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If a flu epidemic hit Boston
By david_yamada on Sat, 04/25/2009 - 10:24am
I know that to some this post will be alarmist, even silly, and -- thankfully at this juncture -- unrelated to Boston, but the flu outbreak in Mexico that shows signs of spreading into the Western and Southwestern states has grabbed my attention.
If you haven't caught the news: boston.com...mexico_struggles_to_contain_swine_flu_outbreak/
Among my fears is this: Despite all the advance notice we've had of what a flu epidemic could do to large populations, does Boston have an effective public health response or protocol in place?
I'm sure the CDC folks right now are alarmed, wondering if this is the Big One that many have predicted for some time now.
An outbreak can occur anywhere. It did in Boston, which was a hot spot for the 1918 flu pandemic: www.pbs.org/wgbh/amex/influenza/sfeature/boston.html. Granted, back then the city was more of a port of call than it is today, but with modern air travel no location is immune.
I hope this post is purely hypothetical. However, I'm not sanguine about the city's ability to engage in crisis prevention and a response, ranging from the insipidness of the "see something, say something" campaign to inadequate training & planning that contributed to the Victoria Snelgrove death at the hands of the Boston P.D. after the Red Sox won the Series. Perhaps I'm connecting dots that shouldn't be connected, but I sometimes fear that this city just doesn't take effective crisis planning as seriously as it should.
I'd be curious if any readers are aware of what the public health response would be in a situation like this one.
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Comments
Doom.
Doom.
Boston hospital learns uncomfortable pandemic lessons
Role-playing a pandemic at NEMC.
The Great Influenza of 1918 in Boston.
Boston Public Health Commission.
David I bet if you called them they could answer 999 of your 1000 possible questions and you would probably be satisified with their answers.
good suggestion
Pete, for now I simply went to the BPHC website and found this:
http://www.bphc.org/programs/infectiousdisease/inf...
BPHC
www.bphc.org/programs/program.asp?b=3&p=200
Swine flu updates
http://www.newfluwiki2.com
http://twitter.com/cdcemergency
World Health Organization weighing in
http://news.yahoo.com/s/ap/un_un_mexico_swine_flu:
"An outbreak of swine flu in Mexico and the United States is a quickly evolving situation that has "pandemic potential," the head of the World Health Organization said Saturday before an emergency meeting of flu experts."
City has been working on this for years
First under John Auerbach, who is now the state's Public Health Commissioner, and now Barbara Ferrer. Quite a bit of planning has gone on with the hospitals (of which we have an embarassment of riches compared to other cities), neighborhood groups, and major employers.
Good news, scary speculation
I'm glad to read comments indicating that public health officials have been playing out these scenarios. Hopefully that planning would make a big difference if and when.
It struck me how seemingly unrelated circumstances could affect a situation like this (heaven forbid). For example, does the recession mean that more people will feel pressured to show up to work sick, thereby increasing the likelihood that someone with early flu symptoms will infect co-workers?
When I started reading into this during the morning, I quickly thought of the woman on the Orange Line yesterday who was sitting a few seats away and coughing uncontrollably, though fortunately into her hands and tissues. But I found myself getting up and moving towards the doors a few stops early...
(I know I'm sounding like an overreacting germ-phobe -- I assure you that I'm not!)
T overcrowding woes solved? :)
If cases turn up in Boston, the paranoid, and perhaps the sensible, will shun mass transit.
Confirmation of my hermit lifestyle
I was doing just fine until I met somebody for an interview the other day. Now I have the Asian Death Cold. Coincidence? I think I'll just start a vegetable garden out back and read up on squirrel recipes.
New Year's Resolution
Bike to work and back much more often when the weather clears.
Fear is a great motivator to avoid the sardine can Orange Line and the packed-as-a-pack-of-gum Big Red. I know I should ride more for my health, but I think my commitment to bike every day has just found new purpose!
Cure!
I just found some mold growing on the bacon in my fridge, so I'm hoping to isolate some swine penicillin in time to save us all. I'll check back in a week with my results.
Well, I won't get it
It's only attacking healthy people and I have a cold, so I'm protected, right? :-).
Actually, the fact that healthy people are dying is Not Good. It's what happened in 1918 and what it might mean is that people's immune systems essentially go into overdrive, produce way too many deadly chemicals and destroy their lungs.
More here.
One Problem
Viruses are resistant to penicillin - antibiotics kill bacterial infections.
Now, if people are dying from secondary bacterial infections, you may have something there in your fridge. If they are dying from Acute Respiratory Distress Syndrome (ARDS), where the immune system is tricked into obliterating the small air sacs in the lungs by the virus (a simplified explanation of what happened to healthy young people in 1918), penicillin won't help.
It might help keep someone alive if they actually have life support long enough to recover ... but that will be a scarce resource in an epidemic.
Yep
Just being completely foolish. Not trying to be accurate at all. Correct science however.
Looks like it's a lot closer to us
As Mexico hunkers down, 2 cases found in Kansas and 8 likely in NYC.
Health Department Testing Finds Probable Cases of Swine Influenza in Students at a Non-Public School in Queens.
Finally!
Nothing like a pandemic to help us forget we're losing our jobs. :)
A cure for epizootic-induced delirium
maple walnut cone at the Ice Creamsmith in Lower Mills, followed by G&T in the backyard.
Alternatively: Drink more beer. The alcohol kills germs and reduces your desire to go outside, but it increases your desire for close contact.
