Access to lifesaving medical resources for African countries: COVID-19 testing and response, ethics, and politics

‘Having navigated Ebola, HIV, and tuberculosis epidemics, and a range of annual, sporadic, and concurrent outbreaks, several African countries have unparalleled disease response capacity. African governments are offering rare examples of effective international cooperation on COVID-19. The African Union started early to strengthen response with readiness assessments, an emergency ministerial meeting, and a continental strategy. However, with a highly transmissible and fast spreading virus these strengths can quickly be overwhelmed.’

Read here (The Lancet, May 7, 2020)

The invisible pandemic: Our most important task is not to stop spread but to concentrate on giving the unfortunate victims optimal care

‘COVID-19 is a disease that is highly infectious and spreads rapidly through society. It is often quite symptomless and might pass unnoticed, but it also causes severe disease, and even death, in a proportion of the population, and our most important task is not to stop spread, which is all but futile, but to concentrate on giving the unfortunate victims optimal care.’

Read here (The Lancet, May 5, 2020)

It’s unfair to blame China for coronavirus pandemic, Lancet editor tells state media

‘The editor-in-chief of The Lancet has said it is “not helpful” and “unfair” to blame China for being the source of the Covid-19 pandemic in an interview with Chinese state media. Richard Horton said the international community should instead work with the Chinese authorities in dealing with the outbreak.

‘His comments came after the US top spy agency said that the intelligence community did not believe the virus had been man-made or genetically modified, but said it will continue to examine whether the outbreak “began through contact with infected animals or if it was the result of an accident at a laboratory in Wuhan”.’

Read here (South China Morning Post, May 2, 2020)

Higher transmission rate among household contacts and individuals traveling with infected people

‘The researchers found that household contacts of COVID-19 cases and individuals traveling with cases were both at elevated risk of infection. Additionally, the secondary “attack rate” (percentage of contacts who tested positive for SARS-CoV-2 infection) among household contacts was at least 11.2%. While attack rates were higher among older adults, the value for children—7.4% and 7.1% for children aged 0-9 years and 10-19 years, respectively—was higher than in younger and middle-aged adults—4.9%-6.1% for adults aged 20-29 years, 30-39 years, and 40-49 years. Individuals aged 0-39 years exhibited lower risk of severe COVID-19 than adults aged 40 years and older.’

Read here (The Lancet, April 27, 2020)

First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment

‘We estimated the instantaneous reproduction number (Rt) of COVID-19 in Beijing, Shanghai, Shenzhen, Wenzhou, and the ten Chinese provinces that had the highest number of confirmed COVID-19 cases; and the confirmed case-fatality risk (cCFR) in Beijing, Shanghai, Shenzhen, and Wenzhou, and all 31 Chinese provinces. We used a susceptible–infectious–recovered model to show the potential effects of relaxing containment measures after the first wave of infection, in anticipation of a possible second wave.

‘In all selected cities and provinces, the Rt decreased substantially since Jan 23, when control measures were implemented, and have since remained below 1. The cCFR outside Hubei was 0·98% (95% CI 0·82–1·16), which was almost five times lower than that in Hubei (5·91%, 5·73–6·09). Relaxing the interventions (resulting in Rt >1) when the epidemic size was still small would increase the cumulative case count exponentially as a function of relaxation duration, even if aggressive interventions could subsequently push disease prevalence back to the baseline level.’

Read here (The Lancet, April 8, 2020)

Offline: COVID-19 and the NHS—“a national scandal” - Commentary in The Lancet

“When this is all over, the NHS England board should resign in their entirety.” So wrote one National Health Service (NHS) health worker last weekend. The scale of anger and frustration is unprecedented, and coronavirus disease 2019 (COVID-19) is the cause. The UK Government's Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn't follow WHO’s advice to “test, test, test” every suspected case. They didn't isolate and quarantine. They didn't contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The UK now has a new plan—Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come...

Read here (The Lancet, March 28, 2020)

Improving epidemic surveillance and response: Big data is dead, long live big data. The Lancet

Urgent investment in surveillance systems and global partnerships are needed to prepare for the pandemics that will continue to emerge in the coming decades. The following are three key challenges that pertain to creating useful epidemic forecasts during an outbreak.

The first challenge: Misaligned incentives. Academics are largely incentivised to write scientific articles and to fund their work through individually led grants... Companies are incentivised by profit, and are rightly beholden to national regulatory frameworks and the public with respect to the data they collect.

The second challenge: Gap between (1) technological or methodological innovation, which often occurs in academic settings in high-income countries, and (2) implementation in field settings, frequently done by NGOs or governments in low-income and middle-income countries.

The third challenge: Epidemic forecasting is inherently uncertain... [With] emerging outbreaks—with COVID-19 highlighting this point—we often lack accurate data about case counts and biological processes driving an epidemic, let alone the behavioural responses of people affected, making it challenging to swiftly adapt or interpret very complex models on the spatiotemporal scales relevant for decision making.

‘These innovations will remain dislocated and impractical until the challenges above are addressed. Encouragingly, all three issues could be improved by moving much of the focus of funding and expertise to the populations most vulnerable to epidemics.’

Read here (The Lancet, March 17, 2020)

Covid-19: The gendered impacts of the outbreak

‘Experience from past outbreaks shows the importance of incorporating a gender analysis into preparedness and response efforts to improve the effectiveness of health interventions and promote gender and health equity goals. During the 2014–16 west African outbreak of Ebola virus disease, gendered norms meant that women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as front-line health-care workers...’

Read here (The Lancet, March 6, 2020)

The psychological impact of quarantine and how to reduce it: Rapid review of the evidence

‘The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.’

Read here (The Lancet, Feb 26, 2020)