Psyche, Science, and Society

Swine flu in Mexico: Citizens’ views

The BBC has comments from Mexican citizens giving a sense of the country as pandemic fear takes hold.  One sample:

‘m a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.

There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.
Antonio Chavez, Mexico City

Let’s hope that communication in the US between the government and its citizens is better than in Mexico. I am glad Obama and not Bush is President now. I do wish the Senate republicans would stop playing politics with his HHS Secretary appointment. What a terrible time for us not to have a Secretry of Health and Human Services.

April 26th, 2009

Swine flu in North America

I know I’ve been extremely concerned with the torture issue recently, and will continue to be. But I’ve also blogged a number of times on the avian  flu epidemic danger. Now word comes that swine flue is in North America. There are 60 potential swine flu deaths in Mexico and seven or so cases in the US, with no deaths. Unlike the fear of the last several years, this isn’t the H5N1 avian flu strain that we’ve beedn dreading might develop human-to-human transmission. Rather its a novel H1N1 strain, to which we have essentially no immunity. Revere at Effect Measure is a good source. he reports on a CDC phone call describing the current situation.

It could be a bumpy ride over the next few weeks or months. Or it could fizzle out. And H5N1 is still around, potentially mutating to allow human-to-human transmission.

3 comments April 24th, 2009

British Jews compare Gaza attack to crushing Warsaw Ghetto

UPDATE: I have added below a Guardian article reporting another letter by prominent British Jewish leaders, also critical of Israel’s actions, though apparently with quite a different tone. [The letter is here.]

The Guardian has published an important letter from over 70  British Jews objecting to the war on Gaza and making the natural connection with the Warsaw Ghetto. They call for “a programme of boycott, divestment and sanctions”:

We the undersigned are all of Jewish origin. When we see the dead and bloodied bodies of young children, the cutting off of water, electricity and food, we are reminded of the siege of the Warsaw Ghetto. When Dov Weisglass, an adviser to the Israeli prime minister, Ehud Olmert, talked of putting Gazans “on a diet” and the deputy defence minister, Matan Vilnai, talked about the Palestinians experiencing “a bigger shoah” (holocaust), this reminds us of Governor General Hans Frank in Nazi-occupied Poland, who spoke of “death by hunger”.

The real reason for the attack on Gaza is that Israel is only willing to deal with Palestinian quislings. The main crime of Hamas is not terrorism but its refusal to accept becoming a pawn in the hands of the Israeli occupation regime in Palestine.

The decision last month by the EU council to upgrade relations with Israel, without any specific conditions on human rights, has encouraged further Israeli aggression. The time for appeasing Israel is long past. As a first step, Britain must withdraw the British ambassador to Israel and, as with apartheid South Africa, embark on a programme of boycott, divestment and sanctions.

Ben Birnberg, Prof Haim Bresheeth, Deborah Fink, Bella Freud, Tony Greenstein, Abe Hayeem, Prof Adah Kay, Yehudit Keshet, Dr Les Levidow, Prof Yosefa Loshitzky, Prof Moshe Machover, Miriam Margolyes, Prof Jonathan Rosenhead and 65 others

UPDATE: Here is the Guardian/Observer article:

Leading British Jews call on Israel to halt ‘horror’ of Gaza

By Peter Beaumont, David Smith and Ben Quinn

A group of Britain’s most prominent Jews has called on Israel to cease its military operations in Gaza immediately, warning that its actions, far from improving the country’s security, will “strengthen extremism, destabilise the region, and exacerbate tensions inside Israel”.

Describing themselves, as “profound and passionate supporters” of Israel – and supporting its right to defend itself against the “war crime” of Hamas rocket attacks – they added that the current tactics threatened to undermine international support for Israel.

The intervention, in a letter published in today’s Observer, came as fears grew that Israel was to launch a “new phase” of its military offensive inside the Gaza strip. Yesterday warplanes dropped leaflets warning Gazans “not to be close to terrorists, weapons warehouses and the places where the terrorists operate”. The two-week-old campaign has already killed more than 800 Palestinians, while 13 Israelis have died, three of them civilians killed by Hamas rockets.

Although individual Jewish writers and religious figures have expressed their opposition to the conduct of Operation Cast Lead, the letter represents the most significant break with Israel’s tactics from a group of UK Jews.

Prominent rabbis, academics and political figures are among the signatories, including Rabbi Dr Tony Bayfield, head of the Movement for Reform Judaism; Sir Jeremy Beecham, former chair of the Labour party; Professor Shalom Lappin of the University of London; Baroness Julia Neuberger; Rabbi Danny Rich, chief executive of Liberal Judaism; Rabbi Professor Marc Saperstein, principal of Leo Baeck rabbinical training college; and lawyer Michael Mitzman, who set up Holocaust Memorial Day Trust for the Home Office.

Their demand comes amid increasing pressure on Israel from the diplomatic community to halt its operations, and rising criticism of the humanitarian impact on Palestinian civilians, including allegations of potentially serious breaches of international humanitarian law. Demonstrations around the world yesterday called for a ceasefire.

“We look upon the increasing loss of life on both sides of the Gaza conflict with horror,” reads the letter. “We have no doubt that rocket attacks into southern Israel, by Hamas and other militant Palestinian groups, are war crimes against Israel. No sovereign state should, or would, tolerate continued attacks and the deliberate targeting of civilians. Israel had a right to respond and we support the Israeli government’s decision to make stopping the rocket attacks an urgent priority.

“However, we believe that now only negotiations can secure long-term security for Israel and the region.”

The letter was written before the escalation of ground fighting in Gaza City itself signalled by Israel yesterday.

