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The WHO says we must work together to fight monkeypox. African doctors are skeptical – CBC News

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As an infectious diseases specialist in Atlanta, Dr. Boghuma Kabisen Titanji spent much of 2020 on the front lines of the COVID-19 battle raging in the U.S. 

When a vaccine arrived in December that year, she felt some relief. But also, fear. 

“I had seen what COVID was capable of doing to people the age of my parents,” Titanji said. 

“I was absolutely terrified because from the moment I had access to vaccination up until the moment my parents had access to vaccination, it was eight months.”

In Cameroon, where Titanji is from, her parents didn’t get a first coronavirus jab until August 2021. By that time, most Canadian and American adults were well past their second shots. 

“It was the most nerve wracking experience of living in fear that they would get COVID,” she said. 

Despite the World Health Organization’s pleas to rich countries to stop stockpiling COVID vaccines and share with the lower-income nations – particularly in Africa – global health experts agree that we failed. 

Dr. Boghuma Kabisen Titanji, an infectious diseases specialist in Atlanta, says no vaccines or antiviral drugs have been available when she has dealt with monkeypox in her home country of Cameroon. (Boghuma Kabisen Titanji )

They also aren’t surprised, because the same inequitable distribution of vaccines and treatments has been a pattern for decades. 

On July 23, the WHO declared monkeypox a “public health emergency of international concern” – and doctors fear the same pattern will repeat itself as Canada, the U.S. and European countries rush to vaccinate at-risk populations. 

They’re using a vaccine originally manufactured for smallpox, which has been eradicated. In Canada, it’s called Imvamune, and small quantities were stockpiled years ago in case smallpox ever returned. Imvamune is also approved to vaccinate people against monkeypox. 

Yet monkeypox has been endemic in several African nations for 50 years. Dozens have died this year alone, Titanji said, but no vaccine has ever been made available, except for targeted studies involving health-care workers.   

When she dealt with monkeypox outbreaks in Cameroon, she said there was also no access to antivirals to treat the disease.

“If you diagnose someone with monkeypox [in Africa], you provide supportive care. So basically, you make the diagnosis and you tell them to isolate and, you know, take paracetamol for their fever … and to rest and recover.” 

Although anyone can become infected through close contact with someone who has monkeypox or with personal items like bed linens, in countries outside Africa, the most at-risk population right now is men who have sex with men. In Africa, it has historically been spread primarily through contact with infected animals.

Lack of concern for illness in Africa

If a pandemic the scale of COVID didn’t galvanize a global response that was equitable, Titanji said, she’s skeptical that the response to monkeypox — not to mention future outbreaks of other diseases — will treat Africa any differently. 

“The issue is that there has been a generalized neglect of health equity in Africa,” said Dr. Githinji Gitahi, head of Amref Health Africa, a group based in Nairobi, Kenya, working to improve health-care access across the continent. 

“The view is that as long as the health threats are limited to African communities, it is all right for the world not to worry.”

But if rich countries want to end epidemics that affect their own citizens, it’s in their best interest to ensure low and middle income nations have the resources to stop the spread of disease, Gitahi said.

“Pandemics and disease threats start in a community,” he said. “If you have one community that isn’t safe, the whole world isn’t safe in our current connectedness.”

“This must change for not just for monkeypox but for other neglected diseases in low-income countries as the world is reminded yet again that health is an interconnected proposition,” the WHO chief said. 

What’s the solution?

One of the things that has to change is the monopoly that rich countries hold on vaccines and medications, including antivirals, African physicians and global health experts said. 

During COVID-19, donations through the vaccine-sharing program COVAX helped, but they arrived in African countries too late, said Gitahi. “People died as they waited for vaccines.” 

In many cases, vaccines were unusable because they landed with “very little shelf life remaining.” 

In addition, by the time they arrived, people who would previously have lined up to get vaccinated had lost both the sense of urgency and trust in the health-care system, with a perception that they were receiving vaccines rejected by rich countries, Gitahi added.

