Effect Measure

In a typically well informed and thoughtful commentary over at the mega-blog, DailyKos, DemFromCT reminds everyone that just because the media aren’t talking about bird flu and pandemics and just because the candidates are arguing about the economy, the war and whose pastor is worse doesn’t mean that anything has changed. All the elements that alarmed the public health community as far back as 1997 when the first human cases of H5N1 appeared are still there. In some respects we should be more alarmed because so much of what we thought about flu then we now know isn’t the case at all. Learning what you don’t know is terribly important, and learning that what you thought you knew you don’t as much, or maybe more, so. Important, yes. But comforting, no. We have no idea what goes into making a virus “go pandemic” — or not. We don’t know how to spot the signs of an incipient pandemic and only limited and chancy means to spot one that has just gotten underway. We have no ready supply of effective or even potentially effective vaccine for any pandemic strain of influenza, of any subtype. We strongly suspect the only effective antiviral will quickly become less so as the virus develops resistance. And worst of all, instead of getting our public health and social service infrastructures ready and able to withstand any shock to the system, pandemic or something else, we have continued to let them deteriorate to the point that they can no longer cope with flu season, much less a pandemic of any sort, flu or something else.

DemFromCT’s piece surveys what the presidential candidates have or have not said on this subject. It is a must read. But a survey of the comments also shows there remain some intelligent and politically progressive people who disagree this is an issue. I would say to them what I say to climate change deniers: let’s stop arguing about this and do the things we all agree are desirable. No one has to give up some cherished idea about what the true risks of a pandemic are or are not to agree that the public health, medical care and social service infrastructures of many countries, but foremost the United States, are in a shambles. Let’s prepare for a pandemic or anything else by fixing them.

This is fundamentally a matter of political ideology. Those of us on the progressive side of the political spectrum believe that many (but by no means all) problems are best approached by pooling our resources, by helping each other out. We are not of the view that all there is to living a good life, is every tub on its own bottom. Our view carries consequences for strongly held views about property and the absolute freedom to deploy resources for whatever one chooses without necessary regard for any one else’s needs. The Right orders things differently, except, apparently, when it comes to taking my money to fight their wars. For the common good, of course. Our battle with the Right wing is not over the risks of bird flu, but over the more important question of the nature of civic life. Their only means of coping with bird flu is to prepare as individuals, something I have no objection to. But for the rest of us, we also have to prepare to help each other.

If and when the time comes, we need to be willing to help everyone, including those who had no interest in helping us. But we won’t be able to help anyone unless we fix what is so clearly broken.

Comments

  1. #1 Grace RN
    June 2, 2008

    Dem’s commentary was excellent, and you raise the most important point-let’s start fixing it (America’s public health system) yesterday.

    For 300,000,00 good reasons.

  2. #2 joel
    June 2, 2008

    The general point is one I agree with. I’ll admit that despite the fact that I am a pandemic planner for a decently large city I am somewhat skeptical about the “cyclic” nature of pandemics. From what I’ve seen the periodicity of pandemics is based on the three from the 1900s, and even they don’t match all that well. That aside, the risk is real, the benefits of preparedness are real, and for the most part the actions necessary to prepare for a pandemic benefit a whole host of other public health and emergency preparedness programs. For those reasons I honestly don’t care how likely a pandemic is, the planning and preparedness are valuable efforts. As GraceRN stated, the point is that the PH system needs to be repaired ASAP.

  3. #3 Robyn
    June 2, 2008

    It’s definitely important to keep struggling to do what you can do while (hopefully) we work on improving the public health sector. I’m lucky to live in a community where there is a VERY functional group of public health and emergency services people (including ambulance and helicopter) consistently working together to anticipate and plan for surges. It may not be a common model, but it isn’t an impossible one to achieve.

