Showing posts with label public health response. Show all posts
Showing posts with label public health response. Show all posts

Tuesday 4 January 2022

Australia 2022: a study in betrayal


SARS-CoV-2 entered Australia on 15 January 2020. It came here by a commercial passenger jet. It was not until 25 January 2020 that the infected passenger was diagnosed with COVID-19 and became our own Patient Zero in Sydney, New South Wales.


That same day two more airline passengers who disembarked in Sydney were also diagnosed with COVID-19.


From the very beginning the public health response of both the Federal and NSW governments was never as swift and comprehensive as it needed to be.


Indeed, over the next 15 months it often seemed that Prime Minister & fundamentalist Liberal Party ideologue Scott Morrison was personally determined to sabotage any chance of coming through this pandemic with minimal viral infections, deaths and long-term health problems for those who recovered from COVID-19.


However, despite the increasing politicization and weaponing of the public health response by the Morrison Government, we almost made it through.


By 15 June 2021 Australia had limited infection spread so that the cumulative total of COVID-19 cases was 30,274 people – just 0.1176% of the entire population. Sadly the COVID-10 related death toll stood at 910 individuals, but on the other hand there were only 116 active cases remaining in the entire country and only 26 of these were still sick enough to require hospitalization. Such outcomes compared favourably with global pandemic data.


On 16 June NSW Health confirmed that SARS-CoV-2 Delta Variant had been discovered after testing a man from Eastern Sydney. It was then that first the population of New South Wales and later by the rest of Australia discovered that, when it came to elected members of the federal and NSW state governments, there had been no lessons learnt from the earlier litany of public health blunders.


The Delta Variant quickly became a state-wide outbreak that was exported to other states and territories once then NSW Premier & Liberal MP for Willoughby Gladys Berejiklian – seemingly in thrall to Scott Morrison – began to insist that communities across the state must learn to ‘live with COVID’ and that the other states needed to follow her plan to re-open borders and scale back public health order conditions & restrictions. Scott Morrison threw his weight behind the only state premier who agreed with him and COVID-19 infections began to grow and spread at an alarming rate.


Over the next 23 weeks the number of confirmed COVID-19 cases in Australia grew to a cumulative total of 205,271 people with a COVID-19 related death toll of 1,985 individuals. The number of active cases remaining at the end of that time numbered 13,492 infected people with 557 ill enough to require hospitalisation.


There was a faint light at the end of the tunnel because infection growth and spread had begun to fall in the state that started the Delta Outbreak. So that at 8pm on Friday, 26 November 2021 the daily number of confirmed new cases of COVID-19 in NSW only totalled 235 people with 174 COVID-19 cases currently hospitalized and, 26 people in intensive care 10 of whom require ventilation.


Two days later NSW Health heralded the arrival of SARS-CoV-2 Omicron Variant after passengers who disembarked in Sydney from southern Africa on 28 November 2021 had tested positive for COVID-19 and their test results were being sequenced for this new variant.


The most charitable explanation for what happened next was that the entire NSW Government mindlessly panicked and, with new Premier & fundamentalist Liberal Party ideologue Dominic Perrottet at the helm, decided to treat this new outbreak in the making as a purely political and economic issue. Scott Morrison encouraged this approach just as he had encouraged open borders, lowering public health order restrictions and living with COVID.


This time Morrison appears to have gone further behind closed doors at the so-called National Cabinet meetings – rumours of verbal abuse, political threats and threats of financial sanctions by the federal government began to filter out.


By 15 December 2021 there was little left of what had always been an inchoate national public health response to the COVID-19 pandemic and, the states had begun to follow New South Wales down the rabbit hole Scott Morrison had so industriously dug.


On 31 December 2021 the national cumulative total of confirmed COVID-19 cases had grown to 395,504 people or 1.536% of the entire population. And tellingly, est. 190,233 more people had fallen ill over the space of the last 5 weeks. The cumulative national COVID-19 related death toll stood at 2,239 individuals. Active cases numbered 137,752 and current hospitalizations 1,591.


By 1 January 2022 that 190,233 figure appeared to have grown to 225,560 additional confirmed COVID-19 cases in Australia in the space of the last 5 weeks. 


When 2 January arrived  there was more unwelcome news. As at 8pm the number of additional confirmed COVID-19 cases in the last 5 weeks had grown to est. 257,194 people nationally. 


