Army Public Health Weekly Update, 4 September 2020

Date Published: 9/4/2020
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​The Army Public Health Update is a collection of articles taken from public sources to offer awareness of current health issues and the media coverage given to them. The articles do not necessarily represent U.S. Army Medical Command opinions, views, policy, or guidance, and should not be construed or interpreted as being endorsed by the U.S. Army Medical Command.

The Army Public Health Weekly Update does not analyze the information as to its strategic or tactical impact on the U.S. Army and is not a medical intelligence product. Medical intelligence is available from the National Center for Medical Intelligence External Link . 

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Table of Contents


    3rd Annual One Health Seminar Day - Health Hazards

    World One Health Day, annually held on 3 November, is a global campaign that celebrates and brings attention to the need for a One Health Approach to address shared threats at the human-animal-environment interface.  Join us for a Health Hazards Session. Virtual Event on Microsoft CVR Teams - Registration Required. APHC

    Army Medicine Campaign Research to Practice Education Series

    Next Seminar: 14 September 2020, 1300-1410 ET: The Army Medicine Campaign Research to Practice Education Series for military providers and staff covers medical readiness topics such as injury prevention, health promotion, and physical performance optimization.  The series is held five times a year on Defense Collaboration Services (DCS) and is co-sponsored by OTSG Physical Performance Service Line and APHC Injury Prevention. APHC


    Air Force still 'struggling' to stop two-year suicide crisis, top general says

    27 August- The top general in the Air Force says his branch is on track to see the same number of airmen commit suicide in 2020 as it did in 2019, a record-breaking year that prompted the service to take a tactical pause to consider the problem and what could be done to solve it. The solution, however, is still a long way off. "From a suicide perspective, we are on a path to be as bad as last year," said Gen. Charles "CQ" Brown in a virtual presentation for the Air Force Sergeants Association on Wednesday. "I'll be honest with you, collectively we're struggling with how to deal with this." An Air Force spokesperson could not give a number on how many airmen have died by suicide so far in 2020, but briefing slides leaked by the popular Facebook page Air Force amn/nco/snco in February showed that 137 airmen and Air Force civilians died by suicide in 2019, a 33% increase over the previous year. Brown said the novel coronavirus (COVID-19) pandemic has created "additional stressors and really fear of the unknown for certain folks." However, the general said most Air Force suicides are based on "relationship issues." Task and Purpose External Link

    COVID-19 exacerbates job woes for veterans, military spouses

    30 August- The unemployment rate for veterans was 2.9% when 2019 came to a close. Now, as the COVID-19 pandemic upends the U.S. economy, that figure has more than tripled, leaving nearly 800,000 veterans searching for work. Allen Walker is one of them. The 38-year-old south Augusta resident and Army veteran has spent all of 2020 trying to find a tech job with his new management information systems degree from Augusta University. The former ammunition specialist with 12 years of service — including a tour in Afghanistan — said he believes the pandemic has made it more difficult to get a foot in the door. It's hard to make an impression through emails and virtual meetings, he said. "Some employers want to see how you interact face-to-face," he said. "Most people like to meet face-to-face. Due to this situation (the pandemic), that is not viable." Walker, who was medically discharged in 2012 for a lower back injury, has received help with his résumé and interview skills through the Wounded Warrior Project's "Warriors to Work" career counseling program. The Jacksonville, Florida-based nonprofit helped him improve his interview skills and polish his résumé and cover letter, which he said has led to more callbacks from employers. "When I first started looking, my resume was not up to par. It had been a while since I had applied for positions," acknowledges Walker, whose last job before pursuing an information technology degree was co-owning a gourmet popcorn business in Augusta and Columbus, Georgia, that lasted about four years. Military Times External Link

    GAO agrees to review Army's sexual harassment program

    28 August-  The Government Accountability Office on Wednesday accepted a request from Sen. Tammy Duckworth, D-Ill., to review the Army's sexual harassment response program in the wake of the disappearance and death of Spc. Vanessa Guillen, the senator's office announced Friday. The review will look at the implementation and effectiveness of the Army's Sexual Harassment/Assault Response and Prevention program, known as SHARP, after Guillen's family said the soldier had experienced sexual harassment on base at Fort Hood, Texas, but was too afraid to report the instances to her chain of command. Those allegations have led to at least four internal Army reviews at Fort Hood. Demand for transparency grew as other veterans and service members shared stories similar to Guillen's using the hashtag #IamVanessaGuillen. "Sexual assault and harassment is a crisis in our nation's military that impacts the lives of far too many women and men in uniform," Duckworth said in a statement. "The military's inability to address this problem fails survivors and harms our military's readiness, recruitment and retention efforts. … I look forward to working with the GAO on this vital oversight. We can and must do better to support survivors of sexual harassment and assault in our military." Stars and Stripes External Link

