A little Friday levity to share. Last night I had the good fortune to participate in Carbondale, Colorado's Seuss-A-Palooza, a local homage to Theodor Seuss Geisel, aka Dr. Seuss. I must say, it was a refreshing, delightful, warm local gathering of adults and young'uns that surely lifted all spirits in this season of political sword fighting. Highly recommended if you have an event of this nature in your whereabouts (usually held on or around Seuss' birthday, March 2nd). I could attempt comment here on the political undertones of Seuss' writings, or the comparisons between Bush and Dr. Seuss. But instead I'll just post my adaptation of "Horton Hears a Who" in observation of anyone who's suffered a bout with the crud this winter. Here's hoping a smile will contribute to your speedy recovery:

Horton Has The Flu

On the 6th day of March, in the mountains of Aspen,
In the white of the snow there was heard a great gaspin’
He was thrashing, and struggling with a chest full of goo
It was Horton the elephant, fighting the flu.

(don't skip the flip...)

Just in case somebody needs a break from our exciting political season, don't forget the flu!

I was digging through some of my Great-Grandfather's papers and came across a letter from my great-aunt written on March 25, 1919.

At the time, her husband was a young doctor in the small farming town of Chambers, Nebraska.  Today's population is 306, so it was probably higher then, but it is at the edge of the Nebraska Sandhills, where farming is marginal.

The letter...

I commend the work done by Revere at Effect Measure and Daily Kos diarist DemfromCT to promote public awareness of the threat of a flu pandemic posed by the H5N1 strain currently epizootic in birds. This has been a useful handle to sling the issue of public health emergency preparedness generally.  But now I think it's time to move this discussion onto much broader ground.

Frankly, in my view, the more time passes without the H5N1 bird flu evolving into a human transmissible strain, the less likely it is that it will ever happen.  (Whether I'm right about that is irrelevant to my point.) Meanwhile, after a few years of raising the alarm, it's starting to sound to a lot of people like Chicken Little.  As far as I'm concerned, the issue was never one particular strain of one particular virus, and the leadership of the World Health Organization clearly agrees with me.  WHO has just released the World Health Report for 2007, and it focuses on public health emergency preparedness -- but it never once mentions bird flu.

While it doesn't make news here, because it's not American deaths or a change from a simmering baseline, H5N1 still percolates in hot spots like Indonesia's Bali. Several resources help illustrate the problem. This map from Bali, Indonesia, where 1.5 million tourists from all over the world visit each year, tracks suspected cases of H5N1. It's put together by volunteers at Flu Wiki:


While a suspected case is not a proven case, not all samples in Indonesia make it to authorized labs for verification, and some of the suspects might have been placed placed on tamiflu, which is suspected of negating accurate testing. While the total number of cases is likely more than official counts, at this point it's not much more. There's no immediate pandemic happening, but H5N1 remains a candidate for one.

Also, a recent acknowledgment of human to human transmission in Indonesia (one of the human hot spots along with Egypt and Vietnam) highlights the need for vigilance.

A new study by a US university has apparently confirmed for the first time that bird flu has been transmitted from human to human.

It is the nightmare possibility that health authorities have been fearing ever since the disease first appeared.

It happened in Indonesia last year and reveals the world only narrowly avoided a global bird flu pandemic.

Did you know that there's a flu outbreak in Australia that's tying up their medical system in knots? And that six kids and nine three adults have died? That's what happens in a bad flu season.

The figures, provided by the federal Department of Health and Ageing today, are believed to be just a fraction of actual flu infections, but they give the best seasonal comparison.

They offer official confirmation that the nation is in the grip of its worst influenza season in many years, with nine lives lost so far.

Six children from four states have died from one of two virulent strains of influenza A virus, H3N2 or H1N1.

Three adults – a 37-year-old Queensland man, a 48-year-old woman from South Australia and a 33-year-old Queensland mother-of-two – have also died after suffering flu-like symptoms.

Severe flu seasons can be as bad or worse than a mild pandemic. Here's a post from our colleague Revere, one of the epidemiologists at Effect Measure, the pogressive public health blog, outlining exactly that. From Effect Measure:

Given our posts (here, here) on the particularly severe flu season in Australia, we thought it useful to remind ourselves that a bad flu season can be really bad -- worse than the 1918 pandemic in some locations. Here is a post we did back in April 2006 about an interesting paper (see link in post) by Cecile Viboud and her colleagues at NIH that looks at historical records on flu mortality. Flu is a bad disease, pandemic strain or not. Why some flu is worse than others we don't know.

The hospital diversions and capacity overflow is a reminder that health issues in this country (not just Australia) need to be kept front and center as a priority. A bad flu season would overwhelm our own EDs

A [2002] study to be published in the April 2002 Annals of Emergency Medicine on emergency department use and capacity in California, sheds light on the overcrowding problem nationwide and provides the first objective data on this crisis in the United States. (Trends in the Use and Capacity of California's Emergency Departments, 1990-1999).

