Army Public Health Weekly Update, 10 July 2020

Date Published: 7/10/2020
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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

    ​ANNOUNCMENTS

    APHC COVID-19

    This site provides Army-specific information and communication resources related to the 2019 Novel Coronavirus (COVID-19). The resources and tools available on this site may be shared with, tailored for, and/or used to create informational and educational materials for Army beneficiaries. APHC

    COVID-19 Guidance and Alerts

    For more information on COVD-19 guidance, alerts and resources click here.

    Now Available: 2019 Health of the Force

    Through annual reporting of key indicators that impact readiness and Soldier well-being, Health of the Force improves awareness and understanding of the health status of the Army. Results are communicated through an online digital platform and traditional reports. The Health of the Force suite of products gives leaders tools to advance programs and strategies that improve performance and reduce illness and injury. APHC

    U.S. MILITARY

    COVID-19 leads to innovation in military health care practices

    2July- The arrival of the novel coronavirus brought many challenges to the health care community. Doctors, researchers, and policymakers around the world had to face the virus and determine the best ways to keep their communities safe. This discussion and collaboration resulted in many medical practice and policy innovations. The military is no exception. Health care professionals throughout the Military Health System worked together to address the new normal, changing how care should be brought to patients worldwide. U.S. Assistant Secretary of Defense for Health Affairs Thomas McCaffery iterated that innovation in the MHS supports the Department of Defense's priorities in COVID-19: protect the workforce, maintain military readiness, and support the national response. Japan Stars and Stripes External Link

    Military Adaptive Sports Program aids with healing our Wounded Warriors

    7 July- Retired Army Col. Michael Malone soldiered through combat deployments, traumatic brain injuries, and a diagnosis of post-traumatic stress disorder. But after he became ill during a deployment in Kuwait, his military career ended. Malone was diagnosed with chronic multisymptom illness, and he credits the Department of Defense's Military Adaptive Sports Program, or MASP, with giving him focus and direction for his post-service life. "When you end up in the Warrior Transition Program, as I did, it's because you're very sick or very injured," Malone said. "So you're in a really dark place. Adaptive sports allowed me to feel competitive again and build my athletic skills. And emotionally, the program really facilitated my recovery." MASP is part of the DoD Warrior Care Program. It provides reconditioning activities and competitive athletic opportunities for wounded, ill, and injured service members and veterans. The Military Health System is shining a spotlight on MASP for National Therapeutic Recreation Week, which highlights the importance of recreational therapy to enhance physical and emotional healing. Health.mil External Link

    Military firefighters say DoD isn't moving fast enough to protect them from toxic chemicals

    2 July- An amendment to the House and Senate defense policy bills would require the Pentagon to provide blood tests for any service member suspected to have been exposed to chemicals used in most firefighting foams, as well as non-stick industrial coatings and stain repellent. But the Department of Defense has yet to begin testing firefighters for these substances, which fall under the class of per- and polyfluoroalkyl substances, or PFAS. They are required to do so by Oct. 1 under last year's National Defense Authorization Act.  Military firefighters say they are glad lawmakers are now considering the dangers of the chemicals, which have been linked to certain types of cancer, birth defects and other health issues. But they don't feel that the Pentagon is moving fast enough to monitor their exposure levels. "Being a DoD firefighter for 14 years, I know I've been covered in that stuff ... what has been done for all us firefighters?" said a service member, who requested that his name not be used because he remains on active duty and fears retaliation. The fiscal 2020 National Defense Authorization Act called for DoD to begin blood testing on military firefighters to determine their exposure levels to PFOS and PFOA. A Defense Health Agency spokesman said DoD is currently developing the procedures for testing the thousands of current firefighters serving in the ArmyNavyAir Force and Marine Corps. "We are actively developing policy and procedures to provide blood testing to determine and document potential occupational exposure to perfluoroalkyl and polyfluoroalkyl substances for each firefighter of the Department of Defense during the annual occupational medical examination conducted by the department for each firefighter," a DHA official said on background, because he was not authorized to speak for the agency. The House and Senate versions of the national defense policy bill contain at least 10 different measures to regulate PFAS, from providing funding to the Centers for Disease Control and Prevention to improving research on the chemicals and prohibiting DoD from buying certain products containing PFAS, and barring DoD from incinerating PFAS products. Military.com External Link

    U.S. government launches campaign to reduce high suicide rates, particularly among veterans