The national daily number of new confirmed COVID-19 cases on 2 January was given as 32,354 people and the number of active cases as est, 188,957 individuals. Currently 1,978 infected people were ill enough to require hospitalisation (1,204 of those being inpatients in NSW hospitals), 148 being in ICUs (95 in NSW) and 51 being ventilated (25 in NSW).


While the cumulative national total confirmed cases according to the Australian Dept. of Health was 462,928 and total deaths since January 2020 were recorded as 2,258 men, women and children.


Unfortunately, after 23 months of community transmission of SARS-CoV-2 , an erratic national public health response and a political response in recent months which has the effect of limiting community access to PCR tests & rapid antigen self- testing kits, the recorded tally of confirmed COVID-19 cases no longer represents a true and accurate total of the number of people who actually contracted the virus. The degree of undetected infection and the under reporting in official data to date has not been publicly quantified in Australia, but there is some suggestion that it could currently be somewhere between 20-25% and up to 50% for the latter part of December 2021. These percentages have the potential to impact on government's ability to assess probability and risk going forward into 2022.


Regions, local government areas and communities across Australia are in uncharted waters. It might never be possible to walk back the current high infection rate in the foreseeable future and, February 2022 may bring a new normal that is debilitating to national, state and regional economies, the public health system and social cohesion. 


