Public Health: Disease, Epidemic & Pandemic Threat (merged thread)

[AdamG]

World warned over killer flu pandemic
By Ben Russell, Political Correspondent
Monday, 21 July 2008

The world is failing to guard against the inevitable spread of a devastating flu pandemic which could kill 50 million people and wreak massive disruption around the globe, the Government has warned.

In evidence to a House of Lords committee, ministers said that early warning systems for spotting emerging diseases were "poorly co-ordinated" and lacked "vision" and "clarity". They said that more needed to be done to improve detection and surveillance for potential pandemics and called for urgent improvement in rapid-response strategies.

http://www.independent.co.uk/life-st...ic-872809.html

[selil]

In evidence to a House of Lords committee, ministers said that early warning systems for spotting emerging diseases were "poorly co-ordinated" and lacked "vision" and "clarity". They said that more needed to be done to improve detection and surveillance for potential pandemics and called for urgent improvement in rapid-response strategies.

I keep saying it, people in the health care industry say, but nobody listens. Universal healthcare is a national security issue not a liberal welfare issue. The early warning system in the United States is the healthcare system through the health departments in the thousands of jurisdictions. If people can not afford health care they stay away until it is to late and the infection/spread rates are totally out of control. This is true for bio threat/terrorism, natural occurring threats, and emerging threats. But, it isn't sexy, it is tainted by politics, and it doesn't involve guns so nobody wants to take it on. The very mobile poor/poverty population engaged in service industry with rapid/expansive/integrated contact with large segments of the population are exactly who should be covered and exactly who are not covered.

Oh well.

[Watcher In The Middle]

you use the term "Universal healthcare", you are screwed. That's the standard code phrase (political speak) for 100% government controlled and provided healthcare, and battle's over at that point - you lose.

Is what we have now really that good - well, not really (and that's being polite). Could we have designed such a disorganized out-of-control rolling cluster of a health care delivery system if we had tried to? - probably not - to get this screwed up, we had to let this whole mess improve with age.

But, doesn't matter - "Universal healthcare" is DOA because of everything it brings to the table.

On the associated topic,

The early warning system in the United States is the healthcare system through the health departments in the thousands of jurisdictions. If people can not afford health care they stay away until it is too late and the infection/spread rates are totally out of control.

That's only partially true, and there's much, much more to it. And "Universal Healthcare" will in no way make it better - probably little, if any effect at all. Here's why (as an example I'm personally aware of).

Most local Health Departments part in the health "food chain" can be broadly summarized as follows (bottom to top):

1. Local Entities/providers:
1.a Local health care providers (individuals/practices)
1.b Hospitals, clinics
2. Local Health Departments:
2.a Environmental Health (Food Safety; Well & Septic, Solid Waste, Radon, etc., etc., etc.)
2.b Clinical Health (provide services to individuals; WIC, etc.)
3. State Public Health
4) Federal Public Health:
3.a CDC
3.b NIH
3.c DHS (don't even get me started on them; with their "grants" to local health departments of such useful items as HAZMAT suits that nobody ever used, radiation detectors, 'lightweight' GPS units which were the weight and size of Chicago street paving bricks, etc.)
3.d Others

Ok, let's start here: Most of the work gets done by the locals. Any hospital doing even a halfway decent job (which honestly, most of them do a decent job at this part) already have in place a rapid response environment (usually digital) for tracking "unusual events" such as infections, unusual situations, etc. The problem in most cases isn't the locals at all.

The problem (at least here in IL) is with our wonderous, quite inept state government. Right around 2001/2002, I believe, the feds set aside $$$$ for each state to create real time digital reporting, run by each state public health agency to quickly identify and report such outbreaks and incidents to the state public health agencies, and consequently to the feds - bypassing the local health departments, because they had been "ineffective" up to this point.

So, our state took the money and ran with it - giving big bucks to a politically well connected firm to create from scratch a new, miracle, magical digital system which would allow the state folks to track everything in every which way known to mankind. And what they did was to spend all the big money (and it was supposedly ended up being in excess of $10 mil, but who really knows) to create a digital version of the paper process that already was in place.

