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[Editorial] India's COVID-19 emergency

Sab, 08/05/2021 - 00:00
The scenes of suffering in India are hard to comprehend. As of May 4, more than 20·2 million cases of COVID-19 had been reported, with a rolling average of 378 000 cases a day, together with more than 222 000 deaths, which experts believe are likely to be substantial underestimates. Hospitals are overwhelmed, and health workers are exhausted and becoming infected. Social media is full of desperate people (doctors and the public) seeking medical oxygen, hospital beds, and other necessities. Yet before the second wave of cases of COVID-19 began to mount in early March, Indian Minister of Health Harsh Vardhan declared that India was in the “endgame” of the epidemic.

[World Report] Media restrictions have “cost lives”

Sab, 08/05/2021 - 00:00
New figures show deteriorating press freedom in 2020, which health experts say will have hampered the COVID-19 response. Ed Holt reports.

[World Report] UK makes massive global health cuts

Sab, 08/05/2021 - 00:00
The global health community has reacted with shock to huge cuts to UK funding, including for women's and girl's health, HIV/AIDS, polio, and UNICEF. John Zarocostas reports.

[World Report] COVID-19 surge threatens health in the Gaza strip

Sab, 08/05/2021 - 00:00
A spike in cases is raising concerns over hospital beds, oxygen supplies, and mental health. Sharmila Devi reports.

[Perspectives] Mary Wortley Montagu's struggle for health and equality

Sab, 08/05/2021 - 00:00
In August, 1773, a Pacific Islander called Ma'i stepped aboard HMS Adventure. Over a year later, he arrived in London, England, where he was squeezed into a velvet coat and satin breeches for an interview with King George III. Ma'i (whose name was anglicised as Omai) was alarmed to find himself being deliberately infected with live virus taken from the pustules of a smallpox sufferer. The illness induced by this variolation procedure might well have proved fatal, but Joseph Banks and Ma'i's other hosts were trying to protect him from a full blown episode.

[Perspectives] Monica Lewin: surgeon to victims of political violence in Jamaica

Sab, 08/05/2021 - 00:00
At the height of the political unrest that rocked Jamaica's capital, Kingston, during the 1960s and 1970s, many of the injured brought to Kingston Public Hospital found themselves cared for by the expert hands of surgeon Monica Lewin. Her career illustrates the combination of high parental expectations, sympathetic mentorship, and personal determination that often underlies extraordinary achievement by people from under-represented groups. For most of Lewin's life, there were few female consultant surgeons, and she was one of the first in her country.

[Perspectives] Patrolling race and the UK's medical borders

Sab, 08/05/2021 - 00:00
In an age of globalisation, public health concerns have increasingly informed calls to manage national borders. Yet, the impulses and anxieties that have led politicians to tighten immigration controls arguably tell us as much about the politics of racialised exclusion as they do about medical crises. As such, unpicking the geopolitics of disease management can illuminate the construction of what medical historian John McKiernan-Gonzalez has termed “medical borders”—ie, the manifest ways in which medical knowledge, personnel, and practices have contributed to the governing of state borders.

[Obituary] W Alwyn Lishman

Sab, 08/05/2021 - 00:00
First UK professor of neuropsychiatry. Born on May 16, 1931, in Houghton-le-Spring, UK, he died peacefully of Alzheimer's disease in Kent, UK, Jan 24, 2021, aged 89 years.

[Correspondence] Catalysing needed change for health systems in the USA

Sab, 08/05/2021 - 00:00
Powerful voices calling for change to address the health-care crisis in the USA are gaining momentum.1–3 These voices are in response to the Lancet Commission on public policy and health in the Trump era: a deep analysis of the causes of long-standing systemic failure of health-care delivery in the country. The proposed change is crucial but daunting, and can be catalysed by deepening the collaboration between clinical medicine and public health. Both efforts share the common goal of maintaining good health; yet they operate on parallel tracks in the USA.

[Correspondence] UK guidelines for managing long-term effects of COVID-19

Sab, 08/05/2021 - 00:00
Robin Gorna and colleagues1 state that people with lived experience should have been involved in developing the National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN), and the Royal College of General Practitioners (RCGP) guideline on managing the long-term effects of COVID-19. The expert advisory panel for developing the NICE–SIGN–RCGP guideline had 23 members who contributed substantial clinician and patient experience to discussions.2 Two stakeholder consultations were held and the guideline was adapted in response to feedback from patient-led, health, and care organisations.

[Correspondence] Effective supply chain surveillance for PPE

Sab, 08/05/2021 - 00:00
Control of the COVID-19 pandemic has been hampered by reported shortages of personal protective equipment (PPE) and other crucial supplies for health-care providers across the USA.1 A key impediment to increasing the supply to meet this demand is reliable data on nationwide needs.2 Reliable forecasting models could help provide information to more accurately scale PPE production, set expectations for health-care facilities on bidding and pricing, and enable appropriate deployment of resources, such as funds from the Coronavirus Aid, Relief, and Economic Security Act (2021).

