Countries in the region must maintain polio vaccinations and surveillance during the pandemic to prevent an outbreak, according to experts at the Pan American Health Organization (PAHO).
“Although as a region we have defeated polio once before, if we allow vaccination coverage rates to fall and become too low, we will be at risk for polio circulation in our communities once again,” said PAHO Director Carissa Etienne. “That is why it is more important than ever to do our part to protect and sustain polio elimination in our region while we wait for countries in other parts of the world to achieve this goal,” Etienne added.
The pandemic has stressed immunization and surveillance systems designed to catch and respond to vaccine-preventable diseases, according to PAHO.
“Now during the pandemic, we must work extra hard to not lose what we have gained,” said Cuauhtemoc Ruiz Matus, head of PAHO’s Immunization Program.
Ruiz said that strong political commitment from governments, strategic partnerships between international agencies, and the work of health care workers contributed to the success to the region’s fight against the virus.
“Without all of these things, we wouldn’t be where we are today,” said Ruiz.
Reported coverage for the polio vaccine for the Americas between 2016 and 2019 ranged between 85-87%, according to PAHO.
Coverage in 2020 might be lower “due to disruptions in primary health care activities caused by the COVID-19 pandemic,” according to PAHO.
Polio once was a common virus. In some young children it can affect the nerves and cause muscle weakness or paralysis. There is no treatment and no cure but getting vaccinated can prevent infection.
Researchers proved that an advanced coronavirus vaccine candidate respects the genetic instructions as intended, producing the desired response inside cells.
Scientists from Bristol University developed new technologies to inspect the quality of vaccines and found that the AstraZeneca/Oxford vaccine follows the programmed genetic instructions.
The independent research is reassuring, showing that the vaccine behaves consistently with the intended plan.
Several coronavirus vaccine trials will complete Phase 3 in the coming months, with one of the frontrunners expecting to seek emergency regulatory approval in late November. That’s assuming Phase 3 trials prove that the drugs are effective and safe. The vaccines will have to protect against infection with the novel pathogen without inducing severe adverse effects. The results for Phase 1 and Phase 2 trials showed that various drugs that are currently tested on volunteers were generally safe. Researchers reported minimal adverse incidents, and those were usually transitory. However, that’s not enough, and the FDA has strict safety requirements for following up with patients enrolled in Phase 3 trials. All volunteers will have to be monitored for two months after their second shot before a company can seek approvals. That’s actually the rule that makes it impossible for any vaccine maker to file paperwork before the presidential election.
That said, there has been an interesting development that warrants plenty of attention from the general public. An independent team of researchers proved that one of the most advanced vaccines works as intended. The conclusions are definitely reassuring, although they’re not enough to conclude the vaccine is safe for use. The researchers found that the drug respects the genetic instructions and behaves exactly as the designers want it to.
Researchers from Bristol University developed new techniques to study the well-known AstraZeneca/Oxford vaccine candidate known as ChAdOx1 nCoV-19 or AZD1222. They were able to show that the vaccine follows genetic instructions accurately, as Oxford University intended it.
The researchers explained in a press release that the Oxford vaccine is made using a common cold virus (adenovirus) from chimpanzees that doesn’t have the ability to replicate inside of the human cells. Oxford replaced about 20% of its code with genetic information that codifies only the spike protein of SARS-CoV-2, the virus that causes COVID-19. That’s the protein that the virus uses to link with cells.
The idea for the vaccine is to enter human cells without causing illness. Once inside the cell, the vaccine will instruct them to copy the spike protein and replicate it. The spike protein will then be perceived as a foreign object, and the immune response will take action. This is how the immune system is trained to create antibodies that can block the spike protein. Upon encountering the actual coronavirus, those antibodies should bind to the real spike protein and prevent the virus from entering cells. This is the key event in the life of a virus particle. Without breaching the cell wall, the virus can’t replicate. If replication is stopped, then the COVID-19 infection is stopped.
The Bristol researchers were able to verify that the vaccine behaves as intended. “Thanks to very recent advances in genetic sequencing and protein analysis technology, researchers at Bristol were, for the first time also able to directly check thousands and thousands of the ‘photocopied’ instructions produced by the Oxford vaccine within a cell,” the release reads. “In this way, they were able to directly validate that the instructions are copied correctly and accurately, providing greater assurance that the vaccine is performing exactly as programmed.”