    NCO evaluation changes create flexibility, boost readiness

    31 August- The Army has begun to shift its rank advancement structure for noncommissioned officers by moving from a two-year promotion projection process to a month-to-month format, as well as allowing top performing Soldiers to be eligible for promotion six months earlier. The overhaul to evaluating NCOs is intended to boost Army readiness and improve the quality of its NCO corps, said Sgt. Maj. Mark Clark, Army G-1 directorate of military personnel management sergeant major. Soldiers will soon feel the impact of those changes as the Army transitions to a greater focus on merit to promote its enlisted leaders rather than on time in service. As part of the changes, the Army is widening the scope of its order of merit list, or OML, to select NCOs for promotion. The list will be used as a guide to select Soldiers for promotion to sergeant first class through sergeant major. Sergeants and staff sergeants will continue to earn promotions based on points and cutoff scores. Instead of a centralized promotion selection board, the service will move to a performance-based annual evaluation for Soldiers eligible for promotion to sergeant first class and above. The OML now contains a "fully qualified" list to identify Soldiers who have earned immediate eligibility for promotion. The OML also determines which Soldiers earn selections to go to training associated with rank advancement. The changes began in fiscal year 2019 with the command sergeant major/sergeant major board in August 2019 and continued with the fiscal 2020 master sergeant board in May. The fiscal 2020 CSM/SGM board is currently underway. The Army's next policy change will be with the fiscal 2021 sergeant first class board, which will convene on Sept. 20. That board will inform decisions that include selection for training to attend the Master Leaders Course, assignment selections and NCOs with substandard performance. "The most important [change] was to give us flexibility to be able to respond to emerging requirements," Clark said in an interview Thursday. External Link

    US troops may have role in mass COVID-19 vaccination effort

    29 August- U.S. military medical personnel or National Guard troops might assist in inoculating the public once a viable, safe vaccine is developed for COVID-19, senior government health officials said Friday. Paul Mango, deputy chief of staff for policy at the Department of Health and Human Services, and Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, said localities are currently developing how to vaccinate Americans when one becomes available. The strategy could include using pharmacies as distribution points, or setting up mass inoculation centers and employing military support, they said. "We are not going to take anything off of the table," Redfield said in response to a reporter's question during a press call Friday. "There is the potential for jurisdictions to want assistance from the National Guard or the military. The military is clearly providing a lead role in [the] logistics of all of this."  Currently, more than 19,800 National Guard personnel are activated and supporting pandemic response across the U.S., according to Brig. Gen. Nick Ducich, vice director of the operations directorate for the National Guard Bureau. They are engaged in supporting testing sites, distributing food and cleaning facilities, Ducich said. Active-duty and Reserve military members also continue to treat civilian patients in coronavirus hotspots across the United States. About 740 military medical and administrative support personnel from the Army, Navy and Air Force were deployed to community medical centers in California and Texas to support coronavirus response as of Friday. External Link


    Doctors chase treatment for kids threatened by dangerous COVID-19 syndrome

    1 September- On a warm, mid-June afternoon a concerned mother brought her 11-year-old daughter, who had a high fever and a severe bellyache, to the emergency room at Hasbro Children's Hospital in Providence, R.I. After doctors ruled out the usual suspects for the symptoms, such as bacterial infections and appendicitis, they started to seriously consider a diagnosis that would have been inconceivable two months prior: an emergent and potentially fatal inflammatory condition that occurs in children about four weeks after they are exposed to the new coronavirus. The rare disease—called multisystem inflammatory syndrome in children (MIS-C) in the U.S. or pediatric multisystem inflammatory syndrome in the U.K., where it was first defined this past spring—is a hyper immune response to SARS-CoV-2. It disproportionately affects Black, Hispanic and Latino children. In some cases of MIS-C, resembling the bacterial overloads of toxic shock syndrome, youngsters arrive at the hospital with shock symptoms and organ failure. In others, they experience a high fever and inflammatory symptoms resembling those of Kawasaki disease, which strikes children's blood vessels. Or the illness can look like neither of those threats, even though affected kids still have a high fever and widespread inflammation. Nearly all of the children treated for MIS-C survive and appear to be healthy afterward. But when it is undiagnosed or untreated, the condition can permanently damage the heart or cause death. The disease is so new that there is no consensus on several of its fundamental features or on how to treat it. But insights from doctors who have been confronting MIS-C this summer, along with new research about its victims, are starting to reveal important clues. For instance, a small study published on August 18 in Nature Medicine concluded that the condition is distinct from Kawasaki disease, as many doctors suspected. And several large research efforts that have recently been launched could soon clarify how to diagnose MIS-C and identify trends in treatments that seem to work best. Scientific American External Link

    Exercise may boost your vaccine response

    26 August- If you are an athlete, you may gain greater immunity from a flu shot than people who are less active, according to two complementary and timely new studies of exercise and vaccinations. The two studies, which involved the same group of elite runners, swimmers, wrestlers, cyclists and other athletes, suggest that intense training amplifies our vaccine response, a finding with particular relevance now, as the flu season looms and scientists work to develop a Covid-19 vaccine. Having an immune system primed to clobber infections and respond robustly to vaccinations is obviously desirable now, during the ongoing pandemic. And in general, exercise aids immunity, most science shows. People who work out often and moderately tend to catch fewer colds and other viruses than sedentary people. More immediately, if you exercise your arm in the hours before a flu shot, you likely will develop a stronger antibody response than if you rest that arm, a few small studies indicate.  But there have also been suggestions that under certain circumstances, exercise may dampen the immune response. Some epidemiological research and personal stories from athletes hint that intense, exhausting exercise might be detrimental to immunity in the short term. Marathon racers, for example, report catching colds at disproportionately high rates soon after a race, although some physiologists suspect these post-race respiratory problems are inflammatory, not infectious. The upshot, though, is that many questions have remained unanswered about whether and how strenuous workouts affect immunity and our bodies' ability to respond favorably to a vaccination, such as the seasonal flu shot.  So, for the new studies, scientists from Saarland University in Germany and other institutions decided to convince a large group of competitive athletes to get vaccinated, an effort more difficult than most of us might expect. In surveys, elite athletes tend to report relatively low rates of vaccination for the flu and other conditions, since many worry the shot will cause side effects that affect their training. But the researchers managed to recruit 45 fit, young, elite athletes, male and female. Their sports ranged from endurance events, like the marathon, to power sports, including wrestling and hammer throw, to team sports, such as basketball and badminton. All of the volunteers were in the middle of their competitive seasons during the studies. The New York Times External Link

