A/H1N1 ("swine") flu outbreaks
 

[quote=ewmayer;171404][URL="http://www.telegraph.co.uk/health/healthnews/5228878/Estimates-of-economic-costs-of-a-flu-pandemic.html"]Estimates of economic costs of a flu pandemic[/URL]: [I]The World Bank estimated in 2008 that a flu pandemic could cost $3 trillion and result in a nearly 5pc drop in world gross domestic product.

< snip >

[/I] You had one top CDC official (Besser) saying "we see no reason to impose travel restrictions ... just monitor airports for people showing signs of possible infection, blah, blah." Hello? We know that the incubation time for this disease is 1-4 days. If a person is infectious during the incubation time (and that's what I wanted to hear something about, even if speculation based on other better-studied strains of flu), wouldn't that be a compelling argument for imposing travel restrictions to and from countries.areas which are hotspots of the outbreak, irrespective of whether a would-be traveler is showing signs of sickness?[/quote]Public health officials have to be cautious about not only the spread of disease, but also the disruption of economy. As soon as travel restrictions are imposed, there begins an accompanying hit on the economy of the restricted regions plus those trading with them. If they provoke a deep depression that otherwise would have been much shallower, that will cause a lot of deaths all by itself.

Also, they have to be very careful about being perceived as having cried "wolf". If there's a general public perception that officials imposed restrictions unnecessarily, then [I]the next time, when it really [U]is[/U] necessary, many of the general public will ignore them[/I]. That could lead to catastrophe.

If, in the current economic environment, the public develops a perception that health officials needlessly deepened a recession, or ensured a depression, that perception would come back to bite us, hard, at some future time when the consequence could be billions, rather than thousands, of deaths.

[quote]It seems that with modern air travel a several-day presymptomatic infectivity window is exactly the thing one needs to be the most concerned about, i.e. rapid spread of a pandemic agent occurring right under one's nose, so to speak. In that scenario, by the time one obviously-sick person gets stopped at an airline gate, hundreds or even thousands of asymptomatic carriers may have already dispersed all over the globe. Think of the movie "12 Monkeys".[/quote]Okay, tell us how [I]you[/I] would simultaneously minimize the "wolf" probability, minimize the chance of unnecessarily impacting the world economy, and maximize the chance of catching a potential pandemic before it's too late to prevent its full flowering.

[quote=ewmayer;171577]The worst-case airline-vectored scenario involves airborne transmission, so let's focus on that: One thing I have long advocated would be to equip all passenger planes operating in and out of the U.S. with a simple kind of air-sampling system, just a compact shoebox-sized sampler which would collect swatches of floating particulates down to virus size.[/quote]Fine. I thought you were advocating some change in WHO's decision process.

Then you'll may be interested in:

"How to Prevent a Pandemic"

[URL]http://www.nytimes.com/2009/04/30/opinion/30wolfe.html[/URL]

[quote=Nathan Wolfe]THE swine flu outbreak seems to have emerged without warning. Within a few days of being noticed, the flu had already spread to the point where containment was not possible. Yet the virus behind it had to have existed for some time before it was discovered. Couldn’t we have detected it and acted sooner, before it spread so widely? The answer is likely yes — if we had been paying closer attention to the human-animal interactions that enable new viruses to emerge.

While much remains unknown about how pandemics are born, we are familiar with the kinds of microbes — like SARS (severe acute respiratory syndrome), influenza and H.I.V. — that present a risk of widespread disease. We know that they usually emerge from animals and most often in specific locations around the world, places like the Congo Basin and Southeast Asia.

By monitoring people who are exposed to animals in such viral hotspots, we can capture viruses at the very moment they enter human populations, and thus develop the ability to predict and perhaps even prevent pandemics.

Over the past 10 years, my colleagues and I have demonstrated that such monitoring is possible. In Cameroon, we have studied hunters who are exposed to the blood and body fluids of monkeys, bats, wild pigs and other hunted animals. By collecting specimens from both the hunters and their prey, we have discovered previously unknown viruses and documented how they’ve jumped from animals to humans. We have seen, for example, a gorilla retrovirus, never before seen in humans, infect one of our study subjects.

