Alongside the Covid-19 pandemic and ongoing battles with cholera and measles, the Congo has now confirmed almost 80 new cases of Ebola. But what makes this 11th outbreak most frightening is the hotspots geographic proximity to Kinshasa, the Capitol of the country and home to more than 11 million people. The newest cases have been identified in Mbandaka (Équateur province), with an estimated 33 reported deaths in just the last few weeks.
“The current Ebola outbreak is running into headwinds because cases are scattered across remote areas in dense rain forests. This makes for a costly response as ensuring that responders and supplies reach affected populations is extremely challenging,” explains WHO’s Regional Director for Africa Dr. Matshidiso Moeti. “Responding to Ebola in the midst of the ongoing Covid-19 pandemic is complex, but we must not let COVID-19 distract us from tackling other pressing health threats,” he warns.
However, with each day the likelihood Ebola will spread from one area to another, and internationally, grows. Not only because of continued violence in the region that has forced thousands to flee (often to other countries), but because of lack of access and reporting in remote regions. As the outbreak gains momentum, it has great potential to cross African borders like the Congo into Uganda, meaning further implications for other nations such as South Sudan and Rwanda cannot be ignored.
So what happens when a contagious disease with around a 50% fatality rate, incessant violence and distrust in the health system collide? The “perfect storm” for the spread of disease. Here’s what you need to know about the latest Ebola outbreak in the DRC and what the country’s Ministry of Health is dealing with to help prevent further spread of disease.
Global health challenges are directly linked to national security. While for many in the Western world the Congo seems a long way away, Covid-19 has shown just how quickly a virus can spread without proper attention and resources. It has also highlighted for many just how important and difficult building trust and fighting bad information can be as it pertains to infectious diseases. The DRC’s 11th Ebola outbreak is a wakeup call for us all, and a reminder that we, along with the rest of the world, must avoid complacency.
In 2018, around 11% of U.S. households reported they were food insecure at some point per the U.S. Department of Agriculture (USDA) – meaning they were without reliable access to a sufficient amount of quality food. The percentage of households as of April 2020 that are deemed food insecure has been estimated between 22-38%. Thus, at minimum, the number of households that lack the resources for a stable food supply has doubled, and possibly tripled. The rates of food insecurity at present are higher than at any point since data collection began.
Even more unsettling, according to Brookings, one survey concluded that more than 17% of mothers with children 12 and under reported that since the Covid-19 pandemic started, “the children in my household were not eating enough because we just couldn’t afford enough food.” These findings are part of a multi-survey initiative the uses validated questions from the USDA to understand trends.
But lack of resources isn’t just about food itself, it’s about all the other associated and underlying issues that pertain to how we access quality food and who can afford it. For example, food insecure households are 47% more likely to visit an emergency room, and be admitted. Lack of access to nutritious food has been proven to lead to obesity, high blood pressure, heart disease, diabetes, and a myriad of other health problems.
Food insecurity is also emotional, and the source of a significant amount of familial stress. For both adults and children, the fear associated with not knowing where meals will come from takes a toll on mental health. This includes increased reports of depressions, anxiety, and suicidal ideation. All of which are health care issues – despite the fact that food itself is not often thought of as health care.
However, research has linked programs such as SNAP (Supplemental Nutrition Assistance Program) with improved health outcomes and lower health care costs. The same can be said for the second largest anti-hunger effort in the U.S., the National School Lunch Program (second only to SMAP) that feeds nearly 30 million children every day. Or did before the Covid-19 pandemic. Thus, current benefits addressing food needs of our most vulnerable are not able to meet demand under current circumstances.
The same can be said for food banks as they struggle with increased demand since the onset of the pandemic. According to National Institute for Health Care Management (NIHCM) Foundation, 98% of food banks in America are reporting increased demand, with about 40% reporting immediate critical funding shortfalls. Feeding Americaasserts that there is “soaring demand” and “plummeting supply” as a direct result of the pandemic. They also contend that almost 70% of food banks are accepting and in need of volunteers to help out.
