Pandemic preparedness
revere | April 27, 2009Usually "What did you expect?" is a rhetorical question, but we have a more serious point to make. Let's start with the familiar and move on to the less familiar. Many of you are coming here to find the latest news about swine flu. It's an imprecise term that covers two different things: what has happened that is new, in the sense of surprising and we didn't already know it would happen; and what is the current situation. Overnight (in the US) Europe (Spain) registered its first confirmed case. That's additional data but not surprising. We know this virus is seeded out there and we shouldn't…
revere | April 26, 2009The White House briefing today had Obama written all over it. It's themes were Obama, it's tone of quiet, serious confidence were Obama. The sense of total command of the situation was Obama. There was the Obama-ese call for "personal responsibility." Government can't do everything. There are things we each have to take personal responsibility for.
Fine. I don't disagree. But I think there are some things missing from this frame. One is that it isn't a binary choice, government or the individual. We all live in a set of overlapping communities: work, home, neighborhood, civic organizations,…
revere | April 26, 2009The White House held a briefing this afternoon with the Secretary of Homeland Security, Acting Director of CDC and Nat'l Security adviser to the President in attendance. If you have been following this you wouldn't have learned much, but the overall tone was one of serious concern but steady confidence. It was good security theater, and I say that in a good way. Information was divulged (judging from some of the press questions there was no danger over estimating the knowledge of the audience) and a sensible plan described.
There are now officially 20 confirmed cases in the US in five states…
revere | April 26, 2009If there was ever a graphic illustration of how global interconnectedness affects public health, it's the swine flu affair. Wherever it started, the current crop of cases seems related to Mexico, either as the epicenter or via travelers. Four US states have cases. Those not on the Mexican border are related to travel to Mexico. Kansas, New York City, the suspect cases in secondary school teachers and students in Auckland, New Zealand just returned from Mexico. And France has two suspect cases also just returned from Mexico, as does Spain. We've discussed the problem of infectious disease on…
revere | April 25, 2009A concise summary of some additional developments, courtesy Bloomberg:
Three teachers and 22 students from Auckland’s Rangitoto high school are being tested for swine flu after returning to New Zealand’s most populous city from Los Angeles following a three week trip to Mexico, Stuff.co.nz reported on its Web site. Some of the travelers had symptoms of flu-like illness and were being isolated as a precaution pending test results, it said, citing the Auckland’s public health service.
In the U.K., a British Airways Plc crewmember with flu-like symptoms was taken to Northwick Park Hospital…
revere | April 25, 2009Canadian Press (Helen Branswell, with contributions from AP reporters) AP has a piece up about how Mexicans are coping that is worth a read, but we were drawn to this description of how the Mexican authorities first recognized something was amiss:.
Health authorities started noticing a threefold spike in flu cases in late March and early April, but they thought it was a late rebound in the December-February flu season.
Testing at domestic labs did not alert doctors here to the new strain, although U.S. authorities detected an outbreak in California and Texas last week.
Perhaps spurred by the…
revere | April 25, 2009There may not have been much news at the CDC briefing, but it is coming thick and fast now. The CDC works through state health departments and defers to them on information about what is going on in their localities. Hence all questions about this were deflected at the 1 pm CDC briefing. I think I understand the thinking behind this but it doesn't serve the goal of getting the information out there quickly. CDC needs to be the information clearing house for all the swine flu news going on around the country and they need to do with absolute transparency. Here's what has developed since that…
revere | April 25, 2009CDC has just concluded a press briefing and the big news is there is no big news. In fact there was hardly any small news. The major questions have been identified -- how transmissible, what is the epidemic curve, are there more cases in the US, are there subtle genetic differences in the US and Mexican versions to account for the apparent difference in clinical and epidemiological features, etc. -- but answering them will take longer.
