Wash your hands and keep informed

Here is a link to a NPR interview with Laurie Garrett, a very articulate investigator of epidemics who works for the Council of Foreign Relations. I have been following Laurie Garrett for about 15 years.

In the interview she has some very positive things to say about improvements in US epidemic readiness since the SARS event and Katrina:

http://www.npr.org/templates/story/story.php?storyId=103495140&ft=1&f=2

Here is her view of the capabilities of the Mexican health system:
http://www.thetakeaway.org/stories/2009/apr/27/swine-flu-update-laurie-garrett-and-keith-bradsher/

“Actually, the Mexican public health system is pretty darned good. They do better than the United States on a lot of public health things such as child vaccination. I know a lot of Americans are prone to think of Mexico as a second-class country, a poor country, but in fact, they have an excellent public health infrastructure and better access to health care for Mexicans than we have in the United States for Americans. That said, the problem they have now is that having rapid diagnostics for influenza and specifically, a very rapid way to diagnose who has this particular strain versus any other type of flu or other illnesses that cause similar symptoms….”

Here is a short article with her in SFGate, which makes some interesting points about tamiflu:

http://www.sfgate.com/cgi-bin/blogs/nov05election/detail?entry_id=39186&tsp=1

“As the World Health Organization raised the threat level from the swine flu to 4 out of a possible 6, a top expert warned that a big danger is that the virus could combine with a drug-resistant strain of a human flu virus currently in circulation.

Laurie Garrett, a senior fellow in global health at the Council on Foreign Relations, said she is “very, very worried” that the swine flu virus could link up with the common human flu version called H1N1 that is resistant to the Tamiflu drug. The Centers for Disease Control issued an alert about the Tamiflu-resistant strain Dec. 20. So far there is no evidence the two viruses have combined.

Flu strains mutate readily, however, picking up genetic material in their host cells. Garrett said swine flu is actually a misnomer, because the current outbreak carries genetic material from three species: pigs, humans and birds, and could as easily be called avian or human flu as swine flu.

Such a triple-species combination of flu strains has never before occurred, Garrett said. She would not eliminate as a possible factor the “fecal lagoons” used to hold pig manure in large animal feed lots, but cautioned that until more data come in, much at this point is speculation.

She said the decision by the World Health Organization to raise the threat level was not taken lightly, given the high costs inflicted on poor countries.

The swine flu could be a “youth priority virus,” like the the famous 1918 Spanish flu pandemic that killed 50 million people within 18 months, facilitated by troop movements in World War I.

Garrett said such a virus hits people aged 14 to 35 hardest precisely because they have a robust immune system that overreacts to the virus. In the 1918 pandemic, people drowned in their own lung fluids. If this virus targets the young, then the elderly and others with weakened immune systems such as those with HIV or AIDS or undergoing chemotherapy would be less at risk.

Another possibility is that last fall’s flu vaccinations are protecting adults. That, said Garrett, would be “very, very good news.”

The Obama administration is reacting with a calculated combination of urgency and calm. The Department of Homeland Security is leading the response, in part because the incoming chief of the Department of Health and Human Services, Kathleen Sebelius, has not yet been confirmed by the Senate. Garrett said government responses have improved markedly since the SARS outbreak and Hurricane Katrina, but that 17 key health positions remain unfilled, as well as important health spots in the State Department. “All I can say is we would all be able to sleep better” if the posts with responsibility for a flu outbreak were filled.”

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