Pandemic preparedness
revere | September 1, 2007There are a lot of industries that will suffer mightily if there were an influenza pandemic so it's hard to single out any one that will be hit harder. But among the most vulnerable certainly must be the travel industry. At the height of a pandemic the problem is probably moot. By that time even the people in the travel industry will have other things to think about. But a pandemic doesn't start in an instant. It starts somewhere and depending upon surveillance systems we will have more or less time to react depending upon where we are. There will also likely be a period of uncertainty when…
revere | August 30, 2007If you want a good snapshot of how poorly prepared Indonesia is for coping with bird flu, look no further than the Letter column of The Jakarta Post:
On Aug. 26 I found a dead wild bird in my yard. I am living in Bali near the area where bird flu related deaths have occurred.
Since I was worried about the possible risk connected with dead birds, I tried to contact some authority to guide me on how to handle this situation.
I tried to reach the main hospital in Bali, Sanglah, and the answer was to go there if sick but they do not know anything regarding dead birds or chickens.
Next I tried to…
revere | August 29, 2007This is a public health blog run by an old geezer (or geezers, depending upon how many of us there are), but if you are a crazed gamer with an age in the low double digits (or not), this post is for you. The part for you is below the fold, at the end. But first some background.
Despite my age, I'm always looking for new and interesting ways to do public health and a year or two ago I started to look at the virtual reality "game" Second Life. I posted about it, noting that CDC had a tiny outpost there, NOAA had a spiffy island set-up, and several notables had avatars there, too: Richard Posner…
revere | August 28, 2007A recent article in TimesOnline (hat tip RobT) raises an inevitable and interesting question about how we are going to ration scarce high tech medical resources in a pandemic. The article reports on a paper by Canadian scientists on SARS patients indicating that certain patterns of protein expression offer clues to clinical prognosis. In particular, the researchers found that protein expression patterns for interferons, known to participate in the innate immune system's reaction to viral infections, seem to indicate that one of two distinct patterns predict a relatively good prognosis, the…
revere | August 23, 2007"Protecting the border" is a battle cry for the most reactionary US politicians but when it comes to flu, they are as unlikely to be successful as they are for people. However it might be the Canadians, who have a functioning public health system, who are most at risk from a surge of US citizens fleeing their own poverty-stricken, understaffed and dysfunctional health care society that will be most interested in keeping those American illegal aliens out of their hospitals. This week the heads of state of Mexico, Canada and the US discussed what to do in a pandemic and they all agreed on the…
revere | August 21, 2007We keep seeing these discussions about the probability of a pandemic next year. Sometimes they center on the "overdue" for a pandemic notion, sometimes on using available data to give an estimate of the rough chances of a pandemic. In the latter category is this little contretemps in the UK:
Contingency plans drawn up by the NHS are based on a 3 per cent chance in any given year that the virus will mutate into a form that infects humans. However, an international review at a summit of avian flu experts put the risk of a pandemic during the next year as between 5 and 20 per cent.
Leading…
revere | August 20, 2007As promised, here is a second post on the situation in Australia, currently struggling through a very bad flu season. In the first post I quoted the late epidemiologist Irving Selikoff who referred to statistics as "people with the tears wiped away." Statistical summaries are the stock in trade of the public health profession but it is important to keep reminding ourselves of the ocean of tears we wipe away when we quote them.
So it's back to Australia:
He kissed her goodnight and she softly whispered: "I love you" so as not to wake their two young sons, fast asleep in her arms.
It was the…
revere | August 17, 2007I'm not sure which is worse. Pandemic flu preparation which puts most of its eggs (pathogen-free, of course) in the vaccine basket or the one that plans to distribute the non-existent vaccine in a way that it misses the most needy and vulnerable. I guess it's obvious that if the first is bad, the second is very bad so it's worse, but it also a warning that other kinds of preparation may also be seriously flawed from the equity point of view. I know many of you don't care about these folks -- undocumented immigrants, substance users, the homeless, homebound elderly, and minorities. Many…
revere | August 15, 2007[Another piece from two years ago, August. Since we recently posted on personal prepping, I thought I'd give you the extreme version.]