In addition to verifying that the vaccine writes the correct data, they also inspected the spike protein copies to see whether they respect the programmed instructions.
“This is an important study as we are able to confirm that the genetic instructions underpinning this vaccine, which is being developed as fast as safely possible, are correctly followed when they get into a human cell,” said Dr. David Matthews, who led the validation research. “Until now, the technology hasn’t been able to provide answers with such clarity, but we now know the vaccine is doing everything we expected, and that is only good news in our fight against the illness.”
These conclusions are definitely reassuring, but they have their limits. The researchers can’t address the potential side-effects that the vaccine can induce. That’s what the Phase 3 trial will help explain. AstraZeneca has disclosed so far three safety incidents, including an unexplained illness that paused the study in early September — the US arm of the study remains on pause. More recently, a volunteer died in Brazil, but the person was on the placebo, not the real experimental drug. The event was investigated, and experts, including Brazil’s regulators, advised that the study proceed.
The Bristol study has been pre-published in Research Square and needs to be peer-reviewed.
Chris Smith started writing about gadgets as a hobby, and before he knew it he was sharing his views on tech stuff with readers around the world. Whenever he’s not writing about gadgets he miserably fails to stay away from them, although he desperately tries. But that’s not necessarily a bad thing.
Researchers have found that metabolite produced following consumption of dietary soy may decrease a key risk factor for dementia–with the help of the right bacteria.
The study, published in the journal Alzheimer’s & Dementia: TRCI, reported that elderly Japanese men and women who produce equol–a metabolite of dietary soy created by certain types of gut bacteria–display lower levels of white matter lesions within the brain.
“White matter lesions are significant risk factors for cognitive decline, dementia and all-cause mortality,” said lead author Akira Sekikawa from the University of Pittsburgh in the US.
“We found 50 per cent more white matter lesions in people who cannot produce equol compared to people who can produce it, which is a surprisingly huge effect,” Sekikawa added.
For the findings, the research team measured equol levels within the blood of 91 elderly Japanese participants with normal cognition.
Participants were sorted by their equol production status, and then six to nine years later underwent brain imaging to detect levels of white matter lesions and deposits of amyloid-beta, which is the suspected molecular cause of Alzheimer’s disease.
The researchers found that while equol production did not appear to impact levels of amyloid-beta deposited within the brain, it was associated with reduced white matter lesion volumes.
They also discovered that high levels of isoflavones–soy nutrients that are metabolized into equol–had no effect on levels of white matter lesions or amyloid-beta when equol wasn’t produced.
According to Sekikawa, the ability to produce equol from soy isoflavones may be the key to unlocking protective health benefits from a soy-rich diet, and his team has previously shown that equol production is associated with a lower risk of heart disease.
As heart disease is strongly associated with cognitive decline and dementia, equol production could help protect the aging brain as well as the heart.
Epidemiological studies in Japan, where soy is regularly consumed, have shown that dietary intake of soy isoflavones has been linked to a lower risk for heart disease and dementia.
“This type of study always catches people’s attention, but we cannot prove that equol protects against dementia until we get a randomised clinical trial with sufficient evidence,” Sekikawa noted.
The United States Agency for International Development (USAID) has announced additional development assistance of $136.5 million, which is about N52 billion to support Nigeria under a bilateral Development Objectives Assistance Agreement (DOAG) with the United States signed in 2015.
The additional funding was aimed at boosting activities to combat trafficking in persons, mitigate conflict, peace, and counter violent extremism, as well as control and prevention of HIV/AIDS.
The US Mission in Abuja disclosed this in a statement issued yesterday.
It read: “USAID recently announced additional development assistance of $136.5 million (NGN 52 billion) to continue its support to Nigeria under a bilateral Development Objectives Assistance Agreement (DOAG) with the United States signed in 2015.
“With this most recent notification to the government of the incremental funding increase, USAID has provided Nigeria $1.94 billion (N743 billion) in assistance under the seven-year DOAG.
“Most of the assistance, nearly $133.5 million, will go to HIV/AIDS control under several new and existing awards that focus on prevention and treatment in some of the most vulnerable areas of the country.
