tag:theconversation.com,2011:/us/topics/epidemics-29539/articlesEpidemics – The Conversation2024-03-07T21:28:26Ztag:theconversation.com,2011:article/2218262024-03-07T21:28:26Z2024-03-07T21:28:26ZWhy ‘One Health’ needs more social sciences: Pandemic prevention depends on behaviour as well as biology<p>On March 11, 2024, <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">it will be four years since the World Health Organization characterized the SARS-CoV-2 outbreak as a pandemic</a>. And while COVID-19 continues to impact people globally, it is only the most recent in a long history of pandemics with likely origins in animals. Examples include <a href="https://www.cdc.gov/plague/transmission/index.html">plague</a>, which usually spreads from rodents to humans via infected fleas, and the 2009 <a href="https://www.cdc.gov/h1n1flu/general_info.htm">H1N1 flu</a>, also known as swine flu due to its <a href="https://doi.org/10.7554/eLife.16777">origins in pigs</a>. </p>
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<img alt="Purple spikes covered with a mossy yellow-green substance" src="https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Microscopic view of Yersinia pestis bacteria, which causes bubonic plague, in a flea.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Given the animal origins of past pandemics, as well as the many recent cases of disease in people linked to animals — such as <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON497">anthrax</a>, <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON506">Middle East respiratory syndrome</a> and <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON504">avian influenza virus</a> — it is very likely that the next pandemic will again originate in animals. </p>
<p>In fact, <a href="https://doi.org/10.3390%2Fmicroorganisms8091405">over 60 per cent of emerging infectious diseases in people originate in animals. Among these, more than 70 per cent are associated with wildlife</a>. Our close interactions with animals and our shared environment is a major factor for why and how these pathogens spill over. </p>
<h2>Pandemic prevention</h2>
<p>Recognizing our interconnected health, there have been increased calls for <a href="https://doi.org/10.1016/S0140-6736(24)00066-7">primary pandemic prevention</a>, which focuses on reducing the chance of an outbreak occurring by preventing the spread of pathogens from animals to people.</p>
<p>One framework for primary pandemic prevention is called “One Health.” One Health recognizes the close links among human, animal and environmental health, whereby promoting health in one part of this triad promotes the health of all. </p>
<p>While this concept of interconnected health has gained awareness in western science in the past century, it is not new. Instead, it is a reflection of what <a href="https://doi.org/10.1126/science.abe2401">Indigenous Peoples have known and practised for millennia</a>. </p>
<h2>One Health</h2>
<p>Global recognition of One Health has been steadily increasing. For example, the formation of the <a href="https://globalohc.org/what-is-one-health">Quadripartite</a> — which consists of global organizations including the <a href="https://www.fao.org/home/en">Food and Agriculture Organization of the United Nations</a>, the <a href="https://www.unep.org/">United Nations Environment Programme</a>, the World Health Organization, and the <a href="https://www.woah.org/en/home/">World Organisation for Animal Health</a> — has been focused on mobilizing One Health. The Quadripartite is advised by the <a href="https://www.who.int/groups/one-health-high-level-expert-panel/members">One Health High Level Expert Panel</a>. </p>
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<img alt="Gloved hands injecting a cow" src="https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A veterinarian vaccinates cattle against disease. Understanding farmers’ barriers to vaccinating livestock is key to successful disease prevention.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Yet despite the interdisciplinary nature of One Health, many initiatives are still falling short. Discussions and decisions about One Health issues are often dominated by veterinary and human health sciences, sidelining the social sciences <a href="https://doi.org/10.1016/j.socscimed.2014.09.048">despite the crucial role</a> of disciplines like psychology, sociology, and communications in understanding human behaviour. </p>
<p>Social science researchers aim to understand people — their perceptions and concerns, their histories, their socio-political, cultural and environmental contexts, and their knowledge — with a view to understanding how structural disparities affect personal and societal behaviour, health and political power.</p>
<p>In interdisciplinary fields such as One Health, this understanding is paramount. One Health interventions include measures such as the vaccination of livestock to prevent spillover events to people, such as <a href="https://doi.org/10.1038/s41541-023-00769-w">Rift Valley fever</a>, which can affect both animals and humans. </p>
<p>The success of these interventions hinges not only on vaccine efficacy, but also on societal factors. For example, social scientists uncover <a href="https://doi.org/10.1371%2Fjournal.pone.0256684">barriers faced by farmers in accessing livestock vaccination services</a>. This ultimately improves access and ensures widespread livestock immunization, and therefore contributes to the primary prevention of future pandemics.</p>
<h2>Recognizing intersections</h2>
<p>Another key factor contributing to the successful implementation of One Health interventions is understanding gender dynamics in society. Often women bear the disproportionate caregiving burden, which impacts their access to health care for themselves and their livestock. Gender roles and responsibilities may also decide who interacts closely with animals, affecting possible disease exposure risks as well as <a href="https://doi.org/10.1080/13552074.2015.1096041">narrowing down the target group for educational efforts</a>. </p>
<p>Recognizing these intersections is crucial for developing inclusive and effective interventions.</p>
<p>And while animals may be the potential source of a future pandemic, it is also important to recognize the important positive contributions wildlife have made to our health and well-being, including their roles in the economy and <a href="https://www.indigenousfoodsystems.org/food-sovereignty">food security</a>, as well as their cultural significance. </p>
<p>The perception that animals are a threat to humans can lead to heightened public fears and apprehensions about wildlife, potentially reducing <a href="https://doi.org/10.1093/ilar.51.3.255">support for wildlife conservation</a>. </p>
<p>Addressing this issue requires a deeper understanding of public perceptions, values, priorities and behaviours — emphasizing the <a href="https://doi.org/10.7589/2014-01-004">necessity of integrating social science</a> in the development of informed, relevant and sustainable surveillance of potential infectious disease in wildlife and conservation programs. </p>
<h2>An interdisciplinary approach to pandemic prevention</h2>
<p>Even beyond the role of social science in understanding the complex systems in which health risks occur, social science can also bridge communication gaps between researchers, policymakers and communities. By integrating social science into One Health approaches, we ensure that initiatives are not only scientifically sound, but also socially and culturally acceptable, appropriate and equitable for all rights holders involved.</p>
<p>A movement towards a true, interdisciplinary and holistic approach to primary pandemic prevention will need a proactive approach to health and well-being instead of a reactive one. It will also require us to critically examine our current health systems to identify innovative solutions to ensure its resilience. </p>
<p>We need to mobilize information and understanding across knowledge systems and elevate the critical role of social sciences to meaningfully integrate One Health into primary pandemic prevention in Canada.</p><img src="https://counter.theconversation.com/content/221826/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kaylee Byers receives funding from the Public Health Agency of Canada to strengthen communications and knowledge mobilization of One Health issues. </span></em></p><p class="fine-print"><em><span>Sarah Robinson receives funding from the Public Health Agency of Canada to strengthen communications and knowledge mobilization of One Health issues.</span></em></p><p class="fine-print"><em><span>Lara Hollmann and Salome A. Bukachi do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pandemics often have animal origins, so prevention is often dominated by health and veterinary sciences. However, social sciences’ role in understanding human behaviour is also crucial to prevention.Kaylee Byers, Assistant Professor, Faculty of Health Sciences; Senior Scientist, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversityLara Hollmann, Research Fellow, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversitySalome A. Bukachi, Associate professor, Institute of Anthropology, Gender and African Studies, University of NairobiSarah Robinson, Postdoctoral Fellow, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2057222023-05-17T12:41:07Z2023-05-17T12:41:07ZPivotal points in the COVID-19 pandemic – 5 essential reads<figure><img src="https://images.theconversation.com/files/526612/original/file-20230516-37571-gp5zr6.jpg?ixlib=rb-1.1.0&rect=43%2C28%2C9547%2C5161&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SARS-CoV-2, the virus that causes COVID-19, has evolved over time into multiple variants and sublineages. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coronavirus-royalty-free-image/1366654397?phrase=covid+virus&adppopup=true">loops7 / E+ via Getty Images</a></span></figcaption></figure><p>Experts have made it clear that the <a href="https://theconversation.com/what-does-ending-the-emergency-status-of-the-covid-19-pandemic-in-the-us-mean-in-practice-4-questions-answered-205165">end of the COVID-19 national emergency</a>, which was lifted on May 11, 2023, <a href="https://www.statnews.com/2023/05/10/public-health-emergency-ashish-jha/">does not mean an end to the pandemic</a>. But this shift signals a remarkable turning point in a pandemic that is well into its fourth year – something that few could have imagined when the U.S. national emergency went into effect in March 2020. </p>
<p>Likewise, the World Health Organization’s announcement on May 5 that it was <a href="https://www.statnews.com/2023/05/05/who-declares-end-to-covid-global-health-emergency/">ending the COVID-19 public health emergency of international concern</a> that had been in place since January 2020 is indicative that the pandemic has entered a new chapter. </p>
<p>It’s daunting to look back at our coverage and narrow it down to just a handful of standout stories amid all the twists and turns of the pandemic. But here are five stories from The Conversation’s archives that resonated with us, written by scholars who helped to illuminate complex issues at pivotal moments in the pandemic.</p>
<h2>1. A whole new vocabulary</h2>
<p>It’s a little hard to remember the days when words like pandemic, endemic diseases, mRNA, variant and spike proteins were not a part of our vernacular or everyday conversations. But I vividly recall the day that the COVID-19 pandemic was declared and a friend asked me “What exactly is a pandemic?” It turns out a lot of people were asking that question and wondering about the difference between an outbreak of an infectious disease, an epidemic and a pandemic.</p>
<p><a href="https://public-health.tamu.edu/directory/fischer.html">Rebecca S.B. Fischer</a>, an assistant professor of epidemiology at Texas A&M University, <a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">put it in straightforward terms</a>: An outbreak is a small but unusual increase in the expected number of cases of a given disease, while the term epidemic is used when an infectious disease outbreak is getting bigger and spreading over a broader geographic area. A pandemic, on the other hand, is used when a disease is “international and out of control.”</p>
<p>She went on to say that some epidemiologists reserve the term pandemic for when a disease is being sustained in newly affected regions through local transmission – a good characterization of the state of COVID-19 in March 2020.</p>
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<a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">What's the difference between pandemic, epidemic and outbreak?</a>
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<figcaption><span class="caption">Epidemic, pandemic and endemic viruses explained.</span></figcaption>
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<h2>2. Comparisons to the 1918 flu ran rife</h2>
<p>From the earliest days of the COVID-19 pandemic, it was impossible to miss the haunting similarities between it and the 1918 flu pandemic, which led to at least 50 million deaths worldwide between 1918 and 1920. Health care experts and the media made frequent comparisons between the two, pointing to similarities in attitudes about mask-wearing and school closures as well as in the patterns of disease waves, spikes and surges.</p>
<p>But while the two once-in-a-century events have shared plenty of likenesses, the comparison also sometimes <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">led to public misunderstandings about how the COVID-19 pandemic could play out</a>, wrote historian <a href="https://www.history.pitt.edu/people/mari-webel">Mari Webel</a> and pediatric infectious disease specialist <a href="https://www.pediatrics.pitt.edu/people/megan-culler-freeman-md-phd">Megan Culler Freeman</a>, both from the University of Pittsburgh. They explain that key differences in the sociopolitical context of the 1918 flu period, as well as marked differences between the virology behind the two diseases, set the 1918 flu and COVID-19 on different paths.</p>
<p>“People seek answers from the experiences of influenza in 1918-19 for a fundamental reason: It ended.”</p>
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Read more:
<a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">Compare the flu pandemic of 1918 and COVID-19 with caution – the past is not a prediction</a>
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<a href="https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two men wearing and advocating the use of flu masks in Paris with a crowd of people behind them." src="https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">French men in 1919 Paris holding signs urging others to wear masks and to fight the flu. Much like in the COVID-19 era, wearing masks to protect against the deadly influenza was embraced by some, while others resisted and refused.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/two-men-wearing-and-advocating-the-use-of-flu-masks-in-news-photo/3333532">Topical Press Agency / Hulton Archive via Getty Images</a></span>
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<h2>3. How and when pandemics end</h2>
<p>In late 2020, people were naturally wondering when and how the COVID-19 pandemic would end, and how we would know it was over.</p>
<p><a href="https://sasn.rutgers.edu/about-us/faculty-staff/nukhet-varlik">Nükhet Varlik</a>, a historian from Rutgers University who studies disease, medicine and public health, wrote an astute piece in October 2020 about the difficulties of <a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">predicting how the pandemic might play out</a>. She presciently noted that “whether bacterial, viral or parasitic, virtually every disease pathogen that has affected people over the last several thousand years is still with us, because it is nearly impossible to fully eradicate them.” These include diseases like tuberculosis, leprosy, measles and plague.</p>
<p>“Hopefully COVID-19 will not persist for millennia,” Varlik wrote. But she went on to say that politics are crucial, noting how when vaccination programs are weakened, infections can “come roaring back.”</p>
<p>“Given such historical and contemporary precedents, humanity can only hope that the coronavirus that causes COVID-19 will prove to be a tractable and eradicable pathogen. But the history of pandemics teaches us to expect otherwise.”</p>
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Read more:
<a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">How do pandemics end? History suggests diseases fade but are almost never truly gone</a>
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<h2>4. The midway point</h2>
<p>The summer of 2021 felt like a particularly grueling moment in time – when excitement and optimism over the launch of the first vaccines to protect against COVID-19 had given way to despair over the stronghold of vaccine resistance and general exhaustion with all things COVID. And then came the delta variant. </p>
<p>Epidemiologist <a href="https://scholar.google.com/citations?user=t3nqdNQAAAAJ&hl=en">Katelyn Jetelina</a>, formerly from the University of Texas Health Science Center at Houston, captured <a href="https://theconversation.com/18-months-of-the-covid-19-pandemic-a-retrospective-in-7-charts-166881">18 months of the COVID-19 pandemic in a series of seven retrospective charts</a> that put all of the high and low points into stark relief. “The race between vaccination and variant spread was upon us,” Jetelina wrote. “The fight was far from over.” </p>
<p>The same may still be true today.</p>
<p><iframe id="zCZWb" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/zCZWb/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
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<a href="https://theconversation.com/18-months-of-the-covid-19-pandemic-a-retrospective-in-7-charts-166881">18 months of the COVID-19 pandemic – a retrospective in 7 charts</a>
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<h2>5. How omicron altered the course of the pandemic</h2>
<p>When the omicron variant arrived on the scene in late 2021 and spread globally in early 2022, it soon became clear that it could bring about a shift in the pandemic. With its ability to spread easily and to also cause milder disease than prior variants, omicron had the potential to act as a natural vaccine of sorts – producing widespread immunity with the help of the existing COVID-19 vaccines.</p>
<p>But the omicron variant had plenty of surprises in store. For one, it gave rise to a family of variants and sublineages that to this day are keeping researchers guessing, with the latest omicron subvariant, XBB.1.16, gaining ground across the U.S. and worldwide as of mid-May 2023.</p>
<p>In January 2022, immunology researchers <a href="https://sc.edu/study/colleges_schools/medicine/about_the_school/faculty-staff/nagarkatti_prakash.php">Prakash Nagarkatti</a> and <a href="https://sc.edu/study/colleges_schools/medicine/about_the_school/faculty-staff/nagarkatti_mitzi.php">Mitzi Nagarkatti</a>, from the University of South Carolina, <a href="https://theconversation.com/is-the-omicron-variant-mother-natures-way-of-vaccinating-the-masses-and-curbing-the-pandemic-175496">explained how the immune system responds to infections</a> and how it remembers those threats through “immunological memory.” </p>
<p>This left room for hope, they wrote, that “when new variants of SARS-CoV-2 inevitably arise, omicron will have left the population better equipped to fight them. So the COVID-19 vaccines combined with the omicron variant could feasibly move the world to a new stage in the pandemic – one where the virus doesn’t dominate our lives and where hospitalization and death are far less common.” </p>
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Read more:
<a href="https://theconversation.com/is-the-omicron-variant-mother-natures-way-of-vaccinating-the-masses-and-curbing-the-pandemic-175496">Is the omicron variant Mother Nature’s way of vaccinating the masses and curbing the pandemic?</a>
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<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/205722/count.gif" alt="The Conversation" width="1" height="1" />
With the emergency phase of the COVID-19 pandemic in the rearview mirror, at least for now, we look back on a handful of stories that provided sharp insights at key moments in the pandemic.Amanda Mascarelli, Senior Health and Medicine EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028572023-04-17T14:24:32Z2023-04-17T14:24:32ZPredicting epidemics isn’t easy. We’ve created a global dataset to help<figure><img src="https://images.theconversation.com/files/520280/original/file-20230411-20-k6ve92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Countries around the world were not prepared to respond to COVID-19.</span> <span class="attribution"><span class="source">Andrew Wasike Shimanyula/Anadolu Agency via Getty Images</span></span></figcaption></figure><p>The world has recently seen a number of high-profile cross-border disease outbreaks and pandemics. The COVID pandemic and multi-country Mpox (monkeypox) outbreaks are just two examples. </p>
<p>But there is very little scientific evidence that would give a clear picture of how fast and how often infectious diseases spread across countries. A key challenge for creating global disease data is the scattering of information. Low-income countries have limited statistical capacity to keep track of disease outbreaks. And datasets from various countries are difficult to combine due to different reporting standards.</p>
<p>To get a better global picture of infectious disease patterns, our team of economists and statisticians set out to create <a href="https://www.nature.com/articles/s41597-022-01797-2">a global dataset</a>. We collected data from the World Health Organization’s <a href="https://www.who.int/emergencies/disease-outbreak-news">“Disease Outbreak News”</a> and <a href="https://covid19.who.int/">Coronavirus Dashboard</a>. </p>
<p>Disease Outbreak News contains information from health authorities and research networks about confirmed acute public health events or events of concern. They include any outbreak or rapidly evolving situation that may have negative consequences for human health and requires immediate assessment and action. Unfortunately, this information is mostly unstructured and is not produced for statistical purposes. It can’t be directly used for systematic analysis. To make such structured statistical information available, we relied on <a href="https://www.parsehub.com/blog/what-is-web-scraping/">web-scraping</a> techniques to extract when and where a particular infectious disease occurred. </p>
<p>Statistical restructuring of this data allowed us to paint a systematic picture of the spread of infectious diseases. Our findings are based on the statistical probabilities of disease outbreak, not the virulence. We found that most disease outbreaks were reported in African countries. High-income countries were significantly affected too – particularly during pandemics like the 2009 “swine flu” outbreak and COVID-19.</p>
<p>The presence of such pandemic events highlights the need for policy preparedness. By analysing how disease outbreaks spread across countries, health authorities can develop targeted measures to contain future outbreaks.</p>
<h2>What the data shows</h2>
<p>Our dataset contains information on over 2,000 public health events that have occurred in 233 countries and territories since 1996. These outbreaks involve 70 different infectious diseases. The figure below shows when those occurred. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/520313/original/file-20230411-26-9f5d14.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520313/original/file-20230411-26-9f5d14.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=512&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520313/original/file-20230411-26-9f5d14.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=512&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520313/original/file-20230411-26-9f5d14.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=512&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520313/original/file-20230411-26-9f5d14.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=643&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520313/original/file-20230411-26-9f5d14.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=643&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520313/original/file-20230411-26-9f5d14.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=643&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Total frequency of outbreaks.</span>
<span class="attribution"><span class="source">Juan Armando Torres Munguía</span></span>
</figcaption>
</figure>
<p>No clear trend over time is visible: there are around 50 public health events that trigger a Disease Outbreak News announcement each year. Instead of an increase over time, temporary surges are visible in the context of the <a href="https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html">2009 “swine flu” influenza A(H1N1) pandemic</a> and COVID-19. These diseases were essentially global and accordingly triggered Disease Outbreak News in many countries. </p>
<p>Our data recorded only one disease outbreak announcement per country, year and disease. For example, COVID-19 in China is recorded once in 2019, once in 2020, and once in 2021. This means the data doesn’t show how serious a disease outbreak was, nor how many people were affected in one country. Instead, the data for each year reflects how many different diseases were recorded, and how many different countries were affected. This is useful from a policy perspective since all recorded outbreaks call for immediate action.</p>
<p>COVID-19 is the most prominent disease in the outbreak news announcements. Almost one third of the 2,227 health events recorded in our dataset concern COVID-19, closely followed by influenza cases of zoonotic nature. Cholera is the third-most recorded infectious disease, but much less frequent than COVID-19 or influenza (about 170 recorded outbreak news).</p>
<p>Countries with the highest records of infectious disease outbreaks are mostly large (in terms of size and population), close to the Equator, and have low or modest income levels. Africa accounts for almost 40% of recorded cases of outbreaks. And it’s home to the two most outbreak-prone countries: the Democratic Republic of Congo and Nigeria each recorded over 40 disease outbreaks since 1996. </p>
<p>High income levels don’t prevent outbreaks. Wealthier countries were affected despite their substantial financial means for public health measures. The US recorded the third highest number of disease outbreaks. France and the UK had over 20 unique disease outbreaks each. </p>
<h2>How the data is useful</h2>
<p>Our analysis shows that there is no clear global increase of infectious disease outbreaks over time. We rather observe temporary waves of single diseases that affect many countries. Public health systems hence need to quickly assess how threatening a disease outbreak in another country is and what measures should be taken to prevent their spreading across and within countries. </p>
<p>Effective public health responses will depend on how diseases usually spread geographically. And our dataset offers rich potential to analyse such spatial disease transmission. </p>
<p>Disease outbreaks are geographically related. Our statisticians tested whether disease outbreaks are randomly scattered around the globe or not. The results are depicted in the map below. A country that is coloured in a darker shade of green is more likely to contribute to cross-country spreading of diseases. Outbreaks are clustered geographically. These clusters – Northern America, Africa and South-/East Asia – provide a first glimpse of international disease transmission patterns. </p>
<p>But more research will be needed to better understand pandemic contagion pathways, which likely differ by disease. Our dataset will be a valuable resource for such analysis.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/520315/original/file-20230411-16-mflczf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520315/original/file-20230411-16-mflczf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=236&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520315/original/file-20230411-16-mflczf.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=236&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520315/original/file-20230411-16-mflczf.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=236&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520315/original/file-20230411-16-mflczf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=297&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520315/original/file-20230411-16-mflczf.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=297&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520315/original/file-20230411-16-mflczf.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=297&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Disease transmission map.</span>
<span class="attribution"><span class="source">Juan Armando Torres Munguía</span></span>
</figcaption>
</figure>
<h2>Policy preparedness</h2>
<p>A better understanding of how different infectious diseases spread across countries can help establish early warning mechanisms and response protocols. One could estimate how likely it is that an outbreak of a disease in one country will spread to another country and over what time period. </p>
<p>Policymakers could even put protocols in place where a certain disease transmission likelihood triggers a response measure (such as rolling out vaccines, or travel warnings). </p>
<p>Similarly, international organisations could use such spatial pandemic models to infer which other countries would most likely be affected by an outbreak, and focus resources accordingly. Chaotic health resource allocations, as was the case of the COVID-19 <a href="https://www.theguardian.com/world/2020/apr/28/face-masks-coveted-commodity-coronavirus-pandemic">masks</a> and <a href="https://press.un.org/en/2021/ga12367.doc.htm">vaccines</a>, could thus be avoided.</p><img src="https://counter.theconversation.com/content/202857/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Konstantin M. Wacker collaborates in a research group that received funding from the ENLIGHT network. His investment portfolio includes minor shares of health companies (details under "disclosure" on his private website).</span></em></p><p class="fine-print"><em><span>Inmaculada Martínez-Zarzoso and Juan Armando Torres Munguía do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new global dataset shows there is no clear global increase of infectious disease outbreaks over time. And it can suggest which countries would most likely be affected by an outbreak.Konstantin M. Wacker, Assistant professor of economics, University of GroningenInmaculada Martínez-Zarzoso, Professor in Economics, Universitat Jaume IJuan Armando Torres Munguía, Research assistant, Georg-August-Universität Göttingen Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2000822023-02-17T04:00:40Z2023-02-17T04:00:40ZWhat is Marburg virus and should we be worried?<figure><img src="https://images.theconversation.com/files/510752/original/file-20230217-28-im18ez.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3494%2C2839&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/search/marburg-virus">Shutterstock</a></span></figcaption></figure><p>An epidemic outbreak of Marburg virus in Equatorial Guinea, Central Africa, was <a href="https://www.afro.who.int/countries/equatorial-guinea/news/equatorial-guinea-confirms-first-ever-marburg-virus-disease-outbreak">confirmed this week</a>, the first time the virus has occurred there. At least 16 cases have been detected, and <a href="https://www.abc.net.au/news/2023-02-15/marburg-virus-kills-nine-in-equatorial-guinea/101974932">nine deaths</a>.</p>
<p>There are no approved treatments for Marburg virus, which is closely related to Ebola virus, but <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02400-X/fulltext#%20">vaccines are in development</a>. Following an unprecedented Ebola epidemic in West Africa in 2014 that caused more than <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">28,000 cases and 11,000 deaths</a>, drugs and vaccines against Ebola were developed.</p>
<p>In fact, some of these were <a href="https://www.sciencedirect.com/science/article/pii/S0006291X20320878?via%3Dihub">repurposed for COVID-19</a> in 2020. That experience may help more rapid vaccine and drug development against Marburg virus. </p>
<h2>What is Marburg virus?</h2>
<p>Marburg is a <a href="https://www.cdc.gov/vhf/virus-families/filoviridae.html">filovirus</a> like its more famous cousin, Ebola. These are part of a broader group of viruses that can cause viral haemorrhagic fever, a syndrome of fever and bleeding. </p>
<p>Filoviruses are the most lethal of all haemorrhagic fevers, compared with more common viral haemorrhagic fevers such as dengue, yellow fever and Lassa fever. The <a href="https://www.cdc.gov/vhf/marburg/index.html">first outbreaks</a> of Marburg occurred in 1967 in lab workers in Germany and Yugoslavia who were working with African green monkeys imported from Uganda. The virus was identified in a lab in Marburg, Germany. </p>
<p>Since then, outbreaks have occurred in a handful of countries in Africa, less frequently than Ebola, with the largest in Angola in 2005 (<a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">374 cases and 329 deaths</a>).</p>