Then, by monitoring infected people and those who are in contact with them, we observe what effects these novel viruses have on people, and how easily they can move from person to person.

We can also identify a virus’s genetic and immunological signatures and other biological information that is needed to create diagnostic tests, vaccines and treatments — so that when a disease appears, it is possible to respond as quickly as possible.

Had similar monitoring systems been in place at farms in Mexico, where the current swine flu outbreak is assumed to have emerged, perhaps we would have been able to identify the movement of the virus at or near the point where it entered humans. Such information could have significantly speeded up our response.

. . .[/quote]


[quote=ewmayer]You're right about not shutting down the economy to an inordinate degree, but that does need to be weighed against the spanish-flu type scenario, i.e. the very real probability of a pandemic which ends up killing on the order of 1% or more of the world's population? What's 100 million lives worth these days? But merely looking for "obviously ill" people at airports is idiotic, in my opinion. We need to be just a little smarter than that.

Compare sampling-based proposals such as the above one to the amount of money being spent on e.g. near-earth asteroid detection - not that I'm against the NEO search, I just want the $ spent on such catastrophe-prevention efforts to be roughly proportional to the potential lives saved.[/quote]Let's see if I have this straight ...

You're implying that the NEO search effort, which aims to prevent a catastrophe that could potentially kill [B]100%[/B] of the Earth's population, is somehow being lavishly funded in comparison with current efforts to monitor outbreaks of diseases which may, in the worst case you cite, kill less than [B]2%[/B]?

Sir, you have some sort of mistaken idea about NEO search funding and/or disease-monitoring funding.

Perhaps one difference between the two, namely that the NEO search can be conducted using specialized technology at only a few locations, while disease-monitoring is inherently widespread (though its information is collected centrally) through millions of doctors and health facilities around the world, has misled you in your estimation of funding. It's a lot easier to add up the short list of NEO funding figures than it is to tally the costs of the monitoring/reporting time spent by millions of health workers annually.

Do you think that worldwide annual NEO search costs averaged over several years (to spread the cost of equipment purchases equitably) exceed the annual CDC (which is only a small part of the world's health monitoring but also includes non-monitoring costs) budget? (I haven't looked up the figures before I post this.)

"Swine flu: why I'm not complaining" on the Effect Measure blog:

It's the comments that are interesting IMO. Link at end of each one.

[quote]2 I work in an already overtaxed emergency room in a major city. Yesterday we were "out of" masks and therefore the nurses in triage went without. It is concerning to me as a nurse that has first contact with those that are ill, that basic resources are not available. I love my job yet I love my family more. Creating a potential reservoir within myself for a virus with so many unkown variables is not an option. You are right in your critique of our health care system. Understaffed and unable to handle the noramal changes in pt census we are truely vulnerable to an exponential increase in patient loads.

Posted by: theloneyoni | [URL="http://scienceblogs.com/effectmeasure/2009/04/swine_flu_why_im_not_complaini.php?utm_source=nytwidget#comment-1601193"]April 30, 2009 10:05 AM[/URL]

3 While the CDC and WHO are sending the right messages, I think we are on the brink of the media backlash (it started in that LA Times reference in the comments of another blog entry) since the body count hasn't started piling up in the US. Note: we may have a very low body count thanks to the CDC and WHO informing the public and making people fearful enough that they are getting checked out. What can be done to fight a media backlash is the real question?

If the 1918 pattern occurs, I think CDC and WHO's public image will be undermined and people will ignore them in the fall. The general public doesn't know the 1918 story - it needs to get out there so people will understand that a summer lull may not mean anything.

Posted by: GeorgeT | [URL="http://scienceblogs.com/effectmeasure/2009/04/swine_flu_why_im_not_complaini.php?utm_source=nytwidget#comment-1601223"]April 30, 2009 10:16 AM[/URL]

. . .

