I really like Climate Depot's Marc Morano, who has become a fixture on John Batchelor's radio show in recent weeks. So I'm interrupting my blogging on swine flu to alert you to a delightful essay by John on how the Climate Change issue fared at the G8 summit in Italy.
Don't miss the article John added to the comment section of his post (third comment) titled Ancient Climate-Change Event Puzzles Scientists.
Regarding this observation in the article: "The urgent challenge now facing us is to find out what was amplifying [temperatures] during this event and understand what it means for Earth's future" --
Well, have they thought of investigating the possibility that the climate changes they're noting are due to Earth's poles starting to reverse themselves -- an event that happens every 250,000 years or so, and one which some scientists consider overdue if the reversal hasn't already started?
Just a suggestion.
Yes I know the subject of pole reversal is Taboo in Green circles. But let's live dangerously for a few minutes, shall we, and take a walk on the wild side?
Would any of humanity survive the space junk that would crash upon us while the Earth's magnetic shield was down during the height of the pole reversal? Sure. We've survived it before.
But we'd survive much better if we stopped tilting at windmills that General Electric seems determined to fob off, gave less attention to exotic financial instruments in the form of cap and trade schemes, and revised our priorities.
What would be the top priority if we were indeed living through the start of the pole shift, which is a normal and necessary part of Earth's housekeeping?
The bad news is that so little is known about the process that scientists can't predict with any accuracy how long it will last, or at what point in the process living creatures will face the toughest slog. The worst could last a quarter century or a thousand years; we just don't know.
What is known at this point is that to survive the worst with some modicum of grace, humans would need all the brainpower we could get.
So if you wanted to prioritize for a Magnetic Storm Epoch, that would mean every government on the planet shoveling mountains of money into education programs right now -- and, in regions where females are barred from formal education, removing all such barriers.
Oh but I forgot! Bad Pundita! Bringing up that subject during a discussion on Climate Change is Taboo. Of course it's easier for 'advanced' democracies to protest the carbon footprint than to read the riot act to governments that support cultural prejudices against educating females.
Moving right along, another way to boost humanity's collective smarts would be to undertake a crash program to turn prisons into colleges. If you protest that this is rewarding criminal behavior -- do you have any idea what a pole reversal means?
For starters, chunks of continents will be covered by oceans, the Australian continent will probably disappear under water, and so will many island nations. Many species will be fried out of existence by the more intense rays from the sun while the magnetic shield is down. In many regions entire seas will dry up, which is saying nothing about the disappearance of rivers that large numbers of humans and wildlife depend on.
Bottom line: to keep our civilization going -- if we don't want to end up back in what's left of the trees -- we'll have to arrange massive 'rolling' population shifts from one region to another, at least until the magnetic shield starts to return. That is going to require feats of engineering we can scarcely imagine today, let alone implement.
And you want to let some guy who's in the clink for robbery sit around for years watching TV, playing basketball, and working at a mindless easy job like making license plates?
As we flogged prisoners to work on road-building chain gangs during an earlier era, any convict whose brain is not half-melted from drugs, booze or malnutrition should be pushed to the limit in prison to study subjects that are priority for human survival.
There is no reason why video-conference classrooms shouldn't be the standard daily grind for prisoners. And no reason why companies can't be formed to hire graduates of prison colleges.
Even without the sword of pole reversal hanging over our head, humanity has passed the time when we can afford to let millions of brains rot in jail. I understand that observation is Taboo. It's also the truth.
For more on pole reversal, see NOVA's 2003 Magnetic Storm.
***************************
This entry is crossposted at RBO. Procrustes found stunning artwork on the pole reversal to accompany the piece.
Wednesday, July 15
Tuesday, July 14
How widespread is swine flu? Without accurate numbers, who knows? (UPDATED)
July 15, 5:15 PM Update
As you can see from the post I published 15 minutes ago the story I discuss here has grown more legs than a centipede. Things are heating up.
*********************
I think the public is generally aware that testing for swine cases has lagged so far behind the actual number that it's been impossible to get a clear picture of how this pandemic is acting. But the data issue is much graver than generally known. On June 3, days before WHO officially declared a pandemic, the New Scientist warned that Europe needed better testing for swine flu and that the region was facing an "invisible pandemic." They were right on both counts.
Because an epidemic will eventually overwhelm data-collection resources it is vital to collect as much data as early as possible during an outbreak. This approach wasn't taken. Many public health departments, under guidance from their federal health agencies, such as the CDC, simply threw up their hands within about two weeks of the outbreak's announcement.
The consequence? In country after country, inadequate tracking of swine flu cases has been one of the greatest problems that hospitals, doctors, and public health agencies have faced while trying to muster an appropriate response to the outbreak.
Another problem is that mathematical models that produce estimates on the number of cases depend on raw data for their accuracy. If the data are wildly off, the old computer programmer's dictum, 'Garbage in, garbage out' applies to the models.
The problem is made far worse when bad data are fed into a model that was inadequately designed, as this illuminating 2007 report (written for the layperson) on mathematical models for pandemics indicates.(1)
I suspect, I hope, the model given much discussion in the report, which was designed by MIT professor Richard Larson and his colleagues, has had a beneficial influence on pandemic modeling during the past two years.
Yet even the best-designed model is up against the limitations of data that reflect inadequate testing in the earliest stage of an epidemic. Now Reuters' Maggie Fox, who has been one of the stalwarts of swine flu reporting since the early days of the outbreak, has written an article that tackles the issue head on.
Brava, Maggie!
As you can see from the post I published 15 minutes ago the story I discuss here has grown more legs than a centipede. Things are heating up.
*********************
I think the public is generally aware that testing for swine cases has lagged so far behind the actual number that it's been impossible to get a clear picture of how this pandemic is acting. But the data issue is much graver than generally known. On June 3, days before WHO officially declared a pandemic, the New Scientist warned that Europe needed better testing for swine flu and that the region was facing an "invisible pandemic." They were right on both counts.
Because an epidemic will eventually overwhelm data-collection resources it is vital to collect as much data as early as possible during an outbreak. This approach wasn't taken. Many public health departments, under guidance from their federal health agencies, such as the CDC, simply threw up their hands within about two weeks of the outbreak's announcement.
The consequence? In country after country, inadequate tracking of swine flu cases has been one of the greatest problems that hospitals, doctors, and public health agencies have faced while trying to muster an appropriate response to the outbreak.
Another problem is that mathematical models that produce estimates on the number of cases depend on raw data for their accuracy. If the data are wildly off, the old computer programmer's dictum, 'Garbage in, garbage out' applies to the models.
The problem is made far worse when bad data are fed into a model that was inadequately designed, as this illuminating 2007 report (written for the layperson) on mathematical models for pandemics indicates.(1)
I suspect, I hope, the model given much discussion in the report, which was designed by MIT professor Richard Larson and his colleagues, has had a beneficial influence on pandemic modeling during the past two years.
Yet even the best-designed model is up against the limitations of data that reflect inadequate testing in the earliest stage of an epidemic. Now Reuters' Maggie Fox, who has been one of the stalwarts of swine flu reporting since the early days of the outbreak, has written an article that tackles the issue head on.
Brava, Maggie!
How bad is swine flu? Without numbers, who knows?1) Medical News Today: Engineer Who Survived Pandemic Of '68 Creates Model To Track Outbreak; 02 June 2007
Tue Jul 14, 2009 7:04pm EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Many people are confused about just how many patients have been infected with the new H1N1 flu, which in turn makes it hard to tell how bad the pandemic is, British researchers said on Tuesday.
But better methods of measuring the swine flu toll in real-time could help reduce some of that confusion, according to the team at Imperial College London.
And without this information, they said, governments are operating in the dark when assessing what their response should be.
"If you don't test people, you don't know how many people are out there who have it," Dr. Tini Garske, an expert in disease modeling who led the study, said in a telephone interview. "The number of confirmed cases doesn't tell you a lot."
The World Health Organization has confirmed 94,512 cases globally and 429 deaths from the new H1N1 swine flu, which was declared a pandemic last month.
But these numbers represent only a fraction of the real cases -- the U.S. Centers for Disease Control and Prevention says at least a million people have been infected and the virus is spreading out of control.
Most countries are now only testing a sample of patients, and many people who become infected are not ill enough to even seek medical attention, let alone get tested.
Diagnostic kits for H1N1 are expensive, and most governments save them for when they are really needed.
But if no one knows just how many people are infected overall, with serious disease and with mild disease, how can anyone say how severe the pandemic is?
DEATH RATES
Writing in the British Medical Journal, Garske and colleagues said current case fatality ratios -- the number of deaths from swine flu divided by the total number of cases -- is only around 0.5 percent. This is similar to the death rate from seasonal influenza, which kills anywhere between 250,000 and 500,000 people globally each year.
But Garske noted this varies greatly from country to country. Unlike seasonal flu, influenza H1N1 is causing severe illness in previously healthy young adults and children.
"Accurately predicting the severity of this swine flu pandemic is a very tricky business, and our research shows that this can only be achieved if data is collected according to well-designed study protocols and analyzed in a more sophisticated way than is frequently being performed at present," Garske said.
"If we fail to get an accurate prediction of severity, we will not be providing healthcare planners, doctors and nurses, with the information that they need to ensure they are best prepared to fight the pandemic as we head into the flu season this autumn."
Garske's team outlined ways to improve estimates, including using individual towns as examples.
Watching families can also help give researchers an idea of how the flu spreads. If one sick family member infects one other family member, or two, or three, that number can be used to estimate the infection rate in places where cases are not being painstakingly diagnosed and recorded, she said.
"You don't need to know about everybody, but you need some subpopulations," she said.
H1N1/swine flu: Mathematics of death as doctors, governments forced to gamble
Hello? Hello? Is there anybody home at Homeland Security?
I'm getting my exercise these few days from pounding the lectern and shouting myself hoarse, as I deal with the rising number of news reports about the terrible choices governments are now having to make -- choices that are no more than a gamble.
All this could have been avoided if governments in countries with heavy international air traffic had extensive air passenger surveillance in place after SARS. In this way they could have bought themselves more time for vaccine development and testing when a real pandemic virus appeared. Beep this is a recording.
And I do not want to hear again, 'Oh Pundita it's too late now.'
What happens if this virus mutates itself into a more virulent form? What happens if it mutates into a Tamiflu-resistant strain? Oh but that's right I forgot: There's already a resistant strain on the loose. If airports were set up to do extensive surveillance they could catch the strain, instead of governments the world over having to cross their fingers and pray the thing dies out.
However, China's government is set up to do extensive airport surveillance, which is how the Tamiflu-resistant mutation was spotted.
July 12: Published comment from Pundita reader "DocJim," a practicing physician, in reply to New Scientist mention that swine flu seems to be pushing out the seasonal influenza strain in a number of countries:
I'm getting my exercise these few days from pounding the lectern and shouting myself hoarse, as I deal with the rising number of news reports about the terrible choices governments are now having to make -- choices that are no more than a gamble.
