-- Pundita, May 11, 2009
It was obvious more than a month ago, even to a casual observer, that the swine flu pandemic is a phenomenon of the almost blanket globalization of air travel. With the exception of a very few countries, such as North Korea, even many of the poorest countries see significant international airline flight arrivals.
The phenomenon has meant that West European and Canadian air passengers have brought swine flu to several countries, and that in the last few weeks infected passengers from Australia have been depositing swine flu around Asia.
But the largest number, if not an overwhelming majority, of the first swine flu carriers to many countries have been airline passengers who've flown from or via a U.S. international airport.
Despite this, the U.S. government has clung to CDC-WHO dogma to rationalize their ongoing refusal to install temperature monitors at international airports in the USA.
Over a series of posts I think I've done a pretty good job of challenging the arguments supporting the dogma, which is that once an airborne infectious disease enters a country there's no way to stop its spread and therefore it's no use to set up draconian surveillance measures at international airports.
And China's success at deploying such measures to slow the initial spread of secondary swine flu infections has pulverized the CDC-WHO arguments.
Yet Washington has continued to play ostrich about installing computerized temperature monitors at U.S. international airplane arrival gates -- when even tiny, dirt-poor Yemen has scared up the wherewithal to install one of the gizmos at their international airport.
It's uninformed to blame this on airlines. As I noted in an earlier post, the U.S. airline industry takes its guidance from the CDC on infectious disease control measures at U.S. airports.
And given that protecting Americans from lethal infectious diseases is a key part of homeland security, this is one of those expenditures that justifies federal funding.
So what the heck is the problem?
The answer was inadvertently supplied in the closing paragraph of a June 30 Reuters report that RBO's Procrustes forwarded me on the same day:
The researchers said the United States receives more than 76 million international visitors from around the world every year and the United States and Canada together generate and receive about one-sixth of the global volume of international air traffic.To be more specific, the answer is found by applying the statistics in the paragraph to the issue of temperature monitoring machines for the U.S. international airports.
In earlier posts I've detailed China's airport-based swine flu battle plan, which relies heavily on computerized temperature monitors and the use of manual thermometers to take the temperature of inbound international air passengers.
The measures are accompanied by quarantines of infected passengers and ongoing surveillance of suspected swine flu cases among the airline passengers, even after the passengers leave the airport.
WHO's Margaret Chan called the plan "resource intensive." It would be incredibly resource intensive if applied in the United States. The bottom line is that given the huge volume of international air traffic in the United States, the expense of buying and installing thousands of thermal imaging machines is the least of the problem:
The machines have to be monitored by trained personnel, as is done in China. And if a machine catches a passenger with an elevated temperature, what then? Simply allowing the passenger to continue on would defeat the purpose of the surveillance, particularly during a pandemic-threat situation.
At the least, medical attention would be required. And quarantine would be required, if you really wanted to slow the rate of secondary infections in the United States and help countries that see inbound air traffic from the USA do the same. But the US government, not the passengers, would have to foot the bill for the quarantines, as they did in China.
So even setting aside the deterrent to air travel that quarantine creates, it's expensive to put someone in a hospital or hotel for anywhere from three to seven days of the quarantine. The isolation must include meals and round-the-clock medical attention -- which, for passengers who test positive for the disease, would include prescription medications.
And readers who followed my discussion about China's quarantines know that there are some finicky air travelers out there, and that all kinds of complications arise during even a brief quarantine.
So the Chinese quarantine officials could tell you it's not just a matter of throwing sick airline passengers into a room and handing them three meals a day. They want phones in their room, they want a TV and internet access. They have dietary requirements.
Oh and by the way those hotels and hospitals have to be guarded so quarantinees understand it's useless to attempt escape. That means money spent on guards, as China did.
But after American tax dollars have been lavished on thermal imaging machines and quarantines, it'd be pretty stupid, wouldn't it, to do the job halfway?
The machines can miss passengers with a temperature. So if you wanted to do it up right, you'd need to send medical personnel up and down the plane aisles with thermometer guns, checking the temperature of each passenger, as China did. That means more labor, and I'll bet those fancy thermometers don't come cheap.
Then what about the passengers who're infected but not yet manifesting a temperature? That would require follow-up surveillance and notification, as China did.
All that isn't even addressing the expense of having to track down and quarantine an entire row of passengers just because one person in the row tested positive, as China did.
By now American readers might be developing a little sympathy for the CDC's stubborn adherence to dogma. Yes indeed; it's easy to cheer on China's Flu-Fighting Brigades -- as long as it's not your tax dollars footing the bill.
I can just see Glenn Beck hunching over his desk and saying to the camera, 'That would take another layer of bureaucracy, and -- ' (pausing for effect)'a Flu Czar.'
So. When the numbers are crunched it turns out that only on paper is it a good idea to install thermal imaging monitors in U.S. airports -- provided you remove a superkiller pandemic from the picture. When you add the superkiller to the accounting ledger, suddenly the picture completely changes.
Even if you remove the direst threat -- the so-called "Armageddon Virus" -- and look only at the billions USD being diverted to the present swine flu pandemic emergencies worldwide, and at the billions lost because of lost tourism and airline profits, etc., China's approach to fighting swine flu plan is the essence of cost-effectiveness. That is, provided all the major trading countries -- the ones with the heaviest commercial international air traffic -- implemented the plan.
With that proviso in mind, imagine the future as the past: Return to early March 2009. The global biosurveillance network is working as it was designed. That means Mexico's health officials quickly spot an atypical pneumonia and flu outbreak. So a Mexican health technician sits down at a computer and types.
Seconds later warning lights in every international airport in North America signal that the biosurveillance alert level has been raised to its highest level. Airport personnel run to their stations, thermal imaging monitors are switched on, medical personnel climb into hazmat suits, and loudspeakers announce to airline passengers from North America that there will be a delay while their temperatures are monitored.
At the same time all airport personnel and airplane crews don face masks, protective glasses, and gloves when they're in contact with passengers. Restaurants in the airports also put their workers on alert, hand out hand sanitizer to customers, and institute special sterilization procedures in the table areas.
None of this activity creates panic or uncertainty among airline passengers because they've been well-briefed on the necessity for biosurveillance alerts at international airports.
Meanwhile, rapid test results from hospitalized pneumonia patients in Mexico are being analyzed to determine whether the pneumonia is connected with a known virus.
Personnel in all major cities are alerted to be on standby for the analysis results; temperature monitors are switched on as governments inform their international airports to begin close surveillance of passengers from North America.
As soon as analyses indicate that the pneumonia is connected with an unknown virus, the Mexican technician returns to the computer. Seconds later major biolabs all around the world are notified to be on standby, so they can start working on genome mapping for the new virus. All vaccine manufacturers are alerted about the new virus.
And within an hour of the first analysis every federal health department in the world has been notified of the situation, and is busy notifying hospitals and health departments nearest to their country's international airports.
Now let's return that future to the present. Go to Google News and look for the thousands of reports posted there on the 2009 swine flu pandemic sweeping the world; there are none because there is no pandemic. There are only a few reports on the progress of vaccine development for the 2009 swine flu, and a smattering of reports on small outbreaks, mostly limited to North America.
Eventually, the few outbreaks will create secondary infections that over a period of several weeks could lead to the pandemic of today. That's because you can't spot every sick person who alights from a plane.
But in the future scenario, that sequence of events will be blocked. That's because humanity has bought itself enough time to allow for the development, manufacture and distribution of a vaccine before the outbreaks create wide-scale secondary infections; i.e., infections in a community that are no longer directly tied to an infected airline passenger.
The future scenario also means something else: a large number of quarantines, of the kind China is using to fight swine flu, won't be necessary. With every major trading country doing their share to monitor airline passengers with fever, and with all countries monitoring passengers during the high alert periods, there just won't be that many passengers with a fever. It will be thinning the forest, greatly.
And that means the cost of good biosurveillance at airports would be manageable for the United States and Canada, despite those countries' high volume of commercial air traffic.
If you ask, 'Would that approach also work for regular influenzas?' -- I think the next generation is going to look back on our methods of infectious disease control with the same patronizing pity that we look back on the medical practice of applying leeches to patients.
The super-vaccine is on its way -- maybe a year from now, maybe a quarter century from today -- but it's going to happen. And when it does we won't have to worry anymore about doomsday pandemics. And just in time, I hope; mathematicians didn't factor in a few things, decades ago, when they calculated that human overpopulation would be a big problem down the line. The problem for humans turned out to be the opposite.
Yet between the advent of the super-vaccine and today is a cliff-hanger era for humanity.
Anyone who tells you, 'Oh don't worry; the Armageddon Virus is a very remote possibility' -- file that along with "This ship is unsinkable" and other Famous Last Words.
As to how far away we are from the future scenario I outlined -- we could be closer than seems evident to you at this moment, unless you've already heard of the BIO.DIASPORA project. The project has been around for a few years but the 2009 swine flu outbreak is giving it a big boost.
What is BIO.DIASPORA? Here is the 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 air travel data obtained from the International Air Transport Association to map how the 2009 swine flu virus spread via air travel. The June 30 Reuters report I quoted from summarizes the study, which is described in greater detail in a June 29 letter published in The New England Journal of Medicine.
If you'd like something to smile about today I suggest you read the June 29 letter, then visit the BIO.DIASPORA website and look at all their cool graphics, which show just how interconnected this world is through airline routes.
I'll give the last word to BIO.DIASPORA team leader for the H1N1 study, Dr Kamran Khan:
"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."