Public health preparedness
revere | May 1, 2009One of the things we are told is not the responsibility of government but an "individual responsibility" is not working sick or sending our kids to school when they are sick. I pointed out that the ability to do this may depend on others, particularly employers. Employers also have a responsibility, not just employees.
The US has some of the worst sick leave and child care policies among industrialized nations. It is nothing short of a scandal. And now these non-policies have the potential to have major public health consequences. The US labor movement is querying its workers about this. Here…
revere | April 30, 2009A reader (hat tip, sandy) has pointed me to a very interesting interview with CDC's chief virologist, Ruben Donis, in Science Magazine's blog, ScienceInsider. In it he provides further information on the confusing reports about the species origin of the current swine flu, originally said to be of swine, human and bird origin but later claimed to be only swine. It may be that both are true, depending on how you look at it.
According to Donis, who has been sequencing the isolates, the virus is all recent swine but bears the marks of human and avian ancestry in some genes. Different genes have…
revere | April 30, 2009There is a tendency to be preoccupied with the latest in fast moving events, but I want to pause for a moment to make a point that has been lost in the discussion: we are witnessing a medical science landmark. Never before have we watched a flu outbreak of global dimensions unfold in real time. Nor have we ever had the opportunity to alter the course of such an outbreak.
I have been critical of WHO for being late to the party, but they are fully on board now and by raising the pandemic threat level to phase 5 have done something very important: served notice that it's time to mobilize…
revere | April 29, 2009In June 2005 a reader over at the old site suggested we put up some of our flu related material on Wikipedia. That sounded like a great idea to me. Even better, why not start a special purpose wiki -- a flu wiki -- to harvest the vast knowledge of the hivemind? Many, if not most, of the problems that would plague us in a pandemic weren't medical or even scientific in nature. They were things like, how do you prepare your small business for the possibility that the one person who knows how to unjam the fax machine is out sick for 4 weeks? Two other bloggers were also doing flu stuff at that…
revere | April 29, 2009A student once complained that no horse was too dead for me to stop beating it. Long time readers are familiar with that here. Over the years I have said that the best way to prepare for a pandemic -- or any other grave threat to our communities -- is to strengthen its public health and social service infrastructures. While some progress along those lines have been made (the additional training and upgrading of the national laboratory system is what allows us to find swine flu cases), in the main public health and social services have continued to deteriorate and weaken. And with the day of…
revere | April 29, 2009As is usual (routine? no, nothing routine about this) in an evolving epidemic contradictory and confusing numbers are appearing. Some of them are the result of information lags (tallies not being updated), some are the result of using different criteria for counting (suspect versus probable versus lab confirmed, etc.), some are just rumors. WHO is saying that in Mexico there are only 7 confirmed deaths, 19 more lab confirmed cases, 159 probable cases and some 1300 being evaluated, based on official reporting to them by officials of a member state, the Mexico. Everyone knows there are many…
revere | April 28, 2009As cases continue to accrue in different places we will hear more talk about quarantine and isolation. These are two terms that are frequently confused, which is too bad, because isolation makes sense for influenza and quarantine doesn't. So what do they mean?
What quarantine and isolation have in common is they are both designed to interrupt the transmission of a disease that spreads from person to person. Quarantine is the legally enforceable segregation of people who people who have been or may have been exposed but who aren't (yet) sick. Some people talk about "voluntary quarantines," but…
revere | April 28, 2009It would be nice to think that the 28 cases at the NY Prep School are it for the city and that the virus has been contained there. But that was always more a wish than a plausible reality:
CBS 2 HD has learned of a confirmed case of swine flu at the Ernst & Young headquarters in Times Square.
One of the staffers became ill over the weekend after coming into contact with a family member who had been exposed to the virus.
The staffer is said to be resting at home and the company believes, due to the virus' 24-hour incubation period, that no one else at Ernst & Young was exposed. The…
revere | April 27, 2009One of the things we'd like to know about the swine flu virus is its Case Fatality Ratio (CFR, commonly called a case fatality rate, although it isn't technically a rate but a proportion). But what is a CFR? And how is it different from a mortality rate?
