Pandemic preparedness
revere | July 5, 2007There was a story about prepping for a pandemic in the Washington Post a couple of weeks ago I made note of but didn't get to commenting on. Now's my chance.
When Alexandrians opened their June FYI newsletter, out slipped a slick brochure with a photo of a stern-faced crowd staring out from the cover. "Be Ready, Alexandria!" the boldface type warned, "For a Pandemic Flu Outbreak."
[snip]
"We must take this risk very seriously," Mayor William D. Euille said in an interview. "If a pandemic were to occur, we are going to have a lot of people infected. People are going to die. Some people are…
revere | July 3, 2007Influenza is primarily a disease of birds but other animals, including mammals, can be infected. Humans are mammals, of course, and we know humans get flu. But there are 144 different subtypes of influenza A and mostly they infect birds. When H5N1 jumped from birds to humans in Hong Kong in 1997 it was a surprise. It was thought the bird viruses needed to acquire human specificity by mixing bird and human viruses in a suitable animal (usually thought to be the pig). Pigs are very lucky. They can be infected by both human and bird viruses. That seemed to be what happened in the 1957 and 1968…
revere | June 30, 2007The British Medical Journal is an odd thing. I was very impressed when they went Open Access a few years ago, only to be disappointed when they stopped, even though their new editor, Fiona Godlee, came over from the world's leading Open Access publisher of medical journals, BioMed Central. Recently they have been publishing pieces that seem to challenge conventional wisdom. This has the odor of "catch up to The Lancet" about it, but maybe not. In any event, conventional wisdom isn't always wrong. In fact it is mainly conventional because it is wise thinking. Not always, but usually. So it's…
revere | June 29, 2007Emerging infectious diseases don't appear out of thin air. Mostly (75%), they come from animals. In the language of science, they are zoonoses. So veterinary pathologists see themselves on the front line of early warning against emerging disease and runaway pandemic disease. Consider bird flu:
So is the threat real? "Whether the bird flu virus will spread to North America is unpredictable at this time," says Corrie Brown, Diplomate of the American College of Veterinary Pathologists (ACVP) and a University of Georgia professor of veterinary medicine. "Although the likelihood of this mutation…
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 19, 2007So much of what goes under the name of pandemic planning at the governmental level iks extremely narrowly construed. Should a pre-pandemic (not precisely matched) vaccine that might offer some cross protection be used? What should be the mix with antivirals (and which one)? Should antivirals be stockpiled, and if so where and for what purpose? Just treatment or should prophylaxis be part of the plan? And who should get the antivirals? When should schools be closed and what should trigger a closing? Air travel? Quarantine? Isolation? Etc., etc. Restricted as they are as pandemic planning goes…
revere | June 14, 2007One of the big issues over sharing of viral isolates from Indonesia was the contention, probably well justified, that the poor nations would be last in lie for any vaccine that might be available in the event of a pandemic. While a well matched vaccine has to await the emergence of a pandemic strain, there are good reasons to think vaccines made from pre-pandemic strains would provide some cross-protection, and such vaccines are already in production, although in small quantities.
The choke point is the clearly inadequate global production capacity for influenza vaccine. Even if there were a…
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 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 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 5, 2007I'm just about done with the TB incident. I've said what I had to say (here, here, here and here) about the incident itself and TB on a plane in general. The one thing left is the significance for pandemic flu prevention.
I don't think there is any significance for pandemic prevention because at the moment we have no way to prevent a pandemic. We don't know what will make a pandemic happen or not happen, but if the biology will let it happen and a strain arises with easy transmissibility between people, then that's the ball game. Even if it burns out in one place it will happen again. And…
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…