Homeland Security Watch

News and analysis of critical issues in homeland security

August 26, 2009

H1N1 mitigation by process of elimination

Filed under: Biosecurity,Preparedness and Response — by Philip J. Palin on August 26, 2009

“This report is being read very carefully.”  That’s what John Brennan said about the PCAST’s H1N1 study released yesterday morning.  I assume you have already heard or seen the headlines full of worst-case numbers.

You, too, can give the 64-page document a close read. Here it is: Report to the President on US Preparations for 2009-H1N1 Influenza (a bit more than 2 megs).

After reading  I hope you can correct a couple of my key take-aways.  It was late (or actually, early) and I was grumpy while reading, so I probably missed something important. 

First, it is unlikely that a vaccine will be available early enough to be of much help.  And other means of medical mitigation are more case-based than population-based. Here’s a quote from the report,

The fall resurgence may well occur as early as September, with the beginning of the school term, and the peak infection may occur in mid-October. But significant availability of the 2009-H1N1 vaccine is currently projected to begin only in mid-October, with several additional weeks required until vaccinated individuals develop protective immunity. This potential mismatch in timing could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk of serious disease.

Second, the report’s authors seem conflicted regarding the principal means of non-medical mitigation. Another quick quote:

A key element in mitigating the spread of an epidemic is compliance with social distancing measures—for example, staying home from work or school or avoiding public gatherings such as concerts or sporting events when ill. However, compliance is unlikely when economic or other disincentives punish individuals for these behaviors. It is critical that appropriate Federal officials take the lead in identifying these disincentives and removing or minimizing them. Since immunizing large segments of the popula­tion likely cannot be completed before late November or early December, the use of social mitigation measures may represent the most effective means for reducing transmission of virus in the fall when it is spreading most efficiently.

Actually, that paragraph — by itself — seems stronger because it is taken out of context.  The tone of the whole report left me with a sense that support for aggressive social distancing is squishy. 

The reluctance I read between-the-lines may emerge from the PCAST’s entirely reasonable preference to impose a social distancing strategy only when and where there is clear empirical evidence for doing so. But as the report also notes, a key shortcoming in national preparedness for pandemic,

… is the lack of a rapid system for assembling detailed clinical data on severe cases that can provide a statistically adequate and continuously updated picture of risk groups and clinical course. Current systems rely on non-standardized reports from local health departments and on peer-reviewed case series, which are slow to become public.

Even if the existing disincentives to social distancing can be minimized in the next few weeks — which strikes me as less than likely — we don’t have a surveillance and reporting system sufficient to make fine-tuned strategic interventions.

So… where does that leave us? Interested in your take-aways.

 More background:

Press Secretary’s positioning of the PCAST report

President’s Council of Advisors on Science and Technology

Surveillance and studies during a pandemic (European Centre for Disease Prevention and Control)

Epidemiology of fatal cases associated with H1N1 (Eurosurveillance)

City has closed mind on closing schools (Juan Gonzalez, Daily News)

While written before the PCAST report was publicly available, this Washington Post indepth piece is relevant: Flu strategists see schools on the front line.

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4 Comments »

Comment by Peter J. Brown

August 26, 2009 @ 6:21 am

Here is US Dept. of Education-issued continuity guidance.

http://www.ed.gov/news/pressreleases/2009/08/08242009.html

Comment by William R. Cumming

August 26, 2009 @ 10:34 am

Well not sure what to call it but Japanese government has announced it will subsidize all flu ops by its hospital system.

Please bring Congress back Mr.President and get them doing what we pay them to do!

Conduct oversight to determine whether legislation is necessary. VACATIONS are not what is meant by “Social Distancing.” Just one example I would like to know of–has any Junior College in America postponed opening for flu social distancing? I pick on that level of education because CDC school guidance seems to be slow in adoption at that level. No “In loco parentis” left or ever was at that level.

Comment by Fighting for my kids

August 26, 2009 @ 5:43 pm

I spend aprox. 15 hours a day researching and I just found this letter yesturday, to have Obama rush production even faster using a different adjuvant (this would be the oil based, not FDA approved for humans cause it causes DEATH and only approved for ANIMAL USE in some countries) and have the pharm. companies label the H1N1 vaccine with “OWN RISK” it’s on page 35 of the letter. Alot of other thing to I hope you can find the time to read it. Link is:

http://www.whitehouse.gov/assets/documents/PCAST_H1N1_Report.pdf

Comment by Tom Russo

August 29, 2009 @ 4:06 am

You’re point is well taken regarding availability of vaccine and the arrival of H1N1. It will miss the early volley’s of swine flu attacks but among high-risk priority groups, should offer protection as the H1N1 virus builds momentum.

Of more concern is that this rosy report fails to address distribution of vaccine. Recommendations describe actions from “accelerate production” to enhance “surveillance and adverse events.” Public health manages a mere seven percent of the seasonal flu vaccine volume yet will be managing 100 percent of the pandemic vaccine distribution through the state departments of health. Public health lacks a logistic system to manage distribution nor are tested plans in place to get vaccine into the hands of providers to assist it with the fall vaccination campaign.

A 2004 GAO report exposed the limitation of the federal pandemic preparedness strategy that it failed to addressed distribution. As the nation wades into this national emergency, departments of health are scrambling to develop alternative methods to deploy vaccine to providers who can stick arms among high-risk priority groups. The private sector seasonal flu vaccine distribution system is sidelined during a national emergency and the report makes no mention of issues surrounding vaccine distribution from pharmaceutical manufacturers to front-line providers. It makes assumptions that a system is in place, yet this system’s workforce has been decimated in the last decade by 2/3 those traditionally charged with the task of public health vaccination.

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