a citizen’s journal by Thomas Nephew

Take and calm down

Posted by Thomas Nephew on 27th April 2009

Via, Dr. Joe Bresee is my favorite kind of swine flu expert — nice and boring and unexcited.

From the transcript:

There is no vaccine available right now to protect against swine flu. However, there are everyday actions that people can take to help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Try to avoid close contact with sick people. If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
  • Avoid touching your eyes, nose, or mouth because germs can spread that way.

As of today, there have been 40 laboratory-confirmed swine flu (H1N1) cases reported in the United States, including 28 in New York City.  There’s an “Emergency Warning Signs” listing on the CDC’s “Taking Care of Yourself: What to Do if You Get Sick with Flu” page.  Seek emergency medical care if someone fits any of the descriptions below:

In children, emergency warning signs that need urgent medical attention include:

  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting

If things get worse with the swine flu situation, and you or someone you know gets sick, there’s apparently not really much a hospital can do that you can’t (unless it’s one of the above emergencies).  Re treatments, the CDC is currently recommending oseltamivir (a.k.a TAMIFLU) or zanamivir (a.k.a. Relenza) for the “treatment and, alternatively, prevention of infection with these swine flu viruses,” but the main thing appears to be rest and fluids.  The CDC has a useful “Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home” reference page.

A while back I ran across this “flu kit” list (via Jim MacDonald, “Making Light”; see also today’s “Flu Redux“), that was developed in case a flu outbreak turns more serious and the health system becomes overwhelmed. The list runs on to 21 items, here are the top 10 (well, 11) you ought to have ample supplies of (for each member of your household):

1. pain and fever reducer of your choice — ibuprofen is generally well-tolerated, while aspirin is more likely to cause stomach upset
2. decongestant (pseudoephedrine-based)
3. antihistamine (like Bendadryl — in case you get some whacked-out allergic reaction while your immune system is in a tizzy)
4. cough suppressant
5. cough expectorant
6. long-keeping juices, clear soups/consommes
7. easily-digestible, easily-prepared, long-keeping staple foods (you’d be surprised how good Cream of Rice can taste)
8. bottled water
9. a basic clean-up kit for infectious spills/vomit, etc.: bleach, a few sponges, some small plastic bin liners, a roll or two of paper towels, and a small bucket (in fact, everything may fit inside the bucket, how convenient!)
10. plain old table salt (to mix with water to help keep your electrolytes up)
11. plain old table sugar (see above)

Let’s assume this won’t get worse — but calmly get ready for that anyway.

EDIT, 4/28: clarification re what hospitals can and can’t help much with.

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Specialty blogwatch

Posted by Thomas Nephew on 20th October 2005

This is just a quick survey of recent posts from some of the interesting, specialized blogs I read now and then from my “specialty” blogroll — maybe you’ll start reading one or the other of them, too.

Schneier on Security — Those tiny little yellow dots you never noticed? They’re Secret Forensic Codes in Color Laser Printers: Many color laser printers embed secret information in every page they print, basically to identify you by. Here, the EFF has cracked the code of the Xerox DocuColor series of printers.

Mystery PollsterGetting Past the Noise: Bush Slide Continues (10/19/2005): The bottom line: the President’s approval has fallen all year, declining about 1% every month since January. But since August we’ve seen a sharper drop. Call it the “Katrina effect.”

Lunar DevelopmentShall McArthur return?: “Russia has met all the engagements on transferring NASA employees to the ISS. Formally, we even do not have to return McArthur to the Earth,” Russia’s space agency Roskosmos senior official Alexey Krasnov said.[] Karen Cramer writes that the story is connected to the Iran Non-proliferation Agreement as well.

Savage Minds — No more “Bushmen of the Kalahari.” Bushmen expelled from Homeland: All but a few of the Bushmen living in Botswana’s Central Kalahari Game Reserve have been forcibly removed from their homes in recent days in what spokesmen for the affected communities said is a final push by the government to end human habitation there after tens of thousands of years. [Washington Post, 10/10/2005] … Before forced removals started in the late 90s, there were over 2,000 Bushmen living there.

The Panda’s Thumb — Covering the “intelligent design” case in Pennsylvania with Waterloo in Dover: The Kitzmiller v. DASD case: The defense needs to defeat the plaintiffs’ arguments concerning both the purpose and the effect of the “intelligent design” policy. For the second, they are most likely to try to convince Judge Jones that “intelligent design”, and specifically the policy adopted by the DASD, are scientific in character, and thus have a place in the science curriculum regardless of any secondary effect they might have in the way of having implications for religious belief. DASD is the Dover Area School District, which is trying to enforce ‘intelligent design’ teaching in biology classes. The post is now updated with new developments every couple of days or so as the case proceeds.

