Rashid Chotani, MD, MPH, DTM, FRCPH

Background: Impact of SARS-CoV-2 infection upon hospitalization, intensive care unit (ICU) admissions and mortality in persons with hepatitis C virus (HCV) infection is unknown.
Methods: We used the Electronically Retrieved Cohort of HCV infected Veterans (ERCHIVES) database to determine the impact of HCV infection upon the rates of acute care hospitalization, ICU admission and all-cause mortality. We identified Veterans with chronic HCV infection and propensity score matched controls… Show more

Background: Impact of SARS-CoV-2 infection upon hospitalization, intensive care unit (ICU) admissions and mortality in persons with hepatitis C virus (HCV) infection is unknown.
Methods: We used the Electronically Retrieved Cohort of HCV infected Veterans (ERCHIVES) database to determine the impact of HCV infection upon the rates of acute care hospitalization, ICU admission and all-cause mortality. We identified Veterans with chronic HCV infection and propensity score matched controls without HCV in ERCHIVES. We excluded those with HIV or hepatitis B virus coinfection. Results: We identified 975 HCV+ and 975 propensity score matched HCV− persons with SARS-CoV-2 infection. Mean FIB-4 score (±SD) was higher in those with HCV (1.9 ± 2.1 vs 1.2 ± 0.9; P < .0001) and a larger proportion of those with HCV had cirrhosis (8.1% vs 1.4%; P < .0001). A larger proportion of HCV+ were hospitalized compared to HCV- (24.0% vs 18.3%; P = .002); however, those requiring ICU care and mortality were also similar in both groups (6.6% vs 6.5%; P = .9). Among those with FIB-4 score of 1.45-3.25, hospitalization rate/1000-person-years was 41.4 among HCV+ and 20.2 among HCV−, while among those with a FIB-4 > 3.25, the rate- was 9.4 and 0.6 (P < .0001). There was no difference in all-cause mortality by age, gender, FIB-4 score, number of comorbidities or treatment with remdesivir and/or systemic corticosteroids.
Conclusions: HCV+ persons with SARS-CoV-2 infection are more likely to be admit- ted to a hospital. The hospitalization rate also increased with higher FIB-4 score. However, admission to an ICU and mortality are not different between those with and without HCV infection. Show less

Directional clinical evaluation and management of coronavirus disease (Covid-19) was initially presumptive based on the Wuhan data set as reported by World Health Organization (WHO). The current recommendations emanate primarily from the Chinese experience and subsequent Centers for Disease Control and Prevention (CDC) guidelines. Here we report a case with an “atypical” patient risk profile and variant longitudinal disease progression contrasting from existing recommendations. Our case report… Show more

Directional clinical evaluation and management of coronavirus disease (Covid-19) was initially presumptive based on the Wuhan data set as reported by World Health Organization (WHO). The current recommendations emanate primarily from the Chinese experience and subsequent Centers for Disease Control and Prevention (CDC) guidelines. Here we report a case with an “atypical” patient risk profile and variant longitudinal disease progression contrasting from existing recommendations. Our case report suggests that a universal 14-day quarantine timeline may not be sufficient; that correlation is needed between viral presence as determined by RT-PCR and a patient’s humoral response tested by serologic immunoassay of IgM & IgG. Hence, a clinical decision-making algorithm that can help clinicians clear a patient from “active infection” status would require testing that is sufficiently reliable, and should include serological testing for immunity. Show less

The battle against COVID-19 has required extraordinary measures that have adversely affected the US economy and many aspects of American life. Healthcare systems across the world have taken a heavy toll and have had to cancel clinics and elective procedures; open more beds, convert operating rooms into intensive care beds to accommodate COVID-19 patients. Such diversion of resources and delay in medical attention for other health problems has resulted in an increase in non-COVID-19 related… Show more

