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Public health folks are doing a terrific job staying on top and ahead of the H1N1 (swine flu) epidemic, which is both local and world-wide. As is often the case, public health officials have to walk a fine line between informing and inflaming the public. Right now there's reason for "cautious optimism" (which I share)

but the CDC says its own count is outdated almost as soon as it's announced. More cases are being confirmed daily. About one-third so far are people who had been to Mexico and probably picked up the infection there. Many newly infected people are getting the illness in the U.S., and the CDC says it probably still is spreading.

In this case, there are a lot of things that really need explaining:

  • what a pandemic is (based on spread, not severity)
  • why there are school closures with only a handful of cases
  • why this appears to be no worse than seasonal flu – yet isn't seasonal flu and has to be treated differently
  • why testing isn't instantly available (needs sophisticated PH lab testing)
  • why not everyone needs tamiflu even though tamiflu "works" (mild flu does not need treatment, regardless of seasonal or swine designation)

So let's tackle some of those difficult points, starting with school closure.

The rationale for school closure was developed in concert with the idea that a pandemic means a widespread geographic range — for the WHO, it has got to be on two continents:

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

For a given region, even in a pandemic, spread may have just started to get underway. See CDC graph for the initiation, acceleration and peak:

We are not at the peak now (but we might be at the acceleration interval.) It's early and worse things can come. So wouldn't that mean we are at phase 6? Well, the thought all along was that it all would start in Southeast Asia and then at Phase 6, come to San Diego. Acceleration matches "spread throughout United States" on the top of the CDC graph and sits within phase 6, and with 21 states involved, we properly might now describe things as exactly that. That's why WHO recently revised the phases. In the new method, phase 5 simply means widespread in one region. In fact, it's in San Diego, and it will be Phase 6 when it moves to Hong Kong or New Zealand or the UK. Therefore, moving to phase 6 doesn't affect what we already have in the US. Declaring a pandemic is for the rest of the world. We got what we got right here, right now, whatever it's called.

link

The peak means sick people, and hospitalizations, and some death. it would be helpful to shrink it, delay it, and mitigate it.

The three major goals of mitigating a community-wide epidemic through NPIs [non-pharmaceutical interventions] are 1) delay the exponential increase in incident cases and shift the epidemic curve to the right in order to "buy time" for production and distribution of a well-matched pandemic strain vaccine, 2) decrease the epidemic peak, and 3) reduce the total number of incident cases and, thus, reduce morbidity and mortality in the community (Figure 1).  These three major goals of epidemic mitigation may all be accomplished by focusing on the single goal of saving lives by reducing transmission.  NPIs may help reduce influenza transmission by reducing contact between sick persons and uninfected persons, thereby reducing the number of infected persons.  Reducing the number of persons infected will also lessen the need for healthcare services and minimize the impact of a pandemic on the economy and society.  The surge of need for medical care associated with a poorly mitigated severe pandemic can be only partially addressed by increasing capacity within hospitals and other care settings.  Thus, reshaping the demand for healthcare services by using NPIs is an important component of the overall strategy for mitigating a severe pandemic.

The less severe the pandemic, the less mitigation is needed. But as far as that peak goes, here's the goal:

Cool! But how do you do it?

You can wash you hands, wear a mask, telecommute... use social distancing (stay away from each other), and the key to that is kids (the humans who don't wash their hands.) Closing schools early before disease spreads is a community mitigation technique that has to be initiated before there is already spread underway. Typically, schools close between 7-30% ill. It is extremely atypical to ask them to close at anywhere near 1% ill, but that's what's needed to reduce spread. Wait any longer and it's too late to make a difference.

Here's a study showing that it might work (scenario 1 is doing nothing and scenarios 2 and 3 are intervening at 1% illness and 0.1% illness):

The attack rate drops the sooner you intervene with NPI's. Adding treatment and targeted anti-viral prophylaxis (TAP) adds further benefit. However, there are practical aspects of intervening too early, so there are always balances and trade-offs:

The timing of initiation of various NPIs will influence their effectiveness.  Implementing these measures prior to the pandemic may result in economic and social hardship without public health benefit and may result in compliance fatigue.  Conversely, implementing these interventions after extensive spread of a pandemic influenza strain may limit the public health benefits of an early, targeted, and layered mitigation strategy.  Identifying the optimal time for initiation of these interventions will be challenging, as implementation likely needs to be early enough to preclude the initial steep upslope in case numbers and long enough to cover the peak of the anticipated epidemic curve while avoiding intervention fatigue.

You can see from that (and the detailed description) that this is not an exact science. And let me repeat this: implementation likely needs to be early enough to preclude the initial steep upslope in case numbers. That's the answer to "but there's only one case! Why are we doing this?" If you wait for "the steep upslope", it's too late to matter.

But is it all theoretical? Not hardly. In 1918, during the terrible pandemic of that year, Philadelphia refused significantly delayed NPI (closing schools, canceling public gatherings), and look what happened compared to St. Louis, which did.

Isn't that a startling mirror of the "goals of community mitigation" curve? It's meant to be. Everything that we are describing is an attempt to be St. Louis and not Philadelphia, even though this year's version is so much milder.

Now, remember, the milder the virus, the less intervention and community mitigation is needed, and the less the plan calls for:

Note that in the above table, it's likely that even a mild pandemic will kill more people than an average seasonal flu. That's what makes it different than seasonal flu even when it's described as "mild". In this context, "mild" means only 3-10x the amount of deaths as usual. And it could turn out to be more.

But when you don't know, in the beginning, how things are sorting themselves out then you err on the side of caution. You can always pull back. And the degree of disease and death will dictate how long the schools close for. The more severe the pandemic, the longer the schools will stay closed.

Now, there are current and active interim recommendations from CDC as to when to close schools:

CDC recommends that affected communities with laboratory-confirmed cases of influenza A (H1N1) virus infection consider activating school dismissal and childcare closure interventions according to the guidelines below.  "Affected communities" may include a U.S. State or proximate epidemiological region (e.g., a metropolitan area that spans more than one State’s boundary).  These guidelines address a flexible and scalable approach that States and local jurisdictions can use based on the situation in their communities (e.g. number of cases, severity of illness, affected groups)...

Dismissal of students in a school and closure of childcare facilities should be considered in schools with one or more laboratory-confirmed or non-subtypable influenza A case among students, faculty or staff in order to decrease the spread of illness in the community.

Beyond that, the detailed guidance suggests close collaboration between school officials and public health officials.

State-wide closure would only happen in a Category 2-3 (where it can be "considered") or greater (it's "recommended for category 4-5"). and that can't happen until we determine that A) we have a pandemic and B) we know the severity and therefore assign a category. But as we discussed above, in the US we already have virus spread (if/when it spreads elsewhere, WHO will declare a pandemic), so health officials are acting now based on what we are seeing today. We don't have a declared pandemic and we don't know what category we are in (maybe a 2, maybe a good deal less). Until we know, the precautionary principle applies and the interim CDC guidelines will be followed.

There are no predictions that can be made about the fall. Whether this virus disappears, smolders, or returns, will have to be carefully monitored.

So, back to the job of public health officials. If they do their job, there'll sometimes be the appearance of over-reacting. If they don't there'll be the appearance of being asleep at the switch. Richard Besser (Acting Director, CDC) in particular, and the entire team is doing very well, but there's a lot more to explain, including that the virus could be back in the fall, that vaccine will take six months to produce (and even then, will need to be prioritized to essential workers first), and that CDC doesn't decide if your local school closes... and when it re-opens. Behind the scenes, communication has also been excellent. In a way, this is a country-wide tabletop for a worse event that still may come (maybe not for years, but eventually it will.) But don't judge things just yet. This story is still in the early chapters.

In the meantime, there's more to discuss, especially about surveillance, vaccines, health reform, and public health infrastructure. But for today, pay attention to school closings and understand why they are happening.

Originally posted to Daily Kos on Sun May 03, 2009 at 08:02 AM PDT.

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Comment Preferences

  •  now, are there times that (51+ / 0-)

    schools close early, or inappropriately? Absolutely. not every locale has good communication, not every decision is a good one. But the more the schools coordinate with the local PH officials, the better.

    "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 Sat May 02, 2009 at 06:36:10 PM PDT

  •  oh, and if you want to dwell on overreaction (14+ / 0-)

    "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 May 03, 2009 at 06:37:37 AM PDT

    •  If you did not see it, you might want to (14+ / 0-)

      review the Fox News Sunday interview of Nepolitano, Sebelius and a physician from CDC by Chris Wallace toay - where Wallace was strongly suggesting that there was an overreaction.  He was really obsessed with the Ft. Worth school system closing.  

      Wallace also harped on closing the Mexican border and then went on to invoke a rather distasteful - some might even say rather racist - similie about keeping mosquitoes out of your house.  Mepolitano called him on it by saying something like, "We are talking about people not mosquitoes".

    •  Now look here . . . (4+ / 0-)

      You are just paying far too much attention to this issue.  It is not particularly a political issue, it has nothing to do with getting Democrats elected, and it is a tiny piece of everything which is important about public health -- issues which go to the very heart of social justice, how we can live sustainably on earth, and what prospects each of us has for a good life.  You say you're capable of multitasking but you don't do it -- the only public health issue we hear about on Kos is influenza, day after day, day and night, month after month.

      Enough of this.  It is ridiculous overkill.  Stop it.

      •  It does affect public policy (9+ / 0-)

        spending priorities and the Republicans have raised it as a partisan issue.  The Obama administration's response will no doubt be compared to the Bush response to hurricane Katrina.  It is relevent.

        Always grateful to wake up alive.

        by Subo03 on Sun May 03, 2009 at 08:25:48 AM PDT

        [ Parent ]

      •  Someone got up on the crabby side (11+ / 0-)

        of the bed this morning. Your concern has been duly noted, and all appropriate action (i.e., nothing) will be taken.

      •  everyone who agrees with cervantes (20+ / 0-)

        (a public health expert in his own right, and is concerned about other neglected aspects of PH), please show your displeasure with me by contributing to ProMED, from the International Society for Infectious Diseases, so they can track other diseases.

        And everyone who agrees with me, please do the same.

        "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 May 03, 2009 at 08:32:17 AM PDT

        [ Parent ]

      •  Think (22+ / 0-)

        of it like tropical storm 500 miles away from the US coast. Might be a mild rain storm, might miss comletely -- or it might turn into a freakin deadly Cat 5 catastrophe. If we happen to have an experts that follow storms in the blogosphere, should they not say anything, and wait to see if it becomes a Cat 5 monster less than a day away writing about it? Or might it make more sense to talk about the state of it now, and offer ideas to deal with it in the event it does become a threat, ideas which might or might not be necessary, but which can transfer to future threats of the same kind?

        Read UTI, your free thought forum

        by DarkSyde on Sun May 03, 2009 at 08:34:57 AM PDT

        [ Parent ]

        •  Or build the damn levees????? (nt) (2+ / 0-)
          Recommended by:
          CalifSherry, phonegery

          Oops! I'm gonna need a whole new sig!

          by sillia on Sun May 03, 2009 at 09:38:17 AM PDT

          [ Parent ]

        •  Yes, but (1+ / 0-)
          Recommended by:
          DemFromCT

          We should definitely be thinking and discussing it.

