Army Public Health Weekly Update, 11 December2020

Date Published: 12/11/2020
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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 

    Army-specific Coronavirus (COVID-19) Information

    Get all the Army-specific information and communication resources related to COVID-19 from the Army Public Health Center. APHC

    U.S. MILITARY

    Coronavirus vaccines for US troops may be available on a voluntary basis

    7 December- U.S. service members will have to volunteer if they want early access to coronavirus vaccines under emergency or early use guidelines set by the Food and Drug Administration, according to the Defense Department. At least three vaccines are better than 90% effective against COVID-19, the respiratory disease caused by the coronavirus, according to news accounts. The U.S. military is planning to distribute two vaccines that are pending FDA approval. Vaccines could become available soon. The FDA takes up a request Thursday for emergency use of the vaccine developed by Pfizer-BioNTech, according to the FDA docket online. The United Kingdom last week approved its use on a temporary, emergency basis, the first country to do so. Moderna has also applied for permission to field its vaccine on an emergency use basis. An FDA committee meets on that application Dec. 17.  Vaccines available on a trial basis will probably be administered first to volunteers, according to a Defense Department statement given to Stars and Stripes on Thursday by Yokota Air Base in western Tokyo. The Defense Department expects quantities will be "limited initially and distributed on a rolling delivery basis as more vaccines become available," according to the email from base spokesman Lt. Stuart Thrift. Inoculations will be voluntary until the vaccines are finally approved by the FDA, according to the DOD statement he provided. Anyone who requests the vaccine will be required to give informed consent, meaning they must confer with their doctor to receive it, according to a Nov. 26 report by Military.com. The report quoted Col. Jessica Spitler, 30th Medical Group commander, who spoke at a town hall on Nov. 6. Inoculations may remain voluntary as long as two years, Military.com quoted Spitler as saying. Stars and Stripes External Link

    COVID-19 pooled testing strategy helps Army leaders protect the force

    4 December- Although much attention in the media of late has been focused on COVID-19 vaccine candidates, a critical element in helping the Army maintain operational readiness is the ability to rapidly test large numbers of asymptomatic Soldiers in order to ensure units can safely train and deploy together. The Army Public Health Center is helping to lead this effort by supporting the Army Forces Command Combat Training Center through pooled sample testing. "At APHC, we conduct pooled surveillance testing, which means that we get large numbers of samples from asymptomatic individuals, and then we test those samples in groups, or "pools", of up to 10 combined samples at once," said Dr. Robyn Nadolny, APHC biologist and program coordinator for the COVID-19 Surveillance Testing Program. "When we see a positive result, that means a person (or multiple people) that were in that pooled sample are likely infected with the virus." The individuals in that pool are then sent to a clinic to have an individual test done, said Nadolny. This allows APHC to rapidly test large numbers of samples, and saves the healthcare workers at installation clinics time and reagents that are often in short supply. "We allow the clinics to focus on testing symptomatic patients, and we focus our efforts on finding those individuals who feel just fine, but are infected with the virus and may be unknowingly spreading it to their close contacts," said Nadolny. "This approach allows us to find those asymptomatic infections, so that those individuals can self-isolate and stop the spread of the virus." APHC is working with the other Army Public Health Labs around the globe to stand up a network of Public Health Labs that can support this kind of asymptomatic pooled surveillance testing. APHC began testing in July, and the lab at Public Health Command Atlantic (Fort Meade) began testing samples using similar methods in October. "We expect the labs at Public Health Command Central and Public Health Command Pacific to be operational in the next few months," said Nadolny. "Public Health Command Europe was the first lab to conduct this kind of testing, in the late spring of 2020." DVIDS External Link 

