Pandemic preparedness
revere | February 16, 2009Keeping public health in the spot light is critical and what better place to do it than the front page of DailyKos, one of the most visited blogs in the world (average daily visits over 800,000). For six weeks DKos frontpager DemFromCT, one of the founders of FluWiki and himself a pulmonary specialist, has been running a series called Flu and You, interviewing public health types (including one of the reveres). This week he interviews Jeff Levi of Trust for America's Health (TFAH), and the entire thing is worth a read. I want to single out only one aspect that is especially timely, the missed…
revere | February 9, 2009I am frankly baffled by a news release from Gideon Informatics, a company that describes its mission as developing and marketing "point-of-care medical-decision support applications that help reduce diagnostic errors." It claims to be "managed by an expert executive team and medical advisory board." Apparently they forgot to give this press release to their advisory board before releasing it:
Despite the recent fatal case of avian flu in Beijing, overall avian flu cases in humans worldwide have decreased 55%, from 88 to 40, from 2007 to 2008, according to GIDEON Online (www.gideononline.com…
revere | February 7, 2009It turns out that we were not the only ones musing on the relationship between the news business and the flu business. Dr. Michael Osterholm, is the Director of the Center for Infectious Disease Research & Policy (CIDRAP), and also Editor-in-Chief of the CIDRAP Business Source, a subscription newsletter offered to the business community on pandemic (and similar) matters. Dr. Osterholm's name has appeared here often, perhaps most memorably as the author of the "We're screwed" observation. A couple of weeks before my recent post he had written to the business community:
The collapsing…
revere | February 6, 2009For reasons other than this blog (I actually have a real life) I was reading a 1965 text by Leavell and Clark, Preventive Medicine for the doctor in his community: an epidemiologic approach, and found this on pp. 67-68 regarding tasks in a disease outbreak:
"Further spread must be prevented; the sick must be cared for, hospitalization must be provided, if necessary; the population must be told how to protect itself; inoculations may be required; and particular attention to the safeguarding of water, milk, and food supplies may be essential."
Concise and to the point. I wonder how much…
revere | February 3, 2009On Sunday DailyKos frontpager, DemFromCT (who is also a founder of the FluWiki and a pulmonary specialist) finished up his two part interview with us. It's cross-posted here below the fold. If anyone doubted we were academics, the display of watching us argue with ourselves would have but those doubts to rest. Scientists cherish the hope that we will make difficult things simple, but often we wind up making simple things difficult. We see complications in everything, even the simple question of what is public health infrastructure. Witness:
Q. Last week I asked you about public health…
revere | January 27, 2009On Sunday my friend and colleague from Fluwiki, DemFromCT, did me the honor of interviewing me on the front page of DailyKos. That's a pretty tall platform, being the most visited blog in the known universe (and beyond), so it's best to be absolutely clear when saying things there. I"m not sure I quite met that standard, but I'll let you judge for yourself, as I am cross-posting the interview below the fold. But this also gives me an opportunity to clarify one point that drew some justified comment. Here's something I said in the interview:
In the past I downplayed individual prepping for a…
revere | December 28, 2008As far as the world is concerned, if any day can be said to be bird flu's birthday, it's today. The disease of birds doctors call influenza A subtype H5N1 may have had a long gestation period, but we're not sure how long. A form of the virus deadly to poultry was isolated from a goose in southern China (Guangdong province) in 1996, marking the first time the highly pathogenic form of the H5 bird virus poked its head above water for us to see. How long it had "been around" before that we don't know. Then in May, 1997, a three year old tot in Hong Kong came down with a flu-like illness that got…
revere | December 10, 2008I'm sitting here reading Tuesday's Wall Street Journal -- what? Revere subscribes to the WSJ? No, but for reasons known only to Darwin, every couple of days a copy is delivered to my door, each with someone else's address on it, and never the same someone else two times in a row -- so, anyway, I'm reading the WSJ about the auto industry bailout goings on, and there's an article about how auto parts suppliers are going under, many whether there's a bailout or not, apparently because demand is so soft and credit so tight and margins so small that they can't make it (I'm reading in dead tree…
revere | November 14, 2008The idea of stopping flu "at the border" has received almost uniformly bad reviews from public health experts. Once human to human transmission starts we won't be able to stop it by closing our borders, although we likely will cause the usual unintended consequences, like preventing vital personnel and supplies from getting to where we need them. At least if we do it in the usual ham handed way this administration is famous for. We learn via CIDRAP News that federal officials are still willing to give a "risk-based border strategy" (RBBS) a go, at least in the form of an exercise. Now, at…
revere | November 13, 2008If there's an influenza pandemic in the near future all bets are off when it comes to unplanned for consequences. Well, maybe not all bets. Right now the only oral antiviral likely to have any effectiveness in a pandemic is oseltamivir (Tamiflu), although how effective and how long it would retain any effectiveness is in question. But there's a lot of it out there and it will be taken in high volume and, either in its capsule form [oseltamivir ethylester-phosphate (OE-P)] or its active form [oseltamivir carboxylate (OC)], excreted into the sewer system in massive quantities (discussed here…