Given the deep rooted and complex challenges associated with supply and distribution of food, there is no quick policy fix. If schools reopen and parents go back to work, some of the insecurity can be filled, but there is no guarantee. Benefits can certainly be increased and distribution chains can be made more efficient, but the food security traumas created during Covid-19 are going to be felt for some time. And possibly exacerbated by a second wave of shutdowns.
Volunteers are needed. Donations are needed. Funding is needed. And, looking out for your neighbor is vital. There are no individual solutions to this growing problem. It will literally take the village.
To learn more about food insecurity in the U.S., in your state, congressional district, and county, visit: Map the Meal Gap by Feeding America.
And if you or someone you know is currently struggling to feed loved ones, here are some programs and agency efforts that can be of assistance:
Meals on Wheels
World Food Program
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Over the past two weeks people have increasingly spent time at home, often turning to television series and movies to distract themselves from being in the same place for days on end. But as the Netflix series dry up and the scary, pandemic-based movies run out, many are turning to books as a means of entertainment and education.
And with the growing awareness of public health, global health, and diseases there has been an interest in learning more about the history and incredible stories associated with some of the world’s greatest challenges and most inspiring stories.
When it comes to infectious disease and public health efforts, real life is often stranger - and more entertaining - than fiction.
With that in mind (and numerous requests for recommendations), We set out to make a list of the books that will entertain, educate, and open up an entirely new world for those without a background in public health or infectious disease. This list is certainly not all-inclusive, and can in no way be ranked. For your sanity, it does not include textbooks or medical literature. The books listed are both enjoyable to read and leave the reader feeling like they know more about the world around them. Many are inspiring, despite the harsh realities and inequalities they present. And all are true stories, as told by those in the fight for better health.
Here are our top 20 recommendations for infectious disease and public health books to read while surviving an infectious disease pandemic:
For good measure, We’ve also included a few “escapist reads” that are more story-telling than public health, but leave you with a better understanding of the world during difficult times in human history as we battle epidemics – and one coloring book for those who have a more visual learning style.
Multiple times a day, every day, for most of your life you performed the act of washing your hands. And if you are like 95% of Americans, you’ve been doing it wrong. According to Michigan State University, only 5% of people actually wash their hands correctly. During cold and flu season this is nothing to make light of.
The average person touches their face anywhere from fifteen to twenty-three times per hour. And, on average, only washes their hands about 10 times per day. This leaves hundreds of opportunities daily to transfer bacteria and viruses from work surfaces, home surfaces, and the people in our lives directly to our nose and mouth.
So before you find yourself taking sick days from work or spreading germs to your loved one during the holidays, here are some top tips for how to limit germ exposure – and most importantly, the right way to wash your hands.
STEP 1: Thoroughly wet your hands with clean, running water. Then turn off the tap and apply soap.
STEP 2: Lather all parts of your hands by rubbing them together with the soap. Don't miss any spots. Lather the backs of your hands, between your fingers, and under your nails.
STEP 3: Scrub your hands for at least 20 seconds. Darting in and out doesn’t cut it. Need a timer to know how long 20 seconds is? Hum the “Happy Birthday” song from beginning to end twice.
STEP 4: Rinse your hands well under clean, running water.
STEP 5: Dry your hands using a clean towel or air dry them. Paper towels are recommended because of the act of wiping away germs.
These five steps may seem simple enough, but 95% of people don’t thoroughly cover their hands in soap and don’t wash long enough to effectively kill germs. It’s important to wash all of your hands and spend at least 20 seconds on the task. But in addition, here are a few more tips and tricks for staying healthy.
August is National Immunization Awareness Month. An annual observance held to highlight the importance of vaccinations for people of all ages. However, this year it feels a bit like an oxymoron, as certain high-income areas of the United States have vaccination rates on par with low-income countries around the world.
For example, until 2015 parents in California could elect to not vaccinate their children through what are called Non-medical Exemptions or Personal Belief Exemptions, whereby parents could be exempted from the traditional medical recommendations because of what they philosophically believe. Despite state-level changes, reports suggest parents in California are still opting at twice the rate as previous years from getting their children vaccinated. This has led to immunization rates in places like Santa Monica and Beverly Hills that are as low as the country of Chad and South Sudan.