          However, there is risk if we take too many steps for what turns out to be mild. To use your storm analogy, if official evacuate an area every time a storm appears on the map, people will stop bothering and will get caught when the real storm appears.

          I really think our 24-hour news coverage does us such a disservice. I think it increases the fatigue factor. The breathless speculation when so few facts are known...

          makfan, San Francisco, -4.25 / -5.33

          by makfan on Sun May 03, 2009 at 01:27:21 PM PDT

          [ Parent ]

          •  perhaps (0+ / 0-)

            but here's where we get to discuss it. let's say YOU are in charge. You are the mayor. Your PH people have given the discussion in this diary.  

            What decision would you make and how would you explain it?

            "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 May 03, 2009 at 01:29:56 PM PDT

            [ Parent ]

            •  Glad I don't have to make the decision (2+ / 0-)
              Recommended by:
              ladybug53, phonegery

              In all seriousness, I think the response so far has been about right. At least they are trying to get the information out to us.

              I've stayed away from the breathless news reports and spent time listening to CDC updates (and some from Canada as well), plus DailyKos of course.

              My partner's father was in a somewhat remote part of Mexico at the time of the outbreak, and he decided to fly back to the US. He was mostly afraid of being too isolated if he needed medical care. He was also a little worried about having enough food sources.

              makfan, San Francisco, -4.25 / -5.33

              by makfan on Sun May 03, 2009 at 01:57:20 PM PDT

              [ Parent ]

      •  How about ... (19+ / 0-)

        considering that most of the front pagers receive no remuneration for their efforts / work, that each has their passions / expertise, and that 'sitting on the throne' of the frontpage enables them to explore/develop that?

        Over the years, the quality of discussion of pandemic flu issues here has been lightyears beyond what one can find in any newspaper around the country. If it is too much for you, you don't have passion, skip the stories. (And, reality is that I don't read all of them but feel my knowledge / understand strengthened when I do ... And, I've sent 'panicking' friends/relatives to stories like this one, to help them put fears into context.)  

        And, well, isn't competence in governance one of those things that we've been missing for awhile. And, a political angle is being educated to be able to respond to those who will scream 'overreaction' if the pandemic doesn't blossom into something massive and who will scream 'incompetence' if there are 1,000s (+?) of deaths in the US.

      •  How can we stop it when it is spreading ? (0+ / 0-)

        “In trouble to be troubled Is to have your trouble doubled. Daniel Defoe No "panic" in "pandemic."

        by Snowy Owl on Sun May 03, 2009 at 08:44:36 AM PDT

        [ Parent ]

      •  it is a little odd (0+ / 0-)

        that "seasonal flu" (which kills tens of thousands every year) gets dismissed as a side note while the panic flag gets waved for the "new" H1N1 (which turns out not to be "new" at all, but rather something that everyone over 50 has probably already had at least once).

        Why don't we shut down schools and public gatherings every time any cases of any flu appear?  Why don't we shut down the highways every year that more than a thousand people die in automobile acidents?

        There are many public health issues that are essentially ignored.  Public health is, in general, woefully underfunded, and public education on public health issues is woefully inadequate.  We spend billions for bombs but lack the basic infrastructure to produce vaccines or anti-viral medicines in the quantities necessary to actually matter.  But we go crazy when someone raises the spectre of "swine flu is coming to get you (and it's "those Mexicans" fault).

        A little proportionality, and rationality, would be nice . . .

        •  This, then, is a teachable moment (3+ / 0-)

          Public concern over this "Swine flu" provides us with an opportunity to show how politics and public policy affect health. If the government responds well and actually leads on this, perhaps the public will learn to trust government a bit more on other public health issues such as vaccination and health insurance.  Having a government that works and deals with this flu problem can be an asset in the upcoming debate on health care reform.

          Always grateful to wake up alive.

          by Subo03 on Sun May 03, 2009 at 08:55:11 AM PDT

          [ Parent ]

          •  it is, but what we're getting (1+ / 0-)
            Recommended by:
            Loquatrix

            is Chicken Little rather than real education.  It's easy to ramp up a "panic reaction", but it rarely leaves people any wiser when the panic subsides.  More likely it leaves them more cynical and complacent next time, as they remember back to the last panic that didn't pan out.

            •  I see a measured response (4+ / 0-)

              What I see coming from the Obama administration is calm and competence.  Decisions are being made on the basis of science.  Media reaction, for sure, is across the board from cynicism to sensationalism.  My own state and local governments as well as the federal administration is performing quite well as far as I can see.  Preparations are being made.  That makes sense to me.  Every year I see my state of Florida's response to urricanes and I'm reassured by its competence.  Most times the  preparations aren't needed but when it is, it generally works.  I spent a few minutes in my classroom this week calming student fears and dispelling rumors with facts and science.  I see the Obama administration doing the same things.

              Always grateful to wake up alive.

              by Subo03 on Sun May 03, 2009 at 09:18:28 AM PDT

              [ Parent ]

            •  the hysteria comes from the media (0+ / 0-)

              trying to hype everything that comes down the pike, in order to attract more customers. Wolf Blitzer et al. It started with Iran hostage and will never end. Add in the nativists, Fauxers, Dobbsers, et al plus the rumor factor....chaos.

              fouls, excesses and immoderate behavior are scored ZERO at Over the Line, Smokey!

              by seesdifferent on Tue May 05, 2009 at 08:49:35 AM PDT

              [ Parent ]

        •  Deward, the difference seems to be (0+ / 0-)

          that we don't have a vaccine for this strain of flu, whereas during "regular" flu season, vaccine is almost always abundantly available for strains  that health officials know will be out there.

          "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

          by SueDe on Sun May 03, 2009 at 09:36:33 AM PDT

          [ Parent ]

          •  There is of course not an (4+ / 0-)

            absolute guarantee that the seasonal vaccine will protect you from getting the flu. It is a compromise mixture based on educated guesses. It does reduce risk, but doesn't eliminate it.

             

          •  they've guessed wrong (0+ / 0-)

            for the past three years, and there's been little protection (except for "natural immunity" and holdover from previous vaccinations) for the "seasonal flu" strains that actually did develop.  If you were correct there would as a practical matter not be a "regular" flu season, as immunization would be widespread.

            In fact thousands of people die each year of "seasonal flu" and we all but ignore it, while going into panic mode over this (relatively mild) re-occurance of H1N1.

            •  that's not correct,actually (2+ / 0-)
              Recommended by:
              CalifSherry, Abra Crabcakeya

              first of all, there's a good deal of partial immunity and second of all, the seasonal flu protected against A but not B.

              "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 May 03, 2009 at 10:13:07 AM PDT

              [ Parent ]

              •  it didn't protect (0+ / 0-)

                the more than ten thousand people who died of "seasonal flu" this past flu season.  Where's the panic about that ? ? ?

                •  what are you talking about? (0+ / 0-)

                  honestly, what are you talking about?

                  "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 May 03, 2009 at 11:38:24 AM PDT

                  [ Parent ]

                  •  influenza (0+ / 0-)

                    http://findarticles.com/...

                    Against that background death rate H1N1 is lost in the noise, and the failure of current vaccination policy is obvious.

                    •  define failure (0+ / 0-)

                      do you think that everyone who should be isn't vaccinated? or that vaccination when given doesn't work? they are all different issues.

                      "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 May 03, 2009 at 12:41:01 PM PDT

                      [ Parent ]

                      •  30,000 plus deaths per year (0+ / 0-)

                        from what should be a preventable disease, is failure.

                        And it makes the Chicken Little handwringing about H1N1 look stupid . . .

                        •  your analysis is, to borrow a phrase (0+ / 0-)

                          strikingly superficial. ;-P

                          Why do you think flu is so easily a preventable disease? You make it sound like if only x and y were done, then that number would be zero - and someone made it be 36K. Do you attribute it to vaccine failure or failure to inoculate? Why is it a "fault" when the elderly do not respond as well to vaccine as younger patients?

                          etc, etc, etc.

                          "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 May 03, 2009 at 01:20:04 PM PDT

                          [ Parent ]

                          •  it's not my job (1+ / 0-)
                            Recommended by:
                            DemFromCT

                            to school you in public health . . . and if you believe that our current policy toward influenza is working fine, and H1N1 is our biggest "flu" problem, I doubt that anyone can.

                            etc, etc, etc.

                          •  I wish people would not be so binary (0+ / 0-)

                            "If people die then the entire public health system is a failure [your word]."

                            Maybe, if they are preventable deaths. Has that been established? Not to my knowledge. That's my point.

                            My friend revere will be doing a post tomorrow or the next day on that 35K-36K number, where it comes from, and what it means. let's understand it better before jumping to "success" or "failure" as a label.

                            "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 May 03, 2009 at 03:10:18 PM PDT

                            [ Parent ]

                          •  when you have to fabricate (0+ / 0-)

                            to make your (failed) point you'd do better to just quit.

                            "If people die then the entire public health system is a failure [your word]."

                            NOT my words, of course . . . what I wrote was

                            30,000 plus deaths per year from what should be a preventable disease, is failure.

                          •  sigh... your point is what, exactly? (0+ / 0-)

                            you have addressed nothing I pointed out. Get a grip on the complexity of the issue.

                            36K is a lot of deaths, but it's neither simple to define, simple to define as "preventable", as you have, nor simple to fix, as you imply. It would be wonderful to be able to do those things and prevent those deaths. Can you point to any, y'know, references, facts or other data that would enlighten us about those key issues? Can you define why they are preventable?

                            If not, maybe you should avoid using the word "failure".

                            "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 May 03, 2009 at 03:46:21 PM PDT

                            [ Parent ]

        •  "Seasonal flu", though, . . . (1+ / 0-)
          Recommended by:
          SlackwareGrrl

          . . . causes the highest mortality among infants and the elderly. "Novel" strains of the flu seem to cause greater mortality among young to middle-aged, otherwise healthy, adults.

          We're seeing an utterly abhorrent, but biologically understandable, double-standard at work: Kids and the elderly are "weak", and not as "valuable" to society. The elderly are "going to die anyway", and children can be "replaced". But if an illness is taking out doctors, firemen, teachers, farmers, politicians -  it's time to do something about it!

          "Have nothing in your houses that you do not know to be useful or believe to be beautiful." -William Morris

          by Robespierrette on Sun May 03, 2009 at 11:01:24 AM PDT

          [ Parent ]

      •  Someone has to do it (2+ / 0-)
        Recommended by:
        elfling, Abra Crabcakeya

        DKos is a huge pot luck of information and opinion. It's value to me comes - in part - from people like Dr. D. who write about important matters of public policy and the common good.

        If you are not interested, you have other choices.

      •  By focusing on this (4+ / 0-)

        we can prepare ourselves for other potential threats on the horizon -- for example, what if the avian flu virus mutated into a form that could be passed between humans? And consider the fact that there are antibiotic-resistant bacteria out there, where we might have to use similar actions (quarantines, school closures, etc.) against the spread of those sorts of illnesses.