    7 July- The federal government launched a broad national campaign Tuesday aimed at reducing high suicide rates, urging the public to reach out to others, especially during the coronavirus pandemic, and acknowledge daily stresses in people's lives. Known as REACH, the government campaign is the core part of a $53 million, two-year effort announced by President Donald Trump to reduce suicide, particularly among veterans. Starting Wednesday, digital ads will hit the internet with the key message that "suicide is preventable" and that collective action not only by government but also by businesses, schools, nonprofits and faith-based organizations can overcome the stigma of discussing mental health and empower people to understand risk factors, stay connected with others and talk openly about problems. "Working together, we can implement this road map and end this national tragedy of suicide," said Vice President Mike Pence's wife, Karen Pence, a lead spokesperson for the government effort. She called it an opportune time, noting increased social distancing because of the coronavirus.
    "All of us have been facing anxieties and isolation," she said. "It's OK to not be OK. ... The best thing is to talk about it more, not less." Military Times External Link

    GLOBAL

    Americans who stayed home before they were told to saved lives, study finds

    1 July- If you were one of the Americans who decided to self-isolate before you were required to by state or local mandate, good for you. You saved lives. That's the finding of a study published Monday in the journal "The Lancet: Infectious Diseases," which used mobile phone data to track how people behaved between January 1 and April 20, a time before widespread calls by state and local officials to stay at home. The study found that individual decisions to stay put in homes, except for necessary outings for food and medical supplies, likely helped slow the spread of coronavirus before state or local stay-at-home orders were implemented by government officials. Within four months of Covid-19 first being reported in the US, the disease had spread to every state and to more than 90% of all counties. The study found that social distancing measures and the slowdown of coronavirus were primarily driven by changes in individual behavior and local regulations, noting that state and federal regulations were implemented either too late or not at all. CNN External Link

    Coronavirus: Immunity may be more widespread than tests suggest

    1 July- For every person testing positive for antibodies, two were found to have specific T-cells which identify and destroy infected cells. This was seen even in people who had mild or symptomless cases of Covid-19. But it's not yet clear whether this just protects that individual, or if it might also stop them from passing on the infection to others. Researchers at the Karolinksa Institute in Sweden tested 200 people for both antibodies and T-cells. Some were blood donors while others were tracked down from the group of people first infected in Sweden, mainly returning from earlier affected areas like northern Italy. This could mean a wider group have some level of immunity to Covid-19 than antibody testing figures, like those published as part of the UK Office for National Statistics Infection Survey, suggest. It's likely those people did mount an antibody response, but either it had faded or was not detectable by the current tests. And these people should be protected if they are exposed to the virus for a second time. Prof Danny Altmann at Imperial College London described the study as "robust, impressive and thorough" and said it added to a growing body of evidence that "antibody testing alone underestimates immunity". BBC News External Link

    Coronavirus: Spanish study casts doubt on herd immunity feasibility

    7 July- The study of more than 60,000 people estimates that around just 5% of the Spanish population has developed antibodies, the medical journal the Lancet reported. Herd immunity is achieved when enough people become infected with a virus to stop its spread. Around 70% to 90% of a population needs to be immune to protect the uninfected. The prevalence of Covid-19 antibodies was below 3% in coastal regions, but higher in areas of Spain with widespread outbreaks, the report said. "Despite the high impact of Covid-19 in Spain, prevalence estimates remain low and are clearly insufficient to provide herd immunity," the study's authors said in the report. "This cannot be achieved without accepting the collateral damage of many deaths in the susceptible population and overburdening of health systems. "In this situation, social distance measures and efforts to identify and isolate new cases and their contacts are imperative for future epidemic control." The study is thought to be the largest of its kind on the coronavirus in Europe. There have been studies of a similar kind in China and the US and "the key finding from these representative cohorts is that most of the population appears to have remained unexposed" to the coronavirus, "even in areas with widespread virus circulation," the Lancet article said. BBC External Link 

    Earth, wind, and fire: Plan for health needs in emergencies

    7 July- The COVID-19 pandemic has kept people close to home so they can avoid the contagious virus. But the National Oceanic and Atmospheric Administration predicts a more active than normal hurricane season. It is also wildfire season for those living in the Western half of the United States. So now's the best time to prepare for health care needs if an emergency requires leaving home to seek safe shelter elsewhere. The Atlantic hurricane season typically starts in June and goes through the end of November. The Eastern Pacific hurricane season usually runs from mid-May to the end of November. Already, there have been three named storms, including Cristobal. NOAA predicts 13 to 19 named storms bringing heavy rain and wind. Six to 10 could become hurricanes, according to NOAA, including three to six major hurricanes. "Major" is defined as category 3, 4, or 5, with winds of at least 111 miles per hour. For those living in the Rocky Mountains, Texas, and the West Coast, wildfires are of particular concern. Peak season is from May through October. More wildfires occur in eastern and central states, according to the National Interagency Fire Center, or NIFC. Wildfires in the West are larger and burn more acreage, the NIFC said. Health.mil External Link

