The World Health Organization and UNICEF have issued new age-specific mask guidance for children, recommending looser masking protocols for younger children.

The agency’s new guidance comes the week after a new study from researchers at the Massachusetts General Hospital found that children infected with COVID-19 had higher virus levels in their nose and throats than adults, despite showing less severe or no symptoms. The findings suggest that children may be “silent spreaders” of the virus, expelling more virus than infected adults despite being less prone to getting symptoms of COVID-19 themselves.

“[Based on preliminary studies] there appears to be a difference in transmission by age group, with the younger children able to transmit less than teenagers, for example, but this data is really limited,” Maria Van Kerkhove, WHO technical lead for COVID-19, told reporters Friday.

Children under the age of 5 should not be required to wear masks, according to the new guidance.

The guidance takes a “risk-based” approach to recommendations for kids between the ages of 6 to 11 years old. They should wear masks if they have adequate adult supervision, they’re able to safely don and doff a mask themselves, or they reside in areas of high COVID-19 transmission. Those 6 to 11 years old should also wear masks if they are interacting with people who have a higher risk of developing severe COVID-19 disease, such as people over the age of 65 or those with preexisting conditions.

Children older than 12 should wear fabric masks under the same conditions as adults – in areas of high transmission, where maintaining physical distancing is impossible, or confined and crowded environments.

“What we understand about transmission in children is still limited,”  Van Kerkhove admitted.

But with the upcoming fall semester beginning all over the world, understanding the role of children in COVID-19 transmission is even more urgent as countries grapple with the decision to reopen classrooms, or pursue remote learning.

Schools are debating between reopening classrooms or continuing remote learning in the fall.

While the risk of severe disease in children is low, public health officials are concerned that children who get infected at school could bring the virus home, potentially exposing older family members or those with preexisting conditions.

Ultimately, the success of controlling the spread of the virus in schools is dependent on controlling the virus’ transmission in the larger community.

“Schools do not operate in isolation. They operate in communities and… if there’s widespread transmission in those communities or intense transmission is possible, the virus can enter the school system,” said Van Kerkhove.

“Just because kids or others have masks does not mean we can forget about the other measures,”  added WHO Health Emergencies Executive Director Mike Ryan. “Wearing a mask is not an alternative to physical distancing. It’s not an alternative to hand washing, and it’s not an alternative to decompressing classes.”

WHO’s current guidance for masking in classroom settings recommends that schools develop a policy on wearing masks or face coverings in line with national or local recommendations.

Children With Few Or No Coronavirus Symptoms May Carry More Virus Than Hospitalized Adults

In a study of 192 pediatric patients at Massachusetts General Hospital and Mass General Children’s Hospital, researchers found that infected children had significantly higher levels of virus in their airways than infected adults.

Levels of virus in the children’s noses and throats were highest in the first two days of symptoms – significantly higher than viral loads in hospitalized adult patients experiencing more severe symptoms.

“I was not expecting the viral load to be so high,” said lead author Lael Yonker in a press release. “You think of a hospital, and of all of the precautions taken to treat severely ill adults, but the viral loads of these hospitalized patients are significantly lower than a ‘healthy child’ who is walking around with a high SARS-CoV-2 viral load.”

The higher the level of virus in the airways, the more likely it is for a patient to transmit the virus onwards. Coupled with the fact that children generally tend to have more mild COVID-19 disease, the study findings imply that children could be a major, unmeasured source of the virus’ spread.

“During this COVID-19 pandemic, we have mainly screened symptomatic subjects, so we have reached the erroneous conclusion that the vast majority of people infected are adults. However, our results show that kids are not protected against this virus. We should not discount children as potential spreaders for this virus,”  said Alessio Fassano, director of the Mucosal Immunology and Biology Research Center at MGH and senior author on the paper.

“Kids are a possible source of spreading this virus, and this should be taken into account in the planning stages for reopening schools,” Fassano added.

Out of the cohort of patients in Massachusetts, some 49 children tested positive for SARS-CoV-2, but only 25 had a fever. Many of the children presented with non-specific symptoms such as a cough or congestion.

The Massachusetts study’s results are more damning than the results of a preliminary report published by the Centers for Disease Control, conducted by researchers at the University of Geneva in Switzerland. The Geneva study compared 12 pediatric patients’ samples to adult samples and found that levels of virus in children and adults were comparable. Still, the Geneva researchers write, their results also show that infected children can transmit the disease.

This story was updated 24 August to reflect new masking guidelines.

Image Credits: Flickr: Jill Carlson, Flickr: Ivan Radic.

House in Bikoro, Équateur, is disinfected following the discovery of a confirmed Ebola case

The Democratic Republic of Congo (DRC) requires “critical” support to fend off a growing Ebola outbreak in the western Province of Équateur, warned WHO’s Regional Director for Africa Matshidiso Moeti on Friday.

Her warnings came as Équateur’s Ebola cases have almost doubled to one hundred in the past five weeks, of which 96 are confirmed and four are suspected.

Only US$6 million of the $40 million required for the Ebola response has been pledged so far, as international donors remain distracted by the COVID crisis. The DRC government has committed $4 million, and WHO has pledged $2 million. 

“Without extra support the teams on the ground will find it harder to get ahead of the virus,” said Moeti. “COVID-19 is not the only emergency needing robust support. As we know from our recent history we ignore Ebola at our peril.”

Since the DRC’s eleventh outbreak was declared on 1 June 2020, it has spread to 11 of the province’s 17 health zones, and claimed the lives of forty-three people, said the WHO Regional Office for Africa in a press release.

