Pandemic preparedness
revere | April 26, 2010What are we to make of the swine flu pandemic? The only thing I feel confident about is that it will be some time before we really know. A great deal of data and experience was gained in the year since the pandemic H1N1 took everyone by surprise but it will be a while before we can harvest all of it. Meanwhile I can say things were better than we thought they might be and certainly better than everyone's worst fears, but how much better -- better, how bad -- they were we just don't know. It was a very good year for people in my age category (over 65) as for reasons now becoming a bit clearer…
revere | April 22, 2010It was a year ago today we put up our first post about swine flu: "The California swine flu cases." I think we were the first blog to notice it, and it began this way:
Late yesterday afternoon a Morbidity and Mortality Weekly Report (MMWR) Dispatch appeared on CDC's website that is unique in my experience. MMWR is usually heavily vetted and edited and nothing gets out of there fast. Indeed, in recent years, nothing at all got out of CDC very fast. And yet here is this Dispatch, with text referring to the same day of issue (April 21), reporting on two young patients with febrile respiratory…
revere | April 20, 2010The Icelandic volcanic eruption is still causing havoc in Europe with ripple effects elsewhere as people and planes are grounded for travel in or out of much of northern Europe. Pressure from the traveling public, air carriers and business is mounting to let passenger and cargo planes fly again. What's changed? Not much. There's about as much uncertainty as there was a week ago, just a lot more pushback. The recriminations are already starting: EU and national transport authorities "over reacted." They should have ... done what? At the same time airlines like Air France-KLM are conducting…
revere | April 9, 2010This week Canadian public health researchers published the long awaited paper on possible association between vaccination for seasonal influenza the previous flu season and risk of having a medically diagnosed infection with pandemic influenza during the first wave of infections (April to July) just as that season was ending. When preliminary results were first announced there was only vaccine against seasonal flu, which was still being given, and the results were contrary to what we thought we knew about flu biology and the immune system. Inevitably it became caught up in the wider anti-…
revere | April 7, 2010Dear influenza virus:
You owe the Council of Europe and a number of others an apology. They are angry -- and rightly so -- that you didn't kill many more people and wreak havoc in every country on the globe. You could have. Other influenza viruses killed a lot of people, especially when there was no natural immunity in the population. As far as anyone can tell you aren't any different. When you surprised us there was no effective vaccine. You had the perfect opportunity and you blew it. As for the vaccine we got later, it's no excuse. I read in the British Medical Journal the vaccine might…
revere | April 3, 2010Better late than never. When the Bush administration proposed sweeping airport quarantine rules in 2005, even those of us most concerned about avian influenza thought it was a fruitless policy on scientific grounds, not to mention issues of civili liberties and economics. The airlines hated it, too:
The regulations, proposed in 2005 during the Bush administration amid fears of avian flu, would have given the federal government additional powers to detain sick airline passengers and those exposed to certain diseases. They also would have expanded requirements for airlines to report ill…
revere | April 1, 2010The AMA just took over a journal called Disaster Medicine and Public Health Preparedness. In fact they proudly announced they were the exclusive publisher and distributor of the journal, formerly published by Lippincott, Williams and Wilkins. I wouldn't even know about it except it was in connection with a press release of an article likely to be of interest any health care worker: ":Which Health Care Workers Were Most Affected During the Spring 2009 H1N1 Pandemic?" by Santos, Bristow and Vorenkamp of Weill-Cornell Medical School in New York. And the AMA even said it was redesigning the…
revere | March 29, 2010A day or two after CDC's Morbidity and Mortality Weekly Reports (MMWR) released a report about risks to pregnant women from pandemic 2009 flu, CDC held a suddenly announced press briefing about the current H1N1 situation (I listened in but a transcript should be up on the site by the time you read this; check this page). The occasion for the briefing was a worrisome increase in hospitalizations and deaths in CDC's Georgia backyard. Despite housing CDC, Georgia has one of the lower flu vaccination rates in the country and now is experiencing an unexpected recrudescence of H1N1 flu, with…
revere | March 26, 2010We continue to learn a great deal about influenza infection as researchers harvest information from the recent swine flu pandemic. The pork producers don't like to call it "swine flu" but it may well be that its long sojourn in that animal since 1918 (did we give Spanish flu to pigs or did pigs give it us?) may hold an important clue to why older people suffered less than younger ones. It seemed fairly likely that the difference was related to immunity, but since H1N1 came back in 1977 after being absent since 1957, it wasn't clear why younger people born after 1977 would be as immune as…
revere | March 23, 2010We are now almost through the period considered to be the traditional flu season (to the end of March in the temperate northern hemisphere) and so far the amount of documented influenza infection is at a relatively low normal level and pneumonia and influenza deaths are about usual for this time of year. Said another way, there so far has been no big "third wave" of pandemic swine flu. Most flu experts didn't know what would happen but if they had to bet, probably would have bet on a resurgence. I suppose it could still happen, since the original transmission in the community occurred "out of…
revere | March 1, 2010It really gives me heartburn to see an otherwise sensible article in AOLNews by Katie Drummond with a headline: "Hyping H1N1: Did It Create a Dangerous Flu Fatigue?" I don't know if that was her title or not. Newspapers have headline writers who often seem never to have read the piece they are headlining, but online authors often title their own pieces. In any event, the word in the headline I object to is "Hyping." It implies deliberate exaggeration for ulterior motives.
