revere | August 5, 2009I have a reflexive skepticism about some conventional flu wisdom. There's so much about flu we don't know and even more we think we know that we find out we're wrong about. But skepticism is an occupational hazard of epidemiologists. Our training and practice focusses on detecting subtle biases that can produce misleading interpretations of data. When it comes to the commonly recommended personal protective measures for pandemic flu, our skepticism is all the greater since there is so little data to be skeptical about. The lack of data isn't an accident. If you think hard about it, you can…
revere | August 4, 2009Of the three main modes of infection for flu -- transmission by large droplets, transmission by tiny suspended aerosols, transmission via inanimate objects (also called fomites) -- it is the last that is the least certain but garners the most attention in the form of hand hygiene, disinfectants and now, fear of magazines and toys in emergency department waiting rooms and acute-care clinics in Canada. Here's the lede from an article in the Montreal-Gazette:
All magazines and toys should be removed from emergency department waiting rooms and acute-care clinics to reduce exposure to human swine…
revere | August 3, 2009There's a swine flu pandemic well underway and efforts are being made to reconstruct how it started. But almost everyone who has been following this knows it's not the first time a swine flu virus has transmitted from person to person. In 1976 in Fort Dix, New Jersey there were a couple of hundred cases, with 13 hospitalizations and one death from an H1N1 swine flu virus. The public health response was the infamous vaccination campaign that reached 44 million Americans before being ignominiously halted in the face of two facts: the feared swine flu outbreak never got out of Fort Dix; and as a…
revere | August 2, 2009Somewhere around mile 500 of the Revere tribe's 1000 mile trek to the beach for an alleged vacation -- long digression that interrupts the clear meaning of the sentence: if I'm on vacation, what am I doing writing about it? That's what Mrs. R. asked, as she headed to the beach, leaving me in air conditioned online splendor in a rented condo that could have been anywhere in the world, as long as it had high speed internet connection -- as I was saying, around mile 500 driving our new-ish car journey, CDC went live on a completely redesigned website for its novel H1N1 (aka swine flu) info. I'…
revere | August 2, 2009I recently had a medical condition that is the only one I know of where the Literal Word of God actually is effective treatment. However, as an atheist I didn't have access to the Literal Word of God (the online version isn't effective) so I asked one of my colleagues, a licensed physician, to treat me, using a modality in which I had faith: heavy science. Unfortunately my faith was misplaced. The treatment failed after three tries (he insisted on using Harrison's Textbook as his treatment source, when I would have used Cecil and Loeb). Desperate, I finally took matters into my own hands in a…
revere | August 1, 2009The Revere troop is still on the road (we arrive at our beach destination later today), and while WiFi in motels is convenient, it's not so easy to blog without the usual creature comforts (a library, good coffee, my own workspace and lots of unread/half read papers with great sounding titles that might become blog posts). However I do have Mrs. R. for company and our old and hobbling dog is along to be a literal creature comfort for both of us. So I'm going to reprise an oldie but goodie from the archives (January 2007), this one the follow-up to an earlier post asking "why are man hole…
revere | July 31, 2009It's late-ish in the evening and this one of the Revere troop has pulled his/her/its new-ish car (funny, it doesn't look newish) into the Best Western parking lot and gotten online for the first time since this morning. First about the car. It isn't brand new. It's a couple of years old but we bought it to replace the infamous 15-year old Volvo sedan shit box I've been complaining about for years here. I finally got someone to take it off my hands for $340. I was asking $800, we settled on $600, but when he drove 100 miles to look at it (he'd seen pictures and I had described it with brutal…
revere | July 30, 2009It seems our enthusiasm for Obama's nomination of epidemiologist David Michaels to be the next head of OSHA was noted over at the high profile Science Magazine blog, ScienceInsider by Jocelyn Kaiser. Ms. Kaiser is among an elite group of science reporters and she almost always gets things right. Recognizing the importance of this nomination is certainly getting things right. My only complaint is that after noting that we (and many others) are delighted by the choice, she also notes that Michaels "is not without critics." That would be fair enough if the "critics" were fair enough. You'll find…
revere | July 29, 2009When the Bush Administration awarded a construction grant to put a Level 4 laboratory in Galveston, Texas to work on the most dangerous biological agents, a lot of people, including we here at Effect Measure, thought it was pretty stupid siting. Isn't Galveston open to Gulf hurricanes? Wasn't it the site of one of the most devastating storm floods in US history? Then came Hurricane Ike. It didn't seem that a hazardous agents lab could be more stupidly sited than Galveston (see here and here). That was an error in judgement on our part.
