When a man with extremely drug-resistant tuberculosis (XDR-TB) is told not to board a plane and then does so anyway, you have to expect the public health bloggers to come out in force. Tara C. Smith at Aetiology has been on top of this from the start, first laying out the story, then explaining its implications, and finally letting readers know why indignation is necessary for responding to a case like this. Revere at Effect Measure explores the legal angle of isolation and quarantine, and provides details about air circulation in aircraft cabins; that blog also features a post about XDR-TB that was published just before this news hit the wires. The Examining Room of Dr. Charles and Cervantes at Stayinâ Alive chide us for focusing on the threat of contracting XDR-TB when we should be concerned about larger problems, and N=1 at Universal Health suggests that this kind of communicable disease problem might increase the U.S. demand for universal healthcare.
In a lead-up to the June 13th Leadership Forum on Pandemic Preparedness the U.S. Department of Health and Human Services is hosting a Pandemic Flu Leadership Blog. During its first week, bloggers â including Greg Dworking, founding editor of the Flu Wiki and Flu Wiki Forum â focused on the need to prepare; now, theyâre looking at the roles different kinds of leaders can and should play.
Elsewhere:
Orac at Respectful Insolence reports that efforts are underway to save the Tripoli Six â six foreign medical workers arrested for allegedly intentionally infecting over 400 children with HIV in a Libyan hospital â from death.
Tim Lambert at Deltoid follows the trail of the Rachel Carson smear campaign back to none other than Big Tobacco.
Cocktail Party Physics reminds us that cholera is still a threat, and tells the stories of outbreaks in 1854 London and 1991 Buenos Aires.
Nandini Oomman at Global Health Policy notes that President Bush has proposed doubling funds for PEPFAR (the Presidentâs Emergency Plan for AIDS Relief), and cautions that the money will only have significant impact if funding decisions are based on evidence and implementation is responsive to countriesâ needs.
The Olive Ridley Crawl welcomes the news that Brazil has offered to build an AIDS drug factory in Mozambique.
Tracy Clark-Flory at Broadsheet wonders if the finding that gender equality correlates to African womenâs HIV risk will be greeted the same way that news about circumcisionâs effects on HIV transmission was.
Nils Daulaire at RH Reality Check examines the progress thatâs been made since the first global Safe Motherhood conference twenty years ago.
Steph Sterling at Womenstake applauds proposed U.S. legislation to prevent unintended pregnancies.
Climate Progress explains whatâs wrong with the coal-to-liquid idea that lawmakers are so excited about.
Andrew Sharpless at Gristmill thinks fishing subsidies stink.
GrrlScientist at Living the Scientific Life introduces us to Marge, the worldâs first nonfat dairy cow.
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I have been participating on the Flu Preparedness Forum. From my, admittedly limited, participation, it appears that the thrust of the focus is on what to do after exposure (provide masks, hand sanitizer, etc.), but very little attention is being paid to how our current medical infrastructure contributes to the spread of infectious diseases.
I represent a patient group with a genetic respiratory disorder called primary ciliary dyskinesia (PCD). Because people with PCD are at increased risk for respiratory pathogens, we focus on identifying and ameliorating risks. However, patients are at the mercy of their healthcare system, so even if they know proper precautions are not being taken, there is little they can do.
Here are two stunning examples:
We have recently moved to Arizona. Out here, and I understand in other parts of the country as well, routine blood work and xrays are not done at the physician's office. They are performed by independent corporations that have free-standing facilities around town. Insurers contract with these facilities. From an "economies of scale" perspective this probably makes sense--you have one central place where laboratory knowledge and procedure billing can be concentrated rather than having individual physician practices attempting to do every lab procedure. However, it is a public health nightmare. These facilities are always packed with patients who have a variety of underlying illnesses and no doubt carrying a diverse and thriving population of microbes. There are no cross-infection prevention efforts in place--none. This is an environment where the population is KNOWN to be ill--that's why they are there--and no effort goes into infection prevention.
Second scenario--my daughter who has PCD has been hospitalized multiple times for pneumonia. Almost always, she is in respiratory isolation until the pathogen is identified and risk to others is assessed. However, depending on who happens to be assigning beds, this is is not always the case. She once was admitted with a raging white blood count, nasty cough and severe chest pain. She was put into a room with a woman who was healthy--only there for revision of a vascular procedure. Not surprisingly, this patient's family was irrate--I would be too. My daughter was too sick to advocate for herself and was counting on the hospital to do the right thing. When I arrived, I asked if they had properly followed "universal precautions" when finding her a room. It was only after I made an issue out of it that she was moved into isolation. It turns out she had Staph (highly contagious) and Pseudomonas (not so much a problem for the general population) and her healthy roommate had been exposed adn required treatment.
If we can't count on our healthcare providers to use common sense about infection prevention, I fear we are in for a very nasty course in the event of a massive outbreak.
Thanks for bringing up this important point, Michele. I know that some bloggers (Revere at Effect Measure is one) have been writing about the importance of public health infrastructure in pandemic response, but I'm sure it's not nearly as widely recognized as it needs to be.
I expect that it will be hard to solve the problem of transmission in hospitals and labs on a large scale until we make some progress in addressing this country's health care crisis - because cost pressures and the staffing issues that accompany them are probably the biggest barrier adopting and/or implementing proper controls. Perhaps if more people realize that a shaky public health infrastructure will affect how we fare in a pandemic, it will increase the urgency for politicians to get behind meaningful healthcare system change.
Of course, individual lab and insurance companies can still improve their procedures. Insurance companies might be able to require lab corporations that contract with them to adopt controls for transmission between patients, since preventing plan members from acquiring infections would lower insurers' costs. Also, I've heard that some insurance companies will no longer reimburse hospitals for treatment of hospital-acquired infections, and this certainly gives hospitals a financial push to make sure that procedures are followed, and improved if necessary.
I've awarded Speaker "Dipsh*t of the Year" over at my blog...
I actually think he should be charged as a terrorist... he was a one-man walking WMD...