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A third of care home residents still waiting for COVID-19 tests - UK

A third of care home residents haven't been tested for COVID-19, despite government promises that all residents and staff would be tested by "early June".A third of care home residents haven't been tested for COVID-19, despite government promises that all residents and staff would be tested by "early June".

A person holding a cell phone: Figures show around one-third (37%) of residents have not been tested at all during the pandemic© PA Figures show around one-third (37%) of residents have not been tested at all during the pandemicNew research from The Data Analysis Bureau (T-Dab) suggests that while testing has risen in the last month, many residents are still missing out.

In May, Health Secretary Matt Hancock said "every resident and every member of staff in our elderly care homes in England" would be tested "between now and early June". But the study of around 32,000 care home residents found that 37% have not been tested, while 15% of care homes have not had any of their residents tested.

Nala Ahmed from the National Care Association said: "It's disappointing. We stressed from the beginning that testing was key to making sure we had a handle on where the virus was and how to contain it within care home communities.

"It is disappointing to think that only not everyone has had tests, despite being told everybody can have them and they are available."

The T-Dab research based on Person Centred Software statistics suggests the proportion of care home residents in England tested in this period has increased from 13% in mid-May to 53% as of Thursday. But it also signals just 10% of residents were tested in the last seven days.

T-Dab director Simon Briscoe said: "The rate of testing rose dramatically in the last week of May and into June as the government sent roughly one million test kits to care homes.

"The many links in the chain of testing from care home staff, local health officials, a website and test centres, combined to leave testing rates very low. "With barely half of residents having been tested it shows that more than simply issuing testing kits is required to provide care homes with the support and guidance they need."

This week's figures from the Office for National Statistics show there were 14,028 coronavirus-related deaths recorded in care homes in England and Wales in the year to 5 June. That means nearly half of all deaths from the virus are happening in care homes.

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Helen Wideborn, director of The Relatives & Residents Association For Quality of Life of Older People in Care, said: "These figures will be hugely concerning and disappointing for relatives and friends of old people receiving care, who were promised this testing system would be rolled out to prevent spread of virus.

"We haven't learned lessons from elsewhere in the world about test, test, test being the route to saving lives." :: Listen to the Daily podcast on Apple Podcasts, Google Podcasts, Spotify, Spreaker A spokesperson for the Department of Health and Social Care said: "We have achieved our target to offer testing to every care home for the over-65s, or those with dementia, in England by 6 June.

"We sent more than one million test kits to almost 9,000 care homes, and are now sending out thousands more tests every day to residents and staff in all remaining care homes." But many fear that with care home staff not medically trained to test vulnerable patients, more will have to be done to improve testing numbers among the most vulnerable in society.

Reference :Sky News :Jenny Longden, news reporter 11 hrs ago June 19th 2020  

What is dexamethasone, how does it work and when will it be used? - Covid19

What is dexamethasone, how does it work and when will it be used?What is dexamethasone, how does it work and when will it be used? Reference: P A Media; By Ted Hennessey, PA 19 hrs ago June 16th 2020A cheap and widely available steroid can help save the lives of patients seriously ill with coronavirus, a trial has found.The drug, dexamethasone is a major breakthrough in the fight against the deadly virus, UK experts say.Here, the PA news agency explains what we know about it so far:–

What is it?

Dexamethasone is a widely-used steroid drug which works to reduce inflammation.It has been used to treat a number of different conditions, including rheumatoid arthritis and asthma.The drug is also used in end-of-life care and can work to prevent the immune system from destroying blood platelets in people with blood disorders.Patients with a brain tumour may also be prescribed dexamethasone to reduce swelling around the tumour.–

When was it created?

The drug was developed in 1957 and was first approved for medical use by the Food and Drug Administration in the US in 1958.–

How much does it cost?

Dexamethasone is relatively cheap, with researchers saying the cost of a course of treatment for people seriously ill with coronavirus is about £40.The NHS now plans to make the drug available to all patients in hospital who will benefit from it.Dexamethasone is also available globally at cheap prices, meaning poorer countries will benefit.–

How was the UK trial conducted?

A team from the University of Oxford recruited 2,104 patients who received 6mg of dexamethasone once a day either orally or by intravenous injection for 10 days.Their outcomes were compared with a control group of 4,321 patients.–

How big a breakthrough is this?