All this could have been avoided if governments in countries with heavy international air traffic had extensive air passenger surveillance in place after SARS. In this way they could have bought themselves more time for vaccine development and testing when a real pandemic virus appeared. Beep this is a recording.
And I do not want to hear again, 'Oh Pundita it's too late now.'
What happens if this virus mutates itself into a more virulent form? What happens if it mutates into a Tamiflu-resistant strain? Oh but that's right I forgot: There's already a resistant strain on the loose. If airports were set up to do extensive surveillance they could catch the strain, instead of governments the world over having to cross their fingers and pray the thing dies out.
However, China's government is set up to do extensive airport surveillance, which is how the Tamiflu-resistant mutation was spotted.
July 12: Published comment from Pundita reader "DocJim," a practicing physician, in reply to New Scientist mention that swine flu seems to be pushing out the seasonal influenza strain in a number of countries:
The winter flu season in the northern hemisphere did not wind down this year. It is continuing through the summertime and a similar pattern was seen with the old 1918 Spanish flu. That is not to say that it is not less than it will be in the fall, but there are lots of Type A influenza cases occurring this summer in the USA and the UK. It is VERY unusual. The SECOND WAVE will come in the fall.July 13, Associated Press, Maria Cheng:
2) Dr. Edwin Kilbourne, emeritus at NY Medical College, was the person most responsible for selling the idea of the 1976 swine flu vaccine. (May symposium at NY Academy of Sciences) He says we simply didn't realize that 1 in 100,000 people vaccinated would develop Guillian-Barre syndrome. Data had not been put together to notice such a rare event and link it to vaccinations until 1976.
If the USA vaccinates the population of 300,000,000, there "should be" about 3,000 cases of Guillian-Barre. Some of those will die. IF we do NOT vaccinate, then with an attack rate of 20% and 1% death rate, 600,000 people in the USA will die of swine flu. These numbers won't be perfect, as not everyone will take the vaccine. It doesn't look very good anyway you run the numbers. By the way, these should be called dead customers for the global business world. That kind of talk makes sense to the finance people and money talks.
"WHO: No licensed swine flu vaccine til end of year"July 14, The Washington Post, Rachel Saslow:
LONDON (AP) -- A fully licensed swine flu vaccine might not be available until the end of the year, a top official at the World Health Organization said Monday, in a report that could affect many countries' vaccination plans.
But countries could use emergency provisions to get the vaccines out quicker if they decide their populations need them, Marie-Paule Kieny, director of WHO's Initiative for Vaccine Research, said during a news conference.
The swine flu viruses currently being used to develop a vaccine aren't producing enough of the ingredient needed for the vaccine, and WHO has asked its laboratory network to produce a new set of viruses as soon as possible.
So far, the swine flu viruses being used are only producing about half as much "yield" to make vaccines as regular flu viruses.
[...]
In a presentation to WHO's vaccines advisory group last week, Kieny said a lower-producing vaccine would significantly delay the timeline for vaccines. That could complicate many Western countries' plans to roll out vaccines in the fall.
British Health Minister Andy Burnham promised that vaccines would start arriving in the U.K. in August — and predicted the country could see up to 100,000 cases a day by the end of that month. [Exponential Grain of Salt Alert]
Before countries can start any mass swine flu vaccination campaigns, the vaccines need to be vetted by regulatory authorities for safety issues. That means testing the vaccines in a small number of humans first, which can take weeks or months.
"I think it will be a very significant challenge to have vaccines going into peoples' arms in any meaningful number by September," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. "At this point, it is still is an issue of when will it be available, who will get it, and what will be the dose?"
Kieny said many of those questions remain unanswered at the moment. But she said WHO's vaccine advisory group recommended that health care workers receive the first swine flu shots since they are on the front lines of the global outbreak.
[...]
WHO's vaccine experts recommend that countries decided that certain groups should get the vaccine first — like pregnant women, people with chronic respiratory problems or obesity, children, and possibly young to middle-aged adults, who have been disproportionately affected by the virus.
The decision to start vaccinating people against swine flu -- which so far remains a mild virus in most people -- will ultimately be a gamble, since there will be limited data on any vaccine. Until millions of people start receiving the shots, experts will not know about rare and potentially dangerous side effects.
The public health community may still be scarred by the U.S.' disastrous 1976 swine flu vaccination campaign, which was abruptly stopped after hundreds of people reported developing Guillain-Barre syndrome, a paralyzing disorder, after getting the flu vaccine.
Several drugmakers are currently considering using adjuvants, ingredients used to stretch a vaccine's active ingredient, which could allow for many more vaccine doses. But little or no data exists on the safety of vaccines with adjuvants in populations including children and pregnant women. And in the U.S., there are no licensed flu vaccines that use adjuvants.
Swine Flu? Don't Ask: Doctors Usually Can't Tell for Sure.July 14: I showed the Wapo report to a physician friend in the Greater Washington, DC area. Here are his comments about the doctors' recommendations quoted in the report :
Sheila Morris is almost certain her 13-year-old son Evan got the H1N1 influenza virus at summer camp two weeks ago -- but she'll never know for sure. And neither will the Centers for Disease Control and Prevention.
The Fairfax County mother suspected H1N1, or swine flu, when her son came home with a temperature of 104. An e-mail from the camp director confirming eight cases of H1N1 among campers solidified her hunch.
"That night we called the doctor's office, and she said, 'Sure, it's probably swine flu,' " Morris says. But the doctor did not suggest that Evan come in for testing. "She didn't think the CDC was interested in anything unless you died."
Parents in the Washington area and beyond are having similar experiences, leaving some angry and others, like Morris, confused.
Private doctors, such as Morris's pediatrician, can't run their own tests for H1N1. That falls to private laboratories and the public-health system, which wants to track the pandemic, not help doctors make treatment decisions.
As of Friday, the CDC had reported 37,246 cases of swine flu and 211 deaths from the illness nationwide. The District has 45 confirmed cases of the virus, Maryland has 686 and Virginia 306, but officials have said the actual number is probably much higher, because not everyone who gets sick goes to the doctor and because it's not practical to give an H1N1 test to everyone with a flulike illness. The CDC estimates that more than a million people worldwide have contracted H1N1. [Er, that's interesting; it seems just the other day CDC was estimating a million cases in the USA alone. Exponential Grain of Salt Alert or reporter mistake]
Last Thursday, the federal government hosted a "flu summit" to talk about vaccinations and preparedness. Health and Human Services Secretary Kathleen Sebelius called H1N1 "a serious virus capable of causing severe disease and death" and said, "We must avoid complacency and ensure we are prepared to deal with whatever the fall flu season brings."
Diane Dubinsky, the medical director of Fairfax Pediatric Associates, gives her patients with flu symptoms a rapid diagnostic test: a nasal swab that detects all flu, including swine flu. (Dubinsky is not Morris's doctor.) The results are clear in about 10 minutes, and if the test is positive for influenza A, she assumes that the patient has the H1N1 virus, which is a type of influenza A.
On a conference call with reporters on June 26, Anne Schuchat, a CDC physician helping to lead its pandemic response, said virtually all of the influenza circulating this summer is the H1N1 variety; 99 percent of the positive samples tested by the CDC are H1N1. Schuchat said the CDC is performing "virologic sampling" to get infection numbers rather than testing every single person with a flulike illness. [Reference Doc Jim's comment about seasonal flu this year]
"We've had cases where patients have been angry, demanding to get tested for swine flu," Dubinsky says. "We calm them down and say who we test and who we don't test."
Today, a month after the World Health Organization declared a swine flu pandemic, the CDC recommends H1N1 testing only for people with flulike symptoms who are at high risk for complications, including infants, the elderly, pregnant women and those with chronic illnesses. The D.C. health department adopted those guidelines June 22.
Not all doctors are following the guidelines. Foxhall Pediatrics in Northwest Washington sent influenza A-positive swabs to a private laboratory for testing through the end of June, even for children older than 5, according to an administrator at that office. The practice did it because doctors and patients both wanted to know the results. Still, the practice plans to follow the CDC guidelines for all future patients.
Diane Helentjaris, the acting director of the Virginia Department of Health's Office of Epidemiology, guesses that some patients are eager to get the swine flu test because they're curious, even "a little excited about having something new." [I can think of other reasons why patients would want to get tested]
Conducting the H1N1 test is not simple. Doctors must transport samples in special containers; the test costs $40 to $200, depending on the exact type and various laboratory issues; and the whole process can take a week. By then, most patients are on the mend. Compare that process with the 10-minute rapid flu test, which costs about $15.
In this context, many local doctors, including Dubinsky, have been telling any patient who tests positive for influenza A that he or she probably has swine flu.
Doctors recommend that patients treat flu symptoms by taking over-the-counter medicines and staying home for a week after falling ill. The antiviral drug Tamiflu is recommended only for at-risk patients who seek treatment within the first 48 hours of symptoms, Dubinsky says.
In Morris's case, she picked her sick son up from camp and prepared for the flu to spread through her family. She kept her son at home and monitored him closely. She bought Tamiflu for her elderly father, who lives with her and is in fragile health. She acted as if her son had swine flu, even though she probably would never know for sure. So far, nobody else in her family has gotten sick.
Yes, this is the appropriate medical response.
Rarely does any Type A flu circulate at this time of the year. New kits for distinguishing Type A vs Type B show swine flu as Type A. Older kits show no reaction, as they didn't pick up this new swine flu Type A. So knowing the capabilities of the testing system, a physician must predict.
It is hard to fault the reasoning that kids who are not very sick don't need antivirals, they need oral fluids, Tylenol and bedrest until better. On the other hand, a few will die, if not treated with Tamiflu or Relenza.
We have passed the point of no return in the epidemic in the USA, it is here and growing. Treatment based on clinical description is adequate now. Doing PCR tests on all cases is a big waste of time and money. That kind of testing is useful at the start to see what is evolving. Now we know. We have epidemic swine flu in the DC metro area.
I plan to give Rx for Tamiflu to every patient who calls with symptoms that fit. Doing less seems unwise, though we will spend a huge amount of money on Tamiflu to save a "few" lives. I hope to save lives among my patients, rather than blow off the low chance of doing so as uneconomic.
Sunday, July 12
H1N1/swine flu: And now for a little mayhem from the United Kingdom
If the following is not enough to worry you, try this one on: According to the latest research BE WARNED you might DIE more readily from a serious swine flu infection if you're FAT. Put down that cheeseburger, she said, opening a bag of potato chips.
Remember to take the estimate of 100K/day infections and 40/day deaths with an exponential grain of salt but there's no question they're heading toward an epidemic across the Pond, if they haven't already arrived. From the (U.K.) Telegraph (H/T Doc Jim). Note the recorded message the National Health Service prepared:
Remember to take the estimate of 100K/day infections and 40/day deaths with an exponential grain of salt but there's no question they're heading toward an epidemic across the Pond, if they haven't already arrived. From the (U.K.) Telegraph (H/T Doc Jim). Note the recorded message the National Health Service prepared:
Swine flu: Routine operations must be put on hold so that the [National Health Service] can cope with the swine flu crisis, doctors' leaders have warned.Exhaustion could be the least of the problem:
By David Harrison and Patrick Sawer
Published: 9:00PM BST 11 Jul 2009
Dr Peter Holden, a member of the British Medical Association's general practitioners committee, said that the Government should implement emergency plans to deal with a swine flu pandemic "with immediate effect".
