Hong Kong’s Coronavirus Response

Coronavirus – Credit CDC PHIL

# 6738

 

No city experienced a greater impact from the SARS epidemic a decade ago than did Hong Kong in 2003. Between March 11th and June 6th, a total of 1750 cases were identified, and of those, 286 died.

 

From the JRSM (Journal of the The Royal Society of Medicine) in August of 2003, we get this description of the spread of the disease in the city.

 

 The SARS epidemic in Hong Kong: what lessons have we learned?)

Lee Shiu Hung, MD FFCM

(Excerpt)

The SARS epidemic in Hong Kong has gone through three phases. The first was an explosive outbreak in a teaching hospital, affecting a large number of hospital staff and medical students. This phase took place in March 2003.

The second phase was an outbreak in the community as a result of the spread of infection from the hospital to the community. This reached its peak in early April 2003 when the disease affected a housing estate known as Amoy Gardens; a total of 329 residents in that estate came down with the disease and 33 died.

The third phase began in early May, with continuing occurrence of the disease in eight hospitals and more than 170 housing estates throughout the city but with the daily number of new cases declining from double to single digits in mid-June (the time of writing).

(Continue . . .)

 

Out of this trial by fire, Hong Kong’s Centre For Health Protection was born, and today it arguably runs one of the most proactive disease surveillance systems in the world.

So one should not be surprised to find a link to the new coronavirus front and center on the CHP’s home page.

 

On September 27th, just 3 days after being notified of the first coronavirus case, Hong Kong modified their Prevention and Control of Disease Ordinance (Cap. 599) to include “Severe Respiratory Disease associated with Novel Coronavirus”  as one of the statutorily notifiable diseases (see Letter To Doctors).

 

You’ll find a variety of notices, and letters to institutions regarding this emergent coronavirus on this page.

 

Today the Hong Kong government posted some remarks by their Secretary for Food and Health, Dr Ko Wing-man. As you’ll see, that while they are watching this situation carefully, at this time they have no plans to upgrade their alert level.

 

 

SFH on overseas cases of Severe Respiratory Disease associated with Novel Coronavirus

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending a public function this afternoon (November 25):

Secretary for Food and Health: Regarding the new novel coronavirus causing severe respiratory disease, there is a concern that over a span of two months, another batch of four new cases (three from Kingdom of Saudi Arabia and one from Qatar) was confirmed by the World Health Organization (WHO). The WHO also pointed out that we cannot assume the source of infection is only present in the countries concerned. Patients who have not got a history of travel to these two particular middle-east countries but developed symptoms of illness similar to the diseases caused by this new novel coronavirus, they might still be considered necessary to undertake the test for the new coronavirus.

Reporter: (On emergency level in Hong Kong for an outbreak of the new disease)

Secretary for Food and Health: The Centre for Health Protection of the Department of Health is consistently conducting risk assessment, following up on whether there will be any new information or new cases reported. Up to this moment, there is no need to upgrade our response level for the infectious disease outbreak. However, the new reported cases (due to infection with the novel coronavirus) highlighted the need to enhance our surveillance measures, both at the hospitals as well as at the immigration check points. 

(Please also refer to the Chinese portion of the transcript.)

Ends/Sunday, November 25, 2012
Issued at HKT 20:23

 

You can pretty much expect an enhanced level of surveillance around the world in the coming days as a result of last week’s announcement from the World Health Organization (see WHO Announces Additional Coronavirus Cases).

 

It is far too soon to know whether this virus will pose a major public health threat, but one of the lessons learned from the SARS outbreak of 2003 is that delays in reporting can have deadly consequences.

 

It is far better for public health officials to be hyper-vigilant today, than to have to play catch up tomorrow.

»» Read More

NWS: Possible Coastal Storm Mid-Week

 

Source CDC

 

 

# 6694

 

As I mentioned on Thursday (see A Worrisome Mid-Week Forecast), computer models are increasingly indicating a coastal storm/Nor’easter for the Mid-Atlantic & New England states later this week.

 

Not only will this increase the misery factor for residents and rescue workers dealing with the aftermath of Sandy, for those without power or heat temperatures and wind chills may drop dangerously low.

 

This is the latest Hazardous Weather Outlook from the New York NWS, issued early this morning:

HAZARDOUS WEATHER OUTLOOK

NATIONAL WEATHER SERVICE NEW YORK NY
339 AM EST SUN NOV 4 2012

THIS HAZARDOUS WEATHER OUTLOOK IS FOR SOUTHERN CONNECTICUT...NORTHEAST NEW JERSEY AND SOUTHEAST NEW YORK.

.DAY ONE...TODAY AND TONIGHT.

TEMPERATURES TONIGHT ARE EXPECTED TO FALL INTO THE 20S AND 30S.

THOSE WITHOUT POWER SHOULD PLAN FOR ANOTHER COLD NIGHT.

.DAYS TWO THROUGH SEVEN...MONDAY THROUGH SATURDAY.

LOW TEMPERATURES MONDAY NIGHT ARE EXPECTED TO FALL INTO THE 20S.

THOSE WITHOUT POWER SHOULD BE PREPARED FOR ANOTHER COLD NIGHT.

THERE IS THE POTENTIAL FOR A COASTAL STORM TO IMPACT THE TRI-STATE REGION WEDNESDAY AND THURSDAY.

THIS STORM HAS THE POTENTIAL TO BRING STRONG GUSTY WINDS...RAIN/WINTRY PRECIPITATION...COASTAL FLOODING AND ADDITIONAL BEACH EROSION TO THE TRI-STATE AREA.

