Omicron
Omicron also enters Bangladesh; first 2 cases detected
Bangladesh on Saturday reported the first two cases of Omicron variant of coronavirus, raising alarm because of its sheer number of mutations, more than what prior variants had.
“These two infected female patients (cricketers) returned from Zimbabwe recently,” ASM Alamgir, chief scientific officer of the Institute of Epidemiology Disease Control and Research (IEDCR), told UNB.He said the Omicron patients are members of the Bangladesh Women's Cricket Team and they do not have any severe symptoms.However, the two female members of the cricket team have been kept in a hotel for isolation, he added.The two cricketers tested positive for Covid-19 on December 6.
READ: Companies rethink return-to-office plans amid omicron casesThe women's team recently returned home from Zimbabwe after confirming their participation in the next 50-over World Cup, which will be Bangladesh’s maiden World Cup appearance as well.
Meanwhile, Health Minister Zahid Maleque on Saturday said samples of other members of the women’s team are being tested to confirm whether there are more cases of Omicron Covid-19 variant.
The minister said, “We’re alert about the new strain of Covid-19. All the overseas returnees will be kept in quarantine,” he said at the inauguration programme of vitamin A campaign at Dhaka Shishu (Children) Hospital.
On December 9, the World Health Organization (WHO) said the omicron coronavirus variant is now present in 57 countries and asked all countries to stay alert about the new variant.
A WHO panel named the Coronavirus variant ‘Omicron’ and classified it as a highly transmissible virus of concern, the same category that includes the predominant delta variant, which is still a scourge driving higher cases of sickness and death in Europe and parts of the USA.
Quoting WHO, Minister Maleque, however, said the Covid-19 vaccines Bangladesh is administering are capable of preventing Omicron and urged all to get vaccinated.
READ: Omicron not ‘less dangerous’; it’s matter of time for Bangladesh to get a case: Experts
New Travel Rules
On December 3, Bangladesh announced new travel rules, making a 14-day institutional quarantine mandatory for all travellers from seven African countries.
The countries are Botswana, Eswatini, Ghana, Lesotho, Namibia, South Africa and Zimbabwe, the Civil Aviation Authority of Bangladesh said on Thursday in its updated travel restriction notification. The order will come into effect Saturday.
According to the new travel rules in Bangladesh, all passengers from these seven African countries will need to stay at government-designated hotels at their own expense.
On the seventh and 14th day of quarantine, they will have to undergo RT-PCR tests at their own expense, it said.
If any passenger tests positive for Covid on the seventh day, they will be separated for further isolation, while Covid-negative travellers will continue their quarantine till the 14th day.
Depending on the RT-PCR test results on the 14th day of their quarantine, Covid-negative passengers will be released.
The passengers returning from these seven countries will need to show proof of hotel bookings in Bangladesh during check-in, said Civil Aviation Authority of Bangladesh (CAAB).
With changes to a previous guideline, incoming passengers from all other destinations, except children below 12 years, will need to mandatorily possess a Covid-negative certificate, with the test conducted within 48 hours of their flight departure, it said.
The UK and other countries have imposed a travel ban on South Africa, Namibia, Zimbabwe and other countries as the new variant is more contagious than the Delta variant.
Amid the growing concern over the new ‘Omicron’ variant of coronavirus, the Directorate General of Health Services (DGHS) suggested the implementation of 15 instructions to prevent the spread of the new variant and urged all concerned to take measures to enforce the instructions.
Bangladesh reports only one covid-linked death in 24hrs with 269 cases
Bangladesh logged only one Covid-related death along with 269 fresh cases in 24 hours till Friday morning.
With the latest cases, the daily-case positivity rate increased to 1.34 per cent from Thursday’s 1.22 per cent, said the Directorate General of Health Services (DGHS).
The deceased was a woman in her eighties from Chattogram division.
Read: 'WB committed to Bangladesh's resilient and inclusive recovery from Covid'
The total fatalities mounted to 28,017 while the caseload mounted to 15,78 819, with the fresh number of cases.
Meanwhile, the mortality rate remained static at 1.77 per cent during the period.
The fresh cases were detected after testing 20,066 samples, amid the growing concern over the new ‘Omicron’ variant of coronavirus.
Besides, the recovery rate remained unchanged at 97.78 per cent with the recovery of 249 more patients during the 24-hour period.