"The Government must push the button now" he said. "Forward planning is vital. We will have to forget about hitting targets for waiting lists.
"Routine operations and preventive treatment will have to take second place."
Dr Holden, who played a key role in drawing up the contingency plans, said the [National Health Service] workforce should be allowed to concentrate on getting ready for a "second wave" of swine flu.
He said the NHS was already under strain and the workload for GPs and other NHS staff in the worst-hit areas was becoming "unsustainable".
"We do not want the troops to be exhausted before the start of what could be a very significant stage in the campaign," he said.
Health workers may flee in pandemic panicTo return to the Telegraph report:
by Rachel Nowak
June 3, 2009
New Scientist
Healthcare workers will desert their posts in droves in a pandemic, unless the safety and psychological issues they face are addressed. So say surveys of doctors, nurses and other staff, such as lab techs, secretaries and porters, from around the world.
The worst predictions are for the UK, where as few as 15 per cent of workers would show up in a pandemic [citation].
Elsewhere, the figures are better but still worrying. Two Australian surveys suggest that 60 to 80 per cent of workers would go to work [citation]. Studies in Hong Kong and the US predict an 85 and 50 per cent turnout respectively. [...]
Dr Holden was speaking after the death toll from the virus rose to 15 when a middle-aged man died after nine days in hospital in Basildon, Essex. It was the first death in the UK of someone without underlying health problems.
More than 9,700 people in the UK are known to have caught the disease, but the real figure is believed to be much higher.
The Government has warned that the number of swine flu cases could soar to 100,000 a day by the end of next month and estimated that the virus could eventually affect up to 50 per cent of the population.
Dr Holden said a "sense of urgency" was needed, with the virus spreading fast and many key NHS staff soon to go on holiday.
Earlier this year the UK was hailed as the western European country best prepared to deal with a pandemic.
The GP said: "That is probably still the case, but these plans now need to translate into action otherwise they are pointless."
The doctor, who has a surgery in Matlock, Derbyshire, said that swine flu could kill 40 people a day by the end of summer.
The virus was accelerating and a "second wave" was likely after schools go back in September.
"The number of cases is rising rapidly and it could get really nasty," he said. "Forty deaths a day is a plausible figure. When this hits us it will be all hands to the pump, and we need to prepare for that now."
Dr Holden said that pregnant woman and asthmatics were emerging as the most at risk from the virus. Previously, experts had said that diabetics were the most vulnerable group.
"The statistics are too small for us to be sure but that is the trend," he said.
He condemned as "mad" suggestions that people should go to "flu parties" in the hope that they would catch a mild form of the virus and be immune from more virulent forms later.
The GP said that ministers should allow workers to to sign themselves off for two weeks without a doctor's note – rather than the usual one week – if they think they have swine flu.
Ministers are considering the proposal, although there are fears that the change would leave the system open to abuse.
Britain's swine flu caseload is the third highest behind the United States, where 33,000 people have caught the disease, and Mexico, where the disease started, where the figure is 10,000.
In London and the West Midlands the virus is approaching epidemic proportions.
Sir Liam Donaldson, the chief medical officer, said the death in Basildon, announced on Friday, "underlines that, although the virus is proving generally mild in most people, it is more severe in some cases".
Patients who fear they have swine flu are waiting for 10 hours or more before a nurse from the NHS Direct helpline contacts them to discuss their symptoms.
The helpline has been inundated with calls from people who fear they may have contracted the disease, with use of NHS Direct running at "unprecedented" levels, according to the organisation.
Over half of all calls to the helpline are now about swine flu, with the number of people contacting it rising to 7,000 a day in the past week.
Up to 70,000 people a day are using its online flu symptoms checker in a bid to determine whether they may have contracted the disease.
One health writer, Alison Moore, reported in Nursing Times that she was told by NHS Direct it would be 10 hours before a nurse contacted her about her 12-year-old daughter's symptoms. In fact nobody rang back.
Other people have posted messages on Twitter about the long delays they have experienced.
Kerry McCay wrote: "I rang bout my husband yesterday at 2.30pm and rcvd a callback at 12.30am – 10hr wait and woke the whole house up! Not great!"
NHS Direct replied: "Sorry to hear that Kerry. We're a 24 hour service and our staff are working around the clock to deal with the swine flu alert."
Another Twitter user, PrincessNikki22, wrote: "I suspect my boyfriend and I might have swine flu, tried to call earlier, on hold for 17 mins then got disconnected! Just answer!"
NHS Direct has dealt with 162,000 calls about swine flu since the outbreak began in April.
A recorded message told callers yesterday: "We are extremely busy because of swine flu and are only dealing with patients who are very unwell. Only stay on the line if you have urgent problems."
Update to last night's British vaccination post including cautions about news reports on swine flu mutations
Pardon the redundancy but I consider the New Scientist article (see below) and my cautions important enough that here I'm separately publishing the update to last night's post; this is for readers who already saw last night's version.
In [last night's post] I mention a letter leaked to the press about the vaccine situation for Scotland, news of which was published July 8. There was another leak, first reported on July 10 and reported today at U.K.'s First Post under the somewhat lurid headline:
I also asked whether Britain's planned fast-tracking would extend throughout the European Union. I have found this report at Xinhua from July 6 titled EU to develop common strategy. The EU statement sounds vague:
If you read the entire First Post news report, you'll note it mentions three "ominous" developments with regard to the swine flu virus, as reported in the New Scientist. The second item is about a "mutation" found in Shanghai. But when you go to the New Scientist report, the discovery refers to a "mutation to the virus's polymerase enzyme, which makes it replicate more efficiently ..."
So here we are again, driving through pea-soup fog. At these times it helps to remember John Batchelor's oft-repeated dictum that in war the first three reports are always wrong.
This virus, as with any virus, is undergoing slight alterations all the time. Is the Shanghai discovery a "significant" mutation, or is it even a mutation in the technical sense? I am not qualified to pronounce on these questions, and I doubt the First Post reporter is, either.
See the June 26 update to my post on the Brazilian (Sao Paulo) swine flu mutation for the meaning of a "significant" mutation.
We have no choice but to await further developments because the New Scientist article does not provide a source for the information on the Shanghai discovery. This caused a correspondent to snap, "I want three independent confirmations" when I sent him the report.
Of more immediate concern is the New Scientist mention that the swine flu virus seems to be pushing out the seasonal influenza strain in a number of countries; if that turns out to be true, and the trend continues and expands globally, the vaccine for the seasonal flu won't be much help, if any. I suggest you read the entire report, which isn't lengthy, for more detail on this angle.
But again, take the discussion with a grain of salt. The winter influenza season is just gearing up in the southern hemisphere, and it's wound down in the northern one. So of course, right at this moment, there would not be that many 'regular' influenza cases.
Again, we have no choice but to wait on developments. We are in the early days of what could be a long war. Steady on.
In [last night's post] I mention a letter leaked to the press about the vaccine situation for Scotland, news of which was published July 8. There was another leak, first reported on July 10 and reported today at U.K.'s First Post under the somewhat lurid headline:
Swine flu: NHS ‘muddle’ as London on brink of epidemicIt goes without saying that the memo would have factored into the British government's decision to announce a fast-tracked vaccination program.
A leaked NHS memo criticises emergency swine flu planning while the Chief Medical Officer says London is almost in an H1N1 epidemic
A leaked memo has revealed that senior NHS [National Health Service] officials consider emergency plans to combat the swine flu pandemic in Britain are muddled and pointless.
[...]
The memo, which was sent by an NHS trust executive and leaked to the Times, criticises the government's "muddled thinking" on emergency planning, including the setting up of a national diagnosis phone line, which is yet to materialise - forcing NHS trusts to set up their own.
[...]
I also asked whether Britain's planned fast-tracking would extend throughout the European Union. I have found this report at Xinhua from July 6 titled EU to develop common strategy. The EU statement sounds vague:
[...] It pointed out that the cooperation will encompass different measures regarding vaccines, antiviral drugs and other public health measures. In this context, it is important to develop strategies to protect people in different risk groups.So I don't believe it's yet known whether the rest of the EU nations will coordinate a fast-tracked vaccination program
If you read the entire First Post news report, you'll note it mentions three "ominous" developments with regard to the swine flu virus, as reported in the New Scientist. The second item is about a "mutation" found in Shanghai. But when you go to the New Scientist report, the discovery refers to a "mutation to the virus's polymerase enzyme, which makes it replicate more efficiently ..."
So here we are again, driving through pea-soup fog. At these times it helps to remember John Batchelor's oft-repeated dictum that in war the first three reports are always wrong.
This virus, as with any virus, is undergoing slight alterations all the time. Is the Shanghai discovery a "significant" mutation, or is it even a mutation in the technical sense? I am not qualified to pronounce on these questions, and I doubt the First Post reporter is, either.
See the June 26 update to my post on the Brazilian (Sao Paulo) swine flu mutation for the meaning of a "significant" mutation.
We have no choice but to await further developments because the New Scientist article does not provide a source for the information on the Shanghai discovery. This caused a correspondent to snap, "I want three independent confirmations" when I sent him the report.
Of more immediate concern is the New Scientist mention that the swine flu virus seems to be pushing out the seasonal influenza strain in a number of countries; if that turns out to be true, and the trend continues and expands globally, the vaccine for the seasonal flu won't be much help, if any. I suggest you read the entire report, which isn't lengthy, for more detail on this angle.
But again, take the discussion with a grain of salt. The winter influenza season is just gearing up in the southern hemisphere, and it's wound down in the northern one. So of course, right at this moment, there would not be that many 'regular' influenza cases.
Again, we have no choice but to wait on developments. We are in the early days of what could be a long war. Steady on.
Saturday, July 11
Britain's government announces plan to fast track their swine flu vaccination program (UPDATED)
UPDATE July 12, 4:30 AM ET
In this post I mention a letter leaked to the press about the vaccine situation for Scotland, news of which was published July 8. There was another leak, first reported on July 10 and reported today at U.K.'s First Post under the somewhat lurid headline:
I also asked in this post whether Britain's planned fast-tracking will extend throughout the European Union. I have found this report at Xinhua from July 6 titled EU to develop common strategy. The EU statement sounds vague:
If you read the entire First Post news report, you'll note it mentions three "ominous" developments with regard to the swine flu virus, as reported in the New Scientist. The second item is about a "mutation" found in Shanghai. But when you go to the New Scientist report, the discovery refers to a "mutation to the virus's polymerase enzyme, which makes it replicate more efficiently ..."
So here we are again, driving through pea-soup fog. At these times it helps to remember John Batchelor's oft-repeated dictum that in war the first three reports are always wrong.
This virus, as with any virus, is undergoing slight alterations all the time. Is the Shanghai discovery a "significant" mutation, or is it even a mutation in the technical sense? I am not qualified to pronounce on these questions, and I doubt the First Post reporter is, either.