Now one can argue about the level of virulence attached to the Omicron Variant and about whether cumulative, active, hospitalised or death toll numbers are important markers. However, what cannot be denied is that everyone of these active cases on any given day represents over time; a potential or real loss of productivity at state and national level, changes in the pattern of business profitability, yo-yoing consumer confidence, a decrease in tourism & hospitality turnover and an assault on the collective sense of safety and wellbeing. As well as a very real possibility that how Australian citizen’s cast their ballot at elections held in 2022 may be very different from past years.


~~~~~~~~~~~~~~~~~~~~


In the first two days of 2022 Northern NSW Local Health District where this blog is situated had recorded a total of 715 new confirmed COVID-19 cases across the 7 local government areas and, reported up to 19 people in hospital with 4 in intensive care.

  • Byron Shire – 260 cases
  • Tweed Shire – 173 cases
  • Ballina Shire – 108 cases
  • Clarence Valley – 76 cases
  • Lismore City – 74 cases
  • Richmond Valley – 14 cases
  • Kyogle Shire – 10 cases

TOTAL  715 


Sources


Monday 3 January 2022

Our tin-eared Prime Minister Scott Morrison once again fails to comprehend how deeply he can offend with his constant self-promoting photoshoots


For reasons best known to himself Australian Prime Minister & Liberal MP for Cook (Sydney NSW) Scott Morrison fancies himself as a bit of a chef.


Though perhaps his persistence in displaying his dubious skills in frequent clunky, over-staged, photoshopped photoshoots could be laid at the feet of Annabel Crabb's ABC television show "Kitchen Cabinet" where in 2015 she featured Morrison cooking a curry while admitting that his self-applied nickname "ScoMo" was quite "new".



He obviously thought that episode a public relations relations success. In the years since he has pushed that #ScottyTheChef persona to a point where it has made him the subject of much derision and not a little bit of satire. 


After he infamously ran away from a national crisis in December 2019, holiday photoshoots have also been well and truly weaponised by the general public, cartoonists & satirists and that weapon pointed straight at his head. 


Take this recent piece..... 


Satirical blog The Shovel on Wednesday, 29 December 2021 when Australia’s daily COVID-19 new case count stood at 32,946 infected people including 8 dead in the last 24 hours:


With the nation facing its highest COVID case numbers ever, and testing facilities stretched to their limit, PM Scott Morrison made an urgent address to the nation this afternoon to announce a new Sri Lankan curry which he says is now one of his favourites.


It’s curry night!” Mr Morrison said, as daily national case numbers climbed towards 20,000 and lines for PCR testing continued to stretch to more than five hours......


However, our emotionally tone deaf prime minister either ignores or fails to see the warning signs that makes it risky to promote his Kirribilli House New Year's Eve private harbourside parties to watch the fireworks. Particularly this time around as the nation enters its third year of a global pandemic.


This was #ScottyTheChef on social media on 31 December 2021 when the national daily COVID-19 new case count was 35,326 infected people, including 13 dead in the last 24 hours:


SNAPSHOT: @adamajacoby


Surely someone in the Office of Prime Minister and Cabinet had registered the increasingly naked distress being expressed on social media, as infection and hospitalisation numbers grew on the Australian east coast, public health response//support measures began to be withdrawn and individuals, families and communities were being told in so many words that they were on their own now 'living with COVID'.

Perhaps his media team might like to suggest to Morrison that he lie low the day before Australia Day 2022 as 25 January is the anniversary of the very first confirmed case of COVID-19.



Sunday 2 January 2022

ACOSS call for Australian Dept. of Health to release more granular COVID-19 data & government to fully subsidise rapid antigen test kits for those living ion or below the poverty line


Echo, 31 December 2021:


When you can find rapid antigen tests (RAT), the cost is prohibitive for many people and the Australian Council of Social Service (ACOSS) is calling on the Federal Government to provide free RATs for people who rely on social security payments.


President Peter McNamara said ACOSS are very concerned that people relying on income support payments just can’t afford $70 for a rapid antigen test (RAT) kit, leaving them unable to assess their risk from COVID-19 for themselves, their families and the community.


It is irresponsible and callous of the Federal Government to fail to make provision for up to three million people already struggling to survive below the poverty line. Especially when we have evidence that people living in the lowest socioeconomic groups have experienced almost four times as many COVID-19 deaths as people in the highest income group.


The people hardest hit

We know that the hardest hit by COVID-19 and all variants are people who are homeless, people with disabilities, First Nations people, especially those who live remotely, the elderly, single-parent households, people relying on JobSeeker ($45/day) and young people on Youth Allowance (just $36/day).


We need to prioritise these groups and the community sector that support them who are on the frontline, and who see and respond to this crisis first.’


Mr McNamara said there needs to be greater clarity of information from the NSW and Victorian governments on how people in these states can access free RATs as well. ‘It seems currently only registered aged care facilities are being supplied with free RATs.


The need for governments to keep all people safe from the virus is as pressing as it ever was. We know from ACOSS member organisations providing services on the ground that there are still certain areas and populations with low vaccination rates.


Ensuring everyone has equitable access to testing

