World Grain Reserves ‘At A Very Low Level, Leaving No Room’ For Extreme Weather, Warns UN

World grain reserves are so dangerously low that severe weather in the United States or other food-exporting countries could trigger a major hunger crisis next year, the United Nations has warned.

Failing harvests in the US, Ukraine and other countries this year have eroded reserves to their lowest level since 1974. The US, which has experienced record heatwaves and droughts in 2012, now holds in reserve a historically low 6.5% of the maize that it expects to consume in the next year, says the UN.

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“We’ve not been producing as much as we are consuming. That is why stocks are being run down. Supplies are now very tight across the world and reserves are at a very low level, leaving no room for unexpected events next year,” said Abdolreza Abbassian, a senior economist with the UN Food and Agriculture Organization. Read more >>

Global food prices jump 10% in July

Global food prices have leapt by 10% in the month of July, raising fears of soaring prices for the planet's poorest, the World Bank has warned. The bank said that a US heatwave and drought in parts of Eastern Europe were partly to blame for the rising costs.

The price of key grains such as corn, wheat and soybean saw the most dramatic increases, described by the World Bank president as "historic". The bank warned countries importing grains will be particularly vulnerable. From June to July this year, corn and wheat prices each rose by 25% while soybean prices increased by 17%, the World Bank said. Only rice prices decreased - by 4%.

In the United States, the most severe, widespread drought in half a century has wreaked havoc on the corn and soybean crops while in Russia, Ukraine and Kazakhstan, wheat crops have been badly damaged. The World Bank said that the use of corn to produce ethanol biofuel - which represents 40% of US corn production - was also a key factor in the sharp rise in the US maize price. Read more >>

Wheat Fields Wilt in Drought as Parched Earth Spreads From China to Kansas

Image via WikipediaThe worst droughts in decades are wilting wheat fields from China to the U.S. to the U.K., overwhelming Russia’s return to grain markets and driving prices to the highest levels since 2008.

Parts of China, the biggest grower, had the least rain in a century, some European regions are the driest in 50 years and almost half the winter-wheat crop in the U.S., the largest exporter, is rated poor or worse. Inventory is dropping 8.8 percent, the most in five years, Rabobank International says. Prices will advance 20 percent to as high as $9.25 a bushel by Dec. 31, a Bloomberg survey of 14 analysts and traders shows.

Wheat as much as doubled in the past year as crops failed, spurring Ukraine and Russia to curb shipments and increasing the U.S. share of global sales by the most since 2004. Russia ending its export ban on July 1 and Ukraine lifting quotas may not be enough as crops wither elsewhere, fuelling gains in food prices which the United Nations says are already near a record.

“In 32 years, I’ve never seen so many problems in so many places,” said Dan Basse, the president of AgResource Co., a farm researcher in Chicago. “We’re concerned about the world story now,” said Basse, who has been studying agricultural markets since 1979 and expects prices as high as $10 this year. More...

D225G Ukraine Norway Link and China Spread

Recombinomics Commentary 14:15
November 25, 2009
The same mutation has been found in both fatal and mild cases elsewhere, including in Brazil, Japan, Mexico, Ukraine, and the United States, said the WHO.

WHO's spokeswoman in Beijing, Vivian Tan, said the agency is aware of three such cases in China that occurred in June and July that were similar to the cases being investigated in Norway. Tan said WHO had no information on the cases mentioned in the Xinhua report Wednesday.

There is no evidence the mutated swine flu virus is circulating widely in the world, Tan said, but since it has been linked to deaths in Norway and elsewhere, investigators are focusing on whether this mutation could be a marker for more severe disease.

The above comments are associated with a report of eight D225G isolates with in China. Genbank has three of the sequences, as noted earlier. The increase in examples to eight is not surprising since D225G was in four of four fatal cases in Ukraine and reports from Norway cited detection in three isolates, 2 fatal and 1 severe case who had recovered.

However, 25 HA sequences deposited at Genbank had an HA sequence that contained D225G, A/Norway/2924/2009, but also had the wild type sequence, raising concerns that D225G was circulating as a mixture that was most easily detected in lung samples, because the D225G was more than a "marker". It is a polymorphisms that was found in 1918 and 1919 samples which were well characterized for receptor binding properties, which indicated the change conferred increased binding to gal 2,3 receptors which are present in lung.