revere | November 10, 2008One resource the incoming Obama administration is certainly to find no shortage of is advice. We don't know whom they will listen to, although we know much of it -- maybe most of it -- is likely to be of the self-serving variety. How to separate the wheat from the chaff will be a delicate task. Powerful people who give lousy advice still get bent out of shape when it isn't followed. So we'll have to see. Meanwhile we will be scanning whatever advice is made public. An example is a report from the Defense Science Board, issued on Election Day, no less. It purports to give the next…
revere | October 23, 2008With the advent of flu season the perennial question of the "next pandemic" is again making an appearance, although I think it is more of a cameo appearance than a substantive one. WHO, CDC and numerous state health departments are warning citizens about seasonal flu, still a major public health problem, and the continuing threat of emergence of a novel flu virus to which the earth's population has little or no immunity. There is something both plaintive and formulaic about these warnings. Seasonal flu is with us every flu season (hence its name) and the feared pandemic of bird flu has yet to…
revere | September 10, 2008We're well into September and flu season is approaching. Seasonal likely won't peak for another four or five months in the US and Europe but we should expect to start seeing cases in the northern hemisphere soon. A pandemic strain could happen at any time. The 1918 flu's second wave started in late August, so the timing of the start of a pandemic is not so predictable. At least one things seems certain, however. We shouldn't expect to see it starting in the current hot spot for human bird flu, Indonesia. Because the Indonesian government, in the person of Health Minister Siti Fadilah Supari,…
revere | August 31, 2008The folks at ScienceDebate2008 pushed hard during the primaries to have the candidates address science policy. Chris Mooney and Sheril Kirshenbaum from Scienceblogs The Intersection were among the leaders in this movement. They didn't succeed in getting a debate then, but now with the field down to the finalists, they have received a response from Barack Obama to 14 questions culled from over 3400 submitted by the 38,000 signers of the ScienceDebate initiative (we were proud to be among them; they include nearly every major American science organization, the presidents of nearly every major…
revere | August 19, 2008News reports that nonagenarians had robust antibodies against the 1918 flu strain were intriguing on several levels but I wasn't sure how many doors were still open to these being antibodies that developed in the years after 1918. After all, the 1918 subtype was H1N1 which circulated freely until the 1950s when it was displaced by the next pandemic strain, H2N2. H2N2 in turn was pushed aside by H3N2 in 1968. Then H1N1 returned in 1977 (some say it escaped from a Russian laboratory) and since then H3N2 and H1N1 have been co-circulating. Some years are predominantly H1N1, some predominantly…
revere | August 6, 2008A curious paper on the 1918 flu pandemic appeared this month in CDC's journal, Emerging Infectious Diseases. It seemed provocative, at least on the surface. It claimed that the conventional wisdom underlying pandemic flu preparations was wrong. It's not the flu virus we should be defending ourselves against but the common bugs of the upper respiratory tract that take advantage of new fertile ground to grow in after the flu virus invades:
Medical and scientific experts now agree that bacteria, not influenza viruses, were the greatest cause of death during the 1918 flu pandemic.
Government…
revere | July 24, 2008The headline said, "Vaccination plan puts health care workers first," but you had to read the article to find out who goes next: the military. This according to the Guidance on allocating and targeting pandemic influenza vaccine released yesterday by the US Department of Health and Human Services (DHHS). The guidance is premised on the assumption that in the early phases of a pandemic, any vaccine will be in short supply and will need to be rationed. The document gives "strong advice" on how DHHS thinks this rationing should take place, although much is left unexplained. Since the allocation…
revere | July 7, 2008So Roche Pharmaceuticals now has sufficient productive capacity to make their influenza antiviral Tamiflu (oseltamivir) meet demand. More than enough, it appears, since they now have come up with a new scheme to unload some of their inventory before its 3 year shelf life expires and to keep turning over the inventory year after year, whether or not there is a demand in any particular year:
With an endorsement from US health officials, Roche, maker of the antiviral drug oseltamivir (Tamiflu), today unveiled a program to encourage more businesses to stockpile the drug to protect employees in…
revere | June 25, 2008In our earlier discussion of the science behind greenhouse gases we pointed out that all objects radiate electromagnetic radiation, doing so at a peak wavelength dependent upon their surface temperatures. That means two things. One is that things at the usual temperatures in our world are radiating EM radiation at wavelengths characteristic of the far infrared region. The other is that by measuring the intensity of infrared you can also measure the surface temperature of the body without touching it. Commercial devices are touted as highly accurate. Clinicians use them to measure body "core…
revere | June 21, 2008The beach in Indonesia may look nice, but don't let that distract you:
There is an English word for deliberately neglecting to tell people something they have asked you about. It's called lying. On that basis, the Indonesian government, primarily in the person of their Minister of Health, Siti Fadillah Supari, are liars. They have publicly declared their intention to lie by announcing they will no longer notify the world promptly about new human cases of bird flu. The acknowledged motive is to improve the reputation of Indonesia in the eyes of the world. Currently the country is the world's…