A cross-sectional cohort study of prevalence of antibodies to COVID-19 in Port-au-Prince, Haiti

Intro: As of January 14, 2021, Haiti has had 10,781 confirmed (first case March 19th) and 45,927 suspected cases of COVID-19, with 240 official deaths. Methods: From May until September, 2020, we tested visitors to 20 clinics, for COVID-19 in five neighborhoods of Port-au-Prince as part of a public health effort to determine prevalence of COVID-19 in the general community. In order to estimate changes in number of deaths, the team visited eighteen funeral homes to solicit data on the number of funerals conducted for each month in 2019 and through October 2020. We also sought to evaluate the attitudes of Port-au-Prince citizens towards a generic COVID-19 vaccine in April 2021. Results: In May and July 2020, 11.4% and 9.1% of those tested were positive for antibodies to COVID-19, respectively. The number of funerals held in the Port-au-Prince area increased by 69.6.% (CI 95% 56.1-83.1) since the official arrival of COVID-19 on March 19th. We found high rates of vaccine hesitancy with 76% saying they would not take a free COVID-19 vaccine. Further research is needed to validate the findings here, but there are strong suggestions that COVID-19 has had more of an impact than previously reported.

Canadian College of Medical Geneticists (CCMG) points to consider: resuming genetic services in a pandemic—a summary

The COVID-19 pandemic has disrupted the provision of genetic care in Canada. With the public health effort to flatten the curve, many clinics have moved to virtual care for select populations of patients while triaging and postponing others. As genetic services are asked to gradually resume, a roadmap is needed to ensure clinical care decisions for at-risk patients are transparent and equitable, that postponed care is resumed and that patients with or waiting for a genetic diagnosis are not disproportionately affected or abandoned.The purpose of this document is to highlight the guiding ethical principles and stakeholder considerations in resuming genetic services to help guide the competing needs going forward of both limiting exposures while maintaining high-quality care. Considerations highlighted are (1) environment of practice, (2) nature of consult, (3) patient factors, (4) provider factors, and (5) laboratory factors. The intended users are those providing genetic care in a Canadian context with the recognition that there are clinic-specific and regional variations that will influence decision-making. While specific to the Canadian context, the ethical principles used to guide these decisions would be relevant for consideration in other jurisdictions.

Feasibility of controlling 2019-nCoV outbreaks by isolation of cases and contacts

BackgroundTo assess the viability of isolation and contact tracing to control onwards transmission from imported cases of 2019-nCoV.MethodsWe developed a stochastic transmission model, parameterised to the 2019-nCoV outbreak. We used the model to quantify the potential effectiveness of contact tracing and isolation of cases at controlling a 2019 nCoV-like pathogen. We considered scenarios that varied in: the number of initial cases; the basic reproduction number R0; the delay from symptom onset to isolation; the probability contacts were traced; the proportion of transmission that occurred before symptom onset, and the proportion of subclinical infections. We assumed isolation prevented all further transmission in the model. Outbreaks were deemed controlled if transmission ended within 12 weeks or before 5000 cases in total. We measured the success of controlling outbreaks using isolation and contact tracing, and quantified the weekly maximum number of cases traced to measure feasibility of public health effort.FindingsWhile simulated outbreaks starting with only 5 initial cases, R0 of 1.5 and little transmission before symptom onset could be controlled even with low contact tracing probability, the prospects of controlling an outbreak dramatically dropped with the number of initial cases, with higher R0, and with more transmission before symptom onset. Across different initial numbers of cases, the majority of scenarios with an R0 of 1.5 were controllable with under 50% of contacts successfully traced. For R0 of 2.5 and 3.5, more than 70% and 90% of contacts respectively had to be traced to control the majority of outbreaks. The delay between symptom onset and isolation played the largest role in determining whether an outbreak was controllable for lower values of R0. For higher values of R0 and a large initial number of cases, contact tracing and isolation was only potentially feasible when less than 1% of transmission occurred before symptom onset.InterpretationWe found that in most scenarios contact tracing and case isolation alone is unlikely to control a new outbreak of 2019-nCov within three months. The probability of control decreases with longer delays from symptom onset to isolation, fewer cases ascertained by contact tracing, and increasing transmission before symptoms. This model can be modified to reflect updated transmission characteristics and more specific definitions of outbreak control to assess the potential success of local response efforts.FundingWellcome Trust, Global Challenges Research Fund, and HDR UK.Research in ContextEvidence before this studyContact tracing and isolation of cases is a commonly used intervention for controlling infectious disease outbreaks. This intervention can be effective, but may require intensive public health effort and cooperation to effectively reach and monitor all contacts. When the pathogen has infectiousness before symptom onset, control of outbreaks using contact tracing and isolation is more challenging.Added value of this studyThis study uses a mathematical model to assess the feasibility of contact tracing and case isolation to control outbreaks of 2019-nCov, a newly emerged pathogen. We used disease transmission characteristics specific to the pathogen and therefore give the best available evidence if contact tracing and isolation can achieve control of outbreaks.Implications of all the available evidenceContact tracing and isolation may not contain outbreaks of 2019-nCoV unless very high levels of contact tracing are achieved. Even in this case, if there is asymptomatic transmission, or a high fraction of transmission before onset of symptoms, this strategy may not achieve control within three months.

Dissociation debates: everything you know is wrong

Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and that DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view. DD are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant improvement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD, including educational efforts in all mental health training programs and increased funding for research.

IMPLEMENTASI PENGALOKASIAN DANA PAJAK (EARMARKING TAX) DARI PENERIMAAN PAJAK ROKOK TERHADAP UPAYA KESEHATAN MASYARAKAT DI PROVINSI SULAWESI UTARA

The cigarette tax is applied in the province of North Sulawesi in 2014. Cigarette tax is a regulate tax that is specific to the health, then the purpose of applying cigarette tax is to protect the public against the dangers of cigarettes. Therefore, cigarette tax in earmarking tax policy is allocated at least 50% for public health service. The purpose of this study is to analyze the implementation of earmarking tax of Cigarettes tax to public health services in North Sulawesi Province has been in accordance with applicable legislation. The method used is descriptive qualitative. The results of this study can be seen that for the year 2016, earmarking tax policy of tobacco tax has not been applied in accordance with the appropriate. This is because spending on public health efforts has not reached the minimum value of 50% of tax revenues for provinces. Earmarking tax in North Sulawesi province runs with revenue and expenditure budget system (APBD), which is implemented through the regional public treasury account (RKUD) in terms of income and expenditure. Dinas Kesehatan as an agency that budgeted for public health effort would improve public health service standard by maximizing spending for the designation. Agencies related to the cigarette tax budgeting policy would prescribe standard operating procedures so that control over these policies can be done as appropriateKeywords: Earmarking tax policy, cigarette tax

Nutrition for homeless populations: shelters and soup kitchens as opportunities for intervention

Nutrition is a daily challenge for the homeless population in America. Homeless individuals suffer from a high prevalence of diseases related to poor diet, yet there has been little public health effort to improve nutrition in this population. Shelters and soup kitchens may have an untapped potential to impact food access, choice and quality. We offer ideas for intervention and lessons learned from ten shelters and soup kitchens around Greater Boston, MA, USA. By advancing food quality, education and policies in shelters and soup kitchens, the homeless population can be given an opportunity to restore its nutrition and health.