See the June 26 update to my post on the Brazilian (Sao Paulo) swine flu mutation for the meaning of a "significant" mutation.
We have no choice but to await further developments because the New Scientist article does not provide a source for the information on the Shanghai discovery. This caused a correspondent to snap, "I want three independent confirmations" when I sent him the report.
Of more immediate concern is the New Scientist mention that the swine flu virus seems to be pushing out the seasonal influenza strain in a number of countries; if that turns out to be true, and the trend continues and expands globally, the vaccine for the seasonal flu won't be much help, if any. I suggest you read the entire report, which isn't lengthy, for more detail on this angle.
But again, take the discussion with a grain of salt. The winter influenza season is just gearing up in the southern hemisphere, and it's wound down in the northern one. So of course, right at this moment, there would not be that many 'regular' influenza cases.
Again, we have no choice but to wait on developments.
************************************
Dateline Sunday July 12 (London) Sunday Times Online:
Already there is concern among the union's health ministries that if the vaccines become more quickly available in some EU countries, this could cause 'vaccine tourism/shopping' in other EU countries. (See entire Times report, below.)
If the answer is yes, Britain's government clearly decided not to wait for an EU announcement about EU-wide fast-tracking. This was likely in reaction to a 'leaked' letter published on July 8, which explained that about half Scotland's population couldn't expect to receive swine flu vaccine until November 2010.
Another question is whether the EU and/or Britain actually intend to go through with the fast-tracking, or whether this is a move to tamp down rising concerns among the public about swine flu. At this moment I'd say that Britain's government seems determined to go through with the plan. Yet the plan is so gravely serious in its implications that below I'm posting the entire article from today's Times Online about the plan.
It's seemed to me that governments in the midst of big political fights have tended to treat the swine flu outbreak as a plot by their political enemies, and I fear that Britain's beleaguered Labor party is no exception. In the space of a couple weeks they've gone from downplaying the seriousness of the outbreak to rushing headlong into a campaign to quickly vaccinate Britons on the strength of 'mock-up' clinical trials of vaccine safety.
From the bottom of my heart I hope the plan works out, but I would also warn the British government that a cover-up would be impossible, if it doesn't. The letter I mentioned is distant thunder to what would be leaked, if the fast-tracked vaccine produces death or injury in large number.
But Gordon Brown and his Labor government -- which are already on very shaky political ground -- are making a triage decision that affects many millions of people. There are few win-win decisions in such situations. Here is the dilemma for triage planners:
Do you risk crashing an already-fragile economy by holding off on a mass vaccination program until extensive tests of vaccine safety are completed?
Or do you fast-track the program and risk severe side effects and deaths among a small number of the population from improperly tested vaccine?
If the answer seems a no-brainer, realize that fully adequate testing takes about six months from the time that volunteers are first injected with the vaccine.
That is Australia's plan; testing of the vaccine on volunteers is scheduled to begin July 15 with follow-up medical examinations spanning six months in order to look for side effects.
Or I should say it was Australia's plan; I don't know whether the news about a Tamiflu-resistant strain of the 2009 swine flu is causing them to consider moving up the timetable.
The news that the Tamiflu-resistant mutation is being transmitted human-to-human, with no falling off in the virulence of the strain, has changed everything for governments, around the world, and their public health systems.
Britain's fast-track vaccination plan is designed to address two critical considerations:
1) Without mass vaccinations, hospitals can be overwhelmed by large numbers of people seriously ill from swine flu; there simply won't be enough beds. The same is true for medical supplies. At the swine flu summit in Cancun a week ago Nancy Cox, chief of the CDC's infectious disease department, mentioned that medical supplies and government preparedness were crucial considerations in keeping deaths low from swine flu.
It's not just the anti-virals that are staving off deaths; it's also antibiotics to treat secondary infections and lung ventilators. Cox pointed out that Argentina, with its lower number of reported swine flu infections, had a much higher death toll than Chile -- despite that country's higher number of reported infections. She said that Argentina, already facing a huge caseload of bronchitis and common flu cases, hasn't had enough ventilators to treat everyone. According to this report, Chile was better prepared and more proactive than Argentina.
I interject that you have to be careful about accepting all of Cox's argument because Argentina's lower number of reported cases represented at that time a suppression of data. The government was trying to downplay the seriousness of the outbreak because they were heading into an election. And even though they released data on hundreds of confirmed cases after the election, it's unlikely their labs have been able to keep up with the outbreak.
But Cox's general observation holds true. This flu seems to have a propensity for attacking the lungs but even without that, obesity and other physical conditions that can limit lung capacity, such as asthma, can make a ventilator and anti-pneumonia antibiotics the difference between life and death for people seriously ill with flu -- of any kind.
If the swine flu outbreak continues to grow at a fast pace, by the height of winter in both hemispheres it's going to be attacking at just the time that regular influenza attacks. That can mean overwhelmed medical facilities and triage decisions about who gets a ventilator. Not a pleasant decision for hospital triage staff to have to make.
2) Britain's fast-track vaccination program also acknowledges that the great power of modern societies rests on highly complex systems that require constant human supervision to continue functioning:
Think of cell-phone towers, gas and electrical systems, garbage disposal, mass transit and vehicular traffic systems, fire and policing, financial markets, computer systems, municipal water supplies and delivery systems.
So it's not like 1918. Today a virus of far less virulence than the 1918 one can wreak devastation on entire societies if critical members of the workforce who maintain key infrastructures are laid up for a week or more with swine flu around the same time.
This observation takes on added weight during the present economic crisis. The grim truth is that many small companies that are barely hanging on through the recession would be pushed over the brink by high employee absenteeism because of swine flu.
And with large numbers of unemployed, the crime rate will shoot up.
So, what seems at first glance a simple decision about whether to rush a vaccination program or hold off for thorough testing is not so simple, is it?
I just received a report from a correspondent that deals with another angle relating to swine flu and the fragile position of the business community. From (U.K.) Guardian Observer datelined July 12:
But this is no time for smirking at standard propaganda ploys. All governments (with the exception of China's) are now wide awake and scared half to death. They know now they've been outplayed and outwitted by a microbe.
I suspect China's government woke up sometime around 2005, after being nearly brought down by panics over SARS, H5N1, and the mysterious pig illness they continue to insist was strep suis. In any event, at some point between then and the 2009 swine flu outbreak they'd learned the hard lessons that other governments are just now learning. And so they decided to battle swine flu at the airports, which greatly slowed the spread of swine flu in their country.
But again, there's no time now for smirking at your government's failings. Time's up; it was up in March 2009. Right now a virus is running humanity's show.
So, how many ventilators does your hospital have on hand? What kind of pandemic plan does your company have? Understand? The time for you to act to protect yourself, your family, and your community is yesterday.
In this post I mention a letter leaked to the press about the vaccine situation for Scotland, news of which was published July 8. There was another leak, first reported on July 10 and reported today at U.K.'s First Post under the somewhat lurid headline:
Swine flu: NHS ‘muddle’ as London on brink of epidemicIt goes without saying that the memo would have factored into the British government's decision to announce a fast-tracked vaccination program.
A leaked NHS memo criticises emergency swine flu planning while the Chief Medical Officer says London is almost in an H1N1 epidemic
A leaked memo has revealed that senior NHS [National Health Service] officials consider emergency plans to combat the swine flu pandemic in Britain are muddled and pointless.
[...]
The memo, which was sent by an NHS trust executive and leaked to the Times, criticises the government's "muddled thinking" on emergency planning, including the setting up of a national diagnosis phone line, which is yet to materialise - forcing NHS trusts to set up their own.
[...]
I also asked in this post whether Britain's planned fast-tracking will extend throughout the European Union. I have found this report at Xinhua from July 6 titled EU to develop common strategy. The EU statement sounds vague:
[...] It pointed out that the cooperation will encompass different measures regarding vaccines, antiviral drugs and other public health measures. In this context, it is important to develop strategies to protect people in different risk groups.So I don't believe it's yet known whether the rest of the EU nations will coordinate a fast-tracked vaccination program
If you read the entire First Post news report, you'll note it mentions three "ominous" developments with regard to the swine flu virus, as reported in the New Scientist. The second item is about a "mutation" found in Shanghai. But when you go to the New Scientist report, the discovery refers to a "mutation to the virus's polymerase enzyme, which makes it replicate more efficiently ..."
So here we are again, driving through pea-soup fog. At these times it helps to remember John Batchelor's oft-repeated dictum that in war the first three reports are always wrong.
This virus, as with any virus, is undergoing slight alterations all the time. Is the Shanghai discovery a "significant" mutation, or is it even a mutation in the technical sense? I am not qualified to pronounce on these questions, and I doubt the First Post reporter is, either.
See the June 26 update to my post on the Brazilian (Sao Paulo) swine flu mutation for the meaning of a "significant" mutation.
We have no choice but to await further developments because the New Scientist article does not provide a source for the information on the Shanghai discovery. This caused a correspondent to snap, "I want three independent confirmations" when I sent him the report.
Of more immediate concern is the New Scientist mention that the swine flu virus seems to be pushing out the seasonal influenza strain in a number of countries; if that turns out to be true, and the trend continues and expands globally, the vaccine for the seasonal flu won't be much help, if any. I suggest you read the entire report, which isn't lengthy, for more detail on this angle.
But again, take the discussion with a grain of salt. The winter influenza season is just gearing up in the southern hemisphere, and it's wound down in the northern one. So of course, right at this moment, there would not be that many 'regular' influenza cases.
Again, we have no choice but to wait on developments.
************************************
Dateline Sunday July 12 (London) Sunday Times Online:
[...] When the new vaccine for swine flu arrives in Britain, regulators said this weekend, it could be approved for use in just five days.Given the EMEA's involvement the question is whether the planned fast-tracking will extend throughout the European Union.
Regulators at the European Medicines Agency (EMEA) said the fast-tracked procedure has involved clinical trials of a “mock-up” vaccine similar to the one that will be used for the biggest mass vaccination programme in generations. It will be introduced into the general population while regulators continue to carry out simultaneous clinical trials. [...]
Already there is concern among the union's health ministries that if the vaccines become more quickly available in some EU countries, this could cause 'vaccine tourism/shopping' in other EU countries. (See entire Times report, below.)
If the answer is yes, Britain's government clearly decided not to wait for an EU announcement about EU-wide fast-tracking. This was likely in reaction to a 'leaked' letter published on July 8, which explained that about half Scotland's population couldn't expect to receive swine flu vaccine until November 2010.
Another question is whether the EU and/or Britain actually intend to go through with the fast-tracking, or whether this is a move to tamp down rising concerns among the public about swine flu. At this moment I'd say that Britain's government seems determined to go through with the plan. Yet the plan is so gravely serious in its implications that below I'm posting the entire article from today's Times Online about the plan.
It's seemed to me that governments in the midst of big political fights have tended to treat the swine flu outbreak as a plot by their political enemies, and I fear that Britain's beleaguered Labor party is no exception. In the space of a couple weeks they've gone from downplaying the seriousness of the outbreak to rushing headlong into a campaign to quickly vaccinate Britons on the strength of 'mock-up' clinical trials of vaccine safety.