        This also highlights the drastic need for health care reform in this country, regardless of what assholes like Ben Nelson or Arlen Spector believe -- if people can't get adequate medical care to catch something like the H1N1 virus early, they just end up spreading it to more people. And it also stresses the need for contingency planning in all areas of society, from employers needing to let employees take time off to get healthy (or to care for sick family members) to figuring out what to do with kids in schools that need to close, all the way to churches discussing how to handle their weekly rituals.

        Unlike what we get in the national media (with the exception of a few sources -- Rachel Maddow the other night was exceptionally good), DemfromCT's posts are informative, and separate the facts from the hype. Your attitude is like someone complaining about all the post-Katrina diaries and calling them "overkill" -- if we can learn something to use the next time something similar comes up, so much the better.

        Civility is the way of telling someone to go fuck themselves in such a way that the someone agrees it probably is a good idea.

        by Cali Scribe on Sun May 03, 2009 at 11:38:50 AM PDT

        [ Parent ]

    •  As I indicated in another post, Y2K (7+ / 0-)

      When you are proactive and exert sufficient effort and expense to minimize widespread pain (in this instance death) and disruption, you are going to be criticized for overreacting "when there was (obviously) no cause for alarm."

      Single Payer...NOW!!!

      by Egalitare on Sun May 03, 2009 at 08:43:50 AM PDT

      [ Parent ]

  •  I wonder what happens in the fall (13+ / 0-)

    If this was just a one shot thing, or if we'll get a variant strain that's a bit more dangerous.

  •  At this time not believed to be a "killer" flu (4+ / 0-)
    Recommended by:
    DemFromCT, Blutodog, kanuk, Snowy Owl

    I believe there is no reason to close schools, even if many students have the flu. At this time this flu is only worse than other flues because we do not have vaccinations.  So people get sick for a week (more or less). Big deal!

    On the other hand we should be concerned about what might come next. Thus the country should increase our medical care for all and the number of hospital beds nation wide. Keep studying flues and other possible pandemics. But don't get overly excited about this flu.

    Be careful with newborns and the elderly, but don't allow fear to rule.

    Practice tolerance, kindness and charity.

    by LWelsch on Sun May 03, 2009 at 08:12:04 AM PDT

    •  with respect (18+ / 0-)

      it isn't what you believe, it's what your local public health official (and other parents, and teachers) believe. That will drive the process. it may mean that in a week the interim guidance is to NOT close schools, but for now, until there's more data to support optimism, it is what it is.

      There's really no reason to 'close schools to clean them' but if it makes people comfortable, that's what will happen.

      "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 May 03, 2009 at 08:16:02 AM PDT

      [ Parent ]

      •  local schools, local poltics (6+ / 0-)

        Nothing is more volatile than a frightened, angry parent.  Also where people gather, not surprisingly, is where the disease spreads.  Schools, churches, and malls certainly fit that category.  I see mini-pandemics in my middle school all the time.  It's an every day process for those of us in education.  We don''t panic but prudence is a virtue and responding to parental concern is a political if not medical necessity.

        Always grateful to wake up alive.

        by Subo03 on Sun May 03, 2009 at 08:30:43 AM PDT

        [ Parent ]

      •  No one has suggested this flu (1+ / 0-)
        Recommended by:
        LABobsterofAnaheim

        is worse than the flues that come every year. Many have said the evidence supports the belief that this flu is no worse than common variety flues.

        Now as to what may come next, we know that we to not have a vaccine.  Getting the flu and fighting it off while the flu is not a "killer" flu will help prevent you from getting a related "killer flu" by building up your body's immune system.

        Elderly and babies have weaker immune systems and are more likely to die from this flu.

        Practice tolerance, kindness and charity.

        by LWelsch on Sun May 03, 2009 at 08:31:17 AM PDT

        [ Parent ]

      •  With all do respect (0+ / 0-)

        It appears that the W.H.O. and the C.D.C. jumped the gun here. The Mexicans have revised their death toll down to less then 30. Why were they reporting hundreds in the first place? This whole thing shouldn't have run on bad data from a place that isn't exactly known for it's advances in Medical care or knowledge. Now it appears these same agencies having thrown caution to the wind are in full CYA mode as this thing turns out to be no more dangerous then the normal flu out here. Yes, nobody has a vaccination etc. Still this shouldn't have been allowed to become what it's starting to develop into a panic by cowardly CYA oriented bureaucrats.

        "It's better to die on your feet then live on your knees" E. Zapata

        by Blutodog on Sun May 03, 2009 at 08:59:02 AM PDT

        [ Parent ]

        •  that's an absurd thing to say on your part (6+ / 0-)

          how can you jump the gun last week based on what you learn 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 May 03, 2009 at 09:00:14 AM PDT

          [ Parent ]

        •  At the worst, its a drill (10+ / 0-)

          I'd rather see my govenment "jump the gun" and get ahead of something than watch them drag their feet and end up with a katrina situation.  Every year here in florida we prepare for the worst during hurricane season and most of the time the threat passes but reacting after the storm arrives would be a recipe for disaster.  Ask Louisiana.

          Always grateful to wake up alive.

          by Subo03 on Sun May 03, 2009 at 09:24:25 AM PDT

          [ Parent ]

        •  Jumping the gun is key (3+ / 0-)
          Recommended by:
          CalifSherry, elfling, Blissing

          To slowing the spread of a pandemic.  If this isn't it?  Oh well.  Pandemic prevention is a "dammed if you do, dammed if you don't" game.

          If this was the killer pandemic, citizens would be crying bloody murder if the government didn't do much at the beginning.  But the point is if you wait to see if it is a killer, it's too late.

          And do we really know what strain of this virus will return in the fall?

          Public health officials deserve a pat on the back IMO.  The world is alert and vigilant.

          This diary is the best I've seen so far in explaining why early overreaction is key to slowing an epidemic.  Just look at the graphs.

          •  Disagree (0+ / 0-)

            We'll have to agree to disagree. I still think when this is all over they'll need to change their alert systems. Right now it's easily misconstrued to mean SEVERITY and SPREAD. This can lead to poor decision making further down the food chain out here. Closed schools canceled events, disruptions of all kinds etc cost the public dearly. This isn't necessary when you have an alert system that is simple and direct. I'm already watching these same agencies going back as this thing turns out to be a mild form, saying , oh and by the way Alert 5 was ONLY about Transmission and spread. The media though doesn't even do that as long as the thing has legs and sells more ads.

            "It's better to die on your feet then live on your knees" E. Zapata

            by Blutodog on Sun May 03, 2009 at 02:28:52 PM PDT

            [ Parent ]

            •  you do understand that what the US does is based (0+ / 0-)

              on what CDC says and not what WHO says? Because it started here, Richard Besser flat out said WHO is not the determining factor, and sensibly so.

              You know, we are working very closely with the World Health Organization.  We've been in direct contact with the Director General, Dr. Chan and the Deputy Director of PAHO having discussions around those questions as well as general control questions for this particular virus.  And they convene an expert panel to look at the conditions to determine whether or not we should elevate the status.

              When we look at what actions we take though we look at actions on the ground.  And so what you're seeing is a lot of activity around San Diego, a lot of activity in one part of Texas, a lot of activity in certain parts of Mexico.  And that's because that’s where we're seeing disease occurring.

              CDC, 4/25:  

              LET ME ADD SOME COMMENTS. I THINK IT'S EASY TO FOCUS ON THE WORLD HEALTH ORGANIZATION PROCESS AND THE STATE. THE PHASES THE W.H.O. MIGHT DECIDE UPON. BUT WHAT'S REALLY IMPORTANT FOR PEOPLE TO KNOW, THAT WE ARE PREPARING, ACTIVELY WORKING AND A CHANGE, FROM THE W.H.O. PERSPECTIVE, WHETHER THEY DECIDE TO DO IT OR NOT, DOESN'T CHANGE OUR VERY FORWARDLY LEANING EFFORTS.

              "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 May 03, 2009 at 03:05:32 PM PDT

              [ Parent ]

      •  It is not about what you believe. (2+ / 0-)
        Recommended by:
        juliesie, NancyK

        Those H1N1 buggers don't give a damn what you believe.  It is about what public health officials know from growing these guys.

        Give every American a fair chance at the race of life - A. Lincoln and B. Obama

        by captainlaser on Sun May 03, 2009 at 09:32:17 AM PDT

        [ Parent ]

    •  This is exactly why your conclusion is wrong (11+ / 0-)

      On the other hand we should be concerned about what might come next.

      We don't know "what might come next." We're still figuring out this bug. Closing individual schools for short periods of time when there's a suspicious flu case is a hell of a lot cheaper, and causes far less disruption, than a major outbreak would be. If we can do small, minimally disruptive, and reasonably inexpensive things now and keep this outbreak at a minimal level, we absolutely should do that. Because if we don't, once we know it's serious enough that we should be doing those things, it's already too late for them to be effective.

      •  closing colleges gets much more expensive and (0+ / 0-)

        troublesome, though there are arguments that can be made for early closure there as well; namely that most college towns assume that young people are going to be healthy, and don't have anywhere near the facilities needed in a pandemic.

        fouls, excesses and immoderate behavior are scored ZERO at Over the Line, Smokey!

        by seesdifferent on Tue May 05, 2009 at 09:03:03 AM PDT

        [ Parent ]

        •  How do you figure? (0+ / 0-)

          Closing colleges isn't expensive--you probably save money. That's certainly the argument the one where I work makes every summer when they go to a four-day workweek. Turn off the lights and turn up the thermostats in empty buildings = energy savings. Even if you still have to pay the employees.

    •  Your right! (2+ / 0-)
      Recommended by:
      Deward Hastings, LWelsch

      This has developed into a panic over very little. The WHO and the CDC basically blew it on this one. They didn't have nearly enough GOOD solid data from Mexico before pushing the PANIC button on their alert system. Plus, they didn't explain that a % on the WHO scale only refers to SPREAD not SEVERITY. The media wasn't any help either. They made this sound like it was 1918 all over again. They live off of these kinds of stories and they immediately go to the worst case, and in this case that has caused a lot of unnecessary FEAR.

      Now looking back you can already see the Career bureaucrats that run these agencies going into full CYA mode.

      "It's better to die on your feet then live on your knees" E. Zapata

      by Blutodog on Sun May 03, 2009 at 09:08:21 AM PDT

      [ Parent ]

      •  didn't "blow it" (2+ / 0-)
        Recommended by:
        Abra Crabcakeya, Oh Mary Oh

        Waiting for the "good data" = too late.  If this was the killer pandemic, we would all be crying bloody murder that the CDC and WHO did nothing.

        Look at the graphs.  Early overreaction is key.  Waiting is deadly.  This flu is a relatively novel strain, and The CDC and WHO would be woefully negligent if they just sat back an assumed it would act like the normal flu.

        And if this thing comes back as a killer strain in the fall?  Guess what, the CDC and WHO has put us on a much better footing to combat it.

