The Jerusalem Post notes:
The US Centers for Disease Control and Prevention (CDC)
may have harmed the country's ability to track and detect the spread of
the CORVID-19 disease due to a series of missteps, including refusing
to use the tests recommended by the World Health Organization (WHO),
according to ProPublica. As
the virus began to spread, the CDC decided to start creating its own,
more complicated test instead of using the test guidelines provided by
the WHO. The test was made to check for a variety of different viruses.
When the test was sent to labs across the country, it didn't work and
falsely flagged the presence of other viruses in harmless samples. Until
Wednesday, the CDC and the Food and Drug Administration (FDA) only
allowed state labs to use the CDC's test. As a result, local officials
didn't carry out "surveillance tests" of hundreds of people in possible
hotspots, a crucial first step when coping with a possible outbreak....The delay in producing a working test could have devastating effects. If
the US has dodged the rapidly spreading outbreaks affecting some
countries, such as Iran and South Korea, then the impact should be
negligible. However, if the disease is currently circulating undetected
in communities across the country, then health official have missed a
valuable chance to lessen the harm caused by the disease.
A few days back it appears that the person in charge of this area at the CDC told the world that there would be a pandemic. Perhaps it is the same person responsible for the above observations. The very agency responsible for making certain this does not happen has apparently not only allowed it, it has possibly facilitated it. All hypothetical of course but somehow connecting the dots makes one wonder.
You cannot expect the President to take the lead on this since we have career professionals in charge, one would think. Again, you want these folks to run your health care?
Also why must we get this from foreign news sources?
Saturday, February 29, 2020
Mortality Rates
It will be interesting to see what the cable folks brew up.
Typhoid Mary?
Disease vectors are not always obvious. Rats, fleas, bacteria, people, water and the list goes on. Typhoid Mary is an interesting example. A carrier but not a victim. The difficult in a epidemic is to understand how the disease is transferred. It may not be linear and it may not be from one sick person to another.
As we understand immunology today, we should be able to determine if someone was exposed. There should be an antibody at the very least and testing for that antibody is well within the realm of our day to day abilities. However one wonder two things. In a residence with an outbreak, why not test everyone there or who has been there? Second, and yes this goes against all we know, is it possible for a carrier not to exhibit an immune response?
Like AIDS, perhaps this may add new light on our immune systems.
As we understand immunology today, we should be able to determine if someone was exposed. There should be an antibody at the very least and testing for that antibody is well within the realm of our day to day abilities. However one wonder two things. In a residence with an outbreak, why not test everyone there or who has been there? Second, and yes this goes against all we know, is it possible for a carrier not to exhibit an immune response?
Like AIDS, perhaps this may add new light on our immune systems.
Friday, February 28, 2020
Public Health
TB was and is highly contagious and quite often deadly. My other grandmother died of it at 27. Now grandmother Hattie went day after day to Sea View following standard protocols to prevent infection and over 12 years dealt with the then deadliest bacterial and viral diseases. The key, wash your hands, don't lean on things, and isolate patients. Medications were non-existent. Many patients survived.
The key was classic public health. People were educated. Facilities existed. Infected persons were quarantined and cared for. Public Health functioned. Regrettably today we do not have any real Public Health. The US Public Health Service, part of CDC, is a bureaucracy, no longer a working professional corps. We have a bloated and self important class of Government workers more worried about how their opinion will be accepted whereas a hundred years ago these people would be working. Managing the Public Health problems.
I guess we have gone backwards.
Blame the Middle Ages
The author contends, as usual without and basis in fact:
The medieval way, inherited from the era
of the Black Death, is brutal: Close the borders, quarantine the ships,
pen terrified citizens up inside their poisoned cities. For
the first time in more than a century, the world has chosen to confront
a new and terrifying virus with the iron fist instead of the latex
glove.
Nice turn of phrase but totally wrong. Just think of Boccaccio and his ten friends. They scooted out of Florence and traded war stories of a sort until the death stopped. Another contribution to Italian literature.
Yersinia pestis is the problem and the vector was dirty bodies. You see bathing and clean clothes were not de regur.
