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I'll only leave this up on the Front Page for about a week. Comments are welcome.
In the afternoon of August 18, I had the opportunity to sit and talk for about an hour with the one person in my state who is probably more in tune with, and concerned about, Pandemic Influenza than anyone I've met off-line. I wish I could divulge his name and title, but he asked that I not do that, due to the politics involved here. But do rest assured that this person knows what he's talking about.
This coming November will be the 2nd live, all-state Pandemic Flu excercise. More on that in an upcoming Diary.
Imagine this scenario: at the main airport in your state, a young girl arrives from overseas. Maybe the plane is from Bangkok, or perhaps from Jakarta.
Wherever they are from, 5 passengers become ill with flu-like symptoms, and are taken to local hospitals. The hospital caring for the young girl announces that she has "the pandemic flu strain" that's being seen overseas.
You are the local health official, getting ready for a press conference in a few hours, and you've got limited amounts of time to convey your messages to an increasingly anxious public.
UPDATE: Tabletop with state and regional health care emergency managers yesterday, field exercise today (Saturday)
Ottilie W. Lundgren was 94 years old when she died of inhalational anthrax in 2001, the only Connecticut resident affected by the anthrax incidents of that year. How she got it and why she died remain a mystery to this day. In her memory, the state's newly acquired mobile field hospital (MFH) is now officially known as the Ottilie W. Lundgren Memorial Field Hospital.
Do you prefer the statistics about home foreclosures, or would you rather read reports about people losing their homes? Do you read the health care analysis diaries or case reports of disasters that hit the uninsured?
Both statistics and case reports tell a story, and they both impact decisions, but in very different ways. The same is true for stats about influenza and stories about children dying from influenza. Both scenarios were on display this week, both in Atlanta (CDC pandemic drill) and Hong Kong (seasonal influenza outbreak). Let's explore that a bit more.
The 7:30 am Director's briefing today:
US cases up to 304, with 32 deaths (11% CFR), with a fairly even distribution all age groups (i.e., not a predominantly pediatric disease). The virus is hitting predominantly migrant workers and homeless shelters, though there are are other at risk populations including nursing homes to be watched closely.
Interestingly, there's been a continuation of high CFR but a lower than expected attack rate, at least up until now. Schools are closing locally in a few isolated hard hit areas, but community mitigation is not yet the norm.
A 22-year-old Georgetown University swim team member just back from Indonesia eats dinner with his teammates but then develops a fever and doesn't accompany them to a meet in New York.
That is how a flu pandemic in the United States started.
It's now six days into the scenario, there are confirmed positive cases of H5N1 in 9 states as well as the District of Columbia, and the Navy has ships off of Guam with more cases.
In addition to the 276 US cases (27 deaths) there are at least nine other countries, but none with as many confirmed cases as the US. The 10-12% CFR is seen everywhere.
The virus appears to be closely related to or descended from clade 2.1 in Indonesia, and genetic analysis suggests sensitivity to oseltamivir and adamantanes, but it's still too early to know about clinical response to these drugs.
It's 7:30 am, and the CDC Director is conducting an executive briefing to fill knowledge gaps, and plan the day's activities.