Public health preparedness
revere | July 8, 2007Some federal money ($430 million) for pandemic preparedness is now being released to help states and communities "to respond to bioterror attacks, infectious disease, and natural disasters that may cause mass casualties." The bulk of federal pan flu money has been for procurement of vaccines and antivirals. Over the years money$2 billion has been released to increase acute care capacity. There isn't a lot of evidence we are in much better shape for all that. So do we think this new bolus of dough will help?
The good news is that it isn't more procurement money for vaccine and antivirals. It's…
revere | July 7, 2007Prepping for bird flu isn't a very good excuse. Excuse for what? Being a racist pig:
A former British National Party member from Lancashire accused of plotting to make bombs from chemicals he bought on the internet has claimed the substances were for cleaning his false teeth and unblocking drains.
Robert Cottage, 49, of Colne, told Manchester Crown Court he thought some of the other chemicals could be used to protect him from bird flu and purify water if supplies were cut off during civil unrest - two of his greatest fears. (Pendleton Today)
I know. Some of you might be saying, "Hey, I'm…
revere | June 24, 2007There's been a bit of a buzz about a paper by Australian researcher Jennifer McKimm-Breschkin at the Toronto flu meetings last week. McKimm-Breschkin told the gathering of 1500 flu obsessed scientists just what they didn't want to hear: that she and her colleagues had evidence from the laboratory that clade 2 H5N1 avian influenza virus isolated from birds in Indonesia were becoming resistant to the only oral antiviral effective against the virus, oseltamivir (Tamiflu). In comparison to clade 1 (southeast asian) virus from a few years back, the sensitivity was 20 to 30 times less.
We'll have…
revere | June 13, 2007Bird flu news tends to be episodic. For long stretches there seems to be little news (unless you deliberately go looking for it; then you find it). Then there are these little spurts as bird flu pops up here and there in the news. Human cases in places where they haven't been for a while tend to be more noticeable. Or suspicion there are cases where they haven't been before. So we have Malaysia quarantines five with suspected bird flu (possible new country for human cases; but suspect cases of febrile illness around poultry outbreaks often turn out "negative," either because they are one of…
revere | June 12, 2007This was the kind of fallout from the TB case I was most concerned about:
States should have the power to restrict the movement of patients with contagious diseases even before they have the chance to disobey doctors' orders, federal health officials say.
The need for such authority to order someone quarantined emerged as lesson No. 1 from the case of the Atlanta lawyer who went to Europe despite having a dangerous form of tuberculosis.
[snip]
"First of all, up front, before the patient left the United States, we believe that we could strengthen our states' ability to restrict the movement of…
revere | June 12, 2007An extremely interesting article is slated to appear in the American Journal of Epidemiology later this month. I haven't seen it yet but Nature News carried a short piece about it. It comes from a team of experts in seasonal flu patterns at NIH's Fogarty International Center (FIC).
The notion that flu epidemics start in areas of high population density and spread outwards may not hold true for the tropics, hints a study from Brazil.
In that country, new research reveals, flu starts in the less densely populated north and moves towards cities in the south. The result indicates that climate,…
revere | June 11, 2007Two Associated Press articles over the weekend suggest to me the US poultry industry is getting ready for avian flu, in earnest. One story reports how news of bird flu in US poultry would affect consumer habits. One reports on the practical problem of having to kill hundreds of thousands of birds quickly and efficiently -- kill the, that is, for purposes other than sating our appetites. Here's the essence of the first story, about consumer attitudes. The results are about what consumers would do in a hypothetical instance and are always subject to how events actually unfold. They also have…
revere | June 9, 2007My defense of the TB guy has drawn a lot of traffic and some of the comments imply my view is colored by a case of misplaced compassion. Since I'm a physician I won't shy away from being called compassionate. Whether true or not in my case, it is a desirable trait for a doctor and nothing to be ashamed of. However I don't think my opinions about this case are due to sentiment. I would defend them on the grounds they are sound judgments of a public health professional. Since I am unlikely to convince the doubters by repeating my arguments (you can find them at these links), I will do something…
revere | June 8, 2007CDC is bowing to reality and grudgingly giving their blessing to civilian use of over-the-counter respirators ("masks" in common parlance) should there be an influenza pandemic. I've repeatedly called attention to the lack of evidence that wearing a respirator would be effective to protect people from influenza virus. Many readers here (mistakenly) believe I am against masks. I am not. Nor am I for them. If this is a pandemic Pascal's wager -- it can't hurt and maybe it will help -- that's fine. As long as the premise -- that it can't hurt -- is true. That's my main reason for wanting some…
revere | June 7, 2007A survey of doctors specializing in the infectious diseases of children attending a conference showed over half weren't very worried about a bird flu pandemic. I guess they know something I don't. Or maybe I've been reading the wrong things. Things like this:
The H5N1 bird flu virus in Indonesia may have undergone a mutation that allows it to jump more easily from poultry to humans, the head of the country's commission on bird flu control said on Wednesday.
