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Mask Effectiveness for Preventing Secondary Cases of COVID-19, Johnson County, Iowa, USA – The Maravi Post

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Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Author affiliations: Johnson County Public Health, Iowa City, Iowa, USA (J. Riley, J.M. Huntley, J.A. Miller, A.L.B. Slaichert); University of Iowa, Iowa City, Iowa, USA (G.D. Brown)

On September 29, 2020, the Iowa Department of Public Health (IDPH) issued new guidance for persons who had been in contact with someone infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (hereafter called case-patients). This guidance recommended that when both the case-patient and the contact were correctly and consistently masked during an exposure, the contact should perform symptom monitoring for 14 days instead of quarantining at home. This guidance deviated substantially from that provided by the Centers for Disease Control and Prevention (CDC), which still recommended at-home quarantine after exposure to someone with coronavirus disease (COVID-19), regardless of mask use. Johnson County Public Health (JCPH) staff decided to follow IDPH guidance but also supported any persons or organizations who chose to continue to follow the CDC recommendation.

Although the IDPH change in guidance provided an opportunity to lessen the burden of the pandemic on Johnson County, we were concerned about a potential increase in transmission rates. Because data supporting this change in guidance were lacking, we designed a prospective cohort study to evaluate the potential risk for increased virus transmission by measuring the secondary attack rates (SARs) of COVID-19 between persons exposed when both parties were masked and those exposed when >1 person was unmasked.

The purpose of this study was to examine how effective masks are at reducing transmission of SARS-CoV-2 and, therefore, whether the new IDPH recommendation for symptom monitoring was appropriate. However, mask use is only 1 of many factors that affect SARS-CoV-2 transmission. While examining the available data, we identified several additional risk factors of interest, including symptom status, exposure setting, and exposure duration. This information enabled us to examine additional guidance relating to COVID-19, such as early release from quarantine and the potential for airborne transmission, to ensure that our recommendations did not increase the risk for transmission in the community.

After reviewing relevant literature (24), we hypothesized that mask use consistent with CDC guidance (5) would reduce the SAR for COVID-19 in nonhousehold contacts from 10% to 5%. The study proposal was evaluated according to internal ethics review protocols, met the criteria for public health practice (1), and was not required to undergo institutional review board review.

Methods

In March of 2020, IDPH issued a mandatory reporting order that required medical providers to report all COVID-19 test results and associated demographic information to IDPH each day. This information was then provided to each county-level public health department to enable case-patient investigation and contact tracing of residents who tested positive for COVID-19. We estimated that we would need a sample size of 1,200 contacts to detect a statistically significant difference in SARs between the 2 groups. We began collecting data on case-patients and their associated contacts that were reported to JCPH on or after October 20, 2020. By March 1, 2021, we had collected exposure and outcome information for ≈1,000 contacts and began to perform analyses while continuing to collect data for future calculations.

After being notified of new COVID-19 cases, we initiated contact with each person who tested positive for COVID-19. During this first contact, JCPH staff provided general isolation recommendations and obtained permission to send a link, via email or text message, to an online case investigation questionnaire that we had developed. This questionnaire collected basic information about demographics and households, details about symptoms, an overview of activities in the days before becoming ill, and a list of potentially exposed persons. The questionnaire was available in English, Spanish, and French. Case-patients also had the option to forgo the questionnaire and complete the investigation via phone interview, with the aid of a translation service if necessary.

After case-patients completed the questionnaire, we called each one to gather any additional information needed about their illness, to provide guidance for isolation and quarantine of household contacts, and to obtain a full list of close contacts. Close contacts were defined as persons who had been exposed to someone with a laboratory-confirmed case of COVID-19 during the case-patient’s infectious period within 6 feet for >15 minutes within a 24-hour period or who had experienced substantial direct exposure to a case-patient. Direct exposure is a somewhat subjective criterion and was evaluated on a case-by-case basis but could include exposures such as sharing food or drink, kissing, or shouting face to face in close proximity. In addition, on the basis of evidence of airborne transmission (6), JCPH classified persons as close contacts if they had spent >2 consecutive hours in the same enclosed space as a case-patient.