  4. Spread of avian flu by drinking water:

    Proved awareness to ecology and transmission is necessary to understand the spread of avian flu. For this it is insufficient exclusive to test samples from wild birds, poultry and humans for avian flu viruses. Samples from the known abiotic vehicles also have to be analysed. There are plain links between the cold, rainy seasons as well as floods and the spread of avian flu. That is just why abiotic vehicles have to be analysed. The direct biotic transmission from birds, poultry or humans to humans can not depend on the cold, rainy seasons or floods. Water is a very efficient abiotic vehicle for the spread of viruses – in particular of fecal as well as by mouth, nose and eyes excreted viruses.

    Infected birds and poultry can everywhere contaminate the drinking water. All humans have very intensive contact to drinking water. Spread of avian flu by drinking water can explain small clusters in households too. Proving viruses in water is difficult because of dilution. If you find no viruses you can not be sure that there are not any. On the other hand in water viruses remain viable for a long time. Water has to be tested for influenza viruses by cell culture and in particular by the more sensitive molecular biology method PCR.

    There is a widespread link between avian flu and water, e.g. in Egypt to the Nile delta or Indonesia to residential districts of less prosperous humans with backyard flocks and without central water supply as in Vietnam: http://www.cdc.gov/ncidod/EID/vol12no12/06-0829.htm. See also the WHO web side: http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf .

    Transmission of avian flu by direct contact to infected poultry is an unproved assumption from the WHO. There is no evidence that influenza primarily is transmitted by saliva droplets: �Transmission of influenza A in human beings� http://www.thelancet.com/journals/laninf/article/PIIS1473309907700294/abstract?iseop=true .

    Avian flu infections may increase in consequence to increase of virus circulation. In hot climates/the tropics flood-related influenza is typical after extreme weather and floods. Virulence of influenza viruses depends on temperature and time. Special in cases of local water supplies with �young� and fresh H5N1 contaminated water from low local wells, cisterns, tanks, rain barrels, ponds, rivers or rice paddies this pathway can explain small clusters in households. At 24�C e.g. in the tropics the virulence of influenza viruses in water amount to 2 days. In temperate climates for �older� water from central water supplies cold water is decisive to virulence of viruses. At 7�C the virulence of influenza viruses in water amount to 14 days.

    Human to human and contact transmission of influenza occur – but are overvalued immense. In the course of influenza epidemics in Germany, recognized clusters are rare, accounting for just 9 percent of cases e.g. in the 2005 season. In temperate climates the lethal H5N1 virus will be transferred to humans via cold drinking water, as with the birds in February and March 2006, strong seasonal at the time when drinking water has its temperature minimum.

    The performance to eliminate viruses from the drinking water processing plants regularly does not meet the requirements of the WHO and the USA/USEPA. Conventional disinfection procedures are poor, because microorganisms in the water are not in suspension, but embedded in particles. Even ground water used for drinking water is not free from viruses.

    http://www.un.org/apps/news/story.asp?NewsID=26096&Cr=&Cr1
    Ducks and rice [paddies = flooded by water] major factors in bird flu outbreaks, says UN agency
    Ducks and rice fields may be a critical factor in spreading H5N1
    26 March 2008 � Ducks, rice [fields, paddies = flooded by water! Farmers on work drink the water from rice paddies!] and people � and not chickens � have emerged as the most significant factors in the spread of avian influenza in Thailand and Viet Nam, according to a study carried out by a group of experts from the United Nations Food and Agriculture Organization (FAO) and associated research centres.

    �Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia: ducks, rice and people� also finds that these factors are probably behind persistent outbreaks in other countries such as Cambodia and Laos.
    The study, which examined a series of waves of H5N1 highly pathogenic avian influenza in Thailand and Viet Nam between early 2004 and late 2005, was initiated and coordinated by FAO senior veterinary officer Jan Slingenbergh and just published in the latest issue of the Proceedings of the National Academy of Sciences of the United States.
    Through the use of satellite mapping, researchers looked at a number of different factors, including the numbers of ducks, geese and chickens, human population size, rice cultivation and geography, and found a strong link between duck grazing patterns and rice cropping intensity.