On Thursday, Bangladesh again logged zero Covid-related death after nearly three weeks as the pandemic is apparently showing signs of easing amid the emergence of a new variant of the virus, Omicron.
The country reported this year’s first zero Covid-related death in a single day on November 20 along with 178 infections since the pandemic broke out in Bangladesh in March 2020.
Bangladesh reported the highest number of daily fatalities of 264 on August 5 this year, while the highest daily caseload was 16,230 on July 28 this year.
So far, 4,20,43,323 people have fully been vaccinated in the country while 6,62,87,396 received the first dose as of Thursday, according to the DGHS.
Among them, 2,07,010 students, aged from 12-17, have fully been vaccinated while 11,89,540 students received the first dose so far.
Read: Bangladesh again reports zero Covid fatality in nearly 3 weeks
However, some of the leading public health experts in Bangladesh have warned that the current trend of plummeting Covid-19 cases in Bangladesh could well be the obvious calm before a cataclysmic storm.
Their fears centre around children below 12 who remain out of the vaccine coverage and the elderly people.
These experts fear a slow pace of vaccination, waning vaccine immunity, sheer disregard for Covid-safety protocols, reopening of schools and increased travel may set the stage for another Covid wave in Bangladesh -- a trend many European countries are witnessing now.
Omicron not ‘less dangerous’; it’s matter of time for Bangladesh to get a case: Experts
Omicron, the new Covid variant having the high mutation capability, may turn deadly if it enters Bangladesh although it now seems to be less lethal in many countries, warn experts.
As the highly transmissible new variant is spreading fast in different countries, including India, they said emergency preparedness should be in place as Omicron may make its way into Bangladesh any time.
Prof Nazrul Islam, ex VC of BSMMU, Dr AM, Zakir Hossain, former director of IEDCR, Prof Dr Bijon Kumar Sil, head of Gono Bishwabidyalay’s Microbiology department and Prof Dr MH Chowdhury (Lenin), head of Health and Hope Hospital’s Medicine department, made the observations while talking to UNB.
The analysts said the government should take proper steps to strictly implement its 15-point guideline and intensify monitoring and screening of the incoming passengers through air and land ports and ensure their quarantine.
They also said the enforcement of the law is also now necessary to force people to maintain health protocols and wear masks since most people are now reluctant about following the health safety rules due to the current very low Covid infection rate.
It’s just matter of time
Dr Lenin said Omicron has already spread to 52 countries in the world, including India, Sri Lanka and Malaysia, Saudi Arabia, the USA and the UK. “As Bangladesh has strong communications and connectivity with these countries, we fear this virus may enter Bangladesh at any time.”
At the same time, he said, a good number of people returned to Bangladesh from African countries and the Omicron-affected nations over the last three weeks.
Also read: How can I protect myself from the new omicron variant?
Vaccine makers racing to update COVID shots, just in case
Vaccine makers are racing to update their COVID-19 shots against the newest coronavirus threat even before it’s clear a change is needed, just in case.
Experts doubt today’s shots will become useless but say it’s critical to see how fast companies could produce a reformulated dose and prove it works -- because whatever happens with omicron, this newest mutant won’t be the last.
Omicron “is pulling the fire alarm. Whether it turns out to be a false alarm, it would be really good to know if we can actually do this -- get a new vaccine rolled out and be ready,” said immunologist E. John Wherry of the University of Pennsylvania.
It’s too soon to know how vaccines will hold up against omicron. The first hints this week were mixed: Preliminary lab tests suggest two Pfizer doses may not prevent an omicron infection but they could protect against severe illness. And a booster shot may rev up immunity enough to do both.
Better answers are expected in the coming weeks and regulators in the U.S. and other countries are keeping a close watch. The World Health Organization has appointed an independent scientific panel to advise on whether the shots need reformulating because of omicron or any other mutant.
But authorities haven’t laid out what would trigger such a drastic step: If vaccine immunity against serious illness drops, or if a new mutant merely spreads faster?
“This is not trivial,” BioNTech CEO Ugur Sahin, Pfizer’s vaccine partner, said shortly before omicron’s discovery. A company could apply to market a new formula “but what happens if another company makes another proposal with another variant? We don’t have an agreed strategy.”
