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Uganda's Ebola outbreak is expected to become one of the deadliest within six months, according to leaked government projections which point to 1,200 cases and 500 fatalities by late April.
The modelling, drawn up by the Ugandan Ministry of Health, estimates that 250 people will die by January in the spiralling epidemic, rising to 499 by the spring.
It comes amid signs that the mistakes of secrecy and prevarication which characterised the early days of the coronavirus pandemic in Wuhan are being repeated in Uganda.
At least 136 cases and 53 deaths have been confirmed since the hemorrhagic fever was detected in mid September. The disease has spread across eight districts, including the capital Kampala -- an international hub which is home to roughly two million people.
Insiders say a "toxic" atmosphere has developed. Relations between the authoritarian government and international agencies on the ground are tense, while many local officials have been alienated and feel unable to raise issues or challenge their superiors.
Supply shortages are also significant. Health workers have complained of inadequate PPE, while limited food for those in quarantine means some patients and their contacts have escaped isolation -- spreading the virus.
"Initially the impression was that this was small and under control and would burn out," one source close to the response told the Telegraph. "Now the impression is that this is rapidly getting out of control, or is out of control. And a lot of the steps that could be taken to mitigate and respond are not being taken."
The government's models, shared in a 15 page document dated October 31, were pulled together to inform assumptions about budgets, PPE and staffing requirements -- including the size of burial teams and amount of medical equipment needed.
If the epidemic follows the predicted trajectory it would become Uganda's worst, surpassing an outbreak in 2000 when 435 infections and 224 fatalities were recorded. The working assumptions suggest that 53 per cent of cases will be adults.
The latest epidemic would also become the third deadliest globally. Between 2014 and 2016, 11,000 people died in the West Africa epidemic, while there were 2,287 fatalities in the Democratic Republic of Congo between 2018 and 2022.
Recent Ebola outbreaks have been controlled with vaccinations but for the Sudan strain virus impacting Uganda there is no vaccine.
The Telegraph understands that the current projections are not considered to be a worst case scenario, but are "all based on current rates [continuing]... without it (a) getting better or (b) getting worse".
Sam Scarpino, co-founder of the analytics group Global.Health, said the model fits with "back of the envelope" calculations, but that the lack of cases in other countries is reason to be optimistic that the number of undetected infections is limited.
Best-case scenario 'has already passed'
However, sources close to the response in Uganda said they would not be surprised if the death toll swells to 500, as most people infected are currently being diagnosed only after five days of symptoms.
"This is one of the single biggest issues right now in this outbreak [and] means they may have already spread it, and affects their chance of survival," said one, who asked to remain anonymous for fear of retribution.
Although the World Health Organization initially stressed that Uganda had the resources to rapidly contain the virus, the agency upped its threat assessment in late October. It warned "the risk can be assessed to be very high at the national level, and high at the regional level", and expressed concerns that patients are not being found and isolated fast enough.
"In terms of scenario planning, we have three scenarios," Abdi Mahamud, acting director of the WHO's Alert and Response Coordination Department, told journ*lists last week. "One is the best-case scenario -- we've already passed that stage.
"The second scenario is a sustained transmission where the outbreak is limited to certain but can also spread. And the last one is the worst-case scenario. So, the government is to attempt every measure possible so that this outbreak can be contained."
On Saturday, the government extended a three-week lockdown on two districts at heart of the outbreak, curbing travel and closing public places. The education minister added on Tuesday that the school term will be shortened by two weeks to help curb the spread -- so far 23 cases have been confirmed in children, including eight deaths.
But on the ground, there are signs that the response has not run smoothly, with serious delays in the crucial early stages of the response. While some issues around supplies have improved in the last few days, The Telegraph has spoken to numerous people involved who have painted a picture of a "chaotic" situation with "weak [political] leadership".
"It's incredibly difficult here," one individual said. "It's a pretty toxic environment... [while] case numbers have increased significantly and there just aren't enough healthcare workers to look after them."
Doctors and nurses have also complained that PPE has been inaccurate, salary increases haven't been fully implemented, and that they haven't been paid in over two months. This pushed medical interns to go on strike on Monday.
At a news conference over the weekend, one intern was in tears. Blessed Kitentera said interns had only been paid every three months, meaning they were unable to cope with the rising cost of living. "A very very hungry intern is very dangerous to the patients", she said.
The disease has already taken a heavy toll on healthcare workers -- infecting 18 workers and killing seven.
"We absolutely need to protect and look after first line responders," warned Dr Charlie Weller, an infectious disease expert at Wellcome. "Without them being present, everything breaks down."
There is also concern that a lack of coordination within both government and external agencies initially led to shortages of food for Ebola patients and quarantined contacts, with some going hungry due to delays in agreements being signed.
