Pandemic preparedness
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, 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 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…
revere | May 5, 2009As I write this the US has 279 confirmed cases and one death from H1N1/2009 in 36 states. WHO has tallied 1085 1124 cases in 21 countries with 25 deaths. There is a backlog of samples waiting for confirmation, so by the time you read this the counters will probably have rolled upward, especially as state laboratories become facile with the new primers and are able to do their own confirmation. And predicting an increasing case count is about all anyone can say with certainty at this point. What we said once about flu pandemics can be said just as appropriately for the flu virus: "If you've…
revere | May 4, 2009There have been questions in the comments about where the CDC estimate of 36,000 to 40,000 influenza related deaths a year comes from. It's a figure I've used a number of times here to say generally that regular old seasonal influenza may be a mild disease for some but not for many others. Even if you don't die of flu, it can be a miserable illness and lay you low for several weeks of acute illness and months of fatigue and malaise. Now the 36,000 deaths number is taking on a life of its own, so it's time to explain exactly what it is and what it isn't. There are more things it isn't that it…
revere | May 3, 2009Newspapers and wireservices are doing a terrific job keeping a flow of information on H1N1/2009 (the virus formerly known as swine flu). And so, I am happy to say, is the blogosphere. I don't want to slight some terrific bloggers by mentioning some and not others, so I won't do a blogroll. OK. I will make one exception to the "not mentioning" by mentioning crof over at H5N1, not only for his usual splendid job of gathering the news but for his great blog roll and resource list on the sidebar.
And, yes, I am going to make another exception for an exceptional blog post by my long time blogging…
revere | May 2, 2009Laurie Garrett of the Council on Foreign Relations and a well-known authority on emerging infectious diseases was on PBS's Newshour last night and she made a very important but little appreciated point. Mexico has made a major national sacrifice for global public health by shutting down its country and interrupting transmission of disease. The cost to Mexico has already been enormous it will continue to pay in other ways. The reputation of the government has suffered because of the way it handled this -- the lack of transparency, the initial slow footedness (which of course it denies), its…
revere | May 1, 2009[NB: I have been traveling and offline all day. No way I can even read much less respond to the many excellent comments, tips, questions. Thanks to all. Help each other. Back at home base now.]
Closing US borders with Mexico for swine flu is fruitless since the virus is already planted in a dozen or more countries. And while right wing xenophobes are trying to blame Mexican immigrants, most of the international spread has come from commercial travelers, either tourists or business people. If we had sealed the borders, would it have included all American nationals in Mexico? Somehow I don't…
revere | May 1, 2009Just a brief note to remind everyone about the case definitions CDC is using for reporting on swine flu (or whatever name we collectively settle on). In order to make sure numbers are comparable from day to day and place to place we have to decide on criteria for knowing we have something to count. Is someone with flu-like symptoms to be counted as a case? Or do we confine it to someone with laboratory proved infection with the virus? Should there be different categories of diagnostic certainty?
For the moment, CDC is using the following definitions for suspected, probable and confirmed cases…
revere | May 1, 2009One of the things we are told is not the responsibility of government but an "individual responsibility" is not working sick or sending our kids to school when they are sick. I pointed out that the ability to do this may depend on others, particularly employers. Employers also have a responsibility, not just employees.
The US has some of the worst sick leave and child care policies among industrialized nations. It is nothing short of a scandal. And now these non-policies have the potential to have major public health consequences. The US labor movement is querying its workers about this. Here…
revere | April 30, 2009A reader (hat tip, sandy) has pointed me to a very interesting interview with CDC's chief virologist, Ruben Donis, in Science Magazine's blog, ScienceInsider. In it he provides further information on the confusing reports about the species origin of the current swine flu, originally said to be of swine, human and bird origin but later claimed to be only swine. It may be that both are true, depending on how you look at it.
