“A statement late Friday said the confirmed cases are in Mbandaka 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.
Three new cases of the often lethal Ebola virus have been confirmed in a city of more than 1 million people, Congo’s health minister announced, as the spread of the hemorrhagic fever in an urban area raised alarm.
The statement late Friday said the confirmed cases are in Mbandaka 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. It was not immediately clear what link the new cases might have to others…
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.” (A)

“The next global plague is coming…
The big picture: The total number of outbreaks every 10 years “has more than tripled since the 1980s,” Yong says. Bill Gates told Yong that if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days.
“Boy, do we not have our act together.” — Bill Gates…
Preparing and confronting a pandemic relies on multiple moving parts, from the doctors to the nurses, appropriate hospital isolation for infected patients, vaccine delivery, Congress appropriation, and more. The director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, told Yong: “It’s like a chain—one weak link and the whole thing falls apart. You need no weak links.”” (B)

Although Chattanooga’s health care systems have never treated anyone for Ebola virus, Africa’s latest outbreak is a reminder that in today’s world, emerging infectious diseases are only a plane ride away.
In the event that a rare, deadly pathogen should strike the region, there’s a network of behind-the-scenes health care professionals — hospital workers, emergency medical services providers, health department staff — trained and prepared to handle the situation. They also know that there’s risk involved…
Following the 2014 Ebola outbreak in West Africa, the United States government sought to beef up the nation’s ability to respond and treat patients infected with Ebola and other emerging infectious diseases in the event they traveled into the country.
Every hospital in Tennessee became a “front-line” facility, and six hospitals around the state — one of which is Erlanger’s main campus — were chosen as assessment facilities, meaning the hospital would provide the first 96 hours of supportive care to patients with suspicious symptoms and diagnose the illness through screening and lab tests. If test results are positive, EMS would transport the patient to a treatment facility in Atlanta.”
Dr. Jay Sizemore, an infectious diseases specialist and medical consultant for the team, said the first step is to know current pathogen activity around the world and where and when the patient traveled. (C)

(A) Congo says 3 new Ebola cases confirmed in large city, https://www.cnbc.com/2018/05/19/congo-says-3-new-ebola-cases-confirmed-in-large-city.html
(B) What we’re reading: U.S. is unprepared for a global plague, by Haley Britzky, https://www.axios.com/america-unprepared-global-plague-pandemic-cfd85278-eea5-49e2-a6f1-58e76ee34171.html
(C) Should Ebola or another infectious disease strike Chattanooga, a team of health care professionals is ready, http://www.timesfreepress.com/news/local/story/2018/jun/17/should-ebolor-another-infectious-disease-stri/473216/

“On average, in one corner of the world or another, a new infectious disease has emerged every year for the past 30 years: mers, Nipah, Hendra, and many more.
…Despite advances in antibiotics and vaccines, and the successful eradication of smallpox, Homo sapiens is still locked in the same epic battle with viruses and other pathogens that we’ve been fighting since the beginning of our history. When cities first arose, diseases laid them low, a process repeated over and over for millennia. When Europeans colonized the Americas, smallpox followed. When soldiers fought in the first global war, influenza hitched a ride, and found new opportunities in the unprecedented scale of the conflict. Down through the centuries, diseases have always excelled at exploiting flux…
Perhaps most important, the U.S. is prone to the same forgetfulness and shortsightedness that befall all nations, rich and poor—and the myopia has worsened considerably in recent years. Public-health programs are low on money; hospitals are stretched perilously thin; crucial funding is being slashed. And while we tend to think of science when we think of pandemic response, the worse the situation, the more the defense depends on political leadership.
When Ebola flared in 2014, the science-minded President Barack Obama calmly and quickly took the reins. The White House is now home to a president who is neither calm nor science-minded. We should not underestimate what that may mean if risk becomes reality.” (A)

“Disease tends to spread more easily and more rapidly among denser populations. And as populations grow, they can put a greater strain on already stretched resources, from sanitation to medical resources such as vaccines. Over the last few years, we have seen demand for emergency stockpiles of vaccines for diseases like cholera and yellow fever increase dramatically. While we can currently meet this demand, the growing number of mega-cities with populations of 10 million or more, and the increasing risk of urban epidemics that come with them, could deplete these stockpiles very quickly…
While stockpiles are essential, they remain only part of the solution. As cities continue to grow, our best defense will be anticipating outbreaks before they occur. For some diseases, that means making childhood immunization and pre-emptive vaccination campaigns a priority. In other cases, it may mean greater investment in sanitation infrastructure, which can help prevent not just cholera but other water-borne diseases, like the diarrhea-causing rotavirus. And many poor countries are in desperate need of basic diagnostics and surveillance capabilities, enabling them to detect an outbreak as early as possible gives them an opportunity to quickly respond.
All too often with infectious diseases, it is only when people start to die that necessary action is taken. To avoid this, the answer is simple: All countries must step up their long-term efforts to prevent and, wherever possible, eliminate infectious disease. If we keep waiting until outbreaks occur, we may soon find that our ability to respond, contain, and end them is gravely inadequate.” (B)