Read:COVID cases spike even as US hits 200M vaccine milestone
It’s a tough decision — and the virus moves faster than science. Just this fall the U.S. government’s vaccine advisers wondered why boosters weren’t retooled to target the extra-contagious delta variant — only to have the next scary mutant, omicron, be neither a delta descendent nor a very close cousin.
If vaccines do need tweaking, there’s still another question: Should there be a separate omicron booster or a combination shot? And if it’s a combo, should it target the original strain along with omicron, or the currently dominant delta variant plus omicron? Here’s what we know.
COMPANIES AREN’T STARTING FROM SCRATCH
COVID-19 vaccines work by triggering production of antibodies that recognize and attack the spike protein that coats the coronavirus, and many are made with new technology flexible enough for easy updating. The Pfizer and Moderna vaccines are fastest to tweak, made with genetic instructions that tell the body to make harmless copies of the spike protein — and that messenger RNA can be swapped to match new mutations.
Pfizer expects to have an omicron-specific candidate ready for the Food and Drug Administration to consider in March, with some initial batches ready to ship around the same time, chief scientific officer Dr. Mikael Dolsten told The Associated Press.
Moderna is predicting 60 to 90 days to have an omicron-specific candidate ready for testing. Other manufacturers that make COVID-19 vaccines using different technology, including Johnson & Johnson, also are pursuing possible updates.
Pfizer and Moderna already have successfully brewed experimental doses to match delta and another variant named beta, shots that haven’t been needed but offered valuable practice.
NOT CLEAR IF TWEAKS ARE NEEDED
So far, the original vaccines have offered at least some cross-protection against prior variants. Even if immunity against omicron isn’t as good, Dr. Anthony Fauci, the top U.S. infectious disease expert, hopes the big antibody jump triggered by booster doses will compensate.
Pfizer's preliminary lab testing, released Wednesday, hint that might be the case but antibodies aren’t the only layer of defense. Vaccines also spur T cells that can prevent serious illness if someone does get infected, and Pfizer's first tests showed, as expected, those don't seem to be affected by omicron.
Also, memory cells that can create new and somewhat different antibodies form with each dose.
"You're really training your immune system not just to deal better with existing variants, but it actually prepares a broader repertoire to deal with new variants,” Dolsten said.
How aggressive a mutant is also plays a role in whether to reformulate the vaccine. Omicron appears to spread easily but early reports from South African scientists hint that it might cause milder infections than previous variants.
Read: Scientist behind UK vaccine says next pandemic may be worse
HOW TO TELL IF UPDATES WORK
The FDA has said companies won’t need massive studies of tweaked vaccines but small ones to measure if people given the updated shot have immune responses comparable to the original, highly effective shots.
Wherry doesn't expect data from volunteers testing experimental omicron-targeted shots until at least February.
WHAT ABOUT COMBINATION SHOTS?
Flu vaccines protect against three or four different strains of influenza in one shot. If a vaccine tweak is needed for omicron, authorities will have to decide to whether to make a separate omicron booster or add it to the original vaccine -- or maybe even follow the flu model and try another combination.
There’s some evidence that a COVID-19 combo shot could work. In a small Moderna study, a so-called bivalent booster containing the original vaccine and a beta-specific dose caused a bigger antibody jump than either an original Moderna booster or its experimental beta-specific shot.
And scientists already are working on next-generation vaccines that target parts of the virus less prone to mutate.
Omicron brings “another important wake-up call,” Wherry said -- not just to vaccinate the world but create more versatile options to get that job done.
Pfizer says COVID booster offers protection against omicron
Pfizer said Wednesday that a booster dose of its COVID-19 vaccine may protect against the new omicron variant even though the initial two doses appear significantly less effective.
Pfizer and its partner BioNTech said lab tests showed a booster dose increased by 25-fold the level of so-called neutralizing antibodies against omicron.
Pfizer announced the preliminary laboratory data in a press release and it hasn’t yet undergone scientific review. The companies already are working to create an omicron-specific vaccine in case it’s needed.
READ: Omicron v. delta: Battle of coronavirus mutants is critical
Scientists have speculated that the high jump in antibodies that comes with a third dose of COVID-19 vaccines might be enough to counter any decrease in effectiveness.
Antibody levels predict how well a vaccine may prevent infection with the coronavirus but they are just one layer of the immune system’s defenses. Pfizer said two doses of the vaccine may still induce protection against severe disease.