    Global experts: Ignoring airborne COVID spread risky

    6 July- The lack of universal recognition that COVID-19 is transmitted via airborne particles, along with unclear infection-prevention recommendations, have led to a false sense of security that is putting the public at risk—especially amid reopening's of workplaces, schools, and colleges, according to a research letter published today in Clinical Infectious Diseases. Study authors Lidia Morawska, PhD, MSc, director of the International Laboratory for Air Quality and Health at the World Health Organization (WHO) Collaborating Centre in Brisbane, Australia, and Donald Milton, MD, DrPH, MOH, of the University of Maryland in College Park, said they implore the medical community and policymakers to acknowledge that SARS-CoV-2 can spread through the inhalation of microscopic respiratory droplets within 2 meters (6.6 feet) or close to the infectious person. Another 237 scientists from around the world signed the research letter, which states that studies have demonstrated "beyond all reasonable doubt" that viruses released during normal breathing, talking, and coughing are small enough to remain airborne and pose an infection risk to others nearby. For example, at usual indoor airspeeds, a 5-micrometer (μm) (0.005-millimeter) particle can travel throughout a typical-sized room, settling from a height of about 1.5 meters (roughly 5 feet) onto the floor.  Lisa Brosseau, ScD, a nationally known expert on respiratory protection and infectious diseases and author of a commentary on COVID-19 transmission published by CIDRAP, said that the airborne route is traditionally defined as inhalation of respiratory pathogens only at a distance from the source. The study authors argue that there is plenty of evidence to indicate that infectious people generate lots of small particles, too, which remain near the source for long periods of time, said Brosseau, who calls this "aerosol transmission." Brosseau is a research consultant for the University of Minnesota's Center for Infectious Disease Research and Policy, which publishes CIDRAP News. CIDRAP External Link

    Sobering data on risks of short-term oral Corticosteroids

    6 July- Corticosteroid bursts as short as 2 weeks or less were still linked to severe adverse events among relatively healthy users, according to a large study from Taiwan. For people taking oral steroids over a median 3 days, the risk of such events was elevated in the 5-30 days after steroid therapy initiation compared with the reference period (5-90 days before initiation):

    - GI bleeding: 27.1 per 1,000 person-years (incidence rate ratio 1.80, 95% CI 1.75-1.84)

    - Sepsis: 1.5 per 1,000 person-years (IRR 1.99, 95% CI 1.70-2.32)

    - Heart failure: 1.3 per 1,000 person-years (IRR 2.37, 95% CI 2.13-2.63)

    Patients with and without comorbid conditions experienced similar increases in adverse events following their steroid bursts. While risk attenuated somewhat during days 31-90, it remained elevated, reported Tsung-Chieh Yao, MD, PhD, of Chang Gung Memorial Hospital in Taoyuan, and colleagues in the Annals of Internal Medicine. "Our findings are important for physicians and guideline developers because short-term use of oral corticosteroids is common and the real-world safety of this approach remains unclear," according to the investigators. Notably, one corticosteroid that fits the bill is dexamethasone, now commonly used as a COVID-19 treatment. The NIH currently recommends dexamethasone 6 mg/day for up to 10 days in COVID-19 patients under mechanical ventilation (dexamethasone is not recommended for people not requiring supplemental oxygen). "We are now learning that bursts as short as 3 days may increase risk for serious AEs [adverse events], even in young and healthy people. As providers, we must reflect on how and why we prescribe corticosteroids to develop strategies that prevent avoidable harms," according to Beth Wallace, MD, and Akbar Waljee, MD, both of the VA Ann Arbor Healthcare System and Michigan Medicine. MedPage Today External Link

    Study finds COVID-19 patients who took hydroxychloroquine were less likely to die

    3 July- Newly released research found that coronavirus patients who took the anti-malarial drug hydroxychloroquine were more likely to survive while being treated in a hospital. The study, conducted by the Henry Ford Health System in southeast Michigan, measured the mortality rates and treatments of 2,541 patients representing a mix of races, genders, and ages. The research team found that 26% of patients who were not given hydroxychloroquine died compared to 13% of those who were taking the drug. The median age of those studied was 64. "In this multi-hospital assessment, when controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin was associated with reduction in COVID-19 associated mortality," the study's authors wrote. The peer-reviewed study was published this week in the International Journal of Infectious Diseases.  The study adds texture to the findings of the Department of Veterans Affairs in a study that showed an increased mortality rate among veterans who were taking the anti-malarial drug. The agency noted that the veterans were at a higher risk because of underlying conditions. Public officials and media pundits have been highly critical of the drug's use during the pandemic because there has been no proven science behind its ability to combat or ward off the coronavirus. The Food and Drug Administration even issued a warning about using the drug to treat the coronavirus outside of a hospital setting or clinical trial, saying it could cause heart rhythm problems. The FDA issued an emergency use authorization that allowed hydroxychloroquine samples donated to the Strategic National Stockpile to be used to treat COVID-19 patients while a clinical trial was unavailable, but it was revoked last month. The agency said its legal criteria for the EUA were no longer being met because it determined the drug was unlikely to be effective in treating the coronavirus. The FDA also noted that the drug may cause other hazardous health effects. Washington Examiner External Link