The CFR is an estimate of the probability that someone with the swine flu will die of it (technically, before dying from something else or recovering). The higher the CFR, the more virulent the virus. So what's virulence? Virulence refers to the severity of the disease the virus produces. Rabies is a virulent virus. Everybody dies from it…
revere | April 27, 2009The daily CDC conference call was not particularly informative, but these daily briefings are still extremely valuable. Things are happening fairly fast but nothing we didn't expect. There are now 40 confirmed US cases in the same 5 states (California, NY, Texas, Kansas, Ohio). The 28 new cases sere contributed by the New York prep school that had the state's first 8 cases. These additional ones are the result of continued case finding. Acting CDC Director said that the only laboratory confirmed human to human transmission is in the Kansas husband and wife (he had just returned from Mexico…
revere | April 27, 2009Usually "What did you expect?" is a rhetorical question, but we have a more serious point to make. Let's start with the familiar and move on to the less familiar. Many of you are coming here to find the latest news about swine flu. It's an imprecise term that covers two different things: what has happened that is new, in the sense of surprising and we didn't already know it would happen; and what is the current situation. Overnight (in the US) Europe (Spain) registered its first confirmed case. That's additional data but not surprising. We know this virus is seeded out there and we shouldn't…
revere | April 26, 2009The White House briefing today had Obama written all over it. It's themes were Obama, it's tone of quiet, serious confidence were Obama. The sense of total command of the situation was Obama. There was the Obama-ese call for "personal responsibility." Government can't do everything. There are things we each have to take personal responsibility for.
Fine. I don't disagree. But I think there are some things missing from this frame. One is that it isn't a binary choice, government or the individual. We all live in a set of overlapping communities: work, home, neighborhood, civic organizations,…
revere | April 26, 2009The White House held a briefing this afternoon with the Secretary of Homeland Security, Acting Director of CDC and Nat'l Security adviser to the President in attendance. If you have been following this you wouldn't have learned much, but the overall tone was one of serious concern but steady confidence. It was good security theater, and I say that in a good way. Information was divulged (judging from some of the press questions there was no danger over estimating the knowledge of the audience) and a sensible plan described.
There are now officially 20 confirmed cases in the US in five states…
revere | April 26, 2009If there was ever a graphic illustration of how global interconnectedness affects public health, it's the swine flu affair. Wherever it started, the current crop of cases seems related to Mexico, either as the epicenter or via travelers. Four US states have cases. Those not on the Mexican border are related to travel to Mexico. Kansas, New York City, the suspect cases in secondary school teachers and students in Auckland, New Zealand just returned from Mexico. And France has two suspect cases also just returned from Mexico, as does Spain. We've discussed the problem of infectious disease on…
revere | April 25, 2009A concise summary of some additional developments, courtesy Bloomberg:
Three teachers and 22 students from Auckland’s Rangitoto high school are being tested for swine flu after returning to New Zealand’s most populous city from Los Angeles following a three week trip to Mexico, Stuff.co.nz reported on its Web site. Some of the travelers had symptoms of flu-like illness and were being isolated as a precaution pending test results, it said, citing the Auckland’s public health service.
In the U.K., a British Airways Plc crewmember with flu-like symptoms was taken to Northwick Park Hospital…
revere | April 25, 2009Canadian Press (Helen Branswell, with contributions from AP reporters) AP has a piece up about how Mexicans are coping that is worth a read, but we were drawn to this description of how the Mexican authorities first recognized something was amiss:.
Health authorities started noticing a threefold spike in flu cases in late March and early April, but they thought it was a late rebound in the December-February flu season.
Testing at domestic labs did not alert doctors here to the new strain, although U.S. authorities detected an outbreak in California and Texas last week.
Perhaps spurred by the…
revere | April 25, 2009There may not have been much news at the CDC briefing, but it is coming thick and fast now. The CDC works through state health departments and defers to them on information about what is going on in their localities. Hence all questions about this were deflected at the 1 pm CDC briefing. I think I understand the thinking behind this but it doesn't serve the goal of getting the information out there quickly. CDC needs to be the information clearing house for all the swine flu news going on around the country and they need to do with absolute transparency. Here's what has developed since that…
revere | April 25, 2009CDC has just concluded a press briefing and the big news is there is no big news. In fact there was hardly any small news. The major questions have been identified -- how transmissible, what is the epidemic curve, are there more cases in the US, are there subtle genetic differences in the US and Mexican versions to account for the apparent difference in clinical and epidemiological features, etc. -- but answering them will take longer.
Meanwhile, no new cases have been identified in the US, but CDC in collaboration with state and local health departments and the academic and medical sectors…
revere | April 25, 2009There will be an update from CDC later today and WHO's expert committee established under the new International Health Regulations (IHR) meets via teleconference this morning North American east coast time at 10 am (4 pm Geneva time) to consider whether the swine flu situation merits declaring it “a public health event of international concern.” If they do, WHO Director General Margaret Chan may respond by raising the pandemic threat alert level from the current phase 3 (new virus: no or limited human to human transmission) to phase 4 (new virus, evidence of increased human to human…
revere | April 24, 2009Friday April 24, 1:40 pm: AP and NYT reporting that Mexican authorities are saying that they have determined that 16 of 60 deaths are "swine flu," with 44 more being tested. They have yet to confirm whether it is the same as the California/Texas cases, but that's a bit irrelevant since either way it sounds like a very worrisome development. There are already a reported 930 plus cases, with schools closed in Mexico City and contemplation of closing government offices. Obama has been notified and the White House is following the situation. WHO and CDC have activated their emergency centers and…