Now, there were at least 2 private companies that already had digital systems that existed, were battle tested by the hospitals which were using them, but no, we got to create our own from scratch. Which we did, right here in IL. And guess what, the local Health Departments are charged with training and getting all the local health providers to use this monstrosity of a system - and guess what, it blows chunks. I mean, it is really terrible to use, nobody who is on the front lines wants to use it, you can easily kill 15+ minutes just putting a single record into this thing, it's a complete and total waste.

And then just to top things off, and let's make things just a little bit worse, then you have to throw in HIPA (Health Insurance Privacy Act) requirements right on top of this thing, so let's just make things a little more complex and even more difficult.

So, here's the hard reality. It's 9:30 AM, and I've got a patient with symptoms that probably should be reported, but we're on the treadmill of seeing patients, and I don't have 5 minutes, much less 15 minutes. It's going to wait, and hopefully staff can get some free time to deal with the reporting system. Course, I'll have to get the 185 page manual out with the step-by-step instructions, and the 3 level logins and passwords required to get in, oh, and btw, what's our state assigned 30 character identifier for our medical practice?

Oh, and btw, the feds are supposedly as happy as clams about IL and their new infectious disease reporting system, even though most everybody who really has to use it thinks it's a mostly worthless piece of crap.

Btw, if you really want to see the true back story, get a copy of the paper reporting forms used before this new system was put in place, and then get a copy of the full user manual for the new system. After you look at the two separate items, it's pretty apparent that the overriding design process was: "Do it the same way it's always been done, only do it a little better".

/End of rant

[Uboat509]

Universal healthcare is a national security issue not a liberal welfare issue

Socialized medicine isn't going to fix this, or any other problems. Watcher covered the issues as they pertain to this particular problem but that is just scratching the surface of the problems with socialized medicine.

SFC W

[selil]

Watcher I agree pretty much with the issues you laid out, but the problem still remains that the indigent plague carrier is not going to seek any kind of medical attention unless it is to late. Unfortunately you are correct that the political baggage is tiresome, but as thought leaders we have to go beyond and at least give correct recommendations. The number and type of cases (advanced symptomatic) seen in emergency rooms proves that people without insurance don't even enter the medical monitoring system. Ever. We have to get beyond "socialized" as bugaboo words and simplistic axioms of rejection. We also have to get beyond a standard of "perfect" in talking about implementing these types of systems. The problem is complex and I can not claim to have all of the answers but I can see that the current system is badly broken. The political punditry surrounding healthcare is fallow ground for ideas and concepts. Department of defense has a mission to look beyond the borders at threats external. Law enforcement has a mission to look at threats of criminal nature. The pandemic threat is an internal threat with a substantive history at least as rich with examples as war. Yet even though the death toll in previous pandemics equalled major wars it is given little to no equivalent concern. The reasons are legion. Mostly the political footballs of failed medical policy, big pharma, the AMA, and various political profit seeking constituencies.

[Norfolk]

Watcher I agree pretty much with the issues you laid out, but the problem still remains that the indigent plague carrier is not going to seek any kind of medical attention unless it is to late. Unfortunately you are correct that the political baggage is tiresome, but as thought leaders we have to go beyond and at least give correct recommendations. The number and type of cases (advanced symptomatic) seen in emergency rooms proves that people without insurance don't even enter the medical monitoring system. Ever. We have to get beyond "socialized" as bugaboo words and simplistic axioms of rejection. We also have to get beyond a standard of "perfect" in talking about implementing these types of systems. The problem is complex and I can not claim to have all of the answers but I can see that the current system is badly broken. The political punditry surrounding healthcare is fallow ground for ideas and concepts. Department of defense has a mission to look beyond the borders at threats external. Law enforcement has a mission to look at threats of criminal nature. The pandemic threat is an internal threat with a substantive history at least as rich with examples as war. Yet even though the death toll in previous pandemics equalled major wars it is given little to no equivalent concern. The reasons are legion. Mostly the political footballs of failed medical policy, big pharma, the AMA, and various political profit seeking constituencies.

Certainly WIM is correct that such a system ("Universal Healthcare") would almost certainly be politically DOA before a pandemic; in the wake of a pandemic, of course, there would be much gnashing of teeth and bitter reproach for not anticipating the threat and establishing a system to deal with it. I wonder what the political watchword for that might be.

But...just to throw a monkey in that wrench, when the SARS scare was on, the public health care system in Toronto was almost overwhelmed by just a few hundred cases, and most of the deaths occurred amongst medical staff. That however, has been attributed largely to inadequate senior leadership at various political levels and within some hospital administrations.