    Trial of Moderna Covid-19 vaccine delayed, investigators say, but July start still possible

    2 July- A 30,000-patient trial of Moderna's coronavirus vaccine candidate, expected to start next week, has been delayed, a potential hurdle in the company's ambitious effort to deliver key data by Thanksgiving. Moderna is making changes to the trial plan, called a protocol, which has pushed back the expected start date of the Phase 3 study, according to investigators. The investigators, who spoke on condition of anonymity, emphasized that protocol changes are common but said it's not clear how long the start will be delayed. "My understanding was that they wanted to get the first vaccines given in July, and they say they're still committed to do that," one investigator said. "As best I can tell, they're close to being on target for that."  Investigators at the University of Illinois at Chicago had previously said Moderna's trial would begin July 9. On Thursday, NIH Director Francis Collins also told lawmakers in Washington that the study would begin this month.  Moderna did not respond to multiple emails asking about how long the delay will last, the nature of the protocol changes, or whether they have anything to do with the vaccine's safety or manufacturing. After publication, CEO Stéphane Bancel told CNBC that Moderna still intends to start the trial in July. In a statement posted to Twitter on Thursday afternoon, the company said it has "worked closely" with the National Institutes of Health, which is funding the Phase 3 study, "to align the final protocol in order to begin the trial on time." Stat News External Link

    U.N. predicts rise in diseases that jump from animals to humans

    6 July- A new United Nations report warns that more diseases that pass from animals to humans, such as COVID-19, are likely to emerge as habitats are ravaged by wildlife exploitation, unsustainable farming practices and climate change. These pathogens, known as zoonotic diseases, also include Ebola, MERS, HIV/AIDS and West Nile virus. They have increasingly emerged due to stresses humans have placed on animal habitats, according to the U.N. Environment Program report Preventing the Next Pandemic: Zoonotic diseases and how to break the chain of transmission, released on Monday. "We have intensified agriculture, expanded infrastructure and extracted resources at the expense of our wild spaces," UNEP Executive Director Inger Andersen said. "The science is clear that if we keep exploiting wildlife and destroying our ecosystems, then we can expect to see a steady stream of these diseases jumping from animals to humans in the years ahead." Andersen said that investing in research of zoonotic diseases would allow the world to get "ahead of the game ... preventing the type of global shutdown we've seen." NPR External Link

    INFLUENZA

    WHO: Influenza Update

    06 July 2020 - Update number 371, based on data up to 21 June 2020:

    - The current influenza surveillance data should be interpreted with caution as the ongoing COVID-19 pandemic might have influenced to varying extents health seeking behavior's, staffing/routines (including case definitions and sampling strategies) in sentinel sites, testing priorities and capacities in Member States as well as reporting of surveillance data. The various hygiene and physical distancing measures implemented by Member States to reduce SARS-CoV-2 virus transmission might also have played a role in mitigating influenza virus transmission.

    - Globally, influenza activity was reported at lower levels than expected for this time of the year. In the temperate zone of the northern hemisphere, influenza activity returned to inter-seasonal levels while in the temperate zones of the southern hemisphere, the influenza season has not commenced.

    - In the Caribbean and Central American countries, no influenza detections were reported in most reporting countries. Severe acute respiratory infection (SARI) activity was reported at an extraordinary level in Honduras.

    - In tropical South American and tropical Africa, there were no or sporadic influenza virus detections across reporting countries.

    - In Southern Asia and South East Asia, no influenza detections were reported

    - Worldwide, seasonal influenza A viruses accounted for the majority of detections. WHO External Link 

    VETERINARY/FOOD SAFETY

    Five children hospitalized in backyard poultry Salmonella outbreak

    3 July- Five children needed hospital treatment in an Australian state as part of a Salmonella outbreak linked to backyard poultry. Queensland Health is investigating Salmonella Typhimurium infections predominantly among young children that had contact with backyard chickens. As of June 26, there had been 17 cases reported across the state. Thirteen of these were children aged 11 years or younger. Five were hospitalized because of their illnesses. Supplier investigation continuing Dr. Alun Richards, acting executive director, Communicable Diseases Branch, Prevention Division at Queensland Health, said most patients reported handling chicks purchased in the two-week period prior to their illness. "These chicks have been obtained from a range of produce and pet stores in Queensland. The investigation into the supplier of chicks to these stores is ongoing. Backyard poultry can harbor and shed Salmonella that cause illness in humans, even though the birds are healthy and clean," he said. Food Safety News External Link

