Emerging Laboratory Diagnostic Options For Sexually: Fill & Download for Free

The Biden Plan to Combat Coronavirus (COVID-19) and Prepare for Future Global Health ThreatsTHE BIDEN PLAN TO COMBAT CORONAVIRUS (COVID-19) AND PREPARE FOR FUTURE GLOBAL HEALTH THREATSFor more information on Joe’s leadership during the Coronavirus pandemic, please visit here.For more information from the Centers for Disease Control and Prevention regarding the coronavirus, please visit here.The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis caused by the coronavirus (COVID-19) outbreak. That is why Joe Biden is outlining a plan to mount:A decisive public health response that ensures the wide availability of free testing; the elimination of all cost barriers to preventive care and treatment for COVID-19; the development of a vaccine; and the full deployment and operation of necessary supplies, personnel, and facilities.A decisive economic response that starts with emergency paid leave for all those affected by the outbreak and gives all necessary help to workers, families, and small businesses that are hit hard by this crisis. Make no mistake: this will require an immediate set of ambitious and progressive economic measures, and further decisive action to address the larger macro-economic shock from this outbreak.Biden believes we must spend whatever it takes, without delay, to meet public health needs and deal with the mounting economic consequences. The federal government must act swiftly and aggressively to help protect and support our families, small businesses, first responders and caregivers essential to help us face this challenge, those who are most vulnerable to health and economic impacts, and our broader communities – not to blame others or bail out corporations.Public health emergencies require disciplined, trustworthy leadership grounded in science. In a moment of crisis, leadership requires listening to experts and communicating credible information to the American public. We must move boldly, smartly, and swiftly. Biden knows how to mount an effective crisis response and elevate the voices of scientists, public health experts, and first responders. He helped lead the Obama-Biden Administration’s effective response to the 2009 H1N1 pandemic and the 2014 Ebola epidemic. Biden also helped lead the response to the greatest economic crisis since the Great Depression and ran point on implementation of the Recovery Act. He knows how to get relief out the door to families, as well as resources to state and local officials to deal with the challenges they are facing.And, even as we respond to this crisis, we must prepare for the next one. As President, Biden will establish and manage a permanent, professional, sufficiently resourced public health and first responder system that protects the American people by scaling up biomedical research, deploying rapid testing capacity, ensuring robust nationwide disease surveillance, sustaining a first class public health and first responder workforce, establishing a flexible emergency budgeting authority, and mobilizing the world to ensure greater sustained preparedness for future pandemics.Congress has taken a step forward by passing an initial bipartisan emergency plan to combat COVID-19. The Trump Administration must now heed the calls of House Speaker Nancy Pelosi and Senate Democratic Leader Chuck Schumer to put the health and safety of the American people first. Much more needs to be done, now, to bring our country together, respond to this emergency, and set the groundwork for bold, long-term reforms, including ensuring quality, affordable health care and a comprehensive paid leave program for every American.Biden will be ready on Day One of his Administration to protect this country’s health and well-being. But he is not waiting until then to communicate his views on what must be done now to properly serve the American people. Biden believes the following steps must immediately be taken. If Trump does not take them, Biden will on Day One as President.The Biden Plan calls for:Restoring trust, credibility, and common purpose.Mounting an effective national emergency response that saves lives, protects frontline workers, and minimizes the spread of COVID-19.Eliminating cost barriers for prevention of and care for COVID-19.Pursuing decisive economic measures to help hard-hit workers, families, and small businesses and to stabilize the American economy.Rallying the world to confront this crisis while laying the foundation for the future.Biden understands that this is a dynamic situation. The steps proposed below are a start. As the crisis unfolds, Biden will build on this policy to address new challenges.RESTORING TRUST, CREDIBILITY, AND COMMON PURPOSEStop the political theater and willful misinformation that has heightened confusion and discrimination. Biden believes we must immediately put scientists and public health leaders front and center in communication with the American people in order to provide regular guidance and deliver timely public health updates, including by immediately establishing daily, expert-led press briefings. This communication is essential to combating the dangerous epidemic of fear, chaos, and stigmatization that can overtake communities faster than the virus. Acts of racism and xenophobia against the Asian American and Pacific Islander community must not be tolerated.Ensure that public health decisions are made by public health professionals and not politicians, and officials engaged in the response do not fear retribution or public disparagement for performing their jobs.Immediately restore the White House National Security Council Directorate for Global Health Security and Biodefense, which was established by the Obama-Biden Administration and eliminated by the Trump Administration in 2018.MOUNTING AN EFFECTIVE NATIONAL EMERGENCY RESPONSE THAT SAVES LIVES, PROTECTS FRONTLINE WORKERS, AND MINIMIZES THE SPREAD OF COVID-19Make Testing Widely Available and FreeEnsure that every person who needs a test can get one – and that testing for those who need it is free. Individuals should also not have to pay anything out of their own pockets for the visit at which the test is ordered, regardless of their immigration status. The Centers for Disease Control and Prevention (CDC) must draw on advice from outside scientists to clarify the criteria for testing, including consideration of prioritizing first responders and health care workers so they can return to addressing the crisis.Establish at least ten mobile testing sites and drive-through facilities per state to speed testing and protect health care workers. Starting in large cities and rapidly expanding beyond, the CDC must work with private labs and manufacturers to ensure adequate production capacity, quality control, training, and technical assistance. The number of tests must be in the millions, not the thousands.Provide a daily public White House report on how many tests have been done by the CDC, state and local health authorities, and private laboratories.Expand CDC sentinel surveillance programs and other surveillance programs so that we can offer tests not only only to those who ask but also to those who may not know to ask, especially vulnerable populations like nursing home patients and people with underlying medical conditions. This must be done in collaboration with private sector health care entities.Task the Centers for Medicare and Medicaid Services to help establish a diagnosis code for COVID-19 on an emergency basis so that surveillance can be done using claims data.Surge Capacity for Prevention, Response, and TreatmentTask all relevant federal agencies to take immediate action to ensure that America’s hospital capacity can meet the growing need, including by:Preparing to stand up multi-hundred-bed temporary hospitals in any city on short notice by deploying existing Federal Medical Stations in the strategic national stockpile and preemptively defining potential locations for their use as needed.Directing the U.S. Department of Defense (DOD) to prepare for potential deployment of military resources, both the active and reserve components, and work with governors to prepare for potential deployment of National Guard resources, to provide medical facility capacity, logistical support, and additional medical personnel if necessary. This includes activating the Medical Reserve Corps, which consists of nearly 200,000 volunteer health care professionals who stand ready to serve across America; training and deploying additional surge capacity, including U.S. Department of Veterans Affairs/DOD medical equipment and U.S. Department of Health and Human Services (HHS) Disaster Assistance Medical Teams; and directing and assisting existing hospitals to surge care for 20% more patients than current capacity through flexible staffing, use of telemedicine support, and delaying elective procedures.Instructing the CDC to establish real-time dashboards tracking (1) hospital admissions related to COVID-19, especially for ICUs and emergency departments, in concert with the American Hospital Association and large hospital chains, for which the HHS must ensure data is able to be shared, as needed; and (2) supply chain information – including availability, allocation, and shipping – for essential equipment and personal protective equipment, including in the various places where there may be federal reserves. The strategic national stockpile must be used to supplement any shortages that exist, especially for essential medical supplies, like oxygen, ventilators, and personal protective equipment.Ensuring that training, materials, and resources reach federally qualified health centers, rural health clinics, and safety-net hospitals, which are typically resource-poor and care disproportionately for vulnerable populations that will bear the brunt of COVID-19. This effort will lay the foundation for a deeper and more lasting public health infrastructure for accessible national health care for all.Surge tele-emergency room, tele-ICU care, and telemedicine through a concerted, coordinated effort by health care providers to enable staff to manage additional patients and save beds for the very sick. Leverage existing efforts like Project ECHO to ensure health professionals have tele-mentoring and other training resources they need to make informed decisions.Support older adults, vulnerable individuals, and people with disabilities. Ensure essential home- and community-based services continue and Centers for Medicare and Medicaid works to provide the waivers necessary for those who rely on medication to have a sufficient supply.Protect health care workers, first responders, assisted living staff, and other frontline workers.Give all frontline workers high-quality and appropriate personal protective equipment – and enough of it and appropriate training to use it – so they don’t become infected. If our health care workers, first responders, and essential workers like transportation and food workers cannot function, we cannot protect and care for the public. The Biden Plan calls for issuing guidance to states and localities to ensure first responders and public health officials are prioritized to receive protective personal equipment and launching an education campaign to inform the general public about equipment that should be reserved for professionals.Direct the Occupational Safety and Health Administration (OSHA) to keep frontline workers safe by issuing an Emergency Temporary Standard that requires health care facilities to implement comprehensive infectious disease exposure control plans; increasing the number of OSHA investigators to improve oversight; and working closely with state occupational safety and health agencies and state and local governments, and the unions that represent their employees, to ensure comprehensive protections for frontline workers.Ensure first responders, including local fire departments and Emergency Medical Services, can meet the staffing requirements needed to respond and are trained to recognize the symptoms of COVID-19.Accelerate the Development of Treatment and VaccinesEnsure the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority are swiftly accelerating the development of rapid diagnostic tests, therapeutics and medicines, and vaccines. NIH must be responsible for the clinical trial networks and work closely with the U.S. Food and Drug Administration (FDA) on trial approvals.Ensure the FDA is working with the NIH to prioritize review and authorization for use of COVID-19 countermeasures and strengthen regulatory science at the FDA to make certain it has the needed resources to evaluate the safety and efficacy of new tools.Provide Timely Information and Medical Advice and GuidanceWork with the CDC and HHS to ensure that health departments and health providers across the country give every person access to an advice line or interactive online advice so they can make an informed decision about whether to seek care or to stay at home. This will preserve the health care system for those who are sick and prevent people who may not need to see a provider from becoming needlessly exposed. Ensure all information provided to the public is accessible to people with disabilities, including through plain language materials and American sign language interpreters.Instruct the CDC to provide