[Uboat509]

As far as I can see, there are now two issues being discussed here. One is "Universal Health Care" which is both a political and practical non-starter and the other is the creation of some sort of early warning system. As has been noted, that early warning system is already in place though it needs work. It worked fairly well during the Anthrax incident a few years ago. CDC does a decent job, not perfect, but good enough. I would be very wary of creating more government beauracracy to try to make it better (or anything else for that matter).

SFC W

[selil]

As far as I can see, there are now two issues being discussed here. One is "Universal Health Care" which is both a political and practical non-starter and the other is the creation of some sort of early warning system. As has been noted, that early warning system is already in place though it needs work. It worked fairly well during the Anthrax incident a few years ago. CDC does a decent job, not perfect, but good enough. I would be very wary of creating more government beauracracy to try to make it better (or anything else for that matter).

SFC W

Actually you are slicing health care and early warning prematurely early. Also, the targeted population during the anthrax event (not threat as people actually got sick) was not the general population. A pandemic is the "population" as with SARS or Bird Flu. Further the CDC has expressed they do not have nor can they respond to a general outbreak. They are an identification and warning agency. More akin to military intelligence operations than operational armor battalions. The wariness you express is the result of the political process. The military has universal healthcare (if you can call tri-care healthcare). The problem is that priorities are askew in considering the specific issues.

Don't get me wrong or attribute political ideology that would be incorrect or misplaced. I can see an issue, identify the problems, recognize the severity of the threat along with the likeliness of an actual event. Without devolving into political speak. I am not an expert at pandemic, but I have read many journal articles, been to many conferences, and listened to people who are experts. This is an issue that simply isn't discussed because of the political baggage of the Clinton presidency.

Yet it is incredibly important.

If I told you that I have a stealth weapon that could wipe out a third of the military without attribution or warning and there is no offensive analog how much would you spend on detection measures? Oh, and it will wipe out a third of the contractor staff, the political representation, and likely families supporting the military? I know fear mongering but some of the conferences talk about increasing threat vectors the longer it doesn't happen with increasing virulence and mortality due to the population interactions.

[Watcher In The Middle]

Originally posted by Selil:

Watcher I agree pretty much with the issues you laid out, but the problem still remains that the indigent plague carrier is not going to seek any kind of medical attention unless it is to late. Unfortunately you are correct that the political baggage is tiresome, but as thought leaders we have to go beyond and at least give correct recommendations. The number and type of cases (advanced symptomatic) seen in emergency rooms proves that people without insurance don't even enter the medical monitoring system. Ever. We have to get beyond "socialized" as bugaboo words and simplistic axioms of rejection. We also have to get beyond a standard of "perfect" in talking about implementing these types of systems. The problem is complex and I can not claim to have all of the answers but I can see that the current system is badly broken. The political punditry surrounding healthcare is fallow ground for ideas and concepts. Department of defense has a mission to look beyond the borders at threats external. Law enforcement has a mission to look at threats of criminal nature. The pandemic threat is an internal threat with a substantive history at least as rich with examples as war. Yet even though the death toll in previous pandemics equalled major wars it is given little to no equivalent concern. The reasons are legion. Mostly the political footballs of failed medical policy, big pharma, the AMA, and various political profit seeking constituencies.

Ok, so let's get started & do some serious "thought processing" here:

Initial Analysis: First off, the above post by Selil should be the starting point. But the following rules need to be attached to it:

01 The entire concept of "Universal Healthcare" does not apply to this process in any way, shape, or form. NONE. This step is a basic requirement, for political purposes. If we don't do this, and stick to it, the entire process is DOA.
02 The information release compliance areas of HIPA (the rules are arcane, and the penalties, even for accidental disclosure are draconian) are currently also applied to public health agencies. These HIPA requirements need to be eliminated for (a) public health reporting purposes, and (b) for private entities making such reports solely to local public health agencies. We need accurate, detailed information fast, and guess what, HIPA requirements as applied out in the real world makes almost all of that process impractical.

So once 01 & 02 are done, now we can get serious about building a Pandemic EW (early warning) system. If you want to do it right the first time, and get it done quickly, here's how.