    Recall of Fresh Express salads in Canada for cyclospora updated

    7 July- The recall of Fresh Express salad products in Canada for possible cyclospora contamination has been updated to include the correct UPC numbers, package sizes, and expiration dates. No illnesses have been reported in Canada, but there is a cyclospora outbreak in the U.S. potentially linked to Fresh Express salads. All of the recalled products have a lot code beginning with "Z 177" or a lower number. They are all Fresh Express brand. The corrected numbers are labeled with a *. The recalled salads are Chopped Kit Chipotle Cheddar in 323 gram packages with UPC number 0 71279 30931 6* and all best before dates up to and including July 8*, 2020; American in 312 gram packages and UPC number 0 71279 24100 5* with all best before dates up to and including July 11, 2020*; Chopped Kit Thai 'N' Cashews in 332 gram packages, with UPC number 0 71279 30925 5*, and all best before dates up to and including July 11, 2020*; and Veggie Lover's in 312* gram packages with UPC number 0 71279 28106 3* and all best before dates up to and including July 11, 2020*. Also recalled are Chopped Kit Sunflower Crisp in 315 gram packages with UPC number 0 71279 30933 0* and all best before dates up to and including July 11, 2020*; Iceberg Garden in 680 gram packages with UPC number 0 71279 10411 9* and all best before dates up to and including July 12, 2020*; Iceberg Garden in 340 gram packages with UPC number 0 71279 10302 0* and all best before dates up to and including July 12, 2020*; and Shreds Iceberg* in 227* gram packages, with UPC number 0 71279 15101 4* and all best before dates up to and including July 12, 2020*. Finally, Green & Crisp is recalled, sold in 312 gram packages, with UPC number 0 71279 10813 1* and all best before dates up to and including July 12, 2020*; Chopped Kit Asian in 340 gram packages with UPC number 0 71279 30929 3* and all best before dates up to and including July 13, 2020*; Chopped Kit Southwest in 326 gram packages with UPC number 0 71279 30930 9* and all best before dates July 12, 2020*; and 3 Colour Deli Cole Slaw* in 397 gram packages, with UPC number 0 71279 12302 8* and all best before dates up to and including July 14, 2020*. If you purchased any of these products don't eat them. Throw them away in a secure garbage can or take them back to the place of purchase for a full refund. Food Poisoning Bulletin External Link 

    State recalls, quarantines raw milk because of Campylobacter

    2 July- California officials have recalled and quarantined raw milk from Valley Milk Simply Bottled because tests have shown it to be contaminated with Campylobacter jejuni. State Veterinarian Dr. Annette Jones announced the recall and quarantine today in a public alert. She warned consumers about the dangers in the alert. There is concern that some people may have unused portions of the unpasteurized milk in their homes. "Consumers are strongly urged to dispose of any product remaining in their refrigerators that were purchased or received on June 19 through June 30, or any product with a code date marked on the container of July 9 or earlier," Jones said. The affected raw milk is distributed in one-gallon plastic jugs under the labels "Valley Milk Simply Bottled Raw Milk" and "DESI MILK Raw Milk." The California Department of Food and Agriculture found the campylobacter bacteria in a routine sample of packaged products collected at the Valley Milk Simply Bottled production and packaging facility. No illnesses have been reported to date. It is against federal law to engage in interstate sales of raw milk, but some states allow the sale of it within their borders. California allows the sale of unpasteurized, raw milk at retail stores, but warning signs must be posted. Anyone who has consumed any of the recalled raw milk should monitor themselves for symptoms of Campylobacter infection. Children who were served the milk should also be monitored for illness. Symptoms of campylobacteriosis include diarrhea, abdominal cramps, and fever. The illness usually occurs 2 to 5 days after exposure to campylobacter and lasts about a week. In some people with compromised immune systems, it can cause a serious, life-threatening infection. A small percentage of people may have joint pain and swelling after infection. Also, a rare disease called Guillain-Barre syndrome that causes weakness and paralysis can occur several weeks after the initial illness. Food Safety News External Link

    WELLNESS

    Five kinds of health appointments you should consider keeping, despite the pandemic

    2 July- Most Americans made a lifestyle U-turn several months ago because of the potential risks posed by the coronavirus pandemic. Activities that once were a given in our day-to-day lives have become less common or have disappeared altogether — such as going out to dinner, taking in a movie or shopping for something other than food. But we've also stopped doing tasks that can affect our health and well-being — such as keeping appointments with doctors, dentists, physical therapists and more. Now that it's clear that the coronavirus waves are going to keep coming, here are five health practices that experts say you might want to reconsider delaying.

    - Cancer screenings

    - Dental visits

    - Physical therapy

    - Blood tests

    - Emergency room visits The Washington Post External Link 

    How safe are outdoor gatherings?