We all know from the last election that security is a major preoccupation of the American public. Hell, that theme won the last election for a guy who not only is a danger to the country, but a danger to the world. So I'm guessing there is a good market for this:
For Sale By Owner - The Ultimate Secure Home
Strategically located in the awesome San Juan mountains of Southwest Colorado, this patented steel-reinforced concrete earth home was built to withstand…
revere | August 9, 2007We've written here frequently about the ineffectiveness of quarantine for stopping the spread of influenza, but now a piece comes out in the Journal of the American Medical Association (JAMA) that claims quarantine was an effective mitigation method for influenza in 1918. Time Magazine, for example, had an article with the headline: "Study: Quarantines Work Against Pandemics":
To plan for the future, researchers in Michigan went straight to the past. Led by Dr. Howard Markel, director of the University of Michigan Medical School's Center for the History of Medicine, a team of public-health…
revere | August 7, 2007Dr. John Agwunobe is the federal official in charge of the US Public Health SErvie Commission Corps and of coordinating the nation's response to pandemic influenza. At least he will be until the end of this month.
Announcement from Department of Health and Human Services:
For Immediate Release Contact: HHS Press Office
August 7, 2007 202/690-6343
STATEMENT FROM HHS SECRETARY MIKE LEAVITT ON THE RESIGNATION OF ASSISTANT SECRETARY FOR HEALTH DR. JOHN…
revere | August 6, 2007A long story in The York Dispatch discusses personal preparation for a pandemic. Taking personal responsibility is a good thing, although it means different things to different people. I have reserved my energy for community activities. I don't have a stash of Tamiflu or water or canned goods, despite the fact we have written (often) here about the possibilities of supply chain and infrastructure. With the understanding I am not against personal prepping, I would still like to urge both some caution and perspective.
Here's some of the news story that attracted my attention, with some of my…
revere | August 1, 2007The intellectual property issues surrounding H5N1 and pandemic influenza in general continue to deepen and ramify into uncharted territory. Currently the usual suspects are meeting in Singapore to try to resolve issues that have arisen when some developing countries, led by Indonesia, have upset the international flu applecart by refusing to provide viral isolates to the WHO laboratory network, asserting that the practice of supplying "their" isolates to pharmaceutical companies who then make vaccines the originating country can't afford was inequitable and intolerable. I have waded into…
revere | July 29, 2007There is an apocryphal story of a politician during the Revolution of 1848 desperately running after a crowd in Paris's Jardin du Luxembourg. "I'm their leader," he cried. "I must follow them!" A couple of years ago most national pandemic planners were occupied with procuring stockpiles of antivirals, worrying about the lack of a vaccine and reassuring people that they had the matter under control if a pandemic were to strike. No one believed them and they knew they were whistling past the graveyard, but the poverty of vision was amazing. There has been much progress since then. Now there is…
revere | July 25, 2007Small steps but steps in the right direction. It's taking time, but there is progress:
Every household in Fairfax County [Virginia] should receive a pamphlet from the county's health department by the end of the month about protecting against a flu pandemic.
Health department staff began mailing the guide to 440,000 households in the county on July 16, and will also be available from the health department in different languages. It is part of the county's endeavor to prepare residents to cope with pandemic influenza, according to Gloria Addo-Ayensu, the county's health director
"Management…
revere | July 22, 2007Cuba has announced it has established a monitoring system for bird flu. I don't know any of the details except that they have trained personnel for the purpose and they say they have invested millions of dollars and are following what goes on elsewhere closely. The US can say the same thing and has health indices not unlike Cuba's. So is there any reason to think Cuban citizens will be any better off than Americans if a pandemic strikes? Yes.
Because Cuba has universal health care and an efficient public health system that accomplishes a great deal despite a cruel embargo imposed by a…
revere | July 9, 2007CIDRAP had an interesting story about some Stanford undergraduates who designed a local pandemic flu hotline staffed by home-based volunteers. The idea emerged from a course in innovation and "entrepreneurship." The course was designed to teach students the rudiments of taking an idea of social utility and getting it implemented and they are fairly common. They give students a perspective on the many steps and obstacles between a good idea and a good product in the real world. But I sometimes wonder if they teach the right things.
First the idea:
The classes aim to teach students methods of…
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 | July 6, 2007France, Germany, the Czech Republic and possibly Austria are the latest EU countries to have a recurrence of H5N1 (bird flu) in wild birds or domestic poultry. Last year also saw many EU countries afflicted, but until the UK turkey outbreak in February (see here, here, here and here) some hoped it wouldn't come back. Now it is spreading again. No surprise, really. Wherever and however it finds a place in birds it seems very hard, if not impossible, to eradicate permanently.
That, of course, is the problem. Let's forget about the argument as to whether a pandemic is "inevitable" because…