From the bottom of my heart I hope the plan works out, but I would also warn the British government that a cover-up would be impossible, if it doesn't. The letter I mentioned is distant thunder to what would be leaked, if the fast-tracked vaccine produces death or injury in large number.
But Gordon Brown and his Labor government -- which are already on very shaky political ground -- are making a triage decision that affects many millions of people. There are few win-win decisions in such situations. Here is the dilemma for triage planners:
Do you risk crashing an already-fragile economy by holding off on a mass vaccination program until extensive tests of vaccine safety are completed?
Or do you fast-track the program and risk severe side effects and deaths among a small number of the population from improperly tested vaccine?
If the answer seems a no-brainer, realize that fully adequate testing takes about six months from the time that volunteers are first injected with the vaccine.
That is Australia's plan; testing of the vaccine on volunteers is scheduled to begin July 15 with follow-up medical examinations spanning six months in order to look for side effects.
Or I should say it was Australia's plan; I don't know whether the news about a Tamiflu-resistant strain of the 2009 swine flu is causing them to consider moving up the timetable.
The news that the Tamiflu-resistant mutation is being transmitted human-to-human, with no falling off in the virulence of the strain, has changed everything for governments, around the world, and their public health systems.
Britain's fast-track vaccination plan is designed to address two critical considerations:
1) Without mass vaccinations, hospitals can be overwhelmed by large numbers of people seriously ill from swine flu; there simply won't be enough beds. The same is true for medical supplies. At the swine flu summit in Cancun a week ago Nancy Cox, chief of the CDC's infectious disease department, mentioned that medical supplies and government preparedness were crucial considerations in keeping deaths low from swine flu.
It's not just the anti-virals that are staving off deaths; it's also antibiotics to treat secondary infections and lung ventilators. Cox pointed out that Argentina, with its lower number of reported swine flu infections, had a much higher death toll than Chile -- despite that country's higher number of reported infections. She said that Argentina, already facing a huge caseload of bronchitis and common flu cases, hasn't had enough ventilators to treat everyone. According to this report, Chile was better prepared and more proactive than Argentina.
I interject that you have to be careful about accepting all of Cox's argument because Argentina's lower number of reported cases represented at that time a suppression of data. The government was trying to downplay the seriousness of the outbreak because they were heading into an election. And even though they released data on hundreds of confirmed cases after the election, it's unlikely their labs have been able to keep up with the outbreak.
But Cox's general observation holds true. This flu seems to have a propensity for attacking the lungs but even without that, obesity and other physical conditions that can limit lung capacity, such as asthma, can make a ventilator and anti-pneumonia antibiotics the difference between life and death for people seriously ill with flu -- of any kind.
If the swine flu outbreak continues to grow at a fast pace, by the height of winter in both hemispheres it's going to be attacking at just the time that regular influenza attacks. That can mean overwhelmed medical facilities and triage decisions about who gets a ventilator. Not a pleasant decision for hospital triage staff to have to make.
2) Britain's fast-track vaccination program also acknowledges that the great power of modern societies rests on highly complex systems that require constant human supervision to continue functioning:
Think of cell-phone towers, gas and electrical systems, garbage disposal, mass transit and vehicular traffic systems, fire and policing, financial markets, computer systems, municipal water supplies and delivery systems.
So it's not like 1918. Today a virus of far less virulence than the 1918 one can wreak devastation on entire societies if critical members of the workforce who maintain key infrastructures are laid up for a week or more with swine flu around the same time.
This observation takes on added weight during the present economic crisis. The grim truth is that many small companies that are barely hanging on through the recession would be pushed over the brink by high employee absenteeism because of swine flu.
And with large numbers of unemployed, the crime rate will shoot up.
So, what seems at first glance a simple decision about whether to rush a vaccination program or hold off for thorough testing is not so simple, is it?
I just received a report from a correspondent that deals with another angle relating to swine flu and the fragile position of the business community. From (U.K.) Guardian Observer datelined July 12:
Swine flu could bring UK to a halt, Whitehall toldIf you wonder whether this news is conveniently coming at the same time as news about a fast-tracked vaccination program -- yes of course the government is trying to prepare the public for getting vaccinated in droves.
Vital sections of society could be paralysed if swine flu reaches epidemic proportions as expected, the government has been warned.
A Whitehall meeting of emergency services and business chiefs has been told that more than a third of Britain's businesses have no response plans at all for dealing with the pandemic, while specific fears have been raised about the ability of the country's broadband network and the London Underground to operate effectively. [...]
But this is no time for smirking at standard propaganda ploys. All governments (with the exception of China's) are now wide awake and scared half to death. They know now they've been outplayed and outwitted by a microbe.
I suspect China's government woke up sometime around 2005, after being nearly brought down by panics over SARS, H5N1, and the mysterious pig illness they continue to insist was strep suis. In any event, at some point between then and the 2009 swine flu outbreak they'd learned the hard lessons that other governments are just now learning. And so they decided to battle swine flu at the airports, which greatly slowed the spread of swine flu in their country.
But again, there's no time now for smirking at your government's failings. Time's up; it was up in March 2009. Right now a virus is running humanity's show.
So, how many ventilators does your hospital have on hand? What kind of pandemic plan does your company have? Understand? The time for you to act to protect yourself, your family, and your community is yesterday.
From The Sunday Times
July 12, 2009
Swine flu vaccine to be cleared after five-day trial
Jon Ungoed-Thomas
The path of a popular medicine from the laboratory to the chemist or doctor’s surgery can involve years of clinical trials on a select group of patients.
When the new vaccine for swine flu arrives in Britain, regulators said this weekend, it could be approved for use in just five days.
Regulators at the European Medicines Agency (EMEA) said the fast-tracked procedure has involved clinical trials of a “mock-up” vaccine similar to the one that will be used for the biggest mass vaccination programme in generations. It will be introduced into the general population while regulators continue to carry out simultaneous clinical trials.
The first patients in the queue for the jab - being supplied to the UK by GSK and Baxter Healthcare - may understandably be a little nervous at any possible side effects. A mass vaccination campaign against swine flu in America was halted in the 1970s after some people suffered Guillain-Barré syndrome, a disorder of the nervous system.
However, regulators said fast-tracking would not be at the expense of patient safety. “The vaccines are authorised with a detailed risk management plan,” the EMEA said. “There is quite a body of evidence regarding safety on the trials of the mock-up, and the actual vaccine could be assessed in five days.”
The UK government has ordered enough vaccine to cover the entire population. GPs are being told to prepare for a nationwide vaccination campaign.
Dr Peter Holden, the British Medical Association’s lead negotiator on swine flu, who has been attending Department of Health meetings on the outbreak, said GPs’ surgeries were prepared for one of the biggest vaccination campaigns in almost 50 years.
He said although swine flu was not causing serious illness in patients, health officials were eager to start a mass vaccination campaign, starting first on priority groups. First, the jabs would reduce the chances of a shortage of hospital beds because of people suffering from swine flu. Second, it would reduce the effect on the economy by ensuring workers were protected from the virus.
“The high-risk groups will be done at GPs’ surgeries. People are still making decisions over this, but we want to get cracking before we get a second wave, which is traditionally far more virulent.”
Holden said it was likely the elderly would be given their seasonal flu jab as well as the swine flu vaccination. The new vaccine is likely to require two doses.
Details of the inoculation plans emerged after the death of a patient, reportedly a middle-aged man, at a hospital in the Basildon area of Essex. The victim had no underlying health problems, but officials say there is no evidence the swine flu virus had mutated into a more dangerous strain.
Holden said it would be the biggest campaign in response to an outbreak since mass vaccination against smallpox in 1962. He said surgeries would be aiming to inoculate about 30 people an hour in a “military-style operation”.
The Department of Health said it had still not finalised which groups would be vaccinated first, but children, frontline health workers, people with underlying illnesses and the elderly are likely to take priority.
The European Commission is also identifying population groups which it believes should get priority. It is keen to ensure that countries such as the UK, which had ordered supplies of the vaccine in advance, do not cause inequities in treatment elsewhere in Europe.
It warned health ministers in a note circulated last month that if the vaccines were more readily available in some countries it could cause “vaccine tourism/shopping in other member states”.
About 15 people have died of swine flu in Britain, but most of those infected get only mild symptoms. According to the latest figures from the Health Protection Agency, the UK has had 9,718 confirmed cases of the disease.
Friday, July 10
Step away from the cherry tree, sir, and tell me how many fingers I'm holding up.
BERLIN -(Reuters)A badger in Germany got so drunk on over-ripe cherries it staggered into the middle of a road and refused to budge, police said on Wednesday.And now for the press analysis:
A motorist called police near the central town of Goslar to report a dead badger on a road -- only for officers to turn up and discover the animal alive and well, but drunk.
Police discovered the nocturnal beast had eaten cherries from a nearby tree which had turned to alcohol and given the badger diarrhea.
Having failed to scare the animal away, officers eventually chased it from the road with a broom.
(Reporting by Dave Graham; editing by Myra MacDonald)
The Sun (U.K.): A DRUNK UNDER SOBER EXTERIOR! SECRET LIFE OF MR BADGER IN 'THE WIND IN THE WILLOWS' UNCOVERED BY GOOD POLICE WORK!
The Nation: Police Brutality? Wildlife Attacked By Broom-Wielding Officer
World Net Daily: Germany's Police State: Innocent Animal Not Allowed To Sleep Off A Bender! Is America Next?
The New York Times: CDC orders Study of Connection Between Fermented Cherries and Alcoholism in Children, Wildlife
My excuses:
1. It's Friday.
2. We're, er, drunk with exhaustion from poring over reports on Piggy Flu.
*********************
Procrustes at RBO is to blame for finding the pix of what just might be a tipsy badger.
Proposed U.S. Swine Flu Vaccination Program: Blueprint for Chaos
(Emphasis throughout news reports mine)
May 6, 2009, The Washington Post
Moving along:
July 10, 2009, The Washington Post:
And who are the other "vulnerable" members of the population besides "children, pregnant women, adults with chronic illnesses, and health-care workers?" The ones who won't receive swine flu vaccine until "later" in the fall?
In other words -- what happened to change the U.S. government's view between May 6 and July 9?
Here's what happened: Three days after Anthony Fauci suggested it was unlikely that a mass immunization program was needed, the bottom fell out:
As I first warned on May 20, "[I]t is very likely that Tamiflu, and not a wimpy version of a swine flu virus, explains the low death rate so far from H1N1 infections."
And I castigated public health officials for not acknowledging that widespread Tamiflu use to treat swine flu was masking the true lethality of the disease.
However, WHO officials continued to say that the swine flu virus was "very stable" -- not mutating in any significant fashion -- and so the public health establishment continued to play ostrich.
From sticking their heads in the sand to running around like chickens with their head cut off in a few weeks: now that a Tamiflu-resistant strain of the virus is out there, of course everybody on the planet has to get vaccinated yesterday.
