Trump tells Democratic congresswomen to ‘go back’ to ‘fix’ countries they came from

So Trump is going back to Germany? What a racist! U.S. President Donald Trump on Sunday told a group of mostly American-born Democratic congresswomen to “go back and help fix the totally broken and crime infested places from which they came,” a comment that was condemned by Democrats as racist.

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The week Trump said jump – and Johnson asked ‘How high?’

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After an explosive leak, the British ambassador resigned. The special relationship has been propelled into a strange and uncertain new era

Donald Trump, president and showman, was staging a military pageant to celebrate the Fourth of July and independence from the British empire. George Washington’s soldiers, he told a rainsoaked crowd in Washington, toppled a statue of King George and melted it into bullets for battle.

Related: Kim Darroch’s fall from grace casts chill over Washington ambassadors

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Permafrost thaw sparks fear of mammoth ivory ‘gold rush’ in Russia

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Prospectors dig up remains of extinct animals for trade worth an estimated £40m a year

Activists and officials in northern Russia have warned of a “gold rush” for mammoth ivory as prospectors dig up tusks and other woolly mammoth remains that can net a small fortune on the rapacious Chinese market.

Melting permafrost from global heating has made it easier for locals to retrieve the remains of woolly mammoths, which have been extinct for thousands of years, and sell them on to China, where the ivory is fashioned into jewellery, trinkets, knives, and other decorations.

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Fairfax Co. Va Health Advisory: Outbreak of Respiratory Illness at a Long-Term Care Facility

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Credit CDC PHIL

#14,185

For the past 3 days newshounds Shiloh and Pathfinder at FluTrackers have been following, and archiving, local media reports of a large – and thus far unidentified – respiratory outbreak at a long-term care facility in Fairfax County, Virginia.

Respiratory illness outbreaks in nursing homes and long-term care facilities (LTCFs) are not uncommon as the residents are usually either elderly, suffer from chronic illnesses, or are otherwise immunocompromised. 

But we usually see them during the fall and winter months, not mid-summer.

A 2017 study, published in Influenza Other Respir Viruses, discusses this all-too-familiar phenomenon.

Influenza in long‐term care facilities

Louise E. Lansbury, 1 Caroline S. Brown, 2 and Jonathan S. Nguyen‐Van‐Tam 1

Published online 2017 Jul 26. doi: 10.1111/irv.12464

Abstract

Long‐term care facility environments and the vulnerability of their residents provide a setting conducive to the rapid spread of influenza virus and other respiratory pathogens. Infections may be introduced by staff, visitors or new or transferred residents, and outbreaks of influenza in such settings can have devastating consequences for individuals, as well as placing extra strain on health services.

As the population ages over the coming decades, increased provision of such facilities seems likely. The need for robust infection prevention and control practices will therefore remain of paramount importance if the impact of outbreaks is to be minimised. In this review, we discuss the nature of the problem of influenza in long‐term care facilities, and approaches to preventive and control measures, including vaccination of residents and staff, and the use of antiviral drugs for treatment and prophylaxis, based on currently available evidence.

What makes the current outbreak in Virginia a bit unusual is the timing, and the lack (thus far) of an identified etiological agent.  The following Health Advisory comes from from the Fairfax County Health Department, after which I’ll return with more:

Outbreak of Respiratory Illness at a Long-Term Care Facility

July 12, 2019

Health Advisory

SUMMARY:

• Fairfax County Health Department is conducting an outbreak investigation at Greenspring, a long-term care facility with assisted living and skilled nursing care, in Springfield, VA.

• Since June 30, 2019, 55 out of the 263 residents assisted living and skilled nursing care have become ill with respiratory symptoms ranging from upper respiratory illness (cough) to pneumonia. Of the ill individuals, 20 have been hospitalized and two have died.

• A specific etiology has not been identified and additional tests are being conducted.

SUGGESTED ACTIONS:

• Respiratory outbreaks at facilities for vulnerable, older adult populations are not uncommon, with 5-10 reported to the Health Department each year. However, outbreaks in the summer are infrequent. Given this outbreak and as staff may work at more than one long-term care facility across the County, we ask all facilities to maintain a heightened index of suspicion for an increase in the number of respiratory illnesses, including pneumonia, throughout your facility.

