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Did a little grain of faith in humanity die when you had to explain that yes, malaria is a problem outside the US? It had that effect for me upon reading it.
Did a little grain of faith in humanity die when you had to explain that yes, malaria is a problem outside the US? It had that effect for me upon reading it.
I was saying it's not a problem here. In other countries (mostly in Africa) it is a serious problem - I do think most people know that too. Just I hadn't seen that there was a medication shortage in other countries. There is - apparently. It's actually pretty shocking there is an extremely high prevalence to develop Lupus in Africa too. By all means there are lots of medical professionals prescribing the medication as a treatment for corona virus. Prices for the drug need to be locked internationally and governments need to put resources into developing more end of story.
If we fail to anticipate the unforeseen or expect the unexpected in a universe of infinite possibilities, we may find ourselves at the mercy of anyone or anything that cannot be programmed, categorized or easily referenced.
- Fox Mulder
Xenomancers wrote: That is concerning. Supply should catch up here in the states though. Malaria is literally of no concern here. Lupus doesn't kill you ether and there are a lot of other treatments.
https://www.lupus.org/resources/medications-used-to-treat-lupus Thank you though - you did prove there is a shortage of said medication. I wonder if it is an issue outside of the US.
Lupus absolutely can kill you, it's the treatment that restores your longevity. The reason that there's a lot of other treatments is because not all medications work for everybody.
The medical community at large does not really have a handle on what causes autoimmune disorders or the specifics of the mechanisms at work. Consequently what can be totally effective for one person can be worthless for another, and doctors don't really know why, they just rotate through until they (hopefully) find a medication that does the trick without making you feel worse than the disease does.
Even if someone could survive a period without their most effective medicine, the fact that they should need to do so because of idiots buying it up without any scientific basis for doing so is outrageous.
It could also inflict damage without "killing them" and the fact that not being dead seems to be your metric for dismissing it as an issue is almost as distressing as your apparent ignorance about the problems malaria causes in the world.
We find comfort among those who agree with us - growth among those who don't. - Frank Howard Clark
The wise man doubts often, and changes his mind; the fool is obstinate, and doubts not; he knows all things but his own ignorance.
The correct statement of individual rights is that everyone has the right to an opinion, but crucially, that opinion can be roundly ignored and even made fun of, particularly if it is demonstrably nonsense!” Professor Brian Cox
Yeah, tell my dead grandmother that lupus didn't kill her.
"Through the darkness of future past, the magician longs to see.
One chants out between two worlds: Fire, walk with me." - Twin Peaks
"You listen to me. While I will admit to a certain cynicism, the fact is that I am a naysayer and hatchetman in the fight against violence. I pride myself in taking a punch and I'll gladly take another because I choose to live my life in the company of Gandhi and King. My concerns are global. I reject absolutely revenge, aggression, and retaliation. The foundation of such a method... is love. I love you Sheriff Truman." - Twin Peaks
queen_annes_revenge wrote: Have you really not realised that insulting people does absolutely nothing to change their mind?
Reasoning and begging didn't work. You also can't shame people into wearing masks who are so very convinced of being correct.
What else is left?
Leaving us alone.
Would love to do that but it gets complicated by the fact that anti-maskers still run around outside with potentially higher infection rates, and some are even attacking random employees for, for example, "outrageous" demands like stores wanting everybody to wear masks while shopping. That's kinda the whole point of this: Your actions don't only affect you in this case, yet we have to deal with it as a collective :/
RiTides wrote: Ah,shoot. I thought this was a public article because it pertains to the pandemic but apparently you need to be a subscriber to read all of it. I can try to copy and paste or maybe there is another similar public source?
I hope at least one person actually reads this after the effort I put in to make this readable:
Spoiler:
‘The Biggest Monster’ Is Spreading. And It’s Not the Coronavirus. Tuberculosis kills 1.5 million people each year. Lockdowns and supply-chain disruptions threaten progress against the disease as well as H.I.V. and malaria. By Apoorva Mandavilli
Aug. 3, 2020
Updated 10:51 a.m. ET
It begins with a mild fever and malaise, followed by a painful cough and shortness of breath. The infection prospers in crowds, spreading to people in close reach. Containing an outbreak requires contact tracing, as well as isolation and treatment of the sick for weeks or months.
This insidious disease has touched every part of the globe. It is tuberculosis, the biggest infectious-disease killer worldwide, claiming 1.5 million lives each year.
Until this year, TB and its deadly allies, H.I.V. and malaria, were on the run. The toll from each disease over the previous decade was at its nadir in 2018, the last year for which data are available.
Yet now, as the coronavirus pandemic spreads around the world, consuming global health resources, these perennially neglected adversaries are making a comeback.
“Covid-19 risks derailing all our efforts and taking us back to where we were 20 years ago,” said Dr. Pedro L. Alonso, the director of the World Health Organization’s global malaria program.
It’s not just that the coronavirus has diverted scientific attention from TB, H.I.V. and malaria. The lockdowns, particularly across parts of Africa, Asia and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs, according to interviews with more than two dozen public health officials, doctors and patients worldwide.
Fear of the coronavirus and the shuttering of clinics have kept away many patients struggling with H.I.V., TB and malaria, while restrictions on air and sea travel have severely limited delivery of medications to the hardest-hit regions.
About 80 percent of tuberculosis, H.I.V. and malaria programs worldwide have reported disruptions in services, and one in four people living with H.I.V. have reported problems with gaining access to medications, according to U.N. AIDS. Interruptions or delays in treatment may lead to drug resistance, already a formidable problem in many countries.