    3 July-  As the coronavirus continues to rage throughout the country, public health officials are telling us to stay home this holiday weekend. Beaches in Texas, Florida and California are closed. And now some recent backyard gatherings are being blamed for new cases of Covid-19. The new restrictions and outbreaks have led to new confusion about the safety of socializing outdoors. But experts say the science hasn't changed: Your risk of catching the virus is much lower outdoors than indoors. If you want to spend time with friends, taking the party outside will reduce your risk of contracting Covid-19. "Outside is definitely safer," said Erin Bromage, a comparative immunologist and biology professor at the University of Massachusetts, Dartmouth. "But it's the type of interactions you have when you're outside that are important." A Japanese study of 100 cases found that the odds of catching the coronavirus are nearly 20 times higher indoors than outdoors. Outdoor gatherings lower risk because wind disperses viral droplets, and sunlight can kill some of the virus. Open spaces prevent the virus from building up in concentrated amounts and being inhaled, which can happen indoors when infected people exhale in a confined space for long stretches of time, said Dr. Julian W. Tang, a virologist at the University of Leicester. The New York Times  External Link

    Prevent dehydration this summer with this doctor's simple advice

    6 July- With years of experience in emergency medicine, Dr. Bonnie Simmons, now ProHEALTH's Chair of Urgent Care, would always travel with water, toting a bottle to meetings and taking sips in between seeing patients.  "That is a challenge now because we're nervous. We're nervous to take the mask off and to drink liquids," Simmons told Fox News. As scorching summer days ensue and states enforce face masks amid spiking cases, Simmons offers advice on staying hydrated this season. Common warning signs of dehydration can include a headache, rapid pulse and fatigue. Some people may feel jittery and a dry mouth can come later on, Simmons said. According to the Centers for Disease Control and Prevention (CDC), water helps the body regulate temperature, cushion joints, protect the spinal cord and remove waste. Simmons' key advice this summer is to make a habit of consuming at least half a bottle of water before putting on a mask and heading out. "If you notice three hours have gone by, try to get yourself outside and drink water again. I think drinking and walking, drinking and working, that's where the challenge is," she said. "We have to separate it."  The two extremes of age, children and the elderly, tend to dehydrate more quickly, Simmons said. Some elderly people may have lost a mechanism in the brain signaling for thirst. While younger people wake up in the morning thirsty, the elderly may not feeling thirsty at all, she said. "Combine that with coronavirus, face masks, and not having access to water, it brings even more trouble," Simmons told Fox News. As for children, parents may be more concerned about their child's' safety during playtime with face masks as opposed to liquid intake, and understandably so, Simmons says. Nevertheless, she advises having white, light clothing and a baseball cap in addition to proper hydration. "We're not even at the point where we're talking about collapsing, or lack of sweating, or runners who don't drink enough water," she said, emphasizing the importance of prevention. "I think that the issues here today are way earlier and that's why we're worried." Fox News External Link

    USAFRICOM

    DRC: Ebola outbreak #11- Cases and deaths rise, UN report on zoonotic diseases released

    7 July- Since our last report on the Ebola Virus Disease (EVD) outbreak in Equateur province, Democratic Republic of the Congo (DRC) Friday, the number of total cases has risen from 34 to 41. According to the DRC Ministère de la Santé Monday, 41 EVD cases have been reported since the outbreak started on June 1 (38 confirmed, 3 probable). 17 deaths have been recorded and 4 patients have recovered. Outbreak News Today External Link

    USCENTCOM

    Israel: Gantz isolates after coronavirus exposure- Live updates

    8 July- Israeli defense minister, Benny Gantz, has said he entered quarantine as a precautionary measure due to suspected exposure to a person infected with the coronavirus. Al Jazeera External Link

    USEUCOM

    Bulgaria: Reports 1st Crimean-Congo hemorrhagic fever case of the year

    4 July- Officials with the Bulgarian National Centre for Infectious and Parasitic Diseases reported a Crimean-Congo hemorrhagic fever (CCHF) case during the week of June 7.  This is the first CCHF case reported in 2020 in Bulgaria. During the same period in 2019, officials reported two cases. Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10–40%. Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus Hyalomma are the principal vector. The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible. Outbreak News Today External Link

    USINDOPACOM

    Australia: Second largest city heads back into coronavirus lockdown

    6 July- Lockdown measures were reimposed in Australia's second biggest city on Tuesday, confining Melbourne residents to their homes unless undertaking essential business for six weeks, as officials scramble to contain a coronavirus outbreak. The decision, which affects around 4.9 million people, was announced just hours before the busy border between Victoria, of which Melbourne is the capital, and New South Wales is scheduled to close for the first time in a century. From midnight on Wednesday, everyone in Melbourne will be required to stay home unless travelling to work, studying, shopping for food or attending medical appointments. Restaurants, cafes and bars will be able to provide takeaway service only, gyms and hair salons closed, household gatherings limited to two people and the current school vacation extended. Victoria Premier Daniel Andrews said the restrictions were onerous but necessary. "I would, with the greatest of respect, put it to you getting this virus and dying from it is very onerous too," he said during a televised media conference. Victoria was responsible for 191 of the 199 new cases reported nationally on Tuesday, the biggest one-day rise since early April. The spike has worried officials, even though the national total of almost 8,800 cases and 106 deaths is far below many other countries. Reuters External Link

