Pandemic preparedness
revere | August 10, 2006China now admits what everyone knows already knows. It had a death from H5N1 in November of 2003, a full year before its "official" first case (The Guardian). In fact everyone also knows that there was H5N1 in February of that year when the disease was diagnosed in Hong Kong in a family just returned from a visit to Fujian province. That occurred at the outset of China's now infamous SARS cover-up. As interesting, the Chinese explanation for why the case not been reported earlier, was it had been misdiagnosed as a SARS case. This may in fact be what happened but it raises another question:…
revere | August 10, 2006The lull in bird flu is over. At least the lull in the news about bird flu. The virus didn't go away. Editors got tired of it and national agricultural officials were quiet about it. Now Thailand is again engulfed with poultry infections and experiencing human cases and Indonesia continues to percolate away with both bird and human cases. In both countries the endemic poultry problem is the underlying cause.
"When you have trouble controlling infection among the chicken flocks, you are naturally going to see continuing infections among humans," Dr. Anthony Fauci, the US National Institutes of…
revere | August 7, 2006There is an AP story circulating in Florida newspapers that IBM Corp. and The Scripps Research Institute want the federal government to pony up $500 million for some of their research on computer models to track the spread of bird flu. Why Florida? Because they also want Palm Beach Country and the city of Boca Raton to fork up $20 million to put their supercomputer facility in Boca Raton.
I guess what I would most like to say to the IBM Corp. and The Scripps Research Institute is this:
are you out of your fucking minds? $500 million dollars? And another $20 million that could be used for…
revere | August 4, 2006A dead swan in a Dresden, Germany zoo signals the return of bird flu to that country (AFP). It is not the only locale where the disease is reappearing after a lull. Laos and Thailand have cases in birds and Thailand has just registered its second death in a week, a nine year old girl. Several more cases are hospitalized and over a hundred are on a watch list because of symptoms that might indicate infection (Reuters).
Vietnam is looking on with worry.
Deputy Agriculture Minister Bui Ba Bong said bird flu, which erupted across much of Asia in late 2003, often hit Thailand first and broke out…
revere | August 1, 2006The most successful armies learn from their adversaries. There is no doubt Hezbollah is an enemy of public health. We'd say the same of the Israel Defense Forces (IDF), but it's Hezbollah which has more to teach public health. Here's what we're getting at.
The New York Times has an excellent story about how the vaunted military might of the IDF has been checked by the disciplined fighters of Hezbollah fighting in their own villages. This shouldn't be a surprise but people have bought the myth of IDF military invincibility, just as they bought the myth of US military invincibility before Iraq…
revere | July 31, 2006I noticed that Governor Mitt Romney, Republican presidential hopeful and much despised Governor of Massachusetts, just vetoed $8.15 million in funding for addiction treatment and prevention in his state. I'm not an expert on substance abuse issues, but I know it is an area of public health where we are in real trouble because of budget cuts. I have written quite a lot about bird flu here and the need to address it by strenghtening the public health infrastructure. Substance abuse is part of that infrastructure. But what, if anything, does cutting these programs have to do with bird flu? I…
revere | July 27, 2006The human bird flu vaccine news from pharma giant GlaxoSmithKline sounds good and it probably is. Probably. There is a lot we don't know yet as the results have not been published in the open medical literature. Here's what GSK is claiming.
First, they claim to have produced a vaccine that raises antibodies in 80% of the test subjects (400 Belgians) with a very small amount of viral material (antigen), 3.8 micrograms given twice (7.6 micrograms, total). Previous attempts to make vaccines against H5N1 have required much more antigen. Because our ability to produce viral antigen in eggs is very…
revere | July 24, 2006That pharmaceutical giant Hoffman-La Roche would have trouble meeting the orders it received for its antiviral Tamiflu was well known and not a surprise. Roche's manufacturing method is said to be laborious, dangerous in spots and have a long production cycle (NB: shorter and cheaper methods have since been discovered but it isn't clear anyone is using them to make Tamiflu at this point; see our post here). So it has surprised and upset many to see the drugmaker marketing Tamiflu to businesses, essentially inviting them to move to the head of the line.
With only a fraction of the doses needed…
revere | July 22, 2006Indonesia has come under strong criticism because its agriculture department has been unable to cope with the avian influenza epidemic in its backyard and commercial poultry. Among other things, Indonesia doesn't have an effective mandatory surveillance program for the infection in birds. Guess who else doesn't have one?
The U.S. Agriculture Department's failure to develop a "comprehensive" program to monitor for bird flu could leave the country unprepared if an outbreak happens, a bipartisan group of senators said on Friday.
In a letter to Agriculture Secretary Mike Johanns, six lawmakers…
revere | July 20, 2006It sounds trivial but it isn't. What to do about pets in the event of a disaster. We saw in the Katrina evacuation how failure to take separation anxiety of pet owners into account created a major public safety problem. People were unwilling to leave their dogs, cats and other pets behind and if told they couldn't take them, they refused to leave. This problem has been known by sociologists and others studying disasters for decades but disaster planners don't bother to consult the literature, it seems. Now, with the problem highlighted on CNN for a week straight, there is finally legal…
revere | July 20, 2006CDC has disgorged $225 million to state and local health departments for bird fluhttp://www.dhhs.gov/news/press/2006pres/20060711.html. That's some good news, made better by the fact that these phase II allocations seem usable for a wider range of public health needs than bioterrorism or bird flu, narrowly conceived.