In India, home to about 27 percent of the world’s TB cases, diagnoses have dropped by nearly 75 percent since the pandemic began. In Russia, H.I.V. clinics have been repurposed for coronavirus testing.
Malaria season has begun in West Africa, which has 90 percent of malaria deaths in the world, but the normal strategies for prevention — distribution of insecticide-treated bed nets and spraying with pesticides — have been curtailed because of lockdowns.
According to one estimate, a three-month lockdown across different parts of the world and a gradual return to normal over 10 months could result in an additional 6.3 million cases of tuberculosis and 1.4 million deaths from it.
A six-month disruption of antiretroviral therapy may lead to more than 500,000 additional deaths from illnesses related to H.I.V., according to the W.H.O. Another model by the W.H.O. predicted that in the worst-case scenario, deaths from malaria could double to 770,000 per year.
Several public health experts, some close to tears, warned that if the current trends continue, the coronavirus is likely to set back years, perhaps decades, of painstaking progress against TB, H.I.V. and malaria.
The Global Fund, a public-private partnership to fight these diseases, estimates that mitigating this damage will require at least $28.5 billion, a sum that is unlikely to materialize.
Delays in diagnosis
If history is any guide, the coronavirus’s impact on the poor will be felt long after the pandemic is over. The socioeconomic crisis in Eastern Europe in the early 1990s, for example, led to the highest rates in the world of a kind of TB that was resistant to multiple drugs, a dubious distinction the region holds even today.
The starting point in this ruinous chain of events is a failure to diagnose: The longer a person goes undiagnosed, and the later treatment begins, the more likely an infectious disease is to spread, sicken and kill.
For malaria, a short delay in diagnosis can swiftly turn fatal, sometimes within just 36 hours of a spiking fever. “It’s one of those diseases where we cannot afford to wait,” Dr. Alonso said.
Apprehensive about malaria’s rise in West Africa, the W.H.O. is now considering giving entire populations antimalarial drugs — a strategy of last resort used during the Ebola epidemic in West Africa and the Boko Haram insurgency.
Across sub-Saharan Africa, fewer women are coming to clinics for H.I.V. diagnosis. A six-month disruption in access to drugs that prevent H.I.V.-positive pregnant women from passing the infection to their babies in utero could increase H.I.V. infections in children by as much as 139 percent in Uganda and 162 percent in Malawi, according to U.N. AIDS.
Diminishing diagnostic capacity may have the greatest effect on TB, leading to dire consequences for households because, like the coronavirus, the bacterium spreads most efficiently in indoor air and among people in close contact.
Each person with TB can spread the disease to another 15 individuals over a year, sharply raising the possibility of people infected while indoors spreading it among their communities once lockdowns end. The prospect is especially worrisome in densely populated places with high rates of T.B., such as the favelas of Rio de Janeiro or the townships of South Africa.
“The more you leave undiagnosed and untreated, the more you will have next year and the year after,” said Dr. Lucica Ditiu, who heads the Stop TB Partnership, an international consortium of 1,700 groups fighting the disease.
The infrastructure built to diagnose H.I.V. and TB has been a boon for many countries grappling with the coronavirus. GeneXpert, the tool used to detect genetic material from the TB bacteria and from H.I.V., can also amplify RNA from the coronavirus for diagnosis.
But now most clinics are using the machines only to look for the coronavirus. Prioritizing the coronavirus over T.B. is “very stupid from a public health perspective,” Dr. Ditiu said. “You should actually be smart and do both.”
In country after country, the pandemic has resulted in sharp drops in diagnoses of TB: a 70 percent decline in Indonesia, 50 percent in Mozambique and South Africa, and 20 percent in China, according to the W.H.O.
In late May in Mexico, as coronavirus infections climbed, TB diagnoses recorded by the government fell to 263 cases from 1,097 the same week last year.
Dr. Giorgio Franyuti, the executive director of Medical Impact, an advocacy group based in Mexico, normally works in the country’s remote jungles, diagnosing and treating TB in the Lacandon people. Unable to travel there during the pandemic, he has worked at a makeshift army hospital treating Covid-19 patients in Mexico City.
There, he has seen nine patients with a sputum-filled cough — characteristic of TB — that began months earlier but who were presumed to have Covid-19. The patients later contracted the coronavirus in the hospital and became seriously ill. At least four have died.
“Nobody is testing for TB at any facility,” he said. “The mind of clinicians in Mexico, as well as decision makers, is stuck with Covid-19.”
“TB is the biggest monster of them all. If we’re talking about deaths and pandemics, 10 million cases a year,” he said, Covid doesn’t compare yet to that toll.
India went into lockdown on March 24, and the government directed public hospitals to focus on Covid-19. Many hospitals shuttered outpatient services for other diseases.
The impact on TB diagnoses was immediate: The number of new cases recorded by the Indian government between March 25 and June 19 was 60,486, compared with 179,792 during the same period in 2019.
The pandemic is also shrinking the supply of diagnostic tests for these killers as companies turn to making more expensive tests to detect the coronavirus. Cepheid, the California-based manufacturer of TB diagnostic tests, has pivoted to making tests for the coronavirus. Companies that make diagnostic tests for malaria are doing the same, according to Dr. Catharina Boehme, the chief executive of the Foundation for Innovative New Diagnostics.
Coronavirus tests are much more lucrative, at about $10, compared with 18 cents for a rapid malaria test.
