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Do you prefer the statistics about home foreclosures, or would you rather read reports about people losing their homes? Do you read the health care analysis diaries or case reports of disasters that hit the uninsured?

Both statistics and case reports tell a story, and they both impact decisions, but in very different ways. The same is true for stats about influenza and stories about children dying from influenza. Both scenarios were on display this week, both in Atlanta (CDC pandemic drill) and Hong Kong (seasonal influenza outbreak). Let's explore that a bit more.

Back in February, 2007 the Center for Disease Control and Prevention (CDC) was confronted with this mock scenario:

A 22-year-old Georgetown University swim team member just back from Indonesia eats dinner with his teammates but then develops a fever and doesn't accompany them to a meet in New York.

That is how a flu pandemic in the United States started.

It's a terrific thing, by the way, that these drills are taking place. Drilling and practice makes the actual response that much stronger, and while no exercise can be completely realistic, systems glitches will occur and be caught and improved on for the next time.

With outbreaks in multiple states, the exercise picked up where it left off a few months later, April 2007:

It's near the end of a 48-hour simulated flu pandemic. The Centers for Disease Control and Prevention's top brass are packed into a conference room glassed off from the hubbub of its Emergency Operations Center at CDC headquarters in Atlanta.

It's a chance to practice decision-making in case of a real pandemic. The gathered staff are discussing how to screen all international travelers for flu symptoms.

CDC director Julie Gerberding interrupts.

"I have a question," she says. "Just what is our containment strategy in Pea Ridge?"

She's talking about an actual place — Pea Ridge, Ark., population 2,346. But according to this fictional scenario, a dangerous new strain of Asian bird flu has found its way halfway around the world to Pea Ridge.

The scenario-writers have given Pea Ridge a small expatriate community from the Marshall Islands in the South Pacific. In the pretend pandemic, a Marshall Islander gets infected with the new flu in Indonesia and brings the virus back to Pea Ridge. That's the kind of thing that can happen when air travel is so fast that people can fly from anywhere to anywhere else before they develop flu symptoms.

In this recent CDC simulation, Gerberding needs to find out what's being done to stop the virus from spreading beyond Pea Ridge.

Flash forward to March 2008, where I joined the CDC exercise for two days as a (mostly) observer. That conference room is just behind the CDC's Emergency Operations Center, pictured above during this week's continuation of the exercise. Each of the 50 monitors is manned by someone coordinating one or another of the fuctions CDC needs to fulfill in a pandemic, such as collecting state data on hospital beds, or sharing their expertise and advice to local and state offcilas on infection control,  quarantine and legal issues. There are liasons with key government partners like State and DoD (in the scenario, military personnel on an overseas ship are affected). It's now day 6 of the pandemic, according to the exercise, and the CDC Director, Julie Gerberding, is calling the Georgia State Emergency Manager to find out if Georgia schools are closing (the answer is: not yet) to assess the impact on CDC employees if their kids are sent home.

That's important information for many reasons. School closure (more properly termed student dismissal – the buildings remain open and might be used for alternate treatment centers or school lunch distribution) is a linch pin in the community mitigation strategy that CDC recommends in a severe pandemic (see this brief discussion on community mitigation from Dec 2006). However, the dependence on local decision making means that smooth execution of well-laid plans is not assured. For example, here's what happened in Atlanta this week (bolded added):

The CDC was very accomodating in allowing the observers access to senior staff and section officers on duty, including sitting in on an hour briefing/conference call with the affected states (whoever played those roles, the accents were perfect - Arkansas sounded nothing like Michigan). States had varying ability to update CDC with real time case numbers ("I'll get back to you on that" must have been the most commonly heard line of the day), and difficulty with adjusting on the fly to requests for extra personnel ("we need you to send 20 staff, varying qualitications, to support screening activities at your state's busiest airport") and rapidly changing policy requests. That was especially evident when the states were asked to consider community mitigation strategies including student dismissal. Some states pushed back on that, with an observation that it would be a) difficult b) disruptive c) expensive. In addition, in some states, there was no clarity as to whether decisions would be made at the local, county or state level (states with only a few cases were less ready to pull the trigger; Hawaii was quite worried about the effect of all this on the tourist industry).

[Remember, the above is role playing, but very realistic role playing. Some states might be more ready, some states less. If they wanted to make a point in the exercise that states were not ready to simply throw a switch and turn on non-pharmaceutical intervention, practice social distancing, close schools, etc, on a moment's notice on a call from CDC, that point was made.]

For more on local response, see the following from a Daily Kos diary written by oregondem in June, 2007 (bolded mine):

Lane County Public Health officials were "stunned" recently when a contagious man with measles went out on the town after he said he would stay put in his apartment.

County officials said they "had no reason" to think a young man might not curtail his active social life. They "take people at their word."

But what if the infection next time is an epidemic of bird flu that sweeps around the world - a pandemic?...

The Centers for Disease Control has stated that our only hope is to keep people from gathering in crowds - so-called "social distancing." This is, of course, what Eugene's measles patient refused to do two weeks ago.

The CDC stated in its February 2007 Pre-Pandemic Plan that schools, child care centers and universities should prepare to close for as much as 12 weeks to limit spread of the disease and save lives.

School closures are a key to effective action. In Seattle during the 1918 flu pandemic, Mayor Ole Hanson closed schools and theaters and banned religious gatherings. Seattle's superintendent of schools called the mayor "hysterical." The mayor replied, "We would rather listen to a live kicker than bury him." But public resistance was so strong that Hanson resigned and left town within a year.

St. Louis, Mo., closed its schools on Oct. 5, 1918, within two days of the first reported case. Philadelphia's mayor ignored pleas from health officials, saying that a patriotic parade planned for Sept. 28 was too important. Within days, the flu spread like wildfire there. The quick actions in St. Louis and Seattle resulted in lower death rates in 1918 than the skyrocketing deaths in Philadelphia. Seattle had one-third as many deaths as Philadelphia.

Local government and public-health officials have been slow to make their plans for a bird flu epidemic available to the public. As a consequence, Eugene-area citizens have no basis for confidence that local officials today will move quickly.

The truth is that while state and local officials are empowered to make school closure decisions, there's every reason to believe they will hesitate when the time comes. In the CDC drill, and in the planning, the trigger for school closure will be an increasing number of cases (click for bigger picture):

You don't want to be disruptive to family life, education, commerce, etc. and close schools too early. At the same time, schools need to close within 10 days or so of cases beginning to spread in order to do any good, or it will be too late. The idea is for schools to close early in the acceleration phase. But you need data to know that's where you are, and early on, surveillance at the state and local level is not so sharp that federal and state planners will have the data they need to make decisions about school closure based on statistics and graphs, not until all states improve their surveillance and reporting mechanisms.

But there's another way schools close. In Hong Kong this week, schools closed because of a severe case of seasonal flu that led to the deaths of a few children. At first, the health authorities figured to ride it out (Wednesay, 12 March; my bolded, and note the ubiquitous response about local closure):

But Secretary for Food and Health York Chow Yat Ngok said there was no need to have a territory-wide closure of schools. He urged people to stay calm.

"We are closely monitoring the situation now and we do not see the need to close all schools at this stage. But if the outbreak of the flu-like disease becomes more serious, we may consider that.

Dr Chow said it was up to individual schools to make the decision whether to close or not.

Well, after a few pediatric deaths, that didn't last. The schools abruptly closed on Thursday, 13 March:

More than half a million primary and kindergarten students in Hong Kong have been ordered to stay home from school for two weeks after a outbreak of the flu.

The school closures, which started Thursday, were ordered after three children died within the last week. The deaths are all suspected to have been caused by the virus...

CTV's Steve Chao, reporting Thursday from Hong Kong, said many parents only found out about the sudden decision to close schools Thursday morning, as they brought their children to school.

"It sparked a degree of panic as many hospitals as well as doctors' offices soon filled up with parents taking their children who had coughs or a degree of fever in."

Chao said memories of the SARS outbreak in 2003 remain strong in the minds of many in Hong Kong.

As reported and translated at Flu Wiki Forum, here's what happened:

Coincidentally, there was apparently a meeting of heads of schools in the Tuen Muen school district. Some of the schools became very concerned, and many parents started calling in to say their kids were sick, just so they could keep them home.  Some parents who were walking their kids to school turned around after they started hearing about school closures and as the news of the latest death spread. One parent said "I have only one son, I don't want anything to happen to him."

At the same time the Centre for Health Protection was holding a series of territory-wide public meetings to address the concerns of teachers and school heads, who repeatedly asked to be given better 'metrics' or criteria as guidance for school closure. There was a lot of confusion and no consensus as to when schools should close.

Reporters and public officials sometimes misuse the term "panic" when they mean "appropriate concern" or confusion. In NYC on September 11, for example, New Yorkers didn't panic, they did the smart thing and got the hell out of the immediate area as quickly as they could. People aren't robots and they're not stupid. If there's a deadly infectious disease in the schools, parents will force school closure by applying the precautionary principle. The HK officials did the right thing. It doesn't matter if the parents (and teachers) are 'right' or 'wrong' about the decision; we've seen that with MRSA and trace asbestos enough times to know that pressure on officials from parents will close schools just as surely as word from health officials, and maybe faster than if those same officials are far away.

That fact is not lost on planners, but school closure is a state/local and not a federal task (nor is CDC in charge of every aspect of pandemic planning. That is a joint task with HHS and DHS and coordinated via the White House Homeland Security Council, following this framework).

The question remains, in a real pandemic will the schools close because of the surveillance and statistics or because of the demands of parents? Either way, they will close. The real questions for the planners are which reason for closure will come first, which will be the more orderly and which will turn out to be the more timely. Data on the aggregate cases may lag behind an early news report of pediatric mortality, or it may be the other way around. But if the schools do not close in a timely manner, and deaths ensue, the point of closing them may be lost altogether. And the fact is that whether it's an Atlanta exercise or a Hong Kong flu outbreak, the data and statistics that officials would ideally want to use to make these decisions will be in short supply.