Healthcare Worker Strike Complicates Efforts
Ebola vaccination campaign in
Mbandaka, Équateur Province (DRC)

In addition to the havoc triggered by COVID-19, a health worker strike in the area has limited the response.

“The situation has been further complicated by a strike by health workers, which is affecting activities, including vaccination and safe burials. DRC has the best trained workforce in the world of for Ebola – this situation needs to be resolved as soon as possible,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told reporters on Friday. 

Healthcare workers in the Ebola response entered a three day strike last week, demanding the government pay and raise their salaries in light of the dangers of facing the virus. Healthcare workers have experienced a high risk of infection and death in previous Ebola outbreaks, including in the 2014-2016 West Africa outbreak.

However, part of the strike involved blocking off access to Ebola testing laboratories, according to Mory Keita, a WHO Ebola incident manager. A number of samples collected two days prior to the strike were unable to be processed.

“When health workers protest or strike, it should be done in a way that doesn’t affect the service they provide to those who need it most,” said Dr Tedros on Friday.

Significant Logistical Challenges Delay Identification Of New Cases
House in Equateur Province gets disinfected following discovery of confirmed Ebola case.

And responders are grappling with ‘significant logistical challenges’ to respond to the ongoing Ebola outbreak. Not only has Ebola spread across a whopping 300 km area both from east to west and from north to south, most affected communities also live in remote, densely forested areas that take ‘days’ to reach by river boat, increasing the time it takes to identify potential cases.

“There is currently a delay of about five days from the onset of symptoms to when an alert about a suspected case is raised. This is concerning, because the longer a patient goes without treatment, the lower their chances of survival, and the longer the virus can spread unseen in communities,” said Dr Tedros.

“The virus is spreading across a wide and rugged terrain which requires costly interventions and with COVID-19 draining resources and attention, it is hard to scale-up operations”, added Moeti. “With 100 Ebola cases in less than 100 days, the outbreak in Équateur Province is evolving in a concerning way.” 

Since the outbreak began, the DRC Government has led the ring vaccination of over 22,600 people at high risk of contracting the deadly virus. It has also screened about 640,000 across 40 points of control, in collaboration with 90 WHO experts on the ground and about 20 partner organizations.

Image Credits: WHO/Junior D. Kannah, WHO/Junior D. Kannah, WHO.

The World Health Organization Headquarters in Geneva, Switzerland

Germany and France are proposing sweeping reforms to strengthen the World Health Organization and ramp up funding for the agency.

A draft paper circulated by the two countries outlines ten key reforms to boost the WHO’s legal authority and funding, while also increasing oversight of the agency’s emergency operations, according to Reuters, which obtained a look at the document.

“Not only during the current pandemic, it has become clear that the WHO partly lacks the abilities to fulfill its mandate,” the document said. The reforms are clearly “pro-WHO,” a diplomat in Geneva familiar with the negotiations told Reuters.

One key proposed reform is the creation of an independent expert committee to assess WHO’s operations in emergency situations as they unfold.

In previous years, WHO has undergone extensive independent reviews only after pandemics have been beaten back. The ongoing independent review of the agency’s COVID-19 response, headed by former Liberian President and Nobel Prize winner Ellen Johnson Sirleaf and former New Zealand Prime Minister Helen Clark, is the first such review to take place as an emergency is unfolding.

While leaders and Health Ministers of both France and Germany have been upfront about their criticism of the WHO, both countries have also steadfastly stood behind the agency as it has weathered repeated attacks regarding its handling of the coronavirus crisis.

And unlike the United States, which followed up its strong criticism of the agency by withholding funding and announcing its intent to withdraw from the WHO, France and Germany are looking to prop up the Organization. Both countries have upped their contributions to the agency following the US’ withdrawal.

In fact, the draft document appeared to recommend giving the WHO more power to autonomously and independently investigate reports of new outbreaks. Currently, WHO must be invited into a country to investigate any outbreaks, WHO Director-General Dr Tedros Adhanom Ghebryesus previously told reporters.

Additionally, the document urges Member States to provide more unspecified funding to the agency, which currently runs on a shoestring budget of about US$5 billion a year, approximately the same budget size as a large, sub-regional hospital.

More than 80% of the agency’s current budget is also earmarked for specific programs, meaning WHO only has about US $1 billion a year to deploy rapidly in the case of unpredicted emergencies.

Ramping up un-earmarked contributions will give the agency more flexibility to respond to outbreaks of novel diseases early, rather than spend time raising money for an emergency response, according to the document.

The proposed reforms could be discussed at the WHO as soon as mid-September, according to Reuters.

A WHO spokesperson declined to comment on the document.

Image Credits: U.S. Mission Geneva/ Eric Bridiers.

Antoine Flahault, director of the Institute of Global Health at the University of Geneva

Six months into the pandemic, the rapidly evolving science behind COVID-19 has complicated efforts to clamp down on the virus’ rampage around the world. Geneva Solutions asked Antoine Flahault, director of the Institute of Global Health at the University of Geneva, and leading voice on COVID-19 science in the region, how we can take swift action to save lives when science hasn’t yet provided definitive answers.

When we don’t have evidence, scientists need to be transparent, he says. In the meantime, masks for everyone, everywhere, and all the time, are vital to fend off the pandemic.

Geneva Solutions: Earlier this year, you advocated homemade masks out of toilet paper on Twitter, even though there was no scientific backing for your claim. Why?