    DOD continues to increase COVID-19 test capacity

    7 December- The Department of Defense has increased its overall capacity to conduct tests for COVID-19 by nearly 50% since July, according to the lead for the Coronavirus Task Force diagnostics and testing effort. Air Force Maj. Gen. (Dr.) Lee Payne told a Pentagon press conference Nov. 24 that there are 158 operational laboratories with the overall capacity to conduct nearly 300,000 tests per week within the Military Health System. That compares to July numbers of 125 global labs certified for COVID-19 testing with the ability to perform more than 200,000 tests per week. In March as the first wave of the pandemic spread, there were only 15 testing sites able to perform 1,000 tests per week. DOD is "regularly able to complete over 99% of their prior tests each week," Payne said, despite supply shortages that are occurring in all the United States. DOD "has taken key steps to identify critical points in this supply chain and appropriate actions to mitigate these shortages throughout each phase of the pandemic," he said. "We will continue to lead from the front, identifying and investing in new technologies that will allow the department to accomplish our missions and protect our force and families," Payne said. Innovations allowing this high rate of completed tests include moving from the gold standard molecular COVID-19 PCR (polymerase chain reaction) tests to new technology such as point-of-care molecular tests, oral swab, and quick blood antigen tests. Army Col. Mikal Stoner, the acting DHA Lab Division chief, said in a statement: "Using our large DOD labs with higher throughput allowed more testing to occur with less staffing resources, in addition to adding more testing locations and platforms throughout DOD." In addition, she noted, an MHS Lab Survey was created early on that allowed a view of supplies and testing numbers across all of MHS, including operational units. Moving toward the future, "we are looking into surveillance pooling models, which use fewer resources and better support commands and their surveillance mission," Stoner said. Health.mil External Link

    Psychological health specialist there for Airmen, Soldiers wellness during the holidays

    4 December- The Michigan Department of Veterans Affairs and Michigan National Guard have the responsibility of supporting and protecting those who defend our country, and so it is imperative that everything possible is done to prevent suicide in the military community. With the holiday season on the horizon and COVID-19 restrictions adding challenges to mental health due to social distancing and travel restrictions, additional stressors have been created. "The holidays are traditionally when everyone can take time off from work and connect with people they care about and break their routine and travel," said Sonya Bilski, director of psychological health (DPH), Michigan Air National Guard. "With COVID-19 surging across most of the country, these activities aren't safe at this time." The coronavirus disease outbreak is unparalleled in its impact on our collective way of life. "We are living in unprecedented times and it is important to take care of ourselves – both physically and mentally," said Heather L. Nystrom, DPH, Michigan Army National Guard. "Paying attention to what our needs are and acting accordingly will help with monitoring our interpersonal and intrapersonal needs." The psychological health office's primary focus is on the Guard member. The health program's four goals are to improve mental health, ensure ready access to care, improve value of mental health care delivery through standardization, and provide short-term, solution-focused support to members who are experiencing interpersonal difficulties. DVIDS External Link

    Researchers develop model to estimate COVID-19 mortality risk in veterans

    7 December- Healthcare professionals can estimate who is at most risk for dying from COVID-19, including seniors and those with a variety of health conditions. However, until recently, that estimate has mostly been based on judgment and experience. That may change with new work led by Joseph King Jr., MD, MSCE, associate professor of neurosurgery at the Yale School of Medicine, and chief of neurosurgery at the VA Connecticut Healthcare System. In a paper titled "Development and validation of a 30-day mortality index based on pre-existing medical administrative data from 13,323 COVID-19 patients: The Veterans Health Administration COVID-19 (VACO) Index," published on November 11, 2020, in the journal PLOS One, researchers developed the Veterans Health Administration COVID-19 (VACO) Index. The index is a formula that uses age, gender, and pre-existing medical conditions to estimate a patient's risk of death over 30 days. This tool provides valuable quantitative data that could identify high-risk patients to health care providers and prompt them step up monitoring or treatment or recommend that someone take extra care to prevent exposure to the virus. Medical Express External Link

