Posts filed under 'Avian flu'
I haven’t mentioned avian influenza for a long time. But that doesn’t mean that the threat is gone. As Revere points out at Effect Measure, the threat is the same it always was. As in all things human, it’s a matter of probabilities ad possibilities, never certainties. Revere today points out that the appropriate public health response our government should be taking would be good for all of us:
Public health’s Maginot Line
Influenza A/H5N1 (bird flu) bubbles away this year much as in past years and public health professionals continue to wait with bated breath for the other shoe to drop. It could happen this year, next year or not at all. That’s the way the world is. Betting on “not at all” isn’t considered prudent by most people in public health, despite the fact that it’s possible. So given the uncertainty, what is the best strategy?
It is a bit disconcerting to see that the overwhelming preponderance of resources to pandemic preparedness resources are going into influenza-specific counter-measures, particularly vaccines and antivirals. If a pandemic doesn’t materialize not all of it is wasted. The boost that the threat of a pandemic has given to vaccine technology is real and significant and will pay off in the long run for diseases other than influenza for which vaccination is a reasonable preventive. So that’s good. Antivirals are more narrowly specific to influenza. Both are narrowly conceived, however, and are framed in terms of an uncertain event. But they are not the only reasonable response, nor even the ones where, if we were gaming out the possibilities, the likelihood of biggest pay-off would come. What are we suggesting?
In our view the biggest benefit comes with investment in public services which strengthen the community’s response to health threats of all kinds. Investment in routine public health — vital data and surveillance, substance abuse, elder care, maternal and child health, infectious disease control, human resources, social service support for the ill in the community and all the rest of it — is the place where we would put most of the money. If national planners are reluctant to give up the “magic bullet” approach of vaccines and antivirals then we are talking about additional investment. Given that every dollar invested in infrastructure is almost certain to pay off in multiple dollars of saved expense, we can afford this. And if a pandemic does come, it will pay off handsomely there, too. Vaccines and antivirals still depend upon the public health system. They don’t work at a distance.
We’ve been saying this for three years. It is not a change in attitude occasioned by a new threat assessment. On the contrary, our threat assessment has not changed at all. Only the virus changes. Whether the viral changes we are seeing is bringing us closer to a pandemic, farther away from one or are neutral in that regard we don’t know. So we have to respond in the most rational way.
The strategy of vaccines and antivirals appears to us a public health Maginot Line. Effective if the enemy comes that way. But if it goe
November 9th, 2007
I’ve been too busy to mention the avian flu pandemic threat for a while.But that doesn’t mean the danger’s dissappeared. Revere at Effect Measure tells us of some things he’s been reading that have him worried. Take a look.
June 8th, 2007
DemFromCT at Daily Kos discusses the threat avian flu may pose to the internet. Kids at home and YouTube may bring it down.
February 14th, 2007
The BBC reports that an outbreak in British poultry has been confirmed as H5N1 avian flu.
The avian flu which killed 2,600 turkeys at a Suffolk farm has been confirmed as the H5N1 virus.
The 159,000 other turkeys on the farm will now have to be slaughtered.
The Department for Environment, Food and Rural Affairs and the European Commission carried out virus tests at laboratories in Weybridge, Surrey.
A three-kilometre protection zone and a 10km surveillance zone will be set up around Holton, which is approximately 27km south-west of Lowestoft.
As revere says at Effect Measure:
This is the second confirmed appearance of the virus in Europe this year and the second appearance in the UK in the last 12 months (previously chickens in Norfolk in April 2006). Most people expect there to be more instances elsewhere in Europe.
The virus is out there. Gone from the headlines doesn’t mean it’s gone from the world.
February 3rd, 2007
After a few months of reduced mortality and news coverage, many people have forgotten about avian flu. The danger seems “so last year,” as they fall back to simplistic defenses about the threat being overblown. But revere at Effect Measure reminds us that 2006 was the worst year so far, with more reported cases and more deaths than any previous year:
Indeed the number of deaths in 2006 exceeded the total of deaths for 2003, 2004 and 2005 combined (79 versus 78), although the number of cases exceeded last year’s by only 18%, compared to an 88% increase in deaths over 2005.
He also reminds us that the quiet in the latter half of 2006 is exactly what is expected:
As in previous years, the second half of the calendar year has seen far fewer cases than the first half. This is the usual pattern. From July, there have been 21 human cases in five countries; from January to June there were 93, an apparent steep drop-off. In 2005 the first 6 months toll of 59 was also followed by a drop-off to 38 cases and in 2004 the numbers were 32 and 14 (data from here with additions of the three Egyptian cases in December). Thus the first half of 2006 was worse than the first half of 2005, but the autumn of 2005 was worse than this year. The general pattern is clear, however. Human cases increase markedly in the first half of the year, and the increase starts now, in January, which has been the peak month in each of the past three years (23, 20 and 25 cases, respectively). We don’t know if this January will be a repeat, but we should be prepared and expecting it.
