As ZIKA and EBOLA reemerge, Trump administration cuts funding to halt international epidemics

March 13th
“The White House appeared to declare victory this week for an Obama-era initiative to stamp out disease outbreaks around the world even as it moved to scale back the program…,
But the United States is set to dramatically shrink its contributions to the initiative, a point that the report omitted. The Centers for Disease Control and Prevention is preparing to narrow epidemic work from 49 countries to 10, an agency spokeswoman said.
That has alarmed health policy experts.
“It’s not a matter of if — but when — there will be another Ebola or Zika, and right now, the world isn’t ready,” said Dr. Thomas R. Frieden, who led the C.D.C. during the West African Ebola outbreak. “Many life-threatening gaps have been identified, but most of them haven’t been closed.” “ (A)

“The response to the Zika virus is fairly typical of both our strengths and weaknesses in dealing with infectious diseases, especially when they emerge. Existing drugs against other viruses were identified as potential therapeutics for Zika, efforts to develop a vaccine are underway and nearing completion, and the concern about Zika spurred some needed and valuable research. Those are encouraging signs, but these efforts were somewhat slow to get started and preceded by the usual complacency. We tend to close the barn door only after most of the horses have escaped.” (B)

May 8th
“The Government of the Democratic Republic of the Congo declared a new outbreak of Ebola virus disease (EVD) in Bikoro in Equateur Province today (8 May). The outbreak declaration occurred after laboratory results confirmed two cases of EVD.
The Ministry of Health of Democratic of the Congo (DRC) informed WHO that two out of five samples collected from five patients tested positive for EVD at the Institut National de Recherche Biomédicale (INRB) in Kinshasa. More specimens are being collected for testing.
WHO is working closely with the Government of the DRC to rapidly scale up its operations and mobilize health partners using the model of a successful response to a similar EVD outbreak in 2017.
“Our top priority is to get to Bikoro to work alongside the Government of the Democratic Republic of the Congo and partners to reduce the loss of life and suffering related to this new Ebola virus disease outbreak,” said Dr Peter Salama, WHO Deputy Director-General, Emergency Preparedness and Response. “Working with partners and responding early and in a coordinated way will be vital to containing this deadly disease.” “ (C)

May 17th
“An Ebola outbreak in the Democratic Republic of Congo has spread to a major city — Mbandaka, with a population of about 1 million people — officials said.
The country’s health minister said authorities are intensifying work to identify those who have been in contact with suspected cases. Another concern is the disease could be spread through commerce, as the city is a major trade thoroughfare on the banks of the Congo River.” (D)

May 17th
National Institutes of Health officials assured lawmakers on Thursday that U.S. health experts are following concerns of an Ebola outbreak in Africa closely and said a number of medical countermeasures have already been deployed in response.
“Obviously given our prior experience, we are on very high alert,” said Anthony Fauci, M.D., head of the National Institute of Allergy and Infectious Diseases, in response to a question about how worried the U.S. should be about reports that Ebola had been found in an urban area of the Democratic Republic of Congo….
…at least one case is now in a more populated area, he said: “Even though there is only one case there, there’s a total now of 44 cases, even though only two have been confirmed. There are 20 that are probable and 20 that are suspicious. So there are probably many more cases.”…
“We are on high alert. We are always concerned when there is Ebola. But we right now have a number of countermeasures that we were able to develop to go in and hopefully block that,” he said. “Our expectations are always cautious. Our hopes are always that we will not have the kind of outbreak that we saw in West Africa.” (E)

May 18th
“Congo at ‘Very High’ Risk as Ebola Strikes Major City. WHO raises the public-health risk to ‘very high,’ as the deadly virus reaches a large port city
Aid organizations and the Congolese government rushed supplies and health experts Friday to a major city in the Democratic Republic of Congo, after the World Health Organization raised the public-health risk from the latest Ebola outbreak to “very high.”
Congo’s threat from the deadly disease was elevated from high by the WHO, who also upped the risk to neighboring nations to high from moderate. Very high is the second-highest risk level available, below serious.” (F)

