revere | May 18, 2009You probably have never heard of the Chemical Safety Board (unless you are a specialist in that area -- or you read The Pump Handle!). The CSB is an independent government agency that has a pretty low profile. Its mission, as its name implies, is to investigate industrial chemical accidents. The CSB is important enough, however, to have its Board members subject to Senate confirmation. CSB was authorized under the 1990 Clean Air Act Amendments but didn't become operational until 1998. Thus it has lived most of its life obscured in the shadow of the Bush administration. Now things have changed…
revere | May 18, 2009Five more schools in the New York City borough of Queens have closed because of suspected swine flu cases. Eleven schools have now been closed there and hundreds of students are down with a flu-like illness. Parents are understandably concerned, the more so because not many days ago Mayor Bloomberg and the city's health commissioner (just named by Obama as the next director of CDC) were reassuring city residents this was pretty much lie seasonal flu.
We thought that was something that might come back to bite them, and now it has:
The city’s schools seem to have become both a sentinel and an…
revere | May 17, 2009At Friday's press briefing on the swine flu outbreak, Canadian Press's Helen Branswell twice asked whether CDC's weekly flu surveillance data showing the uptick in swine flu but also an unexpected prevalence in seasonal influenza was an artifact of increased testing or something new and unusual. CDC's Dan Jernigan was not especially clear, but seemed to acknowledge there was a lot of seasonal flu around:
The CDC said part of the increase is certainly due to the fact that much more influenza testing is going on these days, because of concerns about swine flu. But the agency said it seems that…
revere | May 17, 2009Maude was a 1970s TV sitcom (on CBS) featuring a feisty but occasionally overbearing middle aged woman of the liberal persuasion and her fourth husband, Walter Findlay. Walter owned an appliance store in a suburb of New York. The show was a spin-off of All in the Family, another 70s sitcom that was among the first to feature overtly political themes. In Maude's third season (1975) Walter "got religion," although it turns out he had an ulterior motive (to sell appliances to the church's new social center). In pursuit of this unacknowledged objective, he drags Maude (Bea Arthur) to church,…
revere | May 16, 2009The other shoe has dropped at CDC. Yesterday Obama named a new CDC Director, New York City Health Commissioner Dr. Thomas R. Frieden, an infectious disease specialist (drug resistant TB) who worked at CDC prior to going to New York in 2002. Frieden has long been rumored to be at the top of Obama's short list, so this wasn't a surprise, but the impressive performance on the swine flu outbreak of Richard Besser as Acting Director suggested to some he might get the job. Besser may be relieved he didn't:
At the C.D.C., [Frieden] will inherit a host of immediate and long-term problems, including a…
revere | May 15, 2009It is clear that if you want to get a so-so paper published in a top tier journal, the best way to do it is to write about a breaking medical news event and get there first. We saw this with avian influenza and SARS and now it's being repeated with swine flu. The Scientist had a story yesterday about how The New England Journal of Medicine (NEJM) and Science, two of the highest profile science journals in the world, pushed through some swine flu papers at record speed last week:
An international research team led by Neil Ferguson of Imperial College London published a report online today (May…
revere | May 14, 2009A reader (hat tip River) sent me a link to a New York Times piece quoting a physician who recently saw swine flu cases in Mexico City. He called attention to what seemed like an anomalous clinical presentation of many cases. Besides a higher proportion of gastrointestinal symptoms (nausea, vomiting, diarrhea), Virginia Commonwealth infectious disease specialist Dr. Richard P. Wenzel was surprised that many cases, even severely ill ones, did not have fever:
Many people suffering from swine influenza, even those who are severely ill, do not have fever, an odd feature of the new virus that…
revere | May 13, 2009Over at ScienceInsider (Science magazine's blog) Jon Cohen speculates about why swine flu seems to have spread faster and more widely in North America (Mexicon, US, Canada) than Europe and Asia. CDC thinks one reason is that by the time it was discovered here it had already spread widely. The Europeans, with advance warning, were then able to contain it with aggressive use of antivirals among travelers from the affected areas. I'm not ready to buy this.
This doesn't make sense to me, although nothing about flu viruses make sense, so I could be wrong about this. But it wouldn't explain why…
revere | May 13, 2009Flu can be a nasty illness, nasty enough to kill you. Pregnant women are at more risk than others because their physiology is altered. They are carrying a foreign body (the fetus) so their immune response is not the same, and their cardiovascular and respiratory physiology are also different. CDC is reporting about 20 swine flu cases in pregnant women, and late yesterday they gave a more detailed description of three cases, one of which ended fatally:
Patient A. On April 15, a woman aged 33 years at 35 weeks' gestation with a 1-day history of myalgias, dry cough, and low-grade fever was…
revere | May 12, 2009Trying to figure out where the incipient swine flu pandemic is heading and how fast it is heading there is shooting at a moving target, and this one is moving pretty fast. The best we can do at this point is use whatever information we have to make some educated guesses about different scenarios along with how likely various scenarios are. We used to do this on the back of an envelope, Now we use computer programs. I'm not sure we are doing much better (or much worse), but we can make use of more information and the answer looks prettier when displayed.
