Public health preparedness

Some stories just won't go away. Problems with transparency in China, an impotent government facing a bird flu crisis in Indonesia -- and morale, expertise and credibility going down the toilet at the US Centers for Disease Prevention and Control (aka CDC). Yesterday a very long article in the Atlanta Journal Constitution went over the ground again (hat tip to reader LG). The occasion was an unprecedented letter to CDC Director Julie Gerberding from five of the last six of her predecessors, sent last December: An exodus of key leaders and scientists from the Centers for Disease Control and…
It's just early September and already the number of confirmed cases of bird flu in humans has equalled that of all last year. And we are just entering flu season. Since the resurgence of the disease in late 2003 (four cases that year), there has been a steady escalation, with 46 cases in 2004, doubling to 97 in 2005 and as of today already 97 this year And it's only September. WHO now has recorded 244 cases since 2003, with 143 deaths (WHO). Newspaper editors periodically tire of reporting on bird flu, or run stories that things are looking better, or that a vaccine has been devised. Many…
Katrina. One year later. Heck of a job, FEMA, Bush, Brownie, Chertoff and all of the Department of Homeland Security gang of fuck-ups and their bosses. Some people think that Joe Lieberman's idea to put FEMA in DHS was a bad idea. But DHS is the right place for FEMA. Incompetent, screw-up agencies should always be grouped so it is easier to deal with them when a new administration comes along (we hope in two years). In the meantime . . . DHS has a website, recently updated: Ready.gov. When the Federation of American Scientists first looked at it they thought it could be, well, let's say,…
Here's a particularly worthless article from the AP: Docs say Tamiflu won't affect foetus. This is clearly an important question. In the event of a pandemic, Tamflu will be used prophylactically in pregnant women, either by choice or because the women don't know they are pregnant. There is currently no reliable information on effects of this drug on a developing fetus, and there may not be before we are faced with the problem. So data points are useful. But this example is utter non-sense. In Jakarta, Indonesian doctors are giving a 35 year old 2 months pregnant woman Tamiflu after she…
The lull in bird flu is over. At least the lull in the news about bird flu. The virus didn't go away. Editors got tired of it and national agricultural officials were quiet about it. Now Thailand is again engulfed with poultry infections and experiencing human cases and Indonesia continues to percolate away with both bird and human cases. In both countries the endemic poultry problem is the underlying cause. "When you have trouble controlling infection among the chicken flocks, you are naturally going to see continuing infections among humans," Dr. Anthony Fauci, the US National Institutes of…
We've gotten pretty used to the idea that if H5N1 appears in birds it is legitimate to slaughter birds wholesale within a certain distance of the infected flock. In the west, birds are kept as caged pets by some people but not huge numbers. In Indonesia and other countries, however, birds are the kinds of companion animals that dogs and cats are here. Keep that in mind when you consider this story. In southwest China three people have died from rabies after being bitten by dogs. Rabies is a pretty bad disease. Once you start exhibiting symptoms it is essentially a death warrant (yes, I know…
The most successful armies learn from their adversaries. There is no doubt Hezbollah is an enemy of public health. We'd say the same of the Israel Defense Forces (IDF), but it's Hezbollah which has more to teach public health. Here's what we're getting at. The New York Times has an excellent story about how the vaunted military might of the IDF has been checked by the disciplined fighters of Hezbollah fighting in their own villages. This shouldn't be a surprise but people have bought the myth of IDF military invincibility, just as they bought the myth of US military invincibility before Iraq…
I noticed that Governor Mitt Romney, Republican presidential hopeful and much despised Governor of Massachusetts, just vetoed $8.15 million in funding for addiction treatment and prevention in his state. I'm not an expert on substance abuse issues, but I know it is an area of public health where we are in real trouble because of budget cuts. I have written quite a lot about bird flu here and the need to address it by strenghtening the public health infrastructure. Substance abuse is part of that infrastructure. But what, if anything, does cutting these programs have to do with bird flu? I…