STAY TUNED FOR THE LATEST FORECASTS.

 

 

The 7 day forecast for Newark, NJ gives a pretty good idea of the expected progression of the weather.

 

The concern here isn’t just for the cold, for every year we get tragic reports of people who either started a house fire, or succumbed to Carbon Monoxide poisoning, while trying to heat their homes during a power outage.

 

The sources of CO are numerous; faulty furnaces, snow blocked car exhaust pipes, attempts to use generators inside the house or garage . . . and the use of CO producing emergency heat sources all contribute to the winter body count.

 

The CDC’s MMWR released a report in 2005 called Unintentional Non--Fire-Related Carbon Monoxide Exposures --- United States, 2001—2003 that stated:

 

During 2001--2003, an estimated 15,200 persons with confirmed or possible non--fire-related CO exposure were treated annually in hospital EDs. In addition, during 2001--2002, an average of 480 persons died annually from non--fire-related CO poisoning. Although males and females were equally likely to visit an ED for CO exposure, males were 2.3 times more likely to die from CO poisoning. Most (64%) of the nonfatal CO exposures occurred in homes. Efforts are needed to educate the public about preventing CO exposure.

 

The CDC maintains a webpage on Carbon Monoxide, which you can access here, and has this short video on what they call the `quiet killer’.

 

 

»» Read More

Caveat Twitter

 

 

 

# 6693

 

 

As if the job facing local, state, and Federal emergency officials dealing with the aftermath of Hurricane/Hybrid Sandy were not enough of a challenge, FEMA is reporting that some people are spreading misinformation on social media platforms like Twitter, and Facebook.

 

This from last night’s FEMA BLOG.

 

Rumor Control

There is a lot of misinformation circulating on social networks. Check here for an on-going list of rumors and their true or false status.

• November 3: There have been recent blog posts and social media traffic expressing that FEMA is out of bottled water.  This is FALSE.  We are providing water to our state partners for distribution.
  For New York locations and times of food and water distribution centers and daytime warming centers, visit www.nyc.gov.
• November 3: There have been calls and posts from citizens related to the failure of the Old Bridge Township water system in Old Bridge, New Jersey. This is FALSE. The Old Bridge Municipal Utilities Authority (OBMUA) has reported that the water system is stable and safe and that there are no usage restrictions currently in place.
• November 3: Food stamps being given out to residents of New York and New Jersey as a part of FEMA assistance. This is FALSE. For information on the types of assistance available to those impacted by Sandy, call 1-800-621-FEMA.
• November 2: There is a spike of traffic related to FEMA hiring cleanup crews in both New York and New Jersey. This is FALSE. For information on how you can volunteer in these communities visit Serve.gov/sandy

 

The fault here doesn’t lie with the medium, but with the messenger. Why anyone would deliberately mislead people already suffering from a disaster is beyond my understanding, but some extremely small number of people out there do.

 

Most experts agree that Twitter, Facebook, and other social media platforms have provided excellent service during this, and other, crises.

 

As I wrote, more than three years ago in It Depends who you follow, being selective about who you follow on twitter – or `friend’ on Facebook – is your best defense against inane, annoying, or misleading messages.

 

During a crisis, like last week’s storm, many of us opened up our feeds using  hashtags like #SANDY or #Frankenstorm to try to gather as much information as we could from multiple sources. 

 

While useful, it is important to remember that this temporarily invites strangers into our feed, removing the filter of `trusted friends’ we normally maintain in our social media lives. 

 

All of which means that Caveat Lector – or in this case - Caveat Twitter, must be our guide. 

 

I’m a huge fan of twitter, and I used it every day.

 

But to avoid compounding a felony, I always think twice before re-tweeting a message from someone I don’t know well enough to trust. 

»» Read More

Bulletin Of The Atomic Scientists: Fukushima Crisis in review

 

 

# 6189

 

It’s been nearly a year since the disastrous earthquake & subsequent tsunamis hit northern Japan, leaving a major nuclear accident to unfold in the debris.

 

Only recently have we begun to hear detailed reports of just how chaotic, and apparently ineffectual, the disaster response was in the opening days and weeks of that nuclear crisis.

 

Yesterday, the Bulletin of Atomic Scientists published a 14-page analysis of Japan’s initial response to this nuclear crisis, which found (among other things)  that the Japanese government, and plant owner TEPCO, were:

 

“. . .  astonishingly unprepared, at almost all levels, for the complex nuclear disaster that started with an earthquake and a tsunami.”

 

This entire analysis makes for sobering reading, and is freely available on their website.

 

 

 

Fukushima in review: A complex disaster, a disastrous response

Yoichi Funabashi Kay Kitazawa

Abstract

On March 11, 2011, an earthquake and tsunami crippled the Fukushima Daiichi Nuclear Power Station. The emerging crisis at the plant was complex, and, to make matters worse, it was exacerbated by communication gaps between the government and the nuclear industry.

 

An independent investigation panel, established by the Rebuild Japan Initiative Foundation, reviewed how the government, the Tokyo Electric Power Company (Tepco), and other relevant actors responded.

 

In this article, the panel’s program director writes about their findings and how these players were thoroughly unprepared on almost every level for the cascading nuclear disaster.

 

This lack of preparation was caused, in part, by a public myth of “absolute safety” that nuclear power proponents had nurtured over decades and was aggravated by dysfunction within and between government agencies and Tepco, particularly in regard to political leadership and crisis management.

 

The investigation also found that the tsunami that began the nuclear disaster could and should have been anticipated and that ambiguity about the roles of public and private institutions in such a crisis was a factor in the poor response at Fukushima.  