“Even for outbreaks with excellent vaccines, supplies cannot always be ready fast enough. Once supplies are ready to bring to market, they still need to be fitted into the supply chain, stored properly, and transported to the appropriate individuals — wherever they are.
The logistical issues can be enormous. We are seeing those issues with the experimental Ebola vaccines in the Democratic Republic of the Congo now as aid workers use small boats or motorbikes carrying portable freezers of vaccine to reach remote villages. Vaccines must be administered properly. That means recruiting and training medical professionals and educating the public so that people seek out and receive a vaccine. It also means tracking doses and side effects.
This is why preparedness is vital. Vaccines have a very specific function for containing disease. But even if we develop a vaccine for every possibility, they still have limitations. Local communities must therefore be prepared to prevent and contain outbreaks and limit the impact of those outbreaks on health care and public services.
Preparation means having comprehensive, resilient primary health care services and systems in place with working components: strong leadership, engaged communities, laboratories and hospitals, pharmaceutical systems, supply chains, and disease surveillance systems.”
“Disease outbreaks start and end at the community level, so focusing efforts there is critical. At the global health nonprofit where I work, Management Sciences for Health, we help local authorities develop preparedness plans so that leaders know how to react, communicate risks and lead residents in adopting preventive behaviors.” (C)

“In early May, a strange disease began to affect people in the southern Indian state of Kerala, killing 17 people. The cause was an almost unknown virus called Nipah virus. Even though the virus has been contained, for the moment, WHO is concerned about the Nipah virus which might indeed become the Disease X.
Many of the disease experts consider Nipah to be the most frightening and worrying ’emerging’ virus of the last decades, at least. It is no coincidence that WHO has it as one of the eight priority viruses for which a vaccine should be developed.
According to The New York Times, Nipah infection causes flu symptoms, such as fever, body aches, and vomiting, which often progress to acute respiratory syndrome and encephalitis, or brain inflammation.
Some survivors show persistent neurological effects, including personality changes.
WHO is concerned that Nipah virus might become the Disease X. (D)

“American researchers have developed a platform capable of delivering single-dose vaccines that fully protect against infectious diseases such as Zika, Ebola and Lassa fever…
The vaccines are suitable for repeated use, stable at refrigerator temperatures or lyophilized for non-cold chain needle-free application, and amenable to rapid and affordable scale-up for use in both epidemic response and routine vaccination, according to Basu.
In proof-of-concept studies, the researchers tested three independent vaccines against three different families of viruses. Each vaccine demonstrated full protection after a single dose, using various lethal challenge models. (E)

“The head of the World Health Organization (WHO) on Tuesday cautioned against declaring victory too early in Congo’s Ebola epidemic, despite encouraging signs that it may be brought under control.
“The outbreak is stabilizing, but still the outbreak is not over,” WHO chief Tedros Adhanom Ghebreyesus told journalists on a visit to Democratic Republic of Congo’s capital Kinshasa. “We are still at war, and we need to continue to strengthen our surveillance and … be very vigilant.” (F)

(A) The Next Plague Is Coming. Is America Ready?, by ED YONG , https://www.theatlantic.com/magazine/archive/2018/07/when-the-next-plague-hits/561734/
(B) Do we keep waiting for the next pandemic or try to prevent it?, by Seth Berkley https://www.statnews.com/2018/06/14/pandemic-prevention-ebola-drc-vaccines/?utm_source=STAT+Newsletters&utm_campaign=e1055e5b9f-MR_COPY_07&utm_medium=email&utm_term=0_8cab1d7961-e1055e5b9f-149527969
(C) Let’s not rely on vaccines, here’s how we can prepare for epidemics now, by MARIAN WENTWORTH, http://thehill.com/opinion/healthcare/391889-Lets-not-rely-on-vaccines-heres-how-we-can-prepare-for-epidemics-now
(D) WHO Is Concerned About Nipah Virus, As It Might Become The “Disease X”, by Joe Blair, https://www.healththoroughfare.com/disease/who-is-concerned-about-nipah-virus-as-it-might-become-the-disease-x/9110
(E) Platform developed for single-dose vaccines to treat viruses like Zika, Ebola, https://news.cgtn.com/news/3d3d674e3151444d78457a6333566d54/share.html
(F) ‘We are still at war’ with Ebola: WHO chief, https://www.srnnews.com/we-are-still-at-war-with-ebola-who-chief/
(G)

“Paul Jawor, who has just returned home from the African nation, admitted he was ‘very scared’ about the killer virus in a written account of his time on the ground…
Mr Jawor, a Doctors Without Borders and Médecins Sans Frontières water and sanitation expert, was sent to the DRC on May 20…
The current Ebola outbreak began in the poorly-connected region of Ikoko-Impenge and Bikoro – in the north east of the DRC.
It has since travelled 80 miles (130km) north to Mbandaka, a port city on the river Congo – an essential waterway – with around 1.2 million inhabitants.
Virologists fear there is a ‘major concern’ it will spread to Kinshasa – 364 miles (586km) south on the river, where 12 million people live.
The city, which is the capital of the DRC, has an international airport with regular flights to European cities Zurich, Frankfurt and Brussels.” (A)

