Now, Amanda leads a global team working to make the world safer from the next epidemic while also urgently responding to COVID-19. Medika Life Editor-in-Chief Gil Bashe spoke with Amanda on the challenges facing public health efforts around the world.

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Gil Bashe:  Amanda, I would like to talk about the core problems that you and Resolve to Save Lives work to address. Let’s talk about why these problems are critical to public health globally, why we have to be much more aware of them, and what’s at stake for the world if we neglect to address the challenges that Resolve to Save Lives has decided to shoulder?

To start, what brought you to global public health? I know you’ve worked with very established organizations like the International Red Cross in the past. Can you talk a little bit about the mindset and transition for a moment?

Amanda McClelland: It’s a good question. Like many people who worked in West Africa during the Ebola epidemic, it raised several issues centered around how to make sure something like that didn’t happen again.

As part of the International Federation of the Red Cross, our work needed to scale across 90 – 100 countries with 17 million volunteers. The work is at the community level, which is so critical. Yet, it was missing a connection point into government systems and structures. We’ve led a lot of advocacy and tried to put communities at the center of our efforts, but it didn’t move beyond the kind of rhetoric of “communities are important.”  There was nowhere for communities to engage inside the existing architecture, whether that be at a domestic or global level.

After 15 years of responding to outbreaks, I’ve been going back to the same countries for different reasons. I worked in Sierra Leone from 2012–to 2013 during a very large cholera outbreak. I was back there in 2014–2015 for Ebola. And despite this, the recovery that we talked about didn’t fit sustainably.

Dr. Thomas Frieden approached me about joining Resolve to Save Lives with a focus on strengthening community systems and targeting preparedness as a full-time position, tapping into my real-world experiences. This was an opportunity to try to make sure that we weren’t going back to the same countries over and over again, and that we were building systems that could detect diseases and respond sustainably.

Bashe:  You and Resolve to Save Lives recently launched an important campaign.  You’ve just taken on non-communicable disease and specifically cardiovascular disease. That is rare when people are frightened about the next pandemic.  Too often we forget to recognize that 70 to 80% of people around the world perish from non-communicable diseases such as heart disease, diabetes, respiratory disease, and mental health illnesses.  Now you are elevating the conversation around cardiovascular disease, why?

McClelland: So often people think it’s a bit strange that we work in two areas, preventing epidemics and cardiovascular illnesses. You’re right, we picked two problems where we think we can save the most lives. COVID-19 has shown us the absolute relationship between infectious diseases and the health of a population.

The impact of COVID’s abilities or mortality from COVID is a stark reminder that a healthy community is critical. Social cohesion and community engagement are at the center of all public health problems. And that comes through in cardiovascular disease and epidemics.

Bashe: I find this to be fascinating because when talking about people most at risk for COVID severity or death, tragically often we talk about people with chronic illnesses, it could be obesity, it could be cardiovascular disease, it could be diabetes. Together these comorbidities are tipping points leading to COVID-related death.

McClelland:  I’m a primary health care nurse by training, so I go one step further and look at those individuals who have chronic conditions—those people who get asked to come back in six months.

What’s the root cause of that? Many of these people, don’t have access to care promptly. They don’t necessarily have good health literacy, good nutrition advice, or access to nutritious food. We know that COVID is disease oriented. But we need to understand that there is a relationship in many countries between low socio-economic indicators, access to care and the increasing amounts of chronic diseases that can easily become acute—like they did during COVID-19—and overwhelm the health system.

We must provide clinical care along with public health interventions for those diseases and start collaborating more effectively. And we think about this as a spectrum, from prevention to early detection and early treatment, all the way through to chronic care and palliative disease. If we don’t start working together, we’re going to lose people through the cracks and that’s where it becomes acute.

Bashe: Great answer. I know you recently had a campaign in Africa and as a global organization, could you talk a little bit about the work you’re doing in Africa?

You know I’m a very big believer that when we look at health, we tend to look at the health of the developed world. There are many problems in ensuring health in the developed world, and among developing nations. They are working to put together infrastructure. I would appreciate your perspective about developing and developed but also why Africa specifically?

McClelland: So, my opinion on this is changing quite a lot and I’ll give you one example. When COVID started, I was working in lower-middle-income developing countries.

For the last 15 years, even in Australia, I worked with indigenous communities that you could say were sometimes worse. I lived in an Aboriginal community, which had massive health challenges and an inexcusable disparity between aboriginal health and the white population in Australia. But when we started the COVID-19 response, Dr. Frieden came to me and said we were going to start responding in the U.S. because New York was getting hit extremely hard.