<p>Marburg’s natural host is a fruit bat, but it can also infect primates, pigs and other animals. Human outbreaks start after a person has contact with an infected animal.</p>
<p>It’s spread between people mainly through direct contact, especially with bodily fluids, and it causes an illness like Ebola, with fever, headache and malaise, followed by vomiting, diarrhoea, and aches and pains. The bleeding follows about five days later, and it can be <a href="https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease">fatal in up to 90% of people infected</a>.</p>
<h2>How worried should we be?</h2>
<p>Like Ebola in 2014, the fear is that Marburg could spread and become a much larger epidemic, and spread globally. Travel could see it spread to many other countries. In 2014, Ebola cases spread from Guinea to Liberia and Sierra Leone. The majority of cases occurred in these three countries, but travel-related cases occurred in <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">seven other countries</a> including the United States and the United Kingdom. </p>
<p>If Marburg case numbers increase in Equatorial Guinea or in <a href="https://www.9news.com.au/world/marburg-virus-suspected-cases-in-cameroon/3a86e700-d313-406b-8210-243d5020641e">Cameroon</a>, where it has already spread, or if it spreads to other countries, all countries should be on alert. </p>
<p>Failure to diagnose viral haemorrhagic fever in countries not familiar with it can be deadly. The diagnosis of Ebola was <a href="https://www.nbcnews.com/storyline/ebola-virus-outbreak/nurse-who-caught-ebola-settles-suit-against-dallas-hospital-n672081">initially missed in a traveller from West Africa</a> in Dallas, Texas at the peak of the epidemic in 2014, and a nurse became infected. In Nigeria, the same thing occurred, but resulted in an <a href="https://www.abc.net.au/news/2014-10-20/who-declares-ebola-defeated-in-nigeria/5828414">outbreak and several deaths</a>.</p>
<p>Less is known about Marburg virus than Ebola, which was well-studied during the large 2014 epidemic. It <a href="https://www.medrxiv.org/content/10.1101/2022.06.17.22276538v2">may be less infectious than Ebola</a>, but there are fewer epidemics to assess this. </p>
<p>However, the high fatality rate, lack of available treatments and vaccines, and lessons from Ebola in 2014 should prompt a highly precautionary approach.</p>
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Read more:
<a href="https://theconversation.com/how-are-nurses-becoming-infected-with-ebola-32873">How are nurses becoming infected with Ebola?</a>
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<h2>How to stop its spread</h2>
<p>While researchers will <a href="https://www.nature.com/articles/d41586-023-00468-5">trial Marburg vaccines</a> currently in development against this epidemic, non-phamaceutical measures are the best hope for controlling the epidemic rapidly. That means excellent surveillance and case detection, finding and isolating sick people, tracing their contacts, and quarantine of contacts to prevent transmission. </p>
<p>The infrastructure and planning for this can be substantial, including physical sites for isolation and quarantine. During the Ebola epidemic in Nigeria, a rapid and effective response included <a href="https://www.bellanaija.com/2014/09/must-read-through-the-valley-of-the-shadow-of-death-dr-ada-igonoh-survived-ebola-this-is-her-story/">use of an abandoned building</a> to isolate and treat patients rather than risk further hospital outbreaks.</p>
<p>The importance of identifying and isolating cases was seen in West Africa in 2014, where lack of hospital beds resulted in people dying in the street and worsening spread. <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm#:%7E:text=Extrapolating%20trends%20to%20January%2020,when%20corrected%20for%20underreporting)%20(Appendix**)">One study</a> found if 70% or more of infected people were isolated in a hospital bed, the epidemic could have been controlled without any drugs or vaccines. However it was very late in the epidemic when field hospitals were erected to overcome hospital bed shortages.</p>
<p>Use of <a href="https://www.sciencedirect.com/science/article/pii/S0020748914003319?via%3Dihub">personal protective equipment</a> is also crucial, especially for health workers who are at <a href="https://academic.oup.com/jid/article/218/suppl_5/S679/5091974">increased risk</a> of filovirus infections. Disinfection and safe disposal of <a href="https://medicalguidelines.msf.org/en/viewport/CG/english/viral-haemorrhagic-fevers-16690024.html">biological waste</a> is also important. Funerals where washing of the body is a cultural practice can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709130/">spread infection</a>.</p>
<p>Health promotion and effective, culturally appropriate communication is needed to ensure compliance with health measures. During the Ebola epidemic in 2014, a team of people trying to raise awareness about Ebola were <a href="https://www.bbc.com/news/world-africa-29256443">killed by locals</a> who were fearful of the epidemic and mistrusting of foreigners. These lessons must be heeded if the Marburg epidemic grows.</p>
<p>Both Marburg and Ebola can <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004475">persist in the body</a> after recovery, in organs and fluids including seminal and vaginal fluid, the eye and other sites. This means <a href="https://www.ijidonline.com/article/S1201-9712(15)00292-1/fulltext">outbreaks originating from human survivors</a>, rather than from animals, are possible. </p>
<p>For low-income countries with weak surveillance systems, rapid <a href="https://www.epiwatch.org/">epidemic intelligence</a> using open-source data can help detect signals early. This is where news reports, social media and other data are used to look for patterns that could signify outbreaks of certain diseases in certain areas. We showed we could detect Ebola in the West African epidemic months earlier by <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230322">analysing Twitter posts</a> talking about disease symptoms in the area.</p>
<p>If the current epidemic continues to spread and is poorly controlled, the World Health Organization may declare a “Public Health Emergency of International Concern”, as it did with an <a href="https://theconversation.com/why-the-drc-ebola-outbreak-was-declared-a-global-emergency-and-why-it-matters-121991">Ebola epidemic in 2019</a> in the Democratic Republic of Congo. </p>
<p>For now, we have knowledge and experience of a poorly controlled, catastrophic epidemic of Ebola in 2014 that can inform the response to this epidemic of Marburg virus and hopefully control it quickly.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-would-australian-hospitals-respond-to-a-case-of-ebola-33203">How would Australian hospitals respond to a case of Ebola?</a>
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<img src="https://counter.theconversation.com/content/200082/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from NHMRC and MRFF and leads EPIWATCH, an AI-driven system for rapid epidemic warning signals.</span></em></p>There has been an epidemic outbreak of Marburg virus in Equatorial Guinea for the first time. Here’s what you need to know about the virus, and how it spreads.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1955422022-12-01T21:03:51Z2022-12-01T21:03:51ZOn World AIDS Day, Canada must lead the way in combating HIV-AIDS<figure><img src="https://images.theconversation.com/files/498368/original/file-20221201-12-91tm7n.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C3888%2C2566&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Provinces like British Columbia have reduced infection rates thanks to successful treatment and prevention measures. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Dec. 1 marks <a href="https://www.worldaidsday.org/">World AIDS Day</a>. As researchers focused on fighting the HIV-AIDS epidemic, we are increasingly concerned all the progress made in the fight against the virus is at risk. </p>
<p>In 1996, the first remarkable breakthrough against the HIV-AIDS epidemic came with the novel combination of drugs that became known as <a href="https://www.ncbi.nlm.nih.gov/books/NBK554533/">Highly Active Antiretroviral Therapy (HAART)</a>.</p>
<p>For the first time, HAART was able to stop viral replication and render the virus undetectable in blood and bodily fluids, and consequently promote immune reconstitution. This in turn would prevent an HIV infection from developing into AIDS, significantly reducing premature deaths.</p>
<h2>Treatment as prevention</h2>
<p>The next major breakthrough came in the early 2000s. Through close monitoring of the epidemic in British Columbia, our research documented that HIV infected individuals who have consistent viral suppression with HAART are virtually unable to transmit the infection. This led us to recommend initiating HAART immediately following HIV diagnosis to accelerate overall HIV/AIDS control. </p>
<p>We called the strategy <a href="https://bccfe.ca/tasp/about">Treatment as Prevention</a> (TasP) to illustrate the fact that HAART simultaneously stops progression to AIDS, premature death and HIV transmission.</p>
<p>TasP was enthusiastically embraced by the Joint United Nations (UN) Programme on HIV/AIDS (UNAIDS), in 2010. However, it soon became apparent that the TasP strategy was too ill defined, and this open the door for it to be inconsistently deployed between regions.</p>
<p>In 2014, <a href="http://www.unaids.org/sites/default/files/media_asset/JC2670_UNAIDS_Treatment_Targets_en.pdf">UNAIDS unveiled two sequential TasP-inspired targets</a> to quantify the proportion of people living with HIV who need to be diagnosed, the proportion of diagnosed people who need to be on HAART, and the proportion of people on HAART who need to be <a href="https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/viral-suppression">virologically suppressed</a> by 2020 and 2025. Viral suppression is defined by having less than 200 copies of HIV per milliliter of blood.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498367/original/file-20221201-26-iq7whf.jpg?ixlib=rb-1.1.0&rect=0%2C300%2C3085%2C1958&q=45&auto=format&w=1000&fit=clip"><img alt="A white flag with the words World Aids day and a red ribbon flies in front of the peace tower." src="https://images.theconversation.com/files/498367/original/file-20221201-26-iq7whf.jpg?ixlib=rb-1.1.0&rect=0%2C300%2C3085%2C1958&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498367/original/file-20221201-26-iq7whf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498367/original/file-20221201-26-iq7whf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498367/original/file-20221201-26-iq7whf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498367/original/file-20221201-26-iq7whf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498367/original/file-20221201-26-iq7whf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498367/original/file-20221201-26-iq7whf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Canada has made breakthroughs in the fight against HIV-AIDS, but more must be done to make access to treatment more equitable.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
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</figure>
<p>These targets were specifically designed so that by 2030 the world would see a 90 per cent decrease in AIDS mortality and new HIV infections, and meet the goal of ending the HIV-AIDS pandemic. In 2015, the UN <a href="https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2021/june/20210608_hlm-opens">formally endorsed</a> the <a href="https://doi.org/10.7448%2FIAS.19.1.20917">90-90-90 by 2020</a> target. It endorsed our subsequent <a href="https://bccfe.ca/blog/united-nations-adopts-ambitious-95-95-95-95-target">95-95-95 by 2025</a> target in 2021. </p>
<p>However, a lack of leadership and resources have hampered progress towards the UN targets around the world. This has been exacerbated by the COVID-19 pandemic, which disrupted some medical services, decreased HIV testing, interrupted the provision of HAART and diverted funding. </p>
<h2>Differing success rates across Canada</h2>
<p>In 2020, the Public Health Agency of Canada (PHAC) released a much-awaited <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hiv-canada-surveillance-report-december-31-2020.html">epidemiological HIV/AIDS update</a>. The update came ahead of the <a href="https://aids2022.org/2022/04/29/the-international-aids-conference-returns-to-montreal/">International AIDS Conference</a> held in Montréal in July 2022. </p>
<p>Unfortunately, the results were rather concerning. HIV cases in Canada have remained flat since the 1990s, but there is a marked contrast between British Columbia and the rest of the country. While B.C. saw a steady decline in cases between 1996 and 2020, the rest of Canada saw no further reduction in cases over the same period. </p>
<p>HIV cases peaked throughout Canada in the early 80s. But a decrease in high-risk sexual practices led to a substantial reduction in cases. After that, the course of the epidemics diverged. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498393/original/file-20221201-20-syova6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="HIV incidence across Canada and B.C. from 1980-2020" src="https://images.theconversation.com/files/498393/original/file-20221201-20-syova6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498393/original/file-20221201-20-syova6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=263&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498393/original/file-20221201-20-syova6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=263&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498393/original/file-20221201-20-syova6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=263&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498393/original/file-20221201-20-syova6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=330&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498393/original/file-20221201-20-syova6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=330&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498393/original/file-20221201-20-syova6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=330&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">HIV cases from 1980 until 2020 in Canada and British Columbia.</span>
<span class="attribution"><span class="source">(Public Health Agency of Canada 2020 National HIV Estimates Report)</span></span>
</figcaption>
</figure>
<p>The reason for this discrepancy can be explained by the success of TasP in B.C., where the strategy originated. The graph below compares progress toward the UN’s 2020 target across Canada’s provinces and territories.</p>
<p>B.C., Nova Scotia, Newfoundland and Labrador and the three territories are the only Canadian jurisdictions that surpassed all three components of the <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90.html#s10">benchmark target</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498340/original/file-20221130-24-rlmqen.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A chart showing Canadian provinces' progress towards the UNAIDS 90-90-90 targets" src="https://images.theconversation.com/files/498340/original/file-20221130-24-rlmqen.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498340/original/file-20221130-24-rlmqen.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498340/original/file-20221130-24-rlmqen.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498340/original/file-20221130-24-rlmqen.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498340/original/file-20221130-24-rlmqen.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498340/original/file-20221130-24-rlmqen.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498340/original/file-20221130-24-rlmqen.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Estimated percentage of people living with HIV diagnosed, on treatment and virally suppressed by selected regions in Canada at the end of 2020.</span>
<span class="attribution"><span class="source">(Public Health Agency of Canada 2020 National HIV Estimates Report)</span></span>
</figcaption>
</figure>
<p>A failure to optimally implement TasP nationally has led to markedly different <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90.html">HIV rates</a> across the country. In 2020, the national HIV incidence rate was 4.8 per 100,000 people. B.C., which had the highest domestic incidence rate at the peak of the epidemic in the 1980s, was well below the national average, at 2.5 per 100,000 population. The province is now at the low end of the national spectrum, together with the territories and Atlantic provinces at 2.1 and 2.2 per 100,000 population, respectively. </p>
<p>Alberta and Ontario were within the range of the national average at 4.2 and 4.1 per 100,000 population. At the other end, Saskatchewan, Manitoba and Québec were above the national average at 23.0, 7.7 and 5.8 per 100,000 population, respectively. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498341/original/file-20221130-22-542xnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map of Canadian provinces & territories showing HIV incidence rates in 2020." src="https://images.theconversation.com/files/498341/original/file-20221130-22-542xnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498341/original/file-20221130-22-542xnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=497&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498341/original/file-20221130-22-542xnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=497&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498341/original/file-20221130-22-542xnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=497&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498341/original/file-20221130-22-542xnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=625&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498341/original/file-20221130-22-542xnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=625&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498341/original/file-20221130-22-542xnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=625&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">HIV rates in Canada by province and territory in 2020.</span>
<span class="attribution"><span class="source">(Public Health Agency of Canada 2020 National HIV Estimates Report)</span></span>
</figcaption>
</figure>
<h2>What Canada needs to do</h2>
<p>Clearly, Canada has the tools and the means to end the epidemic. The question remains, are we up to the task? The key requirements are well known: </p>
<ol>
<li>Normalize HIV testing to ensure everybody knows their HIV status.</li>
<li>Remove barriers to <a href="https://www.ohtn.on.ca/out-of-pocket-costs-associated-with-hiv-in-publicly-funded-high-income-health-care-settings/">accessing health services</a>. </li>
<li>Expand support for affected populations, with particular emphasis on harder-to-reach and most affected populations (men who have sex with men, people dealing with substance use, sex workers, inmates, immigrants and First Nations Peoples).</li>
<li>Make free harm reduction services widely available (condoms, lubricants, injection and smoking paraphernalia, supervised injection and smoking consumption sites and safer drug supply programs).</li>
<li><a href="https://doi.org/10.9778/cmajo.20180058">Free HAART</a> for all HIV-positive people.</li>
<li>Free <a href="https://www.cdc.gov/hiv/risk/prep/index.html">pre-exposure prophylaxis (PrEP)</a> to all people at heightened HIV risk.</li>
<li>Free relevant laboratory monitoring for all those on HAART or PrEP. </li>
</ol>
<p>In addition, we must demand full transparency and accountability from our health-care system. That starts with PHAC annually reporting progress towards the UN 95-95-95 by 2025 target, HIV prevalence and AIDS-related mortality. </p>
<p>Finally, the federal government should sponsor a yearly independent summit of all relevant stakeholders to promote accountability and transparency, compare regional progress and share lessons learned in the process. </p>
<p>As a leader in treatment and prevention, Canada has a global responsibility to optimally implement a strategy to effectively combat HIV-AIDS. That will require a major commitment from the provinces given that health care is a provincial responsibility. </p>
<p>Canada knows how to end the HIV-AIDS epidemic. It is high time to get it done.</p><img src="https://counter.theconversation.com/content/195542/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julio Montaner has received support, paid to his institution, from the BC Ministry of Health, Health Canada, the Public Health Agency of Canada, Genome BC, Vancouver Coastal Health and the VGH Foundation. Institutional grants have been provided by Gilead, Merck and ViiV Healthcare.</span></em></p><p class="fine-print"><em><span>Viviane Dias Lima receives funding from the Canadian Institutes of Health Research (PJT-148595; PJT-156147), and the Canadian Foundation for AIDS Research (CANFAR Innovation Grant – 30-101). </span></em></p>Dec. 1 marks World AIDS Day. Canada has the tools and means to end the epidemic. The question remains, are we up to the task?Julio Montaner, Killam Professor, Department of Medicine, University of British ColumbiaViviane Dias Lima, Scientist, Senior Methodologist & Associate Professor, Department of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1868722022-07-15T12:19:03Z2022-07-15T12:19:03ZIs monkeypox a pandemic? An epidemiologist explains why it isn’t likely to become as widespread as COVID-19, but is worth watching<figure><img src="https://images.theconversation.com/files/474184/original/file-20220714-32258-jxqdeg.jpg?ixlib=rb-1.1.0&rect=30%2C69%2C2871%2C1705&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Monkeypox is caused by the monkeypox virus, which are the ovals and circles seen in this electron microscope image of the skin of a person infected with monkeypox.</span> <span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=22664">Cynthia S. Goldsmith, Russell Regnery/CDC</a></span></figcaption></figure><p>Monkeypox is the latest global public health threat to make headlines. Most people who contract the monkeypox virus experience flu-like symptoms and a <a href="https://www.cdc.gov/poxvirus/monkeypox/symptoms.html">blistery rash</a> that lasts two to four weeks, but a small percentage of infected people develop sepsis or other severe and <a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">potentially fatal complications</a>.</p>
<p>It is not uncommon for there to be <a href="https://doi.org/10.1371/journal.pntd.0007791">small outbreaks of monkeypox</a> in Central and West Africa, but in the last few weeks, dozens of countries from other world regions have reported <a href="https://ourworldindata.org/monkeypox">thousands of cases of monkeypox</a>. </p>
<p>As an infectious disease epidemiologist, I’ve received many inquiries from colleagues and friends about whether a monkeypox pandemic will be the next big disruption to our lives. A disease is considered to be <a href="https://doi.org/10.1093/oso/9780192897855.003.0002">pandemic</a> when two separate conditions are met: cases are occurring globally and the number of cases being diagnosed is large enough to qualify as <a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">epidemic</a>. An epidemic is characterized by new cases of a disease occurring at a <a href="https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html">higher than typical rate in at least several communities</a>.</p>
<p>While the monkeypox situation is certainly newsworthy, as of mid-July 2022, it did not clearly meet both of the requirements for pandemic status. More importantly, the current evidence suggests that <a href="https://theconversation.com/what-is-monkeypox-a-microbiologist-explains-whats-known-about-this-smallpox-cousin-183499">monkeypox</a> is very unlikely to become a global health catastrophe even if the virus spreads and becomes pandemic.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A map showing much of the world in red." src="https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=305&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=305&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=305&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=383&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=383&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=383&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As of mid-July 2022, monkeypox cases associated with the current outbreak (shown in red on the map, with previous outbreaks in other colors) were occurring mostly in Europe and the Americas, and few cases were being reported from Africa and Asia.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Monkeypox_By_Country.svg#/media/File:Monkeypox_By_Country.svg">ArcMachaon/Wikimedia Commons</a></span>
</figcaption>
</figure>
<h2>Is monkeypox global?</h2>
<p>Both the 2009 <a href="https://www.who.int/emergencies/situations/influenza-a-(h1n1)-outbreak">H1N1 influenza</a> virus and the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019">SARS-CoV-2 coronavirus</a> that emerged in 2019 quickly spread to every region of the world. Global health experts were in full agreement that those were pandemic events. By contrast, the <a href="https://www.who.int/groups/ebola-virus-disease-in-west-africa-(2014-2015)-ihr-emergency-committee">Ebola virus</a> epidemic in West Africa from 2014 to 2016 was mostly contained to just that one region of the world and never spread globally. </p>
<p>The <a href="https://www.who.int/emergencies/situations/monkeypox-oubreak-2022">current distribution</a> of monkeypox cases is somewhere between those two scenarios. As of mid-July 2022, about <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-covid-19-media-briefing--12-july-2022">9,200 total cases</a> of monkeypox had been reported by 63 countries. For reasons that are not yet fully understood, almost all of those cases happened in <a href="https://cdn.who.int/media/docs/default-source/2021-dha-docs/20220706_monkeypox_external_sitrep_final.pdf">Europe and the Americas</a>, and only a few cases were reported by <a href="https://ourworldindata.org/monkeypox">African, Asian and Middle Eastern</a> countries.</p>
<p>Is that distribution sufficiently global to meet the definition of a pandemic? Maybe. </p>
<h2>Is monkeypox an epidemic?</h2>
<p>The next condition to meet the pandemic threshold is whether places where monkeypox is present are experiencing epidemics.</p>
<p>Europe and the Americas typically have <a href="https://doi.org/10.1371/journal.pntd.0010141">zero cases</a> of monkeypox per year, so the current case counts in these regions are much higher than normal. </p>
<p>But it is also important to look at how much community transmission is happening. If hundreds of people get sick after attending a single event – like a concert or festival – that would typically be classified as an outbreak. The situation would only become an epidemic if infections started occurring among many people who were not close contacts of event attendees. Once widespread and sustained community transmission begins occurring, it is much harder to control a virus. </p>
<p>Most of the people diagnosed with monkeypox in May and June 2022 were 20- to 50-year-old men who identify as members of the <a href="https://doi.org/10.1126/science.add5497">LGBT+ community</a>. In July 2022, cases were not yet occurring at significant levels in multiple age and sociodemographic groups. </p>
<p>Is the current pattern of spread sufficient to classify monkeypox as an epidemic rather than an outbreak? Maybe, but only in some of the countries that have reported monkeypox cases this year.</p>
<p>Since the answers to whether monkeypox is global and an epidemic are both “maybe” rather than “yes,” this suggests that monkeypox is not a pandemic – at least not yet. But it could become one soon.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A photo of a man's torso with many small lesions" src="https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Monkeypox produces blistery skin lesions, as shown in this photo from the Centers for Disease Control and Prevention taken in the Democratic Republic of Congo in 1997.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Monkeypox/3a2240b22aff43aab5eb20d5f5793149/photo?Query=monkeypox&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=33&currentItemNo=1">Associated Press/CDC</a></span>
</figcaption>
</figure>
<h2>How worried should you be about monkeypox?</h2>
<p>Pathogens like <a href="https://doi.org/10.3389/fpubh.2018.00241">monkeypox</a> are usually spread through touch and other types of <a href="https://www.cdc.gov/poxvirus/monkeypox/transmission.html">close contact</a> with an infected person. Epidemiologists worry much less about pathogens with “person-to-person” transmission than they do about respiratory viruses like influenza and the coronavirus that can spread easily through the air.</p>
<p>Over the course of just a few months, COVID-19 transitioned from a local concern in Wuhan, China, into the worst pandemic in a century. That is <a href="https://doi.org/10.1093/cid/cit703">not going to happen with monkeypox</a>.</p>
<p>Why? First, the monkeypox virus is <a href="https://doi.org/10.2471%2FBLT.19.242347">much less contagious</a> than the circulating strains of coronavirus. Second, monkeypox is less deadly than COVID-19. The <a href="https://cdn.who.int/media/docs/default-source/2021-dha-docs/20220706_monkeypox_external_sitrep_final.pdf">case fatality rate</a> during the current international outbreak is less than one death for every 1,000 adult cases, which is lower than the percentage of unvaccinated people who die after getting <a href="https://doi.org/10.1016/S1473-3099(20)30244-9">COVID-19</a>. And, third, <a href="https://apps.who.int/iris/rest/bitstreams/1433527/retrieve">existing vaccines</a> will be able to help slow the spread of monkeypox in high-risk populations if <a href="https://www.msn.com/en-us/news/us/public-health-clinics-running-out-of-monkeypox-vaccine-as-lines-form-and-systems-crash/ar-AAZxMuv">problems with limited supplies</a> can be resolved.</p>
<p>The World Health Organization follows a set of rules called the <a href="https://www.who.int/publications/i/item/9789241580496">International Health Regulations</a> that guide global public health responses to emerging threats. Under these regulations, the WHO has the authority to declare a “public health emergency of international concern” – commonly shortened to the acronym <a href="https://doi.org/10.1093%2Fjtm%2Ftaaa227">PHEIC</a> – when an infectious disease is spreading internationally and might “potentially require a coordinated international response.” The goal is to detect and respond to potential global health crises and prevent them from becoming pandemics.</p>
<p>An <a href="https://www.who.int/emergencies/situations/monkeypox-oubreak-2022">expert panel convened by the World Health Organization on June 23</a> determined that monkeypox was a “multi-country outbreak” but did not meet the criteria to be a public health emergency of international concern. The panel will meet again on July 21 to examine the distribution and frequency of new case reports. If the rate of new cases continues to increase and there is evidence of transmission within more diverse populations, monkeypox may be declared a public health emergency. </p>
<p>But even if monkeypox is declared to be a public health emergency of international concern, it is not going to become a devastating pandemic like COVID-19.</p><img src="https://counter.theconversation.com/content/186872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn H. Jacobsen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The monkeypox virus, which is commonly found in West and Central Africa, is now causing many infections in the U.S., Europe and Latin America.Kathryn H. Jacobsen, William E. Cooper Distinguished University Chair, Professor of Health Studies, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1855472022-06-22T14:53:07Z2022-06-22T14:53:07ZAt what point is a disease deemed to be a global threat? Here’s the answer<figure><img src="https://images.theconversation.com/files/470226/original/file-20220622-23-p5dnh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Whenever there is an outbreak of a disease in the world – such as <a href="https://theconversation.com/monkeypox-this-is-an-entirely-new-spread-of-the-disease-184085">monkeypox</a> – it is up to the World Health Organization (WHO) to consider what sort of weight to give it, including whether or not it constitutes a public health emergency of international concern.</p>
<p>Global efforts to manage epidemics are documented as far back as <a href="https://www.historytoday.com/archive/black-death-greatest-catastrophe-ever">the black plague in Europe in the 14th century</a>. Since that time, rules have been developed and honed to keep up with the emergence of new diseases as well as with the growing complexities of a world that’s increasingly connected.</p>
<p>There are many diseases that can affect large numbers of people. But not all diseases are considered public health emergencies.</p>
<p>The <a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">seriousness of an epidemic</a> is a function of several factors.</p>
<p>These <a href="https://www.sciencedirect.com/science/article/pii/S002074891400234X">include</a> the degree of contagiousness and potential for rapid spread, severity of infection, case fatality rate (the number of infected people who die), availability of vaccines or treatment (it’s more serious if there are none), impact on travel and trade, and the socioeconomic context.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-the-drc-ebola-outbreak-was-declared-a-global-emergency-and-why-it-matters-121991">Why the DRC Ebola outbreak was declared a global emergency and why it matters</a>
