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Wednesday, August 5

In Brazil "Delay and Pray" strategies curb swine flu outbreak; DocJim proposes same for U.S. schools

“It is not just the fear of getting sick, but also the fear for the other.”

Physician DocJim and Bullmoosegal -- the biologist, former business manager and U.S. Army Reserve officer who blogs at The Mod Con -- have weighed in on proposed changes to U.S. federal guidelines for school closings in the face of an epidemic. See Spencer S. Hsu's great report today at The Washington Post for background.(1)

Below I've republished all the comments that DocJim and Bullmoosegal added to the Pundita comment section today relating to Hsu's report.(2) But in brief:

Bullmoosegal asks tough-minded questions about the cost-benefit angle of the damn-the-torpedoes decision to open U.S. schools on time during the swine flu epidemic.

DocJim proposes that officials adopt a "Delay and Pray" approach to the question of whether to keep schools open during the autumn phase of the epidemic:
Closings will give time to Delay and Pray which will lead to getting the hospitals through the first round of super-sick, so that there is room for another round -- that will mean more survivors.

Delay and Pray can give time for distribution of vaccines or anti-virals.

Delay and Pray may make the difference in life or death for your children or your husband or wife.
Bloomberg reports today that Brazil's government is using the same approach with good results -- and in this case the "pray" part is quite literal. A Brazilian priest in the Catholic Church has taken an enlightened, ethical position on the issue of 'social distancing' for Catholic priests and laity during the swine flu epidemic in Brazil.

Let us hope -- and pray -- that religious leaders in the USA and around the world follow his example. From the report filed by Bloomberg reporter Fabiola Moura (3):
[...] Brazilians are helping contain the swine flu in Latin America’s largest country by changing religious habits, canceling travel plans and extending school breaks.

Brazil, where 56 people have died of the pandemic H1N1 flu virus, has Latin America’s lowest mortality rate from the illness at 0.02 deaths per 100,000 people, compared with 0.41 in Argentina, 0.13 in Mexico and 0.11 in Chile, according to data as of July 29 from Brazil’s health ministry. The deaths in Brazil included 36 women, nine of whom were pregnant.


Government efforts to identify and isolate people infected with the virus and educate the public have helped curb the spread in Brazil, said Clelia Aranda, the coordinator of the Department of Disease Control in Sao Paulo.

“Our country is too big,” said Aranda, a pediatrician. “We need to have initiatives individualized to local realities, but without running away from a basic directive.”

In Brazil’s southern states, the area of the country that gets lower temperatures in winter, public schools delayed the return to classes after the winter break ends.[...]
See the rest of the report for details on the school closings. Now here we come to the enlightened part:
Brazilian priest Roberto Francisco Daniel tells his congregation not to hold hands while saying the Lord’s Prayer and to refrain from shaking hands and kissing in his morning mass to avoid getting swine flu.

“At least if you don’t have skin touching, you eliminate contact with secretions of somebody infected,” said the Roman Catholic priest, known as Padre Beto at the Nossa Senhora de Aparecida church in Bauru, about 300 kilometers (187 miles) west of Sao Paulo.


Even in Brazil, the country with the most Roman Catholics, Padre Beto considers outdated Saint Francis of Assisi’s habit, from the 1180s in Italy, of kissing wounds to cure the sick. “Francis’ act was medieval, as the extreme feast was,” he said. “It is a mystical exaggeration.”

Padre Beto, who also holds a doctorate in ethics from the Ludwig-Maximilian University in Munich and teaches in the law program of Instituicao Toledo de Ensino in Bauru, faced a dilemma when called to a hospital to bless a Catholic with the swine flu. He declined, following a recommendation from the hospital crew.

“Even religious matters need to have a limit,” Padre Beto said. “I asked them to tell her we were praying for her.”
See the report at the Bloomberg site for links to information about Padre Beto and his church.

I was also struck by this comment:
Maria Lucia Guedes, who works at Brazil’s state-run Banco do Brasil SA in Brasilia, canceled her family’s trip to Argentina in July, afraid of being infected. Her husband was uncomfortable traveling because a colleague was pregnant and “he thought it would be too much of a responsibility,” she said.

“It is not just the fear of getting sick, but also the fear for the other,” said Guedes, 49.
My hat's off to Guedes and her husband, and to Padre Betro. I wish a philanthropist would donate a boatload of Filligent's BioMasks to his church.

Doubtful the Padre knows anything the about BioMask™ but I will bet he'd be interested to learn that the mask prevents more than secretions from landing on people; it also prevents infection transmission through inhalation and exhalation of the swine flu virus.

The mask is also so breathable and comfy he'd be able to deliver a long homily while wearing one and the choir and congregation could sing through their BioMasks without sounding like a flock of honking geese.

That reminds me; there's an angle to the BioMask™ story that few outside John Batchelor's radio audience know about. When John interviewed Filligent co-founder/CEO Melissa Mowbray-D'Arbela on July 25, she revealed that her interest in developing the world's best pathogen-fighting mask was personal.(4)

She was pregnant and living in Hong Kong during the SARS outbreak there. She recalled the chaos as people fought over limited supplies of surgical masks -- masks that did very little to give protection against the SARS virus.

Guedes's comments point up that there's an ethical consideration to the issue of school closings, which economic arguments for keeping U.S. schools open don't take into account.

Of course school closings will be a hardship for many American parents, which is also an ethical consideration. Yet despite a CDC study showing that pregnant women are four times more likely than the general population to suffer serious complications from swine flu, U.S. officials have been reluctant to deliver public service announcements urging Americans to have "fear for the other."(5)

The issue came up during Glenn Beck's interview last week with John M. Barry, author of The Great Influenza: The Epic Story of the Greatest Plague in History. Beck asked whether swine flu parties were a good idea as a natural means of 'vaccinating' people against swine flu.

Barry replied that it was a judgment call but that the tie-breaker was to consider what would happen if you deliberately infected yourself then ended up standing next to a pregnant woman.

If the kind of people who run in front of four lanes of rush-hour traffic to save themselves a two minute walk to the pedestrian crossing want to risk death by infecting themselves with swine flu -- well, there's no law against it. But unless they're willing to self-quarantine after the swine flu party there are ethical considerations that extend beyond themselves.

The same considerations apply to infected American students flinging their swine flu germs around their pregnant mothers, pregnant aunts, pregnant school staff and pregnant members of the public. This doesn't even get into the subject of flinging swine flu onto Americans who are in other high-risk categories.

Of course germ sharing is a natural part of human life and death, but baseline consideration for the physical welfare of others during a pandemic is what distinguishes humans from lice.

Hello up there on the moon to U.S. officials, this is a pandemic virus -- you know: a special kind of virus? One of the traits of this special virus is that it doesn't read political polls.

Delay the opening of the public schools until you've figured out when the swine vaccination program will get underway. And start cranking out more PSAs about swine flu.

If PSA scriptwriters need inspiration to get in the proper mood for writing warnings about swine flu, I have a suggestion. They could listen to the podcast of John Batchelor's interview with Stephan Talty, author of The Illustrious Dead: The Terrifying Story of How Typhus Killed Napoleon's Greatest Army. BARF ALERT: If you have a delicate stomach best not to listen to the tale while eating.

1) The Washington Post: Strategy On Flu Under Revision: U.S. Officials to Put Less Emphasis on School Closings; Spencer S. Hsu; August 4, 2009

2) DocJim said...
The article by Spencer Hsu in the 08/04/09 "Washington Post" is well written. The Obama administration who were seldom quoted show an appalling lack of being helpful.

Schools closed for a week, even for another week when needed, might be the very thing to save many children and adults lives. True, this Mexican flu is not as bad as the feared Avian flu. But that doesn't mean we should sit by like the English and watch our children and adults die when the vaccine is delayed.

If the epidemic of Mexican swine flu is delayed significantly in the USA, then more people can be protected with the swine flu vaccine. Simple story. Even the nuanced Obama administration should be able to follow this one.

The angle that "widespread financial losses" from school closings might occur is a non-starter. Forget that one guys.

So far, the "helpfulness" of this administration to the nation has been a near-total and complete sham. The clunker program has been too successful, but nothing else has been worthy of bragging rights.

Delay and Pray.

The Obama administration (the federal government) is more concerned about financial shortfalls than deaths in their Mexican swine flu scenarios.

With this in mind, communities must fend for themselves. Five day closings of schools can delay the epidemic, albeit unlikely that it can defeat the epidemic.

Closings will give time to Delay and Pray which will lead to getting the hospitals through the first round of super-sick, so that there is room for another round--that will mean more survivors.

Delay and Pray can give time for distribution of vaccines or anti-virals.

Delay and Pray may make the difference in life or death for your children or your husband or wife.

Even if the boss is crabby when husband or wife stays home to care for the sick (or just out of school) child, there will be fewer cases of flu at that boss's business. There is a real dollar benefit for businesses to be generous in allowing the parents of sick (or about to be sick children) to stay home or work from home. Businesses need to think about this now and become psychologically prepared so that they will get through this period comfortably.
Bullmoosegal said...
[Re statements in Hsu's report:"Federal officials proposed school closings after studying the outbreaks of severe acute respiratory syndrome (SARS) and avian flu in Asia earlier this decade, examining the 1918 and 1957 flu pandemics and using new computer models to consider the data. But opponents of school closings said that the research relied on unrealistic assumptions and overlooked real-world factors.]"

One wonders which 'real-world' factors they refer to. That closures extend the school year, and cost more for extended teacher contracts, cleaning, etc.? If so, these need to be spelled out. Any cost-benefit and risk analyses (which have yet to be done at all as far as I can see) need to clearly spell out all likely options, costs of implementation of those options plus variants, risks of full implementation versus something else, etc. Otherwise decision-making is purely ad hoc and knee-jerk, something they say they want to avoid.
3) Bloomberg: Swine Flu Curbed in Brazil as Mass Habits Change, Schools Delay; Fabiola Moura; August 4, 2009

4) Pity the interview is no longer at the podcast section on John's website else I'd post a link to it here. But for those who keep track of such things, the interview started around the 10 minute mark, Hour 2 of the July 25 podcast. I hope John is archiving all his show's podcasts because it seems he only keeps them on the website for a couple weeks.

5) BBC: Swine flu 'hits pregnant harder;' July 29, 2009
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