And speaking of exercises, everyone ought to consider their proper role in (and preparations for) an emergency such as a pandemic, and that includes blogs. After all, you never know where and when the next natural disaster will hit, and sharing information is something we do really well. Certainly, this blog kept up to the minute coverage of the California wildfires going (see explanation of crisis blogging), and we did our share during Katrina. And while we won't be setting policy we can certainly keep track of things like school closures in a way that shares information with everyone (including any web-surfing officials who want more up to date info than "I'll get back to you on that").

Of course, the internet needs to stay up for us to be of use. But that's a different story for another day.

For more background, see Pandemic Flu Preparation and the Role of Internet Communities, Pandemic Challenges For Hospitals and Flu Stories: SARS And H5N1 — The Precautionary Principle.

Originally posted to Daily Kos on Sun Mar 16, 2008 at 05:52 AM PDT.

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Comment Preferences

  •  uncomfortable to think about but (5+ / 0-)

    great diary thanks

    First of all if Hillary can't get more than 55% of the primary voters running against "uncommitted" she should probably rethink her viability in Michigan.

    by pollwatch on Sun Mar 16, 2008 at 06:00:08 AM PDT

    •  my local community (8+ / 0-)

      is planning a pandemic surge capacity drill next month. other communities will do the same. There have been recommended diaries about California's plan for surge.

      Oh, and H5N1 is still out there.

      Hot topics this week include:

      • China: Outbreaks in birds; fatal seasonal influenza cases
      • Egypt: 1 new confirmed human case, fatal; many suspect cases
      • Indonesia: Widespread outbreaks in birds; numerous suspect cases including 11 from the same village

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 06:07:44 AM PDT

      [ Parent ]

      •  flu shots (1+ / 0-)
        Recommended by:
        ladybug53

        sort of sidebar in case may be useful person to person;

        I am in health catagory that recommends getting flu shot every season 1) age 2) medical conditions

        but I don't take the shots for more reasons than I will list/discuss: but one reason is we have flu shot shortages and I know how to treat flu with home remedies

        beginning of digestive tract:
        uncooked raw onion juice: disgusting though it is it works,put it in broth or peppermint tea well... can't argue with results :-)

        ten drops of apple cider vinegar in glass of water every hour until better; sip it no need to drink whole glass;

        end of the digestive tract:
        usually rice is cooked 2 water to 1 rice - cups

        cook rice 3 water to 1 rice... as odd as it sounds it puts things back together in the bathroom department;

        throwing up flu:
        ice pack applied to vegas nerve (nerve node located under Sternum )

        and if really have the strength hot water bottle on kidney and ice pack on chest....

        anything to get through;

        these remedies are also quite effect against very lethal e-coil infection;

        First of all if Hillary can't get more than 55% of the primary voters running against "uncommitted" she should probably rethink her viability in Michigan.

        by pollwatch on Sun Mar 16, 2008 at 06:22:59 AM PDT

        [ Parent ]

        •  PS haven't had (0+ / 0-)

          flu for decades even though I don't take the shots;

          First of all if Hillary can't get more than 55% of the primary voters running against "uncommitted" she should probably rethink her viability in Michigan.

          by pollwatch on Sun Mar 16, 2008 at 06:29:16 AM PDT

          [ Parent ]

          •  eye of beholder (0+ / 0-)

            when the flu shot doesn't help prevent and God forbid you or loved ones get the flu; there is always Tylenol and chicken soup; you don't have to take my word for it... age old remedies lots of people use;

            First of all if Hillary can't get more than 55% of the primary voters running against "uncommitted" she should probably rethink her viability in Michigan.

            by pollwatch on Sun Mar 16, 2008 at 07:10:23 AM PDT

            [ Parent ]

          •  lived in area (2+ / 0-)
            Recommended by:
            ladybug53, jlms qkw

            long time ago that was hit with Hanta virus; in the morning cough and fever by afternoon suffocating and death; very dangerous infection the key was immediately ( even if think trip to hospital/doctor is waste of time ) get to medical facility let them diagnosis - - it is a matter of speed; it was only after the public was warned about the speed which Hanta virus killed that the public learned not to wait even if it meant a day off work and medical cost for something that turned out to be simple cold;

            the public health department geared up to do the work it needed to coordinate itself and take measures it needed to stamp it out vector was infected rodents; winter short and warm brought early spring the mice population exploded carrying Hanta virus to households from remote rural area which was the point of origin;

            First of all if Hillary can't get more than 55% of the primary voters running against "uncommitted" she should probably rethink her viability in Michigan.

            by pollwatch on Sun Mar 16, 2008 at 07:24:27 AM PDT

            [ Parent ]

            •  we have the reagan administration tho thank (2+ / 0-)
              Recommended by:
              DemFromCT, ladybug53

              for hanta virus.

              not the virus itself, but for the inability of state and local jurisdictions to have enough resources for their jurisdictional health promotion and disease prevention activities.  the reagan block grants forced states to play a priority-making game that meant, in all cases, something was left unattended or improperly addressed.

              hanta was but one expression of the carelessness of the reagan block grants (which were in part just one of the facets of the "starve the beast" approach of the reagan administration to whittle away at core public health activities and functions of the state and local jurisdictions).

              laurie garrett's book the coming plague is an excellent and well-sourced tome that has a great section it it on hanta virus -- and showcases the  remarkable effort by cdc when it came to their rapid response when dealing with hanta several years ago.  basic gumshoe epidemiology.  the book is well-worth the read.

              _________________________________

              "Is leor nod don eolach."

              -9.75 (economic), -7.18 (social)

              by dadanation on Sun Mar 16, 2008 at 10:06:34 AM PDT

              [ Parent ]

        •  Flu shot (0+ / 0-)

          I mention the recent "plague" in Illinois down below. At least one of my friend's had the flu shot (we discussed this specifically) and still came down with a ridiculously bad case of the flu.

          Just something to keep in mind.

          Undecided in Illinois. Help?

          by sunflwrmoonbeam on Sun Mar 16, 2008 at 07:54:43 AM PDT

          [ Parent ]

  •  It would probably help if we (6+ / 0-)

    started promoting the notion that the appropriate response for any illness is for people to stay home, rather than douse themselves with palliatives that make them feel well enough to go spread their germs.

    One of the most negative consequences of having a profit-driven health care industry is that profit depends on increased utilization, whereas the goal in dealing with illness, injury and disease is to DECREASE the need for intervention.  Profit is not indicator of success; increasing profit is indicative of failure.  It's not just a matter of spending more and getting less; it's a matter of spending more and getting worse.

    How do you tell a predator from a protector? The predator will eat you sooner rather than later.

    by hannah on Sun Mar 16, 2008 at 06:09:01 AM PDT

    •  absolutely true (5+ / 0-)
      Recommended by:
      elfling, Kestrel228, ladybug53, mcmom, jlms qkw

      but I am uncertain what's supply and what's demand.

      In any case, on this topic, home care is key. You'll find the beginnings of instruction on that at American Red Cross.

      And keep in mind in this exercise, 11% of those who get pandemic flu die (it's not ordinary seasonal flu at <1%). Outrageous? Right now the case fatality rate for H5N1 is closer to 60%.</p>

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 06:43:25 AM PDT

      [ Parent ]

  •  Somewhat OT (6+ / 0-)

    but I am now reading a great book: The Ghost Map, about a cholera epidemic in 19th c. London.

    Really a stunning piece of cross-disciplinary work.

    •  great book (4+ / 0-)
      Recommended by:
      plf515, mcmom, OHdog, jlms qkw

      this map is from the John Snow UCLA site.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 06:44:54 AM PDT

      [ Parent ]

    •  Quite pertinent to this diary (2+ / 0-)
      Recommended by:
      elfling, plf515

      That particular cholera epidemic (1831-1832) started when city officials in Sunderland tried to cover up a case of cholera to avoid harm to local business from the expected quarantine. By doing so, they ensured death on a massive scale for the local population, many of whom were especially vulnerable because of poverty and cheek-to-jowl living conditions. There is one particular "cholera pit" (deep mass grave) there that's a city block long.

      "America is the only country that went from barbarism to decadence without civilization in between." -- Oscar Wilde

      by expatyank on Sun Mar 16, 2008 at 04:10:37 PM PDT

      [ Parent ]

  •  We have to get a handle on this. (10+ / 0-)

    I work in a major medical system and I see the reports from the health departments and also how many patients have been canceling because of illness.

    I also have been in bed for 5 days with the flu. I am a very healthy 39 year old and I have basically been dealing with recurrent viral infection for the last 6 months.

    The last week was a hellish flu. I have never been sick like this and do not even know someone that has been sick like this.

    Everyone needs to be at work, there is little to no slack so people go sick. Or worse I hear I don't want to use my pto days for when I am sick.

    So we keep spreading things back and forth and our immune systems get beat down by the virus and the stress of working or not working only to work more and going back too soon.

    While you are probably not contagious after a week and may be able to make it back, it is at least a month of taking care of yourself to recover. If you don't the next strain will hit you.

    Again, this is another system of a dysfunctional life style. It is nearly impossible to take care of yourself, family and neighbors in the way you need to. It requires a life style where health is the most important thing, not the 40-60 hour work week.

     

  •  You (4+ / 0-)
    Recommended by:
    Powered Grace, koNko, mcmom, jlms qkw

    had me at the first sentence, that was great hook about stats vs stories.

    Sorry if I missed it, but in the US, who would make the call to close local schools -- I assume the district super -- and who would make the decision on a national level? How much control does the CDC have over those offices?

    Read UTI, your free thought forum

    by DarkSyde on Sun Mar 16, 2008 at 06:17:39 AM PDT

    •  This is a good question (2+ / 0-)
      Recommended by:
      DarkSyde, jlms qkw

      I wonder, too.  Although with the recent bad weather here the State of Ohio stepped in (exactly who it was, I'm not sure) and cancelled ALL travel in the northern part of the state before the snow storm hit this past week.  

      I'll have to get in touch with the school system and see what would happen with an outbreak of illness such as influenza.  We recently had one student at our high school who had been diagnosed with TB and the testing machine went into effect very quickly.  This was all the school system's doing.  

      March is National Multiple Sclerosis Education and Awareness Month. An issue close to my nervous system.

      by Powered Grace on Sun Mar 16, 2008 at 06:33:25 AM PDT

      [ Parent ]

      •  the answer is state by state (5+ / 0-)

        CDC commissioned a study to find out! That's how complex it is.