This is the most important trial result for COVID-19 so far. Significiant reduction in mortality in those requiring oxygen or ventilation from a widely available, safe and well known drug. Many thanks to those who took part and made it happen. It will save lives around the world. — Professor Chris Whitty (@CMO_England) June 16, 2020. It was hailed a “major breakthrough” in the fight against Covid-19 by scientists and politicians alike.Researchers estimate if they had known what they now know about the steroid at the start of the pandemic, 4,000 to 5,000 lives could have been saved.–

What did the trial prove?

The mortality rate of those with Covid-19 who end up on a ventilator is above 40%, but this figure was reduced by a third among those prescribed dexamethasone.It also cuts the risk of death by a fifth for those on oxygen and was described by researchers as “statistically significant”.Based on the results, one death would be prevented by treatment of around eight patients on ventilators, or around one in every 25 patients requiring oxygen alone.–

Does it help treat coronavirus generally?

There was no benefit in those patients who were in hospital with Covid-19, but whose lungs were working sufficiently well not to need oxygen or a ventilator.a man standing in front of a computer: The drug cut the risk of death by a third for coronavirus patients on ventilators© Provided by PA Media The drug cut the risk of death by a third for coronavirus patients on ventilators.

The Government’s chief scientific adviser Sir Patrick Vallance said during Tuesday’s Downing Street press conference that the steroid does not stop people from catching coronavirus.Researchers warned it has not been studied in patients in the community, and people should not be taking dexamethasone for Covid-19.–

Will it be widely used?

It is readily available in hospitals and should now become “standard of care” in Covid-19 patients on ventilators or oxygen, according to researchers.Advice will be going out to all NHS hospitals within the next 24 hours to act on the results, meaning everyone who could benefit from the steroid could get it.–

What do the experts say?

Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, University of Oxford, and one of the chief investigators for the trial, described it as “an extremely welcome result”.“Dexamathasone has delivered significant results in trials to help people recover from Covid 19. This is tremendous news in the fight against this virus.”- PV pic.twitter.com/YIeHEZQ7Uh— Sir Patrick Vallance (@uksciencechief) June 16, 2020The Government’s chief scientific adviser, Sir Patrick Vallance, said:

“This is tremendous news today from the Recovery trial showing that dexamethasone is the first drug to reduce mortality from Covid-19.“It is particularly exciting as this is an inexpensive, widely available medicine.“This is a groundbreaking development in our fight against the disease, and the speed at which researchers have progressed finding an effective treatment is truly remarkable.

”Professor Stephen Powis, NHS England medical director, said: “This is a huge breakthrough in our search for new ways to successfully treat patients with Covid, both in the UK and across the world.“It is thanks to NHS staff and patients who participated in the trial that from now we are able to use this drug to dramatically improve Covid-19 survival for people in hospital who require oxygen or ventilation.

”England’s chief medical officer Professor Chris Whitty said it was “the most important trial result for Covid-19 so far” and “will save lives around the world”.

Reference: P A Media; By Ted Hennessey, PA 19 hrs ago June 16th 2020

Malaria

Prevention

PreventionVector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.

Insecticide-treated mosquito nets

Sleeping under an insecticide-treated net (ITN) can reduce contact between mosquitoes and humans by providing both a physical barrier and an insecticidal effect. Population-wide protection can result from the killing of mosquitoes on a large scale where there is high access and usage of such nets within a community.In 2018, about half of all people at risk of malaria in Africa were protected by an insecticide-treated net, compared to 29% in 2010. However, ITN coverage has been at a standstill since 2016.

Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is another powerful way to rapidly reduce malaria transmission. It involves spraying the inside of housing structures with an insecticide, typically once or twice per year. To confer significant community protection, IRS should be implemented at a high level of coverage.

Globally, IRS protection declined from a peak of 5% in 2010 to  2% in 2018, with decreases seen across all WHO regions, apart from the WHO Eastern Mediterranean Region. The declines in IRS coverage are occurring as countries switch from pyrethroid insecticides to more expensive alternatives to mitigate mosquito resistance to pyrethroids. 

Antimalarial drugs

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. For pregnant women living in moderate-to-high transmission areas, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine, at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.

Since 2012, WHO has recommended seasonal malaria chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.