Concerns that this receptor binding domain change was widely circulating were increased because an HA marker on the Norway isolate with D225G was found on additional isolates in Norway, and worldwide (see list here). This marker was also in the HA sequences from the fatal cases in Ukraine. Full sequences from one of the Norway isolates, A/Norway/3364-2/2009, were deposited, and a marker on the NA sequence matched isolates with the HA marker, linking this broader set of isolate from Norway with the Ukraine sequences, which also had the NA marker, as did multiple other isolates (see list here).

These associations link Ukraine to Norway, but the D225G polymorphism has jumped onto multiple genetic backgrounds, which are widespread, increasing concerns the D225G is circulating undetected because it is concentrated in lung tissues and is poorly represented in nasopharyngeal swabs. Release of full sequences from China, as well as Norway, would be useful.

Ukraine Dead Approach 400 - D225G Spreads
Recombinomics Commentary 23:30
November 24, 2009
1,679,237 Influenza/ARI

99,661 Hospitalized

397 Dead

The above figures from the latest daily update from the Ukraine Ministry of Health support a decline in the rate of increases of cases and deaths, but the total is now almost 400 fatalities (see map). The spread was likely slowed by the country-wide closing of schools along with warmer weather. However, it is likely that the virus will return as temperatures drop and the traditional flu season begins, although it is unclear if seasonal flu will be in circulation in 2010.

The receptor binding domain change, D225G, was in four of four sequence from fatal cases, raising concerns that the 2,3 alpha specificity of D225G drove the H1N1 to the lungs and the total destruction. Three patients in Norway were said to also have D225G, and two of the three died while the third had been in serious condition. 25 HA sequences from Norway were deposited at Genbank, but only one had D225G, and it was a mixture. In Brazil both patients with D225G in lung samples had died, and the case in China had been in serious condition.

However, the severity of the infection may be related to the ratio of sequences with and without D255G, as well as viral load, because milder cases involving D225G have also been reported in the United States and Hong Kong.

More detail on additional cases, including sequences from upper and lower respiratory tract from the same patient would be useful.

A/H1N1 has mutated to something more deadly - 1918 RBD D225G in Lung Cases in Ukraine and Norway

Image via Wikipedia

1918 RBD D225G in Lung Cases in Ukraine and Norway
Recombinomics Commentary 11:29
November 21, 2009

For the two 1918 HA variants, the South Carolina (SC) HA (with Asp190, Asp225) bound exclusively alpha2-6 receptors, while the New York (NY) variant, which differed only by one residue (Gly225), had mixed alpha2-6/alpha2-3 specificity, especially for sulfated oligosaccharides.

The above description is from a paper analyzing receptor binding domain differences in sequences from the 1918 pandemic. The New York variant had D225G, the same change found in lung tissues from fatal swine H1N1 sequences in Brazil, Ukraine, and Norway. The above result clearly demonstrated a change in receptor specificity for D225G, which was present in A/New York/1/1918 and A/London/1/1919, demonstrating the same change I 1918 that has been described in 2009. Although WHO stated that this change was "not significant" in the Ukraine samples, it was associated with the fatal cases and is cause for concern. The concern was increased by the announcement from Norway indicating the same change was found in fatal H1N1 lung infections there also.

Although there have been comments that this change was "spontaneous" and did not spread, the finding of the same change in all four deceased patients in Ukraine from two distinct locations, indicates it did spread, as did the finding of the same change in multiple cases in Brazil and Norway. Although the concept of "random mutation" has been used to explain away the sudden appearance of the same polymorphism on multiple backgrounds, the appearance via recombination is a much stronger argument for the same change to appear at multiple locations at the same time.

The spontaneous mutation theory, which is the foundation of WHO policy and statements on significance of changes relies heavily on a "selection" component, arguing that the same change keeps appearing on different backgrounds because of string selection pressure. However, this same phenomenon was described for a silent mutation on H5N1, which offers no clear selection pressure. Similarly, a silent change was also found in seasonal H1N1 in sequences that had acquired the Tamiflu resistance marker, H274Y. Thus, these silent (synonymous) changes string argue against a coincidental spontaneous mutation, and instead argue that this acquisition is concurrently acquired because of a widespread common donor.

The concept of acquisition via recombination has serious implications for the current pandemic. It was used to predict the D225G change, in part because the change was "in play" and appearing in July/August sequences at increasing frequency, even though the H1N1 sequences represented different genetic backgrounds. Similarly the clusters of Tamiflu resistance in Wales and North Carolina are also driven by recombination, as happened when the identical change was acquired in H1N1 seasonal flu in patients who were not taking Tamiflu (oseltamivir).

