H5N1

Uganda: H1N1 a wake-up call

Via allAfrica.com, an editorial from The New Vision: Swine Flu Scare Should Be a Wake-Up Call. Excerpt:

The epidemic has hit at a critical time in the school calendar when schools are preparing for end of year exams. It should be noted that the examination period is sensitive and an epidemic of this nature might traumatise candidates and impact negatively on their performance. 

The district education office in the affected regions should arrange to have the candidates and all children reassured before they face their exams. The education and health ministries need to join hands with the district leaders to step up sensitisation at grass roots. 

Since schools interact closely with communities, control measures need to be collaborated in a manner that involves communities.

Swine flu is an enemy that must be fought jointly. Given the cross-border movements, it takes more than just sufficient resources to deal with a global pandemic. 

The education and health ministries should be commended for their effort at containing the spread of the swine flu virus. However, the ministries should be more proactive than reactive in handling epidemics of this nature in future.

US: The cost of closing schools

Via the Brookings Institution: H1N1 Containment: Economic Cost and Workforce Effects of School Closures. The full report is available for download on the Brookings website. Excerpt from the introduction:

School closure is an important component of U.S. pandemic flu mitigation strategy. The benefit is a reduction in epidemic severity through reduction in school-age contacts. 

However, school closure involves two types of cost. First is the direct economic impact of the worker absenteeism generated by school closures. Second, many of the relevant absentees will be health care workers themselves, which will adversely affect the delivery of vaccine and other emergency services. Neither of these costs has been estimated in detail for the United States. 

We offer detailed estimates, and improve on the methodologies thus far employed in the non-U.S. literature. We give estimates of both the direct economic and health care impacts for school closure durations of 2, 4, 8, and 12 weeks under a range of assumptions. 

We find that closing all schools in the U.S. for four weeks could cost between $10 and $47 billion dollars (0.1-0.3% of GDP) and lead to a reduction of 6% to 19% in key health care personnel. These should be considered conservative (i.e., low) economic estimates in that earnings rather than total compensation are used to calculate costs. 

We also provide per student costs, so regionally heterogeneous policies can be evaluated. These estimates permit the epidemiological benefits of school closure to be compared to the costs at multiple scales and over many durations.

What flu survivors can teach us

Via the Vancouver Sun: Canadian pharma seeks H1N1 flu victims for research. Excerpt:

A Canadian pharmaceutical company believes a treatment for the H1N1 flu could be hiding in the arteries of people who caught the bug and recovered. 

Winnipeg-based Cangene is looking for volunteers who contracted H1N1 earlier this year and recovered to donate blood for a study aimed a creating a new treatment. 

Dr. Anand Kumar, a Winnipeg doctor and intensive care unit attending physician for the Winnipeg Regional Health Authority, said he asked Cangene to look for a treatment after seeing 40 patients hooked to ventilators earlier this year and feeling helpless. 

"We had 40 people battling for their lives," Kumar said. "It would have been nice to have this treatment."

Makes excellent sense. I hope someone's been doing similar work with bird flu survivors.

Vaccination starts in South Australia

Via Australia's ABC News: Swine flu jabs begin. Excerpt:

SA Health says 400,000 swine flu vaccinations were made available for South Australians today. 

In a joint program between the Federal and State Governments, the swine flu vaccine has been distributed to more than 1000 medical providers across the state. 

South Australia's Chief Medical Officer, Paddy Phillips, says everyone over the age of 10 should have the shot. 

"In the next few weeks to month or so, the results for the studies in children nine and under will become available and I expect it will become available for them as well," he said. 

Professor Phillips says some pregnant women have been worried that the vaccine may be inappropriate for their unborn child. But he says pregnant women should have the shot. 

"The baby inside a pregnant woman is protected from the vaccine, it's the woman who's not protected if they don't have the vaccine and unfortunately influenza and H1N1 can be very serious in pregnant women," he said. 

Dr Katina D'Onise works for the Health Department and is also pregnant. She says she has confidence in the vaccine's ingredients. 

"I'm absolutely convinced that there's no risk to me or my baby," she said.

