Click to Translate to English Click to Translate to French  Click to Translate to Spanish  Click to Translate to German  Click to Translate to Italian  Click to Translate to Japanese  Click to Translate to Chinese Simplified  Click to Translate to Korean  Click to Translate to Arabic  Click to Translate to Russian  Click to Translate to Portuguese  Click to Translate to Myanmar (Burmese)

PANDEMIC ALERT LEVEL
123456
Forum Home Forum Home > Main Forums > General Discussion
  New Posts New Posts RSS Feed - Mayor Bloomberg-Close the Schools!
  FAQ FAQ  Forum Search   Events   Register Register  Login Login

Now tracking the new emerging South Africa Omicron Variant

Mayor Bloomberg-Close the Schools!

 Post Reply Post Reply
Author
Message
Tinijocaro View Drop Down
V.I.P. Member
V.I.P. Member


Joined: May 29 2009
Location: Buffalo, NY
Status: Offline
Points: 122
Post Options Post Options   Thanks (0) Thanks(0)   Quote Tinijocaro Quote  Post ReplyReply Direct Link To This Post Topic: Mayor Bloomberg-Close the Schools!
    Posted: May 31 2009 at 4:27am
http://pundita.blogspot.com/2009/05/h1n1swine-flu-have-cdc-and-dr-thomas.html

For those who've been living in a cave, Dr Thomas Frieden, who is presently New York City's Health Commissioner, is President Obama's choice to head the Centers for Disease Control and Prevention. Dr Frieden's approach to swine flu marks him as a member of the Budgie school of logic; nonetheless, barring a compassionate act of God Dr Frieden will take up his new duties in June.

I'd hoped that the world's misfortune might at least translate into a lucky break for New York City, which has seen an outbreak of swine flu that Dr Frieden has manfully tried to chirp to death. My hopes were dashed yesterday when I learned that Mayor Bloomberg has seemingly come to view the swine flu virus as joined in a plot with his political enemies to flummox his reelection campaign.

I'll allow that politics can give even the intelligent fits of stupidity yet Mike Bloomberg did not earn his billions by acting in irrational fashion. So I am left to darkly wonder if Dr Frieden and his more twittery-minded colleagues at the CDC used pseudo-scientific hoodoo to cloud Hizzoner's mind.

Let us be brutally frank: it doesn't get more bird-brained than to base the criteria for school closings on a percentage of students with a documented fever of 100.4 and overall absenteeism. Yet this is what New York City has done in the effort to appease alarmed parents who've called for stronger action regarding swine flu outbreaks in schools. (H/T reader CGardner; see Note).

Because it's not possible to know how many healthy students/staff are unwittingly acting as carriers for a flu virus, the only rational action in the face of even one instance of swine flu in a school is to immediately close the school. To wait for a percentage or 'cluster' of infected students to build up falls in the tweet chirp range of reasoning about how to deal with a highly infectious disease.

Instead of acting rationally Dr Frieden and the mayor have taken to complaining about what they've termed the "worried well" -- those New Yorkers who have no symptoms of swine flu or any other kind of infection but who're flooding emergency rooms to complain of feeling sick. (1)

Of course many well New Yorkers are worried sick; this phenomenon is very common; it's the inevitable outcome of a government's muddled response to an infectious disease outbreak.

Some of Dr Frieden's recent statements about swine flu are so muddled they're enough to worry any well person ill. Consider these bon mots:

"The fact that we're seeing large clusters [of swine flu outbreaks] in [NYC] schools is a little surprising." (2)

Considering that even the earliest data turned up that the disease was striking at a disproportionate number of young people, where else did you expect to see infection clusters, Dr Frieden? Nursing homes? Bridge tournaments?

"We are now seeing a rising tide of flu in many parts of New York City. Nothing we’ve seen so far suggests that it’s more dangerous to someone who gets it than the flu that comes every year. We should not forget that the flu that comes every year kills about 1,000 New Yorkers.” (3)

Even 'normal' influenza viruses kill people who have underlying health problems. The concern about this matter should have been greatly heightened given the novelty of the swine flu. So I am not clear on why Frieden's department waited 25 days to issue a warning that those New Yorkers with underlying health problems should take special precautions.