    Robotic surgeries are changing the game inside one VA facility

    4 December- Patients who undergo operations on organs inside their chests—thoracic surgeries—often endure long recovery periods and invasive procedures doctors perform intricately by hand. But for some of those surgeries this year at the Columbia Veterans Affairs Health Care System in South Carolina, incisions were made and patients' insides were mended by the arms of a robot.  The Da Vinci XI robotic surgical system has been assisting the Veterans Affairs Department's medical personnel there with procedures for months now, and according to those involved, it's enabling a new level of precision and accelerating patients' recoveries. "Overwhelming evidence has shown certain operations have equal or better surgical results using the robot compared to traditional methods," Dr. JW R. Bolton, chief of surgery at the Columbia VA HCS, told Nextgov via email Friday. "The Columbia VA wanted to provide veterans with the latest, state-of-the-art technology found at other private sector hospitals and improve our patient care for veterans in need of surgery." The health care system's surgery department explored the possibility of introducing a robotics-driven surgical program over the course of a few years, and building on that, the broader Columbia-based system worked directly with VA Central Office more recently to establish the new program within the facility. Bolton explained that at the end of fiscal year 2019, an opportunity arose to purchase the robotic surgical system for approximately $2.3 million through facility funds, which was subsequently reviewed and approved. More traditional methods of thoracic procedures can require long, uncomfortable stays at the hospital and much more than what happens via this assistive machine. In this method, the robot is steered by the surgeon "from an arcade-like control panel," as VA's release put it. The technological tool is able to make four small incisions—about the size of a paperclip—through which its four robotic arms are inserted. Nextgov External Link

    Veterans with PTSD face tougher time dealing with pandemic stress

    6 December- The pandemic has caused many of us to be exposed to extreme mental and emotional stress, but for military veterans already suffering from post-traumatic stress disorder, it can be even worse. But there's help. Former Staff Sgt. Marilyn Harris was a U.S. Army nurse in Operation Desert Shield 30 years ago. She saw a lot. "Body parts, charbroiled people, dead people," Harris said. "Those images are part of the architecture of my brain. I have post-traumatic stress disorder." Since her service, Harris has been through a lot, including years of therapy provided by the veterans' assistance organization Easter Seals. "I started with just one counseling, now we're doing three," Harris said. Harris says the COVID-19 pandemic has been a stressor for all of us, but even more so for vets. "This is a very challenging time for everyone especially for veterans, who have seen some very ugly thing," Harris said. To keep herself grounded, the veteran, mother and entrepreneur says she finds ways to stay connected. Through Easter Seals, she's able to talk through her problems, engage in guided meditations and even practice yoga. "Those services are invaluable to me," Harris said. "I haven't missed a beat. I've been able to do other things in my life to stay grounded and keep focused." Her message to others like her is simple, "Ask for help." "To vets who are trying to deal with it on their own,  stop it," Harris said. KHOU External Link

    GLOBAL

    CDC urges universal mask use while indoors amid coronavirus surge

    5 December- The Centers for Disease Control and Prevention (CDC) is urging Americans to wear masks indoors when they are not home amid a surge of coronavirus cases, hospitalizations and deaths. In a Morbidity and Mortality Weekly Report published Friday, the health agency warned that the country has entered into a "phase of high-level transmission" of the novel coronavirus.  "With colder weather, more time spent indoors, the ongoing U.S. holiday season, and silent spread of disease, with approximately 50% of transmission from asymptomatic persons, the United States has entered a phase of high-level transmission where a multipronged approach to implementing all evidence-based public health strategies at both the individual and community levels is essential," the report said. Other strategies in addition to face mask use include maintaining physical distance and limiting in-person contact, avoiding nonessential indoor spaces and crowded outdoor spaces, increasing testing to rapidly identify and isolate infected persons, contact tracing, safeguarding high-risk individuals, protecting essential workers, postponing travel, increasing room air ventilation and practicing hand hygiene, as well as widespread availability of a vaccine. Fox News External Link 