These companies “have tremendous demand for Covid right now,” said Dr. Madhukar Pai, the director of the McGill International TB Centre in Montreal. “I can’t imagine diseases of poverty getting any attention in this space.”
Treatment interruptions
The pandemic has hindered the availability of drugs for H.I.V., TB and malaria worldwide by interrupting supply chains, diverting manufacturing capacity and imposing physical barriers for patients who must travel to distant clinics to pick up the medications.
And these shortages are forcing some patients to ration their medications, endangering their health. In Indonesia, the official policy is to provide a month’s supply of drugs at a time to H.I.V. patients, but antiretroviral therapy has lately been hard to come by outside of Jakarta.
Even in the city, some people are stretching a month’s supply to two, said “Davi” Sepi Maulana Ardiansyah, an activist with the group Inti Muda.
Mr. Ardiansyah has done so himself, although he knows it has jeopardized his well-being. “This pandemic and this unavailability of the medicines is really impacting our mental health and also our health,” he said.
During the lockdown in Nairobi, Thomas Wuoto, who has H.I.V., borrowed antiretroviral pills from his wife, who also is infected. As a volunteer educator for H.I.V., Mr. Wuoto knew only too well that he was risking drug resistance by mixing or skipping medications. When he finally made it to the Mbagathi County Hospital, he had gone 10 days without his H.I.V. medicines, the first time since 2002 that he had missed his therapy.
People with H.I.V. and TB who skip medication are likely to get sicker in the short term. In the long term, there’s an even more worrisome consequence: a rise in drug-resistant forms of these diseases. Already drug-resistant TB is such a threat that patients are closely monitored during treatment — a practice that has mostly been suspended during the pandemic.
According to the W.H.O., at least 121 countries have reported a drop in TB patients visiting clinics since the pandemic began, threatening hard-fought gains.
“This is really difficult to digest,” Dr. Ditiu said. “It took a lot of work to arrive where we are. We were not at the peak of the mountain, but we were away from the base. But then an avalanche came and pushed us back to the bottom.”
The lockdowns in many places were imposed so swiftly that drug stocks were rapidly depleted. Mexico already had expired drugs in its supply, but that problem has been exacerbated by the pandemic, according to Dr. Franyuti.
In Brazil, H.I.V. and TB drugs are purchased and distributed by the ministry of health. But the coronavirus is racing through the country, and distribution of these treatments has become increasingly difficult as health care workers try to cope with the pandemic’s toll.
“It’s a big logistical challenge to have municipalities have higher stock so they can supply,” said Dr. Betina Durovni, a senior scientist at the Fiocruz Foundation, a research institute in Brazil.
Even if governments are prepared, with some help from big aid agencies, to buy drugs months in advance, the global supply may soon run out.
The pandemic has severely restricted international transport, hindering the availability not just of chemical ingredients and raw materials, but also of packaging supplies.
“The disruption of supply chains is really something that worries me — for H.I.V., for TB, for malaria,” said Dr. Carlos del Rio, chair of the scientific advisory board of the President’s Emergency Plan for AIDS Relief.
The hype over chloroquine as a potential treatment for the coronavirus has led to hoarding of the drug in some countries like Myanmar, depleting its global stocks.
More than 80 percent of the global supply of antiretroviral drugs comes from just eight Indian companies. The cost of these alone could rise by $225 million per year because of shortfalls in supplies and work force, transport disruptions and currency fluctuations, according to U.N. AIDS.
There is also a real risk that Indian companies will turn to more profitable medicines, or will not be able to meet the global demand because migrant workers have deserted cities as the coronavirus spreads.
The Indian government may even decide not to export T.B. medicines, saving its supply for its own citizens.
“We’re very dependent on a few key developers or manufacturers for all of the drugs around the world, and that needs to be diversified,” said Dr. Meg Doherty, who directs H.I.V. programs at the W.H.O. “If you had more locally developed drug depots or drug manufacturers, it would be closer to the point of need.”
Aid organizations and governments are trying to mitigate some of the damage by stretching supplies and stockpiling medications. In June, the W.H.O. changed its recommendation for treatment of drug-resistant TB. Instead of 20 months of injections, patients may now take pills for nine to 11 months. The change means patients don’t have to travel to clinics, increasingly closed by lockdowns.
More than half of 144 countries surveyed by the W.H.O. said they have opted to give patients H.I.V. drugs sufficient to last for at least three months — six months, in the case of a few countries like South Sudan — in order to limit their trips to hospitals. But it’s unclear how successful those efforts have been.
In some countries, such as the Philippines, advocacy groups have set up depots for patients to pick up antiretroviral pills or arrange to drop them off at patients’ homes.
In a few nations, like South Africa, most patients already pick up medications from community centers rather than from hospitals, said Dr. Salim S. Abdool Karim, a global health expert in South Africa and the chair of a government advisory committee on Covid-19. “That has been an important advantage in a way.”
‘What are we not doing right?’
The pandemic has exposed deep fissures in the health care systems of many countries.
In Zimbabwe, staffs in public hospitals were working reduced shifts even before the pandemic, because the government could not afford to pay their full salaries. Some hospitals like the Sally Mugabe Central Hospital in Harare — which was operating at half capacity because of water shortages and other problems — have since closed their outpatient departments, where TB and H.I.V. patients received their medications.
“Hospitals are functioning in an emergency mode,” said Dr. Tapiwa Mungofa, a physician at the Sally Mugabe Hospital.