The study finds that in the past decade (1990-1999) emergency departments in California decreased by 12 percent, while the number of emergency department visits at each hospital increased 27 percent to about 25,778 annually.

and the efforts to prepare for a flu pandemic (whatever strain of virus) only highlight the health infrastructure issues here in the US that are every bit as ignored as crumbling bridges... until they collapse. To their credit, California is trying to address surge capacity issues in their hospitals. Is that happening in other states, with backing from the legislatures?

The SCHIP program's proposed expansion to cover underinsured children (and Bush's virulent and mean-spirited opposition) is in the news now, and other health care issues need to stay in the news through the primaries and right up to the election. Government has an important role in rebuilding our health infrastructure, and we need to make sure the candidates from both parties articulate what they see that role as.

From universal health care coverage to single payor alternatives to mental health coverage to SCHIP and children's insurance, there needs to be a question about health care and public health in every debate from here on in, both for the GOP and for the Democrats. America needs to know what alternatives they have when they go to the voting booth, and what the alternatives will cost (nothing is free). GOP reliance on private sector alternatives need to be highlighted and explored (See Gene Sperling's evaluation of SCHIP).

This election cycle, health and public health infrastructure cannot be ignored, or it, too, will crumble under the ordinary stresses of a flu season (or worse). There's a reason SICKO had such an impact when it was released. And "no one could foresee..." will not be an acceptable answer.

Yes...I wrangled Butterflies today. I had no idea that they arrived via overnight air in little see-through envelopes, either alone or with a little travel buddy. Hundreds. Chilled. Wings straight up. Awaiting "re-awakening" in the sun, in a safe environment to slurp up the pre-set butterfly food stations (i.e., plants with serious necter)

The joy is certainly sublime. Watching a butterfly unfurl it's wings, unsteadily flap them to ready them for flight, soak up the sun then fly off hesitantly only to come back like a insect boomerang and land gently on...your nose.

We almost didn't get them in time. Apparently, the Homeland Security Department has something against these little "flutterers"

But...You came here for NEWS....see below the fold...

If I was to write a several hundred word diary about Barack Obama's signature foreign policy speech, ripping it to shreds based on how it was viewed through the twisted prism of some neo-con analysis, I would've bothered to read the entire speech first.

But, unfortunately, our good friend bought the neo-con spin hook, line and sinker.  I'm writing this diary to unhook him and set him free.

This will be a short diary, as I am NOT AN EXPERT.  But I didn't see this diaried, and would like to get input from the flu experts on this site.  Maybe one of them will write another diary, or comment here

I'm just getting over some kind of cold from heck during which I had a 104 degree fever but otherwise was never quite obviously sick enough to call the doctor.

But I am hypochondriacal enough to try to use Blogsearch to see if I have some kind of thing other than the usual "winter sucks" bug. It looks as if there is, but it's hard to tell. To me, one possible indicator is that the metadiscussions got crankiest as my fever was peaking, which made me wonder if some of the angriest comments were posted by people also running 104 degree fevers.

Anyhow, I was wondering if in your area you'd noticed people getting colds from heck, or maybe even run into someone energetic enough to go to a doctor and identify the bug from heck?

The Daily Mail reports:

British scientists are on the verge of producing a revolutionary flu vaccine that works against all major types of the disease.

Described as the 'holy grail' of flu vaccines, it would protect against all strains of influenza A - the virus behind both bird flu and the nastiest outbreaks of winter flu.

Just a couple of injections could give long-lasting immunity - unlike the current vaccine which has to be given every year.

A recent diary by DemFromCT focused on seasonal patterns in the H5N1 virus, including links to the CDC Flu Wiki.

I have long sensed that pandemic planning advice was mostly flying beneath the radar—i.e., it is deliberately not being highlighted by the government.  There are clues that can be spotted.  This article by Sandy Bergo (Center for Public Integrity) on an unrelated subject is typical--there's pandemic information there if you read between the lines:

His firm does better financially as a government contractor. For example, it won a $1.5 million job handling the logistics for 55 pandemic flu summits around the country from January through August 2006.

   

The most recent issue of the Canadian Medical Association Journal (CMAJ) includes an articleoutlining a triage protocol to determine who will be admitted to ICU during a flu pandemic.

The idea is that the surge in demand for ICU beds, particularly ventilatory support or mechanical ventilation, will outstrip the available resources and we will need some system that has already widely approved to make the tough decisions.