But there's simply not enough vaccine yet, and not enough time to adequately test the first batches -- and a hastily devised triple-vaccination program for tens of millions of people is a blueprint for pandemonium.
This says nothing about the chaos that could be unleashed with any possible thrown-together plan for widespread school closures as a means to attempt to slow the virus' spread. Read the rest of the July 10 Washington Post report for information on that angle.
Not to keep pounding the lectern but note how the Hong Kong case was caught: First it walked in front of a thermal scanner at the international airport. Yet WHO deems thermal scanners useless. (4)
Then the mutation was nailed during a routine surveillance of flu specimens by Hong Kong's Public Health Laboratory Services Branch.(3)
Yet many state-run labs, the world over, are overwhelmed by swine flu cases. And WHO is preparing to recommend that the labs abandon testing for 'routine' swine flu cases.
How is that Hong Kong's lab wasn't overwhelmed? And how do those other state labs expect to catch the Tamiflu-resistant mutation if they abandon routine testing?
For a detailed answer to the first question new readers can work backward through all my posts on swine flu. The short answer, which readers who've followed my posts well know, is that Hong Kong followed China's model of fighting swine flu, which greatly slowed the spread of swine flu cases in the country. Among other things this meant their laboratories weren't overwhelmed by swine flu specimens.
Regarding the second question: I don't know the answer and I doubt any public health official does, either.
As to the emphasis I gave to the National Institutes of Health and the names Anthony Fauci and Harvey Fineberg, that's in the nature of a question mark in my mind.
In one my earlier posts on swine flu I suggested that if there was proof of intelligent life at NIH that they shove the CDC out of the way, given the CDC's flat-footed response to the H1N1 outbreak.
Of course it's easier for administration officials to get to Bethesda than Atlanta, and I don't know whether Fauci and Fineberg have a particular connection to NIH. But if a reader notes mention of NIH or those two names in a news report on swine flu, I'd appreciate it if you could send me the report. Thank you.
1) Dr Fineberg was the co-author; Richard E Neustadt was the lead author on the book, the full title of which is The epidemic that never was: Policy-making and the swine flu scare.
The three used paperback copies available at Amazon are selling for $175 each, which gives an idea how much public interest there was in the topic at the time of publication. I haven't looked up the publication date but clearly the book was written and published before the 2009 swine flu outbreak, else the authors would have added "1976" to the title's mention of swine flu.
2) Canadian Press: Tamiflu resistant H1N1 from Hong Kong more worrying than earlier findings; Helen Branswell, Canadian Press Medical Writer; July 6, 2009.
This is the best analysis of the three Tamiflu-resistant cases and their import that I've found in the general media. I note that the writer provides flu updates on Twitter at CP-Branswell.
3) Bloomberg: Tamiflu-Resistant Swine Flu Virus Found in Hong Kong (Update2); Nipa Piboontanasawat (in Hong Kong) and Jason Gale (in Singapore); July 3, 2009.
I read every Bloomberg report filed or co-filed by Jason Gale I can find; he is among the handful of 'lay' journalists who began specializing in swine flu reporting from the start and who've educated themselves about the disease. I recommend that you read the entire report; taken together with Helen Branswell's analysis it's a good briefing for the layperson on the three swine flu mutations under discussion.
4) Slate: Heat Check: Swine flu, body heat, and airport scanners; William Saletan; April 28, 2009.
Since the start of the swine flu outbreak I've plowed through many articles that point to gross incompetence and institutional bias in the biomedical and public health establishments' approach to pandemic planning. But this one takes the prize. Don't miss the reports the article links to; if you're a high-strung type I suggest you steel yourself before reading the government-funded study of the scanners.
May 6, 2009, The Washington Post
U.S. May Add Shots for Swine Flu to Fall RegimenNo sir, that's not science. That's poor quality-control, awful planning, and crummy logistics. But to continue:
Vaccine and pandemic experts are working with the administration to determine how to produce, test, track and educate the public about two different influenza vaccines in the same flu season.
"They have never tried this before, and there is going to be a great deal of confusion," said William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University School of Medicine.
Memories of the nation's earlier experience with a swine flu vaccine present another challenge. In 1976, hundreds of Americans developed neurological disorders after they were vaccinated for a swine flu strain. The public was asked to receive one of two vaccines developed to combat the strain.
Health officials have asked manufacturers to ramp up production of the seasonal vaccine scheduled for rollout this fall to make way for the possible mass production of a swine flu vaccine.
A decision on whether to produce such a vaccine will have to be made soon, because it typically takes five months to produce a new vaccine and authorities would want it available for the next flu season.
Some medical experts said rolling out two vaccines would present additional challenges in terms of testing and tracking adverse reactions. Health officials and manufacturers will need to know what the negative reactions might be for each vaccine on its own and in combination with the other. Initial tests would be done on animals, and then clinical trials would be conducted with people to determine side effects before either vaccine is rolled out.
Harvey Fineberg, president of the Institute of Medicine, part of the National Academy of Sciences, said officials will have to weigh the risks of the time spent on testing.
"All this takes time, money and organization," said Fineberg, who led an investigation into the government's handling of the 1976 swine flu vaccinations.
The greater challenge will be tracking any adverse reactions as millions of Americans get multiple vaccinations in a matter of months this fall and winter.
"There will be adverse effects to any vaccine. That's just science," said Michael Hattwick, who ran the CDC's vaccine-tracking system during the last swine flu scare.
Hattwick said a "real-time" tracking system would need to be established to provide constant updates to the CDC about adverse reactions. That information, he said, should include lot numbers for the vaccines so health officials can trace each side effect to the manufacturer and the date of production. Routine flu vaccinations are not traced with such precision because reporting is voluntary and often delayed, Hattwick said.May 23, 2009, The Washington Post
Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said he does not expect additional adverse reactions with two vaccinations. The traditional flu vaccine is designed to attack the three flu strains health officials believe to be the greatest threats in a regular season, he said.
"In a regular seasonal flu, you get three vaccines. Adding an additional one should not present a problem," Fauci said.
A record-keeping system would also need to be devised to track which doses patients have received, health experts said.
Without such a system, patients could lose track of which of the three shots they have received or could fail to get the second swine flu inoculation at the proper time.
"We will have to keep them straight and separate," Vanderbilt's Schaffner said. "This will be an enormous challenge, and we haven't figured out how to do it yet. That's one of the things we are trying to sort out."
The federal government has asked three drug companies to make enough swine flu vaccine to immunize at least 20 million people in key positions in health care, national security and emergency services, officials said yesterday. [...]June 30, 2009, AP
The government's pandemic preparedness plan divides the U.S. population into five tiers of priority for getting the vaccine. The first tier, of about 24 million people, includes deployed armed forces members; critical health-care workers; fire, police and ambulance workers; pregnant women and small children. [...]
Obama consults experts on 1976 swine flu outbreakJune 30, 2009, CQ
WASHINGTON — President Barack Obama is hoping that lessons learned from a 1976 flu outbreak can help the country act wisely to combat the current spread of swine flu.
The president and other top administration officials met Tuesday with six experts on the 1976 flu so that — in his words — "we can further prepare the nation for the possibility of a more severe outbreak of H1N1 flu."
In 1976, a mass vaccination against a different swine flu was marred by reports of a paralyzing side effect — and that time the flu didn't spread beyond an outbreak at Fort Dix, N.J.
Among those meeting Tuesday with Obama was the president of the Institute of Medicine, Dr. Harvey Fineberg.
Health Experts Say U.S. Is Prepared for Swine Flu PandemicBy gum, sir, you're right: the behavior of flu viruses is notoriously hard to predict -- especially new flu viruses of the very rare kind that show a quadruple reassortment, such as the 2009 swine flu, and which is to the 1976 swine flu virus what mashed potatoes are to kiwi fruit.
Two public health experts painted a relatively rosy picture Tuesday of the United States’ ability to respond to the swine flu pandemic, saying the country had learned from earlier mistakes and from plans developed during the avian flu scare several years ago.
“The public health measures that were put in place were quite sensible,” said Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, at a briefing on the H1N1 virus held by the Center for Strategic and International Studies, the Congressional Global Health Caucus and the Kaiser Family Foundation.
Fauci and Harvey Fineberg, president of the Institute of Medicine, said the United States had learned from the 1976 swine flu scare. Fineberg, who wrote a book about the scare called The Epidemic that Never Was [1], said a decision to go ahead with nationwide immunizations was made in January 1976, when only a few soldiers at Fort Dix, N.J., had contracted the virus. Even though the disease didn’t spread, 40 million people were still immunized.
Then, Fineberg said, decision makers were “entirely driven by the worst-case” scenario and overreacted to the problem.
“Today, we need to not make the complementary error of only preparing for the most likely case,” he said.
Plans developed for the avian flu, or H5N1, in the middle of this decade should help combat any mass swine flu outbreak, Fauci said. Fortunately, swine flu has proven to be less deadly than its avian cousin, which has killed about half of all those it infects.
Fauci and Fineberg said health officials will need to watch how swine flu spreads and behaves in the southern hemisphere’s winter in order to prepare an appropriate response.
One worry is that the United States won’t be prepared for a mass immunization campaign, if one is necessary. “The real concern is getting organized throughout the country to administer what we need to administer,” Fineberg said.
But there likely won’t be a need for widespread immunizations.
“H1N1 now is acting like a seasonal flu that is out of season,” Fauci said.
But both experts warned predictions about the flu are notoriously difficult to make.
“The thing you can say about influenza that’s predictable is that it’s unpredictable,” Fauci said.
Moving along:
July 10, 2009, The Washington Post:
Students 1st in Line For Flu Vaccine: Mass Campaign Against Pandemic May Begin in FallWhat happened to "deployed armed forces members ... fire, police and ambulance workers?" Are they still on the list of priority candidates for the vaccine?
School-age children will be a key target population for a pandemic flu vaccine in the fall, and they may be vaccinated at school in a mass campaign not seen since the polio epidemics of the 1950s.
The federal government should get about 100 million doses of vaccine by mid-October, if the current production by five companies goes as planned. But enough vaccine for wide use by the 120 million people especially vulnerable to the newly emerged strain of H1N1 influenza virus will not be available until later in the fall.
Those were among the messages administration officials delivered to about 500 state, territorial, city and tribal health officials yesterday at a "flu summit" at the National Institutes of Health's Bethesda campus.
President Obama, speaking by audio link from the Group of Eight summit in L'Aquila, Italy, urged "complete ownership" of preparations for what he termed a "significant outbreak" of H1N1 flu in the next few months.
"We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation," he said. He added that "the most important thing for us to do is to make sure that state and local officials prepare now to implement a vaccination program in the fall."
Children, pregnant women, adults with chronic illnesses, and health-care workers would probably be first in line for the vaccine, Health and Human Services Secretary Kathleen Sebelius told the gathering. [...]
And who are the other "vulnerable" members of the population besides "children, pregnant women, adults with chronic illnesses, and health-care workers?" The ones who won't receive swine flu vaccine until "later" in the fall?