        We should recognize that the CDC and WHO are in a Catch-22 situation.  

        •  Not my point (1+ / 0-)
          Recommended by:
          TheGeneral

          My compliant is how they handled the alerts. They did a POOR job IMO of making it very very clear that a level 5 alert had nothing to do with SEVERITY. Most reasonable viewers came to the immediate conclusion this meant SEVERITY not just Spread or Transmission status. For example you have schools being closed with no reported cases just because the admins. thinks this is like Avian flu or the plague. Did any of these people bother to read what a Level 5 pandemic alert really means? My guess is probably not, instead of stopping and thinking they immediately reacted as if it meant just that. This is my pt. about causing panic. The general public isn't in a panic, it's increasingly parts of the various bureaucracies out here, that are.

          "It's better to die on your feet then live on your knees" E. Zapata

          by Blutodog on Sun May 03, 2009 at 02:18:42 PM PDT

          [ Parent ]

      •  that's just wrong (5+ / 0-)

        what actually happened is that CDC and other officials were explaining what they were doing every day in a transparent manner. Everyone could follow it. There's been few missteps (see Biden) and precious little backtracking. And there's been calm support from the public.

        You and a handful of commenters have been hysterical, no one else.

        "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 May 03, 2009 at 01:33:25 PM PDT

        [ Parent ]

    •  absent vaccine, natural immunity (1+ / 0-)
      Recommended by:
      LWelsch

      Given that the "newly defined" threat is that this H1N1 may come back in the Fall in a more virulant form one could well argue that letting the present mild form spread, and letting the population develop natural immunity, is a better course of action.  Unless, of course, you trust the government to have plenty of properly targeted flu vaccine ready for the 2009-2010 flu season . . .

      •  that's a really interesting topic (0+ / 0-)

        there's data to suggest in 1918, that lead to less death, but not less infection. So, with mild illness, do you...

        "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 May 03, 2009 at 09:20:13 AM PDT

        [ Parent ]

        •  I've been wondering about this.... (0+ / 0-)

          Would mutations that change the virulence also tend to change the immune/antigen characteristics? Because, if a deadly strain appears, wouldn't it be comparatively simple to intentionally infect people with the mild form? Preferable to the deadly form? lol, just have everyone intentionally pass it around. Everyone could be immunized in a week or two... :-)

          Desperate true, but officials fear the 50% mortality strain and 6 months to develop a vaccine.

          I wonder if a deadly strain could be engineered into a mild form as a sort of vaccine, i.e. intentional reassortment events...

          Insanity is a perfectly rational adjustment to an insane world...

          by crazyamerican on Sun May 03, 2009 at 11:02:23 AM PDT

          [ Parent ]

      •  are you suggesting we can stop it from spreading? (5+ / 0-)

        because, we really can't.  We can only slow it down.

        After the 1918 influenza it was discovered that ~90% of the population had gotten it within 3 years.

        What we are concerned with is spreading out the period of time that people exhibit symptoms.  Make no mistake, every person on this planet will catch this virus at some point in their lives.  It is so contagious that it will squeeze out the other previously predominant strains.  That is what it did in pigs, 10 years ago the predominant swine strain was H3N2, then this one came along and made it all but extinct.

        I agree that if there is a mutation that makes it more virulent (worse symptoms), it will be better to gain immunity to the strain now, but we just cant afford to shut down our economy to allow that to happen.  

        The virulence of this strain may be no worse than a normal flu, but picture 40% (or even 25%) of the country sick with the normal flu at the same time, and there is your problem.  

        (-8.50, -7.54) Only the educated are free. -Epictetus

        by Tin hat mafia on Sun May 03, 2009 at 09:34:07 AM PDT

        [ Parent ]

        •  no, I'm suggesting that (1+ / 0-)
          Recommended by:
          CalifSherry

          absent a vaccine we cannot stop it spreading, eventually, and given that reality we are better off to let it spread while it is still "mild".  If we do manage to slow the spread of this mild form the result will be a population more vulnerable when a more deadly strain appears.

          The only justification for suppressing this mild form is a certainty that vaccine will be available before a more severe strain developes . . .

          •  And it will spread. (1+ / 0-)
            Recommended by:
            CalifSherry

            But these precautions will help it spread more slowly. It will still get to you, eventually!

            And, if it's taken enough time, the doctors and hospital beds will be adequate for those who do get secondary infections/pneumonias/etc., and whole areas won't be disrupted by having everyone sick at the same time.

            There is virtue in slowing the spread. No one (knowledgeable) that I've heard has said they're going to be able to prevent the spread of the virus altogether.

            "Have nothing in your houses that you do not know to be useful or believe to be beautiful." -William Morris

            by Robespierrette on Sun May 03, 2009 at 11:08:24 AM PDT

            [ Parent ]

            •  I question the "virtue" (0+ / 0-)

              of slowing the spread while it is mild, and leaving the population vulnerable until it becomes severe.

              "Common wisdom" used to be to make sure your kids got mumps while they were young, because it was much worse to get once you were older.  And the whole idea of vaccination came from the observation that people who'd had cowpox didn't get (severe cases of) smallpox.

              As for getting it "eventually" . . . I've almost certainly already had (a variant of) H1N1, and probably still have at least some immunity.  I'd like to get my "booster" while it's still mild.  Of course I'd prefer an asymptomatic "vaccine" . . . but given our inability to produce enough in time for the next flu season . . .

    •  It seems to me (1+ / 0-)
      Recommended by:
      CalifSherry

      that if we get to choose between closing the schools for a week and keeping everyone healthy and at home for a week, or leaving them open and have 70% of the kids end up too sick to go to school for 10 days, that we're better off closing the schools and then making up the time at the end of the year. Less misery, more learning. In addition, although inconvenient to parents, it's probably easier for them to get understanding from employers and care for their kids when the schools close than when their own individual kid is sick.

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

      by elfling on Sun May 03, 2009 at 10:37:04 AM PDT

      [ Parent ]

  •  My daughter's school closed on Fri (13+ / 0-)

    Supposedly 1 case of swine flu.  No other elementary schools in the district were closed, nor the high schools, but 2  of the junior highs.  I appreciated the concern on the part of the district.  We're supposed to hear tonight if school is in session tomorrow.

    minx 1952. You do the math.

    by chicago minx on Sun May 03, 2009 at 08:12:21 AM PDT

    •  so did mine (Rockville HS, MD) (4+ / 0-)

      Just got an automated phone call from the principle that school will be closed indefinitely and where students will be taking their AP exams etc. The one suspected but probable case has not yet been confirmed by the CDC but I just checked the CDC.gov website and it was updated at 11 AM -- another 66 confirmed cases and is now in 30 states, yesterday it was 160 in 22 states (or something like that)

      sigh. my sons return home from college next weekend, one attends in Boston and the number of confirmed cases increased there overnight.

      I wonder what this week will bring. . .

      Those who survive are those who adapt.

      by donailin on Sun May 03, 2009 at 08:33:03 AM PDT

      [ Parent ]

      •  increased in Massachusetts, not Boston (3+ / 0-)
        Recommended by:
        Fabian, chicago minx, KimD

        sorry! should have edited before hitting send!

        Those who survive are those who adapt.

        by donailin on Sun May 03, 2009 at 08:34:17 AM PDT

        [ Parent ]

      •  MD stats - 4 confirmed cases (0+ / 0-)

        from FluTracker (browse like a google map)

        Full-screen
        Report Date: 5/2/2009
        Reported Location: 9200 Muirkirk Road, Laurel, Maryland 20708
        Confirmed Cases: 1
        The affected schools are: Rockville High School in Montgomery County; Milford Mill Academy in Baltimore County; Folger McKinsey Elementary School in Anne Arundel County; and Montpelier Elementary School in Prince George's County. The schools will be closed for up to 14 days. Extracurricular activities also are canceled. Rockville High never opened Friday because a student there appeared to be the first person in Maryland thought to have acquired the virus without having contact with someone who had traveled to Mexico, the epicenter of the outbreak and the place with the most severe cases. Later, officials determined that the ill student at Montpelier also had no link to Mexico or any other affected country. The schools in Baltimore and Anne Arundel counties, where officials announced Wednesday that there were likely cases, were open for the past two days despite the knowledge that a sick child attended each school. Many parents kept their children home. At Milford Mill, parents are being told that school will open Thursday. Frances Phillips, deputy state health secretary, said decisions to reopen will be made on a case-by-case basis.
        Source: http://www.baltimoresun.com/...

      •  Harvard (0+ / 0-)

        I think the only uni in Boston that had any cases at all was over at the Harvard's Dental school, so if your son isn't there, there's probably no need to worry. I'm sure that Harvard is taking every precaution.

  •  Hahaha.... (20+ / 0-)

    ...it took ten minutes to read this, and it's so much more informative than the past two weeks (read 20,160 minutes) of news coverage. Just leaps and bounds more useful.

    How embarrassing for the media.

    it fitfully blows, half conceals, half discloses

    by Addison on Sun May 03, 2009 at 08:13:20 AM PDT

  •  Interesting stuff (11+ / 0-)

    It is indeed a balancing act.  Here in Fort Worth, we're waiting to see if extreme caution pays off (the entire school district is closed for at least 2 weeks on account of one confirmed case, and our beloved MayFest community festival was cancelled).  At the moment it sort of feels like we're up on a high wire with our junk flappin' in the breeze -- but your post certainly gives some important context to the decisions.  

    Lou Dobbs makes me puke tears of blood (and not the good kind).

    by cardinal on Sun May 03, 2009 at 08:14:04 AM PDT

  •  thank you for a great detailed story (10+ / 0-)

    I finally understand why a school will close with just one case, which didn't make sense before, especially when the case wasn't even confirmed.  

    Lightbulb on!

    From each according to their ability to each according to their need ~Marx

    by k8dd8d on Sun May 03, 2009 at 08:14:07 AM PDT

  •  I feel for public health folks at times like this (19+ / 0-)

    Seems like a 'can't win for losing' kinda situation for them.  If they act decisively and the epidemic is nipped in the bud, well then it was probably never really an epidemic and they pushed the panic button for no good reason.  And if they fail to act decisively (out of a desire not to create panic) and the epidemic gets out of hand, well, that's their fault, too.

    President Obama can talk all he wants about not looking back, but this grotesque past is bigger than even he is. - Frank Rich

    by Mehitabel9 on Sun May 03, 2009 at 08:14:59 AM PDT

  •  hand washing (10+ / 0-)

    I put my flu fears on hold and went to the Colorado Convention Center in Denver to a Green Festival. (Also saw Thom Hartmann speak; that was a treat.)

    I came prepared to use paper towels on the bathroom doorknobs, faucets, etc. I've been getting in the habit for a week at work.

    Well, turns out the bathrooms had no doors! Just large L shaped entrances. And, the flushers and faucets were automatic on sensors. Nice job, Denver.

