Pandemic preparedness
revere | March 18, 2008Last week The US Department of Health and Human Services (HHS) released a comprehensive pandemic flu guidance document for states, accompanying it with a web presentation, the first of three. I haven't seen the Web Seminar and only quickly perused the document, so I am commenting on the basis of a description in CIDRAP News, a reliable source. You can find the Web presentation and document at pandemicflu.gov. It is always best to see the original, so this is my take from a second hand source. Even so, I don't think our take is likely to be wildly off kilter (assuming you don't think we are…
revere | March 17, 2008There are all sorts of ways to prepare for an emergency. One is to simulate it inside a computer (a computer model). But you don't have to simulate inside a computer. You can also do it in "meatspace" (aka, the real world). Dungeons and Dragons using books is one example of this. Another is to do a pandemic version of D&D. It's called a table top exercise, although the size of the table can be pretty big. Recently our wiki partner, DemFromCT (if you can call someone a partner who does all the work), observed a CDC exercise which he has described in detail over at the FluWiki Forum (here,…
revere | March 16, 2008The headline seemed to say it all: "Funding Issues Stymie Pandemic Preparation." Right, I thought. All the money is going in to procurement, too little into shoring up a failing public health system. Little did I know:
The fear of bioterrorism and avian flu are driving a healthy new interest by biotech firms in developing products in the field of infectious diseases. "Even though we were developing a smallpox vaccine in 2000, there is no doubt that 9/11 was the moment that biodefense suddenly came up the funding ladder in the U.S.," said Clement Lewin, Ph.D., vp of marketing policy and…
revere | March 11, 2008I'm an advocate of using computer models to help us think about what might or could happen during various pandemic flu scenarios, but it is a technique with drawbacks. For one, it can suggest that some things might be possible that are either very difficult to do or aren't feasible. This happened in 2005 when some models were published in Science and Nature that suggested a pandemic could be nipped in the bud before it started. Most people thought that what was required was unrealistic but it put WHO in a bind. They had to marshal their resources to show they were willing to try or go down…
revere | March 11, 2008Here's what a flu pandemic might look like:
"In four weeks, we went from a ho-hum flu season to ridiculous overcrowding," said Dr. Maurice Ramirez, an emergency physician who works in several institutions in north Florida. "We have had so many people that we have them, not in beds in the hallway, but in chairs with a number taped to the wall over their heads."
"We've seen a tremendous amount of flu--from an anecdotal standpoint, a much busier season than in recent years," agreed Dr. Peter A. Lipson, a private practice internist in southern Michigan who also sees patients at a walk-in clinic.…
revere | March 7, 2008There are a lot of open questions about the influenza antiviral drug oseltamivir ("Tamiflu"), among them whether it works at all for bird flu (highly pathogenic influenza A/H5N1), and if it does, whether resistance will develop making it ineffective. But all the questions have a common assumption: that the patient is actually taking Tamiflu. How would you know if you were or not? Because the bottle says so? Not necessarily. In December 2005 U.S. Customs and Border Protection (CBP) Officers seized 51 shipments they said were counterfeit Tamiflu pills at their air mail facility in San Francisco…
revere | March 6, 2008If you look at the bar chart below you will see that this year's bird flu season is shaping up to look pretty much like last year. In the first two months of the year there are a few more cases but essentially the picture looks much the same. If that is indeed true, then also expect a spike of cases this month (March) since you can also see that is the past pattern. Already cases are being reported in Egypt, and of course, Indonesia. The countries involved this season have been Vietnam, China, Egypt and Indonesia, just like last year. Whether you consider that reassuring or worrying probably…
revere | March 4, 2008Press releases are the way a lot of scientific information is released today. Straight to the public, no peer review. This has advantages and disadvantages. The advantages are speed and directness. No filtering through reviewers, journal editors, colleagues. And of course that's the disadvantage, too, especially when the news comes from an interested party as it usually does in a press release. This is part of the interpretation of data these days. All that being said, the maker of Tamiflu, Hoffman - La Roche, has released data they have gathered from physicians treating cases of H5N1 in…
revere | March 3, 2008Highly pathogenic variant of avian influenza A of the subtype H5N1 is here to stay, at least in the world's poultry population. While it's around it continues to cause sporadic but deadly human infections, some 369 of them of whom 234 have died (official WHO figures as of 28 February 2008). So this virus can infect humans and make them seriously or fatally ill. There is truly massive exposure because people live in close contact with infected domestic poultry in many countries. And the human population has not seen this subtype of virus before so there is little natural immunity. All that's…
revere | March 2, 2008The Indonesian virus sharing impasse is said to be over, and with the dénouement comes some fascinating new information. Many will remember the row started when an Australian vaccine maker took an Indonesian viral isolate and made an experimental vaccine from it (see many posts among those here). At the time it was said the Indonesian Health Minister objected that her country would never be able to afford the vaccine and she therefore stopped making the virus available to WHO. WHO was the source of the seed strain used by the Australian company to make a prototype vaccine.
