Pandemic preparedness
revere | February 3, 2007CDC held a full scale bird flu drill yesterday and allowed reporters to watch (h/t ch). After some reported what they saw, one wonders if they will do it again. Not that they finished the drill, which was stopped halfway because Atlanta had an ice storm. I hope this doesn't happen during a real emergency. An emergency like this one:
⢠A 22-year-old Georgetown University student who visited his family in Indonesia returned to the United States. He became seriously ill the next day and went to a Washington, D.C. hospital. Lab tests confirmed he had the bird flu that's been killing people in…
revere | February 1, 2007It's flu season. Human flu, that is. Also, it seems, flu in poultry. So if someone comes down with high fever, aches and pains and a cough in an area where there is H5N1 in poultry, is it likely to be bird flu? The answer, so far, is "No." The reason is fairly straightforward, although this is counter-intuitive for many. First, the empirical evidence (from Thailand), then the explanation.
Nearly half of the patients on the bird-flu watch list have, in fact, caught human influenza, the Medical Sciences Department (MSD) disclosed yesterday.
Since bird-flu infections among fowls were detected…
revere | January 31, 2007Our Wiki partner DemFromCT has this post at DailyKos this morning about a CDC media phone conference/advisory tomorrow on its new Public Service Announcements (PSA) on pandemic flu and its guidelines on community measures that can be taken in the absence of a vaccine. This is the kind of ratcheting up some will see as a new an ominous development, but that's not my view. Instead I see it as the kind of thing that should to be done well in advance of anything happening, whether it happens or not. It is just good, routine public health practice.
We still need to see what these PSAs and…
revere | January 29, 2007Having taken on the American Chemical Society the other day, why stop there. Let's talk about the American Chemistry Council, the ACC (neé the Manufacturing Chemists' Association, then the Chemical Manufacturers Association and now ACC). And bird flu. Yes, bird flu. The ACC is a trade association of the largest chemical companies and has a division called the Chlorine Chemistry Division which has just launched a website "dedicated to educating the public on flu prevention and recovery." If you believe that I've got a 1995 Volvo with low mileage (for a Volvo) just for you. Only driven at the…
revere | January 26, 2007It seems like just yesterday the UN's Food and Agriculture Organization was saying that the current resurgence of bird flu is not as bad as last year when it burst out of Asia and extended itself into 40 countries or so. It wasn't yesterday. It was Monday. Enough time for that judgment to look a wee bit premature.
In fairness, FAO cautioned everyone not to let down their guard. Good advice, especially as the first poultry outbreak in Europe this season has now been confirmed in Hungary and the virus has returned to Japan for the first time in three years. We aren't even mentioning China and…
revere | January 25, 2007We spend a lot of time on bird flu here because, as I have explained, it is a useful lens through which to look at the void in public health leadership as well as preparedness issues of the system that allegedly protects us from bird flu and much else. We don't spend all this time on bird flu because we believe it is the most important public health problem in the world. It could become so, but it isn't now. Our view is that if it ever does, we should be ready for it, and it takes leadership for that to happen. But there are other gigantic problems, too, and we want to highlight one of them…
revere | January 23, 2007Dr. Margaret Chan has been on the job at WHO for about a month. So far so good. Two weeks ago she named Dr. Anarfi Asamoa-Baah as WHO's Deputy-Director General. I don't know him, myself, but those who do (and whose judgment I trust) have nothing but the highest praise for him, describing him as "brilliant." This is generally thought of as a wise and effective move. One appointment doesn't make a successful tenure, but I'd rather be giving provisional approval than complaining about something.
Dr. Chan's statements on bird flu, while not startling, are at least accurate. Monday she addressed…
revere | January 16, 2007It's January and once again the bird flu news is unsettling. Reports from Indonesia suggest a new cluster there and one of the isolation wards to be used for suspected bird flu cases is reported to be overwhelmed, although the small number of beds in these facilities doesn't mean huge numbers. Enough to be concerned, though. Another story says that the virus is prevalent in feral cats in Indonesia. That has yet to be confirmed. Besides the list we noted yesterday, Thailand is now reporting a poultry outbreak. Given all this, I continue to be cautious about how to interpret the January bad…
revere | January 11, 2007From yesterday's Jakarta Post:
No extraordinary measures against bird flu this year
JAKARTA (JP): Coordinating Minister for Social Welfare Aburizal Bakrie said Wednesday the government would not take any extraordinary measures against bird flu this year.
Aburizal said the current measures were sufficient to contain the spreading of bird flu in the country.
"We have been applauded by international agencies for our measures to handle the bird flu in the country," he said in a press conference.
A-14-year-old boy died in a hospital in Jakarta on Wednesday after being confirmed to be infected with…
revere | January 10, 2007Yesterday Canada's Campbell commission released its report on the 2003 SARS outbreak in Toronto. SARS is most infectious in the latter part of its disease course, so it isn't surprising that 45% of the victims were health care workers. Two nurses and a doctor died. SARS was a deadly occupational disease.
