I'm just about done with the TB incident. I've said what I had to say (here, here, here and here) about the incident itself and TB on a plane in general. The one thing left is the significance for pandemic flu prevention.
I don't think there is any significance for pandemic prevention because at the moment we have no way to prevent a pandemic. We don't know what will make a pandemic happen or not happen, but if the biology will let it happen and a strain arises with easy transmissibility between people, then that's the ball game. Even if it burns out in one place it will happen again. And again. If the biology isn't right, then it won't. There is no tool in our hands at the moment to stop it. That could change. Maybe we will develop a universal vaccine that is easy to produce and deploy. Maybe there will be a such a potent, cheap and effective antiviral we will be able to do the same thing by smothering outbreaks. Maybe. But that isn't today or the foreseeable near future. One thing for sure. It is unlikely a pandemic can be stopped by shutting down the airline transport system or sealing the borders. Anyone who has looked at the question agrees.
That's why talk about TB and border security represents a combination of political posturing, ignorance and cynicism. Considering the source, New York Senator Charles Schumer, probably all three:
Senator Charles E. Schumer, Democrat of New York, said the mistake at the border was a sign that the Customs and Border Protection bureau was stretched too thin, with just 4,000 agents along a northern border that is required by law to have 5,000.
"The agents of the Customs and Border Control bureau are our first line of defense, Mr. Schumer said. "We cannot afford even one mistake in an incident such as this."(New York Times)
The problem at the Canadian border didn't have to do with short staffing. It was an error in judgment. And of course we can afford even one mistake in an incident like that. We just had an incident like that. Schumer is an ass. Even if he's a Democrat.
What about this episode as a dry run for bird flu? Since I've already said I don't believe you can stop bird flu this way, it isn't relevant -- at all. What is relevant is mindless overreaction and panic. Maybe you think I don't take the risk of bird flu seriously enough? Here's what someone whose concern about bird flu is not in question:
Ultimately, however, the idea of an all-seeing public health and enforcement network that could spot and stop a traveling patient could raise worries of its own, said Michael Osterholm, an epidemiologist who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. "Short of a military state where you have 24/7 surveillance on someone," Dr. Osterholm said, "you have to count on the good will of the individual."
He called this a fact of life in an open society, one that could lead to major problems in an outbreak of pandemic influenza, in which many people would probably be boarding planes knowing they were sick to get away from an epidemic. "They would say, 'I want to make sure I get out,' " whatever the risk to others. In that kind of situation, he said, the public health system would inevitably be unable to keep up.
Right on target. As usual.
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where's the "panic"?
Increased awareness, public learning about TB and XDR-TB, impolitic questions,
outrage, demands for accountability (and actually doing their function correctly)
from places on the public payroll like the CDC and border guards?
The "doing or saying anything authorities have not told the public to say or do"
panic definition?
Or Average Concerned Mom's definition? something about, asking really hard
questions to answer, and/or expressing severe displeasure at the officials?
Revere said: "Schumer is an ass. Even if he's a Democrat."
Revere, my respect for you just went up a notch on that one!
Neal
Schumer is a lot of deleted expletives. He deliberately tried to politicize an issue. If they were stretched too thin Speaker would have not seen a soul as he crossed the bridge. Thanks Chuck.
The agent probably took a look a Speaker and knew what his chances were outside of the country and then decided to take the hit at everyone elses expense in the US. Bad mistake. Speaker if I read the stuff on XDR right has about a snowballs chance in Saudi Arabia. They dont live long. The do not fly and do not enter files are very concise and can drag up information on your dead monther. I think the guy just did a Revere type of compassionate thing. "Whats one case going to hurt?" was probably the thought.
In the 1970s British television drama [Survivors], viewers are shown briefly a virus lab accident, then airports, then basically a nearly deserted country: the world depopulated in very little time. I mention it because of the thoughtful inclusion of international air travel inthis introduction to the story proper, which, or course, is about how a handful of survivors get by.
British science fiction used to do this sort of thing a lot, although not uniquely. I mean imagine the nation's own devastation, from H. G. Wells on - or from purely "historical" speculations before Wells where a new European invasion wuld do similar damage to the country. Before [Survivors], I think, was a cheerfully gloomy little show called [Doomwatch] - a different doom every week. Our "X Files".
Andrew Speaker called in via the phone today while the Gerberdinator was speaking before the Senate along with several others including Fauci.
