New digital technologies such as smartphone apps and localization data have been used to model and monitor the COVID-19 pandemic. But along with hopes that these tools will help curb the pandemic, their use by both authoritarian and democratic governments can invoke images of dystopian surveillance.

These tensions and more will be discussed Wednesday at Will Digital Technologies Save Us from the Pandemic?, the third panel in the Global Pandemics in an Unequal World Series, co-hosted by The New School, The Independent Panel on Global Governance for Health, and Health Policy Watch. 

Cities in China and the Republic of Korea have implemented contact tracing apps that require citizens to input information on daily temperatures and coronavirus symptoms. Taiwan uses a quarantine app that monitors location data on COVID-19 patients, ensuring they remain in isolation. In the United States, anonymized cell phone data has been used to model the spread of the disease. 

“Smartphone apps dominate global discourses on managing the pandemic,” said Sakiko Fukuda-Parr, director of the Julien J. Studley Graduate Programs in International Affairs and professor of International Affairs at The New School. “But let’s not forget public health infrastructure and methods that resulted in 20th century advances in controlling contagious diseases.”  

In the absence of a vaccine or cure, countries have turned towards “classic public health measures” such as contact tracing to map and control the spread of the virus. 

In the United States, which hosts the most coronavirus cases in the world, New York City’s army of contact tracers is doing things the old fashioned way – calling patients who test positive to identify those most at risk of onwards transmission.

Concerns Around Privacy Slow Public Health Surveillance Efforts In NYC
NYC subway resumes normal operation as city shifts to Phase 1. As cities, rapidly identifying new clusters of disease is important to help prevent a resurgence.

But as widespread protests against police brutality grip the United States, old concerns about the ethical use of public health surveillance have resurfaced in New York City, the original epicentre of the US’ COVID-19 epidemic. 

Contact tracing requires asking people for personal information about coworkers, friends, and family members they have been in contact with – and some are hesitant to divulge personal information in the current political climate. Some protestors have been concerned that information used for contact tracing could be repurposed by law enforcement or immigration officers, Naiya*, a community organizer from NYC told Health Policy Watch. 

“While contact tracing may provide critical data to inform policy, it’s use in a racist and carceral society can transform contact tracing into a weapon for state surveillance and for the policing and control of vulnerable people,” they said. “We have to envision community-led, resource oriented, and consensual efforts to contain the pandemic.” 

New York City’s contact tracing team doesn’t ask people about their histories attending protests, according to Sarah*, a contact tracer in Manhattan. Nor does the team ask about immigration status, or divulge patients’ COVID-19 test information to employers or law enforcement. 

Regardless, “some folks are skeptical to share info about their contacts,” said Sarah. “I think privacy is the big concern. For example, home health aides have been hesitant to divulge information about their patients.” 

“If people are hesitant to share, we give them a number to call back after they have done more research on us, and if they feel comfortable sharing their contacts at a later date.”  

Who Creates and Accesses Data in the Smartphone Age?

Some experts are worried that new technologies amplify existing concerns around the ethical use of public health surveillance. In one widely reported case, authorities used information from rideshare company Uber to track down potential contacts of a COVID-19 patient, leading to the suspension of over 240 accounts and two drivers from the platform. 

“Viewed superficially, that’s responsible — but what’s actually happening here is that a private company suspended the livelihood of two drivers and a number of others’ mobility, based on suspicion of exposure, without a whole lot of science,”  writes Sean McDonald, a senior fellow at the Center for International Governance Innovation.

“Concerns surrounding corporate and political interests converge in the contexts of this current global pandemic,”  writes Stephen Roberts, a Global Health Policy fellow at the London School of Economics, noting a growing unease with the increasing role of large, private tech corporations in assisting governments with managing emergencies.

The United Kingdom, for example, recently partnered with Google, Amazon, and data processing firm Palantir on a COVID-19 surveillance project. Google had previously sparked controversy by breaching patient privacy laws when transferring billions of identifiable patient records without consent for a clinical alert app, according to Roberts. Palantir infamously supplied data to United States immigration authorities to inform deportations and family separations. 

 “Public health technologies must be considered within their sociopolitical and economic contexts; and histories,” said Naiya. “In pursuing such measures, we must ask ourselves: Who is this tool benefiting? How do we protect Black, brown, indigenous, undocumented, and disabled communities from violence and retaliation?”

For more on this topic, tune in Thursday to the Will Digital Technologies Save Us from the Pandemic? webinar at 10AM EST/4PM CET.

*Names changed by request of sources

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

Rwanda uses robots to deliver food, drugs & other necessities to quarantined patients, reducing healthcare workers’ exposure to COVID-19.

19 June 2020 (Ibadan, Nigeria) – We are at war with COVID-19, a war we must win to survive, said Dr John Nkengasong, Director of the Africa Centres for Disease Control, on Friday at a workshop on “Home-Grown Solutions to the COVID-19 Health Crisis,” hosted by the United Nations Development Programme.

Since the continent’s first confirmed case of COVID-19 was reported in Egypt in February 2020, the virus has spread across Africa to every country on the continent. However, initial grim predictions about the pandemic in Africa have yet to pass – a development that Nkengasong attributed to early measures that were taken to minimise the pandemic’s impact.

