Public health preparedness
revere | April 24, 2009Late yesterday we summarized a CDC media briefing about the developing investigation of cases of influenza in California and Texas with a previously unknown flu virus with genetic components from pigs ("swine flu", humans and birds). At the same time reports were surfacing of an especially virulent respiratory disease outbreak in central and southern Mexico that had resulted in 20 deaths and hospitalizations with acute respiratory failure. 137 cases have been reported, including health care workers. When asked yesterday, CDC said they were in close touch with their Mexican counterparts but at…
revere | April 23, 2009This afternoon CDC held a "media availability" on the evolving swine flu cases. Evolving is an understatement. There are now more recognized cases, although not all cases are "new," with some cases retrospectively recognized now that more intense investigation is occurring. The total is now seven cases. Two occurred in San Antonio, Texas, two sixteen year old boys in the same school. Three more were found in California (in addition to the initial two cases), including a father - daughter pair. All California cases are in San Diego and neighboring Imperial counties, the location of the initial…
revere | April 22, 2009Late yesterday afternoon a Morbidity and Mortality Weekly Report (MMWR) Dispatch appeared on CDC's website that is unique in my experience. MMWR is usually heavily vetted and edited and nothing gets out of there fast. Indeed, in recent years, nothing at all got out of CDC very fast. And yet here is this Dispatch, with text referring to the same day of issue (April 21), reporting on two young patients with febrile respiratory illnesses, one of whose cases CDC only learned about on April 13, 8 days earlier. April 17 CDC determined that the two children, both from the San Diego, California area…
revere | March 16, 2009There is an attitude toward the prospects of an influenza pandemic and what, or what not, to do about it that I have little patience with. We saw examples a couple of years ago with the writings of Wendy Orent and Marc Siegel and now it is surfacing again from Philip Alcabes, in an op ed in the Washington Post over the weekend. All three are smart and well informed -- but that doesn't prevent them from being wrong headed. The Alcabes piece, ironically entitled "5 Myths About Pandemic Panic" is either built on myths or strawmen, take your pick. Here is my commentary on the "5 Myths":…
revere | March 14, 2009There is a good summary by Robert Roos at CIDRAP News about the $420 billion spending bill signed by President Obama this week to cover the next six months. The good news edges out the bad news, so the net is positive, a welcome change from the kind of deeply depressing budget news to which we became accustomed during the Bush years. Bush took a teetering public health system whose decline started with Reagan and continued through Clinton and put it on life support. Now a couple of items in the spending bill have upped the oxygen slightly but don't increase the circulation in all the critical…
revere | February 16, 2009Keeping public health in the spot light is critical and what better place to do it than the front page of DailyKos, one of the most visited blogs in the world (average daily visits over 800,000). For six weeks DKos frontpager DemFromCT, one of the founders of FluWiki and himself a pulmonary specialist, has been running a series called Flu and You, interviewing public health types (including one of the reveres). This week he interviews Jeff Levi of Trust for America's Health (TFAH), and the entire thing is worth a read. I want to single out only one aspect that is especially timely, the missed…
revere | February 7, 2009It turns out that we were not the only ones musing on the relationship between the news business and the flu business. Dr. Michael Osterholm, is the Director of the Center for Infectious Disease Research & Policy (CIDRAP), and also Editor-in-Chief of the CIDRAP Business Source, a subscription newsletter offered to the business community on pandemic (and similar) matters. Dr. Osterholm's name has appeared here often, perhaps most memorably as the author of the "We're screwed" observation. A couple of weeks before my recent post he had written to the business community:
The collapsing…
revere | February 6, 2009For reasons other than this blog (I actually have a real life) I was reading a 1965 text by Leavell and Clark, Preventive Medicine for the doctor in his community: an epidemiologic approach, and found this on pp. 67-68 regarding tasks in a disease outbreak:
"Further spread must be prevented; the sick must be cared for, hospitalization must be provided, if necessary; the population must be told how to protect itself; inoculations may be required; and particular attention to the safeguarding of water, milk, and food supplies may be essential."
Concise and to the point. I wonder how much…
revere | February 3, 2009On Sunday DailyKos frontpager, DemFromCT (who is also a founder of the FluWiki and a pulmonary specialist) finished up his two part interview with us. It's cross-posted here below the fold. If anyone doubted we were academics, the display of watching us argue with ourselves would have but those doubts to rest. Scientists cherish the hope that we will make difficult things simple, but often we wind up making simple things difficult. We see complications in everything, even the simple question of what is public health infrastructure. Witness:
Q. Last week I asked you about public health…
revere | January 27, 2009On Sunday my friend and colleague from Fluwiki, DemFromCT, did me the honor of interviewing me on the front page of DailyKos. That's a pretty tall platform, being the most visited blog in the known universe (and beyond), so it's best to be absolutely clear when saying things there. I"m not sure I quite met that standard, but I'll let you judge for yourself, as I am cross-posting the interview below the fold. But this also gives me an opportunity to clarify one point that drew some justified comment. Here's something I said in the interview:
In the past I downplayed individual prepping for a…
revere | January 24, 2009A reader sent me a link to The Salt Lake Tribune that made me do a double-take: Health department on chopping block:
Utah could become the only state in the country without a state health department.