“There can be no alternative to a negotiated solution,” said Beecham. “Israel should be demonstrating, along with the Palestinian Authority, that there are economic and political benefits to be gained from peaceful engagement rather than violent confrontation.”

His sentiments were echoed by Lappin: “Relying on overwhelming military force to respond to terrorist provocations invariably imposes horrendous suffering on innocent Palestinian civilians while entrenching the agents of terror in their midst. We have no alternative but to pursue rational, long term political options that promote moderation and marginalise extremists.”

In London violent clashes broke out near the Israeli embassy as tens of thousands marched in protest. Helmeted riot police with batons and shields charged a group of demonstrators who hurled sticks, shoes and traffic cones back at them while chanting “Free Palestine!”

Protesters tried to force entry to the north gate of Kensington Palace Gardens and six climbed an adjoining wall, setting fire to an American flag. The windows of a Starbucks opposite the embassy were smashed.

The police charges created waves of panic. Protester Ahmed Mohammad, 23, claimed he saw women and children get hurt: “It was a peaceful protest until the riot police came. I’ve seen a mother and little girl pushed to the ground.”

Some protesters attempted to throw barriers and other missiles at police.

The Stop the War Coalition, which organised the event, claimed that “at least” 100,000 people had made it “the biggest demonstration of solidarity with the Palestinian people in the history of this country”. The Metropolitan Police estimated the total at 12,000.

Earlier, Speakers’ Corner at Hyde Park was turned into a sea of Palestinian flags and banners condemning Israel. Speakers included human rights advocate Bianca Jagger, singer Annie Lennox and the Rev Garth Hewitt, canon at St George’s Cathedral in Jerusalem.

January 10th, 2009

“Free market” fails us in influenza pandemic preparedness

On another important matter that I’ve given little attention to recently, Revere reminds us that we are woefully unprepared for a flu pandemic, and the “free market,” even with massive government subsidies, isn’t doing anything about it. As Revere suggests, only governments are capable of pursuing the public interest in cases like this where private companies don’t see a profit. But this will only occur if we exert pressure. Otherwise the free market fundamentalists will endanger our health in yet another way. after all, whether Avian flu, or another strain, an influenza epidemic is as certain as death and taxes:

Red Flag on the Flu Vaccine Front

A story in CIDRAP News by the always excellent science journalist Maryn McKenna provides food for thought:.

A flu vaccine manufacturer’s decision not to build a US facility has highlighted the perpetual mismatch between flu-shot supply and demand–and the reality that the mismatch may undermine plans for pandemic flu vaccines.On Tuesday, Solvay Pharmaceuticals Inc. of Marietta, Ga., announced that it was canceling plans to build a US flu-vaccine manufacturing plant, a $386 million project that Birmingham, Ala., and Athens, Ga., have been competing for. The plant would have made both seasonal and pandemic flu vaccines–but at just about the moment when a final site selection was expected, the company announced that the economics of the two-year-old deal no longer make sense. (Maryn McKenna, CIDRAP News)

The US Government sunk almost $300 million into Solvay for design and development of the new plant but didn’t provide enough for capitalizing it. Apparently to make economic sense some companies require that someone else pay all the upfront costs. I’m sure this is true for Solvay, a chemical, plastics and pharmaceutical conglomerate based in Belgium. Why invest a dollar (or a Euro) in flu vaccine, even though it will make you a tidy profit, when you can invest in some other product that can make you a big profit. That makes business sense. So the losers in this one are US taxpayers (so what else is new?). But the problem, as McKenna points out, is probably deeper than a bad investment of tax dollars:

Nevertheless, the Solvay decision deprives the United States of a domestic source for pandemic flu vaccine if or when a global outbreak begins. And by refusing to offer supply into an uncertain market, the company is challenging the central assumption behind US and global planning for pandemic-vaccine capacity: that demand for seasonal vaccine will provide companies with a rationale for making more vaccine than they now do.Federal health officials have asserted many times that demand will boost manufacturing capacity to the level needed for a pandemic. To reach that level, the World Health Organization’s 2006 “Global Pandemic Influenza Action Plan” calls for countries to boost their flu-shot usage to 75% of their populations, including countries where seasonal vaccine has never been used.

Here’s how I would say this: the market doesn’t work for flu vaccine. It is like saying that a war is like the market and will call up a demand for an army. so between wars we can disband the military. I might like that, but if you believe there are real threats out there requiring a military this would be nonsense to you. Since most scientists think there is a pandemic threat out there, why should we let “the market” govern if we have the resources if and when we need them? Because the US government, especially this administration but not only this administration, worships the market (except when they don’t) and kowtows to drug companies (almost always).

If the market doesn’t work for flu vaccine I see no reason to throw up our hands and give up. We construct another mechanism. In this case it could be a global network of regional vaccine laboratories (maybe ten or a dozen, with some large regions, like the US, having several) that have adequate reserve capacity to ramp up production quickly in the case of need. In the absence of demand this produces unused and redundant capacity and is inefficient. As do standing armies in times of peace. The cost would be borne by the global community as a whole.

The alternative is to do as we are dong now, leave it to the private sector which has no incentive to meet the need, and should a pandemic arise will be able to respond too little, too late and at great cost, both because the demand will exceed supply and the loss in pain in suffering from the missed opportunity will be enormous.

The Solvay decision is another warning flag. Of course, we have shown a prodigious capacity to ignore warning flags

October 6th, 2008

Avian flu and public health’s Maginot Line

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

Avian flu danger still lurking

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

Avian flu threatens internet

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

Avian flu in UK

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

Avian flu still a threat

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…

1 comment January 2nd, 2007

Lack of hospital facilities for pandemic

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