Professor Antoine Flahault: It’s true that in late January when COVID-19 began its rampage around the globe, there wasn’t enough evidence to suggest that homemade masks actually worked. I made an assumption that any physical barrier was better than no protection at all. Some of my colleagues said it was irresponsible to make claims on homemade masks without scientific data to back them. At the same time, my colleagues weren’t providing any alternatives to fend off the virus, and there was a massive shortage of surgical masks.

 

During a crisis, doing something is better than doing nothing. In the case of masks, wearing a mask is a really low-risk action that has a huge potential benefit in preventing onwards transmission. When the evidence isn’t there, we need to be transparent and mention the lack of scientific evidence and use our gut feeling because the data may take time to collect — and in that time, lives can be saved. And we shouldn’t be stubborn when the evidence comes our way. We should follow it. In the case of masks, evidence eventually came that masks provide very useful and effective protection against the coronavirus.

However, we wouldn’t want to follow our gut in other instances. For instance, we cannot trust that an untested vaccine works. However, in the case of masks, there is very little risk associated with mask-wearing, and a very large potential benefit, but this is not the case with an untested vaccine, which could have dangerous side effects.

GS: There’s a similar lack of clarity on aerosol transmission of COVID-19. Some scientists think aerosols are primary drivers of transmission, while others — including the WHO — maintain that they are not a primary route of transmission. What should we do when the science is unclear?

AF: Aerosols are small viral particles that float around in the air. We think they’re produced when people speak, sing, cough, sneeze or exhale, but the data is still limited. However, our lack of solid evidence shouldn’t nullify the aerosol hypothesis. Maybe aerosols are not the major route of transmission of COVID-19, but we just don’t know yet.

What we can do now is to protect ourselves with masks in closed spaces that lack ventilation. Keeping distance may simply not be sufficient. We need to be sensible and do the best we can with the tools we have — and that means wearing masks.

Masks should be worn everywhere, all the time, and by everyone – including pupils in classrooms.
GS: We are approaching the fall start of schools. Is there a risk that opening up schools could endanger children?

AF: The latest science tells us that pupils, and anyone below the age of 40, is at a very low risk of becoming critically ill and dying from COVID-19, so opening schools will not endanger children themselves. Rather, the issue is that children could transmit the virus to others in their surroundings, particularly vulnerable groups like older people, those with underlying conditions or even school teachers and staff.

GS: Could schools become a breeding ground for COVID-19 transmission?

AF: Definitely. Given that classrooms in schools are often enclosed and poorly ventilated, schools have potential to turn into clusters of transmission that could spill over into the community.

Some epidemiological findings also suggest that children — and even young children — may transmit the virus as well as adults. This is based on evidence that children carry similar quantities of the virus as adults in their noses and throats. However, we’re still not totally sure whether that means they can transmit as well as adults. Given the data is not well ascertained, we need to stay cautious, and take appropriate measures to mitigate the spread of the virus.

GS: Do you see concrete good practice examples that countries could emulate — in Europe and beyond — with regards to smaller class sizes, masks, remote learning, or other measures, to curb the risk of transmission in schools?

AF: There are three measures we can take to win against this virus and allow schools to stay open for as much as possible throughout the year:

  1. The most important measure we can take is to wear masks in schools throughout the day. Wearing masks is possible for any child older than 3 years of age
  2. We need to improve ventilation in schools, and we also need to promote alternative methods of teaching to reduce the number of students in one space at any point in time. We can achieve the latter by spreading out lunch breaks throughout the day so that kids aren’t all eating at the same time. We could even spread out the time for going to school — not for primary schools because younger children are less autonomous, but maybe for children in secondary schools. This may also take the edge off of overcrowded public transportation, and contribute to dampening down transmission.
  3. We could also implement distance learning or mixed approaches in secondary schools. However, we need to stay cautious, because not all parents will be able to stay at home to supervise their children’s learning. Also, not every family will have computers at home, so we need to take the context into account. There’s also the issue of meals at schools. We need to bear in mind that schools may offer more nutritious meals than at home. That’s why we need to carefully consider the context and work accordingly, and to ensure the strategies we adopt are sensible and appropriate.
Remote learning may help curb COVID-19, but it won’t be appropriate in all contexts.
We are seeing a slow, but steady rise in new COVID-19 cases in Switzerland from 100 per week a less than a month ago to over 200 new cases in the past week. Is there anything Switzerland could do to further curb transmission?

There are several measures Switzerland can adopt today, and that’s to recommend wearing masks in all indoor settings, not only in public transportation, but also in workplaces and businesses in the whole nation. These are the next breeding grounds for transmission.

The second measure we can take is to learn from countries like Australia, Taiwan and Japan. They took very targeted approaches to COVID-19 screening. Instead of randomly testing the entire population, their testing is precise, agile and swift. They took a proactive approach to identify superspreaders and clusters of COVID-19 cases. Once they found a cluster, they very quickly started testing and tracing before the cluster went out of hand and spread across the region.

Targeted screening approaches will be particularly important during the cold season, which will bring many people with mild symptoms to hospitals. If we don’t take more targeted approaches, it will be difficult to tease out COVID-19 symptoms from common colds caused by respiratory viruses other than COVID-19.

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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 24 August. Follow @genevasolutions on Twitter for the latest news updates.

Image Credits: Antoine Flahault, UNICEF, Nenad Stojkovic.

UK Health Secretary Matt Hancock announces that Public Health England will be replaced with a new institute.