May 18th
“What’s the worse-case Ebola outbreak?
Public health officials would say it’s when the virus is spreading in a crowded urban environment that’s a major transportation hub and has dilapidated, ill-equipped health care facilities.
Unfortunately, that’s what’s happening right now in the northwest of the Democratic Republic of the Congo…
That’s why the World Health Organization along with Congolese officials and other aid agencies are scrambling to try to contain this outbreak before it grows much larger…
Congolese health officials now say there have been 45 suspected cases reported in their country since April. And 25 people have died. Laboratory testing of patient blood samples, however, has been progressing slowly; 14 of the cases have been confirmed as Ebola.
Four thousand doses of an experimental Ebola vaccine — which has to be stored at minus 60 degrees Celsius — have shipped to the DRC. Plans are being developed to try to vaccinate hundreds if not thousands in areas near where Ebola cases have been found.
Doctors Without Borders is setting up isolation wards and Ebola treatment centers both near the epicenter of the outbreak and in the port city of Mbandaka.
The Red Cross is recruiting local volunteers to collect and safely bury the dead.
“We have now 20 volunteers trained on how to do these burials,” says Karsten Voigt, operations manager for the International Federation of the Red Cross in the Democratic Republic of the Congo.” (G)

May 18th
“The Ebola outbreak in Democratic Republic of Congo can be brought under control and is not an international public health emergency, experts advising the World Health Organization said on Friday.
Earlier in the day the WHO had said the first confirmation of Ebola in Mbandaka, a city of about 1.5 million people, had prompted it to declare a “very high” public health risk to the country and a “high” risk to the region.
But the WHO’s Emergency Committee of 11 experts said the rapid response had mitigated the risk from the outbreak, which was declared 10 days ago and has killed 25 people since early April.
“Interventions underway provide strong reason to believe that the outbreak can be brought under control,” the committee said in a statement.
They decided not to declare a “public health emergency of international concern” (PHEIC), a formal alert that puts governments on notice and helps mobilise resources and research.
However, committee chairman Robert Steffen said the “vigorous” outbreak response must continue.” (H)

May 19, 2018
“ Three new cases of the often lethal Ebola virus have been confirmed in a city of more than one million people, Congo’s health minister announced, as the spread of the hemorrhagic fever in an urban area raised alarm.
The statement late on Friday said the confirmed cases are in Mbandaka, a city where a single case was confirmed earlier in the week.
There are now 17 confirmed Ebola cases in this outbreak, including one death, plus 21 probable cases and five suspected ones…
While Congo has contained several Ebola outbreaks in the past, all of them were based in remote rural areas. The virus has twice made it to Congo’s capital of 10 million people, Kinshasa, in the past but was rapidly stopped.
Health officials are trying to track down more than 500 people who have been in contact with those feared infected, a task that became more urgent with the spread to Mbandaka, which lies on the Congo River, a busy traffic corridor, and is an hour’s flight from the capital.” (I)

May 19th
“The U.S. government is preparing its most direct response yet to the outbreak that appears to have begun in April, readying staffers from the Centers for Disease Control and Prevention (CDC) to deploy to multiple communities in the Democratic Republic of Congo…
The present outbreak has raised anew questions about WHO and its capacity to respond to deadly viral threats. In the wake of the West African outbreak ago, when the ill-prepared WHO endured withering criticism for its lackluster response to the initial round of cases, the agency has undergone a remarkable round of self-flagellation, reorganizing to prioritize emergency preparedness and response while cutting bureaucracy.” (J)

“Regular vaccines can be tested in a few different ways. In one approach, researchers can vaccinate people and then expose them to the pathogen that the vaccine targets. That was never an option for a virus as deadly as Ebola.
Another approach is the standard randomized clinical trial. Enroll a large number of volunteers who may encounter the pathogen in their day-to-day life, and randomly assign some to be vaccinated. If researchers see more illness in the people who didn’t get the vaccine, it is considered to offer protection.
But a standard randomized clinical trial doesn’t work when a pathogen circulates as rarely as Ebola does. In the 42 years since the first known Ebola outbreak, only about 31,000 people are known to have been infected — and most of those infections occurred in the West African outbreak of 2013-2016. Outbreaks have ranged over a terrain that spans thousands of miles from West Africa to Central Africa.
Researchers could vaccinate thousands of people and follow them for years without seeing any disease in either the vaccine recipients or the control group.
Even testing during an outbreak was traditionally thought to be impossible. But the West African outbreak changed that thinking.
The vaccine now being fielded in the DRC — the VSV vaccine — was shown to be effective in Guinea in a so-called ring vaccination trial, in which people exposed to a case were vaccinated in an attempt to build a wall of immunity that cuts off the virus’s ability to spread.
In the latest outbreak, if the vaccine works as well as earlier studies suggest, it could present a paradigm shift in the way the world thinks about Ebola outbreaks.” (K)

