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Health Advisory

Special Note on the COVID-19 Pandemic:

Coronaviruses are a large group of viruses that are common in people and many different species of animals, including camels, cattle, cats, and bats.  A novel strain of these viruses, known as COVID-19, has spread across the world, with over 100,000 cases recorded, and deaths of thousands of people attributed to the outbreak.

The coronavirus is a respiratory virus that has been named “SARS-CoV-2” and causes the  “coronavirus disease 2019,” which is abbreviated to “COVID-19.” The symptoms of the COVID-19 coronavirus include fever, cough, and shortness of breath. Medical experts advised people to seek medical attention particularly if they had trouble breathing. The proportion of deaths increases with age, but the increase becomes more dramatic over the age of 60.

The World Health Organization (WHO) was not quick to call the coronavirus outbreak, in effect since December 2019, a pandemic. Many  epidemiologists and public health experts, however, have characterized the new  global outbreak as a de facto  pandemic because of the incidences and death associated with this novel coronavirus.  Finally, on March 11, 2020, the WHO declared the COVID-19 outbreak to be a pandemic.

The first part of 2020 saw the coronavirus plague countries across the world in a global pandemic. The infection, which appeared to have started in Wuhan in China in late 2019, was now affecting multiple countries across the globe. From the start of January 2020 to mid-2020, the highly infectious novel coronavirus had spread sufficiently as to outpace malaria and HIV/AIDs in terms of annual lethality.    

Coronavirus death rate averages out to 78,000 per month, whereas HIV/AIDs-related deaths numbered around 64,000 and malaria deaths numbered around 36,000, according to statistics from the World Health Organization.

In the month of June 2020, according to calculations by Reuters, more than 4,700 people were dying every 24 hours from COVID-19-linked illness.  That would equate to 196 people dying per hour, or one person dying every 18 seconds.

Countries of the Americas and Europe were bearing the brunt of coronavirus in terms of cases and deaths. The Eastern Mediterranean and South East Asia followed, with Africa and the Western Pacific seeing fewer cases and deaths than the rest of the world.

In mid-August 2020, according to the World Health Organization, countries of the Americas accounted for 10,590,929  cases of coronavirus and 388,673 deaths.  European countries accounted for 3,582,911  cases of coronavirus and 216,393 deaths. Eastern Mediterranean countries accounted for 1,644,359  cases of coronavirus and 43,433 deaths. Southeast Asian countries accounted for 2,632,773 cases of coronavirus and 53,677 deaths. African Countries accounted for 895,696 cases of coronavirus and 16,713 deaths. Countries of the Western Pacific accounted for 370,621  cases of coronavirus and 8,811 deaths.

One macabre aspect of the coronavirus has been the fact that the high number of deaths has forced countries and cultures to discard their traditional and religious burial rites around the world for practical public health reasons.  Because of the highly infectious nature of the coronavirus, persons severely afflicted often die alone with loved ones prevented from being able to say goodbye in person. Once a patient has died, large funeral services cannot take place, priests or rabbis can obviously not preside for last rites and blessings,  and the disposal of the body has to be done carefully. Even practices by funeral and morgue services have to adapt to the reality of the highly infectious virus, and the sheer volume of deaths, with burial grounds and crematories under stress.

In mid-2020, the first wave of the coronavirus pandemic was still being felt in some parts of the world, such as the Americas, and the United States particularly. Both Brazil and India were also recording spikes in the number of outbreaks. The United States and Brazil were battling for the notoriety of being home to the biggest coronavirus outbreaks across the globe, although Mexico and Peru were starting to compete for the dubious distinction of coronavirus centers in the Americas.  Meanwhile, India was the Asian center of coronavirus, even as  Russia was seeing the highest number of cases in the European/Asian region. South Africa was locking in the highest number of cases from across the African continent.

Nevertheless, the clear leader in coronavirus cases and deaths was the United States. Indeed, the United States had emerged as the global "hotspot" of sorts with new cases surging in mid-2020.  By July 2020, the United States accounted for a full one-quarter of all coronavirus cases and deaths across the world.