    Covid vaccine: What you need to know about vaccine safety

    8 December- One in 1,000 people in the UK have already died after being infected with coronavirus during the pandemic. This is the known threat from the disease that any risks have to be balanced against. In medicine there is an important difference between "safe" and "harmless" and between "risk" and something being "risky". And two people who were given the Pfizer vaccine had allergic reactions. So, what do we mean when we talk about Covid vaccines being "safe" to use? "If you mean absolutely no adverse effect, then no vaccine is 'safe' and no drug is 'safe'. Every effective medicine has unwanted effects" says Prof Stephen Evans, from the London School of Hygiene & Tropical Medicine. "What I mean by safe is the balance of unwanted effects compared with the benefit is very clearly in favor of the benefit." The UK's medicines regulator, the MHRA, has decided the Pfizer/BioNTech vaccine has met that standard. There are some drugs that have truly brutal consequences on the body, but are still approved because they are considered worth the risk. Chemotherapy drugs have a huge list of damaging effects include exhaustion, hair loss, anemia, infertility, memory and sleep problems. Yet when those are pitted against dying from terminal cancer, nobody questions the drugs being used. Others can have severe side-effects which are incredibly rare. The painkiller ibuprofen, which nearly all of us have at home and would take without thinking, can cause bleeding and holes to form in your stomach and intestines, difficulty breathing and kidney damage. The risks are there, but they are far outweighed by the benefits. "Safe is not an absolute thing, it is safe in the context of the usage," Prof Evans told the BBC. The key difference with vaccines is they are given to healthy people and that massively shifts the balance. Any risk has to be incredibly small. BBC News External Link

    Eluru mystery disease infects 300 people in just two days: Patients suffer from vomiting, seizures

    7 December- The new Eluru mystery disease is attacking the people of Southern India. It seems like 2020 still has some negative events up its sleeves. The mysterious illness already took one life and infected more than 300 people in the hospital in the southern Indian state of Andra Pradesh. Dozens of residents in Eluru city were infected on Saturday night, Dec. 5.  Some of them even lost their consciousness after falling ill. According to CBS News' latest report, the patients showed symptoms that are similar or associated with epilepsy. These include seizures, vomiting, and nausea. Business Today reported that the patients were admitted to the Government General Hospital or GGH, which includes several children and women. On Dec. 5, only 55 patients were admitted. The number rose to 170 on Sunday morning, Dec. 6. As of the moment, only 150 people were released. This means that half of the patients are still admitted to Eluru's hospital. Tech Times External Link

    Immunization rates dropping dramatically, much due to the COVID-19 pandemic

    6 December- The World Health Organization (WHO) and UN Children's Fund (UNICEF) warned last month that millions of children are at a heightened risk of polio and measles across the globe due to disruptions of the immunization services worldwide due to the COVID-19 pandemic.  The UN agencies say immunization rates in some countries have fallen by as much as 50 per cent, with people unable to access health services because of lockdown and transport disruptions, or unwillingness due to fear of contracting COVID-19. "COVID-19 has had a devastating effect on health services and in particular immunization services, worldwide," said Tedros Adhanom Ghebreyesus, Director-General of WHO. This prompted the UN agencies to issue a urgent call to action. They say that if left unchecked, the situation posed an "increasingly high risk of explosive outbreaks and potentially further international spread of both polio and measles." Outbreak News Today External Link 