clear, stepwise guidance and resources about both containment and mitigation for local school districts, health care facilities, higher education and school administrators, and the general public. Right now, there is little clarity for these groups about when to move toward social distancing measures, like cancelling school, mass gatherings, and travel and when to move to tele-work and distance learning models.Ensure firefighters and other emergency responders are notified if they have been exposed to individuals infected with COVID-19.Launching Urgent Public Health System Improvements for Now and the FutureWork with businesses to expand production of personal protective equipment, including masks and gloves, and additional products such as bleach and alcohol-based hand sanitizer. Incentivize greater supplier production of these critically important medically supplies, including committing, if necessary, to large scale volume purchasing and removing all relevant trade barriers to their acquisition.Task the U.S. Department of Justice with combating price gouging for critical supplies.Take steps in the aftermath of the crisis to produce American-sourced and manufactured pharmaceutical and medical supply products in order to reduce our dependence on foreign sources that are unreliable in times of crisis. The U.S. government should immediately work with the private sector to map critical health care supplies; identify their points of origin; examine the supply chain process; and create a strategic plan to build redundancies and domestic capacity. The goal is to develop the next generation of biomedical research and manufacturing excellence, bring back U.S. manufacturing of medical products we depend on, and ensure we are not vulnerable to supply chain disruptions, whether from another pandemic, or because of political or trade disputes.Establish and fund a U.S. Public Health Service Reserve Corps to activate former Public Health Service Commissioned Corps officers to expand medical and public health capacity. By creating the Reserve Corps, we will have a larger team of health professionals to deploy across the nation to help train health care systems in detection and response, educate the public, provide direct patient care as needed, and support the public health infrastructure in communities that are often under-resourced and struggling.Expand the Staffing for the Adequate Fire and Emergency Response (SAFER) Grant program so that fire departments – critical first responders in health emergencies—can increase staffing. As Vice President, Biden secured an expansion of the SAFER Act to keep more firefighters on the job during the Great Recession. He will expand the grants to build well-staffed, well-trained fire departments across the country.Providing the Resources Necessary to Achieve These OutcomesTo implement this national emergency response, the Biden Plan calls for an immediate increase of federal resources to cover all necessary federal costs, as well as the creation of a State and Local Emergency Fund that gives state and local leaders the power to meet critical health and economic needs to combat this crisis. This Fund will be designed as follows:Resources will be allocated according to a formula: 45% to state governments; 45% to local governments; and 10% reserved for special assistance for “hot-spots” of community spread.Menus of Permissible Usages: Governors and mayors will be given significant flexibility to ensure that they can target their health and economic spending where it is most needed in their respective states and cities. Such usages include:Paying for medical supplies and expanding critical health infrastructure, including building new or renovating existing facilities, if necessary;Expanding hiring where needed including health care and emergency services workers, caregivers in nursing homes, drivers, childcare workers, substitute teachers, and others;Providing overtime reimbursements for health workers, first responders, and other essential workers.The Fund will also be deployed to cushion the wider economic impact of the crisis, helping hard-hit families and communities, as described later in the fact sheet.Bringing Our Country TogetherNow is the time for empathy, decency, and unity. In times of crisis, Americans come together, and everyone steps up to meet our shared civic duty. We need that spirit now: volunteers standing ready to fill essential gaps, neighbors looking out for neighbors, business taking care of their workers, people contributing to frontline non-profit organizations, social media companies combating the spread of misinformation, universities and the private sector driving innovation in the search for new treatments and vaccines, and all of us following the guidance of health officials to take steps that reduce the spread of the virus. Biden believes this can’t just be a government response — it has to be a whole-of-society response.ELIMINATING COST BARRIERS FOR PREVENTION OF AND CARE FOR COVID-19The cost of preventive care, treatment, and a potential vaccine could be an insurmountable economic barrier for many Americans. If we fail to remove this barrier, we will be turning our backs on these Americans in a time of crisis, and putting all Americans at risk by discouraging people from getting necessary testing and treatment. The Biden Plan:Ensures that every person, whether insured or uninsured, will not have to pay a dollar out-of-pocket for visits related to COVID-19 testing, treatment, preventative services, and any eventual vaccine. No co-payments, no deductibles, and no surprise medical billing. This will be achieved by:Amending the Public Health Service Act to immediately cover all testing, treatment, and preventive services that are necessary to address a Public Health Emergency for an infectious disease. Once triggered by the HHS Secretary in consultation with the CDC, all commercial plans in all markets will be immediately required to cover such services as COVID-19 testing and any eventual vaccine with no copayments and deductibles, including for the visits themselves.Amending the Social Security Act and other authorizing statutes to extend the same requirement to all public health programs. As such, there will be no co-pays for programs including but not limited to Medicare, Medicaid and CHIP, the Indian Health Service, the Dept. of Veterans Affairs, DoD’s TriCare program and the Federal Employees Health Benefit Plan.Fully funding and expanding authority for the National Disaster Medical System (NDMS) to reimburse health care providers for COVID-19-related treatment costs not directly covered by health insurance; this includes all copayments and deductibles for the insured as well as uncompensated care burdens incurred by uninsured and underinsured populations. Direct the HHS Secretary to direct NDMS, in collaboration with the Centers for Medicare and Medicaid Services for administrative and enforcement support, to directly reimburse health care providers for: All uncompensated care associated with the testing, treatment, and vaccines that are associated with COVID-19 for uninsured. This includes Americans in so-called “junk” health plans that are not regulated as compliant with the standards for individual market coverage under the Affordable Care Act. All copayments, deductibles and any cost-sharing for treatment for COVID-19 for insured. Providers will submit cost-sharing claims to NDMS that document private insurance contractual arrangement for co-payments. To ensure maximum provider participation and minimum billing abuses to consumers, current Medicare law’s “conditions of participation” and system-wide prohibitions against balance billing and surprise medical bills will apply. To guard against fraud and abuse by bad-apple health care providers, harsh civil and monetary penalties under the False Claims Act will apply.Secures maximum Medicaid enrollment for currently eligible populations by explicitly authorizing federal matching dollars for presumptive eligibility, simplified application processes, and eligibility criteria. In past public health crises, such as Hurricane Katrina and 9/11, the federal government provided matching dollars for states to expedite enrollment for individuals who are eligible for Medicaid but not yet enrolled. This option must be specifically made available to states for the COVID-19 public health crisis. These policies are consistent with and complementary to the FMAP policy included in the federal economic assistance package below.Reverses the Trump Administration public charge rule, which places new, burdensome restrictions on documented immigrants who receive public benefits and discourages all immigrants from seeking health care services for COVID-19.Supports bipartisan efforts to delay the Medicaid Fiscal Accountability Regulation, which forces states to change how they finance their Medicaid programs and leads to major reductions in funding for critically important health care.Provides explicit authority for the HHS Secretary to approve the commercial price of vaccines that are developed in conjunction with federally funded research. This ensures that the private, as well as the public sector, will not be subjected to vaccine prices that fail a “fair and reasonable” cost standard and, even if the vaccine is available free of charge, will protect the taxpayer from being gouged.Ensures federal workers are able to access workers’ compensation and encourage states to do the same. Because it will be difficult for workers to prove that they were exposed to COVID-19 while on the job, the Biden Plan will ensure the Federal Employees’ Compensation Act program presumes they were exposed while on the job if their job put them in direct contact with infected individuals. And, he will encourage states to do the same.PURSUING DECISIVE ECONOMIC MEASURES HARD-HIT WORKERS, FAMILIES, AND SMALL BUSINESSES AND TO STABILIZE THE AMERICAN ECONOMYThe Biden Plan will provide both financial support for those who are economically harmed by the fall-out of the crisis and help strengthen our economy as a whole. This includes taking immediate, bold measures to help Americans who are hurting economically right now. It means we will need bigger and broader measures to shore up economic demand to ensure we can protect jobs; keep credit flowing to our job creators, and have the economic firepower we need to weather this storm and get our people and economy back to full strength as soon as possible.These immediate measures include both direct federal support and a renewable fund to state and local governments. Both the federal and state/local relief will be designed to be automatically extended upon certification by the federal government of a continuing health or economic threat, determined by clear health and economic criteria. This is critical to ensure that our political and legislative stalemates do not prevent additional rounds of funding from moving out swiftly when it is needed most.Joe Biden believes we must do whatever it takes, spend whatever it takes, to deliver relief for our families and ensure the stability of our economy. This is an evolving crisis and the response will need to evolve, too, with additional steps to come so that we meet the growing economic shocks. We must prepare now to take further decisive action, including direct relief, that will be large in scale and focused on the broader health and stability of our economy.The immediate economic measures in Biden’s plan consist of three parts, with additional measures to come as circumstances warrant, including further direct relief:Providing Guaranteed Emergency Paid Sick Leave and Care-Giving LeaveAs a nation, our goal must be to permanently provide the type of comprehensive 12 weeks of paid family and medical leave envisioned in the FAMILY Act sponsored by Senator Kristen Gillibrand and Representative Rosa DeLauro. We must also provide the type of coverage in the Healthy Families Act spearheaded by DeLauro and Senator Patty Murray, which will ensure workers receive seven days of paid sick leave for routine personal and family health needs, as well as time for survivors of domestic violence and sexual assault to seek services.Providing widespread access to paid sick leave not only allows families to recover from sickness, but it also keeps sick workers and children away from the general population and helps slow the spread of disease. The Biden Plan calls for an emergency paid leave program that will ensure that all workers can take paid leave during the COVID-19 crisis. It calls for passage of the Healthy Families Act with the addition of an emergency plan that will require 14 days of paid leave for those who are sick, exposed, or subject to quaratines—while also ensuring that employers will not bear any additional costs for such additional leave in the midst of this crisis.Types of Paid Leave that Must be Covered: Joe Biden’s emergency paid leave plan will be tailored to cover the various types of leave needed for our nation to get through this crisis. The paid leave plan will create a federal fund to cover 100% of weekly salaries or average weekly earnings capped at $1,400 a week—the weekly amount that corresponds with about $72,800 in annual earnings.Paid Leave for Sick Workers;Paid Leave for Workers Caring for Family Members or Other Loved Ones;Paid Leave for People Unable to Continue Work