    Fear, dread, and panic: Some Covid-19 survivors feel stalked by possibility of reinfection

    28 August- Since Covid-19 flattened him in Southern California in late June, Jarrod Castillo fears that every tickle in his throat and every twinge of pain in his limbs means he's getting sick again. On Long Island, the thought of enduring the illness a second time fills Sadie Nagamootoo with such dread, she gets sick to her stomach. In upstate New York, where Martha Barrera suffered for more than two months with crushing respiratory symptoms, the idea of reinfection gives her such panic, she's unable to enter a supermarket. Anxiety about the coronavirus is widespread, and not just among older adults and those with weakened immune systems. But that fear is especially strong among people who have already experienced the severe symptoms of Covid-19, and are desperate to avoid getting reinfected. Those worries were inflamed this week by news of three confirmed cases of reinfection in Hong KongBelgium, and the Netherlands. While the Hong Kong man's second illness was much milder than the first — something many scientists think will likely be the case for most people who get infected again — we still know very little about the likelihood and risks of reinfection. That leaves recovered Covid-19 patients on edge. Nagamootoo, a 44-year-old personal trainer in Valley Stream, N.Y., was sickened in late March, and while she has tested negative for the virus three times since, she battles ongoing asthma and fatigue. When she reads reports about reinfection in the news and on message boards, her mind reenvisions her most desperately ill self. "I remember myself at my worst and I get nauseous," she said. "I believe if that were to ever happen again, I may not be so lucky."  Psychologist Mary Moffit, an associate professor at Oregon Health and Science University in Portland, said the news about reinfections raises questions about the duration of immunity and increases uncertainty about the future. But she urged caution about drawing the most fearful conclusion. "This may not represent the 'worst-case scenario,' although that may be the initial reaction of patients traumatized by this virus," Moffit told STAT. "Focusing on what we can control today, attending to what we need to improve our well-being here and now, is the most effective strategy to cope with future uncertainty." Stat News External Link

    Remote learning's distractions put extra pressure on students with ADHD

    1 September- COVID-19 forced Keriann Wilmot's son to trade his classroom for a computer. It was a tough transition for a 10-year-old with attention deficit hyperactivity disorder. "It was a different environment for him," Wilmot says. "He wasn't used to this kind of work from school coming in the format of an email in his Chromebook every single day." Her son would avoid math and writing and instead go straight to his favorite subjects: science and social studies. But even then, online assignments could be a problem. "There might be something when he opened it that was like a really pretty PDF that had lots of beautiful illustrations and fonts," Wilmot says. "And he would look at it and just get overwhelmed and shut the laptop and walk away."  Wilmot was much better prepared than most parents to help her son. She'd spent 20 years as an occupational therapist who specializes in helping children with ADHD and other learning disabilities. Even so, working with her own child was tough. "It was a different environment for him, and he wasn't used to me asking him to do these activities," she says. In the COVID-19 era, these are common experiences for parents of children with ADHD, says Haftan Eckholdt, a developmental psychologist and chief science officer at Understood, a nonprofit that serves people who learn and think differently. "Most parents have jobs or they're looking for jobs," he says. "Most households don't have a space that they can say, 'This is now your classroom — this is your space, and you'll have this and nothing else will happen here.' " NPR External Link

    Scientists are reporting several cases of Covid-19 reinfection — but the implications are complicated

    28 August- Following the news this week of what appears to have been the first confirmed case of a Covid-19 reinfection, other researchers have been coming forward with their own reports. One in Belgium, another in the Netherlands. And now, one in Nevada. What caught experts' attention about the case of the 25-year-old Reno man was not that he appears to have contracted SARS-CoV-2 (the name of the virus that causes Covid-19) a second time. Rather, it's that his second bout was more serious than his first. Immunologists had expected that if the immune response generated after an initial infection could not prevent a second case, then it should at least stave off more severe illness. That's what occurred with the first known reinfection case, in a 33-year-old Hong Kong man. Still, despite what happened to the man in Nevada, researchers are stressing this is not a sky-is-falling situation or one that should result in firm conclusions. They always presumed people would become vulnerable to Covid-19 again some time after recovering from an initial case, based on how our immune systems respond to other respiratory viruses, including other coronaviruses. It's possible that these early cases of reinfection are outliers and have features that won't apply to the tens of millions of other people who have already shaken off Covid-19. "There are millions and millions of cases," said Michael Mina, an epidemiologist at Harvard's T.H. Chan School of Public Health. The real question that should get the most focus, Mina said, is, "What happens to most people?" But with more reinfection reports likely to make it into the scientific literature soon, and from there into the mainstream press, here are some things to look for in assessing them. STAT News External Link

    Surgical mask prevents droplet 100%, only .1% better than cotton mask, says new study