The battle against COVID-19 has required extraordinary measures that have adversely affected the US economy and many aspects of American life. Healthcare systems across the world have taken a heavy toll and have had to cancel clinics and elective procedures; open more beds, convert operating rooms into intensive care beds to accommodate COVID-19 patients. Such diversion of resources and delay in medical attention for other health problems has resulted in an increase in non-COVID-19 related mortality throughout the world. In this article we lay out our proposals for a quick reopening of our hospitals and clinics for elective surgeries and other procedures that cannot be handled via telemedicine. The crux of our proposals is a smart COVID-19 screening mechanism that employs several different testing strategies such as point-of-care (POC) rapid antibody test kits, pooled testing and RT-PCR, in a complementary way so as to increase efficiency and feasibility. There is no doubt that for our healthcare system to work and survive, it must not only meet the unprecedented demands generated by COVID-19, but also be able to treat other illnesses and injuries at or close to its pre-pandemic level.
Keywords: COVID-19, elective procedures, POC AB testing, pooled testing Show less

As public health professionals, we have been at the forefront of the COVID-19 crisis - trying to find solutions in the absence of a cure (drug) or a prophylactic (vaccine) against the SARS-CoV-2. As we remember the passing of the all-time greatest champ Mohammed Ali, four years ago, what he said becomes more important now than ever. "Service to humanity is the rent you pay on this earth”. Throughout our career in the public health workforce, we have tried to follow this principle and have urged… Show more

As public health professionals, we have been at the forefront of the COVID-19 crisis - trying to find solutions in the absence of a cure (drug) or a prophylactic (vaccine) against the SARS-CoV-2. As we remember the passing of the all-time greatest champ Mohammed Ali, four years ago, what he said becomes more important now than ever. "Service to humanity is the rent you pay on this earth”. Throughout our career in the public health workforce, we have tried to follow this principle and have urged others to do the same. Show less

Sania Nishtar and Ahmed Mehboob's discussion of the abolition of the Health Ministry in Pakistan1 raises the question of whether the health care problems in Pakistan could be solved by such a move.
The expansion and development of the health sector in Pakistan has never involved strategic, policy, or long-term planning. Since the early 1960s, development has occurred in the context of 5-year or 1-year plans. Only in 1997 was the first national health policy announced, the aim being “Health… Show more

Sania Nishtar and Ahmed Mehboob's discussion of the abolition of the Health Ministry in Pakistan1 raises the question of whether the health care problems in Pakistan could be solved by such a move.
The expansion and development of the health sector in Pakistan has never involved strategic, policy, or long-term planning. Since the early 1960s, development has occurred in the context of 5-year or 1-year plans. Only in 1997 was the first national health policy announced, the aim being “Health for all by 2010”. The slogan soon changed to “Health for all by 2020”.
Perplexingly, although Pakistan has a higher gross national product per capita than neighbouring south Asian countries,2 it falls far behind the averages for low-income countries on health indicators such as infant, child, and maternal mortality.3 Poor health status is partly explained by poverty, low levels of education, the low status of women in large segments of society, and inadequate sanitation.4 But it is also related to serious deficiencies in health services, both public and private. Pakistan's health system is crippled by chronic underinvestment in facilities and staff, with only 2% total expenditure of gross domestic product on health.5
Governance of the health sector is adversely affected by frequent changes in government, with each prime minister appointing their own staff, from cleaners to health ministers. Corruption, feudalism, and high rates of illiteracy are other factors in Pakistan's inability to develop a more effective and efficient health system. The barriers are many, and can produce a sense of helplessness and futility. Failing to improve, we feel unfortunate and wish that someone, somewhere, would give us that missing link or resource that we imagine would make change possible. Changing or demolishing health ministries is unlikely to help, since the people are the same, with their lack of insight. “We want to make health care well”, goes the complaint, “but they won't let us”. Show less

The objective of this study was to find out the frequency of HCV RNA in anti-HCV non-reactive blood donors with raised alanine amino transferase (ALT). The study was conducted at Baqai Institute of Haematology, Baqai Medical University, Karachi, in collaboration with Combined Military Hospital, Malir Cantt, Karachi. The demographic data of blood donors was recorded, and anti-HCV, HBsAg and HIV were screened. Four hundred consecutive donors with raised ALT above the reference range were included… Show more

The objective of this study was to find out the frequency of HCV RNA in anti-HCV non-reactive blood donors with raised alanine amino transferase (ALT). The study was conducted at Baqai Institute of Haematology, Baqai Medical University, Karachi, in collaboration with Combined Military Hospital, Malir Cantt, Karachi. The demographic data of blood donors was recorded, and anti-HCV, HBsAg and HIV were screened. Four hundred consecutive donors with raised ALT above the reference range were included in study. HCV RNA RT-PCR was performed on 5 sample minipools using Bio-Rad Real time PCR equipment. HCV RNA was detected in 1/400 (0.25%) blood donors. Finding of raised ALT in blood donors warrants further investigations. In case, if raised ALT is unexplained presence of HCV RNA may be suspected. Show less

