Public health preparedness
revere | June 28, 2009A few days ago we posted about hedge funds getting ready for a swine flu pandemic. At the time we wondered what other industries and businesses were getting ready. We don't know the answer, but we are seeing more signs the message has gotten through. Yesterday we saw this story about a regional airport in Arizona:
The Valley's Mesa-based reliever airport is gearing up to operate with a surprisingly lean staff should the Swine Flu pandemic decimate the airfield's workforce.
Keeping Phoenix-Mesa Gateway Airport flightworthy with a skeleton crew was added earlier this month to mandatory…
revere | June 9, 2009You learn a lot when you move from investigator to subject. I just heard about Drive-by Tylenol for day-care and school age kids. This is the practice of stuffing a couple of Tylenol down the little tyke's throat to bring down a fever just before entering the daycare center. The objective is to get 4 or 5 hours of work in before being called to school because your child has a fever. The underground lore about it includes not using any flavored Tylenol preps with red dye in them so that when the child urps up everthing after lunch there will be no tell-tale pink color savvy teachers will…
revere | June 4, 2009The UK is having quite a swine flu outbreak, although the authorities aren't owning up to it. As for the public, they are being whipsawed between the usual poles of "it's all hype" and "we're all going to die," with the latter fading in parallel with the fading of effectiveness in selling tabloids. So, yes, there's a lot of dreadful stuff in the news about swine flu, but there's some pretty astute stuff, too. Here's something I ran across in TimesOnline [UK] by Melanie Reid:
When we heard that the only deaths were a few Mexican peasants, we gave a collective shrug: this is not our problem.…
revere | June 3, 2009The unpredictability of flu and difficulty of making any predictions with confidence is tiring to repeat and tiresome to listen to. Unfortunately that doesn't make it any less true. There are things we know -- because we see them happening -- and things we don't know -- because the information isn't available (like an accurate estimate of CFR or prevalence) or they have yet to happen.
What we know is that we are confronted with a new influenza virus that is spreading with ease outside of its normal season, is infecting an age group that normally doesn't get easily infected (the 5 - 24 year…
revere | May 29, 2009As flu season ramps up in the southern hemisphere, the US, Europe and Asia are keeping an eye on it to see what will happen as swine flu finds new pieces of meat to sate its appetite for human flesh. Sorry about the overheated image. I've been reading what's going on in Australia. Because another lesson the southern hemisphere can teach us is how not to react to a pandemic virus.
Consider the Carnival Cruise Line ship, Pacific Dawn. It docked three days ago in Sydney onroute to the Great Barrier Reef to take on new passengers and let off others. But then, according to news reports (but see…
revere | May 23, 2009Queens, a borough of the city of New York, seems to be a hotspot for swine flu and a New York Times reporter on the city beat, Anemona Hartocollis, has been writing very astute and perceptive pieces from there. Yesterday she had one on the problem posed by the "worried well" who are flooding Emergency Rooms in quest of reassurance. Articles about worried parents who bring relatively well kids to the Emergency Room (ER) are not uncommon. They usually include interviews with harassed and overburdened emergency room doctors and nurses dismayed at the unnecessary demand and its consequences for…
revere | May 20, 2009We've talked a lot here over the years about preparing for a pandemic on a community level, not an individual level. Both are important, of course, but our interests here have always been on how neighbors can help neighbors and building strong communities to withstand all sorts of shocks, from recessions to pandemics. Our examples tended to focus on what we called the public health and social service infrastructure, but of course the principle went deeper. Unfortunately it was a message that fell on fallow ground during the Bush years.
There have been a lot of dismaying things about American…
revere | May 18, 2009Five more schools in the New York City borough of Queens have closed because of suspected swine flu cases. Eleven schools have now been closed there and hundreds of students are down with a flu-like illness. Parents are understandably concerned, the more so because not many days ago Mayor Bloomberg and the city's health commissioner (just named by Obama as the next director of CDC) were reassuring city residents this was pretty much lie seasonal flu.
We thought that was something that might come back to bite them, and now it has:
The city’s schools seem to have become both a sentinel and an…
revere | May 11, 2009Yesterday DemFromCT had another in his continuing series at DailyKos on Flu and You (Part VIII). He extended an earlier post (part II) on a critical piece of public health infrastructure, laboratory surveillance. One of the graphics is this chart of influenza positive tests reported to the CDC by the WHO/NREVSS collaborating laboratories:
What you see in this chart is a weekly record of what seasonal influenza types and subtypes are circulating in the community (influenza A/H1N1, A/H3N2, B; swine flu makes a late appearance, far right). Flu seasons differ on dominant subtypes, whether they…
revere | May 10, 2009The spate of swine flu articles in The New England Journal of Medicine last week included an important "Perspective, The Signature Features of Influenza Pandemics — Implications for Policy," by Miller, Viboud, Baliska and Simonsen. These authors are familiar to flu watchers as experienced flu epidemiologists and analysts of archival and other data. Analysis of archival data is sometimes described as archeo-epidemiologic research. In their NEJM article Miller et al. summarize what they see as some common features in the three flu pandemics of the last century (so the generalization that there…
revere | May 9, 2009Maryn McKenna has a great piece at CIDRAP News today about something that should worry all of us as we wait to see if the other shoe drops with swine flu. Our acute care health services system is so brittle it won't take much to break it:.