    Make your mental health a priority this holiday season

    3 December- The holidays can be a great time to reunite with family and friends, relax, and recharge. Of course, even during a typical holiday season, extra travel, shopping, entertaining, and memories of lost loved ones may cause stress. This year, the holidays during the COVID-19 pandemic may bring added stress because the Centers for Disease Control and Protection (CDC) recommends modifying holiday plans by limiting in-person gatherings. Especially in this unusual holiday season, you should take time to think about ways to strengthen your mental health. Here are some tips and a reminder about your TRICARE coverage, which includes mental health services. "This can be a challenging season, potentially made more difficult with the pandemic," said Dr. Krystyna Bienia, a clinical psychologist and senior policy analyst at the Defense Health Agency. "It's important to take care of your mental health, just as you would your physical health, and establish or maintain healthy habits." The CDC reports that during the pandemic, "fear and anxiety can be overwhelming and cause strong emotions" and this certainly applies during the holidays as well. Making time to take care of yourself may help ease those feelings. Here are some steps to help you take care of your mental health:

    - Keep up with healthy habits. These may include getting enough sleep, eating healthy foods, and staying active.

    - Recognize your feelings and be realistic. Just because it's the holiday season, doesn't mean you have to feel jolly. Traditions, holiday plans, and your feelings may be different this year.

    - Reach out. Seek out friends or family members by phone, text, or video chats. Volunteering your time is also a way to lift your spirits while helping others.

    If you're still feeling depressed or anxious and need some help, talk to your doctor. TRICARE offers services to support your mental health needs. In addition, there are many non-clinical counseling and support services that can be very helpful. These include Military OneSource, Military Family Life Counselors, service counseling services, and chaplains. Tricare.mil External Link

    Nasal spray may mitigate coronavirus infection risk

    8 December- Auris Medical Holding Ltd. announced positive efficacy data from testing AM-301 in vitro, a drug-free nasal spray being developed for protection against airborne pathogens and allergens. AM-301 was tested for its capability to prevent or mitigate SARS-CoV-2 virus infection of nasal epithelial cells, which are part of the nasal mucosa and the first barrier against continuously inhaled substances such as pathogens and allergens. Thomas Meyer, Auris Medical's CEO stated in a press release issued on December 1, 2020: "Our first experiments in September showed that AM-301's key component trapped up to 99% of Sars-CoV-2 when brought into contact with a viral suspension." "Now, with our newly developed spray formulation, we have direct evidence that AM-301 has the potential to significantly mitigate the risk of infection of nasal mucosal cells. We look forward to taking AM-301 through additional tests and advancing the program towards the submission of regulatory applications in 2021."Precision Vaccinations  External Link

    Non-fatal drug overdoses in children under 15 on the rise, study finds

    7 December- While overall drug overdoses among youth are infrequent, non-fatal overdoses were on the rise in children under the age of 15 between 2016 and 2019, a new study finds. The rise appears to be driven by stimulants such as cocaine and amphetamines like meth and ecstasy, according to the study published Monday in the journal Pediatrics. If the trend continued into 2020, it could be a wake-up call for parents, as drug overdoses appear to be on the rise during the pandemic. "More than 40 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder," said the American Medical Association (AMA) in a recent issue brief. CNN External Link 

    WHO does not envisage COVID-19 vaccines being made mandatory

    7 December- The World Health Organization does not foresee mandatory vaccinations being introduced around the world to stem the spread of the coronavirus, officials said on Monday. Information campaigns and making vaccines available to priority groups such as hospital workers and the elderly would be more effective, the WHO said, as the global death toll has topped 1.5 million, according to Reuters calculations. Britain begins its vaccine program this week and others are likely to follow soon, so authorities are seeking to reassure people of vaccines' safety and efficacy in order to get a critical mass to take them in the face of what experts say are conspiracy theories entering the mainstream. "I don't think we envisage any countries creating a mandate for vaccinations, " Kate O'Brien, WHO's director of immunization vaccines and biologicals, told a news conference. "There may be some countries or some situations in countries where professional circumstances require it or highly recommend to be vaccinated," she added, saying hospitals might be one such instance. The WHO's top emergency expert, Mike Ryan, added: "We are much better served to present people with the data, present people with the benefits and let people make up their own minds, within reason." Reuters External Link

    INFLUENZA

    CDC: Weekly U.S. Influenza Surveillance Report

    Key Updates for Week 48, ending November 28, 2020:

    Influenza-Associated Hospitalizations: The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in the Emerging Infections Program (EIP) states and Influenza Hospitalization Surveillance Project (IHSP) states. FluSurv-NET estimated hospitalization rates will be updated weekly starting later this season.