Andrews memory seems to be infected along with his lungs. Sure they may have told him he had TB and was still cleared to go, but they recommended against it. Then when they caught up with him in the wilds of Italy he was told NOT to travel. That fact isnt in doubt and its apparent that the Italians told him too.
But he did it anyway. They also told him that he was infectious again as a result of the XDR testing. So Speaker needs to quit speaking or having TB is about to be a crime. I wouldnt speak before a Senate panel under oath for anything. Too easy post of one of those to be indicted for obstruction. Not that you did it, only that you can convince a Grand Jury that you did.
Keep talking Andrew, you'll get your 400 dollar fine for logging your mouth onto the net.
Randy: He didn't "call in while Gerberding was talking." He was asked to testify and he did it by phone, the only way it could be done. You heard what you wanted to hear and interpret the way you want to interpret it. I heard just the opposite: that the situation was pretty much as I had reconstructed it.
It really appears to be a luck of the draw type of scenerio for now. Meaning, some will survive and some will not. It's all becoming so surreal, watching mankind allow this motion of events to transpire. As Robert Carnegie shared above it's the things that science fiction are made of, only this time they'll probably come to life.
Osterholm is accurate in the fact that "we're screwed" because there are thousands of irresponsible individuals in our world, well demonstrated by Speaker. Regardless of the fact that you'll give Speaker the benefit of the doubt revere no one can convince me that he didn't know what the hell he was doing.
What the Speaker Incident proves is the adage "where there's a will there is a way". He obviously knew that the US was hunting him or he would not have taken such a circuitous path back to the US. The point being it will not be possible to prevent a determined, intelligent and well-off person infected with pandemic flu overseas from returning to the EU or US. This is but one way pandemic flu will spread once it acquires efficient human-to-human transmission.
Today millions of people travel across national boarders by air, sea and land and each one could be an asymptomatic carrier once the outbreak occurs. It will not be possible to screen them for disease since unlike SARS; they will not be febrile or even know they are infected. Most will not even be aware they were exposed.
One interesting statement made by Dr. Gerberding today on the Speaker Incident in her response to a question by an incensed Congressman was the reason they did not go to Italy and pick him up on one of the CDC's planes was the fact that the ventilation system within aircraft make it impossible to protect the other passengers and crew from an airborne pathogen like TB. Once H5N1 becomes pandemic its preferred method of spread will be via the air as has been the case with every past influenza pandemic. TB is huge by comparison to the size of the influenza virus and much less infectious. A contagious passenger on an airliner will be expelling literally millions of virons into the cabin air with every cough or sneeze. On a full Boeing 747 traveling from Japan to Los Angles, during the many hours of confinement in such a contagious environment, it would be reasonable to assume that almost every passenger and all the crew would be exposed with about 40% developing clinical influenza within several days. Of course by that time they will be back home in New York City, Chicago, Dallas, Atlanta, Boston.... I think you get the picture.
Grattan Woodson, MD
http://www.france24.com/france24Public/en/administration/afp-news.html?…
I think its on at 02:00 again tonight CDT. You are right Revere, he didnt just call in but Gerberding, Fauci, etc were sitting there while he "testified." So its yet another Bush Bash. Have to have the idiot call in and deny that he was told not to fly. He sure as shit was by at least 5 different officials in Fulton County and was told he needed to be in Colorado and not in Greece.
The health dept. folks told him they preferred he not travel. My doc would prefer if I did a lot of things, but I don't always do them. He was invited to testify, not for Bush bashing but because his testimony was central to the hearing, much more so than Fauci's. I don't know where you get the 5 different officials stuff from. The others were just repeating what the first one said and one who testified admitted he wasn't even in the room.
We have a slightly different read on this Revere. Fact is that he was told not to travel when he got to Italy without question. His memory seems to a little vague and he deliberately slipped out of the country into at least three others. I just dont give him a pass after that. Not to say I might not have tried the same thing. But If I ended up getting caught in Italy or the Czech Republic I think I know which one I would choose.
The Dems lost no time in ragging on the CDC and other officials but without an act of illegality they could do nothing. They have more governance over STD's than what this guy was doing. The health dept. here picks up a box of unsigned detention warrants for people with HIV/AIDS/Syph, Gon, etc. and a full time sherrif deputy to serve those warrants if people dont turn themselves in voluntarily.