»» Read More

WHO Panel: World Ill-Prepared To Deal With A Pandemic

 

 

 

# 5560

 

The World Health Organization is holding its 64th World Health Assembly, and one of the big topics is the post-mortem report on how the world coped with the 2009 H1N1 pandemic.

 

An expert panel, chaired by Dr. Harvey Fineberg President of the IOM, has delivered a 180 page report that outlines what when right, and what went wrong, with the world’s pandemic response. 

 

We saw a preview of this report last March (see IHR Review Committee Report On The Pandemic Of 2009), which gave the WHO a mixed grade for their handling of the pandemic, giving good marks in some areas, while citing a number of shortcomings in others.

 

The final report, issued May 5th, is called

Report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009

 

In the summary, Dr. Fineberg writes:

 

 

Pandemics can be fearsome teachers. No matter what one believes about the response to the 2009
pandemic by WHO and other authorities, all must be grateful that relatively few people died.

 

Influenza viruses are notoriously unpredictable. We were lucky this time, but as the report concludes, the world is ill-prepared for a severe pandemic or for any  similarly global, sustained and threatening public-health emergency.

 

We respectfully offer this assessment to all countries in the hope that our recommendations will assist in making the world a safer place.

 

 

While there is a great deal of detail and many recommendations in this final report, the authors offered three overriding conclusions.

 

 

Summary conclusion 1

The IHR helped make the world better prepared to cope with public health emergencies. The core national and local capacities called for in the IHR are not yet fully operational and are not now on a path to timely implementation worldwide.

Summary conclusion 2

WHO  performed well in many ways during  the   pandemic,  confronted   systemic difficulties   and  demonstrated some shortcomings. The Committee found no evidence of malfeasance.

Summary conclusion 3

The world is ill-prepared to respond to a severe   influenza pandemic or to any  similarly global, sustained and threatening public health emergency. Beyond implementation of core public health capacities  called  for in  the  IHR,  global   preparedness can be advanced  through research,  strengthened health-care delivery systems, economic development in low-and middle-income   countries and improved health status.

 

 

Today, after presenting this report, Dr. Fineberg reiterated our lack of preparation, as reported by this Associated Press story:

 

Flu experts say world poorly prepared to deal with a global health emergency

 

By The Associated Press – 2 hours ago

 

GENEVA — The world is not ready to deal with a lengthy public health emergency, a panel of international experts said Wednesday, basing its conclusions on the swine flu outbreak.

 

The panel's report on the World Health Organization's handling of the 2009 outbreak of the H1N1 flu concludes that the world is "ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public health emergency."

 

(Continue . . . )

 

 

As Dr. Fineberg says, we got lucky with the last pandemic. 

 

The fact that the world came through it relatively unscathed had more to do with the virulence (or lack, thereof) of the virus, than it did with our ability to mitigate it.

 

While some believe it is better to be lucky than good, the truth is you can’t count on your luck holding forever. 

 

Good enough reason to take getting ready for the next pandemic seriously, while we have the luxury of time to prepare.

»» Read More

Brookings Institute: A Year Of Living Dangerously

 

 

 

# 5501

 

 

A fascinating 94-page report this morning on the natural disasters of 2010 from Elizabeth Ferris, Senior Fellow, Foreign Policy and Daniel Petz, Senior Research Assistant, Foreign Policy of The Brookings Institution.

 

 

A Year of Living Dangerously: A Review of Natural Disasters in 2010

April 2011 —

Almost 300 million people were affected by natural disasters in 2010. The large disasters provided constant headlines throughout the year, beginning with the devastating earthquake in Haiti followed one month later by the even more severe—but far less deadly—earthquake in Chile. In the spring, ash spewing from volcano Eyjafjallajökull in Iceland paralyzed flights for weeks in the northern hemisphere. Early summer witnessed the worst Russian wildfires in history while a few months later, the steadily rising floodwaters in Pakistan covered 20 percent of the country. In sum, it was a terrible year in terms of natural disasters causing havoc and destruction around the globe. However, many of the largest disasters barely made headlines in the Western press.

(Continue . . . )

 

Despite the high death toll, and the hundreds of millions of people affected, the total number of natural disasters in 2010 (n=373) was a bit lower than the 10-year average (n=394).

 

In terms of the number of people affected, two Chinese disasters you probably heard very little about take the top spots:

 

• 134 million affected by the floods and avalanches in southern and central provinces that began in early May
• 60 million affected by the worst drought in a century in Yunnan, Guizhou, Guangxi, Sichuan and Chongqing.

 

In comparison, the Pakistan floods, which saw far more international attention (and humanitarian relief donations), affected just over 18 million people.

 

A bit surprisingly, the Haitian earthquake comes in at #10 on this list, with just under 4 million affected.

 

When looking at total fatalities, however, Haiti is far ahead of the rest with 316,000 earthquake related deaths.

 

The disaster that claimed the second highest number of fatalities (n=55,736) was the Russian heat wave and wild fires of last summer.

 

This report is complemented by numerous charts and graphs based primarily on disaster data compiled by EM-DAT: The OFDA/CRED International Disaster Database – www.emdat.be, Université Catholique de Louvain, Brussels (Belgium).

 

 

Perhaps the most sobering statistics are those that deal with the disproportionate funding of disaster relief around the globe.

 

The two highest profile disasters; the Haitian earthquake and the Pakistan floods, received 96.56 % of governmental and large NGO natural disaster humanitarian funds (according to the UN’s Financial Tracking System), with 54 other major disasters  dividing up the remaining 3.54% percent of relief funds.