    Influenza-Associated Pediatric Mortality: No influenza-associated pediatric deaths were reported to CDC during week 48. No influenza-associated pediatric deaths occurring during the 2020-2021 season have been reported. CDC External Link

    VETERINARY/FOOD SAFETY

    30.7 Tons of ready-to-eat eat and poultry escapes inspection

    4 December- Continental Glatt Kosher Meats Corp., doing business as First Choice Kosher Meat & Deli Inc., a Spring Valley, NY firm, has recalled approximately 61,504 pounds of ready-to-eat (RTE) meat and poultry products that were produced without the benefit of federal inspection, according to the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS). The RTE meat and poultry items were produced on various dates from June 26, 2020, through Nov. 20, 2020, with various sell-by dates ranging from October 2, 2020, through April 18, 2021. Food Safety News External Link

    French Salmonella outbreak hospitalizes seven, sickens dozens

    4 December- Seven people have needed hospital treatment as part of a Salmonella outbreak in France linked to dry pork sausages. In total, 31 cases of salmonellosis have been detected by the National Reference Center for Salmonella at Institute Pasteur. Illness because of Salmonella Bovismorbificans has mostly affected young people with at least 17 children sick. Strains were isolated from patients between Sept. 22 and Nov. 14, 2020. The onset of symptoms ranged from Sept. 22 to Nov. 10. Patients live in seven different parts of the country while the Grand-Est region has the most cases with 16. Fourteen men and 17 women have been confirmed sick, ranging in age from 1 to 69 years old. Seven patients were hospitalized but no deaths reported. Almost all patients had eaten dried pork sausage of one brand bought in several locations of the same supermarket chain, according to Santé publique France. The link between illness and eating dry cold meats manufactured by France Salaisons was previously made by the Directorate General for Food (DGAL), Directorate General for Health and Santé publique France. The company is based in the Rhone region of France.  Potentially contaminated product has also been recalled in Belgium, Luxembourg, Poland, Portugal and Slovenia. In France, a withdrawal and recall of several batches of dry sausage of the Saint Azay brand sold at E. Leclerc stores has taken place. France Salaisons also withdrew and recalled certain lots and dates of rosette de Lyon 15 slices of the Saint Alby brand and rosette pre-sliced in 15 slices of the Le Flutiau make. Monterrat used rosette manufactured by France Salaisons on some club rosette sandwiches, prompting a recall. Food Safety News External Link

    WELLNESS

    'Absolutely normal': Covid vaccine side effects are no reason to avoid the shots, doctors say

    3 December- The pain in Timothy Smith's left arm had gotten worse — "It felt like somebody had bashed my arm for a solid hour," he said — and fatigue was starting to set in, but the 34-year-old who describes himself as "pretty all-around healthy" wasn't panicked. About a day earlier on Oct. 7, Smith had gone in for his first injection in Moderna's coronavirus vaccine trial. And because he had done research beforehand and was prepped by the clinical team, Smith said he felt equipped to handle any of the vaccine's reported side effects, which experts say are signs that the body's immune system is working. "I was never in the dark about any of the process," said Smith, a former Washington Post staffer who is now a union organizer in the District. "I think sometimes if people don't know what to expect that can make you a little more fearful, and they were good about laying out everything that could potentially happen." He wasn't told whether he was given the vaccine or a placebo, but he believes he was given the vaccine based on his reaction to the injections. Ahead of the anticipated distribution of Moderna's two-dose vaccine and a similar vaccine developed by Pfizer and German biotechnology company BioNTech, which could be coming in a matter of weeks, experts have stressed the importance of transparent messaging in ensuring wide public acceptance and completion of the vaccination regimens. Though a full, detailed analysis of the safety profile of the vaccines is forthcoming and will be a topic of discussion at the Food and Drug Administration's advisory committee meetings this month, the drug makers' disclosures about the possible side effects coupled with anecdotal reports from trial participants have prompted concern among some experts that people may be hesitant to get vaccinated or won't come back for their second dose. The Washington Post External Link