United Kingdom Secretary of State for Health Matt Hancock’s announcement to replace Public Health England (PHE) with a new agency focused on biosecurity and infectious disease threats has drawn widespread criticism from health experts.

The Health Secretary announced that PHE will be replaced with a new National Institute for Health Protection (NIHP) in a speech on Tuesday, following widespread media reports hinting at the move on Sunday. Ministers, including Prime Minister Boris Johnson, have supposedly been unhappy with the PHE’s handling of the pandemic for weeks.

The NIHP will merge the PHE, the National Health Services’ Test & Trace program, and the Joint Biosecurity Centre (JBC) into a single organization, modeled after Germany’s Robert Koch Institute and focused on protecting the United Kingdom from “new” and “external” infectious threats, according to Hancock.

But critics have called the move a dangerous and distracting play in the middle of the pandemic. They have also questioned how PHE’s other responsibilities, such as managing environmental health or non-communicable diseases, will be taken into account in this reshuffle.

“Where is the evidence, the independent review that has informed such a significant organisational change to the national public health response for England at such a critical time? It takes time to build an organisational culture and the way the tired, hardworking PHE staff heard via a leak at the weekend is shocking,” wrote Gail Carson, deputy chair of the Global Outbreak and Response Network (GOARN).

“Now is not the time to replace Public Health England. The pandemic may have shown us that some changes are needed, but they need to be made at the right time. PHE is playing a key role in keeping the country going, and we really don’t need the upheaval that this move is going to create,” said Andrew Goddard, president of the Royal College of Physicians, in a statement.

Many Uncertainties Remain About New Institute’s Leadership & Responsibilities

In particular, Hancock’s decision to place fellow Conservative Dido Harding, the current head of the widely criticized NHS Test & Trace program, at the helm of the NIHP has sparked ire. Many critics have pointed to the lack of transparency behind Harding’s appointment.

“I was looking forward to applying for the role of Chair of the UK’s National Institute of Health Protection, but somehow I missed the open transparent recruitment process,” Richard Horton, chief editor of the global health journal the Lancet, tweeted.

Similarly, it’s unclear how PHE’s responsibilities in carrying out programs outside the realm of pandemic threats will be managed in the wake of the agency’s dissolution. Outside of COVID-19, PHE managed programs for a variety of health-related issues, including programs focused on curtailing smoking and the harmful use of alcohol, reducing obesity, improving maternal and child health, and managing sexually-transmitted diseases.

“We shouldn’t forget that the overwhelming burden of death and disease in this country is not caused by ‘external threats’ as Matt Hancock put it, such as infections and biological weapons. Instead it is caused by chronic diseases – cancer, cardiovascular disease, diabetes, dementia and others. A significant proportion of these diseases are preventable and Public Health England plays a central role in that through its health improvement functions,” said Linda Bauld, a professor of public health at the University of Edinburgh. “There is a real risk that reorganisation threatens these functions. We don’t yet know how or where they will continue to be delivered.”

And for a coalition of organizations battling a decades-long epidemic at home in the UK, the  institute’s focus on “new” and “external” threats brings out concerns that longstanding domestic health issues will be ignored.

“The announcement made today focuses on “new” and “external” health threats while not acknowledging the public health emergencies that already exist in the UK,” wrote a coalition of UK-based HIV organizations, in a statement. “While attention has rightly been given to the ongoing COVID-19 pandemic, focus must not be lost in tackling long-standing HIV and STI infection rates and reversing sexual health inequalities.

“The Secretary of State’s speech today leaves us with more questions than answers…a knee-jerk restructure of the public health system which is non-transparent, ill-thought through and leads to more fragmentation in accountability structures risks holding us back.”

Receiving a shot of insulin to help control diabetes.

COVID-19 infection may be associated with an increased risk of Type I diabetes in children, according to a new study published by researchers from Imperial College Healthcare NHS Trust.

Diabetes emerged as a high risk factor for severe COVID-19 disease in the early days of the pandemic. But the new study, published in the Diabetes Care Journal, seemed to imply that the opposite relationship could also exist, and that coronavirus infection may be associated with a risk of developing diabetes.

“It appears that children are at low risk of developing serious cases of COVID-19. However, we do need to consider potential health complications following exposure to the virus in children,” said Karen Logan, a clinical nurse specialist at Imperial College Healthcare NHS Trust, and supervising author on the study.

Children have been largely spared from the worst effects of the COVID-19 pandemic, which has hit older people and those with preexisting chronic conditions hard. However, keen clinicians have linked rare complications in children to COVID-19 infection in the past, as in the case of an uncommon, Kawasaki disease-like syndrome that causes inflammation of the blood vessels.

Although the diabetes study only followed a cluster of hospitals in northwest London, some 30 children in hospitals across five paediatric inpatient unites presented with new-onset type I diabetes between 23 March and 4 June, the peak of the pandemic in London. Type I diabetes occurs when damage to the pancreatic cells renders them unable to produce insulin, a hormone that is required to help the body process sugars.

The increase in new type I diabetes cases was highest in two of five paediatric inpatients units, which both saw 10 cases of new-onset type I diabetes during the study, compared to an average of 2-4 cases during the same time period in previous years.

Five out of the 30 children had tested positive for either active or previous COVID-19 infection, although 14 children were not tested in all.

“We believe this study is the first to show a potential link between COVID-19 and the development of type 1 diabetes in some children,” added Logan. However, she noted that the study was limited to only one region in the UK, and more research is required to establish whether there is a definitive link between COVID-19 and new onset Type I diabetes.