LISTEN | African doctors say monkeypox response is another example of vaccine inequity: 

CBC News2:44African doctors say monkeypox response is another example of vaccine inequity

Health experts say they’re skeptical that the world has learned from COVID-19 as rich countries battle monkeypox outbreaks. (CBC The World This Weekend)

The path to even the playing field for low and middle-income countries, according to some experts, is to remove intellectual property protections on essential vaccines and treatments. 

Rich countries invest enormous amounts of money in vaccine manufacturing companies during emergencies, said Titanji. That gives them leverage to make funding contingent on giving lower and middle income countries an equal chance to buy them at a fair price, she said.

Dr. Mary Stephen, technical officer at the WHO Regional Office in Brazzaville, Republic of Congo, says it’s critical to develop Africa’s capacity to manufacture its own vaccines and therapeutics. (Dr. Mary Stephen)

But an even better solution, experts said, is to make sure Africa is able to mount its own emergency responses to epidemics, rather than being forced to wait for charities and rich nations to act. 

“If we want to build a resilient system, there is much, much, much to do beyond just the donation of vaccines,” said Dr. Mary Stephen, technical officer with the Health Emergencies Program at the WHO Regional Office in Brazzaville, Republic of Congo. 

“Just imagine if …  countries on the continent were able to produce their own PPE, were able to produce their lab reagents, their test kits. [If] they were able to produce vaccines, medicines … it will go a long way,” she said. 

An important step in building that self-reliance has been the opening of the “mRNA Vaccine Hub for Africa” in Capetown, South Africa, supported by WHO. Scientists there have produced its first batches of COVID-19 mRNA vaccine. 

As Africa works toward health care self sufficiency, it’s important for the world to remember that the continent has already made significant contributions to global health, Titanji said.

For instance, African participants in many clinical trials have enabled the development of HIV/AIDS treatments received by patients in rich countries, she said. 

Now that the world is confronted with monkeypox, Africa has decades of knowledge about the virus that wealthy nations are relying on, Titanji said. 

“It’s 50 years of research by African scientists, sometimes with incredible challenges to publish this data,” she said of monkeypox studies, including one on health-care workers in Congo that tested the effectiveness of the Imvamune vaccine. 

“We are building on that now to be able to address outbreaks in non-endemic countries, meanwhile, leaving the very people who contributed to that body of knowledge behind.” 

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Feds lift border vaccine requirements, mandatory masks on planes and trains

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OTTAWA — Federal ministers say all COVID-19 border restrictions will be removed as of Saturday, including mandatory vaccination, testing and quarantine of international travellers, as well as the requirement for masks on planes and trains.

The cabinet order maintaining COVID-19 border measures will not be renewed when it expires on Sept. 30.

But Health Minister Jean-Yves Duclos is once again warning that pandemic restrictions could be reinstated if they are needed.

“We have learned over the last (two-and-a-half) years the type of measures that can work,” Duclos said Monday.

“We will therefore leave open all possible options when it comes to protecting the health and safety of Canadians.”

The changes mean foreign nationals will no longer require an approved series of vaccinations to enter the country.

In addition, Canada-bound travellers will no longer be subject to random COVID-19 tests, and unvaccinated Canadians will not need to isolate when they return to the country.

Cruise passengers will not have to do pre-board tests or prove they have been vaccinated.

And people who enter the country after Saturday will not need to monitor and report if they develop signs or symptoms of COVID-19.

The five federal ministers making the announcement said the changes are informed by science and epidemiology, adding that modelling indicates the peak of the latest wave of the disease has “largely passed.”

But they did face questions about whether the move is at least partially politically motivated as the Liberals contend with the newly elected Opposition leader, Pierre Poilievre.

The Public Health Agency of Canada is still strongly recommending that people wear masks, particularly in crowded environments such as planes and trains.

“The science is clear: wearing a mask is clearly a means of personal protection that is extremely effective,” said Dr. Howard Njoo, Canada’s deputy chief health officer.