    China: Suspect bubonic plague case reported in Inner Mongolia

    6 July- The Health Commissioner of Bayannaoer in Inner Mongolia, China has reported (computer translated) a suspect case of bubonic plague. No information about the patient has been released.  This has prompted health authorities to announced to launch a level III emergency response to prevent and control the plague Sunday. The alert also announces (translated): At present, there is a risk of the spread of human plague epidemic in the city. The general public is requested to strictly follow the requirements of the "three no three reports" of plague prevention and control , and effectively do personal protection and improve self-protection awareness and ability. Unauthorized hunting of epidemic animals, non-peeling of epidemic animals, unauthorized carrying of epidemic animals and their products out of the epidemic area; reporting of diseased (dead) marmots and other animals, reporting of suspected plague patients, and unidentified causes Patients with high fever and sudden death should be reported. It is necessary to enter the plague epidemic source cautiously. If you have a history of living in the plague epidemic source, you should go to a designated hospital in a timely manner if you experience fever and other uncomfortable symptoms. Outbreak News Today External Link 

    Philippines: Reports 2,000+ COVID-19 cases, Manila area hospitals reach full capacity

    6 July- The Department of Health (DOH) in the Philippines reported an additional 2,099 COVID-19 cases today, which include 1258 "fresh" cases and 841 "late" cases. In addition, six additional fatalities were reported. The COVID-19 total for the Philippines are 46,333 cases and 1303 deaths as of July 6. The total number of active cases are now 32,845, or about 70 percent of the total. The DOH also reported today that a number of Manila area hospitals have reached full capacity of their COVID-19-dedicated beds. Health Undersecretary Maria Rosario Vergeire said 11 hospitals–Veterans Memorial Medical Center, UST Hospital, University of Perpetual Help Medical Center, Tondo Medical Center, Seamen's Hospital, Philippine Children Medical Center, Metro North Medical Center and Hospital, Las Piñas Doctors Hospital, De Los Santos Medical Center, Chinese General Hospital and Medical Center and Capitol Medical Center–are at 100% utilization rate of their COVID-19-dedicated ICU beds. Several other hospitals are not far off from that mark. Vergeire explained that this is not equivalent to the entire capacity of the said hospitals as they only have a certain number of beds designated for COVID-19 patients. "When we talk about the percentage of beds that had been occupied already, it is not equivalent to the entire capacity of the hospital. Here, we are just referring to the dedicated beds for COVID (patients)," she said. Overall, the critical care utilization rate in Metro Manila stands at 63.41%, although higher from the nationwide average, the DOH said this level is characterized as "moderate risk," Vergeire said. Outbreak News Today External Link

    Sri Lanka and Maldives: Eliminate measles and rubella

    8 July- The World Health Organization (WHO) announced today that Maldives and Sri Lanka were verified having eliminated rubella, making them the first two countries in WHO South-East Asia Region to achieve measles and rubella elimination ahead of the 2023 target.  The announcement was made after the fifth meeting of the South-East Asia Regional Verification Commission for Measles and Rubella Elimination. "Protecting all children against these killer and debilitating diseases is an important step in our endeavor to achieve healthier population and health for all," said Dr. Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region, congratulating Maldives and Sri Lanka on their achievement. The UN agency said a country is verified as having eliminated measles and rubella when there is no evidence of endemic transmission of the measles and rubella viruses for over three years in the presence of a well performing surveillance system. Maldives reported last endemic case of measles in 2009 and of rubella in October 2015, while Sri Lanka reported last endemic case of measles in May 2016 and of rubella in March 2017. Bhutan, DPR Korea and Timor-Leste are other countries in the Region who have eliminated measles. Outbreak News Today External Link

    USNORTHCOM

    U.S.: Los Angeles COVID-19- With the relaxation of Safer at Home orders, mass protests, the potential for community transmission will increase

    6 July- Los Angeles County health officials reported an increase of 7,232 new cases for Thursday, Friday and Saturday. Friday marks the highest report of new cases to date with 3,187 new cases of COVID-19. This brings the total COVID-19 cases in the county to 114,993. As of Saturday, July 4, there are 1,921 people confirmed with COVID-19 currently hospitalized, 28% of these people are in the ICU and 18% are on ventilators. There were 1,947 reported as of Friday, July 3 and 1,933 for Thursday, July 2. This remains higher than the 1,889 reported last week. With the addition of 30 deaths Saturday, this total has risen to 3487. With the relaxation of Safer at Home orders allowing more businesses and workplaces to reopen as well as the mass protests that are ongoing in LA County, the potential for community transmission of COVID-19 will increase. In order to prevent a new surge in hospitalizations and deaths from COVID-19, it is critical that we remind everyone of the need to redouble our prevention and control efforts during this time. Public Health urges everyone to avoid the Three C's: Crowded places, Confined spaces and Close contact with others not in your household. Everyone should always wear a face covering securely over your nose and mouth and keep six feet apart from others not in your household when out in public. Businesses must continue to follow Public Health directives. Public Health reminds everyone that you remain safer at home. Public Health updated the houses of worship protocol in the Health Officer to align with the governor's directive. Singing and chanting are prohibited for indoor services. Outbreak News Today External Link