        Assessment of School Closure Laws in Response to Pandemic Flu

        James G. Hodge, Jr., J.D., LL.M., P.I.; Center Executive Director

        Schools play a critical role in protecting the health of their students, staff, and the community from highly contagious, infectious diseases such as seasonal or pandemic influenza. Modeling and analyses conducted by CDC and others indicate, for example, that community-wide school closures may mitigate the incidence of pandemic influenza, thereby reducing its impact on individuals, groups, healthcare providers, public health systems, and the economy. The public health premise is that closing schools limits the spread of influenza (or other communicable conditions) consistent with social distancing theories.

        Local, state, and federal agencies, however, have incomplete and inconsistent information about the relevant laws and policies that may allow school closure or other measures in public health emergencies. Accordingly, CDC asked the Center for Law and the Public’s Health ("Center") to research key legal provisions among states as to whether state or local department(s) of health, education, and/or emergency management may mandate school closure during non-emergencies and emergencies in response to potential communicable disease outbreaks. For the purpose of this analyses, "schools" are defined to include public and private schools that admit students in grades kindergarten (K) through twelve (12).

        As presented at the 2007 Local, State, and Federal Public Health Preparedness Summit on February 22, 2007, while nearly every state may feature general communicable disease laws during non-emergencies or broad emergency powers that may authorize school closures, the Center's primarily tracks those legal provisions that (1) specifically allow for school closure for communicable disease control or general purposes, or (2) allow for the closure of facilities (that may include schools), for extended periods of time (potentially up to 12 weeks).

        For a copy of the Center's powerpoint presentation from the Summit, please see the link below:

        Assessing Legal Preparedness for School Closures in Response to Pandemic Influenza and other Public Health Emergencies

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 16, 2008 at 06:51:56 AM PDT

        [ Parent ]

      •  Public Health Officers (3+ / 0-)
        Recommended by:
        Powered Grace, mcmom, jlms qkw

        have VERY broad powers written into most state statutes, but the problem becomes enforcement thereof.  Its the lead public health official (usually the Secretary of the State Dept of Health) that can call for quarantines, restrictions of travel and commerce, and other such restrictions, but enforcing it is difficult, not only because a lot of law enforcement are either unaware or unwilling to be told what to do by a PHO, but also because the legal precedents are either murky and/or not well-written in many cases.

        Additionally, note that there is a National level PanFlu exercise scheduled for June 23-27.

        "If everyone is thinking alike, someone isn't thinking." -George S. Patton

        by vmibran on Sun Mar 16, 2008 at 08:03:32 AM PDT

        [ Parent ]

        •  in addition (3+ / 0-)
          Recommended by:
          Powered Grace, mcmom, jlms qkw

          those that have the power to close are often reluctant to exercise it. In CT and in other states, I suspect it'll be a governor level decision, executed by the state health commisioner.

          But every state will struggle with this just as HK did.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 16, 2008 at 08:09:31 AM PDT

          [ Parent ]

          •  Assume that there is an outbreak. (1+ / 0-)
            Recommended by:
            Powered Grace

            Suppose there is a flu epidemic in a few states in the south, a few states in the northeast, a few in the southwest, a few in the northwest, and a few in the midwest. Not likely, of course, but with air travel, perhaps statistically possible. Scenario: a large gathering for a convention of people all over the US in an area where a deadly flu has been identified. Some workers in the convention center are infected, but not yet exhibiting obvious symptoms. The attendees return to their respective states. Is this possible? Who, then would make the decision, as it would be a nation problem? I was thinking about Legionnaires Disease, e.g.

            "This is not our America and we need to take it back." John Edwards.

            by mcmom on Sun Mar 16, 2008 at 10:27:10 AM PDT

            [ Parent ]

            •  that's exactly the scenario (2+ / 0-)
              Recommended by:
              Powered Grace, mcmom

              that CDC was practicing... a swim team went to NYC and infected people.

              In the first week or so, your scenario is what it will look like. Steps then need to be taken to mitigate it. Despite everything done, it will spread... but how can you slow it down?

              more here

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Mar 16, 2008 at 10:33:55 AM PDT

              [ Parent ]

  •  About the present HK school closure (8+ / 0-)

    The case started when a one child became ill Monday, was taken to hospital and put under treatment, then suddenly died several hours later.

    A second child was diagnosed/died Tuesday, then several others diagnosed Wednesday parallel to the announcement of volentary school closures. Thurday as 2 week closure was announced and broadcast through the news meadia and SMS networks by telecom service providers.

    I personally believe the Health Services acted responsibly and quickly advising the general public Tuesday to take precautions and then ordering the closure once it had been established the first two cases were the same viral strain.

    To understand the public panic one must grap the severe effect SARS had in Hong Kong and the region, requiring quarentine of numerous residential and commercial buildins and schools for weeks. Furthermore, the generally crowded living conditions in Hong Kong (some areas have the highest population density on earth) and high humidity present an ideal environment for viral epidemics to occur.  

    When harmonious relationships dissolve, respect and devotion arise; when a nation falls to chaos, loyalty and patriotism are born - Daodejing (paraphrased)

    by koNko on Sun Mar 16, 2008 at 06:18:40 AM PDT

    •  thank you (5+ / 0-)
      Recommended by:
      koNko, mcmom, mommyof3, jlms qkw, ryangoesboom

      and I agree entirely that it was responsible.

      I was trying to relay how difficult it is to make those decisions, and not everything described as 'panic' really is.

      But my main point was that a few deaths are more of a driving force then the shape of the flu patient curve, which might be available next week.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 06:54:57 AM PDT

      [ Parent ]

    •  Plus, Hong Kong has experience with this (7+ / 0-)

      Back in '03 they closed all schools--not just primary schools--for a month over SARS.  It was surreal, but kind of fun.

      I can't speak for all schools, but I know Hong Kong International School (my alma mater) has contingency plans in place for an emergency school closure--they'll basically shift to online courses.  If anyone's prepared for a flu epidemic, it's Hong Kong

      Back in '03, they tried doing stuff over email, but the net result was very few people actually doing anything and many people (like me) being completely unmotivated when they got back.

      •  you're right (4+ / 0-)
        Recommended by:
        koNko, mcmom, jlms qkw, ryangoesboom

        they are one of the best prepared places on earth, and even they struggled with it this week, ultimately making a good and timely decision. It ain't easy, even for HK.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 16, 2008 at 07:40:47 AM PDT

        [ Parent ]

        •  well, there's always a lot of crap going around.. (3+ / 0-)
          Recommended by:
          koNko, haruki, jlms qkw

          and it took them a while to decide to cancel school for SARS, even.  It was obvious for like a week that it was going to happen, but everyone still came to school...

          I remember one Tuesday, I had a bio test (at this point, we were down to like 75% attendance, because the most paranoid parents weren't letting their kids come to school).  I also had a cough.  By the end of the test, everyone else was wearing a surgical mask to protect them from my evil germs.  I stayed home the next day.  The day after that was when they finally canceled school.  So even with an obvious threat like SARS, it took a while...

        •  SARS was a tough lesson for Hong Kong (5+ / 0-)

          And China, but lessons learned.

          In fact, our traditional fresh food markets were partly to blame since handling of poultry was careless and invthe humid climate bacteria and virus incubates and spreads. However, by improving sanitation and increasing segregation of live poultry it's possible to significantly reduce risk.

          Here in Shanghai SARS, regretably, was the end of our traditional open air markets but after a couple of years the supermarkets caught on and opened indoor fresh markets (and now a lot of organic food markets).

          Regards Hong Kong, they actually have one of the most compentent and honest governments in terms of civil service, a positive legacy of British colonial rule.

          When harmonious relationships dissolve, respect and devotion arise; when a nation falls to chaos, loyalty and patriotism are born - Daodejing (paraphrased)

          by koNko on Sun Mar 16, 2008 at 09:18:40 AM PDT

          [ Parent ]

  •  epidemic, pandemic - hysteria (1+ / 0-)
    Recommended by:
    mcmom

    Dear people - isn't it a little bit too early to talk about a worldwide pandemic?. We have the bird flu in Germany for about 2 years. Last year I heard from one place, where the bird flu was discovered - in a poultry faming. They shut it down. Another year is gone with no occasion.
    We don't live with the poultry in the living room - same as you don't.
    A traveller, who is bringing that disease from Asia will be ill very soon. He can be treated or isolated riht away. That is not a reason to initialize a hystera. GWB promised, that he will defeat such as disease with troops (he has left in the US - he is wrong as usual). A controlled and concentrated treatment would solve that problem in an adequately form. Bird flu is not the only disease that is flying around the world.
    This is my opinion and I cannot discuss it because of my bad English - sorry.

    •  no, it's not (5+ / 0-)

      Dear reader -

      the complexity of preparations requires foresight and practice. There's nothing hysterical about it.

      OTOH, pretending that something can't happen because it hasn't happened is wishful thinking.

      A great analogy is category 5 hurricanes. They are rare but devastating. Caring about shoring up the levees before the storm hits is more prudent and much more cost effective than concentrating on rescue and recovery alone, and is hardly hysterical.

      Re pandemics, just because we haven't had one in memory doesn't mean there won't be another one. They happen on average 3 times in a century and are inevitable. H5N1 hap[pens to be a good candidate virus, but no one's saying it's the guaranteed next pandemic. However, any pandemic from the next flu virus, be it H5, H7 or H9, will swamp the system as currently constituted. That's a hard fact.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 07:00:51 AM PDT

      [ Parent ]

    •  Avian flu will probably jump to pigs-then humans (2+ / 0-)
      Recommended by:
      elfling, jlms qkw

      I'm guessing our next dangerous pandemic would probably jump from poultry to pigs, then from pigs to humans.  That's been the path of several of the more virulent flu viruses we've seen over the last century.  That would mean we'd probably see the flu coming out of Asia where the poultry/pig/human contact is high.

      Just because we do not live with ducks in our houses doesn't make us safe- obviously flu travels very, very easily in today's world.  You certainly have enough of a latency period to pick up influenza and fly home before you even start feeling ill.  And imagine if you start becoming infectious on a flight to NYC, or London, or Las Vegas or Disney World- the virus would be worldwide within a couple of weeks.