</strong>
</em>
</p>
<hr>
<h2>What it triggers</h2>
<p>Declaration of a “public health emergency of international concern” by the WHO triggers a number of things.</p>
<p>The first is that it signals a commitment to provide international resources for the response.</p>
<p>The second is that it enables other provisions of the <a href="https://www.who.int/features/qa/emergency-committees/en/">International Health Regulations</a>. These originated from the International Sanitary Regulations of <a href="https://apps.who.int/iris/handle/10665/85636">the mid 1900s</a>, which were used to control cholera epidemics. At this time, there was increasing awareness of the social and economic effects of epidemic diseases across borders, as well as concern about undue interference with trade.</p>
<p>In 1969 the regulations were <a href="https://africacdc.org/download/international-health-regulations/#:%7E:text=The%201969%20Regulations%2C%20which%20initially,the%20global%20eradication%20of%20smallpox.">renamed</a> the “International Health Regulations” by the WHO. They were then modified in 1973 and 1981. But even then they provided a framework for only 3 diseases – cholera, yellow fever and plague. The principles behind them was</p>
<blockquote>
<p>maximum security against the international spread of diseases with a minimum interference with world traffic.</p>
</blockquote>
<p>In 1995, formal revision commenced to expand the scope of the regulations with six proposed categories of <a href="https://www.asil.org/insights/volume/8/issue/8/revision-world-health-organizations-international-health-regulations">reportable syndromes</a>:</p>
<ul>
<li><p>acute haemorrhagic fever syndrome,</p></li>
<li><p>acute respiratory syndrome,</p></li>
<li><p>acute diarrhoeal syndrome,</p></li>
<li><p>acute jaundice syndrome,</p></li>
<li><p>acute neurological syndrome, and</p></li>
<li><p>other notifiable syndromes.</p></li>
</ul>
<p>In addition, five factors were proposed to determine if a cluster of syndromes was urgent and of international importance. These were rapid transmission in the community, unexpectedly high case fatality ratio, a newly recognised syndrome, high political and media profile, and trade or travel restrictions.</p>
<p>The last revision to the regulations was done in 2005 following the <a href="https://www.asil.org/insights/volume/8/issue/7/sars-and-international-law">SARS epidemic of 2003</a>.</p>
<p>The five substantive changes from the prior version were:</p>
<ul>
<li><p>a dramatic expansion of the scope of the regulations,</p></li>
<li><p>the creation of obligations on states to develop minimum core surveillance and response capacities,</p></li>
<li><p>granting WHO the authority to access and use non-governmental sources of surveillance information,</p></li>
<li><p>granting WHO the power to declare a public health emergency of international concern and to issue recommendations on how states-parties deal with it; and</p></li>
<li><p>the incorporation of human rights concepts into the implementation of the regulations.</p></li>
</ul>
<p>The regulations set down how an emergency will be managed. This includes setting up a roster of experts appointed by the Director General of WHO in all relevant fields of expertise. Then an emergency committee is drawn from this roster for advice. The committee has to decide on a range of issues to do with managing the epidemic. This includes whether an event constitutes a global emergency and when it should be ended.</p>
<h2>More than a health issue</h2>
<p>But the regulations can only go so far. Many countries cannot comply with them due to lack of resources.</p>
<p>Many of the problems of global emergencies are not specific health problems, but relate to civil society, community engagement, law and order and border control. In the 2014 Ebola epidemic, for example, a health promotion team <a href="https://www.washingtonpost.com/news/to-your-health/wp/2014/09/18/missing-health-workers-in-guinea-were-educating-villagers-about-ebola-when-they-were-attacked/">was massacred in Guinea</a> because local people were fearful of outsiders coming to their village. During COVID-19 we also saw civil unrest in some countries. All of these issues are considerations for the WHO when deciding whether to declare a public health emergency of international concern.</p>
<p><em>This is a revised extract from an article <a href="https://theconversation.com/why-the-drc-ebola-outbreak-was-declared-a-global-emergency-and-why-it-matters-121991">previously published</a> by The Conversation Africa written by C Raina MacIntyre and Obijiofor Aginam.</em></p><img src="https://counter.theconversation.com/content/185547/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre has consulted for or been on advisory boards in the last year for Sanofi, GSK, Bavarian Nordic. She is on the WHO COVID-19 Vaccine Composition Technical Advisory Group and the WHO SAGE Ad Hoc Working Group on Smallpox and Monkeypox. She receives funding from NHMRC and MRFF. </span></em></p><p class="fine-print"><em><span>Obijiofor Aginam does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The seriousness of an epidemic is a function of several factors, including the degree of contagiousness and potential for rapid spread.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyObijiofor Aginam, Principal Visiting Fellow & Former Deputy Director, International Institute for Global Health (UNU-IIGH), United Nations UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1837112022-05-25T08:44:01Z2022-05-25T08:44:01ZMonkeypox is endemic in Nigeria. But surveillance isn’t what it should be<figure><img src="https://images.theconversation.com/files/465057/original/file-20220524-22-tuml3t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pox virus illustration. </span> <span class="attribution"><span class="source">ROGER HARRIS/SCIENCE PHOTO LIBRARY/GettyImages</span></span></figcaption></figure><p><em>There has been an <a href="https://7news.com.au/news/public-health/monkeypox-has-made-it-to-australia-so-what-is-it-and-how-can-we-prevent-the-spread-of-the-virus-c-6880684">outbreak of monkeypox cases</a> in a number of countries that are not endemic for the virus. Monkeypox is caused by an orthopoxvirus that is closely related to the virus that caused smallpox. Monkeypox is an animal virus that occasionally infects humans after they are bitten or scratched by a monkey or other animal. It does not usually spread easily between humans, and typically only in close contacts. Since May 13, 110 confirmed cases and a further 205 suspected cases <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385">had been reported</a> from 12 countries. Virologist Oyewale Tomori explains what Nigeria, where the virus is endemic, should be doing to prepare for an outbreak.</em></p>
<hr>
<h2>Is Nigeria managing to contain monkeypox?</h2>
<p>Since the <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385#:%7E:text=The%20first%20human%20case%20was,contaminated%20materials%20such%20as%20bedding.">first human case of monkeypox</a> in 1970 in the Democratic Republic of Congo (DRC), the disease has been reported in several other central and western African countries: Cameroon, Central African Republic, Cote d’Ivoire, Gabon, Liberia, Nigeria, Republic of the Congo, and Sierra Leone. Most infections are in the DRC. </p>
<p>Ghana has not reported a human case of monkeypox. However, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857192/">the source of infection</a> of 47 confirmed and probable cases of monkeypox in 2003 in the US was traced to small mammals. These include rodents, rope squirrels (<em>Funiscuirus</em> sp.), tree squirrels (<em>Heliosciurus</em> sp.), Gambian giant rats (<em>Cricetomys</em> sp.), brushtail porcupines (<em>Atherurus</em> sp.), dormice (<em>Graphiurus</em> sp.), and striped mice (<em>Hybomys</em> sp.) imported from Ghana. This was the first time that human monkeypox was reported outside Africa. Of the cases in the current outbreak in several European countries <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385">none seem to have any contact with cases in Africa</a>. </p>
<p>In Nigeria we probably don’t know how much of the disease we have, because <a href="https://ncdc.gov.ng/">surveillance</a> is not what it should be. We are definitely missing many of the monkeypox cases in the rural areas. From September 2017 to the end of April 2022, Nigeria <a href="https://ncdc.gov.ng/diseases/sitreps">reported</a> a total of 558 suspected cases with 231 (41.4%) confirmed. This year, from January 1st to April 30th, we have reported 46 suspected cases and confirmed 15 from 7 states. No death has been recorded this year. </p>
<p>The <a href="https://ncdc.gov.ng/diseases/sitreps">surveillance of diseases</a> in Nigeria was affected by the COVID pandemic. Take Lassa fever, for example. Nigeria confirmed 1181 Lassa fever cases in 2020, the year COVID came, in 2021, the number of confirmed cases dropped significantly to 510, less than half of the number confirmed in 2020. Now that the effect of COVID is waning and things are gradually returning to normal, the number of confirmed Lassa fever cases for the first four months of the year 2022 stands at 759. </p>
<p>The same situation has been reported for the surveillance and reporting of other diseases. The over concentration and shift or resources to respond to COVID and the fear of contracting COVID in health facilities contributed to the low numbers reported from 2020 to 2021 for a host of diseases, including yellow fever and measles. There has also been a drop in delivering routine vaccines to Nigerian children. In Oyo State, Nigeria, <a href="https://www.panafrican-med-journal.com/content/article/41/54/full/">measles coverage dropped from 77.0% in 2019, to 64.6% in 2020</a> while yellow fever vaccine coverage dropped from 74.5% in 2019 to 58.6% in 2020. </p>
<h2>What needs to be done to prepare for the next outbreak?</h2>
<p>We need to anticipate what is going to happen and prepare. </p>
<p>It’s unlikely to be a mutation because monkeypox virus is a DNA virus, which does not change much and has much less propensity for mutation and variant generation, like SARS-CoV-2, which is an RNA virus. But to be on the safe side, we should do our sequencing so that we’ll know exactly what we’re facing and be able compare with what they have in Europe right now. </p>
<p>We must also make communities aware that this is going on. We now know that a UK resident who arrived in Nigeria on April 20, 2022, and travelled to Lagos and Delta states departed Lagos on May 3, 2022, and arrived in the UK, where <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381#:%7E:text=On%207%20May%202022%2C%20WHO,departing%20Nigeria%20on%203%20May.">the diagnosis of monkeypox</a> was confirmed on 6 May, 2022. This information is enough to alert us that someone was infected with monkeypox through contact with a Nigerian, while in Nigeria. We should conduct contact tracing to determine if there are more cases. </p>
<p>It should also be used as an opportunity to get information across to our people and make them aware that we still have this disease and provide prevention and control guidelines. If somebody has a rash, that person should report to the hospital for further investigation and hospital staff should put in place, infection prevention and control procedures – including wearing gloves and other protective materials. To avoid being infected and becoming a source of infection to others, health workers who are dealing with infected people should take standard infection prevention and control precautions: hand washing, personal protective equipment, respiratory hygiene, cough etiquette and safe injection practices
The message is that of awareness and preparedness, but not panic. </p>
<iframe title="Monkeypox endemic countries" aria-label="Locator maps" id="datawrapper-chart-Go4Ne" src="https://datawrapper.dwcdn.net/Go4Ne/1/" scrolling="no" frameborder="0" style="width: 0; min-width: 90% !important; border: none;" height="680" width="100%"></iframe>
<h2>How does monkeypox spread?</h2>
<p>The virus can be spread by direct contact with body fluids of an infected person or with virus-contaminated objects, such as bedding or clothing. In addition, it can be transmitted by respiratory droplets during direct and prolonged face-to-face contact. It is not easily spread as SARS-CoV-2. This is some good news. Therefore, it is important to reduce contact with whoever is infected. </p>
<h2>Should the world be worried? What about treatment?</h2>
<p>Sure, we should be worried. The disease can cause the death of one out of 10 infected people and can spread very quickly. The symptoms – fever, malaise, and headache – of monkeypox are more severe than those of chickenpox.</p>
<p>The other reason for concern is that there is no specific treatment or vaccine available for monkeypox infection. In the past, the anti-smallpox vaccine <a href="https://www.who.int/en/news-room/fact-sheets/detail/monkeypox">was shown</a> to be 85% effective in preventing monkeypox. But smallpox has been <a href="https://www.who.int/health-topics/smallpox#tab=tab_1">eradicated</a> so the vaccine isn’t widely available anymore. </p>
<p>Nevertheless outbreaks can be controlled. The first step is preventing infections. This can be achieved through public health awareness campaigns to reduce the risk of animal-to-human transmission. Key messages would include the fact that people should avoid contact with sick or dead animals that could harbour the virus, especially in areas known to be monkeypox hotspots. </p>
<p>Other precautions include ensuring that infected people are isolated and that health workers caring for ill people must wear gloves and protective equipment. </p>
<h2>Are there many strains?</h2>
<p>So far, no, there seem to be <a href="https://pubmed.ncbi.nlm.nih.gov/19474247/#:%7E:text=Monkeypox%20virus%20is%20divided%20into,evaluated%20in%20non%2Dhuman%20primates">only two types</a> – the Congo Basin and West African strains.</p>
<p>It is unlikely to have strange mutations as happened with SARS-CoV-2, which causes COVID. Remember that monkeypox is a DNA virus. It’s not an RNA virus, which mutate frequently generating variants of concern.</p><img src="https://counter.theconversation.com/content/183711/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Oyewale Tomori does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nigeria must step up its preparedness for monkeypox.Oyewale Tomori, Fellow, Nigerian Academy of ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1752482022-02-13T07:14:37Z2022-02-13T07:14:37ZLessons from the DRC’s 10th Ebola epidemic: the people may know best<figure><img src="https://images.theconversation.com/files/442743/original/file-20220126-39683-12vvtag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The large public health apparatus assembled to fight Ebola created more problems. </span> <span class="attribution"><span class="source">Alexis Huguet/AFP via Getty Images</span></span></figcaption></figure><p>The tenth Ebola epidemic in the Democratic Republic of the Congo (DRC) was declared in North Kivu on 1 August 2018. The international response to the epidemic was significant. More than half a <a href="https://www.liberation.fr/planete/2020/02/04/en-rdc-la-riposte-de-l-oms-rattrapee-par-l-ebola-business_1776970/">billion dollars</a> of international aid flowed into the country. A newly approved, highly protective vaccine was used, and new medicines were tested and found to reduce mortality. </p>
<p>But still, on 25 June 2020, when the epidemic was finally declared over, it had become the largest Ebola outbreak ever to affect the DRC. It was also the second largest and longest globally to date, <a href="https://www.who.int/news/item/25-06-2020-10th-ebola-outbreak-in-the-democratic-republic-of-the-congo-declared-over-vigilance-against-flare-ups-and-support-for-survivors-must-continue">claiming 2,287 lives across a 23-month period</a>.</p>
<p>The large public health apparatus assembled to fight Ebola created problems, including <a href="https://www.reuters.com/article/congo-ebola-sexcrimes-idUSL8N2L953V">sexual abuse</a>. It also generated conflict. Official counts differ, but there were likely <a href="https://cic.nyu.edu/sites/default/files/vir_ebola_report_02082021_en.pdf">between 200 and 300 episodes of violence</a> tied directly to the Ebola epidemic or the national and international Ebola response coalition, known locally as the Riposte.</p>
<p>We wanted to understand why the large public health response caused so much friction in communities. To do this, we studied the different ways that local communities and the Riposte approached Ebola prevention, treatment and after-care.</p>
<p>Analyses of humanitarian action are <a href="https://www.who.int/emergencies/crises/cod/drc-ebola-srp-v20190219-en.pdf">prone</a> to <a href="https://www.cdc.gov/mmwr/volumes/65/su/su6503a5.htm">recommend</a> ways to do international epidemic management better. In our group of papers we propose a different approach altogether. We contend that international epidemic management involves ceding control to a group of foreign experts who possess, at best, a surface-level understanding of a very complex region. And we suggest that local Congolese knowledge and institutions might have the capacity to manage an Ebola epidemic more effectively than their international counterparts.</p>
<h2>Rethinking epidemic management</h2>
<p>Our research was designed – from conception to publication – by a group of Congolese scholars. Our four recently published papers provide unique vantage points from which to view an otherwise heavily studied epidemic. When read alone, their conclusions might seem modest: careful analyses of important sites of the 10th Ebola epidemic. When taken as a whole, however, they challenge the very foundations of international epidemic management. </p>
<p>In <a href="https://ethuin.files.wordpress.com/2021/10/swp6-muhindo-ebola-final.pdf">the first of the four papers</a>, we focus on Mangina, a town in north Kivu. This health zone was the epicentre of the outbreak. Ebola cases had been documented locally three months before the outbreak was officially declared and an international response (the Riposte) deployed. Through a careful tracing of the early chain of transmission, we found that traditional methods of minimising infection transmission were remarkably effective at controlling the spread of Ebola. These included isolating the sick and using plastic bags to bury the dead.</p>
<p>The article shows how locally developed mechanisms for prevention and care slowed down the spread of the epidemic, which exploded from 26 cases in the three months before the Riposte was deployed to 250 cases in the three months after, as people became fearful and began dispersing more widely. The Mangina case offers valuable lessons on how to foster inclusive, trusted, and accepted strategies of epidemic response.</p>
<p>In <a href="https://ethuin.files.wordpress.com/2021/11/swp7-sivyavugha-final.pdf">the second paper</a>, we describe the Ebola testing and treatment apparatus developed by the Riposte. We illustrate the harmful effects of the Riposte’s militarised, fear-based approach to testing and treatment. This approach prompted patients to flee the Riposte, which negatively affected the rate of spread, the morbidity, and the deadliness of the epidemic. </p>
<p>We argue that if existing personnel and institutional structures had been used to manage Ebola instead of imposing new structures, decades of trust in the Congolese health system could have been used to engage the population in control measures.</p>
<p>In <a href="https://ethuin.files.wordpress.com/2021/11/swp8-mukungilwa-final-1.pdf">the third paper</a>, we consider the challenges facing survivors. Improved treatments greatly reduced mortality during the 10th Congolese epidemic. For those who got help early, Ebola was no longer a death sentence but rather a preventable and treatable disease. And so, new measures were introduced for survivors. Survivors were given material goods when discharged from treatment; they were enrolled in support groups; and they were required to follow a very regimented health surveillance system. </p>
<p>In this paper, we demonstrate that the coercive policies and tactics of the Riposte fomented fear of survivors and reinforced the stigma attached to them. We also challenge the assumption that international humanitarian organisations should play a leading role in the reintegration of survivors back into Congolese society.</p>
<p>The <a href="https://ethuin.files.wordpress.com/2021/10/swp5-muhindo-kwiravusa-final.pdf">final paper</a> serves as a conclusion to the quartet. It assesses the strategic and operational challenges around the outbreak and the efforts undertaken by the Riposte to contain it. We highlight how the lack of efficient communication, the uncritical provision of free healthcare, and a blind eye to the prevailing situation of electoral tensions and contested local politics led to poor acceptance of these efforts. As a result, the Riposte was perceived by many locally as a vast machine of economic extraction, further heightening mistrust.</p>
<h2>Bringing in the local</h2>
<p>Based on these findings, we offer concrete recommendations for improved epidemic management. </p>
<p>First, take into account the socio-cultural, political and economic context in the region of intervention. </p>
<p>Second, strengthen, improve or extend the existing health system instead of creating a parallel system that weakens it. </p>
<p>Third, listen to and integrate local actors, skills and practices, rather than marginalise or exclude them. </p>
<p>Fourth, create favourable conditions that provide space for local communities to take ownership of the fight against the epidemic.</p>
<p>More radically, we also propose the possibility of a different form of accounting in epidemics, one that tallies trust and familial duty instead of “Ebola suspects”, that counts dignity and respect rather than “secure burials completed”.</p>
<p>It will take time to change all this. But it must happen. As many a Congolese remarked during the 10th epidemic, “the people see further than the Riposte”.</p><img src="https://counter.theconversation.com/content/175248/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>International epidemic management involves ceding to foreign experts who possess, at best, a surface-level understanding of a very complex region.Rachel Niehuus, Surgeon and medical anthropologist, Emory UniversityBen Radley, Lecturer in International Development, University of BathBienvenu Mukungilwa, Researcher at the Centre de recherches Universitaires du Kivu (CERUKI)Christoph Vogel, Research Director of the Insecure Livelihoods Project, Ghent UniversitySerge Kambale Sivyavugha, Researcher, Université catholique de BukavuLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1756222022-01-31T19:07:37Z2022-01-31T19:07:37ZCOVID will soon be endemic. This doesn’t mean it’s harmless or we give up, just that it’s part of life<p>We have experienced many bumps in the road since 2020 and one would have to be extremely brave to predict what the pandemic may throw at us next.</p>
<p>But in terms of the endgame, many experts believe COVID <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext">will eventually become an endemic disease</a>.</p>
<p>However, what this actually means is a source of considerable confusion. One of the main reasons for this is a misunderstanding of endemicity itself, and what COVID being an endemic disease would actually look like in the real world.</p>
<p>Let’s break it down.</p>
<h2>What does ‘epidemic’ actually mean?</h2>
<p>A disease is either epidemic or endemic.</p>
<p>The most straightforward explanation of an epidemic disease is that it’s one in which the number of cases in the community is unusually large or unexpected. When this occurs, it signals a need for public health action to bring disease transmission under control.</p>
<p>In the case of a pandemic – a worldwide epidemic – this occurs on a much larger scale. Depending on the infectiousness and severity of the disease, it can represent a global public health emergency, as we’ve seen with COVID.</p>
<p>When you have the emergence of a completely new virus like SARS-CoV-2 that has the potential to cause severe illness while also being highly transmissible, the lack of any immunity among the population results in the drivers for disease spread being incredibly strong.</p>
<p>A disease being epidemic indicates there’s an imbalance between these drivers of disease spread and the factors limiting spread in the community. In short, it means the drivers for disease spread overpower the factors limiting spread.</p>
<p>As such, the disease spreads like a raging bushfire. It’s explosive and hard to bring under control once it has seeded.</p>
<h2>From epidemic to endemic</h2>
<p>However, over time, the underlying forces driving an epidemic alter.</p>
<p>As immunity begins to increase across the population – ideally in a controlled way by vaccination, but also by natural infection – the pathogen starts to run out of fuel and its ability to transmit falls.</p>
<p>Pathogens can include a variety of microorganisms, such as viruses, bacteria and parasites. In this case, let’s assume we’re talking about a virus.</p>
<p>On top of immunity, we can also reduce a virus’ ability to spread by behaviour changes, such as limiting contact with others, mask wearing and improved hand hygiene.</p>
<p>In addition to lowering the virus’ ability to transmit, immunity also reduces its ability to cause disease, meaning fewer people become really sick or die.</p>
<p>And finally, if we are lucky, over longer periods of time, the virus may also evolve to become intrinsically less severe.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1486359973395410945"}"></div></p>
<p>The net result of this is we move from an imbalance in terms of the forces driving disease to a more steady state of equilibrium.</p>
<p>Instead of explosive and unpredictable disease spread, we reach a point where the presence of circulating disease represents a lower threat to the community than it did at the beginning of an epidemic.</p>
<p>Transmission becomes more predictable, but not necessarily constant – we may still see some waves, especially seasonally. But these are expected and manageable.</p>
<p>In short, we start to live alongside the virus.</p>
<p>This is what we mean by an endemic disease. Examples of endemic diseases include the common cold, influenza and HIV/AIDS.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-will-likely-shift-from-pandemic-to-endemic-but-what-does-that-mean-167782">COVID will likely shift from pandemic to endemic — but what does that mean?</a>
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<h2>Endemic doesn’t mean we drop our guard</h2>
<p>The discussion around COVID becoming endemic becomes even more complicated by very different views about what this actually translates to in practice.</p>
<p>It’s important to emphasise it doesn’t mean we drop our guard, surrender to the virus or downgrade the threat the virus poses to individuals and the community. </p>
<p>We remain vigilant and respond to surges in cases when they occur, doing what’s needed to keep transmission as low as possible.</p>
<p>Importantly, a disease being considered endemic doesn’t mean we consider it mild. It just means it remains a part of our lives, and therefore we still protect the vulnerable from severe illness, as we do with other diseases.</p>
<p>It’s crucial we understand living with the virus isn’t the same thing as ignoring the virus. Instead, it represents an adjustment in the way in which we respond to the disease.</p>
<h2>It’ll be a bumpy ride</h2>
<p>It’s also important to highlight this transition may not necessarily be smooth and there will no doubt be challenges along the way.</p>
<p>One of the main obstacles we’re going to face is the possible emergence of new variants and how these will impact the infectiousness and severity of the disease.</p>
<p>In order to reduce the likelihood of new variants emerging, it’s vital we really <a href="https://theconversation.com/3-ways-to-vaccinate-the-world-and-make-sure-everyone-benefits-rich-and-poor-155943">step up our rollout of vaccines globally</a> to reduce virus transmission.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/will-an-omicron-specific-vaccine-help-control-covid-theres-one-key-problem-175137">Will an Omicron-specific vaccine help control COVID? There's one key problem</a>
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</p>
<hr>
<p>To aid us in our transition to this next stage of the pandemic, we will, thankfully, be able to draw on many new weapons which are in the pipeline. This includes next-generation vaccines which will be more effective against the latest variants, or <a href="https://abcnews.go.com/Health/variants-emerge-us-government-turns-attention-universal-coronavirus/story?id=82469854">universal vaccines</a> that cover all variants. We expect new vaccines will also be <a href="https://cosmosmagazine.com/health/covid/next-gen-covid-19-vaccines/">better at controlling transmission</a>.</p>
<p>We’ll also have ever-improving <a href="https://theconversation.com/australia-approves-two-new-medicines-in-the-fight-against-covid-how-can-you-get-them-and-are-they-effective-against-omicron-175321">treatments</a>, and better infection prevention and control engineered for specific environments.</p>
<p>The big question, of course is when will this transition to endemicity happen? Many experts believe huge strides will be made along this path in 2022.</p><img src="https://counter.theconversation.com/content/175622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Bennett receives funds from the NHMRC and MRFF, is a COVID-19 Scientific Advisory Board member for ResApp Health, and was on the Australian independent covid-19 vaccine advisory committee for AstraZeneca. </span></em></p><p class="fine-print"><em><span>Hassan Vally does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Endemic doesn’t mean we drop our guard, surrender to the virus or downgrade the threat the virus poses to individuals and the community.Hassan Vally, Associate Professor, Deakin UniversityCatherine Bennett, Chair in Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1730792021-12-12T08:36:03Z2021-12-12T08:36:03ZOne virus, two countries: how the misuse of science compounded South Africa’s COVID crisis<figure><img src="https://images.theconversation.com/files/435549/original/file-20211203-23-1j1hhlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A Soweto resident walks past a graffiti art wall educating locals about the dangers of COVID-19 in South Africa</span> <span class="attribution"><span class="source">Kim Ludbrook/EFE-EPA</span></span></figcaption></figure><p><a href="https://www.bbc.com/news/world-59442129">Now</a>, and in the past, “following the science” on COVID-19 has landed South Africa in trouble. This is not an indictment of science, but of the way it is understood in South Africa.</p>
<p>My new book <a href="https://witspress.co.za/catalogue/one-virus-two-countries">One Virus, Two Countries</a>, which examines South Africa’s response to COVID-19’s arrival in 2020, points out that South Africa fared <a href="http://www.thepresidency.gov.za/newsletters/desk-president%2C-monday%2C-18-may-2020">far worse than the rest of Africa</a> – its case and death numbers were equal to those of the rest of Africa combined. While it is commonly claimed that this is because South Africa tests more, its own scientists have acknowledged that this is not. The book argues that this happened because the minority which takes part in South African public life <a href="https://ewn.co.za/2020/11/03/sa-can-learn-from-europe-s-covid-19-second-wave-say-experts">is fixated on Europe and North America</a>.</p>
<p>Repeated claims that the country was <a href="https://mg.co.za/coronavirus-essentials/2020-06-09-covid-19-free-the-evidence/">“following the science”</a> really meant it was following a particular science <a href="https://ewn.co.za/2020/11/03/sa-can-learn-from-europe-s-covid-19-second-wave-say-experts">followed by some Western scientists</a> – one which ensured high case and death rates because it meant not taking enough of the protective measures needed to prevent the virus’s spread, not only restrictions when they were needed but also <a href="https://theconversation.com/south-africas-covid-19-testing-strategy-needs-urgent-fixing-heres-how-to-do-it-138225">testing and tracing </a>the contacts of infected people.</p>
<p>Only weeks after the virus began circulating, <a href="https://www.samrc.ac.za/people/prof-salim-abdool-karim">Salim Abdool Karim</a>, who was then in effect the government’s chief scientific advisor, declared that a <a href="https://www.science.org/content/article/ticking-time-bomb-scientists-worry-about-coronavirus-spread-africa">“severe epidemic” was inevitable</a> because no country had avoided one – he urged authorities to prepare for bereavements. </p>
<p>It soon became clear that he was expressing a consensus among South African scientists, or at least those quoted in the media. </p>
<p>Daily headlines showed it was not true that no country had avoided a severe epidemic. Many had done just that including South Korea, which faced rapid spread of the virus but avoided a severe outbreak, showing that it was possible to keep cases and deaths down even after the virus began spreading. Although successive waves of COVID-19 did drive up cases and deaths in these countries, they have still avoided severe epidemics: South Korea’s population is similar to South Africa’s but it has <a href="https://graphics.reuters.com/world-coronavirus-tracker-and-maps/countries-and-territories/south-korea/">lost only around 4,000 people</a> to COVID, less than one twenty-fifth of South Africa’s official death toll.</p>