Medical investigators will need to overcome the rural region’s extreme logistical hurdles to reconstruct transmission chains, vaccinate contacts and halt the spread…
Epidemiologists working in the remote forests have not yet identified the first case, nor many of the villagers who may have been exposed. Investigators will need to overcome extreme logistical hurdles to reconstruct how the virus was transmitted, vaccinate contacts and halt the spread.
“For an epidemic to be under control, you need a clear epidemiological picture,” said Dr. Henry Gray, the emergency coordinator for Doctors Without Borders.
“If you don’t know the stories of the people involved — who their families were, what their jobs were, where they went to weddings and funerals — then you don’t know the epidemic.”..
The W.H.O. is monitoring more than 900 contacts throughout Équateur province. As the vaccination program expands to the Bikoro and Iboko communities, where most cases have been reported, teams are relying on contact tracing to identify the most urgent recipients.
“This is where everything gets more complicated,” …The villages surrounding Bikoro and Iboko are among the most isolated and densely wooded pockets of Congo. Aid workers must use motorbikes to navigate cratered dirt roads that flood during the rainy season. Maps of some regions are incomplete, and vast gaps in cellular service thwart efforts to report data to central operations.
“Following the virus’s narrative may sounds easy to do on a suburban street outside Chicago,” said Dr. Salama. “But when you’re traveling hundreds of kilometers in a forest by motorbike to find each person, that’s very different epidemiological work.” …
Until investigators identify the index case, it is impossible to discern whether the first patient detected in April was truly the first human case or the hundredth, according to Dr. Gianfranco Rotigliano, the regional director of Unicef. Until then, it is impossible to quantify the crisis.
“These are the early days of the outbreak,” Dr. Salama said. “There can be lulls. We’ve seen that before. But there only needs to be one event — a super-spreader, like a funeral — to cause an explosion.”” (B)

“Globally, we must address three issues to tackle Ebola and other deadly pathogens. One is community engagement. Lack of trust between responders and communities has resulted in patients fleeing isolation, as well as likely missed cases and contacts. Ebola emerged in a remote community; it is essential to understand community perspectives and structure and to gain trust and enlist the community’s strengths to stop the disease.
Another issue is WHO’s effectiveness. The African Regional Office of WHO now has many staff with the needed technical and operational excellence, and the Geneva-based emergency program is more effective than before. But WHO country offices in DRC and elsewhere are not nearly as effective as they need to be. Tedros Adhanom Ghebreyesus, coming up on his first anniversary as WHO Director General, has unveiled a potentially transformative general program of work. His leadership will be essential for these ambitious goals and inspiring rhetoric to overcome operational and managerial weaknesses at WHO headquarters in Geneva, as well as in some regional and many country offices.” (C)

“The Trump administration has walked back its proposal to reclaim $252 million in unspent Ebola funds on Tuesday, which experts lauded as a welcome shift in the administration’s approach to global health leadership ― especially amid the new Ebola outbreak…
When President Donald Trump moved to cut the money the same week the current Ebola outbreak was announced in the Democratic Republic of the Congo, the public outcry from global health experts and Congress was swift. They argued that Trump was undermining the U.S. leadership role in world health issues.
Their concerns were compounded by the early May departure of Rear Adm. Tim Ziemer, formerly the National Security Council’s head of global health security; the breakup of his team into other divisions; and the April departure of White House homeland security adviser Tom Bossert, another champion of global health investment.
As Ronald Klain, the former Ebola czar under President Barack Obama, told HuffPost at the time: “Proposing a rescission of Ebola contingency funds on the very day that a new Ebola outbreak is announced is badly misguided; forcing out the two top officials in charge of epidemic response at the White House ― Tom Bossert and Tim Ziemer ― is even worse. Doing it all at the same time shows a reckless disregard for the dangers we face.””
Also disquieting was the fact that the U.S. waited a full two weeks after the first announcement of U.K. funds for the latest Ebola outbreak to announce its own full contribution of $8 million from the U.S. Agency for International Development.” (D)

“Companies and other players involved in the development of experimental Ebola drugs are jockeying to have their products tested in the outbreak in the Democratic Republic of the Congo, part of a chaotic and politically charged effort to use them in the midst of a crisis….
Experts say the maneuvering for space in which to try vaccines and drugs brings to mind the frantic days of the West African Ebola outbreak, when there were so many research teams in the field that a free-for-all of experimental testing ensued. Most of the clinical trials produced little in the way of insight into what actually might work against Ebola.
There’s a “rush to evaluate [treatments] because the window of opportunity for evaluating these interventions is always going to be short,” said Ross Upshur, a physician and ethicist who was on the WHO panel…
“If we don’t use the opportunity to learn in this situation, we’ll never be able to know which is better than the other in terms of the drugs,” said Dr. Peter Salama, the WHO’s deputy director-general for emergency response…
“It’s not a simple effort to do this sort of trial in this kind of environment,” Salama said.” (E)

(A) Ebola outbreak in the Democratic Republic of Congo that is feared to have killed 27 people is a ‘race against time’, aid worker warns, by STEPHEN MATTHEWS, http://www.dailymail.co.uk/health/article-5821781/Ebola-outbreak-DRC-race-against-time-aid-worker-warns.html
(B) As Aid Workers Move to the Heart of Congo’s Ebola Outbreak, ‘Everything Gets More Complicated’, https://mobile.nytimes.com/2018/06/01/health/ebola-congo-outbreak.html?rref=collection%2Ftimestopic%2FEbola&action=click&contentCollection=timestopics&region=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=collection
(C) Still not ready for Ebola, http://science.sciencemag.org/content/360/6393/1049.full
(D) Trump Walks Back A Disastrous Ebola Funding Cut And Experts Sigh In Relief, by Lauren Weber, https://www.huffingtonpost.com/entry/trump-walks-back-ebola-funding-cut_us_5b183d68e4b0599bc6dffd4d
(E) Ebola outbreak opens way to chaotic jockeying to test experimental drugs, by HELEN BRANSWELL, https://www.statnews.com/2018/05/30/ebola-experimental-treatments/