If the case-patient identified any close contacts during the case investigation, we asked for details about the exposure and contact: name, phone number, first and last date of exposure, whether the case-patient was masked, whether the contact was masked, if the case-patient was symptomatic at the time of exposure, exposure setting (indoors/outdoors/direct exposure), and exposure duration (>2 hours vs. <2 hours). We obtained this information from the case-patients because contacts were not provided with specific information about their exposure because of privacy concerns. This limitation also prevented us from collecting data about the type of mask worn by a close contact because the case-patient could not be expected to have this information and the contact would not know precisely when the exposure occurred. The many face coverings worn by Johnson County residents included 2-layer cloth masks, disposable surgical masks, double-layer gaiters, and KN95 masks.

After obtaining a list of close contacts for a case-patient, JCPH staff called each identified close contact to gather additional information and provide appropriate quarantine recommendations. Information collected included additional demographic and contact information as well as information regarding the development of signs/symptoms, date of symptom onset, previous diagnosis of COVID-19, date of diagnostic test, COVID-19 vaccination history, and date(s) of vaccine administration. Contacts were also advised to undergo testing for COVID-19 during days 10–13 after their exposure or sooner if they experienced symptoms.

Throughout the study, we compiled data from the case-patient investigations and contact-tracing interviews into an internal database. We matched the data in our system to testing data from the state reporting system for each identified close contact. Contacts were included in the study if they met any of the criteria for a close contact; were exposed outside of a household, healthcare, or long-term care setting; investigators obtained data on mask use during the exposure for both the case-patient and the contact; and a laboratory-confirmed test result was collected 2–14 days after the date of exposure. We excluded from analysis persons who did not meet these criteria.

We computed SARs with 95% CIs for several individual risk factors, including combinations of masking status of case-patient and contact, exposure setting, whether the case-patient was symptomatic, and exposure duration. Subsequently, we conducted a multivariable logistic regression analysis by using these risk factors to ensure that the individual factors remained significant when combined. For the multivariable model, we combined case-patient and contact masking status into a score counting the number of persons masked (0, 1, or 2) because masking behaviors are highly correlated. Age was included as a numeric variable. Statistical significance is reported at a type 1 error rate of 0.05, and 95% CIs are reported.

Results

Figure 1

Age distribution of contacts in study of mask effectiveness for preventing secondary cases of coronavirus disease, Johnson County, Iowa, USA, October 23, 2020–February 28, 2021.

Figure 1. Age distribution of contacts in study of mask effectiveness for preventing secondary cases of coronavirus disease, Johnson County, Iowa, USA, October 23, 2020–February 28, 2021.

From October 23, 2020, through February 28, 2021, we identified 969 nonhousehold contacts who met inclusion criteria and for whom we were able to collect both exposure (mask usage) and outcome (test result) data. These 969 contacts were associated with 431 cases. The average number of contacts per case was 2.25 (range 1–13). Of these contacts, 3 had only an inconclusive test result and were not included in additional analyses. The age range of contacts was 0–90 years; median age was 18 years. The age distribution was skewed toward younger persons (0–18 years). Of the 966 contacts included in the analysis, 768 tested negative and 198 tested positive, resulting in an overall SAR of 20.5% (95% CI 18.1%–23.2%) (Figure 1).