In other words -- what happened to change the U.S. government's view between May 6 and July 9?
Here's what happened: Three days after Anthony Fauci suggested it was unlikely that a mass immunization program was needed, the bottom fell out:
Public health authorities in Hong Kong announced Friday [July 3] they have found a case of Tamiflu resistance in a woman who hadn't taken the drug. That means she was infected with swine flu viruses that were already resistant to Tamiflu, the main weapon in most countries' and companies' pandemic drug arsenals.Just to make sure you're clear on the danger of the mutation found by the Hong Kong lab:
The two earlier cases, reported from Denmark and Japan, involved people who had been taking the medication. While always unwelcome, that type of resistance is known to occur with seasonal strains and may be less of a threat to the long-term viability of this key flu drug.
"It was not at all surprising to see resistance in patients on treatment but seeing it in someone who was not treated, it certainly is more concerning," says Dr. Malik Peiris, a flu expert at the University of Hong Kong.
There is a risk inherent in using the drug to prevent illness. If people who are already infected but aren't yet experiencing symptoms are put on prophylaxis, there won't be enough drug in their systems to kill all the viruses they house. Those that survive develop resistance to the drug.
And that, it appears, may be what happened in the resistance cases in Denmark and Japan. In both instances the women involved had been given Tamiflu prophylaxis after a contact developed swine flu.
But the Hong Kong case was different. A 16-year old girl travelling from San Francisco was stopped in Hong Kong's airport in mid-June after setting off a fever detection device.
She was taken to hospital where she tested positive for swine flu. She had not been taking antivirals and declined to be treated with the drug. She was kept in isolation until she recovered.
Dr. Jennifer McKimm-Breschkin, an influenza expert from Australia and a member of the team that developed Relenza, says this case shows resistant swine flu viruses can spread.
It was previously thought flu viruses that developed resistance to the drug would be crippled in the process and would not transmit to others. But that belief was shattered in 2008 when it was discovered Tamiflu-resistant versions of the seasonal H1N1 viruses were spreading rapidly around the globe. They have since all but wiped out Tamiflu-susceptible seasonal H1N1 viruses.
"This is a patient that hasn't been treated, who has gone from San Francisco to Hong Kong. What that means is that she has caught a resistant virus in San Francisco," says McKimm-Breschkin, virology project leader at the Commonwealth Science and Research Organization - known as CSIRO - in Melbourne. (McKimm-Breschkin does not receive royalties for sales of Relenza.)
"So that means this virus has been transmitted from somebody who's presumably been treated. Which means it's been fit enough to transmit. And that is of a lot more concern than just resistance in a treated patient."
Experts have worried the seasonal H1N1 viruses might reassort or swap genes with the swine H1N1. If swine flu picked up with neuraminidase gene - the N in a flu virus' name - from the seasonal H1N1, it would acquire the resistance its seasonal cousin has developed.
Authorities in Hong Kong have not yet told the WHO whether that is what has happened in this case.
But whether the Hong Kong resistance case is due to reassortment, or from the fact that some swine flu viruses have developed resistance on their own, the situation demands careful monitoring, Fukuda and others say.(2)
The case in Hong Kong indicates that the mutant virus is capable of being transmitted among people, said Jennifer McKimm - Breschkin [...]The hope was that as the virus continued to mutate it would lose punch. So far that hasn't happened.
“It’s very disturbing that, fresh into the human population, this one appears now to be able to retain fitness despite having the mutation and to be able to spread” [...] (3)
As I first warned on May 20, "[I]t is very likely that Tamiflu, and not a wimpy version of a swine flu virus, explains the low death rate so far from H1N1 infections."
And I castigated public health officials for not acknowledging that widespread Tamiflu use to treat swine flu was masking the true lethality of the disease.
However, WHO officials continued to say that the swine flu virus was "very stable" -- not mutating in any significant fashion -- and so the public health establishment continued to play ostrich.
From sticking their heads in the sand to running around like chickens with their head cut off in a few weeks: now that a Tamiflu-resistant strain of the virus is out there, of course everybody on the planet has to get vaccinated yesterday.
But there's simply not enough vaccine yet, and not enough time to adequately test the first batches -- and a hastily devised triple-vaccination program for tens of millions of people is a blueprint for pandemonium.
This says nothing about the chaos that could be unleashed with any possible thrown-together plan for widespread school closures as a means to attempt to slow the virus' spread. Read the rest of the July 10 Washington Post report for information on that angle.
Not to keep pounding the lectern but note how the Hong Kong case was caught: First it walked in front of a thermal scanner at the international airport. Yet WHO deems thermal scanners useless. (4)
Then the mutation was nailed during a routine surveillance of flu specimens by Hong Kong's Public Health Laboratory Services Branch.(3)
Yet many state-run labs, the world over, are overwhelmed by swine flu cases. And WHO is preparing to recommend that the labs abandon testing for 'routine' swine flu cases.
How is that Hong Kong's lab wasn't overwhelmed? And how do those other state labs expect to catch the Tamiflu-resistant mutation if they abandon routine testing?
For a detailed answer to the first question new readers can work backward through all my posts on swine flu. The short answer, which readers who've followed my posts well know, is that Hong Kong followed China's model of fighting swine flu, which greatly slowed the spread of swine flu cases in the country. Among other things this meant their laboratories weren't overwhelmed by swine flu specimens.
Regarding the second question: I don't know the answer and I doubt any public health official does, either.
As to the emphasis I gave to the National Institutes of Health and the names Anthony Fauci and Harvey Fineberg, that's in the nature of a question mark in my mind.
In one my earlier posts on swine flu I suggested that if there was proof of intelligent life at NIH that they shove the CDC out of the way, given the CDC's flat-footed response to the H1N1 outbreak.
Of course it's easier for administration officials to get to Bethesda than Atlanta, and I don't know whether Fauci and Fineberg have a particular connection to NIH. But if a reader notes mention of NIH or those two names in a news report on swine flu, I'd appreciate it if you could send me the report. Thank you.
1) Dr Fineberg was the co-author; Richard E Neustadt was the lead author on the book, the full title of which is The epidemic that never was: Policy-making and the swine flu scare.
The three used paperback copies available at Amazon are selling for $175 each, which gives an idea how much public interest there was in the topic at the time of publication. I haven't looked up the publication date but clearly the book was written and published before the 2009 swine flu outbreak, else the authors would have added "1976" to the title's mention of swine flu.
2) Canadian Press: Tamiflu resistant H1N1 from Hong Kong more worrying than earlier findings; Helen Branswell, Canadian Press Medical Writer; July 6, 2009.
This is the best analysis of the three Tamiflu-resistant cases and their import that I've found in the general media. I note that the writer provides flu updates on Twitter at CP-Branswell.
3) Bloomberg: Tamiflu-Resistant Swine Flu Virus Found in Hong Kong (Update2); Nipa Piboontanasawat (in Hong Kong) and Jason Gale (in Singapore); July 3, 2009.
I read every Bloomberg report filed or co-filed by Jason Gale I can find; he is among the handful of 'lay' journalists who began specializing in swine flu reporting from the start and who've educated themselves about the disease. I recommend that you read the entire report; taken together with Helen Branswell's analysis it's a good briefing for the layperson on the three swine flu mutations under discussion.
4) Slate: Heat Check: Swine flu, body heat, and airport scanners; William Saletan; April 28, 2009.
Since the start of the swine flu outbreak I've plowed through many articles that point to gross incompetence and institutional bias in the biomedical and public health establishments' approach to pandemic planning. But this one takes the prize. Don't miss the reports the article links to; if you're a high-strung type I suggest you steel yourself before reading the government-funded study of the scanners.
Wednesday, July 8
H1N1/swine flu: How to mask the failure of CDC's approach to fighting a pandemic
I see WHO has moved the goal posts again:
July 8, 2009:
Now why is WHO making such a recommendation? Why are they trying to influence how each individual country collects data on swine flu cases? The rationale WHO provided in their 'pre-announcement announcement' goes nowhere near answering that question.
WHO has no political teeth, and in the swine flu outbreak it has played the caboose to the CDC (U.S. Centers for Disease Control and Prevention) and governments that contribute the most to WHO's upkeep, such as the USA.
The CDC has, from the earliest weeks of the swine flu outbreak, encouraged U.S. health departments to abandon swine flu testing for all but the hospitalized cases. This approach was copied by Australia and several other countries, which have substituted mathematical modeling (based on very uncertain data) to project the number of swine flu cases, in lieu of extensive laboratory testing.
It's been hard enough up to this point to get even a rough estimate of the number of swine flu cases in a country; if the majority of countries follow WHO's planned recommendation, that will make it virtually impossible to pursue an empirical approach to studying the swine flu outbreak on a global basis.
Researchers will have to rely on whatever mathematical models a country's federal health department favors. As to how much faith can be placed in the models:
On July 3 Freedom Fairy alerted me that the Drudge Report had posted a group of scary headlines about swine flu including this one: "40 a day could die by end of summer in London," which linked to a report in the United Kingdom's Mail Online newspaper.
The prediction was based on math quoted by Britain's Health Minister, Andy Burnham. He announced to the House of Commons on July 2 that swine flu "Cases are doubling every week, and on this trend we could see more than 100,000 cases per day by the end of August -- although I stress that that is only a projection."
This elicited a remark from John Oxford, the professor of virology at St. Bart's and Royal London Hospital who's been a favorite quotable source for reporters since the swine flu story broke:
"It seems like a lot of mathematical modeling and not too much common sense."
But just to make sure Mr Burnham understood how math-challenged he was, an editor at Effect Measure blog got instructive:
However, the troubled expression on Mr Burnham's face (see the video of his announcement at the Mail link) suggests he's old and smart enough to have figured out that he is Labor's designated sacrificial goat, if Britain's death toll from swine flu skyrockets.
So if Mr Burnham was guilty of bad math, at least he mustered enough survival instinct to strongly warn the British public that swine flu is not to be taken lightly. And he surely knew by last week what has only come to public light today: "Swine flu: Scots will be forced to wait 1½ years for full vaccination."
All right; I've had enough fun for one day with Britain's health ministry. What's really going on with WHO? Well, Ouija is out for repairs again but taking a blindfolded shot in the dark:
"From April 25 to July 5, a total of 8,272 people entering China with flu-like symptoms were transferred to medical institutions for quarantine. Some 228 of them were confirmed as H1N1 flu patients."
The report doesn't say whether the statistic refers only to the Mainland or to the combination of the Mainland, Hong Kong territory, and Macau. But because the announcement came from the central government's Ministry of Health, I'm going to tentatively assume it covers all three regions, which is not ideal for my purpose. However, the statistic gives a rough idea of how many people have been quarantined on the Mainland. Now watch carefully don't blink:
MAINLAND CHINA
Population: 1,338,612,968
May 10
Mainland China reports their first confirmed case of swine flu, an infected Chinese citizen traveling on a flight originating from the USA..
June 01
Confirmed swine flu cases: 38
July 7
Confirmed swine flu cases: 1,151
Confirmed death toll from swine flu as of July 7: 0
(One death by accidental electrocution of a Chinese patient in quarantine).