Additionally, testing was limited during the peak of the pandemic, so not all the children in the cohort were able to be tested for COVID-19, according to Rebecca Unsworth, lead author on the study.

“In the meantime we hope clinicians will be mindful of this potential link,”  said Logan.

A shot containing insulin, used to control type I diabetes

Strong Link Between Diabetes & Death By COVID-19

Meanwhile, a massive study recently published in the Lancet found a strong link between type I diabetes, type 2 diabetes and risk of COVID-19 related death.

Conducted by researchers at Public Health England and the NHS, the study analyzed data from over 6 million patients registered with general practitioners, and 23,698 COVID-19 hospital deaths. The researchers found that over a third of coronavirus deaths between 1 March and 11 May occurred in people with a previous diabetes diagnosis.

“To our knowledge, this is the largest COVID-19-related population study, covering almost the entire population of England, and is the first study to investigate the relative and absolute risks of death in hospital with COVID-19 by type of diabetes,” the authors wrote.

While previous studies have already established that people with diabetes are at increased risk of experiencing severe COVID-19 disease or death, the new study found that the mortality rate was highest in patients with Type 2 diabetes.

However, after adjusting for demographic factors – such as age, sex and poverty – the study found that those with type I diabetes had 3.51 times the odds of dying by COVID-19 compared to patients without diabetes. Patients with type 2 diabetes had 2.03 times the odds of dying by COVID-19 compared to those without diabetes.

Patients with diabetes who were under the age of 40 had a lower risk of dying by COVID-19. However, the study did not analyze deaths in care homes, which accounted for approximately 70% of COVID-19 deaths in England during the study period.

Image Credits: WHO, Flickr: Jill Brown.

Lab technician processes sample for COVID-19 test

An breakthrough new COVID-19 saliva test, named SalivaDirect, received emergency use approval from the US Food and Drug Administration, potentially opening the door to broader testing. 

The new FDA-approved test, developed by researchers from the Yale School of Public Health, is about as sensitive as a traditional COVID-19 test, but is less invasive to perform, easier to store, and compatible with a variety of platforms. It could also be priced as low as $10 per test. 

FDA Commissioner Stephen M. Hahn called the test “groundbreaking” in a press release.

“Providing this type of flexibility for processing saliva samples to test for COVID-19 infection is groundbreaking in terms of efficiency and avoiding shortages of crucial test components like reagents,” he said. 

To collect a test sample, people are asked to think about a favorite food or upcoming meal to generate saliva, then simply spit into a sterile tube. The process is much less invasive than a traditional COVID-19 test, which requires trained professionals to stick swabs far up the nose and down the throat to collect samples.  

And unlike previously approved COVID-19 saliva tests, the samples for this test don’t need to be refrigerated, nor do they require many reagents. This cuts down the cost of the materials needed for the test to under US $5 per test. 

“We simplified the test so that it only costs a couple of dollars for reagents, and we expect that labs will only charge about $10 per sample,” said Nathan Grubaugh, whose lab developed the Yale test. “If cheap alternatives like SalivaDirect can be implemented across the country, we may finally get a handle on this pandemic, even before a vaccine.” 

Traditional COVID-19 tests collect samples by swabbing the back of the nose and throat.
From The National Basketball Association To The FDA

Yale’s breakthrough saliva diagnostic was tested first on samples from an unusual cohort of people – players in the US National Basketball Association (NBA).

NBA players had previously been using a saliva test developed by Rutgers University that cost anywhere from US $60 to $150 per test. However, in a trial sponsored by the NBA and the National Basketball Players Association, the Yale test yielded similarly accurate results for less than a fifth of the price. 

The Yale test circumvents one key step that other tests on the market take – it doesn’t use expensive reagents to stabilize the sample and extract the virus’ genetic material. Instead, the Yale test relies on cheaper reagents and a heating step to separate the virus’ genetic material from the rest of the sample. While this causes the test to be slightly less sensitive, it makes the test much cheaper than most widely used alternatives. 

And while the test has been used so far in NBA players, the Yale researchers hope it can quickly be adapted for broader use. Grubaugh and his co-authors have said they do not wish to commercialize the test. 

The test works with a variety of commonly available reagents and platforms, and the protocol for running the test has been made publicly available.  

Image Credits: Flickr: Penn State Health, Flickr: Prachatai.

WHO recommends postponing routine dentist visits in areas with high community transmission of COVID-19.

The World Health Organization recommended postponing routine dental visits in areas with community transmission of COVID-19 in new guidelines released last week. 

Many dental procedures can generate aerosols, or tiny solid or liquid particles that contain disease-causing pathogens. If dentists were unknowningly treating coronavirus infected patients, aerosols laden with SARS-CoV-2, the virus that causes COVID-19, could contaminate other surfaces, or infect staff or other patients if inhaled.

To minimize the risk of COVID-19 spreading in dental care settings, WHO recommended that patients avoid seeking non-emergency oral care, such as routine check-ups or aesthetic treatments. Routine visits can resume once community transmission is controlled, and only clearly traceable clusters of infection are present in the community

In the meantime, service providers can offer phone or virtual consultation services for patients experiencing mild symptoms, including prescription of analgesics and antibiotics.

However, patients should still seek their dentist’s care in the case of dental emergencies, such as severe swelling, bleeding or intense pain. Seeking emergency oral care at the dental office can free up general emergency rooms for those with COVID-19 specific complications. Patients should call their clinics ahead of time, and confirm that they do not have COVID-19. 