 

When viewed in terms of dollars donated for each person affected by a disaster, Haiti comes in first with roughly $948.37 per person, followed by Pakistan with $121.67 per person. 

 

At the bottom of the list are the 134 million Chinese affected by last years floods who received a total of  $150,000 or about $0.001 per person; almost 1 million times less than was donated for Haiti’s earthquake affected population.

 

Disparities such as these are nothing new, of course.

 

This report points out that the funding for disaster relief after the Indonesian earthquake & Tsunami of 2004  was `over $7,100 for every affected person’.

 

That same year, funding for victims of Bangladesh’s floods worked out to be only $3 per person.

 

You’ll also find detailed discussions on Earthquakes and Floods, Volcano disasters, and the `Renter’s Dilemma’; the finding that renters are a vulnerable and often neglected group during disaster recovery efforts.

 

I’ve just mentioned a few of the highlights of this report, it is filled with much detail, and very much worth downloading and reading in its entirety.

»» Read More

Japan: OCHA SITREP # 4

 

 

 

# 5402

 

 

The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) has released a new situation report on the rescue/recovery operations in the aftermath  of the 9.0 earthquake on Friday.

 

Japan: Earthquake & Tsunami - Situation Report No. 4

Source: United Nations Office for the Coordination of Humanitarian Affairs (OCHA)

Date: 15 Mar 2011

Full_Report (pdf* format - 327.5 Kbytes)

Highlights/Key Priorities

· There has been a third explosion at the Fukushima Nuclear Power Plant

· Radiation from the nuclear plant has reached harmful levels within the evacuation zone

· Emergency relief operations enter into their fifth day with some areas still inaccessible

· Food, water and fuel are reported to be running short in some parts of Japan

· Significant areas of the country remain without power and water

»» Read More

IAEA: Onagawa Facility Declares Level 1 Emergency

 

 

 

# 5386

 

 

The IAEA is now reporting a low level emergency at the Onagawa nuclear facility in Northern Japan.  What few details that are currently available can be found in the report below.

 

 

 

Maps of Nuclear Power Reactors: JAPAN

 

 

Japan Earthquake Update (13 March 2011 13:55 CET)

by International Atomic Energy Agency (IAEA) on Sunday, March 13, 2011 at 10:11am

Japanese authorities have informed the IAEA’s Incident and Emergency Centre (IEC) that venting of the containment of reactor Unit 3 of the Fukushima Daiichi nuclear power plant started at 9:20AM local Japan time of 13 March through a controlled release of vapour. The operation is intended to lower pressure inside the reactor containment.

 

Subsequently, following the failure of the high pressure injection system and other attempts of cooling the plant, injection of water first and sea water afterwards started. The authorities have informed the IAEA that accumulation of hydrogen is possible.

 

Japanese authorities have also informed the IAEA that the first (i.e., lowest) state of emergency at the Onagawa nuclear power plant has been reported by Tohoku Electric Power Company. The authorities have informed the IAEA that the three reactor units at the Onagawa nuclear power plant are under control.

 

As defined in Article 10 of Japan’s Act on Special Measures Concerning Nuclear Emergency Preparedness, the alert was declared as a consequence of radioactivity readings exceeding allowed levels in the area surrounding the plant. Japanese authorities are investigating the source of radiation.

 

The IAEA has offered its “Good Offices” to Japan to support the nation’s response to the 11 March earthquake and tsunami. One IAEA capability intended to help member states during crises is the Response and Assistance Network (RANET). The network consists of nations that can offer specialized assistance after a radiation incident or emergency. Such assistance is coordinated by the IAEA within the framework of the Assistance Convention.

 

The IAEA continues to liaise with the Japanese authorities and is monitoring the situation as it evolves

»» Read More

IAEA Update On Fukushima Plant Explosion

 

 CLICK THIS LINK FOR LATEST/ALL QUAKE UPDATES

 

 

# 5383

 

 

The IAEA (International Atomic Energy Agency) has released a statement on their FACEBOOK page regarding the explosion that took place several hours ago at the Fukushima #1 reactor on Honshu Island.

 

The graphic below indicates the new evacuation zones, and the IAEA is reporting on the Japanese government’s intent to distribute Potassium Iodide (KI).

 

Graphic captured from NHK World Video

 

Latest IAEA update on Japan Earthquake (1340 CET 12 March 2011)

 

by International Atomic Energy Agency (IAEA) on Saturday, March 12, 2011 at 7:47am

Japan’s Nuclear and Industrial Safety Agency (NISA) has informed the IAEA’s Incident and Emergency Centre (IEC) that there has been an explosion at the Unit 1 reactor at the Fukushima Daiichi plant, and that they are assessing the condition of the reactor core. The explosion was reported to NISA by the plant operator, TEPCO, at 0730 CET. Further details were not immediately available.

 

Japanese authorities have extended the evacuation zone around the Fukushima Daiichi plant to a 20-kilometre radius from the previous 10 kilometres. At the nearby Fukushima Daini nuclear power plant, the evacuation zone has been extended to a 10-kilometre radius from the previous three kilometres.

 

The authorities also say they are making preparations to distribute iodine to residents in the area of both the plants.

 

The IAEA has reiterated its offer of technical assistance to Japan, should the government request this.

 

The IAEA continues to liaise with the Japanese authorities, and is in full response mode to monitor the situation closely around the clock as it evolves.

 

 

Potassium Iodide tablets are used in the event of radiation exposure to prevent certain types of radiation damage.

 

The CDC explains their use on this webpage.

 

Potassium Iodide (KI)

What is Potassium Iodide (KI)?

