April 7, 2020

Health system responses to covid-19

Beyond Containment:Health systems responses to COVID-19 in the OECD

From OECD report:
The main focus of this brief is on the policiesaimed at providing effective care and managing the pressure on health systems. Four key measures health systems are putting in place in response to the epidemic are considered: 1)ensuring access of the vulnerable to diagnostics and treatment; 2)strengthening and optimising health system capacity to respond to the rapid increase in caseloads; 3)how to leverage digital solutions and data to improve surveillance and care; and 4)how to improve R&D for accelerated development of diagnostics, treatments and vaccines

PS: From Francesca Colombo

April 5, 2020

Security policies in front of a new molecular vision of life

Pandemics, Pills, and Politics. Governing Global Health Security

The goal of this book in one sentence:
This volume reveals the major challenges involved in securing populations pharmaceutically and explores how governments are designing extensive new medical countermeasure regimes to overcome those challenges. At the heart of this pharmaceutical turn in security policy, I argue, lies something deeper: the rise of a new molecular vision of life that is reshaping the world we live in—including the way we now imagine and practice security.
The author explains the pharmaceutical defenses for a global pandemic, and specially describes the case of Tamiflu.
 The idea of “medical countermeasures” is also fascinating, secondly, because of the terminology it musters. The concept textually embodies the progressive epistemic fusion of the two professional fields of medicine (“medical”) and security (“countermeasures”), attempting to seamlessly blend key vocabularies from both communities into a single notion. Here the term begins to form a fascinating intersection, or bridge, between these two different social fields, giving rise in the process to a fascinating new and interdisciplinary policy space where the respective concerns of pharmaceuticals and security begin to interpenetrate each other, and can also come into direct tension with one another.
The chapter 4 is specially of interest: The Margin Call for Regulatory Agencies and explains what was done in the Tamiflu case.
A cursory review of the FDA approval processes for Tamiflu paints a fairly uneventful picture. In fact, the sequence of events leading up to FDA approval for Tamiflu can be quickly summarized. A month after the Swiss approval, on 27 October 1999, the FDA approved Tamiflu for “the treatment of uncomplicated acute illness due to influenza infection in  adults who have been symptomatic for no more than 2 days” (FDA 1999b). This marketing approval process unfolded rapidly according to the priority review procedure—within six months—following Roche’s initial application for FDA approval on 29 April 1999.
 Again, the case of Tamiflu has been highly instructive. It showed that this new pharmaceutical intervention could only be designed after scientists had first gained a much better understanding of the precise molecular processes involved in viral replication unfolding inside the human body—especially the role played by the influenza virus’s surface proteins such as neuraminidase. Once scientists had understood the vital role played by the neuraminidase and decoded its precise molecular structure, they discovered a “static” site that could form the basis for a new drug target. Scientists could then set about the task of deliberately designing an “artificial” molecule that would bind to that critical site in the neuraminidase and that could inhibit its key role in the process of viral replication. In that sense, our technical ability to develop new pharmaceutical defenses is itself  dependent upon a prior—and deeper—scientific understanding of the life processes unfolding at the scale of the molecular.
The case of covid-19 began without any countermeasure, because molecular knowledge started mid-January once it was sequenced. Nowadays, we can only wait for a successful vaccine and therapy.