“I hope Canadians will make an enlightened decision about this.”

Duclos said the negative attitudes of some passengers have made things very difficult for airlines and crews to enforce the mask mandate in recent months, and cited that as a factor in the decision.

“The transmission of the variants of COVID are domestic-based, for the most part, and therefore, this is what we should stress: masking is highly recommended … but it is not something that can be, in a sense, forced.”

That is a change in messaging from earlier in the summer, when the government and public health officials insisted that maintaining measures at the border was necessary to track and prevent the introduction of new variants.

Public Safety Minister Marco Mendicino said there have been 38 million entries at the border in 2022 so far, more than double the number in all of last year. “We want to keep that momentum going.”

The controversial ArriveCan app will no longer be mandatory when the order expires.

“Going forward, use of ArriveCan will be optional, allowing travellers who so choose to submit their customs declaration in advance at major airports,” Mendicino said.

So far that option is available at international airports in Toronto, Montreal and Vancouver, but that will be expanded to include Calgary, Edmonton, Winnipeg, Ottawa, Quebec City, Halifax and Billy Bishop airport in Toronto.

In addition, the Canada Border Services Agency is looking at adding features to ArriveCan to be able to provide information such as border wait times.

The changes do not remove the quarantine or testing requirements for people who enter Canada before Saturday.

This report by The Canadian Press was first published Sept. 26, 2022.

 

The Canadian Press

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Using artificial sweeteners may raise the risk of heart disease, study shows – Prestige Online Malaysia

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‘Debilitating’ heart palpitations could be sign of Long Covid – do you have the condition? – Express

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Heart palpitations can be a sign of several different problems – both mental and physical. Often, they’re caused by stress and anxiety. But over the course of the last few years, Long Covid has reportedly caused palpitations. A recent study has explored why this might happen.

Long Covid is when people suffer ongoing symptoms of Covid, 12 weeks after infection.

Some people with the condition have struggled with heart palpitations, chest pain, dizziness, or feeling faint.

Researchers, observing their patients, have concluded that these symptoms could be caused by problems with the autonomic nervous system – the part of your nervous system that monitors automatic activities such as heart rate, breathing, and blood pressure.

Doctors and nurses at Hammersmith Hospital and Imperial College London believe that the “debilitating” palpitations and other symptoms were caused by “orthostatic intolerance syndrome”.

READ MORE: Princess Beatrice’s ongoing difficulty with ‘muddled’ thoughts swirling in her head

Orthostatic intolerance syndromes are when moving from a sitting or lying position to an upright position causes a low blood pressure in your arteries.

The British Heart Foundation explains: “When a healthy person stands up, some of the blood in the body will flow downwards with the pull of gravity.

“The body responds to prevent blood pressure falling – blood vessels narrow and there is a slight increase in heart rate.

“But in people with orthostatic problems, these automatic changes don’t happen.

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“Moving to an upright position causes a drop in the blood supply to the heart and brain and a fast heart rate as the body tries to compensate.”

For people that struggle with these issues with moving to an upright position, the study by Hammersmith Hospital and Imperial College London made recommendations.

It suggested: “Non-upright exercise such as cycling on a recumbent exercise bike and swimming are encouraged.”

It added: “The patient should be advised on rising cautiously from a lying or seated position and avoiding exacerbating factors such as prolonged standing, warm environments, and dehydration.”

READ MORE: Princess Beatrice’s ongoing difficulty with ‘muddled’ thoughts swirling in her head

Shingles, memory loss, tinnitus, itchy skin, and tremors were among the more abnormal symptoms experienced.

Some studies have suggested that long Covid is an autoimmune disease, similar to Parkinson’s disease. An autoimmune disease is when the body’s immune system attacks itself.

The body cannot tell the difference between your own cells and foreign cells so causes the body to attack healthy cells.

According to one small study from 2021, 44 percent of long Covid patients involved had high levels of a type of antibody connected with other autoimmune diseases and lupus.

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