So, just as we prepare for earthquakes, even though we don’t know if they will strike in our lifetime, so we should prepare for a possible influenza pandemic. It might come, or might not. But if it does…
January 2nd, 2007
Revere at Effect Measure reminds us that A pandemic could be bad (in case you hadn’t heard). In this case he reminds us that emergency medical services will be stressed beyond their limit, leading to many very serious patients (not just with influenza) being denied treatment. Heart attack? Sorry. Please come back in two months.
As Revere reminds us:
Health care has become so expensive we have tried to wring the last drop of efficiency out of it, cutting down on beds and staffing. With no reserve and no redundancy I have no doubt we will find it to be a false economy. Sometimes inefficiency and redundancy aren’t wasted resources, they are common sense.
December 8th, 2006
Regarding another potential catastrophe, one I haven’t written about for a while, the avian flu pandemic potential, Revere at Effect Measure writes of a new complication. What happens to all that Tamiflu that will be taken and excreted into the environment? Turns out no one knows. Revere thinks we’d beter find out.
October 18th, 2006
Revere at Effect Measure uses a new Atlanta Journal Constitution article on the situation at CDC as an opportunity to remind us of the extent of the damage being imposed upon this critical agency.
We all rely upon the CDC to be competent in its essential mission of preventing and controlling disease outbreaks. It has lost so much of its best expertise that its ability to conduct its mission is put at risk. It appears that “an unprecedented letter to CDC Director Julie Gerberding [was sent last December] from five of the last six of her predecessors.”
“We have all gone through periods of change and recognize the difficulties attendant to change. However, we are concerned about the previous and impending losses of highly qualified and motivated staff,” wrote former CDC directors Dr. William Foege, Dr. James Mason, Dr. David Satcher, Dr. Jeffrey Koplan and Sencer.
As Revere expresses his conclusions:
We’ve worked with CDC scientific colleagues for decades and the people we worked with used to be some of the best in the business. The agency is now full of second and third raters and its competency in even simple programmatic matters, like designing a data collection system, is dreadful. They can’t even do paperwork right. And if you speak out about your concerns, the job security isn’t that good either. Like others, we watch in horror as the agency is being systematically destroyed just at the point in history when we need it most.
September 12th, 2006
While we’ve been preoccupied with other aspects of the sorry state of the world, Revere at Effect Measure reminds us that avian flu is still a major, and growing, threat. We shouldn’t let the absence of headlines lead us to think the potential for a pandemic has passed. Also, we should always keep in mind that, if not H5N1, then another influenza strain will likely become pandemic in the not too distant future.
Excerpt:
If you confront other people who think bird flu has gone away as a concern or read news articles to that effect, consider this. In April of this year there were 45 countries reporting infections in their bird or poultry populations. Now, four months later, there are 55. The UN’s Food and Agriculture Organization (FAO) continues to warn us that the virus is spreading throughout Asia, Africa and Europe.
The number of confirmed human cases now stands at 240, with 141 deaths. The true number is likely larger, although how much we don’t know. So far it is still small compared with the SARS outbreak of 2003, but like SARS, there is grave and plausible suspicion a devastating pandemic could occur.
Read the entire article.
August 25th, 2006
Effect Measure comments on problems at CDC, with senior staff leaving out of frustration that they can’t get anything done. Particularly hard hit, it is reported, are the AIDS and influenza groups. With a potential avian flu pandemic looming, this is the last thing the nation can afford.
The Atlanta Journal Constitution [Discord leaves CDC vulnerable, employees say] is quoted as saying that the lapdog Senate is “investigating”:
The U.S. Senate Finance Committee is investigating whether turmoil within the Atlanta-based CDC caused by a massive reorganization is “resulting in the loss of distinguished medical experts whose participation will be greatly needed in the event of future catastrophic health emergencies,” committee spokeswoman Jill Kozeny said Tuesday night.
As is typical, the massive reorganization is apparently being done with little input from those being reorganized. The latter are naturally disgruntled. Of course, CDC management says everything is fine. Why don’t we feel fine?
Meanwhile, the CDC is simultaneously being investigated for ignoring scientific advice in the creation of performance standards for state bioterrorism preparedness:
Grassley’s committee is investigating whether efforts to create meaningful performance standards have been thrwarted [sic] by CDC management. Employees have told the committee that measurement tools written by scientific experts are “consistently rejected or rewritten” by managers lacking scientific or technical expertise, according to a letter sent on March 2 by Grassley to Michael Leavitt, secretary of the U.S. Department of Health and Human Services, which oversees the CDC.
Unfortunately the AJC article doesn’t give examples of how the performance standards are being modified by management
May 26th, 2006
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