The thing about a lot of agents used in Level 4 labs is…
revere | July 28, 2009Liz Borkowski at The Pump Handle has the scoop, but it's a win for every worker: our friend and epidemiologist colleague and member of the Pump Handle blogger team, Dr. David Michaels, has just been nominated by President Obama to be the next head of the Occupational Health and Safety Administration (OSHA). This is the top health and safety position in the nation. One of his Deputy's is Jordan Barab, currently Acting Director, another long time health and safety professional who worked for the Chemical Safety Board and then the Congress and whose blog, Confined Space, was the premier health…
revere | July 28, 2009CDC wants us to get vaccinated for flu every year. Always for seasonal flu, and this year, if there is a vaccine available, for swine flu. They want us to get vaccinated because they think the vaccine works and they want to prevent people from getting influenza, always a dangerous and unpredictable disease, even if most of us usually escape with just a flesh wound. CDC backs up its recommendations by a quite a few scientific studies demonstrating the vaccine is effective, citing figures that the vaccine is 58% effective or 91% or effective or some other number, depending on what group is…
revere | July 27, 2009CDC's Advisory Committee on Immunization Practices (ACIP) recently rolled out their 2009 Recommendations. It's for seasonal flu, for which a vaccine exists, not for swine flu, for which there is (as yet) no vaccine. There is a lot to say on the subject of vaccines (see what we've said over the years under the vaccine category), but this seems like a good time to review some basic terminology, including what is meant by vaccine efficacy or effectiveness and how it is measured or estimated. There's a lot to say, so we'll split this into two posts, and in this one we'll go over some terms and…
revere | July 26, 2009The Reveres have been around a long time and we know a lot of public health people in different states. Recently we were talking with a colleague about the problem of hospital surge capacity -- the ability to handle a sudden demand for services -- and she described her first job working for a state health department in the early 1980s. Her job was to compile a health resources report, essentially a yearly compilation of licensed and operating beds for all manner of health facilities, including hospitals, nursing homes, psychiatric facilities, outpatient clinics, rest homes, group homes and…
revere | July 26, 2009We rarely put up the same thing twice here. Part of the fun is finding new absurdities. But by accident we again ran across this classic from the Australian Chaser's War on Everything and I laughed all over again. I know we did it before (2007), but the YouTube video was taken down. Luckily we found another one. Anyway, we've had a lot of new people come to the site since the swine flu virus decided we humans would make a suitable place to take up residence, so there's a good chance most readers didn't see it the first time. Even if you did, it's still funny. Or maybe it isn't:
revere | July 25, 2009It's a Saturday morning, it's summer in the northern hemisphere, and in a few days The Reveres are off to the beach for a communal vacation. A Revere-fest (or infestation). A little time away from the pressure cooker is good for people our age, old enough to remember the proto-punk rock band The Velvet Underground. They were part of the New York scene in the sixties when the revere tapping these keys lived there. Lou Reed, one of its best known members and song writers, is almost exactly my age (give or take a few months). We are also both still alive (at least he is).
The Velvet Underground…
revere | July 25, 2009Yesterday CDC announced it would no longer report confirmed and probable swine flu cases. This will likely cause consternation in some quarters, but the reasons make sense. First, it should be said that the real pressure to stop counting is coming from the states, where resources are stretched so thin and the value of the numbers so meager they no longer could afford to do it. The data, like most notifiable disease data, comes from state health departments, not the CDC itself. It is also recognition of what everyone knew from the earliest days of this outbreak: the "official" numbers did not…
revere | July 24, 2009Yesterday CDC's Morbidity and Mortality Weekly Report (MMWR) carried an a note about neurologic complications in children with swine flu. Central nervous system effects -- seizures, encephalitis, encephalopathy, Reye syndrome, and other neurologic disorders -- are known to occur with seasonal influenza in children, but whether they are more or less common with the swine flu variant is unknown at the moment. The MMWR reports four cases from Dallas County, more as a reminder that these kinds of complications can occur and should be considered whenever a child with influenza-like illness (ILI)…
revere | July 23, 2009There have been three reported oseltamivir (Tamiflu) resistant isolates of H1N1 swine flu (added: and now a fourth in Canada) but with those exceptions all others have been sensitive to this oral antiviral. This is in marked contrast to the other H1N1 strain, the seasonal variety which is almost entirely resistant. The spread of Tamiflu resistance in the seasonal strain happened with dramatic suddenness in the winter of 2007 - 2008 and came as an unhappy surprise. People assume that a rapidly mutating virus would inevitably become resistant, but based on several laboratory studies there were…
revere | July 22, 2009The National Pork Producers Council didn't like swine flu being called swine flu. Bad for business. So we now call it 2009 H1N1 or some such thing. It's totally swine-origin, but hey, if Lord Agribusiness doesn't like it, that's that. Same thing with antibiotic resistant bacteria, like methicillin resistant Staphylococcus aureus ("MRSA"; best source on the net Maryn McKenna's blog). The Pork Council doesn't want anyone to die of MRSA. They just don't want it associated with their product, even though a Dutch strain associated with pigs is now spreading in the US (and infecting people).
Some…
revere | July 21, 2009We are hoping that the infuriating failure of the Scienceblogs servers to keep up with traffic leading to submission timeouts (just as aggravating for bloggers as commenters) will be cured by a server upgrade which is to begin shortly. We have just been informed by our Seed Overlords (a.k.a. the publishers) that Commenting will be turned off shortly (between 7 pm and 8 pm EST, July 21) to allow migration to the new server. The site will remain readable and the Comment Form visible but you won't be able to comment.
This affects all of the Scienceblogs.com. We are told the entire process will…