April 1, 2020

Pandemic storytelling

Pandemics, Publics, and Narrative

How people interpret messages to guide action during a pandemic. This is the topic of this book. The effects of storytelling in health communication are crucial and the book starts with the presumed contagion of swine flu by David Cameron.
Our analysis placed engagements with pandemic storytelling across public life in dialogue with the narratives on the enactment of expert advice. This dual approach helped to establish perspectives on how narratives influence publics to take action, or not. We took the view that narrative does not simply mediate pandemic knowledge and advice by helping to structure it intelligibly and meaningfully. We also questioned the idea that narratives persuade in and of themselves in ways that are not very far removed from now discredited notions of linear, hypodermic communications on matters
of health. We adopted the view that media are thoroughly entangled with experience and that pandemic narratives found there help to constitute subjects and the relationships they have with the expert knowledge systems that underpin public health efforts to manage microbial threats
 Unlike states of illness, which depend on determinate biomedical diagnosis and the related transformation of identity and relationality, pandemic experience was most often indeterminate due to the infrequency with which influenza infection is diagnosed in a laboratory and the great variation in influenza symptoms between people, between influenza outbreaks, and even over the course of a particular influenza pandemic.
 Pandemic narratives are placeholders for rich metaphors of life under threat. The metaphorical properties of contagion and immunity give pandemic narratives biopolitical resonance, connecting as they do: political imperatives to do with the production of life; the self defined and protected against the other; the milieu interieur scene for commune with microbial invaders and friends; the tensions implied in proximity and distance; and the coconstruction of narrative and knowledge.
Somebody will have to write a book about current covid-19 pandemic and the title could be: "We are all soldiers against covid". Nothing to add.

March 31, 2020

Unprepared for a pandemic

Unprepared. Global health in a time of emergency

A book that we forgot to read, but it may help (at least for the next time).
This book tells the story of how the fragile and still-uncertain machinery of global health security was cobbled together over a two-decade period, beginning in the early 1990s. It is neither a heroic  account of visionary planning by enlightened health authorities, nor a sinister story of the securitization of disease by an ever-expansive governmental  apparatus. Rather, it is a story of the assemblage of disparate elements— adapted from fields such as civil defense, emergency management, and international public health—by well-meaning experts and officials and of response failures that have typically led, in turn, to reforms that seek to strengthen or refocus the apparatus.9 The analysis centers on the ways that authorities—whether public health officials, national security experts, life scientists, or other privileged observers—conceptualize and act on an encroaching future of disease emergence. This uncertain future can be taken up and made into an object of present intervention according to multiple rationalities: as an object of probabilistic calculation, as a specter that must be avoided through precautionary intervention, or as a potential catastrophe that cannot be evaded but can only be prepared for.10 In the chapters that follow, we see how these various logics come into tension or combine in response to actual and anticipated disease emergencies.
And the key message
The widely acknowledged failure of global health security to adequately manage the Ebola outbreak led to multiple inquiries, commission reports, and recommendations for reform, but it did not put in question the strategic logic underlying the framework. Rather, reformers raised the question of how to better meet the demand for preparedness in time for the next global health emergency. As an internal World Health Organization (WHO) report warned, the frequency and magnitude of such events was increasing but “the world is not adequately prepared to respond to the full range of emergencies with public health implications”—whether disease outbreaks, natural disasters or violent conflict. The report concluded that WHO’s response to Ebola and other recent emergencies “lacked the speed, coordination, clear lines of decision making and dedicated funding to optimize implementation, reduce suffering and save lives.” Given the scale and complexity of anticipated future emergencies, it advised, “WHO must substantially strengthen and modernize its emergency management capacity.”
So what? We have to confront right now the emergency and WHO reform is still pending...

March 30, 2020

To test or not to test (for coronavirus) (3)

Current situation on test results

Covid-19 Incidence: 212 per 100.000 inhabitants

Spreading rate: 0,6

This is good news!

March 29, 2020

Psychology of pandemics

The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease

The patterns of psychological reactions to pandemics are complex. Whereas some people are resilient to stress, other individuals become highly distressed when confronted with threatening events such as pandemic infection. Thus, people vary widely in their reactions to threatened or actual pandemics. Some react with indifference or resignation while others become highly fearful or anxious, and some develop emotional disorders such as PTSD. Some people recover from these emotional problems once the pandemic threat passes, while other people have enduring emotional reactions. Social disruptive behaviors such as rioting can also occur under particular circumstances, although prosocial behaviors appear to be more common during times of pandemic. Immune reactions may explain some of the emotional responses in infected people but these fail to account for widespread fear and social disruption in people who have not yet been infected. To better understand the reasons behind these diverse psychological reactions it is important to understand their motivational roots and vulnerability factors.
This book is devoted precisely to this issue, to understand psychological reactions and its roots.