But four months into the pandemic, the Africa CDC Director noted that current measures including social distancing, wearing face masks, handwashing and movement restrictions will be inadequate in curbing the virus on the continent.

“We have to innovate ourselves out of the war,” Nkengasong said.

John Nkengasong, Africa CDC Director

From the outset of the pandemic, African countries have been scaling up cooperation; Africa CDC has also been coordinating response efforts including procuring diagnostic kits, drugs PPEs for African countries. Nkengasong noted that ongoing collaboration and communication among member states of the African Union will help in accelerating the continent’s journey to recovery from the impact of the pandemic on Africa economies. 

“We cannot unlock economies safely without expanding COVID-19 testing, contact tracing and getting effective treatment,” he said. He also identified diagnostics, vaccines and therapies as important components that must be in place to put the end of the pandemic within reach.

Efforts around these key issues have been advancing globally. Health Policy Watch recently reported the emergence of dexamethasone as an effective treatment in reducing mortality in patients with severe COVID-19 by up to one-third. 

Still, Nkengasong noted, relying on international cooperation alone to develop potent tools for the disease is ineffective.

Opportunities for Innovation Across Africa

Workers manufacture PPE in a Kenyan factory

When Rwanda deployed anti-epidemic robots to aid its response against COVID-19, it became a major example of opportunities for innovation. Clare Akamanzi, Executive Director and Chief Executive Officer of the Rwanda Development Board, noted that the robots have reduced the risks of exposure of the country’s health workers to COVID-19 by taking over routine activities such as temperature checks, food and drug delivery to individuals that tested positive and have been quarantined.

Global shortages of surgical masks and personal protective equipment compelled the country to look inwards for solutions; including importing machines from China to enable local production of much needed health consumables.

“76 local companies are now manufacturing face masks in Rwanda, three are making surgical masks while one is making PPEs – all have been certified by the Rwanda Food and Drugs Authority,” Akamanzi said.

She also mentioned the utilisation of 3D printing technology to make face shields for healthcare workers and the deployment of drones to enforce lockdown and social distancing rules by taking pictures of areas where public gatherings are being held.

Dr Julie Makani, Tanzanian medical researcher, noted that the multi-sectoral deployment of innovations during the COVID-19 pandemic would provide African countries with tools that can be converted for other health services.

For example, she pointed to a number of African countries, including Nigeria and Ghana, that are also deploying telemedicine to ensure that individuals living with sickle cell disease have access to professionals. 

Home Grown Solutions for the Continent

Bience Gawanas, Under-Secretary-General of the United Nations

While Rwanda’s pandemic robots were donated by UNDP, Bience Gawanas, Under-Secretary-General of the United Nations, argued that Africa can also play a more central role in developing the tools that the continent will use to combat the pandemic beyond simply mobilising already existing innovations.

She noted that limited capacities made it difficult for many hospitals in Africa to make use of donated equipment – a problem that could be addressed if Africa were the one that is providing the innovations. Moreover, she noted that Africa is in a better position to define its own priorities – which could differ from one country to another in the middle of the same pandemic.

“This is not just a health issue, it is also a social issue. Necessity is the mother of all invention and Africa’s economic independence will only happen when it changes from relying on foreign products to a continent that can produce,” Gawanas said.

As just one example, several African youths are repairing ventilators, and local innovators in Nigeria and other African countries have also presented prototypes of cheaper ventilators that could save lives, potentially providing easier access to the lifesaving devices that are in short supply globally.

However, controversies surrounding Madagascar’s COVID-19 cure claim brought attention to the continent’s scientific research ecosystem and existing gaps in clinical trials protocol. Author and researcher, Dr. Chika Ezeanya-Esiobu, noted that such developments may be due to the inability of African researchers to afford a conventional clinical trial. 

She noted that COVID-19 has confirmed that Western countries alone can no longer be relied upon to solve all of the world’s health problems and Africa should maximise the opportunity presented by COVID-19 to revamp, improve and localise its drug research strategies – putting the continent’s priorities and peculiarities into consideration. 

“Africa might hold the key to the solution of health challenges that face the whole of humanity which is why we need clinical trial processes that the continent can afford. Current approaches can only be funded by pharmaceutical giants that are driven by profits,” Esiobu noted.

The Enemy from Within

Pharmacy technician working on production of herbal medicines

Before the continent will be able to convince the rest of the world that its drugs and other innovations can be trusted, Ssali Rose, Managing Director of Ssali Publishing House, noted that Africans need to get over negative perceptions about locally developed medicines, especially one that equates local medicines to witchcraft (an esoteric practice).

“We need to decolonize our minds and accept that we must craft our own solutions so that we can quickly get ourselves out of the situation that we’ve found ourselves in. African governments also need to relax barriers so that it would be easier for one innovation from one part of Africa to be adopted by other African countries,” Rose said.

While agreeing that Africa needs to take a more central role in the development of tools for its healthcare sector, Nkengasong noted that the continent’s innovators, governments and other stakeholders must ensure that Africa’s innovations go through the rigor of scientific testing so that the rest of the world will begin to take solutions from Africa more seriously.

“Victory will be continental but the battle will be won locally,” Nkengasong said.

Image Credits: Twitter: Rwanda Ministry of ICT and Innovation, APO/MOH Kenya , AMR Industry Alliance.

A refugee filling an application at the UNHCR registration center in Tripoli, Lebanon.