Potassium iodide (also called KI) is a salt of stable (not radioactive) iodine. Stable iodine is an important chemical needed by the body to make thyroid hormones. Most of the stable iodine in our bodies comes from the food we eat. KI is stable iodine in a medicine form. This fact sheet from the Centers for Disease Control and Prevention (CDC) gives you some basic information about KI. It explains what you should think about before you or a family member takes KI.

What does KI do?

Following a radiological or nuclear event, radioactive iodine may be released into the air and then be breathed into the lungs. Radioactive iodine may also contaminate the local food supply and get into the body through food or through drink. When radioactive materials get into the body through breathing, eating, or drinking, we say that “internal contamination” has occurred. In the case of internal contamination with radioactive iodine, the thyroid gland quickly absorbs this chemical. Radioactive iodine absorbed by the thyroid can then injure the gland. Because non-radioactive KI acts to block radioactive iodine from being taken into the thyroid gland, it can help protect this gland from injury.

What KI cannot do

Knowing what KI cannot do is also important. KI cannot prevent radioactive iodine from entering the body. KI canprotect only the thyroid from radioactive iodine, not other parts of the body. KI cannot reverse the health effects caused by radioactive iodine once damage to the thyroid has occurred. KI cannotprotect the body from radioactive elements other than radioactive iodine—if radioactive iodine is not present, taking KI is not protective.

(Continue . . . )

»» Read More

IHR Review Committee Report On The Pandemic Of 2009

 

 

# 5366

 

 

The full title of the 33 page draft report is:

 

Report of the Review Committee on the Functioning of the International Health Regulations (2005) and on Pandemic Influenza A (H1N1) 2009

 

It has been released in advance of the Fourth IHR Review Committee meeting, scheduled for March 28-30th in Geneva.

 

In it you’ll find a mixed grade for the World Health Organization’s handling of the pandemic, giving good marks in some areas, while citing a number of shortcomings in others.

 

Maria Cheng, AP medical writer provides this report, which includes comments from CIDRAP director Michael Osterholm :

 

 

WHO's response to swine flu pandemic flawed

An expert panel commissioned by the World Health Organization to investigate its handling of the swine flu pandemic has slammed mistakes made by the U.N. body and warned tens of millions could die if there is a severe flu outbreak in the future.

By MARIA CHENG

 

While the media’s interest will no doubt be focused on the flaws detected in the WHO’s response, it would be unfair to focus solely on those aspects.

 

Pandemics are tremendously complex, and rapidly evolving, events. The WHO has neither the resources, or the mandate, to manage the global response to an infectious disease outbreak.

 

This report provides 3 summary conclusions, along with a number of  recommendations.  Follow this link to read them in their entirety.

Summary conclusion 1

The IHR helped make the world better prepared to cope with public health emergencies. The core national and local capacities called for in the IHR are not yet fully operational and are not now on a path to timely implementation worldwide.

 

Summary conclusion 2

WHO  performed well in many ways during  the   pandemic,  confronted   systemic difficulties   and  demonstrated some shortcomings. The Committee found no evidence of malfeasance.

Summary conclusion 3

The world is ill-prepared to respond to a severe   influenza pandemic or to any  similarly global, sustained and threatening public health emergency. Beyond implementation of core public health capacities  called  for in  the  IHR,  global   preparedness can be advanced  through research,  strengthened health-care delivery systems, economic development in low-and middle-income   countries and improved health status.

While many criticisms have been lobbed at the WHO over their handling of the pandemic, my own view of their response has been considerably less harsh.

 

Aside from the occasional communications faux pas – some of which I’ve mentioned in this blog – I’ve felt that overall they did pretty well given the circumstances.

 

Not perfect, of course.   And certainly with room for improvement.

 

But hardly the bungled job that some of the more vocal members of the European Parliament would have us believe (see WHO To Review Their Pandemic Response).

 

The most important point of this report is not that there were (as might be expected) flaws in the WHO’s response to the last pandemic, but that we remain ill prepared to deal with a severe pandemic in the future.

 

Post Mortems like these are necessary, and often very useful.

 

But once completed - and the appropriate lessons taken from it -  the need is to look towards the future.

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PHAC: Lessons Learned From The 2009 Pandemic

 

 

# 5188

 

Today, the Public Health Agency of Canada (PHAC) and Health Canada released a 106 page report in PDF format, outlining the lessons learned from Canada’s response to the H1N1 pandemic.

 

While stating that – overall, Canada’s response was effective - the authors have identified 34 areas for improvement.

 

You can read the summary, excerpts from the report, or download the entire document at the PHAC website below:

 

 

Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic

 

For readers interested in the full version of this report, the document is available for downloading or viewing:

Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic

 November 2010

The information in this report was obtained by the Public Health Agency of Canada Evaluation Services Directorate through a review of relevant material and a series of interviews. This report does not draw exhaustive or definitive conclusions on all the activities leading up to or taken by various individuals or entities during the H1N1 pandemic response.

 

Rather, the observations in this report are meant to give senior management of the Public Health Agency of Canada and Health Canada a general overview of what worked well in response to this particular event and what needs further refinement to be better prepared for future pandemics and other national public health events.

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PLoS Essay: Reflections On The International Pandemic Response

 

 

# 4962

 

 

A long and very informative opinion piece appeared yesterday in PloS Medicine  on what went right, and what went wrong, with the international response to the 2009 pandemic.

 

A brief summary follows, but follow the link to read the report in its entirety.