As to the flu that comes every year killing 1,000 New Yorkers -- what's the average reproduction ratio of that flu? Is it in the range of the 1918 pandemic influenza?

Eurosurveillance reported on May 14 that a new study had turned up that the initial estimate of the reproduction rate had been understated. (4) From ScienceInsider's summary:
[T]he new study concludes that each infected person infects between 2.2 and 3.1 others, a “reproduction ratio” in keeping with other pandemic influenza viruses. The earlier paper in ScienceExpress, which factored in the likelihood that there was much underreporting in the official case numbers, calculated a reproduction ratio of only 1.4 to 1.6. (5)
The United States -- and perhaps no other nation, as well -- is unprepared for that high a ratio:
The current U.S. pandemic control strategy is based on computer simulations that assume a flu virus with an R-naught between 1.6 and 2.4.

Last year, however, [Lone] Simonsen [an epidemiologist at George Washington University] and Viggo Andreasen concluded that the true R-naught of the 1918 flu virus was probably somewhere between 3 and 4. (6)
And does that "flu that comes every year" show a peak infection rate this close to summer?
[...] The new swine flu virus is spreading rapidly around the United States, and more than half of the states are reporting unusually high levels of flu-like illness at a time of year when the respiratory disease usually disappears, federal health officials said [May 15].

About half of the people with flu are testing positive for the new virus, indicating it is playing a significant role in the unusual pattern of disease, officials said.

"We would be expecting to see the season to be slowing down or almost completely stopped," said Daniel Jernigan of the federal Centers for Disease Control and Prevention. "But what we're seeing is there are some areas that actually have reports of the amounts of respiratory disease . . . that are equivalent to peak influenza season." (2)
I understand that swine flu has outraced the epidemiologists but that's just the point with a new virus, isn't it? If you don't know exactly what you're dealing with, you take extra precautions at the start and keep up the precautions until you get a handle on how the virus acts.

And as I pointed out yesterday it's a verbal sleight of hand to portray the swine flu virus as being no more lethal than garden variety influenzas.

Despite all these considerations, New York City's health department did just the opposite of what intelligence would decree in the face of the new. With the virus poorly understood, and with its appearance in the city only days old, the department thought they had it figured out -- at least enough to follow the CDC's reversed advice about not closing schools that saw an outbreak. Once the CDC backtracked, the health department jumped on board, despite the fact that the city had seen one of the biggest confirmed outbreaks of swine flu at the time -- at a school.

The topper is Dr Frieden's call for a Manhattan-Project approach to developing a swine flu vaccine. Of course it's important to develop a vaccine for swine flu. But let's face the drawbacks:
Glaxo on Friday [May 15] said it plans to start producing a pre-pandemic vaccine against the current strain of the A/H1N1 virus causing the swine-flu outbreak. There is no guarantee this vaccine would work during a pandemic if the virus mutates significantly. (2)
Here we come to one of those pesky interpretations of the word 'pandemic' that I complained about recently. Clearly, the Glaxo spokesperson or the reporter intended to mean 'highly lethal pandemic' because a pandemic is already upon us; WHO is simply dragging its feet about raising the Pandemic Alert to 6.

Granted, it's not a classic pandemic; for the most part the initial swine flu infections have been planed around the globe, where they set off small clusters of infections before starting to spread in the more traditional pandemic fashion. That explains the seeming paradox of a globe-spanning disease outbreak that manifested within a matter of days but with a low number of infections.

There is another problem with the flu vaccine -- or rather with the thinking at Glaxo and/or the CDC:
Already, there is controversy over the vaccine, which will include an ingredient called an adjuvant that boosts the body's immune response. The ingredient is not licensed by Food and Drug Administration, but the agency has the power to authorize the use of such products in an emergency.

Some health officials and vaccine watchdog groups say the accelerants may cause a severe reaction -- specifically, swelling in the joints and in the liver -- in people with compromised immune systems.

"It's a big issue. An adjuvant in vaccines given to soldiers is at the center of the debate with the Gulf War syndrome," said Vicky Debold, a public health nurse who serves on the FDA's vaccines advisory committee. "The FDA is very concerned about them, especially what happens when people are given multiple vaccines at once that use a combination of adjuvants that have not been tested together." (1)
I ask reader Bullmoosegal, who is a biologist, to take a flying leap and speculate about what might happen if a boosted immune system met with a more deadly form of the swine flu virus.

I am thinking of the cytokine storm reaction. Would a swine flu vaccine that isn't a match for a mutated virus still provide enough 'introduction' to the mutation to prevent the immune system from having a cytokine storm reaction? If not, would there be a special danger to an adjuvant in the swine flu vaccine? That's probably a dumb question but this layperson has to ask it.

In any event, haste in this instance might be worse than waste; it could spell disaster if the vaccine isn't adequately tested, which takes more time than Dr Frieden's crash approach might allow for.

And he's placing his faith in a false god if he thinks flu vaccine is a substitute for disaster planning/drills and quarantines -- and school closings.

The CDC seems without peer when it comes to lab analysis of disease specimens. The contributions of scientists on that level, and the work of the CDC data collectors and analysts, are invaluable in a battle against a highly infectious disease. The same can be said for the contributions of vaccine developers. Yet it's not by any one route that humanity should prepare to do battle with a new virus that could have beginner's luck and launch a superkiller pandemic that targets the young.

The key to preparedness is to think about such a threat not so much as a medical event but as a natural disaster -- and to make sure that the biomedical viewpoint, while taken into account, does not overwhelm the purely logistical aspects of a response to such a disaster.

The difference here is that the natural disaster could affect the entire nation within a short time. So adequate disaster planning would take an unprecedented effort, and unprecedented coordination among states and indeed among countries. Both Canada and Mexico should be involved in the planning and execution of the preparations.

More about that angle tomorrow or Saturday but for now, I shouldn't have to tell the mayor of a 9/11 city that disaster planning means asking the toughest questions, facing the worst-case scenarios, then devising strategies and tactics from there.

If Dr Frieden and his replacement are not up to the task, there's no shame in that; both men are physicians and shouldn't be expected to be an ace at logistical thinking.(6) But such thinkers must be found immediately and put on the city payroll or begged and borrowed from other New York agencies.

Meanwhile, I urgently suggest to Mayor Bloomberg that he at least follow President Calderon's intelligent lead when he sought to break the back of the epidemic in Mexico:

Stretch the upcoming Memorial Day holiday into a four-day school recess; with two weekends included that will keep children out of schools safely past the 2-7 day incubation time for the virus. At the least, close all the schools in every borough that's seen as much one outbreak of the disease.

Yes, keeping kids home for four working days will be a great inconvenience and even hardship for many working parents, particularly single parents. And this will spill over into hardship for many businesses and the public sector.

But the present outcry from many concerned parents in New York gives lie to the argument that New Yorkers wouldn't stand for more schools being closed at this time. (1)

And clear action by City Hall to deal with the swine flu would do much to dispel rising panic and the "worried well" epidemic in the city.

Finally, contemplate the worst-case scenario at this time: as the disease moves out from the clusters of infections at schools, remember it's not only teenagers who fall into the 'young' category.

Right now New York City is facing the specter of cascading numbers of absent employees in critical services -- young employees who are too sick, even with Tamiflu, to work for an average of four days.

When you look at things that way it's worth the effort to try and slow the rate of infection by any which way, including a school recess.

Note
From yesterday's comment sectionYesterday Chancellor Joel Klein of the NYC Education Dept. finally sent a letter home to parents re: school closings and H1N1:
http://schools.nyc.gov/Home/Spotlight/jkh1n1.htm

NYC is still very cagey about its criteria for closing individual schools, saying they look for "clusters" of illness, the % of students in school with a documented fever of 100.4 and overall absenteeism.

Parents and the Teachers' Union DID manage to get the Education Dept. to start posting daily student absentee rates for each school in the city.

http://schools.nyc.gov/Home/Spotlight/closures.htm
Back to Top
 Post Reply Post Reply
  Share Topic   

Forum Jump Forum Permissions View Drop Down