Republican lawmakers are considering handing the duties of the health department -- from tracking and responding to communicable diseases and trying to reduce obesity and cancer rates to inspecting child care facilities -- to other agencies.
The proposed dismantling would save $1.7 million in administrative costs by cutting director and division director budgets. It came as a shock to David…
revere | January 12, 2009DemFromCt's excellent post at DailyKos alerted us to the fact that this year's vaccine appears to have a mismatched influenza B component. Each year vaccine makers try to anticipate the strains that will be circulating 6 months hence, based on surveillance data. They have been fairly good with their guesses but things seem to be getting more complicated in recent years and mismatched strains are becoming more common, that is, the vaccines don't protect as well or at all against the strains that are actually circulating. There are three strains in the yearly "flu shot," two influenza A strains…
revere | November 14, 2008The idea of stopping flu "at the border" has received almost uniformly bad reviews from public health experts. Once human to human transmission starts we won't be able to stop it by closing our borders, although we likely will cause the usual unintended consequences, like preventing vital personnel and supplies from getting to where we need them. At least if we do it in the usual ham handed way this administration is famous for. We learn via CIDRAP News that federal officials are still willing to give a "risk-based border strategy" (RBBS) a go, at least in the form of an exercise. Now, at…
revere | October 23, 2008With the advent of flu season the perennial question of the "next pandemic" is again making an appearance, although I think it is more of a cameo appearance than a substantive one. WHO, CDC and numerous state health departments are warning citizens about seasonal flu, still a major public health problem, and the continuing threat of emergence of a novel flu virus to which the earth's population has little or no immunity. There is something both plaintive and formulaic about these warnings. Seasonal flu is with us every flu season (hence its name) and the feared pandemic of bird flu has yet to…
revere | October 20, 2008Flu season is upon us and with it the perennial question, should I get a flu shot. In 2006 the Advisory Committee on Immunization Practices (ACIP) extended its 2004 recommendation that children 6 months to 23 months be vaccinated (2 doses) to now include children 6 months to 59 months (
This is a hybrid design called a case - cohort study. It was designed to estimate the effectiveness of inactivated flu vaccine to prevent either inpatient (hospitalized) or outpatient (Emergency Room and doctor's office visits) flu-related events. It was carried out in three counties (around Rochester, NY;…
revere | October 13, 2008Food poisoning can be a miserable experience and sometimes you feel like you want to die rather than endure another minute of the agony, but people rarely die from food poisoning. At least for most causes of food poisoning. The exceptions are the exceedingly rare cases of botulism and the much more common occurrence of listeriosis, infection with the organism Listeria monocytogenes. Listeria is a really nasty bug and serious cases are often fatal. The most at risk are the elderly, the immunocompromised, and pregnant women, biologically immune altered, and their fetuses and neonates. Listeria…
revere | September 20, 2008Generals are often said to be fighting the last war and public health officials likewise are managing the last crisis. At the end of May 2007 we had the notorious flying lawyer with TB flap (see our multiple posts here), so in June 2007 CDC quietly instituted their public health version of the "No Fly" list. I guess because the Department of Homeland Security (DHS) No Fly list has been so incompetently and dangerously implemented CDC didn't want to taint their version with the same name, so they are calling it the Do Not Board (ENB) list. The DHS list is pushing a million entries. Pretty soon…
revere | August 31, 2008The folks at ScienceDebate2008 pushed hard during the primaries to have the candidates address science policy. Chris Mooney and Sheril Kirshenbaum from Scienceblogs The Intersection were among the leaders in this movement. They didn't succeed in getting a debate then, but now with the field down to the finalists, they have received a response from Barack Obama to 14 questions culled from over 3400 submitted by the 38,000 signers of the ScienceDebate initiative (we were proud to be among them; they include nearly every major American science organization, the presidents of nearly every major…
revere | August 19, 2008News reports that nonagenarians had robust antibodies against the 1918 flu strain were intriguing on several levels but I wasn't sure how many doors were still open to these being antibodies that developed in the years after 1918. After all, the 1918 subtype was H1N1 which circulated freely until the 1950s when it was displaced by the next pandemic strain, H2N2. H2N2 in turn was pushed aside by H3N2 in 1968. Then H1N1 returned in 1977 (some say it escaped from a Russian laboratory) and since then H3N2 and H1N1 have been co-circulating. Some years are predominantly H1N1, some predominantly…
revere | August 6, 2008A curious paper on the 1918 flu pandemic appeared this month in CDC's journal, Emerging Infectious Diseases. It seemed provocative, at least on the surface. It claimed that the conventional wisdom underlying pandemic flu preparations was wrong. It's not the flu virus we should be defending ourselves against but the common bugs of the upper respiratory tract that take advantage of new fertile ground to grow in after the flu virus invades:
Medical and scientific experts now agree that bacteria, not influenza viruses, were the greatest cause of death during the 1918 flu pandemic.
Government…