RealClimateGlobal Warming On Earth discusses the latest NASA Goddard Institute surface temperature data analysis: The 2005 Jan-Sep land data (which is adjusted for urban biases) is higher than the previously warmest year (0.76°C compared to the 1998 anomaly of 0.75°C for the same months, and a 0.71°C anomaly for the whole year) , while the land-ocean temperature index (which includes sea surface temperature data) is trailing slightly behind (0.58°C compared to 0.60°C Jan-Sep, 0.56°C for the whole of 1998).

Chris Mooney — Henry Waxman (D-CA-30) is Busy, busy on a number of Bush vs. science fronts, including avian flu, misinformation about sexual health on a government web site, and the ongoing Plan B “morning after pill” fiasco at the FDA. On the latter: The chronology ends with yet another resignation: that of Frank Davidoff, a former FDA advisory committee member who voted for the approval of Plan B and who wrote, “I can no longer associate myself with an organization that is capable of making such an important decision so flagrantly on the basis of political influence, rather than the scientific and clinical evidence.” (link added)

BlogrelReturn to Gyumri: What lessons could Pakistan learn from Armenia’s sputtering reconstruction process, which, 17 years later, has 3,500 families in the city still living in “temporary accommodation” – a euphemism for shacks, metal containers and disused railway wagons? [Guardian]

Effect MeasureYou can’t stop a wrecking ball in mid-swing: As state and local health departments gear up to battle a possible avian flu outbreak, they face a sharp cut in funding from the Department of Health and Human Services. However, the loss could be fixed through funds intended to cover the costs of controlling a pandemic, added as an amendment to the 2006 Defense Department Appropriations bill.

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Ellen Sauerbrey? Mike Brown II

Posted by Thomas Nephew on 3rd October 2005

Unnoticed amidst the Katrina furor, Bush has nominated yet another unqualified political hack to head a key relief agency. Still, I’m excited — because this time the hack hails from my adopted home state of Maryland! On August 31, Bush nominated former State Delegate and 2000 Bush Maryland campaign chief Ellen Sauerbrey to be Assistant Secretary of State for Population, Refugees and Migration.

Population Action International writes:

In her current role as the U.S. Ambassador to the United Nations Commission on the Status of Women […] Sauerbrey has led U.S. efforts to rewrite international consensus agreements that promote women’s reproductive health and freedom. Demonstrating a clear priority of politics over the needs and rights of women, she has championed President Bush’s scientifically unproven ‘abstinence-only’ policies in place of successful and comprehensive HIV-prevention and family planning programs.

The L.A. Times’ Ken Silverstein notes:

Although appointing political allies to government jobs is a tradition in Washington, the refugee bureau is a complex agency with a broad portfolio. Past administrations, Republican and Democratic, have generally turned to someone with technical expertise to head it.

Sauerbrey, 68, was elected to the Maryland House of Delegates in 1978. She has been a conservative activist for decades but has no direct experience mobilizing responses to humanitarian emergencies.

Inexperienced, sure, but at least she’s innovative. During a failed bid for the governor’s office — and together with former Senator Alfonse D’Amato (R-NY) — she helped pioneer the so-called check swap technique to launder campaign donations through an ally’s political action committee. Like so much else these days, it apparently wasn’t strictly illegal — but it came so very, very close. Brava, Ellen!

Who knows, maybe there will even be some way for her to apply the experience to refugee questions — Pentagon money in, “refugee” personnel out, refugee money in, Halliburton profits out. Regardless, I’m confident Sauerbrey will work out fine in her new position — as far as her boss is concerned.

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The next 9/11: still not ready

Posted by Thomas Nephew on 11th September 2005

The Washington Post’s Sari Horwitz and Christian Davenport report (“Terrorism Could Hurl D.C. Area Into Turmoil: Despite Efforts Since 9/11, Response Plans Incomplete”):

On the fourth anniversary of the Sept. 11 attacks, the nation’s capital lacks a comprehensive way to tell people what to do in a state of emergency, especially a terrorist attack with no warning, according to law enforcement and Homeland Security officials involved in emergency preparations.

“What we lack is a coordinated public information system in the event of a major incident,” said David Snyder, a member of the Metropolitan Washington Council of Governments’ homeland security task force. “What we need is a system that will function instantaneously and automatically every time. . . . That doesn’t exist now.”

Local leaders are taking note of the bungled Katrina response:

“For four years, we’ve been hearing from the feds that they are going to take charge so we can respond to any catastrophe that comes our way,” said Montgomery County Executive Douglas M. Duncan (D). “And here’s the first major test, and it’s a failure. . . . I’ve lost confidence in [the Federal Emergency Management Agency] to come in and be part of the solution.

“We’ve got to take all the plans that relied on the federal government and throw them out and start over again,” Duncan said.