    29 August- A new study conducted by the University of Edinburgh's Roslin Institute found that wearing a surgical mask stops 100% of droplets while a homemade mask prevents 99.9% of droplets from spreading into the air when a person speaks or coughs. According to tests conducted by researchers, a person who does not wear a mask and stands six feet away is at 1,000 times higher risk of inhaling droplets than an individual wearing a mask and stands just 1.5 feet away from a coughing person. The study, which is published on preprint server, looked at surgical masks and single-layer cotton masks. Lead researcher Dr. Ignazio Maria Viola, a reader at the University of Edinburgh's School of Engineering, said that face masks of any material can effectively filter small droplets in the air. The research team also found that a homemade single-layer cotton mask can cut the number of droplets by over 1,000 times.  "We discovered that even the simplest handmade single-layer cotton mask is tremendously effective," Viola noted that larger droplets, which are believed to be more threatening. Researchers ran two types of tests: the first was with a mannequin that ejected fluorescent droplets while the second one was with human volunteers who speak and cough. Using laser sheet illumination, the scientists quantify the number of droplets in the air while they used a UV light to check those that landed on the surface.  Putting on masks on the mannequin shows that less than one in 1,000 particles were spread by speaking or coughing. This is significantly less compared when human volunteers spoke and coughed without a mask, which sprayed up to thousands of particles into the air. These findings highlight the importance of wearing a face-covering in public to avoid getting infected by the virus or prevent infecting others for those who already have COVID-19. Tech Times External Link

    Telehealth visits are plunging, forcing providers to recalibrate

    1 September- A nationwide drop-off in telemedicine visits is forcing providers who raced to ramp up virtual care in the face of the pandemic to quickly recalibrate their offerings as more patients turn back to in-person appointments. Telemedicine visits accounted for just 21% of total encounters by the middle of July, down from 69% at the early peak of the public health crisis in April, according to national data from Epic, the electronic health record company. While telemedicine use largely remains well above pre-pandemic levels — and many still say telemedicine's popularity is here to stay — the recent downturn in visits has created an undeniable whiplash effect. Hospitals that rushed to retrain their staff to deliver most types of care virtually in March are now trying to strike a new balance based on shifting patient preferences and needs. "We're trying to right-size, but it's really hard because during the pandemic we switched to nearly 100% virtual in some clinical areas, and we know that's not realistic or sustainable," said Jessie DeVito, director of virtual care at Michigan Medicine, the health system affiliated with the University of Michigan. She said the health system will end up with some empty virtual appointment slots before it finds the right mix between office and telemedicine visits in the coming weeks. STAT News External Link

    Yet more data support COVID-19 aerosol transmission

    31 August- Two studies published late last week in Clinical Infectious Diseases highlight the role of airborne spread of COVID-19 and the importance of efficient ventilation systems. One study found that patients can exhale millions of viral RNA particles per hour in the early stages of disease, and the second tied an outbreak affecting 81% of residents and 50% of healthcare workers at a Dutch nursing home to inadequate ventilation. In the first study, researchers in China analyzed exhaled breath samples from 49 COVID-19 patients from 10 countries, 4 hospitalized patients without COVID-19, and 15 healthy people from Beijing using reverse transcription polymerase chain reaction. They also tested 26 air samples and 242 surface swabs from quarantine hotels, hospitals, and personal belongings. Of the exhaled breath samples, 26.9% were positive for RNA from SARS-CoV-2, the virus that causes COVID-19, while 3.8% of air samples and 5.4% of surface swabs tested positive. The viral RNA breath emission rate was highest in the first stages of disease. Breath samples from two patients were positive for coronavirus RNA, but surface swabs of their cell phones, hands, and toilets were negative. Viral RNA was also detected on an air ventilation duct below another patient's bed. CIDRAP External Link


    WHO: Influenza Update

    31 August 2020 - Update number 375, based on data up to 16 August 2020:

    - The current influenza surveillance data should be interpreted with caution as the ongoing COVID-19 pandemic have influenced to varying extents health seeking behaviors, staffing/routines in sentinel sites, as well as testing priorities and capacities in Member States. The various hygiene and physical distancing measures implemented by Member States to reduce SARS-CoV-2 virus transmission have likely played a role in reducing influenza virus transmission.

    - Globally, influenza activity was reported at lower levels than expected for this time of the year. In the temperate zones of the southern hemisphere, the influenza season has not started. Despite continued or even increased testing for influenza in some countries in the southern hemisphere, very few influenza detections were reported.

    - In the temperate zone of the northern hemisphere, influenza activity remained below inter-seasonal levels.

    - In the Caribbean and Central American countries, sporadic influenza detections were reported. Severe acute respiratory infection (SARI) activity was elevated in some reporting countries, likely due to COVID 19.

    - In tropical South America, tropical Africa, Southern Asia and South East Asia there were sporadic influenza virus or no detections across reporting countries.