According to the American Academy of Family Physicians, “The number of philosophical exemptions to vaccination has increased in two-thirds of the states that allow such exemptions. As a result, researchers suggest that these areas are becoming increasingly vulnerable to vaccine-preventable disease outbreaks.”
What this means is that Measles outbreaks and Whooping Cough, long eradicated from the U.S., are back. Clearly signaling a public health crisis.
Why Are Vaccination Rates Low?
Many point to the anti-vaxx movement in the U.S. and around the world for declining vaccination rates. And parents within that movement often note autism as the reason for avoiding vaccines for their children. However, this is despite study after study around the world, as well as statements by the CDC, indicating that vaccinations have no impact on developing autism.
That said, vaccinations are not perfect, and they sometimes do result in side effects like muscle pain, headaches, and in very rare cases allergic reactions. All of which need to be properly addressed by the medical community.
But the anti-vaxx movement is not the only thing at play when it comes to declining rates of immunity in the US. For example, the number of vaccines recommended by the CDC’s schedule for children entering school, has nearly tripled in the last decade. What that means is that the number of vaccines – often monovalent – or single doses that children need has increased. Consequently, the number of visits for parents, the number of shots, and therefore the costs have also increased. All making it more difficult to complete that schedule.
At the same time, providing vaccinations doesn’t pay well. Despite myths about doctors making money to push immunization shots on patients, on the doctor side of the equation providers have very little incentive to make vaccines a priority for their medical practices.
All these factors in tandem mean that we find ourselves in a public health crisis as we enter National Immunization Awareness Month in 2019. And the only way to solve this crisis is to use local, state and federal solutions together. As well as ensure that educational campaigns inform parents about the risks of not vaccinating.
At the end of the day, we all have to come together to get vaccination rates in the United States above 90%, in which herd immunity can protect children.
When thinking about traumatic brain injuries (TBI), most people immediately conjure images of NFL players, car accidents or nasty falls. But there is a global public health epidemic going completely unrecognized – and untreated: intimate partner violence (IPV). In fact, IPV is the most common form of violence against women in the world, with nearly 1 in 3 women age 15 or older experiencing physical or sexual IPV. And it occurs in all settings, amongst all socioeconomic, religious and cultural groups.
Shockingly, up to 90% of injuries sustained in IPV are to the head, face, and neck. And research has shown that 75% of women with a history of IPV sustained at least one partner-related TBI and nearly 50% sustained repetitive TBIs. Thus, it is sadly not surprising that the women who experience IPV report symptoms consistent with those who have sustained TBIs, such as problems with, “concentration, memory, headaches, depression, anxiety, fatigue, and sleep.”
According to Eve Valera, Ph.D., “The number of women sustaining IPV-related TBIs dwarf the combined number of military and NFL TBIs or concussions reported. Using annual estimates of severe physical violence (totaling 3,200,000 women), about 1,600,000 women are estimated to sustain repetitive IPV-related TBIs in comparison to the total annual numbers of TBIs reported for the military and NFL (18,000 and 281, respectively).” While she suggests that we need to learn more about all of these cohorts, she points out that there are only two IPV/TBI imaging studies published, compared to the growing body of literature on TBI in athletes and military populations. And she should know, because both of those studies are hers.
But what makes this epidemic so difficult to understand, is much greater than just a lack of research on brain injuries. The truth is, there are a number of confounding factors at play including a general lack of research on women, and thus extreme underrepresentation of sex and gender differences that exist in brain injury. Add in that women who suffer from IPV are often unable to join research studies either due to fear of their partner, societal stigma associated with domestic violence, or simply a lack of resources in their daily lives.
While IPV affects all socioeconomic strata, according to the Prevention Institute there is a multifaceted set of risk factors including, poverty, social marginalization, weak social support networks, gender and cultural norms that promote harming others that frequently accompany IPV – making resources and access to care and research extremely limited. Additionally, because domestic violence happens behind closed doors, many individuals are unwilling to get involved in what happens in other people’s homes.