Dental Workers Should Take Extra Precautions

Healthcare workers should take extra precautions to wear proper protective equipment and adhere to cleaning and hygiene protocols. Dental workers should wear respirators and full protective gear when performing aerosol-generating procedures. 

The guidance has encouraged installation of exhaust fans and whirlybirds or high-efficiency particulate air (HEPA) filters to purify the air and maintain safe ventilation throughout the clinic. It warned against warned using air recirculation devices such as split conditioners, which can disperse droplets or aerosols containing the virus throughout a room. 

Appointments should be adequately spaced out, and patients should arrive alone, wear a mask, and keep at least 1 metre apart from other patients in the waiting room. 

Before starting any procedure, the patient should gargle with 1% hydrogen peroxide or 0.2% povidone iodine for 20 seconds and spit in a disposable cup instead of spittoon. All surfaces should be cleaned, and instruments should be sterilized and disposed after each clinic visit. 

WHO recommends that patients who have confirmed COVID-19 or COVID-19 symptoms seek care for dental emergencies in care centers trained to safely care for coronavirus patients.

Image Credits: Flickr: locomomo.

Surveillance officer in Lagos tracks down suspected COVID-19 cases and contacts of cases.

This week, the Africa Center for Disease Control (Africa CDC) will be launching a continent-wide antibody study to measure the true extent of the COVID-19 pandemic in Africa, where reported coronavirus cases are much lower than initial dire predictions.

Africa CDC Director John Nkengasong announced the study at a regular Thursday press briefing. Just a week earlier, the number of confirmed cases of COVID-19 in Africa crossed one million, making Africa the last continent (apart from Oceania) to reach the sobering threshold. 

While the continent has a number of lessons for the rest of the world regarding handling COVID-19 and pandemics, its comparatively lower testing rate is raising concerns that  the official figures from the region do not accurately capture the true extent of pandemic. 

At the outset of the COVID-19 pandemic, Microsoft founder, Bill Gates predicted it could claim about 10 million lives in Africa. His wife and co-chair of the Gates Foundation, Melinda Gates, added that without drastic actions, COVID-19 could lead to dead bodies lining the streets of Africa.

But Africa has recorded fewer COVID-19 cases and deaths than other parts of the world. Despite the poor quality of health systems across the African continent, the case fatality rate (CFR) in Africa is among the longest globally, hovering around 2% against Europe’s 6.3%, South America’s 3.4%, North America (3.9%), and a global CFR of 3.7% as at August 7.

Dr Michel Yao, Emergency Operations Manager at WHO’s regional office for Africa, noted that earlier predictions (of doom) were based on the assumption that Africa would experience widespread community transmission, and weak health systems would be overwhelmed by the outbreak.

“That was a bit worrying for us – the idea that the system could be easily overwhelmed and the disease could spread faster. This was taken into consideration for the prediction,” Yao told a press conference on Thursday. 

“We are pleased to see that [the worst] did not happen,” Yao added. 

But other officials were more pessimistic. A WHO Africa technical officer warned that “the peak was yet to come,” in a statement to Al Jazeera.

Early Confinement Measures May Have Helped Slow Virus, But Reopening Led To New Cases

Yao noted that the decision of African countries to quickly implement lockdown measures may have helped slow  down the spread of the virus. 

“African countries had confinement measures earlier – closing schools as well as limitation of movements. All these reduced the spread,” Yao added.

However, widespread food insecurity and economic hardship forced many African countries to reopen their economies, resulting in an increase in cases. The case of South Africa, which now ranks among the top five countries with the highest coronavirus caseload, suggests that the country’s lockdown measures may have failed.

But Yao also  noted that African countries had given themselves time to build up treatment and laboratory capacities while under lockdown.

And even in South Africa, there is gradual decline in the daily number of new cases reported, noted Dr Matshidiso Moeti, WHO’s regional director for Africa.

“It is something that is starting but we need to observe for a little bit longer before we say firmly that this is a trend,” Moeti said last Thursday

Besides South Africa, Moeti noted a number of other countries that are seeing reduction in the number of cases to a similar degree – about 20% fewer cases were reported in the first week of August compared to the second week of July at the time of the press briefing. These countries include Nigeria, Côte d’Ivoire, Cameroun, Republic of Congo, Mauritania, The Democratic Republic of the Congo, the Central African Republic, Botswana, Liberia and Benin Republic. WHO also noted that while there has been a 13% increase in the number of COVID-19 cases in the African Region in the past week, it was lower than the 18% increase recorded during the previous reporting period.

“We still have countries [where] there was an initial increase in cases [after government relaxation of measures]. Now we are starting to see a decline. But the take home is we need to monitor this and just assure ourselves that the decline continues,” Moeti said.

Delays & Shortages in Testing Could Lead To Undercounting Cases

Several African countries have been facing a shortage of testing kits, raising concerns that the continent’s relatively low number of reported COVID-19 cases was due to lack of testing. 

For the first time, donor countries that often come to Africa’s aid are among the worst hit by the pandemic and are therefore prioritising their countries’ citizens, stockpiling PPEs and testing kits. Only 5 countries in Africa have carried out at least 500,000 COVID-19 tests and many have tested less than 1% of their population.

While 5.4% of tests conducted globally test positive for COVID-19, Africa has the second highest positivity rate of all seven continents at 11.6%. 