Expedited publication of such an…
revere | May 11, 2009Yesterday DemFromCT had another in his continuing series at DailyKos on Flu and You (Part VIII). He extended an earlier post (part II) on a critical piece of public health infrastructure, laboratory surveillance. One of the graphics is this chart of influenza positive tests reported to the CDC by the WHO/NREVSS collaborating laboratories:
What you see in this chart is a weekly record of what seasonal influenza types and subtypes are circulating in the community (influenza A/H1N1, A/H3N2, B; swine flu makes a late appearance, far right). Flu seasons differ on dominant subtypes, whether they…
revere | May 10, 2009The spate of swine flu articles in The New England Journal of Medicine last week included an important "Perspective, The Signature Features of Influenza Pandemics — Implications for Policy," by Miller, Viboud, Baliska and Simonsen. These authors are familiar to flu watchers as experienced flu epidemiologists and analysts of archival and other data. Analysis of archival data is sometimes described as archeo-epidemiologic research. In their NEJM article Miller et al. summarize what they see as some common features in the three flu pandemics of the last century (so the generalization that there…
revere | May 10, 2009[Freethinker Sermonette is a regular Sunday feature here.]
When you don't exist any more as a functioning mechanism, worrying about what happens to your parts is not something to fret much about. And indeed I don't much care.
Well, maybe I care a little bit. Truth be told, there are some things I don't want, something I realized only when I read about a company that will take 1 gram of my ashes (I would like to be burned, by the way) and fly this 1/28-th of an ounce of combustion products of my former self to the moon:
Leaving Earth to touch the cosmos is an experience few have ever known,…
revere | May 9, 2009Maryn McKenna has a great piece at CIDRAP News today about something that should worry all of us as we wait to see if the other shoe drops with swine flu. Our acute care health services system is so brittle it won't take much to break it:.
With the global outbreak of novel H1N1 influenza (swine flu) entering its fourth week, physicians at emergency rooms, clinics, and hospitals around the United States say they are overwhelmed with "worried well" who have as much as doubled their patient loads.
All the clinicians work at medical centers that have planned and practiced for pandemics and…
revere | May 9, 2009Most of us would agree that treating AIDS is not a crime. "Most of us" apparently doesn't include the Iranian judiciary and the Iranian government. We have posted on it several times (here, here, here) but for new readers, here's some background:
Doctor Arash Alaei and Doctor Kamiar Alaei are two Iranian physicians who were detained in June 2008 by Iranian authorities. The physicians, who are brothers, were kept in Tehran’s notorious Evin prison for over six months without charges or trial. On December 31, 2008, a one-day, closed-door trial was held, in which the brothers were tried as…
revere | May 9, 2009Long time readers know that I am poorly disposed to religion (I understate). Particularly religion of the evangelizing sort. I wouldn't care if they didn't actively try to interfere in the public sphere. But they do, often in the most malignant ways. Still, when a religious organization recommends something that makes sense, especially one that isn't being recommended nearly enough, it should be recognized for what it is. A very good idea:
The Evangelical Alliance is calling on churches to prepare to set up networks of ‘flu friends’ to care for the sick in case of a swine flu pandemic,…
revere | May 8, 2009While swine flu as a public health issue is starting to fade from the headlines (its true status as a public health issue is another matter), the problems for the pork industry might just be starting. The industry wasn't well to begin with, and for some of its members, swine flu could be a terminal event, just as with people. Hog prices were very low even before the outbreak and hog futures have declined another 20% since then. This is on top of increased costs related to feed (70% of the cost of production). Even if people can't get sick from eating pork, pigs are getting sick from being…
revere | May 8, 2009Late yesterday The New England Journal of Medicine published a number of papers on the recent swine flu outbreak. The first paper, "Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans" by large federal-state team of epidemiologists describes 642 confirmed cases in 41 states as of May 5, 2009, two days before publication. What I find remarkable is the speed the problem was recognized -- literally days. Identification of the virus was first made in the CDC laboratory on April 15, just 3 weeks ago. Now we are already reading scientific papers providing a wealth of detail.
Among…
revere | May 7, 2009It seems a conversation on one of the comment threads about "swine flu parties" at Effect Measure has made the New York Times:
One of the first open debates of the idea of intentional self-infection was on Effect Measure, a public health blog with many posts by thoughtful people who say they are clinicians, epidemiologists, veterinarians and other professionals, sometimes in government, but who post under pseudonyms to speak freely.
On April 28, a user calling herself OmegaMom posted: “Just a quick note — I just got a Tweet from a mom suggesting ‘swine flu parties’ because the U.S. version…
revere | May 7, 2009Breathing easier, may be an apt phrase for an almost audible collective sigh of relief. So far, the incipient swine flu pandemic is not extremely nasty. Is this perhaps premature? The world's premier scientific journal, Nature, and many flu scientists, suggest it is:
Complacency, not overreaction, is the greatest danger posed by the flu pandemic. That's a message scientists would do well to help get across.
[snip]
There is ample reason for concern: a new flu virus has emerged to which humans have no immunity, and it is spreading from person to person. That has happened only three times in the…