Thus, the concept of recombination predicts that the D225G receptor binding domain change, and the H274Y Tamiflu resistance change, which continue to spread via recombination

British scientists suspect that swine flu virus has mutated in Ukraine

British scientists suspect that swine flu virus has mutated in Ukraine. Some doctors say that flu in the country has shown unprecedented symptoms, creating the effect of burnt lungs, the Daily Mail reports.

Ukraine Dead Increase to 344 - Sequences Released

Recombinomics Commentary 19:17
November 17, 2009

1,502,345 Influenza/ARI

85,904 Hospitalized

344 Dead

The above tally is from the latest update from the Ukraine Ministry of health. The 344 dead represents an increase of 16 from yesterday's total, which is similar to recent daily increases. The steady climb in fatal cases highlights the importance of the release of sequences by Mill Hill a WHO regional center in London.

Included in the sequences from 10 isolates were four HA sequences with the receptor binding domain change, D225G, which was found in the one throat and three lung samples. The change was not found in isolates from nasopharyngeal washes, suggesting D225G may lead to high concentrations of H1N1 in patient's lungs. The high concentration of virus leads to a cytokine storm that destroys the lungs in a few days.

The finding of D225G in lung tissues raises concerns rergarding sequencing of isolates from nasopharyngeal swabs. The monitoring of this important genetic change in the receptor binding domain may require sampling of lung tissues or fluids.

The relationship between the negative nasopharyngeal washes and the lung samples would be useful.

Kudos to Mill Hill and WHO for the prompt release of the panel of H1N1 sequences from Ukraine patients.

RBD D225G in China and Australia Raise Ukraine Concerns
Recombinomics Commentary 14:41
November 18, 2009

The recent outbreak in Ukraine has raised concern that receptor binding domain changes are responsible. Although WHO has issued a new Ukraine situation update and has addressed preliminary changes in a news conference, they have not rule out receptor binding domain changes, and the recent announcement of investigations by two WHO Regional Centers (NIMR in Mill Hill, UK and CDC in Atlanta GA) suggests single nucleotide changes are under investigation.

One such change is the receptor binding domain polymorphism D225G which is present on recently released sequences from China and Australia. The HA sequence from China, A/Zheijiang/DTID-ZJU03/2009, is virtually identical to two earlier sequences from Yiwu (A/Zhejiang/DTID-ZJU02/2009 and A/Zhejiang-Yiwu/11/2009) and all were collected in September and appear to be from the same patient or contacts. The patient eventually recovered, but was seriously ill and hospitalized for several weeks. However, the three sequences from Yiwu match (see list here) sequences from an isolate, A/Hangzhou/1/2009, that is in another location in Zheijiang (see map), indicating D225G was appended onto the Hangzhou genetic background via recombination.

A sequence released Monday at GISAID by the WHO regional center in Australia, A/Sydney/2503/2009, also has D225G, but on a different genetic backbone. The 5' end of the gene matches isolates from Singapore and Japan (see list), which do not have D225G. Thus, D225G is appended onto this background via recombination, but the background in Australia is distinct from the background in China.

Similarly, the two genetic backbones described above are distinct for two isolates in Sao Paulo, which were from fatal cases. The lung isolates signal the jumping of D225G from one genetic backbone to another. This concurrent acquisition has been described in H5N1, as well as the genetic hitchhiking of H274Y in seasonal H1N1.

This jumping of the same polymorphisms form one background to another signals major changes, especially when the polymorphism "in play" is a receptor binding domain change, which is cause for concern.

The recent activity in Ukraine raises concerns that similar changes are in play there, and the failure of WHO to release the sequences or comment on receptor binding domain changes significantly increases these concerns.

“Ukraine swine flu ‘burns’ lungs”– source

russiatoday.com
British scientists suspect that swine flu virus has mutated in Ukraine. Some doctors say that flu in the country has shown unprecedented symptoms, creating the effect of “burnt” lungs, the Daily Mail reports.

Sources said that while British scientists are running their tests of the virus samples from Ukraine, some doctors claim the strain is dangerously mutating.

Read more

These doctors even liken swine flu symptoms in Ukraine with those of the Spanish flu that hit the world in early 20th Century, the Daily Mail reports.

It has also quoted an unnamed doctor in western Ukraine as saying that lungs of Ukraine swine flu victims look strikingly unusual.

“We have carried out post mortems on two victims and found their lungs are as black as charcoal. They look like they have been burned. It's terrifying,” doctor said.