OBJECTIVE: To determine the frequency of HCV RNA in an anti-HCV non-reactive blood donor population with normal ALT, and its cost effectiveness.
STUDY DESIGN:An observational study.
PLACE AND DURATION OF STUDY:Baqai Institute of Haematology, Baqai Medical University, Karachi, and Combined Military Hospital, Malir Cantt, Karachi, from May 2006 to April 2008.
METHODOLOGY:After initial interview and mini-medical examination, demographic data of blood donors was recorded, and anti-HCV… Show more

OBJECTIVE: To determine the frequency of HCV RNA in an anti-HCV non-reactive blood donor population with normal ALT, and its cost effectiveness.
STUDY DESIGN:An observational study.
PLACE AND DURATION OF STUDY:Baqai Institute of Haematology, Baqai Medical University, Karachi, and Combined Military Hospital, Malir Cantt, Karachi, from May 2006 to April 2008.
METHODOLOGY:After initial interview and mini-medical examination, demographic data of blood donors was recorded, and anti-HCV, HBsAg and HIV were screened by third generation ELISA. Those reactive to anti-HCV, HbsAg and/or HIV were excluded. Four hundred consecutive donors with ALT within the reference range of 15-41 units/L were included in study. HCV RNA RT-PCR was performed on 5 sample mini-pools using Bio-Rad Real time PCR equipment.
RESULTS: All 400 donors were male, with mean age 27 years SD + 6.2. ALT of blood donors varied between 15-41 U/L with mean of 31.5+6.4 U/L, HCV RNA was detected in 2/400 (0.5%) blood donors. Screening one blood bag for HCV RNA costs Rs 4,000.00 equivalent to 50 US dollars, while screening through 5 sample mini-pools was Rs. 800.00 equivalent to approximately 10 US dollars.
CONCLUSION: HCV RNA frequency was 0.5% (2/400) in the studied anti-HCV non-reactive normal ALT blood donors. Screening through mini-pools is more cost-effective. Show less

Just-in-time ( JIT) Educational Strategy has been applied successfully to
share scientific knowledge about disasters in several countries. This strategy
was introduced to China in 2008 with the hopes to quickly disseminate accurate
scientific data to the population, and it was applied during the Sichuan
Earthquake and Influenza A (H1N1) outbreak. Implementation of this strategy
likely educated between 10,000 and 20,000,000 people. The efforts demonstrated that an effective JIT… Show more

Just-in-time ( JIT) Educational Strategy has been applied successfully to
share scientific knowledge about disasters in several countries. This strategy
was introduced to China in 2008 with the hopes to quickly disseminate accurate
scientific data to the population, and it was applied during the Sichuan
Earthquake and Influenza A (H1N1) outbreak. Implementation of this strategy
likely educated between 10,000 and 20,000,000 people. The efforts demonstrated that an effective JIT strategy impacted millions of people in China after a disaster occurs as a disaster mitigation education method. This paper describes the Chinese JIT approach, and discusses methodologies for implementing JIT lectures in the context of China’s medical and public health system. Show less

On 27 April 2009, the World Health Organization's alert system was
increased to Level 3 due to a new subtype of Influenza A, commonly referred
to as "Swine Flu" (H1N1) and ultimately reached Level 6, indicating a pan-
derminting, any tales in than, wade report a m Ricio-and the era, , latins
about 200 million people at risk.
Public health education has been known to be an effective strategy for
decreasing human health risks, as well as a good global strategy to reduce… Show more