But alas, borders were not closed, cities were not locked down, and that is how the plague spread. Prague and King Charles managed to stay somewhat out of the fray since ships could not reach them and infected individuals usually died along the way.
Then this writer, who as most Times folks appears to have no handle on history or the facts in my opinion, states:
The White House, in defiance of recent American history, also opted to
go medieval by aggressive measures like barring entry to non-Americans
who were recently in China and advising Americans not to go to China or
South Korea.
Most likely this act did stop the transmission a bit. This was not defiance it was a prudent act. I shudder to think of what would have happened otherwise. Somehow folks seem to make this a political football, especially those who in my opinion and based upon what I assert are the facts seem to be clueless!
Thursday, February 27, 2020
Simple Math
Just an update on the flu stats from the CDC:
The above are the incidence and mortality rates. Roughly incidence, 2017-2018, is about 12% and that is with flu shots. The incidence without flu shots is difficult to assess give the data. The CDC says there were about 160 million shots of vaccine. Thus given a population of about 330 million, there are 170 million without and thus the infection rate is about 35%.
The mortality rate is:
Thus a 35% infection rate without vaccine is about 100 million, and a mortality rate say ten times influenza, which seems a stretch, means 1 million dead. Just as a side note, the NCI notes: In 2018, an estimated 1,735,350 new cases of cancer will be diagnosed in
the United States and 609,640 people will die from the disease.
That is about 17 times the flu and twice that of all cancer deaths. That is if it is transmitted as efficiently as the flu and it has as high a mortality rate as has been projected thus far.
The mortality rate is:
That is about 17 times the flu and twice that of all cancer deaths. That is if it is transmitted as efficiently as the flu and it has as high a mortality rate as has been projected thus far.
A Solution in the Waiting Room?
The Jerusalem Post reports:
A team of Israeli scientists are on the cusp of developing the first vaccine against coronavirus, according to Israel’s Minister of Science and Technology, Ofir Akunis. If all goes as planned, the vaccine could be ready within three weeks and available in 90 days.“Congratulations to MIGAL [The Galilee Research Institute] on this exciting breakthrough. I am confident that there will be further rapid progress, enabling us to provide a needed response to the grave global COVID-19 threat,” Akunis said, referring to the disease caused by the novel coronavirus.For the past four years, a team of MIGAL scientists has been developing a vaccine against infectious bronchitis virus (IBV), which causes a bronchial disease affecting poultry, and whose effectiveness has been proven in pre-clinical trials carried out at the Veterinary Institute.
Hopefully this pans out. Testing for FDA approval, however, still takes a year.
A team of Israeli scientists are on the cusp of developing the first vaccine against coronavirus, according to Israel’s Minister of Science and Technology, Ofir Akunis. If all goes as planned, the vaccine could be ready within three weeks and available in 90 days.“Congratulations to MIGAL [The Galilee Research Institute] on this exciting breakthrough. I am confident that there will be further rapid progress, enabling us to provide a needed response to the grave global COVID-19 threat,” Akunis said, referring to the disease caused by the novel coronavirus.For the past four years, a team of MIGAL scientists has been developing a vaccine against infectious bronchitis virus (IBV), which causes a bronchial disease affecting poultry, and whose effectiveness has been proven in pre-clinical trials carried out at the Veterinary Institute.
Hopefully this pans out. Testing for FDA approval, however, still takes a year.
Wednesday, February 26, 2020
Worth Reading in Full
Yesterday, some CDC employee gave a conference call which in my opinion has set firestorm of concern, for better or worse. It is suggested that one read the call in toto.
It begins:
The U.S. has been implementing an aggressive containment strategy that requires detecting, tracking, and isolating all cases. As much as possible and preventing more introduction of disease notably at points of entry. We’ve restricted travel into the United States while also issuing extensive travel advisories for countries currently experiencing community spread. Our travel notices are changing almost daily. We’ve also enacted the first quarantine of this scale in the U.S. And are supporting the state department and HHS in repatriating citizens from high-risk areas. We are doing this with the goal of slowing the introduction of this new virus into the U.S. And buying us more time to prepare. To date, our containment strategies have been largely successful. As a result, we have very few cases in the United States and no spread in the community.
