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

[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