The surge of coronavirus cases in the United States in mid-2020 was occurring in southern and western states that had re-opened their economies for business, with little attention to physical distancing and diligent mask-wearing.  Instead, bars and restaurants had returned to normal operations in many states, with people crowding them and not adhering to guidance from public health experts warning about exposure to the virus in crowded closed spaces.  The spiking coronavirus cases forced many governors in the United States who re-opened without necessary precautions to shut down once again.

Some of the countries of Asia and Europe that weathered the onslaught of coronavirus earlier in 2020 were gradually easing out of lockdowns and trying to return to some semblance of normalcy — but with accommodations, given the reality that a vaccine might not be available until 2021.

Meanwhile, the rate of death had flattened by this time period in some countries, but new outbreaks in  parts of Asia, such as China, have caused alarm.  Likewise, New Zealand and Australia, which had managed their coronavirus outbreaks admirably were also dealing with new outbreaks. The resurgence in infections led authorities in certain countries to reinstate prohibitions and regulations intended to stem another wave of coronavirus mass deaths.  

Nevertheless, the recorded global coronavirus caseload reached and surpassed 11 million at the start of July 2020 --  more than double the cases of severe influence annually, according to the World Health Organization.  The death toll had also exceeded 500,000 internationally.

On July 13, 2020, according to the World Health Organization, 12,768,307 patients had tested positive for the virus and 566,654 had died as a result of the deadly pandemic. Johns Hopkins University's Coronavirus Resource Center had a slightly different tally:  13,113,181 confirmed worldwide, and 573,288 deaths.

A week later on July 20, 2020, according to the World Health Organization, 14,348,858 patients had tested positive for the virus and 603,691 had died as a result of the deadly pandemic. According to Johns Hopkins University's Coronavirus Resource Center, there were 14,706,950 confirmed cases worldwide and 609,971 deaths.

On Aug. 31, 2020, according to the World Health Organization, 24,854,140 patients had tested positive for the virus and 838,924 had died as a result of the deadly pandemic.  According to Johns Hopkins University's Coronavirus Resource Center, there were 25,330,679 cases of coronavirus worldwide and 848,030 deaths.

On Sept. 13, 2020, the World Health Organization reported the highest one-day increase in coronavirus infections globally since the start of the pandemic. The more than 300,000 new cases were largely attributed to infections in the United States, Brazil, and India.  There were also concerns about a fresh spike in cases in Europe. 

At this time (Sept. 13, 2020), the countries with the highest raw number of coronavirus cases in the world were: United States, India, Brazil, Russia, Peru, Colombia, Mexico, South Africa, Spain, Argentina, Chile, and Iran. 

At this time (Sept. 13, 2020), the countries with the highest raw number of coronavirus deaths in the world were: United States, Brazil, India, Mexico, United Kingdom, Italy, France, Peru, Spain, Iran, Colombia, and Russia.

In late September 2020, with the world hitting an appalling death toll of one million human beings,  the World Health Organization (WHO) announced that 120 million rapid diagnostic tests for the coronavirus would be made available to low and middle income countries as the world approaches a death toll of 1 million.  According to Tedros Adhanom Ghebreyesus, the director of the WHO, the "highly portable and easy to use rapid Covid-19 diagnostic tests" were being developed by manufacturers Abbott and SD Biosensor in partnership with the Bill and Melinda Gates Foundation. Ghebreyesus noted that the tests would cost less than five dollars. 

Regionally, at the start of October 2020, the region of the Americas was maintaining its dubious distinction as home to the highest number of cases: 16,990,036 cases in total and 568,358 deaths, according to the World Health organization's tally. In South-East Asia, there were 7,335,273 cases in total and 119,167 deaths. In Europe, there were 6,187,384 cases in total and 240,148 deaths. In the Eastern Mediterranean/Middle East, there were 2,466,722  cases in total and 63,156 deaths. In Africa, there were 1,198,550 cases in total and 26,264 deaths. In the Pacific, there were 625,642 cases in total and 13,632 deaths.