“Although two doses of the vaccine may still offer protection against severe disease caused by the Omicron strain, it’s clear from these preliminary data that protection is maximized with a third dose of our vaccine,” Pfizer CEO Albert Bourla said in a statement.
READ: How can I protect myself from the new omicron variant?
Pfizer’s announcement had an immediate impact on U.S. markets. Futures that had pointed to a lower open reversed course in seconds and swung solidly to the positive with the Dow jumping almost 200 points.
Omicron v. delta: Battle of coronavirus mutants is critical
As the omicron coronavirus variant spreads in southern Africa and pops up in countries all around the world, scientists are anxiously watching a battle play out that could determine the future of the pandemic. Can the latest competitor to the world-dominating delta overthrow it?
Some scientists, poring over data from South Africa and the United Kingdom, suggest omicron could emerge the victor.
“It’s still early days, but increasingly, data is starting to trickle in, suggesting that omicron is likely to outcompete delta in many, if not all, places,” said Dr. Jacob Lemieux, who monitors variants for a research collaboration led by Harvard Medical School.
But others said Monday it’s too soon to know how likely it is that omicron will spread more efficiently than delta, or, if it does, how fast it might take over.
Also read: More omicron detected as US hospitals strain under delta surge
“Especially here in the U.S., where we’re seeing significant surges in delta, whether omicron’s going to replace it I think we’ll know in about two weeks,” said Matthew Binnicker, director of clinical virology at Mayo Clinic in Rochester, Minnesota.
Many critical questions about omicron remain unanswered, including whether the virus causes milder or more severe illness and how much it might evade immunity from past COVID-19 illness or vaccines.
On the issue of spread, scientists point to what’s happening in South Africa, where omicron was first detected. Omicron’s speed in infecting people and achieving near dominance in South Africa has health experts worried that the country is at the start of a new wave that may come to overwhelm hospitals.
The new variant rapidly moved South Africa from a period of low transmission, averaging less than 200 new cases per day in mid-November, to more than 16,000 per day over the weekend. Omicron accounts for more than 90% of the new cases in Gauteng province, the epicenter of the new wave, according to experts. The new variant is rapidly spreading and achieving dominance in South Africa’s eight other provinces.
“The virus is spreading extraordinarily fast,” said Willem Hanekom, director of the Africa Health Research Institute. “If you look at the slopes of this wave that we’re in at the moment, it’s a much steeper slope than the first three waves that South Africa experienced. This indicates that it’s spreading fast and it may therefore be a very transmissible virus.”
But Hanekom, who is also co-chair the South African COVID-19 Variants Research Consortium, said South Africa had such low numbers of delta cases when omicron emerged, “I don’t think we can say” it out-competed delta.
Also read: How can I protect myself from the new omicron variant?
Scientists say it’s unclear whether omicron will behave the same way in other countries as it has in South Africa. Lemieux said there are already some hints about how it may behave; in places like the United Kingdom, which does a lot of genomic sequencing, he said, “we’re seeing what appears to be a signal of exponential increase of omicron over delta.”
In the United States, as in the rest of the world, “there’s still a lot of uncertainty,” he said. “But when you put the early data together, you start to see a consistent picture emerge: that omicron is already here, and based on what we’ve observed in South Africa, it’s likely to become the dominant strain in the coming weeks and months and will likely cause a surge in case numbers.”
What that could mean for public health remains to be seen. Hanekom said early data from South Africa shows that reinfection rates are much higher with omicron than previous variants, suggesting the virus is escaping immunity somewhat. It also shows the virus seems to be infecting younger people, mostly those who are unvaccinated, and most cases in hospitals have been relatively mild.
But Binnicker said things could play out differently in other parts of the world or in different groups of patients. “It’ll be really interesting to see what happens when more infections potentially occur in older adults or those with underlying health conditions,” he said. “What’s the outcome in those patients?”
As the world waits for answers, scientists suggest people do all they can to protect themselves.
“We want to make sure that people have as much immunity from vaccination as possible. So if people are not vaccinated they should get vaccinated,” Lemieux said. “If people are eligible for boosters, they should get boosters, and then do all the other things that we know are effective for reducing transmission -- masking and social distancing and avoiding large indoor gatherings, particularly without masks.”
How can I protect myself from the new omicron variant?