The money goes to help states pay for activities above and beyond what they normally provide, said Joe Posid of the U.S. Centers for Disease Control and Prevention, which distributes the money.
"They'll use the CDC funds for more macro or public health purposes such as…
revere | July 15, 2006The frozen chicken from China story has a follow-up. You may remember that a warehouse full of the chicken was found in Detroit although import is banned to the US because it came from an area where there is bird flu. An unstated amount of the meat was already in commerce in restaurants and retail stores. If you live in Detroit, you probably haven't received a recall notice, however:
Health officials have begun contacting restaurants and markets supplied by a Troy warehouse suspected of importing Chinese poultry, but there was no plan Thursday for alerting the retail customers of Asia Food…
revere | July 11, 2006The national bird flu plan is quite explicit in its promises to local public health. There aren't any. The plan is, "you're on your own." Fair enough. A pandemic happens everywhere so there's no "outside" to send help from. But how well prepared is local public health? Bush has given them the power and supposedly provided them with money to handle bioterrorism attacks. That should have been some help. It wasn't.
Unfortunately what the left hand giveth, the Right Hand taketh away. From Cape Cod, Massachusetts:
But budget cuts over the past few years, coupled with a lack of staff, have left…
revere | June 30, 2006The question has been broached here before by our commenters: if a pandemic is a threat to our civil infrastructure, how do we know the internet will continue to function? It's fine to tell workers to telecommute, but what if the information highway the commuters travel is grid locked?
Good questions without good answers. But information technology professionals are at least thinking about it. The IT trade mag, Computer World, has a story about a simulation held recently at the world Economic Forum by management consulting firm Booz Allen Hamilton. The scenario was pandemic flu arriving in…
revere | June 27, 2006One of the knocks on the alarms about bird flu is that it is just another in a series of false alarms like Y2K, West Nile and SARS. Not true. Pandemic influenza is indeed another in a series of alarms, but the only one that might conceivably be considered a false alarm (and this isn't even sure) is Y2K. Let's take them one at a time.
The investment in fixing the Y2K bug was substantial on the part of business and government world wide, extending over several years prior to 2000. It is difficult to say what the results might have been without that investment. In many respects it is similar to…
revere | June 27, 2006The first half of 2006 is coming to an end. So far it was the world's worst for avian influenza, as the disease spread to birds across Asia, Europe and Africa, with new human cases being reported every couple of days.Since January, at least 54 people have died from the H5N1 avian influenza strain in Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq and Turkey, according to the World Health Organization. That compares with 19 fatalities in Vietnam and Cambodia in the first six months of 2005. Human cases create opportunity for the virus to mutate into a lethal pandemic form.
[snip…
revere | June 27, 2006The fact seven people in Azerbaijan contracted bird flu from wild birds has been assumed for some time and now has been officially confirmed by researchers in Germany:
Four people have died after catching avian flu from infected swans, in the first confirmed cases of the disease being passed from wild birds, scientists have revealed.
The victims, from a village in Azerbaijan, are believed to have caught the lethal H5N1 virus earlier this year when they plucked the feathers from dead birds to sell for pillows. Three other people were infected by the swans but survived.
Andreas Gilsdorf, an…
revere | June 21, 2006Old soldiers -- and young ones, too -- do die, but if there's a flu pandemic with a lot of absenteeism in the workforce, the VA has plans to let them just fade away. Or something like that.Families of veterans who die during a bird flu outbreak shouldn't count on burying their loved ones in any of the 120 national cemeteries. The Department of Veterans Affairs foresees closing the military graveyards in a pandemic because of staffing problems.
The VA buries more than 250 veterans and eligible family members a day -- about 93,000 a year. Itoperates cemeteries in 39 states and Puerto Rico.…
revere | June 20, 2006There is currently no vaccine for a pandemic strain of H5N1 avian influenza, and if a pandemic strain does emerge it will take at least 6 months to get the first batches of one. Currently the productive capacity for influenza vaccines is so overmatched by the needs of a global population, only a tiny fraction of those that will need it could be immunized.
The current experimental (and relatively ineffectual) vaccines for H5N1 are not for a pandemic strain but for a strain current in southeast asia that is still poorly transmissible from person to person. It is thought an easily transmissible…
revere | June 20, 2006As you read this a meeting of more than three dozen avian flu experts should be convening in Jakarta to discuss the disastrous state of public health in that country. Many poor countries have disastrous public health systems, but Indonesia has something else: a huge population of people living in close contact with a huge population of poultry infected with an influenza A subtype (the H5N1 subtype) that has crossed the bird/human species line. Influenza A is a major killer of human beings worldwide, but the global population has substantial (at least partial) immunity to the circulating…