Meanwhile, according to the World Health Organization, no mutations have been registered in virus samples from Ukraine.

The organization was quoted by AP as saying that preliminary genetic sequencing in British and American laboratories showed the virus from Ukraine is similar to that used for production of the pandemic flu vaccine.

The WHO said that the infection rate in Ukraine is quite in line with that in neighboring countries like Russia and Ukraine.

Meanwhile, versions of an H1N1 virus nature keep multiplying.

“It should be called a Jurassic Flu – the DNA of a woman who died in 1918 Spanish flu was recovered from her corpse,” said investigative reporter Wayne Madsen to RT.

“The DNA was used to recreate this virus and some of the individuals, especially of the University of Wisconsin, Madison, are now involved in a process to develop the vaccine for H1N1. I don’t think it takes a detective very much time to figure out what could be a ‘cause and effect’ relationship there,” he added.

Watch more on swine flu in RT’s CrossTalk program.

Russia is stepping into the campaign to help Ukraine tackle the virus. Prime Minister Vladimir Putin has signed an order to provide humanitarian aid to the country.

The Ministry of Health and Social Development allocated about US$800,000 to buy medication for Ukraine which has been delivered to the country by air.

The Ukrainian Health Ministry has registered some 1.5 million flu and respiratory illnesses since the start of the outbreak.

22 countries have sent aid to Ukraine following an appeal by President Yushchenko.

Pneumonic plague, United States Patent 7572449

http://fto.co.za/news
Whether this has anything to do with whats going on in the Ukraine I am not sure but in August there was a patent filed for antibodies against Yersinia Pestis otherwise known as the pneumonic plague.

It was filed by Hill, James (Salisbury, GB) ,Williamson, Ethel Diane (Salisbury, GB) and Titball, Richard William (Salisbury, GE) and the assignee was The Secretary of State for Defense in Her Britannic Majesty's Government of the United Kingdom of Great Britain and Northern Ireland (GB).

A interesting part of the patent is this part:

"Mab 7.3 was administered −4 hours, +24 hours, +48 hours, or +96 hours relative to s.c. Y. pestis challenge. Protection was observed when antibody was given up to 48 hours post-infection. Also, a delayed time to death was observed in the +96 hours treatment group. One of +96 hours treatment group had died prior to antibody administration and the remainder displayed signs of plague indistinguishable from untreated control animals, suggesting that even when symptoms of plague are apparent antibody therapy can delay death. Mice were treated with Mab 7.3 at −4 hours, +24 hours, +48 hours or +60 hours relative to aerosol infection. Protection was seen in groups that received antibody 24 hours and 48 hours after challenge. All mice treated at +60 hours died, but a statistically significant delay in the TTD was observed, compared with untreated animals."

What is more interesting is why was this patent filed in August this year. Maybe its just coincidence but we felt like putting out there so people can decide for themselves.

MILLION HIT BY 'PLAGUE WORSE THAN SWINE FLU'

Greg Miskiw
The Sunday Express
A DEADLY plague could sweep across Europe, doctors fear, after an outbreak of a virus in Ukraine plunged the country and its neighbours into a state of panic.

A cocktail of three flu viruses are reported to have mutated into a single pneumonic plague, which it is believed may be far more dangerous than swine flu. The death toll has reached 189 and more than 1 million people have been infected, most of them in the nine regions of Western Ukraine.

President of Ukraine Viktor Yushchenko has called in the World Health Organisation and a team of nine specialists are carrying out tests in Kiev and Lviv to identify the virus. Samples have been sent to London for analysis.

President Yushchenko said: “People are dying. The epidemic is killing doctors. This is absolutely inconceivable in the 21st Century.”

In a TV interview, the President added: “Unlike similar epidemics in other countries, three causes of serious viral infections came together simultaneously in Ukraine – two seasonal flus and the Californian flu

“Virologists conclude that this combination of infections may produce an even more aggressive new virus as a result of mutation.”

Prime Minister Yulia Tymoshenko has been touring hospitals where victims are being treated and presidential elections in January could be cancelled .

Four men and one woman have died from the flu in Lviv, said emergency hospital chief doctor Myron Borysevych. Two of the dead patients were in the 22-35 age group, with two others over 60. He diagnosed the disease as viral pneumonia.

“We have sent the analyses to Kiev. We don’t believe it’s H1N1 swine flu. Neither do we know what kind of pneumonia it is.”

Universities, schools and kindergartens have been closed, public meetings have been banned and theatres shut. Last week several border crossings in the country were also closed.