I said I can’t. I haven’t worked in a high-income country for many years, I don’t understand the American health system. We don’t have anything to add in this context. But we did it. We mobilized a team of 45 people and supported numerous activities at the local level across partner jurisdictions. We ran two different teams—a U.S. team and a global team. We wrote two different sets of guidance—guidance for high-income countries and guidance for low-income countries.

After the first eight weeks, we realized the challenges were similar. High-income countries don’t necessarily have highly resourced public health departments. The public health departments here in the United States are completely underfunded and understaffed. The challenges that we face in Uganda, Liberia and Nigeria were actually to manage because there was a lack of bureaucracy. Teams knew how to collaborate with partners and how to accept outside help. They were able to accelerate through the challenges, trying to supplement like high-income countries.

Across the board, the fundamental challenges remain the same—poorly paid and under-staffed public health systems. Core data infrastructure, the ability to manage data and the ability to make good decisions on that data are commonalities that we all face. We have more in common than we think. There are different challenges in terms of access and cost of care, but not from an epidemic prevention perspective, and also from a chronic disease perspective. Moreover, the under-resourcing of public health is common across many, many developed and developing countries.

Bashe: Could you talk a little bit about what you’ve been doing in Africa, specifically?

McClelland: When we were first starting Resolve to Save Lives, we looked across the globe at where we, as a small but nimble non-governmental organization (NGO), could add the most value. Through an initial assessment, we realized the burden of infectious diseases in Africa, so that was a logical place to start.

When the COVID-19 pandemic began, it became clear that the missions and social measures that developed countries were going to put in place to control COVID would have a significant secondary impact in low-income countries that would make it extremely difficult to maintain.

And so very early on in our work in the pandemic, as early as 2020, we joined up with Africa CDC, WHO Africa, World Economic Forum and several product companies, including IPSOS, as part of the Partnership for Evidence-Based Response to COVID-19 (PERC) to collect data on how public health and social measures would be implemented on the continent.

We wanted to measure both the epidemiology and the secondary impacts such as food insecurity and education disruptions. So, we started our work in Africa with regular large-scale surveys during the pandemic, which we did in four waves across 20 countries. We were able to provide decision-makers with enough data to make balanced decisions. Balancing risk and corporate control against the secondary impacts that those measures caused, strengthened our understanding that the pandemic was not just a health issue. It was also a political and social issue that required data and information from all sides to be able to make informed decisions.

Bashe: And what have been some of the results, I mean that’s the program but how do you see the impact of your efforts?

McClelland: We spoke to the World Bank on global funding and others in terms of where we were seeing change on the ground. We noticed that countries that did very well at the beginning of the pandemic were those that leveraged their public health to enforce social measures. They quickly had political support.

There was a large amount of public trust in most of the countries with the initial government response. But we also saw economic impacts in those countries along with security incidents. While strong trust in the public health system improves outcomes, people’s behavior was also impacted by their ability to meet their daily needs. You can only protect yourself from COVID if you still have enough food and enough fuel, etc.

We have to make decisions based on risk, and we saw the risk perception of the community go up and down with the various waves of the COVID Delta wave. We also see political disruption move up and down with the epidemic curve, along with secondary impacts, as governments turned on and off safety measures. It reinforced the idea that we cannot make these types of decisions just based on cases or deaths.

Every country must find a balance for what works for them in terms of balancing out access to economic opportunities and food and security against what they will accept as a level of COVID. And we’ve seen examples of that. New Zealand versus the United States varies in terms of how they managed COVID and the economic impacts, but also the absolute mortality that caused them.

There are varying thresholds of what is acceptable in different communities. Some communities accepted zero deaths and, in some places, 1,500 deaths a week is still the norm and things are getting back to normal. It is important to understand that pandemic control is a choice that’s driven by politics and communities. And that was a difficult realization for many, that the dependency wasn’t wholly and solely within the health domain, that we were one actor of many trying to influence how this was controlled.

Bashe: When you look at the next six months to a year, what do you hope to achieve?

McClelland: We hope to have this recognized as a once-in-a-generation opportunity to build forward better and to make sure that we recognize the threat that biology still has to us—that we haven’t outsmarted the germs, so to speak.

There are things that you can do to control the risk to make sure that we’re better prepared, to make sure that individuals and systems are more resilient. We have this opportunity in the next six months. We must harness the political will, the financial resources required and the lessons that we’ve learned during COVID to make sure that we build a more protected and healthier world. There is a significant risk that we don’t learn any of these lessons and then we go back into this cycle of panic and neglect. The next six months are so critical for us.