  •  Texas schools are closing? (2+ / 0-)
    Recommended by:
    Blutodog, Loquatrix

    It will probably improve the intelligence and education of Texas kids

  •  starting to get closures in DC area (8+ / 0-)

    one high school in Montgomery County, Rockville, was already closed, just before the AP testing season begins - College Board has provisions for makeups, although that will not be for several weeks.

    In Prince George's where I teach, we now have two elementary schools closed, one because of a student and one because of a teacher.  We keep monitoring in case the closures spread.  My AP exam in tomorrow morning, so at least my students will take theirs at the time for which we have prepared.  Who knows what will happen next.

    I know some people think this is overreacting, but we clearly will minimize the spread by cutting down the exposure in close quarters that inevitably occurs in schooling situations - crowded classrooms and corridors are only part of the problem: a large portion of our students travel by bus.

    do we still have a Republic and a Constitution if our elected officials will not stand up for them on our behalf?

    by teacherken on Sun May 03, 2009 at 08:16:45 AM PDT

  •  H1N1/2009 a typical "mild" flu per UK researchers (2+ / 0-)
    Recommended by:
    DemFromCT, kanuk

    BBC's web site, based on WHO/CDC stats, continues to be the best for concise, accurate information on the flu.

    National Institute for Medical Research has concluded that H1N1/2009 is a mild upper respiratory flu typical of yearly flu symptoms and contagion.

    Worst case projections by Northwest University of 1700 total US cases by April 24 look to be fairly accurate, possibly a bit high considering the high number of school closings.

    The school closings are probably over reaction considering how few cases there are in the US but it's one of those can't hurt deals. It might have an unusual affect of lowering number of cases but extending the duration since it will have exactly that effect on the schools who will have to make up the week later in the Spring.

    •  only one problem with that research (0+ / 0-)

      and that is that you need to add the caveat 'in its current form'.  

      Remember, every person it infects brings the potential for new mutation of the DNA.  If someone with another flu strain (and remember it is flu season in the southern hemisphere) catches this one too, the possibilities for DNA transfer are HUGE, in fact it would be certain.

      While the symptoms for the virus as it currently is may be slight, the very fact that it is as contagious as it is insist that we use all efforts in our ability to try and lessen its effect.  If it were to swap the right DNA with a more virulent strain, and maintain its current HA protein (i.e., be just as contagious but more deadly) then there would be an enormous problem world-wide.

      (-8.50, -7.54) Only the educated are free. -Epictetus

      by Tin hat mafia on Sun May 03, 2009 at 09:41:21 AM PDT

      [ Parent ]

      •  No problems with that research. (0+ / 0-)

        "add the caveat 'in its current form'"

        Hardly need to add it, one because it applies to every viral infection from the common cold to cancer, two because it is "in its current form" which is a standard seasonal flu virus, not particularly virulent nor contagious.

  •  Schools are germ factories (9+ / 0-)

    I usually get 2-3 colds a year.  Rare is a day without a sniffling, coughing, wheezing kid.  I managed to reduce my infection rate so far this year by being more aggressive.  I always provice tissues and hand sanitizer for my kids but this year I added alcohol based sanitary wipes.  Once I get the kids on task I take a wipe and clean my door knob inside and out.  It takes about 30 seconds but it seems to have been effective.  Kids cover their mouths when they cough then hand each other pencils, paper, etc and walk through six doors every day.  I tell my kids that using a doorknob is like shaking hands with 160 people, using the handrail on the stairs raises that to 1,300 in my school.  I also send sick kids to the clinic which requires a parent notification.  A lot of parents send sick kids to school sadly because they don't want to take care of them at home.

    I suspect my school board will close quickly just based on their over-caution during hurrican season.  we shall see.  As ov last night local news was reporting confirmed cases in south Florida and a suspicious case in Orlando, about an hour south of me, so it will be interesting to see if we have any interruptions in this last month of school.  I've already had a parent demand a refund for a field trip to EPCOT on May 15 b4cause the child  is too afraid to go.

    Always grateful to wake up alive.

    by Subo03 on Sun May 03, 2009 at 08:23:11 AM PDT

    •  If schools are germ pools, what are day cares? (2+ / 0-)
      Recommended by:
      Abra Crabcakeya, KimD

      I work in a day care, and everyday I have some 2 year old coughing and sneezing on me.  On Friday we had a memo from the Health dept. that said everyone should be 3 feet away from sneezes.  Ya, kids are going to know when they are going to sneeze, and just walk away from you.

      I also believe my immune system is super strong if the big flu ever hits, because I am exposed to every virus that goes around.

    •  It's not because they don't WANT to take care (6+ / 0-)

      of them at home. It's because they work and they CAN'T just take off work for a sick kid. Many people can't take off if they themselves are sick -- so some bosses flip out when you ask to take sick leave for a kid, even firing people who dare to do so. So, I rec'd your comment, but totally disagree with that part of it.

      I actually had an HR lady compare my leaving my kids at home alone while they were sick (HER suggestion) to her leaving her CATS at home alone while they are sick. She actually said to just leave them some food and drinks where they could reach them, and they would be fine while I was at work. My kids were 2 and 6 at the time.

      She was a complete b*tch, but her attitude is that of many supervisors: your sick kid doesn't entitle YOU to miss work.

      Change the attitudes we have toward workers in this country and a lot of things about the working world would change, including the animosity most people have for jerky supervisors who simply want total control over the lives of their employees.

      "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

      by Brooke In Seattle on Sun May 03, 2009 at 10:34:46 AM PDT

      [ Parent ]

      •  Even if your state is a so-called "fire at will" (0+ / 0-)

        state wher labor laws are concerned , you can absolutely beat any crap that comes your way from such a source. I know from experience. You might or might not need a lawyer to handle it for you; your state industrial relations board's local office is the place to start should something happen. Document any such conversation with a supervisor as carefully as possible as soon as possible after it takes place; laziness and delay will cost you.Of course , don't anounce that you are doing that.Even better , hide a small audio recorder with the appropriate kind of microphone on your person or in your purse.In many states this is legal for you to do. In my state employers and supervisory people absolutely will tell you it is not ; it absolutely is.I'm not a lawyer and can't give you legal advice , but have beaten scumbag employers in the past so thoroughly not one would look at me as if they were even dreaming of administering grief ever again. My wife has , as well. Class war , well , take this !

      •  No argument there (0+ / 0-)

        first of all I said "a lot".  but the assumption seems to be that the school is the answer to the problems you've stated so well.  People want that but they don't want to pay for that.  That's why, as I said, parents have to prepare not react.  I was a woring parent long before I was a teacher and Iknow how tough it is.

        Always grateful to wake up alive.

        by Subo03 on Sun May 03, 2009 at 12:30:08 PM PDT

        [ Parent ]

  •  You mean running around in circles in a (1+ / 0-)
    Recommended by:
    Fabian

    screaming panic is NOT one of the prescribed methods to help stop the spread of flu??

    Who woulda thunk it!!

  •  This is one of those examples ... (17+ / 0-)

    where everyone would be better off opening this web page than their daily newspaper.

    Over the years, the quality and digestability of your (and others) discussion of pandemic flu (Asian, Swine) has been heads and shoulders above what is in the traditional mass media outlets. (Including, of course, the rich 'links' / sourcing enabling deeper dives, as desired.)

    Thanks to you / others for this work.

  •  They closed Harvard! (3+ / 0-)
    Recommended by:
    CalifSherry, OLinda, Fabian

    Flu fear shuts Harvard dental

    I'm supposed to speak at a different med school next week, I'm waiting to see if they'll let me (some places now have travel bans) and if they'll be open.  

    Imprisonment without trial, and even examination under torture, were common practice. --A Man for All Seasons

    by mem from somerville on Sun May 03, 2009 at 08:34:59 AM PDT

    •  No cases there why closed? Admin= CYA (0+ / 0-)

      This is BS. Total complete BS. Not ONE case and Harvard folds. What total pussies the people that run that place are. The Admins. of many of these institutions are cowards and are basically playing Cover Your Own Ass just in case. No consideration for anything else. Oh, and they're salaried so they could care less for the majority of people that work for them as well that need a pay check. Assholes!

      "It's better to die on your feet then live on your knees" E. Zapata

      by Blutodog on Sun May 03, 2009 at 08:46:01 AM PDT

      [ Parent ]

    •  Harvard stats (0+ / 0-)

      From FluTracker Browse it like a google map. I you are a data visualizer, sign up for a free account and share your perspective.

      Full-screen
      Report Date: 5/1/2009
      Reported Location: 188 Longwood Ave, Boston, MA
      Suspected Cases: 7
      Confirmed Cases: 1
      The announcement comes as officials were investigating a cluster of nine possible swine flu cases at the Harvard School of Dental Medicine. Two students were identified with probable cases and seven other possible cases at the school. A Boston Public Health Commission spokeswoman said none was hospitalized.
      Source: http://www.patriotledger.com/...

  •  Is there a cure for hype? (1+ / 0-)
    Recommended by:
    Blutodog

    800 cases worldwide, population over 6 billion, what is that percentage?

    "Can I just ask a question? What is Fox News, it's just a Parade of Propaganda, isn't it? It's just a Festival of Ignorance." --Lee Camp, FOX News guest

    by twalling on Sun May 03, 2009 at 08:40:16 AM PDT

    •  What's the tipping point? (3+ / 0-)

      When is the hype justified?

      Was the hype over Hurricane Katrina justified?  Hurricane Rita?  Hurricane Ike?

      How do we know?

      Proud member of the Cult of Issues and Substance!

      by Fabian on Sun May 03, 2009 at 08:50:14 AM PDT

      [ Parent ]

      •  I don't know, maybe some certain percentage (0+ / 0-)

        of the population or something.

        I've been watching this "Swine Flu" thing unfold in the media all week with a grim sort of amusement...

        ...on Monday, Air Force One flew low near the Statue of Liberty, causing a few hundred people to get scared for about 20 minutes or so, and CNN went crazy over it.  If you read that site on Tuesday, there were about 7 stories on in, all about the flyby, culminating in an apology by the White House.

        But, amusingly, peppered amongst the "Terror in New York" stories, were the "swine flu" stories, too.

        And I began to think, how many people is CNN scaring with this?  If it turned out to be nothing, does this not deserve an apology?  Is not scaring the entire population into a panic over a few cases "felony stupidity?"

        "Can I just ask a question? What is Fox News, it's just a Parade of Propaganda, isn't it? It's just a Festival of Ignorance." --Lee Camp, FOX News guest

        by twalling on Sun May 03, 2009 at 10:16:39 AM PDT

        [ Parent ]

        •  RTFA (2+ / 0-)
          Recommended by:
          Fabian, Richard Lyon

          Once the fraction of the population catching this becomes significant, it becomes impossible to stop.  The trick is to catch it early.  Of course, if it's caught in time, it looks in retrospect like a false alarm.

          Compare the graphs from 1918 for St. Louis vs. Philadelphia.

        •  It's a catch-22 (3+ / 0-)
          Recommended by:
          elfling, Fabian, CKendall

          If you take due diligence and prevent a major catastrophe, you're accused of "Chicken Little-ism". But if you do nothing and it turns into a major pandemic, then you're accused of hiding your head in the sand and needlessly causing the death of of thousands or millions of people.