The situation is no better in KwaZulu-Natal, which has the highest prevalence of H.I.V. in South Africa. Dr. Zolelwa Sifumba was a teenager when she saw images of skeletal patients dying of AIDS. Over the past few years in KwaZulu-Natal, she is again seeing patients with full-blown AIDS.
“We’re seeing people come in at the stage where they’re kind of on death’s door,” she said. “What are we not doing right?”
Some remote parts of the world are being decimated by the coronavirus — but their very remoteness makes the pandemic’s impact on these other big infectious killers impossible to measure.
The town of Tabatinga in Amazonas, the biggest state in Brazil, is more than 1,000 miles from the closest city with an I.C.U., Manaus. The government has been using airplanes to transport coronavirus patients to Manaus, but many cases are being missed, said Dr. Marcelo Cordeiro-Santos, a researcher at the Tropical Medicine Foundation in Manaus.
Hospitals are giving chloroquine to people with Covid-19, at the recommendation of the Brazilian ministry of health, even though evidence now suggests it does not help and may even be harmful.
Chloroquine is also a crucial malaria medicine, and its indiscriminate use now may lead to resistance to the drug, Dr. Cordeiro-Santos warned — with possibly dire consequences for those infected in the future. But he also said it’s possible that widespread distribution of chloroquine may help protect residents of Amazonas from malaria.
Other experts said they hope the coronavirus pandemic brings some silver linings.
Aid agencies have long recommended that countries buy drugs in bulk and provide several months’ supply at a time to their citizens. Some governments are considering doing so now for H.I.V., according to Dr. Doherty at the W.H.O.
Health care providers are also embracing video and phone calls to counsel and treat patients, which many people find far easier than traveling to distant clinics.
“Sometimes systems are tough to change,” said Dr. del Rio, “but I think there’s nothing better than a crisis to change the system, right?”
lord_blackfang wrote: Respect to the guy who subscribed just to post a massive ASCII dong in the chat and immediately get banned.
Flinty wrote: The benefit of slate is that its.actually a.rock with rock like properties. The downside is that it's a rock
The Article wrote:The hype over chloroquine as a potential treatment for the coronavirus has led to hoarding of the drug in some countries like Myanmar, depleting its global stocks.
Hospitals are giving chloroquine to people with Covid-19, at the recommendation of the Brazilian ministry of health, even though evidence now suggests it does not help and may even be harmful.
Chloroquine is also a crucial malaria medicine, and its indiscriminate use now may lead to resistance to the drug, Dr. Cordeiro-Santos warned — with possibly dire consequences for those infected in the future. But he also said it’s possible that widespread distribution of chloroquine may help protect residents of Amazonas from malaria.
That's why I brought up what I did initially, RiTides. Just because I didn't read your specific article(beyond what I could get by fast-skimming before it 'blocked' me), does not mean that I have not paid attention to what is going on in the world.
If you just don't want me posting in this thread for fear of stirring up politics, just say so. But I damn well expect you to start cracking down on a specific poster in here. Ignore is not enough of an option when other people are requoting them, and the kinds of crap they're posting is begging to be replied to.
So something totally different.
My area has several big refineries and one is permanently closing do to decreased demand in gas, despite my county/state opening up more.
While it might not be, im wondering if these might end up being a result of a work from home revolution.
I think we are starting to realize just how much of our life revolved around work, not just the act of working, but the physical place of work, and how much of our infrastructure of was built getting people too work.
I definitely do not need to be physically at my workplace to do any part of my job.
The only reason I am here now is because of my employer's compulsive need to exert control over me (while they work remote, because Covid is on an upswing here, and they don't want to maybe get sick obviously).
lord_blackfang wrote: Respect to the guy who subscribed just to post a massive ASCII dong in the chat and immediately get banned.
Flinty wrote: The benefit of slate is that its.actually a.rock with rock like properties. The downside is that it's a rock
Ouze wrote: I definitely do not need to be physically at my workplace to do any part of my job.
The only reason I am here now is because of my employer's compulsive need to exert control over me (while they work remote, because Covid is on an upswing here, and they don't want to maybe get sick obviously).
US culture in a nutshell.
Thanks for reformatting that article btw. Count me among those who had no idea the tb/malaria/HIV situation was being exacerbated so much by all this. But hey at least I know malaria comes from Africa!
I would certainly welcome a world where the majority of the people with general office type jobs work from home. You really don't need to sit in traffic every morning to get your job done. I'm not a hippie tree hugger, but imagine how much better the environment could be with like 50% less smog. Not that it would stop some people from having 4 cars in the driveway when they only need 1. Then there's the extra benefit of not having to get up so early since you need to make time for your commute, so you can get a little more rest each day. For me, my commute was 70-80 minutes. It sucked.
I've barely left the house since March and loving it. I go out twice a week, once for a grocery run and another time to maybe get some takeout.. both times with curbside delivery so I don't have to go inside where there's potential cooties. Just bummed we had to cancel our June cruise, but we got a 125% credit to postpone it till next year.
RiTides wrote: Ah,shoot. I thought this was a public article because it pertains to the pandemic but apparently you need to be a subscriber to read all of it. I can try to copy and paste or maybe there is another similar public source?
I hope at least one person actually reads this after the effort I put in to make this readable:
Spoiler:
‘The Biggest Monster’ Is Spreading. And It’s Not the Coronavirus. Tuberculosis kills 1.5 million people each year. Lockdowns and supply-chain disruptions threaten progress against the disease as well as H.I.V. and malaria. By Apoorva Mandavilli
Aug. 3, 2020
Updated 10:51 a.m. ET
It begins with a mild fever and malaise, followed by a painful cough and shortness of breath. The infection prospers in crowds, spreading to people in close reach. Containing an outbreak requires contact tracing, as well as isolation and treatment of the sick for weeks or months.