By Oct. 19, 2020, there were 39,944,882 confirmed cases of coronavirus, and 1,111,998 people had died of the deadly pandemic, according to the World Health Organization. Johns Hopkins University's Coronavirus Resource Center's tally showed 40,240,700 cases of coronavirus worldwide and 1,115,907 deaths.

The number of cases and deaths noted at this time marked dark and ominous milestones with the number of coronavirus cases internationally now on the 40 million marks, and with the international death toll well past the threshold of one million.  These numbers cannot be understood as mere statistics, but instead, as registers of the spread of the coronavirus pandemic and its resulting devastation to the world -- both in terms of human suffering and in terms of socio-economic catastrophe.

The World Bank rang serious alarm bells during its biennial report on poverty and shared prosperity about the effects of the coronavirus pandemic.  Indeed, in that report, the World Bank announced that the coronavirus pandemic could send as many as 150 million people into extreme poverty by the end of 2021. That many people living in extreme poverty would account for 9.1-9.4 percent of the world's population.  Such an end would reverse three years' worth of strides made on the issue of poverty alleviation.  World Bank President David Malpass characterized  it as a "serious setback to development progress and poverty reduction."

As October 2020 came to a close, coronavirus was surging in significant parts of the world -- the Americas and Europe. In fact, this new autumn surge was promising to be potentially more widespread than the spring surge.  The countries with the most cases of coronavirus at this time were the United States, India, Brazil, Russia, and France, while the countries with the most cumulative deaths were the United States, Brazil, India, Mexico, and the United Kingdom.

In the United States, coronavirus cases were surging across the country, but particularly in Texas and the midwest. Less than a month after the White House became a coronavirus hotspot and the president of the United States, Donald Trump, becoming infected by the coronavirus and hospitalized, several aides to the vice president, Mike Pence, were reported to have been infected as well.  Neither Trump nor Pence was staying off the campaign trail despite this development a week ahead of election day in that country.

In Europe, Spain was forced to announce a state of emergency to address the spike of coronavirus cases there. In France, patients infected by COVID-19 accounted for more than half of the occupants of intensive care units in hospitals. In Italy, renewed lockdown protocols were being reintroduced to mitigate the coronavirus danger.  

As of Oct. 27, 2020, there were 44,351,506 confirmed cases of coronavirus, and 1,171,225 people had died of the deadly pandemic, according to the World Health Organization. On Oct. 29, 2020, Johns Hopkins University's Coronavirus Resource Center had a more grim tally --  45,028,250 cases of coronavirus worldwide and 1,181,085 deaths.

By the first week of November 2020, cases of Covid-19 were increasing across the international spectrum.  The cumulative numbers meant that there were now approximately 50 million reported cases of coronavirus across the world, and over 1.2 million deaths globally since the start of the pandemic, according to both the World Health Organization and Johns Hopkins University's Coronavirus Resource Center.

On Nov. 30, 2020, there were 62,363,527 confirmed cases of coronavirus, including 1,456,687 deaths, according to the World Health Organization.  The tally from Johns Hopkins University's Coronavirus Resource Center on this day was 63,189,103 confirmed cases and 1,466,762 deaths globally.

Meanwhile, there was good news on the pandemic front:  

On Nov. 9, 2020, the pharmaceutical developers Pfizer and BioNTech announced that their effort to develop a Covid-19 vaccine was strongly effective, according to their early data from  a large trial. Early analysis indicated that 90 percent of individuals who received two injections of the vaccine three weeks apart were less symptomatic for Covid-19 than those who received a placebo.  This finding exceeded the expectations of many experts who warned that a vaccine that might only be 60-70 percent effective. 

Once the vaccine was eventually authorized, its supply and distribution were expected to be limited in the early stages.   Nevertheless, in an interview with CNN on Nov. 9, 2020, Pfizer CEO Albert Bourla cast the development of the experimental Covid-19 vaccine as "the greatest medical advance" in the last 100 years.

On Nov. 16, 2020, the pharmaceutical developer, Moderna, announced that its effort to develop a Covid-19 vaccine was strongly effective with more than 90 percent of individuals.  This particular vaccine was believed to be easier to transport than the  Pfizer and BioNTech version that required extremely cold temperatures. 

