering from a serious case of COVID-19, UK Prime Minister Boris Johnson added, “ We must work together to build an impregnable shield around all our people – and that can only be achieved by developing and mass producing a vaccine.”

Boris Johnson announces the UK pledge

The UK has committed up to  £744 million to the global COVID-19 response, of which at least £388 million will be directed towards research and development of COVID-19 therapeutics and vaccines. 

A large portion of all country pledges were also directed towards the Oslo-based Coalition for Epidemic Preparedness and Innovation (CEPI), which is supporting nine COVID-19 vaccine development initiatives. In a commitment to ensuring access to any COVID-19 tools, many countries also announced initial pledges to Gavi, the Vaccine Alliance, the public-private partnership that supports low-income countries’ national vaccine delivery programmes. The UK is hosting Gavi’s sixth replenishment on 4 June. 

Pharma industry and civil society representatives joined in to support the pledging event, and leaders of both have underlined that ensuring access to any new tools is an essential priority, echoing calls from country leaders that a COVID-19 vaccine should be treated as a ‘global public good.’

“Never before has the biopharmaceutical industry moved as quickly and decisively to channel our innovation and mobilize our knowhow in response to this pandemic. We are driven by a deep sense of responsibility towards patients and society as a whole,” said Dave Ricks, chief executive officer of Eli Lilly and chairman of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

“Global demand will outstrip production and supply capacity for some essential medical tools, including personal protective equipment and COVID-19 therapeutics, diagnostics and vaccines. Ensuring the equitable allocation of these tools should therefore be central to any discussions around financing and access,” representatives of Médecins sans Frontières (MSF) wrote in a public comment released on Monday.