[Correspondence] No-fault compensation schemes for COVID-19 medical products

Sab, 08/05/2021 - 00:00
No-fault compensation schemes for severe adverse events can help build confidence in vaccine safety after marketing.1 25 of the 194 WHO member states have implemented such no-fault vaccine injury compensation programmes.2 Although the USA is covering COVID-19 vaccine-associated adverse events with the US Countermeasures Injury Compensation Program (CICP) for the duration of the public health emergency declaration, the country is having challenging issues as CICP does not have the ease of access to, and levels of compensation provided by the US National Vaccine Injury Compensation Program available at normal times, exacerbating long-standing inequities based on income, race, and ethnicity.

[Correspondence] Thwarting the inverse care law through immunisation

Sab, 08/05/2021 - 00:00
The Lancet appropriately celebrated the late Julian Tudor Hart (1927–2018) who is recognised for suggesting the inverse care law (ICL) 50 years ago and astutely observed that “the availability of good medical or social care tends to vary inversely with the need of the population served”.1 Richard Cookson and colleagues2 provided a disquieting companion global assessment of the pervasive reality of the ICL in low-income and middle-income countries (LMICs), evidenced by immensely patchy progress towards achieving universal health coverage (UHC), which the UN General Assembly committed to in December, 2012.

[Correspondence] Differences in modelled estimates of global dietary intake

Sab, 08/05/2021 - 00:00
Robust global dietary data are essential for understanding the risk of undernutrition, obesity, and diet-related non-communicable diseases, which contribute substantially to the global burden of disease.1 Two separate entities—the Global Dietary Database (GDD) and the Global Burden of Disease (GBD) 2017 Diet Collaborators2—have compiled global dietary and proxy data to model quantitative intakes for adults from nearly every country. The underlying data in the modelled estimates from GDD include 24-h recalls, food frequency and Demographic and Health Survey questionnaires, biomarkers, and household surveys.

[Correspondence] Dietary risk versus physical inactivity: a forced comparison with policy implications?

Sab, 08/05/2021 - 00:00
The Global Burden of Disease (GBD) study1 has an ongoing commitment to global health. We respect the huge efforts of GBD researchers, but we are concerned about how the risk factor burden estimates inform the non-communicable disease prevention agenda. For example, diet and physical activity, which are both established components of healthy lifestyles, but the GBD estimated that deaths and disability-adjusted life-years attributable to physical inactivity are less than 10% of those attributable to diet (derived from figure 3 in the GBD study).

[Correspondence] Dietary risk versus physical inactivity: a forced comparison with policy implications? – Authors' reply

Sab, 08/05/2021 - 00:00
Ding Ding and colleagues have raised several concerns regarding the disease burden estimates of low physical activity in our Global Burden of Disease (GBD) study.1 First, they point out the similarities between diet and physical activity and raise concern about the approach to define diet on the basis of its individual components, whereas physical activity was treated as a single construct. The rationale and criteria for selecting GBD risk factors have been described in detail elsewhere.2 Briefly, GBD defines diet on the basis of its individual components because evidence on health effects of diet mostly comes from studies assessing the effect of individual components of diet (eg, fruits and vegetables) on disease endpoints (eg, diabetes), and there is sufficient data at the population level to estimate the exposure to these risk factors across time and geographies.

[Department of Error] Department of Error

Sab, 08/05/2021 - 00:00
The SIREN Study Group. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN). Lancet 2021; 397: 1459–69—For this Article, Mariyam Mirfenderesky and Thushan De Silva should have been included in the SIREN Study Group, and author EJM Monk's initials have been corrected. These corrections have been made to the online version as of May 6, 2021.

[Department of Error] Department of Error

Sab, 08/05/2021 - 00:00
Loibl S, Poortmans P, Morrow M, et al. Breast cancer. Lancet 2021; 397: 1750–69—In figure 3B of this Seminar, the text in the “Trastuzumab deruxtecan” box has been corrected. This correction has been made to the online version as of May 6, 2021, and the printed version is correct.

[Clinical Picture] Adrenalitis and anasarca in idiopathic multicentric Castleman's disease

Sab, 08/05/2021 - 00:00
A 46-year-old man presented to our hospital with abdominal pain and fever. In his medical history he reported three previous episodes of varicella zoster. On examination, he had a temperature of 38·3°C, small cervical lymph nodes, and some right upper quadrant tenderness.

[Comment] COVID-19 and disparities affecting ethnic minorities

Sab, 01/05/2021 - 00:30
Longstanding health disparities affecting ethnic minorities in the UK have been made acutely visible by the COVID-19 pandemic. The disproportionate effects of COVID-19 among minority ethnic groups were present from the beginning, with Black and Asian patients in the UK being over-represented among those with COVID-19 receiving advanced respiratory support.1 Analysis of data from Public Health England later highlighted that deaths from COVID-19 among people from minority ethnic groups were two to four times greater than those among the White population in England.