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Trump’s Justice Department says the ACA is unconstitutional (June 6th)
“The Justice Department will not defend the Affordable Care Act in court, and says it believes the law’s individual mandate — the provision the Supreme Court upheld in 2012 — has become unconstitutional…
The details: The ACA’s individual mandate requires most people to buy insurance or pay a tax penalty. The Supreme Court upheld that in 2012 as a valid use of Congress’ taxing power.
When Congress claimed it repealed the individual mandate last year, what it actually did was drop the tax penalty to $0.
So the coverage requirement itself is still technically on the books. And a group of Republican attorneys general, representing states led by Texas, say it’s now unconstitutional — because the specific penalty the Supreme Court upheld is no longer in effect…
What to watch: The argument against it is by no means a slam dunk. For starters, critics — now including the Justice Department — will have to prove that people are still being injured by the remaining shell of the individual mandate, even without a penalty for non-compliance.” (S)
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Prequel: Part 1. Obamacare/ Trumpcare.
From REPEAL & REPLACE to WRECK & REJOICE (from Obamacare to Trumpcare) (April 25, 2017)

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“Some conservative activists unable to surrender their long-held dream of repealing Obamacare are poised to release a long-shot plan next month to resurrect their failed effort, despite massive political odds against such a measure ever becoming law anytime soon.
But these conservatives are right about one thing: Republicans don’t have a coherent health-care message this election cycle. And they need one…
The latest plan is being forged by leaders at the conservative think tanks Heritage Foundation and the Galen Institute, along with former senator Rick Santorum and Yuval Levin of the Ethics and Public Policy Center. They’ve been meeting regularly over the past eight months to craft a recommendation for Congress to repeal much of the ACA’s coverage requirements and taxes, turn over some of its spending to states through block grants and expand the use of tax-free health savings accounts.” (A)

“Politically, the now-defunct assessment had been that passing a health-policy overhaul would scare too much of the public in an election year, making it a nonstarter. The growing understanding, though, is that Republicans are already at risk of losing to a “blue wave” this fall anyway, and that bold action to energize conservative grassroots might be the only way to stop the wave.
The Left is going to be energized this fall regardless of what Congress does, and those parts of professional suburbia that just won’t vote for Republicans under Trump also aren’t going to become even more anti-GOP than they already are. Indeed, as this is exactly the demographic that suffers the most under Obamacare, it might be slightly less likely, not more, to oppose the GOP if Republicans do actually pass reform.
But giving conservative voters a “win” on Obamacare would surely drive up Republican turnout.
Substantively, the bill design has evolved since January. It still uses the basic template of last year’s Graham-Cassidy bill, but only in the sense that it would remain a system of block grants to the states. As in January, it still envisions a significant expansion of health savings accounts — indeed, from January’s thought of doubling the existing number of HSAs, the new plan now may quadruple them — and also a guarantee that individuals served by state-government-run plans can opt-out and use the money in private markets instead.” (B)

“At the end of last year’s prolonged health care battle, many Americans breathed a sigh of relief. Some may have let down their guard too soon.
That’s because it’s clear the war on health care is far from over. Or, more precisely, the war has shifted from a ground war to a cold war. It’s shifted from major clashes in Washington, DC, heavily covered by the media, to more obscure battlefields: the states and the offices at the Health and Human Services Department where regulatory policymaking is done.
Yet this quieter fight could prove to be just as dangerous to the public…
Protections for people with preexisting conditions — as many as 130 million Americans, and growing every day — are also under attack. The Trump administration is using its executive authority to approve the sale of junk insurance plans that had been outlawed or severely limited under President Barack Obama…
Mostly, Americans want this assault on their ability to care for their families to end so we can begin the process of building back what has been allowed to erode. Americans want to pay less, not more, for health insurance. They don’t want insurance companies to be given unlimited authority again.
They want to see Medicaid strengthened, not weakened. They want the basic dignity of being able to afford medication and an end to the constant fear that grips so many that if they get sick, they will lose everything.
Americans didn’t want last year’s war on Obamacare, and they don’t want this new cold war either.” (C)

“These Congressional plans would lower your costs if: You own a small business. You’d no longer have to pay the penalty if you don’t provide insurance. You own a medical devices company or a tanning salon. You’d no longer have to pay Obamacare taxes. A repeal would affect you even more if you are in one of the states that reduce the 10 essential benefits. It would lower your costs if you are healthy or young.
They would increase your costs if: You have a chronic disease. You are older. The Congressional plans allow insurance companies to charge seniors five times what they charge younger people. Obamacare limited that to three times. Your costs would skyrocket if you are a senior who loses Medicaid coverage under the plan. Many seniors need Medicaid to cover the out-of-pocket Medicare costs. You become pregnant. Many states would drop this from the essential benefits. You need an abortion. The plans prohibit insurance companies sold on the exchanges from covering abortion services. Your company only provided coverage because the ACA mandated it. You are one of the 22 million people who received subsidies or the Medicaid expansion. You use mental and behavioral health services, including drug rehab. The House plan includes $2 billion to pay states for drug treatment. That’s not enough to offset the cuts to Medicaid and insurance companies who drop coverage for these services. You decide to reapply for health insurance after a lapse of 63 days. You’d have to pay a 30 percent premium increase. You are a Planned Parenthood patient. The Senate plan defunds the organization for just one year.” (D)

