WHO has published revised interim guidance on public health surveillance for COVID-19 cases. This document includes revision of suspected and probable case definitions to integrate increased knowledge on the clinical spectrum of COVID-19 signs and symptoms.
WHO has published revised interim guidance on public health surveillance for COVID-19 cases. This document provides guidance to Member States on the implementation of surveillance for COVID-19 and the reporting requirements for WHO.
What is new in this revised version:
revision of suspected and probable case definitions to integrate increased knowledge on the clinical spectrum of COVID19 signs and symptoms;
updated approaches to surveillance, including environmental and serological surveillance for SARS-CoV-2;
revision of variables included in weekly surveillance to fit with new case definitions and surveillance objectives (that is, inclusion of probable cases, health-care worker cases and updated age groups for reporting cases and deaths);
information on the importance of the collection of metadata for analysis and interpretation of surveillance data;
recommendations for ending case-based reporting for global surveillance and replacing it with aggregate reporting.
HRWF (13.08.2020) – Human Rights Without Frontiers HRWF) condemns the death sentence by hanging issued by a Nigerian Sharia court in Kano against a 22-year-old singer for allegedly insulting the Prophet in a song that he wrote and circulated on WhatsApp.
“Blasphemy laws are inconsistent with freedom of expression, including on religious issues or about religious figues,” HRWF director declared. “They should be repealed and the sentence imposed on the singer should be overturned.”
Yahaya Sharif-Aminu, a Muslim musician, is not well-known in northern Nigeria. His songs were not popular outside his Tijaniya Sufi group of North African origin.
The singer had gone into hiding after he composed the song as protesters had burnt down his family home and gathered outside the headquarters of the Islamic police, known as the Hisbah, demanding action against him.
The leader of the protesters that called for the musician’s arrest in March, Idris Ibrahim, told the BBC that the judgement will serve as a warning to others “contemplating toeing Yahaya’s path”.
Sharif-Aminu can appeal the verdict.
Only one of the death sentences passed by Nigeria’s Sharia courts has been carried out since they were reintroduced in 1999.
Public health systems and independent national verification committees in countries of the WHO European Region have shown continued commitment to measles and rubella elimination even with the COVID-19 pandemic creating an extraordinary burden on health systems.
As part of an annual verification process, a majority of countries have submitted their annual status updates on measles and rubella transmission for 2019 for review by the independent European Regional Verification Commission for Measles and Rubella Elimination (RVC).
Exceptional verification process in an exceptional year
The RVC is an independent group of experts that meets each year in June to review surveillance and immunization data submitted by the national verification committees, with the aim of assessing the status of measles and rubella elimination in each country and the Region. This year the RVC meets virtually in a series of sessions, the first of which was held on 29 June 2020 when the Commission reviewed 11 of the submitted annual status update reports. These were from:
Armenia
Azerbaijan
Denmark
Estonia
Finland
Latvia
Netherlands
Norway
Sweden
Tajikistan
Turkmenistan.
The RVC verified that all countries had maintained their measles elimination status; and all countries that had previously achieved rubella elimination maintained this status. The Commission determined that all 11 countries demonstrated the absence of endemic transmission of both diseases in 2019 and commended these countries for the achievement and for documenting their activities.
The Commission based its conclusions on:
routine and supplemental immunization performance;
measles and rubella surveillance with laboratorial and molecular epidemiology segments;
outbreak response;
activities focused on advocacy, communication and health literacy of the population and health-care workers;
commitment of stakeholders to the elimination goal.
Denmark: elimination of rubella confirmed
This first session provided the opportunity for the RVC to reassess the status of rubella transmission in Denmark, using the latest global guidance and data provided in the annual status updates for 2019 and previous years. Basing its assessment on the review of previous and newly submitted data, the Commission determined that for the first time, Denmark was verified as having eliminated rubella.
Final recommendations and reporting
WHO/Europe will work with countries to support completion of the reporting process where needed. The Commission is expected to review all remaining annual status reports in a series of virtual meetings in the coming months. Once the reports from all 53 countries have been reviewed, the full 9th RVC meeting report with conclusions on elimination status in the Region and country-specific recommendations will be published.