As the world hit a sober new milestone of reporting more than 150,000 new COVID-19 cases in one day, another slow burning crisis has also reached new heights.

There are now nearly 80 million refugees around the world, making more than 1% of the world’s population forcibly displaced by the end of 2019, according to the United Nations High Commissioner for Refugees (UNHCR) annual report, released just days ahead of World Refugee Day on 20 June.

The number of new refugees shot up by nearly 10 million people from 2018 to 2019, compared to a 3 million rise in the number of refugees between 2017 to 2018. 

“We reported a dramatic increase in displacement figures last year compared to the year before,” said UNHCR Commissioner Filippo Grandi, speaking at the World Health Organization’s regular Friday COVID-19 press briefing. “This means that the opportunities for solving force displacement are receding. We are living in a world in which making peace is very difficult.”

“Refugees are particularly at risk of COVID-19 because they often have limited access to adequate shelter water, nutrition, sanitation and health services,” said WHO director-General Dr Tedros Adhanom Ghebreyesus.

The pandemic is exposing those forcibly displaced to even “more hardship,” added the DG, noting that in some places like Turkey, up to 70% of refugees have lost their jobs since the pandemic began.

“Contrary to the political rhetoric, almost 85% of refugees live in low- and middle- income countries,” said Grandi. “This means [they are in] countries that not only have fragile institutions and fragile economies, but also often fragile health systems.

“And remember, the majority of refugees and displaced are actually not in refugee camps, they live in communities. And those communities in some places have already been devastated by the pandemic.”

In those communities, it’s “extremely” important that the same services for refugees are being provided for the hosting community, said Grandi and WHO Health Emergencies Director Mike Ryan.

“We can’t create differentials because another risk that a pandemic might generate is further stigmatization of people that are not mainstream in that [host] community,” said Grandi.

Image Credits: Mohamed Azakir / World Bank.

Electron microscope photograph of a dying cell (green) heavily infected with SARS-CoV-2 (purple)

A standardized set of more than 80 compounds with known or predicted activity against SARS-CoV-2, the virus that causes COVID-19, has been compiled by the Medicines for Malaria Venture in an effort to catalyze the discovery of drugs for the disease.

The announcement comes amidst rapid shifts in the research around potential COVID-19 treatments. Just this week, the much-hyped antimalarial hydroxychloroquine lost favor as a potential treatment when preliminary data from the two large clinical trials showed it did not decrease mortality in COVID-19 patients. Fresh hope was pinned on the anti-inflammatory drug dexamethasone, a relatively new player, after results from the United Kingdom’s Recovery Trial found it was associated with a dramatic reduction in mortality in patients suffering from severe COVID-19.

“”Recent reports of the efficacy of dexamethasone for treatment of COVID-19 highlight the value of exploring all options for new treatments,” Dr Timothy Wells, MMV’s Chief Scientific Officer, told Health Policy Watch. “With MMV’s COVID Box we have combed through the scientific data to identify a collection of compounds with claimed or predicted activity against the virus – to our knowledge this is the only attempt to prepare and distribute such a compound set.”

The COVID Box contains some 80 marketed drugs and compounds in development that could potentially be used to treat the virus, and will be available free-of-charge by request to any scientists seeking to research potential treatments for the disease.

In return, researchers using the box are asked to publish their findings in open-access domains, thus making it faster to share relevant information on any of the candidate compounds.

The Box is ‘complementary’ to other initiatives to accelerate new tools for combatting the COVID pandemic, added an MMV spokesperson. Pooling all compounds with activity against the virus in one place gives scientists a base to start narrowing down potential treatment candidates.

Launch of the COVID Box launch follows on from an earlier initiative, the Pandemic Response Box launched by MMV and the Drugs for Neglected Diseases Initiative (DNDi) in 2019. That set contained over 400 compounds with antibacterial, antiviral, or antifungal properties that could potentially be used to combat the next pandemic threat. The advent of the COVID-19 pandemic prompted MMV’s scientists to begin combing through the data on compounds with specific activity against SARS-CoV-2 and 30 related viruses. This led to the selection of the initial 80 compounds in the box. Another 80 compounds will soon be added to the Box, according to an MMV press release.

‘Open Science’ Model Helps Accelerate Research By Narrowing Down Compounds

Dr Sara Cherry’s Virology lab at the University of Pennsylvania has been screening many of the compounds in the original Pandemic Response Box to test for those that may block entry of the SARS-CoV-2 virus into human lung cells.

“Pretty early in the game, we began screening [compounds] using an assay that we developed where we basically take cells, we add drugs, and then we add the virus. And then we look at the viral infection in the cells to see if there are compounds that block infection,” explained Dr Cherry.

But compounds that show activity against the virus in a lab studies may not be effective against the virus in a human body.

And even in lab experiments, compounds can react differently to the virus based on the type of cell model used, according to Dr Cherry.

“Because the [COVID box] narrows the list of compounds down to a smaller set, more people can test them in more relevant models, rather than creating unnecessarily large libraries where it’s hard to screen in more relevant models like lung cells,” said Cherry, welcoming the more targeted set of compounds the box contains.