Local emergency responses to what turned out to be false alarms have not helped build confidence, either. While the nation’s attention was captured by the helter-skelter response to hapless pilots flying into the restricted airspace, there have been more serious lapses. For instance, an anthrax scare in March resulted in hundreds of Pentagon employees receiving antibiotics — yet no local health authorities were informed. If the attack had been real, many people would have died who might have been saved, given the rapid progression of the disease.

The article points out that for some kinds of emergency, the best option may be to “shelter in place” — not try to evacuate, but stay where you are.

But some local leaders are worried that the notion of staying put goes so strongly against human nature that in an emergency, people would flee no matter what they were told — especially after seeing how long it took to get help to the disadvantaged in New Orleans.

“I think people will look at Katrina and think of 9/11 and think what you’re supposed to do in an event of an attack is to run,” [DC delegate Eleanor Holmes] Norton said. “And I think it’s a failure that that’s what people think. The best thing to do most of the time is to stay in place.”

No, no, no, no, no, Ms. Norton! Get with the program! The best thing to do will be whatever “Drownie” and his FEMA flunkies decide is the best p.r. move for Master.

UPDATE, 9/11: How FEMA delivered Florida for Bush, by Charles Mahtesian,, 11/03/2004:”Seldom has any federal agency had the opportunity to so directly and uniquely alter the course of a presidential election, and seldom has any agency delivered for a president as FEMA did in Florida this fall.” Via digby. Nice to know they can deliver when it really counts.

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HIV/AIDS lends SARS resistance?

Posted by Thomas Nephew on 1st May 2003

Laurie Garrett, of Newsday, reports:

…Guangzhou authorities divided the floor of People’s Hospital No. 8 in half, putting SARS patients on one side of the elevator bank, and AIDS patients on the other. Health care workers walked back and forth between the two sides of the floor, and some of those doctors and nurses contracted SARS.

Yet not one of the several dozen AIDS patients or their visitors, some of whom were also HIV positive, developed the disease. […]

Some scientists speculate that the virus doesn’t actually kill human cells — that the immune system’s overreaction actually precipitates the destruction of cells of the lung and other parts of the body, precipitating the acute pneumonia that is the disease’ hallmark. In theory, they say, death may be the result of an aberrant or overly sensitive immune response. If that is proved correct, it’s possible that HIV patients may actually be at lower risk for SARS precisely because they lack strong immune responses.

This is only speculation, of course, but the notion is garnering interest among physicians here. An added bit of evidence supports the theory: The most effective SARS treatment so far is steroids — agents that stifle the immune response.

In other news

…I could hardly believe my eyes: the WHO estimates that 3000 African children die each day from malaria. That’s over a million children per year.

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Anthrax reconsidered: WQMED, part II

Posted by Thomas Nephew on 22nd March 2003

WQMED — “weapons of quite massive enough destruction” — is just a term I coined in response to arguments, by writers like Gregg Easterbrook and Jim Henley, that biological and chemical weapons are not capable of causing mass casualties on a nuclear scale, nor even appreciably more than a “9/11” scale attack. I’ve never quite understood that point of view, especially in the case of anthrax. The fall 2001 anthrax terror-by-mail seemed to suggest more about the limited resources of the killer (or killers) rather than about what to expect if such killers had more significant quantities of the stuff.

On Monday, the Washington Post reports on new findings that anthrax could be a very deadly mass killer indeed. Lawrence Wein and colleagues at the Stanford School of Business modeled the release of two pounds of anthrax spores from 325 feet (that’s what, a 30 story building or so?) over a city of about 11 million with a suburban population of about 700,000. In their article in the Proceedings of the National Academy of Sciences (PNAS)*, Wein et al estimate that about 123,000 would die because of the extremely rapid progression of the disease and the sheer difficulty in distributing Cipro medication quickly enough — especially as symptomatic cases pile up and overwhelm hospitals. Even if Cipro were already stored on location, as many as 60,000 would die.

The study makes practical recommendations. From a “Healthscout” report on the same findings:

Wein is critical of the federal government’s establishment of a “Bio-Watch” surveillance system, with sensors designed to pick up signs of airborne anthrax as early as possible. Money for that system would be better spent on distributing packages of Cipro and other antibiotics to the public and hospitals, to be used only if an attack occurs, Wein contends

From Wein’s own comments at the Stanford Monday press conference, these conclusions:

(1) the person in charge needs to put the intervention process in motion as soon as the first case is diagnosed,

(2) prophylactic antibiotics need to distributed as rapidly as possible to everyone in the affected region,

(3) the affected population requires aggressive education about the importance of adhering to the full course of treatment, and

(4) we need to quickly create a surge in our capacity to aggressively treat the symptomatic patients.

I assume Tom Ridge got all that, that last part sounds familiar…. Wein is an applied mathematician who used operations research methods — a key business technique — and observations from a variety of real world sources, including the fall 2001 anthrax attacks, to arrive at his results.