To determine the effectiveness of masks for reducing SARS-CoV-2 transmission, we compared calculated SARs when both parties were wearing masks with SARs when >1 person was not wearing a mask at the time of exposure (Table 1). Most contacts (590, 61%) were exposed when >1 person was not wearing a mask. Of these 590 persons, 439 tested negative and 151 tested positive, leading to an SAR of 25.6% (95% CI 22.3%–29.4%). The remainder of the contacts (376, 39%) were exposed when both the case-patient and the contact wore masks during the exposure. Of these 376 persons, 329 tested negative and 47 tested positive, resulting in an SAR of 12.5% (95% CI 9.6%–16.3%). The sample sizes for subgroups of contacts exposed when >1 person was not masked were much smaller, but the SAR for contacts exposed when only the case-patient was masked was 29.1% (95% CI 19.3%–43.9%) and when only the contact was masked was 10% (95% CI 4.0%–25.3%).

Figure 2

Number of contacts with test results during study of mask effectiveness for preventing secondary cases of coronavirus disease, Johnson County, Iowa, USA, October 23, 2020–February 28, 2021.

Figure 2. Number of contacts with test results during study of mask effectiveness for preventing secondary cases of coronavirus disease, Johnson County, Iowa, USA, October 23, 2020–February 28, 2021.

To ensure that our calculations were representative of the entire study period and not affected by specific outbreak or superspreader events, we examined the distribution of contacts over time (Figure 2). The number of cases in November increased, resulting in a corresponding increase in the number of contacts. The proportion of contacts testing negative compared with those testing positive remained roughly consistent throughout the study.

Because the age range of participants was skewed toward younger persons, we also calculated SARs for masked and unmasked exposures among school-age children (5–18 years of age) to ensure that our results were not affected by age distribution. Of the 966 contacts, 426 (44%) were within this age range. Of the 426 school-age children, 209 (49%) were exposed when >1 person was not masked; of those, 156 tested negative and 53 tested positive, resulting in an SAR of 25.2% (95% CI 20.1%–32.0%). A total of 217 (51%) school-age children were exposed when both persons were masked. Of those contacts, 191 tested negative and 26 tested positive, resulting in an SAR of 12% (95% CI 8.4%–17.2%). These results are consistent with our calculations for the entire study population.

To ensure that confounding was limited to the extent possible, we analyzed additional variables (Table 2). Overall SARs did not differ significantly when the contact was exposed while the case-patient was symptomatic (21.5%, 95% CI 18.1%–25.6%) compared with when the case-patient was not symptomatic (20.9%, 95% CI 17.4%–25.2%). In accordance with JCPH guidance, duration of exposure was measured as <2 hours or >2 consecutive hours. The SAR for exposures <2 hours was 13.5% (95% CI 9.6%–18.8%) and for exposures >2 hours was 25.6% (95% CI 22.2%–29.5%). SARs were lowest among those exposed while indoors (18%, 95% CI 15.1%–21.3%), followed by outdoors (25%, 95% CI 14.2%–44.0%), and highest among those who had been directly exposed (35.7%, 95% CI 17.7%–72.1%) (Table 2). Exposures for many contacts overlapped into multiple categories. The SAR for exposures that occurred in multiple settings was 25.8% (95% CI 18.4%–36.1%).

Figure 3

Days from exposure to coronavirus disease case-patient to testing of contact for disease, Johnson County, Iowa, USA, October 23, 2020–February 28, 2021.

Figure 3. Days from exposure to coronavirus disease case-patient to testing of contact for disease, Johnson County, Iowa, USA, October 23, 2020–February 28, 2021.

On December 2, 2020, CDC issued guidance allowing early release from quarantine after 7 days with a negative test result collected 5–7 days after exposure or after 10 days without a test result for those who were asymptomatic (7). Because this guidance changed during our study period, we sought to examine the effects it might have on our results and transmission within our community. Our data collection methods enabled us to calculate the time from exposure to test and evaluate this guidance in the population of Johnson County. Of 198 contacts who tested positive, a total of 17 (8.6%) would have met criteria for early release and subsequently tested positive: 6 (3%) after 7 days on the basis of a negative test result and 11 (5.6%) after 10 days on the basis of absence of symptoms (Figure 3). This finding is consistent with the estimates provided by CDC guidance (7).

