Public health preparedness
revere | September 5, 2007What seemed pretty obvious at first, that wild birds could be and were long distance carriers of H5N1 is, like the birds themselves, still up in the air. The problem is that existing data on migrating wild birds has failed to show convincing evidence they are infected:
FAO officials last year voiced concerns that bird migration patterns might have spread disease Asia and Europe to Africa. But as elsewhere in the world, very few cases have been found among wild birds in Africa.
The Wildlife Conservation Society Field Veterinary Program Director William Karesh is among those attending the…
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, 2007If you were an organic farmer you might be a tad pissed if the government came along and sprayed your crop with pesticide without your consent, essentially spoiling it. But that's what happened near Sacramento north of the American River between July 30 and August 1, as the local mosquito control district did aerial spraying to "control" mosquitoes that might be carrying West Nile virus. They aprayed 86 square miles (55,000 acres), home to 375,000 people:
Lab tests by Environmental Micro Analysis, an independent lab in Woodland, showed crops from at least one farm in Citrus Heights were…
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 20, 2007This is about the particularly severe flu season being endured by our friends in Australia. Southern hemisphere, so the flu season is in full swing there, the reverse of the northern hemisphere. But "full swing" doesn't quite describe it, so I'm going to do this one in two parts ((all links from Flu Wiki Front Page, news for August 18). The great epidemiologist Irving Selikoff once described statistics as people with the tears wiped away. So the first post today will be statistics, or the equivalent, without the tears . Later today I'll do the other part:
As the flu epidemic continues to…
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 14, 2007We write so much here about influenza A virus that you might get the idea it is an especially clever virus, always changing genetically in ways that allow it to perform new and nastier tricks. But other viruses are capable of doing the same thing, and one of them West Nile Virus (WNV), is currently becoming a a more persistent and serious public health hazard, all because of a clever little genetic trick it learned in the last decade or so.
WNV has been around longer than that, although we didn't have a problem with it in North America until 1999, when this mosquito-borne disease showed up,…
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 | July 31, 2007One reason Helen Branswell is such a good flu reporter is she has the best contacts. Of course this is a chicken-and-egg proposition, because she has the best contacts because she is the best flu reporter. She gets it right and she explains it the way it was told to her. [By the way, I am not on her payroll. In fact she is uncomfortable about being praised. But I don't do it for her sake. She doesn't need it anyway. My motive is to show other reporters what good flu reporting is and encourage them to do the same. And there are a number of other excellent reporters, which I try to acknowledge…
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 28, 2007If your country had thousands of cases of a potentially fatal disease, spread by mosquitoes, would you panic? Not if you lived in the US, apparently. Last year there were over 4200 cases of West Nile virus infections with 177 deaths. I don't remember panic gripping the nation. So I had to laugh when Canadian public health officials tell their citizens that with a particularly bad West Nile Virus (WNV) season underway south of the border, "There is no need to panic":
"There's no need to panic," Jean Riverin, a [Public Health Agency of Canada] spokesperson, told CBC News. "Many variables need…
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 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…