“This would appear to be Republicans’ last-ditch attempt (well, their latest last-ditch attempt) to repeal Obamacare. It seems broadly similar to the bill from late last year, Graham-Cassidy, but drops the attempt to reform traditional Medicaid.
Hill-watchers are skeptical this effort will go anywhere before the elections later this year. It would require the GOP to pass a budget resolution, craft a bill that meets the requirements of the Senate’s “reconciliation” process (meaning, among other things, that all provisions must affect the budget), bring together the support of 50 of the Senate’s 51 Republicans, and push the legislation through the House as well…
Regarding perks for holdout senators, Spiro suggests the new legislation will “bribe” Senators Lisa Murkowski and Susan Collins. (Murkowski’s Alaska expanded Medicaid; voters in Collins’s Maine approved expansion in a referendum, but the governor is refusing to implement it.)
Remember, if the GOP loses more than one senator, the bill goes down in flames. And beyond Paul, Murkowski, and Collins, that includes John McCain, who sank the previous effort, and whose health problems have been keeping him home from D.C. So a lot rides on whether all these folks find the new formula (A) acceptable in terms of how it treats their own states and (B) something they’re willing to defend in public.” (E)

“On Tuesday, Sen. Bill Cassidy (R-LA) released a policy white paper with ideas he claimed would “make health care affordable again.” By and large, however, the plan would do no such thing.
Some of the plan’s ideas—promoting consumer transparency in health care, for instance, promoting primary care, and cracking down on monopolistic practices that impede competition—have merit, although people can quibble with the extent to which Washington can, or should, solve those problems.
However, those specific solutions have at their core a deeply flawed framework. That framework not only contradicts itself, but it leaves Obamacare’s fundamental architecture in place—indeed, would expand upon it in at least one respect. While Cassidy’s paper decries that Obamacare premiums more than doubled from 2013 to 2017, his plan would do very little to control the skyrocketing price of coverage on the individual market.
Cassidy bases his plan on a state-based block-grant funding model, similar to the legislation he and Sen. Lindsey Graham (R-SC) developed last fall. Cassidy cites various state experimental programs to argue that a block-grant approach would allow more room for innovation.
However, the last sentence of the proposal undermines the rest of the discussion: “Flexibility to states would not jeopardize protections for individuals with pre-existing conditions.” That phrase implies that Cassidy believes, as the Graham-Cassidy bill indicated, that Obamacare’s federal insurance requirements regarding pre-existing conditions should remain in place.” (F)

“The foundation also says the “new path” would build on the reform plan offered last year by GOP Sens. Lindsey Graham of South Carolina; Bill Cassidy of Louisiana; Ron Johnson of Wisconsin, and Dean Heller of Nevada.
The plan is also reportedly backed by former Pennsylvania Republican Sen. Rick Santorum and was crafted with the help of the American Enterprise Institute and the Galen Institute.
Sources said last week that the plan would include financial help to low-income residents, an effort that could help garner some Democratic support, especially from senators facing re-election in swing states or conservative-leaning ones.
Yet supporters will also face the challenge of getting Republican leaders of the GOP-controlled Senate to vote on such legislation, considering the chamber has repeatedly failed to pass such legislation after it has cleared the House.” (G)

“The White House has been quietly but constructively supportive of the project, I am told, and should provide strategic and communications support this time that is well planned, rather than the more seat-of-the-pants effort we all saw last year. Pence, in particular, has been personally engaged.
It would be typical of this White House to insist on a strategy that its own party’s congressional leadership hates with an abiding passion but cannot publicly denounce because it involves Obamacare. But what’s the political theory behind reversing the stand-pat posture of the GOP heading toward the midterms? If you guessed “base mobilization,” you get a gold star on your calendar…
Politically, the now-defunct assessment had been that passing a health-policy overhaul would scare too much of the public in an election year, making it a nonstarter. The growing understanding, though, is that Republicans are already at risk of losing to a “blue wave” this fall anyway, and that bold action to energize conservative grassroots might be the only way to stop the wave…
In the end conservatives will probably be unable to convince enough Republicans that this is a good idea in time to set into motion all the things that would have to happen (most notably that budget resolution) to make Santorum’s dream a reality. But if the president’s Twitter account gets behind it, anything could happen.” (H)

“According to data from Gallup and Sharecare, the number of uninsured Americans rose by 1.3 percentage points in 2017. This is what the start of a death spiral looks like.
Three states have announced preliminary 2019 premium-rate requests for Obamacare individual-market policies, and the numbers don’t look good…
It is not hard to see why prices might spike. Thanks to Republican efforts to sabotage Obamacare, the pool of individual-market enrollees is getting smaller and sicker – and, as a result, much more expensive…
The net effect of all these changes: Younger, healthier and cheaper enrollees are getting siphoned out of the Obamacare marketplace. Older, sicker and more expensive people are sticking around, because they actually need coverage.
This pool of remaining enrollees raises average costs for insurers, who then raise premiums, which drives out additional relatively healthy people, which pushes premiums up further. And so on.” (I)