But the high positivity rate may be due to responders across the continent rationing tests to only those who showed symptoms of disease, who are much more likely to test positive. Moeti also said that the positivity rate has not changed in African countries that are expanding COVID-19 testing, indicating that current testing is capturing most cases in these countries.

“Some countries have increased their testing per capita while maintaining a low positivity rate. They include countries such as Mauritius, Rwanda, Cape Verde and Botswana,” Moeti added.

High Prevalence of SARS-CoV-2 Antibodies in Populations Indicates Higher Spread of Virus Than Testing Positivity Implies

Some countries are finding that many of their citizens are testing positive for antibodies for SARS-CoV-2, the virus that causes COVID-19. This may indicate that the virus has spread to more citizens than the testing positivity rate implies. For example, Mozambique has less than 3,000 confirmed cases of COVID-19 in the entire country, but serological surveys found SARS-CoV-2 antibodies in 5% of households in the city of Nampula and 2.5% of households in the city of Pemba alone. 

Addressing a press conference, Africa CDC director John Nkengasong said “What is important is far fewer people are coming down with the disease. How many people are infected and asymptomatic on our continent? We don’t know that.”

Still, the continent has a relatively lower COVID-19 death rate than expected, even in light of signs of wider spread of the virus. 

With the exception of South Africa, many countries are not observing excess deaths due to respiratory-related symptoms. While death and birth registration lags in Africa compared to other regions of the world, WHO AFRO officials noted that COVID-19 deaths remained low in African countries with efficient death reporting systems, implying that these African countries are seeing a true lower death rate than initially predicted.

Health experts have attributed the lower than expected case-fatality rate to Africa’s comparatively young population, which may withstand the virus better than populations with more older people. COVID-19 death rates are highest in people over the age of 65 years old. 

Collaboration &  Innovative Thinking Help African Countries Leverage Strengths

Another aspect of the African response has been the cooperation seen among various countries, and the coordination role being played by the African Centers for Disease Control (Africa CDC). 

Dr. Ahmed Ogwell Ouma, Africa CDC’s Deputy Director, told Health Policy Watch that the center is supporting African countries in centrally accessing testing kits and consumables including PPEs. It is also assisting in capacity development and risk communication.

With the COVID-19 not ending anytime soon, the WHO and Health Ministers of Rwanda and Niger republic noted that African countries are already taking localised actions that leverage on already existing infrastructure and capacity for the pandemic. 

Moeti mentioned that in Nigeria, advocacy by community leaders encouraged more people to go for testing. In Mauritania, university students are helping to ramp up surveillance while in Kenya, over 79,000 community health workers and 15,000 youth champions have been trained to help raise awareness among 17 million people through household visits and other activities.

Moreover in Zimbabwe, the integration of COVID-19 into polio eradication systems is providing real time information for decision making regarding both diseases. Cote d’Ivoire has also cascaded training to around 10,000 health workers in all of its 113 health districts.

Rwanda is one of the  countries in Africa that is actively deploying innovations to aid its COVID-19 response. Its decision to deploy robots to reduce contacts of health workers with persons that tested positive is already producing results, according to the country’s Health Minister Dr Daniel Ngamije. He revealed that less than ten healthcare workers in the East African country have contracted COVID-19. 

The country is also actively driving the adoption of cashless transactions to prevent possible transmission of the virus from one person to another through cash.

“We came to realise that financial cash transactions were also one of the sources of transmitting the disease. The government encouraged the use of mobile money’s cashless system by facilitating telecom companies to not charge those transactions, reducing the cost of transaction so that people can take advantage of not necessarily doing their transactions by exchanging money but they can do payment or transfer of money using technology,” the Minister said.

He added that the country also embraced digital tools for collecting data, which allow users to reduce the amount of materials and labor required to track down the virus. 

“While we were doing contact tracing, initially we were using some [paper] forms. But those also can be a vector for transmission of the disease, or just bring a lot of work. Then we went through a system of using iPad and mobile phone for collecting information especially when we are doing our contact tracing. We have an app which can be used on the devices. Even when there is no connection, later on the information can be analysed when a person is joining a place where there is connection. This was very helpful for investigation teams,” Ngamije explained.

Decentralisation Allows Countries To Cover More Ground
A surveillance officer visits far flung villages in Lagos to track down COVID-19 cases.

As the pandemic continues its spread and cases continue to rise, Rwanda and several other African countries are decentralising their pandemic response efforts. Over 30 countries have decentralised lab testing capacities, according to the WHO. This means that more testing facilities are emerging thus easing pressure on central facilities. In Nigeria, testing facilities increased from one to over 40. 

Beyond decentralising testing, African countries are also decentralizing case management and treatment. 

“We started with one national referral lab that is able to test COVID-19 in February, today we are with 10 sites in the country where COVID-19 can be tested,” Rwanda’s Health Minister said.

He added the country is already piloting home management of cases in order to decentralise case management. 

“We have started to test home-based management of COVID-19 and we are starting piloting model to see if this can be feasible in some settings in some households – treating COVID-19 at home without necessarily picking the person to isolation center because after 6 months of the pandemic, government is incurring a lot of expenditure and it is a lot of pressure to the health system. We should be anticipating ahead what might happen if there is generalised community transmission. We are already thinking how to manage the scenario,” Ngamije said.

This is a welcomed development for the WHO which has also heralded the introduction of pool testing in Ghana and elsewhere to maximise the limited testing kits and rapidly screening large populations to quickly identify positives.  

