Threat Net: A Metagenomic Surveillance Network for Biothreat Detection and Early Warning.

Early detection of novel pathogens can prevent or substantially mitigate biological incidents, including pandemics. Metagenomic next-generation sequencing (mNGS) of symptomatic clinical samples may enable detection early enough to contain outbreaks, limit international spread, and expedite countermeasure development. In this article, we propose a clinical mNGS architecture we call "Threat Net," which focuses on the hospital emergency department as a high-yield surveillance location. We develop a susceptible-exposed-infected-removed (SEIR) simulation model to estimate the effectiveness of Threat Net in detecting novel respiratory pathogen outbreaks. Our analysis serves to quantify the value of routine clinical mNGS for respiratory pandemic detection by estimating the cost and epidemiological effectiveness at differing degrees of hospital coverage across the United States. We estimate that a biological threat detection network such as Threat Net could be deployed across hospitals covering 30% of the population in the United States. Threat Net would cost between $400 million and $800 million annually and have a 95% chance of detecting a novel respiratory pathogen with traits of SARS-CoV-2 after 10 emergency department presentations and 79 infections across the United States. Our analyses suggest that implementing Threat Net could help prevent or substantially mitigate the spread of a respiratory pandemic pathogen in the United States.

Balancing the health benefits and climate mortality costs of haemodialysis.

Extensive work is underway to quantify the carbon footprint of specific healthcare interventions and identify ways to minimise healthcare-related emissions; however, it remains unclear how to balance the relative benefits from delivering healthcare with the harm from the associated carbon footprint. To estimate emissions-related harms, we used the Mortality Cost of Carbon, a recently developed metric from environmental economics, which presents the impacts of carbon emissions in the form of excess deaths. We convert deaths into years of life lost and compare this with the healthy life years gained, under two temperature scenarios: 'Dynamic Integrated Climate Economy Model with an Endogenous Mortality Response' (DICE-EMR) (2.4°C) and 'DICE-Baseline' (4.1°C). As a case study, we use haemodialysis, a life-prolonging intervention with a large carbon footprint. We estimate that 19-53 and 10-25 healthy life years are gained from haemodialysis per year of life lost from the associated emissions in the DICE-EMR and DICE-Baseline scenarios, respectively, depending on the country and treatment regimen. This brings the distribution of harms, benefits and tradeoffs inherent to the decarbonisation of healthcare into sharper focus. More fully accounting for the harm imposed by carbon emissions could result in better value investments to lower the carbon footprint of interventions and support the implementation of the net-zero healthcare agenda.

The global temperature-related mortality impact of earlier decarbonization for the Australian health sector and economy: A modelling study.

BACKGROUND: Sustained elevated concentration of GHGs is predicted to increase global mortality. With the Australian health sector responsible for 7% of the nation's GHG emissions, the benefits and costs of various decarbonisation trajectories are currently being investigated. To assist with this effort, we model the impact earlier decarbonisation has on temperature-related mortality. DESIGN: We used DICE-EMR, an Integrated Assessment Model with an endogenous mortality response, to simulate Australian GHG trajectories and estimate the temperature-related mortality impact of early decarbonisation. We modelled a linear decline of the Australian health sector's and economy's GHG annual emissions to net-zero targets of 2040 and 2050. MAIN OUTCOME MEASURE: Deaths averted and monetary-equivalent welfare gain. RESULTS: Decarbonisation of the Australian health sector by 2050 and 2040 is projected to avert an estimated 69,000 and 77,000 global temperature-related deaths respectively in a Baseline global emissions scenario. Australian economy decarbonisation by 2050 and 2040 is projected to avert an estimated 988,000 and 1,101,000 global deaths respectively. Assuming a low discount rate and high global emissions trajectory, we estimate a monetary equivalent welfare gain of $151 billion if the Australian health sector decarbonises by 2040, only accounting for the benefits in reducing temperature-related mortality. CONCLUSIONS: Earlier decarbonisation has a significant impact on temperature-related mortality. Many uncertainties exist and health impacts other than temperature-related mortality are not captured by this analysis. Nevertheless, such models can help communicate the health risk of climate change and improve climate policy decision making.

WHO's allocation framework for COVAX: is it fair?

The COVID-19 Vaccines Global Access Facility (COVAX) represents an unprecedented global collaboration facilitating the development and distribution of vaccines for COVID-19. COVAX pools and channels funds from state and non-state actors to promising vaccine candidates, and has started to distribute successful candidates to participating states. The WHO, one of the leaders of COVAX, recognised vaccine doses would initially be scarce, and therefore, prepared a two-staged allocation mechanism they considered fair. In the first stage, vaccine doses are distributed equally among participating countries, while in the second stage vaccine doses will be allocated according to a country's need. Ethicists have questioned whether this is the fairest distribution-they argue a country's need should be taken into account from the start and correspondingly, have proposed a framework that treats individuals with equal moral concern, aims to minimise harm and gives priority to the worst-off. In this paper, we seek to explore these concerns by comparing COVAX's allocation mechanism to a targeted allocation based on need. We consider which distribution would more likely maximise well-being and align with principles of equity. We conclude that although in theory, a targeted distribution in proportion to a country's need would be more morally justifiable, when political realities are taken into account, an equal distribution seems more likely to avert a greater number of deaths and reduce disparities.

Endoscopic management of gastric perforation secondary to chicken bone: A report of 2 cases.

INTRODUCTION: Ingested foreign bodies (IFB) can uncommonly cause perforation of the gastrointestinal tract. The traditional management is surgical exploration via laparotomy or laparoscopy, although endoscopic options are now gaining prominence. PRESENTATION OF CASE: We present two patients with almost identical clinical presentations of post-prandial abdominal pain and anorexia. On examination they were haemodynamically stable with localised epigastric tenderness. Both patients underwent CT scan of the abdomen, with one scan revealing a foreign body in the stomach penetrating the full thickness of the gastric wall with the tip lying extraluminally. They subsequently underwent endoscopy where a chicken bone was found perforating the wall of the stomach. This was removed via snare and endoscopic clips were used to close the site of perforation. DISCUSSION: The majority of ingested foreign bodies pass through the gastrointestinal tract harmlessly. However some IFBs can cause significant complications like bowel obstruction, bleeding, abscess formation, migration to other organs, and in our case perforation. The diagnosis may be delayed due to an insidious clinical presentation especially if the patient does not recall ingesting anything untoward. Our patients managed to avoid surgery by undergoing successful endoscopic therapy. CONCLUSION: In selected cases, endoscopic management is more cost-effective, minimally invasive, has less post-operative complications, and leads to a more expeditious recovery. Therefore, the role of therapeutic endoscopy for gastric perforations secondary to foreign bodies should always be considered.