      Social distancing works very well with influenza, and Glaxo has an H5N1 well matched vaccine in Europe.  Preparing for a pandemic, if done properly and not as a way in which to coerce Americans into accepting martial law, is the right thing to do.

      The first politician I heard talking about proper pandemic measures was Barak Obama, in October 2005.  'Too bad about his name' I thought, 'smart guy, but with a name like that I don't see much future in American poliics'  It's nice to be wrong sometimes.

      •  he was a leader then (2+ / 0-)
        Recommended by:
        mcmom, jlms qkw

        and Clinton as ranking chair member of senate committees that oversee the topic has spoken out most recently. It's one of the rare bipartisan issues in DC these days (Frist and Pat Roberts as well as harry reid, Chris Murphy (CT-05) and others have agreed).

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 16, 2008 at 08:55:31 AM PDT

        [ Parent ]

      •  some points however (1+ / 0-)
        Recommended by:
        mcmom

        the pig-human path is but one of many (1918 flu went directly to humans). And you're quite right about latency period. You can possibly shed virus 24 hours before you're ill (not a nailed down hard fact, but widely assumed), so screening airline passengers for fever won't completely work.

        And we will probably see it come out of Asia but possibly Africa or Egypt.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Mar 16, 2008 at 08:58:01 AM PDT

        [ Parent ]

        •  My husband's parents had moved to (1+ / 0-)
          Recommended by:
          elfling

          Montana, in hopes of separating from the family ranch, for some years. This was in the period of 1916-1925. The only commercial means of travel, and that very limited, was the train. They farmed and lived not far from the Flathead Lake. Another family was on a homestead some distance away. The family's several children had not been in school for a week, so someone rode a horse to their home to see why they were absent. The whole family was dead. We are talking about a very remote area in the early 1900's, yet they died from the same flu epidemic that killed thousands. How they contracted it was a mystery to local and state officials. A frightening story, considering the changes in travel opportunities now.

          "This is not our America and we need to take it back." John Edwards.

          by mcmom on Sun Mar 16, 2008 at 10:38:51 AM PDT

          [ Parent ]

    •  Seeing as how there's been no great earthquake (2+ / 0-)
      Recommended by:
      ladybug53, mcmom

      in San Francisco for over 100 years, we can stop planning for the next one. It's obvious no earthquake will ever hit there again.

      If a strain of influenza is a problem, it won't be carried by birds any more -it will be dangerous because it has mutated to a form that is infecting humans directly and immediately.

      As it is, our schools are already a great petrie dish where the kids play show and tell and share their brand new virus acquisitions after every significant holiday. All the exercises that they are doing apply not only to flu (which will outbreak eventually) but also to any other virus - a tenacious measles, the next ebola/marburg type virus, whatever. Some sort of dangerous infectious disease is as inevitable as the next great earthquake.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Mar 16, 2008 at 10:05:36 AM PDT

      [ Parent ]

    •  When I worked for a Pharmaceutical company... (0+ / 0-)

      a year ago, I was charged to design and implement a system for corporate wide, secure, remote access to the internal systems. In closed discussions, I was told that this was being implemented due to concern about Avian Flu. This was decidedly NOT to be put in my presentations for funding justification, but that was the driver for the executives.

      "I belong to no organized party. I am a Democrat." Will Rogers

      by mlandman on Sun Mar 16, 2008 at 06:09:34 PM PDT

      [ Parent ]

    •  I totally agree! Fear Mongering! (0+ / 0-)

      No way am I going to compromise my immune system by vaccinating.

      There is a lot of good literature out there on the dangers of vaccines.

      I focus mostly on vaccines for animals (or not vaccinating animals as the case may be) but my sources cite human sources.

      Dr. Pitcairn, Dr. Goldstein. Dr. Schoen, the AAHA, Dr. Jean Dodds and many others all talk of the dangers of vaccines to animals.

      They source back to dangers of vaccines to humans.

      My thought is on the tip of my brain but the answer seems to me to be to start at the beginning.

      Provide good health care to the world so that we all have kick butt immune systems.

  •  Military and police action is how the US (1+ / 0-)
    Recommended by:
    mcmom

    plans to implement quarantine procedures in case of a massive influenza epidemic. This is the real problem that opens up a non-paranoid nightmare of government command and control. All the exercises in the world won't help when the "for profit" health system runs so lean on "excess" hospital capacity and the military and para-military decides literally who gets medical care and who is expendable. And dependence on everyone having a 14 day supply of food, water, and medication is totally irresponsible. The ACLU has issued a report on "Pandemic Preparedness" that accuses the federal officials for "conflating public health with national security and law enforcement". (Thanks to the American Society for Microbiology for a heads-up)

    I can count the honest and ethical national newspeople on one hand and still have one finger left for the rest.

    by OHdog on Sun Mar 16, 2008 at 06:43:24 AM PDT

    •  actually not so clear (5+ / 0-)

      it's an excellent report from ACLU, but the personnel required to move from voluntary to mandatory will be ill and unavailable! The health side dismisses the ACLU report as a tad exaggerated for that reason, but it needs to be out there, and we need to be aware of it, talk about it, plan in advance, etc!!

      And it is actually more likely to hit with the next administration, or the one after, not this one.

      And dependence on everyone having a 14 day supply of food, water, and medication is totally irresponsible.

      why is that irresponsible? The Just-in-time economic system has no reserve for stockpiling.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 07:04:10 AM PDT

      [ Parent ]

      •  How do we expect people who live from one (2+ / 0-)
        Recommended by:
        ladybug53, mcmom

        pay check to the next, barely, have a two week supply of anything. Especially when the prices of all needed supplies will go up at the first hint of trouble.

        I can count the honest and ethical national newspeople on one hand and still have one finger left for the rest.

        by OHdog on Sun Mar 16, 2008 at 07:07:38 AM PDT

        [ Parent ]

        •  In a pandemic situation, the good news (2+ / 0-)
          Recommended by:
          ladybug53, OHdog

          is that you won't have to buy gasoline. All other supplies, not so good. I understand that with food prices rising, it is hard to stockpile, if you are already living week-to-week. Check weekly sales at groceries to stock up on canned goods, flour, other staples (including paper goods). Get what you can afford when it is relatively cheap.

          Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

          by riverlover on Sun Mar 16, 2008 at 07:43:21 AM PDT

          [ Parent ]

        •  that is the purpose of stockpiling now (2+ / 0-)
          Recommended by:
          ladybug53, mcmom

          and not waiting until then. Arguments as to whether 2 weeks is enough, but I am not getting into that. 2 weeks will allow you to stay home and care for an ill relative without having to leave and scrounge for supplies and possibly spread virus.

          At FW, we have plenty of advice on how to do it on bare bones paychecks. Some of our contributors are pretty frugal with a penny. But the answer is do what you can.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 16, 2008 at 07:44:01 AM PDT

          [ Parent ]

        •  here's some examples (2+ / 0-)
          Recommended by:
          ladybug53, mcmom

          We are all trying to stretch our prep dollars as far as they will go. Let's all keep an eye on sales and pass along those that are of more than just local interest. Let us know what you are doing in the way of prepping. It may be something that many of us need to buy or work on.

          http://www.newfluwiki2.com/...

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 16, 2008 at 07:52:23 AM PDT

          [ Parent ]

          •  The Mormon church is prepared. (2+ / 0-)
            Recommended by:
            elfling, ladybug53

            They have vast storages of food and supplies, originally begun to help their own members survive personal hard times. They used to have farms, where everyone was expected to work. Each family was also supposed to have stockpiles of food on hand. When we bought our home from a Mormon family thirty years ago, one room, which became our den, was filled with food and other supplies.

            "This is not our America and we need to take it back." John Edwards.

            by mcmom on Sun Mar 16, 2008 at 10:43:47 AM PDT

            [ Parent ]

  •  When it comes to a highly infectious disease... (4+ / 0-)
    Recommended by:
    elfling, the fan man, mcmom, mommyof3

    ...such as influenza - which is spread by viruses attached to respiratory droplets from coughing/sneezing, nasal secretions, saliva - and goes from person to person so easily and quickly, public health measures such as prohibition of gathering of large groups of people, closing schools, isolation of infected people and their immediate associates from the general population and ultimately quarantine - have proven more effective than pharmaceutical interventions.
     Smallpox was eradicated with a combination of isolation/quarantine and timely vaccination - but smallpox virus doesn't mutate like influenza, so vaccination helped to contain the disease.  Smallpox also has a longer infectious period and a higher mortality rate than influenza.
     Anyone remember public swimming pools closing during the 50's in response to polio epidemics?  That is a public health measure that may or may not have been effective, but any way you can avoid one infected person coming into contact with a large number of uninfected, non-immune people is a cardinal measure of controlling an outbreak.
     I could go on and on about public health measures (and home care of the sick), but I won't right now.

    In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

    by drchelo on Sun Mar 16, 2008 at 06:44:59 AM PDT

    •  no, you should! (3+ / 0-)
      Recommended by:
      mcmom, mommyof3, drchelo

      I could go on and on about public health measures (and home care of the sick), but I won't right now.

      it's a wonderful topic, but alas "necessary"  does not = "easy to implement".

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 07:05:11 AM PDT

      [ Parent ]

    •  My parents prohibited us from using (0+ / 0-)

      public swimming pools in Portland after July. For some reason, August was the month that was "dangerous" for contracting polio. Oddly, Idaho was one of the states hardest hit for polio outbreaks. Unfortunately, it was a state that received live vaccine in many areas, and cases of polio increased, of course.

      "This is not our America and we need to take it back." John Edwards.

      by mcmom on Sun Mar 16, 2008 at 10:47:26 AM PDT

      [ Parent ]

  •  Why are you still wasting time on this non-issue (0+ / 0-)

    Pandemic flu is yet another hype-fest used by the public health bureucracracies and pharma to scare the heck out of people with misinformation in order to steal. DemfromCT why you can't see that is beyond me. On other topics you seem like a perfectly rational person. It is the exact same tactic that the Bush asministration uses time and again to distract the public, steal our civil liberties and our treasure at the same time.

    And why anyone on this list would accept anything uttered by Julie Gerberding as anything other than propaganda is beyond me. Just in the past couple months the CDC and Gerberding lied about the safety of the FEMA trailers, health aspects of global warming, pollution in the great lakes and the Hannah Poling case where a girl was awarded damages because her autism was caused by vaccines. Yet you want to associate yourself with this detestable GOP hack?

