Scientists using computational models have reported that, in general, widespread use of facemasks, when combined with lockdowns, may help prevent future waves of infection.
Face masks have been a matter of intense debate during the COVID-19 pandemic. Early on, several government officials and health authorities were discouraging healthy people from wearing masks—noting that there was little evidence for the practice’s ability to prevent spread among the general public and citing concerns that protective face coverings, which were desperately needed by healthcare workers, were in short supply. Gradually, however, governments began to either require or recommend that their citizens wear face masks in public.
In June, the World Health Organization (WHO) recommended widespread mask-use as a way to prevent coronavirus transmission. One model estimates that if at least 95 percent of people wear masks in public between June and October, approximately 33,000 deaths could be avoided in the US.
There are three broad categories of face coverings: tight-fitting masks known as N95 respirators that are designed to filter out both aerosols (often defined as particles that are smaller than 5 micrometers in diameter) and larger airborne droplets, loose-fitting surgical masks that are fluid resistant and capable of filtering out the bigger particles, and cloth masks, which vary widely based on how they’re made.
A growing body of research supports the use of all three types of masks, though the quality of evidence varies. One of the most comprehensive examinations to date, published in The Lancetin early June, systemically assessed 172 observational studies—mostly conducted in healthcare settings—looking at the effect of physical distancing, face masks, and eye protection on the transmission of SARS-CoV-2 and two related coronaviruses. The results revealed that N95 respirators provided 96 percent protection from infection and surgical masks (or comparable reusable masks made with 12 to 16 layers of cotton or gauze) were 67 percent protective.
While research on cloth masks is much more limited, one group of researchers demonstrated that, in the lab, multilayer masks made of hybrid materials (cotton and silk, for example) could filter up to 90 percent of particles between 300 nanometers and 6 micrometers in size. However, it’s important to note this is only the case when there are no gaps around the edges of the mask, which are often present when people wear cloth or surgical masks. Indeed, the researchers’ findings suggest that gaps around any mask can reduce filtration by 60 percent or more. Still, scientists using computational models have reported that, in general, widespread use of facemasks, when combined with lockdowns, may help prevent future waves of infection.
“We’re recommending that N95s still be primarily saved for the healthcare situation,” says Kirsten Koehler, a professor of environmental health and engineering at Johns Hopkins University. “For individuals in the public, wearing a fabric mask is probably still the way to go.”
Four people have died of Ebola in Guinea in the first resurgence of the disease in five years, the country’s health minister said Saturday.
Remy Lamah told AFP that officials were “really concerned” about the deaths, the first since a 2013-16 epidemic — which began in Guinea — left 11,300 dead across the region.
One of the latest victims in Guinea was a nurse who fell ill in late January and was buried on 1 February, National Health Security Agency head Sakoba Keita told local media. “Among those who took part in the burial, eight people showed symptoms: diarrhoea, vomiting and bleeding,” he said. “Three of them died and four others are in hospital.”
The four deaths from Ebola hemorrhagic fever occurred in the south-east region of Nzerekore, he said.
The four deaths from Ebola hemorrhagic fever occurred in the southeast region of Nzerekore, he said.
Keita also told local media that one patient had “escaped” but had been found and hospitalized in the capital, Conakry. He confirmed the comments to AFP without giving further detail.
The World Health Organization has eyed each new outbreak since 2016 with great concern, treating the most recent one in the Democratic Republic of the Congo as an international health emergency.
The epidemic, which began with the death of a two-year-old boy, was part of a larger Ebola virus epidemic in West Africa which spread through Guinea and the neighboring countries of Liberia and Sierra Leone, with minor outbreaks occurring in Senegal, Nigeria, and Mali. In December 2015, Guinea was declared free of Ebola transmission by the U.N. World Health Organization, however further cases continued to be reported from March 2016. The country was again declared as Ebola-free in June 2016.