    In Thailand, for example, the proportion of young ducks in flocks was found to peak in September-October; these rapidly growing young ducks can therefore benefit from the peak of the rice harvest in November-December [at the beginning of the cold: Thailand, Viet Nam, Cambodia, Laos are situated � different from Indonesia � in the northern hemisphere].

    �These peaks in congregation of ducks indicate periods in which there is an increase in the chances for virus release and exposure, and rice paddies often become a temporary habitat for wild bird species,� the agency said in a news release.

    �We now know much better where and when to expect H5N1 flare-ups, and this helps to target prevention and control,� said Mr. Slingenbergh. �In addition, with virus persistence becoming increasingly confined to areas with intensive rice-duck agriculture in eastern and south-eastern Asia, evolution of the H5N1 virus may become easier to predict.�

    He said the findings can help better target control efforts and replace indiscriminate mass vaccination.
    FAO estimates that approximately 90 per cent of the world�s more than 1 billion domestic ducks are in Asia, with about 75 per cent of that in China and Viet Nam. Thailand has about 11 million ducks.

    Dipl.-Ing. Wilfried Soddemann – Epidemiologist – Free Science Journalist soddemann-aachen@t-online.de

  5. #5 anon
    June 3, 2008

    >…All the elements that alarmed the public health community
    >as far back as 1997 when the first human cases of H5N1
    >appeared are still there.

    no, the frequent warnings of the experts have become rarer.

    >In some respects we should be more alarmed because
    >so much of what we thought about flu then we now know isn’t the
    >case at all.

    what we thought then did alarm us, so it’s good when that
    turns out wrong now.

    >…learning that what you thought you knew you don’t as much,
    >or maybe more, so.

    ?

    >… We have no idea what goes into making
    >a virus “go pandemic” — or not.

    we do have some idea. A new HA is usually required,
    temperature plays a role, travel, vaccine etc.
    If we had no idea at all, then why the warnings, why worry ?
    No need to be afraid of the unknown.

    > We don’t know how to spot the signs of an incipient pandemic

    many people becoming sick from a virus with a new HA,
    which transmits efficiently h2h

    >… We have no ready supply of effective or even potentially
    >effective vaccine for any pandemic strain of influenza, of any
    >subtype.

    huh ? We do have some vaccine, but there is actually no “pandemic strain”
    because there is no pandemic, if that’s what you meant.

    >We strongly suspect the only effective antiviral will

    at least 3 different effective antivirals : oseltamivir,zanamivir,
    amantadine

    >quickly become less so as the virus develops resistance.

    maybe,maybe not. We don’t know…

    > And worst
    >of all, instead of getting our public health and social service
    >infrastructures ready and able to withstand any shock to the system,
    > pandemic or something else, we have continued to let them deteriorate
    >to the point that they can no longer cope with flu season, much
    >less a pandemic of any sort, flu or something else.

    but they do cope. Maybe a little worse than before, I don’t know.
    But still better than in most other countries.
    And you really consider this decrease in coping with seasonal flu
    worse than the pandemic threat ?

    >…the public health, medical
    >care and social service infrastructures of many countries, but
    >foremost the United States, are in a shambles.

    still the life expectancy and population grows. So, how bad is it
    as compared with earlier times ? Worse than 1980,1960,1940,1920 ?

    > Let’s prepare for
    >a pandemic or anything else by fixing them.

    no. Let’s fix them if they have to be fixed, let’s prepare for a pandemic
    if that threat is considered high. Doesn’t make sense to mix them.

    >If and when the time comes, we need to be willing to help everyone

    if and when the time comes it’s too late and
    most people should better isolate than help.
    The time for help is before it comes to your place.

  6. #6 Grace RN
    June 4, 2008

    A country prepared for pandemic is a country prepared for anything.

  7. #7 anon
    June 4, 2008

    give that quote a headline like:
    “USA prepares for nuclear war”
    and post it in Russian,Arabian and Chinese

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