The H1N1 virus, otherwise known as Swine Flu, is creeping along at a slow but steady pace, and my work as a public health nurse amidst the outbreak of a novel influenza virus has certainly ebbed----for now.
As predicted by many, the virus is currently no more virulent than your average seasonal influenza, and while more cases and deaths are indeed expected, the rate of the spread of H1N1 is slow and steady rather than rapid and diffuse.
Still, there is a great deal of uncertainty as to what will happen when H1N1 goes somewhat underground over the summer, only to resurface in the Autumn, mutated and ready for the seasonal flu season. Epidemiologists are concerned due to the fact that the 1918 influenza pandemic began with a novel virus emerging in the Spring, spreading slowly but steadily, diminishing in the summer and reemerging in the Autumn, hundreds of times more virulent. Only time will tell.
Another novel aspect of this virus is that, unlike seasonal influenza---which predominately impacts older adults and those with chronic illnesses---the majority of H1N1 cases are those between the ages of 5 and 20, with the vast preponderance being between the ages of 11 and 15. The assumption is that those generations of children have never been exposed to this virus before, whereas the rest of us were alive in the 1970s during the last H1N1 outbreak. And whereas most children and young adults are healthy enough to fight off the infection, there are concerns about children with weakened immune systems and chronic illnesses. When children die from otherwise benign infections, people take notice, and this is an eventuality we all want to avoid.
Be that as it may, the H1N1 scenario is relatively calm for now, and those of us working in public health and other sectors of the health care industry watch, wait, listen, and hope that nothing more comes of this outbreak of a novel virus making its inexorable way around the world.
Showing posts with label infectious disease. Show all posts
Showing posts with label infectious disease. Show all posts
Wednesday, May 27, 2009
Friday, May 01, 2009
Swine Flu Fatigue?
Dear Readers, I apologize for not posting since Monday. My work life has been consumed with swine flu and its effects here on the local level, and Digital Doorway has suffered from a lack of attention. This situation will now be remedied.
So, a lot of people are already complaining of Swine Flu Fatigue. Of course, the media has latched onto this breaking news, disseminating information---and misinformation---throughout the 24-hour news cycle that is part and parcel of our 21st century lives. Still, a novel virus making its way around the world is certainly cause for concern and conversation, and the public health infrastructure is certainly responding as it should in such a circumstance.
On Twitter, on grocery lines, and in workplaces, various individuals claim that the government is overreacting, that public health officials are making a mountain out of molehill, and that the media is fanning the flames for the benefit of increased revenue in dark economic times. But I must beg to differ.
As a (relatively novice) public health official, I am impressed and heartened by the rapid, comprehensive and thoughtful reaction by the global public health community to this new viral threat. I have taken part in numerous conference calls with the CDC, with our state Department of Public Health, FEMA, and other players, and I can see that officials are acting responsibly and appropriately to a credible threat.
When Hurricane Katrina was bearing down on New Orleans and our government was essentially asleep at the wheel, FEMA and other emergency management agencies fell down on the job, and their negligence and slow response certainly resulted in increased suffering, loss and death in the ensuing days during and after the storm. In retrospect, the public and media called for answers, recognizing clearly that preemption of calamity is an essential aspect of managing such situations before they mushroom out of control. The initial Katrina response was essentially a failure, and lessons learned at that time are still being analyzed and digested.
With swine flu, we have another opportunity for the machines of government, public health, surveillance and emergency preparedness to swing into action before all-out calamity strikes. While the current measures and attention being paid to the situation may appear to some to be somewhat overblown, one must only imagine what we might all say at some future date if the government's reaction to the early stages of the outbreak were less robust.
If this indeed becomes a global pandemic of massive scale in the months to come, it will be certain that we will be thankful that the assets and resources made available by the government and associated agencies were activated so early in the development of this viral process.
With antiviral medications at the ready and vast amounts of information being made available to the general public, the media, and the medical community on an up-to-the-minute basis, we can rest assured that the situation is being monitored vigorously by those in positions to make clear and intelligent decisions.
Here on the public health front lines, we local boards of health rely on the federal and state governments to guide us as we answer the public's questions, assuage their fears, and prepare our own local assets for appropriate and timely response. We are very appreciative of the responsiveness of the CDC and our other response partners, and without their guidance, this process would be infinitely more challenging.
In a few weeks or months, if the pandemic proves to be short-lived, we will all breathe a sigh of relief, knowing that we were properly prepared for a feasible and credible threat to public health. While some would potentially point fingers and make light of our credibility vis-a-vis such threats, we will still maintain our thankfulness that we reacted so swiftly and comprehensively based on the information available at the time the outbreak began.
If the outbreak does indeed develop into a larger-scale pandemic, then our reactions will also have been proven to be prudent and correct, and we will be well prepared to face the mounting threat.
Whatever the outcome, I see the national and global response to swine flu as an excellent example of how the public health infrastructure can mount a credible and rapid response on the local, regional, national and global levels when needed. This is a test---no matter the outcome---and in my view, the reaction to swine flu has been an excellent example of prudence, intelligence, and collective preemptive action at a time when such qualities are sorely needed and duly delivered.
So, a lot of people are already complaining of Swine Flu Fatigue. Of course, the media has latched onto this breaking news, disseminating information---and misinformation---throughout the 24-hour news cycle that is part and parcel of our 21st century lives. Still, a novel virus making its way around the world is certainly cause for concern and conversation, and the public health infrastructure is certainly responding as it should in such a circumstance.
On Twitter, on grocery lines, and in workplaces, various individuals claim that the government is overreacting, that public health officials are making a mountain out of molehill, and that the media is fanning the flames for the benefit of increased revenue in dark economic times. But I must beg to differ.
As a (relatively novice) public health official, I am impressed and heartened by the rapid, comprehensive and thoughtful reaction by the global public health community to this new viral threat. I have taken part in numerous conference calls with the CDC, with our state Department of Public Health, FEMA, and other players, and I can see that officials are acting responsibly and appropriately to a credible threat.
When Hurricane Katrina was bearing down on New Orleans and our government was essentially asleep at the wheel, FEMA and other emergency management agencies fell down on the job, and their negligence and slow response certainly resulted in increased suffering, loss and death in the ensuing days during and after the storm. In retrospect, the public and media called for answers, recognizing clearly that preemption of calamity is an essential aspect of managing such situations before they mushroom out of control. The initial Katrina response was essentially a failure, and lessons learned at that time are still being analyzed and digested.
With swine flu, we have another opportunity for the machines of government, public health, surveillance and emergency preparedness to swing into action before all-out calamity strikes. While the current measures and attention being paid to the situation may appear to some to be somewhat overblown, one must only imagine what we might all say at some future date if the government's reaction to the early stages of the outbreak were less robust.
If this indeed becomes a global pandemic of massive scale in the months to come, it will be certain that we will be thankful that the assets and resources made available by the government and associated agencies were activated so early in the development of this viral process.
With antiviral medications at the ready and vast amounts of information being made available to the general public, the media, and the medical community on an up-to-the-minute basis, we can rest assured that the situation is being monitored vigorously by those in positions to make clear and intelligent decisions.
Here on the public health front lines, we local boards of health rely on the federal and state governments to guide us as we answer the public's questions, assuage their fears, and prepare our own local assets for appropriate and timely response. We are very appreciative of the responsiveness of the CDC and our other response partners, and without their guidance, this process would be infinitely more challenging.
In a few weeks or months, if the pandemic proves to be short-lived, we will all breathe a sigh of relief, knowing that we were properly prepared for a feasible and credible threat to public health. While some would potentially point fingers and make light of our credibility vis-a-vis such threats, we will still maintain our thankfulness that we reacted so swiftly and comprehensively based on the information available at the time the outbreak began.
If the outbreak does indeed develop into a larger-scale pandemic, then our reactions will also have been proven to be prudent and correct, and we will be well prepared to face the mounting threat.
Whatever the outcome, I see the national and global response to swine flu as an excellent example of how the public health infrastructure can mount a credible and rapid response on the local, regional, national and global levels when needed. This is a test---no matter the outcome---and in my view, the reaction to swine flu has been an excellent example of prudence, intelligence, and collective preemptive action at a time when such qualities are sorely needed and duly delivered.
Monday, April 27, 2009
Swine Flu and the Rubber Meets The Road
When a novel infectious disease makes its presence known, the public health infrastructure swings into action. Now, with the rapid emergence of swine flu in a number of countries around the world, this is a prime example of where the public health rubber meets the road.
Today, the World Health Organization raised the pandemic level for swine flu to Phase 4, meaning that there is now documented human-to-human transmission of a virus "able to sustain community-wide outbreaks". The WHO pandemic classification uses a scale of 1 to 6, with a rating of 6 signifying a global pandemic, a potential that officials are quick to say may or may not occur.
While no one in the United States has yet died from swine flu infection, the public health community takes the situation seriously, especially in light of the rising death toll in Mexico, and the emergence of disease in Spain, Scotland and Canada. in Queens, New York, a number of children who traveled to Mexico over spring vacation have been officially diagnosed with swine flu, and there are reports of school closings in various parts of the country.
Today, conference calls were scheduled by the CDC, state departments of public health, and other major players in the public health and emergency preparedness arenas.
Since I just recently attended the Integrated Medical, Public Health, Preparedness and Response Training Summit in Dallas last month, I am acutely aware of how the CDC's Strategic National Stockpile figures largely into the response to just this type of public health emergency, and word has it that large amounts of stockpiled antiviral medications are at the ready if mass prophyaxis of the population is needed.
I am duly impressed by the rapid response of the CDC, FEMA and other important agencies involved in the effort vis-a-vis the swine flu outbreak, and we are ready to activate our local Medical Reserve Corps chapter if emergency dispensing of medications or other municipal response is needed.
Speaking of the Medical Reserve Corps, this swine flu outbreak is yet another example of why we need more medical (and non-medical) volunteers to join their local chapters. The MRC is an important part of the public health and emergency response infrastructure, and having a network of thousands of screened, vetted and trained volunteers ready to be mobilized across the country to assist in the response to these types of situations is crucial to protecting local, regional and national responders from being overwhelmed in the case of a surge of need on the part of the public.
For up-to-date information on the outbreak, visit the CDC's Swine Flu Website. This is not a tie for panic, yet it is also a time for vigilance, good hygeine and handwashing, and a circumspectful caution vis-a-vis individuals who exhibit any signs of flu-like illness. Medical providers are receiving detailed information regarding the epidemiology, symptoms and treatment of swine flu. Any individual with flu-like symptoms should refrain from going to work, school or other public places. Such individuals should absolutely wear a mask when in public, and should visit a medical provider as soon as possible.
As a local public health official, I am watching this situation carefully along with my colleagues, and we are in frequent communication with our state department of public health, our local schools, area colleges, and other partner agencies.
The public health infrastructure is indeed in full swing, and I am currently swept up in the rising tide of surveillance as the outbreak widens and deepens.
Today, the World Health Organization raised the pandemic level for swine flu to Phase 4, meaning that there is now documented human-to-human transmission of a virus "able to sustain community-wide outbreaks". The WHO pandemic classification uses a scale of 1 to 6, with a rating of 6 signifying a global pandemic, a potential that officials are quick to say may or may not occur.
While no one in the United States has yet died from swine flu infection, the public health community takes the situation seriously, especially in light of the rising death toll in Mexico, and the emergence of disease in Spain, Scotland and Canada. in Queens, New York, a number of children who traveled to Mexico over spring vacation have been officially diagnosed with swine flu, and there are reports of school closings in various parts of the country.
Today, conference calls were scheduled by the CDC, state departments of public health, and other major players in the public health and emergency preparedness arenas.
Since I just recently attended the Integrated Medical, Public Health, Preparedness and Response Training Summit in Dallas last month, I am acutely aware of how the CDC's Strategic National Stockpile figures largely into the response to just this type of public health emergency, and word has it that large amounts of stockpiled antiviral medications are at the ready if mass prophyaxis of the population is needed.
I am duly impressed by the rapid response of the CDC, FEMA and other important agencies involved in the effort vis-a-vis the swine flu outbreak, and we are ready to activate our local Medical Reserve Corps chapter if emergency dispensing of medications or other municipal response is needed.
Speaking of the Medical Reserve Corps, this swine flu outbreak is yet another example of why we need more medical (and non-medical) volunteers to join their local chapters. The MRC is an important part of the public health and emergency response infrastructure, and having a network of thousands of screened, vetted and trained volunteers ready to be mobilized across the country to assist in the response to these types of situations is crucial to protecting local, regional and national responders from being overwhelmed in the case of a surge of need on the part of the public.
For up-to-date information on the outbreak, visit the CDC's Swine Flu Website. This is not a tie for panic, yet it is also a time for vigilance, good hygeine and handwashing, and a circumspectful caution vis-a-vis individuals who exhibit any signs of flu-like illness. Medical providers are receiving detailed information regarding the epidemiology, symptoms and treatment of swine flu. Any individual with flu-like symptoms should refrain from going to work, school or other public places. Such individuals should absolutely wear a mask when in public, and should visit a medical provider as soon as possible.
As a local public health official, I am watching this situation carefully along with my colleagues, and we are in frequent communication with our state department of public health, our local schools, area colleges, and other partner agencies.
The public health infrastructure is indeed in full swing, and I am currently swept up in the rising tide of surveillance as the outbreak widens and deepens.
Friday, April 24, 2009
World Malaria Day
Today, April 25th, is World Malaria Day, and according to the official website, there are currently 109 malarious countries in four regions of the world. Established goals have set December 31st, 2010 as the target date for delivering universal, effective, and affordable protection and treatment to all vulnerable persons at risk of malaria.
In concert with the United States Millennium Goals, eradicating malaria is seen to be equally important as eradicating poverty and realizing the laudable goals of protecting women's and children's rights around the world.
Some facts from the World Malaria Day website:
The following interventions need to be delivered worldwide by 2010:
In concert with the United States Millennium Goals, eradicating malaria is seen to be equally important as eradicating poverty and realizing the laudable goals of protecting women's and children's rights around the world.
Some facts from the World Malaria Day website:
The following interventions need to be delivered worldwide by 2010:
- More than 700 million insecticide-treated bednets – half of those in Africa
- More than 200 million of doses of effective treatment
- Indoor spraying for around 200 million homes annually
- Approximately 1.5 billion diagnostic tests annually
- In 2009, roughly $5.3 billion will be needed for malaria control worldwide
- In 2010, $6.2 billion will be needed
- From 2011 to 2020, roughly $5 billion per year will be need to sustain the gains of control measures.
- In addition, about $1 billion per year will be needed for research and development of new prevention and treatment tools
A dramatically expanded access to core anti-malaria interventions (protective nets, spraying, diagnostics and effective drugs) will result in a sharp decline of malaria cases and deaths. However, these measures will not eliminate the mosquito vector, the parasite or the favorable environmental conditions for transmission in many countries and regions. In some countries with naturally high transmission rates, control measures may need to be maintained for 15- 20 years or longer until new tools enabling elimination are developed or new research indicates that control measures can be safely reduced without risk of resurgence.
We are all responsible to support these important global programs, and days like World Malaria day serve to remind us of the importance of protecting the most vulnerable members of the global community from diseases which are 100% preventable.
Tuesday, March 24, 2009
World TB Day
Today, March 24th, 2009, is World TB Day. Here is what the Centers for Disease Control and Prevention have posted on their wesbite today:
"World TB Day is observed each year on March 24 to commemorate the date in 1882 when Dr. Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB). Worldwide, TB remains one of the leading causes of death from infectious disease. An estimated 2 billion persons are infected with M. tuberculosis. In 2006, approximately 9.2 million persons became ill from TB, and 1.7 million died from the disease. World TB Day provides an opportunity for TB programs, nongovernmental organizations, and other partners to describe problems and solutions related to the TB pandemic and to support worldwide TB control efforts. The U.S. theme for this year's observance is Partnerships for TB Elimination."
The CDC states that, following more than three decades of decline, worldwide TB cases increased by 20% from 1985 to 1992. And although concerted global efforts have attempted to stem the tide, multidrug-resistant tuberculos is on the rise, and certain ethnic and racial groups are still significantly vulnerable.
To access the CDC's Division of Tuberculosis Elimination, click here.
To visit Stop TB USA, click here.
To read several of my previous posts about XDR-TB, click here or here.
"World TB Day is observed each year on March 24 to commemorate the date in 1882 when Dr. Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB). Worldwide, TB remains one of the leading causes of death from infectious disease. An estimated 2 billion persons are infected with M. tuberculosis. In 2006, approximately 9.2 million persons became ill from TB, and 1.7 million died from the disease. World TB Day provides an opportunity for TB programs, nongovernmental organizations, and other partners to describe problems and solutions related to the TB pandemic and to support worldwide TB control efforts. The U.S. theme for this year's observance is Partnerships for TB Elimination."