An Important Finding from Targeted Screening Studies: Chloroquine & Chloroquine Derivatives Can’t Block Virus Entry into Lung Cells

Colorized electron microscope photograph of SARS-CoV-2 (yellow) heavily infecting a dying cell (blue)

For example, earlier studies of compounds with potential activity against SARS-CoV-2 used a cell line derived from the kidneys of African green monkeys, called Vero, which can easily be infected by novel viruses, thus making it easier to reproduce in large quantities for large studies screening many different compounds.

But Cherry said that while the Vero cell may be simpler to set up as a cell model, it does not most accurately mimic how SARS-CoV-2 attacks the human lungs.

“We found that very few of the drugs that people reported are antiviral in Vero cells are active in [our lung cell model],” said Dr Cherry. Many of the molecules in the same family of drugs as hydroxychloroquine for example, can help block the virus from entering the Vero cell line, but do not block the virus from entering a lung cell, which may partially explain hydroxychloroquine’s lackluster performance in recent clinical trials.

“What this tells you is that the virus can enter cells in different ways, and we should really be focusing on [how it enters] lung cells, because that’s where the problem is during human infection,” said Cherry. A promising candidate compound is camostat mesylate, which blocks  the TMPRSS2 protease, a key protein that helps SARS-CoV-2 enter lung cells.

“With this move towards open science, I think it’s been really helpful for everyone to learn about what drugs might be active against the virus,” said Dr Cherry. “That level of data sharing could move everything faster to potentially help people. So I think MMV, by collating this all together and providing a resource is really very valuable for everyone.”

Image Credits: NIAID, NIAID, MMV.

Unhealthy food habits drive obesity

In the past forty years, the world has done “really well” on improving food availability.  But  meanwhile, diets have shifted in “very bad”, unhealthy directions. Even people who can afford nutritious food are opting for junk food instead, said Steve Godfrey, of the Geneva-based food and nutrition NGO, GAIN, at a conference on food systems hosted by Geneva’s Graduate Institute on Tuesday.

Improving food systems is essential because diet is the “single biggest cause” of disease burden worldwide, added Lina Mahy, WHO’s Technical Officer for Nutrition and Food Safety, who also spoke at Tuesday’s event.

Unhealthy diets claim 11 million lives a year. They also lead to stunting in 20% of children worldwide, and contribute to malnutrition in a third of the population.

“Sugar now is more dangerous than gunpowder”, said Githinji Gitahi, CEO, of the Nairobi-based NGO Amref Health Africa. “More people are dying of sugar than from terrorism and violence…Three times as many people are overweight and obese than those that are hungry.”

At the same time, accessing sufficient food has become an even bigger challenge for many people living on subsistence incomes and diets, particularly in COVID-challenged times. 

School feeding programmes – an important component of nutrition support for children and adolescents  – have shut down completely in some communities, said Igbeka. Products that would have been used by schools remained in producer’s warehouses, where their storage capacity is “very limited” and technologies for long-term preservation are minimal.

After Ebola, “nothing was done” to build resilient health and food systems, said Gitahi, and we are facing the same challenges now. 

“Food is about dignity,” he added, describing food security as a foundation of health.   

Government Lockdowns Have Far-reaching Impacts On Frail Food Systems

COVID-19 had ‘minor impact’ on 3% of businesses surveyed

In Africa, government-imposed lockdowns have had ‘far-reaching’ impacts on already-frail food systems because workers have not been able to get to production sites or access their farms, said Uduak Igbeka, Country Support Manager for the SUN Business Network, a global movement of 61 countries to end malnutrition.

And closed borders have limited exports of foods like avocados or eggs from Nigeria, Kenya and Ghana.

In West Africa, restrictions on movement have “seriously” impacted the planting season – and have slashed production volumes and sales, while also destabilizing food prices in the whole of Africa:

In one study of some 340 small- and medium- sized enterprises (SMEs), 80% reported decreased food sales, and only 3% said that the coronavirus had ‘little impact’ on their business, she added. Over 50% of businesses said the impact was ‘considerable’ and ‘difficult to manage’, with almost one fifth risking closure.

“We can see that there is high demand for technical support”, said Igbeka. “We are carrying out capacity building initiatives in different countries to see how we can bring the right knowledge [to SMEs] and [help] businesses adapt to the current situation [so that they can] survive it themselves.”

Fostering Food Resilience – Stronger Governance Critical

Bees are essential to pollinate food crops

The world has the tools to foster food system resilience for better health, said Gitahi. However, we need to use them “now” to build back better from the pandemic.

Good governance is part of the answer, he said.

Governments need to “make the link” between health, food and the environment said Mahy, because these systems don’t exist in a vacuum.

“Health and food are very intimately connected..the strength of our health systems depends on food [systems]” and on the environment, said Godfrey. 

Bees, for instance, are “essential for our food systems to work, but they’re dying”, said Mahy.

Protecting Health – Smart Investments, Legislation & Stakeholder Engagement 

Carefully-crafted policies also can nudge people to eat healthier food. They can make healthy food accessible to the most vulnerable, while shooing people away from toxic foods that are high in sugar, salt or unhealthy trans fats – principally by making them more expensive:

“We must bring legislation & regulation to the table, and civil society must force governments to improve regulation of unhealthy foods”, said Gitahi. “Countries need to regulate sugar imports, regulate unhealthy fats, and the time to do it is now.”

But such policies and rules also need public support – and that requires awareness-raising about the health benefits of balanced and varied diets:

“This is a time where dietary diversification needs to be emphasized… people need to know what to eat, there needs to be advice on what exactly is good.”