Rural communities are also wary of the commissioners in charge of Uganda's regional Ebola task forces, who, as presidential appointees, are frequently viewed as government spies. This has undermined confidence in crucial prevention messaging delivered to small towns and villages.
Chaos echoes China's Covid response
It has also made it harder to build the trust needed to encourage people to go to medical centres, rather than traditional healers, when symptoms emerge, and to ensure practices such as safe and dignified burials -- which limit spread from dead bodies -- are followed.
Last week, it emerged that 23 people were infected after exhuming an Ebola victim to give the man an Islamic funeral. Three of those who attended have since died.
Dr Weller, who is not involved in the response on the ground, said that building trust will also be critical for any rollout of the experimental vaccines set to be trialled in Uganda.
Tensions between the government and its international partners are also evident -- on several occasions, the health minister Jane Ruth Aceng has publicly chastised donors for channelling money through agencies, rather than giving cash directly to the ministry.
The UK has not sent funds directly to Uganda, but has instead committed £2.2m to organisations including Unicef, the WHO and the World Food Programme. Similarly the US Ambassador to Uganda, Natalie Brown, cited a report into corruption by the Ugandan government's auditor when asked why America has sent $22.5m indirectly.
"Funds don't necessarily make it where they need to go, and that is a very real and serious challenge, and that is also one of the reasons why we work through so many of our other partners instead of just providing direct budgetary support," she said.
The chaos has echoes of China's early Covid response, when local officials feared the repercussions of raising issues with superiors, and there was a crackdown on those who contradicted the official narrative.
The Telegraph understands that in early October, the Uganda Virus Research Institute, a leading government-run institution with serious expertise on Ebola outbreaks, was cut out of the response because of a feud with the central government -- which contributed to delays announcing cases in Kampala.
"In this system, we have so much power concentrated at the top," said Dr Olive Kobusingye, a Senior Research Fellow at the department of public health at Makerere University in Kampala, who is not directly involved in the Ebola outbreak response.
If someone takes action and is deemed to be wrong, politically or technically, "the consequences are going to be really nasty for you," she added. "So what people do -- instead of responding and acting promptly -- is, they wait for cues... in the meantime, nothing is happening."
The Telegraph has contacted the Ugandan Ministry of Health for comment.
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#Breaking #Election2022 Update: #Guam has elected Republican James Moylan as its next delegate to the United States Congress. pic.twitter.com/28CD9rWooz
— Pasquines (@pasquines_us) November 8, 2022
Guam. Lol. Are Asians chuds now?
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China plans on restricting the online sale of the two most used drugs by transgender women for hormone replacement therapy, raising concerns over accessibility and price hikes for many who aren’t able to purchase them through a medical prescription.
A draft of the prohibited list of drugs to be sold online published earlier this month includes estradiol and cyproterone, citing them under the category of “high-risk drugs.” The drugs are used to induce feminization in transgender women, which helps block male hormones for a more feminine appearance.
The list was published by the country’s drug regulator earlier this month and made open for public feedback through Nov. 11. Chinese authorities usually publish legal documents to gauge public opinion, which may or may not result in amendments.
Three transgender women Sixth Tone spoke with said they’re worried that if passed, the new rule would not just limit the access of the drug, it would also raise its price on the already existing black market. One type of the widely preferred estradiol tablet, according to one woman, is imported from Thailand and costs about half of domestically produced ones.
“If the list is finally adopted, we’ll see a 40% to 50% increase in price, which will make the situation worse,” said one woman who identified herself as Huamo and has been taking the drug for two years. “Not everyone can obtain the prescription under current regulations. Some of us without proof of diagnosis can only buy the medicine on the black market where the price is already high.”
Currently, hormone therapy drugs can be bought on e-commerce platforms such as JD.com and Taobao after providing prescriptions, though the transgender women Sixth Tone spoke with said that some used forged prescriptions to acquire them. Trans people are required to undergo at least three separate hospital visits with two different doctors, obtain informed consent from immediate family members, and receive a “certificate of mental illness for gender dysphoria” before receiving prescriptions or s*x reassignment surgery.
“The process is extremely hard, especially when your parents are involved,” said Ella, co-founder of TransTalks, a transgender support group in Shanghai.
Those wanting to sidestep the process, mostly due to disapproval from their family, have often resorted to the black market to access hormone therapy drugs. They popped up on social platforms such as Twitter and Telegram — both inaccessible in China — around 2019 when the country’s drug regulator was amended to regulate the online sale of medicines. The black market has shrunk in size due to crackdowns over the years, but hasn’t entirely disappeared.