How can I protect myself from the new omicron variant?
The same way you guard against COVID-19 caused by any other variant:
Get vaccinated if you haven’t yet, get a booster if you’re eligible and step up other precautions you may have relaxed, like wearing a mask and avoiding crowds.
READ: India's Omicron cases rise to 21
For all the attention omicron is getting, the overwhelming cause of infections and deaths in many places remains the extra-contagious delta variant.
“Delta is the real risk right now. Omicron is an uncertain threat,” Dr. Francis Collins, director of the U.S. National Institutes of Health, told The Associated Press. Regardless of the coronavirus type, Collins said “we do know what to do.”
It will take a few weeks to learn key aspects about this latest variant, including whether it’s more contagious, causes more severe illness or evades immunity -- and if so, how by much.
In the meantime, “what we need to do is add more layers of protection,” says Dr. Julie Vaishampayan of the Infectious Diseases Society of America. That’s especially important with holiday travel and gatherings around the corner.
READ: Nepal reports first cases of omicron variant
A booster shot is one of those layers. The added dose triggers a big jump in virus-fighting antibodies. Even if the antibodies don’t prove quite as effective against omicron as they are against other variants, simply having more of them might compensate -- in addition to bolstering protection against delta.
In addition to masking, avoiding crowds and improving ventilation, testing is another protective step. That’s recommended for anyone who has COVID-19 symptoms or was potentially exposed to the virus. But it also could help ensure safety before holiday gatherings, even if everyone attending has been vaccinated, Vaishampayan says.
Global Covid cases near 266 million
The overall number of Covid cases is fast approaching 266 million amid the emergence Omicron, a new variant of Coronavirus.
According to Johns Hopkins University (JHU), the total case count mounted to 265,331,453 while the death toll from the virus reached 5,248,492 till Sunday morning.
The US has recorded 49,051,140 cases to date and more than 788,202 people have died so far from the virus in the country, as per the university data.
Brazil, which has been experiencing a new wave of cases since January, registered 22,138,247 cases as of Saturday, while its Covid death toll rose to 615,570.
READ: Global Covid cases surpass 264 million
India's Covid-19 tally rose to 34,624,360 on Saturday, as 8,603 new cases were registered in 24 hours across the country, as per the federal health ministry data.
Besides, as many as 415 deaths due to the pandemic since Friday morning took the total death toll to 470,530.
Situation in Bangladesh
Bangladesh logged six more Covid-linked deaths, the highest in the past one week, along with 176 fresh cases in 24 hours till Saturday morning.
With the latest cases, the daily-case positivity rate increased to 1.07 per cent from Friday’s 1.40 per cent, said the Directorate General of Health Services (DGHS).
With the fresh numbers, the total fatalities rose to 27,995 while the caseload mounted to 15,77,246.
Among the latest deceased, two were men and four were women. Three deaths were reported from Dhaka division while one each was from Rajshahi, Barishal and Sylhet divisions.
However, the mortality rate remained unchanged at 1.77 per cent.
The fresh cases were detected after testing 16,223 samples, amid the growing concern over the new ‘Omicron’ variant of coronavirus.
Besides, the recovery rate remained unchanged at 97.77 per cent with the recovery of 162 more patients during the 24-hour period.
READ: Global Covid cases surpass 263 million
On November 20, Bangladesh logged this year’s first zero Covid-linked death with 178 cases.
Bangladesh reported the highest number of daily fatalities of 264 on August 5 this year, while the highest daily caseload was 16,230 on July 28 this year.
So far, 37,829,420 people have fully been vaccinated in the country while 64,414,430 received the first dose as of Thursday, according to the DGHS.
Among them, 86,637 students, aged from 12-17, have fully been vaccinated while 899,510 students received the first dose so far.
Bangladesh’s Peace Conf: Ban Ki-moon seeks quicker action against Omicron
Former UN Secretary General Ban Ki-moon has urged world leaders to gear up the global vaccination drive and synergize sustainable and inclusive recovery as the new variant of Covid-19, ‘Omicron’, posed new challenges.
“The spread of Omicron variant underlines this urgency,” he said in a video message on the occasion of the two-day World Peace Conference that began in Dhaka on Saturday, noting that cooperation and elevated political will is critical.
Now it is the second year that Covid-19 pandemic continues to cause immense sufferings with huge economic losses while reports suggest Omicron has been found in close to 40 countries.