Because They Are At Increased Risk of Health Complications Due to COVID-19;Paid Leave and Child Care Assistance for Dealing with School Closings; andPaid Leave for Domestic Workers, Caregivers, Gig Economy Workers, and Independent Contractors.Reimbursements to Employers: This emergency plan will provide reimbursement to employers or, when necessary, direct payment to workers for up to 14 days of paid sick leave or for the duration of mandatory quarantine or isolation. This will be in addition to existing paid leave provided by a business’s existing policies. No worker or contractor taking such leave during the crisis will impose any additional financial burden on a business. Businesses will be expected to support paid sick leave and seek reimbursement – or deduct against expected tax payments – to ensure workers are not discouraged from reporting symptoms of COVID-19. Direct payment will go to workers where needed due to their work arrangements.Emergency Administration: Biden’s plan will provide all necessary funding to ensure such paid sick leave will be available immediately. One potential option for workers who require direct paid sick leave payments will be to staff up existing Social Security Administration offices to assist with distribution of the emergency paid leave fund. These offices exist throughout our nation and are the vehicle proposed by the FAMILY Act for a national paid leave plan – so this emergency legislation will also start building national infrastructure for a permanent and long-needed national paid leave benefit.Federal Assistance to Hard-Hit FamiliesA Health Crisis Unemployment Initiative to Help all Workers Facing a Loss for Work Due to the COVID-19 Crisis. The reduction in demand for services such as hospitality, necessary closing of workplaces, and disruptions in supply chains will impact workers in all types of work arrangements. Just as the Obama-Biden Administration expanded regular unemployment insurance during the Great Recession, Joe Biden will again call for expanded Emergency Unemployment Compensation that will not only support workers facing extended spells of unemployment, but expand benefits and eligibility to address the nature of the job loss that will be impacted for the duration of the crisis. The Biden Plan calls for immediate expanded federal relief for impacted workers, that includes:Ensuring Unemployment Benefits (UI) Are Available to Those Who Lose Jobs but Would Be Denied Benefits Due to Rules that Should Not Apply in a Major Health Crisis and Economic Downturn: The Biden Plan calls for expanded and broadened unemployment benefits that ensure our unemployment benefit policies are responsive to the depth and nature of this health and economic crisis. That means more support for state offices that will face far higher demand. It means waiving or relaxing work history, waiting and work search requirements that could prevent millions who might lose work due to no fault of their own from being left out in the cold. Current UI rules rightly require recipients to be actively looking for work. The nature of the COVID-19 crisis means, however, that many who lose their jobs will be prevented from looking for work due to public health rules related to containing community spread. The Biden Plan will ensure that workers who lose jobs but cannot meet search requirements due to this public health crisis are not denied benefits. This initiative can be combined with efforts to expand and reform our existing Disaster Unemployment Assistance program.Employment Relief for Reduced Hours or Work-Sharing Arrangements: In addition to assistance for those who lose jobs, the Biden Plan will design unemployment insurance benefits to encourage expanded work-sharing arrangements for workers at businesses that are forced to cut back payroll due to lower economic demand, diminished travel, or cancelled orders. The Biden Plan will ensure that partial unemployment benefits are available to workers facing a significant reduction in hours so as to encourage employers to choose work-sharing over layoffs where possible. Such policies will build on those implemented by the Obama-Biden Administration during the Great Recession. The Biden Plan will require that this is implemented in a way that is consistent with existing collective bargaining agreements and that any employer with employees represented by a union create these arrangements in cooperation with the unions.Provide Employment Relief for Domestic Workers, Caregivers, Gig Workers, or Independent Contractors who face Reduced Pay and Hours: Too often, our unemployment relief only helps those who are in more formal employer-employee relations. It leaves out too many of the hardest working, most hard-pressed Americans who drive cars, clean homes, and care for our younger and older loved ones. The Biden Plan will offer economic relief to all workers who can show hours have been cut back due to COVID-19 or to resulting economic impacts.Expand Food Relief for Hard-Pressed Families and Children: The Biden Plan calls for a health crisis food initiative that addresses both the depth of potential economic hardship for families and the nature of this health crisis. Economic hardship caused by the crisis will stretch family budgets in ways that could reduce needed nutrition. Many students rely on free or discounted meals at schools, which may have to close. The Biden Plan health crisis food initiative will create a federal-state partnership – fully funded by the federal government – that will expand SNAP relief for the duration of the crisis, as well as broaden the type of food relief responses available to states – from supporting food banks across the nation to increased home delivery of food to a broad effort to replace lost school meals. It will adjust current policies that will harshly cut off or deny food benefits to workers unable to find work in this crisis. It will allow schools to submit waiver applications before they are impacted by the crisis, making it easier for them to get permission to provide food even when school is closed.Increase Federal Medical Assistance Percentage (FMAP) for the state-administered Medicaid program: The Biden Plan calls for an increase in the share the federal government pays of Medicaid – the so-called FMAP. This is one of the fastest, most effective means to concurrently address the health and revenue burdens states face when confronting an economic crisis. The Biden Plan will increase the FMAP by at least 10 percent for all states during the crisis, with upward adjustments for states that are facing particularly high unemployment rates. It will also provide additional financial incentives for states that have not yet expanded their Medicaid program and will provide necessary additional support to Puerto Rico and other territories to ensure the health care needs of these populations are not neglected.Establish a Temporary Small- and Medium-Sized Business Loan Facility: Many businesses that would otherwise thrive during normal economic times will face a severe shortfall in cash flow, potentially jeopardizing their ability to make payrolls, pay creditors, and keep their doors open. Working with the Small Business Association and Treasury Department, the Biden Plan proposes to establish a temporary small business loan program designed to address unanticipated shortfalls in revenue by offering interest-free loans to small- and medium-sized businesses around the country through the duration of the crisis. Biden’s plan includes both increased funding capacity for the Small Business Administration, in addition to a new program – modeled after the Obama-Biden State Small Business Credit Initiative–that provides funds to allow states to increase lending to small businesses. The Biden Plan also calls on the U.S. Treasury Department to coordinate with the Federal Reserve to monitor and consider policies to address severe credit and liquidity challenges related to the fall-out of COVID-19 and thus prevent small businesses and those in impacted industries from severe cutbacks, shutdowns, and layoffs.Support for Child Care and Remote Student Learning: Potential school closings will create significant cost issues for parents seeking childcare and for schools and educators seeking to continue teaching remotely including online. The Biden Plan will expand assistance to federal child care centers and assistance to schools – particularly Title I schools — for those facing schools facing extra costs, including efforts to continue remote education or remote activities normally done after-school.Relief or Forbearance of Federal Student Loans and Federally Backed Mortgages: Congress must immediately use new legislation or existing authority to provide assistance of forbearance to students and homeowners to provide financial relief until the worst of the economic fall-out of the crisis is over. As proposed below, there must also be a federal partnership with states and cities to provide rental relief during the crisis, so no one faces evictions due to impacts of the COVID-19 crisis.Protecting union health funds. Union members have fought hard for their health insurance. Biden will commit to ensuring their Taft-Hartley health funds have the financial resources they need to continue despite the crisis.A State and Local Emergency FundIn addition to these federal initiatives, governors and mayors can access funds through the State and Local Emergency Fund to cushion the economic impacts in their communities. This Fund, as noted above, will also provide state and local leaders with resources and flexibility for responding to the immediate health crisis and economic fall-out in ways that best address the needs of their towns, cities, and states. The range of relief will include:Mortgage & Rental Relief for Impacted Workers: No one should face foreclosure or eviction because they are affected by the COVID-19 crisis. The State and Local Emergency Fund will allow mayors and governors to implement rental assistance, no-interest forbearance or mortgage payment relief for workers who have had to reduce their hours, have been laid off, or are otherwise earning less because of COVID-19.Employer Assistance for Job Maintenance: Funds could provide help for employers to keep workers on the job – or to do work-sharing with part-time relief to workers – when they are impacted by falls in economic demand or recession.Interest-Free Loans for Small Businesses: Governors and mayors will also be able to supplement their existing programs to assist local employers who are facing temporary economic distress due to supply-chain disruptions, declines in travel or economic demand due to continuing economic uncertainty related to the COVID-19. To supplement the federal loan program, state and local leaders can access these resources to help small businesses cope with a potential sharp cutback in economic activity.Needed Jobs: To both deal with additional needs due to COVID-19 or to address resulting declines in employment, the fund will be authorized to fund existing or new local and state jobs initiatives.Cash Assistance or Targeted Refundable Tax Relief: Where governors and mayors determine it is necessary to adequately address the full range of economic pain created by the COVID-19, the fund will authorize such leaders to directly draw on it to implement broader progressive cash or tax relief – that could include cash payments to working families, unpaid caregivers, seniors. those with disabilities, and children, or a child allowance. It could also be used to fund new legislation to expand State Earned Income Tax Credit relief.More Will Be NeededBiden understands that the crisis will have broader economic impacts that will no doubt require further action. The steps outlined above must be taken immediately and then Congress must move to understand the broader economic implications and act accordingly. And, any relief provided to states or industries must include conditions to support workers, including protecting their jobs.Making the Economy More Resilient for Future CrisesBiden has released several plans to build a stronger, more inclusive middle class that will increase the resilience of all Americans in the face of a crisis. His plan to create a new public option is the quickest, most effective way to achieve universal health coverage. He will invest in infrastructure, like broadband, essential for mitigating the impact of future pandemics. And, he will encourage union organizing and defend collective bargaining. Unions can help negotiate for better safety and health protections, provide better training for personal protective equipment, protect against layoffs, and help ensure generous wages and benefits to help workers in a crisis. And, unions can provide a critical voice in handling crises, especially those that represent the many workers that are exposing themselves to hazards in order to keep Americans safe. Read Joe Biden’s labor plan here.RALLY THE WORLD TO CONFRONT THIS CRISIS WHILE LAYING THE FOUNDATION FOR THE FUTUREThe only way to stop the threat from infectious diseases like COVID-19 is to detect them early and contain them effectively in communities around the world. Even as we take urgent steps to minimize the spread of COVID-19 at home, we must also help lead the response to this crisis globally. In doing so, we will lay the groundwork for sustained