“An independent federal study found President Donald Trump’s planned expansion of short-term health plans will see higher enrollment and cost more than previously predicted, according to The New York Times.
Here are four things to know from the report.
1. The short-term policies have skimpier protections than employer-based and ACA marketplace insurance, as they aren’t required to provide benefits like maternity care, prescription drug coverage and preventive care. In February, President Trump’s administration projected a few hundred thousand Americans would sign up for the short-term plans.
2. However, a recent study from CMS’ Chief Actuary Paul Spitalnic pegs enrollment at 1.4 million people in the first year of the policy, and 1.9 million by 2022, according to the NYT… (J)

“Democrats run on GOP health care ‘sabotage’. Candidates have a unified message blaming Republicans for ‘sabotaging’ the health law.
They’ve got a unified message blaming Republicans for “sabotaging” the health care law, leading to a cascade of sky-high insurance premiums that will come just before the November midterm elections. They’re rolling out ads featuring people helped by the law. And Tuesday, they’re starting a campaign to amplify each state’s premium increases — and tie those to GOP decisions.
That’s a big change from four election cycles of reluctance to talk about Obamacare on the stump. During those campaigns, red-state Democrats were often on the defensive, dodging accusations they imposed government-run health care on unwilling Americans, made it impossible for people to keep their doctors and health plans, and caused double-digit premium increases every year.
Now, even those Democrats see Obamacare as a political advantage. The Affordable Care Act has grown significantly more popular. And as Republicans learned last year when they failed to repeal it, the public had scant interest in taking away coverage from millions of Americans, including low-income and vulnerable people on Medicaid. Democrats are also seizing the issue of rising prescription drug prices — another health care cost problem for which the public holds the GOP responsible, according to polls.” (K)

“… Expanding health coverage is a winning issue for Democrats; trying to take it away is a losing issue for Republicans. Why would the G.O.P. want to keep charging into that buzz saw?
But the growing popularity of key parts of Obamacare is precisely the reason Republicans are highly likely to make a last-ditch effort to kill the A.C.A. For them, it’s now or never.
Here’s what history tells us: Expansions of the social safety net are relatively easy to demonize before they happen — before people get to see what they actually do. Opponents declare that they’ll destroy freedom, that they’ll be wildly expensive, that they’ll be a national disaster. American politics being what it is, opponents of a stronger safety net also tap into racial resentment, convincing white voters that new programs will benefit only Those People.
Once social programs have been in effect for a while, however, and it turns out that they neither turn America into a hellscape nor break the budget — and also that they end up helping people of all races — they become part of the fabric of American life, and very hard to reverse…” (L)

“The viability of the health-insurance exchanges depends on getting enough people, particularly healthy people, to sign up. Ending the individual mandate removed one means of pressuring likely healthier people into buying insurance in the marketplaces. Furthermore, the Trump administration has made several decisions that will alter the quality of benefits people receive under the ACA. In the fall of 2017, the administration announced it would stop making “cost sharing reduction” payments, which had compensated insurers for the losses they incurred by reducing out-of-pocket expenses for lower-income households receiving insurance through an exchange plan. At the time, President Trump denounced these payments as a “bailout” for the insurance companies, but many observers worried that the move would further undermine already unstable insurance markets. As well, in recent months, the administration has been planning regulatory changes that would allow states to offer coverage that does not include the essential health care benefits included in the ACA and pays a smaller percentage of health care costs.
HHS has also given the green light to states to challenge one of the underlying principles of the Medicaid expansion. One of the truly novel features of the ACA was that it extended Medicaid to cover everyone whose income is below 138 percent of the federal poverty level, no matter what their personal circumstances and with no need to meet criteria of deservingness. Yet, acting on guidance issued by the Trump administration in early 2018, nearly 20 states are developing requirements for people to engage in paid work or unpaid “community engagement” as a condition of Medicaid participation.” (M)

“Following the passage of the ACA, the health-care law faced numerous legal challenges, culminating in a controversial 5–4 decision by the Supreme Court in 2012 to uphold the ACA, with Chief Justice John Roberts delivering the deciding vote…
Roberts’ view that the individual mandate amounts to a tax, despite the language of the bill and repeated denials by the Obama administration that the ACA raises taxes, has been the subject of much criticism, but it could now serve as the basis for eliminating the entire law, thanks in large part to the tax reform bill Congress passed in December.
On January 1, 2019, the Tax Cuts and Jobs Act eliminates the penalty on those who do not purchase qualifying health insurance plans. The fine is currently $695 per adult, up to a family maximum of $2,085, or 2.5 percent of income, whichever is greater. Without the penalty, the Affordable Care Act’s individual mandate can no longer reasonably be considered a tax, and thus the entire basis upon which Roberts built his defense of the law has evaporated.”.. (N)

““Obamacare repeal may be closer than you think.” That was the headline from the Washington Examiner’s Quin Hillyer late last week. It was enough to send a shiver down my spine.
In the column (self-identified as opinion), Hillyer lays out that former Sen. Rick Santorum, Vice President Mike Pence and the minds behind the Graham-Cassidy Obamacare repeal plan haven’t given up their work. It could still be revived, he argued, especially now that the bipartisan health care talks have fallen apart. What do Republicans have to lose in pursuing their signature campaign promise, given that Democrats are already very energized for the 2018 midterms while GOP voters seem demoralized?..
So how seriously should we take this? Are these just the extended death rattles of the GOP’s Obamacare failure? Or could the last act of the 115th Congress be another run at repeal?
To be clear, I don’t have any reason to doubt Hillyer’s reporting that Obamacare repeal planning is still underway and top Republicans, up to and including the vice president, are taking an interest. But I made the rounds today with the K Street insiders who guided us through the health care fight last year, and I found a lot of skepticism.
”I believe the part where they are working on something,” one GOP health care lobbyist told me. “I don’t believe there is any way it gets further than any of the previous attempts in this Congress. What’s the path to victory?”
Another Republican lobbyist laid out the problems in more detail”… (O)