Insecticide resistance

Since 2000, progress in malaria control has resulted primarily from expanded access to vector control interventions, particularly in sub-Saharan Africa. However, these gains are threatened by emerging resistance to insecticides among Anopheles mosquitoes.  According to the latest World malaria report, 73 countries reported mosquito resistance to at least 1 of the 4 commonly-used insecticide classes in the period 2010-2018. In 27 countries, mosquito resistance was reported to all of the main insecticide classes. 

Despite the emergence and spread of mosquito resistance to pyrethroids, insecticide-treated nets continue to provide a substantial level of protection in most settings. This was evidenced in a large 5-country study coordinated by WHO between 2011 and 2016. While the findings of this study are encouraging, WHO continues to highlight the urgent need for new and improved tools in the global response to malaria. To prevent an erosion of the impact of core vector control tools, WHO also underscores the critical need for all countries with ongoing malaria transmission to develop and apply effective insecticide resistance management strategies. 

Diagnosis and treatment

Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT). WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 30 minutes or less. Treatment, solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the third edition of the "WHO Guidelines for the treatment of malaria", published in April 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum malaria parasites to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival. Protecting the efficacy of antimalarial medicines is critical to malaria control and elimination. Regular monitoring of drug efficacy is needed to

inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance.In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong subregion (GMS), a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.

At the World Health Assembly in May 2015, WHO launched the Strategy for malaria elimination in the Greater Mekong subregion (2015–2030), which was endorsed by all the countries in the subregion. Urging immediate action, the strategy calls for the elimination of all species of human malaria across the region by 2030, with priority action targeted to areas where multidrug resistant malaria has taken root.With technical guidance from WHO, all countries in the region have developed national malaria elimination plans. Together with partners, WHO is providing ongoing support for country elimination efforts through the Mekong Malaria. Elimination programme, an initiative that evolved from the ERAR

Surveillance

Surveillance entails tracking of the disease and programmatic responses, and taking action based on the data received. Currently, many countries with a high burden of malaria have weak surveillance systems and are not in a position to assess disease distribution and trends, making it difficult to optimize responses and respond to outbreaks. Effective surveillance is required at all points on the path to malaria elimination. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable. In March 2018, WHO released a reference manual on malaria surveillance, monitoring and evaluation. The manual provides information on global surveillance standards and guides countries in their efforts to strengthen surveillance systems. 

Elimination

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures are required to prevent re-establishment of transmission. Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required once eradication has been achieved.

Globally, the elimination net is widening, with more countries moving towards the goal of zero malaria. In 2018, 27 countries reported fewer than 100 indigenous cases of the disease, up from 17 countries in 2010. Countries that have achieved at least 3 consecutive years of 0 indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. Over the last decade,  10 countries have been certified by the WHO Director-General as malaria-free: Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019) and Argentina (2018). The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination.

Vaccines against malaria

RTS,S/AS01 (RTS,S) is the first and, to date, the only vaccine to show that it can significantly reduce malaria, and life-threatening severe malaria, in young African children. It acts against P. falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. Among children who received 4 doses in large-scale clinical trials, the vaccine prevented approximately 4 in 10 cases of malaria over a 4-year period.In view of its public health potential, WHO’s top advisory bodies for malaria and immunization have jointly recommended phased introduction of the vaccine in selected areas of sub-Saharan Africa.

Three countries – Ghana, Kenya and Malawi – began introducing the vaccine in selected areas of moderate and high malaria transmission in 2019. Vaccinations are being provided through each country’s routine immunization programme.The pilot programme will address several outstanding questions related to the public health use of the vaccine. It will be critical for understanding how best to deliver the recommended 4 doses of RTS,S; the vaccine’s potential role in reducing childhood deaths; and its safety in the context of routine use. 

This WHO-coordinated programme is a collaborative effort with Ministries of Health in Ghana, Kenya and Malawi and a range of in-country and international partners, including PATH, a non-profit organization, and GSK, the vaccine developer and manufacturer. Financing for the vaccine programme has been mobilized through a collaboration between 3 major global health funding bodies: Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid.WHO response

WHO Global technical strategy for malaria 2016-2030 

The WHO Global technical strategy for malaria 2016-2030 – adopted by the World Health Assembly in May 2015 – provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The Strategy sets ambitious but achievable global targets, including:reducing malaria case incidence by at least 90% by 2030;reducing malaria mortality rates by at least 90% by 2030;eliminating malaria in at least 35 countries by 2030;preventing a resurgence of malaria in all countries that are malaria-free.This Strategy was the result of an extensive consultative process that spanned 2 years and involved the participation of more than 400 technical experts from 70 Member States.