• Respiratory disease clusters should be immediately reported to Public Health. Contact the Health Department’s Communicable Disease Section immediately at 703-246-2433 (normal business hours) or 703-409-8449 (evenings and weekends) to report a suspect cluster and for additional guidance on testing and infection control measures. Do not wait for laboratory confirmation before making a report.

• Long-term care facilities should ensure that proper infection control precautions are put in place for all ill residents. Guidance on precautions and duration can be found on the following CDC webpage: https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/type-duration-precautions.html. The Fairfax County Health Department is also available to provide guidance on appropriate precautions related to communicable diseases.

• Appropriate handwashing and respiratory etiquette amongst staff and residents are essential to limit disease spread. Please review handwashing and respiratory etiquette policies, trainings, and educational materials to ensure residents and staff are aware of the most recent guidance and no barriers occur to limit handwashing.

• All long-term care facility staff should be encouraged to report any respiratory illness to facility management. Any staff member with documented fever (>100.1°F) should be excluded from work until they are afebrile for 24 hours. Asymptomatic employees who work at multiple facilities, including Greenspring, do not need to be excluded from work.

While some local media headlines are touting the `Mystery Virus’ angle, in truth it can take a week or longer to run a full gamut of tests, and so I prefer to use the term as-yet-unidentified.

The CDC has a name for it: URDO (Unidentified Respiratory Disease Outbreak). They also have  a work group, and a process, designed to address these types of outbreaks.

https://www.cdc.gov/urdo/downloads/URDO-Factsheet.pdf

While influenza is relatively rare this time of year, and usually fairly easy to identify with rapid tests, there are hundreds of other viruses that must be considered – including RSV, any one of 4 dozen known adenoviruses, and a myriad of Picornavirus infections (which include Rhinoviruses & Enterovirues).

Even with the full firepower of the CDC’s labs, it is possible that a definitive diagnosis may not achieved. A 2015 study published in the NEJM (see The CDC’s EPIC CA-Pneumonia Study) followed 2500 cases over 5 years and found that in the majority (62%) of cases no definitive pathogenic agent was identified.

Specifically, they found:

  • one or more viruses in 530 (23%) cases
  • bacteria in 247 (11%) cases
  • bacterial and viral pathogens in 59 (3%) cases
  • and a fungal or mycobacterial pathogen in 17 (1%) of cases

The most commonly detected pathogens were:

  • Human rhinovirus (in 9% of patients)
  • Influenza virus (in 6%)
  • and Streptococcus pneumoniae (in 5%).

With luck, this outbreak in Virginia will become less mysterious this coming week, and when we learn more, I’ll update this story.

This is a good reminder, however, of the importance of good hand hygiene – not only by the staff, but by the visitors to these facilities. And staying away if you suspect you might have an illness.

For more on the plethora of respiratory viruses that afflict humans, you may wish to revisit ILI’s Aren’t Always The Flu, and some other blogs on respiratory outbreaks in LTCFs include:

DOH: 2nd NJ Facility Reporting Adenovirus Outbreak & 10th Fatality At Wanaque Center

Wisconsin DOH Elizabethkingia Update

Study: HRV In Long-Term Care Facilities

Serena Williams pays tribute to ‘little powerhouse’ Halep after final defeat

• ‘It was just her day,’ says disappointed Williams
• American admits her fitness has not been ideal

Serena Williams denied that nerves or the pressure of chasing down Margaret Court’s record of 24 grand slam titles had anything to do with her stunning 6-2, 6-2 Wimbledon defeat by Simona Halep.

Williams looked far from her best as she sprayed 26 unforced errors compared with only17 winners against Halep, and the American has now lost three grand slam finals since winning her 23rd major title at the Australian Open in 2017.

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‘Worry is contagious’: the vaccine-hesitant parents putting children at risk

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More than committed anti-vaxxers, parents who are unsure about vaccination are one of the top 10 threats to global health this year. What’s behind this crisis of confidence?

My son had his first vaccination within hours of entering the world. In the London borough where he was born eight years ago, tuberculosis rates ran high. When a nurse appeared at my hospital bed bearing the BCG vaccine, I offered my red and roaring baby without a moment’s hesitation.

Since then, he and his sister have had every inoculation going. I proffer them up, willingly and gratefully, to each needle and nasal spray, unwavering in my belief in the scientific consensus that they are safe, effective and essential public health tools.

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