Other measured variables included vaccination before exposure and previous illness. All 16 contacts who reported >1 vaccination before exposure tested negative. Three contacts reported a previous positive test result; 2 had a previous positive test result within 90 days and tested negative after their exposure, whereas the remaining contact had a previous positive test result >180 days before exposure and again tested positive.

Several, but not all, risk factors of interest resulted in substantial differences in secondary SARs. To ensure that these factors remained significant in real-world settings, we performed a multivariable analysis. The multivariable results (Table 3) largely mirror the bivariate comparisons. Mask use was significantly associated with lower SARs (odds ratio [OR] 0.7, 95% CI 0.57–0.84); longer exposure was associated with higher SARs (OR 1.92, 95% CI 1.35–2.76); and age was positively associated with SAR (OR for 10-year increase 1.13, 95% CI 1.04–1.23). Indoor exposure was not significantly associated with SAR (OR 0.69, 95% CI 0.48–1.01), although it retained a negative nominal association. Variance inflation factors were examined, and the maximum value was 1.15, well below the problematic threshold for multicollinearity.

Discussion

Our goal with this study was to evaluate the change in quarantine guidance by examining the effectiveness of mask use for preventing transmission of SARS-CoV-2 and determining whether a resultant reduction in transmission was great enough to warrant symptom monitoring rather than quarantine of close contacts. The results from our analysis suggest that proper mask use is very effective for reducing transmission of SARS-CoV-2, lowering the SAR among contacts by half. However, consistent with a more recent study (8), SARs for both groups were notably higher than originally anticipated. On the basis of these findings, JCPH decided to recommend that persons follow CDC guidance after an exposure but also gave persons the option of following the less restrictive IDPH guidance.

Although sample sizes for subgroups of the unmasked cohort were relatively small, the evidence suggests that masks are more beneficial when worn by the contact than by the case-patient. This finding is further supported by the lack of a significant difference in SARs between contacts who had been exposed to an actively symptomatic case-patient compared with those exposed to a nonsymptomatic case-patient. However, specific symptoms were not included in this analysis. Transmission rates may be higher for persons experiencing symptoms such as cough or fever than for those experiencing symptoms such as headache and fatigue. In addition, we made no differentiation between asymptomatic and presymptomatic cases.

Duration of exposure was a significant predictor of SARS-CoV-2 transmission. JCPH recommends quarantine for persons exposed to a case-patient when indoors for >2 hours, regardless of distance, because of the potential for airborne transmission. Exposures lasting >2 hours were more than twice as likely to result in a positive test result than were exposures lasting <2 hours. We did not include distance as a measure in this study. We believed that distance would not be reliably self-reported and would probably not remain static for the duration of exposure, making any meaningful analysis challenging. Without measuring distance, it is impossible to quantify the number of contacts who were included in the study because their indoor exposure had been >2 hours but that had not been within 6 feet of the case-patient for >15 minutes. Despite this limitation, the difference in SARs between duration categories supports the assertion that airborne transmission occurs (6) because inclusion of any contacts exposed outside a 6-foot radius would otherwise decrease the difference in SARs between the 2 exposure-duration groups.

When we analyzed SAR by exposure setting, as expected the SAR was highest for contacts who had been directly exposed. Unexpectedly, the SAR was lower for persons who were exposed indoors than those who were exposed outdoors, although this finding did not remain significant in the multivariable analysis. This observed marginal association is potentially explained by several factors. Indoor exposures may have been more likely when persons were following social distancing recommendations. Outdoor exposures could have more often involved physical activities, resulting in higher respiration rates, or coincided with less adherence to social distancing.

Although our results suggest that mask use may not eliminate the need for quarantine, they indicate only a minor risk for increased transmission when adhering to shortened quarantine periods as outlined in CDC guidance (7). Only 17 contacts who tested positive would have met the criteria for early release, potentially infecting others. Most (79.5%) of the study population would benefit from a reduced quarantine without posing a risk to others. Because testing was not standardized among contacts, any predictive analysis would be unreliable, but the end result from this change in guidance is a significant reduction in burden to most contacts with only a slight increase in risk for transmission within the community.