    - Worldwide, of the very low numbers of detections reported, seasonal influenza B viruses accounted for the majority of detections. WHO External Link


    Hand sanitizers packaged in food, drink containers could cause serious injury, death: FDA

    29 August- The U.S. Food and Drug Administration (FDA) released a warning on Thursday over alcohol-based hand sanitizers packaged in food and drink containers, and the potential for "serious injury or death if ingested."  "Some hand sanitizers are being packaged in beer cans, children's food pouches, water bottles, juice bottles and vodka bottles," the agency wrote in a news release. "Additionally, the FDA has found hand sanitizers that contain food flavors, such as chocolate or raspberry." In the agency's statement, Dr. Stephen Hahn, FDA commissioner, said he is "increasingly concerned" over the issue because confused consumers may ingest a potentially lethal product. He said kids could smell the hand sanitizer and mistakenly believe it's food, eat it and get alcohol poisoning.  In one case, a consumer reportedly bought a bottle they thought to be drinking water, not realizing it was hand sanitizer. Another report involved a hand sanitizer with cartoon marketing in what resembled a snack pouch. "Drinking only a small amount of hand sanitizer is potentially lethal to a young child, who may be attracted by a pleasant smell or brightly colored bottle of hand sanitizer," the agency wrote. Ingesting hand sanitizer could affect the heart and central nervous system, with people possibly winding up in the hospital, or even losing their life, per the FDA. The agency asked that related issues be reported to the FDA's MedWatch Adverse Event Reporting program. In the meantime, the FDA said it "continues to proactively work with manufacturers to recall potentially dangerous hand sanitizer products and is strongly encouraging retailers to remove these products from store shelves and online marketplaces." Fox News External Link

    Packs of baby food damaged by mice leads to recall in New Zealand

    31 August- Holes found in baby food packaging was likely due to mice, according to officials in New Zealand. Initial investigations also looked at the possibility of a manufacturing fault and involved New Zealand Police to ensure the damage was not caused deliberately. Supermarket chain Woolworths NZ recalled squeezable baby food pouches from stores nationwide after holes were found in about 30 packets in its Auckland and Napier supermarkets. The individual pouches of baby food with damaged packaging were found across six supermarkets in Auckland, and one in Napier. All these products have been removed from shelves. Woolworths New Zealand has also checked all baby food in their stores and distribution centers across the country to ensure no damaged product is still on shelves. Food Safety News External Link

    Salmonella concerns prompt recall of organic microgreens

    1 September-  A Canadian company is recalling organic microgreens because of possible contamination with Salmonella, according to the Canadian Food Inspection Agency (CFIA). The agency is urging consumers to check their homes for the Picoudi brand microgreens and immediately discard them if they have them on hand. The company Les Jardins Picoudi shipped the implicated sprouts to Quebec and New Brunswick, according to the recall notice.  Inspectors from the CFIA as well as staff from the Quebec agriculture department (MAPAQ) are investigating the situation in search of the source of the contamination. "This recall was triggered by MAPAQ. A food safety investigation is being conducted. If other high-risk products are recalled, the Canadian Food Inspection Agency (CFIA) will notify the public through updated food recall warnings," according to the recall notice. "The CFIA is verifying that industry is removing the recalled products from the marketplace. There have been no reported illnesses associated with the consumption of these products. Food Safety News External Link


    Cardio isn't enough for a healthy heart- Add resistance training

    31 August- If the idea of exercising for cardiovascular health makes you think of spin class, it's time to shift that thinking. In addition to traditional "cardio" regimens such as biking, running and high-intensity interval training, there is another kind of workout that benefits your heart: strength training. Although the primary benefits of strength training have been seen as musculoskeletal, and it has been especially recommended for older adults to maintain bone mass and prevent falls and injury, newer research shows that weight training reduces your risk of diabetes, stroke and heart disease. The last, as Kristin Oja, an Atlanta-based nurse practitioner and certified personal trainer, points out, is the leading cause of death in the United States. "We have somebody dying of heart disease every 37 seconds," she says. Multiple studies have found an inverse relationship between strength training and heart disease. A study published in 2017 in Medicine and Science in Sports and Exercise (MSSE) analyzed data from more than 35,000 women for more than a decade. Researchers found that those who performed resistance training had a 30 percent lower chance of being diagnosed with Type 2 diabetes than those who did not. Meanwhile, women who performed any amount of resistance training reduced their risk of cardiovascular disease (including heart attack, stroke, coronary artery bypass graft surgery, an angioplasty or death from cardiovascular disease) by 17 percent. The Washington Post External Link

    Why recovery is the key to effective exercise: How to reboot your workout routine

    31 August- Up until this point in our series, we've focused on creating and maintaining an effective exercise program. In Part I, we covered how to get into the right mindset and establish a habitual pattern of working out. In Part II, we focused on how to move your body effectively to prevent injury. Then, in Part III, we learned how to add weight to those movements to build strength. As we moved on to Parts IV and V, we explored different forms of cardio with a special focus on cycling. And, last week, in Part VI, we learned how to safely ramp up the intensity of our exercise. Now, in this final installment, we're looking at the key to keeping your exercise program working for you: recovery.  Whether your exercise goals are for health, aesthetics or athletics, the means to those ends all come from changing your body composition. That's why our workouts focus on losing fat and building muscle. But true transformation in our bodies doesn't actually occur while we're training. It happens during recovery. The reality is that exercise hurts our bodies. And recovery heals them. When we work out, we push our bodies to the point of cellular breakdown with the intention of building them back up stronger and more efficient. With every strenuous bike ride, weight training session or bout of high-intensity interval training, we give rise to this process. That's why allowing our bodies the time and support to recover is crucial to the effectiveness of our exercise programs. CNN External Link