Last night reports emerged of profiteering over face masks, which have sold out since the outbreak. There are also incidents of anti-virus medication being sold for exorbitant prices. A spokesman for the World Health Organisation said: “We do not have a time scale for the results of the tests in London, although some preliminary results have been obtained. I cannot tell you what they are.

“We did not have enough of the virus samples so we will have to grow some more before we can come to a conclusive decision about its nature.”

Neighbouring Poland has called on the EU to take action, fearing the mystery virus may spread westwards.

Prime Minister Donald Tusk has written to European Commission President Jose Manuel Barroso and the Swedish Prime Minister, Fredrik Reinfeldt, who holds the EU presidency, saying: “The character of this threat demands that rapid action be undertaken at the European Union level.”

Russia, Slovakia, Poland, Hungary and Romania, countries that border Ukraine, have already launched health checks on Ukrainians entering their territory.

Slovakia has closed two of five border crossings.

A doctor in Western Ukraine who did not want to be named, said:” We have carried out post mortems on two victims and found their lungs are as black as charcoal.

“They look like they have been burned. It’s terrifying.”

Ukraine Dead Increase to 239 - 1,253,558 ill with Influenza/ARI

Ukraine Dead Increase to 239 - Still No Sequences
Recombinomics Commentary 20:26
November 12, 2009
1,253,558 Influenza/ARI

65.615 Hospitalizations

239 Deaths

The above numbers are from the latest update from the Ukraine Ministry of Health. The number of deaths increased 26 to 239, so 50 new deaths have been reported in the past 2 days. Although the virus continues to spread (only 5 of the 27 reporting areas have not topped the epidemic threshold) many of the deaths are still being reported from the hard hit areas in western Ukraine(see map). However, the biggest jump in cases was 6.096 in Kiev to 89,339.

The steady increase in the high level of deaths continues to raise concerns about genetic changes in the H1N1. In this morning's press conference the WHO discussed the need for prompt treatment with Tamiflu, but did not address genetic changes in Ukraine. Only general statements on the stability of the H1N1 were made in response to questions on genetic changes in Ukraine. Today's conference is a week after the last comments on the Ukraine H1N1 sequences which indicated that there were no large changes, but an update would be forthcoming in a "few days". It has now been over a week and no updates on genetic changes have been forthcoming.

The release of the sequences from Ukraine is long overdue.

More than 1 million infected in Ukraine

AFP KIEV — Ukraine's epidemic of flu and acute respiratory disorders has now affected more than a million people, the country's deputy health minister said on Tuesday.

Vasyl Lazoryshynets said the death toll from the epidemic had risen to 174, as President Viktor Yushchenko warned the country must brace itself for a second wave of infections.

Nearly 53,000 Ukrainians have now been hospitalised, Lazoryshynets said, but the number in intensive care has fallen by nearly a quarter to around 330.

A total of 67 cases of swine flu have been reported in Ukraine, he said, 14 of which had been fatal.

"Ukraine must prepare properly for a second wave of respiratory infections and flu," including A(H1N1), Yushchenko said Tuesday, according to the Interfax news agency.

A World Health Organisation (WHO) team in Ukraine said on Monday the epidemic had slowed, but warned a second wave was likely.

On Monday the health ministry's previous bulletin on the epidemic, which began in mid-October, reported 969,000 infections, with 155 deaths and 65 cases of A(H1N1).

Ukraine Closes All Borders Amidst Fears of Pneumonic Plague

Today the borders that link Slovakia to Ukraine will be closing down to stop the spread of the h1n1 epidemic, it is still not clear whether this is the h1n1 or pneumonic plague.

All border posts linking the two countries will be closed except one where Doctors and health officials will monitor people that pass and will ban them from entering the country if they display symptoms.

The death toll of the flu outbreak / pneumonic plague has risen to 144 cases according to Ukraine Health officials. It is still unclear whether this is the number of fatalities from h1n1 or the pneumonic plague or both.

The Health ministry of the Ukraine mentioned 14 confirmed deaths of h1n1 but the rest of the fatalities remain unclear.

Additional reports from Buitenland indicate Slowakia has closed all but one border to Ukraine because of the flu outbreak. In Ukraine now more than 900.000 people are infected, 135 died so far.

At the only open border at Vysne Nemecke, doctors are stationed to check EVERY PERSON for flu symptoms. Who ever has flu symptoms will not be allowed in the country.