I watched the drama yesterday and the implication was clear.... How could you people be so incompetent. Gerberding maybe, not Fauci and the others. To listen to Speaker talking it was like he had never heard of the stuff. They mimed what my drinking buddy said and that initially the chances were that he was not infectious, but that the chances were not zero either. That lasted right up until Italy and then they flat told him not to move... He did it anyway.
Haven't watched a great deal of interviews by Speaker but have seen two. I know none of you here know me however, I am very good at picking up on whether a person is being honest or Not. It's just something I've been able to do since childhood.
Anyway ... Saw this guy last night on t.v. and it goes beyond obvious that he's full of BS and now trying to beat down the opposition to his stupidity. He's embarrassed, has bruised his level of intelligence, and is now exploiting the pity-party scenario.
Any Detective worth their salt would tell you that Speaker's stories and excuses are full of holes that lead to reasonable suspicion's of his actions. That he's striving ardently to cover up the details.
Come on all you rational balanced thinkers, this guy is full of hot air. It doesn't take a rocket scientist to see that he's grasping for straws.
Lea: Maybe it doesn't take a rocket scientist, but Dr. Frist's telemedicine diagnosis method probably isn't the right science, either. Your take on Mr. Speaker was the same impression I got from my colleagues in public health. Everyobody trying to justify their actions. As I will detail in another post (at least I'm planning to do it; there is somethimes a gap between plans and execution), others with expertise in this area have the same take I do.
I was reading some 'CDC: Excerpts from Public Health Law News' posted by Cartski (post #8 http://www.flutrackers.com/forum/showthread.php?t=16990 )which included a case being bought by the ACLU on behalf of an XDR-TB patient who broke isolation and is now in an Arizona Sheriff's jail "Daniels has been held without a phone, television, radio, shower, or hot water, and with lights on 24 hours a day, according to court records" further details can be found in the news paper report http://www.azcentral.com/news/articles/0530tbguy0530.html and checkout the comments posted inc. "It's his own fault. He should have wore his mask when he was suppose to."
http://www.azcentral.com/news/articles/0530tbguy0530.html
JJ: Yes, I read it, too. The usual TB isolation case is a bit different than the airplane one in that health authorities get court orders after the subject has refused to comply with treatment. Prior restraint isn't legally possible except by the feds under the new quarantine and isolation Exec Order, and some legal authorities (e.g., Larry Gosten) believes it may not be constitutional in the US system.
This is where I move back up to the middle of the road. Speaker was an idiot who may upset the apple cart. We get into the possibility (underline that), that we might create laws that give states/federal authorities the right to detain without warrant or order (judge) in the sole opinion of the ___________.
They can do it now under the laws relating to the Surgeon Generals authority and how its delegated. Its very loosely worded and no one could ever think about holding anyone for long (Arizona) without some sort of resolution (Guantanamo Bay). But the courts have held on most instances already that such detentions are legal.
"In 2005, WHO estimated there were 8.8 million TB cases and 1.6 million deaths. There were about 420,000 cases of MDR-TB annually, with 66,000 deaths. XDR-TB accounted for about 27,000 cases and 16,000 deaths, making the overall XDR-TB mortality greater than 50%, with a much higher mortality among HIV-infected individuals. Other vulnerable groups are children and those with a compromised immune system." -Reuters 02/07
They can use this as justfication and would in a heartbeat until it becomes so prevalent that it doesnt make any difference. Speaker was an idiot who deliberately tried and suceeded in getting back into the country. It was politicized by the Dems who were all over Gerberding or others. I dont give her much cover at all but its the diff between the law and the lawbreaker. They followed the law, he didnt.
At the point in time where they told him not to move, he became a bio-terrorist. Failing to do as told in this respect and then to enter multiple countries put him on the same footing as a suicide bomber and I wouldnt have donned the gear if I knew he was coming, I would have locked and loaded, told him to step out of the car and if he didnt then we wouldnt have had to worry about the flight to Colorado. Severe? Hell yeah, but I wonder how the HIV's of the US would feel if he was traipsing around their necks of the woods. I think they would have a lot to say about that too. Shit, they probably would have capped him themselves.
Speaker knew exactly what he was doing. I am just glad it wasnt smallpox.
Randy: He broke no laws, so that's the end of that argument. It wasn't smallpox. That's the end of that argument. No one knows whether he knew what he was doing or not, but the question is, What did he think he was doing? So your easy answer is no answer. It is just assuming the answer you want. That's the end of that argument.