          Chances are slim that I'll be involved in a major car accident...but I'm going to fasten my seat belt anyway on the off-chance I might be.

          Civility is the way of telling someone to go fuck themselves in such a way that the someone agrees it probably is a good idea.

          by Cali Scribe on Sun May 03, 2009 at 11:14:24 AM PDT

          [ Parent ]

      •  The key is hoping for the best (2+ / 0-)
        Recommended by:
        elfling, Fabian

        but planning for the worst -- closing a school when there's only 1-2 kids sick (which is the case here in the Bay Area in several cases) can keep more kids from getting sick, and bringing it home to folks who might not be able to handle it as well (especially infant siblings or older relatives). And it might show businesses that they have to have contingency programs in place for when their employees are sick or have to stay home with sick children or other relatives.

        Civility is the way of telling someone to go fuck themselves in such a way that the someone agrees it probably is a good idea.

        by Cali Scribe on Sun May 03, 2009 at 11:11:50 AM PDT

        [ Parent ]

    •  No shit! (0+ / 0-)

      Talk about a total bunch of crap. The W.H.O. and the CDC need to wake up to the real world and stop acting like Homeland Security on steroids under the BV$H regime. Why did they issue these hyped up alerts with almost NO data from Mexico. Mexico of all places! Mexico where the daily death rate for the drug war is probably 10X's the fastly deflating death for this so called Pandemic. Less then 1,000 cases world-wide and we panic humanity because Mexico has it's head up it's proverbial ass. This is a mess!! If I where the President I'd have some heads rolling on this one!

      This is happening because of 8 yrs. of hyped up fear. These agencies all need a good douche to get rid of the scary cowardly people that scream Fire in a crowded theater the minute they THINK they smell smoke. It's usually their own bad breath. This pisses me off.

      "It's better to die on your feet then live on your knees" E. Zapata

      by Blutodog on Sun May 03, 2009 at 08:52:15 AM PDT

      [ Parent ]

  •  Is it true that the demographic getting hit the (2+ / 0-)

    hardest are people under 21? Could there be natural immunity for older people who have been exposed in the past to a variant of this virus?

    Wingnut heads explode:
    Anita Hill for Supreme Court Justice

    by shpilk on Sun May 03, 2009 at 08:41:57 AM PDT

    •  hard to know (6+ / 0-)

      so many cases were from NYC high schools, it's tough to say this early on. The range is from 1 to >80.

      "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 May 03, 2009 at 08:47:06 AM PDT

      [ Parent ]

    •  A news comment (1+ / 0-)
      Recommended by:
      shpilk

      One comment on the news was that before 1957 there was a similar virus strain that could have set up some immunity at that time.

    •  there's apparently some mild immunity in >60 (5+ / 0-)

      that's a good thing.

      "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 May 03, 2009 at 08:47:30 AM PDT

      [ Parent ]

      •  natural immunity (1+ / 0-)
        Recommended by:
        Tin hat mafia

        is what vaccination is intended to mimic.

        In this case we have a mild form of H1N1 which, if allowed to spread, would provide population wide natural immunity should more virulent, and more deadly, strains develop in the future.  Since there is little chance of having sufficient H1N1 vaccine ready before next year's flu season one could argue for using existing supplies of tamiflu to protect the particularly vulnerable populations, while letting the general population be immunized "naturally".  Of course I'm biased . . . as part of the "over 60" crowd I've already had H1N1, and already have some "natural immunity" . . .

        •  that's essentially (1+ / 0-)
          Recommended by:
          LABobsterofAnaheim

          the idea, but tamiflu would have no effect on immunity.

          "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 May 03, 2009 at 09:24:55 AM PDT

          [ Parent ]

          •  correct . . . (1+ / 0-)
            Recommended by:
            LABobsterofAnaheim

            it would reduce morbidity/mortality in the vulnerable populations while allowing immunity to develop even there.  "mild" H1N1 is simply like a naturally distributed vaccine . . . unfortunately there must be enough symptom for it to spread, and some people will become seriously ill.  Those are the ones that should get tamiflu.

        •  Yea, well, fuck that. (0+ / 0-)

          I'm in a high risk group because I suffer from cardiovascular disease. I don't intend to subject myself to the ravages of this virus voluntarily, because it could kill me or cause long term complications. I don't particularly care that many people seem to think that this is "mild" iteration of the swine flu. H1N1 could be very hazardous for me personally, and I therefore support a strategy of viral suppression and eventual vaccination.

  •  "Pork is safe to eat" (1+ / 0-)
    Recommended by:
    Catatonia

    They are going out of their way to say that. Of course, except for the occasional salmonella or trichinosis, and that overall, fatty meats like bacon aren't good for you, the pigs are pumped up with antibiotics, and that the massive pigshit lagoons are foul-smelling, leaching into groundwaters and rivers, breeding diseases (as we see now), and will kill you directly if you got into one without breathing apparatus. But, hey, as long as the price is affordable, right?? We don't have to give a living wage, right?

  •  Sacramento Area (3+ / 0-)
    Recommended by:
    Fabian, ms scarlett leadpipe, KimD

    I have heard that we have three schools closed.  One confirmed case will close the school for 14 days.  All the children in the family need to stay home even if they attend other schools.  My understanding is that public health goes to the home of the confirmed case and gives Tamiflu to the entire family.  There are enough suspects being checked out that I feel we are still at the beginning right now.

  •  At Risk Patients (9+ / 0-)

    Both my wife are what many call "At Risk Patients", people with problems already that if they catch the Flu it would be more dangerous for them than a healthy person. On Friday I was picking up meds for my wife and I when I asked the Pharmacist at the County Pharmacy if she had a good stock of Tamiflu on hand. I was a bit surprised when she told that was classified info she couldn't discuss. Because I have been known to drop off a box of choc. or 2, or some flowers to say thank you to the staff there for all they do for us, ( they bendover backwards to make sure my wife always has her 27 different meds ) I left there knowing by hints that they do have a small amount on hand but not much.
    I bring this all up because I have heard very little discussion about the At Risk group of Americans and what they should be doing.

    Grow Marijuana go to Prison, Torture a Detainee to Death and earn a Medal. No wonder people get high.

    by SmileySam on Sun May 03, 2009 at 08:45:44 AM PDT

  •  It's Geithner's fault! (1+ / 0-)
    Recommended by:
    LABobsterofAnaheim
  •  Day Care Centers? (0+ / 0-)

    I wonder what parents are doing while their kids stay home from school. Call in sick? Go, and pay for day care? (Many parents can't afford it.)

    Bring kids to work?

    None of these options are really acceptable for many people.

    Before public education, one parent would stay home and the other worked. I bet a lot of people would like to return to that model (but without the higher salaries)

    The right wingers in private say "why train people for jobs that don't exist?"

    Lets pray that we dont see more of these illnesses, they could end up destroying public education (or whats left of it)

  •  I agree completely on closing schools (6+ / 0-)

    but I heard a story yesterday on NPR that makes me wonder whether the closings will make much of a difference in some places. Apparently, in the wake of school closings in Fort Worth, hundreds of parents decided to take advantage of the unexpected holiday and take their kids to the zoo.

    Kinda defeats the purpose of school closings, eh?

  •  Pandemic = Spread not severity (5+ / 0-)

    You can't say too much to correct the misconception ... and why it still matters.

    To me, the problem of that spread is not necesssarily how many people die; it is how many of us are all sick at once this month.  

    I don't know what percentage of absentees in crucial service jobs will make life miserable for everyone, but I'd rather not carry out the experiment to find out.

    And remember: If you don't like the news, go out and make some of your own. - Scoop Nisker, the Last News Show

    by North Madison on Sun May 03, 2009 at 08:57:15 AM PDT

  •  Mapping H1N1 (0+ / 0-)

    From  Adena Schutzberg at All Points Blog

    Developing, Documenting and Sharing Dr. Niman's H1N1 Flu Database

    A comment to my post earlier this week on Mapping Swine Flu pointed me to Rhiza Labs, a company working (gratis) with Dr. Niman (bio) on mapping the spread of the disease. I spoke with Michael Higgins, Rhiza Labs CTO, who gave me a better handle on the data set, sharing that data, and the maps.

    If you head to Rhiza's FluTracker website (I noted the company when it launched its Insight product at Where 2.0 last year) you'll see a different map using Dr. Niman's data. Rhiza is periodically downloading the data Dr. Niman and team are collecting and putting them into the Insight system. Higgins was just doing that when I interrupted him...ooops. The Rhiza map cites sources: "The map was compiled using data from official sources, news reports and user-contributions" and uses a different categorization/symbology of the data: confirmed, suspected, negative and fatality. Higgins notes that the "user contributions" as he understands it are only from Dr. Niman.

    Below the map are icons for an RSS feed of the data and a KMZ download of the data; Higgins noted that these sets are simple point location data with no attributes. Right next to them is a link to download the entire (public domain) dataset in CSV format. More on the nature of the data in a second.

    If you click on the map on the main page you'll get a larger interactive map (basically you are in the Rhiza system, Insight that made the map on the front page). Now things get interesting! If you click on a symbol you'll get the record(s) associated with the point(s). Click on fatality/status and you can see the full record - description, lat/long, many other attributes and what I'm interested in: Source URL - the source of the data. Now, not all the points, Higgins explained, especially those collected early on, have sources. If you like you can create a login (see top right of the page) and have access to comments and other capabilities.

    Higgins has some other plans as time (the company is scrambling to do this work alongside actual paying work) and data permit including producing some animations of the cases over time and creating queries that show data only from "authoritative sources. Further, the company is creating snapshots so that it will be possible to go back to different points even as data is updated and corrected.

    FluTracker

    Background here

    There are animations now. I'll pull link and directions for using the data from a chat I had with RhizaLabs CEO Josh Knauer and post it shortly.

  •  If you are sick, you should see a doctor, (1+ / 0-)
    Recommended by:
    KimD

    right?  What is the treatment being given to those people?  

    "Neither a borrower nor a lender be"

    by HenryBurlingame on Sun May 03, 2009 at 09:02:19 AM PDT

    •  in most cases (5+ / 0-)

      supportive care, only. most cases don't need tamiflu. in special circumstances, tamiflu or relenza is used.

      http://www.cdc.gov/...

      Interim Guidance for H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home

      "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 May 03, 2009 at 09:05:08 AM PDT

      [ Parent ]

    •  That sounds so easy. (0+ / 0-)

      My pediatrician doesn't want to see merely "sick" kids.  Coughing, vomiting, fever, diarrhea?  Nope.  A high fever, vomiting/diarrhea for more than 3-5 days, dehydration, or more serious symptoms - bring them in.

      There's not much a doctor can do for standard cold & flu but give advice.

      Proud member of the Cult of Issues and Substance!

      by Fabian on Sun May 03, 2009 at 09:52:20 AM PDT

      [ Parent ]

      •  Me, I'd get a new pediatrician (0+ / 0-)

        Any doctor who "doesn't want to see sick kids" ought to be a game warden out in the wilderness.