"If brain injury is the “invisible illness” of our time, then within this invisible injury, women have been the invisible patients,” says Katherine Snedaker, Founder and Executive Director of PINK Concussions. And the data support Snedaker’s statement. Even if some estimates were overstated, and as few as half (50%) of women who are exposed to IPV suffer TBIs, that would still be one in every eight women – the same statistic as breast cancer. Yet we have very little existing knowledge and research exploring this intersection.
Although very little research has been done on the repetitive damage of IPV and TBI, the number of research faculty around the world is growing. And like Lin Haag and Dr. Valera, their voices are gaining volume and their body of work is growing. There is also a growing awareness amongst the general population that invisible injuries – whether sustained on the battlefield or the sport field – are real and dangerous. And they can be life changing due to the cognitive, emotional and physical challenges associated with a TBI. The next step is making this same realization for women survivors of IPV-related TBI.
Improvements in combating stigma and shame associated with IPV are also making small strides in communities of every religion, race and socioeconomic strata, as mental health efforts grow in number. This also includes training community workers, shelter employees and medical staff to recognize the signs of TBI earlier – and be looking for it in women who present with complaints about cognitive troubles or behavior associated with trauma. Attempting to do just that, Lin Haag, Dr. Colantonio and their team, are just completing a web-based toolkit educating frontline workers about TBI in women exposed to IPV. And, as Dr. Valera hopes, that the education of police forces and judges will make a significant difference in the lives of women and their children. “As first responders and judicial personnel learn to ask about and recognize IPV-related TBI, women’s behaviors may be interpreted in the context of a TBI that occurred behind closed doors rather than simply ‘strange’ or ‘uncooperative’. This interpretation will ultimately help women receive appropriate care and legal decisions.”
All the women in this article are open to being contacted by those with questions about IPV, TBI or how to get involved in their research. If you’re a survivor of intimate partner violence, there is a 24/7 hotline and online resource where you can get help here.
Public Health is Diplomacy.
There is a joke in China that the North Korean’s have two weapons of mass destruction: nukes and tuberculosis (TB). And not just TB, but multidrug resistant TB – which knows no boundaries or borders, and is spread person-to-person through the air. The country is also experiencing exceptionally high rates of malaria and hepatitis B.
While diplomatic efforts with the country focus on denuclearization, the country poses much more of a global deadly force and significant security concern than just nuclear weapons. Despite claims from North Korean media that the country developed a cure-all drug that has eradicated HIV/Aids, cancer and Ebola from the entire country, the truth is that there are millions of lives hanging in the balance, needing access to basic necessities like clean water, food and vaccinations.
Immune To Drugs: How Antimicrobial Resistance Could Kill 10 Million A Year Globally If Nothing Is Done
The Centers for Disease Control and Prevention (CDC) contends that, “Antibiotic resistance is one of the greatest public health challenges of our time.” And it’s true. Bacteria, viruses and parasites are growing evermore resistant to the drugs that have been developed to combat them. In fact, this resistance – antimicrobial resistance – has surged into a public health nightmare around the world.
Annually, at least 700,000 people die from drug-resistant diseases, and that number is expected to increase to 10 million deaths per year by 2050 if nothing is done. And at present, the incentives to get something done are so misaligned it’s a frightening possibility.
Because of this growing emergency, the United Nations created the Interagency Coordinating Group on Antimicrobial Resistance, and published a report with international agencies and experts noting that without immediate global action, the crisis of drug resistance bacteria and viruses could lead to an economic catastrophe as bad as the 2008-2009 global financial crisis, and by 2030 could force as many as 24 million people into poverty.
And it hits home more often than we know. In the U.S., antimicrobial resistance causes more than 2 million infections and 23,000 deaths per year – the equivalent of a Boeing 747 crashing each week. Financially, it is projected that due to lost wages, hospital stays and premature death, the U.S. lost about $35 billion in 2008 to antibiotic-resistant infections, and this number continues to rise.
And sadly, there is no slowdown in sight, as more and more antibiotics lose their effectiveness each year. And there are many reasons for this crisis including overprescribing, hospital breeding grounds, plant and water supply contamination, and lack of new research.
Health Policy, Human Rights, Big Ideas. Strategic Vision.