“Another $3 million boosts activities to combat trafficking in persons, mitigate conflict, peace, and counter violent extremism, and $219,566 will expand USAID’s efforts to increase access to potable water and reduce water borne diseases in Nigeria.”
The USAID Mission Director, Dr. Anne Patterson, was quoted to have said that Nigeria as the most populous country in Africa with the largest economy, has tremendous potential and influence over the future of the continent.
According to Patterson, With this additional funding, the United States continues to demonstrate its commitment to supporting development programs that will benefit the Nigerian people.
The United States is responsible for 80 per cent of the AIDS treatment provided in Nigeria. About 1.9 million Nigerians are living with HIV/AIDS, according to the U.S. supported Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) of 2018.
Patterson added that in 2020, USAID tested 2.4 million Nigerians for HIV, and placed 89 per cent of the 119,000 who tested positive on antiretroviral therapy, bringing the total number of Nigerians on USAID-supported HIV/AIDS treatment to 377,500.
Other activities provide care and support for more than 600,000 children and family members orphaned or otherwise impacted by the virus. Through the President’s Emergency Plan For AIDS Relief (PEPFAR) initiative, over 5.4 million Nigerians have been tested for HIV and one million put on therapy.
“For the first time in modern history, we have the opportunity to control HIV without a vaccine. In partnership with government, civil society, the private sector, and communities, we can help Nigeria overcome this disease.”
Health authorities in Queensland, Australia and New Zealand believe that they have isolated the source of the recent COVID-19 in New Zealand believed to be tied to the shipping industry. Coronavirus testing on the crew aboard a containership arriving in Australia confirmed at least two active cases of the virus.
The Liberian-flagged containership, the Sofrana Suville, a 1,000 TEU vessel operating regionally, arrived in Brisbane, Australia on October 20 and was held at anchor by the health authorities in Queensland. Their New Zealand counterparts asked that the crew be tested to confirm suspicions that it was the source of a case in New Zealand. The vessel had been in Auckland on October 12 and 13 and departed for Noumea in New Caledonia before proceeding to Australia.
Queensland officials were concerned over the potential that the vessel was carrying the virus because they reported only one new case and a total of five active cases in the entire state as of October 21. There were also fears that because the ship was arriving internationally that it could be carrying a different strain of the virus than the one previously seen in Australia.
Initial testing of the 19 crew members aboard the Sofrana Suville confirmed two active cases of the virus and possibly a third crew member who had recovered from the virus. None of the crew members are believed to be displaying and symptoms. Further test results were still pending, but the health authorities decided to move the two crew members who tested positive to a hospital on shore. The ship remains under quarantine anchored off the Australian coast.
This latest incident began when a marine electronics engineer in New Zealand that had been working as a contractor aboard ships arriving in the ports tested positive for the virus. The engineer was diagnosed on October 17 and New Zealand health officials launched a contact tracing effort to identify the likely source of the virus. New Zealand as a country has been successful in containing the virus preventing community spread, leading to suspicions that this case had been introduced from an international source.
New Zealand health officials determined that the engineer had worked first on a domestic ship which they did not believe was the source. He then worked for two days aboard the Sofrana Suville and at the same time, the vessel was implementing a crew change with eight crew members arriving from the Philippines on October 13 and four departing the ship.
After the Sofrana Suville, the contractor traveled to New Plymouth, New Zealand, where he worked for two days on another vessel, the Ken Rai, and spent one night in a hotel before returning home. He became ill and tested positive after returning home.
The Sofrana Suville, which by that time was sailing to Australia, was identified as the likely source of the infection. The Australian health officials agreed to quarantine the ship and test the crew. Also, New Zealand quarantined the Ken Rai which had sailed to Napier as they considered all of the crew aboard to have been close contacts of the infected engineer.
Representatives of Maritime Safety Queensland told The Australian newspaper that this situation would be handled in the same method as all of the other ships arriving in the state. Since the introduction of COVID-19 protocols, they told the newspaper that at least 10,000 ships have entered their waters. They reported that they have had several positive cases of the virus and the protocol remains to hospitalize the crew members and quarantine the ship.