global health security leadership into the future.Leading the Global Response to COVID-19Direct the U.S. Agency for International Development (USAID), in coordination with the U.S. Department of State, DOD, HHS, and the CDC, to mobilize an international response that assists vulnerable nations in detecting, treating, and minimizing the spread of COVID-19, including deploying, when necessary, USAID Disaster Assistance Response Teams. Biden will empower the State Department to ensure the U.S. plays a major role in all global decisions about the outbreak and our experts have the access they need to COVID-19 hotspots. Staying on the sidelines or deferring to other nations ultimately makes us less safe and secure.Call for the immediate creation of a Global Health Emergency Board to harmonize crisis response for vulnerable communities. The Board will convene leadership of the United States, our G7 partners, and other countries in support of the World Health Organization (WHO) to ensure a coordinated health and economic response globally, especially with respect to vulnerable countries. The Board will bring together scientific experts from the WHO and CDC, the Africa Centres for Disease Control and Prevention and other key CDCs, international financial institutions, and leading private sector and non-profit representatives to (1) offset the cost of bringing any eventual vaccines to developing countries, (2) harmonize economic measures with the emergency response globally, and (3) establish and ensure high standards for transparency and communication. In the future, the convening of the Board would be triggered by a public health emergency of international concern declaration by the WHO.Protect America’s troops and deployed citizens, by bolstering CDC and DOD’s disease detection and protection programs overseas, planning for securing diplomatic and military assets and deployments in countries affected by COVID-19, and providing testing, care, and treatment and, if necessary, evacuation for military, public health service, foreign service, and deployed civil service personnel who become infected.Advancing Global Health SecurityUnder the Obama-Biden Administration, the United States established the Global Health Security Agenda to mobilize the world against the threat of emerging infectious diseases. A Biden Administration will not only revitalize and elevate this Agenda after years of neglect under the Trump Administration, but also expand it to ensure it is suited to meet new challenges. Above all, we need to end the cycles of panic investment and neglect for our U.S. public health system and health systems around the world. They need to remain strong and ready to prevent, detect, and respond to pandemic threats whether caused by natural causes and climate change, bioterrorism, or laboratory accidents. Biden will:Fully staff all federal agencies, task forces, and scientific and economic advisory groups focused on health security. This includes establishing an Assistant Secretary at the State Department to oversee an office of Global Health Security and Diplomacy, and engaging regional bureaus and embassies to improve health security readiness, governance, and global coordination.Re-embrace international engagement, including prioritizing sustained funding for global health security – above and beyond emergency appropriations – to strengthen joint standing capacity for biosurveillance and health emergency response. Biden calls for the creation of a Permanent Facilitator within the Office of the United Nations Secretary-General for Response to High Consequence Biological Events, as recommended by experts, to facilitate crisis coordination among health, security, and humanitarian organizations. He also calls for fully resourcing the WHO, especially its Contingency Fund for Emergencies.Support sustainable health security financing to urgently fill substantial gaps in global pandemic preparedness. The Biden Administration will build the global coalition necessary to fill urgent global gaps in pandemic preparedness, enhance accountability for those investments, and produce measurable results.Build a global health security workforce for the 21st century. Biden will prioritize investing in and lifting barriers to the education of public health professionals, especially in less advantaged communities, including by strengthening the CDC’s Field Epidemiology Training Program and Field Epidemiology and Laboratory Program. We must support opportunities for global experts to train together so they are ready to deploy to assist the WHO and partner governments in responding to infectious disease threats, regardless of origin, including to insecure or unstable environments.Fight climate change as a driver of health threats. The link between climate change and health security is well-documented and will create a growing threat to Americans. A Biden Administration will recommit the United States to the Paris Agreement on day one and lead an effort to get every major country to ramp up the ambition of their domestic climate targets. As President, Biden will fully integrate climate change into our foreign policy and global health security strategies, and prioritize efforts to mitigate disease and migration challenges caused by a warming planet. Read Biden’s full climate change plan here.$15Our average contribution this month$38OtherIf you've saved your information with ActBlue Express, your donation will go through immediately.Let's do this. Together.Email AddressZIP CodeMobile PhoneThank you for joining our campaign to elect Joe Biden. By providing your mobile phone number you consent to receive recurring text messages from Biden for President. Message & Data Rates May Apply. Text HELP for Info. Text STOP to opt out. No purchase necessary. Terms and Conditions and Privacy Policy.Support our presidential campaign to elect Joe Biden by signing up to volunteer or making a donation online.To contribute by mail, please click here.AccessibilityWork with UsContact UsYour Privacy RightsTerms and ConditionsLimited LicenseHomeJoe’s VisionJoe’s StoryKamala’s StoryVolunteerCoalitionsHow to VoteStoreThe Latest——-Contrast this with the Donald Trump plan for Covid-19 (Coronovirus): “One day, it will just disappear.”

Please explain what and when the procedure was performed. Has the patient been seen since surgery by the physician? What was the reason provided for not seeing the patient?There is a patient abandonment issue. The person doing the surgery should do follow up for any complication related to the procedure he/she performed. Is it because of noncompliance, schedule conflict, non-payment etc?[Edit: Per additional history provided in the Comments section. The article below addresses medical management after bariatric surgery. The physician has tried to work up surgical complications. This is the section regarding nausea and vomiting. The authors mention antiemetic unless there are other issues. I hesitate to second guess what the surgeon’s train of thought is. I do think there should be response to the patient’s communications. I understand the frustration and the cost of repeat emergency room visits. Someone here has suggested contacting the chief of surgery. Post bariatric surgery recuperation can be problematic and I hope the symptoms resolve in time.Nausea and vomitingNausea and vomiting can often be helped by antiemetic or prokinetic drugs, however, some patients have chronic functional nausea and/or vomiting that does not fit the pattern of cyclic vomiting syndrome or other gastrointestinal disorders, hence particular attention should be directed to potential psychosocial factors post bariatric surgery. Therefore, low dose antidepressant medications and psychotherapy should be addressed. On demand CT scan and Gastroscopy could be the gold standard investigations in chronic situations[39,40].]World J Gastrointest Surg. 2014 Nov 27; 6(11): 220–228.Published online 2014 Nov 27. doi: 10.4240/wjgs.v6.i11.220PMCID: PMC4241489Medical management of patients after bariatric surgery: Principles and guidelinesAbd Elrazek Mohammad Ali Abd Elrazek, Abduh Elsayed Mohamed Elbanna, and Shymaa E BilasyAuthor information ► Article notes ► Copyright and License information ►This article has been cited by other articles in PMC.Go to:AbstractObesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m and those with BMI > 35 kg/m with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.Keywords: Obesity, Bariatric surgery, Postoperative care, Body-mass index, El bannaCore tip: Obesity is a growing health concern worldwide that impacts the life of individuals both physically and psychologically. There are several well-established health hazards associated with obesity. Additionally, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. Bariatric surgery is one of the definite solutions for obesity. In this review, we will briefly discuss the general guidelines that should be considered before bariatric surgery. Also, we discuss the protocols of patients’ postoperative care and the management of medical disorders that must be considered after bariatric surgery.Go to:INTRODUCTIONObesity is a chronic disease that impairs health-related quality of life in adolescents and children. In 2010, overweight and obesity were estimated to cause 3.4 million deaths, 3.9% of years of life loss, and 3.8% of disability-adjusted life-years worldwide. Obesity is increasing in prevalence, currently, the proportion of adults with a body-mass index (BMI) of 25 kg/m or greater is 36.9% in men and 38.0% in women worldwide[1]. Attempts to explain the large increase in obesity in the past 30 years focused on several potential contributors including increase in caloric intake, changes in the composition of diet, decrease in the levels of physical activity and changes in the gut microbiome. More than 50% of the obese individuals in the world are located in ten countries (listed in order of number of obese individuals): United States, China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan and Indonesia. Although age-standardized rates were lower in developing than in developed countries overall, 62% of the world’s obese individuals live in developing countries. Recently, United States accounted for 13% of obese people worldwide, the prevalence of obesity was 31.7% and 33.9% among adult men and women, respectively. In Canada 21.9% of men and 20.5% of women are obese. Reported prevalence rates of obesity include: 27.5% of men and 29.8% of women in Australia, 24.5% of men and 25.4% of women in the United Kingdom, in Germany 21.9% of men and 22.5% of women, in Mexico 20.6% of men and 32.7% of women, in South Africa 13.5% of men and 42% of women, in Egypt 26.4% of men and 48.4% of women, in Saudi Arabia 30% of men and 44.4% of women and in Kuwait 43.4% of men and 58.6% of women Figure ​Figure11)[2].There are several well-established health hazards associated with obesity, e.g., nonalcoholic steatohepatitis (NASH), type 2 diabetes, heart disease, chronic kidney disease, gastroesophageal reflux disease, gastrointestinal motility disorders, sexual disorders, cerebrovascular stroke, certain cancers, osteoarthritis, depression and others[3-10]. The risk of development of such complications rises with the increase of adiposity, while weight loss can reduce the risk. Bariatric surgery could be the definitive clue in many situations[11-15]. Bariatric surgery is one of the fastest growing operative procedures performed worldwide, with an estimated > 340000 operations performed in 2011. While the absolute growth rate of bariatric surgery in Asia was 44.9% between 2005 and 2009, the numbers of procedures performed in the United States plateaued at approximately 200000 operations per year[16,17]. Starting in 2006, the Center for Medicare and Medicaid Services, United States, restricted the coverage of bariatric surgery to hospitals designated as “Centers of Excellence” by two major professional organizations[18]. Medical management and follow up of patients who have undergone bariatric surgery is a challenge due to post operative complications.GENERAL GUIDELINES FOR SURGEONS/GASTROENTEROLOGISTSA well skilled physician or a surgeon has to consider the followings:(1) as the prevalence of obesity increases so does the prevalence of the comorbidities associated with obesity. Losing weight means overcoming illness at the present, complications in future and alleviating the economic burden in the present and future;(2) Overweight; BMI between 25 and 30, technically refers to excessive body weight, whereas “obesity” BMI ≥ 30 kg/m refers excessive body fat, “Severe obesity”, BMI ≥ 35 kg/m, or “morbid obesity” refers to individuals with obesity-related comorbidities. Furthermore, severe obesity and morbid obesity groups who failed dietary and medical regimens are candidates for bariatric surgery;(3) Children obesity; refers to children with BMI > 95th percentile for their age and sex and “overweight” refers to children with BMI between the 85th and 95th percentile for their age and sex;(4) Patients undergoing a bariatric operation should have a nutritional assessment for deficiencies in macro and micronutrients, also with no contraindication for such a major operation;(5) Most of bariatric procedures are performed in women (> 80%) and approximately half of these (> 40% of all bariatric procedures) are performed