Among the limitations to this study is that many persons could not be contacted or declined to cooperate with public health investigations. There are almost certainly substantial differences between case-patients and contacts that we were able to interview and those who declined to provide information or were unable to be reached. In addition, all of the data, with the exception of test results, were self-reported by either contacts or case-patients. Self-reported data can be unreliable. During investigations, case-patients may have had an incentive to provide false information to prevent friends, co-workers, or classmates from quarantining; or they may have demonstrated response bias by telling interviewers what they thought we wanted to hear. Although bias cannot be ruled out, we believe that persons who cooperate with public health investigations are more likely to provide accurate and honest information and to follow other public health guidance, such as social distancing and mask use. However, these challenges would bias our results toward the null, underestimating the benefit of mask use in the general population.

An additional limitation is related to generalizability. The population vaccination rate has risen dramatically since the period under study; we did not observe sufficient numbers of fully or partially vaccinated contacts to claim with certainty how masking policies would interact with changing population immunity. In addition, population immunity will be affected should any variants that escape the immune responses generated by >1 of the available vaccines emerge.

Last, although we detected several associations with SARs, the residual variability is substantial. When evaluated under 5-fold cross-validation, neither the logistic regression model nor a random forest version was able to produce predictions that were substantially above the no-information rate. This finding indicates that although we can quantify elevated risk, the measured information is not sufficient to predict transmission events on an individual level.

Nevertheless, we were able to measure a significant reduction in the rate of transmission when both persons were masked, which has useful implications for policy despite the continually shifting landscape of immunity and behavior. Despite the substantial reduction in transmission attributable to masking, the rate of transmission was still high when both parties were masked, leading us to conclude that in the absence of substantial hardship, quarantine regardless of mask use is generally preferred by public health practitioners. In reality, however, after less restrictive guidance has been issued, it is difficult to revert to recommendations that are more restrictive. This study highlights the value of creating public health guidance based on evidence rather than perception or public opinion.

Mr. Riley is a disease prevention specialist at Johnson County Public Health in Iowa City, Iowa. His primary research interests are in epidemiology, infectious diseases, and translating research into public health practice.

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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.

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African Development Bank Group President Akinwumi Adesina assures Nigeria of Bank’s strong support to achieve food security – The Maravi Post

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The President of the African Development Bank Group, Dr. Akinwumi Adesina, received a high-level Nigerian delegation led by the country’s Minister of Agriculture and Rural Development, Dr. Mohammad Mahmood Abubakar on Monday.

The meeting follows on the heels of an address by Dr. Adesina last week at a mid-term ministerial retreat presided over by President Muhammadu Buhari.

Dr. Adesina and the Nigerian minister discussed means of tackling growing concerns about the country’s food security.

Adesina said the Bank’s strategic support for Nigeria’s food production would be hinged on five factors: support, scale, systemic, speed, and sustainability.

He added, “I want to assure President Buhari that the African Development Bank will provide his government with very strong support to tackle the country’s food security challenges.”

 “Inflation in Nigeria is high, at 16% or more. Of course, the biggest share of the consumer price index is the price of food, at almost 65%. So, if we can drive down the price of food, of course, we can drive down inflation.“

Adesina urged the Nigerian minister to concentrate on building the correct team and tactics to optimize the country’s farming seasons. He said that dramatically increased food output will result in lower food prices, which will in turn lower inflation rates.

Abubakar said his consultative mission to Abidjan was at the instruction of President Buhari.

“Our mission is to examine ways Nigeria could enhance food production, lower food prices, and create wealth,” the minister said.