On 27 April 2009, the World Health Organization's alert system was
increased to Level 3 due to a new subtype of Influenza A, commonly referred
to as "Swine Flu" (H1N1) and ultimately reached Level 6, indicating a pan-
derminting, any tales in than, wade report a m Ricio-and the era, , latins
about 200 million people at risk.
Public health education has been known to be an effective strategy for
decreasing human health risks, as well as a good global strategy to reduce the
risk for disasters. Increasing use of the Internet even in developing countries,
has opened a window to a rapid, low-cost method to disseminate information
regarding new health risks, such as pandemics and disasters.
The Internet has been used by Supercourse to teach public health global-
ly by disseminating about 3,700 PowerPoint files through a network of about
65,000 public health educators and professionals from 174 countries. 1,2 "Just-
in-time" (JIT) has been utilized during disasters due to natural hazards
including pandemics for education through the Supercourse lectures that were
developed by a multidisciplinary group of national and international scien-
tists/educators can rapidly disseminate the risk knowledge within days, if not
hours after an the onset of an event.3 Just-in-time focuses on the golden time
of public interest in a disaster. "Just-in-time" experiences have been recounted
in the literature, such as its use after the tsunami in Southeast Asia, the SARS
epidemic, and Hurricane Katrina.3-S Often during times of disaster, the
media and government officials may not be viewed as credible sources of
information. National and international academics may be viewed as trusted
sources, but rarely are sought out during times of crisis. In this letter, we
recount the experience of creating a Farsi language JIT lecture on H1N1, and
the lessons learned from working with a multinational team.
Show less

Pakistan's Northwest Frontier Province, where the Swat Valley is located, has been excluded from the rest of Pakistan's society for a long time. The population has had no or very little access to economic, judiciary, and social development, let alone a democratic way of thinking. What is being dealt with is a long-term disenfranchisement problem.
With people living under such conditions, this new crisis has sent things from bad to worse. Since May 2, the number of people displaced by… Show more

Pakistan's Northwest Frontier Province, where the Swat Valley is located, has been excluded from the rest of Pakistan's society for a long time. The population has had no or very little access to economic, judiciary, and social development, let alone a democratic way of thinking. What is being dealt with is a long-term disenfranchisement problem.
With people living under such conditions, this new crisis has sent things from bad to worse. Since May 2, the number of people displaced by fighting between government forces and Taliban insurgents in the Swat Valley and its neighbouring districts of Dir and Buner has risen to more than 2·5 million—a rate of about 85 000 people fleeing per day. This internal displacement crisis represents the fastest movement of such a massive number of people since the Rwandan genocide of 1994. An overwhelming majority of the displaced are children.
The UN has warned of a long-term humanitarian crisis among this internally displaced population and has called for massive aid for refugees. On May 22, it appealed for more than US$500 million, of which less than $88 million has thus far been committed.1 Apart from basic services, further assistance will be required to provide education and counselling to the children housed in the camps, of which 60—70% are traumatised, and for repatriation and reconstruction programmes. Most of the internally displaced people are not being housed in camps but by host families whose meagre resources are now being strained to the limit. The already decrepit social, civic, and health-care infrastructure cannot sustain this burden for too long and will collapse. The fear is that once international aid money is exhausted, the right-wing religious elements in Pakistan will once again move in to provide much needed aid, resulting in their gaining popularity among the affected.
It is incumbent upon the world to step up and provide immediate humanitarian aid to the internally displaced people of the Swat Valley. Show less

The article provides a sequential review of historical epidemics, infectious outbreaks and bio-terror events that significantly transformed not only the global epidemiology but also became the spotlight of medical research. With a special focus on biological agents of major concern that can be used in bio-terrorism, major epidemics, outbreaks that hit Europe are discussed. Epidemiological events that require preparedness like Spanish flu [influenza], Hong Kong Flu, Bubonic Plague, West Nile… Show more

The article provides a sequential review of historical epidemics, infectious outbreaks and bio-terror events that significantly transformed not only the global epidemiology but also became the spotlight of medical research. With a special focus on biological agents of major concern that can be used in bio-terrorism, major epidemics, outbreaks that hit Europe are discussed. Epidemiological events that require preparedness like Spanish flu [influenza], Hong Kong Flu, Bubonic Plague, West Nile virus, Diphtheria, Tularemia, and Anthrax during the last century are briefly discussed. Lessons for improving surveillance are derived. Possibilities are highlighted that can add to the current level of preparedness across Europe. Analysing the current control measures and steps taken by the European Commission the authors urge the individual countries to strengthen their biological defence mechanisms to deal effectively with the unexpected internal and external infectious threats. Based on review recommendations are given that can boost up infection control in emergency situation. Show less