Status of measles and rubella elimination in the European Region in 2018
At its 8th meeting in 2019, the RVC concluded that as of the end of 2018, endemic transmission of measles was interrupted in 37 of 53 countries and endemic rubella transmission was interrupted in 42 countries. Twelve countries were considered measles endemic, 11 were rubella endemic, and nine were endemic for both diseases.
Measles outbreaks
The surge in measles cases that began in 2017 peaked in 2019, with over 100 000 cases reported. Monthly case reports in the initial months of 2020 show a significant decrease in transmission compared to 2018 and 2019, with 12 028 reported for January–June 2020. However, this is still higher than for the same period in 2016 and 2017, and may be an underestimation due to disruptions in laboratory surveillance for measles during the peak of COVID-19 outbreaks in the Region.
Under these circumstances, it is commendable that national health systems have recognized the necessity of continuing efforts to fight against devastating vaccine-preventable diseases, by ensuring prioritization of immunization programmes as a vital part of essential health services, continuation of disease surveillance and detection of and response to outbreaks.
Despite insecurity near the border with Somalia, and the threats associated with the COVID-19 pandemic, Safari Doctors, which has won several commendations, including a UN award, for its work, continues its monthly visits to the marginalized communities of Lamu.
Ms. Omar shares her story as part of the #RealLifeHeroes campaign, by the UN Office for the Coordination of Humanitarian Affairs (OCHA), ahead of this year’s World Humanitarian Day, on 19 August.
“I am from Pate Island, in the Lamu archipelago. I went to graduate school in the United States and worked in Washington DC, but I decided to return home and, in 2015, founded Safari Doctors.
Safari Doctors
Umra Omar, from the Lamu archipelago in Kenya, is the founder of Safari Doctors, a mobile doctor unit that provides free basic medical care to hundreds of people every month.
In Kenya, some 70 per cent of the population live in remote areas, where it’s hard to get quality healthcare, and difficult for sick people to reach hospitals. That’s why we decided to bring healthcare to the community.
Finding medicine was the easy part, as it is readily available. The challenge was to get it to those in need. I had to figure out how to raise around $500 a month, to pay for a nurse and fuel for a motorbike. I did that for a whole year. The following year, we added more villages and gained more visibility, especially once we won an award from the international broadcaster, CNN.
A population vulnerable to the pandemic
Lamu is one of Kenya’s worst performing counties in terms of health. It has an understaffed and understocked health system, which leaves the population particularly vulnerable during the current COVID-19 pandemic. This makes our work even more critical.
Between March and June, our outreach team, travelling by boat, treated over 4,000 patients across 17 remote villages, who otherwise lack access to consistent, quality healthcare.
We also have a Safari Vets programme, which treated over 400 animals during this period, explaining how to prevent the spread of animal to human viruses: the origins of the COVID-19 pandemic reminds us that human health is connected to the health of animals and the environment.
Investing in youth
Safari Doctors
Umra Omar, from the Lamu archipelago in Kenya, is the founder of Safari Doctors, a mobile doctor unit that provides free basic medical care to hundreds of people every month.
I will always accompany our team if we’re going into a new village, or an area where there is insecurity. We are a very young team: I’m the oldest, at 37. When other organizations repatriate their staff due to crises, such as the current pandemic, we stay. We have also created a Youth Health Ambassador programme: these are young humanitarians, based in their own villages.
For me, Safari Doctors is about working at a community level, on the ground, seeing issues and taking action immediately, rather than being held up by bureaucracy. And, because of our contacts, we are able to connect all the way up to a global level.
For example, one time, when we had guests visiting us from the US, we met a woman complaining of headaches. We noticed that she had a lump in her neck, and it turned out that it was a bullet: she had been shot two years previously, during an attack on her village.
Because of our network and our contacts, we were able to get her on a plane to a hospital that could treat her. This was just a one-off case, but it was very satisfying to be able to make decisions with very little bureaucracy.
I think we should stop seeing humanitarian work as something that needs to be celebrated: it should be seen as normal. This is part of our aim with Safari Doctors. That’s why we’re putting more investment into civic engagement and youth leadership.”