This insidious disease has touched every part of the globe. It is tuberculosis, the biggest infectious-disease killer worldwide, claiming 1.5 million lives each year.
Until this year, TB and its deadly allies, H.I.V. and malaria, were on the run. The toll from each disease over the previous decade was at its nadir in 2018, the last year for which data are available.
Yet now, as the coronavirus pandemic spreads around the world, consuming global health resources, these perennially neglected adversaries are making a comeback.
“Covid-19 risks derailing all our efforts and taking us back to where we were 20 years ago,” said Dr. Pedro L. Alonso, the director of the World Health Organization’s global malaria program.
It’s not just that the coronavirus has diverted scientific attention from TB, H.I.V. and malaria. The lockdowns, particularly across parts of Africa, Asia and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs, according to interviews with more than two dozen public health officials, doctors and patients worldwide.
Fear of the coronavirus and the shuttering of clinics have kept away many patients struggling with H.I.V., TB and malaria, while restrictions on air and sea travel have severely limited delivery of medications to the hardest-hit regions.
About 80 percent of tuberculosis, H.I.V. and malaria programs worldwide have reported disruptions in services, and one in four people living with H.I.V. have reported problems with gaining access to medications, according to U.N. AIDS. Interruptions or delays in treatment may lead to drug resistance, already a formidable problem in many countries.
In India, home to about 27 percent of the world’s TB cases, diagnoses have dropped by nearly 75 percent since the pandemic began. In Russia, H.I.V. clinics have been repurposed for coronavirus testing.
Malaria season has begun in West Africa, which has 90 percent of malaria deaths in the world, but the normal strategies for prevention — distribution of insecticide-treated bed nets and spraying with pesticides — have been curtailed because of lockdowns.
According to one estimate, a three-month lockdown across different parts of the world and a gradual return to normal over 10 months could result in an additional 6.3 million cases of tuberculosis and 1.4 million deaths from it.
A six-month disruption of antiretroviral therapy may lead to more than 500,000 additional deaths from illnesses related to H.I.V., according to the W.H.O. Another model by the W.H.O. predicted that in the worst-case scenario, deaths from malaria could double to 770,000 per year.
Several public health experts, some close to tears, warned that if the current trends continue, the coronavirus is likely to set back years, perhaps decades, of painstaking progress against TB, H.I.V. and malaria.
The Global Fund, a public-private partnership to fight these diseases, estimates that mitigating this damage will require at least $28.5 billion, a sum that is unlikely to materialize.
Delays in diagnosis
If history is any guide, the coronavirus’s impact on the poor will be felt long after the pandemic is over. The socioeconomic crisis in Eastern Europe in the early 1990s, for example, led to the highest rates in the world of a kind of TB that was resistant to multiple drugs, a dubious distinction the region holds even today.
The starting point in this ruinous chain of events is a failure to diagnose: The longer a person goes undiagnosed, and the later treatment begins, the more likely an infectious disease is to spread, sicken and kill.
For malaria, a short delay in diagnosis can swiftly turn fatal, sometimes within just 36 hours of a spiking fever. “It’s one of those diseases where we cannot afford to wait,” Dr. Alonso said.
Apprehensive about malaria’s rise in West Africa, the W.H.O. is now considering giving entire populations antimalarial drugs — a strategy of last resort used during the Ebola epidemic in West Africa and the Boko Haram insurgency.
Across sub-Saharan Africa, fewer women are coming to clinics for H.I.V. diagnosis. A six-month disruption in access to drugs that prevent H.I.V.-positive pregnant women from passing the infection to their babies in utero could increase H.I.V. infections in children by as much as 139 percent in Uganda and 162 percent in Malawi, according to U.N. AIDS.
Diminishing diagnostic capacity may have the greatest effect on TB, leading to dire consequences for households because, like the coronavirus, the bacterium spreads most efficiently in indoor air and among people in close contact.
Each person with TB can spread the disease to another 15 individuals over a year, sharply raising the possibility of people infected while indoors spreading it among their communities once lockdowns end. The prospect is especially worrisome in densely populated places with high rates of T.B., such as the favelas of Rio de Janeiro or the townships of South Africa.
“The more you leave undiagnosed and untreated, the more you will have next year and the year after,” said Dr. Lucica Ditiu, who heads the Stop TB Partnership, an international consortium of 1,700 groups fighting the disease.
The infrastructure built to diagnose H.I.V. and TB has been a boon for many countries grappling with the coronavirus. GeneXpert, the tool used to detect genetic material from the TB bacteria and from H.I.V., can also amplify RNA from the coronavirus for diagnosis.
But now most clinics are using the machines only to look for the coronavirus. Prioritizing the coronavirus over T.B. is “very stupid from a public health perspective,” Dr. Ditiu said. “You should actually be smart and do both.”
In country after country, the pandemic has resulted in sharp drops in diagnoses of TB: a 70 percent decline in Indonesia, 50 percent in Mozambique and South Africa, and 20 percent in China, according to the W.H.O.
In late May in Mexico, as coronavirus infections climbed, TB diagnoses recorded by the government fell to 263 cases from 1,097 the same week last year.