Ultimately, the most effective way to protect all of us is to ensure everyone has equitable access to testing, vaccinations, including booster shots and other related health and hospital services.


Because of the extraordinary work of community-led health initiatives connecting with those hardest to reach, people who were hesitant about the vaccine, or who had struggled for access, are now better protected. We’ve started closing that gap in coverage rates.


Mr McNamara said the Federal Government needs to increase its investment in community-led health initiatives. ‘These are organisations working locally to inform people about the latest covid-19 developments, explain the benefits of the vaccine, arrange for them to have access to a jab, and checking on them afterwards. They are a vital complementary force to the mass vaccination clinics and GP hubs.


ACOSS also calls on the Department of Health to release more granular data about the infection rates, vaccination rates and death rates of at-risk groups such as those experiencing disadvantage. By knowing who is yet to be vaccinated and where they are, and their vulnerability to the virus, community-led health services can reach them and offer coverage.’


Wednesday 22 December 2021

COVID-19 testing system in NSW buckles under strain after increase in infection numbers along with federal & state policy shifts place public health response burden on the individual not government


 

ABC News, 21 December 2021:


NSW Health Minister Brad Hazzard concedes the state's COVID-19 testing system is under "massive pressure" as clinics turn people away and wait times blow out.


Before the arrival of Omicron variant in late November, when NSW's daily case numbers hovered at the 250 mark, testing rates sat at about 60,000 per day.


Since Friday night, more than 426,000 people have braved queues to be tested across the state, with more than 8,000 new positive cases recorded in the past three days.


Mr Hazzard said testing sites, as well as the public and private laboratories that analysed the swabs, were under pressure.


"Obviously they're trying to access the various products that are required to do the testing, but that's not the sole issue," he said.


"The issue is also that the staffing from not only doing the actual pathology testing, but also the administration — making sure people are advised of their results — is currently under massive pressure."…..


For the sites that are open, queues have stretched around the block, forcing people to line up for hours at some clinics.


Wait times for results have blown out to 72 hours in some cases.


NSW Labor Health Spokesman Ryan Park said the state government needed to "fulfil their end of the bargain" after the Premier asked people to take personal responsibility and get tested in light of the spike in cases.


He said more clinics, staff and equipment were needed to meet the surging demand and to cut wait times.


"It simply doesn't make sense," he said.


"They (the government) need to listen to the message that's coming from the community."


The demand for testing in the lead-up to Christmas has also seen pharmacies run out of rapid antigen test kits.


Health officials convened for several hours on Tuesday morning to consider the stresses faced by the testing system…..


Read the full article here.


Wednesday 1 December 2021

Entering December 2021 and the origins & nature of the Omicron Variant are as clear as mud. Global concern mounts. Australia's total number of Omicron cases stands at 6 people



IMAGE: ALJAZERRA, 30 November 2021













Just two days ago Scott Morrison stood in front of the cameras:


Prime Minister, Deputy Prime Minister, Minister for Infrastructure, Minister for Infrastructure, Transport and Regional Development, Minister for Foreign Affairs, Minister for Women, Minister for Health and Aged Care, Minister for Home Affairs, Joint Media Statement, 29 November 2021, excerpt:


On the basis of medical advice provided by the Chief Medical Officer of Australia, Professor Paul Kelly, the National Security Committee has taken the necessary and temporary decision to pause the next step to safely reopen Australia to international skilled and student cohorts, as well as humanitarian, working holiday maker and provisional family visa holders from 1 December until 15 December.


The reopening to travellers from Japan and the Republic of Korea will also be paused until 15 December.


The temporary pause will ensure Australia can gather the information we need to better understand the Omicron variant, including the efficacy of the vaccine, the range of illness, including if it may generate more mild symptoms, and the level of transmission.


Australia’s border is already closed to travellers except fully vaccinated Australian citizens, permanent residents and immediate family, as well as fully vaccinated green lane travellers from New Zealand and Singapore and limited exemptions.


All arrivals to Australia also require a negative PCR test and to complete Australian traveller declaration forms detailing their vaccination status and confirming requirements to comply with state and territory public health requirements…..


New Zealand currently has a LEVEL 4 (RED) Travel Advisory Alert on Australia warning that if its citizens travel they may have difficulty with being allowed back into New Zealand at a future date and, since 8 November 2021 Singapore has allowed fully vaccinated travellers from Australia to enter Singapore without quarantine, for all purposes of travel.


It is possible that both countries may temporarily close their borders to Australia if community transmission of the Omicron Variant begins in New South Wales.


However, as a suspicion grows around the world that the Omicron Variant has been 'in the wild' for much longer than originally suspected and its community transmission masked by cases being misdiagnosed as Delta Variant, border closures at this stage are thought unlikely to keep SARS-CoV-2 Omicron Variant out of a country. Rather such closures might at this point only slow down the international mobility of this variant.


Then there is this.....


