Suspected Marburg outbreak reported. This time in Tanzania.

That and other stories in "Five on Friday" for January 17, 2025...

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Getty Images/Marc Guitard

Item 1: Suspected Marburg outbreak reported. This time in Tanzania.

The WHO announced a suspected outbreak of Marburg virus in Tanzania this week. So far, little is known and nothing is confirmed. However, some of the classic features of the disease appear to be present in the reported cases. While not a surprise, the case fatality rate of the outbreak is extremely high, with 8 out of 9 suspected cases having died (89%). Tanzania has had Marburg outbreaks before, likely because fruit bats—thought to be reservoirs for the virus—inhabit caves there, where researchers and tourists often encounter them.

So far, officials from Tanzania have apparently denied the issue. Nevertheless, well-placed authorities in the country informed the WHO, which in turn made the announcement this week. Transparency is to be encouraged, but some governments are reticent to provide that, because acknowledging a Marburg outbreak is likely to have a substantial effect on tourism.

However, the recent experience in Rwanda should serve as a guide. A more open and transparent approach there led to quick action that successfully stamped out a frightening outbreak in the country.

Item 2: High rates of mental health symptoms in healthcare workers late in Covid-19 pandemic.

Towards the end of the Covid-19 public health emergency (late 2022-early 2023), healthcare workers exhibited substantial rates of mental health symptoms sufficient to reach diagnostic criteria for various conditions, a new CDC report finds. Surveys reveal that 26% of respondents met or surpassed these thresholds. Of these, most (79%) sought out care. Tellingly, among those who did not seek care, the most common given reason was “It’s difficult to get time off work.” Frequently listed work-related stressors included burnout (59%), higher workload/job demand (57%), fear of becoming ill with Covid-19 (55%), and Covid misinformation (51%).

These are concerning rates, albeit there may be selection bias, as people with mental health struggles might have been more likely to participate in such a survey. Also, it’s unclear how much of this was due to the stressors of the pandemic itself. Burnout and increasing demands on frontline healthcare workers were already hot topics before the pandemic, so it’s unclear how much of this was already in the mix and the study did not account for changes over time. That said, as a frontline clinician myself, I think the demands of the Covid-19 pandemic took already increasingly challenging work environments and made them significantly more difficult.

Item 3: Republicans consider cutting Medicaid spending by around one-third, document shows.

House Republicans are considering budget cuts that would trim Medicaid spending by $5.3-5.7 trillion, which is around one-third of current levels. Currently, Medicaid spending accounts for $1 out of every $6 spent on healthcare in the US. During the pandemic, Medicaid spending increased, both because of need and because federal law temporarily banned states from kicking people off of Medicaid. That policy expired. These proposed cuts would hit deeply, hurting patients and state bottom-lines.

The main ways these cuts would be felt are fairly obvious: decreased coverage for people with low incomes or disabilities and decreased reimbursement to healthcare providers. A document outlining some potential targets of these cuts was published by Politico this week. One target: $15 billion marked for the CDC’s Prevention and Public Health Fund. That seems ironic, given HHS Secretary nominee RFK Jr’s supposed interest in such efforts. The fund supports efforts against diabetes, lead poisoning, and Alzheimer’s disease, among others.

Item 4: FDA moves to lower nicotine levels in cigarettes.

The FDA announced plans to lower the maximum amount of nicotine that cigarettes can contain. The idea has long been floated and the FDA’s move is legally permissible under a statute called the Tobacco Control Act. Under the proposed rule, companies that do not adhere to the new standards could be fined or even have their products removed from the market.

Per the FDA, the new maximum amount of nicotine in cigarettes would be 0.7 milligrams per gram of tobacco in cigarettes (and some other combusted tobacco products) “which is significantly lower than the average concentration in these products on the market today.” The policy would therefore limit the addictive compound in cigarettes, cigarette tobacco, roll-your-own tobacco, most cigars, and pipe tobacco. However some other products are not covered by the policy, though I am not sure why. These include e-cigarettes, nicotine pouches, non-combusted cigarettes, hookah products, smokeless tobacco products (i.e., chewing tobacco), and premium cigars. Some of these (like e-cigarettes) do not contain tobacco (which is the most cancerous aspect of traditional cigarettes, while others (like chewing tobacco) do. So, this is not just about removing the addictive nicotine from cancer-causing products and may have more to do with differences in how these products are regulated.

Item 5: Poll of the Week results.

Here are the results of the last poll. The correct answer was Alaska. How did so many of you all know that?

Item 5a: Poll of the Week!

We are still in the midst of respiratory virus season in the US here. I’m interested in your self-assessment of how often you get sick these days (say 2023, 2024, 2025) compared to before the Covid-19 pandemic (that is, 2019 and earlier)…

And regardless of your answer, I’d like to know why you think this is the case. Thanks! Please contribute to the Comments!

That’s it. Your “Friday Five!”

Feedback! Have any ideas for next week’s Poll of the Week? Any great articles you’ve read elsewhere that you want to share with the Inside Medicine community?