03 Forget the typical software design, where you get tons of committees together & re-build the "Camel". Takes way too long, and probably everybody here can imagine the results.
04 Solution: Take $500 mil, call up Larry Page and Sergey Brin (Founders of a little bitty corporation known as "Google"), tell them there is a project for the development and implementation of a Pandemic EW System (PEWS???) that is essential to the National Security of the United States of America, and it's Google's responsibility to make it happen. They have 3 years to get it done, and $500 mil. Federal anti-trust regs do not apply to this project.

Give them a copy of this thread, with all the posts, and then get the hell out of their way. Let them have at it.

Ok, so there's my "solution" for building a useful, workable, highly functional Pandemic EW System - ID the best and the brightest, tell 'em what the problem is and set the stage for them to handle it, turn them loose, and get the hell out of the way.

Then there's the entire healthcare issue. Oh yeah, that's a jewel. Next post...

[Uboat509]

Actually you are slicing health care and early warning prematurely early. Also, the targeted population during the anthrax event (not threat as people actually got sick) was not the general population. A pandemic is the "population" as with SARS or Bird Flu. Further the CDC has expressed they do not have nor can they respond to a general outbreak. They are an identification and warning agency. More akin to military intelligence operations than operational armor battalions.

That is by design. CDC was always intended to be a coordinating agency as well as performing some research functions. A true epidemic is going to be beyond the capabilities of any one government agency anyway. CDC will coordinate the response of the elements already on the ground to respond to the threat as well as providing information and (I believe) advisers to the local responding elements. CDC does that pretty well as far as I know. The real inherent weakness in the system is just like in MI, the sensors. For the system to work, the sensor (doctor, nurse, health care professional etc.) has to a) recognize that there is something that needs to be reported and b) actually report it. Easier said than done. The only way to get around that would be to place someone in each hospital, clinic etc. to report to the CDC. That's not an especially practical solution. Again, more government bureaucracy is not the answer.

The wariness you express is the result of the political process. The military has universal healthcare (if you can call tri-care healthcare). The problem is that priorities are askew in considering the specific issues.

Nah, TRI-CARE isn't really any better or worse than an average HMO and in fact Tri-West is a subsidiary of Blue Cross/Blue Shield (a fact they don't seem to advertise ).

Don't get me wrong or attribute political ideology that would be incorrect or misplaced. I can see an issue, identify the problems, recognize the severity of the threat along with the likeliness of an actual event. Without devolving into political speak. I am not an expert at pandemic, but I have read many journal articles, been to many conferences, and listened to people who are experts. This is an issue that simply isn't discussed because of the political baggage of the Clinton presidency.

Yet it is incredibly important.

It is also an issue of all the times that wolf has been cried over the years. In the eighties, AIDs was going to kill us all, then it was Ebola, then Mad Cow disease, then SARs and most recently (my personal favorite) H5N1 bird flu. All of these were going to kill us all and none really lived up to the hype. I am a medic. I know that there is some nasty stuff out there waiting for the chance to give us a nasty death (other than tofu, I mean, which is a work of pure culinary Evil) but the hysteria around the "epidemics" that I mentioned mixed with all the other stuff than is going to kill us (plastics, cholesterol, well bad cholesterol or not enough good cholesterol or too many triglycerides, or eggs, no wait a minutes eggs are good for you, no wait they're bad again, no they're good, no bad and so on) have led to a significant amount of apathy on the part of John Q. Public and if John doesn't really care about it then the politicians aren't going to pretend to care either.

SFC W

[AdamG]

London (AFP) - Fears that the west African Ebola outbreak could spread to other continents grew with European and Asian countries on alert and a leading medical charity warning the epidemic was out of control.

Doctors Without Borders (MSF) said the crisis gripping Guinea, Liberia and Sierra Leone would only get worse and warned there was no overarching strategy to handle the world's worst outbreak of the disease.

US Christian charity Samaritan's Purse was temporarily withdrawing its non-essential staff from Liberia, it said, citing regional "instability and ongoing security issues".

Hong Kong announced quarantine measures for suspected cases, although one woman arriving from Africa with possible symptoms tested negative, while the EU said it was ready to deal with the threat.

