Public health preparedness

It's being described as a "dramatic settlement" that will set a pattern for the nation. Let's hope so, because the agreement reached yesterday by the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) and hospital player Catholic Healthcare West (CHW) sounds like just what the doctor ordered. It covers 32 CHW facilities in California and Nevada, where CNA/NNOC represents 13,000 registered nurses. Some details: A centerpiece of the agreement is the creation of a new system-wide emergency task force, comprised of CNA/NNOC RNs and hospital representatives following…
We are otherwise occupied, but fortunately DemFromCT has a great status report on swine flu up at DailyKos. I suggest you also follow the first link to his piece at The Arena, although reading after his astute observations is not for the faint-of-heart. The politicization of this issue by Republicans is to be expected and typically unfair (not to mention uninformed). As Dem points out, the Bush Administration did a lot of the heavy lifting that made dealing with this much easier and deserves credit for that. We took them to task here for not shoring up a badly deteriorated public health and…
On Saturday we posted our take on The Atlantic magazine article by Shannon Brownlee and Jeanne Lenzer. It's a major story in the November issue, a banner across the top of the cover page reading: Swine flu: Does the vaccine really work? We tried to ignore it. People kept asking us to comment on it, but we didn't want to get entangled in vaccine controversies. As Orac warned me, it's a game of Whac-A-Mole. But we got fed up and posted our global response, not a point by point refutation, since that wasn't what the issue was. Our main point was that it was a straw man argument built around the…
I keep getting asked about the Atlantic Magazine article, Does the Vaccine Matter? by Shannon Brownlee and Jeanne Lenzer, two reporters whose particular bias is that we as a nation are "over treated." As a generalization that's probably true, and finding examples isn't hard. Unfortunately by taking as their main example flu vaccine during a pandemic, they have not only picked the wrong example but created more confusion at a time when there's already too much. Here's the gist: Vaccination is central to the government’s plan for preventing deaths from swine flu. The CDC has recommended that…
Via Crof's blog (invaluable, as always) I learned of the decision of Massachusetts state health officials to vaccinate state prisoners before the rest of the population: Prison officials warn that inmates could quickly spread the flu if not inoculated -- particularly those in high-risk groups such as AIDS patients. Middlesex Sheriff James DiPaola told the Boston Herald that prisons were the perfect flu "breeding ground." DiPaola dealt with riots in a Cambridge jail when rumors of swine flu spread there. (AP) State legislators are already complaining that there are other, more vulnerable…
I've been asked a number of times why I am bothering to get both flu vaccines this year (the seasonal flu trivalent vaccine and the swine flu vaccine when it is my turn). I am in the older age group (last in line for swine flu vaccine) and it is my group that is hit the least hard from the swine flu virus. But there are a lot of us and we're still being hit. I don't know if I will be one of the unlucky few in my age group who draws the short straw or not, and I'd rather get vaccinated with an acceptably safe vaccine than take a chance in winding up having a machine breathe for me or not…
The online publication of three papers and a commentary yesterday in the Journal of the American Medical Association (JAMA; free access, links at bottom of post) provides some further data on what demand for critical care resources might be from the current swine flu pandemic. One paper reports on the Mexican experience, where mortality seemed unusually high but where access to services may have made the outcome worse. The papers from Canada are perhaps most pertinent to what might be experienced in the US and Europe. It appears that in terms of demand for ICU beds, the first wave from last…
In an earlier post I said I opposed mandatory vaccination for adults (but not for children), the one exception being for health care workers because they come in contact with people at high risk. My view then was that if you work in a health care institution and won't get vaccinated against flu, then you shouldn't come to work. Now I am re-evaluating my position as a result of some cogent and pragmatic comments from lawyer-bioethicist George Annas, professor of health law, bioethics and human rights at Boston University School of Public Health, and author of "The Rights of Patients." I know…
This is about a paper published Friday. The post is long because the paper provides practical advice on a problem of importance, the issue of school closures. The advice is based on data and could be implemented at the level of a school district or even a single school without requiring a lot of money or effort. It's not cost free, but could probably be done with existing personnel and resources. The fact that it would be grounded in empirical evidence makes a decision to keep a school open or to close it much easier to defend. It would not be arbitrary or a guess. Improvements in the…
A good story by the AP's Lauran Neergaard yesterday highlighted the need for better public health surveillance and the efforts being made to improve it so as to keep track of possible rare side effects from the swine flu vaccine. This is an issue we've talked about a lot here, most recently in the context of not being able to fully test any vaccine for rare adverse outcomes prior to deployment. There's more involved than that, but first here's Neergaard's lede: The U.S. government is starting an unprecedented system to track possible side effects as mass swine flu vaccinations begin next…