    USAFRICOM

    Uganda reports rise in malaria, blamed on heavy rains

    5 December- The Uganda Ministry of Health is reporting a 42 percent increase in malaria cases in the past year (2019/2020), according to a report in the Daily Monitor.  Dr. Joyce Moriku Kaducu said malaria cases went from 10,483,412 cases in 2018/19 to 14,904,773 in 2019/20 , linking the surge to heavy rains during the period. "Malaria was still leading condition among all outpatient department diagnosis for all ages accounting for 29.8 percent of all out patient department attendances followed by pneumonia(cough or cold) 18.1 per cent, urinary tract infections and intestinal worms at 4.7 per cent," Dr. Kaducu said. In response, the government is ramping up the distribution of mosquito nets. Malaria is endemic in 95% of Uganda with about 5% of the country being areas of unstable malaria. Malaria is the leading cause of morbidity in Uganda. Outbreak News Today External Link 

    USCENTCOM

    Lebanon: 'Bread riots' in Beirut over reports subsidies on basic goods will end

    8 December- Protesters have blocked roads in the Lebanese capital Beirut over reports that government subsidies for some basic goods will be cut. Demonstrators burned tyres in the city center, and some also attempted to reach the parliament building. The head of the country's central bank earlier said the subsidies on flour, fuel and medicines could not continue beyond the next two months. UN agencies have warned of a social catastrophe for the poorest households. The hashtags #lifting_of_subsidies and #Lebanon_revolts were the top trending on Twitter in Lebanon on Monday. The central bank has been providing foreign currency to importers of goods including flour and fuel at a favorable rate as the Lebanese pound continues to decline in value during a prolonged economic crisis. Tens of thousands of people have been pushed into poverty in the country, which has also been hit hard by the coronavirus outbreak. BBC News External Link 

    USEUCOM

    Denmark: Mink variant of SARS-CoV-2 affects more of community, less in mink farmers

    7 December- In a follow-up on the SARS-CoV-2 mink-associated variant strain in Denmark, the Statens Serum Institute (SSI) reports there has been a marked decrease in the number of persons residing on mink farms infected with SARS-CoV-2, while at the same time, the strain is infecting more of society in the general community. According to SSI, the number of new infected persons associated with mink production fell to 28 in week 48 against 138 in week 47. Of the 28 infected, 3 were in the North Jutland Region, 10 in the Central Jutland Region and 12 in the Southern Denmark Region. Finally, there were 3 covid-19 infected with connections to the same mink herd in Region Zealand. Some of the new infected are not associated with covid-19 infected mink herds or mink herds in the killing zone. According to SSI, this means that there may have been SARS-CoV-2 in some of the herds that were not subject to restrictions. Outbreak News Today External Link

    Sweden outlines COVID-19 vaccine prioritization

    5 December- The Swedish Public Health Agency Friday specified the recommendations on which groups should be offered vaccines against COVID-19 first. Initially, when the first vaccine doses arrive in Sweden, they first and foremost need to go to people who have the greatest need for protection. The Swedish Public Health Agency therefore recommends in the agency's second sub-report that the following groups be offered vaccination first – and in the following order of priority if volumes are limited:

    - People who live in special housing for the elderly or who have home care, mainly people who are 70 years and older.

    - Staff who meet particularly vulnerable people in elderly care, health care and other care.

    - Adults who live with people who have home care.

