Some people are more worried than others, we all respect the potential, (else there'd be no NPI mitigation strategy), and none of us know. That, in no way, stops people from being concerned about what happens next. We saw the video of a cat grabbing a dead chicken in the Indonesia poultry markets. But the current Indonesian situation does not change the thinking about where we are.
There is no imminent pandemic, as far as anyone can tell "The current situation does not indicate that the pandemic event has already started" was the prevailing sentiment
- Work being done at the Federal level is filtering down to the state level. The NPI (non-pharmaceutical intervention) mitigation strategy is one such example, but the investment in vaccine production and infrastructure is another.
- The questions about mask utilization for the population are on fast track and a document setting out policy, and what we know and what we don't, is to be forthcoming within months.
It's clear that there's two separate tracks here. One is vaccine development, the other is what happens if a pandemic happens prior to vaccine development and production capacity.
- The CDC NPI Mitigation Strategy was praised and critiqued.
The NPI mitigation strategy is an attempt to wrestle with the latter. It is a working paper. It is incomplete. It does not cover day care, which may have been off the radar and may be unwieldy to manage. BUT (and it's a big "but") it represents a sea change for this agency in that it represents a level of transparency and consultation that has not been seen before. This and projects like the vaccine prioritization project need to be given the attention they deserve, so that the consultation and public discussion gets the credit it deserves.
In the meantime, local and grassroots prep plans need to continue, not just in the US but everywhere. Examples of what companies and schools are starting to do were presented. The CDC will be sitting down with all the professional societies (I hope that includes nurses!) including the college folks to start to put together coherent and consistent plans.
Should a pandemic start today, it is not a pretty picture. Our surge capacity is non-existent (this is not new info, but it is better quantified now). A different standard of care would have to be accepted, but the regulations and mindset to allow that have not happened yet. And, re funding, most states can't afford to stockpile tamiflu (assuming it would work). That more Federal funds were needed to help the states was a point frequently made.
- Federal funding and Federal leadership remain a critical issue
Again, this a point made before, but H7, H9 and others need to be watched for as well. However, the response (assuming rapid testing identifies the novel virus) would be similar from a public health perspective.
- H5 is not the only candidate pandemic flu virus out there
In the end, the idea that a pandemic and seasonal flu are both vastly different and similar was one that was difficult to reconcile. If this is treated as a science problem with a science answer (i.e. vaccine), you are going to look at it a bit differently than if it's a public health problem or a business problem or a communications problem. It's all of the above, with both known unknowns and unknown unknowns. And the time frame (soon vs. 2 years vs 10 years) that you assume will also color your thinking.
While there were a handful of throw-away comments about panic, most of the attendees were very serious about the topic and treated all of the concerns raised respectfully. SusanC, Melanie and I all attended different sessions, so they have their own thoughts about the meeting. I will not discuss private conversations online, but they are consistent with what I am writing about here.
In the meantime, there are excellent news reports of the CDC conference here and here. But one splashy piece of news did get reported from Alexandria:
All health-care workers should be required to get a flu shot every year, unless they formally refuse in writing, the Infectious Diseases Society of America (IDSA) said today.
The society called on the federal government to plug what it called a "critical weakness" in the nation's influenza preparedness by ensuring health-care workers are protected.
"It's our professional duty to first do no harm," pronounced Andrew Pavia, M.D., chief of pediatric infectious diseases at the University of Utah and chair of the society's National and Global Public Health Committee.
"Voluntary systems haven't brought immunization rates up far enough," Dr. Pavia said, calling for a regimen with "more teeth in it."
"For the sake of our patients, all health-care workers must get a flu shot every year or they must be required to opt out in writing," Dr. Pavia said. He said fewer than 40% of health-care workers get an annual flu shot, although many are routinely exposed to the virus and therefore can spread it.
ISDA is the professional society for infectious disease docs in America, and there are many others for different specialties. This reflects greater involvement by the professional societies on the topic, and that can only help.
Your comments are most welcome, and I will try to answer questions today. Tomorrow, I'm off to Orlando for the next conference, this one with a business orientation.
Please be respectful of your fellow commenters and posters.