Dr. Giorgio Franyuti, the executive director of Medical Impact, an advocacy group based in Mexico, normally works in the country’s remote jungles, diagnosing and treating TB in the Lacandon people. Unable to travel there during the pandemic, he has worked at a makeshift army hospital treating Covid-19 patients in Mexico City.
There, he has seen nine patients with a sputum-filled cough — characteristic of TB — that began months earlier but who were presumed to have Covid-19. The patients later contracted the coronavirus in the hospital and became seriously ill. At least four have died.
“Nobody is testing for TB at any facility,” he said. “The mind of clinicians in Mexico, as well as decision makers, is stuck with Covid-19.”
“TB is the biggest monster of them all. If we’re talking about deaths and pandemics, 10 million cases a year,” he said, Covid doesn’t compare yet to that toll.
India went into lockdown on March 24, and the government directed public hospitals to focus on Covid-19. Many hospitals shuttered outpatient services for other diseases.
The impact on TB diagnoses was immediate: The number of new cases recorded by the Indian government between March 25 and June 19 was 60,486, compared with 179,792 during the same period in 2019.
The pandemic is also shrinking the supply of diagnostic tests for these killers as companies turn to making more expensive tests to detect the coronavirus. Cepheid, the California-based manufacturer of TB diagnostic tests, has pivoted to making tests for the coronavirus. Companies that make diagnostic tests for malaria are doing the same, according to Dr. Catharina Boehme, the chief executive of the Foundation for Innovative New Diagnostics.
Coronavirus tests are much more lucrative, at about $10, compared with 18 cents for a rapid malaria test.
These companies “have tremendous demand for Covid right now,” said Dr. Madhukar Pai, the director of the McGill International TB Centre in Montreal. “I can’t imagine diseases of poverty getting any attention in this space.”
Treatment interruptions
The pandemic has hindered the availability of drugs for H.I.V., TB and malaria worldwide by interrupting supply chains, diverting manufacturing capacity and imposing physical barriers for patients who must travel to distant clinics to pick up the medications.
And these shortages are forcing some patients to ration their medications, endangering their health. In Indonesia, the official policy is to provide a month’s supply of drugs at a time to H.I.V. patients, but antiretroviral therapy has lately been hard to come by outside of Jakarta.
Even in the city, some people are stretching a month’s supply to two, said “Davi” Sepi Maulana Ardiansyah, an activist with the group Inti Muda.
Mr. Ardiansyah has done so himself, although he knows it has jeopardized his well-being. “This pandemic and this unavailability of the medicines is really impacting our mental health and also our health,” he said.
During the lockdown in Nairobi, Thomas Wuoto, who has H.I.V., borrowed antiretroviral pills from his wife, who also is infected. As a volunteer educator for H.I.V., Mr. Wuoto knew only too well that he was risking drug resistance by mixing or skipping medications. When he finally made it to the Mbagathi County Hospital, he had gone 10 days without his H.I.V. medicines, the first time since 2002 that he had missed his therapy.
People with H.I.V. and TB who skip medication are likely to get sicker in the short term. In the long term, there’s an even more worrisome consequence: a rise in drug-resistant forms of these diseases. Already drug-resistant TB is such a threat that patients are closely monitored during treatment — a practice that has mostly been suspended during the pandemic.
According to the W.H.O., at least 121 countries have reported a drop in TB patients visiting clinics since the pandemic began, threatening hard-fought gains.
“This is really difficult to digest,” Dr. Ditiu said. “It took a lot of work to arrive where we are. We were not at the peak of the mountain, but we were away from the base. But then an avalanche came and pushed us back to the bottom.”
The lockdowns in many places were imposed so swiftly that drug stocks were rapidly depleted. Mexico already had expired drugs in its supply, but that problem has been exacerbated by the pandemic, according to Dr. Franyuti.
In Brazil, H.I.V. and TB drugs are purchased and distributed by the ministry of health. But the coronavirus is racing through the country, and distribution of these treatments has become increasingly difficult as health care workers try to cope with the pandemic’s toll.
“It’s a big logistical challenge to have municipalities have higher stock so they can supply,” said Dr. Betina Durovni, a senior scientist at the Fiocruz Foundation, a research institute in Brazil.
Even if governments are prepared, with some help from big aid agencies, to buy drugs months in advance, the global supply may soon run out.
The pandemic has severely restricted international transport, hindering the availability not just of chemical ingredients and raw materials, but also of packaging supplies.
“The disruption of supply chains is really something that worries me — for H.I.V., for TB, for malaria,” said Dr. Carlos del Rio, chair of the scientific advisory board of the President’s Emergency Plan for AIDS Relief.
The hype over chloroquine as a potential treatment for the coronavirus has led to hoarding of the drug in some countries like Myanmar, depleting its global stocks.
More than 80 percent of the global supply of antiretroviral drugs comes from just eight Indian companies. The cost of these alone could rise by $225 million per year because of shortfalls in supplies and work force, transport disruptions and currency fluctuations, according to U.N. AIDS.
There is also a real risk that Indian companies will turn to more profitable medicines, or will not be able to meet the global demand because migrant workers have deserted cities as the coronavirus spreads.
The Indian government may even decide not to export T.B. medicines, saving its supply for its own citizens.
“We’re very dependent on a few key developers or manufacturers for all of the drugs around the world, and that needs to be diversified,” said Dr. Meg Doherty, who directs H.I.V. programs at the W.H.O. “If you had more locally developed drug depots or drug manufacturers, it would be closer to the point of need.”