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The next six months may be critical for us.  Keep watching the work of Resolve to Save Lives and their in-the-trenches team to see the progress that they are making to sustain and save lives around the world.

The post Is the Developed World Lightyears Ahead in Public Health? Maybe not! appeared first on Medika Life.

As we march together through the pandemic, many people are searching for ways to help others. One of the easiest ways to support the surrounding community is to schedule a local blood bank visit and make a donation.

According to the Red Cross, someone in the US needs blood every two seconds. The US requires 38,000 blood donations every day to meet the demand. While almost half of Americans are eligible to give blood, only 2% of the population donates.

Each blood donation saves up to three lives.

Covid-19 patients often require life-saving blood, plasma, and platelet transfusions. But hospitals need blood products for day-to-day patient care. 

Blood products are used during surgery for car accidents and other trauma. Cancer patients undergoing chemotherapy often require frequent transfusions. Patients with chronic conditions, like sickle cell anemia, require transfusions throughout their lives. 

In my specialty, Obstetrics, and Gynecology, blood transfusions are sometimes needed to save a pregnant person’s life. Pregnancy conditions like preeclampsia destroy red blood cells and prevent blood from clotting. Conditions like uterine atony, placenta previa, and placental abruption often require mass transfusion protocols to keep mom and baby safe.

The Red Cross reports the US uses 36,000 units of red blood cells, 7,000 units of platelets, and 10,000 units of plasma every day

The reduction in blood donations is an under-reported pandemic side effect. Lockdown forced many blood banks across the country to close or delay donations. Community blood drives were canceled. Blood donations slowed a the same time the high number of critically ill patients due to Covid-19 increased the hospital demand.

The surge in Covid-19 cases last fall struck just as national blood banks hit their traditional donation “slow season” from Thanksgiving through the Holiday Season.

One gift Americans can give is a blood donation. Community involvement is crucial to increase the blood products available to people who need them.

Donating blood is not as scary as it sounds. After booking an appointment, donors will fill out a health history. If the donor meets the designated criteria, a staff member will insert an intravenous line (IV) into a vein. The process lasts about 10 minutes for whole blood donation and longer for plasma and platelet donation.

Most blood banks need all blood types and blood products, including plasma and platelets. Red blood cells (RBCs) help deliver oxygen from the lungs to tissues and organs. Platelets help the blood clot after an injury.

Type O negative blood is in high demand. People with type O blood are known as “universal donors.” Type O negative blood can be used in the highest number of people.

The FDA has released updated guidelines regarding blood donation and Covid-19. The FDA highlights the fact that blood transfusions do not transmit respiratory viruses. There have been “no reported cases of transfusion-transmitted coronavirus, including SARS-CoV-2, worldwide.”

Like The Red Cross and Carter Blood Bank, blood banks have updated blood donation eligibility guidelines for those who have already received a Covid-19 vaccine.

People who received the Pfizer, Moderna, or Janssen/Johnson and Johnson vaccine (or AstraZeneca from countries where it has been approved) may donate blood without delay in most cases. Most blood banks request donors provide the data and name of the vaccine to verify eligibility.

All donors must be in good health and have a normal temperature on the day of donation. People who recovered from a previous Covid-19 infection can also donate 14 days after all symptoms have disappeared. Covid-19 survivors who received monoclonal antibody therapy may donate blood with site-specific restrictions.

Blood banks are still in search of plasma donations from Covid-19 survivors. Plasma contains antibodies which are proteins made by the body to help fight infection. Convalescent plasma from patients who recovered from Covid-19 may have life-saving antibodies. The FDA approved convalescent plasma use for hospitalized Covid-19 patients under an emergency use authorization.

Anyone interested in donating plasma after a Covid-19 infection may sign up here.

The Red Cross and Carter Blood Bank will not accept a donation from those currently quarantine by a health care provider after exposure to Covid-19. Donors should wait until fourteen days after exposure before scheduling.

All blood donations are tested for Covid-19 before being released into the nation’s blood pool.

As the world grinds through the long days of the pandemic, each one of us can do our part. A ten-minute blood donation can save lives.

Any donor willing to help save lives may schedule at the Red Cross here. Carter Blood bank is also accepting donations at various locations across the US. To schedule, click here.

 Let’s make kindness more contagious than the pandemic. 

The post Donating Blood is an Easy Way to Help Out During the Pandemic appeared first on Medika Life.