Did many respectable news outlets do this? Some did, no doubt. They are businesses and news is the commodity they are…
revere | January 28, 2010The Reveres have written many posts about the World Health Organization in five years. Some just reported on their activities, others, as seemed appropriate, were critical or praised them. WHO operates in a difficult landscape under rules of engagement not well suited to fighting an enemy that recognizes neither national borders nor national sovereignties and one might question this intergovernmental agency's relevance given those constraints. But we have always bridled at accusations WHO acted unethically or incompetently, neither of which is true. WHO does a difficult job with just a…
revere | January 22, 2010It was some time after the pandemics of 1957 and 1968 that we were able to judge their severity and it will likely be some time after this one has finally burned itself out, most likely to become "just another" seasonal flu, that we will be able to gauge the 2009 swine flu pandemic. A lot of data is being generated but it will take time to harvest it and send it to the scientific market for consumption. A report in today's Lancet reminds us that we aren't seeing all there is to see, even with unprecedentedly rapid means of communication and better surveillance than ever in the history of our…
revere | January 17, 2010There is an old vaudeville joke where a man goes to the doctor complaining about pain in his arm:
Doctor: Have you ever had it before?
Man: Yes, once before.
Doctor: Well, you have it again.
CDC reported on their weekly FluView website on Friday that the Iowa Department of Public Health (IDPH) reported to CDC that in September a boy (age not stated) had a flu like illness from which he fully recovered and for which he hadn't required hospitalization. In November IDPH determined it was swine flu, but not the pandemic H1N1 but a swine-origin H3N2. According to CDC there was "no clear exposure"…
revere | January 13, 2010The finger pointing and the told-you-so-ers are out in force these days and WHO seems to be one of their targets. In the face of wealthy European countries cutting their swine flu vaccine orders because of limited demand, critics are claiming that WHO exaggerated the threat in league with or under the influence of Big Pharma vaccine makers out to make a killing. This is really two issues. One, did WHO appropriately appraise the risk; and two, were they unduly influenced by greedy drug makers. I think the answer to these questions are "Yes" and "No."
In our view WHO was caught between a rock…
revere | January 3, 2010New York Times correspondent Don McNeil is an excellent medical reporter. He always asks intelligent questions at the CDC pressers and he writes good articles. And he's written one for The Times yesterday that I agree with, although his support for it seems to me less than objective. In essence he asked the country's flu establishment how well the US handled swine flu. None of his sources are CDC employees but all of them are deeply involved in flu and flu policy in one way or another. And they gave themselves a big pat on the back. I hope they didn't wrench their shoulders. That might be a…
revere | December 28, 2009It's the end of the calendar year and the traditional time the media looks back on "the biggest stories of the year." There are websites about almost any subject (even one on a particular model of running shoe, I am told), but those of us who write specialized blogs (as opposed to ones about politics or current events) rarely expect our subject matter to show up on one of those lists. We've been writing about flu for over five years, here, and while re recognized the possibility our subject would come into vogue -- that's indeed why we were writing about it -- it still took us and everyone…
revere | December 24, 2009Yesterday CDC had its last press conference of this calendar year on the flu pandemic (.mp3 here). CDC's Anne Schuchat did her usual competent job and was generally upbeat while trying to maintain the need for urgency in the vaccination campaign. She cited numbers of over 100 million swine flu and 100 million seasonal flu doses having been produced for consumption in the US and this is a real accomplishment. She also noted that availability of swine flu vaccine was now much greater. Indeed my medical center notified us that it was generally available regardless of previous priorities. Hence I…
revere | December 17, 2009Irony isn't dead. But it's on a ventilator. No wait. There aren't enough ventilators. So maybe it's just having labored breathing. From February 9:
The target grew out of discussions among a group of moderate Republicans, led by Sen. [Susan] Collins [of Maine], aimed at reining in costs and better targeting federal funds toward job creation. The effort amounts to "rebuilding" the Obama package, according to an individual familiar with the talks. The package would include tax cuts and investments intended to create jobs, such as infrastructure projects, but it would step back from spending…
revere | December 16, 2009A spot-on column in CIDRAP Business Source [subscription] by Center for Infectious Disease Research and Policy's (CIDRAP) Director, Mike Osterholm, reminded me to say something I've wanted to say for a long time. We should banish the word "mild" from the influenza lexicon. There's no such thing as a mild case of influenza, any more than there are "mild" auto accidents. There are cases that for reasons we don't understand don't make you very sick (or sick at all), and there are cases that can lay you lower than you ever want to be, including six feet under. What Osterholm does with great…