Reuters, 30 November 2021:


SYDNEY, Nov 30 (Reuters) - The head of drugmaker Moderna (MRNA.O) said COVID-19 vaccines are unlikely to be as effective against the Omicron variant of the coronavirus as they have been previously, sparking fresh worry in financial markets about the trajectory of the pandemic.


"There is no world, I think, where (the effectiveness) is the same level . . . we had with Delta," Moderna Chief Executive StĂ©phane Bancel told the Financial Times in an interview.


"I think it's going to be a material drop. I just don't know how much because we need to wait for the data. But all the scientists I've talked to . . . are like 'this is not going to be good.'"


Vaccine resistance could lead to more sickness and hospitalisations and prolong the pandemic, and his comments triggered selling in growth-exposed assets like oil, stocks and the Australian dollar.


Bancel added that the high number of mutations on the protein spike the virus uses to infect human cells meant it was likely the current crop of vaccines would need to be modified.


He had earlier said on CNBC that it could take months to begin shipping a vaccine that does work against Omicron.


BioNTech, Moderna and Johnson & Johnson have all begun working on vaccines that specifically target Omicron in case their existing COVID-19 vaccines are not effective against the new variant.


In Australia the Morrison Government is not yet acknowledging this situation but rather arguing about whether or not to bring forward booster shots of the COVID-19 vaccines as a way of countering Omicron Variant infection.


On 30 November 2021 Australia's total number of known SARS-CoV-2 Omicron Variant cases stood at six individuals.



BACKGROUND


World Health Organisation, WHO Director-General's opening remarks at the Special Session of the World Health Assembly - 29 November 2021, excerpt:


More than any humans in history, we have the ability to anticipate pandemics, to prepare for them, to unravel the genetics of pathogens, to detect them at their earliest stages, to prevent them spiralling into global disasters, and to respond when they do.


And yet here we are, entering the third year of the most acute health crisis in a century, and the world remains in its grip.


This pestilence – one that we can prevent, detect and treat – continues to cast a long shadow over the world.


Instead of meeting in the aftermath of the pandemic, we are meeting as a fresh wave of cases and deaths crashes into Europe, with untold and uncounted deaths around the world.


And although other regions are seeing declining or stable trends, if there’s one thing we have learned, it’s that no region, no country, no community and no individual is safe until we are all safe.


The emergence of the highly-mutated Omicron variant underlines just how perilous and precarious our situation is.


South Africa and Botswana should be thanked for detecting, sequencing and reporting this variant, not penalized.


Indeed, Omicron demonstrates just why the world needs a new accord on pandemics: our current system disincentivizes countries from alerting others to threats that will inevitably land on their shores.


We don’t yet know whether Omicron is associated with more transmission, more severe disease, more risk of reinfections, or more risk of evading vaccines. Scientists at WHO and around the world are working urgently to answer these questions.


We shouldn’t need another wake-up call; we should all be wide awake to the threat of this virus.


But Omicron’s very emergence is another reminder that although many of us might think we are done with COVID-19, it is not done with us. ……


Full speech can be read here.


World Health Organisation, 29 November 2021:


Risk Assessment

Given mutations that may confer immune escape potential and possibly transmissibility advantage, the likelihood of potential further spread of Omicron at the global level is high.

Depending on these characteristics, there could be future surges of COVID‐19, which could have severe consequences, depending on a number of factors including where surges may take place. The overall global risk related to the new VOC Omicron is assessed as very high. 


Tuesday 30 November 2021

COVID-19 Delta & Omicron State of Play: Morrison goes to battle against any threat to his plan to throw open Australia before the 2022 federal election campaign

 

IMAGE: Courier Mail, 29 November 2021















Genomic testing has confirmed two more overseas travellers, who recently arrived in New South Wales, have been infected with the Sars-CoV-2 Omicron variant of concern. The total number of confirmed cases of Omicron Variant infection is now four individuals in this state within two days.


The Omicron Variant first entered NSW when two infected individuals flew into Sydney International Airport on Qatar Airways QR908, Doha to Sydney, at 7:06 pm on 27 November 2021, after travelling from an unspecified country or countries in southern Africa. Both people had previously been fully vaccinated against COVID-19.


The second two infected people arrived on Singapore Airlines SQ 211 at Sydney International Airport at 9:20pm on 28 November 2021 – after travelling through an unspecified country or countries in southern Africa.


A fifth individual infected with the Omicron Variant had flown into Darwin Airport from Johannesburg, South Africa on 25 November 2021, presumably on a Qantas international flight.


All five people were taken into quarantine – four at Special Health Accommodation in the Sydney area and one at the Centre for National Resilience in the Darwin area.


Out of the 11 SARS-CoV-2 variants being monitored, to date Australia has only reported 5 surfacing in this country:

B.1.1.7 (Alpha ) B.1.351 ( Beta) P.1 (Gamma ) B.1.617.2 (Delta) B.1.1.529 (Omicron). Only Delta and Omicron remain cause for concern.


As yet little is known about the Omicron Variant's reproduction rate, incubation period, or the level of illness it is likely to cause those it infects. 