    We have real epidemics to contend with that are being completely ignored, juvenile diabetes, autism, juvenile rheutmatism, asthma. Why so much concern about a demonstrably fictional problem and nothing about real epidemics that are destroying hundreds of thousands of childrens' lives.

    •  right (3+ / 0-)
      Recommended by:
      ladybug53, mcmom, redsquareblack

      the rest of the country is deeply involved in preparation and non-partisan professionals at every level (local, state and federal) remain concerned that we are not ready, that our health system cannot take care of the consequences of any major natural catastrophe.

      Understand though, that preparing for pandemic prepares for anything and everything that stresses the system in a big way.

      But what I love is that in disagreeing, you have to be nasty and lash out. What's up with that? Do you know how to discuss issues without personalizing the discussion?

      As for CDC, it's a far bigger and more important organization than any director and will be here long after this one is gone.

      As for other issues, that they are important doesn't make this one any less so.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 07:16:41 AM PDT

      [ Parent ]

    •  Flu is different (6+ / 0-)

      A novel new flu can, potentially, will kill tens if not hundreds of millions in a very short period of time (1 to 2 years). Compare that to AIDS, millions affected over several decades, and you can appreciate why a flu pandemic would be different.

      Flu pandemics occur with a frequency of about 3 every century. In the last 90 years, we had three, one of which, the "Spanish Flu", killed tens of millions. The last flu pandemic occured in the late 1960's (a mild pandemic) and we are due for our next. Will it be another "Spanish Flu" or a milder flu? We just don't know.

      In the early 1990's, a novel new strain, H5N1, a highly pathogenic flu, crossed the species barrier and started killing people. People may not live with poultry in the developed world but people do live with poulty in many parts of the world and people do indeed get infected by their livestock.

      When a virus replicates, it often errs in that replication and virii will drift/shift (like seasonal flu), or, if you will, change over time. It is entirely possible that these changes result in a virus that is more immediately transmissible between humans, as it "adapts" to its new host. A simple change, such as being able to replicate at a lower temperature, might be enough to allow it to move into a mamalian host (e.g. humans). This is what happened with SARS. A disease of bats that, for whatever reason, became transmissible among other mammals such as civet cats and humans.

      There have been instances when H5N1 has not only been transmitted between birds and humans but there has been occasions when it transmitted from person to person. That is definitely cause for concern.

      Flu will hit fast and will hit hard. Everyone and everything will be affected almost simultaneously. If that novel flu just so happens to be H5N1, an influenza strain that has an astonishingly high case fatality rate, then you can appreciate the gravity of the problem.

    •  Oh, my. (1+ / 0-)
      Recommended by:
      mcmom

      You guys get anti-vaxers here, too?

      You obviously didn't read the decision in the Poling case, did you, Autismepidemic?

    •  DarkSyde has not stated that there (0+ / 0-)

      are not other issues of health that are more important, just presented information. No need to get hostile. Information is information, whether or not you wish to use it is a personal choice. You have over-reacted by making his diary personal.

      "This is not our America and we need to take it back." John Edwards.

      by mcmom on Sun Mar 16, 2008 at 10:50:23 AM PDT

      [ Parent ]

    •  Absolutely! 20 recs for you! (0+ / 0-)
  •  RISK MISPERCEPTION- CDC IS CULPABLE! (0+ / 0-)

    The big story about Bird Flu (H5N1) is that we have spent perhaps billions on this single organism that is NOT likely EVER to cause a pandemic in humans.

    The big story on seasonal flu is that the statistics on annual fatalities that the CDC releases represents mostly the frail elderly who are about to die anyway.

    IN MY OPININION FEARMONGERING ABOUT THE FLU (pandemic or seasonal) IS THE BIOLOGICAL EQUIVALENT OF THE FALSEHOODS ABOUT WMD.THE CDC IS CULPABLE.

    You want some very real worldwide epidemics?
    Try malaria and tuberculosis. You want a few real US epidemics? Try obesity and mental illness in all ages.

    We cannot afford to continue to grossly misperceive risks. We continue to do so with Flu at our peril.

    Dr. Rick Lippin
    Southampton, Pa  

    •  If not this flu strain, some pandemic will (0+ / 0-)

      decimate our health system and the probability that it will be some flu strain is high. If your Dr. indicates that you are a physician, you should know better. And your light acceptance of flu deaths among the elderly makes me hope that, if you are a physician, your elderly patients will find another doctor as soon as possible.

      I can count the honest and ethical national newspeople on one hand and still have one finger left for the rest.

      by OHdog on Sun Mar 16, 2008 at 07:01:06 AM PDT

      [ Parent ]

      •  WE NEED TO FOCUS ON REAL RISKS (0+ / 0-)

        OHDog

        Yes I am an MD

        I guess you believed in WMDs as a reason to go to war?

        Re- older patients- I teach a course in Death and Dying. I believe Hospice is a rare good aspect of contemporary American Medicine. Do you really believe that the frail and dying elderly need us to focus on the flu?

        Get real. Get compassionate.We need to spend our resources wisely.

        Dr. Rick Lippin

        •  being an MD does not make you any wiser (2+ / 0-)
          Recommended by:
          mcmom, A Simple Man

          than anyone else

          WHO, CDC, virologists and epidemiologists all accept the risk is real and like a cat 5 hurricane is phenomenally high impact, far more so than other entities (assume not that it is H5, could be any other novel flu, but a pandemic is eventual and inevitable).

          And it's not just the public heath people, it's also economists, businesses and hospitals.

          On this one, you're just flat out wrong. But being an MD does not make one infallible. Trust me on that. ;-)

          Anyway, nice article here, very balanced. Note that even the skeptics support planning:

          Prof Ferguson, who is also a professor of mathematical biology at Imperial College, London, said, "The risk of a pandemic has been hyped, in the sense that many people believe that it is imminent – I don’t think it is.

          "A pandemic is a one-in-30- year event, but just because we haven’t had one for 30 years, doesn’t mean that we are due one.

          "It could happen next year, but my own evaluation is that this is a low-probability event, with a one in 200 or a one in 100 chance of H5N1.

          "But it could be so lethal, given that the virus kills so many birds, that the possibility of having a catastrophic pandemic means that we should be preparing for it and putting resources into it. We should be making those preparations reasonably urgently.

          "I have been a little concerned about some points of the preparedness plan – last year it was starting to slip down the agenda.

          "I’m very pleased that the Government has this year announced a doubling of antiviral drug stocks.

          "Pandemic flu is one of the top five priorities for the NHS, although it is not going to be in the top five of spending, but the Government is still taking the plans seriously."

          Cheers.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 16, 2008 at 07:36:06 AM PDT

          [ Parent ]

          •  READ MARC SIEGEL'S BOOKS (0+ / 0-)

            Dr. Marc Siegel wrote two books-

            "False Alarm" and "Bird Flu"

            Read them and get back to me OK?

            Yes I am an MD but as a citizen-scientist

            - I read a lot - I teach a course at the University level on Risk Perception

            Rick Lippin

            •  great (1+ / 0-)
              Recommended by:
              drchelo

              You're still wrong and so is Marc, who was more concerned about a panic that never happened than emphasizing preparedness. Here's more helpful data from Monica Schoch-Spana, PhD (UPMC) about what to realistically expect from the public; it's far superior to Marc's stuff.

              Risk perception and risk communication are related but not the same. You need to pay more attention to the latter.

              Cheers

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Mar 16, 2008 at 08:27:33 AM PDT

              [ Parent ]

              •  It Starts With Risk Perception (1+ / 0-)
                Recommended by:
                DemFromCT

                DemFromCt

                It all starts with Risk Perception

                If we don't perceive risks properly we communicate THE WRONG RISKS

                Rick Lippin

                PS- Reveal yourself? Blog handles are for the cowardly.

                •  heh (2+ / 0-)
                  Recommended by:
                  Plutonium Page, mcmom

                  the "about" page is for professors.

                  "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                  by Greg Dworkin on Sun Mar 16, 2008 at 08:50:12 AM PDT

                  [ Parent ]

                •  Might I ask what's so brave... (1+ / 0-)
                  Recommended by:
                  elfling

                  about telling people that you're Rick Lippin?

                  What the hell does that tell anyone?

                  Rick Lippin?! THE Rick Lippin?! My stars!

                  •  BLOG HANDLES ARE FOR COWARDS (0+ / 0-)

                    I may not be brave but my name stands by my words

                    Rick Lippin

                    •  You are a funny guy (2+ / 0-)
                      Recommended by:
                      Spathiphyllum, mcmom

                      Dude, before you embarrass yourself any more, click here.

                      And then get back to us about this "coward" thing.

                      •  Now It All Makes Sense (0+ / 0-)

                        Thanks Kos for telling me who your poster was. Dr Dworkin is heavily invested intellectually in promoting the "inevitabilty of a bird flu pandemic". Witness his website!

                        He is an internist who specializes in pediatric pulmonary disease.

                        But nevertheless he is wrong.

                        I happen to be board certified in Preventive Medicine but more importantly I teach RISK PERCEPTION at the University level

                        Dr Marc Siegel just let me know the following

                        "In 2006 an AP IPSOS poll found that more than 50 percent of americans thought they would have bird flu within the year. Sounds like an overreaction to me"

                        Didn't happen just like WMDs wren't there

                        Be Well,

                        Dr. Rick Lippin
                        Southampton,Pa

                        •  PS- A Concurrence from Dr. Susan Parenti (0+ / 0-)

                          Thank you, Rick. Very useful analysis.

                          The "flu-mongering" (as I call it) is a useful smokescreen to hide malaria and tuberculosis epidemics, epidemics that are a consequence of
                          of the poverty that structural violences breeds. (read Paul Farmer's Pathologies of Power).  Structural violence, and poverty, are preventable , by people, now. But those epidemics are outside our country, happening to brown-skinned people, so--who knows about it, thus, who can care? (thank you US Mass Media).

                          The same mechanisms that breed structural violence outside our country, breed mental illness and obesity inside our country: the loss of the middleclass (read The Squandering of America by Robert Kuttner), the stress that comes from gross disparities of income and privilege (the work of Steven Bezruchka in Seattle, and others), the fastfood industry that caters to the poor in our country.