“Stakeholder engagement is very critical in gaining equity,” added Igbeka. “All players need to be able to understand what is in the best interest of each other.”

Data Is Vital To Identify Malnourished and Undernourished

Githinji Gitahi, CEO of Amref Health Africa.

Data is vital to identify groups that are suffering the most from poor access to food or lack of nutritious foods. 

While real-time data is plentiful for COVID-19, there is “very little clear data on food availability, pricing and differentials…that’s quite a big gap” that needs to be addressed, added Godfrey.

“In Africa, there is a lack of disaggregated data to determine who is vulnerable”, said Gitahi. ”Who do you give aid to if you don’t know who’s vulnerable? Data is extremely critical.” 

And even when there is data, it’s often not made publicly available, or it doesn’t target those that actually need help, mainly because of rigid eligibility criteria:

“We don’t know who to give [aid to], so you end up spreading [limited money] across everyone because you don’t know exactly [who needs help].”

According to Gitahi, the best way to improve access to food in Africa in the present health emergency is not going to be via the traditional aid paradigm of big conveys delivering sacks of flour, corn or basic necessities. Rather, data-driven approaches can identify households or communities in greatest need, and systems like mobile cash transfers can help ensure that aid reaches them for the purchase of basic necessities. 

Image Credits: Flip, photophilde.

Smiling schoolgirls get their pictures taken near Jinja, Uganda.

While children seem to largely escape the worst COVID-19 infections, lockdowns to curb the pandemic have increased exposure to a different threat to children’s health – abuse and violence.

In Eastern Uganda, where so far no child has been infected with COVID-19, lockdowns have led to an uptick in reports of child abuse, exploitation, and violence.

In Mayuge district, 59 cases of defilement – or the sexual abuse of a child – have been reported since the national lockdown began two months ago, according to a qualitative study led by local non-profit Community Concerns Uganda. Some 58 cases have been recorded in Jinja district.

“Many girls have entered cross-generational relationships to access basic supplies like pads and soap, which has contributed to early pregnancies,” Brenda Doreen Nakirya, managing director of Community Concerns Uganda, told Health Policy Watch.

Because parents, working as casual labourers or owners of small businesses, have lost their source of income since lockdowns began, many families are unable to feed their children regularly.

And essential menstrual products for girls, like sanitary pads, are “no longer a priority” for cash-strapped families, said Nakirya.

Additionally, the closure of schools, which act as safe havens for many children has increased the risk of experiencing violence.

“Generally, the pandemic has worsened the living conditions of children, putting them at an increased to gender-based violence at a time when reporting channels and referral pathways are severely affected,” said Nakirya.

“COVID-19 has greatly limited children’s access to basic needs including food and health care.”

Child Violence As A Global Problem
A young girl wearing a mask holds a laptop. Children are shifting to online learning as schools shut down during the COVID-19 pandemic.

The situation in Eastern Uganda is just a snapshot of a pervasive global problem. Approximately 1 billion children every year are affected by physical, emotional, sexual, or psychological violence, and COVID-19 lockdowns could be exacerbating abuse, according to a new report published Thursday by several UN agencies, including UNICEF, and the End Violence Partnership.

A staggering 40,105 children were victims of homicide in 2017, according to the report. The homicide rate in boys was almost twice that of the rate in girls worldwide. Boys in the Americas faced the highest risk, with a staggering rate of 9.3 homicides per 100,000 people in boys under 17. Some 120 million girls experienced unwanted sexual contact before the age of 20.

COVID-19 Closures Lead to Increase In Violence Against Children

School closures have forced almost 1.5 billion children to stay at home, with many engaging in online learning for the first time.

Amidst the COVID-19 lockdowns, cases of domestic abuse, as children and spouses are forced to shelter-in-place with their abusers, have spiked. According to the Global Status Report on Preventing Violence Against Children 2020, one in four children under 5 lives with a mother who suffers from intimate partner violence. Nearly 75% of toddlers age 2-4 regularly suffer physical punishment and or psychological violence at the hands of caregivers and parents.

There has been a rise in cyberbullying and online exploitation of children, according to Audrey Azoulay, UNESCO Director-General. A third of students between the ages of 11 to 15 were bullied in the past month, according to the report. Cyberbullying affects 1 in 10 children worldwide.

A young boy plays a video game at the Binational Border Assistance Center on the border of Peru and Ecuador.

And even as cases of violence rise, children are separated from normal sources of emotional support including friends, extended family, and mental health professionals. An increase in calls to domestic violence helplines has been observed, alongside a decrease in the number of abuse cases referred to child protection services.

“Violence against children has always been pervasive, and now things could be getting much worse,” said UNICEF Executive Director Henrietta Fore. “Lockdowns, school closures and movement restrictions have left far too many children stuck with their abusers, without the safe space that school would normally offer.

“It is urgent to scale up efforts to protect children during these times and beyond, including by designating social service workers as essential and strengthening child helplines.”

INSPIRE Framework Promotes Key Child Protection Strategies

Using the INSPIRE framework, which promotes seven key child protection strategies, countries can make progress against violence. However, the report, the first one to compare progress in 155 countries against the framework, found that countries are lagging behind in implementing all seven strategies, despite about 80% of countries having a national strategy to reduce violence against children. 

