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[Editorial] India under COVID-19 lockdown

Sa, 25/04/2020 - 00:00
The largest COVID-19 national lockdown in the world has been extended to May 3. As of April 22, India has reported 18 985 confirmed cases and 603 deaths from COVID-19 in 31 states and union territories since its first case on Jan 30. India was quick to close its international borders and enforce an immediate lockdown, which WHO praised as “tough and timely”. The lockdown has also given the government time to prepare for a possible surge in cases when the pandemic is forecasted to peak in the coming weeks.

[Comment] Reducing malaria transmission with reactive focal interventions

Sa, 25/04/2020 - 00:00
A massive scale-up of investments in malaria control resulted in an estimated 663 million lives saved in sub-Saharan Africa between 2000 and 2015,1 and 11 countries have been certified malaria-free in the current millennium.2 Unfortunately, progress has stalled recently, and increases in malaria incidence were observed in several endemic countries.3 Continuing with business as usual is likely to jeopardise gains made in the past 20 years, and slow the progress towards elimination goals. Innovative and targeted measures are required to complement universal coverage with basic vector control and case management interventions, especially as heterogeneity in case incidence increases with declining transmission.

[Comment] Antiplatelet strategies in ageing patients with acute coronary syndromes

Sa, 25/04/2020 - 00:00
Older patients who present with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are at particular risk of recurrent ischaemic events, but also of bleeding complications.1 Choosing the optimal dual antiplatelet strategy for the ageing patient with ACS can thus present a dilemma in daily practice. Should dual antiplatelet therapy in an older patient include the less potent P2Y12 inhibitor clopidogrel, thus minimising bleeding risk, or should a more potent P2Y12 inhibitor such as ticagrelor or prasugrel be used to avoid recurrent ischaemic events? In addition, the ideal dual antiplatelet therapy duration for these patients remains unclear.

[Comment] An alarming rise in incidence of infective endocarditis in England since 2009: why?

Sa, 25/04/2020 - 00:00
Infective endocarditis is a life-threatening condition with a 50% requirement for early cardiac surgery and 30% mortality at 1 year.1 We have used publicly available annual admission data for hospitals in England2 to examine the incidence of infective endocarditis admissions (primary ICD-10 diagnostic code I33) between 1998 and 2019. These data show stable incidence between 1998–99 (26·6 cases per million) and 2009–10 (26·9 cases per million), but an 86% increase to 50·0 cases per million in 2018–19 (figure).

[Comment] Offline: Why President Trump is wrong about WHO

Sa, 25/04/2020 - 00:00
April 14, 2020: President Trump, speaking at The White House—“Today, I am instructing my administration to halt funding of the World Health Organization while a review is conducted to assess the World Health Organization's role in severely mismanaging and covering up the spread of the coronavirus…The WHO's reliance on China's disclosures likely caused a 20-fold increase in cases worldwide, and it may be much more than that. The WHO has not addressed a single one of these concerns nor provided a serious explanation that acknowledges its own mistakes, of which there were many…so much death has been caused by their mistakes.” Here are the facts.

[World Report] Travel restrictions hampering COVID-19 response

Sa, 25/04/2020 - 00:00
Many countries are limiting travel to stem the pandemic, but these measures are restricting the movement of vital equipment and personnel. Sharmila Devi reports.

[Perspectives] COVID-19 fault lines

Sa, 25/04/2020 - 00:00
My daughter's art project, a small ceramic bowl, tipped over the edge of the table and broke into pieces. To assuage her tears, I used what I had on hand, a thin wood glue, to patch it together. It was a rushed effort, but I deemed it good enough for the moment. The bowl hung precariously together until she decided, one day, to fill it with water to bathe a toy. Under that small challenge, the fragile bonds between the pieces gave way. The water dribbled out, and the bowl cracked open.

[Perspectives] Medicine and meteorology: Cloud, connectivity, and care

Sa, 25/04/2020 - 00:00
The evolution of many professions has been driven by technological innovation and the need to overcome real-world challenges. The combination of advanced computing power with large datasets in areas as diverse as baseball, political polling, and economic forecasting has driven both the science of prediction and its practical application. There is much that can be learned from this technology for health care in the coming years, and the field of weather forecasting could be singularly instructive.

[Perspectives] Modelling can only tell us so much: politics explains the rest

Sa, 25/04/2020 - 00:00
I've been self-isolating with my family because we developed fevers. Whether this is any illness or coronavirus disease 2019 (COVID-19) is hard to say given the UK Government's position on community testing. How this infection started, how many people I might have infected, and how adhering to public health guidance to remain at home alters patterns of disease transmission is crucial information. For this knowledge, policy makers need epidemiologists and mathematical models of how diseases spread in different populations, as described by Adam Kucharski in The Rules of Contagion: Why Things Spread—and Why They Stop.