The CDC states that, following more than three decades of decline, worldwide TB cases increased by 20% from 1985 to 1992. And although concerted global efforts have attempted to stem the tide, multidrug-resistant tuberculos is on the rise, and certain ethnic and racial groups are still significantly vulnerable.
At the Stop TB Partnership Website, a myriad of informative pages are available for your perusal and edification.
To access the CDC's Division of Tuberculosis Elimination, click here.
To visit Stop TB USA, click here.
To read several of my previous posts about XDR-TB, click here or here.
Tuesday, May 29, 2007
XDR-TB: Time to Listen
Just today, the Centers for Disease Control of the United States issued its first government-mandated quarantine of an individual since the early 1960's. According to reports and a CDC press conference this afternoon, a gentleman traveling on two separate trans-Atlantic flights was already infected with Extensively Drug Resistant Tuberculosis (aka: XDR-TB) when he boarded those two planes. Although the relative risk of infection is being characterized as low, the officials at the CDC are taking no chances and have quarantined the individual until further testing and treatment can be accomplished.
I have mixed feelings about today's events. On the one hand, I understand the need for quarantine, and when international travel is involved, the rapid spread of HIV in the early 1980's taught us how air travel can move a dangerous organism around the globe in a matter of hours. On the other hand, issues of individual liberties and freedoms are raised when the government begins issuing orders for quarantine, and it is not difficult to imagine scenarios like those portrayed in Albert Camus' novel The Plague. While Camus' story is more about existential angst, personal redemption, and the growth of Fascism in Europe than it is about infectious disease, it paints a picture of the loss of individual freedom under the guise of government control "for the public good". In these days of Guantanamo Bay and Abu Ghraib, it is not beyond imagination to picture a situation in which a fearful and power-hungry government imprisons political dissidents who are "diagnosed" with a dangerous new infectious organism. Camus' novel is a chilling read and could not be more timely.
In terms of more contemporary scientific literature, Laurie Garret wrote of the "newly emerging diseases in a world out of balance" in her equally chilling (and very non-fiction) tome The Coming Plague in the late 1990s. Ms. Garrett underscored the fact that rapidly spreading, drug-resistant diseases would begin to emerge and traverse the planet with greater frequency and virulence unless something was done to stem the tide. Consider her book a public health version of Al Gore's An Inconvenient Truth.
Many questions were raised today, and very few clear answers seem forthcoming. This one individual has been quarantined, and many passengers and crew from the affected flights will be tested and treated. But I believe today was a wake-up call for the public health community (not to mention the rest of us), and the ramifications of today's events will be enormous and perhaps vastly unforeseen.
I have mixed feelings about today's events. On the one hand, I understand the need for quarantine, and when international travel is involved, the rapid spread of HIV in the early 1980's taught us how air travel can move a dangerous organism around the globe in a matter of hours. On the other hand, issues of individual liberties and freedoms are raised when the government begins issuing orders for quarantine, and it is not difficult to imagine scenarios like those portrayed in Albert Camus' novel The Plague. While Camus' story is more about existential angst, personal redemption, and the growth of Fascism in Europe than it is about infectious disease, it paints a picture of the loss of individual freedom under the guise of government control "for the public good". In these days of Guantanamo Bay and Abu Ghraib, it is not beyond imagination to picture a situation in which a fearful and power-hungry government imprisons political dissidents who are "diagnosed" with a dangerous new infectious organism. Camus' novel is a chilling read and could not be more timely.
In terms of more contemporary scientific literature, Laurie Garret wrote of the "newly emerging diseases in a world out of balance" in her equally chilling (and very non-fiction) tome The Coming Plague in the late 1990s. Ms. Garrett underscored the fact that rapidly spreading, drug-resistant diseases would begin to emerge and traverse the planet with greater frequency and virulence unless something was done to stem the tide. Consider her book a public health version of Al Gore's An Inconvenient Truth.
Many questions were raised today, and very few clear answers seem forthcoming. This one individual has been quarantined, and many passengers and crew from the affected flights will be tested and treated. But I believe today was a wake-up call for the public health community (not to mention the rest of us), and the ramifications of today's events will be enormous and perhaps vastly unforeseen.
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