<p>What the scientists said was not <em>“the science”</em> but <em>“a science”</em>, a particular view rejected by many scientists around the world. </p>
<h2>The big divide</h2>
<p>Medical scientists were divided between those who believed every effort should be made to fight the virus and those who argued only for managing it. The group that argued for just managing it – some of whom influenced Donald Trump and the UK government – <a href="https://www.nytimes.com/2020/10/13/world/white-house-embraces-a-declaration-from-scientists-that-opposes-lockdowns-and-relies-on-herd-immunity.html">were against restrictions</a>. </p>
<p>South Africa’s publicly quoted scientists were in this last camp, which is why most <a href="https://theconversation.com/south-africa-needs-to-end-the-lockdown-heres-a-blueprint-for-its-replacement-136080">denounced the lockdown</a>. Remarkably, while scientists elsewhere hotly debated this highly contentious view, South Africa’s publicly quoted scientists all endorsed it. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/435317/original/file-20211202-21915-4cy5gq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/435317/original/file-20211202-21915-4cy5gq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=841&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435317/original/file-20211202-21915-4cy5gq.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=841&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435317/original/file-20211202-21915-4cy5gq.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=841&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435317/original/file-20211202-21915-4cy5gq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1057&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435317/original/file-20211202-21915-4cy5gq.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1057&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435317/original/file-20211202-21915-4cy5gq.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1057&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>The government, while differing with some scientists on lockdowns, agreed that much disease and death was inevitable. Zweli Mkhize, the then minister of health, echoing scientists, declared that <a href="https://www.enca.com/news/coronavirus-sa-more-60-percent-people-will-be-infected">60% of the country would be touched by COVID</a>. This was the figure cited by scientists who peddled the <a href="https://www.nature.com/articles/d41586-020-02948-4">now discredited theory</a> that the virus should be allowed <a href="https://www.thelancet.com/article/S2213-2600%2820%2930555-5/fulltext">to spread until it ran out of hosts</a> – which was greeted with horror elsewhere because it implied that many would have to die but was a consensus view in South Africa’s debate.</p>
<p>The media agreed. During 2020, not one scientist was asked a single critical question although much of what they said was disputed by scientists elsewhere and some of their claims were clearly wrong. </p>
<p>I argue in the book that COVID-19 is among the media’s most shameful moments – it treated scientists much as media in totalitarian countries treat government leaders.</p>
<p>Business first supported the lockdown, then lobbied against restrictions. The media helped it – while other countries’ television channels showed pain and death in hospitals and cemeteries, South Africa’s was interested only in the loud pain of travel agents and restaurant owners.</p>
<h2>‘First world’ bias</h2>
<p>The scientists did not advocate surrender because they were not up on the latest debates. They did it because South Africa remains divided between <a href="https://theconversation.com/south-africa-remains-a-nation-of-insiders-and-outsiders-27-years-after-democracy-159561">“insiders” and “outsiders”</a> and they, like the media which fawned over them and the lobbies which began mobilising against health restrictions weeks into the pandemic, see the world through “insider” lenses.</p>
<p>Internationally, the pandemic disturbed the view which divides the planet into first and third worlds, the first an island of competence and health in a sea of third world sickness and savagery. The countries which did least to protect people were in the first, not the third.</p>
<p>The planet’s divide is also South Africa’s. The minority which is heard in the national debate lives and thinks like the first world. It is fixated on Western countries whether it praises or criticises them. And it sees the rest of South Africa as a third world of poverty and incapacity.</p>
<p>When the scientists said no country had avoided a severe epidemic, they meant no country they noticed – no first world country. When they said South Africa was doomed to suffer, they assumed that the third world majority would be too ignorant to protect themselves – and that only first world medicine would work but that the country did not have enough of it. The rest of the first world see South Africa in the same way.</p>
<p>It was the biases of its first world which prevented South Africa from mobilising the energies and talents of most of its people (many of whom were far less ignorant of the virus than their first world betters) to reduce cases and deaths to levels elsewhere in Africa. </p>
<p>Those biases may also now ensure that most people are not vaccinated because vaccine arrangements are tailored to the first world.</p><img src="https://counter.theconversation.com/content/173079/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Friedman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It was the biases of its ‘first world’ which prevented South Africa from mobilising the energies and talents of most of its people against COVID-19.Steven Friedman, Professor of Political Studies, University of JohannesburgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1720132021-11-22T16:27:00Z2021-11-22T16:27:00ZBird flu outbreaks in Europe: what you need to know<p>Once again, Europe is experiencing bird flu outbreaks – the deadliest animal disease known. In chickens and turkeys, <a href="https://www.sciencedirect.com/science/article/pii/S0378113500001607?via%3Dihub">over 90%</a> of an affected flock will die within a couple of weeks, although in ducks and geese the disease may be milder.</p>
<p>Bird flu outbreaks are caused by avian influenza viruses, most of which cause mild infection in birds, but two sub-types (called H5 and H7) can occur as a very deadly virus. </p>
<p>Flu viruses have a high mutation rate and can exchange genes when two viruses simultaneously infect a single host. These genetic changes allow them to change their make up and escape immunity in their host and continue spreading.</p>
<p>In the previous century, epidemics of the deadly bird flu were rare and always originated from mild H5 or H7 viruses that <a href="https://doc.oie.int/dyn/portal/digidoc.xhtml?statelessToken=IUK6OztgH_kivlL_Kka2fnPew1Nz3pbqBVGeS_9xDNE=&actionMethod=dyn%2Fportal%2Fdigidoc.xhtml%3AdownloadAttachment.openStateless">mutated into</a> a deadly virus while transmitting in a chicken or turkey flock. Until 1996, resulting outbreaks and epidemics were either effectively controlled or faded out due to a lack of susceptible hosts. </p>
<h2>H5N1 emerges</h2>
<p>Infections caused by these deadly viruses were also never seen in wild birds. This changed after the emergence of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787969/">the H5N1 virus</a> in China. Outbreaks in poultry were not effectively controlled. The virus gradually expanded its territory across China, and from 2003, further into Asia and Africa. Humans in close contact with infected poultry could become infected, resulting in the death of <a href="https://cdn.who.int/media/docs/default-source/influenza/human-animal-interface-risk-assessments/2021_aug_tableh5n1.pdf?sfvrsn=12194b1_6&download=true">456 people</a> to date.</p>
<p>Wild birds became infected because of a spillover from the ongoing spread of the virus in poultry. This gave rise to new H5 viruses that were still deadly to poultry, but of little harm to certain waterbird species. Consequently, migratory waterbirds could fly thousands of kilometres, despite being infected by these viruses, and so were able to spread the viruses over very large distances. </p>
<p>In 2005, wild waterbirds introduced the virus to Europe for the first time during fall migration. This was the first sign that the ecology of these viruses had completely changed; a virus strictly associated with poultry had adapted itself to wild water birds, tremendously increasing its survival potential.</p>
<p>Each year in spring and summer, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972003/">waterbirds mingle</a> on their breeding grounds in Siberia and mix their influenza viruses, creating new variants they then bring to Europe, Asia and Africa during fall migration, causing deadly outbreaks in poultry.</p>
<p>Obviously, there is little we can do to control infections in the wild water birds. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7009867/">Surveillance is recommended</a> to assess the risk of virus exposure to poultry and the removal of carcasses of dead birds from the environment. </p>
<p>Poultry farmers in areas with many waterbirds that stay there over winter are advised to keep poultry inside and should implement biosecurity measures to keep the virus out of their sheds. Faeces of infected wild birds <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048466/">can contain</a> high amounts of virus and can easily enter a poultry shed by uncleaned boots or materials.</p>
<p>Current biosecurity programmes have not been sufficiently effective to prevent infections in risk areas. In the season 2020-21 there were <a href="https://www.efsa.europa.eu/sites/default/files/2021-05/9989.pdf">over 1,000 outbreaks</a> in the EU alone. And in the current season, tens of outbreaks have already been detected. </p>
<p>The yearly recurring outbreaks, with the associated mass killing of poultry, are an obvious threat to the sustainability of poultry farming. </p>
<h2>Poultry vaccine</h2>
<p>Vaccination could be a tool to help solve the problem. However, it is forbidden in many countries and its use results in trade barriers for poultry. The reason for the trade barriers is that most current vaccines prevent disease, but <a href="https://www-sciencedirect-com.proxy.library.uu.nl/science/article/pii/S0034528814002501?via%3Dihub">don’t stop transmission</a> of the infection. </p>
<p>A vaccine that stops disease but doesn’t stop transmission will result in “silent” virus spread, which compromises outbreak control and is undesirable because the virus has the potential to spread from animals to humans. </p>
<p>Fortunately, most of the currently circulating H5 virus variants are <a href="https://www.who.int/docs/default-source/wpro---documents/emergency/surveillance/avian-influenza/ai-20211112.pdf?sfvrsn=30d65594_181">not as dangerous</a> to humans as their ancestor H5N1. Still, caution is needed as this could easily change because of the virus’s ability to change its genetic code. </p>
<p>We urgently need effective vaccines for poultry – it is the only sustainable solution. New-generation vaccines may have more potential to control bird flu, but their effectiveness to stop virus transmission <a href="https://www.internationalegg.com/app/uploads/2018/01/AI-Vaccination-Document-Final.pdf">should be demonstrated</a> in the field. Such vaccines will not only protect poultry but also minimise exposure of humans to the virus.</p><img src="https://counter.theconversation.com/content/172013/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arjan Stegeman receives funding from Dutch ministry of Agriculture, Nature and food safety. </span></em></p>Each year in spring and summer, waterbirds mingle on their breeding grounds in Siberia and mix their flu viruses, creating new variants they then bring to Europe, Asia and Africa.Arjan Stegeman, Professor of Veterinary Medicine, Utrecht UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1674972021-10-26T14:20:08Z2021-10-26T14:20:08ZSomalia and COVID-19: how we used satellite data to track the toll of the pandemic<figure><img src="https://images.theconversation.com/files/419894/original/file-20210907-21-mmgflv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical workers carry the body of a COVID-19 patient at Martini Hospital in Mogadishu, capital of Somalia.</span> <span class="attribution"><span class="source">Xinhua/Hassan Bashi via Getty Images</span></span></figcaption></figure><p>While the impact of the COVID-19 pandemic has been well documented in high-income countries, much less is known about its impact on low-income and conflict-affected countries where there are significant challenges in information generation and dissemination.</p>
<p>Somalia is one of these countries. It has been battered by a series of large-scale <a href="https://www.bbc.co.uk/news/world-africa-22380352">humanitarian emergencies</a>, <a href="https://www.cidrap.umn.edu/news-perspective/2017/08/continued-measles-spread-somalia-crisis-prompts-who-call-donor-support">epidemics</a> and <a href="https://www.lshtm.ac.uk/media/40136">population displacements</a>. These crises were exacerbated, in large part, by three decades of protracted conflict.</p>
<p>But knowing the scale of the impact of COVID-19 is virtually impossible.</p>
<p>Along with other colleagues from the <a href="https://www.lshtm.ac.uk/">London School of Hygiene and Tropical Medicine</a>, the Somali Disaster Resilience Institute and <a href="https://www.hdruk.ac.uk/case-studies/impact-of-the-pandemic-on-somalia/">Satellite Applications Catapult</a>, we <a href="https://www.ijidonline.com/article/S1201-9712(21)00758-X/fulltext">conducted a study</a> to understand the impact of the COVID-19 pandemic on Somalia. </p>
<p>The <a href="http://moh.gov.so/en/covid19/">official</a> figure stood at just over 1,100 deaths as of October this year. But media reports and investigative enquiries of NGOS <a href="https://www.theguardian.com/world/2020/may/02/somali-medics-report-rapid-rise-in-deaths-as-covid-19-fears-grow">point</a> to <a href="https://www.bbc.co.uk/news/av/world-africa-53521563">larger</a> numbers of potential COVID-19 deaths. This suggests that the official data may not capture the full picture of the true burden of COVID-19.</p>
<h2>Collecting data</h2>
<p>The challenge is getting data in a fragile, crisis-affected context. </p>
<p>We overcame this by using commercially available high-resolution satellite data, obtained from <a href="https://www.maxar.com/products/satellite-imagery">Maxar</a>, to count the number of burials in Mogadishu’s Banadir region between January 2017 and September 2020. The Banadir region is on the edge of the city and is home to about 2 million residents.</p>
<p>We compared the number of burials we could count prior to COVID-19 with those between January and September 2020.</p>
<p>We also surveyed key informants to verify what the satellites were showing – in terms of burials – and understand community perceptions of COVID-19 mortality and the challenges associated with controlling the pandemic. </p>
<p>Based on the number of burials we could identify, our analysis found a substantial increase in the burial rate during the COVID-19 period. </p>
<p>Applying this rate to the population of Banadir allowed us to produce a death toll. We repeated this process for burials identified by satellite imagery in the pre-COVID-19 time period, which allowed us to calculate a baseline death toll. The difference between these two figures – which we called the excess death toll – suggested there had been a massive under-reporting of deaths. </p>
<p>Using satellite imagery like this is a novel way to identify how many deaths could be attributable to the pandemic. It’s a promising tool that can be used in resource-constrained settings, where on-the-ground research is a challenge, and where people remain vulnerable to renewed waves and new variants.</p>
<h2>Excess death</h2>
<p>For the satellite data we worked on the assumption that all decedents in Banadir are buried in recognised cemeteries. We then sought to identify and collect data on every cemetery that was “active” (receiving new burials) at any point during the analysis period.</p>
<p>Overall, 68 sequential satellite images were available across the six analysed cemeteries, an average of 11 images per cemetery. We were able to perform an exhaustive grave count for 58.8% (40/68) of images. This was mostly because some images weren’t clear enough to identify graves, or because the view was obstructed by vegetation. We had to rely on satellite data retrospectively collected by Maxar, thus limiting the number of usable data points. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/419954/original/file-20210908-24-1tg0c9k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419954/original/file-20210908-24-1tg0c9k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419954/original/file-20210908-24-1tg0c9k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419954/original/file-20210908-24-1tg0c9k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419954/original/file-20210908-24-1tg0c9k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419954/original/file-20210908-24-1tg0c9k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419954/original/file-20210908-24-1tg0c9k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">All the cemeteries in the region.</span>
</figcaption>
</figure>
<p>For eight images (11.7%) we analysed only the visible area and created a model to predict the missing grave observations.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/419961/original/file-20210908-13-2fdagy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419961/original/file-20210908-13-2fdagy.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419961/original/file-20210908-13-2fdagy.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419961/original/file-20210908-13-2fdagy.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419961/original/file-20210908-13-2fdagy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419961/original/file-20210908-13-2fdagy.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419961/original/file-20210908-13-2fdagy.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sample of very high-resolution images from two cemeteries in Banadir, exemplifying the two typologies or burial pattern observed: (A) expansion into new ‘blocks’ and (B) ‘infilling’ within existing burial area.</span>
</figcaption>
</figure>
<p>During the pre-COVID-19 baseline period (between 2017 and 2019), daily burials across the six cemeteries averaged between 10 and 12. From January 2020, an increase in burials – peaking at more than 20 daily in June 2020 – was evident.</p>
<p>Official figures in October 2020 <a href="http://www.emro.who.int/images/stories/somalia/documents/covid-19-information-note-6.pdf?ua=1">stood at</a> 3,864 cases and 99 deaths across all of Somalia. In contrast, from January to September 2020 we estimated an excess death toll between 3,200 and 11,800 in Banadir region alone. This suggests that the death toll nationwide may be considerably higher.</p>
<h2>Drivers of deaths</h2>
<p>We used interviews with informants to better understand what was driving the high number of deaths in Somalia. We interviewed a range of people, including health authorities, gravediggers and religious leaders. </p>
<p>At the onset of the pandemic in March 2020 the government <a href="https://www.un.org/en/coronavirus/somalia-braces-covid-19">imposed</a> a lockdown as well as restrictions on public movements and meetings. This included the closure of schools, government offices and restriction of international travel. </p>
<p>But the people we spoke to told us that there was a lot of scepticism about the existence of COVID-19. This meant that, in reality, compliance was low, therefore community interactions and public gatherings continued to function as normal. Hotels, teashops, mosques, and other public places remained open. </p>
<p>Our informants painted a picture of a healthcare system ill prepared to cope with the magnitude of the epidemic. Several of our key informants mentioned a shortage of key equipment and treatment facilities. The people we spoke to also mentioned elevated prices of face masks and antiseptics which put them out of the reach of ordinary people. </p>
<p>While most of these deaths are likely to be due to COVID-19, we also heard that some were attributable to the indirect effects of the pandemic, such as socio-economic disruptions or reduced access to health services. </p>
<h2>Knowing the toll</h2>
<p>Our study suggests a considerably higher COVID-19 death toll. It also sheds light on some of the drivers of this high death toll.</p>
<p>We believe that our methods – using satellites and geospatial analysis – can be key to monitoring COVID-19 death rates in other countries, such as South Sudan and Ethiopia, where reporting is challenging due to difficulties in access or conflict. </p>
<p>Death tolls serve as one of the clearest indicators of the impact of the pandemics and can be used by policymakers to make more effective decisions.</p><img src="https://counter.theconversation.com/content/167497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abdihamid Warsame receives funding from UK Research and Innovation as part of the Global Challenges Research Fund</span></em></p><p class="fine-print"><em><span>Terri Freemantle received funding from the UK Foreign, Commonwealth and Development Office (FCDO). </span></em></p><p class="fine-print"><em><span>Abdirisak Dalmar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Satellite imagery can help to get data in fragile, crisis-affected situations.Abdihamid Warsame, Research Fellow, London School of Hygiene & Tropical MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1674822021-10-14T12:08:35Z2021-10-14T12:08:35ZMore ‘disease’ than ‘Dracula’ – how the vampire myth was born<figure><img src="https://images.theconversation.com/files/426277/original/file-20211013-17-1oj68zn.jpg?ixlib=rb-1.1.0&rect=984%2C1205%2C3394%2C2464&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Modern vampires like Dracula may be dashing, but they certainly weren't in the original vampire myths.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/helen-chandler-is-carried-by-bela-lugosi-in-a-scene-from-news-photo/159821076">Archive Photos/ Moviepix via Getty Images</a></span></figcaption></figure><p>The vampire is a common image in today’s pop culture, and one that takes many forms: from Alucard, the dashing spawn of Dracula in the PlayStation game “Castlevania: Symphony of the Night”; to Edward, the <a href="https://theconversation.com/vampires-rebirth-from-monstrous-undead-creature-to-sexy-and-romantic-byronic-seducer-in-one-ghost-story-114382">romantic, idealistic lover</a> in the “Twilight” series.</p>
<p>In many respects, the vampire of today is far removed from its roots in Eastern European folklore. As <a href="https://slavic.as.virginia.edu/people/profile/sjs2z">a professor of Slavic studies</a> who has taught a course on vampires <a href="https://news.virginia.edu/content/dissecting-dracula-chat-vampire-expert-stanley-stepanic">called “Dracula”</a> for more than a decade, I’m always fascinated by the vampire’s popularity, considering its origins – as a demonic creature strongly associated with disease.</p>
<h2>Explaining the unknown</h2>
<p>The first known reference to vampires appeared in written form in Old Russian <a href="https://www.google.com/books/edition/Slavic_Scriptures/-P_huGq9mV4C?hl=en&gbpv=1&dq=upir+etymology+slav&pg=PA218&printsec=frontcover">in A.D. 1047</a>, soon after Orthodox Christianity moved into Eastern Europe. The term for vampire was “<a href="https://starlingdb.org/cgi-bin/response.cgi?basename=dataievasmer&text_word=%D1%83%D0%BF%D1%8B%D1%80%D1%8C&method_word=beginning&ww_word=on">upir</a>,” which has uncertain origins, but its possible literal meaning was “the thing at the feast or sacrifice,” referring to a potentially dangerous spiritual entity that people believed could appear at rituals for the dead. It was a euphemism used to avoid speaking the creature’s name – and unfortunately, historians may never learn its real name, or even when beliefs about it surfaced.</p>
<p>The vampire served a function similar to that of <a href="https://simmonslis.libguides.com/c.php?g=1107583&p=8076095">many other demonic creatures</a> in folklore around the world: They were blamed for a variety of problems, but particularly disease, at a time when knowledge of bacteria and viruses did not exist.</p>
<figure class="align-center ">
<img alt="A 19th-century engraving depicts men in coats and hats shooting at a vampire in a cemetery in Romania." src="https://images.theconversation.com/files/425551/original/file-20211008-18-19q5vyz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/425551/original/file-20211008-18-19q5vyz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/425551/original/file-20211008-18-19q5vyz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/425551/original/file-20211008-18-19q5vyz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/425551/original/file-20211008-18-19q5vyz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/425551/original/file-20211008-18-19q5vyz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/425551/original/file-20211008-18-19q5vyz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Soldiers witnessing vampire hysteria in Eastern Europe – such as people desecrating the graves of suspected vampires – carried tales back home.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/men-shoot-at-a-vampire-lying-staked-through-the-heart-in-a-news-photo/593280150?adppopup=true">Leemage/ Corbis Historical via Getty Images</a></span>
</figcaption>
</figure>
<p>Scholars have put forth <a href="https://theconversation.com/vampire-myths-originated-with-a-real-blood-disorder-140830">several theories</a> about various diseases’ connections to vampires. It is likely that no one disease provides a simple, “pure” origin for vampire myths, since beliefs about vampires changed over time.</p>
<p>But two in particular show solid links. One is rabies, whose name comes from a Latin term for “madness.” It’s <a href="https://www.penguinrandomhouse.com/books/308182/rabid-by-bill-wasik-and-monica-murphy/">one of the oldest recognized diseases on the planet</a>, transmissible from animals to humans, and primarily spread through biting – an obvious reference to a classic vampire trait.</p>
<p>There are other curious connections. One central symptom of the disease is hydrophobia, <a href="https://doi.org/10.1002/ccr3.1846">a fear of water</a>. Painful muscle contractions in the esophagus lead rabies victims to avoid eating and drinking, or even swallowing their own saliva, which eventually causes “foaming at the mouth.” In some folklore, vampires cannot cross running water without being carried or assisted in some way, as an extension of this symptom. Furthermore, rabies can lead to a fear of light, altered sleep patterns and increased aggression, elements of how vampires are described in <a href="https://doi.org/10.1212/WNL.51.3.856">a variety of folktales</a>.</p>
<p>The second disease <a href="https://journals.sagepub.com/doi/pdf/10.1177/014107689709001114">is pellagra</a>, caused by a dietary deficiency of niacin (vitamin B3) or the amino acid tryptophan. Often, pellagra is brought on by diets high in corn products and alcohol. After Europeans landed in the Americas, they transported corn back to Europe. But they ignored <a href="https://doi-org.ezp-prod1.hul.harvard.edu/10.1525/nua.1998.22.1.1">a key step in preparing corn</a>: washing it, often using lime – a process called “nixtamalization” that can reduce the risk of pellagra.</p>
<p>Pellagra causes the classic “<a href="https://doi.org/10.11604/pamj.2020.36.219.24806">4 D’s</a>”: dermatitis, diarrhea, dementia and death. Some sufferers also experience high sensitivity to sunlight – described in some depictions of vampires – which leads to corpselike skin.</p>
<h2>Social scare</h2>
<p>Multiple diseases show connections to folklore about vampires, but they can’t necessarily explain how the myths actually began. Pellagra, for example, did not exist in Eastern Europe <a href="http://dx.doi.org/10.17159/sajs.2018/4597">until the 18th century</a>, centuries after vampire beliefs had originally emerged. </p>
<p>Both pellagra and rabies are important, however, because they were epidemic during a key period in vampire history. During the so-called <a href="https://news.virginia.edu/content/how-spread-disease-juiced-lore-vampires-pandemic-proportions">Great Vampire Epidemic</a>, from roughly 1725 to 1755, vampire myths “went viral” across the continent. </p>
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<p>As disease spread in Eastern Europe, supernatural causes were often blamed, and vampire hysteria spread throughout the region. Many people believed that vampires were the “undead” – people who lived on in some way after death – and that the vampire could be stopped by attacking its corpse. They carried out “<a href="https://doi.org/10.1017/S0959774314000754">vampire burials</a>,” which could involve putting a stake through the corpse, covering the body in garlic and a variety of other traditions that had been present in Slavic folklore for centuries.</p>
<p>Meanwhile, Austrian and German soldiers fighting the Ottomans in the region witnessed this mass <a href="https://www.google.com/books/edition/The_Twilight_Symbols/aMnDXCq9hRkC?hl=en&gbpv=1&dq=upir+etymology+slav&pg=PA398&printsec=frontcover">desecration of graves</a> and returned home to Western Europe with stories of the vampire.</p>
<p>But why did so much vampire hysteria spring up in the first place? Disease was a primary culprit, but a sort of “perfect storm” existed in Eastern Europe at the time. The era of the Great Vampire Epidemic was not just a period of disease, but one of political and religious upheaval as well.</p>
<p>During the 18th century, Eastern Europe faced pressure from within and without as domestic and foreign powers exercised their control over the region, with local cultures often suppressed. Serbia, for example, <a href="https://www.britannica.com/place/Serbia/The-disintegration-of-Ottoman-rule">was struggling between the Hapsburg Monarchy in Central Europe and the Ottomans</a>. Poland was increasingly under foreign powers, Bulgaria was under Ottoman rule, and Russia was undergoing <a href="https://www.jstor.org/stable/j.ctv1pncq7q?turn_away=true">dramatic cultural change</a> due to the policies of Czar Peter the Great.</p>
<p>This is somewhat analogous to today, as the world contends with the COVID-19 pandemic amid political change and uncertainty. Perceived societal breakdown, whether real or imagined, can lead to dramatic responses in society.</p><img src="https://counter.theconversation.com/content/167482/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stanley Stepanic does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The past century’s vampires have often been a bit dashing, even romantic. That’s not how the myth started out.Stanley Stepanic, Assistant Professor of Slavic Languages and Literatures, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1682942021-09-27T15:30:02Z2021-09-27T15:30:02ZWe can’t banish COVID-19. But we can end the pandemic with vaccinations<figure><img src="https://images.theconversation.com/files/423097/original/file-20210924-15-9xe9vi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A vaccination done at a pop-up site in Johannesburg. Not enough South Africans are coming forward to get their shots.</span> <span class="attribution"><span class="source">Photo by Sharon Seretlo/Gallo Images via Getty Images</span></span></figcaption></figure><p>South Africa’s daily rate of new infections has been <a href="https://www.sabcnews.com/sabcnews/sa-seeing-promising-decline-in-confirmed-cases-csir/">on a steady decline for some time</a>. But, truth be told, a fourth wave is probably just on the horizon – and a fifth, and a sixth, and a seventh. This is true of every country in the world.</p>
<p>These waves could be instigated by various phenomena. Perhaps a “super-spreader” event or two, or the arrival of a new and more contagious variant.</p>
<p>Thanks to a successful vaccination programme, smallpox was <a href="https://www.cdc.gov/smallpox/history/history.html">eradicated worldwide by 1977</a>. But as leading American science journalist Christie Aschwanden recently argued, COVID-19 is unlikely to disappear in the same way. Current vaccines just don’t provide enough protection <a href="https://www.nature.com/articles/d41586-021-00728-2">against infection to provide herd immunity</a>. They provide substantial protection against infection as well as severe illness, but they aren’t bullet proof, and reinfection is a reality. </p>
<p>What does this say about the pandemic?</p>
<p>Epidemics do not require the total eradication of the disease to end. More important than the existence of the disease, is the harm it is causing the population. But will the harms of COVID-19 ever be low enough? Will the epidemic ever end? </p>
<p>In short: Yes, it will - so long as enough people get vaccinated and vaccine efficacy continues to protect people from severe illness with new variants. Although exactly what percentage of the population need to be vaccinated to achieve this is hard to say at this stage.</p>
<h2>The pandemic’s end</h2>