US business starts to get the message

Via Contractormag.com, an indication that business is starting to pay attention: H1N1 flu: Employers need to be proactive this flu season. Excerpt:

Plumbing and HVAC contractors need to be proactive and prepare for the possibility of labor shortages the H1N1 Flu, also called the Swine Flu, could cause during this flu season. 

SESCO Management Consultants is offering businesses proactive steps to follow, decreasing employee exposure to the H1N1 flu, and suggesting steps to take if employees do have the H1N1 flu. 

To prepare for possible labor shortages, businesses should plan ways for essential business functions to continue by assessing functions and the reliance that customers have on services or products. 

Businesses should also be prepared to change practices if needed to maintain critical operations and cross-train personnel to perform critical functions, so that the workplace is able to operate even if key employees are absent. 

Businesses also need to be prepared to allow employees to stay home to care for their children if schools and child care centers are closed. It is not recommended that parents bring their children to work. Encourage employees with children to anticipate these closures and to develop contingency plans for the care of their children.

Mexico: 4,000 H1N1 cases in 7 days

Via El Universal: En 7 días, 4 mil casos de influenza A H1N1. [In 7 days, 4,000 cases of H1N1] Excerpt, with my translation:

El rebrote de influenza A H1N1 que se presenta en el país afectó en la última semana a 4 mil personas para alcanzar un total de 31 mil 594 casos, de acuerdo con el reporte de la Secretaría de Salud. 

The resurgence of H1N1 in the country infected 4,000 persons in the last week, making a total of 31,594 cases, according to the Health Secretariat.

Las cifras totales registradas en el mes (9 mil 231 casos) fueron superiores a las del primer brote de abril y mayo, que ascendieron a 6 mil 878 casos. 

The total of confirmed cases in the month (9,231) was greater than in the first outbreak in April and May, which rose to 6,878 cases.

El número de muertes en lo que va de septiembre es de 32, para alcanzar un total de 231 desde que inició la emergencia sanitaria. En el corte correspondiente al 28 de septiembre, a la mayoría de los estados se les duplicó y cuadruplicó, en menos de un mes, el número de contagiados.

The number of deaths in September was 32, for a total of 231 since the health emergency began. As of September 28, most states saw the number of infections double and quadruple in less than one month.

When a pandemic comes, our courts need surge capacity

An opinion piece in today's Globe and Mail: When a pandemic comes, our courts need surge capacity. Excerpt (but read the whole thing):

In preparing a pandemic bedside triage protocol for H1N1, Hamilton Health Sciences has done what we should all do: hope for the best and prepare for the worst. 

This first Canadian protocol is a courageous attempt to set forth who should receive life-saving care if access becomes limited. Yet no matter how thoughtful the protocol, it could become subject to legal challenge at the height of a pandemic. Litigation by loved ones in an attempt to move a patient up the triage hierarchy could prove disastrous if the judiciary is not ready. 

Two recent legal cases have shown that the judiciary's response can create serious challenges to hospitals providing intensive care. 

In the case of Calgary's Zongwu Jin, in 2007, the family sued to ensure that intensive-care physicians would attempt resuscitation if their father required it. The physician believed it would put Mr. Jin, 66, in a persistent vegetative state. The Calgary court temporarily ruled in favour of the family, so he was kept in an ICU bed for four days, not because he needed it (he was ready for transfer to a less expensive bed) but because the court had granted a temporary order pending a full hearing. 

The point isn't that there was disagreement, but that the process of resolving the disagreement created other serious problems. Although four days is a brief time when measured by the ordinary workings of the legal system, hours count in a medical setting that operates around the clock, usually to capacity, even without an epidemic. 

The second case, also in 2007, had even more serious effects. It concerned Samuel Golubchuk, an 84-year-old Winnipeg man whose children sued in order to prevent physicians from removing his artificial ventilation and feeding. 

Despite a nurse's testimony that Mr. Golubchuk had 45 litres of excess fluid leaking from his body, the judge granted a temporary injunction requiring that Mr. Golubchuk continue to receive intensive care. More to the point, the court took two months to rule on the temporary injunction and scheduled the trial 10 months after the initial application. Mr. Golubchuk died four months before trial. No law was developed to guide future disputes. 