Ok so far so good. Now in my opinion she jumps into the fire:
Now I’d like to talk through some examples of what community NPIs look like. These are practical measures that can help limit exposure by reducing exposure in community settings. Students in smaller groups or in a severe pandemic, closing schools and using internet-based teleschooling to continue education. For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options. On a larger scale, communities may need to modify, postpone, or cancel mass gatherings. Looking at how to increase telehealth services and delaying elective surgery. The implementation of environmental NPIs would require everyone to consistently clean frequently touched surfaces and objects at home, at school, at work, and at large gatherings. Local communities will need to look at which NPIs to implement and when based on how transmission and disease is and what can be done locally. This will require flexibility and adaptations as disease progresses and new information becomes available. Some of these measures are better than none. But the maximum benefit occurs when the elements are layered upon each other. Some community level interventions that may be most effective in reducing the spread of a new virus like school closures are also the most likely to be associated with unwanted consequences and further disruptions. Secondary consequences of some of these measures might include missed work and loss of income. I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe.
One would assume that these discussions would have had taken place with at least State and some local Health Care workers. They did 100 years ago with Influenza and TB. Yet we did not close down the US economy. In fact Wilson had us fight a War on top of it all. Also it was not that we did not know about infections. Read any Medical book from that time.
Now consider the following statement:
So in the short-term, it’s the clinician calls the health department. And either the health department already has the test kit themselves or if they don’t yet have it stood up, they send it to CDC. Our turnaround at CDC is within a day. There is a little bit of shipping time. But that’s the process. In terms of timing, I think at this point what I would say is we are working as fast as we can. We understand the frustration of our partners in the health care sector, in health departments.
An itsy bitsy bit of shipping time. How about getting the USPS involved, ya think? She continues:
So the answer to the first question is certainly, we’re considering what the spread of illness in other countries looks like and how it impacts the potential risk the Americans traveling abroad in those countries. Those conversations are going on as we speak. We obviously are working closely with the partners on those considerations. And when there is new information in terms of case definitions, we’ll definitely publicize that broadly. You know, as I said, we are still at the stage of containment, but we are already starting to plan for mitigation. And part of the mitigation planning is the participation of community spread in the united states. And as that happens, it would certainly dramatically impact how we’re considering who is on the case. As you can imagine, the symptoms of novel coronavirus look a lot like other viral respiratory diseases that are circulating this time of year. So it’s going to be difficult for clinicians to differentiate fully on the basis of those — solely on the basis of the symptoms. In terms of diagnostic tests, what I would say is we’re working closely with FDA on this.
So the tests are critical. So where are they? Also travel may have to be carefully restricted. How about Italy, nothing personal.She continues:
What I can say from my perspective is I’ve been at CDC for 25 years and that if you asked public health officials over the course of that time what they feared as an expectation, it was something exactly like this. And so the idea that we might have a pandemic of influenza or a pandemic of a respiratory viral infection is something that we’ve known about and have been planning and preparing for. That’s why we at CDC have been exercising with the state and local health departments. That’s why the whole of government exercise last year, that’s why we’ve invested so much on the foundation we are now responding. But that being said, we are never going to ever be able to be so completely prepared that we’re prepared for any inevitability. We always are going to find that diseases surprise us and that there was some consideration that is slightly different from what we planned for. So have we made a lot of progress in the 25 years I’ve been here? Yes. Are we better prepared today than we were 20 years ago? Yes. But are we completely prepared?
Cover all bets folks, no matter how much we spend it is never enough. Some in Congress see this as another sink hole to be filled with our tax dollars. Twenty five years and we do not seem to have an operational plan.
There are times one wonders just what the purpose of this was and by whom it was made. Needless to say there has been a great deal of speculation. The Messenger is often more important than the message. Perhaps there is a great mis-step here. We shall see.