    U.S.: Miami- Rolls back restaurant dining as U.S. coronavirus deaths top 130,000

    6 July- Florida's greater Miami area became the latest U.S. coronavirus hot spot to roll back its reopening, ordering restaurant dining closed on Monday as COVID-19 cases surged nationwide by the tens of thousands and the U.S. death toll topped 130,000. Restaurants also were targeted for a weekend crackdown on coronavirus enforcement in California, where hospitalizations for COVID-19 have jumped 50% over the past two weeks and the state capitol building in Sacramento was temporarily closed for deep cleaning. For an eighth straight day, Texas registered an all-time high in the number of people hospitalized at any one moment with the highly contagious respiratory illness, up more than 500 admissions from the day before to nearly 8,700. The U.S. military said it would deploy a special 50-member medical team, including emergency room and critical-care nurses and respiratory specialists, to a hard-hit area in and around San Antonio. California, Texas and Florida are all among two dozen states reporting high infection rates as a percentage of diagnostic tests conducted over the past week, an alarming sign of a virus still spreading largely unchecked throughout much of the country. "It's a serious situation that we have to address immediately," Dr. Anthony Fauci, the nation's top infectious disease specialist and member of the White House coronavirus task force, said during a live internet interview on Monday. Reuters External Link

    USSOUTHCOM

    Brazil: COVID-19 cases near 1.6 million, 91% of those infected had some symptoms according to survey

    5 July- Brazilian health officials report that as of Saturday, 1,577,004 confirmed COVID-19 cases have been reported with the additional 37,923 registered in the last 24 hours. Authorities also report 876,359 people have recovered and the death toll has risen to 64,265. In a survey published on Thursday by the Ministry of Health, they report that 91% of people infected with COVID-19 had some type of symptom. Among them, are changes in taste and smell (62.9%); headache (62.2%), fever (56.2%) and cough (53.1%), palpitation (23.1%) and vomiting (23.1%). The study "Evolution of the Prevalence of Infection by COVID-19 in Brazil: Population-Based Study", funded by the Ministry of Health, was carried out by the Federal University of Pelotas. The executive secretary of the Ministry of Health, Elcio Franco, said that the epidemiological survey study is one of the largest in the world and that it will contribute to providing information on the behavior of the virus. "It is a contribution of Brazil to the international scientific community, and managers and health professionals, in the search for adequate solutions to fight the coronavirus", he highlighted. "We are taking another important step with this study. Brazil shows once again its commitment and desire to contribute to the world in information and answers that can be given ", said the secretary. According to him, other elements still need to be analyzed to understand the dynamics of the disease and the transmission of people. "To show the complexity of the analysis that requires the numbers, the study points out that 91% of those infected felt some type of symptom. Again, we will need to understand how the data was captured, since it confronts other studies ", he explained.  The survey showed that the lethality of the infection is 1.15%. That is, for every 100 people infected, one dies. It also revealed that the difference between the number of infected people is six times greater than the number of reported cases. "This is expected, when the majority of cases are mild or asymptomatic, which must be compared with other studies available since other estimates pointed to a higher number for this so-called underreporting," explained the secretary. The result by socioeconomic level, as the study points out, is striking. The poorest 20% of the population had twice as much infection as the richest 20% during the three phases of the survey. The reason should be analyzed in the coming weeks, but, according to the Ministry, there may be, for example, the agglomeration and the number of rooms in the residence. The secretary stressed that the spread of the disease on the poorest shows the importance of offering decentralized assistance. "We need municipalities to adhere to community centers, which will enable closer service to the citizen and assistance before the disease progresses in severity. We need to adequately protect this part of society ". Outbreak News Today External Link 

    Peru: COVID-19 cases top 300K, hundreds of police officers died

    5 July- The Peru Ministry of Health (Minsa) reports in an update today that the country COVID-19 case count has topped 300,000.  As of July 5, 2020, 302,718 positive COVID-19 cases have been reported out of 1,782,846 people tested. To date, there are 11,302 hospitalized patients with COVID-19, of which 1,227 are in the ICU with mechanical ventilation. More than half the cases are reported in Lima (165,307). 10,589 people in the country have died from COVID-19, according to health authorities. Recently, Peru Interior Minister Gastón Rodríguez said 223 policemen died from COVID-19 in 100 days of state of emergency. Another 15,600 were infected during their surveillance work on the streets to comply with the immobilization in force for 100 days, according to the minister. Outbreak News Today External Link