The International Civil Aviation Organization (ICAO) has held talks with global health officials on potential measures to halt the spread of the disease.

http://news.yahoo.com/uk-holds-emerg...084704564.html

[SWJ Blog]

Beating Ebola From The Sea

Entry Excerpt:



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[SWJ Blog]

Ebola and the African Responsibility

Entry Excerpt:



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[AdamG]

Spinoff of the now-locked 2008 thread (http://council.smallwarsjournal.com/...hlight=disease), with a new plot twist for planning ops.

Epidemic transmission of Zika virus (ZIKV) has rapidly occurred in the Americas, with most cases limited to mild or asymptomatic disease.1,2 To date, nine deaths from ZIKV infection that were unrelated to the Guillain–Barré syndrome have been confirmed in adults.1 Here, we report a rapidly progressive, fatal ZIKV infection acquired outside the United States and secondary local transmission in the absence of known risk factors for ZIKV infection.

http://www.nejm.org/doi/full/10.1056...featured_home&

[AdamG]

Although the Ebola and Zika outbreaks in the United States never reached the catastrophic heights projected by some public health experts, these crises demonstrated that the United States is not immune to potentially devastating pandemic events threatening the health and security of the nation.
#
However, major gaps in the pandemic preparedness efforts of the Department of Homeland Security (DHS), one of the primary agencies leading the nation’s public health preparedness efforts, leave the United States unprepared for a pandemic event, according to a recent audit by the DHS Office of the#Inspector General (OIG).
#
Specifically, DHS OIG said the Department does not always provide clear guidance or sufficient oversight of component’s pandemic plans, implementation of pandemic readiness training, completion of reporting requirements and identification of the personal protective equipment and supplies needed for a pandemic response.

http://www.hstoday.us/industry-news/...445f9841a.html

[AdamG]

It’s estimated around 700,000 people die each year because of drug-resistant infections.
The UN Secretary General calls it a “fundamental threat” to global health and security. And a special meeting of the UN General Assembly was recently held to address the issue.
On current trends, the death-toll is expected to rise to around 10 million per year by 2050 unless more is done.#
So how prepared are we for future pandemics? And what measures are being undertaken to ensure we win what Mark Balskovich from the Centre for Superbug Solutions calls an “arms race” with bacteria?

http://www.abc.net.au/radionational/...ndemic/7959344

What should companies do to protect its workers and the surrounding community from a pandemic? NIOSH's Lisa Delaney spoke to 2016 National Safety Congress attendees about emergency preparedness.

http://ehstoday.com/health/nsc-2016-...ou-be-prepared

[AdamG]

Separate thread for max visibility, then Dave can reposition as appropriate.

Anyone with half-a-functioning imagination can see where this problem could be exploited by the Bad People for asymmetrical purposes.

yesterday afternoon, the CDC also released a report about a Nevada woman who died after an infection resistant to 26 antibiotics, which is to say all available antibiotics in the U.S. The woman, who was in her 70s, had been previously hospitalized in India after fracturing her leg, which led to an infection of the bone. There was nothing to treat her infection—not colistin, not other last-line antibiotics. Scientists later tested the bacteria that killed her, and found it was somewhat susceptible to fosfomycin, but that antibiotic is not approved in the U.S. to treat her type of infection

https://www.theatlantic.com/health/a...50/#pt0-840044

[davidbfpo]

From an unheard of website via Twitter, a report that opens with:

Despite recent headlines declaring the success of an experimental Ebola vaccine, the world is not fully prepared for future epidemics — and not in position to use vaccines to prevent another deadly outbreak, a report published Tuesday warned.

Link:https://www.statnews.com/2017/01/17/...ccine-warning/

[AdamG]

They are called superspreaders, the minority of people who are responsible for infecting many others during epidemics of infectious diseases. Perhaps the most famous superspreader was Typhoid Mary, presumed to have infected 51 people, three of whom died, between 1900 and 1907.

https://www.washingtonpost.com/news/...=.27e12c5295da

Applicable advice -> https://youtu.be/vtSmfws0_To

[AdamG]

Tourists with more discretionary income and hubris than brains. Yay.

"Visiting beautiful places like this inspires people to protect tropical ecosystems and the species that live here," Olival says. "At the same time, we need to recognize that there may be potential health risks when people and wildlife come together, and that's why we're working to understand and limit those risks."

"We found 48 new viruses in the surrounding forest," Olival says, "including a virus related to SARS in bats that roost in the cave."

http://www.npr.org/sections/goatsand...g-on-your-head