        Always grateful to wake up alive.

        by Subo03 on Sun May 03, 2009 at 10:04:26 AM PDT

        [ Parent ]

        •  She's a good doc. (1+ / 0-)
          Recommended by:
          elfling

          Kids get what's going around all the time.  I think parents take them to the doctor either because they panic, or because they can't afford to stay home and care for their sick kid.

          The office has a nurse to answer questions and dispense advice.

          I've diagnosed my kids accurately.  Strep throat once, a UTI once - the doctor visit is just for the tests and write the prescription for antibiotics.  If it is really serious, we go straight to the ER.  (Been three times, admitted twice - it's a good track record.)

          Proud member of the Cult of Issues and Substance!

          by Fabian on Sun May 03, 2009 at 10:25:23 AM PDT

          [ Parent ]

          •  For your kids (0+ / 0-)

            Not every sick child can depend on having a parent as educated and experienced as you are.  parents, of course, are the ost important health care providers of their children just as they are of their education.  I still look askance at a doctor who avoids the sick.

            Always grateful to wake up alive.

            by Subo03 on Sun May 03, 2009 at 10:35:03 AM PDT

            [ Parent ]

            •  It's not as bad as it sounds. (1+ / 0-)
              Recommended by:
              Cali Scribe

              If I had called for an appointment, I'd probably be asked for the cause and if all I had was fever/vomting/diarrhea, they'd probably ask a few more questions to find out if it was serious enough to warrant an office visit.  They wouldn't deny me an office visit, but they would point out that if it was a virus that they wouldn't be able to do much.

              I am more (unofficially) educated than Joe/Jane Average.  I just worked in a clerical capacity at a children's hospital.  I picked up a few things like the difference between what your pediatrician can do for you and what a hospital can do for you.  Doctors are great, but if you need more than some routine tests and you need them NOW, then skip the doctor and head to the ER.  

              Proud member of the Cult of Issues and Substance!

              by Fabian on Sun May 03, 2009 at 10:44:16 AM PDT

              [ Parent ]

  •  Thank you DemFromCT (6+ / 0-)
    Recommended by:
    DemFromCT, 88kathy, Fabian, Femlaw, KimD, Snowy Owl

    Pundit roundup A

    Pandemic watch A+

    Thanks you here in the Netherlands we need less  scare tatics and more transparency & information.

    I get my info from dailykos.

    THanks  you very much

    "John McCain likes to say that he'll follow bin Laden to the Gates of Hell - but he won't even go to the cave where he lives."

    by nase48 on Sun May 03, 2009 at 09:03:05 AM PDT

  •  A hypothetical counter argument (1+ / 0-)
    Recommended by:
    DemFromCT

    H1N1 appears to be mild. Flu viruses are very contagious by their nature. There is a strong selection pressure for contagion on the flu virus population. I don't see a strong selection for lethality, unless that's somehow linked to contagion, say through improper procedures with very ill/dead folks. If there is some area of the world where the virus is mutating to favor lethality then it would be important to have as much of our population with an immunity as possible at exposure time to the new, more lethal, strain. That would say that the non-intervention model would have the least overall mortality if the virus mutates into a more deadly version somewhere else and is introduced after the H1N1 flu appears here.

    This is an extension of the theory that normal exposure to pathogens is advantageous by creating a more resilient immune system.

    Again, this is hypothetical but has some interesting conclusions regarding isolation.

    •  but the virus will spread now (2+ / 0-)
      Recommended by:
      The Wizard, KimD

      and vaccine would only be ready in the fall, so if you KNEW the virus would be lethal (see 1918), great. Infect everyone, and some will die iof it is widespread because flu does that.

      if you don't know that, what do you do?

      "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 May 03, 2009 at 09:21:59 AM PDT

      [ Parent ]

      •  I agree, it's a high risk game (0+ / 0-)

        Those in charge are playing with relative mortality rates for various scenarios. Someone made the decision not to close the borders and not to track and isolate every single infection in the US, probably because it is so contagious that it would be difficult. But that decision will result in some deaths. What ever happens I would support our public health officials as all decisions carry risk and may turn out to appear to be not optimum relative to some other hypothetical scenario, mine included. Let's keep our fingers crossed.

    •  Your argument is based on a fallacy (1+ / 0-)
      Recommended by:
      elfling

      We have no power to stop this from spreading.  That is not what this is about.  As I said in a comment above, the 1918 flu strain was caught by literally 90% of the planet within three years of when it first showed up.

      All we can do is slow down its spread, so that not everyone gets it at the same time.  

      (-8.50, -7.54) Only the educated are free. -Epictetus

      by Tin hat mafia on Sun May 03, 2009 at 09:51:53 AM PDT

      [ Parent ]

      •  No, we have vaccines now - BIG DIFFERENCE (0+ / 0-)

        This is true if we don't have vaccines.  Everyone will get infected eventually, but now that we have a vaccine that will be available in the fall there is a great incentive to stop infections now -now matter if it is mild or not.

        Also, the attenuation of the virus could take years and the first mutations could be to a more, not less, virulent strain.

  •  Dem, this is a good informative diary (0+ / 0-)

    I have thought that closing schools with one case is overreaction.  We have 15,000 people in my "school".  If they close on our first case, what was the probability that the flu would spread from that one person?

    How long should a school close based on a single or few cases?  When should you be able to diagnose whether case 0 has spread?

    Give every American a fair chance at the race of life - A. Lincoln and B. Obama

    by captainlaser on Sun May 03, 2009 at 09:20:58 AM PDT

    •  flu is a good but not super-spreader (3+ / 0-)
      Recommended by:
      Catte Nappe, captainlaser, KimD

      and they are infectious, don't forget, a day prior to symptoms. if no more cases appear, and the incubation period is a week, but kids shed for maybe 10 days, the 2 week period is being suggested.

      "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 May 03, 2009 at 09:23:41 AM PDT

      [ Parent ]

      •  I better plan for that "take home" final. (3+ / 0-)
        Recommended by:
        Fabian, Abra Crabcakeya, KimD

        Great diary.  Loved that Philly/St.Louis diagram.  

        Give every American a fair chance at the race of life - A. Lincoln and B. Obama

        by captainlaser on Sun May 03, 2009 at 09:37:11 AM PDT

        [ Parent ]

        •  I suspect you'll see backing off (1+ / 0-)
          Recommended by:
          captainlaser

          of closure over the next week... as the concern shifts toward the fall.

          But I did want to explain why they did what they 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 May 03, 2009 at 10:21:00 AM PDT

          [ Parent ]

          •  Tx. Not that a couple of weeks off from work (0+ / 0-)

            doesn't sound attractive but finishing the semester is also very attractive.

            There is a cry wolf danger here with the anthrax scare, the H5N1 danger and now this.

            Let's hope that they get an effective vaccine built and tested over the summer.

            Give every American a fair chance at the race of life - A. Lincoln and B. Obama

            by captainlaser on Sun May 03, 2009 at 10:39:04 AM PDT

            [ Parent ]

    •  You've also got to consider (0+ / 0-)

      that in that one class with 1-2 cases, there may be students who have siblings in other grades, with the potential to spread it throughout a school. Sometimes it's best to err on the side of caution.

      Civility is the way of telling someone to go fuck themselves in such a way that the someone agrees it probably is a good idea.

      by Cali Scribe on Sun May 03, 2009 at 11:25:17 AM PDT

      [ Parent ]

  •  My son's school closed on Friday... (2+ / 0-)
    Recommended by:
    Fabian, KimD

    ... He got into the car saying, "Spring Break 2 -- Swine '09!"

    Nobody's sick. Thank God he's got World of Warcraft to keep him busy all next week.

    Republicans: Fluffy. White. Happy. -- The Daily Show

    by romwriter on Sun May 03, 2009 at 09:39:30 AM PDT

  •  Thanks for this DemFromCT (5+ / 0-)
    Recommended by:
    Catte Nappe, Fabian, KimD, Snowy Owl, CKendall

    Lots of good info:

    I'm not sure whether pandemic sounds better/worse than epidemic to most Americans.

    It is unfortunate that some reports are describing the deaths so far as 'no big deal' since seasonal flu typically results in more fatalaties. Even if no more people die from this, it is still a tragedy.

    I wouldn't assume that Adults are that good about washing their hands.

    A large part of the problem has to do with the government's lack of credability. After lying to people so much for the last eight years, it's a little tough to say "trust me".

    Do we know if there is any corralation between one person having a mild case, and how virulent the illness will be to those exposed to that individual?

    Henceforth I ask not good fortune. I myself am good fortune. Walt Whitman

    by Sacramento Dem on Sun May 03, 2009 at 09:40:09 AM PDT

    •  the Harvard SPH had 60% adults washing hands more (3+ / 0-)

      that's the glass half full,

      "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 May 03, 2009 at 10:23:34 AM PDT

      [ Parent ]

      •  reference (2+ / 0-)
        Recommended by:
        Sacramento Dem, KimD

        http://www.hsph.harvard.edu/...

        More than half of Americans are responding to the outbreak by washing their hands or using hand sanitizer more frequently (59%), and a quarter are avoiding places where many people are gathered, like sporting events, malls or public transportation (25%).

        "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 May 03, 2009 at 11:40:34 AM PDT

        [ Parent ]

    •  Excellent point. (2+ / 0-)
      Recommended by:
      Sacramento Dem, Catte Nappe

      A large part of the problem has to do with the government's lack of credibility. After lying to people so much for the last eight years, it's a little tough to say "trust me".

      With the right-wing media blasting nonstop untruths about Obama, his administration and anything to do with "government," maintaining/gaining trust on any front is an ongoing challenge.  

      "Don't let what you cannot do interfere with what you can do." John Wooden

      by CKendall on Sun May 03, 2009 at 11:47:27 AM PDT

      [ Parent ]

    •  Hand Washing (0+ / 0-)

      I wouldn't assume that Adults are that good about washing their hands.

      I see so many people use a restroom and leave without going near a sink...

      makfan, San Francisco, -4.25 / -5.33

      by makfan on Sun May 03, 2009 at 02:38:36 PM PDT

      [ Parent ]

  •  If the schools don't close (0+ / 0-)

    can't they spend lots of time washing the kids' hands?

    that's the ticket

    Wash them when they arrive
    Wash them before lunch
    Wash them after lunch
    Wash them before they go home

    Freedom isn't free, but don't tax me. Fox 527 on your dial.

    by 88kathy on Sun May 03, 2009 at 09:43:03 AM PDT

  •  Also....influenza is susceptible to alcohol (3+ / 0-)
    Recommended by:
    Abra Crabcakeya, KimD, CKendall

    so hand sanitizer should kill it if used liberally (and we know what that word means here, right?)...

    I did a diaryon it the other day.

    (-8.50, -7.54) Only the educated are free. -Epictetus

    by Tin hat mafia on Sun May 03, 2009 at 09:53:37 AM PDT

  •  High post quality here shows why news is dying (4+ / 0-)

    Who needs newspapers when you have high quality information like this?  The posts often come from people who really know what they are talking about, and are not filtered through a reporter who does not know what they are talking about.