in reproductive aged women, accordingly, pregnancy planning and contraception options should be discussed in details with women who will undergo bariatric procedures. Fertility improves soon after bariatric surgery, particularly in middle-aged women, who were anovulatory. Additionally, oral contraceptives may be less effective in women who have undergone malabsorptive bariatric procedure. Therefore, it is better to delay pregnancy for 6-12 mo following bariatric surgery. Risk of preeclampsia, gestational diabetes, and macrosomia significantly decrease post bariatric surgery, but the risk of intrauterine growth restriction/small infants for their gestational age may increase. Body contouring surgery is in high demand following bariatric surgery;(6) All bariatric operations are accompanied with restrictive and/or malabsorption maneuvers; less food intake and malabsorption concepts;(7) The most common types of bariatric surgeries performed worldwide are Sleeve gastrectomy (SG): This procedure involves the longitudinal excision of the stomach and thus shaping the remaining part of the stomach into a tube or a “sleeve” like structure. SG removes almost 85% of the stomach (Figure ​(Figure2);2); Roux-en-Y gastric bypass (RYGB): It reduces the size of the stomach to the size of a small pouch that is directly surgically attached to the lower part of the small intestine. In this procedure, most of the stomach and the duodenum are surgically stapled and therefore, bypassed (Figure ​(Figure3);3); The laparoscopic adjustable gastric band (AGB): This is one of the least invasive procedures, where the surgeon inserts an adjustable band around a portion of the stomach and therefore, patients feel fuller after eating smaller food portions (Figure ​(Figure4).4). Bariatric surgical procedures, particularly RYGB, plus medical therapy, are effective interventions for treating type 2 diabetes. Improvement in metabolic control is often evident within days to weeks following RYGB; and(8) Complications reported following bariatric surgery vary based upon the procedure performed. Cholilithiasis, renal stone formation and incisional hernia could be the delayed phase complications; on the other hand, bleeding, leaking, infection and pulmonary embolism could be the early phase complications following the bariatric procedure. The overall 30-d mortality for bariatric surgical procedures worldwide is less than 1%.Roux-in Y Gastrectomy, sleeve gastrectomy. and adjustable gastric band.POST OPERATIVE CARE AND FOLLOW UPEarly post operative period; (1-3) d post bariatric surgeryPatients undergoing a bariatric operation are admitted to the post-anesthesia care unit (PACU) immediately at the conclusion of the operation. Usually, on postoperative day (POD) one, we begin oral therapy in tablet or crushed-tablet and liquid form if there is a naso-gastric tube after the gastrografin leak test. A basic metabolic profile (e.g., complete blood count, electrolytes, renal function, liver function, prothrombin time and partial thromboplastin time) should be obtained every 12 h for the successive two PODs, then every 24 h for another 3 d. Oxygen is administered by nasal cannula and weaned thereafter. The likelihood that, early specific complication, will arise for a given patient is determined by the nature of the procedure, the anesthetic techniques used, and the patient’s preoperative diseases. Respiratory problems are common complication in the early postoperative period following bariatric surgery. Patients with significant comorbidities, particularly neuromuscular, pulmonary, or cardiac problems are at a higher risk for respiratory compromise, but any patient can develop hypoxemia following bariatric surgery. For prophylaxis against Deep Venous Thrombosis (DVT) following bariatric surgeries, ultrasound evaluation is recommended for all patients, D-dimer test should be applied for suspected patients with DVT, especially after long operative time, repeat ultrasound or venography may be required for those with suspected calf vein DVT and a negative initial ultrasound investigation[19,20].Late post operative monitoringAfter the PACU period, most patients are transferred to the inpatient surgical postoperative unit. For the next 24-72 h, the postoperative priorities include ruling out an anastomotic leak following laparoscopic RYGB or laparoscopic SG. If no leak is observed, patients are allowed to start a clear liquid diet and soft drinks. The postoperative care team cares for the following: control of pain, care of the wound, continuous monitoring of blood pressure, intravenous fluid management, pulmonary hygiene, and ambulation. Post-bariatric nausea and vomiting is directly correlated with the length of the surgery; it also increases in females, non-smokers, and those patients with prior history of vomiting or motion sickness. Prophylaxis with pharmacologic treatment before the development of post operative nausea and vomiting significantly reduces its incidence after surgery[21-23].After hospital dischargeDiet: Usually patients are discharged 4-6 d after surgery. Most patients are typically discharged from the hospital on a full liquid diet, patients should be taught to keep monitoring their hydration and urine output. Approximately two-three weeks after surgery, the diet is gradually changed to soft, solid foods. The average caloric intake ranges from (400) to (800) kcal/d for the first month, and thus the daily glycemic load is greatly reduced. We encourage patients to consume a diet consisting of salads, fruits, vegetables and soft protein daily.To control the epigastric pain and vomiting, patients should be taught to eat slowly, to stop eating as soon as they reach satiety and not to consume food and beverages at the same time. For most patients suffering chronic vomiting, prokinetic therapy and proton-pump inhibitors (PPIs) should be considered. Patients, who underwent SG, LAGB or RYGB, benefit from a well-planned dietary advancement. Patients should understand that the surgery has changed their body but not the environment, they have to choose healthy foods, do not skip meals and to visit the dietitian regularly in the first 12 mo after surgery. However, if food intolerance develops, patients may choose a more vegetarian-based diet. Nevertheless, fresh fruits and vegetables are usually tolerated without a problem. The daily protein intake should be between 1.0 to 1.5 g/kg ideal body weight per day[24]. The biliopancreatic diversion/duodenal switch (BPD/DS) is a malabsorptive procedure for both macro- and micronutrients. Hence, we encourage higher protein intake of 1.5 g to 2.0 g of protein/kg ideal body weight per day, making the average protein requirement per day approximately 90 g/d[25,26]. Alcohol is better prevented in the first 6-12 mo after surgery[27].Monitoring: Patients should generally have their weight and blood pressure measured weekly until the rapid weight loss phase diminishes, usually within 4-6 mo, then again at 8, 10 and 12 mo, and annually thereafter. Patients with diabetes are encouraged to check their blood glucose daily. Glycemic control typically improves rapidly following bariatric surgery. Patients maintained on antihypertensive or diabetic medications at discharge should be monitored closely for hypotension and hypoglycemia, respectively, and medications should be adjusted accordingly. We recommend that the following laboratory tests be performed at three, six, nine months and annually thereafter: (1) Complete Blood Count; (2) Electrolytes; (3) Glucose and Glucose Tolerance test; (4) Complete iron studies; (5) Vitamin B12; (6) Aminotransferases, alkaline phosphatase, bilirubin, GGT; (7) Total protein and Albumin; (8) Complete lipid profile; (9) 25-hydroxyvitamin D, parathyroid hormone; (10)Thiamine; (11) Folate; (12) Zinc; and (13) Copper.Complications following the surgical treatment of severe obesity vary based upon the procedure performed. Secondary hyperparathyroidism, Hypocalcemia, Gastric remnant distension, Stomal stenosis/Obstruction, Marginal ulcerations, Cholilithiasis, Ventral incisional hernia, Internal hernia, Hiatus Hernia, Short bowel syndrome, Renal failure, Gastric prolapse, infection, Esophagitis, Reflux, Vomiting, Hepatic abnormalities and dumping syndrome are common late-phase complications after bariatric surgery. However, the clinician should aware of complications specific for every bariatric procedure[28,29]. Before therapy, the clinician should understand that the impact of various bariatric surgeries on drug absorption and metabolism are scarce. On the other hand, RYGB and other malabsorptive procedures that significantly exclude the proximal part of the small intestine, decrease the surface area where most drug absorption occurs and may result in a reduction in systemic bioavailability[30-32].Go to:COMMON MEDICAL CONDITIONS FOLLOWING BARIATRIC SURGERYHypertensionHypertension is not always related to obesity, and dietary interventions do not assure the normalization of blood pressure. However weight loss, whether by an intensive lifestyle medical modification program or by a bariatric operation, improves obesity-linked hypertension. Patients should be monitored weekly until the blood pressure has stabilized, and patients may need to resume antihypertensive medications, but often at adjusted doses[33].DiabetesPatients with diabetes should have frequent monitoring of blood glucose in the early postoperative period and should be managed with sliding scale insulin. Many diabetic patients have a decreased need for insulin and oral hypoglycemic agents after bariatric surgery. Oral sulfonylureas and meglitinides should be discontinued postoperatively as these medications can lead to hypoglycemia after bariatric surgery. Metformin is the safest oral drug in the postoperative period, since it is not associated with dramatic fluctuations in blood glucose. RYGB is associated with durable remission of type 2 diabetes in many, but not all, severely obese diabetic adults. However those who underwent LAGB generally exhibit a slower improvement in glucose metabolism and diabetes as they lose weight in a gradual fashion[34,35].RefluxMedications for gastroesophageal reflux disease (GERD) may be discontinued after RYGB and Laparoscopic AGB, however, SG has been associated with an increased incidence of GERD in some procedures. Recurrent GERD symptoms after RYGB, particularly when accompanied by weight regain, should raise the possibility of a gastrogastric fistula between the gastric pouch and remnant, and should be investigated by an upper GI contrast study or CT scan and referred to the bariatric surgeon. Upper endoscopy is the best investigation to exclude other esophagogastroduodenal disorders. GERD may be associated with esophageal complications including esophagitis, peptic stricture, Barrett’s metaplasia, esophageal cancer and other pulmonary complications. Failure of the PPI treatment to resolve GERD-related symptoms has become one of the most common complications of GERD after bariatric surgery. Most patients who fail PPI treatment have Non Erosive Reflux Disease and without pathological reflux on pH testing. In patients with persistent heartburn despite of medical therapy, it is reasonable to recommend avoidance of specific lifestyle activities that have been identified by patients or physicians to trigger GERD-related symptoms[36-38].Nausea and vomitingNausea and vomiting can often be helped by antiemetic or prokinetic drugs, however, some patients have chronic functional nausea and/or vomiting that does not fit the pattern of cyclic vomiting syndrome or other gastrointestinal disorders, hence particular attention should be directed to potential psychosocial factors post bariatric surgery. Therefore, low dose antidepressant medications and psychotherapy should be addressed. On demand CT scan and Gastroscopy could be the gold standard investigations in chronic situations[39,40].Marginal ulcerationDue to increased risk of ulcer formation from nonsteroidal anti-inflammatory drugs (NSAIDs), these medications should be discontinued postoperatively, especially after RYGB. NSAID use is associated with an increased risk of bleeding. If analgesic or anti-inflammatory treatment is needed, the use of acetaminophen is preferred in a dose of 1-2 g/daily[41-45]. Other factors associated with increased risk of ulcer formation are smoking, alcohol, spicy food, gastrogastric fistulas, ischemia at the site of surgical anastomosis, poor tissue perfusion due to tension, presence of foreign material, such as staples and/or Helicobacter pylori infection. Diagnosis is established by upper endoscopy. According to our strategy, all patients should undergo diagnostic upper endoscopy to exclude congenital or GI diseases prior to bariatric procedures. Medical management is usually successful and surgical intervention is rarely needed[46-48].Go to:DUMPING SYNDROMEDumping syndrome or rapid gastric emptying is a group of symptoms that most likely occur following bariatric bypass. It occurs when the undigested contents of the stomach move too rapidly into the small intestine. Many patients who underwent bariatric bypass experienced postprandial hypoglycemia. However, the dumping syndrome usually occurs early (within one hour) after eating and is not associated with hypoglycemia. It is presumed to be caused by contraction of the plasma volume