Aid organizations and governments are trying to mitigate some of the damage by stretching supplies and stockpiling medications. In June, the W.H.O. changed its recommendation for treatment of drug-resistant TB. Instead of 20 months of injections, patients may now take pills for nine to 11 months. The change means patients don’t have to travel to clinics, increasingly closed by lockdowns.
More than half of 144 countries surveyed by the W.H.O. said they have opted to give patients H.I.V. drugs sufficient to last for at least three months — six months, in the case of a few countries like South Sudan — in order to limit their trips to hospitals. But it’s unclear how successful those efforts have been.
In some countries, such as the Philippines, advocacy groups have set up depots for patients to pick up antiretroviral pills or arrange to drop them off at patients’ homes.
In a few nations, like South Africa, most patients already pick up medications from community centers rather than from hospitals, said Dr. Salim S. Abdool Karim, a global health expert in South Africa and the chair of a government advisory committee on Covid-19. “That has been an important advantage in a way.”
‘What are we not doing right?’
The pandemic has exposed deep fissures in the health care systems of many countries.
In Zimbabwe, staffs in public hospitals were working reduced shifts even before the pandemic, because the government could not afford to pay their full salaries. Some hospitals like the Sally Mugabe Central Hospital in Harare — which was operating at half capacity because of water shortages and other problems — have since closed their outpatient departments, where TB and H.I.V. patients received their medications.
“Hospitals are functioning in an emergency mode,” said Dr. Tapiwa Mungofa, a physician at the Sally Mugabe Hospital.
The situation is no better in KwaZulu-Natal, which has the highest prevalence of H.I.V. in South Africa. Dr. Zolelwa Sifumba was a teenager when she saw images of skeletal patients dying of AIDS. Over the past few years in KwaZulu-Natal, she is again seeing patients with full-blown AIDS.
“We’re seeing people come in at the stage where they’re kind of on death’s door,” she said. “What are we not doing right?”
Some remote parts of the world are being decimated by the coronavirus — but their very remoteness makes the pandemic’s impact on these other big infectious killers impossible to measure.
The town of Tabatinga in Amazonas, the biggest state in Brazil, is more than 1,000 miles from the closest city with an I.C.U., Manaus. The government has been using airplanes to transport coronavirus patients to Manaus, but many cases are being missed, said Dr. Marcelo Cordeiro-Santos, a researcher at the Tropical Medicine Foundation in Manaus.
Hospitals are giving chloroquine to people with Covid-19, at the recommendation of the Brazilian ministry of health, even though evidence now suggests it does not help and may even be harmful.
Chloroquine is also a crucial malaria medicine, and its indiscriminate use now may lead to resistance to the drug, Dr. Cordeiro-Santos warned — with possibly dire consequences for those infected in the future. But he also said it’s possible that widespread distribution of chloroquine may help protect residents of Amazonas from malaria.
Other experts said they hope the coronavirus pandemic brings some silver linings.
Aid agencies have long recommended that countries buy drugs in bulk and provide several months’ supply at a time to their citizens. Some governments are considering doing so now for H.I.V., according to Dr. Doherty at the W.H.O.
Health care providers are also embracing video and phone calls to counsel and treat patients, which many people find far easier than traveling to distant clinics.
“Sometimes systems are tough to change,” said Dr. del Rio, “but I think there’s nothing better than a crisis to change the system, right?”
Oh man, thanks Ouze!!! That really was daunting, which is why I didn't earlier. Really appreciate it
So that's what I was referring to with the possible / projected millions of additional deaths from tuberculosis, HIV and malaria, and setting back the progress of containing the spread of these diseases decades. I really hope those projections are not accurate
At some point it will click with companies that they can give their employees an effective pay raise without needing to pay for it, by implementing work from home. Removing commutes cuts the amount of time spent pseudo-working each week without cutting salary, meaning the hours remaining are worth more. Additionally it lowers expenses like gas, freeing up more of the employee's budget.
Kanluwen wrote: Literally can't read it, thanks to them not liking my adblocker.
And again, see why I mention that two of the three diseases listed are immunocompromisers...and while I didn't mention it initially remember that all all three also have had global programs tied to the WHO as key parts of handling them.
I'm going to side with kanluwen here, i can't read some articles people post to a lot of tmes.
Sometimes it's my adblocker.
Other times people post to subscription sites and when I start to read it a giant screen block appears with "To continue reading SUBSCRIBE! MONEY!" which puts me in a state of homicidal rage.
If you have a subscription to a site please don;t post links to articles on it without noting you need a subscription. It's infuriating to some people
"But the universe is a big place, and whatever happens, you will not be missed..."
nfe wrote: There are some tombs of imams in Iran but that's about it in terms of Islamic holy sites and I don't think any have massive numbers of visitors.
For Shia Islam, Iran is second only to Mecca for Pilgrimage.
EDIT: I'd happily turn my ad blocker off if hosts would take some damn responsibility for the ads that appear on their site. But they don't. So feth that.
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Gamgee on Tau Players wrote:we all kill cats and sell our own families to the devil and eat live puppies.
Kanluwen wrote: This is, emphatically, why I will continue suggesting nuking Guard and starting over again. It's a legacy army that needs to be rebooted with a new focal point.
Confirmation of why no-one should listen to Kanluwen when it comes to the IG - he doesn't want the IG, he want's Kan's New Model Army...
tneva82 wrote: You aren't even trying ty pretend for honest arqument. Open bad faith trolling.
- No reason to keep this here, unless people want to use it for something...