Now, smart people making models are still just that. And getting two pounds of suitably milled anthrax is probably no snap — and one potential source for the stuff is going out of business as we speak. But these findings serve fair warning, and merit at least the same attention as writings by journalists and bloggers on the subject.


* UPDATE 6/10/03: I went back for the PNAS link (Acrobat), not available at the time. To read and download the article costs you $5. For some of the upshot, see my comments on a post by the estimable Patrick Nielsen Hayden.

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End times news you can use (TM): West Nile virus risk map

Posted by Thomas Nephew on 9th October 2002

Via NASA’s Public Health Applications Program and the “Earth Observatory” web site :

State health departments, in cooperation with the CDC, have kept record of infected birds over the past four years. Scientists and health officials have combined disease control data and satellite data to determine areas at risk for West Nile Virus. This is a sample risk map. …

Researchers with INTREPID (International Research Partnership for Infectious Diseases) have been developing information products and databases derived from satellite data to show nationwide temperatures, distributions of vegetation, bird migration routes, and areas pinpointing reported cases. The combined data help scientists predict disease outbreaks by showing when and where habitats are suitable for the insects to thrive and where the disease appears to be spreading.

Empty circles are uninfected crows, dark circles are infected ones, gray means no data, green-to-red scale denotes increasing risk. A full U.S. map is here, with additional discussion here.

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Public health for the common defense

Posted by Thomas Nephew on 28th December 2001

Yesterday and today, Jeff Jarvis has been listing a number of homeland defense recommendations for Tom Ridge to consider. Of all of them, the ones I think would reassure me the most would be the public health related items, such as getting information about new disease threats and diagnoses out pronto,. Foremost among the public health measures should be to have plans and infrastructure capable of handling surges of new patients. Look up “patient surge” and “smallpox” on Google, and you’ll find articles like this one by Monica Schoch-Spana, Ph.D, in the March 2000 Biodefense Quarterly: “Hospitals Buckle During Normal Flu Season: Implications for Bioterrorism Response.” Dr. Schoch-Spana writes:

The prevalence of crowded emergency rooms and ambulance diversions around the country during the 1999-2000 influenza season might suggest that an unusually potent virus was at work, sending sick people to the hospital in droves. Epidemiological data, however, made it clear that the recent flu outbreaks were nothing more than the annual appearance of a familiar respiratory illness, only appearing earlier than expected.

That patients’ urgent demands outstripped the ability of many hospitals to respond with prompt and, in some cases, adequate care was less a result of the disease than underlying pathologies within the healthcare system. Beset with pressures to reduce costs and facing regional nursing shortages, hospitals today lack the flexibility to deal with even nominal upswings in demand, let alone the potential health crisis of a biological attack or pandemic influenza. […]

Influenza is an annually occurring outbreak of an infectious disease with comparatively low morbidity and mortality rates, and an active vaccine campaign. That it creates profound hardships for U.S. hospitals is worrisome from a bioterrorism preparedness perspective. Appraising the 1999-2000 flu season, the President of the Maryland Nurses Association, Mary Beachley, concludes, “If a major super bug hit, we’d be in trouble. Our response in the short-term would be okay, but long-term care with large numbers of critically ill patients [would] be a problem.” The efficiencies achieved through reduced bed capacity, staffing levels, and equipment ownership – survival strategies within a competitive health care industry – have left hospitals ill-equipped to deal with a mass casualty scenario.

There simply is no “give” in the current health care system, “no excess capacity or flexibility to handle things outside the norm, even the slightest blip,” according to Virginia Hastings, Director of Emergency Medical Services for Los Angeles County. Efforts to prepare the country for a potential bioterrorist attack must include a severe accounting of the present state of hospitals – namely the fiscal conditions that have fostered profound inelasticity.

Luckily, there’s a political model for fixing this I assume both fiscal conservatives and bleeding heart liberals can love: the Interstate highway system. That system, built on the public dime, was sold by Eisenhower as a military preparedness measure, to better allow tanks and other military hardware to be ferried hither and yon across these United States; many of the segments of that interstate system make little short-term economic sense, but as a whole, they ensured that military needs (however unlikely) for quick overland transport and relocation of heavy equipment could be met.

Likewise, I think we should consider a major public health initiative, that subsidizes and sponsors hospitals and hospital workers from doctors to nurses to paramedics, with the goal of higher preparedness for patient surges from bioterror attacks. Just as with some stretch of interstate highway in North Dakota or West Virginia, the beds and workers thus subsidized might not meet the strictly economic tests usually applied to a business proposition. But this isn’t just a business proposition; it’s providing for the common defense, against some of the plausible worst threats evil minds can conceive. We know those minds are at work. Let’s provide for some homeland defense — and not let the day-to-day benefits of a less precarious public health infrastructure bother us too much.

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