“It would be a tactical and moral mistake for Democrats to not use [Obamacare] to expand coverage as much as possible.”
Health insurance on Affordable Care Act (ACA) exchanges could be effectively free for families making less than $100,000 a year if state-level legislators were willing to “game the complex design” of Obamacare to create state-run health insurance companies, according to a progressive think tank.
Jon Walker, a health-care policy analyst and writer for the People’s Policy Project, last month outlined a six-step plan showing how state lawmakers could make the federal government pay for health insurance for most residents. It would involve creating a government-run health insurance company to sell insurance on ACA exchanges; requiring insurance be sold at one price for people of all ages (as is already required in New York and Vermont); driving private insurance companies off the state exchanges; and automatically enrolling people who qualify for tax credits into free coverage.”.. (P)

“Healthcare policy experts, business leaders, and patient advocates praised Gov. Phil Murphy’s endorsement of a state requirement that residents obtain medical insurance or face a fine, a move they said will help protect recent gains in insurance coverage, control premium prices, and ensure New Jersey still receives billions in federal funding.
Murphy signed Democratic-backed legislation Wednesday, making New Jersey the second state — after Massachusetts — to create its own individual mandate. The law requires those without health coverage to pay a tax penalty starting next year, when the federal mandate that is part of the national Affordable Care Act is scheduled to end. He also approved a measure to create a healthcare reinsurance fund, fueled by industry fees and federal dollars, to help offset the costs of the most expensive treatments…
“The truth is that most people are unaffected by the mandate because they already have coverage from a job, Medicare, or another source,” said Joel Cantor, a Rutgers professor and director of the health policy center. “But there is plenty of evidence that the mandate will help keep premiums down, and when people hear that they are much more likely to say they support the idea. “ (Q)

“Conservative groups gear up for another summer Obamacare war, but they may be flying solo…
The recommendation, which is being spearheaded by former Sen. Rick Santorum, R-Pa. and includes participation from the Heritage Foundation, would convert the law’s Medicaid expansion and insurance subsidies into block grants provided to states. These changes would not apply to traditional Medicaid. The group is targeting June to coincide with the initial release of rates for Obamacare in most states. Several states have released major rate hikes for Obamacare next year, blaming Trump administration policies and the repeal of the individual mandate’s penalties for the boost in premiums. The goal is to have the Senate take up the block grant recommendation this summer. “Our plan will come out in June and then they have July and part of August really to get their work done,” the source said. “There is really no way you are going to have an impact on 2019 [Obamacare coverage year] premiums unless they act this summer.” (R)

(A) The Health 202: Conservative activists aren’t giving up their Obamacare repeal dream, by Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/05/29/the-health-202-conservative-activists-aren-t-giving-up-their-obamacare-repeal-dream/5b0c18101b326b492dd07eb9/?noredirect=on&utm_term=.fe81c1aa642f
(B) Obamacare repeal may be closer than you think, by Quin Hillyer, https://www.washingtonexaminer.com/opinion/obamacare-repeal-may-be-closer-than-you-think
(C) The Republican cold war on the Affordable Care Act, by Andy Slavitt, https://www.vox.com/the-big-idea/2018/5/14/17350818/affordable-care-act-repeal-attacks-gop-medicaid-preexisting-condition-health
(D) Obamacare Repeal and Replacement Plans, by Kimberly Amadeo, https://www.thebalance.com/congressional-plans-to-repeal-and-replace-obamacare-4160599
(E) Obamacare Repeal: One More Time, with Feeling, by Robert VerBruggen, https://www.nationalreview.com/corner/obamacare-repeal-2018-republicans-attempt-again/
(F) Sen. Bill Cassidy’s New Health Plan Is Obamacare On Steroids, by Christopher Jacobs, https://thefederalist.com/2018/06/01/sen-bill-cassidys-new-health-plan-obamacare-steroids/
(G) Conservative groups, congressional Republicans appear poised for another try at ObamaCare repeal, by Joseph Weber, http://www.foxnews.com/politics/2018/05/26/conservative-groups-congressional-republicans-appear-poised-for-another-try-at-obamacare-repeal.html
(H) Conservatives Plan One More Obamacare Repeal Effort Before the Midterm Wave, by Ed Kilgore, http://nymag.com/daily/intelligencer/2018/04/could-gop-try-a-final-obamacare-repeal-bid-before-midterms.html
(I) Opinion: The slow, continuing decline of Obamacare, by Catherine Campell, https://www.northjersey.com/story/opinion/columnists/2018/05/15/opinion-slow-continuing-decline-obamacare/612623002/
(J) Trump’s health insurance plan could inflate federal spending $38.7B over next decade, by Morgan Haefner, https://www.beckershospitalreview.com/payer-issues/trump-s-health-insurance-plan-could-inflate-federal-spending-38-7b-over-next-decade.html
(K) Democrats are confidently running on Obamacare for the first time in a decade, by DAVID GREENBERG, https://www.politico.com/story/2018/05/15/democrats-embrace-obamacare-2018-539411
(L) The Plot Against Health Care, by Paul Krugman, https://www.nytimes.com/2018/05/31/opinion/republicans-health-care.html
(M) Eight years of attacks and Obamacare still stands by Daniel Béland, Philip Rocco, and Alex Waddan, http://policyoptions.irpp.org/magazines/may-2018/eight-years-attacks-obamacare-still-stands/
(N) How President Trump Could End Obamacare With A Single Tweet, by Justin Haskins and Sarah Lee, http://thefederalist.com/2018/05/07/president-trump-end-obamacare-single-tweet/
(O) 6 reasons Obamacare repeal (probably) isn’t coming back in 2018, by Dylan Scott, https://www.vox.com/policy-and-politics/2018/4/30/17304184/obamacare-repeal-probably-dead
(P) State Lawmakers Could Make Obamacare Free for Most—If They Want, by Dennis Carter, https://rewire.news/article/2018/06/01/state-lawmakers-make-obamacare-free-want/
(Q) MURPHY SIGNS LAW TO CREATE NJ’S OWN HEALTH INSURANCE MANDATE, by LILO H. STAINTON, http://www.njspotlight.com/stories/18/05/31/murphy-signs-law-to-create-nj-s-own-health-insurance-mandate/
(R) Daily on Healthcare: Get ready for the summer Obamacare war, June 2nd
(S) Trump’s Justice Department says the ACA is unconstitutional, by Sam Baker, https://www.axios.com/trumps-justice-department-says-aca-is-unconstitutional-06f8714d-7606-4104-9982-f057786828a7.html

