Pandemic preparedness
revere | December 14, 2006Last week we posted on the Canadians realizing that if a a pandemic hit, even a moderate one, their hospital system would be in deep feces. This week it's the US's turn. Not that this is news, exactly, but it bears repeating. Again. And again. And again. So here's the message. Again:
Half of all U.S. states would run out of hospital beds within the first two weeks of a moderate flu pandemic and 47 states would run out if a bad one hit, according to a report issued on Tuesday.
The report from the Trust for America's Health shows the United States is still poorly prepared for a pandemic,…
revere | December 9, 2006You may think bird flu is a disaster still waiting to happen, but in one way it is a disaster that already happened. One of the shoes dropped between October 2005 and May 2006 when the H5N1 subtyupe of highly pathogenic avian influnza spread to the poultry flocks of 50 countries. Since 2003 the outbreak has resulted in the slaughter of some 240 million birds. In 2005 it burst out of Asia and spread into Europe, the Middle East and Africa. So even without the "other shoe" dropping -- a change in the virus to allow easy transmissibility from human to human -- the damage already done is immense…
revere | December 8, 2006Part of raising awareness about the potential problems we would have in an influenza pandemic is saying the same thing over and over again, sometimes in different ways and sometimes just repeating it. So we're going to do it again. From the Globe and Mail (Toronto):
Severe restrictions that allowed only emergency patients to be admitted to hospitals during the 2003 SARS outbreak in Toronto would not be enough to handle the flood of patients expected during even a mild flu pandemic, a new study has found.
[snip]
"The [various governments' pandemic flu] plans are quite comprehensive, but the…
revere | November 25, 2006After many travails and gnashing of keyboards, The Flu Wiki Forum has a gorgeous new look. We have migrated from PMWiki to SoapBlox and in the process acquired some wonderful new capabilities, among them the option of having nested or threaded comments (you can keep the old forum comment organization if you want to, however) and full-fledged Diaries. First, let us say that the editorial "we" includes The Reveres in spirit but all the heavy lifting -- and we mean just about all of it -- was done by my wiki partners Dem, Melanie, pogge and SusanC (aka anon_22). It's a terrific job and everyone…
revere | November 24, 2006One of the remarkable things about The Flu Wiki is how it has taken root in other places. There are now several non-English versions of it, including français, español, Türkçe and norsk.
In a recent comment our Norwegian colleagues asked we remind you they are there. I went and took a look at the Flu Wiki.no site and if you are in Scandinavia join in. The Swedes and Danes won't have any trouble with the language (my Swedish isn't great and even I could read the Norwegian) and while facility with English is widespread in the Nordic countries they also have their own issues and local…
revere | November 10, 2006Someone should tell the US government: "Big Blogger is Watching You." Both CIDRAP and crof's blog H5N1 picked up a story that the US State Department was advising its diplomatic and consular personnel in in Hong Kong and Macao to prepare for a possible "shelter-in-place" event by laying in a stockpile of food and water to last twelve weeks if there were a complete infrastructure breakdown in an influenza pandemic. CIDRAP noted this differs from advice on the US government pandemic flu site which suggests only a two week buffer.
You can read the original twelve week recommendation thanks to…
revere | October 30, 2006It sounds reasonable at first. If hospitals and clinics are going to be overwhelmed in a flu pandemic, prepare to care for sick family members at home.
But what if there's no one to care for you at home? That's the position of the one in four Americans who live alone. Even for those that have others to care for them there are serious barriers:
Almost half of those surveyed said they would run into financial problems or might run out of important drugs if health officials asked them to stay home for a week or more, said Robert Blendon, a Harvard School of Public Health policy expert who will…
revere | October 27, 2006A letter from Philip Mortimer of the UK's Health Protection Agency to the CDC journal, Emerging Infectious Diseases, calls attention to an apparent increased risk for death from influenza among a subpopulation, pregnant women. Mortimer alerts us to the fact that most (all?) national contingency plans for pandemics do not take this into account.
Mortimer cites literature from the 1918 pandemic that contains ominous figures:
Bland reported on pregnant influenza patients in Philadelphia and elsewhere in the fall of 1918; of 337, 155 died [Bland PB. Influenza in its relation to pregnancy and…
revere | October 12, 2006The Federal government's flu plan is in it final stages of recapitulation -- sorry, I mean, the final stages of preparation. The headline of the AP news story says it all: U.S. Pandemic Flu Plan: Hole up at Home. Jeez.
The federal Centers for Disease Control and Prevention is pitching the plan at medical meetings and aims to send it out for review by the end of the year. State and local governments have asked for unusually detailed and specific advice on such matters as closing schools and canceling public events, one CDC official said.