WHO and partners launched the Access to COVID-19 Tools (ACT) Accelerator to speed up the development, production and equitable access to COVID-19 diagnostics, therapeutics and vaccines
The World Health Organization (WHO) in Africa joined immunization experts in urging the international community and countries in Africa to take concrete actions to ensure equitable access to COVID-19 vaccines, as researchers around the world race to find effective protection against the virus.
“It is clear that as the international community comes together to develop safe and effective vaccines and therapeutics for COVID-19, equity must be a central focus of these efforts,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Too often, African countries end up at the back of the queue for new technologies, including vaccines. These life-saving products must be available to everyone, not only those who can afford to pay.”
WHO and partners launched the Access to COVID-19 Tools (ACT) Accelerator to speed up the development, production and equitable access to COVID-19 diagnostics, therapeutics and vaccines. It brings together leaders of government, global health organizations civil society groups, businesses and philanthropies to form a plan for an equitable response to the COVID-19 pandemic. WHO is collaborating with Gavi, the Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations (CEPI) to ensure a fair allocation of vaccines to all countries, aiming to deliver 2 billion doses globally for high-risk populations, including 1 billion for low and middle-income countries.
The African Union has endorsed the need for Africa to develop a framework to actively engage in the development and access to COVID-19 vaccines. Countries can take steps now that will strengthen health systems, improve immunization delivery, and pave the way for the introduction of a COVID-19 vaccine. These include: mobilizing financial resources; strengthening local vaccine manufacturing, and regulatory, supply and distribution systems; building workforce skills and knowledge; enhancing outreach services; and listening to community concerns to counter misinformation.
Globally, there are nearly 150 COVID-19 vaccine candidates and currently 19 are in clinical trials. South Africa is the first country on the continent to start a clinical trial with the University of Witwatersrand in Johannesburg testing a vaccine developed by the Oxford Jenner Institute in the United Kingdom. The South African Ox1Cov-19 Vaccine VIDA-Trial is expected to involve 2000 volunteers aged 18–65 years and include some people living with HIV. The vaccine is already undergoing trials in the United Kingdom and Brazil with thousands of participants.
According to the African Academy of Sciences only 2% of clinical trials conducted worldwide occur in Africa. It is important to test the COVID-19 vaccine in countries where it is needed to ensure that it will be effective. With more than 215 000 cases, South Africa accounts for 43% of the continent’s total cases. Clinical trials must be performed according to international and national scientific and ethical standards, which include informed consent for any participant.
“I encourage more countries in the region to join these trials so that the contexts and immune response of populations in Africa are factored in to studies,” said Dr Moeti. “Africa has the scientific expertise to contribute widely to the search for an effective COVID-19 vaccine. Indeed, our researchers have helped develop vaccines which provide protection against communicable diseases such as meningitis, Ebola, yellow fever and a number of other common health threats in the region.”
Earlier, this month WHO Africa’s principle advisory group on immunization policies and programmes – the African Regional Immunization Technical Advisory Group (RITAG) – also noted the need to ensure equitable access to COVID-19 and other vaccines in the region.
“As the world focuses on finding a vaccine for COVID-19, we must ensure people do not forget that dozens of lifesaving vaccines already exist. These vaccines should reach children everywhere in Africa – no one can be left behind,” said Professor Helen Rees, Chair of the RITAG.
Initial analysis of the impact of the COVID-19 pandemic on immunization in the African Region suggests that millions of African children are likely to be negatively impacted, as routine immunization services and vaccination campaigns for polio, cholera, measles, yellow fever, meningitis and human papilloma virus have been disrupted.
Despite these challenges, RITAG members also noted significant milestones and markers of progress. For example, there have been tremendous gains in the fight against wild poliovirus, and the African Region is expected to be officially certified free of wild poliovirus in August 2020. The Democratic Republic of the Congo also announced the end of its 10th Ebola outbreak in eastern DRC, which was the worst in its history. An effective vaccine was a key tool in the response.