Mario wrote: Would love to do that but it gets complicated by the fact that anti-maskers still run around outside with potentially higher infection rates, and some are even attacking random employees for, for example, "outrageous" demands like stores wanting everybody to wear masks while shopping. That's kinda the whole point of this: Your actions don't only affect you in this case, yet we have to deal with it as a collective :/
Sigh. Stores=\=Government.
FYI, over here in the UK, those 'anti-maskers' (AKA regular people), make up about 90% of the population. Before this decree I'd see 2 or 3 people wearing masks in the 50-60 people in the supermarket. The vast majority of people didn't care about masks. And now that it's law, do you think they suddenly care/believe the hype? All that's happened is those people have split into those who are either too docile to care that the government is playing them for fools, or are angry about it same as I am. The only people who are happy are a small minority who want to see their own actions and opinions forced on others against their will.
Ah so it's appeals to emotion and name calling for me, but good faith argument for thee? Fair enough.
Well that 90% was an estimation based on my experiences in public. Turns out I wasn't too far off. Most surveys before the new diktat have mask usage between 20-30%, rising slightly just before and steeply after. Threat of fines will do that I guess.
Right, over to you Queen Anne’s Revenge. I await with interest your counter citation from peer reviewed resources. Just in case, David Avocado Wolfe and Goop do not count
Fed up of Scalpers? But still want your Exclusives? Why not join us?
Why would I cite peer reviewed evidence? You're arguing a different point to me, again. I assert that it's not enough to justify the government making them mandatory in arbitrary places like supermarkets. If so, why not make them mandatory everywhere? And why not make the fine £1000? £10 000?
Another study saying that masks DO protect the wearer. Excellent. Let individuals decide whether to wear them or not then.
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Do you really have no qualms at all about being an unwitting vector, given this virus kills, and can leave survivors with serious, lasting lung damage, and possibly brain damage?
Is wearing a mask really that much of a bother? Beyond “I don’t wanna”, do you have legitimate medical reasons not to wear a mask?
Do you understand how wearing a non-surgical mask helps reduce infection rates?
Or do you only get so far as “I don’t wanna”, dig your heels in, then argue until your blue in the face, despite a lack of factual information to support your position?
Do you understand that where a recommendation, based on solid scientific evidence, is ignored, the Government is left with no option to introduce a new law? As they did with seatbelts. And airbags. And not drink driving. And frankly thousands of other public safety related laws?
Fed up of Scalpers? But still want your Exclusives? Why not join us?
nfe wrote: There are some tombs of imams in Iran but that's about it in terms of Islamic holy sites and I don't think any have massive numbers of visitors.
For Shia Islam, Iran is second only to Mecca for Pilgrimage.
Najaf, Samarra, and Kurbala are much bigger deals than any Iranian shrine in terms of holiness, but fair game on checking the bigger Iranian shrined do get a stack more visitors than I thought. No idea how many are from outside Iran, though.
queen_annes_revenge wrote:
Mario wrote: Would love to do that but it gets complicated by the fact that anti-maskers still run around outside with potentially higher infection rates, and some are even attacking random employees for, for example, "outrageous" demands like stores wanting everybody to wear masks while shopping. That's kinda the whole point of this: Your actions don't only affect you in this case, yet we have to deal with it as a collective :/
Sigh. Stores=\=Government.
FYI, over here in the UK, those 'anti-maskers' (AKA regular people), make up about 90% of the population. Before this decree I'd see 2 or 3 people wearing masks in the 50-60 people in the supermarket. The vast majority of people didn't care about masks. And now that it's law, do you think they suddenly care/believe the hype? All that's happened is those people have split into those who are either too docile to care that the government is playing them for fools, or are angry about it same as I am. The only people who are happy are a small minority who want to see their own actions and opinions forced on others against their will.
This is an anecdote fleshed out with some pop psychology and then extrapolated to represent the average ideological positions of almost 70 million people.
People who think masks are a perfectly reasonable idea are also normal people and your wild-guess 90% is baseless. That a person was not wearing a mask prior to a law change does not mean they fundamentally oppose them and are now being strongarmed into obedience.
People's opinions do change. One of the things likely to prompt that, for good or ill, are changes to laws or governmental advice. When government decided that, actually, four pints is probably too much to drink before driving, was everyone who said 'yeah, that's probably fair enough really' a docile little cuckold? Is it possible that some people who did regularly tan four pints and drive home did so because they could and they fancied it that night, rather than because they thought it was their moral right or libertarian duty?
Same here. Plenty were a bit lazy or vain or just didn't fancy masks. Plenty doing so knew that they should probably be wearing a mask but thought 'well, when it's really important someone will mandate it'. Now they have. Lots of others will have thought that they just didn't really want to stand out as ones of those few wearing them but are perfectly comfortable now it's the norm. Lots of others will have thought lots of different things that don't occur to me in the last 30 seconds of typing. People vary.
Following rules coming into force on Friday that mean all Britons must now wear face masks in shops, the proportion of Britons donning a facial covering has shot up.
On July 12 only 38% of Britons reported having worn a face mask in the previous fortnight. As of this weekend [July 27, 2020] that figure has surged by almost 20 percentage points to 57%.
Anecdotally, nearly everyone I saw in Warwick yesterday had a mask on when inside.
"Let individuals decide whether to [infect anyone near] them or not then."
FTFY
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5000pts 
6000pts 
3000pts
Heresy World Eaters/Emperors Children 
6000 pts - 
4000 pts - Harlies: 1000 pts - 
1000 pts