Pandemic preparedness
revere | September 18, 2009Most people are either indifferent to swine flu or fearful, but the makers of Purell hand sanitizer and Chlorox are happy. It's been a boon to the business of sanitizing everything in sight as a way to ward off swine flu. Here's a story about Chlorox (bleach):
The company has secured additional suppliers and will increase production if needed, says Benno Dorer, senior vice president- general manager of Clorox’s cleaning division. Some retailers have already asked for more bleach, he said in a Sept. 4 telephone interview, declining to name specific companies.
An outbreak of the flu may add 2…
revere | September 10, 2009Flu season is over. Before you heave a sigh of relief, I'm talking about the (official) 2008 - 2009 flu season, which ended August 30 in week 34 or the calendar year. Welcome to the new flu season, the one called 2009 - 2010. It promises to be, well, "interesting."
Not that the one just concluded wasn't interesting. Indeed before we get done analyzing the data already collected it's likely to be the most informative in flu science history, partly because we have tools we never had before, partly because we have information gathering and handling capacity we never had before. But mostly…
revere | September 9, 2009One of the most feared outcomes of infection with influenza is Acute Respiratory Distress Syndrome (ARDS; in less severe form it mahy be called Acute Lung Injury, ALI). For reasons we still do not understand, cells deep in the lung that are involved in gas exchange (oxygen and carbon dioxide) become so damaged that the basic work of supplying the body with enough oxygen for life and getting rid of the carbon dioxide generated by metabolism is too much for the patient and either some intervention to relieve the lungs of some of the work is made or the patient dies. ARDS is so severe that often…
revere | September 8, 2009As we expected, yesterday's vaccine piece provoked a lot of discussion, almost all of it thoughtful and pertinent. Since we've already said we might be wrong, we thought we'd take some time to respond, using it as a way to keep thinking things through on our end. Writing is thinking and thinking is needed in this situation.
Over at FluTrackers.com (an excellent flu forum like Flu Wiki with highly informed people) there were a number of lengthy responses, most of them on the negative side. Since these folks follow events closely their opinions are also worth following closely. In addressing…
revere | September 7, 2009When it comes to US swine flu vaccine policy, I'm not calling the shots, but if I were I'd do it differently than the current plan, which calls for a vaccine containing only viral antigen and no immunity boosting adjuvant. I opt for a vaccine with an adjuvant, probably the one that has been used for years in Europe, MF59. If I were to make a decision like that, I could well be making a mistake, because no one really can know at this point what is going to happen or not happen. We can only go on the best data we have coupled with some principles of what's right. On that basis and using my own…
revere | September 3, 2009When I tell people I am an epidemiologist, most of them think it means I'm a skin doctor. I'm not (although the skin disease specialty is much more lucrative). Instead I study patterns of disease in populations and use what I see to try to figure out why the observed pattern rather than another. Since I'm a cancer epidemiologist I usually do large, highly systematic studies that often take years to execute and analyze, but some epidemiologists do much more immediate "shoe leather" epidemiology, investigating disease outbreaks. They are like disease detectives and we can often learn a…
revere | September 1, 2009It's not Labor Day yet, but I guess the Reveres have to consider their vacation over. We're all back at our respective home stations. We admit that not watching flu evolve daily was a relief, although we did sneak peeks when we weren't supposed to. But it also proved to be like the stock market. The daily ups and downs sometimes obscure the bigger picture. So what does it look like now?
We have two contradictory impressions. One is that the pandemic has continued to develop in a very robust fashion. So it's a dynamic picture of change. The second is that it looks like a normal pandemic, just…
revere | August 6, 2009Making predictions about something as unpredictable as flu is foolhardy. I rarely (if ever) do it, but I'm going to do it now. I am predicting a bad and early H1N1 swine flu season in the northern hemisphere next fall and winter. The reasons for this departure from our usual custom is a paper in Nature from 2007 I just re-read. It's entitled "Seasonal dynamics of recurrent epidemics" by Stone, Olinkyl and Huppert from Tel Aviv University and it appeared in vol. 446, pp 533-536, 2007 (doi:10.1038/nature05638; html version here, if you have a subscription). The paper isn't specifically about…
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 | 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 21, 2009The reaction to our post on Sunday about preparing for the ongoing flu pandemic was mixed. Some thought it was right on target while others expressed dismay over what was perceived as minimizing the possible effects, especially as we have been talking for well over four years about the potentially pervasive nature of widespread absenteeism. Still others thought we had retreated to a narrow view focused on the pressure on the health care system while neglecting what might happen in the wider world. There is some truth to all these perceptions, but we didn't take this tack because we changed…
revere | July 20, 2009With flu season in the northern hemisphere looming and H1N1 cutting a nasty swath through good portions of the southern hemisphere's current flu season, attention is being turned to the non-existent but hoped-for vaccine against swine flu. Yesterday we discussed the problem of pinning pandemic planning on a vaccine. That's planning for the best, not hoping for the best. There are a lot of uncertainties regarding whether an unadorned egg-based vaccine -- the bulk of the vaccine now in development -- will be sufficient, available in time or even effective. But those problems just scratch the…
revere | July 19, 2009We've been talking about the possibility of a flu pandemic here for four and a half years. The cliché during much of that time was that the right way to think of a flu pandemic was not "if," but "when." As long as no pandemic materialized, however, there was great scope for what it would look like and hence what to plan for. The hoary adage, "Hope for the best, plan for the worst" made sense but left a great deal of scope for different approaches to planning. What, after all, was the worst we could expect? We had two models, one historical, one hypothetical but plausible. The historical one…
revere | July 13, 2009I am thinking out loud here. Since that's never a pretty sight, you might wish to avert your eyes. With that merest of advance warning, the school closure problem has gotten me to think more generally about social distancing. The term itself is a kind of oxymoron. "Social" emphasizes togetherness, intercourse between people, relations. "Distancing" is negation of the social. We have examples: canceling school, prohibiting mass gatherings, telecommuting, but the underlying idea is straightforward. With a contagious disease that passes from person to person (details still to be worked out, of…
revere | July 10, 2009Had a busy day at work yesterday (the pesky day job problem) but did get a chance to see bits and pieces of the Flu Summit video streamed at Flu.gov. This was aimed at state and local folks, and the parts I saw didn't provide much new information if you have been following this for years. I'll bet, though, it was sobering for many state officials who haven't had the chance or inclination to consider the myriad ways widespread absenteeism can affect our intertwined and interdependent modern way of life. One aspect vividly on display in the opening months of the current swine flu pandemic was…
revere | July 8, 2009A risk factor for swine flu complications is pregnancy. Yet one of the few venues specifically for healthy people in modern health care facilities is for pregnant and postpartum women, the in and out patient portions of the obstetrics department. And what of the newborn whose mother gets the flu? Infants are also at greater risk from influenza complications.
This is a tough problem. CDC has just issued some interim guidance regarding swine flu and obstetrics settings. The guidance is "interim" because CDC is quite frank that there is a great deal we don't know about the probabilities and…
revere | July 4, 2009I don't know what's going to happen with swine flu. I do know that if there is a nasty flu season we'll all get through it better if we help each other, not run from each other. It's national independence day in the US, so I thought this clip of the crowd singing the National Anthem (hat tip, Paul Rosenberg at Open Left) at Boston's Fenway Park (home field of the Boston Red Sox baseball team) was appropriate. It was Disability Awareness Day and to recognize it the anthem was being sung by a handicapped youngster. When he got nervous, the entire ball park came to his rescue: