Tuesday, November 27, 2007

November 27 Flu Update

Must read--CIDRAP and John Barry talk about quarantines during the 1918 flu. Foreward by Dr. Osterholm.

Since publication of his book in 2004, Barry has been involved in the preparedness effort and continued to do research on NPIs. Most of this work has expanded on findings in the book, and some of it has caused him to revise views expressed there. Since the Markel publication in JAMA, Barry has raised serious challenges to the data used by Markel's group to justify their conclusions about the public health actions they reported to have been taken in 2 of the 43 cities (New York City and Chicago). These are the only two cities among the 43 for which Barry did such follow-up research. Barry wrote what I believe to be a convincing and well-supported letter to JAMA with his concerns. Last week his letter and Markel's response were published in JAMA.

Revere blogs this article as well. Must read. (My note: this is so important because when a pandemic comes, we are likely to be in a poor frame of mind for making decisions. And, rash actions will be taken, including the ones debated here.)

Baxter's contract for non-egg vaccine production has been extended.

More poultry interceptions in Saudi Arabia.

Japan is donating a lab to Indonesia.

Article says Massachusetts group led the way to ensure fire fighters got the first pandemic vaccines.

An Iowa pandemic expert will speak at Drake University.

"One city, St. Louis, did the right thing and escaped with a much smaller mortality rate than Philadelphia which, their leaders fiddled around and didn't enact the right kinds of policies to prevent the spread of the disease," Gilchrist says. She says personalities, politics and economics can all come into conflict and cost lives.


At 6:16 PM, Blogger Wulfgang said...


Interesting super powered discourse in your articles today between CIDRAP, John Barry, Mike Osterholm and Revere. Actually, the most important observation on the entire subject of non-pharmaceutical interventions… are those you made yourself Orange: “this is so important because when a pandemic comes, we are likely to be in a poor frame of mind for making decisions. And rash decisions will be taken …”.

My opinion on the subject is that if a pandemic occurs, it will all come to medical science and the disease itself and how the public health officials view the “technical’s”. This will determine the appropriate actions and responses taken by authorities. Technical’s meaning the critical statistics on the virus itself and what is evident – reproduction ratio (Ro), case attack rate (CAR), case fatality rate (CFR), total fatalities, total infections, secondary complications requiring antibiotics and medical treatment, resistance to and the efficacy of antivirals. Acceptable threshold data will translate into not much action, quite frankly. For example, we have epidemics annually that cause mortality rates of 36,000 per year in the US, and no one gets alarmed (unless a family member is a victim, of course). I would even be willing to wager anyone that a reoccurrence of a 1957 or 1968 mild-like pandemic would almost go unnoticed in North America these days.

But if the pandemic statistic’s I mentioned, in the aggregate, start rising to the level of 1918 and beyond – yes, absolutely there will be severe repercussions and very rash decisions made – like irrational attempts at quarantines, forced isolations, border closings, and cessation of travel (international and local), which will exacerbate and probably tip society to the breaking point. Anybody who thinks everything will still remain hunky-dory under a worst case pandemic scenario, is a fool. Society will be stressed and stretched like a cheap rubber band until it snaps. And could measures be taken that limit “individual civil liberties”, be at risk ? You betchum Red Rider. In this kind of situation, either the state and/or the federal government’s will have to step in to take appropriate authoritative actions to maintain civil law and order, or individuals themselves will. Potential conflict - now that will be an understatement, with over 100 million firearms in the US (yeah, and I have one of them).

Let’s get the terminology straight also: a mild 1957 or 1968 pandemic will be a measly “public health crisis”. A severe 1918 like pandemic, SARS, or much worse, will be a damn nationally declared “state of emergency”, clearly involving issues surrounding national security. The emergency could be well beyond 9/11 and terrorism – our entire economy, financial system, and productive capacity, might be in jeopardy of collapsing. What people do not understand or recognize is that the pandemic may mandate National Guard and federal military intervention to temporarily maintain law and order. Civil libertarians and rights activists are beneficial during peacetime, but when a nation is trying to function during a nationally declared state of emergency, and in full-crisis mode, lawyers and politicians are of little value added.

It would be nice to solve this debate about NPI’s beforehand, but quite frankly, I don’t see it. As far as a “hidden agenda by the government or individuals to exploit a pandemic crisis for economic gain”, well, not to worry folks.

You may be doing good just to keep alive and healthy.



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