“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.
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.