                          "Flu-mongering" picks up on the same kind of 'I'm white, I'm right, the world is my global marketplace" mentality that the terrorism propaganda of the neocons have been using so effectively. So people are made to think about this as a continuum of the terrorism hysteria. (Shock, by Naomi Klein).

                          OK, lots of big sentences from me.

                          Patch Adams MD and John Glick MD, with a troop of college students wanting to spend their spring break holding AIDS babies for hours,  have just returned from 2 weeks in Haiti, bringing clowning and supplies to the people there. Tuberculosis, malaria, AIDS---and those on top of manutrition and daily violence in the streets. And hopelessness. Complete hopelessness.

                          Dr.Susan Parenti, School for Designing a Society, Gesundheit Institute

                        •  It all made sense before. (1+ / 0-)
                          Recommended by:
                          Spathiphyllum

                          You just didn't know enough about how blogs work to figure it out, Doc.

                        •  I'm a pediatrician and pediatric pulmonologist (1+ / 0-)
                          Recommended by:
                          Spathiphyllum

                          and Marc's the internist.

                          but don't go by me... there's tons of authorities and experts that agree with me that pandemics are inevitable and need to be prepared for. And I don't promote inevitability of H5N1 nor do I charge exorbitant speaker fees nor try to sell sell books like Siegel.

                          So get your facts straight. Marc's right on the poll results (and in fact, here's a better one):

                          the medical experts saw about a 15% chance of efficient human-to-human transmission, in the next three years. Should it occur, they saw almost no chance of there being adequate vaccines or antiviral responses. They saw varying chances of six other mitigation strategies reducing the threat, expressing the greatest faith in improved surveillance. Compared to the medical experts, the non-medical experts saw much higher chances of both human-to-human transmission and the availability of vaccines and antiviral responses. The medical experts and the non-medical experts had similar, dire predictions for the extent of casualties, should transmission occur in the next three years. Their responses to open-ended questions revealed some of the theories underlying these beliefs.

                          OTOH, your sloppy work is not persuasive, and your comment that 'it hasn't happened yet' is just stupid, as in 'not intelligent'. it doesn't fit anything that we have been saying because no one is predicting when. That's hardly surprising that you don't know that, because you haven't done your homework.

                          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                          by Greg Dworkin on Sun Mar 16, 2008 at 11:25:27 AM PDT

                          [ Parent ]

                          •  Dr Dworkin - Respond to Dr. Parenti Comment? (0+ / 0-)

                            Thanks

                            Rick Lippin

                          •  I think she and everyone (2+ / 0-)
                            Recommended by:
                            elfling, Spathiphyllum

                            who works on those issues does great work and should be commended. I disagree that we are using it to 'hide' issues like malaria and tuberculosis, any more than when we talk about the US health care crisis we are somehow ignoring poverty overseas. These are true and loosely related things.

                            But as I'm sure Dr. Adams and Dr. Parenti are well aware, should H5N1 never move to humans, it's still a disaster for the third world as poor cultures are asked to literally bury their food to stop spread. And in cultures where women can own poultry and little else, another layer of disaster. Finally, as I'm sure Dr. Parenti is aware, any pandemic will hit poor countries hardest (subscription required for Lancet). If she were more familiar with Indonesia, she might look at it differently, or she might still feel the same.

                            I always find 'my issue is more important than yours' discussions distasteful. there are a lot of things that are important, and there are a lot of ways to make the world better. What's also important is that you pick an issue and work on it, instead of ignoring everything, so once again, kudos for those activists who do the work.

                            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                            by Greg Dworkin on Sun Mar 16, 2008 at 11:45:57 AM PDT

                            [ Parent ]

                          •  Thanks For Looking at The Parenti Argument (0+ / 0-)

                            Rick Lippin

                          •  oh, and by the way (0+ / 0-)

                            Save the Children agrees. They link Flu Wiki. And so does the American Academy of Pediatrics.

                            I am proud to be in their good company.

                            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                            by Greg Dworkin on Sun Mar 16, 2008 at 11:57:39 AM PDT

                            [ Parent ]

                          •  Defending Marc Siegel....... (0+ / 0-)

                            ....Who have always said we should rationally prepare for a pandemic someday.What was a monumental scientific blunder was the focus on a single organism (H5N1)until recently when saner voices like Siegel's prevailed.

                            Furthermore Marc Siegel does not charge exhorbitant speaking fees nor does he only promote his good books.

                            WE DO KNOW THAT HYSTERIA SELLS IN THE MEDIA. So those who were incorrectly predicting imminent biological calamity could be challenged for possible economic motives.There are many vested interests. Some of them are unfortunately unsavory.

                            Dr.Rick Lippin

                        •  A lot of twits teach at the University level (0+ / 0-)

                          Love and kisses,

                          smintheus
                          Lowhill, Pa

                    •  no need to capitalize (0+ / 0-)

                      This, of course, reflects a deep divide in e.g., the library sciences community over content vs credentials,  covered at length in this post, and a fascinating topic.

                      And if you think risk assessment profs are curmudgeonly, you should try library science profs! ;-P

                      You really should learn how to click links, though. Start with the About page before you continue with this 'cowardly' stuff that just makes you look foolish or lazy.

                      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                      by Greg Dworkin on Sun Mar 16, 2008 at 09:32:39 AM PDT

                      [ Parent ]

                    •  I stand by mine, too. (0+ / 0-)

                      But I don't make stupid assumptions like, "People know and/or give a shit who Rick Lippin is."

                      My name, like DemFromCT's, is openly available on our "About" page. Now that you know this and can look up my name, I'm sure you feel completely different about how I told you you're an asshole.

                      What are my qualifications for making this determination?

                      I have eyes.

                      •  I've Won When I Can Get You To Lose It! (0+ / 0-)

                        Kangro X

                        By your "intelligent comment" calling me "an asshole" you have revealed enough of yourself rendering you an unworthy uncivil adversary

                        No I will not bother to look up you name.

                        Rick Lippin

                        •  Yeah, I really lost it. (0+ / 0-)

                          I've seen this same Geezer Myopia a thousand times before, Doc. Same shit, different day. Don't flatter yourself (though that appears to be your favorite pastime).

                          You made me lose it... At The University Level! Aiieee! Please! Make the Brain Power stop! It's overwhelming me!

                          University! Do you hear me! I said University!

                          Yawn.

                          And you wouldn't be able to look up my name if you wanted to, Professor. You couldn't even spell my fake one right, even though it's right in front of you.

                          Uncivil? You bet. Out of your league adversary-wise? Oh, hell yeah.

                          •  Criticising Typos (0+ / 0-)

                            Kagro X

                            Your stooping to criticising minor typos is yet another indicator of your not debating a good issue on its merits. But rather when you are beaten you default to personal attacks.Very sad indeed.

                            Please spare me.

                            Rick Lippin  

                          •  It's not stooping. (0+ / 0-)

                            Your stupidity and online stumbling rises to a level at which one need hardly stoop to poke fun at you.

                            You came here to show us all how smart you were, Doc. Being stupid while doing it is too big of a target to let slide.

                            I'm not debating the flu with you, Doc. I'm debating your online idiocy, and the ancient prejudice you harbor which makes you insist on trading business cards and CVs before you'll deign to talk to anyone.

                            So when the issue is your competence to converse online and in writing, typos and technical illiteracy are very much the issue.

                            Your stooping to trying to obfuscate the issue at hand with me is yet another indicator of your not debating a good issue on its merits. But rather when you are beaten you default to personal attacks. Very sad indeed.

                            Please spare us all.

                            At the university level, if you please.

                          •  Minor Typos Are Hardly Stupid (0+ / 0-)

                            ...calling someone an asshole for no good reason is

                            Rick Lippin

                          •  Oh, but I had a great reason! (0+ / 0-)

                            You and your credentialist bullshit. There's no better reason in the world, Professor!

                          •  Kagro X ..... (0+ / 0-)

                            ....has revealed himself on this thread to "get off" on foul language and personal attacks

                            Very sad we have to put up with this

                            Rick Lippin

                          •  Oh my! (0+ / 0-)

                            Please, won't someone think of the university level children!

                            Yes, you'll have to put up with it, Professor. You're not in your classroom anymore, pally.

                            Isn't it amazing how your clubby little measures of power don't help you when you step outside the Ivory Tower?

                            You can't grade me, Doc. You're gonna either have to fight it out on blog terms, or pack it in.

                            F. See me.  :-(

            •  PS (0+ / 0-)

              I argue with cervantes on this issue, too ;-)

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Mar 16, 2008 at 08:32:13 AM PDT

              [ Parent ]

            •  The odds of a space shuttle blowing up (0+ / 0-)

              Are also only about 1/100.

              Fry, don't be a hero! It's not covered by our health plan!

              by elfling on Sun Mar 16, 2008 at 10:25:23 AM PDT

              [ Parent ]

            •   dr lippin --> read laurie garrett (0+ / 0-)

              the coming plague
              or
              betrayal of trust

              while i have no idea your credentials, i am aware of the peabody and polk (twice) and pulitzer prizes that have been awarded ms. garrett for her works.

              have at either of these books.  then get back to me, ok?

              _________________________________

              "Is leor nod don eolach."

              -9.75 (economic), -7.18 (social)

              by dadanation on Sun Mar 16, 2008 at 10:29:17 AM PDT

              [ Parent ]

    •  I couldn't disagree more (3+ / 0-)
      Recommended by:
      elfling, dadanation, drchelo

      Investments in our crumbling public health infrastructure (which is what this is) and basic science (which is also what this is) are never wasted.

      That doesn't mean to say other things are not important. CDC and WHO and public health can and must multi-task. But malaria (we covered that here) and tuberculosis (which had plenty of lessons learned for CDC regarding Andrew Speaker) are different issues and not today's topic.

      The cooperation and communication between local, state and feds that pandemic prep is driving is actually fairly unprecedented in my professional life. It's a good thing that will serve communities well.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 07:26:42 AM PDT

      [ Parent ]

    •  It hardly matters if it is flu or some other (0+ / 0-)

      virus.