 

 

Reflections on Pandemic (H1N1) 2009 and the International Response

Gabriel M. Leung^1*, Angus Nicoll²

1 Food and Health Bureau, Government of the Hong Kong SAR, People's Republic of China, 2 European Centre for Disease Prevention and Control, Stockholm, Sweden

Summary Points

• Many of the initial responses to the 2009 H1N1 pandemic went well but there are many lessons to learn for future pandemic planning.
• Clear communication of public health messages is crucial, and should not confuse what could happen (and should be prepared for) with what is most likely to happen.
• Decisions regarding pandemic response during the exigencies of a public health emergency must be judged according to the best evidence available at the time.
• Revising pandemic plans—to be more flexible and more detailed—should wait for WHO leadership if national plans are not to diverge. Surveillance beyond influenza should be stepped up, and contingencies drawn up for the emergence or re-emergence of other novel and known pathogens.
• Data collection and sharing are paramount, and include epidemiological and immunological data. Clinical management of severe influenza disease should not be limited to the current antiviral regimen, and include the development of other therapeutics (e.g., novel antivirals and immunotherapy).
• Greater and more timely access to antivirals and influenza vaccines worldwide remains an ongoing challenge.

 

 

While this contains much worth reading, the second point of the summary struck me as being one of the most important and most difficult to address:

 

Clear communication of public health messages is crucial, and should not confuse what could happen (and should be prepared for) with what is most likely to happen.

 

 

The problem, of course, is getting the media to treat `worst-case’ estimates and scenarios for what they are – possible but not probable outcomes.

 

Many times I heard public health officials cautiously speak of `possibilities’ only to see them reported in some media venues as either fact, or at least likely to happen.

 

Caveats, or other nuances, were often omitted or minimize in order not to water down a `good story’.

 

And the public – who generally get their news filtered through the lens of the mass media – ends up with skewed perception of the threat.

 

How you get the media (new and old) to report responsibly, when ratings and ad revenue are often enhanced by hyperbole and sensationalism, is a major challenge. 

 

The authors point out, in a list of `firsts’ for this pandemic, that:

 

• The first pandemic with instant communication so that early impressions (such as the experience and response in Mexico and the Ukraine) could be shared ahead of proper scientific analysis.
• The first pandemic in which web-based platforms of traditional journals expedited dissemination, complemented by other innovative online resources (e.g. PLoS Currents: Influenza, http://knol.google.com/k/plos-currents-i​nfluenza#, based on Google's knol technology).
• The first pandemic with a “blogosphere” and other rapid social media messaging tools that challenged conventional public health communication.

 

A good deal of the pandemic rumor mongering, including wild unsubstantiated conspiracy theories, continue online and in the media even after the end of the pandemic.

 

Each day I weed through hundreds of dubious news stories, blog posts, and twitter tweets that are either recycled old news (some intentionally presented as new), are pseudo-news items filled with improbable conspiracy theories or unbridled speculation, or are simply wild tales made up out of whole cloth (see Ukraine And The Internet Rumor Mill).

 

 

This PLoS Medicine  essay goes into far more than just communications issues, including surveillance, antivirals, vaccines, and the use of NPIs (Non-Pharmaceutical Interventions).

 

It provides abundant food for thought and discussion as the post mortem on this pandemic continues.

 

Highly recommended.

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Two From CIDRAP

 

# 4823

 

 

Yesterday morning I mentioned two new government reports that had been released that bear directly on the United State’s ability to respond to a pandemic, or other biological incident. 

 

PCAST Vaccine Report Issued

HHS Unveils Emergency Medical Countermeasures Report

 

Although I’m otherwise occupied moving to another abode, I’m happy to report that Lisa Schnirring and Robert Roos of CIDRAP  have produced a pair of terrific summaries on these two documents.

 

 

Obama's science advisors outline plan for faster pandemic vaccine

 

HHS sees greater federal role in building biodefense tools

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ASEAN-UN-USAID Pandemic Response Exercise

 

 

# 4811

 

 

Even as the last pandemic fades away, representatives from dozens of nations, agencies, and NGOs are gathered this week in Phnom Penh, Cambodia to take part in a major pandemic drill that anticipates dealing with a far more virulent pathogen.

 

The next pandemic may well be years, or even decades away . . .  but it could also arrive next week, next month, or next year. 

 

H5N1 continues to simmer in places like Egypt, China, and Indonesia and as `swine flu’ proved last year, other viruses can sometimes emerge with very little warning. 

 

Since the next pandemic may be far more severe than the one we’ve just gone through, it is imperative that nations prepare accordingly.

 

Here are excerpts from the press release, and a link to a DPA news story on the exercise.

 

 

ASEAN – UN – USAID Joint Press Release: ASEAN, UN and USAID Conduct Major International Exercise to Prepare for Severe Pandemic

Phnom Penh, 10 August 2010

---

The Association of Southeast Asian Nations (ASEAN), the United Nations and the U.S. Agency for International Development (USAID), will shortly host a pandemic preparedness and response exercise focusing on managing the impacts of severe pandemics on societies, governments and organisations in the Southeast Asian region. The exercise, which is a first of its kind anywhere in the world, will take place in Phnom Penh, Cambodia on 16-20 August 2010. It is expected to attract over 170 high-level participants from governments, UN agencies, international bodies and non-governmental organisations.

 

The unprecedented event aims to improve the capabilities of ASEAN Member States, both individually and collectively, to prepare for and respond to a severe pandemic with potentially devastating effects on the region. The exercise also sets out to improve multisectoral preparedness and response at the country, regional and global level among the Member States and other international actors.