This week, CDC awarded $5.2 million in grants related…
revere | October 9, 2006Today marks the second Pandemic Flu Awareness Week, launched by my colleagues over at The Flu Wiki. The good news is that in the year since the first effort to raise the awareness of the blogosphere, much has happened in the way of increased recognition of the pandemic threat. Communities around the world have started to plan for the possibility of a pandemic and the planning process will pay dividends. More good news is that a pandemic strain of H5N1, the leading candidate for a disastrous flu pandemic, has yet to come into the open. The bad news is that there is much, much more that needs…
revere | October 6, 2006I'm still trying to figure out if the statement by Ambassador John Lange, the US State Department's special representative on avian and pandemic influenza, that this country is close to "state-of-the-art" in its preparations for a pandemic of H5N1 and its biosecurity measures is some kind of dark humor about state-of-the-art in general or just an amazingly clueless assessment of where we are. I'm aware that a sense of humor doesn't usually characterize the official prnouncements of this administration, although some of them do produce hysterical laughter. I'm pretty sure he is either clueless…
revere | October 3, 2006Here's a solicitation for reader input.
A medical conference in the UK last week was told that the Government's faith in antivirals as the key to combatting a pandemic is misplaced. There was the usual handwringing about the havoc that a pandemic would bring and dueling views as to whether British society could cope with it without breaking down. I'll put my bets on British society. And American society. And French society. And, etc.
But I'm not a betting man, so some real planning and preparation is obviously in order. We've known this all along, said it all along and even done some of it,…
revere | September 30, 2006There are reasonable and plausible suggestions that there may be other reservoirs for H5N1 than poultry. We have discussed it here numerous times, but we don't know although I certainly wouldn't rule it out. But the poultry reservoir is gigantic and probably the source of most human contact with the virus. Consider Indonesia, with its estimated 300 million poultry:
Bird flu may have infected a quarter of backyard fowl in some of Indonesia's most densely populated areas, the country's top veterinary official said, risking human lives and increasing the threat of a pandemic.
Random tests…
revere | September 30, 2006The Rockefeller Foundation's conference center in Bellagio, Italy on Lake Como is a lovely place (digression: so I'm told by people I know who have spent time there. I haven't -- yet. This is a big hint to the Foundation that I am available to take a week there and tell you what I think. Or you can find out for nothing here. But I'd rather tell you in person.).
In June Ruth Faden, a bioethicist at Johns Hopkins convened a group of experts there to talk about ways to soften the impact of a flu pandemic on the world's most vulnerable:
"Within countries rich and poor, the burden will be felt…
revere | September 27, 2006When we first began to cover the bird flu problem -- back in 2004 -- it wasn't being discussed much anywhere, including the blogs. We started talking about it for two main reasons. First, it seemed to us, as it seemed to many informed public health scientists, that this was a possible freight train coming down the tracks. We didn't know then (nor we know now) how far the train was, whether it would get all the way to us or how fast it would be going if it did get to us. But we could feel the vibrations on the tracks and we knew enough about train wrecks of the past to worry. That was the…
revere | September 26, 2006The City of Boston is now soliciting volunteers for a new Boston Medical Reserve Corps Program, designed to help the city prepare for disasters:
"I want everyone in Boston to consider joining the Boston Medical Reserve Corps; people in our medical, health and business communities, our residents, our college students, retirees -- anyone who wants to help," said Mayor Menino in announcing the recruitment drive. "We're looking for everyday heroes to help make Boston safer and more prepared."
Following many disasters, large numbers of people often come forward to help. Many of those well-…
revere | September 26, 2006Many readers here know that WHO has a pandemic phasing arrangement, and there has been much confusion and consternation about why they have or have not "called" phase 4. In a characteristically informative article, Helen Branswell of Canadian Press gives some of the details, including the names of some of those who will advise WHO on whether to change the warning level.
In short, WHO has established a committee of experts to help them determine the phasing. Branswell says the committee has about 20 experts, including some stalwarts of the influenza science establishment:
The list of 20 or so…
revere | September 20, 2006Nick Zamiska had an interesting piece in yesterday's Wall Street Journal about the difficulty WHO is having encouraging a sense of urgency about a possible pandemic of avian influenza and the many other programs and problems with which they are daily engaged in a (literally) life and death struggle in many places in the world most of us have never heard of. The problem is made more difficult because of the roulette-wheel like nature of an emerging pandemic. We don't know when or if our number will come up or how much we should invest in the event it does. So far it hasn't happened, which is a…
revere | September 17, 2006Huge industrial style poultry farms, where birds are locked in cages in close quarters, are the perfect environment for disease spread. What about locked up people? Two million of them. Two million.
The US locks up more of its population than any nation on earth. By a long way:
This is not something we've always done in the US. It's shockingly recent, within the lifetimes of virtually everyone who is reading this. It really took off with the Reagan counter-revolution and has continued until today, slowing only because states can no longer afford it:
source: Crooked Timber
Since 1980 the…
revere | August 26, 2006The headline -- U.S. border states preparing for pandemic flu threat -- sounded weird, but this is about some good ideas. The weird part was expecting this was about hardening the borders to keep bird flu out. In fact, however, it is about something much more sensible: the clear understanding that this virus doesn't care about political borders:
California and Arizona, two states bordering Mexico, are working together to address the emerging threat of an influenza pandemic.
California Governor Arnold Schwarzenegger and Arizona Governor Janet Napolitano have co-sponsored a joint declaration at…