[snip]
"In the past it took exposure of high intensity and density to the virus to get infected. There are now suspicions, early…
revere | June 6, 2007I don't usually do movie reviews here, much less reviews of movie reviews. But since I was pretty hard on Marc Siegel a year or two ago (I won't link to the posts since that would be just criticizing him all over again; they are on the old site), I'll take the time to say his movie review of Pandemic on the Hallmark channel didn't offend me. I wouldn't have written it that way, but there were some good things in it. What I liked about it was the balanced way he evaluated the veracity and plausibility of the facts portrayed in the movie. Dramatic presentations like this are a mode of public…
revere | June 3, 2007What do we know about transmission of tuberculosis on an airplane? Not much, apparently. There is very little literature on it and not a single case of active TB has ever been traced to an airplane contact. On the other hand, it isn't very easy to estimate the risks. The only way you can do it is in cases such as the current one where you know someone with TB got on an airplane and potentially exposed others. Then you would do intensive follow-up of fellow passengers and crew to see if you could find others who might have gotten infected. Now the problems really start.
First, there's the task…
revere | May 31, 2007I'm not a lawyer and I don't play one on TV. But I think I know the difference between quarantine and isolation, and the widespread media reports that the Georgia resident with XDR-TB was the first person "quarantined" by the US government since 1963 didn't make sense. Quarantine means to segregate and possibly confine people who have been exposed to a contagious disease and therefore may become infectious themselves and spread it to others. But they are not sick. People who are segregated from the public and whose movement is restricted are under isolation, not quarantine. The Georgia…
revere | May 31, 2007Readers here who try to get their neighbors to prep and run into a stone wall aren't alone.
It's tough to convince people they need to be prepared for disasters. It's even harder when they don't believe that the scenario you envision will ever happen.
Nevertheless, local governments in Hall County and throughout Georgia are putting together plans for dealing with an influenza pandemic.
They don't have a choice. (Gainesville Times)
This Gainesville is the one in Georgia, not Florida, and they have no choice because Georgia's Governor, one Sonny Perdue, told them they had to. Governor Perdue is…
revere | May 29, 2007Congress passed the supplemental spending bill last week and Bush signed it immediately. It was a terrible bill, both for what it contained and what it didn't. You all know what it contained: more money for this rotten war in Iraq. What it didn't contain was the paltry $650 million for pandemic preparedness that had been in an earlier version.
Bush's Office of Management and Budget is being blamed in some quarters (CIDRAP: someone in the Office of Management and Budget or elsewhere in the administration "might have made the call that there was less of a sense of urgency"), but I won't let the…
revere | May 24, 2007Reuters Health has a short note on a survey of 169 nurses, doctors and other health care workers (HCWs in the jargon) about whether they would report for duty during a pandemic. It was done by Dr. Charlene Irvin of St. John Hospital and Medical Center in Detroit, Michigan. I don't know where it was published or what its methods were, so it is hard to say how representative of all HCWs the results are. But it probably isn't very far off. Remember, though, I'm an epidemiologist. We are infamous for blithely acting as if numbers like 84 and 86 are the same. Some of you may remember a sign along…
revere | May 23, 2007A new experiment in flu communications was noted yesterday by my wiki partner and fellow blogger (The Next Hurrah) DemFromCT over at the mega-blog, DailyKos:
Recognizing the need for people to take pandemic flu preparations more seriously, and recognizing that blogging is a powerful and effective two-way communications tool, Health and Human Services Secretary Mike Leavitt is hosting a Pandemic Flu Leadership Conference in Washington DC on June 13, to which I've been invited (based on work done at Flu Wiki and here). And as part of the effort to reach as many people as possible, a blog has…
revere | May 22, 2007Sometimes it's good to have a "coordinated message" and sometimes it isn't. The UN agencies dealing with bird flu certainly don't have a coordinated message and that's just fine with me. I don't trust anybody to have the right "message" and we're better served by each agency calling it as they see it. Even if the way the see it seems, well, distinctly odd:
Avian Flu Virus May Be Nearing End as Fewer Birds Die, OIE Says
The avian flu virus that threatens to spark the first pandemic in almost four decades may be nearing the end of its natural cycle after it killed fewer wild and migratory…
revere | May 18, 2007WHO's Director General is talking tough, but is she talking tough to the right people? We don't know, but we can keep our eye open for results:
Addressing concerns raised by developing countries such as Indonesia, Chan said she was committed to finding ways of distributing potentially life-saving vaccines in the event of a human influenza pandemic.
"WHO recognises the concern of many developing countries and I am fully behind you. That's why we are taking a series of actions to make sure that developing countries have equitable access to affordable pandemic vaccines," she said.
Chan also…