New Challenges Emerge As Airplanes Take Flight Over Africa Once More
Checking traveler temperatures at border crossings

With Africa’s airspace opening up and international travel resuming, it is becoming easier to move experts, utilities, PPEs, testing kits and additional around. The WHO is already sending experts to hotspot countries. But there are concerns that this could also lead to the resumption of  importation and exportation of positive cases. In Rwanda, the government said it is making efforts to ramp up testing of travelers. 

“Measures are in place to contain any arrival of imported cases. Even when people are traveling from Rwanda now (because we’ve opened our airspace), we have strict measures to test them before traveling. We are trying to avoid any new imported cases and also avoid exporting cases while we contain transmission of the disease within the country itself,” the country’s Health Minister said.

With major aspects of economies across Africa already reopened, there are concerns that this could make citizens suggest that the pandemic is over. Yao noted that this needs to be addressed and measures need to be enforced. But some cities are already mandating and enforcing the use of face masks and other measures. In Osun state, Nigeria, individuals caught not wearing face masks are being charged and sentenced. Yao noted that for Africa to continue to maintain its good outing with COVID-19 and to start flattening the curve will require encouraging its citizens to continue to abide by the various health advisories. 

“It is not over yet. It is why some of the preventive measures need to be enforced again.  We are noticing in some countries that people are no longer using masks, not observing physical distancing. Countries should continue working. Decentralising is critical, we must be anticipating to avoid a worse scenario,” Yao concluded.

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

Photo Credit: Nenad Stojkovic

Health experts and access advocates warn that rich countries may leave poorer countries in the lurch as states scramble to preorder doses while COVID-19 vaccine candidates enter late stage clinical trials.

The United Kingdom on Friday secured 90 million doses of two promising COVID-19 vaccine candidates, joining a growing group of rich countries buying up doses of promising vaccine candidates before they hit the market. 

It’s “urgent” for the UK government to clarify how it will ensure equitable global access to these vaccines in light of the deals, said Alex Harris, head of Global Policy at the research foundation The Wellcome Trust in a press release. 

“Without this clarity, the risk increases that other rich countries will seek to strike similar bilateral deals, potentially securing significant oversupply, leaving insufficient volumes of vaccine for the rest of the world,” added Harris. 

Access advocates decried the move, accusing the UK of fueling ‘vaccine nationalism’ and joining other rich countries to ‘hoard’ the vaccine before it even hits the market.

“This latest vaccine deal shows the government shows a complete disregard for its own claims about supporting equitable global access to Covid-19 vaccines,” said Heidi Chow, senior campaigns and policy manager at Global Justice Now. “This UK-first approach is fueling vaccine nationalism as rich countries scramble to hoard vaccine supplies, leaving poorer countries without access. The fastest way to end this pandemic is through global collaboration.”

Health experts have generally agreed that a successful COVID-19 vaccine should first be given to healthcare workers, and then to high-risk groups in areas with high transmission of the virus. But many are concerned that the deals being struck between vaccine producers and high-income countries will leave poorer countries with potentially higher numbers of COVID-19 cases without access.

“Instead of accelerating an arms race for access to COVID19 tools by competing with other countries to get preferential access to potential vaccines, the UK should be taking a collaborative approach,” said Diarmaid McDonald, lead organiser for Just Treatment, a patients advocacy group in the UK. 

“If we want to manage this pandemic successfully the UK Government need to be championing global collaboration and coordination,” added Saoirse Fitzpatrick, advocacy manager for STOPAIDS. “This means supporting international efforts to facilitate the sharing of research data to speed the vaccine discovery process, and ensuring that patent monopolies do not drive up the prices of these vaccines and cause supply shortages.”

Countries Scramble to Secure Vaccine Stocks Through Bilateral Deals

The UK signed its latest deals with Novavax and Janssen Pharmaceuticals, a branch of Johnson & Johnson, promising to support clinical trials for both companies’ vaccine candidates. Neither vaccine candidates has entered the last phase of clinical testing before being eligible for regulatory approval. 

Earlier this year, the UK had signed a contract with Sanofi/GSK for 60 million doses of their investigational COVID-19 vaccine, and has also secured deals with the University of Oxford/AstraZeneca and the BioNTech/Pfizer alliance for stocks of their trial vaccines.

The UK deals follow the United States’ announcement of the largest pre-order contract to date of an investigational COVID-19 vaccine. The Trump administration announced Wednesday that it had ordered 300 million doses of Moderna’s investigational COVID-19 vaccine to be manufactured, ready to be deployed if the vaccine shows success in Phase III clinical trials. 

Oxford/AstraZeneca, Moderna, and BioNTech/Pfizer’s vaccine candidates have begun Phase III trials, aiming to enroll around 30,000 volunteers for each trial.

The European Union is also pursuing bilateral deals with pharmaceutical companies to secure doses of the vaccine for Europe. So far, it is in talks with Sanofi/GSK to buy up 300 million doses of their investigational vaccine.

One global initiative, the COVAX facility, aims to secure at least 950 million doses of any successful vaccine for low-income or lower-middle income countries. However, some low and middle income countries are in talks with banks to finance their own bilateral deals with vaccine producers, in an effort to avoid being left behind.

Even the World Health Organization is concerned about the implications of these deals.

“Excess demand and competition for supply is already creating vaccine nationalism and risk of price gouging,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus on Thursday. “This is the kind of market failure that only global solidarity, public sector investment and engagement can solve.”

Image Credits: Flickr: Nenad Stojkovic.