On Nov. 23, 2020, the pharmaceutical developer, Astra-Zeneca, working in concert with Oxford University, announced that late-stage trials showed its coronavirus vaccine was highly effective.  The Oxford-AstraZeneca vaccine was reported to be 90 percent effective in preventing coronavirus in one of its dosing regimens tested, but only 70 percent effective on average.  Still, because it was offering a cheaper vaccine that  did not have to be stored at extremely cold temperatures, it would offer easier access and distribution in developing countries.

With access to three vaccines, there were high hopes that there would be an adequate global supply in 2021, facilitating a return to normalcy from pandemic conditions across the world. 

As November 2020 was coming to an end, there were high hopes that vaccinations would start in December 2020.  To that end, the United Kingdom began the process of vaccinating its population on Dec. 8, 2020, starting with its elderly population and workers in elderly care facilities. Vaccinations began to be administered in the United States on Dec. 14, 2020, with the Pfizer vaccine being approved by the Food and Drug Administration.   Approval for the Moderna vaccine came a week later.

As the year 2020 came to a close, there were 79,232,555  confirmed cases of COVID-19, including 1,754,493 deaths, reported to the World Health Organization.  The tally from Johns Hopkins University's Coronavirus Resource Center on this day was 80,788,307 confirmed cases and 1,764,872 deaths globally.

At the start of 2021, as of Jan. 3, 2021, there were 83,322,449 confirmed cases of COVID-19, including 1,831,412 deaths, reported to the World Health Organization. The tally from Johns Hopkins University's Coronavirus Resource Center on this day was 85,098,528 confirmed cases and 1,842,845 deaths globally.

As January 2021 came to a close, on Jan. 31, 2021, there were 102,083,344 confirmed cases of COVID-19, including 2,209,195 deaths, reported to the World Health Organization. The tally from Johns Hopkins University's Coronavirus Resource Center on this day was 102,922,990 confirmed cases and 2,226,935 deaths globally.

For more information about the COVID-19 pandemic, please see the CountryWatch Coronavirus Special Alert and associated data. 


-- Dr. Denise Youngblood Coleman, Editor in Chief, CountryWatch Inc.


***

 

Please Note:  Most of the entry below constitutes a generalized health advisory, which a traveler might find useful, regardless of a particular destination.  
 
As a supplement, however, reader will also find below a list of countries flagged with current health notices and alerts issued  by the  Centers for Disease Control and Prevention (CDC).   Please note that travel to the following countries, based on these 3 levels of  warnings, is ill-advised, or should be undertaken with the utmost precaution:  
 
Level 3 (highest level of concern; avoid non-essential travel) --
 
Guinea - Ebola
Liberia - Ebola
Nepal - Eathquake zone
Sierra Leone - Ebola
 
Level 2 (intermediate level of concern; use utmost caution during travel) --
 
Cameroon - Polio
Somalia - Polio
Vanuatu  - Tropical Cyclone zone
Throughout Middle East and Arabia Peninsula - MERS ((Middle East Respiratory Syndrome) 
 
Level 1 (standard level of concern; use practical caution during travel) -
 
Australia - Ross River disease
Bosnia-Herzegovina - Measles
Brazil - Dengue Fever
Brazil - Malaria
Brazil - Zika  
China -  H7N9  Avian flu
Cuba - Cholera
Egypt - H5N1 Bird flu
Ethiopia - Measles
Germany - Measles
Japan - Hand, foot, and mouth disease (HFMD) 
Kyrgyzstan - Measles
Malaysia -Dengue Fever
Mexico - Chikungunya
Mexico - Hepatitis A
Nigeria - Meningitis
Philippines - Measles
Scotland - Mumps
Singapore - Hand, foot, and mouth disease (HFMD)
South Korea - MERS ((Middle East Respiratory Syndrome) 
Throughout Caribbean - Chikungunya
Throughout Central America - Chikungunya
Throughout South America - Chikungunya
Throughout Pacific Islands - Chikungunya
 
For specific information related to these health notices and alerts please see the CDC's listing available at URL:
http://wwwnc.cdc.gov/travel/notices
 

Health Information for Travelers to Kenya

Several cases of African trypanosomiasis (African sleeping sickness) have been reported from this region recently, including cases among tourists visiting game parks. For more information and recommendations on trypanosomiasis, see Travelers' Health Information on African Trypanosomiasis (http://www.cdc.gov/travel/diseases/aftrypano.htm).