Dr Moeti spoke about COVID-19 vaccine development in Africa during a virtual press conference today organized by APO Group. She was joined by Professor Shabir Madhi, University of Witwatersrand, Principal Investigator of Oxford Covid-19 Vaccine Trial in South Africa; and Professor Pontiano Kaleebu, Director of the MCR/UVRI and LSHTM Ugandan Research Unit. The briefing was streamed on more than 300 African news sites as well as the WHO Regional Office for Africa’s Twitter and Facebook accounts.
The World Health Organization held a two half-day virtual summit on 1 and 2 July, to take stock of the evolving science on COVID-19 and examine progress made so far in developing effective health tools to improve the global response to the pandemic.
The event brought together researchers, developers and funders from all over the world, all of whom shared approaches and raw data freely, in a show of solidarity from the global science community. All major research institutes carrying out trials shared their data with a view to speeding up scientific discovery and implementation of solutions.
The group reviewed the latest data from the WHO Solidarity Trial and other completed and ongoing trials for potential therapeutics: hydroxychloroquine, lopinavir/ritonavir, remdesivir and dexamethasone. They agreed on the need for more trials to test antivirals, immunomodulatory drugs and anti-thrombotic agents, as well as combination therapies, at different stages of the disease.
The meeting analyzed 15 vaccine trial designs from different developers, and criteria for conducting robust trials to assess safety and efficacy of vaccine candidates. Participants discussed the use of a global, multi country, adaptive trial design, with a common DSMB, and clear criteria to advance candidates through the various stages of trials.
They noted that most internationally funded research projects have so far favoured high-income countries, with very few funded in low- and middle-income countries, highlighting the importance of the ACT-Accelerator Initiative to speed up the development and equitable deployment of COVID-19 tools.
More evidence is emerging that transmission from humans to animals is occurring, namely to felines (including tigers), dogs and minks.
The Summit hosted over 1000 researchers and scientists from all over the world and addressed the following topics:
virus: natural history, transmission and diagnostics;
animal and environmental research on the virus origin, and management measures at the human-animal interface;
clinical characterization and management;
infection prevention and control, including health care workers’ protection;
candidate therapeutics R&D;
candidate vaccines R&D;
ethical considerations for research and;
integrating social sciences in the outbreak response.
The World Health Organisation (WHO) recently noted that “researchers are working at break-neck speed” to understand SARS-CoV-2, the virus that causes coronavirus disease (COVID-19). They are also working to develop potential vaccines, medicines and other technologies that are affordable and equitable. By June 2020 – six months since it was first identified – thousands of therapeutic trials and dozens of vaccine development studies were under way, including one vaccine study each in South Africa and Nigeria.
As a public health specialist and infectious diseases epidemiologist, I am very happy and impressed to see such massive research activity to relieve human suffering from this baffling disease. But then, as an African, I ask myself, when will these treatments or vaccines be available for Africans on African soil? Will the “break-neck speed”, “affordability” and “equity” work for the benefit of Africa?
It is true that African countries are making their own efforts to fight the pandemic. For example, the Democratic Republic of Congo (DRC) is building on its Ebola response to tackle COVID-19; Namibia is working hard on a “test-isolate-treat” strategy; and Nigeria is turning hospitals into COVID-19 treatment centres and calling on volunteer nurses to close the gap in health professionals. The WHO is also supporting the COVID-19 response in the African region, particularly in logistics and the capacity of health and multidisciplinary experts.
But the history of pandemic or epidemic diseases is not encouraging. It shows that treatments and vaccines have been accessible to African countries only after the loss of millions of lives and typically years – sometimes decades – after developed nations have benefited from them. This is mainly because the treatments and vaccines for most diseases are produced in Western countries and are too expensive for African countries. This largely remains in place as the chief barrier to accessibility of treatments and vaccines.
What history tells us
The timelines, affordability and equity of providing services to manage tuberculosis (TB) and HIV illustrate the above point.
The scientist Robert Koch discovered Mycobacterium tuberculosis, the bacteria that causes TB, in 1882. TB become an epidemic disease in Africa a decade later. And it is still a public health threat on the continent. By 2016, there were 2.5 million infections and 420,000 deaths.