E-book and audiobook sales have been robust throughout the period that saw many bricks-and-mortar bookstores shut down across Europe as a result of the Covid-19 crisis, according to a new report by German digital distributor Bookwire and Austrian industry consultant Rüdiger Wischenbart. (The lockdown is identified in the report as running from week 11 to week 19 of 2020).
The study looked at some two million digital transactions across Germany, Austria and Switzerland (DACH) and found e-book sales spiked 26% during the period of lockdown compared with the weeks prior to the order. Audiobook downloads more than doubled, seeing a 109% increase during the period, bolstered by targeted marketing campaigns by publishers and discounts. Once the lockdown period ended, sales at bricks-and-mortar stores bounced back in Germany and across the region, and while the level of e-book and audiobook sales flattened, they remained higher than prior to the lockdown.
“Our data analysis has revealed that the top genres of romance and crime thrillers were not solely responsible for growth during the Covid-19 period. Even books for children and adolescents or nonfiction books can become e-book bestsellers,” said Jens Klingelhöfer, CEO of Bookwire.
Perhaps even more important than the sales rise was the news that the number of people signing up for new digital audiobook subscriptions was up 37% over the period before the lockdown. “We get a strong hint that interest in subscriptions is on the rise,” said Wischenbart. “For so long, the gospel was that this wouldn’t work with trade books. We saw how the model caught on with STM and professional books, yet said, ‘Nah, not with consumer books.’ What we see in our data is strong evidence for a shift in consumer behaviour.”
Wischenbart added that the report also suggests, “E-books aren’t as dead as we read in reports for years.” Like Klingelhöfer, he cited the interest in a broad range of categories, and underscored that marketing was essential to prompting sales. “Smart PR works!,” he said. “Both publishers and retailers can create a huge impact, provided they do the right thing, such as very targeted promotions at the right time for the right audience, and they agree to work together in a coordinated fashion.”
Storytel Sees Gains
Separately, Storytel, the Swedish e-book and audiobook retailer subscription service with wide distribution across Europe, reported big gains in streaming sales, which rose 43% for the first six months of the year, compared with 2019, and a 42% jump in subscription sales over the same period. The company, which is present in 20 countries and is strongest in the Nordic countries of Europe, said it expected to see slower growth for the remainder of the year. The company has 1.2 million paying subscribers and is aiming for 1.5 million by the end of the year. The company continues to expand by acquiring affiliate companies, including Kitab Sawti, an Arabic-language audiobook retailer, and is preparing to launch services in Thailand and Indonesia before the holiday season. The company continues to operate at a loss due to its rapid expansion.
Handwashing facilities – “Access to water, sanitation and hygiene services is essential for effective infection prevention and control in all settings, including schools”, said Tedros Adhanom Ghebreyesus, the WHO Director-General.
“It must be a major focus of government strategies for the safe reopening and operation of schools during the ongoing COVID-19 global pandemic.”
Historic disruption to education
COVID-19 has created the largest disruption to education ever recorded, affecting nearly 1.6 billion students in more than 190 countries, according to UN data.
The study found that last year, 43 per cent of schools globally lacked access to basic handwashing with soap and water: a key condition for schools to be able to operate safely in the midst of the pandemic.
Of the roughly 818 million children worldwide who lack basic handwashing facilities at school, more than one third are in sub-Saharan Africa.
In the 60 countries at highest risk of health and humanitarian crises due to the virus, three-quarters of children lacked the basic ability to wash their hands at school at the start of the outbreak, while half lacked basic water service.
Balancing act for governments
The report stressed that governments seeking to control coronavirus spread must balance the need for implementing public health measures against the social and economic impacts of lockdown measures.
The partners said evidence of the negative impacts of prolonged school closures on children has been well documented.
“Global school closures since the onset of the COVID-19 pandemic have presented an unprecedented challenge to children’s education and wellbeing”, said Henrietta Fore, UNICEF Executive Director. “We must prioritize children’s learning. This means making sure that schools are safe to reopen – including with access to hand hygiene, clean drinking water and safe sanitation.”
Solutions for safe return
The report identifies resources for COVID-19 prevention and control in schools, including 10 immediate actions and safety checklists.
It builds on guidelines on the safe reopening of schools issued in April by UNICEF and partners, geared towards national and local authorities.