    African sleeping sickness: Togo eliminates as public health problem

    30 August- The World Health Organization (WHO) announced last week that the West African nation of Togo has eliminated human African trypanosomiasis or "sleeping sickness" as a public health problem, becoming the first country in Africa to reach this milestone.  Togo's achievement comes after more than two decades of sustained political commitment, surveillance and screening of cases. Togo has not reported any cases in the past 10 years. "This validation makes Togo the first country in Africa to have eliminated human African trypanosomiasis or sleeping sickness," said Hon Moustafa Mijiyawa, Minister of Health and Public Hygiene. "Thanks to the joint efforts of all health actors, the disease has been eliminated in Togo. Neighboring countries are not at the same phase and so surveillance must continue to avoid a resurgence of this disease." There are two forms of sleeping sickness. The first, due to Trypanosoma brucei gambiense, is found in 24 countries in west and central Africa and accounts for more than 98% of cases. The second form, due to Trypanosoma brucei rhodesiense, is found in 13 countries in eastern and southern Africa and represents the rest of cases. If left untreated sleeping sickness is almost always fatal. Outbreak News Today External Link

    DRC: More Ebola and plague cases reported, end of measles epidemic declared

    29 August- The World Health Organization (WHO) African regional office said Friday that there has been an additional confirmed Ebola Virus Disease (EVD) case reported in the current and 11th outbreak in the  Democratic Republic of the Congo (DRC) since 1976. The new case is from Bikoro and in this case, a new death. This brings the total cases and deaths in Équateur Province to 107 cases (101 confirmed, 6 probable) and 47 fatalities.  An additional 16 human plague cases have been reported since our last report during the first week of August. From 11 June to 9 August 2020, a total of 73 cases with 10 deaths (CFR13.6%) were notified in 5 over 22 health areas of Rety health zone. Since the beginning of 2020 to date, Ituri Province has reported a total of 91 cases and 17 deaths (CFR 18.7%) in 5 health zones, namely Aungba, Linga, Rethy, Aru, Logo and Kambala. This compares to 48 cases of bubonic plague, including eight deaths reported in all of 2019.  On Tuesday, DRC Health Minister Eteni Longondo announced the world's largest measles outbreak is over due to a massive vaccination program. "For the past month, we are able to say that this epidemic has been eliminated from across our territory," Health Minister Eteni Longondo told reporters at a press conference on Tuesday. "We can say that measles no longer exists in the DRC." Since 2019 a total of 380, 766 measles cases and 7,018 deaths (CFR 1.8%) have been reported in the country. The DRC announced the end of the measles epidemic on the same day the World Health Organization declared that the wild polio virus has been eradicated from the African continent. Outbreak News Today External Link


    Bahrain, Jordan open walk-in Covid-19 vaccine trials

    2 September- Bahrain and Jordan have become the latest Middle East nations to open walk-in Coronavirus vaccine clinics amid phase three trials of a new treatment for the disease. Thousands of volunteers can now take part in the 4Humanity campaign by attending centres in the two countries, adding to existing facilities in Sharjah and UAE capital Abu Dhabi. As part of the trial, patients are screened for Covid-19 then given a shot of an inactive vaccine – the final step before the treatment is approved for use among the public.  Bahrain's Ministry of Health emphasized that the inactivated vaccine does not cause infection, but triggers an immune response producing antibodies that fight the virus. The effectiveness of the produced antibodies will be assessed as a measure of the success of the vaccine. The phase III clinical trial for the inactivated vaccine follows the success of the Phase I and phase II trials conducted in China, which resulted in 100 per cent of the volunteers generating antibodies after two doses in 28 days. After an initial shot of the vaccine, volunteers receive periodic check-up calls from doctors before receiving a second injection three weeks later. Final checks are conducted in person at the 35-day and 49-day points to assess any adverse effects, with patients then contacted by doctors at least once per month by phone for up to a year during the follow-up phase. The clinical trials – operated by Chinese pharmaceutical giant Sinopharm and Abu Dhabi-based G42 Healthcare – are being conducted in compliance with strict international guidelines stipulated by the World Health Organization (WHO) and the United States Food & Drug Administration (USFDA). Arabian Business External Link


    Coronavirus: Portugal return to quarantine list would cause 'chaos'

    1 September- Holidaymakers will face "chaos and hardship" if coronavirus quarantine measures are reintroduced for those arriving in the UK from Portugal, a travel industry leader has warned. Portugal has recorded 21.1 virus cases per 100,000 people in the past week. The UK considers imposing 14 days of isolation on travelers when a country's infection rate exceeds 20 cases per 100,000, over seven days. The boss of British Airways' parent firm said the numbers were "arbitrary". Less than two weeks ago, the popular holiday destination was added to the list of countries exempt from UK rules requiring travelers to quarantine. This prompted a rise in internet searches for last-minute flights by British holidaymakers. But now the UK government is likely to be considering imposing quarantine rules again as case numbers in Portugal rise. There were 21.1 cases per 100,000 people in Portugal in the seven days to 30 August, up from 19.4 in the seven days to 29 August. BBC News External Link

    Finland COVID-19 cases stable over past three weeks

    28 August- In Finland, the Institute of Health and Welfare reports number of new coronavirus infections remains relatively small at national level. While the number and incidence of cases have risen compared to the low figures at the beginning of July, they have remained stable over the past three weeks.  The increase in the number and incidence of cases since early July is most evident in Helsinki and the Uusimaa region. During the latest period (17–23 August), a total of 159 new cases were reported to the communicable diseases register. In the previous week (10–6 August), the number of reported cases was 164. Infections of both domestic and foreign origin have been reported in Finland. Infections have been traced to a number of countries, and some of these infections have led to new infections and chains of transmission. Some of the new confirmed cases are related to known chains of transmission and clusters of cases that are being monitored, but the source of all infections is not known. A number of domestic mass exposures have been identified, including larger family gatherings and public events. Several incidents of exposure to COVID-19 in day-care centres and schools have been identified in recent weeks. The aim is to carefully track the transmission chains of all new cases in order to prevent new infections as effectively as possible. Outbreak News Today External Link