Quite a bit actually, H5N1 has continued to smoulder in SE Asia. As of October 31, we have more confirmed cases (and more deaths) in 2006 than 2005. We continue to track reported cases in Indonesia, where testing is not always completed. And we note, with some alarm, that China continues to be unclear about what's happening within its own borders. From Science:

  In a not so surprizing move the GOP has managed to make sure  early voters, 50 and over would not be given the free flu shots has promised. What is thier excuse this time ? From the sounds of it, they think only Democratic Voters get flu shots, or are poor enough to need the free ones

Republicans accused Mr. White of using the program to increase Democrats' election prospects. The Harris County Republican chairman, Jared Woodfill, said the offer violated a state law barring people from accepting anything in exchange for a vote.

"I think the program was completely motivated by a plan to turn out Democratic voters," Mr. Woodfill said.

Son of a ....., who would believe Democrats would help the poor ?!? Bribing people with a Flu Vaccine, that should be free to everyone that needs it anyway, the gall !!!

crossposted from unbossed

It's true that I have an obsession with bioethics, health, death, and disease. But why resist? So here are links related to those subjects.

Well folks, today I returned home from Seoul.  (You can see my earlier stories here.)

Maybe it was the fact that the plane was delayed 2 hours. Maybe it was the fact that despite being told that I could bring on liquids purchased after the security checkpoint I was unable to bring purchased water in a sealed bottle onto a plane.

Maybe it was the guy across the aisle from me who coughed non-stop. In coach.

Maybe it was the fact that the new configurations of United planes in coach have one less bathroom.

Maybe it was because I was nearly finished reading a book on the history of the 1918 influenza outbreak (see here).

But I was in no mood to take any bullshit when I landed...

Today a lady who promotes Lantus insulin for Sanofi-Aventis drug company came to my office.  She brought a dietician with her, and brought lunch for me and my office staff as well as the two of them.  They were there partly to promote a diabetic education program they have, which I think is free to the patients, in exchange for me just listening to their promotion of their fairly new, very long acting insulin.

Over the summer, H5N1 continued to smoulder away in places like Indonesia and China. Mostly in birds, sometimes in humans, there have been more deaths from H5N1 - 70 (and more human cases - 104) in 2006 than 2005 (with three months to go). Indonesia now has had more deaths than any other country, and there remains a reservoir of mixing and matching viruses, constantly mutating, that pose a significant risk for future illness. And there remains need to discuss it. As our wiki partner revere sums up:

When we first began to cover the bird flu problem -- back in 2004 -- it wasn't being discussed much anywhere, including the blogs. We started talking about it for two main reasons. First, it seemed to us, as it seemed to many informed public health scientists, that this was a possible freight train coming down the tracks. We didn't know then (nor we know now) how far the train was, whether it would get all the way to us or how fast it would be going if it did get to us. But we could feel the vibrations on the tracks and we knew enough about train wrecks of the past to worry. That was the first reason.

The second reason is more complex. For us, the response (or lack of response) to the genuine possibility of a pandemic of influenza from an avian subtype that had already shown itself capable of infecting humans to deadly effect, was a grotesque metaphor for failed public health leadership, both in our on country (the US) and most everywhere else. The US CDC was preoccupied with a phantom bioterrorism threat and remodeling the agency and US public health in general to respond to the Bush administration message: "be afraid, be very afraid."

There is no current worldwide pandemic. That would take a viral mutation, recombination or reassortment that as yet has not happened. And compared to last year, we know much more about the virus, though not nearly enough. But the fact remains that pandemics (worldwide epidemics of Influenza A) happen, they happen on average three times a century, and we haven't had one since 1968. This virus, the H5N1, is especially alarming because of its high case fatality rate (58% of those infected die). In 1918, 675,000 Americans died from pandemic flu (50 million worldwide) with a CFR of only 2.5% (estimated).

Will H5N1 actually ever move to an easily transmissible form (it's not now) and become a pandemic virus? We don't know. We certainly don't have any proof it won't. And the consequences of this or some other flu virus going pandemic means that a great deal of preparation needs to be done in advance, similar to preparing for a hurricane (even if one doesn't come this year, it will happen sometime - ask New Orleans). Of course, with a pandemic, the problem is that everyone is affected everywhere, so there's no "outside" help. And your local hospital would be overwhelmed with the ill and the very ill (upwards of a third of the community might be sick).

For regular Daily Kos readers, these are familar concepts. But to take a fresh look, Flu Wiki is sponsoring Pandemic Flu Awareness Week starting Oct 9, a week from tomorrow. if you have a blog, consider posting a flu story, a link to pandemicflu.gov or Flu Wiki, or another site that helps explain the current situation (see link for suggestions). And understand that this is a non-profit citizen-sponsered preparedness effort that has never really been done before on any large scale. We called it a "public health experiment" when we first launched Flu Wiki. It still is, though a surprisingly effective one (we've been linked by World Bank, WHO, local health departments, Nature, the Harvard Business Review and multiple media sources, including most recently Slate).

We're not into being alarmists. But we are fond of communicating risk, and you need to know more about the story that the media got tired of covering.