These two cases allocated the scarce medical resource of intensive care on legal procedural grounds: Pending a full hearing, the judgments sought to preserve the status quo. But in medicine, “the status quo” is an elusive concept. A delayed decision can be an actual decision. 

By ruling that Mr. Golubchuk should stay in the ICU for 10 months before a trial could begin, the court was actually deciding on overall management of the unit, and created a situation in which two intensive-care physicians quit. A decision that was ostensibly about one patient had definite, but unreported, effects on many other patients who were not represented in the initial hearing.

Canada: Public impact, no public access

An editorial in today's Globe and Mail: Public impact, no public access. Excerpt:

Canada is facing the H1N1 pandemic in an atmosphere of confusion and doubt, as a result of an unpublished study that no one else in the world has found persuasive. 

Yet the Canadian authors of the study and the unnamed journal they have written it for are citing the usual academic protocols as a reason for keeping the study from the public. Momentous decisions are being made, but the public is being denied access to the basis for those decisions. 

Public-health authorities in this country have not only read the study but responded to it, and the paper has not even been peer-reviewed yet. So it is safe to say the usual protocols are out the window, as they should be when the public's health may be at risk. 

The public should then be given access to the study, too. The public is of critical importance in any vaccination plan, but is being treated as if it should accept on trust, or faith, whatever public-health officials in each province decide for them. That is a recipe for failure. 

The study found that the seasonal flu vaccine may double the risk of catching H1N1. Most provinces have responded by altering their vaccination plans. They will not offer seasonal vaccine shots, or at least, not until January, when the first wave of swine flu is expected to have passed. New Brunswick, on the other hand, says it will give out seasonal flu shots as it always does. 

The decision of the provinces is certainly quick and bold. Whether it is the right decision is open to question. The paper has been shared around the world. It has gone to the World Health Organization, the European Centre for Disease Prevention and Control, the U.S. Centers for Disease Control and Prevention in Atlanta, and British and Australian authorities. None of them has chosen to act on it. (Some scientists abroad have dubbed it "the Canada problem.") 

So who is right? At the moment it is impossible for Canadians to judge.

Egypt: Private schools to fight flu with doctors, e-learning

Via Al-Masry Al-Youm: Private schools to fight flu with doctors, e-learning. Excerpt:

The owners of private schools are developing their own measures to prevent the spread of swine flu when the academic year resumes on 3 October. 

Possible courses of action include shortening the school week, employing “E-learning," recruiting parent volunteers, and sanitizing buses and classrooms. 

School officials may also acquire thermometers and perfumed handkerchiefs to help fight the spread of the disease. They are also developing a plan in case the virus continues to spread. 

Officials are developing these plans in the wake of a swine flu outbreak at a private school in Alexandria. The Alexandria outbreak caused a sense of horror among parents in Cairo, especially those who spend lavishly on their children’s educations. 

Ahmed Ragaei Attiya, the manager of a private school, says the first measure at his institution will be improving sanitization. He plans to purchase atomizers to sanitize classrooms and school buses. 

The number of students inside the classroom, which usually stands at around 24 students, will be scaled down, he says. He will also compel teachers to wear protection masks and encourage the students to do the same.

Swine flu claims first casualty in Bulgaria

Via the Sofia Echo: Swine flu claims first casualty in Bulgaria. Excerpt:

Bulgaria's Healthcare Ministry confirmed on September 30 2009 the first fatality related to the H1N1 strain in the country. 

The 30-year old male has died in Lozenets hospital. He was diagnosed with the first symptoms on September 19 in the town of Samokov and was hospitalised on September 23 in a local hospital. He was transferred to Lozenets Hospital in Sofia on September 25. 

The deceased has been in close contact with five other individuals, of which one has been positively diagnosed as a carrier of the H1N1 strain and has been hospitalised in the St Anna Hospital. 

The other four have not displayed any symptoms whatsoever, but continue to remain under surveillance, Dnevnik daily has reported.