<p>This won’t happen with a bang. What we can expect to see is a fading-away. Waves might well still continue, and even increase in magnitude. But fatalities will reduce and severe illness become less common as vaccination rates improve. </p>
<p>As medical historians Erica Charters and Kristin Heitman put it, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1600-0498.12370">epidemics end</a> once the disease is</p>
<blockquote>
<p>accepted into people’s daily lives and routines, becoming endemic— domesticated—and accepted. </p>
</blockquote>
<p>Whereas diseases become epidemics and pandemics through purely biostatistical means – a matter of how many people are infected and where those people are – they end once the biomedical harms they cause are sufficiently reduced. In other words, when relatively few people are getting seriously ill.</p>
<p>There are currently multiple vaccines that are <a href="https://www.bmj.com/content/374/bmj.n2282">extremely effective</a> in reducing the effects of the virus from a life-threatening disease, to (for the vast majority of people) nothing more than a mild cold. </p>
<p>Even in the face of further waves of infection, were the entire population fully vaccinated, the biomedical harm the disease would cause would be (relative to many diseases we are already dealing with) sufficiently low to call an end to the epidemic. </p>
<p>This would mark the point at which governments could stop implementing many of the economically and socially devastating non-pharmaceutical interventions. </p>
<h2>How far down the road are we?</h2>
<p>The answer to this question depends on which country you’re living in.</p>
<p>If you are in Europe, you’re closer than those of us living in an African country.</p>
<p>Despite the initial shortages, South Africa currently has more than enough vaccines to satisfy demand. Initially, the slow roll out might have been blamed on supply issues, but now the country faces one big problem: <a href="https://businesstech.co.za/news/trending/512982/south-africas-vaccine-headache-switches-from-supply-to-demand/">not enough people are choosing to vaccinate</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/south-africas-immunisation-record-risks-being-dented-by-anti-vaccination-views-153549">South Africa's immunisation record risks being dented by anti-vaccination views</a>
</strong>
</em>
</p>
<hr>
<p>The scourge of disinformation and anti-vax propaganda has people afraid to accept these life-saving vaccines. All too often, this ends in tragedy. </p>
<h2>A call to arms</h2>
<p>Unfortunately, it is quite natural to listen to anecdotal evidence and take it seriously – to think that because “Uncle Richard” took the vaccine and then had a heart attack, the vaccine caused the heart attack. But this is not good evidence of a causal relationship. </p>
<p>Evidence-based medicine is routed in large-scale randomized trials, with many thousands of people participating (and now, many millions have taken the vaccine). </p>
<p>Both the trials and now large-scale roll-outs have conclusively shown that vaccines massively reduce people’s chances of <a href="https://www.bmj.com/content/374/bmj.n2282">hospitalization and death</a>, and further, that by all standard measures of pharmaceutical safety, that they are not harmful. </p>
<p>We do not advocate for legally mandated vaccinations (or indeed for any legally mandated medical treatment). But we must come to terms with the fact that COVID-19 is probably here to stay, and that the only way to end this epidemic is to stop the enormous harm it is doing. </p>
<p>The only way to prevent healthcare systems being periodically clogged up with suffering COVID-19 patients, and to end this epidemic, is to ensure that as many people as possible are vaccinated, and as soon as possible.</p><img src="https://counter.theconversation.com/content/168294/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Epidemics do not require the total eradication of the disease to end.Benjamin T H Smart, Associate Professor, University of JohannesburgHerkulaas MvE Combrink, Lecturer, University of the Free StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648272021-08-09T12:26:52Z2021-08-09T12:26:52ZShutting down school vaccine clinics doesn’t protect minors – it hurts people who are already disadvantaged<figure><img src="https://images.theconversation.com/files/414824/original/file-20210805-13-9sbvnr.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C3982%2C2556&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A high school student gets his COVID-19 shot at a pop-up vaccine clinic at a public charter school in Los Angeles.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/year-old-aaron-delgado-receives-his-pfizer-covid-vaccine-news-photo/1234436892">Al Seib / Los Angeles Times via Getty Images</a></span></figcaption></figure><p><a href="https://www.newspapers.com/image/119585257/">A 1918 newspaper article</a> captures public attitudes toward a typhoid vaccine clinic at the Oakdale schoolhouse in Louisville, Kentucky. “Everybody comes – railroad men, children, young girls, old people, housewives,” it reads, “all with sleeves that roll up and arms ready for the brief stick with the fine needle.” </p>
<p>Until recently, school-located vaccination clinics, or SLVs, have been applauded, or <a href="https://doi.org/10.1177/1059840510369231">simply taken for granted</a>. That changed in mid-July of 2021, when Tennessee <a href="https://www.tennessean.com/story/news/health/2021/07/13/tennessee-halts-all-vaccine-outreach-minors-not-just-covid-19/7928701002/">halted COVID-19 vaccination clinics on school property</a>. The decision was part of a broader effort to cease vaccine messages geared toward children and adolescents. The pause lasted only 10 days and has since been <a href="https://www.tennessean.com/story/news/health/2021/07/23/tennessee-restart-vaccine-outreach-paused-amid-gop-pressure/8043482002/">somewhat reversed</a>, limiting vaccine promotion to messages geared at parents and holding some vaccine events on school property.</p>
<p>Those who want to eliminate school-located COVID-19 vaccination clinics say the sites exist to immunize children without parental consent. However, even before the Food and Drug Administration expanded eligibility to include 12-to-15-year-olds, school-located sites offered COVID-19 vaccines to school staff and other eligible adults.</p>
<p>I am an <a href="https://scholar.google.com/citations?user=KeAdSmgAAAAJ&hl=en">expert on the history of epidemics</a>, and my research shows that this current move is an unprecedented detour from schools’ historical promotion of routine vaccines. Preventing school vaccination clinics does not keep waves of teenagers from getting immunized without consent. Rather, it penalizes those who want to get vaccinated but struggle with access. </p>
<h2>Partisan divide</h2>
<p>Tennessee’s “pause” stemmed from the <a href="https://www.kff.org/policy-watch/the-red-blue-divide-in-covid-19-vaccination-rates-is-growing/">Republican Party’s resistance</a> to publicly embracing COVID-19 vaccination, paired with overhyped attention to the <a href="https://www.tn.gov/content/dam/tn/health/documents/Mature_Minor_Doctrine.pdf">Mature Minor Doctrine</a>. </p>
<p>The Mature Minor Doctrine is a Tennessee law allowing “medical treatment and vaccinations to patients as young as 14,” enabling adolescents to make <a href="https://mckinneylaw.iu.edu/ihlr/pdf/vol13p1.pdf">decisions</a> about their own health. It is especially useful for those who don’t live with their parents, are in situations of neglect or abuse or face emergency circumstances. However, it also covers preventive health care and treatment including vaccinations. Many states hold similar consent exceptions.</p>
<p>Whether minors can get the COVID-19 vaccination without parental approval has <a href="https://www.kff.org/policy-watch/covid-19-vaccination-and-parental-consent/">varied by city and state</a>. After the Pfizer vaccine’s emergency authorization expanded to include ages 12 to 15, <a href="https://www.nytimes.com/2021/06/26/health/covid-vaccine-teens-consent.html">news coverage</a> called attention to teenagers receiving COVID-19 vaccines without consent, in some cases questioning the practice without addressing its prevalence or the <a href="https://www.tennessean.com/story/news/american-south/2021/08/04/teen-covid-19-vaccinations-fight-continues-increase-rate-schools-reopen/5430513001/">risk of not immunizing this age group</a>. In Tennessee, the public health department has stated that only <a href="https://www.tennessean.com/story/news/health/2021/07/23/tennessee-restart-vaccine-outreach-paused-amid-gop-pressure/8043482002/">eight adolescents</a> had received a COVID-19 vaccine without parental consent. Furthermore, no evidence has suggested that SLVs have contributed to these cases. </p>
<p>In other words, misplaced ideology, not data on teenagers getting vaccinated without consent, has been the driving force against SLVs, including COVID-19 vaccine clinics at schools. </p>
<h2>From smallpox to HPV</h2>
<p>Since the mid-19th century, schools have been common sites for vaccine clinics to respond to outbreaks and also provide catch-up immunizations. </p>
<p>In 1875, <a href="https://doi.org/10.1177/1059840510369231">17,505 children</a> were immunized against smallpox in New York City school clinics. Temporary <a href="https://www.newspapers.com/image/66584082/">typhoid vaccine clinics</a> emerged in the 1910s and 1920s across the U.S. And the 1954 polio vaccine field trials took place at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804435/">15,000 public schools</a> across 44 states. </p>
<figure class="align-center ">
<img alt="Nurse puts arm around boy as another nurse administers a polio vaccine shot" src="https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A boy is injected with polio vaccine at a school, circa 1955.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/boy-grimaces-while-being-injected-with-polio-vaccine-news-photo/587497982">USC Libraries/Corbis Historical Collection via Getty Images</a></span>
</figcaption>
</figure>
<p>Even before Jonas Salk’s polio vaccine received approval in April 1955, <a href="https://www.newspapers.com/image/359079723/">SLVs were scheduled in anticipation</a>. They became the main locations for children to receive their vaccines. In the 1960s, SLVs across the country hosted “Sabin Sundays,” providing the oral polio vaccine developed by Albert Sabin to any unvaccinated <a href="https://ohiomemory.org/digital/collection/p267401coll36/id/19113">adult or child</a>. During this time, school campaigns also expanded to offer immunizations against <a href="https://www.newspapers.com/clip/82726551/schools-to-provide-free-vaccine-1971/">rubella and measles</a>. </p>
<p>Since then, SLVs have continued to be used for public health outreach, protecting children against hepatitis B, seasonal influenza and HPV. Many sites emerge for a short window each year, <a href="https://www.newspapers.com/image/523426147/">providing catch-up immunizations</a> for kids who are behind on other vaccines as well as shots against seasonal flu. Others spring up as needed, as demonstrated with H1N1 immunizations in 2009. Even the pop-up clinics at schools typically require parental consent for participation. </p>
<p>Moreover, SLVs are often available to whole communities – not just school attendees. They are widely effective in addressing <a href="https://www.doi.org/10.2105/AJPH.2009.176628">disparities in immunization</a> linked to income and insurance status. Like other mass vaccination sites, SLVs can immunize large numbers of people in a short period of time and <a href="https://doi.org/10.1371/journal.pmed.1003238">reduce disease in a community</a>. </p>
<p>They have <a href="https://www.cdc.gov/vaccines/covid-19/planning/school-located-clinics.html">additional benefits</a>, too. SLVs are convenient for families and school staff, provide a large, temperature-controlled space, create awareness of the importance of vaccines and <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00032366.htm#00000621.htm">boost rates of completion</a> for vaccines given in a series.</p>
<h2>Pandemic disruptions</h2>
<p>The COVID-19 pandemic caused global disruptions in children’s vaccinations. In 2020, <a href="https://www.who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19">routine vaccinations decreased</a> because of stay-at-home orders, <a href="https://www.who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19">delay or cancellation of immunization programs</a> and other reasons connected to the global health crisis. </p>
<p>For the diphtheria, tetanus and pertussis vaccines, known as DTaP, New York City experienced a decrease of <a href="https://www.nytimes.com/live/2021/06/10/world/covid-vaccine-coronavirus-mask">16% for children under 2 and 60% for ages 2 to 6</a>. Researchers estimate that routine vaccinations need to increase <a href="https://doi.org/10.1016/j.vaccine.2020.11.074">as much as 15%</a> for vaccine rates to return to pre-pandemic levels. </p>
<figure class="align-center ">
<img alt="A toddler sits in chair with sleeve pulled down to receive flu shot" src="https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A nurse gives a 3-year-old a flu shot at a mobile immunization clinic set up behind John Ruhrah Elementary/Middle School in Baltimore in October 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/nurse-hellen-lougon-gives-a-flu-shot-to-3-year-old-sofia-news-photo/1229662559">Katherine Frey/The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>It’s important to remember that vaccine-preventable diseases are not distant memories. Only smallpox has been globally eradicated – polio, diphtheria, rubella and other dangerous viruses still exist.</p>
<p>Vaccination reductions can produce costly community outbreaks. A single measles case in 2018 erupted into <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1912514">over 600 cases</a> in an undervaccinated community in New York, costing US$8.4 million in public health response efforts, medical expenses and productivity loss. Similarly, Washington state’s <a href="https://doi.org/10.1542/peds.2020-027037">2019 Clark County measles outbreak</a> cost an estimated $3.4 million. </p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p>
<h2>SLVs for COVID-19</h2>
<p>Starting in March 2020, schools across the country began offering COVID-19 vaccines – first for staff and community members, and in May for those ages 12 and up. Such sites have been <a href="https://doi.org/10.1177/1942602X21991643">especially important</a> for <a href="https://edsource.org/2021/new-l-a-school-vaccination-sites-to-open-for-families-of-students-in-hard-hit-communities/652263">low-income and other underserved communities</a> significantly affected by the pandemic. </p>
<p>Once the eligible age expands to include children ages 11 and younger, school vaccine clinics can serve entire families. The <a href="https://www.nytimes.com/2021/08/05/us/politics/school-vaccinations-biden.html?smid=tw-nytimes&smtyp=cur">White House has encouraged</a> every school district to host at least one pop-up vaccination clinic. As with the typhoid and polio clinics before them, the intention is to curb the spread of disease and improve overall public health – the message that should underscore all vaccination decisions for this pandemic.</p><img src="https://counter.theconversation.com/content/164827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine A. Foss does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For decades, US schools have been common sites for vaccine clinics to respond to outbreaks and provide catch-up immunizations. So why are they suddenly controversial?Katherine A. Foss, Professor of Media Studies, Middle Tennessee State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1638962021-07-14T14:28:22Z2021-07-14T14:28:22ZNigerian academics weigh in on the faults and frustrations of managing COVID-19<figure><img src="https://images.theconversation.com/files/411010/original/file-20210713-13-cjwede.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nigeria's President Muhammadu Buhari shows his COVID-19 certificate after receiving his first dose of the Oxford/AstraZeneca vaccine in March 2021.</span> <span class="attribution"><span class="source">Photo by Kola Sulaimon / AFP via Getty Images</span></span></figcaption></figure><p><em>The Conversation Africa recently held its first policy dialogue session where seasoned academics in Nigeria and the country’s Minister of State, Health, Dr Adeleke Mamora, discussed the country’s handling of COVID-19 so far as well as its preparedness for the next pandemic. In this interview, Doyin Odubanjo, Folasade Ogunsola, Christian Happi and Oyewale Tomori provide their assessment and verdict on Nigeria’s chances of successfully handling another pandemic.</em></p>
<h2>What has been the most frustrating aspect of managing COVID-19?</h2>
<p><strong>Doyin Odubanjo:</strong> It’s communication. I think we underestimated what is required. And by no means am I trying to undermine the need for vaccines, or laboratory testing, and all of that. But what you need more than anything else is behavioural change management. </p>
<p>You can have the testing capacity, but the people will not go to the labs; you have masks as a controlling measure, but the people will not put them on.</p>
<p>We were dependent more on using law enforcement, instead of understanding that we needed to communicate effectively to get people to change their behaviour and follow the directives that we gave for their benefit. </p>
<p><strong>Folasade Ogunsola:</strong> The greatest problem we have is that our systems around health and education are broken. If you’re going to do research in health, it requires knowledge. It requires that you have strong educational systems. It requires that you have strong healthcare systems. </p>
<p>What we have seen across Africa generally is that we have a reactive approach to health rather than a proactive approach. </p>
<p><strong>Oyewale Tomori:</strong> There are two things that contribute to our problems. First of all, we learn lessons and forget them as fast as we learn them. We boast about the 2014 Ebola outbreak. But what followed in 2015, what followed in 2016? We had Lassa fever. It got worse in 2016. It got worse in 2017. Lassa fever in 2018 was even worse than in previous years, that is, until 2019 came and we said we never had it as bad. This year – 2021 – it’s reducing, because every effort is on COVID-19, and reporting of other diseases is neglected. </p>
<h2>Comparing this pandemic with others, what have been the gaps and the gains?</h2>
<p><strong>Oyewale Tomori:</strong> One way to measure gains is by the differences in your response between the epidemics. Your response depends on how well you prepare. And the longer the space between those epidemics, the more we (Nigeria) forget what happened during the previous outbreaks. And at the sight of each new outbreak, we prepare our ammunition at the war front, piling icing on a rotten cake.</p>
<p>The Minister of Health says Nigeria started to build up laboratories in response to COVID-19. We shouldn’t be building laboratories now, 60 years after independence. What we count as success is actually repairing the damage caused by past neglect. We should be ashamed instead of self back-patting. </p>
<p><strong>Christian Happi:</strong> Nigeria was privileged to have some kind of skeletal infrastructure in place to respond to COVID-19. Maybe a bit better than some other African countries that had nothing. But the question is, could it have done more? Could it have been be better prepared? The answer is yes. </p>
<p>Were we better prepared? The answer is no.</p>
<p>Are we testing enough to represent what is going on in the country? I don’t believe that we’re testing enough, which means we could do more. </p>
<p>At the peak of the pandemic, or some time last year, we had a lot of treatment centres that were active. But after a while, when the number of cases was going down, many of them got deactivated. Now that Africa is experiencing a resurgence, can those new centres be reactivated and do we have what it takes to handle a surge like the one that is happening in India and some other African countries? The answer to that is no. </p>
<h2>How can Nigeria catch up with the rest of the world?</h2>
<p><strong>Doyin Odubanjo:</strong> I think policymakers and decision makers have to engage better and more with researchers. We need to build that synergy and close that science to policy gap. We need to note that economic plans are a waste of time without the input of science. </p>
<p>So we have, for instance, a national economic committee in Nigeria, but we don’t have scientists on board. We don’t even have the Minister of Science and Technology there. The president of the Nigerian Academy of Science is also absent. Yet we’ll give speeches that say we know that science, technology and innovation is what drives the economy in this day and age. </p>
<p>We need the private sector very badly to get things running, because apart from the money, there are some efficient systems that the private sector can bring on board to help us manage our public health system. </p>
<p><strong>Christian Happi:</strong> It is crucial that Nigeria invest a lot in health security. And more importantly, it is critical for Nigeria and Africa to invest in vaccine facilities. It is dangerous for a country of 230 million not to have a single facility that can help provide vaccine in case of emergency. It is dangerous for a continent of 1.3 billion people not to have production facilities that can help the continent to respond to an epidemic or pandemic. </p>
<p><strong>Folasade Ogunsola:</strong> We talk about research, but we don’t fund it. There is a gap between doing the research, having the product or the prototype, and commercialisation. When we’ve done the research, you have a product. Taking it the next step requires government, requires the private sector and requires a policy framework that helps to drive that process. That’s missing in Nigeria. </p>
<h2>How prepared is Nigeria for the next pandemic?</h2>
<p><strong>Doyin Odubanjo:</strong> It’s a simple phrase, “we’re not prepared”. So that’s the real takeaway. If we do all the things that have been said, and we address them, maybe we’ll be prepared, but we’re not prepared. No.</p>
<p><strong>Folasade Ogunsola:</strong> Fundamentally, preparedness builds on a system that’s working – and that system is broken. So if we’re really going to prepare for the next pandemic, or we’re going to get the trust, we have to build the systems and make sure that they’re strong. We need good health systems, we need good educational systems.</p>
<p><strong>Christian Happi:</strong> Nigeria would need to rally all its forces - in public health, the private sector and in academia - coming out with a framework that can prepare the country better. </p>
<p>There are many programmes and projects already being piloted in Nigeria like early warning systems for pandemic preemption and response. Nigeria needs to leverage such initiatives in order to strengthen the health system and prepare the country better for pandemic response.</p><img src="https://counter.theconversation.com/content/163896/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian Happi receives funding from the US NIH-H3Africa, the Wellcome Trust, the UK BBSRC, ELMA Foundation. </span></em></p><p class="fine-print"><em><span>Doyin Odubanjo, Folasade Ogunsola, and Oyewale Tomori do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Experts assess Nigeria’s response to COVID-19 so far and express worry that the country does not appear to have learnt much; it isn’t prepared for the next pandemic.Doyin Odubanjo, Executive Secretary, Nigerian Academy of ScienceChristian Happi, Professor of Molecular Biology and Genomics, Redeemer's UniversityFolasade Ogunsola, Professor of Clinical Microbiology, University of LagosOyewale Tomori, Fellow, Nigerian Academy of ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1562772021-06-07T18:13:17Z2021-06-07T18:13:17ZA university course on pandemics: What we learned when 80 experts, 300 alumni and 600 students showed up<figure><img src="https://images.theconversation.com/files/404305/original/file-20210603-23-12w6omk.jpg?ixlib=rb-1.1.0&rect=0%2C127%2C4752%2C2410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Would anyone want to spend more screen time talking about pandemics? Yes, learned an anthropologist, biologist and historian who developed a course on the topic. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>When we decided last summer to create an undergraduate course about pandemics, we faced skepticism. Weren’t students and instructors tired of the COVID-19 pandemic? And would looking at pandemics from the perspective of numerous disciplines make it hard to address the topic with depth, or would we achieve a sense of cohesion? </p>
<p>As an anthropologist, a biologist and a historian, we know that infectious diseases are about a lot more than biology and medicine. Historically, epidemics and pandemics have shaped the world around us, from <a href="https://theconversation.com/a-brief-history-of-masks-from-the-17th-century-plague-to-the-ongoing-coronavirus-pandemic-142959">mask-wearing habits during plague times</a> to the impact of <a href="https://theconversation.com/coronavirus-lessons-from-when-the-1937-polio-epidemic-delayed-school-reopenings-143066">polio on the Toronto school system of the 1950s</a>. </p>
<p>And, just like COVID-19 has affected people differently depending on where they live and work or what social supports they have, so have epidemics of the past. The tragedy of our <a href="https://thelocal.to/a-long-term-tragedy/">long-term care system isn’t new</a> and understanding how infectious diseases might <a href="https://doi.org/10.1111/maq.12092">emerge and spread</a> — <a href="https://www.theglobeandmail.com/opinion/article-ontarios-covid-19-failure-stems-from-politicians-inability-to/">and therefore how to contain them</a> — is a complex matter involving everything from the science of contagion and human behaviour to social systems and the social determinants of health.</p>
<p>At the University of Guelph, we created “Pandemics: Culture, Science and Society.” This multidisciplinary course was offered in a virtual format and open to students as an elective in all programs and to alumni as a complete series of twelve weekly panels per semester. </p>
<p>We initially intended for this to be offered in fall 2020 only, but we quickly realized the value of our approach. We decided to run the course again in winter 2021, with a focus on COVID-19 research and creative projects that emerged at our university, from the sciences and the social sciences to business and the arts. Over two semesters, we engaged with 80 experts and researchers, as well as 600 undergraduates and 300 alumni. </p>
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<img alt="Close up of virus; woman in a brown dress wearing a mask and holding rolls of toilet paper and a bottle of sanitizer." src="https://images.theconversation.com/files/390499/original/file-20210318-17-1q7j85y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390499/original/file-20210318-17-1q7j85y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390499/original/file-20210318-17-1q7j85y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390499/original/file-20210318-17-1q7j85y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390499/original/file-20210318-17-1q7j85y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390499/original/file-20210318-17-1q7j85y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390499/original/file-20210318-17-1q7j85y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Promotional poster for the course on pandemics convened by a biologist, historian and anthropologist.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-in-brown-dress-holding-white-plastic-bottle-painting-4113084/">COVID Mona Lisa by Yaroslav Danylchenko</a>, <a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span>
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<h2>From disease modelling to pandemics in art</h2>
<p>Themes for weekly panels included knowledge and misinformation; pandemics in history and the arts; animals, environments and pandemics; and community, agency and resilience. Students and alumni learned about disease modelling, the impacts of COVID-19 on our food systems, pandemics in the ancient world and the biology of infectious diseases. Each week, panellists — faculty, post-doctoral fellows and other experts — gave short presentations, followed by moderated discussion. </p>
<p>We convened expert panels from departments of population medicine, integrative biology, geography and computer science to economics, sociology and anthropology, fine arts and music, history and others, engaging multiple disciplines at a time. </p>
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Read more:
<a href="https://theconversation.com/how-to-live-in-a-pandemic-is-the-type-of-university-class-we-need-during-covid-19-138254">'How to live in a pandemic' is the type of university class we need during COVID-19</a>
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<p>Panellists helped students and alumni sift through and make sense of the COVID-19 “<a href="https://www.who.int/news/item/23-09-2020-managing-the-covid-19-infodemic-promoting-healthy-behaviours-and-mitigating-the-harm-from-misinformation-and-disinformation">infodemic</a>.” Public health and media experts, mathematicians, biologists, psychologists and philosophers were able to answer questions on the usefulness of masks, suggest ways for students to navigate stressful disagreements with roommates or relatives about COVID-19, and help the class understand how testing models and vaccines were developed. Every week added another layer to class discussions.</p>
<h2>Personal and virtual connections</h2>
<p>As course organizers, we were learners too. Through class discussions, we learned how COVID-19 was affecting all of us — students, alumni and panellists — as many shared some of their experiences. The course demonstrated the ways in which academic knowledge and personal experience can relate and interact with each other. </p>
<p>We know that <a href="https://doi.org/10.1080/01459740.2013.842565">people experience and explain epidemics</a> and pandemics in ways that are shaped by existing economic, political, technological and social circumstances and tensions. As anthropologist Lisa J. Hardy explains, to “understand social and political responses to the global pandemic, it is essential <a href="https://doi.org/10.1080/01459740.2020.1814773">that we continue to investigate xenophobia, inequality and racism alongside the biological impact</a>” because the effects of pandemics are unequal and shaped by societal divisions. This became one of the main themes of the course. </p>
<p>The course allowed us to explore our shared and individual experiences in living through COVID-19. Participants heard how different the experience of the pandemic has been based on factors such as sex and gender, socio-economic status, race and ethnicity, geographic location (for instance, rural versus urban), political circumstance, mental and physical health status and many other factors. </p>
<p>We learned about the resilience of the Canadian <a href="https://arrellfoodinstitute.ca/food-systems-in-a-time-of-disruption/">food system</a> from farm to plate, as well as the ongoing challenges such as the reliance on migrant workers and bottlenecks in distribution. We gained insights into the experiences of
<a href="https://www.guelphtoday.com/local-news/how-grocery-store-workers-are-being-overlooked-during-the-pandemic-u-of-g-research-3552945">grocery store workers</a>, <a href="https://liveworkwell.ca/disability-inclusion-analysis-lessons-learned-and-best-practices-government-canada%E2%80%99s-response-covid">persons with disabilities</a>, <a href="https://news.uoguelph.ca/2020/12/dogs-separated-from-owners-show-stress-during-vet-visits-u-of-g-research-finds/">pets and their people</a> and <a href="http://www.sonictapestry.ca/watch.html">musicians</a>. </p>
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<figcaption><span class="caption">Guelph musicians responds to COVID-19.</span></figcaption>
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<p>We benefited from expert discussions about the emergence and evolution of viruses, vaccine development and deployment, <a href="https://theconversation.com/sewage-surveillance-how-scientists-track-and-identify-diseases-like-covid-19-before-they-spread-148307">wastewater testing</a> and many other technical topics. And, we witnessed the incredible <a href="https://www.uoguelph.ca/arts/covidcreators">creativity</a> on display during a global crisis from colleagues across campus.</p>
<h2>Course and a community</h2>
<p>We also saw the potential benefits of virtual classrooms. The course and its weekly panels in a virtual format offered a model for linking students, alumni from all over Canada and the world, and researchers in an intellectual and supportive community. We believe the meaningful connections that were created would have been harder to develop in a large auditorium.</p>
<p>Even as the pandemic kept us apart physically, the course created a deeply engaging virtual community; some students and alumni told us the panels became a weekly high point for them, and alumni attendance and participation made it clear how much alumni value opportunities for lifelong learning that emerge from ongoing university engagement. </p>