Among 155 countries, only about 20% of those national strategies were fully funded. Some 88% had laws protecting children against violence, but only 47% strongly enforced such laws.

Countries made the most progress in collecting data and school enrollment, with 54% of countries reporting that a sufficient amount of children in need were enrolled in school. Some 83% of countries reported having national data on violence against children.

However, only 21% used national data to set targets to prevent and respond to such violence. And only about a third of countries believed that victims of violence could adequately access support services, and some 26% of countries had programmes supporting parents and caregivers.

Even fewer countries reported enacting programmes to address norms and environments around child abuse. Some 21% of countries reported programmes to change harmful norms, while only 15% had programmes to provide safe physical community spaces for children.

Image Credits: UNICEF, Flickr: neiljs, UNICEF Ecuador.

Mwelecele Ntuli Malecela, director of NTD Control at WHO

As COVID-19 puts the world collectively on pause, essential programmes for neglected tropical diseases (NTDs) are also feeling the cut.

NTDs are estimated to impact up to 1.3 billion people around the world, mostly prevalent in poor, marginalized communities with low access to healthcare.

“One of the things that’s been severely affected is our neglected tropical disease programmes,” said Mwelecele Ntuli Malecela, director of NTD Control at WHO. “Particularly in Africa, as part of the focus on social distancing, we’ve had to stop most of the mass drug administration programmes.”

“NTDs are a group of 20 diseases, including elephantiasis, sleeping sickness, leprosy, trachoma, and intestinal worms that collectively wreak havoc on the poorest and most marginalized communities,” explained WHO Director-General Dr Tedros Adhanom Ghebreyesus. “These diseases disfigure, disable and can kill. And they strike hardest in place spaces of poverty. And in remote areas where access to quality health services is extremely limited.”

Mass drug administration (MDA), or the regular administration of safe anti-parasitic drugs to everyone living an NTD-prevalent area, is a cost-efficient intervention that helps control the most common NTDs, such as intestinal worms.

But in the wake of COVID-19, official WHO guidelines have urged countries to put a pause on MDA campaigns.

The focus now is on how to improve programmes as countries come out of lockdown, post-COVID-19, said Ntuli Malecela.

“Are there innovative ways that we can actually carry out these programs where people can be treated… while ensuring the safety of the people being treated and the safety of the community health workers who are treating them? That is the ongoing discussion,” she added.

A new, 10-year Roadmap for NTD control will be released in late August by the World Health Organization. The organization will be hosting a series of webinars in anticipation of the Roadmap launch.

For more on NTDs, see the draft Roadmap here.

WHO experts speak at the 17 June 2020 COVID-19 press briefing

A rising star in the COVID-19 treatment arena, dexamethasone – a powerful corticosteroid – has stirred excitement among World Health Organization experts and researchers around the world, following the publication of promising early results from the United Kingdom’s Recovery trial. 

In COVID-19 patients only receiving supplemental oxygen, the trial found that dexamethasone reduced mortality by 20%. In patients requiring mechanical ventilation, the drug cut the mortality rate by up to a third.

“We will update our clinical guidance to reflect how and when dexamethasone should be used to treat COVID-19,” announced WHO Director-General Dr Tedros Adhanom Ghebreyesus on Wednesday. “WHO has now started to coordinate a meta-analysis pulling data from several clinical trials to increase our overall understanding of this intervention.”

The cheap drug could become the ‘standard-of-care’ for patients suffering from more severe forms of the disease, Soumya Swaminathan, WHO Chief Scientist, told the Financial Times, echoing comments from Peter Horby, one of the UK trial’s principal investigators. Producers are already poised to ramp up production of the common drug – including Cipla, an Indian generics manufacturer; Aché, the biggest dexamethasone producer in Brazil, and Hikma Pharmaceuticals, a large dexamethasone manufacturer. 

WHO Experts Urge Restraint In Using Dexamethasone

Dexamethasone tablets

The drug acts as an anti-inflammatory drug, calming the swelling around severely ill patients’ lungs, rather than targeting the virus itself like another promising treatment – the antiviral remdesivir.

“[Dexamethasone] is a very, very powerful anti inflammatory drug. It can rescue patients who are in very serious condition where their lungs and cardiovascular system around their lungs may be very inflamed,” said WHO Health Emergencies Executive Director Mike Ryan. “This possibly allows the patients to continue getting oxygen into the blood from the lungs for a very critical period, or it rapidly reduces inflammation at a critical period in the illness.”

However, the drug has shown to only improve outcomes in patients suffering more serious illness. No benefit was observed in patients who did not require respiratory support, and health experts are urging caution for using the drug.

“This is not for mild cases, this is not for prophylaxis,” clarified Ryan. “It is not a treatment for the virus itself, it is not a prevention for the virus.

“In fact, steroids, particularly powerful steroids can be associated with viral replication in other words they can actually facilitate the division and replication of viruses in human bodies. So it’s exceptionally important that this drug is reserved for use in severely ill and critical patients who can clearly benefit from the drug.”