May 24th
Two infected patients who fled from an Ebola treatment center in a Congo city of 1.2 million people later died, an aid group said Wednesday while asserting that “forced hospitalization is not the solution to this epidemic.”
As the number of suspected Ebola cases continued to rise, experts emphasized that more community engagement is needed to prevent the spread of the deadly virus.
Three patients left of their own accord from the isolation zone of the Wangata hospital in Mbandaka city between Sunday and Tuesday, said Henry Gray, emergency coordinator for Medecins Sans Frontieres.
One patient had been about to be discharged, he said. “The two others were helped to leave the hospital by their families in the middle of the night on Monday. One of the men died at home and his body was brought back to the hospital for safe burial with the help of the MSF teams; the other was brought back to the hospital yesterday morning and he died during the night,” Gray said in a statement.” (L)

May 24th
“Congo’s fight to rein in a deadly Ebola outbreak has authorities crossing the border to buy up available thermometers, a World Health Organization official said, as the health ministry on Thursday announced that confirmed cases had reached 30, including eight deaths.
The spread of the often lethal hemorrhagic fever to a provincial capital of 1.2 million people has health officials scrambling to monitor for Ebola at busy ports in the capital, Kinshasa, which is downstream from the infected city of Mbandaka on the Congo River…
In Kinshasa, travelers streamed off boats at ports on the Congo River and ran a gauntlet of health officials watching for signs of infection.
“We want to ensure that ports and airports are effectively protected,” WHO’s Congo representative Allarangar Yakouide told The Associated Press. “I assure you, we have already taken all the thermometers that are in Kinshasa, practically all the thermometers, and there are even colleagues who are going on the other side to Brazzaville to buy thermometers.”
The Republic of Congo’s capital is across the river from Kinshasa, a city of 10 million.” (M)

““A lot of what’s working now is the result of remembering and learning from previous failures,” said Jeremy Konyndyk, a senior policy fellow at the Center for Global Development and the director of foreign disaster assistance at the United States Agency for International Development during the Obama administration.
The Trump White House, however, appears to be uniquely amnesiac. On the same day that officials in the Democratic Republic of Congo reported the new Ebola cases, the administration sought to rescind $252 million in Ebola response funds left over from the earlier epidemic.
Before Congress acts on that request, members should recall how those funds came to be. Public health officials confirmed the 2014 outbreak at the end of a fiscal year, when most agency budgets — at the Centers for Disease Control and Prevention, U.S.A.I.D. and elsewhere — were tapped out. The search for additional funding delayed the American response, which in turn led to more lives lost and, ultimately, more money spent. To prevent the same thing from happening next time, the White House Office of Management and Budget agreed to leave these funds in U.S.A.I.D.’s budget so they would be on hand to combat the next emergency. Rescinding that money brings us back to where we started — ill prepared to mount a rapid response to a new infectious disease threat.
Around the same time that the administration proposed rescinding the funds, the National Security Council dissolved its biosecurity directorate, a small team focused exclusively on global health security threats and led by a director often referred to as the Ebola czar…
The Trump administration has also failed to seek renewed funding from Congress for a global health security initiative begun after the 2014 epidemic…
But whether and how these policy shifts will affect the current Ebola response remains to be seen. Though the outbreak seems to have been quickly contained, it involves a disease that we have fresh and terrifying experience with, in a country that has seen this particular foe nine times in living memory. The next outbreak may not offer such a head start. And when it comes, Mr. Trump’s shortsightedness, if it is not corrected, will have left us far less prepared.” (N)