The guidelines include several protocols on hygiene measures, use of personal protective equipment, cleaning and disinfection, as well as providing access to clean water, handwashing stations with soap, and safe toilets.
UNICEF and WHO underlined their commitment to achieving equitable access to adequate water, sanitation and hygience services worldwide, including through the Hand Hygiene for All initiative that supports vulnerable communities.
Following the announcement by the authorities of the preliminary results from Sunday’s presidential election, immediately questioned by opposition parties, largely peaceful protests erupted throughout Belarus, prompting a heavy crackdown by the security forces.
UN High Commissioner for Human Rights, Michelle Bachelet, condemned the authorities’ violent response: “I remind the Belarusian authorities that the use of force during protests should always be exceptional and a measure of last resort” she said, “clearly differentiating between any violent individuals and peaceful protesters, against whom force should not be used.”
Listen to grievances
In response to reports that police had used unnecessary and excessive force, firing rubber bullets, water cannons and stun grenades, Ms. Bachelet said people’s complaints must be heard.
“State authorities must allow and facilitate the exercise of the rights to freedom of expression and of peaceful assembly and not repress it”, added the top rights official.
“People have the right to speak up and express dissent, even more in the context of elections, when democratic freedoms should be upheld, not suppressed.”
Ill-treatment during detention
Citing accounts that more than 6,000 people had been detained over the last three days, including bystanders and minors, Ms. Bachelet observed “a trend of massive arrests in clear violation of international human rights standards”.
Against the backdrop of reports that police officers have beaten protestors – some while in custody – and that at least 250 people were injured, one of whom died under unclear circumstances, the UN rights chief reminded the Belarusian Government of “the absolute prohibition on torture and other ill-treatment of detainees”.
The High Commissioner called for the immediate release of everyone unlawfully detained, and for prompt, thorough, independent and impartial investigations into all allegations of human rights violations.
“Those arbitrarily detained or ill-treated for peacefully expressing dissent are entitled to justice and redress”, she stressed, maintaining that the authorities “should also hear and respond to people’s grievances regarding the elections”.
Information blackouts
Since Sunday, intermittent internet shutdowns, social media platform stoppages, and blocked NGO and news websites have curtailed the right of freedom of expression, including the right to seek and provide information, according to UN human rights office.
Moreover, journalists covering the demonstrations have been harassed, sometimes attacked, and their equipment destroyed or confiscated.
And more than 50 reporters and bloggers have been detained, with criminal investigations opened against some of them.
“Free flow of information is crucial in any democratic society, and especially in a context of crisis and social unrest”, said the UN rights chief, “but even more so, in the current situation of the COVID-19 pandemic, and where people might feel compelled to express dissent online rather than on the streets”.
“The concept of sustaining peace is essentially about positive peace as opposed to simply ending wars. In other words, it is the idea that the international community accompanies a country well beyond the point of simply putting down guns, to the point where people feel protected and represented”, Secretary-General António Guterrestold the meeting.
Against the backdrop of growing questions over the effectiveness of health systems and trust in institutions and governance across the globe, he said: “All of this means that our commitment to sustaining peace is more urgent than ever”.
Key dangers
The UN chief maintained that coherent, conflict-sensitive approaches to health and humanitarian crises will help deliver sustainable peace.
However, he highlighted three challenges, beginning with the erosion of public trust, which Mr. Guterres said can lead to widespread disillusionment in authority at all levels.
Secondly, he raised concern over a destabilized global economic order, which, fueled by the unprecedented global economic crisis, adds to heightened socio-economic vulnerabilities.
He thirdly highlighted the weakening of the social fabric.
“We have seen many peaceful protests, and in a number of countries, COVID-19 has been an excuse for harsh crackdowns and a spike in state repression”, flagged Mr. Guterres, also noting that “at least 23 countries have postponed national elections or referenda, and almost twice as many have postponed subnational votes”.
Opportunities out of a crisis
However, the pandemic has also created opportunities for peace, including the UN chief’s global ceasefire appeal earlier in the year.
And Security Councilresolution 2532, which demanded a general and immediate cessation of hostilities in all situations, “is a step in the right direction”, Mr. Guterres said.