WHO Hydroxychloroquine Trial Stopped Again

Ana Maria Henao Restrepo clarifies WHO will be stopping the hydroxychloroquine arm of its Solidarity Trial

Meanwhile, the much hyped antimalarial drug hydroxychloroquine seems to be fading from favor, as WHO announced they would stop enrolling new patients into the hydroxychloroquine arm of its multicountry SOLIDARITY trial for COVID-19 treatments. New patient enrollment has also been stopped in the hydroxychloroquine arm of France’s DISCOVERY trial, one of the country arms of the larger WHO trial.

The move was prompted by early results released by the United Kingdom’s Recovery trial, which found no reduction in mortality among around 3000 COVID-19 patients taking the drug compared to those receiving standard treatment.

“After deliberations [between investigators from the Solidarity and Recovery trials], they have concluded that the hydroxychloroquine arm will be stopped in the Solidarity Trial,” announced Ana Maria Henao Restrepo, a medical officer in WHO’s Health Emergencies Programme.

“The internal evidence from the Solidarity-Discovery trial, the external evidence from the UK Recovery trial, and the combined evidence from these large randomized trials brought together suggest that hydroxychloroquine, when compared to the standard of care, in the treatment of hospitalized COVID-19 patients, does not result in the reduction of mortality for those patients,” said Restrepo

The move represents another nail in the coffin for hydroxychloroquine, once touted as one of the most promising COVID-19 treatments, following the United States Food and Drug Administration rescinding emergency use approval for the drug on Monday. The hydroxychloroquine arm of the Solidarity trial had just resumed after being paused for 1 week, following the publication of a massive, now retracted, study in The Lancet that claimed patients taking the drug were at higher risk of mortality.

Still, Restrepo emphasized that the move to stop the hydroxychloroquine arm did not “constitute an official WHO policy,” nor does it apply to investigations around the use of hydroxychloroquine as a preventative treatment for COVID-19.

“This is just based on results from the trials. This does not apply to the evaluation of hydroxychloroquine as possible prophylaxis in patients exposed to COVID-19 – that’s a different thing,” clarified Restrepo.

Image Credits: Twitter: @WHO.

About 1.7 billion people, or 22% of the world’s population, has at least one underlying health condition that puts them at increased risk of becoming seriously ill with COVID-19, according to a new modelling study published in Lancet Global Health.  

Based on the new assessment, about 4% of the world’s population, in total, is at high risk of developing severe COVID-19 requiring hospitalization.  But the actual risk of serious forms of the disease varies considerably by age – from less than 1% of people under the age of 20 to about 20% of those 70 years and older. 

The new estimates reinforce findings from previous studies indicating that older people and those with chronic diseases are at higher risk. 

However, it is the first of its kind to provide national as well as regional and global estimates of people at risk of severe COVID-19 for 188 countries worldwide – based on age, sex and reporting of underlying health conditions. 

“It is time to evolve from a one-size-fits all approach to one that centres on those most at risk…It is time to acknowledge that we are not all at equal risk of severe outcomes from COVID-19 and to work together with those most affected to tailor an effective response,” said lead author Nina Schwalbe, of Columbia University’s Mailman School of Public Health in a statement.

The study also included co-authors from London School of Tropical Hygiene and Medicine, Imperial College London, University College London, the University of Edinburgh, Sun Yat-Sen University, China and the University of Washington, USA.

Seventy Year Olds Are Thirteen Times More Likely To Have One Underlying Condition Than Twenty Year Olds 

About two thirds of people above the age of 70 are at risk of severe COVID-19, in comparison to only 1% of people younger than 20, largely because older people were about thirteen times more likely to have one underlying condition, in comparison to twenty year olds, the study notes.

As a result, regions with older populations, like Europe and Northern America, are at highest risk of having large number of severe COVID-19 cases, in comparison to regions such as Latin America, the Caribbean or Africa, whose populations are younger on average.  

In Europe, for instance, an average of 6.5% of people are at high-risk of developing severe COVID-19, as opposed to 3.1% of people in Africa – mainly because Europe also has double the number of people with a pre-existing health condition.

To quantify the risk of severe COVID-19 in countries, researchers assessed hospitalisation rates for COVID-19 with reference to UN population estimates; disease prevalence data from the Global Burden of Disease 2017, Injuries and Risk Factors Study; and the list of underlying health conditions relevant to COVID-19.

Those, according to the WHO and public health agencies in the United States and the United Kingdom, include: cardiovascular disease, chronic kidney disease, diabetes and chronic respiratory diseases.

Proportion of world’s population at increased risk of severe COVID-19

Avoiding Complacency – An “Unmitigated Pandemic” In Africa Could Put 23 Million At Risk Of Severe COVID-19 

 

Although regions such as Africa, are generally less vulnerable to severe COVID-19 due to their population demographics, that evidence needs to be ‘carefully communicated’ to avoid complacency, warned researchers:

“The share of the population at increased risk of severe COVID-19 is generally lower in Africa than elsewhere due to much younger populations, but a much higher proportion of severe cases could be fatal in Africa than elsewhere,” mostly because health system capacity and resilience is much lower in Africa compared to other regions of the world. 

As a result, an unmitigated pandemic in Africa could put 23 million people at risk of severe COVID-19, the authors concluded.

A child with HIV takes antiretroviral medication

However, the researchers also warn that if routine health services in African health systems continue to be seriously disrupted, more deaths could also result from tuberculosis, malaria or other, even more deadly viruses such as Ebola, which has resurged in recent weeks in the Democratic Republic of the Congo.