    Ukraine reports 16 salmonella outbreaks so far this year

    31 August- Ukraine health officials reported recently that during the first eight months of 2020, the country has seen 16 salmonella outbreaks, including four in Zaporizhia oblast, two in Ivano-Frankivsk oblast and one each in Vinnytsia, Dnipropetrovsk, Zakarpattia, Kirovohrad, Odesa, Poltava, Rivne, Sumy, Cherkasy oblasts and Kyiv.  In total, 2402 salmonella cases have been reported, Officials say the incidence rate per 100,000 population is 5.7, which is 41% lower than in the same period last year. Salmonellosis is an infectious disease caused by a bacterium of the genus Salmonella. The severity of the disease depends on the serotype, the susceptibility of the population and a number of other factors. The source of the pathogen – animals (cattle, pigs, sheep, horses, waterfowl, chickens, reptiles, cats, dogs, domestic rodents), people with salmonellosis or healthy carriers. Carrier status can last from a few days to several years. The mechanism of infection is fecal-oral. Infection occurs through food, water and household routes. Salmonellosis has a summer-autumn seasonality, which is associated with the activation during this period of the mechanism of bacterial transmission. The incidence in cities is 2 times higher than in villages.  The incubation period ranges from 6 hours to 2-3 days. The disease can be mild. However, in some cases, disease-related dehydration can be life-threatening. Symptoms of salmonellosis: fever, headache, weakness, malaise, abdominal pain, nausea, vomiting, diarrhea. Prevention of salmonellosis should include a wide range of veterinary, sanitary and anti-epidemic measures. Outbreak News Today External Link


    India leads global rise in new weekly COVID-19 cases, while deaths down: WHO

    1 September- India reported the most new COVID-19 cases of any country in the past week, its nearly half a million fresh infections pushing the global tally up by 1 percent, the World Health Organization (WHO) said on Tuesday.  Overall global new deaths in the past seven days fell by 3% compared to the previous week, the WHO reported, adding that overall new infections around the world rose by 1.8 million. The respiratory disease is also spreading in the Americas, which continues to account for more than half of reported cases and deaths worldwide, although there have been slight decreases in some areas, WHO said in its latest update. Peru, Mexico, Colombia and Argentina have seen "increasing trends", it said.  Spain, Russia, France, and Ukraine reported the highest number of new cases in Europe in the week to Aug. 30, with a resurgence in Spain matching peaks seen last March and April, the U.N. agency said. New cases in Italy jumped by 85%, it said. "South-East Asia has reported the largest week-on-week increase, largely due to increased case detections in India," the WHO said. "India has reported nearly 500,000 new cases in the past seven days, a 9% increase compared to the previous seven days and the highest numbers of new cases globally." In Africa, cases in Ethiopia reached "new highs", while South Africa - which has the fifth most infections globally and the highest number on the vast continent - has continued a downward trend, it said. Several previous hotspots - including Ghana, Kenya, Gabon and Madagascar - have recorded fewer new cases, the WHO said, adding: "...the figures should be interpreted cautiously as they may be affected by many factors, including the current testing capacity and strategy, and delays in reporting." Reuters External Link 

    Singapore dengue outbreak tops 27,000, Government outreach to schools

    29 August- The Singapore government has now reported more than 27,000 dengue fever cases through Aug 28 in this record setting year after recording around one thousand cases during the past week.  In addition, 20 deaths have been recorded to date. In addition to educating the general public on the prevention of dengue fever, the National Environment Agency (NEA) is working with the Ministry of Education (MOE) to provide mosquito repellent to schools in larger dengue cluster areas. This is to further protect the young from getting infected with dengue, and also to get their family members used to taking steps to protect themselves against dengue, especially where their schools and residences are located in larger dengue cluster areas. Over 46,000 bottles of mosquito repellent have been distributed to students in selected schools. To complement this effort, these schools have also procured mosquito repellent for use in the classroom. In addition, all schools have taught their students how to prevent mosquito breeding and have reiterated the three key protective actions against dengue – 'Spray, Apply, Wear' or 'SAW' in short – to parents through the schools' network, so that both students and their parents are better equipped to protect themselves and their loved ones. As the situation develops, NEA and MOE will continue to work together to provide mosquito repellent to other schools that are located in large dengue clusters of concern. Outbreak News Today External Link


    Canada: Toronto- Officials report 1st human West Nile virus case

    28 August- Toronto Public Health has received a positive laboratory report identifying Toronto's first reported case of West Nile virus for 2020 in an adult resident. West Nile virus is an infection transmitted to people through the bite of an infected mosquito. While the risk of getting infected in Toronto is currently low, Toronto Public Health advises residents to take these precautions to avoid bites from infected mosquitoes:

    - Wear light-colored clothing, long pants and long-sleeved shirts when outdoors.

    - Apply insect repellent containing DEET or icaridin and follow the manufacturer's instructions.

    - Take extra care during peak mosquito-biting hours, dusk and dawn, by using repellent and covering up.

    - Make sure your home has tight-fitting screens on windows and doors.