The Global Malaria Programme

The WHO Global Malaria Programme coordinates WHO's global efforts to control and eliminate malaria by:setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;keeping independent score of global progress;developing approaches for capacity building, systems strengthening, and surveillance; andidentifying threats to malaria control and elimination as well as new areas for action.The Programme is supported and advised by the Malaria Policy Advisory Committee (MPAC), a group of global malaria experts appointed following an open nomination process. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy-setting process. 

"High burden high impact approach"

At the World Health Assembly in May 2018, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, called for an aggressive new approach to jump-start progress against malaria. A new country-driven response – “ High burden to high impact” – was launched in Mozambique in November 2018. The approach is currently being driven by the 11 countries that carry a high burden of the disease (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania).

Key elements include: political will to reduce the toll of malaria; strategic information to drive impact; better guidance, policies and strategies; and a coordinated national malaria response. Catalysed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be prevented and diagnosed, and that is entirely curable with available treatments.NewsWHO and European Investment Bank strengthen efforts to combat COVID-19 and build resilient health systems to face future pandemics 1 May 2020 Facts in pictures

Lusitana and the world’s first malaria vaccine 21 April 2020 

World Malaria Day - Global Health Observatory (GHO) data on malaria - WHO Certification process for malaria elmination - WHO Global Malaria Programme (GMP)Malaria Policy Advisory Committee

Reference: 14 January  2014 - January 20 - 20 20: World Health Organization

Malaria

Key facts

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.In 2018, there were an estimated 228 million cases of malaria worldwide.The estimated number of malaria deaths stood at 405 000 in 2018.Children aged under 5 years are the most vulnerable group affected by malaria; in 2018, they accounted for 67% (272 000) of all malaria deaths worldwide.The WHO African Region carries a disproportionately high share of the global malaria burden. In 2018, the region was home to 93% of malaria cases and 94% of malaria deaths.Total funding for malaria control and elimination reached an estimated US$ 2.7 billion in 2018. Contributions from governments of endemic countries amounted to US$ 900 million, representing 30% of total funding. 

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors." There are 5 parasite species that cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the greatest threat.

In 2018, P. falciparum accounted for 99.7% of estimated malaria cases in the WHO African Region 50% of cases in the WHO South-East Asia Region, 71% of cases in the Eastern Mediterranean and 65% in the Western Pacific.In 2018, P. falciparum accounted for 99.7% of estimated malaria cases in the WHO African Region 50% of cases in the WHO South-East Asia Region, 71% of cases in the Eastern Mediterranean and 65% in the Western Pacific.P. vivax is the predominant parasite in the WHO Region of the Americas, representing 75% of malaria cases.

Symptoms

Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death. Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ failure is also frequent. In malaria endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.

Who is at risk?

In 2018, nearly half of the world's population was at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, the WHO regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are also at risk.Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances.

Disease burden

According to the latest World malaria report, released in December 2019, there were 228 million cases of malaria in 2018 compared to 231  million cases in 2017. The estimated number of malaria deaths stood at 405 000 in 2018, compared with 416 000 deaths in 2017.The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2018, the region was home to 93% of malaria cases and 94% of malaria deaths. In 2018, 6 countries accounted for more than half of all malaria cases worldwide: Nigeria (25%), the Democratic Republic of the Congo (12%), Uganda (5%), and Côte d’Ivoire, Mozambique and Niger (4% each).Children under 5 years of age are the most vulnerable group affected by malaria; in 2018, they accounted for 67% (272 000) of all malaria deaths worldwide.

World malaria report 2019. 

Transmission

TransmissionIn most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. All of the important vector species bite between dusk and dawn. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment. Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs.

Each species of Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small, shallow collections of fresh water, such as puddles and hoof prints, which are abundant during the rainy season in tropical countries. Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why approximately 90% of the world's malaria cases are in Africa.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

Reference: 14 January  2014 - January 20 - 20 20: World Health Organization https://www.youtube.com/watch?v=k138Nc4_o-g