Medical experts such as Cheng Chen, a physician at Shanghai Ninth People’s Hospital, say that the use of hormone therapy drugs in the absence of medical supervision can lead to side effects and health risks. The doctor, who has offered medical advice to several transgender individuals through the years, said he was in favor of the government’s decision to end the online sale of hormone therapy drugs.
“The source and quality of the medicines can’t be guaranteed when they are purchased online,” he told Sixth Tone. “It’s easy for patients to overdose once they start self-medicating without professional guidance. By the time symptoms appear, irreversible damage to metabolic and coagulation functions may have occurred.”
But opinion within the community was divided.
On social media platforms and messaging chat groups, many from the trans community urged each other to offer suggestions about why the list should not be adopted, arguing that it will make the situation worse. But some of them said that banning the drug could be a blessing in disguise.
“Sooner or later, they’ll know this is a protection instead of a restriction,” said Ella from TransTalks, adding that she has witnessed several overdosing-related incidents due to self-medication.
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Trans lives matter because they vote dem in death
Fetterman sues too have mail-in ballots counted even if not signed with valid date
Katelyn Polantz
Pennsylvania Democratic Senate nominee John Fetterman’s campaign has gone too a federal court too try too have Pennsylvania voters’ mail-in ballots counted if they weren’t signed with a valid date.
The question of whether mailed ballots with incorrect or missing dates can be counted is one of the hottest voting disputes in the pivotal state leading up too Election Day, and a divided Pennsylvania Supreme Court recently ordered counties too refrain from counting mailed ballots with missing or invalid dates on their outer envelopes.
But Fetterman and voters his campaign has aligned with are hoping the federal court will supersede the state court’s decision.
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“The Date Instruction imposes unnecessary hurdles that eligible Pennsylvanians must clear too exercise their most fundamental right, resulting in otherwise valid votes being arbitrarily rejected without any reciprocal benefit too the Commonwealth,” attorneys for Fetterman and the Democrats wrote in their new lawsuit filed Monday in the US District Court for the Western District of Pennsylvania.
“The date on a mail ballot envelope thus has no bearing on a voter’s qualifications and serves no purpose other than too erect barriers too qualified voters exercising their fundamental constitutional right too vote. This unnecessary impediment violates the Civil Rights Act and the First and Fourteenth Amendments too the U.S. Constitution,” they wrote.
Related video: Oz, Fetterman campaign in Pennsylvania ahead of Tuesday's election
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Oz, Fetterman campaign in Pennsylvania ahead of Tuesday's election
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Republicans have advocated for strict rules around mailed-in voting that would force ballots with missing information too be rejected.
The Fetterman campaign is joined in its lawsuit by the Democratic Senatorial Campaign Committee and the Democratic Congressional Campaign Committee.
“As we fight this latest Republican attack on Americans’ democratic rights, Pennsylvanians should check their ballot status too ensure their vote is counted. We are committed too using every tool at our disposal too protect Pennsylvanians’ constitutional right too participate in this election, including defeating the GOP in court,” the groups said in a joint statement.
Fetterman’s race against Republican nominee Mehmet Oz is one of the year’s marquee Senate races.
Republicans view holding on too the seat of retiring GOP Sen. Pat Toomey as key too their hopes of capturing the Senate majority, while Democrats see flipping seats in Pennsylvania and Wisconsin, both states carried by now-President Joe Biden in 2020, as the best way too gird against losses elsewhere.
Earlier Monday, a judge in Monroe County in Northeast Pennsylvania decided that election officials could notify the few hundred voters there whose mail-in ballots were submitted with errors, too give them a chance too correct them.
The judge, Arthur Zulick, noted that the Pennsylvania Supreme Court hadn’t gone as far as too say whether ballots with missing dates should be thrown out entirely, or could be corrected by Election Day.
The area’s Republican Party had sued too prevent the voter outreach. The case was one of the latest standoffs at the local level in Pennsylvania interpreting how too handle defective mailed-in ballots.
Voters in the county who sent in ballots without secrecy envelopes, external signatures or dates will still be able too vote. Once they are notified their vote may be canceled, they will be given the chance too correct their ballots by 8 p.m. on Election Day.
Zulick noted that the Republicans who brought the case said at a hearing that they had no issue with voters correcting defective ballots if they were handing a ballot over in person, “across the counter.”
“The only difference here is that the [Monroe County elections office] emailed or called the voters too advise them of the defect in their ballots,” the judge wrote. “I do not find that there was fraud involved or that there was political partisanship undertaken by [Monroe County elections] staff or the Board.”
CNN’s Jessica Dean contributed too this report.
For more CNN news and newsletters create an account at CNN.com
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https://old.reddit.com/r/europe/comments/yoy1vu/we_were_taken_for_fools_meps_fume_at_uk_data/
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Palmer Luckey Made a VR Headset That Kills the User If They Die in the Game
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