Also see:

Withheld Ukraine Sequences Raise Pandemic Concerns

Withheld Ukraine Sequences Raise Pandemic Concerns

Withheld Ukraine Sequences Raise Pandemic Concerns
Recombinomics Commentary 02:30
November 7, 2009
Right now we know that many clinical specimens and viruses have been sent to one of the WHO collaborating centres for further study. We don't know the results of those studies, and it will probably take a couple of days for the full analysis of those viruses to be available. But in the meantime, what we do not have is any evidence of viruses there or anywhere else as showing any big mutations. I raise this point because I have seen in some media reports that there are reports that WHO or other groups are saying that there are mutations and I want to point out that these are rumours and factually, untrue.

The above comments from Keiji Kukuda offer some general comments on the Ukrainian H1N1 sequences at Mill Hill in London. He specifically says WHO doesn't see any "big" mutations in the samples being sequenced, which would refer to reassortment or Tamiflu resistance. However, the changes seen in Ukraine do not require "big" mutations. Small mutations, such as SNP can have profound effects for a virus like pandemic H1N1.

That virus normally circulates in swine, and has recently jumped to humans. It already has many characteristics with the 1918 pandemic strain. Both are swine H1N1 that jumped to humans. Such species jumpers can increase efficiencies with small changes. One good example is position 627 in the PB2 gene. That position comes in two forms. When there is glutamic acid (E) at that position, the PB2 enzyme copies the viral genetic material most efficiently at 41 C, the body temperature of a bird. However, if that position has a lysine (K), the enzyme is most active at 33 C, the temperature of a human nose in the winter. The swine H1N1 has an E, which may be why it goes well in lung, which is 37 C and closer to the optimal replication temperature of 41C. However, a single change that produced the most efficient replication at 37C would lead to even higher levels in the lungs, which could lead to frequent cytokine storms, like those in 1918, instead of the less frequent level seen in Ukraine.

However, the rapid spread of H1N1 in Ukraine (see map), coupled with the high frequency of hemorrhagic pneumonia raise concerns that a small change is leading to a more virulent virus. Similarly, the rapid spread of the virus could also be affected by a small change in another gene, such as HA, which controls entry of the virus to cells and influences tissue tropism.

Mill Hill has acknowledged that they have at least 15 H1N1 positive samples from Ukraine, which would identify a Ukranian specific change. The delay in the announcement of sequence results raises concerns that such changes have been detected, and such changes are undergoing further analysis.

The number of cases in Ukraine continues to expand. The number of patients with H1N1 symptoms is now approaching 1 million. Cases have been increasing at almost 200,000 per day, so it is likely that tomorrow's report will have over 1 million cases. This rapid spread increases concern that the 15 sequences at Mill Hill contain one or more of these small changes, which has led to a delay in the announcement of sequence results.

More detail on the sequences at Mill Hill is overdue. The rapid spread of H1N1 in Ukraine demands rapid sequence results. Continued delay will only increase concerns.

Cases of infected patients in Ukraine double to just under ½ million in two days

Reported Cases in Ukraine Double in Two Days
Recombinomics Commentary 14:34
November 4, 2009

478,456 Influenza/ARI

24,003 Hospitalized

60 Ventilators

81 Deaths

The above numbers are from the latest update from Ukraine. The number of infected patients has almost doubled to just under ½ million, compared to the report two days ago (see map). Hospitalized patients also have spiked higher, to 24K from 15K. ICU cases are not listed, but 60 on ventilators are. However, most (37) of those on ventilators are Chernivisti Oblast, but Lviv, which has the most fatalities and cases, has none, suggesting the data is incomplete or there are significant shortages of ventilators. The number of dead has risen to 81, but media reports describe additional fatalities, include those in the Kiev Oblast.

The explosion of cases again raises concerns that the number of fatalities is significantly higher than the 81 listed. Media reports have described an equal number of pneumonia fatalities which were not considered flu related. The basis of these exclusions remains unclear. Similarly, anecdotal reports suggest the number of fatalities is markedly higher than the 81 in the table.

The rapid rise in reported infections, hospitalizations, and deaths in the past few days raise concerns that the virus is transmitting very efficiently. Spikes in cases have been reported throughout the northern hemisphere, but the spike in fatalities and the frequency in hemorrhagic cases in Ukraine have raised concerns.

Earlier media reports suggest that an update by WHO might be issued today and include preliminary analysis of samples sent to Mill Hill in London.

Daily updates on the rapidly evolving situation in Ukraine, including sequence analysis, would be useful.
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