<p>If the course felt for some like a community, it was in part because we were engaged in understanding the multifaceted dimensions and impacts of phenomena we were living through in different ways. So while this pandemic will pass, this course serves as a model for addressing complex and urgent challenges such as climate change, social and racial injustice, and global food and economic security.</p>
<p>Recordings of our fall 2020 panels are <a href="https://alumni.uoguelph.ca/events/events-listing/pandemics-culture-science-and-society-course">free to access here</a>.</p><img src="https://counter.theconversation.com/content/156277/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The course offers a model for teaching about complex problems, and underlines the critical role of university learning, research and outreach in understanding and addressing them.Elizabeth Finnis, Associate Professor, Sociology and Anthropology, University of GuelphSofie Lachapelle, Professor, History, University of GuelphT. Ryan Gregory, Professor and Department Chair, Department of Integrative Biology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1612972021-06-02T12:13:55Z2021-06-02T12:13:55ZCovid-19: why the lab leak theory must be formally investigated<p>A year and a half into the pandemic, we still do not know exactly where the SARS-CoV-2 virus, which causes Covid-19, came from. The prevailing view so far has been that the virus “spilled over” from bats into humans. But there are increasing calls to investigate the possibility that it emerged from a lab in Wuhan, China, where Covid first appeared at the end of 2019.</p>
<p>So what do we know for sure, and what do we need still to find out?</p>
<p>We know the sequence of the SARS-CoV-2 virus is <a href="https://www.nature.com/articles/s41586-020-2012-7">close</a> to that of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211627/">bat coronaviruses</a>. Several <a href="https://www.nature.com/articles/s41564-020-0771-4">decades ago</a> its “ancestor” was circulating in bat populations in southern Asia.</p>
<p>But there are still many unanswered questions: we don’t know how the virus arrived in Wuhan, how its sequence evolved to allow human infection, and under what conditions it infected the first people who crossed its path. And for each of these stages, we don’t know whether there was a human contribution (direct or indirect).</p>
<hr>
<p><strong>Lire cet article en français:</strong> <a href="https://theconversation.com/origine-de-la-covid-19-lhypothese-de-laccident-de-laboratoire-doit-elle-etre-etudiee-dun-point-de-vue-scientifique-160825">“Origine de la Covid-19 : l’hypothèse de l’accident de laboratoire doit-elle être étudiée d’un point de vue scientifique ?”</a></p>
<hr>
<p>Zoonotic transmission pathways, in other words the passage of viruses from animals to humans, are now <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474123/">widely documented</a> around the world. Scientists even consider that this is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791534/">principal mechanism for the spreading</a> of new viruses.</p>
<p>But the fact that the pandemic began in the vicinity of a main virus research centre that specialises in the study of coronaviruses with epidemic potential in humans – the Wuhan Institute of Virology – has given rise to another hypothesis, the lab leak theory. Lab accidents have <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)16234-X/fulltext">already led</a> to human infections, including the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011184">H1N1 flu pandemic of 1977</a>, which killed more than 700,000 people.</p>
<p>Which theory is correct? In the absence of definitive proof, and without promoting conspiracy theories, there needs to be a serious international conversation about the origin of SARS-CoV-2.</p>
<h2>The zoonosis theory</h2>
<p>In the scientific community, the debate on the origin of SARS-CoV-2 started with the publication of two articles at the very beginning of the outbreak.</p>
<p>The first, dated February 19, 2020, was published in the medical science journal <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30418-9/fulltext"><em>The Lancet</em></a>. This article, signed by 27 scientists, highlighted the efforts of Chinese experts to identify the source of the pandemic and share the results. The authors deplored “rumours and misinformation” about the origins of the virus, and stated that they “strongly condemn conspiracy theories suggesting that Covid-19 does not have a natural origin”. The authors based their opinion on the first published sequence data, but did not detail the scientific arguments supporting a natural origin.</p>
<p>In March 2020, another article published in <a href="https://www.nature.com/articles/s41591-020-0820-9"><em>Nature Medicine</em></a> provided a series of scientific arguments in favour of a natural origin. The authors argued:</p>
<ul>
<li><p>The natural hypothesis is plausible, as it is the usual mechanism of emergence of coronaviruses</p></li>
<li><p>The sequence of SARS-CoV-2 is too distantly related from other known coronaviruses to envisage the manufacture of a new virus from available sequences</p></li>
<li><p>Its sequence does not show evidence of genetic manipulation in the laboratory.</p></li>
</ul>
<p>This last argument can be questioned, as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120940/">methods do exist which allow scientists to modify</a> viral sequences without leaving a trace. These include cutting the genome into fragments that can later be joined together or, more recently, using the <a href="https://pubmed.ncbi.nlm.nih.gov/27548676/">ISA protocol</a>, whereby overlapping fragments naturally come together in cells through <a href="https://www.genome.gov/genetics-glossary/homologous-recombination">homologous recombination</a>: a phenomenon in which two DNA molecules exchange fragments. Besides, genetic manipulation is not the only scenario compatible with a laboratory accident or leak.</p>
<p>Meanwhile, intense research that has been carried out for more than a year to try to prove the zoonotic scenario has not been successful so far: all <a href="https://www.who.int/publications/i/item/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19)">80,000 animal samples</a>, from some 30 species, have tested negative. The samples came from farm animals and wild animals from different provinces in China. But it is important to note that this large number of negative samples does not refute the zoonotic scenario.</p>
<h2>The lab theory</h2>
<p>The first articles arguing for the laboratory accident theory received little attention, perhaps because they came from <a href="https://thebulletin.org/2020/05/natural-spillover-or-research-lab-leak-why-a-credible-investigation-in-needed-to-determine-the-origin-of-the-coronavirus-pandemic/">groups like the Bulletin of the Atomic Scientists</a>, which tends to be <a href="https://thebulletin.org/2020/06/did-the-sars-cov-2-virus-arise-from-a-bat-coronavirus-research-program-in-a-chinese-laboratory-very-possibly/">critical</a> of technology, or outsiders such as the <a href="https://drasticresearch.org/">DRASTIC</a> team (an acronym for “decentralized radical autonomous search team investigating Covid-19”).</p>
<p>Composed of <a href="https://drasticresearch.org/the-team/">24 self-styled “Twitter detectives”</a> who are mostly anonymous with the exception of a few scientists participating under their real names, the DRASTIC group formed on Twitter in 2020 and has set itself the mission of exploring the origins of SARS-CoV-2. Information and arguments from the group have been examined in their own right, taken up and developed by some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859469/">virologists</a>, <a href="https://www.pnas.org/content/117/47/29246">microbiologists</a> and <a href="https://jamiemetzl.com/origins-of-sars-cov-2/">science communicators</a>.</p>
<p>The first scientific articles discussing the possibility of a laboratory accident appeared in peer-reviewed scientific journals in <a href="https://onlinelibrary.wiley.com/doi/10.1002/bies.202000091">July</a> and August 2020 – one of them co-authored by an author of this article, <a href="https://hal.archives-ouvertes.fr/hal-02891455">Etienne Decroly</a>. The lab leak theory gained wider traction after a <a href="https://science.sciencemag.org/content/372/6543/694.1">May 13 article in the journal <em>Science</em></a>, signed by 18 scientists, called again for the origins of SARS-CoV-2 to be examined.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/403764/original/file-20210601-23-izal4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The outside of the Wuhan Institute of Virology" src="https://images.theconversation.com/files/403764/original/file-20210601-23-izal4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403764/original/file-20210601-23-izal4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403764/original/file-20210601-23-izal4a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403764/original/file-20210601-23-izal4a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403764/original/file-20210601-23-izal4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403764/original/file-20210601-23-izal4a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403764/original/file-20210601-23-izal4a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Wuhan Institute of Virology has been mooted as the potential source of SARS-CoV-2.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Wuhan_Institute_of_Virology_main_entrance.jpg">Ureem2805</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>So is it possible? Several elements regarding the emergence of the virus do raise questions. In particular, it has been established that the Wuhan Institute of Virology was <a href="https://reporter.nih.gov/project-details/9819304">handling</a> <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1006698">viruses</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090819/">close</a> to SARS-CoV-2 collected in southern China.</p>
<p>In addition to direct genetic manipulation, a laboratory accident could also have occurred as a result of infection during collection in the wild or during an experiment with a virus that evolved in <a href="https://onlinelibrary.wiley.com/doi/10.1002/bies.202000091">cells or mice</a> in the laboratory, without necessarily directly manipulating its genome.</p>
<h2>How can we find out for sure?</h2>
<p>In an investigation at the start of this year, a joint commission between China and the World Health Organization (WHO) failed to identify the cause of the pandemic, <a href="https://www.who.int/health-topics/coronavirus/origins-of-the-virus">concluding</a> that a zoonotic origin is most likely and the hypothesis of a laboratory accident is very unlikely. But the director-general of the WHO, Tedros Adhanom Ghebreyesus, announced there were <a href="https://www.who.int/news/item/30-03-2021-who-calls-for-further-studies-data-on-origin-of-sars-cov-2-virus-reiterates-that-all-hypotheses-remain-open">still questions</a> that “will need to be addressed by further studies”.</p>
<p>Determining whether SARS-CoV-2 has escaped from a laboratory will require a more thorough investigation in which investigators have access to sequence databases as well as to the various resources used by Chinese researchers, including laboratory notebooks, submitted projects, scientific manuscripts, viral sequences, order lists and biological analyses. Unfortunately, sequence databases for SARS-CoV-2 have been inaccessible to scientists since September 2019.</p>
<p>In the absence of direct evidence, alternative approaches may provide additional information. By analysing the available sequences of SARS-CoV-2-like coronaviruses in detail, it is possible that the scientific community will reach a consensus based on strong clues, as they did for other outbreaks, <a href="https://www.nejm.org/doi/full/10.1056/NEJMra0904322">including the 1977 H1N1 virus</a>.</p>
<h2>Biological black boxes</h2>
<p>Whether the origin is zoonotic or not, it is necessary to question the consequences of our interactions with ecosystems, the industrialisation of intensive breeding, safety protocols on collecting and experimenting on potentially pandemic viruses, and the proliferation of high-security laboratories, <a href="https://asiatimes.com/2020/07/china-goes-on-biosafety-lab-building-spree/">particularly those near megacities</a>.</p>
<p>We need to equip facilities that study viruses with safety systems as demanding as those used for studying nuclear energy. This could include the introduction of <a href="https://hal.archives-ouvertes.fr/hal-03204818/document">“biological black boxes”</a>, similar to flight recorders which allow investigators to recreate the final moments of a plane accident. Access to certain high-risk labs could be made dependent on detailed digital descriptions of experiments; sequencing data could be systematically archived; laboratory air filters could be collected, and if there is a suspicion of pathogen dissemination, the genetic material on their surface could be sequenced.</p>
<p>Such new safety measures should be put in place internationally to limit the risk of future pandemics. As for SARS-CoV-2, it is important to trace its exact origins in order to understand precisely what flaws may have led to its spread.</p><img src="https://counter.theconversation.com/content/161297/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Virginie Courtier has received funding from the "Who I am?" Labex to elucidate the proximal origins of the SARS-CoV-2 virus.</span></em></p><p class="fine-print"><em><span>Etienne Decroly ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The lab accident theory of the origins of Covid-19 has gained traction in recent months. We need a proper investigation to find out what really happened.Virginie Courtier, Directrice de recherche CNRS, génétique et évolution, Université Paris CitéEtienne Decroly, Directeur de recherche en virologie, Aix-Marseille Université (AMU)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1604292021-06-01T13:02:02Z2021-06-01T13:02:02ZThe next pandemic is already happening – targeted disease surveillance can help prevent it<figure><img src="https://images.theconversation.com/files/401991/original/file-20210520-19-yuhq7i.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C7000%2C3919&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sustained surveillance for disease outbreaks at global hot spots may be the key to preventing the next pandemic.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rendering-futuristic-world-map-interactive-royalty-free-image/1216889103?adppopup=true">MR.Cole_Photographer/Getty Images</a></span></figcaption></figure><p>As more and more people around the world are getting vaccinated, one can almost hear the collective sigh of relief. But the next pandemic threat is likely already making its way through the population right now. </p>
<p>My research as an infectious disease epidemiologist has found that there is a simple strategy to mitigate emerging outbreaks: proactive, real-time surveillance in settings where animal-to-human disease spillover is most likely to occur. </p>
<p>In other words, don’t wait for sick people to show up at a hospital. Instead, monitor populations where disease spillover actually happens.</p>
<h2>The current pandemic prevention strategy</h2>
<p>Global health professionals have long known that pandemics fueled by <a href="https://www.news-medical.net/health/What-is-a-Spillover-Event.aspx">zoonotic disease spillover</a>, or animal-to-human disease transmission, were a problem. In 1947, the World Health Organization established a global network of hospitals to <a href="https://www.who.int/influenza/gip-anniversary/en/">detect pandemic threats</a> through a process called <a href="https://www.cdc.gov/nssp/overview.html">syndromic surveillance</a>. The process relies on standardized symptom checklists to look for signals of emerging or reemerging diseases of pandemic potential among patient populations with symptoms that can’t be easily diagnosed.</p>
<p>This clinical strategy relies both on infected individuals coming to <a href="https://apps.who.int/iris/bitstream/handle/10665/259884/9789241513623-eng.pdf">sentinel hospitals</a> and medical authorities who are <a href="https://www.bbc.com/news/world-asia-china-51364382">influential and persistent</a> enough to raise the alarm. </p>
<figure>
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<figcaption><span class="caption">Sentinel surveillance recruits select health institutions and groups to monitor potential disease outbreaks.</span></figcaption>
</figure>
<p>There’s only one hitch: By the time someone sick shows up at a hospital, an outbreak has already occurred. In the case of <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it">SARS-CoV-2, the virus that causes COVID-19</a>, it was likely widespread long before it was detected. This time, the clinical strategy alone failed us.</p>
<h2>Zoonotic disease spillover is not one and done</h2>
<p>A more proactive approach is currently gaining prominence in the world of pandemic prevention: viral evolutionary theory. This theory suggests that <a href="https://doi.org/10.3390/v13040637">animal viruses become dangerous human viruses</a> incrementally over time through frequent zoonotic spillover. </p>
<p>It’s not a one-time deal: An “intermediary” animal such as a civet cat, pangolin or pig may be required to mutate the virus so it can make initial jumps to people. But the final host that allows a variant to become fully adapted to humans may be humans themselves.</p>
<p>Viral evolutionary theory is playing out in real time with the rapid development of <a href="https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant.html">COVID-19 variants</a>. In fact, an international team of scientists have proposed that undetected human-to-human transmission after an animal-to-human jump is the likely <a href="https://doi.org/10.1038/s41591-020-0820-9">origin of SARS-CoV-2</a>.</p>
<figure>
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<figcaption><span class="caption">Viruses jump species through a process of random mutations that allow them to successfully infect their hosts.</span></figcaption>
</figure>
<p>When novel zoonotic viral disease outbreaks like Ebola first came to the world’s attention in the 1970s, research on the extent of disease transmission relied on <a href="https://www.cdc.gov/coronavirus/2019-ncov/testing/serology-overview.html">antibody assays</a>, blood tests to identify people who have already been infected. Antibody surveillance, also called <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/geographic-seroprevalence-surveys.html">serosurveys</a>, test blood samples from target populations to identify how many people have been infected. Serosurveys help determine whether diseases like Ebola are circulating undetected.</p>
<p>Turns out they were: Ebola antibodies were found in more than <a href="https://doi.org/10.1016/S0769-2617(82)80028-2">5% of people tested in Liberia in 1982</a>, decades before the West African epidemic in 2014. These results support viral evolutionary theory: It takes time – sometimes a lot of time – to make an animal virus dangerous and transmissible between humans. </p>
<p>What this also means is that scientists have a chance to intervene.</p>
<h2>Measuring zoonotic disease spillover</h2>
<p>One way to take advantage of the lead time for animal viruses to fully adapt to humans is long-term, repeated surveillance. Setting up a <a href="http://dx.doi.org/10.2471/BLT.16.175984">pandemic threats warning system</a> with this strategy in mind could help <a href="https://doi.org/10.3390/v13040637">detect pre-pandemic viruses</a> before they become harmful to humans. And the best place to start is directly at the source.</p>
<p>My team worked with <a href="https://www.scientificamerican.com/article/how-chinas-bat-woman-hunted-down-viruses-from-sars-to-the-new-coronavirus1/">virologist Shi Zhengli</a> of the Wuhan Institute of Virology to develop a human antibody assay to test for a very distant cousin of SARS-CoV-2 found in bats. We established proof of zoonotic spillover in a small 2015 serosurvey in Yunnan, China: <a href="https://doi.org/10.1007/s12250-018-0012-7">3% of study participants living near bats</a> carrying this SARS-like coronavirus tested antibody positive. But there was one unexpected result: None of the previously infected study participants reported any harmful health effects. Earlier spillovers of SARS coronaviruses – like the first SARS epidemic in 2003 and Middle Eastern Respiratory Syndrome (MERS) in 2012 – had caused high levels of illness and death. This one did no such thing. </p>
<p>Researchers conducted a larger study in Southern China between 2015 and 2017. It’s a region home to bats known to carry SARS-like coronaviruses, including the one that caused the <a href="https://doi.org/10.1038/nature12711">original 2003 SARS pandemic</a> and the one <a href="https://doi.org/10.1038/s41586-020-2012-7">most closely related to SARS-CoV-2</a>.</p>
<p>Fewer than 1% of participants in this study tested antibody positive, meaning they had been previously infected with the SARS-like coronavirus. Again, none of them reported negative health effects. But syndromic surveillance – the same strategy used by sentinel hospitals – revealed something even more unexpected: An additional <a href="https://doi.org/10.1016/j.bsheal.2019.10.004">5% of community participants</a> reported symptoms consistent with SARS in the past year.</p>
<p>This study did more than just provide the biological evidence needed to establish proof of concept to measure zoonotic spillover. The pandemic threats warning system also picked up a signal for a SARS-like infection that couldn’t yet be detected through blood tests. It may even have detected early variants of SARS-CoV-2. </p>
<p>Had surveillance protocols been in place, these results would have triggered a search for community members who may have been part of an undetected outbreak. But without an established plan, the signal was missed.</p>
<h2>From prediction to surveillance to genetic sequencing</h2>
<p>The lion’s share of pandemic prevention funding and effort over the past two decades has focused on discovering wildlife pathogens, and predicting pandemics before animal viruses can infect humans. But this approach has not predicted any major zoonotic disease outbreaks – including H1N1 influenza in 2009, MERS in 2012, the West African Ebola epidemic in 2014 or the current COVID-19 pandemic.</p>
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<figcaption><span class="caption">Gregory Gray and his team at Duke University recently discovered a novel canine coronavirus at a global “hot spot” through surveillance and genetic sequencing.</span></figcaption>
</figure>
<p>Predictive modeling has, however, provided robust heat maps of the <a href="https://doi.org/10.1038/s41467-017-00923-8">global “hot spots”</a> where zoonotic spillover is most likely to occur. </p>
<p>Long-term, regular surveillance at these “hot spots” could detect spillover signals, as well as any changes that occur over time. These could include an uptick in antibody-positive individuals, increased levels of illness and demographic changes among infected people. As with any proactive disease surveillance, if a signal is detected, an outbreak investigation would follow. People identified with <a href="https://doi.org/10.1038/d41586-018-05373-w">symptoms that can’t be easily diagnosed</a> can then be screened using genetic sequencing to characterize and identify new viruses.</p>
<p>This is exactly what Greg Gray and his team from Duke University did in their search for <a href="https://doi.org/10.1093/cid/ciaa347">undiscovered coronaviruses</a> in rural Sarawak, Malaysia, a known “hot spot” for zoonotic spillover. Eight of 301 specimens collected from pneumonia patients hospitalized in 2017-2018 were found to have a canine coronavirus never before seen in humans. Complete viral genome sequencing not only suggested that it had recently jumped from an animal host – it also harbored the same mutation that made both SARS and SARS-CoV-2 so deadly.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-important">The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p>
<h2>Let’s not miss the next pandemic warning signal</h2>
<p>The good news is that surveillance infrastructure in global “hot spots” already exists. The <a href="https://www.cordsnetwork.org/">Connecting Organisations for Regional Disease Surveillance</a> program links six regional disease surveillance networks in 28 countries. They pioneered “participant surveillance,” partnering with communities at high risk for both initial zoonotic spillover and the gravest health outcomes to contribute to prevention efforts.</p>
<p>For example, Cambodia, a country at risk of pandemic avian influenza spillover, established a free national hotline for community members to report animal illnesses directly to the Ministry of Health in real time. Boots-on-the-ground approaches like these are key to a timely and coordinated public health response to stop outbreaks before they become pandemics.</p>
<p>It is easy to miss warning signals when global and local priorities are tentative. The same mistake need not happen again.</p><img src="https://counter.theconversation.com/content/160429/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maureen Miller received funding from USAID that was used to develop the pandemic-threats surveillance warning system discussed in this article. </span></em></p>A more coordinated effort by scientists, stakeholders and community members will be required to stop the next deadly virus that’s already circulating in our midst.Maureen Miller, Adjunct Associate Professor of Epidemiology, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1602232021-05-25T16:32:00Z2021-05-25T16:32:00ZRNA vaccines: what protection do they provide against Covid-19 variants?<p>Ever since the appearance of SARS-CoV-2 variants, a crucial question has been on everybody’s minds: will vaccines developed to protect against the “original” strain also work against new variants?</p>
<p>It’s a legitimate concern. In late March, South Africa announced that it had sold off all its doses of the AstraZeneva vaccine after studies revealed that it was <a href="https://www-ncbi-nlm-nih-gov.ressources-electroniques.univ-lille.fr/pmc/articles/PMC7901269/">less effective against the variant dominant in that part of the world</a> (20H/501Y.V2, from the B.1.351 lineage).</p>
<p>What about the groundbreaking RNA vaccines, then? Researchers have been trying to find out. An <a href="https://www.cell.com/cell/pdf/S0092-8674(21)00298-1.pdf">article published in the journal <em>Cell</em></a> suggests that some of the variants could be able to escape neutralisation by an immune response, whether acquired from a previous infection with the “original” SARS-CoV-2 strain, or from vaccination.</p>
<p>While such studies demonstrate the importance of sustained vigilance, it is far too early to draw conclusions as to potential clinical implications. But let’s take a closer look.</p>
<h2>When a virus “escapes” from a vaccine response</h2>
<p>When environmental conditions are optimal (suitable temperature, abundant food, etc.), microorganisms such as bacteria and viruses can multiply exponentially, producing dizzying numbers of copies of themselves. In the process, mistakes – also known as mutations – occur. Some are neutral, neither helping nor hurting the microorganism. Others are harmful, which can cause the microorganism to die out. Others still are favorable, giving the microbes a certain advantage over those without the mutation.</p>
<p>Different kinds of advantages exist – ability to feed off a new resource, a new defense mechanism, resistance to new environmental conditions, etc. Antibiotic resistance developed by certain bacteria comes from these kinds of “beneficial” mutations. Another example is escape from vaccine response, which allows infectious microorganisms to remain impervious to the immune response intended to eliminate them.</p>
<p>In order to study the infectiousness of viruses without having to handle these dangerous micro-organisms, virologists have developed pseudotyped retroviral particles. These tools act as “pseudoviruses” – particles containing only the genes involved in making the viral envelope of the virus in question. This is where we can find the “keys” that allow the virus to enter the cells it infects (the spike or S protein in the case of the SARS-CoV-2 coronavirus).</p>
<p>To these genes, researchers add <a href="https://www.futuremedicine.com/cms/10.2217/fvl.15.106/asset/images/medium/figure1.gif">another that produces a fluorescent protein</a>. This means that if the pseudovirus succeeds in entering the target cells, they will glow fluorescent, making them easier to observe.</p>
<p>This tool has already allowed us to study, for example, <a href="https://pubmed.ncbi.nlm.nih.gov/15956584/">some entry mechanisms of the Hepatitis C virus in liver cells</a>. It is also often used to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3958090/">demonstrate</a> how patient antibodies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1951279/">block viruses from entering</a>. If they are “neutralising,” it means that the antibodies successfully prevent interactions between proteins used by the virus to penetrate cells and the corresponding receptors, otherwise known as “locks,” which are located on the cell surface. In these cases, the virus is stuck at the door, so to speak.</p>
<p>American, German and South African researchers have used this approach to study the ability of serums from vaccinated individuals to <a href="https://www.cell.com/cell/pdf/S0092-8674(21)00298-1.pdf">neutralize the SARS-CoV-2 spike protein</a>. Here’s what their research showed.</p>
<h2>Mutations allowing for the escape from immune response</h2>
<p>The authors focused on the two messenger RNA vaccines available, i.e. the Pfizer-BioNTech vaccine (brand name Cominarty, <a href="https://www.santepubliquefrance.fr/content/download/340446/3012834">the main vaccine used in France, representing 65.4% of first doses administered</a>) and the Moderna vaccine (in the minority, with 7.7% of first doses). They collected serum samples from 99 vaccinated patients after their first and second injections, and then tested the ability of these samples to neutralize the original S protein, the protein with the D614G mutation, and the S proteins of the so-called “British” variant (B.1.1.7 lineage), “South African” variant (B1.1.351 lineage) and “Brazilian” variant (P1 lineage).</p>
<p>Their results show that the two mRNA vaccines provide effective protection against the original virus, the D614G variant and the British variant, especially after two doses. On the other hand, patient antibodies showed limited neutralization of the S protein from the South African and Brazilian variants, suggesting that these vaccines may be less effective against these variants. This seems to indicate that a small number of mutations could be enough to allow SARS-CoV-2 to escape an immune response induced by these vaccines.</p>
<p>However, the consequences of these results for the population remain to be seen, as highlighted by the authors themselves.</p>
<h2>Stay vigilant</h2>
<p>Though conducted with a high level of rigor, this is nevertheless an <em>in vitro</em> study, meaning that conclusions cannot be drawn as to the clinical repercussions of these results, which were obtained from cultured cells. We are still lacking information on vaccinated individuals’ <a href="https://theconversation.com/comment-notre-corps-se-defend-il-contre-les-envahisseurs-143072">cell immunity</a>, which could protect them despite the lack of humoral immune protection, i.e. protection from antibodies.</p>
<p>It could also be interesting to study the neutralizing capabilities of serums from people who received the AstraZeneca or Johnson & Johnson vaccine, a single-dose vaccine that has been available in French pharmacies since April 24. It could also help us understand the abilities of pseudotyped retroviral particles based on the so-called “Indian” variant (<a href="https://www.santepubliquefrance.fr/les-actualites/2021/point-sur-le-variant-b.1.617-au-sars-cov-2">20A/484Q, B.1.617 lineage</a>) to escape the effects of vaccines. That would provide indications as to their potential role (still up for debate) in the pandemic <a href="https://theconversation.com/pourquoi-apres-une-accalmie-lepidemie-de-covid-19-flambe-t-elle-a-nouveau-en-inde-159778">currently raging in India</a>.</p>
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<p>Finally, these results will have to be corroborated through observations in the general population, in order to answer two questions: can vaccinated people be infected by these variants? If so, do they develop severe forms of the infection, and in what proportions compared to non-vaccinated people?</p>
<p>Still, these new developments are reassuring, particularly for the situation in France – it would appear that the mRNA vaccines currently available provide effective protection against the British variant that is currently circulating in large numbers.</p>
<p>However, the study emphasizes the importance of taking all necessary precautions to monitor and, if possible, limit the spread of the South African and Brazilian variants, should mRNA vaccines prove to be less effective against these variants in vivo as well. Restrictions for people arriving from regions where these variants are circulating are unfortunately justified, in order to avoid yet another wave in the pandemic.</p>