With the global outbreak of novel H1N1 influenza (swine flu) entering its fourth week, physicians at emergency rooms, clinics, and hospitals around the United States say they are overwhelmed with "worried well" who have as much as doubled their patient loads.
All the clinicians work at medical centers that have planned and practiced for pandemics and…
revere | May 9, 2009Long time readers know that I am poorly disposed to religion (I understate). Particularly religion of the evangelizing sort. I wouldn't care if they didn't actively try to interfere in the public sphere. But they do, often in the most malignant ways. Still, when a religious organization recommends something that makes sense, especially one that isn't being recommended nearly enough, it should be recognized for what it is. A very good idea:
The Evangelical Alliance is calling on churches to prepare to set up networks of ‘flu friends’ to care for the sick in case of a swine flu pandemic,…
revere | May 7, 2009It seems a conversation on one of the comment threads about "swine flu parties" at Effect Measure has made the New York Times:
One of the first open debates of the idea of intentional self-infection was on Effect Measure, a public health blog with many posts by thoughtful people who say they are clinicians, epidemiologists, veterinarians and other professionals, sometimes in government, but who post under pseudonyms to speak freely.
On April 28, a user calling herself OmegaMom posted: “Just a quick note — I just got a Tweet from a mom suggesting ‘swine flu parties’ because the U.S. version…
revere | May 7, 2009Breathing easier, may be an apt phrase for an almost audible collective sigh of relief. So far, the incipient swine flu pandemic is not extremely nasty. Is this perhaps premature? The world's premier scientific journal, Nature, and many flu scientists, suggest it is:
Complacency, not overreaction, is the greatest danger posed by the flu pandemic. That's a message scientists would do well to help get across.
[snip]
There is ample reason for concern: a new flu virus has emerged to which humans have no immunity, and it is spreading from person to person. That has happened only three times in the…
revere | May 5, 2009As I write this the US has 279 confirmed cases and one death from H1N1/2009 in 36 states. WHO has tallied 1085 1124 cases in 21 countries with 25 deaths. There is a backlog of samples waiting for confirmation, so by the time you read this the counters will probably have rolled upward, especially as state laboratories become facile with the new primers and are able to do their own confirmation. And predicting an increasing case count is about all anyone can say with certainty at this point. What we said once about flu pandemics can be said just as appropriately for the flu virus: "If you've…
revere | May 4, 2009There have been questions in the comments about where the CDC estimate of 36,000 to 40,000 influenza related deaths a year comes from. It's a figure I've used a number of times here to say generally that regular old seasonal influenza may be a mild disease for some but not for many others. Even if you don't die of flu, it can be a miserable illness and lay you low for several weeks of acute illness and months of fatigue and malaise. Now the 36,000 deaths number is taking on a life of its own, so it's time to explain exactly what it is and what it isn't. There are more things it isn't that it…
revere | May 3, 2009Newspapers and wireservices are doing a terrific job keeping a flow of information on H1N1/2009 (the virus formerly known as swine flu). And so, I am happy to say, is the blogosphere. I don't want to slight some terrific bloggers by mentioning some and not others, so I won't do a blogroll. OK. I will make one exception to the "not mentioning" by mentioning crof over at H5N1, not only for his usual splendid job of gathering the news but for his great blog roll and resource list on the sidebar.
And, yes, I am going to make another exception for an exceptional blog post by my long time blogging…
revere | May 2, 2009Laurie Garrett of the Council on Foreign Relations and a well-known authority on emerging infectious diseases was on PBS's Newshour last night and she made a very important but little appreciated point. Mexico has made a major national sacrifice for global public health by shutting down its country and interrupting transmission of disease. The cost to Mexico has already been enormous it will continue to pay in other ways. The reputation of the government has suffered because of the way it handled this -- the lack of transparency, the initial slow footedness (which of course it denies), its…
revere | May 1, 2009[NB: I have been traveling and offline all day. No way I can even read much less respond to the many excellent comments, tips, questions. Thanks to all. Help each other. Back at home base now.]
Closing US borders with Mexico for swine flu is fruitless since the virus is already planted in a dozen or more countries. And while right wing xenophobes are trying to blame Mexican immigrants, most of the international spread has come from commercial travelers, either tourists or business people. If we had sealed the borders, would it have included all American nationals in Mexico? Somehow I don't…
revere | May 1, 2009Just a brief note to remind everyone about the case definitions CDC is using for reporting on swine flu (or whatever name we collectively settle on). In order to make sure numbers are comparable from day to day and place to place we have to decide on criteria for knowing we have something to count. Is someone with flu-like symptoms to be counted as a case? Or do we confine it to someone with laboratory proved infection with the virus? Should there be different categories of diagnostic certainty?
For the moment, CDC is using the following definitions for suspected, probable and confirmed cases…