 

A severe pandemic could have hugely damaging effects on the Southeast Asia region. While many countries are engaged in meeting such a threat, much of the focus in the past has been on health area preparedness. ASEAN Members States increasingly recognize that non-health sectors can also be gravely affected, impeding a government’s capacity to respond to a pandemic. This thinking has led to the need to come together to identify the gaps in pandemic preparedness, and to strengthen collaboration and coordination among Member States.

(Continue . . .)

 

 

From Monsters and Critics a  Deutsche Presse-Agentur news story on the start of this exercise, with statements by the UN’s Dr. David Nabarro and ASEAN Secretary-General Dr. Surin Pitsuwan.

 

 

 

ASEAN head says members need to coordinate pandemic response plans

Aug 16, 2010, 11:24 GMT

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Dr. David Fedson: The Case For Using Statins In A Pandemic

 

 

# 4750

 

 

During a major influenza pandemic, millions of people could fall desperately ill during the first few months.  Pharmaceutical interventions – like vaccines – take months to produce and distribute, and antivirals are in short supply as well. 

 

What the world really needs is a cheap (preferably generic) medication that will help treat severe influenza cases.

 

Ideally it would be a shelf stable pill, one that is easy to dispense, has a low incidence of side effects, and can reduce influenza morbidity and mortality.

 

A tall order.    But perhaps not impossible to fill.

 

At least, that’s the hope of a number of scientists who are looking into whether statins, or corticosteroids (or a combination of the two), might prove effective in reducing some of the most serious flu symptoms.

 

Dr. David Fedson has long championed the idea that we should be investigating statins and other cheaper drugs that may help modulate the immune response.

 

Fedson is a former Professor of Medicine at the University of Virginia School of Medicine and was formerly Director of Medical Affairs, Aventis Pasteur MSD.

 

 

A couple of his papers on the subject include:

 

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis

David S. Fedson^a

 

New Approaches to Confronting an Imminent Influenza Pandemic

Dr. Fedson and Peter Dunnill, DSc,FREng

 

In 2007 we saw a study that seemed to support the idea, one that indicated that statins lowered the mortality rate of people with pneumonia.

 

Statin drugs lower respiratory death risk: study

Tue Apr 10, 2007 12:40pm EDT

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.

 

And in 2008 this encouraging report made the headlines:

 

Statins may cut pneumonia death, blood clot risks

27 Oct 2008 20:00:13 GMT

Source: Reuters

By Will Dunham

WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.

 

Of course, not all of the studies have been positive.

  

Last July there was a report that found no evidence of benefit among pneumonia patients (see Another Take On Statins And Pneumonia) taking statins.

 

But another study, presented in October of last year at the annual meeting of the IDSA, the Infectious Diseases Society of America, in Philadelphia suggested the opposite - that statins cut the mortality rate for seasonal flu by 50%.

 

Maryn McKenna writing for CIDRAP brought us the details.

 

Statins may help patients with severe seasonal flu

Maryn McKenna Contributing Writer

Oct 29, 2009 (CIDRAP News) – Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

 

So while not all of these studies are in alignment, many of them do support the idea that statins may be of considerable value during a pandemic.

 

Which brings us to a guest editorial posted today on the Center For Biosecurity’s Clinicians’ Biosecurity Network website.  

 

I’ve just reproduced the opening paragraph.  By all means, you’ll want to follow the link to read it in its entirety.

 

An Alternative Approach to Pandemic Influenza That Clinicians Everywhere Could Use

By David S. Fedson, MD, July 23, 2010

The initial waves of the first influenza pandemic of the 21st Century have passed. Despite the best efforts of influenza scientists, health officials, and companies, more than 90% of the world’s people did not have timely access to affordable supplies of vaccines and antiviral agents. Instead, they had to rely on 19th Century public health “technologies.” They should have (and probably could have) had something better.^1-5

(Continue . . . )

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IRIN Analysis: Egypt’s Response To The Pandemic

 

 

# 4734

 

 

Very early on in the pandemic of 2009, a number of countries imposed tough – some would even say `harsh’ – methods to try to control its spread.

 

Thousands of schools were closed, travelers were separated from their families and quarantined, and in a few cases, airline flights to some countries were even canceled. 

 

A couple of examples examples include:

 

 

Beijing gets tough on flu prevention

By Li Xinran  |   2009-6-24  |

BUSINESSES, public institutions and government organizations in Beijing found of doing a poor job of implementing swine flu emergency measures will be fined up to 200,000 yuan (US$29,200), the city government said yesterday.

Travellers warned of new India swine flu measures

Monday, 22 June 2009: India

Rebecca Burns

Travellers to India from countries affected by swine flu (including the UK) are likely to be asked questions or be checked for symptoms by medical staff, according to the UK Foreign Office (FCO).

Travellers suspected of having H1N1 will be admitted to designated governemnt hospitals for compulsory quarantine, testing and treatment.

 

 

Eventually, most of these barriers were relaxed as the virus spread past them, and as the virulence of the virus became better understood.

 

In Egypt, the governmental reaction to the pandemic was extremely vigorous, and often controversial.  Heightened, perhaps, by legitimate concerns over the co-circulation of H5N1 `bird flu’ in that country.

 

For years, Egyptian Health officials had looked for an opportunity to eliminate pigs from their country.  With the emergence of a new strain of swine flu, and concerns that pigs could be vectors, the decision was quickly reached to eradicate hundreds of thousands of swine.

 

The unintended consequence – beyond the hardship placed on pig farmers by the destruction of their herds – is that their cities were overrun with the garbage that the pigs used to eat.

 

From IRIN (Integrated Regional Information Networks), which was founded in 1995 and is part of the UN Office for the Coordination of Humanitarian Affairs, we get analysis of Egypt’s reaction to the Swine Flu pandemic.