      The fact is that we need to have a plan in place for handling a huge medical emergency. A highly transmissible disease is one scenario (need not be flu). On a regional level, some of the same plans will be useful for local disasters, like earthquakes.

      The flu HAS caused pandemics in humans in the past.

      But, if not flu, there are plenty of other viruses that could have a similar effect with just small changes. Imagine if a disease like Marburg had a 1 week incubation period.

      The money is not being spent on H5N1. It is being spent on general disaster preparedness, with this virus being a particularly timely example. It will be well-spent even if H5N1 never breaks out.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Sun Mar 16, 2008 at 10:23:19 AM PDT

      [ Parent ]

    •  Again, this is INFORMATION. (0+ / 0-)

      DarkSyde has not said a flu pandemic is the number one health issue in the world, let alone the US. And, one would have to be blind of deaf not to know that obesity has reached epidemic status. It is all over media. Just talk to your family physician. Ours is very concerned about the rise in type 2 diabetes, even among his own patients, some of whom are children. As for mental illness, I agree we seem to have medieval notions about prevention and treatment, and few resources are available for treatment covered by insurance.

      "This is not our America and we need to take it back." John Edwards.

      by mcmom on Sun Mar 16, 2008 at 10:56:42 AM PDT

      [ Parent ]

  •  Wow, who would have guessed such an (6+ / 0-)

    interesting and important diary would bring out such anger! Whether H5N1 ever mutates to cause a pandemic is only part of the issue. The issue is how prepared we are to respond to a contagious and deadly disease. There will be a flu pandemic, when is unknown. It can potentially kill millions, quickly. Mitigating the loss of life is the point.

    you think you're so clever and classless and free, but you're still fucking peasants as far as I can see- J L

    by the fan man on Sun Mar 16, 2008 at 07:05:57 AM PDT

  •  just a quick typo fix (1+ / 0-)
    Recommended by:
    DemFromCT

    lynch pin in the community mitigation strategy

    Linch pin, dude.  A lynch pin would be... well, something not very nice, I imagine.

    You can't tame the white supremacist power structure with cheese!

    by andlorr on Sun Mar 16, 2008 at 07:25:27 AM PDT

  •  My school division did a census... (3+ / 0-)
    Recommended by:
    DemFromCT, the fan man, drchelo

    of computers available with internet in homes in case of an epidemic, to see if there would be a way to hold classes that way if schools were closed. Unfortunately, it's too spotty to use with any sense of fairness (we have families who don't have a telephone consistently, much less a computer)... but it's a start in preparation.

    Our country can survive war, disease, and poverty... what it cannot do without is justice.

    by mommyof3 on Sun Mar 16, 2008 at 07:25:35 AM PDT

  •  The concept of "public health".. (4+ / 0-)
    Recommended by:
    DemFromCT, elfling, the fan man, mommyof3

    ..measures versus "personal health" involves a completely different approach.
     Your personal physician, approaching one patient (or collectively, that patient's family as well) must, by our oath, "first do no harm" and do everything possible to address the health concerns and measures needed to bring that one person back to health.
     When dealing with a population, the focus becomes not the individual, but the health of the group.  Measures taken to take care of ONE person do not apply in this situation.
     The concept of triage - common in emergency rooms and military hospitals - seems callous to many people; simply put, those who are the most likely to die right away are not treated with the same urgency and immediacy as those who are likely to survive aggressive intervention.  This fact of rationing of care has been around ever since humans started killing each other, and is a very necessary way of dealing with limited resources when faced with overwhelming numbers.
     An epidemic is just that - overwhelming numbers of sick people, and measures must be taken to preserve the largest number of people, given limited resources.  The elderly or the very young are more likely to die from influenza - that does not necessarily mean that they will be purposely ignored to death.  
     Please don't let your anger towards doctors, the CDC, government in general or Big Pharma prevent you from even thinking about the possibility that uncomfortable measures such as isolation, quarantine, and triage may have to be used in the face of an overwhelming number of sick people.

    In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

    by drchelo on Sun Mar 16, 2008 at 07:28:26 AM PDT

    •  Ca is implementing new health disaster plan (1+ / 0-)
      Recommended by:
      drchelo

      which they hope will spread across the country;

      treat only people who are most likely to survive;

      I will have to round up the URL for articles about it;

      First of all if Hillary can't get more than 55% of the primary voters running against "uncommitted" she should probably rethink her viability in Michigan.

      by pollwatch on Sun Mar 16, 2008 at 07:35:46 AM PDT

      [ Parent ]

    •  thank you!!! n/t (1+ / 0-)
      Recommended by:
      drchelo

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 07:49:00 AM PDT

      [ Parent ]

  •  speed of info given to public helped (2+ / 0-)
    Recommended by:
    elfling, drchelo

    long time ago I lived in an area that was hit with Hanta virus; in the morning cough and fever by afternoon suffocating and death; very dangerous infection the key was immediately ( even if think trip to hospital/doctor is waste of time ) get to medical facility let them diagnosis - - it is a matter of speed; it was only after the public was warned about the speed which Hanta virus killed that the public learned not to wait even if it meant a day off work and medical cost for something that turned out to be simple cold;

    the public health department geared up to do the work it needed to coordinate itself and take measures it needed to stamp it out vector was infected rodents; winter short and warm brought early spring the mice population exploded carrying Hanta virus to households from remote rural area which was the point of origin;

    First of all if Hillary can't get more than 55% of the primary voters running against "uncommitted" she should probably rethink her viability in Michigan.

    by pollwatch on Sun Mar 16, 2008 at 07:38:57 AM PDT

  •  I have had some peripheral (2+ / 0-)
    Recommended by:
    DemFromCT, elfling

    experience/reading on this since I worked on a bioterrorism project. Its truly scary how our lousy medical system makes disaster more likely.

    First: Any scenario that starts with  an uninsured person or a person without access to a regular doctor already pushes diagnosis farther down the road than it should be--and thus pushes the number of possibly infected people who encounter "patient X" into higher numbers and more dispersed locations.

    Second: primary care physicians aren't necessarily well integrated with hospitals and often don't see patients at all until things are quite far along, so the lines of quick communication don't get activated.

    Third: emergency room care is quickly overwhelmed and not set up for handling a massive flow of patients who also need to be decontaminated.

    Fourth: well, imagine for yourself.

    A national health care system with a lot of local clinics who were networked to each other so that key cases could be flagged early would be key to figuring out that we needed to start one of the big scenarios up above. As long as we distinguish between legal and illegal residents in terms of health care we are already losing the battle to locate, isolate, and quarantine before a pandemic starts.

    aimai

  •  Recent "pandemic"? (2+ / 0-)
    Recommended by:
    elfling, mcmom

    I realize there's a specific definition for things like pandemic and epidemic, so please forgive me if I confuse them.

    That said, we see all these reports for months and months about the coming flu epidemic, and yet when one seems to hit, not a peep is heard from the media.

    For about 3 weeks, pretty much everyone I knew was sick. Most were having high fevers, several almost wound up in the emergency room. It started as a sore throat and coughing and turned into spending a week in bed trying not to vomit. My personal network isn't that large, and I know at least 20 people from all over my state who had this. I was thankfully lucky enough/smart enough to avoid it.

    If that's not a pandemic/epidemic/everyone is sick crisis, I don't know what is. Yet why didn't I see a single news report on the flu __demic in Illinois? Why did no one say anything?

    Undecided in Illinois. Help?

    by sunflwrmoonbeam on Sun Mar 16, 2008 at 07:53:19 AM PDT

    •  media coverage is spotty at best (1+ / 0-)
      Recommended by:
      mcmom

      a topic we are all too familiar with.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 08:05:39 AM PDT

      [ Parent ]

    •  Was their local or state media coverage? (1+ / 0-)
      Recommended by:
      WayneNight

      Even in Boise, there are reports if several children of any school get sick, and classes are suspended for up to a week. This is common practice, and I suspect the Superintendents would react the same, all over the state, if an epidemic were identified. We are a small state in population, so perhaps it would be easier to manage than in a large metropolitan area, even though we have a chronic shortage of medical personnel in rural areas.

      "This is not our America and we need to take it back." John Edwards.

      by mcmom on Sun Mar 16, 2008 at 11:39:05 AM PDT

      [ Parent ]

      •  Wow. I can't remember ever... (1+ / 0-)
        Recommended by:
        mcmom

        ...having my schools closed for an entire week because of a spreading illness.  And I was in school not all that long ago (I graduated from HS in 2001).

        The sad thing is, as long as I wasn't sick myself, I probably would have been happy to have a "creeping cruds" vacation, instead of being appropriately concerned over the implications.

      •  Not that I saw (0+ / 0-)

        but I don't pay close attention to local news. Also, this was at about the same time as the NIU shootings.

        Undecided in Illinois. Help?

        by sunflwrmoonbeam on Sun Mar 16, 2008 at 03:45:13 PM PDT

        [ Parent ]

  •  Ithaca now has two meningitis cases in college (1+ / 0-)
    Recommended by:
    mcmom

    students, and a student at a University N of here died Friday, without even being hospitalized. Cornell and Ithaca public health officials seem to be on top of it, offering students who had contact with the ill students immunization and/or antibiotics. A list of 3 parties (drinking type) with addresses were given to reach as many of the potentially exposed as possible. It might be spring break now, unfortunately. But this does count as a mini-practice for an infectious agent entering a susceptible population.

    BTW, DemfromCT, what happened with the annual flu vaccine this year? Was that a drift or a recombinational shift, and what is the current strain circulating that is making us vaccinates ill?

    Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

    by riverlover on Sun Mar 16, 2008 at 07:53:33 AM PDT

    •  it's H1N1 and H3N2 brisbane-like strains (1+ / 0-)
      Recommended by:
      drchelo

      that doesn't match well with the previously selected H3N2 and H1N1, so the vaccine only seems to be about 40% effective this year.