    In total, about 600,000 people are included in these mainly priority groups. The recommendation will be updated and adapted based on the situation regarding the disease burden and the spread of infection in society. Which vaccines are approved for use, and which groups they are approved for and recommended for, will also be considered. The Swedish Public Health Agency's recommendation is support for the regions' own decisions on vaccination, and a basis for them to be able to make decisions according to different conditions. It is the regions that are responsible for the vaccinations being carried out when an approved vaccine is available. It is expected to take place sometime in January 2021, or earlier depending on when the vaccine is approved and when vaccination can be performed according to plan. Outbreak News Today External Link

    USINDOPACOM

    Philippines COVID-19: 1,768 new confirmed cases, Police to enforce social distancing with rattan sticks in Manila

    6 December- The Philippines Department of Health (DOH) reported an additional 1,768 new confirmed COVID-19 cases today, bringing the country total to 439,834. Quezon City recorded the most new cases with 112 infections, followed by Laguna with 94, Rizal with 90, Davao City with 71, and Benguet with 69. DOH also reports 408,634 of the cases have recovered to date, of 92.9 percent of those who tested positive. 29 additional deaths were recorded, bringing the total deaths on the archipelago to 8554. In Manila earlier late last week, in an effort to enforce social distancing, police will be armed with "rattan sticks" in public areas in Metro Manila. "We have doubled the deployment of cops and soldiers would also assist us in physical distancing patrols. This was what our chief PNP (Philippine National Police), Gen. Debold Sinas ordered. They have one-meter rattan sticks to enforce the physical distancing rule," Lt. Gen. Cesar Hawthorne Binag said. Outbreak News Today External Link 

    USNORTHCOM

    U.S.: California- Bans private gatherings amid record COVID-19 surge

    7 December- California compelled much of the state to close shop and stay at home on Monday, when some of the harshest coronavirus restrictions in the United States came into effect one day after the state set a record with more than 30,000 new COVID-19 cases. Governor Gavin Newsom's order was triggered in areas where fewer than 15 percent of intensive care hospital beds were available, affecting more than 23 million people in Southern California. In addition, five counties in Northern California surrounding the San Francisco Bay Area have voluntarily imposed the restrictions even before reaching the intensive care unit threshold. California has been under a stay-at-home order for all but essential services since March. The new order, which will last at least three weeks, bans private gatherings of any size, shuts all but critical infrastructure and retail operations, and requires everyone to wear a mask and maintain physical distancing. Newsom, a first-term Democrat, has threatened to withhold funds from local governments that refuse to comply. Even so, the sheriffs of Los Angeles, Orange and Riverside counties have said they will refuse to enforce the order, emboldening non-essential businesses to remain open. Reuters External Link

    U.S.: South Carolina- Reports 16th EEE case in a horse, 3rd in Aiken County

    6 December- In a follow-up on the Eastern Equine Encephalitis (EEE) situation in South Carolina, Clemson Livestock Poultry Health has reported an additional EEE case in a Aiken County horse. The eight-year-old mare did not survive. This is the state's 16th EEE case and Aiken County's third case of 2020. EEE is a mosquito-borne illness that causes inflammation or swelling of the brain and spinal cord. Symptoms include impaired vision, aimless wandering, head pressing, circling, inability to swallow, irregular staggering gait, paralysis, convulsions and death. Once a horse has been bitten by an infected mosquito, it may take three to ten days for signs of the disease to appear. Outbreak News Today External Link 

    USSOUTHCOM

    Brazil: Tocantins records a 87% drop in dengue in 2020

    3 December- Officials in Tocantins state in central Brazil say their has been 1,582 confirmed dengue fever cases in 2020 to date, an 87 percent decrease from 2019.  Last year, 12,051 cases of dengue were reported. In addition to dengue, two other diseases carried by the Aedes aegypti mosquito also saw decreases–167 Zika cases and 55 chikungunya cases last year, compared to five and 18, respectively. Outbreak News Today External Link