There's hopeful news about the possibility of an effective HIV/AIDS vaccine and a weird story from Canada about "preliminary results" saying that you are more at risk from swine flu if you get the seasonal flu vaccine. With flu, anything is possible, but that is more than a little counterintuitive and strikes me as unlikely. Nowhere else has reported a similar experience. Since we don't know the methods or the data or the limitations or much of anything else that could allow us to consider how much to weigh this as evidence I won't say any more about it. While we do write about vaccines here…
Most people are either indifferent to swine flu or fearful, but the makers of Purell hand sanitizer and Chlorox are happy. It's been a boon to the business of sanitizing everything in sight as a way to ward off swine flu. Here's a story about Chlorox (bleach): The company has secured additional suppliers and will increase production if needed, says Benno Dorer, senior vice president- general manager of Clorox’s cleaning division. Some retailers have already asked for more bleach, he said in a Sept. 4 telephone interview, declining to name specific companies. An outbreak of the flu may add 2…
It's not Labor Day yet, but I guess the Reveres have to consider their vacation over. We're all back at our respective home stations. We admit that not watching flu evolve daily was a relief, although we did sneak peeks when we weren't supposed to. But it also proved to be like the stock market. The daily ups and downs sometimes obscure the bigger picture. So what does it look like now? We have two contradictory impressions. One is that the pandemic has continued to develop in a very robust fashion. So it's a dynamic picture of change. The second is that it looks like a normal pandemic, just…
Of the three main modes of infection for flu -- transmission by large droplets, transmission by tiny suspended aerosols, transmission via inanimate objects (also called fomites) -- it is the last that is the least certain but garners the most attention in the form of hand hygiene, disinfectants and now, fear of magazines and toys in emergency department waiting rooms and acute-care clinics in Canada. Here's the lede from an article in the Montreal-Gazette: All magazines and toys should be removed from emergency department waiting rooms and acute-care clinics to reduce exposure to human swine…
The reaction to our post on Sunday about preparing for the ongoing flu pandemic was mixed. Some thought it was right on target while others expressed dismay over what was perceived as minimizing the possible effects, especially as we have been talking for well over four years about the potentially pervasive nature of widespread absenteeism. Still others thought we had retreated to a narrow view focused on the pressure on the health care system while neglecting what might happen in the wider world. There is some truth to all these perceptions, but we didn't take this tack because we changed…
We've been talking about the possibility of a flu pandemic here for four and a half years. The cliché during much of that time was that the right way to think of a flu pandemic was not "if," but "when." As long as no pandemic materialized, however, there was great scope for what it would look like and hence what to plan for. The hoary adage, "Hope for the best, plan for the worst" made sense but left a great deal of scope for different approaches to planning. What, after all, was the worst we could expect? We had two models, one historical, one hypothetical but plausible. The historical one…
I am thinking out loud here. Since that's never a pretty sight, you might wish to avert your eyes. With that merest of advance warning, the school closure problem has gotten me to think more generally about social distancing. The term itself is a kind of oxymoron. "Social" emphasizes togetherness, intercourse between people, relations. "Distancing" is negation of the social. We have examples: canceling school, prohibiting mass gatherings, telecommuting, but the underlying idea is straightforward. With a contagious disease that passes from person to person (details still to be worked out, of…
Had a busy day at work yesterday (the pesky day job problem) but did get a chance to see bits and pieces of the Flu Summit video streamed at Flu.gov. This was aimed at state and local folks, and the parts I saw didn't provide much new information if you have been following this for years. I'll bet, though, it was sobering for many state officials who haven't had the chance or inclination to consider the myriad ways widespread absenteeism can affect our intertwined and interdependent modern way of life. One aspect vividly on display in the opening months of the current swine flu pandemic was…
A risk factor for swine flu complications is pregnancy. Yet one of the few venues specifically for healthy people in modern health care facilities is for pregnant and postpartum women, the in and out patient portions of the obstetrics department. And what of the newborn whose mother gets the flu? Infants are also at greater risk from influenza complications. This is a tough problem. CDC has just issued some interim guidance regarding swine flu and obstetrics settings. The guidance is "interim" because CDC is quite frank that there is a great deal we don't know about the probabilities and…
Crafting a message on swine flu is not easy, and it's easy to make missteps. I think CDC has gotten it pretty much right over the last two months, but not everyone has. We've written here since the beginning (some examples here and here) that describing any flu outbreak as "mild" is inapt. Flu always has the potential to be a serious disease and kill people, even in flu seasons termed "mild" by comparing them to flu seasons that are "bad." Even with virulent flu viruses many people have minimal illness -- in comparison to those who don't. But flu, even in its most common form of a self-…