      Composition of the 2008-09 Influenza Vaccine:

      WHO and FDA have recommended that the 2008-09 trivalent influenza vaccine for the Northern Hemisphere contain A/Brisbane/59/2007-like (H1N1), A/Brisbane/10/2007-like (H3N2), and B/Florida/4/2006-like viruses. All three components have been changed from the 2007-08 Northern Hemisphere vaccine formulation. A/Brisbane/10/2007-like (H3N2) and B/Florida/4/2006-like viruses are currently included in the 2008 Southern Hemisphere vaccines. This recommendation was based on surveillance data related to epidemiology and antigenic characteristics, serological responses to 2007-08 vaccines, and the availability of candidate strains and reagents.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 08:04:31 AM PDT

      [ Parent ]

    •  From what I understand (0+ / 0-)

      there are something like 150+ strains of flu.  Every year the Powers That Be have to make an educated guess as to what 2 or 3 types are likely to hit.  Then they develop a vaccine for those.

      This year they guessed wrong.

      And we all get to enjoy the results.
      Pepto-Bismol anyone?

      "It is not depravity that afflicts the human race so much as a general lack of intelligence."--Agnes Repplier

      by faction on Sun Mar 16, 2008 at 11:06:36 AM PDT

      [ Parent ]

  •  The weakness of local control (2+ / 0-)
    Recommended by:
    DemFromCT, mcmom

    One of the weaknesses of our federal system in a disaster is the many layers of local government make transmitting information and implementing plans like a game of telephone. I don't know what the solution -- there has to be some middle ground between Hawaii not implementing procedures because of concerns about tourism and the US military declaring martial law implementing quarantines.

    We have an Underpants Gnomes method of executing during  a crisis.

    1)We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

    2)The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

    3)domestic disaster

    4)????

    5)Remain calm. All is well!

  •  new CA state guidelines (2+ / 0-)
    Recommended by:
    DemFromCT, WayneNight

    http://www.sacbee.com/...

    In a massive disaster, care will be scarce
    State guidelines lay framework for deliberately letting some people die.

    March 2, 2008

    First of all if Hillary can't get more than 55% of the primary voters running against "uncommitted" she should probably rethink her viability in Michigan.

    by pollwatch on Sun Mar 16, 2008 at 08:01:59 AM PDT

  •  I work for a health care company (3+ / 0-)
    Recommended by:
    mcmom, WayneNight, sunflwrmoonbeam

    They push flu shots HARD for all employees since it is one of the things they make buku money from (I have no doubt that there is an altruistic motive there too.......they're pretty decent for a large corporation).

    I myself have an idiosyncracy/phobia/whatever. I will NOT take a flu shot. When I was in the Air Force in the mid-1970s, the big Swine Flu flap was going on at that time. The Air Force experimented upon us peons. They REQUIRED us (no waivers allowed)to get their experimental swine flu shots in two successive years. The first year I was stationed in California - got so VERY ill from the shot that I showed up for the class I was attending and the instructor sent me home - he was very concerned about me and told me later that he considered calling emergency medical personnel.

    The next year I was stationed in Germany - I BEGGED - and I do mean BEGGED for a waiver from this vaccine, considering how deathly ill I had been the year before..........I was told no waivers were allowed from taking the shot..........so I took it and told my first Sergeant that if I didn't show up for work in the next week, I was probably sick. He kinda sorta didn't believe me about how bad it had been, but he was sympathetic.

    I got absolutely DEATHLY ill............too sick to even drag myself out of bed to a phone.......and it being Germany, and the dollar being strong at the time, I had an off-base apartment, in which I lived alone, so no roommates to go make the call for me.

    I think I almost died, I was that ill. I was technically AWOL for almost a week, but my bosses never did anything to punish me for it. I think they were embarrassed because they didn't stick up for me when I begged them to.

    As a result, I will NOT take flu shots of any kind - and every time this thing comes around every year in my company I get all kinds of flack about it. Screw that. I don't care. I in my travels have been exposed to every flu strain there is, and now I never get the flu any more. Although every time I get a simple head cold I have my coworkers going "you shoulda taken that flu shot".

    F that. Not gonna do it, and I don't even care if that's a counterproductive attitude. I get so sick of being MARKETED to. Take away from that what you will.

    Observers say Castro will be replaced either by his brother Raul or his idiot son, Fidel W. Castro - Letterman, via Bartcop

    by Rosebuddear on Sun Mar 16, 2008 at 08:14:17 AM PDT

    •  I take away that you won't be getting flu shots (2+ / 0-)
      Recommended by:
      mcmom, Rosebuddear

      but you might consider the nasal flu spray.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Mar 16, 2008 at 08:19:35 AM PDT

      [ Parent ]

      •  Well haha maybe so (1+ / 0-)
        Recommended by:
        DemFromCT

        but I never get the flu, so maybe not.

        Great diary by the way. I found it very interesting and informative.

        Observers say Castro will be replaced either by his brother Raul or his idiot son, Fidel W. Castro - Letterman, via Bartcop

        by Rosebuddear on Sun Mar 16, 2008 at 08:21:27 AM PDT

        [ Parent ]

        •  it does emphasize (3+ / 0-)
          Recommended by:
          mcmom, drchelo, Rosebuddear

          the non-pharmaceutical approaches ;-)

          After all, in a real pandemic there likely won't be any shots for ayone for around 6 months.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Mar 16, 2008 at 08:29:13 AM PDT

          [ Parent ]

          •  you're certainly right about that (1+ / 0-)
            Recommended by:
            sunflwrmoonbeam

            "Non-pharmaceutical approaches" haha I like that.

            Chicken soup, bed rest, TLC..........yeah.

            And you're right. In any real pandemic, it will be the rich people that get the flu shots (god help them haha) and the rest of us will have to make to with traditional remedies.

            Frankly, in my experience, us peons just might be better off.

            Observers say Castro will be replaced either by his brother Raul or his idiot son, Fidel W. Castro - Letterman, via Bartcop

            by Rosebuddear on Sun Mar 16, 2008 at 08:33:14 AM PDT

            [ Parent ]

    •  Sadly, my understanding is that... (1+ / 0-)
      Recommended by:
      Rosebuddear

      ...the military has a history of using its troops as lab rats for new vaccines.  My Dad served in Vietnam, and I think I recall him telling me about how he was required to take some kind of vaccine that, after he left the military, he found out was merely "experimental."

      I got absolutely DEATHLY ill............too sick to even drag myself out of bed to a phone.......and it being Germany, and the dollar being strong at the time, I had an off-base apartment, in which I lived alone, so no roommates to go make the call for me.

      So... When you didn't show up, they didn't even bother sending anyone out to check on you?

      •  no they didnt (0+ / 0-)

        I guess they assumed that I was right, and I would be back once I was done being ill. Which they were right about, of course. Although it could have been much worse than it was.

        Interesting about your Dad. I agree, the military is like a big ol' experimental lab with troops that don't have a choice.

        Observers say Castro will be replaced either by his brother Raul or his idiot son, Fidel W. Castro - Letterman, via Bartcop

        by Rosebuddear on Sun Mar 16, 2008 at 03:32:52 PM PDT

        [ Parent ]

  •  I'm planning to take my kids out of school early (2+ / 0-)
    Recommended by:
    DemFromCT, mcmom

    and to have plenty of food available at home so that I can wait out the epidemic. The important thing for a family with kids is to prevent bringing the virus into the house where there is no reasonable possibility of social distancing.

    I am not overly concerned but I plan and I watch what is happening in the news. If the virus starts in a region other than the one I live in I will have a little warning time and I will keep the kids home until it is clear there is not a significant risk. I would rather they miss a few days of school than be one of the folks that waits for the local authorities to pull the trigger on school closure.

    Wonderful diary, thanks.

    Love = Awareness of mutually beneficial exchange across semi-permeable boundaries. Political and economic systems either amplify or inhibit Love.

    by Bob Guyer on Sun Mar 16, 2008 at 09:17:42 AM PDT

  •  great diary CT (1+ / 0-)
    Recommended by:
    mcmom

    but i have to share my real, serious concerns not with the subject matter or its relevance, but for the federal agency entrusted with disease prevention and control.

    gerberding's tenure will thankfully end when there is a new administration.  hard-pressed to remember ween cdc actually was NOT as badly managed and poorly focused as it has been for the past eight+ years.

    i just have this overwhelming sense of frustration with the agency - not a new nagging feeling either but one that has about 20+ years of interaction with them that ground it.

    when a federal agency is incapable of implementing simple activities such as behavioral surveillance with and for at-risk communities or is unable to adequately account for all of its FTEs within a specific center, i can't help but be wary of their capacity to deal with a threat as legitimate and as possible/plausible as an influenza pandemic.

    their almost reflexive response to such challenges has been to reorganize.  again and again.

    hopefully, come january, when science is once again valued by the new (democratic president) administration, we'll have a new director of the the cdc who will tackle and tame the agency.

    seriously, lives are at stake but for luck their mismanagement has not cost us as dearly as i fear it could.

    damn but i sound so jaded about them.

    i used to dream of becoming an EIS (several of the public health officials that i respect the most in this world are EIS) but having the deal with them really soured me on that idea...

    _________________________________

    "Is leor nod don eolach."

    -9.75 (economic), -7.18 (social)

    by dadanation on Sun Mar 16, 2008 at 10:48:05 AM PDT

  •  Public Gatherings (0+ / 0-)

    In Seattle during the 1918 flu pandemic, Mayor Ole Hanson closed schools and theaters and banned religious gatherings.

    I find this interesting.

    This diary mostly discusses the problems involved with closing public schools during a pandemic.  However, if we were to suffer something comparable to the 1918 pandemic, how much power would the various levels of government have over banning other types of gatherings?  Would it be advisable for them to do so?

    I'm thinking that banning religious gatherings, at least, would be a sticky issue, especially in today's climate, with the clout that religious organizations have with many public officials.

  •  At the expense of Dr. Lippin, (0+ / 0-)

    if you'd really like a laugh, you should head here.

    Dr. Lippin is an interesting character. He thinks colds aren't caused by viruses, but by "parasympathetic breakthrough or payback" phenomena.

    I think he's kind of a crank, but, YMMV.

  •  I couldn't help but think.... (0+ / 0-)

    She's talking about an actual place — Pea Ridge, Ark., population 2,346. But according to this fictional scenario, a dangerous new strain of Asian bird flu has found its way halfway around the world to Pea Ridge.

    that Pea Ridge, and lots of NW Arkansas (and NE Oklahoma, for that matter) is chock-full of poultry "growers" (think:  Tyson).  I don't know if DeminCT already knew this or not, or if it factors in or not, but there it is....

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