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Sunday, July 5

H1N1/swine flu: BIO.DIASPORA researcher Kamran Khan to guest on John Batchelor radio show tonight

"For the first time, we can quickly integrate information about worldwide air traffic patterns with information about global infectious disease threats. What this means is that cities and countries around the world can now respond to news of a threat earlier and more intelligently than ever before."

-- Kamran Khan, BIO.DIASPORA project

Kamran Khan, M.D., M.P.H. will be on John's radio show tonight at 9:20 PM Eastern Time on 77-WABC AM in New York (and on 630-WMAL AM in Washington D.C.).

See the schedule for more details on tonight's show and other cities in which the show airs.

The links I provided are to WABC and WMAL online streaming. For listeners outside the USA, WABC can be heard online in many countries around the world. And a podcast of the show will be available on Monday at John's website.

Dr Khan will be discussing the BIO.DIASPORA project with John. It's not possible to overstate the importance of the project; in one sentence it is the best chance humanity has for getting free of the Dark Ages in the public health regime's approach to infectious disease control.

BIO.DIASPORA is not new; it was started in response to the SARS outbreak. Yet governments are still not making effective use of the project's approach.

For readers who missed my last post, here is the BIO.DIASPORA mission statement:
[To] understand global patterns of human travel via commercial airlines as a way to predict how emerging infectious diseases are most likely to spread around the world -- and consequently apply this knowledge to help the world's cities and countries better prepare for and respond to global infectious disease threats of tomorrow.
The project, which is based at St. Michael’s Hospital, a teaching hospital affiliated with the University of Toronto, reflects a convergence of public health management and various scientific, mathematical, and computer disciplines.

BIO.DIASPORA used data obtained from the International Air Transport Association to map how the 2009 swine flu virus spread via air travel. This June 30 Reuters report summarizes the study, which is described in greater detail in a June 29 letter published in The New England Journal of Medicine.

The research outlined in NEJM plotted the relationship between international air traffic flows to different countries and H1N1 importation to reveal that "countries receiving more than 1400 passengers from Mexico were at a significantly elevated risk for importation" in the early months of the outbreak.

If you ask why it should take statistical analysis to demonstrate that the sun shines and rain falls downward: Yes it's self-evident that near-simultaneous outbreaks of swine flu around the world were due to arriving international air passengers infected with the disease. But BIO.DIASPORA puts the observation on a scientific footing.

And without Science prodding them, the public health establishment, and the governments they answer to, will continue to play ostrich about the obvious need to make international airports the staging area for the first line of defense against a pandemic.

This is the strategy that China's government mounted against swine flu, which allowed them to greatly slow the spread of infections in both the country's Mainland and Hong Kong territory. This bought the country's vaccine developers and health departments precious time to gear up for wider outbreaks of the disease.

And because China monitored outbound air international passengers, they prevented the wholesale export of swine flu infections from their country. (Mexico did the same once they realized what they were dealing with.)

Countries that made little or no attempt to monitor inbound air passengers for fever and other signs of illness were quickly overwhelmed by the spread of the disease. And countries with a high incidence of swine flu cases, and which made no effort to monitor outbound air passengers for fever, played 'Typhoid Mary' to the rest of the world.

This negligence is no less barbaric just because 'everybody does it.' Everybody did a lot of dumb and inhumane things in humanity's past. It is time for us to leave the Dark Ages in infectious disease control. If you can help get the word about BIO.DIASPORA to your government and local media outlets, that would be a step toward the light.
Yes, stopping air traffic or at least temporarily quarantining those arriving from an epidemic area gains time.
Two weeks of no significant flights from "X" or "Y" won't bankrupt the airlines, nor seriously ruin international commerce. We do have the internet, after all, and important business communications can go via the internet for a few weeks. That may not be ideal for all of those meetings, but the thousands of people who might die from an infection is too high a price to pay for the convenience of the global economy for a few weeks.
On the other hand, after listening to Dr. Kahn from Toronto, I realized that his work is just entertainment.
He stated that the "incubation period" for influenza is "several days" (24-48 hours is usually stated) and a person could be admitted to a country off an airplane with no fever, but already infected with influenza. In the absence of a policy to quarantine during such epidemics, there is no point in knowing whether a person has influenza or came from the epidemic area.

Failure to use information in a useful way means his studies about air travel spreading infections are only useful for entertainment. I'm surprised the New England Journal of Medicine wasted paper on his report, the New York Times would have done as well.

On the other hand, maybe the tide is turning. The CDC and WHO may be seeing the light. If so, I thank Pundita. There are useful Non-Pharmacological Interventions that can be used to stop an epidemic. Like use of quarantine for "several days" and checking for fever in arriving passengers. Checking an epidemic may give rise to time to get something done that is also useful.

Certainly, the realization that Tamiflu has failed in 3 cases of H1N1 swine flu within the period of May, June, July is a hint that relying on Tamiflu or some new, unknown drug is not our only defense against the microbial world.
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