Abubakar welcomed the Bank’s proposed strategy and described it as a landmark one that would spur Nigeria’s food supply production. “It will reverse the ugly trend of a sharp increase in prices of food in the country. I am pleased with the Bank’s strategy to facilitate the production of 9 million metric tons of food in Nigeria, and to support us in raising self-sufficiency. The Bank’s Special Agro-Processing Zones initiative is a laudable one and Nigeria is grateful.”

Citing successes in Sudan, Adesina explained how the African Development Bank had supported the country with 65,000 metric tonnes of heat-tolerant wheat varieties, cultivated on 317,000 hectares.

“It took two seasons to do this,” he said. “Change will not happen in years. You will see change in seasons. Sudan now produces 1.1 million metric tons of wheat. The same thing happened in Ethiopia in just two seasons with the production of 184, 000 hectares of wheat,“ he added.

In response to Bank successes in Sudan and Ethiopia, Abubakar said: “This gives me an additional measure of confidence. If you can do it in Sudan, you can equally do it in Nigeria. Not just in wheat, but also rice, maize, and soybeans.”

The African Development Bank will provide Nigeria with support through input delivery, including highly improved seeds and fertilizers to farmers, and an integrated input delivery platform.

Extensively discussed at the meeting was the Bank’s Special Agro-Industrial Processing Zone initiative as an effective medium-term plan for revolutionizing Nigeria’s agriculture value chain.

Adesina said: “The task, responsibility, and challenge of feeding Nigeria rests on your shoulders. You will receive maximum support from me, and the African Development Bank for the responsibility that President Buhari has given you. You will not be alone.”

He added: “The Bank stands ready to fully support and help Nigeria in the next farming seasons. So, we must make sure things turn around. The president must succeed, and Nigeria must succeed. Agriculture must succeed.”

Abubakar thanked the African Development Bank for its support and said the meeting gave him reassurances of what Nigeria can achieve with the Bank’s support in the farming seasons ahead.

The minister also called for the Bank’s support to recapitalize the country’s Bank of Agriculture.

Both parties set up a task force team to develop a plan for accelerated implementation within the next 60 days.

Also at the meeting were a member of Nigeria’s National Assembly, Hon. Munir Baba Dan Agundi, Chair of the House Committee on Agricultural Colleges and Institutions;  the African Development Bank’s executive director for Nigeria,  Sao Tome and Principe, Dr. Oyebode Oyetunde; Vice President of Agriculture, Human and Social Development, Beth Dunford; Senior Special Advisor to the President of the Bank on Industrialization, Professor Oyebanji Oyelaran; Director General of the Bank’s Nigeria Country Office in Abuja, Lamin Barrow; the Bank’s Director of Agriculture and Agro-Industries, Martin Fregene; the Director for Agricultural Finance and Rural Development, Atsuko Toda; and senior officials from Nigeria’s Federal Ministry of Agriculture.

President Akinwumi A. Adesina meeting with Dr Mohammed Abubakar, Minister of Agriculture and Rural Development of Nigeria

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Dr. Akinwumi A. Adesina, President, African Development Bank Group

Dr. Muhammad Mahmood Abubakar, Nigeria’s Minister of Agriculture

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Yemen war reaches ‘shameful milestone’ – 10,000 children now killed or maimed  – The Maravi Post

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That’s the equivalent of four children every day, UNICEF spokesperson James Elder said. Urging all parties to the conflict to stop the fighting, he added that “Yemen is the most difficult place in the world to be a child. And, incredulously, it is getting worse.” 

‘World’s worst’ humanitarian crisis

Yemen’s humanitarian crisis continues to be “the world’s worst” according to Mr. Elder, who said that it “represents a tragic convergence of four threats: a violent and protracted conflict, economic devastation, social services on the brink of collapse, including health, nutrition, water sanitation, education, protection; and a critically underfunded UN system”.

According to UNICEF, more than 11 million children, (four in five) are in need of humanitarian assistance in Yemen. Some 400,000 children suffer from severe acute malnutrition, more than two million are out of school and two-thirds of teachers, (more than 170,000), have not received a regular salary for more than four years.