(A) White House Hails Success of Disease-Fighting Program, and Plans Deep Cuts, by Emily Baumgaertner, https://www.nytimes.com/2018/03/13/us/politics/trump-ebola-disease-cuts-global-health-security-agenda.html
(B) Cannot be complacent, by Stephen S. Morse, https://www.theweek.in/health/more/2018/05/05/cannot-be-complacent.html
(C) New Ebola outbreak declared in Democratic Republic of the Congo, http://www.who.int/news-room/detail/08-05-2018-new-ebola-outbreak-declared-in-democratic-republic-of-the-congo#.WvMD0bhGhfE.email
(D) WHO mulling health emergency over Congo Ebola outbreak, by Susan McFarland, https://www.upi.com/Top_News/World-News/2018/05/17/WHO-mulling-health-emergency-over-Congo-Ebola-outbreak/1061526551624/
(E) NIH officials on ‘high alert,’ deploying countermeasures in response to Ebola outbreak, https://www.fiercehealthcare.com/hospitals-health-systems/nih-countermeasures-deployed-hopes-not-to-see-repeat-ebola-outbreak?
(F) Congo at ‘Very High’ Risk as Ebola Strikes Major City, by Nicholas Bariyo, https://www.wsj.com/articles/congo-at-very-high-risk-as-ebola-strikes-major-city-1526640110
(G) Ebola Outbreak: How Worried Should We Be?, by Jason Beaubien, https://www.npr.org/sections/goatsandsoda/2018/05/18/612010495/ebola-outbreak-how-worried-should-we-be
(H) Congo’s Ebola not an international emergency, can be controlled –WHO, by Tom Miles and Fiston Mahamba, https://www.reuters.com/article/us-health-ebola/ebola-congo-outbreak-high-risk-but-can-be-brought-under-control-who-idUSKCN1IJ0CM
(I) Congo says 3 new Ebola cases confirmed in large city,https://www.srnnews.com/congo-says-3-new-ebola-cases-confirmed-in-large-city/
(J) The Ebola superhighway: Why the new outbreak terrifies public health authorities, by Reid Wilson, http://thehill.com/policy/healthcare/388401-the-ebola-superhighway-why-a-new-outbreak-terrifies-public-health
(K) ‘You’re holding your breath’: Scientists who toiled for years on an Ebola vaccine see the first one put to the test, by HELEN BRANSWELL, https://www.statnews.com/2018/05/22/ebola-scientists-outbreak/
(L) Ebola response on ‘knife’s edge’ as timing key, WHO says, https://abcnews.go.com/Health/wireStory/nations-mobilize-prevent-ebola-spread-55374170
(M) Congo says confirmed Ebola cases have reached 30; 8 deaths; by Saleh Mwanamilongo, https://www.washingtonpost.com/world/africa/congo-says-ebola-cases-have-reached-30-warns-against-rumors/2018/05/24/88404b66-5f32-11e8-b656-236c6214ef01_story.html?noredirect=on&utm_term=.cbc0505f0c13
(N) Ebola, Amnesia and Donald Trump, https://www.nytimes.com/2018/05/22/opinion/ebola-outbreak-trump.html

May 3rd
“we are not finished with Zika… It very well could come back.” Are we ready?
highlight and click on

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CURATED CHRONOLOGY OF 2016/ 2017 ZIKA CONUNDRUM & 2018 FLU EPIDEMIC

June 6, 2016
Former hospital prez says: Designate local Zika centers now. Medical experts do not know if, or where, or how much, or on what trajectory the Zika virus may spread across the United States.

August 13, 2016
The ER clerk asked me “How do you spell Zika?

August 19, 2016
With little gudiance about caring for Zika patients, hospitals are planning on their own

September 7, 2016
Hospitals are developing their own Zika preparedness models. Compare the Central Florida and Johns Hopkins approaches! Which template makes more sense?

September 29, 2016
All pregnant women with Zika diagnosed at community hospitals must be referred to academic medical centers for prenatal care!

May 15, 2017
EBOLA is back in Africa. Is ZIKA next? Are we prepared?

June 10, 2017
Study Findings: Five percent of pregnant women with a confirmed Zika infection.. went on to have a baby with a related birth defect

June 21, 2017
When I was a kid the only thing as scary as the polio epidemic was practicing getting under our desks for a nuclear attack…

July 18, 2017
In June WEST NILE was identified nationwide. Today it’s POWASSAN VIRUS. – ARE WE PREPARED FOR A SURGE OF EMERGING MOSQUITO AND TICK BORNE VIRUSES?

July 20, 2017
“Houston Braces for Another Brush With the Peril of Zika” *. But they are doing passive not active surveillance. IS YOU AREA’S HEALTH CARE SYSTEM PREPARED FOR A SURGE OF AN EMERGING VIRUS LIKE ZIKA?

July 27, 2017
Locally transmitted ZIKA case in Texas! Are we ready?

October 11, 2017
CDC deactivated its emergency response center for Zika.. The first probable locally acquired Zika case in 2017 has been confirmed in Texas….

November 7, 2017
a hand held device (was used) to measure the germ-count on some of New York City’s dirtiest surfaces

January 8, 2018
“We are arguably as vulnerable—or more vulnerable—to another (flu) pandemic as we were in 1918.”

January 11, 2018
In the ICU at Massachusetts General Hospital, nurses use Gatorade to combat flu-related dehydration (due to shortages of intravenous fluids)

January 15, 2018
The CDC postponed its briefing on preparation for nuclear war and will focus on responding to severe influenza

January 17, 2018
“Think hospitals are under a strain now, from a slightly bad flu season? Wait until a really bad one hits.”

January 20, 2018
Government Shutdown. “The CDC would furlough key staff amid one of the most severe flu seasons in recent memory….”

January 23, 2018
“..in a severe (flu) pandemic, the U.S. healthcare system could be overwhelmed in just weeks.

updated May 24th

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