Meanwhile, no new cases have been identified in the US, but CDC in collaboration with state and local health departments and the academic and medical sectors…
revere | April 25, 2009There will be an update from CDC later today and WHO's expert committee established under the new International Health Regulations (IHR) meets via teleconference this morning North American east coast time at 10 am (4 pm Geneva time) to consider whether the swine flu situation merits declaring it “a public health event of international concern.” If they do, WHO Director General Margaret Chan may respond by raising the pandemic threat alert level from the current phase 3 (new virus: no or limited human to human transmission) to phase 4 (new virus, evidence of increased human to human…
revere | April 24, 2009Friday April 24, 1:40 pm: AP and NYT reporting that Mexican authorities are saying that they have determined that 16 of 60 deaths are "swine flu," with 44 more being tested. They have yet to confirm whether it is the same as the California/Texas cases, but that's a bit irrelevant since either way it sounds like a very worrisome development. There are already a reported 930 plus cases, with schools closed in Mexico City and contemplation of closing government offices. Obama has been notified and the White House is following the situation. WHO and CDC have activated their emergency centers and…
revere | April 24, 2009Late yesterday we summarized a CDC media briefing about the developing investigation of cases of influenza in California and Texas with a previously unknown flu virus with genetic components from pigs ("swine flu", humans and birds). At the same time reports were surfacing of an especially virulent respiratory disease outbreak in central and southern Mexico that had resulted in 20 deaths and hospitalizations with acute respiratory failure. 137 cases have been reported, including health care workers. When asked yesterday, CDC said they were in close touch with their Mexican counterparts but at…
revere | April 23, 2009This afternoon CDC held a "media availability" on the evolving swine flu cases. Evolving is an understatement. There are now more recognized cases, although not all cases are "new," with some cases retrospectively recognized now that more intense investigation is occurring. The total is now seven cases. Two occurred in San Antonio, Texas, two sixteen year old boys in the same school. Three more were found in California (in addition to the initial two cases), including a father - daughter pair. All California cases are in San Diego and neighboring Imperial counties, the location of the initial…
revere | April 22, 2009Late 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 illnesses, one of whose cases CDC only learned about on April 13, 8 days earlier. April 17 CDC determined that the two children, both from the San Diego, California area…
revere | March 25, 2009"The Stupid. It Burns!" I don't know where this Simpson-esque phrase comes from, but The Stupid burns pretty bright in the brains of Republican Governors Mark Sanford and Bobby Jindal who are refusing stimulus money for unemployment compensation even though their states have some of the highest unemployment rates in the nation. That's stupid. Like refusing help with avian influenza even if you have more cases of the disease than anywhere in the world. The Stupid isn't just an American disease.
Take Indonesian Health Minister Siti Fadillah Supari. Please.
Source: plognark
Indonesian Health…
revere | March 16, 2009There is an attitude toward the prospects of an influenza pandemic and what, or what not, to do about it that I have little patience with. We saw examples a couple of years ago with the writings of Wendy Orent and Marc Siegel and now it is surfacing again from Philip Alcabes, in an op ed in the Washington Post over the weekend. All three are smart and well informed -- but that doesn't prevent them from being wrong headed. The Alcabes piece, ironically entitled "5 Myths About Pandemic Panic" is either built on myths or strawmen, take your pick. Here is my commentary on the "5 Myths":…
revere | March 14, 2009There is a good summary by Robert Roos at CIDRAP News about the $420 billion spending bill signed by President Obama this week to cover the next six months. The good news edges out the bad news, so the net is positive, a welcome change from the kind of deeply depressing budget news to which we became accustomed during the Bush years. Bush took a teetering public health system whose decline started with Reagan and continued through Clinton and put it on life support. Now a couple of items in the spending bill have upped the oxygen slightly but don't increase the circulation in all the critical…
revere | March 6, 2009Flu season is in full swing and cases of bird flu seem to follow the same kind of seasonal pattern as "ordinary" flu. Last year more than half the reported human bird flu cases were in Indoesia. But the Indonesian health minister has already warned the world she was only going to tell us what was happening with human bird flu in her country when she felt like it, and apparently she doesn't feel like telling anyone. In December of 2007 (last flu season) Indonesia officially reported 4 cases of bird flu and the following month, January 2008, 9 more. February 2008 brought another 3. This flu…
revere | March 2, 2009There is as yet no pandemic bird flu vaccine but there are a lot of potential vaccines. The recent fiasco involving Baxter International (here, here) involved one in development. There are many more. They employ old and new technologies and are in various stages, a few in early clinical trials. Many more are in the pre-clinical (animal or test tube) phase, although they are frequently reported in the news because the company developing it wants to attract support or publicity. I often don't pay attention to announcements of "breakthroughs" that are successful in mice. Many vaccines work in…
revere | March 1, 2009The scientific literature is full of specialized papers that on their face would seem to be of little interest. Here's a title like that: "Prevalence and seasonality of influenza-like illness in children, Nicaragua, 2005-2007" (Gordon et al., Emerging Infectious Diseases 2009 Mar). Over 4000 Nicaraguan children, aged 2 to 11 years old and living in the capital of Managua were followed for 2 years, April 2005 to April 2007 and observed for development of ILI (influenza-like illness). We know a lot about influenza in major industrialized countries in the northern and southern temperate zones,…
revere | February 25, 2009A just released report on world wide vaccine production capacity says . . . if you don't have access to the report (and I don't, as yet), what it says depends on which news source you want to read. For example you can read Reuters (the glass half full wire service stroy) or Agence France Presse (the glass half empty wire service study). Here are the ledes in each:
Reuters:
Drug companies have increased their capacity to make bird flu vaccines by 300% in the past two years but will still need four years to meet global demand in the event of a pandemic, a study says.
It also said doses of…