“But much more is needed to translate early gains into concrete action on the ground”. Investing in prevention
The Secretary-General spelled out that pandemic responses must be conflict-sensitive, “starting with a multidimensional analysis on how the pandemic affects underlying risks that drive conflict”.
He underscored that inclusion is “critical” in humanitarian and development responses, especially with communities and marginalized groups, to “help rebuild trust and enhance social cohesion”.
Moreover, sustaining peace requires an integrated and coherent approach across humanitarian, development and peace actors, according to the UN chief.
“The Council’s ongoing collaboration with the Peacebuilding Commission is critical” to help improve collective response. The UN chief also maintained the need for flexible and tailored approaches to peacebuilding in the context of the pandemic.
“COVID-19 is a human tragedy – but we can mitigate the impacts by the choices we make”, upheld the top UN official.
MINUSCA
A peacekeeper from the UN Multidimensional Integrated Stabilization MIssion in the Central African Republic (MINUSCA) pours hand sanitizer into a child’s hand.
Castigating the Council
Speaking on behalf of the Elders, independent global leaders working together for peace and human rights, Mr. Guterres’s predecessor, Ban Ki-moon, welcomed resolution 2532, but noted that within the Security Council, “valuable months were wasted in arguments over the details of the text”.
He argued that their delay had “weakened the message” that the 15-member body must send a message to all warring parties that “now is the time to confront our common enemy”.
The stalemate “further aggravated the current volatile global security situations in the midst of the global fight against COVID-19”, underscored Mr. Ban, pointing to that ramifications of the pandemic in conflict-affected settings on health and humanitarian endeavours, but also in social cohesion, governance and the rule of law.
Moving forward
Notwithstanding his concerns, Mr. Ban called the debate “a timely opportunity” to explore ways to respond to the crisis while bolstering international efforts to sustain peace in the post-COVID-19 era.
“The experience of this crisis should also spur us to change our priorities and our understandings of what threats and values really matter”, he pinpointed, citing the societal inequalities and protection gaps of marginalized communities.
“I believe the UN and its Member States have a generational opportunity to use this concept to help build back better, further catalyze greater inclusivity, and steer humanity and our planet towards a more peaceful and sustainable and future”, concluded the Elder.
UN ‘can no longer work in silos’
Chairing the session, Indonesia’s Foreign Minister, Retno Marsudi, whose country holds the presidency for August, spoke of using a holistic approach to join the dots between the health crisis, social and economic implications, and peace and security.
“Sustaining peace requires synergy between the work of all UN systems”, she said, adding that the Organization “can no longer work in silos” but instead in “a coherent manner”, that harvests the “strengths of its different organs”.
Ms. Marsudi laid out UN responsibilities, beginning with the Council to ensure the “full implementation” of resolution 2532 to enable a timely delivery of aid and COVID-19 treatment to civilians in conflict; UN peacekeepers, who monitor conflict risks during the pandemic, serve as an “early-warning system”; and UN funds, agencies and programmes provide technical capacities to address conflict drivers during the crisis.
Equality and action
Also addressing the virtual chamber, Sarah Cliffe, Director of New York University’s Center on International Cooperation, shone a light on unequal access to coronavirus medicines and equipment so far during the pandemic, and inequalities over accessing COVID-19 vaccine programmes underway, which “exacerbates threats to peace and stability”.
She also cited opinion polls “in all regions”, relaying that there was an “unprecedented demand for more international collective action”.
In the coming months, MEPs are set to vote on the EU’s long-term budget, a new climate law and continue to debate the future of Europe.
Long-term budget and recovery plan
In May the European Commission proposed a €750 billion economic stimulus plan that along with a revised proposal for the EU’s 2021-2027 budget of €1.1 trillion should help mitigate the shock from the coronavirus pandemic and pave the way to a sustainable future. The proposals are subject to negotiations between Parliament and the member states in the Council.
Green Deal
In September, Parliament’s environment committee will vote on the EU’s climate law, as proposed by the Commission in March, including how the EU can achieve climate neutrality by 2050. It is likely to be voted on by all MEPs during a plenary session in October.