Nine-teen Eight-teen
Sorry - somebody had to do it.
Had the 1918 World Series been held as late in the year as it is now, who would have won?
The Flu.
By mid-October, school was canceled throughout the region and large gatherings were prohibited. Any such large gathering as a World Series game would most certainly been postponed or cancelled.
-------------------------
My employer recently moved from the Navy Yard. Soon after I started work, I had dreams about cots with sick people crammed into the rooms and offices of my work space, with gas lights and nurses in turn of the century clothing and masks bustling around our filing cabinets and desks.
I soon after realized that I was superimposing the current configuration of the space with photos of that same space during the epidemic in 1918. The epidemic simultaneously burst out from the Naval Ship Yards in Baltimore and Boston as fall approached, and spread from there.
Once a virus is isolated, it takes about six months to produce vaccine. We can only hope that this virus, if it gets bad enough to create havoc outside of the usual flu season, is enough related to some other virus that has been in a recent vaccination that many people will have partial immunity to it.
When does the Tamiflu hoarding start?
Or riots ...
Already?
I just now went to the Walgreens to get various common household killer flu pandemic items.
I could not find any portable hand sanitizer, when about a week ago they had a freestanding retail display of it right as you walked in.
They still had surgical masks in stock, but I still have a few of those on hand, so I decided to wait and see if they go on Spring Fever Sale.
Superstitious Purchases
The problem is, none of these has been shown to be effective against airborne viral transmission. The masks may keep you from sneezing on somebody else, but they are no where near fine enough to catch viral particles. You would need a very very fine filter and a pump to push air through it because it would be too hard to breathe otherwise.
Hand sanitizer may kill viruses on your hands - or may not - but they won't keep viral particles from flying through the air and into your lungs. It is a grand mythology of science that dirty doorknobs transmit influenza*. There is a growing body of research, as well as numerous statistical analyses of probable transmission patterns that say otherwise. Then there are the studies of air transport epidemics where one flu case got on and seventy came off, the air was recirculated in a specific pattern, and people remained in their seats that suggest that airborne transmission of influenza through inhalation of viruses is the primary route of transmission.
Much of this "just common sense" stuff has never been adequately demonstrated to help in epidemic conditions - and there is good science that says it doesn't help much at all. We like to think that we can do something - and like to blame those who don't sport the latest sanitary style - but the reality is that these weapons are useless.
*the possible exception here would be day care situations, where it's all body fluids all over everything all the time.
All I got was...
...Ricola throat lozenges.
I'll be coughing up blood in soothing comfort when I go.
I hear you
I don't know if I should be more afraid because I know too much. Pallative measures are good, and handwashing doesn't hurt when it comes to not getting stomach bugs.
Until the results of this study are available (or I can bug my old boss for preprints), I think I'll just keep on getting as much fresh air as I can.
No identified cases in Mass. as of Saturday night
Channel 5 reports.
question on the science re flu
This flu strain is reported as a blend of human, bird, and pig viruses. Is this a normal kinda thing, biologically speaking, or is this blend some kind of a Frankenvirus?
oh no!
It's Beast of Royston Vasey Flu!
It's why so many flu strains come out of China
Swine, Avian and Human Flu, Understanding Flu.
China has lots of pigs and ducks and, obviously, people, all in pretty close proximity, so the viruses basically bounce among the three, happily sharing genetic material that helps them evade immune systems.
helpful -- thank you
Got it. I knew that two species could cook up a virus, but it never dawned on me that three could do so.
Very interesting to watch the news cycle on this story. It accelerated bigtime throughout yesterday, now it seems to be in attentive but not obsessive reporting mode -- with everyone waiting and watching for new outbreaks.
Mutations = Host Flexibility
The flu mutates a lot, and that gives it the ability to move around between different species of hosts.
Humans lived close to livestock throughout recent human history and still do in the developing world. It is very common from flu to travel from birds that live with humans (in their houses, quite often) to humans and even back again. This is also why the flu cycle travels from Asia, where large numbers of poultry and people live in close quarters, across the globe in regular cycles.
Swine add an odd spin because they have some features that are a lot like humans. It is less common for flu to travel to swine, mutate, and then go to humans but it isn't all that strange when you think about it. Swine flu can get bad because they can pop out of nowhere. Unusual, but known to happen and known to present higher risks of danger (although this may be because the types of flu that travel to swine are the ones that can become the most deadly in humans, rather than anything Mr. Pig specifically does to change the situation).
The 1918 strain may have traveled via birds and swine, and appears to have arisen in humans the winter before the big epidemic (starting out in the US Midwest, first with farmers and then with barracked soldiers there). It then traveled to Europe with departing soldiers, where it may have changed further such that it became highly virulent and lethal.
This strain is particularly unusual
Transcript of a press conference by Dr. Anne Schuchat of the CDC:
CDC
The CDC serves some great functions.
If I ever have kids, the toy box will have -- in addition to the requisite firefighter hat, police badge, and doctor's stethoscope -- a CDC... um... lab coat?, I guess. Clipboard? Spreadsheet?
The CDC has a merchandising problem.
Time for a TV show
A la Alias
Join our dashing, cynical, and hawt young biostatistician as she delves into the origin of the latest possibly humanity-destroying plague. Watch as her MANOVA explodes into coruscating blinky lights.
Al Gore was right!
He even identified Patient Zero!
It turns out "avian" really means "bear"! I'm being super serial!
ManBearPig is real
?
Flu outbreak maps
Map #1
Map #2