    The posts here on the H1N1 flu are of higher quality than you will find just about anywhere.

    Congrats KOGS!

  •  CDC just announced reports of flu in every state (1+ / 0-)
    Recommended by:
    KimD

    Just on C-Span... It came out after being asked what was meant by the disease being "widespread".

    One-fifth of Americans believe that the sun orbits the Earth. -W Kristof, NY Times

    by yammatal on Sun May 03, 2009 at 10:46:35 AM PDT

  •  Travel restrictions placed on U.S. citizens (3+ / 0-)
    Recommended by:
    thebes, Abra Crabcakeya, KimD

    My mother just told me that a group of teachers from the D.C. area were scheduled to make a trip next week to Reggio Emilia, Italy, where they've gone for years to observe how pre-school education is done.  The Italian government [regional or federal, I don't know] has just forbidden them.

    •  That's a shame (1+ / 0-)
      Recommended by:
      conlakappa

      My daughter attended a Reggio Emilia preschool in DC and her teachers learned so much from those trips and always came back with many great ideas.

      •  I don't know if they'll be able to go at a later (0+ / 0-)

        date but the trip was just canceled last week.  They were due to leave this coming Thursday.  I met a bunch of educators going there 17 years ago so the tradition seems a solid one.  I hope they have the opportunity again soon.

  •  Very good article , this - better than a lot of (4+ / 0-)
    Recommended by:
    DemFromCT, makfan, KimD, CKendall

    the CE info and alerts I got as a public health worker a few years back.Odd how people refer to info and warnings from CDC and local HDs as "overreaction" , somehow confusing government agencies doing their jobs and doing them very well indeed with the crap they watch on television. Inabilty of so many to comprehend and evaluate what they read is a startling view into the failings of the educational systems in the US in recent years.Unpleasant reminder , too , that IQ is pretty much a bell shaped disribution; as many people in range of 60 to 80 as in range 120 to 140.Scary , isn't it?

  •  Thank you for the great diary! (4+ / 0-)
    Recommended by:
    makfan, Abra Crabcakeya, KimD, CKendall

    I've summarized it, included the link and sent it to friends who are beginning to question the necessity of school closings.

    The graphs, especially, really make the point - thanks again for all your work!

  •  This is Bull-Where do kids go when school is out? (0+ / 0-)

    The SJ Merc News interviewed a bunch of kids from the closed schools in Santa Clara county last week, and guess what...they go to the MALL.

    Yep, that's a way of eliminating the spread of disease. Send all the kids to circulate with the general population.

    This including some schools that were closed not because they even had kids with suspected swine flu, but because the schools were near other schools that had suspected cases.

    H1N1 is so overhyped, nobody's making rational decisions here. In the meantime, genuine public health problems continue to get short shrift (the rise in infant mortality, the millions who are now out of health insurance because of the recession, poisoned water and air, etc etc).

    And in this case -- TDK making things worse by joining in the hysteria.

    Some people are intolerant, and I CAN'T STAND people like that. -- Tom Lehrer

    by TheCrank on Sun May 03, 2009 at 01:09:02 PM PDT

    •  perfect name, Crank (2+ / 0-)
      Recommended by:
      CalifSherry, Abra Crabcakeya

      "Where do kids go when school is out?"

      You'd best be working that out, pal. Because, as has been demonstrated, schools WILL close. Hopefully, no more than they have to. In a more severe scenario, every school in the state would close when there's need.

      Now, what will happen in the next week is that the need to do so IN THIS CASE will be re-evaluated, and my best guess is that the advice from CDC will change to match the situation. It's interim advice, and meant as such, subject to change.

      Now, you may have meant that school closure more than just an inconvenience to you, but it didn't come out that way. And there is nothing stupider than people railing about hysteria when there isn't any.

      "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 May 03, 2009 at 01:25:51 PM PDT

      [ Parent ]

    •  oh, and this bit (2+ / 0-)
      Recommended by:
      CalifSherry, Abra Crabcakeya

      "H1N1 is so overhyped, nobody's making rational decisions here" is demonstrably false.

      You may not like the decision.
      You make think it is poorly implemented.
      You may think you are uninformed about the rationale.

      But there's nothing panicky about it. it's just a decision you don't agree with, and true to your name, you have to call everyone else who disagrees with you names.

      "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 May 03, 2009 at 01:28:02 PM PDT

      [ Parent ]

  •  My daughter's preschool just closed (4+ / 0-)

    and I have been working hard to take that in stride and recognize it as my county's public health department doing the best they can to protect as many of us as possible.

    Thanks for the diary, it helped me with that process.

    Losing a week of productivity is rough but keeping my asthmatic daughter from catching a new flu strain we have no immunity to and no vaccine for is probably worth it.

  •  Thank you for doing these (2+ / 0-)
    Recommended by:
    CalifSherry, elfling

    Very informative and helpful.

    I know I am getting supremely frustrated by the nay-sayers - "over reaction", "30K die anyway", "it's just a mild flu" etc. Appreciate you hanging in on the subject anyway.

    There are so many notable differences with this one. If few of us have immune protection, then almost everybody could come down with it. "Mild" doesn't mean what people think it means. And if nothing else, this is cause for thought about closing schools:

    Scientists are still gathering information on how severe the nation's 30 hospitalized cases are, she said. They are mostly older children and young adults, in contrast to ordinary flu, which tends to send the elderly and very young to the hospital, Schuchat said.

    http://www.google.com/...

    "People who have what they want are fond of telling people who haven't what they want that they really don't want it." Ogden Nash (on universal health care?)

    by Catte Nappe on Sun May 03, 2009 at 03:19:58 PM PDT

  •  Source? (1+ / 0-)
    Recommended by:
    elfling

    In 1918, during the terrible pandemic of that year, Philadelphia refused NPI (closing schools, canceling public gatherings), and look what happened compared to St. Louis, which did.

    I'm in conversation with a skeptic who would like to see the numbers behind your graph.

    •  you can find it multiple places (3+ / 0-)
      Recommended by:
      CalifSherry, elfling, Catte Nappe

      http://www.nih.gov/...

      Rapid Response was Crucial to Containing the 1918 Flu Pandemic

      Historical Analyses Help Plan for Future Pandemics

      One of the persistent riddles of the deadly 1918 Spanish influenza pandemic is why it struck different cities with varying severity. Why were some municipalities such as St. Louis spared the fate of the hard-hit cities like Philadelphia when both implemented similar public health measures? What made the difference, according to two independent studies funded by the National Institutes of Health (NIH), was not only how but also how rapidly different cities responded.

      "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 May 03, 2009 at 05:52:03 PM PDT

      [ Parent ]

    •  more from that article (2+ / 0-)
      Recommended by:
      CalifSherry, Catte Nappe

      Officials in St. Louis introduced a broad series of public health measures to contain the flu within two days of the first reported cases. Philadelphia, New Orleans and Boston all used similar interventions, but they took longer to implement them, and as a result, peak mortality rates were higher. In the most extreme disparity, the peak mortality rate in St. Louis was only one-eighth that of Philadelphia, the worst-hit city in the survey. In contrast to St. Louis, Philadelphia imposed bans on public gatherings more than two weeks after the first infections were reported. City officials even allowed a city-wide parade to take place prior to imposing their bans.

      "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 May 03, 2009 at 05:53:36 PM PDT

      [ Parent ]

  •  Hmmm. 1% seems to be pretty well chosen for (3+ / 0-)

    an illness that may be both contagious and dangerous.

    Even that, though, probably isn't enough if you're talking something ebola deadly.

    So -- I guess, one is stuck with squish room.

    Sounds like there is great value in medical "special forces" or "SWAT" teams that go in very quickly and make the best possible early assessment of risk to help all those decision makers around the world figure out where to draw the line.

    Frankly, I'm just glad it's not me making the call because it's impossible to do without setting off a chorus of second-guessers (yours truly included).

    Free speech? Yeah, I've heard of that. Have you?

    by dinotrac on Sun May 03, 2009 at 07:54:44 PM PDT

    •  yes (2+ / 0-)
      Recommended by:
      dinotrac, SkylarkingTomFoolery

      Sounds like there is great value in medical "special forces" or "SWAT" teams that go in very quickly and make the best possible early assessment of risk to help all those decision makers around the world figure out where to draw the line.

      and CDC and WHO employ them. Right now, they are in Mexico and NYC.

      "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 Mon May 04, 2009 at 04:22:10 AM PDT

      [ Parent ]

      •  Seems like there is tremendous bang for buck (0+ / 0-)

        in:

        1. Giving those teams the support to expedite good information, and
        1.  Making sure decision makers understand why the recommendations are what they are.  That, of course, is done ongoing, not at the time of an outbreak, when everybody gets a little loopy.

        Free speech? Yeah, I've heard of that. Have you?

        by dinotrac on Mon May 04, 2009 at 04:30:59 AM PDT

        [ Parent ]

        •  bingo (1+ / 0-)
          Recommended by:
          dinotrac

          we call it 'rebuilding public health infrastructure', a phrase you've likely seen used.

          "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 Mon May 04, 2009 at 05:41:10 AM PDT

          [ Parent ]

          •  The funny thing is, that some of it is cheap. (0+ / 0-)

            Small well-equipped teams with the resources they need probably costs a lot less than the country spends on aspirin in any given month.

            Disseminating information and clearly enunciating the reasoning behind well-thought-out recommendations has to be cheaper than willy nilly panic.

            We've certainly proven that you can spend a lot of money for spotty care.  Seems like a good time to show how being smart instead of stupid could improve both care and cost effectiveness.  And, of course, to be grateful that this flu outbreak looks to be a lot less dangerous than it initially appeared.

            Free speech? Yeah, I've heard of that. Have you?

            by dinotrac on Mon May 04, 2009 at 06:49:45 AM PDT

            [ Parent ]

  •  Where's George? Software forecasting (0+ / 0-)

    progression of outbreak(s): New York Times.

    •  ha ha (0+ / 0-)

      Indeed, the models are not so reassuring if one multiplies the four-week projection by the typical so-called doubling time for a flu pandemic, in which the number of cases doubles every 2.3 days. Do that, and every person in the United States is infected by mid-July. "But we don’t do that," Dr. Brockmann said, "because that would be completely unscientific."

      but other than that...

      "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 Mon May 04, 2009 at 04:24:01 AM PDT

      [ Parent ]

    •  in any case (0+ / 0-)

      the model should be in the right ballpark.

      "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 Mon May 04, 2009 at 04:27:12 AM PDT

      [ Parent ]

  •  Resource for tracking H1N1 Swine Flu (0+ / 0-)

    The CDC and WHO are not reporting all of the suspected and confirmed cases of H1N1 Swine Flu in a timely manner.  You can find out where the flu has spread to, as well as help collect more data and create your own visualizations of the data on http://flutracker.rhizalabs.com

    Sourced from local news reports and local, state and federal agencies, the researchers running the FluTracker site have made it the most comprehensive and accurate sources of information and data on the outbreak.

    See you there!

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