Australian Prime Minister & Liberal MP for Cook Scott Morrison states he plans to call a meeting of state and territory leaders today or tomorrow to discuss how to respond to the Omicron variant, but it is "too early" to make decisions about reinstating quarantine before Christmas.


I rather think there will be a mixed reaction from States and Territories to his urging them to rigidly adhere to his own reopening timetable for internal & international borders, as well as for lessening of public health measures and the cessation of hotel quarantine.


Only Queensland & the Northern Territory have the luxury of a basic quarantine station each. For the remaining states and territory it’s hotel or home quarantine, with the difficulties these bring.


In fact, NSW was still using the COVID-19 hotel quarantine system from 21 to 27 November 2021 and, is hardly likely to feel comfortable with home quarantine until it knows more about the virulence and transmissibility levels of Omicron.


Australian Dept. Of Health table showing the number of cases (predominately involving Delta Variant) and source of infection between 22 November and 28 November 2021:






Sunday 28 November 2021

NSW Perrottet Government takes precautionary steps in response to SARS-CoV-2 Omicron Variant - immediate 14 day hotel quarantine for travellers from Omicron hotspots irrespective of vaccination status & 3 day isolation if entering Australia from elsewhere overseas



NSW Government takes precautionary steps in response to Omicron variant


Published: 27 Nov 2021 

 Released by: The Premier, Minister for Health and Medical Research


The NSW Government has taken precautionary steps in relation to quarantine arrangements for overseas arrivals following the introduction of additional national border security measures by the Australian Government.

Premier Dominic Perrottet said the new measures would help keep people safe as we work through this latest development with COVID.

“Authorities around the world are still investigating the risk posed by this new variant,” Mr Perrottet said.

“As a result, the NSW Government will continue to put community safety first by taking these precautionary but important steps until more information becomes available.”

The new measures, which will take effect at midnight tonight, are:

  • In line with Commonwealth measures, all travellers arriving in NSW who have been in South Africa, Lesotho, Botswana, Zimbabwe, Mozambique, Namibia, Eswatini, Malawi, and the Seychelles during the 14 day period before their arrival in NSW must enter hotel quarantine for 14 days, irrespective of their vaccination status;
  • All travellers who have been in any other overseas country during the 14 day period before their arrival in NSW must travel directly to their place of residence or accommodation and isolate for 72 hours, pending further health advice;
  • All flight crew who have been overseas during the 14-day period before their arrival in NSW must travel directly to their place of residence or accommodation and isolate for 14 days or until their departure on another flight that leaves Australia, consistent with the current rules for unvaccinated flight crew;
  • Anyone who has already arrived in NSW who has been in any of the nine African countries within the previous 14 days must immediately get tested and isolate for 14 days, and call NSW Health on 1800 943 553;
  • All unvaccinated travellers from any overseas country will continue to enter hotel quarantine.

Minister for Health Brad Hazzard said no cases of the Omicron variant have been identified in NSW to date, but urged everyone to stay vigilant.

“I remind the community that vaccination, social distancing and hand hygiene remain our best defence against COVID,” Mr Hazzard said.

Public health advice on quarantine arrangements and isolation requirements will be provided as soon as new information emerges on the risk posed by the new variant and the extent of its international transmission.

People can get the latest information by visiting nsw.gov.au.


The Morrison Government is also applying Omicron Variant state & territory isolate &/or quarantine restrictions to people, for instance international students and skilled migrants, arriving from the safe travel zones established with New Zealand, Singapore, Japan and Republic of Korea, who have been in any of the nine countries within the past 14 days.

As well as suspending all flights from the nine southern African countries for a period of 14 days as a matter of precaution.


BACKGROUND


The Guardian UK, 27 November 2021:


B.1.1.529 has a very unusual constellation of mutations, which are worrying because they could help it evade the body’s immune response and make it more transmissible, scientists have said. Any new variant that is able to evade vaccines or spread faster than the now-dominant Delta variant may pose a significant threat as the world emerges from the pandemic.

Dr Susan Hopkins, the chief medical adviser to the UK Health Security Agency, said the R value, or effective reproduction number, of the B.1.1.529 variant in the South African province of Gauteng, where it was first found, was now 2 – a level of transmission not recorded since the beginning of the pandemic, before restrictions began to be imposed. For an R of anything above 1, an epidemic will grow exponentially.....


How does B.1.1.529 compare with other variants?


Senior scientists on Thursday evening described B.1.1.529 as the worst variant they had seen since the start of the pandemic. It has 32 mutations in the spike protein, the part of the virus that most vaccines use to prime the immune system against Covid. That is about double the number associated with the Delta variant. Mutations in the spike protein can affect the virus’s ability to infect cells and spread, but also make it harder for immune cells to attack the pathogen.


As of 28 November 2021 this new variant has been found in 15 countries - South Africa, Lesotho, Botswana, Zimbabwe, Mozambique, Namibia, Eswatini, Malawi, Seychelles, Israel, Hong Kong, Belgium, Germany, Czech Republic and the United Kingdom, with limited genomic sequencing to date apparently linking all cases outside of the African continent back to travel through southern Africa.


UPDATE