TB treatment in the US and Europe was introduced in 1944. But Africa only started receiving the treatment in the early 1970s, nearly three decades later. The drugs were very expensive and African countries couldn’t afford to import them.
It was the same with the TB vaccine, BCG. European and American babies started receiving it in the 1920s. South Africans had to wait more than 50 years. The vaccine was too expensive and international donors needed several years to rally support for political and economic reasons.
Similarly, antiretroviral therapy (ART) for HIV came to Africa in the early 21st century, roughly a decade after it was available in the developed West. By then the problem was far worse in Africa, despite some fragmented prevention efforts. The death rate in the 1990s was 100-200 per 100,000 in Africa but only 5-10 per 100,000 in Europe. As of 2018, HIV infected 25.7 million and killed 0.47 million Africans.
The price of ART drugs eventually declined because of higher purchase volumes, more producers and the availability of generics.
A strategy of testing for and treating HIV was launched in the US in 2010, and only six years later in parts of Africa. Test-and-treat programmes are still not available in all African countries because of poor infrastructure, shortages of trained professionals and other reasons. ART is still expensive for African countries but has been supported by international donors. Some NGOs that were central to the treatment strategy are handing it over to local governments.
Generally, treatments and vaccines for almost all diseases are developed outside Africa and take years to arrive in low-income countries, which cannot initially afford them. When they do arrive there may be other problems, such as lack of infrastructure to distribute the treatments and deliver vaccines, and lack of skilled health workers to provide the care. The people in need may not take up the available services widely. Modern and traditional healthcare provision aren’t always integrated in ways that enhance health-seeking behaviour.
In addition to the long and complex process of trial research, there are several factors that complicate access to future COVID-19 treatments and vaccines.
First, the traditional donors to African countries themselves are hard-hit by the virus and many are at the brink of deep economic recession, if not depression. Therefore they may not be able to contribute readily to directly supporting Africa’s health systems, subsidising drugs or strengthening existing partnerships between countries and institutions.
Second, the withdrawal of US financial support for the WHO, one of the major supporters of Africa, will most certainly be felt. US allies could also revise their contribution and thereby destabilise the institution. And there could be a disconnect between US scholars and the WHO, to the detriment of Africa.
Third, many African governments may not be able to afford the cost of a COVID-19 vaccine.
Fourth, there are ongoing conflicts and displacement of people in the region, which will challenge access.
So, to manage the COVID-19 crisis, Africa must learn from the history of HIV, TB and other outbreaks. A delayed introduction of treatments and vaccines should not be repeated. And countries should first do all they can to prevent the crisis.
Thirty countries and multiple international partners and institutions have signed up to support the COVID-19 Technology Access Pool (C-TAP) an initiative aimed at making vaccines, tests, treatments and other health technologies to fight COVID-19 accessible to all.
The Pool was first proposed in March by President Carlos Alvarado of Costa Rica, who joined WHO Director-General Dr Tedros Adhanom Ghebreyesus today at the official launch of the initiative.
“The COVID-19 Technology Access Pool will ensure the latest and best science benefits all of humanity,” said President Alvarado of Costa Rica. “Vaccines, tests, diagnostics, treatments and other key tools in the coronavirus response must be made universally available as global public goods”.
“Global solidarity and collaboration are essential to overcoming COVID-19,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Based on strong science and open collaboration, this information-sharing platform will help provide equitable access to life-saving technologies around the world.”
The COVID-19 (Technology) Access Pool will be voluntary and based on social solidarity. It will provide a one-stop shop for scientific knowledge, data and intellectual property to be shared equitably by the global community.
The aim is to accelerate the discovery of vaccines, medicines and other technologies through open-science research, and to fast-track product development by mobilizing additional manufacturing capacity. This will help ensure faster and more equitable access to existing and new COVID-19 health products.