due to fluid shifts into the gastrointestinal tract. Dumping syndrome may result in tachycardia, abdominal pain, diaphoresis, nausea, vomiting, diarrhea, and sometimes, hypoglycemia. The late dumping syndrome is a result of the hyperglycemia and the subsequent insulin response leading to hypoglycemia that occurs around 2-3 h after a meal. Dumping syndrome is a common problem that occurs in patients who have undergone RYGB and when high levels of simple carbohydrates are ingested. Accordingly, patients who have experienced postgastric bypass bariatric surgery should avoid foods that are high in simple sugar content and replace them with a diet consisting of high fiber and protein rich food. Eating vegetables and salad is encouraged; beverages and alcohol consumption are better avoided[49].Go to:PSYCHOSOMATIC DISORDERS/DEPRESSIONMany patients usually experience enhanced self esteem and improved situational depression following weight loss. Depression often requires continued treatment, specially that, many patients with severe obesity often use food for emotional reasons. Therefore, when those patients experience a small gastric pouch postoperatively they may grieve the loss of food. Many studies documented the relationship between eating disorder and anxiety disorder, depression or schizophrenia[50,51]. Displaced emotions can result in somatization with symptoms of depression and psychosomatic disorders. It is important that clinicians recognize the psychological aspect of food loss after bariatric surgery, and reassure patients that the symptoms are related to the small gastric pouch size. Antidepressants often help to decrease the anxiety related to grieving associated with food loss, although the use of antidepressants needs to be approached with an empathetic style. Behavioral and emotive therapies are reported to be very helpful[52,53].Go to:OUTCOMEBariatric surgery remains the only effective sustained weight loss option for morbidly obese patients. The American Society for Metabolic and Bariatric Surgery estimated that in 2008 alone, about 220000 patients in the United States underwent a weight loss operation. The optimal choice for type of bariatric procedure, i.e., RYGB, SG, AGB or the selected surgical approach, i.e., open versus laparoscopic depends upon each individualized goals, i.e., weight loss, glycemic control, surgical skills, center experience, patient preferences, personalized risk assessment and other medical facilities. Laparoscopic sleeve gastrectomy is the most common bariatric procedure. However weight re-gain after long-term follow-up was reported[54-58]. Prospective studies and reviews report a general tendency for patients with metabolic disorders to improve or normalize after bariatric surgery. However weight loss is highly variable following each procedure. Recent studies have evaluated the potential impact of obesity on outcomes in organ-transplant recipients, for example bariatric surgery may be an important bridge to transplantation for morbidly obese patients with severe heart failure[59-63].Go to:RECENT ADVANCES IN BARIATRIC SURGERYA modified intestinal bypass bariatric procedure (Elbanna operation), reported a novel surgical technique designed to maintain good digestion, better satiety, and selective absorption with less medical and surgical complications (Figure ​(Figure5).5). This procedure preserves the proximal duodenum and the terminal ileum and thus preserving the anatomical biliary drainage and enterohepatic circulation[64,65].Figure 5Novel ElBanna surgical procedure.Recently, a novel bariatric technique dedicated; Modified Elbanna technique in childhood bariatric, showed promising success in pediatric surgeries (non published data).Go to:CONCLUSIONThe rising prevalence of overweight and obesity in several countries has been described as a global pandemic. Obesity can be considered like the driving force towards the pre-mature deaths. It increases the like hood for the development of diabetes, hypertension and NASH. The American Heart Association identified obesity as an independent risk factor for the development of coronary heart disease. In order to minimize post-surgical cardiovascular risk, surgical weight loss may become a more frequently utilized option to address obesity. Currently, bariatric surgery passes through a plateau phase, hence medical management and follow up of patients who have undergone bariatric surgery is a challenge.Go to:FUTURE RECOMMENDATIONSChildren obesity has become one of the most important public health problems in many industrial countries. In the United States alone, 5% of children have severe obesity. It is imperative that health care providers should identify overweight and obese children so as to start early counseling and therapy. To establish a therapeutic relationship and enhance effectiveness, the communication and interventions should be supported by the entire family, society, school, public media and primary health care. Bariatric surgery could be considered in complicated cases that failed all other options.Go to:FootnotesP- Reviewer: Amiya E, Firstenberg MS, Narciso-Schiavon JL S- Editor: Tian YL L- Editor: A E- Editor: Lu YJGo to:References1. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–1576. [PMC free article] [PubMed]2. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–781. [PMC free article] [PubMed]3. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375:1609–1623. [PubMed]4. Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Rector A, Dwyer L, Costa M, Lopez AD, Murray CJ. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet. 2010;375:1988–2008.[PubMed]5. Bleich S, Cutler D, Murray C, Adams A. Why is the developed world obese? Annu Rev Public Health. 2008;29:273–295. [PubMed]6. Food and Agriculture Organization Corporate Statistical Database. Food balance sheets. Available from:http://faostat3.fao.org/faostat-gateway/go/to/home/E.7. UN Department of Economic and Social Affairs, Population Division. World population prospects: the 2010 revision. Volume 1: Comprehensive tables. New York: United Nations; 2011.8. Astrup A, Brand-Miller J. Diet composition and obesity. Lancet. 2012;379:1100; author reply 1100–1101. [PubMed]9. Drewnowski A, Popkin BM. The nutrition transition: new trends in the global diet. Nutr Rev. 1997;55:31–43. [PubMed]10. Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004;24:401–431. [PubMed]11. Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr. 2009;90:1453–1456. [PubMed]12. Popkin BM. The nutrition transition and obesity in the developing world. J Nutr. 2001;131:871S–873S.[PubMed]13. Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, Wollum A, Sanman E, Wulf S, Lopez AD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014;311:183–192. [PubMed]14. Ben-Menachem T. Risk factors for cholangiocarcinoma. Eur J Gastroenterol Hepatol. 2007;19:615–617. [PubMed]15. Younossi ZM, Stepanova M, Negro F, Hallaji S, Younossi Y, Lam B, Srishord M. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore) 2012;91:319–327. [PubMed]16. American Society for Metabolic and Bariatric Surgery. Fact Sheet: Metabolic and Bariatric Surgery. Available from: http://www.asbs.org/ Newsite07/media/asbs_presskit.htm.17. Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K, Lane J. Trends in use of bariatric surgery, 2003-2008. J Am Coll Surg. 2011;213:261–266. [PubMed]18. Dimick JB, Nicholas LH, Ryan AM, Thumma JR, Birkmeyer JD. Bariatric surgery complications before vs after implementation of a national policy restricting coverage to centers of excellence. JAMA. 2013;309:792–799. [PMC free article] [PubMed]19. Chen KN. Managing complications I: leaks, strictures, emptying, reflux, chylothorax. J Thorac Dis. 2014;6 Suppl 3:S355–S363. [PMC free article] [PubMed]20. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & amp; Bariatric Surgery. Obesity (Silver Spring) 2013;21 Suppl 1:S1–27. [PMC free article] [PubMed]21. Tucker ON, Szomstein S, Rosenthal RJ. Nutritional consequences of weight-loss surgery. Med Clin North Am. 2007;91:499–514, xii. [PubMed]22. Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, Ahlin S, Anveden Å, Bengtsson C, Bergmark G, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65. [PubMed]23. Bouldin MJ, Ross LA, Sumrall CD, Loustalot FV, Low AK, Land KK. The effect of obesity surgery on obesity comorbidity. Am J Med Sci. 2006;331:183–193. [PubMed]24. Schweiger C, Weiss R, Keidar A. Effect of different bariatric operations on food tolerance and quality of eating. Obes Surg. 2010;20:1393–1399. [PubMed]25. Ortega J, Ortega-Evangelio G, Cassinello N, Sebastia V. What are obese patients able to eat after Roux-en-Y gastric bypass? Obes Facts. 2012;5:339–348. [PubMed]26. Nelson WK, Fatima J, Houghton SG, Thompson GB, Kendrick ML, Mai JL, Kennel KA, Sarr MG. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140:517–522, discussion 522-523. [PubMed]27. Shen Z, Li Y, Yu C, Shen Y, Xu L, Xu C, Xu G. A cohort study of the effect of alcohol consumption and obesity on serum liver enzyme levels. Eur J Gastroenterol Hepatol. 2010;22:820–825. [PubMed]28. Koenig SM. Pulmonary complications of obesity. Am J Med Sci. 2001;321:249–279. [PubMed]29. Holes-Lewis KA, Malcolm R, O’Neil PM. Pharmacotherapy of obesity: clinical treatments and considerations. Am J Med Sci. 2013;345:284–288. [PubMed]30. Sakcak I, Avsar FM, Cosgun E, Yildiz BD. Management of concurrent cholelithiasis in gastric banding for morbid obesity. Eur J Gastroenterol Hepatol. 2011;23:766–769. [PubMed]31. Herrara MF, Lozano-Salazar RR, González-Barranco J, Rull JA. Diseases and problems secondary to massive obesity. Eur J Gastroenterol Hepatol. 1999;11:63–67. [PubMed]32. Lassailly G, Caiazzo R, Hollebecque A, Buob D, Leteurtre E, Arnalsteen L, Louvet A, Pigeyre M, Raverdy V, Verkindt H, et al. Validation of noninvasive biomarkers (FibroTest, SteatoTest, and NashTest) for prediction of liver injury in patients with morbid obesity. Eur J Gastroenterol Hepatol. 2011;23:499–506. [PubMed]33. Hofsø D, Nordstrand N, Johnson LK, Karlsen TI, Hager H, Jenssen T, Bollerslev J, Godang K, Sandbu R, Røislien J, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163:735–745.[PMC free article] [PubMed]34. Service GJ, Thompson GB, Service FJ, Andrews JC, Collazo-Clavell ML, Lloyd RV. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353:249–254. [PubMed]35. Arterburn DE, Bogart A, Sherwood NE, Sidney S, Coleman KJ, Haneuse S, O’Connor PJ, Theis MK, Campos GM, McCulloch D, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23:93–102. [PMC free article] [PubMed]36. Fass R, Shapiro M, Dekel R, Sewell J. Systematic review: proton-pump inhibitor failure in gastro-oesophageal reflux disease--where next? Aliment Pharmacol Ther. 2005;22:79–94. [PubMed]37. Löfdahl HE, Lane A, Lu Y, Lagergren P, Harvey RF, Blazeby JM, Lagergren J. Increased population prevalence of reflux and obesity in the United Kingdom compared with Sweden: a potential explanation for the difference in incidence of esophageal adenocarcinoma. Eur J Gastroenterol Hepatol. 2011;23:128–132.[PubMed]38. Fornari F, Madalosso CA, Farré R, Gurski RR, Thiesen V, Callegari-Jacques SM. The role of gastro-oesophageal pressure gradient and sliding hiatal hernia on pathological gastro-oesophageal reflux in severely obese patients. Eur J Gastroenterol Hepatol. 2010;22:404–411. [PubMed]39. Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008;248:714–720. [PubMed]40. Salgado W, Modotti C, Nonino CB, Ceneviva R. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis. 2014;10:49–54. [PubMed]41. Klockhoff H, Näslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery. Br J Clin Pharmacol. 2002;54:587–591. [PMC free article] [PubMed]42. Maluenda F, Csendes A, De Aretxabala X, Poniachik J, Salvo K, Delgado I, Rodriguez P. Alcohol absorption modification after a laparoscopic sleeve gastrectomy due to obesity. Obes Surg. 2010;20:744–748. [PubMed]43. Woodard GA, Downey J, Hernandez-Boussard T, Morton JM. Impaired alcohol metabolism after gastric bypass surgery: a case-crossover trial. J Am Coll Surg. 2011;212:209–214. [PubMed]44. King WC, Chen JY, Mitchell JE, Kalarchian MA, Steffen KJ, Engel SG, Courcoulas AP, Pories WJ, Yanovski SZ. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307:2516–2525. [PMC free article] [PubMed]45. Sasse KC, Ganser J, Kozar M, Watson RW, McGinley L, Lim D, Weede M, Smith CJ, Bovee V. Seven cases of gastric perforation in Roux-en-Y gastric bypass patients: what lessons can we learn? Obes Surg. 2008;18:530–534. [PubMed]46. Capella JF, Capella RF. Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg. 1999;9:22–27; discussion 28. [PubMed]47. Abd Elrazek AE, Mahfouz HM, Metwally AM, El-Shamy AM. Mortality prediction of nonalcoholic patients presenting with upper gastrointestinal bleeding using data mining. Eur J Gastroenterol Hepatol. 2014;26:187–191. [PubMed]48. Abd Elrazek AE, Yoko N, Hiroki M, Afify M, Asar M, Ismael B, Salah M. Endoscopic management of Dieulafoy’s lesion using Isoamyl-2-cyanoacrylate. World J Gastrointest Endosc. 2013;5:417–419.[PMC free article] [PubMed]49. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20:517–525.[PubMed]50. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307:491–497. [PubMed]51. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235–241. [PubMed]52. García-García ML, Martín-Lorenzo JG, Campillo-Soto A, Torralba-Martínez JA, Lirón-Ruiz R, Miguel-Perelló J, Mengual-Ballester M, Aguayo-Albasini JL. [Complications and level of satisfaction after dermolipectomy and abdominoplasty post-bariatric surgery] Cir Esp. 2014;92:254–260. [PubMed]53. Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci. 2006;331:166–174. [PubMed]54. Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, Nolen WA, Zitman FG, Beekman AT, Penninx BW. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA) J Clin Psychiatry. 2011;72:341–348.[PubMed]55. de Graaf R, Bijl RV, Smit F, Vollebergh WA, Spijker J. Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. Am J Psychiatry. 2002;159:620–629. [PubMed]56. Cesana G, Uccelli M, Ciccarese F, Carrieri D, Castello G, Olmi S. Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy. World J Gastrointest Surg. 2014;6:101–106.[PMC free article] [PubMed]57. Lee WJ, Ser KH, Chong K, Lee YC, Chen SC, Tsou JJ, Chen JC, Chen CM. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147:664–669. [PubMed]58. Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, Heinberg LJ, Kushner R, Adams TD, Shikora S, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & amp; Bariatric Surgery. Surg Obes Relat Dis. 2013;9:159–191. [PubMed]59. Adams PL. Long-term patient survival: strategies to improve overall health. Am J Kidney Dis. 2006;47:S65–S85. [PubMed]60. Gore JL, Pham PT, Danovitch GM, Wilkinson AH, Rosenthal JT, Lipshutz GS, Singer JS. Obesity and outcome following renal transplantation. Am J Transplant. 2006;6:357–363. [PubMed]61. Meier-Kriesche HU, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation. 2002;73:70–74. [PubMed]62. Wikiel KJ, McCloskey CA, Ramanathan RC. Bariatric surgery: a safe and effective conduit to cardiac transplantation. Surg Obes Relat Dis. 2014;10:479–484. [PubMed]63. DiCecco SR, Francisco-Ziller N. Obesity and organ transplantation: successes, failures, and opportunities. Nutr Clin Pract. 2014;29:171–191. [PubMed]64. Elbanna A, Tawella N, Neff K, Abd Elfattah A, Bakr I. Abstracts from the 18th World Congress of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO), Istanbul, Turkey 28-31 August 2013. Obes Surg. 2013;23:1017–1243.65. Elbanna A, Taweela NH, Gaber MB, Tag El-Din MM, Labib MF, Emam MA, Khalil OO, Abdel Meguid MM, Abd Elrazek MAA. Medical Management of Patients with Modified Intestinal Bypass: A New Promising Procedure for Morbid Obesity. GJMR. 2014;14:8–19.Articles from World Journal of Gastrointestinal Surgery are provided here courtesy of Baishideng Publishing Group Inc

Where do you get the information about the USA not signing the WHO covid 19 inquiry? I could not find a list of participating countries._Requested by Et WuUSA IS THE ODD ONE OUT!!! WANTS TO INVESTIGATE CHINA, BUT NOT USA!!SEVENTY-THIRD WORLD HEALTH ASSEMBLY A73/CONF./1 Rev.1Agenda item 3 … 18 May 2020 COVID-19 responseDraft resolution proposed by Albania, Australia, Azerbaijan, Bahrain, Bangladesh, Belarus, Bhutan, Bolivia (Plurinational State of), Brazil, Canada, Chile, China, Colombia, Cook Islands, Costa Rica, Djibouti, Dominican Republic, Ecuador, El Salvador, Fiji, Georgia, Guatemala, Guyana, Honduras, Iceland, India, Indonesia, Iraq, Jamaica, Japan, Jordan, Kiribati, Maldives, Marshall Islands, Mexico, Micronesia (Federated States of), Monaco, Montenegro, Morocco, Nauru,Nepal, New Zealand, North Macedonia, Norway, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Qatar, Republic of Korea, Republic of Moldova, Russian Federation, San Marino, Saudi Arabia, Serbia, Singapore, Sri Lanka, Thailand, the African Group and its Member States, the European Union and its Member States, Tonga, Tunisia, Turkey, Ukraine, United Kingdom of Great Britain and Northern Ireland and UruguayThe Seventy-third World Health Assembly,Having considered the address of the Director-General on the ongoing COVID-19 pandemic,1PP1 Deeply concerned by the morbidity and mortality caused by COVID-19 pandemic, the negative impacts on physical and mental health and social well-being, the negative impacts on economy and society and the consequent exacerbation of inequalities within and between countries;PP2 Expressing solidarity to all countries affected by the pandemic, as well as condolences and sympathy to all the families of the victims of COVID-19;PP3 Underlining the primary responsibility of governments to adopt and implement responses to the COVID-19 pandemic that are specific to their national context as well as for mobilizing the necessary resources to do so;PP4 Recalling the constitutional mandate of WHO to act, inter alia, as the directing and coordinating authority on international health work, and recognizing its key leadership role within the1 Document A73/3.A73/CONF./1 Rev.1broader United Nations response and the importance of strengthened multilateral cooperation in addressing the COVID-19 pandemic and its extensive negative impacts;PP5 Recalling the Constitution of WHO, which defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, and declares that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, political belief, economic or social condition;PP6 Recalling the declaration of a Public Health Emergency of International Concern on novel Coronavirus (2019-nCoV) on 30 January 2020 by the Director-General; and the temporary recommendations issued by the Director-General under the International Health Regulations (2005, IHR) upon the advice of the Emergency Committee for COVID-19;PP7 Recalling the United Nations General Assembly resolutions A/RES/74/270 on “Global solidarity to fight the coronavirus disease 2019 (COVID-19)” and A/RES/74/274 on “International cooperation to ensure global access to medicines, vaccines and medical equipment to face COVID-19”;PP8 Noting resolution EB146.R10 entitled “Strengthening Preparedness for Health Emergencies: implementation of the International Health Regulations (2005)” and reiterating the obligation for all Parties to fully implement and comply with the IHR;PP9 Noting WHO’s Strategic Preparedness and Response Plan (SPRP) and the Global Humanitarian Response Plan for COVID-19;PP10 Recognizing that the COVID-19 pandemic disproportionately affects the poor and the most vulnerable people, with repercussions on health and development gains, in particular in low- and middle-income and developing countries, thus hampering the achievement of the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) including through the strengthening of Primary Health Care, and reiterating the importance of continued and concerted efforts, and the provision of development assistance, and further recognizing with deep concern the impact of high debt levels on countries’ ability to withstand the impact of the COVID-19 shock;PP11 Recognizing further the negative impacts of the COVID-19 pandemic on health, including hunger and malnutrition, increased violence against women, children, and frontline health workers, as well as disruptions in care of older persons and persons with disabilities;PP12 Emphasizing the need to protect populations, in particular people with pre-existing health conditions, older persons, and other people at risk of COVID-19 including health professionals, health workers and other relevant frontline workers, especially women who represent the majority of the health workforce as well as persons with disabilities, children and adolescents and people in vulnerable situations, and stressing the importance of age-, gender-responsive and disability-sensitive measures in this regard;PP13 Recognizing the need for all countries to have unhindered timely access to quality, safe, efficacious and affordable diagnostics, therapeutics, medicines and vaccines, and essential health technologies, and their components as well as equipment for the COVID-19 response;PP14 Noting the need to ensure the safe and unhindered access of humanitarian personnel, in particular medical personnel responding to the COVID-19 pandemic, their means of transport and equipment, and to protect hospitals and other medical facilities as well as the delivery of supplies and2equipment, in order to allow such personnel to efficiently and safely perform their task of assisting affected civilian populations;PP15 Recalling resolution 46/182 of 19 December 1991 on the strengthening of the coordination of emergency humanitarian assistance of the United Nations and all subsequent General Assembly resolutions on the subject, including resolution 74/118 of 16 December 2019;PP16 Underscoring that respect for international law, including international humanitarian law, is essential to contain and mitigate outbreaks of COVID-19 in armed conflicts;PP17 Recognizing further the many unforeseen public health impacts, challenges and resource needs generated by the ongoing COVID-19 pandemic and the potential re-emergences, as well as the multitude and complexity of necessary immediate and long-term actions, coordination and collaboration required at all levels of governance across organizations and sectors, including civil society and the private sector, required to have an efficient and coordinated public health response to the pandemic, leaving no-one behind;PP18 Recognizing the importance of planning and preparing for the recovery phase, including to mitigate the impact of the pandemic and of the unintended consequences of public health measures on society, public health, human rights and the economy;PP19 Expressing optimism that the COVID-19 pandemic can be successfully mitigated, controlled and overcome through leadership and sustained global cooperation, unity, and solidarity;OP1 Calls for, in the spirit of unity and solidarity, intensification of cooperation and collaboration at all levels to contain, control and mitigate the COVID-19 pandemic;OP2 Acknowledges the key leadership role of WHO and the fundamental role of the United Nations system in catalysing and coordinating the comprehensive global response to the COVID-19 pandemic and the central efforts of Member States therein;OP3 Expresses its highest appreciation of and support to the dedication, efforts and sacrifices, above and beyond the call of duty of health professionals, health workers and other relevant frontline workers, as well as the WHO Secretariat, in responding to the COVID-19 pandemic;OP4 Calls for the universal, timely and equitable access to and fair distribution of all quality, safe, efficacious and affordable essential health technologies and products including their components and precursors required in the response to the COVID-19 pandemic as a global priority, and the urgent removal of unjustified obstacles thereto; consistent with the provisions of relevant international treaties including the provisions of the TRIPS agreement and the flexibilities as confirmed by the Doha Declaration on the TRIPS Agreement and Public Health;OP5 Reiterates the importance of urgently meeting the needs of low- and middle-income countries in order to fill the gaps to overcome the pandemic through timely and adequate development and humanitarian assistance;OP6 Recognizes the role of extensive immunization against COVID-19 as a global public good for health in preventing, containing and stopping transmission in order to bring the pandemic to an end, once safe, quality, efficacious, effective, accessible and affordable vaccines are available;A73/CONF./1 Rev.13A73/CONF./1 Rev.1OP7 Calls on Member States,1 in the context of the COVID-19 pandemic, to:OP7.1 Put in place a whole of government and whole of society response including through implementing a national, cross-sectoral COVID-19 action plan that outlines both immediate and long term actions with a view to sustainably strengthening their health system and social care and support systems, preparedness, surveillance and response capacities as well as taking into account, according to national context, WHO guidance, engaging with communities and collaborating with relevant stakeholders;OP7.2 Implement national action plans by putting in place, according to their specific contexts, comprehensive, proportionate, time-bound, age- and disability-sensitive and gender-responsive measures across government sectors against COVID-19, ensuring respect for human rights and fundamental freedoms and paying particular attention to the needs of people in vulnerable situations, promoting social cohesion, taking necessary measures to ensure social protection, protection from financial hardship and preventing insecurity, violence, discrimination, stigmatization and marginalization;OP7.3 Ensure that restrictions on the movement of persons and of medical equipment and medicines in the context of COVID-19 are temporary and specific and include exceptions for the movement of humanitarian and health workers, including community health workers to fulfil their duties and for the transfer of equipment and medicines required by humanitarian organizations for their operations;OP7.4 Take measures to support access to safe water, sanitation and hygiene, and infection prevention and control, ensuring that adequate attention is placed on the promotion of personal hygienic measures in all settings, including humanitarian settings and particularly in health facilities;OP7.5 Maintain the continued functioning of the health system in all relevant aspects, in accordance with national context and priorities, necessary for an effective public health response to the COVID-19 pandemic and other ongoing