9 My 2 cents again:

1. As an ER physician at a teaching hospital, I am constantly frustrated by the lack of attention the govt has given in regard to the fact that most EDs in the USA function above capacity and we have little to NO surge capacity. A white House report in March 2008 called 31 EDs throughout the USA at the same time during a Monday afternoon and asked how many people they could take (simulated a mass casualty event that had same number of victims as the Madrid train bombings several years back--i.e. 215 victims) and most could either take 1 or 2 or none. Yes I wrote those numbers correct. One hospital in Wash DC was functioning at 250% over capacity during that nice phone chat! We have neglected our public health infrastructure and now that we have as Obama said last night not 1 or 2 major problems but 8 or 9--we dont have the money to fix it like it should be. Thankfully this pandemic wanna be were enjoying appears to be a wimp. And now that I am going What in the hell was the WHO thinking in putting so much money and resources on the pipe dream of source containment? That policy was based upon 2 computational models that were flawed and had unmeetable requirements for such as policy to work. Spend the money on prevention stupid!

2. I wrote an (I know self promotion--but this is important) Op ED for CNN on travel and swine flu that folks on this site may find useful when they fly during an outbreak. Please check it out [URL]http://www.cnn.com/2009/HEALTH/04/30/gendreau.swine.flu/index.html[/URL]

Take care everyone and remember sanitize those hands.
Mark

Posted by: Mark Gendreau | [URL="http://scienceblogs.com/effectmeasure/2009/04/swine_flu_why_im_not_complaini.php?utm_source=nytwidget#comment-1601303"]April 30, 2009 10:46 AM[/URL]

. . .

19 The only problem I've had with the "panic mongering" is with CNN, MSNBC, and other major news outlets. They're taking soundbytes from WHO and the CDC and not really providing context. If this was three years ago, before I entered the sciences and started actually learning to read and think, I'd be terrified right about now. People who rely on the major news aren't being given the full picture or how to even view the full picture.

Posted by: e.d. | [URL="http://scienceblogs.com/effectmeasure/2009/04/swine_flu_why_im_not_complaini.php?utm_source=nytwidget#comment-1601795"]April 30, 2009 1:31 PM[/URL]

. . .

25 Revere, as always, thought provoking. Thank you.

Mark: where do you think all those masks and respirators are going to come from? In every country around the world, the same response is occurring. I wonder how many healthcare professionals there are in the world? And what about the millions of everyday workers who use them for protection at work? What will happen to those supplies? I am sure there is not a huge warehouse somewhere full. If manufacturers of these are like every other business hit by the GFC, then I am sure inventory and raw material supplies will be reduced.

Posted by: Pete | [URL="http://scienceblogs.com/effectmeasure/2009/04/swine_flu_why_im_not_complaini.php?utm_source=nytwidget#comment-1602135"]April 30, 2009 3:48 PM[/URL]
[/quote]Hmmm... [I]Are there[/I] large emergency stocks of masks, at least, somewhere?

If not, something to add to the national preparedness checklist.

Long-term deterioration of the rubber straps for holding them on could be a problem.

[quote=cheesehead;171744]Long-term deterioration of the rubber straps for holding them on could be a problem.[/quote]I should have looked at a real germ-screening mask like this:

[URL]http://www.amazon.com/gp/product/B0027ENFX6/ref=s9_topd_gw_tr11?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-8&pf_rd_r=0P0ESEP27WK1ADK9YGXX&pf_rd_t=101&pf_rd_p=475766091&pf_rd_i=507846[/URL]

instead of the little dust masks on my shelf. [I]Real[/I] germ masks have fabric earloops, no rubber.

[QUOTE=cheesehead;171760]I should have looked at a real germ-screening mask like this:

[URL]http://www.amazon.com/gp/product/B0027ENFX6/ref=s9_topd_gw_tr11?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-8&pf_rd_r=0P0ESEP27WK1ADK9YGXX&pf_rd_t=101&pf_rd_p=475766091&pf_rd_i=507846[/URL]

instead of the little dust masks on my shelf. [I]Real[/I] germ masks have fabric earloops, no rubber.[/QUOTE]
I don't think it's the earloop so much as the qusality of the facial fit that matters - in addition to the flitration fineness, obviously.