There are five key elements to the initiative:
Public disclosure of gene sequences and data;
Transparency around the publication of all clinical trial results;
Governments and other funders are encouraged to include clauses in funding agreements with pharmaceutical companies and other innovators about equitable distribution, affordability and the publication of trial data;
Licensing any potential treatment, diagnostic, vaccine or other health technology to the Medicines Patent Pool – a United Nations-backed public health body that works to increase access to, and facilitate the development of, life-saving medicines for low- and middle-income countries.
Promotion of open innovation models and technology transfer that increase local manufacturing and supply capacity, including through joining the Open Covid Pledge and the Technology Access Partnership (TAP).
With supportive countries across the globe, C-TAP will serve as a sister initiative to the Access to COVID-19 Tools (ACT) Accelerator and other initiatives to support efforts to fight COVID-19 worldwide.
WHO, Costa Rica and all the co-sponsor countries have also issued a “Solidarity Call to Action” asking relevant stakeholders to join and support the initiative, with recommended actions for key groups, such as governments, research and development funders, researchers, industry and civil society.
WHO and Costa Rica co-hosted today’s launch event, which began with a high-level session addressed by the WHO Director-General and President Alvarado in addition to Prime Minister Mia Mottley of Barbados and Aksel Jacobsen, State Secretary, Norway. There were video statements by President Lenín Moreno of Ecuador; President Thomas Esang Remengesau Jr., of Palau; President Lenín Moreno of Ecuador; , Michelle Bachelet, United Nations High Commissioner for Human Rights; Jagan Chapagain, Secretary General of the International Federation of Red Cross and Red Crescent Societies; and Retno Marsudi, Minister for Foreign Affairs for Indonesia. Leaders from across the UN, academia, industry and civil society joined for a moderated discussion.
To date, the COVID-19 Technology Access Pool is now supported by the following countries: Argentina, Bangladesh, Barbados, Belgium, Belize, Bhutan, Brazil, Chile, Dominican Republic, Ecuador, Egypt, El Salvador, Honduras, Indonesia, Lebanon, Luxembourg, Malaysia, Maldives, Mexico, Mozambique, Norway, Oman, Pakistan, Palau, Panama, Peru, Portugal, Saint Vincent and Grenadines, South Africa, Sri Lanka,Sudan, The Netherlands, Timor-Leste, Uruguay, Zimbabw
The World Health Organization has warned that severe and mounting disruption to the global supply of personal protective equipment (PPE) – caused by rising demand, panic buying, hoarding and misuse – is putting lives at risk from the new coronavirus and other infectious diseases.
Healthcare workers rely on personal protective equipment to protect themselves and their patients from being infected and infecting others.
But shortages are leaving doctors, nurses and other frontline workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons.
“Without secure supply chains, the risk to healthcare workers around the world is real. Industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. We can’t stop COVID-19 without protecting health workers first,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.
Since the start of the COVID-19 outbreak, prices have surged. Surgical masks have seen a sixfold increase, N95 respirators have trebled and gowns have doubled.
Supplies can take months to deliver and market manipulation is widespread, with stocks frequently sold to the highest bidder.
WHO has so far shipped nearly half a million sets of personal protective equipment to 47 countries,* but supplies are rapidly depleting.
Based on WHO modelling, an estimated 89 million medical masks are required for the COVID-19 response each month. For examination gloves, that figure goes up to 76 million, while international demand for goggles stands at 1.6 million per month.
Recent WHO guidance calls for the rational and appropriate use of PPE in healthcare settings, and the effective management of supply chains.
WHO is working with governments, industry and the Pandemic Supply Chain Network to boost production and secure allocations for critically affected and at-risk countries.
To meet rising global demand, WHO estimates that industry must increase manufacturing by 40 per cent.
Governments should develop incentives for industry to ramp up production. This includes easing restrictions on the export and distribution of personal protective equipment and other medical supplies.
Every day, WHO is providing guidance, supporting secure supply chains, and delivering critical equipment to countries in need.