This incident has also brought more attention to the issue of crew changes and specifically concerns over enforcement of the protocols in the Philippines. Several of the recent outbreaks in Western Australia and now China are being associated with crew coming from the Philippines. Authorities in Manila report that they are following protocols, but announced plans for further steps to isolate incoming and outgoing crew members as an additional precaution against spreading the virus. As a result of this incident, public health experts in New Zealand are calling for tighter controls and the government said it would review the process for incoming crew and ships on short-term calls.
Covid-19 doesn’t just make people physically ill. It has also led to higher levels of anxiety and mental illness across Ireland. Combating it is not simple, requiring enhanced services, economic supports, and a positive public message
These quotes – just three from many accounts shared with The Irish Times from people in psychotherapy – reflect the impact Covid-19 is having on a range of people in Ireland. They tell of losing contact with others, losing loved ones, losing jobs, losing out on life opportunities, sometimes losing their grip on life itself.
The figures on Covid-19 cases and deaths, announced nightly, are a very public declaration of how the virus is infecting the population. Privately, the disease is affecting many more, with higher levels of anxiety and mental illness.
“The people who are ill with Covid-19 require immediate care, but there is silent suffering too,” says Brendan Kelly, professor of psychiatry at Trinity College Dublin.
This suffering has been going on a while. The first lockdown caused more people to feel loneliness, depression or anxiety or left them in a state of what one survey called “post-traumatic stress”. It sparked an increase in prescriptions for sleeping tablets, anxiety medicines and anti-depressants.
There was an initial decline in people seeking mental health treatments, medics say, as people feared contracting the virus if they went into healthcare settings and because a sense of “group trauma” made them feel protected.
Since then – according to surveys, hospitals and mental health professionals who spoke to The Irish Times – more patients have been presenting with self-harm and other emergencies. These are often complex cases, because patients have delayed seeking help and their mental illness is complicated by other emergency health conditions.
As the Government introduces Level 5 restrictions to tame a resurgence of the virus, that silent suffering shows little sign of abating. Amid this uncertainty, however, we must not lose perspective.
“It is important not to pathologise the legitimate worries that people have – people are allowed to be anxious when things are uncertain – and the vast majority of people will have no mental illness, they are just anxious,” says Dr Stephen McWilliams, a consultant psychiatrist at Saint John of God Hospital in south Dublin and an associate clinical professor at UCD.
“There are people with existing mental illness, some of whom may relapse if they become very anxious and stressed. Some people may become ill for the first time without having any underlying mental illness previously.”
The Stillorgan hospital, specialising in mental health treatment and care, said in May that over the second month of the pandemic, half of its admissions related to the intense pressure from Covid-19 restrictions. At that time there was a “dramatic increase” in patients struggling with mood and anxiety disorders, addictions and issues stemming from severe isolation.
“Loneliness and isolation are probably the main issues. We know that families are very important for people with mental health problems. They provide a lot of support and a caring role. This is what Covid-19 has taken away from people with mental illness,” says McWilliams.
Increased isolation and loneliness can affect a person’s mental health and this, combined with the uncertainty about what will happen when the current restrictions come up for review, can bring underlying mental health conditions to the surface.
The restrictions coincide with peaks in mental health issues, requiring extra support and vigilance from services that have long been over-burdened and under-resourced.
“Going to Level 5 intensifies the anxiety that so many people feel about Covid-19, about the effect of the restrictions and about the future,” says Kelly of Trinity College.
To respond to the potential psychological stresses that another lockdown might bring, this week the Government introduced the concept of the “social support bubble” that permit households to “buddy up” with an elderly person or single adult with children to protect people at risk from social isolation or mental ill-health. This will address some of the loneliness people experienced during the first lockdown when the over-70s were told to “cocoon” at home.
A month into the last lockdown, the Irish Covid-19 Mental Health Survey, which included researchers from Maynooth University and Trinity College Dublin found that among 1,000 people, 41 per cent reported feeling lonely, 23 per cent were depressed, 20 per cent had clinically meaningful levels of anxiety, and 18 per cent were suffering the effects of post-traumatic stress.
“Being able to maintain contact for some people could be extraordinarily important,” says Dublin-based clinical and counselling psychologist Eoin Galavan of the new bubbles.
“The Government is trying to weigh up the public health damage that is caused by social-isolation restrictions against the public health benefit of restricting the transmission of the virus.”
Fear of the virus in the early stages of the pandemic meant people with mental health issues were reluctant to present at hospitals because they were worried about contracting Covid-19.