I ordered several dozen N95 Respirators from an outfit in Texas (TASCO) yesterday, just in case - been meaning to add some face masks to the home emergency kit for several years now anyway. They run about $2 each, but importantly (especially if there is an outbreak of something really nasty and you don't want to end up trying to buy enough for several-per-day for say a month) they are washable and reusable at least a few times that way. In a pinch I suppose one could always douse the fabric with rubbing alcohol, which will dry within minutes.

Gonna send at least one box to my Mom, who is flying out next weekend to visit me and my sister and sis's 2 one-month-old twin boys. Airplanes are basically flying petri dishes, that's one place where I'd definitely consider wearing a mask at this time.

[QUOTE=ewmayer;171815]Airplanes are basically flying petri dishes, that's one place where I'd definitely consider wearing a mask at this time.[/QUOTE]

Taking cues from Joe Biden???

[QUOTE=ewmayer;171815]
Gonna send at least one box to my Mom, who is flying out next weekend to visit me and my sister and sis's 2 one-month-old twin boys. Airplanes are basically flying petri dishes, that's one place where I'd definitely consider wearing a mask at this time.[/QUOTE]

[QUOTE=rogue;171820]Taking cues from Joe Biden???[/QUOTE]
Why not? In a full-blown epi/pan-demic, most precautions taken before the fact will seem timid although currently they seem extreme.

I'm more concerned about strip searching a young girl for possibly hiding an ibuprofen and diverting an airliner because it held a pacifistic musician that years ago adopted the Muslim religion.

Joe Biden's advice may be damaging on a macroeconomic and national policy level but is perfectly sensible on an individual and personal level of deciding what risks and preparations for unknown levels of risk we accept on a private decision bases day to day. Even two weeks ago though, wearing any mask on that airline was sure to bring the full force of DHS scrutiny upon the wearer, and maybe still does.

[QUOTE=ewmayer;171815]Gonna send at least one box to my Mom, who is flying out next weekend to visit me and my sister and sis's 2 one-month-old twin boys.[/QUOTE]A major consideration that is often overlooked is having a well stocked larder/cellar/pantry/fridge. If you have to hunker down for a week or 2, you will need to be able to feed yourself(& family). If you are sick, you need things like chicken soup (Jewish penicillian) and other sick friendly foods.

I'll just use my hepa/acid gas respirator. Magneta and yellow cartridges :smile:

[quote=cheesehead;171744]Hmmm... [I]Are there[/I] large emergency stocks of masks, at least, somewhere?
[/quote]... but today I'm seeing/hearing that masks aren't very important flu-spread-preventers all by themselves.

The main virtues for most folks is that they (a) help remind oneself not to touch ones nose or mouth with hands/fingers, and (b) serve as visual reminders to other folks to keep their distance from each other. In addition, those who are already sick should wear them to help prevent spreading disease to others, and health care workers who have to come in close contact with many sick people get some protection from contracting disease.

That is, the average person can get the same benefits as masks are commonly thought to have by (a) washing ones hands frequently, (b) refraining from touching mouth/nose/eyes with hands/fingers, and (c) keeping greater distance from others in social situations.

(* begin excursion *)

Notice that this is yet another case of the general principle (not just in health) that people would much rather use some artificial device or take some pill than change their own behavior, in order to achieve some health or safety benefit. Thus, the general preference for automobile airbags rather than seat/shoulder belts that have to be fastened. Thus, the longing for a fat-blocking pill one could take instead of changing ones dietary and movement habits. Or our resistance to undergoing change in general.

OTOH maybe this complaint simply overlooks the very real important of labor-saving or time-saving convenience. Weren't people generally more physically-fit when they had to chop/haul firewood for heating the home? Scrubbing clothes by hand allows better attention to treating particular stains than just dumping them in a washing machine. And I just love washing dishes by hand in a dishwasher-less apartment after living for ten years in a house with a dishwasher

... not.

(* end excursion *)

Mods, can y'all break out the swine flu to a different thread?????
Thanks.

A/H1N1 ("swine") flu outbreaks
 

Here's a thread for comments on current flu news.