epidemics, and the uninterrupted and safe provision of population and individual level services, for, among others, communicable diseases, including by undisrupted vaccination programmes, neglected tropical diseases, noncommunicable diseases, mental health, mother and child health and sexual and reproductive health and promote improved nutrition for women and children, recognizing in this regard the importance of increased domestic financing and development assistance where needed in the context of achieving UHC;OP7.6 Provide the population with reliable and comprehensive information on COVID-19 and the measures taken by authorities in response to the pandemic, and take measures to counter misinformation and disinformation and as well as malicious cyber activities;OP7.7 Provide access to safe testing, treatment, and palliative care for COVID-19, paying particular attention to the protection of those with pre-existing health conditions, older persons, and other people at risk, in particular health professionals, health workers and other relevant frontline workers;OP7.8 Provide health professionals, health workers and other relevant frontline workers exposed to COVID-19, access to personal protective equipment and other necessary commodities and1 And regional economic integration organizations as appropriate.4training, including in the provision of psychosocial support, taking measures for their protection at work, facilitating their access to work, and the provision of their adequate remuneration, consider also the introduction of task-sharing and task-shifting to optimize the use of resources;OP7.9 Leverage digital technologies for the response to COVID-19, including for addressing its socioeconomic impact, paying particular attention to digital inclusion, patient empowerment, data privacy, and security, legal and ethical issues, and the protection of personal data;OP7.10 Provide WHO timely, accurate and sufficiently detailed public health information related to the COVID-19 pandemic as required by the IHR;OP7.11 Share, COVID-19 related knowledge, lessons learned, experiences, best practices, data, materials and commodities needed in the response with WHO and other countries, as appropriate;OP7.12 Collaborate to promote both private sector and government-funded research and development, including open innovation, across all relevant domains on measures necessary to contain and end the COVID-19 pandemic, in particular on vaccines, diagnostics, and therapeutics and share relevant information with WHO;OP7.13 Optimize prudent use of antimicrobials in the treatment of COVID-19 and secondary infections in order to prevent the development of antimicrobial resistance;OP7.14 Strengthen actions to involve women’s participation in all stages of decision-making processes, and mainstream a gender perspective in the COVID-19 response and recovery;OP7.15 Provide sustainable funding to WHO to ensure that it can fully respond to public health needs in the global response to COVID-19, leaving no one behind;OP8 CALLS on international organizations and other relevant stakeholders to:OP8.1 Support all countries, upon their request, in the implementation of their multisectoral national action plans and in strengthening their health systems to respond to the COVID-19 pandemic, and in maintaining the safe provision of all other essential public health functions and services;OP8.2 Work collaboratively at all levels to develop, test, and scale-up production of safe, effective, quality, affordable diagnostics, therapeutics, medicines and vaccines for the COVID-19 response, including, existing mechanisms for voluntary pooling and licensing of patents to facilitate timely, equitable and affordable access to them, consistent with the provisions of relevant international treaties including the provisions of the TRIPS agreement and the flexibilities as confirmed by the Doha Declaration on the TRIPS Agreement and Public Health;OP8.3 Address, and where relevant in coordination with Member States, the proliferation of disinformation and misinformation particularly in the digital sphere, as well as the proliferation of malicious cyber-activities that undermine the public health response, and support the timely provision of clear, objective and science-based data and information to the public;A73/CONF./1 Rev.15A73/CONF./1 Rev.1OP9 REQUESTS the Director-General to:OP9.1 Continue to work with the United Nations Secretary-General and relevant multilateral organizations, including the signatory agencies of the Global Action Plan for Healthy Lives and Well-Being, on a comprehensive and coordinated response across the United Nations system to support Member States in their responses to the COVID-19 pandemic in full cooperation with governments, as appropriate, demonstrating leadership on health in the United Nations system, and continue to act as the health cluster lead in the United Nations humanitarian response;OP9.2 Continue to build and strengthen the capacities of WHO at all levels to fully and effectively perform the functions entrusted to it under the IHR;OP9.3 Assist and continue to call upon all States’ Parties to take the actions according to the provisions of the IHR, including by providing all necessary support to countries for building, strengthening and maintaining their capacities to fully comply with the IHR;OP9.4 Provide assistance to countries upon their request, in accordance with their national context, to support the continued safe functioning of the health system in all relevant aspects necessary for an effective public health response to the COVID-19 pandemic and other ongoing epidemics, and the uninterrupted and safe provision of population and individual level services, for, among others, communicable diseases, including by undisrupted vaccination programmes, neglected tropical diseases, noncommunicable diseases, mental health, mother and child health and sexual and reproductive health and promote improved nutrition for women and children;OP9.5 Assist countries upon request in developing, implementing and adapting relevant national response plans to COVID-19, by developing, disseminating and updating normative products and technical guidance, learning tools, data and scientific evidence for COVID-19 responses, including to counter misinformation and disinformation, as well as malicious cyber activities, and continue to work against substandard and falsified medicines and medical products;OP9.6 Continue to work closely with the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and countries, as part of the One-Health Approach to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts, including through efforts such as scientific and collaborative field missions, which will enable targeted interventions and a research agenda to reduce the risk of similar events as well as to provide guidance on how to prevent SARS-COV2 infection in animals and humans and prevent the establishment of new zoonotic reservoirs, as well as to reduce further risks of emergence and transmission of zoonotic diseases;OP9.7 Regularly inform Member States, including through Governing Bodies, on the results of fundraising efforts, the global implementation of and allocation of financial resources through the WHO Strategic Preparedness and Response Plan (SPRP), including funding gaps and results achieved, in a transparent, accountable and swift manner, in particular on the support given to countries;OP9.8 Rapidly, and noting OP2 of RES/74/274 and in consultation with Member States,1 and with inputs from relevant international organizations civil society, and the private sector, as1 And regional economic integration organizations as appropriate.6A73/CONF./1 Rev.1appropriate, identify and provide options that respect the provisions of relevant international treaties, including the provisions of the TRIPS agreement and the flexibilities as confirmed by the Doha Declaration on the TRIPS Agreement and Public Health to be used in scaling up development, manufacturing and distribution capacities needed for transparent equitable and timely access to quality, safe, affordable and efficacious diagnostics, therapeutics, medicines, and vaccines for the COVID-19 response taking into account existing mechanisms, tools, and initiatives, such as the Access to COVID-19 Tools (ACT) accelerator, and relevant pledging appeals, such as “The Coronavirus Global Response” pledging campaign, for the consideration of the Governing Bodies;OP9.9 Ensure that the Secretariat is adequately resourced to support the Member States granting of regulatory approvals needed to enable timely and adequate COVID-19 countermeasures;OP9.10 Initiate, at the earliest appropriate moment, and in consultation with Member States,1 a stepwise process of impartial, independent and comprehensive evaluation, including using existing mechanisms,2 as appropriate, to review experience gained and lessons learned from the WHO-coordinated international health response to COVID-19, including (i) the effectiveness of the mechanisms at WHO’s disposal; (ii) the functioning of the IHR and the status of implementation of the relevant recommendations of the previous IHR Review Committees; (iii) WHO’s contribution to United Nations-wide efforts; and (iv) the actions of WHO and their timelines pertaining to the COVID-19 pandemic, and make recommendations to improve global pandemic prevention, preparedness, and response capacity, including through strengthening, as appropriate, WHO’s Health Emergencies Programme;OP9.11 Report to the Seventy-fourth World Health Assembly, through the 148th session of the Executive Board, on the implementation of this resolution.===1 And regional economic integration organizations as appropriate.2 Including an IHR Review Committee and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme.7I have attached in full-entirety Mr Ridswan Abdul Rahman’s informative article:More than 100 countries, including China, have signed the agreement proposed by the EU to investigate the source of the Covid-19 globally. Why does the United States refuse to sign the agreement?Ridzwan Abdul Rahman Thu Lives in Asia.The probable reason is that the US does not want to be investigated.If an investigation were to be carried out to find the origin of the virus, the US must be investigated together with China. Participants at the Wuhan military games last October should be asked to provide information. Many of the athletes, from France, Spain, Italy, Sweden and other countries reported being ill with what appeared to be COVID-19 symptoms. ( Coronavirus may have been spreading since Wuh... | Taiwan News)France could provide some evidence, because a team of researchers in the city of Colmar in northeastern France announced in a release recently that it had identified two X-rays, from Nov. 16 and Nov. 18, showing symptoms consistent with the novel coronavirus. ( New evidence in race to find France’s COVID-19 'patient zero') The Wuhan games were held in October. There is a possibility that these November French infections originated from the athletes who returned from Wuhan after the games.Before the above infections, five US athletes became sick and were taken to an infectious disease clinic in Wuhan. Some people claim it was malaria but that does not make sense because there has been no malaria infections in China for a long time. To suddenly have five cases - all Americans - is hard to believe. China has asked the US to provide the medical records of these 5 athletes but to no avail. US urged to release health info of military athletes who came to Wuhan in October 2019According to Israel, US intelligence agencies alerted Israel to the coronavirus outbreak in China last November, at a time when China was not even aware of its existence. Could the five sick athletes be the reason the US knew? US alerted Israel, NATO to disease outbreak in China in November — TV reportIn March this year a group of European universities did a research on the spread of SARS-CoV-2 and concluded that it started in either Europe or US, then spread to China, then spread again to Europe and US. They wrote:In a phylogenetic network analysis of 160 complete human severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) genomes, we find three central variants distinguished by amino acid changes, which we have named A, B, and C, with A being the ancestral type according to the bat outgroup coronavirus. The A and C types are found in significant proportions outside East Asia, that is, in Europeans and Americans. In contrast, the B type is the most common type in East Asia. (http://ttps://www.pnas.org/content/pnas/early/2020/04/07/2004999117.full.pdf)The Fort Detrick military laboratory in Maryland, that handled high-level disease-causing material, was ordered by the US to close down in July 2019. An independent investigation should be conducted to find out the real reasons for closure.According to estimates by the CDC, the seasonal flu that started in September last year has infected over 30 million US citizens, causing more than 20,000 deaths. Head of CDC, Robert Redfield, admitted in March this year that some coronavirus-related deaths have been found posthumously that were previously thought to be flu-related.So, if an independent investigation is to be carried out to determine the origin of SARS-CoV-2, the US too should be investigated, together with China.