It turns out,…
revere | February 23, 2008Indonesia is providing bird flu specimens to WHO again. And Indonesian Health Minister Dr Siti Fadilah Supari has just published a book declaring the 50 year plus history of global influenza surveillance is part of a conspiracy by the developed world to control the rest of the world:
"Developed countries become richer because they have the capability to develop the vaccine and control the world," she writes.
Dr Supari also expresses alarm at WHO laboratories sharing bird flu virus data with the United States National Laboratory in Los Alamos, New Mexico, where nuclear weapons are developed.
"…
revere | February 22, 2008CDC has just issued a report on the state of US readiness for a health crisis. Its assessment is upbeat:
In the first report of its kind, US health officials said the nation's cities and states made a strong effort to prepare for a flu pandemic, bioterrorism, or other emergency health crises, but big challenges remain.
"I think in terms of effort and progress, an 'A,' " Dr. Richard Besser of the Centers for Disease Control and Prevention said when asked to assign a letter grade. "In terms of amount of work to be done, I would say that's absolutely enormous." (AP)
Let's see if we can interpret…
revere | February 19, 2008There's bird flu in poultry all over Bangladesh and new human cases reported in China, Vietnam and Indonesia. Is this the sound of the other shoe dropping? Or is it just this:
This barchart is from February 5 so it doesn't include all the new cases. But it clearly shows that when we get to flu season we also get to bird flu season. How will we know if something different is happening? It's a good question and I don't have an easy answer. Here are four signals and what I would make of them.
Sudden increase in number of cases that are not connected or are connected by a common source (as…
revere | February 13, 2008If avian influenza comes to North America one likely route is through importation or smuggling of infected birds. To protect ourselves, we need good border controls and to do that the US Department of Agriculture needs to know where in the world outbreaks are occurring. A USDA Inspector General's Report says that isn't happening:
The USDA should have tested new or revised procedures that relate to pandemic planning, but the agency has not tested 14 of 26 tasks for which it was designated the lead agency, the report states. Though the federal plan does not require the USDA to test the…
revere | February 12, 2008A recently published Commentary in the Journal of the American Medical Association (JAMA) raises some interesting and serious questions about conventional efforts for pandemic flu preparedness. The author is John Middaugh of the Florida State Health Department, a long time public health professional. The last I saw him he was in Alaska, so he seems to have put quite a bit of distance between his current and former places of employment. Indeed the question of people distancing themselves from each other is a central theme of the Commentary:
Although continuing to invest in diverse aspects of…
revere | February 5, 2008Bangladesh is a country with more than its share of woes. Now there is H5N1 galloping through its poultry. Bangladesh needs all the help it can get. Which also means it needs to help others, too. How can a resource poor country like Bangladesh help other nations? They can start by sharing the genetic sequences of the viruses isolated from their poultry:
Bangladesh has refused to share the genetic details of its H5N1 bird flu virus with India. In a blow to India's efforts to find the origin of the highly pathogenic avian influenza strain that is presently wreaking havoc in West Bengal,…
revere | February 4, 2008Blogging can be exhausting. A blogger who wants to be read (not all do) has a hungry mouth, a mouth best fed daily. This one gets fed twice (once on Saturday), seven days a week, 365 days a year. The Reveres have been shoveling stuff into this ravenous maw for over three years. So we sympathize and understand the plight of the excellent flu blogger Sophia Zoe who has been missing of late. She explains where she's been in A Lesson in Real Life (hat tip Avian Flu Diary). Characteristic of her excellent blogging, she also draws a pandemic preparedness lesson from it worth pondering. Here's the…
revere | February 3, 2008After our recent rant on the necessity of supporting the public health and social services infrastructure instead of cutting taxes, President Bush has replied. He is cutting the infrastructure:
President Bush's $3 trillion budget for next year slashes mental health funding and rural health care and freezes spending on medical research, among the cuts outlined in budget documents obtained by The Associated Press.
The budget for the Department of Health and Human Services would be reduced by almost 3 percent under the Bush budget plan to be released Monday. The $2 billion in HHS cuts are about…
revere | February 1, 2008The AP's Margie Mason is a pretty good flu reporter and she has a story on the wires today whose title encapsulates the bird flu history of the last four years: Bird flu continues march 4 years later. The number of human deaths is still not large -- a few hundred -- just a day at the office in Iraq. But the virus just keeps extending its geographic range in poultry stocks and wherever it does it there is a risk of human infections. Fourteen countries so far have officially confirmed influenza A/H5N1 cases. The number of birds killed by infection or slaughtered to prevent the spread of…
revere | January 31, 2008The number of deaths in Indonesia from bird flu just shot past the 100 mark without even pausing -- 101 was recorded right afterward. Tibet announced an outbreak and the disease continued to march through the Indian subcontinent, although the UN flu czar, Dr. David Nabarro said he thought the Indian/West Bengal outbreak was "coming under control." The use of the progressive tense here ("coming under control") suggests this is a mix of hope and belief and in any case indicates the outbreak is still not under control. Which won't come as a surprise to the residents of Kolkata (neé Calcutta):…