In the 1200 plus page report, Judge Campbell and his colleagues place the blame on a broken health care system but find no individuals at fault. The Toronto Globe and Mail is disappointed. My initial reaction was irritation they saw a need for scapegoats, but as I read the column by Murray…
revere | January 9, 2007I just returned from our University bird flu task force. We aren't ready. We aren't even close. The good news is that we know we aren't ready and we know we aren't even close. At least we're worried. This isn't some penny ante crowd of mid level managers, either. These are the top dogs at one of the biggest private universities in the country. They take it seriously. But it's tough. Our community is larger than many small cities but not as self sufficient. But if it's the planning and not the plan, we've made progress, because we're meeting regularly although we still don't have a plan.
That…
revere | January 7, 2007The vexing problem of when to close schools in the event of an influenza pandemic and who will do it seems to be, well, still vexing. A brief communication in CDC's journal Emerging Infectious Diseases by Princeton's Laura Kahn makes clear the level of vagueness, if not confusion surrounding it in the US:
The US Department of Health and Human Services' checklist regarding school closures gives conflicting messages. For example, it recommends that schools stay open during a pandemic and develop school-based surveillance systems for absenteeism of students and sick-leave policies for staff and…
revere | December 29, 2006The third of the recently diagnosed H5N1 cases in Egypt has now died, bringing that country's total to 18 cases with 10 deaths, the largest outside asia, southeast asia or Indonesia. The case count for 2006 now shows more cases (114) and more deaths (79) than any previous year. And the virus was more deadly, at last measured by a case fatality ratio (deaths divided by total confirmed cases). Indeed the number of deaths in 2006 exceeded the total of deaths for 2003, 2004 and 2005 combined (79 versus 78), although the number of cases exceeded last year's by only 18%, compared to an 88% increase…
revere | December 28, 2006Like Indonesia, the Philippines is an archipelago, comprising some 7000 islands of varying size. It is also close to Indonesia, which lies just to the south across the Sulu Sea. Indonesia has more bird flu deaths than any country in the world and the disease is endemic in poultry all over that huge country. But so far, The Philippines has reported no H5N1 in poultry or humans. The fact that The Philippines has reported no bird flu is remarkable. Maybe too remarkable.
Here's the map indicating the human cases in Indonesia, as kept up to date by a cadre of dedicated FluWikians, here. The…
revere | December 26, 2006It is an unconscious assumption of many public health officials, experts and most health educators that The Truth Shall Make you Free. We know it won't, not even in something as simple as understanding what to do and not do about bird flu. A paper this month in CDC's scientific journal, Emerging Infectious Diseases, is a case in point. Public health workers at the Pasteur Institute in Cambodia, the London School of Hygiene, the Cambodian Ministry of Agriculture and the UN's FAO undertook a survey about the knowledge, attitudes and practices among rural villagers in Cambodia, a southeast asian…
revere | December 21, 2006This week President Bush signed the Pandemic and All-Hazards Preparedness Act (S. 3678). It has generally gotten favorable reviews from public health professionals concerned with preparedness, including the Clinicians Biosecurity Network and The Trust for America's Health. We've taken a look, too, and find much to like, but whether this will indeed be useful will depend on how it's implemented. We have a few observations of our own, as well.
The law has four Titles, each dealing with a separate but related topic. Title I. pertains to " National Preparedness and Response, Leadership,…
revere | December 19, 2006I've debated (with myself) whether to post anything about disgraced columnist Michael Fumento's rantings that bird flu was a "Chicken Little" story (literally: it's entitled, "Chicken Littles were Wrong"). It was published in the far right rag, Weekly Standard, where Science is a dimunutive figure in the far distance, but now it's been picked up by Yahoo and other outlets, so I guess I'll have to bite the bullet and say something about this sleaze.
Why am I attacking him instead of what he wrote? I'll get to that in a minute, but first let me continue my egregious ad hominem ways. Fumento is…
revere | December 17, 2006We continue our summary of the Institute of Medicine "Letter Report" on non-drug non-vaccine measures to slow or contain the spread of an influenza pandemic of a severity similar or worse than that of 1918 (see previous post on models here). The IOM report examined several analyses of historical data from 1918 to see if it was possible to obtain information on the effectiveness interventions on the pattern of outbreaks in various cities in the US. It is well known that both timing and severity varied a great deal in that pandemic. The goal was to see if differences in morbidity and mortality…
revere | December 16, 2006On December 11, The Institute of Medicine, one of the four constituent parts of the National Academies of Science, released a "letter report" reviewing the scant information on effects from non-drug measures to slow or contain spread of an influenza pandemic (available as a free download here). The report was produced after a special workshop on October 25 in which the panel participants heard from a variety of experts, with subsequent deliberations that produced the summary letter report and its recommendations.
"Letter Reports" are mini-versions of the full IOM treatment where a specially…
revere | December 15, 2006There are many local stories about pandemic flu planning and they all sound pretty much the same. Local officials saying they are making good progress but there's still much left to do and if a pandemic struck they'd be in trouble. Yawn. But every once in a while you read one where you say to yourself, "Some of this has sunk in. They're asking the right questions." Not often, or at least not often enough, but when we started talking about this no one was asking questions like this:
Meals on Wheels delivers 850 meals a day in Rockingham County [New Hampshire], relying on 35-40 drivers and…