However, the World Health Organization (WHO) has said the world should not panic about the new Omicron variant of Covid-19 but it should prepare.
Speaking at a conference on Friday, top WHO scientist Soumya Swaminathan said the situation now was very different to a year ago.
In his video message played during the inaugural session of the conference, the former UN chief highlighted the great importance of coming together to holistically advance peace through social inclusion during the period of great change.
Read:India reports first two Covid cases of Omicron variant
“I believe we’ve invaluable opportunities to change the world for the better, but to do this we need to work together through a driving commitment to peace, sustainability, inclusion, the power of partnership and multilateral cooperation,” Ban said.
He said the Covid-19 pandemic amplified the inequalities and the ongoing recovery will be prolonged. “We need to ensure equitable distribution of Covid-19 vaccine and fight against vaccine inequity. This is the most pressing task ahead of us.”
WHO says measures used against delta should work for omicron
Measures used to counter the delta variant should remain the foundation for fighting the coronavirus pandemic, even in the face of the new omicron version of the virus, World Health Organization officials said Friday, while acknowledging that the travel restrictions imposed by some countries may buy time.
While about three dozen countries worldwide have reported omicron infections, including India on Thursday, the numbers so far are small outside of South Africa, which is facing a rapid rise in COVID-19 cases and where the new variant may be becoming dominant. Still, much remains unclear about omicron, including whether it is more contagious, as some health authorities suspect, whether it makes people more seriously ill, or whether it can evade vaccine protection.
“Border control can delay the virus coming in and buy time. But every country and every community must prepare for new surges in cases,” Dr. Takeshi Kasai, the WHO regional director for the Western Pacific, told reporters Friday during a virtual news conference from the Philippines. “The positive news in all of this is that none of the information we have currently about omicron suggests we need to change the directions of our response.”
That means continuing to push for higher vaccination rates, abiding by social-distancing guidelines, and wearing masks, among other measures, said WHO Regional Emergency Director Dr. Babatunde Olowokure.
Read:India reports first two Covid cases of Omicron variant
He added that health systems must “ensure we are treating the right patients in the right place at the right time, and so therefore ensuring that ICU beds are available, particularly for those who need them.”
Kasai warned: “We cannot be complacent.”
WHO has previously urged against border closures, noting they often have limited effect and can cause major disruptions. Officials in southern Africa, where the omicron variant was first identified, have decried restrictions on travelers from the region, saying they are being punished for alerting the world to the mutant strain.
Scientists are working furiously to learn more about omicron, which has been designated a variant of concern because of the number of mutations and because early information suggests it may be more transmissible than other variants, Kasai said.
Read:US reports 1st case of omicron variant in returning traveler
A few countries in Western Pacific region are facing surges that began before omicron was identified, though COVID-19 cases and deaths in many others have decreased or plateaued, Kasai said. But that could change.
Among the places that have found the variant in the region are Australia, Hong Kong, Japan, South Korea, Singapore and Malaysia — and it is likely to crop up in more places.
The emergence of omicron is of particular concern for organizers of the Beijing Winter Olympic Games, now about two months away.
Beijing is adopting a series of measures to reduce the risk the virus will spread during the Games, Zhao Weidong, spokesperson for the organizing committee, told reporters at a briefing on Friday.
China has adopted a zero-tolerance policy toward COVID-19 transmission and has some of the world’s strictest border controls. Games participants will have to live and compete inside a bubble, and only spectators who are residents of China and have been vaccinated and tested will be permitted at venues.
Globally, cases have been increasing for seven consecutive weeks and the number of deaths has started to rise again, too, driven largely by the delta variant and decreased use of protective measures in other parts of the world, Kasai said.
“We should not be surprised to see more surges in the future. As long as transmission continues, the virus can continue to mutate, as the emergence of omicron demonstrates, reminding us of the need to stay vigilant,” Kasai said.
He warned especially about the likelihood of surges due to more gatherings and movement of people during the holiday season. The northern winter season will also likely bring other infectious respiratory diseases, such as the flu, alongside COVID-19.
“It is clear that this pandemic is far from over and I know that people are worried about omicron,” Kasai said. “But my message today is that we can adapt the way we manage this virus to better cope with the future surges and reduce their health, social and economic impacts.”