AUSTRALIA
Population: 21,007,310
May 09
First confirmed case of swine flu; an infected American airline passenger traveling on a flight originating from the USA.
June 01
Confirmed swine flu cases: 401
July 07
Confirmed swine flu cases: 6,353
Confirmed death toll from swine flu as of July 7: 18
I'm not picking on Australia; I'd prefer to pick on my own country. But I used Australia as the comparator because it's a modernized, economically advanced democratic country and the date of their first confirmed outbreak is close, by one day, to the Mainland's.
I note that Australia's health system was quickly overwhelmed by swine flu cases. From a June 13 report:
Yes, if only one country does it, the strategy is very resource intensive, both in terms of money and labor. But China's strategy worked to greatly slow the spread of swine flu infections in their country; Australia's strategy didn't do the same for their country.
With few exceptions Australia's experience has been echoed by every country that's been hit by an outbreak.
Governments can stack and rack their excuses any way they want -- and I interject there have been some very creative excuses. But they are up against the reality of China's accurate record-keeping -- a feat China pulled off because their way of fighting the pandemic was to greatly limit its spread at the start. That doesn't mean they caught every case. It means they caught every case that came to the attention of a physician or hospital.
Australia's strategy for coping with a pandemic virus is a copy of the CDC one, which WHO has also followed.
The CDC pandemic-fighting model is based largely on analysis of the 1918 swine flu pandemic. China's model is based on empirical observations of the way 'airborne' or aerosolized infectious disease first spreads from country to country in the 21st Century; namely, via globalized, heavy-volume commercial airline travel.
There is no way to erase the data on China's success at doing the Number One thing a national pandemic fighting plan is supposed to do: greatly slow the spread of the disease in a country. But there is a way to downplay the data, to bury it in plain sight:
If every other county abandons laboratory testing for all but clusters of infections and "special" cases, this will skew the country-by-country data on swine flu infections to such an extent that China's data on swine flu becomes meaningless as a comparator.
July 8, 2009:
The World Health Organization will recommend that nations curtail efforts to confirm swine flu cases and assume the H1N1 virus is the culprit.A big thanks to Photoshop artiste "Freedom Fairy" for sending me the above report.
[...]
Meanwhile, the virus is continuing to spread through the Northern Hemisphere this summer -- even though flu normally doesn't spread well in hot weather -- and its effect is growing in the southern half of the globe, which has begun its traditional winter flu season.
[...]
Within the next few days, the WHO will suggest that countries with major outbreaks of swine flu move away from laboratory confirmation of cases and toward larger, national indicators of disease, such as the number of people with flu-like symptoms and cases of pneumonia, Dr. Keiji Fukuda, WHO assistant director-general, said Tuesday in a telephone news conference.
The large number of cases in such countries is overwhelming labs and making it "very hard to keep up" with testing, he said. The new guidelines will "ease the burden on laboratories," he said. In most countries with major outbreaks of the virus, 95% or more of total flu cases are being caused by H1N1.
"In countries with no cases, we will continue to recommend that people be tested so the presence of the new virus can be confirmed," Fukuda said. "In all countries, we will continue to stress testing for unusual cases, clusters, unusually severe cases and new symptoms."
But the number of swine-flu-free countries is likely to be small soon. The most recent figures reported to the WHO indicate that more than 98,000 cases have been confirmed in 120 countries, with 440 deaths, though officials estimate the number of actual infections at 10 to 100 times that. [...]
Now why is WHO making such a recommendation? Why are they trying to influence how each individual country collects data on swine flu cases? The rationale WHO provided in their 'pre-announcement announcement' goes nowhere near answering that question.
WHO has no political teeth, and in the swine flu outbreak it has played the caboose to the CDC (U.S. Centers for Disease Control and Prevention) and governments that contribute the most to WHO's upkeep, such as the USA.
The CDC has, from the earliest weeks of the swine flu outbreak, encouraged U.S. health departments to abandon swine flu testing for all but the hospitalized cases. This approach was copied by Australia and several other countries, which have substituted mathematical modeling (based on very uncertain data) to project the number of swine flu cases, in lieu of extensive laboratory testing.
It's been hard enough up to this point to get even a rough estimate of the number of swine flu cases in a country; if the majority of countries follow WHO's planned recommendation, that will make it virtually impossible to pursue an empirical approach to studying the swine flu outbreak on a global basis.
Researchers will have to rely on whatever mathematical models a country's federal health department favors. As to how much faith can be placed in the models:
On July 3 Freedom Fairy alerted me that the Drudge Report had posted a group of scary headlines about swine flu including this one: "40 a day could die by end of summer in London," which linked to a report in the United Kingdom's Mail Online newspaper.
The prediction was based on math quoted by Britain's Health Minister, Andy Burnham. He announced to the House of Commons on July 2 that swine flu "Cases are doubling every week, and on this trend we could see more than 100,000 cases per day by the end of August -- although I stress that that is only a projection."
This elicited a remark from John Oxford, the professor of virology at St. Bart's and Royal London Hospital who's been a favorite quotable source for reporters since the swine flu story broke:
"It seems like a lot of mathematical modeling and not too much common sense."
But just to make sure Mr Burnham understood how math-challenged he was, an editor at Effect Measure blog got instructive:
The statement that the UK might have 100,000 cases a day made headlines, as well it might. But it's based on the idea that if the current exponential growth rate continues for months on end, then it could reach 100,000 a day by the end of August.I believe the more precise operative term is "useful idiot." Mr Burnham is young (39), new on the job, and (as with his American counterpart, Kathleen Sebelius) spectacularly unqualified by education and experience to hold a post relating to public health, medicine, science, or math of any kind. His previous posting was Secretary of State for Culture, Media and Sport; he was appointed Secretary of State for Health in Gordon Brown's June 5 Cabinet reshuffle.
Anyone familiar with exponential growth and/or epidemiology (is it too much to hope a Health Minister might be familiar with both?) knows that exponential growth cannot and does not continue for very long.
If cases double every week, then by the end of September, one month after Burnham's estimate, they will have increased by a factor of 16 or 1.6 million cases per day. A month later, at the height of flu season we'd be seeing 25 million cases a day. [U.K. population: 60,943,912 ]
Of course if you put E. coli in a petri dish and watch it double every 20 minutes, before long all the mass in the known universe would be incorporated into the E. coli culture you started.
Did I mention this doesn't happen? Ever? What a bloody moron.
However, the troubled expression on Mr Burnham's face (see the video of his announcement at the Mail link) suggests he's old and smart enough to have figured out that he is Labor's designated sacrificial goat, if Britain's death toll from swine flu skyrockets.
So if Mr Burnham was guilty of bad math, at least he mustered enough survival instinct to strongly warn the British public that swine flu is not to be taken lightly. And he surely knew by last week what has only come to public light today: "Swine flu: Scots will be forced to wait 1½ years for full vaccination."
All right; I've had enough fun for one day with Britain's health ministry. What's really going on with WHO? Well, Ouija is out for repairs again but taking a blindfolded shot in the dark:
"From April 25 to July 5, a total of 8,272 people entering China with flu-like symptoms were transferred to medical institutions for quarantine. Some 228 of them were confirmed as H1N1 flu patients."
The report doesn't say whether the statistic refers only to the Mainland or to the combination of the Mainland, Hong Kong territory, and Macau. But because the announcement came from the central government's Ministry of Health, I'm going to tentatively assume it covers all three regions, which is not ideal for my purpose. However, the statistic gives a rough idea of how many people have been quarantined on the Mainland. Now watch carefully don't blink:
MAINLAND CHINA
Population: 1,338,612,968
May 10
Mainland China reports their first confirmed case of swine flu, an infected Chinese citizen traveling on a flight originating from the USA..
June 01
Confirmed swine flu cases: 38
July 7
Confirmed swine flu cases: 1,151
Confirmed death toll from swine flu as of July 7: 0
(One death by accidental electrocution of a Chinese patient in quarantine).
AUSTRALIA
Population: 21,007,310
May 09
First confirmed case of swine flu; an infected American airline passenger traveling on a flight originating from the USA.
June 01
Confirmed swine flu cases: 401
July 07
Confirmed swine flu cases: 6,353
Confirmed death toll from swine flu as of July 7: 18
I'm not picking on Australia; I'd prefer to pick on my own country. But I used Australia as the comparator because it's a modernized, economically advanced democratic country and the date of their first confirmed outbreak is close, by one day, to the Mainland's.
I note that Australia's health system was quickly overwhelmed by swine flu cases. From a June 13 report:
Angry GPs have slammed a "conspicuous lack of leadership" in Australia's response to the swine flu crisis, with some patients waiting eight days for test results or receiving anti-viral drugs too late to limit the infection.All this means the comparison is unfair to China, which up to this point has scrupulously tracked down and recorded every swine flu case they could find in the country. But when you compare the data, there's the answer to WHO's observation that China's strategy for fighting swine-flu is "resource intensive."
The number of Australians infected with the new H1N1 strain is ... believed to be far higher than last night's official national tally of 1391 because Victoria [state] has abandoned its daily caseload updates.
The state last Wednesday cut back its laboratory testing for the virus from about 500 to 1000 samples a day to 50 to 70 a day, after acknowledging it could no longer contain the disease.
Even then, patients were falling through the cracks in the testing system, Melbourne GP Kirstin Charlesworth told The Australian. [...]
Yes, if only one country does it, the strategy is very resource intensive, both in terms of money and labor. But China's strategy worked to greatly slow the spread of swine flu infections in their country; Australia's strategy didn't do the same for their country.
With few exceptions Australia's experience has been echoed by every country that's been hit by an outbreak.
Governments can stack and rack their excuses any way they want -- and I interject there have been some very creative excuses. But they are up against the reality of China's accurate record-keeping -- a feat China pulled off because their way of fighting the pandemic was to greatly limit its spread at the start. That doesn't mean they caught every case. It means they caught every case that came to the attention of a physician or hospital.
Australia's strategy for coping with a pandemic virus is a copy of the CDC one, which WHO has also followed.
The CDC pandemic-fighting model is based largely on analysis of the 1918 swine flu pandemic. China's model is based on empirical observations of the way 'airborne' or aerosolized infectious disease first spreads from country to country in the 21st Century; namely, via globalized, heavy-volume commercial airline travel.
There is no way to erase the data on China's success at doing the Number One thing a national pandemic fighting plan is supposed to do: greatly slow the spread of the disease in a country. But there is a way to downplay the data, to bury it in plain sight:
If every other county abandons laboratory testing for all but clusters of infections and "special" cases, this will skew the country-by-country data on swine flu infections to such an extent that China's data on swine flu becomes meaningless as a comparator.
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:
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.
-- 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.
Thursday, July 2
H1N1/swine flu: BIO.DIASPORA vs CDC-WHO dogma
"Today, a superkiller virus from the other side of the world can alight in large numbers on the same day at several U.S. international airports scattered all around the USA -- even before the lethality of the virus has been discovered by a government."
-- 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:
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:
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:
-- 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."
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