Some 1.7 million children are also now internally displaced and 15 million people (more than half of whom are children) do not have access to safe water, sanitation, or hygiene.

“At current funding levels and without an end to the fighting, UNICEF simply cannot reach all these children. There’s no way to say this simply without international support, more children, those who bear absolutely no responsibility for this conflict will die,” Mr. Elder warned. 

$235 million needed

UNICEF “urgently needs $235 million to continue its lifesaving work” until mid-2022, Mr. Elder said, while emphasizing that the organization has made a positive impact.

It has supported the treatment of severe acute malnutrition in 4,000 primary health care facilities and 130 therapeutic feeding centres; provided emergency cash transfers to 1.5 million households every quarter – benefitting around nine million – and provided safe drinking water to more than five million.

It has also delivered COVID vaccines through the UN-partnered COVAX initiative, provided psychosocial support, mine risk education and direct assistance for the most vulnerable children, and trained and deployed thousands of community health workers.

This year alone it has helped 620,000 children access formal and non-formal education and provided vaccines for preventable diseases – including a polio campaign that reached more than five million children. 

Unpaid work

However, Mr. Elder reiterated the severity of the humanitarian situation in Yemen, where the economy is in a critical condition and GDP has dropped by 40 per cent since 2015.

Huge numbers of people have lost their jobs, and those who are still working quite frequently go unpaid,” he said.

Displacement and the destruction of schools have meant classrooms can have as many as 200 children in them. Despite this, unpaid teachers, are “turning up to those classrooms day after day,” he said.

Following a mission to the north and the south of Yemen, Mr. Elder said he had met “scores of children, many inspiring; all suffering, as well as paediatricians, teachers and nurses who all shared personal stories demonstrating how the country is on the brink of total collapse”.

One doctor’s story

Emphasizing the “selfless commitment of everyday Yemenis” the UNICEF spokesperson said he had met a paediatrician caring for severely malnourished babies: “She was treating a child whose life was hanging in the balance just a week earlier.

With UNICEF supplies, this paediatrician saved the little girl’s life. The paediatrician had studied for a decade, including earning a master’s degree, and practised medicine for eight years.

“She had not been paid once in 2021. Yet she continues to serve her community” he stated. According to Mr. Elder, “people are out of options, which means they are forced to sell everything from jewellery to cooking pots, just to feed their own children”.

Children sit in front of a house damaged by an air strike, inside the old city of Sana'a, Yemen. (file)

© UNICEF/Alessio Romenzi

Children sit in front of a house damaged by an air strike, inside the old city of Sana’a, Yemen. (file)

Children the ‘biggest losers’

The bottom line is that “children in Yemen are not starving because of a lack of food. They are starving because their families cannot afford food”.

“They are starving because adults continue to wage a war in which children are the biggest losers”, he stated.

Funding is critical and donor support is clearly in line with lives saved. However, without more funding, UNICEF will have to stop or scale down its emergency assistance, Mr. Elder made clear.

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Katie Richardson Accident Video Katie Richardson Dies in Tragic Car Crash CCTV Footage

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Unfortunately, here is news that will make you sad and emotional. As per the news, Katie Richardson Passed Away. The death has been confirmed just a few moments back. It is a tragic death and people get sad after knowing the news. There are many people who are sharing social media posts about her death.

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Katie Rechardson death cause is the most searchable term right now and people looking out for this info, We want to tell you that the death cause is unavailable right now. But as per our assumption, she died after some medical problem. Definitely, there was a death reason.

You will get the exact death cause here in few moments. According to a youtube channel, she was passed away after meeting in a car accident. If there is any update related her death then you will get the info here.

Katie Richardson Dies in Tragic Car Crash

Her family is very sad and sharing condolence over the death. There are many people who have shared the post as a tribute to Katie Rechardson. If you have details about her and know about her something then you can share them with us and we can add the information here. There are many social media posts. You can check the social media posts on the platform.

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