Additionally, African countries with a high HIV/AIDS prevalence, such as Eswatini and Lesotho, will have more people at higher risk of severe COVID-19. Similarly, small island nations with high diabetes prevalence, like Fiji and Mauritius, may also see more severe cases. 

Projections Will Help Policymakers Plan How Many Vulnerable People Need To Be Shielded From COVID-19

Shoppers mob malls in Geneva after restaurants and stores reopened on 6 June – following nearly two months of lockdown

As lockdowns continue to be relaxed or lifted around the globe, the study’s projections will help policymakers understand how many vulnerable people need to be shielded from the coronavirus, allowing countries to minimize COVID-19 deaths, while also taking the edge off overwhelmed health systems:

“Shielding has the potential to reduce mortality in susceptible groups (direct benefits), while at the same time mitigating the expected surge in demand for hospital beds (indirect benefits).”

Vulnerable populations, like older people, can be shielded by physical distancing and by receiving priority access to a COVID-19 vaccine or treatment.

But the study is only a ‘starting point’, caution its authors, because estimates don’t take into account other strong drivers of COVID-19 infection and death, such as ethnicity, socioeconomic deprivation, and obesity: 

“Although older age and underlying conditions increase [the risk of severe COVID-19], people subject to structural inequities are more likely to develop underlying conditions and receive poor quality health care…[and] emerging evidence shows that those with unmanaged chronic conditions, including HIV, are more vulnerable to severe outcomes [of COVID-19].”

For example, one other study of COVID-19 death rates in all of the counties of the United States, by the MIT Sloan School of Management, found that death rates in counties doubled for every 10 % increase in African Americans. COVID-19 death rates have been ten times higher than average when African Americans make up 85% of the county’s population.

Image Credits: The Lancet , The Lancet, Deep Knowledge Group, Paul Kamau/ DNDi, S. Lustig Vijay/HP-Watch.

Dexamethasone is an anti-inflammatory drug used against arthritis and asthma

A major clinical trial ongoing in the United Kingdom has fingered dexamethasone, a common anti-inflammatory drug used to treat arthritis and asthma, as the “first” treatment to actually reduce mortality among COVID-19 patients – by as much as one-third. 

The preliminary findings were announced by the trial’s principal investigators, Martin Landray and Peter Horby, both professors at Oxford University. The trial results were welcomed by a number of health experts, including those at the World Health Organization.

“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a press release. “This is great news and I congratulate the Government of the UK, the University of Oxford, and the many hospitals and patients in the UK who have contributed to this lifesaving scientific breakthrough.”

Low doses of dexamethasone, a 59-year old corticosterone drug, reduced deaths among COVID-19 patients on a ventilator by one third, and by 20% among patients on simpler forms of oxygen treatment.

Overall, dexamethasone reduced the 28-day mortality rate by 17%. However, the drug did not appear to have any benefits in patients that did not require respiratory support, and patients outside the hospital setting were not studied.

‘Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result,” said Peter Horby, Professor of Emerging Infectious Diseases at the University of Oxford, also a principal investigator of the trial.

The randomized clinical trial, which is part of the WHO and Wellcome Trust co-sponsored  RECOVERY initiative, compared some 2100 patients receiving 6 mg of dexamethasone daily for ten days, either by mouth or by intravenous injection, and with 4321 patients that received standard care.

Given it is widely available, cheap and has a ‘large’ survival benefit, dexamethasone should already become the new standard of care, said Horby:

“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

“It’s going to be very hard for any drug really to replace this, given that for less than 50 pounds [$63.26],” eight patients on a ventilator can be treated and one life can be saved, said Landray in an online briefing. And for every 25 COVID-19 patients on oxygen support, one life would be saved by treating them with dexamethasone, said Landray.

Researchers explained that the anti-inflammatory drug can calm the cytokine storm that overwhelms the immune systems of seriously ill patients. 

While preliminary results demonstrate “very clearly” that dexamethasone can curb mortality in patients with severe COVID-19, researchers did not make available the full data set on the study, a move that was criticized by some:

“It is unacceptable to tout study results by press release without releasing the full paper,” said Atul Gawande, a public health researcher and surgeon, in a tweet.

Meanwhile, a WHO spokesperson said that the Organization would share a reaction once it had completed the initial review of the preliminary results.

Over 11,500 patients from over 175 National Health Service hospitals (NHS) have been enrolled in the UK’s RECOVERY to test five other treatments for COVID-19:

  • lopinavir/ritonavir, an antiviral
  • hydroxychloroquine, an anti-malarial
  • azithromycin, an antibiotic
  • tocilizumab, an anti-inflammatory
  • convalescent plasma from recovered individuals

There is still no approved treatment or vaccine for COVID-19, apart from Gilead’s remdesivir, a failed Ebola drug that does not improve the odds of survival – though it speeds up recovery in patients with COVID-18 from 15 to 11 days. 

In a parallel development, the recently touted hydroxychloroquine was shown to be “useless” earlier this month by Landray’s group. And yesterday, the US Food and Drug Administration revoked their Emergency Use Authorization (EUA) for the drug.

“Based on its ongoing analysis of the EUA and emerging scientific data, the Food and Drug Administration determined that chloroquine and hydroxychloroquine are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA,” said the FDA on Monday.

Image Credits: Phillip Jeffrey.