    - Remove standing water from your property, where mosquitoes can breed. Standing water includes any water that collects in items such as buckets, planters, toys and waste containers. "While the likelihood of becoming infected with West Nile virus is low in our city, now is a good time to remind residents of simple actions they can take when enjoying the outdoors to further minimize the potential risk. These actions include wearing insect repellent and light-colored clothing, long pants and long-sleeved shirts to prevent getting bitten by an infected mosquito", Toronto's Medical Officer of Health, Dr. Eileen de Villa said. Outbreak News Today External Link

    U.S.: New York City- Nervously braces for another 'explosive spread'

    27 August- Most of the country looked on in horror this spring as Covid-19 flooded New York City hospitals and morgues, and a disease many had never heard of threw America's biggest city into paralysis. Now New York is watching the same scenario play out in states throughout the U.S., while presiding over three months of sustained success in keeping infections low. But with cold weather approaching, schools tentatively reopening and many forced back indoors, the threat of a new outbreak is never far from the minds of public health officials — and this time they know outside help will be harder to come by.  "The second wave is a misconception: It's the omnipresent risk of explosive spread," said Dr. Tom Frieden, former CDC director and current president and CEO of Resolve to Save Lives, an initiative of Vital Strategies. "That's what we're facing." With a total of 237,525 confirmed and probable cases and more than 23,500 dead, New York City has already experienced the worst the coronavirus has to offer. But as hospitals and health officials gird for a second city outbreak, the spread of the virus throughout the rest of the country is bringing some challenges the city did not face the first time around — and some that continue to linger from the darkest days of March and April. In many cases, the city is better prepared: it knows the warning signs, hospitals are communicating weekly to share best practices and other information, and New Yorkers are largely complying with social distancing and mask guidance to cut down on transmission. Politico External Link

    U.S.: South Carolina- Bobcat tests positive for rabies in Marion

    28 August- South Carolina health officials report that a bobcat located near Hassie Road and Mossy Point Court in Marion, S.C., tested positive for rabies. One pet was exposed and will be quarantined as required in the South Carolina Rabies Control Act.  "Keeping your pets up-to-date on their rabies vaccination is the easiest way to protect you and your family from this deadly virus," said David Vaughan, Director of DHEC's Onsite Wastewater, Rabies Prevention, and Enforcement Division. "Any mammal has the ability to carry and transmit the disease to humans or pets. The key to prevention is to stay away from wild and stray animals and keep your pets current on their rabies vaccinations. In South Carolina, rabies is most often found in wildlife such as raccoons, skunks, foxes, and bats, but pets are just as susceptible to the virus. If you see an animal in need, avoid touching it. Contact someone trained in handling animals, such as your local animal control officer or wildlife rehabilitator." If you or someone you know has had contact with or been potentially exposed to this or another suspect animal, please reach out to your local Environmental Affairs office. An exposure is defined as a bite, a scratch, or contact with saliva or body fluids from an infected or possibly infected animal. If your pet is found with wounds of unknown origin, please consider that your pet could have been exposed to rabies and contact DHEC's Environmental Affairs Florence office at (843) 661-4825 during normal business hours (8:30 a.m.-5 p.m., Monday-Friday). To report a bite or exposure on holidays or times outside of normal business hours, please call the DHEC after-hours service number at (888) 847-0902. Outbreak News Today External Link


    Costa Rica: COVID-19- Outbreak update, guidelines for antibody tests

    29 August- The Costa Rica Ministry of Health reported 1,193 new cases of COVID-19 Friday, bringing the country total to 38,485 confirmed cases.  411 people are hospitalized, 140 of them in intensive care with an age range of 13 to 83 years. Ten additional COVID-19 related deaths were reported, bringing the total to 407. In addition on Friday, the Ministry of Health published  the guidelines for the acquisition and use of serological tests for the identification of antibodies to SARS-CoV-2. These blood tests allow us to identify if a person has been previously exposed to the virus that produces COVID-19 and therefore developed antibodies. With this guideline, the governing body for health authorizes the use of tests to detect IgA, IgG, IgM and / or total antibodies that are processed through ELISA, Chemiluminescence or Electrochemiluminescence techniques, and that have an equal or greater sensitivity 85% and specificity equal to or greater than 90%. The Ministry of Health will grant the sanitary registration and authorization for the entry and commercialization of said serological tests. Outbreak News Today External Link

    Ecuador: COVID-19- Cases top 112K, 105-year-old Loja woman recovers

    29 August- The National Institute for Public Health Research (INSPI) in Ecuador is now reporting 112,906 confirmed COVID-19 cases since the first case was confirmed in the country on February 29. More than 80,000 patients have recovered to date and 6,537 people died. In Loja province, health officials report that a 105-year-old woman has recovered from the disease. Esther de Jesús managed to defeat COVID-19, in the Paltas canton, Loja province. Her recovery restores hope to the doctors who treated her, including Dr. Johanna Caraguay. "Overcoming this battle is a great joy and an illusion for everyone. You are a warrior, "the specialist said through tears as she gave the good news to Doña Esther. The older adult recovered at home under the care of the family and health professionals from District 11D03, who constantly visited her or communicated by phone to find out her health status. According to the health professional, Doña Esther faced the symptoms of COVID-19 in a stable way for almost 30 days despite other previous health problems. So it was not necessary to hospitalize her. "The first thing we did as a family was to keep calm and put biosecurity measures into practice (use of a mask, hand washing and isolation inside the house)," commented his granddaughter, Meriann Toledo. Outbreak News Today External Link