Siobhán O’Neill, Northern Ireland’s interim Mental Health Champion and professor of mental health sciences at the Ulster University, said that crisis helplines were reporting longer calls from distressed people, and greater levels of distress and anxiety were being detected among parents home-schooling children, a “group of people we weren’t really expecting to be in the data”.
“It was the community and voluntary sector that were picking up a lot of cases rather than hospitals in the first few months. People with existing mental health issues were distressed and there were new people developing acute anxiety and related mental health problems,” she says.
In a survey of almost 200 mostly community-based psychiatrists in June, the Irish College of Psychiatrists found that 68 per cent of respondents saw an initial lull in referrals to mental health services in the first month of lockdown from the end of March. In the second month of lockdown, almost 60 per cent of psychiatrists reported an increased demand for inpatient beds, while 72 per cent said referrals to secondary mental health services increased or significantly increased.
Psychiatrists at University Hospital Galway found that patients presenting with self-harm dropped by 35 per cent in March and April but increased dramatically, more than doubling, in May, according to a study published in the Irish Journal of Psychological Medicine.
Since the early summer, more people with mental health issues have presented with mental health emergencies. The Mater had 43 presentations in the emergency department in April; this rose to 166 in August. In September, the figure stabilised but it was still 20 to 30 per cent higher than the same month last year, according to liaison psychiatric consultant Dr Ana Maria Clarke.
“We have people with depression that started to become unwell during the pandemic and they would have delayed seeking help, and then they might have had a suicide attempt that resulted in them being admitted to hospital, and then you are dealing with the effects of the suicide attempt as well as their severe depressive illness,” says Clarke.
The psychological impact of the pandemic has concerned the HSE. Chief executive Paul Reid last month noted “a concerning trend” of people presenting to health services with “worrying levels of anxiety and in some cases mental health issues.”
At Tuesday’s National Public Health Emergency Team (Nphet) briefing, Dr Siobhán Ní Bhriain, a psychiatrist and senior HSE manager, said the pandemic was affecting age groups differently.
“Older people are more likely to suffer from anxiety and loneliness. Younger people are more likely to suffer from anxiety and loneliness. Younger people are more likely to suffer from suicidal ideation or thoughts of self-harm,” she said.
This was not translating for now into actual suicide numbers, she said, but the HSE was “very conscious” of the problems and building up mental health services in preparation.
This experience is not unique to this public health emergency. Deaths by suicide increased in the United States during the 1918-19 “Spanish flu” pandemic and among older people in Asia during the 2002-04 Sars outbreak as social disengagement, mental stress and anxiety took a toll, according to the International Association for Suicide Prevention.
In recognition of the growing psychological toll of the pandemic, the Government committed an additional €38 million to mental health services in last week’s budget. Mental health professionals believe the HSE must strike a balance between investing in mental health services in the community and hospitals. Many feel that GPs provide an important first line of defence.
Prof Kelly says the Counselling in Primary Care (CIPC) programme, free through GPs for medical card holders, should be expanded to people on low incomes who are not on medical cards and to the under-18s.
Dr Galavan says that primary-care psychological services that are accessible through GPs is “almost non-existent in many parts of the country” and that the Government needs to reconsider the supports that are available. Accessing more psychological services through GPs would add a “layer of support” for people going into psychological or emotional crises during the pandemic.
“It is an easy solution which could have a big impact on addressing the anxieties, depressions and other mental issues . . . that may emerge in the wake of what is coming down the road,” he says.
Dr Brian Osborne, a GP and director of the Irish College of General Practitioners’ mental health programme, says that GPs are seeing more people with mental health issues attending surgeries.
“A lot of people are coming in with disturbed or interrupted sleep, irritability, general stress and anxiety that they cannot put their finger on. A lot of parents are coming in about concerns about their children, especially during the lockdown, and the lack of schooling, the disruption to their daily routine, the loss of interaction with friends and children acting out,” he said.
Claims for antidepressants on publicly funded drugs increased during the early stages of the pandemic as patients sought medication to treat depression, anxiety and sleep loss, but dropped off in May and June.
The HSE has said that it has maintained its mental health services at about 90 per cent, some of which has been through telephone or virtual appointments such as consultations over Zoom.