It begins:
The U.S. has been implementing an aggressive containment strategy that requires detecting, tracking, and isolating all cases. As much as possible and preventing more introduction of disease notably at points of entry. We’ve restricted travel into the United States while also issuing extensive travel advisories for countries currently experiencing community spread. Our travel notices are changing almost daily. We’ve also enacted the first quarantine of this scale in the U.S. And are supporting the state department and HHS in repatriating citizens from high-risk areas. We are doing this with the goal of slowing the introduction of this new virus into the U.S. And buying us more time to prepare. To date, our containment strategies have been largely successful. As a result, we have very few cases in the United States and no spread in the community.
Ok so far so good. Now in my opinion she jumps into the fire:
Now I’d like to talk through some examples of what community NPIs look like. These are practical measures that can help limit exposure by reducing exposure in community settings. Students in smaller groups or in a severe pandemic, closing schools and using internet-based teleschooling to continue education. For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options. On a larger scale, communities may need to modify, postpone, or cancel mass gatherings. Looking at how to increase telehealth services and delaying elective surgery. The implementation of environmental NPIs would require everyone to consistently clean frequently touched surfaces and objects at home, at school, at work, and at large gatherings. Local communities will need to look at which NPIs to implement and when based on how transmission and disease is and what can be done locally. This will require flexibility and adaptations as disease progresses and new information becomes available. Some of these measures are better than none. But the maximum benefit occurs when the elements are layered upon each other. Some community level interventions that may be most effective in reducing the spread of a new virus like school closures are also the most likely to be associated with unwanted consequences and further disruptions. Secondary consequences of some of these measures might include missed work and loss of income. I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe.
One would assume that these discussions would have had taken place with at least State and some local Health Care workers. They did 100 years ago with Influenza and TB. Yet we did not close down the US economy. In fact Wilson had us fight a War on top of it all. Also it was not that we did not know about infections. Read any Medical book from that time.
Now consider the following statement:
So in the short-term, it’s the clinician calls the health department. And either the health department already has the test kit themselves or if they don’t yet have it stood up, they send it to CDC. Our turnaround at CDC is within a day. There is a little bit of shipping time. But that’s the process. In terms of timing, I think at this point what I would say is we are working as fast as we can. We understand the frustration of our partners in the health care sector, in health departments.
An itsy bitsy bit of shipping time. How about getting the USPS involved, ya think? She continues:
So the answer to the first question is certainly, we’re considering what the spread of illness in other countries looks like and how it impacts the potential risk the Americans traveling abroad in those countries. Those conversations are going on as we speak. We obviously are working closely with the partners on those considerations. And when there is new information in terms of case definitions, we’ll definitely publicize that broadly. You know, as I said, we are still at the stage of containment, but we are already starting to plan for mitigation. And part of the mitigation planning is the participation of community spread in the united states. And as that happens, it would certainly dramatically impact how we’re considering who is on the case. As you can imagine, the symptoms of novel coronavirus look a lot like other viral respiratory diseases that are circulating this time of year. So it’s going to be difficult for clinicians to differentiate fully on the basis of those — solely on the basis of the symptoms. In terms of diagnostic tests, what I would say is we’re working closely with FDA on this.
So the tests are critical. So where are they? Also travel may have to be carefully restricted. How about Italy, nothing personal.She continues:
What I can say from my perspective is I’ve been at CDC for 25 years and that if you asked public health officials over the course of that time what they feared as an expectation, it was something exactly like this. And so the idea that we might have a pandemic of influenza or a pandemic of a respiratory viral infection is something that we’ve known about and have been planning and preparing for. That’s why we at CDC have been exercising with the state and local health departments. That’s why the whole of government exercise last year, that’s why we’ve invested so much on the foundation we are now responding. But that being said, we are never going to ever be able to be so completely prepared that we’re prepared for any inevitability. We always are going to find that diseases surprise us and that there was some consideration that is slightly different from what we planned for. So have we made a lot of progress in the 25 years I’ve been here? Yes. Are we better prepared today than we were 20 years ago? Yes. But are we completely prepared?
Cover all bets folks, no matter how much we spend it is never enough. Some in Congress see this as another sink hole to be filled with our tax dollars. Twenty five years and we do not seem to have an operational plan.
There are times one wonders just what the purpose of this was and by whom it was made. Needless to say there has been a great deal of speculation. The Messenger is often more important than the message. Perhaps there is a great mis-step here. We shall see.
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