[Perspectives] The history of the RTS,S/AS01 malaria vaccine trial

Sa, 25/04/2020 - 00:00
In 1949, an international congress on malaria coincided with the publication of Mark F Boyd's massive two-volume work on the science of malariology. Placing the tomes on the rostrum, Paul F Russell announced to the delegates, “I present you these volumes as tombstones on the grave of malaria.” More than 70 years later, however, it is apparent that Russell's optimism was misplaced: malaria and the mosquitoes that carry this deadly parasitic disease still refuse to be buried. Nevertheless, malaria is a preventable disease, and following WHO's failed eradication attempts in the 1950s and 1960s, global mortality and morbidity have decreased substantially in the past two decades.

[Obituary] Catherine Hamlin

Sa, 25/04/2020 - 00:00
Obstetrician and gynaecologist who transformed treatment of obstetric fistula in Ethiopia. Born on Jan 24, 1924, in Sydney, NSW, Australia, she died on March 18, 2020, in Addis Ababa, Ethiopia, aged 96 years.

[Correspondence] The political nature of medicine

Sa, 25/04/2020 - 00:00
“What should we expect of scientists in society?” This is the question we read in Richard Horton's Comment,1 which is quite important since the answer will be the same as for other similar questions: what should we expect of people having professions in different fields, such as engineers, musicians, economists, or soldiers in society? We agree that to achieve great science, there needs to be excellence in the field. We need to be able to provide the best diagnosis, best design, best music, best management of resources, and so on.

[Correspondence] Bodily distribution of projectile injuries in Chilean protests

Sa, 25/04/2020 - 00:00
On Oct 14, 2019, a series of protests began in Chile after the Ministry of Transport introduced a fare increase for riding in the Metropolitan Public Transport Network, which led to an escalation of confrontations between local police, military forces, and protestors, in turn leading to a record number of patients with projectile-related injuries and severe ocular trauma.

[Correspondence] Rebuilding the broken health contract in Chile

Sa, 25/04/2020 - 00:00
Many Chileans think that their country has lost its way. Massive protests highlight the need for a political reform to prioritise universal health care. The uncritical worship of the most extreme version of the free market by the Pinochet dictatorship led to the dismantling of the social contract and privatisation of the social security system. A system of personal retirement accounts was mandatory for new workers whereas the current workforce could opt out from the existing government-managed schemes.

[Correspondence] Malnutrition needs prioritisation and public resources

Sa, 25/04/2020 - 00:00
Malnutrition is indeed a global emergency, and courageous and timely actions are needed from governments, media outlets, non-governmental organisations, and civil society.1 Nevertheless, I believe that a reduction in malnutrition is only possible if there is political will, economic stability, and a prioritisation of malnutrition as public policy and a developmental issue by governments, especially in developing countries. In Pakistan, public health is a conundrum as the country is facing challenges such as high rates of teenage pregnancies, early child marriages, undernourished mothers, and less-spaced pregnancies (<24 months between pregnancies).

[Correspondence] European education corridors: opportunity for academic solidarity

Sa, 25/04/2020 - 00:00
In times of growing political tensions around migration, health-care providers can help to protect migrant populations from exclusion.1,2 The UCL–Lancet Commission on Migration and Health called for a strengthening, through regulatory and training bodies, of health professionals' and organisations' awareness of discrimination.2 We add that organisations engaged in health science and biomedical education can fulfil their moral and deontological duty to protect populations that are susceptible to discrimination by also promoting the right to education.

[Correspondence] Health access inequities and magic medicine: the first ancient evidence?

Sa, 25/04/2020 - 00:00
Inequities in access to the latest advances in health care and effective drugs constitute public health problems today,1 but was this also the case in ancient societies when practitioners used traditional medicines with limited means? The excavation of frozen graves in Yakutia (present day eastern Siberia, Russia) dating from 1700 CE2 led to the identification of a woman, buried almost naked, covered with a magnificent robe and with half a horse bit in her mouth (figure). The other half of the horse bit was found in the trunk behind her head with her earrings, bracelets, and signet rings.

[Correspondence] Malaria eradication

Sa, 25/04/2020 - 00:00
We share the aspirations of the Lancet Commission on Malaria Eradication for attaining eradication worldwide within a generation.1 Nevertheless, we would like to stress the risks arising from setbacks and the importance of regional actions and long-term plans for achieving malaria elimination, as experienced in the Amazon basin.

[Correspondence] Malaria eradication

Sa, 25/04/2020 - 00:00
We do not agree with the conclusion of the Lancet Commission, that global malaria eradication is achievable by 2050.1 Although shrinking the malaria map from the periphery through country by country elimination appears to be feasible as shown by Sri Lanka, Argentina, Algeria, and even by the emerging malaria-free certification of China, elimination appears to be rather unrealistic with the available tools and the degree of poverty and weak governance in the majority of countries with high malaria burden of sub-Saharan Africa.

[Correspondence] Malaria eradication

Sa, 25/04/2020 - 00:00
We welcome the Lancet Commission on Malaria Eradication's bold call to action in their report advocating for the global eradication of malaria by 2050.1 We are encouraged by the message and agree with the necessity for eradication. Artemisinin-based combination therapies (ACTs) remain the frontline treatment for uncomplicated malaria. Faced with the rise of artemisinin resistance,2,3 do ACTs remain an effective tool in our arsenal? The short and clear answer based on prevailing evidence is yes, as long as the partner drug is chosen correctly.