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<p><em>Translated from the French by Rosie Marsland for <a href="http://www.fastforword.fr/en">Fast ForWord</a></em></p><img src="https://counter.theconversation.com/content/160223/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Goffard has received funding from the University of Lille, the Pasteur Institute of Lille, the CNRS and the ANR. Anne Goffard is deputy mayor of Lille.</span></em></p>One of the main fears regarding new SARS-CoV-2 variants is that they might be resistant to immunity granted by vaccines, including RNA vaccines.Anne Goffard, Médecin, Professeure des Universités – Praticienne Hospitalière, Université de LilleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1600552021-05-07T08:15:32Z2021-05-07T08:15:32Z‘Each burning pyre is an unspeakable, screeching horror’ – one researcher on the frontline of India’s COVID crisis<p><em>Global health researcher Vyoma Dhar Sharma had just embarked on a fieldwork trip to India as COVID-19 began sweeping through the population and overwhelming hospitals. It has taken a terrible toll on her country – and her family.</em></p>
<h2>August 25, 2020</h2>
<p>It is pouring by the time my taxi reaches Oxford’s Gloucester Green bus station. I dash through the rain towards the Heathrow bay as the X90 coach pulls in. The driver gets down to smoke a cigarette and we talk, about COVID-19 obviously. He says he does not know of a single person who has died of this disease. “You only hear it on the news. Frankly, unless people start dropping dead on the street, I’m not believing it”.</p>
<p>A few hours later I am on an Air India repatriation flight to New Delhi, flying home for fieldwork. My <a href="https://www.qeh.ox.ac.uk/people/vyoma-dhar-sharma">study</a> explores how global public health policy, scientific research and medical practice affect women’s health in India. Global health research is driven by statistical and empirical methodologies, typically <a href="https://princeton.universitypressscholarship.com/view/10.23943/princeton/9780691157382.001.0001/upso-9780691157382-chapter-004">sidelining</a> people’s experiences of illness and care-seeking within health systems.</p>
<p>And while gender is widely recognised as a <a href="https://www.who.int/gender-equity-rights/knowledge/breaking-barriers-towards-more-gender-responsive-and-equitable-h/en/">major factor</a> when it comes to good health outcomes, the focus on women’s health is normally limited to reproductive function. This leads to a systematic marginalisation of health issues, such as menopause, uterine prolapse or cervical cancer – all of which lie beyond pregnancy and childbirth. So my work is driven by the need to understand how these issues effect the health of women in countries like India and how they experience the health systems which are supposed to be looking after them.</p>
<p>I break the government mandated <a href="https://www.mohfw.gov.in/pdf/Guidelinesforinternationalarrivals.pdf">quarantine</a> two days after arrival. A little past 10:30pm my masi (aunt) calls, frantically informing me that she just found Nani (my grandmother) unconscious in her bedroom. She was alarmed by the thud of Nani’s walking stick and rushed to find her on the floor, next to her bed. Masi is unsure if she slipped or fainted. The neighbour’s son and my aunt somehow manage to carry Nani, 78, downstairs and take her to the hospital. By the time Mum and I reach Ram Manohar Lohia, a government hospital, it is midnight. We sprint past people standing, sitting, sleeping on the pavement and in the stairwell.</p>
<p>Everyone seems quiet. Mum rushes into the emergency room while I wait, watching stretcher after stretcher make its way in and out of the lifts. I read and re-read the Ministry of Health posters on coronavirus symptoms and safety guidelines. Everyone is wearing a mask; some are wearing two. The hospital is packed and social distancing is impossible. Someone brushes past me every other minute.</p>
<p>COVID-19 cases have been rising for months, creating <a href="https://www.washingtonpost.com/world/asia_pacific/india-coronavirus-hospital-beds/2020/06/12/7b538a8a-ab4d-11ea-a43b-be9f6494a87d_story.html">exorbitant pressures</a> on health personnel and infrastructure. In the middle of all this, lockdown restrictions <a href="https://www.bbc.com/news/world-asia-india-53969118">were eased</a> in June. Later in this week, India will witness over <a href="https://www.hindustantimes.com/india-news/with-nearly-79-000-new-cases-of-covid-19-india-sets-grim-world-record/story-JBYibFMqdCPdL2omb0587O.html">78,000 new cases</a> in 24 hours – then the highest single day increase in in the world.</p>
<p>Hours later I finally see Nani, inert on a gurney, being lifted into an ambulance. She has been transferred to Sir Ganga Ram hospital. After a standard admission test, Nani turns out to be COVID-19 positive. She is placed on ventilator support and spends the next 15 days in the COVID intensive care ward in complete isolation. The doctors diagnose her case as a cerebrovascular accident – a left hemisphere stroke that paralysed the right side of her body and compromised her ability to speak, swallow and breathe naturally.</p>
<h2>September 13</h2>
<p>Nani is shifted out of the COVID-ICU. Mum and Masi have been practically living at the hospital. They sleep on the benches in the waiting area. They refuse to eat. They spend the hours chanting for Nani’s recovery. The doctors are contemplating a <a href="https://www.nhs.uk/conditions/tracheostomy/">tracheostomy</a> (when an opening created in the neck so a tube can be inserted into the windpipe to aid breathing) to take her off the ventilator. Other than that, they offer terse, infrequent updates on Nani’s condition. Over tea in the hospital canteen Mum is fretful: “They don’t say anything, don’t tell us anything.”</p>
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<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>This story is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> and is working with academics from different backgrounds who have been engaged in projects to tackle societal and scientific challenges.</em> </p>
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<p>“I read on WhatsApp news,” begins an uncle who is joining us today, “that COVID is not a virus, it is a large-scale conspiracy for population reduction”. His wife chips in on how the shastras (Hindu scriptures) predicted this kind of devastation hundreds of years ago. </p>
<p>I visit Nani in the ICU a few days after the tracheostomy. She has been made to sit on a recliner. She does not move but looks up when I address her. I am scared of being alone with her. She refuses to close her eyes, insisting that I acknowledge our mutual awareness about her condition. There is a catheter pipe sticking out of her hospital gown, a wide tube piercing her trachea, a nasal feeding pipe, an IV drip on her wrist and an oximeter to measure how much oxygen there is in her blood on her forefinger.</p>
<p>I have never liked the word “vegetative”, but my revulsion for it viscerally comes alive that day. In the next bed there is a man weeping and hugging the unconscious body of his father. I swallow the lump in my throat and ask Nani to give me her left hand if she can understand me. She does. I hold her hand in mine, rubbing her arm gently and weakly reassuring her about her recovery. When I leave, I do not have the strength to look back, but I know she is watching me walk away.</p>
<h2>September 26</h2>
<p>We bring Nani home and set up a room for her. It is still unsettling to meet her gaze when she is awake. For us, her inability to speak is the most painful part. My aunt keeps recounting tiny details from that night in August – the dinner, the fact that they had a slice of mango each, where Nani’s flip-flops were placed, the lights, Nani’s exact position on the floor. </p>
<p>My mind goes to Nani’s portfolio of anecdotes, the ones we grew up with. With these stories, the charm lies in their out-datedness. For example, a village-based relative who went to Simla (a city in northern India) for an exam and was so gobsmacked at the sight of a light bulb in the invigilation hall that he forgot to fill in his answer sheet. Or people running amok at the sound of a bus horn before they got used to it.</p>
<p>On each visit, I would hug her and say, “Nani, you are shrinking!” That made her laugh. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-in-india-the-deep-rooted-issues-behind-the-current-crisis-159854">COVID in India: the deep-rooted issues behind the current crisis</a>
</strong>
</em>
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<h2>October 3</h2>
<p>I wonder if she finds it odd that all of us wear face masks around her. Does she recognise us? We try to cheer her up. We tell her that summer is passing. We promise to take her to the hills when she recovers. She can hear us because she contorts her face into a baby-like grimace and cries. She makes the same face every few hours when the nurse performs suction inside her mouth and the tracheostomy tube.</p>
<p>The patient monitor beeps at a consistent shrill decibel every other second. At first, it felt as though our collective heartbeats ran with the fluctuating numbers of her pulse and oxygen levels. You could not ignore it. Now, it’s clockwork.</p>
<p>I spend most of my time in my room, trying to drown myself in desk-based research, given the restriction on in-person data collection during the pandemic. I send out interview requests to public health practitioners and women willing to speak to me about their gynaecological issues and their experiences of the health system. </p>
<figure class="align-center ">
<img alt="Woman examined by doctor in rural Indian clinic." src="https://images.theconversation.com/files/398901/original/file-20210505-21-nm2l1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398901/original/file-20210505-21-nm2l1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398901/original/file-20210505-21-nm2l1m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398901/original/file-20210505-21-nm2l1m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398901/original/file-20210505-21-nm2l1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398901/original/file-20210505-21-nm2l1m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398901/original/file-20210505-21-nm2l1m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Indian woman examined at a rural pregnancy clinic in Bihar, India, in 2011.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adapur-indianov-8-indian-woman-examined-341874770">Shutterstock/TravelStock</a></span>
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<p>A senior public health communication specialist I know feels that the progress on women’s health is now “two steps back with COVID. Is there any other research happening besides COVID-19? The government wants to hear COVID-19, so everyone is making them hear COVID-19.”</p>
<p>Over the next few months, academics try drawing attention to the gendered manner in which the pandemic has compromised <a href="https://www.guttmacher.org/journals/ipsrh/2020/12/covid-19-and-abortion-making-structural-violence-visible">sexual and reproductive health</a>; and the physical and mental health <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/gwao.12617">implications</a> of working from home in India.</p>
<p>Meanwhile a social anthropologist, based in Uttar Pradesh, and I speak about the impact on women in rural areas. She tells me how antenatal visits had stopped during the lockdown, women were not getting iron supplements or sanitary pads. “No one paid attention to all this during COVID-19,” she said. </p>
<p>One can <a href="https://www.compas.ox.ac.uk/2020/covid-19-unprecedented-crisis-mobility-india/">argue</a> that epidemics do not so much create gendered suffering and socioeconomic inequalities but, instead, reveal it. They reinforce inherent issues within global health and clarify the terms and conditions on which women receive care. </p>
<p>In one of my interviews, the head of a Delhi-based sexual and reproductive health advocacy organisation says: “The lockdown was the worst phase for unmarried women.” Women working or studying in Delhi had to quickly rush back to their hometowns when the nationwide lockdown was announced: </p>
<blockquote>
<p>Many discovered unintended pregnancies … They did not know what to do. They could not tell their parents; they could not say why they wanted to step out. We got calls from Jaipur, we got calls from Delhi to ‘help us out in anyway. I can sneak out of my house at 2am to get the abortion done. I’ll walk to the hospital.‘</p>
</blockquote>
<h2>October 14</h2>
<p>I reach out to over 40 gynaecologists (almost all women) across four famous private hospitals in Delhi and not a single one agrees to an interview. I draw snippets from what my other interview participants tell me about the kind of care they have received from their specialists in recent years. A 27-year-old tells me she once opened up to her gynaecologist about having tried to take her own life. “I often wonder why pretty girls like you try to kill yourself,” the doctor responded.</p>
<p>Another medical student was prescribed contraceptive pills as a 14-year-old to regulate her periods. When she asked what the medicine was, the doctor told her that “taking these everyday makes a girl more beautiful”. No further or accurate explanation was offered. A woman in her early 30s tells me about an exceptionally bad urine infection for which she consulted a doctor online. While the acute pain has subsided, she told the doctor that she continued to feel weak. “Don’t be dramatic, if you’re not pissing blood, you’re fine,” the doctor snapped back. </p>
<p>Yesterday, Nani was diagnosed with drug-resistant pneumonia. She sleeps through most of the day and does not respond to our words. Every day after finishing work, I sit beside her. I slip my fingers through her left hand and ask her to grip it. Most of the times she is unable. Unwilling. Today, just as I was about to draw away my hand from hers, she weakly held it. I feel like she asks me to stay a little bit longer, have a little more faith. Her pulse races over 100. I realise I am crying into my mask.</p>
<h2>October 20</h2>
<p>Nani has not opened her eyes in two days. She is running a fever of 102 and a pulse that jumps between 135 and 33 within hours. Masi no longer leaves Nani’s room. She constantly plays <em>bhajans</em> (religious hymns and songs) on her phone, placing it on Nani’s pillow. To me, they sound menacing, not soothing. Around 6pm that evening, I go into the kitchen and find Mum pouring <em>gangajal</em> (holy water, collected from the Ganges) into a small steel glass. “Mummy doesn’t look right,” she says. </p>
<p>I walk into Nani’s room. Someone has put <em>tilak</em>, a tiny dot of sandalwood paste, in the middle of her forehead. There are thin gold hoops in her ears and two pink bangles on each wrist. She has been dressed up. Prepared to depart. She is breathing deeply. No, she is gasping for breath. Mum and Masi hug Nani, whispering belated apologies for harsh words in the past and reassuring her that she can leave if she wants to. We huddle together around her bed. We take turns rubbing her hands and feet. Masi tries massaging her chest. Later, on multiple occasions, she will mention that it felt spongy, filled with liquid. Her pulse drops below 50. Nani continues to make raspy sounds.</p>
<p>The reading on the small pulse-oximeter connected to her finger continues to fall dangerously. The nurse takes a stethoscope and looks for the pulse. She does not say anything. We do not ask. My gaze veers frantically from the oximeter to Nani’s face and then rests there. She lifts her head up from the pillow and draws her final breath. </p>
<h2>November 11</h2>
<p>When the doctors prescribed a tracheostomy, I looked up a few scientific papers on the viability of the procedure in elderly patients and post-discharge care. Poor survival rates were a prominent finding but for Nani, it was also the only viable course of action. However, none of the papers mentioned that when you remove the tube, it leaves a coin-like hole in the throat of the deceased. And as you prepare your grandmother for cremation, the wound leaks yellow purge fluid onto your hands.</p>
<p>On Nani’s <em>terhavi</em>(the 13th and final day of mourning), visitors come and go, discussing how and why Nani’s condition spiralled. “She caught corona the night they took her to RML.” “Was the stroke what they call long COVID?” “The pneumonia was COVID related.” “No, it is common when you are on ventilator support.” “The tracheostomy caused the infection.” When the mourners exhaust opinions on the deceased, they turn to the disease. The common opinion around the room is that COVID-19 is a sham, a made-up disease. I need to get out. I take a taxi to Connaught Place, the large commercial centre and tourist spot in Delhi, and start pacing around the inner circle.</p>
<p>An elderly female hawker approaches and pleads with me to buy flowers from her. She is barefoot and speaks slowly. She says she has not eaten since the morning. Nani had not eaten since … I quickly ask her to give me two roses, leaving the flood of thoughts that threaten to devastate me. The roses are wilted, petals dangling off the stem, threatening to fall off in the heat. She offers blessings by way of gratitude, but I do not wish to hear them.</p>
<h2>November 20</h2>
<p>Question three on my fieldwork risk assessment form: <em>If the topic area of your research is potentially distressing or emotionally challenging, have you considered how you might cope with the emotional impact on yourself and your participants?</em></p>
<p>Response: <em>Some participants may derive catharsis and closure from the exchange, while others may contend with emotional distress …</em> </p>
<p>At a time when I do not intend on processing my pain, I begin collecting data on that of others. My request for conducting a small number of in-person interviews comes through. I start visiting a government-run clinic in Delhi. Often, participants offer an apologetic disclaimer about not being able to talk “objectively” about their health issues because “this COVID atmosphere has had an impact on everything”. They have missed or deferred doctor’s appointments, ultrasound scans, surgical procedures. They tell me about fibroids (abnormal uterine growths) that are causing prolonged heavy bleeding, painful breast lumps that are making work impossible and recurring vaginal infections that will have to wait for treatment, in a way that husbands, children and household chores will not. </p>
<p>On a cold winter morning in January, a 59-year-old housewife from Shahpur Jat tells me that she obsessively thinks about ways to end her life. She had mentioned that her husband died of a heart attack a few months ago. I ask if these thoughts began after that. She replies:</p>
<blockquote>
<p>I won’t lie … I did not grieve over him. I don’t know what happened to me, I just wanted to die somehow.</p>
</blockquote>
<p>She proceeds to tell me about the day he died. They had returned from Pushkar in the afternoon. He went for a bath. They ate lunch together. Napped. He got up and made chai for himself. Then all of a sudden he complained of nervousness. She details how they took him to the All India Institute of Medical Sciences where he was put on ventilator. I go cold at the sound of that word and remind myself to focus. She describes how his oxygen levels peaked to 100 for a bit and the children calmed down a bit. But then he flatlined. I leave my body.</p>
<p>“God gives more daughters to the poor,” a young nurse tells me. She is explaining how she helped a frail 23-year-old woman deliver her fourth daughter during the lockdown. She studied nursing for 18 months and is now the village “doctor” in my field site in Uttar Pradesh. She says people would call and beg for her help with home births during the lockdown. </p>
<p>People began avoiding government health facilities as much as possible. They feared getting tested or worried that they would be taken away by the police if they tested positive. She does not wear a face mask and I ask her why. She says she stopped wearing it after her mother passed away two months ago. She does not care about anything anymore, she says. The interview questions dry up inside my mouth.</p>
<p>Last week, I walked in on my mum sitting in Nani’s room, sobbing. All of us have occasional dreams about Nani and we tell each other about them. But Nani does not speak in our dreams either. Masi no longer brings up that night as often. But now, every time it comes up, there are less words and more tears.</p>
<h2>April 26, 2021</h2>
<p>Earlier on the day of Nani’s death, I was watching a Royal Society <a href="https://www.youtube.com/watch?v=gXRRoscN3DY">webinar</a> featuring Stephen Fry and Venki Ramakrishnan. Fry defines science as “humility before the facts”. For me, this doesn’t simply signal the value of evidence per se, but a radical re-examination at what counts as evidence in the first place. And on whose command? Fry insists that: “Science can look at how people believe and why they believe and why they can be pushed into believing things that are untrue and why they find it hard to accept things that they don’t want to be true.”</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1388930057696022528"}"></div></p>
<p>Global health prides itself as the objective, apolitical, evidence-based domain of eliminating diseases and saving lives. In extending “<a href="http://www.medanthrotheory.org/article/view/4645">criticality</a>” (or the need to question all assumptions) to the field of global health, one risks accusations of nitpicking without offering answers. Criticality engages with the historical context of a problem. It pushes against the limits of what counts as evidence and questions who is in command and who has been silenced as a result.</p>
<p>The neurosurgeon and writer <a href="https://www.newyorker.com/books/page-turner/my-last-day-as-a-surgeon">Paul Kalanithi</a> said that your relationship with statistics changes when you become a statistic yourself. What happens when the numbers can no longer contain the evidence? Despite being a multi-million dollar, centuries-old enterprise to alleviate suffering and measure impact, global health still finds pain an unquantifiable human experience.</p>
<p>On March 24 2020, a <a href="https://www.bbc.com/news/world-asia-india-52024239">nation-wide lockdown</a> was announced in India. Delhi had 30 confirmed cases that day. <a href="https://www.covid19india.org/">By May 7, 2021,</a> the city had more than 90,000 active cases and 18,398 deaths. Diagnostic labs are <a href="https://indianexpress.com/article/cities/delhi/rt-pcr-tests-dip-in-last-one-week-in-delhi-hc-asks-govt-to-open-more-testing-centres-7290393/">severely short</a> on testing capacity. Hourly notifications are coming in of hospitals <a href="https://timesofindia.indiatimes.com/india/covid-19-its-like-a-war-inside-a-delhi-hospital-desperate-for-oxygen/articleshow/82285994.cms">running out</a> of oxygen. </p>
<p>Morgues are <a href="https://www.independent.co.uk/asia/india/india-covid-deaths-delhi-crematorium-b1833776.html">overflowing</a> as around the clock cremations and burials are <a href="https://www.theguardian.com/world/2021/apr/28/covid-india-suffers-worst-day-of-pandemic-with-record-number-of-cases-and-deaths">becoming insufficient</a>. People are <a href="https://www.thehindu.com/news/cities/Delhi/coronavirus-delhi-casesheet-unending-replay-of-pathos-pain/article34433493.ece">dropping dead on pavements</a>. </p>
<p>Delhi went under lockdown on April 19 2021 with record breaking daily spikes in infections and deaths. When the prime minister addressed a highly anxious nation on <a href="https://theprint.in/opinion/pm-modis-speech-was-short-on-answers-that-indians-demand-of-him-during-second-covid-wave/643350/">April 20</a>, he spoke for 19 minutes and barely said anything. The government is <a href="https://www.tribuneindia.com/news/nation/citing-own-robust-system-india-turns-down-un-supply-chain-help-spokesperson-245401">refusing external assistance</a>. It is also <a href="https://www.telegraphindia.com/india/covid-india-research-community-asks-modi-to-release-data-on-patterns-and-severity-of-infections/cid/1814074">denying public access to data</a> on severity and patterns of the disease.</p>
<p>It has been observed before that our extensive capacity for language distinguishes humans from other animals. But our pain distinguishes us from language. Not because pain silences words, but because it surpasses them. Our subjective experiences exceed measurability and cannot be generalised. All of the dreadful statistics coming out of India relate to people and to suffering.</p>
<p>In New Delhi today, each individual loss, each burning pyre is an unspeakable, yet screeching horror. It is testing the boundaries of what can be said. What should be said. It is testing the boundaries of evidence.</p>
<p><em>The interviews in this piece were carried out in Hindi and have been translated by the author.</em></p>
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<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
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<li><p><em><a href="https://theconversation.com/there-arent-enough-trees-in-the-world-to-offset-societys-carbon-emissions-and-there-never-will-be-158181?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">There aren’t enough trees in the world to offset society’s carbon emissions – and there never will be</a></em></p></li>
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<p class="fine-print"><em><span>Vyoma Dhar Sharma does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The dreadful statistics coming out of India are not just numbers – they relate to people and to suffering.Vyoma Dhar Sharma, DPhil candidate in International Development, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1568532021-03-12T21:33:37Z2021-03-12T21:33:37ZWe’ve designed a safe ‘virtual’ epidemic. Spreading it is going to help us learn about COVID<figure><img src="https://images.theconversation.com/files/389208/original/file-20210312-13-4jdzxh.jpg?ixlib=rb-1.1.0&rect=78%2C61%2C5762%2C2995&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>One of the biggest challenges in managing the coronavirus pandemic has been a lack of real-time information about the virus’s spread. </p>
<p>While the goal of well-intentioned governments is clear — to mitigate spread with minimal economic and social impact — it is very difficult to decide on the best policy to achieve this. </p>
<p>In Australia, public health authorities have been consistent in encouraging testing for the virus. The major driver behind this has been the desire to find positive cases and track their contacts. </p>
<p>A by-product is information about how the virus is spreading in the general population, which can be used to inform decisions about measures such as mask-wearing and restrictions on movement.</p>
<p>However, at best, the information provided by testing individuals is partial, biased and delayed. This makes it hard to make real-time decisions about when to impose restrictions, which are arguably the most important tool in the fight against the pandemic.</p>
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<img alt="" src="https://images.theconversation.com/files/388988/original/file-20210311-13-1yjgfj9.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/388988/original/file-20210311-13-1yjgfj9.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/388988/original/file-20210311-13-1yjgfj9.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/388988/original/file-20210311-13-1yjgfj9.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/388988/original/file-20210311-13-1yjgfj9.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/388988/original/file-20210311-13-1yjgfj9.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/388988/original/file-20210311-13-1yjgfj9.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This graph plots confirmed new coronavirus cases in Victoria last year, alongside the imposition and removal of restrictions.</span>
<span class="attribution"><span class="source">Author provided</span></span>
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<p>To help out, we devised the <a href="https://safeblues.org">Safe Blues</a> framework. This is a joint project between researchers from The University of Queensland, The University of Auckland, The University of Melbourne, Cornell University, Columbia University, Massachusetts Institute of Technology, Macquarie University and Delft University of Technology.</p>
<p>In this framework, virus-like tokens are spread between mobile devices via Bluetooth, similarly to how a biological virus spreads between people. </p>
<p>If adopted, a tool like Safe Blues could help public health authorities better control outbreaks by providing data on the general level of contact between people. <a href="https://www.cell.com/patterns/fulltext/S2666-3899(21)00034-9">Our paper</a> published today in the Cell Press journal <a href="https://www.cell.com/patterns/home">Patterns</a> summarises the idea.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-to-flatten-the-curve-of-coronavirus-a-mathematician-explains-133514">How to flatten the curve of coronavirus, a mathematician explains</a>
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</em>
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<h2>What about COVIDSafe?</h2>
<p>Last year the Australian government released the COVIDSafe contact-tracing app. It was backed by an extensive government-funded media campaign and <a href="https://www.theguardian.com/technology/2021/jan/14/one-third-of-australian-users-have-not-updated-covidsafe-app">initially adopted by millions</a> of users.</p>
<p>COVIDSafe <a href="https://theconversation.com/how-safe-is-covidsafe-what-you-should-know-about-the-apps-issues-and-bluetooth-related-risks-137894">works by</a> using Bluetooth signals to record digital “handshakes” between the smartphone of a user and nearby contacts who also have the app. It stores this information in a form that can be retrospectively accessed if the device’s owner tests positive. Their contacts can then be traced and tested.</p>
<p>While the idea has merit, there have only been <a href="https://www.theguardian.com/australia-news/2020/dec/15/covidsafe-app-identified-close-contacts-in-just-20-nsw-cases-in-six-months-researchers-say">a handful</a> of instances where the app was able to pick up confirmed cases more effectively than human contact tracers. So is the marriage between Bluetooth and public health useless? </p>
<p>We don’t think so.</p>
<h2>Spreading a Bluetooth-powered virtual virus</h2>
<p>Social distancing works on all viruses, not just SARs-CoV-2 (the virus of the COVID-19 pandemic). For example, major COVID-19 lockdowns not only curbed the spread of SARS-CoV-2, but also <a href="https://www.nature.com/articles/d41586-020-03519-3">mitigated the spread of the common cold</a>. </p>
<p>With this in mind, let’s return to the lack of information problem and consider a thought experiment: what if we could create a <em>virtual</em> virus that spreads exactly the same as COVID-19? Although this one would be harmless and traceable in real time. </p>
<p>By studying how this virtual virus evolves, we would be gleaning important insight into how SARs-CoV-2 evolves. This could empower decision makers to devise the best strategies to enforce restrictions and prevent the virus from spreading further.</p>
<p>To implement the framework, the mobile devices of a random subset of the population would be purposefully infected with the safe digital virus, which we call Safe Blues. </p>
<p>Then, based on the measurements of how this “infection” spreads, public health authorities could get a better picture of how the real coronavirus spreads.</p>
<p>Statistically, the number of cases and patterns presented on the Safe Blue app would follow similar trends to the real virus. </p>
<p>Of course, the actual individuals infected with SARs-CoV-2 and those infected with Safe Blues would not be the same. In fact, simulations have shown only a small fraction of the population would need to participate with a Safe Blues app for it to deliver reliable predictions. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/PGvKyd1jAyc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How the Safe Blues idea works.</span></figcaption>
</figure>
<p>It’s important to note Bluetooth signals don’t propagate like viruses. But if we generated hundreds of variants of Bluetooth-based virtual tokens, this ensemble could capture many of the social movement patterns that drive infection — and thus could be correlated with the real virus. </p>
<h2>Where to now with Safe Blues?</h2>
<p>Safe Blues’s machine learning methods have been developed and evaluated using mathematical simulation models. Initial results show that an ensemble of Safe Blues token strands can yield powerful estimates of actual epidemic behaviour. </p>
<p>The Safe Blues team is now working towards a system pilot at The University of Auckland. Using an experimental Safe Blues Android app, the aim is to generate and study how the virtual virus spreads in a campus setting. </p>
<p>The insights provided by the app could also be coupled with data from <a href="https://www.science.org.au/covid19/monitoring-waste-water">waste water measurements</a> and from <a href="https://royalsocietypublishing.org/doi/full/10.1098/rsif.2020.0657">existing social networks</a> such as Google, Apple or Facebook. </p>
<p>We believe virtual virus spread techniques such as Safe Blues could greatly contribute to our real-time understanding of this pandemic, as well as future epidemics.</p><img src="https://counter.theconversation.com/content/156853/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yoni Nazarathy receives funding from the Australian Research Council.
