JAPAN: More Public Health Measures Needed

[SuperNova1987A]

More Public Health Measures Needed
Source: https://www.cabrain.net/news/article.do?newsId=21188&freeWordSave=1

Novel influenza will occur some time in the future and cause a pandemic.
Japanese preparedness, still far from complete, raises concerns whether we
can avoid a panic situation in a pandemic crisis.

Our preparedness is delayed, because we trust too much in the vaccine and
the antivirals, also because the public health in Japan is not established
enough to provide with comprehensive measures to protect the society from
diseases. Government measures so far are heavily biased toward the use of
vaccine and antivirals. However, there is no assurance that these measures
will be effective in a real pandemic.

First of all, H5N1 may not cause a pandemic. There are views that H5N1
cannot become a human flu virus. The current prepandemic vaccine will be
almost ineffective to a different type of virus. With the advent of the Tamiflu-
resistant virus, we cannot fully trust the antivirals any more.

Therefore, without relying too much on the vaccine and the antivirals, we
need to strengthen public health measures that will work on any pandemic
whatever the causing virus will be. Public health measures prevent spread of
disease by quarantining patients or closing schools. The public health studies
how these measures will be effective by analyzing measures in the past
pandemics.

Based on the studies, the US is repeatedly elaborating what measures to be
taken at what time of a pandemic and reviews the policies accordingly. The
US is also proactive in assisting such researches that are useful to the
preparedness as on the effectiveness of personal measures like masks.

In Japan, the government finally reviewed the action plan, including public
health measures. But action is too slow and local governments’ preparedness
is also delayed. I cannot help asking myself what makes this difference.

In the US, the public health goes hand-in-hand with the medical science in
supporting the medical care. Graduate schools for public health exist for a
long time independently from graduate schools for the medical care. Doctors
and lawyers who studied in those schools play an active role as experts
holding the medical science and the society together.

In Japan, the public health has been treated merely as a part of the medical
science for a long time. Just recently, several graduate schools for the public
health are being established since 2000.

The public health is hardly considered in the government policies. The
research group of the Ministry of Health hit the rocks in its investigation on
relevancy of Tamiflu and abnormal behavior. The “metabolic check” was
implemented although there is no scientific basis. These problems can be
attributed to disregard of the public health.

It is impossible to stop a pandemic at our borders. Then, in order to minimize
damage, we will have to utilize the public health more effectively and level up
our preparedness.

[2009/03/24 00:00]　　 Kyodo Press

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The public health definitely is a sector Japan has to put more emphasis on.
Only, I would have been more convinced by this article if the Washington
Post hadn’t published that crap by a public health professor. (Oops. Sorry.)

____________________________________________
SN1987A

 

[gsgs]

Re: JAPAN: More Public Health Measures Needed

> It is impossible to stop a pandemic at our borders

yet, Japan is planning for quarantine, leaving only 3 ports and airports open.

Maybe the hope is not to stop it, but to delay it until
vaccine is available (4-6 months?)


We had several studies which predicted upto 90% reduction
of infections with severe rigorous combined measures.

(I remember the one with the ~50 colored bars of infected people
in several scenarios, can't find the link quickly)

 

[SuperNova1987A]

Re: JAPAN: More Public Health Measures Needed

> It is impossible to stop a pandemic at our borders

yet, Japan is planning for quarantine, leaving only 3 ports and airports open.

Maybe the hope is not to stop it, but to delay it until
vaccine is available (4-6 months?)


We had several studies which predicted upto 90% reduction
of infections with severe rigorous combined measures.

(I remember the one with the ~50 colored bars of infected people
in several scenarios, can't find the link quickly)

You are right. It is so written in the government plan.

However, nobody believes it is really possible to keep the pandemic flu at bay
for good or for long.
In the latest action plan, the government has admitted that and put more
emphasis on how to keep the impact of pandemic on the medical and social
systems as low as possible.

___________________________
SN1987A

 

[gsgs]

Re: JAPAN: More Public Health Measures Needed

it may depend on how severe it is.

In a 1918-or-worse scenario, they will probably try everything.

In a 1968-like scenario the cost are probably too high
and it's cheaper to suffer disease and some deaths.

 

[SuperNova1987A]

Re: JAPAN: More Public Health Measures Needed

it may depend on how severe it is.

In a 1918-or-worse scenario, they will probably try everything.

In a 1968-like scenario the cost are probably too high
and it's cheaper to suffer disease and some deaths.

It can't be severe.

Japan imports 60% of food and 90% of energy from outside.

Hundreds of thousands Japanese visit foreign countries on a temporary basis
every single day.

One million more live in foreign countries and some of them will (at least try
to) come back to Japan.

Japan will not close the door at them unless forced by (say) the international
community.

You often mention about "the cost" in your opinion but I'm sorry I cannot
quite follow you because this is not a question of the cost at all.

___________________________________
SN1987A

 

[gsgs]

Re: JAPAN: More Public Health Measures Needed

it's _always_ a question of cost. That's how the system works.

It is possible to almost isolate a country and it often
happens in wartimes. You need very sophisticated
war machinery then to overcome it - stealth bombers,
submarines, parachuters etc.
This is not expected in a pandemic
since others won't benefit from infecting Japan.
Except maybe some terrorists or extorters such.

 

[SuperNova1987A]

Re: JAPAN: More Public Health Measures Needed

In a 1968-like scenario the cost are probably too high
and it's cheaper to suffer disease and some deaths.

****************************************

it's _always_ a question of cost. That's how the system works.

No. It?s not a question of cost.
This is not a business transaction. (cost vs profit)
This is not risk management of your property. (cost vs value*chance)
This is about people and society which you cannot compare with money.
It is not right to say "the cost is too high and it's cheaper to suffer disease
and some deaths." (and saving money in a less serious case!)

In a pandemic, we will do our best to save more people in a given situation.
Sometimes we cannot do so because our resources are always limited. We
may have to perform triage of patients and stop treating some patients to
save others. But that?s to save more people within limitations and we?ll never
say "Let's forget about them because it's cheaper."

Of course, we have to consider the cost of pandemic measures. We have to
place money strategically and spend it wisely in order to make an optimal
result. But that is again to save people, not money.

In a 1968-like scenario, the Japanese government assumes 160,000 people
will lose their lives. If the cost is ?too high?, how much money will be saved
at the cost of 160,000 lives?

Talking about the scenario, in a real pandemic, we may not be able to know
what scenario we are in.
Just like in the 1918 flu pandemic, morbidity and mortality may change
depending on time, location and situation; viruses may mutate and change
characteristics; pandemic waves may cause different damage on different
places, etc.
It?s probably only after the pandemic is over we are allowed to say how it was.


______________________________
SN1987A

 

[gsgs]

Re: JAPAN: More Public Health Measures Needed

you'll have to decide whether to spend x Yen to save one life
with probability p or to let him die because with the same
money you can save another person's life with probability q>p