Future of Europe conference
The Conference on the Future of Europe is a new initiative looking at what changes are needed to better prepare the EU for the future. The conference was meant to have kicked off in May, but was delayed due to the Covid-19 pandemic. In a resolution adopted during the summer, the Parliament stressed that the conference should start “as soon as possible in autumn 2020”. It is expected to run for two years.
EU-UK negotiations
Talks are ongoing to reach an agreement on the future relationship between the EU and the UK. Under the current withdrawal agreement, there is a transition period until the end of December 2020, so the aim for the two sides is to conclude negotiations before the end of the year. Any agreement can only enter into force if it has been approved by the Parliament.
Digital Services Act
As part of the European Digital Strategy, the Commission has announced it will present a Digital Services Act package in late 2020, which should strengthen the single market for digital services. Parliament’s internal market and consumer protection committee, civil liberties committee and legal affairs committee have all published their draft reports. The committees are expected to vote on their reports in September.
Industrial strategy
In March 2020, the Commission presented a New Industrial Strategy for Europe to ensure that European businesses can transition towards climate neutrality and a digital future. Parliament’s industry and research committee will vote on its report on the matter in September, while all MEPs are expected to vote on it two months after that.
Reform of the EU’s agricultural policy
The final phase of the negotiations on how Europe’s agricultural sector should look after 2020 will depend on a deal on the EU’s budget for 2021-2027. It will also take into account the European Green Deal.
Migration
The Commission is set to present a New Pact on Asylum and Migration, once a preliminary agreement on the EU budget by the member states has been reached. Parliament’s civil liberties committee is currently working on a report on new legal pathways for labour migration to the EU.
Rail passenger rights
The EU is working on new rules to strengthen rail passenger rights, including higher compensation in case of delays and more assistance for people with disabilities. The aim is to be done with this legislative file before 2021, which the Commission has proposed should be the European Year of Rail. After an interruption caused by the Covid-19 pandemic, the interinstitutional negotiations resumed in June.
Crowdfunding
In March 2018, the Commission presented a proposal for a regulation on crowdfunding service providers, as part of its Fintech action plan. The EU market for crowdfunding is underdeveloped compared to other major world economies due to a lack of common rules across the EU. Exactly two years later, Parliament’s economic and monetary affairs committee reached a provisional agreement on the proposal with the Council. This will still need to be formally approved by a majority of MEPs before it can enter into force.
Following the gradual relaxation of emergency measures in EU+ countries,1 in June about half as many applications for international protection were lodged compared to the months immediately prior to the COVID-19 outbreak in Europe.
The impact of emergency measures on asylum trends continued to be visible in June. Although the 31 500 applications in June represented a threefold increase from May, this number was still at about half the level prior to the pandemic. In fact, almost all EU+ countries received fewer applications in June than in the first two months of the year. In the first half of 2020 the overall number of asylum applications dropped by 37 % compared to the same period in 2019.
In the coming months, applications for asylum are expected to continue rising but albeit slowly because asylum services are likely to remain partially limited plus travel restrictions with third countries will continue to reduce entry opportunities, especially in the event of a second wave.
Repeated applications are those that are lodged by applicants in the same country following a previous application that was rejected or discontinued. In June, the share of repeated applications decreased slightly (11 %) but remained higher than pre-COVID-19 levels (8 – 9 %).
Syrians and Afghans continued to lodge the most asylum applications, followed by Venezuelans and Colombians who suddenly started to lodge more applications after two months of very low levels indeed.
For the fourth successive month, first instance decision making exceeded the number of applications that were lodged: in June, over 34 300 first-instance decisions were issued, somewhat more than in May which demonstrates that many asylum services have been able to continue issuing decisions despite this year’s challenges. Indeed, decision making has been rather less affected by the emergency measures in EU+ countries, but the temporary suspension of face-to-face interviews for some time seems to have prevented a more sizeable increase in decisions.
In turn, the number of pending cases at first instance continued to decrease slightly for the fourth month in a row. However, with some 426 700 applications awaiting a decision at first instance at the end of June, the number of pending cases remained significant.
For more information and an interactive data-visualisation, please visit the Latest Asylum Trends page.
[1] Includes European Union Member States, Norway, and Switzerland.