Osborne has said that much of the health system has been “very slow to reopen”. While online services offer some support, the “nuances and complexities of face-to-face consultations is what is needed”.
“The challenges have multiplied during the pandemic. The health service really does need to open just like general practice has,” he said.
Dr Philip Dodd, national clinical adviser at the National Office for Suicide Prevention and a Dublin-based psychiatrist, says that the current level of demand for CIPC services and other mental services are not higher than would normally be at this time of year.
“That does not mean we are not entering into a very anxious period for the whole population,” he says.
The HSE has set up much more specific “psycho-social” supports across its nine community health organisations network, including targeted health guidance and online counselling. “If there is an increased level of demand associated with these increased levels of restrictions, we are in a position to monitor that increased demand and potentially respond to it,” Dodd says.
The economic fallout from the pandemic has an impact on mental health that is both immediate and longer term. The loss of a job creates financial problems but can also cause isolation and loneliness, leaving people feeling cut off. Anxiety levels have been raised by the threat of economic hardship, and the full economic impact may be only starting to be felt.
“We are in the middle of that part of the pandemic in the sense that we don’t think all of the impacts economically have fully happened yet, so there could be a whole lot more pressure on suicide rates in an upward trend,” says Galavan.
Kelly says the economic situation can have delayed effects on mental health and that unemployment in particular can have a “corrosive” effect; an increase of 10 percentage points on the unemployment rate can have “spillover effects” on everyone’s mental health, even on the employed.
The Government’s wage subsidy scheme that allows employers to maintain a link with employees when businesses are shut down is not just an important financial support, he says.
“It has a huge mental health benefit: being employed brings far more than income. It brings connection, it brings self-worth and it brings the notion of being part of a workforce,” he says.
Dodd says that Government measures to protect people’s incomes during the pandemic have a critical additional mental health benefit.
“One of the biggest predictors of increased levels of suicide is economic hardship, so what the Government and our country is doing around people’s income is a really important support around their mental health. Sometimes we can lose that connection,” he says.
Dodd says that encouraging a strong sense of social cohesion, as happened during the last lockdown, would help make the impact of the pandemic less severe on people’s mental health.
“That sense of ‘we are all in it together’ is somewhat protective of people who are at risk of developing psychological or mental health problems as a result of the pandemic,” he says.
This lockdown is more complicated. Public tolerance has weakened since the “in this together” approach shown by the public to the March-May shutdown. Presenting it as being temporary in nature made that lockdown more tolerable. This time around it seems less temporary because of the acceptance now that Level 5 will merely suppress the virus, not eliminate it.
“Early in the pandemic people were told that if they stick with restrictions for a few weeks, things might return to normal, but this time it is different and more difficult to accept. It is the unknown and the unpredictability of how it might work makes it difficult,” says Dr Ana Maria Clarke at the Mater Hospital.
Even the reward that compliance might lead to a more normal Christmas may not help.
“When a pandemic is at play, and restrictions are imposed, all of the research suggests that it has the potential to increase suicide rates and it can have severe implications, psychologically and emotionally, for people. I think a certain amount of that is going to happen, regardless of the social bubbles, regardless of keeping Christmas in play,” says Galavan.
To help over the weeks ahead, Kelly would like to see greater emphasis from the Government and State officials on the “permissions” rather than the “prohibitions” in the public guidance, given the awareness of the mental health implications of Covid-19 and the restrictions.
“I would like to see the message that going out for a walk every day with members of your household is permitted for physical and mental health. That message needs to be stronger and clearer. There are sectors of the population that need the permission emphasised to them,” he says.
McWilliams of Saint John of God Hospital says it is important to remember that people with severe and enduring mental illness can be among the most resilient of people.
“A lot of people will manage generally. We have done tough stuff before as a country. We went through an economic crash 12 years ago and we have the ability to deal with hardship if we need to,” he says.
The reward of “more leeway around Christmas time” and the ability to take “a bit of a break” from the public restrictions, amid the longer wait for a vaccine for Covid-19, will offer hope.
“It is important to maintain hope,” he says. “Things will get better.”
Quotes from people in therapy come from a psychotherapist in private practice
If you are affected by any of these issues, please contact Pieta House on 1800-247247 or the Samaritans by telephoning 116123 for free, texting 087-2609090 or emailing firstname.lastname@example.org