I taught full time in the Baruch MBA in Health Care Administration program from 1972 to 1975, then was a health care administrator for over thirty years, finishing for seventeen years as President & CEO of LibertyHealth/ Jersey City Medical Center, where we built a replacement safety-net hospital (it took 15 years), played a key role on September 11th, 2001, and once again became a medical school affiliated teaching hospital (having been free-standing for decades).
After retiring from LibertyHealth, I returned to the Baruch program for four years as Adjunct Professor and started writing case studies. I developed case studies based on my CEO experiences. Interestingly case studies on failures provided better Lessons Learned than cases on successes. I also used Harvard Case Studies, and invited “Visiting” Professors to present cases typically related to the new realities of Obamacare, mostly C-Level executives I was still in touch with from my first stint at Baruch. I was very proud of what they had accomplished and shared.
In retirement I have watched health care disruption become so complex that there are few, if any, up-to-date case studies. So I developed a method of “raw” contemporaneous cases studies each developed by curating news articles into a coherent thread, after a topic has called out to me. Topics come from navigating the system (think out-of-network physicians, for example), news feeds, and friends and family.
Now, my Career Capstone Project is to bring “raw” cases to AUPHA that can be used in real-time, meaning they can start a discussion for immediate use in class. For example if I was teaching now I would be doing a contemporaneous cases on the opioid crisis, tracking the implications of medicinal/ recreational marijuana, and the stealth plan to reintroduce Trumpcare before Congress adjourns for the mid-term election.

Here’s my way of developing a case:

A. Spend some time looking at the case format at https://doctordidyouwashyourhands.com/

B. To identify CCCS topics sign-up for daily automatic health care news feeds. For example:
1. STAT https://www.statnews.com/
2. MedPageToday https://www.medpagetoday.com/
3. Becker’s Hospital Review https://www.beckershospitalreview.com/
4. Healthcare Dive https://www.healthcaredive.com/
5. FierceHealthcare https://www.fiercehealthcare.com/
6. New York Times
7. Hospital Association Daily News Clips

C. Set up Google Alerts https://www.google.com/alerts https://support.google.com/websearch/answer/4815696?hl=en (for example: Amazon. health care; medical/ recreational marijuana; cost of prescription/ generic drugs; Ebola; Emerging viruses; flu; health care disruption; health care innovation; health insurance; hospital innovation;.; ObamaCare; opioid crisis; Trump Care; Zika)

D. Select topics to follow and make a folder for each (for example: Amazon+, precision medicine, Zika, marijuana, antibiotics; insurance; flu, hospitals; Obamacare/ TrumpCare; opioid crisis; prescription and generic drugs, right-to-try)

E. Then every day from News Feeds select articles on your topics and move them to the appropriate folder.

F. When you are inspired to write a “case” start a Word document, then go to the case folder and select key points from the articles, and cut and paste them to the Word document. As well capture article title, author and hyperlink.

G. Move the key points around until you have created a story.

H. Then label each point A,B.C…and move article title, author and hyperlink to footnotes at the end of the case.

I. Then write an introduction to the case.

Jonathan M. Metsch, Dr.P.H.
http://www.mountsinai.org/profiles/jonathan-m-metsch

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

_____________
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…
https://doctordidyouwashyourhands.com/2017/06/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
https://doctordidyouwashyourhands.com/2017/11/the-second-most-disgusting-germ-count-surface-turned-out-to-be-starbucks-door-handles/

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

On May 3rd we posted:
“we are not finished with Zika… It very well could come back.” Are we ready?

Today:
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.”

(A) http://www.who.int/news-room/detail/08-05-2018-new-ebola-outbreak-declared-in-democratic-republic-of-the-congo#.WvMD0bhGhfE.email