Also, please check the Outbreaks section for important updates on this region, including information on the recent epidemic of Meningococcal Disease in Addis Ababa, Ethiopia (http://www.cdc.gov/travel/outbreaks.htm).

Food and waterborne diseases are the number one cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout the region and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis). Make sure your food and drinking water are safe. (See below.)

Malaria is a preventable infection that can be fatal if left untreated. Prevent infection by taking prescription antimalarial drugs and protecting yourself against mosquito bites (see below). Most travelers to malaria risk areas in this region should take mefloquine to prevent malaria. You can be infected with malaria in all areas of this region except the cities of Addis Ababa, Ismara, and Nairobi, the islands of Reunion and Seychelles, and in highland areas above 2,500 meters. For more detailed information about the risk in specific locations, see Malaria in East Africa (http://www.cdc.gov/travel/regionalmalaria/eafrica.htm).

A certificate of yellow fever vaccine may be required for entry into certain of these countries. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements (http://www.cdc.gov/travel/yelfever.htm).

Dengue, filariasis, leishmaniasis, onchocerciasis, trypanosomiasis (sleeping sickness), and Rift Valley fever are diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases.

Schistosomiasis, a parasitic infection, is found in fresh water in the region, including Lake Malawi. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries. (For more information, please see the Swimming Precautions on the Making Travel Safe page at URL http://www.cdc.gov/travel/safety.htm.)

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid nighttime travel if possible and always use seat belts.

CDC Recommends the Following Vaccines (as Appropriate for Age):
See your doctor at least 4-6 weeks before your trip to allow time for shots to take effect.
• Hepatitis A or immune globulin (IG).
• Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Meningococcal (meningitis) vaccine, if you plan to visit the western half of Ethiopia (see meningitis map at URL http://www.cdc.gov/travel/meninmap.htm) from December through June.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly if you are visiting developing countries in this region.
• Yellow fever, if you travel anywhere outside urban areas.
• As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults. Hepatitis B vaccine is now recommended for all infants and for children ages 11-12 years who did not receive the series as infants.

To Stay Healthy, Do:
• Wash hands often with soap and water.
• Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filter" are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• If you travel to an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from insects by remaining in well-screened areas, using repellents (applied sparingly at 4-hour intervals) and permethrin-impregnated mosquito nets, and wearing long-sleeved shirts and long pants from dusk through dawn.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To Avoid Getting Sick:
• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague). (For more information, please see the Animal-Associated Hazards on the Making Travel Safe page.)
• Don't swim in fresh water, including Lake Malawi. Salt water is usually safer. (For more information, please see the Swimming Precautions on the Making Travel Safe page.)

What You Need To Bring with You:
• Long-sleeved shirt and long pants to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).
• Insect repellent containing DEET (diethylmethyltoluamide), in 30%-35% strength for adults and 6%-10% for children. Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin. (Bed nets can be purchased in camping or military supply stores.)
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more detailed information about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

After You Return Home:
If you have visited an area where there is risk for malaria, continue taking your malaria medication weekly for 4 weeks after you leave the area.
If you become ill after your trip-even as long as a year after you return-tell your doctor where you have traveled.

For More Information:
Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in East Africa, such as:

For information about diseases-

Carried by Insects
Dengue, Malaria, Yellow Fever

Carried in Food or Water
Cholera, Escherichia coli, diarrhea, Hepatitis A, Schistosomiasis, Typhoid Fever

Person-to-Person Contact
Hepatitis B, HIV/AIDS

For more information about these and other diseases, please check the Diseases (http://www.cdc.gov/travel/diseases.htm) section and the Health Topics A-Z (http://www.cdc.gov/health/diseases.htm).


Note:

Kenya is located in the East Africa health region.

Sources:

The Center for Disease Control Destinations Website:

http://www.cdc.gov/travel/indianrg.htm