 

 

Analysis: Did the government overreact to H1N1?

Photo: Amr Emam/IRIN

Piles of garbage being burned in Cairo's streets

CAIRO, 18 July 2010 (IRIN) - While a review is underway of how the World Health Organization (WHO) and national authorities handled last year’s outbreak of the H1N1 virus, also referred to as swine flu, medical experts in Egypt have criticized their government for overreacting to the pandemic, provoking unjustified fear and wasting millions of dollars-worth of much-needed public funds.

 

“Egypt is probably the only country in the world that acted in such an insane way towards the virus,” Saed Aun, a former preventive medicine advisor to the Egyptian health ministry, told IRIN. “The Egyptian government applied the wrong policies in dealing with the crisis.”

 

When H1N1 was first detected in a university dormitory in April 2009, the Egyptian Cabinet in May decided to cull all the nation’s more than 350,000 pigs obstensibly to avert the spread of the virus, although the link between H1N1 and pigs had not been officially established.

 

Apart from the enormous loss to pig farmers, the culling led to an accumulation of rubbish on the streets of the capital as pigs had been eating much of it previously.

 

(Continue . . . )

 

 

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WHO Europe Chief Interview

# 4706

 

 

 

Via the Euroactiv.com  website this morning, a lengthy interview with Zsuzsanna Jakab,  regional director for Europe at the World Health Organization, on the likely change in the pandemic’s status and how that organization handled the outbreak.

 

The interview is available in two incarnations.  A condensed version, and a more complete full version.

 

Among the many questions asked by interviewer Gary Finnegan are:

 

What are the lessons learnt from the H1N1 flu pandemic?

At the moment the WHO has a pandemic alert on a scale of six phases. Do you think a more subtle and complicated instrument will come out of its review?

How do you assess the European institutions' response to the pandemic?

 

The expanded version of this interview covers more than just the topic of pandemic influenza, and gets into a number of other Eurocentric health issues. 

 

Follow this link to read it in its entirety.

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John Barry On The Pandemic Response

 

# 4705

 

 

I’ve been away from my desk since this morning, so I’ve just recently read the opinion piece by author and historian John Barry that Crof over at Crofsblog linked to earlier today.   He calls it the `must read’ of the day, and I quite agree.

 

This appears in the summer issue of the World Policy Journal:  The Next Pandemic.

 

Highly recommended.

»» Read More

HPA Conference: Pandemic Lessons Learned

 

 

# 4677

 

 

Last week the UK’s Health Protection Agency convened a two-day conference in London where scientists, academics and clinicians gathered to examine lessons learned from the pandemic of 2009.

 

You can view the program  for the conference, along with bios of the presenters, here.

 

From the Emerging Health Threats Forum we get the following report, with extensive comments and reactions from Angus Nicoll of the European Centre for Disease Prevention and Control (ECDC).

 

 

 

 

Pandemics: Europe looks ahead

Friday 25 June 2010

ECDC expert evaluates flu response, identifies weaknesses that need to be tackled for next time

 

From a European perspective “it’s hard to think of a better pandemic”, says Angus Nicoll of the European Centre for Disease Prevention and Control (ECDC). Many features of the 2009 pandemic were in Europe’s favour, he says, but adds there are still lessons to be learned about the public health responses countries planned and how well they worked.

 

Speaking at a UK Health Protection Agency conference about the public health response this week, Nicoll says that on balance, Europe managed the pandemic “moderately” well, but that countries were “lucky it was the pandemic it was.”

 

He described the advantages Europe had in tackling the pandemic — that the pandemic virus emerged in Central America from pigs, and was not a variant of the deadly Asian bird flu virus that many had feared, he explained.

(Continue . . .)

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Pandemic Briefing Note 21: WHO Responds To Critics

 

# 4638

 

 

Over the past several months the World Health Organization has come under increasing (and in my mind, largely unwarranted) attack from critics who see conspiracies and duplicity behind their declaration of a pandemic last June.

Recently, the BMJ ran an article calling into question the integrity of the experts who serve as advisors to the WHO, suggesting that they might have been influenced by Big Pharma.

 

On Saturday I covered CIDRAP Dissects The WHO Allegations, and on Sunday I offered my latest take on the situation in Of Pandemics, Hurricanes and An Abundance Of Caution.

 

On Tuesday, the WHO released Margaret Chan’s Open Letter To The BMJ.

 

Today we get a lengthy response from the WHO regarding a number of the criticisms levied towards them.   I’ll not post the whole thing, as it runs roughly 2,000 words. 

Follow the link to read it in its entirety.

 

This briefing covers the following points:

 

Is this a genuine pandemic?

Did WHO remove severity from the definition of a pandemic?

Did WHO exaggerate the threat?

Were any WHO pandemic decisions made to increase industry profits?

What safeguards are in place to guard against conflicts of interest?

What is the function of the Emergency Committee and why have the names of its members not been disclosed?

What evidence supports a role for antiviral drugs during an influenza pandemic?

Was a WHO meeting held in 2002 on influenza vaccines and antiviral drugs influenced by industry?

 

The international response to the influenza pandemic: WHO responds to the critics

Pandemic (H1N1) 2009 briefing note 21

Background

10 JUNE 2010 | GENEVA -- On Friday 4 June 2010, the BMJ, formerly British Medical Journal, and the Parliamentary Assembly of the Council of Europe (PACE) simultaneously released reports critical of the World Health Organization's handling of the H1N1 pandemic. WHO takes the issues and concerns that were raised seriously and wishes to set the record straight on several points.

(Continue . . . )

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