Peter Taylor receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Peter Taylor receives funding from the Australian Research Council (ARC) through Laureate Fellowship FL130100039 and the ARC Centre of Excellence for Mathematical and Statistical Frontiers.</span></em></p>COVIDSafe was only able to detect a handful of cases successfully, but that doesn’t mean Bluetooth isn’t a helpful tool for addressing viral spread.Yoni Nazarathy, Associate Professor of Data Science, The University of QueenslandPeter Taylor, Australian Laureate Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1538402021-02-21T12:05:55Z2021-02-21T12:05:55ZCOVID-19 vaccination: What we can learn from the great polio vaccine heist of 1959<figure><img src="https://images.theconversation.com/files/385353/original/file-20210219-21764-r1fsgf.jpg?ixlib=rb-1.1.0&rect=40%2C5%2C3794%2C2149&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In a pandemic, vaccines are in very high demand, and this threatens their supply.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>We find ourselves at a precarious time in global health. Many people are anxiously awaiting their turn to receive a vaccine for COVID-19, yet roll-out is slow and disorganized, with many countries <a href="https://www.bbc.com/news/explainers-52380823">facing supply shortages</a>. </p>
<p>The conditions are ripe <a href="https://www.washingtonpost.com/outlook/coronavirus-vaccine-rich-people/2020/12/18/3a2f188e-40ae-11eb-8bc0-ae155bee4aff_story.html">for opportunists</a> to exploit the situation. Reports of unethical line-jumping by wealthy elites have <a href="https://www.bbc.com/news/world-us-canada-55805907">started to surface</a>, while others warn of the <a href="https://www.statnews.com/2020/12/03/how-rich-and-privileged-can-skip-the-line-for-covid19-vaccines/">potential for a black-market trade in vaccines</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1362718577468432386"}"></div></p>
<p>This isn’t the first time people have waited anxiously for a vaccine. The looking-glass of history reveals the uneasiness of emotion that accompanies moments like these, as well as the dark consequences that can arise when evil-doers take advantage of them.</p>
<p>One case in particular stands out as an important lesson for today: <a href="https://www.thestar.com/news/canada/2020/12/06/covid-19-vaccines-are-about-to-be-the-hottest-commodity-on-earth-how-do-we-keep-them-safe.html">when thousands of vaccine doses were stolen by armed men during a supply shortage in 1959</a>.</p>
<h2>The polio epidemic</h2>
<p>It was the summer of 1959, when <a href="https://www.cpha.ca/story-polio">the last great epidemic of poliomyelitis swept across Canada</a>. Québec saw the most cases that year, with the <a href="https://www.newspapers.com/clip/68318101/polio-statistics-for-1959/">newspapers reporting</a> over a thousand cases and 88 deaths.</p>
<p>Although the health authorities in Montréal warned the public about the seriousness of the summer epidemic, they also begged the populace to remain calm. This was far from comforting for parents who feared for their children. </p>
<p>Polio infection could cause permanent paralysis and was deadly in five per cent of cases. Montréalers rushed to the vaccine clinics, sometimes waiting for hours in the rain. </p>
<p>Vaccine production in Canada was limited to only two laboratories, with the majority being provided by Connaught Labs at the University of Toronto. This put intense pressure on vaccine supplies and Québec, like the rest of North America, <a href="https://www.newspapers.com/image/500224904/?terms=polio&match=1">soon faced a vaccine shortage</a>. </p>
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<a href="https://images.theconversation.com/files/380370/original/file-20210125-13-1jhc9r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three newspaper photos showing people lining up" src="https://images.theconversation.com/files/380370/original/file-20210125-13-1jhc9r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380370/original/file-20210125-13-1jhc9r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=238&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380370/original/file-20210125-13-1jhc9r1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=238&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380370/original/file-20210125-13-1jhc9r1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=238&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380370/original/file-20210125-13-1jhc9r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=299&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380370/original/file-20210125-13-1jhc9r1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=299&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380370/original/file-20210125-13-1jhc9r1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=299&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Headline images showing the lone lines of people waiting to get a Salk vaccine. ‘The Montreal Gazette,’ Aug. 11, 1959.</span>
<span class="attribution"><a class="source" href="http://newspapers.com/">The Montreal Gazette</a></span>
</figcaption>
</figure>
<h2>A planned robbery</h2>
<p>By August, Montréal was waiting desperately for more vaccines. It was a great relief when a huge shipment of the cherry-red vials arrived from Connaught Labs at the end of the month. The supply was enough to cover the city, and the surplus was planned for redistribution across the province.</p>
<p>Yet the redistribution never came to pass. One man by the name of Jean Paul Robinson, a temporary vaccine worker, had found the circumstances too enticing. Robinson had been tasked with running vials between the various clinics. He knew there was a shortage and that people were desperate. He also knew where the main supply of vaccine was stored: at the Microbiology Institute in the University of Montréal. </p>
<p>At 3 a.m. on Aug. 31, 1959, Robinson and two accomplices broke into the university armed with revolvers. They first locked the night guard <a href="https://www.newspapers.com/clip/68326610/detailed-article-about-the-vaccine/">in a cage with 500 lab monkeys</a>. The thieves then broke the lock on the massive refrigerator, looted all the cases of the vaccine and stole the guard’s car as the getaway vehicle. In the end, they made away with 75,000 vials, <a href="https://www.newspapers.com/clip/68463642/the-robbery-made-front-page-news-all/">valued at $50,000</a> (equivalent to almost $500,000 today). Robinson rented an empty apartment building and stashed his prize.</p>
<p>The crime shocked the country. The next day, <a href="https://www.newspapers.com/clip/68327257/no-vaccine-left-in-the-city-of-montreal/">the city announced it had completely run out of its vaccine supplies</a>. Reporters seized on the situation, publishing reports of desperate mothers turned away from vaccine clinics in vain. </p>
<p>The provincial police were called in, and a special four-man team of investigators was assembled. They began by interviewing the hapless night guard. He couldn’t identify the culprits — who had been wearing nylon leggings over their faces — but he did overhear them speak about transporting the vaccines. The conversation provided the only lead: it seemed that at least one of the men had been “familiar with medical terms.”</p>
<p>The police soon brought in a medical student for questioning. By the next day, they had <a href="https://www.newspapers.com/clip/68273272/">seized a supply of fresh vaccine</a> from the shelves of a Pont-Viau drug store. The confiscated vials displayed the same serial number as the missing supply. Yet questioning both the medical student and the druggist led the police nowhere, and over the next few days, all leads ran dry. Worse yet, it seemed that the city was facing an upswing in infections, <a href="https://www.newspapers.com/clip/68333733/the-week-after-the-vaccine-was-stolen/">with another 36 patients admitted to hospital</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/385350/original/file-20210219-17-1j0hc14.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white photograph of children in a row of hospital beds with an attending nurse." src="https://images.theconversation.com/files/385350/original/file-20210219-17-1j0hc14.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/385350/original/file-20210219-17-1j0hc14.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/385350/original/file-20210219-17-1j0hc14.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/385350/original/file-20210219-17-1j0hc14.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/385350/original/file-20210219-17-1j0hc14.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/385350/original/file-20210219-17-1j0hc14.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/385350/original/file-20210219-17-1j0hc14.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The widespread application of the polio vaccine in the 1950s and ‘60s helped bring polio under control in the early 1970s. Canada was certified 'polio free’ in 1994. This image of polio patients was taken in September 1947 in Edmonton, Alta.</span>
<span class="attribution"><a class="source" href="https://www.cpha.ca/story-polio">(Canadian Public Health Association)</a></span>
</figcaption>
</figure>
<h2>Risk and capture</h2>
<p>Meanwhile, Robinson was trying to figure out what to do with his ill-gotten supply of vaccine. Keeping the product cold was a difficult task — if left unrefrigerated for too long, the vaccine would be useless. He filled the refrigerator (saving one shelf for beer), while the rest of the cases were simply left on the floor at room temperature. Although he had been lucky to sell 299 vials for a tidy sum of $500 to the druggist at Pont-Viau, dispensing with the rest of the vaccine was too risky.</p>
<p>Taking a chance that the police were more interested in recovering the vials than catching the culprit, Robinson placed a call to the public police line. <a href="https://www.newspapers.com/clip/68332052/tip-from-citizen-leads-sleuth-to/">Posing as a concerned citizen</a>, he declared that he had seen a large amount of suspicious cases labelled “Connaught Laboratories” being loaded out of a car on St. Hubert Street in the East End.</p>
<p>The police quickly discovered the missing cases of vaccine, but before they could be used, the vaccines would need to be tested thoroughly. This process <a href="https://www.newspapers.com/clip/68334882/full-story-of-the-recovery-of-the/">could take up to two months</a>, meaning the vials could not be used despite the epidemic. Fresh shipments of the vaccine were not planned to arrive for a few more weeks.</p>
<p>The public met the outcome of the investigation with outrage, with the <em>Montréal Star</em> going so far as to speculate that the police had made a deal with the guilty parties in order to recover the vaccine. Truly, it declared, “in the history of justice in Canada, this case must be unprecedented.” The stolen vaccines were eventually cleared for general use in October.</p>
<p>For their part, the police were far from done investigating. They soon turned their attention to identifying the culprit. They discovered that the man who had provided the police tip was also <a href="https://www.newspapers.com/clip/68335832/article-covering-the-hearing-of/">the man who had sold the Pont-Viau druggist his 299 vials</a>. Evidence continued to mount against Robinson when the janitor of the apartment building identified him. After denying all charges, Robinson fled. He was discovered three weeks later hiding out in a small shed on an “isolated backroad farm.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/380387/original/file-20210125-13-327pxz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4333%2C1216&q=45&auto=format&w=1000&fit=clip"><img alt="Newspaper front page BANDITS TAKE POLIO VACCINE IN BIZARRE LABORATORY RAID" src="https://images.theconversation.com/files/380387/original/file-20210125-13-327pxz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4333%2C1216&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380387/original/file-20210125-13-327pxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=172&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380387/original/file-20210125-13-327pxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=172&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380387/original/file-20210125-13-327pxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=172&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380387/original/file-20210125-13-327pxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=216&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380387/original/file-20210125-13-327pxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=216&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380387/original/file-20210125-13-327pxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=216&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The vaccine heist of 1959 shocked the Canadian public and made headlines across the country. ‘Victoria Daily Times,’ Aug. 31, 1959.</span>
<span class="attribution"><span class="source">(Victoria Daily Times)</span></span>
</figcaption>
</figure>
<h2>‘Beyond reasonable doubt’</h2>
<p>Prosecuting Robinson turned out to be a much harder task, and <a href="https://www.newspapers.com/clip/68457605/results-of-the-prolonged-trial-of-jean/">the case eventually fell apart</a>. Although one of his accomplices had originally identified Jean Paul Robinson as the mastermind of the heist, when the trial came around two years later, the witness recanted his original statement (he would later be <a href="https://www.newspapers.com/clip/68458189/the-gazette/">charged with perjury</a>). </p>
<p>Robinson himself proved imperturbable during courtroom interrogations. He painted himself a public-spirited citizen who had simply tried to <a href="https://www.newspapers.com/clip/68460048/robinson-proved-to-be-unshakable-in-the/">“retrieve” the stolen vaccines from the true criminal mastermind</a>: a mysterious man by the name of Bob. Robinson claimed that Bob had set the whole thing up before he had disappeared and escaped justice. The judge eventually ruled that although Robinson’s story was “strange and a little far-fetched,” in the end, “the Crown had not proven a case beyond a reasonable doubt” and he was acquitted.</p>
<p>As millions of people worldwide anxiously await the distribution of the COVID-19 vaccines, this case warns of the possible consequences of disorganized and poorly planned vaccine programs. <a href="https://www.interpol.int/en/News-and-Events/News/2020/INTERPOL-warns-of-organized-crime-threat-to-COVID-19-vaccines">Those looking to profit from mistakes, shortages and desperation are out there</a>, and it is important that policy makers keep this in mind as vaccination programs are rolled out.</p><img src="https://counter.theconversation.com/content/153840/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paula Larsson receives funding from the Social Sciences and Humanities Research Council of Canada (SSHRC). </span></em></p>In 1959, three armed men broke into the University of Montréal and stole the whole supply of polio vaccine — 75,000 vials valued at $50,000. What have we learned from this event?Paula Larsson, Doctoral Student, Centre for the History of Science, Medicine, and Technology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1544912021-02-04T18:10:15Z2021-02-04T18:10:15ZIn 2010, a virus similar to SARS-CoV-2 was already present in Cambodia<figure><img src="https://images.theconversation.com/files/382238/original/file-20210203-23-cnbn7h.jpg?ixlib=rb-1.1.0&rect=0%2C192%2C4288%2C2541&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A swarm of bats flies out of a cave near Phnom Sampeau, Cambodia.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/Category:Phnom_Sampeau#/media/File:Nowhere_near_the_peak_now_(14452935885).jpg">S. Shankar/Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>In November and December 2010, UNESCO and Cambodian authorities invited researchers from the <em>Muséum National d'Histoire Naturelle</em> in Paris to explore several sites in northern Cambodia. The goal was to study the biodiversity of bats near the <a href="https://whc.unesco.org/en/list/1224/">Temple of Preah Vihear</a>, and a large number of bats species were caught during this survey, including eight types of horseshoe bat (genus <em>Rhinolophus</em>). They’re of great interest for virologists, as they are the reservoir of all Sarbecoviruses, the group of coronaviruses that includes SARS-CoV and SARS-CoV-2, respectively responsible for the <a href="https://doi.org/10.1515/mammalia-2020-0044">SARS epidemic in 2002-2004 and the current Covid-19 pandemic</a>.</p>
<p>In 2020, 10 years after the expedition, the samples stored in a freezer at -80°C were taken out and tested by the Institut Pasteur of Cambodia (IPC) to look for Sarbecoviruses. A PCR test showed two positive results and a full sequencing of their genome started. Two variants of a virus close to SARS-CoV-2 were discovered in two bats of the species <em>Rhinolophus shameli</em> we captured in 2010 in a cave in the province of Steung Treng.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/381759/original/file-20210201-17-164zxrj.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381759/original/file-20210201-17-164zxrj.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381759/original/file-20210201-17-164zxrj.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381759/original/file-20210201-17-164zxrj.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381759/original/file-20210201-17-164zxrj.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381759/original/file-20210201-17-164zxrj.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381759/original/file-20210201-17-164zxrj.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A <em>Rhinolophus shameli</em> bat, the entrance to the cave where a large colony of this species nested, and the forest clearing near the capture site.</span>
<span class="attribution"><span class="source">Alexandre Hassanin</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The results of this research are freely available on the <a href="https://www.biorxiv.org/content/10.1101/2021.01.26.428212v1">bioRxiv website</a> and pending peer review. (This practice is now widely used to rapidly transfer new knowledge about the Covid-19 pandemic.)</p>
<h2>SARS-CoV-2-like viruses are present in bats in the Yunnan province of China and in mainland Southeast Asia</h2>
<p>The discovery is important because the virus is the first found outside China that is close to SARS-CoV-2 – of the 29,913 <a href="https://en.wikipedia.org/wiki/Sequence_alignment">aligned bases</a> in the two viruses’ genomes, 93% are identical. All those previously described were detected in animals collected in China, including two viruses found in two species of <em>Rhinolophus</em> bats in southern China, and two more divergent viruses (90% and 85%) found in pangolins seized by Chinese customs in Guangdong and Guangxi provinces.</p>
<p>The new virus from Cambodia was detected in a bat species endemic to Southeast Asia that does not extend beyond Yunnan, where the two previous bat SARS-CoV-2-like viruses were found.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/382623/original/file-20210204-20-1gel4or.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/382623/original/file-20210204-20-1gel4or.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=437&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382623/original/file-20210204-20-1gel4or.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=437&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382623/original/file-20210204-20-1gel4or.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=437&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382623/original/file-20210204-20-1gel4or.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=549&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382623/original/file-20210204-20-1gel4or.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=549&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382623/original/file-20210204-20-1gel4or.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=549&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Geographical distribution of the three bat species in which viruses close to SARS-CoV-2 have been sequenced. The colored dots indicate the localities of origin of the viruses RaTG13 (blue), RmYN02 (green), RshSTT182 and RshSTT200 (red).</span>
<span class="attribution"><span class="source">Alexandre Hassanin, iucnredlist.org</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The direct implication is that viruses similar to SARS-CoV-2 have been <a href="https://doi.org/10.1038/s41564-020-0771-4">circulating for several decades</a>, as revealed by molecular dating, throughout Southeast Asia and Yunnan, and that different species of bats could have exchanged these viruses in the caves they inhabit.</p>
<p>Chinese researchers have been searching for Sarbecoviruses throughout the country for about 15 years. They found more than 100 SARS-CoV-like viruses but only two related to SARS-CoV-2. The new data thus validates the hypothesis that SARS-CoV-2-like viruses are present mostly in Southeast Asia, while SARS-CoV-like viruses are dominant in China.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/382624/original/file-20210204-14-1lt2ooe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/382624/original/file-20210204-14-1lt2ooe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382624/original/file-20210204-14-1lt2ooe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382624/original/file-20210204-14-1lt2ooe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382624/original/file-20210204-14-1lt2ooe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382624/original/file-20210204-14-1lt2ooe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382624/original/file-20210204-14-1lt2ooe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Number of Covid-19 patients per million inhabitants (in blue) and deaths per million inhabitants (in red) for the different countries of Southeast Asia.</span>
<span class="attribution"><span class="source">Alexandre Hassanin, worldometers.info/coronavirus</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The data in the figure above indirectly support the hypothesis that the SARS-CoV-2 group actually originated in mainland Southeast Asia. Indeed, human populations in Cambodia, Laos, Thailand and Vietnam appear to be much less affected by the Covid-19 pandemic than other countries in the region, such as Bangladesh, Myanmar, Malaysia, the Philippines and Indonesia. This suggests that the populations of these four countries may be benefiting from a level of herd immunity to Sarbecoviruses.</p>
<h2>Pangolins contaminated by bats in Southeast Asia</h2>
<p>Apart from bats, the Malayan pangolin (<em>Manis javanica</em>) is the only wild animal in which SARS-CoV-2-like viruses have been found. The problem is that these discoveries were made in a rather special context, that of pangolin trafficking. Several sick animals were seized by Chinese customs in Guangxi province in 2017-2018 and in Guangdong province in 2019.</p>
<p>Even if the viruses sequenced in pangolins are not that close to SARS-CoV-2 (one was 85% identical and the other 90%), they indicate that at least two Sarbecoviruses could have been imported into China well before the Covid-19 epidemic. Indeed, it has been shown that pangolins from Southeast Asian countries have contaminated each other <a href="https://www.degruyter.com/view/journals/mamm/ahead-of-print/article-10.1515-mammalia-2020-0044/article-10.1515-mammalia-2020-0044.xml">while in captivity</a> on Chinese territory.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/382628/original/file-20210204-16-1u8zyoz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/382628/original/file-20210204-16-1u8zyoz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382628/original/file-20210204-16-1u8zyoz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382628/original/file-20210204-16-1u8zyoz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382628/original/file-20210204-16-1u8zyoz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382628/original/file-20210204-16-1u8zyoz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382628/original/file-20210204-16-1u8zyoz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pangolin, one of the most poached animals in the world, could have served as an intermediate host in the transmission of SARS-CoV-2 to humans.</span>
<span class="attribution"><span class="source">Wahyudi/AFP</span></span>
</figcaption>
</figure>
<p>The question remains on how the pangolins became infected initially. Could it have been in their natural Southeast Asian environment, before being captured? The discovery of a new virus close to SARS-CoV-2 in bats in Cambodia supports this hypothesis, as <em>Rhinolophus</em> bats and pangolins can meet, at least occasionally, in <a href="https://www.degruyter.com/view/journals/mamm/ahead-of-print/article-10.1515-mammalia-2020-0044/article-10.1515-mammalia-2020-0044.xml">caves in Southeast Asia</a>. This strengthens the hypothesis that <a href="https://theconversation.com/coronavirus-origins-genome-analysis-suggests-two-viruses-may-have-combined-134059">pangolin trafficking</a> is responsible for multiple exports of SARS-CoV-2-like viruses to China.</p>
<h2>The “snowballing” effect of breeding small carnivores</h2>
<p>In 2002-2004, <a href="https://www.degruyter.com/view/journals/mamm/ahead-of-print/article-10.1515-mammalia-2020-0044/article-10.1515-mammalia-2020-0044.xml">several small carnivores</a> kept in cages in Chinese markets or restaurants were found positive for SARS-CoV, such as the masked palm civet, the <a href="https://en.wikipedia.org/wiki/Raccoon_dog">raccoon dog</a> and the Chinese ferret-badger.</p>
<p>These small carnivores are solitary and nocturnal mammals – just like pangolins. In the wild, the occasional contamination of an individual of these species by a bat Sarbecovirus has very little chance of causing an epidemic. However, an infected individual placed in an intensive breeding facility can lead to a rapid and uncontrollable evolution of this type of virus.</p>
<p>In 2020, <a href="https://www.theguardian.com/world/2020/oct/11/utah-10000-minks-dead-from-coronavirus">American minks</a> bred for their fur were contaminated with the SARS-CoV-2 virus from humans in Europe and the United States. In November 2020, <a href="https://www.theguardian.com/environment/2020/nov/04/denmark-announces-cull-of-15-million-mink-over-covid-mutation-fears">millions of mink in Denmark were culled</a> after they became infected with Covid-19 and in turn passed a mutated form back to humans.</p>
<p>The Covid-19 crisis taught the world that keeping immense numbers of small carnivores in captivity is a <a href="https://science.sciencemag.org/content/371/6525/172">major health risk</a>: viruses can spread and evolve rapidly in breeding facilities, potentially producing more contaminating or more dangerous variants. As pangolins and small carnivore species were frequently stored and sold together in wet markets, a “snowballing effect” due to interspecies viral transmission could be the last step in starting the human Covid-19 pandemic.</p>
<p>This scenario is mot likely as nearly <a href="https://www.nationalgeographic.com/magazine/2019/06/pangolins-poached-for-scales-used-in-chinese-medicine/">1 million pangolins have been trafficked in the past decade</a> and millions of small carnivores are <a href="https://reporterre.net/Mounting-evidence-suggests-mink-farms-in-China-could-be-the-cradle-of-Covid-19-22020">bred in fur farms in China</a>.</p>
<p>To test this hypothesis and understand why epidemics are emerging in China and not elsewhere, it would be interesting to look for possible infection by Sarbecoviruses in samples from American minks and raccoon dogs bred for their fur in China. These samples exist, they have been collected in the last two decades to study the <a href="https://doi.org/10.1016/j.vetmic.2009.07.010">canine distemper virus</a> or avian flu viruses <a href="https://doi.org/10.1016/j.vetmic.2017.01.028">H5N1</a> and <a href="https://doi.org/10.1016/j.vetmic.2015.01.009">H9N2</a>.</p>
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<p><em>This article was translated from the original French by Elsa Couderc with help from DeepL.</em></p><img src="https://counter.theconversation.com/content/154491/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexandre Hassanin ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>A bat virus discovered a decade ago in Cambodia indicates that pangolin trafficking remains a credible explanation for the origin of the Covid-19 pandemic.Alexandre Hassanin, Maître de Conférences (HDR) à Sorbonne Université, ISYEB - Institut de Systématique, Evolution, Biodiversité (CNRS, MNHN, SU, EPHE, UA), Muséum national d’histoire naturelle (MNHN)Licensed as Creative Commons – attribution, no derivatives.