The human bird flu vaccine news from pharma giant GlaxoSmithKline sounds good and it probably is. Probably. There is a lot we don't know yet as the results have not been published in the open medical literature. Here's what GSK is claiming. First, they claim to have produced a vaccine that raises antibodies in 80% of the test subjects (400 Belgians) with a very small amount of viral material (antigen), 3.8 micrograms given twice (7.6 micrograms, total). Previous attempts to make vaccines against H5N1 have required much more antigen. Because our ability to produce viral antigen in eggs is very…
CDC has disgorged $225 million to state and local health departments for bird fluhttp://www.dhhs.gov/news/press/2006pres/20060711.html. That's some good news, made better by the fact that these phase II allocations seem usable for a wider range of public health needs than bioterrorism or bird flu, narrowly conceived. The money goes to help states pay for activities above and beyond what they normally provide, said Joe Posid of the U.S. Centers for Disease Control and Prevention, which distributes the money. "They'll use the CDC funds for more macro or public health purposes such as…
The frozen chicken from China story has a follow-up. You may remember that a warehouse full of the chicken was found in Detroit although import is banned to the US because it came from an area where there is bird flu. An unstated amount of the meat was already in commerce in restaurants and retail stores. If you live in Detroit, you probably haven't received a recall notice, however: Health officials have begun contacting restaurants and markets supplied by a Troy warehouse suspected of importing Chinese poultry, but there was no plan Thursday for alerting the retail customers of Asia Food…
The national bird flu plan is quite explicit in its promises to local public health. There aren't any. The plan is, "you're on your own." Fair enough. A pandemic happens everywhere so there's no "outside" to send help from. But how well prepared is local public health? Bush has given them the power and supposedly provided them with money to handle bioterrorism attacks. That should have been some help. It wasn't. Unfortunately what the left hand giveth, the Right Hand taketh away. From Cape Cod, Massachusetts: But budget cuts over the past few years, coupled with a lack of staff, have left…
The question has been broached here before by our commenters: if a pandemic is a threat to our civil infrastructure, how do we know the internet will continue to function? It's fine to tell workers to telecommute, but what if the information highway the commuters travel is grid locked? Good questions without good answers. But information technology professionals are at least thinking about it. The IT trade mag, Computer World, has a story about a simulation held recently at the world Economic Forum by management consulting firm Booz Allen Hamilton. The scenario was pandemic flu arriving in…
In a post yesterday we talked about West Nile Virus. It causes a mosquito borne disease and most people will have mild or even asymptomatic infections. But you don't want to the be the exception for this one. So what to do? Here's the typical response in many urban environments: Yuba-Sutter's annual battle against mosquitoes and West Nile virus will hit the streets tonight as spraying begins in residential areas of Robbins and Meridian. The weekly spraying will begin tonight in Olivehurst, Live Oak, Linda, Plumas Lake, Marysville, Sutter, Tierra Buena and Wheatland, said Ron McBride, manager…
One of the knocks on the alarms about bird flu is that it is just another in a series of false alarms like Y2K, West Nile and SARS. Not true. Pandemic influenza is indeed another in a series of alarms, but the only one that might conceivably be considered a false alarm (and this isn't even sure) is Y2K. Let's take them one at a time. The investment in fixing the Y2K bug was substantial on the part of business and government world wide, extending over several years prior to 2000. It is difficult to say what the results might have been without that investment. In many respects it is similar to…
There is currently no vaccine for a pandemic strain of H5N1 avian influenza, and if a pandemic strain does emerge it will take at least 6 months to get the first batches of one. Currently the productive capacity for influenza vaccines is so overmatched by the needs of a global population, only a tiny fraction of those that will need it could be immunized. The current experimental (and relatively ineffectual) vaccines for H5N1 are not for a pandemic strain but for a strain current in southeast asia that is still poorly transmissible from person to person. It is thought an easily transmissible…
Yesterday's WaPo story that HHS Secretary Michael Leavitt is the heaviest user of CDC's Emergency jet is being played like a scandal. This is the most scandal-prone administration in recent memory, not a surprise. But I'm of two minds about it (or maybe 1.56 minds). First the details. Health and Human Services Secretary Mike Leavitt defended his extensive use in recent months of a jet leased to the Centers for Disease Control and Prevention for emergency use. Leavitt's explanation for his use of the jet occurred at a hearing Wednesday of the House Ways and Means Committee. Moments earlier,…