Pandemic preparedness
revere | June 29, 2009Crafting a message on swine flu is not easy, and it's easy to make missteps. I think CDC has gotten it pretty much right over the last two months, but not everyone has. We've written here since the beginning (some examples here and here) that describing any flu outbreak as "mild" is inapt. Flu always has the potential to be a serious disease and kill people, even in flu seasons termed "mild" by comparing them to flu seasons that are "bad." Even with virulent flu viruses many people have minimal illness -- in comparison to those who don't. But flu, even in its most common form of a self-…
revere | June 28, 2009A few days ago we posted about hedge funds getting ready for a swine flu pandemic. At the time we wondered what other industries and businesses were getting ready. We don't know the answer, but we are seeing more signs the message has gotten through. Yesterday we saw this story about a regional airport in Arizona:
The Valley's Mesa-based reliever airport is gearing up to operate with a surprisingly lean staff should the Swine Flu pandemic decimate the airfield's workforce.
Keeping Phoenix-Mesa Gateway Airport flightworthy with a skeleton crew was added earlier this month to mandatory…
revere | June 27, 2009Early returns on what is happening in the southern hemisphere suggest that novel H1N1 is crowding out the expected seasonal strains, something that pandemic strains have usually done. In 1918 there was a pandemic with the H1N1 subtype that settled down as the dominant seasonal flu virus until the "Asian flu" pandemic of 1957 when it was bumped by H2N2. That subtype ruled the seasonal flu roost for only 9 years when a new subtype, H3N2 took its place in the Hong Kong flu pandemic of 1968. Both pandemics were much less severe than 1918 but still resulted in millions of excess deaths globally.…
revere | June 24, 2009For years those concerned about the consequences of an influenza pandemic from an exceptionally virulent flu virus, like A/H5N1 ("bird flu") have despaired about motivating business, government and neighbors to take it seriously enough to make serious preparations. It's understandable. There's are a lot of potential catastrophes competing for our attention and while each can be made plausible if we can get someone to listen long enough, it's rare we can do this. As I said, too much competition. Now that a real life influenza pandemic has arrived, the concern of some is that the public isn't…
revere | June 13, 2009The easiest way for public officials to scare the crap out of people is to tell them "not to panic." A variant on this is, "It's not time to panic," implying that there will be such a time or that there is ever such a time. The first to panic are usually public officials because they feel powerless at a time when people are expecting them to do something. So what they do is incite panic by telling people not to panic. Public anxiety -- often well founded -- is not the same as panic. If parents are keeping their kids out of school from fear it is a flu incubator, that's not panic. That's a…
revere | June 12, 2009However this pandemic evolves, we are going to learn a lot about how pandemics evolve -- or maybe even start. A paper just published online in Nature sets out a bit more of what we know about this pandemic strain (yes, we can officially refer to it that way now) and makes some observations about its prehistory (its history before it became known and documented by we mortals). Maryn McKenna has an excellent run-down over at CIDRAP News, which you should read. Here's our take on it.
First, we'd like to make a "meta-science" observation. This paper is unusual in several ways. The least…
revere | June 11, 2009WHO today declared we an influenza pandemic is underway (aka, phase 6), which is not news to anyone. This beast has been barreling long for at least 3 or 4 weeks and the reluctance to call it what it was was related to resistance from some of WHO's member states (the UK, China and Japan have been often fingered as the chief culprits). The apparent lack of cases in Europe didn't fool most experts. The EU was using a testing protocol designed to minimize the case count. It was refreshing not to have the US party to these kinds of shenanigans, but of course we had no opportunity: it started here…
revere | June 11, 2009In William Osler's day (turn of the 20th century), pneumonia was called "the old man's friend," because it took the elderly away quietly and with relatively little fuss. It was most often caused by the pneumococcal organism, now called Streptococcus pneumoniae. When penicillin came on the scene in the mid 20th century, there was at last a treatment for pneumonia with this organism, but soon resistant strains developed. S. pneumoniae is a frequent resident of the human respiratory tract and usually causes no problems. But if it gets into the wrong place it can also cause sepsis, otitis media…
revere | June 10, 2009Listening to yesterday's press briefing with WHO's Dr. Keiji Fukuda (audio file here), several things seemed clear to me. The first is that everyone, WHO included, thinks a pandemic is well underway. Second, WHO's efforts to explain why they are not making it "official" by going to phase 6 are becoming increasingly awkward and the explanations manifestly tortured. Essentially what Fukuda said was that WHO was waiting for its member nations to signal they knew it was a pandemic and then WHO would say it was a pandemic. It was reminiscent of the cries of one of the principals of the…
revere | June 6, 2009CDC is reporting about 14,000 confirmed or probable cases of swine flu, although they have already said this may represent only a fraction of the total number of infected. I wasn't able to find the latest number of those hospitalized (some of you probably have it but I couldn't locate it with a quick search), but my recollection is that it is somewhere around 300. That puts the hospitalization rate at around 2% of the confirmed/probable cases (I round figures liberally because they are too uncertain to worry about precision). 2% is the same number the Chilean health authorities are using for…
revere | June 4, 2009The UK is having quite a swine flu outbreak, although the authorities aren't owning up to it. As for the public, they are being whipsawed between the usual poles of "it's all hype" and "we're all going to die," with the latter fading in parallel with the fading of effectiveness in selling tabloids. So, yes, there's a lot of dreadful stuff in the news about swine flu, but there's some pretty astute stuff, too. Here's something I ran across in TimesOnline [UK] by Melanie Reid:
When we heard that the only deaths were a few Mexican peasants, we gave a collective shrug: this is not our problem.…
revere | June 3, 2009The unpredictability of flu and difficulty of making any predictions with confidence is tiring to repeat and tiresome to listen to. Unfortunately that doesn't make it any less true. There are things we know -- because we see them happening -- and things we don't know -- because the information isn't available (like an accurate estimate of CFR or prevalence) or they have yet to happen.
What we know is that we are confronted with a new influenza virus that is spreading with ease outside of its normal season, is infecting an age group that normally doesn't get easily infected (the 5 - 24 year…
revere | May 29, 2009As flu season ramps up in the southern hemisphere, the US, Europe and Asia are keeping an eye on it to see what will happen as swine flu finds new pieces of meat to sate its appetite for human flesh. Sorry about the overheated image. I've been reading what's going on in Australia. Because another lesson the southern hemisphere can teach us is how not to react to a pandemic virus.
Consider the Carnival Cruise Line ship, Pacific Dawn. It docked three days ago in Sydney onroute to the Great Barrier Reef to take on new passengers and let off others. But then, according to news reports (but see…
revere | May 25, 2009The World Health Organization (WHO) is not the world's health department or the world's doctor. It is an intergovernmental agency that is part of the United Nations (UN). The UN, despite what hard right wingnuts might think, is not a world government. The international system is technically anarchic, meaning that there is no governing body above nationally sovereign states. For the most part, WHO has no powers beyond those granted it by its member nations (for more background, see our five part series over at the old site here, here, here, here, here). It is only within the last few years…
revere | May 23, 2009Queens, a borough of the city of New York, seems to be a hotspot for swine flu and a New York Times reporter on the city beat, Anemona Hartocollis, has been writing very astute and perceptive pieces from there. Yesterday she had one on the problem posed by the "worried well" who are flooding Emergency Rooms in quest of reassurance. Articles about worried parents who bring relatively well kids to the Emergency Room (ER) are not uncommon. They usually include interviews with harassed and overburdened emergency room doctors and nurses dismayed at the unnecessary demand and its consequences for…
revere | May 21, 2009Military planners are fond of saying that no battle plan survives the first contact with the enemy. The same can be said for the military's pandemic flu plans, although they aren't telling us exactly what those plans are. Some good reporting by Associated Press's Lolita Baldor has uncovered some of it:
The rapid spread of swine flu from Mexico surprised Pentagon officials, who had been focused on a possible Asian-borne pandemic in a response plan that would give the military a last-resort role in helping to impose quarantines and border restrictions.
Drafted and overhauled several times in…
revere | May 19, 2009Is it a pandemic or is it not a pandemic? Since the world has never had a chance to make a call like this at the outset of a pandemic, nobody is quite sure how to handle it. The usual definition -- an epidemic (an increase in cases beyond what is expected) of global dimension -- has a lot of wiggle room and WHO and everyone else is busy wiggling. One reason is not whether this meets the definition or not but what the consequences might be of calling this "a pandemic":
Britain, Japan, China and other nations urged the World Health Organization on Monday to change the way it decides to declare…
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 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…