According to Donis, who has been sequencing the isolates, the virus is all recent swine but bears the marks of human and avian ancestry in some genes. Different genes have…
revere | April 30, 2009There is a tendency to be preoccupied with the latest in fast moving events, but I want to pause for a moment to make a point that has been lost in the discussion: we are witnessing a medical science landmark. Never before have we watched a flu outbreak of global dimensions unfold in real time. Nor have we ever had the opportunity to alter the course of such an outbreak.
I have been critical of WHO for being late to the party, but they are fully on board now and by raising the pandemic threat level to phase 5 have done something very important: served notice that it's time to mobilize…
revere | April 29, 2009In June 2005 a reader over at the old site suggested we put up some of our flu related material on Wikipedia. That sounded like a great idea to me. Even better, why not start a special purpose wiki -- a flu wiki -- to harvest the vast knowledge of the hivemind? Many, if not most, of the problems that would plague us in a pandemic weren't medical or even scientific in nature. They were things like, how do you prepare your small business for the possibility that the one person who knows how to unjam the fax machine is out sick for 4 weeks? Two other bloggers were also doing flu stuff at that…
revere | April 29, 2009A student once complained that no horse was too dead for me to stop beating it. Long time readers are familiar with that here. Over the years I have said that the best way to prepare for a pandemic -- or any other grave threat to our communities -- is to strengthen its public health and social service infrastructures. While some progress along those lines have been made (the additional training and upgrading of the national laboratory system is what allows us to find swine flu cases), in the main public health and social services have continued to deteriorate and weaken. And with the day of…
revere | April 29, 2009As is usual (routine? no, nothing routine about this) in an evolving epidemic contradictory and confusing numbers are appearing. Some of them are the result of information lags (tallies not being updated), some are the result of using different criteria for counting (suspect versus probable versus lab confirmed, etc.), some are just rumors. WHO is saying that in Mexico there are only 7 confirmed deaths, 19 more lab confirmed cases, 159 probable cases and some 1300 being evaluated, based on official reporting to them by officials of a member state, the Mexico. Everyone knows there are many…
revere | April 28, 2009As cases continue to accrue in different places we will hear more talk about quarantine and isolation. These are two terms that are frequently confused, which is too bad, because isolation makes sense for influenza and quarantine doesn't. So what do they mean?
What quarantine and isolation have in common is they are both designed to interrupt the transmission of a disease that spreads from person to person. Quarantine is the legally enforceable segregation of people who people who have been or may have been exposed but who aren't (yet) sick. Some people talk about "voluntary quarantines," but…
revere | April 28, 2009It would be nice to think that the 28 cases at the NY Prep School are it for the city and that the virus has been contained there. But that was always more a wish than a plausible reality:
CBS 2 HD has learned of a confirmed case of swine flu at the Ernst & Young headquarters in Times Square.
One of the staffers became ill over the weekend after coming into contact with a family member who had been exposed to the virus.
The staffer is said to be resting at home and the company believes, due to the virus' 24-hour incubation period, that no one else at Ernst & Young was exposed. The…
revere | April 27, 2009One of the things we'd like to know about the swine flu virus is its Case Fatality Ratio (CFR, commonly called a case fatality rate, although it isn't technically a rate but a proportion). But what is a CFR? And how is it different from a mortality rate?
The CFR is an estimate of the probability that someone with the swine flu will die of it (technically, before dying from something else or recovering). The higher the CFR, the more virulent the virus. So what's virulence? Virulence refers to the severity of the disease the virus produces. Rabies is a virulent virus. Everybody dies from it…
revere | April 27, 2009The daily CDC conference call was not particularly informative, but these daily briefings are still extremely valuable. Things are happening fairly fast but nothing we didn't expect. There are now 40 confirmed US cases in the same 5 states (California, NY, Texas, Kansas, Ohio). The 28 new cases sere contributed by the New York prep school that had the state's first 8 cases. These additional ones are the result of continued case finding. Acting CDC Director said that the only laboratory confirmed human to human transmission is in the Kansas husband and wife (he had just returned from Mexico…